Al-Balqa Applied University

Basic and Applied Nutrition

Midwifery
Prepared By
Eng. Eman Al-Hijazi
2023-2024
1
 Unit Two

Energy Yielding Materials
• Sources • Introduction
• Digestion and absorption • Carbohydrates:
• Fat stores • Overview
• Essential fatty acid • Functions
• Cholesterol • Structure
• Phospholipids • Sources
• Lipoproteins • Properties of sugars
• Uses of sugars
• Protein: • Digestion, absorption
• Types according to structure • Blood sugar level
• Functions • Hormonal control
• Digestion, absorption and disposal • Hazards of CHO
• Daily requirements • Excess CHO
• Sources • Insufficient CHO
• Insufficient protein intake • Fats:
• Standard weight regarding to • Overview
height in adult • Structure

2
 Introduction:
Protein, fat, carbohydrate and alcohol are all dietary energy sources.
The energy content of a food can be calculated from its composition:1g
fat supplies approximately 9 kcal, 1g protein supplies 4 kcal and 1g
supplies carbohydrate 4kcal
An individual's energy requirement depends on both his basal metabolic
rate (BMR) and his activity. The BMR is inf lu enced by age, sex,
environmental temperature, disease and body composition. Any excess
energy not needed for metabolism is converted to fat and stored in the
adipose tissues. Energy may be def ined as the capacity to perform
work.
It is manifested in various ways such as heat, electricity, light or
mechanical energy.
It is never destroyed, but one form of energy may be converted to another.
For example the energy of a waterfall may be converted to a current of
electricity, which in its turn may appear as light or heat, or may be used
to drive a machine.
3
 Carbohydrates
P a i r s of m onosa ccha r i de com bi ne t o for m di sa ccha r i de s. The
disaccharides which are most important in human nutrition are
sucrose, lactose and maltose. Their composition is illustrated below.
Glucose +Fructose → sucrose
Glucose + Galactose → lactose
Glucose +glucose → maltose

Structure of sucrose molecule:

Glucose Fructose
4 Figure 2: structure of sucrose molecule
Large numbers of monosaccharide joined together give polysaccharides.
The most important polysaccharide in human nutrition is starch, which
is composed of many glucose units. There are two types of starch:
amylase and amylopectin.
Amylose consists of a straight chain of 70-350 glucose molecules. Part of
an amylose chain is illustrated below

Figure 3: Amylose chain

O=1 glucose molecule

Amylopectin is a branched chain of up to 100 000 glucose molecules

Figure 4: Amylopectin
5
Sources of carbohydrate
Glucose is prepared commercially from in some fruits, notably
grapes. Fructose is found in honey and in called 'fruit sugar'.
Sucrose is the table sugar we are all obtained from sugar beet and
sugar cane and occurs in some fruits and vegetables.
Lactose is the sugar found in milk.
Galactose does not occur naturally but is produced by the digestion
of lactose.
Maltose is found in sprouting grain and is formed during the
manufacture of beer.
Starch is the storage carbohydrate produced by plants. Considerable
amo unts are f o und in all grains, unripe f ruit and c e rtain
vegetables such as potatoes, peas, beans and lentils.
Glycogen. Animals store carbohydrate as glycogen in the liver and
muscles. Meat is not a dietary source of carbohydrate because
the glycogen is destroyed during the hanging process.

6
Cellulose is a component of plant cell walls. It is found in
cereals, vegetables and fruit and is commonly known as
f iber. It is not available to the human body as food as there
are no digestive secretions present with which to break it
down. It is nevertheless a valuable constituent of the diet
as it adds bulk to the intestinal contents, stimulating
peristalsis and aiding excretion of the feces.
In the case of herbivorous animals cellulose is available as a
food, owing to the presence in the gut of bacteria which
convert it to substances which can be absorbed and
utilized.

