Lipids - Nutrition & Dietetics (RAK Medical & Health Sciences University) PDF

RAK Medical & Health Sciences University RAK College of Nursing Year I BSN Program Course: Nutrition & Dietetics Topic: Lipids Dr.Vimala Edwin BSN.,MSN., Ph.D. Assistant Professor...

RAK Medical & Health Sciences University RAK College of Nursing Year I BSN Program Course: Nutrition & Dietetics Topic: Lipids Dr.Vimala Edwin BSN.,MSN., Ph.D. Assistant Professor RAK College of Nursing. Learning outcome At end of the class the student will be able to 1. Understand the classification of fats or lipids 2.Classify the fats based on fatty acids 3.List the functions of fat 4. Discuss the digestion and absorption of fat 5. Identify the sources of fat 6. Strategies for making healthier Food Choices regarding fat Introduction “Eatless fat” has long been a nutritional mantra. some fats are “good” (unsaturated) and should be eaten in moderation, and other fats are “bad” (saturated fat and trans fats) and should be limited. Fat has many vital functions and improve the overall deliciousness of the diet. 11.Lipids – Fats in the diet or Lipids are insoluble in water, Like carbohydrates they are composed of carbon, hydrogen, and oxygen atoms. There are three classes of lipids, which are referred to as fat. Classification of lipids A.Triglycerides(98%), the major form of fat in food. Triglycerides is a class of lipids composed of a glycerol molecule as its backbone with three fatty acids attached to carboxyl group. B. Compound lipids (which a lipid is combined with another substance)Phospholipids eg)Lecithin C. Cholesterol – is a sterol waxy like substance. A. Triglycerides All individual triglyceride may contain one, two or three fatty acids All food fats contain a mixture of i. Saturated fatty acids. ii. Unsaturated fatty acids. Monounsaturated fatty acids. Polyunsaturated fatty acids. Classification fatty acids: i)Saturated Fats. Saturated fatty acids are solid fats because they are solid at room temperature. Saturated fatty acids occur to the greatest extent in animal fats—the fat in meats, whole-milk dairy products, and egg yolks. The only vegetable fats that are saturated are palm oil, and coconut oil. Saturated fat is commonly known as a “bad” fat.  A strong body of evidence shows that a high intake of most saturated fatty acids is linked with high low-density lipoprotein (LDL) cholesterol, which are risk factors for cardiovascular disease Low-Density Lipoprotein (LDL) Cholesterol: The major class of atherogenic lipoproteins that carry cholesterol from the liver to the tissues. ii)Unsaturated Fatty Acids. Unsaturated fats are commonly known as “good fats” because they are linked to lower blood cholesterol levels and thus a reduced risk of cardiovascular disease when they are eaten in place of saturated fats. Monounsaturated fatty acids are the predominate fat in olives, olive oil, canola oil, avocado, peanut oil, and most other nuts. Polyunsaturated fatty acids They are the predominant fat in corn, soybean, safflower, and cottonseed oils and also in fish(Salmon, Tuna, sardines and mackerel etc). Classification of lipids continued…. B. Phospholipids: a group of compound lipids that is similar to triglycerides in that they contain a glycerol molecule and two fatty acids. What makes them different from triglycerides is that in place of the third fatty acid, phospholipids have a phosphate group. Although phospholipids occur naturally in almost all foods, they make up a very small percentage of total fat intake. Role of phospholipid Phospholipids are both fat soluble (because of the fatty acids) and water soluble(because of the phosphate group), a unique feature that enables them to act as emulsifiers. Emulsifier: a stabilizing compound that helps to keep both parts of an emulsion (oil and water mixture) from separating. Eg) Lecithin is a best known emulsifier Cake, icing, bread and specialty cakes all utilize emulsifiers. C. Cholesterol : Cholesterol is a sterol(lipid molecules) is a waxy substance found only in animal products. All body cells are capable of making enough cholesterol to meet their needs, so cholesterol is not an essential nutrient; High serum levels are clearly associated with an increased risk for atherosclerosis. Cholesterol : High serum levels are clearly associated with an increased risk for atherosclerosis. Trans fat. When manufacturers partially hydrogenate liquid oils, they become more solid and more stable. This substance is referred to as trans fat. Trans fat raises serum cholesterol. Eg)Fried foods, including French fries, doughnuts and fried chicken. 