NUTRITION STUDY GUIDE – METABOLIC – THEORY EXAM #2
Discuss normal digestion, absorption, and metabolism
I. Basic Nutrition Principles
A. Ingestion: consumption of food
B. Digestion: food broken down into tiny nutrients in the stomach
1. Mechanical: involve neuromuscular processes that moves food through GI tract
2. Absorption: movement of smaller elements though the digestive walls into blood
stream
C. Basic metabolism: biochemical reaction within the cell of the body
- Anabolism: build up
Glycogenolysis: catabolism of glycogen into
- Catabolism: breakdown
glucose, carbon dioxide, water
Glycogenesis: anabolism of glucose into
Gluconeogenesis: catabolism of amino
glycogen
acids and glycerol into glucose for energy
Identify essential nutrients, explain the significance of each nutrient, and identify
their dietary sources.
I. Dietary Sources of Essential Nutrients
A. Energy Nutrients – macro nutrients
1. Carbohydrates:
- Contain: carbon, hydrogen, oxygen
- Keep body from using proteins for energy,
- 4kal/gram
prevent ketosis, enhance memory and
- Major supplier of energy, include: sugars,
learning capabilities
starches, fiber
- 45% to 65% of daily caloric intake
Simple carbohydrates
Complex carbohydrate
Broken down & absorbed quick,
quick source of energy
Monosaccharides: glucose,
fructose, galactose
Disaccharides: sucrose, maltose,
lactose
Starches – made up of many units of glucose
Take longer to break down, provide longer periods of energy
***Dietary fiber: non-digestive part of plants
Soluble fiber: combine with waste to assist in their removal
Oat bran, beans, apples, carrots
Insoluble fiber: bulk the diet
Whole grains, skin and seed of fruits
Benefits of fiber:
-Promote cardiovascular health (lower cholesterol level)
-Weight control
-Improve glycemic control in diabetes
-Improve regularity
-Enhance immune function
2. Protein
- Development – maintenance – repair
body tissues, organs, cells
- May provide energy if body doesn’t have
enough fat or carbohydrates
- 10%-35% of daily intake
- Amino acid: must be consumed in food
every day because body doesn’t make or
store it
Complete proteins: contain all essential
amino acids (animal-based)
Incomplete proteins: lack 1 or more
essential amino acids (veggies, seeds, nuts,
grains)
***Amino acids that cannot be used for
synthesis are converted to fat
- Healthy people rarely need protein
supplements
- 2/3 serving of protein-rich food = daily
need
- Nitrogen: growth, pregnancy,
maintenance of muscle mass and vital
organs, wound healing
3. Fats
- Very concentrated
*Trans fat: AVOID!!! (raise LDL, lower HDL,
- Are type of lipid (similar to carbohydrate,
longer shelf life)
less oxygen, not dissolve in water)
Cholesterol:
- 20%-35% of daily intake
- waxy fat-like, produced in liver/ part of
- Functions: supply energy/ insulate body/
cell membrane and nerve tissues
protect vital organs or tissues/ facilitate
- body use this to form vit D and other
nerve conduction/ transport molecules/
hormones
Component of many hormones
- Found ONLY in foods come from animals
- Categories: triglycerides/ Phospholipids/
(butter, eggs, meats)
Sterols
- Not essential
- Types:
- Adult <200, Child 120-200, Infant: 70*Monounsaturated: BEST! (olive oil,
175, Newborn: 53-135
peanut oil, avocado, nuts, canola oil)
- Forms: LDL (deposit cholesterol on the
Polyunsaturated (fish oil, vegetable oil,
wall of blood vessels); HDL (removes
sunflower oil)
cholesterol from cell and bring it back to
Unsaturated: liquid at room temp
liver and intestine to be recycled or
*Saturated: NOT GOOD! (solid at room
excreted
temp, animal source, tropical oil butter)
- Omega 3 & 6:
Necessary for blood clotting, normal brain and nerve system functioning
Prevent atherosclerosis & lower triglyceride
Improve learning ability/ enhance immune function/ improve arthritis symptoms
Lower cholesterol
Reduce risk of heart disease
B. Regulatory Nutrients – micro nutrients
1. Vitamins
Important for metabolic and physiologic functions
DON’T PRODUCE ENERGY
Water soluble
Vitamin B
Facilitate energy production
Act as coenzyme to form RBCs
B1: necessary for production of HCl (for digestion)
B2: maintain healthy skin, adaptation to light
B3: IN COFFEE – critical in formation of fatty acid
