CHO,Lipid and Vit for Pharmacy stu (1).pdf

Macro and micro nutrients for pharmacy tvet programs

1. CARBOHYDRATES (CHO)
Definition:
▪Carbohydrates are defined as biomolecules containing a group of
naturally occurring carboxyl compound(aldehyde or ketones) and
several hydroxyl groups. It consists of Carbon (C), hydrogen (H), and
oxygen (O) atoms.
▪Carbohydrates are an important source of energy in all human diet.
Classification of Carbohydrates
➢Simple carbohydrates
▪Monosaccharide
▪Disaccharide
▪Perceived as sweeter than complex carbohydrates
➢Complex carbohydrates
▪Oligosaccharides
▪Polysaccharides
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Simple Complex

3. Cont…
I.Monosaccharides
Three nutritionally important monosaccharides
a.Glucose
b.Fructose
c.Galactose
a)Glucose
oBlood glucose and blood sugar in the body
oMost abundant monosaccharide in the body
✓Is the preferred and main source of energy for the brain and red blood
cells.
Part of every disaccharide

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4. Cont…
b)Fructose
oSweetest of natural sugars
oFound abundantly in fruits
oPart of high-fructose corn syrup
c)Galactose
oCommonly occurs as part of disaccharide lactose

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5. Cont…
II.Disaccharides
▪Disaccharides (di-means two) are double sugars. One hydrolysis,
they yield two simple sugars.
Three common Disaccharides
a)Sucrose - Most common
b)Lactose
c)Maltose
⁃Least common
⁃Formed from digestion of starches
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6. Cont…
Oligosaccharides
➢Similar in length to simple carbohydrates
➢Similar in makeup to polysaccharides
➢Humans lack the enzymes necessary to digest them
➢Intestinal microflora digest and ferment them
▪Cause bloating, discomfort, and flatulence
➢Food sources
▪Legumes, beans, cabbage, broccoli

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7. Cont…
Polysaccharides
Polysaccharides are carbohydrates formed by long chains of repeating
units linked together by glycosidic bond.
Starch
Plants store glucose in chains of starch
➢Amylose
▪Straight chain
▪More resistant to digestion
▪Resistant starch
➢Amylopectin
▪Branched chains
▪Easier to digest
❖Excellent food sources of starch
▪Grains (wheat, rice, corn, oats, and barley),
▪legumes (peas, beans, and lentils), and tubers (potatoes).

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9. Cont…
Glycogen
➢Long, branched chains of glucose
➢Storage form of glucose in animals (Humans)
➢Stored in liver and muscle
➢Liver glycogen response to blood glucose (BG) levels BG
glycogen breakdown BG
➢Muscle glycogen can be broken down for energy for the muscle
➢Not found in food and therefore not a source of dietary
carbohydrate

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10. Cont…
Fiber
➢Non-digestible polysaccharides
➢Provides no energy
➢Classification
▪Soluble
✓Pectin's, beta-glucan, some gums, mucilage
✓Easily fermented by intestinal bacteria
•Carbon dioxide, methane, some fatty acids
▪Insoluble
✓Cellulose, lignin, some hemicelluloses
✓Not easily fermented
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11. Cont…
Fiber Health Benefits
➢Soluble fibers
▪Slow gastric emptying and may delay absorption of some nutrients
✓Helps reduce serum cholesterol
✓Improve appetite control
✓Normalize blood glucose levels
▪May help protect against colon cancer
✓Cellulose, lignin, some hemicelluloses
✓Not easily fermented
➢Insoluble fibers
▪Relieves constipation (bulk of feces)
➢Most plant foods contain both soluble and insoluble fibers
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12. Cont…
Benefits of Dietary Fiber
✓Helps lower risk of bowel irregularity
✓Prevention of constipation and diverticulosis
✓Prevention of heart disease, cancer and diabetes
✓Helps prevent obesity
✓Increase satiety
✓Reduce food intake
➢Caution: Increase dietary fiber and fluid intake gradually

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13. Cont…
Carbohydrate Digestion and Absorption
➢Disaccharides and starches are digested to monosaccharides
➢Monosaccharides are easily absorbed
➢Fiber passes through the GI tract undigested
Absorption of Carbohydrates
➢Once digested to monosaccharides
▪Absorbed through the intestinal cell mucosa
▪Transported to the liver via the portal vein
▪Metabolic needs direct fate of the monosaccharides

