FUNDAMENTALS OF

NUTRITION

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MAR-ANN B. BRINGAS, MD
Assistant Professor
Department of Biochemistry and Nutrition
FEU-NRMF College of Medicine
9/8/2016 1
 Click to edit Master title style
Nutrition Curriculum
Nutrition Principles

Prevention/
Wellness Therapeutics
Primary Care

Risk factor
Manage changing Primary or adjunct
management with
nutrition needs over therapy with
dietary
the life cycle specific goals
modifications

Fist Year: Second year:

Structure/ function Scientific Basis of Clinical clerkships
courses Medicine
What is Clinical Nutrition
Clinical nutrition is the study of the relationship
between food and a healthy body.

It is the science of nutrients and how they are

digested, absorbed, transported, metabolized,
stored, and eliminated by the body.

It is interested in how the environment affects the

quality and safety of foods, and what influence these
factors have on health and disease.
 Nutrition Definition

NUTRITION is the composition and

quantity of food intake and the
utilization of the food by
the living organism.

Essential Inessential
nutrient Nutrient
 The Meaning of…

Nutrition Health

Food Nutrients

Essential
nutrient
NUTRITION THREE AREAS
 ESSENTIAL NUTRIENTS
Proteins Isoleucine Threonine
Leucine Tryptophan
Lysine Methionine
Phenylalanine Valine
Fat-soluble A/D/E/K
vitamins
Water- Thiamine Pyridoxine
soluble Niacin Cobalamin
vitamins Ascorbic acid Folic acid
Riboflavin
Fats Linoleic acid Arachidonic acid
Linolenic acid

Minerals Calcium Iodine

Iron Sulfur
Potassium Manganese
Magnesium Copper
Chlorine Cobalt
Phosphorus Zinc
Sodium molybdenum
NUTRITIONAL STATUS / NUTRITURE

• The condition of the body as a result of

ingestion and utilization of food.
• Nutritional status is dependent on the:

intake of
dietary relative need body’s ability
nutrients for nutrients to utilize them
 ANTHROPOMETRY
Physical measurement of weight, height, and body
compartments of fat and lean tissue

Growth Body
composition

Energy
expenditure
ANTHROPOMETRY

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 ANTHROPOMETRY Adults
Height measurement
 Stand erect and barefooted
on a STADIOMETER with a
movable headpiece.

 The head piece is leveled

with skull vault & the height
is recorded to the nearest
0.5 cm.

http://www.slideshare.net/soharashed/assessment-of-nutritional-status
ANTHROPOMETRY Infants

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 INDICES OF GROWTH

Weight for
Weight for age
height

Weight/height ratios
Quetelet’s index
Height for age
weight in kg
height in m2
 ANTHROPOMETRY

Height - chronic nutrition

Weight - measure of growth

Gomez classification

Waterlow classification

Body Mass Index (BMI)

 Gomez Classification
The child's weight is compared to that of a normal child
(50th percentile) of the same age. It is useful for
population screening and public health evaluations.
• Formula: Status Weight for age
Actual body weight X 100 Normal 90 – 100%
Ideal body weight Malnutrition
First degree 75-89%
• Interpretation:
Second degree 60-74%
Third degree <60%
Overweight 101-120%
Obese >120%
 Waterlow Classification
Chronic malnutrition results in stunting. Malnutrition
also affects the child's body proportions eventually
resulting in body wastage.
• Formula:
Actual body weight X 100 = Wasting
Standard Stunting Wasting
Weight for height
Normal >95% >90 %
Actual height X 100 = Stunting Mild 87.5-95% 80 – 90%
Height for age
Moderate 80-87.4% 70-79%
Severe <80% <70%
BODY MASS INDEX FOR FILIPINOS
Body Mass Index = Weight [kilograms]/Height [meters]2 OR
= Weight [pounds]x703/ height [inches]2
 BODY MASS INDEX
International standard for assessing body size in
adults is the BMI = weight (kg)/ Height (m2)
BMI-ASSOCIATED RISKS
 Waist circumference
• Predicts mortality better than any other
anthropometric measurement
Waist
circumference
(cm)

No risk of illness due Avoid weight gain or Should drop weight

to overweight drop on weight Seek for help from health
care professionals

Men < 94 cm 94-101 > 102

Women < 80 cm 80-87 > 88

 BIOCHEMICAL DATA
• Assessment or measurement of the level of
nutrient in the body

PROTEIN NUTRIENTS
LIPIDS
plasma amino acid Serum retinol
serum cholesterol
level Serum iodine
serum triglycerides
serum albumin level Calcium
lipoprotein
hair root morphology Vit D levels
 CLINICAL HISTORY AND
PHYSICAL EXAMINATION
• Complete medical history
• Complete physical examination
• Signs/symptoms of nutritional
deficiency
CLINICAL NUTRITIONAL ASSESSMENT

Areas of interest include:

Detailed nutritional • present and past illnesses

history that includes: • family illness history
• food allergies or intolerance
• medications
Clinical • nutritional supplements
Dietary • over-the-counter meds
Socioeconomic • alcohol use
Family issues • work environment
• education level.
 DIETARY ASSESSMENT
National Household Individuals
• Food balance • Food account • 24-hour recall
sheets method • Food records
• Market • List-recall method • Weighed-food
databases • Inventory method records
• Household record • Dietary history
method
• Food frequency
• Telephone survey questionnaire
• Use of household • Observed food
food-consumption consumption
data for National
Video and
Food-
Consumption photographic
methods
DIETARY INTAKE SURVEY

