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Fall 2010 The study of food and how it affects the human body and influences health Building Blocks Carbohydrates, Proteins, Fats supply energy Vitamins, Minerals (micronutrients) help manufacture, repair and maintain cells http://www.youtube.com/watch?v=bNpTPX5gylQ Primary Energy Source-Stored as glycogen in liver and muscles Spare Protein through glycogenolysis Insulin moves glucose into cells Simple/sugars ◦ (monosaccharides, disaccharides) sugar, corn syrup, honey, molasses, fruits Complex(polysaccharides) ◦ vegetables, breads, cereals, pasta, grains, legumes 45%-65% of calories from CHO or 135 grams How many servings of carbohydrates did you eat yesterday? How many were simple carbohydrates? How many were complex carbohydrates? Function-Tissue building, Metabolism (enzymes), Immune system function, Secondary energy source, Acid-base balance Amino acids (20) ◦ Essential (10) & Nonessential (10) Complete (animal sources) ◦ Meat, poultry, fish, eggs, milk Incomplete (plant sources) ◦ Grains nuts, legumes, seeds, vegetables 10%-35% of calories or 1gram per kilogram Reflects how well body tissues are being maintained Breakdown of amino acids yields NH3 (ammonia) which is excreted in the urine as urea. Positive Nitrogen Balance-Intake exceeds output-pool of amino acids available-Healthy state Negative Nitrogen Balance-Intake less than output-IIlness, injury, and malnutrition How many servings of protein did you eat yesterday? How many were complete proteins? How many were incomplete proteins? Did protein foods account for more than 10% of your food intake yesterday? Functions- Back-up energy source, Organ insulation/protection, Supply essential nutrients (fatty acids), Flavor and satiety SaturatedFats: pork, beef, poultry, egg yolk, dairy ◦ Trans fats: hydrogenated oils, some margarines, baked goods, processed foods Unsaturated Fats: olives, vegetable oils (peanut, soybean, cottonseed, corn, safflower), nuts, avocados Essential fatty acids: (omega 6 & omega 3) polyunsaturated vegetable oils, fatty fish Glycerides (mono-, di-, and triglycerides) Sterols (cholesterol)-Formation of cell membranes, Vitamin D, Estrogen, and Testosterone Phospholipids (lipoproteins)-Water solubleTransport lipids to cells by “wrapping” ◦ ◦ Low-density Lipoproteins (LDL) High-density Lipoproteins (HDL) 20%-35% calories from fat (< 10% saturated) How many servings of fat did you eat yesterday? How many were saturated fats? How many were unsaturated fats? How does your diet compare to the USDA Food Guide Pyramid in terms of servings of: ◦ ◦ ◦ ◦ ◦ ◦ Bread, cereal, rice & pasta? Vegetables? Fruits? Milk, yogurt, & cheese Meat, poultry, fish dry beans, eggs, & nuts? Fats, oil, & sweets? What habits could you change to achieve optimal nutrition? Manufacture, repair and maintain cells Vitamins-Fat (A,D,E,K) and Water Soluble (C & B) ◦ ◦ ◦ ◦ ◦ Necessary for metabolism Building & maintaining body tissues Support immune system Healthy vision Help break down and use energy found in carbohydrates, proteins, & lipids Minerals-Major+>100 mg/day ◦ ◦ ◦ ◦ ◦ Assist in fluid regulations Nerve impulse transmission Energy production Health of bones and blood Disease prevention & treatment Makes up ½ of body weight ◦ 55-65% men, 50-55% in women A solvent for chemical processes Transports (as blood) oxygen, nutrients, and metabolic wastes Fills in spaces in body tissues Helps maintain body temperature Body needs approximately 2.5-3 liters daily. 1. What is the body’s most usable energy source? 2. Which nutrient’s primary function is growth and repair of tissue? 3. Which type of vitamin requires daily consumption to maintain appropriate levels? 