UMKC Nutrition in Nursing 2022
6 Classes of Nutrients Carbohydrates, Fats, Proteins (organic, energy-yielding, macro) vitamins (organic, micro) minerals (inorganic, micro) water
(inorganic) Sources of Kcalories carbs and proteins (4 per g) fats (9 per g) alcohol (7 per g) Example: Nutri-grain bar contains 3g fat (27kcal) 27 g carbs
(108kcal) 2g protein (8kcal) = 143 kcal Energy density Measure of the energy (kcal) a type of food provides compared to the amount of food consumed
(grams) Nutrient density The amount of a nutrient compared to the amount of energy obtained from that nutrient Nutritional genomics looks at how
nutrients affect genes and bodily interactions between diet and disease by analyzing nutrition, genomics, and molecular biology Scientific Method
Observation/Question (identify the problem), hypothesis/prediction (form a tentative solution), Experiment (collect data), results/interpretations (draw
conclusions from data) – if your hypothesis is true, develop a theory – if not true, form new observations controls an element that remains unchanged or
unaffected by other variables sample size the number of individual samples measured or observations used in a survey or experiment placebos an inert
treatment or substance that has no known effects blind vs double-blind blind means participants are unaware if they receive the treatment or placebo
whereas double-blind neither participant or researcher knows randomization random assignment of participants to the treatment in an experiment which
helps remove biases control group group of people similar to those undergoing experiment to observe them in natural setting experimental group
group that receives the treatment and are compared to the control group Epidemiological studies Cross-sectional studies (looking at data from a
population at one specific point in time) Case-control studies (compares those with a common characteristic to those similar without the characteristic Ex: cancer vs noncancer pts) Cohort studies (a group of participants that are observed over a long period of time) Experimental studies animal studies
(use animals to mirror human reactions to treatments for certain diseases) in vitro studies (done outside of a living organism and it usually involves
isolated tissues, organs, or cells) human clinical trials (research studies performed in people that are aimed at evaluating a medical, surgical, or
behavioral intervention) Positive Correlation both variables increase or decrease Negative Correlation one variable increases as the other decreases
E.A.R. Average daily nutrient intake level estimated to meet the requirement of 50% of R.D.A. recommended dietary allowance: average daily dietary
nutrient intake level is sufficient to meet the nutrient requirement of 98% of healthy individuals A.I. recommended average daily nutrient intake level
based on observed or experimentally determined approximations or estimates of nutrient intake by a group of healthy people U.L. highest level of nutrient
intake that is likely to pose no risk of adverse health effects for almost all individuals E.E.R. the average dietary energy intake that is predicted to maintain
energy balance in a healthy adult Nutritional Assessment historical info (health status, drug use, alcohol intake, diet) measurements (height, weight)
physical exams, and lab tests Deficiencies Primary (lack of adequate intake in diet) Secondary (other causes such as abnormal bodily absorption often
revealed in health history) Subclinical (early stage prior to symptoms revealed through lab results)
Principles of Diet Planning Adequacy (the sufficient intake of essential nutrients, needed to fulfill nutritional requirements for optimal health) Balance
(contains food from the different food groups to meet dietary intake requirements) Energy Control (relationship between your intake and the number of
calories burned to maintain proper energy levels) Energy Dense high-calorie foods with low levels of nutrients Nutrient Dense packed with
vitamins/minerals, but not necessarily high in calories Food Exchange Lists They are designed to help manage diabetes, weight management,
cardiovascular risk reduction, and general healthy eating. Food Pyramid 1992 grains deserve most emphasis in a diet with no emphasis on physical
activity My Pyramid 2005 emphasized higher servings of vegetables, grains, fruits, milk, meat & beans along with daily physical activity MyPlate 2011
combined USDA food patterns and dietary guidelines to promote personal planning Food (Nutrition) Label not required, restaurant food labels typically
