A. FOOD AND NUTRITION LECTURE I NUTRITION Is the science science of food, the nutrients, nutrients, and the substances substances they contain, their action, interaction, interaction, and balance in relation to health and disease. (Council of the American Medical Association). DIETETICS Practical application of the principles of nutrition which includes planning of meals for the healthy as well as the sick. FOODS Products derived from plants or animals that can be taken into the body to yield energy and nutrients for the maintenance of life and the growth and repair of tissues. 2 Main Sources of Foods: 1. Plants: grains, pulses, fruits, vegetables, tubers, nuts , oilseeds and seaweeds. 2. Animals: meat and entrails, milk, poultry, eggs, fish, and shellfish.
***Manufactured food, also convenience food are products of either of the two or a combination of them.
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Types of Foods: Grai Grains ns & cer cerea eals ls –ric –rice, e, corn corn,, whea wheat, t, sorg sorghum hum,, bar barle ley, y, oats oats,, rye rye,, mil mille let. t. Fruits 1. Tropic Tropical al –pinea –pineappl pple, e, mango, mango, papay papaya, a, banana. banana. 2. Sub-tr Sub-tropi opical cal –cit –citrus rus,, olives olives,, figs. figs. 3. Decidu Deciduous ous –grapes –grapes,, apple, apple, and pear pears. s. 4. Berri Berries es –straw –strawber berrie ries, s, bluebe blueberri rries. es. 5. Ston Stonee – apr apric icot ot and and pea peach ch.. c. Vegetables 1. Fruits –cucumber, tomatoes. 2. Leaf and stem –cabbage, celery, swamp cabbage or kangkong, pechay. 3. Seeds –green peas, mongo, green beans. 4. Root –carrot, radish. 5. Flowers –cauliflowers, broccoli, squash flowers. d. Tubers –sweet potatoes, cassava, yam, potatoes. e. Nuts –pili nut, pistachio, cashew, almond. f. Oilseeds –coconut oil, soybean oil, peanut oil, sesame oil, olive oil. g. Seaweed – agar, carrageenan. h. Pulses –beans, peas, and lentils. i. Meat and entrails –beef, veal, pork, mutton, goat, rabbit, venison, seal, whale, and their internal organs. j. Milk –cow’s, carabao’s, goat’s, sheep’s, camel’s. k. Poultry – chicken, turkey, ducks, geese, quail. l. Eggs –chicken, duck, turtle. m. Fish –(including roe, liver): milkfish or bangus, sardine, tuna, mackerel, cod, catfish, shark, tilapia. n. Shellfish 1. Crustaceans – crab, lobster, shrimp, prawns. 2. Mollusks – clams, oysters, snail, octopus , squids. NUTRIENTS Chemical substances present in food and is used in the body for one or more of the following functions: 1. to prov provid idee ene energ rgy y 2. to bui build ld and and rep repai airr tiss tissue uess 3. to reg regul ulat atee life life pro proce cess sses es
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2 Major Divisions of Nutrients: 1. Macronutrients – they are needed in the body in relatively large amounts. Ex: Carbohydrates, Protein, Fat, Major minerals and Water.
2. Micronutrients – the body needs them in smaller smaller quantity Ex: Vitamins and trace minerals Six Main Groups of Nutrients 1. Carbohydrat Carbohydrates es – are plantplant-deriv derived ed food s composed composed of of sugars. sugars. Starch Starch foods foods ( rice, pasta, pasta, root crops, bread ) and those concentrated in sugars are common sources. Fruits and vegetables contain dietary fiber, a complex form of CHO. 2. Protein Protein – are made made up of amino acids, acids, which which serve serve as the the building building units units of body tissue tissues. s. They are vital for growth, repair, and maintenance of the body. 3. Fats Fats or Lipids Lipids – is a family family of water-in water-insol solubl ublee substa substances nces that include include trigly triglycer ceride idess (fats (fats and oils), phospholipids (lecithin), and sterols (cholesterol and ergosterol). Of the lipids in food, 95% are fats and oils, and 5% are other lipids. 4 Minerals - are pure inorganic elements. They are not metabolized, nor do they yield energy. They are indestructible and need not be handled with the special care. a. Major –sodium –sodium,, potassium, potassium, calcium calcium,, phosphorus, phosphorus, chloride, chloride, sulfur sulfur,, magnesium. magnesium. b. Trace Trace – iron, iron, zinc, copper, copper, fluori fluoride, de, iodine, iodine, seleni selenium, um, manganes manganese, e, molybd molybdenum enum,, chromi chromium, um, cobalt.
5 Water soluble and fat soluble - these are organic but they do not provide energy. Instead, they facilitate the release of energy from CHO, CHON and fat and participate in numerous other activities throughout the body. Because they are complex organic molecules, they are vulnerable to destructio destruction n by heat, light, light, and chemical agents. Thus, food must be handled handled carefully carefully to preserve preserve them. Thiamine(B1), Riboflavin(B2), Niacin, Biotin, Pantothenic acid, Folic acid, a. Water ater-s -sol olub ublle – Thiamine(B1), Pyridoxine(B6), Cobalamin(B12). b. b. Fat-s at-sol olub ublle – Vitamins Vitamins A, D, E, K. 6 Water - is a food food as well as nutrient. nutrient. It provides the environment in in which nearly all the body’s activities are conducted. Classification of Nutrients according to its Chemical Nature 1. Organic Organic nutrients nutrients - contain contain carbon. carbon. Ex: CHO, CHO, CHON, CHON, Fat and and vitamins vitamins 2. Inorganic Inorganic nutrient nutrientss - they do not contain contain carbon. carbon. Ex: Ex: Water Water and minerals minerals Classification of Nutrients according to its Sources 1. Natural Natural nutrient nutrientss - are are obtained obtained from from plant plant and animal animal foods. foods. 2. Synthetic Synthetic nutrient nutrientss - are man-made man-made nutrient nutrientss such as vitami vitamin n or mineral mineral pill. pill. Classification of Nutrients according to its Essentiality 1. Dietary Dietary essential essential nutrien nutrients ts - are those those that the body body cannot make make in sufficie sufficient nt quantity quantity to meet its requirement; they must be obtained from the diet. 2. Non dietary dietary essentia essentiall nutrients nutrients - are are those that that can be produced produced in the the body in enough enough amounts. amounts. Among them are cholesterol and the amino acids. ENERGY-GIVING NUTRIENTS CHO, CHON and fats are energy nutrients that fact that they yield calories when metabolized in the body. Minerals, vitamins and water do not provide energy. Alcohol is not a nutrient but it provides energy. The energy content of food is measured in kilocalories (kcal) or kilojoules (kj) . ONE CALORIE - it is the amount of heat required to raise the temperature of 1 kg of water to 1 degree centigrade. When completely broken down in the body, a gram of CHO yields about 4 kcal of energy; a gram of CHON also also yields 4 kcal; and a gram of FAT yields 9 kcal. Alcohol contributes 29 kcal that can be used for energy.
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Fat, therefore, has a greater energy density than either CHO or protein. CALORIE - a measure of the energy a food provides relative to the amount of food (kcalories per gram). Sample problem: Calculate the total energy available from the given food and the percentage of kcalories each of the energy nutrients contributes to the total.