Properties of sugars
An important characteristic of sugars is their sweetness. The
degree of sweetness varies with different sugars. They are
listed in descending order of sweetness below, fructose
7 being the most sweet and lactose the least sweet.
• Fructose
• Sucrose
• Glucose
• Maltose
• Galactose
• Lactose
All sugars are soluble in water, lactose being the least soluble.

Uses of sugars
Sucrose is used for the most domestic purposes: it is used both as a
sweetener and a preservative. Sucrose is added to many manufactured
foods to improve the taste, texture and appearance.
Glucose is frequently employed where a high energy intake is required, as
it is easily obtained, readily soluble and not so sweet as sucrose, so
that larger amounts may be added to foods without imparting an over
sweet flavor.
Fructose is sometimes used as a sweetener by diabetics. Glucose syrup is
made by hydrolyzing starch and is used in the food industry, particularly
8
in the manufacture of jams.
Digestion
Starch is broken down to maltotriose, alpha limit dextrin's and maltose,
principally as a result of the action of pancreatic amylase. The
disaccharides are converted to their constituent monosaccharide by
the action of disaccharide-splitting enzymes in the small bowel, at the
surface of the mucosal cells. These disaccharides are sucrose,
maltase and lactase. Thus available dietary carbohydrates are
a bsor be d i n t o t h e body i t h e f or m of t h e si n gl e su ga r s, or
monosaccharide. Disaccharides are digested rapidly, and sugars are
absorbed into the blood stream shortly after being taken by mouth.
They therefore provide a more immediate source of energy than starch,
whi ch ha s a l onge r di ge st i v e pr oce ss t o unde r go. Di f fe r e nt
carbohydrate-containing foods are digested and absorbed at different
rates. The rate of digestion is influenced by the food form, fiber content
and type of carbohydrate.

Absorption and utilization

After absorption into the capillaries of the intestinal, the materials
resulting from the digestion of carbohydrate (glucose, fructose and
9 galactose) travel to the liver in the portal vein.
 Fat:
Digestion and absorption
Fat digestion starts in the duodenum where fats are emulsified by bile and
hydrolyzed to free fatty acids and monoglycerides by the pancreatic the
mucosal cells where they reform as triglycerides. Some combine with
protein and cholesterol to form lipoproteins. The remainder are
absorbed directly into the portal circulation as fatty acids and glycerol.

Functions of Fat
• Source of energy. Fats are oxidized in the body to provide energy for
tissue activity and for the maintenance of body temperature. They are
a concentrated source of energy, providing (9 kcal) per gram.
• Incorporated into body structure. Some fat enters the body cells and
constitutes an essential part of their structure.
• Protection. The deposits of fatty tissue around the vital organs hold
these organs in position and protect them from injury.
10
• Insulation. Subcutaneous fat prevents loss of heat from the body.
• Satiety. The presence of fat in the chime as it passes into the duodenum
results in inhibition of gastric peristalsis and acid secretion, thus delaying
the emptying time of the stomach and preventing early recurrence of
hunger after a meal.
• Fat-soluble vitamins. The fats of the diet provide the fat-soluble vitamins
and assist in their absorption from the intestine.

Fat stores
The chief stores of fatty tissue are under the skin and around the abdominal
organs and these are sometimes referred to as the fat depots. but are
continually being inter changed with the fats circulating in the blood
stream, and mobilized for use as fuel.
The metabolism of an unusually large proportion of fat may give rise to is a
feature of diabetes mellitus .here carbohydrate metabolism is impaired
through lack of insulin.
Its have a higher energy value weight for weight than carbohydrate, protein or
alcohol. They contribute an important part I the energy content of the diet
and improve its palatability.
Ingestion
11 of fat beyond the energy needs of the body leads deposition of fat
Fat hazards
• High intake of cholesterol in diet lead to atherosclerosis diseases.
• Low fat intake (prolong starvation) give def iciency in essential poly
unsaturated fatty acids (linoleic and linolenic).
• Since dietary fat is the carrier of vitamin A.D.E. and K so low fat in diet
will lead to deficiencies in those nutrients.

