Biochemistry 4.

November 4, 2011
Dr. Balcueva

Fundamentals of Nutrition
OUTLINE
I. Nutrition
V. Nutrients
VI. Assessment of Nutritional
A. RDA
status
B. Other Terms
VII. Health
II. Concepts on Energy reqts
VIII. Nutritional Disorders
III. Basic Concepts of Nutrition
IX. Current Issues
IV. Calc of Energy reqts
A. BMR
B. TCR Computations

Level of nutrient intake sufficient to meet the needs of almost all

healthy individuals of a life stage and gender group

Fundamentals of Nutrition

TERMINAL COMPETENCIES
The students must be able to:
1. Give competent advice on the composition of a balanced diet that will
satisfactorily meet ones nutrient and caloric requirements.
2. Explain satisfactorily the role of nutrition in the maintenance of health
3. Be aware of the major nutritional problems affecting the Filipino
population.

Legend: * = stuff mentioned in the lecture.

I. NUTRITION
The science
cience of food and nutrients and their actions in the body
body.
Or study
tudy of nutrients and the processes by which they are used by
the body.
cience of how the body uses food or energy, maintenance,
Or science
and growth.
The science of food, nutrients and other substances therein, their
action, interaction and balance in relation to health and disease
and the processes by which the organism ingests, digests,
absorbs, transports and utilizes and secretes food substances
substances.
Wellness Nutrition: Eating patterns designed
d to enhance health
status.

A. RDA (Recommended Dietary Allowance)

The level of dietary intake sufficiently high to meet the
requirements of almost all individuals generated by setting it at 2
s.d. above or below the mean.
o Exception: requirement for energy you can set the RDA 2 s.d.
above or below the mean, but NOT the total caloric intake
*s.d-standard deviation
*note: energy is computed at the mean
Determination of RDA for most nutrients and energy

Figure 1. Distribution of nutrient/energy intake of a given population

Factors that determine RDA:

o Age
o Body size
o Sex
o Workload
o Physiologic condition
Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

LECTURER: Dra. Balcueva

B. OTHER TERMS
ADEQUATE INTAKE (AI) approximate level of an average intake
determined by the observation of or experimentation with a
particular group or population that appears normal.
normal
TOLERABLE UPPER INTAKE LEVEL (UL) The level of nutrient that
SHOULD NOT be exceeded to avoid adverse health risks.
risks
NUTRIENTS
v Chemical constituents derived from food (e.g. fats,
carbohydrates, proteins, vitamins and minerals) that are
essential to the maintenance of health
*can
can cure/improve a patients illness
v Uses:
o Energy
o Structural material
o Reduces
educes risks of some diseases
v 3 Types:
o Macronutrients- proteins, carbs, fats
o Micronutrients- vitamins, minerals
o Phytonutrients- eg. Lycopene (in tomatoes; acts as
antioxidants which destroys free radicals)
NUTRIENT DENSITY amount of micronutrients in relation to the
amount of macronutrients.
cant be converted into energy; vitamins and
*micronutrients-cant
minerals.
*macronutrients-can be converted into energy; CHO, fats, proteins.
ENERGY-YIELDING NUTRIENTS nutrients that break down to yield
energy in the body (CHO, CHON, lipids).
lipids)
DIETARY REFERENCE INDEX standards that define the amount of
energy, nutrients, dietary components, and physical activities that
best support life.
ESTIMATED AVERAGE REQUIREMENT (EAR) The amount of a
nutrient needed to meet the basic requirements of half the
individuals in a specific group.
maam mentioned that dietary reference index and EAR are nice to
*maam
know
FOOD
Products derived from plants and animals
Can be absorbed by the body
Yields energy
MINIMUM DAILY REQUIREMENT (MDR) - The smallest exogenous
supply of a nutrient that must be absorbed or consumed to prevent
manifestations of deficiency.
NUTRITIONAL STATUS refers to the condition of the bodyas a
result of ingestion and utilization of food.
food
MALNUTRITION - A pathological state resulting from arelative lack
or absolute deficiency or excess of one or more of the essential
nutrients. It can be primary orsecondary.
2 Types
o Primary Malnutrition: person does not eat anything
o Secondary Malnutrition:cant
cant absorb or digest food due to a
disease, *ex.
ex. Loss of appetite due to cancer

