SAMENVATTING VOEDING
Boek: Understanding Normal and Clinical Nutrition (11th edition) + aanvullende literatuur
Inhoud
Stof bij hoorcollege 1: ‘Micronutriënten: vitaminen en mineralen’ ................................................................................. 2
H1: An Overview of Nutrition ....................................................................................................................................... 2
H10: The Water-Soluble Vitamins: B Vitamins and Vitamin C ...................................................................................... 3
H11: The Fat-Soluble Vitamins: A, D, E and K ............................................................................................................... 9
H12: Water and the Major Minerals ........................................................................................................................... 13
H13: The Trace Minerals ............................................................................................................................................. 17
Stof bij hoorcollege 2: ‘Fysiologie van het maagdarmkanaal’ ........................................................................................ 22
H3: Digestion, Absorption and Transport ................................................................................................................... 22
H4: The Carbohydrates: Sugars, Starches and Fibers ................................................................................................. 28
H5: The Lipids: Triglycerides, Phospholipids and Sterols ............................................................................................ 29
H6: Protein: Amino Acids ............................................................................................................................................ 31
Stof bij hoorcollege 3: ‘Macronutriënten: energie uit voeding en koolhydraten’ .......................................................... 31
H1: An Overview of Nutrition ..................................................................................................................................... 31
H4: The Carbohydrates: Sugars, Starches and Fibers ................................................................................................. 32
Stof bij hoorcollege 4: ‘Voedselconsumptiemethoden’ ................................................................................................. 37
H17: Nutrition Care and Assessment .......................................................................................................................... 37
Stof bij hoorcollege 5: ‘Macronutriënten: vetten’ .......................................................................................................... 38
H5: The Lipids: Triglycerides, Phospholipids and Sterols ............................................................................................ 38
Stof bij hoorcollege 6: ‘Lichaamssamenstelling’ ............................................................................................................. 41
Methoden voor het vaststellen van de lichaamssamenstelling – professor dr. ir. M. Visser ..................................... 41
H8: Energy Balance and Body Composition ................................................................................................................ 41
H17: Nutrition Care and Assessment .......................................................................................................................... 43
, Appendix E: Nutrition Assessment: Supplemental Information ................................................................................. 44
Stof bij hoorcollege 7: ‘Macronutriënten: eiwitten’ ....................................................................................................... 44
H6: Protein: Amino Acids ............................................................................................................................................ 44
Stof bij hoorcollege 9: ‘Energiebalans’............................................................................................................................ 48
H8: Energy Balance and Body Composition ................................................................................................................ 48
H9: Weight Management: Overweight, Obesity and Underweight ........................................................................... 51
Basic pathology. Chapter 7: ‘Environmental and Nutritional Diseases’. Kumar et al. ................................................ 57
Stof bij hoorcollege 10: ‘De macht van het menu’ ......................................................................................................... 58
Planbureau voor de leefomgeving (2013). De Macht van het Menu. Oplossingsrichtingen voor een duurzamer en
gezonder Nederlands voedselsysteem. Den Haag: PBL. ............................................................................................. 58
Stof bij hoorcollege 11: ‘Voedselverdeling wereldwijd’ ................................................................................................. 64
World View of Nutrition: The Faces of Global Malnutrition – Insel ........................................................................... 64
Stof bij hoorcollege 12: ‘Klinische voeding’ .................................................................................................................... 67
H17: Nutrition Care and Assessment .......................................................................................................................... 67
H18: Nutrition Intervention ........................................................................................................................................ 71
H20: Enteral Nutrition Support ................................................................................................................................... 74
H21: Parenteral Nutrition Support.............................................................................................................................. 76
Werkcollege Klinische Voeding ................................................................................................................................... 78
1
,Stof bij hoorcollege 1: ‘Micronutriënten: vitaminen en mineralen’
H1: An Overview of Nutrition
Dietary Reference Intakes
Using the results of thousands of research studies, 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. These
recommendations are called Dietary Reference Intake (DRI).
Establishing Nutrient Recommendations
The DRI committee consists of highly qualified scientists who base their estimates of nutrient needs on careful
examination and interpretation of scientific evidence. These recommendations apply to healthy people and may not
be appropriate for people with diseases that increase or decrease nutrient needs. There are four categories:
➢ Estimated Average Requirements (EAR): how much of a nutrient is needed in the diet, there is a different
criterion for each nutrient based on its roles in supporting various activities in the body and in reducing
disease risks. Each person’s body is unique and has its own set of requirement. Therefore the
recommendations are clustered into groups based on gender and age. The EAR is the average amount that
appears sufficient for half of the population in that group.
