CHAPTER 8VIT E and K onlyVITAMIN E

One of the most misused and controversial nutrients because of many erroneous claims for its healing powers in variety of ailments

Discovery

1922- female rats and male rats were sterile unless lettuce wheat germ and dried alfalfa were added to their diet

1924- called this fertility vitamin, vitamin E 1936 - vitamin E was isolated from wheat germ oil and

called it alpha tocopherolgreek of child-birth and to carry

Absorption and metabolism

Best absorbed on the presence of fat Conditions that interfere with fat absorption:

o Bilary tract diseaseo Pancreatic insufficiencyo Excessive mineral oil digestion

Intestinal absorption is between 20-30% Vitamin enters lymph unchanged Attaches to lipoproteins as they are being transported

to bloodstream and become tocopherol Stored in:

o Adipose tissueo Muscleo Liver

(in smaller amounts):

o Hearto Uteruso Testeso Adrenals

Function

Antioxidant- limits free-radical chain reactions Protect body cells from lipid peroxidation Make cell membranes more stable Prevents fat from becoming rancid

**vitE requirement is proportional to the amount and the degree of unsaturation of polyunsaturated fatty acid in diet = less polyunsaturated fat, less vitE required

Deficiency

Rare If present, due to congenital or malabsorption disease Anemia - For premature infants born w/ inadequate

reserve of vitE

Treatment

30-100mg daily may be prescreibed Minor symptoms such as mausea and intestinal

distress appears when ingesting 300IU per day

Food Sources

Seed oils = major source wheat germ oil vegetable oils nuts and seeds whole grains egg yolk leafy green vegetables

Toxicity

large doses may increase time required for blood coagulation

symptoms:o headacheo fatigueo weaknesso blurred visiono temporary nauseao flatulenceo diarrhea

VITAMIN K

1931 – chickens were protected from bleeding when they were fed fish meal that was not extracted with ether

1935 – found that VitK was essential for blood coagulation

Chemistry

Derivative of 2-methyl-1,4-napthoquinone K1& K2

o Natural formso Yellowish olso Unstable in UV lighto Easily destroyed by strong acids and

alkaliso K1 – occurs in green plantso K2 - produced by bacterial synthesis in

intestineo K3 – menadione; synthetic form of VitK

Absorption

Requires bile and pancreatic juice Can also be synthesized by bacteria in GI tract in

jejunum and ileum

Function

Aids in blood clotting (main function) Assist in Ca+ absorption Lowers risk of kidney stones

Deficiency

Rare Only occurs in individuals with GI disorders **breastfed infants have VitK due to immaturity

of liver and thus newborn babies are given Vit K suppelements and aor the mother is requested to

eat recommended amount of green leafy vegetables daily

Food Sources

Spinach Broccoli Cabbage Lettuce Vegetable oils

CHAPTER 9• FLUORIDE AND THEIR ROLE IN DENTAL CARIES

PREVENTION • Fluoride • Compound form of fluorine.

– A trace element, halogen.– Very reactive gas.– Not found in free elemental form in

nature.• Major source is from water – artesian wells.• Found in soils rich in fluorspar, cryolite, and other

minerals.• Fluoride • Also found in plants, food, and human – calcified

structures (teeth and skeleton).• Nutrient beneficial to dental health. • Dietary sources - drinking water • Waterborne fluorides are the most important source

of flouride for humans.• Modern diets as a source of flouride.

– Use of fluoridated water in preparation of processed foods and beverages.

• For temperate climates– Optimal fluoride level: 1 ppm of fluoride.

• Dietary sources - drinking water • For infants and young children

– Intake of 2 – 4 glasses of water: 0.5 – 1 mg of fluoride.

• For older children, adolescents and adults– Intake of 6 – 8 glasses of water: 1.5 – 2 mg

of fluoride.• Ingestion of fluoride greater than optimal levels in

drinking water (2 ppm) cause fluorosis.– Dietary sources - foods

• Fluoride in foods by adults– Nonfluoridated communities: 1 mg/day.– Fluoridated communities: 2 – 3 mg/day.

• Not known to be a significant factor in fluorosis (mottled enamel).

• Small amounts: fruits, vegetables, cereals.• Rich amounts: seafoods and tea leaves.

– Dietary sources - foods • Metabolism - absorption • Major site of absorption: stomach.• Studies with animals suggest intestinal absorption

also occurs.• Soluble fluoride in drinking water is completely

absorbed, whereas 50 – 80% of the fluoride in foods is absorbed.

• Metabolism - Distribution • Teeth and skeleton have the highest concentrations

of fluoride.– Due to the affinity of fluoride to calcium.– Cementum, bone, dentin, and enamel.

• Fluoride content of teeth increases rapidly during early mineralization periods and continues to increase with age, but at a slower rate.

• Metabolism - Distribution • Found in both extracellular and intracellular fluids of

soft tissues but at very low concentrations.• Found in saliva, 0.01 ppm.

– Play a part in maintenance of fluoride concentrations in the outer layer of tooth enamel.

• Metabolism - Excretion • Principal route of excretion is urine (90 – 95%).• Remaining 5 – 10% in the feces.• Outstanding characteristic of fluoride excretion is its

speed.– Reabsorption of fluoride from urine is less

efficient. Effective mechanisms for

maintaining low concentrations of fluoride in the soft tissues and plasma.

Metabolism - Excretion Directly related to the degree of

active bone growth. Fluoride excretion is lower

when a child is growing rapidly and is actively depositing bone material than in adults with a mature bone structure and fully mineralized teeth.

• About half of the ingested fluoride is excreted in the urine each day.

• Metabolism - storage • Deposited in calcified structures.• Skeletons of older persons contain more fluoride than

those of younger ones.– Amount of fluoride in bone gradually

increases with age – greatest during active growth years.

• Metabolism - storage • Factors that attract fluoride to bones:

– Presence of an active growth area at the ends of long bones.

– Small size of the bone crystals.– Close contact between bones and the

blood supply • Metabolism - storage • Deposited in the enamel through diffusion.

– Carious enamel may take up 10 times more fluoride than adjacent healthy enamel to inhibit expansion of carious lesion.

• Dentin may contain even more fluoride.– Chemically similar to bone– Highest concentration found adjacent to

pulp: close to blood supply. • Relative safety • Low and moderate intake results to:

– Skeletal fluorosis– Mottled enamel– Osteosclerosis (hardening of bone)– Exostoses (bony projections)– Calcification of ligaments

• High intake may result to death.– Mottled enamel (Endemic Dental Fluoride)

• White or brown spotty staining of tooth enamel.– May be due to food, debris, or plaque.

• Sometimes will have horizontal striations.• Enamel is deficient in:

– Number of cells producing enamel causes pitting (hypoplasia).

– Hypocalcification causes chalkiness.• Mottled enamel (Endemic Dental Fluoride) • Occurs only in teeth that are being formed.

– When exposed to high concentrations of fluoride, opaque spots will develop on the enamel.

• High intake of fluoride results to mottled enamel.– Protection of fluoride is decreased by

severe fluorosis.• Mottled enamel (Endemic Dental Fluoride) • Fluoride and dental caries • Communal Water Fluoridation

– Most effective, practical, feasible and economical public health measure for preventing caries.

– Greatest resistance to caries and greatest amount of fluoride deposition are acquired by starting the intake as early as possible and using it continuously.

• Fluoride and dental caries – Other factors to the decline of caries:

1. Greater dental health awareness.

2. Expansion in dental resources.3. Application of preventive

dentistry.– Fluoride and dental caries

• School Water Fluoridation– Fluoridated with levels of three to seven

times the optimum for communal water fluoridation resulting to reduction in caries incidence.

• Fluoride and dental caries • Fluoride Tablets

– Ingestion daily beginning at 5 – 9 years: permanent teeth can still be significantly protected from caries.

• Fluoride and dental caries – Lozenge is much preferred than tablets or

drops.1. Dissolves slowly, produces both

topical and systemic effects.– Advantage: specific and precise dosage– Disadvantage: assurance of continuous

daily ingestion and cost is greater.1. Fluoride and dental caries

• Prenatal Fluoride Supplement– Fluorides supplements are not

recommended for adults, especially pregnant women, for reducing dental caries.

1. The concentration of fluoride that reaches the fetus is generally lower than that in the maternal blood.

2. Infants exposed will have higher plasma, skeletal and developing enamel fluoride levels.

• Fluoride and dental caries • Fluoride Supplements (Infants and Children)

– Fluoride supplementation at birth gives some protection against caries to the deciduous teeth.

– No fluoride supplements must be given to infants less than 6 months of age ( exception of infants consuming milk)

• Fluoride and dental caries • Fluoride Rinses

– 3 years is necessary to achieve the maximum benefit from a rinse program.

– Effective in children with a higher caries baseline than low caries baseline.

1. The lower the incidence of caries, the more limited the effect of each preventive measure.

– Fluoride and dental caries • Sustained Release Delivery Systems

– Advantages: lower required dosage, reduced toxicity, release constant level of fluoride, better use of fluoride and better patient compliance.

– Clinical studies showed exposure to low levels of fluoride is more effective in decreasing the incidence of caries.

– Fluoride and dental caries – Useful in children who tend to get caries

easily, xerostomia, adults with rampant root or coronal caries.

