CONCEPT MAP

Mr.B 19 YO Men

Physical activity

: Food Intake

Imbalanced Diet

Eat two meals a day

Lunch not varied

Structure ,function ,
source defficiencies

Macronutrient

Micronutrient

Vitamin

Protein

Carbohydrates

Lipid

Polypeptide

Polysaccharides

Triglycerides

Disaccharides

Glycerol + Fatty acid

Dipeptide

Mineral

Digestive System in GI
Tract

Peptide

Amino acid

Monosaccharides

Pyruvic Acid
Hierarchy of Molecules

Acetyl Co A

Catabolism

ATP

Water

Digested in GI
Tract

Lack of Energy

Gluconeogenesys

Fatigue

Decreased

Treatment

CASE REVIEW
Mr. B, 19 YO Men

CC: Easy Feels

Fatigue

HT/ ANAMNESYS
CC: The last one month
This complaint is
frequently occured after
doing activity
Feels better after taking
tea with sugar
His trousers loosely fit
A warehouse employee
Had two meals a day
Had not enought time to
breakfast
Rare having snack
Composition his lunch is
not varied
Very rare eats vegetables
and fruits

PHYSICAL EXAM
Blood pressure, pulse
rate, respiratory rate,
and temperature in
normal limit
Weight: 55kg
Height: 158cm

Diagnose: Lack of nutrient (Imbalance diet)

Treatment
Advised him to have
balanced diet
Gave him supplement of
vitamins and minerals
Proper exercise

Prognosis
Ad vitam: ad bonam
Ad functionam: ad bonam

LAB EXAMINATION

IMBALANCE DIET
1. Balance diet
2. Explain the contents of balance diet
a. Macronutrient: Carbohydrate, lipid, and protein
b. Micronutrient: Vitamin, mineral, and water
3. Explain source and the principle of structure carbohydrate, lipid, and protein
4. Explain source, the principle stucture, classification, and function of micronutrient
5. The concept hierarchy of biomolecule
a. Macromolecule
b. Micromolecule
c. Elements
6. The general principle of macromolecule metabolism in GI track
7. Metabolism micromolecule in the cell until Acetyl CoA
8. Summarize the functional aspect of carbohydrate, lipid and protein
9. BHP and PHOP

BASIC SCIENCE
Balance Diet
Definition: Getting the right types and amounts of foods and drinks to supply nutrition and
energy for maintaining body cells, tissues, and organs for supporting normal growth and
development.
Function: Provides enough energy and nutrition for optiomal growth and development.
Principle:
a) Adequacy : diet provides sufficient energy & enough of all the nutrients to meet the
needs of healthy people
b) Balance : the diet involved consuming enough not too much of each type of food
c) Calory (energy) control : designing an adequate diet without overeating requires
careful planning
d) Nutrition deficiency : select food that deliver the most nutrient for the least food
energy
Recommendation for underweight:
a) Cause:
- Genetic tendencies
- Hunger, appetite, and irregularities
- Metabolic factors
b) Recommendations:
- Energy dense food : choose the highest kCalorie items from each food group,
but dont choose high-fat food.
- Regular melas daily : eat at least three healthy meals everyday.
- Large portions : eat more foods at each meal
- Extra snacks : eat more frequently
- Juice and milk
- Exercising to build muscles
Adequate intake:
a) Macronutrient
- Carbohydrate : Adults: 45-60% calories from carbohydrate
- Lipid : Adults: 20-35 % calories from fat
- Protein : Adults: 10-35% calories from protein
b) Micronutrient
- Mineral

Vitamin
water soluble

fat soluble

*RAE = Retinal Activity Equivalent

Contents of balance diet

Macronutrient
a) Carbohydrate
- Definition
Compound compose of C,H,O, arrange as monosaccharides/multiple monosaccharide.
-

Classification
1. Monosaccharides :Glucose = blood sugar
Fructose = fruit sugar, sweetest sugar

Galactose = part of lactose

2. Disaccharides
:part of monosaccharides linked together
Maltose glucose + glucose
Sucroseglucose + fructose
Lactoseglucose + galactose
3. Oligosaccharides:composed of 3-10 monosaccharides
4. Polisacccharides :compound composed of many monosaccharides linked together.
a. Glycogen :source from meat, storage in liver/muscle cell.
b. Starch : source from plant, kind = amylose (1 chain), amylopectine (have branch)
c. Fiber : found in all plant delived food, whole grain, legumen
-

Sources
primary food (whole, corn, rice, cassava, potato, etc), honey, fruits, vegetables.
Function
1. Main energy source of the body (4kKal/gr)
2. Act as bio fuel
3. As storage food
a. Polysaccharides starch storage food for plants
b. Glycogen storage in liver and muscle, as storage food for animals
c. Inulin storage food of dahlias, onion, and garlic
4. Maintain the cell wall
5. Anticoagulant heparin (polysaccharides)

