Nutrition Basics: Nutrients and Functions

Components of Nutritive Sources

• Essential components include carbohydrates, fiber, protein, lipids, vitamins, minerals, electrolytes, and water.
• Carbohydrates, fats, and proteins are primary energy-yielding nutrients.
• A balanced diet incorporates diverse foods providing all essential nutrients.

Carbohydrates and Fiber

• Composed of carbon, hydrogen, and oxygen (CHO), primarily for energy.
• Minimum carbohydrate intake for brain function: 130 g/day for adults and children.
• Median intake: 305 g/day for males over 20, 228 g/day for females and children.
• AMDR (Acceptable Macronutrient Distribution Range): 45% to 65% of total calories.
• Carbohydrate types:
  • Monosaccharides: Glucose, fructose, galactose.
  • Disaccharides: Sucrose, lactose, maltose.
  • Polysaccharides: Starch, fiber, glycogen.
• Liver converts fructose and galactose to glucose, impacting insulin and blood glucose regulation.
• Fiber, a type of carbohydrate, is essential for bowel health, cholesterol reduction, and stable blood sugar.
• Total fiber AI: 25 g/day for females, 38 g/day for males.

Proteins

• Made of amino acids; obtained from both plant and animal sources.
• Types of proteins:
  • Complete proteins: From animal sources and soy, containing all essential amino acids.
  • Incomplete proteins: Plant sources that lack one or more essential amino acids.
  • Complementary proteins: Incomplete proteins that, when combined, form a complete protein (e.g., beans and rice).
• Functions of proteins include tissue building, metabolic support, nitrogen balance, and immune function.
• RDA of protein: 0.8 g/kg for healthy adults; AMDR: 10% to 35% of total calories.
• Protein energy malnutrition (PEM) can lead to Kwashiorkor and Marasmus deficiencies.

Lipids

• Lipids (fats) serve as concentrated energy stores and are crucial for cellular structure and function.
• Types of fats:
  • Triglycerides: 95% of dietary fat; made of fatty acids (saturated and unsaturated).
  • Phospholipids: Important for cell membranes.
  • Sterols: Include cholesterol; not essential as the liver synthesizes it.
• Essential fatty acids (omega-3 and omega-6) must be consumed through diet.
• AMDR for fats: 20% to 35% of total calories; less than 10% from saturated fats.

Vitamins

• Organic compounds crucial for enzymatic reactions; 13 essential vitamins classified into water-soluble and fat-soluble.
• Water-soluble vitamins include Vitamin C and B-complex.
  • Vitamin C: Aids tissue building and immune function; sources: citrus fruits, greens. Deficiency leads to scurvy.
  • B-complex vitamins: Impact energy metabolism, neurological function, and red blood cell synthesis (e.g., B1, B2, B3, B6, Folate, B12).
• Fat-soluble vitamins (A, D, E, K) can accumulate in the body and pose toxicity risks.
  • Vitamin A: Supports vision and immune function; sources: fatty fish, orange/yellow fruits. Deficiency leads to xerophthalmia.
  • Vitamin D: Regulates calcium and phosphorus; synthesized with sunlight. Deficiency results in bone disorders.
  • Vitamin E: An antioxidant; deficiency can cause anemia.
  • Vitamin K: Essential for blood clotting; found in green leafy vegetables.

Minerals and Electrolytes

• Inorganic elements required for metabolic functions, divided into major and trace minerals.
• Major minerals include calcium, phosphorus, sodium, potassium, magnesium, chloride, and sulfur.
• Sodium: Maintains fluid balance; sources include table salt. Excess can lead to hypertension.
• Potassium: Vital for fluid balance and muscle function; rich sources include bananas and avocados.
• Calcium: Essential for bone health; sources include dairy and dark greens. Deficiency leads to osteoporosis and other issues.
• Electrolytes maintain homeostasis and physiological responses.### Major Actions of Nutrients
• Magnesium (Mg): Essential for bone formation, enzyme reactions, nerve/muscle function, and smooth muscle relaxation.
• Phosphorus (P): Important for RNA/DNA energy transfer, acid-base balance, and formation of bones and teeth.
• Sulfur (S): Key component in vitamin structure, and a by-product of protein metabolism.

