NUTRITION AND MEATABOLISM

• The science of nutrition is an applied field that focuses on the study of food, water, and other
nutrients and the way which living organisms utilize them.
• The fuels of the human body are the sugars, lipids, and proteins derived from food.
• Food provides energy and new molecules to replace those that the body uses.
• The synthesis of new molecules is especially important to small children.
• The reactions that release energy from these substances are among the body’s most important
biochemical processes.
• A human body must be supplied with appropriate nutrients or the needed nutritional
requirements.
• Nutrients is the component of foods and drink that provide for growth, replacement, and
energy.
• However, not all component of food and drinks, such as those that provide flavor, color or
aroma, enhance our pleasure in the food but are not themselves nutrients.
• Nutritionists classify nutrients into six groups:
o Carbohydrates
o Lipids
o Proteins
o Vitamins
o Minerals
o Water
• For food to be used in the bodies, it must be absorbed through the intestinal walls into the
bloodstream or lymph system.
• Some nutrients such as vitamins and minerals, glucose, and amino acids can be absorbed
directly.
• Other such as starch, fats and proteins, must be first hydrolyzed to smaller components.
• The breakdown process of food is called digestion.
• A healthy body needs the proper intake of all nutrients; however, nutrient requirements vary
from one person to another.
• For example, more energy is needed to maintain the body temperature of an adult than that of
a child. For this reason, nutritional requirements are usually given per kilogram of body weight.
• Furthermore, the energy requirements of a physically active individual are greater than those of
a person in sedentary lifestyle.
• Therefore, when average values are given, as in Dietary Reference Intake (DRI) and in the
former guidelines called Recommended Daily Allowance (RDA), one should be aware of the
wide range that these average values represent.
• The public interest in nutrition and diet changes with time and geography. 70 -80 years ago, the
main nutritional interest of Americans was getting enough food to eat and avoiding diseases
such as scurvy. Though still present today but is not a main concern anymore.
o Scurvy is a vitamin C deficiency. It can lead to anemia, debility, exhaustion, spontaneous
bleeding, pain in the limbs, and especially the legs, swelling in some parts of the body,
and sometimes ulceration of the gums and loss of teeth.
• In affluent industrialized nations, today’s nutritional message is no longer “eat more” but rather
“eat less and discriminate more in your food selection”.
• Dieting to reduce body weight is a constant effort in a sizable percentage of the population.
They discriminate the selection of food to avoid bad cholesterol and saturated fatty acids.
• Diet faddism is an exaggerated belief in the effects of nutrition upon health and diseases.
• In 19th century, Dr. Kellogg recommended a largely vegetarian diet based on his belief that meat
produces sexual excess.
• Eventually his religious fervor withered and his brother made a commercial success of the
inventions of grain-based foods.
• Another fad is raw food, which bans any application of heat higher than 106°F to food.
• Heat depletes the nutritional values of proteins and vitamins and concentrates pesticides in
food. Obviously, a raw food diet is vegetarian, as it excludes meat and meat products.
• A recommended food is rarely as good and a condemned food is rarely as bad as they claim.
• Each food contains a large variety of nutrients.
o Example: A breakfast cereal contains milled corn, sugar, salt, malt flavoring and Vitamins
A, B, C and D plus flavorings and preservatives.
o There are laws that governs on labeling of food so that public consumer will know of its
nutritional value.
• It is mandated that most packaged food be labeled in a uniform manner to show the nutritional
values of food.
• Such labels must include the list of percentages of Daily Values of four key vitamins and
minerals
o Vitamin A
o Vitamin C
o Calcium
o Iron
• The percent values on the label are based on a daily intake of 2000 kcal.
• For anyone who eats more than that amount, the actual figures would be lower or higher.
• Note that each label specifies the serving size; the percentages are based on that portion, not on
the contents of the entire package.
✓ FOOD GUIDE PYRAMID
• The Philippines uses the daily nutritional guide pyramid and has developed pyramids for
different population groups. The pyramid is divided into levels of recommended
consumption.
• The healthy food plate for Filipino adults (Pinggang Pinoy) completes the messages of the
pyramid by showing adequate distribution of nutritious foods in a meal.
• The Food Pyramid is designed to make healthy eating easier. It shows the different food
groups and how much of each we need to have a healthy diet. Eating the right amount from
each food group is called eating a "balanced" diet.
• Eating well is important for all of us. In the short-term, it can help us to feel good, look our
best and stay at a healthy weight. In the long-term, a healthy, balanced diet can reduce our
risk of heart disease, diabetes, osteoporosis and some cancers.
✓ EQUIVALENTS OF ONE SERVING PORTION OF COMMON FOODS
• Fats and Oils
▪ 1 tsp coconut oil (5g)
▪ 1 Tbsp coconut cream
▪ 1 tsp margarine/butter
▪ 2 tsps peanut butter
▪ 1 tsp mayonnaise
• Sugar / Sweets
▪ 1 tsp sugar (5g)
▪ 1 tsp honey
▪ 1 tsp fruit flavored drink (powder)
▪ 2-3 tsps fruit flavored drink (concentrate)
▪ 1 pc hard candy
▪ 1/5 glass softdrink/ flavored drink
▪ 2 tsp jam/ jelly/ preserves
• Fish, Shellfish, Meat & Poultry
▪ 1 pc medium size fish
▪ 1/3 cup shellfish, shelled
▪ 3 cm cube cooked pork/ beef/ chicken
• Egg, Dried Beans and Nuts
▪ 1/3 cup cooked dried beans/ nuts
▪ 1/2 cup tofu
▪ 1 piece tokwa
▪ 1 piece chicken egg
▪ 1 slice cheese
• Milk and Milk Products
▪ 1 glass whole milk
▪ 1/2 cup evaporated milk diluted with 1/2 glass water
▪ 4 Tbsps powdered whole milk diluted to 1 glass of water
• Vegetables
▪ 1 serving of leafy vegetables = 1 cup raw or 1/2 cup cooked
▪ 1 serving of other vegetables = 1 cup raw or 1/2 cup cooked
• Fruits
▪ 1 serving of vit-C-rich fruits = 1 med sized fruit or 1 slice of a big fruit
▪ 1 serving of other fruits = 1 med sized fruit or 1 slice of a big fruit
• Rice, Corn, Root Crops, Bread and Noodles
▪ 1 cup cooked rice = 4 slices of loaf bread
= 5 pcs small pan de sal
= 1 cup of corn
= 2 slices/pieces of puto
= 2 cups of noodles
= 1 cup of yellow kamote
 • An important non-nutrient in some foods is fiber, which generally consists of the
indigestible portion of vegetables and grains.
• Lettuce, cabbage, celery, whole wheat, brown rice, peas and beans are all high in fiber.
• Chemically fiber is made up of cellulose which cannot be digested by humans.
• Although we cannot digest it, it is necessary for proper operation of the digestive
system; without it, constipation may result.
• In more serious cases, a diet lacking sufficient fiber may lead to colon cancer.
• DRI recommendation is to ingest 35g/day for men age 50 and younger and 35g/day for
women of the same age.

