Principles of Nutrition By NHI


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  • Nutrition begins with food.
  • Nutrition is a science as it has its roots in the research of many fields including medicine, physiology, chemistry etc. It is not static. It is a growing science which is changing & expanding with the findings of research on which it feeds.
  • Similar foods are grouped in one food-group.
  • Food pyramid is a guide to good eating. It recommends having fewer portions of food near the top and more of the foods near the bottom of the pyramid.
  • Break down of food from complex molecules to simple molecules The nutritive value of food relates only to the edible portion of the food stuff Nutritional requirements differs with age & sex & physiological conditions like pregnancy, lactation, adolescent. When cultures are old and tradition rules the way of life.
  • On the bases of similarities of content and function it has been classified as under six classes.
  • Comparison of different nutrients of foods and of body are given here.
  • Carbohydrates- Rice, Chapattis, Sugars, Potatoes, all Cereals such as Maize, Ragi Fats - Butter, Ghee, Cooking oils, Magarine Proteins - Milk and Milk products, Eggs, fish, poultry, pulses,meats Dietary fibers - Whole grains, fruits, green leafy vegetables Water - Water is an important nutrient since it acts as an emulsifier
  • Vitamins and Minerals are abundant in fruits and vegetables, Milk and egg , sprouts These very fruits and vegetable have a very important Nutrient which is called Phytonutrients. These Nutrients are present in the colours of the skin of the fruits and Vegetables. They say that a person will benefit if he consumes food comprising of all the colours.
  • Vitamins and Minerals are abundant in fruits and vegetables, Milk and egg , sprouts These very fruits and vegetable have a very important Nutrient which is called Phytonutrients. These Nutrients are present in the colours of the skin of the fruits and Vegetables. They say that a person will benefit if he consumes food comprising of all the colours.
  • Minerals are inorganic substances. Their form remains same. While CHO, proteins, fats & vitamins are organic substances.
  • The body uses energy in 3 ways--- Body uses energy for external activities- every voluntary move requires energy For internal activities- involuntary processes such as heart beat, breathing & circulation etc. For storage of energy- yielding materials chiefly during childhood & pregnancy.
  • Carbohydrates, fats & proteins & other nutrients are released from food during digestion, then absorbed into the blood stream and converted into glucose/blood sugar.
  • Calorie is not a nutrient. It is served as a convenient measure of the energy. One calorie is the amount of energy needed to raise the temperature of one gram of water by one degree celcius.
  • When food is burned in our body cells provides our bodies with energy, which is utilized for internal & external activities of the body.
  • What food will give energy? Ans – Fats, sugar, Carbohydrates (CHO) Excess consumption of the above will convert into Fat and stored in the body. Excess energy is stored as fat in adipose tissues and as glycogen in liver.
  • Water is clear, colourless, tasteless, odourless, liquid. It gives no calories yet it is fundamental to all life on earth.
  • The delicate organs like heart, lungs, brain are covered by double layer which has fluid in it & protect them from external shocks. Heat is eliminated by means of evaporation of water from the lungs & from the surface of the skin. Water is an important constituent of blood. It also gives volume to the blood. All lubricants in the joints has water as the major portion.
  • Water is the chief solvent of the nutrients. Nutrients are reduced to a liquid state in digestion, in preparation for absorption. Water brings digestive- juices or enzymes into the digestive tract and carries the product of digestion from intestine into the blood, which is largely composed of water. The blood distributes nutrition to the cells and finally some of the waste products from the cells are removed from the body in the urine which is largely water.
  • Keeping the water balance is more important for staying healthy than food, sleep, or anything else. If you run low on water, salt, or other fluids or have much to much of any– the body is in serious danger.Intake of water in various forms as shown in left colomn is almost 2800 ml per day. But body excretes almost the same amount ( shown in right colomn) This means that one needs to take more water to maintain a healthy body.
  • We consume water along with meals. Our meals are cooked in water medium. Water is consumed according to the activities, like vigorous or moderate activities. Water consumption is also directly proportionate to the temp. around us and so is the humidity. Among adults men need more water than females.
  • Body needs water even if you do not feel thirsty. Any beverage can full-fill the requirement but this cannot be compensated with alcohol, tea, coffee as caffeine act as diuretics (diuretics means that make you urinate more frequently).
  • Plants are the original source of all food proteins. Plants make their own proteins by combining raw materials like nitrogen, carbon, hydrogen, oxygen & energy for the task is obtained from the Sun. Animals eat these plants and build their body proteins.
  • Structural proteins include the collagen of connective tissues, the fibrin of a blood clot and the myosin of muscles. Elastin is found in the protective and supportive tissues of animals such as skin. Keratin contains 11% of the sulphur-containing amino-acid.
  • The tissues of the body are under constant repair. The rate at which they are broken down and replaced very greatly. It is impossible to give a reliable figure for the rate of proteins replacement of the entire body. Amino-acids liberated by the break down of old proteins can be re-utilized to synthesize new proteins.
  • All amino-acids are characterised by the presence of a carboxyl (COOH) group with acidic properties and an amino(NH2) group with basic properties, attached to the same carbon atom.
  • Histidine is believed to be essential for children which is one of the essential amino acid.
  • The adult human body can maintain nitrogenous equilibrium on a mixture of 8 pure amino-acids as its sole source of nitrogen.
  • Food protein is acted upon by number of digestive juices and enzymes then converted into amino-acids, the simpler form of it, then is absorbed by the body.
  • Protiens are digested to form Proteoses,Peptones,Polypeptides and Amino Acids. Digestion of Protiens in fried foods is slower because of delayed gastric emptying and the fat envelope requires digestion in the small intestine before the protein splitting enzymes act. In the stomach the enzyme Pepsin breaks down proteins into Proteoses and Peptone in the presence of HCL. This Proteoses and Peptones are further acted upon by the other enzymes and releases small Peptide chains and Amino Acids. These Amino acids are taken up by the blood stream and transported to the different parts of the body.
  • In this chart we see that Soya bean has the highest amount of Nitrogen which signifies that it is the richest source of Protiens among Pulses and Legumes.
  • The carbohydrates are a class of chemical compounds composed of C,H,& O. They contain 2 atoms of hydrogen and 1 atom of oxygen.
  • Monosaccharides- contains 3-6 atoms of carbon in each molecule. Disaccharidies- It is derived from 1 mole. Of glucose combined with 1 mole. of fructose which can split by hydrolysis in the process of digestion.
  • Glucose (grape sugar) Starch consists of glucose in combined form.
  • This is the animal equivalent of starch and is found in human tissues. The glycogen mole. Is composed of 3000-60,000 glucose units. Like starch this also dissolves in water and readily broken down by the enzyme to yield glucose.
  • Fibers are not considered a nutrient but it is still a component of food that promotes good health. It is a complex mixture of indigestible CHO material.
  • This can be explained and can be used later as an exercise at the end of “Vitamin” chapter as part of revision. There are play cards available for the same or chart paper can be used by each team,
  • Fats contain C, H, & O. They supply more energy than CHO & Proteins because they contain more combustible carbon & hydrogen. Thus they are the concentrated source of energy.
  • TG is the form in which fats chiefly occur in food stuffs and in the fat depots of most animals. TG are the esters of glycerol and FA. FA- over 40 different FA are found in nature. The natural fats are or TG are formed from 1 mole. of glycerol and 3 mole. of FA. These are 3 naturally occurring types of fats. After TG the next largest lipid component of the body are the Phospholipids. They form the important part of the structure of the cell-membrane. Sterols are the important biological substance.
  • Vegetable oils can be hardened and turned into solid fats by the action of hydrogen in the presence of a catalyst. This hydrogenation converts most of the unsaturated FA into saturated FA.
  • EFA are necessary for growth. Like AA they cannot be synthesized by the body and have to be supplied in the diet. Linoleic & Linolenic acid are of vegetable origin. (linoleic-omega 6 FA, linolenic-omega 3 FA).
  • Arachidonic Acid is a Essential Fatty Acids( EFA) with 4 double bonds. This EFA is synthesized from linolenic acid in fish and animals.
  • Linoleic and Linolenic Acids are of vegetable origin and are present in Cotton seed, groundnuts and Linseed oils, while Arachidonic acid is synthesized from Linolenic in Fish and animals. Oils from Fatty fish are rich in the long chain n-3 PUFAs and EPA and DHA. The n-3 PUFA Linolenic acid can act as a precussor for EPA and DHA. Linseed oil is particularly rich in this nutrient.
  • They form part of the structure of cell membranes and are concerned in the transport of fat about the body. Phosphatidyl choline is the predominant substance of lecithin. Lecithin is also the predominant phospholipid in plasma.
  • Sterols are impt. & widely distributed class of biological substance, all of them have the same basic ring structure. Ex. Cholesterol, Bile salts, Ergosterol.
  • These are the rich sources of cholesterol.
  • Physiology tells us how organs and cells function and is further divided into-----------
  • 1-Organ physiology 2-Cellular physiology 3-Molecular physiology
  • At simplest level all living beings are made up of atoms such as O,N,C,& P. When atoms are grouped they form molecules like water, salt, fats, proteins, sugars. Molecules associates to form the organization called cells. There are different types of cells. We say cells are the functional unit of the body. Cells are unified into units called as tissues. Similar type of tissues are organized in functional unit called organs and organs work together in a unit called system. Thus we see the organizational unit of cell and increasing with complexity– this is the process of physiology.
  • Cell membrane is the outer most component of the cell. This membrane is made up of proteins & fats. It does not allow the unwanted material to get in and the required material to g out. Thus acts like a guard.
  • Most materials get into the membrane by two methods. 1--- Passive diffusion 2--- Active transport.
  • Cytoplasm is found in the inner part of the cell. Organelles are found in cytoplasm which perform different functions. Mitochondria- The power houses of the cell. Endoplasm- Converts the amino acids into proteins Lysosomes- Its main function is to collect the cell waste & remove it.
  • Nucleus contains chromosomes, GENES, DNA & RNA. It contains the information of our physical characteristics.
  • The energy is produced from food that we eat. Mitochondria is responsible for producing energy that cells need.
  • The food releases energy through a series of chemical reaction through a process called METABOLISM. Metabolism is of two types--- Anabolism & Catabolism.
  • In case of catabolism (catabolic metabolism) the large complex chemicals are broken down into smaller chemicals which releases energy and then stored as ATP. The main site of catabolism is mitochondria and ATP’s are stored here.
  • Glycogen is a complex molecule consisting of many glucose units. Its main site of storage is liver.
  • Digestion of food starts from mouth. It has to pass through various organs of our body where it is acted upon number of digestive juices and enzymes before it is assimilated in the body.
  • Chewing breaks down the cellulose envelope and make starch and sugar available for subsequent digestion.
  • Saliva contains a starch splitting enzyme (ptyalin) which converts starch into dextrin and liberates some maltose. This food is passed by the epiglottis and enters into the esophagus and then to stomach.
  • Epiglottis is a muscular piece of tissue that blocks food from going into our lungs when we swallow food.
  • Esophageal sphincter separates the esophagus from stomach. This keeps the content of the stomach from going back into the esophagus. The stomach churns the food into a liquid called chyme. At this stage the stomach produces acid, mucus & pepsin. Acid– important for the digestion of the food. Mucus– protects the stomach from eating itself up. Pepsin– important in the digestion of proteins.
  • When the peristaltic movement occurs in opposite direction it is said to be reflux or regurgitation, i.e; removing of food from stomach back to esophagus and mouth. If it occurs too frequently it can be damaging to the esophagus or mouth. Bulimia--- Forced vomiting done to loose weight---- this can severely damage both the esophagus and teeth. Gastrectomy----- removal of some part of the stomach due to some reason. In such case stomach cannot hold much of food and produce chyme and digestion is also not as good as it should be.
  • Liver is the largest organ in our body. It is also called the master organ. It plays an important role in the absorption of fats, vitamins, production of bile-salts, proteins such as albumin, globulin and synthesis of cholesterol.
  • Its main role is the regulation of blood sugar by producing insulin in the body. It produces number of enzymes which helps to digest the food efficiently. Insulin is a hormone. Lack of insulin results in a disease called Diabetes. There are two types of diabetes---- type I & type II.
  • The primary function of the urinary system is the regulation of water and minerals in the body. The kidneys are been shaped which acts as a filter of our body. First water and minerals are taken out of the nephron and sent back into the blood. The unwanted chemicals, water & salts are excreted out as urine. We produces about 1500 ml of urine every day.
  • When we sweat more kidneys respond by producing less urine and reabsorbing more water and minerals. When a person has high BP, increasing water excretion can decrease the BP by the kidneys. As the kidneys produces more urine, more water is removed from the body and BP will go down. When we take drugs or are exposed to chemicals our body must get rid of them. In that case liver and kidneys usually work together. The chemicals first go to liver where it is processed and then sent to the kidneys to be excreted.
  • The process of exchange of oxygen and carbon dioxide between the atmosphere and the body cells during inspiration and expiration is called respiration. Respiratory system consists of nose, trachea, bronchioles and lungs.
  • Pharynx connects the nasal passage with the larynx. Larynx has tonsils in it, which filters out bacteria in the air and removing them before they get into the body. At the end of the tube the larynx divide into two tubes--- the trachea and esophagus which has epiglottis that works like a lid. The trachea is a stiff tube that runs from the pharynx to the bronchia. Trachea is connected to bronchioles. These bronchioles separate and deliver air to each lung. Lining the bronchioles are mucus coated flaps of skin called cilia. Their function is to trap particles before they reach the alveolus.
  • Lungs has tremendous surface area equivalent to a tennis court. The lung functions as a gas exchange process. The exchange of gases takes place in alveolar sacs. The exchange of atmospheric oxygen with the carbon dioxide of the body cell occurs during inhalation and exhalation.
  • The oxygen that enters the lungs are taken up by the hemoglobin, trapped inside the RBC in the blood. Oxygen is required for cellular metabolism which releases energy for cellular activities. As the cell produces the energy it also produce carbon dioxide that must be removed from the body. The blood carries this carbon dioxide to the lungs from where it is removed
  • Blood leaves the heart in a series of vessels called the arteries and returns to the heart in a series of vessels called the veins. Blood leaves the heart through aorta which divides further into smaller and smaller blood vessels till they form capillaries. Arteries and arterioles have smooth muscles around them which give them elasticity. When heart contract the blood is forced out into the arteries (systole) and the arteries expand. When the heart relaxes (diastole) the blood stops entering the vessels by the blood vessels relax.
  • The capillaries of the arterial system join with the smallest vessels of the venous system called venules. These venules give rise to veins which bring back deoxygenated blood back to heart. The venous system has much less muscles & less pulsing pressure compared to the arterial system. Blood also flows smoothly in veins as the pulsing pressure is less.
  • The pressure of the blood with in the arteries primarily maintained by the contraction of the left ventricle of the heart. When we measure the BP we get two values the systolic and the diastolic blood pressure. When the heart contract we get systolic pressure & and when the heart relax we get diastolic pressure.
  • Blood is a liquid which contains RBC, WBC, Platelets, Plasma, oxygen etc. The hemoglobin of the RBC is responsible of carrying oxygen to tissues. The lower count of hemoglobin results in anemia. As the blood travels through out the body the level of oxygen falls & as the blood goes to the lungs oxygen is left very little. When this deoxygenated blood goes through lungs again oxygen binds back to the hemoglobin.
  • White cells are members of our immune system & protect us from infections before they cause disease. Platelets are important for our survival. It helps in the clotting of blood. If there is any cut, platelets accumulate at the cut and plug it.
  • Plasma is the fluid portion of the blood. It constitute about 55% of the total blood volume. Plasma is a solution of water, proteins, sugar, salts, hormones and vitamins.
  • These are the two major divisions of nervous system, CNS– The brain and spinal cord. PNS--- 12 pairs of cranial nerves and 31 pairs of spinal nerves.
  • The spinal cord serves as a coordinating center for reflexes and connects the PNS with the CNS. The brain is the primary center for regulating and coordinating body activities. In an adult it weighs about 3 pounds and has many different parts performing different functions.
  • Spinal nerves come from the top and the bottom of the spinal cord. The top nerves controls our senses and the bottom nerves controls our muscle actions. White & gray matter are the two regions. Spinal cord and the brain are covered by 3 layers called meninges.
  • Spinal nerves come from the top and the bottom of the spinal cord. The top nerves controls our senses and the bottom nerves controls our muscle actions.
  • Brain– Site of consciousness, sensation, memory and coordination. It receives the information from the spinal cord and cranial nerves and prepares a response to the information. The brain can also formulate a plan of action without the external stimulus. The outer portion of the brain has gray matter and the inner portion has white matter.
  • These are the 3 major portions of the brain. Cerebrum-- is the largest part. It is the center of reasoning and memory and defines a persons intelligence and personality. It also controls all five senses, muscle action, learning, logic, creativity. Cerebellum– is a large mass of gray and white tissues that serves as the coordinating center for motor activity. Brain stem– connects the cerebrum with spinal cord. Brain stem is a complex of several smaller parts such as pons & medulla oblongata.
  • PNS stands for peripheral nervous system and is sub-divided into two components------1- Autonomic nervous system. 2- Sensory somatic nervous system. ANS- We have no control over this system. ANS has two sub units sympathetic and parasympathetic nervous system. The sympathetic nervous system function is to maintain our ability to have an effective fight or flight response, while parasympathatic nervous system serves to keep our body in calm state.