Daily Allowances:
Should be calculated for each person about 20% of total calories should
be taken from fats.

Essential Fatty Acids

Certain highly unsaturated (polyunsaturated) fatty acids are needed by the
body and have become known as the essential fatty acids. The
essential fatty acids are linoleic, linolenic and arachidonic, the most
important of which is linolenic.

12
Def iciency has not been reported in healthy persons eating a normal diet,
but there are indications that it can occur in special circumstances, for
example in conjunction with malabsorption of fats, and in persons who
have been fed intravenously for a prolonged time without fat being
included. There is a connection between the proportion of essential
fatty acids in the diet and the incidence of coronary artery disease, and
linoleic acid is an important component of the unsaturated fats (e.g.
corn oil) included in the special diet sometimes advocated for people
prone to this condition.
Vitamin E is important in preventing oxidation of essential fatty acids in
the body, thus preserving their chemical structure ".

Cholesterol
Cholesterol is a fat like substance that is both produced by the body and
found in foods of animal origin. Most of the body's cholesterol is
synthesized in the liver; however, some is absorbed from the diet (e.g.
from milk, egg yolk, and organ meats). Cholesterol is a precursor of bile
acids and is necessary for the synthesis of steroid hormones. Along
with phospholipids, large quantities of cholesterol are present in cell
13membranes as well as other cell structures.
• Cholesterol is a substance usually considered along with the fats. It is
synthesized in the body and is also obtained from the diet. It occurs in
association with animal tissues and in the United Kingdom the
principal dietary source is egg yolk.
• Cholesterol is excreted from the body in the bile, where it is held in
solution by combining with bile salts. If it is precipitated out of solution
it appears in solid form as gall-stones.
• Cholesterol is not a fat, it is a fat related compound.

Phospholipids
Phospholipids are substances allied to the fats. Much of the fatty material
which constitutes an integral part of body cells is in the form of
phospholipids, which are present in large amount in brain and nervous
tissue. They are farmed as an intermediate stage in fat metabolism
and are present in blood plasma.

14
 Protein:
Lipoproteins
• Fats, cholesterol, phospholipids and fatty acids are insoluble in
water, but in blood plasma they form soluble combinations with
some of the plasma proteins, and in this form they are known as
lipoproteins.
• Also Lipoprotein: it define as fat transport vehicle in blood.
– It contains triglycerides, cholesterol and fat soluble vitamin.
– The lipoprotein relative load of fat and protein determines its
density.
– The higher the fat load, the lower its density.
– Low-density lipoproteins (LDL) it carry fat and cholesterol to
cells it called(bad fat).

15
DIncomplete proteins lack one or more essential amino acids (most
commonly lysine, methionine, or tryptophan) and are usually derived from
vegetables. If, however, an appropriate mixture of plant proteins is
provided in the diet, a balanced ration of essential amino acids can be
achieved. For example, a combination of corn (low in tryptophan and
lysine) and beans (low in methionine) is a complete protein. Such
combinations of two or more vegetables are called complementary
proteins. Another way to take full advantage of vegetable proteins is to eat
them with a small amount of animal protein.

Functions of protein
• Repair tissue resulting from catabolism process in body.
• Growth build new tissue (anabolism) especially in infancy, child hood and
pregnancy.
• Source of energy 1g protein give 4 kcal.
• Part of essential body secretions and fluid ex. Mucus.
• Plasma proteins of blood. example. AIbumin which is important in
maintenance of normal osmotic relation among body fluids.
• Plasma proteins function in the transport of other substances e.g. Lipid-
16caring proteins transport cholesterol and triglyceride.
Digestion, absorption and disposal
Proteins are hydrolyzed to amino acids and peptides by digestion.
Digestion starts in the stomach where the combination of an acid
pH and protealytic enzymes hydrolyze the proteins to large
polypeptides which enter the duodenum. These polypeptides are
further hydrolyzed by pancreatic proteolytic enzymes to peptides
and amino acids. Proteolytic enzymes are secreted in an inactive
form that is activated by another enzyme.
The amino acids and peptides produced enter the intestinal cells
and from there have three fates:
• They enter the circulating body amino acid pool from which they
are built into the structural proteins and specif ic enzymes which
are needed by each cell.
• They are converted to other amino acids.
• They are oxidized to produce energy; in some cases the amino
acids are converted to glucose f irst. The urea formed is excreted
by the kidneys.

