NCMA215 Nutrition Midterms Exam Paper PDF

NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN NUTRITION 6 Essential Nutrients Nutrition Is the sum of all the in...

NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN NUTRITION 6 Essential Nutrients Nutrition Is the sum of all the interaction between an organism and the food it consumes. Is what the person eats and how the body use it. * Everyday we need to eat food and drink water in order for us to survive. So, food is not equal to nutrition, NUTRITION is the combination of what we consume, the food, and how our body makes used of this food. * Food will be digested and broken down into vitamins, minerals, fats, etc. * Nutrition is how our body benefits from these elements. Function: * The 6 essential nutrients: Carbohydrates(1), Protein(2), To MAINTAIN LIFE by allowing one to grow and Vitamins(3), Fats(4), Water(5), Minerals(6). be in state of optimum health Carbohydrates FOOD o Anything that we ingest through mouth Considered as the PRIMARY source of fuel or other means like NGT, etc. Nutritive for the brain and the rest of the body. substances that we ingest. o 50%-70% of the total energy NUTRIENTS requirement comes from o Are the carbohydrates, proteins, carbohydrates. vitamins, fats that we essentially need in * These are good, it makes us alive, order for us to survive. gives us energy, but too much of it, CALORIE unable to burn it, that’s the problem. o Carbohydrate à 4 calories per gram o 1 gram CHO = 4 calories upon o Protein à 4 calories per gram complete hydrolysis o Fat à 9 calories per gram * Upon complete absorption and upon * Every food we ate has calories. And calorie is the complete conversion, 1 gram of energy that our body needs in order to burn, For carbohydrate is equals to 4 calories. example, if you have eaten a gram of carbohydrate it Has SUGARS (Composed mainly of means it has 4 calories. SUGARS) * Calories is what our body needs because calories are Organic compounds composed of carbon, energy in order for us to move, survive we need energy hydrogen and oxygen in our body. Definitely, We need calorie in our body, if we Derived from the Greek word “saccharide” did not burn this calorie and if you have eaten a lot of meaning starches and sugars. calories, however, we are not using the energy, this Chiefly found in plants and produced by the calories, then that becomes your fats and makes you process of photosynthesis from H20, CO2 gain weight. and Sun. Classification of carbohydrates Nutrients 1. MONOSACCHARIDES Are organic or inorganic substances found in - Simplest form of sugar foods that are required for body functioning. A. Glucose Nutritive value – the nutrient content of a “physiologic sugar” or “blood sugar”, specified amount of food. “dextrose”, “grape sugar” - principal form *For Example, oranges, it has Vitamin C. used by the body *Potatoes, it has carbohydrates * This is what our body needs, and body NO FOOD provides all essential nutrients. need in order to survive. *There is no one certain food that contains all moderately sweet sugar works for the body’s types or all essential nutrients. brain, nerve cells, RBC *For Example, Bread has glucose and stores last for only hours carbohydrates, and some bread has some Gluconeogenesis – process where protein is protein in it. But there’s no specific food, just one converted to glucose food that have all the essential nutrients that’s Ketosis – less available CHO for energy – why when we eat and plan our meal, it should be more fats to be broken down – form ketone balance in order for us to have all the essential bodies nutrients in our plate. Sources: abundant in fruits, sweet corn, corn syrup 1  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN *We can also found glucose in carrots, and you have eaten a rice or potatoes, or other forms of different greens. carbohydrates, and we needed a much more longer Lycopene-red time, it will require you to sustain the energy, so that Carotene-orange, yellow we have the glycogen that can be stored in liver and Anthocyanin-blue, violet muscle for later use. Cruciferae – green, white Muscle glycogen supplies energy directly to B. Fructose surrounding tissues during work and exercise “fruit sugar”, sweetest of all sugar, “levulose” Liver glycogen is converted to glucose to be sources: ripe fruits and honey used in the body through the process called C. Galactose “glycogenolysis” *Can be found in milk sugar and not all of us o Source: liver, oysters, muscle meat convert or metabolize galactose. If you remember A glycogen storage disease (GSD, also the discussion about galactosemia, infants with glycogenosis and dextrinosis) is a galactosemia are born with this proficiency and metabolic disorder caused by enzyme cannot metabolize galactose. So, nowadays we can deficiencies affecting either already screen galactosemia through newborn glycogen synthesis, glycogen breakdown or screening. glycolysis (glucose breakdown), typically within not found in nature, not found in free foods muscles and/or liver cells. GSD has two classes produced from lactose (milk sugar) by of cause: genetic and acquired. digestion and is converted to glucose Glycogen storage disease type I (GSD I) or Galactosemia – Infants born with an inability von Gierke disease, is the most common of the to metabolize galactose glycogen storage diseases. This genetic disease Republic Act 9288 – New born Screening results from deficiency of the enzyme glucose-6- Test phosphatase, and has an incidence in the American population of approximately 1 in 2. DISACCHARIDES 50,000 to 100,000 births. - two sugar molecules Liver Biopsy – confirmatory test A. Sucrose -”cane sugar”, “table sugar”, “beet *Glycogen stored in the liver and in your sugar” muscle, so in order for us to verify if you have Sucrose = glucose + fructose glycogen storage disease type I, they need to B. Maltose -”malt sugar” check and have liver biopsy, confirmatory tests Derived from the digestion of starch to see if the liver will be able to store glycogen. Maltose = glucose + glucose D. Fibers *If you have digested, let’s say rice or potatoes, ”roughage” because they form bulk of the it can