Buy the Book PDA Download

Update Me E-mail alerts The Merck Manual Minute

Print This Topic Email This Topic

Nutrition is the science of food and its relationship to health. Nutrients are chemicals in foods that are used by the body for growth, maintenance, and energy. Nutrients that cannot be synthesized by the body and thus must be derived from the diet are considered essential. They include vitamins, minerals, some amino acids, and some fatty acids. Nutrients that the body can synthesize from other compounds, although they may also be derived from the diet, are considered nonessential. Macronutrients are required by the body in relatively large amounts; micronutrients are needed in minute amounts.

Lack of nutrients can result in deficiency syndromes (eg, kwashiorkor, pellagra) or other disorders (see Undernutrition). Excess intake of macronutrients can lead to obesity (see Obesity and the Metabolic Syndrome: Obesity) and related disorders; excess intake of micronutrients can be toxic. Also, the balance of various types of nutrients, such as how much unsaturated vs saturated fat is consumed, can influence the development of disorders.

Macronutrients

Macronutrients constitute the bulk of the diet and supply energy and many essential nutrients. Carbohydrates, proteins (including essential amino acids), fats (including essential fatty acids), macrominerals, and water are macronutrients. Carbohydrates, fats, and proteins are interchangeable as sources of energy; fats yield 9 kcal/g (37.8 kJ/g); proteins and carbohydrates yield 4 kcal/g (16.8 kJ/g).

Carbohydrates: Dietary carbohydrates are broken down into glucose and other monosaccharides. Carbohydrates increase plasma glucose levels, supplying energy. Simple carbohydrates are composed of small molecules, generally monosaccharides or disaccharides, which increase plasma glucose levels rapidly. Complex carbohydrates are composed of larger molecules, which are broken down into monosaccharides. Complex carbohydrates increase plasma glucose levels more slowly but for a longer time. Glucose and sucrose are simple carbohydrates; starches and fiber are complex carbohydrates.

The glycemic index measures how rapidly consumption of a carbohydrate increases plasma glucose levels. Values range from 1 (the slowest increase) to 100 (the fastest increase, equivalent to pure glucose—see Table 1: Nutrition: General Considerations: Glycemic Index of Some Foods). However, the actual rate of increase also depends on what foods are consumed with the carbohydrate.

Table 1
Glycemic Index of Some Foods Category Food Index* Beans Kidney 33 Red lentils 27 Soy 14 Bread Pumpernickel 49   White 69   Whole wheat 72 Cereals All bran 54   Corn flakes 83   Oatmeal 53   Puffed rice 90   Shredded wheat 70 Dairy Milk, ice cream, yogurt 34–38 Fruit Apple 38   Banana 61   Orange 43   Orange juice 49   Strawberries 32 Grains Barley 22   Brown rice 66   White rice 72 Pasta — 38 Potatoes Instant mashed (white) 86   Mashed (white) 72   Sweet 50 Snacks Corn chips 72   Oatmeal cookies 57   Potato chips 56 Sugar Fructose 22   Glucose 100   Honey 91   Refined sugar 64 *Values may vary.

Carbohydrates with a high glycemic index may increase plasma glucose to high levels rapidly. It is hypothesized that, as a result, insulin levels increase, inducing hypoglycemia and hunger, which tends to lead to consumption of excess calories and weight gain. Carbohydrates with a low glycemic index increase plasma glucose levels slowly, resulting in lower postprandial insulin levels and less hunger, which probably makes consumption of excess calories less likely. These effects are predicted to result in a more favorable lipid profile and a decreased risk of obesity, diabetes mellitus, and complications of diabetes if present.

Proteins: Dietary proteins are broken down into peptides and amino acids. Proteins are required for tissue maintenance, replacement, function, and growth. However, if the body is not getting enough calories from dietary sources or tissue stores (particularly of fat), protein may be used for energy.

As the body uses dietary protein for tissue production, there is a net gain of protein (positive nitrogen balance). During catabolic states (eg, starvation, infections, burns), more protein may be used (because body tissues are broken down) than is absorbed, resulting in a net loss of protein (negative nitrogen balance). Nitrogen balance is best determined by subtracting the amount of nitrogen excreted in urine and feces from the amount of nitrogen consumed.

Of the 20 amino acids, 9 are essential amino acids (EAAs); they cannot be synthesized and must be obtained from the diet. All people require 8 EAAs; infants also require histidine.

The weight-adjusted requirement for dietary protein correlates with growth rate, which decreases from infancy until adulthood. The daily dietary protein requirement decreases from 2.2 g/kg in 3-mo-old infants to 1.2 g/kg in 5-yr-old children and to 0.8 g/kg in adults. Protein requirements correspond to EAA requirements (see Table 2: Nutrition: General Considerations: Essential Amino Acid Requirements in mg/kg Body Weight). Adults trying to increase muscle mass need very little extra protein beyond the requirements in the table.

