Basic Nutrition

CARBOHYDRATE

Melese.S(Chem,B.Pharm,Msc ,Ass.Professor )
Jimma University
Institute of Health
Faculty of Public Health, Nutrition & Dietetics Department
May 30,2021

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 Objecties
• Describe the function of macronutrients ?
• Describe the function dietary fiber
consumption ?
• Describe disease associated with abnormal
metabolisms of carbohydrate , proteins and
fats ?
• Mention the good source of foods for
macronutrients ?

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 The 6 Essential Nutrients
What You Need to Know!

WATER

Fats &
Carbs Protein Vitamins Minerals
Oils
 “Essential” Nutrients
Nutrients are categories of substances we need
for our nutrition.

Essential Nutrients are nutrient substances that

we can only get from food, because our bodies
cannot produce them on our own.
**For example, your body can’t just decide “hey,
I need some calcium so I’m going to make it!”
You have to consume something that contains
calcium in order for it to get into your body
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 NUTRIENTS

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 Nutrients
• Macro-nutrients
— Protein
— Fat
— Carbohydrates
• Micro-nutrients
— Vitamins
— Minerals & trace-elements
• Water

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 The Nutrients
• Nutrients in Foods and in the Body
– Composition of foods includes the six nutrient classes of
water, carbohydrates, lipids, proteins, vitamins and
minerals. Foods can also contain nonnutrients and other
compounds, such as fibers, phytochemicals, pigments,
additives, alcohols and others.
– Composition of the human body is made of chemicals similar
to food.
– Chemical composition of nutrients includes both organic (those
that contain carbon) and inorganic (those that do not contain
carbon) compounds.
– Essential nutrients are those the body cannot make or cannot
make in sufficient quantities to meet needs. These are also
called indispensable nutrients.
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 The Nutrients
• Energy-Yielding Nutrients: Carbohydrate, Fat and Protein
– Macro- vs. micronutrients
• Carbohydrate, fat, and protein are macronutrients
because the body needs them in large quantities.
• Water, vitamins, and minerals do not provide energy
and are known as micronutrients because the body
needs them in smaller quantities.
– Energy is measured in Calories (calories, kilocalories,
kcalories, kcal).
• Internationally, food energy is measured in joules.

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 Energy-Yielding Nutrients

Calories and kilocalories

• Calories are units by which energy is
measured.
• Food energy is measured in
kilocalories (kcal)
– Carbohydrate = 4 kcal/gram
– Protein = 4 kcal/gram
– Fat = 9 kcal/gram

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Food is eaten and digested in the
body to allow the absorption of
energy and nutrients.
There are two different types of
nutrients:
• macronutrients;
• micronutrients.
There are three macronutrients
that are essential for health.
These are:
• carbohydrate;
• protein;
• fat.
Macronutrients are measured in
grams (g).
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Macronutrient Best for
Protein Building muscles

Carbohydrates (carbs) Primary source of energy

Hormones, nerves, tissues,

Fats vitamin absorption
Secondary source of energy

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 MACRONUTRIENTS

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• Macronutrients: - are nutrients that are
required by our body in larger quantities on
a daily basis and need to be broken down to
smaller units for use by the body.
• They include carbohydrates, lipid and proteins.
• All of them contribute to the energy pool of the
body
• Alcohol also gives energy, but it is not a
macronutrient for we do not need it for survival.

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 Macronutrients contribute to the energy
pool of the body

Energy Pool
Carbohydrates of the body Fats
(45-65%) (100%) 20% - 35%

 45-65% Carbohydrates (sugar, sweets,

bread, cakes)
 20-35% Fats (dairy products, oil) Proteins
 10-35% Protein (eggs, milk, meat,
poultry, fish) (10% - 35%)

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 Cont…

• While each of these macronutrients provides calories, the

amount of calories that each one provides varies.
– Carbohydrate provides 4 calories per gram.
– Protein provides 4 calories per gram (5.2 kcal/gram is removed as
metabolizable energy).
– Fat provides 9 calories per gram.
• Besides carbohydrate, protein, and fat the only other
substance that provides calories is alcohol. Alcohol
provides 7 calories per gram.
• Alcohol, however, is not a macronutrient because we do
not need it for survival.

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 What are Carbohydrates?
• Definition: • Carbohydrates can be found in the
a biological compound containing following:
carbon, hydrogen, and oxygen that is • Fruits
an important source of food and • Vegetables
energy
• Breads, cereals, and other grains
• Milk & milk products
• Your body uses carbohydrates to
• Foods containing added sugar
make glucose which is fuel that gives
your body energy.

• Glucose can be used immediately or

stored.

• Healthier foods high in

carbohydrates are ones higher in
dietary fiber without added sugar.

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 General Characteristics
• The term carbohydrate is derived from the French:
“hydrate de carbone”
• All carbohydrates are compounds composed of (at least)
C, H, and O
• The general formula for a carbohydrate is: (CH2O)n (e.g.
when n = 5 then the formula would be C5H10O5)
• Not all carbohydrates have this empirical formula (e.g.
deoxysugars, aminosugars, etc.)
• Carbohydrates are the most abundant compounds found
in nature (e.g. cellulose: 100 billion tons annually)

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 General Characteristics
• In nature, most carbohydrates are found bound to other
compounds rather than as simple sugars
• Polysaccharides (starch, cellulose, inulin, gums)
• Glycoproteins and proteoglycans (hormones, blood
group substances, antibodies)
• Glycolipids (cerebrosides, gangliosides)
• Glycosides
• Mucopolysaccharides (hyaluronic acid)
• Nucleic acid polymers

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Photosynthesis: Sun’s energy becomes part of glucose molecule

energy
Carbon dioxide
Water GLUCOSE
Chlorophyll

6 CO2 + 6 H20 + energy (sun) C6H12O6 + 6 O2

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 120 grams of glucose / day = 480 calories
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 Functions of Carbohydrates
1) Energy
• glucose fuels the work of most of the body’s cells
– preferred fuel of NERVOUS TISSUE (the brain, nerves) and
RED BLOOD CELLS (RBC)
• excess glucose is stored as GLYCOGEN in liver and
muscle tissue

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 Functions of Carbohydrates
2) Sparing Body Protein
• if diet does not provide enough glucose, then other
sources of glucose must be found
• if carbohydrate intake < 50 - 100 g, body protein will
be used to make glucose
• an adequate supply of carbohydrate spares body
proteins from being broken down to synthesize
glucose

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 Functions of Carbohydrates
3) Preventing Ketosis (Anti-ketogenic)
• carbohydrates required for the complete
metabolism of fat
• incomplete fat metabolism produces KETONES
• an adequate supply of carbohydrate (> 50 –
100 g per day) prevents KETOSIS

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 WHY DO WE NEED CARBOHYDRATES TO SURVIVE?

We need this amount of carbohydrate because:

– 45% - 65% of calories should come from carbohydrate
– Carbohydrates are the body’s main source of fuel.
– All of the tissues and cells in our body can use glucose for
energy.
– Carbohydrates are needed for the central nervous system, the
kidneys, the brain, the muscles (including the heart) to function
properly.
– Carbohydrates can be stored in the muscles and liver and later
used for energy(glycogen).
– Carbohydrates are important in intestinal health and waste
elimination (e.g.. Dietary fiber).

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 “GOOD” CARBS V. “BAD” CARBS
• “Good” Carbohydrates have more fiber
• “Bad” Carbohydrates are referring to
and complex carbohydrates.
foods with refined carbohydrates.
• Guidelines recommend choosing fiber-
• Refined Carbohydrates are items that are
rich carbohydrate choices.
made from white flour or added sugar.
• Fiber-rich foods include:
• Examples: white bread, cakes, &
fruits, vegetables, & whole grain breads cookies
& pastas.

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 Fibrous and
Complex carbs (good starchy carbs Highly processed
carbs (bad simple
carbs) (good carbs) carbs)

Veggies Refined grains

Whole grains Fruits Sugars
Brown rice Lentils Honey
Oatmeal Beans, peas Syrups
Quinoa Sweet potato Soft drinks
Candy etc

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 Types of Carbohydrates
Simple Carbohydrates Carbohydrates may be
A. Refined
– monosaccharides B. Unrefined
Refined means that the food is highly
– disaccharides processed.
Complex Carbohydrates The fiber and bran, as well as many of the
vitamins and minerals they contain,
– oligosaccharides have been stripped away.
Thus, the body processes these
– polysaccharides carbohydrates quickly, and they
• glycogen provide little nutrition although they
• starches contain about the same number of
• fibers calories.
Refined products are often enriched,
meaning vitamins and minerals have
been added back to increase their
nutritional value.
A diet high in simple or refined
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carbohydrates tends to increase the risk
32
of obesity and diabetes.
 Carbohydrates can be…
Simple Carbs Complex Carbs
- Fruits -Grains (bread & pasta)
- Honey -Vegetables (potatoes &
- Milk beans)
- Sugars added to cookies, -Rice
candies, soft drinks -Cereals
-Wheat
-Tortillas
-Whole-wheat rolls

