THE ART OF NUTRITION
MODULE 1 → Nutrition and Diet Therapy - Lecture
BASIC NUTRITION TERMS AND CONCEPTS
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
ART OF NUTRITION
◆ Application of nutrition science to meet individual
needs for the goal of optimal health status
NUTRITION
◆ Science of the processes by which the body uses
food for energy, maintenance and growth
◆ Science of food, the nutrients, and other substances
within food; their action, interaction and balance in
relation to health and disease and the process by
which the organism ingests, digests, absorbs,
transports, uses and excrete substances (Council of
the American Medical Association)
FOOD
◆ Products derived from plants or animals
◆ Important for health and survival providing fuel for
bodily functions and materials for growth, repair
and general health
NUTRIENT
◆ Chemical substance present in food
◆ Needed by the body
◆ 6 main classes (CHO, CHON, Fats, Vitamins,
Minerals & H2O)
MACRONUTRIENTS
◆ Nutrients needed by the body in large amount
◆ Measured in grams or liters
◆ CHO, CHON, Fats, Water
MICRONUTRIENTS
◆ Nutrients needed by the body in small amount
◆ Measured in milligrams or micrograms
◆ Vitamins and Minerals
GOOD NUTRITIONAL STATUS
◆ Appropriate intake of the macronutrients and the
various micronutrients
◆ Can be achieved if there is a good digestion,
absorption, and cellular metabolism of the
nutrients
MALNUTRITION OR POOR NUTRITIONAL STATUS
◆ There is prolonged lack of one or more nutrients
which retard physical development or causes the
appearance of specific clinical conditions
◆ May occur because the diet is poor or because of a
digestion and metabolism problem
◆ Excess nutrient intake which leads to condition such
as
obesity,
heart
disease,
hypertension,
hypercholesterolemia
OPTIMAL NUTRITION
◆ A person is receiving and using the essential
nutrients to maintain health and well-being at the
highest possible level
KILOCALORIES
◆ Unit of measure used to express the fuel value of
CHO, CHON, Fats
◆ CHO, CHON, fats and alcohol are the only sources
of kilocalories
◆ 1 kcal = 4 kj (kilojoules)
DIET
◆ Food and drink that a person regularly consumes
BALANCED DIET
◆ Provides the recommended amount of essential
nutrients
MEAL
◆ Breakfast, lunch, or dinner
HEALTH
◆ More than the absence of disease
◆ High level health and wellness are present when an
individual is actively engaged in moving toward the
fulfillment of his or her potential
➔
➔
PUBLIC HEALTH
◆ Field of medicine that is concerned with
safeguarding and improving the health of the
community as a whole
HOLISTIC HEALTH
◆ A system of preventive medicine that takes into
account the whole individual
◆
➔
Promotes personal responsibility for well-being and
acknowledges
the total influences--biologic,
psychologic and social-- that affects health,
including nutrition, exercise and emotional well
being
MEDICAL NUTRITION THERAPY (MNT)
◆ Previously known as diet therapy
◆ Treatment of disease through nutritional therapy
● Necessary for the following reasons:
○ To maintain or improve nutritional
status
○ To improve clinical or subclinical
nutritional deficiencies
○ To maintain, decrease or increase
body weight
○ To rest certain organs of the body
eliminate
particular
food
○ To
constituents to which the individual
may be allergic or intolerant
○ To adjust the composition of the
normal diet to meet the ability of the
body to absorb, metabolize and
excrete certain nutrients and other
substances
FOOD AND DIETARY COMPONENTS
Non-nutrient Components
➔
Can be useful, neutral or unfavorable
◆ Food additives, phytochemicals, zoochemicals
➔
FOOD ADDITIVES
◆ preservatives, flavors, colors
◆ Keep food safe for an extended period of
time
◆ Used to enhance the nutrient content, texture,
color and flavor
◆ Since some may carry risks, regulation is
needed
PHYTOCHEMICALS
◆ Found in edible fruits, vegetables and other
plant derived foods
◆ Contain health promoting properties in the
