Lec 8 nutrition for health promotion and disease prevention 2

Dr. Siham M.O.Gritly 1

Community and Public Health Nutrition

lec. 8-Nutrition for Health Promotion and Disease Prevention 2Nutrition and the chronic diseases

Prepared byDr. Siham Gritly

Improving diets and increasing levels of physical activity in adults and older people will reduce chronic disease risks for death and disability (WHO).


glossary

• chronic diseases: diseases characterized by a slow progression and long duration. Examples include heart disease, cancer, and diabetes.

• risk factor: a condition or behavior associated with an elevated frequency of a disease but not proved to be causal. Leading risk factors for chronic diseases include obesity, cigarette smoking, high blood pressure, high blood cholesterol, physical inactivity, and a diet high in saturated fats and low in vegetables, fruits, and wholegrains.


• Diabetes Mellitus; a disorder of carbohydrate metabolism due to disturbances in production or utilization of insulin, results in high blood glucose levels and loss of sugar in urine


Nutrition and the chronic diseases

• Chronic diseases; are diseases of long duration and generally slow progression.

• Chronic diseases, such as• heart disease, stroke, • cancer, • chronic respiratory diseases • diabetes, • Disorders of the GI Tract


Ref World Health Organization, 2002

• chronic disease was related to dietary and lifestyle• Chronic diseases are largely preventable diseases• Diet has been known for many years to play a key

role as a risk factor for chronic diseases• In many developing countries, food policies

remain focused only on undernutrition and are not addressing the prevention of chronic disease.


Lifestyle and The biological risk factors that contribute to the development of chronic diseases:

• WHO suggested that; • Unhealthy diets,• physical inactivity • and smoking are confirmed risk behaviours for chronic

diseases.

• The biological risk factors such as • hypertension, • obesity • and lipidaemia are risk factors for coronary heart disease,

stroke and diabetes.


Vegetables rich in fiber, phytochemicals, and the antioxidant nutrients (beta-carotene, vitamin C, and vitamin E) help to protect against chronic

diseases

Ref Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning


For diet, recommendations for communities and individuals should include the following

Diet, nutrition, and the prevention of chronic diseases. Report of a WHO Study Group. Geneva, World Health Organization, 1990(WHO Technical Report Series, No. 797).

• achieve energy balance and a healthy weight• limit energy intake from total fats and shift fat consumption away

from saturated fats to unsaturated fats

• the elimination of trans-fatty acids

• increase consumption of fruits and vegetables, and legumes, whole grains and nuts

• limit the intake of free sugars limit salt (sodium) consumption from all sources and ensure that salt is iodized


• These recommendations need to be considered when preparing national policies and dietary guidelines, taking into account the local situation (WHO).

• Improving dietary habits is a societal, not just an individual problem.

• Therefore it demands a population-based, multisectoral, multi-disciplinary, and culturally relevant approach.


Nutritional factors in selected diseases

• -Cardiovascular disease, • -Diabetes, • -Cancer• -Obesity and weight management• -Disorders of the GI Tract• -nutritional anemia


Nutrition and Cardiovascular disease

• The heart is a four-chambered organ consisting of right and left halves.

• Two of the chambers, the left and right atria, are entry-points into the heart, while the other two chambers, the left and right ventricles, are responsible for contractions that send the blood through the circulation.

• The circulation is split into the pulmonary and systematic circulation


. The role of the right ventricle is to pump deoxygenated blood to the lungs through the pulmonary trunk and pulmonary arteries. The role of the left ventricle is to pump newly oxygenated blood to the body through the aorta

http://upload.wikimedia.org/wikipedia/commons/e/e5/Diagram_of_the_human_heart_(cropped).svg


Cardiovascular Disease (atherosclerosis)

• The major causes of death ,are diseases of the heart and blood vessels, collectively known as cardiovascular disease (CVD).

• Coronary heart disease (CHD) is the most common form of cardiovascular disease and is usually caused by atherosclerosis in the coronary arteries that supply blood to the heart muscle.

• Atherosclerosis is the accumulation of lipids and other materials in the arteries

http://upload.wikimedia.org/wikipedia/commons/e/e5/Diagram_of_the_human_heart_(cropped).svg


Atherosclerosis : a type of artery disease characterized by plaques (accumulations of

lipid-containing material) on the inner walls of the arteries


Atherosclerosis is a process in which blood, fats such as cholesterol, and other substances build

up on artery walls. deposits called plaques. As atherosclerosis progresses, plaque thickens over time, causing arteries to harden, narrow, and become less elastic


Heart Attacks and Strokes

• The deposits may narrow or block arteries. These plaques can also rupture, causing a blood clot.

