Basic Principles of Nutriton
Prof. Dr. Ahmet AYDIN
İÜ Cerrahpaşa Tıp Fak.
Çocuk Sağlığı ve Hastalıkları ABD
Metabolizma ve Beslenme Bilim Dalı Başkanı
(www.beslenmebulteni.com) (besahmet@yahoo.com)
NUTRITIONAL
REQUIREMENTS
• Individual nutritional requirements vary with
genetic and metabolic differences.
• For infants and children, the basic goals are
satisfactory growth and the avoidance of
deficiency states.
• Good nutrition helps to prevent acute and
chronic illness and to develop physical and
mental potential; it should also provide
reserves for stress.
Oral daily water consumption at
various ages
Age
3 days
3 days-6 months
6-12 months
1-4 years
10 years
18 years
Oral daily water
consumption (mL/day)
80-100
130-160
125-145
110-135
70-85
40-50
Water is essential for existence; a lack of it results in death in a matter of
days.
Energy needs
Energy needs
• Energy needs of children at different ages
and under various conditions vary greatly.
• The approximate average expenditures of
energy by the child 6-12 yr of age are basal
metabolism, 50%; growth, 12%; physical
activity, 25%; and fecal loss, about 8%, mainly
as unabsorbed fat.
Enteral and Parenteral Energy
Consumption of a Newborn
Energy consumption
Enteral
Parenteral
Basal metabolism
48
41
Growth
29
29
Physical activity
15
10
Fecal loss
18
-
Thermoregulation
10
minimal
Energy requirement at various
body weights
Weight
Calories
<10 kg
100 kcal/kg
10-20 kg
1000 + 50 kcal/kg
> 20 kg
1500 + 20 kcal/kg
Distribution of calories
Approximately
• 9-15% of the calories are derived from
protein,
• 45–55% are derived from carbohydrate and
• 35–45% are derived from fat.
Each gram of
• Ingested protein or carbohydrate provides 4
kcal.
• 1 g of long-chain fatty acids provides 9 kcal.
Proteins
Proteins
• Protein constitutes about 20% of adult body weight. Its
amino acids are essential nutrients in forming cell
protoplasm.
• Twenty amino acids have been identified; eight were found
to be essential for children and adults.
• Nonessential amino acids can be synthesized and need not
be supplied in the diet.
• New tissue cannot be formed without all of the essential
amino acids simultaneously present in the diet.
• The absence or deficiency of only one essential amino acid
results in a negative nitrogen balance.
Types of amino acids
Essential amino acids
Nonessential amino acids
Valine
Leucine
Isoleucine
Threonine
Lysine
Tryptophan→ Serotonin
Phenylalanine→ Tyrosine
Methionine
Semi-essential
Histidine
Arginine
Glycine
Alanine
Cyst(e)in→taurine
Tyrosine→Dopamin→
Norepinephrin.
Aspartic acid
Glutamic acid→ GABA
Serine
Aspargine
Glutamine
Proline
Daily protein requirements
Age
Daily protein
requirements
Age
Daily protein
requirements
0-6 months
2 g /kg
7-14 years
1.0 g /kg
6-12 months
1.5 g /kg
15-18 years
1.1 g /kg
1-6 years
1.2 g /kg
Adult
0.8 g /kg
Carbohydrates
Carbohydrates
The monosaccharides
• Glucose
• Fructose
• Galactose
The disaccharides
• Lactose: glucose +
galactose
• Sucrose: glucose +
fructose
• Maltose: glucose +
glucose
The polysaccharides
• Starch: glucose +
glucose + glucose ……….
• Glycogen: (animal
starch)
High glycemic load and insulin
resistance
• Highly refined carbohydrates foods with a
high glycemic load and /or index
overstimulate insulin secretion.
• While hyperinsulinemia causes fat depositon
in the fed state, it do not give permission to
hydrolysis of fats.
• Insulin resistance leads to common chronic
diseases.
Glisemik endeksi yüksek rafine
gıdaların açlık ve tokluk
metabolizması üzerine olan
etkileri nelerdir?
Glikojen
KAS
Normal
tokluk
Metabo
-lizması
KARACİĞER
İNSÜLİN (+)
Yavaş emilen
şekerler
İNSÜLİN (+)
Trigliserit
Glikojen
İNSÜLİN (+)
YAĞ DOKUSU
Protein
KARACİĞER
Glikojen
GLÜKOZ
Normal açlık
metabolizması
(insülin düşük)
Protein
KAS
Hormona
duyarlı lipaz
Trigliserit
YAĞDOKUSU
Glikojen
Glisemik
endeksi
yüksek gıda
alımından
sonraki
metabolizma
KARACİĞER
KAS
İnsülin
direnci
GLÜKOZ
Glikojen
Protein
Trigliserit
YAĞ DOKUSU
KARACİĞER
İnsülin
direncinde açlık
metabolizması
Glikojen
(insülin yüksek)
(-)
Yüksek
insülin
Glikojen
GLÜKOZ
(-)
(-)
Protein
KAS
Hormona
duyarlı lipaz
Trigliserit
YAĞDOKUSU
• Açlık sırasında, normalde enerjimizin %80’ini
veren yağların yeteri kadar yıkılmaması kan
şekerini düşürür.
• Aşırı şeker alındıktan sonra oluşan bu şeker
düşüklüğüne tepkisel (reaktif) hipoglisemi
denir.
• Reaktif hipoglisemi değişik nöropsikiatrik
bulgulara yol açar. Hipoglisemiye giren kişi
semptomlarını hafifletmek için şekerli gıdalara
aşırı düşer.
Hipoglisemide görülen semptom ve
belirtiler
Merkezi sinir sistemi
depresyonu
Adrenalin artışı
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Sersemlik
Huzursuzluk
Görme bozukluğu
Garip davranışlar
Başağrısı
Konvülsiyon
Kr. Yorgunluk
Koma
Titreme
Terleme
Çarpını
Halsizlik
Depresyon
Kr. Yorgunluk
Panik atak
Ölüm korkusu
Insulin resistance-common
chronic diseases I
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Headaches
Multiple sclerosis
Alzheimer disease.
Hyperactivity
Anxiety
Depression
Concentration
difficulties
• İnappropriate behavior
• Decreased performance
• Drowsiness
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Chromium deficiency
Copper deficiency
Calcium deficiency
Magnesium deficiency
breast cancer
Ovary cancer
Gastric cancer
Prostate cancer
Rectum cancer
Colon cancer
Gall bladder cancer.
Insulin resistance-common
chronic diseases II
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Reactive hypoglycemia
Coronary heart disease
Rise in triglycerides
Rise in LDL
Decrease in HDL
Wrinkles
Grey hair
Baldness
Alcoholism
Obesity
Gallstones
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Stomach ulcer
Appendicitis
Fatty liver
Crohn's disease
Ulcerative colitis
Dyspepsia
Constipation
Bacterial infection
Candidiasis
Kidney damage
Kidney stones
Insulin resistance-common
chronic diseases III
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Arthritis
Hemorrhoids
Varicose veins
Asthma
Emphysema
Dental caries
Periodontal disease
Osteoporosis
Hypertension
Food allergies
Diabetes
• Cataracts
• Atherosclerosis
• Free radical formation
Fluid retention
• Myopia
• Macular degeneration
• Gout
• Toxemia (pregnancy)
• Premensturel syndrome
• Eczema
Lipids
Lipids
CH3(CH2)n-COOH
Fatty acids
G
l
i
s
e
r
o
l
Cholesterol
Esther of
Cholesterol
Triglycerides
G
l
i
s
e
r
o
l
Sfingozin
Fosfat
Azotlu baz
Phospholipid
Glükoz/
Galaktoz
Sfingolipi
Sphingolipid
Trans and cis fatty acids
ESSENTIAL FATTY ACIDS
• Essential fatty acids (EFA) are polyunsaturated and
grouped into two families, the omega-6 EFAs and the
omega-3 EFAs.
