Minerals PDF

8 Minerals  Objectives ⚫ List at least two food sources of given minerals. ⚫ List one or more functions of given minerals. ⚫ Describe the recommended method of avoiding mineral deficiencies. 8-2...

8 Minerals  Objectives ⚫ List at least two food sources of given minerals. ⚫ List one or more functions of given minerals. ⚫ Describe the recommended method of avoiding mineral deficiencies. 8-2 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Facts ⚫ The human body is made up of specific chemical elements. ⚫ Oxygen, carbon, hydrogen, and nitrogen make up 96% of body weight. ⚫ The remaining elements, minerals, represent 4% of body weight. ⚫ Minerals are essential for good health. 8-3 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Minerals ⚫ Inorganic elements necessary to build tissues, regulate body fluids, and assist in various body functions. ⚫ Found in all body tissues ⚫ Cannot provide energy by themselves but contribute to production of energy within the body 8-4 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Minerals ⚫ Enriched foods are foods to which nutrients, usually B vitamins and iron, have been added to improve their nutritional value. 8-5 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Classification ⚫ Major minerals  Required in amounts greater than 100 mg a day ⚫ Trace minerals  Needed in amounts smaller than 100 mg a day 8-6 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Electrolytes ⚫ Ions  Electrically charged atoms resulting from mineral salts dissolved in water  Cations are positively charged.  Anions are negatively charged.  Must be balanced within the body.  These ions are known as electrolytes. 8-7 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Electrolytes ⚫ Maintain the body’s fluid balance ⚫ Contribute to electrical balance ⚫ Assist in transmission of nerve impulses and contraction of muscles ⚫ Help regulate the body’s acid-balance 8-8 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  What is the best way to receive an adequate intake of minerals? 8-9 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  A balanced diet is the only safe way of including minerals in the amounts necessary to maintain health! 8-10 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Toxicity ⚫ Toxicity occurs when concentrated forms of minerals are taken regularly over time. ⚫ An excessive amount of one mineral can lead to deficiency of another mineral. ⚫ Changes in nearly all tissues may result. ⚫ Concentrated minerals should be used only if prescribed. 8-11 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Major Minerals ⚫ Calcium (cheese and milk) ⚫ Phosphorus(organ meats/turkey ) ⚫ Potassium (banana/potatoes) ⚫ Sodium (canned meat/ bacon) ⚫ Chloride (sea weeds/tomatoes) 8-12 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium (Ca) ⚫ Human body contains more calcium than any other mineral ⚫ In combination with phosphorus, gives strength and hardness to bones and teeth ⚫ Bones provide storage for calcium. ⚫ Needed for normal nerve and muscle action, blood clotting, heart function, and cell metabolism 8-13 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium Regulation ⚫ Hormonal system regulates delivery of calcium to cells. ⚫ Parathyroid glands release a hormone telling the kidneys to retrieve calcium before it is excreted when blood calcium levels drop. 8-14 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Calcium Regulation ⚫ This hormone works with calcitriol causing increased release of calcium from bones by stimulating activity of osteoclasts Both actions increase blood calcium levels. 8-15 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Calcium Regulation ⚫ Every cell needs calcium, and normal blood calcium levels are maintained even if intake is poor. ⚫ Bones become increasingly fragile as calcium is withdrawn from them. ⚫ Osteoporosis may result from years of low calcium intake. 8-16 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Calcium Regulation ⚫ Osteoblasts increase bone mass if blood calcium level is high until one is age 30– 35 years old. ⚫ Bone mass will remain stable in women (until menopause) with adequate consumption of calcium, phosphorus, and vitamin D. 8-17 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium Sources ⚫ Milk and milk products ⚫ Dark green, leafy vegetables  When vegetables contain oxalic acid, as spinach the calcium remains unavailable because the oxalic acid binds it and prevents it from being absorbed.  When the intake of fiber exceeds 35 g/ a day, calcium will also bind with phytates (phosphorus compounds found in some high-fiber cereals), which also limits its absorption. 8-18 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Calcium Absorption ⚫ Enhances absorption of calcium  Vitamin D  Calcium-to-phosphorus ratio that includes no more phosphorus than calcium  Presence of lactose ⚫ Retards absorption  Lack of weight-bearing exercise 8-19 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium Requirements ⚫ 0–6 months 210 mg ⚫ 6–12 months 270 mg ⚫ 1–3 years 500 mg ⚫ 4–8 years 800 mg ⚫ 9–18 years 1,300 mg ⚫ 19–50 years 1,000 mg ⚫ 51–70+ years 1,200 mg 8-20 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Calcium Requirements ⚫ Pregnant women  14–18 years: 1,300 mg  19–50 years: 1,000 mg ⚫ Lactating women same as nonlactating women of same age Source: Dietary Reference Intakes, Food and Nutrition Board, National Academy of Sciences-Institute of Medicine, 1997 8-21 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium Supplements ⚫ Calcium carbonate, the form found in calcium-based antacid tablets, has the highest concentration of bioavailable calcium. ⚫ Appear to be absorbed most efficiently when consumed in doses of 500 mg ⚫ Check for United States Pharmacopeia (USP)-approved products, which are unlikely to contain lead. 8-22 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium Deficiency ⚫ Rickets results in poorly formed bone structure and causes bowed legs, “pigeon breast,” enlarged wrists or ankles, and stunted growth. ⚫ “Adult rickets” causes bones to become soft. ⚫ Osteoporosis causes brittle bones. ⚫ Tetany, characterized by involuntary muscle movement, results from insufficient calcium in the blood. 8-23 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Calcium Excess ⚫ Excessive intake may:  Cause constipation  Cause kidney stones  Inhibit the absorption of iron and zinc 8-24 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Phosphorus (P) ⚫ Constituent of all body cells ⚫ Necessary for the formation of strong, rigid bones and teeth; metabolism of carbohydrates, fats, and proteins; proper acid-base balance; and effective action of several B vitamins 8-25 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Phosphorus Sources ⚫ Stored in bones; absorption is increased in the presence of vitamin D ⚫ Protein-rich foods such as milk, cheese, meats, poultry, and fish ⚫ Cereals, legumes, nuts, and soft drinks 8-26 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Phosphorus Deficiency ⚫ Deficiency is rare. ⚫ Excessive use of antacids affects absorption. ⚫ Symptoms of deficiency include bone demineralization, fatigue, and anorexia. 