3. FUNCTIONS OF FAT IN THE BODY The primary function of fat is to Provides energy Fat deposits insulate and cushion internal organs to protect them from mechanical injury. Fat under the skin helps to regulate body temperature Facilitates the absorption of the fat-soluble vitamins A, D, E, and K Provide structure to cell membranes and facilitate normal function of proteins. Fatty acids play a role in maintaining healthy skin and promoting normal growth in children. 4.HOW THE BODY HANDLES FAT Digestion and Absorption A minimal amount of chemical digestion of fat occurs in the mouth and stomach through the action of lingual lipase and gastric lipases, respectively. Most fat digestion occurs in the small intestine. Pancreatic lipase, the most important and powerful lipase splits off one fatty acid at a time from the triglyceride molecule. The end products of digestion –mostly monoglycerides with free fatty acids and little glycerol are absorbed into intestinal cells. It is normal for a small amount of fat to escape digestion and be excreted in the feces. Cholesterol does not undergo digestion; it is absorbed as it is. Fat Digestion 5. Sources of Fat Food categories that provide naturally occurring fat are protein foods, dairy and oils Vegetables and grains naturally provide little or no fat, However some items within each group may have added fat, such as fried or creamed vegetables and cereals and biscuits. Fruits naturally fat free, with the exception of avocado, coconut and olives. Protein Lean meats(fat trimmed off ) provide 2g fat Medium fat protein meats provides 5g fat Eg) Egg, Fried fish, poultry with skin High fat protein meats provide 8g fat Eg)Turkey or chicken hot dogs Plant based proteins vary in fat content from very little in legumes to 8gm in a tablespoon of nut spreads such as peanut butter, almond butter and soy nut butter Dairy & Yogurt The fat content of milk and yogurt ranges from 0 to 8 g per serving: Whole milk provides 8 g fat/cup. Low-fat milk (1% milk) provides 3 g fat/cup. Fat-free milk (nonfat, skim milk) is virtually fat free. Yogurt: 1 cup plain yogurt provides 8g fat / cup Oils & Fats I serving provides 5gm fat Eg) 1 tsp oil , such as canola, olive, corn, soybean, flaxseed or coconut Dietary reference Intakes Fats that the body can synthesize namely saturated fatty acids and monounsaturated fatty acids and cholesterol do not need to be consumed through food. There is no Recommended Dietary Allowance (RDA) for any of these fats. 6. Strategies For making Healthier Food Choices Regarding fat Make better protein choices. Eat more plant based meals. Eating less total fat as low as possible —especially saturated and trans fat Choose low fat or fat free dairy items Eating more unsaturated fat and increasing fiber intake which increases fecal excretion of cholesterol.  Increase the Amount and Variety of Seafood is associated with reduced cardiac deaths in people with or without cardiovascular disease. Preferably oily fish such as salmon, tuna, mackerel, herring, and trout, at least twice a week (Gidding et al., 2009). Use oils as a healthier option instead of solid fat(Butter) Replace fatty foods with fruit and vegetables References 1. Dudek, Susan G, Nutrition Essentials for Nursing Practice,9th ed,2021, Wolters Kluwer Health RAK MEDICAL & HEALTH SCIENCES UNIVERSITY RAK COLLEGE OF NURSING YEAR I BSN PROGRAM COURSE: Nutrition & Dietetics TOPIC: Waters & Minerals Dr. Vimala Edwin BSN.,MSN., Ph.D. Assistant Professor RAK College of Nursing. Learning Outcome At end of the session the student will be able to 1.Discuss the constituent of water 2. Identify the functions of water 3. Explain the mechanism of water balance 4. Understand the Recommended Dietary Allowance for water 5.Differentiate inadequate and excess intake of fluid 6. Discuss minerals and the types, Functions, Mineral balance, toxicities, sources, interactions and supplements 1. Water Water is fundamental to life. It is the single largest essential component of the human body, averaging approximately 60% of the total body weight. It is the medium in which all biochemical reactions take place. Water occupies essentially every space within and between body cells and is involved in almost every body function.  Muscle cells have a higher concentration of water Men generally have more muscle mass than women and, therefore, have a higher percentage of body water. 