BIOMEDICAL IMPORTANCE

• In addition to water, the diet must provide metabolic fuels (mainly

carbohydrates and lipids),
• protein (growth),
• fiber ,
• minerals (containing elements with specific metabolic functions),
• vitamins &
• essential fatty acids.

• The polysaccharides, triacylglycerols, and proteins that make up the bulk

of the diet must be hydrolyzed to their constituent monosaccharides, fatty
acids, and amino acids, respectively, before absorption and utilization.
 BIOMEDICAL IMPORTANCE

• Globally, undernutrition is widespread, leading to

1. impaired growth,
2. defective immune system,
3. reduced work capacity.

• By contrast, in developed countries, and increasingly in developing countries,

there is excessive food consumption (especially of fat), leading to obesity, and
the development of diabetes, cardiovascular disease, and some cancers.

• Worldwide, there are more overweight and obese people than

undernourished people.

• Deficiencies of vitamin A, iron, and iodine pose major health concerns in

many countries, and deficiencies of other vitamins and minerals are a major
cause of ill health.
 Clinical Corelations
1. Excessive secretion of gastric acid, associated with Helicobacter
pylori infection, can result in the development of gastric and
duodenal ulcers;
2. small changes in the composition of bile can result in
crystallization of cholesterol as gallstones;
3. failure of exocrine pancreatic secretion (as in cystic fibrosis)
leads to undernutrition and steatorrhea.
4. Lactose intolerance is the result of lactase deficiency, leading to
diarrhea and intestinal discomfort when lactose is consumed.
5. Absorption of intact peptides that stimulate antibody responses
causes allergic reactions; celiac disease is an allergic reaction to
wheat gluten.
• OVERVIEW
• Nutrients are the constituents of food necessary
to sustain the normal functions of the body. All
energy is provided by three classes of nutrients:
fats, carbohydrates, and protein, with ethanol
providing calories in some diets.
Essential nutrients obtained
from the diet. [Note: Ethanol is
not considered an essential
component of the diet but may
provide a significant
contribution to the daily caloric
intake of some individuals.]
 DIETARY REFERENCE INTAKES
• Dietary Reference Intakes (DRIs) are estimates of the amounts of
nutrients required to prevent deficiencies and maintain optimal health
and growth
Definition of Dietary Reference Intake
• The DRIs consist of four dietary reference standards for the intake of
nutrients designated for specific life stage (age) groups, physiologic
states, and gender
• 1.Estimated Average Requirement: The average daily nutrient intake
level estimated to meet the requirement of one half of the healthy
individuals in a particular life stage and gender group is the Estimated
Average Requirement (EAR). It is useful in estimating the actual
requirements in groups and individuals.
• 2. Recommended Dietary Allowance: The RDA is the average daily
dietary intake level that is sufficient to meet the nutrient requirements
of nearly all (97%–98%) individuals in a life stage and gender group.
The RDA is not the minimal requirement for healthy individuals, but it
is intentionally set to provide a margin of safety formost individuals.
• 3. Adequate Intake: An Adequate Intake (AI) is set
instead of an RDA if sufficient scientific evidence
is not available to calculate an EAR or RDA. The
AI is based on estimates of nutrient intake by a
group (or groups) of apparently healthy people.

• 4. Tolerable Upper Intake Level: The highest

average daily nutrient intake level that is likely to
pose no risk of adverse health effects to almost all
individuals in the general population is the
Tolerable Upper Intake Level (UL). As intake
increases above the UL, the potential risk of
adverse effects may increase.
 ENERGY REQUIREMENT IN HUMANS

• The Estimated Energy Requirement (EER) is the average

dietary energy intake predicted to maintain an energy
balance (that is, when the calories consumed are equal to the
energy expended) in a healthy adult of a defined age, gender,
and height whose weight and level of physical activity are
consistent with good health

• For example, sedentary adults require about 30 kcal/kg/day to

maintain body weight, moderately active adults require 35
kcal/kg/day, and very active adults require 40 kcal/kg/day.

Average energy available from

the major food components
 Use of food energy in the body
• The energy generated by metabolism of the macronutrients is used for three
energyrequiring processes that occur in the body: resting metabolic rate
(RMR), physical activity, and thermic effect of food (formerly termed specific
dynamic action).
• The number of calories expended by these processes in a 24-hour period is
the total energy expenditure (TEE)
• 1. Resting metabolic rate: RMR is the energy expended by an individual in a
resting, postabsorptive state. It represents the energy required to carry out the
normal body functions, such as respiration, blood flow, and ion transport.
• 2. Physical activity: Muscular activity provides the greatest variation in the
TEE. The amount of energy consumed depends on the duration and intensity
of the exercise. The daily expenditure of energy can be estimated by carefully
recording the type and duration of all activities to determine a physical
activity factor.
• 3. Thermic effect of food: The production of heat by the body increases as
much as 30% above the resting level during the digestion and absorption of
food. This is called the thermic effect of food, or diet-induced thermogenesis.
 DIGESTION & ABSORPTION OF LIPIDS

