Basic Concepts in Nutrition and Diet Therapy
Basic Concepts in Nutrition and Diet Therapy
Basic Concepts in Nutrition and Diet Therapy
In addition to providing energy and serving as building blocks for bigger
macromolecules, carbohydrates are essential for proper functioning of the nervous
system, heart, and kidneys.
As mentioned, glucose can be stored in the body for future use.
HEALTH IMPLICATIONS
Health risks are associated with excessive sugar consumption, but it is difficult to make positive
correlations between sugar consumption and the development of many diseases that have been
linked to it. Included among the associations of sugar and health problems are the following:
1. Obesity
2. Cardiovascular disease
3. Diabetes
4. Dental caries
5. Cancer
6. Fiber
Macronutrients
- Carbohydrates
In other words…
The main role of a carbohydrate is to provide energy and fuel the body the same way gasoline
fuels a car. Foods such as corn, chayote, beans, plantains, rice, tortilla, potatoes and other root
vegetables such as yucca, bread and fruit deliver sugars or starches that provide carbohydrates
for energy.
Energy allows the body to do daily activities as simple as walking and talking and as complex as
running and moving heavy objects. Fuel is needed for growth, which makes sufficient fuel
especially important for growing children and pregnant women. Even at rest, the body needs
calories to perform vital functions such as maintaining body temperature, keeping the heart
beating and digesting food.
Storage
Proteins in the form of amino acids are the building blocks of the body.
Protein as such is not stored; therefore, a daily intake is required.
Sources
Animal sources of protein include milk and milk products, meat, fish, poultry,
and eggs.
Plant sources include breads and cereal products, legumes, nuts and seeds,
and textured vegetable protein.
Cereal grains are the primary source of protein for the majority of the world’s
population.
The production of large animals for protein will become less practical as the
world’s population grows and space for humans must take precedence over
space for raising large animals.
The health practitioner should be familiar with the complementary proteins in
foods.
Animal protein is relatively expensive.
As the world’s protein supply diminishes, an understanding of
complementarity will become increasingly important.
The proper mixing of ingested plant protein foods can provide nutritional value
similar to that of animal protein.
Adequate amounts of high-quality protein are not difficult to obtain in diets
that contain dairy products and eggs.
However, achieving nutritional balance in a strict vegetarian diet requires
considerable knowledge of the contributions of various foods to our dietary
requirements.
Utilization
To be absorbed, proteins must be broken down to individual amino acids or small peptides (by-
products of protein digestion composed of 2 to 10 amino acids).
The products of protein digestion are absorbed into the bloodstream as amino acids and are
transported via the portal vein to the liver and then to all the body cells.
Some amino acids stay in the liver to form liver tissue itself or to produce a wide variety of
blood proteins.
The remaining amino acids circulate in the bloodstream, from which they are rapidly removed
and utilized by the tissues.
When amino acids are broken down, the nitrogen containing part is split off from the carbon
chain.
Most of the nitrogen is converted to urea in the liver and excreted via the kidneys.
Then the carbon-containing portion that remains is utilized for energy.
Proteins provide 4 kcal per g, the same as carbohydrates.
AMINO ACID SUPPLEMENTS
Of all the supplements that have come to market since people have been
attempting to find magic bullets to prevent aging, increase their libido, and
improve their bodies, amino acid supplements have been at the top of the list.
This phenomenon has been greatly enhanced by competitive athletes, both
professional and amateur, and their coaches.
Some 25 to 30 amino acid supplement advertisements can be found in any one
body building or popular health magazine each month.
Two major reasons are given by athletes for using amino acid supplements:
(1) the belief that it gives them the “competitive” edge
(2) the belief that amino acids build muscle and are a major energy source.
Neither of these beliefs is correct.
Exercise builds muscle, not protein, and carbohydrates are the body’s major
energy source.
Excess protein (amino acids) is detrimental in that it places an undue burden
on the kidneys to excrete the excess nitrogen, and on the metabolism of the
body.
Excess protein will also convert to fat.
Two other groups most vulnerable to the claims made by
companies for their products are the elderly, who are attempting to
avoid health problems and retain their youth, and persons with
chronic diseases or terminal diseases such as AIDS.
All health professionals should be aware of the attitudes and
beliefs of many of their clients and should attempt to educate them
about potential health risks.
The requirement for protein and each essential amino acid varies with age in
absolute and relative quantities.
Approximately 40% of an infant’s protein must be from essential amino acids,
but only 20% for an adult.
A food that may be an adequate protein source for adults may be inadequate
for the young child.
Protein requirements increase in certain kinds of illnesses or malnutrition.
Excess protein intake has raised questions about health risks.
For optimal use of protein, intake should be spread throughout the day rather
than being consumed at one meal.
VEGETARIANISM: RATIONALE AND CLASSIFICATION
There are many reasons why individuals eliminate animal foods from their diets.
The most common reasons are economic concerns, religious guidelines, health considerations,
and concern for animal life.
When a vegetarian consumes no meat, fowl, or fish as food, the further restrictions on the
remaining part of the diet can be classified as follows:
1. Fruitarians: individuals who eat only fruit.
2. Vegans: individuals who eat no animal flesh nor any food of animal origin. They are
sometimes called strict vegetarians.