Role In The Body

1. Using Glucose for energy
2. Making Glucose from Protein
3. Making Ketone Bodies from Fat Fragments
4. Using glucose to make fat

Deficiency
1. Lack of energy
2. Brain stop producing cerotonyn
3. Ketosis

b) Lipid
-

Definition:
Compunds composed primarily of C, H, and O atoms, characterized by insolubility in
water (anti-water) and solubility in ether & alcohol.
Structure:
1. Composed of C, H, and O
2. Organic acida chain of carbon atoms with hydrogens attachedthat has an
acid group(COOH) at one end and a methyl group (CH3) at the other end
3. Example:

each corner on the zigzag line represents a carbon atom with two attached
hydrogens
4. Sphingolipid is divided into 2:
a. Sphingomyelin: major phospholipid component of membranes in neural
tissue
b. Glisisphingolipid (berisi karbohidrat) is divided into 2:
Cerebrocide: found in neural tissue membrane
Gangliocide
-

Function:
1. Protection cover bones and vital organs
2. Isolation thermoregulator, keep body temperature in normal
3. Regulation regulates metabolism (liquid fat)
4. Structure important parts of cell membrane
5. Solvent for vitamin A, D, E, K
6. Prevent hair and skin from drying
7. 2nd energy source (9 kKal/gr)
8. Hunger mechanism stimulate on inhibit hunger

Classification of Lipid:
1. Simple lipid
a. Triglycerides: trimesters of glycerol and fatty acids
b. Fatty acid
Based on chain length of fatty acid
Short chain (SCFA): <6 carbon atoms, such as butiric acid
Medium chain (MCT): 6-10 carbon atoms, usually synthetic fat
Long chain (LCT): 12-24 carbon atoms, usually natural fat

Based on degree of saturation

Saturated fatty acids (SAFA): fatty acid with a carbon chain
containing all the hydrogen
Example: stearic acid

Monounsaturated fatty acids (MUFA): contain only one double

bond
Example: Oleic Acid

Polyunsaturated fatty acids (PUFA): contain two or more double

bonds
Example: Linoleic acid

2. Compound lipids
a. Phospholipid: compound of triglycerides + nitrogen base + phosphate,
function as cell structure, cell membrane, and cytoplasm
b. Glycolipid: triglycerides + carbohydrate function as cell structure and cell
membrane
c. Lipoprotein: triglycerides + protein function as lipid transportation in blood
3. Derived lipids:
a. Sterol: cholesterol function as cell membrane, base to form steroid
hormones, vitamin D, bile acid
b. Sphyngo lipid:
Sphyngomyelin: major phospholipid component of membranes in
neural tissue
Glycisphingolipid: contain carbohydrate
Cerebrocides: found in neural tissue membrane (myelin sheath)
Gangliocides

Source:
1. Based on degree of unsaturation
a. SAFA: meat, chicken skin, milk, cheese, yoghurt, ice cream, cakes, snack,
instant noodle, coconut oil
b. MUFA: zaitun oil, avocado, nuts, almond nuts
b. PUFA: corn oil, soya beans, fish oil: cod, herring, mackarel, salmon, tuna, trout,
halibut, sardines
2. Based on essential fatty acids
a. Omega-3: soya beans, canola, salmon, tuna, mackarel
b. Omega-6: vegetable oil ( overcooked), nuts

Lipid Transportation
1. Chylomicron transport lipid from small intestine to the body
2. VLDL (very low density lipoprotein) transports triglyceride to the body
3. LDL (low density lipoprotein) transports cholesterols to body cells
4. HDL (high density lipoprotein) transports cholesterols to liver to be recycled or
removed

Deficiencies of Lipid
1. Growth disturbance
2. Reproductive failure lack production of sex hormone
3. Liver & kidney disturbance, minor nerve and sight system disorder

c) Protein
- Stucture consist of C, H, O, N

Amino acids
1. Essential Amino Acids: the human body cant make it (from food)
2. Non-Essential Amino Acids: the human body can synthesize them for itself by
metabolism

Resources of Protein
a. Animal protein: meat, fish, egg, milk
b. Nabati protein: legumes (soya, grain, mung bean, etc)

Function:
a. Building and repair of body tissue
b. Form enzymes, hormones, and many immune molecule
c. Essential body process water balance, nutrient transport, muscle contraction
d. 3rd energy source (4kKal/gr)
e. Keep skin, nail, and hair healthy
f. Acid-base regulator
g. Antibody
h. Blood clotting, vision, and neurotransmitter
i. Movement coordination
j. Regulates body growth

Levels of Protein Structure

a. Based on the chain
Primer: The primary structure is like the order of letters in a very long word.

Sekunder: Is the result of hydrogen bonds between the repeating constituents of

the polypeptide backbone (not the amino acid side chains).