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II. CONCEPTS ON ENERGY REQUIREMENTS

EQUIREMENTS
1 kilocalorie (kcal) = the amount of heat required to raise tthe
temperature of 1 kg of water 1C
C . (direct calorimetry)
The international unit is Joule (J).
1 kcal = 4.184 kJ
*note:
note: the unit kcal is usually used in Philippine setting, however in
international journals Joules are more commonly used.
RQ or Respiratory Quotient
o Used to indirectly determine the heat evolved (caloric content)
from the oxidation of food or caloric requirements of
organisms, in contrast to direct calorimetry.
o It is the ratio of CO2/O2 in the oxidation of food
o Ratio of the volume of CO2 produced and volume of O2
consumed; an indication of the mixture of metabolic fuels being
oxidized [Harper, 2014b]
Table 1. Energy Yield of Different Body Fuels
Fuel
RQ
Kcal/g
Carb
1.0
4
Fat
0.7
9
Protein
0.8
4
Alcohol
7

kJ/g
17
37
17
29

III. BASIC CONCEPTS OF NUTRITION

Nutrition is the food you eat and how the body uses it. Nutrition
provides the body with needed energy and essential constituents
that cannot be synthesized de novo.
Food is made up of different nutrients needed for growth and
health; all nutrients needed by the body are available through
food and many combinations of food lead to a well
well-balanced diet.
No food by itself has all the nutrients needed for full growth and
health; most nutrients do their best work when teamed with
other nutrients.
All persons have the need for the same nutrients but in varying
amounts influenced by age, sex, size, activity, and state of health.
The way food is handled influence the amount of nutrients in
food, its satiety, appearance and taste
tion depends on a proper dietary regimen or food
Sound nutrition
intake, to sustain normal growth, development and health.

Table 2. Heats of combustion and energy available frommajor food

sources

Table 3. Non-protein RQ values

IV. CALCULATION OF ENERGY

ENERG REQUIREMENT
Considered the most basic nutritional requirement taking
precedence over all other nutritional needs.
Components:
o Basal metabolism (BMR, REE or resting energy expenditure)
o Physical activity
o Metabolic response to food (Thermic effects of food or SDA/
Specific Dynamic Action of Food)
/REE resting energy expenditure
A. BMR or Basal Metabolic Rate/REE
the energy expenditure by the body when at rest, but not asleep
under controlled condition of thermal neutrality[Harper]
by indirect calorimetry = 24 kcal/kg/day
kcal/kg/da
differs from REE by less than 10%; measured soonafter waking, 12
hours after a meal (post absorptive state) awake, in a reclining
position(*at rest).
Harris & Benedict (1919) equation estimates REE,using weight in
kg, height in cm and age inyears
1981 Joint FAO/WHO/UNU consultation estimatesBMR :
o Adult male (18-30):
30): 15.3 x W (kg) + 679
o Adult female (18-30)
30) 14.7 x W (kg) + 496
REE increases
o ~ 20% routine activity;
30%for patients with multiple fractures;
o 10-30%for
o 20-50%
50% for patients with sepsis;
o 90-100% forpatients with burn injury
BMR increases with fever, hyperthyroidism, coldclimate,
increased muscle mass, higher in malesand children
BMR decreases w/ increasing age, even when body weight
remains constant; result of muscle tissue replacement by adipose
tissue w/c is metabolically less active [Harper]
Women have significantly lower BMR than do men of the same
body weight because womens bodies contain proportionally
more adipose tissue [Harper]
diges
Energy required by an awake individual during physical, digestive,
and emotional rest:
BMR = Weight (in kg) x 100 kJ/day (or 24 kcal/day)
B. TCR(total caloric requirements) Computation (3 Ways)
1.. Joint FAO/WHO/UNU consultation
Calculate BMR = Wt. X 24 Kcal/day
* Use ideal body weight if you want the ideal BMR:
Tannhausers formula for IBW in kg =
(Height (in cm) 100) x 90%
Calculate for TCR: BMR + P.A. + SDA (factorial method)
P.A= Physical Activity SDA=specific dynamic action,
action 6% of sum of
BMR and P.A
Description of Activity Levels:
Light office workers, most professional men and women,
unemployed men, housewives in houses with mechanical or
electrical appliances, students
Moderate most men in light industry, farm workers, fishermen,
housewives without mechanical household appliances
Heavy some agricultural workers, forestry workers, army soldiers
in active service, dancers, athletes, lumberjacks
2. Factorial Method
Calculate BMR using standard formula of 24 kcal/kg/ day (may
deduct 10% per kg for every hour of sleep)

Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

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 Calculate for physical activity:

o Light = 30% of BMR
o Moderate = 40% of BMR
o Heavy = 50% of BMR
Calculate for SDA: 6% of sum of BMR and Physical activity
Calculate for TCR: BMR + P.A. + SDA
Example:
Given: male adult, farmer,, with height of 160 cm, compute TCR
1. Determine IBW: (160 100) x .90 = 54 kg
2. BMR: 24 x 54 = 1296 kcal
3. P.A. : 1296 x 0.4 = 518 kcal
4. S.D.A. : 6% (1296 + 518) = 109
5. TCR: 1296 + 518 + 109 = 1923
3. Krause Method
Most practical and rapid
Based on DBW and type of work or occupation
Used in clinics and hospitals
Steps:
1. Determine DBW (desirable body weight)
2. Multiply the activity factor based with DBW (see table)
Table 4. Energy expenditure in different types of occupation

NON-ESSENTIAL NUTRIENTS can be synthesized by the body from

precursors (dispensable)
COMPOSITION OF BODY FUEL STORES
1. Triacylglyceride:
adipose triacylglycerol is the major fuel store (85 %);
adipose tissue has more stored calories per gram and less
water (~15%) compared to muscle which has 80% water.
2. Glycogen stores (1%),
small but important
Liver glycogen maintains glucose during early stages of fasting;
muscle glycogen is oxidized for muscle contraction.
3. Protein
1/3 of body protein can be degraded for energy
HUMAN NUTRITIONAL REQUIREMENTS
1. Amino acids
2. Fatty acids
3. Vitamins
4. Minerals
5. Fiber
6. Energy
7. Water
v In practice, the proper diet for an adult is the one that maintains
health and a constant body weight .
Table 6. DIETARY RECOMMENDATIONS

Example:
Given: GM< 50y/o female, weighing 50kg (DBW), athlete (Heavy
work)
50 x 40 kcal = 2000kcal/day

Carbohydrates
Complex 48%
Refined and processed 10%
Fats
Saturated 10%
Monounsaturated 10%
Polyunsaturated 10%
Protein
Cholesterol
Salt

55-70%

% of TCR
58%

20-40%

30%

10-15%
300 mg/day
5 g/day

12%

TABLE 5 .ADDITIONAL ENERGY EXPENDITURE

PENDITURE FOR A 70 K
KG MAN

ADDITIONAL CONCEPTS
v Adding one mile of walking each day for one year oxidizes the
caloric equivalent of 10 pounds
v To lose or gain weight: 31.5 MJ (7,500 kcal) per kg
V. NUTRIENTS
MACRONUTRIENTS
1. Carbohydrates
2. Proteins
3. Lipids
ESSENTIAL NUTRIENTS cannot be synthesized by the body so
these should be provided by the diet (indispensable)
Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

Figure 2. Food pyramid (old version)

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B. NUTRITIONAL CONSIDERATIONS FOR PROTEIN

Figure 3. Food pyramid (new version)

Recommended intake is 0.8 g/kg/day; 60 g/day for men

Essential amino acids (PVT
PVT TIM HALL, see Table 8) cannot be
synthesized by the body and must be in the diet for protein
synthesis
Related to nitrogen balance:
o Nitrogen balance state where the amount of nitrogen ingested
each day is balanced by the amount excreted, resulting in no net
change in that total body nitrogen [Devlin]
o Dietary protein is 16% nitrogen and is the major nitrogen
source.
o Normal adults on adequate protein intake is in nitrogen balance
(protein degradation = synthesis or protein intake = protein
excreted (urea))
o Negative nitrogen balance: results from inadequate protein or
deficiency of specific amino acid in the diet, stress, illness
nitrogen loss is greater than the intake [Devlin]
o Positive nitrogen balance:: occurs during growth, pregnancy
nitrogen intake is greater than loss [Devlin]
Requirement for protein is affected by caloric content of the diet
Animal proteins are more digestible than vegetable proteins
Protein quality is based on the amount and proportion of
essential amino acids present:
o Protein efficiency ratio (PER) = growth in grams /amt of protein
ingested in grams
o Biological value (BV) = amount of protein retained /amount of
protein absorbed
o Net protein utilization (NPU) = amount of protein retained/
amount of protein ingested

