The art of nutrition Introduction We are nation of immigrants and as such, our genetically based health problems can be traced back to the roots of our many heritages, whether our ancestors originated in Northern Europe, and etc., . Diabetes, high blood pressure, obesity, and atherosclerosis appear in families for genetic reasons. This is referred to as medical genealogy. Partly because of medical genealogy, a return to maintenance of plant-based diets is promoted around the world. Traditional ethnic is often based around legumes (beans), which has been the mainstay of cooking for centuries. The definition of healthy eating has changed over the ye ars. In the 1940s, there were seven recommended food groups and butter was one of them. In 1950s, when the baby-boom was being born, the Basic Four Food Groups classification (meat, grains, dairy, and vegetables and fruits) was developed by the U.S. Department of Agriculture (USDA) to replace the old concept of seven food groups. In 1990, the USDA replaced the Basic Four Food Groups with the Food Guide Pyramid, and in 2005 the new MyPy ramid was developed. WHAT ARE THE BASIC TERMS TO UNDERSTAND IN THE STUDY OF NUTRITION? 1. A nutrient is a chemical substance that is present in the food and needed by the body. Macronutrients include include the energy nutrients carbohydrate, fat, and protein. Micronutrients include vitamins, minerals, and water. A nutrient dense food is one that has a high portion of micronutrients in relation to the macronutrients. Empty kcalories implies the opposite. 2. Nutrition is the science of the process by which the body uses food for energy, maintenance, and growth. Good nutrition status implies appropriate intake of macro and micronutrients. 3. Malnutrition or poor nutritional status is a state in which a prolonged lack of one or more nutrients retards physical development or c auses appearance of specific clinical condition (anemia, goiter and etc.,). 4. Optimal nutrition means that the person is receiving and using essential nutrients to maintain health and well-being at the highest possible well-being. 5. A kilocalorie (or kcal) is a unit of o f measure used to express the fuel value of carbohydrates, fats, and proteins. proteins. The large Calorie or (kcal) used in nutrition represents the amount of heat necessary to raise the temperature of 1 kg of water 1Celcius. 1 pound of fat equates to 3500 kcal.
6.
Health is currently recognized as being more than the absence of the disease. High level health and wellness are presented when an individual is actively engaged in moving toward the fulfillment of his/her potentials.
7. Public health is a field of medicine that is concerned with safeguarding and improving the health of the community as a whole. 8. Holistic health is a system of preventive medicine that takes into account the whole individual. 9. Medical nutrition therapy (MNT) is the treatment of disease through nutritional therapy by registered dieticians (RD). RDs are uniquely qualified to provide MNT because of their extensive training in food composition and p reparation, nutrition and biochemistry, anatomy and physiology, as well as life-cycle concerns and disease states. HOW IS NUTRITION AN ASPECT OF TOTAL HEALTH CARE? WHAT IS A HEALTH CARE TEAM? The health care team is composed of all health care professionals who work with a given person and or family towards the common goal of optimal health. This include the me dical part (physician, or other health care care provider, nurse, dietician, physical therapist and etc., etc., ) and other community resource personnel personnel who play the role of facilitating good health. HOW DO FOOD AND DIETARY PATTERNS DEVELOP? Sound nutrition begins at birth, through the influence of food culture and exposure to flavor foods through amniotic fluid in utero. The family l ater affects the growing childs meal environment and exposure to food. In the ideal scenario the infant is exposed to a variety of foods and is fed in a manner that promotes positive meal association. Then the infant is more likely to become a child who learns to like variety of foods that are high quality and dense in nutrients. Many factors can change this ideal scenario. Children may have food allergies or food intolerances, and these foods become associated with physical discomfort. Learned food aversion fall into this classification. WHAT ARE BIOPSYCHOSOCIAL CONCERNS IN HEALTH CARE? Biopsychosocial Biopsychosocial concerns address the interplay between betwee n external environment (psychologic and social factors) and internal forces (genetic). For example, the diagnosis of diabetes is primarily a biochemical or internal problem, but for the person hearing this diagnosis it involves psychologic issues of acceptance acceptance versus denial and anger and social concerns of healthy living in an environment that may be stressful and that discourages adherence to a healthy diet.
6.
Health is currently recognized as being more than the absence of the disease. High level health and wellness are presented when an individual is actively engaged in moving toward the fulfillment of his/her potentials.
7. Public health is a field of medicine that is concerned with safeguarding and improving the health of the community as a whole. 8. Holistic health is a system of preventive medicine that takes into account the whole individual. 9. Medical nutrition therapy (MNT) is the treatment of disease through nutritional therapy by registered dieticians (RD). RDs are uniquely qualified to provide MNT because of their extensive training in food composition and p reparation, nutrition and biochemistry, anatomy and physiology, as well as life-cycle concerns and disease states. HOW IS NUTRITION AN ASPECT OF TOTAL HEALTH CARE? WHAT IS A HEALTH CARE TEAM? The health care team is composed of all health care professionals who work with a given person and or family towards the common goal of optimal health. This include the me dical part (physician, or other health care care provider, nurse, dietician, physical therapist and etc., etc., ) and other community resource personnel personnel who play the role of facilitating good health. HOW DO FOOD AND DIETARY PATTERNS DEVELOP? Sound nutrition begins at birth, through the influence of food culture and exposure to flavor foods through amniotic fluid in utero. The family l ater affects the growing childs meal environment and exposure to food. In the ideal scenario the infant is exposed to a variety of foods and is fed in a manner that promotes positive meal association. Then the infant is more likely to become a child who learns to like variety of foods that are high quality and dense in nutrients. Many factors can change this ideal scenario. Children may have food allergies or food intolerances, and these foods become associated with physical discomfort. Learned food aversion fall into this classification. WHAT ARE BIOPSYCHOSOCIAL CONCERNS IN HEALTH CARE? Biopsychosocial Biopsychosocial concerns address the interplay between betwee n external environment (psychologic and social factors) and internal forces (genetic). For example, the diagnosis of diabetes is primarily a biochemical or internal problem, but for the person hearing this diagnosis it involves psychologic issues of acceptance acceptance versus denial and anger and social concerns of healthy living in an environment that may be stressful and that discourages adherence to a healthy diet.
Religious impact on eating, such as giving up chocolates for Lent or f ollowing a kosher diet, occurs. For the month of Ramadan, Muslims fast during daylight. WHAT IS A SLOW FOOD MOVEMENT? The slow food movement began in 1980s in I taly in recognition that thousands of varieties and flavors were being replaced by a few foods f oods with standardized flavors. This movement has spread around the world, including the US. Traditional ethnic foods and enjoyment eating are being encouraged by the 80,000 members of this movement. WHAT IS KNOWN ABOUT VEGETARIAN DIETS? What are different types of Vegetarian Diets? There are 3 main classifications of vegetarian diets: 1. Lacto-ovo-vegetarian. Lacto-ovo-vegetarian. Plant foods (whole grain, g rain, legumes, fruits, and vegetables) veg etables) are supplemented with dairy products and eggs. Most common type of vegetarian diet. Lacto comes from the Latin word for milk, and ovo comes from ovum (eggs). Lacto-ovovegetarians may also eat fish and chicken. 2. Lacto-vegetarian. Dairy products products are included, but eggs are not. 3. Total vegetarian (vegan). Animal Animal food sources are completely excluded. For this reason the diet may be low or inadequate inadequate in iodine, vitamin v itamin B12, iron, zinc, riboflavin, and vitamin D. WHO FOLLOWS VEGETARIAN? Two religious groups that forgo consumption of meat and other animal products are SeventhDay Adventist and Muslims. Many persons of the Jewish faith adopt a vegetarian eating plan to help them follow a kosher diet. WHAT IS THE EFFECT OF VEGETARIANISM ON HEALTH? HEALTH? People who follow a vegetarian diet is planned around legumes, whole grains, a variety of fruits and vegetables, and low fat milk products can improve their health through reduction of cholesterol levels. Good planning is needed to ensure a healthy veg etarian diet. Just because the person avoids meat does not mean he/ she is following a healthy diet. Athletes who are vegetarian may have less endurance because of low level o f muscle creatine (important in ATP production). One problem is the deficiency of B12. This condition is related to megaloblastic anemia (characterized (characterized by large red blood cells), commonly called as pernicious anemia.
HOW DOES SNACKING AFFECT NUTRITION? Many people find it more convenient to eat when they can, and snacking has become part of our culture. The term grazing is sometimes applied to a f requent all-day eating in which many people engage. When am individual eats generally does not matter for the healthy population. Rather, it is more important to consider what is ea ten and how much, remembering the principles of moderation, balance and variety. As a general rule, snack with low nutrient density should not replace nutrient-dense foods. HOW DOES FAST FOOD AFFECT NUTRTION? Biologic nutrients needs are not always appropriate provided by common fast-food offerings. Some fast-food meals have been found to contain almost one and a half times the amount of kcalories than traditional African diets. This high caloric density of meals may interfere with genetically based appetite control mechanisms, leading to weight gain and obesity (Prentice and Jebb, 2003). Portions has been increased over time, being two to five times larger than the original size (Young and Nestle, 2003). It has been noted that the increased number of fast-food restaurants correlate to the prevalence of state-level obesity (Maddock, 2004). FOOD GUIDES How does Nutrition Labeling Aid the Consumer? The change aimed at reducing the prevalence and complication of chronic illnesses, such as heart disease, HPN, and DM. nutrition labeling is a valuable tool for lea rning to apply nutrition requirements. Ingredients are listed in order of content in the product. If sugar is listed as the first ingredient, the amount of sugar is greater than the amount of other content. The health claims that can be made on food labels under the labeling law are as follows: y
Foods high in fiber may reduce the risk o f cancer and heart disease.
y
A low-fat diet may reduce the risk of cancer and heart disease.
y
A low-sodium diet may prevent high blood pressure.
y
Foods high in calcium may help prevent osteoporosis.
y
Folate leads to reduced neural tube defects.
y
Sugar alcohols reduce dental carries.
y
Soy proteins reduce cardiovascular disease.
