Nutrition n diet

Presented By:

Vinay jain

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INTRODUCTION

DefinitionsBalanced dietFunction of foodCalories Need According To LifestyleRole of Nutrition in Periodontal Disease Effects of Nutrition on PeriodontiumNutritional Requirements of the Periodontal Patient

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DEFINITIONS

NUTRITION :are substances found in foods that provide energy and materials for cell development, growth, and repair.

NUTRIENTS : Molecules present in the food, which helps in the nourishment of the body

DIET : It is the food prescribed according to the requirement of the body.

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A balanced diet means getting the right types and amounts of foods and drinks to supply nutrition and energy for maintaining body cells, tissues, and organs, and for supporting normal growth and development.

Balanced

Diet

Balanced Diet

Contd…..

There are 6 kinds of nutrients in balanced diet

Proteins

Carbohydrates

Fats

Vitamins

Minerals

Water

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Proteins are large molecules that contain carbon, hydrogen, oxygen and nitrogen. They are made up of amino acids.

Amino acids are the building blocks of protein Essential amino acids cannot be made by the body’s cells, and must be supplied by the food you eat

Protein is used for growth and repair of body cells and helps to form muscle, skin and hair

Balanced Diet Contd…..

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Carbohydrates are the main source of energy in the body.

There are three types of carbohydrates: sugar, starch and fiber

Sugars are simple carbohydratesFound in table sugar, fruits, honey,

milk…Simple carbohydrates are digested and

absorbed quickly


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Starches and fiber are complex carbohydrates

Complex carbohydrates are absorbed more slowly; they help maintain healthy blood sugar levels facilitate steady, long-lasting bouts of energy.


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Starches are made up of many simple sugars in long chains

Pasta, potatoes, rice, white breads…


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Fiber is found in the cell walls of plant cells

Fiber cannot be digested. It is needed to keep your digestive system healthy

Fiber is found in whole grain breads and

cereals, beans, vegetable and fruits



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Fats or lipids are necessary nutrients because they provide energy and help your body absorb vitamins

Fat tissue cushions your internal organs

Fat is a storage unit for energy; it can release twice as much energy as carbs

Excess energy from all foods you eat is converted to fat and stored for later use.


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Unsaturated fats are liquid at room temperature

Vegetable oils, avocado, the fats in nuts and seeds


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Saturated fats are solid at room temperature

Animal products such as meat and milk are sources of saturated fat

Saturated fats are associated with high levels of cholesterol in the blood

Cholesterol can block blood supply to organs and increase blood pressure. This can lead to heart disease and stroke


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Vitamins are organic nutrients needed in small amounts for growth, regulating body functions, and preventing diseases.

Most foods provide some vitamins, but no one food has them all


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Minerals are inorganic nutrients that regulate chemical reactions in the body

Your body uses about 14 different minerals

The minerals used in largest amounts are calcium and phosphorus

Other minerals include potassium, iron, and sodium


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Water is the most important nutrient for survival

The human body as about 60 percent waterYour cells need water to carry out their functions.


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Your body loses water through breathing, sweat, and excretion

Water needs to be replaced every day

Water is not only found in liquids but also in many foods


Because no food has every nutrient, you need to eat a variety of foods to maintain optimum health.

A food group is a collection of foods that contain the same type of nutrient

There are five food groups:

Bread/cereal

Vegetables

Fruit

Dairy

Meat/beans


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FUNCTIONS OF FOOD

1. Energy-yielding

2. Body-building and

3. Protective function

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FUNCTIONS OF FOOD

Food provides energy to keep the body warm, themuscles active for work and play and the variousorgans alert to carry out the daily activities.

Food supplies body building nutrients needed forgrowth, while the fetus develops in the mother’swomb, new tissues are being continuously built.This proceeds right through infancy, childhood andadolescence. During these stages of life, there is atremendous demand for body building nutrientsthat are essential everyday to replace the daily‘wear and tear.’

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Protective function

Required in minute quantities.

Variety of these nutrients, eachresponsible for a specific task in the body.If the diet is deficient or lacking in one ormore of these vital substances, it leads toderangement of the normal functioning ofthe different parts of the body, resulting inill-health, stunted growth and imperfectdevelopment.