A. A sandwich sandwich having having 23 g CHO, 5 g CHON and and 5 gram of fat fat per serving. serving. B. One slice slice of bread with one tablesp tablespoon oon of peanut butter butter on it contains contains 16 grams grams CHO, 7 grams protein, and 9 grams fat. Factors Affecting an Individual’s Calorie Need 1. Age Age and and grow growtth 2. Gender 3. Climate 4. Sleep 5. Activity 6. Fever 7. Illness NON-NUTRIENT COMPONENTS OF FOOD 1. Alcohol 2. Pigments 3. Additiv Additives es – preserv preservati atives ves,, flavors flavors and and colors colors 4. Phytoc Phytochem hemica icals ls – non-nut non-nutrie rient nt compou compounds nds found in plantplant-der derive ived d foods foods that have biologi biological cal activity in the body. Ex: lycopene in tomatoes, allylic sulfites in garlic, and lignans in wheat. NEW FORMS OF FOOD 1. Pharmafoods Pharmafoods - food food or nutrient nutrient that claims claims medical medical or health health benefits benefits related related to prevention prevention and treatment of disease. 2. Func Functi tion onal al food foodss - are are food foodss or ingred ingredie ient ntss that that have been been modi modifi fied ed to provid providee a heal health th benefiting beyond their nutrient contributions. 3. Design Designer er foods foods - are process processed ed foods foods that are supple supplemen mented ted with with food ingredi ingredient entss naturall naturally y rich in disease-preventing substances. This may involve genetic engineering of food. 4. Nutr Nutrac aceut eutic ical al - are are produ product ctss that that may be consid consider ered ed a food food or part part of a food food and provi provide dess medical or health benefits. 5. Organic Organic foods - are products products that are are grown without without manufactur manufactured ed fertilizer fertilizerss or pesticides. pesticides. DAILY FOOD SELECTION DIET – the food and drink that a person regularly consumed 2 Forms of Diet: 1. Special diet - a selection of food based on health conditions or disease management goals. Examples: low calorie diet for weight control, low salt diet for control of blood pressure. pressure. 2. Balance diet- provides the correct amount of essential nutrients.
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Factors Influencing Food Habits and Selection of Food Stuffs Habi Habitt and and pre prefe fere renc ncee- The The sele select ctio ion n of food food is is tie tied d to to a per perso son’ n’ss rou routi tine ne and and pra pract ctic ices es.. Tast Taste, e, tex textu ture re,, and appearance also mainly dictate an individual’s food options. Cost Cost,, avai availa labi bili lity ty,, and and conv conven enie ienc ncee- Peo Peopl plee sel select ect food foodss whi which the they y can can affo afforrd to buy buy, whic which h are are readily available, and do not require much time to prepare or cook. In today’s modern lifestyle, foods that are fast and delicious are frequently chosen. Cult Cultur uree and and trad tradit itio ionn- Each Each area area of the the wor world ld and and eve every ry regi region on of a cou count ntry ry had had own own typi typica call foo foods ds and and ways of combining them into meals. Religious rules about foods can further dictate the composition of
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diet. Many Muslims refrain from eating pork and beef of unknown origin. Some Jewish people do not eat pork or serve milk products and meat at the same meal. Soci Social al pre press ssur uree- Soc Socia iall pres pressu sure re ope opera rate tess in all all cir circl cles es and and acr acros osss all all cult cultur ural al lin lines es.. Clos Closee frie friend ndss shar sharee similar food choices. Special occasions are associated with the serving of specific foods and it is often impolite to refuse food or drink offered by a host. Adve Advert rtis isin ingg- Comm Commer erci cial al ads ads and and pack packag agin ing g of the the food food ind indus ustr try y are are quit quitee suc succe cess ssfu full in in enti entici cing ng the the public to choose certain foods. Medi Medica call cond condiitions ons and and heal health belie belieffs- The There re are are med mediical cal condi conditi tion onss and and thei theirr trea treatm tmen entts limi limitt the the foods a person can select. A client with hypertension might need to adopt a low salt diet. The chemotherapy needed to treat cancer can interfere with the persons appetite. Body Body Imag Imagee- Peop Peoplle may may opt opt for for food ood tha thatt the they y link ink wi with ideal dealss of of body body image mage.. Emot Emotio iona nall Sta State te-- Som Somee indi indivi vidu dual alss eat eat in in res respo pons nsee to emot emotio iona nall sti stimu muli li such such as as bor bored edom om,, anxi anxiet ety, y, and and depression. Principles of Planning a Healthy Diet: Carefully planned meals deliver sufficient amount of all vital nutrients. Elements of Nutritious Diet 1. AdequacyAdequacy- The foods foods chosen chosen provide provide enough of each each important important nutrient nutrients, s, fiber, fiber, and energy. energy. 2. Proportion Proportionalit alityy- The choices choices do not overemphas overemphasized ized one nutrient nutrient or food food type at the the expense expense of another. 3. Calorie Calorie controlcontrol- The foods foods provide the the amount of calories calories a person person needs to to sustain sustain appropriate appropriate weight. 4. ModerationModeration- The The foods do not provide provide extra fat, fat, salt, sugar, sugar, or other unwanted unwanted constitu constituents. ents. 5. Variety 6. Nutri Nutrient ent-den -densit sityy- Select Select foods that deliver deliver the most nutrien nutrients ts for the least least amount amount of food energy. Tools in Designing a Healthy Diet A nutri nutriti tiona onall lly y sati satisf sfac acto tory ry diet diet is base based d on a wise wise sele select ctio ion n of a vari variet ety y of foods foods in recommended amount.
1. U.S. Food Guided This is a food group plan that assigns food to major groups. It suggests the proper combination of foods in a meal and serving sizes. Ex: the U.S. Food Guide a. 6-11 servings of breads, cereals, and other grain products per day b. 3-5 servings of vegetables per day c. 2-4 servings of fruits per day d. 2-3 servings of meat, poultry, fish and alternatives per day e. 2 servings of milk, cheese and yogurt per day f. Fats, Sweets, and Alcoholic beverages: use sparingly 2. Your Guide to Good Nutrition Is a practical guide in planning meals/diets for Filipinos; foods are classified into groups on the basis of similarity in nutrient content. a. Energy-givi Energy-giving ng foods – are are high in CHO and and fats such such as rice & rice rice products, products, breads, breads, corn, corn, root crops, sugar and sweets, past and noodles; butter, margarine, mayonnaise, cooking oil, etc. b. Body-b Body-buil uildin ding g foods foods - are rich rich in CHON and minera minerals ls such as meat, meat, fish, fish, poultry, poultry, eggs eggs and dried beans. c. Body-regul Body-regulating ating foods foods - are rich in vitamins vitamins,, minerals, minerals, fiber and water water like fruits fruits & vegetables vegetables 3. Food Guide Pyramid A pictorial form of the daily food guide; it teaches the principle of eating a variety of food foodss every everyday day,, the the need need for for mode modera rati tion on in some some food food grou groups ps whil whilee empha emphasi sizi zing ng the the importance of other food items. The broad base at the bottom conveys the message that the food group should form the foundation of a healthy diet and foods that belong in this level must be taken abundantly compared to other food groups. The apex indicates that foods belonging to this group should be eaten sparingly. 4
Ex: U.S. Food Guide Pyramid and Food Guide Pyramid for Filipinos
4. The Nutrition Guideline These are most important recommendations to promote good health through proper food intake; they are short, simple statements that give advice on the consumption of foods and food components for which there are public concerns. The guidel guideline iness aim to foster foster an adequat adequate, e, balanc balanced ed diet diet and desira desirable ble food food and nutrit nutrition ion practices and healthy habits suitable for the general population. The latest NUTRIONAL GUIDELINES FOR FILIPINOS given by the Food and Nutrition Research Institute – DOST are: 1. Eat a wide wide varie variety ty of of foods foods everyd everyday. ay. 2. Breast-fee Breast-feed d infants from from birth to 4-6 months, months, and then give give appropriate appropriate foods while while continuin continuing g breast-feeding. 3. Maintain Maintain children’s children’s normal normal growth growth through proper proper diet and monitor monitor their their growth growth regularly. regularly. 4. Consume Consume fish, fish, lean meat, poultry, poultry, or dried dried beans. 5. Eat more more fruit fruits, s, vegeta vegetable bles, s, and root root crops crops.. 6. Eat foods prepared prepared with with edible edible cooking cooking oil oil daily. daily. 7. Consum Consumee milk, milk, milk products products,, or other other calcium calcium-ri -rich ch foods such as small small fish and dark, green leafy vegetables every day. 8. Use iodized iodized salt, but avoid avoid excessi excessive ve intake intake of salty salty foods. foods. 9. Eat Eat cle clean an and and saf safee food foods. s. 10. Exercise regularly, do not smoke, and avoid avoid drinking alcoholic beverages.
