-Anu Chopra

12 Dec. 2014

Food and NutritionFood?

Anything eaten or drunk which can be ingested, digested and absorbed by the body. Used as:Energy Source Building, repair or protective material

Nutrition?“Food at work”Process by which all body parts receive and utilize nutrients

Nutrients?Components or Chemicals in food needed to grow, reproduce and lead healthy life

Food and Nutrition (cont …)Optimum NutritionNutritional status Malnutrition

Under nutrition Over nutrition

Signs of Good Nutrition Shiny hair Smooth skin Clear eyes Alert expression Well developed bone structure Resistance to diseases Regular sleep and elimination habits Increased life span

Food ComponentsMacro Nutrients

CarbohydratesProteinsFatsWater

Micro NutrientsVitaminsMinerals

Food Pyramid

Food GroupsVegetable and Fruit

Green and Yellow vegetables and fruitsAmla-guava-citrus fruits

Whole grainsPlant oilsPulsesEgg, Fish and poultryLow fat dairy and soy productsNuts and oilseedsSugar and Jaggery

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Proteins - IntroductionGreek word meaning Prime ImportanceBuilding blocks of human body75% of body solids is ProteinsOrganic Substances made of Amino AcidsNitrogenous compoundsMust for growth and repair of all cells and

tissues

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Proteins - SourcesLean meatLean poultryFishMilk, cheese and yogurtBeansEggsNuts, seeds and peanut butter

Fish

Milk

SoyaBean

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Complementary Proteins

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Proteins – Digestions and absorption

Mouth No digestion

Stomach Pepsin Enzyme acts in an acidic medium

Small Intestine Trypsin, Chymotrypsin and Carboxypeptidase

Enzymes break proteins into amino acidsAbsorption of amino acids takes place in

GIT

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Proteins – FunctionsGrowth and maintenanceSource of energy (4KCal/gm)Regulation of body processes

Immunoglobins or antibodiesHormones (Insulin, TSH)Enzymes Contractile Proteins (Actin and Myosyin in

muscles) Structural Proteins (Collagen, Keratin)Transport Proteins (Hemoglobin)

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Proteins – Deficiency and ExcessDeficiency leads to PEM

Excess (more than 2gm/Kg body wt. for prolonged period)Kidney failureIncreased Calcium excretionAllergies

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Protein RequirementMales – 0.9 to 1.0 gm/Kg body weightFemales – 0.8 to 0.9 gm/Kg body weight10-35% of calories should come from protein sources. Excess protein beyond what is recommended provides no additional

benefits toward athletic performance or muscle building. Only athletic training builds muscle.Requirement may vary under certain conditions

Physiological state Calorie adequacy Protein quality Physical exercise Heat and environment Metabolic stress Infection

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Lipids - IntroductionLipids – Heterogeneous compounds including

fats, oils, waxesInsoluble in waterSoluble in organic solvents like ether and

chloroformConcentrated form of energy (9KCal/gm)Complex molecule made of fatty acids and

glycerolLiquid at 200 C?

Yes – FatNo – Oil

Less Oxygen compared to Carbohydrate

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Fatty Acids

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Fatty Acids - ClassificationEssential

Cannot be synthesized by bodyE.g. Linoleic (omega-6) and Linolenic (omega-3) acidHelp in brain development, retinal function and

preventing dermatitisAct as precursors of hormone like substance called

EICOSANOIDS (prostaglandin, thromboxane, leukotrines) which help in regulation of BP, heart rate, blood clotting and immune response

Non-EssentialCan be synthesized by bodyE.g. Palmitic acid, Oleic acid.

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Fats – Digestion and absorptionMouth

No digestionStomach

No digestionOnly fat size is reduced

Small Intestine Hormone cholecystokinin is secreted which control

secretion of bile (produced by liver, and stored in gall bladder)

Pancreatic and intestinal lipase act on fat in alkaline medium and break into fatty acids and glycerol

Absorption takes place in Small IntestineExcess is stored in adipose tissue

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Fats – Functions Source of energy (9kcal/gm)Supplies heat and insulationProvides padding around vital organsCarrier of fat soluble vitamins (A, D, E, K)Provides satiety valueAdd flavor and texture to foodProtein sparing actionCholesterol helps in synthesis of sex

hormonesEFA needed for maintenance of body

functions

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Fats – Deficiency and ExcessDeficiency

