Dr.

Jetty Lee
Nutrition Fundamentals Email: jettylee@hku.hk
School of Biological Sciences
Topics: Nutrition

• Nutrition Fundamentals
• Macromolecules (Macronutrients + Water)
• Vitamins and Minerals
• Digestive System
• Food for Life: Nutrition & Disease, Physical Activity and
Energy

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How many different types of saccharides, amino acids and fatty
acids in these common foods?

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Learning Objectives

• Students will conceptualize global health and

nutrition
• Students be able to relate the food we eat and its
nutritional values
• Students will be able to understand food is our
main energy resource

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Global Perspective: Nutrition and Chronic
Diseases
• Historical focus on Under-nutrition
• Nutrition transition today: Over-nutrition
• Globalization and changing food habits
• Chronic disease are a major global burden
• Policies and health services should promote healthy diets

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 Global Perspective: Cause of Death (WHO)

Is it nutrition related?

• Undernutrition: diarrhea,
premature birth, lung infections,
HIV etc
• Overnutrition: Many chronic
diseases such as heart disease,
stroke, diabetes, premature birth
and obesity, cancer and
hypertension etc., are associated
with poor lifestyle and poor
nutrition practice

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 34.1 36.8
30.3 31.5
0 0

2000 2005 2010 2015 2019 2000

2000 2005 2010 2015 2019

Percentage of stunted, overweight and wasted Number (millions) of stunted, overweight and wasted

Global Perspective: Children Nutrition

children under 5, global, 2000–2019 children under 5, global, 2000–2019

Source: UNICEF, WHO, World Bank Group joint malnutrition estimates, 2020 edition. See Notes on Data on page 14 on why only one time point is presented for wasting on the
graphs above.

Africa and Asia bear the greatest share of all forms of malnutrition

Asia 54% Africa 40% Asia 69% Africa 27% Asia 45% Africa 24%

In 2019, more than half of all In 2019, more than two thirds of In 2019, almost half of all
stunted children under 5 lived in all wasted children under 5 lived overweight children under 5
Asia and two out of five lived in in Asia and more than one quarter lived in Asia and one quarter
Africa. lived in Africa. lived in Africa.

UNICEF/ WHO/ World Bank Group – Joint Child Malnutrition Estimates 2020 edition 3

GLOBAL OVERVIEW
Malnutrition rates remain alarming. Stunting is
declining too slowly while wasting still impacts the
lives of far too many young children

stunting wasting overweight 95% confidence interval

40 200

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32.4 199.5
160
30 183.4
169.8
25
120 155.0
Number (millions) 144.0
Percentage

21.3
20

80
15

10

40
47.0
6.9

5
5.6
4.9
34.1 36.8 38.3
30.3 31.5
0 0

2000 2005 2010 2015 2019 2000

2000 2005 2010 2015 2019

Percentage of stunted, overweight and wasted Number (millions) of stunted, overweight and wasted
children under 5, global, 2000–2019 children under 5, global, 2000–2019

Source: UNICEF, WHO, World Bank Group joint malnutrition estimates, 2020 edition. See Notes on Data on page 14 on why only one time point is presented for wasting on the
graphs above.
 14.3 million were severely wasted.
Improving children’s nutrition requires effective and
There is also an emerging face of malnutrition: childhood sustained multi-sectoral nutrition programming over the long
overweight and obesity. There are now 38.3 million term, and many countries are moving in the right direction.
Global Perspective: Definition of Malnutrition
overweight children globally, an increase of 8 million since
2000. The emergence of overweight and obesity has been
Regular data collection is critical to monitor and analyse
country, regional and global progress going forward.
shaped, at least in part, by industry marketing and greater

Forms of malnutrition* highlighted in this key findings report

Stunting refers to a child
who is too short for his or her
age. These children can suffer
severe irreversible physical
and cognitive damage that
accompanies stunted growth.
The devastating effects of
stunting can last a lifetime and
even affect the next generation.
Overweight refers to a child
who is too heavy for his or her
height. This form of malnutrition
results from energy intakes from
food and beverages that exceed
children’s energy requirements.
Overweight increases the risk of
diet-related noncommunicable
diseases later in life.
Wasting refers to a child who
is too thin for his or her height.
Wasting is the result of recent
rapid weight loss or the failure
to gain weight. A child who is
moderately or severely wasted
has an increased risk of death,
but treatment is possible.