8-27 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Potassium (K) ⚫ Found primarily in intracellular fluid ⚫ Essential for fluid balance and osmosis ⚫ Maintains fluid level within the cell ⚫ Necessary for transmitting nerve impulses and muscle contractions 8-28 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Potassium Sources ⚫ Fruits: especially melons, oranges, bananas, and peaches ⚫ Vegetables: mushrooms, Brussel sprouts, potatoes, tomatoes, winter squash, lima beans, and carrots 8-29 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Potassium Deficiency and Excess ⚫ Deficiency = hypokalemia  Caused by diarrhea, vomiting, diabetic acidosis, severe malnutrition, or excessive use of laxatives or diuretics  Symptoms include nausea, anorexia, fatigue, muscle weakness, and heart abnormalities ⚫ Excess = hyperkalemia  Caused by dehydration, renal failure, excessive intake  Cardiac failure can result. 8-30 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Sodium ⚫ Primary function is the control of fluid balance in the body ⚫ Maintains acid-base balance ⚫ Participates in the transmission of nerve impulses essential for normal muscle function 8-31 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Sodium Sources ⚫ Table salt contains 40% sodium. ⚫ One teaspoon of table salt contains 2,000 mg of sodium. ⚫ Naturally available in animal foods ⚫ Dietary Reference Intake for sodium is 1,500 mg. ⚫ Tolerable upper limit is 5,800 mg, which is easily exceeded by the general population. 8-32 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Sodium Deficiency ⚫ Caused by severe vomiting, diarrhea, and heavy perspiration ⚫ Can upset the acid-base balance ⚫ Tetany resulting from alkalosis can develop. 8-33 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Sodium Excess ⚫ May cause edema and resulting hypertension ⚫ Associated with hypertension and congestive heart failure ⚫ Treatment includes sodium-restricted diets; 3–4 g (no added salt, ) or 1–2 g sodium-restricted diet. Diets below 1 g are rarely prescribed. 8-34 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Chloride (Cl) ⚫ Essential for maintenance of fluid, electrolyte, and acid-base balance ⚫ Found in hydrochloric acid, cerebrospinal fluid, and muscle and nerve tissue ⚫ Helps blood carry carbon dioxide to the lungs and is necessary during immune responses when white blood cells attack foreign cells 8-35 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Chloride (Cl) ⚫ Found almost exclusively in table salt or in foods containing sodium chloride ⚫ Deficiency is rare. ⚫ Can occur with severe vomiting, diarrhea, excessive use of diuretics and alkalosis 8-36 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Magnesium (Mg) ⚫ Vital to both hard and soft body tissues ⚫ Essential for metabolism ⚫ Regulates nerve and muscle function ⚫ Plays a role in the blood-clotting process 8-37 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Magnesium Sources ⚫ Found primarily in plant foods ⚫ Sources are green, leafy vegetables, legumes, nuts, whole grains, some fruits (avocados and bananas) and milk in sufficient quantities 8-38 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Magnesium Sources ⚫ Deficiency among people on normal diets is unknown. ⚫ Experimentally induced symptoms of deficiency include nausea, as well as mental, emotional, and muscular disorders. 8-39 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Sulfur (S) ⚫ Necessary to all body tissue and for metabolism ⚫ Contributes to the characteristic odor of burning hair and tissue ⚫ Component of some amino acids ⚫ Found in protein-rich foods ⚫ Neither the amount of sulfur required by the human body nor its deficiency is known. 8-40 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Iron (Fe) ⚫ Delivers oxygen to body tissues ⚫ Component of hemoglobin ⚫ Component of myoglobin(sub unit of hemoglobin), a protein compound in muscles that provides oxygen to cells ⚫ Used by enzymes that are involved in making amino acids, hormones, and neurotransmitters 8-41 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Iron Sources ⚫ Meat, poultry, and fish are the best sources of iron. Animal flesh contains heme iron, which is absorbed more than twice as efficiently as nonheme iron. ⚫ Nonheme iron is found in whole-grain cereals, enriched grain products, vegetables, fruit, eggs, meat, fish, and poultry. 8-42 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Iron Requirements ⚫ Recommended Daily Allowance doubled during pregnancy; difficult to meet by diet alone ⚫ Iron supplement commonly prescribed during pregnancy. ⚫ Increased need during infancy and teens 8-43 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Iron Deficiency ⚫ Caused by insufficient intake, malabsorption, lack of stomach acid, or excessive blood loss ⚫ Most common nutrient deficiency worldwide is iron-deficiency anemia ⚫ Symptoms include fatigue, weakness, irritability, shortness of breath, pale skin, and spoon-shaped fingernails 8-44 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Iron Excess ⚫ Hemochromatosis is a condition resulting from an inborn error of metabolism that causes excessive absorption of iron. ⚫ “Hemachromatosis-disorder in which body can build up too much iron in skin, heart ,liver ,pancreas and joints.” ⚫ Untreated, can damage liver, spleen, and heart ⚫ To control buildup of iron, clients with this condition must give blood on a regular basis. 8-45 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Iodine (I) ⚫ Component of thyroid hormones, thyroxine (T4), and triiodothyronine (T3) ⚫ Necessary for the normal functioning of the thyroid gland, which determines rate of metabolism ⚫ Sources include iodized salt, seafood, and some plant foods grown in soil bordering the sea 8-46 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Iodine (I) ⚫ Additional amounts needed during pregnancy and lactation ⚫ Lack of iodine results in decrease in thyroxine and triiodothyronine ⚫ Gland grows, forming a lump on the neck, called a goiter. 8-47 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Iodine (I) ⚫ Myxedema is a condition of hypothyroidism in adults. ⚫ Cretinism is low thyroid in a child; physical and mental development are retarded 8-48 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Zinc (Zn) ⚫ Cofactor for more than 300 enzymes ⚫ Essential for growth, wound healing, taste acuity, glucose tolerance, and mobilization of vitamin A within the body ⚫ Sources include meat, fish, eggs, dairy products, wheat germ, and legumes 8-49 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Zinc (Zn) ⚫ Increased requirements during pregnancy and lactation ⚫ Symptoms of deficiency include decreased appetite, taste acuity, delayed growth, dwarfism, poor wound healing, anemia, acnelike rash, impaired immune response 8-50 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Selenium (Se) ⚫ Constituent of most body tissues ⚫ Concentrated in liver, kidneys, and heart ⚫ Component of an enzyme that acts as an antioxidant, thereby protecting cells against oxidation and sparing vitamin E ⚫ Sources include seafood, kidney, liver, muscle meats ⚫ High doses are toxic, causing vomiting, loss of hair and nails, and skin lesions. 