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Faculty of Medicine Introduction to Community Medicine Course (31505201) Unit 2 Nutrition and Nutrition Assessment and Diet Introduction and Terminology used in nutrition By Hatim Jaber MD MPH JBCM PhD 25-09-2016 Presentation outline Time Introduction to unit 2 12:00 to 12:10 Nutrition in Health and Medicine 12:10 to 12:20 The Nutrients & their Categories. 12:20 to 12:40 Food Pyramid 12:40 to 12:50 Unit 2 Nutrition Learning objectives • Understand and Describe the relation between nutrition and health • Name nutrient categories according to their physiologic roles, and outline the ecology of malnutrition with differential characterization of the various types and classes of nutritional disorders. • Identify nutrition-risk groups by application of proper criteria and suggest ideas for the prevention and control of nutrition-related diseases. • List the scientific reasons that justify the launching of public campaigns that target at the promotion of breast feeding practice for infants Unit 2 Nutrition Unit contents • • • • • • • • • Introduction and Terminology used in nutrition. The Nutrients & their Categories. Nutritional Allowances & Requirements Spectrum of public nutrition problems: Malnutrition & its Ecology Assessment of Nutritional Status. Anthropometric Assessment Common nutritional disorders in Jordan Formula feeding Breast feeding & Breast milk. PERSPECTIVES ON NUTRITION • To scientists, nutrition is the study of: – The nutrients found in foods – The body’s handling of nutrients to maintain health • Nutrients (some of which provide energy for processes in the body) are substances that can promote: – Growth – Maintenance – Repair For many, nutrition is all about losing weight! Nutrition definition • “The science/study of nutrients (that come from food), their action, interaction, and balance in relation to health and disease; and the process by which the organism (body) ingests, digests, absorbs, transports, utilizes and execrates food substances” • .. Science of food and its relationship to health… • .. Is a dynamic process in which the food that is consumed is utilized for nourishing the body.. NUTRITION AND HEALTH • Health professionals agree that the overall composition of the diet has an important effect on health. • Eating too much fat, sat. fat and cholesterol and not eating enough vegetables, fruits, and fiber has been linked to an increase in heart disease and other cancers. • The federal government constantly revises its official U.S. Dietary Guidelines for Americans to help consumers choose a healthy diet. • These guidelines make Recommendations for Americans 2 years of age and older. Diet, Dietetetics and Good nutrition – Diet: a mixture of foodstuffs, which are selected to satisfy the daily nutritional requirements of the body…. The foods one consumes: The quality of which affects the risk of chronic diseases • Dietetetics:.the practical application of principles of nutrition: ht includes the planning of meals for the well and the sick. • Good nutrition : “ maintaining a nutritional status that enables us to grow well and enjoy good health” Adequate nutrition is characterized by: 1-Daily intake of nutrients, which are (quantitatively and qualitatively). 2-Adequate nutrition should consider physiological status and pathological disorders. 3- Normal digestion, absorption, metabolism, excretion. FOOD • Is a composite mixture of various nutrients in a varying proportion, together with water Classifications of foods FOOD LABELS • Food labels provide the following information: – Common name of product. – Name and address of manufacturer, packer or distributor. – Net contents (wt, measure or count). – Nutrient content of product – Serving size – Servings per container – Calories/calories from fat – Nutrient amounts and percentages of Daily Values – Daily values and calories/gram reminder – Ingredients Food label HOW MUCH FOOD DO WE NEED? RDA (recommended dietary allowances) • Primary nutrient intake standards for US for many years. DRI (dietary reference intake) • Recently replaced RDA as primary standards • Expands on RDAs Food security and safety • Food security: availability of the right quality and quantity of food to supply the recommended daily nutrients to maintain good health and prevent malnutrition. • Food safety: reflection of food sanitation and is related to safeguarding from the immediate or late health hazards resulting from biological, chemical , or physical contamination of food ( production, transport, distribution, processing, and subsequent use are properly handled ) CLASSIFICATION OF FOODS • Classification by origin: - Foods of animal origin - Foods of vegetable origin • Classification by chemical composition: - Proteins – – – – Fats Carbohydrates Vitamins Minerals 16 Background definitions • Nutrients: “Chemical substances in food that nourish the body by providing energy, building materials, and factors to regulate needed chemical reactions.” • Essential nutrients: Must be provided by food because the body does not produce them in sufficient quantities or can not make them at all. • Nonessential nutrients: Healthy, well-nourished bodies can make them in sufficient quantities to satisfy their needs. CLASSIFICATION BY PREDOMINANT FUNCTION • Body building foods: • -meat, milk, poultry, fish, eggs, pulses etc • Energy giving foods: • -cereals, sugars, fats, oils etc. • Protective foods: • -vegetables, fruits, milk, etc 18 MORE FOOD RELATED FACTS …. • Vitamins - only organic nutrient that does not supply energy but is needed to get energy from foods. • Essential nutrient - body cannot make enough of and must get from food. • Some dietary and lifestyle practices (smoking, inactivity, drinking alcohol) are risk factors for many health conditions. • Substances (non-nutrients) in foods are phytochemicals that give foods the characteristic taste and smell. Definitions and concepts • Food is a composite mixture of various nutrients in a varying proportion, together with water. • Nutrients are chemical substances, which are required in grams (e.g. macronutrients) or in milligrams or micrograms (e.g. micronutrients). Food Constituents Macronutrients & Micronutrients • Protein • Carbohydrates • Fat -Water Soluble Vitamins • Fat Soluble Vitamins • Minerals • Trace elements Water Foods are grouped on the basis of their predominant function into: 1-Energy yielding foods (carbohydrates and fats). 