10/23/2023 Melese .S Slide 33 of 35

 Dietary Carbohydrates

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 Dietary Carbohydrates

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 CLASSIFICATION OF CARBOHYDERATES
Free Oligo- Polysaccharides (Complex
Sugars saccharid Carbohydrates)
es
1. Monosacch 1.Starch Polysaccharides.
arides (One These are  Amylose(straight chain
CHO carbohydrate starch)
molecule) s that  Amylopectin (branched
e.g. contain from chain starch)
 Glucose 3-10 2. Non starch polysaccharides
 Fructose Monosaccha  Cellulose
 Galactos rides units in  Pectin
e their  Hemicellulose
 manose, molecules.  Gums
 Ribose The  Mucilage
 Deoxirib following are 3. Glycogen
ose some
2. examples
Disaccharides  Raffinos
(Two CHO e
molecule) e.g..  Stachyo
 Maltose se
 Sucrose  Verbasc
 Lactose ose
 Trehalo  Fructans
s  Galactan
3.Sugar s
alcoholes e.g.
 Sorbitol
 manitol
 Inisitol
 Dulcitol
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 Monosaccharides: Single Sugars

Glucose
– carbohydrate form used by the
body, referred to as “blood sugar”
– basic sub-unit of other larger
carbohydrate molecules
– found in fruits, vegetables, honey

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 Monosaccharides: Single Sugars

Fructose
– sweetest of the sugars
– occurs naturally in fruits & honey,
“fruit sugar”
– combines with glucose to form
sucrose

Galactose
– combines with glucose to form
lactose, “milk sugar”

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 Monosaccharides (Hexoses)
Sugar Source Importance Clinical significance

D-Glucose • Fruit juices,  The sugar of the body. Present in the urine
(Dextrose)
Grape sugar
• Hydrolysis of  The sugar carried by
the blood, and the
(glycosuria) in
starch diabetes mellitus
Blood sugar cane sugar, principal one used by owing to raised
maltose & the tissues, RBCs,
brain cells
blood glucose
(Aldose) lactose (hyperglycemia)
• Stored as
 Acts as immediate
energy source for
glycogen cellular functions like
muscle contraction,
nerve transmission and
tissue repair
 Can be converted into
other sugars or
derivatives required for
GAGs & Glycolipids

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Monosaccharides (Hexoses)
Sugar Source Importance Clinical significance

D-Fructose • Fruit juices, Can be Herediatary

• Fruit Sugar Honey changed to Fructose intolerance
• Levulose • Hydrolysis of glucose in the leads to fructose
• Keto sugar cane sugar & inulin
• Seminal fluid is
liver and so accumulation and
• Sweeter used in the hypoglycemia
than Glu rich in Fructose
body

D-Mannose Hydrolysis of • A constituent of many

• Aldo- Sugar plant mannans Glycoproteins
and gums • When oxidized
• Epimer of gives IdUA-a
glucose component of Heparin

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Monosaccharides (Hexoses)

Sugar Source Importance Clinical

significance
D-Galactose • Can be changed Failure to
• Aldo- Sugar
Hydrolysis of to glucose in the metabolize
 Milk sugar liver and then leads to
• Epimer of metabolized. galactosemia
Glucose  Galactolipids
• Synthesized in
and cataract
• Less sweet
 Glycoproteins the mammary (Galactitol)
than Glu gland to make
the lactose of milk.

• A constituent
of glycolipids and
Glycoproteins

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 Hexoses of Physiologic Importance.

Sugar Source Biochemical Importance Clinical Significance

D-Glucose Fruit juices, hydrolysis The main metabolic fuel for Excreted in the urine
of starch, cane or beet tissues; "blood sugar" (glucosuria) in poorly
sugar, maltose and controlled diabetes
lactose mellitus as a result of
hyperglycemia
D-Fructose Fruit juices, honey, Readily metabolized either Hereditary fructose
hydrolysis of cane or via glucoseor directly intolerance leads to
beet sugar and inulin, fructose accumulation
enzymic isomerization and hypoglycemia
of glucosesyrups for food
manufacture
D- Hydrolysis of lactose Readily metabolized Hereditary
Galactose to glucose; synthesized in the galactosemia as a result
mammary gland for synthesis of failure to metabolize
of lactose in milk. A galactose leads to
constituent of glycolipids and cataracts
glycoproteins
D-Mannose Hydrolysis of plant Constituent of glycoproteins
mannan gums

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 Disaccharides

Sucrose (“table sugar”)

– glucose + fructose

Lactose (“milk sugar”)

– glucose + galactose

Maltose (“malt sugar”)

– glucose + glucose

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SUCROSE: Table sugar/cane sugar

 It’s the main transport form of CHOs in plants.

 Obtained from cane and beet commercially.
 Made of 2 monosaccharides glucose and fructose which are linked by a glycosidic
linkage; α for glucose and β for fructose.
 It can be cleaved to its 2 components by enzyme sucrase.
 Provides 20-30% of the total calories.

Sucrose----------------------> Glucose + Fructose

Sucrase/invertase

Glycosidic linkage is α 1-2 bond.

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 LACTOSE: (milk sugar)

Major dietary CHO for infants.

10% of total CHOs consumed. Lactose is the only natural source of
galactose.
Lactose is hydrolysed to its monosaccharides by lactase in humans
and by β-galactosidase in bacteria.
Synthesized also during lactation.

Galactose is joined to glucose by

a β-1,4-glycosidic linkage.

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MALTOSE: Malt sugar

 Produced by the hydrolysis of starch and is in turn hydrolysed to glucose by

maltase.

 Present in germinating cereals and not naturally found in diet.

 Maltose in beer is produced by partial digestion of starch.

Glycosidic linkage is α 1-4 bond

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 Disaccharides

• Lactulose (Gal + Frc)

– Used in the treatment of some chronic liver diseases
associated with hyper-ammonemia

• Lactitol (galactosido-sorbitol)
– Also used in the treatment of some chronic liver
diseases

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 Complex Carbohydrates
Oligosaccharides
– short carbohydrate chains of 3 - 10
monosaccharides
– found in legumes and human milk
– Examples:
cannot be broken down by human enzymes,
• raffinose though can be digested by colonic bacteria
• stachyose

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 Oligosaccharides

• Glycoproteins containing oligosaccharide

chains include

– Integral membrane proteins,

– Receptors

– Hormones and

– Other proteins (like antibodies, clotting factors)

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 Complex Carbohydrates
Polysaccharides
• long carbohydrate chains of
monosaccharides linked by glycosidic bonds
– alpha (a) bonds (starch)
– beta (b) bonds (found in fiber)

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 amylose
Complex Carbohydrates

Starch amylopectin

– plant storage form of

carbohydrate
– long branched or
unbranched chains of
glucose
• amylose
• amylopectin

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 Complex Carbohydrates
Glycogen
– highly branched chains of
glucose units
– animal storage form of
carbohydrate
• found in LIVER and MUSCLE
• Humans store ~ 100g in liver; ~
400g in muscle
– negligible source of
carbohydrate in the diet (meat)

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 Complex Carbohydrates
Dietary Fiber
– non-digestible carbohydrates (chains of monosaccharides)
and lignin that are intact and intrinsic in plants (includes
oligosaccharides)
Functional Fiber
– isolated, non-digestible carbohydrates that have beneficial
physiological effects in humans

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 Complex Carbohydrates

• dietary fiber found in all types of plant

foods
• refining removes fiber from whole grains
and other foods

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 Complex Carbohydrates

• types of non-starch
polysaccharides include:
 cellulose
 hemicelluloses
 pectins
 gums & mucilages
 b-glucans
 chitin & chitosan
 lignans

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 Dietary fiber
• Fiber refers to certain types of carbohydrates that our
body cannot digest (oligosaccharides and non-starch
polysaccharides).

• These carbohydrates pass through the intestinal tract

intact and help to move waste out of the body.

• Diets that are low in fiber have been shown to cause

problems such as constipation and hemorrhoids and to
increase the risk for certain types of cancers such as colon
cancer.
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 Dietary Fiber
• Chronic constipation can
lead to diverticulosis and
diverticulitis
• Prevention of constipation
and diverticulosis
– Insoluble fiber helps reduce
transit time of foods in the
colon
– Soluble fiber helps make
stool easier to pass by
increasing bulk and softening
texture
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Figure 4.12
 Benefits of Fiber

i) Prevent constipation
Insoluble fiber binds water, making stools softer and
bulkier.
Therefore, fiber especially that found in whole grain
products is helpful in the treatment and prevention of
constipation, hemorrhoids and diverticulosis.
Diverticula are pouches of the intestinal wall that can
become inflamed and painful.
In the past, a low-fiber diet was prescribed for this
condition.
A high-fiber diet gives better results once the
inflammation has subsided.
 Cont …
• beneficial for weight control by contributing to satiety
& delay gastric emptying
• soluble fibers lower blood cholesterol to help reduce
risk of cardiovascular disease
• minimizes risk of and helps control Type II Diabetes
• insoluble fibers help promote intestinal health by
enlarging stool size and easing passage of stool

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 ii) Lower cholesterol levels
• Low blood cholesterol levels (below 200 mg/dl.) have been
associated with a reduced risk of coronary heart disease.

• The body eliminates cholesterol through the excretion of bile

acids. Water-soluble fiber binds bile acids, and hence a high-
fiber diet may result in an increased excretion of cholesterol.

• Some types of fiber appear to have a greater effect than others.

• The fiber found in rolled oats is more effective in lowering blood

cholesterol levels than the fiber found in wheat.

• Pectin has a similar effect in that it, too, can lower the amount
of cholesterol in the blood.
 Dietary Fiber
• Prevention of heart disease and diabetes
– Viscous, soluble fiber helps lower elevated blood
cholesterol levels
• Interferes with reabsorbtion of bile acid

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Figure 4.13
 Cont…
• Diets high in fiber; however, have been shown to
decrease risks for heart disease, obesity, and
they help lower cholesterol.

• Foods high in fiber include fruits, vegetables, and

whole grain products.

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 iii) Reduce the risk of some cancers

Dietary fiber may help reduce the risk of some cancers,

especially colon cancer.