✓ WHY DO WE COUNT CALORIES?

• The largest part of our food supply goes to provide energy for our bodies.
• This comes from the oxidation carbohydrates, lipids and proteins.
• The energy derived from food is usually measured in calories. One nutritional
calorie equals to 1000 Cal or 1 kCal.
• A young male adult needs 3000 Cal and female needs 2,000 Cal daily nutritional
requirement.
• However, children and older requires lesser energy.
• For bodies completely at rest, males only need 1800 Cal while females only need
1300 Cal.
• Basal Caloric Requirement is the term used for caloric requirement for a resting
body usually given in Cal/day.
• Imbalance on the calorie intake and caloric requirement will create health problems.
• Chronic starvation called marasmus increases infant mortality by as much as 50 %.
• In excess, it will cause obesity.
• BMI or Body Mass Index is a measure of body fat based on height and weight that
applies both to adult men and women.
• To reduce obesity or just merely to lose weight, one must combine a low caloric
intake coupled with exercise over extended period of time.
• Crash diets gives an illusion of quick weight loss, but most of this decrease is due to
loss of water, which can be regained very quickly.
• To reduce obesity, we must lose body fat, not water.
• Achieving this goal takes a lot of effort, because fats contain so much energy.
• A pound of fat is equivalent to 3500 Cal. Thus, to lose 10 lbs, it is necessary to
consume 35,000 Cal fewer, which means 350 Cal per days for 100 days.

