Exam 12 - Nutritional Concepts

Life Cycle Nutrition: Adulthood

• During adulthood, nutrient needs change little compared to adolescence, but basal metabolic rate slows, decreasing caloric needs.
• Activity levels also often decrease in adults, resulting in weight gain.
• Encourage adults to eat nutrient-dense foods and maintain an active lifestyle.

Nutritional Concerns of Adults in Long-Term Care Facilities

• Malnutrition is common in long-term care residents, affecting physical health and quality of life.
• Factors contributing to poor nutrition include cognitive or physical impairment, disease processes, and emotional disturbances.
• Residents may need assistance with eating and drinking, and care providers should be educated and trained to ensure adequate nutritional intake.
• Dietary restrictions, such as those for sodium, fat, or diabetes, can impact food palatability and hinder intake.
• Inadequate fluid intake and dehydration can happen due to decreased thirst sensation, decreased independence, difficulty swallowing, and incontinence.
• Pressure injuries in non-ambulatory residents increase kilocalorie, protein, and nutrient needs.
• Coordinate personalized care to ensure nutritional needs are met, and address concerns quickly.
• Offer familiar foods and incorporate cultural needs within prescribed diets.
• Use liquid nutritional supplements to help increase intake if needed, but not as a substitute for regular food.
• Offer fluids regularly to prevent dehydration.
• Encourage family involvement and socialization at mealtime to increase intake.

Lifespan Considerations: Aging and Nutrition

• Aging affects the eating process due to changes in dentition, decreased saliva production, and alterations in swallowing, potentially impacting nutrient intake.
• Adjust food consistency to facilitate intake as needed, but serve in as palatable a manner as possible.
• Changes in aroma and taste due to aging, along with special diets that restrict salt, sugar, and fats, can lead to inadequate nutrient intake.
• Use flavorings, seasonings, and spices to enhance flavor and aroma.
• Changes in digestive secretions, gastrointestinal mucosa, and enzyme production affect digestion, absorption, and excretion.
• Water, dietary fiber, and physical activity help prevent constipation in older adults.
• Aging often leads to loss of muscle mass, reducing basal metabolic rate.
• Kilocalorie needs may decrease with age, by 5% for each decade between ages 55 and 75 and 7% for each decade after 75.
• Older adults may need more protein, riboflavin, vitamin B6, vitamin B12, folate, vitamin D, and calcium.
• A multivitamin and mineral supplement is often beneficial for individuals with low calorie intake or poor intake periods.
• Some older adults may not need as much vitamin A as younger adults.
• Advise patients not to consume large doses of any nutrient without a healthcare provider's supervision.
• Many older adults take numerous medications that can affect their nutritional status.
• Be aware of drug-nutrient interactions and side effects to influence dietary intake.
• Some older adults struggle to obtain and prepare nutritious food due to illness, restricted mobility, or financial limitations.
• Social and mental changes, such as forgetfulness, loneliness, and apathy, can affect eating habits.
• Chronic medical conditions often require therapeutic diets, such as for diabetes, cardiovascular disease, renal insufficiency, osteoporosis, diverticulosis, anemia, and lactose intolerance.
• Always determine individual needs and situations before recommending nutrition therapy.

Nutrient-Drug Interactions

• Many older adults take prescription and over-the-counter medications that can affect their nutritional status.
• Medications can increase or decrease appetite or the ability to eat, and affect the absorption, metabolism, and excretion of nutrients.
• Food intake and vitamin or mineral supplementation can also affect the absorption, distribution, metabolism, and action of medications.

Caffeine

• Caffeine is a central nervous system stimulant and diuretic with potential side effects like nervousness, irritability, anxiety, insomnia, heart dysrhythmias, and palpitations.
• It can affect blood pressure, circulation, and gastric acid secretion.
• Caffeine tolerance may decrease with aging, so older adults should be encouraged to moderate their caffeine intake.

Medical Nutrition Therapy and Therapeutic Diets

• Medical nutrition therapy is the use of specific nutritional variations to improve health.
• Therapeutic diets are diets used as medical treatments, often involving modifications to specific nutrients, calories, or consistency.
• When recommending therapeutic diets, consider the patient’s cultural and religious preferences to increase compliance.

