Nutrition n diet

INTRODUCTION
Definitions
Balanced diet
Function of food
Calories Need According To Lifestyle
Role of Nutrition in Periodontal Disease
Effects of Nutrition on Periodontium
Nutritional Requirements of the Periodontal Patient
2

DEFINITIONS
NUTRITION :are substances found in foods that
provide energy and materials for cell development,
growth, and repair.
NUTRIENTS : Molecules present in the food, which helps
in the nourishment of the body
DIET : It is the food prescribed according to the
requirement of the body.
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A balanced diet means getting the right types
and amounts of foods and drinks to supply
nutrition and energy for maintaining body cells,
tissues, and organs, and for supporting normal
growth and development.
Balanced
Diet

Balanced Diet
Contd…..
There are 6 kinds of nutrients in balanced diet
Proteins
Carbohydrates
Fats
Vitamins
Minerals
Water
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Proteins are large molecules that contain
carbon, hydrogen, oxygen and nitrogen. They are
made up of amino acids.
Amino acids are the building blocks of protein
Essential amino acids cannot be made by the
body’s cells, and must be supplied by the food
you eat
Protein is used for growth and repair of body
cells and helps to form muscle, skin and hair
Balanced Diet Contd…..

7
Carbohydrates are the main source of
energy in the body.
There are three types of carbohydrates:
sugar, starch and fiber
Sugars are simple carbohydrates
Found in table sugar, fruits, honey,
milk…
Simple carbohydrates are digested and
absorbed quickly

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Starches and fiber are complex carbohydrates
Complex carbohydrates are absorbed more
slowly; they help maintain healthy blood sugar levels
facilitate steady, long-lasting bouts of energy.

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Starches are made up of many simple sugars in long
chains
Pasta, potatoes, rice, white breads…

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Fiber is found in the cell walls of
plant cells
Fiber cannot be digested.
It is needed to keep your
digestive system healthy
Fiber is found in
whole grain breads and
cereals, beans, vegetable
and fruits

Fats or lipids are necessary nutrients because they
provide energy and help your body absorb vitamins
Fat tissue cushions your internal organs
Fat is a storage unit for energy; it can release
twice as much energy as carbs
Excess energy from all foods you eat is converted
to fat and stored for later use.
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Unsaturated fats are liquid at room temperature
Vegetable oils, avocado, the fats in nuts and
seeds

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Saturated fats are solid at room temperature
Animal products such
as meat and milk are
sources of saturated fat
Saturated fats are associated with high levels of
cholesterol in the blood
Cholesterol can block blood supply to organs
and increase blood pressure. This can lead to
heart disease and stroke

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Vitamins are organic nutrients needed in small
amounts for growth, regulating body functions,
and preventing diseases.
Most foods provide some
vitamins, but no one food has
them all

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Minerals are inorganic nutrients that regulate
chemical reactions in the body
Your body uses about 14 different minerals
The minerals used in largest amounts are calcium
and phosphorus
Other minerals include potassium, iron, and
sodium

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Water is the most important
nutrient for survival
The human body as about 60 percent water
Your cells need water to carry out their
functions.

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Your body loses water through
breathing, sweat, and excretion
Water needs to be replaced every day
Water is not only found in liquids but
also in many foods