• Fluoride and dental caries • Fluoridated Milk

– Milk is used as an instrument for fluoride administration.

– Fluoridated milk was found to be as effective as fluoridated water in reducing dental caries.

– Fluoride and dental caries • Fluoridated Salt

– Use salt as a vehicle for fluoride in the diet.– Salt is about 2/3 as effective as the water.– Mechanisms of anticaries action of fluoride

1. Increase in the enamel’s resistance to acid solubility− Enamel formed has more perfect and

larger crystals, less soluble in acid, and less likely to develop caries.

Fluoride favors formation of fluorapatite, a more acid – resistant apatite than hydroxyapatite.

− Mechanisms of anticaries action of fluoride 2. Remineralization

− Greater concentration of fluoride released from the dissolved enamel or already present on the plaque, the more will remineralization be favored and carious process be slowed.

− Use of topical fluoride raises the fluoride level of tooth surface and underlying tissues to a level expected to protect against caries.

− Mechanisms of anticaries action of fluoride 3. Antibacterial effects of fluoride

− Inhibition of enzymes essential to cell metabolism and growth.

− Lower the surface energy of the tooth.− Can strip off bacteria from hydroxyapatite.

Fluoride can bind more effectively to positively charged areas on the apatite crystal than can the bacteria.

• Dental benefits • Fluorosis of the deciduous teeth is rarely seen and is

not a problem.• First 2 to 3 years of life are the most critical period for

the development of mottled enamel on the permanent anterior teeth and for this reason only.

– 0.25 mg/day is prescribed from birth until 2 years of age.

• Dental benefits – 0.5 mg/day from 2 to 3 years of age.– 1.0 mg/day from 3 until 13 years of age.

• Use of fluoridated water or fluoride supplements as early as 1 year of age enhance the formation of the relatively caries – resistant fluorapatite in the enamel surface.

Thank you J

CHAPTER 10

The Macrominerals:Calcium, Phosphorusand Magnesium

Their Role in the Health of the Body and Especialy the Oral Cavity

Calcium

Functions Provides rigidity and strength to the bones and teeth Functions (cont…) Serum calcium performs specific functions:

Contraction and relaxation of heart muscle. Helps in blood clotting Low blood calcium will increase the irritability of

nervous tissue and may cause tetany. Activate enzymes such as pancreatic lipase and

alkaline phosphatase. Activates rennin which causes curding of milk

during its digestion Necessary for the release of NTs

(neurotransmitters) Regulates transport of ions across cell

membranes Absorption Active process Reqiures Vitamin D and calcium-binding protein 20-30% of calcium is absorbed and the rest are

excreted in the feces, urine and perspiration. Factors affecting absorption of Calcium 1. Needs of the body

Growing child, pregnant, a person healing from a bone fracture- increased calcium absorption

2. Gastric acidity Acidity in the stomach converts the

insoluble calcium salts into more soluble types

3. Hormonal influences Parathormone and cacitonin

Vitamin D Deficiency in Vit. D- decreased calcium

absorption4) Lactose

The disaccharide lactose found in milk promotes calcium absorption.

Lactose in ileum change the intestinal bacteria lowering the pH thus increase calcium absorption

6) Citric acid6) Its low pH promotes calcium

absorption7) Oxalic and phytic acid8) Intake of foods rich in oxalic

such as spinach and phytic acids found in cereal grain and meal flour causes formation of insoluble complexes (calcium salts) within intestinal lumen that leads to increased calcium absorption.

7) Fat6) Decreased fat, bile or salts

produces insoluble calcium thus increase calcium absorption.

7) Emotional reactions8) Stress may cause hormonal

changes that affects calcium metabolism

11) Exercise Weight-bearing exercise helps

maintain calcium in bone. Storage calcium and phosphorus are stored in the trabeculae

but can be withdrawn out when it is needed in the blood

The blood and tissue calcium serve as reserves The degree of bone development amount of calcium

deposited in are directly related to the amount of the calcium available from the diet.

Excretion Out of the 100og dietary intake of calcium, 700 – 800g

are excreted in feces but it could be less than that when the dietary intake is low.

During lactation, mother loses 150 -300mg of calcium daily but normally, it is not affected because of human adaptability.

Excess calcium from the bone are excreted in the urine

Unimportant daily lost of 15mg of calcium through perspiration

Regulation of calcium balance Calcium in serum is regulated by the:

Parathormone (PTH) Calcitonin

-serum calcium rises, PTH is inhibited

-serum calcium falls, secretion of PTH increases

-serum calcium rises, calcitonin increases

Role of Bone, Kidney, and Intestine Kidney can resorb calcium Intestine - acidity

Bone – activity of the osteoblast and osteoclast. How?

Vitamin D Necessary for normal intestinal absorption

of calcium and helps maintain bone cells, thus regulating serum calcium and serum phosphate levels.

Recommended Dietary Allowance and Sources Avrage adult- 800mg Infants- 360-450mg 1-10 yrs.old – 800mg 11-18 yrs.old- 1200mg During lactation- 1200mg *all daily Sources Cheddar cheese – highest level of calcium Best sources are hard cheese, milk, and dark green

leafy vegetables (the darker the green, the more calcium),

Good sources are ice cream, blackstrap molasses, broccoli, baked beans, dried legumes, and dried figs.

Fair sources are cottage cheese, string breans, parsnips, lima beans lettuce and other sald greens, eggs and bread.

Calcium supplements Calcium carbonate or oyster shell calcium is

frequently recommended for persons who cannot eat dairy products.

When children refuse to drink milk, it should be incorporated either in fluid or powder form in soups, gravies, casseroles, or baked goods.

Macromolecule: Magnesium Should be provided in the foods that we eat every day Third most abundant mineral in teethOne of the major cations in plant & animal tissueEssential ion (enzymatic reactions & protein synthesis)Found mostly in bones and muscles, cell types and body fluidsHuman body = 20 to 35 mg of MgEssential constituent of bone & soft tissuesFunctions: Regulate body’s nerves &musclesPlays a role in protein synthesisActivator of numerous coenzymes (carboxylase and co-A)Helps in catalyzing the transport of phosphate groupsBinds mRNAImportant in synthesis & degradation of DNACritical for normal metabolism& function of the organismAbsorption & Excretion 1/3 is absorbed and utilized in the bodyHigh intake of other macromolecule (Ca, P, lactose) will interfere with Mg absorption Stored in bone---little excretion through the intestineMg is lost via urine &fecesMaintenance of the normal level of Mg in the blood depends on a balance between absorption and renal excretion of sodium.Magnesium Deficiency Conditions: Chronic malabsoprtion syndromeAcute diarrheaChronic renal failure Chronic alcoholism Symptoms: Hyperexcitability Behavioral disturbancesWeakness

Depression TremorsConvulsionsChronic Renal Failure: Definition: Slow loss of kidney function over time Signs & Symptoms: Appetite lossNauseaHeadacheWeight loss Chronic Alcoholism Definition: Primary disease with genetic, psychosocial, and environmental factors influencing its development and manifestations Signs & Symptoms: Neglecting responsibilities due to drinkingTolerance (over time, one needs more and more alcohol to feel the same effects): 1st major warning sign of alcoholismWithdrawal (body is used to alcohol and experiences withdrawal symptoms if it’s taken away): 2nd major warning sign of alcoholismAnxietyDepressionIrritability and so on. Acute Diarrhea Definition: Abrupt onset of abnormally high fluid content in the stool Signs & Symptoms: Watery stoolAbdominal painFever dehydration Chronic malabsorption syndrome Definition: Alteration in the ability of the intestine to absorb nutrients adequately into the bloodstream Signs & Symptoms: DiarrheaBloatingFlatulenceWeight losscramping Hypomagnesemia Definition: Low levels of Magnesium in the bloodOften leads to hypocalcemia (inhibition of parathyroid hormone; does not resolve until the magnesium deficiency has been corrected) Signs & Symptoms: Muscle WeaknessConvulsionsFatigueSources Mustard greensWhole grainsNutsSoybeansGreen leafy veggiesDietary allowance Male: 350 mg Females: 300 mg Thank you and have a good day. J

Toxicity Hypercalcemia (excess calcium in the blood)

Hypercalcinuria (excess calcium in the urine) Kidney stones (result in high levels of calcium in the

serum and urine calcification of soft tissues) Hyperparathyroidism PHOSPHORUS One of the most essential elements of the body Available in all foods of plant and animal origin Second most abundant mineral in body, after calcium >600 g of phosphorus in the normal human body, 80-

90% combined with calcium to form bones and teeth Absorption and Metabolism Dietary phosphorus intake : 1.5 g/day Phosphorus balance is regulated by the metabolic

and hormonal factors vitamin D, calcitonin, parathyroid hormone

Amount of phosphorus in the body is controlled by excretion in the urine rather than by absorption

Function Major functions:

-formation of bone and tooth mineral-production and transfer of high-energy phosphates

Plays a role in absorption and transport of nutrients Regulates the acid-base balances Plays an important role in cell protein synthesis (part

of the nucleic acids DNA and RNA, the substances that control heredity)

Buffers in blood and tissue (chemicals that prevent change in the concentration of other chemicals)

