Nutrition: Guidelines & Food Security

• Nutrition is essential for normal growth and development, tissue repair and maintenance, cellular metabolism, and organ function.

General Information

• Food security means household members have access to sufficient, safe, and nutritious food for a healthy lifestyle.
• Consistent food availability and household resources are needed to obtain appropriate food for a nutritious diet.
• Decreased food security can lead to negative patient outcomes, longer hospital stays, delayed healing, and adverse events.
• Diet therapy is a major treatment for diseases like type 1 diabetes mellitus (DM) or mild hypertension.
• Specialized nutritional support, such as enteral nutrition (EN) or parenteral nutrition (PN), is required for conditions like severe inflammatory bowel disease.
• Current standards of care prioritize optimal nutrition for all patients.

Nutritional Guidelines

• Healthy People 2030 aligns with Health for All (WHO) goals.
• Overall goals: promoting health/healthy behaviors and reducing chronic disease.
• Nutritional goals and objectives are set by USDHHS and the Public Health Service.
• Healthy People initiatives are updated every decade, with the latest focusing on fewer, prioritized objectives to avoid overlap.
• Objectives include baseline data for measuring progress.
• Consumers need motivation to adhere to dietary recommendations, reducing chronic disease risk.

Scientific Knowledge Base - Key Nutrients

• Carbohydrates: main energy source, existing as complex and simple saccharides.
• Fats: Saturated, polyunsaturated & monounsaturated; calorie-dense.
• Vitamins: Vital for metabolism, existing as water-soluble or fat-soluble.
• Proteins: Made up of amino acids, with albumin and insulin examples; needed for nitrogen balance.
• Water: Every cell function is dependent on a fluid environment.
• Minerals: Catalysts for enzymatic reactions. Macrominerals and trace elements.

Food's Role in the Body

• Fueling cellular metabolism & repair.
• Maintaining proper organ function.
• Supporting growth & development.
• Facilitating body movement.

Carbohydrates Explained

• Primary energy providers, separated into simple and complex categories.
• Simple carbohydrates are commonly called sugars, named based on saccharide units.
• Monosaccharides: single sugar unit.
• Disaccharides: two sugar units.
• Complex carbohydrates: long saccharide chains known as polysaccharides.

Carbohydrate Functions

• Provide energy for muscles and organ function.
• Spare protein by preventing the breakdown of body protein and lipids when glycogen stores are low; fats convert into ketones.
• Play a role in nutrition and metabolism.
  • Enhance insulin secretion.
  • Increase satiety (feeling of fullness and satisfaction).
  • Improve sodium absorption and calcium excretion.

Proteins Explained

• Complex molecules composed of amino acids.
• Essential amino acids must be obtained from the daily diet as they cannot be manufactured.
• Nonessential amino acids are synthesized by the body from other sources..
• Complete protein foods have all amino acids necessary for protein synthesis.
• Incomplete proteins lack all essential amino acids.

Functions of Proteins

• Tissue building (structural material of all cells).
• Metabolism.
• Immune system function (lymphocytes and antibodies).
• Fluid balance.
• Acid-base balance.
• Secondary energy source.

Lipids Explained

• Organic substances insoluble in water.
• Fats are solid at room temperature and oils are liquid.
• Types of lipids include:
• Glycerides: true fats like glycerol, fatty acids, triglycerides.
• Sterols.
• Phospholipids: low-density lipoproteins [LDLs, High-density lipoproteins HDLs]).
• Saturated and Unsaturated Fatty Acids (saturated, unsaturated, or trans fats) exist.
• Dietary fat should primarily be polyunsaturated and unsaturated to reduce stroke risks.

Lipid Functions

• Supply essential nutrients.
• Energy source.
• Flavor and satiety.

Vitamins and Minerals

• Vitamins are fat-soluble (A,D,E, K) and water-soluble (Vitamin C, B-complex).
• Major minerals are needed in amounts of 100 mg/day+.
• Trace minerals are needed, but at lower levels.
• Sources:
• Calcium: milk, broccoli, egg yolks, nuts, sardines.
• Potassium: avocados, peaches, molasses, meat, dates, figs, potatoes.
• Sodium: eggs, celery, baking soda, baking powder.
• Phosphorus: dairy, beef, pork, beans, sardines, eggs, chicken, wheat bran, chocolate.
• Iron: red meat, fish, poultry, eggs, broccoli, spinach.

