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Chapter 1
The Art of Nutrition in
a Social Context
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Role of Genetics in
Health and Disease
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Medical Genealogy: families or groups of
people are at increased risk of obesity,
diabetes, heart disease
Nutrigenetics: genetic predisposition to
disease is influenced by diet
Nutrigenomics: diet influences gene
expression
A return to traditional diets and lifestyle is
being promoted around the world to
reduce many common health conditions.
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Basic Nutrition Terms in
the Study of Nutrition
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Macronutrients: carbohydrates, proteins, & fats
(kilocalorie sources)
Kilocalorie (kcal): energy or amount of heat
required to raise 1 kg water by 1 degree Celsius
Micronutrients: vitamins, minerals,
phytochemicals, and water
Nutrient density: amount of micronutrients in
relation to the amount of macronutrients; nutrient
dense food is high in micronutrients for the
amount of macronutrients; empty kilocalories is
the opposite
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Terms (continued)
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Nutrition: the science of how the body uses
food for energy, maintenance, and growth
Malnutrition: undernourished, as in vitamin
or protein deficiencies; or overnourished, as
in obesity
Medical nutrition therapy: nutritional therapy
provided by a registered dietitian with
application of science of nutrition and food
choices to achieve or maintain optimal
health and well-being
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Food Idealism: Types and Impact of
Vegetarianism on Nutritional Status
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Lacto-ovo vegetarians (include milk and eggs)—easiest to meet
nutritional needs; use of low-fat milk with diet can help lower risk
of heart disease. Lacto-vegetarians include milk but not eggs;
pescetarians include fish
Vegans (avoid all animal-based foods)—most difficult to meet
nutritional needs; can be harmful nutritionally but might be
beneficial to health, such as reduced heart disease and obesity*
All vegetarians benefit from intake of legumes, nuts, seeds, and
whole grains to ensure adequate protein intake.
*Vegans require vitamin B12 supplement and need a vitamin D
source if there is inadequate sunlight. Calcium is difficult to
obtain, and individuals might need supplementation. Monitoring
serum B12 levels advised; monitoring homocysteine levels might
also be appropriate.
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Possible Reasons for
Practicing Vegetarianism
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Social: for environmental reasons or animal
rights issues or support of family and friends
Health:
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(Positive) Goal aimed at reduced heart disease
and obesity with foods high in fiber and low in
saturated fats
(Negative) Possible rationale given for masking
an eating disorder, especially with a vegan diet
Religious: Seventh-day Adventists, Hindus,
some Muslims
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Also helps adherence to kosher diet, where meat
and milk products not served at the same meal
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Examples of Positive
Traditional Ethnic Eating Habits
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French: small portions, slow pace of
eating, emphasis on vegetables
Mediterranean: emphasis on “beans &
greens” and olive oil, low intake of meats,
sweets limited to special occasions, salads
served after main meal
Asian: soybean products and/or tofu; high
intake of rice, vegetables, and fish; low
intake of desserts; sesame and peanut oil
emphasized
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Balance, Variety, Moderation
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“All foods can fit”
Occasional intake of high-fat, high-sugar
foods can be part of a healthy diet
Regular intake of high-fat, high-sugar
foods is acceptable if portions are small
Variety of foods best ensures adequate
intake of nutrients needed for health
A balanced meal includes at least three of
the food groups (e.g., grain + vegetable or
fruit + protein source/milk product)
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History of Food Guides
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1940s—Seven food groups: included butter (for a vitamin D source);
science of nutrition rapidly developed as result of World War II and
recognition of lack of military fitness from malnutrition in many young
men who grew up during the Great Depression of the 1930s
1950s—“Basic four” food groups: bread, vegetables and fruits, dairy,
and meat or protein source
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1990s—Food label changes, development of the food guide
pyramid: the foundation of the diet (base of the pyramid) is
plant-based; meat portrayed in smaller section; fats and sugars
form the smallest part of the diet (tip of the pyramid)
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2005—The MyPyramid Food Guidance System: aimed at
individualizing food guidance through the interactive website
www.MyPyramid.gov, with physical activity being promoted in the
new symbol
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Food Labels
