APPLIED HUMAN NUTRITION(2+0)

WELCOME
Prepared by:
Dr. Mukti Bhandari
 Applied Human Nutrition
Terminology related to human nutrition:
• Acidosis: accumulation of acids, excess loss of bicarbonates.
• Acetyl CoA: chief precursors of lipid, imp intermediate of kreb’s cycle.
• Alkalosis: reduction of acids or increase of base
• Basal metabolism: energy needed by body for maintainance when the
person is at physical, digestive and emotional rest.
• Beri-beri: d/s of peripheral nerves caused by Thiamin deficiency
• Beta-oxidation: breaking down fatty acids into 2-carbon fragments of
acetyl-CoA residue.
• Cheilosis: swelling and reddening of lips.
• Cholesterol: fat related compound, a sterol, normal constituent of bile and
principle constituent of gall stone, precurssor of sex hormones and
adrenal corticoids, synthesized by liver.
• Chyme: semisolid fluid mass after gastric digestion.
• Diuretics: agents that promote urine excretion.
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• EAA: indespensible to life and growth, must supplied through diet.
• EFA: fatty acid necessary to body i.e. linoleic, linolenic and arachidonic.
• Gastritis: infalmmation of stomach.
• Geophagia: clay eating
• Glossitis: swollen and reddening of toungue, due to riboflavin deficiency.
• Glycosuria: high concn. Of glucose in urine.
• Goiter: inflammation of thyroid gland due to lack of iodine to produce
thyroxin.
• Hematuria: blood in urine.
• Haemopoiesis: formation of blood.
• Keratinization: epithelial cell slough off, dry, flattened, harden, form rough
horny scale due to vit. A deficienct, mostly in; resp., digest., genito-urinary
tract and skin.
• Kwashiworker: syndrome by protein deficiency
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• Malnutrition: syndrome due to poor diets, over eating.
• Metabolism: production of energy for functioning.
• Myoglobin: m/s protein that contains iron.
• Obesity: excessive adipose t/s, more than required for body function.
• Neoplasm: new or abnormal growth.
• Night blindness: inability to see at night due to lack of vit. A.
• Oligouria: reduced amount of urine in comparison to water intake.
• Osteomalacia: bone softening, due to impair mineral uptake, due to
calcium and vit. D Deficiency.
• Pellegra: due to lack of niacin, and amino acid tryptophan (precursors of
niacin) i.e. 3D d/s (dermatitis, diarrhoea, dementis/death).
• Xeropthalmia: cornea and conjuctiva becomes dry.
• Tetany: caused by abnormal Ca-metabolism
• Wilson d/s: herediatary d/s, copper absorbed in brain liver and liver t/s.
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Introduction:
• Term nutrition from Latin word i.e. “nutri” means to nourish or nurture.
• Dietetics: science of study of food and nutrition.
• Nutrition: Robinsons defined as: science of foods, nutrients and other
substances, their action, interaction and balance in relationship to health