Because no food has every nutrient, you need to eat a
variety of foods to maintain optimum health.
A food group is a collection of foods that contain the
same type of nutrient
There are five food groups:
Bread/cereal
Vegetables
Fruit
Dairy
Meat/beans
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FUNCTIONS OF FOOD
1. Energy-yielding
2. Body-building and
3. Protective function
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FUNCTIONS OF FOOD
Food provides energy to keep the body warm, the
muscles active for work and play and the various
organs alert to carry out the daily activities.
Food supplies body building nutrients needed for
growth, while the fetus develops in the mother’s
womb, new tissues are being continuously built.
This proceeds right through infancy, childhood and
adolescence. During these stages of life, there is a
tremendous demand for body building nutrients
that are essential everyday to replace the daily
‘wear and tear.’
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Protective function
Required in minute quantities.
Variety of these nutrients, each
responsible for a specific task in the body.
If the diet is deficient or lacking in one or
more of these vital substances, it leads to
derangement of the normal functioning of
the different parts of the body, resulting in
ill-health, stunted growth and imperfect
development.
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Energy-yielding foodstuffs
 Foodstuffs form the great bulk of the ordinary
diet.
 They supply energy to keep the body warm
and are hence known as ‘fuel-food.’
 A few examples of energy-yielding foodstuffs
are cereals starchy vegetables, pulses, nuts,
sugars, and oils .
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Body-building foodstuffs
 Contain a satisfactory amount of the nutrients
needs to build the body and replace the worn-
out tissues.
 Milk and its products, meat, fish, and eggs are
the best representatives of this group of
foodstuffs.
 The other examples are dals, dried beans, peas
and nuts.
 Cereals also contain some body-building
nutrients.
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Protective foodstuffs
 Provide large number of the protective
substances needed by the body.
 Almost all natural foodstuffs contain one or
more of these protective nutrients.
 There is no single foodstuff in which all the
different protective substances are present in
quantities sufficient to meet the daily needs of
the body.
 This is why a combination of different kinds of
foodstuffs is essential in a diet.
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Contd…..
 Best examples of this group of foodstuffs are
green vegetables, fresh fruits, milk, meat, fish,
and eggs.
 Protective foodstuffs contain sufficient
amounts of one or more of the protective
nutrients so that a combination of them yields
enough to maintain life.
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Calories Need According To Lifestyle
• The number of calories you need to attain or
maintain a desired weight would depend on your
level of physical activities.
• If you are gaining weight over time this means that
you should be exercising more and/or eating less.
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 Basal or Resting Metabolic Rate measures
the calories the body needs to keep it in
being. 1654 calories per day is the number
of calories to keep the circulatory system
and other vital bodily functions in
operation.

 Light Activity means you are engaged in
activities such as light house keeping. To
maintain your current weight you could
consume approx 2150 calories per day.
 Moderate Activity means you walk a couple
miles per week on a regular basis. To maintain
your current weight you could consume
approx 2480 calories per day.
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 Heavy Activity means you run at least 10 miles
a week. To maintain your current weight you
could consume approx 2811 calories per day.
 Very Heavy Activity means you are training for
marathons running at least 30 miles a week.
To maintain your current weight you could
consume approx 3307 calories per day.
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Nutritional mechanisms of inflammation
•Acute inflammation is protective but chronic and non-
resolving inflammation is destructive .
•Oxidative stress is a key driver of chronic inflammation and
as a result has a central role in the pathogenesis of a wide
range of chronic inflammatory diseases (e.g. type 2 diabetes,
cardiovascular disease and metabolic syndrome)

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In health a fine balance exists between, oxidants
and on the other antioxidants which are found in
all tissues of the body

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. If this fine balance is disturbed by excess production of
oxidants and/or depletion of local antioxidants the resulting
oxidant excess causes oxidative stress and is associated with
the local tissue damage seen in periodontitis

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Oxidative stress cause direct tissue damage by altering molecules,
such as proteins, lipids and DNA, thus damaging cells directly, or by
activating redox-sensitive transcription factors within the cell that
leads to downstream gene expression changes and production of pro-
inflammatory molecules. (CYTOKINES)

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Foods rich in antioxidants may help reduce oxidative
stress, for example green leafy vegetables (broccoli,
spinach etc.), berries (e.g. blueberries, blackberries,
cranberries, strawberries etc.), red beans, red wine, and
dark chocolate with greater than 70% cocoa are all rich
in key antioxidant micronutrients.
ANTIOXIDANT DIET

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Nutrition effects on the
Periodontium

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Important in DNA and RNA replication, transcription of RNA
and the translation of proteins necessary for new cell growth.
May be associated with changes in the connective tissue that
result in altered wound healing.
Nutrient effects on the Periodontium

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Important in DNA and RNA replication,
transcription of RNA and the translation of proteins
necessary for new cell growth.
Antioxidant that impact the immune response.
Involved in collagen metabolism by affecting cell
differentiation.

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Decrease in the rate of
proliferation of epithelial cells.
Affect bone formation

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•Important in tissue maintenance and the
production of new cells during development and
healing.
Vitamin B deficiency :
•Breakdown of the mucosal barrier to
pathogens.
•Loss of integrity of the oral mucosa “stomatitis,
angular cheilitis and glossitis”.
•Inability to produce adequate energy.
•Affect protein synthesis including DNA and RNA

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Vitamin C :
Antioxidant that impact the immune response.
Maintaining integrity of oral mucosa.
Affect bone formation.
Vitamin C deficiency :
Scurvy “swollen & inflamed gingiva, loosening of the
teeth, hemorrhage, weakness, malaise, sore joints,
bruising and weight loss”.
Conditioning factor in the development of gingivitis.
Breakdown of the mucosal barrier to pathogens.
Affect neutrophill function.