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Revised in the early 1990s to include
percent-daily values based on 2000 kcal
reference diet
Percentages based on 30% total fat, 10%
saturated fat, 60% carbohydrate, minimum of 50 g
protein, with 25 g/day recommended fiber and
2400 mg/day sodium
Marker nutrients (vitamins A and C, minerals
calcium and iron); 100% intake of these nutrients,
as found naturally in foods, promotes good intake
of other needed nutrients found in conjunction
2006: Food labels now include trans fatty acid
content of foods
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Amount of nutrients in g
and mg based on
serving size listed →
Marker nutrients →
← Percentage of
nutrients based on
2000 kcal and daily
reference needs
Daily Reference
Values →
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Approved Health Claims
on Food Labels
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Foods high in fiber may reduce the risk of cancer
and heart disease
A low-fat diet may reduce the risk of cancer and
heart disease
A low-sodium diet may help prevent high blood
pressure
Soy protein reduces cardiovascular disease
Foods high in calcium may help prevent
osteoporosis
Folate leads to decreased neural tube defects
Sugar alcohols reduce dental caries
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Dietary Guidelines for Americans
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1980—the Public Health Service of the Department of
Health and Human Services and the USDA published the
first guidelines
Changes are made every five years; revisions generally
have been written to be more positive (e.g., what to do vs.
what not to do)
2000 guidelines, “Aim for Fitness, Build a Healthy Base, and
Choose Sensibly,” included a total of 10 strategies
2005 Dietary Guidelines for Americans very similar to the
2000 guidelines, with more specific guidance to include at
least three whole grains daily and increase fruits and
vegetables to 4.5 cups for adults; the MyPyramid Food
Guidance System reinforces the revised dietary guidelines
2010 Dietary Guidelines to be printed 2011 and available on
Evolve at that time
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MyPyramid.gov
.
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The Food Exchange System
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A food guide originally developed by the
American Diabetes Association and the
American Dietetic Association for diabetes
management
Generally no longer advised for diabetes
management but useful to recognize the
macronutrient content of foods
(carbohydrate, protein, and fat)
Appendix 3 EVOLVE shows the latest food
exchange system
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Health Care Team
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Health care provider: MD or nurse
practitioner and, in some areas, physician’s
assistant; can prescribe
Nurse: RN, LPN, CNA
Social worker
Physical therapist
Occupational therapist
Registered dietitian or licensed, certified
nutritionist
Others: speech-language pathologist,
pharmacist
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The Nutrition Care Process
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Begins with Assessment of Needs
Followed by Planning based on
Assessment of Needs
Intervention adheres to the Plan
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May include other members of the Health Care
Team
Evaluation is incorporated into the Plan,
using measurable outcomes; outcome
measures after Planned Intervention
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Assessment Areas All Health Care
Team Members Can Help Assess
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Assess needs in three realms:
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Cognitive: assess individual’s nutritional
knowledge and fallacies related to health
needs; assess whether auditory or visual
learner; check reading ability and level of
terminology needed
Affective: attitudes toward nutrition and health
and willingness to make desired changes
Psychomotor: current nutritional behaviors and
ability to change
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Assess Cultural Food Habits
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Is there frequent eating at fast-food restaurants or deli
store?
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Does the family eat sitting down together, or separately in
front of the television or computer, or in other rooms such as
the bedroom?
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Is this due to convenience or preference?
Is this a positive environment with quiet conversation or noisy
with the television on or family arguments happening?
Is there a “clean the plate” philosophy?
Are home-cooked meals emphasized?
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Meat, potato, and vegetable type of meals or casseroles?
Are ethnic foods prepared?
 Are convenience foods frequently used at home?
 Do individual family members prepare their own meals?
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Summary
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Good nutritional status requires the
appropriate intake of all essential nutrients
for health (the science of nutrition)
Knowledge of nutritional needs is
important, but the “art” of good nutritional
intake is related to the biopsychosocial
needs of the individual
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