1. Nutrition for Health Professions Lecture 6 Mr. Adham I. Ahmed “BSN, RN, MCN” University of Palestine Health Sciences College Associate Degree Program

2. Mr. Adham Ahmed Lipids or Fats

3. Lecture 6Mr. Adham Ahmed3 Objectives  State the functions of fats in the body  Identify sources of dietary fats  Explain common classifications of fats  Describe disease conditions with which excessive use of fats is associated

4. Lecture 6Mr. Adham Ahmed4 Facts  Fats belong to a group of organic compounds called lipids.  Greasy substances that are insoluble in water.  Each gram of fat contains 9 kcal.  Composed of carbon, hydrogen, and oxygen; lower proportion of oxygen than carbohydrates.

5. Lecture 6Mr. Adham Ahmed5 Functions  Provide energy  Carry fat-soluble vitamins  Supply essential fatty acids  Protect and support organs and bones  Insulate from cold  Provide satiety to meals

6. Lecture 6Mr. Adham Ahmed6 Food Sources Animal Fatty meats Lard شحم الخنزير Butter Cheese Cream; whole milk Egg yolk Plant Vegetable oils Nuts Chocolate Avocados Olives Margarine

7. Lecture 6Mr. Adham Ahmed7 Visible and Invisible Fats Visible fats Fats in foods that are purchased and used as fats, such as butter or margarine, lard, cooking oils Invisible fats Fats that are not immediately noticeable such as those in egg yolk, cheese, cream, and salad dressings

8. Lecture 6Mr. Adham Ahmed8 You are the nurse teaching a class about nutrition. What are some suggestions you can give? A client asks about ways to decrease the amount of fat in the diet. What are some suggestions you can give?

9. Lecture 6Mr. Adham Ahmed9  Beware of hidden fats!  Decrease the amount of fatty meats (sausage, luncheon meats) and use lean meats instead.  Use low-fat or skim milk.  Use egg whites instead of yolks when possible. (Egg white contains no fat; it is almost entirely protein and water.)

10. Lecture 6Mr. Adham Ahmed10 Classification Triglycerides Most lipids in the body (95%) are triglycerides Composed of three fatty acids attached to a framework of glycerol Phospholipids Sterols Cholesterol

11. Lecture 6Mr. Adham Ahmed11 Fatty Acids  Fatty acids are organic compounds of carbon atoms to which hydrogen atoms are attached.  They may be classified in two ways.

12. Lecture 6Mr. Adham Ahmed12 Fatty Acid Classification May be classified by the body’s need for them Essential Nonessential May be classified by degree of saturation with hydrogen atoms Saturated Unsaturated - Monounsaturated - Polyunsaturated

13. Saturated VS Unsaturated Lecture 6Mr. Adham Ahmed13

14. Lecture 6Mr. Adham Ahmed14 Essential Fatty Acids  Cannot be synthesized by the body  Must be obtained from the diet  Types -Linoleic acid (unsaturated omega-6 fatty acid) -Linolenic acid (unsaturated omega-3 fatty acid)

15. Lecture 6Mr. Adham Ahmed15 Non-essential Fatty Acids  Can be synthesized by the body  Arachidonic fatty acid, previously thought to be essential, can be synthesized in the body from linoleic fatty acid.

16. Lecture 6Mr. Adham Ahmed16 Saturated Fats  Each of its carbon atoms carries all the hydrogen atoms possible.  In general, animal foods contain more saturated fatty acids than unsaturated.  Usually solid at room temperature.  Examples: Meat, poultry, egg yolks, whole milk, whole milk cheeses, cream, ice cream, butter, chocolate, coconut, palm oil

17. Lecture 6Mr. Adham Ahmed17 Monounsaturated Fats  Fewer hydrogen atoms attached to one place among the carbon atoms of its fatty acids than saturated fats.  Lowers low-density lipoprotein (LDL or “bad cholesterol”).  Examples: Olive oil, canola oil, avocados, cashew nuts 15% of total daily kcal  Recommended: 15% of total daily kcal

18. Lecture 6Mr. Adham Ahmed18 Polyunsaturated Fats  Fewer hydrogen atoms attached to two or more places among the carbon atoms of its fatty acids than saturated fats.  Examples: Cooking oils made from sunflower, safflower, sesame seeds or from corn or soybeans, soft margarines whose major ingredient is liquid vegetable oil, and fish

19. Lecture 6Mr. Adham Ahmed19 Polyunsaturated Fats  Foods containing high proportions of polyunsaturated fats are usually soft or oily.  Omega-3 fatty acids (found in fish) lower the risk of heart disease.  Omega-6 (linoleic acid) has a cholesterol- lowering effect.  Recommended: 10% of total daily kcal

20. Lecture 6Mr. Adham Ahmed20 Hydrogenated Fats  Polyunsaturated vegetable oils to which hydrogen has been added commercially to make them solid at room temperature.  This process, called hydrogenation, turns polyunsaturated vegetable oils into saturated fats.  Margarine is made in this way.

21. Lecture 6Mr. Adham Ahmed21 Trans-Fatty Acids (TFAs)  Produced when hydrogen atoms are added to monounsaturated or polyunsaturated fats to produce a semi-solid product like margarine and shortening.  TFAs raise low-density lipoproteins (LDL) and total cholesterol.  Major source: baked goods and restaurant foods

22. Lecture 6Mr. Adham Ahmed22 Phospholipid  Found in both plant and animal foods, and is synthesized in the liver.  Natural emulsifier that helps transport fat in the bloodstream.  Example: Lecithin

23. Lecture 6Mr. Adham Ahmed23 Cholesterol  Cholesterol is a sterol  Fatlike substance  Exists in animal foods and body cells  Does not exist in plant foods  Essential for the synthesis of bile, sex hormones, cortisone, and vitamin D  Needed by every cell in the body

24. Lecture 6Mr. Adham Ahmed24 Your client has been diagnosed with a high cholesterol level greater than 200 mg/dl. Answer the following questions:  What risks are associated with a high cholesterol level?  What can be done to lower a high cholesterol level?

