NUTRITION & GROWTH 1

Dr Lailan Safina, M.Si.Med

NUTRITION
Al-Ghidza (Arabic): food
Important at every stage of the life span As the indicator of health status to maintain the optimal quality of life

Adequate Diet
is composed of various nutrients that the body needs for: - maintenance - repairs - living processes - growth / development

Characteristics of a healthy diet

Variety + Balance + Moderation

 Variety no single food supplies all the nutrients needed Balance a balance diet incorporates appropriates amounts of foods from all food groups, providing needed calories and nutrients Moderation careful selection of foods and beverages to control the intake of excess calories, salt, sugar, fats/cholesterol

4 sehat 5 sempurna
Makanan 4 sehat terdiri dari: 1. Makanan pokok (staple food): karbohidrat 2. Lauk pauk: protein hewani dan nabati 3. Sayuran 4. Buah-buahan sayuran dan buah merupakan sumber vitamin dan mineral utama 5 sempurna: susu

BODY MASS INDEX (Adults)

BMI = Body Weight (kg) / Height 2 (m)2 BMI (Kg/m2) Underweight Normoweight Overweight Obes I < 18,5
18,5 22,9

23 24,9 25 29,9

Obes II

> 30

Malnutrition
1. Undernutrition Severe undernutrition, particularly in infants & young children high mortality rates Decreases in growth Deficits in physical and mental development In adults: compromises health, endurance, productivity and increases susceptibility to infection

2.Overnutrition
Obesity 3 leading causes of death in adults in North America: hearth disease, Ca, stroke Sedentary lifestyle, eating out big portion, high fat and salt.

Nutrient needs
Nutrients: substances that are essential for growth and good health > 40 nutrients Essential : it cannot be synthesized by the organism in sufficient quantities and must be obtained from external source Types of nutrient: - macronutrient: nutrients needed in large quantities (carbohydrate, protein, lipid) - micronutrient: nutrients needed in relatively small quantities (vitamin, mineral, water)

Nutrient needs
1. Energy 2. Carbohydrate 3. Protein 4. Lipid 5. Vitamin 6. Mineral 7. Water

 Influences on Nutrient needs: - age - gender - reproductive status - environment - lifestyle habits - presence of disease

 3 general functions of nutrients: - providing energy (energetic food): carbohydrate, protein, lipid - forming structural components of the body (building food): protein, mineral, water - regulating body functions (regulatory food): protein, mineral, water.

Energy
The energy obtained from food is measured in kilocalories or kilojoules 1 kcal = 4,184 kJ (4,2 kJ) - carbohydrate : 4 kcal/g (17 kJ/g) - protein : 4 kcal/g (17 kJ/g) - fat : 9 kcal/g (37 kJ/g) Average calories intake: - male : 2000 kcal/day - female : 1600 kcal/day

 Carbohydrate, protein, fat : provide energy to perform body functions Alcohol, which supplies 7 kcal/g, is not considered as a nutrient because it has no required function in the body. Vitamin, mineral, water : do not provide energy but performing body functions.

Pedoman Umum Gizi Seimbang (PUGS) Energy needs 60-75% carbohydrate 10-15% protein 10-25% fats

Calculation of energy in foods / diet

1 slice of toast with butter and strawberry jam, contains: 3 g protein, 7 g fat, 26 g carbohydrate. How much energy does it provide? - 3 g protein = 3x4 kcal = 12 kcal - 7 g fat = 7x9 kcal = 63 kcal - 26 g CHO = 26x4 kcal = 104 kcal Total = 179 kcal or 752 kJ

Energy Balance
If energy intake > energy expenditure = weight gain If energy expenditure > energy intake = weight loss

Classification of Carbohydrate
Simple Carbohydrates 1. Monosaccharides (sugar): C6(H2O)6 dan C5(H2O)5 glucose, fructose, galactose 2. Disaccharides: C12(H2O)11 sucrose, maltose, lactose 3. Sugar alcohols 4. Oligosaccharides Complex Carbohydrates 1. Polysaccharides : - starch (plant) cereal grains: wheat,rice, corn, oat, potatoes - glycogen (animal/human) 2. Polysaccharide non-starch : cellulose, fiber

