Food – Nutrition and Disease

The normal person needs nutrition in his life span- from conception through infancy, childhood, adolescence, adulthood, and old age. A balanced diet at this stage prevents deficiency symptoms of any nutrients as well as secondary diseases, Mostly malfunctioning is caused by lack of nutrition. . Diet therapy can be considered as a shield, which is effectively used, can protect a person from further attack of disease and can help in restoring normal health. The use of medicinal alone is not always sufficient to cure any health disorder unless there is proper nutritional management. On the other hand in the absence of good and proper nutrition the drug therapy, even though at its best, may become a total failure. On the contrary, it may be possible at least in some instances to avoid and limit drug therapy with proper nutrition. Because of this awareness, the field of therapeutic diets in nutrition has become popular and graining wide acceptance in a major cross-section of our society. Diet therapy is the use of food in the treatment of disease. This is accomplished by changing the patient’s normal diet in order to meet the altered requirements resulting from disease or injury. Diet therapy is concerned with the modification of the normal diet to met the requirements of the sick individual. Its purposes are:

To maintain a good nutritional status.
To correct deficiencies.
To afford rest to the whole body or the body that is affected.
To maintain the body’s ability to metabolize the nutrients.
To bring about changes in body weight whenever necessary.

Therapeutic nutrition being with the normal diet. Advantages of using normal diets as the basis for the therapeutic diet are:

It emphasizes the similarity of psychological and social needs of those who are ill and those who are well, even though there is a quantitative and qualitative difference in requirements.

Food preparation is simplified when the modified diet is based upon the family pattern and the number of items required in special preparation is reduced to a minimum.

The calculated value for the basic plan is useful in finding out the effects of addition or omission of a certain food, e.g., if vegetables are restricted vitamin A and C deficiency may occur.

Different diseases

Diabetes

The underlying disease conditions which require a change in the diet
The possible duration of the disease
The factor in the dietary which must be altered to overcome these condition and
The patient tolerance for food by mouth. In planning meals for a patient his economic status, his food preferences and his occupation and times of meals should also be considered.

The normal diet may be modified

To provide a change inconsistency as in fluid and soft diets,
To increase or decrease the energy value.
To include a greater or lesser amount of one or more nutrients, e.g. high protein, low sodium, etc.
To increase or decrease bulk high and low fiber diets.
To provide food bland in flavor.

The planning of a therapeutic diet implies the ability to adapt the principles of normal nutrition to the various regimens for adequacy, correctness, economy, and palatability. It requires recognition of the need for dietary supplements such as vitamin and mineral concentrates when the nature of the diet itself imposes a severe restriction, the patient’s appetite is poor, or absorption and utilization are impaired so that the diet cannot meet the needs of optimum nutrition.

Dietary history should serve as the basis for planning each diet. The dietary history will reveal the patient’s past habits of eating with respect to dietary adequacy, likes and dislikes, meal hours, where meals are eaten, budgetary problems, ability to obtain and prepare foods. The likes and dislikes of patients are respected because food habits are deep-seated it is not possible to change them overnight. It requires considerable encouragement and understanding on the part of the doctor-nurse-dietician team to bring about important changes in the diet. Intelligent planning of therapeutic diets necessitates consideration of food coast, the avoidance of waste, and retention of nutrient values so that the diet is economically practicable.

Diabetes mellitus, commonly known as diabetes, is a disorder of carbohydrate metabolism characterized by high blood sugar level (hyperglycemia) and high level of sugar in the urine (glycosuria)

Carbohydrates: These should provide about 55% of the total energy intake of which simple carbohydrates must be about 20% and complex carbohydrates should fulfill the remaining carbohydrate requirement. Dietary fiber may be enhanced to an intake of 25-30 per day. Carbohydrate include fruits like apples, blueberries, and strawberries, whole intact grains like brown rice, whole wheat bread, whole grain pasta and oatmeal, starchy vegetables like corn, green peas, sweet potatoes, pumpkin, and plantains; and beans and lentils like black beans,

Fats: About 30% of the total energy intake must be obtained from saturated fatty acid (include butterfat, meat fat, and tropical oils like palm oil, coconut oil, and palm kernel oil), 50% from monounsaturated fatty acids (This fat is in avocado, nuts, and vegetable oils, such as canola, olive, and peanut oils) and 25% from polyunsaturated fatty acid (fats include omega-3 and omega-6 fats). Cholesterol intake must not exceed 150mg per day.

Omega fatty acids: These have been found to lower serum cholesterol moderately and serum triglyceride level markedly. Popularly, they are known as fish oil, which has been found to decrease platelet aggregation, which may potentially reduce cardiovascular disease in diabetes. The intake of fish oil must not exceed 4g/day.