have higher portion sizes, ingredients listed from most to least amount and must include all ingredients, serving sizes established by FDA Required
Nutrient Quantities total food energy and food energy from fat, total fat (saturated, trans, cholesterol), sodium, total amounts of carbs/fiber/sugars,
protein amounts, other nutrients (vitamin A, C, iron, and calcium)
Process of Digestion Mouth (Chewing breaks up food Fluids from salivary glands blend with food and liquids to ease swallowing as it progresses to the
pharynx) → esophagus (takes food from the mouth to the stomach with Two sphincter muscles control movement…upper [protect against reflux of food
into the airways as well as prevent the entry of air into GI tract] and lower [food transit from the esophagus into the stomach and prevents the reflux of
gastric contents back into the esophagus and esophageal damage]…) → stomach (food is ground up into a liquid called chyme, gastric juices prevent
bacteria w/ pH of 2, HCl uncoils and starts to break down proteins through hydrolysis, from here it heads to the Pyloric sphincter which connects the
stomach and small intestine) → small intestine (~23ft long/3cm in diameter, divided into 3 parts: duodenum + jejunum + ileum, neutral pH allows the
growth of bacteria that produce vitamin K, carbs adhere to cell walls) → large intestine (~5ft long/8cm in diameter, divided into 4 parts: ascending +
transverse + descending + sigmoid colon, where water + sodium are reabsorbed and most fiber is turned into waste) → rectum (Stores waste prior to
elimination of feces) → anus Other Important Organs and Enzymes liver (Manufactures bile salts, detergent-like substances, to help digest fats)
gallbladder (organ that stores and concentrates bile) appendix (Extends from the beginning of the colon that stores lymph cells) pancreas (Bicarbonate
neutralizes acidic gastric juices; pancreatic enzymes break down carbohydrates, fats, and proteins) salivary glands (Fluid eases swallowing; salivary
enzyme breaks down some carbohydrates) sphincters (prevent backflow) bile (Emulsifier bringing fats into suspension with water that is produced by the
liver and stored in the gallbladder) gastrin (the hormone that stimulates the stomach to release HCl) secretin (Bicarbonate-rich juices secreted into the
small intestine to maintain a slightly alkaline pH) bicarbonate (Neutralizes acidic chyme) cholecystokinin (Bile secreted into the duodenum to emulsify
fats) Important Processes and Digestive Actions bolus (Swallowing-voluntary) mastication (Chewing-voluntary) peristalsis (wavelike muscular
contractions of the GI tract that push its contents along) stomach action (Strongest muscles work to force chyme downward until hitting pyloric sphincter)
segmentation (a periodic squeezing or partitioning of the intestine at intervals along its length by its circular muscles) simple diffusion (Some nutrients
(such as water and small lipids) are absorbed by simple diffusion. They cross into intestinal cells freely) active diffusion (Some nutrients (such as glucose
and amino acids) must be absorbed actively. These nutrients move against a concentration gradient, which requires energy) facilitation diffusion (Some
nutrients (such as the water-soluble vitamins) are absorbed by facilitated diffusion. They need a specific carrier to transport them from one side of the cell
membrane to the other. (Alternatively, facilitated diffusion may occur when the carrier changes the cell membrane in such a way that the nutrients can
pass through) Anatomy of Absorption System villi (fingerlike projections from the folds of the small intestine that Select and regulate which nutrients
are absorbed) shaved villi (caused by diarrhea, revamp within a few days, prevent proper absorption + filtration) microvilli (tiny hairlike projections on
each cell of every villus that can trap nutrient particles and transport them into the cells full of enzymes) crypts (Valleys between the villi that secrete
intestinal juices) goblet cells (mucus secretion) Medications antibiotics (substance or compound that kills or inhibits the growth of bacteria) probiotics
(live microorganism, when administered in adequate amounts confers a health benefit on the host that cause competitive inhibition) prebiotics
(nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth of one or a limited number of bacterial species in the
colon) Roles of the Lymphatic system protect your body from illness, maintaining body fluid levels, absorbing digestive tract fats, and removing cellular
