Wa0046

THIKA SCHOOL OF MEDICAL
& HEALTH SCIENCES

DEPARTMENT: DEPARTMENT FOOD NUTRITION AND
DIETETICS
PRINCIPLES OF HUMAN NUTRITION
By:
JOSEPH NDUNG’U
joseph.m.ndungu@gmail.com
PROGRAMME: DISTANCE LEARNING DIPLOMA IN

HUMAN NUTRITION AND DIETETICS
DEPARTMENT OF HUMAN NUTRITION AND
DIETETICS
MR JOSEPH TEACHING NOTES 2017
PREFACE
Principles of human nutrition is a basic nutrition course designed for Diploma In Human
Nutrition & Dietetics students. The role of nutrition in achieving and maintaining optimal
health and fitness has long been recognized. Human life is nourished by food, and the
substances in food on which life depends on are the nutrients.
The aim of this course is to familiarize you with the nutrients that are important in human
life, their food sources and the problems associated with an inadequate or excess intake
of one or more nutrients.
The course will furnish you with theoretical knowledge in a form that will help you
identify nutrition related problems in the community and help in finding solutions to
these problems because hunger and malnutrition remain among the devastating problems
facing the majority of the developing world’s poor and needy.
EACH LECTURE IS EQUIVALENT TO A WEEK OF STUDY
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ABBREVIATIONS AND ACRONYMS

BMI Body Mass Index
FAO Food Agriculture Organization
MUAC Mid-Upper Arm Circumference
PEM Protein Energy Malnutrition
RBC Red Blood Cells
RDA Recommended Dietary Allowance
RIN Recommended Intakes of Nutrients
RNI Recommended Nutrient Intakes
WHO World Health Organization
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Table of Contents
LECTURE ONE: INTRODUCTION .............................................................................. 7
1.0 What is Nutrition? ................................................................................................. 7
1.1 Objectives .............................................................................................................. 7
1.2 Nutrients ................................................................................................................ 8
1.3 Classes of Nutrients ............................................................................................... 8
1.3.1 Water .............................................................................................................. 8
1.3.2 Macronutrients ................................................................................................ 8
1.3.3 Micronutrients ................................................................................................ 9
1.4 Nutrients in the Body: Biochemical and Physiological Needs .............................. 10
1.5 Structural Nutrients .............................................................................................. 10
1.7 Nutrient Requirement: How much of each Nutrient do we need? ......................... 11
1.8 Effects of Too Little or Too Much Nutrients ........................................................ 11
1.8.1 Under-Nutrition ............................................................................................ 11
1.8.2 Over-Nutrition .............................................................................................. 13
1.9 Short and long term effects of poor nutrition ........................................................ 13
1.10 Conceptual Framework of Malnutrition ............................................................. 14
1.11 Summary of Definitions ..................................................................................... 15
1.12 Summary ........................................................................................................... 16
1.12 Activity.............................................................................................................. 16
1.13 Question ............................................................................................................ 16
1.14 Further Reading ................................................................................................. 17
LECTURE TWO: THE SCIENCE OF NUTRITION .................................................... 18
Introduction ............................................................................................................... 18
Recommended Dietary Allowances (RDA) ............................................................ 18
Estimating a minimal Requirement ............................................................................ 19
Establishing a generous Recommendation ................................................................. 19
Using the RDA .......................................................................................................... 19
Revising the RDA.................................................................................................. 20
Definitions Summary................................................................................................. 21
2.7 Activity ............................................................................................................... 21
Further Reading ......................................................................................................... 22
LECTURE THREE: PLANNING A HEALTHY DIET ................................................. 22
3.0 Introduction ......................................................................................................... 22
3.1 Objectives ............................................................................................................ 22
3.2 Diet Planning Principles ...................................................................................... 23
3.7 Activity ............................................................................................................... 26
3.8 Questions ............................................................................................................. 26
3.10 Further Readings................................................................................................ 26
LECTURE FOUR: CARBOHYDRATES ..................................................................... 27
4.0 Introduction ......................................................................................................... 27
4.1 Objectives ............................................................................................................ 27
4.2 Carbohydrates- Chemical Structure...................................................................... 28
4.4 Functions of Carbohydrates ................................................................................. 33
4.5 Digestion and Absorption of Carbohydrates ......................................................... 34
4.5.1 Digestion ...................................................................................................... 34
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4.5.2 Lactose Intolerance ....................................................................................... 34

4.5.3 Maintaining glucose homeostasis .................................................................. 36
4.6 Definition Summary ............................................................................................ 37
4.7 Question .............................................................................................................. 38
4.8 Activity ............................................................................................................... 38
Further Reading ......................................................................................................... 38
LECTURE FIVE: LIPIDS ............................................................................................. 39
5.0 INTRODUCTION ............................................................................................... 39
5.1 OBJECTIVES ..................................................................................................... 39
5.2 Definitions ........................................................................................................... 39
5.3 Types of Fatty Acids ............................................................................................ 39
5.4 Essential Fatty Acids ........................................................................................... 40
5.4.1 Essential Fatty Acids Deficiency ................................................................... 40
5.5 Triglycerides ........................................................................................................ 40
5.6 Phospholipids ...................................................................................................... 41
5.7 Sterols – Cholesterol ............................................................................................ 41
5.10 Digestion, Absorption and Transport of Lipids ................................................... 44
5.13 Question ............................................................................................................ 48
5.14 Activity.............................................................................................................. 48
LECTURE SIX: PROTEINS ......................................................................................... 49
6.0 INTRODUCTION ............................................................................................... 49
6.1 OBJECTIVES ..................................................................................................... 49
6.2 Definitions ........................................................................................................... 49
6.4 Proteins in Foods ................................................................................................. 54
6.5 Protein Deficiency ............................................................................................... 54
6.6.0 Kwashiorkor ................................................................................................. 54
6.6.1 Marasmus ..................................................................................................... 55
6.7 Nitrogen Balance ................................................................................................. 56
6.11 Activity.............................................................................................................. 57
6.12 Question ............................................................................................................ 57
LECTURE SEVEN: VITAMINS .................................................................................. 58
7.0 INTRODUCTION ............................................................................................... 58
7.1 OBJECTIVES ..................................................................................................... 59
7.2 Fat Soluble Vitamins ........................................................................................... 59
7.2.1 Vitamin A ..................................................................................................... 59
7.2.2 Vitamin D ..................................................................................................... 60
7.2.3 Vitamin E ..................................................................................................... 61
7.2.4 Vitamin K ..................................................................................................... 62
7.3 Water Soluble Vitamins ....................................................................................... 63
7.3.1 Vitamin B ..................................................................................................... 63
7.3.2 Biotin and Pantothenic Acid .......................................................................... 64
7.3.3 Vitamin B6 .................................................................................................... 64
7.3.4 Folate and B12 ............................................................................................... 64
7.3.5 Vitamin C ..................................................................................................... 66
7.4 Water Intake ........................................................................................................ 68
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7.5 Minerals .............................................................................................................. 69

7.5.1. Sodium ........................................................................................................ 69
7.5.2. Chloride (Cl) ................................................................................................ 70
7.5.3. Potassium..................................................................................................... 70
7.5.4 Calcium ........................................................................................................ 71
7.5.5 Phosphorus ................................................................................................... 72
7.5.6 Magnesium ................................................................................................... 72
7.5.7 Sulfur ............................................................................................................ 73
7.6 Trace Minerals ..................................................................................................... 73
7.6.1 Iron ............................................................................................................... 73
7.6.2 Zinc .............................................................................................................. 74
7.6.3 Iodine............................................................................................................ 76
7.6.4 Selenium ....................................................................................................... 77
7.6.5 Copper .......................................................................................................... 77
7.7 Activity ............................................................................................................... 77
7.8 Question .............................................................................................................. 78
7.9 Summary ............................................................................................................. 78
LECTURE EIGHT: HUMAN DIGESTIVE SYSTEM .................................................. 79
8.0 DIGESTION SYSTEM ....................................................................................... 79
8.1 OBJECTIVES ..................................................................................................... 79
8.2 Human Digestion Process .................................................................................... 79
8.3 Fat Digestion ....................................................................................................... 88
8.5 Carbohydrate Digestion ....................................................................................... 88
8.6 Protein Digestion ................................................................................................. 88
8.7 Types of Absorption ............................................................................................ 89
8.8 Question .............................................................................................................. 89
8.9 Activity ............................................................................................................... 90
8.10 Summary ........................................................................................................... 90
Sample Formative and Summative Evaluation ............................................................... 92
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LECTURE ONE: INTRODUCTION
1.0 What is Nutrition?

Nutrition is a process by which substances in food are transformed into body tissues and
provide energy for the full range of physical and mental activities that make up human
life.
1. Nutrition is more than just the food we eat. It is a science that encompasses
all the interactions that occur between living organisms and food.
2. These interactions include the physiological processes by which an organism,
 Ingests
 Digests
 Absorbs
 Transports and utilize food.
3. Nutrition includes the biological actions and interactions of food with the
body and their consequences for health and disease.
4. It also includes the psychological, social, cultural, economic, and
technological factors that influence which foods we eat.
5. The biological importance of food is dictated by the nutrients it contains.
6. Other aspects of food such as taste, color, smell, texture, presentation and
packaging help determine its psychological, cultural, social and personal
value.
1.1 Objectives
By the end of this lesson you should be able to:
1. Define the terminology used in nutrition.

2. Classify Nutrients.
3. State nutrient needs of the body.
4. State the consequences of poor nutrition.
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1.2 Nutrients
These are substances in foods that are required by the body for growth, maintenance and
reproduction. They provide energy, contribute to structure and regulate biological
processes.
Essential Nutrients
An essential nutrient is a nutrient required for normal body functioning that either
cannot be synthesized by the body at all, or cannot be synthesized in amounts adequate
for good health (e.g. niacin, choline), and thus must be obtained from a dietary source.
Essential nutrients are also defined by the collective physiological evidence for their
importance in the diet. Some categories of essential nutrients include vitamins, dietary
minerals, essential fatty acids, and essential amino acids. Different species have very
different essential nutrients. For example, most mammals synthesize their own ascorbic
acid, and it is therefore not considered an essential nutrient for such species. It is,
however, an essential nutrient for human beings, who require external sources of ascorbic
acid (known as Vitamin C in the context of nutrition).
Non-Essential Substances
Can be made by the body for example; Lecithin, which is needed for nerve function, is
not an essential nutrient because it can be made in the body from other substances. On
the other hand, Vitamin A, which is needed for vision, is essential in the human diet
because it cannot be made by the human body.
1.3 Classes of Nutrients

Food is more than something to satisfy your appetite. Food is fuel for your body. Each
type of nutrient has a specific purpose and meets a specific need that your body has. The
six nutrients are: Water, Carbohydrates, Protein, Lipids and Micronutrients which are
Vitamins and Minerals.
1.3.1 Water
Is water a nutrient in a class by itself? Yes, water is a nutrient on its own. It is the most
important nutrient. Water makes up about 60% of the human body. Your body uses water
24 hours a day. It functions as a solvent, a lubricant, a transport medium, and a regulator
of body temperature. It does not provide energy. .
1.3.2 Macronutrients
Macronutrients constitute the majority of an individual’s diet, “thereby supplying energy,
and the essential nutrients that are needed for growth, maintenance, and activity”.
Macronutrients include carbohydrates, proteins, fats, macro minerals, and water.
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Carbohydrates, proteins, and fats are interchangeable as sources of energy, with fats
yielding 9 calories per gram, and protein and carbohydrates each yielding 4 calories per
gram.
Carbohydrates
Include sugars, simple carbohydrates, and starches, more complex carbohydrates that are
made of many sugars linked together. They provide a readily available source of energy.
Fruits, vegetables and grains are the main sources of carbohydrates in the diet. Fiber is
also a form of carbohydrate.
Protein
Protein provides structure and regulation of body processes. They are made of amino
acids. Some amino acids can be made by the body, and others are essential in the diet.
 Dietary protein must provide the correct combination of amino acids to meet the
need for the essential amino acids.
 Meat, milk, grains and legumes are good dietary sources of protein.
Lipids
Lipids commonly referred to as fats, provide a storage form of energy. Most lipids
contain fatty acids. Several of which are essential nutrients. Lipids in the diet include
fats and oils that occur naturally in food and those that are added in cooking or at the
table.
Alcohol consumed in the diet also provides energy, but alcohol is not an essential
nutrient.
1.3.3 Micronutrients
Micronutrients are vitamins and trace minerals. Vitamins and trace minerals are labeled
as micronutrients because the body only requires them in very small amounts. Vitamins
are organic substances that we ingest with our foods, and that “act as catalysts, substances
that help to trigger other reactions in the body”. Trace minerals are inorganic substances
that once ingested play a role in a “variety of metabolic processes, and contribute to the
synthesis of such elements as glycogen, protein, and fats”. Vitamins and Minerals shall
be covered in details in subsequent lectures.
Vitamins and Minerals
Vitamins are organic substances (made by plants or animals), minerals are inorganic
elements that come from the earth; soil and water and are absorbed by plants. Animals
and humans absorb minerals from the plants they eat. Vitamins and minerals are nutrients
that your body needs to grow and develop normally. They have the following
characteristics:
 The amount required is expressed in milligrams or micrograms.
 They do not provide energy but help regulate the production of energy from
macronutrients.
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 Vitamins and minerals are found in most of the foods we eat. Fresh foods are
generally the best sources of vitamins and minerals because storage, processing
and cooking often result in losses.
 Many of the vitamins and minerals in today’s diet come from those intentionally
added to food during manufacturing and processing or from nutritional
supplements.
1.4 Nutrients in the Body: Biochemical and Physiological Needs

Together, the macronutrients and micronutrients provide three basic functions:-
 Energy
 Structure
 Regulation
Which by the body needs for:-

 Growth
 Maintenance
 Reproduction
Kilocalories
The energy needed for all body processes and activities is measured in Kilocalories or in
kilojoules.
1 Kilocalorie = 4.18 K joules
 Carbohydrates and protein provide 4 K calories per gram
 Lipids provide 9 K calories per gram
 Alcohol provides 7 K calories per gram.
If more energy is consumed than needed, the extra is stored as body fat, resulting in
weight gain. If less energy is consumed in the diet than is needed, the body will burn its
own carbohydrates, protein and lipids in order to meet energy needs.
1.5 Structural Nutrients

Nutrients from the diet are also needed for the formation and maintenance of body
structure, water, proteins, lipids and minerals are important structural nutrients. For
example, muscle is made up of primarily protein and water, and bone is composed of a
protein core embedded with minerals.
1.6 Regulatory Nutrients

Nutrients are also involved in the regulation of the biochemical reactions of the living
body. Together these reactions are referred to as metabolism.
 Reactions must be regulated by being turned on and off and speeded up and
slowed down at appropriate times in order to maintain a constant environment
inside the body, referred to as homeostasis. Essentially they the catalysts for body
biochemical reactions.
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 Vitamins, minerals, proteins are the chief regulatory nutrients. For example,
proteins are involved in the regulation of body fluids. If we drink too little,
protein signals the kidneys to decrease the amount of water lost in the urine
through increase in production of anti-duretic hormone (ADH). Without
regulation of this process, dehydration would frequently occur.
 The regulation of the amount of sugar, glucose in the blood is another example of
homeostasis regulated by proteins. Insulin and Glucagon interchangeable regulate
the amount of blood sugar at various instances.
 When a food is high in sugar, such as a bottle of soda, is consumed, the
concentration of glucose in blood will rise. This causes the release of a protein
that signals the removal of glucose from the blood and speeds up the chemical
reactions needed to store the sugar for later use, or use it for energy. When this
process is not regulated it can result in a disorder called diabetes.
1.7 Nutrient Requirement: How much of each Nutrient do we need?