Attachment of phosphate to the matrix of bone and teeth is one of the initial steps in their mineralization

Failure of bone calcification results from a lack of phosphorus as often as from a lack of calcium

Increase in serum alkaline phosphatase is associated with poor bone calcification as seen in rickets (vitamin D deficency disease resulting in bone deformities) and osteomalacia (softening of the bone in adults)

Recommended Dietary Allowances and Sources Intakes of 800 to 1200 mg of phosphorus daily are

recommended Animal foods rich in protein are also rich in

phosphorus (meat, fish, poultry, eggs and milk) Nuts, legumes and whole-grain cereals are also good

sources of phosphorus* Excess dietary phosphorus in animals will increase bone loss and bone porosity (significantly decrease bone mineral and cause calcification of the kidney, tendons, heart and thoracic aorta)

Osteoporosis A condition in which the rate of bone resorption is

greater than the rate of bone formation, resulting in decreased bone density and a reduction in the total bone mass

Caused by deficiencies of calcium and estrogen hormone

Osteomalacia Abnormal bone calcification Due to:

- deficiency of Vitamin D, Calcium and phosphates Results in:

- excessive uncalcified osteiod -Abnormal bone mineral composition

Clinical Manifestations:-weakness-aching

Treatment

-dietary calcium and vitamin D Osteoporosis

Abnormal organic matrix formation Due to:

-deficiencies of calcium and estrogen Results in:

-decreased ossification (forming activity)-mineral composition of bone remains normal

Clinical Manifestations:-hip and back pain-decreased height-tendency to bone fracture

Treatment-estrogens, protein, calcium, vitamin D and fluoride

FACTORS INDICATE GREATER RISK OF OSTEOPOROSIS Heredity Smoking Alcohol Coffee(5 or more cups daily) Low calcium intake Certain levels of hormones, PTH, calcitonin, estrogen,

androgen, insulin, growth hormone, throid hormones, protein

Drugs like phenytoin (anticonvulsant) and phenobarbital

Clinical diagnosis Osteoporosis occurs most commonly in older people,

>60 age Osteoporotic individuals tends to have a lower intake

and a higher urinary excretion of calcium than normal persobs

Loss of height because of shortening of the trunk and collapsed of the vertebrae

Therapy Ingestion of high calcium diets , estrogen, fluoride,

calcitonin, PTH, active form of vitamin D Estrogen and diet: reduces vertebral, hip and forearm

fractures Fluoride: large doses of fluoride can stimulate bone

formation Calcitonin: can increase bone mass PTH increases with age, also found to increase bone

mass

CHAPTER 11

• FLUORIDE AND THEIR ROLE IN DENTAL CARIES PREVENTION

• Fluoride • Compound form of fluorine.

– A trace element, halogen.– Very reactive gas.– Not found in free elemental form in

nature.• Major source is from water – artesian wells.• Found in soils rich in fluorspar, cryolite, and other

minerals.• Fluoride • Also found in plants, food, and human – calcified

structures (teeth and skeleton).• Nutrient beneficial to dental health. • Dietary sources - drinking water • Waterborne fluorides are the most important source

of flouride for humans.• Modern diets as a source of flouride.

– Use of fluoridated water in preparation of processed foods and beverages.

• For temperate climates– Optimal fluoride level: 1 ppm of fluoride.

• Dietary sources - drinking water • For infants and young children

– Intake of 2 – 4 glasses of water: 0.5 – 1 mg of fluoride.

• For older children, adolescents and adults– Intake of 6 – 8 glasses of water: 1.5 – 2 mg

of fluoride.• Ingestion of fluoride greater than optimal levels in

drinking water (2 ppm) cause fluorosis.– Dietary sources - foods

• Fluoride in foods by adults– Nonfluoridated communities: 1 mg/day.– Fluoridated communities: 2 – 3 mg/day.

• Not known to be a significant factor in fluorosis (mottled enamel).

• Small amounts: fruits, vegetables, cereals.• Rich amounts: seafoods and tea leaves.

– Dietary sources - foods • Metabolism - absorption • Major site of absorption: stomach.• Studies with animals suggest intestinal absorption

also occurs.• Soluble fluoride in drinking water is completely

absorbed, whereas 50 – 80% of the fluoride in foods is absorbed.

• Metabolism - Distribution • Teeth and skeleton have the highest concentrations

of fluoride.– Due to the affinity of fluoride to calcium.– Cementum, bone, dentin, and enamel.

• Fluoride content of teeth increases rapidly during early mineralization periods and continues to increase with age, but at a slower rate.

• Metabolism - Distribution • Found in both extracellular and intracellular fluids of

soft tissues but at very low concentrations.• Found in saliva, 0.01 ppm.

– Play a part in maintenance of fluoride concentrations in the outer layer of tooth enamel.

• Metabolism - Excretion • Principal route of excretion is urine (90 – 95%).• Remaining 5 – 10% in the feces.• Outstanding characteristic of fluoride excretion is its

speed.– Reabsorption of fluoride from urine is less

efficient. Effective mechanisms for

maintaining low concentrations of fluoride in the soft tissues and plasma.

Metabolism - Excretion Directly related to the degree of

active bone growth. Fluoride excretion is lower

when a child is growing rapidly and is actively depositing bone material than in adults with a mature bone structure and fully mineralized teeth.

• About half of the ingested fluoride is excreted in the urine each day.

• Metabolism - storage • Deposited in calcified structures.• Skeletons of older persons contain more fluoride than

those of younger ones.– Amount of fluoride in bone gradually

increases with age – greatest during active growth years.

• Metabolism - storage • Factors that attract fluoride to bones:

– Presence of an active growth area at the ends of long bones.

– Small size of the bone crystals.– Close contact between bones and the

blood supply • Metabolism - storage • Deposited in the enamel through diffusion.

– Carious enamel may take up 10 times more fluoride than adjacent healthy enamel to inhibit expansion of carious lesion.

• Dentin may contain even more fluoride.– Chemically similar to bone– Highest concentration found adjacent to

pulp: close to blood supply. • Relative safety • Low and moderate intake results to:

– Skeletal fluorosis– Mottled enamel– Osteosclerosis (hardening of bone)– Exostoses (bony projections)– Calcification of ligaments

• High intake may result to death.– Mottled enamel (Endemic Dental Fluoride)

• White or brown spotty staining of tooth enamel.– May be due to food, debris, or plaque.

• Sometimes will have horizontal striations.• Enamel is deficient in:

– Number of cells producing enamel causes pitting (hypoplasia).

– Hypocalcification causes chalkiness.• Mottled enamel (Endemic Dental Fluoride) • Occurs only in teeth that are being formed.

– When exposed to high concentrations of fluoride, opaque spots will develop on the enamel.

• High intake of fluoride results to mottled enamel.– Protection of fluoride is decreased by

severe fluorosis.• Mottled enamel (Endemic Dental Fluoride) • Fluoride and dental caries • Communal Water Fluoridation

– Most effective, practical, feasible and economical public health measure for preventing caries.

– Greatest resistance to caries and greatest amount of fluoride deposition are acquired by starting the intake as early as possible and using it continuously.

• Fluoride and dental caries – Other factors to the decline of caries:

1. Greater dental health awareness.

2. Expansion in dental resources.3. Application of preventive

dentistry.– Fluoride and dental caries

• School Water Fluoridation

– Fluoridated with levels of three to seven times the optimum for communal water fluoridation resulting to reduction in caries incidence.

• Fluoride and dental caries • Fluoride Tablets

– Ingestion daily beginning at 5 – 9 years: permanent teeth can still be significantly protected from caries.

• Fluoride and dental caries – Lozenge is much preferred than tablets or

drops.1. Dissolves slowly, produces both

topical and systemic effects.– Advantage: specific and precise dosage– Disadvantage: assurance of continuous

daily ingestion and cost is greater.1. Fluoride and dental caries

• Prenatal Fluoride Supplement– Fluorides supplements are not

recommended for adults, especially pregnant women, for reducing dental caries.

1. The concentration of fluoride that reaches the fetus is generally lower than that in the maternal blood.

2. Infants exposed will have higher plasma, skeletal and developing enamel fluoride levels.

• Fluoride and dental caries • Fluoride Supplements (Infants and Children)

– Fluoride supplementation at birth gives some protection against caries to the deciduous teeth.

– No fluoride supplements must be given to infants less than 6 months of age ( exception of infants consuming milk)

• Fluoride and dental caries • Fluoride Rinses

– 3 years is necessary to achieve the maximum benefit from a rinse program.

– Effective in children with a higher caries baseline than low caries baseline.

1. The lower the incidence of caries, the more limited the effect of each preventive measure.

– Fluoride and dental caries • Sustained Release Delivery Systems

– Advantages: lower required dosage, reduced toxicity, release constant level of fluoride, better use of fluoride and better patient compliance.

– Clinical studies showed exposure to low levels of fluoride is more effective in decreasing the incidence of caries.

– Fluoride and dental caries – Useful in children who tend to get caries

easily, xerostomia, adults with rampant root or coronal caries.

• Fluoride and dental caries • Fluoridated Milk

– Milk is used as an instrument for fluoride administration.

– Fluoridated milk was found to be as effective as fluoridated water in reducing dental caries.