What are Daily Reference Values? Daily reference values, generally referred to as dai ly value (DVs), is a term developed for food labels. The percentage of DVs for the marker nutrients vitamins A and C and t he minerals
calcium and iron can be found on food labels. The percentage of DVs for macronutrient s and cholesterol, Na, and K are also included under the Nutrition Facts section of the food label. These percentages are based on the DVs provided in g and mg for 2000 kcal reference diet. Guidelines for the following are also provided for a 2500 kcal level: y
Fat is based on 30 % of kcal.
y
Saturated fat is based on 10 % kcal.
y
Carbohydrate is based on 60 % kcal.
y
Fiber is based on 11.5g of fiber per 1000 kcal.
WHAT IS THE ROLE OF THE NURSE OR OTHER HEALTH CARE PROFESSIONAL IN T HE FAMILY MEAL ENVIRONMENT? The nurse or other health professional should be aware of nutritional inadequacies or excesses as represented in MyPyramid. For application with MNT, other health care professional can emphasize that any alterations in diet should still include the minimum foods needed for health. The nurse or other health professional plays a vital role in assessing and identifying individual and family needs while facilitating the solution using counseling approach. Meal planning can be relatively simple when few or no negative influences the family. Many community services are available that can complement the skill of the health care team.
CARBOHYDRATES, PROTEINS AND FATS WHAT ARE MACRONUTRIENTS AND WHERE ARE THEY FOUND? The energy (kcal) in the food we eat comes from carbohydrates, proteins and fats, otherwise known as macronutrients. Balanced meal contains all 3 macronutrients. The macronutrients provide the fuel for body functioning. All 3 macronutrients contain the elements carbon, hydrogen and oxygen. Proteins differ from CHO and fats because it contains Nitrogen. CHO and CHON provide 4 per gram of weight, and fats provide 9 kcal / g. Although alcohol is produced from the source of CHO, the body uses it differently once the CHO are fermented in the alcohol. There are only 2 sources of CHO: plant material and milk. Proteins are naturally found in all foods but are not present in negligible amount in f ruit. There are no proteins in fats and sugar. The highest source of protein is meat or muscles of animals, poultry, fish and eggs, nuts , seeds, and milk. Legumes contains significant amounts of both CHO a nd CHON. Fats are naturally found within all protein foods and some fruits, but only trace amounts in vegetables.
CARBOHYDRATES: FUNCTIONS AND RECOMMENDATION FOR APPROPRIATE INTAKE Why are CHO found in all plant sources? CHO are made through the process of photosynthesis (in which the suns energy allows plant leaves to take in carbon dioxide-CO2) from the air and water through the roots. Carbon (carbo-) and water (-hydrates) are formed into carbohydrates, and the plant gives off oxygen as a result. Hence, CHO are mainly found in foods of plant orig in. What are the basic forms of carbohydrates? 1. Sugar, a simple CHO, is a single or double ,molecule made up of carbon, hydrogen, and oxygen (C6 H12 O6) and may be also be referred to as a monosaccharide (single unit) or disaccharide (double units or double sugar) Two types of monosaccharide molecules: y
Glucose- (blood sugar)
y
Fructose- (fruit sugar)
Type of disaccharides: y
Lactose- (milk sugar)
2. Starch, in the past is called complex CHO, is a chain of sugar links and is referred to as polysaccharides (multiple units). It is now known that starch is digested rapidly as sugar, within just 1 hour. 3. Dietary fiber- is the most complex form of CHO. Although it is a polysaccharide like starch the complexity of the polysaccharide chain in fiber makes digestion by humans nearly impossible. There are two broad groupings of fiber based on t heir solubility in water. Insoluble fiber (generally found in the skin and seed of the plants) tends to be crunch, whereas soluble fiber includes cellulose and hemicellulose. Soluble fibers include gums, ligins and pectins. What are the functions of CHO? CHO are readily converted to energy needed for p hysical activity and basic life process. One gram of weight CHO yields 4 kcal of physical energy. CHO have the following functions: y
Spares the burning of CHON for energy (proteins have more important functions, such as building and repairing body structures)
y
Allows for more efficient and complete oxidation (burning) of fats for energy.
y
As sugar, can have a laxative effect.
y
As starch, provides an economic and abundant source of energy after being digested into glucose. Sugar and starch are both digested quickly.
y
As lactose, aids in the absorption of calcium.
y
As dietary fiber, promotes normal functioning of the intestines by adding bulk. Fiber slows down the time of digestion which helps promote satiety.
What are the recommendations for intake of CHO? Most persons should derive at least 60% of their kilocalories from CHO. This recommendation is found with daily values on food labels. Based on 2000kcal, 300g of CHO for most adults, as found on food labels. Some individuals benefit in lower amount of CHO, but everyone needs at least 100g daily to prevent ketosis (rapid breakdown of fat leading to ketone f ormation and lowered pH) Sugar is now considered appropriate as part of the total CHO intake as long as the mi nimum micronutrient needs are being met. Recommended amount of fiber is 20-35g, or 14 g of fiber per 1000 kcal. PROTIENS: FUNCTIONS AND RECOMMENDATIONS FOR APPROPRIATE INTAKE Protein is the basic element of all life. Whether in animal or plant sources, proteins will be found. It is made up of amino acids and always contains nitrogen. Through the process of digestion, proteins in food are broken down into amino acid, then resembled into proteins by the liver. The digestion takes for 2 hours. The highest concentrations are in the muscle. All forms of muscles are high in protein (red and white meat and fish). What are the functions of proteins? The nitrogen in proteins is what sets it apart from the other macronutrients. Nitrogen gives protein their unique function of building and repairing of all b ody tissues, allowing the production of hormones, and digestive enzymes, a strong immune system. Proteins have numerous functions: y
Repairing or replacing worn-out tissues
y
Supplying for growth and tissue building
y
Providing some energy (4 kcal/g)
y
Constructing and properly maintaining important body compounds.
y
Helping to prevent edema through its role in main taining vascular osmotic pressure.
What are the types of proteins?
The term biologic value describes how well a particular protein food approximates the amount and combination of essential amino acids in the body. Essential amino acids cannot be produced by the body hence need to be included in t he diet. A complete protein is said to contain all of the essential amino acids, whereas an incomplete protein has some of the essential amino acid but is lacking to others. Food sources that are complete proteins are also referred to as having high-biologic value protein. What are amino acids? Protein is made up of 22 basic amino acids. Amino acids are called the building blocks of protein, because they are the foundation for the synthesis of a la rge number of proteins. The following amino acids are essential, which means they cannot be synthesized and must therefore must be obtain from the diet: y
Histidine
y
Isoleucine
y
Leucine
y
Lysine
y
Methionine- is synthesized into nonessential amino acids taurine (brains most abundant amino acid) and homocysteine.
y
Phenylalanine
y
Threonine
y
Tryptophan
y
Valine
There are 12 basic nonessential acids important for health: y
Alanine
y
Arginine
y
Asparagine
y
Aspartic acid
y
Cysteine
y
Glutamic acid
y
Glutamine
y
Glycine
y
Proline
y
Serine
y
Tyrosine
What are the recommended for protein intake? Protein should generally be about 10-15% of kcal intake, up to a maximum of 35%. Generally, 45-60g of protein will meet the health needs of most adults. Nitrogen balance refers to a condition in which the nitrogen consumed in the form of proteins is equal to the nitrogen lost daily in the urine and other body secretions. The allowance is 0.8 g of proteins for each kg of body weight. This translates into 63 g of proteins for a man weighing 79 kg and 50 g for a woman weighing 63 kg. For infants, the allowance are based on the amount of proteins provided by the quantity of m ilk required to ensure a satisfactory rate of growth. This is estimated to be 2.24 g/kg/day during the first month of life and falls gradually to about 1.5 g/kg/day by the six month. For the children and adolescents, the allowances decrease gradually from1.5g/kg/day between 6 th
months and 1 year to 0.8g/kg/day by the 18 year. During the pregnancy, an intake of at least 60g
of protein is recommended daily. Some authorities advocate as much as 100 g in the
pregnant womans daily diet. Athletes needs a higher protein intake of 1.0-1.5 g/kg of the body weight because of the stress on the body tissues of the increased physical activity. The elderly need a n intake of 1.0-1.2 g/kg of the body weight because of reduced efficiency of the liver in producing proteins from available amino acids. Albumin measure of serum protein status. An albumin level less than 3.5 mg/dL is an indication of mild protein deficiency. What problems are associated with inadequate protein intake? Kwashiorkor refers to a condition in which the individual may have an adequate caloric intake but lacks adequate dietary proteins. However, protein def iciency is frequently associated with deficiency in calorie as well. When the diet is low in calories, proteins are used as a source of energy, leaving little of this nutrient to build and repair tissue and maintain immune function. Such as a condition termed protein-energy (also called marasmus) and its prevalent in most developing countries. FATS AND CHOLESTEROL: FUCTION AND RECOMMENDATIONS FOR APPROPRIATE INTAKE Fats are found in many food containing proteins and are added through cooking or flavoring foods. The amount of fats found in grains, vegetables and most fruits is generally insignificant. The exceptions coconuts, avocados, and olives. Fats extracted from the vegetables source (such as olives, corn) are usually found in liquid form and generally are not harmful to health unless they are hydrogenated ( hydrogen has been added to liquids oils in order to make solid fats-
also called trans fats). Fats that are solid (naturally found mostly in animal products such as butter and red meat) are referred to as saturated fats) What are the Functions of Dietary Fats? The primary function of fats is to serve as a concentrated source of heat and energy. y
Sparing burning of protein for energy
y
Adding and palatability to the diet
y
Giving satiety value to the diet (fat slows the digestive process up to 4 hours and thereby retards the development of hunger)
y
Promoting absorption of fat-soluble vitamins
y
Providing a structural component of cell membranes, digestive secretions and hormones
y
Insulating and controlling body temperature in the form of fat
y
Protecting body organs
Animal fats and fortified fats not only contain some of the fat-soluble vitamins (A, D, E, and K), but also aid in their absorption. They also play a role in the absorption of fatty acids. Excess fat stored in the body as adipose tissue insulates and protects organs and nerves. Fats also lubricate the intestinal tract. Fatlike substances that have important roles in the body include phospholipids (fat plus the mineral phosphorus is the basic of cell membrane structure) and sterols (ergosterol in plants and cholesterol in animal fats). Monounsaturated fats are becoming increasingly favored over both saturated and polyunsaturated fats for a variety of reasons. What are the functions of essential fatty acid? Essential fatty acids are necessary for the nutritional well-being of all animals and must be supplied in the diet. Two principal essential fatty acid for humans are: 1. Linoleic acid- an omega-6 fatty acid 2. Alpha-linoleic acid- which is an omega-3 fatty acid Omega-6 fatty acids are found in vegetables and seed oils and are forms of polyunsaturated fatty acids. Omega-3 fatty acids are found in fatty fish, walnuts, flaxseed, and canola oil and are another form of polyunsaturated fat, sometimes called highly unsaturated fatty acid.