8-51 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Copper (Cu) ⚫ Found in all tissues; heaviest concentration in the liver, kidneys, muscles, and brain ⚫ Helps in formation of hemoglobin; aids in transport of iron to bone marrow for the formation of red blood cells; and participates in energy production ⚫ Sources include organ meats, shellfish, legumes, nuts, cocoa, whole-grain cereals, and human milk 8-52 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Copper (Cu) ⚫ Deficiency is rare. ⚫ People with malabsorption conditions and gross protein deficiency such as premature infants; clients on long-term parenteral nutrition programs lacking copper; and people taking excess zinc supplements are candidates for deficiency. ⚫ Anemia, bone demineralization, and impaired growth can result. 8-53 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Copper (Cu) ⚫ Excess is highly toxic ⚫ Wilson’s disease is an inherited condition causing damage to liver cells and neurons. Detected early, copper-binding agents may be used to bind copper in the bloodstream and increase excretion. 8-54 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Manganese (Mn) ⚫ Constituent of several enzymes involved in metabolism ⚫ Important in bone formation ⚫ Sources include whole grains, tea, vegetables, and fruits ⚫ No deficiency or toxicity from ingestion is known ⚫ Inhalation linked to neurological problems 8-55 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Fluoride (F) ⚫ Increases resistance to dental caries, and may strengthen teeth and bones ⚫ Sources include fluoridated water, fish and tea, as well as commercially prepared foods with fluoridated water. ⚫ Deficiency can result in increased tooth decay. ⚫ Excess can cause permanent discoloration or mottling of children’s teeth. 8-56 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Chromium (Cr) ⚫ Associated with glucose and lipid metabolism ⚫ Levels decrease with age except in lungs, where chromium accumulates ⚫ Sources include meat, mushrooms, nuts, yeast, organ meats, and wheat germ ⚫ Deficiency related to disturbances in glucose metabolism 8-57 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Molybdenum (Mo) ⚫ Constituent of enzymes, and thought to play a role in metabolism ⚫ Sources include milk, liver, legumes, and cereals ⚫ No deficiencies noted ⚫ Excess inhibits copper absorption 8-58 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Conclusion ⚫ Megadoses of minerals are dangerous. ⚫ Minerals are necessary to promote growth and regulate body processes. ⚫ Minerals originate in soil and water and are ingested via food and drink. ⚫ Deficiencies can result in anemia, rickets, and goiter. ⚫ Excess can be toxic, resulting in hair loss and changes in nearly all body tissues. 8-59 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  9 Water  Objectives ⚫ Describe the functions of water in the body. ⚫ Explain fluid balance and its maintenance. ⚫ Name the causes and consequences of water depletion. ⚫ Give some causes and consequences of positive fluid balance. ⚫ Describe the acid-base balance in the human body. 9-2 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Facts ⚫ Humans can live about 30–45 days without food. ⚫ Humans can live only 10–14 days without water. ⚫ Water is present in all body cells. ⚫ Water is 50%–60% of the body weight of normal adults. ⚫ The percentage is highest in newborns; it decreases with age. 9-3 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Facts ⚫ Two basic compartments 1. Intracellular fluid (ICF): within cells; 65% of total body fluid 2. Extracellular fluid (ECF): outside cells; 35% of total body fluid ◆ Found in intravascular fluid , interstitial fluid and glandular secretions. 9-4 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Functions ⚫ Major component of blood plasma ⚫ Solvent for nutrients and waste products ⚫ Necessary for hydrolysis of nutrients ⚫ Essential for metabolism ⚫ Lubricant in joints and digestion ⚫ Cools the body through perspiration ⚫ Provides some mineral elements 9-5 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Sources ⚫ Drinking water is the best source. ⚫ Other beverages are second-best source. ⚫ Other sources include fruits, vegetables, soups, milk, and gelatin desserts. ⚫ Energy metabolism produces water. 9-6 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Estimated Daily Fluid Intake for an Adult ⚫ Ingested liquids: 1,500 mL ⚫ Water in foods: 700 mL ⚫ Water from oxidation: 200 mL ⚫ Total: 2,400 mL 9-7 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Fluid and Electrolyte Balance ⚫ Electrolytes are measured in milliequivalents (mEq/L). ⚫ Sensible water loss is water lost through urine. ⚫ Insensible (unnoticeable) water loss is in feces, perspiration, and respiration. ⚫ Waste products of metabolism excreted in the form of urine (500 mL of water each day). 9-8 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Fluid and Electrolyte Balance ⚫ Solute: substance dissolved in a solution ⚫ Osmosis: water flows from the side with the lesser amount of solute to the side with the greater solute concentration ⚫ Sodium, chloride, and potassium maintain the balance between intracellular and extracellular fluids. 9-9 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Fluid and Electrolyte Balance ⚫ Potassium is the principal electrolyte in intracellular fluid. ⚫ Sodium is the principal electrolyte in extracellular fluid. ⚫ Osmolality measures particles in a solution. 9-10 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Fluid and Electrolyte Balance ⚫ When electrolytes in extracellular fluid are increased, Intracellular fluid moves to the Extracellular Fluid to equalize the concentration of electrolytes on both sides of the membrane. This reduces the amount of water in the cells. 9-11 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Fluid and Electrolyte Balance ⚫ The hypothalamus stimulates the pituitary gland to excrete ADH or vasopressin ⚫ ADH causes kidneys to reabsorb water. ⚫ Thirst causes a healthy person to drink fluids. 9-12 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Fluid and Electrolyte Balance ⚫ When sodium in Extracellular fluid is reduced, water flows from Extracellular fluid into cells, causing cellular edema. ⚫ Adrenal glands secrete aldosterone which triggers kidneys to increase the amount of sodium reabsorbed. ⚫ When sodium is replaced in the Extracellular fluid, excess water moves back to the Extracellular fluid and edema is relieved. 9-13 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Fluid and Electrolyte Balance ⚫ Amount of water use varies, depending on age, size, activity, environmental temperature, and physical condition. ⚫ Average adult requirement is 1 mL for every calorie of food consumed. 