• Fats are molecules with a long carbon chain and they
have two ends. One end has a methyl group and the
other end has a carboxyl group.
• The Greek symbol "omega" is used as it is the last
letter in the Greek alphabet. When omega is used in
reference to fatty acids it is referring to the methyl
end of the fatty acid.
• Thus Omega-3 fatty acids refer to the
family of fatty acids in which the first
cis double bond closest to the methyl
end of the fat is in the 3rd position.
• Omega-6 refers to the family of fatty
acids where the first cis double bond
closest to the methyl end is in the 6th
position.
carboxyl
group
methyl
group
• Although we do need both omega-3s and omega-6s it
is becoming increasingly clear that an excess of
omega-6 fatty acids can have dire consequences.
• Our ancestors evolved on a diet with a ratio of
omega-6 to omega-3 of about 1:1.
• A massive change in dietary habits over the last few
centuries has changed this ratio to >20:1 and this
spells trouble.
Sources and requirements
• The main sources of omega-6 fats are vegetable oils
such as corn oil and soy oil that contain a high
proportion of linoleic acid.
• Omega-3 fats are found in flaxseed oil, walnut oil, and
marine plankton and fatty fish.
• The main component of flaxseed and walnut oils is
alpha-linolenic acid while the predominant fatty acids
found in fatty fish and fish oils are eicosapentaenoic
acid (EPA) and docosahexaenoic acid (DHA).
• Humans do not synthesize linoleic or linolenic
acid. Both must be supplied in the diet and
are, therefore, "essential."
• Linoleic acid is the precursor of arachidonic
acid, the prostaglandins and the leukotrienes.
• Essential fatty acids are necessary for
growth, skin and hair integrity, regulation of
cholesterol metabolism, lipotropic activity,
decreased platelet adhesiveness, and
reproduction.
Inflamatory mediators
Tissue
phospholipids
Fosfolipase A2
Dietary
omega-6s
Archidonic acid
Lipooxigenase
(-)
Cyclooxigenase
(-)
Dietary omega-3’s
Leukotiriene A4
Prostaglandin H2
Hydrolase
Leukotiriene
B4
Prostaglandin E2
Thrombaxane A2
Antiinflamatory mediators
Tissue phospholipids
Dietary
omega-3s
Fosfolipase A2
Eicosapentoenoic acid
Lipooxigenase
(-)
(-)
Cyclooxigenase
Dietary omega-6’s
Prostaglandin H3
Leukotiriene A5
Hydrolase
Leukotiriene B5
Prostaglandin E3
Thrombaxane A3
Inflamation
(-)
cytokines
TNF-α
interleukine-1(b)
interleukine -6
Omega-3
Dehydroepiandrosterone
Vitamin K
Vitamin E
n-acetyl cystein
Nettle seed
Vitamin D
II. group prostaglandins,
IV. Group leukotiriens
(omega-6)
I. and III. group
prostaglandins,
V. Group leukotiriens
(omega-3)
Inflamatory
Hyperalgesic
Thrombotic
Mitogenic
Antiinflamatory
Analgesic
Antithrombotic
Antimitogenic
Diseases related to omega-3
fatty acids deficiency
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Acne
Psychiatric Disorders
AIDS
Allergies
Alzheimer
Angina pectoris
Atherosclerosis
Arthritis
Behavioral disorders
Senility
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Immune deficiency
Heart disease
Cancer
Cystic fibrosis
Learning disorders
Leukemia
Lupus
Malnutrition
Menopause
Schizophrenia
Diseases related to omega-3
fatty acids deficiency
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Diabetes
Dermatitis
Infection
Inflamatory Diseases
Breast Cancer
Breast cyst
Palsy
Vision disorders
Hypertension
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Hyperactivity
Metastasis
Multipl Sclerose
Otoimmunity
Obesity
Chronic fatigue
syndrome
• Psoriasis
• Reye syndrome
Saturated fatty acids
Butter
Beef tallow
Margarine
Monounsaturated fatty
acids (omega-9)
Olive oil
Hazelnut oil
Fatty acids
Poliunsaturated fatty
acids (omega-3)
Fish / liver oil
Flaxseed oil
Wall nut oil
Canola oil
Poliunsaturated fatty
acids (omega-6)
Corn
Sun flower
Soya
Cotton
Minerals
Minerals
• Macrominerals. Minerals in which the requirements are over 50
mg/day for an adult.