What is the difference between types of fats and cholesterol? A lipid includes all types of fats and fat-related compounds. Cholesterol is a fat-related compound that is not a kilocalorie. It is found only in animal fat. Fats from plants sources do not contain cholesterol. It is important to note that mineral oil is not considered a food fat because it cannot be digested and used by the body. Fats that are of a liquid consistency at room temperature are usually called oils. Oils are composed predominantly of unsaturated fatty acids; the solid fats are the saturated forms. Saturated fats are typically found in products containing animal fats, such as milk, butter, and red meat. What is the role of saturated fats in disease states? Nerve functions are influenced by the type of fats and lipids in cell membranes. The neural portion of the brain has a high level of unsaturated essential fatty acids. Abnormal level s of essential fatty acids in cell membranes of persons with schizophrenia has been noted. There is some evidence that the omega-3 fatty acid may have antipsychotic activity. Arachidonic acid is converted into eicosanoids, which regulate nerve function and inflammatory responses. What are the functions of cholesterol? Cholesterol has an essential role in the structure of adrenal and sex hormone and in increasing the bodys production of vitamin D through the exposure of UV light to the s kin. It is made stored in the liver and also occurs in the form of lipoprotein (lipid combined with protein) in the blood. What are the recommendations for intake of fats and cholesterol? There are no specific requirements for fats other than the bodys need for the essential fatty acids, which is usually met through a diet that contains appropriate food fats. A minimum of 20 g of fats are consumed. An intake of 30g fats is more likely to ensure adequate intake of the essential fatty acids.
The Micronutrients of Balanced Meals
As we become more knowledgeable about our vitamin and mineral needs, it is helpful to keep the history of that knowledge in perspective. Vitamins are now known to be organic substances that are genetically produced by plants, and many are also found in animal products. Minerals, the seeming equivalent of vitamins in the consumers eye, are inorganic substances that have some similarities to vitamins but also have many differences. The most notable difference is
that minerals are elemental, which means that they do not break down. This characteristic of minerals prevents their destruction by heat and air-destruction to which vitamins are susceptible. Vitamins and minerals become available to the body cells from food we eat after the process of digestion and absorption. Vitamins and minerals are integral to the function of metabolic enzymes at the cellular level for basic l ife processes. Plant based food are also a source of phytochemicals (substances in foods that are beneficial to health but are not vitamins and minerals). What are the dietary references intakes? The U.S. Recommended Dietary Allowances (RDAs) and Canadian Recommended Nutrient Intake (RNIs) have been replaced with the dietary reference intakes (DRIs), the term used collectively to describe four measures of recommended dietary intake. Nutrient intake amounting to less than the lower end of the range of the DRIs may lead to nutrient deficiency. Intake amounting more than the upper limit may give rise to toxicity level. The specific reference values that comprise the DRIs are as follows: y
Estimated average requirements (EAR): the amount a nutrient estimated to meet half of healthy individuals need based on life stage and ge nder.
y
Recommended dietary allowance (RDA): the average daily dietary intake level that meets the nutrient requirement of more than 97% of the healthy population in particular life stage and gender group.
y
Adequate intake (AI): a recommended intake of v itamins and minerals based on the observation of nutrient intake by a group of healthy persons that is assumed to be adequate.
y
Tolerable upper intake level (UL): the highest leve l of daily nutrient intake that is likely to pose no risk of adverse health effects in almost all individuals in the general population.
What is the role of vitamins and in nutrition? Vitamins are classified as body regulators because of the following functions: y
Regulating the synthesis of many body tissues.
y
Participating in the cellular metabolism of macronutrients through their function with metabolic enzymes as coenzymes and cofactors.
y
Preventing nutritional deficiency diseases and allowing for optimal health at all ages.
y
Serving as antioxidants to reduce damage at the cellular level from the process of oxidation.
What is the difference between fat-soluble and water-soluble? Vitamins are classified into 2 groups: y
Fat-soluble- are stored in the body fat and can reach toxic lev els.
a. Vitamin A- can be obtained in 2 forms. Precursor form- is carotene, which is found in abundance in dark green, leafy vegetables and deep orange vegetables and fruits (except orange). The color of carotene is orange that is why those fo ods high in carotene are of similar color and why a persons skin can turn orange when these foods are eaten. It is converted into vitamin A in the liver; also called retinol . It can also be found in animal products such as liver, milk fat as in whole milk and cream, butter egg yolks and is able to produce toxicity when taken In large amount. A deficiency in vitamin A intake by breast-feeding mother can put the nursing offspring at risk for iron deficiency and eye disease called retinitis pigmentosa. Vitamin A in foods measured in retinol equivalent (RE) or international units (IU). b. Vitamin D-has physiological roles beyond those re lated to bones, including regulating blood pressure and acting as a tumor suppressant. There is the controversy regarding optimal intake of vitamin D. Vitamin D deficiency le ads to secondary hyperparathyroidism, increases bone turnover, bone loss, and when severe, osteomalacia. Hypovitaminosis D (a condition with low vitamin D) is associated with impaired neuromuscular function, tuberculosis, rheumatoid arthritis, multiple sclerosis (MS), inflammatory bowel diseases, hypertension, diabetes and specific types of cancer. Vitamins D needs may be higher than the current DRI of 5 15 mcg (200 to 600 IU) per day. Vitamin d supplementation should be routinely recommended in pregnancy if there is inadequate intake of fortified milk or fish liver. Vitamin D has been known to prevent rickets (bowing of the legs caused by increasing weight of the soft bones of the growing child. c. Vitamin E- was initially recognized as essential for reproduction in rats. It acts as an antioxidant (preventing cell damage from oxidation). Although known toxic effects form excess ingestion of vitamin E is limited to premature infants, persons receiving anticoagulant medication. At this time, there is no medical justification for the use of large doses. Vitamin E deficiency can cause neurological disorders, and is important in regulating call signaling and gene expression. Hypovitaminosis E can lead to ataxia (irregularity of muscular action).
d. Vitamin K- is not only found in dietary sources such as dark green leafy vegetables but it can also be synthesized by bacteria in the jejunum and ileum. I t was first recognized as a ant hemorrhagic factor. Because it is essential for the formation of prothrombin (a clotting factor), defective blood coagulation is the main symptom of Vitamin K deficiency. It is also involved in other physiologic processes, including vascular function and bone metabolism. Vitamin K is common among infants because of low-levels of the Vitamin K-synthesizing bacteria in the intestinal tract at birth. A parenteral vitamin K injection is recommended, y
Water-soluble- are generally not stored in any significant amounts in the body, which means that they need to be included in the diet on a daily basis. The vitamin B complex refers to all water soluble vitamins except ascorbic acid (vitamin C). These include thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pyridoxine and related substances (collectively known as vitamin B6), cobalamin (vitamin B12) folacin, biotin, choline a nd panthotenic acid.
a) Thiamin (vitamin B1)- is a cofactor (an organic molecule that connects with another element or enzyme to allow metabolic processes to occur). Thiamin is required by at least three enzymes to allow for carbohydrate metabolism. Metabolic products related to thiamin use are needed for protein synthesis, deoxyribonucleic acid (DNA) and brain chemicals. Neuropathy is associated with the deficiency of thiamin. b) Riboflavin (vitamin B2) - the requirement of riboflavin is related to caloric requirements. It is involved in many enzyme reactions that allow energy use at a cellular level. It is important for healthy skin, lips, and tongue and maintaining the health of the ey e surfaces. Deficiency symptoms are associated with skin changes such as cheilosis and vulval and scrotal skin changes and generalized dermatitis. Without the ess ential intake of consumption of milk and milk products, riboflavin intake is likely to be i mpaired. Other foods such as enriched with white-flour products do contribute to riboflavin status, along with nuts, legumes, fish, organ meats, avocadoes and mushrooms. c) Niacin (nicotinic acid or vitamin B3)- niacin requirements, along with thiamin and riboflavin, are related to caloric intake and are essential for e nergy metabolism at the cellular level. Niacin is meeting in part in the conversion of amino acid tryptophan, found in milk, eggs, and turkey. Pellagra is the main deficiency syndrome. I is characterized by 4 Ds: diarrhea, dementia, dermatitis and death.
