Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Chapter_030
Document related concepts
Transcript
Nutrition and Health Promotion Chapter 30 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Learning Objectives Define, spell, and pronounce the terms listed in the vocabulary. Apply critical thinking skills in performing patient assessment and care. Recognize the impact of cultural influences on diet choices. Analyze the relationship between poor diet and lifestyle choices and the risk of developing diet-related diseases. Classify the types and functions of dietary nutrients. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Learning Objectives Describe the role of carbohydrates, fats, and protein in the daily diet. Explain the function of appropriate amounts of vitamins, minerals, and water in the diet. Apply Food Guide Pyramid guidelines to patient dietary recommendations. Implement nutritional assessment techniques. Compare patient BMI calculations with the risk of diet-related disease development. Compare the concepts of therapeutic nutrition. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Learning Objectives Interpret food labels and their application to healthy diets. Instruct patients according to their needs to promote health maintenance and disease prevention by demonstrating the nutritional labeling of food products to a patient. Summarize the causes of eating disorders and obesity and their impact on patient health. Define the concepts of health promotion. Describe the role of the medical assistant in nutrition and health promotion. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Health Promotion and Disease Prevention Sound nutrition Regular exercise Avoidance of smoking and tobacco Limited alcohol intake Management of stress Avoidance of environmental contaminants Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Health Problems Related to Poor Nutrition Anemia Cancers Constipation Type 2 diabetes Hypercholesterolemia and atherosclerosis Hypertension Osteoporosis Stroke Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 Reasons for Food Choices Convenience Cost Emotional comfort Routine Positive experiences Ethnic or regional influences Health and weight Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Cultural Eating Patterns Asian diets Latin American diets Mediterranean diets Mexican diets Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Cultural Eating Patterns Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Nutrition and Dietetics Nutrition refers to all the processes involved in the intake and use of nutrients. Nutrients carbohydrates, fats, proteins, vitamins, minerals, and water Dietetics is the practical application of nutritional science to individuals. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Metabolism Process in which nutrients are used at the cellular level A combination of two processes Anabolism—building of smaller molecules into larger compounds, e.g., amino acids combine to form protein molecules Catabolism—breaking down of larger molecules, e.g., complex glycogen broken down into glucose molecules for energy Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Nutrients Nutrients essential nutrients nonessential nutrients Provide energy, protection, and insulation; build and repair tissues; and regulate metabolic processes BMR—amount of energy used by a fasting, resting individual to maintain vital functions Determined by the amount of oxygen used Defined in units of heat energy—calories Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Carbohydrates CHO—chemical compound Three groups: Simple sugars Complex CHO Dietary fiber Carbohydrates provide a ready source of energy. 4 kcal/g Digested CHO is glucose Stored glucose is glycogen; excess amounts stored as adipose tissue Protein-sparing effect Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Dietary Fiber Roughage—indigestible Maintains regularity Water-soluble fiber Insoluble fiber Lowers blood cholesterol levels Oat bran, fruits, vegetables Helps prevent colon cancer and heart disease Whole grains and beans Refer to Table 30-1 for foods rich in fiber Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Making Healthy Grain Choices Bran – the tough fibrous covering of a grain Enriched or fortified – government requires thiamin, riboflavin, niacin, folate, and iron be added to refined grain products Refined or white – process removes the coarse parts of the grain and bleached to create white color Stone ground flour – the process of grinding the grain Unbleached flour – similar to white flour in nutritional value Wheat flour or brown bread – made from wheat that contains molasses to color the bread brown Whole grain or whole wheat flour – entire grain kernel is ground Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Recommendations for CHO Intake 55% to 57% of the total calories consumed each day Choose fiber-rich fruits, vegetables, and whole grains Consume 15 g of fiber for every 1000 calories eaten Limit simple sugars and starch snacks 2 cups of fruit and 2 1/2 cups of vegetables daily Consume a variety of dark green, orange, and starchy vegetables and legumes 3 servings of grains daily; at least half whole grains 3 cups of fat-free or low-fat milk or milk products each day Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Dietary Fat Storage form of energy Concentrated form of fuel = 9 kcal/g Lipids provide essential fatty acids Needed for absorption of fat-soluble vitamins Gives food flavor Creates feeling of satiety When