臨床營(yíng)養(yǎng)學(xué)課程教學(xué)課件全冊(cè)教學(xué)課件匯總

1、授課人：XX XX 臨床營(yíng)養(yǎng)學(xué)XX學(xué)院 XX 專業(yè)【全套課件】第1頁(yè)，共1350頁(yè)。 第1章 能量 第2章 蛋白質(zhì)第3章 碳水化合物第4章 脂類 第5章 維生素目錄精品課程第6章 礦物質(zhì)和水第2頁(yè)，共1350頁(yè)。 第7章 植物性非營(yíng)養(yǎng)生物活性物質(zhì) 第8章 食物與藥物的相互作用第9章 住院病人的營(yíng)養(yǎng)膳食第10章 食譜的制定 第11章 營(yíng)養(yǎng)與呼吸系統(tǒng)疾病目錄精品課程第12章 營(yíng)養(yǎng)與循環(huán)系統(tǒng)疾病第3頁(yè)，共1350頁(yè)。 第13章 營(yíng)養(yǎng)與消化道疾病 第14章 營(yíng)養(yǎng)與肝、膽、胰疾病第15章 營(yíng)養(yǎng)與腎臟疾病第16章 營(yíng)養(yǎng)與糖尿病 第17章 營(yíng)養(yǎng)與肥胖病 目錄精品課程第18章 營(yíng)養(yǎng)與痛風(fēng)第4頁(yè)，共1350頁(yè)。

2、 第19章 食物、營(yíng)養(yǎng)與癌癥 第20章 營(yíng)養(yǎng)與燒傷第21章 創(chuàng)傷和手術(shù)病人的營(yíng)養(yǎng)支持 第22章 營(yíng)養(yǎng)與兒科疾病 第23章 營(yíng)養(yǎng)與婦科疾病目錄精品課程第24章 營(yíng)養(yǎng)與其他疾病第5頁(yè)，共1350頁(yè)。臨床營(yíng)養(yǎng)學(xué)上 篇主頁(yè)目錄-Home第6頁(yè)，共1350頁(yè)。基本 概念 主頁(yè)目錄-Home第7頁(yè)，共1350頁(yè)。營(yíng)養(yǎng)（nutrition）是指人體攝取、消化、吸收、轉(zhuǎn)運(yùn)和利用食物中營(yíng)養(yǎng)物質(zhì)以滿足機(jī)體生理需要并排除廢物的生物學(xué)過(guò)程。It is a biological process which nutrients and functional compositions in the foods are in

3、gested , digested, absorbed, transported , utilized and the waste materials are excreted.主頁(yè)目錄-Home第8頁(yè)，共1350頁(yè)。營(yíng)養(yǎng)學(xué)（nutriology）研究膳食、營(yíng)養(yǎng)與人體健康關(guān)系的科學(xué)，廣義的營(yíng)養(yǎng)學(xué)，還包括社會(huì)、經(jīng)濟(jì)、文化、生活習(xí)慣和膳食心理等多種領(lǐng)域和學(xué)科。 It is a science of foods and the nutrients and other substances they contain, and of their actions within the body. A br

4、oader definition includes the social, economic, cultural, and psychological implications of food and eating. 主頁(yè)目錄-Home第9頁(yè)，共1350頁(yè)。營(yíng)養(yǎng)素（nutrients）食物中可給人體提供能量、機(jī)體構(gòu)成成分和組織修復(fù)以及有生理調(diào)節(jié)功能的化學(xué)成分。Chemical substances obtained from food and used in the body to provide energy, structural materials, and repair of the

5、bodys tissues; Nutrients may also reduce the risk of some diseases. 主頁(yè)目錄-Home第10頁(yè)，共1350頁(yè)。 protein lipids carbohydrate (dietary fiber) minerals vitamin water macronutrientsmicronutrients植物化學(xué)物：phytochemicals 非營(yíng)養(yǎng)素 植物的次級(jí)代謝產(chǎn)物Classification of Nutrients主頁(yè)目錄-Home第11頁(yè)，共1350頁(yè)。營(yíng)養(yǎng)素生理需要量（Nutritional Requirement