d) Pyridoxine , pyridoxal and pyridoxamine and related substances (vitamin B6)- three interrelated substance-pyridoxine (from plants), pyridoxal and pryidoxamine (from animal products) are collectively known as vitamin B 6.the need for B6 increases with high protein diets, pregnancy, the tuberculosis medication isoniazid (because interference with the synthesis of pyridoxine; a supplement of vitamin B6 is necessary) and some contraceptives. It is necessary for normal cell membrane function primarily in cellular metabolism of protein and amino acids. It is also important in energy metabolism. A low level of vitamin B6 may cause depression, as it is a cofactor in tryptophan-serotonin pathway. Excess ingestion of pyridoxine causes severe sensory neuropathy in h umans. Previous attempts at controlling premenstrual syndrome (PMS)with 500 to 5000mg of this daily resulted in peripheral neuropathy in few years. The use of vitamin B6 at doses less than 100mg/day appears safe for adults. e) Cobalamin (vitamin B12)- cobalt mineral is an essential part of vitamin B12. Pernicious anemia ( the primary form) is caused by autoimmune destruction related to the ability to produce intrinsic factor ( a glycoprotein secreted in the stomach that attaches to vitamin B12 to aid absorption). All forms of vitamin B12 deficiency are commonly referred to pernicious anemia but more correctly are known as megaloblastic anemia. f) Folate- the active form of folate acid, which is formed from folate by vitamin C. many forms of this water-soluble vitamin exist. Folate got its name from the word foliage, because all dark green, leafy vegetables are high in folate. Fol ate aids in metabolism of protein and DNA, a basic structure of genes found in cells. Folate helps prevent spina bifida, a nueral tube defect that starts during the first month of pregnancy when the spinal cord is not fully enclosed. It is recommended that all women of childbearing age consume 0.4mg of folic acid daily. g) Choline- is a constituent of several compounds that are necessary for certain aspects of nerve function and lipid metabolism. Choline is important for normal membrane function and the production of acetylcholine (an important neurotransmitter). h) Panthothenic acid- is a n essential constituent of complex enzymes involved fatty acid metabolism and synthesis of certain body constituent. Deficiency are unlikely, but marginal ones may exist in general malnourished individuals, as well as deficiency of other Bcompolex vitamins. The usual dietary intake is between 5 and 20mg daily. i)
Biotin- is a sulfur-containing vitamin that is essential for the activity of many enzyme systems. It is widely distributed in nature and is bound in foods and tissues. It plays a central role in synthesis of fatty acid and participates in se veral metabolic reactions at the cellular level.it is also essential in growth and development and for a healthy skin.
j)
Vitamin C (ascorbic acid)is a water-soluble derivative of glucose and performs a variety of functions. It so an essential cofactor for range of enzymes involve in diverse metabolic pathways. It aids in the formation and maintenance of the cellular cement substance of body tissue and therefore is important for tooth dentin, bones, cartilage, connective tissues and blood vessels. Higher levels of intake may be necessary during condition of stress, with certain medications or in persons who smoke. Citrus fruits, melon, dark green leafy vegetables, potatoes, and green pepper are all high in vitamin C. Inadequate intake may eventually lead to swollen and bleeding gums, loose teeth, and rupture small blood vessels, which are forerunners of scorbutus, also known as scurvy. A safe dose of vitamin C is less than 1000mg daily, 500mg being already nearly 10 times the recommended daily amount.
How are minerals classified? Major minerals:
a) Calcium- is an important component of a healthy diet and a mineral necessary for life. The National Osteoporosis Foundation says, "Calcium plays an important role in building stronger, denser bones early in life and keeping b ones strong and healthy later in life." Approximately ninety-nine percent of the body's calcium is stored in the bones and teeth. The rest of the calcium in the body has other important uses, such as some exocytosis, especially neurotransmitter release, and muscle contraction. In the electrical conduction system of the heart, calcium replaces sodium as the mineral that depolarizes the cell, proliferating the action potential. In cardiac muscle, s odium influx commences an action potential, but during potassium efflux, the cardiac myocyte experiences calcium influx, prolonging the action potential and creating a plateau phase of dynamic equilibrium. Longterm calcium deficiency can lead to rickets and poor blood clotting and in case of a menopausal woman, it can lead to osteoporosis, in which the bone deteriorates and there is an increased risk of fractures. While a lifelong defi cit can affect bone and tooth formation, over-retention can cause hypercalcemia (elevated levels of calcium in the blood), impaired kidney function and decreased absorption of other minerals.
[19]
High calcium intakes or high
calcium absorption were previously thought to contribute to the development of kidney stones. However, a high calcium intake has been associated with a lower risk for kidney stones in more recent research. Vitamin D is needed to absorb calcium. Dairy products, such as milk and cheese, are a well-known source of calcium. Some individuals are allergic to dairy products and even more people, particularly those of non Indo-European descent, are lactose-intolerant, leaving them unable to consume nonfermented dairy products in quantities larger than about half a liter per serving. Others, such as vegans, avoid dairy products for ethical and health reasons. Fortunately, many good sources of calcium exist. These include seaweeds such as kelp, wakame and hijiki; nuts and
seeds (like almonds and sesame); blackstrap molasses; beans; oranges; figs; quinoa; amaranth; collard greens; okra; rutabaga; broccoli; dandelion leaves; kale; and fortified products such as orange juice and soy milk. Research has found an association between [23][24][25]
diets high in animal protein and increased urinary calcium loss from the bones.
A
diet high in fruit, vegetables and cereals was demonstrated to result in greater femoral bone mineral density in older men, in comparison to a range of other diets. Diets high in candy were found to result in lower bone density in both men and women. An overlooked source of calcium is eggshell, which can be ground into a powder and mixed into food or a glass of water. Cultivated vegetables generally have less calcium than wild plants. The calcium content of most foods can be found in the USDA National Nutrient Database. b) Magnesium- is the 11th most abundant element by mass in the human body; its i ons are essential to all living cells, where they play a major role in manipulating important biological polyphosphate compounds like ATP, DNA, and RNA. Hundreds of enzymes thus require magnesium ions to function. Magnesium is also the metallic ion at the center of chlorophyll, and is thus a common additive to fertilizers. Magnesium compounds are used medicinally as common laxatives, antacids (i.e., milk of magnesia), and in a number of situations where stabilization of abnormal nerve excitation and blood vessel spasm is required (i.e., to treat eclampsia). Magnesium ions are sour to the taste, and in low concentrations help to impart a natural tartness to fresh mineral waters. c) Phosphorus- is a component of DNA, RNA, ATP, and also the phospholipids that form all cell membranes. It is, thus, an essential element for all living cells. The most important commercial use of phosphorus-based chemicals is the production of fertilizers. d) Potassium- ion is necessary for the function of all living cells, and is thus present in all plant and animal tissues. It is found in especially high concentrations within plant cells, and in a mixed diet, it is most highly concentrated in fruits. The h igh concentration of potassium in plants, associated with comparatively very low amounts of so dium there, historically resulted in potassium first being isolated from the ashes of plants (potash), which in turn gave the element its modern name. Heavy crop production rapidly depletes soils of potassium, and agricultural fertilizers consume 93% of the potassium chemical production of the modern world economy. The functions of potassium and sodium in living organisms are quite different. Animals, in particular, employ sodium and potassium differentially to g enerate electrical potentials in animal cells, especially in nervous tissue. Potassium depletion in animals, including humans, results in various neurological dysfunctions.
e) Sodium- The most common sodium salt, sodium chloride ('table salt' or 'common salt'), is used for seasoning and warm-climate food preserv ation, such as pickling and making jerky (the high osmotic content of salt inhibits bacterial and fungal growth). The human requirement for sodium in the diet is about 1.5 grams per day, which is typically less than a tenth as much as many diets "seasoned to taste." Most people consume far more sodium than is physiologically needed. Low sodium intake may lead to sodium deficiency (hypernatremia). Persons suffering from severe dehydration caused by diarrhea, such as that by cholera, can be treated with oral rehydration therapy, in which they drink a solution of sodium chloride, potassium chloride and glucose. This simple, effective therapy saves the lives of millions of children annually in the developing world. Traced minerals: a) Fluoride-containing compounds are used in topical and systemic fluoride therapy for preventing tooth decay. They are used for water fluoridation and in many products associated with oral hygiene. Originally, sodium fluoride was used to fluoridate water; however, hexafluorosilicic acid (H2SiF6) and its salt sodium hexafluorosilicate (Na2SiF6) are more commonly used additives, especially in the United States. The fl uoridation of water is known to prevent tooth decay and is considered by the U.S. Centers for Disease Control and Prevention as "one of 10 great public health achievements of the 20th century". In some countries where large, centralized water systems are uncommon, fluoride is delivered to the populace by fluoridating table salt. Fluoridation of water is not without critics, however (see Opposition to water fluoridation). b) Iron- Iron uptake is tightly regulated by the human body, which has no regulated physiological means of excreting iron. Only small amounts of iron are lost daily due to mucosal and skin epithelial cell sloughing, so control of iron levels is mostly by regulating uptake. Regulation of iron uptake is impaired in some people as a result of a genetic defect that maps to the HLA-H gene region on chromosome 6. In these people, excessive iron intake can result in iron overload disorders, such as hemochromatosis. Many people have a genetic susceptibility to iron overload without realizing it or being aware of a family history of the problem. For this reason, it is advised that people do not take iron supplements unless they suffer from iron deficiency and have consulted a doctor. Hemochromatosis is estimated to cause disease in between 0.3 and 0.8% of Caucasians. MRI finds that iron accumulates in the hippocampus of the brains of those with Alzheimer's disease and in the substantia nigra of those with Parkinson disease.
