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NUTRITION AND DIET THERAPY LECTURE PRELIMS (MNT), group dietary therapy and food service INTRODUCTION AND mana...

NUTRITION AND DIET THERAPY LECTURE PRELIMS (MNT), group dietary therapy and food service INTRODUCTION AND management. IMPORTANCE OF NUTRITION NUTRITION CONCEPTS OF NUTRITIONAL SCIENCE It is the science that interprets the interaction of nutrients and other substances in food in NUTRITION EDUCATION relation to maintenance, growth, Allows patients to learn about the dietary reproduction, health and disease of an factors that a ect their particular medical organism. condition. It is essential for growth and development, Ideally, this knowledge motivates them to health and wellbeing. Eating a healthy diet change their diet and lifestyle to improve their contributes to preventing future illness and health status. improving quality and length of life. A nutrition education program should be According To American Medical Assoc. tailored to a person’s age, level of literacy, It is the science of food, the nutrients and the and cultural background. substances. Learning style should also be considered: It is study of all the processes (digestion, some peoplelearn best by discussion absorption, metabolism, etc.) and how the supplemented with written materials. body absorb and utilize food substances. As Nutrition is the foundation of good health, According To World Health Org. education is the cornerstone of good nutrition It is an input to and foundation for health and because to attain good nutrition, the development. individual must be taught to make good food Better nutrition means stronger immune selection and to maintain an env’t conducive systems, less illness and better health. to the utiilization of the nutrients provided by Healthy children learn better. Healthy people the food. are more stronger, are more productive. According To Babcock (1961) Nutritionist “To establish good food habits, people must a person who advises on matters of food and be able to learn, and nutrition educators must nutrition that impacts on health. be able to teach.” a quali ed nutrition professional that has the expertise to provide a range of evidence IMPORTANCE OF NUTRITION based nutrition services related to nutrition, Good health, vitality and energy public health nutrition, policy and research, To mature at the proper time and community health. To overcome the stresses of the environment DIETICS To ful ll this biological life To enjoy extended time of life It is the interpretation and communication of To withstand the many hazards of aging. the science of nutrition where individual can To prevent obesity and diet-related diseases make practical choices about food and life style in terms of both health and diseases. IMPORTANCE OF NUTRITION TO NURSING Dietitian Education is the key factor in enabling nurses are the healthcare professionals and experts to instigate nutritional care appropriately. who treats nutritional problems and overview Nursing students need to be educated in the the patients by providing dietary needs, plans screening and assessment, planning, menus, and instructs patients and their implementation and evaluation of nutritional families about proper nutritional care. care. They have the expertise to provide individual A rm grounding in the principles of dietary counselling, medical nutrition therapy nutritional science is essential to understand RAGUINDIN | BSN II - JOHNSON Page 1 fi fi fi ff  NUTRITION AND DIET THERAPY LECTURE PRELIMS the rationale behind the components of Dietary Minerals, Vitamins, And Water nutritional care. Substances that support metabolism As a future nurse, studying nutrition is Non-Nutrient important in order to give the best nursing Some substances that are useful, neutral, or care to your clients. detrimental to health. To know the right diet or food required/ e.g: alcohol, pigments, additives and prescribed to a certain patients. phytochemicals Enables you as the primary care giver to Food Additives impart health teaching about the patient’s Preservatives, avours and colors food intake thus leads to a faster recovery or It makes the food safe if you keep it for an maintenance of health. extended period GOOD NUTRITION Help preserve freshness by increasing the acidity of a food. An acidic food creates a It is the basis for good health. It enhances hostile environment for microorganisms. appearance as it is exempli ed by shiny hair, e.g: acids like lemon juice and vinegar clear skin, clear eyes, erect posture, alert expression and rm esh on well-developed Sugar bone structures. Helps preserve foods by absorbing excess water FOOD Without water, microorganisms cannot grow It is necessary to our survival. it sustain life inside a food. and promote growth. Salt It acts as a body fuel that gives energy It has long been used to prevent meat and required for bodily functions. are products sh from spoiling. derived from plants/ animals. Like sugar, salt inhibits the growth of microorganisms by reducing the amount of TYPES OF FOODS water available to them. Plants Oil - grains, cereal corn, oats and wheat pulses Helps foods stay fresh by preventing Fruits and vegetables microorganisms from coming into contact - tubers, cassava, sweet potato with the food. Nuts It reduces the rate of oxidation in a food, - oil seed – olive, sesame, coconut, soybean which helps prevent it from spoiling quickly. oil, seaweed agar, carageenan Spices Animals Some spices seem to retard the growth of Meat and Entrails microorganisms while some also reducing the Milk, Eggs, and Shell sh rate of oxidation Poultry and Fish e.g: cloves, mustard, sage, thyme, rosemary and oregano. COMPONENTS OF FOOD PHYTOCHEMICALS NUTRIENTS Compounds produced by plants. They are found in edible fruits, veggies and It is the product of digestion of foods which other plant-derived foods that have biological are the nourishing material vital for human activity in the body and according to research functioning. that it is use in the prevention of chronic They are used to build and repair tissues, diseases such as CA and CVD regulate body processes and are converted Some researches estimate there are up to to and used as energy. 