• The Result: Heart Attacks and Strokes When atherosclerosis in the coronary arteries becomes severe enough to restrict blood flow and deprive the heart muscle of oxygen, CHD develops.

• The person with CHD often experiences pain and pressure in the area around the heart (angina). A heart attack occurs.


• when blood flow to the heart is cut off and that area of the heart muscle dies. Restricted blood flow to the brain causes a transient ischemic attack (TIA) or stroke.


Risk Factors for Coronary Heart Disease

• High blood LDL cholesterol• Low blood HDL cholesterol• High blood pressure (hypertension)• Diabetes• Obesity (especially abdominal obesity)• Physical inactivity• Cigarette smoking• An “atherogenic” diet (high in saturated fats and

low in vegetables, fruits, and whole grains


Risk Factors for Coronary Heart Disease High blood LDL cholesterol Major lipoproteins in the blood

• Lipoproteins; clusters of lipids associated with proteins that serve as transporter for lipids in the lymph and blood

• The body makes four main types of lipoproteins, distinguished by their size and density.* Each type contains different kinds and amounts of lipids and proteins


four main types of lipoproteins

• chylomicrons, Chylomicrons the class of lipoproteins that transport lipids from the intestinal cells to the rest of the body

• very-low-density lipoproteins VLDL

• low-density lipoproteins LDL

• high-density lipoproteins (HDLs).


Major lipoproteins in the blood


The body makes four main types of lipoproteins, distinguished by their size and density. Each type contains different kinds and amounts of lipids and proteins


very-low-density lipoproteins

• VLDL; in the liver the most active site of lipid synthesis—cells are making;-

• cholesterol,• fatty acids, • and other lipid compounds.

• the lipids made in the liver and those collected from chylomicron remnants are packaged with proteins as VLDL (very-low-density lipoproteins) and shipped to other parts of the body


• As the VLDL travel through the body, cells remove triglycerides, causing the VLDL to shrink.

• As VLDL lose triglycerides, Cholesterol becomes the predominant lipid, and the lipoprotein density increases. The VLDL becomes LDL (low-density lipoprotein).

• * This transformation explains why LDL contain few triglycerides but are loaded with cholesterol


low-density lipoproteins LDL

• The LDL circulate throughout the body, making their contents available to the cells of all tissues—muscles (including the heart muscle), fat stores, the mammary glands, and others.

• The cells take triglycerides, cholesterol, and phospholipids to build new membranes, make hormones or other compounds, or store for later use.

• Special LDL receptors on the liver cells play a crucial role in the control of blood cholesterol concentrations by removing LDL from circulation.


High-density lipoproteins(HDLs).

• The liver makes HDL to remove cholesterol from the cells and carry it back to the liver for recycling or disposal.

• In addition, HDL have anti-inflammatory properties that seem to keep atherosclerotic plaque from breaking apart and causing heart attacks.


Health ImplicationsEllie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth

Edition. 2011, 2008 Wadsworth, Cengage Learning

• The distinction between LDL (bad) and HDL (good) has implications for the health of the heart and blood vessels.

• The blood cholesterol linked to heart disease is LDL cholesterol.

• HDL also carry cholesterol, but elevated HDL represent cholesterol returning from the rest of the body to the liver for breakdown and excretion.

• High LDL cholesterol is associated with a high risk of heart attack, whereas high HDL cholesterol seems to have a protective effect.


• the cholesterol itself is the same in LDL and HDL, and that the differences between LDL and HDL reflect the proportions and types of lipids and proteins within them—not the type of cholesterol.

• numerous genes influence how the body handles the synthesis, transport, and degradation of lipids and lipoproteins


Dietary Strategies to Reduce Risk of CHD

Energy: Balance energy intake and physical activity to prevent weight gain and to achieve or maintain a healthy body weight.

Saturated fat, trans fat, and cholesterol: Choose lean meats, vegetables, and low-fat milk products; minimize intake of hydrogenated fats. Limit saturated fats to less than 7 percent of total kcalories, trans fat to less than 1 percent of total kcalories, and cholesterol to less than 300 milligrams a day


Soluble fibers:

a diet rich in vegetables, fruits, whole grains, and other foods high in soluble fibers.