9-14 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  How many glasses of fluid would be required for an adult eating 1,800 kcal/day? 9-15 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  1 mL × 1,800 cal = 1,800 cc 1,800 cc  240 oz = 7.5 glasses of water It is recommended that adults drink eight 8-ounce glasses of fluid a day. Youth, fever, diarrhea, unusual perspiration, and hyperthyroidism increase the requirement. 9-16 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Dehydration ⚫ Occurs when amount of water in the body is inadequate ⚫ Caused by inadequate intake or abnormal loss ⚫ Loss can occur from severe diarrhea, vomiting, hemorrhage, burns, diabetes mellitus, excessive perspiration, excessive urination, or the use of certain medications, such as diuretics. 9-17 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Dehydration ⚫ Symptoms include low blood pressure, thirst, dry skin, fever, and mental disorientation. ⚫ As water is lost, electrolytes are also lost. ⚫ Treatment involves replacement of electrolytes and fluids. 9-18 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Dehydration ⚫ 10% loss of body water can cause serious problems. ⚫ Blood volume and nutrient absorption are reduced, and kidney function is upset. ⚫ 20% loss can cause circulatory failure and death. ⚫ Infants are at high risk for dehydration when fever, vomiting, and diarrhea occur. ⚫ Treatment may involve IV fluids 9-19 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Dehydration ⚫ Thirst sensation fall behind the body’s need for water, especially in the elderly, children, athletes, and the ill. ⚫ Feeling thirsty is not a reliable indicator of when the body needs water. ⚫ Fluids should be drunk throughout the day to prevent dehydration. 9-20 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Dehydration ⚫ Failure to replace water lost through perspiration could lead to one of the four stages of heat illness: 1. Heat fatigue 2. Heat cramp 3. Heat exhaustion 4. Heat stroke 9-21 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Signs of Dehydration ⚫ Health history reveals inadequate intake of fluids ⚫ Decrease in urine output ⚫ Weight loss ⚫ Eyes appear sunken ⚫ Tongue has increased furrow and fissures 9-22 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Signs of Dehydration ⚫ Oral mucous membranes are dry ⚫ Decreased skin turgor ⚫ Changes in neurological status 9-23 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Excess Water Accumulation ⚫ Positive water balance–more water taken in than excreted; edema results ⚫ May be caused by hypothyroidism, congestive heart failure, hypoproteinemia, some infections, some cancers, and some renal conditions ⚫ Fluids and sodium may be restricted. 9-24 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Acid-Base Balance ⚫ Regulation of hydrogen ions ⚫ Acid gives off hydrogen ions. ⚫ Base picks up hydrogen ions. ⚫ Acidic substances have pH 1 to 7. ⚫ Alkaline substances have pH 7 to 14. ⚫ A pH of 7 is considered neutral. 9-25 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Acid-Base Balance ⚫ Blood plasma has Ph of 7.35 to 7.45. ⚫ Intracellular fluid has pH of 6.8. ⚫ Kidneys maintain acid-base balance. ⚫ What a person eats affects the acidity of the urine, not of the body. 9-26 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Buffer Systems ⚫ Excess sodium bicarbonate is excreted via the kidneys. ⚫ The kidneys can excrete urine from pH 4.5 to pH 8. ⚫ The pH of average urine is 6. 9-27 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Acidosis and Alkalosis ⚫ Renal failure, uncontrolled diabetes mellitus, starvation, or severe diarrhea can cause acidosis. ⚫ Alkalosis can occur when the body has suffered a loss of hydrochloric acid from severe vomiting or has ingested too much alkali, such as too many antacid tablets. 9-28 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  A client is unhappy with her low-sodium, fluid- restricted diet. How can the health care professional best help the client? 9-32 9-29 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Discuss realistic ways of planning menus for her and with her. Base menus on good nutrition, and on the client’s normal habits and desires. Review former diet with the client. Point out high-salt and high-liquid foods and present alternative foods in a positive manner. 9-33 9-30 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Conclusion ⚫ Water is a component of all tissues. ⚫ Solvent for nutrients and body wastes ⚫ Provides transport for both ⚫ Essential for hydrolysis, lubrication, and maintenance of normal temperature ⚫ Best sources are water, beverages, fruits, vegetables, soups, and water-based desserts 9-31 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Conclusion ⚫ Dehydration can result from lack of water. ⚫ Positive water balance is an excess accumulation of water in the body. ⚫ Acid-base balance is the regulation of hydrogen ions in the body. ⚫ Healthy people have intricate maintenance systems for fluid, electrolytes, and acid-base balance. 9-32 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  10 Food-Related Illnesses and Allergies  Objectives ⚫ Identify diseases caused by contaminated food, their signs, and the means by which they are spread. ⚫ List signs of food contamination. ⚫ State precautions for protecting food from contamination. ⚫ Describe allergies and elimination diets and their uses. 10-2 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Food-Related Illnesses ⚫ Result from food contaminated with pathogens or chemicals ⚫ Pathogens can be bacteria, viruses, molds, worms, and protozoa. ⚫ Chemicals may be intentionally added to foods or accidentally added through carelessness or pollution. ⚫ Food poisoning is a general term for foodborne illness. 10-3 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Food-Related Illnesses ⚫ Food poisoning includes:  Foodborne illness, caused by a pathogen  Food intoxication, caused by toxins produced by the pathogen 10-4 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Food-Related Illnesses ⚫ Symptoms of food poisoning include vomiting, diarrhea, headache, and abdominal cramps. ⚫ May be mistaken for the flu ⚫ May be life-threatening in young children, the elderly, or the immunocompromised 10-5 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Bacteria That Cause Foodborne Illness ⚫ Campylobacter jejuni ⚫ Clostridium botulinum ⚫ Clostridium perfringens ⚫ Cyclospora cayentanensis ⚫ Escherichia coli 10-6 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Bacteria That Cause Foodborne Illness ⚫ Listeria monocytogenes ⚫ Salmonella ⚫ Shigella ⚫ Staphylococcus aureus 10-7 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Campylobacter Jejuni ⚫ One of the most prevalent causes of diarrhea ⚫ Can contaminate meat during slaughter ⚫ Causes diarrhea, fever, headache, muscle and abdominal pain, and nausea ⚫ Symptoms occur 2–5 days after infection. ⚫ Transmitted via unpasteurized milk, contaminated water, and raw or undercooked meat, poultry, and shellfish 10-8 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Clostridium Botulinum ⚫ Botulism ⚫ Found in soil and water, on plants, and in the intestinal tracts of animals and fish ⚫ Can be produced in sealed containers such