CHP300:Community Health Program-l Mohamed M. B. Alnoor NUTRITION AND HEALTH.

CHP300:Community Health Program-lMohamed M. B. Alnoor

NUTRITION AND HEALTH

Objectives: To define nutrition and related words. To identify nutritional requirements. To understand Food pyramid. To list types of nutrients and their relation

to health. To define malnutrition and its

classification. To list main malnutrition problems. To understand Obesity.

Nutrition

Definitions

NUTRITION AND HEALTH

Nutrients Macronutrients Micronutrients

Community Nutrition:

Dietetics: Nutritional

Epidemiology:

- Foods of animal origin

- Foods of vegetable origin

CLASSIFICATION OF FOODS by origin

Carbo-hydratesProtein Fat

Water

Vitamins

Minerals

-Proteins-Fats

-Carbohydrates

-Minerals-Water

-Vitamins

CLASSIFICATION OF FOODS by chemical composition

Body building foods:

CLASSIFICATION OF FOODS by predominant function

Energy giving foods:

Protective foods:

The adequate diet & Food Pyramids

Food Group System: Classifies foods according to similarity in nutrient content.

Nutritional Requirements

2- Eat good fats (avoid bad fats):Oils found in nuts, seeds, grains and fish. Rich in unsaturated fats necessary for good health.Should constitute > 30 to 45% of the total fat.

1- Maintain a healthy weight. BMI: 18.5 to 24.9

Food PyramidsLessons from Food Pyramid


19 to 25

More nutritious than refined carbohydrates More slowly digested Less stress on pancreas.

Food Pyramids Lessons from Food Pyramid


3 .Eat whole-grain carbohydrates . (whole meal bread, whole wheat, brown

rice) Why?

4-Avoid red meat as a protein source and emphasize plant proteins.

5- Take a multivitamin daily. Insurance against any deficiency.

Food PyramidsLessons from Food Pyramid


6- Eat plenty of dark green leafy vegetables and fruits.

Lowers blood pressure and cholesterol and reduces the risk of cancer.

Carbohydrates Lipids Protein

Vitamins Minerals Water

Energy Supplying Nutrients:

Main types of Nutrients

Non-Energy Supplying Nutrients:

PROTEINS

Complex organic nitrogenous compounds.

Contain sulfur, phosphorous and iron. About 20 different amino acids(aa) in

human body. 8-9“essential” aa

Why are they called “essential” ?Essential for what ?

Main types of NutrientsEnergy Supplying

Nutrients

Protein Needs:

Adults: 0.8 gm/kg body weight per day

Excess protein is not used to build more muscle

- extra aa are used for energy - or converted to fat and stored.

PROTEINS


Nutrients

Animal sources : Complete proteins; have all essential aa.

Plant sources : Incomplete proteins; lack one or more essential aa.

Sources of Proteins :

PROTEINS


Nutrients

Body building Repair and maintenance of body

tissues Maintenance of osmotic pressure Synthesis of bioactive substances

and vital molecules e.g. immunoglobulins

Functions of Proteins:

PROTEINS


Nutrients

Lipids include cholesterol and triglycerides

Fats are necessary for health

Functions 1 – Highest source of energy (9Kcal/g). 2 - Spare protein. 3 - Adipose tissue holds the body organs

and nerves in place. 4 - Maintain body temperature. 5 - Transportation of fat soluble

vitamins.

