Fundamentals of Human Nutrition and Concept of Balanced Diet

Dr. Neena Chawla Deptt. Veg. Sci. P.A.U., Ludhiana

Clinical nutrition is the study of the relationship between food and a healthy body. More specifically, it is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and eliminated by the body. The study of nutrition dates back to the 18th century, when the French chemist Lavoisier discovered that there was a relationship between food consumption and respiration. By the early 20th century, scientists were able to relate the occurence of certain diseases such as beri-beri, rickets, scurvy, and pellagra with certain diets. In 1912, the Polish chemist Casimir Funk discovered vitamin B1 that could prevent beri-beri; he named it "vitamine." In a very short time we knew that that a number of diseases were caused by the lack of specific nutrients -- vitamin B1 (Beri-Beri), vitamin D (Rickets), vitamin C (Scurvy), and vitamin B3 (Pellagra). Apart from vitamins, we now know that diet as a whole has to be complete with all the nutrients like carbohydrates, lipids and proteins along with some protective agents like antioxidants (carotene, selenium, vitamin E and vitamin C). These agents, when consumed in food, appear to protect against the development of heart disease, cancer, and other chronic degenerative diseases. In the early 1940s, the National Research Council set Recommended Dietary Allowances (RDAs) for all the nutrients. The RDAs set the minimum amount of a nutrient needed to prevent diseases like beri-beri and rickets. The old RDAs have now been replaced by Dietary Reference Intakes (DRIs), which show how much of a nutrient we need every day to maximize health and to lower the risk of chronic disease. The beneficial effects of a healthy diet have been now well developed into custom-diets for individual diseases. The role of clinical nutrition has, therefore, advanced from preventive to therapeutic diets and is being increasingly incorporated into mainstream medical treatment. The ingested food in our diet is not only meant to provide energy for our physical work (muscular activity), but also for the metabolic work which includes - digestion, absorption, assimilation of food; interconversion of various metabolites and synthesis of new molecules and tissues; and maintenance of body homeostases (water/electrolyte balance, acid-base balance and body temperature). Since physical as well as metabolic demands of the body change with time; the nutritional requirements, therefore, are dependent upon age, sex and the life style of an individual.

Introduction

 Calorie is a general measure for energy, where one calorie refers to the amount of heat required to raise the temperature of one gram of pure water through 1oC. Since the calorie is a very small unit, the energy content of foods is generally given in terms of kilocalorie, and 1 kilocalorie equals 4.2 kilojoule. The calorific value of foods can be measured by burning the food in oxygen using a bomb calorimeter. Different foods have different calorific values, e.g. carbohydrates and proteins provide 4 kilocalories per gram, fats provide 9 kilocalories per gram while alcohol produces 7 kilocalories per gram.

Calorific Value

 It is the ratio of volume of carbon dioxide produced to the oxygen consumed. Different types of food will have different values, e.g. the RQ for carbohydrates is 1.0; the corresponding values for fats and proteins being 0.7 and 0.8, respectively. Since the diet of any community will almost invariably be of mixed type, the value of RQ generally lies between 0.71.0. This accounts for fall in RQ value in diabetic patients, as the utilization of carbohydrates is drastically reduced.

Respiratory Quotient (RQ)

Basal Metabolic Rate (BMR)

Basal Metabolic Rate (BMR) is the energy required by an individual who is awake but is at absolute physical and mental rest. By physical rest, we not only mean the individual should not be moving but he should also be at digestive rest, i.e. the person must have completed the digestion/absorption of his last meal. By mental rest we mean the person should be absolutely free from any kind of mental stress or anxiety. In this condition, the energy requirement is at the minimum and is only used for the most essential vital functions of the body, viz, heart pump, respiration, maintenance of body temperature and brain activity. The requirement of energy for these basal activities depends upon the size of the person, or more precisely, body surface area; therefore, BMR is expressed as kcal/m2/hr. Another term, resting metabolic rate (RMR) has been introduced recently. It is slightly (about 3%) higher than BMR and refers to the amount of energy consumed to maintain vital functions in an awake, non-fasting individual. Measurement of BMR Traditionally, BMR has been measured by types of instruments, viz, a) Open-circuit systems, b) Closed-circuit systems. Atawater-Benedict-Roth BMR apparatus (closedcircuit) has been most videly used instrument for the measurement of BMR. The person is kept awake, at rest at atmospheric temperature of 25 oC and is made to breathe in oxygen from a metal cylinder for 6 minutes. The carbon dioxide evolved is absorbed in soda lime and the volume of oxygen consumed is recorded. The heat produced in 6 minutes is calculated as: 4.8 X No. of litres of oxygen consumed. This formula is based on the principle that the calorific value of oxygen is 4.8 kilocalories per litre. The value can further be expressed on per hour or per day basis, depending on the experimental requirements. Since BMR is expressed in terms of body surface area, the surface area can be calculated by a number of methods, the most common being Du Bois formula A (m2) = H0.725 X W0.425 X 0.0071.84, Where H is height in cm and W is weight in Kg.

Normal Ranges of BMR

34-37 kcal/m2/hour for adult males 30-35 kcal/m2/hour for adult females. Average BMR for a healthy adult: 24 kcal/kg body weight/day, i.e. an average adult consumes about 1680 Kcal fuel energy every day.