2. Water performs the following functions a. Approximately two-thirds of the body’s water is located within cells (intracellular fluid). Water provides shape and structure to the cells. b. Regulates body temperature. Because water absorbs heat slowly, the large amount of water contained in the body helps to maintain body temperature homeostasis despite fluctuations in environmental temperatures. Evaporation of water (sweat) from the skin cools the body. C. Aids in the digestion and absorption of nutrients. Approximately 7 to 9 L of water is secreted in the gastrointestinal tract daily to aid in digestion and absorption. Except for the approximately 100ml of water excreted through the feces, All of the water contained in the gastrointestinal secretions (saliva, gastric secretions, bile, pancreatic secretions, and intestinal mucosal secretions) is reabsorbed in the ileum and colon. d. Transports nutrients and oxygen to cells. Water allows oxygen to dissolve and move into blood for distribution throughout the body. e. Serves as a solvent for vitamins, minerals, glucose, and amino acids. f. Participates in metabolic reactions. for example, water is used in the synthesis of hormones and enzymes. g. Eliminates waste products. Water helps to excrete body wastes through urine, feces, and expirations. H. Act as lubricating fluids. water reduces friction in joints 3. Water balance Water balance is the dynamic state between water output and water intake. Under normal conditions, Output and Intake are approximately equal. On average, adults lose approximately 1750 to 3000 ml of water daily Water output Insensible water losses- Immeasurable losses Extreme environmental temperatures (very hot or very cold), high altitude, low humidity, and strenuous exercise increase insensible water losses from respirations and the skin. Water evaporation from the skin is also increased by prolonged exposure to heated or recirculated air, For example: During long airplane flights. Sensible water losses –Measurable water losses Sensible water losses from urine and feces make up the remaining water loss. The body needs to excrete a minimum of 500 ml of urine daily to rid itself of metabolic wastes. The minimum daily total fluid output is approximately 1500 ml. to maintain water balance, intake and output. WATER INTAKE Total water intake averages about 2½ liters per day, of which approximately 80% is from fluids and 20% from solid food (institute of medicine [iom], 2005). The body also produces a small amount of water from normal metabolism: on average, 250 to 350 ml of metabolic water is produced daily, depending on total calorie intake. Percentage of water content of various foods 4. Water recommendations Water is an essential nutrient because the body cannot produce as much water as it needs. There is no Recommended Dietary Allowance (RDA) for water because of insufficient evidence linking a specific amount of water intake to health; Actual requirements vary depending on diet, physical activity, environmental temperatures, and humidity. For men age 19 to older than 70 years, the adequate intake is 3.7 L/day, which includes 3 L as fluids. For women of the same age, the AI is 2.7 L, which includes approximately 2.2 l from fluids  Methods to estimate fluid needs METHOD 30 ML/KG BODY WEIGHT EXAMPLE: A 70-KG PERSON NEEDS 2100 ML/DAY. (70 KG 30 ML/KG 2100 ML/D) 5. Inadequate fluid intake An inadequate intake of water can lead to dehydration, characterized by impaired mental function, impaired motor control, increased body temperature during exercise, increased resting heart rate when standing or lying down, and an increased risk of life-threatening heat stroke. Clinical situations in which water losses are increased—and thus water needs are elevated—include vomiting, diarrhea, fever, thermal injuries, uncontrolled diabetes, hemorrhage, certain renal disorders, and the use of drainage tubes. Fluid needs can be estimated by several methods. intake and output records are used to assess adequacy of intake. Excessive fluid intake An excessive water intake may cause hyponatremia, but it is rare in healthy people who consume a typical diet. Symptoms of hyponatremia include lung congestion, muscle weakness, lethargy, and confusion. Hyponatremia can progress to convulsions and prolonged coma death can result. 