Nutrition

Table of Contents

Humans derive their energy from food. Foods provide both building material and energy in the form of nutrients to the body. Nutrients are substances that are not synthesised in the body in sufficient amounts and hence need be obtained through the diet.

Definition of Nutrition :

Utilization of food by living organisms.

Caloric value of foods:

Energy content of foods
Definition: Amount of heat obtained by burning 1 gm of the food stuff completely in presence of O2.

Fig: Calorific values of major nutrients

Unit of Energy/ Heat:

Calorie:

Amount of heat required to raise the temperature of one gram of water by 1˚C (from 15˚C to 16˚C).
1000 calories = 1 kcal (1 Cal) “C” = 4.128 KJ
Calorie “C” always means a kilocalorie “C”.

Joule “J”:

(Internationally accepted unit) Energy required to move 1kg of mass by 1m by a force of 1 Newton acting on it.
1 KJ = 0.239 Cal

Respiratory Quotient (RQ):

Definition: Ratio of volume of CO2 produced by the volume of O2 consumed (CO2/ O2) in the oxidation of foodstuffs during a given time.

Factors affecting RQ:

Role of diet

Carbohydrates: The volume of carbon dioxide produced is equal to the volume of oxygen utilised when a carbohydrate diet is consumed (RQ is 1).

Lipids: The RQ of fats is relatively lower and is about 0.7

Proteins: The RQ of proteins cannot be measured directly. By indirect methods it is calculated to be about 0.8.

Mixed diet: The RQ of a mixed diet is dependent upon the relative proportions of carbohydrates, lipids and proteins in it and in a well balanced diet, it is approximately around 0.8.

Effect of interconversion in the body:

Carbohydrates → Fats: RQ ↑
Fats → Carbohydrates : RQ ↓ , below 0.7

Muscular exercise:

In Moderate exercise : unaltered
In violent exercise : RQ ↑ , above 2

Clinical aspects of RQ:

In Acidosis : CO2 output more : RQ Increases
In Alkalosis : CO2 retained : RQ Decreases
In Febrile condition: breathing increased : CO2 output more: RQ Increases
In Diabetes Mellitus :

Advanced Stages: Energy from fat oxidation: RQ decreases

On Insulin: carbohydrates start burning : RQ increases

Starvation : RQ Decreases

Initial 1 to 2 days : 0.78 (stored glycogen)

Later : 0.7 (fat combustion)

Significance of RQ:

Type of foodstuffs burning
Nature of synthesis or conversion in the whole body & in a particular organ
Determination of metabolic rate
Non protein RQ (total energy output & proportion of various foodstuffs burnt)
Diagnosis like acidosis, alkalosis, Diabetes Mellitus.

Energy expenditure:

A) For physical work & exercise

Depends upon the extent of work

B) For involuntary works

Relatively constant & occurs at a basal rate.

Energy expenditure in man is attributed to the following processes that occur in the body.

Basal metabolic rate (BMR)
Specific dynamic action (SDA)
Physical activity

Apart from these three energy determinants, certain physiological conditions like age, pregnancy, lactation, convalescence and so on demand extra supply of energy.

Physical activity:

Provided the BMR and SDA are more or less constant, physical activity is highly variable in different individuals.
Energy requirements in average adults are roughly as follows (energy required for BMR, SDA and physical activity).

Light work 2000–2500 Cal/day
Moderate work 2500–3000 Cal/day
Heavy work 3000–4000 Cal/day

Basal Metabolic Rate (BMR):

Definition: Minimum amount of energy required by the body to maintain life at complete physical & mental rest, under comfortable conditions of temp, pressure, humidity in post-absorptive state.
Resting metabolic rate RMR.

Units: Cal/ sq.m/ hr

Normal values of BMR :

Adult man : 35-38Cal/sq.m/hr= 1600 Cal/d
Adult woman: 32-35Cal/sq.m/hr =1400 Cal/d

Basal conditions:

Rate of energy production in an individual by its overall cellular metabolism is more or less constant: Basal metabolism

Awake but at complete physical & mental rest.
Post-absorptive state(12-18 hrs without food)
Normal temperature (20˚to 25˚ C)
Normal pressure & humidity.
Recumbent/ reclining position in bed.

A constant ratio of endogenous lipids, carbohydrates, proteins is metabolized.

