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San Pablo Colleges COLLEGE OF NURSING NCM 105 – Nutrition and Diet Therapy First Semester, AY 2024-2025 LECTURE 1 DEFINITION OF TERMS NU...

San Pablo Colleges COLLEGE OF NURSING NCM 105 – Nutrition and Diet Therapy First Semester, AY 2024-2025 LECTURE 1 DEFINITION OF TERMS NUTRITION Science of food, nutrients and how our body uses it FOOD ❖ Any substance when taken into the body nourishes the body ❖ Gives energy, builds and repairs tissues and regulates body processes ❖ Derived from plant and animal sources NUTRIENTS ❖ Chemical components of foods needed by the body to function well ESSENTIAL NUTRIENT ❖ Nutrients that can be obtained from food because the body cannot synthesize it at the right amounts HEALTH ❖ State of complete well being DIET ❖ Pattern of food and drink taken from day to day ❖ Affected by nutrient needs, culture and purchasing power BALANCED DIET ❖ A diet that provides the recommended intake of all the nutrients and a wide variety of foods NUTRITIONAL ASSESSMENT ❖ A comprehensive approach to determine a person’s nutritional status NUTRITIONAL STATUS ❖ Condition of the body that results from the utilization of the nutrients of the body MALNUTRITION UNDERNUTRITION Condition that results from inadequate energy available to the body for a prolonged periods of time OVERNUTRITION Condition that results from excessive amounts of energy available to the body for a prolonged period of time. Malnutrition, in every form, presents significant threats to human health. Today the world faces a double burden of malnutrition that includes both undernutrition and overweight, especially in low- and middle-income countries. There are multiple forms of malnutrition, including undernutrition (wasting or stunting), inadequate vitamins or minerals, overweight, obesity, and resulting diet-related noncommunicable diseases. ERAS OF NUTRITION NATURALISTIC ERA (400 BC – AD 1750)- Food is used as cosmetics or as medicines in the treatment of wounds. In some of the early Far-Eastern biblical writings, there were references to food and health. Vague ideas about taboos and magical powers or medicinal value of food Biblical times- A person observed that men who ate pulses (Legumes and soya) and drank water performed better than those who ate the king’s food and drank wine CHEMICAL AND ANALYTICAL ERA (1750- 1900) Experiments with the human body and intake of food. Discovery of the metabolism of food. Composition of food BIOLOGICAL ERA (1900-1955) VITAMIN was coined (Vital + amine) Discovery of water-soluble and fat-soluble vitamins CELLULAR OR MOLECULAR ERA (1955- PRESENT) Use of electron microscopes and ultracentrifuge Nutrition breakthroughs – research, dietary guidelines, and food policies NUTRIENTS- there are 6 classes of nutrients NUTRIENTS- Chemical components of foods needed by the body to function well No food by itself has all the nutrients needed for full growth and health, all nutrients work best in the body when teamed with other nutrients All persons throughout life need the same nutrients but in varying amounts, which is influenced by age, sex, size, activity, and state of health. CLASSES OF NUTRIENTS MACRONUTRIENTS- are nutrients needed by the body in relatively large quantities (many grams per day and include carbohydrates, fats, and proteins. MICRONUTRIENTS- are nutrients needed by the body in very small quantities (usually less than 1 gram per day) and include vitamins and minerals. THEIR AMOUNTS ARE MEASURED IN MILLIGRAMS AND MICROGRAMS Vitamins- Fat and Water Soluble Mineral- Macro and Micro Water MACRONUTRIENTS: CARBOHYDRATES CHO – arranged as monosaccharides or multiple monosaccharides Simplest form is glucose Sugars and starches are produced in plants through Photosynthesis. Metabolized to produce 4kcal of energy/ gram Energy-giving foods composed of sugars Common staple eaten regularly, accounting for up to 80% of the diet in developing countries Quickly absorbed by the body Sources – rice, bread, noodles, fruits, vegetables and sugars FUNCTIONS: 1. ENERGY SOURCE- for the brain and muscles 2. PROTEIN- SPARING ACTION- spares use of protein for energy 3. ANTIKETOGENIC EFFECT 4. CONTROL OF FAT OXIDATION- spares use of fats for energy 5. REGULATORY- effects of fiber on bowel movements, cholesterol and glucose regulation 6. STRUCTURAL- as constituents of brain and nerve tissues  7. DETOXIFYING AGENT- natural detox (e.g., fiber) CLASSIFICATION OF CARBOHYDRATES SIMPLE CARBOHYDRATES MONOSACCHARIDES- Simplest sugar; cannot be hydrolyzed into simpler compounds. 1. GLUCOSE- Dextrose and Blood sugar; BODY’S MAJOR FUEL THAT PROVIDES ENERGY, FORMED IN THE BODY THRU STARCH DIGESTION, FOUND IN DEXTROSE, GRAPE SUGAR, AND CORN SUGAR, MILDLY SWEET 2. FRUCTOSE – aka Levulose; Fruit Sugar- sweetest sugar 3. GALACTOSE- Milk sugar; SYNTHESIZED IN THE MAMMARY GLANDS, NOT FOUND IN FREE STATE IN NATURE, hardly tastes sweet and least soluble among the hexoses DISACCHARIDES- two monosaccharides linked together by glycosidic bonds. 