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NS 270: NUTRITIONAL ASSESSMENT AND MANAGEMENT Unit 3: Assessing Food Intake for Nutrient Deficiencies WHAT TO DO THIS WEEK? Read Chapter 5 and 6 (Stanfield and Hui) Participate in Discussion Participate in Seminar CASE STUDY You should have accessed this case study already in order to be prepared We will complete the case study in class, as a group, and partially as a field trip When asked, please complete the question assigned to you. www.fitday.com access using NS270KU as the username and password, go to data for 7/23/09 Use same password and username for www.mypyramid.gov under pyramid tracker POSITION OF AMERICAN DIETETIC ASSOCIATION To promote health and reduce risk of chronic disease, choose variety of foods. Food provides all vitamins you need. Fortified foods and supplements can help some meet their nutrition needs. VITAMINS Fat Soluble and Water Soluble What are vitamins? Are they organic or inorganic? We have 13 essential vitamins? What’s the difference? Essential here means what? Where do we find vitamins? VITAMIN DEFICIENCIES Vitamin A: may result in xerophthalmia Vitamin D: rickets and osteomalacia Vitamin K: deficiency in newborns; made in intestines by good bacteria Vitamin C: scurvy; delayed wound healing; decrease in iron absorption; capillary bleeding VITAMINS Vitamin C Collagen, wound healing, aids in iron absorption, antioxidant ◦ Sources ◦ Vitamin B1 (thiamin) ◦ ◦ Releases energy from fat and carbohydrate, transmits nerve impulses, breaks down ETOH Sources Vitamin B2 (riboflavin) ◦ ◦ Release energy from CHO, fat, PRO; healthy skin and growth, visual health Sources VITAMINS Vitamin B6 (pyridoxine) Breaks down and rebuilds amino acids, produces antibodies and red blood cells, function of nervous system Sources Vitamin B12 (cobalamin) Red blood cell formation, part of RNA and DNA, bone marrow formation, prevention of pernicious anemia Sources PEOPLE >50 & VITAMIN B12 Most adults meeting recommended amounts Deficiency most likely to occur as a result of an inability to absorb B12 from food. B12 needs stomach acid & intrinsic factor to be absorbed; less gastric secretions over age 50, so decrease in absorption. Recommend for >50 years old to eat fortified B12 foods or take supplement. VIATMINS Niacin Releases energy from CHO, PRO, fat; synthesizes proteins and nucleic acids; synthesize fatty acids from glucose Sources Folic Acid (Folate) Synthesizes nucleic acids, essential for the breakdown of most amino acids, needed for red blood cell formation Sources WOMEN AND FOLIC ACID Necessary for all women of childbearing age and women who are pregnant. Reduces the risk of neural tube defects and Spina Bifida. Food fortification RDA: 400 g (adults); 600 g (pregnancy) VITAMINS Pantothenic Acid Helps release energy from macronutrients, aids in formation of cholesterol, hemoglobin and hormones Sources Biotin Coenzyme in metabolism of fat and carbohydrate Sources VITAMINS Vitamin A (Retinol) Helps maintain healthy skin, helps eye adjust to changes in light, develops healthy teeth/bones, synthesizes glycogen in the liver, regulates fat metabolism in the formation of cholesterol Sources Vitamin D Promotes absorption of calcium and phosphorus in the intestine, helps maintain blood calcium and phosphorus levels, aids in formation of bone matrix Sources (What makes this vitamin different?) SPECIAL GROUPS & VITAMIN D Fat-soluble; obtain from food and sun Deficiency diseases: Rickets & Osteomalacia Food sources High risk of deficiency: Breastfed infants Older adults Limited sun exposure Individuals with dark skin VITAMINS Vitamin E (Tocopherol) Antioxidant, assists in cellular repiration, maintains intact cell membranes Sources Vitamin K Prothrombin formation, blood clotting Sources What medication does this interact with? MULTIVITAMINS NIH Consensus and State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention (2006) with results indicating: There is not strong evidence for beneficial health-related effects of supplements. There is insufficient evidence to recommend either for or against the use of multivitamin/mineral supplements by the American public to prevent chronic disease. NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention. Ann Intern Med. 2006;145:364–371. WATER Essential to life Provides no energy Component of all cells Lubricant