Sources of carbohydrate
Simple carbohydrate
Table sugar Cakes Biscuits-plain Jam Chocolate Candy Gums / sweets Honey Soft drinks Tinned fruits

Complex carbohydrate
Pasta Macaroni Spaghetti Brown rice Potatoes Other root vegetables Wholemeal breads Wholegrain cereal All bran Cassava Corn Peas Beans lentils

CHO Function
1. Source of energy CHO contribute the largest proportion to daily caloric energy consumption: 50-75% The minimal amount of carbohydrate required, either from endogenous or exogenous sources, is determined by the brains requirement for glucose. The brain is the only carbohydrate-dependent organ, normally requires glucose exclusively for its energy need 2. Energy Reserve - liver glycogen - muscle glycogen 3. Sweetness

Daya kemanisan gula dan pemanis buatan

Jenis gula/ pemanis Daya kemanisan (sukrosa=1,0) Sumber/penggunaan Konsumsi yang dianggap aman Gula Fruktosa Sukrosa Glukosa Maltosa Laktosa Gula alkohol Manitol Sorbitol xylitol Pemanis buatan Sakarin Siklamat

1,7 1,0 0,7 0,4 0,2 0,7 0,6 0,9

Buah, madu, minuman ringan Gula pasir, gula merah, permen Sirup jagung Biji berkecambah Susu dan produknya Permen khusus untuk diet Permen khusus untuk diet Permen karet tanpa gula

500 80

aspartam

200

Minuman ringan diet Minuman ringan diet, permen karet tanpa gula, pemanis khusus diet, makanan/minuman jajanan Permen karet tanpa gula, minuman diet, pemanis diet

50-300 mg/kg BB 11 mg/kg BB

40 mg/kg Bb

4. Prevent glukoneogenesis CHO is needed to protect protein from being used as energy source 5. Anti Ketogenic - In the event of insufficient supply of glucose, the brain utilizes ketoacids for part of its energy requirements - In response, the liver increases production of ketoacids. This occurs after the glycogen store of the starving person is depleted. - FAO/WHO : the amount of CHO required to avoid ketosis is 50 g/day in adults 6. Increase fecal bulk

Fiber
variety component sample Physiologies effect
Not digest Non CHO CHO Lignin cellulosa Hemicellulosa Wheat bran Wheat products Brown Rice bulk feses, effect estrogen-like bulk feses increase intestinal transit time

Digest

CHO

Pektin, gum, mucilago, some of hemiselulosa

Apel, banana, orange, carrot, barley, oats, red bean

Decreased gastric emptying; Decreased glucose absorption; decreased blood cholesterol

Fiber product energy 0,5-3 kcal/g

Physiologic effect of dietary fiber

Stimulating chewing, saliva flow, gastric juice secretion Fills the stomach and provides a sense of satiety Increase fecal bulk Normalizes intestinal transit time Become a substrate for colonic fermentation Delay gastric emptying Slows the rate of digestion and absorption Lower serum cholesterol

Glicemic Index
A numerical index that ranks CHO based on their rate of glycemic response (i.e their conversion to glucose within the human body) Scale 0 100, with higher values given to foods that cause the most rapid rise in blood sugar A reference point: pure glucose (GI = 100)

Glycemic Indexes
Reference: glucose=100 Low < 55 - High > 70

Pasta
Red rice Rice Spaghetti 55 56-72 41 49 55 85 62 73 65 23 46

Fruit
Apple Banana Lemon orange 38 55 25 44

Fruit
Boiling carrot Sweet corn Bake potatoes Boiling potatoes Madu Sucrose Fructose Lactose

Soft drink
Apple juice Orange juice Coca cola 40 46 63
54 77 49 80

Sugar

Snack
Potato chips Wafer vanila Chocolate Jelly

Composition C (50-55%), H (6-7,3%), O (19-24%), N (13-19%), S(0-4%)P, Fe dan Co Dietary protein is usually measured not as protein but as nitrogen 6,25 gr protein content 1 gram of nitrogen Total Protein = 6,25 x total N in food

