Nutrition Quiz: Fiber and Fats

Chapter 26: Concepts of Basic Nutrition and Cultural Considerations

• ATI Fundamentals Chapter 39
• ATI Nutrition Chapter 1

Overview of the Gastrointestinal System (p. 467)

• Structures involved in the digestive system
  • Mouth
  • Teeth
  • Tongue
  • Pharynx
  • Esophagus
  • Stomach
  • Small intestine
  • Large intestine
  • Anus
• Accessory organs
  • Salivary glands
  • Liver
  • Gallbladder
  • Pancreas

Functions of the Organs of Digestion

Mouth

• Contains tongue and 32 permanent teeth
• Receives secretions from salivary glands
• Tongue composed of skeletal muscle
• Receives food and breaks it down into smaller pieces, mixes food with saliva, starting digestion
• Parotid glands: largest salivary glands, one on each side (anterior and inferior to the ear)
• Secrete saliva into the mouth, beginning digestion of starches

Pharynx

• Connects nasal and oral cavities to the esophagus
• Food forced into pharynx by the tongue

Esophagus

• Muscular tube approximately 20 cm long
• Propels food into the stomach
• Lining secretes mucus

Stomach

• Located in the upper-left quadrant of the abdomen, capacity approximately 1.5L
• Has two sphincters that prevent gastric acid from moving back up the esophagus
• Temporary storage place for food
• Mixes food with digestive juices (gastric acids)
• Changes food into a semiliquid state
• Begins digestion of proteins
• Absorbs vitamin B12

Small Intestine

• (Duodenum, jejunum, ileum)
• Mixes food with secretions from liver and pancreas
• Finishes digestion
• Absorbs nutrients

Large Intestine

• (Ascending, transverse, descending, and sigmoid colon; rectum, anus; cecum)
• Absorbs fluid and electrolytes
• Eliminates waste products

Liver and Gallbladder

• Concentrate, store, and secret bile into the duodenum when stimulated by fatty foods

Pancreas

• Secretes digestive juices
• Produces insulin

Changes in the Digestive System that Occur with Aging

• Dental carries and tooth loss
  • Decrease ability to chew
• Decreased gag reflex
  • Increases aspiration risk
• Decreased sense of taste
  • May lead to loss of appetite
• Decreased sphincter tone
  • Increase reflux risk
• Decreased gastric secretions
  • May interfere with digestion
• Decreased peristalsis
  • Increased constipation risk

Metabolism

• Process in which large molecules are broken down into smaller molecules
• Makes energy available to the body
• Enables absorbed nutrients to enter the bloodstream following digestion
• Digestion converts food into chemical compounds (proteins and simple sugars) to be used for energy production and cellular metabolism

Dietary Guidelines

• USDA MyPlate
  • Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk products
  • Includes lean meats, poultry, fish, beans, eggs, and nuts
  • Low in saturated fats, trans fats, cholesterol, sodium, and added sugars
  • Variety of foods from each group needed to achieve a healthy diet
• See also the AHA 2015 Diet and Lifestyle Recommendations

Protein

• Constant supply essential for rebuilding and replacing body tissues
• Plays a role in hormone production, fluid balance, antibody production, and transportation of nutrients
• Composed of amino acids
  • 9 essential and 11 nonessential
• Animal sources contain all 9 essential amino acids
  • Red meat, eggs, milk, poultry, fish (Complete protein)
• Plant sources are incomplete proteins
  • Grains, legumes, most vegetables (Incomplete protein)

Protein Dietary Reference Intakes :

• Average DRI is 46 to 56 g of protein per day for healthy adults
• Combination of meat and plant sources.
• Protein intake should be 10% to 15% of total daily calories.
• May vary based on activity level, health, and availability of protein food sources.
• Individuals highly active or ill need more protein.

