NDT-2-PPT-PRELIM-1.pdf

CHAPTER 1 NUTRITION  NUTRITION Study of food and how the body makes used of it. It deals not only with the quantity and quality of food consumed but also with the process of receiving and utilizing it for growth and renewal of the body and for the maintenance of the different body...

CHAPTER 1 NUTRITION  NUTRITION Study of food and how the body makes used of it. It deals not only with the quantity and quality of food consumed but also with the process of receiving and utilizing it for growth and renewal of the body and for the maintenance of the different body functions. The process of taking in food using it for growth, metabolism and repair. And Nourishing substances such as nutritional solutions delivered to hospitalized patients via IV and ID. The basic function of nutrition is to maintain life by allowing an individual to grow and be in a state of optimum health.  Nutrients Chemical nutrients that are present in food and delivered to the body. ion Function 1. Provide energy. Energy- building food which are rich in carbohydrates and fats and needed by the body for: ▪ Providing enough energy to make the body strong ▪ Examples: rice, corn, bread, cassava, sweet potato, banana, sugar cane, honey, cooking oil, coconut milk, margarine. Build and repair tissues. Body building food which are rich in protein and needed by the body for: ▪ Normal growth and repair of worn-out body tissues ▪ Supplying additional energy ▪ Fighting infections. ▪ Examples, fish, pork, chicken, beef, cheese, butter, kidney beans, mongo, peanuts, shrimps  Regulate body/life processes. Body- regulating food which are rich in vitamins and minerals and needed by the body for: ▪ Normal development of the eyes, skin, hair, bone and teeth ▪ Increased protection against diseases ▪ Examples: ripe papaya, guava, mango, yellow corn, banana, orange, squash and carrot Let’s review DIGESTION Digestion is defined as the process of breaking down food into substances like carbohydrates, proteins, fats and vitamins that aid the body in its different functions. Function of the Digestive System Break down the Absorb digested Take in food food. molecules Eliminate wastes. Provide nutrients.  The lips and cheeks are Mouth (oral important in the process of cavity) mastication or chewing. They First part of digestive tract. help manipulate the food within the mouth and hold the food in place while the teeth crush or tear it. Mastication begins the process of mechanical digestion, in which large food particles are broken down into smaller ones.  Tongue is a large, muscular organ that Salivary gland. They occupies most of the oral cavity. The tongue produce saliva, saliva helps moves food in the mouth and in cooperation with lips and cheeks, holds the food in the keep oral cavity moist and place during mastication. It also plays a major contains enzymes that role in the process of swallowing. The tongue is a major sensory organ for the tastes, as well begins the process of as being one of the major organs of speech. chemical mastication. Saliva is secreted at the rate of approximately 1 Salivary amylase. (digestive enzymes) which liter per day (anatomy and break the glucose molecules in starch and physiology) other polysaccharides to produce the disaccharides, maltose and isomaltose Stomach is an enlarged segment of the digestive tract in the left superior of the abdomen. Storage and mixing chamber for ingested food. As food enters the stomach, it is mixed with the stomach secretion to become a semifluid mixture called chyme. Pepsinogen is converted by Hydrochloric acid to active enzymes pepsin. Pepsin breaks of protein to form smaller peptide chain. Gastrin is a hormone that helps regulate stomach secretion. Approximately 2 L of gastric secretion is produced each day. Small Intestine Is the major site of digestion and absorption of food, which are accomplished by the presence of a large surface area. The major function of small intestine is the absorption of nutrients. Most absorption occurs in the duodenum and jejunum, although absorption also occurs in the ileum. Most of the secretions entering the small intestine are produced by the intestinal mucosa, but the secretions of the liver and the pancreas also enter small intestine and play important roles in the process of digestion. Peptidases breaks the peptide bonds in proteins to amino acids. Liver and pancreas Two large accessory glands, the liver and the pancreas, produce secretion that empty into the duodenum. Liver performs important digestive and excretory functions, store and processes nutrients, synthesizes new molecules and detoxifies harmful chemicals.  