Nutrition & Disease 287.10

7/31/2019 Nutrition & Disease 287.10

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NUTRITION & DISEASE

Dr M N Rama KrishnaB.Sc.,M.B.B.S, M.D, A.F.I.H

Dy. Chief Medical Officer (Corp.)Main HospitalKOTHAGUDEM


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A. By Origin 1. Vegetable

2. Animal

B. By Chemical Composition 1. Proteins2. Fats3. Carbohydrates4. Vitamins5. Minerals

C. By Predominant Function

1. Body Building Foods i. Milkii. Meatiii. Poultryiv. Fishv. Eggsvi. Pulses.vii. Groundnuts

CLASSIFICATION OF FOODS


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2.Energy Giving Foods

i. Cerealsii. Sugarsiii. Roots & Tubersiv. Fatsv. Oils

3. Protective Foodsi. Vegetablesii. Fruitsiii. Milk


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PROTEINS

Proteins constitute 20 % of Body weight in an adult

Proteins are made up of amino-acids ( About 24)

Out of 24 Amino- acids 9 are Essential Amino - Acids

1. Isoleucine 6. Threonine2. Leucine 7. Valine3. Lysine 8. Histidine4. Methionine 9. Tryptophan5. Phenylalanine


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Functions of Proteins

Body BuildingRepair & Maintenance of Body TissuesMaintenance of Osmotic PressureSynthesis of Anti-bodies, Plasma Proteins, Hb, Enzymes, Hormones &Coagulation Factors.Immune Mechanism of the BodyEnergy

SOURCES OF PROTEIN

Animal Sources MilkMeatEgg (Called as Reference Protein)CheeseFish

Vegetable Sources Pulses( Poor in EAA) Cereals

BeansNutsOil Seed Cakes etc


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Features Marasmus KwashiorkorClinical Always Present

Muscle Wasting Obvious Sometimes hidden by oedemaand fat

Fat Wasting Severe loss of Fat often retained but notsubcutaneous fat firm

Oedema None Present in lower legs, andusually in face and lowerarms

Weight for height Very low Low but may be masked byoedema

Mental Changes Sometimes quiet Irritable, moaning, apatheticand apathetic


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Features Marasmus Kwashiorkor

Clinical SOME TIMES PRESENT

Appetite Usually good Poor

Diarrhoea Often Often( Current and past ( Current and past)

Skin Changes Usually none Diffuse pigmentation,sometimes flaky paintdermatosis

Hair changes Seldom Sparse, Silky, easilypulled pulled out

Hepatic enlargement None Sometimes, due toaccumulation of fat


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KWASHIORKAR


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MARASMUS & ANG. STOMATITIS


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FATSFats & Oils are concentrated sources of energy

Human body can synthesize Triglycerides and Cholesterol

Other fats are called Essential Fatty Acids

Fats yield Fatty Acids : SaturatedUn Saturated

Essential Fatty Acids :Linoleic Acid Saffola Oil

Sunflower OilSoya Bean OilMustard Oil

Groundnut Oil

Linolenic Acid Soya BeanGreen leafy Vegetables

Arachidonic Acid MeatEggsMilk


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SOURCES OF FATS

Animal Fats GheeButterMilkCheeseEggsMeat

FishVegetable Fats Ground NutMustardCoconutSun FlowerSoya Bean etc .

Other Sources Cereals(Invisible Fats) Pulses

NutsVegetables


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Functions ofFats

High Energy FoodsServe as vehicle for fat-soluble vitaminsSupport viscera like heart, kidney, Intestines

etc.,Fat under skin provide insulation against coldGives taste to food

Gives shape to body


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Fats & DiseaseObesity

Phrenoderma ( due to deficiency of EFA)

CAD

Cancer Diets high in Fat increases risk

of cancer colon & Breast.

Fat Requirement :

20-30 % of daily total energy requirement should be from fats. 50 % of

fat should be from vegetable source.

20 gms / day is the daily requirement of added oil.

Energy :Fat Yields 9 K.cals / gm

CARBOHYDRATES


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CARBOHYDRATESMaximum source of energy

Essential for oxidation of Fats and synthesis of certain Amino-acids

Three main components of carbohydrates1.Starch Cereals

TubersRoots

2.Sugars Glucose, Lactose etc3.Cellulose Indigestible component

Dietary Fiber : It is non-starch, component of diet.

