預防醫(yī)學課件：2-fat,energy,vitamin and minerals

1、 fat/triglyceride saturated fatty acid fatty acid Lipid unsaturated fatty acid (MUFA, PUFA) lipoid: phospholipid, glucolipid, steroids, lipoproteins Glycerin/GlycerolClassificationClassification Triglycerides of human body mainly distribute Triglycerides of human body mainly distribute among abdomen

2、, subcutaneous tissue and among abdomen, subcutaneous tissue and muscular fiber. muscular fiber. Saturation Saturation refers to the refers to the number of number of hydrogens a hydrogens a fatty acid fatty acid chain is chain is holding. holding. Function: uStore and provide energy: 37.7kJ/g(9kcal

3、/g) uconstitute body tissue, and endocrine. usupply essential fatty acid (EFA) upromote absorption of fat-soluble vitamin uPromote appetite and food satiety Essential fatty acid, EFA Essential fatty acid, EFA Definition: a fatty acid required in the diet because the body cannot synthesize it. Two fa

4、tty acids: linoleic acid（亞油酸）（亞油酸） and alpha-linolenic acid（ -亞麻酸）亞麻酸） Linoleic acid is the primary member of a group of fatty acids named the omega-6 fatty acid family. AA Linolenic acid is the primary member of the omega-3 fatty acid family. DHA、 EPA EFAEFA缺乏：頸前、腋下出現(xiàn)缺乏：頸前、腋下出現(xiàn) 皮膚干燥，鱗狀脫屑發(fā)紅及皮膚干燥，鱗狀脫

5、屑發(fā)紅及 增厚等濕疹樣改變增厚等濕疹樣改變 該病例經(jīng)該病例經(jīng)EFAEFA治療治療2 2個個 月后，癥狀消退。月后，癥狀消退。 Sources and RNISources and RNI uplant oil and animal fats uPlant oil and nut: PUFA uAnimal fats: SFA and MUFA S:M:P=1：1：1 u RNI: adult 20%30% of total energy uEFA3% of total energy u cholesterol: 300mg/d 食物食物脂肪含量脂肪含量% %食物食物脂肪含量脂肪含量% % 花生

6、花生39.239.2豬肉（瘦）豬肉（瘦）28.828.8 黃豆（干）黃豆（干）18.418.4牛肉（腰）牛肉（腰）19.119.1 葵花子葵花子51.151.1羊肉羊肉13.613.6 核桃核桃63.063.0兔肉兔肉0.90.9 杏仁杏仁49.649.6雞肉雞肉 2.52.5 松子松子63.363.3鴨肉鴨肉7.57.5 榛子榛子49.749.7鵝肉鵝肉11.211.2 芝麻芝麻61.761.7大黃魚大黃魚0.80.8 西瓜子西瓜子49.949.9青魚青魚5.25.2 雞蛋雞蛋11.611.6雞蛋黃雞蛋黃30.030.0 4. Energy Unit: J, kJ, MJ; cal, kca

7、l 1kcal=4.184kJ 1kJ=0.239kcal The energy expenditure uBasal Metabolism (BM) uThermic Effect of Food (TEF) or Specific Dynamic Action (SDA ) uActivity BM: the energy expenditure needed to maintenance basic life activity (the main energy expenditure,60%-70% ) BMR : the basal metabolism energy expendit

8、ure of each m2 body surface in an hour. Unit: KJ/(m2.h) Factors influencing BM: uSurface area of body, lean body mass uPhysiologic and pathological status uSex uEnvironmental factors Specific dynamic action (SDA ) Thermic effect of food (TEF) Definition Extra expenditure of energy resulted from food

9、 intake. Energy produced by itself: protein 30% carbohydrate 5%6% fat 4%5% Mixed foods: 10% of BM Activity :the main factor influencing energy expenditure , 15%-30% strength, duration of labor, physical activity Classification uLight labor uModerate labor uHeavy labor RNI and Sources Carbohydrate 16

10、.7kJ/g or 4 kcal/g Fat 37.7kJ/g or 9 kcal/g Protein 16.7kJ/g or 4 kcal/g The ratio of energy Carbohydrate: 55%65% Fat: 20%30% Protein: 10%15% Definition Organic dietary substances, not as carbohydrate, fat, or protein, which neither produce energy nor constitute body tissue, but they are usually nec

11、essary in only very small quantities to perform a particular metabolic function or to prevent an associated deficient disease. It can not be synthesized by the body and therefore must be supplied by food. Deficiency primary: intake insufficiency secondary: absorption decrease or requirement increase

