Nutrition and Diet Therapy: Section 1 Chapter 1: The Relationship of Food and Health Nutrients Vitamins
Nutrition and Diet Therapy: Section 1 Chapter 1: The Relationship of Food and Health Nutrients Vitamins
Nutrition and Diet Therapy: Section 1 Chapter 1: The Relationship of Food and Health Nutrients Vitamins
Food Customs
- Food habits may be based on - Digestion begins here
nationality, culture, and religion. - Enzyme (salivary amylase) acts on
- Foods available in a certain area may starch
be favored for economic reasons. - Starch is a complex carbohydrate
- Economic status and social status - Teeth break up food; food mixes
contribute to food habits. with saliva
- “Bolus” formed
Chapter 3: Digestion, Absorption, & - Length of time food is in mouth is
Metabolism brief
- Small amounts of carbohydrates
Digestion changed
- The breakdown of food in the body ✓ Esophagus
in preparation for absorption. - Food travels through this muscular
- Mechanical digestion: food is tube
broken up by teeth and moved along - Connects mouth to stomach
GI tract by peristalsis. - Peristalsis and gravity act to move
- Chemical digestion: carbohydrates, bolus
proteins, and fats are broken down - Cardiac sphincter opens at lower end
into nutrients tissues can absorb and of esophagus to allow passage of
use. bolus into stomach
- Chemical changes occur through
hydrolysis (the addition of water and ✓ Stomach
breaking down of food molecules). - Temporary storage of food
- Enzymes act on food substances, - Mixing of food with gastric juices
causing them to break down into - Regulation of a slow, controlled
simple compounds. emptying of food into the intestine
- An enzyme can act as a catalyst, - Secretion of the intrinsic factor for
which speeds up the chemical vitamin B12
reactions without itself being - Destruction of most bacteria
changed in the process. inadvertently consumed
Absorption ✓ Stomach
- The passage of nutrients into the - Hydrochloric acid prepares the
blood or lymphatic system. gastric area for enzyme action
- Nutrients must be in their simplest - Pepsin breaks down proteins
form - In children, rennin breaks down milk
• Carbohydrates: simple sugars proteins
• Proteins: amino acids - Lipase acts on emulsified fats
• Fats: fatty acids and glycerol ✓ Small Intestine
- Most absorption occurs in the small - Hormones released
intestine; some occurs in the large • Secretin causes pancreas to
intestine. release sodium bicarbonate to
- Water is absorbed in the stomach, neutralize acidity of chyme
small intestine, and large intestine. • Cholecystokinin triggers
gallbladder to release bile
The Digestive System - Bile
• Emulsifies fat after it is secreted
✓ Mouth into small intestine
• Produced in liver; stored in • Also known as aerobic
gallbladder metabolism
- Enzymes are found in the pancreatic - Energy is released as nutrients are
juice that is secreted into small oxidized.
intestine. - Anaerobic metabolism reduces fats
• Pancreatic proteases (trypsin, without the use of oxygen.
chymotrypsin, - The complete oxidation of
carboxypeptidases): split carbohydrates, proteins, and fats is
proteins commonly called the Krebs cycle.
• Pancreatic amylase: converts - Anabolism is the process of using
starches (polysaccharides) to energy from oxidation to create new
simple sugars compounds.
• Pancreatic lipase: reduces fats to - Catabolism is the breakdown of
fatty acids and glycerol compounds during metabolism.
- Produces enzymes - Controlled primarily by hormones
- Prepares foods for absorption secreted by the thyroid gland:
- Lactase, maltase, sucrase convert Triiodothyronine (T3) and thyroxine
lactose, maltose, sucrose to simple (T4).
sugars Energy
- Peptidases reduce proteins to amino - Needed for involuntary and
acids voluntary activity
- Twenty-two feet long - Involuntary activity: maintenance of
- Villi, hairlike projections, increase body tissue, temperature, growth
surface area for maximum - Voluntary activity: walking,
absorption swimming, eating, reading, typing
✓ Large Intestine - Three groups of nutrients provide
- Colon walls secrete mucus to protect energy
against acidic digestive juices in • Carbohydrates
chyme. • Proteins
- Major tasks of the large intestine: • Fats
• Absorb water - Carbohydrates should be primary
• Synthesize some B vitamins and source of energy.
vitamin K - The unit used to measure the energy
• Collect food residue value of foods is the kilocalorie.
Metabolism - kcal: amount of heat needed to raise
- The use of food by the body after the temperature of 1 kilogram of
digestion water 1 degree Celsius.
- Results in energy - kcal is commonly called calorie.
