NUTRITION STUDY GUIDE ON CARBOHYDRATES AND LIPIDS

CARBOHYDRATES
CLASSIFICATION OF CARBOHYDRATES
The term carbohydrate is itself a combination of the “hydrates of carbon”. They are also known
as “Saccharides” which is a derivation of the Greek word “Sakcharon” meaning sugar. The
definition of carbohydrates in chemistry is as follows:
“Optically active polyhydroxy aldehydes or polyhydroxy ketones or substances which give these
on hydrolysis are termed as carbohydrates”.
Some of the most common carbohydrates that we come across in our daily lives are in form of
sugars. These sugars can be in form of Glucose, Sucrose, Fructose, Cellulose, Maltose etc.
he main classification of carbohydrate is done on the basis of hydrolysis. This classification is as
follow:
1. Monosaccharides: These are the simplest form of carbohydrate that cannot be
hydrolyzed any further. They have the general formula of (CH2O)n. Some
common examples are glucose, Ribose etc.
2. Oligosaccharides: Carbohydrates that on hydrolysis yield two to ten
smaller units or monosaccharides are oligosaccharides.  They are a large category
and further divides into various subcategories.
3. Disaccharides: A further classification of oligosaccharides, these give two units of
the same or different monosaccharides on hydrolysis. For example, sucrose on
hydrolysis gives one molecule of glucose and fructose each. Whereas maltose on
hydrolysis gives two molecules of only glucose,
4. Trisaccharides: Carbohydrates that on hydrolysis gives three molecules of
monosaccharides, whether same or different. An example is Raffinose.
5. Tetrasaccharides: And as the name suggests this carbohydrate on hydrolysis give
four molecules of monosaccharides. Stachyose is an example.
6. Polysaccharides: The final category of carbohydrates. These give a
large number of monosaccharides when they undergo hydrolysis, These
carbohydrates are not sweet in taste and are also known as non-sugars. Some
common examples are starch, glycogen etc.
SOURCES OF CARBOHYDRATES
There are both healthy and unhealthy sources of carbohydrates. Healthy sources of
carbohydrates include both food sources-animal and plant products, such as fresh fruits,
vegetables, corn, potatoes, milk and milk products. Unhealthy sources include soda, white
bread, artificial sugar, pastries, and other highly processed foods.
Carbohydrates can be found in different forms, such as sugars, starch, and fibres. Here is a
list of carbohydrates from different sources and different forms.
Also refer: Nutrients 

Types of Carbohydrates
There are two types of carbohydrates:

 Simple carbohydrates.
 Starchy Carbohydrates.
 Fibrous Carbohydrates.
 Complex carbohydrates.
Carbohydrates cannot be produced by the human body. So, they should be taken through diet.
Simple Carbohydrates
Fresh fruits like apples, oranges, banana, pineapple, sweet potatoes, berries are rich sources
of healthy simple carbohydrates. Foods that have artificial sugars and highly processed foods
are unhealthy sources of it. Milk is also a rich source of simple carbohydrates.

Starchy Carbohydrates
Grains are rich sources of carbohydrates. Grains include whole grains, grain bread, etc. Some
foods that are rich in carbohydrates are beans, potatoes, sweet potatoes, and some nuts.
Cereals are also a rich source of carbohydrates.

Fibrous Carbohydrates
Fibrous carbohydrates can be found in fresh vegetables like pumpkin, carrot, tomatoes, beans,
broccoli, cucumbers, squash, etc.

Complex Carbohydrates
Complex carbohydrates are found in beans, peas, whole grains, barley, oats, wild rice, brown
rice, etc.
Complex carbohydrates are good carbohydrates as they contain starch and fibre. Also, these
carbohydrates do not spike sugar levels in the blood thereby helping in minimal sugar level in
blood.