6、）是指能保證人體健康，達(dá)到應(yīng)有發(fā)育水平并能充分有效地完成各項(xiàng)體力、腦力活動(dòng)所需要的能量和各種營(yíng)養(yǎng)素的必需的量。The lowest continuing intake of energy and nutrients that maintain the specified criterion of adequacy (that will maintain the specific biochemical and physiological functions of the body)最低需要量：指僅能維持生理平衡或不致發(fā)生營(yíng)養(yǎng)缺乏病的量。 適宜需要量：指維持人體健康、促進(jìn)生長(zhǎng)發(fā)育、保證最高勞動(dòng)效

7、率的量。主頁(yè)目錄-Home第12頁(yè)，共1350頁(yè)。營(yíng)養(yǎng)素推薦攝入量（Recommended Nutrient Intake，RNI），是指通過(guò)膳食，滿足某一特定性別、年齡及生理狀況群體中絕大多數(shù)（97%98%）個(gè)體需要的能量和各種營(yíng)養(yǎng)素的量。 Reference Nutrient Intake (RNI): The RNI is the amount of a nutrient that is enough to ensure that the needs of nearly all the group (97.5%) are being met . 主頁(yè)目錄-Home第13頁(yè)，共1350頁(yè)。

8、第一章 能量Energy 主頁(yè)目錄-Home第14頁(yè)，共1350頁(yè)。單位 1J：一牛頓力把1kg物體移動(dòng)1m所需要的能量 1 kcal=4.184KJ 1kJ=0.239 kcal 1000 kcal=4.184MJ 1MJ=239 kcal產(chǎn)能營(yíng)養(yǎng)素 碳水化合物：（1g4kcal）：55%65% 蛋白質(zhì)：（1g4kcal）：10%15% 脂 肪：（1g9kcal）：20%30% 酒（乙醇）：1g7kcal主頁(yè)目錄-Home第15頁(yè)，共1350頁(yè)。 第一節(jié) 人體的熱能消耗 Section 1 The body spends energy （一）基礎(chǔ)代謝（60%75%）（二）體力活動(dòng)(15%30

9、%)（三）食物的特殊動(dòng)力作用（TEF）(10%)主頁(yè)目錄-Home第16頁(yè)，共1350頁(yè)。(一) Basal Metabolism 1.Definition The energy needed to maintain life when a body is at complete rest after a 12-hour fast (禁食). 2. Basic energy expenditure, BEE (基礎(chǔ)代謝的熱能消耗) (1) Basal metabolic rate, BMR (基礎(chǔ)代謝率) Definition The rate of energy used for metab

10、olism under basal condition, usually expressed as kcal per surface of body per hour (or kcal per kilogram body weight per hour) 主頁(yè)目錄-Home第17頁(yè)，共1350頁(yè)。3. Calculation of BEE BEE = BMRbody surface areatimeBMR (refer to the table)body surface area()0.0065body size(cm) 0.0126body weight(kg) 0.1603 1). Acc

11、ording to BMR主頁(yè)目錄-Home第18頁(yè)，共1350頁(yè)。表1-10 人體基礎(chǔ)代謝率年齡(歲) 男 女 年齡 男 女kJ/m2 kcal/m2 kJ/m2 kcal/m2 (歲) kJ/m2 kcal/m2 kJ/m2 kcal/m2 1221.853.0221.853.030154.036.8146.935.13214.651.3214.251.235152.736.5146.435.05206.349.3202.548.440151.936.3146.034.97197.747.3200.045.445151.536.2144.334.59189.945.2179.142.850

12、149.835.8139.733.911179.943.0175.742.055148.135.4139.333.313177.042.3168.640.360146.034.9136.832.715174.941.8158.837.965143.934.4134.732.217170.740.8151.936.370141.433.8132.631.719164.039.2148.535.575138.933.2131.031.320161.538.6147.735.380138.133.0129.330.925156.937.5147.335.2引自營(yíng)養(yǎng)與食品衛(wèi)生學(xué)，第三版，第21頁(yè)。主頁(yè)

13、目錄-Home第19頁(yè)，共1350頁(yè)。2). Harris and Benedict formula 4). The method suggested by WHO: refer to the Table BEE(man)66.4730+13.75bw.(kg)+5.0033bs.(cm) - 6.7550age(y) BEE(woman)65.0955+9.463bw.(kg)+ 1.8496bs.(cm) - 4.6756age(y)Man BEE (per hour) 1.00 kcal/kg.hr body weight (kg)Woman BEE (per hour)0.95 kca

