4th Edition

Understanding Nutrition
Australian & New Zealand Edition
4th Edition
You absolutely do need this text
(online version available, also available through “Mindtap” – best option)

Misconception amongst some students:

All exam questions come from lecture slides. Definitely Not True !
We have 3 hours of lecture and 1 hour of tutorials per week for 12 weeks
That is 48 hours of contact per semester.
Read the University handbook: It says 120-140 hours of work per subject per semester
Meaning you are meant to read the chapters and other readings given out.
The lectures cover the concepts related to each topic, the detail is in the readings.
Lectures cannot cover all material. No university does.
World top class universities usually try and cover about 10-20% of material in class.
You need to learn the rest by studying.
Even in high school you were meant to study at home as well as attend classes.
 Chapter 1

An Overview of Nutrition
(Read pages 1 – 38)
 What is Nutrition ?
“Nutrition is the science of foods and the nutrients they
contain and their actions within the body (including
ingestion, digestion, absorption, transport, metabolism and
excretion). It also includes the social, economic, cultural,
and psychological implications of food and eating”.

What is Food ?
Products derived from plants or animals that can be
consumed to yield energy and nutrients for the
maintenance of life and growth and repair of tissues.

What is Diet ?
The foods and beverages a person consumes.
Part 1. Food Choices
(pages 1-4)
 Food choices can significantly affect our health and
are influenced by multiple factors, including:
(Read details and summarise from text)

• Personal preferences for flavours

• Genetics
• Habit
• Cultural or religious beliefs and traditions
• Social interactions, such as special events, customs and holidays
where food is involved
• Food availability, convenience and the economy
• Personal values related to ethical treatment of animals and the
planet
There are positive and negative associations with
food choice, such as:

• Eating for emotional comfort

• Body weight and image
• Political views or environmental concerns
• The nutrition and health benefits of foods, such as whole,
modified or fortified foods

A healthy diet is essential for a healthy body and it’s important to

consider nutritional properties of food when making choices.
• Unfortunately for many people this is the least considered aspect of food choice
• For others their concept of healthy foods is misdirected by poor media
including social media
Part 2: The Nutrients
(pages 4-10)
 There are six nutrient classes:
1.Lipids 5.Vitamins

2.Proteins Micronutrients
4.Water 6.Minerals
3.Carbohydrates
Macronutrients
Energy containing

• Water, proteins, carbohydrates and lipids are classed as

macronutrients. All contain energy except water

• Vitamins and minerals are micronutrients

• Food also contains non nutrients such as contaminants

and phytochemicals that don’t have a known essential
function or contain energy
Energy yielding
 Nutrients in Foods and the Body
• Foods contain organic and inorganic compounds.
• Organic compounds: protein, carbohydrate, lipids and vitamins.
• Inorganic compounds: minerals and water.
• Our bodies can derive all the energy, structural materials and regulating
agents we need from the foods we eat.
• Chemical analysis of your body would show that it is made of materials
similar to those found in foods.
• We are a collection of atoms, molecules, cells, tissues and organs. There
is truth in the saying ‘you are what you eat’.
• Cells die (either lost or broken down), new cells are created.
- Oldest red blood cell is ~120 days, Intestinal lining cells are renewed every 3 days
- Skin is totally replaced every 7 years
• Food replenishes bodily requirements for structure and energy.
• It is the nutrients found in food that makes this possible.
The human body exhibits similar
composition to foods
(not surprising since we are an animal and
food to other animals)

• Water makes up two thirds of our

body weight

• Organic substances; protein, fat,

carbohydrates & vitamins make up
the bulk of the remaining body mass

• Inorganic substance including

minerals, make up a tiny portion
only
 Nutrient composition of food is
determined by chemical analysis

Where can such data be found:

• NUTTAB, 2010 (FSANZ webpage)
• Commercial software packages (eg FoodChoices and FoodWorks by Xyris
software)
Table of selected compositional data for some foods

Water Protein Fat Carbs Fibre Niacin Thiamin Sodium

(Na)

Bread 38.3 g 8.6 g 2.5 g 47.3 g 2.7 g 1.5 mg 0.1 mg 450 mg

(White)