be your malt sugar. diet C. Lactose -”milk sugar” act as broom in our digestive tract Least sweet among sugars *because it helps, it produce bulk in the Lactose = glucose + galactose large intestine which can help us to excrete Source: milk and milk products our feces 3. COMPLEX CARBOHYDRATES OR POLYSACCHARIDES *Constitute of plants or this are usually - contains many monosaccharides linked together vegetables, fruits, with seeds, etc. A. Starch - storage form of carbohydrates in plants indigestible part of food and primary - supply energy for a long period of time constituent of plant cell wall Source: cereal grains, rice, wheat (Bread, Cereals, not digested by human due to lack of Pasta, Rice, Potatoes, Beans & Chestnuts) which we enzyme that will split or break it usually eat on a daily basis. Requirement: 20-35 g/day *so that we can B. Dextrin - Derived from dextrose be able to remove or excrete the toxins from (glucose), dextrin is a low-molecular-weight our body through defecation. carbohydrate produced from the hydrolysis of starches. *Examples of Complex carbohydrates which are good An intermediate product of starch digestion plus acid for our body, pasta, bananas, broccoli, because these with application of heat of 150-200 C. are fibers; Your grains, breads, sweet potatoes, berries, Starch (dextrin) =maltose + 2 glucose units oatmeal’s and of Dextrin is used in many glue products due to its course simple carbs or adhesive qualities and safety. The indigestible usually the ones that form of dextrin is often used as a fiber makes us happy and supplement. satisfaction but these C. Glycogen - “animal starch”, storage form of CHO are types of in the body found in the liver and muscle carbohydrates that are *Carbohydrates is also like sugar, we store harmful from our body. glycogen in liver and muscle so that if, for example, 2  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN FUNCTIONS OF CARBOHYDRATES Normal osmotic relations in body fluids (albumin) *Normal amount of protein in the body fluids will Chief source of energy, protein sparing maintain the homeostasis in the different Supplies energy to the body compartment in the body. Takes part in building body tissues to some 10%-15% of total energy needs is supplied by limited extent CHON Regulator of intestinal peristalsis and provider of 1 gram CHON= 4 calories upon complete bulk *because of the fiber hydrolysis or metabolism or conversion LACK OF CARBOHYDRATE RESULTS TO: Simple proteins: Underweight and/or rapid weight loss albumins – soluble in water, coagulated by heat General weakness globulins – insoluble in water, soluble in salt Poor physical performance solution, coagulated by heat Fainting or collapse in severe deficiency Hypoglycemia in acute carbohydrate deficiency ACCORDING TO ESSENTIALITY EXCESSIVE CARBOHYDRATE MAY RESULTS IN: A. ESSENTIAL AMINO ACID (EAA) OR INDISPENSABLE Dental caries *especially if you have eaten too AMINO ACID-is one that cannot be synthesized much glucose or sugar by the body Obesity/overweight *meaning your body cannot produce it that’s why we need to have this in our diet or if the body Diabetes mellitus cannot produce it, if we ingest it, some organs Gas formation will need to convert it this type of amino acids. Obesity, DM Samples of these are: o Histidine o Phenylalanine o Isoleucine o Threonine Weight loss o Leucine o Tryptophan Hyperglycemia o Lysine o Valine o Methionine B. SEMI-ESSENTIAL AMINO ACID OR SEMI-INDISPENSABLE AMINO ACID- Hypoglycemia reduce a need for a particular EAA and partially spares it *types of semi-eaa are: o Arginine o Tyrosine o Cystine o Glycine o Serine Health Effects of Starch and Fibers 1. Promote weight loss/ weight control – increase fibers, low fats and added sugar *especially for fibers because it acts like a broom in our digestive system 2. Protect against heart disease and stroke – high in carbohydrates 3. Protect against cancer – high in carbohydrates 4. Fight against diabetes – high in carbohydrates and low fats control weight 5. Promote gastrointestinal health – increase fibers enhances healthy large intestine *in moderation, this starch and fibers which should be a bit higher in our diet will help us to promote this health effects. C. NON-ESSENTIAL AMINO ACID (NEAA) is not dietary essential because the PROTEINS body can synthesize it Complete and Incomplete Proteins *example of * it is not essential because the body can protein produce it on its own, unlike with essential amino-acid in Has amino acids which serve as the building which the body cannot produce it or cannot convert it on units of the body tissues *because proteins can its own that’s why we need to have it in our diet. help with healing the tissues and can help our o Glutamic Acid o Aspartic acid body muscles and tissues o Alanine o Proline Organic compounds composed of carbon, o Norleucine o Citrulline hydrogen, oxygen and nitrogen o Hydorxyglycin o Hydroxyproline 3  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN areas especially in the mountains and especially if they don’t have their own supply of poultry or chicken or pig, or etc. They don’t have nearby market to buy or they don’t have enough budget to buy proteins or source of proteins. *As you can see, with Kwashiorkor, the entire body is thin, the face is a bit swollen and there is a moon face and there is bulging abdomen, there is not fat but this are ascites, these are the fluid shifting because of decrease albumin in the body. *Marasmus, in here, the typical malnutrition that you know in which the entire body is thin. Thin and bones because there is deficiency in calories, also. FUNCTIONS OF PROTEINS Builds and repairs body tissue for growth and maintenance *Histidine and arginine are very essentials. » Anabolism – repairing worn out body tissue *We need this in our diet because the body » Catabolism – continued wear and tear cannot sensitize it on our own. going on in the body *Protein can help repair your muscles and tissues. Two types of protein Deficiency: Builds resistance to infection by helping form antibodies MARASMUS vs KWASHIORKOR Supplies additional energy *it helps the carbohydrates Marasmus Kwashiorkor