body
◆ Currently under extensive study in the
prevention of chronic diseases
◆ e.g. lycopene (tomatoes) allylic sulfites (garlic)
ZOOCHEMICALS
◆ Found in animal foods that are not essential
nutrients but may have health promoting
properties
◆ e.g. zeaxanthin and lutein (egg); omega 3
fatty acids (fish)
➔
➔
Nutrients
➔
➔
Chemical substances found in food and is used in the
body to provide energy, build and repair body tissues
and to regulate life processes
Can be classified based on:
◆ AMOUNT NEEDED BY THE BODY
● Macronutrients
● Micronutrients
◆
CHEMICAL NATURE
● Organic Nutrients - Contain carbon
CPF, vitamins
● Inorganic Nutrients - does not contain
carbon, water and minerals
◆
EUROPEAN COUNTRIES - Pie or Plate
◆
CANADA - Rainbow
● Contains 4 food groups
presented in a rainbow
shape with grains
representing the largest
component
○ Grain Products
○ Vegetable and
Fruits
○ Milk Products
○ Meat and Alternatives
PHILIPPINES AND USA - Pyramid
● A pictorial type of the daily food guide
● Teaches principle of eating a variety of food
everyday, the need for moderation in some
food groups while emphasizing the importance
of other food
◆
➔
SOURCE
● Natural Nutrients - obtained from
plants and animals
● Synthetic Nutrients - man-made used
in correcting deficiencies e.g. vitamin
and mineral pills
◆ ESSENTIALITY
● Dietary Essential Nutrients - those the
body cannot make in sufficient
quantity to meet its requirement
○ must be obtained from the
diet
○ E.g. linoleic and linolenic
acids
● Non-dietary Essential Nutrients - can
be produced by the body in enough
amounts during normal conditions
○ E.g. Cholesterol, Alanine,
Cystine
The Energy Giving Nutrients
◆ Carbohydrates, Protein and Fats
● Give out calories when chemically
broken down in the body
● Provide the fuel/energy for body
functioning
● CPF contain the elements carbon,
hydrogen and oxygen
● Protein contains Nitrogen
● CHO (Carbohydrates)
○ 1 gm = 4 kcal
● CHON (Protein)
○ 1 gm = 4 kcal
● Fats
○ 1 gm = 9 kcal
◆ Alcohol is a potential source of energy but is
NOT A NUTRIENT. It hinders growth and repair
of the body.
● 1 gm = 7 kcal
NUTRITION TOOLS
➔
serves as our guide in choosing our food and in preparing
hearty meals
FOOD GUIDES
➔
Customized according to individual cultures
◆ CHINA AND KOREA - Pagoda Shape
◆
➔ Your Guide to Good Nutrition
1.
Body Building Foods – rich in CHON and minerals such
as meat, fish, poultry, eggs, dried beans
2.
Energy Giving Foods –rich in CHO and fats e.g. rice and
rice products, corn, root crops, sugar and sweets, pasta,
butter, etc.
3.
Body Regulating Foods –rich in vitamins and minerals,
fiber and water like fruits and veggies
A balanced diet may be planned by combining foods from each
category.
➔ PORTION CONTROL - Hand can be used as a useful
guide to controlling food portions.
➔
PHILIPPINE DIETARY REFERENCE INTAKE 2015 (PDRI 2015)
➔
➔
For planning and assessing diets of healthy groups and
individuals
Collective term comprising reference value for energy and
nutrient levels of intakes
➔
Components
➔
➔
➔
➔
Estimated Average Requirement (EAR)
◆ daily nutrient intake level that meets the median or
average requirement of healthy individuals in
particular life stage and sex group, corrected for
incomplete utilization or
dietary nutrient
bioavailability
Recommended Energy/Nutrient Intake (REI/RNI)
◆ level of intake of energy or nutrient which is
considered adequate for the maintenance of health
and well-being of healthy persons in the population
Adequate Intake (AI)
◆ daily nutrient intake level that is
based on
observed
or
experimentally-determined
approximation of the average nutrient intake by a
group (groups) of apparently healthy people that
are assumed to sustain a defined nutritional state
Tolerable Upper Intake Level or Upper Limit (UL)
◆ highest average daily nutrient intake level likely to
pose no adverse health effects to almost all
individuals in the general population.
