Alcohol, Digestion, Energy Balance NTR 300 – Fundamentals Dr. Lorna Shepherd Alcohol/Ethanol Consumed by ~60% of AmericansProvides 3% of total energy intake7kcal/gm Is a narcotic Reduces sensation, consciousness, central nervous system depressant Sources Beer5-11%Wine 5-14%Distilled spirits >22%Liquors Alcohol listed as “proof” which is double the alcohol content A standard drink15gm of alcohol12oz beer5oz wine10oz wine cooler1.5oz hard liquor Moderate ETOH Consumption One drink daily for femaleTwo drinks daily for males Does not require digestionAbsorbed by simple diffusion Easily crosses cell membranes but does damage as it passes through Metabolism of ETOHThe cells of the GI tract metabolize 10- 30% of the alcohol ingested The remainder is metabolized by the liverNot stored so takes priority in metabolization alcohol –> acetaldehyde –>acetyl Co-A Potential Benefit of ETOHModerate intake reduces risk of CVDReduces LDL High Alcohol intake With high ETOH intake the liver uses an alternate path (microsomal ethanol oxidizing system) MEOSMore efficientRequires energyIncreases tolerance Decrease ability to metabolize drugs Health Effects of AlcoholIncrease blood pressure and stroke Cirrhosis of liverPoor food intake Deficiency of B vitamins Niacin needed for alcohol metabolismThiamin absorption affectedIncreased excretion of B6May impair absorption of B12 Excessive Intake of ETOHIncreased risk of Brain damageOral and esophageal CABreast CAIrritation of stomach liningCirrhosis of liver Pancreatitis and pancreatic CA Impaired nutrient use Fetal alcohol syndrome Fetal Alcohol Syndrome 1 in every 1000First 12 – 16 weeks of fetal development most critical Fetal alcohol effect Short attention span Learning and behavioral difficultieshyperactivity Actual Picture Energy Metabolism Substrates Converted to Acetyl CoA and enter to Kreb’s cycle to produce energyCarbohydrates – 4kcal/gmLipids – 9kcal/gmProteins – 4kcal/gmAlcohol – 7 Kcal/gm Metabolism Ketone Bodies Produced by liver and (kidney)The brain uses it during periods of fasting when glucose is not available Hormones involved in Energy Metabolism (Regulation)InsulinGlucagonThyroid Energy Balance Basal Metabolic Rate (BMR)The minimum amount of energy needed when resting and fasting Factors that affect BMRMuscle massBody surface areaGender body temperature Thyroid hormoneStages of growth Stimulants Sedatives Methods of Calculating Energy Requirement Predictive equations Harris-BenedictSimple method – 30-35kcal/kg Harris Benedict Equation Male66.5+(13.8xWt)+(5xHt)-(6.8xage)Females655.1+(9.6xWt)+(1.9xHt)-(4.7xage)Activity factorSedentary – 1.0Low – 1.1Active - 1.26Very active – 1.46 BMI Formula Body Mass IndexInterpretation of BMI:Under weight <18.5 Healthy – 18.5 to 24.9Over weight – 25 to 29.9Obese - >30 Ideal Body Weight (IBW) HamwiMalesFirst.

1. Alcohol, Digestion, Energy Balance
NTR 300 – Fundamentals
Dr. Lorna Shepherd
Alcohol/Ethanol Consumed by ~60% of AmericansProvides 3%
of total energy intake7kcal/gm Is a narcotic Reduces sensation,
consciousness, central nervous system depressant
Sources Beer5-11%Wine 5-14%Distilled spirits >22%Liquors
Alcohol listed as “proof” which is double the alcohol content
A standard drink15gm of alcohol12oz beer5oz wine10oz wine
cooler1.5oz hard liquor

