NuCm 105 Module 4.pdf

NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 Module 4: Dietary Standards, Tools, and Recommendations Module Overview This module focuses on dietary guidelines and nutritional standards adopted and implemented by the country....

NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 Module 4: Dietary Standards, Tools, and Recommendations Module Overview This module focuses on dietary guidelines and nutritional standards adopted and implemented by the country. You will learn how to read and interpret food labels, locate dietary references, and use food exchange lists in drafting meal plans for clients. Motivation Question After calculating your daily caloric requirements, how do you now plan your meal and choose what to eat? Module Pretest Instructions: Answer the questions as honestly and as quickly as you can. This is not graded. Remember your answers as much as possible a check if they are correct or not as you read along. 1. What portion of processed food packages will you inspect to look for nutrient contents of the processed food? 2. The lead implementing agency of the country’s nutritional thrusts is _______. 3. In order to choose food substitutes that constitute the same nutrient and caloric content, you can inspect the __________. 1 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 Lesson 4.1: Nutrition and Dietary Standards, Tools, Guidelines, and Recommendations Lesson Summary The Philippines through the National Nutrition Council and Food and Nutrition Research Institute of the Department of Science and Technology implements the Pinggang Pinoy and Filipino Food Pyramid as advocacies for healthy diet among Filipinos. Along with these, Filipinos can also read Nutrition Labels to determine caloric contents of processed foods. Also, the Food Exchange System helps Filipinos plan their meals better according to choice, availability, and affordability. Learning Outcomes 1. Familiarize with the use of the different Dietary Reference Intakes in the PDRI Table; 2. Utilize dietary guidelines and food label interpretation in making decisions regarding food choices; and 3. Draft a meal plan according to dietary guidelines using food exchange lists. Motivation Question You know about calories, macronutrients, and micronutrients. How do you exactly know how much of which to eat? Discussion Nutrition Standards ▶ Different countries have set recommended daily intake of specific nutrients per age group, and by gender. This means that if you as a health care provider is handling a male thirty-year-old client, all you have to do is refer to the nutrition standards for intake specific to that person’s age and gender and base your plan of care for nutrition there. Although more often doctors and dietitians are the ones who use these tools, nurses who have more client contact and providing holistic care and client education, must know how to utilize these tools. Dietary Reference Index (DRIs) ▶ DRIs are standards which originated form the US and was adopted by countries, including the Philippines. These contain recommended nutrient intake of the population by age and gender. Under the DRIs are subcategories (EAR, RDA, AI, UL) which health professionals can use. Take note that these DRIs are intended for use with healthy individuals and are subject to change when Dietary reference index - contains recommended nutrient intake of population A. Ear 2 B. RDA C. Ai Ul NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 new research data suggests changes in the list. Nurses should utilize updated lists when using DRIs. ▶ Estimated Average Requirements (EAR). This is the average daily nutrient intake estimated to meet the requirements of 50% of the healthy people in that age group. ▶ Recommended Dietary Allowance (RDA). This is the average dietary intake level of a nutrient considered sufficient to meet the requirements of nearly all (97-98%) healthy individuals in each life-stage and gender group. ▶ Adequate Intake (AI). The suggested daily intake of a nutrient when there is insufficient research to establish an RDA, but the amount established is believed to be adequate for most healthy individuals in the demographic group. ▶ Tolerable Upper Intake Levels (UL). The highest level of daily nutrient intake that can be safely consumed with no risk of toxicity or adverse effects on human health. ▶ Among the four, RDA is the most reliable reference for daily intake. RDA is sometimes interchangeably used with the term RENI, or Recommended Nutrient Intake. To avoid confusion and for consistency, the term RDA will be used throughout the module. A copy of the Philippine Dietary Reference Intakes (PDRI) is attached in this lesson. Familiarize yourself with how to look for data in the table. Dietary Guidelines ▶ Every country’s government, the Philippines included, have developed tools and guidelines to promote healthy diets and activity levels. In the country, the lead agency which spearheads the implementation of nutrition programs is the National Nutrition Council (NNC) together with the Food and Nutrition Research Institute (FNRI) of the DOST. Among the dietary advocacies of the institution includes the Nutritional Guidelines for Filipinos (Mga Gabay sa Wastong Nutrisyon Para sa Pilipino) and the Pinggang Pinoy. ▶ Nutritional Guidelines for Filipinos. The guidelines drafted by the FNRI and approved and endorsed by the NNC were first published in 1990, revised in 2000 and again in 2012. These are directed to the general Filipino population, including lactating mothers and feeding of children. The messages in the 2012 Nutritional Guidelines for Filipinos (NGF) are as follows: ▶ Eat a variety of foods everyday to get the nutrients needed by the body. ▶ Breastfeed infants exclusively from birth up to six months, then give appropriate complementary foods while continuing breastfeeding for two years and beyond for optimum growth and development. ▶ Attain normal body weight through proper diet and moderate physical activity to maintain good health and prevent obesity. ▶ Consume fish, lean meat, poultry, egg, dried beans or nuts daily for growth and repair of body tissues. ▶ Eat more vegetables and fruits everyday to get the essential vitamins, minerals and fiber for regulation of body processes. ▶ Limit intake of salty, fried, fatty and sugar-rich foods to prevent cardiovascular diseases. ▶ Consume milk, milk products, and other calcium-rich foods, such as small fish and shellfish, everyday for healthy bones and teeth. 3 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 ▶ Use iodized salt to prevent Iodine Deficiency Disorders. ▶ Consume safe foods and water to prevent diarrhea and other food- and water-borne diseases. ▶ Be physically active, make healthy food choices, manage stress, avoid alcoholic beverages and do not smoke to help prevent lifestyle-related non-communicable diseases. ▶ To complete the advocacy of healthy eating and lifestyle, the Filipino Food Pyramid and Pinggang Pinoy was launched. These aim to show adequate distribution of nutritious foods in a meal. Various versions of the Filipino Food Pyramid are available, depending on the age group of the client. The food pyramid below shows the food pyramid for Filipino adults. Figure 1. FNRI Eating plan for healthy living of adults. 4 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 Figure 2. NNC Pinggang Pinoy for adults. 5 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 Food Labels ▶ If you check the entire packaging of processed foods, you will notice a black and white table with the heading ‘Nutrition Facts’. This food label allows the buyers to check the nutrient contents of food inside the pack to help them make healthy food choices. It is important for the nurse to understand the nutrition facts label when working with individuals and families to plan nutritious meals. The layout of the label has been revised throughout the years by the FDA, and the latest revision was made in 2016. Let us examine the components of a nutrition facts label. , N Figure 3. Nutrition facts label sample. ▶ Food amount and energy content. The amount of food in the package is listed by serving size, weight, the number of servings expected for the container, and the number of calories in each serving. The serving size should be carefully noted because the portion the individual plans to eat may exceed the serving size. In the food label above, the whole container contains eight servings. In most cases, one individual gets to eat the whole container (this is true even in your case, right?) without knowing that he/she exceeds to eat one serving. ▶ Macronutrient content. Fat, CHO, and CHON are listed in grams. Amounts of total fat, saturated fat, trans fat, and cholesterol are also listed. MUFA and PUFA are listed as well. Carbohydrates 6 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 are subcategorized into dietary fiber and sugars. “Added sugars” are indicated to help consumers recognize the number of calories added sugars contribute to the diet. ▶ Micronutrient content. Labels are required to list Na, K, vitamin D, Ca, and Fe. Vitamins A and C are not required but may be included on a voluntary basis. ▶ Daily reference values (%DV). The right column of the table indicates the daily reference values of the food contents based on a 2,000-kcal diet. The number is the advised daily caloric intake for healthy adults. In cases where persons need to consume less than 2,000 kcal/day, it follows that the %DV of the contents will increase. Grab any processed food with a Nutrition Facts label and familiarize yourself by interpreting the percentages in the label. ▶ Ingredient List. Another tool that consumers and nurses can use to arrive at healthy food choices is the ingredient list section. The law requires that all ingredients be listed down in descending order by weight. This means that the first ingredient in the list is the highest contributor to caloric and nutrient value. How can this help the client make sound decisions? Say for example you grab two different cans of pineapple juice in the store and examine their nutrition facts. Can A lists water, sugar, flavoring as the first ingredients while can B lists pineapple puree as the first ingredient. Which can do you think has more nutritional value? Right, can B. You get more nutritional value from real fruit juices than fruit juices out of flavoring and sugar. ▶ Another feature