CLASSIFICATION OF AMINO ACID

ESSENTIAL AA histidine, leucine, isoleucine, valine, tryptophan, phenilalanine, methionine, threonine, lysine

CONDITIONALLY AA proline, serin, tirosin, cystein, taurin, glycin NON ESSENTIALE AA glutamate, alanin, aspartat, dan glutamin

Classification AA based on Structure

Alifatic :Glysine, Serine, Treonine, Alanine, Valine, Leusine, Isoleusine Aromatic: Phenilalanine, Tyrosine Content sulfur : cystein, Cystin, Methionin

Heterosiclic: Tryphtofan, Proline, Hidroksi Prolin, 3 Hidroksi proline

The importance of protein & amino acids

Catalyzes virtually all chemical reactions in the body Regulate gene expression Comprise the major structural elements of all cells Regulate the immune system Form the major constituent of muscle Individual AA also serve as neurotransmitters, hormones and modulators of various physiological processes

Nutritional quality of food proteins

Depends on 2 factors: The content of essential amino acids The digestibility of the protein Complete protein contain all essential AA in a good proportion needed for growth animal protein Incomplete protein contain no/not all essential AA vegetable protein, except soybean

Net Protein Utilization (NPU)

A measure of quality protein based on the percentage of ingested nitrogen that is retained in the body
N in food (N urin + feces) NPU = N in food

Bahan Makanan
Telur Susu sapi Daging sapi Beras tumbuk Kacang tanah Beras giling Gandum utuh Jagung Kacang kedelai Biji-bijian

NPU
94 82 67 59 55 57 49 36 61 53

Nitrogen Balance
Nitrogen Balance = N consumed N loss
(urine, feces, sweat, hair/skin loss)

Nitrogen Balance if N consumed = N lost no growth, adult people Nitrogen Balance Positif if N consumed > N loss infant, children, teenager, pregnant, lactating Nitrogen Balance Negative if N loss > N consumed disease, post-op

Protein sources
1. Animal protein: Egg and product Meat Poultry Fish Milk and dan product 2. Vegetable protein: Beans: soybean and products (tahu, tempe, kecap) Nuts Whole grains

DIGESTION OF PROTEIN
Gaster :hidrocloride acid and pepsin degradation protein peptide Small intestinum: chimotripsin and peptidase pancreas breakdown polipeptide amino acid , for absorption

General signs of protein deficiency

Underweight Stunting Poor musculature Edema Fragile hair Skin lesions Biochemical changes including low serum albumin Hormonal imbalances

LIPID
25-35% of total energy 9 kcal/gram of energy Dietary fat is stored in adipose cells located in depots on human frame Survive w/o food for weeks months

insufficient fat starvation--malnutrition

Adipocytes

48

Classes of lipids
Triacylglycerols (triglycerides) Glycolipids Phospholipids Sphingolipids Sterol esters

 Triacylglycerols (triglycerides/TG) - fats and oils in foods are made of TGs (98%+) - each molecule of TG contains 3 FA + glycerol - TGs serve as reserve of energy stored in adipose (fat) tissue in animals and in seeds of plants

Glycolipids - FAs combined with sugars - Associated with cell surfaces

Phospholipids - FAs combined with glycerol & phosphorus - Important structural component in cells - Supply FA precursors for the synthesis of eicosanoids which are potent controllers of many physiological processes

Sphingolipids - FAs combined with long-chain amines - Important components of brain tissues & CNS Sterol esters - Sterols combined with FAs - Structural role in cell membranes - Precursors of steroid hormones & vit D

Fatty Acid
FA = straight chains hydrocarbons possessing a carboxyl (COOH) group at one end and methyl (CH3) at the other end

The length of chains: - Short-chain FA: 6C or less - Middle-chain FA: 8C 12C - Long-chain FA: 14C 18C - Very long-chain FA: 20C or more