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DIETARY INTAKE SURVEY

http://www.slideshare.net/soharashed/assessment-of-nutritional-status
DIETARY INTAKE SURVEY

http://www.slideshare.net/soharashed/assessment-of-nutritional-status
DIETARY INTAKE SURVEY

http://www.slideshare.net/soharashed/assessment-of-nutritional-status
Recommended Energy and Nutrient Intake
(RENI)

• Formerly termed RDA

• Amount of energy and essential nutrients needed to
meet the minimum requirement to:
* maintain health
* provide reserves
* added amount for incomplete digestion
• Factors that influence RDA:
* Age
* Sex
* physiologic stresses
Recommended Energy and Nutrient Intake (RENI)
Philippines, 2002 Edition
COMPONENTS OF ENERGY EXPENDITURE

Basal Metabolic
Rate Physical Activity
PA
BMR

Specific Dynamic
Action of Food Growth
SDA
 BASIC METABOLIC RATE
• Largest component of energy expenditure
• Energy used at rest
• Indicates amount of energy used to
sustain life’s processes
• Affected by numerous factors/variables
 Factors That Affect BMR
FACTOR EFFECT ON BMR
Age Lean body mass diminishes with age
Height In tall, thin people, the BMR is higher
Growth In children and pregnant, BMR is higher
Body More lean tissue, highest BMR.
composition/ More fat tissue, lower BMR
gender
Fever Fever raises BMR
Stresses Stresses raise BMR
 Factors That Affect BMR
FACTOR EFFECT ON BMR
Environmental Both heat and cold raises BMR
temperature
Fasting/ starvation Lowers BMR
Malnutrition Lowers BMR
Hormones (gender) Thyroid, male hormones,
premenstrual hormones raise BMR
Smoking/Caffeine Increases energy expenditure
Sleep BMR lowest when sleeping
 PHYSICAL ACTIVITY

• Second largest component

• More vigorous physical
work would require
greater energy
SPECIFIC DYNAMIC ACTION OF FOOD

• Production of heat by the body above basal level

during digestion and absorption of food
• Highest for proteins (12%)
• Low for carbohydrates (6%) and fats (4%)
• SDA contribute approx 10% of the consumed
calories
 GROWTH

Additional energy to cover for the

cost of increasing body weight and height
 ENERGY REQUIREMENT
• Most basic nutritional requirement
taking precedence over all other
nutritional needs
• Energy – the capacity to do work
• Measured in terms of calories
 CALORIE
• Standard unit for measuring energy
• Amount of heat energy needed to raise
the temperature of 1 ml of water by 1
degree centigrade.
• Kilocalorie
ENERGY YIELD OF FOOD SOURCES

NUTRIENT In vitro In vivo Standard

Bomb Oxidation Conversion
Calorimeter Kcal/g factor
Kcal/g Kcal/g
CHO 4.10 4.00 4
CHON 5.65 5.20 4
FATS 9.45 9.00 9
ALCOHOL 7.10 7.10 7
 ESTIMATING DAILY ENERGY
EXPENDITURES
TEE

• Total Energy Expenditure Amount

TER
of
• Total Energy Requirement
Calories
needed
TCR
per day
• Total Caloric Requirement
 CALCULATION OF TER: Factorial Method

IBW • Determination of ideal body weight

BMR • Calculation of BMR for 24 hrs.

cBMR • Correct the BMR for sleep

PA • Compute for physical activity

SDA • Compute for SDA

TCR • Compute for TCR = cBMR + PA + SDA

 PHYSICAL ATIVITY
Bed rest - 10% of corrected BMR
Sedentary - 30% of corrected BMR
Light - 50% of corrected BMR
Moderate - 75% of corrected BMR
Heavy - 100% of corrected BMR
 TER CALCULATION

Case
◦ Height: 5’4’’ or 160 cm
54 inches tall = 64 inches
64 in. x 2.54 = 162.56 or 160 cm.
◦ Actual Body Weight : 65kg
 TER CALCULATION
A. DETERMINATION OF IBW
• Use the standard weight and height tables

Fernando’s Method
Tannhauser method Males:
IBW = 50 kg + 2.3 kg every inch over 5 ft.
[height in cm. – 100] – [(height cm - 100)10%]
Females:
Example: If height is 160 cm. IBW = 45.5 kg + 2.3 kg every inch over 5 ft.

Example: 5 feet 2 inch male

[160 – 100] – [(160 – 100) 10%] =
54 kg. = 50 + (2x2.3 kg)
= 54.6 kgs or 120 lbs
 TER CALCULATION

B. DETERMINE BMR FOR 24 HRS

Male = 1 kcal/ kg IBW/hr x 24

Female = 0.95 kcal/kg IBW/hr x 24

Example: Male IBW = 54 kg.

1 kcal/kg x 54 kg x 24 = 1296 kcal/day
 TER CALCULATION

C. CORRECT THE BMR

Subtract 10% of kcal/kg/IBW/hr of sleep
from BMR

Example: Slept for 8 hrs.