• The principal macrominerals are cations such as calcium,
magnesium, potassium, and sodium and their comparable anions
are phosphorus, sulfur, and chloride.
• Microminerals: Minerals in which the requirements are below 50
mg/day for an adult.
• Iron, iodine, and cobalt appear in important organic complexes.
The trace elements fluorine, copper, zinc, chromium, manganese,
selenium, and molybdenum have known metabolic roles; silicon,
boron, nickel, aluminum, arsenic, bromine, and strontium are
toxic and also present in the diet and in the body.
Vitamins
Water and fat soluble vitamins
B complex vitamins are
coenzymes of enzymatic
reactions.
B complex vitamins that have
roles in energy
metabolism
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Vitamin B1 (thiamin)
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Vitamin B2 (riboflavin)
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Vitamin B3 (Niacin=
nicotinic acid)
•
Vitamin B5 (pantothenic
acid)
•
Biotin
Other B complex vitamins
• B12 vitamini (cyanocobalamin)
• Folic acid
• Vitamin B6 (pyridoxine)
II. Vitamin C (antioxidant)
Fat soluble vitamins
• Vitamin A (antioxidant)
• Vitamin E (antioxidant)
• Vitamin D (calcium
metabolism)
• Vitamin K (coagulation)
Water soluble vitamins
• Because of their water solubility, excesses of these
vitamins are excreted in urine and so rarely
accumulate in toxic concentrations.
• They are heat-labile and can be absorbed in
malabsorption syndromes.
Fat soluble vitamins
• Because of their fat solubility, excesses of these
vitamins are not excreted in urine and accumulate in
toxic concentrations.
• They are heat-resistant and can not be absorbed in
malabsorption syndromes.
Flavonoids
Flavonoids
• Flavonoids are water soluble polyphenolic molecules
containing 15 carbon atoms. Flavonoids belong to the
polyphenol family.
• Flavanoids can be visualized as two benzene rings
which are joined together with a short three carbon
chain.
• The flavonoids consist of 6 major subgroups: chalcone,
flavone, flavonol, flavanone, anthocyanins and
isoflavonoids.
• Together with carotenes, flavanoids are also
responsible for the coloring of fruits, vegetables and
herbs.
Flavonoids
• Flavonoids have antioxidant activity. Flavonoids are
becoming very popular because they have many health
promoting effects.
• Some of the activities attributed to flavonoids include:
anti-allergic, anti-cancer, antioxidant, anti-inflammatory
and anti-viral.
• Epidemiological studies have illustrated that heart
diseases are inversely related to flavonoid intake.
• The contribution of flavonoids to the total antioxidant
activity of components in food can be very high because
daily intake can vary between 50 to 500 mg.