as cans, jars, and vacuum-packaged foods ⚫ The rarest but most deadly of all food poisonings 10-9 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Clostridium Botulinum ⚫ Onset is 4–36 hours after eating. ⚫ Symptoms include double vision, speech difficulties, inability to swallow, and respiratory paralysis. ⚫ Fatality rate in the U.S. is about 65%. ⚫ Great care must be taken to prevent botulism when canning foods at home. 10-10 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Clostridium Perfringens ⚫ The “cafeteria” or “buffet” germ ⚫ Transmitted by eating heavily contaminated food ⚫ Symptoms include nausea, diarrhea, and inflammation of the stomach and intestine. ⚫ Onset is 6–24 hours. ⚫ To prevent, maintain foods at proper temperatures 10-11 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Cyclospora Cayentanensis ⚫ A parasite that causes gastroenteritis ⚫ Transmitted by poor hygiene and contaminated water ⚫ Symptoms include watery diarrhea, abdominal cramps, decreased appetite, and low-grade fever. ⚫ Onset is 1 week. ⚫ Prevent by drinking clean water, thorough washing, and proper handling of produce 10-12 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Escherichia Coli ⚫ Escherichia coli, commonly called E. coli, is a group of bacteria that can cause illness in humans. ⚫ Found in intestines of some mammals, raw milk, and contaminated water ⚫ Transmitted through contaminated water, unpasteurized milk or apple juice, raw or rare ground beef products, unwashed fruits or vegetables, and directly from person to person 10-13 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Escherichia Coli ⚫ Onset is 3–9 days. ⚫ Symptoms include severe abdominal cramps, diarrhea that may be watery or bloody, and nausea. ⚫ Complications: hemorrhagic colitis, hemolytic uremic syndrome in children ⚫ Control by careful choice and cooking of food 10-14 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Listeria Monocytogenes ⚫ Bacteria often found in human and animal intestines, and in milk, leafy vegetables, and soil ⚫ Transmitted by unpasteurized dairy foods; leafy, raw vegetables; and processed meats. ⚫ Onset is 12 hours to 8 weeks after ingestion. 10-15 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Listeria Monocytogenes ⚫ Symptoms include fatigue, fever, chills, headache, backache, abdominal pain, and diarrhea. ⚫ Prevent by thoroughly cooking meats and poultry and carefully washing salad greens. Make sure dairy products are pasteurized. 10-16 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Salmonellosis ⚫ Found in raw meats, poultry, fish, milk, and eggs ⚫ Transmitted by eating contaminated food or by contact with a carrier ⚫ Symptoms include headache, vomiting, diarrhea, abdominal cramps, and fever. ⚫ Onset is 6–48 hours. ⚫ Prevent by properly handling and cooking raw foods. 10-17 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Shigella ⚫ Found in feces of infected people ⚫ Typically transmitted by an infected food handler with poor handwashing practices ⚫ Cold foods are common carriers. ⚫ Onset is 1–7 days. ⚫ Symptoms include diarrhea, fever, chills, headache, nausea, and abdominal cramps. 10-18 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Staphylococcus Aureus ⚫ Found on human skin ⚫ Transmitted by carriers and by eating foods that contain the toxin these bacteria create ⚫ Onset is 30 minutes to 8 hours. ⚫ Symptoms include vomiting, diarrhea, and abdominal cramps. ⚫ Prevent by storing and cooking food at proper temperature. 10-19 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  You are teaching a class about preventing food poisoning. What food preparation safety guidelines will you discuss? 10-20 10-20 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  All meats and poultry should be cooked thoroughly. Ground beef, veal, and lamb should be cooked to 160 degrees Fahrenheit, and ground poultry to at least 165 degrees Fahrenheit. 10-21 10-21 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Fruits and vegetables should be carefully washed, and unpasteurized milk, dairy products, vegetable and fruit juices should be avoided. People with compromised immune systems should be especially vigilant. 10-22 10-22 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Thaw poultry and meats in the refrigerator or microwave and cook immediately. Avoid cross-contamination of raw and cooked foods by carefully cleaning utensils and counter surfaces that were in contact with raw food. 10-23 10-23 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Do not eat raw or undercooked eggs or foods that contain them. Keep hot foods hot and cold foods cold. 10-24 10-24 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Other Substances That Cause Food Poisoning ⚫ Molds ⚫ Trichinella spiralis ⚫ Protozoa 10-25 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Mold ⚫ A type of fungus ⚫ May cause respiratory problems ⚫ Can cause cancer ⚫ Symptoms include abdominal pain, vomiting, and diarrhea ⚫ Onset is 1 day to several months after ingestion. 10-26 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Trichinella Spiralis ⚫ A parasitic worm that causes trichinosis ⚫ Transmitted by eating inadequately cooked pork from infected pigs ⚫ Onset is 24 hours. ⚫ Symptoms include abdominal pain, vomiting, fever, chills, and muscle pain. ⚫ Cook all pork to an internal temperature of at least 170 degrees Fahrenheit. 10-27 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Protozoa (Dysentery) ⚫ Introduced to food by carriers or contaminated water ⚫ Symptoms include severe diarrhea that can occur intermittently. 10-28 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Prevention of Foodborne Illnesses ⚫ Cleanliness of kitchen and equipment ⚫ Proper handwashing ⚫ Wear gloves if cooking with any hand wound. ⚫ Cover and store foods to prevent microbes or animals from reaching it. ⚫ Prepare, cook, and store foods to appropriate temperatures. 10-29 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Prevention of Foodborne Illnesses ⚫ Prevent known carriers from preparing foods. ⚫ Select only packages and jars that were sealed by the manufacturer. ⚫ Avoid bulging cans, foods that look or smell odd, and foods showing signs of mold. 10-30 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Miscellaneous Food Poisoning ⚫ Ingestion of plants or animals that contain poison (mushrooms, or fish from polluted water) ⚫ Cleaning agents ⚫ Insecticides ⚫ Drugs 10-31 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Food Allergies ⚫ Food allergy occurs when the immune system reacts to a food substance, usually a protein. ⚫ Food intolerance does not involve the immune system. ⚫ Allergic reactions can be life-threatening. 10-32 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Types of Allergic Reactions ⚫ Hay fever ⚫ Dermatitis ⚫ Urticaria ⚫ Nausea ⚫ Edema ⚫ Dizziness ⚫ Headache ⚫ Asthma 10-33 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Treatment of Allergies ⚫ Removal of allergen when identified ⚫ To identify the allergen  Food diary  Laboratory tests  Elimination diet  Client education 10-34 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Elimination Diet ⚫ A limited diet in which only certain foods are allowed in an attempt to pinpoint the food allergen causing the reaction ⚫ Additional foods are introduced slowly until an allergic reaction occurs. 