and diseases by which the organism ingests, digests, absorbs, transports ,
utilizes nutrients and disposes of their end products out of the body
systems.
• Nutrients: CHOs, proteins, fats, minerals, and water i.e. chemicals
obtained from the foods that allow proper functioning of systems.
• Nutritional status: type and amounts of nutrients present in human body.
• Function of nutrition: sustain life, promote growth, provide energy etc.
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Relationship of food and nutrition to human health:
• Nutrition and Health: nutrition required for physiological, mental and
intellectual development. Low protein and energy cause malnutrition and
cause disorder to health.
• Nutrition and Immunity: malnutrition decreases immunocompetence and
makes body vulnerable to attack of d/s. low nutrition leads weakness of
lymphoid tissue including T-cells (needs carotenoids, Zn, Cu, Vit. B6),
phagocytosis impaired in under nutrition (vit. C and Zn).
• Nutrition and ageing: def. of natural antioxidants i.e. Vit. C, E, A cause
damage to cells. Bioactive phytochemical of food helps in scavenge free
radicals and protects cell from damage.
• Nutrition and mental function: nutritions are precursors of
neurotransmitters, eg: tryptophan is precursors for serotonin i.e. related
to sleep, food intake and mood req. in old age).
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• Nutrition and CHD: BMI (wt in kg/ height in meter square) more than 25
means over weight and more than 30 means undesirable. Ideal weight
maintain by proper nutrition, exercise. CF and omega – 3 FA reduce serum
cholesterol. All SFA are hypercholesterolaemic.
• Nutrition and cancer:
 tobacco- cancer of mouth,
 high fat – development of rectal and breasts cancer,
 high animal protein, red meat- prostrate, uterine, ovarian cancers,
 CF intake – inhibit colon cancer,
 beta-carotene, vit. A, vit. C, riboflavin-protects cancer of Alimentary and
resp. tracts
 Grilling , smoking of foood- carcinogenic
 Food with fungi (aflatoxin)- cause liver and kidney cancer
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• Health: Acc. To WHO; state of physical, mental, social well being and not
merely an absence of disease.
• Classification of foods:
1. By origin: animal origin and vegetable origin.
2. By chemical composition:
 Protein
 fats.
 CHO
 Vitamins
 Minerals
3. By predominant functions:
 Body building: milk, meat, eggs, fish , pulses
 Energy giving: cereals, sugars, roots, tubers, fats, oils
 Protective foods: fruits, milk, vegetables
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4. By nutritive value:
 Cereals and millets
 Pulses and legumes
 Milk, eggs and flesh foods
 Vegetable fruits
 Fats and oils
 Sugar and jaggery
 Nuts and oil seeds
 Condiments and species: flavoring agents, turmeric have anti-cancer
properties