Proteins: About 10-15% of the total energy need must be fulfilled by proteins. A diabetic individual on average consumes more protein than no-diabetics, and excessive protein consumption is linked with diabetic nephropathy. Hence high biologic value protein at about 10% of the total energy intake is ideal.

Most diabetic diets are made up of about 50% carbohydrates, 20% protein, and 30% fat. The carbohydrates on a diabetic diet are primarily complex carbohydrates, including fruits, vegetables, and whole-grain bread and cereals. These complex carbohydrates in prescribed amounts are thought to produce relatively small changes in blood sugar level.

Simple sugar found in the dessert is usually thought to produce rapid rises in blood sugar levels that require a large dose of insulin to control. Although it is not recommended to use fructose as a sweetener, Fruit should not be avoided because of its fructose content. Benefits may be obtained by consumption of dietary fiber in conjunction with carbohydrates as Francis (1987) points out, evidence suggests that carbohydrate consumed with dietary fiber will have a less major impact on the glycemic rise than the same amount of carbohydrate consumed alone.

Two low-calorie sweeteners-saccharin and aspartame – are on the market. They should be used in limited amounts because they contain small amounts of dextrin or lactose, which are natural sugars. Saccharin has also been reported to cause bladder cancer in animals.

Diabetic sweets like candies, cakes, ice cream, and pastries are not recommended for diabetics because they may actually contain more calories than products sweetened with sugar. Many products contain fat, flour, and sweeteners that should not be eaten on a diabetic diet and, when they are eaten, must be calculated in the diet.

To maintain a relatively constant blood sugar level, it’s not OK to skip a meal and eat more at the next level meal. This is dangerous for a person on insulin.

Diet guidelines for diabetics:

Eat starches such as those prevent in wheat, jawar, bajra, ragi, etc. instead of sugars like sucrose, glucose, and fructose present in table sugar, honey, fruit juice, etc.
Use whole pulses like chana, rajma, soybean, instead of split pulses or their dals.
Soya bean or garam flour can be incorporated into the atta and chapatis made out of it, thus increasing the protein content of the food.
Green leafy and all types of raw vegetables such as cucumber, carrot, cauliflower, cabbage, lettuce onion, and tomato can be eaten in plenty to fill the stomach.
Use such cooking methods that require a minimum amount of fat. So one should eat boiled, steamed, broiled, and grilled food instead of fried food. Using a non-stick pan reduce fat consumption.
Fiber-rich food such as whole grain, pulses, and raw vegetables can be preferred to refined flours, cooked vegetables, and peeled fruits. Consumption of potatoes, chikoos, apples, and pears with their peel on is beneficial.

Heart disease

Heart disease affects people of all ages, but is most frequent in middle age and is most often caused by atherosclerosis. The disease may affect the pericardium, myocardium, or endocardium. In addition, blood vessels within the heart, leaving the heart or heart valves may be diseased. A heart attack and a stroke are by no means always fatal. Some can go back to their old activities, some remain invalid and some are handicapped.

In atherosclerosis, the walls of small arteries become thickened to aging or due to hypertension.

The word atherosclerosis is derived from Greek; there means a gruel and sclerosis means hardening.

Role of fat in the development of atherosclerosis:

Cholesterol and triglycerides are the main forms of fat carried in the bloodstream. These fat or lipids come partly from food, the body’s production in the liver. Fats are not water-soluble and hence cannot travel through the blood easily. With the help of lipoprotein, digested fat from the liver is carried to various parts of the body by the blood vessels. The cholesterol returns to the liver and repeats its job. The liver places cholesterol into packages called lipoproteins, made from lipids and protein. There are mainly four kinds of lipoprotein packages namely chylomicrons, VLDL ( very low-density lipoprotein), LDL (Low-density lipoprotein), and HDL (High-density lipoprotein).

Chylomicrons carry triglycerides whose fatty acid content more than 10-12 carbon atoms, monoglycerides, glycerol, and a small amount of cholesterol and phospholipids. VLDL also transports glycerides but mainly endogens triglycerides formed in the liver. The VLDL travels through the blood vessels unload fat throughout the body. The empty VLDL becomes LDL. LDL is the main carrier of cholesterol. Some LDL pieces get stuck to the blood vessel wall, narrowing the same. High LDL decrease endothelium-derived Relaxing Factor and blood vessel become narrow and cannot dilates. LDL is called cholesterol because it causes atherosclerosis. HDL plays a role in the reverse transport of cholesterol from tissues throughout the body back to the liver for conversion to bile acids or excretion as biliary cholesterol. HDL is called good cholesterol.

Coronary heart disease is not a single event. There is a distinct relationship between the onset of the disease and the high level of total blood cholesterol and HDL.