2. Moderate ETOH Consumption One drink daily for femaleTwo
drinks daily for males Does not require digestionAbsorbed by
simple diffusion Easily crosses cell membranes but does damage
as it passes through
Metabolism of ETOHThe cells of the GI tract metabolize 10-
30% of the alcohol ingested The remainder is metabolized by
the liverNot stored so takes priority in metabolization alcohol –
> acetaldehyde –>acetyl Co-A
Potential Benefit of ETOHModerate intake reduces risk of
CVDReduces LDL
High Alcohol intake With high ETOH intake the liver uses an
alternate path (microsomal ethanol oxidizing system)
MEOSMore efficientRequires energyIncreases tolerance

3. Decrease ability to metabolize drugs
Health Effects of AlcoholIncrease blood pressure and stroke
Cirrhosis of liverPoor food intake Deficiency of B vitamins
Niacin needed for alcohol metabolismThiamin absorption
affectedIncreased excretion of B6May impair absorption of B12
Excessive Intake of ETOHIncreased risk of Brain damageOral
and esophageal CABreast CAIrritation of stomach
liningCirrhosis of liver Pancreatitis and pancreatic CA Impaired
nutrient use Fetal alcohol syndrome
Fetal Alcohol Syndrome 1 in every 1000First 12 – 16 weeks of
fetal development most critical Fetal alcohol effect Short
attention span Learning and behavioral difficultieshyperactivity

4. Actual Picture
Energy Metabolism Substrates Converted to Acetyl CoA and
enter to Kreb’s cycle to produce energyCarbohydrates –
4kcal/gmLipids – 9kcal/gmProteins – 4kcal/gmAlcohol – 7
Kcal/gm
Metabolism
Ketone Bodies Produced by liver and (kidney)The brain uses it
during periods of fasting when glucose is not available
Hormones involved in Energy Metabolism
(Regulation)InsulinGlucagonThyroid

5. Energy Balance
Basal Metabolic Rate (BMR)The minimum amount of energy
needed when resting and fasting
Factors that affect BMRMuscle massBody surface areaGender
body temperature Thyroid hormoneStages of growth Stimulants
Sedatives
Methods of Calculating Energy Requirement Predictive
equations Harris-BenedictSimple method – 30-35kcal/kg

6. Harris Benedict Equation Male66.5+(13.8xWt)+(5xHt)-
(6.8xage)Females655.1+(9.6xWt)+(1.9xHt)-(4.7xage)Activity
factorSedentary – 1.0Low – 1.1Active - 1.26Very active – 1.46
BMI Formula
Body Mass IndexInterpretation of BMI:Under weight <18.5
Healthy – 18.5 to 24.9Over weight – 25 to 29.9Obese - >30
Ideal Body Weight (IBW)
HamwiMalesFirst 5’ = 106#6# for each additional inchFemales
First 5’ = 100#5# for each additional inch
Other: measurement of body fatSkin fold thicknessBioelectric
impedance Underwater weighing

7. Percentage Body FatDescription Women Men Essential
fat 10-13% 2-5% Athletes 14–20% 6-13%
Fitness 21–24% 14-17% Average 25–31%
18–24% Obese 32%+ 25%+
Health risk associated with obesity Increase risk for
DiabetesHypertensionSome types of CancersColon, uterus,
prostate CardioVascular DiseaseJoint disorders/arthritis Sleep
apnea
Distribution of fat
Waist Circumference Males 40 inches (102cm) or lessFemales35
inches (88cm) or less

8. Weight Reduction InterventionsReduce caloric consumption
DietBehavior modification SurgeryIncrease energy
expenditure3500kcal = 1 pound (#)500kcal/day
Eating disorders Anorexia nervosaRefusal to maintain weight at
or above normalIntense fear of gaining weightDisturbance in
perception of body image or denial of seriousness of low body
weightAmenorrhea
Anorexia symptoms Low body weightLower body
temperatureSlower metabolic rateAnemiaRough scaly skinLoss
of hairLow WBC count Lanugo
Bulimia NervosaRecurrent binge eating episodesInappropriate
compensatory behavior to prevent weight gainPurging –
vomiting or abuse of laxatives Undue influence of body weight

