DIET & NUTRITION Basics of food and nutrition

DIET & NUTRITION (Basics of food and nutrition)

1. DIET & NUTRITION Dr.Sukanya patel

2. Agenda 2 Need For Good Nutrition & Diets MACRONUTRIENTS & MICRONUTRIENTS MALNUTRITION Marasmus KWASHIORKOR MALNUTRITION & INFECTIOUS DISEASE

3. Introduction DIET & NUTRITION 3 Nutrition, or nourishment is the supply of materials – food – required by organisms to stay alive. Our food choices affect our health, and this is why they say — we are what we eat. Good Diet & Nutrition forms an important part of a healthy lifestyle. Combined with physical activities, our diet can help maintain a healthy weight, reducing the risk of developing chronic diseases and promoting our overall health. DIET & NUTRITION

4. DEFINITIONS DIET & NUTRITION 4 Diet The Sum Of food/drinks habitually consumed by a person or by a group daily and the mental and physical circumstances connected to eating. Nutrition Nutrition may be defined as the science of food and its relationship to health. It is concerned primarily with the past played by nutrients in body growth, development and maintenance. Good nutrition means, "maintaining a nutritional status that enables us to grow well and enjoy good health." The subject of nutrition is very extensive. Since our concern is with community aspects of nutrition, it is paramount to understand the other two terms i.e., health and public nutrition. Let us try to understand what health means.

5. DEFINATIONS DIET & NUTRITION 5 Health (WHO Definition of Health) It states, " Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity."

6. 6 DIET & NUTRITION Need For Good Nutrition & Diets 1. Good Nutrition Improves Well-Being Eating a poor diet reduces physical and mental health because eating healthy allows people to be more active. Two-thirds of people who eat fresh fruit and vegetables daily report no mental health issues, as reported by the Mental Health Foundation. Compare this to those who do have some level of mental health problems and have generally reported eating less healthy foods and more unhealthy foods. Feelings of well-being can be protected by ensuring that our diet is full of essential fats, complex carbohydrates, vitamins and minerals. 2. It’s Expensive To Be Unhealthy diet-related coronary heart disease, stroke, cancer and diabetes. 3. Delays the Effects Of Aging Foods like tomatoes, berries, avocados, nuts and fish all contain certain vitamins and minerals that are good for the skin. For example, tomatoes contain vitamin C, which helps build collagen, in turn making your skin look firmer and slow premature aging. Berries- antioxidants and vitamins and eating them promotes cell regeneration for new skin . 4. Helps You Manage A Healthy Weight  Adding a variety of fruits and vegetables to meals can help you control your weight, blood pressure, and cholesterol.

7. 7 DIET & NUTRITION 5. Increases Focus Food has an impact on the way we think. When the body is low on glucose, the brain is not receiving the energy it needs to remain focused. Diets high in fat and cholesterol can seriously damage the brain by building up plaque in brain vessels, damaging brain tissue and causing strokes. Eating fruits and vegetables throughout the day helps keep the mind healthy and engaged. 6. Healthy Diets May Lengthen Your Life Your body needs food in order to survive, but the process of breaking down food nutrients, or metabolizing, causes stress on the body. Overeating creates more stress on the body and could lead to a shorter lifespan. 18 percent of deaths leads due to obesity. Obesity could potentially lead to a decline in life expectancy. Diets that are rich in nutrients and do not contain processed foods have been found to have a positive effect on life expectancy. 7. Healthy Eating Positively Affects Your Mood A diet rich in protein, moderate in carbohydrates and low in fat will have a positive effect on mood because it leaves an adequate supply of iron, omega-3 fatty acids and iron. Diets low in carbohydrates increase feelings of tension whereas diets high in carbohydrates have a more uplifting effect on mood. As much as food affects our mood, mood affects our food choices. When we experience feelings of sadness, we are more likely to choose unhealthy foods. People feeling happier feelings are more likely to choose healthier foods . 8 Reduces The Risk of Chronic Disease According to the Centers for Disease Control and Prevention, risk factors for chronic diseases, like type 2 diabetes, have been increasingly seen at younger ages as a result of unhealthy eating and weight gain. Among adults ages 20 to 74, diabetes remains the leading cause of kidney failure, blindness and non-traumatic lower-extremity amputation. Dietary habits are typically established in childhood and carry on into adulthood, making it crucial to teach children the importance of eating a healthy diet early on.