➢ Recommended Dietary Allowances (RDA): what intake of a nutrient is recommended for everybody. If
people consumed exactly the average requirement of a given nutrient everyday, approximately half of the
population would develop deficiencies of that nutrient. Recommendations are therefore set greater than the
EAR to meet the needs of most healthy people. Small amounts greater than the daily requirement do no
harm. To ensure that the nutrient RDA meet the needs of as many people as possible, the RDA are set near
the top pend of the range of the population’s estimated requirements.
➢ Adequate Intakes (AI): when there is insufficient scientific evidence to determine an EAR (which is needed to
set an RDA). Then an AI is established instead of an RDA. An AI reflects the average amount of a nutrient that
a group of healthy people consumes. Like the RDA, the AI may be used as nutrient goals for individuals.
Although, an AI must rely more heavily on scientific judgements because sufficient evidence is lacking.
➢ Tolerable Upper Intake Levels (UL): the point beyond the recommended intake where a nutrient is likely to
become toxic.
Establishing Energy Recommendations
In contrast to the RDA and AI values for nutrients, the recommendation for energy is not generous. Excess energy
can’t be readily excreted and is eventually stored as body fat. These reserves may be beneficial when food is scarce,
but they can also lead to obesity and its associated health consequences.
➢ Estimated Energy Requirement (EER): the energy recommendation represents average dietary energy intake
(kcalories per day) that will maintain energy balance in a person who has a healthy body weight and level of
physical activity. Balance is key to the energy recommendation. Enough food energy is needed to sustain a
healthy and active life, but too much can lead to weight gain and obesity.
➢ Acceptable Macronutrient Distribution Ranges (AMDR): people don’t eat energy directly; they derive energy
from foods containing carbohydrates, fats and proteins. Each of these three nutrients contributes to the
total energy intake, and those contributions vary in relation to one another. The composition of a diet that
provides adequate energy and nutrients and reduces the risk of chronic diseases:
• 45-65% kcalories from carbohydrate
• 20-35% kcalories from fat
• 10-35% kcalories from protein
Using Nutrient Recommendations
Although the intent of nutrient recommendations seems simple, they are the subject of much misunderstanding and
controversy. Perhaps the following facts will help put them in perspective:
1. Estimates of adequate energy and nutrient intakes apply to healthy people. They need to be adjusted for
malnourished people or those with medical problems who may require supplemented or restricted dietary
intakes.
2. Recommendations are not minimum requirements, nor are they necessarily optimal intakes for all
individuals. They only target most of the people and can’t account for individual variations in needs.
3. Most nutrient goals are intended to be met through diets composed of a variety of foods whenever possible.
Because foods contain mixtures of nutrients and nonnutrients, they deliver more than just those nutrients
covered by the recommendations.
2
, 4. Recommendations apply to average daily intakes. Trying to meet the recommendations for every nutrient
every day is difficult and unnecessary. The length of time over which a person’s intake can deviate from the
average without risk of deficiency or overdose varies for each nutrient, depending on how the body uses and
stores the nutrient.
5. Each of the categories serves a unique purpose. For example, the EAR are most appropriately used to
develop and evaluate nutrition programs for groups. The RDA (or AI) can be used to set goals for individuals.
The UL serve as a reminder to keep nutrient intakes less than amounts that increase the risk of toxicity.
Comparing Nutrient Recommendations
At least 40 different nations and international organizations have published nutrient standards. Slight differences
may be apparent, reflecting differences both in the interpretation of the data from which the standards where
derived and in the food habits and physical activities of the populations they serve. Many countries use the
recommendations developed by two international groups: FAO (Food and Agriculture Organization) and WHO
(World Health Organization). The FAO/WHO nutrient recommendations are considered sufficient to maintain health
in nearly all healthy people.
H10: The Water-Soluble Vitamins: B Vitamins and Vitamin C
The Vitamins – An Overview
The vitamins differ from macronutrients in the following ways:
➢ Structure. Vitamins are individual units; they are not linked together.