5. Recommended Dietary Allowances (RDA) Is the average daily amount of a nutrient considered enough to meet the known nutrient needs of practically all healthy people. These are set at levels higher than the requirements of most individuals. In the Philippines (2002), it is now called the Recommended Energy and Nutrient Intakes (RENI). UNDERSTANDING FOOD LABELS Food labels give information about the product’s contents, ingredients, and nutritional value. They provide the consumers information so that they can make healthier food choices. Information in the food label helps the consumers see how a food fits into their overall daily diet. The Bureau of Food and Drugs of DOH - is the government’s major implementor of nutrition labeling in the Philippines. Food and Drug Administration - in the USA. INFORMATION ON FOOD LABEL A. Mandatory Information on Food Labels; Every food label must prominently display and express in ordinary words. 1. Name Name of produc productt- This This tells tells the consumer consumerss what they are are buying buying and must not give a false false impression, ex. Strawberry yoghurt must contain strawberries where as “flavored” yoghurt don’t have. 2. Name Name & addr addres esss of manu manufa fact ctur urer er,, packe packerr or dist distri ribut butor or-- This This is show shown n for for comm commen ents ts// complaint/ or questions the consumer may wish to ask. 3. Place of originorigin- Some Some products products may appear appear misleading misleading if their their place of origin origin is not stated. stated. 4. Preparati Preparation on Instruction Instructionss- This should should be shown especiall especially y on high-risk high-risk foods so all all of bacteria bacteria are killed during cooking. 5. Weight Weight or quantityquantity- This This data will will help consume consumers rs compare compare products products fairly. fairly. 6. Storage Storage Instructio Instructionsns- The storage storage instructi instructions ons should should be given so that the date date mark is valid. valid.
B. Open-date Markings: All foods should be date marked apart from very long life products. 1. Consume Consume before or use use before or expirat expiration ion date - signifie signifiess the end of the estimat estimated ed shelf life life of a product beyond which certain quality attributes become significantly impaired. 2. Best use by - indicat indicates es the end of a period period after which which certain certain qualities qualities of the product product must must be expecte expected d to deteri deteriora orate. te. After After such such date, date, the produc productt may still still be satisf satisfact actory ory for human human 5
consumption and may remain marketable, but the makers presumably no longer guarantee its best quality. C. The Ingredient List – should be listed in descending order of predominance by weight and state on the label that they have done so. If water makes up more than 5% then it must be listed. Example : An orange powder that contains “sugar, citric acid, orange flavor”…. Versus a juice that contains “water, tomato concentrate, concentrated juice of carrots, celery… D. Serving Size - it reflects the amount that people customarily c ustomarily consume. E. Serving per container - this suggests the number of servings in the food package. F. Nutrition Facts panel - it provides information on certain nutrients. 1. The Percentage Daily Value (%) - this part of the panel tells whether the nutrients in a serving of food contribute a lot or a little to your total daily diet. Thus, the lower percentages indicate that the food provides less of the nutrient and higher percentages indicate that it gives more of the nutrient. They are based b ased on recommendations for a 2000-calorie diet. 2. Daily Values (DV) - are reference values set by the government for food labeling purposes. They are based on Daily Reference Values (DRVs) and Reference Daily Intake (RDIs). G. Health Claims - claims about the relationship between a nutrient/food and the risk of a disease or health-related condition may also show up on the front of the package. It was authorized by Food and Drugs Administration. Example: 1-calcium and osteoporosis- must contain 20% (200mg) or more of the RDI for calcium per serving. 2- Sodium and Hypertension- Must meet low sodium descriptor requirements and must not exceed disqualifying level for fat, saturated fat and cholesterol. RELATION OF NUTRITION TO HEALTH 1. Growth Growth and Development Development – good nutriti nutrition on is essential essential for the the attainment attainment of normal normal growth growth and development. 2. Spec Specif ific ic Defic Deficie ienc ncy y – good good nour nouris ishm hment ent is esse essent ntia iall for for the the prev prevent entio ion n of dise diseas ases es and and promotion of good health. 3. Resi Resist stan ance ce to Infe Infect ctio ion n – maln malnut utri riti tion on infl influe uenc nces es the the cour course se & outc outcom omee of many many clin clinic ical al disorders. 4. Mortality Mortality and Morbidi Morbidity ty – malnutriti malnutrition on contributes contributes to high high general death death rate, high IMR, IMR, high sickness rate & lower expectation of life. Over nutrition, in turn, is responsible for obesity, diabetes, HPN, CVD, renal diseases, liver and gallbladder disorders. NUTRITION- NURSE’S RESPONSIBILITIES Be aware of patients who are at risk for malnutrition & provide preventive care. Watch out for S/SX of malnutrition. Know the patient’s medical history. Know the patient’s social, economic & environmental limitations related to nutrition. Verify, communicate and record findings. Be familiar with different types of diets. Encourage patient’s participation in feeding. Be aware of the psychological impact of feeding assistance on the patient. Promot Promotee factor factorss that that improv improvee patien patient’ t’ss appeti appetite te such such as pleasa pleasant nt & comfor comfortab table le surroundings. ANATOMY & PHYSIOLOGY OF DIGESTIVE SYSTEM The Primary functions of Digestive System The The basi basicc role role of the the dige digest stiv ivee syst system em is to brin bring g esse essent ntia iall nutr nutrie ient ntss into into the the inte intern rnal al environment so that they are available to each cell of the body. The Various mechanism used to accomplish the primary functions of GIT include. 1. Inge Ingest stio ionn- Food Food is tak taken en.. 2. DigestionDigestion- Breakdo Breakdown wn of complex complex nutrient nutrientss into simpl simplee nutrients. nutrients. 3. Motili Motility ty of the wallwall- Physica Physically lly breaks breaks down large large chunks of foods materi material al and moves moves food along the tract.
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4. SecretionSecretion- Release Release of digestiv digestivee enzymes enzymes allows allows chemical chemical digesti digestion. on. 5. AbsorptionAbsorption- Movement Movement of nutrie nutrients nts through through the GI mucosa mucosa into the internal internal environmen environmentt . 6. Eliminati Elimination-Excr on-Excretion etion of materi material al that that is is not absorbed. absorbed.
The Gastrointestinal Tract The digestive system is composed of different parts through which food passes: 1. Mouth 2. Esophagus 3. Card Cardia iacc sphi sphinc ncte ter r 4. Stomach 5. Pylo Pylori ricc sphi sphinc ncte ter r 6. Small Small interstin interstinee (duodenum (duodenum,jeju ,jejunum num and ileum). ileum). 7. Ileo Ileoce ceca call valv valvee 8. Large intest intestine ine (Ascendin (Ascending, g, transvers transverse, e, descending, descending, sigmoi sigmoid d colon) 9. Rectum 10. 10. Anus Anus The Mouth
@ Composed of the lips, cheeks, teeth, tongue, salivary glands and palate @ Salivary glands (an exocrine glands) that include the parotid, submandibular and sublingual glands. @ Salivary amylase- An enzyme that splits amylose a(a form of starch) @ Subligual lipase- An enzyme that splits fats to a limited degree. The Pharynx
@ Tube through which food passes when moves from mouth to esophagus @ Divisions: 1. nasopharynx, 2. oropharynx, 3. laryngopharynx. @Epiglottis is the cartilage structure in the throat that prevents fluid or food from entering the trachea when a persons swallows. The Esophagus
@An elastic muscular tube about 25 cm long and lined with the mucus membrane that allows food to pass through easily. The tube that connects the pharynx to the stomach. This is where peristalsis starts. Peristalsis pushes the swallowed food, called bolus, along the digestive system: It is achieved through the successive waves of involuntary muscular contractions along the wall of the GIT. The Stomach
@ A saclike organs that receives the food from the esophagus. @ Divisions: Divisions: 1 Cardia – the part that immediately adjoins the esophagus, 2. Fundus- the upper domeshape part. 3. Body- the main central part, 4. Antrum- is the lower third of the stomach. @ Sphincter muscles 1. Cardiac sphincter – The sphincter muscle at the junction between the esophagus and the stomach. It keeps the entrance of the stomach closed and prevents gastric regurgitation. 2. Pyloric sphincter- the sphincter muscle separating the stomach from the small intestine ( also called pyloric valve). It is regulates the flow of chime to the small intestine. @ Chyme – A thick, creamy, acid liquid expelled by the stomach into the duodenum. @Gastric Mucosa – 1. epithelial lining (rugae), 2. gastric glands –release gastric juice, 3. Chief cells – secrete enzymes of the gastric juice and pepsin. 4. Parietal cells – secrete the very strong hydrochloric acid. @Functions : 1. Reservoir for food; Can hold up u p to 2 ½ pints of food which wh ich usually remains for 2 to 4 hours. 2. Produces the hormone gastrin which stimulates the secretion of gastric juice. 3. Secretes gastric juice (mixture of water, hydrochloric acid, enzymes and mucus) to aid in digestion of food.
