Protein Nutrition Its role in Infection

Protein in Nutrition: Its Role in Infections Classification, caloric value and functions of protein Digestion, absorption and metabolism of protein Classification of amino acids Oral relevance and the effect of its deficiency Protein From Greek word meaning of the first rank Prime importance to all of life Indispensable constituent of the cytoplasm & nuclei of all cells Serves as building blocks for cellular membranes & tissue structures Precursors of antibodies Essential components of enzymes and hormones Source of energy in place of CHO & fats Protein Next to water is the most plentiful in the body Half the dry weight of the body is protein 1/3 found in muscle 1/5 in bone & cartilage 1/10 in skin Remainder in other tissues & body fluids Protein chemical nature Large complex molecules that contain carbon, hydrogen, oxygen & nitrogen

Arranged into amino acids Often include phosphorus, sulfur, iron, copper , iodine, zinc and manganese Protein chemical nature Consist of number of amino acid held together by peptide linkage Dipeptide, tripeptide Peptone Protein classification Simple protein Yield amino acids on hydrolysis Globulins found in legumes such as beans & peas Conjugated protein Compounds formed by attachement of a proteind molecule Globin to a non-protein molecule or prosthetic group such as hemoglobin Derived protein Products resulting from the hydrolysis of proteins Protease & cooked egg albumin Protein digestion & absorption The first step in the digestion of protein takes place in the stomach HCL from the gastric glands Pepsin- protein splitting enzyme Rennin-chymosin Found only in infants stomach Slows down the passage of milk

Acts on casein ( milk protein) Deficiency will cause milk intolerance Protein digestion & absorption 2nd step in protein digestion occurs in the alkaline medium of the small intestine Trypsin- pancreatic enzymes Erepsin intestinal enzymes Hydrolysis splitting of protein into amino acids Absorbed by the mucosal cells lining the small intestine Peptide absorption is a major route of amino acid uptake Protein metabolism Liver is the main site of catabolism of most of the amino acids Food protein provides amino acids that are absorbed from the small intestine into the portal system Synthesized into tissue proteins, structural proteins of cellular membranes, plasma proteins, enzymes or hormones Other amino acids are primarily degraded in muscle and kidney Excess amino acids are converted to CHO & oxidized for needed energy Protein metabolism decarboxylation of amino acids will result to new compund Serotonin- neurotransmitter End products of protein Urea Ammonia-small amount

Uric acid Creatinine Fecal nitrogen- excreted form of unabsorbed small amount of dietary nitrogen Protein turnover Tissues of the body are under constant repair Mucosal lining of small intestine-1-2 days RBC- 120 days 300 g of the 10 kg of body protein in the body is replaced everyday Excess Amino acids are not stored No reservation of protein in the body Source of energy Protein turnover No value for consuming extra protein in anticipation of stress The time for eating the extra protein is during illness Especially convalescing or recovery Labile protein- protein reserves During protein deprivation, cellular proteins are broken down to supply the amino acids to the pool Nitrogen balance The balance exists between the intake and output of nitrogen in the body Depends on the amounts & proportions of essential amino acids in the diet + N2 intake Nitrogen balance N2 intake = N2 output Negative nitrogen balance N2 output > N2 intake

Results from breakdown of body protein Occur as a result of infection, fever, surgical trauma, blood loss or loss of plasma due to burns Amino acids Essential amino acids 22 essential amino acids required for synthesis of tissue proteins Absence of anyone could prevent body protein formation Non-essential amino acids Can be synthesized by the body Not needed in the diet As important as the essential amino acids to growth and body metabolism Amino acids Dietary supply of 9 or 10 amino acids is essential for human body Histidine Isoleucine Leucine Lysine Methionine + cystine Phenylalanine + tyrosine Threonine Tryptophan Valine Protein Complete protein Consists of all the essential amino acids in significant amounts & in proportions fairly similar to those found in the body Supply the needs of the body for the maintenance, repair and growth

best sources: meat, fish, eggs, milk & cheese Protein Incomplete protein Plant proteins: grains, nuts, fruits & vegetables Deficient in quantity & proportion of amino acids