1. SUCROSE- Glucose and fructose 2. LACTOSE – Glucose and galactose 3. MALTOSE- Glucose and glucose COMPLEX CARBOHYDRATES ▪ OLIGOSACCHARIDES-contains 3-15 monosaccharide units; Not absorbed nor hydrolyzed by the digestive system ▪ POLYSACCHARIDES – Starch, Glycogen, Dietary Fiber and Dextrin- most abundant form of carbohydrates STARCH- Plant polysaccharide Hydrolysis-> amylose and amylopectin All starches derived from plants Plant cells store glucose as starch Grains is the richest source of starch Cereals, breads, crackers, pasta, rice, corn, legumes, potatoes and other root crops and vegetables GLYCOGEN- Highly branched, tree like, structured animal polysaccharide. Animal starch Manufactured from glucose and stored in the liver and muscles Found only in limited amounts in meats Can be depleted by hunger or severe muscular work Helps sustain blood sugar level during fasting period like sleeping or produce immediate fuel for muscle action DIETARY FIBER Crude fiber Structural parts of plants that are not hydrolyzed by human digestive enzymes but can be broken down by GIT bacteria Found in all plant derived foods Properties: 1. Water holding capacity- works like a sponge 2. Viscosity- ability to form gel 3. Cation- exchange capacity; ability to bind to minerals 4. Bile-binding capacity 5. Solubility- Pertains to the ability to form a solution in water 6. Fermentability- refers to the extent to which bacteria can breakdown fiber to short chain fatty acids  TYPE OF FIBER MAJOR FOOD SOURCES ACTIONS IN THE BODY SOLUBLE FIBER Gums, pectin, some hemicellulose and Fruits (apples and citrus), oats, barley, Delay glycemic index transit mucilages and legumes Delay glucose absorption Lower blood cholesterol INSOLUBLE FIBER Cellulose, many hemicelluloses, lignins Wheat bran, corn bran, whole grain ✔ Accelerate glycemic index breads and cereals, some vegetables transit ✔ Increase fecal weight ✔ Slow starch hydrolysis ✔ Delay glucose absorption CARBOHYDRATES: Digestion 1. Mastication breaks the food into small particles and mixes it with saliva 2. Salivary amylase acts on starch and begins its breakdown into dextrins and maltose 3. Pancreatic secretions contain pancreatic amylase. Intestinal secretions contain sucrase, lactase, and maltase that breakdown dextrins and maltose to monosaccharides. CARBOHYDRATES: Absorption 1. Glucose and galactose are either absorbed by diffusion or by a Na-dependent active transport 2. Fructose is absorbed by facilitated diffusion. 3. Galactose and fructose are converted into glucose in the liver 4. Insulin is a hormone that facilitates the entry of glucose into the cells, except for brain and liver CARBOHYDRATES: Metabolism 1. Metabolic fates of carbohydrates ▪ Source of blood glucose; ▪ Carbohydrates in the diet; and ▪ Liver and muscle glycogen 2. Energy Source 3. Precursor of fats Metabolic Processes of blood glucose control ❖ Glycogenesis- synthesis of glycogen from glucose which takes place in the liver or the muscles. ❖ Glycogenolysis – breakdown of glycogen to form glucose ❖ Gluconeogenesis- synthesis of glucose from non-carbohydrate sources like glycerol from fat, and amino acid, lactate ❖ Cori Cycle- conversion of glycogen to lactate ❖ Lipogenesis – synthesis of fats in the abundance of carbohydrates ❖ Lipolysis- breakdown of fats to glycerol and fatty acids to provide substrate for energy ❖ Hexose monophosphate shunt- refers to the pathway by which glucose is used to synthesize fatty acids and reduce substances. HEALTH EFFECTS OF CARBOHYDRATES 1. Dental caries- can cause bacterial over growth and tooth decay 2. Obesity- excessive intake of CHO can cause fat accumulation in the body 3. High- blood triglyceride levels 4. Hyperactivity- observed in children; “sugar high’ 5. Flatus- caused by indigestible CHO or lactose intolerance  6. Marasmus- severe wasting “skin and bones” 7. Cancer- GLV as phytochemicals and fiber that can protect against Cancer. 8. Diabetes- can cause and delay onset of DM 9. Nutrient deficiencies- when there is an over consumption can displace other nutritious foods. MACRONUTRIENTS: LIPIDS/FATS CHO – but with less oxygen in proportion to carbon and hydrogen Family of compounds that includes triglycerides (fats and oils), phospholipids and sterols Metabolized to produce 9kcal of energy/ gram PROPERTIES OF FATS/LIPIDS 1. Effects of heat include a pungent odor and an acrolein formation upon exposure to excessive heat 2. Rancidity – unpleasant change in color, tastes and odors due to oxidation of fats and the formation of acrolein. 