c) Iodine- The daily Dietary Reference Intake recommended by the United States Institute of Medicine is between 110 and 130 µg for infants up to 12 months, 90 µg for children up to eight years, 130 µg for children up to 13 years, 150 µg for adults, 220 µg for pregnant women and 290 µg. for lactating mothers. The Tolerable Upper Intake Level (UL) for adults is 1,100 g/day (1.1 mg/day). The tolerable upper limit was asse ssed by analyzing the effect of supplementation on thyroid-stimulating hormone. The thyroid gland needs no more than 70 micrograms /day t o synthesize the requisite daily amounts of T4 and T3. The higher recommended daily allowance levels of iodine seem necessary for optimal function of a number of body s ystems, including lactating breast, gastric mucosa, salivary glands, oral mucosa, thymus, epidermis, choroid plexus, etc. The high iodide-concentration of thymus tissue in particular suggests an anatomical rationale for this role of iodine in the immune system. The trophic, antioxidant and apoptosisinductor actions and the presumed anti-tumor activity of iodides have been sugge sted to also be important for prevention of oral and salivary glands diseases. Natural sources of iodine include sea life, such as kelp and certain seafood, as well as plants grown on iodine-rich soil. Iodized salt is fortified with iodine. As of 2000, the median intake of iodine from food in the United States was 240 to 300 g/day for men and 190 to 210 g/day for women. In Japan, consumption is much higher due to the frequent consumption of seaweed or kombu kelp. After iodine fortification programs (e.g. iodized salt) have been implemented, some cases of iodine-induced hyperthyroidism have been observed (so called Jod-Basedow disease). The condition mainly seems to occur in people over forty, and the risk appears higher when iodine deficiency is severe and the initial rise in iodine intake is high. In areas where there is little iodine in the diet, typically remote inland areas and semi-arid equatorial climates where no marine foods are eaten, iodine deficiency gives r ise to hypothyroidism, symptoms of which are extreme fatigue, goitre, mental slowing, depression, weight gain, and low basal body temperatures. Iodine deficiency is the leading cause of preventable mental retardation, a result which occurs primarily when babies or small children are rendered hypothyroidic by a lack of the element. T he addition of iodine to table salt has largely eliminated this problem in the wealthier nations, but as of March 2006, iodine deficiency remained a serious public health problem i n the developing world. Iodine deficiency is also a problem in certain a reas of Europe. In Germany it has been estimated to cause a billion dollars in health care costs per year. Other possible health effects being investigated as being related to deficiency include:
Breast cancer- The breast strongly and actively concentrates iodine into breast-milk for the benefit of the developing infant, and may develop a goiter-like hyperplasia, sometimes manifesting as fibrocystic breast disease, when iodine level are low. Studies indicate that iodine deficiency, either dietary or pharmacologic, can lead to breast atypia and increased incidence of malignancy in animal models, while iodine treatment can reverse dysplasia. The role of iodide in breast dysplasia and development of breast cancer is an area of active research. Stomach cancer- Some researchers have found an e pidemiologic correlation between iodine deficiency, iodine-deficient goiter and gastric cancer. A decrease of the incidence of death rate from stomach cancer after implementation of the effective iodine-prophylaxis has been reported also. d) Selenium- Although it is toxic in large doses, se lenium is an essential micronutrient for animals. In plants, it occurs as a bystander mineral, sometimes in toxic proportions in forage (some plants may accumulate selenium as a defense against being eaten by animals, but other plants such as locoweed require selenium, and their growth indicates the presence of selenium in soil). It is a component of the unusual amino acids selenocysteine and selenomethionine. In humans, selenium is a trace element nutrient that functions as cofactor for reduction of antioxidant enzymes s uch as glutathione peroxidases and certain forms of thioredoxin reductase found in animals and some plants (this enzyme occurs in all living organisms, but not all forms of it in plants require selenium). The glutathione peroxidase family of enzymes (GSH-Px) catalyze certain reactions that remove reactive oxygen species such as hydrogen peroxide and organic hydroperoxides: 2 GSH + H2O2----GSH-Px GSSG + 2 H2O Selenium also plays a role in the functioning of the thyroid gland and in every cel l that utilizes thyroid hormone, by participating as a cofactor for the three known thyroid hormone deiodinases, which activate and then deactivate various thyroid hormones and their metabolites. It may inhibit Hashimotos's disease, in which the bodys own thyroid cells are attacked as alien. A reduction of 21% on TPO antibodies was reported with the dietary intake of 0.2 mg of selenium. Dietary selenium comes from nuts, cereals, meat, fish, and egg s. Brazil nuts are the richest ordinary dietary source (though this is soil-dependent, since the Brazil nut does not require high levels of the element for its own needs). In descending order of concentration, high levels are also found in kidney, tuna, crab, and lobster. The human body's burden of selenium is believed to be in the 13-20 milligram range. e) Zinc- Dietary intakeIn the U.S., the Recommended Dietary Allowance (RDA) is 8 mg/day for women and 11 mg/day for men. Median intake in t he U.S. around 2000 was 9 mg/day for women and 14 mg/day in men. Red meats, especially beef , lamb and liver have some of the highest concentrations of zinc in food.
The concentration of zinc in plants varies based on levels of the element in soil. When there is adequate zinc in the soil, the food plants that contain the most zinc are wheat (germ and bran) and various seeds (sesame, poppy, alfalfa, celery, mustard). Zinc is also found in beans, nuts, almonds, whole grains, pumpkin seeds, sunflower seeds and blackcurrant. Other sources include fortified food and dietary supplements, which come in various forms. A 1998 review concluded that zinc oxide, one of the most common supplements in the United States, and zinc carbonate are nearly insoluble and poorly absorbed in the body. This review cited studies which found low plasma zinc concentrations after zinc oxide and zinc carbonate were consumed compared with those seen after consumption of zinc acetate and sulfate salts. However, harmful excessive supplementation is a problem among the relatively affluent, and should probably not exceed 20 mg/day in healthy people, although the U.S. National Research Council set a Tolerable Upper Intake of 40 mg/day. For fortification, however, a 2003 review recommended zinc oxide in cereals as cheap, stable, and as easily absorbed as more expensive forms. A 2005 study found that various compounds of zinc, including oxide and sulfate, did not show statistically significant differences in absorption when added as fortificants to maize tortillas. A 1987 study found that zinc picolinate was better absorbed than zinc gluconate or zinc citrate. f) Chromium- in trace amounts influences sugar and lipid metabolism in humans, and its deficiency is suspected to cause a disease called chromium deficiency. However, chromium deficiency is thought to be extremely rare in the g eneral population and has only ever been confirmed in three people on parenteral nutrition, which is when a patient is fed a liquid diet through intravenous drips. In contrast, hexavalent chromium is very toxic and mutagenic when inhaled. Cr (VI) has not been established as a carcinogen when in solution, though it may cause allergic contact dermatitis (ACD). The use of chromium-containing dietary supplements is controversial due to the complex effects of the used supplements. The popular dietary supplement chromium picolinate complex generates chromosome damage in hamster cells. In the United States the dietary guidelines for daily chromium uptake were lowered from 50-200 µg for an adult to 35 µg (adult male) and to 25 µg (adult female). g) Copper- Copper is antibacterial /germicidal, via the oligodynamic effect. For example, brass doorknobs disinfect themselves of many bacteria within a period of eight hours. Antimicrobial properties of copper are effective against MRSA, Escherichia coli and other pathogens. At colder temperatures, longer times are required to kill bacteria.
Copper kills a variety of potentially harmful pathogens. On February 29, 2008, the United States EPA registered 275 alloys, containing greater than 65% nominal copper content, as antimicrobial materials. Registered alloys include pure copper, an assortment of brasses and bronzes, and additional alloys. EPA-sanctioned tests using Good Laboratory Practices were conducted in order to obtain several antimicrobial claims valid against: methicillin-resistant Staphylococcus aureus (MRSA), Enterobacter aerogenes, Escherichia coli O157: H7 and Pseudomonas aeruginosa . The EPA registration
allows the manufacturers of these copper alloys to legally make public health claims as to the health effects of these materials. Several of the aforementioned bacteria are responsible for a large portion of the nearly two million hospital-acquired infections contracted each year in the United States. Frequently touched surfaces in hospitals and public facilities harbor bacteria and increase the risk for contracting infections. Covering touch surfaces with copper alloys can help reduce microbial contamination associated with hospital-acquired infections on these surfaces. h) Manganese- Manganism has occurred in persons employed in the production or processing of manganese alloys, patients receiving total parenteral nutrition, workers exposed to manganese-containing fungicides such as maneb, and abusers of drugs such as methcathinone made with potassium permanganate. Excessive exposure may be confirmed by measurement of blood or urine manganese concentrations. Chronic exposure to excessive Mn levels can lead to a variety of psychiatric and motor disturbances, termed manganism. Generally, exposure to ambient Mn air concentrations in excess of 5 g Mn/m3 can lead to Mn-induced symptoms. Increased ferroportin protein expression in human embryonic kidney (HEK293) cells is associated with decreased intracellular Mn concentration and attenuated cytotoxicity, characterized by the reversal of Mn-reduced glutamate uptake and diminished lactate dehydrogenase (LDH) leakage. Molybdenum- The human body contains about 0.07 mg of molybdenum per kilogram of
weight. It occurs in higher concentrations in the liver and kidneys and in lower concentrations in the vertebrae. Molybdenum is also present within human tooth enamel and may help prevent its decay. Pork, lamb and beef liver each have approximately 1.5 parts per million of molybdenum. Other significant dietary sources include green beans, eggs, sunflower seeds, wheat flour, lentils, cucumbers and cereal grain. The average daily intake of molybdenum varies between 0.12 and 0.24 mg, but it depends on the molybdenum content of the food. Acute toxicity has not been seen in humans, and the toxicity depends strongly on the chemical state. Studies on rats show a median lethal dose (LD50) as low as 180 mg/kg for some Mo compounds. Although human toxicity data is unavailable, animal s tudies have shown that chronic ingestion of
more than 10 mg/day of molybdenum can cause diarrhea, growth retardation, infertility, low birth weight and gout; it can also affect the lungs, kidneys and liver. Sodium tungstate is a competitive inhibitor of molybdenum. Dietary tungsten reduces the concentration of molybdenum in tissues. Dietary molybdenum deficiency from low soil concentration of molybdenum has been associated with increased rates of esophageal cancer in a geographical band from northern China to Iran. Compared to the United States, which has a greater s upply of molybdenum in the soil, people living i n these areas have about 16 times greater risk for esophageal squamous cell carcinoma. Molybdenum deficiency has also been reported as a consequence of non-molybdenum supplemented total parenteral nutrition (complete intravenous feeding) for long per iods of time. It results in high blood levels of sulfite and urate, in much the same way as molybdenum cofactor deficiency. However, presumably since pure molybdenum deficiency from this mechanism is seen primarily in adults, the neurological consequences have not been as marked as for the congenital cofactor deficiency. Related diseases: A congenital molybdenum cofactor deficiency disease, seen in infants, results in interference with the ability of the body to use molybdenum in enzymes. It causes high levels of sulphite and urate, and neurological damage. The cause is inability of the body to synthesize molybdenum cofactor, a heterocyclic molecule which binds molybdenum at the active site in all known human enzymes which use molybdenum.
