NUT201: Fundamentals of Human Nutrition

Spring 2023

Chapter 1: Introduction to
Nutrition and Health
 Learning Outcomes
[Link] the relationship between
nutrition and health
[Link] between macronutrients
and micronutrients
[Link] the Dietary Reference
Intake (DRI) glossary and food labels
 What is the percentage of individuals dying in
Lebanon because of Nutrition related conditions?

35% 48%

80% 87%
 Part 1:
What is Nutrition?

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 Nutrition defined

The science that links foods to health and disease

It includes the processes by which the human organism ingests,

digests, absorbs, transports, and excretes food substances
(Smith;Collene et al., 2018)
 Mortality:
Lebanon ≈80% of total deaths are due to
conditions influenced by nutrition

(World Health Organization, 2018)

 Nutrition & Diseases

Not all diseases are equally influenced by the diet

 Some are purely genetic, some may be influenced by diet,

some are purely dietary

(Smith;Collene et al., 2018)

What is Malnutrition?
Failing health that results from long-standing dietary practices that
do not coincide with nutritional needs

Overnutrition: A state in which nutritional intake greatly exceeds the body’s needs
Undernutrition: Failing health that results from a long-standing dietary intake that is
not enough to meet nutritional needs

Neither state is
conductive to
good health
(Smith;Collene et al., 2018)
Nutrients vs. Food

Food: any substance that the body can take in and assimilate that will
enable it to stay alive and to grow
 It is the carrier of nourishment

Nutrients: components of food that are vital for the body’s functioning,
growth and maintenance

(Smith;Collene et al., 2018)

 Nutrients

Micronutrients (Needed in Small Amounts) Macronutrients (Needed in Large Amounts)

Vitamins Minerals Carbohydrate

Fat
Organic Inorganic substances Protein
substances originating from the Water
made by plants soil and water and
or animals then absorbed by
plants or consumed by
animals

(Smith;Collene et al., 2018)

 Terms defined…
What is the difference?

Nutrition Nutrients
study of nutrients in foods and in the body components of foods that are needed
for the body’s proper functioning

Malnutrition Diet
any condition caused by inappropriate
dietary intake compared to an individual the foods a person usually eats and drinks
dietary needs
 Part 2:
Nutrients & Energy

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Where does our
energy come from?
Energy in food fuels our body

This energy is measured in Calories (Cal or Kcal) which is a unit of energy

A Calorie: the amount of heat energy necessary to raise the temperature of 1 kg

water 1 degree Celsius
 Energy-Yielding
Nutrients
 Nutrients that the body can use as energy source:
Carbohydrates, Fats (Lipids), Proteins
Nutrient Energy
Carbohydrate 4 Cal/g (Kcal/g)
Protein 4 Cal/g (Kcal/g)
Fat 9 Cal/g (Kcal/g)

 Alcohol: 7 Cal/g but alcohol is not considered a nutrient

 Water, Vitamins, and Minerals do not yield energy (Wardlaw & Smith, 2009)
 Calculating Calories
How many calories in a typical deluxe hamburger sandwich?

- Carbohydrate: 39 grams

- Fat: 32 grams

- Protein: 30 grams

Total calories = 156 + 288 + 120 = 564 Kcal

Why do we need
energy?

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Metabolic Pathways
 How do we judge which
foods are most nutritious?

(Smith;Collene et al., 2018)

Foods that offer the most nutrients per calorie count are most nutritious
 Nutrient Density
 Nutrient density is used to determine the nutritional quality of a food

 Foods rich in nutrients relative to their energy contents are nutrient dense

amount of nutrients
amounts of calories

 The more nutrients and the fewer the Calories, the higher the nutrient density

(Smith;Collene et al., 2018)

Empty calories?
Comparison
of Nutrient
Density

(Smith;Collene et al., 2018)

 Beyond Nutrients…
 In addition to nutrients, foods may contain additional
beneficial non-nutrients called phytochemicals
 Phytochemicals

Compounds in plant-derived foods that have biological

activity in the body

Confer color, taste, etc. on foods

Many are thought to have desirable health benefits

(Biesalski, 2008)
 Phytochemicals
Capsaicin: a compound in pepper that gives burning taste with heart
health benefits