8. 8 DIET & NUTRITION 9. Gives You Energy The main nutrients our body uses for energy are carbohydrates, fats and protein. Carbohydrates such as whole-grain breads and starchy vegetables are the best for prolonged energy since they are digested at a slower rate. Water is necessary for transport of nutrients, and dehydration can cause a lack of energy. A deficiency in iron may cause fatigue, irritability and low energy. Food rich in iron includes seafood, poultry, peas and dark green leafy vegetables such as spinach. To better absorb iron from these foods, it is best to consume vitamin C at the same time. Include vitamin C rich foods like broccoli, kiwi, peppers, leafy greens and tomatoes in meals full of iron. 10. Maintains Your Immune System Immune system is our defense against disease, but poor nutrition is the most common cause of Immunodeficiencies worldwide. system requires an intake of proper vitamins and minerals. well-balanced diet, including fruits, vegetables and food low in fats, will definately help support a healthy immune system.

9. 9 DIET & NUTRITION MACRONUTRIENTS & MICRONUTRIENTS MACRONUTRIENTS Carbohydrates, proteins and fat are macronutrients  (macro means large), so these are the nutrients that we need to eat in relatively large amounts in the diet as they provide our bodies with energy and also the building blocks for growth and maintenance of the body MICRONUTRIENTS Vitamins and minerals are micronutrients, which are essential nutrients your body needs in small amounts to work properly. Although water is not always included in the strict definition of a nutrient, it is essential for health and life.

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14. 14 DIET & NUTRITION Macro-nutrients Versus Micro-nutrients Macro-nutrients Micro-nutrients Requirement Macro-nutrients are required in larger amount/quantity on a daily basis Micro-nutrients are required in small or tiny amount/quantity on a daily basis Function Macro - nutrients is essential for growth, repair and develop new tissues (carbohydrates), maintain body temperature (fats), conduct nerve impulses, and regulate life process. ·   Micro-nutrients support macro-nutrients to carry out bodily functions. They are also an essential component for building healthy brain, body and bones. Benefits/ advantages Macro - nutrients contribute to the bulk energy needed for the metabolic system. ·  Macro-nutrients provide calories that gives energy to the body ·   Micro-nutrients contribute to body growth and disease prevention. ·   Micro-nutrients comprises of high volume of antioxidants which protects the body against various diseases

15. 15 DIET & NUTRITION Role Macro-nutrients plays a vital role in the construction of body composition. Micro-nutrients do not have any role in the construction of body composition. Concentration Macro-nutrients are available in high concentration inside the body. Micro-nutrients are present in minute concentration inside the body. Composition / known as Macro-nutrients are also called as major elements. Micro-nutrients are also called trace elements. Food composition Cereals, legumes, meat, fish, yams, potatoes, nuts, oilseeds are rich in macro-nutrients. Mainly vegetables, fruits, eggs, green leafy vegetables, fermented foods are rich in micro-nutrients. Types and examples There are mainly three macro-nutrients required by the body; carbohydrate, protein and fats Different types of micro-nutrients required by the body include vitamins, minerals and trace elements.  Examples: iron, magnesium, calcium, phosphorus, zinc etc. Quantity Macro-nutrients are divided into two classes: Primary and Secondary, as they are required in large quantities. Micro-nutrients are not classified in different types, as it is required in trace amount.

16. 16 DIET & NUTRITION Composition Primary macro-nutrients include nitrogen, phosphorus, and potassium in larger quantities. Secondary macro-nutrients include calcium, magnesium, and sulfur in lesser quantity. Micro-nutrients include zinc, iron, manganese, copper, boron, molybdenum and chlorine in trace quantities. Toxicity Macro-nutrients are normally not toxic to the cell if they are present in comparatively higher concentration than in the normal level. Micro-nutrients are toxic if present exorbitantly in the cell than the required amount. Excessive ingestion Excessive intake of micro-nutrients leads to obesity and diabetes. Excessive consumption of micro-nutrients leads to suppressing immune function. Consequences of deficiency Deficiency of macro-nutrients causes Protein Energy Malnutrition (PEM), Kwashiorkor, marasmus etc. Deficiency of micro-nutrients causes different diseases like night blindness, beriberi, scurvy, goiter etc. Consequences of overdose Overdose of macro-nutrients causes obesity, heart diseases, diabetes and other metabolic syndromes Overdose of micro-nutrients may harm specific organs of the body. E.g.: overdose of vitamins affect liver