Pancreas it is complex organ composed of both endocrine and exocrine tissues that perform several functions. The endocrine part of the pancreas consists of pancreatic islets the islet cells produce the hormones insulin and glucagon, which enter the blood. The exocrine part of the pancreas is a compound acinar gland. The acini produce digestive enzymes. Pancreatic amylases include a group lipid-digesting enzymes called pancreatic lipase.  Large Intestine Consists of the cecum, colon, rectum and anal canal Normally 18-24 hours is required for material to pass through the large intestine in contrast to the 3-5 hours required movement of chyme through the small intestine. While in the colon, chyme is converted to feces. Absorption of water, salt, the secretion of mucus and extensive action of microorganisms are involved in the formation of feces. Some bacteria in the synthesis vitamin k and other vitamins, which is passively absorbed in the colon.  MACRONUTRIENTS are needed by the body in large amounts (carbohydrates, protein and fats) LESSON 2: provide energy and building blocks for proteins, carbohydrates and fats Classification of Nutrients MICRONUTRIENTS are needed by the body in small amounts (vitamins, minerals and trace elements. They do not provide energy, they’re essential for functions like digestion, hormones production and brain function. ENERGY CONTENT OF FOOD Body obtains energy as: ATP (adenosine triphosphate) ATP is used for: all body functions The energy content of food is measured in: CALORIE (kilocalorie) What are calories? The amount heat required to raise the temperature by 1 gm. Of water by 1̊ C Protein - 4 kcal/gm Fat - 9 kcal/gm “fats is considered the macronutrients with the HIGHEST energy” Carbohydrates - 4 kcal/gm (if you burn 1gm of carbohydrates then it is going to provide 4kcal) Acceptable Macronutrients Distribution Range (AMDR) Adequate intake of macronutrients to prevent the risk of disease ADMR for adults CHOs: 45-65% Protein: 10-35% Fats: 20-35%  MACRONUTRIENTS CARBOHYDRATES Their major role in diet is energy production. RDA: 130 grams/day for adults and children CHO intake above RDA causes: weight gain or obesity due to increased fat storage in adipose tissue. The most common food sources of carbohydrates are, sugars, cereal grains and their products (rice, corn, oat, breads and other baked goods, noodles or pasta, etc.); root crops, starchy vegetables and dried legumes. Fruits and milk also contribute good amounts of carbohydrates.  Classification of Carbohydrates MONOSACCHARIDES: Fructose (fruit The sweetest of all sugars. It occurs sugar) naturally in fruits and honey. It is commonly added to foods, in the form of high fructose corn syrup (HFCS). It is hydrolyzed from sucrose and insulin. It is also called “levulose” Glucose (Dextrose) Also known as Dextrose/grape sugar. Found in the blood, so it’s often called blood sugar. Glucose is the main source form of carbohydrate that cells use to produce energy. Glucose is present in some foods such as fruits, vegetables, corn syrup, and honey. All other sugars are converted into glucose, and it is oxidized in the cells to release energy. Galactose is not found free in nature but is hydrolyzed from lactose or milk sugar. Is a component of some compound lipids called the cerebrosides which are found in the brain and nerve tissues.  DISACCHARIDES: Sucrose Sucrose comes from plants such as beets, sugar “table sugar.” cane, and corn. is sometimes called cane sugar or beet sugar since it is commercially prepared from sugarcane and sugar beets. It is also abundant in molasses, maple syrup, sorghum and some fruits. Is the most common form of sugar in cooking and in table service, hence is called “table sugar.” MALTOSE “Malt is also called malt sugar because it is derived from the digestion Sugar” of starch with the aid of the enzyme, diastase, found in sprouting grains. In the intestines, maltose is not readily fermented by bacteria and this is beneficial for infant feeding. Usually this is combined with dextrin (dextrimaltose) for infant milk formula. Lactose “” milk The main sugar in milk. Some people have trouble digesting sugar Lactose, which is known as lactose intolerance. It is hydrolyzed to glucose and galactose and is slowly digested compared to the other disaccharides. It is the least sweet among common sugars, only 1/6 as sweet as sucrose or table sugar. POLYSACCHARIDES - they are not water- soluble compared to mono and disaccharides. STARCH  is the world’s most abundant and cheap form of carbohydrates.  