Chapters 1-9 Nutrition and Health PDF

1 KEY TERMS anthropometric measurements atherosclerosis biochemical tests THE RELATIONSHIP OF NUTRITION AND HEALTH caliper carbohydrates (CHO) circulation clinical examination cumulative effects deficiency diseases dietary-soc...

1 KEY TERMS anthropometric measurements atherosclerosis biochemical tests THE RELATIONSHIP OF NUTRITION AND HEALTH caliper carbohydrates (CHO) circulation clinical examination cumulative effects deficiency diseases dietary-social history dietitian digestion OBJECTIVES elimination essential nutrients After studying this chapter, you should be able to: fats (lipids) food diary { Name the six classes of nutrients and their primary functions goiter iron deficiency { Recognize common characteristics of well-nourished people malnutrition { Recognize symptoms of malnutrition minerals { Describe ways in which nutrition and health are related nourishing nutrient density { List the four basic steps in nutrition assessment nutrients nutrition The United States was historically referred to as the “melting pot” because it rep- nutrition assessment nutritional status resented people of many nationalities who immigrated to this country in hopes of nutritious finding a better life. The individuals in this country bring all their cultural diversi- obesity ties with them, including their cuisine. Many choose to assimilate immediately by osteomalacia learning the language and trying the foods of their new country; others may favor osteoporosis the foods and customs of their country of origin. The diet that individuals follow will peer pressure determine, to a large extent, their health, growth, and development. It has never proteins been more imperative that active measures be taken to make our social, cultural, respiration rickets political, and economic environment in relation to diet a health-promoting one. 24-hour recall Taking care of one’s health is all about prevention. In the past, the focus vitamins was on treatment of diseases, with little, if any, attention to prevention. Preven- water tion, however, can often be less costly than treatment and offer a better quality wellness of life for an individual as well as the community. Nutrition and diet choice form a logical starting point for preventive health care measures and education to improve quality of life. 3 -_ 4 SECTION 1 Fundamentals of Nutrition –— ¶ wellness Achieving wellness that integrates body, mind, and spirit should be the a way of life that integrates body, mind, main goal in life. This can be accomplished through lifestyle changes such as and spirit focusing on healthy food choices, not smoking, participating in regular physical activity, and maintaining a healthy weight. Expanding one’s mind through con- tinued education, in both nutrition and other areas, and finding a source of inner strength to deal with life changes will all contribute to one’s sense of wellness. Living a long life without major health problems is possible. The younger one is when positive changes are made, the healthier one is throughout the life span. NUTRIENTS AND THEIR FUNCTIONS To maintain health and function properly, the body must be provided with ¶ nutrients nutrients. Nutrients are chemical substances that are necessary for life. chemical substances found in food that They are divided into six classes: are necessary for good health { Carbohydrates (CHO) { Fats (lipids) { Proteins { Vitamins { Minerals { Water The body can make small amounts of some nutrients, but most must be obtained from food in order to meet the body’s needs. Those available only in ¶ essential nutrients food are called essential nutrients. There are about 40 of them, and they are nutrients found only in food found in all six nutrient classes. The six nutrient classes are chemically divided into two categories: or- ganic and inorganic (Table 1-1). Organic nutrients contain hydrogen, oxygen, and carbon. (Carbon is an element found in all living things.) Before the body can use organic nutrients, it must break them down into their smallest compo- nents. Inorganic nutrients are already in their simplest forms when the body ingests them, except for water. Table 1-1 The Six Essential Nutrients and Their Functions ORGANIC NUTRIENTS FUNCTION Carbohydrates Provide energy Fats Provide energy Proteins Build and repair body tissues Provide energy Vitamins Regulate body processes INORGANIC NUTRIENTS FUNCTION Minerals Regulate body processes Water Regulates body processes CHAPTER 1 The Relationship of Nutrition and Health -_ 5 –— Each nutrient participates in at least one of the following functions: ¶ carbohydrates (CHO) the nutrient class providing the major { Providing the body with energy source of energy in the average diet { Building and repairing body tissue { Regulating body processes ¶ proteins the only one of the six essential nutrient Carbohydrates (CHO), proteins, and fats (lipids) furnish energy. classes containing nitrogen Proteins are also used to build and repair body tissues with the help of vitamins ¶ fats (lipids) and minerals. Vitamins, minerals, and water help regulate the various body highest calorie-value nutrient class processes such as circulation, respiration, digestion, and elimination. Each nutrient is important, but none works alone. For example, carbohy- ¶ vitamins drates, proteins, and fats are necessary for energy, but to provide it, they need organic substances necessary for life the help of vitamins, minerals, and water. Proteins are essential for building although they do not, independently, and repairing body tissue, but without vitamins, minerals, and water, they are provide energy ineffective. Foods that contain substantial amounts of nutrients are described ¶ minerals as nutritious or nourishing. Nutrients are discussed in detail in Chapters 4 one of many inorganic substances essential through 9. to life and classified generally as minerals ¶ water CHARACTERISTICS OF GOOD NUTRITION major constituent of all living cells; composed of hydrogen and oxygen Most people find pleasure in eating. Eating allows one to connect with family and friends in pleasant surroundings. This connection creates pleasant memo- ¶ circulation ries. Unfortunately, in social situations it is easy for one to make food choices the body process whereby the blood is that may not be conducive to good health. moved throughout the body What determines when one needs to eat? Does one wait until the body signals hunger or eat when one sees food or when the clock says it is time? ¶ respiration breathing Hunger is the physiological need for food. Appetite is a psychological desire for food based on pleasant memories. When the body signals hunger, that is the ¶ digestion indication that there is a decrease in blood glucose that supplies the body with breakdown of food in the body in energy. If one ignores the signal and hunger becomes intense, it is possible to preparation for absorption make poor food choices. The choices one makes will determine one’s nutrition status. A person who habitually chooses to eat, or not to eat, as a way of coping ¶ elimination with life’s emotional struggles may be suffering from an eating disorder. The evacuation of wastes various eating disorders will be discussed in Chapter 16. ¶ nutritious Once foods have been eaten, the body must process it before it can foods or beverages containing substantial be used. Nutrition is the result of the processes whereby the body takes amounts of essential nutrients in and uses food for growth, development, and the maintenance of health. These processes include digestion, absorption, and metabolism. (They are ¶ nourishing discussed in Chapter 3.) One’s physical condition as determined by the diet foods or beverages that provide is called nutritional status. substantial amounts of essential nutrients Nutrition helps determine the height and weight of an individual. Nutri- tion also can affect the body’s ability to resist disease, the length of one’s life, ¶ nutrition the result of those processes whereby the and the state of one’s physical and mental well-being (Figure 1-1). body takes in and uses food for growth, Good nutrition enhances appearance and is commonly exemplified by development, and the maintenance of