This idea is based on information that insoluble fiber

increases the rate at which wastes are removed from the
body.

This means the body may have less exposure to toxic

substances produced during digestion.

A diet high in animal fat and protein also may play a role
in the development of colon cancer.
 How does fiber prevent different health
problems?

Cancer (Colonic, breast..)

• Prevents secondary bile acid circulation
• Decrease intestinal transit time
• Decrease contact of carcinogens with intestinal
cells
• Fermentation product butyrate has apoptotic
effect
• Decreases absorption fats and sugars
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 Cont…

• Dietary Fiber prevents Constipation,

Hemorrhoids & Diversticulosis by:

• Increasing perystalsis making stool bulk

• Decreasing straining to pass stool

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 iv) Useful for losing weight

High-fiber diets may be useful for people who wish to lose

weight.

Fiber itself has no calories, yet provides a "full" feeling

because of its water-absorbing ability.

For example, an apple is more filling than a half cup of apple

juice that contains about the same calories.

Foods high in fiber often require more chewing, so a person is

unable to eat a large number of calories in a short amount of
time.
 Fiber

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 Soluble Fiber
• examples include gums, pectins, mucilages,
some hemicelluloses
• functions:
– delay gastric emptying
– slow transit through the digestive system
– delay glucose absorption
– bind to bile, help decrease cholesterol
• food sources: fruits

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 Insoluble Fiber
• examples include cellulose, hemicellulose
• functions:
– speed transit through the digestive tract
– delay glucose absorption
– increase fecal weight and soften stool to ease passage
– reduces risk of hemorrhoids, diverticulitis and appendicitis
• food sources: cereal grains, legumes, vegetables,
nuts

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 Nutrient Sources
Water insoluble dietary fibers
β-glucans (a few of which are water soluble)
Cellulose cereals, fruit, vegetables (in all plants in general)

Chitin in fungi, exoskeleton of insects and crustaceans

Hemicellulose cereals, bran, timber, legume
Hexosane wheat, barley
Pentosane rye, oat
stones of fruits, vegetables (filaments of the garden bean),
Lignin
cereals

Xanthan production with Xanthomonas-bacteria from sugar substrates

water soluble dietary fibers

replace or complement in some plant taxa the starch as
Fructans
storage carbohydrate
Inulin in diverse plants, e.g. topinambour, chicory, etc.
Polyuronide
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Pectin in the fruit skin (mainly apples, quinces), vegetables
Effect of dietary fiber on breast Cancer
Systematic review

Sourec: Annals of Oncology, Jnaury, 2012

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 Insoluble fibre has more effect on weight

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 Fiber and Colorectal Cancer: review of evidence

10/23/2023 Source
Melese: .S 74
 Adverse effect
• Although fiber is important, it is just one part of a
properly balanced diet.

• Too much fiber may reduce the amount of calcium, iron,

zinc, copper and magnesium that is absorbed from
foods.

• Deficiencies of these nutrients could result if the amount

of fiber in the diet is excessive, especially in young
children.

• Fiber supplements are sold in a variety of forms from

bran tablets to purified cellulose.
• Many laxatives sold as stool softeners actually are fiber
supplements.

• Fiber's role in the diet is still being investigated.

• Various types of fiber have different roles in the body.

• For these reasons fiber supplements should be avoided.

• Eating a variety of fiber-rich foods is the best way to

receive the maximum benefits from each type of fiber
present in foods, and obtain necessary nutrients.
 Fiber: Too much of a good thing?
Excessive amounts of fiber may lead to:
– displacement of other foods in the diet
– intestinal discomfort
– interference with the absorption of other
nutrients

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 Butyrate and colon cancer.
• Butyrate has been shown to act as both preventive and inhibitory
in carcinogenesis of the colon. The chemopreventive effect is
mediated by upregulation of detoxifying enzymes for xenobiotics
and oxidants
 helps prevent and inhibit colonic carcinogenesis. Extra-intestinal
beneficial effects of butyrate include
1) increasing fetal hemoglobin production;
2) lowering serum cholesterol levels;
3) stimulating neurogenesis in brain after ischemic injury; and
4) providing positive effects in the treatment of obesity, insulin resistance,
cystic fibrosis, urea cycle enzyme deficiency, and sickle cell disease
 The role of butyrate in the inhibition and prevention of colon
cancer is likely one of its most important beneficial effects.
Source: Am J Physiol Cell Physiol 301: C977–C979, 2011;
doi:10.1152/ajpcell.00290.2011.
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 Food sources of Carbohydrates
• Free sugars are found from: fruits, juices, confectionery, Soft
drinks, , milk, sugar, sugar cane, honey and yogurt, Cereal grains,
Legumes & dried fruits, vegetables, processed foods (pasta), jams,
pastries, breads, candies fruits like banana, dates, and sweet potato
• Starch is found from: starchy foods (like cereals and legumes
and potatoes), Other foods like fruits, vegetables, beans, nuts,
seeds
• OligoSacharides are found from : Garlic, onion, Whole grain
cereals and legumes (beans and peas)
• Non starch polysaccharides are found from: Fruits,
vegetables, Whole grain cereals and legumes

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 Soluble or Viscous Fiber
Goal Soluble Fiber grams
Barley, ½ cup cooked 1
Increase to 10-25 Oatmeal, 1 cup cooked 2
grams per day Psyllium seeds, ground 1T 5
Apple, banana, peach 1
Orange, grapefruit, pear 2
Beans, cooked, 1 cup 4-
6
Broccoli, ½ cup cooked 1
Brussels Sprouts, ½ cup ckd 3
Carrots, ½ cup cooked 1
Source: ATP 3 TLC Guidelines

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 Practical Steps To
Increase Your Intake
of High-Fiber Foods
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 Dietary Fiber-Eat More Fruit
Fruit is a good source
1 of fiber; low in fat and Fruits fiber, g
calories, and Apple, 1 medium 3.3
cholesterol-free. Applesauce, canned 1/2 C 1.5
Apricots, 3 medium 3.8
Two or more cups of Banana, 1 medium 3.1
fruit per day are Blackberries, fresh, 1 C 7.6
recommended. Blueberries, frozen, 1 C 4.2
Cantaloupe, 1 C pieces 1.4
Kiwi, 1 medium 2.6
Orange, 1 medium 3.1
Peach, 1 medium 1.5
Pear, 1 small 4.6
Prunes, 1/2 C cooked 4.7
Strawberries, raw, 1 C 3.1

USDA National
10/23/2023 Nutrient Database Melese .S 82
 Dietary Fiber-Eat More Vegetables
Vegetables are low in fat Vegetables fiber g
2 and calories and high in Asparagus, ½ C cooked 1.8
Broccoli, ½ C cooked 2.6
fiber, vitamins, and
Brussels sprouts, ½ C ckd 2.0
minerals.
Carrot, ½ C cooked 2.3
Three to five or more Coleslaw, ½ C 0.9
servings of vegetables per Green beans, ½ C cooked 2.0
day are recommended. Green peas, ½ C cooked 4.4
Greens, ½ C cooked 2.1
Potato, baked, 1 medium 3.8
Summer squash, ½ C ckd 1.3
Winter squash, ½ C baked 2.9
Sweet potato, 1 med. Baked 3.8
Tomato, fresh, 1 medium 1.5

10/23/2023USDA National Nutrient DatabaseMelese .S 83

 Eat MoreMore
Dietary Fiber-Eat Whole Grains
Whole Grains

Whole grains are a good Grains fiber-g

3 source of fiber. They are
Bran Flakes cereal, 3/4 C 5.3
Grape-Nuts, 1/4 C 2.5
usually low in fat, and they
Oatmeal, 3/4 C, cooked 3.0
tend to fill you up.
Pancakes, three 4” cakes 1.5
Three or more servings of Pasta, 1C, cooked 2.5
whole grains per day are Rice, brown, 1C cooked 3.5
recommended. Rice, white, 1C cooked 1.4
Shredded wheat, 1 C 5.0
Tortilla, 1, whole corn 1.5
Wheaties, 1 C 3.0
White bread, 1 slice 0.6
Whole-wheat bread, 1 slice 1.7

USDA National
10/23/2023 Nutrient Database Melese .S 84
 Dietary Fiber-Eat More Legumes
Legumes are the foods Legumes fiber g
4 highest in fiber. They are Black beans, ½ C cooked 7.0
also good sources of Burrito, bean & cheese, 1 15.0
protein. Chickpeas, ½ C cooked 5.3
Eat three or more servings Hummus spread, ¼ C 3.8
per week. Daily intake is Lentils, ½ C cooked 7.8
ideal. Lima beans, baby, ½ C 7.0
Pinto beans, 1 C cooked 15.4
Tofu, raw, firm, ¼ block 1.9
Tofu, raw, regular, ¼ block 0.3

USDA National Nutrient Database

10/23/2023 Melese .S 85
 Dietary Fiber-Choose Fruit/Veg Juice
Juice fiber g
Pure fruit and vegetable
5 juices contribute some
Apricot nectar, 6 oz 1.1
Grape juice, 1 C 0.3
fiber and are good sources Grapefruit juice, ½ C 0.1
of vitamins. Orange juice, 1 C 0.5
Look for juices without Pineapple juice, ½ C 0.5
added sugar. Tomato juice, 1C 1.0
V-8 juice, 1C 1.9
Soft drink*, 1 can 0.0
* Soft drinks are loaded with sugar
and calories but not nutrients.