Allicin: a compound in garlic that gives pungent flavor and has

antimicrobial properties

Tannins: antioxidants found in wine and tea that may prevent some
cancers

(Biesalski, 2008)
 Phytochemicals

(Biesalski, 2008)
 Part 3:
Nutrition Guidelines

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The challenge of
choosing the right
foods

FLA
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All foods once looked like this...
...but now
many foods
look like this
 The variety of foods available to the
consumer today makes it harder, rather
than easier to plan a nutritious diet
Factors
Affecting
Food
Choices
 The 5 Characteristics
of a NUTRITIOUS DIET
Adequacy (provides enough of the essential nutrients)

Balance (does not overemphasize one nutrient or food type at the expense of another)

Calorie control (choose foods with the right amount of energy to maintain a healthy
weight, adjusted to energy expenditure)

Moderation (stay moderate with salt, sugar, saturated and trans fatty acids, etc.)

Variety (have different food choices each day to ensure intakes of all nutrients)
 Dietary Reference Intakes
“Reference values that are quantitative estimates
of nutrient intakes to be used for planning and
assessing diets for apparently healthy people”

Umbrella term that includes four reference

intakes and a recommendation for energy intake
DRI

EAR RDA AI UL EER

(USDA)
 Dietary Reference Intakes (DRI) Glossary
Estimated Average Estimated Energy Recommended
Tolerable Upper
Requirements Requirements Daily (or Dietary) Adequate Intake
Intake Level (UL)
(EAR) (EER) Allowance (RDA)

The highest Daily nutrient Adequate

Energy intake nutrient intake intake of a intake based
Amount of to meet the level that is nutrient on
sufficient to energy balance likely to pose sufficient to approximations
maintain a in a healthy no risk of meet the needs
specific body adult of a adverse health of 97.5% of
function in half defined age, effects to healthy
of the gender, weight, almost all individuals in a Used when
population height, and individuals in specific age insufficient
activity level the general and gender evidence to
population. group determine RDA

Research use Clinical use Safety concern Target intake Target intake
(USDA)
for the public for the public
DRI glossary

(Smith;Collene et al., 2018)

(National Academies of Sciences & Medicine, 2019)
Dietary Guidelines

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 Dietary Guidelines

Tailored to a nation’s nutrition guidelines

Different countries have different
guidelines and different pictorial
representations
 Have you seen these before?

1992 pyramid 2005 pyramid

 MyPlate

 Current American pictorial guide

Illustrates the five food groups that are
the building blocks for a healthy diet
using a familiar image
Divided into sections of approximately
30% grains, 30% vegetables, 20% fruits,
and 20% protein, and a smaller circle for
dairy, such as a glass of low-fat/nonfat
milk or a yogurt cup
(Smith;Collene et al., 2018)
(Smith;Collene et al., 2018)
 MyPlate:
Three Main Points
1. Balancing calories
• Enjoy your food, but eat mindfully
• Avoid over-sized portions
2. Foods to increase
• Make half your plate fruits and vegetables
• Make at least half your grains whole grains
• Switch to fat-free or low-fat (1%) milk
3. Foods to decrease
• Limit foods and beverages higher in added sugars, saturated fat, and
sodium, and limit alcoholic beverages
• Drink water instead of sugary drinks
WHO Eastern Mediterranean Region: user-friendly guide— key recommendations

(Houalla; Al-Jawaldeh et al., 2012)

 Food-based
Dietary Guidelines
LEBANON

• Food-Based Dietary Guidelines for Lebanese Adults

• Promoting healthy eating in the Lebanese adult
population
(Hwalla;Nassreddine et al., 2013)
 14 food-based guidelines
[Link] and maintain a healthy body weight
[Link] physically active every day
[Link] a variety of nutritious foods every day
for a balanced diet
[Link] cereals, especially whole grains, as the
basis of daily meals
[Link] more fruit and vegetables daily
[Link] legume-based dishes regularly
and enjoy some unsalted nuts and seeds
[Link] low-fat milk and dairy products
every day
(Hwalla;Nassreddine et al., 2013)
 14 food-based guidelines
8. Consume at least two servings of fish,
including fatty fish, every week
[Link] lean red meat and poultry
[Link] intake of sugar, especially added
sugar from sweetened foods and beverages
[Link] intake of solid fats and replace with
vegetable oils
[Link] intake of table-salt and high-salt foods
[Link] plenty of safe water every day
[Link] safe food

(Hwalla;Nassreddine et al., 2013)

(Haven, 2021)
 Part 4:
The Mediterranean Diet
& Nutrition Information

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Mediterranean Diet?
 Interest in the diet began in the 1950s

 Acciaroli, a southern Italian town with about

300 people who have hit 100 years of age!!