  • Sensory nerves carries information from our five sense organs and the responses of our CNS back to skeletal muscles & the organs in the body. Somatic muscle nerves (spinal nerves) control much of our skeletal activity.
  • Muscles connect with bones through tendons. When muscles contract or relax the bones move and our body moves. We can control the information going to the skeletal muscles and thus called voluntary muscles. Skeletal muscles are also called voluntary muscles. The red muscle fiber contains myoglobin similar to hemoglobin and can work for a long time without becoming tired. White fibers respond quickly but tires rapidly. Somatic nerves cells respond most rapidly to nervous stimulation.
  • Smooth muscles are involuntary . These muscles are most frequently found in Visceral Organs and Blood vessels. No conscious control over these muscles. These cells contract and relax in a group and not as individual cells. These muscles make the heart work as a pump.
  • For contraction and relaxation of muscles they need energy, ATP and certain minerals like Ca, K for proper muscle function.
  • This system is made up of skin, hair, nails and glands. Epidermis is the outer layer, tightly packed cells and no blood vessels. Dermis is the second layer and has blood vessels Skin serves the barrier in three ways.
  • Melanin is a skin pigment that protects our skin from sunlight. Skin allows us to lose heat from our body by sweating & evaporation & from blood by dilating blood vessels close to skin surface.
  • Synthesizing vit.D from sunlight is one of the important function of the skin. Skin is a sense organ that tells us about pressure, touch, pain, heat and send the information to the CNS for the body to respond.
  • Vitamins are special chemicals found in food.
  • Vitamins are organic substances which the body require in small amounts to perform specific functions that promote growth, normal metabolism, reproduction and normal maintenances of health and life.
  • Vitamins do not supply energy but are essential to metabolic activities and help in the utilization to the proximate principles. They are also involved in the utilization of the major nutrients like proteins, CHO & fats.
  • Substances that occur in foods which are not themselves vitamins, but are capable of conversion into vitamins in the body e.g; carotens are the pro-vitamin of vitamin A.
  • Vitamin is a precursor of two enzymes—Flavin-mononucleotide & Flavin adenine di-nuleotied. Release of energy from foods as it effects growth and cellular metabolism Needs in normal vision and may help against cataract. Sources– Milk, eggs, organ meat, mushrooms, shellfish, cereals and pulses.
  • NAD & NADP- are the active form of niacin named as nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate. -These coenzymes are involved in more than 50 different metabolic reactions. -Extracts energy from CHO and glucose. -proper nervous system functioning. Sources- Organ meats, liver, poultry, fish, milk, eggs, wheat germ, whole wheat, yeast.
  • -A clinical condition due to niacin deficiency, characterized as 3Ds. -Weakness, irritability, burning tongue as the mucous membrane of the mouth is inflamed. -High doses results in irritation of the gastrointestinal tract.
  • Originally called vitamin H. Egg, liver, kidney, yeast, pulses, nuts, chocolates, cauliflower and green vegetables.
  • --Biotin coenzyme participate in the metabolism of fat and CHO in the synthesis of fatty acids and amino acids. --Helps metabolize proteins, fats and CHO & thus helps to produce energy in body cells. --Assists in the synthesis of FA. --Incorporate AA into proteins & help with the formation of DNA & RNA.
  • Sources– Whole grain cereals, vegetables, peanuts, cheese, eggs-yolk, organ meats.
  • This vitamin is a constituent of co-enzyme A and is present in all living matter. Important for cellular metabolism of CHO & fats to release energy.
  • Pyridoxine and its co-enzymes have a wide variety of metabolic functions especially— -AA metabolism and its transportation. -Production of antibodies, RBC, synthesis and functioning of both DNA & RNA. - Fish, poultry, egg yolk, soya- bean, bananna, potatoes, cauliflower.
  • Due to the deficiency of B6 , the RBCs are pale and small and the Anemia is said to be Hypochromic and Microcytic.
  • Sources– Spinach, liver, peas, sweet potato, bean sprout, wheat germ, soya flour, milk, fruits.
  • -Deficiency leads to impaired RBC production. -Megaloblastic anaemia If the maturation of the RBCs in the bone marrow is impaired by lack of Folic acid or Vitamin B12, the cells which enter the blood stream are irregular in size and shape, but usually on average larger than normal. Such anemia is orthochromic and megalocytic. It is usually referred to as Megaloblastic Anemia.
  • Bulk of body stores of vitamin B12 is in the form of coenzyme B12.
  • This vitamin has cyanide group and cobalt group. From animal foods like goat liver, fish, eggs & milk.
  • Variations in the size and shape of the blood cells. Results in peripheral neuropathy. Loss of mental energy, depression, tingling, numbness, diminished or absent sensation in extrimities.
  • Also helps to maintain healthy blood vessels.
  • Amala, guava, oranges, all citrious fruits, dark green leafy vegetables, tomatoes, etc.
  • --General manifestation of scurvy are fever, rapid pulse, and susceptibility to injection and wound healing is delayed. --Bleeding gums, common cold, delayed wound healing. --Gastrointestinal disturbances, dysuria, skin sensitivity.
  • Circulates in the plasma with the specific retinol binding protein. This combination is called halo-RBP.
  • -Encourages immune system to produce the cells you need to fight off infection and promotes rapid recovery. -As anti-oxidant and may aid in reducing the risk of cancer. -Also promotes the growth of healthy bones.
  • -It is a vision vitamin. -Keeps skin and mucous membranes smooth and supple. -Promotes the growth of bones and teeth. -Sources- Eggs, liver, fish liver oil, milk and milk products & green leafy vegetables.
  • It may be affected in severe vitamin A deficiency. It becomes dull and then corneal scar occurs. Takes part in the formation of bony matrix.
  • Changes in the eyes like night blind ness, xeropthalmia, skin changes ,effects the mucous membrane of the respiratory tract, alimentary tract and genito-urinary tract. Toxicity– Fatigue, loss of appetite, nausea, vomiting, weight loss, irritability, cracking lips, dry skin and hair loss, swelling over long bones.
  • In liver it is stored in the form of retinyl esters.
  • Also called Sun shine vitamin. Skin prepares vitamin D in the presence of sunlight.
  • -as it reduces the production of vitamin D. -Osteomalacia is more common in adults. The calcium deficiency results in de-mineralization of bones. -should be taken carefully.
  • Maintain the blood (plasma) Ca & P levels. Acts like a hormone. Vitamin D main site of action is in the small intestine where promotes Ca & P absorption from the gut & also has direct action on the gut. Raises concentration of plasma Ca & P to promote bone deposition.
  • Deformity of the weight bearing bones, knock knees, bowing of legs. Loss of bone mineral. Pain in bones. Excessive thirst, diarrhea, nausea, weakness & headach.
  • Alpha-Tocopherol is the most common and the most active of the seven mentioned forms.
  • -Natural antioxident. It helps to reduce oxidation of lipid membranes, USFA & breakdown of other nutrients by oxygen. -Protect the cell membrane destruction. -It reacts with free radicals & oxidizing agents. -Found in cell membrane that contain PUFA. It inhibits the reaction involving oxygen. -It protects both vitamin A & carotene from oxidation.
  • -prevents the oxidation of USFA -protects lungs from oxidative damage from environmental substances. -protects RBC membrane from oxidative damage.
  • Deficiency– low fat diet, malabsorption syndrome or after gastric surgery. RBC hemolysis occur more easily in vitamin E deficiency.
  • Originally called Koagulation vitamin.
  • K1 is the naturally occurring form of vitamin K. Bacteria in GI synthesis vitamin K. Normal synthesis is inhibited by the intake of oral antibiotics– K2 vitamin.
  • Bile production is impaired if there is sever damage to liver as secretion of bile salts is necessary for normal absorption of vitamin K. In steatrrhoea, ulcerative colitis fats are not absorbed effectively, bleeding due to vitamin K deficiency may occur. Sulfa drugs and antibiotics spoils the GI bacterial flora.
  • New born babies has sterile GI tract for about a week & hence a low blood prothrombin level. Due to prolonged antibiotic therapy, prevents the growth of intestinal bacteria. Deficiency of vitamin K produces a lowered prothrombin time. Vitamin K deficiency involves abnormal bleeding as in nose bleeding and internal hemorrhage which can be sever.
  • Successful building of a human body depends upon ability of his body to accept or reject the elements that the food provides After digestion the food is absorbed in the form of a simple, soluble compounds or ions. Once absorbed they are freely excreted. Some essential metals are largely bound to proteins and cannot be excreted by kidneys. To some extent nature also controls the toxicity of metals.
  • Phytates the salt of phytic acid bind with Fe, Ca, Zn, Mg. In presence of Ca & Mg it forms insoluble complexes with iron & thus makes unavailable to body. Oxalates the salt of oxalic acid interferes with Ca absorption by forming insoluble salts with Ca.
  • Sodium forms 90% base (cation) of the extracellular fluid. 95% sodium is excreted through kidneys.
  • Na is very soluble in water & thus easily absorbed from the stomach and small intestine. Jejunal Na absorption is stimulated by the presence of actively transported glucose or amino acid.
  • Chloride is an acidic anion. Cl is closely associated with Na in the extracellular fluid. Cl is taken into the body largely as Nacl. It may be lost to the body in urine in association with NH4. This leads to acid base balance.
  • Plasma chloride is required for the secretion of HCL by the stomach. Very few foods are never as acidic as gastric juices. However in vomiting due to gastric outlet obstruction chloride is lost as HCL without the corresponding loss of Na.
  • K is also necessary for the maintenance of acid base balance. K is the main base of the cellular compartment just as Na is of the extra-cellular compartment.
  • K is lost from cells due to dehydration, acidosis and tissue breakdown. Persistent vomiting. There is considerable loss of K through urine when diuretics are administered. When liquid stool is passed with laxatives an appreciable amount of vitamin K is lost. Continuous diarrhea results to deficiency. Prolonged use of steroids produces retention of Na & excretion of K which may produce clinical manifestations.
  • Besides the above it also maintains Neuro-muscular functions
  • Ca constitutes 2% of the total body weight. Most of the body Ca is stored in bones and teeth. The skeleton is the dynamic reservoir where Ca is continuously deposited & reabsorbed. Bones are the Ca bank. When ever required the Ca from the bones are mobilized to maintain the normal serum levels.
  • An equilibrium exists between the calcium coming and going from the bones. Osteoblast cells lay down fresh Ca cells. Osteoclast are constantly eroding redundant Ca deposit.
  • After the bones have stopped growing in length at about the age 18 years they may continue to get more dense for a few years. By the age of 30 bones begin to atrophy. In old people there is no change in the quality of bones.
  • Ionized Ca is vital to life as it affects the neuromuscular excitability of both voluntary & involuntary muscles.
  • Ionized Ca is more diffusible. It is controlled by parathyroid hormone. Serum Ca is bound to protein.
  • Calcium along with Magnesium and Potassium can help prevent high blood pressure and help make clotting possible. Calcium deficiency can cause an over production of the hormones Portisone and Aldosterone which in turn causes the Kidneys to hold salt and water. The blood volumes swells and results in Hypertension. Calcium actually lowers the blood Cholesterol. In research it was found that Calcium combines fatty acids in the intestines and forms a calcium soap which is eliminated in body waste as calcium intake increases the amount excreted is increased. Studies have shown that increased intake of calcium in combination with Vitamin B particularly from supplements may lower the risk of Type II Diabetes by 33%. Studies have also shown that Calcium has protective effect against Colon and Rectum Cancer. Increasing intake of dietary Calcium or decreased dietary fat foods significantly reduces colon cells proliferation.
  • Parathyroid hormone also enhances intestinal Ca absorption. More is the concentration of Ca in intestine more will be the absorption.
  • Osteoporosis is the result of negative calcium balance. It occurs due to low Calcium intake , hormonal. Physical and circulatory factors. Lactose increases absorption of instestinal Calcium and Phosphorus. There is a normal daily bone loss of of approx. 30-40 mg. After menopause in women it is accelerated by 17% or more.
  • The volume of the bone does not change with age but as it atrophies bone mass is reduced and its density falls.
  • P is widely distributed in all the cells, tissues and body fluids. P is present both in blood red cells & plasma. P is an important anion with in the cells.
  • P is an important element in the phospholipids cell membrane, nucleic acid and phosphoproteins required for mitochondrial function. Many of the B vitamins are effective when combined with phosphate in the body. Certain proteins like casein contains P in there structure & called phosphoprotein.
  • As P is part of Nucleic acid. P is the source of high energy bonds of ATP. Some enzymes and vitamin of B group become efficient when combined with P.
  • Take care of calcium and phosphorous will take care of itself.
  • It is the second most abundant intracellular Cat-Ion in the body. Enzymes which supplies the energy required for the Na pump. 65% of Magnesium is in the bones, 34% in the intracellular space and only 1% in the extracellular fluid.
  • It is essential part of many enzyme system responsible for the transfer of energy. Ex. Co-carboxylase and Co-enzyme A only act in the presence of Mg. -Mg activates enzymes that are important for protein, CHO metabolism & needed in DNA production. -Mg helps to transfer phosphate molecule to ATP an energy source generated by the cytochrome system.
  • -Mg is present intracellular in heart muscle cell that helps in contraction. -Ca stimulates muscle contraction. -Mg relaxes the muscle. Thus also called as anti-stress mineral.
  • -High alcohol intake produces Mg deficiency. -Metabolic syndrome. -Alimantry loss of Mg may occur in vomiting or diarrhea.
  • All living matter contains proteins and all proteins contain some sulfur. This element is therefore essential for life. Sulphate ions are present in the cells and sulphate also occurs bound to various molecules e.g. heparin. -Greater part of sulfur is present in the two sulfur containing aminoacid.
  • Trace minerals are concerned in some way with enzymatic action.
  • Example : Magnesium deficiency produces Sodium accumulation in the cells and causes loss of potassium out of the cell. This cannot be corrected by supplement alone unless magnesium is also administered. It is also reported that cobalt is required for optimum utilization of low doses of Iodine,
  • Mg deficiency produces Na accumulation in the cells and causes loss of potassium out of the cell. This cannot be corrected by potassium supplements alone unless Mg is also administered.
  • Fe is important component of hemoglobin which transports oxygen to the various tissues of the body. Life & Fe are inseparable. Vit C reduces Ferric iron to Ferrous iron which remains soluble even at neutral PH and is better absorbed.
  • There is about 4 gm. Of iron in an healthy adult. Major portion is present in hemoglobin.
  • Most tissue enzyme contain iron. There are intracellular enzymes which contain iron prophyrins.
  • Iron absorption decreases on a cereal diet occur with phosphate & phytates by precipitating ionized iron. Fiber in wheat and maize decreases iron absorption. Tea, coffee forms insoluble iron tannate that is not absorbed. Iron absorption is considerably decreased on a soya bean diet compared to a diet of egg albumin or casein of milk.
  • In small intestine iron absorption is by a process of diffusion.
  • Iron is absorbed into the blood stream and not into the lymph. In blood iron gets bound to a plasma protein belonging to beta globulin. The total binding (TBC) is increased when the need for iron is increased for iron is increased as in the later stages of pregnancy or in anemia. Iron absorption is increased with iron deficiency anemia, low plasma iron.
  • The normal lifespan of RBC is 120 days. About 20 mg of iron is released daily from the breakdown of Hemoglobin. It is oxidised to Ferric form and incorporated into ferritin or Hemosiderin until it is re utilized for the formation of RBC. Iron binding Protien are Tranferrin. Transferrin transports protien and binds 2 atoms of iron. Mucosal transferrin binds iron in the lumen of the gut to transport it across the brush border of the intestinal mucosa.
  • The body conserve iron well. The normal body losses in the bile, faces and sweat are small and the urinary excretion.
  • Znic is used as a cofactor in more than 100 enzymes involved with digestion, metabolism, reproduction & wound healing. Zinc is essential in the synthesis of DNA, RNA. Maintains the body levels of vitamin A.
  • In alcoholic chirrosis of the liver zinc concentration in the plasma is reduced
  • Iodine is contained in the hormones stored & secreted by the thyroid gland. Iodine in food & water is quickly absorbed from alimentary canal mostly as inorganic iodide.
  • Active form of selenium is selenocystein which slows the biological aging process.
  • For the availability of Iron for the formation of RBC Formation of Myelin by allowing Phospolipid synthesis
  • Coper plays vital role in number of metallo-enzymes, is concerned in the metabolism of catecholamines and ascorbic acid. - oxidation of ferrous to ferric ions for the availability of ironfor the formation of RBC. - concerned in the formation of myelin by allowing Phospholipid synthesis. - copper deficiency leads to Leucopenis and anemia.
  • It exist in trivalent & hexavalent forms. Only trivalent chromium is biologically active.
  • Chromium acts as a cofactor for Insulin. Insulin is activated by Chromium thus prevents continued elevation of blood sugar. The growth in some protein deficient children is enhanced by chromium.
  • These were the percentages of leading causes of death in Dec. 2004 by WHO. CVD, stroke, & cancer, are believed to remain the leading cause.
  • According to WHO Obesity is one of the 10 most preventable health risk.
  • Obesity is bad news for both body and mind. It not only makes a person feel tired and uncomfortable, it can also wear down joints and put extra stress on other parts of the body. It is also associated with the above mentioned problems. Obesity affects all age groups.
  • Childhood overweight is a serious health concern for children and adolescents. Data from the surveys show that the prevalence of overweight is increasing for children aged 2-5 yrs . Over weight children and adolescents are at risk for health problems during their youth and as adults.