Table 2
Essential Amino Acid Requirements in mg/kg Body Weight Requirement Infant (4–6 mo) Child (10–12 yr) Adult Histidine 29 — — Isoleucine 88 28 10 Leucine 150 44 14 Lysine 99 49 12 Methionine and cystine 72 24 13 Phenylalanine and tyrosine 120 24 14 Threonine 74 30 7 Tryptophan 19 4 3 Valine 93 28 13 Total essential amino acids (excluding histidine) 715 231 86

The amino acid composition of protein varies widely. Biological value (BV) reflects the similarity in amino acid composition of protein to that of animal tissues; thus, BV indicates what percentage of a dietary protein provides EAAs for the body. A perfect match is egg protein, with a value of 100. Animal proteins in milk and meat have a high BV (~90); proteins in cereal and vegetables have a lower BV (~40), and some derived proteins (eg, gelatin) have a BV of 0. The extent to which dietary proteins supply each other's missing amino acids (complementarity) determines the overall BV of the diet. The recommended daily allowances (RDA) for protein assumes that the average mixed diet has a BV of 70.

Fats: Fats are broken down into fatty acids and glycerol. Fats are required for tissue growth and hormone production. Saturated fatty acids, common in animal fats, tend to be solid at room temperature. Except for palm and coconut oil, fats derived from plants tend to be liquid at room temperature; these fats contain high levels of monounsaturated fatty acids or polyunsaturated fatty acids (PUFAs).

Partial hydrogenation of unsaturated fatty acids (as occurs during food manufacturing) produces trans fatty acids, which are solid or semisolid at room temperature. In the US, the main dietary source of trans fatty acids is partially hydrogenated vegetable oils, used in manufacturing certain foods (eg, cookies, crackers, chips) to prolong shelf-life. Trans fatty acids may elevate LDL cholesterol and lower HDL; they may also independently increase the risk of coronary artery disease.

Essential fatty acids (EFAs) are linoleic acid, an ω-6 (n-6) fatty acid, and linolenic acid, an ω-3 (n-3) fatty acid. Other ω-6 acids (eg, arachidonic acid) and other ω-3 fatty acids (eg, eicosapentaenoic acid, docosahexaenoic acid) are required by the body but can be synthesized from EFAs.

EFAs are needed for the formation of various eicosanoids (biologically active lipids), including prostaglandins, thromboxanes, prostacyclins, and leukotrienes (see also Undernutrition: Essential Fatty Acid Deficiency). Consumption of ω-3 fatty acids may decrease the risk of coronary artery disease.

Requirements for EFAs vary by age. Adults require amounts of linoleic acid equal to at least 2% of total caloric needs and linolenic acid equal to at least 0.5%. Vegetable oils provide linoleic acid and linolenic acid. Oils made from safflower, sunflower, corn, soya, primrose, pumpkin, and wheat germ provide large amounts of linoleic acid. Marine fish oils and oils made from flaxseeds, pumpkin, soy, and canola provide large amounts of linolenic acid. Marine fish oils also provide some other ω-3 fatty acids in large amounts.

Macrominerals: Na, Cl, K, Ca, P, and Mg are required in relatively large amounts per day (see Table 3: Nutrition: General Considerations: Macrominerals, Table 4: Nutrition: General Considerations: Recommended Dietary References Intakes* for Some Macronutrients, Food and Nutrition Board, Institute of Medicine of the National Academies, and Table 2: Mineral Deficiency and Toxicity: Guidelines for Daily Intake of Minerals*).

Table 3
Macrominerals Nutrient Principal Sources Functions Ca Milk and milk products, meat, fish, eggs, cereals, beans, fruits, vegetables Bone and tooth formation, blood coagulation, neuromuscular irritability, muscle contractility, myocardial conduction Cl Many foods, mainly animal products but some vegetables; similar to Na Acid-base balance, osmotic pressure, blood pH, kidney function K Many foods, including whole and skim milk, bananas, prunes, raisins, meats Muscle activity, nerve transmission, intracellular acid-base balance, water retention Mg Green leaves, nuts, cereals, grains, seafood Bone and tooth formation, nerve conduction, muscle contraction, enzyme activation Na Many foods, including beef, pork, sardines, cheese, green olives, corn bread, potato chips, sauerkraut Acid-base balance, osmotic pressure, blood pH, muscle contractility, nerve transmission, maintenance of cell membrane gradients P Milk, cheese, meat, poultry, fish, cereals, nuts, legumes Bone and tooth formation, acid-base balance, energy production