To support life and maintain health, nutrients must not only be supplied, they must be
supplied in appropriate amounts.
 Both deficiencies and excess of nutrients can affect health either in short term or
over a lifetime.
 The amount of each nutrient needed by the body depends on the nutrient’s
function as well as the needs of individuals.
1.8 Effects of Too Little or Too Much Nutrients

Conditions resulting from either too much or too little of one or more nutrients are
referred to as malnutrition. E.g Low intakes of protein in the diet would result to
Kwashiorkor while High doses of vitamin D have been known for many years to be toxic
to humans, rats and other animals. In humans, manifestations of vitamin D toxicity
include hypercalcemia, hypercalciuria, nausea, anorexia, lethargy, mental disturbances,
and ectopic soft tissue calcification, including vascular calcification and
nephrocalcinosis, and renal failure
1.8.1 Under-Nutrition
A deficiency of nutrients, starvation, the most severe form of under nutrition is a
deficiency of energy that causes poor growth, weight loss, decreased ability to do work,
the inability to reproduce and if severe enough death.
 Deficiencies of individual nutrients may also occur.
 The symptoms of a single nutrient deficiency demonstrate the body functions that
rely on the deficient nutrient.
 For example, vitamin A is necessary for vision, as a result, a deficiency interferes
with vision. Vitamin D is necessary for bone development; therefore a deficiency
causes abnormal bone development referred to as rickets.
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Further consequences of a poor diet include:

 A poor diet can lead to energy imbalance (e.g., eating more calories than one
expends through physical activity) and can increase one’s risk for overweight and
obesity.
 A poor diet can increase the risk for lung, esophageal, stomach, colorectal, and
prostate cancers.
 Individuals who eat fast food one or more times per week are at increased risk for
weight gain, overweight, and obesity.
 Drinking sugar-sweetened beverages can result in weight gain, overweight, and
obesity.
o Providing access to drinking water gives students a healthy alternative to
sugar-sweetened beverages.
Hunger and food insecurity (i.e., reduced food intake and disrupted eating patterns
because a household lacks money and other resources for food) might increase the risk
for lower dietary quality and undernutrition. In turn, undernutrition can negatively affect
overall health, cognitive development, and school performance.
Nutrient Deficiency Stages
Here is what is happening in under-nutrition
PRIMARY (OUTWARD) Diet history

SIGNS AND SYMPTOMS
DECLINING STORES
Laboratory tests
ABNORMAL FUNCTIONS
INSIDE THE BODY
Physical examination and

PHYSICAL (OUTWARD) anthropometric Measures
SIGNS AND SYMPTOMS
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1.8.2 Over-Nutrition
An excess of nutrients, is also a form of malnutrition. When food is consumed in excess
of energy need, the extra is stored as body fat. Some fat is necessary to insulate the body
and store energy, but an excess of body fat, called obesity, increases the risk for many
chronic diseases such as high blood pressure, heart disease and diabetes.
 When excess of specific nutrients are consumed, an adverse or toxic reaction may
occur. For example, a large dose of vitamin A can cause liver and kidney
damage. Nutrient toxicities rarely occur as a result of food consumption because
the amounts of vitamins and minerals in individual foods are well below nutrient
requirements. Our intake of foods and therefore, vitamins and minerals is limited
by our need for energy and the size of our stomachs.
 On some rare occasion, a toxic level of a nutrient can be obtained from food. For
instance, fish oils which are high in vitamin A can cause toxic reactions if eaten in
high amounts.
 Nutrient toxicity results more frequently from the use of vitamin and mineral
supplements; than from food.
1.9 Short and long term effects of poor nutrition

The effects of a nutritional excess or deficiency may occur rapidly or take a lifetime to
develop. Both short-term and long-term nutritional effects have important health
implications.
 For example, the symptoms associated with lack of water occur rapidly. An
athlete exercising in hot weather may become dehydrated in a matter of hours,
developing symptoms of such as headaches, dizziness, and confusion. Drinking
water relieves the symptoms as rapidly as they appeared.
 The effects of other nutritional imbalances may take weeks or months to manifest
themselves. For example consumption of an iron-deficient diet over weeks or
months will slowly cause symptoms such as a decreased capacity to work and
irritability, which are indicative of iron deficiency anemia.
 Large doses of vitamin B 6 when taken for months to years, cause nervous system
abnormalities such as numbness and poor co-ordination.
 An excess or deficiency of energy is another nutritional imbalance that takes a
long term to manifest itself. When excess energy is consumed, excess body fat is
deposited, but it may be months before the weight gain is significant. Likewise, as
anyone who has tried to lose weight knows, it can take months of consuming less
energy to use up the excess fat.
 Recently nutritional effects that occur over a much longer time have become an
important health focus. An individual’s nutrient intake today can affect the
development of cancer, or heart disease 20, 30 or 40 years from now.
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 The specific effects of nutrition on the development of chronic disease are

difficult to determine because numerous variables or risk factors such as, heredity,
air pollution, and stress, poverty, displacement etc. are often involved.
 However nutrition has received a great deal of attention because it can be changed
to decrease an individual’s risk.
1.10 Conceptual Framework of Malnutrition

The immediate causes are inadequate dietary intake and infection, such as diarrhoeal
diseases. Generally, there are problems with both the quantity and quality of foods
consumed and these results in multiple deficiencies, notably in energy, protein, and
micronutrients such as vitamin A, iodine, iron and zinc.
Figure: Conceptual Framework of Malnutrition (UNICEF, 1992)
The strategies for preventing malnutrition are well known and include:
 in infants; promoting exclusive breastfeeding for the first 6 months of life, and its
continuation into the second year; improving complementary feeding of children
aged 6-24 months;
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 preventing childhood infections such as diarrhoea which lead to poor nutrient

utilization and are a cause of poor appetite; improving the availability of food in
the household (food security);
 providing environmental sanitation and personal hygiene;
 making health services available; and
 improving the status and education of women in society
1.11 Summary of Definitions

Foods products derived from plants or animals that can be taken into the body to yield
nutrients for maintenance of life and the growth and repair of tissues.
Nutrients substances obtained from food and used in the body to provide energy and
structural materials and to regulate growth, maintenance and repair of body’s tissues;
nutrients may also reduce the risk for some chronic diseases.
Essential nutrients
Nutrients a person must obtain from food because the body cannot make them for itself in
sufficient quantity to meet physiological needs, also called indispensable nutrients.
About 40 nutrients are known to be essential for human beings.
Energy
The capacity to do work. The energy in food is chemical energy. The body can convert
this chemical energy to mechanical, electrical or heat energy.
Energy –Yielding Nutrients
The nutrients that breakdown to yield energy the body can use:-
- Carbohydrates
- Fat
- Protein
Calorie
This is a unit by which energy is measured. Food energy is measured in kilocalories
(1000 calories equal 1 kilocalorie)
 One kilocalorie is the amount of heat necessary to raise the temperature of 1
kilogram of water 10 C
Macronutrients
Nutrients needed by the body in large amounts. These include Carbohydrates, Proteins
and Lipids.
Metabolism
The sum of all the chemical reactions that take place in a living organism.
Homeostasis
The capacity to maintain a balanced internal body environment.
Malnutrition
Poor nutritional status resulting from a dietary intake either above or below that which is
optimal to meet nutritional needs.
Under nutrition
Poor nutrition status resulting from a dietary intake below that which meets nutritional
needs.
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Over nutrition
Poor nutritional status resulting from a dietary intake in excess of that which is optimal
for nutritional needs.
Toxic
The capacity to produce injury at some level of intake.
Risk factor
A characteristic or circumstance that is associated with the occurrence of a particular
disease.
1.12 Summary
In this lesson an overview of the nutrition, nutrients and consequences of poor

nutrition was provided. There are six categories of nutrients that the body needs to
acquire from food: Protein, carbohydrates, fat, fiber vitamins and minerals and
water. These nutrients can be classified as macronutrient and micronutrient. All nutrients play
a key role in maintaining the normal growth and functioning of the body, as well as
prevention of nutrition related health conditions.
1.12 Activity
Assess the dietary trends in Kenya and identify some of the issues that would impact
on the nutrition status of individuals and communities.
1.13 Question
1. Define nutrition.
2. What is an essential nutrient?
3. List the six classes of nutrients.
4. List three functions provided by nutrients.
5. What unit(s) is (are) used to measure energy in nutrition?
6. What are some of the consequences of poor nutrition?
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1.14 Further Reading
Garrow JS, James WPT, Ralph A (2000) Human nutrition and dietetics. 10 th
ed. Churchill Livingstone, Edinburgh.
WHO (1985) Energy and protein requirements. Report of a joint FAO/WHO/UNU

meeting (WHO Technical Report Series 724) WHO.
Smolin A and Grosvenor B (1994) Nutrition Science and Applications. Saunders

College Publishing, USA.
Gibson, R.(1990) Principles of Nutritional Assessment. New York: Oxford University

Press.
Bennion M, Scheule B (2000) Introductory Foods. 11th ed. Macmillan Publishing

Company, USA.
National Research Council(1989) Food and Nutrition Board. Recommended Dietary

Allowances. 10th ed. Washington, DC: National Academy Press.
Whitney E and Rolfes S (1996) Understanding Nutrition. 7th ed. West Publishing New
York
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LECTURE TWO: THE SCIENCE OF NUTRITION

.
Introduction
The science of Nutrition is the study of the nutrients in foods and the body’s handling of
those nutrients. Good nutrition can help prevent disease and promote health. There are six
categories of nutrients that the body needs to acquire from food: protein, carbohydrates,
fat, fibers, vitamins and minerals and water.
Nutrition science is further defined a biological science, within a broader and integrated
conceptual framework, and it encompasses social and environmental science. As such it
will be concerned with personal and population health, and with planetary health--the
welfare and future of the whole physical and living world of which humans are a part.
Nutrition Research
Research always begins with a question. For example, “what foods or nutrients might
protect against a common cold?” In search of an answer, scientists make educated
guesses (hypotheses) and then systematically conduct research studies to test each
hypothesis. Research is done to develop new knowledge or test existing knowledge.
Nutrition research seeks to identify the application of nutrition science in food and
nutrition policy with great width and breadth of vision and scope, in order that it can fully
contribute to the millennium development goals of preservation, maintenance,
development and sustenance of life on Earth.
Recommended Dietary Allowances (RDA)

The amounts of selected nutrients considered adequate to meet the known needs of
practically all healthy people. RDAs are based on scientific knowledge and are prepared
by a committee of Food and Nutrition Board of the National Academy of Sciences. At
least 40 different nations and International Organizations have published standards
similar to the RDA.
 For nutrients that are abundant in the diet, estimated minimum requirements have
been set.
 For nutrients that are less-well studied, estimated safe and Adequate Dietary
Intakes (ESADDI) are given.
RDA is set for Energy, Protein, Vitamins A,D,E,K thiamine, riboflavin, Niacin, B6,
folate, B12 and calcium, phosphorous, magnesium, iron, zinc, iodine and selenium
minerals.
Estimated minimum requirements is set for Sodium, potassium, chloride
Estimated safe and Adequate Dietary Intake (ESADDI) is set for Vitamins biotin and
pontothenic acid and copper, manganese, fluoride, chromium, molybdenum minerals.
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Energy RDA
Each person’s food energy intake must equal the energy expended if the person is to
maintain body weight. The RDA for energy is an average for a healthy population for a
given age or sex. The RDAs assume that most people are engaged in light to moderate
activity and not those who are more physically active. E.g. average RDA for 19-24 years
man is 2900 k calories.
Protein RDA
Protein recommendations are based on body weight. Protein RDA is high unlike energy
RDA so it covers the needs for most people.
Carbohydrate and Fat

No RDA is given for carbohydrate and fats but it is recommended that more than half of
daily energy should come from carbohydrate 55-60% and 1/3 from fat, 20-30%.
Water Recommendation
The bigger and more active a person is the more water the persons needs. Generally most
people need at least six to eight glasses of water or liquids a day.
Fiber Recommendation
There is no RDA for fiber. Instead it is recommended that people eat sufficient fiber
from fruits, vegetables, legumes and whole-grain products which also provide minerals
and vitamins, and water as well as fiber.
Estimating a minimal Requirement

This information is based on a healthy population’s needs. The estimates are drawn from
information from studies on deficiency and depletion of stores. An amount is then set,
that appears sufficient to maintain body processes. When people consistently obtain a
deficient intake one that is less than the requirement, their nutrient stores decline, which
over time leads to deficiency symptoms.
Establishing a generous Recommendation

RDAS are set at the average requirement for each nutrient, which is assumed to be closest
to everyone’s needs. If the RDA is placed at exactly the average, half of the population
would therefore be deficient. To take care of this the RDA committee sets the
requirements a little higher than the average for protein, vitamins and minerals. However
to avoid toxicity an upper safe level is set. RDAs are therefore stated as “safe and
adequate” range, “safe” meaning “not too low” and not too high.
Using the RDA

Although the intent of the RDA may seem simple enough, they are the subject of
misunderstanding and controversy. The following facts will help to put the RDA in
perspective.
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1. The RDA serves as estimates of adequate energy and nutrient intakes of healthy
people. They do not apply to people with health problems who may require
supplemented or restricted intake.
2. The RDAs are intended to be met through diets composed of a variety of foods.
Because foods contain a mixture of nutrients, they deliver more than just those
nutrients named in the RDA table. Excess intake of vitamins and minerals are
unlikely when their sources are foods rather than supplements.
3. The RDAs are safe and adequate recommendations that include a generous
margin of safety. They are not minimum requirements, nor are they necessarily
optimal intakes for all individuals.
4. The RDA applies to average daily intakes. To try to meet the RDA of every
nutrient every day is difficult and unnecessary. The length of time over which a
person’s intake can deviate from the average without risk of deficiency or
overdose varies, for most nutrients, it is best to try to achieve the average intakes
recommended by the RDA within three days or so.
5. The RDAs are most appropriately used to develop and evaluate nutrition
programs for populations such as school children or military personnel. The RDA
can be used to estimate the risks of deficiencies for an individual only if the
person’s intakes are determined and averaged over a sufficient length of time.
After all, the recommended intakes do meet the needs of essentially all members
of a healthy population, so by definition, they apply to individuals within that
population. To use the RDA this way, though, an individual must compare the
RDA with the typical intake, and not just with an arbitrary day’s intake.
Revising the RDA

Suggestions for next revision include:-
1. Providing several sets of RDA,

 One for health
 One for disease prevention
 Another for disease treatment
2. Providing a range of values to accommodate people’s diverse needs.
3. Using the most current RDA for food labels.
4. Establishing RDA for nutrients and non nutrients such as fiber, cholesterol and
beta carotene that influence health.
5. Addressing the needs of elderly people and other nutritional vulnerable subgroups
such as those in hardship areas.
6. Changing the name from dietary to nutrient allowances in recognition that in
some circumstances desired intakes may not be possible from foods alone.
20
Definitions Summary
 Requirement : The amount of a nutrient that will maintain normal biochemical
and physiological functions and prevent the development of specific deficiency
signs, distinguished from the RDA, which is a recommended and generous
allowance that provided for variability among individuals.
 Deficient: The amount of a nutrient below which almost all healthy people can
be expected, overtime, to experience deficiency symptoms
 Upper safe margin: The amount of a nutrient that appears safe for most healthy
people and beyond which there is concern that some people will experience
toxicity symptoms.
 Nutrition Assessment: A comprehensive approach completed by a
nutritionist/dietician, to defining nutrition status that uses health, socioeconomic,
diet history, anthropometric measurements, physical examination and laboratory
tests.
 Overt: Out in the open and easy to observe
 Primary deficiency: A nutrient deficiency caused by inadequate dietary intake
of a nutrient.
 Secondary deficiency: A nutrient deficiency caused by something other than
diet, such as a disease condition that reduces absorption, accelerates use, hastens
excretion or destroys the nutrient.
 Sub clinical deficiency: A deficiency in the early stages, before the outward
signs have appeared.
 Covert: hidden as if under covers
 Food consumption Survey: A survey that measures the amounts and kinds of
foods people consume (using diet histories) estimates the nutrient intakes, and
compares them with a standard such as the RDA.
 Nutritional status survey: A survey that evaluates people’s nutrition status using
diet histories, anthropometric measures, physical examinations and laboratory
tests.
 Chronic diseases: Degenerative diseases characterized by deterioration of the
body organs, also called chronic, non communicable diseases, e.g. heart disease,
cancer and diabetes.
2.7 Activity
1. Compare the purpose of the Dietary Guidelines to that of the RDAs.

2. Discuss the methods you would use to determine the nutrition status of an individual.
Illustrate this with a specific example
3. Discuss how you would determine the nutrition status of your family members.
21
Further Reading
Garrow JS, James WPT, Ralph A (2000) Human nutrition and dietetics. 10 th
ed. Churchill Livingstone, Edinburgh.

Smolin A and Grosvenor B (1994) Nutrition Science and Applications. Saunders

College Publishing, USA.

Press.

Company, USA.

Whitney E and Rolfes S (1996) Understanding Nutrition. 7 th ed. West Publishing New
York
LECTURE THREE: PLANNING A HEALTHY DIET
3.0 Introduction
Dietary standards are guidelines for the amounts of essential nutrients that must be
produced in the diet to avoid nutritional deficiencies in the population. They are designed
to meet the needs of the majority of healthy persons. As a result, dietary standards are not
dietary requirements. Their recommendations exceed the requirements for most
individuals because they are designed to suggest intakes at which practically no one will
suffer a deficiency.
3.1 Objectives
By the end of this lesson the student will be able to:
1. State the principles of diet planning.

2. Identify tools which have been developed for planning individual diets.
3. List the types of information included on food labels
22
3.2 Diet Planning Principles

Diet planners have developed several ways of selecting foods. Whatever plan or
combination of plans they use, they keep in mind the six basic diet planning principles.
1. Adequacy
2. Balance
3. K calorie (energy) control
4. Nutrient density
5. Moderation
6. Variety
Adequacy
RDA is all about adequacy. An adequate diet provides sufficient energy and enough of
all nutrients to meet the needs of healthy people. For example: - Iron, each day the body
loses some iron, so people have to replace it by eating foods that contain iron. A person
whose diet fails to provide enough iron rich foods may develop the symptoms of iron-
deficiency anemia. The person may feel weak, tired, and listless, have frequent
headaches, and find even the smallest amount of muscular work very tasking. To prevent
these deficiency symptoms, diet planners must include foods that supply adequate iron.
Balance
It refers to consumption of food items from different food groups. E.g. From cereal group
to dairy to fruits and vegetables.
K calorie (Energy Control)
Diets should not include too much or too little energy foods, but just enough to meet an
individual’s needs.
Nutrient Density
The food guide provides a strong foundation for a healthy diet but does not explain the
nutrient density of some foods such as processed food. To eat well without overeating,
select foods that deliver the most nutrients for the least food energy. Nutrient Density is
the amount of a particular nutrient in a serving of food divided by the number of
kilocalories in that serving.
For example- calcium, you can get about 300 milligrams of calcium from either 45
grams of cheddar cheese or 250 ml or 1 cup of milk. Milk will provide exactly same
amount of calcium as cheese but less k calories or a glass of coke and a bowl of
watermelon. Each provides 150 k calories, but the water melon offers a little protein,
some vitamins, minerals and fiber along with energy, the coke beverage offers only
“empty” k calories. Water melon or any fruit is more nutrient dense than carbonated
beverages.
23
Moderation
Foods rich in fat and sugar provide enjoyment and energy, but have relatively few
nutrients. Eaten in excess promote weight gain. These foods should therefore be eaten in
moderation.
Variety
People should select foods from each of the food groups daily. People also vary the
choices within each food group from day to day for several reasons.
1. Different foods within the same food group contain different nutrients. For
example among fruits, strawberries are very high in vitamin C while watermelon
is richer in vitamin A.
2. “Variety is the spice of life”. Even if a person eats beans frequently, the person
can choose pinto beans, chick peas etc. to include variety in recipes to avoid
monotony.
FOOD GUIDE PYRAMID
24
Five food groups:-

 Breads, cereals, and other grain products and staples.
 Vegetables
 Fruits
 Meat, poultry, fish and alternatives.
 Milk, cheese and yoghurt.
 Miscellaneous foods
Synthetic drinks e.g. chocolate drink, salad dressing, jams etc. do not fit into any
food group. They mostly provide too much sugar or fat. Such foods should be
used sparingly.
25
3.7 Activity
Keep a food record of everything you eat for three days, list next to each food
the food group from the Food Guide Pyramid in which it belong and the
number of servings you consumed. For mixed foods, list all food groups that
apply. Compare the number of servings from each group that you consumed
with the number recommended. Does your diet meet the guidelines of the Food Guide
Pyramid?
3.8 Questions
1. State the key dietary planning principles give examples.