✓ BODY MASS INDEX

✓ FLOW OF ENERGY IN THE BIOSPHERE
• The sun is the ultimate source of energy used in all biological processes.
• The sun’s enormous energy output is the result of the fusion of hydrogen atoms into
helium atoms.
• The reaction net process is:
• 4H → He + energy
• A portion of the liberated energy reaches Earth as sunlight and is absorbed by
chlorophyll pigments in plants.
• In the plants, the energy drives the reactions of photosynthesis that converts CO2
and water first into glucose, and then into starch, triglycerides and other storage
forms of energy.
• The net reaction for glucose production is
• 6CO2 + 6H2O + ENERGY → C6H12O6+6O2
• All animals obtain energy either directly or indirectly from these energy stores in
plants.
• During cellular respiration, both plants and animals combine these energy-rich
compounds with oxygen from the air, producing CO2 and water, and releasing
energy.
• A portion of the energy released during respiration is captured within the cells in the
form of ATP, a chemical energy carrier, from which energy can be obtained and
used directly for the performance of biological work.

✓ METABOLISM
• Living cells are in a dynamic state, which means compound are constantly being
synthesized and then broken down into smaller fragments.
• Metabolism is the sum total of all chemical reactions involved in maintaining
dynamic state of the cell.
• In general, we can classify metabolic reactions into two broad groups:
1) Those in which molecules are broken down to provide energy needed by the
cells
2) Those that synthesize the compounds needed by cells-both simple and complex.
• CATABOLISM
o The process of breaking down molecules to supply energy
• ANABOLISM
o The process of synthesizing molecules (building up)
• The same compounds may be synthesized in one part of the cell and broken down in a
different part of the cell.
• Metabolism affect growth process and can be related to the circadian rhythm of an
individual.
• For example, in circadian rhythm, cells are in a more active metabolic sate when an animal is
awake than when it is asleep.
• Another example, the cells that promote cancer cell growth and mutation genes that
suppresses cancer cells growth can shift metabolic patterns to those characteristic of tumor
 cells, from those found in normal cells. To explain further, it has been known that when
cancer cells metabolizes sugar products it does not go directly to the metabolic pathways
but instead, they are used to aid uncontrolled cell growth, which is the characteristic of
cancer cells.
• BIOCHEMICAL PATHWAY is a series of consecutive biochemical reactions.
• METABOLIC PATHWAY enormous array of chemical reactions that are organized into
orderly, well-regulated sequences.
• There are three stages of metabolism of food.
o Stage 1 Digestion
▪ Large, complex molecules are chemically broken into relatively small. Simple
ones.
o Stage 2: Production of Acetyl CoA
▪ Small molecules from digestion are degraded to even simpler units primarily
the two-carbon portion of acetyl-CoA
o Satge 3: The common catabolic pathway
▪ Sometimes referred as the common catabolic pathway
▪ Energy released during this stage appears in the form of ATP
• The body uses a different energy-conversion pathway for each of the biomolecule.
• The small molecules produced from the original large molecules of food drop into an
imaginary collecting funnel that represents the common catabolic pathway.
• The purpose of the catabolic pathways is to convert the chemical energy in foods to
molecule ATP.
• In the process, foods also yield metabolic intermediates, which the body can use for
synthesis.

✓ WHAT ARE MITOCHONDRIA AND WHAT ROLE DO THEY PLAY IN METABOLISM?

• Possess two membranes, are the organelles in which common catabolic pathway
occurs in higher organisms.
• The enzyme that catalyzes the common pathway are all located in this organelle.
• Because these enzymes are synthesized in the cytosol, they must be imported in the
two membranes.
o TOM – translocator outer membrane
o TIM – translocator inner membrane
• The inner membrane of a mitochondrion is quite resistant to the penetration of any
ions and most uncharged molecules.
• However, ions and molecule can still get through the membrane through carrier
proteins embedded in it.
• The outer membrane, in contrast, is quite permeable to small molecules and ions
and does not have transporting membranes.
• The matrix is the inner non-membranous portion, highly corrugated and folded.
• George Palade, Romanian-born American cell biologist, proposed his baffle model
of the mitochondrion in 1952.
• The baffles, which are called cristae, project into the matrix like bellow of an
accordion.
 • Enzymes for oxidative phosphorylation cycle are localized in the cristae.
• The space between the inner and outer membrane is called intermembranous
space.
• George Palade, Romanian-born American cell biologist, proposed his baffle model
of the mitochondrion in 1952.
• The baffles, which are called cristae, project into the matrix like bellow of an
accordion.
• Enzymes for oxidative phosphorylation cycle are localized in the cristae.
• The space between the inner and outer membrane is called intermembranous
space.