Terms

• Basal metabolic rate (BMR): energy needed at rest for life-sustaining activities.
• Resting energy expenditure (REE): energy needed at rest for 24 hours.
• Nutrients: elements necessary for normal body function.
• Nutrient density: nutrient value in comparison to kilocalories.
• High-density foods examples: fruits/vegetables.
• Low-density foods examples: alcohol/sugar.
• High nutrient density foods: needed for higher energy demands to heal, especially for burn patients.

Concept of Nutrition

• All variations in nutrition can present problems: too much vs too little.
• Anatomy and physiology must be reviewed.

Dietary Guidelines

• Dietary Reference Intakes (DRIs) offer evidence-based ranges for vitamins and nutrients based on gender and age group.
• DRIs are for planning and assessing healthy diets.
• Components of DRI include:
  • Estimated Average Requirement (EAR): nutrient amount to meet needs of 50% of healthy individuals in a specific demographic.
  • Recommended Dietary Allowance (RDA): average daily intake sufficient to meet the requirements of 98% of healthy people.
  • Adequate Intake (AI): amount of nutrient consumed by a healthy group.
  • Tolerable Upper Intake Level (UL): max daily intake unlikely to cause adverse health effects in almost all individuals.
• The U.S. Department of Agriculture and the U.S. Department of Health and Human Services publishes dietary guidelines.
• Four Major Guidelines:
• Follow a Healthy Dietary Pattern across all life stages.
• Customize and enjoy food and beverage choices considering preferences, culture, and budget.
• Focus on meeting food group needs with nutrient-dense foods and staying within calorie limits.
• Limit added sugars, saturated fats, sodium, and alcoholic beverages.
• Created by the FDA, Daily Values (DVs) exist as two reference sets for food values:
• Referenced Daily Intakes (RDIs): needed protein, vitamins, and minerals based on the RDA.
• Daily Reference Values (DRVs): needed fats, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium.

ChooseMyPlate

• ChooseMyPlate is a basic guide for healthy food choices, developed by the U.S. Department of Agriculture.
• It covers balancing calories, decreasing portion sizes, increasing healthy foods and water, and decreasing fats, sodium, and sugars.

Factors Influencing Nutrition

• Sociological and psychological factors affect eating and drinking.
• Caloric needs and nutrition change throughout life, body composition, pregnancy/lactation, activity levels, and existing diseases.
• Environmental factors: limited grocery store access, high healthy food costs, and lack of exercise, potentially leading to obesity (68.7% of Americans).

Infants Through School Age

• Consist of infants, Toddlers, and school-age Children
• Food Deserts: areas lacking full-service grocery stores, affecting 13.5 million people, with Chicago being the largest food desert in America.
• Infants need rapid growth and have high protein, vitamin, mineral, and energy requirements.
• Breastfeeding is recommended for the first 6 months.
• Introduce solid foods one at a time over 4 to 7 days to identify allergies.
• No cow's milk in the first year to prevent risk of milk product allergies.
• Infants double birth weight by 4-5 months and triple it at 1 year.
• Toddlers develop strong food preferences and become picky eaters.
• School-age children: gradual decline in energy needs per unit of body weight.
• School-age children: gradually decrease physical activity, and increase consumption of high-calorie foods, thus increasing childhood obesity.

Adolescent, Young, Middle, and Older Adults

• Adolescents' needs: use physiological age as guideline, with increased demands and eating disorders.
• Young/Middle Adults' needs: energy needs decline, and physical activity typically decreases.
• Pregnancy/Lactation: child's needs are prioritized; folic acid (600 mcg) prevents neural tube defects; breastfeeding women need +500 Kcal per day.
• Older Adults' needs: thirst sensation decreases, increasing risk of fluid deficit; taste cells diminish, altering food flavor and possibly decreasing intake.

Alternative Food Patterns

• Consideration based on religion, cultural background, ethics, beliefs, and preferences.
• There are different styles of Vegetarian Diet which include:
• Ovolactovegetarian (no meat, but eggs and milk).
• Lactovegetarian (drinks milk but avoids eggs).
• Vegan (consumes only plant foods).
• Fruitarian (fruit, nuts, honey, and olive oil).
• Zen macrobiotic (brown rice, other grains, and herb teas).
• Individuals on a vegetarian diet can meet recommendations for essential protein through food selection.
• A vitamin B12 deficiency can occur since it is only found in animal protein (unless fortified).
• Fruitarian and Zen macrobiotic diets may cause malnutrition, particularly in protein and vitamin B12.
• Dietitians may need to be consulted.