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14. Cont…
➢Galactose and fructose
▪ Used by the liver for energy
▪Converted to glucose
➢Glucose
▪Used for energy
▪Converted to glycogen through glycogenesis
▪Converted to glycerol and fatty acids for storage in addipocytes

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15. Glucose Is Stored in the Liver and Muscle Cells as Glycogen
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16. Cont…
Lactose Intolerance
➢Deficiency of lactase, the enzyme that digest lactose
▪Maldigestion – inability to digest lactose due to low levels of the
enzyme
▪Intolerance
✓Maldigestion resulting in nausea, cramps, bloating, flatulence, and
diarrhea

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17. Cont…
Functions of Carbohydrate
➢Provide energy
▪6-10kcal/gm/kg daily
▪Red blood cells use only glucose for energy
➢Maintain blood glucose
▪Carbohydrate intake
▪Glycogenolysis > 4 hours after a meal
➢Spare protein
▪Prevents the need for gluconeogenesis
➢Prevents ketosis
▪ Fat breakdown during fasting forms ketones
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18. Cont…
Carbohydrate Sources
➢Best choices should include nutrient-dense, low-saturated fat
foods, simple carbohydrates, fiber, complex carbohydrates
The main sources of carbohydrates are:
➢Cereals (bread, wheat, maize, rice), potatoes of all kinds,
cassava,‘shiro’, pasta, macaroni, ‘kocho’, banana, sweets, sugar
cane, sweet fruits, and honey.
➢Other foods like vegetables, beans, nuts and seeds contain
carbohydrates, but in lesser amounts.
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19. Cont…
Food Sources of Fiber
➢Fresh fruits and vegetables,
➢Peas and beans,
➢Whole grains (whole wheat flour and unrefined maize or
sorghum flour, barley,oats, rice) give us fiber
How Much Carbohydrate?
➢Recommended Dietary Allowance (RDA) is 130 grams/day to
supply adequate glucose to the brain
➢Acceptable Macronutrient Distribution Range (AMDR) is 45% to
65% of daily calories
➢Focus on fiber-rich carbohydrate foods
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20. Cont…
Complex Carbohydrates
➢Adequate Intake (AI) for fiber
▪25 g per day for women
▪38 g per day for men, or
▪14 g of fiber for every 1,000 kcal per day
➢It is best to get fiber from food (also a source of vitamins and
minerals)
➢An adequate fluid intake with high-fiber diets is recommended
Simple Carbohydrates
➢Diets high in simple sugars:
▪Can cause tooth decay
▪May contribute to obesity
▪Elevated level of fat in the blood
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21. LIPIDS
Definition:
▪Lipids are organic compounds composed of a carbon skeleton with
hydrogen and oxygen substitutions. Nitrogen, sulfur, and phosphorus
are also present in some lipids. The most abundant lipids are sterols or
esters of fatty acids with various alcohols such as glycerol and
cholesterol.
Category of compounds that includes:
➢Triglycerides
➢Sterols
➢Phospholipids
▪Contain carbon, oxygen, and hydrogen
▪Hydrophobic
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22. Cont…
Triglycerides
A triglyceride is an ester derived from glycerol and three fatty
acids.

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24. Cont…
Phospholipids
➢Hydrophilic on one end; hydrophobic on the other
➢Make up the phospholipid bilayer in the cell membrane
▪Lecithin
✓A major phospholipid in the cell membrane
✓Used as an emulsifier in foods
➢Synthesized by the liver

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25. Cont…
Sterols
➢More complex than phospholipids or triglycerides
▪Four connecting rings of carbon and hydrogen
➢Do not provide energy
➢Cholesterol is the best-known sterol
▪Found in every cell in the body
▪Helps with numerous body processes
➢Phytosterols – major plant sterols