Several functions occurring continuously in the body:

Maintenance of body temperature, circulation, respiration, muscle tone,
Functions of viscera like kidney, liver & brain
Conduction of nerve impulse
GI motility
Ion transport across membrane

Factors affecting BMR:

1) Surface area

Directly proportional to BMR.
Because heat loss proportional to SA.

2) Sex

In men, marginally higher (about 5%): higher proportion of lean muscle mass.

3) Age

Inversely proportional to age.

In children : Higher BMR

Greater SA – more lean muscle mass

With advancing age BMR gradually falls (about 2% per decade of life). Muscle tissue replaced by fat and water.
After 40 yrs age : decreases 5% each decade
After 60 yrs age : decreases10% each decade

4) Physical activity

In Athletes & manual workers BMR increases: As regular exercise increases their Surface Area

5) Environment

Colder climates: higher BMR (to maintain body temperature)

Tropical climates: lower BMR

6) Body temperature

Increase in 1˚C body temperature= Increases BMR by 12%

7) Hormones

Thyroid, adrenal medulla, anterior pituitary hormones : stimulates BMR
Thyrotoxicosis : ↑50%- 100%
Myxoedema : ↓30%- 45% below normal.

8) Drugs

Caffeine, Epinephrine, Nicotine, Alcohol: Increases BMR
Anesthetics : Decreases BMR

9) State of nutrition

BMR lowered: malnutrition, starvation, wasting diseases
During starvation, energy intake has an inverse relation with BMR; Decreases upto 50%

10) Barometric pressure

Moderate reduction in barometric pressure: No effect

Fall to 1/2 an atmosphere (mountain climbing): Increase BMR

11) Disease states:

BMR elevated :

Fever, Infections

Leukemia, polycythemia, anemia

Cardiac failure, hypertension, dyspnoea

Cushing’s disease, Cushing’s syndrome, Acromegaly (Increased cellular activity)

Hyperthyroidism

- BMR decreased : Addison’s disease (adrenal insufficiency)

Hypothyroidism

Importance of BMR:

As a diagnostic aid: For the diagnosis of various pathological conditions specially assessing the thyroid function.
For calculation of caloric requirements: For prescribing diet of adequate calorific value and planning nutrition for individuals as well as communities.
Effect of foods and drugs: To note the effect of foods and drugs on BMR.

Specific Dynamic Action (SDA):

Calorigenic action or thermogenic action or thermic action (effect) of food.
Definition: The extra heat production by the body, over & above the calculated caloric value, when a given food is metabolized by the body is known as SDA.
Stimulant action of foods on the body metabolism.

SDA for different foods

The SDA for carbohydrates is 5%, for lipids 15% and for proteins, it is about 30%.
Proteins- highest SDA; Carbohydrates- lowest.

SDA for mixed diet:

SDA for a mixed diet is taken at 10% of overall calories.

Presence of fats & carbohydrates reduces SDA of proteins.
Fats are most efficient in reducing SDA of foodstuffs.

Mechanism of SDA:

Due to the energy required for digestion, absorption, transport, metabolism & storage of foods in the body.
Comparable to handling charges collected by the bank to issue a demand draft.
So, actual energy from the food is lesser than that of theoretical calculation.
SDA is considered as activation energy needed for chemical reaction.

Significance of SDA:

Expenditure by the body for the utilization of foodstuffs.
Additional 10% should be added to the energy needs of the body (Diet planning)
Proteins: higher SDA: Not good source of energy.
Fats: lowering effect on SDA: the best source of energy.

Nutritional importance of carbohydrates:

Common sources of digestible carbohydrates include cereals (rice, wheat) (60%–80%), pulses (50%–60%), roots and tubers (20%–40%), bread (50%–60%), meat (40%–50%), vegetables and fruits (30%–50%), table sugar (100%), honey (80%).

Classification:

Carbohydrates utilized by the body: Starch, Glycogen, Sucrose, Lactose, Glucose, Fructose
Carbohydrates not utilized by body-Cellulose, Hemicellulose, Pectins, Gums.
Chief source of energy: RDA- 60-70% of total caloric requirements of the body

Functions of carbohydrates:

Major source of energy. The energy content of dietary carbohydrate is approximately 4 Cal/g.
Protein sparing action.
Absolute requirement by brain.
Required for oxidation of fat.
Energy supply for muscle work.
Synthesis of pentoses: Nucleic acids, Coenzymes.
Synthesis of nonessential amino acids.
Synthesis of fat.