- Occurs after digestion and ❖ 1 gram of carbohydrate yields 4 kcal
absorption; nutrients are carried by ❖ 1 gram of protein yields 4 kcal
the blood to the cells of the body ❖ 1 gram of fat yields 9 kcal
- Oxidation ❖ 1 gram of alcohol yields 7 kcal
• Nutrients combine with oxygen
• Carbohydrates reduce to carbon Stop and Share
dioxide and water If you eat a dessert with 19 grams of fat
• Protein to carbon dioxide, water, in it, how many calories from fat does it have?
and nitrogen 171 calories
Fat contains 9 kcal per gram 110 pounds 2.2 (pounds per kg) = 50 kg
Dessert has 19 grams of fat 50 kg × 24 hours in a day = 1,200 kcal
9 kcal/gram × 19 grams of fat = 171 kcal 1,200 kcal × 0.9 =1,080 kcal
Sources Sources
- meats, poultry, fish, peanuts, • poultry, fish, liver, kidney, potatoes,
legumes. bananas, spinach, and unrefined whole
- Milk and eggs are sources of grains (oats and wheat).
tryptophan (precursor).
Deficiency
Requirement • symptoms include irritability,
- Measured in niacin equivalents (NE). depression, and dermatitis.
- 1 NE = 1 mg of niacin or 60 mg of • Deficiency in infants can cause
tryptophan (an amino acid that is a various neurological symptoms and
precursor of niacin). abdominal problems.
❖ Average adult female requires 14
mg/NE. Excess
❖ Average adult male requires 16 mg/NE. • Toxicity is rare; may cause
temporary neurological problems.
-
Excess Requirements:
- Excessive amounts of niacin may • Measured in milligrams.
cause flushing due to vascular ❖ Average adult female requires 1.3-1.5
dilation, GI problems, itching, and mg/day.
liver damage.
❖ Average adult male requires 1.3-1.7 • Excess can mask vitamin B12
mg/day. deficiency and inactivates phenytoin,
• Need increases as protein increases. an anticonvulsant drug used by
• Oral contraceptives interfere with epileptics.
metabolism of vitamin B6 and can • FDA limits amount in over-the-
result in a deficiency. counter supplements to:
❖ 100 g for infants
Vitamin B Complex: Folate ❖ 300 g for children
• folacin, and folic acid are ❖ 400 g for adults
chemically similar compounds, and
names are used interchangeably. • Cobalamin–contains mineral cobalt.
• Needed for DNA synthesis, protein • Stored in body three to five years.
metabolism, formation of • Involved in folate metabolism,
hemoglobin. maintenance of the myelin sheath,
and healthy red blood cells.
Sources • To be absorbed, must bind with
• cereals fortified with folate, green leafy intrinsic factor in stomach.
vegetables, legumes, sunflower seeds, Pernicious anemia may result from
fruits such as orange juice and loss of intrinsic factor.
strawberries.
Vitamin B Complex: B12
Requiremment
• Measured in micrograms. Sources
❖ Average adult female requires 400 • animal foods, especially organ
g/day. meats, lean meat, seafood, eggs,
❖ Average adult male requires 400 g/day. dairy products.
• Increased need during pregnancy and
growth. Requirement
❖ 600 g/day required one month before ❖ Average adult requires 2.4 g/day.
conception through first six weeks of ❖ Increased need during pregnancy and
pregnancy. lactation.
• Amount absorbed will depend on
Deficiency current need.
• Deficiency linked to neural tube
defects in fetus such as spina bifida Deficiency
(spinal cord or spinal fluid bulge • Deficiency is rare and may be due to
through the back) and anencephaly congenital problems of absorption or
(absence of the brain). years of a vegetarian diet with no
• Other signs include inflammation of animal foods.
mouth and tongue, poor growth, • Symptoms inclued megaloblastic
depression and mental confusion, anemia, pernicious anemia (if
problems with nerve functions, intrinsic factor absent), anorexia,
megaloblastic anemia. glossitis, sore mouth, tongue, pallor,
depression, dizziness, weight loss,
Excess neurological system damage.
Vitamin B Complex: Pantothenic Acid - symptoms include nausea, anorexia,
• Involved in metabolism of depression, pallor, dermatitis,
carbohydrates, fats, proteins. increase in serum cholesterol.
• Essential for synthesis of
neurotransmitter acetylcholine and Vitamin C or Ascorbic acid
steroid hormones. - Has antioxidant properties and
• Thought to be synthesized by the protects food from oxidation.
body. - Role in formation of collagen.
