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Nutrition Courseware.Pdf : : Biochemistry 211 SIBC Nutrition Chinnavuth Vatanashevanopakorn, M.D. Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University E-mail : [email protected] 1 Objective • สารอาหารและการจําแนกชนิดของสารอาหาร • Recommended Dietary Allowances • ความต้องการและการใช้พลังงานของร่างกาย • ความสําคัญของสารอาหารทีให้พลังงานทางด้านโภชนาการ • ภาวะโภชนาการและการประเมินภาวะโภชนาการ • สารพิษในอาหาร • บทบาทของอาหารในการส่งเสริมและป้องกันโรค 2 Nutrition • การศึกษาถึงความสัมพันธ์ระหว่างอาหารและสุขภาพของร่างกาย – ปริมาณและสัดส่วนของสารอาหารทีร่างกายควรได้รับ – การเปลียนแปลงของสารอาหารเพือการนําไปใช้ โดยผ่านขบวนการต่าง ๆ ตังแต่digestion, absorption, metabolism, transport, storage และ excretion • ความต้องการพลังงานและสารอาหารจะมีการเปลียนแปลงได้โดย ขึนกับ อายุ เพศ และสิงแวดล้อม 3 Food • สิงทีบริโภคแล้วไม่เป็นพิษ หรือก่อให้เกิดโทษแก่ร่างกาย • สามารถจําแนกออกเป็น 5 หมู่ – หมู่ที 1 เนือสัตว์ต่าง ๆ นม ไข่ และถัว – หมู่ที 2 ข้าว เผือก มัน และนําตาล – หมู่ที 3 ผักต่าง ๆ – หมู่ที 4 ผลไม้ต่าง ๆ – หมู่ที 5 ไขมัน และนํามันพืช 4 Nutrients (สารอาหาร) • ส่วนประกอบของอาหารทีจําเป็นต่อร่างกาย – สารทีให้พลังงาน – Essential molecules • แบ่งเป็น 2 กลุ่ม – Macronutrients : CHO, lipid and protein – Micronutrients : vitamins, minerals and water • หน้าทีของสารอาหาร – Providing energy : CHO, lipid (and protein) – Forming structures : lipid, protein and minerals – Regulating body processes : CHO, lipid, protein, vitamins, minerals and water 5 Nutrition recommendations • The first nutrition recommendations were made in the UK in the 1860s. • After World War I – To sustain life and are protective of health – fruits and green vegetables were included in a healthy diet. • In the US, Recommended Dietary Allowances (RDAs) were used after World War II • Recently, Dietary Reference Intakes (DRIs) have replaced the RDAs 6 Recommended Dietary Allowances • Intakes that are sufficient to meet the nutrients needs of almost all healthy people in a specific life-stage and gender group • ปริมาณสารอาหารทีร่างกายต้องการในการทําให้มีสุขภาพดี ซึงเป็น ค่าทีสูงกว่าค่าเฉลีย • ปัจจัยทีมีผลต่อ RDAs – อายุ : เด็ก > ผู้ใหญ่ – เพศ : ชาย > หญิง – สภาวะของร่างกาย : หญิงตังครรภ์/ให้นมบุตร 7 Nutrition facts 8 Nutrition facts 9 Energy requirement • Male (20-29 year-old) : 2,800 kcal • Female (20-29 year-old) : 2,000 kcal – Pregnancy : + 300 kcal – Lactation : + 500 kcal Dietary goal of macronutrients CHO : protein : lipid = 58% : 12% : 30% 10 Energy expenditure • Basal energy expenditure (BEE) • Thermic effect of food (TEF) • Physical activity (PA) BEE 60-75% BMR TEF 10% PA 15-30% PA TEF 11 Basal energy expenditure (BEE) • พลังงานทีร่างกายใช้ในเวลา 24 ชัวโมง ในขณะทีร่างกายอยู่ใน ภาวะพักผ่อน (physical and mental rest) • เป็นพลังงานพืนฐานทีร่างกายใช้ในการดํารงชีวิตตามปกติ – การหายใจ การไหลเวียนโลหิต – การสร้างสารต่าง ๆ – การรักษาอุณหภูมิกาย • อวัยวะต่าง ๆ จะมีการใช้พลังงานนีไม่เท่ากัน • วัดได้ในรูปของ basal metabolic rate (BMR) หรือ resting metabolic rate (RMR) 12 Basal metabolic rate (BMR) • Unit : kcal/hr • วัดในตอนเช้าหลังตืนนอน วัดในท่านอน โดยห่างจากอาหารมือ สุดท้าย 12 ชัวโมง • มีค่าประมาณ 1 kcal/kg/hr (male) และ 0.9 kcal/kg/hr (female) 13 Resting metabolic rate (RMR) • หรือ resting energy expenditure (REE) • Unit : kcal/hr • วัดในช่วงเวลาใดของวันก็ได้ โดยห่างจากอาหารมือสุดท้าย5 -6 ชัวโมง • ค่าจะสูงกว่า BMR ประมาณ 10-20% 14 Harris & Benedict equation Female : BMR = 655 + 9.56W + 1.85H - 4.68A Male : BMR = 66.5 + 13.75W + 5H - 6.78A หรือ Female : BMR = W x 0.95 x 24 Male : BMR = W x 1 x 24 W = weight (kg) ; H = height (cm) ; A = age (year) 15 Factors influence BMR • Body surface area (BSA) • Sex : male > female • Age : children > adults • Body temperature : 1°C BMR 13% • Nutritional status : malnutrition BMR • Pregnancy & lactation • Infection, injury & post operation • Hormones : hyperthyroidism BMR • Others : genetics, environment, health, exercise 16 17 Thermic effect of food (TEF) • Specific dynamic action (SDA), diet-induced thermogenesis (DIT) • ประมาณ 10 % ของ total energy expenditure • เป็นพลังงานความร้อนทีเกิดขึนจากmetabolism การย่อย และ การดูดซึมอาหารของร่างกาย • เป็นพลังงานในรูปของความร้อน มีประโยชน์เพียงช่วยให้ความ อบอุ่นแก่ร่างกาย • SDA ในสารอาหารชนิดต่าง ๆ : - protein 15-30% - CHO 6-8% - fat 2-3% 18 Physical activity • พลังงานทีใช้ในการทํางานทีอยู่ภายใต้การบังคับของจิตใจ • เป็นพลังงานทีมีความหลากหลายมากทีสุด • ร่างกายจะใช้พลังงานส่วนนีมากน้อยขึนกับ – ขนาดของร่างกาย – ระยะเวลา – ลักษณะของงานทีทํา 19 Energy balance • The amount of energy consumed in the diet compared with the amount expanded by the body over a given period • Energy consumption equals energy expenditure : weight remains constant • Negative energy balance : weight loss • Positive energy balance : weigth gain 20 Determining the amount of energy in food • พลังงานทีได้รับจากสารอาหาร วัดได้โดยใช้ bomb calorimeter • Caloric value of food (1 kcal = 4.128 kJ) – CHO = 4.1 kcal/g – protein = 5.4 kcal/g – lipid = 9.3 kcal/g • การเผาไหม้สารอาหารในร่างกาย จะได้ความร้อนน้อยกว่า – CHO = 4 kcal/g – Protein = 4 kcal/g – Lipid = 9 kcal/g 21 Bomb calorimeter When dried food is combusted inside the chamber of a bomb calorimeter, the rise in temperature of the surrounding water can be used to determine the energy content of the food 22 Photo from : Smolin & Grosvenor. Nutrition : Science and applications. John Wiley & sons, 2008. Measuring energy expenditure • Direct calorimetry : respiration calorimeter • Indirect calorimetry : assessing oxygen use and carbon dioxide production • Doubly-labeled water : water labeled with isotopes of oxygen and hydrogen 23 Indirect calorimetry Photo from : St. Bartholomew’s hospital 24 / Science /custom medical stock photo Importance of macronutrients Fatty acids CO2 ETS O2 - urine AA TCA e H O cycle 2 sweat ATP Glucose ATP-ADP cycle CO2 ATP Energy utilization Energy production - Biosynthesis of Carbohydrate macromolecules Lipid - Muscle contraction Protein - Active ion transport - Thermogenesis 25 O2 ADP + Pi Carbohydrate • Source of energy : 4 kcal/g, excess CHO glycogen & fat • Requirement : - no definite RDA - at least 100 g/d (58% of dietary goal) • Protein preservation • Antiketogenic action : adequate CHO ทําให้สลายไขมัน เป็น CO2 และ H2O ได้สมบูรณ์ 26 Carbohydrate • Toxic substances degradation : glucoronic acid • Maintain normal flora : lactose ทําให้ bacteria ในลําไส้ใหญ่เจริญได้ดี • Regulation of excretion : fiber • Synthesis of substances : heparin, non-essential amino acid, mucopolysaccharide, etc. 27 Dietary fiber • Non-starch polysaccharide (NSP) from – Cell wall of plants : cellulose, hemicellulose, pectin – Other part of plants : gums, mucilages, algal polysaccharides • Can be divided into 2 forms – Soluble fiber : • Pectin, gums, mucillages and some hemicelluloses • ช่วยอุ้มนําไว้ทําให้กากอาหารในลําไส้ใหญ่อ่อนนุ่ม – Insoluble fiber : • Cellulose, some hemicelluloses and lignin • ช่วยเพิมกากอาหารทําให้ระบบขับถ่ายปกติ 28 Dietary fiber • Requirement : – 25-35 g/d or 10-13 g/1,000kcal – Soluble : insoluble fiber = 1 : 3 – Too much fiber ingestion : reduce absorption of Calcium & Zinc esp. in children and elderly • ประโยชน์ : – กระตุ้นการหลังของนําลายขณะเคียวอาหารและนําย่อยในกระเพาะอาหารขณะย่อย อาหาร – ลดความเสียงของการเกิดมะเร็งลําไส้ใหญ่ โดย lignin จับกับสารก่อมะเร็งบางชนิด – Pectin, lignin, gums ลด cholesterol ได้ถ้ามีปริมาณมากพอ – อาหารทีมี fiber สูง มักมี antioxidant (vitamin A, C) สูงด้วย – Soluble fiber ทําให้อิมนาน จึงลดความอยากอาหาร 29 Carbohydrates and health CHO excess • Dental caries : – The most common health problem associated with CHO – Refined CHO • Increase triglyceride : – excess CHO TG adipose tissue – Increase risk of atherosclerosis CAD • Lactose intolerance CHO deficiency • ไม่ค่อยพบ • ยกเว้นในภาวะควบคุมนําหนักโดยงดCHO ร่างกายจะนํา glycogen มาใช้ ถ้าไม่เพียงพอจะใช้ fat กับ protein และอาจทําให้เกิด ketosis ได้ 30 Lactose intolerance • 70% of adult Small intestine • 2° cause : small intestine Lactose infection, malnutrition Lactase • Large amount (>12g) : deficiency may cause symptoms Galactose + glucose Large intestine Small intestine Lactose Lactose -galactosidase (lactase) Bacteria Galactose 2 & 3 C-metabolites + + CO2 + H2 Glucose H2O Bloating, diarrhea, cramps Portal circulation 31 Lipid • Source of energy : 9 kcal/g • Requirement : - no definite RDA - 30% of dietary goal - PUFA : MUFA : SFA = 10 : 10 : 10 % - ω-6 : ω-3 = 4-10 : 1 • Types of lipid – Triglyceride (FA + glycerol) – Phospholipid – Sterol 32 Importance of lipid • Source of energy : ในภาวะ starvation จะมีการสลาย TG ที adipose tissue เพือให้พลังงาน • Fat soluble vitamins absorption & transport : vitamin A, D, E and K • Source of phospholipid & cholesterol: cell membrane • Gluconeogenesis : สร้าง glucose จาก glycerol ทีตับ • Delayed gastric emptying time : ทําให้อิมนาน 33 Types of lipid • ไขมันจากสัตว์ : – ไขมันจากเนือสัตว์ นํามันหมู เนย ไขมันในนํานม และไข่แดง – ประกอบด้วย cholesterol และ saturated FA ยกเว้นปลาจะมี unsaturated FA เป็นส่วนใหญ่ • ไขมันจากพืช : – นํามันพืชชนิดต่าง ๆ กะทิ และมาการีน – ประกอบด้วย unsaturated FA และ essential FA ไม่มี cholesterol ยกเว้น นํามันมะพร้าว นํามันปาล์ม และกะทิ จะมีsaturated FA – มี β-sitosterol : cholesterol reducing agent 34 Types of lipid • ไขมันจากการสังเคราะห์ : – Medium chian triglyceride (MCT) • 8-10 C ให้พลังงาน 8.3 kcal/g ตัวอย่างเช่น MCT oil • ย่อยและดูดซึมง่าย ใช้ในผู้ป่วยทีมีความผิดปกติเกียวกับการย่อยและดูดซึม – Structured lipid • ประกอบด้วย MCT & linoleic acid or ω-3 FA • ร่างกายดูดซึมได้เร็ว ใช้ในผู้ป่วยทีถูกไฟไหม้ และผู้ป่วยหลังผ่าตัด – Fat substitutes • โครงสร้างต่างจากไขมันทีพบตามธรรมชาติ ให้พลังงานน้อยหรือไม่ให้พลังงานเลย
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