25. Lecture 6Mr. Adham Ahmed25  High cholesterol leads to atherosclerosis, a cardiovascular disease in which plaque (fatty deposits containing cholesterol and other substances) forms on the inside of artery walls.  This can lead to heart attacks and strokes.

26. Lecture 6Mr. Adham Ahmed26  Reduce the amount of total fat, saturated fats, and cholesterol.  Increase monounsaturated fats in the diet, lose weight and exercise.  Increase consumption of soluble dietary fiber.  Medication may be prescribed in some cases.  Daily cholesterol intake should not exceed 300 mg.

27. 27 Digestion and Absorption  95% of ingested fats are digested  Complex process  Chemical digestion of fats occurs mainly in the small intestine  No digestion of fats occurs in the mouth  Slight digestion in stomach where gastric lipase acts on emulsified fats such as those found in cream and egg yolk.

28. Lecture 6Mr. Adham Ahmed28 Digestion and Absorption Digestion in the small intestine Bile emulsifies the fats The enzyme pancreatic lipase reduces the fats to fatty acids and glycerol The body subsequently absorbs through the villi of the small intestine

29. Lecture 6Mr. Adham Ahmed29 Digestion and Absorption

30. Lecture 6Mr. Adham Ahmed30 Lipoproteins  In the initial stages of fat absorption, bile joins with the products of fat digestion to carry fat.  Later, protein combines with the final products of fat digestion to form special carriers called lipoproteins.  Lipoproteins carry the fat in the blood to the body cells.

31. Lecture 6Mr. Adham Ahmed31 Lipoproteins Classified according to mobility and density Types Chylomicrons Very-low-density lipoproteins (VLDLs) Low-density lipoproteins (LDLs) High-density lipoproteins (HDLs)

32. Lecture 6Mr. Adham Ahmed32 Chylomicron  First lipoprotein identified after eating  Largest lipoprotein  Lightest in weight  Composed of 80-90% triglycerides

33. Lecture 6Mr. Adham Ahmed33 Very-low-density Lipoproteins (VLDLs)  Made by the liver to transport lipids throughout the body.  Composed of 55-65% triglycerides.  Carry triglycerides and other lipids to all cells.  As the VLDL lose triglycerides, they pick up cholesterol from other lipoproteins in the blood and they then become LDL.

34. Lecture 6Mr. Adham Ahmed34 Low-density Lipoproteins (LDLs)  Composed of 45% cholesterol with few triglycerides.  Carry most of the blood cholesterol from the liver to the cells.  Elevated blood levels greater than 130 mg/dl of LDL are thought to be contributing factors in atherosclerosis.  “Bad cholesterol”

35. Lecture 6Mr. Adham Ahmed35 High-density Lipoproteins (HDLs)  Carry cholesterol from the cells to the liver for eventual excretion.  Levels of HDL greater than 35 mg/dl are thought to reduce the risk of heart disease.  Exercise, maintaining a desirable weight, and giving up smoking are all ways to increase one’s HDL.  “Good cholesterol”

36. Lecture 6Mr. Adham Ahmed36 Metabolism and Elimination  The liver controls fat metabolism.  The metabolism of fats occurs in the cells.  Fatty acids are broken down to carbon dioxide and water, releasing energy.

37. Lecture 6Mr. Adham Ahmed37 Metabolism and Elimination  Portion of fat not needed for immediate use stored as adipose tissue.  Carbon dioxide and water are waste products removed from the body by the circulatory, respiratory, and excretory systems.

38. Lecture 6Mr. Adham Ahmed38 Your client asks you about a new dietary supplement that advertisers claim provides essential nutrients and lowers cholesterol “naturally”. How do you advise your client?

39. Lecture 6Mr. Adham Ahmed39  Any new dietary “supplement” for which a nutrition claim is made should be carefully evaluated.  If the item is not included in the RDA or DRI, it is safe to assume that medical research has not determined that it is essential.  Ingestion of dietary supplements of unknown value could, ironically, be damaging to one’s health.

40. Mr. Adham Ahmed40 Fat Alternatives Olestra: Made from carbohydrates and fat FDA approved for use in snack food Government requires that food labels indicate olestra “inhibits absorption of some vitamins and other nutrients” Contains no calories; can cause cramps and diarrhea Simplesse: Made from egg white or milk protein Oatrim: Carbohydrate-based; derived from oat fiber

41. Lecture 6Mr. Adham Ahmed41 Dietary Requirements  The Food and Nutrition Board’s recommends that people reduce their fat intake to 30% of total kcal.  American Heart Association’s newest recommendation is to consume </=7% of saturated fats, 8-10% polyunsaturated fats and 15% monounsaturated fats.  At present, 36% of kcal in U.S. diets is derived from fats.

42. Lecture 6Mr. Adham Ahmed42 Conclusion  Fats provide energy, carry essential fatty acids and fat-soluble vitamins, protect organs and bones, insulate from cold, and provide satiety to meals.  Composed of carbon, hydrogen, and oxygen and are found in both animal and plant foods.

43. Lecture 6Mr. Adham Ahmed43 Conclusion  Each gram of fats provides 9 kcal.  Digestion occurs primarily in small intestines.  An excess of fat in the diet can result in obesity and possible heart disease or cancer.