institute of dental science, bareilly.u.p.

1. GOD,GIVE US FOOD WHICH DOES NOT
CAUSE ANY DISEASE & ALSO GIVES US
STRENGTH….

2. DIET AND NUTRITION
Dr. SALABH SINGH PARIHAR P.G – I YEAR

3. Introduction
Classification of foods
Nutrients, function and
deficiency impact
vitamins and systemic effects
Fat soluble vitamins
water soluble vitamins
Minerals
Food pyramid
Diet counselling
Dietary intake
Balance diet
Normal diet
conclusion
Part-1
Part-2
3
Contents-

4. INTRODUCTION
Council of food and nutrition of the American Medical Association
Defines nutrition as-
“The science of food, the nutrients and other substances therein ,their
action ,interaction and balance in relation to health and diseases and the
processes by which the organism ingest, digest, absorbs, transports
,utilizes and excretes food substances.”
4

5. CLASSIFICATION OF FOODS
1. Classification by origin
 Foods of animal origin
 Foods of vegetable origin
2.Classification by Chemical composition
 Protein
 Fats
 Carbohydrates
 Vitamins
 Minerals
 water
5

6. 3.Classification by predominant function:
 Body-building foods e.g. milk, meat, poultry, fish,
eggs, pulses etc.
 Energy-giving foods e.g. cereals, sugars, roots and
tubers, fats and oils.
 Protective foods e.g. vegetables, fruits, milk
6

7. Nutrients
Nutrients may be divided into:
 Macronutrients: These are proteins, fats and
carbohydrates which are often called “proximate
principles” because they from the main bulk of food.
 Micronutrients: These are vitamins and
minerals. They are called micronutrients
because they are required in small amounts
which may vary from a fraction of a milligram
to several grams.
7

8. PROTEIN
 Protein are body building nutrients.
 Proteins are complex organic nitrogenous compounds
which constitute about 20% of the body weight in an
adult.
 ICMR recommended 1.0gm protein/kg. body weight for
an Indian adult.
8

9. Proteins are VITAL to any living organism for-
 Body building.
 Repair and maintenance of body tissue (Make good loss
of Wear & Tear)
 Synthesis of certain substances like haemoglobin,
enzymes, hormones etc.
 Immune (Defence) mechanism
9

10. Sources:
 Animal Sources: Proteins of animal origin are
found in milk, meat, eggs, cheese & fish. These
proteins contain all the EAA in adequate amounts.
Egg protein is referred as Reference protein.
 Vegetable Sources: Vegetable proteins are
found in pulses (legumes), cereals, beans, nuts etc.
They are poor in EAA.
10

11. Supplementary Action of Proteins
 We derives protein not from a single source, but from a
variety of food sources, animal and vegetable.
 Cereal (rice etc.) proteins are deficient in lysine and
threonine and pulse proteins in methionine. These are
known as “limiting” amino acids.
 When we mix different combinations like Dal & Rice
their proteins supplement one another and fulfil the
protein requirement.
11

12. Carbohydrates
 Carbohydrates they are digested and released into the
bloodstream as glucose, they signal cells in the pancreas to
produce insulin, which escorts glucose into the cells, where
it is metabolized into energy.
 Carbohydrates are divided into two main categoreies:
1.Simple and
2.Complex
 Main source of energy providing 4 kcals/gm
12

13.  ICMR has recommended that 60-70% of total energy
intake should come from Carbohydrates.
 The carbohydrate reserve (Glycogen) of a human
adult is about 500 gm which is rapidly exhausted
when a man is fasting.
 If the dietary carbohydrates do not meet the energy
needs of the body, protein and glycerol from dietary
and endogenous sources are used by the body to
maintain glucose homeostasis.
13

14. FIBER
 Fiber is the roughage or the undigested part of food
that can be classified into two broad categories,
namely soluble and insoluble fiber.
 It is recommended that an average man should
consume about 20 to 35 grams of fiber each day.
 All kinds of plant oriented foods act as good sources
of both types of dietary fiber.
 A high fiber diet is especially recommended for
population suffering from Chronic Constipation.
14