USDA National
10/23/2023 Nutrient Database Melese .S 86
 Dietary Fiber-Eat Nuts and Seeds
Nuts fiber
Nuts are good sources of
6 fiber, protein, and
g
Almonds (23), 1 oz. 3.3
unsaturated fats. Cashews (18), 1 oz. 0.9
Nuts have been found to Filberts (21), 1 oz. 2.7
reduce the risk of heart Mixed nuts, 1 oz. deluxe 1.6
disease. Peanut butter, 2 T 2.6
Peanuts, 1 oz. 2.3
Pecans (15 halves), 1 oz. 2.7
Pistachios (49), 1 oz. 2.9
Sunflower seeds, 1 oz. 2.6
Pumpkin seeds (142), 1 oz. 1.1
Walnut halves, 1 oz. 1.9

USDA National Nutrient Database

10/23/2023 Melese .S 87
 Dietary Fiber-Eat Less Refined Foods

Much of the fiber is Sample Foods fiber g

7 removed in refined and Apple, 1 med. 3.3
processed foods. Applesauce, canned 1/2 C 1.5
Apple juice, 1 cup 0.2
Choose more unrefined,
Soft drink, 1 can 0.0
natural foods.
Whole-wheat bread, 1 slice 1.7
White bread, 1 slice 0.6
Twinkie, 1 0.1

Soft drinks, ice cream, candy

sugar, butter, margarine 0.0

USDA National Nutrient Database

10/23/2023 Melese .S 88
 Dietary Fiber – Read Food Labels
Nutrition Facts
• When buying
8 foods, check the
Serving Size 2.5 oz. (71g)
Servings per container 4
Amount Per Serving
label for fiber Calories
130
content. Calories from fat 25

• You will soon Total Fat 3g

% Daily Value
5%
learn which foods Saturated fat 1 g
5%
are higher in Polyunsaturated fat 0.5g
Monounsaturated fat 1.5g
dietary fiber. Cholesterol 10 mg
4%
Sodium 290 mg
12%
Total Carbohydrate 18g 6%
10/23/2023 Melese .S
Dietary fiber 5g 89
20%
Glucose Production Glucose Consumption

125g
Blood
glucose brain
Glucose
50g
Glycogen
50g
(75%)
rbc
wbc

muscle

10/23/2023 fatMelese
cell .S 90
Glucose Production Glucose Consumption

CO2
125g
Blood
glucose brain
Glucose
50g
Glycogen
50g
(75%)
rbc
pyruvate wbc
lactate (10-15%)

certain
amino acids (10-15%) CO2
glycerol (2%) muscle

10/23/2023 fatMelese
cell .S 91
 Carbohydrate digestion
a. Digestion of starch and disaccharides
-Che m ical Starch, Lacto se
salivary Am ylase D e xtrin, Lactase Sucro se
Mo uth and
(Ptyalin) &
sm all
Pancre atic
inte stine Sucrase
am ylase Gluco se
 -Me chanical;- + Gluco se
biting actio n o f +
Galacto se
the te e th Fructo se
From the sm all
Maltose inte stine
Maltase

Gluco se + Gluco se
Absorbed by simple
diffusion

Absorbed by active transport

mechanism coupled with sodium

10/23/2023 Melese .S 92
 Digestion & Absorption

1. Mouth
• chewing
• salivary amylase
2. Stomach
• fibers remain in the
stomach longer, delays
gastric emptying
10/23/2023 Melese .S 93
 Digestion & Absorption
Small Intestine
• pancreas secretes enzyme pancreatic amylase
• enzymes located on the cell membranes of the intestinal
epithelial cells complete digestion

maltase
maltose glucose + glucose

sucrase
sucrose glucose + fructose

lactase
lactose glucose + galactose
10/23/2023 Melese .S 94
b. Digestion of oligosaccharides, resistant starch and non-
starch polysaccharides
O ligosaccharide s (e g. Raffinose , Stachyo se)
and non-starch po lysaccharide s re sistant
starch

Escape digestion in the

upper gut (small intestine

They get fermented in the

colon by anaerobic bacteria

Production of
gases likes co2, Production of
methane and short chain fatty Increased faecal Biomass
hydrogen acids (SCFA) resulting in increased
sulphide  Acetate peristalsis
 Propionate
10/23/2023  Butyrate Melese .S 95
10/23/2023 Melese .S 96
 Digestion & Absorption
Small Intestine cont.
• only monosaccharides can be absorbed
– glucose & galactose absorbed by ACTIVE TRANSPORT
– fructose absorbed by FACILITATED DIFFUSION
• all three monosaccharides travel in the portal vein
to the liver
• three fates of glucose at the liver
– Energy, storage as glycogen, released to blood

10/23/2023 Melese .S 97
10/23/2023 Melese .S 98
 Digestion & Absorption
Large Intestine
• resistant starches and fibers may be digested
by bacteria
– produces short chain fatty acids
• absorbed by the intestine and used for energy
(dietary fiber yields about 2 kcal/g)
• other health benefits

10/23/2023 Melese .S 99
Digestion of
carbohydrates.

10/23/2023 Melese .S 100

10/23/2023 Melese .S 101
 Metabolism of Carbohydrates
Glucose –6-Phosphate

Fructose-6-phosphate
Glycolysis

Fructose1, 6-diphosphate

3-Dihydroxy Acetone phosphate

Glyceraldehyde-3 phosphate
bGlyceraldehyde 3-phosphatephosphate
Acetyl CoA

Crebs Cycle
CO2+ Energy+H2O

10/23/2023 Melese .S 102

10/23/2023 Melese .S 103
 Overview of Metabolism
protein polysaccharides lipids
ADP + Pi ADP + Pi ADP + Pi
ATP ATP ATP
amino acids hexoses
fatty acids
ADP + Pi pentoses
ADP + Pi ADP + Pi
ATP ADP + Pi
ATP
ATP
pyruvate ATP
urea
acetyl-CoA ADP + Pi
urea O2
ATP
cycle
electron transport
e- chain
citric acid oxidative
cycle phosphorylation
CO2
10/23/2023 Melese .S 104
ATP
 Overview of Catabolic Processes
Proteins
Proteins Carbohydrates
Carbohydrates Fats
Fats
Stage 1
Amino
Aminoacids
acids Simple
SimpleSugars
Sugars Fatty
Fattyacids
acids

Glycolysis
Glycolysis
Stage 2
Pyruvate ATP
Pyruvate

Acetyl
AcetylCoA
CoA

Citric
Citricacid
acidcycle
cycle Stage 3

Oxidative
Oxidativephosphorylation
phosphorylation

ATP
10/23/2023 Melese .S 105
10/23/2023 Melese .S 106
10/23/2023 Melese .S 107
10/23/2023 Melese .S 108
 Stage 1 – postparandial
All tissues utilize glucose

Stage 2 – postabsorptive
KEY – Maintain blood glucose
Glycogenolysis
Glucogneogenesis
Lactate
Pyruvate
Glycerol
AA
Propionate
Spare glucose by metabolizing fat

Stage 3- Early starvation

Gluconeogenesis

Stave 4 – Intermediate starvation

gluconeogenesis
Ketone bodies

Stage 5 – Starvation
10/23/2023 Melese .S 109
 General Characteristics of the Energy
Systems
ATP/PC System Lactic Acid System Aerobic System

Anaerobic Anaerobic Aerobic (oxygen)

Very rapid Rapid slow

PC and ATP utilized Glycogen/glucose used Glycogen, fats, and

protein used
Very limited production Limited production of ATP Unlimited production of
ATP
Limited stores in muscle - By product - lactate and No fatiguing by products
fatigue with depletion acidity leads to fatigue
Used in sprint and high- Activities that are Long duration activities, 5
power short duration maximal for 1-3 minutes minutes plus
activity
10/23/2023 Melese .S 110
TABLE 4.7 Major hormones involved in regulation of blood glucose levels
Hormone Gland Stimulus Action
Insulin Pancreas Increase in blood Helps transport glucose into
glucose cells; decreases blood glucose
levels.
Glucagon Pancreas Decrease in blood Promotes gluconeogenesis in
glucose; Exercise liver; helps increase blood
stress glucose levels.
Epinephrine Adrenal Exercise stress; Promotes glycogen breakdown
decrease in blood and glucose release from the
glucose liver: helps increase blood
glucose levels
Cortisol Adrenal Exercise stress; Promotes breakdown of protein
decrease in blood and resultant gluconeogenesis;
glucose helps increase blood glucose
levels

10/23/2023 Melese .S 111

10/23/2023 Melese .S 112
10/23/2023 Melese .S 113
10/23/2023 Melese .S 114
10/23/2023 Melese .S 115
10/23/2023 Melese .S 116
10/23/2023 Melese .S 117
10/23/2023 Melese .S 118
 GLUCOSE TRANSPORTERS
family of proteins called the solute carriers (SLC)

GLUT1: RBC’s
GLUT2 :intestine, pancreatic β-cells, kidney and liver(glucose sensor)
GLUT3: binds glucose with high affinity
GLUT4: insulin-sensitive tissues, such as skeletal muscle and adipose tissue
GLUT5: fructose transporter

10/23/2023 Melese .S 119

 Glucose transporters
Name Tissue Function
GLUT1 (erythrocyte) wide distribution, esp. Basal glucose transport
brain, kidney, colon, fetal
tissues
GLUT2 (liver) Liver, b-cells of pancreas, Non-rate-limiting glucose
small intestine, kidney transport

GLUT3 (brain) Wide distribution, esp. Glucose transport in

neurons, placenta, testis neurons
GLUT4 (muscle) Skeletal muscle, cardiac Insulin-stimulated
muscle, adipose tissue glucose transport*

GLUT5 (small intestine) Small intestine, kidney, Fructose transport

skelatal muscle, brain,
adipose tissue

*insulin low…GLUT4 in intracellular compartments;

insulin high…GLUT4 translocates to membrane

10/23/2023 Melese .S 120

10/23/2023 Melese .S 121
 Effect of food processing on Carbohydrates

• Polishing – loss of vitamines (eg. Thiamin)

• Fermenting
– increase mineral bioavailability (Fe, Zn, Mg, Ca)
– Functional foods (prebiotic VS probiotic)

• Germination
– Decreases viscosity due to gelatinization
– Increases nutrient density

10/23/2023 Melese .S 122

 Probiotic vs Prebiotic
• Probiotics are live bacteria in yogurt, other dairy products
and pills. And while probiotics have been shown effective
in managing certain gastrointestinal conditions, they do
not have the same power that prebiotics do.
• The Prebiotic is a specialized plant fiber that beneficially
nourishes the good bacteria already in the large bowel or
colon. The body itself does not digest these plant fibers;
instead, the fibers act as a fertilizer to promote the growth
of many of the good bacteria in the gut.

