Understanding Nutrition and Malnutrition

• Nutrition is the process by which the body uses food.
• Malnutrition is a condition resulting from a lack of proper nutrients in the diet.

Who is at Risk for Malnutrition?

• Malnutrition is common among people living in poor, developing countries.
• In the United States, older adults who are socially isolated or living on fixed incomes are at risk for malnutrition.
• Homeless people, children with low socioeconomic status, and pregnant teenagers are at risk for malnutrition.
• People with substance abuse problems, such as alcoholism and clients with eating disorders, such as anorexia nervosa and bulimia nervosa are at risk for malnutrition.

Human Nutritional Needs

• Calories are the energy value of food.
• Proteins are composed of amino acids and are essential to build, maintain, and repair tissue.
• Carbohydrates are the primary source for quick energy.
• Fats are a concentrated energy source categorized as saturated and unsaturated.
• Minerals are noncaloric substances that regulate chemical processes.
• Vitamins are chemical substances necessary for normal growth, maintenance of health, and functioning of the body.
• Water-soluble vitamins are eliminated with body fluids
• Fat-soluble vitamins are stored in the body as reserves for future needs.

MyPlate

• Amounts from various food group categories can be individualized according to a person's age, gender, and level of activity.
• The MyPlate food groups are grains, vegetables, fruits, proteins, and dairy products.
• Recommended percentages for MyPlate are 30% grains, 30% vegetables, 20% fruits, and 20% proteins, along with low or non-fat milk and other dairy products.

Nutrition Labeling

• Nutrition labeling provides disease prevention guidelines.
• Nutrition labels show the amount of nutrition per serving using household measurements.
• Nutrition labels show the percentage of Daily Value (DV) standards per serving.
• Nutrition labels include vitamin/mineral content per serving.
• The federal Nutrition Labeling and Education Act requires companies to comply with standard definitions if they use health-related claims on their labels (e.g., "low fat”).

Influences on Eating Habits

• Food preferences are acquired during childhood and affect current eating habits.
• Established patterns for meals and personal attitudes influence food choices.
• Knowledge of nutrition, income level, and time available for food preparation play a role in eating behaviors.
• The number of people in the household, access to food markets, and the use of food for comfort, celebration, or symbolic reward affect food choices.
• Satisfaction or dissatisfaction with body weight and religious beliefs can influence eating habits.
• In Hinduism and Buddhism, killing living creatures is disliked, and meat consumption is usually forbidden.
• Judaism and Islam forbid the consumption of pork.
• Meat intake is restricted on fasting days among orthodox Christians and on Fridays among Catholics.

Protein Complementation

• Complete proteins contain all the essential amino acids and are found in animal sources.
• Examples of complete proteins are fish, chicken, turkey, beef, pork, eggs, milk, yogurt, and cheese.
• Incomplete proteins contain only some essential amino acids and are found in plant sources.
• Examples of incomplete proteins are lentils, peas, beans, quinoa, mixed nuts, and seeds.
• Protein complementation involves combining plant sources of protein which helps a person acquire all essential amino acids from non-animal sources.

Nutritional Status Assessment

• Nutritional status assessment includes subjective and objective data, physical assessment, and laboratory data
• Subjective data includes diet history and assessment of eating habits and factors that affect nutrition.
• Diet history includes examples of appetite, unintentional weight loss or gain of 10% in the past 6 months, and the number of meals the client eats per day.
• Objective data includes: anthropometric measurements of body size and composition, body mass index (BMI), body measurements such as midarm circumference, triceps skinfolds measurement, and abdominal circumference.
• Physical assessment includes: general appearance, oral structures and function, skin and hair assessment, flexibility and strength evaluation, and attention and concentration levels.
• Laboratory data includes: Hgb & Hct, glucose, serum albumin and transferrin, cholesterol, triglyceride, and lipoprotein.

Management of Problems Interfering with Nutrition

• Problems that interfere with nutrition include obesity, emaciation, anorexia, nausea, vomiting, and stomach gas.
• Nursing interventions address conditions such as imbalanced nutrition, deficient knowledge, impaired swallowing, self-care deficit, and risk for aspiration.
• Nursing responsibilities include ordering and canceling diets for clients, serving and collecting meal trays, helping clients eat, and recording the percentage of food that clients eat.
• Knowledge of a client's diet involves knowing type of diet prescribed, purpose for the diet, and characteristics of the diet.

Common Hospital Diets

• Regular or general diets allow unrestricted food selections.
• Light diets differ from regular diets in preparation and omits fried, fatty, gas-forming, and raw foods, and rich pastries.
• Soft diets contain foods soft in texture, are usually low in residue and readily digestible, and may have few or no spices or condiments.
• Mechanical soft diets resemble light diets, but are used for clients with chewing difficulties.
• Full liquid diets consist of fruit and vegetable juices, creamed/blended soups, milk, ice cream, yogurt, pudding, milkshakes, gelatin, custards, and cooked cereals.
• Clear liquid diets consist of water, broth, fruit juices, gelatin, popsicles, clear soft drinks, tea, and coffee
• Special therapeutic diets consist of food prepared to meet special needs, such as low in sodium, fat, calories, or fiber.

Common Special Diets

• Cardiac diets aim to reduce the risk of cardiovascular disease by encouraging people to eat heart-healthy, anti-inflammatory foods.
• Cardiac diets include a wide variety of vegetables and fruits, limited sugar/salt, whole grains, protein from plant sources, lean meats, low fat or fat-free dairy, olive oil, and limited highly processed foods.
• Diabetic diets require that half the plate is filled with non-starchy vegetables.
• Diabetic diets require that one quarter is filled with a lean protein.
• Diabetic diets require that one quarter is filled with complex carbohydrates, grains, or starchy vegetables.
• Diabetics should limit starchy vegetables and focus on non-starchy vegetables because they are already getting complex carbohydrates
• Non-starchy vegetables are commonly referred to as complex carbohydrates
• Balance is key for blood sugar control.

Feeding Strategies

• Different feeding strategies are used for clients with dysphagia, visual impairment, and dementia.

Older Adults

• Older adults require evaluation of nutritional status in annual examinations, or more frequently.
• Older adults experience diminished senses of smell and taste.
• Older adults require fewer calories and should have nutritional supplements evaluated.
• If sedentary, older adults benefit from exercise.
• Oral and dental problems affect food intake in older adults.
• Chronic conditions, food-drug interactions, dysphagia, socioeconomic barriers, and psychosocial impairments put older adults at risk of malnutrition.

Answering Questions

• High-density lipoprotein (HDL) is referred to as "good cholesterol."
• Vitamin B complex and vitamin C are water-soluble vitamins.
• Vitamin A can be toxic to the body at high levels.
• In clients with dysphagia have difficulty in swallowing.