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Energy-yielding foodstuffs

Foodstuffs form the great bulk of the ordinarydiet.

They supply energy to keep the body warmand are hence known as ‘fuel-food.’

A few examples of energy-yielding foodstuffsare cereals starchy vegetables, pulses, nuts,sugars, and oils .

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Body-building foodstuffs

Contain a satisfactory amount of the nutrientsneeds to build the body and replace the worn-out tissues.

Milk and its products, meat, fish, and eggs arethe best representatives of this group offoodstuffs.

The other examples are dals, dried beans, peasand nuts.

Cereals also contain some body-buildingnutrients.

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Protective foodstuffs

Provide large number of the protectivesubstances needed by the body.

Almost all natural foodstuffs contain one ormore of these protective nutrients.

There is no single foodstuff in which all thedifferent protective substances are present inquantities sufficient to meet the daily needs ofthe body.

This is why a combination of different kinds offoodstuffs is essential in a diet.

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Contd…..

Best examples of this group of foodstuffs aregreen vegetables, fresh fruits, milk, meat, fish,and eggs.

Protective foodstuffs contain sufficientamounts of one or more of the protectivenutrients so that a combination of them yieldsenough to maintain life.

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Calories Need According To Lifestyle

• The number of calories you need to attain or maintain a desired weight would depend on your level of physical activities.

• If you are gaining weight over time this means that you should be exercising more and/or eating less.

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Basal or Resting Metabolic Rate measuresthe calories the body needs to keep it inbeing. 1654 calories per day is the numberof calories to keep the circulatory systemand other vital bodily functions inoperation.

Light Activity means you are engaged inactivities such as light house keeping. Tomaintain your current weight you couldconsume approx 2150 calories per day.

Moderate Activity means you walk a couplemiles per week on a regular basis. To maintainyour current weight you could consumeapprox 2480 calories per day.

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Heavy Activity means you run at least 10 milesa week. To maintain your current weight youcould consume approx 2811 calories per day.

Very Heavy Activity means you are training formarathons running at least 30 miles a week.To maintain your current weight you couldconsume approx 3307 calories per day.

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Nutritional mechanisms of inflammation

•Acute inflammation is protective but chronic and non-resolving inflammation is destructive .

•Oxidative stress is a key driver of chronic inflammation and as a result has a central role in the pathogenesis of a wide range of chronic inflammatory diseases (e.g. type 2 diabetes, cardiovascular disease and metabolic syndrome)

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In health a fine balance exists between, oxidants and on the other antioxidants which are found in all tissues of the body

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. If this fine balance is disturbed by excess production of oxidants and/or depletion of local antioxidants the resulting oxidant excess causes oxidative stress and is associated with the local tissue damage seen in periodontitis

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Oxidative stress cause direct tissue damage by altering molecules, such as proteins, lipids and DNA, thus damaging cells directly, or by activating redox-sensitive transcription factors within the cell that leads to downstream gene expression changes and production of pro-inflammatory molecules. (CYTOKINES)

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Foods rich in antioxidants may help reduce oxidative stress, for example green leafy vegetables (broccoli, spinach etc.), berries (e.g. blueberries, blackberries, cranberries, strawberries etc.), red beans, red wine, and dark chocolate with greater than 70% cocoa are all rich in key antioxidant micronutrients.

ANTIOXIDANT DIET

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Nutrition effects on the Periodontium

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Important in DNA and RNA replication, transcription of RNA and the translation of proteins necessary for new cell growth.

May be associated with changes in the connective tissue that result in altered wound healing.

Nutrient effects on the Periodontium

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Important in DNA and RNA replication, transcription of RNA and the translation of proteins necessary for new cell growth.

Antioxidant that impact the immune response.

Involved in collagen metabolism by affecting cell differentiation.

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Decrease in the rate of proliferation of epithelial cells.

Affect bone formation

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•Important in tissue maintenance and the production of new cells during development and healing.

Vitamin B deficiency :

•Breakdown of the mucosal barrier to pathogens.

•Loss of integrity of the oral mucosa “stomatitis, angular cheilitis and glossitis”.

•Inability to produce adequate energy.

•Affect protein synthesis including DNA and RNA

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Vitamin C :

Antioxidant that impact the immune response.Maintaining integrity of oral mucosa.