 Lower rates of Alzheimer's & heart disease!

 People who eat traditional Mediterranean

diets die much less frequently than those
eating the American diet and Northern
Europe diet
 The
Mediterranean
Food Guide
Pyramid
The Mediterranean Diet is:
Higher in fat than the usual (>40% of calories from fat)
Low in saturated fats, high in monounsaturated fats (olive oil)
Low in meat & meat products
High in legumes & grains
High in fruits & vegetables (phytochemicals, antioxidants)
Moderate in milk & milk products (yogurt)
Moderate in alcohol
Milk
 Spotting accurate
nutrition information

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Elements of Nutritional
Quackery in a nutshell
Claim is too good to be true
Claims to have a secret formula
Makes unrealistic guarantees
Claims weight loss much greater than half a kilogram in a
week
Uses “Star” testimonials
 Scientific Challenge

One experiment does not “prove” or “disprove” anything

A finding that has stood up to repeated rigorous testing

may become a theory

Information must be looked at with an educated eye

 How to determine if a
website is reliable?
WHO? Is the owner of the website qualified to speak on nutrition
(Dietitian? Physician? Other?)
WHEN? When was the website updated?
WHERE? .gov/ .org/ .edu/
WHY? selling of a product?
WHAT? What is the message-beware of information that
contradicts common knowledge
 Reliable Websites
Examples
Credible Website/Scientific Databases
[Link] [Link]
[Link] [Link]
[Link] [Link]
[Link] [Link]
[Link] [Link]
[Link] [Link]
[Link] [Link]
 Part 5:
Food Labelling

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 Nutrition Fact Label
Descriptive matter attached to a food or beverage product
Helps in food choice selection and in planning a nutritious and balanced diet
Information on the label should contain:
Name of product
Name and address of manufacturer
Net content (weight)
Expiry and manufacturing dates
An ingredient list
A nutrition facts panel

The label may also contain one or more nutritional claims or Health claims
(US Food and Drug Administration, 2022)
Nutrition Facts Label

Updated in 2016 to incorporate

updates in public health nutrition

(US Food and Drug Administration, 2022)

 Food Labels in Lebanon

• Labels should include

• The net weight of the product
• The manufacturer
• Production and expiry date
• Ingredients
• The country of origin
• Labels should be printed on the imported goods
• In Arabic, English, or French

NUTRITION FACTS LABEL IS NOT MANDATORY

(International Trade Administration, 2022)
 How to Read
Nutrition Facts
1. Check Serving Information
2. Check Calories
3. Check Nutrients
4. Check % Daily Values
 1. Serving Information
• The first place to start when looking at the Nutrition Facts label
• Serving size
• Number of servings in the package
• The size of the serving on the food package influences the number of calories
and all the nutrient amounts listed on the top part of the label
• Example: In this label, one serving of macaroni and cheese equals one cup
• If you ate the whole package
• You would eat 4 cups
• If you ate two cups
• You would be consuming two servings
• That doubles the calories and other nutrient numbers
(Smith;Collene et al., 2018)
[Link] Retrieved June 26, 2022
 2. Calories

• Calories = how much energy there is in a serving of this food

General Guide to Calories

 40 Calories is low
 100 Calories is moderate
 400 Calories or more is high

• Example
• In the example, there are 280 calories in one serving of lasagna
• What if you ate the entire package?
• Then, you would consume 4 servings, or 1,120 calories

(Smith;Collene et al., 2018)

[Link] Retrieved June 26, 2022

 3. Nutrients

• Some key nutrients that impact health

• The label can be used to support personal dietary
needs

• Nutrients to get less of:

• Saturated Fat, Sodium, and Added Sugars

• Nutrients to get more of:

• Dietary Fiber, Vitamin D, Calcium, Iron, Potassium

(Smith;Collene et al., 2018)

[Link] Retrieved June 26, 2022

 4. % Daily Value (%DV)