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26. Cont…
Fatty Acids:
➢Building blocks for triglycerides and phospholipids
➢A chain of carbon and hydrogen atoms with a carboxyl group
at the alpha end and a methyl group at the omega end.
➢Higher ratio of carbon and hydrogen to oxygen than in carbohydrates and
protein
▪9 kilocalories per gram of fat
➢20 different fatty acids with varied length, saturation, and shape
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27. Cont…
Fatty Acids Vary in Length:
➢Short-chain fatty acids
✓Two to four carbons
✓Liquid at room temperature
➢Medium-chain fatty acids
✓Six to ten carbons
➢Long-chain fatty acids
✓12 or more carbons
✓Most common type of fatty acid in foods
✓Solid at room temperature
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29. Cont…
Fatty Acids Vary in Saturation:
➢Saturated
✓All the carbons on the fatty acid are bound to hydrogen
✓Solid at room temperature
➢Unsaturated
✓Some carbons on fatty acid form a double bond with each other instead
of binding to hydrogen
✓Monounsaturated fatty acids (MUFA)
▪Has one double bond
✓Polyunsaturated fatty acid (PUFA)
▪Has two or more double bonds
✓Liquid at room temperature

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30. Cont…
What Happens to the Lipids You Eat?
➢Lipids from foods Fat, phospholipids, and sterols Digested to
✓Free fatty acids, glycerol, and mono glycerides with the aid of the
enzyme lipase
Lipoproteins Transport Fat Through the Lymph and Blood:
➢Lipoproteins
▪Chylomicrons
▪Very low-density lipoproteins (VLDLs)
▪Low-density lipoproteins (LDLs)
▪High-density lipoproteins (HDLs)
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31. Cont…
➢Chylomicrons
✓Are the largest lipoproteins.
✓They have the lowest protein to lipid ratio and therefore lowest density.
➢Very low-density lipoproteins(VLDL)
✓VLDL is a lipoprotein class synthesized by the liver that is analogous
to the chylomicrons secreted by intestine.
✓Largely depleted of its triglycerides content in these tissues and gives
rise to an intermediate-density lipoproteins.
➢Low-density lipoproteins(LDL)
✓Low-density lipoproteins are derived from VLDL and IDL in the
plasma and contain a large amount of cholesterol and cholesteryl esters
➢High-density lipoproteins(HDL)
✓HDL are the highest protein-to-lipid ratio.
✓Plays a primary role in the removal of excess cholesterol from cells and
returning it to the liver, where its metabolized to the bile acids.
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32. Cont…
Functions of Lipids
➢Store and provide energy
✓Fats provide 9 kcal per gram
➢Provide insulation
➢Help manufacture steroids and bile salts
➢Play a role in transporting fat-soluble nutrients in the blood
➢Used to manufacture major sex hormones
➢Key to the structure of cell membranes
➢Cushion major organs
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33. Cont…
How Much Fat Do We Need Each Day?
➢Acceptable Macro-nutrientDistribution (AMDR) recommandation
✓20–35% of daily kilocalories should come from fat
➢For heart health
✓Consume no more than 10% of total kilocalories from saturated fat
✓Limit trans fats to < 1%
➢The liver synthesizes cholesterol needed by the body
✓Liver synthesizes ~900 mg/d
✓Liver decrease synthesis based on dietary intake
➢To reduce the risk of cardiovascular disease, dietary cholesterol
should be limited to < 300 mg/d
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34. Cont…
Best Food Sources of Fat
➢Lean meat and poultry, fish, low-fat or nonfat dairy products and
limited amounts of nuts and cheese
✓Best sources of essential fatty acids
✓Limit intake of saturated and trans fats
➢Commercially prepared baked goods and snack items
✓Are high in kilocalories
✓Are high in saturated and trans fats
✓Should be consumed rarely
➢Use vegetable oils in the place of butter
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35. Cont…
Sources of fat in food:
➢Fat-dense foods—those with more than 60% of total calories as fat
include plant oils, butter, margarine, mayonnaise, nuts, bacon, avocados,
peanut butter, cheddar cheese, steak, and hamburger.
➢Of the foods we typically eat, cholesterol is found naturally only in
those of animal origin, with eggs being a primary source.
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36. VITAMINS
Definition:
▪Vitamins are nutrients that are essential for normal cellular function,
but are required in much smaller quantities than the aliments
(carbohydrates, fats and proteins). Vitamins are essential cofactors to
or components of enzymes that are integral in intermediary
metabolism and many other biochemical processes.
Vitamins are divided into two categories:
I.Water soluble:-vitamin B complex (including vitamin B12,folate,
thiamine, nicotinic acid, pantothenic acid and biotin), vitamin C
II.Fat soluble :-vitamins A, D, E and K
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37. Cont…
Vitamin A (Retinoic acid)
❑Vitamin A (retinol) has essential roles in the development of vision,
bone growth, the maintenance of epithelial tissue, the immunological
process, and normal reproduction.
✓Three forms: - retinol, retinal and retinoic acid
✓Sources: - animal – retinol vegetable – provitamins (carotenes) which
are converted to vitamin A in liver
✓Normal Laboratory value: adult – 20-100 mcg/dl
✓Causes of deficiency
▪Inadequate dietary intake
▪Pregnancy Lactation
▪Mal-absorption syndrome and Hepato-biliary disease
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38. Cont…
❑Manifestations of deficiency
✓Xerophthalmia - involves xerosis (dryness) of eye,
✓Night blindness (nyctalopia) progressing to total blindness,
✓Dry and rough skin with papules,
✓Hyper-keratinization,
✓Keratinization of bronchopulmonary epithelium,
✓Increased susceptibility to infection
❑Uses
▪Tretinoin (all trans-retinoic acid) and isotretinoin (synthetic
retinoid) are used in acne vulgaris and to facilitate healing of skin.
For prophylaxis in children.
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Vitamin A Deficiency