Nutritional Sources

• Magnesium: Found in green leafy vegetables, nuts, whole grains, tuna, halibut, and chocolate.
• Phosphorus: Available in dairy, peas, meat, eggs, and legumes.
• Sulfur: Primarily sourced from proteins.

Deficiency and Excess Findings

• Magnesium Deficiency: Symptoms include weakness, dysrhythmias, convulsions, elevated blood pressure, and anorexia.
• Magnesium Excess: Can cause diarrhea, nausea, muscle weakness, hypotension, bradycardia, and lethargy.
• Phosphorus Deficiency: No known significant symptoms.
• Phosphorus Excess: Leads to decreased blood calcium levels.
• Sulfur Deficiency: Only observed in severe protein malnutrition; no known health issues from excess sulfur.

Nursing Actions

• Magnesium: Follow seizure precautions, monitor level of consciousness and vital signs.
• Phosphorus: Assess antacid and alcohol use as these can impair phosphorus absorption.
• Sulfur: Generally not monitored.

Trace Minerals

• Required in small amounts; major trace elements include iron, iodine, zinc, copper, manganese, chromium, selenium, molybdenum, and fluoride.

Iodine

• Crucial for thyroxine synthesis, a hormone regulating metabolism.
• Iodine deficiency causes goiter; excessive iodine can lead to thyrotoxicosis.
• Good sources include seafood and iodized salt.
• Recommended dietary allowance (RDA) for adults is 150 mcg.

Iron

• Integral for oxygen transport in hemoglobin and myoglobin.
• Dietary iron exists as heme (from meat) and non-heme (from plants).
• Iron supplements may cause constipation, nausea, or staining of teeth; best taken with food.
• Vitamin C enhances iron absorption.

Fluoride

• Binds to calcium, essential for dental health.
• Deficiency can lead to cavities and osteoporosis; toxicity may cause fluorosis.

Water

• Supports cellular function, essential for survival; adults need approximately 2.7 L/day (females) and 3.7 L/day (males).
• Daily water loss averages 1000 mL; minimum intake should be 1500 mL.
• Dehydration more common in young children and older adults.

Phytonutrients

• Natural plant compounds with health benefits including detoxification and immune stimulation.
• Found in fruits, vegetables, and whole grains; no specific intake recommendations exist.

Metabolism

• Comprises all biochemical processes for homeostasis: includes catabolism (energy release) and anabolism (energy use).
• Basal metabolic rate (BMR) and resting metabolic rate (RMR) are measurements of body energy usage.

Factors Influencing Metabolic Rate

• Increase BMR: Lean body mass, extreme temperatures, stress, physical conditioning.
• Decrease BMR: Short stature, overweight, starvation, age-related changes.

Nitrogen Balance

• Indicates protein metabolism and tissue health.
• Positive nitrogen balance occurs during growth; negative indicates insufficient protein intake.

Nutritional Assessment

• Monitoring includes dietary intake, fluid intake/output, and laboratory values like albumin and prealbumin.
• Key anthropometric tools: weight, body mass index (BMI), and biochemical markers for nutritional status.

Tools for Diet History

• Evaluates usual foods, beverages, and dietary habits to assess for malnutrition risks.
• Components include meal timing, special food preferences, and dietary restrictions.

Clinical Values

• Fluid intake/output for adults typically ranges from 2000 to 3000 mL/day.
• Normal albumin levels range from 3.5 to 5 g/dL; prealbumin is used to assess acute malnutrition risk.### Genetic and Psychological Factors
• Genetic predisposition includes conditions such as lactose intolerance and osteoporosis.
• Age influences nutritional needs and health risk factors.
• Psychological factors, including mental illness (e.g., clinical depression), excessive stress, and negative self-concept, can impact dietary habits and nutritional status.
• The use of comfort foods may be a coping mechanism for psychological distress.

Social Determinants of Health (SDOH)

• Neighborhood and Built Environment:

  • Pollutants in air, soil, and water pose risks to food safety and supply.
  • Limited access to nutritious food options in communities affects dietary choices.
  • Insufficient transportation options hinder grocery shopping and food access.

