PPT_Chapter_24_Nutrition

Chapter 24

Nutrition

Review Tip

Increasing emphasis is placed on nutrition in treating disease and maintaining wellness. The certification exams always include questions on therapeutic diets, as well as vitamins and their functions in the body.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Overview

Nutrition is the process of taking food into the body and using it.


Steps of Nutrition

1. Ingestion —taking in of nutrients; eating and drinking

2. Digestion —physical and chemical changing of nutrients in the body to allow absorption

3. Absorption —transferring of digested nutrients from the gastrointestinal system to the blood circulation

4. Metabolism —synthesizing of nutrients from the bloodstream, producing energy


Nutrients

Nutrients are components of food necessary for the body to perform physiologic functions.

Energy Nutrients

Energy nutrients produce energy/calories when metabolized.

■ Carbohydrates —sugars and starches, the body’s primary energy source; they produce 4 calories per gram

■ Proteins —nutrients with amino acids (building blocks); build and heal body tissue; they produce 4 calories per gram

• Complete—protein nutrient that contains all nine essential amino acids

• Incomplete—protein nutrient that does not contain all nine essential amino acids

■ Fats (lipids) —greasy material in nutrients; transport fat-soluble vitamins, insulate the body from the cold


Nutrients, cont’d.

■ Fats (lipids) —greasy material in nutrients; transport fat-soluble vitamins, insulate the body from the cold and provide fatty acids; they produce 9 calories per gram

• Saturated fats—primarily found in meat, butter, and egg yolks; usually solid at room temperature; increase blood cholesterol

• Unsaturated fats—primarily found in vegetable and olive oils; usually liquid at room temperature; help decrease blood cholesterol

• Cholesterol—found in animal foods and manufactured by the body; not a true fat or lipid but a lipoprotein; necessary for vitamin D and acid bile production

- High-density lipoprotein, or HDL (good cholesterol) — works to stabilize LDL by transporting select amounts of it to the liver for elimination



- Low-density lipoprotein, or LDL (bad cholesterol) —waxy material that clogs blood vessels, causing cardiovascular disease

• Triglycerides—component molecule of fat found in fatty foods; a combination of fatty acids and glycerol; high levels clog blood vessels, causing cardiovascular disease





Nonenergy Nutrients

■ Fiber —nondigestible but edible portion of plants; necessary for the gastrointestinal elimination function

■ Vitamins —organic substances found naturally in foods; needed in small amounts for metabolism and prevention of certain diseases

(Note: The certification exams ask questions about which vitamins are water-soluble and which are fat-soluble.)

• Vitamin B1 (thiamin)—water-soluble vitamin primarily found in whole grains and beans necessary for carbohydrate metabolism

• Vitamin B2 (riboflavin)—water-soluble vitamin primarily found in animal products and broccoli; necessary for protein metabolism

• Vitamin B6—water-soluble vitamin primarily found in brewer’s yeast, whole grains, and nuts; aids in regulation of central nervous system



• Vitamin B12 (cyanocobalamin)—water-soluble vitamin primarily found in animal products and soybeans; promotes red blood cell (RBC) formation; a deficiency causes pernicious anemia

• Vitamin C (ascorbic acid)—water-soluble vitamin primarily found in citrus fruits and tomatoes; promotes stress resistance, wound healing, and oral health

• Vitamin A—fat-soluble vitamin primarily found in milk and yellow vegetables; promotes good eyesight and protects skin from infection; a deficiency causes night blindness

• Vitamin D—fat-soluble vitamin primarily found in sunlight and dairy products; strengthens bone development; a deficiency causes rickets

• Vitamin E—fat-soluble vitamin primarily found in green leafy vegetables, nuts, and whole grains; protects RBCs; a deficiency causes anemia



• Vitamin K—fat-soluble vitamin primarily found in green leafy vegetables and tomatoes; promotes blood clotting

