1. Principles of Nutrition
DR . Hanan M. A. Abdel Razek

2. The objectives of Principle of nutrition are:
Provide high-quality dietetic services to help to fulfil Addenbrooke’s role as a provider of comprehensive health services to the residents of Cambridge and the surrounding area.
Body development and maintenance: Amino acids, minerals, trace elements, vitamins and fatty acids respond to the basic nutritional needs for the development maintenance of the body.
Energy provision: Lipids and carbohydrates are the main energy sources for dogs. Cats are also dependent on proteins for their energy metabolism.
Nourishing and prevention: Some nutrients are incorporated in the ration (antioxidants, pre-biotics, fibre, essential fatty acids, etc), to prevent such risks as kidney disease, digestive problems and the effects of ageing.
Nourishing and caring: Certain nutrients are added and others limited in food to support the therapeutic or convalescence process, helping pets recover from a number of ailments.
Increase specialist work and develop specialist dietetic teams within the department.
Improve the links between these specialist teams and other dietitians in the region.

3. The objectives of Principle of nutrition are:
Improve the links between these specialist teams and other dietitians in the region.
Ensure quality is amongst the best, and adopt an approach to constant quality improvement.
Employ high-calibre staff and invest in their education and training.
Use evidence-based practice to develop effective therapies and new treatments.
Work to the highest professional standards.
Work with others to ensure nutrition is included as a priority in patient care.

4. Dietary intake 10 to 15% protein 60 to 65% carbohydrates 20 to 30% fat
1gram protein = 4 cal
1gram carb = 4 cal
1gram fat = 9 cal
1gram alcohol = 7 cal
Total caloric content = sum of cal/gm: (gm CHO x 4 ) + ( gm fat x 9) + ( gm protein x 4)

5. CHO Content (quantity and quality)
CHO Content (quantity and quality) * Total CHO ≈ % of total calories complex CHO = > 70 % simple CHO = < 10 % * Example : If total calories allowed = 1500 cal.: Then CHO content = 1500 X 60% = 900 cal.

6. CHO Content (quantity and quality) Complex CHO = 70 % x 900 = 630 cal ≈ 160 gm Sugars < 10 % x 900 = 90 cal ≈ 22 gm Complex CHO : with low G / l : grains-legumes-pasta-whole grain bread-boiled rice Simple CHO : refined sugars , fruit sugars

8. Fat Content * Fat restriction : helps control displipidemia and hyperglycemia ( decrease daily calorie ) Control body weight * Total fat content : > 30% of total calories polyunsaturated ( plant oil ) 10% monounsaturated (olive oil ) 10 % saturated : ( animal fat < 10%) * Essential fatty acid supplements ( soya beans, nuts, rapeseed oils) * Omega 3 fat ( fish) anti athirogenic ( 2.3 fish meals/wk or fish oil caps 0.3 g)

9. Protein * Average total protein content: 15% of total calories ( 10-15%) e.g. in total 2000 cal :15%= 300 cal.= 75 gm prot * Or ( gm/kg body weight) * Animal and plant proteins ( essential amino acids) * Protein restriction in renal function impairment * Allow for : growth , pregnancy , lactation, acute catabolic states, wound healing

10. Fibre ( undigested parts of diet ) Types : Soluble insoluble (pectins , gums ( cellulose, semi-cellulose, gel. , mucilage ) legnins ↓ ↓ Effects: metabolic effect increase bulk ( CHO & lipid) Recommendation : double the av. normal intake ( gm) gradual increase to avoid flatulence include both sol. & insoluble

11. One person (male) eat 213 gram prot, and 106 g fats , age 28 year, length 180 cm , weight 97kg and very active
BMR= (10x97)+(6.25X 180)-(5X28)+5=1950
TDEE= 1950 X 1.8= 3510 calorie
4 calorie X 213 g prot= 852 calorie
9 calorie X 106 g prot= 954 calorie
852 calorie calorie = 1806 calorie
3510 calorie calorie=1704 calorie
2094 calorie / 4 calorie (carb)= 426 g carb

12. Maintenance= to maintain body weight
Keep your calories
Bulking = to increase body weight
Increase the calories (health fats calorie)
Cutting = to reduce body weight
Reduce the calories (health fats calorie)

13. Energy requirement at various body weights
Energy needs
Energy requirement at various body weights
Weight
Calories
<10 kg
10-20 kg
> 20 kg
100 kcal/kg
kcal/kg
kcal/kg