• The major lipids in the diet are triacylglycerols and, to a lesser

extent, phospholipids.
• These are hydrophobic molecules and have to be hydrolyzed and
emulsified to very small droplets (micelles, 4-6 nm in diameter)
before they can be absorbed.
• The fat-soluble vitamins, A, D, E, and K, and a variety of other lipids
(including cholesterol and carotenes) are absorbed dissolved in the
lipid micelles.
• Absorption of carotenes and fat-soluble vitamins is impaired on a
very low fat diet.
 Micelles
 Micelles are disk shaped clusters of amphipathic lipids that coalesce
with their hydrophobic groups on the inside and their hydrophilic
groups on the outside of clusters

10
 DIGESTION & ABSORPTION OF LIPIDS

• Hydrolysis of triacylglycerols is initiated by lingual and gastric lipases, which

attack the ester bond forming 1,2-diacylglycerols and free fatty acids, which act
as emulsifying agents.

• Pancreatic lipase is secreted into the small intestine and requires a further
pancreatic protein, colipase, for activity.
• It is specific for the primary ester links—ie, positions 1 and 3 in triacylglycerols
—resulting in 2-monoacylglycerols and free fatty acids as the major end
products of luminal triacylglycerol digestion.
• Inhibitors of pancreatic lipase are used to inhibit triacylglycerol hydrolysis in
the treatment of severe obesity.
 Bile Salts

 Bile salts are required for the proper functioning of the pancreatic lipase enzyme
 Bile salts help in combination of lipase with two molecules of a small protein called as
Colipase.
 This combination enhances the lipase activity.
 Bile salts also help in the emulsification of fats

12
 Contents of Pancreatic Juice

 Pancreatic Lipase - For the digestion of triglycerides

 Phospholipase A2 - for the digestion of Phospholipids
 Cholesterol esterase - For the digestion of Cholesteryl
esters

13
 Bile Salts and Acids
• Bile salts, formed in the liver and secreted in the bile, permit emulsification of
the products of lipid digestion into micelles together with dietary phospholipids
and cholesterol secreted in the bile as well as dietary cholesterol.
• Micelles are small, and soluble, so they allow the products of digestion, including
the fat-soluble vitamins, to be transported through the aqueous environment of
the intestinal lumen to come into close contact with the brush border of the
mucosal cells, allowing uptake into the epithelium.
• The bile salts remain in the intestinal lumen, where most are absorbed from the
ileum into the enterohepatic circulation.
 DIGESTION & ABSORPTION OF LIPIDS
• Glycerol released in the intestinal lumen is absorbed into the
hepatic portal vein; glycerol released within the epithelium is
reutilized for triacylglycerol synthesis via the normal
phosphatidic acid pathway.
• Long-chain fatty acids are esterified to yield to triacylglycerol in
the mucosal cells and together with the other products of lipid
digestion, secreted as chylomicrons into the lymphatics, entering
the bloodstream via the thoracic duct.
• Short- and medium-chain fatty acids are mainly absorbed into the
hepatic portal vein as free fatty acids.
 DIGESTION & ABSORPTION OF LIPIDS
• Glycerol released in the intestinal lumen is absorbed into the
hepatic portal vein; glycerol released within the epithelium is
reutilized for triacylglycerol synthesis via the normal
phosphatidic acid pathway.
• Long-chain fatty acids are esterified to yield to triacylglycerol in
the mucosal cells and together with the other products of lipid
digestion, secreted as chylomicrons into the lymphatics, entering
the bloodstream via the thoracic duct.
• Short- and medium-chain fatty acids are mainly absorbed into the
hepatic portal vein as free fatty acids.
 DIGESTION & ABSORPTION OF LIPIDS
• Cholesterol is absorbed dissolved in lipid micelles and is
mainly esterified in the intestinal mucosa before being
incorporated into chylomicrons.
• Plant sterols and stanols (in which the B ring is
saturated) compete with cholesterol for esterification,
but are poor substrates, so that there is an increased
amount of unesterified cholesterol in the mucosal cells.
• Unesterified cholesterol and other sterols are actively
transported out of the mucosal cells into the intestinal
lumen.