LIPIDS


Nutrients

Classification of Fats

Saturated fat: Animal

foods

Palm oil

coconut oil

LIPIDS


Nutrients

(Richest source)

Monounsaturated fat:


Olives oil Peanuts

oil

canola oil

LIPIDS


Nutrients

Polyunsaturated fat:


Corn oil

Sunflower oil

cotton seed oil

nut

oil

LIPIDS


Nutrients

Richest source

Trans Fatty AcidsHydrogenated &Partially hydrogenated fats


LIPIDS


Nutrients

liquid oilsmore solid margarinehydrogenation

Saturated fat and trans fatty acids could be harmful to health

Baked products and fried foods are often made with hydrogenated fats


Hydrogenated fat:

LIPIDS


Nutrients

Necessary for:


Cholesterol:

LIPIDS


Nutrients

cell membranes production of: vitamin D

Bile some hormones

Only in animal foods


Cholesterol:

LIPIDS


Nutrients

blood levels risk of heart

disease

The WHO Expert committee on Prevention of Coronary Heart Disease has recommended that only 20 to 30% of total dietary energy is to be provided by fats. (<30%)

At least 50 % of fat intake should consist of vegetable oils rich in essential fatty acids.

Fat requirements

LIPIDS


Nutrients

1 - Main source of energy: 4 Kcals/gram.

2 - Essential for the synthesis of certain non-essential aa.

3 - Necessary for normal fat metabolism.

4 - Necessary for integrity of nerve cells.

CARBOHYDRATES


Nutrients

Functions:

5 - Lactose allows growth of beneficial bacteria in the intestine. 6 - Important for normal elimination (excretion); fibers

Recommended intake is 55% to 65% of calories, primarily from

starchy foods.

CARBOHYDRATES


Nutrients

Functions:

The inability of the body to metabolize carbohydrates properly = DM

1- Monosaccharides: glucose or fructose 2- Disaccharides: Sucrose (G + F) 3- Oligosaccharides (3-10). 4- Polysaccharides (11-1000) a-Digestible e.g. starch b-partially digestible e.g. dextrin c-Indigestible e.g. cellulose

Classification of CHOS

CARBOHYDRATES


Nutrients

Fiber Indigestible plant material e.g. cellulose Dietary fiber is mainly non-starch

polysaccharide It is found in vegetables, fruits and grains. Soluble fiber swells or dissolves in water. Rich sources include apples, bananas,

citrus fruits, carrots

CARBOHYDRATES


Nutrients

Importance:Reduces cholesterol absorption Slows absorption of glucose

Soluble fiber

Fiber

CARBOHYDRATES


Nutrients

Insoluble fiber remains unchanged in water.

Fiber

CARBOHYDRATES


Nutrients

Insoluble fiber

Rich food sources include brown rice, wheat bran, and whole grain products.

Reduces the risk of:

Fiber

CARBOHYDRATES


Nutrients

Insoluble fiber Importance:

Heart disease Diabetes type II Diverticulosis Hemorrhoids Constipation Colorectal cancer

Refined CHOS Versus Whole Grains

Whole grains are higher than refined carbohydrates in fiber, vitamins, minerals, and other beneficial compounds

Whole grains:• Take longer to digest• Make people feel full sooner• Cause a slower rise in glucose

levels

CARBOHYDRATES


Nutrients

Choose foods that have a whole grain as the first item on the ingredient list on the food label

• Whole wheat, whole rye, whole oats, oatmeal, whole-grain corn, brown rice, popcorn, barley, etc.

ADVICE

CARBOHYDRATES


Nutrients

Refined CHOS Versus Whole Grains

Vitamins

Minerals

Water

Main types of NutrientsNon-Energy Supplying

Nutrients

Regulate growth. Maintain tissues. Help carbohydrates, proteins, and

fats release energy.


NutrientsVITAMINS

Functions:

• Provide no calories (no energy)

• Needed in very small amounts

Water Soluble:

Fat Soluble:


NutrientsVITAMINS Classification of

Vitamins

Water Soluble: 8 different B Vits and vitamin C

Fat Soluble: Vits A, D, E, and K - Healthy people do not need supplements;


NutrientsVITAMINS Classification of

Vitamins

-Supplementation toxic high levels

«Vitamin A» covers both: a pre-formed vitamin: retinol

(animal sources) a pro-vitamin: beta carotene(plant

sources) which is converted to

retinol in the intestinal mucosa.