3. Saponification – formation of insoluble soaps in the intestinal tract 4. Hydrogenation- process of adding hydrogen to double bonds 5. Emulsification- process of dispersing fat globules onto another liquid to become miscible FUNCTIONS 1. STORAGE FORM OF ENERGY- 1g of fats yields or provides 9kcal/ 37.8 Kj of energy 2. TRANSPORTS VITAMINS A, D,E AND K 3. SOURCES OF ESSENTIAL FATTY ACIDS-Linoleic (omega 6) and linolenic (omega 3) acid 4. THERMAL INSULATION-ADIPOSE OR BODY FAT MAINTAINS TEMPERATURE WITHIN THE VITAL RANGE NECESSARY FOR LIFE (37-37.5) 5. VITAL ORGAN PROTECTION-Padding of the adipose tissue around the vital organs from the mechanical shock or injury 6. IMPORTANT CONSTITUENT OF TISSUE STRUCTURE 7. PARTICIPATES IN THE TRANSPORT OF NUTRIENTS AND METABOLITES ACROSS CELL MEMBRANES 8. ESSENTIAL PRECURSOR SUBSTANCES 9. SURVIVAL-Female needs about 12% and male- 3% 10. REPRODUCTION 11. MEMBRANE FUNCTION CLASSIFICATION OF LIPIDS SIMPLE LIPIDS – Esters of fatty acids + alcohol a) Triacylglycerol or triglyceride (TAG) – esters of FA + glycerol b) Waxes- esters of FA + high molecular weight monohydric long chain of alcohol COMPOUND LIPIDS- fatty acids + alcohols + other compounds a) Phospholipids – FA + alcohol + Phosphoric acid + nitrogenous base b) Glycolipids – FA + Sphingosine and carbohydrate c) Lipoproteins – Lipid + protein d) Mucolipids – pertains to carbohydrate-containing lipids DERIVED LIPIDS- formed in the hydrolysis of simple and compound lipids a) Fatty acids- primary component of lipids b) Steroids c) Eicosanoids d) Ketone bodies CLASSIFICATION OF LIPIDS A. By chain length 1) Short Chain- Fatty acids of 4 or less Carbon atoms 2) Medium Chain- Fatty acids of 6-12 Carbon atoms 3) Long Chain- Fatty acids of 14 or more Carbon atoms B. By degree of saturation- affects the melting point and the state of the lipid @ room temperature 1. Saturated- solid at room temperature; with 1 double bond. 2. Unsaturated- liquid at room temperature; with 2 or more double bonds a. Monounsaturated- lacks 1 pair of H atoms b. Polyunsaturated- lacks 2 or more H atoms LIPIDS: Digestion 1. Bulk of the chemical digestion of fat takes place in the small intestine. 2. Fat stimulates the secretion of the hormone cholecystokinin which cause the gallbladder to contract and release. 3. Bile salts make fat increase area for the action of lipase. The Protein colipase enables the reaction to take place. 4. Pancreatic secretions that are released into the small intestine contain the pancreatic lipase or steapsin, cholesterol esterase and intestinal lecithinase. 5. Fatty acids, glycerol and monoglycerols and some diglycerides are the end products LIPIDS: Absorption 1) Synthesis of triglyceride 2) Oxidation of fatty acids for energy. 3) Synthesis of glucose from glycerol if there is inadequate glucose 4) Formation of ketone bodies when glucose is lacking 5) Synthesis of lipoproteins 6) Synthesis of bile and cholesterol 7) Synthesis of steroid hormones and other biologically important substances HEALTH EFFECTS OF LIPIDS 1. Cancer-Fats have been associated with cancers, but no clear and direct relationship has been established. Some studies suggest that fat do not initiate cancer formation but may have a role in the promotion of carcinogenesis 2. Cardiovascular diseases-PUFA have been implicated because of their susceptibility to oxidation. SFA and cholesterol have been implicated because of their ability to cause hypercholesterolemia. Hypercholesterolemia and oxidation are two atherogenic factors (may lead to atherosclerosis). Trans FA behave like SFA 3. Essential fatty acid deficiency- 4. Weight Control-Excessive intakes of fat can easily cause weight gain 5. Gall bladder disease-Decrease of fat intake may cause poor gall bladder movement, increase in fat intake may increase cholesterol deposition LIPOPROTEINS- transport vehicles of lipids in the lymph or blood 1. CHYLOMICRON- Triglycerides and transports lipids from the intestines to the liver 2. VERY LOW-DENSITY LIPOPROTEIN (VLDL)- largely made up of triglycerides 3. LOW-DENSITY LIPOPROTEIN (LDL)- largely made out of cholesterol 4. INTERMEDIATE-DENSITY LIPOPROTEIN (IDL) 5. HIGH-DENSITY LIPOPROTEIN (HDL)- largely made out of proteins MACRONUTRIENTS: PROTEIN CHON- arranged into amino acids linked in a chain A protein is made up of about 20 different amino acids, each with a different side group Amino acids have the same basic structure- a central carbon atom with a hydrogen, an amino group and an acid group attached to it. Metabolized to produce 4kcal of energy/gram CLASSIFICATION OF AMINO ACIDS: 1.Essentiality ESSENTIAL SEMI-ESSENTIAL NON-ESSENTIAL TRYPTOPHAN ARGININE ALANINE VALINE HISTIDINE ASPARAGINE THREONINE ASPARTIC ACID ISOLEUCINE HYDROXYPROLINE LEUCINE HYDROXYLYSINE LYSINE PROLINE PHENYLALANINE SERINE METHIONINE TYROSINE FUNCTIONS: 1. GROWTH AND MAINTENANCE OF TISSUES- CHON Provide AA needed for the synthesis of specific cellular tissue proteins and other essential nitrogen containing substances such as enzymes and hormones 