Other traced minerals: a) Chloride- Chlorine is a toxic gas that irritates the respiratory system. Because it is heavier than air, it tends to accumulate at the bottom of poorly ventilated spaces. Chlorine gas is a strong oxidizer, which may react with flammable materials. Chlorine is detectable in concentrations of as low as 0.2 ppm. Coughing and vomiting may occur at 30 ppm and lung damage at 60 ppm. About 1000 ppm can be fatal after a few deep breaths of the gas. Breathing lower concentrations can aggravate the respiratory system, and exposure to the gas can irritate the eyes.The toxicity of chlorine comes from its oxidizing power. When chlorine is inhaled at concentrations above 30 ppm, it begins to react with water and ce lls, which change it into hydrochloric acid (HCl) and hypochlorous acid (HClO). When used at specified levels for water disinfection, the reaction of chlorine with water is not a major concern for human health. However, other materials present in the water may generate disinfection by-products that can damage human health.
b) Cobalt- Cobalt is an essential element for life i n minute amounts. The LD50 values soluble cobalt a salt has been estimated to be between 150 and 500 mg/kg. Thus, for a 100 kg person the LD50 would be about 20 grams. After nickel and chromium, cobalt is a major cause of contact dermatitis and is considered carcinogenic. In 1966, the addition of cobalt compounds to stabilize beer foam in Canada led to cardiomyopathy, which came to be known as beer drinkers cardiomyopathy .
c) Sulfur- Sulfur may also serve as energy (chemical food) source for bacteria that use hydrogen sulfide (H2S) in the place of water as the electron donor in a primitive photosynthesis-like process in which oxygen is the electron receptor. The photosynthetic green and purple sulfur bacteria and some chemolithotrophs use elemental oxygen to carry out such oxidization of hydrogen sulfide to produce o elemental sulfur (S ), oxidation state = 0. Primitive bacteria which live around deep ocean volcanic vents oxidize hydrogen sulfide in this way with oxygen: see giant tube worm for an example of large organisms (via bacteria) making metabolic use of hydrogen sulfide as food to be oxidized. The so-called sulfur bacteria, by contrast, "breathe sulfate" instead of oxygen. They use sulfur as the electron acceptor, and reduce various oxidized sulfur compounds back into sulfide, often into hydrogen sulfide. They also can grow on a number of other partially oxidized sulfur compounds (e. g. thiosulfates, thionates, polysulfides, sulfites). The hydrogen sulfide produced by these bacteria is responsible for the smell o f some intestinal gases and decomposition products. Sulfur is absorbed by plants via the roots from soil as the sulfate and transported as a phosphate ester. Sulfate is reduced to sulfide via sulfite before it is incorporated into cysteine and other organosulfur compounds.
What are electrolytes? +
+
2+
In physiology, the primary ions of electrolytes are sodium(Na ), potassium (K ), calcium (Ca ), 2+ 2 magnesium (Mg ), chloride (Cl ), hydrogen phosphate (HPO4 ), and hydrogen carbonate (HCO3 ). The electric charge symbols of plus (+) and minus () indicate that the substance in question is ionic in nature and has an imbalanced distribution of electrons, which is the result of chemical dissociation. All known higher life forms require a subtle and complex electrolyte balance between the intracellular and extracellular milieu. In particular, the maintenance of precise osmotic gradients of electrolytes is important. Such gradients affect and regulate the hydration of the body as well as blood pH, and are critical for nerve and muscle function. Various mechanisms exist in living species that keep the concentrations of different electrolytes under tight control. Both muscle tissue and neurons are considered electric tissues of the body. Muscles and neurons are activated by electrolyte activity between the extracellular fluid or interstitial fluid, and intracellular fluid. Electrolytes may enter or leave the cell membrane through specialized
protein structures embedded in the plasma membrane called ion channels. For example, 2+ + muscle contraction is dependent upon the presence of calcium (Ca ), sodium (Na ), and + potassium (K ). Without sufficient levels of these key electrolytes, muscle weakness or severe muscle contractions may occur. Electrolyte balance is maintained by oral, or in emergencies, intravenous (IV) intake of electrolyte-containing substances, and is regulated by hormones, generally with the kidneys flushing out excess levels. In humans, electrolyte homeostasis is regulated by hormones such as antidiuretic hormone, aldosterone and parathyroid hormone. Serious electrolyte disturbances, such as dehydration and overhydrating, may lead to cardiac and neurological complications and, unless they are rapidly resolved, will result in a medical emergency.
How can vitamins and minerals be preserved in food preparation? The following food handling practices will enhance vitamin and mineral retention: 1. Store vegetables properly to avoid wilting and drying out, which cause loss of v itamins and minerals. 2. Cook vegetables whole as often as possible. Cutting and peeling release oxidative enzymes and increase surfaces form which water-soluble vitamins and minerals leach out. 3. Use cooking water and canned food juices to conserve soluble nutrients, or preferably, steam fresh and frozen vegetables to lessen the le aching of nutrients. 4. Avoid using baking soda in cooking vegetables, as it is destructive to thiamine and ascorbic acid and avoid long cooking for the same reason. 5. Store fats covered- and preferably refrigerated- to prevent them from becoming rancid, which destroy vitamin A. 6.
Keep milk in a glass container away from light.
7. Keep fruit juices covered and cold to prevent oxygen from destroying vitamin C. 8. While cooking foods containing vitamin C, avoid stirring because oxygen destroys it. 9. Cook vegetables quickly in a covered container just until fork tender. 10. Cook vegetables in the microwave or in a streamer. What is food fortification?
Food fortification is the public health policy of adding micronutrients (essential trace elements and vitamins) to foodstuffs to ensure that minimum dietary requirements are met. Simple diets based on staple foods with little variation are often deficient in certain nutrients, either because they are not present in sufficient amounts in the soil of a region, or because of the inherent inadequacy of the diet. Addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases in these cases. Several ranges of food supplements are recognized: additives which repair a deficit to "normal" levels additives which appear to enhance a food supplements taken in addition to the normal diet Many physicians today disagree with the premise that foodstuffs need supplementation, but accept that - for example - added calcium may provide benefit, o r that adding folic acid may correct a nutritional deficiency especially in pregnant women. On a more controversial level, but well founded in scientific basis, is the science of using foods and food supplements to achieve a defined health goal. A common example of this use of food supplements is the extent to which body builders will use amino acid mixtures, vitamins and phytochemicals to enhance natural hormone production, increase muscle and reduce fat. Moving on from this reasonably accepted usage, there is increasing evidence for the use of food supplements in established medical conditions. This nutritional supplementation using foods as medicine (nutraceuticals) has been effectively used in treating disorders affecting the immune system up to and including cancers. This goes beyond the definition of "food supplement", but should be included for the sake of completeness. y y y
How does nutrition influence the outcome of pregnancy? The mothers nutrition and health status influences the growth and development of the fetus, but it can even affect the ability to conceive a pregnancy. Polycystic ovary syndrome (PCOS) is associated with reproductive dysfunction. Reversing obesity and insulin resistance has been shown increase infertility without the need for costly assisted reproduction. Good nutritional status helps reduce the risk of miscarriage. Selenium supplementation has resulted in successful pregnancy outcomes in veterinary practice. Maternal nutritional counseling should cover the conception and postpartum periods and the more traditional gestational or prenatal period. Neural tube defects are common among the most common and serious birth defect. Folate should be consumed within first few weeks of pregnancy until the time when the spinal column closes. In addition, vitamin B12 deficiency interferes with the cellular use of folate, and vitamin B12 fortification of foods may further reduce the risk of ne ural tube defects. Choline is also important for normal development of the brain and is essential for the normal function of all body cells. Prevention of orofacial clefts (abnormal opening of the lips or palate) appears related to adequate intake of the B vitamins. Vitamin C foods, such as citrus fruits and dark green, leafy vegetables, should be increased during pregnancy lactation. A well balanced diet will help the fetus grow well and allow the mother to stay healthy for the future pregnancies.
What nutritional advice is recommended during p regnancy? y
Weight gain- a major determinant of fetal outcome during pregnancy is maternal weight gain. Adequate weight gain improves fetal growth. A woman who underweight before pregnancy needs to gain more weight than a typically recommended to best promote growth of the product of conception, especially the placenta because it transfers maternal nutrients to the fetus. However, excess weight gain needs to be avoided for the health of the mother and the growing fetus. Ideal weight gain is now considered to be about 25 to 35 pounds for normal-weight women mass index (BMI) of 20 to 26, 28 to 40 pounds for an underweight woman (BMI <20), and 15 to 20 pounds per week in the second and third semesters of pregnancy. A grid can be used to plot the weight gain throughout the pregnancy.
y
Nutritional needs- to promote healthy diet, a pregnant woman should be encouraged to consume at least the minimum number of servings recommended by the dietary guidelines and the MyPyramid food guidance system, with the focus on the use of whole grains and unprocessed or minimal processed foods. Adequate carbohydrate intake is important. Although avoiding a high-glycemic-index diet can reduce blood glucose levels, a diet with low dietary glycemic index can increase the risk of low birth weight. Protein intake needs to be adequate; the minimum intake should be 60g, which is met by the inclusion of the minimum number of se rving recommended by dietary guidelines. An intake of up to 100g of protein daily. The kilocalories needed to provide appropriate weight gain are supplied by from additional carbohydrates and fats. A minimum of 30 g of fat is required to provide the essential fatty acids for the growth and development. A high intake of linoleic acid, as found in se ed oils and corn oil, during pregnancy and lactation has been implicated in the epidemic of childhood obesity as a result of hormonal alteration. Pregnant women following a vegan diet need to ensure adequate intake of vitamin B12 through fortified foods or supplements. Vitamin D is also obtain in vegan diet; the pregnant womans diet should therefore be supplemented. Good nutritional intake should be maintained after delivery for healthy lactation and in preparation for the future pregnancy.
y
Food safety concerns- women are advised to avoid excess intake of mercury during pregnancy. The most common source is canned tuna fish. The large ocean fish such as shark, swordfish, and marlin or lake fish often contain high amount of mercury and should be avoided during pregnancy. Another concern during pregnancy is food poisoning. Safe food-handling practices should be followed. It is recommended that deli meats be heated, especially during pregnancy.
What are the common problems related to pregnancy?
Nausea- is a sensation of unease and discomfort in the upper stomach with an urge to [2]
vomit. An attack of nausea is known as a qualm. The most common cause is gastroenteritis (a stomach infection) or food poisoning but nausea also frequently occurs as a medication side effect and in pregnancy. There are some medications, called antiemetic, that improve symptoms of nausea, including metoclopramide and ondansetron. Nausea or "morning sickness" is a common symptom of pregnancy. In the first trimester nearly 80% of women have some degree of nausea. Pregnancy therefore should be considered in any women of child bearing age. While usually it is mild and self-limiting severe cases known as hyperemesis gravidarum may require treatment.
