1. Chapter 1 NUTRITION BASICS

2. Chapter 1 Outline Principles of Human Nutrition ◦Food = Basic Need ◦Energy, Nutrients, Needs, and Diet Balance ◦Results of Poor Nutritional Intake ◦Individuals at Higher Risk of Inadequate Nutritional Intake ◦Chronic Diseases Associated with Nutritional Intake Food Labeling Nutrition Assessment Public Food and Nutrition Programs Major Diet and Health Guidelines

3. Food = Basic Need of Humans Food security—having access at all times to sufficient supply of safe, nutritious foods Food insecurity—limited or uncertain availability of safe, nutritious foods ◦About 14% of U.S. households are food insecure ◦20% households with children ◦35% household with children headed by single women ◦26% Black, non-Hispanic households ◦24% Hispanic households

4. Energy, Nutrients, Needs, and Balance Foods provide energy (calories), nutrients, and other substances needed for growth & health ◦Calorie: energy from food ◦Nutrients: chemical substances in food ◦Six categories of nutrients: ◦Carbohydrates ◦Proteins ◦Fats ◦Vitamins and Minerals ◦Water

5. Factors that Impact Nutrient Needs Age Body size Gender Genetic traits Growth Illness Lifestyle habits Medications Pregnancy and lactation

6. Stages of the Life Cycle Pregnancy Lactation Infancy ◦0 – 1 year old Toddler & Preschooler ◦1 – 5 years old Childhood & Preadolescence ◦5 – 12 years old Adolescence ◦13 – 20 years old Young Adulthood ◦21 – 44 years old Middle Adulthood ◦45 – 64 years old Older Adults ◦65 + years old

7. Life-Course Approach to Nutrition and Health Healthy individuals require the same nutrients throughout life. ◦Amounts of nutrients vary based on age, growth and development. Diets may be defined by cultures and religions.

8. Dietary Intake Standards Dietary Reference Intakes (DRIs): ◦Recommended Dietary Allowances (RDAs) ◦Adequate Intakes (AIs) ◦Estimated Average Requirements (EARs) ◦Tolerable Upper Intake Levels (ULs)

9. Dietary Intake Standards: DRIs Dietary Reference Intakes (DRIs) ◦An umbrella term used to determine other nutritional reference values ◦Nutrient intake standards for healthy people

10. Dietary Intake Standards: EARs Estimated Average Requirements (EARs) ◦Estimated values to meet requirements of half of the healthy individuals in a group ◦EARs are used to assess adequacy of intakes of population groups ◦NOTE: for each nutrient, a specific bodily function is chosen as a criterion ◦Example: EAR for Calcium is set to maximize bone health of populations

11. Dietary Intake Standards: RDAs Recommended Dietary Allowances (RDAs) ◦Recommended levels of essential nutrients ◦Adequate for most healthy people ◦~98% ◦Consuming RDAs of nutrients can decrease risk of certain chronic diseases ◦It is recommended that healthy individuals aim to meet the RDAs of nutrients

12. Dietary Intake Standards: AIs Adequate Intakes (AIs) ◦“Tentative” RDAs ◦Used when scientific information is less conclusive ◦It is recommended that healthy individuals aim to meet the AIs of nutrients when the EARs or RDAs are not established ◦Example: All DRI values for infants are AIs derived from nutrient value of human breast milk

13. Dietary Intake Standards: ULs Tolerable Upper Intake Levels (ULs) ◦Upper limits of nutrients compatible with health ◦Established to distinguish healthful and harmful nutrient intakes ◦These are the limits that should not be exceeded

14. Standards of Nutrient Intake on Nutrition Labels Daily Values (DVs) DVs are standards for daily intakes of nutrients used on nutrition label of foods The “% DV” listed on nutrition labels is representative of the percentages nutrients obtained from one serving of the food item