– Fluoride and dental caries • Fluoridated Salt

– Use salt as a vehicle for fluoride in the diet.– Salt is about 2/3 as effective as the water.– Mechanisms of anticaries action of fluoride

1. Increase in the enamel’s resistance to acid solubility− Enamel formed has more perfect and

larger crystals, less soluble in acid, and less likely to develop caries.

Fluoride favors formation of fluorapatite, a more acid – resistant apatite than hydroxyapatite.

− Mechanisms of anticaries action of fluoride 2. Remineralization

− Greater concentration of fluoride released from the dissolved enamel or already present on the plaque, the more will remineralization be favored and carious process be slowed.

− Use of topical fluoride raises the fluoride level of tooth surface and underlying tissues to a level expected to protect against caries.

− Mechanisms of anticaries action of fluoride 3. Antibacterial effects of fluoride

− Inhibition of enzymes essential to cell metabolism and growth.

− Lower the surface energy of the tooth.− Can strip off bacteria from hydroxyapatite.

Fluoride can bind more effectively to positively charged areas on the apatite crystal than can the bacteria.

• Dental benefits • Fluorosis of the deciduous teeth is rarely seen and is

not a problem.• First 2 to 3 years of life are the most critical period for

the development of mottled enamel on the permanent anterior teeth and for this reason only.

– 0.25 mg/day is prescribed from birth until 2 years of age.

• Dental benefits – 0.5 mg/day from 2 to 3 years of age.– 1.0 mg/day from 3 until 13 years of age.

• Use of fluoridated water or fluoride supplements as early as 1 year of age enhance the formation of the relatively caries – resistant fluorapatite in the enamel surface.

Thank you J

CHAPTER 12 Trace Minerals Other Than Fluorides Essential Trace Minerals Essential Trace Minerals Trace elements or micro-minerals Inorganic nutrients required by humans in very small

amountsfrom micrograms (o.oo1 mg) to no more than a few mg - less than 100 mg/day

Essential for humans with vital functions to avoid a deficiency disease.

Mn, Mo, Se, Cr, Co – human enzymatic actions

Fe, I, Zn – recommended daily allowances Cu, F – estimated safe ranges and adequate intake Trace Elements: Modes of Action Act as catalysts either as

Metallo-enzymes the trace element is an integral

part of the enzyme molecule Fe, Zn, Mo Cu – firmly bound and

incorporated in the protein molecule of the enzyme tyrosinase

Metal-enzymes the metal ion is loosely

associated with the enzymes Arginase

Functions as constituents and activators of hormones Iodine: found in thyroid hormones Chromium: insulin activator Cobalt: acts as a structural center of vit.B12

Dietary Sources & Classification Good sources

Meat Fish Natural plant foods

Grains Beans Fruits Vegetables

Consumption of processed foods REDUCES the intake of essential micronutrients, unless these foods are fortified to conc’ns at least equal to those naturally occurring in the product.

2 categories: Those that have well-defined human

requirements – Fe, Zn, I, Cu, F Those that are integral constituents or

activators of enzymes – Mn, Mo, Se, Cr, Co Iron Iron One of the most important minerals in nutrition Involved in oxygen transport and cellular respiration (in

hemoglobin) Serves as an oxygen reserve in muscles metabolism (in

myoglobin) Total quantity ofironin the body averages about 4g,

consisting of two major fractions: 70% essential body iron

hemoglobin, myoglobin, and intracellular enzymes such as cytochrome

30% mobilizable iron reserves ferritin&hemosiderin

Physiological Functions Absorption Transport Absorption Humans have difficulty in efficient iron absorption. Only 7-10% of iron in cereals and vegetables 10-30% in animal protein and soybeans Iron is absorbed in the reduced ferrous state (divalent)

in the upper portion of the small intestine Ascorbic acid, citric acid, and amino acids

convert the less absorbable ferric (trivalent) iron present in foodsèmore phosphoric absorbable ferrous form

If phytates (a salt of phosphoric acid ester) present in bran or food phosphates are ingested in excess, the absorption of iron can be impaired.

Absorption The Ferrous iron is initially taken up by the brush

border of the intestinal wall, where it is passed into the intestinal mucosal cells.

In the mucosal cells, it can be either bound to: Transferrin

an iron-binding protein for transport of iron in blood

And absorbed into the bloodstream or combined with another protein:

Apoferritin This protein complex is known as ferritin (the storage

form of iron), which remains within the cells and is released as needed.

Control of iron absorption depends on the amount of iron deposited as ferritin in the mucosal cells

Absorption 2 most important factors determining the regulation of

iron absorption: The state of iron stores in the body The state of RBC formation in the bone

marrow Absorption is increased in conditions that decrease

body iron during growth or pregnancy when new

RBCs are being produced during anemia resulting from hemorrhage

Transport Transferrin

special carrier protein in the plasma designed for binding and transporting iron.

attach to the immature RBC and rapidly pass iron to them.

attaches to the liver cells and more slowly transfers iron to them

responsible for recycling iron and transporting it to the bone marrow by production of new RBCs

The normal plasma iron concentration= 100 µg per 100 mL

The total iron-binding capacity (TIBC) of transferrin = 330 µg/per 100 L

Transport A drop in the saturation of transferrin below 10-15%

indicates iron deficiency anemia After 120 days, RBCs are destroyed by

reticuloendothelial cells (large phagocytic cell) and the released iron is taken up by the transferrin molecules.

Iron and Storage Overload Ferritin

storage form of excess iron in the liver cells as when it is deposited there among all cells of the body

also found in the cells of spleen and bone marrow

Hemosiderin an insoluble storage form of iron in the

body as when the amount of of iron in the liver, spleen, and bone marrow EXCEEDS the capacity of the cells to form ferritin.

Hemochromatosis

occurs when there is excessive levels of hemosiderin or iron overload.

characterized by excess deposition of iron in the tissues, especially in the liver, and by skin pigmentation

Iron and Storage Overload Common causes of Hemochromatosis:

Numerous transfusions in patients with hemolytic anemia (separation of hemoglobin from red blood cells) anemias

Excessive iron intake from food cooked in iron vessels

Drinking excessive amounts of cheap wines Failure of the body to regulate absorption,

as in alcoholics on low-protein diets and in patients with hereditary hemochromatosis

Recommended Dietary Allowances Iron intake usually tends to be inadequate in the infant

and child during the first 2 years. The recommended dietary allowance (RDA)=10-15

mg/day Males

11-18 yrs. old: 18 mg daily 19 and older: 10 mg daily

Females At childbearing age: 18 mg daily After menopause: 10 mg

The amount of iron expected from a normal diet is about 6 mg/1000 kcal

Only 10% of iron from is food is absorbed, as this approx. replaces the 1 mg/day lost physiologically in a normal adult

Food Sources 3 forms of iron in food

Heme Nonheme Additive iron

Enriched white bread, rolls, and crackers are a major source of iron.

The amount of iron to be absorbed from the food depends or on the bodily need for iron.

The greater the need, the greater the absorption Heme form of iron in hemoglobin and in myoglobin that is

absorbed intact found in organ meats (liver, heart, kidney, spleen), red

meats, veal, pork, poultry, fish, oysters, and clams, but not milk or milk products

About 40% of iron in meat and fish is heme iron although only 1/3 can be absorbed by the body

Nonheme Accounts for the other 60% of iron in animal protein

and all the iron in molasses, fruits (figs, dates), green veggies, dried beans, nuts, and grain products (wheat germ)

Only 2-10% can be absorbed by the body Additive iron found in both enriched and fortified products Iron Deficiency Anemia Occurs due to inadequate intake or excessive loss of

iron or both. Characterized by the production of small RBCs that are

deficient in hemoglobin. The most common type of nutritional anemia

It leads to loss of efficiency and impaired general health

Occurrences and Causes Occurs most frequently in infants and children due to

undergoing rapid growth and having rapid RBC formation

Occurs in pregnant women due to the increasing demand of the growing fetus on the mother’s body iron

In adult males and postmenopausal women –pathological blood loss

In premenopausal women – menstruational blood loss Bizarre food habits (avoidance of meat and vegetables) Inadequate intake among the elderly due to poverty Vomiting, diarrhea, and intestinal hypermotility

increases iron loss. Clinical Manifestations Slow development; takes for months or years Anemia

Characterized by weakness, fatigue, pallor, and numbness and tingling of the extremities

Epithelial changes – early manifestations Nail changes; dullness, brittleness Fingernails may be flat instead of convex;

spoon-shaped appearance with longitudinal ridges (koilonychia)

Hair growth may be altered Dysphagia (difficulty in swallowing) in severe cases Clinical manifestations: oral area Glossitis

Inflammation of the tongue Fissures (clefts or grooves) at the corners of the mouth The papillae of tongue are atrophied, giving a smooth,

shiny, red appearance to the tongue The clinical appearance of the tongue in iron deficiency

resembles that in vit.B complex deficiency Oral mucous membranes may be atrophied and ashen

gray More susceptible to carcinoma (cancer arising from

epithelial cells) Plummer-Vinson syndrome

Combination of dysphagia, koilonychia, angular stomatitis, and atrophic glossitis

THERAPY Administration of 200 mg of ferrous sulfate tablets 3x a

day (after each meal) as prescribed by a physician Treatment should be continued for approximately 2

months after the hemoglobin level has returned to normal.