Genetics. Some people are born with faster metabolisms; some with slower metabolisms. Gender. Men have a greater muscle mass and a lower body fat percentage, hence higher BMR. Age. BMR represents vigor of the body, therefore, is high for the growing children and young adults. BMR decreases with advancing age. After 20 years, it drops about 2 % per decade. Weight. More the weight, the higher is BMR. Body Surface Area. The greater Body Surface Area factor, leads to higher BMR. Tall, thin people have higher BMRs. Body Fat Percentage. The lower is the body fat percentage, the higher is BMR. The lower body fat percentage in the male body is one reason why men generally have a 10-15% faster BMR than women. Diet. Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by up to 30 %. Restrictive low-calorie weight loss diets may cause the BMR to drop as much as 20%. Body Temperature/Health. For every increase of 0.5o C in internal temperature of the body, the BMR increases by about 7 %. The metabolic reactions in the body actually occur more quickly at higher temperatures. So a patient with a fever of 102.5 oF would have an increase of about 50 % in BMR. External temperature. Environmental temperature also affects BMR. Exposure to cold temperature causes an increase in the BMR, so as to create the extra heat needed to maintain the body's internal temperature. A short exposure to hot temperature has little effect on the body's metabolism as it is compensated mainly by increased heat loss. But prolonged exposure to heat can also raise BMR. Hormones. A number of hormones affect the BMR, e.g. estrogen and testosterone increase BMR. Thyroid hormones are particularly important for BMR since they act by increasing the general metabolic rate. BMR has been used as an indicator of thyroid function when estimation of thyroid hormones was not available. Hyperthyroidism is characterized by increased whereas hypothyroidism by decreased BMR. Epinephrine also increases BMR but to a lesser extent. Exercise. Physical exercise not only influences body weight by burning calories, it also helps raise the BMR by building extra muscle mass.

Factors Affecting BMR

Specific Dynamic Action (SDA)

SDA refers to the thermogenic affect of food and is defined as the increased heat production following the intake of food. Initially it was thought that SDA is the heat generated during digestion and absorption of food ingredients. However, it is noticed that intravenous administration of the digested ingredients, e.g., amino acids or glucose, also generates heat which could even be more than when given orally. The SDA appears to be associated with the assimilation (conversion of digested food into storage form) and can be termed as the activation energy required for the assimilation of the food. This activation energy is trapped from the reserves in the body, therefore, an individual should actually take extra food to compensate for the SDA. The SDA value for proteins is the highest, i.e. 30% above its calorific value. Similarly, SDA for carbohydraes is 5% whereas that of fats is about 15%. For a mixed diet, about 10% extra calories should be taken.

Caloric Requirements
The life style and the extent of physical activity of an individual determine the dietary requirements. Any physical or mental activity would require energy above the BMR. The activity levels may be divided into: sedentary, moderate and heavy. An additional 30 %, 40% and 50% of BMR, respectively, has to be taken by the individual falling under these categories. There is no hard and fast rule for categorization, but a general overview of the persons activity provides an idea of the category, e.g. officers doing the table work fall in light activity group (sedentary work); students, sales personel and housewives fall in light activity group (light work); miners, athletes and factory workers fall under very active group (moderate work); while construction workers, farm workers and labourers are involved in strenous muscular activity (heavy work) group. An additional 300 kcal per day during pregnancy and an additional 500 kcal per day during lactation is required.

Type of Work

Sedentry Light Moderate Heavy

Caloric Requirem ent (Calories per day) 2000-2400 2700-3200 3200-4000 =/> 4000

Balanced Diet
A complete diet must supply the elements: carbon, hydrogen, oxygen, nitrogen, phosphorus, sulfur, and at least 18 other inorganic elements, in the right proportion. The major elements are supplied in carbohydrates, lipids, and protein. In addition, at least 17 vitamins and water are necessary. If an essential nutrient is omitted from the diet, certain deficiency symptoms appear. The major dietary principles of our diet are carbohydrates, lipids and proteins, supplemented adequately with minerals and vitamins.

Carbohydrates
Carbohydrates cater to maximum proportion of the energy needs of the body, in addition they also supply major crunch of the fibre content essential for proper digestion. Under ideal conditions, carbohydrates should not constitute more than 60% of the energy needs of the body. Carbohydrates are categorized under the available and unavailable carbohydrates, referring to the component which can be metabolized to give energy, e.g. starch & sugar; and those which cannot be, e.g. fibre. Starch is the main polysachharide present in the diet, which can be digested by amylase to maltose units which are further hydrolyzed by maltase into glucose. Ultimately, glucose supplies energy to most of the organs and tissues. Sucrose (cane sugar) is another carbohydrate , a disachharide, composed of glucose and fructose. It is the most common sweetening agent and at the same time, the compound responsible for dental caries. Excessive intake of sucrose leads to excessive calorie intake, hyperglycemia and a rise in plasma lipids. Cellulose - The unavailable form of carbohydrate, fibre, is necessary to maintain the healthy peristaltic movement of the intestine. It can exist in various forms, viz. cellulose (polymer of glucose) , hemicellulose( pentoses, hexoses and uronic acids) , lignins ( Aromatic alcohols) and pectins ( partially esterified rhamno galacturans). The various functions performed by dietary fibre are: promotion of peristalsis, retention of water in feces, increase in acid secretion, increase in bile acids secretion, slowing down of gastric emptying, excretion of bile acids. In addition, lignins have some antioxidant activity. The RDA for fibre is about 30 g per day.

Food Carbo Source (%DW) Cane sugar 100

Rice
Honey Wheat Cakes Bread Potato

80
80 70 50 50-60 25

Sweets occupy an important place in our diet, particularly, in the Indian cuisine. The average adult consumes about 18 Kg of sucrose per year accounting for 10-12% of total energy intake. High sugar intake is associated with adverse effects like obesity, dental caries and also aggravates hyperglycemia. Therefore, artificial sweeteners are used by a number of diabetes mellitus patients as well as health concious individuals. Health beverages like Diet Pepsi are sweetened by one of the following sweeteners Saccharin: It is a petroleum byproduct and occurs as a white crystalline powder. It is 200 - 700 times sweeter than sucrose. It is not metabolized in the body and is excreted unchanged in the urine. It is considered safe at <1% dietary level but excessive intake has been associated with the potential risk of bladder cancer. Pregnant women are advised to avoid saccharin. Aspartame: It is a dipeptide of aspartic acid and phenylalanine. Aspartame is 180 times as sweet as sucrose. It is heat and acid labile and is metabolized into several products including phenylalanine and aspartic acid. It should not be taken by individuals with phenylketonuria (PKU). There are some reports about the harmful effect of aspartame due to the CNS toxicity of high levels of phenylalanine. Acesulfame-K: A derivative of acetoacetic acid and is 200 times sweeter than sucrose. It is heat stable and is approved for broad product applications. Sucrose polymers: Made by selective chlorination of sucrose, are 600 times sweeter than sucrose and are becoming very popular as alternate sweeteners.