40. Cont…
❑Adverse effects
▪Long-term ingestion of more than double the recommended daily
intake of vitamin A can lead to toxicity and chronic
hypervitaminosis.
✓Itching and dry skin;
✓Raised intracranial pressure irritability and headache;
✓Tender hyperostosis in the skull and long bones;
✓Hepatotoxicity;
✓Congenital abnormalities
❑Contraindications
▪Excess vitamin A during pregnancy causes birth defects.
Therefore, pregnant women should not take vitamin A
supplements.
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41. Cont…
Vitamin D
❑Vitamin D (calciferol) is another fat-soluble vitamin that is
chemically related to steroids and essential for the normal formation
of bones and teeth and for the absorption of calcium and phosphorus
from the GI tract. Deficiency of the vitamin results in rickets in
children, the destruction of bony tissue, and osteoporosis.
❑Vitamin D is used for the prophylaxis and treatment of rickets,
osteomalacia, and other hypocalcemic disorders (tetany) and
hypoparathyroidism.
❑Vitamin D3 is the predominant form of vitamin D of animal origin. It
is found in most fish liver oils, butter, bran, and egg yolks. It is
formed in skin exposed to sunlight or ultraviolet rays.
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42. Cont…
❑Hypervitaminosis D produces a toxicity syndrome that may result in
▪Hypercalcemia
▪Malabsorption (which can lead to constipation),
▪Kidney stones, and calcium deposits on bones
❑Vitamin D therapy is contraindicated in hypercalcemia,
malabsorption syndrome, and renal dysfunction, or if an individual
has evidence of vitamin D toxicity or abnormal sensitivity to the
effects of vitamin D. Vitamin D2 is also called ergocalciferol.
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43. Cont…
Vitamin E
❑Vitamin E (tocopherol) is a fat-soluble vitamin that is essential for
normal reproduction, muscle development, and resistance of
erythrocytes to hemolysis. It is an intracellular antioxidant and acts to
maintain the stability of polyunsaturated fatty acids.
❑Deficiency of vitamin E is rare, but can lead to anemia in babies,
especially if premature. In adults, erythrocytes may have a shortened
lifespan, which may result in muscle degeneration of vascular system
abnormalities and kidney damage.
❑Vitamin E is relatively non-toxic, and may cause problems only in the
large-dosage range of about 300 mg per day (RDA is only 10 mg per
day). At this range, interference with thyroid function and a
prolonging of blood clotting time may occur.
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44. Cont…
❑Sources of vitamin E include vegetable oils such as;
✓Soybean, corn, cottonseed, and sun flower, as well as
✓Nuts, seeds, and wheat germ.
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45. Cont…
Vitamin K
❑Vitamin K is essential for the synthesis of prothrombin in the liver.
The naturally occurring forms, also called quinones, are vitamin K1
(phylloquinone), which occurs in green plants, and vitamin K2
(menaquinone), which is formed as the result of bacterial action in
the intestinal tract.
❑Water soluble forms of vitamins K1 and K2 are also available. The
fat-soluble synthetic compound, menadione (vitamin K3), is about
twice as potent biologically as the naturally occurring vitamins K1
and K2, on a weight basis.
❑Vitamin K is used for coagulation disorder and vitamin K deficiency.
It is given prophylactically to infants to prevent hemorrhagic disease
of the newborn. Natural vitamin K is stored in the body and is not
toxic.
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46. Cont…
Vitamin B Complex
❑Vitamin B complex is a group of water-soluble vitamins that differ
from each other structurally and in their biologic effects. Heat and
prolonged cooking, especially cooking with water, can destroy B
vitamins.
Vitamin B1 (thiamine)
❑Is a water-soluble component of the B vitamin complex that is
essential for normal metabolism and the health of the cardiovascular
and nervous systems. Thiamine plays a key role in the metabolic
breakdown of carbohydrates.
❑Rich sources of vitamin B1 are pork, organ meats, green leafy
vegetables, legumes, sweet corn, egg yolks, corn meal, brown rice,
yeast, and nuts.
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47. Cont…
❑Deficiency of thiamine leads to the disease called beriberi, which has
neurologic, cardiovascular, and GI symptoms. Thiamine toxicity can
occur if very large doses are taken for long periods, and this can result
in hepatotoxicity.
❑Alcohol is well-known for its ability to inhibit the absorption of
thiamine and folic acid. Alcohol abuse is the most common cause of
thiamine deficiency.
Vitamin B2
❑Vitamin B2 (riboflavin) is one of the heat-stable components of the B
vitamin complex. It is essential for certain enzyme systems in the
metabolism of fats and proteins. It is sensitive to light.
✓It plays an important role in preventing some visual disorders,
especially cataracts.
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48. Cont…
Vitamin B3
❑Vitamin B3 (niacin or nicotinic acid) contains parts of two enzymes
that regulate energy metabolism. It is essential for a healthy skin,
tongue, and digestive system.
❑Severe deficiency results in pellagra, mental disturbances, various
skin eruptions, and GI disturbances. Pellagra may also occur during
prolonged isoniazid therapy, and in cancer patients.
❑Major sources of vitamin B3 include:
✓Lean meats, chicken, eggs, fish, cooked dried beans and
✓Peas, liver, nonfat or low-fat milk and
✓Cheese, soybeans, and nuts.
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Sources of Vitamin B3

