Week 7 Nutrition PDF - NUR 425

**[Week 7: Nutrition ]** **[Nutrition]** - Refers to how the body uses food for energy, growth, maintenance and repair of tissues  - Nutritional status  - Under- occurs when there is an insufficient intake of nutrients leading to various health issues  - Optimal - ac...

**[Week 7: Nutrition ]** **[Nutrition]** - Refers to how the body uses food for energy, growth, maintenance and repair of tissues  - Nutritional status  - Under- occurs when there is an insufficient intake of nutrients leading to various health issues  - Optimal - achieved when there is a balanced intake of all essential nutrients, supporting overall health and well being  - Over- results from excessive intake of nutrients, which can lead to obesity and other health related problems.  - Role of bias - personal and cultural biases can significantly influence our dietary choices and perceptions of what constitutes as healthy diet  ***Major Nutrients *** - Carbohydrates (including fibre) - primary source of energy - Fat - provide energy and act as insulation  - Protein - needed for tissue growth, repair, and maintenance  - Vitamins & Minerals - essential for various metabolic processes and maintaining health - Water - crucial for hydration and bodily functions  - Average adult requires approximately 20-35 kcal/kg of body weight daily  - Increased requirements with illness, activity  ***Carbohydrates *** - Primary source of energy for the body  - Make up 45-65% of daily calories generally  - Simple: includes monosaccharides & disaccharides  - Complex: polysaccharides  - Fibre - Indigestible part of plant foods  - High levels associated with improved cholesterol & improved glycemic control  - Sources of healthy carbohydrates: fruits, vegetables, legumes, nuts, seeds, whole grain foods (e.g. whole grain breads, brown rice, oats, quinoa, barley)  ***Fats *** - Source of energy & acts as insulation  - Integral to the structure of cell membranes, contributing to the proper functioning of cells, and are involved in hormone synthesis that regulate many physiological processes  - Make up 25-35% of daily calories generally  - Carry essential fatty acids and fat-soluble vitamins (A, D, E, K) - Types  - **Monounsaturated** (e.g. olive oil, avocados, nuts) (healthy fat) - Help reduce LDL cholesterol levels and lower risk of heart disease/stroke  - **Polyunsaturated** (e.g. salmon, flaxseeds, walnuts) (healthy fat)  - Essential for brain function and cell growth  - **Saturated** (e.g. meat, butter, cheese, coconut oil, palm oil)  - Limit intake bc they can raise cholesterol levels and inc risk of heart disease and stroke  - **Trans** (e.g. partially hydrogenated oils, many processed foods)  - Most harmful type of fat, increases LDL cholesterol and dec HDL cholesterol, significantly raising the risk of heart disease, stroke, and type 2 diabetes. (Best to avoid as much as possible)  - Sources of healthy fats: nuts, seeds, avocado, fatty fish, vegetable oils (e.g. olive oil), soybeans and soy products  ***Protein*** - Needed for tissue growth, repair & maintenance, body regulatory functions & energy production  - Make up 10-35% of daily calories generally  - Made up of amino acids  - Balanced intake is essential for maintaining muscle mass, supporting immune function, and producing enzymes and hormones.  - Sources of healthy protein: eggs, lean meats and poultry\*, nuts and seeds, fish and shellfish, lower fat dairy products (e.g. lower fat milk, lower fat yogurts, lower fat kefir), beans, peas and lentils  - \*consume more plant-based proteins  ***Vitamins***  - Organic compounds needed for normal metabolism, growth & maintenance of health  - Needed for creation of energy, but do not actually provide energy  - Fat soluble: vitamins A, D, E, and K  - Stored in body's fatty tissues  - Consume within recommended limits to avoid AEs  - Water soluble: vitamins B & C  - Need to be consumed more regularly as they are not stored in the body  - Water soluble vitamins and vitamins A & K help metabolize amino acids, fats and carbohydrates by acting as co-enzymes  ***Vitamin and mineral supplements *** - Usually not required if healthy and eating a variety of nutritious foods  - Multivitamin with folic acid: all adults and adolescents who become pregnant  - Vitamin D:  - infants/children (breastfeeding): 400 IU/day  - Ages 2-50: ensure daily dietary source of Vitamin D (e.g. egg yolks, fatty fish, lower fat milk); if dietary intake insufficient, supplement with 400 ID/day  - Ages 50+: advised to take supplement of 400 IU/day, and encourage to consume foods rich in Vitamin D  ***Malnutrition* ** - Deficit, excess or imbalance of the essential components of a balanced diet  - Types of malnutrition  - Starvation-related malnutrition - prolonged lack of food intake  - Chronic disease-related malnutrition - associated with long term health conditions  - Acute disease or injury-related malnutrition - due to sudden illness or trauma  ***Causes of malnutrition*** - Food insecurity: limited access to food d/t a lack of financial resources (significant contributor) - Physical illness  - Impact of illness, surgery, injury, hospitalization  - Anorexia & Cachexia - lead to severe weight loss and muscle wasting  - Malabsorption syndrome: impaired absorption of nutrients from the small intestine  - Incomplete diet - dietary pattern that lacks sufficient amounts of one or more of the essential nutrients needed for optimal health.  - Can result from dietary restrictions, poor food choices, and lack of knowledge about nutrition  - Eating disorders  - Anorexia nervosa  - Abnormal weight loss, deliberate self-starvation, intense fear of gaining weight  - May present with:  - Lanugo - fine, soft hair that develops in response to significant weight loss and lack of body fat, serves as a way for the body to insulate itself in the absence of fat stores - Sensitivity to cold - d/t low body fat diminishing insulation  - Compulsive exercising - means to control weight or cope with anxiety driven by distorted body image  - Absent or irregular menstruation - d/t hormone imbalances caused by low body fat, body prioritizes essential functions for survival over reproductive processes  - Dry skin - d/t lack of essential fatty acids  - Constipation - d/t reduced food intake and low fibre consumption + potential dehydration  - May see hypokalemia - related to inadequate dietary intake of potassium rich foods or of the individual engages in purging behaviors such as vomiting or excessive use of diuretics → significant potassium loss  - Hypokalemia can cause muscle weakness, irregular heart rhythms, and potential cardiac complications  - Bulimia nervosa  - Periods of food restriction, followed by binge eating. Feelings of loss of control, and concern with body image  - May present with:  - Dental issues - tooth decay and erosion d/t frequent exposure to stomach acid from vomiting - Swollen salivary glands - d/t repeated vomiting → stimulates glands and causes them to become inflamed and enlarged  - Broken blood vessels in eyes - d/t physical strain assoc. With purging → increase pressure in the head  - Peripheral edema - d/t electrolyte imbalances caused by purging → fluid retention  - May see increased amylase, hypokalemia  - Amylase is produced by salivary glands and the pancreas to help with digestion of carbohydrates  - Frequent vomiting can stimulate the salivary glands, leading to hypertrophy and increased production of amylase. This elevation can serve as a biochemical marker of the disorder.  ***Pathophysiology of starvation *** A diagram of fats converted into glycerol and fatty acids Description automatically generated - During starvation, body undergoes several metabolic changes to meet its energy needs  - Initially, carbohydrates in the form of glycogen are used to provide energy. As glycogen stores deplete, fats are converted into glycerol and fatty acids  - Glycerol is then converted into glucose, while fatty acids produce ketones, which serve as an alt. Energy source  - When fat stores are exhausted, the body begins to breakdown proteins into amino acids, which are converted into glucose  ***Malnutrition: physical exam findings *** - Dry scaly skin, brittle nails, hair loss - Vitamin B, iron, and protein deficiency - May see oral crusting and ulcerations - Vitamin B and C deficiency  - Decreased muscle mass  - Weakness  - Irritability, confusion - lack of glucose and essential vitamins and minerals  - Findings may be more pronounced in older persons who are at risk for malnutrition d/t dec appetite, metabolic changes, and underlying health issues  ***Refeeding Syndrome*** - Serious and potentially life threatening  - Can occur when a person who has been malnourished or has experienced starvation, and nutrition is introduced too quickly  - Can cause fluid and electrolyte changes that can lead to cardiopulmonary (heart failure and pulmonary edema), hematologic (anemia) & neurologic changes (coma - confusion) - Most common electrolyte imbalances involve phosphorus, potassium and magnesium - Hypophosphatemia results in muscle weakness, resp failure, & hemolytic anemia  - Hypokalemia leads to cardiac arrhythmias and muscle paralysis  - Hypomagnesemia can cause neuromuscular complications and seizures.  - To **prevent** refeeding syndrome: gradually reintroduce calories. Close monitoring of essential levels and clinical signs. Enable timely interventions and ensure safe recovery.