Energy Balance

By
Gaga Irawan Nugraha, MD., MS.

Department of Medical Nutrition

Energy: Fuel for Work

Energy source
Chemical

energy in carbohydrates, fat, protein

Food energy to cellular energy

Stage

1: digestion, absorption, transport Stage 2: breakdown of molecules Stage 3: transfer of energy to a form cells can use

Cell is the metabolic processing center

Nucleus Cytoplasm

Cytosol + organelles

ATP is the bodys energy currency

ATP

= adenosine triphosphate Form of energy cells use

NAD and FAD: transport shuttles

Accept

high energy electrons for use in ATP production

Metabolism is an integrated set of chemical reactions occuring in the body that enable us to extract energy from the environment and use it to synthesize building blocks that are used to make essential proteins, carbohydrates and lipids.

Fundamental points about metabolism: Each reaction does not occur in isolation but provides a substrate. Pathways producing a continuous process. Metabolic map. Some of the reactions are one way. Concepts & purposes of reactions.

Metabolism pathways can be classified as either catabolism or anabolism. Catabolism

Reactions

that breakdown compounds into small units

Anabolism
Reactions

that build complex molecules from smaller ones

Catabolism pathways names end is lysis meaning to breakdown. glycogenolysis: glycogen breakdown proteolysis: protein breakdown lipolysis: lipid breakdown glycolysis: glucose breakdown

Anabolic pathways names end in genesis meaning to create. glycogenesis: glycogen synthesis lipogenesis: fatty acid synthesis gluconeogenesis: glucose synthesis protein synthesis

The transfer of energy in reactions: when chemical bond breaks, energy can be released as heat, captured in another chemical bond, or both.

The site of reactions: metabolic work is going on all the time within the cells. Catabolism of energy-rich compound (carbohydrate, protein & fat):
anaerobic

reactions (cytosol) aerobic reactions (mitochondria)

Regulations of pathways: metabolic reactions almost always require enzyme (or hormone) to facilitate their action. Enzymes need coenzymes. The enzymes are subject to strict regulation to ensure that: The rate of the pathway is adapted to the cells needs. Anabolic & catabolic pathways are not active at the same time.

Production of H2O & Energy in the mitochondria:

H2 + O2 H2O+ energy

The energy potential produced, could form high energy phosphate molecules (ATP & GTP)

ADP + phosphate + energy ATP GDP + phosphate+ energy GTP

Each organ has a preferential fuel; that is, the substrate that it prefers to use for energy production.

 Glucose:

brain, red blood cells, adrenal gland and muscle in anaerobic activity and high intensity aerobic activity. acids: heart, liver, smooth muscle and skeletal muscle in low intensity aerobic activity.

Fatty

 Ketone

bodies: heart, skeletal muscle and after adaptation of starvation, by the brain. chain amino acids (BcAA): skeletal muscle. amino acid: liver.

Branch

Other

Breakdown and Release of Energy

Extracting energy from carbohydrate

Glycolysis

Pathway splits glucose into 2 pyruvates Transfers electrons to NAD Produces some ATP

Pyruvate

to acetyl CoA

Releases CO2 Transfers electrons to NAD

Breakdown and Release of Energy

Extracting energy from carbohydrate

Citric acid cycle Releases CO2 Produces GTP (like ATP) Transfers electrons to NAD and FAD
Electron transport chain Accepts electrons from NAD and FAD Produces large amounts of ATP Produces water End

products of glucose breakdown

ATP, H2O, CO2

Breakdown and Release of Energy

Extracting energy from fat

Split

triglycerides into glycerol and fatty acids Beta-oxidation

Breaks apart fatty acids into acetyl CoA Transfers electrons to NAD and FAD
Citric

acid cycle

Acetyl CoA from beta-oxidation enters cycle

Electron

transport chain End products of fat breakdown

ATP, H2O, CO2

Breakdown and Release of Energy

Extracting energy from protein

Split

protein into amino acids Split off amino group

Converted to urea for excretion
Carbon

skeleton enters breakdown pathways End products

ATP, H2O, CO2, urea

Breakdown and Release of Energy

The breakdown of high energy phosphate molecules will occur if the cells need energy.

