Nutrition and Diet Therapy – Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 6

LESSON TITLE: Metabolism, Energy Balance, and Body Materials:

Composition Pen and notebook

LEARNING OUTCOMES:

At the end of the lesson, you can:

1. List the principal organs of metabolism, describe their
primary roles in metabolism;
2. Explain how an excess of any of the three energy-yielding
nutrients contributes to body fat and how an inadequate
intake of any of them shifts metabolism;
3. Describe energy balance and identify the components of
energy expenditure, the factors that affect a person’s Reference:
BMR; and, DeBruyne, L.K., Pinna, K., & Whitney E., (2016).
4. Describe the differences between body weight and body Nutrition and diet therapy: Principles and practice
composition, including methods to assess them and (9th ed.). USA: Cengage Learning.
health implications.

LESSON PREVIEW/REVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: Illustrate the pathway of digestive process.

MOUTH SMALL
ESOPHAGUS STOMACH INTESTINE

RECTUM LARGE
INTESTINE

MAIN LESSON
You will study and read their book, if available, about this lesson.

A. The Organs and Their Metabolic Roles

The metabolic reactions of every organ contribute to the body’s ability to function normally and maintain health. Metabolic
reactions also use or release energy and therefore affect body weight, with consequences for health.

The Digestive Organs, the digestive system transports foods through the gastrointestinal (GI) tract, produces digestive
juices and enzymes, absorbs nutrients, provides transport proteins to carry lipids and vitamins to other sites in the body,
and reabsorbs salts and fluids. The digestive system also possesses the body’s most rapidly multiplying cells: when
healthy, they replace themselves every few days.

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The Liver. Nutrients absorbed into the bloodstream are taken first to the liver. The liver is one of the body’s most active
metabolic factories. It receives nutrients and metabolizes, packages, stores, or ships them out for use by other organs. It
manufactures bile, which the body uses to emulsify fat for digestion and absorption. It metabolizes and detoxifies drugs,
prepares waste products for excretion, and participates in iron recycling and blood cell manufacture. It also makes many
proteins necessary for health, including immune factors, transport proteins, and clotting factors.

The Pancreas The pancreas not only contributes digestive juices to the GI tract, but also has another metabolic function:
it produces the hormones insulin and glucagon that regulate the body’s use of glucose. After a meal, as blood glucose
rises, the pancreas secretes insulin. Insulin prompts cells to take up glucose and use it as fuel; insulin also prompts liver
cells to store glucose as glycogen. When blood glucose falls (as occurs between meals), the pancreas responds by
secreting glucagon into the blood.

The Heart and Blood Vessels. The heart and blood vessels conduct blood, with its cargo of nutrients and oxygen, to all
the other body cells and carry wastes away from them. Diseases of the heart and arteries therefore affect the health of the
whole body. Metabolic reactions that affect the heart and blood vessels include, most importantly, the making and
transport of lipoproteins, which are the carriers of cholesterol and other lipids from the liver to the tissues and back again.
High blood levels of low-density lipoproteins (LDL) and very-low-density lipoproteins (VLDL) promote atherosclerosis,
which increases the risk of disability or death from heart attacks and strokes.

The Kidneys. The kidneys are also active metabolic organs. Unceasingly, for 24 hours of every day, they filter waste
products from the blood to be excreted in the urine and reabsorb needed nutrients, thereby maintaining the blood’s
delicate chemical balances. The kidneys’ cells also produce compounds that help to regulate blood pressure and convert
a precursor compound to active vitamin D, thereby helping to maintain the bones.

B. The Body’s Metabolic Work

Heat Energy and Body Temperature. The cells of each organ conduct metabolic activities specific to that organ. In
addition, all cells must maintain themselves, and many must reproduce. To do this, they must have all the essential
nutrients available to them: energy nutrients, vitamins, and minerals, as well as water. As cells do their metabolic work,
the chemical reactions that are involved release heat, and this heat keeps the body warm. By regulating the rates at which
these metabolic reactions release heat energy, the body maintains its constant normal temperature of about 98.6°F.

Accelerated Metabolism. During severe stress to the body, metabolism speeds up. Fever sometimes develops. An
accelerated metabolism signifies that fuels are being used at a rate more rapid than normal; this may lead to wasting of
body organs and loss of weight, including loss of vital lean tissue.