health shiny hair, clear skin, clear eyes, erect posture, alert expressions, and firm flesh on well-developed bone structures. Good nutrition aids emotional adjustments, ¶ nutritional status provides stamina, and promotes a healthy appetite. It also helps establish regu- one’s physical condition as determined lar sleep and elimination habits (Table 1-2). by diet -_ 6 SECTION 1 Fundamentals of Nutrition –— Figure 1-1 Good nutrition shows in the happy faces of these children. Table 1-2 Characteristics of Nutritional Status GOOD POOR Alert expression Apathy Shiny hair Dull, lifeless hair Clear complexion with good color Greasy, blemished complexion with poor color Bright, clear eyes Dull, red-rimmed eyes Pink, firm gums and well-developed teeth Red, puffy, receding gums and missing or cavity-prone teeth Firm abdomen Swollen abdomen Firm, well-developed muscles Underdeveloped, flabby muscles Well-developed bone structure Bowed legs, “pigeon” breast Normal weight for height Overweight or underweight Erect posture Slumped posture Emotional stability Easily irritated; depressed; poor attention span Good stamina; seldom ill Easily fatigued; frequently ill Healthy appetite Excessive or poor appetite Healthy, normal sleep habits Insomnia at night; fatigued during day Normal elimination Constipation or diarrhea MALNUTRITION ¶ malnutrition Malnutrition can be caused by overnutrition (excess energy or nutrient in- poor nutrition take) or undernutrition (deficient energy or nutrient intake). We usually think of malnutrition as a condition that results when the cells do not receive an CHAPTER 1 The Relationship of Nutrition and Health -_ 7 –— SUPERSIZE USA Supersizing in the fast-food industry and large quantities served in restaurants lead to portion distortion. Those growing up in the supersized world may have no concept of what constitutes a normal portion. Children who are encouraged to, or have been made to, eat everything on their plates may feel compelled to finish their supersized meals, easily contributing to obesity and type 2 diabetes. adequate supply of the essential nutrients because of poor diet or poor utiliza- tion of food (Figure 1-2). Sometimes it occurs because people do not or cannot eat enough of the foods that provide the essential nutrients to satisfy body Figure 1-2 The poor-quality hair, needs. At other times people may eat well-balanced diets but suffer from dis- mottled complexion, dull expression, eases that prevent normal usage of the nutrients. spindly arms and legs, and bloated Overnutrition has become a larger problem in the United States than abdomen of this baby girl exem- undernutrition. Overeating and the ingestion of megadoses of various vitamins plify many signs of malnutrition. and minerals (without prescription) are two major causes of overnutrition in (Courtesy of the Centers for Disease Control and Prevention, Public the United States. Health Image Library) Nutrient Deficiency A nutrient deficiency occurs when a person lacks one or more nutrients over a period of time. Nutrient deficiencies are classified as primary or secondary. Primary deficiencies are caused by inadequate dietary intake. Secondary defi- ciencies are caused by something other than diet, such as a disease condition that may cause malabsorption, accelerated excretion, or destruction of the nutrients. Nutrient deficiencies can result in malnutrition. INDIVIDUALS AT RISK FROM POOR NUTRITIONAL INTAKE Teenagers may eat often but at unusual hours. They may miss regularly sched- uled meals, become hungry, and satisfy their hunger with foods that have low nutrient density such as potato chips, cakes, soda, and candy. Foods with low nutrient density provide an abundance of calories, but the nutrients are ¶ nutrient density primarily carbohydrates and fats and, except for sodium, very limited amounts nutrient value of foods compared with number of calories of proteins, vitamins, and minerals. Teenagers are subject to peer pressure; that is, they are easily influenced by the opinions of their friends. If friends favor ¶ peer pressure foods with low nutrient density, it is difficult for a teenager to differ with them. pressure of one’s friends and colleagues Crash diets, which unfortunately are common among teens, sometimes result of the same age in a form of malnutrition. This condition occurs because some nutrients are eliminated from the diet when the types of foods eaten are severely restricted. Pregnancy increases a woman’s hunger and the need for certain nutrients, especially proteins, minerals, and vitamins. Pregnancy during adolescence requires extreme care in food selection. The young mother-to-be requires a diet that provides sufficient nutrients for the developing fetus as well as for her own still-growing body. -_ 8 SECTION 1 Fundamentals of Nutrition –— EXPLORING THE WEB SPOTLIGHT on Life Cycle Search the Web to find information on iron deficiency Infants, toddlers, adolescents (teenagers), the elderly, and pregnant women and iron deficiency anemia. (especially teenagers) are at greater risk for malnutrition than the rest of the Is low iron intake the only population. Infants and toddlers whose parents lack knowledge of proper cause? Who is at most risk? nutrition and portion sizes will suffer the consequences of poor or inadequate What mental and physical nutrition choices. It may be difficult for toddlers who are “picky” eaters to consequences of inadequate obtain all their needed nutrients from food. iron intake can occur? Many factors influence nutrition in the elderly. Depression, loneliness, lack of income, inability to shop, inability to prepare meals, and the state of overall health can all lead to malnutrition. Chapter 15 is another source of information on the elderly. ¶ cumulative effects results of something done repeatedly over many years CUMULATIVE EFFECTS OF NUTRITION There is an increasing concern among health professionals regarding the cu- ¶ atherosclerosis a form of arteriosclerosis affecting the mulative effects of nutrition. Cumulative effects are the results of something intima (inner lining) of the artery walls that is done repeatedly over many years. For example, eating excessive amounts of saturated fats (saturated fats are discussed in Chapter 5) for many years ¶ obesity contributes to atherosclerosis, which leads to heart attacks. Years of over- excessive body fat, 20% above average eating can cause obesity and may also contribute to hypertension, type 2 (non-insulin-dependent) diabetes, gallbladder disease, foot problems, certain ¶ deficiency diseases cancers, and even personality disorders. diseases caused by the lack of one or more specific nutrients ¶ iron deficiency Deficiency Diseases intake of iron is adequate, but the body When nutrients are seriously lacking in the diet for an extended period, defi- has no extra iron stored ciency diseases can occur. The most common form of deficiency disease in ¶ rickets the United States is iron deficiency, which is caused by a lack of the mineral deficiency disease caused by the lack of iron and can cause iron deficiency anemia, which is discussed further in vitamin D; causes malformed bones and Chapter 8. Iron deficiency is particularly common among children and pain in infants and children women. Iron is a necessary component of the blood and is lost during each menstrual period. In addition, the amount of iron needed during childhood ¶ osteomalacia and pregnancy is greater than normal because of the growth of the child or a condition in which bones become soft, the fetus. usually in adults because of calcium loss Rickets is another example of a deficiency disease. It causes poor bone and vitamin D deficiency formation in children and is due to insufficient calcium and vitamin D. These ¶ osteoporosis same deficiencies cause osteomalacia in young adults and osteoporosis in condition in which bones become brittle older adults. Osteomalacia is sometimes called “adult rickets.” It causes the because there have been insufficient bones to soften and may cause the spine to bend and the legs to become bowed. mineral deposits, especially calcium Osteoporosis is a condition that causes bones to become porous and excessively CHAPTER 1 The Relationship of Nutrition and Health -_ 9 –— ¶ goiter Table 1-3 Nutritional Deficiency Diseases and Possible Causes enlarged tissue of the thyroid gland due DEFICIENCY DISEASE NUTRIENT(S) LACKING to a deficiency of iodine Iron deficiency Iron ¶ nutrition assessment evaluation of one’s nutritional condition Iron deficiency anemia Iron Beriberi Thiamin ¶ dietitian Night blindness Vitamin A professional trained to assess nutrition status and recommend appropriate diet Goiter Iodine therapy Kwashiorkor Protein Marasmus All nutrients ¶ anthropometric Osteomalacia Calcium and vitamin D measurements of height, weight, head, chest, skinfold Osteoporosis Calcium and vitamin D, phosphorus, magnesium, and fluoride ¶ clinical examination Pellagra Niacin physical observation Rickets Calcium and vitamin D ¶ biochemical tests Scurvy Vitamin C laboratory analysis of blood, urine, and Xerophthalmia (blindness) Vitamin A feces ¶ dietary-social history evaluation of food habits, including brittle. Too little iodine may cause goiter, and a severe shortage of vitamin A client’s ability to buy and prepare food can lead to blindness. Examples of other deficiency diseases (and their causes) are included in ¶ caliper mechanical device used to measure Table 1-3. Information concerning these conditions can be found in the chap- percentage of body fat by skinfold ters devoted to the given nutrients. measurement NUTRITION ASSESSMENT That old saying, “You are what you eat,” is true, indeed; but one could In The Media change it a bit to read, “You are and will be what you eat.” Good nutrition is essential for the attainment and maintenance of good health. Determining EATING BREAKFAST MAY BE whether a person is at risk requires completion of a nutrition assessment, GOOD FOR YOUR HEART which should, in fact, become part of a routine exam done by a registered Breakfast really is the most important meal of the day. dietitian or other health care professional specifically trained in the A small study in the United diagnosis of at-risk individuals. A proper nutrition assessment includes Kingdom found that women anthropometric measurements, clinical examination, biochemical who skip breakfast eat more tests, and dietary-social history. calories during the rest of the day. This could be a Anthropometric measurements include height and weight and measure- contributing factor to weight ments of the head (for children), upper arm, and skinfold (Figure 1-3). The gain. Also, studies indicated skinfold measurements are done with a caliper. They are used to determine that LDL, “bad cholesterol,” the percentage of adipose and muscle tissue in the body. Measurements out of was high and insulin sensitivity was poorer for those line with expectations may reveal failure to thrive in children, wasting (catabo- not consuming breakfast. lism), edema, or obesity, all of which reflect nutrient deficiencies or excesses. (Source: Adapted from Farchi, During the clinical examination, signs of nutrient deficiencies are noted. Taylor, and Macdonald, 2005.) Some nutrient deficiency diseases, such as scurvy, rickets, iron deficiency, and -_ 10 SECTION 1 Fundamentals of Nutrition –— A B C D Figure 1-3 (A) Height is one anthropometric measurement used in the nutrition SUPERSIZE USA assessment. (B) Weight is an anthropometric measurement used in the nutrition as- sessment. (C) Head circumference is an anthropometric measurement used to assess Where do you live? Is your city brain development during the first year of life. (D) Skinfold is an anthropometric one of the fattest cities in the measurement used to assess lean muscle mass versus fat. country? Don’t know? Check this list of the 10 fattest cities, in descending order. kwashiorkor, are obvious; other forms of nutrient deficiency can be far more 1. Miami, FL subtle. Table 1-4 lists some clinical signs and probable causes of nutrient defi- 2. Oklahoma City, OK ciencies. 3. San Antonio, TX Biochemical tests include various blood, urine, and stool tests. A defi- 4. Las Vegas, NV ciency or toxicity can be determined by laboratory analysis of the samples. The 5. New York, NY 6. Houston, TX tests allow detection of malnutrition before signs appear. The following are 7. El Paso, TX some of the most commonly used tests for nutritional evaluation. 8. Jacksonville, FL Serum albumin level measures the main protein in the blood and is 9. Charlotte, NC used to determine protein status. 10. Louisville-Jefferson, KY Source: Adapted from Men’s Serum transferrin level indicates iron-carrying protein in the blood. Fitness Magazine, June 2009. The level will be above normal if iron stores are low and below normal if the body lacks protein. CHAPTER 1 The Relationship of Nutrition and Health -_ 11 –— Table 1-4 Clinical Signs of Nutrient Deficiencies CLINICAL SIGNS POSSIBLE DEFICIENCIES Pallor; blue half circles beneath eyes Iron, copper, zinc, B12, B6, biotin Edema Protein Bumpy “gooseflesh” Vitamin A Lesions at corners of mouth Riboflavin Glossitis Folic acid Numerous “black-and-blue” spots Vitamin C and tiny, red “pinprick” hemorrhages under skin Emaciation Carbohydrates, proteins; calories Poorly shaped bones or teeth or Vitamin D or calcium delayed appearance of teeth in children Slow clotting time of blood Vitamin K Unusual nervousness, dermatitis, Niacin diarrhea in same client Tetany Calcium, potassium, sodium Goiter Iodine Eczema Fat (linoleic acid) Blood urea nitrogen (BUN) may indicate renal failure, insufficient re- nal blood supply, or blockage of the urinary tract. Creatinine excretion indicates the amount of creatinine excreted in the urine over a 24-hour period and can be used in estimating body muscle mass. If the muscle mass has been depleted, as in malnutrition, the level will be low. Serum creatinine indicates the amount of creatinine in the blood and is used for evaluating renal function. Examples of other blood tests are hemoglobin (Hgb), hematocrit (Hct), red blood cells (RBCs), and white blood cells (WBCs). A low Hgb and Hct can indicate anemia. Not a routine test, but ordered on many clients with heart conditions, is the lipid profile, which includes total serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and serum triglycerides. Urinalysis also can detect protein and sugar in the urine, which can indicate kidney disease and diabetes. The dietary-social history involves evaluation of food habits and is very im- ¶ 24-hour recall listing the types, amounts, and preparation portant in the nutritional assessment of any client. It can be difficult to obtain an of all foods eaten in past 24 hours accurate dietary assessment. The most common method is the 24-hour recall. In this method, the client is usually interviewed by the dietitian and is asked to give ¶ food diary the types of, amounts of, and preparation used for all food eaten in the 24 hours written record of all food and drink prior to admission (PTA). Another method is the food diary. The client is asked to ingested in a specified period -_ 12 SECTION 1 Fundamentals of Nutrition –— list all food eaten in a 3–4-day period. Neither method is totally accurate because EXPLORING THE WEB clients forget or are not always totally truthful. They are sometimes inclined to say they have eaten certain foods because they know they should have done so. Search the Web for Computer analysis of the diet is the best way to determine if nutrient intake is ap- nutritional assessment tools. What resources propriate. It will reveal any nutrient deficiencies or toxicities. are available for the The dietary-social history is important to determine whether the client health care professional has the financial resources to obtain the needed food and the ability to properly in making nutritional store and cook food once home. After completing the dietary-social history, the assessments of clients? dietitian can assess for risk of food–drug interactions that can lead to malnutri- Assess the advantages and tion (see Appendix E). Clients need to be instructed by a dietitian on possible disadvantages of each tool interactions, if any. you find. When the preceding steps are evaluated together, and in the context of the client’s medical condition, the dietitian has the best opportunity of making an accurate nutrition assessment of the client. This assessment