It is the storage form of carbohydrates in plants: in grains, seeds, tubers, roots, and unripe fruits. DEXTRIN  is an intermediate product of starch digestion or is formed from partial hydrolysis of starch.  The action of dry heat on starch (as in toasting bread or browning of cake crust in the oven) produces dextrin. GLYCOGEN “animal  is sometimes called animal starch because it is the storage form starch” of carbohydrate in the body, chiefly in the liver and muscles.  Function of Carbohydrates Chief source of energy - body cells require a steady and constant supply of energy mainly as glucose and its intermediate products. Factors that lower blood sugar level – the dietary and metabolic factors are: prolonged undernutrition, increased exercise, poor absorption of glucose, liver damage, kidney malfunction, and hormonal deficiencies like adrenal insufficiency, insulin increase, hypothyroidism and anterior pituitary deficiency. Factors that increase blood sugar level – these include excessive carbohydrate intake, reduced exercise, increased glucose absorption, some liver disorders, toxemias, diabetes mellitus, increase pituitary and hyperactive adrenal cortex hormones, fright and anger. Factors that maintain blood sugar level – they are reversible glycogen-glucose reaction in the liver, conversion of carbohydrate to fat, excretion of glucose, formation of glycogen in the muscle and glycogen utilization, and utilization of carbohydrate by other tissues. Cheap and main energy food - carbohydrate foods mainly as cereal grains, sugars, most fruits and starchy vegetables contribute at least half or 50% of total energy needs of people. They are low-cost and widely distributed around the world. Protein sparer – the energy need of the body is given first priority over body- building needs. Thus, if carbohydrate foods are not adequately supplied, protein will be catabolized to provide heat and energy instead of being used for building and repairing tissues. Regulator of fat metabolism – carbohydrates prevent incomplete oxidation of fat. Sole energy source for the brain and nerve tissues – the brain and nerve tissues utilize only glucose for energy. A constant supply of glucose must reach these important tissues. Otherwise, lack of glucose or oxygen needed for the oxidation of glucose to release energy will result in an irreversible damage to the brain. Storage form of energy as glycogen – unlike fat storage in adipose tissues, glycogen provides immediate source of energy. Regulator of intestinal peristalsis and provider of bulk – commonly called fiber or roughage in the diet, cellulose, and indigestible polysaccharide acts as a broom and regulates intestinal peristalsis.  Carbohydrate Malnutrition In severe deficiencies, as in the case of famine and prolonged starvation, the ill effects of a limited total food intake result in multiple nutrient deficiencies, particularly, PEM (Protein Energy Malnutrition). Clinical signs: decreased blood sugar level, weight loss, and retarded growth for infants and children. In excessive intake of calories, whether from carbohydrates, fats, or proteins, obesity or adiposity becomes the problem. If the intake of fat and protein is normal, but the carbohydrates intake is lower than the recommended level to supply caloric requirements, ketosis or acidosis occurs.  