➔
➔
➔
FOOD EXCHANGE LISTS
➔
➔
Foods are divided into several main groups which contain
about the same amounts of macronutrients and calories
Allows an individual to meet specific CHO, CHON, fat and
energy needs based on the recommended calculated diet
given by a medical doctor or a dietitian
SAMPLE FOOD EXCHANGE LIST
➔
Storage Instructions - should be given so that the date
mark is valid
Open Date Markings
◆ “Consume before” or “Use before” or
“expiration date”- signifies the end of the
estimated shelf life of a product beyond which
certain quality attributes become significantly
impaired
◆ “Best Used By” - indicates the end of a period
after which certain qualities of a product is
expected to
deteriorate, may still be
satisfactory for human consumption but the
best quality is no longer guaranteed
The Ingredient List
◆ Tells you what is in the food in descending
order of predominance by weight
◆ Required on all products containing more than
one ingredient
◆ Generic and collective names must be avoided
◆ Include also additives that were used
Servings per container - Suggests the number of servings
in the food package
Nutrition Facts Panel - Product makers are required to
give information on certain nutrients. Each package
should reflect the amount of specified nutrients and food
constituents for one (1) serving.
◆ The mandatory components and the order in
which they must appear consist of the total
calories , calories from fat, total fat, sodium,
total CHO, dietary fiber, sugars, protein, Vit.A,
Vit. C, Calcium and Iron.
◆ Other nutrient information on the label is
voluntary
◆ Total fat, saturated fat, cholesterol and sodium
–yellow (need to be controlled)
◆ Dietary fiber, Vit. A, Vit. C, Calcium, Iron – blue
or green (get enough of these nutrients)
Nutrient Claim Guide
◆ Health claims, a relationship between a nutrient
and the risk of a disease or health condition
◆ e.g. fat free, low fat, sugar free
NUTRITION AS AN ASPECT OF TOTAL HEALTH CARE
➔
➔
FOOD LABELS
➔
➔
➔
➔
Provide information about the product’s contents, ingredients
and nutritional value, etc.
Allow consumers to make healthier food choices
Help consumers see how a food fits into their overall daily
diet
FDA (Food and Drug Administration) Philippines is the
government’s major implementor of nutrition labelling
➔
➔
Information on Food Labels
➔
➔
➔
➔
➔
Name of Product - tells what the consumer is buying and
must not give a false information
Name, Address of Manufacturer, Packer or Distributor for comment/complaint or question the consumer may
wish to ask
Place of Origin - may appear misleading if place of
origin is not stated
Preparation Instructions - especially on high risk foods
to kill all bacteria during cooking
Weight or Quantity – will help consumer compare
products fairly
➔
➔
NUTRITION
◆ An integral part of health care
◆ With physical, social, psychiatric and
economic
aspects
HEALTH CARE TEAM
◆ Composed of all healthcare professionals who work
with a given person or family with a common
goal-optimal health
◆ Medical part –MD, RN, RND, PT, RP
◆ Social professionals –social worker, OT, psychologist
◆ Community Resource Personnel -BHW
TEAM APPROACH
◆ Because of unique perspective in needs assessment and
health care planning
◆ Involve the individual in planning
HEALTH CARE PROVIDER
◆ Usually MDs or doctors
◆ Final health care decisions often are the responsibility
of the physician
◆ Should be kept informed of concerns of the healthcare