Pantothenic acid B5:
Biotin B7: form purines (essential for DNA & RNA)
B6: synthesis & catabolism of amino acid
B12: RBC production, maintain myelin (protective sheath of the nerve),
necessary to make DNA
B9 Folic acid: synthesis of DNA, RBC formation,  neural tube defect
Vitamin C
Most important vitamin
Collagen synthesis
Antioxidant
ENHANCE ABSORPTION OF IRON
Promote strong immune system
Help with infection & night vision
Bone & teeth development
Deficiency: night blindness,  immunity, impaired growth and development
Liver, milk, egg yolk, dark leafy green veggie, orange/yellow veggie and fruits
“sunshine vitamin”
Bone and tissue development (Collaborate with calcium and phosphorus)
Development of collagen
Dairy products, eggs, fortified products, liver, fatty fish (salmon, mackerel)
Essential for protein synthesis (promote blood clotting)
Synthesized in body by bacteria in large intestine
Liver needs vitamin K to produce a protein called PROTHROMBIN
Deficiency: bruising/ bleeding
Dark leafy veggies: broccoli, spinach, Brussel sprout, cabbage
Antioxidant, protect cell from free radicals
Promote healthy immune system
Nuts, seeds, soybean, canola, corn, other vegetable oils
Excreted in urine
Easily destroyed by
light, air, cooking
Not stored in body,
must be digested
daily
Fat soluble
Soluble in fats and
can be stored in
body tissues and
tend to remain
Hypervitaminosis:
too much vitamins
stored in body
Vitamin A
Vitamin D
Vitamin K
Vitamin E
2. Minerals
- Quickly used or lost in waste products 
must consume every day
- No calories
- Calcium: nerve conduction, muscle
contraction, blood vessel expansion/
contraction, secretion of hormone
- Phosphorus: bone development, muscle
contraction, kidney function, nerve
conduction, heartbeat regularity
- Magnesium: work with calcium,
structural support, BP and heartbeat
regulation, nerve/muscle function
- Zinc >< magnesium
Sodium/ Potassium/ Chloride:
Iron: vital part of hemoglobin
Iodine: thyroid gland functioning
3. Water
- Function:
Control body temp
Maintain acid-base balance
Regulate fluid and electrolytes
Transporting nutrients and waste
- Dehydration: excessive sweating,
diarrhea, vomiting.
Dietary Recommendations
Special Diets
Clear
liquid
Pureed
Thickened
Diabetic
Renal
Short period of time
Juice (no pulp)/ see-through
At room temp
Blended – No nuts/ seeds
Avoid raw egg
Pt has difficulty swallowing/ risk for
aspiration
Thin: like normal beverages
Nectar: sip through a straw
Honey: eat w/ spoon, no straw
Spoon-thick: have shape, eat w/ spoon
Control carb/ avoid high glycemic food
Prefer high fiber
Restrict potassium/ sodium/ protein/
phosphorus
Prefer fresh fruit, veggies
Limit: meats, processed food, peanut butter,
cheese, nuts
*Fluid restriction
Zinc: immune function, wound healing,
blood clotting, thyroid function,
maintaining vision
Symptoms: headache, loss of concentration.
Men: 3.7L/day, Women: 2.7L/day
- Water intoxication: excessive intake,
failure to excrete
- 60%-70%: adult, 54%: older adult, 77%:
newborn, 97% embryo
Full liquid
Mechanical
soft
Gluten free
Cardiac
Vegan
All items in clear liquid
Juice (with or w/o pulp)/ milk
Yogurt/ pudding/ cream soup
Easy to chew food
No wheat, barley, rye, oats
Low cholesterol/sodium
Minimize animal products/
processed foods
No meat
Need B12 supplements
Discuss factors influencing nutrition
Factors Affecting Ingestion
A. Physiological impairments
-Limited mobility of hands and arms
-Poor tolerance of activity
-Poor cognition
-Poor physical state
B. Lifespan considerations
- Infants: critical period, need: vitD,
- Adolescents: need additional calories/
fluoride, iron
proteins/ minerals/ B-vitamins, iron
- Toddlers/ preschoolers:
deficiency in girls due to menstruation
Long life habits are established
- Young/ middle-aged adults: calories
Growth spurts
requirement lower/ steadily decline
Food safety
- Older adult: over/under nutrition
C. Psycho-social considerations
1. Economics: food insecurity
2. Dietary preferences: meaning of food
Identify developmental nutritional considerations and describe how nutrition
influences growth and development throughout the life cycle
Nutrition is always relevant
It helps to maintain or increase wellness