2. SOURCE OF ENERGY- Some AA can be converted to glucose via gluconeogenesis 3. SPECIFIC PHYSIOLOGIC ROLES- a. Taurine-sulfur containing AA formed from methionine and is abundant in human milk.it is needed for retinal and visual function, brain development and stability of CNS activity Although taurine is commonly added to formula products because of the anticipated benefits on visual, auditory, and intestinal development of infants, relevant evidence from human studies is lacking. b. Carnitine- again formed from methionine with lysine- converts the products of fat metabolism to fewer toxic forms and removes them from the cell c. Albumin – exerts oncotic pressure for water balance d. Lipoproteins- transports lipids e. Globulins- involved with immune response  f. Fibrinogen-necessary for blood clotting PROTEIN: Digestion 1. Mastication breaks the food into small particles and mixes it with saliva 2. Chemical digestion begins in the stomach with the help of pepsin 3. HCl provides the degree of acidity that is necessary to convert inactive pepsinogen to its active form pepsin 4. Digestion proceeds with trypsin, chymotrypsin carboxypeptidases from the pancreas, and aminopeptidases and dipeptidases from the intestines. 5. End products of protein digestion are amino acids that are ready to be absorbed by the intestinal mucosa PROTEIN: Absorption Amino acid absorption occurs by an active transport in the proximal portion of the small intestine, requiring carrier, energy, pyridoxine and Manganese. PROTEIN: Metabolism 1) Maintenance of amino acid pool 2) Anabolism 3) Catabolism 4) Fates of amino acids HEALTH EFFECTS OF PROTEINS Excess a) Burden on liver for ammonia detoxification and kidneys for nitrogen excretion b) Obesity c) Depressed calcium absorption d) Hypercholesterolemia e) Heart diseases f) Cancer g) Weight control Deficiency a) Kwashiorkor – CHON malnutrition b) Clinical manifestations i. Presence of bilateral pedal edema ii. Loss of subcutaneous fats iii. Appetite loss iv. Sparse hair v. Muscle wasting vi. Pale, thin, peeling skin vii. infections MICRONUTRIENTS: Vitamins o Accessory growth factors o Discovered last o Organic compounds present in small amounts o Essential for normal health and growth o Not catabolized as a source of energy and are not used for structural purposes o Most serve as coenzymes o Most cannot be used in the form in which they are absorbed o Some absorbed from the diet must be converted into its active form Related substances: a) PROVITAMINS- chemical precursors of vitamins that are converted within the body to active vitamins. b) ANTIVITAMINS or ANTAGONIST- substances chemically related to true vitamins but cannot perform the biologic function of the true vitamins CLASSIFICATION OF VITAMINS FAT- SOLUBLE VITAMINS WATER- SOLUBLE VITAMINS Vitamin A, D, E, and K. Vitamin C, B-Complex vitamins VITAMINS: Fat Soluble VITAMIN SOURCES FUNCTIONS IN SIGNS OF SIGNS OF THE BODY TOXICITY DEFICIENCY VITAMIN A Orange, yellow and Maintains healthy Nausea, vomiting, Night blindness, green vegetables, eyes, skin, bone dry skin, rashes, eye infections, liver, margarine, growth and tooth hair loss, rough skin, and egg yolk development, headache, and respiratory possible aid in fatigue infections cancer protection VITAMIN D Milk, eggs, liver, Promotes Loss of appetite, Rickets (poor bone exposure of skin to absorption of headache, nausea, development), sun’s UV rays phosphorus and weakness, malformation of calcium to build and calcification of bone teeth maintain bones and soft tissue VITAMIN E Wheat germ, whole Protects red blood General digestive Rupture of red grains, vegetable cells; stabilizes cell discomfort blood cells, anemia, oils, legumes, nuts, membranes nerve abnormalities dark GLV VITAMIN K GLV, lover, kale, Assist in normal Anemia Slow clotting of cabbage, made in clotting of blood blood, hemorrhage the body by especially in intestinal bacteria newborns VITAMIN C (Ascorbic Acid) - Stable in acid but easily destroyed by light, oxidation, alkali and heat especially in the presence of iron and copper. ✔ Collagen formation ✔ Synthesis of carnitine ✔ Hormone and neurotransmitter synthesis ✔ Immune function effector ✔ Food sources: Citrus fruits, ripe papaya, cabbage, tomatoes, guava, mango, cantaloupe, sweet peppers, strawberry, turnips, organ meats and kidney Deficiency SCURVY- petechiae, weakness, swelling, infection and bleeding of gums, and joint and muscle pains Others: anemia, infection, depression and rough skin, delayed healing of wounds VITAMIN B1 (Thiamin) - Aka antineuretic factor and anti- beriberi factor ✔ Energy transformation ✔ Membrane and nerve conduction ✔ Maintains normal appetite ✔ Regulates muscle tone of the GIT necessary for digestion ✔ Food sources:Organ meats, lean pork, egg yolk, whole grains, cereals, mung beans, other beans, nuts (pili, cashew and