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a. Hydrochloric acid- secrete by parietal cells Functions; 1. activates pepsinogen to pepsin. 2. Kills pathogenic bacteria swallowed with food. 3. renders some minerals suitable for absorption in the intestine. 4. Breaks food into small particles and mixes them with gastric juice. 5. Begins the process of digesting protein and fats. The Small Intestine
@ A 10-foot long coiled muscular tube of small diameter (1in) @ Divisions: 1. Duodenum – The top portion of the small intestine and receives digestive juices from the liver, gallbladder and pancreas. 2. Jejunum – The first two-fifths of the small intestine beyond the duodenum. 3. Ileum – the last segment where most of the absorption of food takes place, it is the site of absorption for Vit B12. @ Villi – Numerous fingerlike projections on the surface of intestinal wall; when magnified, a single villus turns out to be composed of several hundred cells called microvilli. Microvilli can trap nutrients particles and transport them into the cells. Once entered, nutrients are transmitted into the blood stream or the lymphatic system. In either case, the nutrients end u p in the blood. @ Functions: 1. It serves as the major site of digestion o f food and absorption of nutrients. 2. Through intestinal flora (bacteria), some amount of vital materials are manufactured like biotin and vitamin K: bacteria also protects the body from infection. @ Ileocecal valve – the sphincter muscle separating the small and large intestines. The Colon or Large Intestine @ The last portion of the GIT; Its length is abou t 1.5 to 1.8 m. @ Divisions: 1. Cecum – the large, primary section of the large intestine which accepts food by product from the ileum. 2. Apendix – A narrow blind sac at the apex of the colon. 3. Ascending Colon . 4. Transverse Colon 5. Desending colon 6. Sigmoid Colon – Connects the end of the descending colon to the rectum. 7. Rectum – The muscular terminal terminal part of the GI tract tract extending from the sigmoid to the anus. It stores waste prior to the elimination. 8. Anus – Is a sphincter muscle that controls the elimination of feces. The Role of the Accessory Organs The Pancreas
@ A gland that secrete enzymes and digestive juices into the duodenum through its pancreatic duct, this is the exocrine function of the pancreas. Its endocrine function is the secretion of hormone insulin and other hormones into the blood. The Liver
@ Considered the largest of the body’s gland. @ Functions : 1. Aids in the digestion of fats by secreting bile into the duodenum. Bile is composed of cholesterol, bile salts, and bile pigments. 2. Destroy RBC. 3. Forms urea for the of nitrogenous waste. 4. Forms fibrinogen used in blood coagulation. c oagulation. 5. Stores glycogen. 6. Helps in the metabolism and storage of vitamins. 7. Produces protective and antioxidant substances. 8
The Gallbladder
@ The organs that stores and concentrates bile, an emulsifier that prepares fats and oils for digestion. Located in the underside of the liver. @ When gallbladder receives the signal that fat is present in the duodenum . It contracts and squirts bile through the bile duct into the duodenum.
ABSORPTION OF NUTRIENTS DUODENUM Vit.A and B1 Iron and Calcium Monoglycerides, glycerol, fatty acids
Amino acids Monosaccharides Disaccharides
JEJUNUM ILEUM COLON Glucose, galactose Disaccharides Na, K, H2O Amino acids,dipeptides Na, K, Cl, Ca, Mg, P, I Acids and gasses Glyc Glycer erol ol,, fatt fatty y acid acids, s, Vit. D, E, K, B1, B2, Some short-chain short-chain fatty fatty mono/diglycerides B6, B12 and C acid acidss prod produc uced ed from from plant fibers Cu,Zn,K,Ca,Mg,P,I,Fe Most of the water Undigested starch Fat/Water soluble vit Vitamins made by bacteria (biotin & K) Remaining al alcohol
Prepared by: Florenz chiong
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B. CARBOHYDRATES AND SUGARS Is the preferred (main) energy source for most of the body’s activities including the brain and muscle functions. Compounds which contain carbon, hydrogen and oxygen.
Classification 1. Simple CH CHO a. _______________ __________________ ___ – single single sugars. sugars. Ex: glucose, glucose, fructose fructose and galactose galactose.. b. _______________ __________________ ___ - sugars sugars composed composed of pairs pairs of monosacchar monosaccharide. ide. Ex: sucrose, sucrose, maltos maltosee and lactose. 2. Complex CHO a. _______________ ___________________ ____ - large large molecules molecules composed composed of of chains chains of monosaccha monosaccharide. ride. Ex: Ex: starch, starch, dextrins and glycogen. Monosaccharide These compounds cannot be hydrolyzed to simpler compounds. Glucose, Galactose and Fructose have same formula (_______). But they differ in the arrangement and are distinctive in their physical properties such as solubility & sweetness.
A. Glucos Glucosee (a.k. (a.k.aa ______ ________) __) It is white, crystalline, and easily soluble in water with sweet taste. It is readily absorbed from the stomach. It is also present in fruits and honey. B. Fructo Fructose se (a.k.a (a.k.a.___ ._______ _____) _) It is sweeter than glucose. It is obtained by the hydrolysis of sucrose. C. Gala Galact ctos osee It is not found free in nature. Its only source being from hydrolysis of lactose. It also occurs in cerebrosides present in brain and nervous tissue (nutritionally important). Disaccharides Formed Formed by the condensatio condensation n of two monosacchari monosaccharides des with the elimination elimination of one molecule of water. A. Sucr ucrose Occurs in sugarcane and beet root. Formed by the condensation of one molecule of glucose and one molecule of fructose. Easily hydrolyzed to glucose and fructose either by dilute mineral acids or by the enzyme SUCRASE present in intestinal juice. Sucrose glucose + fructose B. Maltose Present in malt. Formed in cereal grains during germination by the hydrolysis of starch. It is formed when starch present in the food is digested by salivary and pancreatic amylase. 10
Maltose is also formed by the condensation of 2 glucose molecules. It is hydrolyzed to glucose by the enzyme MALTASE. Maltose glucose + glucose
C. Lactose Type of sugar present in milk of all mammals. Formed by the condensation of one molecule of glucose and one molecule of galactose. It is hydrolyzed to glucose and galactose by the enzyme LACTASE present in intestinal juice. Lactose glucose + galactose Polysaccharides large molecules composed of chains of monosaccharide. 2 Groups of Polysaccharides 1. ________________ - are complex CHO that can be broken down into sugar units. Ex: Starch & dextrins. 2. ________________ - are complex CHO that contain sugar units held together by bonds that human digestive system cannot break, thus, they yield little, if any, energy. - a.k.a Dietary Fibers 2 Classes of Dietary Fibers 1. __________________ - are the tough, fibrous structures of fruits, grains and ve getables. - They are so called because they do not dissolve in water. - Ex: cellulose, hemicellulose, lignin 2. __________________ - are indigestible food components that readily dissolve in water and often imparting gummy or gel-like characteristics of food. - Ex: pectin, gums, psyllium and algal polysaccharides
OTHER FORMS OF SUGAR: Sugar Alcohols (___________________) Are sugar-like compounds that are sweet to taste but yield less kcal per gram. They They are are used used as a sucr sucros osee subs substi titu tute te in cand candie ies, s, chew chewin ing g gum, gum, beverages & other foodstuffs. Ex: Sorbitol, Mannitol and Dulcitol. Artificial Sweeteners (__________________) Make food taste sweet without promoting damage to tooth enamel. They are non-CHO, non-caloric sweetening agents. Ex: Aspartame, Saccharin, Sucralose FOOD SOURCES There are three main sources of Carbohydrates: Carboh ydrates: ___________ – these are present in cereal, roots & tubers, etc. (rice, rice products, sweet potatoes, other root crops, corn, breads, pasta, noodles, refined grain products). ___________ - monosaccharide & disaccharides. (sucrose – table sugar, candies, softdrinks, chocola chocolates tes,, etc.; etc.; fructo fructose se – honey, honey, ripe ripe fruits fruits & some some vegetab vegetables les;; lactos lactosee – milk milk & milk milk products) ___________ - is a tough fibrous lining found in vegetables, fruits & cereals, etc. It is hard to digest and has no nutritive value. However, it acts as roughage and prevents constipation. ( stems/leaves of vegetables, apples, root vegetables, cab bage family, peas and beans, etc.) FUNCTIONS OF CHO Protein sparer Fat sparer (anti-ketogenic effect) 11
Sole energy source for the brain and nerve tissues. Reserve fuel supply Regulator of normal bowel movement Acts as structural component
RECOMMENDED INTAKE OF CHO (RDA) The suggested total amount of CHO in the diet varies & is typically based on the food habits: American diet: ___ to ___ percent of the daily total calorie intake RDA: 130 g/day Filipino diet: ___ to ___ percent of the daily total calorie intake, majority should come from complex CHO such as starches and fibers. Moderate sugar intake is encouraged amounting to maximum of ___% of total calories. Recommended intake of dietary fiber is ___ to ___ grams per day. HEALTH EFFECTS 1. Sugars Nutrient Deficiencies Dental caries Obesity Atheroclerosis 2. Star Starch ch and and Fib Fiber erss Weight loss Satiety value Lower risk of heart disease Lower risk of diabetes Enhanced health of the colon
ISSUES & CONTROVERSIES ABOUT CHO 1. 2. 3. 4. 5. 6. 7. 8.
