2OutlineIntroductionNutrient Standards (Recommended dietary allowance (RDA))Composition of the bodybody massbody surfaceEnergy expenditureNutritional requirements (Macro/micronutrients)energy from carbohydrate and fatnitrogen balancevitamins for biochemical functionsmineral for physiological and biochemical functions
3Introduction (1) Definition Food: medically, any substance that the body can take in and assimilate that will enable it to stay alive and to grow; the carrier of nourishment; socially, a more limited number of such substances defined as acceptable by each culture.
4Introduction (2) Definition Nutrients: components of food that are indispensable to the body’s functioning. They provide energy, serve as building material, help maintain or repair body parts, and support growth.Nutrients : water, carbohydrate, fat, protein, vitamins, and minerals
5Introduction (3) Definition Nutrition : the study of the nutrients in foods and in the body; sometimes also the study of human behaviors related to food.Diets : the food (including beverages) a person usually eats and drinks.
6Introduction (4) Definition Essential nutrients : the nutrients the body cannot make for itself (or cannot make it fast enough); nutrients that must be obtained from food to prevent deficiencies.Calories : unit of energy (strictly speaking, kilocalories), amount of heat energy necessary to raise temperature of a 1 kg of water 1 degree C.
7Introduction (5) Why study nutrition poor diet, sedentary lifestyle-->risk factor for chronic disease and death
8Introduction (6) Leading causes of death In US (2002): Heart disease (primarily heart attack)CancerStrokeChronic lower respiratory diseasesAccidents (unintentional injuries)DiabetesInfluenza/PneumoniaAlzheimer's diseaseNephritis, nephrotic syndrome, and nephrosis (CVS)Septicemia
9Introduction (7) Nutritious diet: a, b, c, m, v principle: adequacy balancecalories controlmoderationvariety
10Nutrient StandardsNutrient standard from Dietary Reference Intakes (DRIs) committee: 4 dietary reference standards1. Estimated Average Requirement (EAR)2. Recommended Dietary Allowance (RDA)3. Adequate Intake (AI)4. Tolerable Upper Intake Level (UL)
11Estimated Average Requirement (EAR) The intake level estimated to meet the requirement defined by a specified indicator for 50% of people in a specific age and gender group. At this level of intake, the remaining 50% of the group would not have its needs met.
12Recommended Dietary Allowance (RDA) The daily level of dietary intake sufficient to meet the needs of nearly everyone (97-98%) in a specific age and gender group, This list of nutrient allowances published by Food and Nutrition Board of the National Academy of sciences.
13Adequate Intake (AI)AI determined if there is not enough scientific evidence available to calculate an EAR, is based on observed or experimentally determined estimates of what appears to be an adequate intake for each specific age and gender group.
14Tolerable Upper Intake Level (UL) The maximum level of daily intake at which a nutrient is unlikely to pose adverse health risks for most people in a specific group.
15Dietary Reference Intakes (DRI) Reference values that can be used to assess diets for healthy populations. DRIs refer to at least three types of reference values: EAR, RDA and ULEARRDAAIULNo. of peopleNutrient intake
161 1 EAR is the intake at RDA is the intake at which the risk of At the intake abovethe UL, the risk ofadverse effect increaseEAR is the intake atwhich the risk ofinadequacy is 50%RDA is the intake atwhich the risk ofinadequacy is 2-3%AI does not bear a predictable relationshipto the EAR or RDA. AI is based on an estimate ofnutrient intake of healthy people.11EARRDAULRisk of inadequacyAIRisk of adverse effectLevel of nutrient intake
17Daily Reference Value (DRV) Dietary references for macronutrients considered energy-producing sources, including fat, saturated fat, cholesterol, carbohydrate (including fiber), protein, sodium, and potassium. The DRVs are derived from the values listed below, which describe the relative percentage of each macronutrients found in a healthy diet.Fat 30% (30)*of calories/energy intake(saturated fat 7% (10))Carbohydrate 55-60% (60) of calories/energy intakeProtein % (10) of calories/energy intakeFiber 11.5 (12.5) grams per 1000 calories*Thai DRV
18Daily Value (DV)Rough guide for comparing nutrient content of food to app. Human needsusing on food label for children above the age of 4 and adults (Thai = > 6 yrs)based on a 2000-calories dietFood for children under age 2 do not carry information about calories associated with fat , unsaturated fat, polyunsaturated fat, monounsaturated fat and cholesterol because infants’ fat intake should not be restricted. When babies do not take in enough energy-much of it in the form of fat- the result can be failure to thrive.