0.1 x 54 kg x 8 hrs = 43.2 kcal
1296 kcal – 43.2 kcal = 1252.8 kcal
 TER CALCULATION

D. COMPUTE FOR PHYSICAL ACTIVITY

Example: Moderate Physical Activity

75% of corrected BMR
0.75 x 1252.8 = 939.6 kcal
Bed rest - 10% of corrected BMR
Sedentary - 30% of corrected BMR
Light - 50% of corrected BMR
Moderate - 75% of corrected BMR
Heavy - 100% of corrected BMR
 TER CALCULATION

E. COMPUTE FOR SDA

10% of the sum of cBMR and PA

Example: 10% (cBMR + PA)

0.1 (1252.8 + 939.6) = 219.24
kcal/day
 TER CALCULATION
F. COMPUTE FOR TOTAL ENERGY
REQUIREMENT

TER = cBMR + PA + SDA

TER = 1252.8 + 939.6 + 219.24
TER = 2411.64 kcal/day
 CALCULATION OF NUTRIENT
DISTRIBUTION BASED ON TER:

Nutrient Percentage
Carbohydrate 55-70%
Protein 10-15%
Fat 20-30%
 CALCULATION OF NUTRIENT
DISTRIBUTION BASED ON TER:
Given TER 2400kcal/day
NUTRIENT % COMPUTATION GRAMS
equivalent
CHO 60% 2400 kcal/d x .6 = 1447 kcal 1447/4 = 360
Protein 10% 2400 kcal/d x .10 = 241 kcal 241/4 = 60
Fat 30% 2400 kcal/d x .30 = 724 kcal 724/9 = 80

Diet Rx:
TER 2400 kcal, 362g CHO, 60g Protein, 80g Fats
 TEE/TER/TCR

Resting or Basal
Metabolic Rate
(BMR)
Harris-Benedict
Equation

TCR = BMR x Activity Factor x Injury Factor (1.0)

 ENERGY FOR BMR
HARRIS –BENEDICT EQUATION

• Men = 66+ ( 13.7 x weight kg ) + ( 5 x height Cm ) -

( 6.8 x age in years )
• Women = 655.1 + ( 9.6 x weight kg ) + ( 1.8 x ht cm)
- ( 4.7 x age in years)

SHORT METHOD

• Men: 1 kcal/kg/hour x 24 hours

• Women: 0.9 kcal/kg/hour x 24 hours
 ACTIVITY FACTOR
LEVEL OF TYPE OF ACTIVITY ACTIVITY TEE(Kcal/Kg/
INTENSITY FACTOR Day)

Very light Seated and standing activities. Painting trades, 1.3 (men) 31
driving, laboratory work, typing, sewing, ironing, 1.3(women) 30
cooking, playing cards, musical instrument
Light Intensive exercise for at least 20 minutes 1 to 3 1.6 (men) 38
times/ week. Bicycling, jogging, basketball, 1.5 (women) 35
swimming, skating, etc. If you do not exercise
regularly, but you maintain a busy life style that
requires you to walk frequently for long periods,
you meet the requirements of this level
Moderate Walking 3.5-4mph. Intensive exercise for at least 1.7 (men) 41
30 to 60 minutes 3 to 4 times per week. Any of 1.6 (women) 37
the activities listed above will qualify Intensive
exercise for at least 3-4x/week
Heavy Intensive exercise for 60 minutes or greater 5 to 2.1 (men) 50
7 days per week Labor-intensive occupations 1.9 (women) 44
include construction work (brick laying, carpentry,
general labor, etc.). Farming, landscape worker or
similar occupations.
Exceptional Training in professional or world-class athletic 2.4 (men) 58
events 2.2 (women) 51
 STRESS FACTOR/INJURY FACTOR
Starvation 0.8-1.0
Normal/ Non-Stressed 1.0-1.3
S/P surgery without 1.25-1.35
complications
Moderate Stress from chronic 1.35-1.5
illness
Severe stress (acute illness, 1.5
severe infection, trauma etc)
 STEPS IN CALCULATING DIETS USING
The HARRIS -BENEDICT Equation

A Filipino laborer, 36 years of age, 5 feet 4 inch

tall, engaged in moderate physical activity.

Height: 162cm Ideal Body weight: 54 kgs

Nutrient distribution of TER:

• Carbohydrates = 60%
• Protein = 10 %
• Fats = 30 %
 BMR
Harris-Benedict Equation

• Men’s BMR = 66+ (13.7 x weight kg) + (5 x ht cm) -

(6.8 x age in years)
• BMR = 66+ (13.7 x 54 kg) + (5 x 162 cm) – (6.8 x 36 yo)
• BMR = 66+ 740 + 810– 244.8
• BMR = 1371 kcal = 1400 kcal

Short Method

• Men: 1 kcal/kg/hour x 24 hours

• BMR = 54 x 24 = 1296 kcal = 1300 kcal
 TOTAL CALORIC REQUIREMENT

TCR = BMR x Activity Factor x Injury Factor (1.0)

TCR = 1400 x 1.7 x 1 = 2380 kcal or 2400 kcal

(round to nearest 50)

TCR = 30-58 kcal/kg/day (refer to table)

= 41 x 54 = 2200 kcal
 ACTIVITY FACTOR
LEVEL OF TYPE OF ACTIVITY ACTIVITY TEE(Kcal/Kg/
INTENSITY FACTOR Day)