  • Over weight children and adolescents are more likely to become obese as adults . One study found that approx. 80% of children who were overweight at aged 10-15 yrs were obese adults at 25yrs.. Another study found that 25% of obese adults were overweight as children. The latter study also found that if overweight began before 8 yrs of age, obesity begins before 8 yrs of age , obesity in adulthood is likely to be more severe.
  • Small parts of the DNA that people inherit from their parents that determine s trait. Some of the genes tell the body how to metabolize food and how to use the extra calories or stored fat. Some people burn calories faster or slower than others do because of their genes. Certain illness like Thyroid gland problems or unusual genetic disorders, are uncommon causes for people gaining weight. Sometimes emotions can fuel obesity as well. Some people tend to eat more when they are upset, anxious, sad, stressed out or even bored. Another factor is sedentary life style.
  • Doctors and nutritionists plays important role in preventing & controlling CVD.
  • When not enough oxygen is supplied by the blood, part of the heart muscle dies. It may heal or may lead to death.
  • In all the four cases the normal functioning of the heart is impaired.
  • The part of the heart muscle that die due to failure of blood supply may heal leaving a scar in the heart. Such patients are severely disabled or may be able to return to restricted physical activity, but carry an increased risk of another infarct. Thus when scar tissue is more there is less percentage of functional heart.
  • High blood pressure is recognized as the greatest of CV risk factors because it is initially largely symptom less. Atherosclerosis refers to the deposition of yellowish plaques of cholesterol, lipids and cellular debris that builds up in the inner layer of the walls of large and medium sized arteries. This makes the arteries walls thick and less elastic, thus increases their resistance and pressure and makes heart work harder.
  • High Blood pressure is recognized as the greatest of cardiovascular risk factors and because it is initially largely symptom less, has often been dubbed the ‘silent killer’. It can cause the heart muscles to enlarge and weaken and it is a powerful promoter of atherosclerosis in the coronary arteries.
  • Some times thrombus forms in an atherosclerotic coronary artery and blocks the lumen. Sometimes there is no thrombus and the infarct arises because the lumen of a coronary artery has been so narrowed by atherosclerosis that the blood flow is insufficient to supply the oxygen needed to maintain a hyperactive cardiac muscle. Which can wear down this vital muscle to starve.
  • When narrowing of vessels occurs, serious impairment of the blood supply to important structures may result. Untreated hypertension may lead to further other complications such as cerebrovascular accident or stroke.
  • If kidneys are unable to excrete water from body due to some damage. They control how much sodium your body contains and thus how much water stays in your blood (Na retains water). More water means more fluid trying to get through the blood vessels– and higher blood pressure. Obesity is also one of the predisposing factor. Stress and strain. In some diseases, endocrine disorder, pregnancy are some of the undetermined causes.
  • Damage to arteries actually begins at blood pressure levels. Untreated hypertension leads to cerebrovascular accident (stroke). Diseases of heart. Retina. Kidneys or peripheral arteries. Hypertension accelerates the on set of IHD.
  • Taking a well balanced diet. Drinking plenty of water. Meditation. Avoiding stress and tension.
  • Cholesterol is a waxy substance produced from the fats you eat. Sources—The exogenous, from food and endogenous synthesis by liver and intestine.
  • Small, dense LDL is especially lethal as they can penetrate artery walls with ease laying the foundation for the plaque build up of atherosclerosis. HDL actually fuses with LDL and remove their cholesterol. HDL also works as antioxidants, blocking LDL from causing plaque promoting damage.
  • Cigarette smokers has 3 times higher risk of heart diseases than non- smokers. The risk increases with no. of cigarettes particularly in those over 50 years. -as in high blood pressure heart has to work harder, may results in increase risk of CVD. High levels of cholesterol and fats increases the risk of CVD. Heredity- short, stocky and short-necked subjects are more likely to develop CVD than tall, thin people. -Hormones- males in general are more predisposed to CVD than females. It is possible that female sex hormones have an inhibitory effect on coronary artery disease. -CVD usually manifests itself after the age of 50 yr.
  • -Atherosclerotic patients have diabetes or a tendency to high blood sugar and increased insulin secretion. Obesity is related to coronary heart disease. Those with a punch, i.e. higher waist to hip ratio are more prone to CVD and death. Moderate exercise is beneficial in middle aged persons. Vigorous exercise produces neuromuscular injuries and ventricular fibrillation specially in those with coronary heart disease.
  • Fixed risk factors we cannot change but can control to some extent by modifying our life style and developing good eating habits.
  • This is a key factor for good health if we also include exercise.
  • The exogenous plasma TG are derived from the ingestion of fatty acids. Endogenous TG are produced mainly by the liver from free fatty acids and CHO. TG combining in the liver with phospholipids, cholesterol and proteins form VLDL, which are transported to the tissues for use as fuel or to the fatty tissues for storage.
  • The following fats have a higher proportion of fatty acids– butter, ghee, cream, hydrogenated oils, egg yolk.
  • MUFA posses the ability of lowering the levels of lipoproteins in plasma. Use olive oil or rapeseed oil for salad dressings. MUFA in nuts make them excellent snack. But to guard against overeating, limit yourself to one serving and put the rest away. Choose unsalted nuts to keep your blood pressure under control.
  • There are 3 naturally occurring types of fats– MUFA, PUFA, & SATURATED FA. A fourth type of fat-Trans fats, are man made. It is advisable to cut down trans fats from your diet
  • Be careful while using oils, type of oil, quantity of oil. Use cooking methods which require little or no fat.
  • The epidemiological studies which attempt to relate high blood pressure with high intake of salt have not been convincing. Of various possibilities genetic factors are certainly important. An excessive intake of energy leads to obesity is often associated with hypertension. A low salt diet causes a marked reduction in blood pressure.
  • These are the best way to control blood pressure.
  • Losing just 10% of your body weight could lower your high blood pressure down to a normal range without drugs. Physical activities flushes out your arteries, cleaning them and keeping them clear and supple. Exercise will raise the levels of HDL cholesterol, thus reducing total cholesterol levels.
  • Fiber plays vital role in controlling bad cholesterol, regular bowel movement and decreasing the risk factor of heart diseases.
  • Obesity is responsible for no. of these health problems.
  • Diabetes Mellitus is a clinical syndrome characterized by hyperglycemia, due to deficiency or diminished effectiveness of insulin.
  • Typical inactivity and in rare cases certain medication, pregnancy, diesease, or accidents that has damaged the Pancreas also cause diabetes.
  • -- pancreas fails to produce insulin, which is necessary for survival. -- results from the body’s inability to respond properly to the action of insulin produced by the pancreas. --Diabetes Insipidus is a rare disease in which there is passage of large amounts of urine, that is caused by a disorder of the pituitary gland. --Gastational diabetes refers to the hyperglycemia which may occur temporarily during pregnancy in women.
  • Juvenile diabetes is a chronic metabolic condition. Type I diabetes onset of it begins in childhood. This diabetes usually develops before the age of 40 years of life in patients of normal or less than normal weight. The majority develops sever symptoms of diabetes over a period of several weeks.
  • In the absence of insulin the blood sugar is raised & liver glycogen is depleted, liver converts amino acids to glucose that increases nitrogen excretion. This reduces protein synthesis, serum lipids increases and ketone bodies accumulate in the blood. Insulin is the only hormone that promotes storage of fatty acids in the cells against many hormones which tend to release cellular fatty acids.
  • Many patients with type II diabetes have a long history of mild symptoms which may come and go. May not require insulin shots daily. Instead a healthy diet and exercise can control it.
  • Diabetes insipidus is a condition associated with the kidney’s inability to conserve water. It is caused by the failure of the hypothalamus to release anti diuretic hormone, resulting in the passage of large amounts of urine this is often accompanied by a change in appetite, loss of strength, and emaciation.
  • Type I - juvenile onset type. Type – maturity onset type. GDM – gestational diabetes. IGT – increase glucose tolerance.
  • A good metabolic control can delay the onset and progression of diabetic retinopathy, slow down the progress of renal damage and may delay or prevent heart disease in people with diabetes.
  • To manage young insulin dependent diabetics a careful balance has to be maintained between diet for adequate growth, weight regulation, exercise and insulin dosage.
  • Characterized by the chronic excretion of large amount of pale dilute urine which results in dehydration.
  • This is usually associated with obesity and is not prone to ketosis.
  • Controlled clinical trials has shown positive response of weight loss on fasting blood glucose and fasting insulin levels, reduced cholesterol levels.
  • Increasing weight is always a danger signal. The association of obesity and diabetes has long been recognized, but it is still uncertain. Diabetics should be encouraged to maintain a healthy body weight with a BMI in the range of 18.5-25 kg/m2. Regular physical activity improves insulin resistance and lipid profile.
  • When controlled diet, physical activity and drugs are ineffective then it becomes necessary to give insulin.
  • The effective management of these adjustment depends on the individual’s knowledge and motivation. Weight reduction and exercise has been already discussed. Meals should be coordinated with type of insulin recommended, if insulin dependent. Weight reduction will help to reduce blood glucose and cholesterol levels. Exercise has the potential to control the diabetes by non medical means.
  • In the absence of insulin the blood sugar is raised and liver glycogen is depleted. Insulin is the only hormone that promotes storage of FA in the cells against many hormones which tend to release cellular FA. Some hormones are antagonistic to the action of insulin.
  • Exercise can help control weight and lower blood cholesterol & sugar levels, raises HDL levels, reduces the severity of the disease & reduce the risk of long term complications.
  • A dietary plan is designed around an individual’s life style and eating habits. Any dietary program is complicated by the fact that the same food may be eaten by different people and produce different responses in blood sugar levels. There is two-to-four fold increase in the prevalence of macrovascular diseases in persons with diabetes. Each person with diabetes should know their individualized blood glucose goal ranges, which may differ from normal. For persons with type 2 diabetes ,moderate weight loss, regardless of starting weight, has been shown to reduce hyperglycemia, dyslipidemia and Hypertension. Calories should be prescribed to provide for normal growth and development in children and adolescents. The meal plan is not a Restriction of calories but is intended to ensure resonable consistent food intake and a nutritionally balanced diet.
  • Proportions of calories, CHO, proteins and fat are estimated for each individual based on the need to maintain, lose or gain weight. Proteins are broken down to amino acids. They are transport fats in the body via lipoproteins. CHO converts glucose to cellular fuel. CHO causes release of insulin. CHO are the raw material the liver need to manufacture triglycerides, monounsaturated fatty acids & cholesterol.
  • Same as we have already studied. More portions of food to be consumed from bottom and less from top.
  • High fiber foods, the body digests the food over time, slowly releasing chunks of glucose into the system. When glucose is released, it triggers a rise in the hormone called insulin, which uses the glucose. If the insulin rise is gentle, the body does well. But if the rise is sudden and very sharp, which typically happens with the consumption of refined food, then the side effects of high insulin levels emerge– weight gain, cholesterol problems, imbalanced blood sugar and irregular cycles in women.
  • Soluble fiber slow down the digestion of CHO, which results in better glucose metabolism.
  • Sugar substitutes are so much sweeter than sugar that very small amount are needed to create a sweet taste. That is what keeps the calories of the substitute at a minimum. They also contribute almost no CHO to foods, so diabetics can enjoy more sweet food without affecting
  • In diabetes insipidus there is increased blood sodium and if the diabetic is suffering from hypertension. Then sodium is restricted.
  • Sulphonylureas lower blood sugar by stimulating pancreatic insulin secretion and increasing insulin receptors on cells. Dietetic control is still essential even with the tablets.
  • -Good metabolic control can delay the onset of diabetic retinopathy. -Diabetes is among the leading cause of renal failure and is related to the severity and duration of the disease. -Diabetic neuropathy is probably the most common complication of diabetes. Major risk factors of this condition are the level and duration of elevated blood glucose. The first is the management of a stabilised diabetic who has to undergo an operation. -Macrovascular complications produce coronary heart disease, thrombosis or hemorrhage in the brain and gangrene in the limbs. -Obesity is a strong predisposing factor in middle age diabetes. Increasing weight is always a danger signal.
  • Nephropathy can complicate both type I and type II diabetes. The clinical features are micro-albuminuria in the first stages, then progressing to proteinuria, hypertension, and progressive CRF.
  • The chief abnormality present in syndrome X is insulin resistance. That is, the body’s tissues do not respond normally to insulin. As a result, insulin levels become elevated in the body’s attempt to overcome the resistance to insulin. The elevated insulin level leads , directly or indirectly to other metabolic abnormalities seen in these patients. When diabetes occurs, the high risk of CV complications goes even higher. The characteristic disorders present in metabolic syndrome X include : Insulin resistance, Hypertension,, abnormalities of blood clotting, Low HDL and High LDL Cholesterol level, High TG levels.
  • The degree of which increased lipolysis occurs is proportional to the degree of insulin deficiency. In such condition the plasma concentration of FFA may remain 3-4 times the normal.
  • Dietary instructions for diabetic must be simple. Greater flexibility should be offered so that it is easer to follow the instructions. The word MEAL denotes breakfast, lunch and dinner. The exchange plan, the counting CHO plan & the continuous CHO plan are the 3 main meal plans that people with diabetes use to manage their eating. It is important to eat the same amount of CHO, proteins & fats every day to maintain better control of blood glucose level. Find the one that fits your life.
  • A dietician gives specific instructions, gives wide choices in food and also give some sample menu to understand easily for the patient.
  • Exchange list is given to the patients so that on there on they can create variety in their meals.
  • --Hyperglycemia arises from two main sources- a reduced rate of removal of glucose from the blood by the peripheral tissues and an increased rate of released of glucose from the liver into the circulation. --Decreased glucagon secretion produces hypoglycemia. --The excessive breakdown of fats in an attempt to provide energy results in an accumulation of ketone bodies which the tissues are not able utilize rapidly. Ketone bodies are thus accumulated in the blood and lead to the withdrawal of water from the cell. They are strong acids which release hydrogen ions into the body fluids and thus an increase in plasma CO2 in the arterial blood. This state is called ketoacidosis.
  • Decreased glucagon produces hypoglycemia these symptoms which may disappear in a short time. It can happen even during those time when you are doing all you can to manage your diabetes.
  • Hyperglycemia is a major cause of many of the complications that happen to people who are diabetic. Glucose level increases after a meal, but quickly returns to normal as cells remove excess glucose from the blood stream. This normal process for energy falls apart in diabetes. Either the pancreas cells do not make insulin or cells of the body cannot use the insulin properly. Without insulin cells are unable to take up glucose. These are the consequences of hyperglycemia.
  • Diabetic ketoacidosis is a serious condition where the body has dangerously high levels of ketones or acids that build up in the blood and it can lead to diabetic coma or even death.
  • When the clinical symptoms are present, the diagnosis is often beyond reasonable doubts then it may be confirmed by the findings of GTT and urine test. In that case a doctor should be consulted. The aim for treatment---- -- the abolition of symptoms while avoiding hypoglycaemia. -- the correction of hyperglycemia and glycosuria. -- the attainment and maintenance of an appropriate and body weight.
  • Cancer is a condition that can affect nearly every organ system in the body. Its prognosis is enormously variable with nearly 100% survival to almost 100% mortality depending on the site of the cancer.
  • All these factors play role in precipitating cancer. Cancer is caused more specifically by both external (chemicals, viruses, radiation) and internal factors (hormones, immune conditions, inherited mutation).
  • More than 80% of the cancer cases are attributed to cigarette smoking.
  • These are the external factors which has proved to cause cancer. Asbestos has been banned in no. of other countries.
  • Some of the external causes can be controlled to prevent cancer.
  • The evidence from research has shown that about 1/3 of the 500,000 cancer deaths that occur in united states alone each year are due to dietary factors. Thus we can say that it is of more importance. Many dietary factors can affect cancer risk:--types of foods, food preparation methods, portion sizes, food variety and over all caloric balance. Western diets are very deficient in Vit . C due to inadequate amounts of fresh fruits and vegetables. Vit C is essential for building and maintaining collagen, for proper utilization of oxygen in cells, for integrity of the immune system. .
  • There are strong evidence that increase consumption of fruits and vegetables reduce the risk of colon cancer. Some foods like soya bean, broccoli have anticarsinogenic property. Excess fat in the diet definitely increase the incidence of breast, uterine, ovarian, colon & prostat cancer. Antioxidents give protection from free radicles which may give rise to cancer. Gerson diet- based on raw fruits and vegetables , low in sodium and high in Potassium, has proven most effective in restoration of Cancer patients and patients with all types of metabolic diseases. This diet also includes supplementary enzymes , forms the basis of all successful cancer therapy. Enzymes of many kinds derived from both plant and animal sources are now available in powdered or tablet forms.
  • If the detection is done at the early stage then there is 100% survival. Cancer prevention means early detection, so that necessary surgery, drugs and radiation can be applied sooner to prevent its prognosis. Cancer develops when cell in a part of the body begins to grow out of control. Although, there are many types of Cancer, they all start because of out of control growth of abnormal cells. Cancer cells develop because of damage to DNA. Often Cancer cells travel to other parts of the body where they begin to grow and replace normal tissues. This process is called Metastasis. Invasion – Solid tumors develop initially as a single mass of cells. Cancer invasion is the process in which cells break away from the primary tumor and crawl through surrounding tissues. This enables the cells to move into a blood vessel and be transported through the body possibly establishing a secondary tumor at another site.