15. LIPID
 The major kinds of fatty acids in the foods we eat are
saturated, polyunsaturated & monounsaturated fatty
acids.
 Saturated fats raise blood cholesterol. Dietary
cholesterol also raises blood cholesterol.
 A high level of cholesterol in the blood is a major risk
factor for coronary heart disease, which leads to heart
attack, and also increases the risk of stroke.
15

16.  Deficiency of essential fatty acids is known to occur in infants
and young children and cause follicular hyperkeratosis.
 Lipid play an important role in the by helping in the absorption
of fat soluble vitamin A,D,E & K.
 Ordinarily, excess fat intake should be avoided because this
increases adiposity, hypercholesterolemia and ketosis.
 Such adeposition leads to loss of elasticity and heart failure.
16

17. Fat is insoluble in water.
Fat + Protein (in body)
Depending on the type of the Protein which binds with fat
it can be divided as
High Density Protein
Soluble in
body
H.D.L.
Low Density Protein
Very Low Density Protein
Glycerol
L.D.L.
V.L.D.L.
Triglyceride

18. Guideline Daily Amount Values
Typical values Women Men
Children (5-10
years)
Calories 2,000 kcal 2,500 kcal 1,800 kcal
Protein 45 g 55 g 24 g
Carbohydrate 230 g 300g 220 g
Sugars 90 g 120 g 85 g
Fat 70 g 95 g 70 g
Saturates 20 g 30 g 20 g
Fibre 24 g 24 g 15 g
Salt 6 g 6 g 4 g
18

19. NUTRIENTS, FUNCTION
AND
DEFICIENCY IMPACT
19

20.  Excellent reviews of vitamin history with appropriate references
include Funk (1922), McCollum (1957), Wagner and Folkers (1962),
Widdowson (1986), and Loosli (1991).
 Important books that describe the historical discovery of three specific
vitamin deficiency diseases include the following: Eijkman, 1890–
1896; Funk, 1911; Williams, 1961 (beriberi); Hess, 1920; Carpenter,
1986 (scurvy); Harris, 1919; and Carpenter, 1981 (pellagra).
20
HISTORY OF VITAMINS

21. • Vitamins are defined as a group of complex organic compounds present in
minute amounts in natural foodstuffs that are essential to normal
metabolism and lack of which in the diet causes deficiency diseases.
• Vitamins are required in trace amounts (micrograms to milligrams per day)
in the diet for health, growth, and reproduction.
• Many of the vitamins function as coenzymes (metabolic catalysts); others
have no such role, but perform certain essential functions.
21

22. Classification of vitamins
22

23. 23

24. Vitamin A(Retinol) 24

25. VitaminD
(cholecalciferol)
 Vitamin D (cholecalciferol) itself is inactive but is converted to the active
form 1,25 dihydroxy cholecalciferol by two hydroxylation reactions
which occur in the liver and kidney.
 The principal actions of vitamin D are to increase the absorption of
calcium in the small intestine and to mobilize calcium from firmed bone
(in an attempt to maintain plasma levels).
25

26. Vitamin E(Tocopherol)
26

27. VITAMIN K(Phylloquinone, Menaquinones)
27

29. VITAMIN C:
 Vitamin C or ascorbic acid is essential for the formation of collagen and
intercellular material, bone and teeth, and for the healing of wounds.
 It helps maintain elasticity of the skin, aids the absorption of iron, and
improves resistance to infection.
 Present in a range of fresh fruits and vegetables and human milk. Most
abundantly found in citrus fruits.
29

30.  The concentration of ascorbic acid in WBCs is about 16mg/100ml of
blood, which is higher than that of plasma 0.5 – 1mg/100ml.
 The plasma level of the vitamin fluctuates with a fluctuation in the diet,
nicotine intake and the use of oral contraceptives.
 The vitamin is important in maintaining the function of the WBCs.
30