Fibers in nutrition:

Complex carbohydrates not digested by human enzymes.
Cellulose, pectins, hemicellulose, lignins, gums, mucilage.
RDA: 20-30 gm/day

Sources of Fibers:

Fruits
Leafy vegetables
Whole wheat legumes
Rice bran

Beneficial effects of fibers:

Prevents constipation: Maintain GI motility
Eliminates bacterial toxins
Decreases GIT (colon) cancers
Improves glucose tolerance, glycemic control and increases sensitivity to insulin.
Reduces plasma cholesterol (hypolipidemic effect)
Satiety value- Long term weight management.

Adverse effects of fibers

Digestion & absorption of protein & certain minerals (Ca, P, Mg) are decreased.
Intestinal bacteria ferment some fibers causing flatulence and often discomfort.

Glycemic index:

Simple carbohydrates: High compared to complex carbohydrates (Digestion and absorption slow).
When carbohydrates combined with fiber, fat & protein: Glycemic index is low. (Ice-cream)
Useful in formulating therapeutic diet for diabetic patients.
Foods with low glycemic index favored in diabetics.

Nutritional importance of lipids:

RDA: 15-20% of total caloric requirements.

Sources of dietary lipids

Food items such as butter, ghee, various vegetable oils and fish oils, milk and milk products, egg, meat, pulses and cereals are the dietary sources of fats and lipids.

Functions of lipids:

Energy storage source for animals
Structural elements (plasma membrane) of cells and organelles
Signal transduction molecules.
Provides EFA & Fat soluble vitamins.

EFA content of foods:

PUFA present in vegetable oils and fish oils include sunflower, cotton seed, corn, soya bean oil.
Fats of animal origin: less PUFA.
At least 30% of dietary fat should contain PUFA.
SFA: MUFA: PUFA :: 1:1:1 ratio
Cholesterol intake less than 250mg/day.

Most ideal Edible oil:

SFA: MUFA: PUFA :: 1:1:1 ratio
No such single oil
Use combination of different oils instead of single type.
PUFAs, as eicosapentaenoic acid found in fish oils appear to prevent coronary artery disease.

EFA:

Deficiency:

Phrynoderma or toad skin: scaly dermatitis on post. & lateral parts of limbs & buttocks.
Poor wound healing & hair loss.

Excess PUFA:

Injurious to the cells.

Free radicals overproduction.

Cholesterol and heart disease:

Cereals, pulses and vegetables do not contain cholesterol, which is obtained only from foods of animal origin. It is well known that high cholesterol levels (>240 mg/dl) are associated with increased risk of coronary artery disease.
In normal individuals, the cholesterol level in the blood ranges between 150–200 mg/dl (desirable <180 mg/dl).

Nutritional importance of protein:

RDA : 10-15% of total caloric requirements

Dietary sources of proteins

Meat, eggs, fish, milk are good sources of protein. Legumes, beans, peanuts, peas, soyabean are the best plant sources

Function of proteins:

Body building foods
Fundamental basis of cell structure and function.
Enzymes, hormones, Immunoglobulins, transport carriers.
Maintenance of osmotic pressure, blood clotting, muscle contraction.
During starvation it serves as major supplier of energy.

Nitrogen balance:

In normal healthy adult nitrogen equilibrium since daily dietary intake (I)= loss through urine(u) + feces(f) + sweat(s)
Nitrogen balance : I = O
Positive nitrogen balance: I > O

Growing children, pregnant women, during recovery after serious illness

Negative nitrogen balance: O > I

kwashiorkor or marasmus, cancer, uncontrolled diabetes

Reflects the status of protein utilization in the body

Fig: Nitrogen balance

Assessment of nutritive value of proteins:

Quantity of dietary protein alone is not sufficient.
Quality of dietary protein which depends upon composition of essential AAs is important.
Protein efficiency ratio (PER)
Biological value (BV)
Net protein utilization (NPU)
Chemical score

Protein efficiency ratio (PER):

PER = Gain in body weight (g)

Protein ingested (g)

The PER for egg protein is 4.5; for milk protein 3; for rice protein 2.2
The quality of a protein can be determined by its ability to produce growth. It is the assessment of weight gain per gram of protein taken. PER is the measurement of the ability of a protein to promote growth in an animal.