Tersier: is the overall shape of a polypeptide resulting from interactions between

the side chains (R groups) of the various amino acids.

Quartener: is the overall protein structure that results from the aggregation of
thesepolypeptide subunits.

b. Based on the shape of protein is divided into:

globular
fibrosa
- Deficiency
a. Marasmus
b. Kwashiorkor

Micronutrient

a) Vitamins
Vitamins are essential nutrients needed in tiny amounts in the diet both to prevent
deficiency diseases and to support optimal health. Vita = life ; amine = containing nitrogen
(the first vitamin discovered contain nitrogen)
Characteristics:
1. They are individual units (not linked together)
2. they do not yield energy when metabolized but asssist the enzymes that participate in
the release of energy from carbohydrate, fat, protein
3. they are measured in microgram or miligram

Water Soluble Vitamins

Fat Soluble Vitamins

*Tambahan
Phantothenic Acid (B5) is an integral part of CoA
Sources : rices, dry cereal, cooked mushroom, salmon
Function : Acetyl CoA forming, part of fatty acid synthesis, alcoholic acetilation, and amino acid
synthesis
Metabolism :
Pantothenic acid 4-phospopantothenic acid 4-phospopantothenoylcysteine 4phospantotherne CoA

b) Minerals
Inorganic elements :
1. always retain their chemical identity
2. remain in the body until excreted
2. can be lost from food only when dissolve into water
- Major Minerals
Minerals needed in our body more than 100 mg/day

Trace Mineral
Minerals needed in our body less than 100 mg/day

Selenium (Se)

Tembaga (Cu)

Mangan (Mn)

Krom (Cr)

Molibden

Seafood,
daging, antioksidan
buah-buahan

Gangguan sistem
saraf,
penyakit
Keshan
Seafood,
kacang- Komponen beberapa Kerusakan
hati,
kacangan,
padi- enzim yang berperan anemia, kelainan
padian
dalam reaksi oksidasi
tulang
Kofaktor
untuk Kacang-kacangan,
Gangguan sistem
beberapa enzim
sayuran
yang saraf
mengandung banyak
daun, teh
Daging,
terutama Membantu aktivitas Kondisi yang mirip
hati
insulin
dan dengan diabetes
mempengaruhi
toleransi glukosa
Susu, sayuran hijau
Kofaktor
untuk
beberapa enzim

c) Water
Water Classification
1. Hard Water : contain high calcium and magnesium concentration
2. Soft Water: contain high sodium and potassium concentration
Intracellular fluid : fluid inside the cell, contain high potassium and phosphate concentration.
Two thirds of water in the body.
Extracellular fluid: fluid outside the cell, contain high sodium cincentration
Water excretion : lung breath, skin sweat, kidney urine
Source : metabolic reaction, most fruit and vegetable, meat and cheese
Function:
1. Carries nutrients and waste products throughout the body
2. Maintains the structure of large molecules such as proteins and glycogen
3. Participates in metabolic reactions
4. Serves as the solvent for minerals, vitamins, amino acids, glucose, and many
other small molecules so that they can participate in metabolic activities
5. Acts as a lubricant and cushion around joints and inside the eyes, the spinal
cord, and, in pregnancy, the amniotic sac surrounding the fetus in the womb
6. Aids in the regulation of normal body temperature, as the evaporation of
sweat from the skin removes excess heat from the body

7. Maintains blood volume

Metabolism in Gastrointestinal Tract

a. Carbohydrate

b. Protein

c. Lipid

Biomolecules Hierarchy
Biomolecules hierarchy is organic molecules that make up the body of the organism and the
particular characteristics of the product have biological activity

SUPRAMOLECULE The combination of macromolecules that form a

functional unit
(eg: Ribosom, Mitocondria)

MACROMOLECULE The combination of micromolecules

(eg: protein, lipid, polysaccharides, DNA)

MICROMOLECULE monomers as body builder

(eg: amino acid, monosaccharides, fatty acid, nucleic acid)

ELEMENTS Substance that is made entirely from one

type of atom
(eg: C, H, O, N, P, etc)
Metabolism In Cell
(Carbohydrate, Protein, Lipid)

BHP AND PHOP

PHOP
1. Promotive
: Education about impact of imbalanced diet
2. Preventive
: Eat normaly
3. Curative
: Give info about good nutrient
Psychotherapy: - Family based intervention
- Adolescence individual focus theory
Cognitive Behavior Theory: Directed at reduction on diet restraint
4. Rehabilitation : Supervision of balance diet, Counseling nutritional rehab

BHP
1. The patient should get clear explanation from the medical personnel about his illness
2. The patient should know the risk factors and how the disease occurred
3. The patient should be informed the solution to the disease
According to Law no. Health 23 of 1992 on chapter elucidation of article 53, paragraph 2, patients
right consists of:
1.
2.
3.
4.

The right to obtain information

The right to give consent
Right to confidential medical
Right to second opinion