• Social and Community Context:

  • Food preparation practices may increase the risk of food-borne illnesses.
  • Unstable living situations can lead to inconsistent access to food.
  • Cultural preferences may not be represented in health education materials.

• Economic Stability:

  • Individuals often face trade-offs between purchasing quality food and meeting housing or education costs.
  • Lack of health insurance may limit access to dietary consultations.
  • Insufficient access to affordable, nutritious food can result in both undernutrition and overnutrition.

Health and Nutrition

• Food and Nutrition Availability:

  • Access to healthy food choices and reliable food sources is vital for maintaining health.

• Health Care Access:

  • Lack of primary care services limits follow-up for obesity-related chronic conditions.
  • Few school nurses may lead to inadequate screening for nutritional deficiencies.
  • Limited telehealth resources inhibit access to nutrition consultations.

Educational Factors

• Literacy impacts the ability to read food labels, crucial for making informed dietary choices.
• Higher education levels correlate with better job opportunities to support healthy eating.

Risk Factors Affecting Nutritional Status

• Certain medical conditions, such as edema, may necessitate diuretics and low-sodium diets, leading to nutrient imbalances.
• Osteoporosis risk factors can be modified through increased vitamin D and calcium intake, weight-bearing exercises, and lifestyle choices.
• Poor self-concept may lead to reduced food intake or overeating behaviors.

Nursing Actions for Nutritional Assessment

• Assess nutrient and calorie intake alongside other factors that may affect nutrition.
• Collaborate with healthcare providers to adjust treatment plans as needed for improved nutritional outcomes.
• Schedule client activities to minimize disruptions during mealtime and reduce fatigue.

Dietary Guidelines for Americans

• Published every five years by USDA and HHS, providing evidence-based food and physical activity advice.
• The 2020-2025 guidelines include recommendations unique to each life stage, emphasizing diverse, nutrient-dense food choices.
• Advocates for limited intake of added sugars, saturated fats, and sodium while encouraging variety and balance in dietary patterns.

General Dietary Recommendations for Adults

• Recommended servings based on a 2,000-calorie daily diet include:
  • Vegetables: 2 ½ cups
  • Fruits: 2 cups
  • Grains: 6 ounces, preferably whole grains
  • Dairy: 3 cups
  • Protein: 5 ½ cups
  • Oils: 27 grams

Food Safety Guidelines

• Key practices ensure food safety, including proper food storage, handling, and preparation.
• Awareness of expiration dates and safe cooking temperatures is essential.
• The risk of foodborne illnesses is especially high among vulnerable populations (e.g., children, the elderly).

Vegetarian Diets

• Vegetarian diets are plant-focused and can meet all nutrient needs if properly planned.
• Variants include vegan (no animal products), lacto-vegetarian (includes dairy), and lacto-ovo-vegetarian (includes dairy and eggs).
• Nutritional vigilance is essential for ensuring adequate intake of vitamins and minerals (e.g., B12, calcium).

Food Labels

• FDA mandates transparency on nutritional content and allergens on food labels.
• Food labels include essential details like ingredient lists and daily value percentages.

Promotion of Health through Nutrition

• Heart health can improve by limiting saturated fats and increasing fiber intake.
• Adequate B vitamins and minerals are crucial for neurological function and bone health.
• High-fiber and low-fat diets contribute to cancer prevention and better overall health outcomes.

Foodborne Illness Prevention

• Education on food safety practices is critical to reduce the risk of foodborne illnesses.
• Common pathogens include Salmonella, E. coli, and Listeria.
• Proper food handling, cooking, and storage can mitigate risks associated with foodborne pathogens.