Artificial Sweeteners

Fats and Lipids

Fats: Most concentrated source of energy, providing 9 kcal/g. Functions: Make up part of the structure of cells, form a protective cushion and heat insulation around vital organs, carry fat soluble vitamins, and provide reserve storage for energy. Three unsaturated essential FAs: linoleic, linolinic, arachidonic; have 2, 3, and 4 double bonds respectively. Saturated fats, along with cholesterol, have been implicated in arteriosclerosis, "hardening of the arteries". For this reason, the diet should be poor in saturated fats (animal) and rich in unsaturated fat (vegetable). Lately there has been drastic decrease in fat consumption in developing countries, coming down to about 10% from the earlier 40% of the dietary calories. Diet must contain some lipids to meet the requirements of essential FAs & to metabolize the fat soluble vitamins. Fats provide energy, in addition to providing palatability and texture to the food. The RDA for lipids is 20 g/day for normal adults, 30 g/day during pregnancy and 45 g/day during lactation. Fat may be visible, e.g. butter, ghee, oils; or invisible, e.g. present in egg, fish, nuts, cereals and oil seeds. Under ideal conditions, fats may comprise up to 20 % of the calorie requirement, out of which about 25-30% must be from PUFAs. This implies about 3 g PUFA per day. However, PUFA should not constitute > 30 % of the total fat intake, because they have an inherent capacity to generate free radicals, which are involved in a number of disease processes and hasten ageing. Ideally, saturated, monounsaturated & polyunsaturated fatty acids must be present roughly in equal proportions.

Cholesterol
Cholesterol is one lipid of paramount importance in human health as it is known as the mother steroid. Most of the steroids in our body including steroid hormones are derived from cholesterol. On the other hand, cholesterol is implicated in the development of atherosclerosis and is a major risk factor for myocardial infarction and stroke. About one third of cholesterol in our body is synthesized endogenously in liver. No cholesterol is present in vegetables, fruits, pulses and cereals. At the same time, the plant sterols inhibit the absorption of cholesterol. Saturated fats contribute to rise in serum cholesterol, whereas PUFAs reduce cholesterol level by its esterification and excretion. PUFAs are precursors of leukotrienes and prostaglandins. The major source of PUFA is the vegetable oils. Fish oils contain -3-fatty acids, which lower the low density lipoproteins (VLDL and LDL) level in plasma, hence are anti-atherogenic. Also, dietary fibers help to lower serum cholesterol, lower LDL fraction and raise the good cholesterol, i.e. HDL fraction in serum.

Source

Cholester ol(mg/100 g)

Egg Yolk Liver

1330

Brain Whole egg Butter 280 Chicke 100 n Milk 10-22

300600 2000 450

Dietary Fat and Cancer

High levels of dietary fat are thought to increase the risk of many types of cancer: colon, lung, ovary and prostate. Epidemiological as well as animal studies have demonstrated that not only the amount but also the type of fat consumed is important. The -3 fatty acids may protect against certain cancers. At present, the mechanism by which dietary fat increases cancer risk is not clear; however, modulation of prostaglandin and leukotriene synthesis appears to be a possible mechanism. The dietary recommendations made by AICR/WCRF to reduce cancer risk include limiting the total fat intake and using vegetable oil instead of animal fat. The overall amount of fat in a diet should not be > 30% of total energy intake, with a predominance of mono- and polyunsaturated FAs. Use of monounsaturated fats, such as olive oil, especially with minimum hydrogenation, may be beneficial.

Fat Substitutes

These are substances that provide similar viscosities and organoleptic (taste) properties as fat and have been recommended for use in low fat foods and diets for fat management. Two types of fat substitutes are approved by the FDA for human use. Microencapsulated Proteins: Proteins from egg and/or milk are microencapsulated to provide a creamy smooth sensation very much like that of fat. Since it is a protein, it gives only 3.8 kcal/g energy instead of 9 kcal/g and it is digested like dietary protein. Since the encapsulation process does not ensure heat stability, this may only be used in low fat foods and diets not involving cooking or frying. A microencapsulated protein product, GRAS, is used as a fat substitute in ice cream. A product made from oat bran has been also shown to be useful in glycemic load and cholesterol management. Sucrose polyesters: These are another type fat substitute made from sucrose and vegetable oils. They are mixtures of 6 to 8 molecules of dietary FAs esterified to the hydroxyl groups of sucrose. The physical characteristics are dependent upon the type of FAs used. It is heat stable and is not metabolized in the body. The organoleptic properties are similar to those of common dietary fats. These polyesters are available in potato chips and similar snack foods in the USA. However, fat soluble vitamins should be added to these products to compensate for the decreased absorption of these vitamins.

