Transcript Key Nutrients to Prevent Metabolic and Nervous System

Key Nutrients to Prevent Metabolic
and Nervous System Disorders
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Dr. Sukhinder K. Cheema, Ph.D.
Professor & Deputy Head
Department of Biochemistry & Faculty of Medicine
Memorial University, Canada
30 October,
2015
Biochemistry and Nutrition
• Biochemistry: the study of
chemical processes associated
with living organisms.
• Nutrition: the science that
studies the means by which
we intake and utilize food, and
how foods and nutrients
regulate biochemical
pathways.
• Food Science: the study of the
physical, biological, and chemical
makeup of food; and the concepts
underlying food processing.
Medical Oath
• I will practise my profession with
conscience and dignity.
• The health of my patient will be my first
consideration.
• …………
http://www.ima-india.org/
Leading Causes of Death: The Role of Diet
India and Heart Disease Issues
WHO,
WHO 2014
India May Have the Most Suicides
The U.N.’s health agency found that India accounted for more
than 258,000 of the 804,000 suicide deaths worldwide in 2012.
That’s more than in any other country.
The Wall Street Journal, India, Sep 2014
Learning Objectives
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Dietary fats in health
Vitamin D in health
Dietary protein and health
Folic acid and health
Maternal nutrition and health of
the next generation
Nutritional Status in India
• Under nourished
380million
• Overnourished
80 million
• Calorie sufficient
• /nutrient deficient
570 million
– 342 million consume higher than normal calories with
high fat intake
FICCI Ernest & Young Wellness Report 2009
Types of Dietary Fats
Saturated
Fatty Acids
(SFA)
Monounsaturated
Fatty Acids
(MUFA)
Polyunsaturated
Fatty Acids
(PUFA)
ESSENTIAL
PUFA
n-6 PUFA
(Linoleic
Acid)
n-3 PUFA
(α-Linolenic
acid)
FLAX SEEDS
Trans Fats!
• Trans fatty acids are made
through hydrogenation to
solidify liquid oils to increase
the shelf life
• Heating omega-6 oils, such as
corn oil, to high temperatures
creates trans fats
• Trans fats are found in fried
foods
• The intake of trans fatty acids
raises the risk of CVD
Synthesis of Longer Chain PUFA
20:4 n-6
Prostate Gland
Nobel prize 1982
Prostaglandins Actions?
• Constriction or dilation in vascular smooth
muscle cells
• Aggregation or disaggregation of platelets
• Sensitize spinal neurons to pain
• Induce labor and regulate hormones
• Regulate inflammation
• Control cell growth
Prostaglandins Actions?
• Acts on thermoregulatory center of
hypothalamus to produce fever
• Acts in the glomerulus of the kidney to
increase glomerular filtration rate
• Acts on parietal cells in the stomach wall
to inhibit acid secretion
Donald B. Jump, Ann. Rev. Nutr. 1999. 19:63-90
Synthesis of Longer Chain PUFA
20:4 n-6
Prostate Gland
Nobel prize 1982
N-3 PUFA
X
Balance of N-6 and N-3 PUFA
(n-6 PUFA)
(n-3 PUFA)
20:1
Current ratio of n-6 to n-3 fatty acids is 20-30:1 as opposed to
1-2:1 in earlier times of human evolution
The American Heart Association
recommends two servings of fish
per week to prevent heart disease.
Dietary Fat Intake
Heart function
Brain function
Brain Growth Is Rapid in the First Two Years
DHA Accumulation
Neurological disorders are linked to lower n-3 PUFA content
Dobbing & Sands, 1973, Archives of Disease in Childhood, 48: 757
DHA is supplied by the mother
during fetal development
The amount of DHA in
Breast Milk is related to
maternal status
Milk DHA
Breast Milk provides
DHA after birth
Maternal DHA
Biological Activities of DHA
• Lipids make more than 50% of newborn’s
brain mass
• Brain grey matter contains high levels of
DHA, deficiency can result in learning
deficits
• Changes in neuronal cell membrane DHA
content alters the availability of
neurotransmitters
Biological Activities of DHA
• Very high amounts of DHA in the
membranes of retina (50% of total fatty
acids)
• DHA is essential for the normal
development and function of the retina
– Better visual acuity, retinal response to light
DHA and N-3 Intake is Too Low
How can one increase the
intake of n-3 PUFA?