14、l/kg.hr body weight (kg)3). Simple formula ( for adult ) Resting Metabolic Rate, RMR ( 靜息代謝率 ) energy expenditure of body under the rest after 4-hour fast. RMR is more than BMR. 主頁(yè)目錄-Home第20頁(yè)，共1350頁(yè)。WHO 建議的計(jì)算基礎(chǔ)代謝公式年齡(y)公式（男）公式（女）03(60.9 W)-54(61.0W)-51310(22.7 W)+495(22.7 W)+4991018(17.5 W)+651(12.2

15、W)+7461830(15.3 W)+679(14.7 W)+4963060(11.6 W)+879(8.7W)+82960(13.5 W)+487(10.5 W)+596注:W為體重(kg)。摘自Technical Report Series724,Geneva,WHO,1985。主頁(yè)目錄-Home第21頁(yè)，共1350頁(yè)。表1-12 人體24小時(shí)靜息代謝參考值(Kcal)年齡(y)40 50 57 64 70 77 84 91 100體重（kg） 男性10181351152616481771187619982121224324011830129114441551165817501857196

16、4207122093060134314591540162116911772185319352039 60102711621256135114231526162117161837女性10181234135614411527160016851771185619661830108412311334143715251628173118331966306011771264132513861438149915601621169960101611211195126813311404147815521646摘自Nutrition Science and Application,第二版，第190頁(yè),1997。主

17、頁(yè)目錄-Home第22頁(yè)，共1350頁(yè)。4. The factors affecting BMR (1) Body surface area: (or lean mass fatty tissue)(2) Gender: male female (3) Age: 2% of decline per 10 years after age 30 5% of decline per 10 years after age 60 (4) Nutrition state: Low energy intake decreases BMR about 10%-20% (5) Physiological sta

18、tus: Pregnancy increases BMR (6) Body temperature: Fever increases BMR (7) High or low air temperature, hormone system activity, nerve and eating too much increase BMR (Adaptive Thermogenesis , 適應(yīng)性生熱作用) (8) Caffeine and tobacco increase BMR 主頁(yè)目錄-Home第23頁(yè)，共1350頁(yè)。(二) Physical Activity The energy neede

19、d during physical activity depends on body lean mass, intensity (強(qiáng)度) and time of activity. The energy is about 15%-30% of total energy use in sedentary(久坐的) people. 主頁(yè)目錄-Home第24頁(yè)，共1350頁(yè)。(三) Specific dynamic action (or Thermic Effect of Food, TEF)食物特殊動(dòng)力作用或食物熱效應(yīng) 1. Definition The amount of extra energ

20、y used by body during digestion, absorption, metabolism, and storage of energy-yielding nutrients. 2. Energy expenditure 5%-6% of total calorie produced by carbohydrates carbohydrateslipids 4%-5% of that protein 30% of that mixed food 10% of total energy consumed（消耗） 主頁(yè)目錄-Home第25頁(yè)，共1350頁(yè)。3. The mech

21、anism Energy storage: ATP and fat ATP: protein 32%-34% carbohydrate and lipids:38%-40% FAT: lipids fat glucose glycogen or fat amino acid protein or fat主頁(yè)目錄-Home第26頁(yè)，共1350頁(yè)。4.Affecting factors of TEF(1)protein-rich food is much higher than others(2) large meals show higher values than normal meals(3

22、) TEF decreases with advancing age. (4) Meal frequency. 主頁(yè)目錄-Home第27頁(yè)，共1350頁(yè)。(一) 計(jì)算法calculation 三、Estimating energy requirem 能量需要量的確定 能量消耗的計(jì)算=BEEPAL（physical activity level） 活動(dòng)水平工作內(nèi)容舉 例PAL系數(shù)男女輕中重辦公室工作、修理電器鐘表、售貨員、酒店服務(wù)員、化學(xué)實(shí)驗(yàn)操作、講課等學(xué)生日?；顒?dòng)、機(jī)動(dòng)車(chē)駕駛、電工安裝、車(chē)床操作、金工切割等非機(jī)械化農(nóng)業(yè)勞動(dòng)、煉鋼、舞蹈、體育運(yùn)動(dòng)、裝卸、采礦等1.551.782.101.561.

