预防医学英文版课件：2-fat,energy,vitamin and minerals

Lipid

fat/triglyceridesaturatedfattyacid

fattyacidLipidunsaturatedfattyacid

(MUFA,PUFA)lipoid:phospholipid,glucolipid,steroids,lipoproteins

Glycerin/GlycerolClassification[Triglycerides]ofhumanbodymainlydistributeamongabdomen,subcutaneoustissueandmuscularfiber.Saturationreferstothenumberofhydrogensafattyacidchainisholding.Function:Storeandprovideenergy:37.7kJ/g(9kcal/g)constitutebodytissue,andendocrine.supplyessentialfattyacid(EFA)promoteabsorptionoffat-solublevitaminPromoteappetiteandfoodsatiety[Essentialfattyacid,EFA]Definition:afattyacidrequiredinthedietbecausethebodycannotsynthesizeit.Twofattyacids:linoleicacid（亚油酸）

andalpha-linolenicacid（

-亚麻酸）Linoleicacidistheprimarymemberofagroupoffattyacidsnamedtheomega-6fattyacidfamily.AALinolenicacidistheprimarymemberoftheomega-3fattyacidfamily.DHA、EPAEFA缺乏：颈前、腋下出现皮肤干燥，鳞状脱屑发红及增厚等湿疹样改变该病例经EFA治疗2个月后，症状消退。SourcesandRNIplantoilandanimalfatsPlantoilandnut:PUFAAnimalfats:SFAandMUFAS:M:P=1：1：1RNI:adult20%~30%oftotalenergyEFA>3%oftotalenergy

cholesterol:<300mg/d食物脂肪含量%食物脂肪含量%花生39.2猪肉（瘦）28.8黄豆（干）18.4牛肉（腰）19.1葵花子51.1羊肉13.6核桃63.0兔肉0.9杏仁49.6鸡肉2.5松子63.3鸭肉7.5榛子49.7鹅肉11.2芝麻61.7大黄鱼0.8西瓜子49.9青鱼5.2鸡蛋11.6鸡蛋黄30.04.Energy

Unit:J,kJ,MJ;cal,kcal

1kcal=4.184kJ1kJ=0.239kcal

TheenergyexpenditureBasalMetabolism(BM)ThermicEffectofFood(TEF)orSpecificDynamicAction(SDA)ActivityBM:theenergyexpenditureneededtomaintenancebasiclifeactivity(themainenergyexpenditure,60%-70%)BMR:thebasalmetabolismenergyexpenditureofeachm2bodysurfaceinanhour.Unit:KJ/(m2.h)FactorsinfluencingBM:Surfaceareaofbody,leanbodymassPhysiologicandpathologicalstatusSexEnvironmentalfactors

Specificdynamicaction(SDA)Thermiceffectoffood(TEF)Definition

Extraexpenditureofenergyresultedfromfoodintake.Energyproducedbyitself:protein30%carbohydrate5%~6%fat4%~5%Mixedfoods:10%ofBMActivity:themainfactorinfluencing

energyexpenditure,15%-30%strength,durationoflabor,physicalactivityClassificationLightlaborModeratelaborHeavylaborRNIandSources

Carbohydrate16.7kJ/gor4kcal/gFat37.7kJ/gor9kcal/gProtein16.7kJ/gor4kcal/gTheratioofenergy

Carbohydrate:55%~65%Fat:20%~30%Protein:10%~15%Definition

Organicdietarysubstances,notascarbohydrate,fat,orprotein,whichneitherproduceenergynorconstitutebodytissue,buttheyareusuallynecessaryinonlyverysmallquantitiestoperformaparticularmetabolicfunctionortopreventanassociateddeficientdisease.Itcannotbesynthesizedbythebodyandthereforemustbesuppliedbyfood.VitaminsDeficiency

primary:intakeinsufficiencysecondary:absorptiondecreaseorrequirementincreaseProcess:decreaseintissuestoragephysicalandbiochemistrychangeclinicalsymptomVitaminNamesFat-solublevitaminsWater-solublevitaminsVitaminAVitaminDVitaminEVitaminKBvitamins

Thiamin(B1)Riboflavin(B2)Niacin(B5)FolateVitaminB12VitaminB6BiotinPantothenicacidVitaminC