Note: (plant extracts useful to health –study yourself)

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Guidelines for cancer prevention:
 Body weight maintainance.
 Use whole grain cereals and
pulses.
 Fat between 20-25 % of total
calories
 Use fresh veg. and fruits.
 Mod. of processed, preserved
foods.
 Limit intake of fried, burnt salted,
pickled, fermented
 Moderation of beverage
Guidelines for heart d/sprevention:
 Calories should be sufficient for
appropriate body weight.
 Fat intake 15-25% of total calories.
 Cholesterol not more than
300mg/day
 PUFA less than 10 % of total calories
 Linoleic acid range 3-7% of calories
 Proteins 10-15% of total calories
 CHO ranges 55-65 % of calories
 Sugar less than 10-15% of calories
 Salt intake 5-7 gm/day
 DF ranges 40 gm/day
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Assignment:
• Roll no.: 1 – 9: Classification, function, requirements,
deficiency systems and food source of CHO and
Water
• Roll no. 10 -18: Protein and Vitamins
• Roll no. 19 – 27: Lipids and Minerals
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Energy:
Force or power that enables the body to carry on the life sustaining activities.
Produced as a results of breakdown of CHO, protein and Fats.
Forms of energy: Four basic forms:
Chemical energy: synthesis of new compounds
Mechanical energy: m/s contraction.
Electrical energy: brain and nerves activity
Thermal energy: regulation of body temperature
Transformation of energy:
Free energy (at any moment in the performance of task)
Potential energy (stored or bound in various chemicals and is available for
conversion to free energy when needed).
ATP: adenosine triphosphate: cashed in by the body for energy as needed.
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Measurement of energy:
Calories: Measure of heat.
Kcal is amt. of heat required to raise 1kg of water 1degree C.
Joule: Energy expended when 1kg of substance is moved 1 mt by force of 1N.
Food energy measured in two basic ways:
Calorimetry: instruement measuring heat output of the body or the energy
value of the food is k/a calorimeter.
Proximate composition: measuring food energy by computing nutrient
composition of food. Fuel factors; CHO (4kcal), protein(4 kcal), fat(9kcal).
Bomb calorimeter: bomb inside vessel of water, initial temperature noted,
food stuff placed in a small crucible, bomb filled with oxygen at high
pressure, food ignited by means of electric leads, heat produced,
temperature increase in surrounding water.
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Basal metabolism:
BMR: rate of internal chemical activity of resting tissue.
Factors affecting BMR:
Growth period: rises during growth
Surface area: smaller person tend to have higher rate of metabolism per unit
of surface area than large persons.
Sex: women have lower BMR, menstruating women have a 9% increase in
energy expenditure during 14 day luteal phase following
ovulation.
Pregnancy: increase in m/s mass of uterus, size of mammary glands, fetal
mass, placenta.
Lactation period: increase BMR due to milk production.
Fever: increase BMR about 7 % for each 1 degree F rise.
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Climate: BMR increases in response to lower temperature for maintainance.
Disease: BMR increase due to cellular activity
Starvation and malnutrition: BMR usually lowered.
Hormones: like thyroxin stimulates BMR.
Obesity: no effect on BMR.
Energy expenditure/hour during various activities:
1. Light: sitting, standing, slow walking; 120-150 kcal.
2. Light to mod.: domestic work, yard work, light work, walking; 150-300 kcal
3. Moderate activities: 300-420 kcal.
4. Heavy: 420-600kcal.
General formula:
Women: 0.9 kcal/kg bw/hr. And Men: 1kcal/kg bw/hr.
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Effect of energy insuffieciency:
If insufficient for short periods; body reserves may be substituted. But if
for long times; disease results:
1. Young children: growth failure and some cases death.
2. Adults: weakness, fatigue, loss of weight, wasting of tissue, appearance of
lethargy and sluggishness.
3. Mental changes: depression, tiredness, moodiness.
4. pregnancy: still birth, infant death
5. Atrophy: wasting away through under nourishment.
6. Dystrophy: progressive weakness of muscles.
7. Dyspeptic: Dyspepsia i.e. indigestion.
Note: one ATP stores 7 Kcal of energy in the mitochondria of the cell.
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• Why do we breathe faster after heavy exercise?
We need large amount of energy during heavy exercise. So, more food
should be broken down with more oxygen. So we breathe faster to fulfill
the demand of oxygen. But there is limit of energy through aerobic
respiration. Hence, anaerobic respiration starts in m/s cells. Anaerobic
respiration produce lactic acids along with energy. If large amount of lactic
