Cont.Fundamentals of NutritionLOURDES L. BALCUEVA,M.D.

Current Issues in NutritionVegetarism a practice which has arisen as a result of religious belief, health, economic, ethnic or ecological reasons.Diet includes: vegetables yeast seeds fruits dry beans sugars cereals peas seaweeds bread nuts bean curd

Issues Lacto-ovo include eggs and dairy productsLacto vegetarians- include dairy productsPesco vegetarian- include fishPollo vegetarian- include poultrySome vegetarians exclude all animal products; present risk of inadequate nutrition

Nutrients low in vegetarian diet:IronB12CalciumEssential amino acids lysine, methionine,threonine, tryptophanZinc

Types of Diet in Different Regions

French- small portion, slow paced,emphasis on vegetablesMediterranean- emphasis on beans and green with olive oil, low intake of meat, sweets limited to special occasions; salads are served after main mealAsian- soybean products or tofu; high intake of rice, vegetables and fish, low intake of dessert; sesame oil and peanut oil emphasized

Food Safety Issues1. Use of pesticides2. Use of additives in food to enhance quality, flavor, texture, nutritive value and palatability 3. Microbial contaminations 4. Natural toxicants in food solamine- narcotic like substance in potatoes nitrates,nitrites- green leafy vegetables aflatoxin- peanuts,cereal grains protease inhibitors- legumes hemagglutinins- peanuts, red kidney beans, soybeans cyanide- cassava, apple seeds

5. environmental pollution- affect air, soil and water mercury- causes GIT, hepatic and renal disorders lead- anemia,GIT disorders, CNS Cadmium- renal polychlorinated biphenyls radioactive materials

6. GMO- to improve functional properties, increase resistance to diseases, decrease perishability. 7. Microwave- inadequate heating may lead to food-borne illness 8. Use of food substitutes- still being studied

Nutrient Supplementation

- FNRI survey, Filipinos deficient in iron, Vit. A and iodine - pregnant women and lactating women - elderly - lifestyle of some individuals: smokers alcohol drinkers dieters heavy exercisers heavy caffeine drinkers children vegetarians

Megavitamin therapy- 10-1000 times the RDA- may alleviate symptoms in certain disorders;

Antioxidants - block free radical effects beta carotene Vitamin C Vitamin E Selenium

Food Exchange ListA grouping of common foods with practically the same amount of CHO, CHON and FATs. Within a group, one food item can be exchanged with anotherFoods included are simple

Summary of the 7 Exchange List Food Group Cal/grp CHO CHON Fats veg. A - - - veg. B 16 3 1 - Fruit 40 10 - - Milk 170 12 8 104 Rice 100 23 2 - Meat A. Low Fat 50 - 8 2 B. Medium fat 95 - 8 7 C. High fat 122 - 8 10 Fat 45 - - 57 Sugar 20 5 - -

List 1: vegetablesLeafy vegtables- 1 exvhange =1 cup raw (25 g) or 1 cup cooked (45g)Non-leafy vegetables- 1 exchange = cup raw (40 g) or cup cooked (45 g)

List 2 Fruit Exchangesper exchange- 40 cal, 10 gms CHO

Atis small 5x4 cmBayabas 2 medium, 4 cm.Strawberry 1/3 cupPapaya 1 slice 5 x 2 x 1cmMangga 1 small 11x 6 cmPakwan 1 slice 5x 3 cmPinya 1 slice 5x 3 x 2 cmSaging lakatan 1 small 10 x 3 cm

List 3: Milk exchanges1 exchange = 140 cal, 12 gms CHO,8gms CHON,10 gms fat

Evap milk- 1/4 glass (undiluted)Yoghurt cupPowdered whole milk 4 level tbsp.Powdered non-fat milk 4 level tbsp

List 4: Rice exchanges1 exchange = 100 cal,23 gms CHO, 2 gms CHON Rice 1/2 cupBread 1 slicePan de sal 1 bigmamon - 1 pc 6 x 3 cmHot cake 1 pc. 8 cm diameter Pretzels 8 pcsDoughnut pc 9 x 5 cmNoodles - cupCamote 1 small piece

List 5: Meat exchanges

Low fat: 1 exchange = 50 cal, 8 gms CHON, 2 gms fat Pork liver 1 slice 5 x 4 x 1cm Beef lean meat 1 pc. 5 cm cube tenderloin - same

Fish lapu-lapu 1 slice, 10 x 5 x 3cm galunggong pc 25 x 8 cm dilis 1/3 cup

Medium Fat exchanges1 exchange = 95 cal,8 gms CHON, 7 gms fatPork pata 1 pcs 2 cm cubeGoto beef cupChicken wings 1 small

High Fat:1 exchange = 8 gms CHON, 10 gms Fat, 122 calPork pigi pc 3 cm cubeOx tongue cupBalut 1 egg = 65 gms

List 6: Fat exchanges5 gms fat, 45 calButter 1 tspCoconut milk 1 tspBacon stripMayonnaise 1 tspSitsaron 1 pc. 3 x 4 cmPili nut 5 pcs

List 7: Sugar exchanges5 gms sugar, 20 calCaramel 1pc 2 x 2 cmHard candy 1 pcChocolate candy 1 pc roundSugars 1 tspUbe halaya 1 tspYema 1 pc 5 x 1 cm

Free foodsBouillon (fat free syrup)Clear broth Other spicesCoffee Pickle dill or sour Garlic Tomato pasteGelatin (unsweetened) Tomato sauceKamyas Tea Lemon vinegar Mustard

Assignment:

- Using your computation of your TER, make a menu for your breakfast, lunch,and dinner (include snacks, if needed) - Distribute them into appropriate amount of calories as CHO, CHON and Fats - Use the list of food exchange for your guide - Use the Food Composition table if a particular food is not found in the exchange list.

NUTRITIONAL DISORDERS

Protein Energy Malnutrition (PEM)

intake of energy and protein nutritional losses nutrient requirement (underlying illness, fever, surgery, CA)

Clinical correlation: KWASHIORKOR

Deficiency of proteins in the diet but adequate in calories Signs/symptoms:Muscle wasting plasma proteins (albumin) interstitial fluid: Edema/ascites/anasarca ability to synthesize new proteins (- N balance)Digestive enzymesNew epithelial cells

Clinical correlation: MARASMUS

Calorie and protein deficiency

Emaciation and failure to thrive

Susceptibility TO infection

Nutritional disorders (cont)

B. OVERWEIGHT: BMI between 25 29.9

C. OBESITY: Excess body adipose tissueClass 1: BMI 30 34.9Class 2: BMI greater than 35

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