Sources of N-3 PUFA
•
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•
Marine
Salmon
Tuna
Atlantic Pollock
Sole
Cod
Shrimp
Vegetarian
Walnuts
Flax
Chia
Soy
Canola Oil
Hemp
Dietary Fat: Recommendations
• No more than 30% calories from fat (total
caloric intake)
• No more than 10% of total caloric intake from
saturated fat + trans fat
• 1 gram fat=9 calories
• 1 teaspoon=4 grams of fat
• Limit is 65 grams per day
It is suggested that more than
10% of the Indian population is
essential fatty acid deficient
Things to find out from your patient….
• Is your patient consuming essential fatty
acids?
• Is your patient’s diet sufficient in n-6 fatty
acids?
• Is your patient’s diet sufficient in n-3 fatty
acids?
Fat soluble vitamins: Vitamin D
Vitamin D: Issues & Importance
Vitamin D Status In India
• 70-100% of the Indian population is vitamin D
deficient
• Deficiency is defined as 25(OH)D <20ng/ml,
insufficient = 20-29ng/ml and sufficient >= 30
ng/ml
• Deficiency highly prevalent in 50+ years old,
pregnant and lactating women, and their
breastfed infants
– mother’s vit D status reflected in breastmilk
• Cooking habits destroy vitamin D, heating
above 200C
Vitamin D: Functions
• Promotes absorption of calcium and
phosphorous
• Helps deposit calcium and phosphorous in
bones and teeth
• Regulates cell growth
• Important in immunity
– Prevents heart disease, diabetes, obesity and
cancer
Vitamin D: Sources
• Sunlight exposure (at least 45 minutes per day
to bare skin vs. 10-15 minutes twice a week
for Caucasians)
– Darker skin has high melanin, a natural sunscreen
• Salmon with bones
• Milk (fortified otherwise very low in vit. D)
• Fortified foods
• High salt and high grain (phytates) foods
interfere in calcium absorption
Vitamin D Supplements: India
• D3 supplements of 60,000 IU is the highest
selling, once per week
• Most physicians recommend 60,000 IU per
day for 10 days, followed by 60,000 IU per
week for 5-6 weeks
ISSUES:
• Vitamin D- fat soluble, body stores, not
excreted
• Vitamin D toxicity- brittle bones
Vitamin D:RDA
• Recommended Dietary Allowance (RDA) for
vitamin D - 600 IU a day (1 to 70 years of age),
and 800 IU a day for 70+.
• For children under 1 year, adequate intake (AI)
is 400 IU a day.
Protein Malnourishment?
“In-utero Programming
Barker’s Hypothesis”
• Low Birth Weight=
Cardiovascular disease
• Placental Insufficiency
• Maternal Undernutrition
• Dutch hunger famine
The Barker Hypothesis
Maternal Undernutrition
Fetal Growth Retardation
Poor Childhood
Growth
Structural Change
within Organs
Metabolic and
Endocrine
Dysfunction
Disease In Later Life
Death Rates (standardized mortality ratio) From
CHD According to B. Wt. in 10141 Men and 5585
Women Hertfordshire, UK
Godfrey & Robinson (1998) Proc. Nutr. Soc. 57:105
Odds Ratio of Type 2 Diabetes at
Different Birth Weights
JAMA. 2008;300(24):2886-2897
Birth Wight and Insulin Resistance Syndrome
Barker et al. Diabetologia 1993; 36:62-67
Protein Recommendations
• 10 to 35% of energy intake
• OR 0.8g/kg B.wt/day
• Approximately 40-60 grams (approximately 4
tablespoons)
• Animal protein provides all essential amino
acids (high quality), while plant based proteins
are of low quality – need to eat a variety of
foods to get all the essential amino acids
Things to ask your patient….
• Is your patient’s diet sufficient in protein,
especially that of pregnant women
Mechanisms of Programming?
Nutritional Influence
Altered Cell Number or
intracellular organization
Reorganisation of organ structure
Abnormal early cell-cell interactions?
Metabolic Differentiation
DNA Control?
(altered cell specific gene regulation)
DNA Environment?
(altered DNA binding proteins)
Altered DNA methylation?
Mitochondrial DNA
?
Defining Epigenetics:
“Epigenetics refers to chromatin and DNA
modifications that are heritable through cell division,
but do not involve changes in the underlying DNA
sequence”
or:
“Gene expression effects mediated by chromatin
structure and DNA METHYLATION, but not DNA
sequence”
Sedivy et al. 2007 Cell 314:1909-2007
Folic Acid
Folate
• Folate plays an important role in cell
division and in the synthesis of amino
acids and nucleic acids like DNA
• Essential to the normal development of the
spine, brain and skull of the fetus,
especially during the first four weeks of
pregnancy.