14. السعرات الحرارية بوحدة "ك
السعرات الحرارية بوحدة "ك.ك" وهي اختصار ل " كيلو كالوري" كما يستخدم اختصار آخر وهو " ك.ج" وهو اختصار ل" كيلو جول".  
"كيلو كالوري" هي مرادف آخر لكلمة " السعر الحراري"، وعندما نكتب رقم 1000 كالوري فإن ذلك يعادله 1000 كيلو كالوري. أما الكيلو جول فهو القياس المتري للسعرات الحرارية ولمعرفة كمية الطاقة بالكيلو جول ضاعف الرقم من السعرات الحرارية بنسبة 4:2.
يمكنك استخدام المعلومات عن كمية السعرات الحرارية لمعرفة ما هو الطعام الملائم لاستهلاكك اليومي، وكدليل توجيهي يحتاج الرجل إلى (2500كيلو كالوري) أي ما يعادل (10,500 كيلو جول) للحفاظ على وزنه، والمعدل الذي تحتاجه المرأة هو (2000كيلو كالوري) اي ما يعادل (8,400 كيلو جول).

16. Reduce # of kcal eaten and/or burn off through exercise
Caloric Balance
Caloric intake vs. Caloric expenditure
How do I adjust calories to lose weight?
Reduce # of kcal eaten and/or burn off through exercise
3500 kcal = 1 lb of fat
Safe weight loss = 1-2 lb/week

17. Why is “Pound” Abbreviated as “lb”?
Lb is an abbreviation of the Latin word libra. The primary meaning of libra was balance or scales (as in the astrological sign), but it also stood for the ancient Roman unit of measure libra pondo, meaning “a pound by weight.” We got the word “pound” in English from the pondo part of the libra pondo but our abbreviation comes from the libra.

18. NEVER LESS THAN 1200 CALORIES PER DAY
Caloric Intake
Weight(lbs.) x 10 light activity
15 moderate activity
20 heavy activity
Subtract 100calories oF age 35-44
200calories oF age 45-54
300calories oF age 55-64
400calories oF age 65-up
NEVER LESS THAN 1200 CALORIES PER DAY

19. RMR (resting metabolic rate) Men = Weight (lbs) x 11 kcal/lb
RMR Women = Weight (lbs) x 10 kcal/lb
Daily caloric requirement = RMR x Activity factor
Exercise less than 2 times per week 1.42
Exercise 3 – 4 days per week 1.55
Exercise 5 or more days per week 1.8

20. Balancing energy in and energy out
Balancing energy intake by eating food with output through resting metabolism, growth, exercise and digesting food is one of the key components of maintaining health.

21. energy in = energy out.

22. If insufficient food is eaten, there is a negative energy balance, resulting in weight loss.
If too much food is eaten, there is a positive energy balance, and the excess energy is stored as body fat resulting in weight gain.

23. Assessing Body Weight and Body Composition
A Healthy Weight Depends On:
Body structure
Height
Weight distribution
Fat to lean tissue ratio
Muscle weighs more than fat, so muscular individuals might be overweight based on traditional height/weight charts.

24. Ideal weight = body weight ± 2 kg

25. A figure used to assess the % of fat in your body.
Body Mass Index
A figure used to assess the % of fat in your body.

26. Assessing Body Weight and Body Composition
Body Mass Index (BMI)
Index of the relationship between height and weight
BMI = weight (kg)/height squared (m2)
BMI of 18.5 to 25 kg/m2 indicates healthy weight
Youth and BMI
Labeled differently, as “at risk of overweight” and “overweight”

28. Body Mass Index (BMI)

30. Category BMI (kg/m2)
from to
Very severely underweight
Severely underweight
Underweight
Normal (healthy weight)
Overweight
Obese Class I (Moderately obese)
Obese Class II (Severely obese)
Obese Class III (Very severely obese)
Obese Class IV (Morbidly Obese)
Obese Class V (Super Obese)
Obese Class VI (Hyper Obese) 60

31. Calculating Your BMI
For the mathematicians you would divide your weight in kg by your height in metres squared.
For example someone who weighed 68kg, and was 1.68m tall
1.68 x 1.68 = 2.82
68 divided by 2.82 = 24
The following website will calculate your BMI for you.

32. BMI If your BMI is 25.0-29.9 you are considered to be overweight.
This means that your weight exceeds the normal standard based on height and frame size.
If your BMI is above 30 your are considered to be obese.
This means that you have a high % of body fat.

33. BMI
Body composition is the % of your body that is fat versus the % which is lean, e.g. muscles, bones, organs.
BMI is a figure used by Government to try to slow down the trend of increasing obesity in the UK.
It is estimated by the Government Office for Science’s Foresight programme that if obesity continues to increase at current rates nearly 90% of adults and two thirds of children in 2050 will be overweight or obese.
This statistic will include your children!