Flavonoid Subclass
Dietary Flavonoids
Some Common Food
Sources
Anthocyanidins
Cyanidin, Delphinidin,
Malvidin, Pelargonidin,
Peonidin, Petunidin
Red, blue, and purple
berries; red and purple
grapes; red wine
Flavanols
Monomers (Catechins):
Catechin, Epicatechin,
Epigallocatechin
Epicatechin gallate,
Epigallocatechin gallate
Catechins: Teas
(particularly green and
white), chocolate, grapes,
berries, apples
Dimers and Polymers:
Theaflavins,
Thearubigins,
Proanthocyanidins
Theaflavins, Thearubigins:
Teas (particularly black
and oolong)
Proanthocyanidins:
Chocolate, apples, berries,
red grapes, red wine
Flavonoid Subclass
Dietary Flavonoids
Some Common Food
Sources
Flavanones
Hesperetin, Naringenin,
Eriodictyol
Citrus fruits and juices,
e.g., oranges,
grapefruits, lemons
Flavonols
Quercetin, Kaempferol,
Myricetin, Isorhamnetin
Widely distributed:
yellow onions, scallions,
kale, broccoli, apples,
berries, teas
Flavones
Apigenin, Luteolin
Parsley, thyme, celery,
hot peppers,
Isoflavones
Daidzein, Genistein,
Glycitein
Soybeans, soy foods,
legumes
Probiotics
• There are 100 trillion beneficial bacteria =
probiotics (1.5 kg) in your bowels (Bowel
flora).
• Bacteria in your bowels outnumber the cells in
your body by a factor of 10 to one.
• The health of your body is largely tied into
the health of your gut, and it’s hard to have
one be healthy if the other is not.
• A large part of the influence of the "bad"
bacteria is on the intestinal lining (mucosal
barrier) that is over 300 square meters, or
about the size of a tennis court.
• Beneficial bacteria in your gut can help to
boost the immune system, prevent allergic
inflammation and food allergy, clear up
eczema in children and heal the intestines
from a variety of ailments.
• However, if you are eating as many sugars as the
typical Western diet (about 100 kg per year) then you
are feeding the "bad" bacteria, which are more likely
to cause disease than promote health, rather than
promoting the "good" bacteria that help protect you
from disease.
• Exposure to chemicals will also contribute to this
disruption in your gut microflora, and over time the
imbalance will lead to illness.
• The well-known probiotics are fermented foods.
yogurt, prickle, kefir
Antioxidants
What are free radicals?
• Free radicals are unstable because they have
unpaired electrons in their molecular
structure.
• Oxygen, or oxyl, free radicals are especially
dangerous.
• These unstable molecules that interact
quickly and aggressively with other molecules
and destroy them.
Physiological functions of free
radicals
Free radicals are involved in many cellular functions
and are a normal part of living. For example;
• The mitochondria oxidizes the glucose and fatty
acids and in so doing generates free radicals.
• White blood cells also use free radicals to attack
and destroy bacteria, viruses and virus-infected
cells.
• The detoxifying actions of the liver also require
free radicals.
Oxidative Stress
• Although free radicals have useful functions
in the body under controlled conditions, they
are extremely unstable molecules that can
damage cells if left uncontrolled.
• Oxidative stress occurs when the available
supply of the body’s antioxidants is
insufficient to handle and neutralize free
radicals of different types.
• The result is massive cell damage that can
result in cellular mutations, tissue breakdown
and immune compromise.
• Free radicals destroy cellular membranes;
enzymes and DNA.
• They accelerate aging and contribute to the
development of many diseases, including
cancer and heart disease.
Toxins and free radicals
• Its important to note here that free
radicals are also released in the body
from the breaking down or
detoxification of various chemical
compounds.
Fats and free radicals
• The major sources of dietary free radicals are chemicallyaltered fats from commercial vegetable oils, margarine or
vegetable shortening and all oils heated to very high
temperatures.
• Replace these harmful fats with natural, cold pressed oils such
as olive oil (which can be used for cooking) and small amounts of
flax oil or walnut oil (which should never be heated).
• Organic butter and tallow are also excellent choices, especially
for cooking.
• Both of these naturally saturated fats are rich in certain fatty
acids that have proven activity against bacteria, harmful yeasts,
fungi and tumor cells.