Toddlers: Nutrition Guidelines

• Growth during toddler years includes an increase of 2 to 3 inches in height and weight gain of 5 to 6 lbs/year.
• Whole cow’s milk is crucial for children aged 1 to 2 years for adequate brain fat during development.
• Limit 100% juice intake to 4 to 6 oz daily and adhere to serving size of 1 tbsp per year of age.
• Typical acceptance of new foods may require exposure 15 to 20 times.
• Monitor for allergic reactions when introducing potentially allergenic foods, particularly in children with a family history of allergies.
• Toddlers tend to favor plain foods and finger foods, enjoying staples like macaroni and cheese, spaghetti, and pizza.
• Maintain regular meal times and nutritious snacks, minimizing high-sugar, high-fat, or high-sodium foods.
• Choking hazards should be avoided; always supervise toddlers during meals and snacks.

Nutritional Concerns/Risks for Toddlers

• Iron deficiency anemia is prevalent among children; lean red meats are a key source of absorbable iron.
• Consume vitamin C-rich foods with plant-based iron sources for improved absorption; limit milk to 24 oz per day to encourage iron intake.
• Adequate vitamin D (5 mcg/day) is important for bone development; sources include milk and fatty fish.
• Limited sunlight exposure increases risk for vitamin D deficiency.

Preschoolers: Nutrition Guidelines

• Preschoolers grow about 2 to 3 inches and gain 5 to 6 lbs/year, needing 13 to 19 g of complete protein daily.
• A well-balanced diet from all five food groups generally negates the need for additional vitamin/mineral supplements.
• Preference for raw vegetables as finger foods is common, although strong-tasting vegetables are often rejected.
• Meal habits are influenced by family and peers, with MyPlate serving as a useful guideline for appropriate intake.

Nutritional Concerns/Risks for Preschoolers

• Monitor for overfeeding and limit high-calorie snacks, junk food, and soft drinks.
• Importance of breakfast is tied to age-appropriate BMI; skipping breakfast is observed in roughly 10% of children.
• Early intervention is critical for preventing childhood obesity, currently affecting about 41% of children.

School-age Children: Nutrition Guidelines

• Growth patterns continue with school-age children, similar to toddlers and preschoolers.
• Diet should focus on variety, balance, and moderation in accordance with MyPlate recommendations.
• Educate children to make healthy snack choices and the importance of eating based on hunger.

Nutritional Concerns/Risks for School-age Children

• Breakfast consumption is crucial for optimal school performance; regular eaters tend to maintain healthier BMIs.
• Encourage physical activity to combat rising overweight and obesity rates among children.
• Nutritional education should address risks of skipping meals and dependency on unhealthy fast food options.

Adolescence: Nutritional Needs

• Adolescence is marked by a rapid growth rate, causing increased needs for energy, proteins, calcium, iron, and zinc.
• Female growth spurts occur typically between 10 and 17 years; male spurts from 12 to 21 years.
• Aim for daily energy intakes of 2,000 cal (female) and 2,200-2,800 cal (male) during this period.

Nutritional Risks in Adolescence

• Many adolescents have diets deficient in essential nutrients like vitamins A, C, D, calcium, and iron.
• Risk of eating disorders is heightened, linked to societal pressures regarding body image and dieting habits.

Young Adulthood to Older Adulthood: Nutrition Guidelines

• Dietary patterns should include a focus on nutrient-dense foods while limiting added sugars, saturated fats, and sodium.
• Recommended dietary intake includes a proper balance of carbohydrates, fats, and proteins, with increased protein needs in older adults.
• Regular exercise is emphasized for maintaining muscle mass and promoting overall health.

Nutritional Concerns in Older Adults

• Aging impacts nutrient absorption, necessitating careful monitoring of calcium and vitamin intake.
• Common issues include difficulty with chewing and swallowing; social isolation can affect dietary habits.
• Encourage hydration, with the understanding that fluid needs can be met through both beverages and solid food moisture.

Nursing Assessment and Interventions

• Nurses should evaluate dietary profiles, including intake patterns and nutritional needs across all age groups.
• Educate clients about healthy eating guidelines and provide resources to enhance understanding of nutritional requirements.
• Refer clients to appropriate resources for food security assistance, nutritional counseling, and dietary education to combat malnutrition.### Malnutrition Diagnosis
• Clients meet malnutrition criteria with at least two of the following: inadequate calorie intake, muscle mass loss, subcutaneous fat loss, unintentional weight loss, decreased handgrip strength, weight loss masked by edema, or protein-energy malnutrition (PEM).
• PEM is a calorie deficit from inadequate proteins, carbohydrates, and fats, often seen in children and older adults.