A. NUTRITIONAL ROLES OF NUTRIENTS

Table 7. AMINO ACID SCORE & LIMITING AMINO ACIDS

Major energy sources are carbohydrates & fats

Vegetables and fruits are good sources of vitamins and
minerals(*which
which are required as cofactors and co enzymes in
biochem reactions)
50 to 100 g of Carbohydrates per day required to prevent ketosis
(12 g for every 1000 kj or 5 g for every 100 kcal)
Carbohydrates also have structural function, protein sparer,
provide carbon skeletons for nonessential a.a. and antiketogenic
Essential fattyy acids are required for synthesis of prostaglandins
and other eicosanoids
Linoleic and linolenic acids are essential fatty acids and are the
major dietary sources of omega 6(*HDL and LDL)
LDL) respectively
Fats adds palatability and satiety to the diet
A P/S ratio (polyunsaturated to unsaturated ratio) of fatty acids is
desirable for its plasma cholesterol lowering effect
o Polyunsaturated fats from plants
o Saturated fats from animals
Glycemic index measures the average amount your blood glucose
rises after eating a given amount of carbohydrate, normalized to
glucose = 100
o foods that have a low glycemic index are considered to be more
beneficial since they cause less fluctuation in insulin secretion
[Harper]
o Important for diabetics whose rise in blood sugar level should
be controlled.
o Examples:
baked potato = 98
grapefruit = 26
banana = 62
pasta = 50

Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

Amino acid score or chemical score measures protein quality as to

its essential amino acid content in relation to a reference protein.
Reference protein refers to a protein with an amino acid
composition providing adequate amounts of essential amino acids
for optimum growth (e.g. egg albumin,
album milk, meat and fish)

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Table 8. Essential Amino Acids and their Relative amounts in Egg

and Milk

b. For Adults
2
i. Body Mass Index (BMI) = Weight in kg / (Height in meters)
Classification
BMI
Underweight
Normal
Overweight
Obese

C. RECOMMENDED INTAKES FOR FIBER

Fiber: plant cell wall components which are indigestible (e.g.
insoluble lignins and cellulose, and soluble polysacc
polysaccharides like
gum, hemicelluloses and pectin)
Sources: liberal intake of fruits, vegetables and whole grain
cereals
Also known as unavailable carbohydrate with no caloric value but
functions to regulate bowel movement, decrease incidence of
colon cancer, beneficial to diabetics and prevents atherosclerosis
With low or lack of fiber:
o there is delayed fecal transit leading to constipation,
diverticulosis, or colonic cancer
o may also lead to increased absorption of nutrients leading to
obesity, atherosclerosis and ischemic heart disease.
*Fiber is also important in preventing constipation, cancer,
diverticulosis, atherosclerosis. Also absorbs cholesterol
VI. ASSESSMENT OF NUTRITIONAL STATUS
1. Dietary survey
food recall
food diary
food composition table
food exchange list
2. Anthropometry
a. For Preschoolers
i. Gomez classification (weight for age); not used anymore
Classification
% of Standard Weight for Age
Moderate Malnutrition
60-75
Mild Malnutrition
75 90
Normal
90 110
Overweight
110 120
Obese
>120
ii. Waterlow Classification
weight for height and Height for age
detects wasting for acute malnutrition and stunting for
chronic malnutrition

Classification

% of Standard

Normal
Mild
Moderate
Severe

>95 %
90 95
80 90
80

Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

<18
18 24
25 30
>30

3. Medical History
4. Clinical Examination:
* Waist Lines
- Male: 40 in. and below
- Female: 35 in. and below
5. Biochemical tests occurs earlier than clinical manifestation in
detecting specific nutrient deficiency
VII. HEALTH
Health is a quality of life involving SOCIAL, EMOTIONAL, MENTAL,
SPIRITUAL, and BIOLOGIC FITNESS of an individual as a result from
adaptations from the environment
vironment Rene Dubos
1. Physical Health: Efficient body functioning
2. Intellectual Health: Use of intellectual abilities
3. Emotional Health: Ability to control emotions
4. Social Health: Interactions and relationships with others
5. Spiritual Health: Cultural beliefs about the purpose of life
BIO: include the physical problems that affect nutritional intake and
health; effect of high blood glucose or food allergies
PSYCHO: includes the psychological effects of emotions on
nutritional intake and health
SOCIAL: effect of regional, cultural, ethnic, and religious dietary
habits on the control of health issues