23、641.82中國(guó)營(yíng)養(yǎng)學(xué)會(huì)建議的我國(guó)成人活動(dòng)水平分級(jí)(2001年)主頁(yè)目錄-Home第28頁(yè)，共1350頁(yè)。 中國(guó)1859歲居民能量推薦攝入量估算年齡/歲 RNI/(kcal/d) 年齡/歲 RNI/(kcal/d) PAL 男 女 男 女 男 女 18495059參考體重(kg) 63 56 參考體重(kg) 65 58 BEE1561 1253BEE1551 1267輕2420 1955輕2404 19761.55 1.56中2779 2055中2761 20791.78 1.64重3278 2280 重3257 2306 2.10 1.82 摘自葛可佑主編中國(guó)營(yíng)養(yǎng)科學(xué)全書(shū)，第27頁(yè)主頁(yè)目錄

24、-Home第29頁(yè)，共1350頁(yè)。（一）計(jì)算法2. Nutritional survey (or Dietary survey) 膳食調(diào)查 57天 攝入食物種類數(shù)量， 食物成分表或食物成分分析軟件三、Estimating energy requirements 能量需要量的確定 主頁(yè)目錄-Home第30頁(yè)，共1350頁(yè)。(二)測(cè)量法measuring energy use by body直接測(cè)熱法（direct calorimetry）： 測(cè)熱裝置，水溫變化間接測(cè)熱法(indirect calorimetry) （產(chǎn)生CO2量/耗氧量=呼吸商）生活觀察法 24h 各種活動(dòng)及其時(shí)間，查日?；顒?dòng)能

25、量消耗表能量平衡法：1kg體重=29MJ（6931 kcal）三、Estimating energy requirements 能量需要量的確定 體重增加（能量正平衡）日能量消耗量(MJ)= 能量攝入量(MJ)平均體重增加量(kg)29MJ/調(diào)查天數(shù)(d)體重減少（能量負(fù)平衡）日能量消耗量(MJ)= 能量攝入量(MJ)+平均體重減少量(kg)29MJ/調(diào)查天數(shù)(d)主頁(yè)目錄-Home第31頁(yè)，共1350頁(yè)。Energy Recommended Nutrition Intake, RNI 熱能推薦攝入量 中國(guó)居民膳食能量推薦攝入量(RNIs)年齡/歲RNI/(MJ/d) 男 女RNI/(kcal

26、/d) 男 女?huà)雰?0.4MJ/(kg.d) 95kcal/(kg.d)0.50.4MJ/(kg.d) 95kcal/(kg.d) 主頁(yè)目錄-Home第32頁(yè)，共1350頁(yè)。 年齡/歲 RNI/(MJ/d) 男 女 RNI/(Kcal/d) 男 女兒童14.604.401100105025.024.811200115035.645.431350130046.065.831450140056.706.271600150067.106.671700160077.537.101800170087.947.531900180098.367.9420001900108.808.3621002000111

27、0.049.20240022001412.009.6229002400（續(xù)表）中國(guó)居民膳食能量推薦攝入量(RNIs)主頁(yè)目錄-Home第33頁(yè)，共1350頁(yè)。（續(xù)表）中國(guó)居民膳食能量推薦攝入量(RNIs) 年齡/歲 RNI/(MJ/d) 男 女 RNI/(kcal/d) 男 女成年 18 輕體力活動(dòng)10.038.8024002100 中體力活動(dòng)11.299.6227002300 重體力活動(dòng)13.3811.3032002700 孕婦 46個(gè)月+0.84+200 79個(gè)月+0.84+200 乳母+2.09+500注：AI,非乳母喂養(yǎng)應(yīng)增加20%。主頁(yè)目錄-Home第34頁(yè)，共1350頁(yè)。（續(xù)表）中

28、國(guó)居民膳食能量推薦攝入量(RNIs) 年齡/歲 RNI/(MJ/d) 男 女 RNI/(MJ/d) 男 女 50 輕體力活動(dòng)9.628.0023001900 中體力活動(dòng)10.878.3626002000 重體力活動(dòng)13.009.2031002200 60 輕體力活動(dòng)7.947.5319001800 中體力活動(dòng)9.208.3622002000 70 輕體力活動(dòng)7.947.1019001700 中體力活動(dòng)8.808.0021001900 807.747.1019001700主頁(yè)目錄-Home第35頁(yè)，共1350頁(yè)。QuestionDescribe each component of energy