4. What distinguishes a major mineral from a trace mineral? Is measured in calories [kilocalories (kcal)] Too few kcal = undernourished Too many kcal = obesity & increased risk for ◦ Carbohydrates = 4 kcal/g ◦ Protein=4 kcal/g ◦ Fat=9 kcal/g ◦ Weakens immunity ◦ Stunts growth ◦ Disrupts hormones ◦ ◦ ◦ ◦ ◦ Diabetes Atherosclerosis Hypertension Hyperlipidemia Cancer You have just eaten a food consisting of 4 grams of protein, 18 grams of carbohydrate, and 1 gram of fat….. ◦ 1. What would your total kcal intake be? ◦ 2. What percentage of your kcal are from carbohydrates? ◦ 3. What percentage of your kcal are from protein? ◦ 4. What percentage of your kcal are from fat? Body composition Growth periods Body temperature Environmental temperature Disease processes Prolonged physical exertion Highly emotional states of agitation & restlessness A MEASURE OF THE AMOUNT OF ENERGY REQUIRED BY RESTING TISSUE TO MAINTAIN BASIC FUNCTION Body Composition Growth Periods Body Temperature Environmental Temperature Disease Processes Prolonged Physical Exertion Men = 1 kcal/kg of body weight per hour Women = 0.9 kcal/kg of body weight per hour Weight (in kilograms) x ____kcal x 24 = Number of kilocalories needed to replace those used for basic metabolism plus those used in physical activities (See page 593 Table 26-7) Estimates ◦ 1600 kcal/day ◦ 2200 kcal/day ◦ 2800 kcal/day Sedentary women & older adults Children, teenage girls, active woman, and most men Teenage boys, active men, and very active women How would you classify his activity level? Is his intake sufficient or insufficient to maintain his present daily energy requirement? Men 106 lb. for first 5 ft., then 6lb/in. Women 100 lb. for first 5 ft. then 5lb/in. Use weight standards and tables with caution (Everyone is unique) Lean body mass (muscle, bone and connective tissue) weighs more than fat. Physical fitness matters! 1. Why are the infant’s nutritional needs per unit of body weight greater than any other time? 2. Why is it sometimes a challenge to meet the nutritional needs of toddlers? 3. What is the challenge in meeting the nutritional needs of school-age children? 4. Which age group experiences a growth spurt second only to that of infants? 5. Why are energy (kcal) requirements less for older adults? Folic acid critical 1st Tri. to prevent neural tube defects Adequate protein and calcium essential to fetal growth Iron essential to maintain maternal and fetal blood supplies Pregnant women need approx. 300 additional kcal/day Lactating women need approx. 500 additional kcal/day Dietary Patterns Oral Contraception-Lowers Vit. C and several B Vits. Using food to cope Smoking-Can reduce Vit. C by 30% Alcohol-Adds calories; decreases rate of fat metabolism; and, in excess, interferes with adequate nutrition by replacing real food, depressing appetite, decreasing absorption of nutrients by toxic effect on intestinal mucosa and, impairing storage of nutrients Semi-vegetarian-Eat fish, eggs, and dairy Ovo-lacto vegetarian-Eat eggs and dairy Lacto-vegetarian-Eat dairy Vegan-Only foods of plant origin Fruitarian-Only fruit, nuts, honey and vegetable oil At risk for deficiencies in: ◦ Vitamin B12, D ◦ Protein ◦ Iron Muslim ◦ No pork, fasting during Ramadan Judaism ◦ Fasting, strict dietary laws (Kosher) African American ◦ Lactose intolerance, often high fat diets Asian American ◦ Lactose intolerance, green tea European Americans ◦ Meat & potatoes Hispanic Americans ◦ Lactose intolerance, spicy foods Native Americans ◦ Preferences vary greatly 1. List 3 nutrients that may be more difficult to supply through a vegetarian diet. 2. Why should you encourage clients from various cultures to follow their traditional diets? 