4000 pythochemicals but only a small fraction Cho, Chon, And Fats have been studied closely. Substances that provide energy RAGUINDIN | BSN II - JOHNSON Page 2 fi fl fi fl fi fi  NUTRITION AND DIET THERAPY LECTURE PRELIMS Common names: avones, iso avones, allyl sul des, phytonutrients, polyphenols, CLASSIFICATION OF NUTRIENTS cathechins, carotenoids, anthocyanidins and CHO isothiocyanates Lycopene Also known as your carbohydrates Bene t/s: They are composed of carbon, oxygen, and cancer (prostate), heart health hydrogen atoms, are macronutrients and Source/s: energy sources for the body, converted into tomatoes, grapefruit, watermelon, red sugar for cell use. peppers A carbohydrate is an organic compound Lutein made up of carbon, hydrogen, and oxygen. They are one of the three main Bene t/s: macronutrients in our diet, along with proteins eye health, cancer, heart health and fats, and they serve as the body’s Source/s: primary source of energy. spinach, broccoli, lettuce Sources Betacarotene Simple carbohydrates Bene t/s: - Sugars found in fruits (apple, oranges, immune system, vision, skin health, bone banana), milk, sweeteners like honey health and sugar. Source/s: - These are the sugar molecules, yello, orange and dark green foods consisting of one or two, that are quickly Resveratrol absorbed by the body. Bene t/s: Complex carbohydrates heart lung health, cancer, in ammation - Beans, peas, whole grains, barley, oats, Source/s: brown rice red wine, grapes, peanuts - These consist of long chains of sugar Anthocyanidins molecules, which take longer for the Bene t/s: body to break down and provide a blood vessel health steady release of energy. Source/s: Fibrous carbohydrates red and purple berries, red radishes, red - Fresh vegetables like pumpkin, carrot, potato tomatoes, beans, broccoli, cucumbers, Iso avones squash. Bene t/s: - These foods are rich in dietary ber, menopause, breast cancer, bone health, joint which is not digested by the body but is in ammation, lower cholesterol crucial for maintaining digestive health Source/s: and preventing certain diseases. soybeans Functions Allylic Sulphites Main source of energy Bene t/s: Maintain a healthy digestive system Aids in fat metabolism antioxidant, anti-in ammatory Lower blood cholesterol Source/s: Retains protein from being burned garlic De ciency Diseases Lignans Hypoglycemia: Low blood sugar causing Bene t/s: disorientation, fatigue, and dizziness lowered risk of heart disease, menopausal Ketosis: There is insu cient carbohydrate symptoms, osteoporosis, breast cancer intake, causing the body to burn fat for Source/s: energy wheat RAGUINDIN | BSN II - JOHNSON Page 3 fl fi fi fl fi fi fi fi fi fi fi fi fl fl ffi fl fi fl  NUTRITION AND DIET THERAPY LECTURE PRELIMS Toxicity Diseases Kidney damage Obesity FATS Type 2 diabetes mellitus Dental caries Fats are also called ‘fatty acids’ or ‘lipids.’ Metabolic syndrome Fats in our body are made up of three Dyslipidemia molecules joined together. This three-molecule structure is called a CHON “triglyceride”. Protein or CHON are large complex organic SATURATED FATS compounds composed of amino acids as the building units linked together in peptide Have been linked to an increase in LDL (low- bonds. density lipoprotein) cholesterol, often It contains carbon, hydrogen, oxygen, referred to as “bad”cholesterol. nitrogen. UNSATURATED FATS From the greek word “protos” which means “primary”or”holding rst place” or “of prime Polyunsaturated fats play a crucial role in importance”and it is the rst substance overall health. Omega-3 fatty acids, in recognized as a vital part of a living tissue particular, are known for their anti- Sources in ammatory properties and are bene cial for Animal sources: Meat, poultry, sh, eggs, heart health, and brain function. and dairy products Monounsaturated fats are considered heart- - They provide high-quality proteins healthy because they can help lower LDL containing all essential amino acids cholesterol levels while maintaining or even Plant sources: Legumes, nuts, seeds, whole raising HDL (high-density lipoprotein) grains, and vegetables cholesterol, often referred to as “good” - They o er protein, although some may cholesterol. lack certain essential amino acids, TRANS FATS making them incomplete proteins These are arti cially created fats found in Functions processed foods, which increase LDL (bad) Build, repair worn out body cells and tissue cholesterol and decrease HDL (good) proteins cholesterol. Source of heat and energy Take part in essential body secretions and TRIGLYCERIDES uids, enzymes, and proteins The most common type of fat in the body, Regulates osmotic pressure made up of three