NUD 232; HUMAN NUTRITION

INTRODUCTION TO HUMAN NUTRITION

Human nutrition describes the processes whereby cellular organelles, cells,
tissues, organs, systems, and the body as a whole obtain and use necessary
substances obtained from foods (nutrients) to maintain structural and functional
integrity. For an understanding of how humans obtain and utilize foods and
nutrients from a molecular to a societal level, and of the factors determining and
influencing these processes, the study and practice of human nutrition involve a
spectrum of other basic and applied scientific disciplines. These include
molecular biology, genetics, biochemistry, chemistry, physics, food science,
microbiology, physiology, pathology, immunology, psychology, sociology,
political science, anthropology, agriculture, pharmacology, communications,
and economics. Nutrition departments are, therefore, often found in Medical
(Health) or Social Science, or Pharmacy, or Agriculture Faculties at tertiary
training institutions.
The study of human nutrition therefore seeks to understand the
complexities of both social and biological factors on how individuals and
populations maintain optimal function and health, how the quality, quantity and
balance of the food supply are influenced, what happens to food after it is eaten,
and the way that diet affects health and well-being. This integrated approach has
led to a better understanding of the causes and consequences of malnutrition,
and of the relationship between nutrition and health.
 Figure 1.2 shows that individuals can be broadly categorized into having
optimal nutritional status or being undernourished, overnourished, or
malnourished. The major causes and consequences of these nutritional states are
indicated. It is important to realize that many other lifestyle and environmental
factors, in addition to nutrition, influence health and well-being, but nutrition is
a major, modifiable, and powerful factor in promoting health, preventing and
treating disease, and improving quality of life.
The health or disease state of the different organs and systems will determine
the nutrient requirements of the body as a whole.
Nutrients: the basics
People eat food, not nutrients; however, it is the combination and amounts of
nutrients in consumed foods that determine health. To read one must know the
letters of the alphabet; to do sums one must be able to count, add, subtract,
multiply, and divide. To understand nutrition, one must know about nutrients.
The study of nutrients, the ABC and numeric calculations of nutrition, will form
a major part of the student’s nutrition journey, and should include:
● the chemical and physical structure and characteristics of the nutrient
 ● the food sources of the nutrient, including food composition, the way in
which foods are grown, harvested, stored, processed and prepared, and the
effects of these on nutrient composition and nutritional value
● the digestion, absorption, circulatory transport, and cellular uptake of the
nutrient, as well as regulation of all these processes
● the metabolism of the nutrient, its functions, storage, and excretion
● physiological needs (demands or requirements) for the nutrient in health and
disease, and during special circumstances (pregnancy, lactation, sport events),
as well as individual variability
● interactions with other nutrients, nonnutrients (phytochemicals), antinutrients,
and drugs
the consequences of underconsumption and overconsumption of nutrients
● the therapeutic uses of the nutrient
● factors influencing food and nutrition security and food safety.
The study of nutrition also includes how to determine nutrient requirements
to make recommendations for intakes and how nutritional status is monitored by
measuring intakes, anthropometry, body composition, biochemical markers
reflecting nutritional status, and the clinical signs of malnutrition. This
knowledge of nutrients and their functions will enable the nutritionist to advise
individuals what and how much to eat. However, this knowledge is not
sufficient to understand and address the global problem of malnutrition facing
mankind today. This perception has resulted in the cultivation of social science
disciplines to support knowledge from the biological sciences to address global
malnutrition.
 Relationship between nutrition science and practice
The journey through the scientific domain of nutrition will, at a specialized
stage, fork into different roads. These roads will lead to the different scopes or
branches of nutrition science that are covered in the second, third, and fourth
texts of this series. These different branches of nutrition science could lead to
the training of nutrition specialists for specific practice areas. The main aim of
nutrition professionals is to apply nutrition principles to promote health and
wellbeing, to prevent disease, and/or to restore health (treat disease) in
individuals, families, communities and the population. To help individuals or
groups of people to eat a balanced diet, in which food supply meets nutrient
needs, involves application of nutrition principles from a very broad field to
almost every facet of human life. It is therefore not surprising that these
different branches or specialties of nutrition have evolved and are developing.
They include clinical nutrition, community nutrition, public health, and public
nutrition. It can be expected that there will be overlap in the practice areas of
these specialties.
● The clinical nutritionist will counsel individuals from a biomedical–disease–
behavioral paradigm to promote health, prevent disease, or treat disease. The
clinical nutritionist will mostly work within the health service (facility-based
settings such as hospitals, clinics, private practice).
