Chapter 37: Nutrition - Textbook

Chapter 37 Nutrition Copyright © 2011 Copyright Wolters © 2023 Kluwer Wolters Health All Kluwer | Lippincott Williams & Wilkins Rights Reserved Nutrients...

Chapter 37 Nutrition Copyright © 2011 Copyright Wolters © 2023 Kluwer Wolters Health All Kluwer | Lippincott Williams & Wilkins Rights Reserved Nutrients Specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury o Essential—not synthesized in the body or are made in insufficient amounts; must be provided in the diet or through supplements o Macro—supply energy and build tissue; i.e., carbohydrates, fats, and proteins o Micro—regulate and control body processes; i.e., vitamins and minerals Copyright © 2023 Wolters Kluwer All Rights Reserved Six Classes of Nutrients Nutrients that supply energy o Carbohydrates o Protein o Lipids (fats) Nutrients that regulate body processes o Vitamins o Minerals o Water Copyright © 2023 Wolters Kluwer All Rights Reserved Energy Balance Energy is derived or obtained from foods consumed Measured in kilocalories (often called calories) Only carbs, protein, and fat provide calories Total daily energy expenditure—all of the calories used to perform physical activity, maintain metabolism, and digest, absorb, and metabolize food Total daily energy intake—total calories for each food item eaten Daily intake and expenditure differences determine stable weight, weight loss, or weight gain Copyright © 2023 Wolters Kluwer All Rights Reserved Basal Metabolic Rate (BMR) BMR is energy (number of calories) required to fuel the involuntary activities of the body at rest after 12 hours; energy needed to sustain metabolic activities of cells and tissues Males have a higher BMR due to larger muscle mass Factors that increase BMR o Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones Factors that decrease BMR o Aging, prolonged fasting, and sleep Copyright © 2023 Wolters Kluwer All Rights Reserved Body Mass Index  Ratio of weight in kilograms to height in meters squared  Provides an estimate of body fat  Can be used as an initial assessment of nutritional status  Calculated with a mathematical formula  Provides an estimation of relative risk for diseases that can occur with more body fat: heart disease, type 2 diabetes, hypertension, and certain cancers  May be inaccurate for certain groups of people  Overweight and obesity defined differently for children and teens Copyright © 2023 Wolters Kluwer All Rights Reserved BMI for Age Percentile Copyright © 2023 Wolters Kluwer All Rights Reserved Body Fat Distribution Location of where body fat is deposited is thought to be an important and reliable indicator of disease risk Central abdominal obesity poses greater risk o Waist circumference is a good indicator of abdominal fat o Risk increases with a waist measurement of 40 inches or more for men and 35 inches or more for women Waist-to-hip ratio (WHR)—tool used to identify central obesity Copyright © 2023 Wolters Kluwer All Rights Reserved Copyright © 2023 Wolters Kluwer All Rights Reserved Carbohydrates #1  Sugars and starches; organic compounds composed of carbon, hydrogen, and oxygen  Serve as the structural framework of plants; lactose is only animal source (sugar present in mild)  Most abundant and least expensive source of calories in the world o Intake often correlated to income: as income increases, carbohydrate intake decreases  Classified as simple or complex sugars  Primary function is to supply energy  Recommended as 45% to 60% of total calories for adults Copyright © 2023 Wolters Kluwer All Rights Reserved Carbohydrates #2  More easily and quickly digested than protein and fat  90% of carbohydrate intake is ingested  Converted to glucose for transport through the blood  Efficient fuel that certain tissues rely on almost exclusively for energy (i.e., nervous system)  Transported from the GI tract, through the portal vein, to the liver  Liver stores glucose and regulates entry into the blood  Cells oxidize glucose to provide energy, carbon dioxide, and water Copyright © 2023 Wolters Kluwer All Rights Reserved Protein #1  Vital component of every living cell; required for the formation of all body structures  More than 1,000 different proteins are made in the body by combining various of the 22 amino acids  Complete proteins contain sufficient essential amino acids to support growth  Incomplete proteins are deficient in one or more essential amino acids  Animal proteins are complete; plant proteins are