FUNCTIONS OF CARBOHYDRATES
Carbs Provide Your Body With Energy
One of the primary functions of carbohydrates is to provide your body with energy.
Most of the carbohydrates in the foods you eat are digested and broken down into glucose
before entering the bloodstream.
Glucose in the blood is taken up into your body’s cells and used to produce a fuel molecule
called adenosine triphosphate (ATP) through a series of complex processes known as cellular
respiration. Cells can then use ATP to power a variety of metabolic tasks.
Most cells in the body can produce ATP from several sources, including dietary
carbohydrates and fats. But if you are consuming a diet with a mix of these nutrients, most of
your body’s cells will prefer to use carbs as their primary energy source (1Trusted Source).
Summary One of the primary
functions of carbohydrates is to provide your body with energy. Your cells
convert carbohydrates into the fuel molecule ATP through a process called
cellular respiration.
They Also Provide Stored Energy
If your body has enough glucose to fulfill its current needs, excess glucose can be stored for
later use.
This stored form of glucose is called glycogen and is primarily found in the liver and muscle.
The liver contains approximately 100 grams of glycogen. These stored glucose molecules can
be released into the blood to provide energy throughout the body and help maintain normal
blood sugar levels between meals.
Unlike liver glycogen, the glycogen in your muscles can only be used by muscle cells. It is
vital for use during long periods of high-intensity exercise. Muscle glycogen content varies
from person to person, but it’s approximately 500 grams (2Trusted Source).
In circumstances in which you have all of the glucose your body needs and your glycogen
stores are full, your body can convert excess carbohydrates into triglyceride molecules and
store them as fat.
Summary Your body can
transform extra carbohydrates into stored energy in the form of glycogen.
Several hundred grams can be stored in your liver and muscles.
Carbohydrates Help Preserve Muscle
Glycogen storage is just one of several ways your body makes sure it has enough glucose for
all of its functions.
When glucose from carbohydrates is lacking, muscle can also be broken down into amino
acids and converted into glucose or other compounds to generate energy.
Obviously, this isn’t an ideal scenario, since muscle cells are crucial for body movement.
Severe losses of muscle mass have been associated with poor health and a higher risk of
death (3Trusted Source).
However, this is one way the body provides adequate energy for the brain, which requires
some glucose for energy even during periods of prolonged starvation.
Consuming at least some carbohydrates is one way to prevent this starvation-related loss of
muscle mass. These carbs will reduce muscle breakdown and provide glucose as energy for
the brain (4Trusted Source).
Other ways the body can preserve muscle mass without carbohydrates will be discussed later
in this article.
Summary During periods of
starvation when carbohydrates aren’t available, the body can convert amino
acids from muscle into glucose to provide the brain with energy. Consuming at
least some carbs can prevent muscle breakdown in this scenario.
They Promote Digestive Health
Unlike sugars and starches, dietary fiber is not broken down into glucose.
Instead, this type of carbohydrate passes through the body undigested. It can be categorized
into two main types of fiber: soluble and insoluble.
Soluble fiber is found in oats, legumes and the inner part of fruits and some vegetables. While
passing through the body, it draws in water and forms a gel-like substance. This increases the
bulk of your stool and softens it to help make bowel movements easier.
In a review of four controlled studies, soluble fiber was found to improve stool consistency
and increase the frequency of bowel movements in those with constipation. Furthermore, it
reduced straining and pain associated with bowel movements (5Trusted Source).
On the other hand, insoluble fiber helps alleviate constipation by adding bulk to your stools
and making things move a little quicker through the digestive tract. This type of fiber is found
in whole grains and the skins and seeds of fruits and vegetables.
Getting enough insoluble fiber may also protect against digestive tract diseases.
One observational study including over 40,000 men found that a higher intake of insoluble
fiber was associated with a 37% lower risk of diverticular disease, a disease in which pouches
develop in the intestine (6Trusted Source).
Summary Fiber is a type of
carbohydrate that promotes good digestive health by reducing constipation and
lowering the risk of digestive tract diseases.
They Influence Heart Health and Diabetes
Certainly, eating excessive amounts of refined carbs is detrimental to your heart and may
increase your risk of diabetes.
However, eating plenty of dietary fiber can benefit your heart and blood sugar levels
(7Trusted Source, 8Trusted Source, 9Trusted Source).
As viscous soluble fiber passes through the small intestine, it binds to bile acids and prevents
them from being reabsorbed. To make more bile acids, the liver uses cholesterol that would
otherwise be in the blood.
Controlled studies show that taking 10.2 grams of a soluble fiber supplement called psyllium
daily can lower “bad” LDL cholesterol by 7% (10Trusted Source).
Furthermore, a review of 22 observational studies calculated that the risk of heart disease was
9% lower for each additional 7 grams of dietary fiber people consumed per day (11Trusted
Source).
Additionally, fiber does not raise blood sugar like other carbohydrates do. In fact, soluble
fiber helps delay the absorption of carbs in your digestive tract. This can lead to lower blood
sugar levels following meals (12Trusted Source).
A review of 35 studies showed significant reductions in fasting blood sugar when participants
took soluble fiber supplements daily. It also lowered their levels of A1c, a molecule that
indicates average blood sugar levels over the past three months (13Trusted Source).
Although fiber reduced blood sugar levels in people with prediabetes, it was most powerful in
people with type 2 diabetes (13Trusted Source).
Summary Excess refined
carbohydrates can increase the risk of heart disease and diabetes. Fiber is a
type of carbohydrate that is associated with reduced “bad” LDL cholesterol
levels, a lower risk of heart disease and increased glycemic control.
Are Carbohydrates Necessary for These Functions?
As you can see, carbohydrates play a role in several important processes. However, your
body has alternative ways to carry out many of these tasks without carbs.
Nearly every cell in your body can generate the fuel molecule ATP from fat. In fact, the
body’s largest form of stored energy is not glycogen — it’s triglyceride molecules stored in
fat tissue.
Most of the time, the brain uses almost exclusively glucose for fuel. However, during times
of prolonged starvation or very low-carb diets, the brain shifts its main fuel source from
glucose to ketone bodies, also known simply as ketones.
Ketones are molecules formed from the breakdown of fatty acids. Your body creates them
when carbs are not available to provide your body with the energy it needs to function.
Ketosis happens when the body produces large amounts of ketones to use for energy. This
condition is not necessarily harmful and is much different from the complication of
uncontrolled diabetes known as ketoacidosis.
However, even though ketones are the primary fuel source for the brain during times of
starvation, the brain still requires around one-third of its energy to come from glucose via
muscle breakdown and other sources within the body (14Trusted Source).
By using ketones instead of glucose, the brain markedly reduces the amount of muscle that
needs to be broken down and converted to glucose for energy. This shift is a vital survival
method that allows humans to live without food for several weeks.
Summary The body has
alternative ways to provide energy and preserve muscle during starvation or
very low-carb diets.
DIGESTION AND ABSORPTION OF CARBOHYDRATES
Mouth or Oral Cavity
As you chew your bite of pizza, you’re using mechanical digestion to begin to break it into
smaller pieces and mix it with saliva, produced by several salivary glands in the oral cavity.
Some enzymatic digestion of starch occurs in the mouth, due to the action of the
enzyme salivary amylase. This enzyme starts to break the long glucose chains of starch into
shorter chains, some as small as maltose. (The other 
carbohydrates
 in the bread don’t undergo any enzymatic digestion in the mouth.)
 Figure 4.4.
24.4.2: The enzyme salivary amylase breaks starch into smaller 
polysaccharides
 and maltose. (Copyright; author via source)
Stomach
The low pH in the stomach inactivates salivary amylase, so it no longer works once it arrives
at the stomach. Although there’s more mechanical digestion in the stomach, there’s little
chemical digestion of 
carbohydrates
 here.
Small intestine
Most carbohydrate digestion occurs in the small intestine, thanks to a suite of 
enzymes
. 
Pancreatic amylase
 is secreted from the pancreas into the small intestine, and like salivary amylase, it breaks
starch down to small 
oligosaccharides
 (containing 3 to 10 glucose molecules) and maltose.

Figure 
4.4.34.4.3: The enzyme 
pancreatic amylase
 breaks starch into smaller 
polysaccharides
 and maltose. (Copyright; author via source)
 
The rest of the work of carbohydrate digestion is done by 
enzymes
 produced by the enterocytes, the cells lining the small intestine. When it comes to digesting
your slice of pizza, these 
enzymes
 will break down the maltose formed in the process of starch digestion, the lactose from the
cheese, and the sucrose present in the sauce.
Maltose is digested by maltase, forming 2 glucose molecules.

Lactose is digested by lactase, forming glucose and galactose.

Sucrose is digested by sucrase, forming glucose and fructose.

