BCH 323

(HUMAN NUTRITION)

April 2023
Outline
• FOOD POISONING AND INTOXICATION,
• FOOD SENSITIVITIES, PREVENTION AND CURE.
• NUTRIRIONAL DISORDERS
 FOOD POISONING

• Defined as food borne illness

associated with consumption of food
which is contaminated with a disease
pathogen or toxicant.

• Such food contains enough pathogens

or toxicants necessary to make a
person sick.

• There is usually acute manifestation

of diarrhea or vomiting caused by
toxins produced by microorganisms.
 ORGANISMS IN FOOD

Foodborne Organisms
(Microorganisms that can be transmitted
to humans or animals through food).

Spoilage Organisms
Beneficial/Useful Organisms Foodborne Pathogens Grow and produce physical and
chemical changes in foods.
Render foods harmful to humans if
Microorganisms used in various consumed, even at low Produce unacceptable flavor, odor, gas
food fermentation processes. concentration. accumulation, release of liquid exudates,
and changes in color and appearance.
Therefore no advance warning
signals of the danger associated with Also, extracellular or intracellular
consumption of the contaminated enzymes released by spoilage organisms
foods. can result in deterioration of food
quality.
 FOOD BORNE INFECTION

• Caused by the oral ingestion of living microorganism(s) in adequate amounts to build up an infection.

• Upon consumption, the microbial cells continue to grow and illness can result.

• Commencement of symptoms is normally delayed (long incubation period), indicating the time required
for an infection to develop.

• Usually characterized by fever.

• Examples of causative organisms are enteric viruses, bacteria (Salmonella, Campylobacter and Vibrio
species) and parasites.
 TYPES OF FOOD BORNE INFECTIONS
Bacterial foodborne infection include;
I) BACTERIAL FOOD BORNE INFECTION • a) Salmonellosis
• Dangerous biological food borne disease • b) Campylobacteriosis
because, many foods serve as the ideal culture • c) Escherichia Coli infection
for the growth of bacteria.
• d) Shigellosis
• e) Cholera
• The physico-chemical environment in the food
has a major influence, and it is by manipulating • f) Yersinosis
this environment that it is possible to control the • g) Vibrio parahemolyticus
growth of pathogenic organisms.
• h) Vibrio vulnificus.
• Some of the environmental factors include;
temperature, pH, controlled atmosphere and
water activity (aw). • Bacterial food poisoning commonly produces acute
gastroenteritis, which is often short and self-limiting.
• The major problems arise in young and the elderly and
in individuals whose immunological defenses are
weak for some reasons.
• Gastroenteritis can cause severe dehydration and loss
of electrolytes, which is a major cause of child
mortality in developing countries.
Ecsherichia coli (E. coli) Infection Enterotoxigenic E. coli (ETEC)

• Causes most cases of travellers' diarrhoea in developing

• This pathogen is widely distributed. countries.

• E. coli strains involved in food borne • ETEC colonize the proximal small intestine and produce
infection include; heat stable enterotoxin that elicits fluid accumulation and a
diarrheal response after 1-2 days incubation.
• a) Enteropathogenic E. coli (EPEC),
• The illness is usually mild and self-limiting after 3-4 days.

• b) Enterohaemorrhagic E. coli (EHEC), • Antibiotics, such as ciprofloxacin have been used to limit
the duration of symptoms but are of questionable value.

• c) Enterotoxigenic E. coli (ETEC), • Humans are the principal reservoir of ETEC.

Clinical features:
• d) Enteroinvasive E. Coli (EIEC). Watery diarrhea with no blood,
Abdominal cramping,
Anorexia,
Fever etc.
Enterohaemorrhagic E. coli (EHEC) Bacillary Dysentery (Shigellosis)

• It causes haemorrhagic colitis in human, • Shigellae are Gram-negative rods, closely related to E. coli, that
diarrhoea, abdominal pain, fever etc. invade the colonic mucosa.
• There are four main groups: Shigella dysenteriae, Shigella flexneri,
• Complications include bloody diarrhoea, Shigella boydii, Shigella sonnei.
acute ulcerative or ischaemic colitis and • It infects humans and its spread is facilitated by its low infecting
Haemolytic uraemic syndrome (HUS) . dose of around 10 organisms.