15. Recall: Calories per Gram NutrientCalories per Gram Carbohydrates4 Protein4 Fat9 Alcohol7

16. Carbohydrates Main function: source of readily available energy Recommended intake level ◦45-65% of calories ◦Added sugar: 25% or less of calories ◦21-25 g fiber/day for females ◦30-38 g fiber/day for males Food sources ◦Sweeteners, sweetened beverages, milk, yogurt, candy, fruits, starchy vegetables, grains, legumes

17. Carbohydrates: Question 2000 calorie diet 50% calories from carbohydrates How many grams of carbohydrates?

18. Carbohydrates: Answer 2000 × 50% = 1000 calories 1000 calories ÷ 4 calories per gram = 250 grams carbohydrates

19. Protein Main Function: provide body with amino acids to build and maintain tissues ◦Amino acids—”building blocks” of proteins ◦Essential—body cannot make; must be provided in diet ◦Nonessential—body can make Protein quality ◦High-quality proteins provide all essential amino acids ◦Animal proteins such as meats, eggs, milk, and cheese ◦Plant sources of protein (legumes) paired with grains or seeds yield high- quality proteins Recommended intake ◦10-35% of calories

20. Protein: Question 2000 calorie diet 20% calories from protein How many grams of protein?

21. Protein: Answer 2000 × 20% = 400 calories 400 calories ÷ 4 calories per gram = 100 grams protein

22. Fats (Lipids) Main function: cholesterol and sex-hormone synthesis, components of cell membranes, vehicles for carrying fat-soluble vitamins, and suppliers of essential fatty acids Fats = solid at room temperature Oils = liquid at room temperature

23. Fats: Essential Fatty Acids Essential fatty acids ◦Linoleic acid (omega-6) ◦Vegetable oil, meats, human milk ◦Alpha-linolenic acid (omega-3) ◦Dark green veggies, oils, flaxseed, cold-water fish, human milk Most adults do not consume adequate levels of omega-3 fatty acids and consume excessive amounts of omega-6 fatty acids

24. Fats: Saturation States Saturated: no double bonds Unsaturated ◦Monounsaturated: one double bond ◦Polyunsaturated: two or more double bonds Hydrogenation and Trans Fats ◦Hydrogenation—adds hydrogen to unsaturated fatty acids ◦Turns oils from liquid to solid, increasing shelf life

25. Fats: Recommended Intakes Not all fats are created equal “Unhealthful” fats ◦Those that raise LDL-cholesterol ◦Examples: Trans and saturated fats and cholesterol “Healthful” fats ◦Those that raise HDL-cholesterol ◦Examples: Monounsaturated, polyunsaturated, linolenic, EPA, and DHA

26. Fats: Recommended Intakes 20-35% of calories from fat, limiting unhealthful fats as much as possible Linoleic acid (omega-6): 17 g/day for men, 12 g/day for women Alpha-linolenic acid (omega-3): 1.6 g/day for men, 1.1 g/day for women

27. Fats: Question 2000 calorie diet 30% calories from fat How many grams of fat?

28. Fats: Answer 2000 calories × 30% = 600 calories 600 calories ÷ 9 calories per gram = 67 grams fat

29. Vitamins Water-soluble vitamins ◦Thiamin (B 1 ), Riboflavin (B 2 ), Niacin (B 3 ), Vitamin B 6, Folate, Vitamin B 12, Biotin, Pantothenic acid, Choline, Vitamin C ◦Bodily stores are limited and run out within weeks – months after inadequate intake. Exception: Vitamin B 12 Fat-soluble vitamins ◦A, D, E, K ◦Bodily stores can be sizable and last months – years when intake is low Functions ◦Coenzymes in metabolism ◦Vitamin A, Thiamin, Riboflavin, Folate ◦Antioxidants to maintain body tissues and prevent disease ◦Vitamin C, Vitamin E, beta-carotene

30. Minerals There are 15 essential minerals

31. Water Adults are 60-70% water by weight Recommended daily intakes ◦15-16 cups for males ◦11 cups for females ◦75% from fluids; 25% from foods Dietary sources ◦Best to drink water & nonalcoholic beverages ◦Alcoholic beverages increase water loss through urine