3. Describe the effects on nutrition of: ◦ ◦ Smoking Heavy alcohol use DISEASES OTHER ISSUES ◦ Poor appetite-alcoholism, medications ◦ Impaired cognitive function-developmental delay, mental illness, confusion, memory loss ◦ Ability to get food / poverty ◦ Ability to prepare food-fatigue, stamina ◦ Decayed / missing teeth ◦ Swallowing disorders ◦ Stomach function ◦ Peristalsis-slowed or increased transit time ◦ Drugs / chemotherapy / radiation Regular / House NPO Modifications of consistency ◦ Clear liquid-lacking essential nutrients ◦ Full liquid-difficult to get essential nutrients-low in iron, vitamin B12, vitamin A, and thiamine ◦ Mechanical soft-low in fiber ◦ Pureed-blenderized Modifications for Disease ◦ Calorie restricted-for weight loss ◦ Sodium restricted-hypertension or fluid balance ◦ Fat restricted-elevated cholesterol, triglycerides ◦ Diabetic ◦ Renal diet-to manage electrolytes and fluids ◦ Antigen-avoidance diets-Ex. Gluten free for celiac disease ◦ Calorie-protein push-to heal wounds, maintain or increase weight or promote growth Which nutrients are missing or difficult to obtain from these diets? Clear liquid Full liquid Mechanical soft diet Anthropometric measurements ◦ Height and weight ◦ Skinfold measurement ◦ Circumferences ◦ Body mass index ◦ Imaging techniques ◦ Underwater weighing Screening ◦ Evaluate height, weight, brief dietary history, and body mass index- ◦ Current health Recent weight loss/gain, diet/appetite changes, stress/trauma, medications ◦ Health history ◦ Dietary History by food diary 24 hour recall Food frequency questionnaire 3 day Food record ◦ Socioeconomic status ◦ Physical assessment When risks are identified, perform further assessment! SKINFOLD THICKNESS Use a caliper Measure triceps in children and women Measure subscapular area in men CIRCUMFERENCES Mid-upper arm Abdominal ◦ Waist-to-hip ratio >1 in men and >0.8 in women indicates obesity and = increased risk for HTN., DM, Hyperlipidemia, and CVD IMAGING TECHNIQUES ◦ Dual-energy x-ray absorptiometry (DEXA) ◦ Computed tomography (CT) ◦ Magnetic resonance imaging (MRI) UNDERWATER WEIGHING Gold standard for body composition measures but impractical for children, elderly, severely ill What are the most reliable locations for skinfold measurement? What are the implications of an increased WHR? BMI=weight in kilograms1 meter = 39.37 inches 1 kilogram = 2.2 pounds How do you measure up? Underweight Normal Obesity <18.5 18.5 – 24.9 >30 General Survey Alterations in vital signs Poor skin turgor, wound healing Concave abdomen / ascites Change in muscle mass / wasting Reduced activity tolerance Laboratory results List 10 physical examination findings that would lead you to suspect nutritional problems. What factors would lead to poor wound healing? Weight loss / gain Reduction mid-arm circumference, decrease in skin-fold Alcoholism Cognitive impairment Malabsorption syndromes Multiple medications Fatigue, memory loss, loss of functional status ↡ Serum levels albumin, transferrin, prealbumin Folate, iron, zinc deficiencies Blood Glucose-Fuel available for cellular energyNormal=70-110 Serum Protein levels-Indicators of protein stores ◦ Albumin-1/2 life 18-21 days- Normal=3.5-5 ◦ Pre-albumin-Fluctuates daily-Marker of acute change-Normal=15-36 ◦ Transferrin-Faster detection than albumin-Normal =204-360 mg/dL Urea (BUN)-End product of protein metabolismIndicator of kidney and liver function-Normal=8- 20 Creatinine (Cr)-End product of skeletal muscle metabolism-Excellent indicator of kidney function-Normal=0.5-1.2 mg/dL Lymphocytes (WBCs)-Decreased in malnutrition, protein deficiency, alcoholism, bone marrow