31.  The body is unable to produce this vitamin endogenously and is
totally dependent on dietary intake.
 A dietary deficiency of vit. C produces scurvy which is a rare entity
in contemporary society, but occasionally diagnosed in the elderly,
living alone at home, alcoholics, dietary faddists, infants who are fed
exclusively on sterilized milk and food.
 It helps in the hydroxylation of lysine and proline which occurs in the
formation or synthesis of collagen molecule.
 It is also associated with alkaline phosphatase enzyme, the activity of
which is reduced in ascorbic acid-deficiency.
31

32. Clinical Features Of Scurvy
 Signs – Petechiae, ecchymoses and spontaneous bruising of the
extremities.
 Haematuria, epistaxis, bleeding into the tissues, joints and muscles
occur.
 Vascular congestion in the hair follicles leads to enlargement, keratosis
and a localized reddening of the skin.
 Hemorrhages in the subperiosteal region of long bones cause severe pain
and tenderness.
32

33.  Anemia may result from blood loss.
 Generalized lethargy and increased susceptibility to infections.
 Wound healing is delayed particularly in deeper layers that rely on capillary
growth and the production of collagen fibers for successful organization.
33

34. Vitamin B-complex
 The vitamin B-complex refers to all of the known essential water-soluble
vitamins except for vitamin C.
34
Thiamine
(vitamin B1)
Riboflavin
(vitamin B2)
Niacin (vitamin
B3)
Pantothenic acid
(vitamin B5)
Pyridoxine
(vitamin B6)
Biotin Folic acid and
The cobalamins
(vitamin B12).

35. Vitamin B1 (Thiamin)
 A deficiency in thiamin intake leads to a severely reduced capacity of cells
to generate energy.
 The earliest symptoms of thiamin deficiency include constipation, appetite
suppression, and nausea, mental depression, peripheral neuropathy, and
fatigue.
 Chronic thiamin deficiency leads to more severe neurological symptoms
and to cardiovascular and musculature defects.
35

36. Vitamin B2 (Riboflavin):
 Riboflavin deficiencies are rare in developed countries due to the
presence of adequate amounts of the vitamin in eggs, milk, meat, and
cereals.
 Riboflavin deficiency is also often seen in chronic alcoholics due to
their poor dietetic habits. Symptoms associated with riboflavin
deficiency include glossitis, angular stomatitis, cheilosis, and
photophobia.
36

37. Vitamin B3 (Niacin):
 A diet deficient in niacin leads to glossitis, dermatitis, weight loss, diarrhea,
depression and dementia.
 The severe symptoms of depression, dermatitis, and diarrhoea are associated
with the condition known as pellagra.
 Several physiological conditions (e.g. Hartnup disease and malignant
carcinoid syndrome) as well as certain drug therapies (e.g. isoniazid) can
lead to niacin deficiency.
37

38. Vitamin B5 (Pantothenic acid)
 Deficiency of pantothenic acid is rare due to its widespread distribution
in whole-grain cereals, legumes, and meat.
 Symptoms of pantothenic acid deficiency are difficult to assess since
they are subtle and resemble those of other vitamin B deficiencies.
38

39. Vitamin B6 (Pyridoxine)
 The requirement for vitamin B6 in the diet is proportional to the level of
protein consumption ranging from 1.4- 2 mg/day for a normal adult.
 During pregnancy and lactation, the requirement for vitamin B6 increases
approximately 0.6mg/day.
 Deficiencies of vitamin B6 are rare and are usually related to an overall
deficiency of all the B-complex vitamins
39

40. VitaminB7 (Biotin)
 Biotin is found in numerous foods and is also synthesized by intestinal
bacteria, making deficiencies of the vitamin rare.
 Deficiencies are generally seen only after long antibiotic therapies.
40

41. Vitamin b9(folic acid)
 The most pronounced effect of folate deficiency on cellular processes is on
DNA synthesis.
 Only about 10% of the various forms of folate in most foods are absorbed
with the exception of those in liver, yeast and egg yolk.
 50 – 90% of folate is destroyed in cooking, canning and other processing.
41

42. The predominant causes of folate deficiency are:
 Impaired absorption or metabolism - Certain drugs such as anticonvulsants
and oral contraceptive an increased demand for the vitamin - Poor dietary
habits.
 Daily folate requirement is dependent on metabolic and cell turnover rates.
 Stress, such as infections increases metabolic rate and therefore increases
folate requirements.
42

