NUTRITION & DISEASE

Dr M N Rama Krishna B.Sc.,M.B.B.S, M.D, A.F.I.H Dy. Chief Medical Officer (Corp.) Main Hospital KOTHAGUDEM

CLASSIFICATION OF FOODS
A. By Origin 1. Vegetable 2. Animal 1. Proteins 2. Fats 3. Carbohydrates 4. Vitamins 5. Minerals

B. By Chemical Composition

C. By Predominant Function
1. Body Building Foods i. Milk ii. Meat iii. Poultry iv. Fish v. Eggs vi. Pulses. vii. Groundnuts

2.Energy Giving Foods i. Cereals ii. Sugars iii. Roots & Tubers iv. Fats v. Oils

3. Protective Foods

i. Vegetables ii. Fruits iii. Milk

PROTEINS Proteins constitute 20 % of Body weight in an adult Proteins are made up of amino-acids ( About 24) Out of 24 Amino-acids 9 are Essential Amino-Acids 1. Isoleucine 2. Leucine 3. Lysine 4. Methionine 5. Phenylalanine 6. 7. 8. 9. Threonine Valine Histidine Tryptophan

Functions of Proteins
Body Building Repair & Maintenance of Body Tissues Maintenance of Osmotic Pressure Synthesis of Anti-bodies, Plasma Proteins, Hb, Enzymes, Hormones & Coagulation Factors. Immune Mechanism of the Body Energy
SOURCES OF PROTEIN Animal Sources

Milk Meat Egg (Called as Reference Protein) Cheese Fish

Vegetable Sources ( Poor in EAA)

Pulses Cereals Beans Nuts Oil Seed Cakesetc

Note: * Cereals are deficient in - Lysine & Threonine * Pulses are deficient in Methionine Daily Requirement -- 1 gm / kg Body wt./day Deficiency : Protein Energy Malnutrition ( PEM) * Kwashiorkar * Marasmus

Features
Clinical
Muscle Wasting

Marasmus
Always Present
Obvious

Kwashiorkor

Sometimes hidden by oedema and fat Fat often retained but not firm

Fat Wasting

Severe loss of subcutaneous fat

Oedema

None

Present in lower legs, and usually in face and lower arms Low but may be masked by oedema Irritable, moaning, apathetic

Weight for height

Very low

Mental Changes

Sometimes quiet and apathetic

Features
Clinical Appetite Diarrhoea

Marasmus

Kwashiorkor

SOME TIMES PRESENT Usually good Often ( Current and past Usually none Poor Often ( Current and past) Diffuse pigmentation, sometimes flaky paint dermatosis Sparse, Silky, easily pulled out Sometimes, due to accumulation of fat

Skin Changes

Hair changes pulled Hepatic enlargement

Seldom

None

KWASHIORKAR

MARASMUS & ANG. STOMATITIS

FATS
Fats & Oils are concentrated sources of energy
Human body can synthesize Triglycerides and Cholesterol Other fats are called Essential Fatty Acids Fats yield Fatty Acids : Essential Fatty Acids : Linoleic Acid Saturated Un Saturated Saffola Oil Sunflower Oil Soya Bean Oil Mustard Oil Groundnut Oil

Linolenic Acid

Soya Bean Green leafy Vegetables

Meat Eggs Milk

Arachidonic Acid

SOURCES OF FATS

Animal Fats

Vegetable Fats

Ghee Butter Milk Cheese Eggs Meat Fish Ground Nut Mustard Coconut Sun Flower Soya Bean etc. Cereals Pulses Nuts Vegetables

Other Sources (Invisible Fats)

Functions of Fats
High Energy Foods Serve as vehicle for fat-soluble vitamins Support viscera like heart, kidney, Intestines etc., Fat under skin provide insulation against cold Gives taste to food Gives shape to body

Fats & Disease

Obesity Phrenoderma ( due to deficiency of EFA)

CAD
Cancer Diets high in Fat increases risk of cancer colon & Breast.

Fat Requirement :
20-30 % of daily total energy requirement should be from fats. 50 % of fat should be from vegetable source.

20 gms / day is the daily requirement of added oil.