6. Understanding Minerals Minerals account for only about 4% of the body’s total weight. They are found in all body fluids and tissues. Eg) Calcium, phosphorus, magnesium, sulfur, sodium, etc Minerals do not undergo digestion nor are they broken down or rearranged during metabolism. Minerals are not destroyed by light, air, heat or acids during food preparation Minerals are lost only when they leach from foods soaked in water or when food is completely burned Classifications of Minerals The classification as major or trace minerals is based on the quantity in the body and amount needed, not by their importance. Both groups are essential for life Major Minerals Trace Minerals Calcium, phosphorous, magnesium, Iron,iodine,zinc,selenium,copper,ma sulfur , sodium, potassium, and nganese,fluoride, chromium,are chloride are considered major classified as trace minerals or minerals because they are present trace elements, because they are in the body in amounts greater present in the body in amounts less than 5gm(the equivalent of one than 5gm tspoon) As many as 30 other potentially harmful minerals are present in the body including lead, gold, and mercury. Their presence appears to be related to environmental contamination General functions of Minerals a. To provide structure to body tissue b. To regulate body process such as fluid balance c. Acid base balance that regulates blood pH. d. Transmission of nerve impulses and muscle contraction Mineral balance The body has several mechanisms by which it maintains mineral balance, depends on which mineral is involved, such as a. Releasing minerals from storage for redistribution as needed Eg) Calcium is released from bones to restore normal serum calcium levels when intake is inadequate b.Altering rate of absorption(GI absorption). for example, Iron absorption increases when the body is deficient c. Urinary excretion. Nearly all of the sodium consumed in the diet is absorbed. The only way the body can rid itself of excess sodium is to increase urinary sodium excretion. For most people, the higher the intake of sodium, the greater is the amount of sodium excreted in the urine. Excess potassium is also excreted in the urine. Mineral toxicities Minerals that are easily excreted, such as sodium and potassium, do not accumulate to toxic levels in the body under normal circumstances Instead, mineral toxicity is related to excessive use of mineral supplements, environmental or industrial exposure, human errors in commercial food processing, or alterations in metabolism. Mineral interactions Mineral balance is influenced by hundreds of interactions that occur among minerals and between minerals and other dietary components. For example, Caffeine promotes calcium excretion. whereas vitamin D and lactose promote calcium absorption. Vitamin C enhances the absorption of iron. High dose of iron supplements can impair Zinc absorption  Major sources of selected minerals by food group Food Group Potassium Calcium Phosporous Magnesium Iron Zinc Selenium Vegetables √ Fruit √ Grains √ √ √ Dairy √ √ √ √ √ √ Protein food √ √ √ Sources of minerals Generally, unrefined or unprocessed foods have more minerals than refined foods. Within most food groups, processed foods are high in sodium and chloride. Drinking water contains varying amounts of calcium, magnesium, and other minerals; sodium is added to soften water. Fluoride may be a natural or added component of drinking water. Mineral supplements Mineral supplements, alone or combined with vitamins, contribute to mineral intake To the greatest extent possible, nutrient needs should be met through food not through supplements. REFERENCES 1. CAROL TAYLOR ET AL., FUNDAMENTALS OF NURSING,2019,9TH EDITION, LIPPINCOTT WILLIAMS & WILKINS, PHILADELPHIA. 2. DUDEK, SUSAN G, NUTRITION ESSENTIALS FOR NURSING PRACTICE,9TH ED,2022, WOLTERS KLUWER HEALTH  RAK Medical & Health Sciences University RAK College of Nursing Year I BSN Program Course: Nutrition & Dietetics Topic: Nutrition for Patients with Cardiovascular Disorders and Kidney Disorders Dr.Vimala Edwin BSN.,MSN., Ph.D. Assistant Professor RAK College of Nursing. Learning outcome At end of the class the student will be able to 1.Discuss Heart Healthy eating pattern 2. Understand Nutrition for cardiovascular disease risks 3. Identify the nutritional therapy for secondary prevention of cardiovascular diseases 4Understand the nutrition in maintaining kidney health 5.Identify the nutrition therapy for Nephrotic Syndrome, Chronic Kidney Injury and renal stones Introduction Cardiovascular disease (CVD) is an umbrella term for diseases that affect the heart and blood vessels, such as coronary heart disease (CHD), stroke, heart failure (HF), hypertension, and arterial diseases. A healthy lifestyle throughout life , namely ,a healthy eating pattern ,adequate physical activity, avoidance of tobacco is the most important way to prevent heart diseases. The kidneys play many vital roles in maintaining overall health. Impairments in kidney function can cauase disruption in metabolism, Nutritional status and nutrient requirements. 