2. List four dietary planning tools and explain how you would use them in
planning meals.
3.10 Further Readings
Garrow JS, James WPT, Ralph A (2000) Human nutrition and dietetics. 10 th ed.
Churchill Livingstone, Edinburgh.
WHO (1985) Energy and protein requirements. Report of a joint

FAO/WHO/UNU meeting (WHO Technical Report Series 724) WHO.
Smolin A and Grosvenor B (1994) Nutrition Science and Applications. Saunders College
Publishing, USA.

Press.

Company, USA.

Whitney E and Rolfes S (1996) Understanding Nutrition. 7th ed. West Publishing New
York
26
LECTURE FOUR: CARBOHYDRATES
4.0 Introduction
Carbohydrates may be classified as monosaccharides, disaccharides, or polysaccharides
depending on the number of monomer (sugar) units they contain. They constitute a large
part of foods such as rice, noodles, bread, and other grain-based products.
Monosaccharides contain one sugar unit, disaccharides two, and polysaccharides three or
more. Polysaccharides are often referred to as complex carbohydrates because they are
typically long multiple branched chains of sugar units. The difference is that complex
carbohydrates take slightly longer to digest and absorb since their sugar units must be
separated from the chain before absorption. The spike in blood glucose levels after
ingestion of simple sugars is thought to be related to some of the heart and vascular
diseases which have become more frequent in recent times. Simple sugars form a greater
part of modern diets than formerly, perhaps leading to more cardiovascular disease. The
degree of causation is still not clear, however.
Simple carbohydrates are absorbed quickly, and therefore raise blood-sugar levels more
rapidly than other nutrients. However, the most important plant carbohydrate nutrient,
starch, varies in its absorption. Gelatinized starch (starch heated for a few minutes in the
presence of water) is far more digestible than plain starch. And starch which has been
divided into fine particles is also more absorbable during digestion. The increased effort
and decreased availability reduces the available energy from starchy foods substantially
and can be seen experimentally in rats and anecdotally in humans. Additionally, up to a
third of dietary starch may be unavailable due to mechanical or chemical difficulty.
4.1 Objectives
 Define carbohydrates
 State the basic units of carbohydrates and their sources.
 State the functions of carbohydrates.
 Describe the digestion and absorption of carbohydrates.
27
4.2 Carbohydrates- Chemical Structure

i) Simple Sugars
Chemical Structures of the Monosaccharide: Glucose, Galactose and Fructose
ii. Types of monosaccharide
a. Glucose
This sugar is found naturally in:
 Dextrose
 Blood sugar
The glucose is usually metabolized glycogen in the liver through a process
referred to as glycogenesis. Whenever glucose is required in the blood but none is
supplied through digestion, glycogen is broken down to glucose through
glycogenolysis.
Glucose major sugar in blood and preferred energy source by body cells.
Liver rearranges the other sugars to form glucose.
b. Fructose
This sugar is found naturally in:
 Fruits and honey
 High fructose corn syrup
It is usually metabolized in the body to glucose and then to glycogen for storage.
c. Galactose
This sugar is naturally found in:
 Milk lactose combined with glucose.
 It is metabolized to glucose and used in energy production. It can also be
metabolized to glycogen or fat for storage.
28
i) Dissacharides
Chemical Structures of the Disaccharides: maltose, lactose, sucrose
Types of Disaccharides
Formation- two monosaccharide joined together by condensation i.e. a H 2O molecule is
released
a) Maltose
Glucose +Glucose e.g. in “malt” beer.

b) Sucrose
 Glucose + Fructose e.g. in table sugar, honey sugarcane, beets and maple sugar.
c) Lactose
 Glucose + Galactose e.g. in dairy products
29
Types of Complex Carbohydrates

Complex carbohydrates contain many glucose units and a few other monosaccharides
strung together as polysaccharides. Three are important in nutrition: glycogen, starch and
fiber. Glycogen is a storage form of energy in the animal’s body (human). Starch plays
the same role in plants.
a. Oligosaccharides
1. They are formed when 3-10 monosaccharides are joined together.
2. Two major oligosaccharides are:
a. Starchyose found in legumes (beans + nuts) and other vegetables
b. Raffinose
b. Polysaccharides
They are formed when 3000 monosaccharides are joined together

a. Starches and glycogen ;
b. Cellulose found in cereals
c. Fiber
Dietary fiber is a carbohydrate (or a polysaccharide) that is completely not absorbed in
humans and in some animals. Like all carbohydrates, when it is metabolized it can
produce four Calories (kilocalories) of energy per gram. There are two subcategories:
soluble and insoluble fiber. There are many health benefits of a high-fiber diet. Dietary
fiber helps reduce the chance of gastrointestinal problems such as constipation and
diarrhea. They are found in plant foods, vegetables, fruits, grains and legumes and they
are polysaccharides
Recommended adequate amounts of fiber are 20-35 grams per day
Examples of Fibers
Cellulose
This is the primary constituent of plant cell walls and therefore occurs in all vegetables,
fruits and legumes. The characteristics of cellulose includes
 They are made up of glucose molecules connected in long chains.

 Their chains do not branch and they are held together by beta bonds
 They are therefore indigestible by human enzymes.
Hemicelluloses
They are the main constituents of cereal fiber.
 Are composed of various monosaccharides with branching side chains.
 Some are soluble and others insoluble depending on the arrangements of the
chains.
30
Pectins
Consist of a backbone of carbohydrate with side chains of monosaccharide.
 Found mainly in vegetables and fruits especially citrus fruits and apples.
 Pectins can be isolated and used by food industry to thicken jam, keep salad
dressing from separating and control texture and consistency
 Pectins can perform many functions because they readily form gels in water.
Gums and mucilage’s

 Are secreted by cut branch of a plant.
 Are composed of various monosaccharide and their derivative.
 Gums e.g gum arabic are used as additives by food industry.
 Mucilages are similar to gums in structure e.g. guar and carrageen.
 Are added to foods as stabilizers.
Lignin - Has a 3 – dimensional structure that gives strength
 Because of its toughness it is rarely consumed by people.

 It is found in the woody parts of vegetables e.g. carrots or small seeds of fruit e.g.
strawberries.
Types of Fibers
Soluble Fibers
Found mostly in fruits, oats, barley, and legumes
Functions
 Delay the stomach’s emptying and the transit of chyme through the intestines.
 Delay glucose absorption
 Lower blood cholesterol
Insoluble Fibers
Found mostly in vegetables, wheat and cereals.
Functions
 Accelerate the transit of chyme through the intestines.
 Increase fecal weight
 Slow starch breakdown and delay glucose absorption into the blood.
Both soluble and insoluble fiber

 Influence transit time and nutrient absorption in the GI tract.
 Are partially fermented by micro organisms in the digestive tract to fragments that
the body can use.
 Other physical properties of fibers that affect the GI function and nutrient
absorption.
1. Water holding capacity - the capacity to capture water like a sponge,
swelling and increasing the bulk of the intestine’s contents.
31
2. Viscosity – the capacity to form viscous, gel-like solutions

3. Cation – exchange capacity – the ability to bind minerals.
4. Bile – binding capacity – the ability to bind bile.
5. Ferment ability – the extent to which bacteria can ferment them in the
digestive tract.
Phytic acid - A non nutrient component of plant seeds, also called phytate. Found in the
husks of grains, legumes, and seeds and is capable of binding minerals e.g. zinc, iron,
calcium, magnesium and copper.
Health benefits of Fiber

These includes:
 Enhances weight control
 Lowers blood cholesterol
 Helps prevent colon cancer
 Helps prevent and control diabetes
 Helps prevent and alleviate hemorrhoids
 Helps prevent appendicitis
 Helps prevent diverticulitis of the colon
Excess fiber
 Displaces energy and nutrient dense foods
 Causes intestinal discomfort and distention
 Interferes with mineral absorption
Glycemic Effect
The term glycemic effect describes the effect of food on blood glucose:
That is how quickly glucose is absorbed after a person eats, how high glucose rises and
how quickly it returns to normal. Fast absorption, a quick rise in blood glucose, and an
overreaction that forces glucose below normal are undesirable.
In this consideration;
 Different foods have different glycemic index e.g. ice cream which is a sugar food,
produces less response compared to potatoes a high starch food.
 It also differs depending on whether a food is eaten alone or as a mixed meal.
 Also eating small meals frequently spreads glucose absorption across the day,
therefore has the same advantage as foods of low glycemic index.
 This information is very important for people with diabetes. Glycemic index
should be included in meal planning to improve glucose control.
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4.4 Functions of Carbohydrates
Categorised as: available and unavailable Carbohydrates

Available: Simple sugars and starches are easily digested in the small intestines,
they are joined by alpha bonds
Unavailable: Oligosaccharides and dietary fiber are not digestible in the small
intestines. They are joined by beta bonds.
Functions:
1. Energy Production
CHO are converted to glucose which in turn is used by body cells to generate energy.
Fats and proteins can also be used for energy production.
2. Specific energy needs
Brain and Red blood cells depend on carbohydrates as a source of energy. They cannot
use fat directly for energy. If CHO is low in diet protein is converted to glucose to
provide energy.
3. Protein Conservation
After several days of CHO deficiency (Starvation) the body uses fat for energy in order to
spare proteins. Fat is broken down to form ketones which are used for energy. Ketones
are made in liver. The Brain and red blood cells use some energy from ketones in time of
energy deprivation. High levels of ketones in the blood can cause dehydration (ketosis)
due to acidity from accumulation of ketones a condition refered to as ketosis.
4. Regulation of blood glucose
Blood glucose levels are controlled at:
 Normal levels 70-120 mg /dl
 Hyperglycemia > 170 mg /dl
 Hypoglycemia < 40-5- mg/dl
5. Hormonal regulation
Insulin is regulated by the level of glucose in the blood:
 Its secreted when blood glucose is high
 Insulin allows glucose into cells
 Excess glucose is converted to glycogen in liver and muscles
Glucagon is secreted when one is hungry (fasting state)
During this time the blood glucose level is low. Pancreas releases glucagon which leads
to:
 Glycogen is broken down to glucose
 Protein is used to make glucose
33
4.5 Digestion and Absorption of Carbohydrates
4.5.1 Digestion
Mouth: Salivary amylase starts to hydrolyze starch to shorter polysaccharides and to
maltose.
Stomach: Salivary enzyme amylase is digested by protein digesting enzymes. Starch is
therefore not digested because there are no enzymes to digest CHO. Fibers delay gastric
emptying. This provides a feeling of fullness and satiety.
Small intestine: Pancreatic amylase enters the intestine via the pancreatic duct and
continues breaking down the polysaccharides to shorter glucose chains and disaccharides.
The final step takes place on the outer membranes of the intestinal cells.
Enzymes action
 Maltase - breaks maltose into 2 glucose molecules.
 Sucrase - breaks sucrose into 1 glucose and 1 fructose molecule.
 Lactase – breaks lactose into 1 glucose and 1 galactose molecule.
 Fructose and galactose are processed in the liver to form glucose.
 Fibers delay the absorption of carbohydrates and fats in the small intestines
 Fiber in the intestines binds minerals.
 Can cause a risk of deficiency, this can be kept minimal when fiber is taken in
moderation.
Large intestine
 Within 1 to 4 hours after a meal all sugars and most starches are digested. Bacteria
in the intestines tract ferment fibers.
 This process generates water, gas and short – chain fatty acids.
 Short-chain fatty acids are absorbed in the colon and are used for energy.
 Fiber contributes up to 15% of the daily food energy.
Absorption into the Blood Stream

 Glucose can be absorbed in the mouth.
 Monosacchorides are absorbed into the cells lining the small intestines by active
transport and are taken up in the blood circulation.
 Liver - fructose and galactose are converted to glucose and other compounds.
4.5.2 Lactose Intolerance

Normally the enzyme lactase is responsible for the digestion and efficient absorption of
lactose a dissacharide found in milk. Lactase levels are highest after birth to digest milk
which is the first and only food for infants. Lactase activity declines dramatically during
childhood and adolescence to about 5 to 10% of the activity at birth.
Lactose intolerance is a condition that results from inability to digest the milk sugar
lactose; characterized by bloating, gas, abdominal discomfort and diarrhea. Lactose
34
intolerance differs from milk allergy, which is caused by an immune reaction to the
protein in milk.
Symptoms of less lactase to handle the lactose hydrolysis are:

 The undigested molecules attract water and cause bloating, abdominal discomfort
and diarrhea.
 The undigested lactose also becomes food for intestinal bacteria, which multiply
and produce irritating acid and gas, contributing further to discomfort and
diarrhea.
Causes
 Lactase deficiency due to:
- Intestinal villi being damaged by disease
- Certain medicines when taken
- Prolonged diarrhea
- Malnutrition hence poor gut motility
- Being born with a lactase deficiency
Prevalence
The prevalence of lactose intolerance varies widely among ethnic groups, indicating that
the trait is genetically determined.
Dietary changes for management of lactose intolerance.

- Excluding milk and milk products can lead to nutrient deficiencies e.g. calcium and
B2.
- Most people can tolerate a small amount of milk with meals.
- Most people can tolerate- fermented milk products e.g. yoghurt and cheeses. The
bacteria in these foods digest lactose for their own use.
Glucose
 Primary role is to supply energy to body cells.
 Glucose plays a central role in carbohydrate metabolism.
Glucose is stored as glycogen.

Liver - stores 1/3 of the body’s total glycogen.
 Glycogen is hydrolyzed to supply energy to the central nervous system and other
organs regardless of whether a person has eaten or not.
Muscle cells – store 2/3 of the body’s total glycogen.

 Glycogen holds water, it is therefore bulky. It can only be stored for short periods
of time.
35
4.5.3 Maintaining glucose homeostasis

Normal blood glucose is 80 - 120mg/dl. Blood glucose level is regulated by 2 hormones,
insulin and glycogen.
Insulin
1. High blood glucose stimulates the pancreas to release insulin.
2. Insulin stimulates the uptake of glucose into cells and storage as glycogen in the
liver and muscle.
3. Insulin also stimulates the conversion of excess glucose into fat for storage.
4. Blood glucose begins to decline.
Glucagon
1. Low blood glucose stimulates the pancreas to release glucagon into the blood
stream.
2. Glucagon stimulates liver cells to breakdown glycogen and release glucose into the
blood, blood glucose begins to rise.
Other hormones.
Stress hormone epinephrine and other hormones also bring glucose out of storage.
Balancing within normal range
 Eating balanced meals helps maintain a happy medium between extremes.
 Balanced meals provide abundant complex CHO, fibers and protein and a little fat.
The fibers and fat slow down the digestion and absorption of CHO, so that glucose
enters the blood gradually, proving a steady supply.
 Dietary proteins stimulate the secretion of glucagon, whose effects oppose those of
insulin helping maintain blood glucose within normal range.
Diabetes or hypoglycemia
Caused by inability to regulate blood glucose.
In insulin dependent diabetes (IDDM)
The pancreas does not produce insulin – causes
 Genetics
 Toxins
 Virus
 Disorder of immune system
In non insulin dependent diabetes (NIDDM), cells fail to produce insulin causing
obesity. Fat cells resist insulin.
Dietary control - low fat, complex carbohydrates and fiber, limited sugars
Spreading total food intake over many meals and snacks a day without an increase in
energy intake is a relatively easy and effective way to lower blood glucose
Cholesterol becomes harmful when it forms deposits in the artery walls. The deposit
leads to atherosclerosis, a disease that causes heart attacks and strokes.
36
Making glucose from protein

 When glycogen stores are depleted, body proteins are broken down to make
glucose.
 This process is referred to as gluconeogenesis.
 Only enough CHO can prevent this use of protein for energy.
 This role of CHO is known as its protein sparing action.
Making ketone bodies from fat

 Low glucose leads to fat use.
 Fat is broken down to provide energy in the presence of glucose, this ensures
complete breakdown of fat.
 But when glucose is absent fat breakdown is not complete and forms ketone bodies.
 Muscles and tissues can use ketone bodies for energy.
 When their production exceeds their use, they accumulate in the body to and cause
ketosis.
To ensure complete sparing of protein and prevent ketosis requires 50-100 gms of
carbohydrate a day
Converting glucose to fat

Liver breaks extra glucose into smaller molecules and then puts them together to form
fat. Then fat travels to the fatty tissues of the body for storage. Fat cells can store
unlimited amounts of fat.
4.6 Definition Summary

Homeostasis: Maintaining an equilibrium environment in the body e.g. glucose
homeostasis- maintain blood glucose levels at 60-120 mg/dl
Hyperglycemia: high concentration of glucose in the blood (^ 120 mg/dl)
Insulin: A hormone from the pancreas.
Glucagon: A hormone from the pancreas, releases glucose from liver to raise blood
glucose levels.
Gluconeogenesis: Liver makes glucose from protein and glycogen.
Ketosis: Rapid fat break-down in starvation and fasting.
Basal metabolism: The energy needed to maintain life when a body is at complete rest.
Basal metabolic rate (BMR): The rate at which the body spends energy for maintenance
of the above activities.
Body composition – the proportions of muscle, bone, fat and other tissues that makes up
a person’s total body weight.
37
4.7 Question
1. State the different classes of carbohydrates.