fatty acids and glycerol. Resistance of the body to infections/ High levels of triglycerides in the blood can diseases increase the risk of heart disease. De ciency Diseases Marasmus: It is marked with “old man’s PHOSPHOLIPIDS face” ((no edema), thin muscles, head looks A type of fat that makes up cell membranes bigger than the body, prominent ribs, normal and plays a crucial role in protecting cells. hair. They are also involved in transporting fats in Kwashiorkor: It is marked with loosed, thin the bloodstream. muscles, “moon’s face” (due to edema), swollen belly, pigmented legs, hair changes STEROLS (coarse, sparse, usually discolored) A category of fats that include cholesterol. Toxicity Diseases While cholesterol is essential for making Hyperammonemia hormones and building cells, too much can Uremia lead to plaque buildup in arteries, increasing Protein poisoning the risk of heart disease. RAGUINDIN | BSN II - JOHNSON Page 4 fl fl fi ff fi fi fi fi fi  NUTRITION AND DIET THERAPY LECTURE PRELIMS Sources Water-soluble vitamin and essential cofactor Unsaturated for collagen biosynthesis, carnitine and Monounsaturated catecholamine metabolism, and dietary iron - Peanut butter, almonds, cashews, absorption. hazelnuts, peanuts and pistachios. Sources Polyunsaturated Citrus fruits, Peppers, Strawberries, - Oily sh like kippers, mackerel, and Blackcurrants, Broccoli, Brussels sprouts, salmon. Potatoes Saturated Functions - Processed and fatty meats Whole milk, Plays a role in protein metabolism. cream, and ice cream. Butter, lard, ghee, Supports the immune system suet, palm oil, and coconut oil. Important for proper wound healing and Trans tissue repair - Fried foods and takeaways. Snacks like De ciency Diseases biscuits, cakes, pies, and pastries. Scurvy Functions Toxicity Diseases Fat helps absorb vitamins, like vitamins A, D, Hypervitaminosis C (lead to gastrointestinal E, and K issues) Fat keeps our skin healthy Kidney stones Essential fats like Omega-3 are important for High doses of Vitamin C may interfere with heart health the absorption of other essential nutrients Healthy fats, like unsaturated fats from plant VITAMIN B1 - THIAMINE oils, can help lower levels of LDL (lousy) cholesterol It is one of the 8 B-complex vitamins and is Fat adds avor to food classi ed as a water-soluble vitamin that Fat keeps you feeling satis ed longer after a travels through the bloodstream. meal It occurs naturally in speci c diets, is added De ciency Diseases to food products, and is available in dietary Heart Diseases supplements. Night blindness and osteomalacia. Sources Weakened Immune System Whole grains and forti ed cereals, legumes, Hormonal Imbalance: Disruption in hormone pork, brewer’s yeast and yeast extracts, sh, production, leading to reproductive issues. nuts and seeds Neurological disorders, dry skin, Functions in ammation. Helps prevent complications in the: nervous Dermatitis system, brain, muscles, heart, stomach, Bone Health Issues intestines Toxicity Diseases Helps the body’s cells change carbohydrates Obesity into energy. Cardiovascular Diseases Plays a role in muscle contraction and Type 2 Diabetes conduction of nerve signals. Liver Disease Important for the metabolism of pyruvate, Certain Cancers: breast and colon cancer. which is an important molecule in several Hypertension chemical reactions in the body. In ammation De ciency Diseases Metabolic Syndrome Beriberi: Wet Beriberi or Dry Beriberi VITAMIN C Wernicke-Korsako Syndrome: - Wernicke’s Encephalopathy It is an antioxidant that helps prevent cell - Korsako ’s Psychosis damage caused by free radicals RAGUINDIN | BSN II - JOHNSON Page 5 fl fl fi fi fi fi fi ff fl ff fi fi fi fi  NUTRITION AND DIET THERAPY LECTURE PRELIMS Toxicity Diseases body convert food (carbohydrates) into fuel High-Dose Supplementation E ects (glucose), which the body uses to produce - Allergic Reactions energy. - Gastrointestinal Issues Sources Intravenous Administration Beef, pork, poultry, sh, brown rice, forti ed - Injection Site Reactions cereals and breads, nuts, seeds, legumes and - Systemic Reactions bananas. Functions VITAMIN B2 - RIBOFLAVIN Responsible for converting the food we eat It is a water-soluble vitamin. It is a key into energy and helps the body to use component of two coenzymes, avin proteins and fats, and it keeps the skin, hair, mononucleotide (FMN) and avin adenine and nervous system healthy. dinucleotide (FAD), which are essential for De ciency Diseases numerous metabolic processes in the body. Pellagra: three main symptoms- dermatitis Sources (skin rashes), diarrhea, and dementia (mental Dairy products, Forti ed cereals and grains, confusion or memory loss). Meat and poultry, Fish and seafood, Fruits Toxicity Diseases and vegetables. Liver damage and stomach ulcer Functions Dizziness Essential for body growth and development Low blood pressure Used to metabolize carbohydrates, fats, and Fatigue protein into glucose for energy. Nausea Helps in health of the mouth, skin, eyes, and mucosa of intestine VITAMIN B5 - PANTOTHENIC ACID Responsible for the yellow color of urine: It is a water-soluble vitamin that helps the occurs when taking vitamin tablets. body break down fats and carbohydrates for De ciency Diseases energy. Aribo avinosis Sources - Cheilosis Meat, sh, grains, dairy products and - Angular Stomatitis legumes. - Glossitis Functions Eye Issues It is essential for overall health, supporting - Photophobia energy production by