1.Heart Healthy eating pattern Healthy eating patterns is to promote overall health and reduce the risk of all acute and chronic illness. Recommended diet for the primary prevention of Cardio Vascular Diseases(CVD). A.DASH (Dietary Approach to stop Hypertension) diet B. Mediterranean diet Both patterns of diet emphasize ✓The intake of vegetables, fruit, legumes, nuts, whole grains, vegetable oils and fish ✓And Consume higher in fiber, vitamins, antioxidants, minerals, phytonutrients, and unsaturated fat Phytonutrients- produced by the Plant Antioxidant- prevent or delay cell damage(Fruits & Veg) Limit the intake of Red and processed meat Refined grains Added sugars Butter High sodium foods and trans fat.(French fries) Limited Intake of B. Mediterranean Diet Another heart healthy food group approach is the traditional Mediterranean diet Likethe DASH diet, it is characterized by a high intake of vegetables, fruits, whole grains, plant proteins (e.g., nuts and legumes), and fish. In addition olive oil is included 2. Nutrition for cardiovascular disease risks (Selected) A. Overweight and obesity B. Hypertension C. Hypercholesterolemia 2. Nutrition for cardiovascular disease risks A. Overweight and obesity Comprehensive weight loss programs are recommended to attain and maintain weight loss. They consists of the following A hypocaloric diet such as 1200-1500 calories/day for women and 1500-1800cal/day for men Aerobic physical activity (Eg: Brisk walking) Self monitoring of intake, weight and physical activity and modified accordingly Nutrition Management Overweight and Obesity Use a healthy meal pattern DASH Mediterranean diet Low carbohydrate Low fat, high protein and vegetarian. B. Hypertension Hypertension is a symptom, not a disease, arbitrarily defined as sustained elevated blood pressure greater than or equal to 140/90 mmHg. Some of the diet related components that have been associated with hypertension include Overweight and obesity Excess intake of sodium. Inadequate intake of potassium, calcium, magnesium, proteins (particularly from vegetables ),fiber and fish fats. Recommended interventions for the prevention and treatment of hypertension Lose weight if overweight Consume DASH diet Limit sodium intake-Eg.Bread and rolls, Pizza, Sandwiches, Cured meats, Soup, Burritos and tacos Increase potassium intake unless contraindicated High potassium Diet include- ✓Dried apricots, raisins and prunes, Potatoes both sweet and white ,Leafy greens and legumes ✓Certain fruit and vegetables –Prune juice, Tomato, carrot, orange, and vegetable juice ✓Milk and yogurt ✓Seafood Dietary approaches to stop Hypertension Diet (DASH-Style Diet) The American Heart Association’s diet metric for ideal cardiovascular health is to consume appropriate calories within a DASH-style diet (Lloyd-Jones et al., 2010) that includes 4.5 or more cups of fruits and vegetables daily Two or more 3½ oz servings of fish per week, preferably oily fish Three or more servings of whole grains daily Fewer than 1500 mg sodium per day Less intake of sugar-sweetened beverages Four or more servings of nuts, legumes, and seeds per week Two or fewer servings of processed meats per week The amounts listed are based on a 2000-calorie diet and will vary depending on the calorie content of the diet. C. Hypercholesterolemia Hypercholesterolemia is the medical term for high cholesterol. But too much raises the risk of heart disease and other cardiovascular problems The ideal total cholesterol less than 200 mg/dl Nutritional therapy FOR Hypercholesterolemia continued Heart healthy eating patterns, such as the DASH diet and the Mediterranean –style eating pattern. These emphasis on vegetable, fruits, wholegrains, legumes, healthy protein sources (low fat dairy, low fat poultry fish, seafood, and nuts) and non tropical vegetable oils Egg yolks high in cholesterol , it is advisable to limit intake in healthy individuals to up to a whole egg daily D. Secondary prevention of cardiovascular diseases Secondary prevention of cardiovascular diseases focuses on the management of care for clients who have history of Eg) myocardial infection, angina, stroke, etc Goal: To prevent recurrent events , improve quality of life Treatment approaches Drug therapy Cardiac rehabilitation Life style