Adults and adolescent girls increased their average kcal intake

Eating away from home has increased
Larger portion sizes of foods and beverages are being consumed
Sweetened beverages intake has increased (a normal small-sized
small
drink contains 30 g. of sugar)

MARKER NUTRIENTS
Vitamins A and C
Minerals: Calcium and Iron
* 100% intake of the above nutrients as found naturally in foods
promotes good intake of other needed nutrients found in
conjunction
In 2006 Food labels now include trans fatty acid content
Trans fats-solid
solid and stiff forms of F.A
Cis F.A- ideal for enzyme breakdown
VIII. NUTRITIONAL DISORDERS
1. Protein Energy Malnutrition (PEM)
intake of energy and protein
nutritional losses
nutrient requirement (underlying illness, fever, surgery,
cancer)
distinguishing feature: fluid retention, leading to edema and
fatty infiltration of the liver [Harper]
associated with decreased concentration
of plasma proteins [Harper]

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 Clinical Correlations:
o Kwashiorkor
- Deficiency of proteins in the diet
- but adequate in calories
- Signs/symptoms:
Muscle wasting
plasma proteins (albumin)
interstitial fluid: edema/ ascites/anasarca
- ability to synthesize new proteins (- N balance)
Digestive enzymes
New epithelial cells

Kwashiorhor
Marasmus
o Marasmus
- Calorie and protein deficiency
- Emaciation and failure to thrive
- Susceptibility TO infection
- Outcome of prolonged negative energy balance [Harper]
2. OVERWEIGHT: BMI between 25 30
3. OBESITY: Excess body adipose tissue
Class 1: BMI 30 34.9
Class 2: BMI greater than 35
IX. CURRENT ISSUES IN NUTRITION
A. Vegetarism
A practice which has arisen as a result of religious belief, health,
economic, ethnic or ecological reasons.
Diet includes:
vegetables yeast
seeds
fruits
dry beans sugars
cereals
peas
seaweeds
bread
nuts
bean curd
All vegetarians benefit from intake of legumes, nuts, seeds, and
whole grains to ensure adequate protein intake
Issues on Vegetarian Diet
o LACTO-OVO VEGETARIANS include eggs and dairy products
(eg. milk); easiest to meet nutritional needs
o LACTO VEGETARIANS includes dairy products, but not eggs
o PESCO VEGETARIAN- include fish
o POLLO VEGETARIAN- include poultry
o Some vegetarians exclude all animal products:
presents risk of most inadequate nutrition
most difficult to meet nutritional needs
need B12 supplement and vitamin D source (If sunlight is
inadequate, calcium is difficult to obtain and individuals may
need supplementation)
Nutrients Low in Vegetarian Diets:
o Iron
o B12
o Calcium
o Essential amino acids lysine, methionine, threonine,
tryptophan
o Zinc

Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

B. Types of Diet in Different Regions

French small portions, slowly paced eating, emphasis on
vegetables
Mediterranean emphasis on beans and greens and olive oil,
low intake of meat, sweets limited to special occasions, salads
served after main meal
Asian soybean products and/or tofu, high intake of rice,
vegetables and fish, low intake of desserts, sesame and peanut oil
emphasized
C. Food Safety Issues
a. Use of pesticides
b. Use of additives in food to enhance quality, flavor, texture,
nutritive value and palatability
c. Microbial contaminations
d. Natural toxicants in food:
Toxicants
Food Products
Solanine
potatoes
Nitrates, nitrites
Green leafy vegetables
Aflatoxin
Peanuts, cereal grains
Protease inhibitors Legumes
Hemagglutinins
Peanuts, red kidney beans, soybeans
Cyanide
Cassava, apple seeds
e. Environmental pollution- affect air, soil and water
mercury- causes GIT, hepatic and renal disorders
lead- anemia,GIT disorders, CNS
Cadmium- renal
polychlorinated biphenyls
radioactive materials
f. GMO- to improve functional properties, increase resistance to
diseases, decrease perishability.
g. Microwave- inadequate heating may lead to food-borne illness
h. Use of food substitutes- still being studied (Ex. Sugar substitutes
such as aspartame)
D. Nutrient Supplementation