Very light Seated and standing activities. Painting trades, 1.3 (men) 31
driving, laboratory work, typing, sewing, ironing, 1.3(women) 30
cooking, playing cards, musical instrument
Light Intensive exercise for at least 20 minutes 1 to 3 1.6 (men) 38
times/ week. Bicycling, jogging, basketball, 1.5 (women) 35
swimming, skating, etc. If you do not exercise
regularly, but you maintain a busy life style that
requires you to walk frequently for long periods,
you meet the requirements of this level
Moderate Walking 3.5-4mph. Intensive exercise for at least 1.7 (men) 41
30 to 60 minutes 3 to 4 times per week. Any of 1.6 (women) 37
the activities listed above will qualify Intensive
exercise for at least 3-4x/week
Heavy Intensive exercise for 60 minutes or greater 5 to 2.1 (men) 50
7 days per week Labor-intensive occupations 1.9 (women) 44
include construction work (brick laying, carpentry,
general labor, etc.). Farming, landscape worker or
similar occupations.
Exceptional Training in professional or world-class athletic 2.4 (men) 58
events 2.2 (women) 51
 TCR

Harris
Factorial Short
Benedict
Method Method
Method
2412 kcal 2200 kcal
2400 kcal

Use 2400 kcal

 CALCULATION OF TER
Use corrected body weight in Obese patients

Ideal Body Weight

• Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.

Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.

CORRECTED BODY WEIGHT

(if % IBW is => 125%)
• CBW= IBW + [(ABW– IBW) x 25%]
Example: Corrected Body Weight
Given
• Height: 5’4”
• Actual Body Weight 65kg

IBW = 50 kg + 2.3 kg for each inch over 5 feet.

• IBW = 50 + (2.3x4) = 59.2 59 kgs

%IBW= ABW/IBW x 100%

• = 65 kg/59kg x 100%
• = 110%
• NO NEED TO USE CORRECTED BODY WEIGHT
Example: Corrected Body Weight
Given
• Height: 5’4”
• Actual Body Weight 80 kg

IBW = 50 kg + 2.3 kg for each inch over 5 feet.

• IBW = 50 + (2.3x4) = 59.2 59 kgs

%IBW= ABW/IBW x 100%

• = 65 kg/59kg x 100%
• = 135%
• USE CORRECTED BODY WEIGHT
Example: Corrected Body Weight
CORRECTED BODY WEIGHT

• CBW= IBW + [(ABW– IBW) x 25%]

CBW= 59kg + (80kg-59kg) x 25%

• = 59kg + (21 x 25%)

• = 59kg + 5.25kg
• = 64.25 kg

USE 64 kg in computing TER instead of 59 kg

 CALCULATION OF NUTRIENT
DISTRIBUTION BASED ON TER:

Nutrient Percentage
Carbohydrate 55-70%
Protein 10-15%
Fat 20-30%
 CALCULATION OF NUTRIENT
DISTRIBUTION BASED ON TER:
Given TER 2400kcal/day
NUTRIENT % COMPUTATION GRAMS
equivalent
CHO 60% 2400 kcal/d x .6 = 1440 kcal 1440/4 = 360
Protein 10% 2400 kcal/d x .10 = 240kcal 240/4 = 60
Fat 30% 2400 kcal/d x .30 = 720kcal 720/9 = 80

Diet Rx:
TER 2400 kcal, 360g CHO, 60g Protein, 80g Fats
 DIET PRESCRIPTION

Rx Kcal 2400 kcal

CHO 360 g , CHON 80 g, Fats 60 g

60% 15% 30%

Grams of each day may be rounded off

FOOD EXCHANGE LIST
List I. Vegetable Exchange
List II. Fruit Exchange
List III. Milk Exchange
List IV. Rice Exchange
List V. Meat Exchange
List VI. Fat Exchange
List VII. Sugar Exchange
 FOOD EXCHANGE LIST

LIST I. Vegetable

• Green leafy and non-leafy vegetables.

• Two exchanges of vegetable A is equal to One
exchange of vegetable B

LIST II. Fruit Exchanges

• This includes fresh fruits, canned, dried, and fruit

juices specified as concentrated or diluted and
sweetened or unsweetened
 FOOD EXCHANGE LIST
LIST III. Milk Exchanges
• Varieties of milk appear in the milk exchanges.
• Milk is classified into whole and non-fat types specified as
concentrated or diluted.
• The nutrient value of ½ glass evaporated milk as whole milk is
given as well as the equivalent of other types of milk.

LIST IV. Rice Exchanges

• Varieties of bread, bakery products, rice and corn products
• Considering patients who are on low fat diet, bakery products
with high fat content are to be restricted or should be
considered in the fat exchange.
 FOOD EXCHANGE LIST
LIST V. Meat Exchanges
• 3 categories based on the amounts of fat:
• Low fat meat exchange = 8 g protein , 2 g fat
• Medium fat meat exchange = 8 g protein , 7 g fat.
• High fat meat exchange = 8 g protein , 10 g fat.
• Each category differs by almost 35 kcal.

LIST VI. Fat Exchanges

• Saturated or polyunsaturated fatty acids.