Contributes to numerous body secretions and fluids Food deprivation Maintain water balance Severe Semi-starvation SOURCES OF PROTEIN ANIMAL SOURCE- egg, milk, milk products, meat, fish, poultry and seafoods Onset 6 mon – 4 years 1 – 6 years PLANT SOURCE- cereals (wheat, rice, corn), legumes (munggo beans, peas, peanuts, Protein and soybeans), processed vegetable protein Deficiency Calories Protein only (vegemeat, tofu) LACK OF PROTEIN RESULTS IN: Appearance Old Man’s Face Moon’s Face Retarded growth in children *because it can help build tissues and muscles Low resistance to infection at any age Slow recovery from illness Low birth weight Protein energy malnutrition: Marasmus and Kwashiorkor Loss of weight Edema, skin lesions, mental sluggishness EFFECTS OF EXCESSIVE PROTEIN INTAKE *any excess is harmful this can: Kidney function – high CHON diet - increase work of kidneys Mineral losses – increase CHON diet - calcium excretion rises Obesity – high CHON diet – increase intake rich *These 2 are types of malnutrition, especially protein fat foods deficiency. Heart disease – foods rich in animal protein – *Kwashiorkor, you can see this usually in remote areas rich n saturated fats in which they really don’t have source of meat and Cancer – increase in CHON diet – increases protein and what they usually ingest will be corn, rich saturated fats foods intake vegetables, bananas, that they do not really have the source of meat. You can see this in children in far flung 4  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN FATS 3. Derived lipids Facilitates absorption of the fat-soluble vitamins – fat substances produced from fats and fat (A, D, E, K) compounds o You need fats in order to absorb the vit. Fatty Acids A,D,E & K – basic structural unit of fat As insulator and protector *from heat 1. Saturated fatty acids Two Fatty Acids – basic structural unit of fat. – palmitic and stearic acids They are the key refined fuel forms of fat that the o Bacon o Butter cell burns for energy o Grated coconut o Coconut Serve as the continuing supply of energy each o Coconut oil o Margarine and every hour o Mayonnaise o Cream o Just like the protein and carbohydrates, o Sandwich spread o Whipping Cream fats in good amount also needed by the o Chicharon o Cholesterol rich foods body because it helps with our energy. *Any excess of the saturated fats, fatty acids is Fatty acids are good, what’s bad is trans harmful in the body. and saturated fats. What are Trans Fats? Organic nutrient containing C,H,O attached in a » Trans Fats Are An Extremely Dangerous Fat glycerol base. That You Should Avoid At All Costs 1 gram fat=9 calories » They are Generally Found in Processed Foods 20%-30% of TER is from fat. Such As… Remains in the stomach for the longest period of o Burgers time o Fries Classification of FATS o Margarines Simple Lipids - neutral fats *If you have eaten trans fat in excess, this can lead o chemical name is triglycerides to heart diseases and poor cholesterol level. o glycerol is derived from a water soluble » The Health Risks of Consuming Trans Fast form of CHO Include… Compound lipids - combination of fats with o Increased Heart Disease Risk other components o Poor Blood Cholesterol Level - important in human nutrition What is Good Fat? A. Phospholipids GOOD FAT - fatty acids, phosphoric acids and nitrogenous » Monosaturated fats & Omega-3’S base » Avocados, salmon, almonds, walnuts, flax seed, 1. Lecithin - most widely distributed olive oil, etc. can help lower triglyceride levels - traces placed in liver, egg yolk and and decrease inflammation. vegetable oil; added to food products such as cheese NOT AS GOOD FAT and margarine to aid emulsification » Saturated Fats *can be found in the liver like pork liver, chicken » Saturated fats like full-fat dairy products, and liver, egg yolk and vegetable oil and be seen in yeast fatty animal proteins, might increase the risk of and margarine. heart disease, high cholesterol, and some 2. Cephalin - needed to form thromboplastin for cancers, including colon. blood clotting. REALLY BAD FAT 3. Sphigomyelin - found in brain and other nerve » Trans Fats tissue; serves as insulator around nerve fibers » Fried foods, packaged chips, candy, etc. B. Glycolipids decrease good cholesterol, increase bad cholesterol and inflammation, and increase risk - fatty acids combined with CHO (carbohydrates) of heart disease and cancer. and nitrogen 2. monounsaturated C. Lipoprotein – oleic acid (omega 9) - lipids combination of protein *fats and protein o Avocado o Peanut butter 1. Chylomicrons - transport diet-derived lipids o Peanut oil o Pili nut - mostly triglycerides o Olive oil o Shortening 2. Pre-beta lipoprotein - VLDL (very low density 3. polyunsaturated fatty acids lipoprotein) – linolenic acid- Vitamin F, Omega 3, linoleic - fat circulating in the blood during fasting state acid – Omega 6 *good for the body 3. Beta lipoprotein - LDL (low density lipoprotein) o Vegetable oil o Corn - transport in the artery wall o Soy bean o Rapeseed 4. Alpha lipoprotein – scavengers; GOOD o Canola o Sunflower sesame CHOLESTEROL 5  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN Underweight Sluggishness Skin irritation similar to eczema in infants Signs and symptoms of fat-soluble vitamin deficiency EXCESS INTAKE OF FAT RESULTS IN: obesity/overweight cardiovascular diseases Nutrients Food Sources Deficiency Excess Carbohydrates Sugar as one of the Acute: Acute: Hyperglycemia main ingredients of Hypoglycemia Chronic: Diabetes and the food product Chronic: Weight loss Obesity Ripe fruits Grains, Legumes Proteins Poultry, Eggs Protein Energy Cardiovascular Meat, Milk Malnutrition Diseases Seafoods, SOYBEAN 1. Marasmus 2. Kwashiorkor Obesity Cereals, Grains Vegetables, Legumes Cancer – prostate, pancreas, kidney, Fats Red meat ADEK deficiency breast and colon Egg, Poultry Underweight Dairy Products Kidney Disease Seafoods Vegetable oils Nuts, Tuna Soybean Vitamins » Fat Soluble vitamin will be the Vitamin A,D,E & K » Water soluble will be the Vitamin B. Fat Soluble Water Soluble B. Glycerol - water soluble component of triglycerides Not absolutely needed daily Must be supplied everyday