Comp Comple lex x CHO CHO are are fatt fatten enin ing g Refined Refined sugar (sucrose) (sucrose) and and foods containin containing g concentrated concentrated sugars sugars are empty-calor empty-calorie ie foods. Suga Sugarr caus causes es dent dental al cari caries es.. Sugar alcohols alcohols are calorie-fr calorie-free ee carbohydrate carbohydrates. s. Too much much suga sugarr caus causes es diabet diabetes. es. Use of artif artificial icial sweeteners sweeteners poses health health risks. risks. Sugar causes hyperactivi hyperactivity ty or aggres aggressivene siveness ss in young young children children.. Honey Honey is is bette betterr sweet sweeter er than than suga sugar. r.
CARBOHYDRATE DIGESTION & ABSORPTION DIGESTION The purpose of Carbohydrate digestion is to h ydrolyze the disaccharides and polysaccharides of the diet to their simplest forms. This is accomplished by the enzymes of the digestive juices and yields the respective end products.
ABSORPTION Most absorption of carbohydrates occurs in jejunum. The absorption of carbohydrates from the intestine is controlled by certain factors like condition of the intestinal tract and muscle tone, endocrine glands, etc.
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Prepared by: Romeo C. Tuazon Jr. RN LECTUERE III
C. PROTEINS AND AMINO ACIDS The word protein is derived from the Greek word “primary or holding or first place _” which means principal components of all living cells and are important in practically all aspects of cell structure and functions. Proteins are vital for growth, repair and maintenance of the body. Chemically, proteins contain the same atoms as carbohydrates and lipids – C, H, and O – but protein also contain nitrogen atoms. Proteins are made up of about 20 common acids. All amino acids have the same basic structure – a central carbon (C) atom, with an amino group (NH2), an acid group (COOH), hydrogen (H), and a side group attached. The side group is a unique chemical structure that differentiates one amino acid from another.
Classification of Amino Acids 1. Essential amino acid - are those that cannot be synthesized in the body. Thus they can be attained from food alone. Ex: Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine.
2. Non-essential amino acid - are those that body can synthesize from an available source of nitrogen and carbon skeleton. and therefore are not as necessary for consideration in the diet. Ex: Alanine, Arginine, Asparigine, Aspartic acid, Cysteine, Glutamic acid, Glutamine, Glycine, Proline, Serine, Tyrosine. Classification of Proteins according to its origin 1. Complete protein - protein foods of animal origin, such as eggs, milk, fish, poultry, pou ltry, and meats. They provide all the essential amino acids in sufficient amount to meet the body’s needs. 2. Incomplete protein - plant protein foods, except soya. 3 Main Classifications of Proteins 1. Simple proteins - on hydrolysis by acid, alkali or enzymes yield only amino acids or their derivatives. - Ex: albumin & globulins found within all body cells (blood serum), keratin, collagen & elastin in supportive tissues of the body (hair and nails), globin (hemoglobin and myoglobin).
2. Compound protein or Conjugate protein or Proteids - these are composed of simple proteins combined with a non-proteinaceous substance. - Ex: Lipoproteins (carrier needed for the transport of fats in blood), Nucleoprotein (the protein of cell nuclei), Phosphoprotein (casein milk & ovovitellin in eggs), Metalloproteins (enzymes tha contain mineral elements), Mucoproteins (found in connective tissue). proteins- these 3. Derived proteinsthese are substa substance ncess result resulting ing from from the decompo decomposit sition ion of simple simple and conjugated proteins.
Chemical Stages of Protein
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As indicated by its name, an amino acid has a chemical structure that combines both acid and bases (amino factors). This important structure gives amino acids a unique buffering capacity. This acid-base nature of amino acids also enables them to join one another to form the characteristic chain structure of protein. The amino (base) group of one amino acid joins the acid (carboxyl) group of another.This characteristic chain structure of amino acids is called peptide linkage. Long chains of amino acids that are linked in this manner are called polypeptides.
FOOD SOURCES a. Sources Sources of of Comple Complete te Protei Proteins ns (Anima (Animall sources) sources) Fish, shellfish Chicken, turkey, duck Beef Soybeans (tofu) Hard cheese, cheddar Milk, yogurt, reduced fat ice cream Lamb, pork, egg b. Sources Sources of Incom Incomple plete te Protein Proteinss (Plant (Plant sources) sources) Cereals: ready to eat, oatmeal, wheat Grains: wheat, rice, corn, oats, barley, spaghetti, bread Vegetables: broccoli, potatoes, green peas, leafy green vegetables Legumes: beans, peanuts FUNCTIONS OF CHON Protein are used in repairing worn out body tissue protein (anabolism) resulting from the body continued wear and tear (catabolism) going on in the body. Proteins are used to build new tissue by supplying the necessary amino acids building blocks. Proteins are source of heat and energy. They supply 4 calories per gram of protein. Proteins contribute contribute to numerous essential essential body secretions secretions and fluids, enzymes enzymes and proteins. proteins. Proteins Some hormones have protein or amino acid components. Mucus and milk are largely protein. Sperm cells are large protein as is the fluid in which sperm cells are contained. Proteins are important in the maintenance of normal osmotic relations among the body various body fluids. Proteins play a large role in the resistance of the body to disease. Dietary proteins furnish the amino acids for a variety of metabolic functions. RECOMMENDED INTAKE OF CHON (RDA) Daily protein allowance may be estimated based on desirable body weight. Protein allowance=DBW (kilo) x protein allowance per k DBW Group Protein Allowance per kilogram weight Infants 2.75-3.0 g Children 1.5-2.0 g Early adolescent 1.5 g Older adolescent 1.25 g Adults 1.12 g(Filipinos), 0.8 g (Americans)
HEALTH EFFECTS of CHON Heart Disease – Food rich in animal protein tends to be rich in saturated fats. Cancer – Studies suggest a relationship between high intakes of animal protein and some types of cancer like cancer of the prostate prostate gland, pancreas, kidneys, breast and colon.