Affect bone formation.

Vitamin C deficiency :Scurvy “swollen & inflamed gingiva, loosening of the teeth, hemorrhage, weakness, malaise, sore joints, bruising and weight loss”.

Conditioning factor in the development of gingivitis.

Breakdown of the mucosal barrier to pathogens.

Affect neutrophill function.

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Regulate absorption of calcium.

Collagen synthesis and accumulation of mineralized bone are dependent on adequate levels of vit. D and calcium.

Stimulates osteoclasts to help mobilize the calcium stored in bone.

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•Antioxidant that impact the immune response.

•Improve cellular immune function.

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•Affect overall immune response.

•Affect antibody production

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Affect bone formation.

Involved in calcified tissue.

:Inadequate formation of peak bone mass.

Accelerated bone loss postmenopausally.Osteoporosis

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•Important participant in collagen metabolism and wound healing.•Essential for the cross-linking of both collagen and elastin.•Involved in calcified tissue.•Antioxidant that impact the immune response

: •Reduce tensile strength of collagen.•Bone fragility•Affect proliferation of neutrophils.

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•Important for optimum wound healing.

•Antioxidant that impact the immune response

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•Affect neutrophil phagocytic activity.

•Affect proliferation of lymphocytes

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The recommendations of the 2011 European workshop on Periodontologysuggest that the dental team should consider including advice to all patients on increasing levels of fish oils, fibre, fruit and vegetables and to reduce levels of refined sugars as part of a periodontal prevention/ treatment regime and a general health benefit message.

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Nutritional counselling for a patient with chronic periodontal disease

Step 1: Evaluate the diet and if necessary, demonstrate the A food intake evaluation chart is one in which all foods are classified into 4 food groups. 1. Vegetable fruit group.2. Bread cereal group.3. Milk cheese group.4. Meat, fish and beans group.

Step 2: Explain the nutrition periodontal relationship: The advise will be:1. Reducing sugar intake.

2. Replacing sweets and other empty calorie foods with nutritious, firm and fibrous foods that will stimulate and strengthen the periodontal tissues.

3. Selecting a well balanced, varied, adequate diet to provide all the essential nutrients and to support overall health in general and the health of tooth supporting structures in particular.

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Step 3: Assess nutritional status by taking a detailed medical history

Social and Diet histories:

Examine for clinical signs of malnutrition

Step 4: Prescribe a balanced diet.

Step 5: Follow up

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Diet Before Periodontal Surgery

When prescribing a diet before periodontal surgery, the goal is to enable the patient to meet the stress of surgery.

A well nourished state is optimal for wound healing

If the periodontal patient is malnourished, a diet high in protein and enough carbohydrates and fat to provide about 2,500 K cal should be prescribed for 7-14 days before surgery.

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Postoperative Dietary Management of Hospitalized Periodontal Surgery patient

During periodontal surgery under general anesthesia, intravenous levels of solution of 0.45% saline with 5% dextrose in water and 38.5 milliequivalents of sodium is given.

The intravenous infusion is terminated in the recovery room if the patient is in good health.

If the patient seems dehydrated, it may be wise to continue the infusion until the patient is fully reactive and can take fluids by mouth.

When fully recovered from the anesthesia, the patient should be given clear fluid as tolerated. In addition to water, beverages such as cola drinks, ginger ale, apple juice and orange juice .

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On the first post operative day, in addition to the beverages mentioned,

sherbets, custards and ice creams may be advised if the patient is hungry.

Cereal topped with sugar and milk, as well as, egg or chicken, pea or vegetable soup can be suggested.

On the second post operative the patient may supplement the diet with the

following: 1. Vegetable fruit group: Citrus fruits such as oranges and grapes are recommended

as are tomato and other fruit and vegetable juices. 2. Bread cereal group: Strained gruels can be given eg: wheat with milk. Period3. Milk group: Milk in all forms can be given such as ice -creams, milk shakes and

malted milks. 4. Meat group: Eggs in the form of eggnogs may be given in a liquid diet.

A full liquid diet that furnishes 2000 calories and 80 gm of proteins per day is recommended.

OBESITY

Defined as excess accumulation of body fat.

Has several adverse health effects and caneven lead to premature death.

