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NUTRITION & DISEASE
Dr M N Rama KrishnaB.Sc.,M.B.B.S, M.D, A.F.I.H
Dy. Chief Medical Officer (Corp.)Main HospitalKOTHAGUDEM
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A. By Origin 1. Vegetable
2. Animal
B. By Chemical Composition 1. Proteins2. Fats3. Carbohydrates4. Vitamins5. Minerals
C. By Predominant Function
1. Body Building Foods i. Milkii. Meatiii. Poultryiv. Fishv. Eggsvi. Pulses.vii. Groundnuts
CLASSIFICATION OF FOODS
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2.Energy Giving Foods
i. Cerealsii. Sugarsiii. Roots & Tubersiv. Fatsv. Oils
3. Protective Foodsi. Vegetablesii. Fruitsiii. Milk
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PROTEINS
Proteins constitute 20 % of Body weight in an adult
Proteins are made up of amino-acids ( About 24)
Out of 24 Amino- acids 9 are Essential Amino - Acids
1. Isoleucine 6. Threonine2. Leucine 7. Valine3. Lysine 8. Histidine4. Methionine 9. Tryptophan5. Phenylalanine
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Functions of Proteins
Body BuildingRepair & Maintenance of Body TissuesMaintenance of Osmotic PressureSynthesis of Anti-bodies, Plasma Proteins, Hb, Enzymes, Hormones &Coagulation Factors.Immune Mechanism of the BodyEnergy
SOURCES OF PROTEIN
Animal Sources MilkMeatEgg (Called as Reference Protein)CheeseFish
Vegetable Sources Pulses( Poor in EAA) Cereals
BeansNutsOil Seed Cakes etc
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Features Marasmus KwashiorkorClinical Always Present
Muscle Wasting Obvious Sometimes hidden by oedemaand fat
Fat Wasting Severe loss of Fat often retained but notsubcutaneous fat firm
Oedema None Present in lower legs, andusually in face and lowerarms
Weight for height Very low Low but may be masked byoedema
Mental Changes Sometimes quiet Irritable, moaning, apatheticand apathetic
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Features Marasmus Kwashiorkor
Clinical SOME TIMES PRESENT
Appetite Usually good Poor
Diarrhoea Often Often( Current and past ( Current and past)
Skin Changes Usually none Diffuse pigmentation,sometimes flaky paintdermatosis
Hair changes Seldom Sparse, Silky, easilypulled pulled out
Hepatic enlargement None Sometimes, due toaccumulation of fat
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KWASHIORKAR
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MARASMUS & ANG. STOMATITIS
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FATSFats & Oils are concentrated sources of energy
Human body can synthesize Triglycerides and Cholesterol
Other fats are called Essential Fatty Acids
Fats yield Fatty Acids : SaturatedUn Saturated
Essential Fatty Acids :Linoleic Acid Saffola Oil
Sunflower OilSoya Bean OilMustard Oil
Groundnut Oil
Linolenic Acid Soya BeanGreen leafy Vegetables
Arachidonic Acid MeatEggsMilk
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SOURCES OF FATS
Animal Fats GheeButterMilkCheeseEggsMeat
FishVegetable Fats Ground NutMustardCoconutSun FlowerSoya Bean etc .
Other Sources Cereals(Invisible Fats) Pulses
NutsVegetables
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Functions ofFats
High Energy FoodsServe as vehicle for fat-soluble vitaminsSupport viscera like heart, kidney, Intestines
etc.,Fat under skin provide insulation against coldGives taste to food
Gives shape to body
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Fats & DiseaseObesity
Phrenoderma ( due to deficiency of EFA)
CAD
Cancer Diets high in Fat increases risk
of cancer colon & Breast.
Fat Requirement :
20-30 % of daily total energy requirement should be from fats. 50 % of
fat should be from vegetable source.
20 gms / day is the daily requirement of added oil.
Energy :Fat Yields 9 K.cals / gm
CARBOHYDRATES
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CARBOHYDRATESMaximum source of energy
Essential for oxidation of Fats and synthesis of certain Amino-acids
Three main components of carbohydrates1.Starch Cereals
TubersRoots
2.Sugars Glucose, Lactose etc3.Cellulose Indigestible component
Dietary Fiber : It is non-starch, component of diet.