If too much fat consumed, the liver makes extra VLDL carry the fat. More LDL pieces stuck to if not enough HDL to rescue them all. The blood vessel may become blocked. If this happens to a blood vessel in the heart, a heart attack may result.

Saturated fatty acids raise the level of LDL and total blood cholesterol level. Both of these effects increase the risk of CHD. The activity of the LDL receptor- its ability to mediate the entry of LDL- appears to be suppressed by saturated fatty acids. When LDL receptor activity decreases and blood levels of LDL increase.

Individual saturated fatty acids differ in their ability to change blood LDL- cholesterol levels. Palmitic, myristic, and to a lesser degree lauric acids increase the LDL- cholesterol level. In contrast stearic acid and medium to short-chain saturated fatty acids do not.

Trans fatty acids raise LDL cholesterol to the same extent as myristic acid while lowering HDL cholesterol. Further trans fatty acids have been found to raise lipoprotein levels, thus raising the risk of CHD. Trans fatty acids in the diet come from two main sources

a). Bacterial fermentation: In the gut of ruminants trans fatty acids are produced. Meat and dairy products contain trans fatty acids.

b). Hydrogenated fats: Hydrogenation of vegetable oils alter the geometric structure of the polyunsaturated fatty acids (PUFD) from natural ‘cis’ to ‘trans’ forms. Depending on the degree of hydrogenation, trans-fats in food products contain anywhere from 5% to a high 40%.

The normal serum triglyceride level is 50-200 mg/dl. Hypercholesterolemia occurs when the cholesterol level exceeds 240mg/dl.

Principle of diet:

Low calories, low fat particularly low saturated fat, low cholesterol, high PUFA (Polyunsaturated Fatty Acids), low carbohydrate, and normal protein, minerals, and vitamins are suggested. A high fiber diet is also recommended.

General guidelines about the diet:

The total fat should be less than or equal to 30% of the total energy intake.
Cholesterol-raising fatty acids,i.g. the saturated and trans fatty acids should be less than 7%.
MUFA (Monounsaturated Fatty Acids) should be between 10-15%, PUFA (Polyunsaturated Fatty Acids) less than 10%.
Carbohydrates should contribute 55% and protein 15% of the daily energy requirement.
Cholesterol intake must be less than 200mg per day.

Total energy: The total calories should be restricted so as to reduce the weight to the expected normal for height, age, and sex.

Fat: Dietary fat should be controlled in quality and quantity by substituting PUFA in the diet for part of the saturated fats which were customarily consumed earlier. A normal person fulfills about 15-20% of his calorie requirement through fat intake. It should be lowered to contribute only about 10% of daily calorie requirements. Predominantly, saturated fat such as ghee, vanaspati, butter, lard, and margarine should be restricted and preferable avoided. Vegetable oils are permitted in moderated amount, the best recommendation is safflower oil for heart patients is because of its high linoleic acid content as compared to the other oils. Coconuts and palm oils also contain high amounts of fatty acids and should be best avoided. Cholesterol intake through diet should be curtailed. Foods containing high amounts of cholesterol like eggs, liver, cheese, butter, cream, shrikhand, chocolates, cakes, etc. should be restricted.

Carbohydrates: The easily assimilable sugar, like sucrose, glucose, and fructose also cause hyperlipidemia only if consumed in excess. Hence their intake must be minimal. On the other hand, complex carbohydrates and resistant starch which less likely to cause lipidemia are desirable, such as those found in whole grain flour, legumes, etc. Consumption of dietary fiber through leafy vegetables, raw unpeeled fruits are also advised since fiber has shown a beneficial effect on the blood lipid profile.

Protein calorie malnutrition

The condition in which people became weak and sick because of insufficient and unbalanced food is called malnutrition.

Protein calorie malnutrition (PCM) is one of the largest public health problems of our country. As the same suggests, this condition is a deficiency of protein and calorie in the diet carbohydrate and fat provide us energy, so a deficiency of protein, carbohydrates,s, and fats leads to protein-energy malnutrition. Protein-energy malnutrition is the most important nutritional disorder which affects the children in our country in the age group 1 to 5 years. PCM is a consequence of not only of inadequate food intake but also poor living conditions, an unhygienic environment, and lack of health care. It is primarily a disease of socio-economic inequalities and misdistribution of food and health.

Protein-energy malnutrition causes two diseases:

a). Kwashiorkor

b). Marasmus

Twenty-two years ago a world food conference in Rome, the world community committed itself to end hunger and malnutrition within a decade.

Although since then the number of chronically undernourished people in developing countries has dropped from 36 percent in 1969 to 20 percent in 1990, today almost 800 million people or one in seven of the world’s population still suffer from chronic malnutrition.