Figure 4.12. Action of the 

enzymes
 maltase, lactase, and sucrase.
(Recall that if a person is lactose intolerant, they don’t make enough lactase enzyme to digest
lactose adequately. Therefore, lactose passes to the large intestine. There it draws water in by 
osmosis
 and is fermented by bacteria, causing symptoms such as flatulence, bloating, and diarrhea.)
By the end of this process of enzymatic digestion, we’re left with three monosaccharides:
glucose, fructose, and galactose. These can now be absorbed across the enterocytes of the
small intestine and into the bloodstream to be transported to the liver.
Digestion and absorption of 
carbohydrates
 in the small intestine are depicted in a very simplified schematic below. (Remember that the
inner wall of the small intestine is actually composed of large circular folds, lined with many
villi, the surface of which are made up of microvilli. All of this gives the small intestine a
huge surface area for absorption.)
Fructose and galactose are converted to glucose in the liver. Once absorbed 
carbohydrates
 pass through the liver, glucose is the main form of carbohydrate circulating in the
bloodstream.
Large Intestine or Colon
Any 
carbohydrates
 that weren’t digested in the small intestine—mainly fiber—pass into the large intestine, but
there’s no enzymatic digestion of these 
carbohydrates
 here. Instead, bacteria living in the large intestine, sometimes called our gut microbiota,
ferment these 
carbohydrates
 to feed themselves. Fermentation causes gas production, and that’s why we may experience
bloating and flatulence after a particularly fibrous meal. Fermentation also produces short-
chain 
fatty acids
, which our large intestine cells can use as an 
energy
 source. Over the last decade or so, more and more research has shown that our gut
microbiota are incredibly important to our health, playing important roles in the function of
our immune response, nutrition, and risk of 
disease
. A diet high in whole food sources of fiber helps to maintain a population of healthy gut
microbes.
EXCESSIVE INTAKE OF CARBOHYDRATE CAUSES
Weight Gain
One of the first sign of an excessive carbohydrate intake is weight gain or an inability to lose
weight. Not only does an excess carb intake contribute extra calories to your diet, it also
stimulates the release of larger amounts of insulin. High insulin levels help you control your
blood sugar levels by shoveling the sugar circulating in your blood, which is the result of the
digestion of carbohydrate-containing foods, into your cells, where it is stored as fat.
High Blood Sugar Levels
During the digestion process, carbohydrates break down into glucose, or sugar, which is then
absorbed into your bloodstream. The more carbohydrates you eat, the higher your blood
sugar levels rise after eating. Insulin is usually released by your pancreas in amounts that are
proportional to increases in your blood sugar levels. However, with time, your pancreas may
become less efficient at producing these large amounts of insulin. If you have prediabetes or
diabetes, your pancreas is already showing signs of fatigue. As a consequence, your excessive
carb intake could lead to high blood sugar levels and uncontrolled diabetes.
 During the digestion process, carbohydrates break down into glucose, or sugar, which
is then absorbed into your bloodstream.
 As a consequence, your excessive carb intake could lead to high blood sugar levels
and uncontrolled diabetes.
High Triglycerides
Your triglycerides should ideally be below 150 milligrams per deciliter to keep your heart
healthy. Eating too many carbs is associated with higher triglycerides levels, while decreasing
your carb intake can help you bring these levels back into the desirable range, according to a
paper published in August 2005 in "Nutrition & Metabolism."
Low HDL Cholesterol Levels
HDL cholesterol is often referred to as the good cholesterol that protects your heart from
cardiovascular diseases. Ideally, your HDL cholesterol should be 60 milligrams per deciliter
or more. A high-carb diet is often associated with lower HDL cholesterol levels. In a study
published in May 2004 of "Annals of Internal Medicine," the group eating a calorie-
restricted, high-carb diet had a drop of 1.6 milligrams per deciliter in their HDL cholesterol
levels, while the group assigned to the low-carb diet boosted their HDL by 5.5 milligrams per
deciliter.
 HDL cholesterol is often referred to as the good cholesterol that protects your heart
from cardiovascular diseases.
DEFICIENCY OF CARBOHYDRATES
 1. Hypoglycemia
It is very important to have normal blood glucose level, when the glucose level in
blood drops below normal value it is called low blood glucose or hypoglycaemia.
Hypoglycaemia is generally seen in diabetics but it can happen if adequate amounts of
carbohydrates are not consumed because all carbohydrates are converted into glucose.
Hypoglycaemia can cause a feeling of dizziness, lethargy, confusion and triggers
hunger. It can be corrected by eating small amounts of carbohydrate or glucose rich
food immediately.

2. Ketosis
When the body does not have adequate supply of carbohydrates to produce energy, it
starts breaking down the fats to meet the metabolic demands. Ketones are produced in
the process of fat breakdown and an excessive amount of ketones in blood is termed as
ketosis, mild ketosis can cause nausea, headache, smelly breath and metal fatigue
whereas severe ketosis can seriously damage the vital organs. The minimum amount
of carbohydrates required by the body is 130 gm per day and an intake of 225 to 325
gm of carbohydrates every day is recommended to avoid ketosis.

3. Weight Gain
Carbohydrates are generally avoided for the fear of weight gain but it is a scientifically
proven fact that severe restriction of carbohydrates is not very helpful in losing
weight. Carbohydrate deficiency triggers hunger and leads to extra calorie
consumption. Taking adequate amounts of low calorie, healthy carbohydrates keeps
you full for longer and produces early satiety with the high fibre content. According to
a recent research people who ate recommended amounts of complex carbohydrates are
more likely to reduce weight and maintain it as compared to those who consume no
carbohydrates.

CALORIFIC VALUE OF CARBOHYDRATES

Carbohydrates are sugar and starch. These are the major source of cellular fuel which
provides energy. The caloric value of carbohydrate is 4.1 Kcal per gram and its
physiological fuel value is 4 Kcal per gram.
DIFFRENCES BETWEEN KWASHIORKOR AND MARASMUS
Kwashiorkor Marasmus

Causes

Deficiency of proteins. Deficiency of both proteins and calories.

Age factors

Between the age of 6 months and 3 years of

Between the age of 6 months and 1 year of age.
age.

Oedema
 Present. Absent.

Subcutaneous fat

Present. Absent.

Weight loss

There is some weight loss. There is severe weight loss.

Symptoms

The thinning of muscles and limbs. The thinning of limbs.

Fatty liver cells

There is an enlargement in the fatty liver

There is no enlargement in the fatty liver cells.
cells.

Appetite

Voracious feeder. Poor appetite.

The texture of the skin

Flaky paint appearance on the skin. Dry and wrinkled skin.

Requirement of Nutrition

Adequate amounts of proteins, carbohydrates and

Adequate amounts of proteins.
fats.

DAILY REQUIREMENT OF CARBOHYDRATES

With all the media hype about low-carb diets, you might assume carbohydrates are bad for
you. On the contrary, carbohydrates are an essential part of your diet that you need for
energy production and digestive health, among other things. The minimum carbohydrate
requirement for adults is 130 grams or 45 percent of daily calories. While getting enough
carbohydrates is important, it's also vital to eat the right types of carbs.
The recommended dietary allowance, or RDA, for carbohydrates for all adults is at least
130 grams per day. This is the minimum amount deemed necessary for good health for 97
to 98 percent of healthy adults. Dietary recommendations for carbohydrates are also made
in the form of acceptable macronutrient distribution ranges, or AMDRs. This takes into
account the number of calories consumed each day, which can vary widely by age, sex and
activity level. The AMDR for carbs is 45 to 65 percent of total daily calories. Using the
AMDR, the carbohydrate intake for a moderately active 32-year-old male would be 1,170
to 1,690 calories from carbs. Because carbohydrates have 4 calories per gram, this
translates to 292 to 423 grams of carbs each day, significantly higher than the minimum
requirement.
METABOLISM OF CARBOHYDRATES
Carbohydrates are one of the widely discussed topics among students of science across the
world and they are simply referred by names like disaccharides, monosaccharides, and
polysaccharides or by terms like complex carbohydrates. There are different ways in which
carbohydrates helps living beings like storing energy in the form of glycogen and starch. It
helps in cell signalling as glycolipids and glycoproteins that act as determinants of blood
groups. It helps in transporting energy to the muscles and the nervous system. This would
mean every individual cell in particular other than the mainly chosen primary fuel molecule
with particular differences on distinct cell types. Also, it acts as surface makers of cells,
forms a part of nucleic acids like mRNA, tRNA, ribosome, and genes and so on. As far as
humans are concerned, the carbohydrates that aid the metabolism are available in the form of
starch and glycogen as alpha glycosidic bonds.

Carbohydrate Metabolism
Dietary glucose is found aplenty in starch. Amalyses are the enzymes that degrade starch for
assisting metabolism. Glucose has many sources such as lactose (from milk), fructose (from
fruits), and sucrose (from table sugar). Active membrane transport systems aid the absorption
of fructose, glucose, and fructose which are known by the name monosaccharide species.
Monosaccharide components are formed by the division of disaccharides by special intestinal
glucosidases. Glucose types like maltose are hydrolyzed by isomaltase with less ability to get
desired results. Intolerance for lactose is caused by lactase deficiency – an enzyme which is
needed to break down the lactose in milk and other dairy products.
The small intestine contains intestinal mucosal cells that transport the monosaccharides into
the circulatory system, where they move on into the liver. Here, the galactose and fructose are
converted into glucose. The liver’s primary role is to regulate the levels of glucose in the
blood, or in other words, act as a blood “glucostat”. Glucose molecules produced in excess
are stored primarily in the liver and muscle cells as glycogen. It is also stored in the form of
metabolized fat in adipocytes. Instead of fat, only glycogen would be used to maintain an
adequate level of glucose in the bloodstream when food intake is restricted. Fat can be used
for the oxidative regeneration of ATP and reductive power (NADH).
CLINICAL FEATURES OF MARASMUS
“Marasmus can be defined as a form of nutrition deficiency disorder, usually occurring in
children. It can be life-threatening if not diagnosed at an early stage.”