2. What are considered to be the normal range of glucose and which are the
hormones responsible for maintaining it?
3. What are the health benefits of fibre discuss this giving specific example?
4. How is energy expenditure calculated and what are some of the health risks associated
with too much energy intake?
5. What are the enzymes involved in the digestion of carbohydrates? Why are some
carbohydrates digestible and others are not?
6. What is lactose intolerance?
4.8 Activity
If your diet contains less than the recommended 55 to 60% of energy from
carbohydrate, suggest some high carbohydrate alternative to your low-
carbohydrate.
Discuss the health condition that is associated with poor regulation of blood glucose
levels.
Further Reading

Publishing, USA.
Dietary Fiber: Essential for a healthy diet.

http://www.mayoclinic.com/health/fiber/NU00033
Shils et al. (2005). Modern Nutrition in Health and Disease. Lippincott Williams and
Wilkins. ISBN 0-7817-4133-5.
Hallfrich J, (1990) Metabolic effects of dietary fructose. FASEB j.4:2652-2660.
38
LECTURE FIVE: LIPIDS
5.0 INTRODUCTION
Lipids are organic compounds, most of which do not dissolve in water. Lipids are the
body’s most concentrated source of stored energy, providing 9kcalories per gram. They
are an important structural component of cells, particularly in the brain and nervous
system. As a component of all cell membranes, lipids protect the internal environment of
cells. The layer of adipose tissue that lies under the skin and around internal organs
protects the body from changes in temperatures and provides a cushion to protect against
shock. Lipids help transport fat soluble substances such as vitamins A, E and D through
the intestinal tract and bloodstream. They are needed for the synthesis of hormones that
regulate body function.
5.1 OBJECTIVES
By the end of this lesson, you should be able to:

1. State the difference between lipids and fats.
2. Differentiate between saturated fatty acid and unsaturated
3. Discuss the role of lipids in the body.
4. State the functions of fat in the diet.
5.2 Definitions
Fats are lipids that are solid at room temperature. Oils are lipids that are liquid at room
temperature. They dissolve in chloroform, benzene, and ether but not in water. Lipids
contain fewer oxygen atoms per carbon atom compared to carbohydrates and proteins.
They have more kilocalories per gram (9) compared to carbohydrates (4) or protein (4).
Trigycerides are the main form of fat in food
5.3 Types of Fatty Acids

Saturated fatty acids- refers to a fatty acid in which the carbon atoms are bound to as
many hydrogens as possible and therefore contains no carbon – carbon double bond e.g.
.stearic
Unsaturated Fatty acids- refers to a fatty acid that contains one or more carbon-carbon
double bonds e.g. monounsaturated fatty acid contains one carbon-carbon double bond
e.g. oleic acid – olive oil, while polyunsaturated fatty acid contains two or more carbon –
carbon double bond e.g. linoleic and linolenic acid, corn, soybean and sunflower are good
sources. Omega - 3 (ω-3) fatty acid has a double bond at the 3rd carbon – e.g. linolenic
acid e.g. fish oils. Omega – 6 (ω -6) fatty acid has a double bond at the sixth carbon e.g.
linoleic acid. Omega – 3 and omega – 6 are essential fatty acids.
39
Functions of lipids
 Form part of vital structures in the body - growth
 Take part in immune system and vision
 Form cell membrane
 Make hormone – like compounds – eicosanoids.
5.4 Essential Fatty Acids

These are fatty acids that must be present in the diet to maintain health because they
cannot be synthesized by the body in adequate amount. They include linoleic found in
vegetable oil, arachidonic found in both animal and vegetable fats and alpha-linolenic
acids found in vegetable oils.
RDA- 10 % kcal, of essential fatty acid should come from poly-unsaturated fat.
5.4.1 Essential Fatty Acids Deficiency

This is a condition that results when the diet does not supply sufficient amounts of
linoleic, arachidonic or alpha-linolenic acid. Symptoms such as flaky, itchy, sore skin,
diarrhea and retarded growth may occur.
5.5 Triglycerides
These are the major form of lipids in food and the major storage form of lipid in the
body. They form 95% of fat in the body and food. They consist of three fatty acids
attached to a glycerol molecule.
General structure of a triglyceride
The chemical formula is RCOO-CH2CH(-OOCR')CH2-OOCR", where R, R', and R" are

longer alkyl chains. The three fatty acids RCOOH,
Esterification /Condensation- The process of putting together 1 glycerol molecule + 3

fatty acids to form a Triglyceride.
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of Triglycerides
 Unlimited storage of energy
 Main source of energy for muscles
 40%of energy used by the body at rest.
 Insulates and protects the body organs (adipose tissue)
 Transports fat – soluble vitamins (A, D, E AND K)
5.6 Phospholipids
They are lipids with a phosphorus-containing group called a phosphate group.
1. E.g. lecithins are important components of all cell membranes.
2. They participate in the digestion of fat in the intestines.
3. Are non-essential
5.7 Sterols – Cholesterol

 Found in animal foods only
 Makes some hormones e.g. vitamin D
 An essential part of the cell
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Cholesterol and lecithin

 Made by the body are non-essential
 Cholesterol needed for Synthesis of steroid hormones e.g. estrogen testosterone,
vitamin D calcitriol
 Bile salts – fat emulsification
 Part of the cell structure.
 Too much cholesterol is associated with heart disease and cancer.
Cell membrane + phosphor lipids
Constituents of the lipoprotein
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FAT ABSORPTION
Emulsification
Phospholipids and cholesterol act as emulsifiers in digestion and also in fats and oils in
foods e.g. salad dressings.
RDA for fat
 There is no RDA for fat.

 Recommended intake is 20-30% of total kcal.
 Cholesterol >300 mg/day
Concentration of Fat in foods:

Highest nutrient dense for fat
100%–salad oils, butter, margarine and mayonnaise
80% - walnuts, bologna, avocados, bacon
75% - peanut butter and cheddar cheese
60 % - steak, hamburgers
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50 % - chocolate bars ice-cream, doughnuts, whole milk.

35 % - pumpkin pie, cupcake
15 % - bread
5.10 Digestion, Absorption and Transport of Lipids

On average the GI receives 50 to 100gms of triglyceride per day, 4 to 8 grams of
phospholipids and 300 to 450 mg of cholesterol.
Lipid Digestion
The goal is to breakdown triglycerides into small molecules that the body can absorb and
use, for example monoglycerides, fatty acids and glycerol.
Mouth
 Starts off slowly in the mouth.
 Salivary glands at the base of the tongue release a lipase enzyme that plays a small
role in fat digestion; this enzyme is more active in infants than adults. In infants
this enzyme efficiently digests the short and medium – chain fatty acids found in
milk.
Stomach
Little fat digestion – floats on top of the other food components.
Small intestines
 When fat enters the small intestine, the hormone cholecystokin (CKK) signals the
gall bladder to release its stores of bile an emulsifier.
 Liver manufactures bile acids from cholesterol, and the gall bladder stores the bile
until it is needed.
 At the end of each bile acid are side chains of amino acids and at the other end is a
sterol portion that is attracted to fat. Bile draws fat molecules into the surrounding
watery fluids. There, the fats meet lipase enzymes from the pancreas and small
intestine and are fully digested.
Emulsification of fat by bile

1. In the stomach, the fat and water GI juices tend to separate. The enzymes are in
the water and can’t get at the fat.
2. When fat enters the small intestines, the gall bladder secrets bile. Bile has an
affinity for both fat and water, so it can bring the fat into solution in the water.
3. After emulsification, the fat is mixed in the water solution, so the enzymes have
access to it.
Bile contains acids and salts, cholesterol, phospholipids (leathin) antibodies, water
electrolytes and bilirubi (a pigment from breakdown of hemicellulose.
The fibers that are most effective in lowering cholesterol are the soluble pectin and gums
found in fruits, oats and legumes.
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5.11 Lipid Absorption

 Glycerol, shortchain and medium chain fatty acids diffuse into the intestinal cells,
are absorbed directly into the blood stream.
 Larger units, the monoglycerides, and long-chain fatty acids, merge into
complexes, called micelles. The micelles easily diffuse into the intestinal cells.
Once inside the monoglycerides + long chain fatty acids are reassembled into new
triglycerides.
 In the intestinal walls the triglycerides and other large lipids (cholesterol and
phospholipids) are packed into transport vehicles known as chylomicrons. The
intestinal cells then release the chylomicrons into the lymphatic system.
5.12 Lipid Transportation

 Lipids are transported in the blood as lipoproteins.
 There are four different kinds of lipoproteins they differ in amounts of various
components.
 Chylomicrons – transport lipids to liver. Special receptors on membranes of liver
cells recognize and remove the lipids from the blood.
 In the liver the chylomicrons are broken down. VLDL – very low density
lipoproteins (high in triglycerides)
 The liver picks up the fatty acids arriving from the blood and use them to make
- Cholesterol
- Other fatty acids
- Other compounds.
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Lipids absorption and transport in the body
46
Functions of Lipids in the body

1. Provide energy
2. Insulating against extreme temperature
3. Protect against shock
4. Building cell structures.
Storing Fat as Energy

 Fat provides more than 2x the energy of CHO and fat, making it an extremely
efficient storage form of energy.
 Body’s storage for energy in adipose tissue is unlimited.
 Adipose cells have a special enzyme on their surface-lipase CLDL) that captures
circulating triglycerides from lipoproteins.
 Hydrolyzes them to fatty acids and monoglycerides.
 Inside the cell the enzymes reassemble the pieces for storage.
Making fat from CHO or protein

Special enzyme can convert CHO or protein to fat.
Efficiency of making fat from fat
 Fats are more easily converted to fat as compared to CHO where the process in
much longer and uses up energy.
 To limit fat storage therefore limit amount of fat intake.
Using Fat for Energy

 Fat supplies 60% of the body’s energy needs during rest.
 During exercise or prolonged periods of food deprivation fat stores may be used for
energy needs.
 An enzyme, hormone-sensitive lipase inside the adipose cells breakdown the stored
fat in form of triglycerides to glycerol and fatty acids and releases them to the blood
stream.
 Body fat cannot be broken down completely in the absence of glucose thus leading
to ketosis.
Health Effects
1. Heart disease if cholesterol is high.
2. Risks from saturated fats as they raise blood cholesterol.
3. Effects of polyunsaturated and monounsaturated fatty acids.
- Lower LCL cholesterol.
- Polyunsaturated fatty lower both HDL and LDL.
- Monounsaturated fats raise HDL
4. Risks from trans-fatty acids since they raise LDL and lower HDL like some
saturated fats.
5. Benefits from CO3 fatty acids.
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 Improves lipid profile therefore improve blood lipids.

 Prevents blood clots
 Lower blood pressure especially in people with hypertension or atherosclerosis.
6. Cancer- dietary fat is linked to some types of cancer in animal studies.
Reduced or delayed cancer development and reduced rate of growth and size and number
of tumors, with CO3 and CO6 fatty acids.
7. Obesity - Intake of fat contributes to fat storage and hence weight gain.
5.13 Question
1. What is a lipid?
2. What are the four classes of lipids found in the body?
3. What distinguishes a saturated fat from a monounsaturated or
polyunsaturated fat?
4. Name the functions of fats in the diet.
5. Name the functions of essential fatty acids in the body
5.14 Activity
Review all three days of the food record you kept in lesson three. Identify two
foods from your diet that are sources of each of the following:
a. Cholesterol
b. Saturated fat
c. Polyunsaturated fat
d. Monounsaturated fat
e. Omega-3 fatty acids
f. Partially hydrogenated vegetable oils.
State the recommended intake of fats in the diet. What are some of the health benefits of
fat in the body? Discuss the risks associated with excess intake of some types of fat.

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LECTURE SIX: PROTEINS
6.0 INTRODUCTION
Proteins are the basis of many animal body structures (e.g. muscles, skin, and hair). They
also form the enzymes which control chemical reactions throughout the body. Each
molecule is composed of amino acids which are characterized by inclusion of nitrogen
and sometimes sulphur (these components are responsible for the distinctive smell of
burning protein, such as the keratin in hair). The body requires amino acids to produce
new proteins (protein retention) and to replace damaged proteins (maintenance). As there
is no protein or amino acid storage provision, amino acids must be present in the diet.
Excess amino acids are discarded, typically in the urine. About twenty amino acids are
found in the human body, and about ten of these are essential, and therefore must be
included in the diet. A diet that contains adequate amounts of amino acids (especially
those that are essential) is particularly important in some situations: during early
development and maturation, pregnancy, lactation, or injury (a burn, for instance). A
complete protein source contains all the essential amino acids; an incomplete protein
source lacks one or more of the essential amino acids.
6.1 OBJECTIVES
By the end of this lesson, you should be able to:
 Describe the chemical structure of proteins

 Discuss the role of essential Amino Acids
 Explain the concept of nitrogen balance
 Explain the causes and consequences of dietary protein deficiency
6.2 Definitions
Protein: - Compose 16% of body weight in a lean individual. Amino acids are the
building blocks for protein.
Proteins are involved in key body functions including: blood clotting, fluid balance,
production of enzymes and hormones, vision, cell repair, a component of body structure,
provides energy and Immune function.
Amino Acids: - In structure, proteins resemble chains, consisting of amino acid linked
together. Amino Acid contains carbon, hydrogen, oxygen and nitrogen and some have
sulfur, chains of amino acids are formed when the amino group of one amino acid links
the acid group of another amino acid. Two amino acid link together to form a dipeptide.
A polypeptide is formed when many amino acids link together.
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Amino acid
Protein is made up of 20 different amino acid, nine from Essential amino acids which
cannot be made by the body, also called indispensable amino acid; and eleven from Non-
essential amino acids which can are synthesized by the body, also called dispensable.
Conditionally indispensable Amino acids are amino acids that are normally nonessential,
but must be supplied by the diet in special circumstances when the need for it exceeds the
body’s ability to produce it, for example Cysteine are made from Methionine and
Tyrosine from Phenylalanine. Most protein foods contain at least 100 amino acids.The
body can join different amino acids in different patterns to make proteins for specific
functions
Transamination: - metabolic process for synthezing non-essential amino acids.
Deamination: - removal of the amino Group from the amino acid. The amino group (-
NH2) is incorporated into urea for excretion. The carbon skeleton is then used for energy.
Tripeptide: - 3 amino acids
Oligopeptide: -3 – 50 amino acids
Sickle-cell disease: - incorrect sequence of amino acids that form the hemoglobin.
Denaturation of proteins- alteration of the form of proteins, due to treatment by heat,
acid, alkaline solution or agitation. For example boiled egg coagulates because of heat
and curdling of milk due to acid.
High-quality proteins- Dietary protein that contains all the essential amino acids in the
right proportions also called complete proteins. Can support growth and maintenance e.g.
animal proteins.
Dietary proteins that lack one or more essential amino acids also called incomplete
proteins. Cannot support growth and maintenance e.g. plant proteins.
Limiting amino acids - essential amino acids supplied in less amounts than needed to
support protein synthesis e.g. Grains - lysine, threonine; Legumes – methionine; Nuts
and seeds – lysine and Vegetables - methionine
Complementary value of protein- achieved by putting two sources of proteins together
in order to complement each other for the limiting amino acid e.g. rice + red beans,
Chapati + green grams.
Biological value of a protein is a measure of high efficient a food protein can turn into
body tissue.
6.3amino Acids
Amino acids are the building blocks of protein.
Proteins are polymer chains made of amino acids linked together by peptide bonds.
Amino acids can be divided into either essential amino acids or non-essential amino
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acids. Proteins and carbohydrates contain 4 kcal per gram as opposed to lipids which
contain 9 kcal per gram.
The essential amino acids, which must be obtained from food sources, are leucine,
isoleucine, valine, lysine, threonine, tryptophan, methionine, phenylalanine and
histidine. On the other hand, non-essential amino acids can be made by the body from
other amino acids.
The non-essential amino acids are arginine, alanine, asparagine, aspartic acid,
cysteine, glutamine, glutamic acid, glycine, proline, serine, and tyrosine.
Proteins are broken down in the stomach during digestion by enzymes known as
proteases into smaller polypeptides to provide amino acids for the body, including the
essential amino acids that the organism cannot be biosynthesized by the body itself. Thus,
protein from one's diet should provide both essential and non-essential amino acids for
protein synthesis.
Most animal and certain vegetable proteins are considered complete proteins with a full
complement of essential amino acids in adequate proportions. People who avoid animal
products for religious and health reasons may practice protein combining to get the
essential amino acids in their diet.
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52
Functions of Proteins
Antibodies - are specialized proteins involved in defending the body from antigens
(foreign invaders). One way antibodies destroy antigens is by immobilizing them so that
they can be destroyed by white blood cells.
Contractile Proteins - are responsible for movement. Examples include actin and
myosin. These proteins are involved in muscle contraction and movement.
Enzymes - are proteins that facilitate biochemical reactions. They are often referred to
as catalysts because they speed up chemical reactions. Examples include the enzymes
lactase and pepsin. Lactase breaks down the sugar lactose found in milk. Pepsin is a
digestive enzyme that works in the stomach to break down proteins in food.
Hormonal Proteins - are messenger proteins which help to coordinate certain bodily
activities. Examples include insulin, oxytocin, and somatotropin. Insulin regulates
glucose metabolism by controlling the blood-sugar concentration. Oxytocin stimulates
contractions in females during childbirth. Somatotropin is a growth hormone that
stimulates protein production in muscle cells.
Structural Proteins - are fibrous and stringy and provide support. Examples include
keratin, collagen, and elastin. Keratins strengthen protective coverings such as hair,
quills, feathers, horns, and beaks. Collagens and elastin provide support for connective
tissues such as tendons and ligaments.
Storage Proteins - store amino acids. Examples include ovalbumin and casein.
Ovalbumin is found in egg whites and casein is a milk-based protein.
Transport Proteins – they are carrier proteins which move molecules from one place to
another around the body. Examples include hemoglobin and cytochromes. Hemoglobin
transports oxygen through the blood. Cytochromes operate in the electron transport
chain as electron carrier proteins.
Maintaining Fluid Balance

- Blood proteins albumin and globulin help maintain fluid balance in the body.
- Blood pressure in arteries forces fluid out to the extracellular space to take nutrients to
the cells.
-Proteins counter this by attracting fluid back to the blood. (Osmotic and entotic
pressures)
If a person does not eat enough protein; water is retained in the tissues (oedema). Other
conditions that lead to oedema include: Heart disease; Kidney disease; Liver disease;
Pregnancy; Children with PEM
Contribution to Acid –Base Balance

Proteins act as buffers by providing hydrogen ions to maintain a neutral pH.
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Forms Glucose
If the diet does not provide enough carbohydrates, then the liver makes glucose from
amino acids - gluconeogenesis.
Provide Energy
Provides 4 calories per gram of protein –Deamination
6.4 Proteins in Foods