Consistency, Texture, and Frequency Modifications

• Therapeutic diets can include modifications in textures, consistencies, and meal frequency.
• Liquid diets are used before diagnostic tests, surgeries, and during episodes of vomiting or diarrhea.
• There are two types: clear liquid and full liquid.
• The clear liquid diet consists of easily digested liquids that leave little residue in the GI tract. It is low in calories, protein, and most nutrients. It is used temporarily, preferably for 2 to 3 days.
• The full liquid diet is more nutritionally complete but still lacks some nutrients. It is also used temporarily.
• Soft and low-residue diets are used for conditions affecting the GI tract, such as acute diverticulitis, inflammatory bowel disease, gastritis, esophageal varices, and during periods of indigestion or diarrhea.
• A soft diet is generally low in fiber and includes foods from all food groups, but avoids strong spices.
• A mechanical soft diet is ordered for those with difficulty chewing or swallowing.
• A low-residue diet resembles a soft diet but also limits milk and milk products, as they leave more residue in the colon.
• High-fiber diets are used for constipation and diverticulosis.
• Increase fiber intake gradually to prevent excess gas formation.

Kilocalorie Modifications

• The body requires energy from food and fluids to maintain functions.
• High-kilocalorie and high-protein diets are used during times of physiologic stress to maintain adequate nutritional intake.
• They provide increased amounts of calories and protein in small volumes.
• Obesity is a complex, chronic, relapsing disease caused by a chronic energy imbalance.
• It is defined as excess body fat above healthy levels.
• Body mass index (BMI) is used to screen for health problems related to weight.
• BMI is determined by dividing body weight (in kilograms) by height (in meters squared).
• A BMI below 18.5 is considered underweight, 18.5 to 24.9 is normal, 25 to 29.9 is overweight, and 30 or greater is obese.

Obesity Etiology

• Obesity is caused by chronic energy imbalance when more energy is consumed than expended.
• Genetic, environmental, and behavioral factors contribute to obesity.
• Sedentary lifestyles, high-fat, high-calorie diets, and readily available food contribute to this energy imbalance.

Obesity Treatment

• Treat obesity as a complex, chronic, relapsing disease with empathy and without prejudice.
• Effective therapy requires lifelong commitment to healthy lifestyle behaviors, addressing medical and psychosocial aspects.
• The goal is weight management, not just weight loss.
• Set realistic, achievable weight loss goals that can be maintained.
• A sound weight management program requires hard work and individual motivation.
• A good diet should provide no fewer than 1200 kcal/day, and a multivitamin and mineral supplement is recommended when the diet provides less than 1500 kcal/day.

Dietary Recommendations for Weight Management

• Very low calorie and semistarvation diets should only be used under strict medical supervision.
• Physical activity is crucial for weight loss and maintenance, aiming for most days of the week.
• Gradually increase physical activity, breaking it into shorter sessions if needed.
• Recreational activities contribute to overall physical activity.
• Aerobic exercise promotes fat reduction, while resistance training preserves muscle mass and bone density.
• Choose enjoyable activities to ensure sustainable participation.
• Moderate-intensity exercise is safer and more sustainable than extreme exercise.
• Effective weight management includes psychological interventions focusing on self-esteem, body image, and coping mechanisms.
• Mindfulness and body awareness help individuals respond to internal hunger cues instead of external triggers.

Bariatric Surgery for Obesity

• Bariatric surgery is commonly used for severely obese patients (BMI ≥ 40) and those with BMI ≥ 35 with related medical conditions.
• It leads to significant weight loss and often improves weight-related conditions like diabetes and hypertension.
• While generally beneficial, risks include nutritional deficiencies, dumping syndrome, and diarrhea.
• Multivitamin and mineral supplementation is essential after surgery.
• Encourage small portions, slow eating, chewing thoroughly, and separate consumption of food and beverages.

Pharmacologic Therapy for Obesity

• Weight-loss medications should be part of a comprehensive program including diet and physical activity.
• Over-the-counter medications may temporarily suppress appetite.

Carbohydrate-Modified Diets

• Primarily used for diabetes management due to the disease's impact on nutrient utilization.
• Focuses on controlling and preventing complications through dietary modification to manage blood glucose and lipids.
• Individualized nutrition therapy is essential, avoiding standardized preprinted plans.
• Emphasizes consistency in meal timing and carbohydrate intake.
• Encourages whole grains, fruits, vegetables, and low-fat dairy.
• Total carbohydrate amount is more significant than the source.
• Fiber intake should be consistent with general population recommendations.
• Fat intake should be limited to control blood lipid levels.