32. Poor Nutritional Intake Poor nutrition can result from both inadequate and excessive levels of nutrient intake. ◦Prolonged inadequate intake results in obvious deficiency diseases ◦Vitamin A deficiency = irreversible blindness ◦Overdoses of nutrients (usually by supplements) result in mild to severe alterations in functioning ◦Vitamin C toxicity = diarrhea ◦Vitamin D overdose = mental retardation in young children

33. Steps in Development of Nutrient Deficiencies and Toxicities

34. Malnutrition Malnutrition can result from poor diets and from disease states, genetic factors, or combinations of these causes ◦Primary malnutrition: dietary in origin ◦Secondary malnutrition: caused by a disease state, surgical procedure, or medication

35. High Risk Individuals Some groups of individuals are at higher risk of becoming inadequately nourished than others Can you think of a particular group of individuals that may be at a higher risk of malnutrition?

36. High Risk Individuals Pregnant women Breastfeeding women Infants Children People who are ill Frail elderly persons ◦Within each of these groups, those with lower socioeconomic statuses are at the highest risk

37. Nutrient Intake & Chronic Disease Poor nutrition can influence the development of certain chronic diseases ◦Heart disease ◦Hypertension ◦Cancer ◦Stroke ◦Osteoporosis ◦Type 2 diabetes ◦Obesity

38. Nutrient Intake & Chronic Disease Disease/DisorderDietary Connection Heart DiseaseHigh saturated fat, trans fat, and cholesterol intakes; low vegetable, fruit and whole grain intakes CancerHigh alcohol and processed meat intakes; Low vegetable and fruit intakes Type 2 DiabetesHigh saturated fat and calorie intake; low vegetable and fruit intake HypertensionHigh sodium and alcohol intakes; low potassium, vegetable, and fruit intakes OsteoporosisLow calcium, vitamin D, vegetable, and fruit intakes Alzeheimer’s DiseaseHigh intake of high-fat animal products; low olive oil, vegetable, fruit, whole grain, fish, and wine intakes

39. Nutrigenomics The study of nutrient-gene interactions and the effects of these interactions on health. Examples of nutrient-gene interactions on health status: ◦Consuming high-glycemic index diet increases risk of developing type 2 diabetes in those with a certain form of a gene involved in insulin production and secretion ◦Alcohol intake during pregnancy in some women increases the risk of fetal alcohol syndrome, but other women with different genetic traits are not affected

40. “Good” vs. “Bad” Foods There are no “good” or “bad” foods ◦All foods can fit into a healthful diet ◦If nutrient needs are met ◦If calorie intake maintains healthy body weight Adequacy, variety and balance are key characteristics of a healthy diet ◦Focus on nutrient-dense foods ◦Limit “empty-calorie” foods

41. Nutrition Labeling Nutrition Facts panel ◦MUST list calories, and content of fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars, protein, vitamins A and C, calcium and iron ◦% Daily Value Nutrient content and health claims Ingredient label

42. Labeling: Ingredient Listing Food products must list ingredients in an “ingredient label” Ingredients are listed by weight, starting with the greatest amount

43. Labeling: Dietary Supplements Supplement Facts panel lists serving size, ingredients, and % DV Nutrition content claims ◦Can be labeled with standardized nutrition content claims ◦“High in calcium” ◦“Good source of fiber” Health claims (must include disclaimer) ◦Cannot claim to treat, cure, or prevent disease ◦Able to claim “May reduce risk of heart disease”

44. Labeling: Other Concerns Enrichment and fortification ◦Enrichment: refined grain products have added thiamin, niacin, riboflavin and iron ◦Fortified: addition of any other nutrient ◦Refined flour  folic acid ◦Milk  vitamin D ◦Low-fat and skim milk  vitamins A & D ◦Some salt  iodine