 Fruit and fat groups - no protein
 Vegetables- 2gms per exchange
 Starch/bread - 3gms exchange
 Meat - 7gms exchange
 Milk - 8gms exchange
6.5 Protein Deficiency
Protein Energy–Malnutrition (PEM) – is a condition caused by consuming insufficient

amounts of protein and k calories overtime. The deficiency results in body wasting and
increased susceptibility to infections. 500 million children are affected by PEM.
6.6.0 Kwashiorkor
This is a form of PEM that results from inadequate protein intake. It is most common
among children aged 1 – 3 years who are unable to meet their high protein needs with the
available diet.
Protein deficiency causes Kwashiorkor
Symptoms include:
 Apathy
 Listlessness
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 Failure to grow and gain weight

 Withdrawn
 Edema
 Dry flaky-paint skin
 Anorexia
 Enlarged liver
 Thinning and loss of hair color
 Infection and parasites
6.6.1 Marasmus
This is another form of PEM that results from a severe deprivation, or impaired
absorption, of energy, protein, vitamin and minerals causing severe body wasting.
Marasmus is common in children aged 6 to 18 months.
Protein-Energy defiency causes marasmus
Causes:
 Illness, infections and disease
 Improper weaning practices
 Famine and other disasters
 Ignorance of care takers
 Poverty
 Mother’s education
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Symptoms
 Failure to grow and gain weight
 Very wasted, no subcutaneous fat
 Illness and infections
 No edema
 Hair, sparse, thin, dry, pull out
 Good appetite
 Skin, dry, easily wrinkles
Both marasmus and kwashiorkor are characterized by edema for kwashiorkor and
wasting for maramus. The combination of Infection, fever, electrolyte imbalances, and
anemia often leads to Heart failure and occasionally sudden death.
Rehabilitation
 24-48 hours – fluid and electrolytes to blood pressure and strengthen heart.
 Protein and energy foods is very small amounts gradually
 Easier to treat marasmus than kwashiorkor child
Those most likely to be affected by protein deficiency include.
 Infants and children in underdeveloped countries

 Those around the world who live in extreme poverty
 The elderly who live by themselves
 Those with eating disorders such as anorexia nervosa, or who simply don’t eat
enough
 Those addicted to drugs or alcohol, especially when combined with low income
 Those pursuing a low-protein diet for whatever reason, including fads or weight
loss
 Those with tuberculosis or AIDS
 Those whose main diet is low in protein due to poor food choices, eating too
much junk food
6.7 Nitrogen Balance

When the body maintains the same amount of protein in its tissues from day to day it is in
nitrogen balance. Nitrogen balance is the amount of nitrogen consumed as compared with
the amount of nitrogen excreted in a given period of time.
 Positive nitrogen balance- Nitrogen intake exceeds output e.g. in growing infants
and children, Pregnant women, People recovering from protein deficiency.
 Negative nitrogen balance more protein loss than intake e.g. in starvation,
injuries, fever burns, infections.
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6.10 Protein Digestion
Mouth
Protein are crushed and moistened in the mouth.
Stomach
In the stomach, hydrochloric acid denatures proteins so that digestive enzymes can act on
the peptide bonds, and also converts the inactive form of enzyme pepsinogen to active
form pepsin. Pepsin breaks down large polypeptides into smaller polypeptides and some
amino acids.
Small intestine
In small intestine, pancreatic and intestinal protease hydrolyzes polypeptides further into
short peptide chains oligopeptides, tripeptides, dipeptides and amino acids.
Trypsin - among other proteases which digest protein in the small intestine, breaks large
proteins to peptides.
Absorption
The cells of the small intestine absorb amino acids and have peptidase enzymes on their
surfaces that split most of the dipeptides and tripeptides into single amino acids. The
membranes of intestinal cells transport the amino acids into the cells, where they are
released into the bloodstream.
6.11 Activity
Imagine that you have decided to become a lacto-vegetarian. Replace the animal foods
in your diet with plant foods or dairy products. Calculate the protein content of this
lacto-vegetarian diet. Does it meet your RDA for protein? If you already consume a
lacto-vegetarian diet, try to convert your diet into a vegan diet by substituting plant
sources of protein for dairy products.
6.12 Question
1. How are amino acids classified, give examples?

2. List the main functions of proteins in the body.
3.
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LECTURE SEVEN: VITAMINS
7.0 INTRODUCTION
 Vitamins are essential organic that provide no energy but are needed in small
amount in the diet to promote and regulated body functions. Vitamin deficiencies
remain a major problem worldwide. Vitamin supplements taken in excess are
becoming a major concern toxic.
 How much of a vitamin is available to the body is regulated by the absorption,
transport, activations, storage and excretion of that vitamin. Vitamins are
established by evaluating the results from many different kinds of studies,
including depletion – repletion studies, nutrient balances studies, studies that
relate to a parameter of metabolic function, information from animal experiments
and epidemiology observations. When information is not sufficient to develop a
specific recommendation, estimated safe and adequate dairy intakes are
suggested. Too little will results in a deficiency and excess can be toxic.
 In most cases adequate intakes of vitamins can be obtained from a well balanced
diet but certain people may need vitamin supplementation. How food is
transported handled, processed, prepared and cooked must be considered in diet
planning.
 Most people can meet their vitamin needs from food. Except in special
circumstances e.g. population of high risk for malnutrition due to inadequate
nutrient intake, people with chronic diseases, vegetarians, drug and alcohol abuse,
people in certain stages of life cycle. Supplements can be recommended
sometimes under these conditions.
 Vitamin differ from the carbohydrates, fats and proteins in the following ways:
- Structure- vitamins are individual units; they are not linked in long chains.
- Function – vitamin do not yield usable energy when broken down, they
assist enzymes that release energy from carbohydrates, fats and proteins.
- Food contents- the amount of vitamins required are measured in
micrograms or milligrams rather than grams.
 The fat soluble vitamins include vitamins A,D,E,K while water-soluble vitamins
are Vitamin B and C.
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7.1 OBJECTIVES
 Discuss the differences between fat soluble and water soluble vitamins
 Describe the function and dietary sources of vitamins
 List the dietary reference values for vitamins.
 Explain the consequences of inadequate and excessive vitamin intake
7.2 Fat Soluble Vitamins

These include vitamins A, D, E, and K, they are normally found in the fats and oils of
foods. They are insoluble in water, so they require bile for digestion and chylomicrons for
absorption.
7.2.1 Vitamin A
There are several forms of vitamin A. The retinoids, which include retinal, retinol and
retinoic acid which are used by the body to promote vision and for growth and cell
differentiation and thereby maintaining the health of epithelial tissues and skin, support
the immune system, promoting growth and bone remodeling. It is found in the diet in
both preformed as retinal, and retinoic acid and precursor forms, carotenoids, most
commonly beta carotene. Although carotenoids are not toxic, preformed vitamin A can be
toxic. The major food sources of preformed vitamin A include liver, fish and fortified
dairy products.
There are also provitamins A form called carotenoids. They are used by the body as
Vitamin A but must be converted to retinoids. They protect cells against damage by
oxygen. Carotenoids are found in fruits and vegetables e.g. pawpaw, mangoes, plums,
carrots, tomatoes, green leafy vegetables etc. There is epidemiological evidence that a
diet high in fruits and vegetables containing beta- carotene protects against cancer.
Vitamin A is a micronutrient of public health concern in Kenya and other developing
countries.
Functions of Vitamin A
1. Retinol has an important function in the visual process; necessary for vision in dim
light.
2. Is necessary for maintaining the integrity of healthy epithelium especially the
membrane line of eyes, mouth, gastrointestinal, respiratory and genitourinary tract.
3. Is required for normal skeletal growth and tooth development.
4. Vitamin A also facilitates other functions such as for reproductive cycle, in iron
metabolism.
5. Beta-carotene is a powerful antioxidant. It helps to protect the easily oxidized
nutrients, such as PUFAs, from oxidation. It is also able to protest the body from the
harmful effects of the free radicals in the body.
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Deficiency
Vitamin A deficiency is one of the major nutrition problems for the developing countries.
More than 100 million children worldwide have some degree of vitamin A deficiency and
so are vulnerable to infectious disease.
One of the earliest signs of vitamin A deficiency is known as ‘night blindness’-a
condition when it is difficult to see in dim light. It is caused by shortage of retinol
derivative called ‘rhodopsin’. Vitamin A is essential for the maintenance of healthy skin
and mucous membranes. Long-term deficiency causes dead cells to accumulate on
surface of eye making it dry and opaque (xeropthalmia). In case of infection and
ulceration of cornea (keratomalacia) and may lead to blindness. This is a major public
health problem in our country.
Symptoms of vitamin A deficiency include:

 Unhealthy epithelial tissue results in infection due to invasion by bacteria and virus e.g.
respiratory infections and diarrhea.
 Failure of growth of bones
 Dry eyes and skin
 Anemia
Toxicity
As deficiency of vitamin A affect all the body system, so does toxicity.
 Too much vitamin A is toxic
 Headaches, pain in joints
 Itching and rashes
 Loss of hair
 Muscle weakness
 Diarrhea, loss of appetite
 Amenorrhea, enlarged liver and spleen
Food Sources
Plant origin-Dark green, orange, red fruits and vegetables
Animal origin-Meat especially liver, fish liver oils, milk and milk products and eggs.
7.2.2 Vitamin D
Vitamin D is different from other nutrients in that the body can synthesize it with the help
of sunlight; it is therefore not an essential nutrient but the dietary requirement varies
depending on the amount synthesized. Vitamin D is essential for calcium absorption from
the intestine, calcium deposition and release from the bone and the kidney.
Synthesis and forms of Vitamin D

Several forms (vitamers) of vitamin D exist (see table). The two major forms are vitamin
D2 or ergocalciferol, and vitamin D3 or cholecalciferol, vitamin D without a subscript
refers to either D2 or D3 or both. These are known collectively as calciferol. Vitamin D2
was chemically characterized in 1932. In 1936, the chemical structure of vitamin D 3 was
established and resulted from the ultraviolet irradiation of 7-dehydrocholesterol.
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Chemically, the various forms of vitamin D are secosteroids; i.e., steroids in which one of
the bonds in the steroid rings is broken. The structural difference between vitamin D 2 and
vitamin D3 is in their side chains. The side chain of D2 contains a double bond between
carbons 22 and 23, and a methyl group on carbon 24.
Vitamin D2 is a derivative of ergosterol, a membrane sterol, and is produced by some

organisms of phytoplankton, invertebrates, and fungi in response to UV irradiation; D 2 is
not produced by land plants or vertebrates. The biological fate for producing 25(OH)D
from vitamin D2 is expected to be the same as for D3, although some controversy exists
over whether or not D2 can fully substitute for vitamin D3 in the human diet
Absorption, synthesis and metabolism of Vitamin D; adpted from Morsby (1993)
Deficiency of Vitamin D
Symptoms of vitamin D deficiency include:

 Rickets in children
 Osteomalacia in adults
Toxicity
Toxicity can increase calcium absorption and bone mineralization, high blood calcium
which causes deposition of calcium in the kidneys, heart, lungs and arteries.
Food Sources
Animal origin include: Eggs yolk, Liver, Fatty fish, Butter, Fortified milk
The body makes vitamin D from exposure to the sun.
7.2.3 Vitamin E
Vitamin E functions primarily as a fat soluble antioxidant and a primary defender of the
body against oxidation, protecting the lipids and other vulnerable components of the cells
and their membranes from destruction. Since polyunsaturated fats are particularly
susceptible to oxidative damage, its requirement increases as the polyunsaturated fat
content of the diet increases. Vitamins E are very active in the lungs and red blood cells
where there is high exposure to oxygen; it also helps to protect the lungs against air
pollutants especially when a person is breathing hard during exercising. Vitamin E plays
a role in the immune system by protecting the white blood cells.
Function
The principal role of vitamin E is as an antioxidant, though the exact mechanism is not
yet known. Various other functions are as follows:
a) Regulation of immune response through cell mediated immunity.
b) Protects from various diseases like cancer, arthritis and ischaemic heart disease by
preventing peroxidation and maintaining integrity of cellular membrane.
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c) Prevents oxidation of beta carotene, vitamin A and vitamin C. Prevents lipid

peroxidation of polyunsaturated fatty acids(PUFA) in cells.
d) In rats, Vitamin E affects the reproductive biology. But no such definitive role has
been observed in human subjects.
e) The vitamin derivative is found to be necessary for Coenzyme Q synthesis.
f) They are used in the food industry as antioxidants and permitted food additives.
Deficiency
 Hemolysis of red blood cells
 Loss of muscle co-ordination and reflex.
 Impaired vision and speech
 Deterioration of respiratory muscles
 Associated with some types of cancers.
Toxicity
High doses of vitamin E can interfere with functions of vitamin K. A lot of people take
vitamin E supplements for various reasons e.g. improved physical performance, enhances
sexual performance, slows process of aging, slow progression of some diseases. These
claims have no scientific basis.
Food Sources
Oil seeds, meats, eggs, nuts, soybean oil, wheat germ, plant oils and green vegetables.
7.2.4 Vitamin K
Vitamin K is found in plants and synthesized by bacteria in the gastrointestinal tract.
Vitamin K is essential for blood clotting. It also participates in the synthesis of bone
protein. A deficiency of vitamin K results in a failure of blood to clot. Since this is a
problem in new born, an anti vitamin K factor, dicumarol is used medically as an
anticoagulant.
Metabolism
In the presence of bite salts Vitamin K is readily absorbed along with fats in the upper
small intestine and is transported to liver in the chylomicrons.
Function
• The main function is in the formation of a number of coagulation factors like
prothrombin factor II, VII, IX and X.
• Some studies have suggested the role of vitamin K and D on bone mineral density/ bone
health.
Deficiency
The dietary deficiency is usually unlikely, but the deficiency may occur due to
interference with the absorption or synthesis. The deficiency leads to an increase in the
prothrombin time and thus an increase risk of hemorrhage.
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Recommended Dietary Allowance

Due to the variation in intestinal synthesis, no dietary allowances have been
recommended. Still ‘safe intake’ advised for adults is 1-2 μg/kg Body Weight/day and
10μg/day for infants.
Dietary sources
Green leafy vegetables are good sources of vitamins K, though the absorption is
relatively poor as it is bound to membrane of the chloroplasts. Some plant derived oils
such as Soya and Canola oils are also rich in vitamin K. Further research is still required
to find the bioavailability and bioactivity of Vitamin K form in different food sources.
Toxicity
No documentation of vitamins K toxicity has been reported.
Food sources
Liver, leafy vegetables and cabbage.
7.3 Water Soluble Vitamins

These are vitamin B and C. The water-soluble vitamins are found in the watery
compartments of foods. On being absorbed, the water-soluble vitamins move directly in
to the blood. The kidneys, monitoring the blood that flows through them, detect and
remove excess water-soluble vitamins.
7.3.1 Vitamin B
The 8 B vitamins serve as coenzymes to the enzymes that are involved in the breakdown
of carbohydrates, fats and proteins to produce energy. Thiamine, Riboflavin and niacin
are the key vitamins involved in energy metabolism so their requirement varies with
energy intake. Thiamine is required for the generation of energy from macronutrients and
the synthesis of the neurotransmitter acetylcholine. Riboflavin coenzymes are needed for
the generation of energy. Riboflavin is needed for the utilization of several other
vitamins. Niacin coenzymes are important in the breakdown of carbohydrates, proteins
and fat and in the synthesis of fatty acids and steroids. Supplements of the nicotinic acid
form of niacin can lower elevated blood cholesterol, but their use is limited by toxicity
symptoms such as flushing, tingling sensations and a red skin rash.
Best food sources for:

Niacin- Beef, chicken, fish and enriched grain products. The amino acid tryptophan can
be converted into niacin, Liver, whole grains, legumes nuts, milk, yogurt and vegetables,
Thiamine- lean pork, legumes, and whole or enriched grains and cereals,
Riboflavin - milk, meat, and enriched grain products.
Deficiencies
 Thiamine – Beriberi causes nervous systems abnormalities. Deficiencies are
common in alcoholics. No toxicity identified
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 Riboflavin – affects facial skin, eyes and GI tract

 Niacin – pellagra (dementia, dermatitis, diarrhea, death).
7.3.2 Biotin and Pantothenic Acid

Biotin is needed for the synthesis of glucose, fatty acids and DNA and the metabolism of
certain amino acids. A RDA has not been established because some biotin is made by
gastrointestinal bacteria. Pantothenic acid is part of coenzyme A (COA), which is
required for the production of energy from protein, carbohydrates and fat and the
synthesis of fat and cholesterol deficiency is rare.
Deficiency
Insomnia, depression, muscle pain and weakness, fatigue
Food sources
Liver, eggs, yolks, cereals, and yeast.
7.3.3 Vitamin B6
Pyridoxal phosphate, the coenzyme form of vitamin B6 is needed for the activity of more
than 50 enzymes involved in the metabolism of protein, carbohydrates, and fat. Vitamin
B6 is essential for amino acid and fatty acid metabolism, so its requirement is affected by
protein intake. It’s involved in making non-essential amino acids and neurotransmitters.
It also helps to make the blood cells.
Deficiency
Insomnia, weakness, irritability, growth failure, impaired motor function, convulsions.
Toxicity
Nerve damage, numbness, muscle weakness.
Food Sources
Meats, fish, eggs, poultry, green and leafy vegetables, legumes, fruits and whole grains.
7.3.4 Folate and B12

Vitamin B12 and folate are closely related, each depends on the other for activation.
Folate is necessary for DNA synthesis; it plays a major role in cell differentiation and
division so it is particularly important for rapidly dividing cells such as those in the bone
marrow where blood cells are formed. The requirements are increased during pregnancy
and folate supplement before and during pregnancy have been shown to prevent neural
tube defects. Vitamin B12 is needed to maintain metabolism of folate and fatty acids and
to maintain the insulation – myelin, surrounding nerves. The absorption of B12 requires
intrinsic factor, which is a protein secreted in the stomach. Deficiency is a problem in
vegetarians and individuals who do not produce intrinsic factor.
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Vitamin B12 Metabolism
S-adenosylhomocysteine is formed during S-adenosylmethionine-dependent methylation

reactions, and the hydrolysis of S-adenosylhomocysteine results in homocysteine.
Homocysteine may be remethylated to form methionine by a folate-dependent reaction
that is catalyzed by methionine synthase, a vitamin B12-dependent enzyme. Alternately,
homocysteine may be metabolized to cysteine in reactions catalyzed by two vitamin B 6-
dependent enzymes.
The Recommended Dietary Allowance (RDA)
The current RDA was revised by the Food and Nutrition Board (FNB) of the Institute of
Medicine in 1998. Because of the increased risk of food-bound vitamin B12
malabsorption in older adults, the FNB recommended that adults over 50 years of age get
most of the RDA from fortified food or vitamin B12-containing supplements.
Recommended dietary allowances for different groups are given below.