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18. 18 DIET & NUTRITION Malnutrition Malnutrition generally refers both to Under-Nutrition and Over-Nutrition, but in this guide, we use the term to refer solely to a deficiency of nutrition. (WHO) Many factors can cause malnutrition, most of which relate to poor diet or severe and repeated infections, particularly in underprivileged populations. Inadequate diet and disease, in turn, are closely linked to the general standard of living, the environmental conditions, and whether a population can meet its basic needs such as food, housing and health care. Malnutrition is thus a health outcome as well as a risk factor for disease and exacerbated malnutrition, and it can increase the risk both of morbidity and mortality. Although it is rarely the direct cause of death (except in extreme situations, such as famine), child malnutrition was associated with 54% of child deaths (10.8 million children) in developing countries in 2001. Malnutrition which is the direct cause of death is referred to as “Protein-energy Malnutrition ’’.

19. 19 DIET & NUTRITION Malnutrition

20. 20 DIET & NUTRITION CHRONIC MALNUTRITION Stunting –(too short for age) an indicator of the long-term cumulative effects of nutrition deficiency. Children <5 yrs particularly affected. Short term implications –growth faltering and weight loss with associated micronutrient deficiencies. Increases susceptibility to disease & infection. Longer term effects –impaired physical & mental development. Consequences of stunting increase the demands on medical, public health, and food assistance during crises SEVERE ACUTE MALNUTRITION (SAM) Normal physiological mechanisms adapt - Mobilise energy & nutrient reserves - Decrease energy & nutrient demands As severity increases these adaptations prevent the body’s ability to respond to stresses e.g. infection

21. 21 DIET & NUTRITION Clinical forms of SAM •Marasmus–severe weight loss leaving „skin and bones‟ •Kwashiorkor –bloated appearance due to water accumulation (oedema) • Marasmic -kwashiorkor –a combination of both Marasmus Extremely emaciated (fat & muscle tissue grossly reduced) Thin flaccid skin, hanging in loose folds; “baggy pants”, “old man‟s appearance” Normal hair Frequent infections with minimal signs Electrolyte imbalance (no oedema) Frequent association with dehydration Alert & irritable

22. 22 DIET & NUTRITION Causes of Malnutrition

23. 23 DIET & NUTRITION Disorder Due to malnutrition: Protein Energy malnutrition KWASHIORKOR and Marasmus Kwashiorkor is a disease marked by severe protein malnutrition and bilateral extremity swelling. It usually affects infants and children, most often around the age of weaning through age 5. The disease is seen in very severe cases of starvation and poverty-stricken regions worldwide. Bilateral pitting edema, beginning in the lower legs and feet, can become more generalized (hands and arms, “moon face”) Reduced fat muscle tissue (often masked by the edema) Hair changes colour (yellow/reddish) and becomes sparse; curly hair becomes straight; dry & brittle, easily pluckable. Skin lesions and hypo-pigmentation: Dark skin may become lighter esp. in the skin folds Outer layers of skin may peel off - ulceration The lesions may resemble burns - prone to infection. Frequent infections Electrolyte imbalance Frequent association with dehydration (often masked by oedema) Generally apathetic, lethargic, miserable, and irritable. They show no signs of hunger, and it is difficult to persuade them to eat.

24. 24 DIET & NUTRITION Marasmus Symptoms visible wasting of fat and muscle. Prominent skeleton. The head appears large for the body. The face may appear old and wizened. Dry, loose skin (skin atrophy). Dry, brittle hair or hair loss. Sunken fontanelles in infants. Lethargy, apathy and weakness.

