Clinical nutrition

Jardine Jade Albert C. Valdez, RMT, MSMT(c)

• Proteins
• Energy substrates
• Inorganic salts
• Vitamins
• Essential nutrients
• The daily requirements for these nutrients are
determined by many factors, including:
– Age
– Sex
– Physical activity
– Presence of disease
 Definitions of terms
1. Antioxidants – substance that protect body cells
and the immune system from damage by
harmful chemicals in air and foods
2. Electrolyte minerals – Na, Cl, and K which
control and balance fluid flow in an out of cells
3. Fat soluble vitamins – vitamins absorbed and
transported by fat.
4. Free radicals – harmful by product excreted
when cells burn oxygen to produce energy
5. Hypertension – high blood pressure linked to high
salt intake
6. Iron deficiency anemia – lack of enough iron in the
body, resulting in fatigue, weakness, and shortness of
breath
7. Major minerals – microminerals with special duties in
the body; calcium, phosphorus, magnesium, sodium,
chloride and potassium
8. Osteomalacia – a disease caused by a lack of vitamin
D in adults
9. Osteoporosis – condition caused by calcium
deficiency, bones become porous, weak and fragile.
10.Pica – condition linked to iron deficiency, causes
unusual appetite for ice, clay and other nonfood
items.
11.Toxicity – excessive amount of substance that
reacts as poison in the body
12.Trace minerals – minerals needed in only small
amount but serving vital body functions
13.Water soluble vitamins – vitamins dissolve in
water and pass easily into the bloodstream
during digestion.
 Classes of Vitamins

Fat Soluble Vitamins: Water Soluble Vitamins:

stored in tissues not stored in tissues, must
have constant supply

Examples Examples
A B, B1, B2, B6 & B12
D Niacin
E Folic Acid
K
C
 General Concepts
• Divided into two major groups: fat soluble and
water soluble
• fat soluble: A, D, E, K
• most of the 15 shown as essential for fish, but not
for all species
• requirements vary with species, size, growth rate,
environment (temperature, presence of toxins,
etc.) and metabolic function (growth, stress
response, disease resistance)
• many species can utilize intestinal bacteria
synthesis for meeting vitamin requirements
 Nutrients
• Chemical substances necessary for life.
• Functions:
– Provide energy
– Build and repair tissue
– Regulate body processes
 Nutrients
• Six classes:
– Carbohydrates
– Fats (lipids)
– Proteins
– Vitamins
– Minerals
– Water
 Nutrients
• Organic • Inorganic
– Contains carbon, – In simplest form
hydrogen, oxygen when ingested
– Carbon is found in all – Function: regulate
living things body processes
– Example: – Example:
• Carbohydrates, fats, • Water, minerals
proteins, vitamins
 Carbohydrates
•Provides major source of energy
•Examples: cereal grains, vegetables, fruits,
nuts, and sugars
 Fats (lipids)
•Provides energy
•Highest kilocalorie value
•Sources of fat: meats, milk, cream, butter,
cheese, egg yolks, oils, nuts
 Protein
•Builds and repairs body tissues
•Provides energy
•Only one of the six nutrients that contains
nitrogen
•Sources of protein: meats, fish, poultry, eggs,
milk, cheese, corn, grains, nuts, and seeds
 Vitamins
• Organic compounds
• Regulate body processes
• Examples: vitamins A, B, C, D, E and K
 Minerals
•Inorganic compounds
•Regulate body processes
•Examples: calcium, phosphorus, potassium,
sodium, chloride, iron, magnesium, zinc
 Water
• Major constituent of all living cells
• Composed of hydrogen and oxygen
 The Six Essential Nutrients and
Their Functions
Organic Nutrients Function
Carbohydrates Provide energy
Fats Provide energy
Proteins Build & repair tissues
Vitamins Regulate body processes
Inorganic Nutrients Function
Minerals Regulate body processes
Water Regulates body processes
 Water Soluble Vitamins
• Vitamin B1 (thiamin)
• Thiamin pyrophosphate is a cofactor in
the metabolism of pyruvate to acetyl
coenzyme A (CoA), 2-oxoglutarate to
succinyl CoA, and in a reaction of the
pentose shunt pathway catalyzed by the
enzyme transketolase.
• The body contains only about 30 times the
daily requirement of this vitamin.
• Diet high in carbohydrate require more
thiamin for their assimilation than diets high
in fat
 Deficiency of Vitamin B
• Sensory polyneuropathy (dry beriberi)
• Cardiac failure (wet beriberi)
• Wernicke’s encephalopathy – characterized by
ophthalmoplegia and ataxia and which may
process rapidly to stupor and death
• Korsakoff’s psychosis – memory loss is usually
the most obvious feature.
 Nicotinic acid
• Nicotinic acid is the precursor of nicotinamide.
This is a constituent of the coenzymes
nicotinamide adenine dinucleotide (NAD) and
its phosphate (NADP), which are essential to
glycolysis and oxidative phosphorylation.
 Deficiency:
• Pellagra – comprising an erythematous skin
rash that leads to desquamation,
gastrointestinal disturbance, particularly
diarrhea and dementia.
• Carcinoid syndrome
• Hartnup disease – rare inherited disorder of
the epithelial transport of neutral amino acids,
due to dec. intestinal absorption of
tryptophan from gut.
 Folic acid
• A derivative of folic acid is vital to purine
and pyrimidine (and hence nucleic acid)
synthesis.
• Folic acid deficiency is relatively
common: its most usual manifestation is
a macrocytic anemia with megaloblastic
marrow changes.
• Folic acid is usually measured by
immunoassay, although microbiological assays
were widely used in the past.
• The concentration in red cells reflects the
body’s folate reserves, while plasma
concentrations reflect recent dietary intake.
• It is essential to diagnose the cause of
megaloblastic anemia before it is treated.
• Giving folate alone to patients with vitamin
B12 deficiency risks precipitating or
exacerbating the neurological manifestations
of vitamin B12 deficiency.
• The use of folate supplements in pregnancy to
reduce the risk of neural tube defects is
discussed in a later secretion
 Vitamin B12
• Vitamin B12 comprises a number of closely
related substances called COBALAMINS, which
are essential to nucleic acid synthesis.
• Deficiency can cause: megaloblastic anemia
and neurological manifestations, either alone
or together.
• The neurological features, which may be
caused by demyelination, include peripheral
neuropathy, subacute combined degeneration
of the spinal cord, dementia and optic
atrophy.
• Dietary deficiency of this vitamin is rare except
in strict vegetarians
• Considerable amounts are stored in the liver,
with the result that deficiency is not common
even with severe malabsorption
• Pernicious anemia
• Vitamin B12 is measured in plasma by
immunoassay
• Subclinical deficiencies of both folate and
vitamin B12 increase plasma concentrations of
homocysteine which is a risk factor for
cardiovascular disease.
 Vitamin C
• Ascorbic acid
• This is essential for the hydroxylation of
proline residues in collagen and thus for
the normal structure and function of this
protein.
• Powerful antioxidant and acts by
maintaining iron in the hydroxylating
enzyme in the reduced (Fe2+) state
• Vit. C also facilitates the intestinal
absorption of dietary non-heme iron
by keeping it in the Fe2+ state.
 Fat soluble vitamins
• Vitamin A
• This vitamin is a constituent of the retinal
pigment rhodopsin.
• It is also essential for the normal
synthesis of mucopolysaccharides and
growth of epithelial tissue.
• Mild deficiency causes night blindness,
while in more severe cases degenerative
changes in the eye may lead to complete
loss of vision.
• The liver contains considerable stores of
the vitamin, and deficiency is rarely seen
in affluent societies.
• Vitamin A is present in the diet and can also
be synthesized from dietary carotenes. It can
be measured in plasma, in which it is
transported bound to prealbumin and a
specific retinol-binding globulin.
 Vitamin A: retinol
• Can only be found intact in animal sources
• in its natural form, it is alcohol known as retinol
• also isolated from various lipids and beta
carotene
– 1 beta carotene (plants) = 2 retinols (body)
• stored in the liver
• retinol + opsin (protein) = rhodopsin (vision)
• deficiency = improper growth, exophthalmia
• feeds contain non-oxidizable form, proper storage
• requirement level = 1,000 I.U. (international units)
• sources: fish oils
 Vitamin D3: cholecalciferol