peanuts) and legumes Deficiency Beriberi- anorexia, easy fatigability, numbness of the legs, constipation or indigestion, mental confusion, loss of ankle and knee jerk Wernicke Korsakoff- associated with alcohol abuse VITAMIN B2 (Riboflavin) ✔ Lactoflavin, Ovoflavin, Vitamin G ✔ Bitter tasting, orange yellow crystalline compound ✔ Not destroyed by acid, heat and oxidation ✔ Unstable in the presence of alkali and light ✔ Normal growth and development ✔ Normal skin tone, vision and light adaptation ✔ Formation of red blood cells in the bone marrow ✔ Food sources: Liver, kidneys, heart, milk, cheese, egg yolk, alimango, aligue, tahong, talangka, dried mushrooms, seaweeds, dark GLV Deficiency Ariboflavinosis- photophobia, dimness of vision, angular stomatitis, glossitis, corneal vascularization, sore lips/throat, cheilosis VITAMIN B3 (Niacin) ✔ Occurs in two forms Niacin/ Nicotinic acid or niacinamide ✔ Stable in heat, alkali, light, acid and oxidation ✔ Release of energy from CHO, CHON and lipids ✔ Normal function of skin, mucous membranes and nervous system ✔ Food sources: Milk, eggs, meat, poultry, fish, beans, nuts and seeds. Deficiency Pellagra- dementia, diarrhea, dermatitis and death. Early signs: muscular weakness, anorexia, indigestions VITAMIN B5 (Pantothenic acid) ✔ Soluble in water ✔ Stable in moist heat and in neutral solutions ✔ Easily destroyed by heat acid and alkali ✔ Metabolism of CHO, CHON and lipids ✔ Maintenance of normal skin and development of CNS ✔ Food sources: Present in all plant and animal foods; thus deficiency is unlikely VITAMIN B6 (Pyridoxine) ✔ Not destroyed by heat and acids ✔ Destroyed in alkaline solutions by oxidation and UV light ✔ Amino acid metabolism ✔ Production of antibodies ✔ Food sources: Vegetable oils, rice, wheat germ; whole grain cereals, legumes, nuts and seeds Deficiency Microcytic anemia- smooth tongue, cracked corners of mouth, irritability, muscle twitching, kidney stones Others: Poor growth, anemia, skin lesions VITAMIN B7 (Biotin) ✔ Stable in heat, light and acids ✔ Unstable in alkali and to oxidation ✔ Plays a role in antibody formation ✔ Food sources: Egg yolk, kidney, liver, milk, molasses and yeast VITAMIN B9 (Folic acid) ✔ Slightly soluble in water ✔ Sensitive to light ✔ Aka folate, folacin, Factor U, Vitamin M ✔ Formation of the heme group hemoglobin ✔ Synthesis of amino acids: methionine, histidine and serine ✔ Food sources: GLV, wheat germ, legumes, seeds and organ meats like liver Deficiency Megaloblastic anemia Glossitis GI upsets Neural tube defects- malformations of the brain and spinal cord (spina bifida or anencephaly) VITAMIN B12 (Cobalamin) ✔ Aka Animal protein factor ✔ Stable in heat ✔ Animals derive their cobalamin from microorganisms ✔ DNA synthesis and cell growth and division ✔ Food sources: Meat, fish, shellfish, poultry and milk Deficiency Sore tongue GI discomfort Coldness of extremities Pernicious anemia At risk: elderly, alcoholics, and vegans MICRONUTRIENTS: Minerals o Inorganic elements that remain as ash when food is burned CLASSIFICATION: a) MACRONUTRIENT MINERALS- essential for human nutrition and present in amounts greater than 5 grams. These are calcium, sodium, phosphorus, potassium, sulfur, chlorine and magnesium  b) MICRONUTRIENT MINERALS- essential for human nutrition and present in amounts lesser than 5 grams, these are iron, iodine, zinc, selenium, manganese, copper, molybdenum, cobalt and chromium. MINERAL FUNCTION FOOD SOURCES DEFICIENY TOXICITY CALCIUM Bone and teeth Dried fish, milk, Stunted growth, Rickets Hypercalcemia formation shellfish, cheese, Osteomalacia, Renal Calculi Regulation of beans and leafy osteoporosis, Tetany muscle activity vegetables PHOSPHORUS Calcification of Meat, fish, poultry, Same as Calcium Hyperphosphatemia bone and teeth organs, egg yolk, milk, cheese, beans POTASSIUM Cell integrity Fruits, vegetables Hypokalemia, muscle Hyperkalemia, Maintains acid- and legumes irritability, heart may Muscular base balance, develop a gallop rhythm weakness, vomiting normal fluid and cardiac arrest, balance, important nausea and vomiting in the release of insulin SODIUM Maintenance of Salt, soy sauce, Muscle cramps Hypertension. extracellular fluid processed foods Diarrhea, vomiting and Edema balance profuse sweating, loss of apetite MAGNESIUM Bone mineralization Nuts, legumes, whole Hypomagnesemic Hypermagnesemia Muscle contraction grains, dark GLV, tetany that may result to chocolates hypotension CHLORIDE Maintains normal Salt, soy sauce, Endocrine disorders: Hyperkalemia fluid and electrolyte meat, milk, eggs, hyperactivity of the Vomiting imbalance processed foods adrenal cortex WATER ▪ Accounts for about 60% of the total body weight ▪ Most abundant constituent of the body ▪ Found in every cell, in spaces around the cells, fluid tissue and body cavities ▪ Carries dissolved nutrients throughout the body and assists in functions like: digestion, excretion, regulation of body temperature and cushioning sensitive parts of the body ▪ Maintains blood volume ▪ Maintains acid-base balance ▪ Maintains fluid and electrolyte balance ▪ Body temperature regulation SOURCES: 1) Fluids- beverages 2) Foods 3) Metabolic water- end-product of metabolism LOSS OF WATER 1) Kidneys 2) Lungs 3) Skin 4) Feces NUTRITION ACROSS THE LIFE SPAN ROLE OF NUTRITION IN GROWTH, DEVELOPMENT, AND AGING 1. Life depends upon the cells; the structure and function of cells determine the quality of life of the human being. 