  • Family history and genetic susceptibility also are an important factor. Sometimes cancer cells are dormant in the body for many years. Thus in that stage early detection is helpful.
  • There are two types of tumors. Benign tumors are non cancerous & Malignant tumors are cancerous.
  • Metastasis means to spread from one organ to another. The abnormal growth of new tissues and cells tend to invade surrounding tissues and cells and metastasize to different body tissues.
  • In some cases surgery is the best option. Radiation therapy and chemotherapy is given as a part of treatment. A strong healthy immune system is also an essential part of this plan.
  • In spite of knowing people do not want to follow.
  • Cancer of these organs are common.
  • The majority of patients can maintain nutritional status with normal or fortified diets with or without the need of oral nutritional supplements, by remaining physically active and no smoking.
  • With years of studies and research we have been able to lay down certain protective and risk factors. When protective factors are followed, the risk factors are covered.
  • All these vegetables has anti carcinogenic property and rich source of antioxidants. These vegetables contain flavones which are thought to have anti- cancer activities
  • Fiber fights Cancer particularly Colon Cancer. Fiber moves food more quickly through the instetines, helping to eliminate carcinogens. It also draws water into the digestive tract. The water and fiber makes the fecal matter bulkier so carcinogens are diluted.. Fiber also binds with bile acids and evicts them from the instetines.
  • ---have the potential to decrease LDL cholesterol by 20% equivalent to a first line statin drug.
  • antioxidents
  • Ginseng– it is an herb that has been used to stimulate the adrenal gland and there by increase energy, a stress reliver also. Soya has a greater cholesterol lowering effect.
  • Studies have shown that fruits and vegetables phytochemicals extracts exhibit strong antioxidant and anti proliferative activities. The major part of total antioxidant activity is from the combination of Phytochemicals. Phytochemicals of strawberry , Blueberry contains angiogenesis inhibitors. Inhibition of angiogenesis will result in reduced tumor growth. Modulation of Breast Cancer resistance protein by Flavonoids. Flavonoids are diverse and include their ability to modulate enzymes required for metabolic activation of procarcinogens and detoxification of carcinogens and potent antioxidant activities. Phytochemicals helps in platelet aggregation reduction thus preventing angina myocardial infarction and ECG evidence of ISCHEMIC HEART disease. Phytochemicals significantly lowers cholesterol, reduces stickiness of blood.
  • An imbalance of caloric intake and output can lead to overweight, obesity and increase risk for cancers at several sites like colon, rectum, prostat, breast and kidney.
  • Excess dietary fats increases the risk of cancer such as breast, colon, uterine and ovarian. The fats of more concern include saturated animal fats as found in meats and dairy products.
  • Foods are preserved by these very methods Salts inhibits growth of spoilage – causing micro – organism by causing osmosis. Nitrates / Nitrites not only kills bacteria , but also produces characteristic flavor. Smoking adds chemicals to the surface of an item which affect the ability of bacteria to grow, inhibit oxidation and improve flavor.
  • Alcoholic beverages along with cigarette smoking and chewing tobacco may cause cancers of the oral cavity, esophagus and larynx. Cancer increase with the amount of alcohol consumed and may start to rise with intake of as few as two drinks per day.
  • AIDS are commonly associated with wasting. Increased nutrient intake is the key to the treatment although drug management also required. As the immune system worsens no. of complications start to take over. For many people the first signs of infection are large lymph nodes or swollen glands which may last for more than 3 months. Other symptoms are lack of energy, loss of weight, frequent fevers and sweats, short term memory loss.
  • People with advanced HIV infection are vulnerable to infection & malignancies that are called opportunistic infections because they take advantage of the opportunity offered by a weakened immune system. Symptoms significant in altering nutritional status include diarrhea, anorexia, nausea & vomiting and malabsorption severely reduce oral intake.
  • Although nutritional interventions have not been effective in reversing advanced HIV infection or mortality, early nutritional assessment, intervention, successful symptoms management, & muscle-strengthening exercises improve health and quality of life and may improve response to treatment.
  • HAART (Highly Active Anti-Retroviral Therapy) can reduce the amount of HIV in someone’s body & restore their immune system. The introduction of HAART has dramatically reduced the infection of opportunistic infections among HIV + ve people who have received the drugs. Yet the prevention & treatment of opportunistic infection remains essential.
  • This treatment is very expensive with complex schedule, and the poor resistance of the person.
  • Auto immune disorders occurs when the immune system confuses normal body tissues ”self” with a foreign intruder & attacks. As a way to avoid being attacked by the immune system, some infectious organisms such as bacteria & viruses learn to expose only those parts of themselves that mimic “self” tissues. Thus when immune system becomes weakened the opportunistic infections occurs.
  • Providing prevention & treatment of opportunistic infections not only help HIV +ve people to live longer, healthier lives but can also help prevent TB & other Transmissible opportunistic infections from spreading to others. The therapeutic approach may be done by prevention of disease progression & treatment of complications that arises.
  • Eating well can help strengthen the immune system. This disease has profound effect on nutritional status. Involuntary weight loss is a common feature. An enriched diet can slow the progression of the disease. This disease is accompanied by malnutrition so careful attention to diet is important. Optimal nutrition influences tolerance and response to treatment. It is important to establish goals for intervention and are to identify client at risk, to intervene early to maximize nutritional status and body mass and to minimize loss of lean body mass if or as the disease progress. The client, family, others as well as the health care team must discuss and agree on goals, e.g. when and how to give aggressive nutrition for the client.sss
  • The main goal of nutrition for a HIV infection person is to maintain the body’s weight and muscles. This will help the individual stay as strong as possible and live an active life.
  • Malabsorption leads to malnutrition. There is inadequate dietary intake due to loss of appetite. There poor nutritional absorption due to gastrointestinal complications like nausea, vomiting, early satiety, delayed gastric emptying , abnormal taste and dental problems. Side effects of medication results in Diarrhoea.
  • Due to malabsorption, poor appetite, frequent diarrhoea and other complications aggrevates the loss of water and fat soluble vitamins and certain minerals also.
  • AIDS may make it difficult to eat & digest food properly because of poor appetite, diarrhea, nausea, mouth sores are often the result of poor immune system. At that time supplements are good. Researches have also indicated that increase intake of certain vitamins and minerals and essential fatty acids can boost the immune system and helps the body to fight AIDS.
  • Some of these conditions can be treated without pharmaceutical intervention based on the general principles of Nutritional Healing. Maintain normal body weight Build muscles/ maintain lean body mass( avoid wasting) Optimize digestion. Eating 4-6 small meals and chewing food carefully can make its job easier. Eat more healing foods, fewer processed foods. Drink 8-10 cups of non caffeinated fluids daily Use Supplements rationally and consistently
  • Better to take one multivitamin and mineral tablet daily.
  • Supplements may help to meet the increased nutritional requirements but nutritional supplements cannot replace eating a balanced diet. Dietary supplements boost the immune system. Use supplements consistently for 6-8 weeks in order to see results. Never take supplements on empty stomach. Absorption will be better if supplements are taken along with food.
  • Selenium is directly related to improved mortality in HIV INFECTION.
  • Food science is a discipline concerned with all technical aspects of food beginning with harvesting and ending with cooking and consumption. It is considered one of the agriculture science and usually considered distinct from the field of nutrition.
  • In simple words we can say this part of science deals with the use of preservatives, means of preserving food, increasing the shelf life of the food, different methods used to retain maximum nutritive value, also taking care of toxins, there packaging and handling, attractive color and texture of the food, and carried to different locations.
  • Almost everything we eat starts with the planting of a seed that grows into a plant & consumed by humans or a crop that is used as livestock feed. The advancement in the agriculture science has progressed to produce seed verities, resulted in improved production . Many farmers globally are beginning to implement alternate agricultural techniques in an effort to reduce their use of chemicals inputs from pesticides and fertilizers for a variety of reasons.
  • IPM Works in partnership with nature to produce foods efficiently. This is gaining popularity as it reduce the potential risk to farm workers and the impact on environment, and to promote public confidence in food safety.
  • The word pesticides refers to a broad class of crop protection chemicals, including 4 major groups. If improperly used these may reach the final food products un amounts which may be toxic to the consumer.
  • Encouraging organic farming which needs functional group of species and essential ecosystem process as its main “input” to compensate for the restriction on synthetic input use. In organic farming, bio-diversity is both instrument and aim. Natural ecological balance, below and above ground is key to its success. A healthy soil is the base of food production and diversity of plants and animals on land prevents pest and disease out breaks.
  • The regulatory system for ensuring food safety and quality consists of various local. state, federal and international agencies that may also vary from country to country. The system that these agencies form is responsible for 4 main functions mentioned.
  • Food born illness generally refers to illness caused by microorganisms consumed by eating any type of food. Food born illness are the greatest food safety threats. Bacteria can also spread from unclean knife, chopping board, dirty napkins and utensils. There are many pathogenic organisms which may gain entrance to the body through infected water or food and cause various types of illness.
  • Food irradiation is only one tool for improving food safety by killing pathogenic microorganisms. This process is often called cold pasteurization because it kills harmful bacteria without the use of heat.
  • Any substance added to food to look good, preserve, flavor, thick or blend, is called an additive. These preservatives have been in usad in home for generations.
  • Common preservatives in use are sulphur, sulphite and benzoic acid. Many synthetic substances mimic the flavour of fruits and vegetable. Many synthetic substances mimic the flavour of fruits and vegetables.
  • Now a days it is difficult to sell food products unless the color is pleasing. This especially applies to sweets and cakes. Large number of organic dyes have been used to color foods.
  • Parsley and tomatoes are now a days much used to give color to a dish.
  • Water is added to milk In tea caffeine and theobromine. Pesticides residues in fruits & vegetables Some antibiotics/drugs given to cattles Heavy metals in soil, utensils
  • Maximum adulteration is done these products as they are maximum consumed by the society In tea –used tea residue, other leaves with added color. Coffee- starch, roasted dates, tamarind seeds.
  • In milk water is added. Synthetic milk is prepared by mixing urea to detergents/soap water. All these adulterants are white. Caustic soda, sodium, sugar and hydroxide, starch, gelatin and pesticide residue are added. When milk is transported the milk stock churns inside the containers, churning separates the fat, which is again extracted. More fat extraction means more profit.
  • Khesari dal alone mixed causing Lathyrus Sativus.
  • Added to oils
  • Physical contamination— Whole turmeric coated with lead chromate or coal tar dye. Turmeric power has yellow earth, starch or talc colored yellow with coal tar dye. Cumin seeds artificial cumin seed like product. Black pepper with dried papaya seeds.
  • Animal fat and other high melting fats, edible oils- palm oil, argemone oil, non edible olis.
  • Protection of food from flies. these important features are especially for mothers.
  • All foods that are eaten raw should be carefully washed immediately before consumad.
  • Raw and ready to eat foods should be kept separate.ssss
  • Thawing or defrosting foods in a critical control point to prevent food born illness. During thawing take care of cross contamination and to minimize time in the temperature danger zone. Thawing food properly can be done in any of these 4 ways— In a refrigerator at 41 degree F Use microwave As part of the cooking Under running water.
  • As it kills the germs.
  • Foods that is cooked should be maintained at a sufficient temperature long enough to ensure the death of any pathogens that it may contains. This time & temperature varies very much from one food to another.
  • Do not keep raw foods along with cooked foods.
  • Foods kept in danger zone allows bacteria to grow fast.
  • Chopping board should be smooth and without pores so that bacteria don’t grow in those cracks.
  • Biotechnology is a technology based on Biology, especially when used in agriculture, food science and medicine. Biotechnology means any technological application that uses biological systems, living organisms or derivatives thereof, to make or modify products or processes for specific use. It combines disciplines like genetics, molecular biology, bio-chemistry embryology and cell biology ,which are linked to practical disciplines like chemical engineering, information technology and robotics
  • The answer depends on your eating habits, lifestyle and some factors beyond your controlsuch as your age. Dietary supplements may be needed if You do not eat well. You are a vegetarian You consume less than 1200 kcal a day. You have a medical condition which affects how your body absorbs, uses or excretes nutrients You are a post menopausal woman Heavy bleeding during menstural cycle You are pregnant or lactating You drink alchohol or smoke
  • Nutrition: Dietary changes are of paramount importance . These comprise of I) reduction of salt intake to an average of not more than 5 g per day ii) Moderate fat intake iii) avoidance of alcohol iv) restriction of carbohydrate intake to just the daily body needs The word nutrient is used for dietary constituents like proteins, carbohydrates, fats vitamins and minerals. The subject of nutrition is very extensive. Nutrition gained recognition as a scientific discipline, with roots in physiology and biochemistry. Specific nutritional diseases were identified and technologies developed to control them as for example protein energy nutrition, nutritional anemia, diarrhea. It is of significance that the science of nutrition has move out of he laboratory and linked itself to epidemiology. This association has given birth to newer concepts in nutrition such as epidemiological assessment of nutritional status of communities, nutritional and dietary surveys, nutritional and growth monitoring,nutritional interventions - all parts of the nutritional epidemiology. Epidemiology methods are now increasingly used not only in the elucidation of disease and identification of risk factors of disease and eliminating the same. All countries should develop a National nutrition and food policy . The dietary goals recommended by WHO are as below: 1) Dietary fat should be limited to approximately 20-30 percent of total daily intake 2) saturated fats should contribute no more than 10 percent of the total energy intake 3) Excessive consumption of refined carbohydrate should be avoided Food means not only proteins fats minerals , vitamins and other nutrients . Nations and civilization are linked together not only by ideas but also nutrition. In the more developed countries of the world nutrition problems are somewhat different. Over nutrition is encountered much more frequently than under nutrition. The health hazards from over nutrition are a high incidence of obesity, diabetes, hypertension, cardiovascular disease , renal disease etc.