50. Cont…
Vitamin B6
❑Vitamin B6 (pyridoxine) is a coenzyme essential for the synthesis and
breakdown of amino acids, the conversion of tryptophan to niacin, the
breakdown of glycogen to glucose, and the production of antibodies.
Therefore, vitamin B6 is important in the metabolism of blood, CNS,
and skin.
❑Deficiency of pyridoxine is rare, because most foods contain vitamin
B6. However, deficiency may result from malabsorption, alcoholism,
oral contraceptive use.
❑Vitamin B6 deficiency may cause anemia, anorexia, neuritis, nausea,
dermatitis, and depressed immunity.
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Vitamin B6 Rich Foods

52. Cont…
Vitamin B12
❑Vitamin B12 (hydroxocobalamin) is often found as cyanocobalamin
in pharmaceutical preparations. It is involved in the metabolism of
protein, fats, and carbohydrates. It aids in hemoglobin synthesis, is
essential for normal functioning of all cells, and is important in energy
metabolism.
❑Vitamin B12 is available in meat and animal protein foods. Its
absorption is complex; it occurs in the terminal portion of the small
intestine (ileum) and requires intrinsic factor (a secretion of the
stomach walls). Deficiency causes pernicious anemia and
neurological disorders.
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Vitamin B12 Rich Foods

54. Cont…
Vitamin C
❑Vitamin C (ascorbic acid) is essential for the formation of collagen
tissue and for normal intercellular matrices in teeth, bone, cartilage,
connective tissues, and skin.
❑Ascorbic acid may protect the body against infections and help heal
wounds. Therefore, ascorbic acid has multiple functions as either a
coenzyme or cofactor. Its role in enhancing absorption of iron is well
recognized.
❑Deficiency causes scurvy, lowered resistance to infections, joint
tenderness, dental caries, bleeding gums, delayed wound healing,
bruising, hemorrhage, and anemia.
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Food Sources of Vitamin C