Nutrition and Diet Therapy PDF

Nutrition and Diet Therapy Natural Nutrients - obtained from plants and animals M-1: lesson 1 Basic Nutrition Terms and Synthetic Nutrients – man made used Concept...

Nutrition and Diet Therapy Natural Nutrients - obtained from plants and animals M-1: lesson 1 Basic Nutrition Terms and Synthetic Nutrients – man made used Concept in correcting deficiencies ART OF NUTRITION - Application of 2. Based on Essentially nutrition science to meet individuals needs for Dietary Essential Nutrients - those the the goal of optimal health status body cannot make in sufficient quantity to meet its requirements; must be NUTRITION - Science of the processes by obtained from the diet which the body uses food for energy, Non-Dietary Essential Nutrients - can maintenance and growth be produced by the body enough amounts during normal conditions - Science of food, the nutrients, and others substances within food; their Carbohydrates(CHO) 1 gm = 4 kcal action,interaction and balance in relation Protein ( CHON) 1 gm = 4 kcal to health and disease and the process by Fats 1 gm = 9 kcal which the organism ingests, digests, absorbs,transports, uses and excretes MACRONUTRIENTS substances (Council of the American - Nutrients needed by the body in large amounts Medical Association) - measured in grams or liter - Carbohydrates, Protein, Fats, water FOOD - Products derived from plants or animals Important for health and survival MICRONUTRIENTS providing fuel for bodily functions and materials - Nutrients needed by the body in small for growth, repair and general health amount - Measured in milligrams or micrograms NUTRIENT - Chemical substances found in - Vitamins and minerals food and is used in the body to provide energy, build and repair body GOOD NUTRITIONAL STATUS tissues and so on regulate life processes - Appropriate intake of the macronutrients and the various micronutrients 6 main classes - Can be achieved if there is good Carbohydrates digestion, absorption and cellular Protein metabolism of the nutrients Fats Vitamins POOR NUTRITIONAL Minerals STATUS/MALNUTRITION Water - There is prolonged lack of one or more nutrients which retards physical development or causes the appearance Classification of nutrients of specific clinical conditions 1. Based on sources  - May occur because the diet is poor or - Promotes personal responsibility for because of a digestion and metabolism well being and acknowledges the total problem influences-biological, psychological and - Excess nutrient intake which leads to social-that affect health, including conditions such as obesity, heart disease, nutrition, exercise and emotional well hypertension, hypercholesterolemia. being OPTIMAL NUTRITION - A person is MEDICAL NUTRITION THERAPY receiving and using the essential nutrients to - Previously known as diet therapy maintain health and well being at the highest - Treatment of diseases through possible level nutritional therapy KILOCALORIE Necessary for the following reasons: - Unit of measure used to express the fuel 1. To maintain or improve nutritional status value of CHO, CHON, fats, CHO, 2. To improve clinical or subclinical nutritional CHON, fats and alcohol are the only deficiencies sources of kilocalories - 1 kcal=4.184 kj (Kilojoules) Food Components 1. Nutrients DIET - Food and drink that a person regularly 2. Non- Nutrients consumes - can be useful, Neutral, or unfavorable - Food additives, phytochemicals and BALANCE DIET - Provides the recommended zoochemicals amount of essential nutrients ZOOCHEMICALS - found in animal food that MEAL - Breakfast, Lunch, Dinner, Snacks are not essential nutrients but may have health promoting properties HEALTH - More than the absence of the disease PHYTOCHEMICALS - found in edible fruits, - High level health and wellness are vegetables and other plant derived foods present when the individual is actively - Contain health promoting properties in engaged in moving towards the the body fulfillment of his or her potential PUBLIC HEALTH Medical Nutrition team - Field of medicine that is concerned with safeguarding and improving the health Medical Part of the community as a whole. MD RN HOLISTIC HEALTH RND - A system of preventive medicine that PT takes into account the whole individual RP  - Transcribes the patient’s