  • Principles of Nutrition By NHI

    1. 1. Principles of NutritionNutrilite Health Institute certification course By Amway India
    2. 2. Introduction AGENDA
    3. 3. The Complete Course Agenda 15 Min Introduction 15 Min Food Guide Pyramid 60 Min Nutrition “What is it ?" - Water & Protein 30 Min Nutrition “What is it ?” - Carbohydrates & Fats 10 Min Review/Activities/Group 20 Min Break 10 Min Human Physiology – Introduction 60 Min Cells and Cell Physiology Cell Structure Cell and energy Fat Metabolism Protein Metabolism Glucose Metabolism 20 Min Revision Total: 240 mins
    4. 4. The Complete Course Agenda 10 MIN Summarize previous day learning 20 MIN Opener/Activity 50 MIN Digestive System Stomach Liver Pancreas 40 MIN Urinary System – Kidney 20 MIN Tea / snacks BREAK 10 MIN Review/Activity/Group 50 MIN Respiratory System - Nose & Nasal Passages; Pharynx ; Trachea; Bronchioles; Lungs 50 MIN Cardiovascular System – Heart; Blood Flow (Heart) ; Blood Vessels; Blood Pressure; Blood as Delivery System 10 MIN Review/Activity/Group
    5. 5. The Complete Course Agenda 10 MIN Summarize previous day learning on Nutrition 15 MIN Central Nervous System - Brain 15 MIN Peripheral Nervous System - Autonomic Nervous System ; Sensory Somatic Nervous System 15 MIN Musculature System – Skeletal; Cardiac; Smooth 15 MIN Integumentary System – Skin; Hair; Nails 10 MIN Human Physiology Review 20 MIN Tea / snacks BREAK 10 MIN Activity: Short quiz on Physiology 120 MIN Water Soluble Vitamins – Vitamin C; Vitamin B; B1- Thiamin; B2- Riboflavin; B3- Niacin; B5- Pantothenic Acid;B6- Pyridoxine B12- Cobalamin; Biotin; Folic Acid 10 MIN Review/Activity/Group
    6. 6. The Complete Course Agenda 10 MIN Summarize previous day learning 60 MIN Fat-Soluble Vitamins – Vitamin A ; Vitamin D 60 MIN Fat-Soluble Vitamins – Vitamin E ; Vitamin K 15 MIN Review/Activity/Group 20 MIN Tea / snacks BREAK 10 MIN Opener / Activity 60 MIN Minerals - Calcium, Chromium; Copper; Iron; Selenium 60 MIN Mineral – Zinc; Potassium; Sodium; Magnesium; Phosphorus 10 MIN Short class test/ Review/Activity/Group
    7. 7. The Complete Course Agenda 10 MIN Total Nutrition Review 10 MIN Diet and Disease Introduction 90 MIN Cardiovascular Disease - Pathophysiology; Diet Therapy 20 MIN Tea / snacks BREAK 60 MIN Diabetes - Pathophysiology; Diet Therapy 50 MIN Cancer - Pathophysiology; Diet Therapy 10 MIN Review/Activity/Group
    8. 8. The Complete Course Agenda 10 MIN Review/Activity/Group 60 MIN AIDS/HIV - Pathophysiology; Diet Therapy 20 MIN Tea / snacks BREAK 60 MIN Food Science & Technology - Agriculture and food products; Alternative agriculture methods; Integrated pest management; Organic farming; Pesticides; Food safety and food borne illness; Food irradiation; food additives; Biotechnology 60 MIN Organic farming –Cd; Supplementation 30 MIN Short class test/Review/Activity/Group Date will be announced: FINAL TEST 1 1/2 Hours
    9. 9. Nutrition “What is it” Nutrition “What is it”
    10. 10. Nutrition
    11. 11. Food Guide Pyramid FOOD PYRAMID
    12. 12. What is Nutrition?Metabolism of FoodsNutritive Value of FoodsQualitative and QuantitativeRequirementsChanges in NutrientRequirementsCultural Factors
    13. 13. Six Classes of Nutrients Carbohydrate Vitamins Fat Minerals Protein Water*The Human Body Like Food is Composed Largely of Nutrients
    14. 14. NutritionComposition Composition of Foods of Body 70% Water 60% Water 1% Fat 20% Fat 4% Protein 20% Protein, 24% Carbohydrates Carbohydrate 1% Vitamins & , Vitamins, Minerals and Minerals
    15. 15. Macro NutrientsThese nutrients are required in a large amount by the body. Carbohydrates Energy Rich Fat Foods • Proteins • Dietary Fiber Body Building foods • Water
    16. 16. Micro Nutrients These nutrients are required in a verysmall quantity, However are extremelycritical for the normal functioning of the body. Vitamins Minerals Protective foods
    17. 17. Video 1- Micro Nutrients Click to Start
    18. 18. Elements of Nutrients Carbon Hydrogen Oxygen Nitrogen MineralsInorganic Nutrients Minerals WaterOrganic Nutrients Carbohydrates Fats Proteins a Vitamins b a Proteins also contain the mineral sulfur b Some vitamins contain nitrogen, some contain minerals
    19. 19. EnergyCapacity to do WorkEnergy in Food is ChemicalEnergyBody Converts ChemicalEnergy mechanicalenergy
    20. 20. Energy -yielding Nutrients Carbohydrate Fat Protein
    21. 21. Measurement of EnergyEnergy is measured in CaloriesCalorie: A Unit by Which Energy is MeasuredFood Energy is measured in Kilocalories 1000 Calories = 1 Kilocalorie1 Kilocalarie of Heat is needed to raise theTemperature – 1 Kilogram of Water 1 Degree Celsius
    22. 22. Energy in FoodsCarbohydrates = 4 kcal/gramProtein = 4 kcal/gramFat = 9 kcal/gramAlcohol* = 7 kcal/gram*
    23. 23. Energy in the BodyNutrients to Fuel Metabolic and Physical Activities Heart -Beating Brain- Thinking Legs -Walking Breathing Eliminating Wastes
    24. 24. Excess Nutrient Consumption Excess Consumption of Energy-Yielding Nutrients Converted to Fat and Stored in the Body
    25. 25. Classification of Nutrients Macronutrients (Macro = BIG) Protein, Carbohydrate, Fat, and Water Micronutrients (Micro = small) Vitamins and Minerals
    26. 26. WaterIndispensable NutrientFundamental to All Life onEarth
    27. 27. Water in Body FluidsIntracellular Fluid: Fluid Within Cells– Approximately 2/3 of Body Water– High in Potassium and PhosphateInterstitial Fluid: Fluid Between Cells Approximately 1/3 of Body Water Large Component of Extra Cellular Fluid Usually High in Sodium and Chloride
    28. 28. Waters RoleShock AbsorberBody Temperature RegulationMaintains Blood VolumeLubricant and Cushions Joints
    29. 29. Waters RoleCarries Nutrients and WasteHelps form Structure of MoleculesParticipates in Chemical ReactionsSolvent for Small Molecules
    30. 30. Water SourcesBeverage and WaterFoods Contain Water Fruit and Vegetables = Up to 95% Water Meats and Cheese = Up to 50% Water Object 7
    31. 31. Water content in foodsDry seeds, such as the grains and legumes were intentionally left of the following list as they should have a common moisturecontent of 10% or less. All pure fats and oils contain no water. The water content of each of the foods below is shown by thenumber following the food. After these foods have been dehydrated, their weight will be reduced by close to the followingpercentage: Almonds 7% Collards Boiled 91% Apples 85% Corn Sweet Fresh 74% Apricots 85% Cucumbers Raw 96% Bananas 76% Eggs Raw Whole 74% Bean Sprouts 92% Egg Plant Raw 92% Bread Whole Wheat 35% Fruit Cocktail 80% Broccoli 91% Pickles Dill 93% Butter 20% Pineapple Raw 85% Cabbage Raw 92% Plums Raw 87% Carrots Raw 88% Potatoes Raw 85% Olives 80% Pumpkin Canned 90% Onions 89% Radish Raw 95% Oranges 86% Spinach Raw 92% Papayas Raw 89% Squash Boiled 96% Parsley Raw 86% Grape Fruit Raw 88% Peaches Raw 90% Grapes 82% Peanuts Shelled Trace Honey 15% Peanut Butter Trace Jams / Preserves 30% Pears Raw 82% Lettuce Head 91% Peas Raw 81% Macaroni/Spaghetti Cooked 72% Pecans 7% Margarine 20% Peppers Green 94% Okra Boiled 91% Cauliflower Raw91% Straw Berries 90% Celery 94% Sweet Potatoes Boiled in Skin 71% Cherries Raw 80% Tomatoes Raw 93% Chicken Broiled Turkey Roasted 62% Coconut Dried 7%
    32. 32. Water BalanceWater Sources Amount (ml) Water Excretion Amount (ml)Liquids 550 to 1500 Kidneys 500 to 1400Foods 700 to 1000 Skin 450 to 900Metabolic Water 200 to 300 Lungs 350 Feces 150 1450 to 2800 2450 to 2800
    33. 33. Water Recommendations t Recommendations: Diet Activity Environmental Temperature Humidity Adult Recommendations *Amount of Water = Amount of Energy Expended
    34. 34. Water Recommendations Person Expending 2,000 Kcal per Day 2 to 3 Liters of Water 7 To 11 Cups Best Sources: Water, Milk, and Juice Not Substitutes: Alcohol, Caffeine- Beverages *Act as Diuretics
    35. 35. What are Proteins?The name Protein was suggestedby Mulder in 1838 to the complex, organic, nitrogeneous substances found in animal and plant tissues.
    36. 36. What are Proteins?• Proteins are the foremost & forefront nutrients Important constituents of tissues and cells of the body These are present inside the cell as well as in the plasma They form 16% wet weight of the cell As enzymes and hormones they are concerned with vital metabolic processes As antibodies they help defend against infections
    37. 37. Classification of Proteins Structural proteins Proteins which form part of the body structure • Collagen - gives tensile strength to the body • Elastin - provides elasticity to the skin • Keratin – helps formation of nails & hair They have a slow turnover and therefore a long half life
    38. 38. Classification of Proteins Functional proteins Proteins which regulate the various functions in the body. - Enzymes acts as catalyst for various metabolic functions - Hormones trigger some specific reactions e.g. Insulin which regulates the glucose metabolism in the body, has half life of 0.5 second and if not so will result in hypoglycemia They have a faster turnover and shorter life span
    39. 39. Classification of Proteins Depending upon the combination in which they exist in the body, Proteins can also be classified as : • Muco protein: Protein when combined with carbohydrates .eg saliva mucos. • Lipo protein: Protein when combined with lipids eg. cholestrol, triglyceride in emulsion form. • Transport protein: Protein when used as carrier eg . Iron is transported in the form of haemoglobin in the body
    40. 40. Structure of ProteinProteins are made up of Amino acids Dietary proteins provide amino acids for the synthesis of body proteins Amino acids are composed of carbon, hydrogen, oxygen, nitrogen, sulphur and sometimes phosphorus
    41. 41. Amino Acids• There are 22 naturally occurring amino acids.• Of these 22 amino acids, 9 amino acids are known as essential since they cannot be synthesized in the body Rest are non essential as they can be synthesized in the body by inter conversion of compounds already present in the body
    42. 42. Types of Amino AcidsDepending upon the chemical structure AminoAcids can also be classified as under : • Aliphatic : Glycine, Alamine, Threonine, Serine • Acidic : Aspartic, Glutamic • Branched Chain : Valine, Leucine, isoleucine • Aromatic : Phenylalanine, Tyrosine, Tryptophan • Basic : Lysine, Arginine, Histidine • Sulphur containing amino acids : Cystine, Cystaine, Methionine • Iminoacid : Proline
    43. 43. Limiting Amino Acids Essential Amino AcidA Protein from Plants (Usually Limiting) Corn: Deficient in Tryptophane and Lysine Legumes (Beans): Deficient in Methionine Grains (Wheat): Deficient in Lysine
    44. 44. Complete ProteinsEssential Amino AcidsNonessential Amino AcidsAnimal Sources = Essential Amino Acids Meat Cheese Fish Eggs Poultry Milk
    45. 45. Digestion and Absorption of Protein Protein in Food Do Not Become Body Proteins Protein in Food Supply Amino Acids
    46. 46. Digestion and Absorption of Protein Hydrolysis of Protein Begins in the Stomach Acted upon by Gastric juices HCL ( in the Stomach) Amino Acids Blood Stream
    47. 47. Various Sources of proteins • Cereals and Millets • Pulses, legumes • Milk and milk products • Egg and Flesh Foods • Soya
    48. 48. Functions Of Dietary Proteins Provide AA for the formation of tissues during growth. To provide AA for the growth of fetus in pregnancy and for the production of milk proteins during lactation.
    49. 49. Functions Of Dietary Proteins • To replace the daily loss of body protein. • To provide AA for the formation of enzymes, blood protein and certain hormones of protein nature.
    50. 50. RDA of Protein ….. contd
    51. 51. Experimental assessment of Protein sources.
    52. 52. Experimental assessment of Protein sources. Protein Digestibility Corrected Amino Acid Score – Measures the nitrogen content of undigested protein to indicate the digestibility of protein present in a particular source. – Measured on a scale of 0 - 1 - where 0 represents least digestibility and 1 represents maximum digestibility.
    53. 53. Count What You Eat
    54. 54. Count What You Eat Protein Value Of Cooked Preperations Preperation Weight(gm) Proteins ( gm) SNACKS Samosa 65 3 Sandwich 65 3 Sevian 80 3 Idli 115 5 Dosa 85 6 Vada 45 6 Dahi vada 165 11 Upma 130 5 Masala omlettee 100 7 CHUTNEY Coconut 55 2 Coriander 20 1 Mint 18 trace Tomato 50 1 NON - VEG Handi Chicken 125 26 Fish cutlet 80 14 Fried fish 85 18 Liver 140 22 Mutton 145 18 Prawn curry 145 18
    55. 55. CarbohydratesCompounds composed of carbon,oxygen and hydrogen molecules Carbo = Carbon Hydrate = With Water (H2O)
    56. 56. Carbohydrate Family Simple Complex Carbohydrates (Sugars) Carbohydrates Monosaccharides Starch (Polysaccharides)* Glucose (Blood Sugar) Fibers (Nonstarch Fructose (Fruit Sugar) Polysaccharides) Galactose (Milk Sugar) Soluble S Disaccharides Insoluble – Sucrose (Table Sugar) – Lactose – Maltose*Glycogen is a Complex Carbohydrate (a Polysaccharide), but not a Dietary Source of Carbohydrate
    57. 57. StarchGlucose Molecules LinkedPlants Store Glucose asStarchHumans Eat PlantsBody HydrolysisStarch to Glucose Energy
    58. 58. GlycogenAnimal PolysaccharideManufactured and Stored in LiverNot Significant Source ofCarbohydrateNot Complex Carbohydrate inFoodsFood Sources
    59. 59. Fiber Structural Part of Plants – Vegetables, Fruits, Grains, Legumes• Non-Starch Polysaccharides: – Cellulose, Hemicellulose, Pectins, Gums, Mucilages• Non Polysaccharides: Lignins, Cutins, Tannins
    60. 60. Fiber: Sources, Actions, Structures Soluble Fibers Insoluble Fibers Food Sources Fruits (Apples, Citrus), Wheat Bran, Whole-Grain Oats, Barley, Legumes Breads and Cereals, Vegetables Delay GI Transit Accelerate GI Transit Action in the Delay Glucose Absorption Increase Fecal Weight Body Lower Blood Cholesterol Slow Starch Hydrolysis Delay Glucose Absorption Gums, Pectins, Some Cellulose, Many Type of Fiber Hemicelluloses, Mucilages Hemicelluloses, Lignins
    61. 61. Video 2: Good Fats Click to Start
    62. 62. FatDefinition
    63. 63. Lipid FamilyTriglycerides (Fats and Oils)a Glycerol (1 per Triglyceride) Fatty Acids (3 per Triglyceride) Saturated Monounsaturated Polyunsaturated Omega-6 Omega-3Phospholipids (Such as Lecithin)Sterols (Such as Cholesterol)
    64. 64. Saturated FatsHydrogenated Fatty Acids Chemical Process: • Hydrogen Atoms + Mono or Polyunsaturated Fats– Fats More Stable– Prolongs Shelf Life– Protects Against Oxidation– Sources: Margarine, Shortening, Baked Goods
    65. 65. Effects on HealthSaturated Fats Elevate Blood Cholesterol Heart DiseaseHydrogenated Fats Trans Fatty Acid Heart DiseaseUnsaturated Fats Lower Blood Cholesterol Heart Disease
    66. 66. Role of Triglycerides and Fatty Acids Provide Energy Enhance Palatability Influence Texture of Foods Enable Absorption of Fat Soluble Vitamins Insulate the Body Protect Organs Against Shock Help Body Use Carbohydrates and Proteins
    67. 67. Essential Fatty Acids Body Can Make All But "2" Fatty Acids Linoleic Acid Linolenic Acid Indispensable to Body Function Supplied by Diet
    68. 68. Comparison of Dietary Fats
    69. 69. Linoleic Acid: Omega 6 Arachidonic Acid Structure and Function of Cell Membranes and Inflammation Reactions
    70. 70. Linolenic Acid: Omega 3 Body Can Produce EPA - Eicosapentaenoic Acid DHA - Docosahexanenoic Acid • Development and Maintenance: – Brain and Retina of Eye – Integrity of Skin, Kidney, Liver, Reproductive Organs
    71. 71. Linolenic Acid: Omega 3 Essential for Normal Growth and Development Regulates: Blood Clotting Blood Pressure Lipid Concentrations Inflammation Responses
    72. 72. Linolenic Acid: Omega 3 Important Role in Prevention and Treatment of: Heart Disease Hypertension Arthritis Cancer
    73. 73. Sources of Omega Fatty Acids Omega-6 Linoleic Acid Leafy Vegetables, Seeds, Nuts, Grains, Vegetable Oils (Corn, Safflower, Soybean, Cottonseed, Sesame, Sunflower) Meats (or can be Made from Linoleic Acid) Arachidonic Acid Omega-3 Fats and Oils (Canola, Soybean, Walnut, Wheat Germ, Linolenic Acid Margarine, and Shortening Made from Canola and Soybean oil) Nuts and Seeds (Butternuts, Walnuts, Soybean Kernels) Vegetables (Soybeans) Human Milk EPA and DHA Shellfish and Fish* (Mackerel, Tuna, Salmon, Bluefish, Mullet, Sturgeon, Menhaden, Anchovy, Herring, Trout, Sardines) (or can be Made from Linolenic Acid)
    74. 74. PhospholipidsSimilar to TriglycerideCholine and Phosphate GroupLecithin - Used as an EmulsifierEmulsifier: Promotes the Mixture of Two Substances such as Oil and Water, that are not Mutually Soluble