9. or shape on self-evaluation SymptomErosion of teeth enamel,
GI problems
Factors Influencing Food Selection
Fundamental NTR 300
Dr. Lorna Shepherd
Ed.D, R.D, L.D/N
Factors Influencing Food SelectionFlavorDemographicsCulture
and religionHealthSocial and emotional OtherCost,
convenience, nutrition Food industry and media
Flavor AppearanceSmellTasteTextureTemperature
Demographics Age GenderEducational levelIncome
Culture and ReligionCultureBehavior and beliefs of a certain
social, ethnic or age groupReligionJudaismRoman
CatholicismMormonismSeventh-Day

10. AdventistIslamHinduismBuddism
HealthOver weightIllness preventionChronic
illnessDMHTNCVD
Social and EmotionalSocial situationsPeer pressureEating at
restaurantsEmotionsDepressionChildhood memories Comfort
foods
Environmental ConcernsPesticides OrganicSustainable Humane
Food Industry and MediaAdvertisingReporting of
nutrition/health studies
Life CyclePregnancy/lactationInfancyChildhoodAdolesence
Aging
Fundamentals of Nutrition
NTR 300
Dr. Lorna Shepherd

11. Nutrition OverviewObjectivesDefine nutrients Identify the
major nutrition components of a diet; their sources, function
and metabolism Carbohydrates, protein, lipids, vitamins,
minerals, water Describe the American dietIdentify appropriate
nutrition goals
Diet:What we eat consistently on a daily basis over a period of
time.Shaped by food habits we developHealthy or unhealthy
Characteristics of a Balanced Diet:Nutrient
DenseAdequacyPortion ControlVarietyEssential Nutrients
NutritionNutritionThe science of foods and its components;
their interactions, including digestion, absorption, assimilation
and excretion
Food provides the nutrients needed for fuel, building and
maintaining body cells
Essential nutrientsSubstances essential for health that the body
cannot make or cannot make in sufficient quantity to meet
bodily needs.
Energy Yielding Nutrients CarbohydrateProtein Lipids

12. Non-Energy Yielding Nutrients:Vitamins
Minerals
Water
Non- Nutritive Components of plant foods:
Phytochemicals:Include carotenes & lycopeneConfer protection
against some cancers.Some studies show improved immune
function and decreases in inflammatory processes.
Balanced Diet
Fundamentals NTR 300
Dr. Lorna C. Shepherd
Balanced Diet:Nutrient DensityPortion ControlEssential
NutrientsVarietyAdequacy
Nutrition Standards Dietary reference intake
(DRI)Recommended dietary allowance (RDA)Estimated average
requirement (EAR)Adequate intake (AI) Tolerable Upper Limit
(UL)

13. Estimated Average Requirement (EAR)Amounts of nutrient
estimated to meet the nutrient needs of 50% of the persons in a
certain life stage .For example adolescents or pregnant women.
Recommended Dietary Allowance (RDA)Daily nutrient intake
to meet the needs of nearly all individuals (97-98%)
Goal is to prevent chronic diseases not just prevent deficiency
Adequate Intake (AI)Used when there is not sufficient scientific
data to establish EAR
Tolerable Upper LevelMaximum daily amount that is not likely
to cause adverse health effects
Which Dietary Reference Intake is provided when there is not
enough scientific information for an EAR?
RDA
AI
Tolerable Upper Limit
None of the above
Daily Reference ValuesBased on 2000 calorie Fat 30%Saturated
fat 10%Carbohydrate 55%Protein 15%Fiber 11.5gm/1000
calories The other values are not based on calories