Nutritional requirements:

The ration behind dietary management is to provide levels of protein and energy which will not only meet immediate demands but will also promote ‘catch up’ growth. Foods especially rich in protein or protein concentrates are unnecessary.

Energy: The child should be given 150 to 200 kcal/kg body weight/day for the existing weight. For children less than 2 years 20kcal/kg body weight and for older children 150-175 kcal/kg body weight should be given. It is very important there should be enough calories in the diet, otherwise, the protein will be utilized for energy purposes and not for building the tissues. Malted cereals also can be given to increase calorie density. Fifty percent of the total calories can be from carbohydrates.

Protein: For the existing weight 5g of protein/kg body weight/day should be given. The calories derived from protein should be 10% of the total calculated calories per day if the main source is animal protein. If the main and only source is from cereals and pulses, then the calories derived from the proteins can be 13-14% of the total calories. This is because the net protein utilization of the cereals and pulses is around 60 whereas for milk or egg it is around 90%.

Fats: Forty percent of total calories can be from fat which can be tolerated by children. Saturated fat such as butter, milk and coconut oil are referred because unsaturated fatty acids worsen diarrhea.

Electrolytes: Potassium chloride (2.4g) and magnesium chloride (0.5g) should be added daily to the diet for a period of 2 weeks.

Vitamins: If vitamin A deficiency is present, oral administration of a single dose of 50,000 IU of fat soluble vitamin A should be given immediately, followed by 5000 units daily. The deficiency symptoms disappear in 2 weeks.

Anemia

Deficiency or lack of various minerals and vitamins in the human diet gives rise to diseases.

Anemia is found to be due to different causes such as iron deficiency, folic acid deficiency, vitamin B12 deficiency, and deficiency of vitamin C. However the most common type is iron deficiency, which occurs more commonly among women than among men. Girls suffer from anemia particularly around puberty, due to menstrual disturbances. The blood showed a low hemoglobin level and the cells are pale and small. The person suffers from weakness, frequent headaches, pallor, breathlessness, and dislike for work exertion. There is giddiness, sleeplessness, heartburn, palpitation, blurred vision, and swelling of the feet.

Dietary improvement:

Proper diet can definitely prevent anemia through anemia cannot be cured by diet alone.

The absorption of haemal iron which is derived from meat and flesh foods is better while that of non-haemal iron derived from cereals, pulses, vegetables, and fruits is low. The absorption of low non-haemal iron could however be enhanced by increasing the vitamin C content of the diet. The consumption of tea or coffee along with meals greatly reduces the absorption of non-haemal iron.

*Regular consumption of iron-rich foods (whole grain cereals and pulses, nuts, dates, jaggery, and foods of animal origin) and vitamin C rich foods ( amla, all citrus fruits, guava, green leafy vegetables and salads, and seasonal fruits) by all, with special emphasis during pregnancy, lactation, infancy, childhood, and adolescence.

*Consuming sprouted pulse regularly after giving some heat treatment as sprouting increases bio-availability of iron as well as increases the content of Vitamin C and B-complex vitamins in the grain and heating destroys the inhibiting factors.

*Incorporating green leafy vegetables, (cauliflower greens and arakeerai) seasonal vegetables and fruits in the diet of infants and pre-school children once or twice daily.

Calcium Deficiency

Rickets: Generally occurs during childhood and are a combination of deficiencies of calcium, phosphorus, vitamin D, and vitamin C. The child suffers from growth retardation bones become fragile and bent, with the short bones being affected more. Knock-Knees and bowed legs are the characteristic symptoms of rickets. The young infant develops teeth late and there is delayed closure of the fontanels. Bleeding time is longer and the bones are porous. Adult rickets is also known as osteomalacia. Generally, women who remain indoor or in purdah and old person are found to suffer from osteomalacia.

To avoid calcium deficiency, calcium-rich food should be included in the diet. Calcium is present in both animal and plant foods. The richest source of calcium among animal foods is milk and among the vegetable sources, it is green leafy vegetables. Among the leafy vegetable amaranth, fenugreek, and drumstick leaves are particularly rich in calcium. Most cereals and millets contain some amount. Ragi is a particularly rich source of calcium. Some of the pseudocereals like amaranth (rajkeera) are a good source of calcium.

Obesity

Obesity is a state in which there is a generalized accumulation of excess adipose tissue in the body leading to more than 20% of the desirable weight. Usually, obesity is due to a positive energy balance. That is the intake of calories is more than the expenditure of calories. Calories restriction for weight reduction is the safest, most effective method. Obesity invites disability, disease and premature death. Excess body weight is a hindrance, leading to breathlessness on moderate exertion and exertion and predisposes a person to diseases like atherosclerosis, high blood pressure, stroke, diabetes, gall bladder diseases, and osteoarthritis of weight-bearing joints and varicose vein.