    75. 75. Role of Phospholipids Constituents of Cell Membranes Lipid Transportation Fat Soluble Substances: Vitamins and Hormones Emulsifiers
    76. 76. SterolsLiquid CompoundsMultiple Ring StructureCholesterol
    77. 77. CholesterolAnimal Foods Meats Eggs Fish Shellfish Poultry Dairy Products Organ Meats (Liver, Kidneys)
    79. 79. Physiology Organism Cellular Molecular
    80. 80. Structural Organization Atoms Molecules • Organ Cells Tissues • Systems Organism
    81. 81. CellsCells: Building Blocks of Our Body Membrane Fat Holds Cell Together Separates Cells
    82. 82. CellsCells: Building Blocks of Our Body Passive Diffusion Active Transport
    83. 83. CytoplasmLiquid Inside "Cell Membrane"Organelles "Tiny Organs" Mitochondria Endoplasm Lysosomes
    84. 84. NucleusBrain of CellDNARibosomes "RNA"Protein Synthesis
    85. 85. EnergyFood = EnergyATP = EnergyObject 2Mitochondria
    86. 86. Metabolism Anabolic - small large Amino Acids Proteins Uses ATP• Catabolic Fat Acetyl CoA ATP – Proteins Amino Acids – Make ATP
    87. 87. FatAnabolic - TriglyceridesFatCatabolic - Fat AcetylCoA ATP
    88. 88. ProteinAnabolic - Amino Acids ProteinCatabolic - Protein Amino Acids Essential Amino Acids Non-Essential Amino Acids
    89. 89. SugarAnabolic - Sugar GlycogenCatabolic - Glycogen Sugar ATP
    90. 90. PHYSIOLOGYDigestive System
    91. 91. Digestive SystemPicture 3 Esophagus Stomach Small intestine 21 ft long Large intestine – 5 Ft long Appendix
    92. 92. Digestive SystemDigestion: Breaking Complex Food Into Smaller Particles Mouth Teeth Breakdown Food
    93. 93. Digestive System Picture 4 Teeth Tongue Salivary glandEpiglottisEsophagus
    94. 94. Digestive System Tongue Propels Food Taste Buds (Sweet, Sour Salt)• Salivary Glands (Saliva) – Moisten Food Begin Digestion - Starch• Tonsils – Part of Immune System
    95. 95. Digestive System Epiglottis Muscles to Prevent Food Entering Lungs Directs Food to Esophagus and Blocks Trachea Coughing• Esophagus – Muscular Tube to Stomach
    96. 96. Digestive SystemStomach Sphincter-Muscle Closes Stomach • Reflux Churns Food-Chyme • Mixes With Acid and Pepsin– Mucus Protects Stomach– Intrinsic Factor
    97. 97. Digestive SystemStomach Vomiting • Reflex • Bulimia - Esophagus, Teeth– Ulcers– Gastrectomy
    98. 98. Digestive System Accessory OrgansLiver - Largest Organ Liver Stomach Metabolism Bile Production Vitamin Storage Remove Chemicals Cholesterol Production Essential for Life
    99. 99. Digestive System Accessory OrgansPancreas – 5 inches long Pancreas Digestion Picture 5 Blood Sugar Levels Diabetes - Type I and Type II Duodenum
    100. 100. Urinary SystemKidney Urinary DuctsUrinary BladderFiltration System KidneyUrine Chemical Waste Urinary Salts duct Water Bladder
    101. 101. Urinary System More Sweat = Less Urine Kidney Plays Role in Blood Pressure – Urine Production Blood Pressure – Salt Balance• Chemicals Metabolized in Liver Excreted in Kidney
    102. 102. RespirationNose Trachea BronchiolesLungs Picture 9 Nose nasal area Filter Warm trachea Moisten lungs
    103. 103. RespirationNose Trachea BronchiolesLungs Trachea Stiff Tubes pharynx Larynx larynx • Bronchioles – Tubes to Lungs trachea – Cilia – Mucus
    104. 104. RespirationNose Trachea BronchiolesLungs Alveoli Gas Exchange Surface Area • Inhalation/Exhalation – Brain – Gas Exchange – Surface Area
    105. 105. RespirationNose Trachea BronchiolesLungs Hemoglobin Protein Oxygen/Carbon Dioxide
    106. 106. Cardiovascular SystemBody Left Heart Lungs Right HeartBody Artria Contract Ventricles Contract Heart Rhythm Pacemaker 60-80 Beats/Minute
    107. 107. Cardiovascular System Blood Vessels Arteries Blood from Heart Muscular Systole/Diastole Blood pressure (Pulse) • Feel Your Wrist Capillaries Tiny (Feed Body)
    108. 108. Cardiovascular System Blood Vessels Venuoles – Tiny (Take Blood to Veins) Veins Blood to Heart Little Muscle Smooth Blood Flow
    109. 109. Cardiovascular System Blood Pressure 120/80 mmHg Heart Pump Blood Vessels Amount of Blood • Need to Move Blood – Too Much Bad Hypertension – Too Little Bad Hypotension
    110. 110. Cardiovascular SystemBlood Red Cells/White Cells/Plasma Red Cells - Hemoglobin/Oxygen Lungs Metabolism + Oxygen Metabolism and Carbon Dioxide Anemia
    111. 111. Cardiovascular SystemBlood Red Cells/White Cells/Plasma White Cells Immunity Infection • Platelets – Blood Clot
    112. 112. Cardiovascular SystemBlood Red Cells/White Cells/Plasma Plasma - Liquid Proteins
    113. 113. Nervous System Nervous System
    114. 114. Nervous System Central Nervous System (CNS) Peripheral Nervous System (PNS)
    115. 115. Nervous SystemBrain Spinal Cord NervesNerves Spinal Cord BrainCoordinates Body Actions +FunctionsProcesses Information External Internal
    116. 116. Nervous System CNSSpinal Cord Gray Matter White Matter Meninges Backbone
    117. 117. Nervous System CNSConnects PNS with BrainCoordinates ReflexesSpinal Nerves Senses Movement
    118. 118. Nervous System BrainComputerCoordinates + Processes AllInformationPrepares + Coordinates ResponsesGray Matter/White Matter
    119. 119. Nervous System BrainCerebrum (Memory, Reasoning,Intelligence, Personality, Senses, Logic)Cerebellum (Physical Activity)Brain Stem Brain Cord Cord Brain
    120. 120. Nervous SystemPeripheral Nervous System (PNS) Autonomic Nervous System We Do Not Control This System Sympathetic/Parasympathetic Blood Pressure Digestion Intestines Lungs "Fight or Flight"
    121. 121. Nervous System PNS Sensory Nerves – (Taste, Smell, Sight, Touch, Hearing)• Somatic Muscle Nerves (Movement)
    122. 122. MusculatureSkeletal Muscles Movement Connected to Bones Voluntary Red Fibers Slow White Fibers Fast Everywhere Somatic Nerves
    123. 123. MusculatureSmooth Muscles– Involuntary– Blood Vessels, Visceral organs– Autonomic NervesCardiac Muscles Heart Involuntary Autonomic nerves
    124. 124. MusculatureConsume ATP to do WorkNeed Calcium, Sodium, Potassium
    125. 125. Integumentary System Skin Epidermis (Barrier) Dermis (Blood, Muscles, Connection)• Barrier – Infection – Waterproof – Mechanical
    126. 126. Integumentary System Pigment – Protect Against Sunlight Heat Regulation Sweating Blood Flow
    127. 127. Integumentary System Vitamin D from Sunlight Touch Pain Pressure Heat Nerve Fibers
    128. 128. Vitamins
    129. 129. VitaminsVita = LifeAmine = Containing Nitrogen The First Vitamin Discovered Contained Nitrogen
    130. 130. VitaminsOrganicEssential NutrientsRequirements Minute (Small)Perform Specific Functions Growth Reproduction Maintenance of Health and Life
    131. 131. VitaminsVitamins Differ from Energy-Yielding Nutrients such as Carbohydrate, Proteins and Fat• Structure• Function• Food Contents
    132. 132. VitaminsVitamins Similar to Energy-Yielding Nutrients: Carbohydrate, Protein and Fat• Vital to Life• Organic
    133. 133. VitaminsAvailable in FoodsOrganic – Destructible: • Light: Riboflavin (B2) • Oxygen: Vitamin C • Heat : Thiamin (B1) and Vitamin C
    134. 134. Vitamins• Solubility: Hydrophilic: (Water-Soluble) Carbohydrate, Protein Vitamins B and C – Hydrophobic: (Fat-Soluble) • Fat • Vitamins A, D, E, K
    135. 135. PrecursorsProvitamins Inactive VitaminFormChemically Changed to ActiveForm of Vitamins
    136. 136. Riboflavin-Vitamin B2 Functions Coenzymes FMN and FAD Energy Metabolism Supports Normal Vision Supports Skin Health Food Sources
    137. 137. Riboflavin-Vitamin B2 Deficiency Disease – Ariboflavinosis Deficiency Symptoms Skin Rash Cracks and Redness of Mouth Sensitivity to Light
    138. 138. Niacin-Vitamin B3Functions Coenzymes NAD and NADP Energy Metabolism Nervous System Digestive SystemFood Sources
    139. 139. Niacin-Vitamin B3 Deficiency Disease – Pellegra• Deficiency Symptoms
    140. 140. BiotinFood Sources
    141. 141. BiotinFunctions Coenzyme Energy Metabolism Fat Synthesis Amino Acid Metabolism Glycogen Synthesis
    142. 142. BiotinDeficiency Symptoms Loss of Appetite and Nausea Abnormal Heart Action Depression Muscle Pain and Weakness
    143. 143. Pantothenic Acid-Vitamin B5 Food Sources
    144. 144. Pantothenic Acid-Vitamin B5 Functions Coenzyme A Energy Metabolism
    145. 145. Pantothenic Acid-Vitamin B5 Deficiency Symptoms Insomnia Fatigue
    146. 146. Pyridoxine-Vitamin B6 Object 6Functions Coenzymes PLP and PMP Amino Acid Metabolism Fatty Acid Metabolism Converts Tryptophan to NiacinFood Sources
    147. 147. Pyridoxine-Vitamin B6 Deficiency Disease Anemia (small-cell type)
    148. 148. Folate-Folic Acid-Folacin Functions DNA Synthesis New Cell Formation • Food Sources
    149. 149. Folate-Folic Acid-Folacin Deficiency Disease – Anemia (large-cell type) • Deficiency Symptoms Diarrhea Depression/Mental Confusion
    150. 150. Cobalamin-Vitamin B12 Functions Coenzymes New Cell Synthesis Fatty Acids Amino Acids Maintain Nerve Cells
    151. 151. Cobalamin-Vitamin B12 Food Sources
    152. 152. Cobalamin-Vitamin B12 Deficiency Disease – Pernicious Anemia • Deficiency Symptoms Fatigue Degeneration of Peripheral Nerves Hypersensitivity
    153. 153. Ascorbic Acid-Vitamin C Functions Collagen Synthesis Antioxidant Amino Acid Metabolism Absorption of Iron Resistance to Infection
    154. 154. Ascorbic Acid-Vitamin C Food Sources
    155. 155. Ascorbic Acid-Vitamin C Deficiency Disease – Scurvy • Deficiency Symptoms
    156. 156. Fat Soluble Vitamins Fat-Soluble Vitamins
    157. 157. Fat Soluble Vitamins: A, D, E, K *Differ From Water-Soluble Vitamins Found in Fat and Oily Parts of Foods Insoluble in Water Lymphatic System
    158. 158. Fat Soluble Vitamins: A, D, E, K *Differ From Water-Soluble Vitamins Greater Risks for Toxicity Stored in Liver and Adipose Tissue Not Readily Excreted
    159. 159. Vitamin A and Beta-carotene First Fat-Soluble Vitamin Recognized Beta-Carotene, Precursor to Vitamin A Three Forms of Vitamin A (Retinoids) Retinol (an Alcohol) Retinal (an Aldehyde) Retinoic Acid (an Acid)
    160. 160. Beta Carotene as an Antioxidant Protects the Body Against Disease Free Radicals Heart Disease Cancer Arthritis Cataracts
    161. 161. Retinol-Vitamin A Functions – Vision – Maintenance of Cornea – Mucous Membranes – Skin, Bone, and Tooth Growth• Food Sources
    162. 162. Retinol-Vitamin A in VisionCorneaTransportation of Light Energy Nerve Impulses at RetinaSupports Growth of Bones Remodeling of Bone
    163. 163. Retinol-Vitamin A Deficiency Disease – Hypovitaminosis A• Deficiency Symptoms
    164. 164. Retinol-Vitamin A Deficiency Vitamin A Stores: 90% in Liver Adequate Protein Vitamin A Food SourcesGlobal Nutrition Problem Night Blindness 100 Million Children with Deficiency
    165. 165. Calciferol-Vitamin DSignificant Sources Food Sunlight
    166. 166. Calciferol-Vitamin D from the Sun Natural Exposure to Sunlight Sun Imposes No Risk of Toxicity • Prolonged Exposure Degrades the Vitamin D Precursor
    167. 167. Calciferol-Vitamin D from the Sun Ultraviolet Rays of the Sun Dark Skinned People Prone to Rickets Deficiency More Likely in Elderly Vitamin D Fortified Foods or Supplements
    168. 168. Calciferol-Vitamin DFunctions Raises Blood Calcium and Phosphorus Hormone Organs: Intestines, Kidneys, Bones Stimulates Absorption from GI Tract Bone Growth
    169. 169. Calciferol-Vitamin D Deficiency Disease Rickets Osteomalacia Deficiency Symptoms
    170. 170. Tocopherol-Vitamin E 1922, Discovery in Vegetable Oils Anti sterility Factor = Tocopherol Compound Named Vitamin E Alpha Beta Gamma Delta
    171. 171. Tocopherol-Vitamin E Food Sources 20% = Vegetable Oils 20% = Fruits and Vegetables 15% = Grain Products• Animal Fats: Meat and Milk Fat Contain Little or No Vitamin E
    172. 172. Tocopherol-Vitamin EFunctions Antioxidant Stabilization of Cell Membranes Regulation of Oxidation Reactions Protection of PUFA Protection of Vitamin A
    173. 173. Vitamin E as an Antioxidant Oxidation Transformation of Energy Fuels to ATP Oxidation of Polyunsaturated Fatty Acids Protection of Lungs • Air Pollutants (Nitrogen or Ozone) – Protects Red Blood Cells
    174. 174. Tocopherol-Vitamin E Deficiency Rare in Humans Fat Malapsorption Cystic Fibrosis • Causes of Vitamin E Deficiency – Erythrocyte Hemolysis
    175. 175. Vitamin K Blood Clotting “K” = Danish Word Koagulation (Coagulation or Clotting) 13 Different Proteins and Calcium Vitamin K Essential Synthesis of Protein Blood-Clotting Process Calcium and thromboplastin Fibrinogen Vitamin K (a soluble (a phospholipid) from blood platelets protein) Prothrombin Fibrin ThrombinPrecursor (an inactive (a solid (an active protein) clot) enzyme)
    176. 176. Vitamin KSignificant Sources Food Non-Food Bacteria in GI Bacterial Synthesis
    177. 177. Vitamin KFunctions Blood-Clotting Synthesis Bone Growth
    178. 178. Vitamin K Deficiency Deficiency is Rare Bile Production Diarrhea Malabsorption Diseases (Crohn’s) Sulfa Drugs Antibiotics
    179. 179. Vitamin K DeficiencySurgery: Blood Clotting Time CheckedNewborn Babies: Sterile Digestive Tract Vitamin K-Producing Bacteria Plasma Prothrombin Concentrations Hemorrhagic Disease
    180. 180. Minerals• Major Minerals: Macrominerals – Essential nutrients in larger amounts – Amounts larger than 5 grams• Trace Minerals: Microminerals – Essential nutrients in smaller amounts – Amounts smaller than 5 grams
    181. 181. Minerals in 60kg Human Body
    182. 182. Inorganic ElementsMinerals are inorganic elementsRetain chemical identityCannot be destroyed by:– Heat– Acid– Air– Mixing
    183. 183. Inorganic ElementsPreservation of mineralsAsh from food remainsMinerals lost through leaching in water
    184. 184. Body’s Handling of MineralsAmount of minerals absorbedEase of absorption, transportation andexcretionCarriers to be absorbed andtransportedIncreased risk of toxicity
    185. 185. Variable Bioavailability Binders – Phytic Acid: calcium, iron, zinc • Legumes and grains – Oxalic Acid: calcium and iron spinach and chocolate
    186. 186. Sodium Principal cation (+) of extracellular fluid – Cation: positively charge ions – Extracellular fluid: fluid outside cell• Maintain acid-base balance• Essential to nerve transmission• Essential to muscle contraction
    187. 187. Sodium Roles in the Body Foods provide more sodium than the body needs Intestinal tract absorbs sodium readily Sodium travels freely in the blood Kidneys filter all sodium out of the blood Kidneys return to bloodstream exact needs Excretion = Consumption
    188. 188. Sodium RecommendationsDiets rarely lack sodiumCommittee on dietary allowances– Minimum: adults = 500 mg per day– Maximum: (NaCl) less than 6 g per day
    189. 189. Sodium Recommendations Salt (sodium chloride) is about 40% sodium 1 g salt = 400 mg sodium 5 g salt = 1 tsp 1 tsp salt = 2,000 mg sodium
    190. 190. Sodium and Hypertension Majority of people with HTN, salt restriction does not lower blood pressure Most effective dietary treatment for HTN is weight loss
    191. 191. Sodium in FoodsProcessed foods highamounts of sodiumFresh fruits and vegetables low sodium 75% sodium added to foods at table or during preparation 15% sodium added during cooking 10% natural sodium in foods
    192. 192. Chloride Roles in the Body Major anion (-) in extracellular fluids Association with sodium (NaCl) Moves freely across membranes Critical for fluid and electrolyte balance
    193. 193. Chloride Roles in the Body Chloride ion is part of hydrochloric acid (HCL) Strong acidity of gastric juice Proper digestion Protein digestion and iron absorption Vomiting loss of HCL
    194. 194. Chloride Recommendations and IntakesAbundant in foods (especially processed)No RDA set Estimated minimum requirement 750 mg per day
    195. 195. PotassiumPositively charged ion (+)Body’s principal Cat-Ion inside the cells
    196. 196. Potassium Roles in the Body Maintaining fluid and electrolyte balance Maintaining cell integrity Homeostasis (steady heartbeat)*If cells were to give up to the blood only 6% of the K(+) they contain,it would stop the heart
    197. 197. Potassium Recommendations and IntakesAbundant inside all livingcellsRichest sources are fresh  Cannedfoods vegetables  Luncheon Fruits meats Processed foods: more  Ready to eat sodium less potassium cereals
    198. 198. Potassium and Hypertension Potassium – Prevent or help to correct HTN Low potassium diets raise blood pressure: – Hypertensive • High potassium intake protects against stroke
    199. 199. Potassium DeficiencyDietary deficiency rareExcessive losses versus deficientintake: - Diabetic acidosis - Dehydration - Prolonged vomiting - Diarrhea - Diuretics - Steroids - Laxatives
    200. 200. CalciumMost abundant mineral in the bodyFound primarily in: Bones Teeth