Building Up and Breaking Down Compounds. When not needed by the cells for energy, the basic units of the energy-
yielding nutrients are used to build body compounds.
⎯ Anabolism: reactions in which small molecules are put together to build larger ones. Anabolic reactions require
energy (ATP).
⎯ Catabolism: reactions in which large molecules are broken down to smaller ones. Catabolic reactions release
energy (ATP).

C. The Body’s Use of Fuels

Energy metabolism is the sum total of all the chemical reactions that the body uses to obtain or expend energy from foods.
Earlier chapters described how the energy yielding nutrients—carbohydrate, fat, and protein—are broken down into basic
units that are absorbed into the blood:
⎯ From carbohydrates: glucose
⎯ From fat (triglycerides): glycerol and fatty acids
⎯ From proteins: amino acids

TCA Cycle. The breakdown of energy nutrients continues in the TCA cycle (tricarboxylic acid cycle), as enzymes break
down acetyl CoA molecules. With each turn of the TCA cycle, hydrogen atoms are carried by coenzymes to the electron
transport chain. The waste product of these reactions is carbon dioxide, which is eventually exhaled.

Electron Transport Chain. The final step in energy metabolism occurs at the electron transport chain. In this process,
enzymes attach a phosphate group to ADP, creating ATP. The hydrogen atoms that were collected by coenzymes

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during glycolysis, fat breakdown, and the TCA cycles provide the chemical energy that drives ATP production. Finally, the
same hydrogen atoms are linked with oxygen to produce water.

Aerobic and Anaerobic Metabolism. The production of ATP via the electron transport chain requires oxygen in the final
step and is called aerobic metabolism. Glycolysis produces ATP without oxygen and is therefore called anaerobic
metabolism. When exercise intensity requires more ATP than can be provided by the electron transport chain (due to
limited oxygen or other factors), ATP production from glycolysis is stepped up, making glucose a critical fuel for the
exercising muscles.

D. Glucose Production

When glucose levels drop, glucose can be produced from several other compounds in a process called gluconeogenesis.
Glucose can be produced from compounds that can be converted to pyruvate, including glycerol and most amino acids.
Fatty acids can be used only for energy and cannot make glucose.

E. Energy Balance

A day’s energy balance can be stated like this: change in energy stores equals the food energy taken in (kcalories) minus
the energy spent on metabolism and physical activities (kcalories). More simply:

The energy in food and beverages is the only contributor to the “energy in” side of the energy balance equation. Before
you can decide how much food will supply the energy you or one of your clients’ needs in a day, you must first become
familiar with the amounts of energy in foods and beverages.

Energy Out. The body expends energy in two major ways: to fuel its basal metabolism and to fuel its voluntary
activities. People can change their voluntary activities to expend more or less energy in a day, and over time they can
also change their basal metabolism by building up the body’s metabolically active lean tissue.
⎯ The basal metabolic rate (BMR) is the rate of energy use for metabolism under specified conditions: after a 12-
hour fast and restful sleep, without any physical activity or emotional excitement, and in a comfortable setting. It is
usually expressed as kcalories per kilogram of body weight per hour.
⎯ Resting metabolic rate (RMR) is a measure of the energy use of a person at rest in a comfortable setting—
similar to the BMR but with less stringent criteria for recent food intake and physical activity. Consequently, the
RMR is slightly higher than the BMR.

Energy for Physical Activities. The number of kcalories spent on voluntary activities depends on three factors: muscle
mass, body weight, and activity. The larger the muscle mass required for the activity and the heavier the weight of the
body part being moved, the more kcalories are spent. The activity’s duration, frequency, and intensity also influence
energy costs: the longer, the more frequent, and the more intense the activity, the more kcalories areexpended.

Energy to Manage Food. When food is taken into the body, many cells that have been dormant become active. The
muscles that move the food through the intestinal tract speed up their rhythmic contractions, and the cells that
manufacture and secrete digestive juices begin their tasks. All these and other cells need extra energy as they participate
in the digestion, absorption, and metabolism of food. This cellular activity produces heat and is known as the thermic
effect of food. The thermic effect of food is generally thought to represent about 10 percent of the total food energy taken
in. For purposes of rough estimates, though, the thermic effect of food is not always included.

F. Body Weight and Body Composition

Body Mass Index (BMI) an index of a person’s weight in relation to height;
determined by dividing the weight (in kilograms) by the
square of the height (in meters).
⎯ A healthy weight falls between a BMI of 18.5 and 24.9
⎯ Underweight below 18.5
⎯ Overweight above 25
⎯ Obese above 30.