➢ Function. Vitamins do not yield energy when metabolized; many of them do, however, assist the enzymes
that participate in the release of energy from carbohydrates, fats and proteins.
➢ Food contents. The amounts of vitamins people ingest from foods and the amounts they require daily are
measured in micrograms (ug) or milligrams (mg), rather than grams (g).
The vitamins are similar to the energy-yielding nutrients in that they are essential, organic and available foods.
Bioavailability
Some water-soluble vitamins are synthesized by GI tract bacteria and absorbed by the large intestine, but not in
quantities great enough to meet the body’s needs; foods must supply these essential nutrients. The amount of
vitamins available from foods depends not only on the quantity provided by a food but also on the amount absorbed
and used by the body – referred to as the vitamins’ bioavailability. The quantity of vitamins in a food can be
determined relatively easy. Determining the bioavailability of a vitamin is a more complex task because it depends
on many factors, including:
➢ Efficiency of digestion and time of transit through the GI tract
➢ Previous nutrient intake and nutrition status
➢ Method of food preparation
➢ Source of the nutrient
➢ Other foods consumed at the same time
Precursors
Some of the vitamins are available from foods in inactive forms known as precursors, or provitamins. Once inside the
body, the precursor is converted to an active form of the vitamin. For example, beta-carotene is a precursor to
vitamin A. Thus, in measuring a person’s vitamin intake, it’s important to count both the amount of the active
vitamin and the potential amount available from its precursors.
Organic nature
Fresh foods naturally contain vitamins, but because these vitamins are organic, they can be readily destroyed during
processing. Therefore, processed foods should be used sparingly, and fresh foods should be handled with care
during storage and in cooking.
Solubility
Carbohydrates and proteins are hydrophilic and lipids are hydrophobic. The vitamins divide along the same lines –
the hydrophilic, water-soluble ones are the B vitamins (thiamin, riboflavin, niacin, biotin, pantothenic acid, vitamin
B6, folate and vitamin B12) and vitamin C; the hydrophobic, fat-soluble ones are vitamins A, D, E and K. solubility is
apparent in the food sources of the different vitamins, and it affects their absorption, transport, storage and
excretion by the body. The water-soluble vitamins are found in the watery compartments of food; the fat-soluble
3
Boek: Understanding Normal and Clinical Nutrition (11th edition) + aanvullende literatuur
Inhoud
Stof bij hoorcollege 1: ‘Micronutriënten: vitaminen en mineralen’ ................................................................................. 2
H1: An Overview of Nutrition ....................................................................................................................................... 2
H10: The Water-Soluble Vitamins: B Vitamins and Vitamin C ...................................................................................... 3
H11: The Fat-Soluble Vitamins: A, D, E and K ............................................................................................................... 9
H12: Water and the Major Minerals ........................................................................................................................... 13
H13: The Trace Minerals ............................................................................................................................................. 17
Stof bij hoorcollege 2: ‘Fysiologie van het maagdarmkanaal’ ........................................................................................ 22
H3: Digestion, Absorption and Transport ................................................................................................................... 22
H4: The Carbohydrates: Sugars, Starches and Fibers ................................................................................................. 28
H5: The Lipids: Triglycerides, Phospholipids and Sterols ............................................................................................ 29
H6: Protein: Amino Acids ............................................................................................................................................ 31
Stof bij hoorcollege 3: ‘Macronutriënten: energie uit voeding en koolhydraten’ .......................................................... 31
H1: An Overview of Nutrition ..................................................................................................................................... 31
H4: The Carbohydrates: Sugars, Starches and Fibers ................................................................................................. 32
Stof bij hoorcollege 4: ‘Voedselconsumptiemethoden’ ................................................................................................. 37
H17: Nutrition Care and Assessment .......................................................................................................................... 37
Stof bij hoorcollege 5: ‘Macronutriënten: vetten’ .......................................................................................................... 38
H5: The Lipids: Triglycerides, Phospholipids and Sterols ............................................................................................ 38
Stof bij hoorcollege 6: ‘Lichaamssamenstelling’ ............................................................................................................. 41
Methoden voor het vaststellen van de lichaamssamenstelling – professor dr. ir. M. Visser ..................................... 41
H8: Energy Balance and Body Composition ................................................................................................................ 41