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Osteoporosis – Calcium excretion rises as protein intake increases. Obesity – Protein rich foods are also rich in fat which lead to obesity with associated health risks. Kidney Disease – Excretion of end products of protein metabolism depends on a sufficient fluid intake and healthy kidneys. A high protein diet increases the work of the kidneys. Protein Energy Malnutrition Malnutrition – This results when a person is deprived of protein, energy or both; manifested by poor growth in children, weight loss and wasting in adults.
PROTEIN ENERGY MALNUTRITION (PEM) A deficiency of protein, energy, or both, including kwashiorkor, marasmus and instances in which they overlap. It is one of the most prevalent and an d devastating forms of malnutrition in the world. It most often strikes early in childhood.
2 Stages of Protein Energy Malnutrition 1. Acute PEM - caused by recent severe food restriction; characterized in children by thinness for height (wasting). 2. Chronic PEM- caused by long-term food deprivation; characterized in children by short height for age (slunting). Classifications of PEM 1. Marasmus Appropriately named from the Greek word meaning “drying away”. A form of PEM that results from a severe deprivation, or impaired absorption of energy, protein, vitamins, and minerals.
2. Kwashiorkor It was originally a Ghanian word meaning “the evil spirit that infects the first child when the second child is born”. A form of PEM that results either from inadequate protein protein intake intake or, more commonly, commonly, from infections.
FEATURES OF MARASMUS AND KWASHIORKOR IN CHILDREN MARASMUS Infancy (6 to 18 months of age)
Severe deprivation or impaired absorption of protein, energy, vitamins and minerals Develops slowly (chronic PEM) Severe weight loss Sever everee mus muscl clee wa wastin sting, g, with with no body body fat Growth: <60% weight for age No detectable edema No fatty liver Anxiety, apathy Good appetite possible Hair Hair is is spar sparse, se, thin, thin, and and dry dry;; easil easily y pull pulled ed out out Skin is dry, thin and easily wrinkles
KWASHIORKOR Older infants & young children (18 months to 2 years old) Inadequate protein intake or, more commonly, infections Rapid onset (Acute PEM) Some weight loss Som Some mus muscl clee was wastting, ing, wit with ret reten enti tion on of som some body fat Growth: 60-80% weight for age Ed e m a Enlarged fatty liver Apathy, Misery, Irritability, Sadness Loss of appetite Hair Hair is is dry dry and britt brittle; le; easily easily pulled pulled out; out; chang changes es color; becomes straight Skin develops lesions
Treatment and Prevention of PEM 1. In de developing co countries, br breast fe feeding sh should be be en encouraged an and it it en ensures adequate supply of nutrients and antigens.
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2. Food stuffs that contain su sufficient am amounts of essential Am Amino ac acids should be be provided. 3. Improvement of sanitation and program of immunization. 4. Fluids wi w ith el e lectrolytes of o f so s odium an a nd po p otassium wh w hich wi w ill ma m aintain electrolyte balance.
PROTEIN DIGESTION & ABSORPTION DIGESTION The purpose of digestion is to hydrolyze proteins to Amino acids so that they can be absorbed readily by the body. There is no protein breaking enzyme in saliva. So the digestion (hydrolysis) os protein protein begins in the stomach. The enzyme enzyme PEPSIN PEPSIN secreted by gastric gastric glands in the stomach stomach breaks down protein to peptones and proteoses. In the case of milk, milk protein is first converted to casein by the enzyme called RENIN. Casein combines with calcium to form calcium caseinate. Pepsin converts this to peptones. Strong enzymes are needed to breakdown the peptide linkage. The stronger enzymes are are foun found d in pancr pancrea eati ticc and and inte intest stin inal al juic juices es.. The The pancr pancreat eatic ic juic juicee cont contai ains ns TRYP TRYPSI SIN N and and CHYMOTRYPS CHYMOTRYPSIN. IN. The final breakdown breakdown of all proteins fractions fractions to amino acids is brought about by ERPSIN secreted by intestinal mucosa. ABSORPTION Amino acids are absorbed by the small intestine and thereby carried to the liver by portal vein. The amino acids reach the respective tissues where the required metabolism occurs.
Prepared by: Roderick Magpantay
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LECTURE IV D. FATS AND OTHER LIPIDS LIPIDS A family of compounds that includes triglycerides (fats and oils), phospholipids (lecithin), and sterol (cholesterol). They are characterized by their insolubility in water.
Classification of Lipids 1. Trig Trigllyceri ceride dess The chief form of fat in the diet and the major storage form of fat in the body. Of the lipids in foods, 95 % is fats and oils (triglycerides). Of the lipids stored in the body, 99% is triglycerides. Composed of a molecule of glycerol with 3 fatty acids attached. Glycerol – an alcohol composed of a three-carbon chain, which can serve as the backbone for a triglyceride. Ex: fats and oils FATS
It belongs to a group of substances called lipids. It is a lipid that is solid at room temperature (250C). The fat in foods is a combination of three different fatty acids.
Classifications of Fats 1. Visibl Visiblee fats fats - include include butter butter,, oils, oils, mayonnai mayonnaise, se, fat attached attached to meat, are obvious obvious fats that are plain to see. 2. Invisi Invisible ble fats - are presen presentt in avocado avocado,, peanut peanuts, s, milk, milk, sausag sausages, es, cheese, cheese, egg yolk, seeds seeds and even lean meats (about 6% of the total fat remains). FATTY ACIDS An organic compound composed of a carbon chain with hydrogen attached and an acid group (COOH) at one end and a methyl group (CH3) at the other end. Like CHO, fatty acids and triglycerides are composed of C, H and O. They differ from CHO in that they contain much less oxygen and much grater proportions of carbon. Classifications of Fatty Acids 1. Satu Satura rate ted d - a fatt fatty y acid acid carryi carrying ng the the maxi maximu mum m possi possibl blee numb number er of hydr hydrog ogen en atom atomss – for for example, stearic acid. A ___________ fat is composed of triglycerides in which most of the fatty acids are saturated. 2. ________ ___________ _______ ________ ____ - a fatty fatty acid acid that lacks lacks hydrogen hydrogen atoms atoms and has at least one double double bond between carbons. An _________________ fat is composed of triglycerides in which most of the fatty acids are unsaturated. 17
a. ________ ___________ _______ ________ ______ __ - a fatty acid acid that lacks lacks 2 hydrog hydrogen en atoms atoms and has 1 double double bond bet betwe ween en carb carbons ons – for for exam exampl plee olei oleicc acid. acid. A _____ _______ _____ _____ _____ ____ _ fat fat is comp compos osed ed of triglycerides in which most of the fatty acids are monounsaturated. b. _______________ ____________________ _____ - a fatty fatty acid that that lacks lacks four or more more hydrogen hydrogen atoms atoms and has two or or more more doubl doublee bonds bonds betw betwee een n carb carbon onss – for for examp example le,, linol linolei eicc acid acid & lino linole leni nicc acid. acid. A ________________ fat is composed of triglycerides in which most of the fatty acids are polyunsaturated. Depending on the location of the double bonds, this may be: A1. ____________________ - first double bond 3 Carbons away from methyl end. A2. ____________________ - first double bond 6 carbons away from methyl end. OILS
It is a lipid that is liquid at room temperature (250C).
2. Phospholipids compound similar similar to a triglyceri triglyceride de but having a phosphate phosphate group (a phosphorus-contai phosphorus-containing ning A compound salt) and choline (another nitrogen-containing compound ) in place of one of the fatty acid. The best-known phospholipid is lecithin. Lecithin is used as an emulsifier to combine water-soluble and fat-soluble ingredients that do not ordinarily mix, such as water and oil. The lecithins and other phospholipids are important constituents of cell membranes. 3. Sterols Compounds containing a four-carbon ring structure with any of a variety of side chains attached. The most famous sterol is cholesterol. 2 Types of Cholesterol a. ________ ___________ _______ ____ - a.k.a a.k.a high high density density lipopro lipoprotei tein n (HDL), (HDL), type of lipopr lipoprote otein in that that trans transpor ports ts cholesterol back to the liver from the cells; composed primarily of protein. b. _______________ _______________ - a.k.a a.k.a low density density lipoprot lipoprotein ein (LDL), (LDL), a type of protein protein derived derived from very very low density lipoproteins (VLDL) as VLDL triglycerides are removed and broken down; It carries cholesterol back to the cells of all tissues. Composed primarily of cholesterol.