19Reference Values for Nutrition Labeling (1) (Based on a 2000 Calorie Intake; for Adults and Children 4 or More Years of Age)NUTRIENTS DAILY VALUESTotal Fat (g)Saturated fatty acids (g)Cholesterol (mg)Sodium (mg)Potassium (mg)Total carbohydrate (g)Fiber (g)Protein (g)Vitamin A (IU)Vitamin C (mg)Calcium (mg)
20Reference Values for Nutrition Labeling (2) (Based on a 2000 Calorie Intake; for Adults and Children 4 or More Years of Age)NUTRIENTS DAILY VALUESIron (mg)Vitamin D (IU)Vitamin E (IU)Vitamin K (µg)Thiamin (mg)Riboflavin (mg)Niacin (mg)Vitamin B (mg)Folate (µg)Vitamin B (µg)Biotin (µg)
21Reference Values for Nutrition Labeling (3) (Based on a 2000 Calorie Intake; for Adults and Children 4 or More Years of Age)NUTRIENTS DAILY VALUESPantothenic acid (mg)Phosphorus (mg)Iodine (µg)Magnesium (mg)Zinc (mg)Selenium (µg)Copper (mg)Manganese (mg)Chromium (µg)Molybdenum (µg)Chloride (mg)
29Descriptive terms used on food labels (1) Energy terms:low calorie < 40 calories/ servingreduced calorie at least 25% lower in calories than regular or reference foodcalorie free < 5 calories/ servingFiber terms:high fiber > 5 g/ servinggood source of fiber g/ servingmore or added fiber at least 2.5 g/ serving than reference food
30Descriptive terms used on food labels (2) Fat and cholesterol terms:cholesterol free < 2 mg cholesterol and < 2 g sat. fat/ servingfat free < 0.5 g/ servinglow cholesterol < 20 mg cholesterol and < 2 g sat. fat/ servinglow fat < 3 g fat/ serving
31Descriptive terms used on food labels (3) Other terms:free eg. fat free, sugar free = < 0.5 g/ servinglight ( 3 meanings)1/3 calories or 1/2 fat of regular productlow-calorie, low-fat food with 1/2 Na normally presentlight in color and texture
32Composition of the body Body composition and nutritional storesLean body mass : water and protein content of the bodyFat : energy storeBone : calcium and mineralsvary with factors: age, gender, stage of development, physical fitness, hormonal status, pregnancy28 wks fetus: 88% waternewborn baby: 75% water2-mo baby: 65% water4-mo baby: 60% water
33Estimating body composition Normal composition of a 65 kg man:protein: 11 kg (17%)fat: 9 kg (13.8%)carbohydrate: 1 kg (1.5%)water: 40 kg (61.6%)minerals: 4 kg (6.1%)Physical measurementsheight and weightmuscle mass and body mass: mid-arm circumference and triceps skin-fold thickness-->value > or < 10 %
35Body surface area The Mosteller¹ formula BSA (m²) = ( [Height(cm) x Weight(kg) ]/ 3600 )½ e.g. BSA = SQRT( (cm*kg)/3600 )The DuBois and DuBois² formulaBSA (m²) = x Height(m)0.725 x Weight(kg)0.425The Haycock³ formulaBSA (m²) = x Height(cm) x Weight(kg)0.5378The Gehan and George4 formulaBSA (m²) = x Height(cm) x Weight(kg)The Boyd formula5BSA (m2) = x Height(cm)0.3 x Weight(grams)( ( x LOG(grams) )
36Lean body weightLean Body Weight (men) = (1.10 x Weight(kg)) ( Weight2/(100 x Height(m))2)Lean Body Weight (women) = (1.07 x Weight(kg)) ( Weight2/(100 x Height(m))2)
37Ideal body weightIdeal Body Weight (men) = ( Height (in) - 60 )eg. H = 175 cm; 70 inW should be =73 KgIdeal Body Weight (women) = ( Height (in) - 60 )eg. H = 160 cm; 64 inW should be =54.7 Kg
38Body mass index Body Mass Index = Weight (kg) / Height (m)2 Women Men underweight < <20.7ideal weightmarginally overweightoverweightvery overweight or obese > >31.1
39Energy potential in food Energy expenditure (1)Nutrients and energyProtein4 kcal/gCarbohydrate4 kcal/gAlcohol7 kcal/gLipid9 kcal/gEnergyEnergy potential in food
40Energy expenditure (2)Amount of energy a person expends on daily basis = total energy expenditure (TEE)include :energy expended during physical activitythermic effect of food (thermogenic effect)resting metabolic rate (RMR; minimal energy necessary to sustain body temp, respiration, blood flow etc.; in resting, postabsorptive state)70 kg man: RMR 1800 kcal50 kg woman: RMR 1300 kcal[environmental temp]
41Major components of energy expenditure Fuel used to maintain basic physiological functions10060%% energy expenditureFuel for physical activityFuel to process the food we eat30%10%TEFBasal metabolismPhysical activity