H17: Nutrition Care and Assessment .......................................................................................................................... 43
, Appendix E: Nutrition Assessment: Supplemental Information ................................................................................. 44
Stof bij hoorcollege 7: ‘Macronutriënten: eiwitten’ ....................................................................................................... 44
H6: Protein: Amino Acids ............................................................................................................................................ 44
Stof bij hoorcollege 9: ‘Energiebalans’............................................................................................................................ 48
H8: Energy Balance and Body Composition ................................................................................................................ 48
H9: Weight Management: Overweight, Obesity and Underweight ........................................................................... 51
Basic pathology. Chapter 7: ‘Environmental and Nutritional Diseases’. Kumar et al. ................................................ 57
Stof bij hoorcollege 10: ‘De macht van het menu’ ......................................................................................................... 58
Planbureau voor de leefomgeving (2013). De Macht van het Menu. Oplossingsrichtingen voor een duurzamer en
gezonder Nederlands voedselsysteem. Den Haag: PBL. ............................................................................................. 58
Stof bij hoorcollege 11: ‘Voedselverdeling wereldwijd’ ................................................................................................. 64
World View of Nutrition: The Faces of Global Malnutrition – Insel ........................................................................... 64
Stof bij hoorcollege 12: ‘Klinische voeding’ .................................................................................................................... 67
H17: Nutrition Care and Assessment .......................................................................................................................... 67
H18: Nutrition Intervention ........................................................................................................................................ 71
H20: Enteral Nutrition Support ................................................................................................................................... 74
H21: Parenteral Nutrition Support.............................................................................................................................. 76
Werkcollege Klinische Voeding ................................................................................................................................... 78
1
,Stof bij hoorcollege 1: ‘Micronutriënten: vitaminen en mineralen’
H1: An Overview of Nutrition
Dietary Reference Intakes
Using the results of thousands of research studies, 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. These
recommendations are called Dietary Reference Intake (DRI).
Establishing Nutrient Recommendations
The DRI committee consists of highly qualified scientists who base their estimates of nutrient needs on careful
examination and interpretation of scientific evidence. These recommendations apply to healthy people and may not
be appropriate for people with diseases that increase or decrease nutrient needs. There are four categories:
➢ Estimated Average Requirements (EAR): how much of a nutrient is needed in the diet, there is a different
criterion for each nutrient based on its roles in supporting various activities in the body and in reducing
disease risks. Each person’s body is unique and has its own set of requirement. Therefore the
recommendations are clustered into groups based on gender and age. The EAR is the average amount that
appears sufficient for half of the population in that group.
➢ Recommended Dietary Allowances (RDA): what intake of a nutrient is recommended for everybody. If
people consumed exactly the average requirement of a given nutrient everyday, approximately half of the
population would develop deficiencies of that nutrient. Recommendations are therefore set greater than the
EAR to meet the needs of most healthy people. Small amounts greater than the daily requirement do no
harm. To ensure that the nutrient RDA meet the needs of as many people as possible, the RDA are set near
the top pend of the range of the population’s estimated requirements.
➢ Adequate Intakes (AI): when there is insufficient scientific evidence to determine an EAR (which is needed to
set an RDA). Then an AI is established instead of an RDA. An AI reflects the average amount of a nutrient that
a group of healthy people consumes. Like the RDA, the AI may be used as nutrient goals for individuals.
Although, an AI must rely more heavily on scientific judgements because sufficient evidence is lacking.
➢ Tolerable Upper Intake Levels (UL): the point beyond the recommended intake where a nutrient is likely to
become toxic.
Establishing Energy Recommendations
In contrast to the RDA and AI values for nutrients, the recommendation for energy is not generous. Excess energy
can’t be readily excreted and is eventually stored as body fat. These reserves may be beneficial when food is scarce,
but they can also lead to obesity and its associated health consequences.
➢ Estimated Energy Requirement (EER): the energy recommendation represents average dietary energy intake
(kcalories per day) that will maintain energy balance in a person who has a healthy body weight and level of
physical activity. Balance is key to the energy recommendation. Enough food energy is needed to sustain a
healthy and active life, but too much can lead to weight gain and obesity.