Common Foods Spread/Transmission

• Raw milk and raw beef • Spread occur via contaminated food or flies, but transmission by
unwashed hands after defecation is by far the most important factor.
Transmission in Foods
• Transferred to beef by contact with the Clinical symptoms
animal intestine. • Fever, watery diarrhea, dehydration, abdominal pain etc.
• Transmission can also occur from • The illness begins 1 to 4 days after ingestion of bacteria and may last
carriers who do not wash hands after between 4 to 7 days.
using toilet.
Prevention Management
• Cooking food very well. • Oral rehydration therapy or, if diarrhoea is severe, intravenous
• Avoiding raw milk products. replacement of water and electrolyte loss will be necessary.
• Personal hygiene.
• Antibiotic therapy with ciprofloxacin.
Salmonellosis • Foodborne infection frequently caused by infection with Salmonella bacteria.
• Found in intestinal tract of warm blooded animals.
• Salmonella typhimurium, Salmonella entritidis, Salmonella choleraisus,
Salmonella infantis are mainly associated with the infection.
• A dose of about 10,000-1,000,000 bacilli/gram of food is needed to cause the
infection.
• It has an incubation period of 12-24 hours.
Common Foods
• Raw meat and poultry products, egg, dairy products, pork etc.
Transmission
• Cross contamination from raw food (esp. poultry)
• From food contact surfaces (cutting boards) or from handlers.
• From vectors such as flies, cockroaches, rats, in food environment
Clinical Features: Fever, diarrhea, vomiting, headache, leucopenia etc
Prevention
1) Cook food thoroughly 2) Personal hygiene 3) Clean food contact surfaces.
II) VIRAL FOOD BORNE INFECTION

• A number of viruses are known to infect man through the gastrointestinal

tract and can be isolated form the faeces of infected individuals.

• Hepatitis A virus, rotaviruses and Norwalk viruses are well-established as

carriers of infection.

• In many cases man acts as the reservoir for the viruses.

• Unlike bacteria, the viruses do not multiply in the food.

Transmission
• By contaminated water or foods, especially shellfish growing up in
contaminated water
• Vegetables which have been irrigated with inadequately treated water
from sewage.
• By food handlers.
Hepatitis A Virus (HAV)
Transmission
• Person to person contact
• Is a non-enveloped single-stranded RNA virus.
• Cross contamination
• Fecal contamination
• The first largest outbreak occurred in China in 1988
where 3 million people were infected after
consumption of harvest from a sewage-polluted area. Symptoms
• Fever, nausea and abdominal discomfort, followed within a
• Other outbreaks associated with oyster, mussels, few days by jaundice.
green onions, lettuce, strawberries in Australia,
Brazil, Italy and Spain have been reported. • May also cause liver damage, usually from the host's
immune response to the infection of the hepatocytes. In some
• In most of these outbreaks, sewage was the source of cases, the liver damage may lead to death
pollution. Prevention

• Causes highly contagious liver infection. 1) Handle and cook food properly.
2) Avoid eating raw sea food.
Common Foods
• Foods washed with non potable water like raw 3) Personal hygiene.
vegetables and raw seafood
 FOOD BORNE INTOXICATION

• Caused by the ingestion of toxins that have been Food borne intoxication can be:
pre-formed in the food.
Bacterial,
Therefore, there is no necessity for live organisms Fungal,
to be present in the food and the onset of the
symptoms is rapid (short incubation period). Chemical,

The toxins are mainly classified into: Plant toxicants and

Poisonous animals/substances
Bio-toxicants: which are found in tissues of
certain plants and animals e.g. mushroom toxicity.

Metabolic products (toxins): formed and

excreted by microorganisms, while they multiply
in the food or in the GIT.

Poisonous substances: which enters the food

during production, processing, transportation or
storage of food.
I) BACTERIAL INTOXICATION

• Bacterial toxins that produce

intoxications are the exotoxin
type of either:
• Enterotoxin (affecting the gut)
as in staphylococcal intoxication
or
• Neurotoxin (affecting the
nervous system) as in botulism.
• Another category of intoxications
are the mycotoxicoses (due to
ingestion of mycotoxins) and the
diseases caused by algal toxins
(shell fish poisoning).