Types of Malnutrition

• Starvation-related: complete nutrient absence without inflammation.
  • Marasmus: inadequate calorie and protein intake, serum proteins may be normal, muscle and fat wasting occurs.
  • Kwashiorkor: protein deficiency with adequate calorie intake, low serum proteins.
• Chronic disease-related: seen in clients with chronic illnesses leading to decreased appetite and nutrient utilization.

Nutritional Risks Associated with Chronic Conditions

• Chronic alcohol use disorder can lead to malnutrition and associated liver disorders.
• HIV/AIDS increases the risk of wasting syndrome and malabsorption issues.

Effects of Chronic Conditions on Nutrition

• Conditions like COPD and chronic kidney disease affect calorie and protein needs, with kidney disease leading to electrolyte imbalances.
• Clients may experience poor appetite due to gastrointestinal symptoms or treatments.

Acute Disease-Related Malnutrition

• Occurs during major infections or traumas, leading to decreased appetite and impaired absorption.
• Total parenteral nutrition (TPN) may be necessary if the GI tract is compromised.

Nutritional Support in Acute Illness

• Enteral nutrition (EN) is preferred if the GI tract is functional. Fluid requirements should be individualized based on clinical conditions.
• Indirect calorimetry is the most accurate method for assessing caloric needs.

Nutritional Goals and Strategies

• Goals focus on decreasing infection morbidity and length of hospital stays.
• Monitor daily calorie intake, assess nutritional status through laboratory studies, and consider refeeding syndrome when reintroducing carbohydrates.

Complications of Undernutrition

• Include decreased cardiac output, susceptibility to infections, muscle mass reduction, impaired wound healing, and skin changes.

Social Determinants of Health

• Factors like low income, lack of transportation, education about nutrition, and cultural considerations can contribute to malnutrition risks, especially in older adults.

Patient-Centered Care for Malnutrition

• Standards require screening for malnutrition within 24 hours of admission.
• Treatment includes balanced diets, oral supplements, and possible enteral or parenteral nutrition based on client needs.

Nursing Actions for Nutritional Support

• Ongoing assessment of appetite, weights, and intake/output alongside laboratory monitoring.
• Collaboration with interdisciplinary teams for holistic care involving dietitians and social workers.

Interventions to Enhance Nutritional Intake

• Support clients through pain management, comfort measures, and creating a conducive dining environment.
• Strategies to increase calorie and protein intake include adding calorically dense foods during meals and promoting nutrient-dense choices.

Obesity Overview

• Chronic condition from excessive calorie intake affecting various health metrics.
• Factors include genetics, hormones, behavioral patterns, and cultural influences.

Assessment of Obesity

• Body Mass Index (BMI) and waist circumference are key metrics for evaluating obesity risks.
• Laboratory tests can assess risks for related diseases such as cardiovascular issues and diabetes.

Patient-Centered Nutritional Plans for Obesity

• Implement reduced-calorie diets and promote physical activities to achieve weight loss.
• Medications may be necessary for clients with higher BMI and related complications.

Surgical Interventions for Obesity

• Bariatric surgery effectively manages obesity with significant lifestyle changes required post-operation to prevent deficiencies.
• Protein intake and monitoring of micronutrients post-surgery are crucial for ongoing health.

Cardiovascular Nutritional Considerations

• Understanding cholesterol levels, including HDL and LDL, helps in assessing and managing heart disease risks.
• Optimal cholesterol levels and lifestyle changes are key to preventing complications related to cardiovascular health.### Risk Factors for Coronary Heart Disease (CHD)
• Non-modifiable risk factors: age, male sex, family history of early CHD.
• Modifiable risk factors: high LDL cholesterol, low HDL cholesterol, high saturated fat diet, hypertension, diabetes, metabolic syndrome, obesity, sedentary lifestyle, and nicotine use.