• Vitamin D found as ergocalciferol (D2) and

cholecalciferol (D3)
• most land animals can use both, except
chickens (only D3)
• fish appear to use only D3
• both activated in plants/animal skin by UV
radiation
• D3 primarily used as precursor for calcium
regulation
 Vitamin E: tocopherol

• Active form is alpha tocopherol

• good antioxidant: most feed antioxidants have vit E
activity, but only 1/6 that of -tocopherol
• antioxidants used to prevent oxidation of lipids
• requirement is tied to selenium deficiency (Se is cofactor
in glutathione peroxidase)
• deficiency in fish = muscular dystrophy, reduced fertility
• requirement: 50-100 mg/kg for fish/shrimp
• sources: alfalfa meal, fish meal, rice bran, wheat
middlings, barley grains
 Vitamin K: menadione
• Originally identified as a fat-soluble factor
required for normal blood clotting
• menadione is the most active form
• actually works by activating blood-clotting
proteins
• requirement: shrimp (none), fish (unknown)
• dietary sources: alfalfa meal, liver meal
Thank you!!!!
Nutrition in Practice

Alcohol in Health & Disease

 Alcohol
• Primary cause of liver • Moderate alcohol
disease – Can help with heart
• Can be toxic to brain, GI disease
tract, & pancreas – Middle-aged & older
adults
• Abuse leads to nutrient
– Increases HDLs
deficiencies
– Reduces tendency for
blood clotting
 Dietary Guidelines
• Women, 1 drink/day
• Men, 2 drinks/day
• One drink
– 12 oz beer
– 5 oz wine
– 10 oz wine cooler
– 1½ oz of 80 proof spirits
One drink =
 Contraindicated

• Pregnant & lactating

• Children & adolescents
• Those with potential medication
interactions
• Those unable to voluntarily stop
• Activities requiring attention &
coordination
 Alcohol in the Body
• Supplies 7 kilocalories/gram
• Liver is the site of most metabolism
• Suppresses glycogen storage & glucose
availability
• Suppresses breakdown of fat
• Can inhibit protein synthesis
© 2007 Thomson - Wadsworth
 Alcohol & the Brain
• Is a CNS depressant • In excess
– Can cause sedation – Impairs judgment
– Slow reaction time – Reduces inhibitions
– Impairs speech & motor
– Relieve anxiety
function
• Extremely high levels
– Coma
– Respiratory depression
– Death
Long-Term Consequences
• Liver disease
• Damaged GI tract
• Damaged pancreas
• Can raise heart attack risk
 Alcohol & Nutrition Status

• Can displace essential nutrients

• Can cause deficiencies of
– Vitamin A
– Thiamin
– Folate
 Alcohol & Medication
• Heavy drinking can increase
medication potency
• Problematic with
– Sedatives
– Blood glucose-lowering medications
• Can reduce drug absorption
Thank you!!!!