acid accumulates m/s will not be able to contract. This is why person feel
muscular pain after heavy exercise. Lactic acid later broken down into CO2
and water in presence of O2. So, after heavy exercise we continue to
breath heavily for some time inorder to supply with extra amount of O2
needed to break dowm the lactic acid accumulated in m/s.
• BMI: 20-25 kg/m2: desirable, 25-30kg/m2: health risk, 40-above kg/m2:
morbid obesity.
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• Nutrient losses:
1. preparation/processing losses: cooking leads to tasty, palatable,
digestible. Avidin of egg lost, trypsin inhibitor of soyabean lost.
cooking food in excess of water and discarding water removes good
amount of protein and water soluble vitamins and minerals. Boiling of milk
cause loss of vit. C, frying of foods cause loss of vit A.
Fat; overheated become oxidized polymerized to toxic products.
Milling cause nutritive loss of wheat flour. Thiamin loss of rice.
2. storage losses: deterioration in weight, taste, nutrient, germination. Be
careful about moisture otherwise moulds, bacteria, pest attacks.
3. post harvest losses: microbial growth, oxidative spoilage(fats/oils), non-
enzymatic browning in dried foods i.e. caramelization(dehydration of
sugars leads to off flavor, discolor and use sulfurous acid to protect)
4. secondary processing: baking; loss of B-vitamins.
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• Enhancing the nutritive value:
• Drying: bacteriostatic.
• Canning: bactericidal with heat.
• Freezing: destroys MO’s and inhibits growth.
• Freezedrying: fruits and seafoods. Retains original shape, size.
• Dehydrofreezing: fruits and vegetables. First dehydrated to 60% moisture
of original weight.
• Irradiation: x-rays, gamma rays kills MO’s.
• Addition of chemicals: NaCl, acidification with acetic acid, fatty acid such
as sod. Diacetate, sulfurdioxide, sorbic acid, sod. Nitratre etc.
• Antioxidants: i.e. vit. E, C and tannins.
• Parboiling of rice: steaming/boiling of unhusked rice after soaking in water
leads to easy removal of husk without nutrient loss.
• Fortification: nutrients added to food. i.e. wheat deficient in lysine; maize
deficient in lysine, tryptophan; salts with iodine.
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• Anti-nutritional factors in foods: natural toxicants in foods due to
abnormal environment, improper storage cause acute and chronic
pharmacological effects.
• Toxic amino acids: Lathyrus poision:cause d/s of spinal cord (lathyrism)
causing crippling and permanent paralysis, neurotoxin from seeds of
lathyrus sativus, BOAA(beta-N-oxalyl-amino-l-alanine).
• Toxic alkaloids:
a. argimone contamination: in poppy seeds;sometimes mustard seeds,
oils; alkaloids sanguinarine inhibits oxidation of pyruvic acid; pyruvic acid
accumulates blood and cause dropsy.
b. alkaloids in potatoes: exposed to light then sprouting developes to
green due to solanine and chacomine, poisioning of GI, diarrhoea,
vomiting, abdominal pain.
c. cyanogenic glycosides: cassava, tapoica or sorghum; linamarin and
lotausralin in cassava; taxiphyllin in bamboo shoots; amygdalin in almonds.
• Trypsin inhibitor: active against pancreatic proteolytic enzymes; found in
red gram, bengal gram, cow pea, soyabean, sweet potato; heat liable
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• Haemagglutinins: heat liable, from field beans and horse grams;
haemolytic property more in green seeds and diminishes as the seed
matures; agglutinin combine with cell lining of intestinal walls and
interferes with absorption; nausea ,vommiting, diarrhoea.
• Flatulence factors: lagr consumption of red gram, soyabean, lima beans,
navy beans, black gram associated with production of gases and
digestibility disorders. Soaking overnight reduces flatulence factors.
• Mycotoxins: aspergillus and penicillin are storage fungi; aflatoxin in
cereals due to improper storage.
• Goitrogenic substances: cabbage, mustards, rape; due to
glucosinolates(prevent thyroxin synthesis) and thiocyanates(reduce concn
of iodine).
• Cycads nuts: cyasin affects CNS, remove by washing
• Mushroom poisioning: Amanita, wild mushroom, fata,
• Favism: ingestion of pollen if fava beans cause haemolytic anaemia; due to
def of enzyme G-6-P-D.
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• Malnutrition:
Defined as the “pathological state resulting from a relative or absolute
deficiency or excess of one or more essential nutrients”. Comprises four
form:
a. Undernutrition: insufficient food is eaten over an extended period of
time.
b. Overnutrition: excesssive quantity of food over an extended period of
time.
c. Imbalance: disproportion among essential nutrients with or without the
absolute deficiency of any nutrients.
d. Specific deficiency: resulting from a relative or absolute lack of an
individual nutrients.
(460 million people i.e. 15 % of the world excluding china are