➢ Acceptable Macronutrient Distribution Ranges (AMDR): people don’t eat energy directly; they derive energy
from foods containing carbohydrates, fats and proteins. Each of these three nutrients contributes to the
total energy intake, and those contributions vary in relation to one another. The composition of a diet that
provides adequate energy and nutrients and reduces the risk of chronic diseases:
• 45-65% kcalories from carbohydrate
• 20-35% kcalories from fat
• 10-35% kcalories from protein
Using Nutrient Recommendations
Although the intent of nutrient recommendations seems simple, they are the subject of much misunderstanding and
controversy. Perhaps the following facts will help put them in perspective:
1. Estimates of adequate energy and nutrient intakes apply to healthy people. They need to be adjusted for
malnourished people or those with medical problems who may require supplemented or restricted dietary
intakes.
2. Recommendations are not minimum requirements, nor are they necessarily optimal intakes for all
individuals. They only target most of the people and can’t account for individual variations in needs.
3. Most nutrient goals are intended to be met through diets composed of a variety of foods whenever possible.
Because foods contain mixtures of nutrients and nonnutrients, they deliver more than just those nutrients
covered by the recommendations.
2
, 4. Recommendations apply to average daily intakes. Trying to meet the recommendations for every nutrient
every day is difficult and unnecessary. The length of time over which a person’s intake can deviate from the
average without risk of deficiency or overdose varies for each nutrient, depending on how the body uses and
stores the nutrient.
5. Each of the categories serves a unique purpose. For example, the EAR are most appropriately used to
develop and evaluate nutrition programs for groups. The RDA (or AI) can be used to set goals for individuals.
The UL serve as a reminder to keep nutrient intakes less than amounts that increase the risk of toxicity.
Comparing Nutrient Recommendations
At least 40 different nations and international organizations have published nutrient standards. Slight differences
may be apparent, reflecting differences both in the interpretation of the data from which the standards where
derived and in the food habits and physical activities of the populations they serve. Many countries use the
recommendations developed by two international groups: FAO (Food and Agriculture Organization) and WHO
(World Health Organization). The FAO/WHO nutrient recommendations are considered sufficient to maintain health
in nearly all healthy people.
H10: The Water-Soluble Vitamins: B Vitamins and Vitamin C
The Vitamins – An Overview
The vitamins differ from macronutrients in the following ways:
➢ Structure. Vitamins are individual units; they are not linked together.
➢ Function. Vitamins do not yield energy when metabolized; many of them do, however, assist the enzymes
that participate in the release of energy from carbohydrates, fats and proteins.
➢ Food contents. The amounts of vitamins people ingest from foods and the amounts they require daily are
measured in micrograms (ug) or milligrams (mg), rather than grams (g).
The vitamins are similar to the energy-yielding nutrients in that they are essential, organic and available foods.
Bioavailability
Some water-soluble vitamins are synthesized by GI tract bacteria and absorbed by the large intestine, but not in
quantities great enough to meet the body’s needs; foods must supply these essential nutrients. The amount of
vitamins available from foods depends not only on the quantity provided by a food but also on the amount absorbed
and used by the body – referred to as the vitamins’ bioavailability. The quantity of vitamins in a food can be
determined relatively easy. Determining the bioavailability of a vitamin is a more complex task because it depends
on many factors, including:
➢ Efficiency of digestion and time of transit through the GI tract
➢ Previous nutrient intake and nutrition status
➢ Method of food preparation
➢ Source of the nutrient
➢ Other foods consumed at the same time
Precursors
Some of the vitamins are available from foods in inactive forms known as precursors, or provitamins. Once inside the
body, the precursor is converted to an active form of the vitamin. For example, beta-carotene is a precursor to
vitamin A. Thus, in measuring a person’s vitamin intake, it’s important to count both the amount of the active
vitamin and the potential amount available from its precursors.
Organic nature
Fresh foods naturally contain vitamins, but because these vitamins are organic, they can be readily destroyed during
processing. Therefore, processed foods should be used sparingly, and fresh foods should be handled with care
during storage and in cooking.
Solubility
Carbohydrates and proteins are hydrophilic and lipids are hydrophobic. The vitamins divide along the same lines –
the hydrophilic, water-soluble ones are the B vitamins (thiamin, riboflavin, niacin, biotin, pantothenic acid, vitamin
B6, folate and vitamin B12) and vitamin C; the hydrophobic, fat-soluble ones are vitamins A, D, E and K. solubility is
apparent in the food sources of the different vitamins, and it affects their absorption, transport, storage and
excretion by the body. The water-soluble vitamins are found in the watery compartments of food; the fat-soluble
3