29、expenditure. What factors influence each? How can energy expenditure be estimated? 主頁(yè)目錄-Home第36頁(yè)，共1350頁(yè)。第二章 蛋白質(zhì)Protein 主頁(yè)目錄-Home第37頁(yè)，共1350頁(yè)。含量：體重 16%19%更新： 動(dòng)態(tài)平衡，不斷更新，每天約3%，腸和骨髓最快。功能： 1.機(jī)體構(gòu)成成分 2.構(gòu)成各種生理活性物質(zhì)和重要的生理功能 3.提供熱能 人體中蛋白質(zhì)主頁(yè)目錄-Home第38頁(yè)，共1350頁(yè)。人體組織的構(gòu)成成分 Required for building and repair of body ti

30、ssues 構(gòu)成各種生理活性物質(zhì)和重要的生理功能 Enzymes, hormones, and many immune molecules are proteins. Essential body processes such as water balancing, nutrient transport, and muscle contractions require protein to function. 提供熱能 Protein is a source of energy。肽、氨基酸特有的生理功能 第一節(jié) 蛋白質(zhì)功能Section 1 Functions of protein主頁(yè)目錄-H

31、ome第39頁(yè)，共1350頁(yè)。The first structure 蛋白質(zhì)(protein) 氨基酸（Amino acid, AA） 非必需AA(nonessential-)：9種 半必需AA（條件必需AA）：2種 （semi-,or conditionally-）必需AA（essentional-）：9種 多肽（poly-）10 AA以上寡肽（oligo-）410 AA以下 3肽（tri-）3AA 2肽（di-）2AA 肽(peptide) 主頁(yè)目錄-Home第40頁(yè)，共1350頁(yè)。1. 種類：20種 (1) 必需AA（EAA） (2) 非必需氨基酸（NEAA） (3) 半必需氨基酸 (

32、semi-EAA or conditional EAA) 半胱酸（Cysteine）蛋氨酸（Methionine） 酪氨酸（Tyrosine）苯丙氨酸（Phenylalanine）2. 必需氨基酸： 人體不能合成或合成速度不能滿足機(jī)體需要，必需從食物中直接獲得的AA。 Amino acids that the body cannot synthesize in amount sufficient to meet physiological needs and has to obtain them from foods. 第二節(jié) 氨基酸和必需氨基 Section 2 Amino acid and

33、 EAA主頁(yè)目錄-Home第41頁(yè)，共1350頁(yè)。氨基酸英文氨基酸英文必需氨基酸非必需氨基酸異亮氨酸Isoleucine (Ile)丙氨酸Alanine (Ala)亮氨酸Leucine (Leu)精氨酸Arginine (Arg)賴氨酸Lysine (Lys)天門(mén)冬氨酸Aspartic acid (ASP)蛋氨酸Methionine (Met)谷氨酸Asparagine (Asn)苯丙氨酸Phenylalanine (Phe)谷氨酰胺Glutamic acid (Glu)蘇氨酸Threonine (Thr)甘氨酸Glycine (Gly)色氨酸Tryptophan (Trp)脯氨酸Prolin

34、e (Pro)纈氨酸Valine (Val)絲氨酸Serine (Ser)組氨酸*Histidine (His)天冬酰胺Asparagine (ASN)條件必需氨基酸半胱氨酸Cysteine (Cys)酪氨酸Tyrosine (Tyr)表 1-1 人體內(nèi)的氨基酸*組氨酸為嬰兒必需氨基酸，成人需要量可能較少。 摘自Modern Nutrition in Health and Disease,第9版,第14頁(yè),1999。主頁(yè)目錄-Home第42頁(yè)，共1350頁(yè)。氨基酸模式(AA Pattern)和限制氨基酸 (limiting AA)1. 氨基酸模式 (AA Pattern) ： 蛋白質(zhì)中各種必需

35、氨基酸的構(gòu)成比例。主頁(yè)目錄-Home第43頁(yè)，共1350頁(yè)。氨基酸人體全雞蛋牛奶牛肉大豆面粉大米異亮氨酸4.0亮氨酸7.0賴氨酸2.3蛋氨酸+半胱氨酸2.3苯丙氨酸+酪氨酸6.0蘇氨酸4.0纈氨酸5.0色氨酸1.01.01.01.01.01.01.0表1-2 幾種食物和人體蛋白質(zhì)氨基酸模式數(shù)據(jù)摘自營(yíng)養(yǎng)與食品衛(wèi)生學(xué)，第3版，第9頁(yè)。主頁(yè)目錄-Hom

