Chapter 73

Nutrients are substances that are not synthesized in sufficient amounts in the body and therefore must be supplied by the diet. Nutrient requirements for groups of healthy persons have been determined experimentally. For good health, we require energy-providing nutrients (protein, fat, and carbohydrate), vitamins, minerals, and water. Human requirements for organic nutrients include 9 essential amino acids, several fatty acids, glucose, 4 fat-soluble vitamins, 10 water-soluble vitamins, dietary fiber, and choline. Several inorganic substances, including 4 minerals, 7 trace minerals, 3 electrolytes, and the ultra trace elements, must also be supplied by diet.

The required amounts of the essential nutrients differ by age and physiologic state. Conditionally essential nutrients are not required in the diet but must be supplied to individuals who do not synthesize them in adequate amounts, such as those with genetic defects, those having pathologic states with nutritional implications, and developmentally immature infants. Many other organic and inorganic compounds present in foods have health effects. For example, lead and pesticide residues may have toxic effects.

### Energy

For weight to remain stable, energy intake must match energy output. The major components of energy output are resting energy expenditure (REE) and physical activity; minor sources include the energy cost of metabolizing food (thermic effect of food or specific dynamic action) and shivering thermogenesis (e.g., cold-induced thermogenesis). The average energy intake is about 2600 kcal/d for American men and about 1900 kcal/d for American women, though these estimates vary with body size and activity level. Formulas for estimating REE are useful for assessing the energy needs of an individual whose weight is stable. Thus, for males, REE = 900 + 10m, and for females, REE = 700 + 7m, where m is mass in kilograms. The calculated REE is then adjusted for physical activity level by multiplying by 1.2 for sedentary, 1.4 for moderately active, or 1.8 for very active individuals. The final figure provides an estimate of total caloric needs in a state of energy balance. For further discussion of energy balance in health and disease, see Chap.75.

### Protein

Dietary protein consists of both essential and nonessential amino acids that are required for protein synthesis. The nine essential amino acids are histidine, isoleucine, leucine, lysine, methionine/ cystine, phenylalanine/tyrosine, threonine, tryptophan, and valine. Certain amino acids, such as alanine, can also be used for energy and gluconeogenesis. When energy intake is inadequate, protein intake must be increased, because ingested amino acids are diverted into pathways of glucose synthesis and oxidation. In extreme energy deprivation, protein-calorie malnutrition may ensue (Chap. 75).

For adults, the recommended dietary allowance (RDA) for protein is about 0.6 g/kg desirable body mass per day, assuming that energy needs are met and that the protein is of relatively high biologic value. Current recommendations for a healthy diet call for ...

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