Protein Deficiency

• Marasmus
  • Severe starvation, a form of protein-energy and nutrient malnutrition
  • Occurs chiefly in the first year of life
  • Characterized by growth retardation and wasting of subcutaneous fat and muscle
• Kwashiorkor
  • Condition occurring in infants and young children soon after weaning from breast milk
  • Severe protein deficiency, even with adequate intake of other nutrients
  • Symptoms: Edema, skin pigment changes, impaired

Protein Excess

• Stressful to the liver and kidneys
• Kidneys remove excess waste products
• Liver strained with excess protein to metabolize
• Can lead to excess fat in the diet
• Leads to obesity, heart disease, and certain types of cancer

Vegetarian Diets

• Well-planned vegetarian diets may offer health benefits.
• Lacto-ovo-vegetarian: Dairy products, eggs, and plant foods included
• Lactovegetarian: Eggs excluded; dairy products and plant foods included
• Vegan: Excludes all animal foods, including honey
• May have a diet deficient in vitamin B6, vitamin B12, iron, zinc, riboflavin, and vitamin D

Carbohydrates

• The body's main source of energy
• Should make up 50% to 60% of the daily diet
• Regulate protein and fat metabolism
• Fight infection and promote growth of body tissues
• Three main types
  • Simple carbohydrates (monosaccharides)
  • Complex carbohydrates (polysaccharides)
  • Fiber

Simple Carbohydrates

• Glucose: metabolized form of sugar, found in Table sugar (sucrose), fruit sugar (fructose), and high-fructose corn syrup added to foods.
• Milk sugar (lactose)
• Quickly absorbed into the bloodstream
• Cause a quick rise in serum glucose

Complex Carbohydrates

• Oatmeal, whole-grain breads, pasta, cereals, and rice
• Broken down into simple sugars for use by the body.
• Provide a more consistent serum glucose level than simple sugars

Fiber Carbohydrate

• The portion of the carbohydrate that cannot be broken down during digestion; passes through intestines undigested
• Increases bulk in the stool, aiding in elimination
• May decrease fat and cholesterol absorption.
• Delays carb absorption, beneficial to diabetic patients.
• Recommended intake 21 to 38 g/day

Food Sources of Fiber

• Fruits: Apples, bananas, oranges, grapefruits, cantaloupe, strawberries
• Vegetables: Green beans, broccoli, cauliflower, celery, corn, potato
• Grains: Whole wheat breads, all bran, oatmeal, shredded wheat
• Legumes: Kidney beans, pinto beans, lima beans, black-eyed peas

Fats (Lipids)

• Essential nutrient
• Supplies concentrated form of energy
• Made up of fatty acids and glycerol.
• Called triglycerides
• Adds flavor to foods and contributes to texture
• Dissolves and transports fat-soluble vitamins and fat-soluble phytonutrients (carotenoids)
• Insulates and controls body temperature
• Makes food smell appetizing
• Cushions and protects body organs.
• Facilitates transmission of nerve impulses
• Gives feeling of fullness after eating

Fats: Saturated vs. Unsaturated

• Fatty acids are classified as saturated or unsaturated
• Fatty liquids at room temperature are called oils.
• Most oils are unsaturated fats (corn oil, safflower oil, canola oil)
• Omega-3 fatty acids are a form of unsaturated fatty acid found in salmon, halibut, sardines, tuna, canola oil, soybean oil, chicken, eggs, and walnuts

Fats: Cholesterol

• Component of fat linked to heart disease and hardening of the arteries.
• Found in animal products and oils (palm and coconut)
• Blood studies associated with fats -HDL (high-density lipids): Want these high, helps remove cholesterol from arteries
  • LDL (low-density lipids): Want these low, main source of buildup in arteries
  • Triglycerides: Fats found in the blood; high levels may increase risk of heart disease

Vitamins

• Essential nutrients that must be taken through food sources or supplements.
• Water-soluble vitamins are easily absorbed into the bloodstream and used by the body.
• Fat-soluble vitamins are absorbed like other fats, by action of bile in the duodenum and are stored in the liver. (A, D, E, and K)