34. Problems Associated With Obesity
Joint disorders such as osteoarthritis, which is wear and tear on the cartilage of joints.

35. Problems Associated With Obesity
Coronary heart disease
This could be hardening of the artery walls.
This could also be narrowing of the space in arteries due to fatty deposits restricting blood flow.
Angina and heart attacks.

36. Lowering Your BMI
The World Health Organisation recommends that all adults below 65 should accumulate 30+ mins of moderate-intensity physical activity on most, preferably all days of the week.
This would be brisk walking, cycling, or gardening.
This will help your body to burn fat as a fuel, as well as increasing your energy expenditure and improving your general health.

37. Assessing Body Weight and Body Composition
Overweight and Obesity
Overweight—having a body weight more than 10 percent above the healthy recommended levels; in an adult, having a BMI of 25 to 29
Obesity—a body weight more than 20 percent above healthy recommended levels; in an adult, having a BMI of 30 or more
Morbid Obesity—having a body weight 100 percent or more above healthy recommended levels; in an adult, having a BMI of 40 or more

38. Obesity:
30% body fat women
25% body fat men

39. Men and Women Have Different Expected Amounts of Fat

40. Assessing Body Weight and Body Composition
Weight Circumference and Ratio Measurements
Waist-to-hip ratio
Weight in abdominal region associated with more risk
Waist circumference greater than 40 in. for men and greater than 35 in. for women represents an increased risk of disease

41. Assessing Body Weight and Body Composition
Measures of Body Fat
Underwater (hydrostatic) weighing
Skinfolds
Bioelectrical impedance analysis (BIA)
Dual-energy X-ray absorptiometry (DXA)
Bod Pod

42. Factors Contributing to Overweight and Obesity
Genetic and Physiological Factors
Body type and genes
Metabolic rates
Basal metabolic rate (BMR)—the rate of energy expenditure by a body at complete rest in a neutral environment
A BMR for the average healthy adult is usually between 1,200 and 1,800 calories per day.

43. Factors Contributing to Overweight and Obesity
Resting metabolic rate (RMR) includes the BMR plus any additional energy expended through daily sedentary activities.
Exercise metabolic rate (EMR) is the energy expenditure that occurs during exercise.

44. Factors Contributing to Overweight and Obesity
Thermic Effect of Food
An estimate of how much energy is necessary to burn food calories
Adaptive Thermogenesis
The theory that thin people send more effective messages to the hypothalamus and therefore can consume large amounts of food without gaining weight
Yo-Yo Diets
Refer to dieters who resume eating after their weight loss so their BMR is set lower, making it almost certain that they will regain the pounds they just lost

45. Factors Contributing to Overweight and Obesity
Endocrine Influence: The Hungry Hormones
Less than 2 percent of the obese population has a thyroid problem and most experts agree weight problems can be traced to a metabolic or hormone imbalance.
Hunger—an inborn physiological response to nutritional needs
Appetite—a learned response to food that is tied to an emotional or psychological craving
Satiety—to feel satisfied, or full, when one has satisfied their nutritional needs and the stomach signals “no more”

46. Factors Contributing to Overweight and Obesity
Hormones
Gherlin—“the hunger hormone”
Obestatin—a genetic relative of gherlin
Leptin—tells your brain when you’re full
GLP-1—slows down the passage of food through the intestines to allow the absorption of nutrients

47. Factors Contributing to Overweight and Obesity
Environmental Factors
Bombarded with advertising
Changes in working families
Bottle feeding in infants
Increase in sedentary lifestyle
Misleading food labels
Increased opportunities for eating

48. Factors Contributing to Overweight and Obesity
Early Sabotage: A Youthful Start on Obesity
Vulnerable to food ads
Larger portions, junk food
Social factors
Decline of home cooking
Increased production of calorie laden fast foods
Internet
Video games
Over 17 percent of youth in United States are now overweight or obese.
Heavy adolescents generally become heavy adults.

49. Factors Contributing to Overweight and Obesity
Psychosocial and Economic Factors
Food as reward
Socioeconomic factors can provide obstacles or aids to weight control.
Studies show that the more educated you are, the lower your BMI is in the United States.
In poor countries where malnutrition is prevalent, those with higher education tend to have a higher BMI.

50. Factors Contributing to Overweight and Obesity
Lifestyle Factors
Lack of physical activity
Any form of activity that burns additional calories helps maintain weight
Data from the National Health Interview Survey show that 4 out of 10 adults in the United States never engage in any exercise, sports, or physically active hobbies in their leisure time.