Sources : VegetablesFruitsGrains

Functions : Prevents constipation,Lowers Bl.Sugar

Reduces CholesterolWeight reductionPrevents Divertculosis & Cancer of Colon


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VITAMINSVitamins help the body to use other nutrients. They

are organic components and essential nutrients

1. Fat Soluble : ADE

K2.Water Soluble: B Complex

(Thiamine B1Riboflavin B2

Pyridoxine B6Cobalamine B12Niacin (Nicotinic Acid)Biotin

Folic Acid)C Vitamin


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VITAMIN A ( RETINOL & B -CAROTINE)

Source : Milk, Butter, cheese, Egg Yolk, Liver, Fatty Fish,

Meat, Amaranth, Spinach, Papaya, Mango, Pumpkin & Carrot(Cheapest sources)

Functions : * For Normal Vision* For retinal Pigments in dim vision.* To maintain integrity of epithelial and glandular tissue.* Supports skeletal growth* Acts as anti- infective* Protect against Epithelial cancers & Lung cancers

Vitamin A Deficiency causes :

- Night Blindness- Xerosis of Conjunctiva & Cornea- Bitot Spots- Keratomalasia ( Liquifaction of cornea)- Follicular Keratitis


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BITOTS SPOTS & GLOSSITIS


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Vitamin A Excess (Toxicity )

Mild - Dry Scaly skin

- Hair Loss- Mouth Sores- Anorexia- Vomiting

Severe - Papilloedema- Headache- Hepato-megaly- Cirrhosis of Liver

Prevention : Vit A liquid 2 lakh I.U. Every 6 months to children from1 yr to 5 yrs.

Vitamin D


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Vitamin D(Chole-calciferol)

(Kidney Hormone )

Sources : SunlightFatty FishFish Liver OilsButterEggs

Not Available in Vegetarian Food

Functions :

- Promotes intestinal absorption of calciumand phosphorus

- Enhances bone resorption and affectscollagen maturation.

- Increases tubular re-absorption of Phosphate.- Permits normal growth

VITAMIN D


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VITAMIN D

Deficiency : leads to

1. Rickets : - Usually observed in young childrenbetween 6 months to 2 yrs.- Reduced calcification of growing bones- Growth failure- Bone deformity ( curved legs, deformed

pelvis, pigeon chest, Harrisons sulcus, Kypho-scoliosis).

- Muscular Hypotonea- Tetany & convulsions

2. Osteomalacia : Softening of the bone

Requirement : 2.5 mcq ( 100 iu)/day ( Adults)5 mcq ( 200 iu)/day ( Infants & Children)


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RICKETS

VITAMIN K


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VITAMIN K Sources : - Dark green leafy vegetables

- Cows Milk- Fruits- Synthesized in colon by bacteria

Function : Stimulate the production of certain coagulationfactor.

Deficiency : Decreases Prothrombin content of blood and

clotting mechanism is delayed.

* Deficiency occurs usually in Obstructive jaundice, mal-absorption and also in prolonged oral antibiotic usage

WATER SOLUBLE VITAMINS


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WATER SOLUBLE VITAMINSVitamin C ( Ascorbic Acid )

Sources : - Amla- Guava- Citrus fruits- Berrys- Green leafy vegetables

Vit C is very easily destroyed by heat .

Functions : - Required for tissue oxidation

- Formation of collagen- Facilitates absorption of iron- Wound healing

VITAMIN E (Tocopherol)


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VITAMIN E (Tocopherol) Sources :

Vegetable OilsWhole grain cerealsFatty FishEgg YolkButter

Deficiency: Cystic FibrosisAtaxiaVisual scotomas

Vit E : Plays a role in Protection against

CancerCADCataract

WATER SOLUBLE VITAMINS


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WATER SOLUBLE VITAMINSVITAMIN C

Deficiency : Causes Scurvey

Early Stages - Peri follicular hemorrhages- Petiche & Purpura- Splincter haemorrhages- Bleeding gums- Sub- periosteal haemorrhages- Joint Haemorrhages

- Anaemia- G.I Bleeding

Late Stages - Edema- Oligurea- Neuropathy- Intra cerebral haemorrhage- Death

Certain conditions like Trauma, Surgery, Burns, Infections, Smoking, usage of Cortisones, Aspirin, Indomethacin, Tetracyclines etc. increase demand of VitC

Daily requirement is 60 mg.

THIAMIN (B1)


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THIAMIN (B1)Sources :

- Germinating cereals & Yeast- Legumes- Green leafy vegetables- roots

- Fruits- Nuts- Pork, Meat & Fish- Liver

Not found in Oils & Fats .Lost if cooked with excess water

Destroyed if baking soda is added

Deficiency (B1)


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y ( )Beri Beri :

Early Stage ( Dry Beri Beri)

Wasting of musclesAnorexiaHeavy-ness and weakness of legsPalpitationTingling & NumbnessCalf muscle tenderness

Late Stages ( Wet Beri Beri ) : EdemaPalpitationsHeart enlargementHeart failure

Wernicks Encephalopathy : Usually seen in AlcoholicsPatient in confusion stateNystagmusBilateral Symmetrical OphthalmoplegiaAtaxiaStuper & Death

Korsakoff Psychosis : Loss of memoryDisorientationPolyneuropathy


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RIBOFLAVIN (B2 )Sources :

Liver, Kidney, Milk, Meat, Cheese, Eggs (Good sources)

Green Leafy Vegetables : ( moderate Sources)

Deficiency : Angular stomatitisCheilosisScrotal dermatitisAnaemia

Pyridoxine (B 6)


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Sources : Liver, whole grain cereals, peanuts, bananas, milk, egg, fish,vegetables, cereals.