• Examples includes Staphylococcus aureus, Bacillus cereus,

Clostridium perfringes and Clostridium botulinum.
II) FUNGAL INTOXICATIONS III) CHEMICAL INTOXICATION:
These are caused by consumption of metabolites called
mycotoxins produced by fungi, while growing in food. This arise from consumption of food containing poisonous
Grains (poor dry storage), oilseeds, fruits and vegetables are
mostly involved. chemicals, which are added to food as a result of

Aflatoxicosis processing, transporting or storage

• This is caused by aflatoxins produced by fungi e.g.
Aspergillus flavis and Aspergillus parasiticus. It is usually a The chemicals involved are heavy metals (mercury, lead,
poultry disease.
• Effects of aflatoxins: acute hemorrhagic syndrome (large cyanide, fluoride etc.), pesticides and insecticides.
dose; lethal), histotoxic changes (medium doses; sub-lethal),
liver tumors (small doses; potent carcinogens). Herbicides and fungicides, radionuclides (radium, barium
Prevention of Aflatoxicosis etc).
• Proper drying and storage of grains
• Quality control of potentially hazardous foods using
analytical tests
• Use of fungicides to protect stored cereals and other foods
like pulses and potatoes against fungal invasion.
 FOOD SENSITIVITIES
“One man’s food is another man’s poison”
Food sensitivities are of different types, thus complex, often confusing and not easily defined.
Symptoms may be delayed for up to days, making it difficult to diagnose.
Food sensitivities are as a result of toxic responses to food and are of two categories; Food allergies and Food
intolerance.
Food Allergies Food Intolerance
- Toxic reactions to food or food additives that • - Reproducible response to food that does not
involve the immune system. involve the immune system.
- Over 60% of immune reactivity involves mouth
• - Unlike food poisoning, toxins are naturally
and intestinal tract. Others are skin lung and nose. occurring or intentionally added to foods.
- Mechanism involves release of histamine and
other chemicals which causes anaphylactic • - Many types, most common are:
reaction. • Lactose intolerance; affects up to 10% of adults as a
- Most common symptoms include vomiting, result of lactase enzyme deficiency.
diarrhoea, Blood in stools, eczema, hives, skin • Tyramine intolerance (or Phenylalanine);
rashes wheezing and runny nose.
• causes angioaedema and migraine.
- Foods responsible include cow's milk, Wheat,
proteins, Peanuts, Fish, Tree nuts (Almonds, • Gluten intolerance: Gluten is complex mixture of
Cashew, Walnut) problem • CHO, acting as a binder..
GUIDELINES FOR PREVENTION
AND CONTROL OF FOOD
POISONING
1. All involved in food production and
service should have elementary training
in food hygiene.

2. HAZARD ANALYSIS AND

CRITICAL CONTROL POINTS
(HACCP) system should be applied to
the entire food production process.

3. Personal hygiene of the food handler

coupled with the conditions under
which cooked foods are stored are
critical for preventing food-borne
disease. Proper maintenance of
refrigeration temperatures is essential
for the storage of cooked and raw foods.

4. Finally, CLEANLINESS, plays a

pivotal role in the prevention of food
poisoning.
 DEFINITIONS
NUTRITIONAL DISORDERS
MALNUTRITION: Is a pathological state resulting
• These are diseases that occur when a person’s dietary from a relative or absolute deficiency or excess of one or
intake does not contain the right amount of nutrients more essential nutrients.
for healthy functioning, or when a person cannot
correctly absorb nutrients from food.
UNDERNUTRITION: This is a condition that results
• Can be caused by under nutrition, over nutrition or when insufficient food is consumed over an extended
an incorrect balance of nutrients. period of time.

OVERNUTRITION: This is a pathological state

• Protein-Energy Malnutrition (PEM), resulting from the consumption of excess quantity of
Micronutrient deficiency and Eating disorders are food over an extended period of time.
well known nutritional disorders.

IMBALANCE: This is a pathological state resulting

from disproportion among essential nutrients with or
without absolute deficiency of any nutrient.

SPECIFIC DEFICIENCY: A pathological state

resulting from a relative or absolute lack of specific
nutrient.
 PROTEIN-ENERGY MALNUTRITION (PEM)
• Also called protein calorie malnutrition
Note:
(PCM).
Symptoms of both marasmus and Kwashiorkor are sometimes
produced in a mixed way depending on the relative degrees of
• It is a form of malnutrition where there is
protein and calorie deficiencies.
inadequate protein and calorie intake.
Marasmus and Kwashiorkor may follow each other in some
patients and is referred to as Marasmic-Kwashiorkor.
• It is the most common nutritional disorder of
the developing countries. Marasmus Kwashiorkor
Occur in weaned infants (< 1 year) Occur in pre-school children (1-5yrs)
Due to low calorie intake Due to low protein intake
• PEM is widely prevalent in infants and pre- Edema absent Edema present
Old man’s face appearance Moon face appearance
school children.
Shrunken abdomen Protruding abdomen
Presence of vitamin deficiency Presence of vitamin deficiency
• Kwashiorkor and Marasmus are the two Fasting decreased Fasting decreased

extreme forms of protein-energy malnutrition. Comparative Features of Marasmus and Kwashiorkor