FOOD SOURCES Saturated Fatty Acids: mainly found in animal fats like butter, palm oil, coconut oil, beef, lard, meats, bacon & sausages, dairy fats, organ meats, milk & milk products, egg yolk Monounsaturated fatty acids: are abundant in peanuts and peanut oil, pecans, canola oil, olive oil, avocado, and chicken fat. Polyunsaturated fatty acids: - Omega-3 Omega-3 = are are plenty plenty in fresh fresh tuna, tuna, pink pink salmon salmon,, king crab, crab, cod live liverr oil, oil, salmon salmon oil, oil, mackerel and herring - Omega-6 = are are found found mainly mainly in in corn oil, sunflower sunflower oil, cottonseed cottonseed oil, soya oil. Cholesterol-rich foods: high in egg yolk, internal organs of meat, sweetbreads, mayonnaise Foods with moderate amount of cholesterol: crabs, lobster, shrimp, fats on meats, tinned or powdered milk, biscuits, butter, cheese, most commercial cakes, pastries, ice cream Choles Cholester terolol-fre freee foods: foods: all types types of vegetab vegetables les,, all vegetab vegetables les oils, oils, fruits fruits including avocado and olives, pasta (without eggs), nuts, cereals, and unbuttered popcorn. FUNCTIONS OF FATS Provides essential fatty acids Contributes to feeling of fullness, taste and smell 18
Dietary fat serves as conveyor for vitamins A, D,E, and K Energy reserve and emergency fuel Regulator of body functions Insulator Protector Cell structure
RECOMMENDED INTAKE OF FATS (RDA) American diet: ___ to ___ percent of the daily total calorie intake Filipino diet: ____ to ___ percent per day for infants and ___ to ____ % per day for all others. SFA: <10% of daily energy intake MUFA: 10-15% of energy intake PUFA: < 10% of energy intake Cholesterol: no more than 300 milligrams per day is ideal. HEALTH EFFECTS of FATS Heart Disease (good and bad) Cancer Obesity Fat-soluble vitamin deficiency LIPID DIGESTION, ABSORPTION AND TRANSPORT DIGESTION The digestion of fats begins in small intestine. The fats are emulsified to form CHYME. When the chyme enters duodenum, it stimulates the release of ENTEROGASTRONE. This hormone reduces the motility and stabilizes the flow of chyme in order to correspond to the availability of pancreatic secr secret etio ions ns.. The The pres presenc encee of fat fat in duode duodenu num m also also stim stimul ulat ates es the the inte intest stin inal al wall wall to secr secret etee CHOLECYSTOKININ hormone which stimulates the contraction of gallbladder pouring bile into the small intestine after passing through common bile duct. ABSORPTION Most of the absorption of fat occurs in jejunum. TRANSPORT Lipoproteins – clusters of lipids associated with proteins that serve as transport vehicles for lipids in the lymph and blood. 4 Main Types of Lipoproteins 1. ____________________ - the class of lipoproteins that transports lipids from the intestinal cells to the rest of the body. 2. ____________________ - the type of lipoprotein made primarily by the liver cells to transport lipids to various tissues in the body; composed primarily of triglycerides. 3. ____________________ - the type of lipoprotein derived from VLDL as VLDL triglycerides are removed and broken down; composed primarily of cholesterol. 4. ____________________ - the type of lipoprotein that transports cholesterol back to the liver from cells; composed primarily of protein. p rotein.
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Prepared by: Romeo C. Tuazon Jr. RN
LECTURE V E. MINERALS
are Inorganic elements. Because the body cannot synthesize them, they have to be provided in the diet. About 1% to 6% of body bo dy weight is mineral. Because minerals are inorganic, they are indestructible and need not be handled with the special care that vitamins require. They give no caloric value and remain as ash when completely burnt.
Classification of Minerals 1. MAJO AJOR MIN MINER ERAL ALS S Essential mineral nutrients found in the human body in amounts larger than 5g. They are so named because they are present, and needed, in larger amounts in the body.
MINERAL & CHIEF DEFICIENCY FUNCTIONS Muscle cramps, mental SODIUM Maintains normal fluid apathy, loss of appetite & electrolyte balance; assist in nerve impulse transmission & muscle contraction Do not occur under CHLORIDE Maintains normal fluid normal circumstances and electrolyte balance; part of HCL found in stomach, necessary for proper digestion Muscle weakness, POTASSIUM Maintains normal fluid paralysis, confusion and electrolyte balance; facilitates many reactions; supports cell integrity; assist in nerve impulse transmission
TOXICITY
Edema, acute hypertension
Vomiting
Muscular weakness; vomiting; if given into a vein – can stop the heart
SOURCES
Table salt, soy sauce; moderate amounts in meats, milks, breads and vegetables; large amounts in processed foods Table salt, soy sauce; moderate amounts in meats, milks, eggs; large amounts in processed foods All whole foods; meats, milks, fruits, vegetables, grains, legumes
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and muscle contractions CALCIUM Mineralization of bones & teeth; also involved in muscle contraction & relaxation, nerve functioning, blood clotting, BP, immune defenses PHOSPHORUS Mineralization of bones and teeth; part of every cell; important in genetic material, part of phospholipids, used in energy transfer and in buffer systems that maintain acid-base balance MAGNESIUM Bone mineralization, building of protein, enzyme action, normal muscle contraction, nerve impulse transmission, maintenance of teeth, and functioning of immune system SULFUR As part of proteins, stabilizes their shape by forming disulfide bridges; part of the vitamins biotin and thiamin and the hormone insulin
Stunted growth in children; bone loss (osteoporosis) in adults and (osteomalacia) in pedia. Tetany
Constipation; increased risk of urinary stone formation & kidney dysfunction; interference with absorption of other minerals
Milk & milk products, small fish (with bones), tofu, greens (broccoli), legumes.
Muscular weakness, bone pain
Calcification of nonskeletal tissues, particularly the kidneys.
All animal tissues (meat, fish, poultry, eggs, milk).
Weakness, confusion; if extreme, convulsions, bizarre muscle movements (especially of eye and facial muscles), hallucinations, and difficulty in swallowing and children, growth failure None known; protein deficiency would occur first
From nonfood sources only; diarrhea, alkalosis, dehydration
Nuts, legumes, whole grains, dark green vegetables, seafood, chocolate, cocoa
Toxicity would occur only if sulfurcontaining amino acids were eaten in excess; this (in animals) depresses growth
All protein-containing foods (meat, fish, poultry, eggs, milk, legumes, nuts)
Safe Upper Limit of Major Minerals for Adults (19-70 years old)
Calcium – 2500mg Phosphorus – 3000 mg (>70) and 4000 mg (<70) Sodium – 2400 mg (recommended maximum intake) Magnesium – 350 mg Chloride – not known Potassium – 4500 mg
Absorption Inhibitors of Major Minerals Many factors affect the availability of minerals for body absorption. Such factors may include drugs and certain food or its component. componen t.
Calcium – high phosphorus, salt, or protein intake; alcohol, oxalic acid, phytic acid, some laxatives, some diuretics, some antibiotics and large doses of B complex pills Magnesium – alcohol, diuretics, calcium carbonate and antacid. Phosphorus – excess magnesium and aluminum, aluminum and magnesium-containing antacids Sodium – some diuretics and anti-gout drugs Potassium – excess sodium intake, alcohol, coffee, some diuretics and anti-gout drugs 21
2. TRAC TRACE E MIN MINER ERAL ALS S Essential mineral nutrients found in the human body in amounts smaller than 5g. They are so named because beca use they are present, and needed, in relatively small amounts in the body.