Biological value (BV):

Percentage of absorbed nitrogen retained by the body.
BV = Nitrogen retained X 100

Nitrogen absorbed

Though BV is a widely used index to express the nutritional value of proteins, it has certain inherent defects.
It cannot take into account the nitrogen lost during the digestion process it may not provide an accurate nutritional assessment of proteins.
Ingested N: 100 mg;
Absorbed N: 10 mg;
Retained N: 8 mg
BV = 8/10 X 100 = 80%

BV for egg protein is 94.

Net protein utilization (NPU):

NPU = Nitrogen retained X 100

Nitrogen ingested

NPU for egg protein is 90.
This is a better nutritional index compared to BV as it takes into account the factor of digestion.

Chemical score:

Chemical score =

Mg of limiting AA per g test protein X 100

Mg of same AA per g egg protein

Based on the chemical analysis the protein for the composition of essential AAs.
Chemical score of egg protein is 100.

Protein requirements:

RDA: adult 0.75 g protein/kg body wt
Animal proteins are superior in their nutritive value than vegetable proteins.

Limiting Amino Acids:

Egg : None
Rice & wheat : Lysine, Threonine
Bengal gram: S- containing AAs.

Mutual supplementation:

Two different vegetable proteins together: Amino Acids patterns complement each other and provide sufficient Amino Acids.
Mixed diet with different foods. (Rice & Dal)
Dietary deficiency of Essential Amino Acids is most uncommon.

Dietary allowance

RDA represents the quantities of the nutrients to be provided in the diet daily for maintaining good health and physical efficiency of the body.
Not the minimum amount but allowance is given for safe margin.
Factors affecting RDA:

Sex-Men about 20% higher than women.
Age- Higher in growing age.

Balanced/ prudent diet:

Diet which contains different types of foods, possessing the nutrients-carbohydrates, proteins, fats, vitamins & minerals- in a proportion to meet the requirements of the body.
Supplies a little more of each nutrient than the minimum requirements to withstand short duration of leanness and to keep body in a state of good health.

Composition of Balanced diet:

Basic composition: Highly variable.

Differs from:

Country to country- availability of foods.
Social & cultural habits.
Economic status.
Age
Sex
Physical activity.

Balanced diet- Aim:

It is intended to promote optimum health and to prevent nutritional deficiencies (under-nutrition) and obesity (excess calories).

Basis:

A balanced diet should be based on:

Locally available foods
Should be within the economic means of the people.
Should fit with the local food habits.
Diet should be easily digestible and palatable.

Principles of prescribing a balanced diet:

Age, Sex and Physical activity:

To be taken into account while calculating Calorie and Protein requirement.

Selection of nutrients from “Basic Food Groups”:

Required quantities of food items are to be selected from basic food groups in such a way that their total nutritive values satisfy the estimated requirements.
Food Exchange system: Foods with similar nutrient composition can be grouped together and can be exchanged to provide dietary variety.

Basic food group for balanced diet:

Milk group- including dairy products.
Meat group- meat, fish, egg.
Pulses, beans, nuts.
Green leafy vegetables, roots, fruits.
Cereal group- bread, rice, wheat, barley.

Economic status of the individual:

It must be taken into account so that diet is within the purchasing capacity of the individual.

High-Cost and Low-cost Diet:

In case of a person from a low-income group, cheaper items have to be selected and care should be taken that nutritional and calorie requirements are fulfilled.

In vegetarians, an additional intake of milk and pulses is recommended.

Table: Mixed diet for an average adult (Weighing 60 Kg)

Fig: Food guide pyramid

Principles of prescribing diet:

Calorie requirement has to be assessed based on age, gender, build, health status and physical activity.
Protein requirement has to be assessed based on age, gender, build, health status and physical activity.

Protein requirement: 0.8 g/kg body weight/day. During growing age, pregnancy and lactation it can be more than 2 g/kg body wt. The calorie yield from a protein diet should be 10%–15% of total calorie requirements.
Fats can provide 20%–25% of total calorie requirements of the individual. Visible (fats and oils) should be restricted to not more than 20 g/day for a healthy adult. However, in various physiological states it can be enhanced, such as growing children (25 g), pregnant women (30 g) lactating mothers (45 g). It is advisable that obese individuals, old people and persons at risk of cardiovascular disease restrict fat content to less than 20 g a day.
Different vegetable oils can be used to balance the composition of SFA, MUFA and PUFA to 1:1:1.
Choose a diet with plenty of whole grains, vegetables and fruits and green leafy foods which contain both digestible carbohydrates and dietary fibre. Ideally 55%–65% of calories can be obtained from carbohydrate diet.