• This means that plant sterols and stanols

effectively inhibit the absorption of not only dietary
cholesterol, but also the larger amount that is secreted
in the bile, so lowering the whole body cholesterol
content, and hence the plasma cholesterol concentration.
Physiologically important lipases

18
 DIETARY FATS
• The incidence of a number of chronic diseases is significantly influenced by the kinds
and amounts of nutrients consumed.
• Dietary fats most strongly influence the incidence of coronary heart disease (CHD), but
evidence linking dietary fat and the risk for cancer or obesity is much weaker
• Plasma lipids and coronary heart disease
• Plasma cholesterol may arise from the diet or from endogenous biosynthesis. In either
case, cholesterol is transported between the tissues in combination with protein and
phospholipids as lipoproteins.
• 1. Low-density lipoprotein and high-density lipoprotein: The level of plasma cholesterol
is not precisely regulated but, rather, varies in response to the diet. Elevated levels of
total cholesterol (hypercholesterolemia) result in an increased risk for CHD.
• A much stronger correlation exists between CHD and the level of cholesterol in low-
density lipoproteins ([LDL-C]). As LDL-C increases, CHD increases. In contrast, high
levels of high-density lipoprotein cholesterol (HDLC) have been associated with a
decreased risk for heart disease
• 2. Benefits of lowering plasma cholesterol: Dietary or drug
treatment of hypercholesterolemia has been shown to be
effective in decreasing LDL-C, increasing HDL-C, and reducing
the risk for cardiovascular events. The diet-induced changes of
plasma lipoprotein concentrations are modest, typically 10%–
20%, whereas treatment with “statin” drugs decreases plasma
cholesterol by 30%–60%

• Dietary fats and plasma lipids TAGs are quantitatively the most
important class of dietary fats. The influence of TAGs on blood
lipids is determined by the chemical nature of their constituent
fatty acids. The absence or presence and number of double
bonds (saturated versus mono- and polyunsaturated), the
location of the double bonds (w-6 versus w-3), and the cis
versus trans configuration of the unsaturated fatty acids are the
most important structural features that influence blood lipids.
• 1. Saturated fat: TAGs composed primarily of fatty acids whose
hydrocarbon chains do not contain any double bonds are referred to
as saturated fats. Consumption of saturated fats is positively
associated with high levels of total plasma cholesterol and LDL-C and
an increased risk of CHD. The main sources of saturated fatty acids
are dairy and meat produts and some vegetable oils, such as coconut
and palm oils

• 2. Monounsaturated fats: TAGs containing primarily fatty acids with

one double bond are referred to as monounsaturated fat. Unsaturated
fatty acids are generally derived from vegetables and fish. When
substituted for saturated fatty acids in the diet, monounsaturated fats
lower both total plasma cholesterol and LDL-C but maintain or
increase HDL-C. This ability of monounsaturated fats to favorably
modify lipoprotein levels may explain, in part, the observation that
Mediterranean cultures, with diets rich in olive oil (high in
monounsaturated oleic acid), show a low incidence of CHD.
• 3. Polyunsaturated fats: TAGs containing primarily fatty acids with more than
one double bond are referred to as polyunsaturated fats. The effects of PUFAs
on cardiovascular disease is influenced by the location of the double bonds
within the molecule.
A. ω-6 Fatty acids: These are long-chain PUFAs, with the first double bond
beginning at the sixth bond position when starting from the methyl (ω) end of
the fatty acid molecule. Consumption of fats containing w-6 PUFAs,
principally linoleic acid (18:2 [9,12]), obtained from vegetable oils, lowers
plasma cholesterol when substituted for saturated fats. Plasma LDL-C is
lowered, but HDL-C, which protects against CHD, is also lowered.
B. ω-3 Fatty acids: These are long-chain PUFAs, with the first double bond
beginning at the third bond position from the methyl (ω) end. Dietary w-3
PUFAs suppress cardiac arrhythmias, reduce serum TAGs, decrease the
tendency for thrombosis, lower blood pressure, and substantially reduce risk of
cardiovascular mortality but they have little effect on LDL-C or HDL-C levels.
• Evidence suggests that they have anti-inflammatory effects. The w-3 PUFAs,
principally α- linolenic acid, 18:3(9,12,15), are found in plant oils, such as
flaxseed and canola, and some nuts
• 4. Trans fatty acids: Trans fatty acids ( Figure 27.13 ) are
chemically classified as unsaturated fatty acids but behave more
like saturated fatty acids in the body because they elevate serum
LDL-C (but not HDL-C), and they increase the risk of CHD. Trans
fatty acids do not occur naturally in plants but occur in small
amounts in animals. However, trans fatty acids are formed during
the hydrogenation of liquid vegetable oils (for example, in the
manufacture of margarine and partially hydrogenated vegetable
oil). Trans fatty acids are a major component of many commercial
baked goods, such as cookies and cakes, and most deep-fried foods

• 5. Dietary cholesterol: Cholesterol is found only in animal

products. The effect of dietary cholesterol on plasma cholesterol is
less important than the amount and types of fatty acids consumed.
Cholesterol consumption should be no more than 300 mg/day.