Food and Drug Interactions

• It is important to keep food and drug interactions in mind during medication administration and noted in drug guides.
• Important examples:
• Tetracycline: give 1 hour before or 2 hours after meals, with no dairy products.
• Grapefruit: elderly people should avoid the consumption of grapefruit products due to polypharmacy.
• Tyramine-rich foods (cheese, wine, organ meats, beer, yogurt, sour cream, bananas): avoid MAO inhibitors (antidepressants) to prevent crises.

Assessment

• Nutritional assessment is a comprehensive process.
• Includes health history, physical examination, anthropometric measurements, and lab data.
• Screen for malnutrition risk utilizing tools like the Mini-Nutritional Assessment (MNA).

Anthropometry

• Systematic body measurement provides hospital admission or entry data, trending providing useful info.
• Rapid weight changes indicate fluid shifts, one pint equals to one pound.
• Ideal Body Weight: an estimate.
• Body Mass Index: weight corrected for height and used as an alternative to traditional methods:
• Overweight = 25-30.
• Obese = >30, increasing risk of some cancers, coronary heart disease, DM and HTN.

Biochemical Tests

• Serum Protein Levels:
• Albumin: levels can be low due to many aspects, and there are delays detecting nutritional problems.
• Prealbumin: reacts daily and is is a better marker for change.
• Transferrin: protein that binds with iron, allows for faster deficiencies to be detected due to albumin.
• Also electrolytes, BUN (decreased in patients with low protein intake), creatinine, glucose, cholesterol, triglycerides, CBC with differential is common.
  • Anemia encourage diet high in iron (Dark green leafy vegetables) and vitamin C (Citrus fruits and vegetables)
• emoglobin A1C average blood sugar over past 2-3 months

Health and Diet History

-Habitual intake of foods and liquids.

• Health status, age, etc, use of drugs, knowledge of nutrition and ability to obtain food
• EX: Hx of GERD teach to not eat for several hours before bedtime, small meals, decrease fluid with meals, can lead to overdistention of stomach
• Assess the patients home eniviroment.

Physical Exam

• Skin/Hair may indicate deficiency with nail hint, such as pail, mottled nails.
• Box 45.7, p. 1188 Causes of Dysphagia. Some complications include: Aspiration Pneumonia, malnutrition, and decreased functional capacity.

Dysphagia

• Screening to identify and speech language referrals.
• Aspiration needs to be avoided. Swallowing techniques: head flexed to chin-down, eat on unaffected side. Consistent Dietary Modification: pureed foods and thickened liquids to nectar, honey and spoon thickness Feed slowly to allow the medication to absorb correctly.

Analysis of Diagnoses

• Risk for undernutrition, Diarrhea
• Readiness, Feeding self, Imbalance in nutrition

Plans and Goals

• Reflect all physiological and individual needs.
• Education to understand the current diet and how it helps the current ailments.

Implementations

• Community based.
• Educate on high quality ingredients, provide with a budget, and keep safe conditions. Frequent checkups: Daily weights, intake and calorie count to show any risk factors to ill patient. This includes the following: acute illness or surgery, decreased exposure, high select nutrition, clear or full liquid or pureed diets in soft or low residue ingredients.
• Diet, high in Fiber, low in Cholesterol, and low Sodium, Diet can be taken as Gradual at any level

Assistance with Oral Feeding and Appetite

Consider: glasses, dentures, the patient must be positioned for eating, must be told where the plate and food resides Take note of the intake and report of the meal Note the patients care to prevent them from going long term without nutrients. frequent oral cares, 2Hr for ice and candy.

Enteral and parenteral nutrition

Consider: tube, checkups, gastric residual and all ordered medication Note: formula causes diahhrea, use X-ray in tube. Make sure tube is verified prior to feeding: Aspiration and degree is high.

Parenteral nutrition

Consider: PICC, Central Line and Electrolytes Note: continuous monitoring.

Medical Nutrition

• Goal decrease high blood glucose.
• Watch hypo and hyper glucose and maintain table
• Check liver and biopsy and antibiotics

High consumption of: fiber, small portion, and proton

• Baceria: Check endo
• Limit NSAIDS

CV and Cancer

• Eat fiber and avoid high salt

• Cancer; watch all dietary, stimulate and increase the patient's needs.

• HIV/AIDS result = Severe Consequence DASH Diet

• significantly lowers BP if incorporated, watch for high sodium and add fruits.