metabolizing - Conjunctivitis carbohydrates, fats, and proteins, and Neurological Symptoms aiding in the synthesis of Coenzyme A, Numbness and Tingling crucial for biochemical reactions like fatty Toxicity Diseases acid production. Ribo avin has a low toxicity pro le De ciency Diseases A ribo avin de ciency most often occurs with Pantothenic acid de ciency may other nutrient de ciencies, such as in those causesymptoms like fatigue, irritability, who are malnourished. numbness, muscle cramps, and a condition Ribo avin may cause urine to have a more called “burning feet syndrome” characterized yellow color than normal, especially if large by pain and a sensation of burning in the feet. doses are taken. Toxicity Diseases VITAMIN B3 - NIACIN Fatigue Insomnia It is also known as nicotinic acid and has 2 Depression other forms, niacinamide (nicotinamide) and Gastrointestinal disturbances (diarrhea and inositol hexanicotinate, which have di erent abdominal cramps) e ects from niacin. All B vitamins help the Respiratory infections RAGUINDIN | BSN II - JOHNSON Page 6 ff fi fi fi fl fl fl fl fi fi fi fi fi fi fl fl fi ff ff fi  NUTRITION AND DIET THERAPY LECTURE PRELIMS VITAMIN B6 - PYRIDOXINE Conjuctivitis Nueropathy A water-soluble vitamin that plays a crucial Depression role in various physiological processes and Anemia also involved in over 100 enzyme reactions Muscle pain primarily related to protein metabolism Toxicity Diseases Sources Biotin is generally considered to be safe and Fish, beef liver and other organ meats, does not cause toxicity when excess potatoes and other starchy vegetables, and amounts are given. The excess is excreted in fruits. urine. Functions Helps the body ght infections VITAMIN B9 - FOLATE/FOLIC ACID Maintain nerve function Folate: The natural form found in foods like Produce hemoglobin leafy greens, legumes, and certain fruits. Helps break down proteins and Folic Acid: The synthetic form used in Regulate blood sugar levels supplements and forti ed foods. De ciency Diseases Sources Associated with microcytic anemia, Green leafy vegetables, organ meats (liver), electroencephalographic abnormalities, lean beef, wheat, eggs, sh, dry beans, dermatitis with cheilosis and glossitis, lentils, cowpeas, asparagus, broccoli, depression and confusion, and weakened collards, yeast. immune function. Functions Toxicity Diseases Essential for biosynthesis of nucleic acids Microcytic Anemia Essential for the formation of red and white Dermatitis blood cells, and for their maturation Depression Is a single-carbon carrier in the formation of Weakened immune function heme. VITAMIN B7 - BIOTIN Functions as a coenzyme-tetrahydrofolic acid. It is a cofactor for enzymes that are involved Necessary for Neural Tube Development in the biochemical processes. It is non-toxic Plays a pivotal role in improving the cognitive and doses above normal is not serious or functioning of the brain lethal. De ciency Diseases Sources Megaloblastic Anemia Avocados, Egg yolks, Nuts (e.g., almonds. Growth Retardation in Children peanuts), Cauli ower, Salmon, Seeds (e.g.. Cognitive Impairments; Increased risk of sun ower seeds) dementia Functions Elevated Homocysteine Levels; associated Metabolizes fats with cardiovascular diseases Converts carbohydrates into glucose. Toxicity Diseases Assists in protein metabolism Masking Vitamin B12 De ciency Supports cellular energy production Autism spectrum disorder (ASD) Promotes healthy hair growth. Potential Cardiovascular Risks Maintains skin integrity Insulin Resistance and Obesity in O spring Strengthens nails. Regulates gene expression VITAMIN B12 - COBALAMIN De ciency Diseases It is a water-soluble vitamin that plays a Dermatitis crucial role in the production of red blood Hair loss (Alopecia) cells and the proper functioning of the Brittle nails nervous system. RAGUINDIN | BSN II - JOHNSON Page 7 fi fi fi fl fl fi fi fi fi ff  NUTRITION AND DIET THERAPY LECTURE PRELIMS Sources VITAMIN E - TOCOPHEROL Meat, poultry, sh, eggs, and dairy products. It can be added to some breakfast cereals It is an oxidation resistant fat-soluble vitamin and nutritional yeasts. that is an excellent source of antioxidants needed to scavenge free radicals from bodily Functions cells. Red blood cell formation Tocopherol Nervous system function - the main compound that has antioxidant Metabolism activity in the oilseeds. Energy production Tocotrienol De ciency Diseases - The tocotrienol are used for people who Anemia have high cholesterol, cancer, stroke, Neurological problems and many conditions. Increased risk of heart disease Increased risk of certain cancers 8 Chemical Forms Alpha-tocopherol Toxicity Diseases Beta-tocopherol It can cause gastrointestinal side e ects such Gamma-tocopherol as diarrhea, nausea, and abdominal pain. Delta-tocopherol VITAMIN A Alpha-tocotrienol Beta-tocotrienol It is essential in the normal physiological Gamma-tocotrienol functioning of vision, immunity, reproduction Delta-tocotrienol and growth and development. Vitamin A is the name of a group of fat- Sources soluble retinoids, primarily retinol and retinyl Plant oils, nuts and seeds, cereals, meat, esters as well as retinoic acid. poultry, eggs, tomatoes, broccoli, spinach. Sources Functions Beef liver, sweet potato, carrots, black-eyed Antioxidant peas, spinach, broccoli, mango, tomato Protection against heart disease Enhances immune function Functions Protects cells from free radical damage Helps form