Lettuce 95.8 g 0.9 g 0.1 g 0.4 g 1.7 g 0.4 g 0.03 mg 23 mg

Steak 75.0 g 21.5 g 3.5 g 0g 0g 0g 0.05 mg 50 mg

 Micronutrients
• Vitamins and minerals do not provide energy and are known as
micronutrients because the body needs them in smaller quantities.
• Vitamins are organic, essential nutrients that allow the body to
obtain energy from carbohydrate, fat and protein.
• Minerals are inorganic, essential nutrients that are found in the
bones, teeth and body fluids.
• Most foods contain a mix of macro- and micronutrients.
Note: Water is an indispensable and abundant essential nutrient
that participates in many life processes. Various authorities
describe it as a micronutrient or a macronutrient. As it is need in
large supply each day (relatively) it should be referred to as a
macronutrient – but non energy yielding.
Energy from nutrients ?
a) Non-Energy yielding
1. Minerals: are chemical elements that cannot be changed, as they
enter and leave the body in the same form, hence contribute no
energy, eg:

Some excreted

2. Water (H20)

3. Vitamins: These support enzyme function, contain C, H, 0 , some

nitrogen and other elements, but contribute no energy.
b) Energy yielding

Carbohydrates Lipids (Fats & Oils)

• Contain C, H, O • Contain C, H, O
• 17 kJ energy/gram • 37 kJ/gram
• sugars/starches/some fibre • Several classes
(non energy) (TG, PL, sterols etc)

Protein
• Contain C, H, O, N (S)
• 17 kJ/gram
• Made up of amino acids
 Macronutrient molecules
(proteins, carbohydrates, lipids)
are composed of atoms, so where is
the energy contained in these
molecules?
The energy yielded from macronutrients is in
the chemical bonds !

and chemical bonds are pairs of electrons !

 During catabolic metabolism, macronutrient
molecules are broken down and the broken bonds
release their energy
Average bond energies,
kcal/mole
C-H 98
O-H 110
C-C 80
C-O 78
H-H 103
C-N 65
O=O 116 (2 x 58)
C=O 187* (2 x 93.5)
C=C 145 (2 x 72.5)
(* as found in CO2)

The released energy is used to fuel other chemical reactions and physical
activities including the building of new molecules.
Energy Atoms
 Note: Special role of protein
• In energy terms, our diet mainly consists of carbohydrates
(~ 50%) and fat (~ 35%) and protein (~ 15% most of which
is not metabolised for energy at all).
• So protein’s role in providing energy is limited (now).
However it has other critical functions
• Functions of proteins include:
 muscle tissue (structural)
 skin (structural)
 enzymes (cellular reactions)
 hormones (messengers)
 antibodies (immune function)
Overview of
energy
metabolism
Interlude: 1. Conversion factors and definitions

 Essential nutrients – must be obtained from food,

cannot be made in the body, approx 40 known.

 Energy units – In Australia we use kilojoules (kJ). In

the USA they refer to energy in kilocalories (Calories).
1 kcal = 4.2 kJ

 Metabolism – The process by which nutrients are

broken down to yield energy or are rearranged into
body structures (catabolism and anabolism)
Interlude: 2. Energy calculations
Nutritionists and dietitians consider a persons’ diet in terms of what
contribution to energy each macronutrient makes, not the actual
absolute gram amount of each (even though most protein is not
actually used for energy).
Eg. If a person’s food intake equals 130 g of carbohydrates, 90g
protein and 80g fat and 10g of alcohol per day:
g/day kJ/day % energy
Carbohydrate 130 (x17) = 2210 2210/6990 x 100 = 31.6%

Protein 90 (x17) = 1530 1530/6990 x 100 = 21.9%

Lipid 80 (x37) = 2960 2960/6990 x 100 = 42.4%

Alcohol 10 (x29) = 290 290/6990 x 100 = 4.2%

= total of 6990 kJ 100%

Interlude: 3. Ratios
• Another way to look at information regarding a persons’ diet for
comparison between people and too standard recommended values is to use
ratios
• A comparison of two or three values where one is reduced to the value of one
(often the lowest but not always). Often used to indicate the proportion of
different types of fat in the diet.