digested are metabolized into fatty acids and glycerol Fatty acids can be either saturated or unsaturated Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Adipose Tissue Stored form of fat in the body. Any excess calories that are not burned for energy are converted into adipose tissue for energy storage. Supports and protects vital organs. Helps regulate body temperature via insulation. Plays important nervous system role. Protects nerve fibers Relays nerve impulses Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Saturated Fats Contain all the hydrogen possible and therefore are denser, heavier, and solid at room temperature Examples dairy products, eggs, lard, meat, and hydrogenated fats such as margarine Fats in soft-type margarines are partially hydrogenated and usually soft at room temperatures. Most saturated fats come from animal sources. Trans fats—hydrogenated margarines Elevate serum lipid levels Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Unsaturated Fats Unsaturated fatty acids can take on more hydrogen and therefore are less heavy and less dense. Fatty acids with one unfilled hydrogen bond are called monounsaturated. Olives and olive oil, peanuts and peanut oil, canola oil, pecans, and avocados Polyunsaturated fats have two or more unfilled hydrogen bonds, are found in plants, and are usually liquid at room temperature. Safflower, corn, cottonseed, and soy oils Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Benefits of Omega-3 Fatty Acids Antiinflammatory effects – improve the immune response, protect blood vessels such as the coronary arteries, and inhibit the formation of blood clots Sources – cold water fish including mackerel, salmon, tuna, and trout; certain oils including canola, flaxseed, soybean, wheat germ; walnuts; soybean kernels; and soy beans Recommendation – consume two servings of fish weekly. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Cholesterol Nonessential nutrient Anabolized in the liver Synthesized only in animal tissue so not found in plant foods Food sources – egg yolks, organ meats, all animal sources of food contain cholesterol Excess amounts form atherosclerotic plaques on arterial walls Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Lipoprotein Categories Good fats, high-density lipoproteins (HDLs), carry free cholesterol from body tissues and bloodstream to liver for metabolism and excretion. Bad fats, low-density lipoprotein (LDLs) and very-low-density lipoprotein (VLDLs), carry fat and cholesterol to tissues. LDLs and VLDLs form atherosclerotic plaques on arterial walls; result in heart disease, hypertension, and strokes. Lipoprotein levels can be improved: Limit cholesterol and saturated fats, eat monounsaturated fats Increase fiber intake Exercise Recommendations: LDL below 100 and HDL 60 or greater Total cholesterol <200 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 Recommendations for Fat Intake Total fat intake 20–35% daily No more than 10% from saturated and trans fats Limit cholesterol to less than 300 mg/day Lean cuts and smaller portions of meat; trim visible fat Substitute poultry without skin and fish for red meat Avoid adding fat to cooking process Limit intake of organ meats and egg yolks If cholesterol is elevated, limit eggs to two or three per week Low-fat or fat-free milk and milk products Low-fat or fat-free products Use canola or olive oils Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24 Antioxidants Our bodies protect us against toxins created by oxidation through the use of antioxidant vitamins C and E and beta carotene, but their amounts are not always sufficient. Antioxidants prevent cholesterol from oxidizing and causing arterial damage. Dietary sources of antioxidants: Broccoli Oranges Strawberries Almonds Almonds Oatmeal Soy beans Sunflower seeds Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 Protein Complex molecules composed of amino acids Recommendations: 45 g/day females; 55–60 g/day males 20 different amino acids, eight are essential Complete proteins—animal sources—contain all eight essential amino acids Incomplete proteins—vegetable sources—must be combined to provide eight essential amino acids, for example: • Black beans and rice • Peanut butter on whole wheat sandwich Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26 Protein Functions and Sources Build and repair body tissue Aid in body's defense mechanisms against disease Regulate body secretions and fluids Provide energy 4 kcal/g Food sources: Meat, fish, poultry Eggs, dairy products, nuts Legumes, soy, whole grains Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Recommendations for Protein Intake Maximum of 18% of daily calories Consume about 6 oz of lean meat, poultry, or fish each day. 1 ounce of meat equals one egg, 1/4 cup of dry beans, 1 tablespoon of peanut butter, 1/2 cup of cooked beans, or 1/2 cup of tofu. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28 Vegetarians Must combine foods that complement incomplete proteins to get needed essential amino acids Lactoovovegetarians—eat vegetables, eggs, dairy Lactovegetarians—vegetables and dairy Vegans—strict vegetarians; no animal proteins Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29 Vitamins and Minerals Vitamins are essential for metabolic functions. Vitamins regulate the synthesis of body tissues, aid in the metabolism of nutrients, prevent deficiency diseases, play a vital role in disease prevention. Fat-soluble—A, D, E, K Water-soluble—B complex and C Table 30-3 Not regulated—look for USP symbol on label Minerals help maintain water-electrolyte and acid-base balances, regulate muscular action, normal heart rhythm, blood clotting, and nervous activities. Table 30-4 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 30 Sodium, Blood Pressure, and the DASH Diet Sodium >2400 mg (risk of developing hypertension) How can you cut down on salt intake? Dietary Approaches to Stop Hypertension (DASH) diet 4 to 5 servings of both fruits and vegetables 7 to 8 servings of whole grains 6 ounces or less of meat, fish, and poultry 4 to 5 servings per week of nuts, seeds, and dry beans 2 to 3 cups of milk 2 to 3 teaspoons of oils 5 tablespoons of added sugar per week 1500 to 2000 mg of sodium per day Total fat should not exceed 22% of calories Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31 Water The body is approximately 80% water and can survive longer without food than it can without water. Water is part of almost every vital body process. Functions Helps maintain body temperature Medium for biochemical reactions Vehicle for transport of substances Lubricant for joints and mucous membranes Recommendation: 8 glasses/day Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32 The Food Guide Pyramid Developed by the government as a visual dietary guideline. Illustrates how the proportions of each basic food group contribute to a balanced diet. Individualized to help consumers choose the foods and amounts that are right for them. Considers the individual’s age, sex, and activity level. Refer to Figure 30-1. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 33 Nutritional Status Assessment A healthy diet is one that: Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products Includes lean meats, poultry, fish, beans, eggs, and nuts Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34 Eating Tips Make half your grains whole Vary your veggies Focus on fruit Get your calcium-rich foods Go lean with protein Find your balance between food and physical activity Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 35 Assessment The assessment of nutritional status includes Patient age, height, weight Overall health status Recent changes in weight Diet and exercise habits Lifestyle habits Culture and ethnic background Skin turgor Percentage of body fat Body mass index (BMI) Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 36 BMI Measurement of the ratio of height to weight More accurate predictor of weight-related health risks than traditional height/weight charts Provides a good estimate of degree of body fat Formula: weight in pounds × 705, then divide by height in inches twice Refer to nomogram Figure 30-3 Recommended ranges: 19–25 healthy range 25–30 overweight >30 obese Mortality rates significantly higher at 25 and above – Refer to Table 30-6 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 37 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 38 Fat-Fold Measurement Body fat can be measured using calipers to measure fat folds Measure triceps, subscapular region, and suprailiac area Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 39 Therapeutic Nutrition Patients with hypertension, hypercholesterolemia, certain gastrointestinal diseases, and diabetes mellitus types 1 and 2 all benefit from a therapeutically planned diet. Consider the patient’s lifestyle, cultural influences, and background to ensure compliance with recommended dietary changes. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 40 Modifying a Diet Consistency Calorie level Amounts of one or more nutrients Degree of bulk or fiber Spiciness Levels of specific foods Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 41 Diets Soft or Light—eliminate fiber; decrease strain on GI tract Mechanical Soft—regular diet that is chopped, ground, or pureed; after dental or oral surgery or patients with dysphagia Liquid—clear or full liquid; for diagnostic test preparation or after surgery Bland—restricts dietary irritants; decrease spices or high-fiber foods, no fried food, no gas-forming vegetables; GI disorders Elimination—used to treat allergies; remove foods suspected of causing allergy High or Low Fiber—increase or decrease bulk Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 42 Diabetic Diet Goal is to balance diet and exercise to maintain consistent blood glucose levels and healthy weight range. Traditionally based on exchange lists—foods grouped according to similar caloric, CHO, protein, and fat content. Refer to Table 30-7. New rating system—glycemic index—CHO rated from slowest to fastest effects on blood glucose levels. Eating CHO that takes longer to affect blood glucose levels helps control hyperglycemic peaks. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 43 Heart Healthy Diet Monounsaturated or polyunsaturated fats and oils Low-fat or fat-free dairy products Whole grain bread, cereal, pasta, etc. Dark green leafy vegetables Decreased sodium Fresh or frozen fruits Fish Chicken and turkey Limit eggs, red meat Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 44 Cross-Cultural Tips for Reducing Sodium and Fat Limit soy or teriyaki sauce amounts Eat fresh or frozen fruits and vegetables Bake or broil meats; limit beef products; remove chicken skin before cooking; increase intake of unprocessed fish Cook with olive or canola oils Limit servings of cured foods; avoid pickles or other foods that are prepared in brine; limit condiments Cook rice and pasta without added salt; avoid instant versions Do not add salt to food; use substitute