can then be used by the entire health care team. The doctor will find it helpful in evaluating the client’s condition and treatment. The dietitian can use the information to plan the client’s dietary treatment and counseling, and other health care pro- fessionals will be able to use it in assisting and counseling the client. CONSIDERATIONS FOR THE HEALTH CARE PROFESSIONAL The practice of good nutrition habits would help eliminate many health prob- lems caused by malnutrition (Figure 1-4). The health professional is obligated to have a sound knowledge of nutrition. One’s personal health, as well as that of one’s family, depends on it. Parents must have a good, basic knowledge of nutrition for the sake of their personal health and that of their children. Chil- dren learn by imitating their parents. Family members and friends who know that the health professional has studied nutrition will ask questions. Anyone, in fact, who plans and prepares meals should value, have knowledge of, and be able to apply the principles of sound nutrition practice. Figure 1-4 Hands-on experiences foster the development of positive feelings about food. CHAPTER 1 The Relationship of Nutrition and Health -_ 13 –— Clients will have questions and complaints about their diets. Their anxi- eties can be relieved by clear and simple explanations provided by the health professional. Sometimes clients must undergo diet therapy, prescribed by their physicians, which becomes part of their medical treatment in the hospital. The health professional must be able to check the client’s tray quickly to see that it contains the correct foods for the diet prescribed. In many cases, diet therapy will have to be a lifelong practice for the client. In such cases, eating habits will have to be changed, and the client will need advice or instructions from a registered dietitian and support from other health professionals. Nutrition is currently a popular subject. It is important to recognize that some books and articles concerning nutrition may not be scientifically correct. Also, food ads can be misleading. People with knowledge of sound nutrition practices will be less likely to be misled. They will recognize fad and distinguish it from fact. SUMMARY 4. What are the six classes of nutrients? What are their three basic functions? Nutrition is directly related to health, and its effects are cumulative. Good nutrition is normally reflected by good 5. Why are some foods called low-nutrient-density health. Poor nutrition can result in poor health and even foods? Give some examples found in vending in disease. Poor nutrition habits contribute to athero- machines. sclerosis, osteoporosis, obesity, and some cancers. 6. Ask anyone in the class who has been on a crash To be well nourished, one must eat foods that contain diet to discuss the diet’s effects. Discuss possible the six essential nutrients: carbohydrates, fats, proteins, reasons for those effects. minerals, vitamins, and water. These nutrients provide the 7. What is meant by the saying “You are what you body with energy, build and repair body tissue, and regu- eat”? late body processes. When there is a severe lack of specific 8. What is meant by the phrase “the cumulative ef- nutrients, deficiency diseases may develop. The best way to fects of nutrition”? Describe some. determine deficiencies is to do a nutrition assessment. With sound knowledge of nutrition, the health 9. How could someone be overweight and at the professional will be an effective health care provider and same time suffer from malnutrition? will also be helpful to family, friends, and self. 10. Discuss why health care professionals should be knowledgeable about nutrition. DISCUSSION TOPICS SUGGESTED ACTIVITIES 1. Why is food commonly served at meetings and parties? 1. List 10 signs of good nutrition and 10 signs of poor nutrition. 2. What relationship might nutrition and heredity have to each of the following? 2. List the foods you have eaten in the past 24 hours. a. the development of physique Underline those with low nutrient density. b. the ability to resist disease 3. Write a brief description of how you feel at the end of c. the life span a day when you know you have not eaten wisely. 3. What habits, in addition to good nutrition, con- 4. Name the laboratory tests used to determine tribute to making a person healthy? nutritionally at-risk clients.  -_ 19 –— 2 KEY TERMS balanced diet daily values descriptors Dietary Guidelines for Americans PLANNING A HEALTHY DIET dietary laws Dietary Reference Intakes (DRIs) flavonoids food customs foodways fusion lacto-ovo vegetarians lacto-vegetarians OBJECTIVES lactose intolerance legumes After studying this chapter, you should be able to: masa harina mirin miso { Define a balanced diet MyPyramid { List the U.S. government’s Dietary Guidelines for Americans and explain vegans the reasons for each wasabi { Identify the food groups and their placement on the MyPyramid { Describe information commonly found on food labels { List some food customs of various cultural groups { Describe the development of food customs The statement “eat a balanced diet” has been repeated so often that its impor- tance may be overlooked. The value of this statement is so great, however, that it deserves serious consideration by people of all ages. A balanced diet includes all six classes of nutrients and calories in amounts that preserve and promote good health. Daily review of the Dietary Reference Intakes (DRIs) and the Rec- ommended Dietary Allowances (RDAs) would provide enough information to plan balanced diets. However, ordinary meal planning would be cumber- some and time consuming if that table had to be consulted each time a meal was planned. Fortunately, the U.S. Department of Agriculture (USDA) and 19 -_ 20 SECTION 1 Fundamentals of Nutrition –— ¶ balanced diet the U.S. Department of Health and Human Services (USDHHS) developed one that includes all the essential a simple system to help with the selection of healthful diets. It is called nutrients in appropriate amounts the Dietary Guidelines for Americans. In addition, MyPyramid was released in 2005 by the USDA as an outline for daily food choices based on ¶ Dietary Reference Intakes the Dietary Guidelines. (DRIs) combines the Recommended Dietary Allowances, Adequate Intake, Estimated Average Requirements, and the Tolerable DIETARY GUIDELINES FOR AMERICANS Upper Intake Levels for individuals into one The Dietary Guidelines provide science-based advice to promote health and value representative of the average daily nutrient intake of individuals over time to reduce the risk for chronic diseases through diet and physical activity. The guidelines are targeted to the general public over 2 years of age in the United ¶ Dietary Guidelines States. Below are the titles of the topics for each section; all of the following for Americans key recommendations are taken from www.health.gov/dietaryguidelines. The general goals for optimal nutrient intake Dietary Guidelines themselves form an integrated set of key recommendations ¶ MyPyramid in each of the topic areas and will be discussed under the respective topics. outline for making selections based on Dietary Guidelines for America, 2005. { Adequate nutrients within calorie needs From the U.S. Department of Agriculture. { Weight management { Physical activity EXPLORING THE WEB { Food groups to encourage The “Dietary Guidelines for Americans 2005” are { Fats science-based advice and { Carbohydrates suggestions for improving health through sound { Sodium and potassium nutrition and physical activity. { Alcoholic beverages These guidelines serve as helpful reminders to many { Food safety Americans, especially those who are overweight or obese, eat too much fat, and no longer think exercise Adequate Nutrients within Calorie Needs is important. The Dietary A basic premise of the Dietary Guidelines is that recommended diets will provide Guidelines encourage a all the nutrients needed for growth and health and that the nutrients consumed healthy diet, which means individuals should choose: should come primarily from foods. Foods contain not only the vitamins and min- Fruits, vegetables, whole erals found in supplements, but also hundreds of naturally