12、 Process: decrease in tissue storage physical and biochemistry change clinical symptom Vitamin Names Fat-soluble vitamins Water-soluble vitamins Vitamin A Vitamin D Vitamin E Vitamin K B vitamins Thiamin (B1) Riboflavin (B2) Niacin (B5) Folate Vitamin B12 Vitamin B6 Biotin Pantothenic acid Vitamin C

13、 (1)Vitamin A also called retinol(視黃醇視黃醇) retinol retinal retinoic acid 視黃醇視黃醇 視黃醛視黃醛 視黃酸視黃酸 uSource Animals：preformed vitamin A Plants： provitamin A Vitamin A -Carotene -Carotene -Carotene -cryptoxanthin (隱黃素隱黃素) Total retinol equivalent( g RE)= retinol( g) +-carotene ( g)0.167 (1/6) +other provita

14、min A0.084 (1/12) uPhysiological function Maintenance the normal vision. visual purple Increase growth and differentiation of epithelial cells，maintenance the normal structure of skin. Reproduction function. Improving immunity function, increase resistance of infection and anti-carcinoma of lung (an

15、tioxidant actions). Promote the development of bones. uDeficiency Eye: dark adaptation, night blindness. Injury of conjunctiva, ulcer of cornea, eye dry, xerophthalmia, Bitots spots(畢脫氏斑畢脫氏斑) Skin: dry, squamous（有鱗片的），（有鱗片的）， Immunity decrease: respiratory tract respiratory tract infection, diarrhea

16、 uSources and RNI Sources animal foods liver, cod liver oil, egg, milk and milk products plant foods -carotene, green and yellow vegetable, some fruits. RNI adult man: 800ug RE adult woman : 700 ug RE Vitamin D2 (ergocalciferol)麥角鈣化醇麥角鈣化醇 Vitamin D3 (cholecalciferol)膽鈣化醇膽鈣化醇 Vitamin D 25-OH-VD3 1,25

17、-(OH)2-VD3 LIVERLIVERKIDNEYKIDNEY uFunction Increasing Ca and P absorption and regulating Ca and P metabolism uDeficiency children: rickets adult: osteomalacia osteoporosis 方顱：以額骨和頂骨為中心向外隆起，使頭部成方方顱：以額骨和頂骨為中心向外隆起，使頭部成方 形改變，常見于形改變，常見于78個月的佝僂兒個月的佝僂兒 郝氏溝：膈肌牽引軟化 肋骨，導致肋弓緣上部 內(nèi)陷，形成溝狀 肋骨骺部膨大， 呈串珠樣 膝及踝腫大，兩腿呈“

18、O”形 弓形腿 膝及踝明顯腫大，兩 腿彎曲呈“X”形 uRNI and sources RNI adult: 5ug/d. child and old man: 10 ug/d. Sources cod liver oil, yolk, liver, fish. uFunction Antioxidant actions prevent arteriosclerosis, anti-cancer, improving immunity function, delay aging. Promote protein synthesize Related with reproduction -toc

19、opherols uSources and RNI RNI Adult: 14mg/d sources plant oil, nut, seeds, wheat germ, legume (1)Vit B1 （thiamine） uFunction Mainly take part in energy metabolism in the form of TPP (thiamine pyrophosphate ). (焦磷酸硫胺素焦磷酸硫胺素) Other forms: TMP,TDP,TTP. Maintaining the normal function of nerve, muscular

20、, circulation system. Carbohydrate, Fat, ProteinCarbohydrate, Fat, Protein 丙酮酸丙酮酸, ,酮戊二酸酮戊二酸 氧化脫羧氧化脫羧( (TPPTPP是氧化脫羧酶的輔酶是氧化脫羧酶的輔酶) ) 乙酰乙酰CoA,CoA,琥珀酰琥珀酰CoACoA 三羧酸循環(huán)三羧酸循環(huán) ATPATP 磷酸戊糖通路中磷酸戊糖通路中transketolation-transketolation-轉(zhuǎn)酮醇作用轉(zhuǎn)酮醇作用( (TPPTPP 是轉(zhuǎn)酮醇酶的輔酶是轉(zhuǎn)酮醇酶的輔酶) )是核酸合成的戊糖及脂肪酸合成是核酸合成的戊糖及脂肪酸合成 中的中的NADPHNA