Type 1 Diabetes Mellitus

• Requires lifelong insulin therapy.
• Eating plans should provide sufficient calories for growth and development.
• Balancing carbohydrate intake with insulin and exercise is crucial.

Type 2 Diabetes Mellitus

• Aims to achieve and maintain a healthy weight, blood cholesterol, and blood glucose levels.
• Encourages lifestyle changes, including reduced energy intake and increased physical activity.
• Mild to moderate weight loss can significantly improve metabolic control.

Meal Planning Approaches

• Patients can use regular foods with meal planning tools.
• Carbohydrate counting focuses on total carbohydrate intake and can be easier for some individuals.

Other Nutritional Considerations

• Hypoglycemia can result from inadequate carbohydrate intake, leading to symptoms like headache, weakness, and dizziness.
• Treat hypoglycemia with immediate glucose intake.
• Acute illness requires careful blood glucose monitoring and continued insulin therapy.
• Alcohol consumption should be moderate and taken with food to reduce hypoglycemia risk.

Dumping Syndrome

• Occurs after stomach removal or bariatric surgery due to rapid gastric emptying.
• Symptoms include nausea, cramping, diarrhea, and lightheadedness.
• Diet focuses on small, frequent meals higher in protein and fat, lower in carbohydrates, and avoiding concentrated sweets.

Lactose Intolerance

• Results from lactase enzyme deficiency and inability to digest lactose.
• Symptoms include nausea, cramps, and diarrhea.
• Diet excludes milk and milk products.
• Encourage alternative calcium sources and supplementation.
• Some individuals tolerate small amounts of yogurt and cheese.

Fat-Modified Diets

• Modifying dietary fat reduces the risk of cardiovascular disease and some cancers.

Low-Fat Diets

• Primarily for preventing or treating atherosclerosis, heart disease, and high lipid levels.
• Encourage low-fat choices across food groups, including lean meats, skinless poultry, and fish.
• Limit eggs, organ meats, and added fats.
• Promote healthy fats like monounsaturated and omega-3 fatty acids from sources like fish and olive oil.
• Emphasize moderation and balance of fat intake.

Fat-Controlled Diets

• For treating diarrhea, steatorrhea, and flatulence, or diseases affecting the digestive system and lymphatic system.
• Significantly restricts fat intake, limiting visible fats and focusing on lean protein sources.
• Encourage consumption of grains, fruits, and vegetables.
• Supplementation may be necessary.

Metabolic Syndrome

• A group of risk factors associated with increased risk of heart disease, stroke, and type 2 diabetes.
• Key risk factors include abdominal obesity, high cholesterol, high blood pressure, and insulin resistance.
• Abdominal obesity is particularly crucial, with a waist circumference of 40 inches or more for men and 35 inches or more for women.
• Prevalence is increasing dramatically.

Life Cycle Nutrition

• Adult nutrient needs change little compared to adolescents, however, basal metabolic rate slows, and caloric needs decrease.
• Adults often gain weight due to reduced activity levels and decreased energy needs.
• Remind adults to eat nutrient-dense foods and maintain an active lifestyle.
• Aging increases health concerns with conditions like heart disease, arthritis, osteoporosis, diabetes, and kidney disease.
• Individual nutrient needs can vary significantly in older adults.
• Provide personalized dietary education and explain the importance of any restrictions.

Nutritional Concerns of Adults in Long-Term Care Facilities

• Malnutrition is common in long-term care residents, impacting physical health and quality of life.
• Residents may experience cognitive or physical impairments, disease processes, and emotional disturbances that affect their nutritional intake.
• Residents may need assistance with eating and drinking, so all caregivers must be trained to ensure adequate nutrient intake.
• Restricted diets, like low sodium or low fat, can affect food palatability and hinder nutritional intake.
• Dehydration risk is increased in long-term care residents due to decreased thirst sensation, independence, swallowing difficulties, and incontinence.
• Pressure injuries in non-ambulatory residents require increased kilocalorie, protein, and nutrient needs.
• All members of the healthcare team must coordinate care to address the nutritional needs of residents and prevent nutritional compromise.
• Offering familiar foods and incorporating cultural needs into meals is important.
• Liquid nutritional supplements can be used to increase kilocalorie, protein, and nutrient intake when intake is suboptimal, but they should not replace regular food.
• Fluids should be offered at all meals and between meals to ensure adequate intake.
• Healthcare providers should monitor for signs of dehydration and correct any deficits quickly.
• Family involvement and socialization during mealtimes can help increase residents’ dietary intake.