Diet in Diabetes Mellitus:

Calorie restriction and moderate exercise plays a valuable role in diabetes management.
Avoid excess calories: Maintain ideal body weight according to height. A low calorie diet is advocated to diabetic patients.
Variety of foods should be taken to ensure to ensure an adequate intake of all nutrients.

Nature of Lipids:

Avoid too much of fat in the diet.
Saturated fats to be avoided and include oils having PUFA.
Low TAG, low cholesterol, low SFA and generous amounts of PUFA are adviced.

Nature of Carbohydrates:

Eat food with complex carbohydrates like starches ex. cereals, whole grains than simple sugars.
Sugars with high glycemic index must be minimized in the diet. Avoid too much sucrose.

High protein & fiber rich:

Highly protein and fiber rich items to be included in diet.
Pulses, beans, nuts, fruits and vegetable to be included.
Whole fruits to be preferred to juices.

Salt: Avoid too much of salt.

In addition to restricted calorie intake, diabetics should be encouraged to exercise regularly, to walk, cycle, and swim and so on for 30 minutes daily.

Dietary advice in Coronary artery Disease:

1. Consumption of PUFA (Omega 3 FA reduce LDL-C)
2. Avoid high carbohydrate (refined) diet

Sucrose steeply raises triacylglycerol levels.

3. Avoid cholesterol rich diet:

Restrict overall fat intake : < 20%

Restrict SFA & Trans FA : < 10%

Restrict Cholesterol: < 200 mg/day.

Dietary fiber: Decrease the absorption of dietary cholesterol
Consume sufficient amounts of Vitamin C, E, beta carotene: Natural antioxidants- prevent formation of oxidised LDL.
Moderate alcohol consumption (Red wine) can be beneficial.

Diet in Pregnancy:

Calorie Requirement:

ICMR nutrition expert group recommends extra allowance of 300 Cal/day.
Reason for this additional requirement: For the growth and development of fetus, placenta and maternal reproductive organs like uterus and mammary glands.

Protein Requirement:

ICMR nutrition expert group recommends extra allowance of 10 gm/day.
Reason for this additional requirement: Synthesis of hemoglobin, plasma proteins and tissue proteins in growing tissues of fetus and maternal reproductive organs.

Iron requirements:

ICMR nutrition expert group recommends extra allowance of 10 gm/day.
Reason for this additional requirement: Synthesis of hemoglobin, plasma proteins and tissue proteins in growing tissues of fetus and maternal reproductive organs.

Calcium, Phosphorus and Vitamin D requirements:

ICMR nutrition expert group recommends extra allowance of Calcium 500 to 600 mg/day.
Also additional phosphorus and 400 IU of vitamin D daily in latter half of pregnancy.
Reason for this additional requirement: To provide minerals for the growing foetal bones for calcification. (mineralization of bone)

Vitamin K:

Should be provided in the last trimester of pregnancy as a protection against excessive bleeding during parturition and to build up body stores of vitamin K in the foetus.

Water Soluble Vitamins:

ICMR nutrition expert group recommends extra allowance per day of

2 mg thiamine
2 mg riboflavin
2 mg niacin
50-200 micrograms Folic acid
5 microgram Vitamin B12
50 mg Vitamin C

Reason for this additional requirement:

Increased Folic acid and Vitamin B12 are needed for helping in nucleic acid synthesis in proliferating tissue cells and maturing RBCs both in mother and fetus.
Increased need for vitamin C is due to increasing synthesis of collagen in growing tissues.

Diet in Lactation:

Calorie Requirement:

ICMR nutrition expert group recommends extra allowance of 700 Cal/day.
Reason for this additional requirement: To synthesize and provide milk constituents.

Protein Requirement:

ICMR nutrition expert group recommends extra allowance of 20 gm/day.
Reason for this additional requirement: To supply amino acids for synthesis of milk proteins and also for maintaining secreting mammary glands.

Calcium requirement:

ICMR nutrition expert group recommends extra allowance of Calcium 500 to 600 mg/day.

Vitamin A:

ICMR nutrition expert group recommends extra allowance of vitamin A of 400 microgram/day.