NutrientsFat Soluble VitaminsVitamin A

Essential for normal vision. Necessary for maintaining the

integrity and the functioning of glandular and epithelial tissue which lines intestinal, respiratory and urinary tracts as well as the skin and eyes.

Functions of Vitamin A:


NutrientsFat Soluble VitaminsVitamin A

It supports growth, especially skeletal growth

It may protect against some epithelial cancers such as bronchial cancers.


NutrientsFat Soluble Vitamins

Functions of Vitamin A:

Vitamin A

The nutritionally important forms of Vitamin D in man are: -Calciferol (Vitamin D2) and -Cholecalciferol (Vitamin D3)


NutrientsFat Soluble VitaminsVitamin D



Functions of Vitamin D: Intestine: Promotes intestinal

absorption of calcium and phosphorus

Bone: Stimulates normal mineralization, enhances bone reabsorption( resorption), affects collagen maturation

Kidney: Increases tubular reabsorption of phosphate

Vitamin D

Leads to:



Deficiency of Vitamin D:

Vitamin D

-Rickets in children

-Osteomalacia in adults

Antioxidant, Protects RBCs from haemolysis.

Vitamin E deficiency :

Neurological problems:• spinocerebellar ataxia• myopathies

Aaemia


NutrientsFat Soluble VitaminsVitamin E

Important for blood coagulation

Deficiency causes hemorrhagic manifestations.


NutrientsFat Soluble VitaminsVitamin K

Function: essential for the utilization

of carbohydrates, (found on the

membranes of neurons).


NutrientsWater Soluble VitaminsVitamin B1 (Thiamine)

Deficiency of (Thiamine) Beriberi may occur in three main forms:


Nutrients

Vitamin B1 (Thiamine)

Infantile beriberi

Wet beriberi Dry beriberi

Water Soluble Vitamins

Important for cellular metabolism,

oxidation and reduction. Deficiency: angular stomatitis &

glossitis (magenta tongue).


Nutrients

Vitamin B2 (Riboflavin)


Pyridoxine (vitamin B6) plays an

important role in the metabolism of amino acids, fats and carbohydrate.

The requirement of adults vary directly with protein intake.


Nutrients

Vitamin B6 (Pyridoxine)


The primary role of vitamin B6 is to act as a coenzyme to many enzymes in the body that are involved predominantly in metabolism.

Toxicity: Can occur with supplementation with high doses for long periods of time.


Nutrients

Vitamin B6 (Pyridoxine)


Destruction of dorsal root ganglia

Vitamin B12 is a complex organo-

metallic compound with a cobalt atom

(Cyanocobalamine)


Nutrients

Vitamin B12 (Cyanocobalamine)


Cooperates with folate in the synthesis of DNA.

Separate biochemical role, unrelated to folate, in synthesis of fatty acids in myelin.


Nutrients



Associated with megaloblastic anaemia (pernicious anaemia), demyelinating neurological lesions in the spinal cord.

Dietary deficiency of B12 may affect

subjects who are strict vegetarians and eat no animal product.

Vitamin B12 deficiency


Nutrients



Important for maintenance of the nervous system and healthy epithelium

Deficiency: Pellagra, dermatitis, dementia

and diarrhoea


NutrientsVitamin B3 (Niacin, Nicotinic acid)


Vitamin C (ascorbic acid) is a water-soluble vitamin.

It is the most sensitive of all vitamins to heat.

Vitamin C has an important role to play in tissue oxidation


NutrientsVitamin C (Ascorbic acid)


It is needed for the formation of collagen in connective tissue, which constitutes 25% per cent of total body protein.

Present in vegetables and fruits.




Deficiency of vitamin C Results in scurvy. Signs of scurvy are:

Swollen and bleeding gums, Subcutaneous bruising, Bleeding into the skin or joints, Delayed wound healing, Anaemia and weakness.