malnourished, 300 million from south Asia, main victims below 15
years(below 5 yrs hit the hard)
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Causes of malnutrition:
1. Demographic causes:
a. Food supply per person may be reduced due to natural disaster i.e.
drought, flood, earthquake or by man made disaster such as war, over
population, poverty, poor distribution.
b. Low agricultural production: the chief causes of agricultural
unproductiveness is climate irregularities, soil erosions, insufficient
farming.
2. Economic causes/factors:
a. Unequal distribution of foods: direct relationship between foods, health
and income.
b. Income and the structure of the national diets: proportion of animal
protein in the diet increases with increase in the income.
c. Lack of leisure: for preparation of meal if a person is working far away
from home.
d. d. Lack of transport, lack of jobs, bad budgeting, bad shopping etc.
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3. Social factors:
a. Ignorance of the nutritive value of different available foods.
b. Broken families; divorced family.
c. Lack of family planning; children coming too fast due to short birth interval.
d. Too many children.
e. Bottle feeding: leads bottle starvation, i.e. required amount may not be
added or the bottle may not be washed properly so cause infection due
to growth of MO’s.
4. Religion and culture:
a. Ban on cattle slaughter
b. Traditional food habits
c. Gender sensitivity
d. Family planning
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Effect of malnutrition on the outcome of pregnancy:
• Fatal, maternal d/s and death of mother.
• Low birth weight of child and death of child in poor family annually.
• Prenatal handicaps, still-birth, congenital injuries.
• 3.5 kg gain in weight by end of 20 wks of pregnancy and 0.5kg/week until
last trimester. If not recorded such weight gain then leads to prenatal
death and still-birth.
Effect of malnutrition on physical development:
Normal human life cycle follows the four phase of overall growth:
a. Infancy: during first year infant grow very fast.
b. Child hood: between infancy and adolescence. growth rate slows and
becomes erratic.
c. Adolescence: second rapid growth takes place, physical changes in
puberty.
d. Adult: growth levels off and declines during senescence.
(Adequate nutrition leads to under wt., less clever, dwarfism and d/s susceptible).
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Effect of malnutrition on mental development:
• Brain grows faster just before birth and during few months after birth.
• Malnourished child is less interested in what is going around him.
• Hungry and feels sleepy in classrooms.
• Fails in examination and less clever.
Effect of malnutrition on national development:
• For country development, every adult and child needs to be as clever, as
able and as skillful.
• Country needs good farmer, builder, other technician for development.
• Such citizens can be prepared only through good nutrition.
• Good result requires hard works and hard works requires plenty of energy.
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Strategy to combat malnutrition:
1. Strategy to increase food production: Use bare land for cultivation,
improve method of farming, produce nutrients which could be used as
foods by chemical engineering, genetic engineering, or through GMC/A.
2. Food consumption and distribution system should be improved:
a. Government action: legislation
b. Food subsidies: artificial lowering of price
c. Rationing scheme: to make food available in limited amounts
d. Black markets: should controlled.
e. Food enrichment program: food enriched or fortified by addition of def.
nutrients.
f. Welfare food program: for poor people as school meal, nursing mothers.
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3. Government procurement and distribution system should be improved:
a. Transport problems
b. Storage of foods
c. Price control
4. International aids should be properly utilized on social justice basis so
that real target will benefit it.
5. Nutrition education and functional literacy program: teach about health
education (people of all sector teach to their patients/pupils/consumers
etc)
6. Nutrition intervention program:
a. Nutritional measures: such as food subsidies, rationing scheme,
fortification, welfare food as school meal etc.
b. Non-nutritional measures: radio, TV, newspapers, magazines plays role in
extension of knowledge about importances of health education.
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• Nutritional deficiency d/s in developing countries and their prevention:
1. Protein-Energy Malnutrition: not only an important cause of childhood
morbidity and mortality but it also leads to permanent impairment of physical
and mental growth of those who survive.
Inadequate dietary intake