Dietary factors could be the cause of illness or could help restoring health
Identify risk factors for and clinical signs of malnutrition
-Condition with ability to ingest, digest,
-Obesity
absorb nutrients
-Anorexia nervosa/ bulimia
-Congenital anomalies
-cancer/ radiotherapy
-Surgical revisions of GI tract
-Immobilization
-Fed through IV only for > 1 week
-Living alone
-Pregnant pt
-Alcohol/ substance abuse
-Poor dietary habit
*Clinical signs:
Eyes: dark circle/bags under eyes/ poor night vision/ ruptured blood vessel in eyes/
nearsightedness/ pale lower eyelid
Teeth and gum: bleeding gum/ crowed teeth
Hair: hair loss, dry hair, dandruff
Nails: spoon shape, white marks, pale nails, brittle nails, cuticle tears easy
Muscle & joint: cramping, twitching, edema swelling, numbness/ tingling, clicking joints
Mouth: cracks in corner, weak tooth enamel, painful tongue, loss of smell or taste
Skin: bumps on back of arms, dry/rough skin, unusual nosebleed, easy bruising, dermatitis,
stretch marks
CNS: depression, dementia, nervousness, irritability, insomnia, dizziness
Identify classifications and factors relating to nutritional alterations of more than
body requirement and less than body requirement
1. More than body requirement
a) Classifications
1) Overweight: BMI 25-29.9
2) Obese: BMI 30-39.9
3) Extreme obesity: BMI 40+
b) Epidemiology
c) Etiology and pathophysiology
Body weight beyond physical requirement
Abnormal increase and accumulation of fat cells
Adipocytes: increase in number (hyperplasia) and size (hypertrophy)
d) Genetics
e) Physiologic regulatory mechanisms
Research in: eating behavior, energy
metabolism, body fat metabolism
Leptin: suppresses appetite, increase fat
metabolism (satiety hormone)
Ghrelin: regulate appetite (hunger
hormone)
f) Environmental factors
Access to food
Lack of physical exercise
Low socioeconomic status
g) Psychological factors
Associations begins in childhood
Sense of satiety can be altered
Mindless eating
Eating is social, associated with pleasure and fun
h) Health risks associated with obesity
Cardiovascular problems (high LDL, low HDL, high triglycerides)
Diabetes (type 2)
GI and liver problems
Respiratory and sleep problems (sleep apnea, obesity hypoventilation)
Musculoskeletal problems: osteoarthritis, inflammatory mediators, cartilage deterioration,
hyperuricemia and gout
Cancer: breast, endometrial, kidney, colorectal, pancreas, esophagus, gallbladder
Psychological problems: stigmatization, low self-esteem, social isolation, depression
2. Less than body requirement
a) Malnutrition
Lack of nutrients, insufficient to meet body metabolic needs
Contribute factors: starvation and physical illness (surgery, injury, hospitalization,
undernutrition, GI disease)
b) Malabsorption
Impaired absorption of nutrients from GI tract
c) Clinical manifestations
Poor wound healing
Develop pressure ulcers, infection,  muscle strength, post-op complication, increased
morbidity and mortality risks
Diagnostic studies
Swallowing and Gag reflex
Lab tests/studies
A. Albumin (slow)
B. Pre-albumin (preferred)
C. Total Protein
D. CBC
D. Total Protein
E. Serum glucose
F. UA
Discuss enteral nutritional administration
A. Gastrointestinal intubation
1. Short-term nutritional support
a. Nasogastric (NG) tubes
b. Nasointestional (NI) tubes
2. Long-term nutritional support
a. Percutaneous endoscopic gastrostomy (PEG) tube
b. Gastrostomy tubes
B. Tube feeding safety
Identify blood components and their functions
A. Blood Cells
1. Erythrocytes (RBC)
2. Leukocytes (WBC)
3. Thrombocytes (Platelets)
B. Plasma and Plasma Proteins
Blood tests
A. CBC
B. RBC
C. WBC
D. Hemoglobin (Hgb)
E. Hematocrit (Hct)
F. Platelets (Plt)
G. Differential (Diff)
Nutritional Anemias Across the Life Span
A. Overview
B. Iron Deficiency Anemia
1. Pathophysiology
2. Clinical Manifestations
3. Assessment and Diagnostic Findings
4. Medical Management
5. Nursing Management
C. Folic Acid Deficiency Anemia
1. Pathophysiology
2. Clinical Manifestations
3. Assessment and Diagnostic Findings
4. Medical Management
5. Nursing Management
D. Vitamin B12Deficiency Anemia
1. Pathophysiology
2. Clinical Manifestations
3. Assessment and Diagnostic Findings
4. Medical Management
5. Nursing Management