10/23/2023 Melese .S 123

 PREBIOTIC VS PROBIOTIC
PREBIOTICS PROBIOTICS
PREBIOTICS are a special form of PROBIOTICS are live bacteria in yogurt,
dietary fiber dairy products and pills. There are hundreds of
probiotic species available. Which of the hundreds of
available probiotics is best for the average healthy
person is still unknown.

PREBIOTIC powders are not affected by heat, cold, PROBIOTIC bacteria must be kept alive. They may be
acid or time. killed by heat, stomach acid or simply die with time.

PREBIOTICS provide a wide range of health benefits to PROBIOTICS are still not clearly known to provide
the otherwise healthy person. Most of these have been health benefits to the otherwise healthy. Some are
medically proven. suspected but still not proven.
PREBIOTICS nourish the good bacteria that everyone PROBIOTICS must compete with the over 1000
already has in their gut. bacteria species already in the gut.

PREBIOTICS may be helpful for Certain PROBIOTIC species have been shown to be
helpful for childhood diarrhea, irritable bowel disease
several chronic digestive disorders or and for recurrence of certain bowel infections such as C.
inflammatory bowel disease. difficile.

10/23/2023 Melese .S 124

10/23/2023 Melese .S 125
 Diseases associated with abnormal carbohydrate
metabolism include

Diabetes mellitus
Galactosemia
Lactose intolerance
Glycogen storage diseases
Hypoglycemia.

10/23/2023 Melese .S 126

 Carbohydrate malabsorption
Lactose intolerance
• Most mammals normally cease to produce lactase,
becoming lactose intolerant, after weaning
• It is estimated that 75% of adults worldwide show some
decrease in lactase activity during adulthood
• The frequency of decreased lactase activity ranges from
5% in northern Europe through 71% for Sicily to more than
90% in some African and Asian countries

• This distribution is now thought to have been caused by

recent natural selection favoring lactase-persistent
individuals in cultures in which dairy products are available
as a food source.
10/23/2023 Melese .S 127
 Cont …
• occurs as a result of insufficient lactase & low lactase
activity
• lactose molecules from milk remain in the intestine
undigested
• lactose intolerance  milk allergy
• undigested lactose digested by bacteria producing
irritating acid and gas
– symptoms include bloating, abdominal discomfort,
diarrhea

10/23/2023 Melese .S 128

 Cont …
• individuals who consume little or no milk products may
be at risk of developing nutrient deficiencies
• dairy options: yogurt, aged cheddar, small quantities
of milk (~ ½ cup), acidophilus milk, cottage cheese
• best to consume with other foods and spread intake
throughout day
• gradual increases in milk intake may cause intestinal
bacteria to adapt

10/23/2023 Melese .S 129

 There are 3 types of lactase deficiency:
1. Inherited lactase deficiency:
• In this syndrome, which is relatively rare, symptoms
of intolerance develop very soon after birth
• The feeding of a lactose-free diet results in
disappearance of the symptoms
• The occurrence of lactose in the urine is a prominent
feature of this syndrome, which appears to be
attributable to an effect of lactose on the intestine

Hanadi Baeissa
2. Secondary low-lactase activity:
• Because digestion of lactose is limited even in
normal humans, intolerance to milk is not
uncommon as a consequence of intestinal disease
• Examples are tropical and non tropical (celiac)
spure,Crohn’s disease, kwashiorkor, colitis, and
gastroenteritis.
• The disorder may be noted also after surgery for
peptic ulcer

Hanadi Baeissa
3. Primary low-lactase activity:
• This is a relatively common syndrome, particularly
among non white populations
• Since intolerance to lactose was not a feature of
the early life of adults with this disorder, it is
presumed to represent a gradual decline in activity
of lactase in susceptible individual

Hanadi Baeissa
 Cont …
• Lactose Intolerance - Dietary Changes
– Increase consumption of milk products
gradually.
– Mix dairy with other foods.
– Spread dairy intake throughout the day.
– Use of acidophilus milk, yogurt, and kefir
(fermented products)
– Use of enzymes
– Individualization of diets
– Must be careful that vitamin and mineral
deficiencies do not develop
10/23/2023 Melese .S 133
 Mechanism of Lactose-Induced Diarrhea and
Flatus
Lactase-sufficient
people absorb Glucose Lactose
Galactose Small
>80% of lactose
bowel
Lactase-deficient Lactose

people absorb
<50% of lactose SCFA
Colon
lactose
6-20 grams malabsorbed glucose
lactose = flatus CO2+H2 galactose
(1 g = 44 ml H2)

>20 grams malabsorbed

lactose = flatus+diarrhea
10/23/2023
FLATUS
Melese .S
OSMOTIC DIARRHEA
134
 Lactose Intolerance
• more lactose is consumed than can be digested
– lactose molecules attract water
• cause floating, abdominal discomfort, diarrhea
– intestinal bacteria feed on undigested lactose
• produce acid and gas

10/23/2023 Melese .S 135

 Abnormal
lactose
metabolism.

10/23/2023 Melese .S 136

 Consequences of chronic elevation in concentration
of hexoses in blood

 2 possible consequences are

• Enzymatic formation of sugar alcohols
• Nonenzymatic glycosylation (“glycation”) of proteins
 Both of these associated with long term pathologies of
nerves, blood vessels, kidneys, and lens as found in
diabetes and galactosemia

10/23/2023 Melese .S 137

 Galactose Metabolism
• By far major source of galactose in human diet is in
form of lactose
• Major source of lactose is milk and milk products
• Major organ involved in galactose metabolism is liver
• There are several inborn errors involving
metabolism of galactose

10/23/2023 Melese .S 138

 2 types of galactosemia are caused by
deficiency or absence of:
D-galactose 1-P uridyltransferase andgalactokinase
• The first more common (prevalence = 1 in 70,000) than
second (prevalence = 1 in 1 x 105) and has far greater
clinical importance in terms of associated pathologies,
especially in homozygotes

• In Illinois the incidence of the first defect is ~1 in 30,000

live births

10/23/2023 Melese .S 139

10/23/2023 Melese .S 140
The pathologies associated with defective D-galactose
1-P uridyl transferase include:
• severe mental retardation, hepatomegaly, cataracts, and
non-specific morphological changes in the CNS

• In Illinois, all newborns are screened for galactosemia

• Affected infants MUST be placed on a galactose-free (i.

e., milk-free) diet immediately to prevent irreversible
damage

10/23/2023 Melese .S 141

 Fructose Metabolism
• Major sources of fructose in diet are fruits, honey,
sucrose and, now, in form of high fructose corn syrup or
solids as an added sweetener in soft drinks, candy, etc.
• Fructose -in one form or another- may account for 30 -
60% of total dietary carbohydrates for some
• Major organ involved in fructose metabolism is the liver

10/23/2023 Melese .S 142

 There are two (rare) inherited diseases of fructose
metabolism
• Essential fructosuria - caused by deficiency in
fructokinase and leads to transitory elevation of blood
fructose level and to fructosuria (fructose in the urine)
• Fructose intolerance - MUCH MORE SERIOUS
EFFECTS similar to those associated with galactosemia
- caused by a defect in fructose-1-P aldolase (aldolase
B)
• In fructose intolerance fructose and its sources
(sucrose!) must be eliminated from diet

10/23/2023 Melese .S 143

 Regulation of Blood Glucose
Optimal functioning of the body is dependant on
keeping levels of glucose within certain parameters.
 Elevated blood glucose = Hyperglycemia
 Low blood glucose = Hypoglycemia
The ENDOCRINE SYSTEM is primarily responsible for
regulating blood glucose. The two main hormones are
INSULIN and GLUCAGON.