MINERAL & CHIEF DEFICIENCY FUNCTIONS Anemia; weakness, IRON Part of the protein fatigue, headaches; hemoglobin, which impaired work carries oxygen in the performance; impaired blood; part of the immunity; pale skin, protein myoglobin in nail beds, mucous muscles, which makes membranes, and palm oxygen available for creases; concave nails; muscle contraction; inability to regulate necessary for energy body temperature, pica metabolism ZINC Growth retardation, Part of insulin and delayed sexual many enzymes; maturation, impaired involved in making immune function, hair genetic material and loss, eye and skin proteins, immune lesions, loss of appetite reactions, transport of Vit. A, taste perception, wound healing, the making of sperm, & normal fetal development IODINE Underactive thyroid A component of the gland, goiter, mental thyroid hormones that and physical retardation help to regulate growth, (cretinism) development, and metabolic rate SELENIUM Associated with Keshan Part of an enzyme that disease defends against oxidation; regulates thyroid hormone COPPER Anemia, bone Helps form abnormalities hemoglobin; part of several enzymes MANGANESE Cofactor for several enzymes FLUORIDE Helps form bones and teeth; confers decay resistance on teeth CHROMIUM Enhances insulin action rMOLYBDENUM
TOXICITY
SOURCES
GI distress; iron overload: infections, fatigue, joint pain, skin pigmentation, organ damage
Read meats, fish, poultry, shellfish, eggs, legumes, dried fruits
Loss of appetite, impaired immunity, low HDL, copper and iron deficiencies
Protein-containing foods: red meats, fish, shellfish, poultry, whole grains
Underactive thyroid gland, elevated TSH, goiter
Iodized salt; seafood; plants grow in iodinerich soil and animals fed those plants
Nail and hair brittleness and loss; fatigue; irritability and nervous system disorders, skin rash, garlic breath odor Liver damage
Seafood, organ meats; other meats, whole grains, and vegetables (depending on soil content) Seafood, nuts, legumes, whole grains, seeds
R a re
Nervous symptom disorders
Nuts, whole grains, leafy vegetables, tea
Susceptibility to tooth decay
Fluorosis (pitting and discoloration) of teeth
Drinking water if fluoride containing or fluoridated, tea, seafood
Diabetes-like condition
None reported
Unknown
None reported
Meats (liver), whole grains, brewer’s yeast Legumes, cereals, 22
Cofactor for several enzymes
organ meats
Safe Upper Limit of Trace Minerals for Adults (19-70 years old) Iron – 65 mg Chromium – 1000 mcg Iodine – 1000 mcg Fluoride – 10 mg Copper – 9 mg Manganese – 700 mg Selenium – 200 mcg Zinc – 30 mg Absorption Inhibitors of Trace Minerals
Iron Iron – phytat phytates es (found (found in seeds, seeds, nuts, nuts, and grains grains), ), large large quantit quantities ies of tea/co tea/coffe ffee, e, calciu calcium m supplements, aspirin, narcotics (codeine, morphine), and anti-gout drugs. Zinc – alcohol, some diuretics, contraceptive pill, hormone replacement therapy, phytates, large amounts of coffee/tea, diet high in iron, and iron supplements Copper – high zinc diet, zinc supplements, high intake of iron, manganese, molybdenum, and vitamin C, and antacids Iodine – goitrogenic substances in foods (turnips, cabbage, cassava, and Brussels’s sprouts)
Prepared by: Roderick C. Magpantay
NUTRITION ASSESSMENT A comprehensive analysis of a person’s nutrition status that uses health, socioeconomic, drug, and diet histories; anthropometric measurements; physical examinations; and laboratory tests. Malnutrition – any condition caused by excess or deficient food energy or nutrient intake or by an imbalance of nutrients. 2 Types of Malnutrition 1. ____________________ - deficient energy or nutrients. 2. ____________________ - excess energy or nutrients.
A. Histor Historica icall Inform Informati ation on 1. _____ ________ _____ _____ _____ _____ _____ _____ ___ Reflects a person’s medical record and may reveal a disease that interferes with the person’s ability to eat or the body’s use of nutrients. person’s ’s famil family y histor history y of major major diseas diseases es is also also notewor noteworthy thy,, especi especiall ally y for The person conditions such as heart disease that have a genetic tendency to run in families. Ex: current and previous health problems and family health history that affect nutrient needs, nutrition status, or the need for intervention to prevent health problems. 2. _____ ________ _____ _____ _____ _____ _____ _____ ___ record rd of a pers person on’s ’s soci social al and and econo economi micc back backgr grou ound, nd, incl includ udin ing g such such fact factor orss as A reco education, income and ethnic identity. Ex: personal, cultural, financial, financial, and environment environmental al influences influences on food intake, nutrient nutrient needs, and diet therapy options. 3. _____ ________ _____ _____ _____ _____ _____ _____ ___ A record of ell the drugs, over-the-counter ov er-the-counter and prescribed, that a person takes routinely. medications,, illicit illicit drugs, dietary supplements, supplements, and alternative alternative therapies that affect affect Ex: medications nutrition status. 23
4. _____ ________ _____ _____ _____ _____ _____ _____ ___ A record of eating behaviors and the foods a person eats. Ex: Nutrient intake excesses or deficiencies and reasons for imbalances. 24-hour recall: a record of foods eaten by a person for one 24-hour period. B. Anthropometric Measurements Are physical measurements that reflect body composition and development. 1. _____ ________ _____ _____ _____ _____ _____ _____ ___ Reflects abdominal fluid retention and abdominal organ size. 2. _____ ________ _____ _____ _____ _____ _____ _____ ___ Reflects over nutrition and under nutrition; growth in children 3. _____ ________ _____ _____ _____ _____ _____ _____ ___ Reflects brain growth and development in infants and children under age two. 4. _____ ________ _____ _____ _____ _____ _____ _____ ___ Reflects subcutaneous and total body fat. 5. _____ ________ _____ _____ _____ _____ _____ _____ ___ Reflects body fat distribution
C. Physical Examination Used to search for signs of nutrient deficiency or toxicity. Many physical signs are nonspecific; they can reflect any of several nutrient deficiencies as well as conditions not related to nutrition.
BODY SYSTEM
ACCEPTABLE FINDINGS
Shiny, Shiny, firm firm in in the the scal scalp p
MALNUTRITION FINDINGS
Dull, Dull, brit brittle tle,, dry, dry, loose; loose; falls out Bright, clear pink Pale membrane; spots; membranes; adjust redness; adjust slowly easily to light to darkness No pain or caries, gums Missing, discolored, firm, teeth bright decayed teeth; gums bleed easily and are swollen and spongy Clear complexion Off-color, scaly, flaky, without dryness or cracked skin scaliness No lumps Swollen at front of neck Red, bumpy, rough Sore, smooth, purplish, swollen Smooth, firm, good Dry, rough, spotty. color “sandpaper” feel or sores; lack of fat under skin Firm, pink Spoon-shaped, brittle, ridged, pale Regular heart rhythm, Abnormal heart rate, heart rate, and blood heart rhythm, or blood
WHAT THE FINDINGS REFLECT
PEM Vitamin A, B, zinc and iron status Mineral and vitamin C status
PEM, vitamin A and iron status PEM and iodine status Vitamin B status PEM, essential fatty acid, Vitamin A, B, and C status Iron status PEM and mineral status 24
pressure; no pressure; enlarged liver, impairment of digestive spleen; abnormal function, reflexes, or digestion; burning, mental status tingling of hands, feet; loss of balance, coordination; mental confusion, irritability and fatigue Muscle tone; posture, “wasted” appearance of PEM, mineral, and long bone development muscles; swollen vitamin D status appropriate for age bumps on skull or ends of bones; small bumps on ribs; bowed legs or knock knees
D. Laboratory Tests It confirms suspicions raised by other o ther assessment methods. Taking samples of blood or urine, analyze them in the laboratory, and compare the results with normal values for a similar population.
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