ZINC Zinc Approx. 2-3 g of zinc in human body Is concentrated in the eyes, liver, bones, prostate,

prostatic secretions, and hair In blood, 85% in RBCs, but each WBC has about 25x

than each RBC. Functions An integral part of at least 70 enzymes that belong to

metallo-enzymes Active component of carbonic anhydrase

Essential for the transport of CO2 to the lungs

Other enzymes with zinc content Alcohol dehydrogenase Lactate dehydrogenase

Activates enzymes (carboxypeptidase and aminopeptidase) that function in the digestion of proteins

Is part of alkaline phosphatase − bone metabolism Added to insulin to prolong the hypoglycemic effect It plays an essential role in RNA, DNA, and protein

synthesis Functions Essential for wound healing, tissue growth, and

prevention of dwarfism, production of hormones. Zinc inadequacy may play an important role in the

reduced immune response in protein-calorie malnutrition

Used in the treatment of sickle-cell disease Assist in restoring a missing sense of taste in some

cases Important for thymic hormone activity since its

removal reduces hormone functions Recommended Dietary Allowance RDI: 15 mg a day During pregnancy and lactation: 20-25 mg/day Infant at 6 mos. old: 3 mg/day 6 mos.-1 yr.: 5 mg/day 1-10 yrs.: 10 mg/day

*These are relatively high values when considered in proportion to the amount of food eaten.

Food Sources Protein rich foods such as meat and fish Oysters and herring as highest zinc content per ounce Milk --- total dietary zinc intake

**Grains contain dietary fiber and phytic acid, that can bind zinc, inhibiting its absorption, but when used in making bread with yeast, it inactivates the phytates and the body now obtains more of the zinc.

Deficiencies Causes

Poor diet Excessive alcohol intake Liver disease Chronic kidney disease Genetic disorders

Acrodermatitisenteropathica A sever

gastrointestinal and cutaneous disease

May intensify the anemia of sickle-cell disease

Deficiencies Clinical Manifestations

Retardation of both growth and sexual development

Poor appetite Slow healing of wounds Loss of sense of taste Progressive pustular dermatitis of the

extremities, mouth, anus, and genital areas Emotional irritability Tremors Loss of coordination In pregnancy

Abnormal taste sensations Prolonged gestation Protracted labor Increased risks to the fetus

Supplementation

Consuming excessive amounts of zinc may increase the risk of cardiovascular disease due to:

Low HDL High LDL

Common zinc level in popular vitamin/mineral preparations is 15 mg (safe)

Clinical Application Zinc sulfate supplements can decrease wound healing

time significantly Zinc peroxide powder when used topically on acute

gingival lesions in acute necrotizing gingivitis, the soreness disappears soon enough and the mouth restores to its normal healthy condition

SELENIUM Selenium Essential component of the enzyme that catalyzes

oxidation of glutathione which protects red blood cells through destruction of hydrogen peroxide protecting hemoglobin from oxidative damage

Extremely effective in reducing the prevalence of keshan disease, which is characterized by abnormalities in the heart muscle.

Estimated safe and recommended daily intake of selenium for adults is 0.05 to 0.2mg while for infants, children and adolescents is somewhat less.

MOLYBDENUM Molybdenum Part of the molecular structure of two enzymes:

Xanthineoxidase and Aldehydeoxidase, Xanthineoxidase is responsible for the conversion of xanthine to uric acid.

Daily intake is 0.15 to 0.5mg CHROMIUM Chromium Trivalent chromium is the biologically active form of

chromium Required for the maintenance of normal glucose and

energy metabolism May act as cofactor in insulin and stimulates synthesis

of fatty acids and cholesterol in the liver Daily intake is 0.05 to 0.2mg COPPER Copper Functions :1. Aids in synthesis of hemoglobin in the bone marrow2. Form and maintain compounds having enzymatic

activity3. Influence the central nervous system physiology4. Aids in formation of pigments 5. Component of enzyme necessary for the oxidation of

the amino acid tyrosine and vitamin C6. May also have a role in the maintenance of the myelin

sheath around the nerve tissue Copper Deficiency : 1. Copper deficiency seen in australian lambs called

“swayback disease” characterized by demyelination and degeneration of motor nerves in CNS, its prevented by giving copper supplements to ewes(female sheep) during pregnancy.

2. Found by clinicians that combined administration of copper and iron is more effective in treating hypochromic anemia than the administration of iron alone

Copper Effects of excess :

Accumulation of excess copper in body tissues, probably because of genetic absence of liver enzyme is called Wilson’s disease, characterized by neurological degeneration and cirrhotic liver changes.

Reduction of dietary copper may be useful in treating this disease.

Also be arrested by giving chelating agents like penicillamine to mobilize copper from tissues and promote excretion in the urine.

Copper Excess copper concentrations found in human saliva

appear to inhibit acid production, although there is nothing conclusive to this theory.

Daily intake is 2 to 3mg COBALT Cobalt Part of the vitamin B₁₂ molecule May also be involved in the metabolism of sulfur

containing amino acids Inadequacies of cobalt will cause anemia Essential for adequate nutrition of sheep and cattle,

deficiency will cause extreme emaciation and wasting. High dose of cobalt stimulates the bone marrow to

produce excessive numbers of red cells(polycythemia) and higher than normal hemoglobin level

MANGANESE Manganese Functions :1. needed for normal bone structure2. For reproduction3. Normal functioning of CNS4. Important catalyst and component of many enzymes in

body, Enzymes involved in the synthesis of carbohydrates, those necessary for the protection of cells from high levels of oxygen and enzymes necessary for mucopolysaccharide synthesis

Manganese Effects of deficiency and excess : 1. Manganese deficiency produces skeletal abnormalities

in animals2. Excesses can produce profound neurological

disturbances similar to those of Parkinson’s disease Manganese Average adult estimated safe and adequate daily

dietary intake appears to be between 2.5 to 5mg IODINE Iodine One of the first trace elements recognized essential for

normal health Integral part of the hormones thyroxine and

triiodothyronine, functions to maintain the control of the energy metabolism of the body.

Most important in synthesis of thyroid hormone is the ability of the thyroid gland to trap and oxidize iodine molecules into free iodine.

Effects of Imbalance Hypothyroidism Goiter, Thyroid gland enlargement Develops swelling in the front of neck in the area of

hyoid bone Iodine deficiency Potassium iodide in small doses may completely

eliminate goiter Current level of enrichment furnishes 76 mg of iodine

per g of salt

Hypothyroidism Cretinism and Myxedema are pathological conditions

resulting from low thyroid activity Treatment is administration of thyroid hormone until

euthyroid(normal) state is achieved If it affects a fetus prior to birth, cretinism develops Hyperthyroidism Excessive activity of thyroid gland brought by

deficiency of iodine producing an enlarged excretory gland as a result of hyperplasia of the cells lining the follicles along with increased colloidal material

Produces hypermetabolic rate(increase pulse rate, temperature and blood pressure, extreme nervousness, irritability, increased sweating, dyspnea, weight loss and tiredness)

Patients with diffuse primary thyroid hyperplasia may develop exopthalmos(abnormal protrusion of the eyeball)

Oral Effects of Imbalance In severe hypothyroidism, jaws are small and rate of

tooth eruption is retarded Hyperthyroid patients conceivably develop caries

rapidly due to their increased need for calories and possible use of excessive sugars

Effects on development of dental caries Mineral Elements That May Inhibit or Promote Caries 5 Categories of Elements accdg. to their Cariogenicity

(by Navia)1. Caries-promoting: Selenium, Magnesium,

Cadmium, Platinum, Lead, Silicon2. Mildly cariostatic: Molybdenum, Strontium,

Calcium, Boron, Lithium, Gold3. With doubtful effect on caries: Beryllium,

Cobalt, Manganese, Tin, Zinc, Bromine, Iodine

4. Caries-inert: Barium, Aluminum, Nickel, Iron, Palladium, Titanium

5. Strongly cariostatic: Fluorine, Phosphorus Possible Mechanism of Trace Elements Action on

Dental Caries By altering the resistance of the tooth by modifying the

local environment at the plaque-tooth enamel interface

By altering the size of enamel crystals available to acid exposure; influencing enamel solubility

Smaller crystals have a greater surface area (more exposed to acid solubility) than larger crystals in enamel rods of similar size

By influencing the microbial ecology of plaque to either inhibit or promote the growth of caries-producing bacteria

CHAPTER 13

Food Composition,Preparation,Processing,Preservation, Fabrication, and Labeling

Food Composition Food

an edible substance made up of a variety of nutrients that nourish the body

Two Categories:a. Plantb. Animal

Plant Foods

where the food eaten by human beings,including meat, originates

Basic requirement for human survival Three very good reasons why to increase intake of

plant foods:› 1. more readily available› 2. more economical› 3. more healthful

Cereals Derived from the seed of grasses Important cereal grains:

› Corn› Wheat› Rice› Barley› Rye› Oats

Corn or maize,first grown by American Indians most truly American cereal

› Sweet corn Developed by hybrid breeding High quality and suitable for

human consumption› Yellow corn

rich in carotene (provitamin A), zein ( an incomplete protein of low biological value), and starch