1.Fat-soluble

(1)VitaminA

alsocalledretinol(视黄醇)retinolretinalretinoicacid

视黄醇视黄醛视黄酸SourceAnimals：preformedvitaminAPlants：provitaminAVitaminA

β-Carotene

α-Carotene

γ-Carotene

β-cryptoxanthin(隐黄素)Totalretinolequivalent(μgRE)=

retinol(μg)+β-carotene(μg)×0.167(1/6)+otherprovitaminA×0.084(1/12)

PhysiologicalfunctionMaintenancethenormalvision.visualpurpleIncreasegrowthanddifferentiationofepithelialcells，maintenancethenormalstructureofskin.Reproductionfunction.Improvingimmunityfunction,increaseresistanceofinfectionandanti-carcinomaoflung(antioxidantactions).Promotethedevelopmentofbones.DeficiencyEye:darkadaptation↓,nightblindness.Injuryofconjunctiva,ulcerofcornea,eyedry,xerophthalmia,Bitot‘sspots(毕脱氏斑)Skin:dry,squamous（有鳞片的），Immunitydecrease:respiratorytractinfection,diarrheaSourcesandRNISourcesanimalfoodsliver,codliveroil,egg,milkandmilkproductsplantfoodsβ-carotene,greenandyellowvegetable,somefruits.RNIadultman:800ugREadultwoman:700ugRE(2)VitaminD

VitaminD2(ergocalciferol)麦角钙化醇

VitaminD3(cholecalciferol)胆钙化醇VitaminD25-OH-VD3

1,25-(OH)2-VD3LIVERKIDNEYFunction

IncreasingCaandPabsorptionandregulatingCaandPmetabolismDeficiency

children:ricketsadult:osteomalaciaosteoporosis方颅：以额骨和顶骨为中心向外隆起，使头部成方形改变，常见于7~8个月的佝偻儿郝氏沟：膈肌牵引软化肋骨，导致肋弓缘上部内陷，形成沟状肋骨骺部膨大，呈串珠样膝及踝肿大，两腿呈“O”形弓形腿膝及踝明显肿大，两腿弯曲呈“X”形RNIandsourcesRNIadult:5ug/d.childandoldman:10ug/d.Sourcescodliveroil,yolk,liver,fish.

(3)VitaminE(tocopherols）

FunctionAntioxidantactionspreventarteriosclerosis,anti-cancer,improvingimmunityfunction,delayaging.PromoteproteinsynthesizeRelatedwithreproduction-tocopherolsSourcesandRNIRNIAdult:14mg/dsourcesplantoil,nut,seeds,wheatgerm,legume2.water-solublevitamin(1)VitB1（thiamine）

FunctionMainlytakepartinenergymetabolismintheformofTPP

(thiaminepyrophosphate).(焦磷酸硫胺素)Otherforms:TMP,TDP,TTP.Maintainingthenormalfunctionofnerve,muscular,circulationsystem.

Carbohydrate,Fat,Protein

丙酮酸,酮戊二酸氧化脱羧(TPP是氧化脱羧酶的辅酶)

乙酰CoA,琥珀酰CoA

三羧酸循环

ATP磷酸戊糖通路中transketolation---转酮醇作用(TPP是转酮醇酶的辅酶)是核酸合成的戊糖及脂肪酸合成中的NADPH的重要来源Deficiency:

Beriberidryberiberi:neuritiswetberiberi:mixedberiberi:干性脚气病（dryberiberi）以多发性周围神经炎症状为主，出现上行性周围神经炎，表现为指（趾）端麻木、肌肉酸痛、压痛，尤以腓肠肌为甚。膝跳反射在发病初期亢进，后期减弱甚至消失。向上发展累及腿伸屈肌、手臂肌群，而出现垂足、垂腕症状。湿性脚气病（wetberiberi）多以水肿和心脏症状为主。由于心血管系统障碍，出现水肿，右心室可扩大，有心悸、气短、心动过速，如处理不及时，常致心力衰竭。混合型脚气病的特征是既有神经炎又有心力衰竭和水肿。RNIandsourcesRNIMale:1.4mg/d,Female:1.3mg/dSourcesanimalorgansuchasliver,kidney,brain,leanmeat,grain,legume,nut,yeast(2)VitB2（riboflavin）Function

Mainlytakepartinenergymetabolismintheformof

FMN(flavinmononucleotide)FAD(flavinadeninedinucleotide)Deficiency(oro-genitalsyndrome)Mouthangularstomatitis,cheilosis,glossitisEyecornealinflammationSkinseborrheicdermatitis（脂溢性皮炎）RNIandsources