Sources : VegetablesFruitsGrains
Functions : Prevents constipation,Lowers Bl.Sugar
Reduces CholesterolWeight reductionPrevents Divertculosis & Cancer of Colon
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VITAMINSVitamins help the body to use other nutrients. They
are organic components and essential nutrients
1. Fat Soluble : ADE
K2.Water Soluble: B Complex
(Thiamine B1Riboflavin B2
Pyridoxine B6Cobalamine B12Niacin (Nicotinic Acid)Biotin
Folic Acid)C Vitamin
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VITAMIN A ( RETINOL & B -CAROTINE)
Source : Milk, Butter, cheese, Egg Yolk, Liver, Fatty Fish,
Meat, Amaranth, Spinach, Papaya, Mango, Pumpkin & Carrot(Cheapest sources)
Functions : * For Normal Vision* For retinal Pigments in dim vision.* To maintain integrity of epithelial and glandular tissue.* Supports skeletal growth* Acts as anti- infective* Protect against Epithelial cancers & Lung cancers
Vitamin A Deficiency causes :
- Night Blindness- Xerosis of Conjunctiva & Cornea- Bitot Spots- Keratomalasia ( Liquifaction of cornea)- Follicular Keratitis
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BITOTS SPOTS & GLOSSITIS
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Vitamin A Excess (Toxicity )
Mild - Dry Scaly skin
- Hair Loss- Mouth Sores- Anorexia- Vomiting
Severe - Papilloedema- Headache- Hepato-megaly- Cirrhosis of Liver
Prevention : Vit A liquid 2 lakh I.U. Every 6 months to children from1 yr to 5 yrs.
Vitamin D
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Vitamin D(Chole-calciferol)
(Kidney Hormone )
Sources : SunlightFatty FishFish Liver OilsButterEggs
Not Available in Vegetarian Food
Functions :
- Promotes intestinal absorption of calciumand phosphorus
- Enhances bone resorption and affectscollagen maturation.
- Increases tubular re-absorption of Phosphate.- Permits normal growth
VITAMIN D
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VITAMIN D
Deficiency : leads to
1. Rickets : - Usually observed in young childrenbetween 6 months to 2 yrs.- Reduced calcification of growing bones- Growth failure- Bone deformity ( curved legs, deformed
pelvis, pigeon chest, Harrisons sulcus, Kypho-scoliosis).
- Muscular Hypotonea- Tetany & convulsions
2. Osteomalacia : Softening of the bone
Requirement : 2.5 mcq ( 100 iu)/day ( Adults)5 mcq ( 200 iu)/day ( Infants & Children)
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RICKETS
VITAMIN K
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VITAMIN K Sources : - Dark green leafy vegetables
- Cows Milk- Fruits- Synthesized in colon by bacteria
Function : Stimulate the production of certain coagulationfactor.
Deficiency : Decreases Prothrombin content of blood and
clotting mechanism is delayed.
* Deficiency occurs usually in Obstructive jaundice, mal-absorption and also in prolonged oral antibiotic usage
WATER SOLUBLE VITAMINS
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WATER SOLUBLE VITAMINSVitamin C ( Ascorbic Acid )
Sources : - Amla- Guava- Citrus fruits- Berrys- Green leafy vegetables
Vit C is very easily destroyed by heat .
Functions : - Required for tissue oxidation
- Formation of collagen- Facilitates absorption of iron- Wound healing
VITAMIN E (Tocopherol)
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VITAMIN E (Tocopherol) Sources :
Vegetable OilsWhole grain cerealsFatty FishEgg YolkButter
Deficiency: Cystic FibrosisAtaxiaVisual scotomas
Vit E : Plays a role in Protection against
CancerCADCataract
WATER SOLUBLE VITAMINS
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WATER SOLUBLE VITAMINSVITAMIN C
Deficiency : Causes Scurvey
Early Stages - Peri follicular hemorrhages- Petiche & Purpura- Splincter haemorrhages- Bleeding gums- Sub- periosteal haemorrhages- Joint Haemorrhages
- Anaemia- G.I Bleeding
Late Stages - Edema- Oligurea- Neuropathy- Intra cerebral haemorrhage- Death
Certain conditions like Trauma, Surgery, Burns, Infections, Smoking, usage of Cortisones, Aspirin, Indomethacin, Tetracyclines etc. increase demand of VitC
Daily requirement is 60 mg.
THIAMIN (B1)
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THIAMIN (B1)Sources :
- Germinating cereals & Yeast- Legumes- Green leafy vegetables- roots
- Fruits- Nuts- Pork, Meat & Fish- Liver
Not found in Oils & Fats .Lost if cooked with excess water
Destroyed if baking soda is added
Deficiency (B1)
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y ( )Beri Beri :
Early Stage ( Dry Beri Beri)
Wasting of musclesAnorexiaHeavy-ness and weakness of legsPalpitationTingling & NumbnessCalf muscle tenderness
Late Stages ( Wet Beri Beri ) : EdemaPalpitationsHeart enlargementHeart failure
Wernicks Encephalopathy : Usually seen in AlcoholicsPatient in confusion stateNystagmusBilateral Symmetrical OphthalmoplegiaAtaxiaStuper & Death
Korsakoff Psychosis : Loss of memoryDisorientationPolyneuropathy
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RIBOFLAVIN (B2 )Sources :
Liver, Kidney, Milk, Meat, Cheese, Eggs (Good sources)
Green Leafy Vegetables : ( moderate Sources)
Deficiency : Angular stomatitisCheilosisScrotal dermatitisAnaemia
Pyridoxine (B 6)
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Sources : Liver, whole grain cereals, peanuts, bananas, milk, egg, fish,vegetables, cereals.