Transport medium Extracellular fluid Intracellular fluid Solvent MINERALS OVERVIEW Only 4% of the human body Inorganic Macrominerals and microminerals (trace minerals) Functions Part of cell structure Components of enzymes, hormones, blood and other body compounds Regulators of Acid base balance of body Nerve response to stimuli Muscle contractions Cell membrane permeability Osmotic pressure and water balance CALCIUM NEEDS Calcium (Ca) – mineral in largest the body Bone and teeth formation, maintains serum Ca levels, muscle contraction relaxation, aids in nerve impulse transmission, maintains normal heart rhythm Sources: dairy, green leafy veggies Deficiency? %DV= 1000 mg/day Adequate Intake= 1000-1200 mg/day for adults Adequate Intake= 1300 mg/day for adolescents (9-18 yrs. old) U.L.= 2500 milligrams/day Increases risk of kidney stones amount in serum and OSTEOPOROSIS Decreased bone density “A pediatric disease w/ geriatric consequences” Peak bone mass complete at ~ 20 y.o. Small increases 20-30 y.o.; loss begins ~30 y.o. Women experience increased bone loss after menopause (age ~50-70) then levels off Affected by gender, race, familial pattern, other genetic factors Slender, inactive women who smoke are most at risk (Caucasian & Asians highest risk) ESSENTIAL MINERALS Phosphorus (P) Bone and teeth formation, maintains metabolism of fats and carbs, role in controlling pH of blood Sources: dark cola (who knew this?), dairy, grains Sodium Water balance, osmotic pressure, regulates nerve impulses, muscle contractions, aids in carb and protein absorption Sources What organ regulates Na? What other disorders need to watch sodium intake? ESSENTIAL MINERALS Potassium Protein and carb metabolism, water balance, normalizes osmotic pressure, regulates muscle activity Sources: mostly fruits and veggies (which fruits are really high in K) Intracellular ESSENTIAL MINERALS Magnesium (Mg) Body fluid regulation, activates enzymes, regulates metabolism of macronutrients, needed for ATP formation Sources: grains, green veggies, soybeans, milk, poultry Chlorine (Cl) Maintains fluid and electrolyte balance, aids in digestion (HCl) Sources: table salt (NaCl), protein foods ESSENTIAL MINERALS Sulfur – component of some amino acids Iodine Source? Deficiency? Zinc – promotes wound healing, affects sensitivity to taste and smell, aids in protein synthesis Iron (only a small amount needed) Part of what body component? Deficiency? IRON-DEFICIENCY ANEMIA Most common form of anemia Iron supplements may be needed (by MD only) Insufficient intake and stores Body cannot eliminate excess iron- can be toxic Heme vs. Non-Heme iron Food Sources: organ meats, beef, pork, chicken, fish, turkey, prunes/dried fruit, whole grains, beans, molasses, spinach Vitamin C enhances iron absorption ESSENTIAL MINERALS Others Fluoride (F)– Source Copper (Cu) Cobalt (Co) Manganese (Mn) Selenium (Se) DIFFERENCES IN SUPPLEMENTS AND RX: Vitamins, Minerals, Supplements Manufacturer does not need FDA approval before marketing. FDA does not approve vitamins, minerals, & supplements for safety before reaching consumers. Prescription Drugs Prescription drugs must be proven safe and effective for their intended use before marketing. Extensive research and studies. FDA MONITORING Post-marketing responsibilities: Monitoring safety (voluntary dietary supplement adverse event reporting) Product information such as labeling, claims, package inserts, and accompanying literature. FDA has the responsibility for showing that a dietary supplement is "unsafe," before it can take action to restrict the product's use or removal. ARE VITAMINS, MINERALS, & DIETARY SUPPLEMENTS SAFE? Many safe and consumed daily without adverse effects; some beneficial for health conditions. Reasons for recalls include: Microbiological, pesticide, & heavy metal contamination Absence of dietary ingredient claimed to be in product Presence of more or less than the amt of dietary ingredient claimed on the label Recall of Balanced Health Products, Inc. Starcaps dietary supplement capsules (11/26/08). WEBLINKS Dietary Reference Intakes http://fnic.nal.usda.gov/nal_display/index.php?inf o_center=4&tax_level=2&tax_subject=256&topic _id=1342&placement_default=0 Iron Deficiency Anemia http://www.nlm.nih.gov/medlineplus/ency/article/ 000584.htm Office of Dietary Supplements http://ods.od.nih.gov/ QUESTIONS