1. By: Dr. Wael Thanoon C.A.B.M. College of medicine ,Mosul University.
Nutrition
By:
Dr. Wael Thanoon
C.A.B.M.
College of medicine ,Mosul University.

2. Physiology of nutrition :
Nutrients in the diet can be classified into:
1)macronutrients: which are eaten in relatively large amounts to provide fuel for energy which include carbohydrates,proteins and lipids
2) micronutrients: e.g. vitamins and minerals, which do not contribute to energy balance but are required in small amounts because they are not synthesized in the body.

4. Carbohydrates: The body’s chief source of energy Sugar Starches Fibers
Simple Carbohydrates
Glucose: Blood
Fructose: Fruit
Galactose: Milk
Sucroce: Table sugar
Starches
Complex Carbohydrates
Fibers

5. Fats: Important energy source
Lipid family which includes fats and oils
Hydrogenation: adds hydrogen atoms to unsaturated fatty acids (liquid) turning them into more saturated solid fats
Crisco and margarine sticks
Cholesterol: fat like substance found in every cell in the body
Important… found in skin tissue, produces hormones
Two types: Dietary and Blood

6. Proteins: Provide energy, encourage growth and tissue repair
Made up of small units called amino acids
20 important to the human body: 9 your body can’t make and 11 it can
Complete protein: animal foods and soy
Incomplete proteins: plant foods
Must pair 2 foods together: beans and rice.

7. Obesity: Complications of obesity:
'Metabolic syndrome‘:Type 2 diabetes, Hypertension, dyslipidaemia and central obesity which lead to increase risk of Coronary heart disease,stroke, and complication of diabetes.
Liver fat accumulation:Non-alcoholic steatohepatitis(NASH),cirrhosis.
Restricted ventilation:Exertional dyspnoea, Sleep apnoea, Respiratory failure (Pickwickian syndrome).
Mechanical effects of weight:Urinary incontinence,Osteoarthritis,Varicose veins.

8. Increased peripheral steroid interconversion in adipose tissue:Hormone-dependent cancers (breast, uterus),Polycystic ovary syndrome (infertility, hirsutism)
Others:Psychological morbidity (low self-esteem, depression), Socioeconomic disadvantage (lower income, less likely to be promoted), Gallstones, Colorectal cancer, Skin infections (groin and submammary candidiasis; hidradenitis).

10. Management :
Lifestyle advice :Regular eating patterns and maximising physical activity are advised.
Weight loss diets :
Drugs:Currently recommended:
Orlistat:a Pancreatic lipase inhibitor
Sibutramine,a Serotonergic in CNS.
Surgery:'Bariatric' surgery to reduce the size of the stomach is by far the most effective long-term treatment for obesity and is the only anti-obesity intervention that has been associated with reduced mortality. Bariatric surgery should be contemplated in motivated patients who have very high risks of complications of obesity , in whom extensive dietary and drug therapy has been inadequately effective.

11. Vitamins:
Fat soluble vitamins:
A,D,E and K

12. 2. Water soluble vitamins:

13. Fat-soluble vitamins :
Vitamin A : Early deficiency causes impaired adaptation to the dark (night blindness). Keratinisation of the cornea (xerophthalmia) causes characteristic Bitot's spots, which progresses to keratomalacia, with corneal ulceration, scarring and irreversible blindness.

14. Vitamin D:
Clinical features of deficiency: Vitamin D deficiency in children causes delayed development, muscle hypotonia, craniotabes (small unossified areas in membranous bones of the skull that yield to finger pressure with a cracking feeling), bossing of the frontal and parietal bones and delayed anterior fontanelle closure, enlargement of epiphyses at the lower end of the radius, and swelling of the rib costochondral junctions ('rickety rosary').