occurring substances, grains, and fat-free or low- including carotenoids, flavonoids and isoflavones, and protease inhibitors that fat milk and milk products; may protect against chronic health conditions. Lean meats, poultry, fish, beans, eggs, and nuts; and beans Key Recommendations. Foods low in saturated fats, trans fats, { Consume a variety of nutrient-dense foods and beverages within cholesterol, salt (sodium), and among the basic food groups while choosing foods that limit the and added sugars. intake of saturated and trans fats, cholesterol, added sugars, salt, Read about the nine topic and alcohol. areas to see what you might need to change to ensure a { Meet recommended intakes within energy needs by adopting a healthy life: www.mypyramid balanced eating pattern such as the USDA Food Guide or the Dietary.gov/guidelines. Approaches to Stop Hypertension (DASH) Eating Plan (Appendix C-1). CHAPTER 2 Planning a Healthy Diet -_ 21 –— Key Recommendations for Specific Population Groups. { People over age 50. Consume vitamin B12 in its crystalline form (e.g., fortified foods or supplements). { Women of childbearing age who may become pregnant. Eat foods high in heme-iron and consume iron-rich plant foods or iron- fortified foods with an enhancer of iron absorption, such as vitamin C–rich foods. { Women of childbearing age who may become pregnant and those in the first trimester of pregnancy. Consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet. { Older adults, people with dark skin, and people exposed to insufficient ultraviolet band-radiation (i.e., sunlight). Consume extra vitamin D from vitamin D–fortified foods and supplements. Weight Management Over the last 20 years the prevalence of overweight in the general population, and especially among children and adolescents, has increased substantially; it is estimated that as many as 16% of children and adolescents are overweight. Overweight and obesity of both adults and children are of great public health concern because excess body fat leads to a higher risk of premature death, type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, stroke, gall- bladder disease, and other chronic diseases. Key Recommendations. { To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. { To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity. Key Recommendations for Specific Population Groups. { Those who need to lose weight. Aim for a slow, steady weight loss by decreasing calorie intake while maintaining an adequate nutrient intake and increasing physical activity. { Overweight children. Reduce the rate of body weight gain while allowing growth and development. Consult a health care provider before placing a child on a weight reduction diet. { Pregnant women. Ensure appropriate weight gain as specified by a health care provider. { Breastfeeding women. Moderate weight reduction is safe and does not compromise weight gain of the nursing infant. -_ 22 SECTION 1 Fundamentals of Nutrition –— { Overweight adults and overweight children with chronic disease and/or on medication. Consult a health care provider about weight loss strategies before starting a weight reduction program to ensure appropriate management of other health conditions. Physical Activity Americans are relatively inactive. Regular physical activity and physical fitness make important contributions to one’s health, sense of well-being, and maintenance of a healthy body weight. Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. Regular physical activity has been shown to reduce the risk of certain chronic diseases, including high blood pressure, stroke, coronary artery disease, type 2 diabetes, colon cancer, and osteoporosis. Therefore, it is recommended that adults engage in at least 30 minutes of moderate-intensity physical activity on most days of the week. Regular physical activity is also a key factor in achieving and maintaining a healthy body weight for adults and children (Tables 2-1, 2-2, and 2-3). It is recommended that males over age 40 and females over age 50 check with their health care provider before beginning aerobic activities. Key Recommendations. { Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and healthy body weight. { To reduce the risk of chronic disease in adulthood, engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration. Table 2-1 Health Benefits of Regular Physical Activity Increases physical fitness Helps build and maintain healthy bones, muscles, and joints Builds endurance and muscular strength Helps manage weight Lowers risk factors for cardiovascular disease, colon cancer, and type 2 diabetes Helps control blood pressure Promotes psychological well-being and self-esteem Reduces feelings of depression and anxiety Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th edition, Washington D.C.: U.S. Government Printing Office. January 2005. www.healthierus.gov/dietaryguidelines. CHAPTER 2 Planning a Healthy Diet -_ 23 –— Table 2-2 Examples of Physical Activities for Adults For at least 30 minutes most days of the week, preferably daily, do any one of the activities listed below—or combine activities. Look for additional opportunities among other activities that you enjoy. AS PART OF YOUR ROUTINE ACTIVITIES: Walk, wheel, or bike-ride more; drive less. Walk up stairs instead of taking an elevator. Get off the bus a few stops early and walk or wheel the remaining distance. Mow the lawn with a push mower. Rake leaves. Garden. Push a stroller. Clean the house. Do exercises or pedal a stationary bike while watching television. Play actively with children. Take a brisk 10-minute walk or wheel in the morning, at lunch, and after dinner. AS PART OF YOUR EXERCISE OR RECREATIONAL ROUTINE: Walk, wheel, or jog. Bicycle or use an arm pedal bicycle. Swim or do water aerobics. Play racket or wheelchair sports. Golf (pull cart or carry clubs). Canoe. Cross-country ski. Play basketball. Dance. Take part in an exercise program at work, home, school, or gym. Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th edition, Washington D.C.: U.S. Government Printing Office. January 2005. www.healthierus.gov/dietaryguidelines. { To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood, engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements. { To sustain weight loss in adulthood, participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a health care provider before participating in this level of activity. -_ 24 SECTION 1 Fundamentals of Nutrition –— Table 2-3 Physical Activities for Children and Teens AIM FOR AT LEAST 60 MINUTES TOTAL PER DAY: Be spontaneously active. Play tag. Jump rope. Ride a bicycle or tricycle. Walk, wheel, skip, or run. Play actively during school recess. Roller-skate or in-line-skate. Take part in physical education activity classes during school. Join after-school or community physical activity programs. Dance. Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th edition, Washington, D.C.: U.S. Government Printing Office. January, 2005. www.healthierus.gov/dietaryguidelines. { Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance. Key Recommendations for Specific Population Groups. { Children and adolescents. Engage in at least 60 minutes of physical activity on most, preferably all, days of the week. { Pregnant women. In the absence of medical or obstetric complications, incorporate 30 minutes or more of moderate- intensity physical activity on most, if not all, days of the week. Avoid activities with a high risk of falling or abdominal trauma. { Breastfeeding women. Be aware that neither acute nor regular exercise adversely affects the mother’s ability to successfully breastfeed. { Older adults. Participate in regular physical activity to reduce functional declines associated with aging and to achieve the other benefits of physical activity identified for all adults. Food Groups to Encourage Increased intakes of fruits, vegetables, whole grains, and fat-free or low-fat milk products will have important health benefits. Those who eat more generous amounts of fruits and vegetables as part of a healthful diet may reduce the risk of chronic diseases, including stroke and other cardiovascular diseases, type 2 diabetes, and cancers in certain sites (oral cavity and pharynx, larynx, lung, esophagus, stomach, and colon-rectum). In addition to fruits and vegetables, whole grains are an important source of fiber and other nutrients. Consuming at least three or more ounce-equivalents of whole grains per day can reduce the CHAPTER 2 Planning a Healthy Diet -_ 25 –— Table 2-4 Whole Grains That Are Most Often Consumed SPOTLIGHT in the United States on Life Cycle Whole wheat Wild rice The most common nutrient Whole oats, oatmeal Buckwheat deficiency in the world is lack Whole-grain corn Triticale of iron. This is particularly Popcorn Bulgur (cracked wheat) prevalent among infants, Brown rice Millet adolescents, and pregnant and Quinoa menstruating women. It can Whole rye result in iron-deficiency anemia. Whole-grain barley Sorghum The health care provider can Source: U.S. Department of Health and Human Services and U.S. Department of help by: Agriculture. Dietary Guidelines for Americans, 2005. 