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Regulate absorption of calcium.
Collagen synthesis and accumulation
of mineralized bone are dependent on
adequate levels of vit. D and calcium.
Stimulates osteoclasts to help
mobilize the calcium stored in bone.

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:
•Antioxidant that impact the immune
response.
•Improve cellular immune function.
:
•Affect overall immune response.
•Affect antibody production

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:
Affect bone formation.
Involved in calcified tissue.
:
Inadequate formation of peak bone
mass.
Accelerated bone loss postmenopausally.
Osteoporosis

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•Important participant in collagen metabolism and
wound healing.
•Essential for the cross-linking of both collagen and
elastin.
•Involved in calcified tissue.
•Antioxidant that impact the immune response
:
•Reduce tensile strength of collagen.
•Bone fragility
•Affect proliferation of neutrophils.

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•Important for optimum wound healing.
•Antioxidant that impact the immune response
:
•Affect neutrophil phagocytic activity.
•Affect proliferation of lymphocytes

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The recommendations of the 2011 European workshop on Periodontology
suggest that the dental team should consider including advice to all
patients on increasing levels of fish oils, fibre, fruit and vegetables and to
reduce levels of refined sugars as part of a periodontal prevention/
treatment regime and a general health benefit message.

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Nutritional counselling for a patient with chronic
periodontal disease
Step 1: Evaluate the diet and if necessary, demonstrate the
A food intake evaluation chart is one in which all foods are classified into 4 food
groups.
1. Vegetable fruit group.
2. Bread cereal group.
3. Milk cheese group.
4. Meat, fish and beans group.
Step 2: Explain the nutrition periodontal relationship:
The advise will be:
1. Reducing sugar intake.
2. Replacing sweets and other empty calorie foods with nutritious, firm and fibrous
foods that will stimulate and strengthen the periodontal tissues.
3. Selecting a well balanced, varied, adequate diet to provide all the essential
nutrients and to support overall health in general and the health of tooth
supporting structures in particular.

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Step 3: Assess nutritional status by taking a detailed medical
history
Social and Diet histories:
Examine for clinical signs of malnutrition
Step 4: Prescribe a balanced diet.
Step 5: Follow up

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Diet Before Periodontal Surgery
When prescribing a diet before periodontal surgery, the goal
is to enable the patient to meet the stress of surgery.
A well nourished state is optimal for wound healing
If the periodontal patient is malnourished, a diet high in
protein and enough carbohydrates and fat to provide about
2,500 K cal should be prescribed for 7-14 days before surgery.

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Postoperative Dietary Management of
Hospitalized Periodontal Surgery patient
During periodontal surgery under general anesthesia, intravenous levels
of solution of 0.45% saline with 5% dextrose in water and 38.5
milliequivalents of sodium is given.
The intravenous infusion is terminated in the recovery room if the
patient is in good health.
If the patient seems dehydrated, it may be wise to continue the infusion
until the patient is fully reactive and can take fluids by mouth.
When fully recovered from the anesthesia, the patient should be given
clear fluid as tolerated. In addition to water, beverages such as cola drinks,
ginger ale, apple juice and orange juice .

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On the first post operative day, in addition to the beverages mentioned,
sherbets, custards and ice creams may be advised if the patient is hungry.
Cereal topped with sugar and milk, as well as, egg or chicken, pea or vegetable soup
can be suggested.
On the second post operative the patient may supplement the diet with the
following:
1. Vegetable fruit group: Citrus fruits such as oranges and grapes are recommended
as are tomato and other fruit and vegetable juices.
2. Bread cereal group: Strained gruels can be given eg: wheat with milk. Period
3. Milk group: Milk in all forms can be given such as ice -creams, milk shakes and
malted milks.
4. Meat group: Eggs in the form of eggnogs may be given in a liquid diet.
A full liquid diet that furnishes 2000 calories and 80 gm of proteins per day is
recommended.