● The community nutritionist, with additional skills from the psychosocial
behavioral sciences, should be aware of the dynamics within particular
communities responsible for nutritional problems. These would include
household food security, socioeconomic background, education levels, childcare
practices, sanitation, water, energy sources, healthcare services, and other
quality-oflife indicators. The community nutritionist will design, implement,
and monitor appropriate, community-participatory programs to address these
problems.
● The public health or public nutritionist covers the health and care practice
areas but will also be concerned with food security (agricultural) and
environmental issues on a public level. The public health or public nutritionist
will, for example, be responsible for nutrition surveillance, and the design,
implementation, and monitoring of dietary guidelines that address relevant
public health problems. A background knowledge in economics, agriculture,
political science, and policy design is essential for the formulation and
application of nutrition policy in a country. Many developing countries will not
have the capacity or the financial resources to train and employ professionals for
different specialties. However, future specialized training and employment of
different professionals could result in a capacity to address nutritional problems
more effectively.
ENERGY BALANCE
Man is a heterotrophic organism, deriving its energy from organic compounds.
Energy is defined as the ability to do work or to supply heat .through the
process of digestion, we convert the food we eat to energy. is provided by the
oxidation of nutrients, being the carbohydrates, proteins and fats consumed,
called the macronutrients.
UNITS OF ENERGY
The energy value of food is expressed in terms of kilocalories (KCAL) or
megajoules (MJ).The international union of nutritional sciences has suggested
the use of megajoule as the energy unit in place of Kcal.
These units are defined as follows:
Kilocalorie: one kilogram calorie is the quantity of heat required to raise the
temperature of 1kg of water through 1C.
Joule: a joule is defined as the energy required to move 1kg mass by 1 metre by
a force of 1 Newton acting on it.
Newton: one newton is the force needed to accelerate 1 kg mass by less than a
second.
1KCAL=4.184KJ
1000Kcal=4.184 Megajoule(MJ)
1MJ=240Kcal

ENERGY BALANCE
Energy balance in the body is the balance between how much energy is
consumed and how much is expended. Energy balance occurs when the energy
content of food is matched by the total amount of energy that is expended by the
body. When energy intake exceeds energy expenditure, a state of positive
energy balance occurs. Thus, positive energy balance occurs when excessive
overfeeding relative to energy needs occurs, and the body increases its overall
energy stores. Examples of positive energy balance include periods around
major festivals when overeating and inactivity generally prevail, and during
pregnancy and lactation when the body purposefully increases its stores of
energy. When energy intake is lower than energy expenditure, a state of
negative energy balance occurs, for example during periods of starvation. In this
regard, evidence suggests that, under conditions of substantial energy
imbalance, be it positive or negative, energy expenditure may reach a level that
is beyond what could be predicted by body weight changes. This so-called
“adaptive thermogenesis” might contribute to the occurrence of resistance to
lose fat in the context of obesity treatment or the achievement of a new body
weight plateau following overfeeding. If energy intake chronically exceeds
energy expenditure by as little as 105 kJ/day, then, over time, a person will
become substantially obese. The achievement of energy balance is driven by the
first law of thermodynamics, which states that energy can be neither destroyed
nor created. This principle necessitates that when energy intake equals energy
expenditure, body energy stores must remain constant. This chapter explains
how the body is able to achieve this state of energy balance through control of
energy intake and energy expenditure. In addition, the various ways that body
energy stores can be measured and some examples of conditions in which
energy balance may be disrupted are summarized. Particular emphasis is placed
on obesity, which is the end-result of a positive energy balance and is now
considered one of the major nutritional disorders.
It is important to note that energy balance can occur regardless of the levels of
energy intake and expenditure; thus, energy balance can occur in very inactive
individuals as well as in highly active individuals provided that adequate energy
sources are available. It is also important to think of energy balance in terms of
the major sources of energy, i.e., carbohydrate, protein, and fat. For example,
carbohydrate balance occurs when the body balances the amount of
carbohydrate ingested with that expended for energy.
 Energy intake corresponds to the energy content of macronutrients in
food. the sources of energy in the food we eat include the major macronutrients:
protein, carbohydrate, and fat, as well as alcohol. Carbohydrate and protein
provide 16.8 kJ of energy for each gram; alcohol provides 29.4 kJ/g, whereas fat
is the most energy dense, providing 37.8 kJ/g.
Note that 4.2 kJ is defi ned as the amount of heat that is required to raise the
temperature of 1 liter of water by 1°C. The energy content of food can be
measured by bomb calorimetry, which involves combusting a known weight of
food inside a sealed chamber and measuring the amount of heat that is released
during this process. Thus, 1 g of pure fat would release 37.8 kJ during its
complete combustion, whereas 1 g of pure carbohydrate would release 16.8 kJ.
Thus, if the gram quantities of any type of food are known, the energy content
can easily be calculated.
