Nutrition Over view

Profesor drg. Dwi Prijamokop, PhD

Major Food/Nutrition
Carbohidrate as main energy source Protein Fat

Nutritional significance of Lipid

Is most concentrated dietary energy source 9 kcal/g (37Kj/g) Man has a wide range of sources Animal / plant sources Animal : Monogastric : Kind of fat depends on fat ingested Ruminant : fat is re-synthesized to form saturated

Nutritional significance
Is most concentrated dietary energy source 9 kcal/g (37Kj/g) Man has a wide range of sources Animal / plant sources Animal : Monogastric : Kind of fat depends on fat ingested Ruminant : fat is re-synthesized to form saturated

Function
1. 2. Increase palability of food Act as a vehicle for Fat-soluble vitamins Membrane cell structure To transport energy: As VLDL TG FA As FFA bound to albumin Store of Energy as TG Control metabolism Transport cholesterol

Protein requirement is affected by the following factors:

1. 2. 3. 4. 5. 6. 7. 8. Body Size Age (> growth period) Sex (>Male, More muscle) Pregnancy/lactation Climate (> hot, N loss via sweat increased) Activity Emotional status (> mental stress) Disease (>surgery, accident recovery)

Source of Protein

Absorption & Metabolism

Human requiredment
Depends on the Obligatory Nitrogen lost Childhood, where growth and Development is in progress After injury, surgery and recovery from illness In Chirrotic patient, Protein absorption and metabolism is disturbed.

Metabolic Profiles Disease

IN THE BODY, MAJOR NUTRITION IS STORED AS

1. FAT MASS 2. FAT-FREE MASS Total Body Water (TBW) Total Body Mineral (TBM) Lean Body Mass (LBM)

The Assessments Provide

Information on energy store An integral part of NUTRITIONAL STATUS ASSESSMENT Risk factors for pathological processes and prognosis in variety of of acute and chronic illnesses Evaluation of treatment progress

BMI IS SIMPLE METHOD TO ASSESS BODY COMPISITION BW (Kg)

2 Height (m)

Changes in Body Composition

1. Markers of biological development 2. Indicators of disease processes Associated with Over Nutrition - Obesity - NIDDM - Vascular disease

Associated with Under Nutrition -Marasmus/Kwashiorkor - Malignancy - Chronic disease - Infection

Variation
1.
2. Sex Race Oriental Blacks LBM Whites Heredity weight and height is Under genetic influence

3.

Pregnancy
Total weight gain 12-14kg 4.2 Kg Fetus Placenta Amniotic fluid 8.2 Kg Maternal tissues Plasma Edema EC/IC 4 Kg Fat

LBM
Men > Women (2/3) Thus requirement for (Women) Protein Energy is

The Influence of Nutrition on Body Composition

Energy deficit : weight reduction (Fm, LBM) Thin individuals lost more LBM ( ) than that of obese Energy excess : 1/3 LBM 2/3 fm Positive energy balance: obese

Health significance of changes

All cause of mortality Obesity : CVD Endocrine disturbances, include : (NIDDM, Hirsustism, infertility, gallstone formation, osteoarthritis, malignancy)

Increase FM
Hypertension Hypercholesterolemia, Hypertriglyceride Risk increases when FM is distributed abdominally
Assessment : W/H ratio

Under Nutrition
TBP decrease TBW distortion DRY Risk of Infection increases Poor wound healing Mortality increases

Who at Risk of changes body composition?

NIDDM Childhood obesity Parental obesity OVER WEIGHT Anorexia/Bulimia Physical disability Inadequate Food intake Chronic GIT disease Poor dentition Malignancy Poor food knowledge

Influence of hormones on BC changes

Adrenal corticosteroids (N balance +) LBM, Bone Mass increases : Body Builders How about those suffer from Cushings Syndrome ? Parathyroid, thyroid hormones disorder? Treatment of children with hypopituitarism? Diabetes Mellitus ?