Instructions: Read and analyze the case scenario carefully and write on Self- the space provided at the end of the midterm coverage Assessment then compile it in your learning portfolio. Exercise Scenario: Lorna has been diagnosed to have diabetes. No.1.1 : Case She is overweight and has been placed on 1,200 calorie diet by her physician. She finds it really hard to follow the Study: diet She is often hungry. Managing 1. What should she include in her daily meals Diabetes Mellitus 2. Write two goals for Lorna related to her diet and blood sugar 3. Write a nursing diagnosis for Lorna 4. What sources of carbohydrates would help Lorna lose weight and maintain her blood sugar Self- Assessment Direction: Design a whole day menu for Exercises No. yourself making sure to include sugars, 2.2 - starches and fibers Fill in the template Carbohydrates, provided at the end of the midterm starches, sugars coverage. and fibers WRITE: SHORT BOND PAPER ENCODED DEADLINE: 1 WEEK BEFORE MIDTERM PROTEIN Protein helps repair and build your body’s tissues. Drives metabolic reactions, maintains pH and fluid balance, and keeps the immune system strong. Transports and stores nutrients and can act as an energy source. Originated from a Greek word proteios meaning “to hold first place” or “is of prime importance.” SOURCES: Meat, poultry, fish, milk, wheat, corn, beans, nuts RDA: (gms/kg body weight) How to determine the Weight in kg x 0.8 (gram of average adult’s protein per kilogram of body weight). daily protein requirement:  Note: Protein supply amino Normal adults: 0.8 acids and amino nitrogen for Athletes: 1.0 the body. Protein are the only source of nitrogen in the Pregnancy/ body. Lactation: up to 30 Children :2.0  Used in the synthesis of different tissues and enzymes. Note: if you are eating an extra amount of Amino proteins, then the body can react in two ways: acid Either the excess protein is break down and used as an energy source Or it will convert into acetyl-CoA (acetyl coenzymes A) which is used in fat synthesis (so we can conclude that excessive amounts of protein are stored as FAT)  1.Essential amino acids Body can’t synthesize, must be supplied in Classification the diet of Proteins PVT TIM HALL: Phenylalanine, Valine, Tryptophan, Threonine, Isoleucine, Methionine, Histidine, Arginine, Lysine, Leucine “you should memorize them”  Body can synthesize them 2.Non- Essential it is also called “dispensable amino acid” because it is not a dietary essential. Ex. Glutamic acid, aspartic acid, alanine, proline, norleucine, citrulline, hydroxyglycine, hydroxyproline  Build and repair cells and tissues (structural role) Supply energy ( a fuel nutrient) FUNCTIONS OF Regulate body processes (regulator of physiologic PROTEINS processes) – protein regulates osmotic pressure; hence helps maintain water balance and acid-base balance.  Fortification – refers to the addition of amino acids in desirable levels so that food contains more than what originally exists. (i.e. lysine added to bread) Enrichment – to restore what was lost during the milling WAYS OF process by adding an amino acid according to Food and Drug standards (i.e. lysine to Cerelac) IMPROVING Supplementation – refers to the addition of protein rich foods PROTEIN to regular diet so as to increase total protein content and QUALITY: improve its standards (i.e. high protein milk given in addition to lugao or fruits or vegetables Complementation – refers to the combination of food proteins such that one lacking in an essential amino acid is provided by another rich in that amino acid. Examples are: rice and munggo, soybean and wheat, soybean and nuts, soybean and corn, soybean and red kidney bean.  A condition or disease caused by not eating enough food leading to energy malnutrition or not eating a balanced diet PROTEIN- leading to protein malnutrition. ENERGY Malnutrition due to inadequate of proteins MALUNTRION or energy. Either the amount of total protein taken is adequate or protein taken in is adequate, but the caloric intake is not enough to sustain like. Disorder Marasmus kwashiorkor Causes Inadequate intake of energy with adequate protein Inadequate intake of protein with adequate energy intake intake (kwashiorkor is more of an acute state while marasmus is chronic) Age and food 1–3-year-old After weaning (few months to at about 1 year) intake Mothers milk is supplemented with food (cereals) Diet mainly contains CHOs. Why does kwashiorkor occur? Sometimes mother wean the babies much earlier than they should (take them deficient in calories off milk) so now the baby’s diet is composed of carbs mostly so the amount of blood protein will go down, hence edema will occur symptoms Arrested growth Edema “due to decreased protein levels” Extreme muscle wasting why does this occur even though Distended abdomen protein intake is adequate? Because you are not getting enough Diarrhea energy from carbs, so the protein will be used as an energy Dermatitis due to fat loss/thin hair source Enlarged fatty liver due to decreased in lipoproteins so the lipids Weakness will accumulate in the liver Weight loss Low plasma albumin No edema or changes in plasma proteins.  