42Factors affect RMR Body composition age fitness sex genetics stage of growthhormone levelsfevernutritional status
43Factors affect RMR Increase RMR Decrease RMR Total body weight large body surface areahot and cold ambient tempfeverhyperthyroidismstresscaffeinesmokingincreased lean body massrapid growthpregnancy and lactationDecrease RMRAgingfemale genderfasting/starvationhypothyroidismsleepGeneticssome medications
44Approx energy expenditure of organ in adults % RMRLiverBrainHeartKidney 7Skeleton muscle (rest) 18Remainder (including bone) 17100
45Measurement of energy expenditure Calorimetrydirect calorimetry : energy use by the body by measuring heat released from organism enclosed in small insulated chamber surrounded by water --> temp of waterindirect calorimetry : measured by gas exchange, oxygen uptake or carbon dioxide output
46Estimating total energy expenditure Harris-Benedict Equationsbased on age, height, weight, and sexadult men: RMR = W + 5.0H - 6.8Aadult women: RMR = W + 1.8H - 4.7ATEE = 10% (RMR + EEPA)TEE = RMR + TEF + EEPAenergy intake = energy output
47Lifetime variation in nutritional requirements Infants: mother’s milk (4 mo) WHO recommends breast feeding for 6 mo: Fe, I may be inadequate1-3 yrs4-10 yrs11-18 yrsadults yrspregnant womenlactating womenadults 50+ yrs
48Nutritional requirements energy from carbohydrate and fatcarbohydrate = 4 kcal/g, fat = 9 kcal/gnitrogen balanceprotein = 4 kcal/gpositive/negative nitrogen balancevitamins for biochemical functionsco-enzymesmineral for physiological and biochemical functionsmacronutrients/micronutrients
49Dietary Carbohydrates Monosaccharide, di-, oligo-, polysaccharidesugar alcohols: abs slowly than sugarsorbitol, manitol, lactitol, xylitol :sweetenercomplex carbohydrate: polysaccharides, dietary fiber or non-starch polysaccharide (plant cell wall)cellulose, pectins, gums, mucilagelignin, cutins and waxesan apple a day keeps the doctor aways
50Dietary fiberSoluble fiber: fibers form a viscous gel when mixed with a liquidpectin, gum, mucilageInsoluble fiber:hemicellulose, lignin
51Actions of dietary fiber Reduces constipation and hemorrhoid formation, soften stoolsIncreases bowel motility, thus reducing exposure of gut to carcinogensDecreases absorption of dietary fat and cholesterol; increases fecal loss of cholesterol(lower LDL cholesterol level)Delays gastric emptying; generates sensation of fullness; reduces postprandial blood glucose concentration
52Foods rich in soluble dietary fiber fruits: apple, cranberries, grapefruit, mango, orangesvegetables: asparagus, broccoli, brussels sprouts, carrotsnuts and seeds: peanuts, pecans, walnutslegumes: most legumesgrains: oat bran, oatmeal, psyllium
53Foods rich in insoluble dietary fiber fruits: apple, banana,berries, cherries, pearsvegetables: broccoli, green peppers, red cabbage, spinachnuts and seeds: almonds, sesame seeds, sunflower seedslegumes: most legumesgrains: brown-rice, whole-wheat breads, wheat-bran cereals
54Dietary carbohydrate and blood glucose Glycemic index: the area under the blood glucose curves seen after ingestion of a meal with carbohydrate-rich food, compared with the area under the blood glucose curves observed after a meal consisting of the same amount of carbohydrate in the form of glucose or white bread.140High glycemic indexBlood glucose (mg/dL)70Low glycemic indexMinutes after ingestion of food
55Clinical importance of Glycemic index Controversialfood with low glycemic index-->create a sense of satiety over a longer period of time, may helpful in limiting caloric intakehigh, moderate, low GIGlycemic index high in sticky rice
56Requirements of carbohydrates RDA 130 g/dThai 300 g; fiber 25 g55-60% of total energy from carbohydratesrecommendation: added sugar > 10% of total energy (Thai RDA; USA 25%)