10-35 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Common Food Allergens ⚫ Milk ⚫ Tree nuts ⚫ Wheat ⚫ Peanuts ⚫ Corn ⚫ Chocolate ⚫ Eggs ⚫ Soybeans ⚫ Citrus Fruit ⚫ Pork ⚫ Strawberries ⚫ Fish ⚫ Tomatoes ⚫ Shellfish ⚫ Legumes 10-36 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Teaching Considerations ⚫ Avoid microbial contamination of food supplies at home. ⚫ Read food labels. ⚫ Ask about ingredients of foods in a restaurant and at another person’s home. 10-37 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Conclusion ⚫ Human ignorance or carelessness is usually the cause of food infection or poisoning. ⚫ There are many safety factors related to food handling that can prevent contamination of food. ⚫ Most common food allergens are milk, chocolate, eggs, tomatoes, fish, citrus fruit, legumes, strawberries, and wheat. 10-38 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Chapter 11 Diet during Pregnancy and Lactation  Objectives ⚫ Identify nutritional needs during pregnancy and lactation. ⚫ Describe the nutritional needs of pregnant adolescents. ⚫ Modify the normal diet to meet the needs of pregnant and lactating women. 11-2 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Weight Gain during Pregnancy ⚫ Average weight gain is 25–35 pounds for normal-weight women. ⚫ Underweight women should gain 28–40 pounds. ⚫ First trimester: 2–4 pound weight gain ⚫ Second and third trimester: 1 pound/week ⚫ No one should lose weight during pregnancy. 11-3 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Weight Gain during Pregnancy ⚫ No additional calories are usually required during the first trimester. ⚫ An additional 300 calories needed during the second and third trimesters. ⚫ Folic acid supplementation prior to conception decreases risk of brain and spinal cord defects. 11-4 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Nutritional Needs during Pregnancy ⚫ The protein requirement is increased by 20% for the pregnant woman over age 25 (25% for pregnant adolescent). ⚫ No need to increase vitamin A; excess vitamin A can cause birth defects. ⚫ Vitamin D requirement is 10 g. ⚫ Vitamin E requirement is 5 g. ⚫ Vitamin K requirement is 75–90 g depending upon age. 11-5 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 11-6 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Nutritional Needs during Pregnancy ⚫ Requirements for all the water-soluble vitamins are increased. ⚫ Requirements for vitamins B and C are increased. ⚫ Requirements for calcium, iron, zinc, iodine, and selenium are all increased. ⚫ Iron supplements are commonly prescribed. 11-7 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Fulfillment of Nutritional Needs during Pregnancy ⚫ Base diet on MyPyramid. ⚫ Drink additional fat-free milk or appropriate substitute. ⚫ Prenatal vitamins and iron supplement may be prescribed. ⚫ Over-the-counter nutrient supplements may be harmful to the fetus. 11-8 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Concerns during Pregnancy ⚫ Nausea ⚫ Pregnancy-induced ⚫ Constipation hypertension ⚫ Heartburn ⚫ Pica ⚫ Excessive weight ⚫ Anemia gain ⚫ Alcohol, caffeine, drugs, and tobacco 11-9 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Nausea ⚫ “Morning sickness” occurs most commonly in first trimester. ⚫ Suggestions  Eat dry crackers or dry toast before rising  Eat small, frequent meals  Avoid food with offensive odors  Avoid liquids at mealtime 11-10 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Hyperemesis Gravidarum. ⚫ Occurs when the nausea becomes so severe that it is life-threatening ⚫ May require hospitalization and parenteral nutrition 11-11 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Constipation ⚫ Caused by relaxed gastrointestinal tract due to progesterone ⚫ Eat a high-fiber diet. ⚫ Participate in daily exercise. ⚫ Drink eight glasses of water per day. 11-12 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Heartburn ⚫ Caused by pressure on the stomach by the growing fetus and relaxation of the cardiac sphincter. ⚫ Eat small, frequent meals. ⚫ Avoid spicy or greasy foods. ⚫ Avoid liquids with meals. ⚫ Wait at least 1 hour after eating to lie down and 2 hours before exercising. 11-13 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Excessive Weight Gain ⚫ Re-evaluate diet and eliminate foods that do not fit within MyPyramid. ⚫ Drink fat-free milk. ⚫ Eat clean, crisp, raw vegetables as a snack. ⚫ Eat fruits and custards made with fat-free milk as desserts. ⚫ Broil, bake, or boil instead of frying. 11-14 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Pregnancy-Induced Hypertension ⚫ Formerly called pre-eclampsia or toxemia ⚫ Characterized by high blood pressure, presence of protein in the urine, and edema in third trimester ⚫ May progress into the eclamptic stage with convulsions, coma, and possible death of the mother and infant 11-15 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Pregnancy-Induced Hypertension ⚫ Higher incidence during first pregnancy, multifetal pregnancies, morbidly obese mothers, or those with inadequate diets, especially protein deficient 11-16 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Pica ⚫ Pica is the craving for nonfood substances such as starch, clay (soil), or ice. ⚫ Ingestion of soil should be discouraged due to possible contamination and nutrient deficiencies. ⚫ Multiple nutritional deficiencies can result from pica. 11-17 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Anemia ⚫ Anemia is a condition caused by an insufficiency of red blood cells, hemoglobin, or blood volume. ⚫ Causes weakness, fatigue, poor appetite, and pallor 11-18 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Anemia ⚫ Iron-deficiency anemia is the most common form. ⚫ Folate deficiency may lead to megaloblastic anemia and is prevented by folate supplement. 11-19 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Alcohol, Caffeine, Drugs, and Tobacco ⚫ Fetal alcohol syndrome (FAS) is characterized by a growth deficiency, central nervous system dysfunction, microcephaly (small head), and other physical characteristics. ⚫ Fetal alcohol effect (FAE) causes fewer physical defects, but many behavioral and psychosocial problems. 11-20 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Alcohol, Caffeine, Drugs, and Tobacco ⚫ Abstinence of alcohol is recommended. ⚫ Caffeine has been shown to cause birth defects in rats, but no data exist for humans. Limit caffeine intake to < 300 mg/day. ⚫ Illegal drugs can cause the infant to be born addicted. 11-21 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Alcohol, Caffeine, Drugs, and Tobacco ⚫ Drugs derived from vitamin A can cause fetal malformations and spontaneous abortions. ⚫ Tobacco smoking is associated with low birth weights, sudden infant death syndrome (SIDS), fetal death, spontaneous abortions, and complications at birth. 