25. 25 DIET & NUTRITION Measles

26. 26 DIET & NUTRITION Malnutrition Measles & Vitamin A Measles is known to interact particularly with malnutrition and vitamin A. It is a common precipitating cause of potentially blinding eye lesions in young children, and of severe growth faltering and malnutrition. Risk of mortality from measles is reduced by 50% with Vitamin A supplementation. Malaria Major cause morbidity & mortality Often affects poor and malnourished populations -vulnerable, children & pregnant women Malaria causes haemolysis , which in turn causes anaemia . Conflicting evidence that undernutrition is an underlying cause of malaria morbidity & mortality Iron Deficiency Uncorrected iron deficiency leads to: severe anaemia (major obstetric problem; maternal mortality) lbw risk (2x as high in malaria-endemic area) Stillbirths, miscarriage reduced work capacity diminished learning ability increased susceptibility to infection

27. 27 DIET & NUTRITION Malnutrition Reduce Malaria or supplement iron? Conflicting information Iron supplementation protects a child who is at high risk of dying from severe anaemia in the first 2 years of life. The malaria parasite requires iron for its multiplication in blood, and thus may be less infective in the iron-deficient individual. Undernutrition increases the incidence and severity of diarrhea Diarrhea's detrimental to nutritional status (acute weight loss, malnutrition & stunting). Diarrhoeal diseases account for 10-80% of growth retardation in the first few years of life worldwide, affected by: aetiology and clinical type of diarrhoea , the source and adequacy of dietary intake, treatment, and feeding practices. The case fatality rate is highest among children aged 6-12 months because:? Dehydration is the most direct effect of diarrhoea , accounting for the majority of deaths. The widespread adoption of oral rehydration therapy (ORT) has greatly reduced the mortality related to diarrhoea . Diarrhoeal illnesses in young children continue to be a leading cause of morbidity and mortality worldwide treatments). Why?

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30. 30 DIET & NUTRITION TREATMENTS FOR MALNUTRITION It is necessary for the health experts to provide treatment to the patient according to his/her general health and severity of the abnormality or deformity. According to Treatment of a person with malnutrition depends on the person’s general health and how severely malnourished they are. The first dietary advice is usually: Use foods that are high in calories and protein Snacking between meals Having drinks that contain lots of calories Avoid Excessive intake of food Use diet when needed. PREVENTING MALNUTRITION According to NHA (2015), it is necessary for a person to avoid malnutrition and also to use all those food ingredients or healthy diet which promote his/her health. Healthy diet include to use Plenty of fruit and vegetables Plenty of bread, rice, potatoes, pasta and other starchy foods Milk and dairy foods Meat, fish, eggs, beans and other non-dairy sources of protein

31. 31 DIET & NUTRITION Malnutrition And its effects

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34. 34 DIET & NUTRITION Malnutrition And infectious diseases

35. 35 DIET & NUTRITION Proportional Mortality In Children Younger Than 5 Years Old

36. 36 DIET & NUTRITION CARBOHYDRATE Carbohydrates are a large family of naturally occurring compounds including sugars, starches, and cellulose, as well as materials found in bacterial cell walls and insect exoskeletons. Carbohydrates can also be called saccharides, a general word derived from the Latin word for sugar. Classification of Carbohydrates Carbohydrates are classified into three major groups: Monosaccharides, Oligosaccharides Polysaccharides Monosaccharides (Simple Sugars) Monosaccharides (Simple Sugars) Simplest form that cannot be hydrolyzed further into smaller units. Low molecular weight carbohydrates and cannot be hydrolysed further. Crystalline, soluble in water, and sweet in taste. Classified into triose, tetrose , pentose, hexose and heptose depending upon the number of carbon atoms. They may be either aldoses or ketoses depending upon whether they contain a (potential) free aldehyde (OH) or ketone (C=O) group, respectively. All monosaccharides are reducing in nature.