LIST VII. Sugar Exchanges

• Soft drinks, fruit concentrates and alcohols are included to
provide additional information and to aid in the dietary
computation.
 COMPOSITION OF FOOD EXCHANGES
LIST FOOD MEASURE CHO CHON FAT ENERGY
gram gram gram kcal kj
I-A Vegetable A 1 cup, raw - - - -
½ cooked
I-B Vegetable B ½ cup 3 1 16 67
cooked/raw
II Fruit varies 10 40 167
III Milk
Evap ½ cup 12 8 10
Whole 1 cup 12 8 10
Powdered 4 tbsp 12 8 10 170 711
Skim 4 tbsp 12 8 5 80 335
Very Low 12 8 trace
IV Rice varies 23 2 100 418
IV Meat
Low fat Varies 8 2 50 209
Med fat Varies 8 7 95 398
High fat Varies 8 10 122 510
VI Fat 1 tsp 5 45 188
VII Sugar 1 tsp 5 20 84
TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL

BREAK EXCH FOOD

FAST
Fruit 1 1 slice papaya
Milk 1 1 glass fresh cow’s milk
Sugar 1 2 teaspoons jelly
preserves/spread
Rice 3 6 pcs. Pan de sal
Meat 2 2 slices cheese/
3 tbsp corned beef
TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL

LUNCH EXCH. FOOD

Veg A 1 ½ cup talong
Veg B 2 1cup kalabasa
Fruit 1 1 medium slice mango ripe
Sugar 2 4 pcs. Chocolate candy with
milk
Rice 3 1 ½ cup rice
Meat 2 2 medium size chicken wings
Fat 1 1 cup coconut milk
(ginataang gulay)
 FOR WEIGHT LOSS
Using the Harris-Benedict Equation, individuals can take
a mathematical approach to weight loss.

There are 3500 kilocalories in 1 lb (0.45 kg) of body fat.

Using the Harris-Benedict Principle, if someone has a

daily allowance of 2500 kilocalories, but he reduces his
intake to 2000, then the calculations show a one pound
loss every 7 days.

3500 kcal/ 7 days = 500 kcal/day

FOOD LABELS
 DAILY VALUES OF FOOD LABELS
Food labels must present the “% daily Value” for these nutrients

Food Component Daily value Calculation factor

Fat 65 g 30% of kcal
Saturated fat 20 g 10% of kcal
Cholesterol 300 mg -
Carbohydrate (total) 300 g 60% of kcal
Fiber 25 g 11.5 g per 1000 kcal
Protein 50 g 10% of kcal
Sodium 2400 mg
Note: Daily Values were established for adults and children over 4 years old.
Potassium
The values for energy-building3500 mg are based on 2000 kcalories a day.
nutrients
Vitamin C For fiber, the daily60 mg was rounded up from 23.
values
Vitamin A 1500 ug
Calcium 1000 mg
Iron 18 mg
Note: Daily Values were established for adults and children over 4 years old. The
values for energy-building nutrients are based on 2000 kcalories a day. For fiber, the
daily values was rounded up from 23.
HOW TO CALCULATE DAILY VALUES
The Daily values on food labels are designed for a
2000- kcalorie intake.
Macronutrients have daily requirements of:
Carbohydrates 60%, Fats 30%, Protein 10% of TCR.
To compute:
2000 kcal x 0.60 kcal from CHO = 1200 kcal from CHO
2000 kcal x 0.30 kcal from fat = 600 kcal from fats
2000 kcal x 0.10 kcal from protein = 200 kcal from protein
A person who prefer to count in grams should convert using
the 4-4-9 rule.
1200 kcal/ 4 kcal per gram = 300 grams CHO
600 kcal/ 9 kcal per gram = 66 or 65 grams fats
200 kcal/ 4 kcal per gram = 50 grams protein
HOW TO CALCULATE THE ENERGY
AVAILABLE IN FOODS:
1 slice of bread with 1 tablespoon of
peanut butter on it contains To determine the percentage
16 grams carbohydrate, of kcal from fat:
7 grams proteins, and 81 fat kcal / 173 = 0.468
9 grams fat: ( rounded to 0.47)

TOTAL 173 Then multiply by 100

to get the percentage:
16 g carbo x 4 kcal/g 64 0.47 x 100 = 47%

7 g protein x 4 kcal/g 28 47% of this serving

is from FAT
9 g fat x 9 kcal/g 81
1 slice of bread with 1 tablespoon of peanut butter on it contains :
16 grams carbohydrate, 7 grams proteins, and 9 grams fat:

Nutrition Facts
Calories 173 % Calories 173 % Daily
Value Value
Total Fat 9 g 81 47%
Total Fat 9 g 14%
Total CHO 16 g 64 37%
Total CHO 16 g 5%
Total CHON 7 g 28 16%
100% Total CHON 7 g 14%

9 g fat x 9 kcal/g = 81 kcal Based on a 2000 kcal diet:

16 g carbohydrate x 4 kcal/g = 64 kcal (9g/65 g) x 100 = 13.8 = 14%
7 g proteins x 4 kcal/g = 28 kcal (16 g/300 g) x 100 = 5%
Total = 173 kcal (7/50 g) x 100 = 14%
LET’S CHECK!
Fat:
(6.5/65) 100 = 10%