• DV: reference amounts

(expressed in g, mg, or μg)
of nutrients to consume or
not to exceed/day

• %DV: % of the DV for each

nutrient in 1 serving

[Link] Retrieved June 26, 2022

 4. %DV
• %DV
• Shows how much a nutrient in a serving of a
food contributes to a total daily diet
• Based on 100% of the daily requirements
for that nutrient (2,000 Kcal diet)

• Helps determine if a serving of food is high or

low in a nutrient
• 5% DV or less of a nutrient per serving: low
• 20% DV or more of a nutrient per serving: high

(US Food and Drug Administration, 2022)

[Link] Retrieved June 26, 2022

 4. %DV
• How do the DV relate to the %DVs?
• For each nutrient, there is a DV, a
%DV, and dietary advice or a goal

• Following this dietary advice allows to

stay within public health experts’
recommendations, based on a
2,000-calorie daily diet

(US Food and Drug Administration, 2022)

[Link] Retrieved June 26, 2022

 4. %DV

• Upper Limit - Eat "Less than"...

• Upper limit means it is recommended to stay below or eat "less than" the Daily
Value of the nutrients’ amounts listed per day
• For example, the DV for saturated fat is 20g, which is 100% DV for this nutrient
• What is the goal or dietary advice?
• To eat "less than" 20g or 100%DV each day

• Lower Limit - Eat "At least"...

• The DV for dietary fiber is 28g, which is 100% DV for this nutrient
• This means it is recommended to eat "at least" this amount of dietary fiber on
most days

(US Food and Drug Administration, 2022)

[Link] Retrieved June 26, 2022

 4. % Daily Value (%DV)
• Example: Look at the amount of sodium in 1 serving
• Is %DV of 37% contributing a lot or a little to your diet?
• This is a HIGH sodium product (>20% DV for sodium)
• If you consume 2 servings
•  74% of the DV for sodium (≈¾ of an entire day’s worth of sodium)

(US Food and Drug Administration, 2022)

[Link] Retrieved June 26, 2022

 4. % Daily Value (%DV)
Unlike RDA, DV do not vary among age groups and life stages

Reflect the needs of an “average” person – a person eating

2000Cal/d (no gender difference, set close to RDA)

Because the DV apply to all people, they are much less useful as
nutrient intake goals for individuals

(US Food and Drug Administration, 2022)

 Nutrients without (%DV)

Trans fat, sugars and proteins do not list a %DV on the

Nutrition Facts label

1. Trans fats should be kept as low as possible…

setting a daily value is like allowing some intake

2. Sugars include the natural sugars and the added

sugar together, so no recommended intake

3. Proteins recommendations are per Kg of body weight

 Ingredients
The product’s ingredients must be listed in
descending order of predominance by weight

Sugar highest by weight Whole grain oats highest by

weight and Vitamin E lowest
 Front of pack label
• The World Health Organization (WHO) has recommended the use of
Front of Pack (FoP) Nutrition labels to:
• Support individuals in assessing the diet quality of food products
• Empower individuals to make healthy dietary choices
• Promote food reformulation

• More than 30 governments have issued FoP though mandatory or

voluntary approaches.

• Analysis is under way to assess the effectiveness of FoP label

(Thow;Jones et al., 2020)

 Front of pack label

(Thow;Jones et al., 2020)

 Nutrient Claims

If a food meets specified criteria, the label may

display certain approved nutrient claims
concerning the product’s nutritive value
(US Food and Drug Administration, 2022)
 Nutrient Claims

They have very precise/approved nutritional meanings

– Reduced calories: at least 25% lower in Cal than regular food

– Low Cal: not more than 40 kcal/serving
– Fat free: less than 0.5g of fat per serving
– Low sodium: 140 mg or less sodium/serving
– Low cholesterol: <20mg of cholesterol/ serving
 Health Claims

Health claims describe a relationship between a food substance (a

food, food component, or dietary supplement ingredient), and reduced
risk of a disease or health-related condition

Claims on labels should be from a list of approved Health Claims

Any additional claims must be reviewed and evaluated prior to use

 Health Claims

Some approved health claims

•Diet with enough calcium associated with a
↓ risk of osteoporosis
•Diet low in total fats associated with a ↓risk
of some cancers
•Diet low in saturated fat and cholesterol
associated with a ↓ risk of cardiovascular
disease
•Diet low in sodium and high in potassium
associated with a ↓ risk of hypertension

•“May” or “Might” qualifier must be

present in the statement
 Feel like pizza?