37. 37 DIET & NUTRITION Oligosaccharides Contain 2-10 monosaccharides joined by Glycosidic bonds. Low molecular weight carbohydrates which can be hydrolysed by enzymes or acids to yield Monosaccharides. Powdery or crystalline, soluble in water and sweet in taste. Classified into disaccharide, Trisaccharide, Tetrasaccharide and Pentasaccharide depending upon the number of Monosaccharides they contain. Some of them are reducing and some of them are non reducing in nature Polysaccharides (Glycans) Contain many Monosaccharides joined by glycosidic bonds. They can be hydrolysed by enzymes or acids. Insoluble in water, tasteless, linear or branched. Classified into homoglycans and heteroglycans depending upon the kind of monosaccharides present. Depending upon the function, they are classified as storage and structural polysaccharides. Non reducing in nature. Cells mainly in the form of glucose utilize carbohydrate. The three principal Monosaccharides resulting from the digestive processes are glucose, fructose and Galactose. Both fructose and Galactose are readily converted to glucose by the liver. Pentose sugars such as xylose, arabinose and ribose may be present in the diet, but their fate after absorption is obscure. Since glucose is the compound formed from starch and glycogen, the carbohydrate metabolism commences with this monosaccharide.

38. 38 DIET & NUTRITION The Major Metabolic Processes In Carbohydrates Are : Glycolysis: splits glucose to pyruvate, which can be converted to lactate under anaerobic condition. Gluconeogenesis: converts pyruvate to glucose. Glycogenesis: synthesis of glycogen, carbohydrate fuel storage form. Glycogenolysis: breakdown of glycogen. Pentose Phosphate Pathway (PPP) or HMP pathway: produces NADPH for cell biosynthesis. Kreb's TCA cycle or Citric Acid Cycle: converts Acetyl CoA to C02 and energy Functions of Carbohydrates: Providing energy and regulation of blood glucose. Sparing the use of proteins for energy. Breakdown of fatty acids and preventing ketosis. Biological recognition processes. Flavor and Sweeteners. Dietary fiber

39. 39 DIET & NUTRITION Fats Fats also known as lipids Lipids arechemically heterogenous group of compounds that are insoluble in water butsoluble in non-polar solvents such as hexane, chloroform. Lipids occur in plants and animals as storage and structural components. Structurallipids present in animals and plants are in the form of meat and vegetables, respectively. Storage fats occur in milk and adipose tissue of farm animals and in seed oils. Fats supply over twice as much ener'gy per unit weight as proteins or carbohydrates, Lipids are anhydrous due to non-polar nature and represent more energy than carbohydrates which are heavily hydrated due to polar nature. The presence of lipids in diet contributes considerably to palatability. A fat- free diet would be unpleasant to eat. Lipids contribute palatability in two ways. They induce olfactory responses, namely, taste in the mouth and aroma through nose,Secondly , they contribute to the texture of food and is responsible for the mouth-feel. Lipids also supply the essential fatty acids which are not synthesised in human beings but are essential for growth. Lipids are essential for the effective absorption of fat-soluble vitamins A, D, E and K from intestine, Many enzymes require lipid molecules for maximal activity. Examples are microsomal enzyme, glucose 6-phosphatase and mitochondrial enzyme, p-hydroxybutyrate dehydrogenase. Adrenal corticosteroids, sex hormones and vitamin D3 (Cholecalciferol) are synthesized from lipid derivative (cholesterol). Much of the lipid of mammals is located subcutaneously and acts as insulation against excessive heat loss to the environment.

40. 40 DIET & NUTRITION Classification of Lipids Simple Lipids Esters of fatty acids with glycerol and monohydric alcohols. Depending upon the constituent alcohols they are further subdivided into fats or oils and waxes. Fats, also termed as triacylglycerols are esters of fatty acids with glycerol e.g., Plants-vegetable oils;Animals-ghee and butter. Waxes are esters of fatty acids and alcohols other than glycerol e.g., Plant wax-carnauba wax; Insect wax-beeswax; Animal wax -lanolin. Compound Lipids Esters containing chemical groups in addition to alcohol and fatty acids. Depending upon the chemical groups they are further subdivided into phospholipids, glycolipids, sulpholipids and lipoproteins. Phospholipids contain phosphate group. Phopholipids are further grouped as glycerophospholipids, if the constituting alcohol is glycerol (e.g., Lecithin) or as sphingophospholipids , if the alcohol is sphingosine (e.g., Sphingomyelin). Glycolipids contain hexose units preferably galactose alongwith fatty acids and alcohol e.g., cerebrosides. Plant sulpholipids contain sulfated hexose with fatty acids and alcohol. Lipoproteins contain protein subunits along with lipids. Depending upon density and lipid compound they are further classified as VLDL. LDL and HDL.