in - available for the formation of glucose in the diet from food sources the diet C. Steroids - fat related substances that contain sterols - main member is cholesterol – important Have precursors Do not have precursors constituent of body cells and tissues. Not stored in the body, any Stored in the body FUNCTIONS OF FATS excess is excreted in urine Supplies food energy in concentrated form for body activities. *just like proteins Deficiency develops slow Deficiency develops fast Protects vital body tissue and insulates body * our organs are somehow protected by fats, our *Precursors – means it cannot act alone, it should be abdomen which protected by fats, our organs combined with an element like fat, kaya nga fat-soluble. can be protected by fats. *Do not have precursors – meaning it can be metabolize * If we will have anything in excess, this can lead on its own, can’t act on its own. to organ failure *With fat soluble, if you have deficiency in Vitamin K, you Supplies essential fatty acids. might have bleeding. If you have deficiency in Vitamin A, Serves as a carrier of the fat-soluble vitamins you might have problems in your eyesight. Vitamin D = (A,D,E,K) *they need fats in order to work in the problems in the bones. But the deficiency will develop body overtime. Unlike with water-soluble, if you have Adds palatability and satiety value (sense of deficiency in Vitamin B, which usually the effects of this fullness) to your meals. is in the nerve conduction, the manifestation of the *with fats and oil can make the things stays deficiency can show rightaway. better, but of course it satisfy our palate, but in moderation it’s okay. LACK OF FAT IN THE DIET RESULTS IN: Water-Soluble Vitamins 6  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN Vit. Uses Deficiency o When you say fortified they added it in the process of making the food. B1 Normal function of the heart, muscles, Beri beri nerves Vitamin C = Citrus fruits, green peppers, strawberries, tomatoes, broccoli and sweet and white potatoes are all excellent food sources of B2 Maintain health tongue, mouth and Ariboflavinosis vitamin C (ascorbic acid) ocular Magenta red tongue (Glossitis) Vit. Uses Deficiency Excess Cheilosis Photophobia A Antioxidant Night blindness Hepatomegaly Growth and development Bitot’s spot of skeletal and muscle Xerophthalmia B3 Keeps normal activity of the GIT and CNS Pellagra (4D) tissues (SEVERE) Maintain healthy skin Eyesight Faulty skeletal and dental development D Calcium and phosphorus Rickets in children Muscle spasms absorption Osteomalacia in adult Demineralization of B6 Essential for the formation of tryptophan Peripheral neuritis ↓ bones and deposits in and conversion to Vit. B3 Important for the soft tissues Taken with Isoniazid (INH) formation of normal Kidney stones bones and teeth Vit. Uses Deficiency E Antioxidant functions Anemia Cramps, diarrhea Healthy skin Nerve degeneration Dizzines Weakness Blurred vision B9 Essential for formation of RBC Megaloblastic Anemia Headaches Taken with Iron supplements during Neural Tube Defects pregnancy K Essential for Excessive bleeding BLOOD CLOTTING Easy bruising Vitamin A = Sources of vitamin A and beta- carotene: B12 Essential for formation of RBC Pernicious anemia Helps maintain nerve cells o Vitamin A comes from animal sources such as eggs, meat and dairy products. o Beta-carotene, a precursor of vitamin A, C Antioxidant Scurvy comes from green, leafy vegetables and Immune system Iron absorption intensely colored fruits and vegetables Healing of wounds and fracture § Bell pepper, carrot etc. Vitamin D = The body itself makes vitamin D when it is exposed to the sun o Cheese, butter, margarine, fortified milk, B1 = Vitamin B1 (Thiamine) is found in fortified fish and fortified cereals are food breads and cereals, fish, lean meats and milk sources of vitamin D. o When you say fortified bread, it means Vitamin E (Tocopherol) = Vitamin E id found in when they create or when they cook the corn, nuts, olives, green, leafy vegetables, bread, they included thiamine in the vegetable oils and wheat germ, but food alone ingredients. cannot provide a beneficial amount of vitamin E, B2 = Food sources of Riboflavin (vitamin B2): and supplements may be helpful o Cereal, nuts, milk, eggs, green leefy Vitamin K = Food sources of vitamin K include vegetables and lean meat cabbage, cauliflower, spinach and other green, B3 = Food sources of Niacin (Vitamin B3) leafy vegetables, as well as cereals include dairy, poultry, fish, lean, meats, nuts and Vitamin content is highest in FRESH eggs. FOODS that are consumed as soon as B6 = Food sources of Vitamin B6 (pyridoxine) possible after harvest include beans, legumes, nuts, eggs, legumes, nuts, eggs, meat , fish, breads and cereals. Minerals o Peripheral neuritis = tingling sensation/less sensation in the area or Iron » Micronutrients, 100 namamanhid or lack of sensation Zinc such as iron, B9 = (Folate) Food sources of folate include » Minerals Manganese chlorine or beans and legumes, citrus and juices, whole which are Iodine chloride, zinc, required, Flouride copper, iodine, grains, dark green leafy vegetables, poultry, Calcium Phosphorus macronutrien promune and pork, shellfish and liver ts that are Sulfur cobalt are Sodium B12 = Natural sources of Vitamin B12: Potassium required/esse Selenium micronutrients o Eggs, meat, poultry, shellfish, milk and Magnesium ntial at levels that are 100 milk products Chloride of 100 mg or essential in a few mg per o B12 is also added to fortified green more/day day. products such as cereals. 