    201. 201. Calcium Roles in the Body 99% of body’s calcium in bones Bone structure • Rigid frame • Attachment point for muscles Calcium bank Readily available source Readily to body fluids
    202. 202. Calcium in BonesFormation/dissolutionsimultaneouslyState of constant flux Osteoblast cells build bone Osteoclast cells break down bone
    203. 203. Calcium in Bones Birth to 20 years: – Actively growing in length, width, shape 12 to 29 years: Peak bone mass Bones growing thicker and denser• 30 to 40 years: – Bone loss exceeds new bone formation
    204. 204. Calcium in Body Fluids1% circulates as ionizedcalciumIonized calcium is vital to life Regulation in muscle contraction Clotting of blood Transmission of nerve impulses
    205. 205. Calcium in Body Fluids Ionized calcium is vital to life: Secretion of hormones Activation of some enzyme reactions Cofactor in a protein (calmodulin) Conveys signals to the inside cells Helps maintain normal blood pressure
    206. 206. Calcium and Disease Prevention Preventing and treating hypertension – Epidemiological studies show low dietary calcium correlates with high prevalence of hypertension• Relationship between dietary calcium• and blood cholesterol, diabetes, and cancer
    207. 207. Calcium BalanceBlood calcium falls too low, 3 organ systems may raise it:– Intestines: absorb more calcium– Bones: release more calcium– Kidneys: excrete less calcium
    208. 208. Factors Influencing Calcium Absorption Factors that Promote Factors That Interfere Calcium Absorption with Calcium Absorption Hormones that Diminished absorption promote growth with aging Ingestion with a meal; Lack of stomach acid stomach acid Vitamin D deficiency Vitamin D High phosphorus intake Lactose High-fiber diet Phosphorus in an Phytates and oxalates optimal ratio High protein intake
    209. 209. Calcium-Binding ProteinBody regulates calcium absorption Average calcium absorption • Adult = 30% • Pregnant women = 50% • Growing child = 50-60%
    210. 210. Calcium Recommendations and Intakes Internationally, recommendations vary Calcium intakes are low in most of world WHO recommends: – 400-500 mg per day (adults)• Protein intakes are also low in most of world
    211. 211. Calcium SourcesMost abundant in milk and milk productsRecommended daily milk servings: Children 2 cups Teenagers 3 cups Adults 2 cups Pregnancy (women) 3 cups Pregnancy (teens) 4 cups
    212. 212. Absorbability of Calcium Foods Ranked According to Absorbability of Calcium Excellent Cauliflower, watercress, brussels sprouts, mustard greens, broccoli, turnip greens, carrot, dates Milk, soy milk, tofu* Good Almonds, sesame seeds, pinto beans Fair Spinach Poor *Calcium-set tofu
    213. 213. OsteoporosisOsteoporosis: bone loss reaches pointwhen bones fracture under commoneveryday stress
    214. 214. Calcium DeficiencyBone mass peaks = skeletal maturity (30) Dense bone mass is best protection against age-related bone loss and fracture Low calcium intake during growing years impairs acquisition of optimal bone mass Adults lose bone as they age (40)
    215. 215. Phases of Bone Development Age in Years Bone 10 20 30 40 50 60 70 80 Density Time of Peak Bone Mass Bone Loss Active Growth
    216. 216. Phosphorus Roles in the Body Found in blood plasma as phosphorus salts (Phosphates) In all body cells as part of buffer system Phosphoric acid Salts Maintains acid-base balance
    217. 217. Phosphorus Roles in the Body Phopholipids help transport other lipids in the blood Phospholipids are major structural Cell Membranes components of cell membranes Effect transport of nutrients into and out of cells Proteins, casein, contain phosphorus in
    218. 218. Phosphorus Roles in the Body Part of DNA and RNA Genetic code material in every cell necessary for all growth• Assists in energy transfer during cellular metabolism – Enzyme and B vitamins activity – ATP, uses three phosphates
    219. 219. Phosphorus Recommendations Same as calcium, except during infancy Diets that provide adequate energy and protein also supply adequate phosphorus
    220. 220. Phosphorus Recommendations Age Nutrient 0 – 6 months 400 mg Calcium 300 mg Phosphorus 6 months – 1year 600 mg Calcium 500 mg Phosphorus
    221. 221. MagnesiumCat-Ion (Mg++) within bodys cellsActive in many enzyme systemsOver half of bodys magnesium is inbones
    222. 222. Magnesium1% in the extracellular fluidBone magnesium is reservoir toensure availabilityRemaining magnesium found inmuscle and tissue
    223. 223. Magnesium Roles in the Body Important to 300+ enzyme systems Energy metabolism Catalyst reaction - the reaction of ATP Essential to the bodys use of glucose Synthesis of protein, carbohydrates and nucleic acids Cells membrane transport system
    224. 224. Magnesium Roles in the Body Muscle contraction and blood clotting Calcium promotes processes Magnesium inhibits processes Regulates the functioning of the lungs Prevent dental caries Supports normal functioning of immune system
    225. 225. Magnesium Deficiency*Even when average magnesium intakes are below RDA, symptoms are not apparent except with disease Protein malnutrition Renal or endocrine disorders Prolonged vomiting or diarrhea Extensive use of diuretics
    226. 226. Magnesium and Hypertension Magnesium ion is critical to heart function Protects against hypertension protects against heart disease deficiency causes walls of arteries and capillaries to constrict- possibly contributing to hypertension Studies on magnesium show intakes are lower in men who have heart attacks
    227. 227. SulfurPart of some amino acidsBody does not use sulfur by itselfMethionine, and cysteineSkin, hair, and nailsSevere protein deficiency will lacksulfur containing amino acidsThiamin and Biotin also contain sulfur
    228. 228. Trace Minerals: Overview Body requires them in small, minuscule quantities Function similarly to minerals – Assists enzymes in diverse tasks all over body• Each has special duties that only it can perform
    229. 229. Trace Mineral Food Sources Content in foods unpredictable: Soil Water quality Processed foods Factors in diet and body affect absorption and bioavailibility Abundant in a variety of foods, whole foods
    230. 230. Trace Mineral Deficiencies Severe deficiencies of common minerals more easily recognized Mild deficiencies are easy to overlook Common result of deficiency Children failure to grow and thrive (GI tract, heart, bones, blood muscles, CNS)
    231. 231. Trace Mineral Interactions Excess of one trace mineral may cause deficiency of another, e.g., Manganese overload iron deficiency Iron deficiency makes the body much more susceptible to lead poisoning
    232. 232. Trace Mineral Interactions Deficiency of one may exacerbate problems associated with deficiency of another – Combined iodine and selenium deficiency thyroid hormone production Factors that enhance absorption of one may decrease absorption of another Vitamin C enhances absorption of iron but depresses that of copper
    233. 233. IronEssential nutrient that is vital for energyAccumulation in body causes harm Iron is found in two ionic states: Ferrous ion (reduced): Fe++ Ferric ion (oxidized): Fe+++
    234. 234. Iron Roles in the BodyMost of body’s iron found in twoproteins Hemoglobin in the red blood cells Myoglobin in the muscle cellsIron helps accept, carry andrelease oxygen
    235. 235. Iron Roles in the BodyFound in many enzymes that oxidizecompoundsRequired by enzymes involved inmaking part of all cells metabolismAmino acids, hormones,neurotransmitters
    236. 236. Heme and Nonheme IronHeme iron found flesh of animals Meats, poultry, fish (40% heme, 60% nonheme) 10% of the average person’s intake Well absorbed by the body at a constant rate of 23% Iron deficiency absorption
    237. 237. Heme and Nonheme Iron Nonheme iron found in plant and animal foods Vegetables, fruits, milk 90% of the average person’s intake Absorption rates 2% - 20% and influenced by: Dietary factors Body iron stores
    238. 238. Heme and Nonheme Iron in Foods From all foods From meats only me He Heme Nonheme Nonheme Nonheme Only foods derived All the iron in foods Dietary iron intake, from animal flesh derived from plants daily average provide heme, but is nonheme iron they also contain nonheme iron
    239. 239. Absorption InhibitorsPhytates and fibers in wholegrain cereals and nutsCalcium and phosphorus in milkEDTA in food additivesTannic acid (tea, coffee, nuts,fruits, vege)
    240. 240. Adaptability of Absorption 10% -15% dietary iron is absorbed Absorption varies from person to person 2% in person with GI disease 35% in a rapidly growing, healthy child
    241. 241. Adaptability of Absorption Absorption adjusts to supply and to need Iron absorption is increased: If the need increases (pregnancy) If a person’s iron intake diminishes
    242. 242. Iron Recycling Spleen Average red blood cell live 3 months Liver and spleen Remove iron from blood, take it apart, prepare for excretion or recyclingLiver Iron is salvaged liver attaches it to blood transferrin transports back to bone marrow for new RBC
    243. 243. Iron RecyclingBody loses some iron daily Via the GI tract If bleeding occurs Tiny amounts in urine, sweat, shedded skin
    244. 244. Prevalence of Iron Deficiency Worldwide, most common deficiency Affects an estimate 15% of world’s population with highest prevalence in developing countries Young children and pregnant women Iron deficiency Anemia.
    245. 245. ZincCofactor by more than 100 enzymes inevery organ of the body DNA and RNA Manufactures heme for hemoglobin Essential fatty acid metabolism Releases Vitamin A from liver stores
    246. 246. ZincCofactor by more than 100 enzymes inevery organ of the body Metabolizes carbohydrates Synthesizes proteins Metabolizes alcohol in the liver Disposes of damaging free radicals
    247. 247. IodineIodine is indispensable to lifeNeeded in trace amountsIodine in foods is converted toiodide ion in the GI tract
    248. 248. SeleniumEssential mineral that is an antioxidant.Antioxidant effect may also benefit theCVS and give protection againstCancer.Enzyme that converts thyroid hormoneto its active formNot commonly found in food.
    249. 249. CopperBody contains about 100 mg ofcopper 1/3 is in the muscles 1/3 is in the liver and brain 1/3 is in the bones, kidneys, blood, and other tissues
    250. 250. Copper Roles in the Body Copper serves as a constituent of enzymes Enzymes catalyze oxidation of ferrous to ferric ions Iron metabolism makes it a key factor in hemoglobin synthesis Functions as an antioxidant Formation of Myelin
    251. 251. Copper Roles in the Body Copper serves as a constituent of enzymes Helps manufacture collagen and heal wounds Helps in the formation of Myelin sheath. Mild Anti- Inflammatory effect Oxygen Free Radical Metabolism
    252. 252. ChromiumEssential mineralParticipates incarbohydrate and lipidmetabolism
    253. 253. Chromium Roles in the Body Helps maintain glucose homeostasis Works with hormone insulin to facilitate glucose uptake into cells and energy release Diets low in chromium may impair glucose tolerance, insulin response, and glucagon response Glucose tolerance factor (GTF) enhances insulins action
    254. 254. INTER RELATIONSHIP BETWEEN VARIOUS NUTRIENTS NUTRIENTS ASSOCIATED WITH VITAMIN A Requires ZINC for its release from the Liver; needs FAT for its proper absorption VITAMIN D Works along with CALCIUM & PHOSPHORUS ; together they ensure proper Bone development needs FAT for its proper Absorption VITAMIN E Works synergistically with SELENIUM as potent antioxidants . Needs FAT for its proper absorption. VITAMIN K Works in association with CALCIUM thereby helping in Blood clotting. Needs FAT for its proper Absorption
    255. 255. INTER RELATIONSHIP BETWEEN VARIOUS NUTRIENTS NUTRIENTS ASSOCIATED WITHVITAMIN C Crucial for IRON AbsorptionFOLIC ACID Aids in IRON Absorption; Also ↓ Homocystein levelsCOPPER Aids in IRON AbsorptionMAGNESIUM Works with CALCIUM to Promote Bone Growth & Muscle ContractionPHOSPHORUS Associated with VITAMIN B1, B2 B3, B6 for their Co-enzyme Activity
    256. 256. Diet & DiseaseSOME FACTSBy 2020, scientistsexpect 40 millionAmericans will sufferfrom Osteoarthritis.1 in 8 people living inIndian metros sufferfrom diabetes!
    257. 257. Causes of Death Infectious diseases – TB, diarrhea, malaria, AIDS Cardiovascular – Heart, coronary, cerebrovascular• Cancer• Respiratory
    258. 258. Leading Causes of Death in 2004 Deaths in India per 100,000 population in Year 2004 14.9 (2%) 12.3 (2%) Diabetes Nutritional 72.6 (11%) 113.6 (17%) deficiencie Perinatal conditions s Infections diseases (tuberculosis, diarrhea, HIV/AIDS, malaria) ) Infectious Diseases Circulatory disease Cancer Respiratory Perinatal Diabetes Nutritional Deficiencies 107 (16%)Respiratory 267.7 (41%) 71 (11%) Circulatory diseases Cancer disease/conditions (coronary heart, cerebrovascular) ) (lung, stomach, colon and rectum, liver, breast)
    259. 259. Diet and diseaseObesity 1.2 billion people in the world are overweight 300 million of them are Obese
    260. 260. Diet and diseaseHow to calculate BMI BMI = weight in kg /height (mts x mts) BMI > 18.5 is underweight 18.5- 24.9 is normal weight 25.0 – 29.9 is overweight 30.0 – 39.9 is Obese 40.0- and higher is severely obese
    261. 261. Hazards of ObesityAdult Children Pre mature deaths Bowing of legs because of Maturity onset diabetes weight Pain in the hip joint Sever headache can lead to vision loss Heart disease Suffer daytime sleepiness Hypertension Breathing difficulty during Cancer sleep Fatty Liver disease Obese female may develop Vascular disorders polycystic ovary disease Thrombosis chances of diabetes Obstructive Sleep Apnea Hypertension Musculoskeletal problems Gall bladder disease Gastro esophageal reflux Raised blood cholesterol
    262. 262. Obesity may lead to……..HypertensionHeart diseasesDiabetesIncreased blood cholesterol levelsBreathing difficultyStrokeHigh rate of certain type of cancerFatty liverVascular diseases.Reproductive problems in females
    263. 263. Childhood Obesity ……..Obesity among Children is on the risefrom 1998 to 2006 2-5 yrs prevalence increased 5%- 13.9% 6-11yrs prevalence increased 6.5%- 8.8 % 12-19yrs prevalence increased by 5%-17.4%
    264. 264. Childhood Obesity …….. Object 5
    265. 265. Childhood Obesity ……..Factors that lead to childhood obesity. Genetic factors or some genetic Disorders Underlying illness (Hypothyroidism) Eating Disorders Certain Medication Sedentary lifestyle Psychological/Emotional Disturbances
    266. 266. Video 4: Childhood Obesity….. Click to Start
    267. 267. Preventing Obesity ……..Tips to parents• Children do not need to finish everybottle or meal.• Avoid prepared and sugared foods when possible• Limit the amount of High calorie foods kept in the home• Provide a healthy diet with 30% or fewer calories derived from Fat
    268. 268. Preventing Obesity ……..Tips to parents• Provide ample fiber in the child’s diet• Skimmed milk may safely replace whole milk at 2 yrs of Age• Do not provide food for comfort or as a reward.• Limit the amount of T.V. viewing• Encourage active Play such as walks, ball games etc
    269. 269. Diet and Heart Disease
    270. 270. Why Does the Heart Quit? Not enough oxygen and nutrition Poisons build up in the heart Muscle dies
    271. 271. What happens Then?Heart gets biggerHeart works harderHeart tires outHeart fails
    272. 272. When Heart Muscles Die What Happens? Muscle replaced with scar tissue Scar tissue does not work More scar tissue less muscle Heart quits
    273. 273. What Causes Heart Failure? High blood pressure (Hypertension) Coronary blood vessel disease Atherosclerosis
    274. 274. How Does High Blood Pressure Affect the Heart? Heart must work harder Uses more energy Muscle starves
    275. 275. What Does Coronary Vessel Do? Blocks blood through heart muscle Less food and oxygen to heart Muscle starves
    276. 276. What Does Atherosclerosis Do? Blocks blood flow to brain Brain does not get food and oxygen Brain cells die
    277. 277. What Causes High Blood Pressure? Sometimes water balance problems Obesity Other diseases Undetermined causes
    278. 278. High Blood Pressure Leads To Stroke Congestive heart failure Heart attack Kidney disease Blood vessel damage
    279. 279. How Can We Treat High Blood Pressure? Exercise, diet, stress reduction Increase urine flow Make the heart work less hard Relax blood vessels
    280. 280. CholesterolIs a fat-like waxy substanceessential to body chemistryIs manufactured by our bodiesContained in foods we eat
    281. 281. Cholesterol• LDL “Bad” cholesterol Lower is better• HDL – “Good” cholesterol – Higher is better
    282. 282. Saturated FatsDECREASE YOUR SATURATED FATS!