✓ PRINCIPAL COMPOUNDS OF THE COMMON METABOLIC PATHWAY

• The common catabolic pathway has two parts: the citric acid cycle and the electron
transport chain and phosphorylation (together called oxidative phosphorylation
pathway).

A. AGENTS FOR STORAGE OF ENERGY AND TRANSFER OF PHOSPHATE GROUPS

o The most important of these agents are three rather complex compounds:
▪ AMP – 3.4 kcal/mol
▪ ATP - 7.3 kcal/mol
▪ ADP – 7.3 kcal/mol
o They all contain heterocyclic amine adenine, sugar D-ribose joined together
by ß- N-glycosidic bond, forming adenosine.
o In all three molecules, the first phosphate is bonded to the ribose by a
phosphoric ester bond.
o The only difference between the three molecules is the number of
phosphate groups.
o ADP and ATP contain high-energy phosphoric anhydride bonds.
o The energy gained in the oxidation of food is stored in the form of ATP but
they do not last longer than about 1 min.
o They are hydrolyzed to ADP and inorganic phosphate to yield energy that
drives other processes such as muscle contraction and nerve signal
conduction.
o It is estimated that the human body manufactures and degrades approx. 40
kg of ATP every day.
B. Agents for Transfer of Electrons in Biological Oxidation-Reduction Reactions
o Coenzymes are involved that contains the ATP core.
o NAD+ – nicotinamide adenine dinucleotide
o FAD – flavin adenine dinucleotide
o Both molecules, ADP is handled by which the apoenzyme binds to the
coenzyme; the other end of the molecule carries out the actual chemical
reaction.
o When NAD+ is reduced, it forms a NADH.
o When FAD is reduced, it forms FADH2.
 C. Agent for transfer of Acetyl group
o Coenzyme A or CoA which is the acetyl-transporting molecule and the
central compound in metabolism.
o Coenzyme A contains ADP, but the next structural unit is pantothenic acid,
another B vitamin.
o CoA molecule is linked to an acetyl group by a high-energy thioester bond,
for which the energy is 7.31 kcal/mol.
o The active part of CoA is captoethylamine.

✓ Role of Citric Acid Cycle in Metabolism

• a central driver of cellular respiration.
• It takes acetyl CoA as its starting material and, in a series of redox reactions,
harvests much of its bond energy in the form NADH, FADH, and ATP molecule. The
reduced electron carriers of the two-coenzyme generated in the TCA cycle will pass
their electrons into the electron transport chain and, through oxidative
phosphorylation, will generate most of the ATP produced in cellular respiration.
✓ Oxidative Phosphorylation
• Metabolic pathway in which cells use enzymes to oxidize nutrients, thereby
releasing the chemical energy stored within in order to produce adenosine
triphosphate.
• Oxidative phosphorylation is the process in which ATP is formed as a result of the
transfer of electrons from NADH or FADH 2 to O 2 by a series of electron carriers. This
process, which takes place in mitochondria.

✓ WHY IS IT HARD TO LOSE WEIGHT?