36、e第44頁(yè)，共1350頁(yè)。限制氨基酸 （limiting amino acid） 與人體蛋白質(zhì)模式比較，食物蛋白質(zhì)中含量相對(duì)較低的必需AA。 The essential amino acid found in the shortest supply relative to the amount needed for protein synthesis in the body. FourAA are mostlikelytobe limiting: Lysine，Methionine，Threonine，Tryptophan .主頁(yè)目錄-Home第45頁(yè)，共1350頁(yè)。參考蛋白、完全蛋白和蛋白質(zhì)

37、的互補(bǔ)作用參 考 蛋 白用于測(cè)定食物蛋白質(zhì)質(zhì)量的標(biāo)準(zhǔn)蛋白。 Reference Protein: A standard against which to measure the quality of other proteins.完 全 蛋 白必需氨基酸模式與人體蛋白質(zhì)相對(duì)一致，能滿足機(jī)體蛋白質(zhì)合成需要的食物蛋白質(zhì)。 Complete Protein: A dietary protein containing all the essential amino acids in relatively the same amounts that human being required. (incl

38、uding animal protein and soy protein ) Incomplete protein蛋 白 質(zhì) 互 補(bǔ) 將兩種或兩種以上的食物蛋白質(zhì)混合事用，使不同食物中必需氨基酸以多補(bǔ)少，從而提高膳食蛋白質(zhì)的營(yíng)養(yǎng)價(jià)值。 Complementary Protein: Two or more proteins whose amino acids assortments complement each other in such a way that the essential amino acids missing from one are supplied by the othe

39、r.主頁(yè)目錄-Home第46頁(yè)，共1350頁(yè)。第三節(jié) 蛋白質(zhì)的消化、吸收和代謝 消化和吸收（digestion and absorption） 主頁(yè)目錄-Home第47頁(yè)，共1350頁(yè)。Gastric Juice : 1. Acid denaturation 2. 胃蛋白酶Pepsin- not highly specific but preferential attack on bonds adjacent to aromatic AA and 亮氨酸(leucine). 3.Carboxypeptidase-terminal aromatic or branch-chained; argi

40、nine or lysine; neutral- dietary Protein Panc- elastase(彈性蛋白酶)- arometic AA reatic trypsin(胰蛋白酶)- NH2- juice chymotrypsine(糜蛋白酶) - lysine, arginine dipeptide , tripeptide and free AA absorbed through the mucosal cells of small intestine 肽酶peptidase through three active free AA transport systems neut

41、ral-,basic- and acidic-. Liver and other organs 主頁(yè)目錄-Home第48頁(yè)，共1350頁(yè)。代謝與氮平衡 (metabolism and nitrogen balance)1.代謝攝入蛋白質(zhì)90克 消 化 道(30%)肌肉(50%)器官體液其它機(jī)體蛋白質(zhì)氨基酸池糞便10g(1.6gN)尿75g(12gN)其它5g(0.8gN)(20%)腸道內(nèi)源性蛋白質(zhì)70g消化、吸收蛋白質(zhì)150g圖1-1 蛋白質(zhì)代謝及氮平衡主頁(yè)目錄-Home第49頁(yè)，共1350頁(yè)。氮平衡（Nitrogen balance）(1)必要的氮損失（obligatory nitrogen

42、 losses） (2) 氮平衡： BI（UFS）Positive nitrogen balanceN in N outN in = N outNitrogen equillibriumNegativenitrogen balanceN in N out主頁(yè)目錄-Home第50頁(yè)，共1350頁(yè)。第四節(jié) 食物蛋白質(zhì)營(yíng)養(yǎng)學(xué)評(píng)價(jià) (一)蛋白質(zhì)含量 (content）(2)表觀消化率（apparent -）:(二)蛋白質(zhì)消化率(digestibility)(1)真消化率（true -）主頁(yè)目錄-Home第51頁(yè)，共1350頁(yè)。(三)蛋白質(zhì)利用率（utilization）1.Biological val