2. Nutrition aims to supply each cell with substances needed for its growth, maintenance and metabolic activities. 3. The degree to which the requirements of the cell for nutrients are met determines the level of somatic growth and the ability of the cells to do their metabolic functions. GROWTH- increase in size of the body as a whole and/or its parts. Stages of growth: 1. Hyperplasia- increase in cell number 2. Hyperplasia with hypertrophy- increase in cell size 3. Cell proliferation with hypertrophy AGING- combination of processes that occur at different times - Characterized by decline of functions of the cells, organs and the human being as a whole MATURITY- attainment of body size, conformation and physiological capabilities and characteristics of the species and the hereditary materials with the organism is endowed. DEVELOPMENT- associated process of growth in which tissues and organs take on increased complexity of function ✔ Each stage of life cycle is associated with a distinct set of nutritional status ✔ All persons throughout life need the same nutrients but in varying amounts. ✔ Health promotion and disease prevention are underlying lifetime goals. ✔ Disease management may impact significantly on dietary planning 3 FACTORS INFLUENCING GROWTH AND DEVELOPMENT 1. Genes- GENETIC INHERITANCE IS ESTABLISHED AT CONCEPTION 2. Environment - FAMILY, RELIGION, CLIMATE, CULTURE, SCHOOL, COMMUNITY 3. Nutrition NUTRITION ACROSS THE LIFE SPAN: Pregnancy and Lactation Pregnancy /gestation- the period in which a fetus develops inside a woman’s womb or uterus -period from conception to delivery 280 days or 40 weeks or 9 months Physiological changes in pregnancy Local changes ✔ Uterus ✔ Ovaries ✔ Abdominal wall ✔ Breast ✔ Integumentary Systemic changes  ✔ Respiratory ✔ Blood volume and composition ✔ Urinary ✔ Cardiac ✔ Endocrine ✔ Metabolic adjustments ✔ Weight increase ✔ GIT NUTRITIONAL NEEDS IN PREGNANCY Fetus is completely dependent on nutritional support from the mother Quantitative requirements are small in the beginning and gradually increase until birth A correct equilibrium must be maintained among the various nutrients circulating in the maternal blood Abnormal nutrition leads to tissue alterations, delayed growth, malformations, and death INDICATORS OF HIGH-RISK PREGNANCY 1. Birth spacing- an interval of less than 2 years since last birth 2. Age- below 18 and above 35 y/o 3. Number of children- 4 or more 4. Weight 5. Failure to gain weight during pregnancy 6. Nutritional Status 7. Goiter or other medical conditions 8. With previous baby weighing less than 2 kgs at birth 9. Previous pregnancy was difficult or CS 10. Previous miscarriage, abortion or still birth POSSIBLE PROBLEMS WITH NUTRITIONAL IMPLICATIONS Mild nausea and vomiting Loss of appetite- give high carbohydrate foods, small frequent feedings, make sure fluids are taken with meal Constipation- usually during 3rd trimester; increase fruits and vegetables in the diet, and adequate fluid intake. Regular sleep and exercise are also recommended Cravings and aversions Anemia- if not enough Fe sources in diet or if there is malabsorption Pregnancy-induced hypertension- eclampsia and preeclampsia- sudden development; pregnancy induced- treatment depends on symptoms. Gestational Diabetes- Diabetes that developed during pregnancy Pica- compulsion for persistent ingestion of unnatural foods- determine what and why it was ingested, nutrition education NUTRITIVE NEEDS a) To meet the normal requirements of the mother b) To meet nutrient needs of the growing fetus c) To build reserves in preparation for delivery and lactation GOOD MATERNAL NUTRITION ❖ Increased chances of normal pregnancy leading to normal delivery ❖ Absence or reduced chances of complications during pregnancy ❖ Lower incidence of premature deliveries  ❖ Reduced incidence of morbidity and mortality ❖ Increased chance of successful lactation ❖ Normal growth and development ❖ Reduced incidence of IUGR ❖ Reduced chances of stillbirths, congenital malformation and neonatal deaths ❖ Less incidence of illness and stronger resistance to infections ❖ Adequate nutrient reserves Lactation -period of production of milk by the mother’s mammary glands to feed the infant. A. LACTATION 1. The mammary glands synthesize and secrete milk through a process called lactogenesis. 