10/23/2023 Melese .S 144

 Regulation of Blood Glucose

10/23/2023 Melese .S 145

 Diabetes Mellitus
• a disorder of energy metabolism due to failure of
insulin to regulate blood glucose
• results in hyperglycemia
• acute symptoms include thirst, increased urine
production, hunger
• long term consequences include increased risk of
heart disease, kidney disease, blindness, neural
damage
• two forms: Type I and Type II

10/23/2023 Melese .S 146

 Diabetes Mellitus
No Insulin
Consume Available or
Blood Glucose
Carbohydrates Cells
Rises
Resistant

Liver Breaks Down

Glycogen and
Produces Glucose Cell
Blood Glucose
from Non- Starves
Rises
Carbohydrate
Sources

Body Uses
Ketoadicosis Fat for
Fuel

10/23/2023 Melese .S 147

 Diabetes Mellitus
Type I
• accounts for about 10% of cases
• occurs when b cells of the pancreas are destroyed
– insulin cannot be synthesized
• without insulin, blood glucose levels rise because the
tissues are unable to access the glucose
• death occurs shortly after onset unless given
injections of insulin

10/23/2023 Melese .S 148

 Forms of Diabetes
• Type 1
– Usually begins in childhood or early adulthood
– 5–10% of diabetics
– Immune system destroys beta cells of the
pancreas
• No insulin produced
– Common symptoms of elevated blood sugar
• Polydipsia
• Polyuria
• Polyphagia
– Require insulin and frequent blood glucose
monitoring
10/23/2023 Melese .S 149
 Diabetes Mellitus
Type II
• occurs when cells of body are unable to respond to
insulin
• called “insulin insensitivity” or “insulin resistance”
• blood glucose levels rise
• insulin secretion increases in an attempt to
compensate
– leads to hyperinsulinemia

10/23/2023 Melese .S 150

 Forms of Diabetes
• Type 2
– Overweight individuals develop this form
frequently
– 90–95% of diabetics
– Can go undiagnosed
• Damages vital organs without individual being aware of
it
• Polycystic ovary syndrome
– Hormonal imbalance in women
– Have higher incidence of insulin resistance and
hyperinsulinemia
• Increased risk of developing type 2 diabetes
10/23/2023 Melese .S 151
10/23/2023 Melese .S 152
 How Diabetes Develops

10/23/2023 Melese .S 153

Copyright 2005 Wadsworth Group, a division of Thomson Learning
 Hypoglycemia
• dramatic drop in blood glucose
• symptoms similar to an anxiety attack: rapid weak
heart beat, sweating, anxiety, hunger, trembling,
weakness
• RARE in healthy people
• may occur as a result of poorly managed Diabetes or
other causes:
– reactive hypoglycemia
– fasting hypoglycemia

10/23/2023 Melese .S 154

Complications Of Diabetes

10/23/2023 Melese .S 155

Copyright 2005 Wadsworth Group, a division of Thomson Learning
 Forms of Diabetes
• Prediabetes
– Impaired glucose tolerance
– Fasting blood sugar between 100 mg/dl and 126
mg/dl
– High risk of developing diabetes and heart disease

10/23/2023 Melese .S 156

 Diabetes
• Long-term damage from diabetes
– Nerve damage • Tooth loss
• Gum problems
– Leg and foot amputations
• Kidney disease
– Eye diseases • Heart disease
– Blindness
• Slowing of onset of complications
– Control level of blood glucose through
• Diet
• Insulin or oral medication
• Monitoring blood glucose
• Regular healthcare visits
10/23/2023 Melese .S 157
 Management of DM
• The major components of the treatment of
diabetes are:

A • Diet and Exercise

• Oral hypoglycaemic
B therapy

C • Insulin Therapy

10/23/2023 Melese .S 158

 Some dietary recommendations for diabetes
- Saturated fatty acids, <10% of total energy
- w -6 polyunsaturated fatty acids, <10% of total
energy
Components of dietary energy
- Protein, 10-20% of total energy
- Carbohydrate and cis-monounsaturated fatty acids,
for the remainder
- Low glycemic index foods and those rich in soluble
fibre recommended
- Vegetables, fruits, pulses and cereal-derived foods
preferred
Carbohydrate issues
- Sucrose, <10% total energy acceptable in certain
circumstances
- Timing of intake essential for those on insulin

- Non-alcoholic beverages sweetened with non-

nutritive sweeteners are useful
Special 'diabetic' and 'dietetic' foods - Other special foods not encouraged
- No particular need of fructose and other 'special'
nutritive sweeteners over sucrose
10/23/2023 Melese .S 159
 Whole Grains and Type 2 Diabetes
• Finnish study: 1.00
– 4,300+ men/women 1.00

Type 2 Diabetes (RR)

– 10 year study 0.75
• Those eating the most
0.65
whole-grains had 35% 0.50
less type 2 diabetes.
0.25 0.39
• Those with highest
cereal fiber intake had
0.00
61% less diabetes. Low High 29+ g
Cereal
Fiber
Whole Grain Intake

Amer Jour
10/23/2023 Clin Nutr 77: 527-529 Melese .S 160
 Whole Grains & Risk of Mortality
• ARIC study, 15,792
1.00
people 45-64, 11 yrs

Mortality, any cause (RR)

1.00

• Those eating the most 0.75

0.84

whole-grains had a 48%

0.66
decrease in mortality. 0.63
0.50 0.52
• After adjusting for BMI,
exercise, cholesterol, 0.25
etc. they still had a 23%
lower risk of dying from 0.00
any cause. 0.1 0.5 1 1.5 3

Whole Grains, Servings/Day

(Quintiles)

Amer Jour Clin Nutr 78: 383-390

10/23/2023 Melese .S 161
 Glycemic Index: Definition

• Glycemic index (GI) measures how fast a carbohydrate is

digested and raises blood sugar and insulin levels
• Measure of relative glycemic response to dietary carbohydrates
• Rate and degree of blood sugar elevation following
consumption.
• Reference food:
– White bread or Glucose = 100
– Higher index  faster and greater rise of postprandial
glucose and/or insulin
• Glycemic index debate
-low glycemic index supposedly helpful in reducing glucose load
via reduced insulin response required

10/23/2023 Melese .S 162

 Blood Glucose and Insulin Curves
High energy
storage
zone

After eating:
• White bread (solid line) Hunger Zone

and then
• Spaghetti (dotted line) High insulin response
leads to obesity,
(each food was eaten on insulin resistance and
exhaustion
different days)

JAMA, May 8, 287:2415

10/23/2023 Melese .S 163
 The Glycemic Index
• a measure of the extent to which a food raises
blood glucose concentration & elicits an insulin
response compared to pure glucose

Low Moderate High

pasta banana white bread
baked beans orange juice cornflakes
bran cereals ice cream potatoes
apples jelly beans
milk watermelon
10/23/2023 Melese .S 164
 The Glycemic Index

10/23/2023 Melese .S 165

 The Glycemic Index cont.
Glucose 100
Baked potato 85
Jelly bean 78
Honey 73
Bagel 72
Sucrose 65
Boiled new potato 62
Brown rice 55
Chocolate 49
Boiled carrots 47
Orange 44
Spaghetti 42
Apple 38
Skim milk 32
Lentils 29
Fructose 23

10/23/2023 Melese .S 166

 Glycemic Index (contd)
• Use of Glycemic Index
– Lower GI foods digest & Fastest Glucose
Dextrose
convert to glucose more slowly
Starch (branched-chain)
– High-fiber slower than low
Sucrose/Corn Syrup
– High-fat slower than low Fructose
– Solids slower than liquids Starch (straight-chain)
– Cold foods slower than hot Lactose
– Type of sugar/starch affects GI Galactose
Slowest Sugar Alcohols

10/23/2023 Melese .S 167

Glycemic Index
 Glycemic Index (GI)

The GI reflects the rate of digestion and absorption of

CHO

Blood glucose area after test food

GI = X 100
Blood glucose area after reference food

10/23/2023 Melese .S 169

 What Does the Glycemic Index Value Mean?
• The glycemic index (GI) is expressed as a ratio comparing the blood glucose increase caused
by a test food to that of a reference food (usually glucose [G], historically white bread [WB])
for 2 hours following ingestion:

Area Under the Curve for Test Food

× 100 = GI
Area Under the Curve for Reference Food
• Conversion for different reference foods: GIG × 1.4 = GIWB
– The GIG for carrots (mean of 4 studies) = 47
– The GIWB for carrots (mean of 4 studies) = 68
• How about a ½ cup of carrots? GI of 47% and it contains about 6 g carbohydrate

GL + 47 x 6/100= 3g
• Let’s take a medium apple. It has a GI of 40% and it contains 15 grams of carbohydrate
GL = 40 x 15/100 = 6 g
• What about a small baked potato? Its GI is 80% and it contains 15 g of carbohydrate

GL = 80 x 15/100 = 12 g
10/23/2023
Atkinson FS, et al. Diabetes Care. 2008;31(12):2281-2283. Melese .S 170
 GI rating for some common carbohydrates

• A Glycaemic Index of
 less than 55 is considered Low,
 56 to 69 Medium and
 Greater than 70 is High.
• Values will vary depending on brand, variety,
ripeness, preparation etc.

10/23/2023 Melese .S 171

Factors Influencing GI Ranking

• Type of starch
• Physical entrapment
• Viscosity of fiber
• Sugar content
• Fat and protein
• content
Acid content
• Food processing
• Cooking

10/23/2023 Melese .S 172

Factors Influencing GI Ranking

Type of Starch
Amylose Amylopectin
• Absorbs less water • Absorbs more water
• Molecules form tight • Molecules are more open
clumps • Faster rate of digestion
• Slower rate of digestion
Lower GI Higher GI

Kidney beans (28) Russet potato (85)

Uncle Ben’s converted LG rice (50) Glutinous rice (98)

10/23/2023 Melese .S 173

Factors Influencing GI Ranking

Physical Entrapment

Bran acts as a physical barrier that

Bran slows down enzymatic activity on
the internal starch layer.
Endosperm
Lower GI All Bran (38)
Pumpernickel bread (50)
Germ

Higher GI Bagel (72)

Corn Flakes (92)

10/23/2023 Melese .S 174

Factors Influencing GI Ranking

Viscosity of Fiber
Viscous, soluble fibers transform intestinal
contents into gel-like matter that slows
down enzymatic activity on starch.