6th edition, Washington, D.C.: U.S. Identifying those clients at Government Printing Office. January 2005. www.healthierus.gov/dietaryguidelines. risk (e.g., children under 2 years of age, adolescents, women with heavy menstrual flow, risk of several chronic diseases and may help with weight maintenance. pregnant women, individuals with malabsorption syndromes, Table 2-4 can help one recognize the names of whole grains. gastrointestinal bleedings, and gross dietary deficiencies). Key Recommendations. Performing complete { Consume a sufficient amount of fruits and vegetables while staying nutritional assessments on high- within energy needs. For a 2,000-calorie intake, 2 cups of fruit and risk clients. Encouraging clients to eat 21⁄ 2 cups of vegetables per day are recommended, with higher or foods high in iron. These lower amounts depending on the calorie level. include lean meats, poultry, fish, { Choose a variety of fruits and vegetables each day. In particular, enriched breads, legumes, leafy select from all five vegetable subgroups (dark green vegetables, green vegetables, dried fruits, and nuts. orange vegetables, legumes, starchy vegetables, and other vegetables) several times a week. { Consume three or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from ¶ legumes enriched or whole-grain products. In general, at least half the grains plant food that is grown in a pod; for should come from whole grains. example, beans or peas { Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. Key Recommendations for Specific Population Groups. { Children and adolescents. Consume whole-grain products often; at least half the grains should be whole grains. Children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. Fats Fats and oils are part of a healthful diet, but the type of fat makes a difference to heart health, and the total amount of fat consumed is also important. High in- take of saturated fats, trans fats, and cholesterol increases the risk of coronary heart disease due to high blood lipid levels. Fats supply energy and essential -_ 26 SECTION 1 Fundamentals of Nutrition –— fatty acids and serve as a carrier for the absorption of the fat-soluble vitamins A, D, E, and K and carotenoids. Key Recommendations. { Consume less than 10% of calories from saturated fatty acids and less than 300 mg/day of cholesterol and keep trans-fatty acid consumption as low as possible. { Keep total fat intake between 20 and 35% of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. { When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low fat, or fat-free. { Limit intake of fats and oils high in saturated and trans-fatty acids, and choose products low in such fats and oils. Key Recommendations for Specific Population Groups. { Children and adolescents. Keep total fat intake between 30 and 35% of calories for children 2 to 3 years of age and between 25 and 35% of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. Carbohydrates Carbohydrates are part of a healthful diet. Foods in the basic food groups that provide carbohydrates—fruits, vegetables, grains, and milk—are important sources of many nutrients. Dietary fiber is composed of nondigestible carbohy- drates. Sugars and starches supply energy to the body in the form of glucose. Sugars can be naturally present in foods or added to the food. The greater the consumption of foods containing large amounts of added sugars, the more dif- ficult it is to consume enough nutrients without gaining weight. See Table 2-5 to help identify the names of added sugar on labels. Table 2-5 Names for Added Sugars That Appear on Food Labels A food is likely to be high in sugars if one of these names appears first or second in the ingredient list or if several names are listed. Brown sugar Glucose Maltose Corn sweetener High-fructose corn syrup Molasses Corn syrup Honey Raw sugar Dextrose Invert sugar Sucrose Fructose Lactose Syrup Fruit juice concentrate Malt syrup Table sugar Source: U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th edition, Washington D.C.: U.S. Government Printing Office. January 2005. www.healthierus.gov/dietaryguidelines. CHAPTER 2 Planning a Healthy Diet -_ 27 –— Key Recommendations. { Choose fiber-rich fruits, vegetables, and whole grains often. { Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as the amounts suggested by the USDA MyPyramid and the DASH Eating Plan. { Reduce the incidence of dental caries by practicing good oral hygiene and consuming foods and beverages containing sugar and starch less frequently. Key Recommendations for Specific Population Groups. { Older Adults. Dietary fiber is important for laxation (the elimination of fecal waste through the anus). Since constipation may affect up to 20% of people over 65 years of age, older adults should choose to consume foods rich in dietary fiber. { Children. Carbohydrate intakes of children need special considerations with regard to obtaining sufficient amounts of fiber, avoiding excessive amount of calories from added sugars, and prevention of dental caries. Sodium and Potassium On average, the higher one’s salt (sodium chloride) intake, the higher one’s blood pressure. Keeping blood pressure in the normal range reduces one’s risk of coronary heart disease, stroke, congestive heart failure, and kidney disease. When reading labels, look for the sodium content; foods that are low in sodium (less than 140 mg) are low in salt. Lifestyle changes includ- ing reducing salt intake, increasing potassium intake, losing excess body weight, increasing physical activity, and eating an overall healthful diet can prevent or delay the onset of high blood pressure and can lower elevated blood pressure. Key Recommendations. { Consume less than 2,300 mg of sodium (approximately 1 teaspoon of salt) per day. { Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables. Key Recommendations for Specific Population Groups. { Individuals with hypertension, blacks, and middle-aged and older adults. Aim to consume no more than 1,500 mg of sodium per day and meet the potassium recommendation (4,700 mg/day) with food. -_ 28 SECTION 1 Fundamentals of Nutrition –— Alcoholic Beverages Alcoholic beverages supply calories but few essential nutrients. As a result, ex- cessive alcohol consumption makes it difficult to eat sufficient nutrients within one’s daily calories and to maintain a healthy weight. Alcoholic beverages are harmful when consumed in excess. Key Recommendations. { Those who choose to drink alcoholic beverages should do so sensibly and in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men. { Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions. { Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery. Food Safety Avoiding foods that are contaminated with harmful bacteria, viruses, para- sites, toxins, and chemical and physical contaminants is vital for healthful eat- ing. It is estimated that every year about 76 million people in the United States become ill from pathogens in food. Chapter 10 discusses this further. Key Recommendations. { Clean hands, food contact surfaces, and fruits and vegetables. { Separate raw cooked and ready-to-eat foods while shopping, preparing, or storing foods. { Cook foods to a safe temperature to kill microorganisms. { Chill (refrigerate) perishable food promptly, and defrost foods