For example:
Total dietary intake of fat/day = 90g of which 20g is polyunsaturated fatty
acids (PUFA), 40g monounsaturated fatty acid (MUFA) and 30g is saturated
fatty acids (SFA).
Ratio P:M:S = 20 : 40 : 30 (divide by lowest)
= 20/20 : 40/20 : 30/20
= 1: 2 : 1.5
Note : For fats, because we want a comparison to saturated fat intake, the
ratio is often obtained by dividing all by sat fat level, eg:

= 0.7 : 1.3 : 1
Part 3:The science of nutrition
(pages 10-17)
 The Science of Nutrition
• Nutrients provide the physical and metabolic basis for nearly all
that we are and all that we do.
• The science of nutrition is the study of the nutrients and other
substances in foods and the body’s handling of them.
• Types of studies to expand nutrition knowledge include:
– Epidemiological studies include cross-sectional, case-control
and cohort designs.
– Laboratory-based studies include animal studies and
laboratory-based in vitro studies.
– Human intervention or clinical trials.
Epidemiological studies include: cross sectional population studies, case-
control studies and cohort studies (prospective and retrospective)
Epidemiological

Cross
sectional
and
cohort

Laboratory animal and Clinical trials

invitro studies
The scientific method
Nutrition researchers use “the
scientific method” to guide their work.
It is totally objective and not
subjective

This is the basic method that humanity

has to distinguish real truth from beliefs,
opinions and dogmatic teachings
 Experimental design
• Consider the following hypothesis:
‘Vitamin C supplements prevent the common cold’

• How is an experiment designed to test this hypothesis?

Use 2 groups of subjects with everything in common except the experimental substance

Experimental Control Group

Group Matched for
(gets a placebo)
(gets Vit C) Age
Sex
BMI
Diet
Health
Habits
 Experimental Criteria
Important and basic concepts in experimental design and
subsequent validity of results for animal and human studies
include the following:

• Use of controls
• Determination and use of adequate sample size
• Placebos
• Randomisation of subjects
• Blinded and double blinded
• Correct and adequate statistical analysis of results
• Peer review of studies prior to publication
• Publication in reputable journals in the discipline area (high impact factor)
• Future replication of study findings prior to general acceptance
Correlations and causality
A correlation occurs when the results of studies show a
relationship between two factors ie; vitamin C and colds or
saturated fat intake and CVD.
This is not evidence of causation (cause and effect)! But an indication
as to a possible association that needs to be investigated by lab
experiments

Rate of
CVD in a
population
But not evidence that
saturated fat causes
CVD

Saturated fat consumption

 Evaluating Published Research
• To be accepted into the body of nutrition knowledge, a finding
must stand up to rigorous, repeated testing in experiments
performed by several different researchers.
• A peer review process is used to evaluate the procedures used
and the conclusions drawn from a study.
• Published studies should be evaluated for reliability based on:
 the journal (impact factor in its class),
 study funding source,
 authors (relevant discipline training, society membership,
track record etc),
 The study methodology and discussion of results (eg do the
conclusions match the results ??)
Replication should be used to confirm or disprove findings.
Peer review
• Peer reviewed literature ie; scientific journals – articles
checked by other scientists to weed out poor experiments
• Non peer reviewed ie; books, magazines, newspaper
articles, web sites, social media. There can be great
variability in content and accuracy.
• Articles appearing in scientific journals have been checked
by other experts in the field in regards to the experimental
design and results
- was there a control and experimental group?
- was the sample size sufficient?
- was a placebo used?
- was the experiment double blind?
- is there connection to existing scientific knowledge?
- is existing knowledge cited and referenced?
- do the conclusions drawn follow logically and objectively?
 Nutrition Information and
Misinformation
• Nutrition on the net (internet, cyberspace, websites, social media):
– Internet information can be published by ANYONE.
– May be high-quality information: National Library of
Medicine’s PubMed.
– May be misleading, incomplete and inaccurate or just crazy.
• Nutrition in the News:
– Can be misleading and contradictory due to many factors.
– May report scientific findings prematurely or inaccurately.
Note: Journalists have little or no scientific training so cannot put
results of new studies in context
eg. Recent study shows omega-3 fats dangerous (major headline), however
over 20,000 previous studies show wide range of beneficial effects ?
Finding nutrition information
Who is qualified to speak on nutrition?
- Nutrition researchers Misinformation hard to
- Dietitians detect. Often glossy
- Nutritionists magazines, websites,
- Medical practitioners books lack research
or good interpretation.
Scientific journals , eg:
- Nutrition and Dietetics (Aust)
- American Journal of Clinical Nutrition Most critically , news
- European Journal of Clinical Nutrition paper reports on
- Journal of Nutrition scientific studies are
- Nutrition Reviews, etc
generally
Internet sensationalised and
inaccurate.
- PubMed www.ncbi.nlm.nih.gov/PubMed/
- Credible organisation websites ie; Nutrition Australia, Better Health Channel