Lower GI Higher GI

Apple (40) Whole wheat bread (73)

Rolled oats (51) Cheerios (74)

10/23/2023 Melese .S 175

Factors Influencing GI Ranking

Sugar Content
sugar sucrose glucose + fructose
(GI 60) (GI 100) (GI 19)

starch maltose glucose + glucose

(GI 105) (GI 100) (GI 100)

Lower GI Higher GI

Frosted Flakes (55) Golden Grahams (71)

Raisin Bran (61) Rice Krispies (82)

10/23/2023 Melese .S 176

10/23/2023 Melese .S 177
Factors Influencing GI Ranking

Fat & Protein Content

Fat and protein slow down gastric
emptying, and thus, slows down digestion
of starch.
Lower GI Higher GI

Peanut M&M’s (33) Jelly beans (78)

Potato chips (54) Baked potato (85)
Special K (69) Corn Flakes (92)

10/23/2023 Melese .S 178

Factors Influencing GI Ranking

Acid Content
Acid slows down gastric emptying, and
thus, slows down the digestion of starch.

Lower GI Higher GI

Sourdough wheat bread (54) Wonder white bread (73)

10/23/2023 Melese .S 179

Factors Influencing GI Ranking

Food Processing
Highly processed foods require less
digestive processing.

Lower GI Higher GI

Old fashioned, rolled oats (51) Quick, 1-minute oats (66)

10/23/2023 Melese .S 180

Factors Influencing GI Ranking

Cooking
Cooking swells starch molecules and
softens foods, which speeds up the rate of
digestion.
Lower GI Higher GI

Al dente spaghetti – boiled Over-cooked spaghetti –

10 to 15 minutes (44) boiled 20 minutes (64)

10/23/2023 Melese .S 181

Factors Influencing GI Ranking

Type of starch Cooking

Physical entrapment Food processing

Viscosity of fiber Acid content

Sugar content Protein content

Fat content

How does all this affect our glycemic levels?

How does all this make us feel after eating

carbohydrate-containing foods?
10/23/2023 Melese .S 182
 The six elements to determine the GI of a food
1.Does it contain carbohydrate?
• Pure protein foods such as meat, fish, poultry and eggs, and pure
fats such as oils, butter and margarine, contain no carbohydrate.
As a result, the effect they have on glucose production is
negligible. These foods are therefore low Gl.
2.How much starch does it contain, and in what form?
• The easiest ingredient for our body to convert into glucose is
starch. When foods are raw, this starch is generally found in hard,
compact particles that the body finds hard to break down.
However, if something disturbs these starch particles (e.g. milling
into flour), the body finds it much easier to digest them and they
turn into glucose faster.
3.How much fibre does it contain?
• Fibre slows the time it takes the body to break down a food. This
is one reason why beans and pulses (which are wrapped in a
fibrous shell) have such a lowMelese
10/23/2023
Gl..S 183
 Cont …
4.What kind of sugar does it contain?
• There are four main types of sugar, and they raise blood sugar levels
at different rates. Foods with a high concentration of glucose (such
as sports drinks) need no conversion, so they raise blood sugar
rapidly. Fructose (the sugar in fruit), however, converts slowly; as
does lactose which is the main sugar in dairy products. This gives the
majority of foods containing either fructose or lactose a low Gl. The fourth sugar,
sucrose, has a medium Gl.
5.Does it contain fat?
• As well as having no effect on glucose itself, fat slows the speed at which food
leaves the stomach and reaches the liver, slowing glucose production. This is the
reason why potato crisps have a lower Gl than most other types of potato.
6.How acidic it?
• Foods can contain acid ingredients - citrus fruits like oranges or lemons are a good
example of this. The tang they create on your tongue comes from the citric acid
they contain. Other acidic ingredients include lactic acid in milk products, and
added ingredients, such as vinegars, in pickled products, just like fat, acidity slows
a food's progress through the system, and therefore slows the rate at which it
10/23/2023 Melese .S 184
converts into glucose.
 Glycemic load
• The glycemic index indicates only how quickly carbohydrates in a
food are absorbed into the bloodstream.
• It does not include how much carbohydrate a food contains, which
is also important.
• Glycemic load, a relatively new term, includes the glycemic index
and the amount of carbohydrate in a food.
• A food, such as carrots, bananas, watermelon, or whole-wheat
bread, may have a high glycemic index but contain relatively little
carbohydrate and thus have a low glycemic load. Such foods have
little effect on the blood sugar level.
• Glycemic load also includes how changes in blood sugar are
affected by the combination of foods eaten together. The glycemic
index does not.

10/23/2023 Melese .S 185

 Glycaemic Load
• While GI is a very useful concept, it cannot be taken as the sole
predictor of the effects of eating a particular type of carbohydrate.
That is because blood glucose response is also determined by the
amount of food eaten. A more reliable rating system is the
'glycaemic load' (GL), which takes account of both the quality (GI
value) of a given carbohydrate and the amount consumed, so
more accurately predicting its effects on blood sugar.
• The glycaemic load, in units, of a portion of carbohydrate is
expressed as:
• GI rating x grams of carbohydrate in portion size / 100.
• Note that each unit of GL produces the same effect on blood sugar as eating 1g of pure glucose.
• A 120g banana contains around 24g of carbohydrate, which has a GI value of 58.
The GL is: (58 x 24) / 100 = 13.92 units.
• 120g of chocolate provides 75g of carbohydrate, which has a GI value of 49
The GL is: (75 x 49) / 100 = 36.75 units.
• By to talling up the GL units for foods you eat during the day, you can arrive at an overall GL for the
day. A Glycaemic Load of Less than 80 units is considered Low, 80 to 120 units is Medium and
greater than 120 units is High.
10/23/2023 Melese .S 186
 What Is the Glycemic Load?
• The glycemic load (GL) takes into account the
amount of carbohydrate (CHO) in a common
serving in addition to its glycemic index (GI):

GL = (GI of CHO × grams of CHO per serving) ÷ 100

• Example:The GL G of carrots is: (47 × 5) ÷ 100 = 2.4

– Carrots (peeled, boiled) have a GI of 47 and 5 g
CHO per serving

Abbreviations: CHO, carbohydrate; GL, glycemic load; GI, glycemic index.

10/23/2023
Atkinson FS, et al. Diabetes Care. 2008;31(12):2281-2283. Melese .S 187
 Glycemic Load
• Glycemic index relative to the serving size
• Some CHO have high GI but are consumed in
small quantities per serving
• GL = (GI x CHO/serving)/100
• Ratings of glycemic loads
– High GL = >20
– Medium GL = 11-19
– Low GL = <11

10/23/2023 Melese .S 188

 High Glycemic Load Meals
• Eating high glycemic load meals, compared to
lower glycemic load meals, results in:
– Higher 24-hour blood sugar levels
– Higher insulin levels
– Higher glycosylated hemoglobin levels (HbA1c)
– Increased hunger following reactive low blood sugar
• It also results in increased risk for diabetes, obesity,
and coronary heart disease.

JAMA, May 8, 287:2415

10/23/2023 Melese .S 189
Glycemic Load (GL): What does it mean?

Glycemic load measures the degree of

glycemic response and insulin demand produced
by a specific amount of a specific food.

Glycemic load reflects both the quality and

the quantity of dietary carbohydrates.

GL = GI/100 x CHO (grams) per serving

Example: GL of an apple = 40/100 x 15g = 6g

10/23/2023 Melese .S 190

Glycemic Load (GL): Ranking

Individual food portion:

Low 0-10
Moderate 11-19
High 20+

Whole day:
Low < 80
Moderate 100
High > 120

10/23/2023 Melese .S 191

GI vs. GL

Glycemic Index: ranks carbohydrates based on

their immediate blood glucose
response.
GI = glycemic quality

Glycemic Load: helps predict blood glucose

response to specific amount of
specific carbohydrate food.
quality
GL = glycemic
quantity
10/23/2023 Melese .S 192
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Benefits of Low GI Diet

Are there any documented benefits to

lowering the GI of one’s diet?

YES!
BG levels type 2 DM risk

cholesterol levels heart disease risk

weight

10/23/2023 Melese .S 194

 Glycemic Load and Risk of Heart Disease

2.00 N = 75,521
Risk of Heart Disease (RR)

10 year study 1.98

1.50
1.51
1.25
1.00
1.00 1.01

0.50

0.00
117 145 161 177 206
Low glycemic load High glycemic load
Glycemic Load Quintiles

AJCN, 71:1455-61
10/23/2023 Melese .S 195
 Glycemic Index and Dietary Fiber and Risk of Diabetes

Women’s Health study 2.5

Risk of Getting Diabetes (RR)

• Women who ate the least fiber 2.50
were twice as likely to get 2.0
diabetes as those who ate the
most fiber. 1.80
1.5
• Women with the highest
glycemic index were 51% more
likely to get diabetes then 1.0
1.00
women who ate the lowest GI
diet. 0.5
• Overall risk was 2.5 times higher
on the low fiber, high GI diet. 0.0
Decreasing fiber
Increasing Glycemic Index

10/23/2023 Melese .S 196

Journal of the American Medical Association 277 (6): 474-477
 Glycemic Index - Oats
Glycemic Index
52 Low GI is less than 55
Steel cut oats Medium GI = 55-59
High GI = 60+
55
Oatmeal