■ Minerals —elements usually found in the earth’s crust, the human body, and some foods; necessary to carry out bodily functions

• Major minerals—essential elements needed by the body in larger amounts: calcium (Ca), chloride (Cl), magnesium (Mg), phosphorus (P), potassium (K), sodium (Na)

• Trace minerals—essential elements needed by the body in very small amounts: copper, fluoride, iodine, iron, zinc






Dietary Guidelines

The United States Department of Agriculture (USDA) developed guidelines to assist the general population in making healthy food choices. Prior to 2005, these guidelines were displayed in a food pyramid that divided foods into groups. The group with the most recommended servings per day was on the bottom, and the group with the fewest recommended servings per day was on the top, forming the pyramid shape. The new version was introduced in 2005 when the

Dietary Guidelines Advisory Committee met and the latest in 2010. The major change is that the estimated energy requirement ( EER ) is more specific and based on gender, age, height, weight, and activity level. EERs decrease with age, and children have separate recommendations. The food groups in the new pyramid are displayed in a vertical presentation rather than horizontal.


Dietary Guidelines, cont’d.

Figure 24-1. My Pyramid.



General USDA Recommendations

■ Eat a variety of foods from each food group

■ Combine healthy eating with physical activity

■ Choose a diet low in saturated fat and cholesterol

■ Eat plenty of grain products, fruit, and vegetables

■ Note sodium content in food products and use in moderation

■ Use alcoholic beverages in moderation



Food Groups in Order of Largest to Smallest

1. Grains

2. Vegetables

3. Milk

4. Fruits

5. Meats and beans

6. Oils



Common Therapeutic (Special) Diets

■ Pregnancy/lactating diet

• Calorie intake as recommended by health care provider

• Calcium, iron, vitamin C, and folic acid intake should increase

• Weight gain as recommended by health care provider

■ Clear liquid

• Used in introducing foods back into diet (e.g., after illness or surgery and in preparation for specific procedures such as a colonoscopy)

• Rule of thumb: clear liquids are those you can see through, such as apple juice, tea, clear broth, or noncaffeinated sodas

■ Soft

• Normal foods in mashed or puréed form

• Accommodation for patients with difficulty chewing



■ Bland

• Nonirritating foods (e.g., most dairy products, hot cereals, mashed potatoes, grits)

• Used in gastrointestinal tract disorders, such as various ulcer forms, ulcerative colitis, or gastritis

■ Diabetic

• Goal is to prevent abnormal fluctuations in insulin and blood glucose levels

• Simple sugars should be limited

• Intake of complex carbohydrates, protein, and unsaturated fats should increase

• Calorie intake is tailored per patient



■ Low (restricted) sodium

• Used in hypertension, congestive heart failure, and other diseases that increase the body’s normal fluid load

• Educate patient to read sodium contents in food ingredient labels

■ Low cholesterol (low fat)

• Used in patients with high cholesterol, increased triglycerides, and cardiovascular disease

• Limitation of fat calories to less than 20% of total daily caloric intake



■ Low purine

• Used in patients who have gout or the inability to metabolize uric acid

• Limitation of purine-rich foods such as organ meats, red meat, asparagus, salmon, halibut

■ Food intolerance

• gluten free—avoid this protein contained in wheat, oats, barley and rye

• lactose free—avoid or limit dairy products


Ethnic Considerations

The demographics of the United States continue to change as diverse populations grow. Certain diseases prominent in specific races or cultures (e.g., hypertension in African Americans and diabetes in certain Native American tribes) are often controlled by diet. It is important for the patient educator to determine the dietary habits of the involved ethnic group. Every attempt should be made to maintain the foods of the specific culture with, perhaps, different methods of preparation — for example, baking instead of frying. The educator, who often is the medical assistant, must know the prescribed therapeutic diet and understand the fundamentals of nutrients. All health care workers are obligated to stay current as standards and guidelines change.


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