7  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN o Not all of us will have the same need for fats. Not all of us have the same need Calcium and for protein, fats or carbohydrates, so Phosphorus with this Dietary Reference Intake, we will know what are the appropriate amount or value needed of that specific person. Estimated Average Requirement (EAR) make up 80% of all mineral is a daily nutrient intake level that meets the elements in the body median or average requirement of healthy WATER – 60-70% total body weight individuals in particular life stage and sex ü deprivation of 10% water – illness; 20% group, corrected for incomplete utilization or - death dietary nutrient bioavailability. ü next to O2 for maintenance of life o This is the average need, average daily ü 45 liters – water found in the body of nutrient need of a person, so in order for normal adult this patient to survive the day or in order ü 30 liters intracellular (inside or within the for this patient to be productive on that cells) day, this is their average nutrient ü 15 liters extracellular (outside the cells) requirement and depends on the Functions: particular life stage whether; newborn, Acts as solvent for all products of digestion toddler, preschooler, adolescent, school- (universal solvent) age, geriatric patient, is the patient male Carries nutrients to the tissues or female, there activities of daily living, Removes waste products from the tissue the amount or the energy that they Helps regulate body temperature and the acid- would need for their work is important base balance indicator for their average estimated Sends messages between cells so you can requirement. think, see, touch, hear, feel and move The estimated average requirement (EAR) is the amount of a nutrient that is estimated to NUTRITION TOOLS, STANDARDS AND meet the requirement for a specific criterion GUIDELINES NUTRIENT RECOMMENDATION of adequacy of half of the healthy individuals of The Philippines is one of the countries in the a specific age, sex, and life-stage. world where a significant number of children The amount of the nutrient necessary to meet remain malnourished despite the economic the appropriate criterion of adequacy varies growth and development in the country over the from one individual to the next, but the data past decades. are usually distributed normally or can be Data from the 2013 National Nutrition Survey transformed to achieve a normal distribution. (2013 NNS) in the Philippines reported that o It varies from one person to another but among children under 5 years old, the in general, for example, adolescent- prevalence of malnutrition measured by female patient nurse. That is the criteria underweight, and stunting was 20% and 30%, of your patient, she said “Nurse, female, respectively, and the prevalence starts to and let’s say around 21-25 years old”. increase at 6–11 months. So although that person will have o Stunted: they are not growing according different needs compare to another to their age. person that is almost similar with the set o In order for us to be a tool to significantly of conditions like let’s say, driver-female; decrease this numbers, it is also 30 years old, both of them are important for us to understand nutrition. adolescents, females and having job that has physical work. Your EAR will tell Dietary Reference Intakes (DRIs) you the amount of food and nutrients Dietary Reference Intakes (DRIs) is a generic that these 2 people need. term for a set of nutrient reference values A recommended dietary allowance (RDA) for that includes the Recommended Dietary a nutrient is derived from Allowance (RDA), Adequate Intake (AI), an estimated average requirement (EAR), which Tolerable Upper Intake Level (UL), and is an estimate of the intake at which the risk of Estimated Average Requirement (EAR). inadequacy to an individual is 50%. This is for planning and assessing diets of Recommended Energy/Nutrient Intake (RENI) healthy groups and individuals. PDRI is the collective term comprising reference value for also known as Recommended Daily energy and nutrient levels of intakes. Allowances is a level of intake of energy or nutrient which is considered adequate for the 8  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN maintenance of health and well-being of The AI is based on observed or healthy persons in the population. experimentally determined estimates of The Recommended Dietary Allowance (RDA) is nutrient intake by a group (or groups) of the average daily dietary intake level that is healthy people. For example, the AI for sufficient to meet the nutrient requirement of young infants, for whom human milk is the nearly all (97 to 98 percent) healthy recommended sole source of food for the individuals in a particular gender and life stage first 4 to 6 months, is based on the daily group (life stage considers age and, when mean nutrient intake supplied by human milk applicable, pregnancy or lactation). for healthy, full-term infants who are o Notice at the back of your food that has exclusively breastfed. label, you will see there are the serving o That group of infant has different AI suggestion per 2,000 calorie diet. needs compare to toddlers. o 2,00 calorie diet is your recommended The main intended use of the AI is as a goal daily allowance. for the nutrient intake of individuals. For o For example, male-35 and a example: if an individual has a total calorie professional basketball player, in a day of 1,500, that individual can take at recommended daily allowance is 2,000 least 75% of the total calorie for a day which calorie = estimated daily allowance in is 1,125 calorie is allowable. order to maintain health and well-being Tolerable Upper Intake Level or Upper Limit (UL) as person. is a highest average daily nutrient intake The 2015 Philippine Dietary Recommended level likely to pose no adverse health effects Intake (PDRI) shall be used for planning and to almost all individuals in the general assessing diets for individuals and groups, population. developing food-based dietary guidelines, As intake increases above the UL, the risk of formulating standards and regulations on food fortification, nutrition labeling and claims, and adverse effects increases. The food safety, designing and evaluating food and term tolerable intake was chosen to avoid nutrition assistance programs, determining food implying a possible beneficial effect. Instead, bundles, setting food production targets, and the term is intended to connote a level of other related uses that require consideration of intake that can, with high probability, be nutrient and dietary intakes. tolerated biologically. o When we say tolerable Upper intake RDA (Recommended Daily Allowance) level or upper limit, this is