Overweight Stunted * Some children suffer from more than one form of malnutrition – such as stunting
and and and overweight or stunting and wasting. There are currently no joint global or
regional estimates for these combined conditions.
stunted wasted

2 UNICEF/ WHO/ World Bank Group – Joint Child Malnutrition Estimates 2020 edition

• Malnourished children are more likely to succumb to, as well as die from, the
leading causes of child death such as pneumonia, diarrhoea and malaria
• Poor nutrition weakens children’s immune systems and renders them more
vulnerable to deadly diseases, which further deteriorates their nutritional status

The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
 Deaths Associated with Undernutrition

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The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
 Diet and Disease
ble to diet
Diet high in sodium
Diet low in whole grains
Diet low in fruits
Diet low in nuts and seeds
Diet low in vegetables
Diet low in seafood omega-3 fatty acids
Diet low in fibre
Diet low in polyunsaturated fatty acids
Diet low in legumes
Diet high in trans fats
Diet low in calcium
Diet high in sugar-sweetened beverages
Diet high in processed meat
Diet low in milk
Diet high in red meat
0 0
Lancet 2019; 393: 1958–72
ble to diet
Number of deaths at the global level attributable to diet
0 1000
Number of deaths (in thousands)
Number of DALYs at the global level attributable to diet
Is it nutrition related?
• A substantial disease burden,
including chronic diseases such as
heart disease, stroke, diabetes
and cancer, is attributable to
health risks related to
overnutrition or the
overconsumption of certain food
or food components
• In many developing countries,
especially in the urban populations,
there is an increase in the
consumption of energy-dense
nutrient poor foods (high in fats
and sugars and not enough
nutrients) and a decrease in
physical activity
• Social and economic progress has
Cause led to the greater consumption of
Cardiovascular diseases
Type 2 diabetes
meats, oils and sugars as cheap
Neoplasms
Other causes
processed foods.
2000 3000
• At the same time, the consumption
of fruits, vegetables and grains has
decreased
Overnutrition: Heart Disease e.g. Cardiovascular
Int. J. Mol. Sci. 2018, 19, 3988 2 of

other risk factors, such as excess weight, hypertension, diabetes, or dyslipidemia [8]. In this sens
the identification and classification of nutrients, foods, or dietary patterns that can enhance CV
prevention is a priority.

Figure 1. Unhealthy dietary patterns, together with a lack of exercise, overweight and obesity, aging,
gender, genetics, or a smoking habit, among others, might lead to the development of cardiovascular
disease (CVD).

Atherosclerosis is an inflammatory disease that contributes to major incidence and mortality

CVD. Oxidative stress and systemic inflammation are modifiable by nutrition [10–13], with an exce
energy intake and physical inactivity as contributors of pro-inflammatory cytokines’ secretion [1
Inflammatory processes involve the sub-endothelial area of the arterial wall, accumulating lipid
and lipid-laden macrophages among other cell types [15,16]. Current scientific evidence show
that chronic inflammation plays a key role in the pathogenesis of coronary artery disease (CAD
including the initiation and progression of atheroma plaque and rupture, and post-angioplasty an
Overnutrition: Diabetes

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 Globalization and Changing Food Habits
• Factors Affecting Health: Most fast foods are
high in sugar, fat, salt
• Globalization
• Changing food habits

Fast Food trends

Convenience Foods

Finger food:
eating fast and
eating more

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Chronic Diseases are Major Global Burden
• Government nutrition policies
are needed to reduce the risk
of chronic diseases and reduce
dietary and health inequities
• Strong government policy is
essential to help achieve a
healthy, profitable, equitable
and sustainable food system Relationship of Food, Nutrition & Health
that benefits all
• Policy made based on resource
Deficiency-role of inadequate
allocation, changing cultural intake & illness Health &
Sanitation-role
norms, Science…..needs to be of contamination well-being
Excess: Diet linked with
sustainable & illness
non-communicable diseases

• One example that is a New roles for

Germ
sustainable policy: Theory
Vitamin
Theory
Diet & nutrients
in disease
Chronic Disease
Recommended Dietary <1900 1910 1950 1980 1990 2002
Allowance (RDA)
RDAs DRIs