Be aware of private web sites pushing sales or personal opinions, or lobby group views
Make MEDLINE (Pubmed) your primary source of new nutrition research information

www.ncbi.nlm.nih.gov/PubMed/
Beware of Nutrition Quackery
 Beware of industry (and
individuals) self
promotion, including
website advertising of
products (that often do not
seem like advertising)

Understand the difference between:

• Objective measurement
• Subjective commentary
Part 4: Nutrient Reference Values
(pages 17 - 21)
The Nutrient Reference Values (NRV)
(Dietary Reference Intakes (DRI) - USA & China)
(Dietary Reference Values – UK)

• Systems of nutritional references designed to give guidance on

adequate nutrient intakes as well as toxic levels

• Outline the levels of intake of essential nutrients on the basis of

scientific knowledge, to be adequate to meet the known nutritional
needs of practically all healthy people for the prevention of deficiency.

• Nutrition experts have produced a set of standards that define the

amounts of energy, nutrients, other dietary components and physical
activity that best support health, ‘Nutrient Reference Values’.

RDIs EARs AI UL
 Definitions
• Estimated Average Requirement (EAR)
A daily nutrient level estimated to meet the requirements of half the healthy individuals.

• Recommended Dietary Intake (RDI)

The average daily dietary intake level sufficient to meet the nutrient requirements of
nearly all healthy individuals in a particular life stage and gender group.

• Adequate Intake (AI)

Used when an RDI cannot be determined. The average daily intake level based on
observed or experimentally determined approximates of nutrient intake by a group that
are assumed to be adequate.

• Upper Level of Intake (UL)

The highest average daily nutrient intake level likely to pose no adverse health effects to
almost all individuals in the general population. As intake increases above the UL the
risk of adverse effects increase.
As we all differ in size.
metabolism and genetics,
the amount of any nutrient
we need on a daily basis
varies between people.

The RDI and AI are

approximates only and in
general there is a broad
range around them that is
generally sufficient and safe
for most people
Common belief

Dose levels and

Usual reality
effects:
Eg. Vitamin C

A common myth !
Occassional reality

Eg. Vitamin A
 RDI

(EAR) (RDI) UL

2 standard
deviations

Setting the RDI for a nutrient

This does not apply
for energy intake
 RDI
EER
Mean = RDI

Setting the RDI for Energy

EER = Estimated energy requirement, (the average dietary energy intake that will
maintain energy balance in a person with a healthy body weight and level of activity).
AMDR = Acceptable macronutrient distribution ranges, (45 – 65 % energy from
carbohydrates, 20 – 35 % E from fats and 15 – 25 % E from proteins)
Meeting the RDI’s

• The RDI (RDA) include a generous margin of safety.

• The RDI is intended to be met through dietary intake of a

variety of foods.

• Meeting the RDI for each nutrient every day is difficult

and not necessary. This is dependent on the body’s use and
storage of that nutrient.