the Nutrients highest number or value of nutrients Protein Rda=60g or calorie or energy that a person Carbohydrate Rda=300g can take for a day that is considered Fibre Rda=25g High=40g normal. Fat Rda=53g o For example, a person’s adequate intake is around 1,700, that is their Adequate Intake (AI) adequate intake, so that person is a daily nutrient intake level that is based (again it depends), can tolerate up on observed or experimentally- to 2,0000 or let’s say 2,500 calorie determined approximation of the average or nutrient or the caloric need of that nutrient intake by a group (groups) of patient is 1,700, that’s the adequate apparently healthy people that are assumed intake. But, when you say TUIL, that to sustain a defined nutritional state. person can tolerate up to 2,500 Adequate Diet is composed of various calorie without any adverse effect, nutrients which body needs for without harming the value. Anything maintenance, repair, and for growth and that will exceed up to 2,500 for that development. person, will be detrimental or be o Let’s say a comatose patient or a harmful for the person. patient with limited COMPONENTS OF ENERGY EXPENDITURE movement/sedentary lifestyle, BASAL METABOLISM patient who is physically active, so measure of energy needed by the body at these are the groups and these rest for its internal chemical activities like groups have different adequate respiration, cellular metabolism, circulation, intake. They might have the same glandular activity and maintenance of body age group or with the same gender temperature but if their group or their determined Energy that you need in order for the group is different, they will also have organs/body to basically function. different AI. 9  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN approximately 1 calorie per kg of body weight Activity - increased muscular activity increase per hour BMR. Greater energy expenditure requires more Let’s say I’m 52 kilos, I need 52 calories calories. per hour just to sustain the activities of The more you move, the more calorie my organ. you need. BASAL METABOLISM RATE (BMR) State of nutrition - a decrease in mass of active tissue like in malnutrition, undernourished or rate of basal metabolism in a given person at a given time and situation starvation causes decrease BMR. Illness increases energy requirements because of Will depend from another person to increased metabolic rate. another. The energy need for the Hence, when you are sick, your body specific time and situation. needs more nutrients. For example, you are working or doing Sleep - Less energy required during sleep, excessive exercises in the morning, of metabolic rate drops due to muscular relaxation course you will need a much bigger and decreased activity of the sympathetic energy to sustain that activity. And that nervous system. depends on what you are doing. as for comatose patient, you can Factors affecting BMR or Individuals Caloric compute how much calorie the Need comatose patient need, because in this Surface Area - the greater the body surface cause, the comatose patient is not area or skin area, the greater the amount of heat actively moving loss will be, increases heat - increases BMR. We don’t that much calorie when you WHY? Muscle tissue requires more O2 than sleep, because it only require less BMR adipose tissue. when you sleep. So, the bigger your surface are is, you Therefore, dinner is ideally the lightest body is, you will need a higher basal meal. metabolism rate. Endocrine glands - the secretion of the Sex/Gender - Men is higher BMR than women. endocrine glands are the principal regulators of WHY? Women have a little more fat and less the metabolic rate. Therefore, male sex muscular development than men. So, men hormones increase about 10-15% the BMR and requires more calories the female sex hormone a little less. Age - BMR is highest the periods of rapid Fever - increases the BMR about 7% for each growth; first 2 years of life, adolescence, degree rise in the body temperature above pregnancy requires more calories, BMR declines 98.6F. slowly with increasing age, decrease age, So, when the patient is having fever or increase BMR – increase age, decrease BMR. the patient is warm, that increases your WHY? Lowering muscle tone from lessened basal metabolism rate to 7% that’s why activity. if you have fever, you need to hydrate First 2 years of life is very crucial, very yourself and try to eat because if your important because this is when, we or hungry, the body needs calorie. the body requires more energy because Climate - cold climate causes higher BMR so it’s growing exponentially. people need more calories due to increased Adolescence, same, because the body thyroxine level in people who live in cold climate is going through a lot of changes so the When cold, increase calorie intake, the body needs a higher BMR. higher BMR is needed to metabolize the Pregnancy as well, because there’s body. growing person inside you. A higher calorie is needed in order for So as you age, your BMR also you to move or survive. decreases because your body is no PHYSICAL ACTIVITY (PA) longer, there will be a point in life where à calorie requirements depend upon the type your body is no longer developing and and amount of exercise or work engaged into. you will be working less compared to The more vigorous the physical work, the greater the before, hence as you age, your activity calorie cost. tolerance also decreases, hence, you will not need more BMR. Food and Fluid Intake Regulating Mechanisms Body composition - a large proportion of (Hypothalamus) inactive adipose tissue lowers the BMR. Athletes Thirst – triggered by loss of body fluid of more with greater muscular development increases than 2% BMR than non-athletic individuals. If we lose body fluid of more than 2%, a Muscle growth needs high BMR. lose of body fluid to 10% can cause damage. A lose of more than at least 10  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN 20% of total body water can cause 2. Children death. If you are losing 2% of your body fluid, it » DBW = age in years x 2 + 8 will trigger the thirst so you will drink 3. Adults (Tanhausser’s Method) water. » DBW = ht. in cm – 100 – (10%) Hunger – triggered by low blood glucose level » DBW = ht. in cm – 100 (Standard normal blood glucose level = (70-110 mg/dl) DBW) » If your blood glucose level is below Asian adjusted: 70, you will feel hungry, and then » Computed Standard DBW x.9 = Asia DBW you will eat. DM (Diabetes Mellitus): more than 140 Range: mg/dl for 2 consecutive readings Asia DBW x 0.9 = Lowest » For a patient with DM, the blood Asia DBW x 1.10 = Highest glucose level of more than Example: 140mg/dcl for 2 consecutive days is Ht.: 167cm; Male; 21 considered/can be considered 167 – 100 = 67kg = Standard DBW diabetes. 