and maintain healthy teeth, skeletal and soft tissue, mucus membranes, De ciency Diseases and skin, it is a nutrient important to vision, Ataxia (a neurological disorder that a ects growth, cell division, development, coordination and balance.) reproduction and immunity. Muscle weakness Vision Problems De ciency Diseases Impaired speech Night Blindness (Nyctalopia) Peripheral neuropathy Xerophthalmia Keratomalacia Toxicity Diseases Bitot’s spots Gastrointestinal disturbances. Growth Retardation Neurological symptoms Infertility Vision problems: Blurred vision. Blood clotting issues Toxicity Diseases Hypervitaminosis: A that can result in VITAMIN K signi cant organ damage, including the liver, A fat-soluble vitamin essential for several bones, central nervous system, and skin. bodily functions, including blood clotting, Hypercalcemia: elevate blood calcium levels bone health, and possibly heart health. and an imbalance in the regulation of bone Vitamin K1 metabolism. - Under the Vitamin K1, this has Phylloquinone which is the natural version RAGUINDIN | BSN II - JOHNSON Page 8 fi fi fi fi fi ff ff NUTRITION AND DIET THERAPY LECTURE PRELIMS of K1 and the Phytonadione which is the CHEMICAL PROPERTIES synthetic type of K1. - This is known as the only form that is Organic Nutrients available in the United States. It contains hydrogen, oxygen and carbon( an Vitamin K2 element found in all living things). - Under the Vitamin K2, this has the Organic means “literally alive” Menaquinone. Before the body can use organic nutrients, it Vitamin K3 must be broken down into their smallest - Under the Vitamin K3, this has the components. Menaphthone and Menadione. Ex. CHO, CHON, fats and vitamins. CHON Sources and vits. contain nitrogen. Vitamin K1: green leafy vegetables Inorganic Nutrients Vitamin K2: animal products, dairy, and They contain no carbon. fermented foods. They are already in their simplest form when Functions the body ingest them. Blood Clotting Minerals (Dietary) Bone Health They are the simplest nutrient. Each mineral is Heart Health a chemical element, its atom are alike. As a Brain Function result, its identity never changes. Wound Healing They are not broken down and changed by the body. They leave the body as they CLASSIFICATION OF NUTRIENTS entered it. Too much or too little of a mineral may AS TO: adversely a ect a persons health. FUNCTIONS ESSENTIALITY Cho, Chon, And Fats It refers to the important contribution to the Provide energy body’s physiological functioning Protein Essential Nutrients For growth repair and maintenance of the These nutrients are required for life. body It is also called as “indispensable nutrients” Minerals Essential means more than just “necessary”. It regulates body processes These must be obtain from food because the Vitamins body cannot make them for itself in su cient Vital helpers in many body processes quantity to meet physiological needs. It includes many amino acids, some fatty Water acids, many vitamins and some minerals and It is a food as well as nutrient. It helps trace elements. regulate the various processes such as e.g: Amino acids - phenylalanine, circulation, digestion and elimination and tryptophan, lysine, leucine, isoleucine, valine, respiration. threonine, methionine. The next simplest nutrient is water, a e.g: Fatty acids – linoleic and linolenic acids. compound made of 2 elements (hydrogen and oxygen) Non-Essential Nutrients Needed for metabolic reactions. These are those nutrients that can be made Supplies the medium for transporting by the body, they may often also be absorbed materials to cells and waste products away. from consumed food. e.g: cholesterol RAGUINDIN | BSN II - JOHNSON Page 9 ff ffi NUTRITION AND DIET THERAPY LECTURE PRELIMS CONCENTRATION - The fuel factor of CHO is 4 kcal/gram - Protein yields 4 kcal/gram Some nutrients are needed in large amount - Fat yields 9 kcal/gram than others. - Alcohol yields 7 kcal/gram Macronutrients - Fat therefore, has a greater energy density CHO, CHON, Fats and Water are collectively than either CHO or CHON. known as macronutrients because they are Bomb Calorimeter needed by our body in relatively large It can be used to determine the calorie amounts. content of a product. They are essential to provide energy and to It is used in food and metabolic studies to regulate and control the di erent functions of examine the e ects of energy content in food the body. on humans and animals. Micronutrients Energy In The Body Vitamins and Minerals are called as The body uses the energy-yielding nutrients micronutrients as the body needs them in to fuel all its activities smaller amount or quantity. It sends electrical impulses thru the brain and Nutrient Density nerves. to synthesize body compounds and It refers to the concentration of nutrients in a to move muscles. given amount of food source relative to its If the body does not use these nutrients to caloric content fuel its current activities, it rearranges them Consider calories from CHO, fats, protein, vits into storage compounds (such as body fat), and minerals and water. The higher the to be used between meals and overnight nutrient density, the greater the nutritional when fresh energy supplies run low value in a small amount of food. If more energy is consumed than expended, Calorie the result is an increase in energy stores and It represents the energy measurement of weight gain. nutrients that foods provide. If less energy is consumed