Causes of Marasmus
As mentioned above, it is a nutrition deficiency disease and is mainly caused by:
 a severe deficiency of protein, vitamins, minerals, carbohydrates, and lipids.
 Viral, bacterial, and parasitic infections are also a major cause for this disorder.
 Children, older adults, and people with a weak immune system are more prone to
marasmus.
Other causes of marasmus include:
 Poverty
 Starvation
 Famine or unavailability of food
 Lack of education about nutritional requirements.
 Intake of medicines that interfere with the absorption of nutrients.

Symptoms of Marasmus
The symptoms of marasmus are more common to the symptoms of kwashiorkor, which
includes:
 Dizziness
 Weight loss.
 Dehydration.
 Lack of energy
 Stunted growth.
 Chronic Diarrhoea.
 Shrinkage of Stomach.
 Respiratory infections.
 Dry skin and brittle hair.
 Underweight or loss of muscle mass and subcutaneous fat.

Risk Factors of Marasmus

The risk factors for marasmus include:
 The people living in developing countries are more at risk of contracting marasmus.
 The famine and poverty struck areas have a larger percentage of children suffering
from marasmus.
 If the infants are not breastfed by nursing mothers due to malnutrition, the risk of
marasmus increases in children.
 Insufficient medical care and high disease rates are other reasons that increase the risk
of marasmus in the population.

Diagnosis of Marasmus
This deficiency disease can be diagnosed by the physician through a physical examination
such as:
 Skin test for the functioning of the immune system.
 A blood test to check for the presence of any microbial infections.
 Height, weight and physical activity of a child according to age.
 General counselling of a child to study the child’s mental state and behaviour.
 Urine and stool test for examining diarrhoea and other nutritional deficiency
disorders.

Treatment for Marasmus

The first and primary treatment prescribed for the patient suffering from marasmus includes:
 Multivitamin supplements to improve appetite and nutrition deficiency.
 Dehydration symptoms can be prevented by the intake of water and other fluids that
contain electrolytes.
 Few antibiotics or other medications are given to treat children with pathogenic
infections.
 A well-balanced diet is given once after the child’s condition is stable and starts to
recover slowly.
 Diet rich in protein like skimmed milk, and other energy providing food supplements
to increases the energy content.

Prevention and Safety Measures for Marasmus

Marasmus is a life-threatening nutrition deficiency disorder which may also lead to death if
the symptoms are ignored. Complete recovery can take a month together even with proper
diet and medication. Along with the treatment, the patient should also take some preventive
steps like:
 Drinking boiled water.
 Eating washed and cooked food.
 Intake of more water to stay hydrated.
 Maintain good sanitation and hygiene.
 Having a healthy and well-balanced diet.
 Learning the importance of nutrition and providing good nutrition for both pregnant
women, lactating mothers and educating every mother to breastfeed their infants for 5
– 6 months to protect them from nutritional difficulties and to improve their
immunity.
CLINICAL FEATURES OF KWASHIORKOR
Kwashiorkor is due to a quantitative and qualitative deficiency of protein, but in which
energy in take may be adequate. It is mainly a disease of rural areas occurring in the second
year of life. This disease occurs when the child is weaned into the traditional family diet; this
may be low in protein because of poverty, insufficient land and poor agricultural practice.
There is no supplement of milk. The disease is frequently precipitated by outbreaks of febrile
illnesses, such as malaria, measles or gastroenteritis. It arises as a result of poverty and igno-
rance. Many mothers have received no satisfactory instruction in infant feeding although
there is money to buy food. In Africa, the disease is commoner.

Clinical Features of Kwashiorkor:

a. There are oedema, anorexia, diarrhoea and a generalized unhappiness or apathy. An
infection often precipitates at the onset for which the child is brought to the doctor.

b. Failure of growth is an early sign. Oedema is more marked in the lower limbs.

c. The characteristic dermatosis consists of areas of both hypo- and hyperpigmentation. The
skin first becomes thickened as if varnished. This then peels and appears like “flaky paint”
leaving cracks or denuded areas of shallow ulceration. In moderate cases the dermatosis
resembles crazy paving; when severe, the desquamated part looks as if there has been a burn.
The lower limbs, buttocks and perineum are usually most affected but ulcers can occur over
pressure points and deep cracks in skinfolds.

d. The hair is sparse, soft and thin. Negro children lose their characteristic curl. There may be
changes in pigmentation with diffuse patches or streaks which may be red or grey in colour.

e. Angular stomatitis, cheilosis and a smooth atrophic tongue are commonly seen, as in
ulceration around the anus.

6. Watery diarrhoea or large semisolid, acid stools are usual. The liver can generally be
palpated and is firm, not tender.

g. The muscles are always wasted and as a result many children may no longer be able to
walk or crawl.
h. Some degree of anemia is always present and may be severe.

i. Apathy is a characteristic feature and the child appears constantly unhappy. Neurological
features are unusual, but some children during recovery have tremors resembling
parkinsonism.

j. Many patients show a mixture of some of the features of both marasmus and kwashiorkor.
These children are said to have marasmic kwashiorkor.

k. Some children adapt to prolonged insufficiency of food by a marked retardation of growth.

They resemble children a year or more younger.
IMPORTANCE OF DIETARY FIBRES
Dietary fiber, also known as roughage or bulk, includes the parts of plant foods your body
can't digest or absorb. Unlike other food components, such as fats, proteins or carbohydrates
— which your body breaks down and absorbs — fiber isn't digested by your body. Instead, it
passes relatively intact through your stomach, small intestine and colon and out of your body.
Fiber is commonly classified as soluble, which dissolves in water, or insoluble, which doesn't
dissolve.

 Soluble fiber. This type of fiber dissolves in water to form a gel-like material. It

can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats,
peas, beans, apples, citrus fruits, carrots, barley and psyllium.
 Insoluble fiber. This type of fiber promotes the movement of material through
your digestive system and increases stool bulk, so it can be of benefit to those who
struggle with constipation or irregular stools. Whole-wheat flour, wheat bran,
nuts, beans and vegetables, such as cauliflower, green beans and potatoes, are
good sources of insoluble fiber.
The amount of soluble and insoluble fiber varies in different plant foods. To receive the
greatest health benefit, eat a wide variety of high-fiber foods.
Benefits of a high-fiber diet
A high-fiber diet:

 Normalizes bowel movements. Dietary fiber increases the weight and size of your
stool and softens it. A bulky stool is easier to pass, decreasing your chance of
constipation. If you have loose, watery stools, fiber may help to solidify the stool
because it absorbs water and adds bulk to stool.
 Helps maintain bowel health. A high-fiber diet may lower your risk of developing
hemorrhoids and small pouches in your colon (diverticular disease). Studies have
also found that a high-fiber diet likely lowers the risk of colorectal cancer. Some
fiber is fermented in the colon. Researchers are looking at how this may play a
role in preventing diseases of the colon.
 Lowers cholesterol levels. Soluble fiber found in beans, oats, flaxseed and oat
bran may help lower total blood cholesterol levels by lowering low-density
lipoprotein, or "bad," cholesterol levels. Studies also have shown that high-fiber
foods may have other heart-health benefits, such as reducing blood pressure and
inflammation.
 Helps control blood sugar levels. In people with diabetes, fiber — particularly
soluble fiber — can slow the absorption of sugar and help improve blood sugar
 levels. A healthy diet that includes insoluble fiber may also reduce the risk of
developing type 2 diabetes.
 Aids in achieving healthy weight. High-fiber foods tend to be more filling than
low-fiber foods, so you're likely to eat less and stay satisfied longer. And high-
fiber foods tend to take longer to eat and to be less "energy dense," which means
they have fewer calories for the same volume of food.
 Helps you live longer. Studies suggest that increasing your dietary fiber intake —
especially cereal fiber — is associated with a reduced risk of dying from
cardiovascular disease and all cancers.
DIGESTION OF STARCH

Digestion Starts in the Mouth

The goal of digestion is to break down foods into particles your body can use for fuel.
Because starch has multiple bonds holding it together, your body has its work cut out for it in
this process — and it all starts with your first bite.
"Carbohydrate digestion actually begins in your mouth as you start chewing," says Brittany
Modell, RD, of Brittany Modell Nutrition and Wellness in New York City. Chewing begins
the gradual process of breaking down starch's long chains. As you chew, your salivary glands
also activate, stimulating the production of saliva.
"Your saliva contains an enzyme called salivary amylase," says Modell. "This enzyme starts
to break apart starches into smaller, more simple carbohydrates," a process also known as
hydrolysis. But because food doesn't stay in the mouth for very long, these enzymes are only
doing preparatory work. The bulk of starch digestion is yet to come.

Middle Phases of Digestion

When you swallow, food passes through your esophagus down to your stomach. It's here that
starch digestion stalls because the low acidic pH of the gastric juice in your stomach mostly
stops the salivary amylase — the enzyme that worked to break down food when it was in
your mouth — from further breaking down starch, according to an October 2016 report
in Current Diabetes Reports. However, the stomach does work to physically mix and churn
the food.
Moving past the stomach, starch continues on to the small intestine. It's in this part of the
digestive tract that the real action of starch digestion happens, per May 2019 research
in Frontiers in Nutrition.
When food (now churned into a substance called "chyme") enters the small intestine, the
pancreas releases its own digestive enzymes to help break down starch, says Frontiers in
Nutrition's research. This enzyme enters the small intestine through the pancreatic duct and
gets to work on deconstructing starch into smaller chains and individual molecules.
In addition, the brush border of the small intestine contains other enzymes, such as maltase,
sucrase and lactase, which also help with digestion and breaking down food, according
to Colorado State University. The majority of starch digestion takes place in the small
intestine, thanks to the activity of the enzymes in the pancreas and small intestine,
notes Frontiers in Nutrition.

End Product of Starch Digestion

When all is said and done, starches have been broken down into their smallest, usable
components: primarily the monosaccharide glucose, as well as some fructose and galactose.
These simple sugars are known as the "end products" of starch digestion. Your body can now
distribute them for use as energy or store them.
According to a study published in the August 2017 issue of the journal Starch, the glucose
and galactose that result from starch digestion get distributed to the body's cells via two
transport proteins, SGLT1 and GLUT2. Once in the cells, glucose and galactose can be used
for energy.
Fructose, on the other hand, is transported via the proteins GLUT2 and GLUT5, according to
research published in November 2015 in the journal Clinical and Translational
Gastroenterology. It gets stored in the liver as a backup source of energy. And thus completes
the body's process of digesting starch — until your next meal.
LACTOSE INTOLERANCE
People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a
result, they have diarrhea, gas and bloating after eating or drinking dairy products. The
condition, which is also called lactose malabsorption, is usually harmless, but its symptoms
can be uncomfortable.
Too little of an enzyme produced in your small intestine (lactase) is usually responsible for
lactose intolerance. You can have low levels of lactase and still be able to digest milk
products. But if your levels are too low you become lactose intolerant, leading to symptoms
after you eat or drink dairy.
Most people with lactose intolerance can manage the condition without having to give up all
dairy foods.
Symptoms
The signs and symptoms of lactose intolerance usually begin from 30 minutes to two hours
after eating or drinking foods that contain lactose. Common signs and symptoms include:

 Diarrhea
 Nausea, and sometimes, vomiting
 Stomach cramps
 Bloating
 Gas
Causes
Lactose intolerance occurs when your small intestine doesn't produce enough of an enzyme
(lactase) to digest milk sugar (lactose).
Normally, lactase turns milk sugar into two simple sugars — glucose and galactose — which
are absorbed into the bloodstream through the intestinal lining.
If you're lactase deficient, lactose in your food moves into the colon instead of being
processed and absorbed. In the colon, normal bacteria interact with undigested lactose,
causing the signs and symptoms of lactose intolerance.
LIPIDS
CLASSIFICATION OF LIPIDS
Lipids can be classified into two main classes:

 Nonsaponifiable lipids
 Saponifiable lipids

Nonsaponifiable Lipids
A nonsaponifiable lipid cannot be disintegrated into smaller molecules through hydrolysis.
Nonsaponifiable lipids include cholesterol, prostaglandins, etc

Saponifiable Lipids
A saponifiable lipid comprises one or more ester groups, enabling it to undergo hydrolysis in
the presence of a base, acid, or enzymes, including waxes, triglycerides, sphingolipids and
phospholipids.
Further, these categories can be divided into non-polar and polar lipids.
Nonpolar lipids, namely triglycerides, are utilized as fuel and to store energy.
Polar lipids, that could form a barrier with an external water environment, are utilized in
membranes. Polar lipids comprise sphingolipids and glycerophospholipids.
Fatty acids are pivotal components of all these lipids.

Types of Lipids
Within these two major classes of lipids, there are numerous specific types of lipids important
to live, including fatty acids, triglycerides, glycerophospholipids, sphingolipids and steroids.
These are broadly classified as simple lipids and complex lipids.
Also read: Biomolecules in Living Organisms

Simple Lipids
Esters of fatty acids with various alcohols.

1. Fats: Esters of fatty acids with glycerol. Oils are fats in the liquid state

2. Waxes: Esters of fatty acids with higher molecular weight monohydric alcohols

Complex Lipids
Esters of fatty acids containing groups in addition to alcohol and a fatty acid.

1. Phospholipids: These are lipids containing, in addition to fatty acids and alcohol, a
phosphoric acid residue. They frequently have nitrogen-containing bases and other
substituents, eg, in glycerophospholipids the alcohol is glycerol and in
sphingophospholipids the alcohol is sphingosine.
 2. Glycolipids (glycosphingolipids): Lipids containing a fatty acid, sphingosine and
carbohydrate.

3. Other complex lipids: Lipids such as sulfolipids and amino lipids. Lipoproteins may
also be placed in this category.

Precursor and Derived Lipids

These include fatty acids, glycerol, steroids, other alcohols, fatty aldehydes, and ketone
bodies, hydrocarbons, lipid-soluble vitamins, and hormones. Because they are uncharged,
acylglycerols (glycerides), cholesterol, and cholesteryl esters are termed neutral lipids. These
compounds are produced by the hydrolysis of simple and complex lipids.
Some of the different types of lipids are described below in detail.