67 x.9 = 60.3kg = Asia Adjust » It is normal for a diabetic person to 60.3 x.9 = 54.27kg = Lowest DBW have 130, 120, 140 because they 60.3 x 1.10 = 66.33kg = Highest are diabetic, hence, they will require BMR Calculation less unless they are having or Rule of thumb - 1 kcal per kg per hour (Male) injecting insulin or taking oral - 0.9 kcal per kg per hour (Female) hypoglycemics, of course they need Example: to eat. Male 75 kg = 1 kcal X 75 X 24 = 1,800 kcal Appetite – triggered by sight, smell and thought of food Female 65 kg = 0.9 kcal X 65 X 24 = 1,404 kcal Satiety – triggered by gastric distention. Total Calorie Requirement/day Satiety is the ability to be full or feel full. 1. Infants Body Mass Index Calculation a. 0 – 6 mos. !"#$%& ()$) » TER = DBW x 120 cals/ day KDBW BMI = %"#$%& (+)^- b. 7 – 12 mos. » TER = DBW x 110 cals/ day KDBW BMI Interpretation 2. Children 40 Extremely Obese Housewife with maid MODERATE: 40 – Vendor, mechanic, public utility Desirable Body Weight (DBW) vehicle and car driver 1. Infants HEAVY: 45 – Farmer, laborer, coal miner, fisherman, a. 0-6 mos. heavy equipment operator, wrestler, sports player » DBW = Birthweight (g) + (age in mos. METHODS C P F Method 1 60 15 25 X 600) Method 2 70 10 20 b. 7-12 mos. Method 3 65 15 20 Method 4 60 10 30 » DBW= Birthweight (g) + (age in mos. Method 5 50 20 30 X 500) *If the birthweight is unknown used 3000 grams 11  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN LIST FOOD EXCHANGE HOUSEHOLD CHO(g) PRO (g) FAT (g) ENERGY o This is typically designed for Filipinos, GROUPS MEASURE (CALORIES) more or less the type of food should be IA Veg A 1 1 cup raw or ½ 0 0 0 0 cup cooked easily sourced here in our country. IB Veg B 1 ½ cup raw or ½ 3 1 0 16 Pinggang Pinoy – (established by the National cup cooked Nutrition Council of the Philippines) II Fruit 1 varies 10 0 0 40 o To establish a diet to help Filipinos III Milk 1 varies Full Cream maintain and even improve overall 12 8 10 170 Low Fat 12 8 5 125 health and reduce risk of diet -related Skimmed 12 8 trace 80 diseases IV Rice 1 varies 23 2 0 100 o Directed to healthy Filipino adults 19-64 V Meat & 1 years old with moderate physical activity varies Fish 0 8 1 41 o Not directed for treatment of disease or Low Fat 0 8 6 86 individuals with medical problems Medium 0 8 10 122 As its name suggests, Pinggang Pinoy is High Fat specially designed for Filipinos which features VI Fat 1 1 teaspoon 0 0 5 45 the three (3) food groups GO, GROW and VII Sugar 1 1 teaspoon 5 0 0 20 GLOW foods represented by food items DIETARY GUIDELINES AND FOOD GUIDES commonly consumed by the population. Go food The Food Pyramid is designed to make represents carbohydrates, Grow food represents healthy eating easier. (so that we will know protein and Glow food represents vitamins and which part/component will have more servings minerals. Go or energy-giving foods, such as compared to the other.) Healthy eating is about rice, grains and other starches, provide energy getting the correct amount of nutrients – protein, to keep one going throughout the day. fat, carbohydrates, vitamins and minerals you Grow or body-building foods, such as meat, fish, need to maintain good health. Grains should be dairy and eggs, provide the protein and minerals taken as the major dietary source. Eat more fruit necessary for the growth and repair of tissues, and vegetables. Have a moderate amount of muscles and bones. Recognizing the different meat, fish, egg, milk and their alternatives. nutrient requirements of the different age The Philippines uses the daily nutritional guide groups, the FNRI has developed the Pinggang pyramid and has developed pyramids for Pinoy plates for children, adolescents, pregnant different population groups. The healthy food women and lactating mothers and the elderly. plate for Filipino adults (Pinggang Pinoy) completes the messages of the pyramid by showing adequate distribution of nutritious foods in a meal. Sundin ang 10 Kumainments para sa sigla at lakas ng buhay! » The National Nutrition Council (NNC) developed the “10 KUMAINMENTS” to popularize the Nutritional Guidelines for Filipinos developed by an inter-agency Technical Working Group led by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI- DOST) and approved by the National Nutrition Council Governing Board in October in 2012. » The “10 KUMAINMENTS” are simple and easy to remember guidelines to help improve the Pinggang Pinoy (Filipino Plate) nutritional status of Filipinos to be able to live is a new, easy to understand food guide that healthier and more productive lives. uses a familiar food plate model to convey the » The “10 KUMAINMENTS” aim to improve the right food group proportions on a per-meal basis, eating habits and behaviors of Filipinos to to meet the body’s energy and nutrient needs of prevent malnutrition and diet-related non- Filipino adults. Pinggang Pinoy serves as visual communicable diseases such as cancer, tool to help Filipinos adopt healthy eating habits diabetes, and cardiovascular diseases. at meal times by delivering effective dietary and 10 KUMAINMENTS (Sigla at Lakas ng Buhay) healthy lifestyle messages. 