Energy :Fat Yields 9 K.cals / gm

CARBOHYDRATES
Maximum source of energy
Essential for oxidation of Fats and synthesis of certain Amino-acids Three main components of carbohydrates 1.Starch Cereals Tubers Roots 2.Sugars Glucose, Lactose etc 3.Cellulose Indigestible component Dietary Fiber : It is non-starch, component of diet. Sources : Vegetables Fruits Grains Prevents constipation, Lowers Bl.Sugar Reduces Cholesterol Weight reduction Prevents Divertculosis & Cancer of Colon

Functions :

VITAMINS
Vitamins help the body to use other nutrients. They are organic components and essential nutrients 1. Fat Soluble : A D E K B Complex (Thiamine B1 Riboflavin B2 Pyridoxine B6 Cobalamine B12 Niacin (Nicotinic Acid) Biotin Folic Acid) C Vitamin

2.Water Soluble:

VITAMIN A ( RETINOL & B-CAROTINE)

Source : Milk, Butter, cheese, Egg Yolk, Liver, Fatty Fish, Meat, Amaranth, Spinach, Papaya, Mango, Pumpkin & Carrot (Cheapest sources)

Functions :

* For Normal Vision * For retinal Pigments in dim vision. * To maintain integrity of epithelial and glandular tissue. * Supports skeletal growth * Acts as anti- infective * Protect against Epithelial cancers & Lung cancers

Vitamin A Deficiency causes : - Night Blindness - Xerosis of Conjunctiva & Cornea - Bitot Spots - Keratomalasia ( Liquifaction of cornea) - Follicular Keratitis

BITOTS SPOTS & GLOSSITIS

Vitamin A Excess (Toxicity)

Mild - Dry Scaly skin

- Hair Loss - Mouth Sores - Anorexia - Vomiting Severe - Papilloedema - Headache - Hepato-megaly - Cirrhosis of Liver

Prevention : Vit A liquid 2 lakh I.U. Every 6 months to children from

1 yr to 5 yrs.

Vitamin D (Chole-calciferol) (Kidney Hormone) Sources :

Sunlight Fatty Fish Fish Liver Oils Butter Eggs Not Available in Vegetarian Food

Functions :
- Promotes intestinal absorption of calcium

and phosphorus - Enhances bone resorption and affects collagen maturation. - Increases tubular re-absorption of Phosphate. - Permits normal growth

VITAMIN D
Deficiency : 1. Rickets : leads to Usually observed in young children between 6 months to 2 yrs. Reduced calcification of growing bones Growth failure Bone deformity ( curved legs, deformed pelvis, pigeon chest, Harrisons sulcus, Kypho-scoliosis). Muscular Hypotonea Tetany & convulsions

2. Osteomalacia : Softening of the bone

Requirement : 2.5 mcq ( 100 iu)/day ( Adults) 5 mcq ( 200 iu)/day ( Infants & Children)

RICKETS

VITAMIN K
Sources : - Dark green leafy vegetables - Cows Milk - Fruits - Synthesized in colon by bacteria Stimulate the production of certain coagulation factor.

Function:

Deficiency: Decreases Prothrombin content of blood and clotting mechanism is delayed. * Deficiency occurs usually in Obstructive jaundice, malabsorption and also in prolonged oral antibiotic usage

WATER SOLUBLE VITAMINS

Vitamin C ( Ascorbic Acid)
Sources: - Amla - Guava - Citrus fruits - Berrys - Green leafy vegetables Vit C is very easily destroyed by heat. Functions : - Required for tissue oxidation - Formation of collagen - Facilitates absorption of iron - Wound healing

VITAMIN E (Tocopherol)
Sources : Vegetable Oils Whole grain cereals Fatty Fish Egg Yolk Butter Deficiency: Cystic Fibrosis Ataxia Visual scotomas

Vit E : Plays a role in Protection against Cancer CAD Cataract

WATER SOLUBLE VITAMINS

VITAMIN C
Deficiency: Early Stages Causes Scurvey - Peri follicular hemorrhages - Petiche & Purpura - Splincter haemorrhages - Bleeding gums - Sub- periosteal haemorrhages - Joint Haemorrhages - Anaemia - G.I Bleeding

Late Stages

- Edema - Oligurea - Neuropathy - Intra cerebral haemorrhage - Death

Certain conditions like Trauma, Surgery, Burns, Infections, Smoking, usage of Cortisones, Aspirin, Indomethacin, Tetracyclines etc. increase demand of VitC Daily requirement is 60 mg.

THIAMIN (B1)
Sources : - Germinating cereals & Yeast - Legumes - Green leafy vegetables - roots - Fruits - Nuts - Pork, Meat & Fish - Liver Not found in Oils & Fats. Lost if cooked with excess water Destroyed if baking soda is added

Deficiency (B1)
Beri Beri :

Early Stage ( Dry Beri Beri)

Wasting of muscles Anorexia Heavy-ness and weakness of legs Palpitation Tingling & Numbness Calf muscle tenderness

Late Stages ( Wet Beri Beri) :

Edema Palpitations Heart enlargement Heart failure

Wernicks Encephalopathy:

Usually seen in Alcoholics Patient in confusion state Nystagmus Bilateral Symmetrical Ophthalmoplegia Ataxia Stuper & Death

Korsakoff Psychosis :

Loss of memory Disorientation Polyneuropathy

RIBOFLAVIN (B2) Sources :