Protein Complementary protein To provide good nutrition, plant proteins of lower quality must be supplemented by other foods that will supply the missing or adequate amino acids Complementary protein feeding Amino acids from incomplete proteins are better used if the missing essential amino acids are supplied by other foods so that all essential amino acids can be eaten at the same meal Complementary proteins These food should be eaten at the same meal

Corn- high in methionine, low in lysine Beans- high in lysine, low in methionine

Bread or cereal- low in lysine & threonine Milk- high in lysine & threonine Protein RDA 0.8g/kg of body weight Added protein are needed form age groups 1-18 To cover for growth

Pregnant & lactating women 30 g additional for pregnant women 20 g additional for lactating women

Protein food sources Meat Fish Poultry Soybeans Dried beans Effects of Protein Excess Excess protein is used for energy High-protein diet may be hazardous to: Person with kidney problems & retains nitrogen Person with liver problem & cannot metabolize protein Effects of Protein Deficiency Nutritional liver disease Common medical problem resulting from protein deficiency in developed countries Seen most often in alcoholics with adequate caloric intake but ingest inadequate amounts of protein These people develop fatty liver disease Can be moderated by a high-protein diet Effects of Protein Deficiency Stress results from trauma & anxiety Injuries such as burns, fractured bones or surgical operations followed by a

period of negative nitrogen balance Effects of Protein Deficiency Phenylketonuria An inborn error of protein metabolism Phenylalanine is not oxidized & accumulates in the blood, producing mental deficiency unless treated Tx: careful restriction of dietary phenylalanine Effects of Protein Deficiency Hunger edema Associated with starvation May result from simple protein deficiency Secondary, or conditioned protein deficiency may arise from kidney disease, hemorrhage & intestinal disorders.

Adverse effect of Protein Undernutrition Kwashiorkor Caused by a severe dietary protein deficiency Clinical manifestations Anemia Edema Pot belly Depigmentation of the skin Loss of hair Change in hair color Adverse effect of Protein Undernutrition Marasmus A prolonged dietary deficiency of both protein & calories in young children

Adverse effect of Protein Undernutrition Increased morbidity from infectious disease due to inadequate immune response Serum immunoglobulin A may be slightly elevated if the infection is present Adverse effect of Protein Undernutrition Mild to moderate deficiency of only proteins exhibit defects in their phagocytic system Protein Nutrition in Oral Health & Disease Effects of Protein deficiency on the Jaw & Teeth Effect of Protein deficiency on Dental Caries Role of Protein in the Biochemistry of Periodontal Tissues Effect of Protein on Periodontal Disease Effects of Protein deficiency on the Jaw & Teeth Poor protein diet during pregnancy had retarded development of bone & teeth Crowded teeth or rotated teeth probably resulting from underdeveloped or retarded growth of the jaw Hypoplasia of the teeth Poorly calcified dentinal matriz Effect of Protein deficiency on Dental Caries Protein deficient diet = defect in the matrix of the tooth enamel = caries susceptible tooth surface Casein( a phosphoprotein)- added to diet = significant reduction in caries index Amino acids such as lysine & glycine help prevent caries Protein deficiency= increased CHO ingestion= increased caries formation Role of Protein in the Biochemistry of Periodontal Tissues The epithelium of the gingival crevice or pocket adheres to the tooth surface by physiochemical forces mediated by the proteins & glycoproteins in the

gingival fluid The connective tissue consists of cells & fibers in a ground substance consists of serum proteins, glycoproteins & mucoproteins PDL fibers embedded in ground substance that are made up of collagen Role of Protein in the Biochemistry of Periodontal Tissues The alveolar bone provides rigidity to the periodontium Sensitive to protein & mineral metabolism Collagen is required for bone crystallization Effect of Protein on Periodontal Disease Periodontal Disease is a reflection of the proteolysis or proteinaceous material found both in the ground substance as mucoproteins & in fibers as collagen Bacterial enzymes that contribute to tissue proteolysis Hyaluronidase Collagenase Other proteases Effect of Protein on Periodontal Disease Dietary protein deficiency negatively affects the activity of fibroblasts, osteoblasts & cementoblasts Atrophic & degenerative changes in the connective tissue of the gingiva & periodontal ligaments are seen Bone & cementum also show similar evidence of breakdown Effect of Protein on Periodontal Disease Resorption of the alveolar crest Downgrowth of the epithelial attachment Inflammatory exudate are increased & accentuated