than expended, The energy released from CHO, fats and the result is a decrease in energy stores and proteins can be measured in calories. weight loss Energy Density If alcohol can be consumed in excess can be It is a measure of the energy a food provide converted to body fat and stored. relative to the amount of food. (kcalories per MEASUREMENTS gram). Foods high in energy density help w/ Household Measures weight gain, whereas those w/ a low energy Cups, quarts and teaspoons density help w/ weight loss. Metric Measures Alcohol is not considered a nutrient bec it can Millilitres, liters, and grams interferes w/ growth, maintenance and repair Volume of the body but it does yield 7 kcal per gram 1L = 1000 ml when metabolized in the body. 0.9L = 1 quart Energy is expressed in.. 1ml =0.03 d. Oz - 1000 calorie metric units known as 240 ml = 1 cup kilocalories (kcalories/kcal) but Weight: Grams commonly called “calories”. 1 g = 1000 mg - Kilojoules (kj): international unit of work 1 g = 0.04 oz energy 1 oz. = 28.35 g or 30 g - 1 kcal is equal to 4.2 kj 100 g = 3 ½ oz. When cho, fats and proteins completely 1 kg = 2.2 lbs broken down in the body:(by the process of 454 g = 1 lb metabolism): RAGUINDIN | BSN II - JOHNSON Page 10 fl ff ff  NUTRITION AND DIET THERAPY LECTURE PRELIMS NUTRITIONAL STATUS This is a part of routine exam done by a RD other health care professionals trained in the It is a measurement of the extent to w/c an diagnosis of at risk individuals – doctors/ individual’s physiologic need for nutrients is nurses. being met. DIETARY - SOCIAL HISTORY NUTRITION TOOLS, STANDARDS The dietary evaluation would provide AND GUIDELINES NUTRIENT information w/ regards on client’s food habit, RECOMMENDATIONS usual food pattern, likes and dislikes and type of meals eaten for a long period of time, DIETARY REFERENCE INTAKES (DRIS) because these information would help the examiner to determine any nutritional These are reference values that are de ciencies or excesses. quantitative estimates of nutrient intakes used for planning and screening diets for healthy individuals. MOST COMMON METHOD USED Recommended Dietary Allowance (RDA) DIET HISTORY The average daily dietary intake level that is enough to meet the nutrient requirement of It is a comprehensive record of eating-related almost all (97% or 98% healthy individuals in behaviours and foods a person eat a group. Contents Of Diet History Of Adults: Adequate Intake (AI) Check appetite – good, poor, any factors A value based on observed estimation of that a ect appetite, taste and smell nutrient intake by a group of well individuals. perception This is used when an RDA cannot be Ask for allergies, intolerances or food determined. avoidances – foods avoided and reasons, For instance, how many liters of water do a 20 length of time of avoidances year old male need? Anthropometry – ht, wt, skin-fold, etc. Tolerable Upper Intake Level (UL) Take 24 hour dietary recall or food It refers to the highest level of daily nutrient frequency checklist intake that may pose no risk of side effects on Consider ethnic and cultural background - health to almost all healthy people in the eating habits and food preferences and general population. religion This indicates that intake increases above the - People eat the foods they grew up eating. UL makes the risk of adverse effects increase. Every country or every region of a country, Estimated Average Requirement (EAR) has its own typical foods and ways of It refers to a nutrient intake value estimated to combining them into meals. meet the requirement of half the healthy - American diet or even Filipino diet individuals in a includes many ethnic foods from di countries, all adding variety to the diet. NUTRITIONAL ASSESSMENT - Ex. Chinese, Italian, Korean, Japanese. Consider religion Provides the information needed for Ex. some religious sect forgo meat during identifying nutrition problems and designing a lent, the period prior to easter. nutritional care plan. Muslims fast between sunrise and sunset It identify clients at risk for malnutrition/ those during Ramadan. w/ poor nutritional status Food preference - spicy foods, sweetness of This information can be obtained from the sugar and the savoriness of salt. High fat Medical, Social and Diet histories, foods curry spices of Indian cuisine. Anthropemetric data, Biochemical data and Habits - choosing food out of habit Clinical data. RAGUINDIN | BSN II - JOHNSON Page 11 fi ff ff  NUTRITION AND DIET THERAPY LECTURE PRELIMS Ex. Eating cereal every morning, bec they aspirin (controls pain and fever and for always eat cereals for b-fast. Eating a blood thinning) – a gram of which familiar food makes them comfortable increases the taste perception of Evaluate dental and oral health- problems bitterness. w/ eating, foods that cannot be eaten, ANTHROPOMETRIC MEASUREMENT problems w/ swallowing, salivation Economic status –income, amount of money It is the science of measuring the size, weight for food each week or month. People eat and proportions of the human body. foods that are accessible, quick and easy to It may reveal a failure to thrive in children prepare and w/ in their nancial means. It re ects a nutrient de ciencies or excesses. Evaluate physical activity level - occupation It includes the height, weight, head (type, hours/week,shift, energy expenditure), circumference, upper arm, skin fold and chest Exercise (type amount, frequency), Sleep circumference (for