2. Milk secretion may be identified according to the time it is secreted during lactation, thus: COLOSTRUM- thin yellowish fluid during the first few days after parturition, before the formation of the true milk is established FOREMILK- milk secreted at the beginning of one nursing period HINDMILK- milk secreted at the end of one nursing period B. MAMMARY GROWTH 1. During normal pregnancy, it is controlled by hormones from the ovary, adrenal glands, pituitary glands and the placenta working together in a joint effort 2. Mammary growth is restricted to extension and proliferation of the duct system and limited alveolar (milk sacs) development C. LACTATION PROCESS 3. Initiation and maintenance of lactation consists of complex process involving the sensory nerves in the nipples and the adjacent skin 4. Milk production: Secretion and propulsion (ejection of milk) Infancy-period from birth to one year - Transition from intrauterine to extrauterine life. - Child dependent for survival on the care and feeding by the mother TYPES OF INFANTS 1. Full term- born at the end of 270-290 days 2. Premature- born before term or fewer than 270 days. 3. LBW- weight is less than 3000g 4. Postmature- born beyond 43 weeks or 300 days of pregnancy 5. Dysmature- Born with weight of 4.5kg WEIGHT Normal: 2.7-3.2 kg Average weight gain per day for the 1st 4 months:20-25g; 15 g/day for the next 8 months By 5-6 months, weight is doubled By 12 months, weight is tripled Males increase in weight to twice their birth weights earlier than females DIGESTION AND ABSORPTION ✔ Little saliva is secreted ✔ Normal functioning of GIT after few days ✔ Stomach capacity increases from 10-20 ml at birth to 200ml by age 1 ✔ Capable of digesting protein, simple CHO and emulsified fats ✔ Increased production of digestive enzymes Food and nutrient intake change due to: ❑ Rapid then gradual declining rate of physical growth ❑ Maturation of oral structures and functions ❑ Development of fine and gross motor skills ❑ Establishment of relationships with parents and family MAIN FOOD FOR INFANTS IS MILK. BREAST MILK IS BEST AND BREASTFEEDING SHOULD BE ENCOURAGED AT ALL TIMES. INFANTS SHOULD BE EXCLUSIVELY BREASTFED UP TO 6 MONTHS, THEN, APPROPRIATE FOODS WHILE CONTINUING BREASTFEEDING Exclusive BF- nothing is fed to the infant other than breastmilk (except medicines and water by dropper, spoon, or cup) Other methods of feeding the infant: 1. Artificial feeding or bottle feeding- infant is fed with a formula from the bottle 2. Mixed feeding- infant is fed from both breast and bottle a) Supplemental feeding b) Complementary feeding COMPLEMENTARY FEEDING Introduction of solid foods into an infant’s diet begins the weaning process in which the infant transitions from a diet if only Breastmilk to a more varied one. Weaning- accustom to the baby to different food flavors, note allergic reactions - To start after 6 months (2-3 tsp and the gradually increase) Preschool Age- period from two to six years - Critical and dangerous. HEIGHT Increases by 2-3 in/year WEIGHT Approx 5x the BW With equal yearly gains of 2-3 kgs Average weight gain of 5-6 lbs. per year Gain mostly in muscle and bone mass Food intake characteristics 1. Fewer calories but more CHON and Minerals 2. Decreased growth rate = decreased appetite 3. Can talk and ask for food 4. Can self-feed and prepare simple meals 5. More sensitive about food Nutritional Needs ✔ Designed to include a variety of foods ✔ Aims to promote optimal growth and to meet the child’s developmental and behavioral needs. ✔ Foods are given in age-appropriate amounts, nutrient-dense forms ✔ Food selection focuses on good sources of: Vitamin A Vitamin C Protein Iron Calcium  ✔ Development of food preferences, habits and intake Recommendations: ❖ All foods should be well prepared and attractive in color, flavor and texture ❖ Excessive intake of milk = reduce consumption of other foods ❖ Use seasonings in moderation ❖ Small frequent feedings is encouraged ❖ Suitable eating environment ❖ Avoidance of sticky and slippery foods ❖ School Age-period between 6 to 12 years of age - Benign and latent time of growth - Important period in the formation of attitudes toward food and food habits - Less dependent on parents - Appetite is increased, thus, increase of body reserves in preparation for adolescent stage WEIGHT Approx 3-6 lbs. in weight is added/ year HEIGHT Increases by 2-2.5 in./ year Girl is taller and heavier than boys by the age of 13 GROWTH SPURT Begins between 12-16 years in males Food intake characteristics: 1. Increase in food intake and accepts a variety of foods 2. Rejection of vegetables and mixed dishes 3. Accepts raw vegetables more readily than cooked ones in limited amounts 4. Sweetness and familiarity are factors that influence food preferences in