Proteins

All life requires protein since it is the chief tissue builder and part of every cell in the body. Functions: Make the muscle mass of the body; make hemoglobin in the blood that carries oxygen to the cells; form antibodies that fight infection; supply nitrogen for DNA and RNA (genetic material); and supply energy. Proteins are necessary for nutrition because they provide AAs required to build the proteins and AA derivatives like hormones, body pigments and biogenic amines. Human body is unable to synthesize eight called essential AAs(VITTAL LYMPH). A food containing protein may be of poor biological value if it is deficient in one or more of the 8 essential AAs: valine, isoleucine, tryptophan, threonine, arginine, leucine, lysine, methionine, phenylalanine,histidine. Arginine and histidine are synthesized in the body but can become essential under increased requirement. The quality of proteins in our diet is more important than their quantity. In general, the overall height and stature of an individual is determined (apart from the genetic make up) by the quality and quantity of dietary proteins consumed during growing age. The proteins, therefore, can be evaluated on the basis of their digestibility, AA content and other quality parameters. The nutritive value of a protein may be measured by giving that particular protein as the sole nitrogen source to an animal and measuring the consequent weight gain.

Biological Value
The ratio of nitrogen retained to the nitrogen absorbed during a given period is called biological value of the protein. To measure BV, a known amount is given to the animal in 24 hours and the excretion through feces and urine is measured. BV is expressed as percentage. Vegetable proteins have lower biological value than the animal proteins. Rice has good bioloigcal value where as maize, peas and grams have low biological values. The BV of food also depends upon its processing and the mode of cooking. The cooking may increase or decrease the BV of a protein food due to its effect on the digestibility. Animal proteins have the highest biological value because they contain a greater amount of the essential AAs. Overall quality of protein would also depend upon the ratio of different essential AAs in the protein. All the AAs must be available at the same time and in the requisite proportions, otherwise they are not utilized for protein synthesis (growth). Animal proteins have higher BV because their proportionality relationship matches with that in the human beings.

Animal
Source BV
Whole egg Cow milk Egg white Pork Fish Beef Lamb 94 85 83 77 75 69 60

Vegetable
Source BV
Rice Gram Cashe w Barley Wheat Soybe an Maize Peas 86 76 72 71 67 64 60 56

Net protein utilization (NPU)

It conveys the same information as BV but is a better index of the nutritional value and bioavailabilty of a protein. The NPU depends upon the digestibility as well as BV of the protein. NPU of some common food items are given in Table 13.5

Protei NPU n source Egg 91

Protei NPU n source Rice 57

Lamb

76

Soybe an

54

Milk

75

Wheat

47

Fish

72

Peas

45

Liver

65

Groun dnut

45

Net Dietary Protein Value (NDPV)

It is an indicator of protein quality as well as quantity in the diet. Protein Efficiency Ratio (PER): The weight gain/g of protein intake is referred to as PER. It is a very good indicator of the bioavailability of proteins. Chemical Score : Milligrams of a particular AA per gram of protein, and is a good indicator of the essential AA content of a protein. Since egg contains all the AAs in adequate amounts, it is given a chemical score of 100 and other proteins are graded in reference to the egg protein. Chemical score tells us about the relative proportion of essential AAs in the protein and hence serves as its nutritive value. If a protein is deficient in one or more essential AAs, then the missing AA is known as the limiting AA. If such a protein is given as the sole protein source to an animal, the growth will be compromised. However, growth rate is restored upon supplementation with the limiting AA. Chemical Score is defined as the ratio of the concentration of the most limiting AA in the test protein to concentration of the same AA in the egg protein. Some proteins may be deficient in one or more essential AA, which, if given alone as protein source, will limit growth of the individual. The chemical score of these proteins would be zero. To circumvent the problem of limiting amino acids, more than one type of proteins is recommended in the diet, so that the deficiency of one protein is supplemented by the other. This is known as mutual supplementation. For example, lysine is deficient in wheat but not in pulses. On the other hand, methionine is deficient in legumes but not in wheat. So, the two foods taken together will supplement each others deficiency and good quality protein is available from a mixed diet. Some classical examples of supplementary foods are rice + legumes, wheat + legumes, zein (corn) + meat, gelatin + milk. Protein Source Chemical Score Protein Source Chemical Score

Egg

100

Rice

60

Lamb

70

Soybea n Wheat

57

Milk

65

42

Fish

60

Peas

42

Liver

66

Ground nut

44

Daily requirement of proteins

Description g/Kg body wt./day

Proteins are not the primary energy source, but have a sparing effect on carbohydrates. That is, when the carbohydrates are not present in sufficient amounts, some energy may be derived from proteins. Primarily, proteins serve as the building blocks of the body and only about 15% of the energy is derived from proteins. AAs may serve as the exclusive sources of energy during starvation. The minimum level of intake of proteins is 0.75 g/Kg body weight per day. However, the requirements vary with age and physiological staus of the individual. The deficiency of even a single AA in the diet may lead to impaired metabolism.

Infants

2.40

Up to 10 yrs

1.75

Adolescent boys

1.60

Adolescent girls

1.40

Adultmen/women

1.90

Pregnant women

2.00

Lactating women

2.50

Nitrogen Balance day, and normal A lot of nitrogen is cycled through the body every
healthy individual is said to be in nitrogen balance state, as the intake roughly equals the output via urine, skin and feces. The balance is negative if the output exceeds the intake and positive for the reverse condition. Nitrogen constitutes roughly 16% of the weight of a protein; hence, nitrogen balance can be calculated by measuring the nitrogen intake and output. Nitrogen balance of any individual is affected by various factors: Protein deficiency: The deficiency of one or more AAs may cause negative nitrogen balance. Since all the AAs are required in the right proportion for protein synthesis, the intake of AAs has to be very critically watched in any diet. Physiological state: Starvation is a major cause of disturbance in nitrogen balance. During the active growth period, nitrogen balance is positive due to tissue building up. Similarly, the balance is negative during malignancy, uncontrolled diabetes mellitus and other chronic diseases. However, convalescence after an illness or surgery is accompanied by tissue regeneration, hence a positive nitrogen balance. A pregnant woman is also under state of positive nitrogen balance due to protein retention for the growth of fetus. Hormonal status: Different hormones have different impact on nitrogen balance, e.g. growth hormone, insulin and androgens promote positive nitrogen balance while corticisteroids promote negative nitrogen balance.