intervention Healthy eating pattern Nutritional therapy for the secondary prevention of cardiovascular diseases Healthy eating pattern Mediterranean style eating pattern Individual preference should determine whether a DASH diet or Mediterranean –style eating pattern is used because both patterns are heart healthy and can be adjusted for appropriate calories and sodium content Nutrition for clients with kidney disorders Introduction The kidneys perform many vital functions. They maintain normal blood volume and composition by reabsorbing needed nutrients and excreting wastes through urine. Impairments in kidney function can cause widespread disruptions in metabolism, bone health, fluid balance, nutritional status, and nutrient requirements. Conversion of inactive vitamin D to its active form 4. Nutrition in maintaining kidney health The risk of several chronic diseases such as obesity, diabetes, hypertension, and cardiovascular diseases increases due to ✓High intake of red meat, saturated fat, trans fat added sugar and processed foods and a low intake of fruits, vegetables, whole grains and fish. These chronic diseases increase the risk of kidney disease. Healthy eating pattern DASH Diet –Lowering blood pressure and reduce inflammation Mediterranean –style eating pattern-May help preserve kidney function  5. A. Nephrotic Syndrome: a kidney disorder that occurs when increased capillary permeability in the glomeruli that results in losses of albumin and other plasma protein. Nutrition therapy Although nephrotic syndrome is characterized by increased urinary losses of albumin and other proteins, a high-protein diet is contraindicated because it worsens urinary protein losses, promoting further kidney damage. Nutrition therapy Nephrotic Syndrome continued…. Recommended protein intake in adult is 0.8 to 1g/kg/day Sodium intake < 2gm/day to help control edema and blood pressure Adequate Calorie intake approximately 35 cal/kg/ A low fat, low cholesterol diet is recommended. Supplements of vitamin D are provided when vitamin d deficiency is diagnosed B. Chronic Kidney Disease (CKD): Chronic kidney disease (CKD) is characterized by a gradual decline in renal function related to progressive and irreversible loss of kidney function. General Nutrition therapy for CKD- Nutrition therapy vary among individuals and according to the nature and stages of the disease. To slow the progression of CKD, Sodium is restricted to control blood pressure. Excessive protein intake is avoided to limit proteinuria. A heart-healthy diet is recommended to decrease the risk of cardiovascular disease. Glucose control in people with diabetes  Example Nutrition therapy for CKD continued….. Foods higher in Potassium and phosphorous(Food preservatives and processed foods) are restricted Vitamin D supplements to correct impaired vit D metabolism resulting from decreased kidney function. As renal function deteriorates, ✓Diet modifications are made in response to symptoms ✓Eventually alterations in the intake of protein, calories, potassium, phosphorus, calcium, and other vitamins and minerals are necessary Milk products , a rich source of calcium are generally restricted because they are also high in phosphorous. Vitamin D supplements to correct impaired vit D metabolism Iron supplementation is used to treat anemia of CKD. C. KIDNEY STONES Stones are formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase. They vary in size from sand-like “gravel” to large, branching stones, and although they form most often in the kidney, they can occur anywhere in the urinary system. Nutrition therapy for kidney stones Nutrition therapy cannot dissolve a kidney stone Increasing fluid intake may help promote its excretion However, nutrition and lifestyle may help prevent stones formation The DASH diet, for preventing kidney stones Avoid frequent intake of sugar –sweetened beverages has been reported to increase the risk of kidney stones by 30% to 40%. NUTRITION RECOMMENDATIONS FOR KIDNEY STONES Drink more fluid throughout the day(if not contraindicated), with most in the form of water. Avoid high-oxalate foods: peanuts, tree nuts (such as almonds, cashews, hazelnuts), soybeans, soy milk, wheat bran (including cereals), spinach, black tea, instant tea, beets, most dried beans ,chocolate, and sweet potatoes. Avoid large doses of supplemental vitamin C. Maintain adequate calcium intake (e.g., 3 servings/day) that is spread out over the day. Avoid high intakes of animal protein and sodium References 1. Dudek, Susan G, Nutrition Essentials