team and their recommendation
NURSE
◆ Can provide good insight because of in depth patient
contact
◆ Assessment and monitoring of patient eating habits
and health status are important roles of the nurse
SOCIAL WORKER
◆ Expertise in community resources including financial
counseling, technical
support and educational
resources
◆ Can help a person identify and express barriers
➔
➔
➔
➔
➔
PHYSICAL THERAPISTS
◆ Helps a person enhance physical capabilities that had
been impaired by illness or trauma
◆ e.g. increase muscle strength
OCCUPATIONAL THERAPISTS
◆ Emphasizes the remaining strengths
◆ Identifies adaptive devices that would enhance
independent functioning (e.g. long handled spoon,
reaching devices)
◆ Occupational Therapy –goal is to increase the amount
and type of ADL that an individual with impairment
can perform
SPEECH LANGUAGE PATHOLOGISTS
◆ Assess swallowing
◆ Prevention of aspiration of food
◆ Determine the degree of risk of aspiration and make
appropriate plans that other healthcare professionals
can use in developing their plans (e.g. for PT, correct
positioning for swallowing; OT for feeding devices,
RND for food consistency)
PHARMACIST
◆ Responsible for preparing the nutritional solutions that
the physician prescribes
◆ Parenteral nutrition
◆ Drug and nutrient interactions
REGISTERED DIETITIANS
◆ Interpret the science of how food is used by the body
in health and disease states
◆ Evaluate how MNT can promote a positive nutritional
status
● Nutritionists
○ An educator as well as a counselor
○ All RDs are nutritionists
➔
➔
Advertising
➔
Body Image
➔
Medical
Conditions and
Health
Benefits
➔
Emotional
State
➔
➔
➔
➔
FACTORS AFFECTING FOOD INTAKE PRINCIPLES IN
MEAL PLANNING
➔
BIOPSYCHOSOCIAL CONCERNS
➔
Interplay between external environment and internal forces
External could be psychologic and social factors
Internal could be genetic or biologic
Cost,
Availability
and
Convenience
Social
Pressure
Culture and
Tradition
➔
People may opt for food or diet they link
with ideals of body image
e.g. Ketogenic Diet, Intermittent Fasting
There are health conditions that limit the
foods a person can select
A client with hypertension might need to
adhere to a low salt diet
The chemotherapy, treatment for cancer
can interfere with the person’s appetite
Some individuals eat in response to
emotional stimuli such boredom, anxiety
and depression
A person’s daily food choices may benefit or harm his
body’s health only a little but when these choices are
repeated over the years, the reward or choice
become major
POSITIVE MEAL ENVIRONMENT
Nutritional guidance should be based on willingness
to change and interest in doing so
In order to make change, recognition that change is
needed is generally the first step
Habit and
Preferences
➔
Commercial ads and packaging of the
food industry are quite successful in
enticing the public to choose certain
foods
Food producers spend enormous amount
of money on marketing and promotion in
order to create demand for their
merchandise
REMINDER:
➔
➔
➔
➔
➔
➔
REMINDER:
➔
➔
Religious rules about foods can further
dictate the composition of diet
Muslims refrain from eating pork
➔
➔
➔
➔
➔
➔
➔
Selection of food is tied to a person’s
routine and practices
Taste, smell, texture and appearance also
mainly dictate an individual’s food option
People select foods which they can
afford to buy, which are readily
available and do not require much time
to prepare or cook.