incomplete (except that soy and quinoa are complete)  Vegetarians, who do not eat animal protein, can combine different plant proteins to supply a complete protein Copyright © 2023 Wolters Kluwer All Rights Reserved Protein #2 Dietary protein is broken down into amino acids by pancreatic enzymes in the small intestine which are absorbed and transported to the liver In the liver, amino acids are recombined into new proteins or are released for use by tissues and cells Protein tissues are in a constant state of flux. Tissues are continuously being broken down (catabolism) and replaced (anabolism) RDA for adults is 0.8 g/kg of body weight, 10% to 35% total calorie intake Copyright © 2023 Wolters Kluwer All Rights Reserved Question #1 Tell whether the following statement is true or false. Red meat is an incomplete protein. A. True B. False Copyright © 2023 Wolters Kluwer All Rights Reserved Answer to Question #1 Answer: B. False Rationale: Red meat is a complete protein. Copyright © 2023 Wolters Kluwer All Rights Reserved Fats #1 Insoluble in water and blood; composed of carbon, hydrogen, and oxygen 95% of lipids in diet are triglycerides Contain mixtures of saturated (raise cholesterol levels) and unsaturated (lower cholesterol levels) fatty acids o Most animal fats are saturated o Most vegetable fats are unsaturated Copyright © 2023 Wolters Kluwer All Rights Reserved Fats #2 Digestion occurs largely in the small intestine Bile which is secreted by the liver and stored in the gallbladder, emulsifies fat so that pancreatic enzymes can break it down for digestion Fats are absorbed into the lymphatic circulation and transported to the liver Most concentrated source of energy in the diet Recommended intake: limit saturated fats to less than 10% of daily calories and intake of trans fats to as low as possible Copyright © 2023 Wolters Kluwer All Rights Reserved Question #2 What is the name for the product that occurs when manufacturers partially hydrogenate liquid oils? A. Lipids B. Triglycerides C. Cholesterol D. Trans fat Copyright © 2023 Wolters Kluwer All Rights Reserved Answer to Question #2 Answer: D. Trans fat Rationale: Trans fat occurs when manufacturers partially hydrogenate liquid oils; trans fat raises serum cholesterol. Lipids are fats in the diet. Triglycerides are the predominant form of fat in food and the major storage form of fat in the body. Cholesterol is a fat-like substance found only in animal products. Copyright © 2023 Wolters Kluwer All Rights Reserved Vitamins Organic compounds needed by the body in small amounts; do not provide calories Needed for metabolism of carbohydrates, protein, and fat Fresh foods are higher in vitamins than processed Water soluble: C, B-complex vitamins; not stored in body Fat soluble: A, D, E, K Absorbed through the intestinal wall directly into bloodstream Copyright © 2023 Wolters Kluwer All Rights Reserved Question #3 Which one of the following vitamins affects visual acuity in dim light, formation and maintenance of skin and mucous membranes, and the immune function? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K Copyright © 2023 Wolters Kluwer All Rights Reserved Answer to Question #3 Answer: A. Vitamin A Rationale: Vitamin A affects visual acuity, skin and mucous membranes, and immune function. Vitamin D provides calcium and phosphorus metabolism and stimulates calcium absorption. Vitamin E is an antioxidant that protects Vitamin A. Vitamin K helps the synthesis of certain proteins necessary for blood clotting. Copyright © 2023 Wolters Kluwer All Rights Reserved Minerals Organic elements found in all body fluids and tissues Some function to provide structure in the body, others help regulate body processes Contained in the ash that remains after digestion Macrominerals include calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium Microminerals include iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine Copyright © 2023 Wolters Kluwer All Rights Reserved Water Accounts for between 50% and 60% of adult’s total weight Two thirds of body water is contained within the cells (intracellular fluid [ICF]) The remainder of body water is extracellular fluid (ECF), body fluids (plasma, interstitial fluid) Provides fluid medium necessary for all chemical reactions in the body Acts as a solvent and aids digestion, absorption, circulation, and excretion Copyright © 2023 Wolters Kluwer All Rights Reserved Question #4 Tell whether the following statement is true or