- Aids in absorption of nonheme iron.
Sources - May be involved with formation or
• meats, poultry, fish, eggs, whole functioning of norepinephrine, some
grain cereals, and legumes. amino acids, folate, leukocytes, the
immune system, allergic reactions.
Requirement
• Food and Nutrition Board has Sources
provided an estimated intake of 5 mg • Sources include citrus fruits, melon,
a day for normal adults. strawberries, tomatoes, potatoes, red
and green peppers, cabbage,
Excess broccoli.
• Toxicity from excess not confirmed.
Requirement
Deficiency ❖ Average female adult requires 75
• Natural deficiencies unknown. mg/day.
• Signs include weakness, fatigue, ❖ Average male adult requires 90 mg/day.
burning sensation in feet ❖ Stress and cigarette smoking increase
(deficiencies produced need.
experimentally). ▪ Stop and Share
Deficiency Sources
- Deficiency is rare. - Table salt contains 40% sodium.
- Excessive use of antacids affect - One teaspoon of table salt contains
absorption. 2,000 mg of sodium.
- Symptoms of deficiency include - Naturally available in animal foods.
bone demineralization (loss of
minerals), fatigue, and anorexia. Requirements
❖ 0-5 months 120 mg
Potassium (K) ❖ 6-11 months 200 mg
- Found primarily in intracellular ❖ 1 year 225 mg
fluid. ❖ 2-5 years 300 mg
- Essential for fluid balance and ❖ 6-9 years 400 mg
osmosis. ❖ 10-18 years 500 mg
- Maintains fluid level within the cell. ❖ > 18 years 500 mg
- Necessary for transmitting nerve
impulses and muscle contractions. Deficiency
• Caused by severe vomiting, diarrhea, and
Sources heavy perspiration.
• Fruits–especially melons, oranges, • Can upset the acid-base balance.
bananas, peaches • Tetany due to alkalosis may develop.
Excess • Green leafy vegetables, legumes, nuts,
- May cause edema and resulting whole grains, some fruits (avocados and
hypertension. bananas)
- Associated with hypertension and • Milk in sufficient quantities
congestive heart failure.
- Treatment includes sodium- Requirements
restricted diets; 3-4g (no-added salt, o Adequate Intake
or NAS) or 1-2g sodium-restricted ❖ 0-6 months 30 mg
diet. Diets below 1g rarely ❖ 6-12 months 75 mg
prescribed. ❖ Boys and girls 1-3 years 80 mg
4-8 years 130 mg
Chloride (Cl) 9-13 years 240 mg
- Essential for maintenance of fluid, ❖ Boys 14-18 years 410 mg
electrolyte, and acid-base balance. ❖ Girls 14-18 years 360 mg
- Found in hydrochloric acid, ❖ Men 19-30 years 400 mg
cerebrospinal fluid, and muscle and ❖ Women 19-30 years 310 mg
nerve tissue. ❖ Men 31-70+ years 420 mg
- Helps blood carry carbon dioxide to ❖ Women 31-70+ years 320 mg
the lungs and is necessary during ❖ Pregnant women
immune responses when white blood 14-18 years 400 mg
cells attack foreign cells. 19-30 ears 350 mg
- Found almost exclusively in table 31-50 years 360 mg
salt or in foods containing sodium ❖ Lactating women
chloride. 14-18 ears 360 mg
-30 ears 310 mg
Requirement 31-50 years 320 mg
- Estimated minimum requirement for
normal adults is 750 mg a day. Deficiency
- Deficiency among people on normal
Deficiency diets is unknown.
- Deficiency is rare. - Experimentally induced symptoms
- Can occur with severe vomiting, include nausea, mental, emotional,
diarrhea, excessive use of diuretics, muscular disorders.
and alkalosis. Sulfur (S)
- Necessary to all body tissue and is
Magnesium (Mg) found in all body cells.
- Vital to both hard and soft body - Contributes to the characteristic odor
tissues. of burning hair and tissue.
- Essential for metabolism. - Necessary for metabolism.
- Regulates nerve and muscle - Component of some amino acids.
function. - Found in protein-rich foods.
- Plays a role in the blood-clotting - Neither the amount of sulfur required
process. by the human body nor its deficiency
is known.
Sources
• Found primarily in plant foods. Trace minerals
Iron (Fe)
- Delivers oxygen to body tissues. - Heavy need during infancy and
- Component of hemoglobin. teens.