Fats and free radicals
• Since saturated fats (from animal foods and the tropical oils)
and monounsaturated oils (from olive oil and cold-pressed nut
oils) are more chemically stable, they are much less susceptible
to oxidation and rancidity than their polyunsaturated cousins,
which are mostly found in vegetable oils.
• Trans-fatty acids (TFAs), are produced during hot-processing
of polyunsaturated oils.
• As a general rule, then, although the body does require a small
amount of naturally occurring polyunsaturated oils in the diet
each day, it’s best not to consume too much of them as they
are more prone to free radical attack in the body.
• They can destroy the body’s supply of vitamin E, C and other
antioxidants cause muscular lesions, brain lesions, and
degeneration of blood vessels.
ANTIOXIDANTS
• Fortunately, the body maintains a sophisticated
system of chemical and biochemical defenses to
control and neutralize free radicals.
• Chemical antioxidants scavenge free radicals, that is,
they stabilize the unstable free radicals by giving
them the electron they need to “calm down.”
• But they also inhibit free radical formation inside the
body
• The antioxidants are usually consumed or used up in
this process—they sacrifice themselves.
• The main antioxidants are vitamins A, E and C, betacarotene, glutathione, bioflavonoids, selenium, zinc,
CoQ10 (ubiquinone), and various phyto-chemicals from
herbs and foods.
• Lipoic acid, repair enzymes such as catalase,
superoxide dismutase (SOD), glutathione peroxidase.
• Melatonin, a hormone produced by the pineal gland, is
also a potent antioxidant.
• Cholesterol, produced by the liver, is another
major antioxidant, which the body uses to
repair damaged blood vessels.
• It is probably for this reason that serum
cholesterol levels rise as people age.
• With age comes more free radical activity
and in response the body produces more
cholesterol to help contain and control the
damage.
Glutathione
• Of all the antioxidants, glutathione
appears to be pivotal.
• Made up of three amino acids (cysteine,
glycine, and glutamic acid), glutathione
is part of the antioxidant enzyme
glutathione peroxidase and is the major
liver antioxidant.
1) Intercellular antioxidants
A) Superoxide dysmutase (SOD).
• 2O2+2H+ —SOD→ H2O2+O2
• SOD has two isoenzymes with Cu-Zn and Mn
B) Catalase
• 2H2O2 —catalase→ 2H2O+O2
C) Glutathione peroxidase (GSH-Px)
• H2O2 + 2 glutathione (GSH) —(GSH-Px)→ 2H2O+ GSSG
• GSH-Px has two isoenzymes (selenium dependent and selenium
independent)
D) Cytochrom oxidase
E)Glutathione:The most important intercellular antioxidant .
• glutathione (oxidised) —( glutathione reductase)→ glutathione
(reduced)
2) Antioxidants in the
membrane
• Vitamin E (alfa-tokoferol): the most
powerful lip soluble antioxidant.
• Beta-carotene
• Lipids in membrane: Cholesterol and
saturated fats in the membrane e have
antioxidant power.
3) Extracellular antioxidants
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Ascorbic acid: The most powerful
Transferrin
Lactoferrin
Haptoglobuline and hemopexine
Ceruloplasmine
Uric acid
Bilirubine
Mucus
Illnesses Associated With
Oxidative Stress
•
GI Tract: Diabetes, pancreatitis, liver damage, and leaky gut syndrome
Brain and Nervous System: Parkinson’s disease, Alzheimer’s disease,
hypertension, multiple sclerosis, Down’s Syndrome
Heart & Blood Vessels: Atherosclerosis, coronary thrombosis.
Lungs: Asthma, emphysema, chronic pulmonary disease.
Eyes: Cataracts, retinopathy, macular degeneration.
Joints: Rheumatoid arthritis
Kidneys: Glomerulonephritis
Skin: “Age spots,” vitiligo, wrinkles.
Body in General: Accelerated aging, cancer, autoimmune diseases,
inflammatory states, AIDS and lupus.