 KWASHIORKOR Occurrence and Causes Prevention

• Kwashiorkor is predominantly • Consists of providing a diet

• It is a form of malnutrition caused
found in children between 1-5 containing an adequate quality protein
due to insufficient protein in the
years of age. for infants and children. In those areas
diet (e.g. No milk, eggs but only
cereal grains, starchy foods and where kwashiorkor is endemic parents
• This is primarily due to should be taught the nutritional needs
roots. etc.).
insufficient intake of proteins, of all family members and adequate
as the diet of a weaning child amounts of food should be provided
• Infectious diseases like acute
mainly consists of to fulfill these needs.
diarrhea, respiratory infection and
carbohydrates.
measles precipitate the occurrence of
kwashiorkor, as they lead to Clinical Symptoms
deterioration of diet, poorer Treatments
utilization and higher requirement. • The major clinical
• Ingestion of protein-rich foods or the
manifestations of kwashiorkor
• It is the most common and dietary combinations to provide about
include stunted growth, edema
widespread nutritional disorder in 3-4 g of protein/kg body weight/day
(particularly on legs and hands),
developing countries. will control kwashiorkor.
diarrhea, discoloration of hair
• The treatment can be monitored by
and skin, anemia, apathy and
measuring plasma albumin
Ga tribe of Ghana refer to it as moon face.
concentration, disappearance of edema
• "sickness the older child gets, when the next
and gain in body weight.
child is born",
 MARASMUS
Treatment
• Marasmus which mean “to waste” • Administration of adequate calories and essential nutrients to
mainly occurs in children under one correct the dietary insufficiency and to promote normal
year of age. growth

• Predominantly due to the deficiency of

calories usually observed in children
given watery gruels (of cereals) to
supplement the mother's breast milk.

Symptoms
• Growth retardation, emaciation,
anemia and weakness.

• A marasmic child does not show

edema or decreased concentration
of plasma albumin.
Biochemical Changes in PEM

A number of biochemical parameters are altered:

 Decreased plasma levels of serum albumin and other serum proteins are most commonly seen. In

kwashiorkor, the serum albumin may fall to a value as low as 2 g/dl.

 The level of retinol-binding protein (RBP) is also characteristically lowered.

 In kwashiorkor, blood urea may decrease and excretion of creatinine in urine is reduced due to loss of

muscle mass.

 Features of associated deficiency of vitamins and minerals (mostly iron) are commonly seen.

 Hypokalaemia and dehydration occur when there is diarrhoea

OBESITY

• Obesity is a state in which excess fats (triacylglycerols) accumulate in the body.

• Increased number and/or size of adipocytes occurs in obesity.
• This is due to the increased energy intake and decreased energy expenditure.

OBESITY INDEX (BODY MASS INDEX (BMI)): It is used to assess the obesity status.

BMI = Weight (kg) / Height2 (m2)

BMI (Kg) NIH CLASSIFICATION

<18.5 Underweight
18.5-24.9 Normal Weight
25-29.9 Overweight
30-34.9 Obesity I
35-39.9 Obesity II
>40 Extreme Obesity
Common Causes of Obesity

• One of the most serious problems among the urban affluent populations is consumption of excessive calories with
inadequate exercise, of which obesity is the natural consequence.

However, besides excessive calorie consumption; several other factors contribute to obesity development. Which include;

i. Genetic predisposition
 Genetic predisposition has been suggested based on the familial incidence of obesity. If one parent is obese, 40–50%
chances are there that the children would also suffer from obesity. However, no single gene is responsible for obesity.

ii. Leptin
• Leptin (Greek: Leptos _ thin) is a 16-kD polypeptide, encoded by the obese genes in adipocytes, that influences appetite
control system in the brain.
• These proteins cause decreased food intake, thus representing “satiety signal” in the body.
• Defect in the leptin coding gene is seen in ob/ob mice, that tend to over eat and develop obesity.
• When injection of leptins is given to these animals, they eat less and lose weight.

iii. Metabolic aberrations

• Certain metabolic aberrations are commonly associated with obesity. Hypothyroidism, hypogonadism, Cushing’s syndrome
and hypopituitarism may lead to obesity. Women are more prone to become obese during puberty, pregnancy and after
menopause.
Effects of Obesity on Biochemical Parameters

i. Increased lipid parameters

• Elevation of serum concentration of free fatty acids, cholesterol and triacylglycerol is common.