Appetite loss Weight loss

Nutrient loss Growth altering
Malabsorption Immunity lowered
Altered metabolism Mucosal damage

Disease incidence during severity

Fig: Malnutrition/Infection cycle

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• Influence of each generation’s ntritional status on the following
generation:

Nutritional status of women of child bearing age

Nutritional status at puberty nutritional status of pregnant women

Girls nutritional status Nutritional status of neonates and infant

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• Detection of PEM: First detection of PEM is under weight for age.
• Classification of PEM: Gomez classification: Base don weight retardation.
The child’s weight is compared to a normal child of same age.
• Weight for age %= (wt. of child/wt. of normal child of same age) * 100
• Value when;
 Between 90 and 100 % = normal status
 Between 75 and 89 % = 1 degree malnutrition
 Between 60 and 74 % = 2 degree malnutrition
 Under 60 % = severe malnutrition
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Kwashiworker:
Symptoms: growth retardation,
edema, m/s wasting,
depigmentation of hair, skin and
diarrhoea
Etiology: insufficient protein to meet
demand of growth and cell
repair
Occurrence/magnitude: child under
5 yrs, poor countries of Asia and
Africa, South America, Middle-
East countries
Control: ignorance and poverty are 2
causes; education concerning
source of dietary protein as skim
milk powder, legumes, fish meal
should provided; motivate to
provide adequate food
Marasmus:
Symptoms: under wt.; child with only
skeleton, skin, bones; atrophy of
m/s and s/c fat; diarrhoea;
physical stunting, mental and
emotional impairment; infant
sleeps restlessly; temperature
may be sub-normal bcoz of
absence of fat
Etiology: chronic dietary under
nutrition, starvation, lack of
calories and proteins
Occurrence: in infants from 6-18
months, in countries where socio-
economic status is poor
Control: same as Kwashiworker
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2. Nutritional anaemia:
Symptoms: weakness, pallor, extreme fatigue, headache, gastritis, lack of HCl
secretion in stomach, anorexia, constipation, low Hb level.
Etiology: deficiency of Iron, Folic acid and vit. B12. Folic acid def is due to;
Dietary lack of vitamins, poor intestinal absorption, increase metabolic
demands such as during pregnancy.
Control: Food with Iron; inclusion of green vegetables, fruits in regular diets;
nutrition education.
3. xeropthalmia: Dry of cornea and conjunctiva and cause blindness of eye
Symptoms: drying, roughness and wrinkling of conjuctiva; swelling and
redness of eyelids; pain; light sensitivity; become clouded; ulcers may
form. If treatment not done then cornea softens and perforation may
occurs resulting total blindness.
Etiology: def. of vit. A and its precursors.
Occurrence: in young in major part of world
Control: educate people concerning food sources of vit. A.
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4. Endemic goiter:
Symptoms: enlargement of thyroid gland.
Etiology: failure of thyroid gland to receive sufficient iodine to maintain it’s
normal structure and function of producing thyroxin; also due to
goitrogenic substances i.e. found in cabbage, mustard, turnips etc.
Control: Iodized salts
5. Beri Beri:
Dry beri beri: gradual loss of body tissue.
Wet beri beri: swelling of the limbs.
Symptoms: Tingling(sound of small bell); Numbness(deprived of power to
feel) of extermities; paralysis; vomiting; constipation; edema in legs and
progress upwards (in wet beri beri)
Etiology: Thiamin deficiency
Controls: improvement in education, economics, fortification, enrichments.
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6. Pellegra: Also called 3D’s disease.
Symptoms: diarrhoea including anorexia, indigestion, stomatitis, wt. loss;
dermatitis; dementia (mental apathy, depression, anxiety)
Etiology: Deficiency of Niacin.
Control: diet supplementation with niacin and tryptophan.
7. Endemic fluorosis: if dW contains excessive fluorine (3-5mg/L).
a. Dental fluorosis: due to excess fluoride ingestion; mottling of dental
enamel; tooth shining losses; chalk white patches; later white patches
become yellow and brown or black; enamel losses cause corroded
appearance of teeth.
b. Skeletal fluorosis: when lifetime daily intake of 3-6 mg/L fluoride; heavy
fluoride deposition in skeleton, leads to permanent disability.
Intervention: changing the water source, water should be defluorinated.
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8. Lathyrism: Paralysis d/s of human and animals; in human refers to
neurolathyrism because it affects nervous system; and in animals
osteolathyrism because the pathological changes occurs in bones resulting in
skeletal deformities.
Cause: toxin present in lathyrus seeds has been identified as BOAA; mostly affect
men between 15-45 years.
Latent stage: physical stress exhibits ungainly gait.
No-stick d/s: walks with short jerky steps with out aid of a stick.
One stick d/s: walked with crossed gaits with tendency to walk on toes; m/s
stiffness makes it.
Two stick d/s: more sever symptoms; excessive bending of knees and crossed legs
patients need crutches for support.
Crawler stage: erect posture become impossible as the knee joints can not
support the wt. of body; atrophy of thigh and leg m/s
Intervention: Banning the crop.
Removal of toxin by parboiling; soaking in hot water for 2 hrs(toxin are water
soluble), discard water and dry in sun.
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• Assessment of the Nutritional status:
• Nutritional status of an individual is assessed from following methods:
1. Clinical examinations:
2. Laboratory investigations:
3. Anthropometric:
4. Vital statistics:
5. Dietary survey:
6. National studies:
7. Family survey:
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