• Supports maternal and fetal tissues growth
Neural Tube Defect
http://simplifiedmed.weebly.com/
Neural Tube Defects: India
• A recent meta-analysis concluded: “The
overall prevalence of neural tube defects
from India is high compared to other
regions of the world, while that of orofacial
clefts is similar to other countries. The
majority of studies included in the review
were hospital based”.
Allagh et al, PLoS One. 2015; 10(3): e0118961.
CVD
X
Vegetarians and B12?
Other Factors Influencing Folate
Metabolism
Efficient folate metabolism requires other B
vitamins
• vitamin B12
• vitamin B6
• riboflavin
Folate metabolism is affected by
• alcohol – inhibits folate absorption
• smoking – may impair folate utilisation
Health Canada: Folic Acid
What is India Doing?
• Weekly iron folic acid supplementation (WIFS) to
reduce the prevalence and severity of anaemia
in adolescent population (10-19 years).
• School going adolescent girls and boys in 6th to
12th class enrolled in government/government
aided/municipal schools. Out of school
adolescent girls.
• Administration of supervised weekly iron-folic
acid supplements of 100mg elemental iron and
500ug folic acid using a fixed day approach.
• Screening of target groups for moderate/severe
anaemia and referring these cases to an
http://nrhm.gov.in/
appropriate health facility.
Oct19, 2015
Hindustan Times
Sources of Folate
Health Canada
Things to ask your patient….
• Is your patient’s diet sufficient in folic acid,
especially that of pregnant women
Nutritional Status in India
• Under nourished
380million
• Overnourished
80 million
• Calorie sufficient
• /nutrient deficient
570 million
– 342 million consume higher than normal calories with
high fat intake
– Sugar is another major issue
FICCI Ernest & Young Wellness Report 2009
WESTERNIZATION
A process whereby societies adopt
Western culture in areas such as
industry, technology, politics,
economics, lifestyle, diet, clothing,
language, philosophy and values.
http://www.slate.com/
"Let food be thy medicine and medicine
be thy food."
“If we could give every individual the right
amount of nourishment and exercise, not
too little and not too much, we would have
found the safest way to health."
-Hippocrates c. 460 - 377 B.C.
“Pregnant women and nurturing
mothers need to remember that
they are eating not only for
themselves but for the next
generation”
3As to Improve Health
 Awareness:
Children/Parents/schools/community
Dieticians and doctors
Fitness centers
Media
 Attitude: Disease prevention
 Availability and cost
 Cheema S
Nutrition Research in India
• Recommendations are generally based on the
North American/European population
• Recommendations need to be established for the
Indian population
– Genetic make up, environment and lifestyle is
different
• Solid scientific data needs to be generated in
India
• Evidence based research is important to establish
proper guidelines and recommendations
• The scientific body must be comprised of
scientists from nutrition, food science, medical
practitioners, economists and policy makers
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Acknowledgements
Graduate Students
Koyode Balogun
Kanta Chechi
Raniru Randunu
Brad Feltham
Anthony Akerele
PostDocs:
Dr. John McGuire (MUN)
Dr. Y. K. Yamori (Japan)
Dr. Ramesh Goyal (India)
Abeer Ahmed
Alka Mawal
Anura Jayasureya
Hitesh Vaidya
Surendiran Gangadharan
Technical Staff
Sophie Gagnon
Suresh Belkhode
Adam Byrne
Danielle Gardiner
Several Honours
and NSERC Summer Students
Sources of DHA
• 3 oz salmon (Atlantic, farmed), cooked 1238 mg
• 3 oz salmon (sockeye, canned) - 750mg
• 3 oz white tuna, canned in water - 535mg
• 3 oz cod (Atlantic), cooked – 131mg
• 6 large shrimp, steamed – 48mg
• 1 omega-3 shell egg – 125mg
Disproportionate Size at Birth Is
Implicated in Programming
Folate-mediated one-carbon metabolism is a conduit
between the cellular nutrient environment and genome
synthesis and methylation
________________________________________
Malnourishment In India
• “120 million malnourished children across India who
depend on a government-run program serving lunch
five days a week. Still, the modest menus are clearly
not enough to make up for the calories and nutrition
that poverty has denied…………..More than half the
children in Madhya Pradesh state, with a population
of nearly 77 million, are underweight and
malnourished…………So last month, it was suggested
that eggs — a key source of protein — be added to
the lunch program. But that idea was
rejected………….."
http://bigstory.ap.org/
Icebergs Around St. John’s
© Sukhinder Cheema, St. John’s, NL
Vitamin D Synthesis & Activation
Vitamin D2
Vegetable sources
Sun-exposed mushrooms
and yeast
UVB
Things to find out from your patient….
• What is the vitamin D status of your
patient, especially pregnant and lactating
women, and 50+ population?