In today’s modern lifestyle, foods that
are fast and delicious are frequently
chosen
Close friends share similar food choices
Special occasions are associated with the
serving of specific foods and it is often
impolite to refuse food or drink offered
by a host
Each area of the world and every region
of a country has own typical foods and
ways of combining them into meals
➔
➔
➔
Focus on positive conversations; avoid points of potential
conflict and frictions
Use soft music, candles or both to facilitate quiet, relaxed
atmosphere
Eat slowly to promote safety and aim for 2 or 3 different
food groups in a meal
Encourage children to eat with the family; but do not force
them to eat
Encourage the “one taste rule” and emphasize that tastes
are learned
Serve foods that look appealing by using a combination of
colors, textures and sizes
Watch portion sizes; smaller portions are useful for small
appetite and for weight control
Promote relaxing activities before and after meals
PRINCIPLES IN MEAL PLANNING
➔
➔
➔
➔
➔
➔
➔
Adequacy – foods chosen contain enough important nutrient,
fiber and energy
Proportionality - proper distribution of overall food intake
throughout the day or week
Balance – does not overemphasize one nutrient or food type
at the expense of another
Calorie Control – food provides the amount of calories a
person needs to sustain appropriate weight
Moderation – having enough but not in excess of what is
needed
Variety – foods chosen differ from one day to the next;
selecting foods from different food groups; eating a variety
of food helps ensure adequate nutrient intake. No single
food contain all the nutrients we need
Nutritional Density – Select foods that deliver the most
nutrients for the least amount of food energy (calories)
THE ENERGY MACRONUTRIENTS AND ENERGY BALANCE
MODULE 2 → Nutrition and Diet Therapy - Lecture
CARBOHYDRATES
➔
➔
➔
➔
➔
➔
Primary fuel for our
body
widely available and
are an economic source
of energy
They are easily packed
and have a long
shelf-life in dry storage
They are mild flavoured
and combine well with other foods. & foods are easy to
prepare.
Made through the process of photosynthesis
Carbohydrates contain carbon, hydrogen and oxygen. The
suffix hydrate indicates that water and oxygen occur in the
same proportion as in water.
Maltose
➔
Cow's milk contains 4.8% lactose while
human milk has 7%. It favors calcium and
phosphorus assimilation.
➔
It is produced by hydrolysis of starch and is
converted into glucose in digestion.
It occurs in malt products and in germinating
cereals.
It can be found in certain infant formulas,
beer, and malt beverage products.
It is less sweet compared to glucose and
sucrose.
➔
➔
➔
POLYSACCHARIDES
➔
➔
CLASSIFICATION OF CARBON
composed of many molecules of simple sugars
They are commonly known as complex sugar include the
following:
◆ Starch
◆ Dextrins
◆ Cellulose
◆ Pectins
◆ Glycogens
STARCH
➔
➔
➔
Glucose (Dextrose)
➔ Also known as: BLOOD SUGAR and the principal form
in CHO is used in the body
➔ It is found in fruits, sweet corn, and corn syrup
➔ fuels the work of the body's cells
➔ provide energy for the brain, other nerve cells, and
developing red blood cells
DEXTRINS
➔
➔
➔
➔
➔ the sweetest of simple sugars
➔ It is found in honey, most fruits, and some vegetables
➔ It is converted into glucose in the body
➔
➔
➔ not found free in foods
➔ It is produced from lactose (milk sugar) by digestion
and is converted into glucose in the body
DISACCHARIDES OR DOUBLE SUGARS
Sucrose
➔
➔
➔
Lactose
(Milk
Sugar)
➔
➔
➔
➔
Are not found free in foods
They are formed as intermediate products
breakdown of starch.
in the
CELLULOSE
Fructose (Levulose)
Galactose
is the most significant polysaccharide in human nutrition.
Its major food sources include cereal grain potatoes and
other root vegetables, and legumes.
It is converted entirely into glucose upon digestion; is
more complex than sugars; and requires a longer time to
digest.
➔
➔
ordinary table sugar - granulated,
powdered, or brown is processed from cane
and beet sugar
It is found in fruits, vegetables, syrups, and
sweet food production and is converted into
glucose and galactose upon digestion
It is composed of glucose and fructose.
1.
is found in milk and milk products except
cheese.
It is converted into glucose and galactose in
digestion and is less soluble and less sweet
than sucrose.