for Nursing Practice,9th ed,2021, Wolters Kluwer Health RAK Medical & Health Sciences University RAK College of Nursing Year I BSN Program Course: Nutrition & Dietetics Topic: Vitamins Dr.Vimala Edwin BSN.,MSN., Ph.D. Assistant Professor RAK College of Nursing. Learning outcome At end of the class the student will be able to 1. Understand the classification of vitamin, its functions, sources and deficiency 1. Understanding vitamins Vitamins are organic compounds made of carbon, hydrogen, oxygen, and sometimes, nitrogen or other elements. Vitamins helps to regulate body processes such as growth and metabolism(Chemical reactions in the body cells that change food into energy). Vitamins are needed in microgram or milligram quantities, not gram quantities, and so are called micronutrients Vitamins are Susceptible to Destruction Vitamins in food are susceptible to destruction and subsequent loss of function. Thiamin is heat sensitive and is easily destroyed by high temperatures and long cooking times. Riboflavin is resistant to heat, but is quickly destroyed by light. That is why riboflavin-rich milk is sold in opaque, not transparent, containers. Folate(Vitamin B9) From 50% to 90% of folate in foods may be lost during preparation, processing, and storage. Vitamin C is destroyed by heat, air, and alkalis. Functions of vitamin a. Important for reproduction, needed for vision and acts as a hormone to regulate growth Eg) vitamin A b. Vitamins are Coenzymes- Many enzymes cannot function without coenzyme and many vitamins are coenzymes. Participates in enzymatic reactions that extract energy from glucose, amino acids, and fat. C. Some Vitamins are antioxidants Antioxidants protect body cells from being destroyed..Eg)Major antioxidants are vitamin C, vitamin E d. Some vitamins are food additives Some vitamins are used a food additives in certain foods to boost their nutritional content. Eg) Vitamin C enriched drinks e. In mega doses, vitamins function like drugs , not nutrients. Eg) Vitamin C promote wound healing for patients with impaired bone and wound healing A. Vitamin classifications based on solubility  Fat-Soluble Vitamins Vitami Recommende Sources Functions d Dietary n Allowance RDA Vitamin Adult RDA: beef, liver, milk, Enables the eye to adapt to A Men: 900 g butter, cheese, dim light Women: 700 cream, egg yolk, Normal growth and g margarine, development of bones and “greens”(turnip, teeth beet, spinach, To maintain healthy broccoli, carrots, functioning of skin and peaches, pumpkin, membranes, hair, gums, and sweet potatoes, various glands mango, apricots Important role in immune function  Fat-Soluble Vitamins Vitamin Recommended Sources Functions Dietary Allowance RDA Vitamin Adult RDA: Sunlight on Stimulating the D Up to age 70 the skin release of calcium years: Cod liver oil, from the bones 15 g/day oysters,most Stimulating calcium 71 years: fish,egg yolks, absorption from the 20g/day fortifi ed kidneys milk, cereals, and margarine  Fat-Soluble Vitamins Vitamin Recomme Sources(selected Functions nded ) Dietary Allowance RDA Vitamin E Adult RDA: Vegetable oils, ✓ Acts as an antioxidant 15 mg salad to protect vitamin A and dressing, nuts, polyunsaturated fatty seeds, dark green acids from being vegetables, Destroyed whole grains, ✓ Protects cell cereals membranes  Fat-Soluble Vitamins Vitamin Recommende Sources Functions d Dietary Allowance RDA Vitamin K Adult AI: Broccoli, Synthesis of blood clotting Men: 120 g cauliflower, Proteins(Eg Fibrinogen) and a Women: 90 g spinach, lettuce, bone protein that regulates carrots, green blood calcium beans,eggs  Fat soluble Vitamin Deficiency Vitamin Deficiency disease(Selected) Vitamin A Xerophthalmia(Dry eyes), Blindness Bone growth ceases; Vitamin D Rickets (in infants and children) Retarded bone growth Bone malformations (bowed legs) Vitamin E Skin lesions Vitamin K Hemorrhaging (Bleeding) Water-Soluble Vitamins  Water-Soluble Vitamins Vitamin Recommended Sources Functions Dietary Allowance RDA Thiamin Adult RDA Whole-grain Promotes normal (vitamin Men: 1.2 mg and enriched appetite and B1) Women: 1.1 mg breads nervous and cereals, liver, system functioning nuts, pork, dried peas and beans  Water-Soluble Vitamins Vitamin RDA Sources Functions Riboflavin Adult RDA Milk and other dairy Coenzyme in energy (vitamin Men: 1.3 mg products; whole-grain metabolism B2) Women: 1.1 and enriched breads mg and cereals; liver, eggs, meat, spinach Vitamin B6 Men: 1.3–1.7 Meats, fish, poultry, Helps produce insulin, (Pyridoxine mg fruits, green