OBESITY
 Defined as excess accumulation of body fat.
 Has several adverse health effects and can
even lead to premature death.
 It increases the risk of high blood pressure,
high blood cholesterol and triglycerides, heart
disease, diabetes, gallstones and certain
cancers.
 Obesity is not a simple consequence of
overeating.
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 Adult human may not normally regulate his daily
energy intake to balance his daily energy
expenditure.
 Overweight and obesity are due to positive energy
balance.
 Overeating and reduced physical activity together
lead to obesity.
 Genetic predisposition cannot be ruled out as a
contributing factor.
 Prevention and control of obesity are directly related
to dietary management and physical activity.
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 Obesity is based on the degree of excess fat.
Body Mass == Weight in Kilogram
Index Height in meters2
 Normal (ideal) BMI ranges between 18.5 and 25.
 An average BMI of a population should be 21 or
22.
 Less than 18.5 denotes chronic under-nutrition.
 Between 25-30 considered as overweight.
 Above 30 indicate obesity.
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HOW TO REDUCE BODY WEIGHT ?
 Weight reduction diets should contain at least
800 Kcal/day and provide all nutrient
requirement.
 Loss of half a kilogram per week is generally
considered safe.
 Extreme approaches should be avoided and
use of drugs may be dangerous.
 In children, obesity should be controlled by
increasing physical activity rather than
restricting food intake.
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 Modifications in dietary habits have to be
incorporated into one’s lifestyle along with adequate
exercise to keep the body weight within the normal
limits.
 Refined sugars and alcohol provide empty calories
and should be avoided.
 Plant foods that provide complex carbohydrates and
fiber may need preferred as they reduce blood
glucose, cholesterol, and triglycerides.
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 Weight-reducing diets must be rich in proteins
and low in carbohydrates and fats.
 Frequent fasting/semi-fasting followed by
adequate or excess food consumption will also
aggravate the problem of weight gain.
 All reducing regimens should be monitored by
a doctor and a dietitian.
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 Slow and steady reduction in body weight is advised.
 Severe fasting may lead to health hazards.
 Enjoy a variety of foods in amounts needed to
balance your physical activity.
 Eat small meals regularly at frequent intervals.
 Cut down on sugar, fatty foods, and alcohol.
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BLOOD PRESSURE CLASSIFICATION
Systolic mmHg Diastolic mmHg
Normal <120 And <80
Pre Hypertension 120-139 Or 80-89
Hypertension Stage 1 140-159 Or 90-99
Hypertension Stage 2 ≥ 160 Or ≥ 100
Isolated Systolic
Hypertension
>140 And <90
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HOW TO REDUCE HYPERTENSION ?
 Sodium is the major electrolyte in the
extracellular fluid.
 Sodium plays an important role in nerve
conduction and fluid balance in the body.
 Sodium intake needs to be balanced by
potassium intake.
 There is strong association between salt intake
and blood pressure.
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 Prevalence of hypertension is low in populations
consuming less than 3g salt per day.
 The usual increase in BP with age is also not seen with
such intakes.
 Drastic restriction of dietary salt decreases the risk of
hypertension.
 Potassium-rich foods such as fresh vegetables and fruits
decrease blood pressure.
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 Restrict intake of preserved and processed foods
like pickles, sauces, ketchup, salted biscuits, chips,
cheese and fish.
 Eat plenty of vegetables and fruits to provide
adequate potassium.
 Use always iodized salt.
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DIABETIC SAMPLE DIET
 Divide the plate into ½
and the 2nd half into
equal ¼.
 Fill the 1st half with non
starch vegetables like
spinach,carrots,tomato
es.
 The ¼ with
meat/proteins like
egg,fish,chicken.
70

 The remaining ¼ with rice,bread,potatoes,cereals.
 1 serving of non fat sugar free yoghurt
or milk.
 One serving of fruits like guava,
apple.
Contd..
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ADVANTAGES
 Even carbohyrate distribution throughout the day.
 Lowers carbohydrate intake
 Contain more fibre,antioxidants,photochemicals and
quality proteins
72