of the ingredients list is that it highlights the eight major food allergens if present: milk, egg, crustacean, shellfish, tree nuts, peanuts, wheat, and soy. They are printed in bold letters if present in the food. ▶ Take note, however, of different ingredients in the food that have the same caloric value. For example, you notice different types of sugars present in the food which are listed differently in the ingredients list. Individually, these may pose little or no risk, but when combined, may comprise a significant amount that may well be the first ingredient in the list. Nutritional Claims ▶ Reduced fat, low fat, fat-free, fortified, enriched. These are some terms you often see on food packages of processed foods. These claims are made by food manufacturers to supposedly help consumers make the right choice in buying their products. Don’t deny it, the moment you see terms like “Less sugar” or “Reduced fat”, you tend to buy the product. But do these terms really indicate that the product has good nutritional value? In some light, yes, but more often, these confuse customers more, especially those without nutritional education. It is your job as a nurse to be well-versed with the legal definitions of nutritional claims like these in order to educate the patient and help clear any wrong assumptions. Let us examine these terms. ▶ Low. This means an amount that would allow frequent consumption of a food without exceeding the daily value (DV) of the nutrient. Labels may also list this as few or low source of. ▶ Reduced. This refers to at least 25% less of a given nutrient or calories than the comparison food. This is also listed as less or fewer. ▶ Free. This is also listed as zero, no and without. It means that a food provides insignificant amounts of nutrient. Products with less than 0.5g/serving of fat or sugar can list 0 gram on the Nutrition Facts Panel. 7 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 ▶ Light. Sometimes spelled “lite”, this means that a food has 1/3 fewer calories, or 50% or less fat or sodium than the comparison food. ▶ More. This means that the food has at least 10% more of the nutrient indicated than the comparison food. ▶ Good source. This indicates that the food provides 10% to 19% of the daily value of that nutrient indicated. ▶ High / Rich in / Excellent source. This indicates that the food provides at least 20% of the indicated nutrient. ▶ Lean. Contains less than 10g of fat, 4.5g of saturated fat and trans-fat combined, ad no more than 95 mg of cholesterol either per serving or per 100g of meat. ▶ Extra lean. The term means that the food has 5g of fat, 2g of saturated and trans-fat combined, and not more than 95mg of cholesterol either per serving or per 100g of meat, poultry, or seafood. You know about the dietary guidelines. You know how much calories to consume in a day. You know how much fat, carbs, and proteins to eat. Question is, how do you know how much of which food to eat? How do you plan your meal? This is where we learn about food exchange. Food Exchange System ▶ This is a system of grouping foods with more or less the same number of calories, carbohydrates, fats and protein. They are grouped into lists (hence the term Food Exchange List). From the term exchange, you can exchange one food with another food from the same list depending on food choice, or availability, or practically speaking, budget, because, as mentioned, these foods have roughly the same caloric and nutrient content. ▶ Food Exchange List. There are various food exchange lists available from a variety of sources but for uniformity’s and context’s sake, we will be using the 4th Edition Food Exchange Lists from the Food and Nutrition Research Institute. There are seven main groups in the list: vegetable, fruit, milk, rice, meat, fat, and sugar. It is important that you familiarize with the list so that it would be easier for you to use. Take note of the equivalent household measure per exchange. One exchange does not have to be the same quantity in household measure as another exchange of the same caloric density. Take note of the terms as purchased (AP) and edible portion (EP). AP means the food as sold in markets or as acquired during harvest, with both edible and non-edible portions (peelings, bones, seeds, etc.). Allot time to browse through the list. It will help facilitate meal planning if you find the list comfortable to use. 8 NuCM105: Nutrition and Diet Therapy in Nursing For instructional purposes only 1st Semester SY 2020-2021 Practice for Mastery It’s a good habit to be aware of what you eat. Try looking into Nutrition facts of processed foods before eating them and make a crude calculation of how much calories you took in from that food, including calories from macronutrients. Take note that one pack of a processed food is not always equivalent to one serving. More often, one pack contains more than one serving. Familiarize your FEL as well. Try browsin through it, just look at serving sizes and caloric contents. Try formulating meals in your mind taking into account the amount of calories you have to take in from the macronutrients. It’s like taking legos and building different things out of small different blocks. 9