Anemia- is a decrease in normal number of red blood cells (RBCs) or less than the
normal quantity of hemoglobin in the blood. However, it can include decreased oxygenbinding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency. Because hemoglobin (found inside RBCs) normally carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs. Because all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences. Anemia is the most common disorder of the blood. There are several kinds of anemia, produced by a variety of underlying causes. Anemia can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, and discernible clinical spectra, to mention a few. The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis). Constipation- refers to bowel movements that are infrequent and hard to pass.
Constipation is a common cause of painful defecation. Severe constipation includes obstipation and fecal impaction (see also Bowel obstruction). Constipation is common; in the general population incidence of constipation varies from 2 to 30%. Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility ). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow t ransit constipation include diet, hormones, side effects of medications, and heavy metal toxicity. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and surgery. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause.
Heartburn Heartburn, also known as pyrosisor acid indigestionis a burning sensation in
the chest, just behind the breastbone or in the epigastrium. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is usually associated with regurgitation of gastric acid (gastric reflux) which is the major symptom of gastroesophageal reflux disease (GERD). It however may also be a symptom of ischemic heart disease so concluding that it is heartburn prematurely may lead to misdiagnosis. Pica- is a medical disorder characterized by an appetite for substances largely nonnutritive (e.g. metal [coins, etc.], clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g. flour, raw potato, raw rice, starch, ice cubes, salt). In order for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for magpie, a bird that is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities. Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) when their BMI is between 2 2 2 25 kg/m and 30 kg/m , and obese when it is greater than 30 kg/m . Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, breathing difficulties during sleep, certain types of cancer, and [2] osteoarthritis. Obesity is most commonly caused by a combination of excessive dietary calories, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. Evidence to support the view that some obese people eat little y et gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass. The primary treatment for obesity is dieting and physical exercise. To supplement this, or in case of failure, anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or an intragastric balloon is placed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from f ood.
Pregnancy induced hypertension Gestational hypertension or pregnancy-induced
hypertension is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestation. Hypertension can arise before week 20 if the wo man has multiple fetuses or a hydatidiform mole. There exist several hypertensive states of pregnancy: Gestational hypertension = usually defined as a BP over 140/90
Preeclampsia = gestational hypertension (BP > 140/90), and proteinuria (>300
mg of protein in a 24-hour urine sample). Severe preeclampsia involves a BP over 160/110 (with additional signs) Eclampsia = seizures in a preeclamptic patient HELLP syndrome = Hemolytic anemia, elevated liver enzymes and low platelet count Acute fatty liver of pregnancy is sometimes included in the preeclamptic spectrum. Pre-eclampsia and eclampsia are sometimes treated as components of a common syndrome. Diabetes- Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending [2] on the population studied. No specific cause has been identified, but it is believed that the hormones produced during pregnancy increase a woman's resistance to insulin, resulting in impaired glucose tolerance. Babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks. Women with gestational diabetes are at increased risk of developing type 2 diabetes mellitus (or, very rarely, latent autoimmune diabetes or Type 1) after pregnancy, as well [3] as having a higher incidence of pre-eclampsia and Caesarean section ; their offspring are prone to developing childhood obesity, with type 2 diabetes later in life. Most patients are treated only with diet modification and moderate exercise but some take [3] anti-diabetic drugs, including insulin and Metfornin . Restless leg syndrome- Restless legs syndrome (RLS), also known as WittmaackEkbom syndrome, is a condition that is characterized by an irresistible urge to m ove one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can [1] also affect the arms or torso, and even phantom limbs. Moving the affected body part modulates the sensations, providing temporary relief. RLS causes a sensation in the legs or arms that can most closely be compared to a burning, itching, or tickling sensation in the muscles. Some controversy surrounds the marketing of drug treatments for RLS. It is a "spectrum" disease with some people experiencing only a minor annoyance and others experiencing major issues.
Epilepsy- is a common chronic neurological disorder characterized by recurrent [1][2]
unprovoked seizures. These seizures are transient signs and/or symptoms of [3] abnormal, excessive or synchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy, with almost 90% of these people being in developing
[4]
countries. Epilepsy is more likely to occur in young children, or people over the age of [5] 65 years; however, it can occur at any time. As a consequence of brain surgery, epileptic seizures may occur in recovering patients. Epilepsy is usually controlled, but cannot be cured with medication, although surgery may be considered in difficult cases. However, over 30% of people with epilepsy do not [6][7] have seizure control even with the best available me dications. Not all epilepsy syndromes are lifelong some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as syndromic with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.
Phenylketonuria- Phenylketonuria (PKU) is an autosomal recessive metabolic genetic
disorder characterized by a deficiency in the hepatic enzyme phenylalanine hydroxylase [1]:541 (PAH). This enzyme is necessary to metabolize the amino acid phenylalanine ('Phe') to the amino acid tyrosine. When PAH is deficient, phenylalanine accumulates and is converted into phenylpyruvate (also known as phenylketone), which is detected in the [2] urine. Since its discovery, there have been many advances in its treatment. It can now be managed by the patient with little or no side-effec ts, just the inconvenience of managing the treatment. If, however, the condition is left untreated, it can cause problems with brain development, leading to progressive mental retardation, brain damage, and seizures. In the past, PKU was treated with a low-phenylalanine diet. Latter-day research now has shown that diet alone may not be enough to prevent the negative effects of phenylalanine levels. Alcohol use Fetal/Foetal alcohol syndrome (FAS) is a pattern of mental and physical defects which develops in some unborn babies when the mother drinks excessive alcohol during pregnancy. The timing and frequency of excessive alcohol during pregnancy are also important with regard to the risk of a child developing foetal alcohol syndrome. The ingestion of alcohol does not always result in FAS, but no amount of alcohol whatsoever is proven safe for consumption during pregnancy. The current recommendation of both the Surgeon General of the United States and the British [1][2][3] Department of Health is not to drink alcohol at all during pregnancy. Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, and cause other [4][5][6] physical, mental, or behavioral problems. Surveys found that in the United States, 1015% of pregnant women report having recently used alcohol, and up to 30% use [7][8][9] alcohol at some point during pregnancy. The main effect of FAS is permanent central nervous system damage, especially to the brain. Developing brain cells and structures are underdeveloped or malformed by p renatal alcohol exposure, often creating an array of primary cognitive and functional disabilities (including poor memory, attention deficits, impulsive behavior, and poor cause-effect reasoning) as well [6][10] as secondary disabilities (for example, mental health problems, and drug addiction).
The risk of brain damage exists during each trimester, since the fetal brain develops [11] throughout the entire pregnancy.
Drug addiction- Drug addiction is a pathological or abnormal condition which arises due
to frequent drug use. The disorder of addiction involves the progression of acute drug use to the development of drug-seeking behavior, the vulnerability to relapse, and the decreased, slowed ability to respond to naturally rewarding stimuli. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has categorized three stages of addiction: preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect. These stages are characterized, respectively, everywhere by constant cravings and preoccupation with obtaining the substance; using more of the substance than necessary to experience the intoxicating effects; a nd experiencing tolerance, withdrawal [2] symptoms, and decreased motivation for normal l ife activities. By the American Society of Addiction Medicine definition, drug addiction differs from drug dependence and drug tolerance.
Adolescent pregnancy- is defined as a teenaged or underage girl (usually within the ages
of 1319) becoming pregnant. The term in everyday speech usually refers to women who have not reached legal adulthood, which varies across the world, who become pregnant. The average age of menarche (first menstrual period) in the United States is 12 years old, though this figure varies by ethnicity and weight, and first ovulation occurs only irregularly until after this. The average age of men arche has been declining and continues to do so. Whether fertility leads to early pregnancy depends on a number of factors, both societal and personal. Worldwide, rates of teenage pregnancy range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea. Pregnant teenagers face many of the same obstetrics issues as women in their 20s and 30s. However, there are additional medical concerns for younger mothers, particularly those under fifteen and those living in developing countries. For mothers between 15 and 19, age in itself is not a risk factor, but additional risks may be associated with socioeconomic factors. Data supporting teenage pregnancy as a social issue in developed countries include lower educational levels, higher rates of poverty, and other poorer "life outcomes" in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. For these reasons, there have been many studies and campaigns which attempt to uncover the causes and limit the numbers of teenage pregnancies. In other countries and cultures, particularly in the developing world, teenage pregnancy is usually within [7] marriage and does not involve a social stigma. Among OECD developed countries, the United States and New Zealand have the highest level of teenage pregnancy, while Japan and South Korea have the lowest.
Celiac disease- is an autoimmune disorder of the small intestine that occurs in
genetically predisposed people of all ages from middle infancy onward. Symptoms include chronic diarrhoea, failure to thrive (in children), and fatigue, but these may be absent, and symptoms in other organ systems have been described. A growing portion of diagnoses are being made in asymptomatic persons as a result of increased screening, and is thought to affect between 1 in 1,750 to 1 in 105 people in the United States. Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the tribe Triticeae (which includes other common grains such as barley and rye). Upon exposure to gliadin, and specifically to three peptides found in prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy. Post-partum depression- Postpartum depression (PPD), also called postnatal depression, is a form of clinical depression which can affect women, and less frequently men, after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual prevalence rate unclear. Among men, in particular new fathers, the incidence of postpartum depression has been estimated to be between 1.2% and 25.5%. Postpartum depression occurs in women after they have carried a child, usually in the first few months, and may last up to several months or even a year. Symptoms include sadness, fatigue, changes in sleeping and eating patterns, reduced libido, crying episodes, anxiety, and irritability. It is sometimes assumed that postpartum depression is caused by a lack of vitamins, but studies tend to show that more likely causes are the significant changes in a woman's hormones during pregnancy. On the other hand, hormonal treatment has not helped postpartum depression victims. Many women recover because of a support group or counseling.