• Total Fat : 10g

• Total Carbohydrates (CHO): 36g
• Total Protein: 12g
• Sodium: 640mg
TOTAL CALORIES???
 Pizza slice

• Total Fat : 10g x 9 Cal = 90 Cal

• Total Carbohydrates (CHO): 36g x 4 Cal = 144 Cal

• Total Protein: 12g x 4 Cal = 48 Cal

• Sodium: 640mg –NO CALORIES

TOTAL 90+144+48= 282 Cal

Can you compare caloric, protein and fat content?

Product 1 Option 2

4 tablespoons regular labneh +

1 standard zaatar mankoushe 1 loaf of Arabic bread + 2 boiled eggs
a cucumber + a tomato
 Food Labels

Product 1 Product 2

1. Which product has more

calories per cup?
2. Which product has more
added sugars per cup?
(Smith;Collene et al., 2018)
 Recommendations for Food Choice
How to translate the science of nutrition into practical terms?

Dietary
Dietary Pictorial
Reference
Guidelines Guidelines
Intakes
Scientists & Researchers Government Agencies Government Agencies

Nutrient needs for each Nutrient needs are Dietary Guidelines are
nutrient, determined translated into guidelines transformed into easy-to-
through research of food intakes read images

Grams & milligrams &

Food is categorized into Made for the consumer &
micrograms for nutrients
groups and portions are include examples like the
to avoid deficiency &
recommended pyramid, the plate…
toxicity
(Smith;Collene et al., 2018)
 References
• Biesalski, H. (2008). Water Electrolytes and Micronutrients. Retrieved from:
[Link]
• Coats, L., Bernstein, J., Dodge, E., Bechard, L., & Aboul-Enein, B. H. (2019). Food-based dietary guidelines of
Arabic-speaking countries: A culturally congruent profile. Public health nutrition, 22(6), 1129-1137.
• Houalla, N., Al-Jawaldeh, A. E., Bagchi, K., Hachem, F., El Ati, J., Omidvar, N., . . . Organization, W. H. (2012).
Promoting a healthy diet for the WHO Eastern Mediterranean Region: user-friendly guide.
• Hwalla, N., Nassreddine, L., & Jarrar, S. (2013). The Food-Based Dietary Guideline Manual for Promoting
Healthy Eating in the Lebanese Adult Population. Beirut, Lebanon: The Faculty of Agricultural and Food
Sciences, American University of Beirut.
• Montagnese, C., Santarpia, L., Iavarone, F., Strangio, F., Sangiovanni, B., Buonifacio, M., . . . Pasanisi, F.
(2019). Food-based dietary guidelines around the world: eastern Mediterranean and Middle Eastern countries.
Nutrients, 11(6), 1325.
• National Academies of Sciences, E., & Medicine. (2019). Dietary Reference Intakes for sodium and potassium.
• Smith, A. M., Collene, A., & Spees, C. (2017). Contemporary nutrition: A functional approach: McGraw Hill
Education.
• Thow, A. M., Jones, A., Huckel Schneider, C., & Labonté, R. (2020). Increasing the public health voice in global
decision-making on nutrition labelling. Globalization and health, 16(1), 1-6.
 References
• International Trade Administration. (2022). Lebanon - Country Commercial Guide, Retrieved from
[Link]
• Haven, J. (2021). Make Every Bite Count with the Dietary Guidelines, 2020-2025: Start Simple with MyPlate!
• USDA. DRI Glossary. Food and Nutrition Information Center. Retrieved from
h[Link]
• US Food and Drug Administration. (2022). Labeling & Nutrition Guidance Documents & Regulatory Information.
Retrieved from [Link]
supplements/labeling-nutrition-guidance-documents-regulatory-information
• Wardlaw, G. S., A. (2009). Contemporary Nutrition: A Functional Approach McGraw Hill Higher Education
• World Health Organization. (2016). Report of the commission on ending childhood obesity: World Health
Organization.
• WHO (Producer). (2018, April 9, 2021). Lebanon. World Health Organization - Noncommunicable Diseases
(NCD) Country Profiles, 2018. Retrieved from [Link]