It increases the risk of high blood pressure,high blood cholesterol and triglycerides, heartdisease, diabetes, gallstones and certaincancers.

Obesity is not a simple consequence ofovereating.

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Adult human may not normally regulate his dailyenergy intake to balance his daily energyexpenditure.

Overweight and obesity are due to positive energybalance.

Overeating and reduced physical activity togetherlead to obesity.

Genetic predisposition cannot be ruled out as acontributing factor.

Prevention and control of obesity are directly relatedto dietary management and physical activity.

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Obesity is based on the degree of excess fat.

Body Mass == Weight in Kilogram

Index Height in meters2

Normal (ideal) BMI ranges between 18.5 and 25.

An average BMI of a population should be 21 or22.

Less than 18.5 denotes chronic under-nutrition.

Between 25-30 considered as overweight.

Above 30 indicate obesity.

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HOW TO REDUCE BODY WEIGHT ?

Weight reduction diets should contain at least800 Kcal/day and provide all nutrientrequirement.

Loss of half a kilogram per week is generallyconsidered safe.

Extreme approaches should be avoided anduse of drugs may be dangerous.

In children, obesity should be controlled byincreasing physical activity rather thanrestricting food intake.

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Modifications in dietary habits have to beincorporated into one’s lifestyle along with adequateexercise to keep the body weight within the normallimits.

Refined sugars and alcohol provide empty caloriesand should be avoided.

Plant foods that provide complex carbohydrates andfiber may need preferred as they reduce bloodglucose, cholesterol, and triglycerides.

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Weight-reducing diets must be rich in proteinsand low in carbohydrates and fats.

Frequent fasting/semi-fasting followed byadequate or excess food consumption will alsoaggravate the problem of weight gain.

All reducing regimens should be monitored bya doctor and a dietitian.

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Slow and steady reduction in body weight is advised.

Severe fasting may lead to health hazards.

Enjoy a variety of foods in amounts needed tobalance your physical activity.

Eat small meals regularly at frequent intervals.

Cut down on sugar, fatty foods, and alcohol.

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BLOOD PRESSURE CLASSIFICATION

Systolic mmHg Diastolic mmHg

Normal <120 And <80

Pre Hypertension 120-139 Or 80-89

Hypertension Stage 1 140-159 Or 90-99

Hypertension Stage 2 ≥ 160 Or ≥ 100

Isolated Systolic Hypertension

>140 And <90

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HOW TO REDUCE HYPERTENSION ?

Sodium is the major electrolyte in theextracellular fluid.

Sodium plays an important role in nerveconduction and fluid balance in the body.

Sodium intake needs to be balanced bypotassium intake.

There is strong association between salt intakeand blood pressure.

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Prevalence of hypertension is low in populationsconsuming less than 3g salt per day.

The usual increase in BP with age is also not seen withsuch intakes.

Drastic restriction of dietary salt decreases the risk ofhypertension.

Potassium-rich foods such as fresh vegetables and fruitsdecrease blood pressure.

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Restrict intake of preserved and processed foodslike pickles, sauces, ketchup, salted biscuits, chips,cheese and fish.

Eat plenty of vegetables and fruits to provideadequate potassium.

Use always iodized salt.

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DIABETIC SAMPLE DIET

Divide the plate into ½ and the 2nd half into equal ¼.

Fill the 1st half with non starch vegetables like spinach,carrots,tomatoes.

The ¼ with meat/proteins like egg,fish,chicken.

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The remaining ¼ with rice,bread,potatoes,cereals.

1 serving of non fat sugar free yoghurt

or milk.

One serving of fruits like guava,

apple.

Contd..

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ADVANTAGES

Even carbohyrate distribution throughout the day.

Lowers carbohydrate intake

Contain more fibre,antioxidants,photochemicals and quality proteins

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DO’S AND DONTS

Eat food at fixed day hours

Have three proper meals & light snacks in between

The gaps between meals should be short

Drink a lot of water that will help flush the toxins off

Avoid fried foods and sweetmeats

Include fresh vegetable salad in every meal

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Contd…

Don't fry foods instead bake or boil

Eat less high-fat red meat and fish. Avoid organ meats

Limit the use of such as ketchup,- high in salt and sugar

Limit salt

Avoid ready to eat and junk foods

Don't skip meals and medicine

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SPECIAL FOOD FOR DIABETICS

BLACKBERRY- Contain glucoside

GARLIC- contain potassium,zinc &sulphur

ONION- Diuretic & Digestive property

FIBRES- Aids slow digestion & absorption of nutrition

CINNAMON SOLUTION- Promote glucose metabolism & reduce cholesterol

ANTIOXIDANT

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Protein-Energy Malnutrition

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• MALNUTRITION

WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.“Malnutrition is the condition that develops when the body does not get the right amount of the vitamins,minerals, and other nutrients it needs to maintain healthy tissues and organ function.