Protein Energy Malnutrition (PEM)

PEM is a very common problem, especially in the developing and the under-developed countries. The condition affects 20-50 % of children, in different regions of the globe, depending upon the educational and financial status of the population. Malnutrition is expressed as Marasmus or Kwashiorkor syndromes. Marasmus is a result of continued severe deficiency primarily of dietary calories and secondarily protein deficiency, while Kwashiorkor arises due to protein deficiency despite sufficient caloric intake. Sometimes, the symptoms of marasmus and kwashiorkor are overlapping which causes difficulty in diagnosis. The important clinical changes in PEM are lower BMR, hypoalbuminemia, raised immunoglobulin G level, fatty liver (only in Kwashiorkor), hypoglycemia (only in Marasmus), hypokalemia, dehydration and hypomagnesemia. The condition is fully reversible, and can be treated by providing 3-5 g/Kg body weight of protein per day. The markers for monitoring of improvement are weight gain, rise in serum albumin and disappearance of edema. However, severe continued PEM in early years of life may result in permanent problems, like lower intelligence quotient. Hence PEM is best prevented or at the most, treated as soon as symptoms appear.

Comparative features of Marasmus and Kwashiorkar

Feature Onset age Growth retardation Deficient Cause Appetite Skin Marasmus 0-12 months Significant Calories Early weaning/ Recurrent infection Normal Dry Kwashiorkor 12-60 months Mild Protein Carbohydrate diet after weaning, Acute infection Marked anorexia Marked dermatitis

Hair Presentation
Serum albumin Cortisol Behaviour

Normal Diarrhoea, muscle dehydrated skin

2-3 g/dl High Irritable

Abnormally thin & straight weakness/atrophy, Diarrhoea, muscle edema on face & legs
< 2 g/dl Low Lethargic

wasting,

Minerals
The minerals in foods do not contribute directly to energy needs but are important as body regulators and as essential constituents in many vital substances within the body. A mineral is rather loosely defined as any element not normally a part of the structures of carbohydrates, proteins, and fats. More than 50 elements are found in the human body. About 25 elements have been found to be essential, since a deficiency produces specific deficiency symptoms. Although minerals may not be part of the structures of carbohydrates, proteins, and fats, they are mixed in the foods in trace amounts during the growing process by uptake from the soil. Major Minerals in terms of body requirement are calcium, phosphorus, iron, sodium, potassium, and chloride ions. Other essential minerals are copper, cobalt, manganese, zinc, magnesium, fluorine, and iodine.

Vitamins
Vitamins are essential organic compounds that the human body cannot synthesize by itself and must therefore, be present in the diet. The term vitamin (vital amines) was coined by Casmir Funk from the Latin vita meaning "life" (essential for life) and amine because he thought that all of these compounds contained an amine functional group. Since they can not be synthesized in the body, they need to be supplied in the diet. Water soluble vitamins can not be stored in the body and being water soluble, are excreted through urine; therefore, they have to be supplied continuously in the diet. Fat soluble vitaminsare stored in the body in liver and in adipose tissue. These vitamins can be taken in high doses infrequently and can serve the requirement for a long time. Deficiency of one or more vitamins produce deficiency disorder.

Obesity
Obesity is a complex syndrome with an increase in body wt. (> 10% above normal). The generalized deposition of fat in the body interferes with the normal body functions. Obesity and its complications cause as many as 300,000 premature deaths each year, making it 2nd to cigarette smoking as a cause of death. Prevalence of obesity increases with age and with lower socioeconomic status in developed countries; it is on the increase in developing countries in all ages. Obesity is life-threatening. It increases the risk of developing type II diabetes, heart attack, stroke and cancers of colon, breast, prostate and endometrium. Obesity is classified on the basis of body mass index (BMI), but other indices like, waist and hip circumferences and their ratio; and body composition analysis by skinfold thickness, underwater weighing and various imaging techniques, are also used in the clinics.

BMI

Obesity Status Underweigh t Normal

Obesity Indicators
Body Mass Index (BMI ): Wt.(Kg) / Height(m2) It is an age- and race-specific parameter. In children and adolescents, overweight is BMI 95th percentile based on age- and sex-specific CDC growth charts. BMI-mortality relationship is a U-shaped curve that indicates abnormal increases as well as decreases are related with mortality. It may be noted that large muscle mass, without excess body fat, may result in a false high BMI as in bodybuilders. Waist circumference reflects the degree of visceral fatness in proportion to body fatness. Excess central or trunkal fat is called android and gives an appleshaped obesity, & is associated with a greater risk for hypertension, insulin resistance, diabetes, dyslipidemia and coronary heart disease. A waist circumference of >93 cm in men, and >79 cm in women is a risk factor for complications of obesity. Trunkal obesity is also reflected in waist circumference to hip circumference ratio that is <0.8 for women and <1.0 for men.

<20.0

20.0-25.0

25.0-29.9

Overweight

30.0-34.5

Moderate Obesity Severe Obesity Extreme Obesity

35.0-40.0

>40

Skinfold Thickness
Body composition analysis for the percentage of body fat versus muscles is measured by using skinfold thickness or by using mid upper arm circumference. It is based on the assumption that approximately onehalf of the total body fat is deposited as subcutaneous tissue loosely attached to underlying muscles. However, it is highly race-dependent with wide ranges. Skinfold thickness measures the thickness of a double layer of skin with their subcutaneous fat using a special caliper. It can be measured at specific body sites that include posterior triceps (the most appropriate), subscapular, lower thoracic, iliac, and abdominal sites. Typical posterior triceps skinfold thickness is 1.2 cm (range 0.5-2.5 cm) in healthy men and 2.0 cm (range 1.2-3.4 cm) in healthy women.