- Component of myoglobin, a protein Deficiency
compound in muscles that provides - Caused by insufficient intake,
oxygen to cells. malabsorption, lack of stomach acid,
- Utilized by enzymes that are or excessive blood loss.
involved in making amino acids, - Most common nutrient deficiency
hormones, and neurotransmitters. worldwide is iron-deficiency
anemia.
Sources - Symptoms include fatigue,
• Meat, poultry, and fish are the best weakness, irritability, shortness of
sources of iron. Animal flesh contains breath, pale skin, and spoon-shaped
heme iron, which is absorbed more than fingernails.
twice as efficiently as nonheme iron.
• Nonheme iron is found in whole grain Excess
cereals, enriched grain products, - Hemochromatosis is a condition
vegetables, fruit, eggs, meat, fish, and due to an inborn error of metabolism
poultry. and causes excessive absorption of
iron.
Factors that Affect Iron Absorption - Untreated, can damage liver, spleen,
Increase heart.
▪ Acid in the stomach - To control buildup of iron, patients
▪ Heme iron with this condition must give blood
▪ High body demand for red blood cells on a regular basis.
(blood loss, pregnancy)
▪ Low body stores of iron Iodine (I)
▪ Meat protein factor (MPF) - Component of thyroid hormones,
▪ Vitamin C thyroxine (T4) and triiodothyronine
Decrease (T3).
▪ Phytic acid (in fiber) - Necessary for the normal functioning
▪ Oxalic acid of thyroid gland, which determines
▪ Polyphenols in tea and coffee rate of metabolism.
▪ Full body stores of iron
▪ Excess of other minerals (Zn, Mn, Ca) Sources
▪ Some antacids • iodized salt, seafood, and some plant foods
grown in soil bordering the sea.
Requirements
- Men lose approximately 1 mg/day. Requirement
- Women lose approximately 1.5 - RDA for adults is 150 g a day.
mg/day. - Additional amounts needed during
- RDA for men is 10 mg, and for pregnancy and lactation.
women age eleven through
childbearing is 15 mg. Deficiency
- RDA doubled during pregnancy; - Lack of iodine results in decrease in
difficult to meet by diet alone. thyroxine and triiodothyronine.
- Iron supplement commonly - Gland grows, forming a lump on the
prescribed during pregnancy. neck called a goiter.
- Myxedema is a condition of - Selenium supplements appear to be
hypothyroidism in adults. effective in treating Keshan disease
- Cretinism is low thyroid in a child; - High doses are toxic causing
retards physical and mental vomiting, loss of hair and nails, and
development. skin lesions.
Sources Source
• fluoridated water, fish and tea. • milk, liver, legumes, and cereals
Commercially prepared foods with
fluoridated water. Requirement
- Safe and adequate daily intake for
Deficiency adults is 45 g.
- Deficiency can result in increased
tooth decay. Deficiency or Excess
- No deficiencies noted.
Excess - Excess inhibits copper absorption.
- Excess can cause discoloration or
mottling of children’s teeth.
Chapter 9: Water
Requirements - Humans can live about 8 weeks
▪ 0-6 months .01 mg without food.
▪ 6-12 months 0.5 mg - One can live only a few days without
▪ 1-3 years 0.7 mg water.
▪ 4-8 years 1.0 mg - Water is in all body cells.
▪ 9-13 years 2.0 mg - 50-60% body weight of normal
❖ Boys 14-18 years 3.1 mg adults.
- Percentage is highest in newborns; - Energy metabolism produces water.
decreases with age.
- Two basic compartments Estimated Daily Fluid Intake for an Adult
• Intracellular fluid (ICF): within ❖ Ingested liquids 1,500 ml
cells; 65% of total body fluid. ❖ Water in foods 700 ml
• Extracellular fluid (ECF): ❖ Water from oxidation 200 ml
outside cells; 35% of total body Total 2,400 ml
fluid.
Divided into intravascular fluid (in blood stream) Fluid and Electrolyte Balance
and interstitial fluid (between cells) - Electrolytes are measured in
milliequivalents (mEq/L).
Body Fluid Compartments - Sensible (noticeable) water loss is
water lost through urine.
- Insensible (unnoticeable) water loss
is in feces, perspiration, and
respiration.
- Waste products of metabolism
excreted in the form of urine (500
ml of water each day).
Food Allergies
A food allergy occurs when the
immune system reacts to a food
substance, usually a protein.
Treatment of Allergies
• Removal of allergen
• Food diary
• Laboratory tests
• Elimination diet
• Patient education
Elimination Diet
A limited diet in which only certain
foods are allowed in an attempt to
pinpoint the food allergen causing
the reaction. Additional foods are
introduced slowly until an allergic
reaction occurs.