Dr.

Victor Tambunan, MS, SpGK

Department of Nutrition
Faculty of Medicine
Universitas Indonesia

Erdman Jr JW et al. Present Knowledge in Nutrition

10th ed., 2012

Gropper SS, Smith JL. Advanced Nutrition and Human

Metabolism 6th ed., 2013
Mahan LK et al. Krauses Food and the Nutrition Care
Process 13th ed., 2012

Wahlqvist ML. Food and Nutrition: Australasia, Asia and

the Pacific, 1997

Found primarily in plant tissues

Small amount in animal tissues
Carbohydrate (CHO) in foods traditionally
classified as:

Simple CHO (sugars): mono & disaccharides

Complex CHO: polysaccharides
4

Classification according to degree of

polymerization (number of monomeric
units)

(Food and Agriculture Organization/World Health

Organization Expert Consultation of
Carbohydrates in Human Nutrition, 1998)

The major dietary carbohydrates

Class (degree of

Subgroup

polymerization*)

Sugars (12)

Monosaccharides
Disaccharides
Polyols (sugar alcohols)

Oligosaccharides Maltooligosaccharides
(39)
Other oligosaccharides

Polysaccharides
(>9)

Starch
Non-starch
polysaccharides (NSP)

Components
Glucose, galactose, fructose
Sucrose, lactose, maltose
Sorbitol, mannitol
Maltodextrins
Raffinose, stachyose,
fructooligosaccharides (FOS)
Amylose, amylopectin, modified
starches
Cellulose, hemicellulose,
pectins, hydrocolloids

*Number of monomeric units

6

2. Protein-Sparing Action
Sufficient CHO to meet energy demands
prevents the protein breakdown for this purpose
7

CHO
- Starch & dextrins

- Glycogen
- Sucrose
- Lactose
- Glucose

- Fructose

Food Sources
Grains, vegetables (esp. tubers &
legumes)
Meat products, seafood
Cane & beet sugars, molasses,
maple syrup
Milk & milk products
Fruits, honey
Fruits, honey, corn syrup

Physiological definition:
the remnants of plant cells after
hydrolysis by the enzymes of human digestives system
Chemical definition:
plant non-starch polysaccharides plus lignin

A great deal of the plant material that resists digestion

in human diets originates from the cell walls of the
tissues of fruits, vegetables, & cereal grains
9

10

Oat
Legumes
Guar
Barley

Apple
Citrus fruits
Strawberry
Carrot

White-wheat flour
Bran
Vegetables

Oat

Bran
Whole grains

Plantago ovata

Mature vegetables
Wheat
Fruits with edible seeds,
such as strawberry
11

Sources of (cont'd)
Fibre-like Substances

Inulin
Fructooligosaccharides (FOS)
Chitosan

FOS
12

Sources of (cont'd)
Food Sources:

Chicory root
Onion
Garlic

Leek
Banana

Animal-derived materials that resist digestion

Food source: Crustacea (shrimp, crab, lobster)
13

Physical and Chemical Properties of

Fibre & Fibre-like substances
Water insoluble
Non-fermentable or

partly fermentable
Non-viscous
Hold water

Water soluble
Fermentable:
fermentation yields short
chain fatty acids (acetate,
propionate, butyrate)
Viscous/gelling

Water soluble
Fermentable
Non-viscous
14

Physiological Benefits of Fibre

Reduce constipation, faecal mass, softness &

frequency, and accelerate intestinal transit

Promote growth of ileal & colonic mucosa (?)
Enhance protection from bacterial infection (?)

15

Physiological Benefits (cont'd)

Delay gastric emptying and small intestine transit

Modulate GI motility
Faecal mass, volume & softness (mild effects)
Reduce diarrhoea ( water absorption)
Promote growth of ileal & colonic mucosa
Provides energy to the intestinal mucosa
Colonic pH
Protection from infection (barrier function, immunity)
Glucose tolerance
increases
High total & LDL cholesterol levels with viscosity
16

Physiological Benefits (cont'd)

Inulin & FOS

Promote healthy gut microflora (prebiotic/bifidogenic
effect)

Colonic pH (lactic acid production)

Protection from infection (barrier function, immunity)

Reduce diarrhea and constipation (?)

High blood glucose levels & improve blood lipids (?)