Saturated Level of FA
Saturated FA: single bonds between C atoms Unsaturated FA: double bonds between C atoms - monounsaturated FA - polyunsaturated FA Generally, at room temperature - saturated FAs are hard - unsaturated FAs are oils

The greater the degree of unsaturation in FA the more vulnerable it is to lipid peroxidation protected by antioxidants

 Unsaturated FAs: - lowering LDL cholesterol - reducing the coagulability of blood platelets - reducing the risk of heart disease

Types and sources of dietary fats

Saturated Coconut oil Monounsaturated Polyunsaturated Olive oil Corn oil

Palm kernel oil

Beef / pork fat Chicken skin

Canola oil
Peanut oil

Soybean oil
Sunflower oil Safflower oil

Cocoa butter
Milk fat & products

Fish oil

Essential FA
FA that cannot be constructed within an organism (humans), therefore must be obtain from the diet Two families of EFA: - linoleic acid (18:2 -6) - linolenic acid (18:3 -3) Derivatives of EFA which is important: - arachidonic acid (20:4 -6) - eicosapentaenoic acid/EPA (20:5 -3) - docosahexaenoic acid/DHA (22:6 -3)

 EFAs are needed especially for foetal growth and infant synthesis of structural component in cells. Almost 50% of brains component lipid 50% : polyunsaturated FA Breast milk polyunsaturated FA >> (arachidonic acid & DHA)

 EFAs are precursor for eicosanoid group: prostaglandin, prostacyclin, tromboxane, leukotrien blood pressure, heart beat, immunity, nervous system, muscle contractility, wound healing

Formation of Arachidonate in Mammals

CO2H

Linoleic acid

As CoA ester: 1) Elongation 2) Desaturation x 2

8 5

14

11

CO2H

Arachidonic acid (20:45, 8, 11, 14) (Eicosa-5,-8,11,14-tetraenoic acid)

Prostaglandins

61

Omega-3 Fatty Acids

CO2H

-3 double bond

Eicosapentaenoic acid (20:55, 8, 11, 14, 17)

CO2H

Docahexaenoic acid (22:64, 7, 10, 13, 16, 19) Found in fish oils, esp. cold water fish Important in: Growth regulation Modulation of inflammation Platelet activation Lipoprotein metabolism
62

Manifestation of essential fatty acid deficiency

Flaky, itchy skin Diarrhea Infections Growth retardation Poor wound healing anemia

Trans Fatty Acids

Found in animal and plant foods Originally unsaturated the good ones which are changed to bad ones (saturated fat) through chemical changes including hydrogenation of oils Recent research suggests that trans FAs can increase the risk for heart disease The American Heart Association: limitation the amount of trans FAs & saturated FAs to less than 10% of total calories consumed daily

Food sources of trans fat

Trans FAs are formed when vegetable oils are partially hydrogenated to make them solid at room temperature Trans FAs are found in commercially baked cookies and cakes, salty snack foods such as chips, some margarines and commercially fried foods Meats and dairy products (from naturally occuring chemical changes in the animals body as it digests food)

Cholesterol
Cholesterol in food comes from animal sources only Cholesterol is also produced in our bodies Limit our dietary intake to no more than 300 mg/day Sources: - meat, poultry, shell fish, egg yolks - whole milk & dairy products: butter, cheese, ice cream

Functions of Lipids
Concentrated energy (diet and storage) Provides essential FAs Insulation for body Padding around organs Transport fat-soluble vitamins: A,D,E,K Contribute to satiety Flavor and mouth feel of foods Present in cell membranes

Risk of excess fat intake: obesity

Some cancers atherosclerosis Stroke & heart attack

OBESITY

hypertension

Gallbladder disease

diabetes

Health claims on food labels

Fat free : less than 0,5 g/serving and less than 0,5 g trans FAs Low fat : 3 g or less of total fat Reduced or Less Fat : at least 25% less than the original product Saturated Fat Free : less than 0,5 g/serving and less than 0,5 g trans FAs Low Saturated Fat : 1 gr or less/serving and not more than 15% calories from saturated FAs Cholesterol Free : less than 2 mg/serving Cholesterol Low : 20 mg/serving