RNIMale:1.4mg/d,Female:1.2mg/dSources

animalfoodssuchasliver,kidney,heart,egg,milk,legume,fish,greenvegetable(3)Vitaminpp(niacin)Function

Takepartinthemetabolismofnutrientsintheformof

CoⅠandCoⅡDeficiency:pellagra“threeD”symptomsdiarrhea(腹泻)dermatitis（皮炎）dementia（痴呆）(4)VitB6FunctionalformsPyridoxine,PN(吡哆醇)Pyridoxal,PL(吡哆醛)Pyridoxamine,PM(吡哆胺)FunctionAminoacidmetabolism.Glycogenandfattyacidmetabolism.Others.Deficiency

cheilosis,glossitisseborrheicdermatitis（

seborrheicdermatitis(脂溢性皮炎)

SourcesandRNISourcesmeat,vegetable,fruits,nutandcereals.AI

adult:1.2mg/d;pregnantandlactatingwoman:1.9mg/d(5)Folacin,FAAlso

calledpteroylglutamicacid,PGA.蝶酰谷氨酸

FA

THFA(活性形式)

terahydrofolate（四氢叶酸）

Deficiency

highhomocysteinemiaCongenitalmalformation(neuraltubedefects,NTDs)homocysteine

SourcesandRNISources:Liver,beans,nut,greenvegetableandfruits.RNI:Dietaryfolateequivalent(DFE)foradultis400μg/day.(6)VitaminC(ascorbicacid)

FunctionInvolveinthereactionofhydroxides,promotetheformationofcollagenFe3+→Fe2+,folicacid→tetrahydrofolicacidEnhancetheresistancetodiseasesAntioxidantactions.Acceleratethetoxintoexcrete

Deficiency:scurvySourcesandRNIFreshfruitandvegetable:orange，strawberryRNI:adult100mg/d

Classification

macroelements:＞0.01%bw

CaMgKNaPSCl

microelements:＜0.01%bw

FeZnISeCuMoCrNiFMnFunctionsTheconstituentsofthebodyRegulationTheconstituentsandactivatingfactorsofenzymesMinerals

1.Calcium

boneandteeth(99%)misciblecalciumpool(1%)Function

constituentsofboneandteethmaintainingnerve-muscleirritabilityactivityfactorsofenzymeskeepingacid-baseequilibriumFactorsinfluencingCaabsorptionIncreasingfactors

DecreasingfactorsvitaminD

phyticacidincerealsprotein

oxalicacidinvegetablelactose

fattyacidaciddrugs

dietaryfiberbodyneed↑

basicdrugs

bodyneed

↓

DeficiencyRickets:childrenOsteomalacia:adultsOsteoporosis:olderRNIandSourcesRNI:Adult:800mg/dChildren:1000mg/dSources:milkandmilkproductsdriedsmallshrimpssoybeanandsoybeanproducts2.Iron

Distribution:

4~5g,

Functionalironhemoglobin：60%-75%myoglobin：3%Enzymes:1%Storediron25%ferritin（铁蛋白）,hemosiderin（含铁血黄素）Functionoxygentransport.FormationandmaturingofRBCOthers:β-caroteneVA

FactorsinfluencingFeabsorption

bodyneed：caninfluenceHeme-FeandNon-HemeFeabsorption

HemeFe:existinanimalfoods,10%~30%

Non-HemeFe:existinbothanimalandplantfoods,<10%.

favourablefactors:

VitC,VitA,meatfactors,glucose,fructose,

aciddrugs

unfavourablefactors:

phyticacid,oxalicacid,Zn,Cu,

basicdrugs

DietaryironHeme(smallportion)Nonheme(largestportion)FoodsourcesAbsorptionrateNoneinplantsources;40%ofironinanimalsourceRapid;transportedandabsorbedintactAllplantsourcesofiron;60%ofironinanimalsourcesSlow;tightlyboundinorganicmoleculesCharacteristicsofhemeandnonhemeportionsofdietaryironDeficiencyStagesofanemiaIrondeficiencystore(ID):

Festored↓(serumferritin)Irondeficiencyerythropoiesis(IDE):serumferritin↓,serumFe↓,FEP↑Irondeficiencyanemia,IDAHb↓，anemiaRNIandsourc