Fatty Acids
Fatty acids are carboxylic acids (or organic acid), usually with long aliphatic tails (long
chains), either unsaturated or saturated.

 Saturated fatty acids

Lack of carbon-carbon double bonds indicate that the fatty acid is saturated. The saturated
fatty acids have higher melting points compared to unsaturated acids of the corresponding
size due to their ability to pack their molecules together thus leading to a straight rod-like
shape.

 Unsaturated fatty acids

Unsaturated fatty acid is indicated when a fatty acid has more than one double bond.
“Often, naturally occurring fatty acids possesses an even number of carbon atoms and are
unbranched.”
On the other hand, unsaturated fatty acids contain a cis-double bond(s) which create a
structural kink that disables them to group their molecules in straight rod-like shape.
FUNCTION OF LIPIDS
 Lipids are a Good source of energy for animals.
 Lipids are the carrier of fat-soluble vitamins and essential fatty acids
 They make food more palatable and decrease its mass.
 They help to decrease gastric motility and secretions.
 Lipids contour to the body.
 Lipids are the main source of anatomical stability.
 These are the block for energy reservoirs in adipose tissues.
 Lipids perform an Insulating effect on the nervous system.
 They are mainly part of protoplasm and membranes as well.
 Lipids are the precursor of important physiological compounds in biology.
 They are resistant in the absorption of water-soluble substances
 Lipids prevent water evaporation from the skin of animals.
 Sphingosine help in the transmission of nerve impulses.
 Lipids mainly help in synapsis and form postsynaptic membrane receptor
abundantly.
 Prostaglandin lipids have the hormones which perform actions for the body.
SOURCES OF LIPIDS
Oils
Edible oils are lipids. These include vegetable oils such as:
 canola
  cottonseed
 grape seed
 corn
 olive
 peanut
 many others
Vegetable oils usually come from the seeds of the vegetable and most are high in
monounsaturated or polyunsaturated fats. Marine oils are also lipids, and include cod liver oil
and whale oil.
Dairy Products
Cream, milk and butter are lipids. Butter and cream are often used to make food taste better.
Milk is considered a healthy beverage and cheese, sour cream and ice cream are dietary
favorites. Fat-free dairy products have had most lipids removed.
 Cream, milk and butter are lipids.
Nuts
Nuts and seeds contain excessive lipids but are regarded as health foods because they contain
monounsaturated fats. Nuts also provide your body with vitamin E and zinc.
Meats, Poultry and Fish
Pork, beef, poultry and poultry skins contain large amounts of lipids. The Cleveland Clinic
suggests trimming visible fat from meats or purchasing leaner cuts. (See Reference 2) Some
fish, such as salmon, mackerel and trout, are high in fats. Fish and fish oils provide omega-3
fatty acids thought to be necessary for heart health.
 Pork, beef, poultry and poultry skins contain large amounts of lipids.
 Fish and fish oils provide omega-3 fatty acids thought to be necessary for heart health.
Vegetables
Some vegetables are high in fat, including olives and avocados. However, they contain
monounsaturated fats and are heart healthy.
Sauces
Prepared sauces made with oils or fats contain lipids. Mayonnaise, salad dressings and any
sauces made with oils often contain partially hydrogenated fats or trans fats, synthetically
created and not good for you.
Packaged and Processed Foods
The University of Pennsylvania lists several packaged foods that contain trans fats and can
lead to heart disease 2. (Reference 3, Spreads) Margarine top the list. In order to avoid eating
trans fats, you must read labels. Commercially produced and packaged foods often use trans
fats since they are cheaper and do not readily spoil. Cake mixes, fast foods, canned soups,
frozen casseroles and most baked goods from delis contain trans fats. If you make these foods
at home, you will probably use butter or oils. The saturated fats in the butter or
polyunsaturated fats in oils are better for you than the commercial trans fats.
 The University of Pennsylvania lists several packaged foods that contain trans fats
and can lead to heart disease 2 Margarine top the list.
CALORIFIC VALUE OF LIPIDS
Lipids from vegetables and fruits average 9.30 kcal. The average heat of combustion (bomb
calorimeter) for lipid is generally given as 9.4 kcal per gram. The net energy (average
calories) for humans is the same, at 9.4 kcal per gram of fat. This is usually rounded to 9
calories per gram.
DAILY REQUIREMENTS OF LIPIDS
Under the current DRIs, there is no RDA for lipids, more commonly referred to as “fat.”
However, the recommendations specify an adequate amount for infants to be 31 grams per
day (g/d) from 0 to 6 months of age, and 30 g/d from 7 to 12 months of age. Children and
adults can follow the ranges given in "Krause's Food & Nutrition Therapy" by Kathleen
Mahan and Sylvia Escott-Stump 3:

1 to 3 years: 30 to 40 % of your total calorie intake per day 4 to 18 years: 25 to 35 % of your

total calorie intake per day Over 19 years: 20 to 35 % of your total calorie intake per day

DIGESTION AND ABSORPTION OF FATS

The first step in the digestion of triglycerides and phospholipids begins in the mouth as lipids
encounter saliva. Next, the physical action of chewing coupled with the action of emulsifiers
enables the digestive enzymes to do their tasks. The enzyme lingual lipase, along with a small
amount of phospholipid as an emulsifier, initiates the process of digestion. These actions
cause the fats to become more accessible to the digestive enzymes. As a result, the fats
become tiny droplets and separate from the watery components.
In the stomach, gastric lipase starts to break down triglycerides into diglycerides and fatty
acids. Within two to four hours after eating a meal, roughly 30 percent of the triglycerides are
converted to diglycerides and fatty acids. The stomach’s churning and contractions help to
disperse the fat molecules, while the diglycerides derived in this process act as further
emulsifiers. However, even amid all of this activity, very little fat digestion occurs in the
stomach.

As stomach contents enter the small intestine, the digestive system sets out to manage a small
hurdle, namely, to combine the separated fats with its own watery fluids. The solution to this
hurdle is bile. Bile contains bile salts, lecithin, and substances derived from cholesterol so it
acts as an emulsifier. It attracts and holds onto fat while it is simultaneously attracted to and
held on to by water. Emulsification increases the surface area of lipids over a thousand-fold,
making them more accessible to the digestive enzymes.

Once the stomach contents have been emulsified, fat-breaking enzymes work on the
triglycerides and diglycerides to sever fatty acids from their glycerol foundations. As
pancreatic lipase enters the small intestine, it breaks down the fats into free fatty acids and
monoglycerides. Yet again, another hurdle presents itself. How will the fats pass through the
watery layer of mucus that coats the absorptive lining of the digestive tract? As before, the
answer is bile. Bile salts envelop the fatty acids and monoglycerides to form micelles.
Micelles have a fatty acid core with a water-soluble exterior. This allows efficient
transportation to the intestinal microvillus. Here, the fat components are released and
disseminated into the cells of the digestive tract lining.