43、ue, BV:生物價(jià) The amount of protein nitrogen that is retained for growth and maintenance,expressed as a percentage of the protein nitrogen that has been digested and absorbed. To determine the actual value of an absorbed protein as it is used by the body. 主頁(yè)目錄-Home第52頁(yè)，共1350頁(yè)。2.Net Protein Utilization,

44、NPU蛋白質(zhì)凈利用率 The amount of protein nitrogen that is retained from a given amount of protein nitrogen eaten. To determine the amino acid composition and digestibility of a test protein.主頁(yè)目錄-Home第53頁(yè)，共1350頁(yè)。 3.Protein Efficiency Ratio, PER: 蛋白質(zhì)功效比值 A measure of protein quality assessed bydetermining how

45、 well a given protein supportsweight gain in growing rats. Used to establish the protein quality for infantformulas and baby foods.主頁(yè)目錄-Home第54頁(yè)，共1350頁(yè)。4.Amino Acid Score,AAS氨基酸評(píng)分 The lowest score is the score of limiting AA which is the AAS of the protein. A method of evaluating protein quality by

46、comparing a test proteins amino acid pattern with that of a reference protein; sometimes called chemical scoring. 主頁(yè)目錄-Home第55頁(yè)，共1350頁(yè)。表1-4 幾種食物和不同人群需要的氨基酸評(píng)分模式氨基酸人群（mg/g 蛋白質(zhì)）1歲以下 25歲 1012歲 成人食物(mg/g蛋白質(zhì))雞蛋 牛奶 牛肉組氨酸26191916222734異亮氨酸46282813544748亮氨酸93664419869581賴氨酸66584416707889蛋氨酸+半胱氨酸4225221757334

47、0苯丙氨酸+酪氨酸726322199310280蘇氨酸4334289474446纈氨酸55352513666450色氨酸171195171412總計(jì)460339241127512504479摘自WTO Technical Report Series 724,第12頁(yè),1985年。主頁(yè)目錄-Home第56頁(yè)，共1350頁(yè)。表1-5 常見(jiàn)幾種食物蛋白質(zhì)質(zhì)量食物BVUPN(%)PERAAS全雞蛋94843.921.06全牛奶87823.090.98魚(yú)83814.551.00牛肉74732.301.00大豆73662.320.63精制面粉52510.600.34大米63632.160.59土豆6760

48、0.48摘自“營(yíng)養(yǎng)與食品衛(wèi)生學(xué)”，第3版，第11頁(yè)。主頁(yè)目錄-Home第57頁(yè)，共1350頁(yè)。5.Protein Digestibility corrected AAS, PDCAAS:（經(jīng)消化率校正的氨基酸評(píng)分） A measure of protein quality assessed bycomparing the amino acid score of a food proteinWith the amino acid requirements of preschool-ageChildren and then correcting for the truedigestibility

49、of the protein; Recommended by the FAO/WHO and used toestablish protein quality of foods for daily valuepercentage on food labels. 主頁(yè)目錄-Home第58頁(yè)，共1350頁(yè)。表1-6 幾種食物蛋白質(zhì)的PDCAAS食物蛋白PDCAAS食物蛋白PDCAAS酪蛋白1.00斑豆0.63雞蛋1.00燕麥粉0.57大豆分離蛋白0.99花生粉0.52牛肉0.92小扁豆0.52豌豆粉0.69全麥0.40菜豆0.68摘自Understanding Nutrition, 第7版，第21

50、5頁(yè)，1996年。主頁(yè)目錄-Home第59頁(yè)，共1350頁(yè)。 第五節(jié) 蛋白質(zhì)營(yíng)養(yǎng)不良、營(yíng)養(yǎng)狀況評(píng)價(jià)及食物供給 Kwishiorkor: A Ghanaian word meaning “the evil spirit that infects the first child when the second child is born”. The second child suddenly switched from nutrient dense, protein-rich breast milk to a starchy, protein-poor cereal, soon begins to

51、 sicken and die.Marasmus: A severe deprivation of food over a long time (chronic PEM) and therefore is caused by an inadequate energy and protein intake ( and by inadequate essential fatty acids,vitamins, and minerals as well).主頁(yè)目錄-Home第60頁(yè)，共1350頁(yè)。蛋白質(zhì)營(yíng)養(yǎng)不良KwashiorkorMarasmus主頁(yè)目錄-Home第61頁(yè)，共1350頁(yè)。Maras