57Sweeteners Nutritive sweeteners Non-nutritive sweetener natural sweeteners: honey, maple syruprefined sweeteners: mono-, disacch. Extract from plant foods: table sugar (sucrose), glucose, fructosesugar alcoholartificial sweeteners: saccharin ADI = 5 mg/kg (300x sucrose)-bladder cancer, aspartame-ADI = 50 mg/kg, acesulfame-K-ADI = 15 mg/kg (200x sucrose) heat dose not destroyalitame (2000x sucrose): Ala+AspD-tagatose derive from lactoseNon-nutritive sweetenersucralose (SplendaR): made from sucrose (600x sucrose)
59Carbohydrates and health Diabetes militusDental cariescomplex carbohydrates : decrease risk ofobesitytype 2 DMcancer: colonCVS disease--fiber can lower cholesterol levelGI disorders: constipation, hemorrhoid
60Lipids Triacylglycerol: fat and oil 2% of dietary lipids = phospholipidsmall % = sterols : cholesterol, corticol, vit Dsaturated, monounsaturated, polyunsaturated FA-->solid, liquid form in r.t.stearic acid (C-18 sat) in chocolate, meat fatolive oil (C-18 monounsat= oleic acid)soybean oil (C-18 diunsat = linoleic acid)Thai RDA: total fat 65 g, sat fat 20 g, chlesterol 300 mg
61Eicosanoids, omega-3, omega-6 FA Omega-6s: first db begin at 6th carbonlinoleic acid (18:2; ,12) :essential FAlower plasma LDLs and HDLsnuts, avocados, olives, soybeans and various oils: sesame, cottonseed, corn oilOmega-3s: first db begin at 3rd carbonlenolenic acid (18:3; 9,12,15) :essential FAsuppress cardiac arrythmias, reduce serum triglycerideslittle effect on LDL, HDL cholesterol levelsfish oil (docosaheaenoic acid, DHA; eicosapentaenoic acid, EPA)
62Eicosanoids, omega-3, omega-6 FA Source of Omega-6s: seeds, nut, vegetable oilssource of Omega-3s: linseed oil, soybean oil, canola oil, walnutEPA and DHA : fish oil (salmon, mackerel, anchovie, sardine, herring, tuna,)requirement:omega-6: 2% of caloriesomega-3: should be 1.3% of calories
64Eicosanoids, omega-3 FA Eicosapentaenoic acid (20:5, n-3) Fish oils from dietEicosapentaenoic acid (20:5, n-3)cyclooxygenase lipoxygenasePGH3LeukotrienesPGI3 ,PGD3,PGE3TXA3Platelet: weak aggregationEpithelia: strongly inhibit aggregation
65Trans fatty acid COO- COO- Trans FA (hydrogenation of liquid vegetable oil eg. margarinebehave like sat FAelevate serum LDLincrease risk of CHDHHHHTransCis
66Dietary cholesterolFood: highest in brain, high in liver, moderate in meatdairy product : butterfat portion, egg yolk, breast milkdietary cholesterol has little influence on plasma chloesterol
67Fat substitutes Generally: starch, fiber examples: olestra= sucrose polyester, not absorb, may cause symptom of fat malabsorption
68Fat and health Obesity Heart diseases Total cholesterol: <200 mg/dL LDL-cholesterol : < 100 mg/dLHDL-cholesterol : > mg/dLTriglyceride : < 150 mg/dL
69Fat and supplements EPA, DHA in fish oil capsule Lecithin (mixture of phospholipid)CLA (conjugated linoleic acid): linoleic acid with only one saturated bond b/w its two double bondsDHEA (dihydroepiandrosterone) : antiaging
75Protein quality (3) gelatin lack of Trp soybean protein (less Cys) = complete proteincomplementary protein :pasta low in Lys; high in Met & Cyskidney bean low in Met & Cys; high in Lys
76Protein and amino acids as additives and supplements Gelatin added to yogurt, fillingCasein added to frozen dessert toppingMSG : flavor enhancerLys for cold soreTrp for pain relieve-->reason?
77Protein and Health Malnutrition Kwashiorkor : protein deficiency Stunted growth, edema, skin lesions, depigmented hair, anorexia, enlarged fatty liver, decreased plasma albuminMarasmus : protein and energy deficiency
79Protein and Health Excess dietary protein kidney function protein from animal (rich in S-containing amino acid, acidic) tend to draw Ca out of body, increase of urinary Ca increase risk of nephrolithiasis and osteoporosisobesity, heart diseasecancer (colon, breast, prostate, pancreas)
80ReferencesChampe PC, Harvey RA, and Ferrier DR. Lippincott’s Illustrated review: Biochemistry, Lippincott Williams &Wilkins, Philadelphia, 2005, ppMayer PA, Nutrition in Harper’s Biochemistry, 24th ed., Prentice Hall, New Jersey,1996, ppInsel P, Turner RE, and Ross D, Nutrition, Jone and Bartlett Publishers, Boston, 2002.ประกาศกระทรวงสาธารณสุข (ฉบับที่ 182 ) พ.ศ เรื่อง ฉลาก โภชนาการ