Metabolic Syndrome

• Defined by three of five criteria:
  • Abdominal obesity: ≥40-inch waist for males, ≥35-inch waist for females.
  • Elevated triglycerides: ≥150 mg/dL or medication for high triglycerides.
  • Low HDL cholesterol: ≤40 mg/dL (males), ≤50 mg/dL (females) or medication.
  • High blood pressure: ≥130 mm Hg systolic or ≥80 mm Hg diastolic or antihypertensive medication usage.
  • Fasting blood glucose: ≥100 mg/dL or medication for blood glucose control.

Types of Anemia

• Iron Deficiency Anemia

  • Risk factors: blood loss, poor dietary intake, alcohol use, malabsorption, pregnancy, adolescence, infections.
  • Symptoms: fatigue, lethargy, pale nail beds, cold intolerance, headaches, tachycardia.

• Vitamin B12 Deficiency Anemia

  • Risk factors: lack of meat/dairy, bowel resections, chronic diarrhea, tapeworm, excess bacteria in the intestines.
  • Symptoms: pallor, jaundice, weakness, fatigue, glossitis, anorexia, indigestion, weight loss, decreased concentration, paresthesia, poor coordination, irritability, delirium.

• Folic Acid Deficiency Anemia

  • Risk factors: inadequate folic acid intake, malabsorption syndromes, certain medications.
  • Symptoms similar to vitamin B12 deficiency except for neurologic issues.

Nutrition and Nursing Interventions in CHD

• Preventative nutrition emphasizes diets low in trans fats, saturated fats, and cholesterol.
• The Therapeutic Lifestyle Change (TLC) diet recommends less than 200 mg of cholesterol per day.
• Increase fiber intake to lower LDL cholesterol; include sources like oats, beans, and fruits.
• Encourage omega-3 fatty acids from fish and plant sources to reduce coronary artery disease risk.

Hypertension

• Defined as sustained blood pressure ≥130/80 mm Hg.
• Significant risk factors include family history, obesity, smoking, high sodium, low potassium, excessive alcohol consumption, stress, and aging.
• The DASH diet promotes low sodium (initially less than 2,300 mg, ideally 1,500 mg), high potassium, and calcium to manage hypertension.

Heart Failure

• Characterized by inadequate blood flow and fluid retention.
• Risk factors include CHD, arrhythmias, metabolic syndrome, diabetes.
• Dietary interventions: reduce sodium intake, monitor fluid intake, increase protein, and offer small, frequent meals.

Myocardial Infarction (MI)

• Occurs due to inadequate oxygen supply to the heart muscle.
• Immediate post-MI care includes a liquid diet, avoiding caffeine, and small, frequent meals.

Nutritional Sources for Anemia

• Iron Sources: Red meat, fish, poultry, tofu, dried beans, whole grains, fortified foods.
• Vitamin B12 Sources: Fish, meat, poultry, dairy; supplements are crucial for individuals over 50 and those on vegan diets.
• Folic Acid Sources: Green leafy vegetables, citrus, fortified cereals and breads.

Social Determinants of Health (SDOH) and Nutritional Barriers

• Low socioeconomic status affects access to healthy foods, increasing reliance on cheaper, unhealthy options.
• Food deserts exist in low-income areas, inhibiting access to fresh produce.
• Awareness of nutritional needs is impacted by factors such as cognitive disorders, sensory impairments, and misinformation about nutrition.

Nursing Interventions for Nutritional Barriers

• Provide nutritional education, assess dietary intake, and promote community resources.
• Address physical limitations in food preparation, such as assisting those with poor dentition or swallowing difficulties.
• Encourage consumption of nutrient-dense foods and the use of dietary guidelines.

Special Considerations for Impaired Swallowing

• Clients with neurological disorders may require a modified diet (thickened liquids) and specific eating strategies.
• Monitor aspirating clients closely during meals and have emergency equipment ready.

Education and Awareness Promotion

• Encourage understanding of nutrition and reading food labels.
• Help clients develop meal plans that align with their preferences and dietary restrictions.

This quiz explores the essential components of nutrition, including carbohydrates, proteins, fats, vitamins, and minerals. Understanding these nutrients is crucial for maintaining a healthy diet and energy levels. Test your knowledge on how these components contribute to overall well-being.