• Intake of most water soluble vitamins (ie; thiamin, Vit C)

can be averaged over several days to meet needs where as
intake of fat soluble vitamins (ie; vitamin A, and even B12)
can be averaged over weeks and still meet needs.
 The Nutrient Reference Values (NRV)
• Nutrient reference values apply to healthy people.
• Recommendations are not minimum requirements and can be adjusted for individuals
by dietitians.
• Are achieved by consuming a variety of foods.
• Apply to average daily intakes.
• Each NRV category serves a unique purpose, either nutritional assessment of individuals
or populations.
• EARs for groups/populations.
• RDI / AIs for individuals.
See details: Nutrient Reference Values for Australia and New Zealand Including
Recommended Dietary Intakes:
https://nhmrc.gov.au/sites/default/files/images/nutrient-refererence-
dietary-intakes.pdf
https://www.nrv.gov.au

Note : Don’t attempt to print unless you wish to have a hard copy, 320 pages
Part 5: Nutrition Assessment
(pages 22 - 25)
Nutrition Status Assessment
• Malnutrition includes both over-nutrition and under
nutrition

• Over-nutrition is due to excess energy and or fat intake.

Common in Western lifestyle diseases ie; diabetes,
cardiovascular disease.

• Under-nutrition often exists as protein energy

malnutrition (PEM) resulting in weight loss, infection,
muscle wasting or a specific nutrient deficiency.
Nutrition assessment of individuals:

• Evaluates the many factors that influence or reflect nutritional

health.
• Historical information regarding diet, health status, drug use
and socioeconomic status is gathered.
• Anthropometric data measure physical characteristics including
height, weight, body fat composition, waist:hip ratio and BMI.
• Physical examinations , including hair, eyes, tongue, fingernails
etc, require skill but can reveal possible nutrition imbalances.
• Laboratory tests detect early signs of malnutrition, particularly
blood and urine tests, where measurements are compared with
population normal values.
Body fat
determination
Body shape
and risk of
chronic
diseases
Waist : Hip ratio
Body Mass
Index
(BMI)
 BMI
And
Mortality
risk
 Nutrition Assessment- The population
National nutrition surveys:
• Most western countries have a periodic national diet survey.
• Australia has a more ad hoc approach (depending on what government is in
power).
• There have been four national surveys in the last 50 years:
 National Dietary Survey of Adults – 1983
 National Dietary Survey of Children – 1985
 National Nutrition Survey – 1995
 Australian Health Survey - 2012
• National nutrition monitoring programs use survey research to collect data on
foods people eat and people’s health status.
• Data collected is used for development of nutrition policy, food assistance
programs and food supply regulation.
National trends show an increased intake of fast food, increased portion sizes and an increased
consumption of energy-dense foods and drinks. This intake is associated with an increased risk
for overweight and obesity and other chronic conditions.
Part 6: Diet and Health
(pages 25-28)
The changing relationship of diet and health

• Early nutrition research was primarily focussed on diseases of

nutritional deficiency, which were once very common when diets were
poor and unbalanced.
• In modern times however most nutritional research is focussed on
chronic diseases, which in general result from overnutrition in an
environment where food is plentiful.
• In particular the food available in western societies has become more
processed and hence more energy dense, leading to excess energy intake
and weight gain as fat and chronic diseases such as CVD, cancers,
diabetes etc.
• Micronutrient deficiencies can still occur if a diet is processed food
dominated, but in a society where broad food type availability is
common, it should not be an issue.
Risk factors
Definition: A condition or behaviour associated with an elevated frequency
of a disease – but not definitively known to cause the disease status.
Clusters: Risk factors tend to cluster, which indicates a degree of interaction.
For example obesity, physical inactivity, high BP and high blood
cholesterol are often seen together and all impact heart disease.

Types of risk factors:

• Modifiable risk factors contributing to deaths
- smoking, diet, physical inactivity, alcohol, overweight etc

• Non modifiable risk factors

- genetics, age, sex

• Measurable risk factors (biomarkers)

- Blood pressure , plasma lipids, BMI, insulin resistance etc
Diet and Chronic Diseases
• Historically, nutrient deficiencies
were linked to diseases (scurvy,
rickets etc).

• In modern day Western Society

chronic diseases are associated with
energy and sometimes nutrient
excess (over nutrition).

Note:
Updated 2017 figures differentiate
between different cancers.