DO’S AND DONTS
Eat food at fixed day hours
Have three proper meals & light
snacks in between
The gaps between meals should
be short
Drink a lot of water that will help
flush the toxins off
Avoid fried foods and sweetmeats
Include fresh vegetable salad in
every meal
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Contd…
 Don't fry foods instead bake or boil
 Eat less high-fat red meat and fish. Avoid
organ meats
 Limit the use of such as ketchup,- high
in salt and sugar
 Limit salt
 Avoid ready to eat and junk
foods
 Don't skip meals and medicine
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SPECIAL FOOD FOR DIABETICS
BLACKBERRY- Contain glucoside
GARLIC- contain potassium,zinc &sulphur
ONION- Diuretic & Digestive property
FIBRES- Aids slow digestion & absorption of
nutrition
CINNAMON SOLUTION- Promote glucose
metabolism & reduce cholesterol
ANTIOXIDANT
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Protein-Energy
Malnutrition
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• MALNUTRITION
WHO defines Malnutrition as "the cellular
imbalance between the supply of nutrients
and energy and the body's demand for them
to ensure growth, maintenance, and specific
functions.“
Malnutrition is the condition that develops when the
body does not get the right amount of the vitamins,
minerals, and other nutrients it needs to maintain
healthy tissues and organ function.
Definitions
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• PROTEIN ENERGY MALNUTRITION
It is a group of body depletion disorders which
include kwashiorkor, marasmus and the
intermediate stages
• MARASMUS
Represents simple starvation . The body adapts
to a chronic state of insufficient caloric intake
• KWASHIORKOR
It is the body’s response to insufficient protein
intake but usually sufficient calories for energy
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AETIOLOGY:
Different combinations of many aetiological factors
can lead to PEM in children. They are:
• Social and Economic Factors
• Biological factors
• Environmental factors
• Role of Free Radicals & Aflatoxin
• Age of the Host
79

• Amongst the Social, Economic, Biological and
Environmental Factors the common causes are:
 Lack of breast feeding and giving diluted formula
 Improper complementary feeding
 Over crowding in family
 Ignorance
 Illiteracy
 Lack of health education
 Poverty
 Infection
 Familial disharmony
80

The clinical presentation depends upon the
type , severity and duration of the dietary
deficiencies. The five forms of PEM are :
1. Kwashiorkor
2. Marasmic-kwashiorkor
3. Marasmus
4. Underweight child
81

KWASHIORKOR
• The term kwashiorkor is taken from the Ga
language of Ghana and means "the sickness of the
weaning”.
• Kwashiorkor, also called wet protein-energy
malnutrition, is a form of PEM characterized
primarily by protein deficiency.
• This condition usually appears at the age of about
12 months when breastfeeding is discontinued, but
it can develop at any time during a child's
formative years.
• It causes fluid retention (edema); dry, peeling
skin; and hair discoloration.
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MARASMUS
• The term marasmus is derived from the Greek
word marasmos, which means withering or wasting.
• Marasmus is a form of severe protein-energy
malnutrition characterized by energy deficiency.
• Primarily caused by energy deficiency, marasmus is
characterized by stunted growth and wasting of
muscle and tissue.
• Marasmus usually develops between the ages of six
months and one year in children who have been
weaned from breast milk or who suffer from
weakening conditions like chronic diarrhea.
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•A severely malnourished child with
features of both marasmus and
Kwashiorkor.
•The features of Kwashiorkor are
severe oedema of feet and legs and
also hands, lower arms, abdomen
and face. Also there is pale skin and
hair, and the child is unhappy.
• There are also signs of marasmus,
wasting of the muscles of the upper
arms, shoulders and chest so that
you can see the ribs
MARASMIC-KWASHIORKOR

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•Children with sub-clinical
PEM can be detected by
their weight for age or
weight for height, which
are significantly below
normal. They may have
reduced plasma albumin.
They are at risk for
respiratory and gastric
infections
UNDERWEIGHT CHILD

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TREATMENT
Treatment strategy can be divided into three stages.
Resolving life threatening conditions
Restoring nutritional status
Ensuring nutritional rehabilitation.
There are three stages of treatment.
1. Hospital Treatment
The following conditions should be corrected. Hypothermia,
hypoglycemia, infection, dehydration, electrolyte imbalance,
anaemia and other vitamin and mineral deficiencies.

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2. Dietary Management
The diet should be from locally available staple foods -
inexpensive, easily digestible, evenly distributed
throughout the day and increased number of feedings
to increase the quantity of food.
3. Rehabilitation
The concept of nutritional rehabilitation is based on
practical nutritional training for mothers in which they
learn by feeding their children back to health under
supervision and using local foods.

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•Promotion of breast feeding
•Development of low cost weaning
•Nutrition education and promotion of
correct feeding practices
•Family planning and spacing of births
•Immunization
•Food fortification
•Early diagnosis and treatment
PREVENTION
Conclusion

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Conclusion
Usually, the role of diet and nutrition in the management gingival and periodontal
disease is primarily that of prevention and maintenance. The benefits from good
nutrition are important, especially with respect to increase in the capacity of
periodontal tissues to:
1. Resist infection.
2. Strengthen and maintain the epithelial barrier.
3. Promote the repair of damaged periodontal tissues.

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