Recommended Dietary Allowance (RDA) for Vitamin B12
Life Stage Age Males (mcg/day) Females (mcg/day)
Infants 0-6 months 0.4 0.4
Infants 7-12 months 0.5 0.5
Children 1-3 years 0.9 0.9
Adolescents 14-18 years 2.4 2.4
Adults 19-50 years 2.4 2.4
Adults 51 years and older 2.4* 2.4*
Pregnancy all ages - 2.6
Breast-feeding all ages - 2.8
*Vitamin B12 intake should be from supplements or fortified foods due to the age-related
increase in food bound malabsorption.
Deficiency
 Immature large blood cells- Megaloblastic anemia
 Blood disorder caused by lack of intrinsic factor and characterized by deficit of red
blood cells- Pernicious anemia if not treated it can be fatal.
Food Sources
Folate: vegetables, legumes, seeds, liver.
B12: animal foods and products fermented by micro organisms.
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7.3.5 Vitamin C
Vitamin C is necessary for the maintenance of connective tissue in the body. In some
settings, vitamin C helps specific enzyme perform its job such as synthesis of essential
molecules such as collagen, neurotransmitters, and hormones, but in others, it acts as an
antioxidant. It also strengthens resistance to infection and in absorption of iron. High
doses cause diarrhea and abdominal pain.
Ascorbic acid or vitamin c is a water soluble white crystalline compound (C H O The

6 8 6).
molecule does not contain a free carboxyl group and is a lactone. Lactones behave like
acids. Ascorbic acid has a sharp taste usually associated with acids and will form salts. It
is optically active and is dextrorotatry. It is a good strong reducing agent and gets easily
oxidized. It is one of the unstable nutrients and is easily destroyed by atmospheric
oxidation, exposure to light or high temperatures, alkalinity and metal ions especially
copper. The rate of oxidation is reduced in weak acid solution and at low temperatures.
Functions
• Ascorbic acid is easily oxidized. It is able to protect other substances from oxidation;
acting as an antioxidant. Synthetic ascorbic acid & its sodium and calcium salts are
used as permitted antioxidants in food industry.
• In body tissues, ascorbic acid protects the easily oxidizable nutrients. It is effective in
‘mopping up’ free radicals. It has a preventive function for diseases in which free
radicals are involved.
• It helps in absorption of dietary iron
• Is involved in collagen (intercellular connecting protein) synthesis, formation of bone
and teeth calcification & many other reactions.
Recommended Dietary Allowances

The recommended dietary allowance is 40mg/day for adults; 25mg/day for infants and 80
mg/ day for lactating women.
Pregnancy and lactation
During pregnancy there is a moderate extra drain on vitamin C, particularly during the
last trimester, and 8 mg/day of vitamin C is reported to be sufficient to prevent scorbutic
signs in infants aged 4-17 months. Therefore, the additional needs during pregnancy are
unlikely to be more, particularly during the last trimester. An extra 10 mg/day throughout
pregnancy should enable reserves to accumulate to meet the extra needs of the growing
foetus in the last trimester.
During lactation, however, 20 mg/day of vitamin C is secreted in milk. For an assumed

absorption efficiency of 85 percent, an extra 25 mg will be needed by the mother. It is
therefore recommended that the RNI should be set at 70 mg to fulfil the needs of both the
mother and infant during lactation.
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Children
As mentioned earlier, 8 mg/day of vitamin C is sufficient to prevent scorbutic signs in

infants. The vitamin C concentration in mature human milk is estimated to be 40 mg/l
(mean, SD 10), but the amount of vitamin C in human milk appears to reflect maternal
dietary intake and not the infants needs. RNIs for infants aged 0-6 months are therefore
set, somewhat arbitrarily, at 25 mg/day, and the RNI is gradually increased as children
got older.
Elderly
Elderly people frequently have low plasma ascorbate values and intakes lower than those
in younger people, often because of problems of poor dentition or mobility. Elderly
people are also more likely to have underlying sub-clinical diseases, which can also
influence plasma ascorbate concentrations. It has been suggested, however, that the
requirements of elderly people do not differ substantially from those of younger people in
the absence of pathology, which may influence absorption or renal functioning. The RNIs
for the elderly are therefore the same as those for adults (45 mg/day).
Smokers
Kallner et al. reported that the turnover of vitamin C in smokers was 50 percent greater
than that in non-smokers. However, there is no evidence that the health of smokers would
be influenced in any way by increasing their RNI. The panel therefore found no Sources
of Vitamin C: Major sources are fruits and vegetables; fresh vegetables contain this
vitamin. The citrus fruits (lemons and oranges), berries and melons are particularly rich
in the vitamin. Tomatoes and potatoes also contain good amount. Gooseberry (Amla) is
one of the richest sources of this vitamin. Storage causes decrease in the vitamin C
content. Germinated grains have a higher vitamin C than nonsprouted cereal and
legumes.e.g. Sprouted green grams, from fruits; gooseberry (amla) and Guava are very
rich sources of vitamin C.
During cooking, around 75% of ascorbic acid is lost. It is advised that a minimum
amount of water should be used for cooking vegetable. It is best to place the vegetables in
boiling water as this contains no dissolved oxygen. Addition of soda bicarbonate
(alkaline condition) should be avoided. Heating or drying leads to Vitamin C destruction
but gooseberry (Amla) is an exception.
Deficiency
Scurvy is characterized by poor wound healing, bleeding, and other symptoms related to
improper formation and maintenance of collagen.
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Water Soluble vs Fat Soluble Vitamins
Water Soluble Vitamin B & C Fat Soluble Vitamin A,D,E,K
Absorption Directly into blood 1st into lymph then the blood
Transport Travel freely Require protein carrier
Storage Freely circulate in water filled parts Trapped in cells association

of body with fat
Excretion Kidney detect and remove excess in Less readily excreted remain
urine In fat storage
Toxicity Less toxicity Toxic when consumed in
Excess
Requirement Needed frequently Needed in periodic doses
7.4 Water Intake

Water is an essential nutrient, as important to life as the others. You can survive only a
few days without water while deficiency of the other nutrients may take weeks, months
or even a year to develop. The dietary water sources include water, beverages, fruits and
vegetables and water generated during metabolism. Thirst and satiety influence water
intake in response to changes sensed by the mouth, hypothalamus and nerves.
Dehydration the condition in which body water output exceeds water input e.g Heavy
sweating, diarrhoea and vomiting. Water intoxication is the condition where body water
contents are too high e.g. kidney disorder.
Water losses
Urine 1500mls a day
Lungs -vapor
Skin- sweat
Feaces
Total loss 21/2 liter a day
Recommended intake
A person who spends 2000kcal a day needs 2 to 3 liters of water (7 to 11
glasses)
Infant - 1.5ml/kcal
Adults – 1.0 to 1.5 ml/kcal
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7.5 Minerals
Minerals perform a wide range of vital structural and regulatory roles.
 Are Inorganic elements
 Major minerals – are essential mineral nutrients found in amount larger than
5gms, e.g Calcium, phosphorus, potassium, sulphur, sodium, chloride, magnesium
 Trace minerals – are essential mineral nutrient found in amounts less than 5 gms,
e.g iron, zinc ,copper, manganese, iodine, selenium
 Bioavailability - some minerals are bound by chemicals in foods e.g phytic and
oxalic acid in legumes and grains that bind calcium, iron and zinc
VITAMINS MINERALS
Organic - carbon , hydrogen , nitrogen, In organic very simple structures

Oxygen, Phosphorus. Sulphur,
Do not provide energy
Do not provide energy
Used in the body to promote chemical
help to regulate and Support reactions in reaction and form body structures
the body
Coenzymes, hormones Major minerals large amounts, trace
minerals small amounts
Are needed in very small amounts in diet
7.5.1. Sodium
Sodium is cation in extracellular fluid and the primary regulator of its volume. It helps
maintain acid base balance and it is essential to nerve transmission for muscular
contraction
Deficiency Toxicity
Muscular cramps Oedema
Mental apathy Acute hypertension
Loss of appetite
Food sources
Table salt, soy sauce, processed foods, meats, milks, vegetables
69
Estimated minimum requirement

Adults 500ml(0.5gms)/day
1g salt = 400mg sodium
5g salt = 1tsp
1tsp = 200mg sodium
Recommended intake
6gm of salt a day
2gm a day to prevent hypertension
7.5.2. Chloride (Cl)

Major anion in the extracellular fluid
Main Function
An electrolyte that maintains normal fluid and electrolyte balance
Part of hydrochloric acid found in stomach
Necessary for proper digestion
Deficiency
Very rare
Estimated minimum requirement

Adults 750mg/day no RDA
Food sources
Table salt, processed foods, meats, milk, eggs
7.5.3. Potassium
The principal cation within the body cells
Function
Maintains normal fluids and electrolyte
Facilitates many reactions
Support cell integrity
Assist in nerve impulse transmission and muscular contraction
Deficiency Toxicity
Muscular weakness muscular weakness
Paralysis vomiting
Confusion can stop heart
Estimated minimum intake

2000mg/day
Meat, milk, fruits, vegetables, grains, and legumes
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7.5.4 Calcium
The most abundant mineral in the body. It’s found in the body’s bones and teeth. About
99% of calcium is in the body’s bones where it forms an integral part of bone structure,
providing a rigid frame that holds the body upright and serves as a calcium bank offering
a readily available source to body fluid in case of a drop.
1% in blood and fluids
Main functions
1. Muscular contraction and relaxation
2. Nerve functioning
3. Blood clotting
4. immune defenses
Calcium balance i.e calcium homeostasis involves a system of hormones and vitamin D
that promotes calcium deposits into bone whenever blood calcium rises too high:
Parathormone from parathyroid and calcitonin from thyroid glands + vitamin D regulates
calcium balance:
- Parathormones raises calcium levels
 Calcitonin lower calcium levels
 Vitamin D Raises blood calcium
 Vitamins D acts on:
 Intestine absorb more calcium
 Bone release more calcium
 Kidney excrete less calcium
Factors that influence calcium absorption

Promote
 Hormones that promote growth
 Ingestion with a meal, stomach acid
 Vitamin D, lactose and phosphorus
Deficiency
Stunted growth in children and bone loss in adult (osteoporosis)
Osteoporosis
 Mostly women at menopause
 Loss of calcium from bones brittle and easy to break
 Calcium and vitamin D intake
 Activity
 Smoking, alcohol, caffeine
 Excessive anti acid use
 Diabetes
Toxicity
Constipation increase risk for urinary stone formation and kidney dysfunction
Interference with absorption of other minerals.
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7.5.5 Phosphorus
This is the second most abundant mineral in the body. It assists in energy transfers during
cellular metabolism. Lipids containing phosphorus as part of their structures
(phospholipids) help to transport other lipids in the blood.
Food sources
Milk and milk products like yoghurt, small fish, tofu bean curd, dark green vegetables
and legumes
RDA
1200mg/day (19-24yrs)
800mg/day (25-older)
Interferences of phosphorus levels in the body

 Diminished absorption with aging
 Lack of stomach acid
 Vitamin D deficiency
 Phosphorus intake
 Fiber intake
 Phytates and oxalates
 Protein intake
7.5.6 Magnesium
Magnesium is a mineral that affects the metabolism of calcium, sodium and potassium.
About 40% of body magnesium is in muscle and other soft tissues, about 1% is in the
extracellular fluid and the remainder is in bone.
Functions
 Involved in bone mineralisation
 The building of protein
 Enzymes action
 Normal muscular contractions
 Nerve impulse transmission
 Maintenance of teeth
 Immune system
Deficiency
 Weakness, confusion, convulsion
 Bizarre muscle movement e.g eye and face
 Hallucinations
 Difficult in swallowing
 Growth failure in children
Toxicity RDA
Rare 350mg/day men,
280mg/day women
72
Food sources
Nuts, legumes, whole grains, dark green, seafood, chocolate and cocoa
7.5.7 Sulfur
Sulfur in the diet comes from protein and some food preservatives which are used as
antioxidants. It is an important component of essential amino acid methionine and the
non essential amino acid cysteine. No deficiency, no toxicity
Functions
 As part of proteins, stabilizes their shape by forming disulfide bridges.
 Part of the vitamins biotin and thiamine and the hormone insulin.
Food sources
All protein contain food eggs, meat, fish, poultry, milk, legumes, nuts
7.6 Trace Minerals

These are minerals that are required by the body in an amount of 100mg or less per day.
They include: Iron, zinc, iodine and selenium
7.6.1 Iron
Iron is an essential nutrient that is vital to the processes by which cells generate energy.
Iron is a problem nutrient for many people as some do not consume enough to support
their health optimally while some have so much that it threatens their well-being.
Function
Part of protein heamoglobin and part of protein myoglobin in muscles, which makes
oxygen available for muscle contraction necessary for the utilization of energy as part of
the cell metabolic system.
Absorption
Two main proteins are important in absorption of iron in the intestine
Mucosal feritin receives iron from the GI tract and stores it in mucosal cell. When body
needs iron feritin release iron to a carrier.
Heme - animal source and non heme iron- plant source of iron. Vitamin C enhance
absorption of non heme iron while meat promote absorption of non heme iron
Absorption inhibitors of iron

 Phytates and fibers in whole grain cereals nuts
 Calcium and phosphorus in milk
 Tannin in tea coffee, nuts, some fruits, and vegetables
 Iron storage ferritin and hemosiderin
73
Iron deficiency
Stages of iron deficiency:
 Iron stores diminish
 Transport iron decreases.
 Hemoglobin production falls.
1. Eye- Blue sclera a tough fibrous tissue that covers the “white” of the eye
2.Immune system
 Reduced resistance to infection
 Lowered immunity
3.Nervous / muscular systems
 Reduced work productivity tolerance to work and voluntary work
 Reduced physical fitness
 Weakness and fatigue
 Impaired cognitive function
 Reduced learning ability
 Increased inability to pay attention
 Impaired visual discrimination
 Impaired reactivity and co-ordination (infant)
4. Skin
 Itching
 Pale nail beds
 Eye membrane and palm creases
 Concave nails
 Impaired wound healing
 General reduced resistance to cold inability to regulate body temperature
 Pica(clay eating etc)
Toxicity
 Infection lethargy
 Joint disease
 Pigmentation
Food sources
Meat, liver, chicken, shell fish, eggs, legumes, dried fruits, dark leafy vegetables, fortified
flour and breakfast cereals.
7.6.2 Zinc
Zinc is a versatile trace element required as a co factor by more than 100 enzymes in
every organ in the body. Wherever protein is zinc is. All cells contain zinc but the highest
concentration is in the bone, prostate gland and eyes. Muscles contain 60% of total body
zinc
Functions
Part of many enzymes; associated with the hormone insulin; involved in many genetic
materials and protein; immune reactions; transport vitamin A; taste perception; wound
healing; making of sperm; normal development of fetus; growth and development; blood
74
clotting; affects thyroid hormone function and influences behavior and learning
performance
Zinc absorption
Metallothionein a zinc binding protein helps to regulate zinc absorption.
Enteropancreatic circulation of zinc facilitates the preservation of the mineral.
Factor affecting zinc absorption

 More absorption with increased needed by the body
 Zinc bioavailability from beef x4 greater than from high fiber cereal
 Fiber and phytates bind zinc
 Casein in milk binds zinc
Transport
 Zinc is transported by protein albumin protein. Protein deficiency in pregnancy and
in children reduces zinc absorption.
 Large doses of zinc inhibit iron absorption
 Large doses of zinc inhibit absorption of copper
Deficiency Symptoms
1. Blood and bones
 Blood high ammonia, low alkaline phosphatase, low insulin
 Bones growth retardation
 Abnormal collagen
2. Cells/ metabolism
 Slow Cells metabolism
 Slow DNA synthesis
 Impaired cell division
 Impaired protein synthesis
3. Digestive system
 Weak sense of smell
 Poor sensitivity to taste of salt
 Weight loss
 Delayed glucose absorption
 Diarrhea, nausea , impaired folate absorption
4. Eyes
 night blindness
5. Glandular system
 Delayed onset of puberty
 Small gonads in males decreased synthesis of testosterone
 Abnormal glucose tolerance
 Reduces synthesis of adrecortical hormones
 Altered thyroid function
6. Immune system
 Altered skin test responses
 Low white blood cell count
75
 Few anti body forming cells

 Thymus atrophy
 Susceptibility to infections
 Enlarge liver and spleen
Others
 Anorexia , mental lethargy irritability
 Impaired reproductivity function
 Generalized hair loss
 Lesions, rough, dry appearance
 Slow healing of wounds and burns
 Chronic deficiency affect central nervous system and brain functioning
High risk groups for deficiency include: pregnant women, young children, teenagers
elder, HIV/AIDS patients and the poor. Common symptoms include, poor growth, poor
appetite, impaired immune response and abnormal vision in darkness
RDA
Men 15mg/day
Women 12mg/day
Toxicity
 Anaemia reduced hemoglobin production
 Growth in length but no normal zinc content in bone
 Increased LDL and reduced HDL
 Diarrhea,vomiting,decreased, calcium, and copper absorption
 Renal falure
 Muscle pain and incoordination
 Heart muscle degeneration
 Exhaustion dizzeness
 Drowness
 Reproductivity failure
Food sources
Protein containing foods, oysters, meats, fish, poultry, whole grain cereals, legumes and
nuts eaten alongside vegetables to enhance zinc absorption.
7.6.3 Iodine
Iodine is an element that comes from the sea. There is high concentration of iodine in sea
water and seafood.
Functions
Iodide is an integral component of 2 thyroid hormones that help to regulate growth,
metabolic rate, body temperature, reproduction, the making of blood cells, nerve and
muscle function.
76
Deficiency
Goiter cretinism this is a deficiency disease resulting from iodine deficiency
characterized by enlarged thyroid gland, weight gain, mental and physical retardation of
infants.
RDA
150mg/day
Food Sources
Iodized salt, seafood, bread, dairy, products, plants grown in iodine rich soil
7.6.4 Selenium
Part of an enzymes system Glutathione peroxidose that works with vitamins E to protect
the body against antioxidants
Food sources
Sea food, meat, grains.
7.6.5 Copper
Function
 Necessary for the absorption and use of iron in the formation of hemoglobin
 Part of many enzymes
Other minerals
Manganase
Facilitates enzymes action of many cell processes
Fluoride
Bone and teeth mineralization
Chromium
Associated with insulin activity in energy metabolism
7.7 Activity
What are the three major food sources of vitamin A in your diet? Do they contain
performed vitamin A or beta-carotene?
77
7.8 Question
1. What is a vitamin?
2. List five factors that affect how much of a vitamin is available to the body.
3. List five groups of people for whom vitamin supplements might be needed to meet
nutritional needs.
4. What do enrichment and fortification mean?
5. What is the benefits of consuming nutrients in foods rather than supplements.
7.9 Summary
Vitamins are essential, organic nutrients that do not provide energy and are required in small
quantities in the diet to promote and regulate chemical reactions in the body. They are classified
by their solubility in either fat or water. The fat soluble vitamins are vitamins A, D, E and K.
The water soluble vitamins are vitamin C and the B vitamins. Minerals are elements needed by
the body to regulate chemical reactions and provide structure. Their bioavailability is affected
by interactions with other minerals, vitamins, and other dietary components such as fiber.
Garrow JS, James WPT, Ralph A (2000) Human nutrition and dietetics. 10 th ed. Churchill
Livingstone, Edinburgh.