 Bioelectrical impedance analysis. Bioelectrical impedance analysis determines % of body fat simply and non-invasively through direct measurement of the percentage of total body water, from which percentage of body fat is derived indirectly. However, chronic disorders that change the percentage of total body water, e.g., moderate obesity and diabetes mellitus affect its accuracy. Underwater (hydrostatic) weighing. It is the most accurate method for measuring percentage of body fat. Because it is costly and time-consuming, its usage aims at research. Other indicators. Other research methods that also determine the fat distribution include the following imaging techniques: computed tomography, magnetic resonance imaging and dual-energy X-ray absorptiometry. Blood pressure, fasting blood glucose and plasma lipids profile should be measured routinely in obese patients.

Causes of adiposity
1. 2. 3. The body can deal with an excess of dietary calories in three ways: Convert excess fuel to fat and store it in adipose tissue, Burn excess fuel by extra exercise, and Waste fuel by diverting it to heat production (thermogenesis) in uncoupled mitochondria. The body has unlimited capacity of storage of fat in the adipose tissue, still total adipose tissue mass does not, generally, increase beyond a particular level. According to the Lipostat Theory adipose tissue mass in an individual varies within a limited range. Whenever adipose tissue mass exceeds this limit, it slows down the intake of food and stimulates lipolyiss and oxidation of FAs. The balance or set point is determined by a number of factors as discussed below. Excess consumption of food energy - Excess energy from food, left after that consumed in metabolism and physical activity, is stored as fat in the fat cells of the adipose tissue under the skin and around viscera. Obesity involves an increase in both the number of adipocytes (hyperplastic) during the period from third trimester of gestation to puberty (rarely in adulthood), and/or increased size of adipocytes (hypertophic) in all ages. Fat cells, once gained, are never lost and weight loss in obese persons leads only to a reduction in the size of fat cells. This highlights the importance of preventing rather than treating obesity. High caloric food with sedentary life. The major factor in the worldwide increase in the prevalence of obesity is the availability of high caloric food accompanied by sedentary life style. This causes a prolonged imbalance between caloric intake (energy input) and caloric expenditure (energy output), because every 9.3 kilocalories excess energy precipitates one gram of body fats. Once developed, even reduction of the energy input to balance body requirements will maintain the already established obesity. This is why reduction in the energy input rather than increase in the energy output is required for weight loss. Differentiation of the preadipocytes. Adipocytes are formed from fibroblast-like preadipocytes by differentiation. This cyfferentiation into adipocytes takes place by induction of a number of adipositespecific genes. This induction is mediated by a transcription factor named the peroxisome proliferatoractivated receptor (PPAR), which forms heterodimers with the retinoid receptor (RXR) to regulate the expression of two more transcription factors: C/EPB and STAT5. The combined action of PPAR, STAT5 (signal transducer and activator of transcription 5), and C/EPB leads to the expression of adipocytespecific genes and cellular differentiation. Steroids like dexamethasome and insulin are lipogenic since they induce the transdifferentiation of fibroblasts into adipocytes. The acid forms of vitamin A (retinoic acid) compete with the PPAR for the RXR and prevent the transdifferentiation of fibroblast into adipocytes, induce death of the already formed large-sized adipocytes, control leptin secretion and improve response to insulin through several mechanisms. Retinoic

 Polygenic genetic predisposition. There is a polygenic genetic predisposition to obesity. As many as 59 chromosomal regions contain obesity-related genes. Also, rare mutations in at least 6 human genes were found to underlie morbid obesity. Genetic defects in 2 genes, viz. ob-gene and db-gene, have been found to be responsible for obesity. Abnormalities in the peptide cytokines and hormones and/or their receptors that regulate food intake, e.g., leptin and melanocortin-4 receptor are rare causes of obesity. Thus, genetic predisposition requires inducing environmental and behavioral-life style factors. Changes in the BMI and the amount of body fat are 33% heritable. Moreover, body fat distribution (abdominal versus hip), BMR, energy expenditure, diet-induced thermogenesis, and non-voluntary activityassociated thermogenesis are under regulation by genetic factors. There are genetic variations in thermogenins, number, size and type of adipocytes (brown versus adipose tissue) and lipoprotein lipase. Secondary causes of obesity include Cushings syndrome, hypothyroidism and polycystic ovary syndromes.

 Dietary and environmental factors. Diets high in fresh fruits and vegetables, fibers and complex carbohydrates minimize weight gain. A sedentary lifestyle promotes weight gain. Drugs, e.g., corticosteroids, lithium, traditional antidepressants (tricyclics, tetracyclics and monoamine oxidase inhibitors), benzodiazepines and antipsychotic drugs, often cause weight gain. Pregnancy, brain damage and endocrine disorders disturb weight regulation. Hyperinsulinism due to pancreatic endocrine tumors and Cushing's syndrome induce body weight gain. Risk factors for obesity in infants are low birth weight and maternal obesity, diabetes, and smoking. Psychological and behavioral pathologic eating patterns. These include the binge eating disorder (uncontrolled quick eating of large amounts of food followed by distress) and night-eating syndrome (morning anorexia, evening hyperphagia and insomnia).