    283. 283. Athersclerosis Leads To Heart attack Stroke Sudden death
    284. 284. Major Risk Factors for CVD Cigarette smoking High blood pressure High levels of cholesterol and fat in blood Family history of heart disease Male gender Increasing age
    285. 285. Major Risk Factors for CVD Diabetes Overweight Lack of exercise
    286. 286. Compounding Risk Factors Cigarettes and Cholesterol and Cigarettes High Blood and Pressure Cigarettes Cholesterol None
    287. 287. Coronary Risk FactorsModifiable Fixed Hypercholesterolemia Family history Hypertension Age Smoking Menopausal females without Physical inactivity hormone Diabetes mellitus replacement Low LDL Obesity
    288. 288. To Reduce Your Risk • Control High Blood Pressure • Do NOT smoke • Follow proper diet
    289. 289. ALSO: To Reduce Your Risk Exercise regularly Have regular medical check-ups Identify and treat diabetes
    290. 290. TriglyceridesTriglycerides are the fat in foodwe eatOur bodies manufacture andstore triglycerides when we eatmore calories than we need
    291. 291. Saturated Fatty Acids Saturated fatty acids are the main culprit in raising blood cholesterol levels
    292. 292. Dietary Recommendation Total fat intake should be less than 30% of calories Saturated fatty acid intake should be less than 10% of calories
    293. 293. Dietary Recommendation Monounsaturated fatty acids should make up 10% - 15% of total calories Monounsaturated fatty acids seem to lower blood cholesterol if the diet is low in saturated fats but still provide fat-dense calories
    294. 294. Proper Mix of Fat in Diet Up to 10% polyunsaturated Less than 10% saturated Balance from monounsaturated
    295. 295. Trans Fatty AcidsTend to raise LDL cholesterollevelsMajor sources: Margarine Vegetable shortening Fast foods Baked products
    296. 296. Coronary Heart Disease 1% drop 2% drop cholesterol = coronary heart disease risk
    297. 297. Dietary Treatment for Coronary Heart Disease Less than 7% of calories as saturated fat Less than 200 mg per day cholesterol 30% or less of calories as total fat 55% or more of calories as carbohydrate 15% of calories as protein
    298. 298. Dietary Treatment 3 to 4 teaspoons servings of fatand oils per day Use cooking methods with littleor no fat (bake, broil, roast, steam, poach,sauté, ormicrowave) Trim visible fat before cooking meat and poultry, drain
    299. 299. Dietary TreatmentLimit use of organ meatsChoose skim or 1% fatmilk, nonfat or low-fatyogurt or cheeseLimit intake of saturatedfatty acidsRead labels for amount andtype of fat
    300. 300. SodiumEpidemiological evidenceIndividual responsePatients likely to have the greatestresponse to sodium: Older persons Those with high initial blood pressure Those with a family history of hypertension
    301. 301. Salt/SodiumUse less salt at the table andin cookingUse herbs, spices instead ofsaltLimit intake of foods high inadded sodiumLook for unsalted varieties offoods
    302. 302. Lifestyle ModificationFor Control of HypertensionReduce weight if necessaryLimit daily intake of alcoholReduce daily sodium intake to<6 grams NaCl (salt) or <2.4grams sodiumExercise regularly
    303. 303. Fiber Eat FibMore erFiber
    304. 304. ObesityBlood pressureAtherosclerosisHeartGall bladderDiabetesPregnancy andsurgeryJoint disease
    305. 305. Diet and Diabetes
    306. 306. Diabetes MellitusA clinically and geneticallyheterogeneous group ofdisorders that is characterizedby elevated blood glucose.
    307. 307. What Causes Diabetes? Causes and cures remain unknown Researchers believe tendency is present at birth Who is most likely to get diabetes? People over 40 Women with a high birth weight baby Overweight Family History
    308. 308. Types of DiabetesDiabetes Mellitus Type I (IDDM: Insulin dependent) Type II (NIDDM: Non-insulin dependent)Diabetes InsipidusGestational Diabetes
    309. 309. Type I (IDDM) DiabetesJuvenile diabetesPancreas makes little or no insulinInsulin dependent diabetesAppears suddenly and worsensrapidly
    310. 310. Type I Diabetes
    311. 311. Type II (NIDDM) Diabetes Makes enough insulin but the body does not use it effectively Usually occurs in adults after age 40 Non-insulin dependent diabetes Develops slowly and can go undetected for years
    312. 312. Type II Diabetes
    313. 313. Diabetes InsipidusKidney’s inability to conserve waterFailure of the hypothalamus to releaseADHLarge amounts of urine Change in appetite Loss of strength Emaciation
    314. 314. Classification of Diabetes Type I ~5% ~6% of population Type II ~95% GDM ~2% - 4% pregnant women IGT ~11% of population
    315. 315. Screening for Diabetes Fpg* (MG/DL) Significance Action <115 Normal Retest in 3 years 116 - 140 IGT 1. Additional testing 2. Check risk factors 3. Medical nutrition therapy >140 Diabetes likely 1. Confirm by second FPG 2. Treat diabetes *Fasting plasma glucose
    316. 316. What Problems Face a Diabetic? • Maintaining blood sugar levels - Measuring blood - Diet Insulin injections Medications Exercise Weight • Organ failures: - Eyes - Kidneys Nervous system Blood vessels Heart disease Stroke
    317. 317. How Do We Treat Diabetes? Type I Exercise Diet Injected insulin Fast acting Moderate Long acting
    318. 318. How Do We Treat Diabetes? Diabetes insipidus Usually patient is comfortable except with annoyance of frequent: Need to drink Need to urinate
    319. 319. Type II DiabetesNon-insulin dependent Insulin secretion insufficient or excessive Tends to occur after age of 40 80% are above ideal body weight
    320. 320. Benefits of Weight Loss Reduces blood pressure Reduces serum triglycerides, total cholesterol Increases HDL-cholesterol Reduces blood glucose levels
    321. 321. Obesity Object 10Obesity is the most important,modifiable risk factor for type 2diabetes BMI greater than 35risk for type 2 diabetesby 93-fold in females BMI greater than 35risk for type 2 diabetesby 42-fold in males
    322. 322. Indications for Insulin in Type II Ineffectiveness of: Meal plan Physical activity OHAs Endogenous insulin As therapy for an acute medical condition
    323. 323. Treatment Obese, Non-Insulin Dependent Meals coordinated with insulin Weight reduction* Regular exercise *May eliminate or reduce need for insulin
    324. 324. Regulation of Blood Glucose Levels Blood Counterregulatory Insulin Glucose Hormones Fed Fasting
    325. 325. Benefits of ExerciseImproved fitness• Flexibility, endurance, strength• Reduces cardiovascular risk factors• Dyslipidemia, hypertension, obesity• Lowers blood pressure• type II and IGT• psychological well-being
    326. 326. Goals of Medical Nutrition Therapy Achieve blood glucose goals Achieve optimal lipid levels Provide appropriate calories for: Reasonable weight Normal growth and development Pregnancy and lactation Prevent, delay, or treat nutrition- related complications Improve health through optimal nutrition
    327. 327. Nutrition RecommendationsFor Persons With Diabetes Protein • Fat Carbohydrate • Fiber
    328. 328. Diabetes Food Pyramid ~6% of population
    329. 329. High-Fiber FoodsLegumes Contains guar and pectinFresh fruitRaw vegetablesWhole grains: Contains cellulose Oats, wheat, brown rice
    330. 330. Consuming High-Fiber Foods Consuming high-fiber foods may: Lower post-meal blood glucose Lower fasting blood glucose Lower insulin requirements
    331. 331. Nonnutritive Sweeteners Aspartame, acesulfame-K, saccharin Safety based on Acceptable Daily Intake ADI: amount of a food additive that can be safely consumed on a daily basis over a person’s lifetime without any adverse effects Includes a 100-fold safety factor Average intake of aspartame ~4% ADI Safe for use, including pregnancy
    332. 332. Sodium• To choose low sodium in food:
    333. 333. Oral Hypoglycemic Medication Increases sensitivity of receptor to insulin Stimulates pancreas to increase production of insulin Picture 4
    334. 334. Effects of Adequate Insulin on Protein Metabolism Anticatabolic – Proteolysis – Gluconeogensis Anabolic – Protein synthesis • Amino acid transport
    335. 335. Diabetes-Related Conditions Requiring Medical Nutrition Therapy Hypertension Nephropathy Gastroparesis Diabetes complicated by surgery Macrovascular complications Obesity
    336. 336. NephropathyType I diabetes ~35%Type II diabetes ~ 20%Accounts for ~35% ofnew cases of end-stage renal disease(ESRD)
    337. 337. Syndrome X Obesity Genetics(Upper Body) Insulin Resistance HyperinsulinemiaDyslipidemia Hypertension Glucose Intolerance (IGT and Type II)
    338. 338. Lipoprotein Abnormalities Related to Diabetes• TG and VLDL (type II)• HDL-C• Cholesterol and LDL-C similar to general public• Chylomicron clearance
    339. 339. Select Meal Planning Approaches General guidelines Menu planning systems Exchange systems Counting systems
    340. 340. General Guidelines• Benefits: Easy to understand Good “first step” tool Inexpensive Allows patient to make choices
    341. 341. Menu Planning Systems • Benefits: Gives specific instructions Simple to use Variety of choices May include recipes
    342. 342. Exchange Lists• Benefits: Groups foods with similar nutrition content Teaches portion control Can adjust calories Teaches about CHO, fat, and protein Cookbooks based on exchanges
    343. 343. Acute Complications of Diabetes Hypoglycemia Hyperglycemia Diabetic ketoacidosis (DKA)
    344. 344. Factors Affecting Blood Glucose Levels• Insulin deficiency • Too much insulin or resistance or OHA• Food • Not enough food• Glucagon or other • Unusual amount CRH of exercise• Stress • Skipped or• Illness delayed meals• Infection
    345. 345. Hypoglycemia Causes Symptoms Shakiness Sweating Confusion Irritability
    346. 346. HypoglycemiaTreat blood glucose < 70mg/dl 15 g CHO Wait 15 minutes Retest and monitor symptomsHypoglycemic unawareness
    347. 347. Hyperglycemia Symptoms Polyuria Polydipsia Dry mouth Weight loss Fatigue
    348. 348. Hyperglycemia Can lead to DKA, coma, and death DKA Blood glucose > 250 mg/dl Urine ketones
    349. 349. Treatment Plan for Hyperglycemia Test urine or blood Call physician or health care team Report results and symptoms Follow doctor’s advice
    350. 350. Diet and Cancer
    351. 351. Burden of Cancer in India Estimated number of new cancers diagnosed in India every year: 700 - 900,000.
    352. 352. Causes of Cancer Tobacco*** Sunlight*** Genetic* Environment* Diet
    353. 353. TobaccoLung, mouth, liver,kidneyChemicals in smokecause cancerDaily, continuousexposure
    354. 354. How Do We Decrease Tobacco-Related Causes?• STOP smoking• Decrease amount of cigarette smoked• Do not inhale• Filters
    355. 355. How Does Sunlight Cause Cancer U.V. light Damages DNA Mutation cancer Skin cancer
    356. 356. How Do Genes Play a Role in Cancer? Prevent cell death Increased mutations Breast, prostate, intestine Cancer families
    357. 357. What Can We Do to Decrease Gene-Related Cancers? Not much yet Future (?)
    358. 358. What Environmental Causes are There? Radon Some chemicals • Mostly are work place ¢Asbestos
    359. 359. What Can We Do to Decrease Environmental Risks? Remove radon and asbestos Better chemical control
    360. 360. What Roles Does Diet Play in Cancer? Difficult to determine Causation versus correlation Salt Fats* Food preparation and storage Microbes and cancer
    361. 361. How Can We UseDiet to Decrease Cancer Risk? Fiber* Good nutrition Preservatives Antioxidants
    362. 362. Why is Cancer So Deadly? Detection Invasion Metastasis
    363. 363. What Makes Detection So Important?Currently a cancer may bein the body for up to 20yearsKills normal cellsGoes elsewhere in thebody
    364. 364. What is Invasion?Benign tumorsCysts: displace normal tissueMalignant tumors Invade normal tissue Disrupt organ function Invades blood vessels and lymph
    365. 365. What is Metastasis Spread of cancer throughout the body Blood vessels Lymph system The real killer
    366. 366. Treatment of Cancer Surgery Radiation Drugs Immune system
    367. 367. Prevention of Cancer:Best But Poorly Understood Stop smoking*** Decrease sun exposure*** Diet Antioxidants Alcohol
    368. 368. Cancer IncidenceOesophagusLungStomachColon/rectumBreastProstate
    369. 369. Cancer Prevention60-70% of all cancer casescould be prevented through: Sensible dietary choices Maintaining a healthy body weight Keeping physically active Not smoking
    370. 370. Good News!ProtectivefactorsRisk factors
    371. 371. Protective Factor: 1Cabbage family vegetablesMustard family vegetables Cabbages Mustards Broccoli Brussels sprouts Cauliflower
    372. 372. Protective Factor: 2 Fiber Whole grain breads Whole grain flours Wholes grain cereals Peas Beans Fruits Vegetables
    373. 373. Antioxidants¢ Population studies show that high intake of Plant foods (fruit and vegetables) is associated with reduced risk of cancer and heart disease¢ Plant Foods are rich in antioxidants as flavonoids, Vitamins E and C, and Carotenoids
    374. 374. Protective Factor: 3Vitamin ABeta Carotene Spinach Squash Lettuce Broccoli Carrots Sweet potatoes Peaches Apricots
    375. 375. Protective Factor: 4Vitamin C Tomatoes Cauliflower Peppers Broccoli Celery Mustard greens Brussels sprouts
    376. 376. Protective Factor: 4 Vitamin C Mangoes Kiwi fruit Currants Lemon Amla
    377. 377. PhytochemicalsChemicals in plants that havenutrient or other functions. Dietary Sources • soy, oats, tea, grapes, garlic, tomato Supplements Sources ginseng, echinacea
    378. 378. Activities of PhytochemicalsAntioxidants GeneticEnzyme Modulation Anti-InflammatoryCell Proliferation Endocrine functionAngiogenesis Platelet aggregation Vascular Reactivity
    379. 379. Protective Factor: 5 Weight Control
    380. 380. Walk Away the CaloriesBrisk Walking For: Equals:20 minutes 100 calories30 minutes 150 calories45 minutes 225 calories60 minutes 300 calories70 minutes 350 calories
    381. 381. CancerCancer risk reductionEliminate risk factors
    382. 382. Risk Factor: 1 Dietary fat Fat calories
    383. 383. Risk Factor: 2 Salt cured Nitrite cured Smoked foods
    384. 384. Risk Factor: 3Cigarettes are 87% of lungcancer30% of all cancer issmoking related
    385. 385. Risk Factor: 4AlcoholCompound risk:Alcohol + Cigarettes
    386. 386. Risk Factor: 5Excessive sun Avoid midday sun Sunscreen SPF 15 Protective clothing Avoid sunlamps, tanning pills and tanning parlors
    387. 387. AIDS/HIVAIDS/HIV
    388. 388. What is Aids?Acquired ImmuneDeficiency syndrome
    389. 389. How Does Virus Affect Us? Targets immune cells Kills lymphocytes Stored in macrophages Lose immune system
    390. 390. How Do We Lose Our Immune System? Virus invades lymphocyte (helper) Moves to cell nucleus Takes over cell DNA Cell makes too much virus Cell dies Virus spreads to more lymphocytes
    391. 391. What Kills an AIDS Patient? Infections: "opportunistic infections" Diet problems Organ failure
    392. 392. How Can We Prevent AIDS? "Safe sex" Clean needles Common sense
    393. 393. How Do We Treat AIDS? Diet Exercise Drugs
    394. 394. What Do Drugs DoPrevent virus from replicatingPrevent virus from reforming
    395. 395. What Are the Problems With Drugs? Very expensive Complex schedules of drug taking Resistance
    396. 396. Immune SystemPrevents againstinvading organismsKills tumor cells
    397. 397. What If Immune System Malfunctions Autoimmune disease: immune system attacks itself Cancer develops Opportunistic infections
    398. 398. Nutrition and HIV/AIDS Optimize your health Prevention and treatment of HIV/AIDS associated malnutrition
    399. 399. Weight Loss Means11Kg = 17,500 calories
    400. 400. Why Nutrition?Optimize immune function tominimize disease progressionManage symptoms to reduce riskweight loss and wastingComponent team-based approachto managing HIV/AIDS disease
    401. 401. Wasting; A DefinitionInvoluntary weight loss greater than10% baseline body weight + eitherchronic diarrhea or chronic weaknessand documented fever in the absenceof concurrent illness or condition otherthan HIV infection
    402. 402. Link between Malnutrition and HIV/ AIDS Malnutrition wastingIncreased requirements Decreased Decreased Intake Immunity Increased losses HIV Opportunistic Infections Increased risk of mortality
    403. 403. Causes of Malnutrition Calorie intake Nutrient absorption Altered energy expenditure Hormone and nutrient dysregulation Malabsorption Change in physical activity
    404. 404. Dietary Changes to Treat: Increased lipids Weight loss Diarrhea Increased triglycerides Increased blood glucose Taste changes, nausea, swallow difficulties
    405. 405. Nutrition GoalsPreserve BCMAdequate nutrients and fluidManage side effects ofmedicationsAddress symptoms to avoidnutritional consequencesNutrition and exercise are keyfactors to maintaining andrestoring lean tissue stores
    406. 406. Malabsorption Signs and symptoms Weight loss Nutrient deficiency Abdominal distention, gas, discomfort Fullness, early satiety• Consequences – Compromised immune function and metabolism – Reduced medication tolerance
    407. 407. Common Nutrient Deficiencies Total Calories Vitamin E Vitamin A Folic Acid Vitamin B6 Magnesium Vitamin B12 Selenium Zinc
    408. 408. Possible Interventions Exercise intervention Food supplements Vitamin, mineral, protein supplement Appetite stimulants
    409. 409. Other Concerns/ Early Interventions Lack of appetite Chronic diarrhea Taste changes Nausea and Mouth sores, vomiting dryness GI discomfort Lactose Swallow intolerance difficulties Lipo-dystrophy
    410. 410. MultivitaminsBest source foodAbility to absorbmay improve or lessenResearch isinconclusive