Most people think of meat, fish and poultry as good sources of Critical protein. While they provide most protein per serving portion in a daily diet. It is a mistake to assume that these are the only good source of protein. Thinking Discuss the following questions (Please write your answers 2.1 : on the answer sheet provided at the end of Midterm coverage. Please compile all your outputs in your Learning Portfolio). Protein: 1. Identify and discuss at least 2 protein related diseases. Include sign and symptoms, causes and dietary changes. Amino 2. What are the health effects of protein? (explain this further in 100 words) Acid 3. Differentiate acute protein-energy malnutrition (PEM) from chronic PEM. (Explain in not less than 100 words)  A concentrated source of energy (9 kcals/ gram). All types of fat are high in energy. A gram of fat, whether it's saturated or unsaturated, provides 9kcal FATS AND RDA (gm/day) total fats: 65, saturated: 20 Importance: OTHER Supply essential fatty acids such as LIPIDS linoleic and linolenic acids. Provide phospholipids for membrane function Source of fat-soluble vitamins (A, D, E, K) and help in their absorption. Main types of fat found in food are: Saturated fats-found in many foods, both sweet and savory (animal sources, including meat and dairy products, as well as some plant foods, such as palm oil and coconut oil.) Cholesterol and saturated fats Cholesterol is a fatty substance that's mostly made by the body in the liver. It's carried in the blood as: low-density lipoprotein (LDL), high- density lipoprotein (HDL) Eating too much saturated fats in your diet can raise "bad" LDL cholesterol in your blood, which can increase the risk of heart disease and stroke. "Good" HDL cholesterol has a positive effect by taking cholesterol from parts of the body where there's too much of it to the liver, where it's disposed of. Saturated fat guidelines Government recommends that: Men should not eat more than 30g of saturated fat a day Women should not eat more than 20g of saturated fat a day Children should have less Trans fats Trans fats are found naturally at low levels in some foods, such as meat and dairy products. They can also be found in partially hydrogenated vegetable oil. Hydrogenated vegetable oil must be declared on a food's ingredients list if it's been included. Like saturated fats, trans fats can raise cholesterol levels in the blood. Government recommended: Adults should not have more than about 5g of trans fats a day. Unsaturated fats Found in oils from plants and fish, unsaturated fats can be either monounsaturated or polyunsaturated. If you want to reduce your risk of heart disease, it's best to reduce your overall fat intake and swap saturated fats for unsaturated fats. There's good evidence that replacing saturated fats with some unsaturated fats can help to lower your cholesterol level Monounsaturated fats Monounsaturated fats help protect your heart by maintaining levels of "good" HDL cholesterol while reducing levels of "bad" LDL cholesterol in your blood. Monounsaturated fats are found in: (olive oil, rapeseed oil and spreads made from these oils, avocados, some nuts, such as almonds, brazils, and peanuts Polyunsaturated fats Polyunsaturated fats can also help lower the level of "bad" LDL cholesterol in your blood  omega-3 and omega-6.Some types of omega-3 and omega-6 fats cannot be made by your body, which means it's essential to include small amounts of 2 main types of them in your diet. polyunsaturated Omega-6 fats are found in vegetable oils, such as: rapeseed, corn, sunflower fats Nuts that have higher amounts of omega-6 include walnuts, almonds, cashews Omega-3 fats are found in oily fish, such as: sardines, salmon, mackerel  The nutrition labels on food packaging can help you cut down Buying on total fat and saturated fat (also lower fat listed as "saturates", or "sat