52、mus Kwashiorkor Infancy(less than 2 yr) older infants and young children(1-3 yr) Develops slowly;chronic PEM rapid onset; acute PEM Severe weight loss some weight loss Severe muscle wasting, with fatSome muscle wasting,with retention of some body fatGrowth:60% weight-for-age growth:60%-80% weight-fo

53、r-age 主頁(yè)目錄-Home第62頁(yè)，共1350頁(yè)。No detectable edema edemaNo fatty liver enlarged fatty liver Anxiety焦急, apathy淡漠 apathy, misery痛苦, irritability易怒, sadness Good appetite possible loss of appetite Hair is sparse,thin and dry; Easily pulled out hair is dry and brittle; easily pull out; changes color; become

54、s straight Skin is dry, thin, and easily wrinkles skin develops lesion主頁(yè)目錄-Home第63頁(yè)，共1350頁(yè)。 高蛋白質(zhì)膳食過(guò)多的危害problems of excess protein） Adult Bone Loss (Osteoporosis骨質(zhì)疏松): Calcium excretion rises as protein intake increases. Recommen-dation of calcium-to-protein is more than 20(mg) to 1(g). Cancer: popul

55、ation studies suggest a correlation between high intakes of animal protein and some type cancer ( cancer of colon, breast,kidneys, pancreas, and prostate) Gain Weight: Protein-rich foods are often fat-rich foods. Others. Heart Disease: Foods rich in animal protein tend tobe rich in saturated fats an

56、d cholesterol; homocystei（高半胱氨酸）may be an independent risk factor for heart disease.主頁(yè)目錄-Home第64頁(yè)，共1350頁(yè)。蛋白質(zhì)營(yíng)養(yǎng)狀況評(píng)價(jià)Assessment of protein nutrition in human bodySerum albumin: 35-50g/L Serum transferritin: 2.2-4g/L Retinol-binding protein: 26-76mg/L Thyroxine-binding-albumin:280-350mg/L主頁(yè)目錄-Home第65頁(yè)，共

57、1350頁(yè)。蛋白質(zhì)供給量和食物來(lái)源 （DRIs and Food source） RNI: 1) 數(shù)量 2）質(zhì)量 (優(yōu)質(zhì)蛋白質(zhì))Food Source: animal and plant foods. Milk and Soy been主頁(yè)目錄-Home第66頁(yè)，共1350頁(yè)。中國(guó)居民膳食蛋白質(zhì)的推薦攝入量: RNI與RDAAge (year)RNI（2000）RDA（1988）manwomanmanwoman01.53.0g/kg.bw.2.04.0g/kg.bw.0.51353535352404040403454545454505050455555555506555555557606060

58、608656565609656565651070657065主頁(yè)目錄-Home第67頁(yè)，共1350頁(yè)。RNI與RDA：續(xù)表Age (year)RNI（2000）RDA（1988）manwomanmanwoman11757570807080148580809080輕7565807018中80709080重908010090孕期早+5中+15+15晚+20+25乳 母+20+256075657565主頁(yè)目錄-Home第68頁(yè)，共1350頁(yè)。QuestionWhat is the difference between essential and nonessential amino acids? E

59、xplain these terms: protein-sparing effect, amino acid pattern, protein complementary action . How to evaluate the food protein What are the health consequences of ingesting inadequate protein and energy? 主頁(yè)目錄-Home第69頁(yè)，共1350頁(yè)。 第三章 碳水化合物 carbohydrate 李 李主頁(yè)目錄-Home第70頁(yè)，共1350頁(yè)。單糖(monosaccharide) 雙糖(disa

60、ccharide) 寡糖(oligosaccharide) 多糖(polysaccharide)一、分類Classification主頁(yè)目錄-Home第71頁(yè)，共1350頁(yè)。（一）單糖 (monosaccharide)1.葡萄糖（Glucose）: D-and L-. A little in the natural foods.2.果糖（ Fructose）: 主要存在于水果和蜂蜜中，人工制造的玉米糖漿中含 40%-90% 。 Glucose主頁(yè)目錄-Home第72頁(yè)，共1350頁(yè)。3. 半乳糖（Galactose）：以乳糖形式存在于 天然食物中。 It is not usually foun