Lifespan Considerations: Aging and Nutrition

• Aging affects the eating process with changes in dentition, decreased saliva production, and swallowing difficulties.
• Food consistency may need to be adjusted to facilitate intake.
• The aroma and taste of foods are often affected by aging, and special diets may further restrict salt, sugars, and fats.
• Use flavorings, seasonings, and spices to enhance flavor and aroma.
• Aging changes affect digestive secretions, gastrointestinal mucosa, and enzyme production, affecting how food is digested, absorbed, and excreted.
• Water, dietary fiber, and adequate physical activity are important for preventing constipation.
• Aging leads to loss of muscle mass, reducing basal metabolic rate, and decreasing kilocalorie needs by approximately 5% for each decade between ages 55-75 and 7% for each decade after age 75, depending on activity level.
• Older adults may have increased needs for protein, riboflavin, vitamin B6, vitamin B12, folate, vitamin D, and calcium.
• A multivitamin and mineral supplement supplying 100% of the RDA can be beneficial for individuals with low kilocalorie intake or during periods of poor intake.
• Older adults may not need as much vitamin A as younger adults.
• Advise patients not to consume large doses of any nutrient without a health care provider’s supervision.
• Medications can significantly affect nutritional status.
• Be aware of drug-nutrient interactions and side effects that may influence dietary intake.
• Some older adults may have difficulty obtaining and preparing nutritious food due to illness, limited mobility, or financial limitations.
• Age-related social and mental changes, such as forgetfulness, loneliness, and apathy, may affect eating habits.
• Chronic medical conditions often necessitate therapeutic diets, including those for diabetes mellitus, cardiovascular disease, renal insufficiency, osteoporosis, diverticulosis, anemia, and lactose intolerance.
• Determine individual needs and situations before deciding on the most appropriate nutrition therapy.

Nutrient-Drug Interactions

• Older adults often take multiple prescription and over-the-counter medications, which can negatively impact nutritional status.
• Medications can affect appetite, ability to eat, and the absorption, metabolism, and excretion of nutrients.
• Food intake and vitamin or mineral supplementation can also influence the absorption, distribution, metabolism, and action of medications.

Medical Nutrition Therapy and Therapeutic Diets

• Medical nutrition therapy uses specific nutritional variations to improve health.
• Therapeutic diets are medical treatments involving specific nutrient or calorie modifications or changes in diet consistency.
• When prescribing therapeutic diets, consider cultural and religious preferences to enhance compliance.

Consistency, Texture, and Frequency Modifications

• Liquid diets, such as clear and full liquid diets, are used before diagnostic tests, surgery, or during episodes of vomiting or diarrhea.
• Clear liquid diets are low in kilocalories, protein, and most nutrients and should be used temporarily.
• Full liquid diets offer more nutritional completeness but are still lacking in some nutrients and should be used temporarily.
• Soft and low-residue diets are used as transitions or for conditions affecting the GI tract.
• Soft diets are low in fiber and include foods from all food groups but avoid strong spices.
• Mechanical soft diets are ordered for patients with chewing or swallowing difficulties.
• Low-residue diets are similar to soft diets but restrict milk and milk products.
• High-fiber diets are a variation of the regular diet and are used for constipation, diverticulosis, and to reduce or eliminate the need for laxatives.

Kilocalorie Modifications

• The body requires energy for its tasks, which is obtained through food and fluids.
• Energy balance, weight, and nutritional status are influenced by energy intake and output.
• High-kilocalorie and high-protein diets provide increased amounts in small volumes to support patients with increased energy needs, trauma, or compromised nutritional status.
• Obesity is a growing health concern worldwide, increasing the risk of numerous diseases and health conditions.
• Obesity is defined as an excess of adipose tissue or body fat.
• Body mass index (BMI) measures body fat and is used to screen for health problems related to weight.
• Location and amount of body fat can be better predictors of health risk than BMI alone.