ATP ADP + Energy

Functions of the energy released: to conduct nerve impulse (electric) actin & myosin contraction (mechanic) transfer of molecules across membrane (osmotic) to produce heat (thermic) anabolism (chemical)

Biosynthesis and Storage

Making carbohydrate (glucose)

Gluconeogenesis Uses pyruvate, lactate, glycerol, certain amino acids

Storing carbohydrate (glycogen)

Liver,

muscle make glycogen from glucose

Making fat (fatty acids)

Lipogenesis Uses acetyl CoA from fat, amino acids, glucose

Storing fat (triglyceride)

Stored

in adipose tissue

Biosynthesis and Storage

Making ketone bodies (ketogenesis)

Made

from acetyl CoA

Inadequate glucose in cells

Making protein (amino acids)

Amino

acid pool supplied from

Diet, protein breakdown, cell synthesis

Regulation of Metabolism
May favor either anabolic or catabolic functions Regulating hormones

Insulin Glucagon Cortisol Epinephrine

Special States

Feasting
Excess

energy intake from carbohydrate, fat, protein

Promotes storage

Special States

Fasting
Inadequate

energy intake

Promotes breakdown

Prolonged

fasting

Protects body protein as long as possible

ENERGY BALANCE
Key Term: Energy intake Energy expenditure Energy requirement Energy balance

Equilibrium of energy intake and energy expenditure determine the energy status.

ENERGY STATUS

Energy st. assessment for children weight for age. Energy st. assessment for adults weight for height: Body Mass Index (BMI).

Balanced energy: if energy intake sufficient with the energy expenditure. Surplus of energy: if energy intake larger than energy expenditure energy storage increase:
stored as glycogen (limited) and as lipid (abundance). Fatty acids stored as lipid. Protein stored as lipid.
CH

Energy deficit = if energy intake insufficient for energy expenditure. Storage molecules will be used.
7 Kkal of energy similar to 1 gram of body tissue. Loss of energy: 500 Kkal/day or 3500 Kkal/week catabolism of body tissue: 3500 : 7 = 500 g body tissue/week.

Energy intake obtain from the food. Various amount of energy in the food, depends on the composition of the foods. 1 gram CH 4 Kkal 1 gram Protein 4 Kkal 1 gram fatty acid 9 Kkal Vitamin, mineral and water do not provide adequate energy.

Daily amount of energy intake depends on: food class, quantity per portion, and frequency of food intake per day.

Nutrient composition & amount of energy per 100 gram food stuff are available in Food Composition List. Food stuff weight comes from Household measurement.

Total Energy Expenditure = TEE : sum of Basal Energy Expenditure (BEE), Physical Activity (PA) and Spesific Dynamic Action of food (SDA) or Thermic Effect of Food (TEF). The calculation: TEE = BEE + PA + SDA (TEF)

BEE is energy expenditure in basal condition , the ongoing activity while the body rest: heart beat, peristaltic, hormone secretion, enzyme secretion, muscle contraction, etc.

Basal condition:
12 16 hours after the last meal Lying position No physical activity an hour before the test Relax Normal body temperature Room temperature should be 21-25oC Normal humidity

Harris & Benedict calculation for BEE:

Men : 66 + (13,7 x BW kg) + (5 x BH cm) (6,8 x age) Women: 665 + (9,6 x BW kg) + (1,7 x BH cm) (4,7 x age)

Simple calculation for BEE:

Men : 1 Kkal / BW Kg / h = 24 Kkal / BW Kg / d Women: 0,9 Kkal / BW Kg / h = 21,6 Kkal / BW Kg/ d

Factors that influence BEE

Body weight, height, age, gender, growth, temperature, muscle mass, sleep, endocrine activity, nutrition status.

Age : above 20 BEE will decrease 2% every 10 y. Gender : BEE in men > women (at age >10 y) Growth: highest for baby and adolescence. Height: the taller the higher BEE Muscle mass : the greater the higher BEE Temperature : every 1oC elevation of body temperature (body temp above 37oC) BEE will increase 13%

Sleep : BEE decrease 10% Endocrine:- hiperthyroid: BEE increase 75-100% - hipothyroid : BEE decrease 30-40% - right before menstruation BEE slightly increase and during menstruation BEE decrease Nutrition status : BEE decrease in PEM Pregnancy : BEE increase 15-25%

Physical Activity (PA)

PA very light PA light PA moderate PA heavy AF very heavy

= 10-30% BEE = 30-50% BEE = 50-80% BEE = 80-100% BEE = > 100% BEE

Level of Activity

Very light:

Light:
Moderate: Heavy

Very heavy

- Activity in sitting position - Bedrest Teacher, lecturer, general practitioner, housewife. Farmer, student(+ sport), office worker : Athlete during TC, unskilled worker, manual laborer, army during training : Sawyer of wood,blacksmith, ricksaw carrier, becak driver.

SDA or TEF
SDA /TEF is the amount of energy used for digestion, absorption and utilization of food consumed. - SDA of protein 30% BEE - SDA of carbohydrate < protein - SDA of fat the lowest SDA of Indonesian food on the average is 10% of BEE + AF