children). ( hours/day, uninterrupted), handicaps. Height And Weight Determine home life and meal patterns – It is useful in determining nutritional status in Number in household (eat together?), person adults who buy food, person who does cooking, It is a good indicator of satisfactory diet and food storage and cooking facilities (stove, recent food intake. refrigerator), type of housing (home, Height apartment, room). It is a less sensitive indicator of current Assess gastrointestinal conditions – nutritional status than weight - for - age since problems of heartburn, bloating, diarrhea, height does not decrease but simply slows vomiting,constipation, frequency of problems, down in times of nutrient deprivation. antacid, laxative or other drugs. Weight Consider presence of chronic disease – It is a sensitive marker of current nutritional treatment, length of tx, dietary modi cation status. including physician prescription, date of Re ects an immediate inability to meet modi cation, education, compliance w/ diet. nutritional requirements and this may indicate Evaluate recent weight change – loss or nutritional risk. gain, how much, over what length of time, Desirable Body Weight intentional or non-volitional. It is also known as Ideal or reference weight Food Frequency - a record of how often the but it is more appropriately called the healthy di foods are eaten. The types ( and weight. sometimes the amount, its preparation) of It is the weight found statistically to be most foods a person routinely consumed in a week compatible w/ health longevity. or a month can be taken. Tannhauser's Method 24-hour recall – done by dietician. Listing the Step I : DBW (K) = HEIGHT (CM) - 100 types, amounts and preparation of all foods Step 2: Deduct 10% - if a Filipino unless eaten in past 24 hours frame size is known (either med or large) Food Diary – written record of all food and Example: drink ingested in a speci ed period- for about Subject: 5'2"female (5'2"- 157.48cm) 3-4 day period. but some clients are not Step 1: DBW (K)=157.48cm - 100 = truthful and tend to forget the food they had 57.48 kilos eaten. May include records of behaviours / Step 2: 57.48 kilos less 5.748(10%) = emotions and symptoms, physical activities 51.7 or 52kg and medications. Medications may decrease CONVERSION the desire of food, absorption of nutrients, 1 foot = 12 inches metabolism of nutrients. 1 inch = 2.54cm Ex. antihistamines - decrease saliva 1m = 100cm causing dry mouth and loss of appetite. RAGUINDIN | BSN II - JOHNSON Page 12  ff fl fl fi fi fi fi fi  NUTRITION AND DIET THERAPY LECTURE PRELIMS ACTUAL BODY WEIGHT OBESITY (27 or more) - indicates high risk of developing helth May be in uenced by changes in the person's problems uid status. - weight 20% above average Weight measurement obtained at the time of UNDERWEIGHT (less than 18.5 10 to 15% examination below ave.) OVERWEIGHT (25-29 10 to 20% above ave.) OTHER PARAMETERS OF HEALTHY (between 18.5-24.9) ASSESSING NUTRITIONAL STATUS BMI tend to increase with age WAIST TO HIP RATIO (WHR) BMI OR BODY MASS INDEX It is a valuable indicator of body fat Also called the Quetelet index is a good distribution and adiposity. It is also a estimate of the degree of obesity or amount of valuable guide in evaluating health risk (heart total body fat. disease, diabetes, etc.) It also helps to determine how much risk Alternatively it is called abdominal/gluteal people have of developing certain health ratio or abdominal girthmeasurement. problems because of their weight (e.g. diabetes, heart problems) Obtaining Correct Measurement It can indicate over or under nutrition. Use non stretchable tape measure (in FORMULA: centimetre) BMI = W (in kilos)/H (in meters)2 Subject should stand erectly, abdominal Constant: muscles relaxed, arms at the sides, and feet 5 ft = 1.524m together. The measurer faces the subject and 4 ft = 1.2192m places the tape measure. Measure waist at 1 inch = 0.0254m the most narrow area below the rib case Example: above umbilicus. H = 5' 3" Measure hip circumference at the widest point W= 62kgs around the hips or buttocks with the subject 62kg/(1.6) = 62/2.56 = BMI = 24.22 standing. Read measurement to the nearest 0. 1 cm. CLASSIFICATION OF WEIGHT STATUS Formula: Classi cation BMI Risk of co- WHR = Waist circumference (cm)/Hip morbitidies circumference (cm) A WHR of 1.0 or greater in men or 0.8 or Underweight less than18.5 Low (risk of clinical greater in women is indicative of android problems) obesity and an increased risk for obesity- related diseases. This also appears to be true Normal 18.5 - 24.9 Average in children. Overweight 25 above Gynoid “pear-shaped”' people, store more fat in the Pre-obese 25-29.9 Increased buttocks, thighs and hips. Obese I 30.0 - 34.9 Moderate Android "apple-shaped" people, carry their extra fat Obese II 30-40 Severe around the abdomen/ upper body. Obese III 40 above Very severe The WHR may partially explain the difference in high blood pressure between men and Obesity Categories (BMI Grade) women. Men are more likely to be "apples" Grade 1: 25 to 29.9 and women to be "pears". Men have higher Grade 2: 30 to 40 rates of HTN and more complications. Grade 3: 40+ RAGUINDIN | BSN II - JOHNSON Page 13 fl fi fl  NUTRITION AND DIET THERAPY LECTURE PRELIMS Waist Circumference - Iron de ciency anemia: (children beyond It serves as a marker of abdominal fatness. 