It remains in the intestine longer than other
sugars and encourages the growth of certain
useful bacteria.
It forms approximately 40% of milk solids.
2.
forms the framework of plants found in unrefined grains,
vegetables, and fruits
They are non-digestible because digestive enzymes are
unable to break them down.
It is nondigestible by humans; no specific enzyme is
present and provides important bulk in the diet which
helps move digestive food mass along and stimulates
peristalsis.
Main sources are stems and leaves of vegetables, seed
and grain coverings, skins, and hulls.
Cellulose, hemicellulose and pectins which are
components of the skins of fruits, coverings of seeds and
the structural parts of edible plants are referred as
FIBRE.
Lower the blood glucose levels of people with diabetes
mellitus.
CLASSIFICATION OF CELLULOSE
Insoluble Fiber
➔ Structural parts of plant cell walls (cellulose,
hemicellulose and lignin)
➔ whole wheat, wheat bran, seeds, nuts and
vegetables.
➔ accelerate gastrointestinal transit, increase fecal
weight, slow down starch hydrolysis, and delay
glucose absorption.
Soluble Fiber
➔ Viscous plant fibres are soluble in water
➔ Pectins, gums and mucilages
➔ Soluble fibres are found in fruits, oat and barley ,
oats, legumes and beans.
➔ Delay gastrointestinal transit and glucose
absorption, and lower blood cholesterol
◆
◆
➔
PECTINS
➔
➔
➔
➔
PECTINS which occur in ripe fruits have the ability to
absorb water and to form gels. This property of pectins is
made use of in the preparation of jams and jellies.
Non-digestible, colloidal having a gel property.
Sources includes mostly fruits and are often used as base
for jellies.
Use for treatment of diarrhea as they absorb toxins and
bacteria in the intestines and bind cholesterol reducing
the amount the blood can absorb.
GLYCOGENS (animal starch)
➔
➔
➔
Formed from glucose and stored in liver and muscle
tissues.
Food sources mainly meats and seafoods.
Converted entirely into glucose upon digestion.
Carbohydrates
Main Food Source
Remarks
FUNCTIONS OF CARBOHYDRATES
➔
➔
➔
➔
POLYSACCHARIDES
Cellulose and
Hemicellulose
Stalks and leaves of
vegetables
Outer covering of seeds
Indigestible
Pectins
Fruits
Indigestible
Gums and
mucilages
Plant secretions and seed
exudates
Indigestible
Starch and
dextrins
Grains, Legumes and Tubers
Digestible
Glycogen
Meats and seafood
Digestible
➔
➔
➔
➔
DISACCHARIDES
Sucrose
Cane and Beet sugar, molasses
Digestible
Lactose
Milk and milk products
Digestible
Maltose
Malt products, some breakfast
cereals
Digestible
➔
➔
➔
Glucose
Fruits, honey, corn syrup
Digestible
Fructose
Fruits, Honey
Digestible
Galactose
Milk
Digestible
UTILIZATION IN THE BODY (DIGESTION)
➔
MOUTH
◆ All monosaccharide require no digestion while
disaccharides are not digested in the mouth
◆ Starch is partly hydrolyzed by ptyalin (salivary
amylase) in the mouth to dextrose and maltose
STOMACH
The primary function of carbohydrates in the body is to
supply energy
Carbohydrates act also as reserve fuel supply in the form of
glycogen, stored in muscles and liver
Carbohydrates serve other special functions in the body.
Carbohydrates provide a chemical framework, which
combine with the nitrogen to synthesize non-essential amino
acids in the body
Carbohydrates and their derivatives work as precursors of
important metabolic compounds. These include nucleic acids,
the matrix of connective tissue and galactosides of nerve
tissue.
Lactose, the milk sugar, provides galactose needed for brain
development. It aids absorption of calcium and phosphorus,
thus helping bone growth and maintenance.
Lactose forms lactic acid in the intestinal tract due to the
action of the bacteria (lactobacilli) present.