• The underlying cause of the altered lipid profile can be traced to decreased sensitivity of peripheral tissues (including
adipocytes) to insulin. The number of insulin receptors on cell surface is decreased (e.g. down-regulation) so that
these tissues respond poorly to insulin, even though plasma insulin level is elevated.

• The major ill-effects of obesity are reduced lifespan and coronary artery disease due to the prevailing alterations of lipid
profile. Obese individuals are at higher risk of developing

ii. Diabetes
• Nearly 80% of the adult diabetic individuals are obese.
• The underlying cause of diabetes in obese people is decrease in number of insulin receptors and decreased sensitivity
to insulin. Moreover, decreased sensitivity to insulin results in hyperglycaemia and hence a persistent stimulus for the
pancreatic beta-cells.

iii. Hyperinsulinaemia and hypertension:

• Increaed insulin level leads to hyperinsulinaemia which in turn causes stimulation of sympathetic nervous system,
which results in vasoconstriction. and retention of sodium and water Both these changes lead to hypertension.
 Treatments of Obesity

• The best treatment for the obese individuals—in fact the only effective mode of treatment—is reduction of
body weight.

• All the aforementioned metabolic changes get significantly reversed if the ideal body weight is attained.

• This goal can be accomplished by reducing the intake of calories and performing controlled exercise.

• Frequent small meals with lots of vegetables have been found especially effective.

• Fat restricted diet may retard the ageing process also and thus prolong the lifespan?
Nutritional Anemia

Anemia is characterized by lower concentration of hemoglobin (reference 14-1 6 g/dl)

with a reduced ability to transport oxygen.
Nutritional anemia are classified based on the size of erythrocytes.

 Microcytic anemia: most common/ with reduced RBC size. Occurs due to the
deficiency of iron, copper and pyridoxine.

 Macrocytic anemia: RBC are large and immature. Mostly due to the deficiency of
folic acid and vitamin B12.

 Normocytic anemia: Size of the RBC is normal, but their quantity in blood is low.
Mostly found in protein-energy malnutrition
 MINERALS DEFICIENCY
Iron
• Iron deficiency is the most common and widespread nutrition disorders affecting people of all age groups in
the world.
• About 30% of world population is suffering from anemia caused by iron deficiency.
• Brain development in anemic children is seriously affected.
• Anemic person usually has less number of red blood cells and low oxygen supply.
• Diet diversification, supplementation with iron, folic acid as well as vitamin B12 and worm disinfestation
supports reduction in anemia. Folic acid deficiency itself is a serious issue particularly among women of child
bearing age.

Iodine: Iodine deficiency disorder (IDD) occurs due to inadequate production of thyroid hormone. It is most common
preventable mental impairment disease worldwide. WHO reported that 71% of world’s population use iodized salt but
still 28.5% of them have iodine deficient or insufficient status. In spite of universalization of iodized salt, people living
in areas where soil is deficient in iodine are still at high risk of IDD. Iodine deficiency may not cause death but can
result in disability.

Selenium: Selenium is needed for the metabolism of thyroid hormones and its deficiency is often seen in some
parts of the world.

Zinc: Zinc is essential for normal growth, pregnancy outcome, immune system and neuro behavioral
development. Analysis of Food balance sheet reveals that 17% of world population consume inadequate amount of
zinc. Zinc supplementation has shown reduced incidence of diarrhea, pneumonia, acute lower respiratory
infection in young children otherwise due to such infectious condition mortality rate was relatively high.
 EATING DISORDERS

This is an abnormal eating habits which has ill-effect on physical and mental health.

ANOREXIA NERVOSA

• This is an eating disorder characterized by immoderate food restriction. Inappropriate eating habits or
rituals, obsession with having a thin figure, and irrational fear of weight gain, as well as body self-perception.

BULIMIA NERVOSA

An eating disorder characterized by binge eating and purging or consuming a large amount of food in a short
amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting,
taking a laxative, diuretic, or stimulant and/or excessive exercise, because of an extensive concern for body
weight.

CLINICAL MANIFESTATION: Hypotension, Bradycardia or tachycardia, Depression, Swollen joints, Dry

hair and skin, fatigue etc.