Obesity: Etiology

• Obesity is caused by a chronic energy imbalance, where more energy is consumed than expended.
• Genetic, environmental, and behavioral factors contribute to obesity.
• Genetics, hormones, and metabolism contribute to appetite and energy metabolism regulation.
• Environmental factors, such as sedentary lifestyles, readily available high-fat foods, and larger portion sizes, contribute to obesity.
• Behavioral factors include lack of physical activity, excessive food consumption, and inadequate satisfaction from eating.

Obesity: Treatment

• Obesity treatment should focus on achieving long-term weight management through lifestyle changes.
• Treatment should address medical and psychosocial aspects of the disease with empathy and without prejudice.
• Realistic weight loss goals should be set, aiming for a 5-15% reduction in body weight.
• Weight management programs should focus on reducing energy intake and changing dietary and exercise habits.
• Diets should provide at least 1200 kcal/day, and a multivitamin and mineral supplement is recommended with a diet of less than 1500 kcal/day.

Weight Loss & Management

• Very low calorie and semi-starvation diets are cautioned against unless under strict care of a healthcare provider.
• Physical activity is vital for weight loss and maintenance.
• Aim for physical activity most days of the week for a prescribed duration for initial weight loss, and continuation for maintenance.
• Encourage a gradual increase in physical activity, breaking it down into shorter increments if needed.
• Recreational activities such as sports and gardening contribute to the total physical activity.
• Aerobic exercises like brisk walking, jogging, cycling, and cross-country skiing are most effective in reducing body fat.
• Resistance training like weightlifting and calisthenics help maintain lean body mass and bone density, preventing BMR reduction.
• Encourage participants to find enjoyable physical activities they can sustain.
• Moderate-intensity exercise is more sustainable and carries less risk of injury.
• Effective psychological interventions promote a healthier attitude towards eating and body image.
• Counseling emphasizes self-esteem, body image, body acceptance, and coping with societal pressures.
• Patients practice mindfulness and body awareness, learning to sense fullness based on internal cues.
• This process reduces focus on weight loss and food, shifting attention to overall health and life.
• Support systems from family, friends, or groups greatly benefit the process.

Surgical Treatment

• Bariatric surgery has become common for the treatment of obesity.
• Candidates typically have a BMI ≥ 40 or a BMI of 35 or higher with medical conditions like cardiovascular disease or type 2 diabetes.
• Patients achieve significant weight loss after surgery and maintain it with diet and exercise adherence.
• Weight-related disorders like diabetes, hyperlipidemia, hypertension, and sleep apnea often improve considerably.
• Mortality rates for surgically treated obese patients are lower than those treated traditionally.
• Benefits of bariatric surgery generally outweigh the risks, which include nutritional complications like deficiencies, dumping syndrome, and diarrhea.
• Multivitamin and mineral supplements, along with other nutritional supplements, are typically prescribed.
• Common deficiencies after surgery include iron, folic acid, and vitamin B12.
• Encourage small portion sizes, slow eating, thorough chewing, separate food and beverage consumption, and avoidance of poorly tolerated foods.
• Adequate physical activity is encouraged to maintain weight loss.

Pharmacologic Therapy

• Prescription drugs or over-the-counter medications are used in pharmacologic therapy for obesity management.
• Weight-loss drugs should be part of a comprehensive program, including diet and physical activity.
• Over-the-counter medications can temporarily suppress appetite.