14. Food Labeling Food package must list product name, address of
manufacturer, amount of product in the package, serving size,
ingredients
Ingredient list
Ingredient list Listed according to weight of ingredientThe most
abundant is listed first and so on to the least
Which ingredient must be listed first on the food label?
Lowest weight
Medium weight
Highest weight
Doesn’t need to be listed
Claims on Food Labels
CaloriesCalorie free<5 calorie/servingLow calorie40 calories or
less per servingReduced calorie25% less calories than the
originalLight/lite50% less fat or 30% less calories
Sodium Sodium free<5mgVery low Na35mg or lessLow

15. Na140mg or lessLightly salted At least 50% less than is
normally added
A food package with the claim of fat free should contain which
of the following?
40 % less fat than original
No fat
Less than 5% fat
25% less fat than the original
Health ClaimsDescribe a relationship between a disease and a
nutrientCa and osteoporosisFat and some cancersSaturated fat,
cholesterol and CVDLow fat/cholesterol plus high soy
(>25mg/day) and CVDOmega 3 fats/fish oil and CVD
Health ClaimsMargarines with plant stanols and CVDLow Na,
high K and HTN or strokeSugarless gum and tooth decayDiet
rich in fruits/vegetables and cancerDiet rich in fiber and CVD –
must also state diet should be low in sat fat/cholesterolDiet rich
in whole grains and low sat fat/cholesterol and CVD also CA
MyPyramid A personal approach to healthy eating and physical
activity

16. DairyCalcium Phosphorous
CarbohydrateProteinRiboflavinVitamin DMagnesiumZinc
Meat and BeansProtein ThiaminRiboflavinNiacinB6FolateB12
Phosphorous MagnesiumIron Zinc
Fruits CarbohydrateVitamin CVitamin
AFolateMagnesiumPotassiumFiber
Vegetables Carbohydrates Vitamin AVitamin
CFolateMagnesiumPotassiumfiber
Grains Carbohydrate Thiamin
RiboflavinNiacinFolateMagnesiumIronZincFiber
Oils
Essential fatty acidsVitamin E
Which food group listed provides essential fatty acids and
vitamin E?
Grains
Vegetables
Dairy

17. Oils
Dietary Guidelines for Americans US Department of Health and
Human Services US Department of Agriculture Summarize
knowledge into a pattern of recommendations that can be
adopted by the public
Adequate Nutrients within calorie need Consume a variety of
nutrient dense food and beverages while limiting intake of
saturated and trans fats, cholesterol, added sugars, salt and
alcohol.
Weight ManagementBalance calories from food and beverages
with calories expendedTo prevent gradual weight gain make
small decreases in food and beverage calories and increase
physical acitvity
Physical Activity Engage in regular physical activity and reduce
sedentary activities to promote health, psychological well-being
and a healthy body weight Achieve physical fitness by including
cardiovascular conditioning, stretching for flexibility and
resistance and improving muscle strength and endurance
Food groups to encourage Consume sufficient amount of fruits
and vegetables while staying with in energy need Choose a

18. variety of fruits and vegetables each dayConsume 3 or more
whole grain products (at least half grains form whole grain
products)Consume 3 cups per day of fat free or low-fat milk or
milk equivalent
FatsConsume < 10% of calories from saturated fats and <
300mg cholesterol, and keep trans fat as low as possible Keep
total fat intake between 20-30% with most coming from poly
and mono-unsaturated sourcesWhen selecting prepared meats,
poultry, dry beans and milk or milk products choose lean, low-
fat, fat-free
Carbohydrates Choose fiber rich fruits, vegetables and whole
grains often.Prepare foods with little added sugar or caloric
sweeteners Reduce dental caries by practicing good oral hygiene
and consuming sugar and starch containing foods and
beverages less frequently
Sodium and PotassiumChoose less than 2300mg of sodium per
dayChoose and prepare foods with little salt; at the same time
consume potassium rich food such as fruits and vegetables

19. Which tool is the most recent tool used to educate the public on
nutrition recommendation?
My pyramid
Dietary guidelines for Americans
My Plate
Basic 5 Food Groups
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