17

Gel formation in the stomach

Delayed gastric emptying

Uniform levels of CHO to the small intestine

Flattened blood glucose curve
Insulin surge

18

Delayed gastric Interference with

emptying
digestive enzymes

Flattened glucose
curve

Interference with
micelle formation

May sequester
May contain
lipase inhibitors lipid + CHO from
digestive enzymes

Inhibition of
cholesterol biosynthesis

May bind Bacterial fermentation

bile acids produces propionate

Bile
Propionate inhibits
Impaired absorption Cholesterol
Insulin secretion
of lipid & CHO cant be absorbed reabsorption HMG-CoA reductase
Stimulation of
HMG-CoA reductase
by insulin

Substrate for
hepatic lipid
synthesis

Exogenous
cholesterol available
for cholesterol synthesis

Cholesterol pulled
out of blood to
make new bile

Cholesterol
biosynthesis

Dietary starch that resists digestive enzyme action

and reaches the colon; a starch encased in a nondigestible plant seed coat or modified by cooking or
processing can be resistant
Western diets:
resistant starch may be as much as 10% of
daily starch intake (840 g/day)
Starch-rich diets:
resistant starch >>>

Recommended Intakes
FAO/WHO expert consultation (1998):
optimal diet should consist at least 55% of
total energy from CHO obtained from a variety
of food sources.
A wide range of intakes is regarded as acceptable
---- up to 75% of total energy

Pedoman Umum Gizi Seimbang (PUGS) Indonesia:

CHO 50% of total calorie
Sugar not more than 5% of total energy

21

Recommended (cont'd)
Restricting total CHO to <130 g/day are not
recommended
Too low intake of CHO fatty acid oxidation
for source of energy ketone bodies production
?

A state of ketosis is undesirable because:

May impair cognitive function
In pregnant women fetus may be adversely
affected
22

Recommended (cont'd)

Ratio of insoluble to soluble fibre:

3:1
can be obtained with 5 servings of fruits &
vegetables and 6 servings daily of whole-grain
breads, cereals, and legumes
23

Dietary Lipids
Triglycerides (triacylglycerols)
Cholesterol

Phospholipids
24

Combinations of fatty acids with glycerol

Fats: solids
Oils: liquids

25

Common Fatty Acids

Trivial name

Biochemical
abbreviation

Food sources

SATURATED
Short-chain
Butyric
Caproic
Caprylic

C4:0
C6:0
C8:0

Butter
Butter
Coconut oil

C10:0
C12:0
C14:0

Palm oil
Coconut oil
Butterfat, coconut oil

C16:0
C18:0

Palm oil, animal fat

Cocoa butter, animal fat

Medium-chain
Capric
Lauric
Myristic

Long-chain
Palmitic
Stearic

26

Common Fatty (cont'd)

Trivial name

Biochemical
abbreviation

Food sources

MONO-UNSATURATED
(MUFA)
Oleic
Erucic

C18:1 n-9
C22:1 n-9

Olive, canola, peanut oil

Canola oil

C18:2
C18:3
C20:4
C20:5
C22:6

Seeds fats--corn, cottonseed

Flaxseed, soybean oil
Lard, meats
Some fish oil, shellfish
Some fish oil, shellfish

POLY-UNSATURATED
(PUFA)
Linoleic
a-linolenic
Arachidonic
Eicosapentaenoic (EPA)
Docosahexaenoic (DHA)

n-6
n-3
n-6
n-3
n-3

27

Classification and Food Sources of Omega Fatty Acids

Biochemical
abbreviation

Food Sources

Omega-3 a-linolenic acid

EPA
DHA

C18:3 n-3
C20:5 n-3
C22:6 n-3

Flaxseed, soybean oil

Some fish oil, shellfish
Some fish oil, shellfish

Omega-6 Linoleic acid

Arachidonic
acid

C18:2 n-6
C20:4 n-6

Corn, cottonseed oil

Lard, meats

Omega-9 Oleic acid

C18:1 n-9

Olive, canola, peanut

oil

Class

Fatty acid

28

Role of Fat
In the Diet
In the Body

29

In the Diet
1. Source of energy (9 kcal/g fat)
2. Satiety value tends to leave

the stomach relatively slow

3. Carrier of fat-soluble vitamins
(A, D, E, and K)
4. Essential fatty acids supply
5. Palatability responsible for
much of the texture & flavor of
food

In the Body
1. Constituent of cell membranes
2. Energy reserve as triglycerides
3. Regulator of body functions

arachidonic acid (n-6 PUFA)

a-linolenic acids (n-3 PUFA)
precursors of eicosanoids
(prostaglandin, thromboxane)
4. Insulator prevent heat loss
5. Protector protect vital organs