properly. { Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts. Key Recommendations for Specific Population Groups. { Infants and young children, pregnant women, older adults, and those who are immunocompromised. Do not eat or drink raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, and raw or undercooked fish or shellfish. CHAPTER 2 Planning a Healthy Diet -_ 29 –— { Pregnant women, older adults, and those who are immunocompromised. Only eat certain deli meats and frankfurters that have been reheated to steaming hot. MYPYRAMID Dietary Guidelines for Americans, 2005, serve as the U.S. federal nutrition policy (USDHHS & USDA, 2005). These guidelines form the basis for the MyPyramid Food guidance system unveiled in April 2005. MyPyramid is applicable to Americans over age 2. By introducing all Americans to MyPyramid and its slo- gan, “Steps to a Healthier You,” the USDA hopes to help people make informed and healthier food choices. These choices can lead to a decrease in major nutrition-related chronic diseases, such as anemia, diabetes mellitus, coronary heart disease, hypertension, and alcoholic cirrhosis. MyPyramid is the former Food Guide Pyramid tipped on its side. The color bands in MyPyramid represent the types of foods that should be con- sumed, and the width of the band denotes the approximate relative quantity of each food that should be consumed. In addition, MyPyramid incorporates the concept of physical activity into its design. A person climbing the stairs denotes the importance of physical activity in one’s daily life, just as the food groups denote daily food intake. Personalization of one’s diet is easier to accomplish by accessing the MyPyramid.gov Web site, where age, gender, and physical activity can be keyed in and more specific nutrition guidelines are provided. Twelve different pyramids are available on the Web site using these parameters. The 12 pyramids range from daily intake levels of 1,000 to 3,200 calories. By following the appropriate pyramid, the individual should be able to maintain a healthy body weight and decrease the risk of nutrition- related chronic diseases. Quantities are stated in household measures such as cups and ounces instead of the servings that were used in the Food Guide Pyramid. MyPyramid has the following features: { MyPyramid Plan. Provides a quick estimate of what and how much food you should eat from the different food groups by entering your age, gender, and activity level. { MyPyramid Tracker (www.mypyramidtracker.gov). Provides more detailed information on your diet quality and physical activity status by comparing a day’s work of foods eaten with current nutrition guidance. { Inside MyPyramid. Provides in-depth information for every food group, including recommended daily amounts in commonly used measures, like cups and ounces, with examples and everyday tips. Included in this section are recommendations for choosing healthy oils, discretionary calories, and physical activity. { Start Today. Offers tips and resources that include downloadable suggestions on all the food groups and physical activity and provides a downloadable worksheet to track what you are eating. -_ 30 SECTION 1 Fundamentals of Nutrition –— Figure 2-1 MyPyramid Food Guidance System. (U.S. Department of Agriculture, Center for Nutrition Policy and Promotions. MyPyramid. 2005. www.MyPyramid.gov) (continues) MyPyramid (Figure 2-1) has six color bands representing five food groups and oils. The bands are wider at the bottom, representing foods with little or no solid fats, added sugars, or caloric sweeteners, and become narrower at the top, in- dicating that the foods that contain fats and sugars should be limited. The five food groups represented along with oils have not changed. They are the following: { Grains—bread, cereal, rice, and pasta group { Vegetable group { Fruit group { Milk, yogurt, and cheese group { Meat, poultry, fish, dry beans, eggs, and nuts group { Fats, oils, and sweets group CHAPTER 2 Planning a Healthy Diet -_ 31 –— Figure 2-1 (continued) The emphasis of MyPyramid, which takes its guidance from the Dietary Guidelines for Americans, 2005, is not on a percentage of intake but on daily EXPLORING THE WEB servings. Depending on the information one enters into MyPyramid, a calorie Visit the Wheat Foods level will be individually determined. See Table 2-6 for intake patterns for Council Web site at www various caloric levels..wheatfoods.org. This Web site provides an abundance of information on grains Bread, Cereal, Rice, and Pasta Group and nutrition. Visit the Resources section to find The largest section of MyPyramid is made up of the grains—the bread, cereal, slide shows and information rice, and pasta group (Table 2-7). As the table shows, the number of servings to share with your clients. from grains is established with the recommendation that at least half of the Create fact sheets from the servings should be whole grains. Whole grains provide dietary fiber, B vitamins, information found at this iron, and magnesium. Enriched products also contain B vitamins and iron, but site that can be distributed if they are not made from whole grains, they contain little dietary fiber. to clients. -_ 32 SECTION 1 Fundamentals of Nutrition –— Table 2-6 MyPyramid Food Intake Patterns DAILY AMOUNT OF FOOD FROM EACH GROUP The suggested amounts of food to consume from the basic food groups, subgroups, and oils to meet recommended nutrient intakes at 12 different calorie levels. Nutrient and energy contributions from each group are calculated according to the nutrient-dense forms of foods in each group (e.g., lean meats and fat-free milk). The table also shows the discretionary calorie allowance that can be accommodated within each calorie level, in addition to the suggested amounts of nutrient-dense forms of foods in each group. CALORIE LEVEL1 1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200 Fruits 1 cup 1 cup 1.5 cups 1.5 cups 1.5 cups 2 cups 2 cups 2 cups 2 cups 2.5 cups 2.5 cups 2.5 cups Vegetables 1 cup 1.5 cups 1.5 cups 2 cups 2.5 cups 2.5 cups 3 cups 3 cups 3.5 cups 3.5 cups 4 cups 4 cups Grains 3 oz–eq 4 oz–eq 5 oz–eq 5 oz–eq 6 oz–eq 6 oz–eq 7 oz–eq 8 oz–eq 9 oz–eq 10 oz–eq 10 oz–eq 10 oz–eq Meat and beans 2 oz–eq 3 oz–eq 4 oz–eq 5 oz–eq 5 oz–eq 5.5 oz–eq 6 oz–eq 6.5 oz–eq 6.5 oz–eq 7 oz–eq 7 oz–eq 7 oz–eq Milk 2 cups 2 cups 2 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups Oils 3 tsp 4 tsp 4 tsp 5 tsp 5 tsp 6 tsp 6 tsp 7 tsp 8 tsp 8 tsp 10 tsp 11 tsp Discretionary calorie allowance 165 171 171 132 195 267 290 362 410 426 512 648 1 Calorie levels are set across a wide range to accommodate the needs of different individuals. ESTIMATED DAILY CALORIE NEEDS To determine which food intake pattern to use for an individual, the following chart gives an estimate of individual calorie needs. The calorie range for each age and gender is based on physical activity level, from sedentary to active. Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life. Active means a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life. CALORIE RANGE CALORIE RANGE SEDENTARY → ACTIVE SEDENTARY → ACTIVE Children Males 2–3 years 1,000 → 1,400 4–8 years 1,400 → 2,000 Females 9–13 1,800 → 2,600 4–8 years 1,200 → 1,800 14–18 2,200 → 3,200 9–13 1,600 → 2,200 19–30 2,400 → 3,000 14–18 1,800 → 2,400 31–50 2,200 → 3,000 19–30 2,000 → 2,400 51 2,000 → 2,800 31–50 1,800 → 2,200 51 1,600 → 2,200 Source: From U.S. Department of Agriculture, Center for Nutrition Policy and Promotions. MyPyramid Food Intake Patterns. April, 2005. http://www.mypyramid.gov/downloads/MyPyramid_Food_Intake_Patterns.pdf. CHAPTER 2 Planning a Healthy Diet -_ 33 –— Table 2-7 Bread, Cereal, Rice, and Pasta Group BREADS Whole wheat Rolls or biscuits made with whole Dark rye wheat or enriched flour Enriched Flour, enriched Oatmeal bread whole wheat, other whole grain Cornmeal, whole grain, or enriched grits, enriched CEREALS Whole wheat Other cereals, if whole grain or Rolled oats restored RICE Brown rice Converted rice PASTA Noodles, spaghetti, macaroni Table 2-8 Vegetable Subgroup Amounts CALORIE LEVEL 1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200 Dark green veg. 1 c/wk 1.5 c/wk 1.5 c/wk 2 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk Orange veg. 0.5 c/wk 1 c/wk 1 c/wk 1.5 c/wk 2 c/wk 2c/wk 2 c/wk 2 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk Legumes 0.5 c/wk 1 c/wk 1 c/wk 2.5 c/wk 3 c/wk 3 c/wk 3 c/wk 3 c/wk 3.5 c/wk 3.5 c/wk 3.5 c/wk 3.5 c/wk Starchy veg. 1.5 c/wk 2.5 c/wk 2.5 c/wk 2.5 c/wk 3 c/wk 3 c/wk 6 c/wk 6 c/wk 7 c/wk 7 c/wk 9 c/wk 9 c/wk Other veg. 3.5 c/wk 4.5 c/wk 4.5 c/wk 5.5 c/wk 6.5 c/wk 6.5 c/wk 7 c/wk 7 c/wk 8.5 c/wk 8.5 c/wk 10 c/wk 10 c/wk Source: From U.S. Department of Agriculture, Center for Nutrition Policy and Promotions. MyPyramid Food Intake Patterns. April, 2005. http://www.mypyramid.gov/downloads/MyPyramid_Food_Intake_Patterns.pdf. Vegetable Group The food intake patterns have established the number of daily servings per calorie level of vegetable. All vegetables are included in the vegetable group: green and leafy, yellow, starchy, and legumes (Table 2-8). Vegetables provide carbohydrates; dietary fiber; vitamins A, B-complex, C, E, and K; and iron, calcium, phosphorus, potassium, magnesium, copper, manganese, and some- times, molybdenum. This guideline, if followed, also guarantees that one will receive a vari- ety of nutrients, phytochemicals, and flavonoids. One-half cup of cooked or ¶ flavonoids chopped raw vegetables or two cups of uncooked, leafy vegetables is considered naturally occurring water-soluble plant pigments that act as antioxidants one serving. -_ 34 SECTION 1 Fundamentals of Nutrition –— Table 2-9 Fruit Group SOURCES OF VITAMIN A SOURCES OF VITAMIN C Bananas Oranges Cantaloupe Cantaloupe Lemons Kiwi fruit Avocados Grapefruit Honeydew melon Apricots Limes Watermelon Mangoes Raspberries Mangoes Strawberries Papaya Pineapple Fruit Group All fruits are included in the fruit group. They provide vitamins A and C, potas- sium, magnesium, iron, and carbohydrates, including dietary fiber (Table 2-9). It is recommended that one eat a variety of fruit daily, following the food intake patterns for quantity, and go easy on the fruit juice. The calories in fruit juice add up quickly, especially if one is thirsty and drinks large amounts of juice. One serving is three-quarters cup of fruit juice; a half of a grapefruit; one whole raw medium apple, orange, peach, pear, or banana; a half cup of canned or cooked fruit; and a quarter cup of dried fruit. Milk, Yogurt, and Cheese Group Milk, yogurt, and cheese are excellent sources of carbohydrate (lactose); cal- cium, phosphorus, and magnesium; proteins; riboflavin, vitamins A, B12, and, if the milk is fortified, vitamin D. Unfortunately, all contain sodium, and whole milk and whole-milk products also contain saturated fats and cholesterol. Fat- free milk has had the fats removed. It is recommended that two to three servings of these foods be included in one’s daily diet. The serving size is one 8-ounce glass of milk or the equivalent in terms of calcium content. Children 2 servings Adolescents 3 servings Adults 3 servings Pregnant or lactating women 3 servings Pregnant or lactating teens 4 servings The following dairy foods contain calcium equal to that found in one 8-ounce cup of milk. The best choices would be low fat. { 11⁄ 2 ounces cheddar cheese { 2 cups cottage cheese { 13⁄ 4 cups of ice cream { 1 cup yogurt CHAPTER 2 Planning a Healthy Diet -_ 35 –— Milk used in making cream sauces, gravies, or baked products fulfills part of the calcium requirement. A cheese sandwich would fulfill one of the serv- ing requirements, and a serving of ice cream could fulfill half of one of the serving requirements. Obviously, drinking milk is not the only way to fulfill the calcium requirement. Some clients suffer from lactose intolerance and cannot digest milk or milk products. If they eat or drink foods containing untreated lactose, they experience abdominal cramps and diarrhea. This condition is caused by a defi- ciency of lactase (see Chapter 4). In such cases, milk that has been treated with lactase can be used, or commercial lactase can be added to the milk or taken in tablet form before drinking milk or eating dairy products. Meat and Beans Group All meats, poultry, fish, eggs, soybeans, dry beans and peas, lentils, nuts, and seeds are included in this group (Table 2-10). These foods provide proteins, iron, copper, phosphorus, zinc, sodium, iodine, B vitamins, fats, and cholesterol. Caution must be used so that the foods selected from this group are low in fat and cholesterol. Many meats contain large amounts of fats, and egg yolks and organ meats have very high cholesterol content. Let the food intake patterns be the guide for the number of ounces one should eat daily. In general, 1 ounce of lean meat, poultry, or fish, 1 egg, 1 table- spoon of peanut butter, 1 ⁄ 4 cup of cooked dry beans, or 1 ⁄ 2 ounce of nuts or seeds can be considered as a 1 ounce-equivalent from the meat and beans group. Fats This group contains butter, margarine, cooking oils, mayonnaise and other salad dressings, sugar, syrup, honey, jam, jelly, and sodas. All of these foods have a low nutrient density, meaning they have few nutrients other than fats and carbo- hydrates and have a high calorie content. One’s limit for fat will be figured and listed as oils in accordance with the food intake patterns shown in Table 2-6. It is recommended that the fat sources be from fish, nuts, and vegetable oils. Table 2-10 Meats, Poultry, Fish, Dry Beans, Eggs, and Nuts Beef Dried beans Lamb Dried peas Veal Lentils Pork, except bacon Nuts Organ meats, such as heart, liver, Peanuts kidney, brain, tongue, sweetbread Peanut butter Poultry, such as chicken, duck, Soybean flour goose, turkey Soybeans Fish, shellfish -_ 36 SECTION 1 Fundamentals of Nutrition –— The Mediterranean diet has received attention because of the American Heart Association’s recommendation to increase monounsaturated fats in the diet. The recommendations are outlined in Chapter 5. The following guidelines are recommended: 1. Eat the majority of food from plant sources, such as potatoes, grains and breads, beans, fruits, vegetables, nuts, and seeds. 2. Eat minimally processed foods, with an emphasis on fresh, locally grown foods. 3. Replace other fats and oils with olive oil. 4. Keep total fat in a range of less than 20–35% of energy. Saturated fat should be no more than 7–8% of energy. 5. Eat low to moderate amounts of cheese and yogurt (low fat and fat- free preferable). 6. Eat low to moderate amounts of fish and poultry and from zero to four eggs per week (those used in cooking need to be counted). 7. Eat fruit for dessert; desserts that contain a significant amount of sugar and saturated fat should be eaten only a few times per week. 8. Eat red meat a few times per month, not to exceed 12–16 ounces per month. 9. Engage in regular exercise to promote fitness, a healthy weight, Nutrition Facts Serving Size 1/2 cup (114g) and a feeling of physical well-being. Servings Per Container 4 10. Drink wine in moderation (wine is optional). Wine with meals—one Amount Per Serving to two glasses per day for men and one glass per day for women. Calories 90 Calories from Fat 30 % Daily Value Total Fat 7g Saturated Fat 4g 5% 20% FOOD LABELING Trans Fat 0g 0% As a result of the passage by Congress of the Nutrition Labeling and Education Act Polyunsaturated Fat 1g 0% (NLEA) in 1990, nutrition labeling regulations became mandatory in May 1994 Monounsaturated Fat 0g 0% Cholesterol 0mg 0% for nearly all processed foods. The primary objective of the changes was to ensure Sodium 300mg 13% that labels would be on most foods and would provide consistent nutrition infor- Total Carbohydrate 13g 4% mation. The resulting food labels provide the consumer with more information on Dietary Fiber 3g 12% Sugars 3g the nutrient contents of foods and how those nutrients affect health than former Protein 3g labels provided. Health claims allowed on labels are limited and set by the Food and Drug Administration (FDA). Serving sizes are determined by the FDA and not Vitamin A 80% Vitamin C 60% Calcium 4% Iron 4% by the individual food processor. Descriptive terms used for foods are standardized. Percent Daily Values are based on a 2,000 calorie diet. Your For example, “low fat” means that each serving contains 3 grams of fat or less. daily values may be higher or lower dependi