Leads to failure in growth and reproductionIn infants eczema of skin

ExcessObesityDigestion and absorption of food is slowedCalcium absorption decreasesKetosis occurs

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Fats - SourcesPlant sources

Nuts and oil seeds (Peanuts, soybean, palm)Hydrogenated vanaspati, margarineCereal, pulses and fruits are poor sources

Animal SourcePork, poultry, eggs, dairy products

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Fat – Requirement20-30% of total calories should come from fat Majority coming from unsaturated fats and less than

10% from saturated fatsSFA:MUFA:PUFA should be 1:1.5:1Omega-6:Omega-3 should be 4:1

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CholesterolWhite soft waxy compound

found in blood stream and body cells

Use to form cell membranes, hormones, brain and nerve cells

2gm synthesized dailyStored in liverFound only in animal foodNormal level – 150-200 mg/100

ml bloodRich sources

Egg yolk, organ meats, dairy fatLipoprotiens help to transport

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Vitamins - IntroductionOrganic compounds required in minute

amountsRequired to maintain growth and

normal metabolismDo not provide any energyMost vitamins cannot be synthesized by

body

Vitamin A (retinol, carotene)Vitamin A is fat-soluble vitamin needed for the normal structure and functioning of the cells in the skin and body linings, e.g. in the lungs.This vitamin also helps with vision in dim light, as well a keeping the immune system healthy.

It is found in two forms; retinol in foods from animal sources and carotenoids (the most abundant of which is the beta-carotene) from plant sources.

Vitamin A – retinol is found in liver and whole milk, Vitamin A – carotenoids are found in dark green leafy vegetables, carrots and orange coloured fruits.

Too much or too little?Deficiency leads to poor vision in dim light or night blindness. Severe deficiency can lead to total blindness.

Vitamin A is stored in the liver and too much vitamin A can be toxic.

Consuming too much vitamin A whilst being pregnant has been linked to birth defects.

Vitamin D (Cholecalciferol)Vitamin D is needed for the absorption of calcium and phosphorous from foods, to keep bones healthy.

Recent research also suggests that vitamin D enhances immune function and improves muscle strength.

Vitamin D is found in the diet, but most of our vitamin D is made in the body the action of ultra violet rays on the skin.

Vitamin D occurs naturally in some animal products, including fish liver oils, oily fish, egg yolk, and butter.Cereals, margarine and low fat spreads are also fortified with vitamin D.

Too much or too little?Deficiency of vitamin D leads to rickets and the formation of soft bones. This causes the bones in the legs to bend. Deficiency in adults causes Osteomalacia resulting in pain and muscular weakness.

Vitamin D can be stored by the body. Too much vitamin D can lead to excess levels of calcium in the blood.

Young children, housebound older adults, and people who practice religions where their skin must be covered, may be at risk of deficiency through lack of exposure of their skin to sunlight.

Vitamin E (Tocopherol)Vitamin E is a group of similar molecules with common properties and functions.

Vitamin E acts as an antioxidant and protects cells in the body against damage.

Vitamin E is mainly found in vegetable oils, nuts, seeds and wheat germ.

Deficiency and excess of vitamin EA deficiency in this vitamin is rare because it is so widely available in the diet.

In very rare cases neurological disabilities such as lost reflexes have developed.

Vitamin E has a low toxicity, but in very large doses may interfere with absorption of vitamin A.

Vitamin KVitamin K is needed for normal clotting of blood and is also required for normal bone structure.

Infants are given vitamin K at birth.

Vitamin K is also produced by the bacteria in the gut.

Vitamin K is found in green leafy vegetables e.g. broccoli, lettuce, cabbage, spinach and meat and dairy products.

Too much or too little?

Deficiency of vitamin K is rare in adults, but is sometimes seen in new born babies.

Thiamin (B1)Thiamin is needed for the release of energy from carbohydrate. It is also involved in the normal functioning of the nervous system and the heart.

Thiamin is mainly found in whole grains, nuts, meat (especially pork), fruit and vegetables and fortified cereals.

Too much or too little?Thiamin deficiency can lead to the development of the disease beri-beri. Symptoms include fatigue, weakness of the legs and anorexia.

As the body excretes any excess thiamin, there is no evidence of any toxic effects of high doses.