fat"). foods Nutrition information can be presented in different ways on the front and back of packaging. Total fat high fat – more than 17.5g of fat per 100g low fat – 3g of fat or less per 100g, or 1.5g of fat per 100ml for liquids (1.8g of fat per 100ml for semi-skimmed milk) fat-free – 0.5g of fat or less per 100g or 100ml  high in sat fat – more than 5g of saturates per 100g Saturated fat low in sat fat – 1.5g of saturates or less per 100g or 0.75g per 100ml for liquids sat fat-free – 0.1g of saturates per 100g or 100ml  Excessive fat intake Atherosclerosis can cause: Obesity  Some fats are visible, such as in butter, shortening and oil. Others, however, are visible such as in milk, egg yolk, and certain food mixtures. Critical Discuss the following questions (Please write your Thinking answers on the answer sheet provided at the end of Midterm coverage. Answer questions number 2-4 in not Checkpoint less than 100 words. Please compile all your outputs in your Learning Portfolio). No. 2.2: The Lipids: 1. Identify and discuss at least 2 fat-related diseases. Include sign and symptoms, causes and dietary Triglycerides, changes. phospholipids 2. What are the health effects of lipid? & sterols 3. What are the benefits derived from omega-3 polyunsaturated fats? 4. Which is better, butter or margarine? Why?  Organic compounds present in small quantities in different types of food. Help in various biochemical process in cell. Most act as coenzymes. MICRONUTRIENTS VITAMINS Important for growth and maintaining good health. Essential Non-caloric, they don’t give energy Required in very small amount Vitamins are Classified Based on solubility Fat -Soluble Vitamins Vitamin A Vitamin D Vitamin E Vitamin K Stored in the body ADEK Water- Soluble Vitamins Ascorbic acid Thiamin Riboflavin Niacin (Vitamin C) (VitaminB1) (Vitamin B2) (Vitamin B3) Pyridoxine Pantothenic Biotin Folate (Vitamin B6) acid Cobalamin (Vitamin B12)  Vitamin E Vitamin B1 (Thiamin) Active a-tocopherol is the most active Thiamin pyrophosphate form form in the body (TPP) Vitamin functio Antioxidant (prevents oxidation As a coenzyme for E and n of cell components by molecular transketolase in HMP oxygen and free radicals) pathway Vitamin May have a role in fertility and And oxidate anti-aging effect. decarboxylation B1 reaction in Krebs cycle+ linking Krebs cycle with glycolysis source Vegetables oil-nuts-seeds- Plants-cereals-meat s vegetables RDA Adult:15 mg/day Adult:1.2 mg/day Children: 7 mg/day Children: 0.6 mg/day Deficiency of vitamin E results in: Defective lipid absorption Anemia due to oxidate damage RBCs Neurological problems Male infertility  Thiamin deficiency The activity of these two dehydrogenases- catalyzed reactions (transketolase and oxidative decarboxylation reaction) is decreased. Causing: Low ATP production and therefore, defective cellular function Disorder of Vitamin B12 (thiamine) deficiency Beri-Beri Wernicke-Korsakoff syndrome What it A type of chronic peripheral neuritis due to Common in alcoholics due is severe thiamine deficiency. to defective intestinal absorption of thiamine or dietary insufficiency. Leads Weakness, paralysis, neuropathy, Apathy, loss memory to disorderly thinking facts -thiamine has a role in nerve conduction -Neuropathy affects glial cells (astrocytes) of the brain and spinal cord causing neuro death Vitamin C: Functions Sources and RDA Citrus fruits, Men: 90, tomatoes, women: 75 melon, peppers children: 15-25  Its an abnormal collagen Deficiency production of vitamin c: Gums become painful, swollen Scurvy (also and spongy and bleeding called sailor disease) The pulp is separated, and the teeth are lost DIRECTIONS: Fill in the blanks with what you know about vitamins and their roles in the diet. Write your answer on the space provided at the end of the midterm coverage Why are vitamins called micronutrients? __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________ Can vitamins be seen or tasted? Support your answer. __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________ Why do humans need vitamins? __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________ What can happen to a person who does not get enough of the essential vitamins __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________  Microminerals (>100 Microminerals (