Wheat is grown in temperate climates of countries contains gluten (a highly nutritious protein)

Rice Principal cereal food commodity of Asians Grown in moist tropical or semitropical climates

› Bran of the rice removed by polishing or milling

to make the rich kernel more palatable,lowered nutrional value of rice

rich in thiamin(can be preserved only if the unhusked rice is parboiled)

Barley Hardy plant and is the oldest known cereal Used in soups and as flour for infants who may be

allergic to wheat Used as malt and as food for livestock

Rye Grown in cold northern climates Used in making rye bread

Oats Eaten mostly in the form of cooked oatmeal,contain

slightly more protein,Ca,and fat than any other cooked cereal

Used mainly as food for livestock Legumes pods, the seed case of peas,beans, or lentils Have almost twice as much protein than cereal grains used as meat substitute

› Dried peas 22% protein because of their

low moisture content› Fresh peas or cooked dried ones

6% to 8% protein Average serving of legumes= 1/3 as much protein as

an average serving of meat

An incomplete protein unless combined with at least complementary protein such as corn or rice

Peanut Not a true nut but a beanlike legume,rich in oils and

protein 1 pound of peanut provides more protein(but

incomplete) than a pound steak,more carbohydrate than a pound of potatoes,approximately as much fat as pound of butter

Double virtue1. high in food value2. have long shelf-lifeSoybean

Most important legume Dry,whole bean contains 40% protein and 20% fat Soy can be used as a flour in bread or as a breakfast

food Fruits Edible,more or less succulent,products of seed-

bearing plants› Fleshy fruits

Have numbers of seeds in the center of their pulp such as apples and pears

› Stone fruits Contain a single

stone or pit such as peaches,cherries, and apricots

Fruit-vegetables› Known as vegetables but really are fruits

such as tomatoes,peppers,okra,squash, and avocadoes

Fruits like banana,fig,coconut,date and breadfruit Are staple articles of food for

people of the tropics• Apple is the most popular fruit and next to it are the

citrus fruits—oranges, lemons,limes and grapefruit Fruits are good sources for:

› Vitamin C› Cellulose

Decreases the time of passage of waste products through the large intestine

› Pectin Assists in formation of jelly

› Fructose and glucose Citrus fruits and peaches yield an alkaline ash(fully

oxidized in the body) Plums and cranberries yield an acid ash( used in

conjunction with a low-calcium dieatary regimen to create a urinary environment less conducive to formation of kidney stones

Vegetables May be any part of the plant, the leaf stalk,leaves or

the roots. Greatest part of it is water, therefore it is sensitive to

weather changes and tend to spoil quickly› Vitamins most commonly found in

vegetables Ascorbic acid,B complex

vitamins,provitamin A› Minerals most commonly found in

vegetables Calcium and Iron

Potatoes

› tubers(plant’s swollen underground root stems)

› Contain 75% to 80% water and yield 70 to 90kcal/100g,most of which is from starch

Sugars Derived from the Persian word “shakar”,which was

derived from a Sanskrit word meaning small grains or pebbles

Used as a food preservative in ancient times Manufactured by plants from water and air by

photosynthesis Extra supply of sugar in plants is converted into starch

and stored for future use (e.g. potato),converted into fats and oils (e.g. nuts) or converted into protein (e.g. beans)

Sucrose found on extracts from sugar cane,sugar beets,sorghum and sugar maples

Oils Found in fruits and seed of plants such as poppy and

sunflower seeds,soybeans,corn,cotton,peanuts, coconuts, and olives

› Corn oil and Safflower oil Good sources of unsaturated

fatty acids(desirable in reducing elevated serum cholesterol levels)

› Peanut Oil Used for shortening

Food odor source such as in onion Animal Products Best source of protein of high biological value Meat and Milling Meat Animal product Composed of:

› Muscle› Connective tissue› Fat

Important source of energy Meat Rich in:

› Phosphorus› Niacin› Riboflavin

*Red meat à source of iron*Pork à rich in thiamine

Organ meat› Significant nutritional value› Liver

More vitamins and iron Feeds Doesn’t increase the amount of nutrients in the meat

produced Prevent deficiencies Improve food conversion efficiency

› Lower cost production Processed meat Fresh à other form

› Curing, smoking, seasoning, cooking, or any combination of these processes

Limited amounts of cereal, soybeans products and milk products

› Improve the binding qualities Cooking

Preserve product Enhance flavour and texture Convenience of item Concentrates the content of:

› Protein› Minerals› Vitamins

Reduces fat Milling, or Refining of Cereals whole grain products, like whole wheat

› Poor keeping qualities Subject to infestation Decay rapidly due to action of

bacteria Kernel of wheat Bran layer

› Fibrous outer husks Cellulose and hemi cellulose

Aleurone layer› Some protein, niacin, iron› Outer layer of endosperm

Endosperm› Inner portion

Starch and some proteins Germ

› Found at one end of a kernel› B complex vitamins, iron, and vitamin E› Refining

Makes white wheat flour Bran, aleurone, and germ are removed

› To prevent rancidity› Prolong storage time

Since the three parts/layers are lost, the law is requiring that white wheat flour is to be added with:

› Thiamin › Riboflavin› Niacin› Iron

Refining Refined wheat flour

› Composed of: 70 – 80% starch 7.5 – 14% protein

Product of Flour One loaf of bread contains:

› 40% thiamine› 20% niacin› 15% riboflavin› 25% iron

*recommended dietary allowance Refining of sweeteners Honey,raw sugar,brown sugar and white sugar are

practically the same nutritionally. pasteurization Heating raw milk 60 c in order to destroy any

pathogenic microorganisms that maybe present.Canning -uses heat processing time based on microbial deathFreezing -principle behind use of refrigeration. Low temperature=slows growth of microorganismsDehydration

-removal of most of all waterex: powdered milk,condense milk dried fruits

Advantages and disadvantages of preservation

Advantages such as increased storage time,decreased home preparation time,ensure food safety and enhanced overall product and edibility

Disadvantages such as destruction of some nutrients,increases cost,decreased taste appeals for some person

Formulated foods Mixtures of two or more foodstuffs other than

seasoning Ex: liquid meals Prepared breakfast Snack foods Guidelines of quality of formulated foods They must contribute 5% or more of any

recommended nutrient requirement Should contain nutrients similar to those they

resemble Caloric content should be determined by intended

use Food labeling Food labeling program designed by FDA is to provide

nutrition informationIngredient labeling

all food labels must have the basic info: legal names of products Net weight including packaging medium such as

water in canned vegetables Name and location of the manufacturer Ingredients listed on descending order by weight

Nutrition labeling Number of servings,number of calories followed by

amount of protein,carbohydrate and fat per serving. Eight indicator nutrients: protein,vit. A,C,

thiamin,riboflavin,niacin,calcium and iron. Other vitamins and minerals are optional. USDRA United states recommended daily allowances-

represents the amount of nutrients needed every day by healthy people plus a 30%-50% excess to allow for individual variations.

Recommended Daily Intake (RDI) 3 categories of USDRA

› Used for conventional food: adults and children 4 or more years of age

› Used for special dietary foods: infants uder 4 years of age and pregnant or lactating women

CHAPTER 14:

Recommended Dietary Allowances; Food Groups; Dietary Goals

Part 1By DE LEON, JANINE KRISTEL M.

Recommended Dietary Allowance Since 1943, the Food and Nutrition Board, a group of

nutrition scientists, has published at approximately 5-year intervals revised and updated editions of the Recommended Dietary Allowances

RDA – set of values for levels of intake of nutrients currently considered essential which should meet the physiological needs of nearly all individuals

Designed for planning and procuring nutritionally adequate food supplies for population groups rather than for individuals

RDA serves as basis for:1. Food guides2. Development of diets and products for

therapeutic uses3. Formulation of new food products4. Guide for foods provided by community

resources for nutrition Application of the RDA Used for planning menus with feeding large groups of

people The RDAs are not considered absolute requirements

and should be regarded as flexible recommendations because the specific amounts recommended by the Food and Nutrition Board are purely judgemental. There is a “minimum risk level” that is above the actual need of practically every one in the group.

Used as rough guides Final evaluations of nutritional status must be

considered by the condition of the person not by the calculated nutrient intake

Limitations of the RDA RDAs are

◦ Acceptable levels of intake for population groups

◦ Goals at which to aim when providing for the nutritional needs or assessing the nutritional status of groups

◦ Allowances and estimates of nutrients that should meet the needs of nearly all healthy individuals within a group

◦ In excess of nutrient requirements except for energy needs, and they ensure growth and maintenance of health of most people

RDAs are not◦ Intended for evaluation of the nutritional

status of an individual◦ Recommendations for an ideal diet◦ Average requirements◦ Adequate to cover the special needs of

such problem as inherited metabolic disorders, infections, chronic diseases and traumas

Food Group Guides Purpose The food group guides serve as a practical and

workable plan for helping the homemaker select the kinds and amounts of food that need to be included in each day’s meal to provide a balanced diet.

Nutrient Contributions to diets of Adults-refer to table ah ah ah~!