Riboflavin (B2)Riboflavin is needed for the release of energy from carbohydrate, protein and fat.

It is also involved in the transport and metabolism of iron in the body and is needed for the normal structure and function of skin and body linings.

Riboflavin is found in milk, eggs, rice, fortified breakfast cereals, liver, legumes, mushrooms and green vegetables.

Too much or too little?There is no deficiency related disease, however, the tongue, lips and skin become affected when the body is low in riboflavin.

As the body excretes any excess thiamin, there is no evidence of any toxic effects of high doses.

Niacin (B3)Niacin is important for releasing energy from food, and is important for the normal structure of the skin and body linings.

Niacin is also needed for the normal functioning of the nervous system.

Niacin can be found in meat, wheat and maize flour, eggs, dairy products and yeast.

Too much or too little?Deficiency of niacin can result in the disease pellagra. Symptoms can include:• dermatitis;• dementia;• diarrhoea.

Problems associated with excessive intakes are rare.

Vitamin B12Vitamin B12 is needed for the formation of red blood cells and the normal functioning of the nervous system.

Vitamin B12 also helps to release energy from food.

Vitamin B12 is found exclusively in animal products, plant products do not provide any vitamin B12.

It is found in meat, fish, cheese, eggs, yeasts extract and fortified breakfast cereals.

Deficiency of vitamin B12

Deficiency of vitamin B12 can lead to pernicious anaemia.

It can also lead to some neurological problems.

Deficiency is rare, but may be a problem for people following strict vegan or vegetarian diets.

Folate (Folic acid)Folate is important for the formation of healthy red blood cells.

It is also needed for the nervous system and specifically for the development of the nervous system in unborn babies.

It can reduce the risk of neural tube defects in a fetus, e.g. spina bifida.

Good sources of folate include green leafy vegetables brown rice, peas, oranges, bananas and fortified cereals.

Deficiency of folateDeficiency of folate can lead to megaloblastic anaemia. Symptoms can include insomnia, depression and forgetfulness.

It is recommended that all women who are planning a pregnancy take a daily supplement of folic acid. Once pregnant, supplementation should continue for the first 12 weeks to reduce the risk of neural tube defects.

Vitamin C (Ascorbic acid)Ascorbic acid is needed to make collagen which is required for the normal structure and function of body tissues, such as skin, cartilage and bones.

It also acts as an antioxidant that protects the body from damage by free radicals.

Sources of ascorbic acid include fresh fruits, especially citrus fruits and berries, green vegetables, peppers and tomatoes. Ascorbic acid is also found in potatoes (especially in new potatoes).

Too much or too little?Scurvy can result from lack of ascorbic acid. It tends to occur in infants and the older adults.

Scurvy leads to spots on the skin, bleeding gums and loose or loss of teeth.

Over nutrition of ascorbic acid is rare.

MineralsMinerals are inorganic substances needed by the body for many different functions.

Some minerals are needed in very tiny amounts, these are known as trace elements, such as fluoride.

Calcium (Ca)Calcium is important for the formation and maintenance of strong bones and teeth, as well as the normal functioning of nervous system and muscles.

It is also involved in blood clotting.

Milk and dairy products are the most important sources of calcium. Other sources include bread, calcium enriched soya products, green leafy vegetables and fish with soft edible bones.

Too much or too little?Poor intakes of calcium can result in poor bone health which can increase the risk of diseases such as osteoporosis later in life.

Taking high doses of calcium supplements can cause stomach pains and diarrhoea.

Iron (Fe)Iron is needed for needed for the formation of haemoglobin in red blood cells which transport oxygen around the body.

It is also required for energy metabolism and has an important role in the immune system.

Haem iron is present in animal sources in the form of haemoglobin. Non haem iron is present in plant sources such as beans, nuts, dried fruits, wholegrains, soya bean flour and dark green leafy vegetables.

Too much or too little?A lack of iron will lead to anaemia. Symptoms include:

feeling of tiredness; lacking in energy; general weakness; poor concentration.

Too much iron in the diet can result in constipation, nausea and vomiting.

Phosphorus (P)Phosphorus is essential for the structure bones and teeth, for the structure of cell membranes and for energy metabolism.

Phosphorus is found in red meat, dairy products, fish, poultry, bread, rice and oats.

Potassium (K)Potassium is essential for water and electrolyte balance and normal functioning of cells, including nerves.