Table 4
Recommended Dietary References Intakes* for Some Macronutrients, Food and Nutrition Board, Institute of Medicine of the National Academies Category Age or Time Frame (yr) Protein (g/kg) Energy(kcal/kg) Calcium (mg/kg) Phosphorus (mg/kg) Magnesium (mg/kg) Infants 0.0–0.5 2.2 108.3 66.7 50.0 6.7   0.5–1.0 1.6 94.4 66.7 55.6 6.7 Children 1–3 1.2 100.0 61.5 61.5 6.2   4–6 1.2 90.0 40.0 40.0 6.0   7–10 1.0 71.4 28.6 28.6 6.1 Males 11–14 1.0 55.6 26.7 26.7 6.0   15–18 0.9 45.5 18.2 18.2 6.1   19–24 0.8 40.3 16.7 16.7 4.9   25–50 0.8 36.7 10.1 10.1 4.4   51+ 0.8 29.9 10.4 10.4 4.5 Females 11–14 1.0 47.8 26.1 26.1 6.1   15–18 0.8 40.0 21.8 21.8 5.5   19–24 0.8 37.9 20.7 20.7 4.8   25–50 0.8 34.9 12.7 12.7 4.4   51+ 0.8 29.2 12.3 12.3 4.3 Pregnant   0.9 4.6 18.5 18.5 4.9 Breastfeeding 1st yr 1.0 7.9 19.0 19.0 5.4 *These amounts, expressed as average daily intakes over time, are intended to provide for individual variations among most healthy people living in the US under usual environmental stresses.

Water: Water is considered a macronutrient because it is required in amounts of 1 mL/kcal (0.24 mL/kJ) of energy expended, or about 2500 mL/day. Needs vary with fever, physical activity, and changes in climate and humidity.

Micronutrients

Vitamins and minerals required in minute amounts (trace minerals) are micronutrients (see Vitamin Deficiency, Dependency, and Toxicity and see Mineral Deficiency and Toxicity).

Water-soluble vitamins are vitamin C (ascorbic acid) and 8 members of the vitamin B complex: biotin, folate, niacin, pantothenic acid, riboflavin (vitamin B₂), thiamin (vitamin B₁), vitamin B₆ (pyridoxine), and vitamin B₁₂ (cobalamin).

Fat-soluble vitamins are vitamins A (retinol), D (cholecalciferol and ergocalciferol), E (α-tocopherol), and K (phylloquinone and menaquinone).

Only vitamins A, E, and B₁₂ are stored to any significant extent in the body; the other vitamins must be consumed regularly to maintain tissue health.

Essential trace minerals include chromium, copper, iodine, iron, manganese, molybdenum, selenium, and zinc. Except for chromium, each of these is incorporated into enzymes or hormones required in metabolism. Except for deficiencies of iron and zinc, micromineral deficiencies are uncommon in developed countries (see Mineral Deficiency and Toxicity).

Other minerals (eg, aluminum, arsenic, boron, cobalt, fluoride, nickel, silicon, vanadium) have not been proved essential for people. Fluoride, although not essential, helps prevent tooth decay by forming a compound with Ca (CaF₂), which stabilizes the mineral matrix in teeth.

All trace minerals are toxic at high levels, and some (arsenic, nickel, and chromium) may cause cancer.

Other Dietary Substances

The daily human diet typically contains as many as 100,000 chemicals (eg, coffee contains 1000). Of these, only 300 are nutrients, only some of which are essential. However, many nonnutrients in foods are useful. For example, food additives (eg, preservatives, emulsifiers, antioxidants, stabilizers) improve the production and stability of foods. Trace components (eg, spices, flavors, odors, colors, phytochemicals, many other natural products) improve appearance and taste.

Fiber: Fiber occurs in various forms (eg, cellulose, hemicellulose, pectin, gums). It increases GI motility, prevents constipation, and helps control diverticular disease. Fiber is thought to accelerate the elimination of cancer-causing substances produced by bacteria in the large intestine. Epidemiologic evidence suggests an association between colon cancer and low fiber intake and a beneficial effect of fiber in patients with functional bowel disorders, Crohn's disease, obesity, and hemorrhoids. Soluble fiber (present in fruits, vegetables, oats, barley, and legumes) reduces the postprandial increase in plasma glucose and insulin and can reduce cholesterol levels.

The typical Western diet is low in fiber (about 12 g/day) because of a high intake of highly refined wheat flour and a low intake of fruits and vegetables. Increasing fiber intake to about 30 g/day by consuming more vegetables, fruits, and high-fiber cereals and grains is generally recommended. However, very high fiber intake may reduce absorption of certain minerals.

Last full review/revision July 2007 by Margaret-Mary G. Wilson, MD

Content last modified July 2007