Potassium and sodium:

a diet high in potassium-rich fruits and vegetables, low-fat milk products, nuts, and whole grains.

• with little or no salt (limit sodium intake to 2300 milligrams per day).


adapted from; Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition (2008),

Added sugars: Minimize intake of beverages and foods with added sugars.

Fish and omega-3 fatty acids: Consume fatty fish rich in omega-3 fatty acids (salmon, tuna, sardines) at least twice a week.

Soy: Consume soy foods to replace animal and dairy products that contain saturated fat and cholesterol.

Alcohol: If alcohol is consumed, limit it to one drink daily for women and two drinks daily for men.


• Lifestyle Choices Strategies to Reduce Risk of CHD

• Physical activity: Participate in at least 30 minutes of moderate-intensity endurance activity on most days of the week.

• Smoking cessation (end): Minimize exposure to any form of tobacco or tobacco smoke


Risk Factors for Coronary Heart Disease High Blood Pressure (hypertension)

• hypertension: higher-than-normal blood pressure. Two types;

• Essential or primary hypertension; Hypertension that develops without an identifiable cause

• Secondary hypertension; hypertension that is caused by a specific disorder such as kidney disease


• The high blood pressure is above normal, the risk of death from CVD.

• Low blood pressure, on the other hand, is generally a sign of long life expectancy and low heart disease risk.

• The high blood pressure contributes to more than a million heart attacks and half a million strokes each year.


Arterial Blood Pressure Expressed as systolic/diastolic

• The Cardiac Cycle or Arterial Blood Pressure : includes all of the events between two consecutive cycles;-

1 -Systole: contraction phase;-systolic pressure- the blood pressure in the arteries when the heart is contracting and pumping blood (the pressure at which a sound of heart beat heard)

2 -Diastole: relaxation phase;-diastolic pressure- the blood pressure in the arteries when the heart is at rest between beats (the pressure at which the sound disappears)


if the resting blood pressure is above normal, the reading should be repeated before confirming the

diagnosis of hypertension

Sphygmomanometer


Classification of blood pressure for adults (WHO)

category Systolic(mmHg) Diastolic (mmHg)

Normal < 120 < 80Pre-hypertension 120-139 80-89Hypertension*Stage one

*Stage two

140-159

> 160

90-99

> 100


Dietary Strategies to Stop Hypertension (DASH) ,

• The following dietary plans based on;-

• USDA (United States Department of Agriculture)

• the American Heart Association Dietary Strategies to Stop Hypertension (DASH) ,


Dietary Strategies to Stop Hypertension (DASH)

• The Dietary Strategies to Stop Hypertension (DASH) recommended that;-

• diet rich in fruits, vegetables, nuts, and low-fat milk products and low in total fat and saturated fat have positive effect on blood pressure.


• the DASH diet lowers total cholesterol and LDL cholesterol.

• Compared to the typical American diet, the DASH eating plan provides more fiber, potassium, magnesium, and calcium and less red meat, sweets, and sugar-containing beverages


The DASH Eating Plan and the USDA Food Guide

These diet plans are based on 2000 kcalories per day

Food Group DASH USDA

Grains 6–8 oz 6 ozVegetables 2–2 c 2 cFruits 2–2 c 3 cMilk (fat-free/low-fat

2–3 c 2 c

Lean meats, poultry, fish

6 oz or less 5. oz

Nuts, seeds, legumes

4–5 oz per week combines nuts, seeds, and legumes with meat, poultry, and fish.


• Salt/Sodium Intake control;

• The combination of the DASH diet with a limited intake of sodium, however, improves blood pressure better than either strategy

• the lower the sodium intake, the greater the drop in blood pressure.

• Dietary Guidelines for Americans recommended no more than 1500 mg of sodium per day and to meet the potassium recommendation


• Weight Control to reduce high blood pressure

• Weight loss alone is one of the most effective nondrug treatments for hypertension.

• Physical activity helps with weight control, but moderate aerobic activity, such as 30 to 60 minutes of brisk walking most days, also helps to lower blood pressure directly.


Lifestyle Modifications to Reduce Blood Pressure adapted from; Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition (2008),

Modifi cation Recommendation Expected Reductionin Systolic Blood prssure

Weight reduction

Maintain healthy body weight (BMI below 25).