diet Social professionals - Supervises the tray line Social worker - Check the prepared feedings. OT Psychologist 3. CLINICAL DIETITIAN - Visits the patient for nutrition Community resources assessment, calorie counting and diet Personnel - BHW instructions —------------------------------------------------------ 4. WEIGHT MANAGEMENT DIETITIAN ATTENDING MEDICAL DOCTOR - Gives advice on proper diet and - Responsible for the overall medical exercises treatment of the patient. - Interpret the science of how food is used - He refers the patient to the allied health by the body in health and disease states members. - Evaluate how MNT can promote a - Should be kept informed of concerns of positive nutritional status the health care team and their recommendation 5. NUTRITIONIST - An educator as well as counselor NURSE - Checks for food and drug, as well as - Front liner of patient care drug and drug interactions - They perform the nutrition screening of - Prepares the parenteral nutrition(PN) patients upon admission. solutions - They also ask about their specific food - Responsible for preparing the nutritional allergies. solutions that the physician prescribes - They encourage the patient to feed adequately, and take medications OCCUPATIONAL THERAPIST regularly. - helps the patient regain activities of - Can provide good insight because of in daily life (ADL) like eating depth patient contact independently. - Assessment and monitoring of patient - They help determine if the patient's diet eating habits and health status are may be progressed with a swallowing important roles of the nurse. test as specified by a rehabilitation doctor. - Emphasizes the remaining strengths NUTRITIONIST DIET - Identifies adaptive devices that would enhance independent functioning (e.g. 1. FOOD SERVICE DIETITIAN long handled spoon, reaching devices) - Menu planning, purchasing - Oversees the preparation of meals in the PHYSICAL THERAPIST dietary department - Helps a person enhance physical capabilities that had been impaired by 2. THERAPEUTIC DIETITIAN  illness or trauma (e.g. increase muscle strength) SPEECH LANGUAGE PATHOLOGIST - Assess swallowing Prevention of aspiration of food - Determine the degree of risk of aspiration and make appropriate plans that other healthcare professionals can use in developing their plans - e.g. for PT, correct positioning for swallowing; OT for feeding devices, RND for food consistency) SOCIAL WORKER - Expertise in community resources including financial counseling, technical support and educational resources Can help a person identify and express barriers. MODULE 2: The energy macronutrients and energy balance CARBOHYDRATES Primary fuel of our body  Widely available and are an economic - Converted into glucose and galactose source upon digestion They are easily packed and have a long shelf life in dry storage Lactose (glucose + galactose) They are mild flavored and combine - Found in milk and milk products except well with other foods and easy to cheese prepare - Converted into glucose and galactose in Made through the process of digestion and is less soluble and less photosynthesis sweet than sucrose Contains Carbon, hydrogen, and oxygen - It remains in the intestine longer than other sugars and encourages the growth Classification of Carbohydrates of certain useful bacteria Simple carbohydrates Maltose ( glucose + glucose) 1. Monosaccharide - Produced by hydrolysis of starch and is Glucose converted into glucose in digestion - Blood sugar and the principle form in - It occurs in malt products and CHO is used in the body germinating cereals. - Found in fruits, sweet corn, and corn - It can be found in certain infant syrup formulas, beet, and malt beverage - Fuels the work of the body’s cells products - Provide energy for the brain, nerve cells - It is less sweet compared to glucose and and developing red blood cells sucrose Fructose - Sweetest form of simple sugar Complex carbohydrates Polysaccharides - It is found in honey, most fruits and Starch some vegetables - Is the most significant polysaccharide in - It is converted into glucose in the body human nutrition - Its major food sources include cereal Galactose grain potatoes and other root vegetables, - Not found free in foods and legumes. - It is produced from lactose(milk sugar) - It is converted entirely into glucose by digestion and is converted into upon digestion; is more complex than glucose in the body sugars; and requires a longer time to digest. 