11-22 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Diet for the Pregnant Woman with Diabetes ⚫ The nutrient requirements of the pregnant woman with diabetes are the same as for the nondiabetic pregnant woman. ⚫ The dietitian should plan the diet depending on the type and number of insulin injections required. ⚫ Gestational diabetes occurs during pregnancy and disappears after the infant is born. 11-23 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Diet for the Pregnant Woman with Diabetes ⚫ Routine screening for gestational diabetes is part of prenatal care. ⚫ Insulin is used during pregnancy to control any type of diabetes. ⚫ Oral hypoglycemic agents have not been used during pregnancy. ⚫ Artificial sweeteners have been found to be safe during pregnancy. 11-24 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Pregnancy during Adolescence ⚫ The nutritional, physical, psychological, social, and economic demands on pregnant adolescents are tremendous. ⚫ Nutrition must meet the needs of her growing body and the needs of the fetus. ⚫ High risk for pregnancy-induced hypertension and premature delivery 11-25 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Pregnancy during Adolescence ⚫ Inadequate nutrition of the mother is related to both mental and physical birth defects. ⚫ Much counseling and emotional support is needed. 11-26 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Lactation ⚫ The production and secretion of breast milk for the purpose of nourishing an infant ⚫ Recommended that no supplemental feedings be given until feeding routine is established. ⚫ Human milk is formulated to meet the nutrient needs of infants for the first 6 months of life. 11-27 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Benefits of Breastfeeding for the Infant ⚫ Breast milk has the perfect composition for a baby’s needs. ⚫ No babies are allergic to their mother’s milk. ⚫ Human milk contains at least 100 ingredients not found in formula. 11-28 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Benefits of Breastfeeding for the Infant ⚫ Lower incidence of ear infections, diarrhea, allergies, and hospital admissions ⚫ Breastfed babies receive antibodies from breast milk. ⚫ Promotes good jaw development ⚫ Decreases risk of obesity later in life ⚫ Facilitates bonding 11-29 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Benefits of Breastfeeding for the Mother ⚫ Helps lose the weight gained during pregnancy ⚫ Stimulates uterus to contract back to its original size ⚫ Breastfeeding is economical. ⚫ Provides opportunity for resting ⚫ Milk is always at the right temperature and is readily available. 11-30 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Nutrient Requirements during Lactation ⚫ The Food and Nutrition Board suggests an increase of 500 calories a day. ⚫ Most nutrient requirements are increased, especially protein. ⚫ Nutrition should be based on MyPyramid. ⚫ Fluid intake should replace fluids used for milk production. 11-31 (continues) Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Nutrient Requirements during Lactation ⚫ Most chemicals can pass into the mother’s milk. ⚫ Check with obstetrician before using any medication or nutrient supplement. ⚫ Caffeine may make an infant irritable. 11-32 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Considerations for the Health Care Professional ⚫ Articles in newspapers and magazines may be inaccurate. ⚫ Re-education may be necessary. ⚫ Teaching pregnant teenagers presents the biggest challenge. 11-33 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Conclusion ⚫ A pregnant woman is most likely to remain healthy and bear a healthy infant if she follows a well-balanced diet. ⚫ Anemia and PIH are two conditions that can be caused by inadequate nutrition. ⚫ Caloric and most nutrient requirements increase for pregnant and lactating women. 11-34 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  12 Diet during Infancy  Objectives ⚫ State the effect that inadequate nutrition has on an infant. ⚫ Discuss positive aspects of breastfeeding and bottle feeding. ⚫ Describe when and how foods are introduced into the baby’s diet. ⚫ Describe inborn errors of metabolism and their dietary treatment. 12-2 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Nutritional Requirements of the Infant ⚫ Birth weight doubles by 6 months of age and triples within the first year. ⚫ During the first year the normal child needs about 98–108 calories per kilogram of body weight each day. ⚫ Infants need 1.5 mL of water per calorie. ⚫ Nutritional needs depend on a child’s growth rate. (continues) 12-3 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Nutritional Requirements of the Infant ⚫ A vitamin K supplement is routinely given at birth ⚫ Basis of infants’ diet is breast milk or formula. ⚫ Excess vitamin A or D can be toxic to infants. ⚫ Fluoride may be supplemented as needed. 12-4 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Breastfeeding ⚫ Provides infant with temporary immunity to many infectious diseases. ⚫ It is economical, nutritionally perfect, and sterile. ⚫ Breast milk is easily digested. ⚫ Breastfed infants have fewer infections. ⚫ Breastfeeding promotes oral motor development. (continues) 12-5 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Breastfeeding ⚫ Breast should be offered every 2 hours in the first few weeks. ⚫ The infant should nurse 10–15 minutes on each breast. ⚫ Growth spurts occur at about 10 days, 2 weeks, 6 weeks, and 3 months during which infant may nurse more frequently. ⚫ Breastfeeding is also beneficial to mothers (continues) 12-6 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Breastfeeding ⚫ Indications of adequate nutrition include:  The infant has six or more wet diapers per day.  The infant has normal growth.  The infant has 1–2 bowel movements per day.  The breast becomes less full during nursing. 12-7 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Bottle Feeding ⚫ The infant should be cuddled and held in a semiupright position. ⚫ Baby should be burped often. ⚫ Formulas are made from modified cow’s milk to resemble breast milk in nutritional value. ⚫ Synthetic formula made from soybeans may be used for sensitive or allergic infants. (continues) 12-8 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Bottle Feeding ⚫ Formula must be prepared with the correct amount of water to prevent health complications. ⚫ Cow’s milk can cause gastrointestinal blood loss in infants and should not be used. ⚫ Use consistent temperature for formula. ⚫ Putting infants to bed with a bottle may cause baby bottle mouth. 12-9 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Share with a partner your own feelings regarding breastfeeding versus bottle-feeding. Do you support a woman who decides to breastfeed? Do you support a woman who decides to bottle feed? Could your beliefs affect the care you give? 12-10 Copyright Copyright © 2007 © 2007 Thomson Thomson Delmar Delmar Learning, Learning, a division a division of Thomson of Thomson Learning Learning Inc.Inc. All All rights rights reserved. reserved.  