21、DPH的重要來源的重要來源 uDeficiency:Deficiency: Beriberi Beriberi dry beriberi: neuritisdry beriberi: neuritis wet beriberi: wet beriberi: mixed beriberi:mixed beriberi: 干性腳氣?。╠ry beriberi） 以多發(fā)性周圍神經(jīng)炎癥狀為主， 出現(xiàn)上行性周圍神經(jīng)炎，表現(xiàn) 為指（趾）端麻木、肌肉酸痛、 壓痛，尤以腓腸肌為甚。膝跳 反射在發(fā)病初期亢進，后期減 弱甚至消失。向上發(fā)展累及腿 伸屈肌、手臂肌群，而出現(xiàn)垂 足、垂腕癥狀。 濕性腳氣?。╳et be

22、riberi） 多以水腫和心臟癥狀為主。 由于心血管系統(tǒng)障礙，出現(xiàn)水腫，右心室可擴大，有心悸、 氣短、心動過速，如處理不及時，常致心力衰竭?；旌闲?腳氣病的特征是既有神經(jīng)炎又有心力衰竭和水腫。 uRNI and sources RNI and sources RNI RNI Male:1.4mg/d, Female:1.3mg/d Male:1.4mg/d, Female:1.3mg/d SourcesSources animal organ such as liver, kidney, animal organ such as liver, kidney, brain, lean meat,

23、 grain, legume, nut, brain, lean meat, grain, legume, nut, yeast yeast (2)Vit B2 (2)Vit B2 （riboflavinriboflavin） uFunction Function Mainly take part in energy Mainly take part in energy metabolism in the form of metabolism in the form of FMNFMN (flavin mononucleotide) (flavin mononucleotide) FAD FA

24、D (flavin adenine dinucleotide) (flavin adenine dinucleotide) uDeficiency (oro-genital syndrome)Deficiency (oro-genital syndrome) MouthMouth angular stomatitis, cheilosis, glossitis angular stomatitis, cheilosis, glossitis Eye Eye corneal inflammation corneal inflammation SkinSkin seborrheic dermati

25、tis seborrheic dermatitis（脂溢性皮炎）（脂溢性皮炎） uRNI and sourcesRNI and sources RNI RNI Male: 1.4mg/d, Female: 1.2mg/dMale: 1.4mg/d, Female: 1.2mg/d Sources Sources animal foods such as liver, kidney, heart, animal foods such as liver, kidney, heart, egg, milk, legume, fish, green vegetableegg, milk, legume

26、, fish, green vegetable (3)Vitamin pp (niacin )(3)Vitamin pp (niacin ) uFunctionFunction Take part in the metabolism of nutrients in Take part in the metabolism of nutrients in the form ofthe form of Co and CoCo and Co uDeficiency:Deficiency: pellagra pellagra “three Dthree D” symptoms symptoms diar

27、rhea diarrhea ( (腹瀉腹瀉) ) dermatitisdermatitis（皮炎）（皮炎） dementiadementia（癡呆）（癡呆） uFunctionFunction Amino acid metabolism.Amino acid metabolism. Glycogen and fatty acid metabolism.Glycogen and fatty acid metabolism. Others.Others. uDeficiencyDeficiency cheilosis, glossitischeilosis, glossitis seborrhei

28、c dermatitisseborrheic dermatitis（ seborrheic seborrheic dermatitisdermatitis( (脂溢性皮炎脂溢性皮炎) ) uSources and RNISources and RNI SourcesSources meat, vegetable, fruits, nut and cereals. meat, vegetable, fruits, nut and cereals. AI AI adult:1.2mg/d; adult:1.2mg/d; pregnant and lactating woman:1.9mg/d pr

29、egnant and lactating woman:1.9mg/d AlsoAlso called pteroylglutamic acid, PGA.called pteroylglutamic acid, PGA.蝶酰谷氨酸蝶酰谷氨酸 FA FA THFA (THFA (活性形式活性形式) ) terahydrofolateterahydrofolate（四氫葉酸）（四氫葉酸） u Deficiency high homocysteinemia Congenital malformation(neural tube defects, NTDs) homocysteine u Source

30、s and RNI Sources: Liver, beans, nut, green vegetable and fruits. RNI: Dietary folate equivalent (DFE) for adult is 400g/day. Function nInvolve in the reaction of hydroxides, promote the formation of collagen nFe 3+ Fe2+ , folic acid tetrahydrofolic acid nEnhance the resistance to diseases nAntioxid