Minerals

• Inorganic substances found in animals and plants
• Essential for metabolism, cellular function, and proper nerve and muscle function.
• Mineral actions are interrelated; a deficiency in one impacts the action of another.
• Major minerals: Calcium, magnesium, sodium, potassium, phosphorus, sulfur, and chloride
• High sodium foods listed in Table 26.5, p.469
• Trace minerals: Iron, copper, iodine, manganese, cobalt, zinc, molybdenum, selenium, fluoride, chromium

Water

• Most essential nutrient
• Water requirement is 1 mL/calorie of intake
• Used in every body process
• Large amount must be stored in the body
• General rule: Intake needs to be equal to recorded output + 500 mL

Factors Influencing Nutrition

• Age: Infants, toddlers, preschool, school-age, adolescents, adults, and older adults
• Illness: Increased need
• Emotional status: Overeating or undereating
• Economic status: Limited income, healthy choices
• Religion: Islam, Judaism, Seventh-Day Adventist
• Culture: African American, Hispanic, Asian
• Food safety: Wash fruits and vegetables; Cook ground beef and chicken thoroughly

Cultural Influences on Nutrition

• African American: Variety of greens, dry beans, cornbread, sweet potatoes, pork, catfish, and chicken - High in fat, sugar, and salt content
• Hispanic American: High in carbohydrates (beans, rice, corn, tortillas) - Can be high in fat (lard use)
• Asian American: High in carbohydrates and vegetables, low in meat and fish. - Use of monosodium glutamate (MSG) to enhance flavor, may still have high sodium and fat content.
• Middle Eastern American: Fermented dairy products (yogurt), meats, grains (wheat or rice), fruits, and vegetables - Foods may be prepared according to religious practices.

Nutrition Counseling

• Modify culture's traditional diet to achieve a healthier composition while maintaining basic components.
• Teach how to make meals healthier by preparing food with less fat and sodium.

Nutritional Needs Through the Life Span:

Infants

• Double birth weight by 6 months, triple by 1 year
• Breast milk recommended (AAP)
• Formulas: Modified cow's milk, more digestible with added carbohydrate and fat
• Solids introduced gradually, one at a time, starting at 4 to 6 months. (Rice or oatmeal is a good choice, no eggs or fish in first year)

Toddlers/Preschool

• Ages 2 to 5 years
• Consume less milk, increase с intake
• Provide small servings and easy-to-chew foods
• Avoid combination foods, try colorful foods.
• Provide a pleasant environment and appropriate plates/utensils.

School-Age Children

• May desire sweet, non-nutritive foods (soda, candy, cake, ice cream)
• Provide nutritious breakfast before school and after-school snacks
• High-calorie, high-sodium preferences may lead to obesity.
• Obesity becomes a health issue during school years.

Adolescents

• Tend to consume fast foods.
• Increased caloric and nutrient needs during growth spurts
• Adolescent females need increased iron after menstrual cycle begins
• Adrenals are very aware of appearance and concern can lead to eating disorders.

Adults

• Focused on work, child rearing, and family
• Often rely on fast foods and convenience foods
• Increased prevalence of obesity and hypertension
• Increased fat, sodium, and sugar intake
• Lack of exercise

Older Adults

• High risk for inadequate nutrition
• May need to decrease calories if activity decreases (nutrient requirements don’t change).
• Physical limitations may make food preparation more difficult; arrange for companionship during meals.
• Limited incomes and cognitive decline may limit food choices.

Nutrition Assessment

• Determine factors impacting nutrition (diagnosis, surgery, etc.)
• Medical, family, and social history
• Physical examination: (Assess BMI – Fig 26.5, pg. 485)
• Lab studies (Recommended BMI is 18.5 to 24.9)

Nutrition Implementation

• Assist patients with meal trays and feeding when needed
• Pleasant environment, free of odors.
• Position patient upright.
• Verify correct diet order for the correct patient.
• Serve hot food hot and cold food cold.
• Provide enteral or total parenteral nutrition.
• Patient education: Therapeutic diet.