5–20 mm Hg/10 kg lost

DASH eating Adopt a diet rich in fruits, vegetables, and 8–14 mmHg low-fat milk products with reduced saturated fat intake.

8–14 mm Hg

Sodium restriction

Reduce dietary sodium intake to less than 2–8 mm Hg 2400 milligrams sodium (less than 6 grams salt) per day.

2–8 mm Hg


Risk Factors for Coronary Heart Disease overweight and obesity

• Obesity is a disease of multiple etiologies characterized by an excess accumulation of adipose tissue (more than 20% of the desirable weight) and due to

• enlargement of fat cell size (hypertrophic obesity) or• an increase in fat cell number (hyperplastic obesity)

or • a combination of both.


• Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity for both sexes and for all ages of adults.


components of body composition

• A two-component of body composition divides the body into;

• 1-fat component

• 2-fat-free component (Lean body mass)


Fat component

• Body fat is the most variable constituent of the body. The total amount of body fat consists of essential fat and storage fat.

• Fats, the energy reserve of body stored as triglycerides in adipose tissue and under the skin and around internal organs (bone marrow, lung, liver, spleen, kidneys, intestine, heart and lipid rich tissues in nervous system)

• Adipose tissue is located under the skin (storage fat)

• Triglycerides are the main fat depot


• visceral fat: fat stored within the abdominal cavity in association with the internal abdominal organs; also called intra-abdominal fat

• Visceral fat that is stored around the organs of the abdomen is referred to as central obesity or upper-body fat.


Abdominal Fat

In overweight people, excess abdominal fat increases the risks of diseases.

In healthy-weight people, some fat is stored around the organs of the abdomen


Apple and PearBody Shapes

Lower-body fat is more common in women than in men and is not usually associated with chronic diseases.

Upper-body fat is more common in men than in women and is closely associated with heart disease, stroke, diabetes, hypertension, and some types of cancer.

central obesity is associated with increased risks of heart disease, stroke, diabetes, insulin resistance, hypertension, gallstones, and some types of cancer.


Causes of Obesity

• Genetic factors• Psychological factors• Hormonal imbalance• Sedentary lifestyle• Excess consumption of calorie rich foods.• If a person is obese it is very essential to know

the hazardous consequences of obesity


Health Consequences of Obesitywww.cdc.gov/chronicdisease/resources/publications/aag/obesity.htm

• Obesity increases the risk of many health conditions, including the following:

• Coronary heart disease, stroke, and high blood pressure.• Type 2 diabetes.• Cancers, such as breast, and colon cancer.• High total cholesterol or high levels of triglycerides.• Liver and gallbladder disease.• respiratory problems.• Degeneration of cartilage and underlying bone within a joint

(osteoarthritis).• Reproductive health complications such as infertility.• Mental health conditions.


five target areas identified by CDC for preventing and reducing obesity

• Increase consumption of fruits and vegetables.• Increase physical activity.• Increase breastfeeding• Decrease consumption of sugar drinks.• Decrease consumption of high-energy-dense

foods, which are high in calories.


Management of obesity

• There are three basic components for the reduction of weight:

• Diet• Exercise• Behavior modification


What is diabetes?

• Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

• Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.


• WHO projects stated that diabetes will be the 7th leading cause of death in 2030

• Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes


• diabetes mellitus are of two types either;

• 1- Type 1 DM; (insulin-dependent, juvenile or childhood-onset) people cannot produce insulin.

it results from the body's failure to produce insulin, and presently requires the person to inject insulin.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.


• 2- Type 2 DM; (non-insulin-dependent or adult-onset) the insulin they produce is ineffective in stimulating the uptake of blood sugar (glucose) into the body's cells.

• Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

• Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.


HypothalamusResponse of hypothalamus to blood glucose level

If the sugar levels in the blood fall far below their usual range, the brain (hypothalamus) responds by stimulating;*the adrenal glands, *the pancreas and * the pituitary gland


Response of hypothalamus to blood glucose level

• the brain (hypothalamus) responds by stimulating;

• *the adrenal glands to release, 1-adrenaline or norepinephrine, 2-epinephrine and 3-cortisol,

• 1-adrenalin or norepinephrine, increase energy in the form of glucose and free fatty acids mainly during activities or exercise


• 2-Epinephrine stimulate the liver to release glucose and accelerates the use of glycogen in the muscle

• 3-cortisol, release of amino acids from muscle tissue to provide substrate to liver for gluconeogenesis


The Adrenal Glandadrenalin, epinephrine and cortisol


the pancreasthe endocrine pancreas, secretes hormones called insulin and glucagon.These hormones regulate the level of glucose in the blood.