Potassium is present in all foods, but found richly in fruit (dried fruits, bananas, berry fruits), leafy green vegetables (e.g. broccoli and spinach) meat, nuts, seeds and pulses.

Sodium (Na)Sodium is needed to regulate body water content and electrolyte balance.

Sodium is also needed for the absorption of some nutrients and water from the gut.

Sodium is present in very small amounts in raw foods. It is often added as salt during processing, preparation, preservation and serving.

High salt processed foods include bacon, cheese, yeast extract and smoked fish.

Too much or too little?Consuming too much sodium increases the risk of high blood pressure. High blood pressure is linked with an increased risk of heart disease and stroke.

Sodium deficiency is unlikely, but can be caused by excessive sweating or vomiting and diarrhoea.

It is recommended that adults and children over the age of 11 years cut down on salt and consume no more than 6g per day.

Fluoride (F)Fluoride is needed for the formation of strong teeth and protects against dental decay (caries).

Fluoride is a trace element, therefore only a small amount is required for good health.

Fluoride can be found in drinking water and in small amounts in tea and saltwater fish. Some areas add fluoride to the drinking water.Fluoride toothpastes are another important source.

Too much or too little?

An excessive intake of fluoride can lead to mottling or discolouration of teeth.

Nutrient interactionsSome nutrients work together in the body completing different functions.

For example:• the vitamins A,C and E;• calcium phosphorus and fluoride;• calcium and vitamin D;• iron and vitamin C;• carbohydrates and B vitamins.

Anti-oxidantsVitamins A, C and E are anti-oxidants and work together in the body to protect cells against oxidative damage from free radicals.

This damage to cells can increase the risk of developing diseases such as heart disease and cancer.

Calcium, phosphorus and fluorideThese nutrients are involved in the mineralisation of teeth and bones which keep them hard and strong.

Vitamin D and calcium

Vitamin D controls the amount of calcium available. A lack of vitamin D in the body results in reduced absorption of calcium.

Iron and ascorbic acidAscorbic acid aids the absorption of non haem iron (non meat sources of iron) when eaten at the same time.

This is particularly important for people following strict vegan or vegetarian diets.

Carbohydrates and Vitamins BRiboflavin and thiamin are involved in the release of energy from carbohydrate.

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WaterBody’s transport medium – nutrients,

gases and waste products Lubrication of our jointsProper muscle contractionTemperature regulation

% Body Weight Loss

Symptoms

0.5 Thirst

2 Loss of appetite, discomfort

3 Dry mouth, impaired physical performance

5 Difficulty in concentrating

8 Dizziness, mental confusion, weakness

10 Muscles spasm

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Diet Planning PrinciplesConsume enough to meet needs for energy

and for essential nutrients – AdequacyProportion of foods in diet – BalanceEnergy balance – Calorie ControlNutrient vs. Energy content – Nutrient

Density All foods can fit in a good diet – ModerationWide selection from all food groups – Variety

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Diet Planning – other considerationsFamily needs – different age groupsSave time and energyEconomic consideration and easy

availabilityLikes and dislikesReligious and social considerations

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Exchange ListGrouping of foods in which the carbohydrates,

fats, proteins, and calories are similar for the serving sizes listed

Why? Convenience, variety, adequacyFor example, one can substitute one chapati

with other cereals such as rice, bajra, bread or noodles, etc. – in the amount that gives approximately the same carbohydrates as one chapati.

The various groups for which exchange can be done are cereals, meat, milk and milk products, legumes and grams, fats and oils, fruits and vegetables.

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Cereal Exchange

No Name Raw Amount (g) Household Measures

1 Idli 30 2

2 Dosa 30 1

3 Poha 30 ¾ Katori

4 Porridge 30 1 Katori

5 Chapati 30 1 (6-inch)

6 Bread 40 2 (small)

7 Rice 30 1 Katori

8 Glucose Biscuits 15 2-3

9 Marrie 25 4-5

CALS: 100kcal, CHO: 21 g, PRO: 3 g, FAT: 0.5g

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Pulse Exchange

No Name Raw Amount (g) Household Measures

1 Dal (Moong, Masur, Tur) 30 1 Katori

2 Whole Pulses (Rajma, Channa)

30 1 Katori

3 Rasam 30 2 Katoris

CALS: 100kcal, CHO: 17 g, PRO: 7 g, FAT: 0.5g

No Name Raw Amount (g) Household Measures

1 Soya bean 23 1 Katori

CALS: 100kcal, CHO: 4.7 g, PRO: 10 g, FAT: 4.5 g

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Meat and Egg ExchangeNo Name Raw Amount (g) Household