Carbohydrates are an important part of some compounds,
which increase our resistance to infection
(immunopolysaccharides)
Carbohydrates are needed for ensuring complete normal
metabolism of fats, thus preventing acidosis
Carbohydrates are needed to prevent dehydration.
Dietary fibre acts like a sponge and absorbs water.
HEALTH EFFECTS OF STARCH AND FIBERS
MONOSACCHARIDES
➔
Mechanical digestion continues (peristalsis)
Gastric secretions contain no specific enzyme for
breakdown of CHO
SMALL INTESTINE AND LARGE INTESTINE
◆ Starch and dextrin are further hydrolysed to maltose by
amylase in the small intestine. Maltose, sucrose and
lactose are further broken down to glucose, fructose
and galactose (simple sugar units) by the enzymes
maltase, sucrase and lactase
◆ Much of the chemical digestion of CHO happens in the
small intestine and is completed by enzymes such as
amylase (starch to maltose) and disaccharidases like
sucrase, lactase, maltase (disaccharides to
monosaccharides-ready for absorption)
◆ Lactose remains in the intestine longer than other sugars
and encourages growth of certain useful bacteria. Also
aids in calcium and phosphorus absorption
◆ Fiber passes through the small intestine undigested and
forms bulk of the stool
◆ Bacteria in the large intestine breakdown undigested
CHO producing gas and some short chain fatty acids
which are used by colonic cells for energy
➔
➔
➔
➔
➔
➔
➔
They stimulate the peristaltic (rhythmic) movements of the
gastrointestinal tract by adding bulk to the intestinal contents
The insoluble fibre needs chewing and may improve
mastication of food.
Fibre reduces transit time and binds some minerals such as
calcium, iron, zinc, etc
Soluble fibre binds bile acids and cholesterol and helps
carry these out of the body.
WEIGHT CONTROL – Fibers rich in complex carbohydrates
tend to be low in fat and added sugars and can promote
weight loss.
HEART DISEASE –high carbohydrates diets, rich in whole
grains can protect an individual against heart disease and
stroke.
CANCER – High carbohydrate diets can help prevent many
types of cancer
➔
➔
DIABETES –high carbohydrates, low fat diets help control
weight.
GASTROINTESTINAL HEALTH
➔
➔
RECOMMENDED INTAKE OF CARBOHYDRATES
➔
➔
➔
➔
➔
GLYCEMIC INDEX
➔
Effect of foods on a person’s blood glucose level
◆ A low GI food (<55) will release glucose more slowly
and steadily which leads to a more suitable post
prandial blood glucose readings
◆ Intermediate GI (55-70)
◆ A high GI (>70) food causes more rapid rise in blood
glucose levels and is suitable for energy recovery after
exercise or for a person experiencing hypoglycemia
➔
FACTORS THAT MAY INFLUENCE GLYCEMIC INDEX
➔
➔
➔
➔
➔
➔
Form of CHO
How food is prepared
Fat and fiber content
Foods with lower index are healthier option to control blood
sugar levels; can also decrease risks for fiber related
diseases
Foods rich in unrefined CHO, fat and CHON have a lower
glycemic index
Foods with purer sources of sugar or starch have a higher
glycemic index
CLASSIFICATION OF
PROTEIN
EXAMPLE
1.
➔
SIMPLE PROTEINS
those which yield only
amino acids upon
hydrolysis.
Albumins, Glutelins, Prolamins,
Globulins, Histones and
Protamines, ALbuminoids
2.
➔
COMPOUND PROTEIN
conjugated proteins or
proteids
Performs functions that a
constituent could not
properly perform by it
self
Nucleoproteins,
Chromoproteins, Mucoproteins
and Glycoproteins,
Lipoproteins, Metalloproteins,
phospoproteins
➔
GLYCEMIC LOAD
➔
➔
How much CHO is in the food and how much each gram of
CHO in the food raises blood glucose levels
Based on glycemic index
◆ CHO content (grams) per serving X GI/100
GI
Low GI
Intermediate
GI
High GI
3.