45. Labeling: Functional Foods Foods made “functional” by removing potentially harmful or increasing beneficial substances ◦Removing egg yolks to decrease cholesterol ◦Removing lactose from milk for individuals with intolerance ◦Adding fiber, calcium, vitamin C, vitamin D Prebiotics: fiber-like, indigestible CHO broken down by bacteria Probiotics: live, beneficial bacteria

46. Nutrition Facts Panel: How- To

47. FDA’s Proposed Nutrition Facts Panel

48. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInform ation/LabelingNutrition/ucm387533.htm

49. Nutrition Assessment Community-level assessment ◦Assessing a community’s “state of nutritional health” ◦Uses statistics, surveys, observations ◦Used to develop community nutrition programs Individual-level assessment ◦Nutrition assessment of individual ◦Clinical/physical assessment ◦Dietary assessment ◦Anthropometric assessment ◦Biochemical assessment

50. Nutrition Assessment: Individual Clinical/physical assessment ◦Visual inspection for features that may be related to malnutrition Dietary assessment ◦24-hour dietary recalls and records ◦Dietary history ◦Food frequency questionnaires ◦Resources: instruments, websites, apps

51. Individual Assessment: Dietary Recall

52. USDA Automated Multiple Pass Method Computerized, interactive method to collect 24-hr diet recalls Used in government-sponsored nutrition studies Five steps ◦1) The quick list ◦2) The forgotten food lists ◦3) Time and occasion list ◦4) The detail cycle ◦5) Final probe review

53. Individual Assessment: Anthropometrics Anthropometric assessment ◦Measurements of body size and shape ◦Height, weight, BMI, waist circumference, waist:hip ratio ◦BMI Calculation: ◦(weight × 703) ÷ ((height) 2 ) ◦Weight in pounds ◦Height in inches ◦Waist:Hip Ratio Calculation: ◦waist measurement ÷ hip measurement

54. Individual Assessment: Anthropometrics BMIInterpretation Underweight< 18.5 Normal Weight18.5 – 24.9 Overweight25.0 – 29.9 Obese≥ 30.0 Waist:Hip Ratio Interpretation MaleFemale ≤ 0.95≤ 0.80Low Risk 0.96 – 1.00.81 – 0.85Moderate Risk > 1.0> 0.85High Risk

55. Public Food and Nutrition Programs Community Programs ◦Food shelves/pantries ◦Second Harvest Programs ◦Salvation Army ◦Missions State- and Federal-Level Programs ◦School Lunch Program ◦SNAP ◦Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Approximately 1 in 5 Americans participates in of the the USDA’s 15 food assistance programs each year

56. Federal Food and Nutrition Programs ProgramActivity SNAP (Food Stamps)Subsidizes food purchases of low-income families and individuals WICServes low-income, pregnant, and breastfeeding women and children up to 5 years of age. Provides supplemental formulas, foods, and nutrition education. School Breakfast & Lunch ProgramProvides free breakfasts and reduced- or no-cost lunches to children from low-income families Summer Food Service ProgramProvides foods to children in low-income areas during the summer Head Start ProgramIncludes nutrition education for children and parents; supplies meals for children in the program

57. Nationwide Priorities for Improvements U.S. Nutrition and Health Guidelines ◦Dietary Guidelines for Americans (DGA) ◦Updated every 5 years ◦Implementation of DGA = MyPlate.gov ◦USDA’s Food Groups ◦Consistent with DGA = The DASH Diet

58. DGA: Executive Summary Maintain calorie balance overtime to achieve and maintain a healthy weight ◦Prevent/reduce overweight and obesity by improving dietary and physical activity behaviors ◦Control calorie intake to manage weight ◦Increase physical activity ◦Maintain appropriate calorie balance through each stage of life

59. DGA: Executive Summary Focus on consuming nutrient- dense foods and beverages ◦Reduce consumption of sodium, saturated fat, trans fat, cholesterol, added sugars, and refined grains; alcohol only in moderation ◦Increase consumption of fruits, vegetables, low-fat or fat-free dairy, lean protein, oils, and potassium, fiber, calcium, and vitamin D

61. Any Questions?