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Most people with a BMI within the healthy weight range have few of the health risks typically associated with too-low or
too-high body weight. Risks increase as BMI falls below 18.5 or rises above 24.9 (see Figure 6-8), reflecting the reality
that both underweight and overweight impair health status.

The BMI values are most accurate in assessing degrees of obesity and are less useful for evaluating nonobese people’s
body fatness. BMI values fail to provide two valuable pieces of information used in assessing disease risk: they don’t
reveal how much of the weight is fat, and they don’t indicate where the fat is located. To obtain these data, measures of
body composition are needed

Body Composition

For many people, being overweight compared with the standard means that they are overfat. This is not the case, though,
for athletes with dense bones and well-developed muscles; they may be overweight but carry little body fat. Conversely,
inactive people may seem to have acceptable weights but still carry too much body fat. In addition, among some racial
and ethnic groups, BMI values may not precisely identify overweight and obesity. African American people of all ages may
have more lean tissue per pound of body weight than Asians or Caucasians, for example. Thus, a diagnosis of obesity or
overweight requires a BMI value plus some measure of body composition and fat distribution.

Central Obesity. The distribution of fat on the body may influence health as much as, or more than, the total fat alone.
Visceral fat that is stored deep within the central abdominal area of the body is referred to as central obesity or upper
body fat.

Waist Circumference. A person’s waist circumference is a good indicator of fat distribution and central obesity. In general,
women with a waist circumference greater than 35 inches and men with a waist circumference greater than 40 inches
have a high risk of central obesity–related health problems.

Skinfold Measures. Skinfold measurements provide an accurate estimate of total body fat and a fair assessment of the
fat’s location. About half of the fat in the body lies directly beneath the skin, so the thickness of this subcutaneous fat is
assumed to reflect total body fat. Measures taken from central-body sites (around the abdomen) better reflect changes in
fatness than those taken from upper sites (arm and back). A skilled assessor can obtain an accurate skinfold measure
and then compare the measurement with standards.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Two activities that contribute to the basal metabolic rate are:

a. walking and running.
b. maintenance of heartbeat and running.
c. maintenance of body temperature and walking.
d. maintenance of heartbeat and body temperature.
ANSWER: D
RATIO: The beating of the heart, the inhaling and exhaling of air, the maintenance of body temperature, and the
transmission of nerve and hormonal messages to direct these activities are the basal processes that maintain life.

2. Three factors that affect the body’s basal metabolic rate are:
a. height, weight, and energy intake.
b. age, body composition, and sodium intake.
c. fever, body composition, and altitude.
d. weight, fever, and environmental temperature.
ANSWER: D
RATIO: For the most part, the BMR is highest in people who are growing and in those with considerable lean body mass.
One way to increase the BMR, then, is to maximize lean body tissue by participating regularly in endurance and strength-
building activities. The BMR is also fast in people who are tall and so have a large surface area for their weight, in people
with fever or under stress, in people taking certain medications, and in people with highly active thyroid glands. The BMR
slows down with a loss of lean body mass and during fasting and malnutrition.
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3. The largest component of energy expenditure is:
a. basal metabolism.
b. physical activity.
c. indirect calorimetry.
d. thermic effect of food.
ANSWER: A
RATIO: Basal metabolism is the largest component of energy expenditure, and the thermic effect of food is the smallest.

4. Which of the following reflects height and weight?

a. Body mass index
b. Central obesity
c. Waist circumference
d. Body composition
ANSWER: A
RATIO: Body Mass Index (BMI) is a person's weight in kilograms (or pounds) divided by the square of height in meters (or
feet).

5. The BMI range that correlates with the fewest health risks is:
a. 16.5 to 20.9.
b. 18.5 to 24.9.
c. 25.5 to 30.9.
d. 30.5 to 34.9.
ANSWER: B
RATIO: A healthy weight falls between a BMI of 18.5 and 24.9. Most people with a BMI within the healthy weight range
have few of the health risks typically associated with too-low or too-high body weight.

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER:
RATIO:

2. ANSWER:
RATIO:

3. ANSWER:
RATIO:

4. ANSWER:
RATIO:

5. ANSWER:
RATIO:

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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning. Let us see
your progress in this chapter!

Three things you learned:

1. I learned about the principal organs of metabolism and their roles.
2. I learned about how an excess of any of the three energy-yielding nutrients contributes to body fat
3. I learned about energy balance

Two things that you’d like to learn more about:

1. I’d like to learn more about the components of energy expenditure.

2. I’d like to learn more about the factors that affect a person’s BMR

One question you still have:

1. So far, none.

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