Supplementary Foods ⚫ Solid foods should not be introduced before 4 to 6 months of age and should be done gradually. ⚫ Solids should be started with iron-fortified rice cereal, then other infant cereals. ⚫ Cooked and pureed vegetables follow, then cooked and pureed fruits, egg yolk, and finally, finely ground meats. (continues) 12-11 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Supplementary Foods ⚫ Between 6 and 12 months, toast, Zwieback teething biscuits, and Cheerios can be added. ⚫ Honey should never be given to an infant because it could be contaminated with Clostridium botulinum bacteria. (continues) 12-12 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Supplementary Foods ⚫ When the infant learns to drink from a cup, juice can be introduced. ⚫ Juice should never be given from a bottle because babies will fill up on it and not get enough calories from other sources. ⚫ Use only 100% juice products and limit to 4 ounces per day because they are nutrient dense. 12-13 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Indications for Readiness for Solid Foods ⚫ Disappearance of extrusion reflex ⚫ Willingness to participate in the process ⚫ Ability to sit up without support ⚫ Having head and neck control ⚫ Drinking more than 32 ounces of formula or nursing 8 to 10 times in 24 hours 12-14 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Developing Good Eating Habits ⚫ By age one most babies can eat foods from all food groups. ⚫ Table foods can be used. ⚫ Avoid excess sugar and salt. ⚫ Avoid foods that can cause choking. ⚫ Help children develop an active lifestyle and healthy eating habits. 12-15 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Special Nutritional Needs ⚫ Premature infants ⚫ Children with cystic fibrosis ⚫ Failure to thrive ⚫ Metabolic disorders  Galactosemia.  Phenylketonuria  Maple syrup urine disease 12-16 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Premature Infants ⚫ An infant born before 37 weeks’ gestation ⚫ The sucking reflex is not developed until 34 weeks’ gestation. Infants born earlier will require total parenteral nutrition, tube feedings, or bolus feedings. (continues) 12-17 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Premature Infants ⚫ Other concerns include: low birth weight, underdeveloped lungs, immature gastrointestinal tract, inadequate bone mineralization, and lack of fat reserves ⚫ Many special formulas are available but breast milk is best because its composition is perfect, even for premature babies. 12-18 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12-19 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12-20 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Cystic Fibrosis ⚫ An inherited disease in which the body secretes abnormally thick mucus ⚫ Decreased production of digestive enzymes and malabsorption of fat ⚫ Recommendation: 35%–40% of diet should be from fat. (continues) 12-21 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Cystic Fibrosis ⚫ Digestive enzymes and fat-soluble vitamin supplementation at meal times ⚫ Nighttime tube feedings may be indicated. 12-22 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Failure to Thrive. ⚫ Determined by plotting the infant’s growth on standardized charts ⚫ May be caused by watering down formula congenital abnormalities, acquired immunodeficiency syndrome (AIDS), lack of bonding, child abuse, or neglect ⚫ The first 6 months are the most crucial for brain development. 12-23 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Galactosemia. ⚫ A condition in which there is a lack of the liver enzyme transferase. ⚫ Transferase normally converts galactose to glucose. ⚫ The amount of galactose in the blood becomes toxic. ⚫ Results in diarrhea, vomiting, edema, and abnormal liver function. (continues) 12-24 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Galactosemia ⚫ Cataracts may develop, galactosuria occurs, and mental retardation occurs. ⚫ Diet therapy: exclusion of anything containing milk from any mammal; nutritional supplements of calcium, vitamin D, and riboflavin ⚫ Lifelong elimination of lactose in diet 12-25 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Phenylketonuria (PKU). ⚫ Phenylalanine ⚫ Infants lack the liver enzyme phenylalanine hydroxylase, which is necessary for the metabolism of the amino acid phenylalanine. ⚫ Infants are normal at birth, but if untreated become hyperactive, suffer seizures, and become mentally retarded between 6 and 18 months old. (continues) 12-26 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Phenylketonuria (PKU) ⚫ Diet therapy: commercial formula Lofenalac, regular blood tests, synthetic milk for older children, avoidance of phenylalanine ⚫ Lifelong diet therapy ⚫ Hospitals are required to screen newborns for PKU before discharge. 12-27 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Maple Syrup Urine Disease (MSUD) ⚫ Congenital defect resulting in the inability to metabolize three amino acids: leucine, isoleucine, and valine. ⚫ Named for the odor of clients’ urine (continues) 12-28 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Maple Syrup Urine Disease (MSUD) ⚫ Hypoglycemia, apathy, and convulsions occur and, if not treated promptly, may result in death. ⚫ Mild form of the disease may cause mental retardation and bouts of acidosis. ⚫ Diet therapy: extremely restricted amounts of the three amino acids; a special formula and low-protein diet is used; diet therapy necessary throughout life. 12-29 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Spotlight on the Life Cycle ⚫ Women, Infants, and Children (WIC)  A federally funded program that provides monthly food packages of infant formula or milk, cereal, eggs, cheese, peanut butter, and juice to new mothers 12-30 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Conclusion ⚫ Babies must have adequate diets so that their physical and mental development are not impaired. ⚫ Breastfeeding is nature’s way of feeding an infant. ⚫ Formula feeding is also acceptable. ⚫ Some infants have special nutritional needs. 12-31 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  14 Diet during Young and Middle Adulthood  Objectives ⚫ Identify the nutritional needs of young adults and the middle aged. ⚫ Explain sensible, long-range weight control for this age group. ⚫ Discuss the importance of exercise in weight control. ⚫ Discuss diet-related diseases that can be prevented by good nutrition at this age: osteoporosis, heart disease, and diabetes. 14-2 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Adulthood ⚫ Broadly divided into three periods: young, middle, and late adulthood  Young adulthood age range is from 18–40 years.  Middle period ranges from about 40–65 years of age.  Late adulthood is over 65 years of age 14-3 Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.  Nutrient Requirements ⚫ Growth is usually complete by age 25. ⚫ Nutrient requirements of healthy adults during these years change very little. ⚫ The iron requirement for women is higher than men until after menopause. (continues) 14-4 Copyright © 2007 Thomson Delmar Learn