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Nutritional and Dietary Issues: A Survey Galit Sacajiu MD MPH Director, Medical Education HME Project Dietary recommendations Maintain calorie balance over time to achieve and sustain a healthy weight. focus on consuming nutrient-dense foods and beverages. recommended Macronutrient Proportions carbohydrate Protein Young children (1–3 yrs) 45–65% 5–20% fat 30–40% Older children (4–18 yrs) 45–65% 10–30% 25–35% Adults (19 and older) 10–35% 20–35% 45–65% Foods and food components to reduce Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and special chronic disease Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consume less than 300 mg per day of dietary cholesterol. Keep trans fatty acid consumption as low as possible Reduce the intake of calories from solid fats and added sugars. Limit the consumption of foods that contain refined grains, foods and nutrients to increase Increase vegetable and fruit intake. Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas. Consume at least half of all grains as whole grains. Increase intake of fat-free or low-fat milk and milk products.6 Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans, soy products, and unsalted nuts and seeds. Use oils to replace solid fats where possible. Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. Vitamins Nutrients Nutritional assessment of an adult patient – History ClinicalDetailed food consumption history Recent Weight loss or gain GI Symptoms (BM; N/V; Abd Pain) Derm/neuro/Psych Social Access to food (quantity and quality) Shelter Dependents Cooking utensils Nutritional assessment of an adult patient – Physical Exam Body Mass Index Inspection of skin, hair, nails, gums Neurological exam Abdominal exam Signs of edema Basal Energy Expenditure (BEE) (kcal/day) Men = 66 + (13.7 x wt in kg) + (5 x ht in cm) - (6.8 x age). Women:= 655 + (9.6 x wt in kg) + (1.7 x ht in cm) - (4.7 x age). Nutritional assessment of an adult patient – laboratory tests Proteins- Albumin, Prealbumin, Transferrin Immune function- Total Lymphocytes Measurements of specific vitamin and minerals Assessment of Anemia Stool examinations Mal-nutrition in Rich countries CAN OBESITY CO-EXIST WITH HUNGER AND FOOD INSECURITY? YES! The trade-off between food quantity and quality. Overeating when food is available. Physiological changes may occur to help the body conserve energy. Mal-Nutrition in Resource poor countries not enough food, and of poor quality Merci THANK YOU