2. Disaccharides Dextrins Sucrose ( glucose + fructose) - Are not found free in foods. - Ordinary table sugar-granulated, - They are formed as intermediate powdered or brown and is processed products in the breakdown of starch from cane or beet sugar - Found in fruits, vegetables, syrups and Cellulose sweet food production  - Form the framework of plants found in unrefined grains, vegetables and fruits. All monosaccharides require no - It is non-digestible by humans, no digestion specific enzyme is present and provides Disaccharides are not digested in the important bulk in the diet mouth - Main sources are stems and leaves of Starch is partly hydrolysed by ptyalin vegetables, seed and grain coverings, (salivary amylase) in mouth to dextrose skins, and hulls. and maltose - They lower the blood glucose levels of people with diabetes mellitus Glycemic Index - effect of food on a person’s Classification: blood glucose level Insoluble fiber - Low GI food (70) food causes more rapid - Accelerate gastrointestinal transit, rise in blood levels and is suitable for increase fecal weight, slow down starch energy recovery hydrolysis, and delay glucose absorption. Glycemic Load - how much carbohydrates is in Soluble fiber the food and how much each gram of CHO in - Viscous plants fibers are soluble in the food raises blood glucose levels water - Low GL (20 barley, oats, legumes and beans. - Delay gastrointestinal transit and glucose absorption, and lower blood cholesterol. PROTEINS Pectins Most abundant component of the body - Occur in ripe fruits have the ability to Present in all living tissues, both plant absorb water to form gels and animal - Non-Digestible, colloidal having a gel Essential to life because vital parts of property the nucleus and protoplasts of every cell - Mostly from fruits and use for jellies Very large organic compounds - Use for treatment of diarrhea Contains about 16 percent nitrogen More complex than carbohydrates and Glycogen fats - Formed from glucose and stored in liver Plants are the primary source of proteins and muscle tissues Combination of amino acid and nitrogen - Mainly from meats and seafoods About 20 common kinds of amino acids - Converted entirely into glucose upon digestion  Digestion takes about 2 hrs, it is broken - The body is able to synthesize 13 of into amino acids then reassemble into these but is unable to make 9 others proteins by the liver - 9 amino acids have to be provided in the diet in sufficient amounts which is Amino acids that the body cannot make called essential amino acids. P - phenylalanine V - valine Protein digestion starts only in the T - threonine stomach as there are no protein splitting T - Tryptophan enzymes in the saliva I - Isoleucine In stomach, protein is hydrolysed by M - methionine enzymes with hydrochloric acid H- histidine Amino acids are absorbed either by the L - leucine stomach wall, intestinal walls or colon L - lysine amino acids are absorbed in the small intestine Recommended protein intake: 10-15% Pancreas Classification of proteins Trypsin - converts proteoses and peptones into plypeptides and peptide 1. Simple protein - yield only amino acids Chymotrypsin - converts proteoses and upon hydrolysis peptones into polypeptides and Albumins dipeptides, also coagulates milk Glutelins Carboxypeptidase - converts Prolamins polypeptides into simpler peptides, Globular dipeptides, and amino acids Histones and protamines albuminoids Intestines 2. Compound protein(conjugated proteins Aminopeptidase - converts polypeptides and proteins) - performs function that a into peptides and amino acid constituent could not proper perform by Dipeptidase - convert dipeptides into itself amino acids Nucleoproteins Mucoproteins & glycoproteins Principal functions of Proteins Lipoproteins 1. Body building or building of new tissues Phospoproteins 2. Maintenance of tissues metalloproteins 3. Regulatory Functions 3. Derived proteins - products formed in 4. Proteins as precursors of enzymes, the various stages of hydrolysis of hormones, and antibodies protein molecule 5. Transport of nutrients Amino acids FATS OR LIPIDS - There