3. Lacto-vegetarians: individuals who eat plant proteins, and also use milk.
4. Ovo-vegetarians: individuals who eat plant proteins, as well as eggs.
5. Lacto-ovo-vegetarians: individuals who eat both milk and eggs along with plant proteins.
6. Semivegetarians restrict red meats only—that is, beef, pork, lamb, and game animals. Fish,
poultry, dairy foods, eggs, and plants furnish proteins for their diet.
EXCESSIVE AND DEFICIENT PROTEIN INTAKE
Normal tissue growth in infancy and childhood and during pregnancy and lactation requires
more amino acids than those needed for tissue maintenance.
As has been demonstrated in many laboratory studies, in the absence of adequate protein,
growth is slowed down or even stopped.
The feeding of infants in strict vegetarian families is of particular concern to the health
professional.
If breastfeeding is not possible, a formula such as nutritionally fortified soybean milk should be
provided.
The soybean formula fortified with vitamin B12 should continue to be given by cup after the
child is weaned.
A wide variety of foods should be chosen, with emphasis on those that are high in iron and
vitamins A, B complex, and C.
In addition to soybean milk, mixtures of legumes and cereals are needed to supply sufficient
protein.
Excesses
Questions raised about excessive protein intake include the following:
1. Excess nitrogen must be cleared by the kidneys. This may negatively affect kidneys that are
malfunctioning, damaged, or underdeveloped.
2. High protein consumption has recently been cited as one factor in bone demineralization,
especially if coupled with low calcium intake.
3. While inconclusive at this time, research indicates that high protein consumption may
increase risks of colon cancer by changing the internal environment and altering the
bacteria of the colon.
4. Large amounts of protein, especially of animal origin, also contain saturated fats. Most
authorities are convinced that saturated fats contribute to a high incidence of heart
disease.
5. Since excess protein from any source is converted to fat and stored as adipose tissue, it can
contribute to obesity.
Deficiencies
Large losses of protein may occur during illness or surgical procedures.
These situations require substantial increases in protein consumption.
Lack of increased protein intake during illness will result in delayed wound
healing, slow convalescing, low resistance to infections, and inability to return to
optimum health.
Protein Energy Malnutrition
Protein energy malnutrition (PEM) is the most serious and
widespread deficiency disease in developing countries.
The two major types are:
1. nutritional marasmus due to caloric deficiency
2. kwashiorkor due to a deficiency of protein
Comparison of Children with Kwashiorkor
and Marasmus
Although they are treated as two separate diseases, they are
closely related.
Diets low in calories will almost always be low in protein.
Even if there is adequate protein, the body will use it for energy
instead of for growth and development.
While primarily considered a child’s disease, PEM also develops in
adults.
Adults with PEM exhibit weight loss, fatigue, and other symptoms of acute
malnutrition.
A low intake of protein and calories also results in the deficiency of three
nutrients: vitamin A, iron (causing anemia), and iodine (causing endemic goiter).
Vitamin A, being a fat-soluble vitamin, will be low in a protein restricted diet.
Vitamin A deficiency negatively affects growth, skin, and vision, sometimes
causing blindness.
Many women die in childbirth from low iron levels.
If there is an infection from parasites such as hookworm, even less iron is
available.
PEM will produce stunted growth and mental retardation.
A malnourished woman is likely to give birth to a premature, often retarded
infant with less resistance to infection and illness.
Poorly nourished persons have a shortened life expectancy, and common
childhood diseases are often fatal to the malnourished child.
Enzyme and hormone production is inadequate in these victims.
Although they badly need extra nutrients, they are unable to digest and absorb
them.
Some infants are born with an inability to metabolize phenylalanine
(Phenylketonuria) , an essential amino acid.
Mental retardation results if the disease is not treated.
The protein in specific foods is considered to be the cause of food allergies. In
this case, careful addition of protein foods to an infant’s diet must be practiced.
RESPONSIBILITIES OF HEALTH PERSONNEL
The health professional should do the following:
1. Recommend moderate amounts of animal protein. Excess protein is wasteful, since the
excess is converted to energy, and excess energy is converted to fat. Protein food is an
expensive form of energy.
2. Be aware that protein foods are not low in calories. They provide the same number of
calories per gram as carbohydrates. Furthermore, protein foods from animal sources
(such as meats, cheese) frequently contain excessive calories from fat.
3. Advise clients to eat good-quality protein at each meal to provide a consistent supply of
essential amino acids. Protein cannot be stored in the body and is used constantly in its
major functions.
4. Plan some meals for clients around complementary vegetable protein foods for variety,
economy, and increased fiber.
RESPONSIBILITIES OF HEALTH PERSONNEL
5. Be aware that meals containing legumes and grains are very nourishing and
less expensive than meals containing meat.
6. Be aware of the importance of eating extra protein during illnesses, which
cause excessive breakdown of body tissue.
7. Recognize that certain illnesses require alterations in amounts and types of
protein ingested.
8. Ask clients questions regarding their use of supplements and advise them of
any undesirable side effects.
Macronutrients
4. Water
There is one other nutrient that we must have in large quantities: water.
Water does not contain carbon, but is composed of two hydrogen atoms and one oxygen atom
per molecule of water.
More than 60 percent of your total body weight is water.
Without water, nothing could be transported in or out of the body, chemical reactions would
not occur, organs would not be cushioned, and body temperature would widely fluctuate.
On average, an adult consumes just over two liters of water per day from both eating foods and
drinking liquids.
Since water is so critical for life’s basic processes, total water intake and output is supremely
important.