Physical Activity
Active physical activity - LBM develop - FM undeveloped/less body fat - Thicker bone Immobilization (blood Vol ), Space travel - Decrease in LBM, Bone density (N, Ca, P decrease) and Paralyzed limbs,

Osteoporosis
Occur more often in Women More common in: Physical inactivity Age over 40 yo (Women)

Main Function of dietary Carbohydrate

1. Provide Energy 2. Texture of food 3. As sweeting agents

Digestion
All carbohydrates have to be hydrolyzed into monosaccharide. - Can be absorbed - Crossed intestinal wall After absorption - Portal Circulation - Liver

Intolerance
1. Inability to hydrolyzed carbohydrate and absorb especially Laktose 2. Oral Tolerance Test Is used in the diagnosis of Carbohydrate intolerance 3. Symptoms
Abdominal discomfort Borborygmi Flatulence Diarrhea

Enzyme/ Carrier Deficiency

1. Primer : Enzyme/Carrier defect Lactase deficiency in adults, Insuline deficiency 2. Secondary : Arise due to disease/ disorder of the Intestinal infection - Celiac disease

Carbohydrate and Adipose tissue

Excess energy intake is converted to fat. Adipose tissue : Over weight Liver : Fatty Liver Plasma : Free Fatty Acid Etherification

Carbohydrate and disease

1. Carries : No Correlation between Sucrose and dental caries, but interaction between carbohydrate + time + mycobacterium. 2. Obesity: Excess energy is stored as FM. Sucrose, Fructose provide more weight gain than that of glucose

3. Diabetes Mellitus The relationship between DM and Carbohydrate consumption is conflicting. Sucrose consumption = Blood glucose (Am Diabetes mellitus Assoc Report : Diabetes 20:633-634. 1971) draw consensus regarding Carbohydrate diet and DM. Fructose & Sorbitol produce minimal insulin level response

4. Cardiovascular disease. Dietary carbohydrate may have role in ischemic HD Type IV hyperlipidemia is associated with coronary artery disease due to the level of TG is dependent on level of carbohydrate consumed Effect of sucrose is greater over starch However, if P.U.F is added, the effect on TG level is reduced.

5 Cataracts Galactose and glucose play significant role in the development of cataract. This mono sacharide is further metabolized in the lens. (Osmotic effects!) Glucose cataract is seen in DM patient Galactose cataract is seen in galactosemia

Protein Energy Malnutrition

1. Inadequate supply of protein & Energy in a long period of time 2. Growth retardation 3. Marasmus 4. Kwashiorkor

Factors leading to PEM

1. 2. 3. 4. 5. 6. Under-developed society Insufficient food supply Over population Lack of knowledge about food Poor hygiene Unpalatable diet

Clinical signs
1. Tissue wasting 2. Oedema (fall in plasma protein & decrease in connective tissue). 3. Changes in appearance of hair and nails 4. Metabolic impairment 5. Impaired immunity

MALNUTRITION PHYSICAL SIGNS OF DEFICIENCY STATE

Infants and Children Lack of subcutaneous fat Wrinkling of skin on light strocking Poor muscle tone Rough skins Hemorrhage of Newborn (-K) Bad posture

Cheilosis Rapid heart Red tongue Dental abnormalities

Adolescents and adult

Cheilosis Changes in tongue color or texture Red swollen lingual papillae Glossitis Papillary atrophy of tongue Stomatitis Bleeding gums

Poor muscle tone Dermatitis, Facial butterfly Nonspecific vaginitis Rachitis Anemia not responding to Iron Fatigue of visual accomodation Purpura etc

Vegetarian diets
1. Most vegetarians are healthy, thus this type of diet must be adequate ? 2. Two types : Strict Vegetarian (Vegan); no milk, milk products, egg Lacto-ovo-vegetarians (Vegetarian)

3. Vegan diet may inadequate !

1. Some people are vegetarian by choice (based on religious custom or habit, Hindu) 2. Animal lover 3. Protein products are expensive

Vegan diet
May be deficient in protein The diet must be well varied Legumes should contribute 15% dietary energy. Cereal : Legume = 70:30 Low plasma iron (Pregnancy and lactation required more iron !