Carbohydrate-Modified Diets

Diabetes Mellitus

• Carbohydrate-modified diets are primarily used for diabetes mellitus treatment.
• Diabetes mellitus involves the body's inability to produce or use insulin properly, impacting energy conversion from food.
• The cause is unknown, though genetics and factors like obesity and inactivity play a role.
• Two main types of diabetes exist:
  • Type 1 diabetes, typically diagnosed in youth, involves the body not producing insulin. Requires lifelong insulin therapy. Makes up about 5% of diabetes cases.
  • Type 2 diabetes involves the body's inability to effectively use insulin, making up around 95% of diabetes cases. Its prevalence has increased due to aging population and increased obesity and sedentary lifestyles.
• Nutrition therapy for diabetes is vital due to its direct impact on nutrient utilization.
• Control and prevention of complications are key goals.
• Normal nutrition and dietary modifications to control blood glucose and lipids are crucial.
• Patient education about proper diet enables them to make changes in eating and exercise habits for better metabolic control.
• Coordinated effort from healthcare providers, nurses, diabetic educators, dietitians, the patient, and their family is necessary.
• Nutrition therapy must be personalized, avoiding standardized preprinted sheets.
• Each patient requires a realistic and achievable eating plan.
• Factors like lifestyle, current practices, caloric and nutrient needs, existing conditions, and medication use are considered.
• While healthy lifestyle nutrition is important for all, diabetes requires closer carbohydrate monitoring and control.
• Consistent meal timing (every 4-5 hours) and carbohydrate content are emphasized.
• Inclusion of carbohydrates from whole grains, fruits, vegetables, and low-fat milk is recommended.
• Dietary carbohydrate intake is tailored to individual needs, following MyPlate guidelines and Dietary Guidelines for Americans.
• Total carbohydrate content is prioritized over source or type.
• Encouragement of a variety of fiber-rich foods is recommended.
• Fat intake should be limited to control blood lipid levels.
• Saturated fat should be less than 5-6% of calories, dietary cholesterol below 200 mg/day, and trans fatty acids minimized.
• Monounsaturated fats can help lower triglycerides and improve glycemic control, encouraging fish consumption (two or more servings weekly).

Type 1 Diabetes

• Due to frequent childhood and adolescence diagnoses, meal plans must provide sufficient calories for growth and development, offering flexibility.
• Balancing carbohydrate intake with insulin administration and exercise is crucial.
• Consistent meal and snack timing and content are vital initially to determine insulin requirements.
• Patients learn to monitor blood glucose levels and adjust insulin dosages accordingly.

Type 2 Diabetes

• Primary objectives of nutrition therapy are achieving and maintaining desired weight, normal blood cholesterol, and blood glucose levels.
• Encouragement of lifestyle changes for reduced energy intake and increased physical activity is beneficial.
• Mild to moderate weight loss (5-7% of starting weight) improves metabolic control even without reaching desired weight.
• Physical activity aids weight reduction, improves blood glucose levels, decreases insulin resistance, and reduces cardiovascular risks.

Meal Planning Approaches

• While diabetes requires monitoring carbohydrate and fat content, it doesn't necessitate special foods.
• Various tools are available to help with regular food choices.
• Exchange lists, commonly used in the past, divide foods into groups based on carbohydrate, protein, and fat content.
• This can be complex and overwhelming for some.
• Carbohydrate counting focuses on the total carbohydrates consumed, sometimes easier than exchange lists.
• It directly correlates carbohydrate intake with blood glucose levels, facilitating adherence.
• However, weighing and measuring food and calculating carbohydrate grams can be challenging.
• Protein and fat are not counted, but consistent protein intake and low-fat food choices are encouraged.

Other Nutritional Considerations

• Insufficient carbohydrate intake in insulin-dependent individuals can lead to hypoglycemia, resulting in symptoms like headache, disorientation, weakness, perspiration, shallow breathing, nervousness, visual disturbances, and vertigo, potentially causing unconsciousness.
• Immediate administration of glucose or any carbohydrate containing glucose is needed for treatment.
• The 15-15 rule is a strategy: consume 15g of carbohydrate, wait 15 minutes, and check blood glucose for adequate response.
• If unconsciousness occurs, intravenous glucose is essential.
• Acute illness increases diabetic ketoacidosis risk in type 1 diabetes and hyperosmolar hyperglycemic nonketotic syndrome risk in type 2 diabetes.
• Continuous insulin intake and careful blood glucose monitoring are crucial during illness.
• Adequate fluid intake and carbohydrate consumption, especially if blood glucose falls below normal, are encouraged.
• Beverages like juices, punch, popsicles, gelatin, crackers, puddings, and ice cream are carbohydrate-containing options for sick individuals.
• Alcohol guidelines for individuals with diabetes mirror those for the general population.
• Limiting intake to one drink daily for women and two for men is recommended.
• Consumption with food is advised to minimize hypoglycemia risk.