43.  Deficiency of folate leads to impaired DNA production and asynchronism
between protein synthesis and cell division which prevent cell maturation
from reaching completion, as a consequence of which epithelial barrier
function is impaired.
 Folate deficiency has also been related to a decrease in host
immunocompetence .
43

44. Vitamin B12 (Methylcobalamin)
 Vitamin B12 is synthesized exclusively by microorganisms and is found in the
liver of animals bound to protein as methylcobalamin.
 Pernicious anemia is a megaloblastic anemia resulting from vitamin B12
deficiency that develops as a result of a lack of intrinsic factor in the stomach
leading to malabsorption of the vitamin.
 The anemia results from impaired DNA synthesis due to a block in purine and
thymidine biosynthesis.
44

45. Function of protein:-
 Protein should account for 10% to 20% of the calories consumed
each day protein is essential to the structure of red blood cells , for
the proper functions of anti bodies resisting infection , for the
regulation of enzymes & hormones, for growth & for the repair of
the body tissue.
45

46. 46MAKE HEALTHY LIFE STYLE YOUR HABIT
&
YOUR HABIT WILL MAKE YOU HEALTHY

47. 47

48. Contents:-
Minerals
Food pyramid
Diet counselling
Balance diet
Normal diet
conclusion
48

49. MINERALS
49

50. Major(principal) Minerals:
 Sodium
 Chloride
 Potassium
 Calcium
 Phosphorus
 Magnesium
 Sulfur
50

51. Sodium
Function-
 Maintains the acid base balance,
 Maintain normal state of water balance in body,
 Plays a role in gaseous transport,
 Regulates the degree of hydration of plasma protein.
Deficiency- Acidosis,
 Heat stroke.
 Hyponatremia
Toxicity-
 Hypernatremia
 Edema and hypertension.
51

52. Potassium
Functions:
 Maintaining muscle and nerve irritability,
 maintains the acid base balance,
 Maintain normal state of water balance in body,
 Plays a role in gaseous transport,
Deficiency:
 Hypokalamia
 Electrolyte imbalance
 Mental confusion
 muscle weakness
52

53. Calcium
 most abundant mineral in body
Function-
 Major constituent bone structure
 Required for muscle contraction
 Required for blood coagulation
 found primarily in milk and milk products
 Deficiency and clinical aspect-
 Tetany
 Rickets and osteomalacia
 Blood clotting disorder
 Osteoporosis
53

54. Phosphorus
 2nd most abundant.
Function-
 energy metabolism, transport lipids,
 Constituent of bone and teeth,
 Acid- base regulation,
 Role in energy transfer.
Deficiency-
 Clinical conditions such as osteomalacia, Rickets.
Toxicity- acidosis.
54

55. Magnesium
Functions-
 Constituents of bones, teeth.
 Cofactor for many enzymes that metabolize carbs, lipids and amino
acids.
 Required for neuro-transmission.
Deficiency-
 Mental depression,
 Muscular tremor.
 Migane headache.
55

56. Toxicity-
 Can affect the nervous system,
 Depress deep tendon reflex and respiration.
Sources-
 found in nuts, whole grains, leafy veggies,
56

57. Chloride
 Essential nutrient, main ion of plasma.
Functions-
 Acid-base balance,
 Cl- in HCL secretion,
 Osmotic pressure regulation.
Clinical significane-
Intense vomiting may cause Cl- depletion.
Daily requirement-
Adults -1.5-5 g, Infants- 0.25g-1 g.
57

58. Sulfur
 Mostly sulfur remains present in amino acid & thiamine .
 high sulfur content inskin, hair, nails.
58

59. Trace Minerals
 Iron
 Zinc
 Iodine
 Selenium
 Copper
 Manganese
 Fluoride
 Chromium
 Molybdenum
59

60. Iron
Function-
 Transport of oxygen by haemoglobin,
 Helps in DNA synthesis,
 Play an important role in the fixation of nitrogen and hydrogen.
 Body Iron-
 Hemoglobin
 carrier of oxygen
 myoglobin
 protein in muscles, making oxygen available,
60