Adapted from http://medocs.ucdavis.edu/imdbcm/419/Syllabus/04/Lec5-Functional.ppt 14

Dietary Guidelines
 SCIENCE AND POLITICS OF NUTRITION
Policy (for reference only)
Global

BMJ: first published as 10.1136/bmj.k2426 on 13 June 2018. Downloaded from http://www.bm

Governmental Global food
availability

Agricultural, Government- Climate

industry and market society structure and season

Community Land use and Government International

environment transportation priorities trade agreements

Workplace food International

Sociocultural environment Food production Food and food standards
and distribution agricultural
Social and School food policies
systems
Individual cultural norms environment International
commodity pricing
Age, gender, personal norms, education, Food availability
income, taste preferences, nutritional Social support Food and Food assistance
at local stores
knowledge and skills, health status, eating beverage industry programmes
incentives International
behaviours, attitudes, motivation, sleep, Social class Accessibility to food distribution
screen time, alcohol use supermarket and and shipping
Race/ethnicity Economic
grocery stores Agriculture and systems
food industry
Accessibility to Multinational
lobbying
restaurants and corporate lobbying
Healthcare
Accessibility fast food
Neighbourhood Food marketing systems
socioeconomic to transport and media Dietary research
status and science
Food safety

Fig 1 | Multilayered influences beyond personal knowledge and preference alter food choices. Government can consider these influences as
potential targets, barriers, facilitators, and effect modifiers of food policies. Reproduced with permission from Ashfin et al2

British Medical Journal, 2018;361:k2426; doi: 10.1136/bmj.k2426

 What is Nutrition ?
Definition:
• Nutrition is the science that
interprets the interaction of nutrients
and other substances in food in
relation to maintenance, growth,
reproduction, health and disease
of an organism

• It includes food intake, absorption,

assimilation, biosynthesis (anabolism),
catabolism and excretion

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Why Study Nutrition ?
The aim is to improve the quality of life through the understanding of
interactions among food, environment and human body
The Potential Interactions of Rising CO2 and Climate
Change on Food Safety and Nutrition

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 Why Study Nutrition ?

Lipids

Cardiovascular Diseases

salt
http://hk-diabetes.com/index2.htm

www.high-blood-pressure-monitors.com/ Diabetes
nurse_nancy.gif
Hypertension glucose
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Why Study Nutrition ?
To understand how our genetic make up, health condition, cultural, social
and economic factors can influence our food choice and food behavior

Food & health: social and

cultural factors

Food and health – genetic,

physical and biological factors
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 Why Study Nutrition ?
To understand, how individuals, social and environmental factors influence
human health (nutrition and public health)

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 Why Study Nutrition ?
To understand how impact of weather/natural disaster
affect food supply globally

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 The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.

The Functions of Foods

• Source of energy Feeling good when we eat
• Source of essential nutrients
• Pleasure of eating

Eating creates an excellent environment for conversation

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Why do we really need to eat?

• We eat to obtain food that provide us Nutrient and
Energy

• Energy is obtained through oxidation of

macronutrients

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Why do we really need to eat?

We eat to obtain elements to build our body

The human body mass is made of the elements of carbon, nitrogen,

calcium, sodium, potassium, phosphorus, magnesium, oxygen and
sulfur, hydrogen, chlorine, phosphorus 24
 We are made up of Nutrients

Organic compounds (protein, lipids and carbohydrates) contain the majority of

the carbon and nitrogen), most of the oxygen and hydrogen is present as water
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 What are nutrients?
• Nutrient Definition:
• A nutrient is a component in foods that an organism uses
to survive and grow. Divided as macro- and micro-
nutrients
• Macronutrients
• Provide energy an organism’s metabolic system needs to
function
• Micronutrients
• Provide the cofactors for metabolism to be carried out.
• To build and repair tissues and to regulate body processes
while macronutrients are converted to, and used for,
energy

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 The Six Categories of Nutrients

• Macronutrients
1. Carbohydrate Require in greater amount
2. Protein provides ENERGY
3. Fat
Require in greater amount
Water DO NOT provide ENERGY

• Micronutrients
4. Vitamins Requires in less amount
5. Minerals DO NOT provide ENERGY

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What is Energy ?