31、ant actions. Accelerate the toxin to excrete uSources and RNISources and RNI Fresh fruit and vegetable: orangeFresh fruit and vegetable: orange， strawberrystrawberry RNI: adult 100mg/d RNI: adult 100mg/d ClassificationClassification macroelementsmacroelements: : 0.01% bw0.01% bw Ca Ca Mg K Na P S Cl

32、 Mg K Na P S Cl microelementsmicroelements: : 0.01% bw0.01% bw FeFe Zn I Se Cu Mo Cr Ni F Zn I Se Cu Mo Cr Ni F MnMn FunctionsFunctions The constituents of the body The constituents of the body Regulation Regulation The constituents and activating factors of The constituents and activating factors o

33、f enzymes enzymes bone and teeth (99%) bone and teeth (99%) miscible calcium pool (1%) miscible calcium pool (1%) FunctionFunction constituents of bone and teethconstituents of bone and teeth maintaining nerve-muscle irritability maintaining nerve-muscle irritability activity factors of enzymesactiv

34、ity factors of enzymes keeping acid-base equilibriumkeeping acid-base equilibrium Factors influencing Ca absorptionFactors influencing Ca absorption Increasing factorsIncreasing factors Decreasing factorsDecreasing factors vitamin D vitamin D phytic acid in cereals phytic acid in cereals protein pro

35、tein oxalic acid in vegetableoxalic acid in vegetable lactose lactose fatty acidfatty acid acid drugs acid drugs dietary fiberdietary fiber body needbody need basic drugsbasic drugs body need body need Deficiency Deficiency Rickets: childrenRickets: children Osteomalacia: adultsOsteomalacia: adults

36、Osteoporosis: olderOsteoporosis: older RNI and SourcesRNI and Sources nRNI: Adult: 800mg/d RNI: Adult: 800mg/d Children: 1000mg/d Children: 1000mg/d nSources: milk and milk products Sources: milk and milk products dried small shrimps dried small shrimps soybean and soybean soybean and soybean produc

37、tsproducts Distribution :Distribution : 45g, 45g, Functional ironFunctional iron hemoglobinhemoglobin： 60%-75 %60%-75 % myoglobin myoglobin ： 3%3% Enzymes: 1%Enzymes: 1% S Stored iron tored iron 25% ferritin 25% ferritin（鐵蛋白）（鐵蛋白）,hemosiderin,hemosiderin（含鐵血（含鐵血 黃素）黃素） Function Function oxygen trans

38、port. oxygen transport. Formation and maturing of RBCFormation and maturing of RBC Others: -carotene VAOthers: -carotene VA body needbody need：can influence Heme-Fe and Non-Heme Fe can influence Heme-Fe and Non-Heme Fe absorption absorption H Heme Fe :eme Fe : exist in animal foods, 10%30% exist in

39、animal foods, 10%30% Non-Heme Fe:Non-Heme Fe: exist in both animal and plant foods, exist in both animal and plant foods, 10%.10%. favourable factors:favourable factors: Vit C, Vit A, meat factors, glucose, fructose, Vit C, Vit A, meat factors, glucose, fructose, acid drugsacid drugs unfavourable fa

40、ctors:unfavourable factors: phytic acid, oxalic acid, Zn, Cu, phytic acid, oxalic acid, Zn, Cu, basic drugsbasic drugs Dietary ironDietary iron Heme(small portion)Heme(small portion)Nonheme(largest portion)Nonheme(largest portion) Food Food sourcessources Absorption Absorption raterate N o n e i n p

41、 l a n t N o n e i n p l a n t sources; 40% of sources; 40% of i r o n i n a n i m a l i r o n i n a n i m a l sourcesource Rapid; transported Rapid; transported a n d a b s o r b e d a n d a b s o r b e d intactintact All plant sources of iron; All plant sources of iron; 60% of iron in animal 60% o

42、f iron in animal sourcessources Slow; tightly bound in Slow; tightly bound in organic moleculesorganic molecules Characteristics of heme and nonheme portions of dietary iron DeficiencyDeficiency Stages of anemiaStages of anemia Iron deficiency store (ID):Iron deficiency store (ID): Fe storedFe stored (serum ferritin) (serum ferritin) Iron deficiency erythropoiesis ( IDE):Iron deficiency erythropoiesis ( IDE): serum ferritin, serum Fe , FEP serum ferritin, serum Fe , FEP Iron deficiency anemia, IDAIron deficiency anemia, IDA Hb Hb ，anemia anemia RNI and sourcesRNI and sources nadul