Regulation of obesity
The food intake is regulated by local GI tract-derived pre- and post-absorptive signals and by integral central mechanisms, mainly through control of hunger and appetite. Centrally, the hypothalamus utilizes several hormones to regulate energy balance in accordance with the required activity. This determines a consequent increase or decrease in food intake and body weight control. Signals controlling energy content originate from the adipose tissue leptin hormone (leptin = to slim) and pancreatic insulin hormone to be conveyed to the CNS. In response, the brain sends efferent signals, which are mediated by a complex network of neuropeptides, to regulate appetite and hunger. Leptin and Leptin Receptor Discovered in 1994, Leptin (Greek leptos, thin) is a small protein (167 AAS) that is produced in adipocytes. Deficiency of leptin, due to genetic defect (ob/ob) in mice, causes profound changes in the behavior and metabolism of animals. They are in a constant state of starvation and develop habit of continuos eating. They become severely obese, are unable to stay warm and are sterile. A second mouse gene, designated DB (diabetic) was also found to have role in appetite regulation. The db/db mice are obese and diabetic. Now we know that the DB gene encodes for the leptin receptor. When the leptin receptor is defective, the signaling function of leptin is lost and mice become obese. Leptin carries the message that fat reserves are sufficient and promotes a reduction in fuel intake, increased expenditure of energy, stimulates the sympathetic nervous system resulting in increased blood pressure, increased heart rate and increased generation of heat (thermogenesis). Leptin and insulin act directly on the central hypothalamic arcuate nucleus neurons that control appetite and energy expenditure. These neurons secrete two neuropeptides: the catabolic proopiomelanocortin (POMC), and anabolic neuropeptide Y/agouti-related protein (NPY/AgRP). Proopiomelanocortin is cleaved to release melanocortins (such as -melanocyte stimulating hormone, MSH), that decrease food intake. Oppositely, NPY/AgRP stimulates neurons expressing melanin-concentrating hormone (MCH) and orexins A and B. MCH and orexins A and B act on brain stem neurons to control food intake. These neurons connect with satiety center in the brain cortex to promote hunger and to stimulate secretion of another set of hormones such as thyrotropin (TRH), corticotrophin (CRH) and oxytocin.

Adiponectin Adiponectin is a peptide hormone (224 AAs) produced almost exclusively in adipose tissue. It acts on muscle cells to increase the FA uptake and stimulate -oxidation. It also promotes the glucose uptake by the muscles. On the liver cells, adiponectin acts to suppress FA synthesis and gluconeogenesis. It increases glycolytic activity in the hepatocytes. Therefore, adipose tissue secretes adiponectin in proportion to the fat mass which enhances the utilization of fats and decreases the generation of new FAs. Ghrelin Ghrelin is a peptide hormone (28 AAS) produced in cells lining the stomach. It is a powerful appetite stimulant that works on a shorter time scale (between meals) than leptin and insulin. Ghrelin receptors are located in the pituitary gland & in the hypothalamus (affecting appetite), as well as in heart muscle and adipose. The hormone is secreted from the stomach upon ingestion of food and three peaks in the secretion of ghrelin correspond with the meal timings. It binds its receptor in the CNS and stimulates NPY/AgRP-expressing neurons to increase short-term food intake, and may decrease energy expenditure and fat catabolism

PYY336 PYY36 is a peptide hormone (34 AAs) secreted by endocrine cells in the lining of the small intestine and colon in response to food entering from the stomach. Humans injected with PYY3 36 feel little hunger and eat less than normal amounts for about 12 hours.

Other Hormones Other hormones released by adipose tissue, such as adiponectin and resistin (resists insulin action), may mediate insulin resistance observed in obesity and associating metabolic syndrome. The amount of adiponectin secreted is inversely related to fat mass. Thyrotropin increases thermogenesis and food intake, whereas corticotrophin decreases food intake and increases energy expenditure through the sympathetic activity. Brain endorphins increase the appetite, whereas serotonin increases brain relaxation and satiation. Insulin is lipogenic and decreases energy intake, whereas noradrenaline and adrenaline are lipolytic. Further signals involved in the central control of food intake come from the GI tract and are mediated by GI peptides such as glucagon-like peptide 1, cholecystokinin, glucagon-like peptide, amylin and bombesin-like peptide that reduce food intake. Gastric stretching itself also affects the food intake. Finally, hypoglycemia decreases the activity of the satiety centre.

Biochemical basis of the treatment of obesity

Obesity is treated by exercise, dietary and/or behavior modification, and sometimes drugs or surgery depending on its severity and presence or absence of the complications. Healthy low-fat diet with modest calories (1000-1400 kcal/day), and some protein substitution for carbohydrate have the best long-term outcome. Intake of 500 kcal less than the required calories per day leads to an average weight loss of approximately 0.5 kg/week. Fresh fruits, vegetables and fibers should substitute refined carbohydrates and processed food, and water should replace soft drinks or juices. Foods with a low glycemic index and marine fish oils or vegetable monounsaturated fats (e.g., olive oil) reduce the risk of cardiovascular disorders and diabetes. Persons on caloric restriction should ensure adequate mineral and vitamin intake by supplementation. The intake of high biological value protein of at least 2060 g should be maintained. Weight loss improves the expression of LPL at the protein and mRNA levels. Exercise increases energy expenditure, BMR and diet-induced thermogenesis. Onethird of the energy expenditure is used for muscle activity. This increases with higher muscular activity to reach three-fourths of the energy expenditure. Exercise also seems to regulate appetite to more closely match caloric needs. Other benefits include increased insulin sensitivity, improved plasma lipid profile, reduced blood pressure, better aerobic fitness, and improved psychological well-being. Resistance exercises increase muscle mass. Because muscle tissue burns more calories at rest than fat tissue, increasing muscle mass produces lasting increases in BMR. Drugs are indicated if BMI is >30 or for lower BMI that has obesity complications (hypertension, insulin resistance). However, drugs are more useful for maintaining weight loss.. Sibutramine & Orlistat are the common anti-obesity drugs. Surgery is indicated if exercise, diet and behavioral therapy are ineffective in patients who are very obese (BMI >40) or have serious complications. It includes the gastric bypass and the adjustable and reversible gastric bands.