6 mons) lack in iron Waist circumference alone has been - Dehydration: (loss of water & electrolytes) considered a valid indicator for both men and s/s- sunken eyeballs, dry mucous women. membranes, thirst, etc. Interpretation: women with a waist ASSESSMENT BY BIOCHEMICAL TEST circumference greater than 35 inches and men with waist circumference greater than It includes various blood, urine, saliva and 40 inches have high risk of central obesity- stool test. related health problems. According to Dellova, it provides information on protein balance, vit, mineral, and uid SKINFOLD THICKNESS status, body composition, organ function and Assess body composition, fat distribution and metabolic status. reserve calories by using a calliper for to ten According to Roth a de ciency/ toxicity can be wil wen determined by laboratory analysis of the The most accurate way to measure body fat. samples. These test allow detection of malnutrition Harpenden caliper Lange caliper before signs appear. MOST COMMONLY USED TEST FOR NUTRITIONAL EVALUATION BLOOD TEST Serum Albumin Level - measures the main protein in the blood and is used to determine protein status - 3. 5 - 5.0 g/d or 35-50g/L Di erent Sites For Skinfold Measurement Albumin Triceps - commonly used - is a protein found in plants and animals. Below the scapula Low levels Biceps - with malnutrition, burns, infections, cancer Above the iliac crest/ Suprailiac and those taking birth pills, chronic disease Upper thigh of liver, kidney and heart. If it is more than ½ inches — over wt. Serum Transferrin Level If less than ½ inch - under wt. - indicates iron-carrying protein in the blood ASSESSMENT BY CLINICAL METHOD Transferrin - It is a glycoprotein that binds and transport Clinical assessment of nutritional status deals iron. Most is produced in the liver. If result basically with the examination of changes that is below normal there would be hepatic can be seen or felt in super cial tissues such failure, nephrosis, cachexia as the skin, hair and eyes. Blood Urea Nitrogen In other words, its the physical observation or - Increased level may indicate renal failure, assessment. insuf cient renal blood supply or blockage In here, signs of nutrient de ciency are noted in the urinary tract, dehydration and Gl and some nutrient de ciency diseases are bleeding. observed such as: - 2.9 - 8.9 mmol/L - Scurvy: Gingival swelling and Blue spots Creatinine Excretion on the skin - It indicates the amount of ceatinine - Rickets: (lack of Ca and vit D s/s) poorly excreted in the urine over a 24 hour period shaped bones and teeth RAGUINDIN | BSN II - JOHNSON Page 14  ff fi fi fi fi fi fi  fl  NUTRITION AND DIET THERAPY LECTURE PRELIMS and can be used in estimating body muscle Serum Calcium mass. - low levels seen in calcium and vit. D - low creatinine excretion - indicative of malabsorption (recall that steatorrhea can muscle mass depletion, as in malnutrition. lead to calcium and vit D.malabsorption) Serum Creatinine D-xylose test - It indicates the amount of creatinine in the - test of CHO absorption blood and is used for evaluating renal Schilling test functions. - identi es vit B1 and B2 malabsorption. - 60-132 mmol/L - high value: acute/chronic renal URINE TEST insuf ciency, urinary tract obstruction. Creatinine Hemoglobin (Hgb) - high level: muscle wasting, starvation and - women: 1 2-16g/dl cachectic status, hyperthyroidism and - men: 14-18g/dI febrile status. - decreased level would mean anemia - low level: hypothyroidism, renal Hematocrit Hct) insuf ciency - women: 42-52% - Men: 0-50 mg/24 hour - men: 37-48% - Women: 0-100 mg/24hour - decreased level would mean anemia Calcium Lipid Pro le - high level: hyperparathyroidism, elevated - for clients w/ heart abnormalities/ CAD serum calcium (coronary artery dse.) - 50-150mg/24 hr. Or 1.05 - 1.3 mmol/L Total Serum Cholesterol Urinalysis - less than 200 mg/dl - can detect protein and sugar in High Density Lipoprotein (HDL) urine(indicative of kidney disease and - more than 35mg/dl diabetes) Low Density Lipoprotein (LDL) - COLOR: Normal is clear, straw-colored/ - less than 130mg/dl light yellow. Lighter than normal may Serum Triglycerides result from excessive d. Intake,diuretic. - 2.9 - 8.9 mmol/L or less than 200mg/dI Darker than normal is caused by liver Uric Acid, Serum or Plasma disease and certain drugs. - men: 3-9.9mg/dl - ODOR: Depends on the food intake/with - women: 2.5-7.7 mg/dl concentration of urine (asparagus/onions), - high level: gout, toxemia of pregnancy, this depends with how much d. You drink. leukemia, polycythemia,renal insuf ciency, - PROTEIN: Presence of this is found on down's syndrome, glycogen storage kidney disease, multiple myeloma, heart disease. failure, stress or surgery. - low levels: occasionally in acute hepatitis. - pH: This varies with diet, but usually acidic all vitamins and minerals would cause a w/ a range of pH 5-6. Alkaline urine is certain disease if there would be associated w/ a vegetarian diet or fruit diet abnormalities on the intake, either low or esp citrus, vomiting, diuretics and excess high..but in water soluble vitamins, no over taking in antacids dosage. - SPECIFIC GRAVITY: It is high (concentrated) in Dhn, DM or in condition STOOL EXAM w/c it has an excess protein in the urine. Direct Stool Exam - Checked for oily materials. - Excess fat in stool suggest steatorrhea. Chemical analysis of fecal fat - greater than 7g/day when the diet includes 100 g of fat/day indicates malabsorption RAGUINDIN | BSN II - JOHNSON Page 15 fi fi fi fi ( fl fi fi