41. 41 DIET & NUTRITION Derived Lipids Substances derived from simple and compound lipids by hydrolysis of alcohols, fatty acids, aldehydes, ketones, sterols and hydrocarbons. Lipids are water-insoluble that are either hydrophobic (nonpolar) or amphipathic (polar and nonpolar regions). Lipids are in many ways the most diverse of the biological macromolecules, since they are something of a rag-tag bunch of leftovers. Lipids are pretty much everything in the cell that isn't very water soluble, and chemically they don't have a great deal in common with one another. The best known lipids are probably the fatty acids. The Fatty Acids The fatty acids are long chain Carboxylic acids synthesised by the condensation and reduction of acetyl co enzyme-A units by fatty acid synthase. The more important ones have nonsystematic names in wide use. Stearic and palmitic acids are saturated (no double bonds), oleic acid is monounsaturated, and linoleic and linolenic are polyunsaturated. All these common fatty acids are cis (E) fatty acids. Because of the links in the chain caused by the double bonds, the unsaturated fatty acids tend to be liquids at room temperature (they are less easy to pack together to form a solid). Bacteria and plants (which cannot thermo-regulate) will use more unsaturated acids in their cell membranes when they are exposed to cold this helps to maintain membrane fluidity.

42. 42 DIET & NUTRITION Properties Of Fat Chemical Fat is hydrolysed to yield three molecules of fatty acid and one molecule of glycerol. The hydrolysis of fat is effected by alkali and enzyme. The process of alkali hydrolysis is called 'saponification'. The alkali salt of fatty acid resulting from saponification is soap Hydrolysis of triacylglycerol may be accomplished enzymatically through the action of lipases. Development of disagreeable odour and taste in fat or oil upon storage is called rancidity. Rancidity reactions may be due to hydrolysis of ester bonds (hydrolytic rancidity) or due to oxidation of unsaturated fatty acids (oxidative rancidity). The partial hydrolysis of the triacylglycerol to mono and diacylglycerol is called Hydrolytic rancidity. The hydrolysis is hastened by the presence ofmoisture , warmth and lipases present in fats or air. In fats like butter which contains a high percentage of volatile fatty acids, hydrolytic rancidity produces disagreeable odour and taste due to the liberation of the volatile butyric acid. Butter becomes rancid more easily in summer. The unsaturated fatty acids are oxidised at the double bonds to form peroxides, which then decompose to form aldehydes and acids of objectionable odour and taste (Oxidative rancidity).

43. 43 DIET & NUTRITION Physical They are insoluble in water and soluble in organic solvents. Pure triacylglycerols are tasteless, odourless , colourless and neutral in reaction. They have lesser specific gravity (density) than water and therefore float in water. Though fats are insolu1;>le in water, they can be broken down into minute droplets and dispersed in water. This is called emulsification. They contain hydrophilic colloidal particles such as proteins,carbohydrates and phospholipids which act as stabilizing agents. Emulsification greatly increases the surface area of the fat and this is an essential requisite for digestion of fat in the intestine.

44. 44 DIET & NUTRITION Function Of Fats Fat Is Essential To The Life Of All Cells. Helps You Maintain Healthy Skin And Hair, Transport Fat-soluble Vitamins (A, D, E, And K) Throughout Your Body, And Regulate Blood Cholesterol. Dietary Fats Also Give You A Feeling Of Satiety After A Meal Because Fat Slows Down The Stomach's Emptying Time. It Has Ability To Store The Body's Extra Energy, But It Is Also Quite Active-fat Deposits Secrete More Than A Hundred Different Chemicals That Can Affect Your Health. Good Neurological Function Healthy Metabolism Balanced Blood Sugar Temperature Regulation Balanced Hormone Levels Better Reproductive Health Adequate Vitamin Storage

45. Thank you Dr.Sukanya Patel Founder and Chief scientific officer Nutrisukan Biotech PVT Ltd Bangalore [email protected]