all children 5. Skipping of breakfast Nutritional Needs 1. Furnishing energy needed for the vigorous activity at this age 2. Helping to maintain resistance to infection 3. Providing building materials for growth 4. Providing adequate nutrient stores to assist in adolescent growth. Adolescence-Period of transition from childhood to adulthood -Intense physical and psychological changes beginning and ending in the second decade of life -Most undisciplined age level in nutrition Puberty-Period characterized by increase in hormone secretions, rapid growth and appearance of secondary sex characteristics, pubescence 1. Hormones play important roles in the development a) Growth hormones b) T3 and T4- overall body growth and skeletal maturation c) Adrenal cortical steroids- promotes growth and sexual development and function 2. Adolescent growth spurt a) Growth in height and weight accelerates b) Females: 10-13y/o and peaks at 12-13 y/o; Males: 12-16y/o and peaks at 15-16y/o c. Intensity: Males > Females d. Full stature: Females- 19y/o; Males- 21 y/o e. Weight increase- muscle growth and bone ossification f. Fat is distributed throughout the body EATING DISORDERS 1. Anorexia Nervosa- voluntary starvation 2. Bulimia- Gorge and Purge Adulthood-Phase of stabilization in the development process -Maintenance of good physical and mental health -Management of nutrition related problems LEADING CAUSES AND RISK FACTORS Android Obesity- accumulation of body fat around the abdomen Hypertension- High BP; reading or greater than 140/90 mmHg Hyperglycemia- Abnormally high glucose concentration in the blood Dyslipidemia- increase in LDL, decrease in HDL and increase in total cholesterol and plasma triglyceride NUTRITION NEEDS: Adulthood ❖ Decrease in rate of metabolism = diet of lower energy value ❖ Dietary modifications may be necessary if there is an existing nutritional or medical problem ❖ Aim to maintain good nutritional status and delay the decrease in health of older adults ❖ Enough water and fiber Enough calcium, iron, B12 and Vit C HEALTHY EATING GUIDES 1. Multiple servings of fruits and vegetables 2. Reduce sodium intake 3. Less fat 4. Proper hydration 5. Enough Ca intake 6. Limit gas forming foods 7. Small frequent feedings Nutritional Guidelines for Filipinos 1. Eat a variety of foods everyday 2. Breastfeed infants exclusively from birth to six months, and then, give appropriate foods while continuing breastfeeding. 3. Maintain your children’s normal growth through proper diet and monitor their growth regularly. 4. Consume fish, lean meat, poultry, or dried beans. 5. Eat more vegetables, fruits, and root crops. 6. Eat foods cooked in edible/cooking oil daily. 7. Consume milk, milk products, and other calcium-rich foods such as small fish and dark green leafy vegetables every day. 8. Use iodized salt, but avoid excessive intake of salty foods. 9. Eat clean and safe foods. 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking alcoholic beverages. Daily Nutritional Guide Pyramid for Filipinos A dietary guide that teaches the principle of eating a variety of foods every day at the right amounts. Composed of six food groups  DNGP is based on the Filipino dietary pattern (rice + viand or “ulam”, and fruits) DNGP also shows the importance of drinking water, exercise or physical activity, and personal and environmental hygiene PHILIPPINE DIETARY REFERENCE INTAKES This is for planning and assessing diets of healthy groups and individuals. PDRI is the collective term comprising reference value for energy and nutrient levels of intakes. PINGGANG PINOY A food guide using a food plate model to show the recommended proportions by food group in every meal MALNUTRITION: FORMS, CAUSES AND CONSEQUENCES Malnutrition- pathological state resulting from a relative lack or absolute deficiency or excess of one or more of the essential nutrients. It also is a state wherein adequate nutrients are not delivered to the cells to provide the substrate for optimal functioning. FORMS/TYPES OF MALNUTRITION 1. UNDERNUTRITION- Inadequate consumption of food over an extended period of time 2. OVERNUTRITION- Excessive consumption of food over an extended period of time 3. SPECIFIC NUTRIENT DEFICIENCY- Results from a relative lack or absolute deficiency of an individual nutrient 4. NUTRIENT IMBALANCE- Results from disproportion among the essential nutrients with or without deficiency of any of the nutrients TYPES OF MALNUTRITION CAN BE: 1. According to duration- can be acute or chronic 2. According to cause- Primary or Secondary 1. Primary- lack of food 2. Secondary- other factors CAUSES OF MALNUTRITION 1. Immediate- inadequate food intake or presence of disease or illness 2. Underlying- Low income; inaccessible food, over population 3. Basic- political, Social and economic structures Review Nutrition related laws mandated in the Philippines