Definition
• The capacity to do work. The energy in food is chemical energy.
The body can convert this chemical energy (from food) to
mechanical, electrical or heat energy

• Energy is measured in kilocalories (kcal) or kilojoules (kJ)

• One kcal (equals 1000 calories) is the amount of heat
necessary to raise the temperature of one kg of water 1oC.
1 kcal = 4.184 kJ

• Energy content listed in all books, journals & magazines has the unit
kcal even though it may appear as cal !

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 The Energy yielding Nutrients

Nutrient cal/g
Carbohydrate 4
Protein 4
Fat 9
Fiber 0-2
Alcohol 7

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The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.

Calories of Foods

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Nutrients provide different forms of energy
(mechanical, electric and heat)

Cellular Respiration takes place in the mitochondria – Metabolism of

carbohydrates, fats, proteins and alcohol can produce Adenosine
Triphosphate (ATP) as mechanical energy and heat energy
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Example: Glucose produces Energy (ATP)

Glucose is a major energy source

ATP = Adenosine Triphosphate (energy)

1 molecule of glucose produce 37 molecules of ATP

plus carbon dioxide and water during cellular respiration (oxygen)
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What is ATP?
Adenosine Triphosphate (ATP):
- It is referred as “molecular currency”
- Is a complex organic chemical that participates in many processes
- Substrate of energy, as a coenzyme, as precursor to RNA and DNA etc

Biochemical reaction of ATP releases energy:

Hydrolysis (water) of ATP to ADP (adenosine
diphosphate), and AMP (adenosine monophosphate)
and inorganic phosphate (P) gives out energy free
energy of 7.3 kcal/mol and 10.9 kcal/mol,
respectively:

ATP + H2O → ADP + Pi ΔG° = −30.5 J/mol

(−7.3 kcal/mol)
ATP + H2O → AMP + PPi ΔG° = −45.6 J/mol
(−10.9 kcal/mol)

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Production of ATP

• ATP can be produced by several cellular processes; the

THREE main pathways in eukaryotes are:
1. Glycolysis: glucose converts into pyruvate
2. Citric Acid cycle/oxidative phosphorylation (also called
the Krebs cycle, or Tricarboxylic acid (TCA cycle):
Oxidation of acetyl-coa derived from carbohydrates, fats
and proteins
3. Beta-oxidation: Fatty acids breakdown to generate
acetyl-coa

We need the ENERGY for our METBOLISM

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What is Metabolism?

• Metabolism = Greek means “change”

• It defines as the set of life-sustaining chemical transformations within
the cells or organisms

Three main purposes of metabolism:

• Conversion of food/fuel to energy to run cellular processes.
• Conversion of food/fuel to building blocks for proteins, lipids
and nucleic acids and some carbohydrates
• Elimination of nitrogenous wastes: divided into Catabolism
and Anabolism

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Metabolic Pathways
• The chemical reactions of metabolism
are organized into metabolic pathways,
in which one chemical is transformed
through a series of steps into another
chemical, by a sequence of enzymes

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Metabolism: Divided into Catabolism
and Anabolism
Catabolism
• Breaking down of larger
molecules to smaller molecules
such as glucose to pyruvate by
cellular respiration (releases
energy)

Anabolism
• Building up of larger
components of cells such as
from proteins to smaller
molecules such as amino acids
(require energy)

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Example of Catabolism and Anabolism
Through series of catabolic and anabolic pathways – energy in
the form of ATP is produced from nutrients (food)

Adenosine Triphosphate (ATP)

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Food provides nutrient and energy for growth,
development and repair

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Nutrient Requirements

The nutrients are required in varying

amounts. Requirements: life-cycle Example: calcium requirement is
dependent and do change with age, higher for pregnant and lactating
sex, physical activity and health
condition, etc mothers

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Key Concepts to Remember

ü Definition of nutrition
ü The global and individual factors that influence the quality of
food, food choice and our health
ü The main biological functions of food
ü ATP definition and its relationship to food nutrients
ü The energy- and non-energy nutrients
ü Definition of metabolism, catabolism and anabolism
ü Nutrient requirement is life-cycle dependent and changes with
age, sex, physical activity and health condition

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Reference

• Food, Nutrition and Diet Therapy by Mahan Escott-

Stump. Fifth Edition
• Nutrition: Maintaining and Improving Health by Geoffrey
P. Webb. Fifth Edition

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