2-Body building foods (Protein) . 3-Maintenance and regulation of tissue functions (vitamins and minerals) 2.1. Formation of Cells. Required Nutrients: mainly protein. 2.2. Building and Maintenance of Bones and Teeth: Required Nutrients: • Calcium and phosphorus are the basic nutrients. • Vitamin D for absorption and metabolism of calcium and phosphorus. • Fluorine teeth. for healthy decay - resistant enamel of 2.3. Formation of Blood Cells a) Red cells are formed in the bone marrow. Haemopoictic nutrients are: • Iron and protein, to form hemoglobin. • Vitamin B12 and folic acid, for development and maturation of red cells in the bone marrow. • Vitamin C helps absorption of iron. • Copper helps absorption of iron, and synthesis of hemoglobin. b) White nutrition. cells also need adequate 3- Protective (Vitality) foods: For maintenance and regulation of tissue functions: Required nutrients are. • B-vitamins. • Vitamin A: Iodine: • Others: cytochrome (intracellular iron), vitamin K, calcium, phosphorus 4- Water. Adequate diet provides the basic food nutrients (protein, carbohydrates, fat, vitamins, essential elements, water) and energy. NUTRIENTS • Organic and inorganic complexes contained in food are called nutrients. They are broadly divided in to: • Macronutrients: • -proteins • -fats • -carbohydrates • Micronutrients: • -vitamins • -minerals 28 The Nutrients Copyright 2005 Wadsworth Group, a division of Thomson Learning The 6 Essential Nutrients • • • • • • Water Carbohydrates Protein Fat Vitamins Minerals ©2002 Learning Zone Express 30 Energy-Yielding Nutrients • Calories and kilocalories Copyright 2005 Wadsworth Group, a division of Thomson Learning Water • Inorganic • Not energy-yielding • Essential Copyright 2005 Wadsworth Group, a division of Thomson Learning Eating Pattern for Longevity • Healthy habits of the Okinawans • Enough is enough • Moderation & a healthful lifestyle are key cultural values • Psychological & spiritual health matters FOOD CHOICES • Select foods to provide adequate amounts of nutrients and energy! • When humans eat, foremost in their minds is that they are consuming foods, not nutrients! • • • • • • • • The following influence food choices: • Personal Preference Advertising • Positive Associations Availability • Geographical location Convenience Economy • Social Pressure Comfort • Values and beliefs Ethnicity • Body weight Habit • Nutritional Value Understanding Our Food Choices • • • • • • Hunger vs. appetite Availability Income, food prices, & convenience Advertising & the media Social & cultural factors Personal values or beliefs Variables which affect nutrient needs: 1. Age 2. Gender 3. Activity Level 4. Climate 5. Health 6. State of nutrition Aim for Fitness 1. Aim for a healthy weight 2. Be physically active each day Build a Healthy Base 3. Let the pyramid guide your choices 4. Choose a variety of grains daily, especially whole grains 5. Choose a variety of fruits and vegetables daily. 6. Keep food safe to eat. Choose Sensibly 7. Choose a diet that is low in saturated fat and cholesterol and moderate in total fat 8. Choose beverages and foods to moderate your intake of sugars 9. Choose and prepare food with less salt 10. Individuals over 21 who drink alcoholic beverages should do so in moderation FOOD PYRAMID:: diagram that represents a healthy diet by placing food groups ina pyramid according to the number of servings from each group to be eaten every day. Food Guide Pyramid Daily exercise and weight control Clinical Nutrition (Medical Nutrition Therapy) Purpose – To achieve or maintain good nutritional status. Patient Care: Team Approach (Interdisciplinary) • Physician • Registered Dietitian • Registered Nurse, Licensed Vocational Nurse, Certified Nursing Assistant • Pharmacist • Speech Therapist • Occupational Therapist • Social Worker The Nutrition Care Process • Identifying and meeting a person’s nutrient and nutrition education needs. Five steps: 1. Assess Assessment of nutritional status 2. Analyze Analyze assessment data to determine nutrient requirements 3. Develop Develop a nutrition care plan to meet patient’s nutrient and education needs. 4. Implement: Implement care plan 5. Evaluate: Evaluate effectiveness of care plan: ongoing follow-up, reassessment, and modification of care plan. Illness Example : Cancer Altered Food Intake Examples: Loss of appetite, altered food likes/dislikes, difficulty chewing and swallowing, reduced saliva secretion Altered Digestion and Absorption Examples: radiation enteritis, surgical resection of GI tract, diarrhea Altered Metabolism Example: increased energy needs due to altered energy use in cancer Malnutrition Altered Nutrient Excretion Examples: fecal loss of fat-soluble vitamins and calcium in clients with cancers that affect enzyme secretion or bile salt production What is a vegetarian diet? • one that does not include meat (including fowl) or seafood, or products containing those foods – The American Dietetics Association • Includes: fruits, vegetables, beans, legumes, cereal grains, nuts, and seeds, with or without dairy products and eggs Other Forms of Vegetarian Diets • Vegan-excludes meat, dairy, eggs, honey • Lacto – excludes meat, eggs (but includes dairy products and honey) • Ovo – excludes meat, dairy products (but includes eggs and honey) Why? A vegetarian diet may be chosen for: Ethical Health Environmental Religious Political Cultural Aesthetic Economic …or other reasons Health Advantages • Vegetarian diets have been associated with the following when compared to nonvegetarian diets: – – – – – – – Lower LDL cholesterol levels lower risk of death from ischemic heart disease lower blood pressure lower rates of hypertension type 2 diabetes lower body mass index lower overall cancer rates Vegan Food Pyramid (Adapted from J Am Diet Assoc. 2003;103:771-775) 57 The Student Diet صحة وهنا Thank You