• One of the great tragedies of being a human is that it is far too easy to gain weight
and far too difficult to lose it.
• If we had analyzed the specific chemical reactions involved in this reality, we would
look carefully at the citric acid cycle., especially the decarboxylation reactions.
• Of course, all food that is eaten in excess are stores as fats.
• In addition, these molecules can be interconverted, with the exception that fats
cannot give a net yield of carbohydrates.
✓ Why fats cannot yield carbohydrates?
• The only way that a fat molecule could make a glucose would be to enter the citric
acid cycle as acetyl-CoA and then be drawn off as oxaloacetate for gluconeogenesis.
• Unfortunately, the two carbon atoms that enter the citric acid cycle are effectively
lost by the decarboxylation.
• This now leads to an imbalance in the catabolic vs anabolic pathways.
• All roads lead to fats, but fats cannot lead back to carbohydrates.
• Humans are very sensitive to glucose levels in the blood because so much of our
metabolism is geared toward protecting our brain cells, which prefer glucose as fuel.
• If we eat more carbohydrates than we need, the excess carbohydrates will turn to
fats.
 • As we grow older, our metabolism decreases so it is very easy to put on fats.
✓ What about we just stop eating? Won’t it reverse the process?
• The answer is yes and no.
• When we start eating less, fat stores become mobilized for energy production.
• Fat is an excellent source of energy because it forms acetyl-CoA needed for the citric
acid cycle.
• Thus, we can lose some weight by reducing caloric intake.
• Unfortunately, our blood sugar will also drop as our glycogen stores run out because
we have very little glycogen storage that could be tapped as glucose source for our
blood levels.
• When the blood sugar levels drop, we become depressed, sluggish and irritable.
• Then we start having negative thoughts about our diet.
• If we continue the diet and given that we cannot turn fats into carbohydrates,
where will the blood glucose come from?
• Only source is left and that is proteins. Protein will be degraded to amino acids and
eventually will be converted to pyruvate for gluconeogenesis. Thus, we will begin to
lose muscle as well as fat.
✓ But if we use our knowledge in biochemistry, there’s a better way to lose fat and that is
through exercise.
• If you exercise correctly, you can train your body to use fats to supply acetyl-CoA for
the citric acid cycle.
• If you consume a normal diet, you will maintain your blood glucose and not degrade
proteins for that purpose.; your ingested carbohydrate will be just enough to
maintain your blood glucose levels.

✓ How does the body process Dietary Carbohydrates?

o The major function of dietary carbohydrates is to serve as an energy source.
• The monosaccharides unit are connected to each other by glycosidic bonds.
• Glycosidic bonds are cleaved through hydrolysis.
• In the body, this hydrolysis is catalyzed by acids and by enzymes.
• When a metabolic need arises, storage polysaccharides-amylose, amylopectin, and
glycogen are hydrolyzed to yield glucose and maltose.
• Enzymes that are involved are:
• α – amylase – attacks all three-storage polysaccharide at random, catalyzing the
hydrolysis of α-1,4-glycosidic bond
• ß –amylase – catalyze the hydrolysis of α-1,4-glycosidic bonds but in orderly fashion,
cutting disaccharide maltose units one by one from the nonreducing end of a chain.
• Debranching enzyme – catalyzes the α-1,6-glycosdic bonds.
• The digestion of starch and glycogen starts in our mouth, where α – amylase is one of
the main components of saliva.
 • Hydrochloric on the stomach and other hydrolytic enzymes in the intestinal tract
hydrolyze starch and glycogen to produce mono- and disaccharides.\End products enter
the bloodstream and is carried to the cells to be utilized as energy.
• For this reason, D-glucose is called blood sugar.
• In healthy people, little or none of this sugar ends up in the urine except for a short
period of time.
• In diabetes mellitus, however, glucose is not completely metabolized and does appear in
the urine.
✓ Glycolysis
• An important part of the catabolic process by which body gets energy from
carbohydrates.
• Mainly monosaccharides are broken down to absorbable form of energy in the body.
✓ Glycogenesis
• Process by which glucose is converted into glycogen.
• Glucose consumed in excess of immediate body requirements are stored in the liver and
muscle tissues.
✓ Glycogenolysis
• The breakdown of glycogen back to glucose.
• This occurs in the liver (kidney and small intestines) but not in the muscle tissue.
✓ Gluconeogenesis
• Glucose synthesized from noncarbohydrate material.
• When glucose intake is low and when glycogen stores are depleted, glycerol and certain
amino acids are used to synthesize pyruvate, which is converted into glucose.

✓ HOW DOES THE BODY PROCESS DIETARY FATS?