The Daily Food Guides The USDA Daily Food Guide divides commonly eaten

foods into five groups according to their respective contributions:

◦ Vegetable-fruit◦ Bread-cereal◦ Milk-cheese◦ Meat, poultry, fish and beans◦ Fats, sweets and alcohol

Vegetable-Fruit Group Contribute to Vitamins A and C and fiber as well Vitamin A - dark green and deep yellow vegetables

(carrots than corn, spinach than celery)

Apricots, broccoli, cantaloupe, carrots, chard, collards, cress, kale mangoes, persimmons, pumpin, spinach, sweet potatoes, turnip greens and winter squash

Most dark green vegetables, if not overcooked, are also reliable source of Vitamin C as well as riboflavin, folacin, iron and magnesium

Certain greens – collards, kale, mustard greens, turnips and dandelions – provide calcium

Sources of Vitamin A (from carotenes in Plants Best 1 raw or 1/3 cup cooked carrots ½ cup cooked greens ½ cup winter squash ½ medium sweet potato ½ medium cantaloupe About Half as much* ½ cup broccoli ½ cup pumpkin 3 raw apricots 1 wedge (4x8 inch) watermelon Sources of Vitamin C Best 1 medium orange ½ cup orange juice ½ medium grapefriut ½ cup grapefruit juice ½ cantaloupe 2/3 cup fresh strawberries ½ cup broccoli About half as much 1 medium tomato ½ to 2/3 cup tomato juice 1 medium tangerine 1 wedge (4x8 inch) watermelon ¼ raw pepper 1 medium to large potato ½ cup cooked asparagus ½ cup cooked kale or other greends ½ cup coleslaw

Recommended Dietary Allowances; Food Groups; Dietary Goals REPORTED BY IRENE GISELLE ONG

BREAD-CEREAL GROUP à Most economical source of nutrientsà Includes: wheat, rye, rice, oats, corn, barleyà Contain substantial amounts of B VITAMINS and IRONà Major source of PROTEIN for vegetariansà Contribute: MAGNESIUM, FOLACIN, FIBERà CEREAL

May be related to the progression of dental caries due to the pre-sweetening process

à Recommended average serving: 4 servingsà Counted as one serving are:

a. 1 oz. ready-to-eat cerealb. ½ to ¾ c of cooked cereal/corn meals/macaroni

noodles/spaghetti/ricec. one slice of bread

MILK-CHEESE GROUP MILKà Provide: ⅔ of calcium, ½ of riboflavin, and ¼ of protein (in foods normally eaten)àLow in VITAMIN C and IRONà Types of milk:

Non-fat milk Less expensive than fresh milk Contain lesser FATS and VITAMIN A Can be compensated by consuming fortified

margarine Evaporated milk

Whole milk from which more than half the water has been removed by evaporation

Cheaper than cream and has more calcium and protein content

FERMENTED MILK Buttermilk

Equal to skim milk in food value Costs less than regular milk

Yogurt Equivalent to whole milk Can be a substitute for people with lactose

intolerance No special health values greater than whole

milk Condensed milk

Prepared by adding about 42% sugar to the milk before the water is evaporated

CHEESE à The curd (solid) of milk separated from whey (liquid) by coagulationà Contains PROTEIN, CALCIUM, and RIBOFLAVINà Types:

CHEDDAR CHEESE: whole milk cheese product that has been cured (preserved by salting)

PROCESSED CHEESE: pasteurized and made by blending different cheeses and adding emulsifiers

COTTAGE CHEESE: made from pasteurized skim milk and provides high quality protein

CREAM CHEESE: made from whole milk added with cream and contains high percentage of fat and vitamin A but less protein compared to cottage cheese

MILK-CHEESE GROUP à Cheese-milk equivalent

1 in cube cheddar cheese ⅔ cups milk ½ cups cottage cheese ⅓ cups milk½ cups ice cream ¼ cups milk

à Average serving: 8 oz of milk or 1 in cube of cheddar cheeseà Daily consumption of different age groups:

Children and adolescents 3 to 4 cups Adults 2 cups Women over age 50 (prone to osteoporosis)

3 to 4 cups

MEAT, POULTRY, FISH, AND BEANS GROUP à Valued for PROTEIN, PHOSPHOROUS, NIACIN, VITAMIN B₁₂, and IRONà Most expensive items in the dietà Organ meats (liver, kidney, heart) has high nutritional value* NOTE! Expensive cuts do not equate to higher nutritional content* NOTE! Only foods of animal origin provide VITAMIN B₁₂ MEAT, POULTRY, AND FISHà Has little difference in protein and iron content among beef, veal, lamb, and porkà Pork has higher thiamin content.à Fish, poultry, and eggs: complete protein foods +can be used as meat equivalents

BEANS GROUPà Economicalà Does not contain complete proteinà To compensate, they are usually eaten with other vegetablesà Dishes that incorporate this: chile con karne, pea soup with ham, frankfurters with beansà Nuts can also be included for variety.MEAT, POULTRY, FISH, AND BEANS GROUP à VARIETY IS A MUST due to distinct nutritional advantages:

Red meats + oysters: good sources of ZINC Liver + egg yolks: sources of VITAMIN A Dry beans, peas, soybeans, nuts: sources of

MAGNESIUM Fish + poultry: low in SATURATED FAT Sunflower + sesame seeds: contribute

POLYUNSATURATED FATTY ACIDS \ Organ meats + egg yolks: high in CHOLESTEROL Fish and shellfish (except shrimp): low in

CHOLESTEROLà Recommended average serving: 2 or more servingsà 1 serving: 3 to 4 oz of lean, cooked meat, poultry, or fish filletà 1 oz of meat equivalent: ½ to ¾ cups cooked dried beans, dry peas, soybeans, or lentilsà Two eggs are equivalent to about 3 oz of meat

FATS, SWEETS, AND ALCOHOL GROUP à Provides mostly caloriesà Includes:

Vegetable oils: supply VITAMIN E and essential fatty acids

Margarine + butter: provide VITAMIN A 2 to 4 tbsps. of polyunsaturated oil daily are

recommended.à In general, these foods provide practically no essential nutrients such as vitamin, minerals, and protein.à Because of this, no serving sizes are defined.

LIMITATIONS OF THE FOOD GROUP GUIDE à Oversimplifiedà Overgeneralized à Does not meet the high amounts of iron required by pregnant, lactating, and premenopausal womenà Cannot classify the ready-to-eat processed and fabricated food (ie. soft drinks) into a food groupà Junk foods, like potato chips, can’t be classified into a food group because processing already destroyed the vitamins.à Combinations of foods, such as pizza and casseroles, make group classification difficult.

THE DIETARY GOALS à Established due to the concern about the contribution of dietary practices to the relatively high incidence of obesity, diabetes, dental caries, atherosclerosis, coronary disease, and hypertensionà Purpose: to provide guidelines for the proper amounts of macronutrients in the diet THE DIETARY GOALS AND CHANGES IN FOOD SELECTION

1. Increase consumption of fruits and vegetables and whole grains.

2. Decrease consumption of refined and other processed sugars and foods high in such sugars.

3. Decrease consumption of foods high in total fat, and partially replace saturated fats with polyunsaturated fats.

4. Reduce consumption of animal fat and favor veal and poultry to reduce saturated fat intake.

5. Substitute low-fat and nonfat milk for whole milk and use other low-fat dairy products (except for children).

6. Decrease consumption of butterfat, eggs, and other sources of cholesterol .

*take into consideration the age for #67. Reduce consumption of salt and foods high in salt

contentà IN SUMMARY:

Eat a variety of foods. Avoid consuming too much fat, saturated fat, and

cholesterol by consuming more skim milk, poultry, and fish.

Eat foods with adequate starch and fiber. Eat a minimum to moderate amount of sugars. Eat a minimum to moderate amount of sodium. Consume alcohol only in moderation. Achieve and maintain ideal weight.

CHAPTER 15 Chapter 15 (part 1)

Health Foods and Additivesandrea laura o. de los santosdba

Health Foods Possess health-giving, curative properties beyond

their ordinary nutritive action. Organically-grown foods foods grown without the use of any manufactured

agricultural chemicals and fertilizers (insecticides, pesticides, herbicides, antibiotics, hormones)

processed without the use of food chemicals or additives(synthetic sweeteners, preservatives, dyes, emulsifiers, stabilizers)

Natural foods Food in their original state.

Raw fruits Vegetables

*with minimal refinement and processing Food Additives Substances that are combined with food to

1.prevent growth of microbes or spoilage2.improve nutrient quality3.enchance texture, flavor, color, and odor.

Used to keep food safe and edible. Chemical and Microbial Inhibitors Sodium Chloride (NaCl) and Sucrose Oldest and most used microbial inhibitors

* Why? -they absorb water, and make food less available for chemical reactions and microbial growth.

Citric acid, acetic acid, phosphoric acid They lower the pH of food to an acid state in which

organisms cannot grow. Other growth microbial growth inhibitors Calcium propionate

Added to bread Sorbic acid

Added to beverages Antioxidants Added to foods to reduce spoilage Natural food component

examples:

*sprinkling vitamin C powder on sliced apples and potatoes

(this will prevent browning through action of enzymes.)