For example, if a protein-rich nutrition snack contains 21 g of carbohydrate, 6 g
of fat, and 14 g of protein, then the total energy content is
(21 × 16.8) + (6 × 37.8) + (14 × 16.8) = 814.8 kJ. The macronutrient
composition of food is typically assessed in the percentage contribution of each
macronutrient to the total number of calories. If a food has a carbohydrate
content of 21 g, which is 352.8 kJ, and the total energy content is 820 kJ the
proportion of energy derived from carbohydrate is 43%; the fat content is 6 g, or
226.8 kJ, equivalent to 28% of the energy; and the protein contributes 14 g,
235.2 kJ and 29% of the energy.
Components of energy balance
Energy intake: Energy intake is defined as the caloric or energy content of food
as provided by the major sources of dietary energy: carbohydrate (16.8 kJ/g),
protein (16.8 kJ/g), fat (37.8 kJ/g), and alcohol (29.4 kJ/g).
Energy storage: The energy that is consumed in the form of food or drinks can
either be stored in the body in the form of fat (the major energy store), glycogen
(short-term energy/carbohydrate reserves), or protein (rarely used by the body
for energy except in severe cases of starvation and other wasting conditions, as
discussed later in the chapter), or be used by the body to fuel energy-requiring
events.
Energy expenditure: The energy that is consumed in the form of food is
required by the body for metabolic, cellular, and mechanical work such as
breathing, heart beat, and muscular work, all of which require energy and result
in heat production. The body requires energy for a variety of functions. The
largest use of energy is needed to fuel the basal metabolic rate (BMR), which is
the energy expended by the body to maintain basic physiological functions (e.g.,
heart beat, muscle contraction and function, respiration). BMR is the minimum
level of energy expended by the body to sustain life in the awake state. It can be
measured after a 12 hour fast while the subject is resting physically and
mentally, and maintained in a thermoneutral, quiet environment. The BMR is
slightly elevated above the metabolic rate during sleep, because energy
expenditure increases above basal levels owing to the energy cost of arousal.
Because of the diffi culty in achieving BMR under most measurement
situations, resting metabolic rate (RMR) is frequently measured using the same
measurement conditions stated for BMR. Thus, the major difference between
BMR and RMR is the slightly higher energy expended during RMR (~ 3%)
owing to less subject arousal and nonfasting conditions. Because of this small
difference, the terms basal and resting metabolic rate are often used
interchangeably. RMR occurs in a continual process throughout the 24 hours of
a day and remains relatively constant within individuals over time. In the
average adult human, RMR is approximately 4.2 kJ/min. Thus, basal or resting
metabolic rate is the largest component of energy expenditure and makes up
about two-thirds of total energy expenditure. In addition to RMR, there is an
increase in energy expenditure in response to food intake. This increase in
metabolic rate after food consumption is often referred to as the thermic effect
of a meal (or mealinduced thermogenesis) and is mainly the energy that is
expended to digest, metabolize, convert, and store ingested macronutrients,
named obligatory thermogenesis. The measured thermic effect of a meal is
usually higher than the theoretical cost owing to a facultative component caused
by an activation of the sympathoadrenal system, which increases energy
expenditure through peripheral β-adrenoceptors. The energy cost associated
with meal ingestion is primarily infl uenced by the composition of the food that
is consumed, and also is relatively stable within individuals over time. The
thermic effect of a meal usually constitutes approximately 10% of the caloric
content of the meal that is consumed. The third source of energy expenditure in
the body is the increase in metabolic rate that occurs during physical activity,
which includes exercise as well as all forms of physical activity. Thus, physical
activity energy expenditure (or the thermic effect of exercise) is the term
frequently used to describe the increase in metabolic rate that is caused by use
of skeletal muscles for any type of physical movement. Physical activity energy
expenditure is the most variable component of daily energy expenditure and can
vary greatly within and between individuals owing to the volitional and variable
nature of physical activity patterns. In addition to the three major components of
energy expenditure, there may be a requirement for energy for three other minor
needs.
Energy Metabolism 33
● The energy cost of growth occurs in growing individuals, but is negligible
except within the fi rst few months of life. ● Adaptive thermogenesis is heat
production during exposure to reduced temperatures, and occurs in humans,
e.g., during the initial months of life and during fever and other pathological
conditions, but also as a contributor to daily energy expenditure. ●
Thermogenesis is increased by a number of agents in the environment,
including in foods and beverages. Nicotine in tobacco is the most important one,
and heavy smokers may have a 10% higher energy expenditure than
nonsmokers of similar body size and composition and physical activity.
Caffeine and derivatives in coffee, tea, and chocolate, capsaicin in hot chilies,
and other substances in foods and drinks may possess minor thermogenic
effects that affect energy expenditure.