Dumping Syndrome

• It can occur after stomach removal surgery (partial or total gastrectomy) or bariatric surgery for weight reduction.
• Rapid stomach emptying into the small intestine causes excess fluid attraction, resulting in symptoms like nausea, cramping, diarrhea, sweating, lightheadedness, and palpitations.
• Symptoms typically occur after meals or consuming too much simple sugar.
• Diet therapy aims to slow gastric emptying and distribute contents over time.
• Small, frequent meals higher in protein and fat, and lower in carbohydrates are recommended.
• Concentrated sweets should be avoided, and fluids consumed 30-60 minutes before or after meals.
• Lying down after meals can also help slow emptying.
• This diet might be temporary until the body adjusts to the changes caused by surgery.

Lactose Intolerance

• It occurs due to a lack of the digestive enzyme lactase, preventing lactose breakdown.
• This is a hereditary condition, with higher prevalence among African Americans, Hispanics, Asian Americans, and Native Americans.
• Distinct from milk allergy, symptoms include nausea, cramps, bloating, flatulence, and diarrhea, appearing 30 minutes to 2 hours after milk product consumption.
• The diet excludes milk and milk products like ice cream, puddings, cheese, and powdered milk.
• Avoiding foods with added milk (biscuit mixes, soups, prepared foods) and processed foods containing lactose (waffles, pancakes, processed meats) is necessary.
• Dietary counseling includes alternative calcium sources and potential supplementation recommendations.
• With a deficiency instead of complete absence of lactase, small amounts of milk products (yogurt, cheese) may be tolerated.
• Lactase enzyme preparations are available before consuming dairy, and lactose-free options are increasingly available.

Fat-Modified Diets

Low-Fat Diets

• Modifying dietary fat content can reduce heart and vascular disease risk by about 14% and decrease certain cancer risks.
• Low-fat diets are necessary for prevention and treatment of atherosclerosis, heart disease, and hyperlipidemia.
• The American Heart Association and the National Cholesterol Education Program (TLC) provide dietary guidelines for reducing fat intake.
• Compliance can be challenging due to perceived lack of flavor and satisfaction.
• Encourage choice of low-fat options in all food groups: low-fat dairy, lean meats, skinless poultry, fish, limiting eggs to four weekly and organ meats to one serving or less.
• Added fats like butter, margarine, mayonnaise, cream, and sour cream should be restricted.
• Inclusion of monounsaturated fats and omega-3 fatty acids can lower cholesterol and triglycerides, so substitution for saturated and trans fats is encouraged.
• Identify food sources like fish, olive oil, canola oil, peanut oil, flaxseed oil, soy products, and nuts.
• While fat is beneficial and enjoyable when eaten, many mistakenly believe all fat is bad, leading to resistance to low-fat diets.
• Choosing a low-fat, low-cholesterol diet doesn't mean eliminating all fatty foods.
• Total amount of fat, saturated fat, and cholesterol is crucial.
• High-fat foods contribute essential nutrients and eliminating them can compromise nutritional value.
• Moderation is encouraged, balancing high-fat foods with lower-fat options, maintaining variety and moderation.

Fat-Controlled Diets

• These diets treat diarrhea, steatorrhea, flatulence, hepatobiliary tract, pancreas, intestinal mucosa, lymphatic system diseases, and malabsorption syndromes.
• Fat restriction can be as low as 25g/day depending on symptom severity.
• Visible fats like butter, cream, and oil are excluded.
• Only nonfat dairy and lean meat, fish, poultry (no more than 5 oz/day) are allowed.
• Emphasize consumption of grains, cereals, fruits, and vegetables.
• Vitamin and mineral supplementation may be necessary to address deficiencies.

Metabolic Syndrome

• It represents a cluster of metabolic risk factors increasing coronary artery disease, stroke, and type 2 diabetes risk.
• Includes abdominal obesity, dyslipidemia, elevated blood pressure, and insulin resistance.
• Abdominal obesity and insulin resistance are particularly crucial, with waist circumferences of 40 inches or more for men and 35 inches or more for women.
• Its prevalence has increased dramatically, with an estimated 50 million cases in the United States.

This quiz explores the critical aspects of nutrition and dietary needs for residents in long-term care facilities. It covers topics such as hydration, aging impacts on food perception, and the effects of medication on nutrition. Test your knowledge on the best practices for ensuring optimal nutrition among older adults in care settings.