depression and anemia Hemoglobin (Hg)-Indicator of inadequate iron intake or chronic blood loss, insufficient protein intake or excessive protein loss ◦ HEME-iron-rich compound ◦ GLOBULIN-protein Why is it important to identify the serum albumin level? Why would pre-albumin be a better indicator of acute nutritional changes than albumin? With clear instructions you may delegate: UAP’s ◦ Height ◦ Weight ◦ Intake and output LPN/LVN ◦ Collect nutritional history RN ◦ Reviews and interprets data Imbalanced Nutrition: Less Than Body Requirements ◦ R/T eating disorders, difficulty chewing, vomiting, alcoholism, food intolerances, metabolic disorders, absorption disorders Imbalanced Nutrition: More Than Body Requirements ◦ R/T overeating, lack of exercise, metabolic/endocrine disorders Risk for Imbalanced Nutrition Self Care Deficit (Feeding) Consuming nutrients in excess of metabolic demands ◦ ◦ ◦ ◦ Activity Gender Height Weight Overweight = body mass index > 25 but < 29.9 Obesity = body mass index > 30 Insufficient intake of protein, fat, vitamins, minerals Consuming less calories than needed according to: ◦ Activity ◦ Gender ◦ Height ◦ Weight Nutritional counseling / teaching Support special nutritional needs ◦ Impaired swallowing ◦ NPO ◦ Older adults Assisting patients with meals Weight weekly Diet modifications / supplements Dietitian consult Methods to improve appetite Food Stamp Programs Commodity Distribution Programs Supplemental Food Programs for Women, Infants and Children (WIC) National School Lunch and Breakfast Programs Assess for functional deficits Assess intake for adequacy Demonstrate assistive devices Serve one food at a time; serve small amounts Have casual conversation with patient during feeding Assist only as necessary; encourage independence Serve finger foods Provide privacy if pt. is embarrassed Use napkin, not a bib Sit down while providing assistance to pt.-Do not rush Offer frequent, small meals Restrict liquid intake with meals Keep environment neat and clean Provide or assist with oral hygiene Provide a pleasant eating environment Serve foods attractively and within easy reach Position patient comfortably Cater to patient likes as much as possible (encourage family to bring food from home) Control pain and avoid treatments during meals. Definition-Delivery of nutrition through a tube Requires a functional GI tract Risk-Aspiration leading to infection, pneumonia, abscess formation, ARDS Complications-Diarrhea, alterations in drug absorption, metabolic alterations ◦ ◦ ◦ ◦ Nasogastric Nasoenteric Percutaneous gastrostomy tube (PEG)-into the stomach Jejunostomy tube-into the jejunum Definition-Delivery of nutrition through a central venous catheter Preferred method for patients without a functioning GI tract or a GI tract needing rest Total Parenteral Nutrition (TPN) Excellent medium for bacterial growth-can lead rapidly to sepsis-requires aseptic catheter care and dedicated line More info to come at a later date! A. B. C. D. Using calipers to measure the skinfold on the triceps Obtaining the waist to hip ratio (WHR) Hydrodensitometry 24-hour food recall A. B. C. D. Fasting serum glucose of 87 mg/dL BUN of 16 mg/dL Serum albumin level of 1.8 g/dL Total white blood cell count of 6,000/mm³ A. Mr. J, who weighs 180lb, is active, has a normal weight and is taking in 3240 kcal per day. B. Mrs. S who weighs 220 lb, is sedentary, overweight, and taking in 1000 kcal per day C. Susan, who weighs 100 lb, is slightly underweight, plays soccer three times a week, and is taking in 1500 kcal per day. D. Mr. C, who works a desk job, weighs 190 lb (a normal weight for his height) and is currently taking in 2800 kcal per day.