are 22 amino acids which is vital - Fats constitute 34% of the energy in the to human life and health human body  - Includes substance such as fat, oil, - Green leafy vegetables, cabbage and waxes lettuce, tuna, sardines and salmon - Provides a more concentrated source of energy compared to carbohydrates Linoleic acid and linoleic acid are not - Layer of fat beneath the skin act as synthesized in human body, it requires insulation against cold important function and are available - Protects the vital organs only through diet - Acts as lubricant around the joints - Digestion takes 4 hours Triglycerides - FATTY ACIDS, FATS, and OIL, - Combine with glycerol to form a PHOSPHOLIPIDS, STEROLS and glyceride LIPOPROTEINS - Most are hydrolysed to form free fatty acids, monoglycerides and glycerol Classification of lipids absorbed into the intestinal cells and 1. Simple lipids - fats and oils majority are rebuild into triglycerides 2. Compound lipids - phospholipids, Phospholipids glycolipids, and lipoprotein - formed mainly in the liver from fatty acid, glycerol, phosphoric acid and nitrogenous base 3. Derived lipids - fatty acids, glycerol, and steroids Lecithin- a phospholipid contains choline-phosphate attached to one hydroxyl of 2 phospholipid found in brain the glycerol molecule 1. Sphingomyelins 2. cerebrosides Fatty acids Steroids - lipids with a multi ringed structure - Main building blocks of fats - About 20 fatty acids Cholesterol - an important sterol. It is a waxy - Have methyl group at one end and substance, it is a precursor of Vitamin D, carboxyl group at the other end hormones and bile acids. Fatty acids in foods Lipoproteins 1. Saturated fatty Acid - single bond - Synthesized in the liver 2. Unsaturated - one or more double bond - Vehicle for fat transport in the 3. Monounsaturated fatty acid - One bloodstream double bond - Contains triglycerides, cholesterol and 4. Polyunsaturated Fatty Acid - two or other substances such as fat soluble more double bonds vitamins Oleic acid - Omega 9 fatty acid (MUFA) 4 groups of lipoprotein Linoleic acid - Omega 6 fatty acid (PUFA) 1. Chylomicron - Vegetables oils, less amount nut, seeds, 2. Low density lipoprotein(LDL) - bad grains 3. High density lipoprotein (HDL) - good Linolenic acid - Omega 3 fatty acid (PUFA) 4. Very low density lipoprotein (VLDL) 2 groups of essential nutrients 1. Essential fatty acids 2. Fat soluble vitamins (A,D,E,K) Digestion of fats starts in the stomach Chemical changes necessary for fat digestion occur in the small intestine, entry of fat in the duodenum Small intestine - secretes bile from the gallbladder Pancreatic lipase- breaks off one fatty acid at a time from triglyceride Lecithinase - secreted by the small intestine, acts on lecithin to break into its components for absorption. Some fat is used to supply energy Energy balance - change in energy stores equals the food energy taken in (kcalories) minus the energy expended on metabolism and physical activities Changes in energy stores = energy in (kcalories) - energy out (kcalories) Energy in: energy provided by food and beverages is the contributor to the side of the MICRONUTRIENTS energy balance equation. MINERALS Energy out - the body expends energy in TWO - essential to human health MAJOR WAYS: - obtained in our diet from different types - Basal metabolism of food. - Voluntary activities - 20 essential minerals that must be consumed in our diets to remain healthy. - elements in their simple inorganic form. - present or required in small amounts- trace elements or trace minerals Trace minerals Chromium Copper Fluorine Iodine Iron  Manganese Seafoods whole grains Molybdenum Milk and cocoa Selenium Peas and beans Zinc Effect of Deficiency Hypomagnesemic tetany MAJOR MINERALS Effect of Excessive Hypermagnesemia or toxicity stage Calcium Distribution: Sodium 1.5% to 2.2% Distribution: Function: 50% in extracellular fluid For bones and teeth, it participates in 10% within the cells muscle contraction and relaxation, 40% in skeleton promotes blood coagulation/clot 1.8mg in a fat-free body Food sources Function: Fatty fish, leafy greens, dairy products Maintains fluid balance Effect of Deficiency Maintains acid-base balance Retarded growth osteomalacia(rickets) - Allows materials to pass through the cell increase