Quick oats 65

White bread 70

Cheerios 74

Table sugar 65

Glycemic Index (GI) based on glucose

0 10 20 30 40 50 60 70 80 90 100 110

University
10/23/2023of Sydney, Nutrition Department
Melese .S 197
Legumes Lower Glucose Levels and CHD Risk
• Legumes are high in fiber
and have a very low
glycemic index.
• Adding 1 cup of legumes to
the diets of 121 diabetics
for 3 months significantly
lowered:
– Blood A1C levels
– Body weight and blood
pressure
– Risk of coronary heart
disease
Archives
10/23/2023 of Internal Medicine 2012;172(21):1653-1660
Melese .S 198
 Glycemic Index and Obesity
High Glycemic Index Meal

Postprandial Hyperglycemia

Hyperinsulinemia

Relative Lipogenesis
Reactive
Hypoglycemia OBESITY

Counterregulatory Hunger ↑ Food Intake

Hormones
 Glycemic Index and Diabetes
High Glycemic Index Meal

Postprandial Hyperglycemia ↑ FFA

Hyperinsulinemia Glucotoxicity Lipotoxicity

Relative INSULIN
Reactive RESISTANCE
Hypoglycemia BETA CELL
FAILURE
Counterregulatory
Hormones
 The Low Glycemic Index Diet:
Epidemiologic Studies
• In some but not all studies, low GI diets
are associated with:
– Increased insulin sensitivity
– Reduced adiposity
– Reduced risk of metabolic syndrome
– Reduced risk of type 2 diabetes
 The Low Glycemic Index Diet:
Clinical Trials
• Low GI diets:
– Reduce postprandial glucose levels in normal
individuals and people with diabetes (Ludwig,
JAMA, 2002)
– Produce modest improvements in HbA1c in
patients with diabetes (Brand-Miller, Diabetes Care,
2003)
– May or may not affect insulin sensitivity
(improvements noted in 2 of 7 studies)
 The Low Glycemic Index Diet:
Clinical Trials
• Low GI diets:
– May be beneficial for weight management,
particularly in individuals with features of the
metabolic syndrome (Pittas, Diabetes Care, 2005)
– May reduce LDL cholesterol and TG and
increase HDL (Luscombe, EJCN, 1999 and Pereira,
JAMA, 2004)
– May reduce inflammatory markers such as C-
reactive protein (Pereira, JAMA, 2004) and IL-6 (Kallio,
AJCN, 2008)
– May increase antioxidant capacity (Botero,
Obesity, 2009)
 Questions
• Does the DASH diet or the low GI improve
insulin sensitivity, in the absence of weight loss?
• Does the DASH diet or the low GI diet improve
other features of the metabolic syndrome (such
as dyslipidemia and inflammation), in the
absence of weight loss?
• Do these dietary patterns and weight loss have
synergistic effects?
 Glycemic Load of Common Foods

Food Glycemic Load Food Glycemic Load

Instant rice, ½ C Banana, 1
25 13
Baked potato, sm. Spaghetti, ½ cup
16
20
Apple, 1 fresh
Corn flakes, 2/3 C 8
21 Lentils, ½ C
White bread, 2 s. 6
21 Carrot, 1
Rye bread, 2 slices
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5
Journal of the American Medical Association 287:2415 205
 Glycemic Load Principle
High Glycemic Load Foods Low Glycemic Load Foods
• Snack foods • Fresh fruit & Vegetables
• Fast foods • Legumes, peas, beans,
• Pastry, cookies garbanzos, soy, tofu
• Sweets • Nuts
• Soda pop • Whole-grain breads and
cereals including oatmeal
• White bread/rice
and brown rice
• Refined carbohydrates
• Protein rich foods
• Potatoes
• Healthy fats

10/23/2023 Melese .S 206

 Glycemic Index of Selected Foods
Foods Glycemic Index Foods Glycemic Index
White Bread 100 Oatmeal 82
Table sugar 84 Orange juice 75
Baked potato 104 Bran flakes 74
Cheerios 106 All bran 72
Pancake 119 Pasta 71
Cornflakes 120 Baked beans 60
White rice 102 Apple, raw 51
Instant rice 129 Skim milk 46
Fruit punch/soda pop 95 Soy beans (soy milk 43) 35
Banana 88 Peanuts 20
Pizza 86 Broccoli 15

Based on a “White Bread Standard”. To convert to the “Glucose Standard”, multiply by 0.7 .

Harvard
10/23/2023 Nutrition Department, (white Melese
bread .S standard) 207
 Glycemic Standards - using glucose

Glycemic Index (GI) Glycemic Load (GL)/Food

Low GI Less than 55 Low GL 10 or less
Medium GI 56-59 Medium GL 11-19
High GI 60 or more High GL 20 or more

Glycemic Load/Day A GL of 150 or higher was linked

Low GL Less than 80 to a high risk of heart disease in
High GL 150 or more the Women's Health Study.

University
10/23/2023 of Sydney Melese .S 208
 Grains – Glycemic Index
Food G.I. Food
French bread G.I.
136 Pastry
White rice 84
126 Rice (Basmati), white 83
Corn chips Pita bread
125 82
Brown rice
English muffin
79
110 Oatmeal cookie 79
Doughnut Sweet corn
108 78
Waffle Pound cake
109 77
Bread, White
10/23/2023 Melese WW
.S bread, stone ground 76 209
 Cereals – Glycemic Index
Food G.I. Food G.I.
Barley, pearled, ckd 36 Corn meal 98
All-bran 60 Shredded wheat 99
Oatmeal, old fashioned 70 Cream of wheat 100
Whole wheat, quick 77
Millet 101
Kellogg’s mini-wheats 81
Bran chex 83
Cheerios 106
Wheat kernels, whole 84 Corn chex 118
LIFE cereal 94 Corn flakes 119
Grape-nuts 96 Rice chex 127

10/23/2023 Melese .S 210

 Fruits – Glycemic Index
Food G.I. Food G.I.
Cherries 32 Grapes 66
Grapefruit 36 Orange juice 74
Apricots, dried 44 Banana 77
Pear 53 Apricots 81
Apple 54 Raisins 91
Apple juice 57 Apricots, canned syrup 91
Peach 60 Pineapple 94
Orange 63 Watermelon 103

10/23/2023 Melese .S 211

 Legumes & Vegetables Glycemic Index

Legumes G.I. Vegetables G.I.

Soy beans 26 Parsnips 139
Soy milk 44 Potato baked 121
Lentils 41 French fries 107
Pumpkin 107
Kidney beans 42
Potato steamed 93
Butter beans 44 Beets 91
Split peas 45 Sweet corn 78
Pinto beans 55 Sweet potato 77
Chick peas 60 Carrot 70
Peanuts 21 Green peas 68
Broccoli, greens, cabbage 20
cauliflower, s. squash

10/23/2023 Melese .S 212

 Sugars – Glycemic Index
Sugars G.I. Misc. foods G.I.
Fructose 32 Milk, skim 46
Lactose 65 Milk, full fat 39
Yogurt, sweetened 51
Honey 83
Tomato soup 54
HF corn syrup 89 Ice cream, full fat 87
Sucrose (table sugar) 92 Coca Cola 90
Glucose 137 Soft drink 97
Maltose 150 Soda crackers 106
Dates, dried 146
Tofu frozen dessert 164

10/23/2023 Melese .S 213

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 Risks of Excess Consumption?

Which of the following are risks of excess sugar

consumption?
– nutrient deficiencies?
– development of dental caries?
– development of Type II Diabetes? Obesity?
– hyperactivity in children?

10/23/2023 Melese .S 215

 Empty Calories?

Compare:
Honey Coke Apricots
Size of 100 kcal portion 1.5 1 cup 6
tbsp
Carbohydrate (g) 26 26 24
Protein (g) trace 0 2
Calcium (mg) 2 6 30
Vitamin A (mg) 0 0 554
Vitamin C (mg) trace 0 22
10/23/2023 Melese .S 216
 Dental Caries

Sugars, whether
consumed from the diet
or from complex
carbohydrates partially
digested in the mouth,
contribute to tooth
decay.
10/23/2023 Melese .S 217
 Which is more cariogenic?

more likely to cause

cavities

10/23/2023 Melese .S 218

 Reducing risk of caries formation
• eat sugary foods with meals
• limit between meal snacks containing sugars
and starches
• brush and floss teeth regularly
• if brush and flossing not possible, rinse teeth
with water or chew sugar-free gum

10/23/2023 Melese .S 219

Can sugar free help with weight loss?

10/23/2023 Melese .S 220

 How much carbohydrate do I
need?
AMDR (Adults)
– 45 - 65% of total average energy intake
RDA for Carbohydrates (Adults) = 130 g per day
Daily Value (2000 kcal diet) = 300 g per day
AI for Fiber (Adults)*
– Men: 38 g per day
– Women: 25 g per day
Sugar = max 10% of energy intake

*Note: after age 50, recommendations decrease to 30 and 21 g per day for
men and women respectively.

10/23/2023 Melese .S 221

 Sugar Recommendations
DRI:
– < 10% of average daily energy intake should be from sugars
Tips for limiting sugar intake:
– use food labels determine amount of sugar in products
– use ingredient lists to identify multiple sugar sources and added
sugars
– use less added sugar
– limit soft drinks, juice, sugary cereals, candy
– choose fresh or frozen fruits

10/23/2023 Melese .S 222

 Calculating the Energy in Foods
• Each energy-yielding nutrient provides a set
number of kilocalories per gram
– 4 kilocalories per gram of carbohydrates
– 4 kilocalories per gram of protein
– 9 kilocalories per gram of fat (lipid)
– 7 kilocalories per gram of alcohol (non-nutrient)
• Number of kilocalories in one serving of a given
food can be determined based on
– Grams of carbohydrates, protein, and fat in the food

10/23/2023 Melese .S 223

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 Thank You!
10/23/2023 Melese .S 227