51. The Concept of Energy Balance

52. Managing Your Weight

53. Managing Your Weight Keeping Weight Control in Perspective
Each person is different.
Weight loss is not simple.
Depression, stress, culture, and available foods can affect a person’s ability to lose weight.
Set realistic goals.
Work out a maintainable lifestyle change.

54. ABC News Video: Food Diary Diet Writing
Discussion Questions
What is the best way to manage weight?
Is it possible to wake up one day and decide to lose weight and be successful? What are necessary steps to making this type of decision and following-through?

55. Managing Your Weight Understanding Calories Including Exercise
Unit of measure of energy obtained from food
1 pound of fat = 3,500 calories
Including Exercise
Basal metabolic rate (BMR)
Resting metabolic rate (RMR)
Exercising metabolic rate (EMR)
The number of calories spent depends on:
The amount of muscle mass moved
The amount of weight moved
The amount of time the activity takes

56. Managing Your Weight Improving Your Eating Habits
Evaluate what triggers your eating.
Seek assistance from the MyPyramid plan.
Set goals.
Keep a detailed daily log of eating triggers.
Reward yourself when you lose pounds.
Avoid weight loss programs that promise quick, “miracle” results.

57. Avoid Trigger-Happy Eating

58. Tips for Sensible Snacking

59. Managing Your Weight Considering Drastic Weight-Loss Measures
Very-Low-Calorie Diets
Must be medically supervised
Formulas with daily values of 400 to 700 calories
Can cause significant health risks
Ketoacidosis is one potentially dangerous complication
Drug Treatment
FDA approval is not required for over-the-counter “diet aids” or supplements
Dangerous side effects and potential for abuse
Obesity Surgery
A last resort and particularly for people who are severely overweight and have weight-related diseases

60. Managing Your Weight Trying to Gain Weight
Determine why you cannot gain weight.
Tips for gaining weight
Get moderate exercise.
Eat more calories.
Eat at regularly scheduled times.
Supplement your diet.
Avoid diuretics and laxatives.
Relax!

61. An Example in Diet Construction: if a Pt needs daily requirement = 2500 calories and is overweight ( BMI = 35 )  Goal : to lower body weight by 1kg/ wk ( 1 kg loss requires loss of 7000 calories i.e /day X )  subtract from his intake calories / day  daily intake : = 1500 calories

62. An Example in Diet Construction: To distribute the 1500 calories :- e.g % CHO % fat % protein = 100 % (900 cal.) (360 cal.) (240 cal.) ↓ ↓ ↓ ( 225 gm ) ( 40 gm ) ( 60 gm ) CHO fat protein

63. Standard Body Weight Control by Dietary Restriction
Standard Body Weight Control by Dietary Restriction * Goal : loose 1 Kg b. weight per week * plan / calculation: kg/ wk = 7000 cal. deficit /wk = 1000 cal. deficit / day  lower caloric intake by 1000 cal/day less than daily need e.g. : = 1500 cal./ day

64. Stringent diet restriction : - total cal. Intake : 400-600 cal
Stringent diet restriction : total cal. Intake : cal./day only for patients with very high BMI requires hospital monitoring (electrolytes, E.C.G., etc) note : provide protein content , vitamin and mineral requirements.

65. Body Weight Control by exercise
Body Weight Control by exercise * Exercise supplements diet restrictions to control body weight and → more lasting effect * Additional value for exercise : 1- ↓ hyperglycemia ↓ CHD risk factors .

66. Body Weight Control by exercise ( cont. )
Body Weight Control by exercise ( cont.) * Calculating expenditure of energy by walking: is related to “body weight” and “distance” ( not to speed of walking ) e.g.: a 70 kg person walking for one mile spends cal. ( increases if more body weight , or walking uphill )

67. Sugar Substitutes , Sweeteners The Ideal : Sweetening power, taste, cost, side effects, consistency & form, heat stability ,caloric content. Types : * Natural : fructose - sorbitol - manitol - xylose * Synthetic : saccharin - aspartame

68. Sugar Substitutes , Sweeteners
Side effects
max
cost
Cal/gm
Swt.p
Diarrhea
Diarrhea Diarrhea
75 gm
50 gm
Expensive.
Less
less 4
1-2
Fructose
Sorbitol
Manitol
Most popular
Heat unstable
1gm
50/kg
Cheap
Expensive
v. low
300
200
Saccharin
Aspartame

69. Fat Substitute

70. Nutrition Facts Labels
-Calories
-Serving size
-Major Nutrients
-Total Fat
-Amount of substances in one serving size.
-Percentage of daily values for selected vitamins and minerals

71. Questions

72. Thank You
DR . Hanan M. A. Abdel Razek
Please study well : - )