15. Osteomalacia in adults presents insidiously
Osteomalacia in adults presents insidiously. Mild osteomalacia can be asymptomatic or present with fractures and mimic osteoporosis. More severe osteomalacia presents with muscle and bone pain, general malaise and fragility fractures. Proximal muscle weakness is prominent and the patient may walk with a waddling gait and struggle to climb stairs or get out of a chair. There may be bone and muscle tenderness on pressure and focal bone pain can occur due to fissure fractures of the ribs and pelvis.

16. Vitamin E:
Human deficiency is rare and has only been described in premature infants and in malabsorption. It can cause a mild haemolytic anaemia, ataxia and visual scotomas. Vitamin E intakes are considered safe up to 3200 mg/day (1000-fold greater than recommended intakes). Diets rich in vitamin E are consumed in countries with lower rates of coronary heart disease. However, randomised controlled trials have not demonstrated cardioprotective effects of vitamin E or other antioxidants.

17. Vitamin K :
Vitamin K deficiency leads to delayed coagulation and bleeding. In obstructive jaundice, dietary vitamin K is not absorbed and it is essential to administer the vitamin in parenteral form before surgery. Warfarin and related anticoagulants act by antagonising vitamin K. Vitamin K is given routinely to newborn babies to prevent haemorrhagic disease. Symptoms of excess have been reported only in infants, with synthetic preparations linked to haemolysis and liver damage.

18. Water soluble vitamins:
Vitamin C (ascorbic acid)
Ascorbic acid is the most active reducing agent in
the aqueous phase of living tissues and is involved
in intracellular electron transfer. It takes part in the
hydroxylation of proline and lysine in protocollagen to
hydroxyproline and hydroxylysine in mature collagen.
It is very easily destroyed by heat, increased pH and
light, and is very soluble in water; hence many tradi­
tional cooking methods reduce or eliminate it. Claims
that high­dose vitamin C improves immune function
(including resistance to the common cold) and choles­
terol turnover remain unsubstantiated.

19. Deficiency – scurvy
Vitamin C deficiency causes defective formation of col­
lagen with impaired healing of wounds, capillary haem­
orrhage and reduced platelet adhesiveness (normal
platelets are rich in ascorbate).
A dose of 250 mg vitamin C 3 times daily by mouth should
saturate the tissues quickly. The deficiencies of the
patient’s diet also need to be corrected and other vitamin
supplements given if necessary. Daily intakes of more
than 1 g/day have been reported to cause diarrhoea and
the formation of renal oxalate stones.

21. Minerals:
Calcium:A mineral important for strong teeth and bones and for muscle and nerve function. The major mineral constituent of bone.
sources: milk and milk products, fish with bones that are eaten, turnip and mustard greens, tofu, almonds and broccoli.
Chloride: A mineral that regulates body fluid volume, concentration and acid-base balance. Balance intertwined with that of sodium
Chromium: A mineral important in regulating blood glucose. sources: brewer's yeast, whole grains and meats
Copper: A mineral that is important for nerve function, bone maintenance, growth, blood formation and utilization of glucose.
sources: organ meats, sea foods, nuts and seeds

22. Fluoride: A mineral that is important to dental and bone health
Fluoride: A mineral that is important to dental and bone health. Greatly improves resistance to cavitites
sources: fluorinated water, foods cooked in or containing fluoridated water, fish with bones that are eaten, and tea
Phosphorus: A mineral essential to bone formation and maintenance, energy metabolism, nerve function and acid balance.
sources: meat, poultry, fish, eggs, dairy products and cereal products.
Potassium: A mineral that is essential for nerve function, muscle contraction and maintenance of normal blood pressure.
sources: fruits and vegetables.

23. Selenium: A mineral associated with antioxidant properties and fat metabolism. It has been claimed to help prevent cancer and cardiovascular disease
sources: seafoods and organ meats.
Sodium: A mineral that regulates body fluid volume, concentration and acid-base
sources: table salt (sodium chloride), foods processed with table salt, milk, milk products, eggs and seafoods
Zinc: A mineral involved in wound healing, taste sensation, growth and sexual maturation and part of many enzymes regulating metabolism
sources: meat, liver, eggs and seafood (oysters).