17
Daily protein requirements
For adults the protein requirement per kg body weight is considered to
be the same for both sexes at all ages the value accepted for the
safe level of
Daily average energy requirements and safe level of protein intake for
infants and children age 3 months to 10 years Age median safe level
of protein intake.
Table 1: Daily requirements of protein for children
g/day g/kg Weight(kg) Months
13 1.85 7 3-6
14 1.65 8.5 6-9
14 1.50 9.5 9-12
Years
13.5 1.20 11 1-2
15.5 1.15 13.5 2-3
17.5 1.10 16.5 3-5
21 1.00 20.5 5-7
18 27 1.00 27 7-10
Protein and energy requirements during pregnancy and lactation.
Average extra requirements for energy and protein during pregnancy
and lactation.
Table 2
Daily requirements of protein & energy during pregnancy and
lactation
Protein (g) Energy (kcal/energy)
6 300 Pregnancy
Lactation
17.5 500 First 6 months
13 500 After 6 months

Low protein intake resulted in to many problems.

• Edema.
• Growth retardation.
• Wasting of body tissues.
• 19General weakness.
But high amount of protein:
No harm because kidney can handle large amounts of Nitrogenous
waste.
It may be harmful only for people with chronic kidney disease.

Sources:
• Complete proteins: which contain all essential amino acids in
sufficient quantity for growth and maintenance.
example. Egg, milk, meat, fish, poultry.
• Incomplete proteins: food protein lacking suf fic ient amount of
one or more of the essential amino acids. example. Grains and
cereals.

Proteins in food:
• Casein in milk.
• Albumin in eggs white.
• Gluten in wheat products.
20
Insufficient protein intake
It is most unusual in this country to meet with obvious signs of
protein def iciency resulting from grossly defective diet, but it
is not known to what extent minor def iciencies may arise,
a n d ma y b e res p on s i b l e for i l l -h ea l t h a n d i mp a i red
development. Marginal intakes should be avoided, especially
in times of increased need such as growth, pregnancy,
lactation, and during recovery from injury, when insuf ficient
protein can impair wound healing and increase susceptibility
to infection. Protein def ic iency may arise as a result of
illness.
• If the energy requirement is increased, as in fevers or
hyperthyroidism, the use of protein for energy production
may result in a lack of protein for growth and replacement,
and this may be aggravated by the withdrawal of protein
from the body tissues to help meet energy needs.

21
• Burns, fractures and other injuries, including those resulting from
operative procedures, are followed by a period when breakdown of
body protein exceeds intake, in other words a period of negative
nitrogen balance.
• Deficiency may also result from failure to utilize protein, as occurs in
some disorders affecting the gastrointestinal tract, and when the
liver is diseased.
weight, high disease prevalence, a shorter life expectancy and low birth
weight in the babies of marasmic mothers.
PEM is a major problem that confronts developing countries and can
be overcome by the following public health measures:
Breast feeding should be encouraged. Bottle feeding is unsatisfactory
both because of its cost and the need for sterilization and for clean
water. However, it must be remembered that the nutritional
requirements of the mother are increased whilst she is breast
feeding. A combination of poor maternal diet and prolonged breast
feeding can cause Kwashiorkor.
Nutritional supplements are needed for vulnerable groups. Children,
pregnant and lactating women, whose nutritional needs are not met
22
by their diet.
 Nutrition Education:
This must be spec if ic to the c o mmunity and is mo st
successfully carried out in maternal and child health
centers where mothers can learn of the need for an
adequate diet and how to provide it.
Improved sanitary conditions and provision of clean water will
reduce the incidence of infections disease, particularly
gastroenteritis.