These hormones have competing functions; -insulin stimulates glucose uptake by body tissues, - glucagon increase the rate of gluconeogenesis in the liver and help to increase blood glucose levels


insulin a hormone secreted by special cells in the pancreas in response to (among other things) increased blood glucose

concentration. The primary role of insulin is to control the transport of glucose from the bloodstream into the muscle and fat cells.


glucagon: a hormone that is secreted by special cells in the pancreas in response to low blood glucose concentration and

elicits release of glucose from liver glycogen stores.


the pituitary gland

hypothalamus stimulate the pituitary gland to release growth hormone, all of which cause the liver to regulate glucose into the blood


• Gestational diabetes• Gestational diabetes is hyperglycaemia with

onset or first recognition during pregnancy.• Symptoms of gestational diabetes are similar

to Type 2 diabetes.• Gestational diabetes is most often diagnosed

through prenatal screening, rather than reported symptoms.


• Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)

• Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.


What are common consequences of diabetes?

• Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

• Diabetes increases the risk of heart disease and stroke.

• Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.


• Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina.

• Diabetes is among the leading causes of kidney failure

• The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.


Nutrition and Diabetes

• Goals of nutritional therapy• Achieve physiologic blood glucose levels• Maintain desirable plasma lipid levels• Reduce complications of diabetes mellitus• Retard development of atherosclerosis• Provide optimal selection of nutrients


• Attain and maintain desirable body weight• Individualize to preferences and food

available.• Address special requirements (such as

pregnancy)• Tailor for therapeutic needs (such as renal

failure


Calorie Requirement Based on Weight/age.

• Ref Advances in Diet Therapy by VIMLA• An excessive calorie intake results in weight

gain and obesity

• See page 160


• Carbohydrates• The present recommendation is to provide generous

amounts of complex carbohydrates and fibre and restricted fat.

• Carbohydrates should provide 50 – 60 per cent of energy

• Complex carbohydrates should account for approximately 2/3 of total carbohydrate. Among this,

• 60 – 70% should be complex carbohydrate• 30 – 40% should be simple carbohydrate


Glycemic index

• Glycemic index represents a ranking system relative to the effect that consumption of 50 grams of particular carbohydrates that influence blood glucose within 2 hours.

• The values that used to rank glycemic index of food as follows;-

*70 or more------high GI

*69-55------------medium GI foods

*55 or less--------low GI foods

A glycemic index GI value tells only how rapidly a particular carbohydrate turns into sugar


• Protein• Protein should provide 12 – 20% of energy intake• An additional 30 g may be necessary during

pregnancy and lactation• Protein requirement is increased in malnutrition,

surgery or wound healing.• In insulin dependent diabetics adequate dietary

protein (1 – 1.5g/kg body weight) is necessary for growth and development.

• Protein from vegetable source is preferable to that from animal sources


• Fat• Diabetes of all types have a greater incidence

of hyperlipidemia and atherosclerosis than do the nondiabetics.

• High fat diets offer short term benefits for glycomic control


The Healthy Eating Pyramid


Cancerref WHO Fact sheet N°297. Reviewed January 2013

• Cancer is a leading cause of death worldwide, accounting for 7.6 million deaths (around 13% of all deaths) in 2008.

• Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year.

• The most frequent types of cancer differ between men and women.


• About 30% of cancer deaths are due to the five leading behavioral and dietary risks:

• high body mass index, • low fruit and vegetable intake,• lack of physical activity, • tobacco use,• alcohol use.


What is cancer

• Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms.

• cancer is the rapid formation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs.

• This process is referred to as metastasis. Metastases is the spread of cancer from one part of the body to another

• Metastases are the major cause of death from cancer.


What causes cancer?

• Cancer arises from one single cell. The transformation from a normal cell into a tumour cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumours.

• These changes are the result of the interaction

between a person's genetic factors and three categories of external agents, including:


• 1-physical carcinogens, such as ultraviolet and ionizing radiation;

• 2-chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and other food containing carcinogens; and

• 3-biological carcinogens, such as infections from certain viruses, bacteria or parasites.


Nutrition and Cancer

Cruciferous vegetables, such as cauliflower, broccoli, and brussels sprouts, contain nutrients and phytochemicals that may inhibit cancerdevelopment.