61. Clinical significance and deficiency-
It is associated with -
 iron deficiency anemia(hypochro-mic , micro-cytic),
 Haemorrhage,
 Scurvy,
 Polycythemia,
Toxicity –
Siderosis, hereditary hemochroma-tosis
61

62. Iron Deficiency Anaemia – pale
inner eye lids
Pale hands and
tongue
62

63. Zinc
Function-
 cofactor for many enzymes affecting growth and digestion,
 Play an vital role in wound healing,
 Role in vitamin-A metabolism,
Deficiency-
 growth retardation,
 sexual immaturity,
 impaired immune response,
 Alopecia.
 Dermatitis.
Toxicity- GI irritation, vomiting.
63

64. Iodine
 converted to iodide in GI tract
Function-
Essential component of thyroid hormone,
Regulates temperature, reproduction, growth, cell production.
RDA-0.1 mg/day
.
64

65. Deficiency:
 goiter: enlarged thyroid gland,
 Myxedema,
 Cretinism
 In case of children,
 irreversible mental and physical retardation.
Toxicity disease:
Thyrotoxicosis
65

66. Signs of iodine deficiency- goiter
66

67. Goiter and
cretinism 67

68.  World’s ocean and iodized salt , sea foods are best sources of Iodine.
68

69. Selenium
Function-
 Essential antioxidant nutrient
Deficiency-
 Associated with heart disease,
 Protein energy malnutrition.
Sources-
 seafood, meats, whole grains, vegetables
 dependent on soil content
Toxicity-
 loss and brittleness of hair and nails
69

70. Copper
copper is an essential constituent of several enzymes(catalase,
cytochrome oxidase)
Functions-
 Important player in several enzyme reactions,
 Role in iron absorption.
RDA-
 3mg/day
70

71. Deficiency –
 Anemia(hypo-chromic, micro-cytic),
 Menke’s syndrome.
Food sources-
 legumes, whole grains, nuts, shellfish, seeds.
Toxicity-
 Very rare, secondary to wilson’s disease.
71

72. Fluoride
Functions-
 Essential for the growth of bones and teeth,
 Inhibit the metabolism of oral bacterial enzymes,
 It forms a protective layer of fluroapetite which is acid resistant.
 Anticariogenic effect on teeth.
RDA-
 2mg/day
72

73. Deficiency manifestation-
 Dental caries.
Toxicity-
 Dental fluorosis.
 Skeletal fluorosis.
Sources-
 fluoridated water is best source.
73

74. Chromium
Functions-
 Essential nutrient involved in carbohydrate and lipid metabolism
 Maintains “glucose tolerance factor”.(Trivalent chromium)
Deficiency-
 creates diabetic like symptoms,
 Impaired glucose tolerence.
Sources-
liver, whole grains, yeast.
74

75. Function-
 cofactor for many oxidase enzymes.(Xanthine oxidase)
Sources-
 legumes, cereals, organ meat.
Toxicity-
 Hypermolybdinosis.
Molybdenum
75

76. DIET COUNSELING
 It deals with providing guidance in the art of food planning and
food preparation and food services.
 It assists a person to adjust food consumption to his or her health
needs.
 It involves giving advice on food selection based on the
individual’s reason for liking or not liking certain foods.
76

77. Objectives of Counseling
 Correction of diet imbalance that could affect the patient’s general health
and sometimes reflect on his oral health.
 Modification of dietary habits, particularly the ingestion of sucrose
containing foods in forms, amount, and circumstances that cause caries
formation.
77

78. Five ‘W’s and one ‘H’ of diet consultation.
WHO, WHAT, WHY,WHEN, WHERE AND HOW.
6 questions are to be made before making decision about which
pts. will benefit from diet counseling
 WHO may be benefited?
 WHAT are the objectives of diet and nutrition counseling?
 WHY is counseling beneficial?
 WHEN is counseling conducted?
 WHERE should the counseling occur?
 HOW to counsel?
78