30

Essential:
The body cannot synthesize or cannot make in
sufficient amounts must obtain from the diet
Absence leads to a defined deficiency state
Nutritionally essential fatty acids:
linoleic acid & a-linolenic acid
Arachidonic acid is not an essential fatty acid
can be synthesised from linoleic acid
31

Prostaglandin & Prostacyclin

Thromboxane
Leukotriene

Have many functions, including:

Regulation of blood pressure
Stimulation of pain & fever
Induction of blood clotting

Modify the processes of inflammation

32

Omega-6 series

Omega-3 series

Linoleic acid
18:2n-6

a-Linolenic acid
18:3n-3
Elongation
Desaturation

Arachidonic acid

Eicosapentaenoic acid

20:4n-6

20:5n-3
in platelets

Thromboxane2

Thromboxane3

in blood vessels
Prostaglandin3

Prostaglandin2
in leukocytes
Leukotriene4

Leukotriene5

Production of eicosanoids from n-3 & n-6 fatty acids

33

Is a fat-related compound belonging to

sterols family

Not yield energy

Found only in animal foods
Component of cell membranes
Precursors of steroid hormones

34

Cholesterol (cont'd)
Food Sources
Food high in cholesterol:
Brain
Egg yolks
Organ meats such as liver & kidney
Lobster

35

Food Sources (cont'd)

Lesser amounts occur in other animal food
sources:
Meats, especially fatty meats
Whole milk
Cream, butter, cheese, ice cream, & other whole milk
dairy products

36

Recommended Intakes
Pedoman Umum Gizi Seimbang (PUGS) Indonesia:

Lipids:
25% of total energy
(at least 10% of total energy)

37

Proteins are made up of chains of amino

acids linked by bonds to form ribbon-like
peptide chains.
Over 300 different amino acids
occur in nature
There are only 20 common amino acids
which make up most protein

Only L-a-amino acids occur in proteins

38

Nutritional Classification of Amino Acids:

Essential (indispensable)

Non-essential (dispensable)

39

Must be supplied in the diet because:

Cannot be synthesized in the body
Cannot be synthesized at a sufficient rate
to meet body requirements
phenylalanine, valine, threonine, methionine,
tryptophan, histidine, isoleucine, leucine, & lysine

can be synthesized within the body

40

Functions
Major functions of proteins in the body
1. Part of cell membranes
2. Enzymes & some hormones
3. Special proteins of blood:

hemoglobin, albumin, transferrin

4. Nucleoproteins:
stabilise the structure of RNA & DNA

5. Antibodies
6. Contractile protein in muscle
41

Complete proteins or proteins of high

biological value contain all of the
essential amino acids in proportions capable
of promoting growth when they are the sole
protein in the diet

All animal proteins, except gelatin,

are complete proteins
42

Incomplete proteins or proteins of low

biological value lack or have limited
amounts of one or more of the essential
amino acids and so are incapable of
promoting growth when they are the sole
protein in the diet

43

Food Source
Most of the foods we eat contribute some protein
to the diet
Protein is the major component of lean meat,
fish, and egg white (protein contributes
>20% of energy)

44

Food Source (contd)

Cereals contribute intermediate amounts of
protein (7% to 18%)

Fruits & vegetables contribute much less

(0% to 5%)

45

Protein in foods
Food

Protein amount in food

(g/100 g)

High content (protein contributes >20% of energy)

Beef & lamb (lean meat, cooked)
Chicken
Fish (whiting, without batter)
Eggs
Milk
Peas (fresh or frozen)

28
25
18
12
3.3
5

Medium content (protein contributes 7 to 8% of energy)

Bread (white)
Corn (sweet)
Potatoes (cooked)
Rice (cooked)

7.8
4.1
1.6
2.2

Low content (protein contributes 0 to 5% of energy)

Cassava
Apples
Butter and margarines

0.7
0.3
<0.4
46

Life-Stage Group

RDA/AI (g/kg/day)

Infants

1.5

13 years

1.1

413 years

0.95

1418 years

0.85

Adults

0.8

Pregnant (using pre-pregnancy

weight) women

1.1

Lactating women

1.1

RDA: Recommended Dietary Allowances

AI : Adequate Intake
Washington DC, 2002. The National Academies Press
47

Excess dietary protein

May adversely affect calcium (Ca) status
Ca absorption is enhanced by higher intakes
of protein, but urinary excretion of Ca is also
Rate of Ca urinary loss is higher than Ca uptake
There may be a net loss of Ca
48

World Health Organization (WHO), 2003

49