• The lipids in the food we eat must be hydrolyzed into smaller components before they
can be absorbed into the blood or lymph system through the intestinal walls.
• The enzymes that promotes hydrolysis of lipids are found in small intestine and are
called lipases.
• However, because lipids are insoluble in the aqueous environment of the stomach, they
must be dispersed first into colloidal particles before the enzyme can act on them.
• Bile salts perform this important function, manufactured in the liver from cholesterol
then stored in the gall bladder.
• From there they are secreted through the bile ducts into the intestine.
• Lipases act in emulsion produced by bile salts and dietary fats, into fatty acids, alcohols
and carbohydrates.
• These hydrolysis p roducts are then absorbed through the intestinal wall.
• There are only two essential fatty acids: linoleic and linolenic
✓ FAT MOBILIZATION
• The process when fat cells in the adipose tissue, epinephrine stimulates the hydrolysis of
triglycerides to fatty acids and glycerol, which enters the blood stream.
✓ GLYCEROL METABOLISM
 •The glycerol, entering glycolysis can be converted to pyruvate and contribute to cellular
energy production.
✓ OXIDATION OF FATTY ACIDS
• Fatty acids are converted into fatty acyl CoA by reaction with CoA.
• This fatty acyl CoA then enters the mitochondria are then degraded to catabolic process
called ß-oxidation.
✓ ENERGY FROM FATTY ACIDS
• Oxidation of a single glucose is approx. 32 ATPs whilst a lipid produces approx. 96 ATPs.

✓ HOW DOES THE BODY PROCESS DIETARY PROTEIN?

• The digestion of dietary proteins starts with cooking, which denatures proteins.
• Denatured proteins are easily hydrolyzed by HCl acid in the stomach. Stomach acid
contains about 0.5 % HCl.
• This HCl both denatures the proteins and hydrolyzes the peptide bonds randomly.
• Pepsin, the proteolytic enzyme of stomach juice. Hydrolyzes the peptide bonds on the
amino acids; tryptophan, phenylalanine and tyrosine.
• Most protein digestions occur in the small intestine.
• There, the enzyme chymotrypsin hydrolyzes internal peptide bonds at the same amino
acids.
• Another enzyme trypsin, hydrolyzes them only on the carbonyl side of arginine and
lysine.
• The human body is incapable of synthesizing ten essential amino acids and must be
obtained from the food we eat.
• The body hydrolyzes food proteins into their amino acid constituents and puts them
together.
• For proper nutrition, diet should contain 20 % protein.
• It is called complete protein if the diet contains all of the essential amino acids.
• Casein, protein milk, is a complete protein as well as protein found in meat, fish and
eggs. About 50g/day of complete proteins constitutes an adequate quantity.
• An important protein that is not complete is gelatin, which is made by denaturing
collagen. It lacks tryptophan and is low in several amino acids such as isoleucine and
methionine.
• Many people on quick-reducing diets consume “liquid protein”, which is mostly
composed of denatured collagen.
• Therefore, some amino acids may be lacking in the diet.
• Many plant proteins are incomplete.

• For example, corn protein lacks lysine and tryptophan; rice proteins lack lysine and threonine;
and legumes are low in methionine and cysteine. Even soy protein is not complete.
• Protein complementation is one such diet, where two or more foods complement each other’s
deficiencies.
• In developing countries, protein deficiency is widespread.
• Kwashiorkior whose symptoms include a swollen stomach, skin discoloration and retarded
growth.
• The difference of protein from the other two biomolecules, is that it doesn’t have a stored form.
• Therefore, it essential that adequate protein intake is consumed daily.

✓ NURSES’ ROLE IN THE NUTRITIONAL ASSESSMENT

• Monitoring and intervention to clients needing acute and chronic nutritional care.
• Incorporate family nutritional habits into nutritional care.
• Active role in community teaching about nutrition.
• Physical Assessment and History taking
• Anthropometric tools
• Clinical Values
✓ NURSING DIAGNOSIS
• Imbalanced Nutrition: Less Than Body Requirements related to the intake that is less
(protein) is characterized by not eating, anorexia, weight loss, height is not increased.
• Activity intolerance related to physical infirmity
• Risk for Infection related to low body resistance
✓ NURSING INTERVENTIONS
• Ascertain healthy body weight for age and height. Refer to a dietitian for complete
nutrition assessment and methods for nutritional support.
• Set appropriate short-term and long-term goals.
• Set appropriate short-term and long-term goals.
• Provide oral health care.
• If patient lacks strength, schedule rest periods before meals and open packages and cut
up food for patient.