The Metabolic Syndrome

The most prominent consequence of obesity, particularly the apple-shaped trunkal abdominal obesity, is the development of the metabolic syndrome. The metabolic syndrome includes hypertension, hyperlipidemia, hyperinsulinemia and insulin resistance. Persons showing the metabolic syndrome (previously called syndrome X or insulin resistance syndrome), are characterized by excess apple-shaped trunkal abdominal fat with high waist-to-hip ratio accompanying at least by two of the following: insulin resistance (glucose intolerance, and hyperinsulinemia), dyslipidemia (low HDL and elevated VLDL), and hypertension. These changes reflect abnormal molecular signals originating from the increased mass of adipocytes. Metabolic syndrome is very common in developed countries and is growing in developing countries with improvement in quality of life. The obese persons with pear-shaped hip fat accumulation with a low waist-to-hip ratio perform near normal. Trunkal fat releases excess FFAs into circulation that induces hepatic and muscle insulin resistance, compensatory hyperinsulinemia, dyslipidemias due to reduction of LDL receptor expression and excess synthesis of VLDL, increased HDL clearance, hypertension, and ultimately, diabetes mellitus and coronary artery disease. There is high liability to thrombosis due to the increased levels of fibrinogen and plasminogen activator inhibitor I. There is hyperuricemia. A vicious circle would be established because insulin resistance in adipose tissue increases activity of hormone-sensitive lipase and lipolysis to release more FFAs into the blood that is extracted by the liver. In the liver, FAs are converted to TG & cholesterol that are secreted back to the blood as VLDL.

Nutritional supplements The term "nutritional supplement" refers to vitamins, minerals, and other nutrients that are used to support good health and treat illness. For example, plant compounds known as phytochemicals (found in tomatoes and soybeans) have powerful disease-fighting properties. While it's always best to get nutrients through the foods you eat, sometimes taking a supplement can help. For example, taking zinc supplements has been reported to shorten the duration of the common cold and lower the incidence of acute diarrhea in children. Calcium has long been used as dietary supplement to support growth of bones in children, Glucosamine and chondroitin sulphate are recommended for osteoarthritis patients. Functional Foods The tenet "Let food be thy medicine and medicine be thy food," espoused by Hippocrates nearly 2,500 years ago, is receiving renewed interest. In particular, there has been an explosion of consumer interest in the health enhancing role of specific foods or physiologically-active food components: functional foods. Clearly, all foods are functional, as they provide taste, aroma, or nutritive value. Within the last decade, however, the term functional as it applies to food has adopted a different connotation -- that of providing an additional physiological benefit beyond that of meeting basic nutritional needs. Japan was the first country to formulate a specific regulatory approval process for functional foods. Known as Foods for Specified Health Use (FOSHU). More than 250 products have been licensed as FOSHU foods in Japan.

 The International Life Sciences Institute of North America (ILSI) defines functional foods as foods that, by virtue of physiologically active food components, provide health benefits beyond basic nutrition. Thus, a functional food is a food, which has successfully demonstrated health effects when consumed, in normal amounts, as part of the regular diet. A functional food can be a natural food or a food in which one or more components have been modified. Numerous functional components have been studied and classified. However, most have not been sufficiently researched to bear health claims.

Functional Food

Key Component

Potential Health Benefits

Black and Green Tea

Catechins

Reduce risk for cancer

Broccoli

Sulphoraphane

Reduce risk for cancer

Fish

-3 fatty acids

Reduce risk for heart disease

Garlic

Sulfur compounds

Reduce risk for cancer & heart disease

Oats and oat-containing food

Soluble fiber glucan

Reduce cholesterol

Purple Grape juice

Polyphenolic compounds

Improve cardiac function

Soya foods

Soy protein

Reduce cholesterol

Tomatos & tomato products Yogurt

Lycopene

Reduce risk for cancer

Probiotics

Improve GIT health

Bitter gourd

Momordicin

Control hyperglycemia in diabetes

Pro- and Prebiotics

The human intestinal tract is greatly influenced by functional foods. The intestinal microflora represents a rich ecosystem composed of a wide range of microorganisms that play an important role in influencing the health of the host. Some strains have pathogenic effects, whereas others are considered to promote health. There is interest in increasing the number and activity of probiotics in the gut. Foodstuffs provide the principle growth substrates for these colonic bacteria, they influence microfloral composition and thus have a major role in the functional food concept. Probiotic A probiotic is a live bacteria contained in a food (e.g. functional food such as yogurt) or a food supplement which beneficially affects the host by improving its intestinal microbial balance. Today many different microorganisms are added to yogurts for their probiotic potential. These include: a) Lactobacilli, b) Gram positive cocci, and c) Bifidobacteria. The probiotic supplemented should thrive in the gastric environment and remain metabolically active. Probiotics stimulate the growth of beneficial bacteria and inhibit the growth of harmful bacteria. They also stimulate the immune system, help in the absorption of certain ions and the synthesis of vitamins such as B vitamin and folic acid. Prebiotic A prebiotic is a non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of bacteria in the colon that can improve host health. Inulin and oligofructose are described as prebiotics because they are non-digestible and selectively stimulate the growth of potentially health promoting intestinal bacteria. They are present as plant storage carbohydrates in a number of vegetables and plants including wheat, onion, banana, garlic and chicory. Inulin and oligofructose are respectively long chain, and short and medium chains of -D fructans in which fructosyl units are bound by 2-1 glycosidic linkage and thus remain undigested in the small intestine. Prebiotics are often used in combination with probiotics. These combinations have synergistic effects, referred to as symbiotic, because in addition to the prebiotic action they promote the growth of existing strains of beneficial bacteria in the colon. These symbiotic concepts are currently being used by many dairy drink and yogurt manufacturers.