23
 Summary:
Proteins are vital constituents of all cells. They are complex structures
made from amino acids.
Foods of animal and plant origin both contain proteins. They are
hydrolyzed by proteofytic enzymes to release amino acids before
they are absorbed. An adequate supply of all amino acids is
necessary for body growth and repair. Some amino acids can be
man u factu red by th e b ody. T h ose w h ich th e b ody can n ot
synthesize must be provided by the diet and are called essential
amino acids.
When carbohydrate intake is restricted, proteins are catabolised to
provide energy.
Every living cell has protein as one of its principal constituents. In
structure, proteins resemble chains consisting of amino acids
linked together. Animals can synthesize proteins from amino acids
but are unable to synthesize amino acids. Plants are able to
synthesize amino acids from carbon dioxide, water and nitrogen-
24
containing materials from the soil: Thus, man only obtains protein
Energy Balance
Food and the energy used by the body. The body obtains energy in
the form energy for voluntary, activities such as walking and
talking and for energy balance is determined by comparing their
energy intake with their energy output.

Energy Intake
• caloric value. A calorie is a unit of heat energy. A small calorie is
the C. This unit of measure is used only in chemistry and physics.
A large the temperature of 1 gram of water 15 to 16 degrees C
and is the unit used in measurement, replace the kilocalorie. A kilo
joule is the amount of energy distance.
One Calorie (Kcal) equals 4.18 kilojoules. The energy liberated from
the metabolism of food has been determined to be:
• 4 Calories/ gram (about 16kJ) of carbohydrates.
• 4 Calories/gram (about 16kJ) of protein.
• 9 Calories/ gram (about 37 kJ) of fat.,
25
Energy Output
Resting energy expenditure (REE) is that mount of energy
required to maintain basic body functions; in other words,
the c alo rie s re q uire d to maintain life . The re sting
expenditure of energy is generally about 1 cal/kg of body
weight/hr for men and 0.9 cal/kg/hr for women.
The actual expenditure of energy depends upon the degree of
activity of the individual.
To determine the number of calories expended per minute
based on activity, the following values are used:
• Sedentary: multiply REE by 0.4 to 0.5.
• Lightly active: multiply REE by 0.55 to 0.65.
• Moderately active: multiply REE by 0.65 to 0.7.
• Heavy activity: multiply REE by .75 to 1.0.

26
Metabolism refers to all biochemical and physiologic processes by
which the body grows and maintains itself. Metabolic rate is
normally expressed in terms of the rate of heat liberated during
these chemical reactions. The basal metabolic rate (BMR) is the
rate at which the body metabolizes food to maintain the energy
requirements of a person who is awake and at rest. The energy in
food maintains the basal metabolic rate of the body and provides
energy for activities such as running and walking.
Total energy requirements can then be calculated by adding the REE
and calories required for activity. See the box above.

Body Weight and Body Mass Standards

Maintaining a healthy or ideal body weight requires a balance
between the expenditure of energy and the intake of nutrients.
Generally when energy requirements of an individual equate with
the daily caloric intake, the body weight remains stable. Ideal body
weight (IBW) is the optimal weight recommended for optimal
health. To determine an individual's IBW, the nurse can consult
27standardized table.
 Table 3
Calories need for person with 68kg

Estimating the caloric needs of a 150 pound (68 kg) person

• REE calculation
68 kgx1kcal kgx24hr/ day=16321day=1632kcal/day
• Determine the Calories required for activity 1632kcal/dadayx0.65(65
(moderately active)=1061 kcal/ day
• Add the REE and activity needs 1632 kcal/al/day+1061 kcal/day=2693
keal/ day.

28
29
30
31