Deficiency: - Peripheral Neuropathy- Dermatitis- Glossitis- Angular stomatitis
Cyanocobalamine ( B12)
Sources : - Liver- Kidney- Meat- Fish- Eggs
- Milk- Cheese
Not found in Vegetables. It is synthesized in colon by Bacteria
Deficiency:
- Anemia (Megaloblastic or Pernicious)- De-myelinating lesion of spinal cord
NIACIN ( Nicotinic Acid)Sources :
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Sources :- Meat- Liver- Fish
- Cereals- Pulses- Legumes- Groundnuts
A cup of good coffee provides good amount of Niacin
Deficiency : Leads to Pellagra
Pellagra : It is characterised by 3 D s - Diarrhoea- Dermatitis- Dementia ( Depression , Irritability,Delirium)
and -Glossitis & Stomatitis
Seen in Telengana in Jowar eating Population
FOLIC ACID
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Sources : LiverMeat
Dairy ProductsEggMilkFruits
CerealsLeafy vegetables
Deficiency :AnemiaGlossitisDiarrhoea, Distension & Flatulence
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MINERALSMore than 50 chemical elements are found in the body
which are required for growth, repair and regulation of vitalbody functions . Most important are:
* CALCIUM* PHOSPHOROUS* SODIUM* POTASSIUM
* IRON* FLUORINE* IODINE
CALCIUM
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CALCIUMAdult body contains 1200 gms. of calcium (98% in bones)
SOURCES :* Milk & Milk products* Eggs* Fish* Green leafy vegetables
* Cereals & Millets* Drinking water
FUNCTIONS :*Formation of Bones & Teeth*Coagulation of Blood*Contraction of Muscles*Cardiac Action*Milk Production*Relay of Electrical & Chemical messages
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PHOSPHORUS
Essential for formation of Bones & Teeth
Sources : All Vegetables
Deficiency : Rarely occurs
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SODIUM
Adult Human Body contains 100 gms. of Sodiumion
Sodium is lost through Urine & Sweat
Depletion of Sodium causes Muscular cramps
Excess causes HTN & CHD
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POTASSIUM
Human body contains about 250 gms. ofpotassium
Sources : All vegetables & fruits
Deficiency : Rarely occurs
IRON
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Sources : LiverMeatPoultryFishCerealsGreen leafy vegetableLegumes
NutsOil seedsJagggeryDry fruits
Functions : Formation of HemoglobinBrain development & functionRegulation of body temperatureMuscle activity
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Essential : For Immune systemBinding oxygen to blood cellsOxygen transport & cell respiration
Deficiency : AnaemiaImpaired ImmunityReduced resistance to infectionsDiminished work performance
IODINE
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Required for synthesis of Thyroid hormones
Sources : Sea foodMilkMeatVegetablesCereals
WaterDeficiency : Goiter
HypothyroidismDecreased IntelligenceMental deficiencyHearing defectsSpeech defectsSquintNeuro-muscular weaknessCretinismIntra-uterine death
FLUORINE
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FLUORINE
Essential for normal mineralisation of Bones & DentalEnamel
Sources : Drinking waterSea fishCheeseTea
Deficiency : Dental Caries
Excess : Skeletal & Dental Fluorosis
NUTRITIONAL FACTORS IN SELECTED DISEASES
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Cardiovascular Diseases A). Cholesterol :
LDL : Coronary Heart DiseaseHDL: Protects Heart
B). Essential Fatty Acids :
Linoleic acid & Arachidonic acid (PUFA)inhibit platelet aggregation & thrombusformation.
C). Triglycerides : Increase risk of CHD.
D). Carbohydrates :CHD rates are lowest in people eating highcarbohydrate diets.
E). Salt: Low Sodium diets prevent HTN & CHD
N i i l f i S l d Di
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Nutritional factors in Selected Diseases
DIABETES
Deficiency of Trace Elements such as Chromium ,Copper , Zinc may play role in DM
Excess consumption of Alcohol can damage Pancreas& Liver & promotes Obesity & thus increase risk ofDiabetes .
N t iti l f t i S l t d Di
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Nutritional factors in Selected Diseases
OBESITY
The basic cause of Obesity is
OVER-NUTRITION
N t iti l f t i S l t d Di
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Nutritional factors in Selected Diseases
CANCER
A). High Fat Intake : Cancer ColonCancer Breast
B). Low Dietary fiber : Cancer ColonC). Deficiency of Vit. A & C : Cancer Lung &
StomachD). Food Additives:
Preservatives : Cancer StomachCoffee : Cancer Bladder &
PancreasE). Alcohol : Cancer Liver
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Thank You
All Good Wishes To You
and