FNRI survey: Filipinos deficient in iron, vit. A and iodine

pregnant women and lactating women
elderly
lifestyle of some individualswho need iron:
o smokers
o alcohol drinkers
o dieters
o heavy exercisers
o heavy caffeine drinkers
o children
o vegetarians

E. Megavitamin Therapy

needed by chronically ill patients

10-1000 times the RDA
May alleviate symptoms in certain disorders
Antioxidants nutrients - block free radical effects
o Beta carotene
o Vitamin C
o Vitamin E
o Selenium

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F. Food Exchange List

Beef
o lean meat 1 pc. 5 cm cube
o tenderloin - same
Fish
o lapu-lapu 1 slice, 10 x 5 x 3cm
o galunggong pc 25 x 8 cm
o dilis 1/3 cup

A grouping of common foods with practically the same amount of

CHO, CHON and FATs.
Within a group, one food item can be exchanged with another
Foods included are simple
The 7 Exchange Lists:

List 1: Vegetables
Vegetable A: can be eaten ad libitum (to your desire) leafy
vegetables
Leafy veg:: 1 exchange =1 cup raw (25 g) or cup cooked (45g)
Vegetable B:: fleshy vegetables (eg. starchy veggies like potatoes
potatoes)
Non-leafy veg:: 1 exchange = cup raw (40 g) or
cup cooked (45 g)
List 2: Fruit Exchanges
per exchange = 40 cal, 10 gms CHO
Atis small 5x4 cm
Bayabas 2 medium, 4 cm.
Strawberry 1/3 cup
Papaya 1 slice 5 x 2 x 1cm
Mangga 1 small 11x 6 cm
Pakwan 1 slice 5x 3 cm
Pinya 1 slice 5x 3 x 2 cm
Saginglakatan 1 small 10 x 3 cm
List 3: Milk Exchanges
CHON,10g fat
per exchange = 140 cal, 12g CHO, 8gCHON,10g
Evap milk- 1/4 glass (undiluted)
Yoghurt cup
Powdered whole milk 4 level tbsp.
Powdered non-fat milk 4 level tbsp
List 4: Rice Exchanges
1 exchange = 100 cal, 23g CHO, 2g CHON
Rice 1/2 cup
Bread 1 slice
Pan de sal 1 big
mamon - 1 pc 6 x 3 cm
Hot cake 1 pc. 8 cm diameter
Pretzels 8 pcs
Doughnut pc 9 x 5 cm
Noodles - cup
Camote 1 small piece

B.

Medium Fat: 1 exchange = 95 cal, 8g CHON, 7g fat

Pork pata 1 pcs 2 cm cube
Goto beef cup
Chicken wings 1 small

C.

1 exchange = 8 gms CHON, 10g Fat, 122 cal

High Fat:1
Pork pigi pc 3 cm cube
Ox tongue cup
Balut 1 egg = 65 gms

List 6: Fat Exchanges

1 exchange = 5g fat, 45 cal
Butter 1 tsp
Coconut milk 1 tsp
Bacon strip
Mayonnaise 1 tsp
Sitsaron 1 pc. 3 x 4 cm
Pili nut 5 pcs
List 7: Sugar exchanges
1 exchange= 5g sugar, 20 cal
Caramel 1pc 2 x 2 cm
Hard candy 1 pc
Chocolate candy 1 pc round
Sugars 1 tsp
Ube halaya 1 tsp
Yema 1 pc 5 x 1 cm
FREE FOOD

Bouillon (fat free syrup)

Clear broth

Coffee, tea

Garlic

Gelatin (unsweetened)

Kamyas

Lemon vinegar

Mustard

Other spices

Pickle dill or sour

Tomato paste, Tomato sauce

List 5: Meat Exchanges

A. Low Fat:1 exchange = 50 cal, 8g CHON, 2g fat
Pork
o liver 1 slice 5 x 4 x 1cm
Group # 3 | Angel Ang, Jeremy Ang, Jubelle Aquino

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