waste Functions of circulatory system arteries (vessels that carry blood away from the heart) capillaries (connect arteries to veins and exchange
oxygen + nutrients for waste and CO2) veins (vessels that carry blood back to the heart; two main - hepatic [blood from the liver to heart] and portal
[blood from the heart to liver]) Homeostasis Stability of conditions within the body regulated by feedback systems and the body systems
Types of saccharides mono including glucose/fructose/galactose (the simplest carbohydrates, the building block molecules, and contain single sugar
units) di including glucose + maltose/sucrose/lactose (double sugar units, provide quick energy source to the body) and poly including
starches/fibers/straight or branched chains (most abundant and are responsible for structural support, energy storage, and cellular communication)
general chemical formula for all monosaccharides (C6H12O6) condensation reactions Links two monosaccharides together such as H + OH → H2O
hydrolysis reactions Breaks a disaccharide in two monosaccharides such as H2O → H + OH carbohydrate Digestion in the GI Tract main goal is to
break down glucose for absorption and use via hydrolysis suffix “ase” meaning marks something as an enzyme lactose intolerance Too little of an
enzyme produced in your small intestine (lactase) is usually responsible for lactose intolerance. You can have low levels of lactase and still be able to
digest milk products. But if your levels are too low you become lactose intolerant, leading to symptoms after you eat or drink dairy glycemic index of
food Foods are classified as low, medium, or high glycemic foods and ranked on a scale of 0–100. The lower the GI of a specific food, the less it may
affect your blood sugar levels (Prediabetes 100 to 125 mg/dL • Diabetes > 126 mg/dL)
general makeup of a triglyceride glycerol and three fatty acids (C6H8O6); Formed via series of condensation reactions Fatty acids even numbers of
carbons that can be saturated or unsaturated Saturated fats have all their hydrogens and are liquid at room temperature Unsaturated fats missing all
their hydrogens and are solid at room temperature; Monounsaturated fats have one double bond, while polyunsaturated fats have two to six double
bonds general makeup of fatty acid methyl group at one end and acid group (carboxylic acid) at the other end double bonds get assigned a carbon
number starting at the methyl end linolenic versus linoleic acid both are polysaturated, found in the cell membrane, help with immune response, used
to make other fatty acids needed by the body; linolenic “omega-3” (the first of 3 double bonds is 3 carbons away from the methyl end of the carbon chain
and can be found in nuts (walnuts), seeds (flaxseed), vegetable oils, wheat germ, shellfish, fish, seafood, soybeans) linoleic “omega-6” (the first of two
double bonds is six carbons from the methyl end of the carbon chain and can be found in nuts, seeds, vegetable oils, leafy vegetables, grains, meats,
poultry fat) 3 fatty acids on glycerol can be and usually are a mix of fatty acids carbon, oxygen, and hydrogen fats more susceptible to spoilage
polyunsaturated fats due to the more unstable double bonds, which allow more oxygen to react at those points Fatty Acid Composition of Common
Food Fats pick foods with less saturated fats and more unsaturated fats coconut oil can cause high cholesterol levels, 90% saturated fat, not as
healthful as vegetable oils like olive oil and soybean oil, which are mainly unsaturated fat and therefore both lower LDL and increase HDL
hydrogenation Protects against oxidation, Makes liquid oils more solid, Partial hydrogenation most common, Lower HDL (good cholesterol) and raise
LDL (bad cholesterol) in the body trans-fat, what that means, what is cis versus trans, and how it is made unsaturated fatty acids that contain at
least one double bond in the trans position which causes decreased mobility and fluidity and hardening into fat that occur naturally (milk, butter, and meat
from ruminant animals) or are made artificially (hydrogenation of oils as seen in many fried and snack foods); cis fats are natural, trans are artificial
Phospholipids composed of a phosphate group, two alcohols, and one or two fatty acids. On one end of the molecule are the phosphate group and one
alcohol with hydrophilic phosphate heads and hydrophobic lipid tails. The function includes being part of cell membranes, Emulsifiers, Allowing
fat-soluble substances (vitamins A,D,E,K), and hormones to pass easily in and out of cells. Solubility in fat and water Lecithin vital to the normal