Definitions

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• PROTEIN ENERGY MALNUTRITION

It is a group of body depletion disorders which include kwashiorkor, marasmus and the intermediate stages

• MARASMUS

Represents simple starvation . The body adapts to a chronic state of insufficient caloric intake

• KWASHIORKOR

It is the body’s response to insufficient protein intake but usually sufficient calories for energy

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AETIOLOGY:Different combinations of many aetiological factors can lead to PEM in children. They are:

• Social and Economic Factors

• Biological factors

• Environmental factors

• Role of Free Radicals & Aflatoxin

• Age of the Host

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• Amongst the Social, Economic, Biological and Environmental Factors the common causes are:

Lack of breast feeding and giving diluted formula

Improper complementary feeding

Over crowding in family

Ignorance

Illiteracy

Lack of health education

Poverty

Infection

Familial disharmony

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The clinical presentation depends upon the type , severity and duration of the dietary deficiencies. The five forms of PEM are :

1. Kwashiorkor

2. Marasmic-kwashiorkor

3. Marasmus

4. Underweight child

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KWASHIORKOR

• The term kwashiorkor is taken from the Galanguage of Ghana and means "the sickness of the weaning”.

• Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM characterized primarily by protein deficiency.

• This condition usually appears at the age of about 12 months when breastfeeding is discontinued, but it can develop at any time during a child's formative years.

• It causes fluid retention (edema); dry, peeling skin; and hair discoloration.

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MARASMUS

• The term marasmus is derived from the Greek word marasmos, which means withering or wasting.

• Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency.

• Primarily caused by energy deficiency, marasmus is characterized by stunted growth and wasting of muscle and tissue.

• Marasmus usually develops between the ages of six months and one year in children who have been weaned from breast milk or who suffer from weakening conditions like chronic diarrhea.

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•A severely malnourished child with features of both marasmus and Kwashiorkor. •The features of Kwashiorkor are severe oedema of feet and legs and also hands, lower arms, abdomen and face. Also there is pale skin and hair, and the child is unhappy.• There are also signs of marasmus, wasting of the muscles of the upper arms, shoulders and chest so that you can see the ribs

MARASMIC-KWASHIORKOR

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•Children with sub-clinical PEM can be detected by their weight for age or weight for height, which are significantly below normal. They may have reduced plasma albumin. They are at risk for respiratory and gastric infections

UNDERWEIGHT CHILD

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TREATMENT

Treatment strategy can be divided into three stages.Resolving life threatening conditionsRestoring nutritional statusEnsuring nutritional rehabilitation.

There are three stages of treatment.

1. Hospital TreatmentThe following conditions should be corrected. Hypothermia, hypoglycemia, infection, dehydration, electrolyte imbalance, anaemia and other vitamin and mineral deficiencies.

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2. Dietary ManagementThe diet should be from locally available staple foods -inexpensive, easily digestible, evenly distributed throughout the day and increased number of feedings to increase the quantity of food.3. RehabilitationThe concept of nutritional rehabilitation is based on practical nutritional training for mothers in which they learn by feeding their children back to health under supervision and using local foods.

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•Promotion of breast feeding•Development of low cost weaning•Nutrition education and promotion of correct feeding practices•Family planning and spacing of births•Immunization•Food fortification•Early diagnosis and treatment

PREVENTION

Conclusion

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Conclusion

Usually, the role of diet and nutrition in the management gingival and periodontal disease is primarily that of prevention and maintenance. The benefits from good nutrition are important, especially with respect to increase in the capacity of periodontal tissues to:

1. Resist infection.2. Strengthen and maintain the epithelial barrier. 3. Promote the repair of damaged periodontal tissues.

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