Just as lipids require special handling in the digestive tract to move within a water-based
environment, they require similar handling to travel in the bloodstream. Inside the intestinal
cells, the monoglycerides and fatty acids reassemble themselves into triglycerides.
Triglycerides, cholesterol, and phospholipids form lipoproteins when joined with a protein
carrier. Lipoproteins have an inner core that is primarily made up of triglycerides and
cholesterol esters (a cholesterol ester is a cholesterol linked to a fatty acid). The outer
envelope is made of phospholipids interspersed with proteins and cholesterol. Together they
form a chylomicron, which is a large lipoprotein that now enters the lymphatic system and
will soon be released into the bloodstream via the jugular vein in the neck. Chylomicrons
transport food fats perfectly through the body’s water-based environment to specific
destinations such as the liver and other body tissues.
Cholesterols are poorly absorbed when compared to phospholipids and triglycerides.
Cholesterol absorption is aided by an increase in dietary fat components and is hindered by
high fiber content. This is the reason that a high intake of fiber is recommended to decrease
blood cholesterol. Foods high in fiber such as fresh fruits, vegetables, and oats can bind bile
salts and cholesterol, preventing their absorption and carrying them out of the colon.

If fats are not absorbed properly as is seen in some medical conditions, a person’s stool will
contain high amounts of fat. If fat malabsorption persists the condition is known as
steatorrhea. Steatorrhea can result from diseases that affect absorption, such as Crohn’s
disease and cystic fibrosis.

EXCESSIVE INTAKE OF LIPIDS

Cardiovascular Complications
Too much lipid consumption can lead to an array of cardiovascular complications. Saturated
fat is especially harmful as it can cause high blood cholesterol, leading to arterial hardening,
heart disease and stroke, according to MedlinePlus. The American Heart Association, or
AHA, says that saturated fat is the main dietary cause of high cholesterol and is abundant in
fatty meats, butter, cream, milk and other dairy items. Minimizing your intake of these foods
can significantly reduce cholesterol levels.
Obesity
A diet abundant in lipids can lead to obesity, according to "Food Factors for Health
Promotion." Accompanying metabolism abnormalities also are due to daily excess fat intake.
Unlike packing on a few extra pounds, obesity is having way too much body fat that can
wreak havoc on the body. Even losing 5 percent to 10 percent of your weight can inhibit the
onset of certain diseases, according to MedlinePlus.
Increased Risk of Disease
A high fat diet also increases your risk of diseases like arthritis, some cancers and diabetes,
MedlinePlus warns. If you're obese, you are at a higher risk of type 2 diabetes, which usually
accompanies high cholesterol and triglyceride levels, according to MayoClinic.com. Trans fat
that comes in the form of partially hydrogenated oils, also lipids, is particularly damaging to
your body. It increases low-density lipoprotein, or bad cholesterol, while lowering high-
density lipoprotein, or good cholesterol.

DEFICIENCY OF FATS
Those striving to lose weight on a low fat diet can encounter fat deficiency symptoms. Many
may have a fatty acid deficiency, but aren’t aware that they aren’t getting enough fat in the
diet.
Skin Issues
Some fats are essential for keeping your skin healthy. That shiny glow, elasticity, and
immunity to small cuts and scrapes is due to dietary fat in your diet.
Without these healthy fats in your diet, water cannot be retained as easily in your skin. This
leaves your skin dry and scaly. It also makes it harder for wounds to heal. That is because
dry, water-deficient skin makes it harder for new skin to form.
Brain Functionality
Dietary fats are important for proper brain functions like memory and mental performance.
Without these fats you put yourself at risk for developing dementia and Alzheimer’s disease.
A good proportion of brain tissue has concentrated levels of omega-3 fatty acids. It’s also
been shown in this randomized controlled trial that low dietary intake of omega-3 fatty acids
is associated with depression, impulsive behavior, and anger. So, be sure to eat plenty of
omega-3 fats for a better mood!
Vision Problems
Dietary fats are also crucial to keeping proper eye health. In particular, two types of fatty
acids are responsible for communication between your retina and brain. It helps form the
light that enters into images that get processed by the brain.
Incorporating dietary fats can also reduce the risk of dry eyes. It can also prevent macular
deterioration that is due to the aging of the eyes.
REFINED OIL
Refined oil means that crude vegetable oil is refined through special process to remove
harmful impurities which is not good for human being and storage, the final oil is refined oil.
Some vegetable oil is not edible only after refined such as rice bran oil ,cottonseed oil,
sunflower oil ,palm oil etc. Olive oil, sesame oil, coconut oil,groundnut oil can be just cold
filtered without refining. 

Vegetable oil refining process has four basic steps: degumming ,deacidification, decoloration
and deodorization. Main purpose is to remove phophatide,colorant,free fatty acid etc to make
sure that refined oil meets national oil standard.

Depending on different technology to remove free fatty acid, vegetable oil refining is divided
into chemical refining and physical refining. Chemical refining is adding alkali to neutralize
free fatty acid . Physical refining is using high temperature vacuum steam to evaporate free
fatty acid. For high acid value crude oil, such as rice bran oil is better use physical refining to
reduce oil loss.

Depending on different capacity and automation, vegetable oil refining is divided into batch
refining,semi continuous refining and continuous refining. Batch refining normally is used
for small scale oil refining less than 15 tons per day. Capacity for more than 50 tons per day
must adopt continuous refining. From 30-50 tons per day, you can choose semi continous or
continuous refining.

EMULSIFICATION
Emulsification is the formation of emulsions from two immiscible liquid phases is probably
the most versatile property of surface-active agents for practical applications. Fats (oils) and
water do not stay mixed, but often it is desirable for them to do so. Therefore, fats are often
emulsified.

Significance of emulsification of fats

Emulsification is a vital process in the digestion. The fats are emulsified. The significance of
emulsification of fats are listed below