Synthetic Antioxidants Added to polyunsaturated acids to prevent formation

of toxic substances Examples:

BHT (butylated hydroxytoluene) BHA (butylated hydroxyanisole)

Other antioxidants Metal chelating agents

Bind trace metals and prevent them from catalyzing the oxidation of lipids.

examples:○ EDTA ○ Citric acid

3 processes used for improving nutrient quality of food

1. Restoration2. Enrichment 3. Fortification Restoration Selected nutrients are added to a food to restore

nutrients lost through processing Example:

Adding vitamin C to sterilize fruit juice Enrichment Nutrients are added to a food to conform to

standards established for certain nutrients. Example:

Iron Niacin Thiamin Riboflavin Calcium Vitamin D

(added to flour or bread) Fortification Selected nutrients not normally present in that

particular food is added. Example:

Vitamin D in milk Vitamin A in margarine Agents Essential for food Processing

Agents Essential for Food processing 1. Leaving agents (yeast, baking powder)

-cause bake foods to rise2. Emulsifiers (lecithin)

-keep oil- or fat-containing ingredients mixed with water base

-give bake foods a light texture

Agents Essential for Food processing 3. Thickeners (gelatin)

-give foods a smooth thick texture-prevent ice crystal formation in frozen foods such as

ice cream4.Humectants

-prevent foods such as marshmallows from absorbing water

Agents Essential for Food processing 5. Artificial flavors and colors

-impart the expected flavor and color to a food (margarine is colored yellow to resemble butter)6.Foaming agents

-cause bubbles in such beverages as instant hot chocolate mix

Unacceptable and Questionably safe additives 1. Diethylstilbestrol (DES)

-synthetic growth hormone that was used in animal feeds, has been removed

2. FDC red dye #2 -coloring agent used in lipstick and beverages -has been under study for mutagenic effects but

permits have been granted for its use at lower levels * FDC red dye # 3-used in plaque disclosing tablets is acceptable

3. Violet dye # 1-used for stamping the grades of meat into beef

carcasses , is suspected of being carcinogenic. If exposure is so low it is not considered a significant risk

Unacceptable and Questionably safe additives 4. Synthetic sweeteners ( cyclamates and saccharin)

-still being used but are periodically being assessed regarding their safety.5. Monosodium glutamate (MSG)

-it’s a flavor enhancer-shown to cause tissue damage to the brain in mature

rats -has been removed to baby food

Chapter 15 (part2)Food Facts and Fallacies

Pastor,Rydni B. Dairy products Cow’s milk

Fallacy: any milk other than cow’s milk is desirable. Goat’s milk is nutritious and is recommended

Fact: goats are not susceptible to tuberculosis. Pasteurization makes the cow’s milk safe by killing the tuberculosis germ.

Dairy products Yogurt-is fermented whole milk eveporated to 2/3 of

its original volume Fallacy:yogurt is nutritionally superior to

milk Fact: yogurt has the same nutritive value

as whole milk. It provides a source of milk in other forms

Dairy products Milk and cheese

Fallacy: these are constipating Fact: milk and cheese are easily digested

and leave a little residue. (constipation may occur when the diet lacks food that contain bulk)

Dairy products Pasteurized milk

Fallacy: it is “dead milk” Fact: pasteurization does not alter the

nutritional value of milk except to reduce the Vitamin C content slightly.(milk is a poor source of Vitamin C)

Pasteurization destroys bacteria that can cause undulant fever and tuberculosis

Bread and Cereal Products Fallacy: Gluten,protein bread and dark bread are less

fattening than white bread

Fact: breads vary little in caloric ocntent. Thus one bread is not superior to another in the standpoint of weight loss

Bread and Cereal Products Fallacy: white bread and white flour are unfit for

human consumption because all of the vitamins and minerals have been removed and the bleaching process is poisonous

Fact: almost all commercial white breads and white flours are restored and enriched (according to law) with niacin, iron, thiamine and riboflavin.

Chlorine Dioxide is a harmless compound that is used to bleach flour.

Meat, Fish, and Eggs Fallacy: eggs with brown shells are more nutritive

than white shell eggs Fact: the color of the shell is determined by the breed

of the hen and it does not indicate the nutritive value of the egg

Meat, Fish, and Eggs Fallacy:the characteristics of the type of meat are

transmitted by consumption Fact: this is not true Meat, Fish, and Eggs Fallacy: meat that is raw or cooked rare is more

nourishing than well-done meat Fact: proteins are not damaged by cooking.

Cooking protects the individual from bacterial infections and disease e.g. trichinosis

Meat, Fish, and Eggs Fallacy: fish is brain food Fact: The brain contains phosphorus and fish is a rich

source of this mineral. The reasoning is invalid.

Vegetables Fallacy: drink your vegetables Fact: vegetable juice make excellent contribution to

the diet but do not contain the bulk necessary to the diet

Vegetables Fallacy:

Tomatoes clear the brain Onions will cure the cold Lettuce is soothing to the nerves

Fact: there is no scientific evidence to substantiate his claims

Sugars Fallacy: blackstrap molasses cures practically every

affliction,from restoring color to gray hair to restoring youth

Fact: it contains small amounts of calcium(from the limewater used in processing), iron(comes from the contact with the factory machinery) and B complex vitamins

Condiments Fallacy:spices and condiments have the power to

prevent disease Fact: the belief that diseases originated in foul-

smelling air may have led to the conclusion that pungent smell can ward of disease

Condiments Fallacy:spicy foods have the reputation for being

cooling and for that reason are eaten in tropical countries

Fact: hot weather and a natural increase in water intake cause appetites to lag. Spices tend to stimulate a desire for food.

Water Fallacy: drinking water with meals dilute the gastric

juice and interfere with digestion Fact:water stimulates the flow of digestive juice Water Fallacy: large amounts of water are said to thin the

blood Fact: there is no evidence for this Water Fallacy: drinking water will increase weight Fact: water drunk in excess of body needs to be

eliminated Lecithin Fallacy: Lecithin removes fat deposits Fact: There is no good evidence to indicate that

lecithin lowers serum cholesterol levels or that it has a role in the treatment of coronary heart disease

Megavitamin Therapy Use of megadoses of vitamins for improvement of

health is based on the concept that if a little is good,more must be better(which is not true)

Use of megadoses of vitamins for conditions other than acute vitamin deficiency is not scientifically sound

Excessive doses of vitamins may have pharmaceutical or toxic effect or both

Megavitamin Therapy Only two groups of disorders are corrected or

alleviated by large doses of specific vitamins: Malabsorption syndrome Some inborn errors of metabolism

Megavitamin Therapy Justifications for megadoses of vitamins:

Providing optimal health Individual variability

e.g.pregnant women*large doses of Vitamins A and D,which can be stored are actually toxic when they accumulate

Megavitamin Therapy Megadoses of Vitamin C

There is no evidence that Vitamin C can kill cold-carrying virus.There is some preliminary evidence that Vitamin C may have antihistamic effects(some people will have reduced symptoms if they take vitamin C)

Can cause: acidic urine with accompanying

burning sensations on urination Inaccurate glucose tests in

diabetes Can cause kidney

problems(overproduction of oxalate can result in formation of oxalate stones)

*RDD=60 mg for an adult Megavitamin Therapy Megadoses of Vitamin E

Vitamin E acts as an antioxidant vitamin E excess can induce the

development of ‘flu-like’ symptoms and may be toxic to some extent

Can cause an Interference with vitamin K activity(prolongation of coagulation time)

Vegetarianism Vegetarian

a person whose diet is composed predominantly of plant food

Abstains from the consumption of meat, fowl or fish but may eat eggs and dairy products

Different types of vegetarians include: Pure vegetarian (vegan)-

consumes only plant foods Lactovegetarian-eats dairy

products as well as plant foods Fruitarian-whose diet consists

chiefly of fruits Motives:

Health concerns Religious or philosophical belifs both

Risks of a Vegetarian Diet Caloric needs are difficult to meet (particularly in

children)because the diet is high in bulk. Diminished caloric intake would require increased

bodily use of protein (which may not be abundant in the diet) as an energy source

There may be low calcium,vitamin D and riboflavin intake especially for children.(a lactovegetarian diet is safe for children)

Zinc and vitamin B12 deficiency may develop because the best sources of both are animal products

May cause iron deficiency to infants, children, and pregnant women (those who have a great need for iron)

Benefits from a Vegetarian Diet Less likelihood of atonic constipation Lower incidence of artherosclerosis Reduced blood pressure Lower death rates from cancers of breast, intestines,

lungs, and mouth Low blood levels of cholesterol and triglycerides Health risks can be a voided when dietary planning is

based on: Milk group Protein group Fruit and vegetable group Bread and cereal group

*If more calories are necessary,the fifth group may be used prudently with the approal of your physician

Fats,sugars and alcohol

This is table AH Ah AHFrom chapter ano, um chapter 14

Food Group 10 to 25% of diet 25 to 50% of diet 50-75% of diet 75& or more of diet Milk Calories, Vitamin A, Thiamin Riboflavin

Protein Calcium

Meat Calories,Vitamin A (liver) Protein ,Thiamin , IronRiboflavin

Niacin

Fruits and Vegetables Calcium,Calories, Iron, Thiamin, Riboflavin, Niacin

Vitamin AAscorbic Acid

Bread Calories, Protein, Iron, Riboflavin, Niacin

Thiamin