Minerals are certain elements that may: regulate chemical reactions in the body be part of organic molecules:

Iron in hemoglobin Calcium in bone and teeth

Small amounts are needed for health


NutrientsMinerals

Most plentiful mineral in the body

regulating blood pressure,

blood clotting, and

muscular movements

Calcium


NutrientsMinerals

Involved in

Needed for strong bones and teeth

Bones store calcium Osteoporosis

Bones lose mineral density and strength

Aging people, especially menopausal women, are at risk

Calcium


NutrientsMinerals

Most of the body’s iron is in hemoglobin, which is in red blood cells

The iron in hemoglobin picks up oxygen from the lungs and transports it to the cells.

Iron


NutrientsMinerals

Sources of vitamins & trace elements

Vit. AVit. E

Vit. DVit. KVit. B1 Vit. B2Vit. B3Vit. B12

Vit. B6Vit. CIro

nCalciumBody

buildingEnergy FoodsProtectiv

efoods

liver

meat

milk

berrie

s

Required

homework.

Included in the EXAM

Variety of functions: Helps transport of materials in the body, Involved in many chemical reactions.Beverages and most foods, especially fruits and vegetables, supply waterDiuretics such as alcohol and caffeine increase losses of water from the body


NutrientsWater

To be properly hydrated, a person needs at least 8 cups of water daily

Dehydration can be deadly Sports, drinks replenish minerals and

water that are lost during heavy exercise


NutrientsWater

Thirst sensation is not sensitive enough Continue drinking after you are no

longer thirsty Clear or near clear urine indicates

hydration


NutrientsWater

Signs of Dehydration

Headache Fatigue Needlessly lifeless Dark, concentrated urine


NutrientsWater

Malnutrition is a pathological state

resulting from a relative or absolute

deficiency or excess

of one or more of the essential nutrients.

Definition:

MALNUTRITION

Under-nutrition:

MALNUTRITION

Over-nutrition:

The major forms of malnutrition :

It is a pathological state resulting when nutrient intake does not meet the nutrient needs for cell activities and body maintenance.

Under-nutrition:

MALNUTRITIONThe major forms of

malnutrition :

It includes: Macronutrient deficiency e.g., protein-

energy malnutrition (marasmus &kwashiorkor).

Micronutrient deficiency e.g. iron deficiency anaemia, vitamin A deficiency, Iodine deficiency….etc.

Under-nutrition:


malnutrition :

The major malnutrition problems in the world are:

1 .Protein–energy malnutrition (PEM)2. Iron deficiency anaemia3. Iodine deficiency disorders (IDD)4. Vitamin A deficiency (VAD)

Under-nutrition:

MALNUTRITION

Over 2 billion people suffer from some form of iron deficiency

One of the most common nutritional disorders worldwide.

Iron deficiency anemia Under-nutrition:


malnutrition :

incidence Africa & South Asia.

Under-nutrition:


malnutrition :

Parasitic infestation contributes to high percent of cases in developing countries.

Common causes are dietary deficiency and chronic blood loss

Iron deficiency anemia

Reduces work capacity, thus reduces productivity & earnings

Associated with 50% of maternal deaths Retards fetal growth, causes low birth

weight (LBW) & increases infant mortality Impairs ability to resist disease; in

childhood it reduces learning ability

Consequences

Under-nutrition:


malnutrition :


Improving Iron status Iron tablets Iron fortification of basic foods (bread) Increased consumption of iron rich

foods & factors which enhance

absorption(e.g. vit. C) Control of parasitic infections

Under-nutrition:


malnutrition :


2 billion people worldwide at risk of IDD At least 655 million with goitre 43 million with some degree of mental

impairment 11 million with cretinism Moderate Iodine deficiency is associated

with average reduction of over 13 IQ points

Iodine deficiency disorders(IDD)

Under-nutrition:


malnutrition :

Adequate intake of Iodine can: prevent all IDD make milder forms of goiter

disappear improve development of older

children mildly affected

Prevention of(IDD)

Under-nutrition:


malnutrition : Iodine deficiency disorders(IDD)

Severe forms of IDD such as cretinism, cannot be reversed; but, can be prevented by:

Prevention of(IDD)

Under-nutrition:


malnutrition :

Adequate intake of Iodine during pregnancyNow, iodized salt is all over the world

Iodine deficiency disorders(IDD)

Vitamin A deficiency (VAD)

May be subclinical, severe or moderate Clinical (xerophthalmia)

2.8 million children 0-4 years old

Blindness, total or partial at least half a million children a year about half die within a few months

Under-nutrition:


malnutrition :

Conjunctival xerosis

The signs of Vitamin A deficiency (VAD)

Under-nutrition:


malnutrition :

Follicular hyperkeratosis

Night blindness


The signs of Vitamin A deficiency (VAD)

Under-nutrition:


malnutrition :

Keratomalacia

Corneal xerosis

Bitot's spots


Improving vitamin A status Increased intake of vitamin A rich

foods e.g. eggs; butter, whole milk; liver; red palm oil; dark green, yellow & red fruits

& vegetables Fortification of food (oils &

margarine) Supplements e.g. capsules of

Vitamin A 2-3 times per year to young children

Under-nutrition:


malnutrition :


It is a pathologic state resulting

when nutritional intake exceeds the body needs. This leads to caloric excess, usually over an extended period of time.

Over-nutrition:

MALNUTRITION The major forms of

malnutrition :

It is a disorder of Body Regulatory

System leading to Excess Body Fat Assessment: Body Mass Index (BMI) Waist Circumference (WC) Waist to Hip ratio (WHR)

Fat

Over-nutrition:


malnutrition :

OBESITY

Causes & Associated Factors

Over-nutrition:


malnutrition :

OBESITY

Genes Metabolism Behavior Environment Culture SES

Assessment of ObesityOver-nutrition:


malnutrition :

Body Mass Index (BMI)

Waist circumference

Waist Hip Ratio (WHR)

Assessment of Obesity

The international standard for assessing body size in adults .

BMI is computed using the following formula: BMI = Weight (kg)/ Height (m²)

Evidence shows that high BMI (obesity level) is associated with:

• type 2 diabetes & • cardiovascular morbidity & mortality

Over-nutrition:


malnutrition :

Body Mass Index (BMI)

BMI (WHO - Classification)

Underweight…………………………………….……………….<18.50Normal range…………………………………..……….….18.50 - 24.99 Overweight …................................................….25.00 - 29.99(Pre-obese) Obese class I…………………………………………....30.00 - 34.99 Obese class II………………………..……………...35.00 - 39.99 Obese class III……………….................…..≥40.00

Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.

Over-nutrition:


malnutrition :

Assessment of ObesityBody Mass Index (BMI)

Waist circumference

Waist circumference predicts mortality better than any other anthropometric measurement.Waist measurement alone can be used to assess obesity.Two levels of risk have been identified:

Over-nutrition:


malnutrition :


MALES FEMALELEVEL 1 > 94cm > 80cmLEVEL2 > 102cm > 88cm

Level 1 is the maximum acceptable waist circumference irrespective of the adults and there should be no further weight gain.Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complications.

Over-nutrition:


malnutrition :


MALES FEMALELEVEL 1 > 94cm > 80cmLEVEL 2 > 102cm > 88cm

Waist circumference


Visceral obesity (apple shaped)

Peripheral obesity (Pear shaped)

WHR > 0.8 F > 1.0 M

WHR< 0.8 F< 1.0 M

Interpretation of WHR Females: WHR= >0.80 or >80% Males: WHR= >0.95 or >95% It indicates central (upper body) or

visceral obesity and is considered high risk for diabetes & CVS disorders.

A WHR below these cut-off levels is considered low risk (peripheral obesity).


High risk :

Over-nutrition:


malnutrition :


CHP300:Community Health Program-l Mohamed M. B. Alnoor NUTRITION AND HEALTH.

Documents

foods of animal origin

fats classification

body building foods

food pyramidslessons

sources of proteins

plant proteins

food pyramids lessons

main types of nutrientsnon