false. Food is more vital to life than water because it provides the medium necessary for all chemical reactions and it is not stored in the body. A. True B. False Copyright © 2023 Wolters Kluwer All Rights Reserved Answer to Question #4 Answer: B. False Rationale: Water is more vital to life than food because it provides the medium necessary for all chemical reactions and it is not stored in the body. Copyright © 2023 Wolters Kluwer All Rights Reserved Adequate Diet Selection Dietary Guidelines for Americans Dietary Reference Intakes (DRIs) Recommended dietary allowance MyPlate food guide Food labeling Copyright © 2023 Wolters Kluwer All Rights Reserved Factors Affecting Nutrition Physiologic and physical factors: stage of development, state of health, medications Social determinants of health: economic stability, health care access and quality, social and community context, education access and quality, neighborhood and built environments Culture, religion, food ideology, and learned aversions Copyright © 2023 Wolters Kluwer All Rights Reserved Developmental Considerations Growth: infancy, adolescence, pregnancy, and lactation increase nutritional needs Activity increases nutritional needs Age-related changes in metabolism and body composition Nutritional needs level off in adulthood Fewer calories required in adulthood because of decrease in BMR Copyright © 2023 Wolters Kluwer All Rights Reserved Additional Factors That Influence Nutritional Requirements Sex assigned at birth State of health Alcohol use disorder Medications Megadoses of nutrient supplements Copyright © 2023 Wolters Kluwer All Rights Reserved Factors That Influence Food Choices Social determinants of health Religion Meaning of food Culture Copyright © 2023 Wolters Kluwer All Rights Reserved Food Intake Decreased: anorexia (lack of appetite) Increased: Obesity (BMI ≥30) Copyright © 2023 Wolters Kluwer All Rights Reserved Components of Nutritional Assessment History taking o Dietary, medical, socioeconomic data Physical assessments o Anthropometric and clinical data Biochemical data o Protein status, body vitamin, mineral, and trace element status Copyright © 2023 Wolters Kluwer All Rights Reserved Dietary Data 24-hour recall method Food diaries/calorie counts Food frequency record Diet history Copyright © 2023 Wolters Kluwer All Rights Reserved Nursing Interventions Teaching nutritional information Monitoring nutritional status Stimulating appetite Assisting with eating Providing oral nutrition Providing long-term nutritional support Copyright © 2023 Wolters Kluwer All Rights Reserved Diets Therapeutic diets o Consistent carbohydrate o Fat or sodium restricted o High or low fiber o Renal Modified consistency diets o Clear liquid o Pureed o Mechanically altered Copyright © 2023 Wolters Kluwer All Rights Reserved Short-Term Nutritional Support Using the nasogastric or nasointestinal route Confirming NG feeding tube placement o Radiographic examination o Assessment of aspirate pH o Measurement of tube length and tube marking o Carbon dioxide monitoring o Confirming nasointestinal tube placement Copyright © 2023 Wolters Kluwer All Rights Reserved Long-Term Nutritional Support An enterostomal tube may be placed through an opening created into the stomach (gastrostomy) or into the jejunum (jejunostomy) A gastrostomy is the preferred route to deliver enteral nutrition in the patient who is comatose Placement of a tube into the stomach can be accomplished by a surgeon or gastroenterologist via a percutaneous endoscopic gastrostomy (PEG) or a surgically (open or laparoscopically) placed gastrostomy tube Copyright © 2023 Wolters Kluwer All Rights Reserved Enteral Feeding Feeding schedule and formulas, and pumps Monitor for tolerance o Gastric residual volume (GRV) Promote patient safety Monitor for complications Provide comfort measures Provide education Copyright © 2023 Wolters Kluwer All Rights Reserved Parenteral Nutrition (PN) Contains the three primary components necessary to maintain nutrition: amino acids, carbohydrates, and lipids Highly concentrated, hypertonic nutrient solution Given intravenously through a central venous access device Monitor for and prevent complications Copyright © 2023 Wolters Kluwer All Rights Reserved Complications of TPN Insertion problems Infection and sepsis Metabolic alterations Fluid, electrolyte, and acid–base imbalances Phlebitis Hyperlipidemia Liver and gallbladder disease Copyright © 2023 Wolters Kluwer All Rights Reserved