Publishing, USA.

Press.
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LECTURE EIGHT: HUMAN DIGESTIVE SYSTEM
8.0 DIGESTION SYSTEM

The digestive system provides two major functions: digestion and absorption.
Carbohydrates, fats and proteins are digested and absorbed as sugars, fatty acids and
amino acids, respectively. Not all components of food are digested. Vitamins, minerals,
and water can be absorbed without digestion, and some substances, such as components
of fiber, cannot be digested by humans and so are excreted without being absorbed. These
unabsorbed substances pass through the digestive tract and out in the feces.
8.1 OBJECTIVES
1. Name the organs involved in the digestion and absorption of food.

2. List mechanisms by which nutrients are absorbed.
3. List organs involved in elimination of waste products from the body
8.2 Human Digestion Process
Introduction
Digestion is a multi-stage process in the digestive system, starting from ingestion of food.
Ingestion usually involves some type of mechanical and chemical processing. Digestion
is separated into four steps:
1. Ingestion: placing food into the mouth (entry of food in the digestive system),
2. Mechanical and chemical breakdown: mastication and the mixing of the resulting
bolus with water, acids, bile and enzymes in the stomach and intestine to break
down complex molecules into simple structures,
3. Absorption: of nutrients from the digestive system to the circulatory and
lymphatic capillaries through osmosis, active transport, and diffusion, and
4. Egestion (Excretion): Removal of undigested materials from the digestive tract
through defecation.
Underlying the process is muscle movement throughout the system through swallowing
and peristalsis. Each step in digestion requires energy, and thus imposes an "overhead
charge" on the energy made available from absorbed substances. Differences in that
overhead cost are important influences on lifestyle, behavior, and even physical
structures. Examples may be seen in humans, who differ considerably from other
79
hominids (lack of hair, smaller jaws and musculature, different dentition, length of
intestines, cooking, etc.).
The major part of digestion takes place in the small intestine. The large intestine
primarily serves as a site for fermentation of indigestible matter by gut bacteria and for
resorption of water from digesta before excretion.
Preparation for digestion begins with the cephalic phase in which saliva is produced in
the mouth and digestive enzymes are produced in the stomach. Mechanical and chemical
digestion begin in the mouth where food is chewed, and mixed with saliva to begin
enzymatic processing of starches. The stomach continues to break food down
mechanically and chemically through churning and mixing with both acids and enzymes.
Absorption occurs in the stomach and gastrointestinal tract, and the process finishes with
defecation.
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The whole digestive system is around 9 meters long. In a healthy human adult this
process can take between 24 and 72 hours. Food digestion physiology varies between
individuals and upon other factors such as the characteristics of the food and size of the
meal.
Phases of gastric secretion
 Cephalic phase - This phase occurs before food enters the stomach and involves
preparation of the body for eating and digestion. Sight and thought stimulate the
cerebral cortex. Taste and smell stimulus is sent to the hypothalamus and medulla
oblongata. After this it is routed through the vagus nerve and release of acetylcholine.
Gastric secretion at this phase rises to 40% of maximum rate. Acidity in the stomach
is not buffered by food at this point and thus acts to inhibit parietal (secretes acid) and
G cell (secretes gastrin) activity via D cell secretion of somatostatin.
 Gastric phase - This phase takes 3 to 4 hours. It is stimulated by distension of the
stomach, presence of food in stomach and decrease in pH. Distention activates long
and myenteric reflexes. This activates the release of acetylcholine which stimulates
the release of more gastric juices. As protein enters the stomach, it binds to hydrogen
ions, which raises the pH of the stomach. Inhibition of gastrin and gastric acid
secretion is lifted. This triggers G cells to release gastrin, which in turn stimulates
parietal cells to secrete gastric acid. Gastric acid is about 0.5% hydrochloric acid
(HCl), which lowers the pH to the desired pH of 1-3. Acid release is also triggered by
acetylcholine and histamine.
 Intestinal phase - This phase has 2 parts, the excitatory and the inhibitory. Partially
digested food fills the duodenum. This triggers intestinal gastrin to be released.
Enterogastric reflex inhibits vagal nuclei, activating sympathetic fibers causing the
pyloric sphincter to tighten to prevent more food from entering, and inhibits local
reflexes.
Oral cavity
In humans, digestion begins in the oral cavity where food is chewed. Saliva is secreted in
large amounts (1-1.5 litres/day) by three pairs of exocrine salivary glands (parotid,
submandibular, and sublingual) in the oral cavity, and is mixed with the chewed food by
the tongue. The saliva serves to clean the oral cavity and moisten the food, and contains
digestive enzymes such as salivary amylase, which aids in the chemical breakdown of
polysaccharides such as starch into disaccharides such as maltose. It also contains mucus,
a glycoprotein which helps soften the food and form it into a bolus. An additional
enzyme, lingual lipase, hydrolyzes long-chain triglycerides into partial glycerides and
free fatty acids.
Swallowing transports the chewed food into the esophagus, passing through the
oropharynx and hypopharynx. The mechanism for swallowing is coordinated by the
swallowing center in the medulla oblongata and pons. The reflex is initiated by touch
receptors in the pharynx as the bolus of food is pushed to the back of the mouth.
81
Pharynx
The pharynx is the part of the neck and throat situated immediately behind the mouth and
nasal cavity, and cranial, or superior, to the esophagus. It is part of the digestive system
and respiratory system. Because both food and air pass through the pharynx, a flap of
connective tissue, the epiglottis closes over the trachea when food is swallowed to
prevent choking or asphyxiation.
The oropharynx is that part of the pharynx which lies behind the oral cavity and is lined
by stratified squamous epithelium. The nasopharynx lies behind the nasal cavity and like
the nasal passages is lined with ciliated columnar pseudostratified epithelium.
Like the oropharynx above it the hypopharynx (laryngopharynx) serves as a passageway

for food and air and is lined with a stratified squamous epithelium. It lies inferior to the
upright epiglottis and extends to the larynx, where the respiratory and digestive pathways
diverge. At that point, the laryngopharynx is continuous with the esophagus. During
swallowing, food has the "right of way", and air passage temporarily stops.
Esophagus
The esophagus is a narrow muscular tube about 20-30 centimeters long which starts at the
pharynx at the back of the mouth, passes through the thoracic diaphragm, and ends at the
cardiac orifice of the stomach. The wall of the esophagus is made up of two layers of
smooth muscles, which form a continuous layer from the esophagus to the colon and
contract slowly, over long periods of time. The inner layer of muscles is arranged
circularly in a series of descending rings, while the outer layer is arranged longitudinally.
At the top of the esophagus, is a flap of tissue called the epiglottis that closes during
swallowing to prevent food from entering the trachea (windpipe). The chewed food is
pushed down the esophagus to the stomach through peristaltic contraction of these
muscles. It takes only about seven seconds for food to pass through the esophagus and
now digestion takes place.
Stomach
The stomach is a small, 'J'-shaped pouch with walls made of thick, elastic muscles, which
stores and helps break down food. Food which has been reduced to very small particles is
more likely to be fully digested in the small intestine, and stomach churning has the effect
of assisting the physical disassembly begun in the mouth. Ruminants, who are able to
digest fibrous material (primarily cellulose), use fore-stomachs and repeated chewing to
further the disassembly. Rabbits and some other animals pass some material through their
entire digestive systems twice. Most birds ingest small stones to assist in mechanical
processing in gizzards.
82
Food enters the stomach through the cardiac orifice where it is further broken apart and
thoroughly mixed with gastric acid, pepsin and other digestive enzymes to break down
proteins. The enzymes in the stomach also have an optimum, meaning that they work at a
specific pH and temperature better than any others. The acid itself does not break down
food molecules, rather it provides an optimum pH for the reaction of the enzyme pepsin
and kills many microorganisms that are ingested with the food. It can also denature
proteins. This is the process of reducing polypeptide bonds and disrupting salt bridges
which in turn causes a loss of secondary, tertiary or quaternary protein structure. The
parietal cells of the stomach also secrete a glycoprotein called intrinsic factor which
enables the absorption of vitamin B-12. Other small molecules such as alcohol are
absorbed in the stomach, passing through the membrane of the stomach and entering the
circulatory system directly. Food in the stomach is in semi-liquid form, which upon
completion is known as chyme.
After consumption of food, digestive "tonic" and peristaltic contractions begin which
help to break down the food and move it through. When the chyme reaches the opening
to the duodenum known as the pylorus, contractions "squirt" the food back into the
stomach through a process called retropulsion, which exerts additional force and further
grinds down food into smaller particles. Gastric emptying is the release of food from the
stomach into the duodenum; the process is tightly controlled with liquids being emptied
much more quickly than solids.Gastric emptying has attracted medical interest as rapid
gastric emptying is related to obesity and delayed gastric emptying syndrome is
associated with diabetes mellitus, aging, and gastroesophageal reflux.
The transverse section of the alimentary canal reveals four (or five, see description under
mucosa) distinct and well developed layers within the stomach:
 Serous membrane, a thin layer of mesothelial cells that is the outermost wall of the
stomach.
 Muscular coat, a well-developed layer of muscles used to mix ingested food,
composed of three sets running in three different alignments. The outermost layer
runs parallel to the vertical axis of the stomach (from top to bottom), the middle is
concentric to the axis (horizontally circling the stomach cavity) and the innermost
oblique layer, which is responsible for mixing and breaking down ingested food, runs
diagonal to the longitudinal axis. The inner layer is unique to the stomach, all other
parts of the digestive tract have only the first two layers.
 Submucosa, composed of connective tissue that links the inner muscular layer to the
mucosa and contains the nerves, blood and lymph vessels.
 Mucosa is the extensively folded innermost layer. It can be divided into the
epithelium, lamina propria, and the muscularis mucosae, though some consider the
outermost muscularis mucosae to be a distinct layer, as it develops from the
mesoderm rather than the endoderm (thus making a total of five layers). The
epithelium and lamina are filled with connective tissue and covered in gastric glands
that may be simple or branched tubular, and secrete mucus, hydrochloric acid,
pepsinogen and rennin. The mucus lubricates the food and also prevents hydrochloric
acid from acting on the walls of the stomach.
83
Small intestine
It has three parts Duodenum, Ileum and Jejunum.
After being processed in the stomach, food is passed to the small intestine via the pyloric
sphincter. The majority of digestion and absorption occurs here after the milky chyme
enters the duodenum. Here it is further mixed with three different liquids:
 Bile, which emulsifies fats to allow absorption, neutralizes the chyme and is used to
excrete waste products such as bilin and bile acids. Bile is produced by the liver and
then stored in the gallbladder. The bile in the gallbladder is much more concentrated.
 Pancreatic juice made by the pancreas.
 Intestinal enzymes of the alkaline mucosal membranes. The enzymes include
maltase, lactase and sucrase (all three of which process only sugars), trypsin and
chymotrypsin.
The pH level increases in the small intestine. A more basic environment causes more
helpful enzymes to activate and begin to help in the breakdown of molecules such as fat
globules. Small, finger-like structures called villi, each of which is covered with even
smaller hair-like structures called microvilli improve the absorption of nutrients by
increasing the surface area of the intestine and enhancing speed at which nutrients are
absorbed. Blood containing the absorbed nutrients is carried away from the small
intestine via the hepatic portal vein and goes to the liver for filtering, removal of toxins,
and nutrient processing.
The small intestine and remainder of the digestive tract undergoes peristalsis to transport
food from the stomach to the rectum and allow food to be mixed with the digestive juices
and absorbed. The circular muscles and longitudinal muscles are antagonistic muscles,
with one contracting as the other relaxes. When the circular muscles contract, the lumen
becomes narrower and longer and the food is squeezed and pushed forward. When the
longitudinal muscles contract, the circular muscles relax and the gut dilates to become
wider and shorter to allow food to enter.
Large intestine
After the food has been passed through the small intestine, the food enters the large
intestine. Within it, digestion is retained long enough to allow fermentation due to the
action of gut bacteria, which breaks down some of the substances which remain after
processing in the small intestine; some of the breakdown products are absorbed. In
humans, these include most complex saccharides (at most three disaccharides are
digestible in humans). In addition, in many vertebrates, the large intestine reabsorbs fluid;
in a few, with desert lifestyles, this reabsorbtion makes continued existence possible.
In humans, the large intestine is roughly 1.5 meters long, with three parts: the cecum at
the junction with the small intestine, the colon, and the rectum. The colon itself has four
parts: the ascending colon, the transverse colon, the descending colon, and the sigmoid
84
colon. The large intestine absorbs water from the bolus and stores feces until it can be
egested. Food products that cannot go through the villi, such as cellulose (dietary fiber),
are mixed with other waste products from the body and become hard and concentrated
feces. The feces is stored in the rectum for a certain period and then the stored feces is
eliminated from the body due to the contraction and relaxation through the anus. The exit
of this waste material is regulated by the anal sphincter.
Digestive hormones
Action of the major digestive hormones
There are at least five hormones that aid and regulate the digestive system in mammals.
There are variations across the vertebrates, as for instance in birds. Arrangements are
complex and additional details are regularly discovered. For instance, more connections
to metabolic control (largely the glucose-insulin system) have been uncovered in recent
years.
 Gastrin - is in the stomach and stimulates the gastric glands to secrete pepsinogen(an
inactive form of the enzyme pepsin) and hydrochloric acid. Secretion of gastrin is
stimulated by food arriving in stomach. The secretion is inhibited by low pH .
 Secretin - is in the duodenu and signals the secretion of sodium bicarbonate in the
pancreas and it stimulates the bile secretion in the liver. This hormone responds to the
acidity of the chyme.
 Cholecystokinin (CCK) - is in the duodenum and stimulates the release of digestive
enzymes in the pancreas and stimulates the emptying of bile in the gall bladder. This
hormone is secreted in response to fat in chyme.
 Gastric inhibitory peptide (GIP) - is in the duodenum and decreases the stomach
churning in turn slowing the emptying in the stomach. Another function is to induce
insulin secretion.
85
 Motilin - is in the duodenum and increases the migrating myoelectric complex

component of gastrointestinal motility and stimulates the production of pepsin.
Significance of pH in digestion
Digestion is a complex process which is controlled by several factors. pH plays a crucial

role in a normally functioning digestive tract. In the mouth, pharynx, and esophagus, pH
is typically about 6.8, very weakly acidic. Saliva controls pH in this region of the
digestive tract. Salivary amylase is contained in saliva and starts the breakdown of
carbohydrates into monosaccharides. Most digestive enzymes are sensitive to pH and will
denature in a high or low pH environment.
The stomach's high acidity inhibits the breakdown of carbohydrates within it. This acidity
confers two benefits: it serves to denature proteins for further digestion in the small
intestines, and provides non-specific immunity, damaging or eliminating various
pathogens.
In the small intestines, the duodenum provides critical pH balancing to activate digestive
enzymes. The liver secretes bile into the duodenum to neutralize the acidic conditions
from the stomach, and the pancreatic duct empties into the duodenum, adding bicarbonate
to neutralize the acidic chyme, thus creating a neutral environment. The mucosal tissue of
the small intestines is alkaline with a pH of about 8.5.
86
Human Digestion; courtesy of Morsby 1993
87
DEFINATIONS
Saliva - Fluid produced by salivary glands in the mouth, contains lubricants, enzymes
and other substances.
Mucus - A thick fluid secreted by glands in the body. Acts as a lubricant and a means of
protection for cells.
Cysozyme - Produced by body cell. Protects against bacteria.
Sphincters - Regulate passage or flow of materials from one part to the next.
Heartburn and ulcers - Caused by high acid in stomach.
Bicarbonate ions - from pancreas neutralize the chime before it moves to small
intestines.
Peristalsis - Food is propelled through the GI by peristalsis, a wave of muscle action.
Stomach wall is very muscular to facilitate grinding and mixing action. (diagonal,
circular, longitudinal).
Enzymes in digestion - Most digestive enzymes are made by the pancreas and small
intestines, few in the mouth and stomach.
8.3 Fat Digestion

Stomach - lipase needs an acid media (gastric lipase).
Small intestines - pancreatic lipase.
Cholecystokinin - a hormone that stimulates the enzymes to be released from the
pancreas and bile from the gall bladder.
Bile - emulsifies fats to form water soluble micelles which can be digested by “lipases.
Gastric inhibitory peptide (GIP) a hormone that controls the emptying of the stomach.
8.5 Carbohydrate Digestion