79. Counseling should be done in a step by step
procedure starting with:
 Interviewing, where the diet diary is introduced with a brief
discussion of the purpose of diet.
 24 hr diet record prepared to get an idea of food, the pt. is
consuming
 Seven-day diet diary advised to be prepared by pt.
 Complete record of 7 day diet diary is analyzed regarding the
balanced and unbalanced diet.
 Isolate the sugar factor.
 Educating the pts. in the role of sugars in the process.
 Consumption of acceptable substitutes of more cariogenic food.
 Recognition of practical limitation to immediate success.
79

80. Food Group Guides/ Food guide
pyramid
Purpose:
 To translate dietary standards into simple and reliable devices for
nutritional education of lay person.
 It serves as a practical, workable plan for helping the lay persons or
home-maker to select the kinds and amount of food that needs to be
included or excluded in order to make each day’s meal a balanced diet.
80

81.  Divided into-
1. Bread-cereal group
2. Vegetable-fruit group
3. Milk-cheese group
4. Meat, poultry, fish, beans, nuts group
5. Fats, sweet, alcohols group
81

82. Limitations
 It has over-simplified and over generalized the eating plans. For e.g. high
amount of iron is required by pregnant, lactating women which cannot be
met by the 5 food groups.
 Ready to eat processed, formulated fruit drinks cannot be classified into
food groups because they do not follow the nutrition pattern of anyone
food group.
 Combination of foods like pizza, makes groups difficult to classify.
82

83. Normal Diet
 A Normal Diet consists of any and all foods eaten by you in health. It is
planned keeping the basic food groups in mind so that optimum amounts
of all nutrients are provided.
Foods allowed:
All foods that you eat in normal health.
Foods partially restricted:
1. Fatty foods like rich cakes, pastries etc.
2. Fried foods
3. Strongly flavored vegetables like turnip, capsicum, radish etc.
4. Too many spices, relishes or pickles
83

84. BALANCED DIET
8

85. Conclusion
 The effects nutrition on periodontal disease status and response to
treatment has been studied using different methods and study
models.
 Since periodontal disease is dependent on host susceptibility,
prophylactic nutrient supplementation for the prevention of
periodontal disease onset and progression is still not indicated.
 Considering that nutrient supplementation shows minimal or no side
effects, if future prospective, controlled clinical trials are able to
demonstrate that it could be used to enhance response to therapy,
such supplementation may prove valuable in producing more
predictable treatment outcomes dicated.
85

86. 86

87. References
 Text book of biochemistry-Prem Prakash Gupta
 Text book of medical biochemistry-MN Chatterjee
 Biochemistry –U.Satyanarayana
 Biochemistry textbook- Harper
 Lee Russell McDowell Vitamins in Animal and Human Nutrition.
 Essentials of biochemistry-Dr.m.c.pant
87

88. 88

89.  Avoid frying the food. Food absorbs the fats from the cooking oils, increasing
dietary fat intake. If it has to be fried, use polyunsaturated oils such as corn
oil.
 Including adequate fiber in diet is very important. Fiber is found in green
leafy vegetables, fruit, beans, bran flakes, nuts, root vegetables and whole
grain foods.
89

90.  Eggs are a good source of protein and low in saturated fat, eggs are very high
in cholesterol and should be eaten in moderation for that reason.
 Fish and poultry are recommended above red or processed meats because they
are less fattening.
 Choose fresh fruits for deserts rather than cookies, cake or pudding.
90

91. DIETARY INTAKE
91

92.  Avoid frying the food. Food absorbs the fats from the cooking oils, increasing
dietary fat intake. If it has to be fried, use polyunsaturated oils such as corn
oil.
 Including adequate fiber in diet is very important. Fiber is found in green
leafy vegetables, fruit, beans, bran flakes, nuts, root vegetables and whole
grain foods.
92

93.  Eggs are a good source of protein and low in saturated fat, eggs are very high
in cholesterol and should be eaten in moderation for that reason.
 Fish and poultry are recommended above red or processed meats because they
are less fattening.
 Choose fresh fruits for deserts rather than cookies, cake or pudding.
93

94. DIETARY INTAKE
94

95. SODIUM-POTASSIUM PUMP
95