Download NS 220: Nutritional Planning and Management

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