Carbohydrate
(15/300) 100 = 5%

Sodium
(240/2400)100= 10%

Protein
(3/50)100 = 10%

Cholesterol
(30/300) 100 = 10%
 Calorie balance is like a scale. To remain in balance and maintain your body
weight, the calories consumed (from foods) must be balanced by the calories
used (in normal body functions, daily activities, and physical activity).
 CARBOHYDRATES
• Major source of energy
• Cheapest source of energy
• Provide quick and sustained body fuel
 CARBOHYDRATES
CLASSIFICATION SUGAR
Monosaccharide Glucose
Fructose
Galactose
Disaccharides Sucrose
Lactose
Maltose
Polysaccharides Starch
Glycogen
Cellulose
DIETARY FIBER
CARBOHYDRATES Functions:
• Fuel for energy
• Protein sparer
• Allows for normal fat metabolism
• Maintains functional integrity of the CNS
• Facilitates excretion of toxins
• Precursor of nucleic acid, connective tissue
matrix, galactoside to nerve tissue
• Aids in normal elimination of waste materials
• Promote growth of coliform bacteria
CARBOHYDRATES Sources:
• Starches
• Root crops
• Fruits
• Sugar and candies
• Vegetables
• Liver glycogen
RENI FOR CHO: 55-70% of TCR
FATS Types

• Lipids
• Provides high caloric value
• Classification:
– Simple
– Compound lipids
– Derived lipids
FATS Types
FATS Types
• Visible fat
• Hidden fat
• Cholesterol - vital substance in human cell metabolism
Functions:
 Vital substance in human metabolism
 Precursor of steroid hormones
 Precursor of vitamin D
 Essential in forming bile acids
 Brain and nervous tissue component
 Cell membrane component
FATS ESSENTIAL FATTY ACIDS

• Linoleic Acid
• Alpha - Linolenic Acid
• Arachidonic Acid
FATS Types
Radical chain reaction mechanism of lipid peroxidation
From Wikipedia, the free encyclopedia
FATS Types
SFA PUFA MUFA
Most animal Vegetable seed oils Olive Oil
products (sunflower oil, Canola Oil
Milk and dairy safflower oil, Peanut Oil
prod. corn oil and soybean
Cocoa butter oil)
Coconut Oil Nut oil
Palm Kernel oil Cold water ocean fish
COMPOSITION OF COMMONLY ENCOUNTERED
DIETARY LIPIDS

FROM ANIMALS FROM PLANTS FROM PLANTS

• Rich in • Rich in • Rich in

saturated fatty saturated fatty monounsaturated
fatty acids
acids acids • Olive oil and
• Butter and • Coconut and Canola oil
Lard Palm oil • Rich in
polyunsaturated
fatty acids
• Soybean oil and
Corn oil
GROWTH
FATS ESSENTIAL FATTY ACIDS
FATS ESSENTIAL FATTY ACIDS
• Insoluble in water
• Cannot be made by the body
• Soluble in solvents with low polarity
• Low melting point
• Liquid at room temperature
• Double bonds are oxidizable (DANGER)
FATS ESSENTIAL FATTY ACIDS
• Humans evolved on a diet with equal amounts of
omega-6 and omega-3 FA
• Present diet : omega 6:omega 3 is 20-25:1
• Desirable ratio : 5-10:1
FATS ESSENTIAL FATTY ACIDS

Greenland Inuit gutting a seal in the early 1900s.

Their diet consisted largely of fish, whale, seal,
and walrus, resulting in a high intake of omega 3
fatty acids. Copyright Arctic
Institute
FATS ESSENTIAL FATTY ACIDS

Cold water fishes:

tuna ,cod, sardines, mackerel,
salmon, herring
FATS ESSENTIAL FATTY ACIDS
 FATS
MECHANISM OF ACTION OF EFA
PG 2 series PG3 series
Vasoconstriction Vasodilatation
Potent platelet aggregator Inhibit platelet aggregator
Increases LDL Decreases LDL
Decreases HDL Increases HDL

Antiarrhythmic
Antithrombotic
Anti-atherosclerotic
Anti-inflammatory
Lowers blood pressure
Improves endothelial function
Lowers triglyceride concentrations
FATS Functions
• Source of energy
• Protein sparer
• Serve as shock absorber
• Strengthens biological membrane
structure
• Body insulator
• Dietary vehicle
• Supplies taste and flavor to food
 FATS Source
• STORAGE OF FATS
– White fats
– Brown Fats

• SOURCES OF FATS
– animals (butter, lard, meat, eggs, milk)
– plants (vegetable oils)

RENI FOR FATS: 20-30% of TCR

 PROTEIN
• First substance recognized as a vital part of
living tissue
• Nitrogen-containing compounds which yield
amino acids upon hydrolysis
• Classification:
– Indispendible AA
– Dispensible AA
– Conditionally dispensible
PROTEIN
 PROTEIN
• Repair of worn-out body tissue proteins
• Muscle building
• Maintenance of growth
• Source of heat and energy
• Maintains normal osmotic relations among
body fluids
• As enzymes and hormones
• As acid-base regulators
• As transporters
PROTEIN Sources

Animal Plant
 PROTEIN Quality

• Determined by the
extent of indispensable
amino acids needed by
the body to maintain
equilibrium

Complete Incomplete
 PROTEIN Quality
NET
PROTEIN EFFICACY
AMINO ACID SCORE BIOLOGIC VALUE (BV) PROTEINUTILIZATION
RATIO
(NPU)

• Analyze protein • Analyze • Proteins with complete

• Product of
essential amino acids
as to its essential proteins in will maintain nitrogen BV and
amino acid terms of balance but those with Degree of
content in promoting incomplete essential
growth and amino acids will food protein
relation to a promote negative digestibility
reference weight gain for nitrogen balance
protein every gram of
protein