excitability of the nerve and wall uncontrolled reaction of muscle tissue Maintains normal muscle irritability and Hypocalcemia excitability Effect of Excessive Sources: Hypercalcemia - calcium level in the Carrots, celery, beets, spinach, peas blood is above normal Soy sauce, catsup, fish sauce Interfere: Effect of Deficiency Oxalic and phytic acids Hyponatremia Mental stress or emotional instability Effect of Excessive and alcohol Hypernatremia edema Magnesium Distribution: Potassium 50% Distribution Function: 2.6mg/kg fat-free weight ( 0.35% of Energy transfer body weight) Important in photosynthetic reaction to Function: plants Maintains fluid and electrolyte balance Active muscle tissue and liver Plays a role in skeletal and cardiac Regulates phosphorus level muscle Conduction of nerve impulses normal Act as muscle relaxant in contrast to muscle contraction calcium Increase the stability of calcium in the Important in carbohydrate and protein tooth enamel metabolism Sources: Sources Nuts Meat  Fruit Detoxification reaction Legumes Sources Dark vegetables Protein Effect of Deficiency Effects of deficiency Hypokalemia Cystinuria - stones made from an amino Mental confusion acid form in kidney, ureter or bladder Apathy Effects of excess Abdominal distention Brain cell death Muscular weakness Effect of Excessive Chlorine Hyperkalemia Distribution: Major anion in the extracellular fluid Highest concentration in cerebrospinal Phosphorus fluid Distribution: Found in GI secretions 1% Function: Functions: Maintains fluid, electrolyte balance and Component of bones and teeth acid base balance Component of every cell Contributes to acidity necessary in the pH regulation stomach HCL Facilitates the passage of substances Sources: through cell membranes Table salt Sources Effects of Deficiency Meat Alkalosis Fish Effects of excess Eggs Pulmonary edema Dried beans Dairy products TRACE MINERAL Effects of deficiency Rickets in children Iron Osteomalacia in adults (softening of Distribution bones) 75 mg/kg in a fat free body weight Effects of excess Function Natural phosphate cause NO HARM Constituent of hemoglobin and voided in the stools myoglobin High elemental phosphate is highly Carrier of oxygen needed POISONOUS Hemoglobin formation Active component of tissue enzyme Sulfur Sources: Distribution Organs (Liver) o.25% Rice Function Ampalaya and malunggay leaves Maintains protein structure Sweet potato, green and red monggo, Activates enzymes petsay, saluyot Effects of deficiency Cretinism Anemia Myxedema Effects of excess Effects of Excess Hemosiderosis Thyroid gland inflammation and thyroid cancer Types of iron 1. Heme - found only in meat Zinc 2. Non Heme - found in plants Distribution: 2 - 5 mg Caffeine - reduce absorption Function: Ascorbic acid - increase absorption Integral part of several metalloenzymes Present in the RNA Copper Related to hormone insulin, glucagon, Function: ACTH growth hormone, testosterone Essential in formation of hemoglobin Enhances wound healing Promotes absorption of iron Maintain normal sense of taste Catalyst in oxidation-reduction Sources: mechanisms Whole grains Maintains integrity of myelin sheath Milk products Part of tyrosinase Oysters Source: Red meat and poultry Shellfish Beans Seeds and nuts Effects of Deficiency Meat organs Growth retardation wheat/whole grain Loss of appetite Dark chocolate Impaired immune function Effect of deficiency Effects of excessive Depigmentation of skin and hair Nausea Hypothermia Vomiting CNS abnormalities anemia Loss of appetite Chronic microcytic Stomach cramps Hypotonia Diarrhea Effects of excess Headache Wilson’s disease Low copper levels, low immunity and low levels of HDL Iodine Distribution: Fluorine 20 to 30 mg Function: Function: Prevention of cavities Thyroid hormone production Resist acid and dental caries Source: Inhibit bacterial growth that may cause Seafoods, seaweeds, iodized salt cavities Effects of deficiency Sources Goiter Fluoride water  Tea Seaweed, seafood Effects of Deficiency Dental Caries Effects of excess Dental fluorosis -characterized by hypomineralization of tooth enamel cause by ingestion of excessive fluoride during enamel formation Osteosclerosis - characterized by abnormal hardening of bone and an elevation in bone density Growth depression Fatal poisoning