12  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN I. Kumain ng iba’t-ibang pagkain. II. Sa unang 6 months ni baby, breastfeeding lamang, mula 6 months, bigyan din siya ng ibang angkop na pagkain. III. Kumain ng gulay at prutas araw-araw. IV. Kumain ng isda, karne at ibang pagkaing may protina. V. Uminom ng gatas; kumain ng pagkaing mayaman sa calcium. VI. Tiyaking malinis at ligtas ang ating pagkain at tubig. VII. Gumamit ng iodized salt. VIII. Hinay-hinay sa maaalat, mamantika at matatamis. IX. Panatilihin ang tamang timbang X. Maging aktibo. Iwasan ang alak; huwag manigarilyo. LIST FOOD GROUP EX Household MEASURE CHO (g) PRO (g) FATS (g) ENERGY (Calories) IA Vegetable A 2 2cups raw or 1cup - - - - Food Exchange Lists For Meal planning cooked Food Exchange List IB Vegetable B 1 1/2cup raw or ½ cup 3 1 - 16 cooked The Food Exchange Lists (FEL) for Meal Planning is one of the basic tools in nutrition II Fruit 1 varies 10 - - 40 and dietetics. It is a tool for quick estimation III Milk Full cream 1 varies 12 8 10 170 of the energy and macronutrients for use in Low fat 1 4T 12 8 5 125 Skimmed 1 varies 12 8 Trace 80 planning meals of individual clients. Exchange lists provide a way of grouping foods IV Rice 1 varies 23 2 - 100 together to help people on special diets stay on V Meat & Fish track. Each group lists foods in a certain serving Low fat 1 Varies - 8 1 41 size. Med fat High fat 1 1 Varies varies - - 8 8 6 10 86 122 In the food exchange list, commonly use foods are divided into seven groups or list. Each list or VI Fat 1 1 teaspoon - - 5 45 group contains approximately the same amount VII Sugar 1 1 teaspoon 5 - - 20 of carbohydrates, proteins, fats and calories per exchange. A food in any one group can thus be Food Labels substituted for or exchange with another food in Food labels provide more than just the same list or sub-group. This food list can be use in meal plan but substituting each group in nutriCon facts, though. They also tell the the same group. Nurse can use this list to give public what's in a packaged food (i.e., the more choices in planning a meal for a client. ingredients). Food manufacturers are FOOD SUBSTITUE LIST/FOOD EXCHANGE LIST required to list all ingredients in the food on You will see different servings or different types the label. But some ingredients can be listed of vegetables o For each food exchange to calories. collecYvely as "flavors," "spices," "arYficial You can easily pick, the food item that you would flavoring," or in the case of color addiYves like to include in his/her breakfast, lunch, dinner exempt from cerYficaYon, "arYficial colors", or snack. without naming each one. o Important to read the label incase having allergies, food intolerance or problems with your metabolism. 13  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN (9) Attain normal body weight through proper diet and moderate physical activity to maintain good health and help prevent obesity. (10) Be physically active, make healthy food choices, manage stress, avoid alcoholic beverage, and do not smoke to help prevent lifestyle-related non-communicable disease USDA Food Guide The Dietary Guidelines for Americans (Dietary Guidelines) is the cornerstone for Federal nutrition programs and a go-to resource for health professionals nationwide. The Dietary Guidelines provides food-based recommendations to promote health, help Nutrient Guidelines for Filipino prevent diet-related chronic diseases, and meet nutrient needs. The Nutritional Guidelines for Filipinos (NGF) is a set of dietary guidelines based on the Serving Up MyPlate eating pattern, lifestyle, and health status of is a collection of classroom materials that Filipinos. The NGF contains all the nutrition helps elementary school teachers integrate messages to healthy living for all age groups nutrition education into Math, Science, English from infants to adults, pregnant and lactating Language Arts, and Health. This yummy women, and the elderly. curriculum introduces the importance of eating from The first NGF released in 1990 was composed all five food groups using the MyPlate icon and a of five messages called “Dietary Guidelines for variety of hands–on activities. Students also learn Filipinos.” In 2000, a revised nutritional the importance of physical activity to staying healthy. guidelines composed of ten messages was released and it was called the Nutritional Guidelines for Filipinos. The 2012 NGF now includes the basis and justification for each of the ten nutritional and health message. The following 2012 NGF: (1) Eat a variety of foods everyday to get the nutrients needed by the body. (2) Breastfeed infants exclusively from birth up to six months and then give appropriate complementary foods while continuing breastfeeding for two years and beyond for optimum growth and development. (3) Eat more vegetables and fruits to get the essential vitamins, minerals, and fiber for regulation of body processes. (4) Consume fish, lean meat, poultry, egg, dried beans or nuts daily for growth and repair of body tissues. (5) Consume milk, milk products, and other calcium-rich food such as small fish and shellfish, everyday for healthy bones and teeth. *The bones of the fish or tinik is rich in calcium. (6) Consume safe foods and water to prevent diarrhea and other food-and water-borne diseases. (7) Use iodized salt to prevent Iodine Deficiency Disorders. (8) Limit intake of salty, fried, fatty, and sugar-rich foods to prevent cardiovascular diseases. 14  NCMA215: Nutrition and Diet Therapy Prof: Mrs. Shiella May P. Edquibal, MAN, RN the BMR will be higher to those people as compare to NUTRITIONAL CARE PROCESS (ADIME) him/her who has sedentary lifestyle. PROCESS Nutritional Status Assessment “Nutrition Diagnosis: A critical Step in the Nutrition Dietary History and Intake Data Care Process” A. 24 Hour Recall » Our nursing process is assessment, diagnosis, planning, intervention and evaluation (ADPIE) – patient or individual completes a questionnaire or » For nutrition, they also have their own nutritional maybe an interview asking to recall everything that he or care process, which is called ADIME. It also she ate within the last 24 hours. assessment, diagnosis, intervention, monitoring *the patient, through interview, or the patient, they and evaluation. ask to answer the questionnaire and the patient should » ADIME is a care process for registered be able to recall everything she eats for the entire/last 24 nutritionist dietician. Since, our nursing hours. When we say everythi