Liver, Kidney, Milk, Meat, Cheese, Eggs (Good sources)
Green Leafy Vegetables : ( moderate Sources)

Deficiency: Angular stomatitis

Cheilosis Scrotal dermatitis Anaemia

Pyridoxine (B 6)
Sources :

Liver, whole grain cereals, peanuts, bananas, milk, egg, fish, vegetables, cereals.
- Peripheral Neuropathy - Dermatitis - Glossitis - Angular stomatitis Cyanocobalamine ( B12)

Deficiency:

Sources : - Liver - Kidney - Meat - Fish - Eggs - Milk - Cheese Not found in Vegetables. It is synthesized in colon by Bacteria Deficiency: - Anemia (Megaloblastic or Pernicious) - De-myelinating lesion of spinal cord

NIACIN ( Nicotinic Acid) Sources : - Meat - Liver - Fish - Cereals - Pulses - Legumes - Groundnuts A cup of good coffee provides good amount of Niacin Deficiency : Leads to Pellagra Pellagra : It is characterised by 3 D s - Diarrhoea - Dermatitis - Dementia ( Depression , Irritability,Delirium) and -Glossitis & Stomatitis

Seen in Telengana in Jowar eating Population

FOLIC ACID

Sources :

Liver Meat Dairy Products Egg Milk Fruits Cereals Leafy vegetables
Anemia Glossitis Diarrhoea, Distension & Flatulence

Deficiency :

MINERALS
More than 50 chemical elements are found in the body which are required for growth, repair and regulation of vital body functions. Most important are:

* CALCIUM * PHOSPHOROUS * SODIUM * POTASSIUM * IRON * FLUORINE * IODINE

CALCIUM
Adult body contains 1200 gms. of calcium (98% in bones) SOURCES: * Milk & Milk products * Eggs * Fish * Green leafy vegetables * Cereals & Millets * Drinking water FUNCTIONS: *Formation of Bones & Teeth *Coagulation of Blood *Contraction of Muscles *Cardiac Action *Milk Production *Relay of Electrical & Chemical messages

PHOSPHORUS

Essential for formation of Bones & Teeth

Sources: All Vegetables

Deficiency: Rarely occurs

SODIUM
Adult Human Body contains 100 gms. of Sodium ion Sodium is lost through Urine & Sweat Depletion of Sodium causes Muscular cramps

Excess causes HTN & CHD

POTASSIUM
Human body contains about 250 gms. of potassium

Sources: All vegetables & fruits

Deficiency: Rarely occurs

IRON
Sources: Liver Meat Poultry Fish Cereals Green leafy vegetable Legumes Nuts Oil seeds Jagggery Dry fruits Formation of Hemoglobin Brain development & function Regulation of body temperature Muscle activity

Functions:

Essential :

For Immune system Binding oxygen to blood cells Oxygen transport & cell respiration

Deficiency:

Anaemia Impaired Immunity Reduced resistance to infections Diminished work performance

IODINE
Required for synthesis of Thyroid hormones Sources : Sea food Milk Meat Vegetables Cereals Water

Deficiency :

Goiter Hypothyroidism Decreased Intelligence Mental deficiency Hearing defects Speech defects Squint Neuro-muscular weakness Cretinism Intra-uterine death

FLUORINE
Essential for normal mineralisation of Bones & Dental Enamel Sources : Drinking water Sea fish Cheese Tea Dental Caries Skeletal & Dental Fluorosis

Deficiency : Excess :

NUTRITIONAL FACTORS IN SELECTED DISEASES

Cardiovascular Diseases
A). Cholesterol: LDL : Coronary Heart Disease HDL: Protects Heart B). Essential Fatty Acids : Linoleic acid & Arachidonic acid (PUFA) inhibit platelet aggregation & thrombus formation. C). Triglycerides : Increase risk of CHD. D). Carbohydrates : CHD rates are lowest in people eating high carbohydrate diets. E). Salt: Low Sodium diets prevent HTN & CHD

Nutritional factors in Selected Diseases DIABETES

Deficiency of Trace Elements such as Chromium, Copper, Zinc may play role in DM Excess consumption of Alcohol can damage Pancreas & Liver & promotes Obesity & thus increase risk of Diabetes.

Nutritional factors in Selected Diseases

OBESITY
The basic cause of Obesity is OVER-NUTRITION

Nutritional factors in Selected Diseases CANCER

A). High Fat Intake: Cancer Colon Cancer Breast B). Low Dietary fiber: Cancer Colon C). Deficiency of Vit. A & C: Cancer Lung & Stomach D). Food Additives: Preservatives: Cancer Stomach Coffee: Cancer Bladder & Pancreas E). Alcohol: Cancer Liver

Thank You
and

All Good Wishes To You