Water Soluble Vitamins:

ICMR nutrition expert group recommends extra allowance per day of

4 mg thiamine
4 mg riboflavin
5 mg niacin
50 micrograms Folic acid
5 microgram Vitamin B12
30 mg Vitamin C

Reason for this additional requirement:

Increased Folic acid and Vitamin B12 are needed for helping in nucleic acid synthesis in proliferating tissue cells and maturing RBCs both in mother and fetus.
Increased need for vitamin C is due to increasing synthesis of collagen in growing tissues.

Diets for weight loss:

VLCL (Very low calorie diets)
500-800 Cal and 50 gm protein along with vitamin and mineral supplement a day.
Ideal low calorie diet:
Restrict the intake of fats and carbohydrates
Adequate quantity of protein along with water and vitamin-mineral supplement.
Dieting: Diet restriction to shed unwanted excess weight

Malnutrition and its effects

Malnutrition is a state arising from

Insufficient calorie intake causing under nutrition
Insufficient intake of one or more essential nutrients, especially proteins.

Nutritional disorders:

Protein energy malnutrition/ Protein calorie malnutrition
Most common nutritional disorder in developing countries.
Prevalent in infant and preschool children
Two extreme forms.
Kwashiorkor & marasmus

Kwashiorkor	Marasmus
· Occurs between 1-5 years of age (Mostly in 2^nd year)	· Occurs below 1 year
· Infectious disease (acute diarrhoea, respiratory infection) acts as a precipitating factor.	· Premature babies with inadequate feeding acts as a predisposing factor.
· Protein deficiency	· Calorie deficiency with retarded growth
· Bilateral pitting edema with a protruding abdomen	· No edema with shrunken abdomen
· Muscle wasting is not marked	· Severe muscle wasting
· Subcutaneous fat is present	· Subcutaneous fat is minimal
· Sparse grey colored hair which can be easily plucked. Depigmented hairs alternate with pigmented hairs “Flag sign”	· No characteristic change in hair
· Low serum albumin is a characteristic feature. Total serum proteins are also decreased.	· Serum albumin near normal
· Serum Electrolytes: Potassium depletion (K+) due to diarrhoea.	· Serum electrolytes: Normal
· Serum cortisol in decreased.	· Serum cortisol in increased.
· Insulin levels are increased.	· Insulin levels are low.
· Fatty liver not common	· Fatty liver may be seen

Other nutritional diseases:

Obesity
Atherosclerosis
Vitamin deficiency -xerophthalmia, rickets, beri-beri, pellagra, scurvey,
Goiter
Anemia

Microcytic-deficiency of iron, copper, pyridoxine

Macrocytic -deficiency of folic acid and vitamin B12

Obesity:

Individuals with excess body fat.
Body mass index BMI = Weight in Kg

Height in m²

	BMI
Normal	18.5-24.9
Over weight	25.0-29.9
Obese	30.0-39.9
Morbidly obese	≥ 40

Causes of Obesity:

Excess calorie intake with lack of enough physical activity results in obesity.

Genetic influences
Physiological

Overeating than calorie requirement
Pregnancy
Postmenopausal women
Use of oral contraceptives for prolonged periods

Metabolic:

Diabetes mellitus type II
Hyperlipidemia Type IV and Type V.

Hypothalamic injuries or abnormalities (Ex. Prader-Willi Syndrome)
Miscellaneous and endocrine disorders

Hypothyroidism, Acromegaly
Cushing’s disease and Cushing’s syndrome
Polycystic ovary syndrome

Metabolic Changes/Effects in obesity:

Lipid Metabolism:

Increased triglyceride level
Hypercholesterolemia
Increased lipoprotein lipase activity

Carbohydrate Metabolism:

Hyperinsulinemia: It may aggravate obesity by promoting lipogenesis and inhibiting lipolysis.
Insulin resistance

Acid-Base status:

Massive obesity associated with alveolar hypoventilation leading to CO2 retention: Obesity-hypoventilation syndrome (Pickwickian Syndrome)

Energy Metabolism: Normal; BMR- Normal.

Importance of Obesity: Health risks

Obese people are more prone to certain diseases than the average population.

Diabetes Mellitus Type II
Cardiovascular disorders: Hypertension, atherosclerosis, thromboembolisms
Metabolic diseases like gout
Skin disorders: Intertriginous dermatitis. Intertrigo is common in the fold below the breasts and in the inguinal region.
Gynecological disorders: Amenorrhea, oligomenorrhoea, toxemia of pregnancy.
Surgical postoperative complications