Measures

1 Chicken 90 5 medium pieces

2 Goat meat (lean) 80 4 medium pieces

3 Fish 115 3 pieces

CALS: 100kcal, CHO: 0 g, PRO: 20 g, FAT: 2 g

No Name Raw Amount (g) Household Measures

1 Egg, whole 50 1

CALS: 85kcal, CHO: 0 g, PRO: 6.7 g, FAT: 6.7 g

No Name Raw Amount (g) Household Measures

1 Egg white 30 1

CALS: 15kcal, CHO: 0 g, PRO: 3.6 g, FAT: 0 g

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Vegetable ExchangeNo Name Raw Amount (g) Household

Measures

1 Palak 100

2 Lettuce, Cabbage 100

3 Cauliflower 100

4 Tomato 100

5 Bhindi 100

6 Cucumber 100

CALS: 20kcal, CHO: 5 g, PRO: 0 g, FAT: 0 g

No Name Raw Amount (g) Household Measures

1 Carrots 100

2 Onions 100

3 Mushrooms 115

4 Potato 50

CALS: 50kcal, CHO: 10 g, PRO: 2 g, FAT: 0 g

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Fruit Exchange

No Name Raw Amount (g) Household Measures

1 Bananas 45 2 small

2 Pear 100 1 small

3 Apple 85 1 medium

4 Orange 110 1 medium

5 Mango 40 2 slices

6 Watermelon 300 2-3 slices

7 Grapes 75 18-20

CALS: 50kcal, CHO: 12.5 g, PRO: 0 g, FAT: 0 g

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Milk ExchangeNo Name Raw Amount Household

Measures

1 Cow’s Milk 150 ml 1 cup

2 Paneer (Cow’s Milk) 30 g 4 cubes

3 Curd 150 g ¾ Katori

CALS: 100 kcal, CHO: 4 g, PRO: 5 g, FAT: 7 g

No Name Raw Amount Household Measures

1 Buffalo Milk 85 ml ½ cup

CALS: 100 kcal, CHO: 5 g, PRO: 4.3 g, FAT: 6.5 g

No Name Raw Amount Household Measures

1 Skimmed Milk 350 ml 2 cups

CALS: 100 kcal, CHO: 16 g, PRO: 8.8 g, FAT: 0.4 g

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Fat Exchange

No Name Raw Amount Household Measures

1 Oil/Ghee 11 g 2 tsp

2 Butter 14 g 3 tsp

CALS: 100 kcal, CHO: 0 g, PRO: 0 g, FAT: 11 g

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Food Guide Pyramid• Dairy = calcium, carbohydrate, protein, riboflavin, vitamin D, magnesium, zinc• Meat = protein, thiamin, riboflavin, zinc niacin, B6, folate, B12, magnesium, iron• Fruits or Vegetables = carbohydrate, vitamin C, vitamin A, magnesium, potassium, dietary fiber, folate• Grains = carbohydrate, thiamin, riboflavin, niacin, folate, magnesium, iron, zinc, dietary fiber

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Nutrition Assessment of IndividualsHistorical information

Health statusMedicationsFamily historyMarital status, ethnic background,Education level, drug and alcohol

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Anthropometric DataHeightWeightTriceps SkinfoldHead Circumference in infants and

children

Compared to standards for age group used over time

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Steps in Meal Planning1. Calculate Ideal Body Wt (IBW)

Height (cm) – 100, for Males Height (cm) – 105, for Females

2. Energy Needs Depending on wt. and physical activity

Activity Calories per Kg IBW

Obese Normal UnderweightSedentary 20-25 30 35

Moderate 30 35 40

Heavy 35 40 45

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Steps in Meal Planning (cont …)3. Distribution of Calories

15-18% From Proteins 60-70% from CHO 20-25% from Fats

4. Prepare Master Exchange List To arrive at required calories, CHO and Fats

5. Prepare a sample menu6. Counseling Tips

• Express empathy• Reflective listening• Positive re-enforcement• Visual aids• Eye contact