What are lactation management goals and concerns? Diet influence on the nursing couple- the effect of maternal diet on infant growth and
development does not end at delivery. This is t rue even for non-nursing mothers, who need to maintain their nutritional status to cope best with the demands of the new baby. During lactation, adequate diet becomes more critical. Caloric intake can affect the quantity of milk produced; therefore it is important for the breast-feeding woman to lose any excess weight slowly. Beriberi can occur in breast-feeding mothers have inadequate intake of vitamin B1. Indication of beriberi includes congestive heart failure along with other abnormalities that improve with thiamine provision. Poor vitamin A
status during the first month of life was found sig nificantly increase the risk of abnormal development of the respiratory system. Health benefits associated with lactation- jaundice is common newborns. Frequent
bowel movements associated with breast-feeding reduces the risk of developing jaundice through increase secretion of bilirubin. If a breast-fed infant develops hyperbilirubinemia, the advice should be continue the breast-feeding and withhold the supplementary feedings. Brest-fed babies have been shown to spend to spend about half as much time receiving antibiotics during the first y ear of life as compared to formula-fed babies. This is believed to be a result of transferal of the mothers immune substance called immunoglobulin A (IgA). What are the common nutritional issues of children and adolescents? Anemia and iron deficiency-- is a decrease in nor mal number of red blood cells (RBCs) or
less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency. Because hemoglobin (found inside RBCs) normally carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs. Because all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences. Anemia is the most common disorder of the blood. There are several kinds of anemia, produced by a variety of underlying causes. Anemia can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, and discernible clinical spectra, to mention a few. The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis) Lead toxicity- Lead poisoning (also known as pl umbism, colica Pictonum, saturnism,
Devon colic, or painter's colic) is a medical condition caused by increased levels of the heavy metal lead in the body. Lead interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, and reproductive and nervous systems. It interferes with the development of the nervous system and is therefore particularly toxic to children, causing potentially permanent learning and behavior disorders. Symptoms include abdominal pain, headache, anemia, irritability, and in severe cases seizures, coma, and death. Routes of exposure to lead include contaminated air, water, soil, food, and consumer products. Occupational exposure is a common cause of lead poisoning in adults. One of the largest threats to children is lead paint that exists in many homes, especially older ones; thus children in older housing with chipping paint are at g reater risk. Prevention of
lead exposure can range from individual efforts (e.g. removing lead-containing items such as piping or blinds from the home) to nationwide policies (e.g. laws that ban lead in products or reduce allowable levels in water or soil).
Dental decay Dental caries, also known as tooth decay or cavity, is a disease where
[1]
bacterial processes damage hard tooth structure (enamel, dentin, and cementum). These tissues progressively break down, producing dental caries (cavities, holes in the teeth). Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, [2] infection, and, in severe cases, death. Today, caries remains one of the most common diseases throughout the world. Cariology is the study of dental caries. Childhood obesity- Childhood obesity is a condition where excess body fat negatively affects a child's health or wellbeing. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health eff ects it is being recognized as a serious [1] public health concern. The term overweight rather than obese is often used in children [2] as it is less stigmatizing.
Poor weight gain- Growth failure is a medical term for a rate of a child's growth which is
poorer than norma for age, sex, stage of maturation, and genetic height expectation. Growth failure usually has an abnormal cause or causes. Many short children are growing normally and this is not referred to as growth failure. Linear growth is measured by change of recumbent length in infants until age 2 t o 3 years, when a child's height can be measured standing. Growth Failure is a term used to describe failure to grow in length. Growth is a dynamic process that starts before a child is born and continues until the bones fuse after puberty. After puberty, bones continue to mature to achieve prime bone density. Growth in length per year is age dependent and may be affected by many different factors including, but not limited to; hormonal abnormalities, chronic illness, and genetic abnormalities. Failure to grow should be taken seriously as it may indicate a hidden illness, a pediatrician should be consulted if a child is exhibiting slow growth outside of the ranges shown below. All ranges described are averages for the age range. In addition, to rate of growth, the position of the child on the growth chart (which compares other children of the same age) should be observed. Cystic fibrosis- Cystic fibrosis (also known as CF or mucoviscidosis) is a common disease
which affects the entire body, causing progressive disability and often early death. The name cystic fibrosis refers to the characteristic scarring (fibrosis) and cyst formation [1] within the pancreas, first recognized in the 1930s. Difficulty breathing is the most serious symptom and results from frequent lung infections that are treated, though not cured, by antibiotics and other medications. A multitude of other symptoms, including
sinus infections, poor growth, diarrhea, and infertility result from the effects of CF on other parts of the body. CF is caused by a mutation in the gene for the protein cystic fibrosis transmembrane conductance regulator (CFTR). This gene is required to regulate the components of sweat, digestive juices, and mucus. Although most people without CF have two working copies of the CFTR gene, only one is needed to prevent cystic fibrosis. CF develops when neither gene works normally. Therefore, CF is considered an autosomal recessive disease. CF is most common among Caucasians; one in 25 people of European descent carry one gene for CF. Approximately 30,000 Americans have CF, making it one of the most common life-shortening inherited diseases. Individuals with cystic fibrosis can be diagnosed before birth by genetic testing, or by a sweat test in early childhood. Ultimately, lung transplantation is often necessary as CF worsens. Asthma is a common chronic inflammatory disease of the airways characterized by [1]
variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. [2] Symptoms include wheezing, coughing, chest tightness, and shortness of breath. Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist [3] (such as salbutamol). Symptoms can be prevented by avoiding triggers, such as [4] [5] allergens and irritants, and by inhaling corticosteroids. Leukotriene antagonists are [6] less effective than corticosteroids and thus less preferred. The prevalence of asthma has increased significantly since the 1970s. As of 2009, 300 [7] [7] million people were affected worldwide. In 2009 asthma caused 250,000 deaths, although generally with treatment, prognosis is good.
Food allergies A food allergy is an adverse immune response to a food protein.
[1][2]
They
are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions. A protein in the food is the most common allergic component. These kinds of allergies occur when the body's immune system mistakenly identifies a protein as harmful. Some proteins or fragments of proteins are resistant to digestion and those that are not broken down in the digestive process are tagged by the Immunoglobulin E (IgE). These tags fool the immune system into thinking that the protein is ha rmful. The immune system, thinking the organism (the individual) is under attack, triggers an allergic reaction. These reactions can range from mild to severe. Allergic responses include dermatitis, gastrointestinal and respiratory distress, including such life-threatening anaphylaxic responses as biphasic anaphylaxis and vasodilation; these require immediate emergency intervention. Non-food protein allergies include latex sensitivity. Individuals with protein allergies commonly avoid contact with the problematic protein. Some medications may prevent, minimize or treat protein allergy reactions.
Constipation refers to bowel movements that are infrequent and hard to pass.
Constipation is a common cause of painful defecation. Severe constipation includes obstipation and fecal impaction (see also Bowel obstruction). Constipation is common; in the general population incidence of constipation varies from 2 to 30%.Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormones, side effects of medications, and heavy metal toxicity. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and surgery. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Pediatric migraine It is a relatively uncommon variant of migraine in which the patient may experience aura, nausea, photophobia, hemiparesis and other migraine symptoms but does not experience headache. While it is generally classified as an event fulfilling the conditions of migraine with aura with no (or minimal) headache, it is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine. Attention deficit hyperactivity disorder- Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD) is a neurobehavioral developmental disorder. It is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age. ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3% to 5% of children globally and diagnosed in about 2% to 16% of [7] school aged children. It is a chronic disorder with 30% to 50% of those individuals diagnosed in childhood continuing to have sy mptoms into adulthood. Adolescents and adults with ADHD tend to develop coping mechanisms to compensate for some or all of their impairments. 4.7% of American adults are estimated to live with ADHD. ADHD is diagnosed two to four times as frequently in boys as in girls, though studies suggest this discrepancy may be due to subjective bias of referring teachers. ADHD management usually involves some combination of medications, behavior modifications, lifestyle changes, and counseling. Its symptoms can be difficult to differentiate from other disorders, increasing the likelihood that the diagnosis of ADHD will be missed. Additionally, most clinicians have not received formal training in the assessment and treatment of ADHD, particularly in adult patients.
Autistic spectrum disorder Autism forms the core of the autism spectrum disorders.
Asperger syndrome is closest to autism in signs and l ikely causes; unlike autism, people with Asperger syndrome have no significant delay in language development. PDD-NOS are diagnosed when the criteria are not met for a more specific disorder. Some sources also include Rett syndrome and childhood disintegrative disorder, which share several
signs with autism but may have unrelated causes; other sources combine ASD with these two conditions into the pervasive developmental disorders. According to the National Autistic Society of the United Kingdom, Pathological demand avoidance syndrome belongs and is increasingly being recognized as belonging to the autistic spectrum.
Eating disorder Eating disorders are a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and emotional health, binge eating disorder, bulimia nervosa, anorexia nervosa being the most common specific forms in the United States, Though primarily thought of as affecting females (an estimated 510 million being affected in the U.S.), eating disorders affect males as well (an estimated 1 million U.S. males being affected). The causes of eating disorders are complex and poorly understood, though it is clear that they are often associated with other conditions and social situations; for example, one study found that girls with ADHD are many times more likely to develop certain eating disorders and another found that women raised in foster care are many times more likely to develop bulimia nervosa. Some also think that peer pressure and idealized body-types seen in the media are also a significant factor. While proper treatment can be highly effective for many of the specific types of eating disorder, the consequences of eating disorders can be severe, including death (whether from direct medical effects of disturbed eating habits or from comorbid conditions such as suicidal thinking).
y
y
is an eating disorder characterized by refusal to maintain a healthy body weight, and an obsessive fear of gaining weig ht due to a distorted self-image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating. It is a seri ous mental illness with a high incidence of comorbidity and also the highest mortality rate of any psychiatric disorder. It can affect men and women of all ages, races, socioeconomic and cultural backgrounds. The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: a (, prefix of negation), n (, link between two vowels) and orexis (, appetite), thus meaning a lack of desire to eat. Anorexia nervosa
Bulimia- nervosa is an eating disorder characterized by recurrent binge eating, followed [1] by compensatory behaviors. The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over [2] exercising are also common.