hemoglobin, myelin ) Women: 1.3– leafy vegetables, whole Sheaths(layers around 1.5 mg grains, nerves), and nuts, dried peas and antibodies beans  Water-Soluble Vitamins Vitamin Recommended Sources Functions Dietary Allowance RDA Vitamin Adult RDA: 2.4 g Animal products: Synthesis of new B12 meat, fish, poultry, cells shellfish, milk, dairy Maintains nerve cells products, eggs Helps metabolize some fatty acids and amino acids Vitamin Recommended Sources Functions Dietary Allowance RDA Vitamin C Adult RDA Citrus fruits and Antioxidant Men: 90 mg juices, red Promotes iron Women: 75 mg and green absorption peppers, broccoli, Involved in the cauliflower, metabolism of kiwifruit, certain amino strawberries, acids tomatoes Immune system functioning  Water Soluble Vitamin- Deficiency Vitamin Deficiency disease(Selected) Vitamin B1 Beriberi (Mental confusion, decrease in short term Memory, etc) Vitamin B2 Cheilosis(Inflammation of the both or one corner of the mouth) Glossitis(Inflammation of the Tongue) Vitamin B6 Dermatitis, cheilosis, glossitis, Vitamin B12 Glossitis, anorexia, indigestion, recurring diarrhea or constipation, and weight loss, Anemia Vitamin C Scurvy, Bleeding Gums Summary Vitamins are organic compounds made of carbon, hydrogen, oxygen, and sometimes, nitrogen or other elements. They differ in their chemistry, biochemistry, function, and availability in foods. Vitamins facilitate biochemical reactions within cells to help regulate body processes such as growth and metabolism. References 1. Dudek, Susan G, Nutrition Essentials for Nursing Practice,9th ed,2021, Wolters Kluwer Health RAK Medical & Health Sciences University RAK College of Nursing Year I BSN Program Course: Nutrition & Dietetics Topic: Nutrition for Patients with Obesity and Diabetes Dr.Vimala Edwin BSN.,MSN., Ph.D. Assistant Professor RAK College of Nursing. Learning outcome At end of the session the student will be able to 1.Define obesity 2.List the causes of obesity 3. Understand the classification of Obesity 4. Explain the management of overweight and obesity 5. Define Diabetes and identify the diagnostic criteria for Diabetes and prediabetes 6. Discuss the management of diabetes Introduction Obesity is a complex chronic condition that typically develops over an individuals lifetime. Obesity is a problem of excessive calorie intake. Obesity has expanded its reach globally, and many people in UAE have also been affected. Diabetes is one of the most costly and burdensome chronic diseases.Increasing prevalence of overweight and obesity are at higher risk of diabetes. Nutrition therapy is a vital component of diabetes prevention and management.  As per the latest UAE Obesity statistics the prevalence of this ailment among small children and teenagers is from 6% to 15% in males and from 4% to 19% in females. In adult males the range is 2% - 29%, and for adult females, it is 4% - 46%. These statistics clearly indicate that individuals in UAE are on the edge of experiencing severe ailments that occur due to obesity. 1. Obesity Obesity can be defined as abnormal or excessive body fat accumulation that leads to adverse health consequences. The cause of obesity seems obvious :excessive calorie intake compared to calorie expenditure over a period of time (ie.,people eat more calories than they use) 2. Causes of Obesity i)Dietary patterns and inactivity are among the primary contributing factors. Obesity occurs when calorie intake exceeds calorie expenditure (i.e., people eat more calories than they use) ii)Genetic iii) Physiological Causes of obesity continued…. Physiological factors Diseases- Eg) Hypothyroidism, Cushing syndrome Hormonal Side effects of medications-Eg) Antidepressants, Antipsychotics, Corticosteroids Mental disorders – Eg) Depression, Eating disorder Factors that may contribute to obesity iv.Sociocultural/ Behavioural – Eg) Preference of foods high in fat and carbohydrates Increase in sedentary occupations Lack of adequate sleep v.Environmental – Communities not conducive to physical activity Living near high concentration of fast food restaurants 3.Understand the classification of Obesity Body Mass Index BMI is calculated by dividing weight in kilogram by height in meters squared. BMI is considered as a screening tool to identify obesity Waist circumference Waist circumference is a measure of central obesity. It is not used routinely to diagnose overweight and obesity Still waist circumference is a strong predictor of obesity. ≥  Measures of Obesity Categories BMI(kg/m2) Obesity Class Underweight