functioning of the brain, nerves, liver, and other organs; thought to help lower cholesterol and is the most common phospholipid; C35H66NO7P; found in
soybeans sterols structural component of cell membranes found in plants and cholesterol Origin of cholesterol food you eat and your liver Understand
how fat is emulsified and digested In the stomach fat is separated from other food substances. In the small intestines, bile emulsifies fats while
enzymes digest them. The intestinal cells absorb the fats. Long-chain fatty acids form a large lipoprotein structure called a chylomicron that transports
fats through the lymph system. Chylomicrons are formed in the intestinal cells and carry lipids from the digestive tract into circulation. Short- and
medium-fatty chains can be absorbed directly into the bloodstream from the intestinal microvillus because they are water-soluble. Cholesterol absorption
is hindered by foods high in fiber. When energy supplies are low the body utilizes its stored fat reserves for energy. Lipoproteins Chylomicrons (Largest
and least dense, Transport diet-derived lipids, Liver removes remnants from blood) Very-low-density lipoproteins (VLDL, Normal blood range: 5-40
mg/dL, Made in the liver, Composed primarily of triglycerides) Low-density lipoproteins (LDL, Normal blood range: 0-99 mg/dL, Composed primarily of
cholesterol, Bad one!, Liver regulation, High LDL poses Risk of heart attack; linked to heart disease) High-density lipoproteins (HDL, Normal blood range:
40-59 mg/dL, Composed primarily of protein, Remove cholesterol from cells, Carry cholesterol to the liver for recycling, Anti-inflammatory properties)
general structure of an amino acid Carbon, Hydrogen, Amino group, Acid group, side group or side chain essential amino acids Histidine, Isoleucine,
Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine nonessential amino acids Alanine, Arginine, Asparagine, Aspartic acid,
Cysteine, Glutamic acid, Glutamine, Glycine, Proline, Serine, Tyrosine diet is lacking an essential amino acid decreased immunity, digestive problems,
depression, fertility issues, lower mental alertness, slowed growth in children, and many other health issues proteins Sequence (Order of appearance of
amino acids in the peptide chain varies) Shape (influences function, depends on sequence, Bonds linking amino acids, Interaction of side chains with
each other and with the surrounding molecules) Protein folds (Hydrophobic groups inside, Hydrophilic groups fold outside) Phenylketonuria PKU the
most frequent inherited disorder of amino acid metabolism (about 1:10,000) caused by a defect in the enzyme phenylalanine hydroxylase (PAH), which
converts the essential amino acid phenylalanine to tyrosine and results in decreased levels of tyrosine, an accumulation of phenylalanine in blood and
tissues and severe brain damage with intellectual impairment protein denaturation Disruption of stability causes the protein to Uncoil and lose shape
usually in Stomach acid (Examples: Cooking an egg or Curdling of milk) Protein Digestion in the GI Tract and what happens where Mouth →
Stomach (Hydrochloric acid denatures proteins, Pepsinogen to pepsin) → Small intestine (Hydrolysis reactions-proteases, Peptidase enzymes such as
Carboxypeptidases Cleave amino acids from the acid (carboxyl) ends of polypeptides and Tripeptidases that Cleave tripeptides to dipeptides and amino
acids) protein synthesis DNA template to make mRNA (Transcription) mRNA carries code to Ribosomes (protein factories) mRNA specifies a sequence
of amino acids to make tRNA (Translation) can cause Sequencing errors amino acid sickle cell anemia SCA (Val-His-Leu-Thr-Pro-Val-Glu) vs normal
(Val-His-Leu-Thr-Pro-Glu-Glu) mutation provides partial protection against lethal Plasmodium falciparum malaria roles of proteins Hormones
(Messenger molecules, Transported in blood to target tissues) Regulators of fluid balance (Edema) Acid-base regulators (Attract H+ ions) Transporters
(Specificity) Antibodies (Defend body against disease, Specificity such as immunity/memory) Source of energy and glucose (Starvation and insufficient
carbohydrate intake) Blood clotting and Vision What two factors determine the quality of food protein content of the protein and digestibility of the
protein marasmus severe undernourishment causing an infant's or child's weight to be significantly low (matchstick arms) kwashiorkor edema and
enlarged liver causing enlarged stomach in malnourished children RDA of protein for adults is 0.8 grams per kg body weight per day highest safe level
of protein 102g