AA score PER BV NPU

= mg IDAA/g test protein = growth in grams amount of protein retained N intake – N output
--------------------------- x 100 ------------------------- -------------------------------- x 100 ---------------------------
mg IDAA/g reference protein Protein intake in grams amount of protein ingested N intake
PROTEIN Quality
 NITROGEN BALANCE
CONDITION MEASUREMENT SIGNIFICANCE
Positive N intake > N excretion Growth
Equilibrium N intake = N excretion Maintenance
and repair
Maintenance N intake < N excretion Wasting
FOOD PROTEIN SUPPLEMENTATION

• Combination of complete and

incomplete protein in sufficient
quantity and quality
• Examples:
– Cereal and milk
– Macaroni and cheese
– Rice, beans, and fish sauce
– Wheat and beans
WHAT FOODS SHOULD WE EAT?
HI- 5 DIET: Fruits and vegetables

Whole Grain Cereals

More on Fish

Beans, Nuts and Legumes

Full Cream Milk &

Soft Boiled Eggs
 Traffic Light of Nutrition
FOOD PROCESSING
 Pork & pork products  Frying (lipid peroxides)
 Crabs, shell, shrimps  Baking (acrylamides)

 Beef  Broiling (benzopyrene)

 Chicken  Microwaving (plastic)

 Fish  Raw
 Full cream powdered milk  Boiling

 Soft boiled eggs  Steaming

 Fruits & Vegetables  Cooking in coconut milk

 Whole Grain/Cereals  Cooking in curry

 Beans, nuts, legumes

 MALNUTRITION
Pathologic state resulting from a relative or absolute deficiency or
excess of one or more essential nutrients

Under Specific
nutrition deficiency

Over
Imbalance
nutrition
 MALNUTRITION
Pathologic state resulting from a relative or absolute deficiency or
excess of one or more essential nutrients

Primary Secondary
• Dietary inadequacy in amount • Pathologic or physiologic
or in kind condition of the body
• Iron deficiency, Iodine preventing adequate ingestion
deficiency of food or proper metabolism
of nutrients
• Fever, Infection, Metabolic
disease
• Pregnancy, adolescence
 MANUTRITION Etiology

Pregnancy or lactation Lack of Family Planning

Improper Weaning practices Lack of Immunization
Poverty Congenital Diseases
2 or more children under Malabsoprtion: Celiac,
the same household Lactose Intolerance,
Giardiasis, Cystic Fibrosis
Poverty Metabolic
Incompetent/Ignorant Infections: TB
mother
PROTEIN ENERGY MANUTRITION

 the most common, most disastrous form of

malnutrition in the world.
 It is characterized not only by an energy deficit due to a
reduction in all macronutrients but also by a deficit in
many micronutrients.
3 FORMS:
Dry (thin, desiccated)
Wet (edematous, swollen)
Combined form between dry and wet
PROTEIN ENERGY MANUTRITION

Marasmus Kwashiorkor
MARASMUS PATHOPHYSIOLOGY

Triglyceride in fat
Liver glycogen is
Insufficient Body draws on its depots are
exhausted within
energy intake own stores broken down into
a few hours
free fatty acid

Fatty acids are Rise Cortisol & GH Skeletal muscle for

incompletely
Low Insulin, TH and protein is used via
oxidized to ketone
plasma protein level gluconeogenesis
bodies
 KWASHIORKOR
• Protein Malnutrition
• Nutritional Edema Syndrome
• Etiology:
Insufficient intake of good
quality protein
 KWASHIORKOR

DIAGNOSTIC SIGN
Edema

COMMON SIGNS
OCCASIONAL SIGNS
Hair changes
Flaky paint rash
Skin depigmentation
Hepatomegaly
Moon face
Infections
Anemia
 KWASHIORKOR

CHO intake Decreased visceral Hypoalbuminemia

CHON intake protein synthesis

Fat mobilization Impaired beta

and amino acid lipoprotein Dependent
release from synthesis edema
muscle

Fatty liver
Moderate energy deficit Protein-Energy (calorie) Severe energy and
with severe protein
deficit
malnutrition protein deficit

Kwashiorkor Marasmus
(edema with maintenance of (skin and bones appearance with
some subcutaneous fat tissue) little or no subcutaneous fat tissue)
 KWASHIORKOR vs. MARASMUS
KWASHIORKOR MARASMUS
Primary PROTEIN deficiency, due to no protein in OVERALL ENERGY
Deficiency: diet or inadequate absorption. deficiency
Description: "A response to some kind of stress" "A slow adaptation
to starvation"
Incidence: 1-3 years 0-2 years
Edema EDEMA is present -- due to lost oncotic Absent
pressure in blood vessels, in turn due
to hypoalbuminemia
Hypo LOW ALBUMIN is the cardinal symptom. Absent
albuminemia Liver shuts down albumin production
to conserve on protein which is
lacking.
 OVERNUTRITION
• Obesity
• Weight is 20% above IBW
• Etiology:
– Excessive intake of food compared with its
utilization
– Other factors: Genetic constitution
Psychic disturbances
Lack of exercise
Metabolic
 OVERNUTRITION

• Male % body fat >/= 25%

• Female % body fat >/= 30-35%
• BMI = 30 or above
• Scale weight is 20% above Healthy body
weight
OVERNUTRITION
 OVERNUTRITION