Mouth - saliva - Amylase breaks down starch to smaller sugar units e.g. maltose.
Amylase does not work in acid environment.
Small intestine - amylase monosaccharides and dissacharides. - sucrose, malatose lactose
(dissacharidases) glucose, fructose, galactose.
Absorption
Small intestines site for most digestion and absorption of nutrients.
Wall of intestine:
 Folded
 Finger like projects
 Villi
 Absorptive cells - each has a brush border - micro villi
 All these folds, fingers and indentations in the small intestine increase surface area
600 times.
8.6 Protein Digestion

Stomach - pepsin - peptones
Gastric - a hormone that stimulates enzyme and acid secretion in the stomach.
88
Small intestine
Chime - a mixture of stomach secretions and partially digested food. - neutralized by
bicarbonate ions.
Secretion - A hormone that causes bicarbonate ions to be released by the pancreas.
Trypsin - among other proteases which digest protein in the small intestine, breaks large
proteins to peptides.
8.7 Types of Absorption
Passive - substances are permeable to the walls of the small intestine e.g. water and some
minerals. Move from area of high concentration to area of low concentration.
Facilitated a carrier e.g. sodium but not energy is needed to carry the substances across
the intestinal walls e.g. fructose.
Move from area of high concentration to area of low concentration.
Active – uses a carrier and energy e.g. glucose, galactose and amino acids.
Portal and Lymphatic systems
Portal vein > capillaries from the intestine and stomach drain into a large portal vein that
goes to the liver e.g. water soluble nutrients (proteins, carbohydrates, short-chain fatty
acids, B vitamins and vitamin C.
Lymphatic system
Carry fat soluble nutrients (long-chain fatty acids, fat soluble vitamins A, D, E, and K)
Large intestines
Small intestine 85% - 90% of the water absorbed.
Large intestine – some H2O potassium and sodium.
Bacteria - vitamin K and Biotin.
8.8 Question
1. List three organ systems involved in the digestion and absorption of food.
2. List the functions of the liver
3. What products of digestion are transported by the lymphatic system?
4. What is the form of energy used by cells?
89
8.9 Activity
Most foods contain some protein, carbohydrate, and fat. Discuss where in the digestive
tract the digestion of each of these nutrients begins. Does the presence of high-protein
food in the digestive tract inhibit the digestion and absorption of foods high in
carbohydrate or fat? Why or why not?
8.10 Summary
Lesson eight discusses digestion as a process by which food is broken down into units
that are small enough to be absorbed. Absorption is the process by which nutrients are
transported into the body.
8.11 Further readings

Garrow JS, James WPT, Ralph A (2000) Human nutrition and dietetics. 10th ed. Churchill
Livingstone, Edinburgh.
WHO (1985) Energy and protein requirements. Report of a joint FAO/WHO/UNU meeting
(WHO Technical Report Series 724) WHO.
Publishing, USA.
Gibson, R.(1990) Principles of Nutritional Assessment. New York: Oxford University Press.
Bennion M, Scheule B (2000) Introductory Foods. 11th ed. Macmillan Publishing Company,
USA.
Whitney E and Rolfes (1996) Understanding Nutrition. 7th ed, West publishing, New York.
90
CAT ONE 40MKS (ATTEMPT ANY TWO)
RESEARCH REFLECT RECORD
1. Discuss the UNICEF conceptual framework of malnutrition (20mks)

2. Discuss the role of nutrition in sports and physical fitness (20mks)
3. Discuss the dietary tips to discuss with a long distant runner (20mks)
4. Describe ways of combating deficiency disorders (20mks)
5. Discuss the causes of the following
a) Iron deficiency anaemia (10mks)
b) Vitamin A deficiency (10mks)
6. Discuss, in details, the five principles of human nutrition and diet therapy
(20mks)
7. Demonstrate the relationship between infections and nutritional status
(20mks)
8. Outline the dietary recommendation for patients with
a) Diabetes mellitus (10mks)
b) Obesity (10mks)
9. Discuss various human nutrition perspectives (20mks)
10. Describe the digestion and absorption of the following nutrients
a) Carbohydrates (4mks)
b) Proteins (4mks)
c) Lipids (4mks)
d) Water (4mks)
e) Micronutrients (4mks)
11. Discuss factors affecting food metabolism (20mks)
91
Sample Formative and Summative Evaluation

THIKA SCHOOL OF MEDICAL AND HEALTH SCIENCES
COLLEGE EXAMINATION 2016
CONTINOUS ASSESSMENT TEST
UNIT: PRINCIPLES OF HUMAN NUTRITION
DATE: JUNE 2016 TIME: 1 HOUR
INSTRUCTIONS:
a) CLEARLY LABEL YOUR WORK.
b) DO NOT WRITE ON THE QUESTION PAPER.
c) ATTEMPT ALL QUESTIONS [40MKS]
Section A: Multiple Choices (12 Marks). Select the most appropriate answer
1. I serve many functions in the body. I help carry nutrients to the body’s cells and I also
help regulate body temperature. I am____________ (1mk)
A. Vitamins
B. Carbohydrates
C. Water
D. Minerals
2. I can be converted into energy. I am also used to build, maintain and repair body
tissues. I am_________ (1mk)
A. Vitamins
B. Minerals
C. Carbohydrates
D. Proteins
3. I have a bad reputation in many people’s minds but I do serve many functions in the
body. For example, I am the most concentrated source of energy and I also am needed
for growth and healthy skin. I am______________ (1mk)
A. Lipids
B. vitamin A
C. magnesium
D. Amino acid
4. I am the body’s main source of energy and I come in two forms, simple and complex. I
am_______________ (1mk)
A. Proteins
B. Carbohydrates
C. Selenium
D. Lipids
5. _________ is an organic compound depended on for nearly every process necessary
for life and the body require 16 types. (1mk)
A. Vitamins
B. Triglycerides
C. Amino Acids
D. Minerals
92
6. To be transported throughout the body, fats are packaged in structures called (1mk)
A. Phospholipids.
B. Micelles.
C. Lipoproteins.
D. Triglycerides.
7. Nutrient density can be defined as (1mk)

A. The amount of kilocalories in a food divided by the amount of kilocalories
needed in a day.
B. The amount of a particular nutrient in a serving of food divided by the number
of kilocalories in that serving.
C. The amount of a particular nutrient in a serving of food divided by the number
of grams of protein.
D. The amount of a nutrient in a serving of food divided by the amount of the
nutrient needed for that day.
8. Which of the following is not true about water? (1mk)

A. Provides a way to transport nutrients and waste
B. Dietary need of approximately 8 cups per day
C. Provides 4 kilocalorie of energy per gram
D. By-product of cell chemical reactions
9. Which of the following contains a rich supply of omega-3 fatty acids? (1mk)
A. Pork
B. Chicken
C. Broccoli
D. Salmon
10. Niacin is necessary to prevent the disease (1mk)

A. Pernicious anemia.
B. Beriberi
C. Pellagra
D. Scurvy
11. This mineral can be protective for the teeth when introduced into the water supply;
however it can cause tooth mottling when consumed in high quantities. (1mk)
A. Fluoride
B. Selenium
C. Iron
D. Copper
12. Body weight in kilograms divided by height squared in meters yields (1mk)
A. The obesity index.
B. Body mass index.
C. Relative weight.
D. Percent body fat.
93
Section B: Short Answer Questions (16 Marks)
13. Identify four common nutritional disorders in Kenya (4mks)
14. Briefly explain the digestion of proteins in the digestive system (4mks)
15. State four nutrients vital for immunity (4mks)
16. Explain four underlying causes of malnutrition (4mks)
Section C: Essay Question (12 Marks)
17. According to WHO (2016) Iron Deficiency Aneamia (IDA) is the most common
and widespread nutritional disorder in the world. Its prevalence worldwide is 30% (2
billion people) in both developing and industrialized countries. This is despite the fact
that iron is fourth most abundant element in the earth crust at 4.6%.
a) Explain why the prevalence of IDA is highest despite iron abundance (4mks)
b) Discuss four factors affecting iron absorption (8mks)
94

COLLEGE EXAMINATION 2016
END OF TERM EXAMINATION
UNIT: PRINCIPLES OF HUMAN NUTRITION
DATE: JAN 2016 TIME: 2 HOURS
INSTRUCTION: DO NOT WRITE ANYTHING ON THE QUESTION PAPER
SECTION A: ANSWER ALL QUESTIONS (30 MARKS)
1. I serve many functions in the body. I help carry nutrients to the body’s cells and I also
help regulate body temperature. I am____________ (1mk)
A. Vitamins
B. Carbohydrates
C. Water
D. Minerals
2. I can be converted into energy. I am also used to build, maintain and repair body
tissues.
I am_________ (1mk)
A. Vitamins
B. Minerals
C. Carbohydrates
D. Proteins
3. I have a bad reputation in many people’s minds but I do serve many functions in the
body. For example, I am the most concentrated source of energy and I also am needed
for growth and healthy skin. I am______________ (1mk)
A. Lipids
B. vitamin A
C. magnesium
D. Amino acid
4. I am the body’s main source of energy and I come in two forms, simple and complex. I
am_______________ (1mk)
A. Proteins
B. Carbohydrates
C. Selenium
D. Lipids
5. _________ is an organic compound depended on for nearly every process necessary
for life and the body require 16 types. (1mk)
A. Vitamins
B. Triglycerides
C. Amino Acids
D. Minerals
95
6. To be transported throughout the body, fats are packaged in structures called (1mk)
A. Phospholipids.
B. Micelles.
C. Lipoproteins.
D. Triglycerides.
7. Nutrient density can be defined as (1mk)
A. The amount of kilocalories in a food divided by the amount of kilocalories
needed in a day.
B. The amount of a particular nutrient in a serving of food divided by the number
of kilocalories in that serving.
C. The amount of a particular nutrient in a serving of food divided by the number
of grams of protein.
D. The amount of a nutrient in a serving of food divided by the amount of the
nutrient needed for that day.
8. Which of the following is not true about water? (1mk)
A. Provides a way to transport nutrients and waste
B. Dietary need of approximately 8 cups per day
C. Provides 4 kilocalorie of energy per gram
D. By-product of cell chemical reactions
9. Which of the following contains a rich supply of omega-3 fatty acids? (1mk)
A. Pork
B. Chicken
C. Broccoli
D. Salmon
10. Niacin is necessary to prevent the disease (1mk)
A. Pernicious anemia.
B. Beriberi
C. Pellagra
D. Scurvy
11. This mineral can be protective for the teeth when introduced into the water supply;
however it can cause tooth mottling when consumed in high quantities. (1mk)
A. Fluoride
B. Selenium
C. Iron
D. Copper
12. Body weight in kilograms divided by height squared in meters yields (1mk)
A. The obesity index.
B. Body mass index.
C. Relative weight.
D. Percent body fat.
13. Vitamins involved in red blood cell synthesis are (1mk)
A. Vitamin B12 and folate.
B. Folate and thiamin.
C. Folate and pantothenic acid.
D. Thiamin and niacin.
96
14. As one finds his or her weight loss slowing during a weight control program, the
best practice is to (1mk)
A. Increase physical activity.
B. Go off the weight control program and take a break.
C. Restrict more food choices.
D. Reduce food intake to 1,000 kilocalories.
15. All the following are sources of cholesterol except (1mk)
A. Peanut butter
B. Turkey meat
C. Whole milk
D. Butter
16. Fibers belong to the class of nutrients known as (1mk)
A. Minerals
B. Proteins
C. Lipids
D. Carbohydrates
17. Constipation can best be prevented by (1mk)
A. Restricting fluids.
B. Using laxatives.
C. Engaging in little physical exercise.
D. Eating dietary fiber.
18. Which of the following is true about the way we should eat to achieve good
nutritional status? (1mk)
A. Eat only plant products because animal products are bad and generally filled
with hormones for animal growth
B. Eat fruits and vegetables because we can get all the nutrients we need from
these.
C. Eat a wide variety of foods because no single natural food meets all human
nutrient needs
D. Do the best we can but take supplements to fill in the deficient areas.
(1mk)
19. Which of the following is true about carbohydrate digestion? (1mk)
A. Carbohydrate digestion begins in the stomach
B. Saliva production does not influence starch digestion
C. Carbohydrate digestion is assisted by cooking; softens tough skins
D. Chewing food does not assist in carbohydrate digestion
20. Scurvy can be prevented with adequate intakes of (1mk)
A. Niacin
B. Vitamin C
C. Thiamin
D. Riboflavin
97
21. Carbohydrate loading (1mk)

A. Involves a tapering in the intensity of workouts with a corresponding increase
percentage of carbohydrate intakes.
B. Involves loading up on carbohydrate-laden foods the day before an endurance
event
C. Involves little exercise and a high-carbohydrate diet the first 3 days, followed
by heavy exercise and a low-carbohydrate diet right before competition.
D. Does not increase glycogen stores to any significant degree.
22. Outline four human nutrition perspectives (4mks)
23. Identify five factors that affect digestion (5mks)
SECTION B: COMPULSORY QUESTION (20 MARKS)

24. According to WHO (2016), an estimated 250 million preschool children are vitamin
A deficient. An estimated 250,000 to 500,000 vitamin A deficient children becomes
blind every year, half of them dying within 12 months of losing their sight.
a. Discuss FIVE causes of Vitamin A Deficiency (VAD) (10mks)
b. Apart from blindness, explain FIVE signs and symptom of VAD (10mks)
SECTION C: CHOOSE ONE QUESTION (10 MARKS)

25. Suggest FIVE nutrition tips to share with a long distance runner (10mks)
26. Discuss FIVE principles of human nutrition (10mks)
98

COLLEGE EXAMINATIONS 2016
SEP-DEC 2016 SERIES
END TERM EXAMINATION FOR DIPLOMA IN NUTRITION
INSTRUCTION: DO NOT WRITE ANYTHING ON THE QUESTION PAPER
SECTION A: ANSWER ALL QUESTIONS (30 MARKS)

1.
a) Explain meaning of Body Mass Index (5mks)
b) Outline biological functions of food. (5mks)
c) Identify two risk factors of diabetes mellitus (5mks)
d) Distinguish between satiety and hunger (5mks)
e) Identify five population groups at risk of vitamin D deficiency (5mks)
f) Identify two common nutritional disorders in Kenya (5mks)
SECTION B: COMPULSORY QUESTION (20 MARKS)
2. Iodine Deficiency Disorders (IDD) is a spectrum of ill-effects arising from iodine
metabolism. According to Global Iodine Network (2016), 25% of global population has
iodine deficiency.
a) Identify the most successful intervention against IDD (4mks)

b) Discuss four factors affecting iodine metabolism (8mks)
c) Describe the spectrum of IDD in human population (8mks)
SECTION C: CHOOSE ONE QUESTION

3. Discuss 5 approaches to prevention nutritional deficiencies (10mks)
4. Describe 5 effects of nutrient excesses in the human body (10mks)
99

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THIKA SCHOOL OF MEDICAL

& HEALTH SCIENCES

PRINCIPLES OF HUMAN NUTRITION

PROGRAMME: DISTANCE LEARNING DIPLOMA IN

EACH LECTURE IS EQUIVALENT TO A WEEK OF STUDY

ABBREVIATIONS AND ACRONYMS

FAO Food Agriculture Organization

MUAC Mid-Upper Arm Circumference

PEM Protein Energy Malnutrition

RBC Red Blood Cells

RDA Recommended Dietary Allowance

RIN Recommended Intakes of Nutrients

RNI Recommended Nutrient Intakes

WHO World Health Organization

4.5.2 Lactose Intolerance ....................................................................................... 34

7.5 Minerals .............................................................................................................. 69

LECTURE ONE: INTRODUCTION

1.0 What is Nutrition?

By the end of this lesson you should be able to:

1. Define the terminology used in nutrition.

1.3 Classes of Nutrients

Vitamins and Minerals

1.4 Nutrients in the Body: Biochemical and Physiological Needs

Which by the body needs for:-

1.5 Structural Nutrients

1.6 Regulatory Nutrients

1.7 Nutrient Requirement: How much of each Nutrient do we need?

1.8 Effects of Too Little or Too Much Nutrients

Further consequences of a poor diet include:

Nutrient Deficiency Stages

Here is what is happening in under-nutrition

PRIMARY (OUTWARD) Diet history

Physical examination and

1.9 Short and long term effects of poor nutrition

 The specific effects of nutrition on the development of chronic disease are

1.10 Conceptual Framework of Malnutrition

Figure: Conceptual Framework of Malnutrition (UNICEF, 1992)

 preventing childhood infections such as diarrhoea which lead to poor nutrient

1.11 Summary of Definitions

In this lesson an overview of the nutrition, nutrients and consequences of poor

1.14 Further Reading

WHO (1985) Energy and protein requirements. Report of a joint FAO/WHO/UNU

Smolin A and Grosvenor B (1994) Nutrition Science and Applications. Saunders

Gibson, R.(1990) Principles of Nutritional Assessment. New York: Oxford University

Bennion M, Scheule B (2000) Introductory Foods. 11th ed. Macmillan Publishing

National Research Council(1989) Food and Nutrition Board. Recommended Dietary

LECTURE TWO: THE SCIENCE OF NUTRITION

Recommended Dietary Allowances (RDA)

Carbohydrate and Fat

Estimating a minimal Requirement

Establishing a generous Recommendation

Using the RDA

Revising the RDA

1. Providing several sets of RDA,

1. Compare the purpose of the Dietary Guidelines to that of the RDAs.

WHO (1985) Energy and protein requirements. Report of a joint FAO/WHO/UNU

Smolin A and Grosvenor B (1994) Nutrition Science and Applications. Saunders

Gibson, R.(1990) Principles of Nutritional Assessment. New York: Oxford University

Bennion M, Scheule B (2000) Introductory Foods. 11th ed. Macmillan Publishing

National Research Council(1989) Food and Nutrition Board. Recommended Dietary

LECTURE THREE: PLANNING A HEALTHY DIET

1. State the principles of diet planning.