Deficiency: - Peripheral Neuropathy- Dermatitis- Glossitis- Angular stomatitis

Cyanocobalamine ( B12)

Sources : - Liver- Kidney- Meat- Fish- Eggs

- Milk- Cheese

Not found in Vegetables. It is synthesized in colon by Bacteria

Deficiency:

- Anemia (Megaloblastic or Pernicious)- De-myelinating lesion of spinal cord

NIACIN ( Nicotinic Acid)Sources :


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Sources :- Meat- Liver- Fish

- Cereals- Pulses- Legumes- Groundnuts

A cup of good coffee provides good amount of Niacin

Deficiency : Leads to Pellagra

Pellagra : It is characterised by 3 D s - Diarrhoea- Dermatitis- Dementia ( Depression , Irritability,Delirium)

and -Glossitis & Stomatitis

Seen in Telengana in Jowar eating Population

FOLIC ACID


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Sources : LiverMeat

Dairy ProductsEggMilkFruits

CerealsLeafy vegetables

Deficiency :AnemiaGlossitisDiarrhoea, Distension & Flatulence


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MINERALSMore than 50 chemical elements are found in the body

which are required for growth, repair and regulation of vitalbody functions . Most important are:

* CALCIUM* PHOSPHOROUS* SODIUM* POTASSIUM

* IRON* FLUORINE* IODINE

CALCIUM


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CALCIUMAdult body contains 1200 gms. of calcium (98% in bones)

SOURCES :* Milk & Milk products* Eggs* Fish* Green leafy vegetables

* Cereals & Millets* Drinking water

FUNCTIONS :*Formation of Bones & Teeth*Coagulation of Blood*Contraction of Muscles*Cardiac Action*Milk Production*Relay of Electrical & Chemical messages


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PHOSPHORUS

Essential for formation of Bones & Teeth

Sources : All Vegetables

Deficiency : Rarely occurs


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SODIUM

Adult Human Body contains 100 gms. of Sodiumion

Sodium is lost through Urine & Sweat

Depletion of Sodium causes Muscular cramps

Excess causes HTN & CHD


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POTASSIUM

Human body contains about 250 gms. ofpotassium

Sources : All vegetables & fruits

Deficiency : Rarely occurs

IRON


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Sources : LiverMeatPoultryFishCerealsGreen leafy vegetableLegumes

NutsOil seedsJagggeryDry fruits

Functions : Formation of HemoglobinBrain development & functionRegulation of body temperatureMuscle activity


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Essential : For Immune systemBinding oxygen to blood cellsOxygen transport & cell respiration

Deficiency : AnaemiaImpaired ImmunityReduced resistance to infectionsDiminished work performance

IODINE


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Required for synthesis of Thyroid hormones

Sources : Sea foodMilkMeatVegetablesCereals

WaterDeficiency : Goiter

HypothyroidismDecreased IntelligenceMental deficiencyHearing defectsSpeech defectsSquintNeuro-muscular weaknessCretinismIntra-uterine death

FLUORINE


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FLUORINE

Essential for normal mineralisation of Bones & DentalEnamel

Sources : Drinking waterSea fishCheeseTea

Deficiency : Dental Caries

Excess : Skeletal & Dental Fluorosis

NUTRITIONAL FACTORS IN SELECTED DISEASES


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Cardiovascular Diseases A). Cholesterol :

LDL : Coronary Heart DiseaseHDL: Protects Heart

B). Essential Fatty Acids :

Linoleic acid & Arachidonic acid (PUFA)inhibit platelet aggregation & thrombusformation.

C). Triglycerides : Increase risk of CHD.

D). Carbohydrates :CHD rates are lowest in people eating highcarbohydrate diets.

E). Salt: Low Sodium diets prevent HTN & CHD

N i i l f i S l d Di


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Nutritional factors in Selected Diseases

DIABETES

Deficiency of Trace Elements such as Chromium ,Copper , Zinc may play role in DM

Excess consumption of Alcohol can damage Pancreas& Liver & promotes Obesity & thus increase risk ofDiabetes .

N t iti l f t i S l t d Di


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OBESITY

The basic cause of Obesity is

OVER-NUTRITION

N t iti l f t i S l t d Di


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CANCER

A). High Fat Intake : Cancer ColonCancer Breast

B). Low Dietary fiber : Cancer ColonC). Deficiency of Vit. A & C : Cancer Lung &

StomachD). Food Additives:

Preservatives : Cancer StomachCoffee : Cancer Bladder &

PancreasE). Alcohol : Cancer Liver


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Thank You

All Good Wishes To You

and

Documents

Nutrition & Disease 287.10