Central, apple, android Lower, pear, gynecoid

OVERNUTRITION
OBESITY IS RELATED TO MANY DISEASE ENTITIES
• Osteoarthritis
O
• Breathlessness
B
• Endocrine disorders
E
• Stroke
S
• Increased lipid/
I • Cholesterol levels

T • Tumor/ Cancer

Y • hYpertension
 OVERNUTRITION
THE WEIGHT LOSS TRIAD
Control Energy
Intake

Perform Control
regular physical Problem
activity behaviors
 BREAST FEEDING

Most appropriate
Optimal method
Gold standard form of nutrition
of feeding infants
for infants

Complete food
Better than
for infants up to
bottle feeding
6 months of life
BREAST FEEDING
MILK LET-DOWN REFLEX
Prolactin – produces milk
Oxytocin – release milk
 BREAST FEEDING
• Factors affecting
composition of breast milk:
– Time of day
– Diet of mother
– Mother’s emotional state
– Foremilk or hindmilk
– Drugs
– smoking
 BREAST MILK Colostrum
• Secretion of breast during the first 2-4 days post-partum
• Deep yellow in color
Energy, protein, vitamins,
Nutritional
minerals, carbohydrates,
factors fats

IgA, IgG, IgM, IgD, IgE,

lactoferrin, polypeptide,
Colostrum Immune factors oligosaccharides,
cytokines, lactoalbumin,
lysosomes

Growth factor PDGF, EGF, IGF1, VEGF,TGF

 BREAST MILK

FOREMILK HINDMILK
First milk obtained during a Last milk obtained during a
nursing period nursing period

Clear, thin bluish Thick, cream-white

BREAST MILK Storage
 BREAST MILK
Typical contents of 100 ml breastmilk produced on days 1-5 (colostrum) and
more than 15 days (mature milk) post-partum

CONTENTS COLOSTRUM MATURE MILK

Energy (kcal) 55 67
Fat (g) 2.9 4.2
Lactose (g) 5.3 7.0
Protein (g) total 2.0 1.1
IgA 0.5 0.1
Lactoferrin 0.5 0.2
Casein 0.5 0.4
Calcium 28 30
Sodium 48 15
Vit A 151 75
Vit C 6 5
BREAST MILK Composition
NUTRIENT COMPOSITION

Carbohydrates Lactose
Fats More than 98% TAG
- Oleic and palmitic acid
- Linoleic acid and Linolenic acid
Functions: brain development
Proteins 75% of breastmilk composition
- micellar casein (beta casein)
- acqueous whey
(a-lactalbumin, lactoferrin,
secretory IgA, and serum albumin)
BREAST MILK Composition
ANTIMICROBIAL FACTORS GROWTH FACTORS
secretory IgA, IgM, IgG epidermal (EGF)
lactoferrin nerve (NGF)
lysozyme insulin-like (IGF)
complement C3 transforming (TGF)
leucocytes taurine
bifidus factor polyamines
lipids and fatty acids
antiviral mucins, GAGs
oligosaccharides

CYTOKINES/ANTI-INFAMMATORY DIGESTIVE ENZYMES

tumour necrosis factor amylase
interleukins bile acid-stimulating esterase
interferon-g bile acid-stimulating lipases
prostaglandins lipoprotein lipase
a1-antichymotrypsin
a1-antitrypsin
platelet-activating factor: acetyl hydrolase
BREAST MILK Composition
HORMONES TRANSPORTERS
feedback inhibitor of lactation (FIL) lactoferrin (Fe)
insulin folate binder
prolactin cobalamin binder
thyroid hormones IgF binder
corticosteroids, ACTH thyroxine binder
oxytocin corticosteroid binder
calcitonin
parathyroid hormone
erythropoietin
POTENTIALLY HARMFUL SUBS OTHERS
viruses (e.g., HIV) casomorphins
aflatoxins d -sleep peptides
trans-fatty acids nucleotides
nicotine, caffeine DNA, RNA
food allergens
PCBs, DDT, dioxins
radioisotopes
drugs
 BREAST MILK Composition
HUMAN MILK COW’S MILK
Water Same Same
Kcal/ 100 ml 71 66
Proteins (g/100 ml) 1-1.5 % 3.3 %
Casein 35 % 82%
Whey 65 % 18%

Lactose (g/100 ml) 6.5-7 % 4.5 %

Fats (g/100 ml) 3.8 % 3.7 %
Mineral .15-.25 % .70-.75 %
Vitamins Adequate Vit Low vit. C/D
C/D
Digestibility More digestible Less digestible
BREAST MILK Composition
BREAST MILK Attributes

INFANT
• Bacteriologically safe
• Always fresh and ready to go
• Contributes to maturation of GIT
• Reduces risk of food allergies
• Establishes habit of eating in
moderation
• Contributes to proper development
of jaws and teeth
• Decreases ear infections
• Facilitates bonding with mother
BREAST MILK Attributes
• Proper quality and quantity of nutrients
• Anti-infective properties are universally
effective
• Prevents hypersensitivity or allergy
• Psychological advantages
• Contraceptive effects
• Safe, convenient, and always available
BREAST MILK Unsuccessful
• Lack of motivation and preparation
• Aesthetic reasons
• Working mothers
• Fear of pain
• Anxiety
• Chronic diseases
• Intake of medications
 MAR-ANN B. BRINGAS, MD
FUNDAMENTALS OF Assistant Professor
Department of Biochemistry and Nutrition
FEU-NRMF College of Medicine
NUTRITION

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