Recommendations for Reducing Cancer Risk

• Body fatness: normal range of body weight.• Physical activity: Be physically active as

part of everyday life. • Limit consumption of energy-dense foods

and avoid sugary drinks. Consume energy-dense foods (>225 kcalories/100 grams food),


• Plant foods: Eat mostly foods of plant origin. Eat at least five servings of a variety of non starchy vegetables and fruits every day. Eat relatively unprocessed grains and/or legumes with every meal. Limit refined starchy foods

• Animal foods: Limit intake of red meat and avoid processed meat. Eat no more than 18 ounces of red meat a week, very little if any of which is processed.

• Alcoholic drinks: Limit alcoholic drinks


• Preservation, processing, preparation: Limit consumption of salt and avoid moldy grains or legumes.

• Avoid salt-preserved, salted, or salty foods.• Limit consumption of processed foods with

added salt to ensure an intake of less than 6 grams of salt (2.4 grams of sodium) a day.

• Do not eat moldy grains or legumes


• Dietary supplements: Aim to meet nutritional needs through diet.

• Dietary supplements are not recommended for cancer prevention.


• To minimize carcinogen formation during cooking:

• • Roast or bake meats in the oven.• • When grilling, line the grill with foil, or wrap

the food in foil.• • Take care not to burn foods.• • Marinate meats beforehand.


Disorders of the GI Tract nutrition


the upper GI tract

Upper GI tract — mouth, pharynx, esophagus and stomach. The stomach leads to the small intestine


the lower GI tractLower GI tract — intestines (bowel) and the anus. The bowel is made up of two sections:Small intestine — the duodenum, jejunum and ileumLarge intestine — the rectum (where the appendix is attached), colon and rectumIn addition, the liver, pancreas and gallbladder


the lower GI tract

Common Intestinal Problems;Intestinal gas or flatulenceConstipationDiarrheaSteatorrhea


Diseases of Small Intestine

• Celiac disease• Caused by inappropriate autoimmune reaction to

gliadin (found in gluten) Results in damage to villi of intestinal mucosa – atrophy, flattening

• Brush border enzyme deficiencies; Deficiency of brush border disaccharidases, Lack of sucrase, isomaltase, lactase in newborns

• Inflammatory Bowel Disease such as Crohn’s disease May involve any part of GI, Inflammation, ulceration, abcesses, fistulas


Diseases of Large Intestine

• Irritable Bowel Syndrome; Abdominal pain, bloating, abnormal bowel movements, irregular diarrhea, constipation

• Diverticular Disease; Sac-like herniations or outpouches of the colon wall

• Colon Cancer


references

• http://www.webmd.com/hiv-aids/guide/nutrition-hiv-aids-enhancing-quality-life• Key TJ. The effect of diet on risk of cancer. Lancet, 2002, 360:861-868.

• Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human Metabolism, fifth ed. WADSWORTH

• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill

• World Cancer Research Fund/American Institute for Cancer Research, Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective (Washington, D.C.: AICR, 2007), pp. 373–390.

• Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and Ross A. Catharine eds. 9th edition

• Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B. Company

http://www.webmd.com/hiv-aids/guide/nutrition-hiv-aids-enhancing-quality-life


• Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning

• http://www.livestrong.com/article/354549-the-effect-of-exercise-on-the-cardiorespiratory-system/#ixzz2UUaL51TH

• http://www.mayoclinic.com/health/medical/IM00642

• Scott K. Powers & Edward T. Howley; Theory and Application to Fitness and Performance, 6th edition. EXERCISE PHYSIOLOGY

• Sports Fitness Advisor: The Cardiovascular System and Exercise

• Read more: http://www.livestrong.com/article/192489-immediate-effects-of-exercise-on-the-cardiovascular-system/#ixzz1miWxuYrs

• Diastolic Blood Pressure During Exercise | eHow.com• Lactate Theshold Training. Len Kravitz, and Lance Dalleck,

http://www.livestrong.com/article/354549-the-effect-of-exercise-on-the-cardiorespiratory-system/

http://www.livestrong.com/article/354549-the-effect-of-exercise-on-the-cardiorespiratory-system/

http://www.mayoclinic.com/health/medical/IM00642

http://www.ehow.com/about_5074637_diastolic-blood-pressure-during-exercise.html

Lec 8 nutrition for health promotion and disease prevention 2

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