spices Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 45 Reading the Food Label Label front must show health claims Serving size and number of servings per container Total calories per serving and calories derived from fat Percent of daily required nutrients per serving Total grams of fat, cholesterol, sodium, CHO, protein Total CHO broken into dietary fiber and sugars Recommended daily amounts for each nutrient Ingredients listed in order of amount Procedure 30-1 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 46 Food Label Nutritional Claims Light – 1/3 fewer calories Fresh or Raw – never frozen or preserved Calorie-free – <5 calories/serving Sugar-free – <0.5 g of sugar/serving Sodium-free – <5 mg of sodium/serving Fat-free – <0.5 g of fat/serving Saturated fat-free – <2 g of saturated fat/ serving High – provides >20% of recommended daily consumption Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 47 Food Label Nutritional Claims Lean – meat has <10.5 g of fat; <3.5 g saturated fat Extra lean – meat with <4.9 g of fat; <1.8 g saturated fat Low-sodium – <140 mg Low-calorie – <40 calories Low-fat – 3 g or less Low saturated fat – 1 g or less of saturated fat Low cholesterol – 20 mg or less of cholesterol; 2 g or less saturated fat Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 48 Sample Food Label From U.S. Food and Drug Administration: Accessed January 26, 2010 at: www.cfsan.fda.gov Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 49 Food-Borne Diseases Escherichia coli, Salmonella, and Campylobacter Common signs and symptoms: nausea, vomiting, stomach pain, and/or diarrhea Incubation period Treatment: replacement of fluid and electrolytes; antidiarrheal medications; drugs that coat the gastrointestinal tract Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 50 Food-Borne Diseases When screening phone calls from patients with gastrointestinal symptoms, these are some of the items to consider: Presence of a fever of 38.6°C (101.5°F) and above Diarrhea for more than 3 days Prolonged vomiting Blood in the stools Signs of dehydration: Decrease in urination, dry mouth, vertigo Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 51 Food Safety Guidelines Wash hands and preparation surfaces frequently Keep cold foods cold and hot foods hot Refrigerate leftovers immediately after serving Sanitize cutting boards used to cut raw meat Cook meat well-done Do not sample cookie dough Clean kitchen surfaces with a sanitized cloth Defrost food in refrigerator Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 52 Food Contaminants FDA monitors the presence of contaminants in the food chain and issues warnings as needed Mercury is the most common heavy metal found in food – primarily fish Other environmental contaminants – cadmium, lead, PCBs Toxic mercury levels can poison the nervous system, especially that of the developing fetus Pregnant and childbearing women, nursing mothers, and young children should not eat any fish that are known to have high mercury levels. King mackerel, swordfish, shark, and any freshwater fish from lakes or rivers contaminated with mercury Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 53 Eating Disorders: Anorexia Nervosa Self-induced starvation Typically affects female adolescents Patients are extremely sensitive to failure and criticism Use not eating as a way of controlling their feelings Fear becoming grossly overweight if they allow themselves to eat Suffer from extreme malnourishment May require IV or NG feedings Require psychotherapy to help form positive self-image Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 54 Bulimia More common than anorexia. Characterized by cycles of binging and purging. Usually begins in adolescence from failed dieting. Individual associates self-worth with being thin. Some form of stress upsets the individual, who then turns to food for consolation. Binge period can be as high as 20,000 calories followed by vomiting, laxatives, enemas, excessive exercise, food abstinence. Patient has normal to above-average weight. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 55 Obesity 60% of the American population. Every year approximately 300,000 adults in the United States die of causes related to obesity. Approaches: Detailed nutrition and physical activity history Teach patient how to calculate BMI and associated health risks Set weight loss goal of 10% over 6 months to 1 year Refer to a registered dietitian for in-depth diet counseling Eat a low-fat diet high in complex CHO Learn how to read food labels Eat breakfast every day Be physically active 60 to 90 min/day Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 56 Health Promotion Considers general wellness, adequate nutrition, environmental health and safety, health education needs, and disease prevention Components include: Exercise Stress management—control fight or flight Health screening—TB test; PAP smear; PSA level; hemoccult, colonoscopy, mammogram after 40, urinalysis, cholesterol, chest x-ray examination, ECG Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 57 Patient Education When talking to patients about a diet, the medical assistant may find the following helpful: Use charts and diagrams to illustrate diets. Consider the patient’s dietary likes and dislikes. Remember that ethnic and cultural foods are important. Encourage the patient to play an active role in the learning process. Suggest local support groups that can help in diet maintenance. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 58