 The crystallization of emulsified fat can contribute to the desired or undesired

destabilization of emulsions, and it is crucial to microstructure and texture
development of emulsified fat during the processing of butter, spreads, and dairy
desserts.
 Bile aids in the emulsification of fats to facilitate absorption.
 Fatty acids of longer carbon chain more than 14 carbons form triglycerides in the
absorptive cells and combine with cholesterol, phospholipids, and similar substances
with a protein coat the compound formed are called a chylomicron.
ESSENTIAL FATTY ACIDS
Essential fatty acids, or EFAs, are fatty acids that humans and other animals must ingest
because the body requires them for good health but cannot synthesize them.[1]
The term "essential fatty acid" refers to fatty acids required for biological processes but does
not include the fats that only act as fuel. Essential fatty acids should not be confused
with essential oils, which are "essential" in the sense of being a concentrated essence.
Only two fatty acids are known to be essential for humans: alpha-linolenic acid (an omega-3
fatty acid) and linoleic acid (an omega-6 fatty acid).[2] Some other fatty acids are sometimes
classified as "conditionally essential", meaning that they can become essential under some
developmental or disease conditions; examples include docosahexaenoic acid (an omega-3
fatty acid) and gamma-linolenic acid (an omega-6 fatty acid).
Mammals lack the ability to introduce double bonds in fatty acids beyond carbon 9 and 10,
hence the omega-6 linoleic acid (18:2n-6; LA) and the omega-3 linolenic acid (18:3n-3;
ALA) are essential for humans in the diet. However, humans can convert both LA and ALA
to fatty acids with longer carbon chains and a larger number of double bonds, by alternative
desaturation and chain elongation.
In humans, arachidonic acid (20:4n-6; AA) can be synthesized from LA. In turn, AA can be
converted to an even longer fatty acid, the docosapentaenoic acid (22:5n-6; DPA). Similarly,
ALA can be converted to docosahexaenoic acid (22:6n-3; DHA), although the latter
conversion is limited, resulting in lower blood levels of DHA than through direct ingestion.
This is illustrated by studies in vegans and vegetarians.[7] If there is relatively more LA than
ALA in the diet it favors the formation of DPA from LA rather than DHA from ALA. This
effect can be altered by changing the relative ratio of LA:ALA, but is more effective when
total intake of polyunsaturated fatty acids is low.
In preterm infants, the capacity to convert LA to AA and ALA to DHA is limited, and
preformed AA and DHA may be required to meet the needs of the developing brain. Both
AA and DHA are present in breastmilk and contribute along with the parent fatty acids LA
and ALA to meeting the requirements of the newborn infant. Many infant formulas have AA
and DHA added to them with an aim to make them more equivalent to human milk.
Essential nutrients are defined as those that cannot be synthesized de novo in sufficient
quantities for normal physiological function. This definition is met for LA and ALA but not
the longer chain derivatives in adults.[8] The longer chain derivatives particularly, however,
have pharmacological properties that can modulate disease processes, but this should not be
confused with dietary essentiality.
Between 1930 and 1950, arachidonic acid and linolenic acid were termed 'essential' because
each was more or less able to meet the growth requirements of rats given fat-free diets. In the
1950s Arild Hansen showed that in humans: infants fed skimmed milk developed the
essential fatty acid deficiency. It was characterized by an increased food intake, poor growth,
and a scaly dermatitis, and was cured by the administration of corn oil.
Later work by Hansen randomized 426 children to four treatments: modified cow's milk
formula, skimmed milk formula, skimmed milk formula with coconut oil, or cow's milk
formula with corn oil. The infants who received the skimmed milk formula or the formula
with coconut oil developed essential fatty acid deficiency signs and symptoms. This could be
cured by administration of ethyl linoleate (the ethyl ester of linoleic acid) with about 1% of
the energy intake.[9]
Collins et al. 1970[10] were the first to demonstrate linoleic acid deficiency in adults. They
found that patients undergoing intravenous nutrition with glucose became isolated from their
fat supplies and rapidly developed biochemical signs of essential fatty acid deficiency (an
increase in 20:3n-9/20:4n-6 ratio in plasma) and skin symptoms. This could be treated by
infusing lipids, and later studies showed that topical application of sunflower oil would also
resolve the dermal symptoms.[11] Linoleic acid has a specific role in maintaining the skin
water-permeability barrier, probably as constituents of acylglycosylceramides. This role
cannot be met by any ω-3 fatty acids or by arachidonic acid.
The main physiological requirement for ω-6 fatty acids is attributed to arachidonic acid.
Arachidonic acid is the major precursor of prostaglandins, leukotrienes that play a vital role
in cell signaling, and an endogenous cannabinoid anandamide.[12] Metabolites from the ω-3
pathway, mainly from eicosapentaenoic acid, are mostly inactive, and this explains why ω-3
fatty acids do not correct the reproductive failure in rats where arachidonic is needed to make
active prostaglandins that cause uterine contraction.[13] To some extent, any ω-3 or ω-6 can
contribute to the growth-promoting effects of EFA deficiency, but only ω-6 fatty acids can
restore reproductive performance and correct the dermatitis in rats. Particular fatty acids are
still needed at critical life stages (e.g. lactation) and in some disease states.
In nonscientific writing, common usage is that the term essential fatty acid comprises all the
ω-3 or -6 fatty acids. Conjugated fatty acids like calendic acid are not considered essential.
Authoritative sources include the whole families, but generally only make dietary
recommendations for LA and ALA with the exception of DHA for infants under the age of 6
months. Recent reviews by WHO/FAO in 2009 and the European Food Safety
Authority[14] have reviewed the evidence and made recommendations for minimal intakes of
LA and ALA and have also recommended intakes of longer chain ω-3 fatty acids based on
the association of oily fish consumption with a lower risk of cardiovascular disease. Some
earlier review lumped all polyunsaturated fatty acids together without qualification whether
they were short or long-chain PUFA or whether they were ω-3 and ω-6 PUFA.
Some of the food sources of ω-3 and ω-6 fatty acids are fish and shellfish, seaweed
oil, flaxseed (linseed) and flaxseed oil, hemp seed, olive oil, soya oil, canola (rapeseed)
oil, chia seeds, pumpkin seeds, sunflower seeds, leafy vegetables, and walnuts.
Essential fatty acids play a part in many metabolic processes, and there is evidence to suggest
that low levels of essential fatty acids, or the wrong balance of types among the essential fatty
acids, may be a factor in a number of illnesses, including osteoporosis.[19]
Fish is the main source of the longer omega-3 fats; eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA), though they initially acquire these fats through the
consumption of algae and seaweed. Some plant-based foods contain omega-3 in the form of
alpha-linolenic acid (ALA), which appears to have a modest benefit for cardiovascular health.
[20]
 The human body can (and in case of a purely vegetarian diet often must unless
certain algae or supplements derived from them are consumed) convert ALA to EPA and
subsequently DHA. This elongation of ALA is inefficient. Conversion to DHA is higher in
women than in men; this is thought to reflect the need to provide DHA to the fetus and infant
during pregnancy and breast feeding.[21]
Omega-3 and omega-6 fatty acids are absolutely essential for human life and health, but they
must be provided by our diet. They play particularly key roles in brain development and
function. · Various physical signs are associated with deficiencies in these essential fatty
acids. These include excessive thirst, frequent urination, rough, dry or scaly skin, dry, dull or
‘lifeless’ hair, dandruff, and soft or brittle nails. Raised bumps on the skin are particularly
characteristic. (This is called ‘follicular keratosis’ as it results from a build-up of hard, dry
skin around the hair follicles). · Research has shown that these fatty acid deficiency signs are
unusually common in people with ADHD, dyslexia and autistic spectrum disorders.(1-7)
They have also been linked with behaviour, learning and health problems in boys with and
without an ADHD diagnosis,(4) with the severity of reading, spelling and related difficulties
in dyslexic children(5) and with visual, auditory and other features of dyslexia in adults.(6)
This and other evidence has led to treatment trials to find out if supplementing the diet with
fatty acids may help in these conditions. · A simple checklist rating scale used in many of
these studies to assess fatty acid deficiency signs is available as a separate document.(8) This
can easily be used as an informal measure by parents, teachers, health professionals or
researchers who may be interested. Across groups, scores have been shown to correlate with
blood levels of fatty acids. However, results from this scale should never be interpreted in
isolation, and any reliable diagnosis of fatty acid deficiency would require other information
and professional advice. (Blood fatty acid analyses or other measures may be useful if
available and properly conducted, but the response to dietary supplementation with fatty
acids – if appropriate – would usually be a fairly definitive indicator). · Many other features
or clinical signs can sometimes reflect deficiencies or imbalances of omega3 or omega-6 fatty
acids. These include: - Allergic or ‘atopic’ tendencies (such as eczema, asthma, hayfever etc.)
- Visual symptoms (such as poor night vision, sensitivity to bright light, or visual
disturbances when reading - e.g. letters and words may appear to move, swim or blur on the
page) - Attentional problems (distractibility, poor concentration and difficulties in working
memory) - Emotional sensitivity (such as depression, excessive mood swings or undue
anxiety) - Sleep problems (especially difficulties in settling at night and waking in the
morning)