➔
GL
<55
55-70
>70
Low GL
Intermediate
GL
High GL
<15
15-20
>20
➔
➔
➔
➔
Next to water, protein is the most abundant component of the
body.
Proteins are present in all living tissues, both plant and
animal.
They are essential to life because vital parts of the nucleus
and protoplasts of every cell are proteins.
Proteins are very large organic compounds
DERIVED PROTEINS
Products formed in the
various stages of
hydrolysis of protein
molecules.
AMINO ACID
➔
➔
➔
PROTEIN
Proteins contain about 16 percent nitrogen, which is their
unique feature and distinguishes them from carbohydrates
and fats.
​Proteins are more complex than fats and carbohydrates, as
the size of the molecule is large and there is a great
variation in the units from which it is formed.
Plants are the primary source of proteins in nature.
Made from a combination of amino acids (building blocks of
protein) and always contain nitrogen
About 20 common kinds of amino acids are needed for the
formation of proteins in the body
Nine of these amino acids cannot be made in the body, thus,
must be consumed in the diet
◆ Essential or Indispensable amino acids
1. Histidine
2. Isoleucine
3. Leucine
4. Lysine
5. Methionine
6. Phenylalanine
7. Threonine
8. Tryptophan
9. Valine
Digestion takes about 2 hrs. When digested, they are broken
down into amino acids then reassembled into proteins by the
liver
Recommended Protein Intake:
◆ 10-15% of the total calories
◆ Normal intake should not exceed 20%
◆ extra protein consumed adds burden to the
kidneys
◆ Excess are converted into body fats
◆ High in meat protein could lead to increase in
cholesterol or other diseases such as gout
There are 22 (or more) amino acids, all of which are vital to
human life and health
The body is able to synthesize 13 of these but is unable to
make 9 others
These nine amino acids have to be provided in the diet in
sufficient amounts and are called ESSENTIAL AMINO ACIDS.
RECOMMENDED INTAKE OF PROTEINS
PROTEIN DIGESTION AND ABSORPTION
➔
➔
➔
➔
➔
Protein digestion starts only in the stomach as there are no
protein splitting enzymes in the saliva
In the stomach, protein is hydrolysed by the enzymes with the
help of hydrochloric acid into peptides or amino acids
The amino acids thus formed are absorbed either by the
stomach wall, the intestinal walls or by the colon.
Most of the amino acids are, however, absorbed in the small
intestine.
After passing through the walls of the digestive tract, the
amino acids are picked up by the circulating blood stream
and transported to the liver and to the various body tissues.
FATS AND LIPIDS
➔
➔
➔
➔
➔
➔
➔
➔
PANCREAS
◆ Trypsin (produced first as inactive precursortrypsin and
then activated by enterokinase) converts protein
proteases, and peptones into polypeptides and
peptides.
◆ Chymotrypsin (produced first as inactive precursor
chymotrypsinogen and then activated by active trypsin)
converts proteoses and peptones into polypeptides and
dipeptides; also coagulates milk.
◆ Carboxypeptidase converts polypeptides into simpler
peptides, dipeptides, and amino acids.
➔
➔
➔
➔
CLASSIFICATION OF LIPIDS
INTESTINES
◆ Aminopeptidase converts polypeptides into peptides
and amino acids
1.
2.
3.
FUNCTIONS OF PROTEIN
➔
➔
The PRIMARY FUNCTION of proteins is TISSUE BUILDING.
Proteins are the main solid matter in the muscles, they are
also the major constituents of blood, matrix of bones, teeth,
skin, nails and hair
SIMPLE LIPIDS - includes fats and oils
COMPOUND LIPIDS - which comprise of phospholipids,
glycolipids, and lipoproteins
DERIVED LIPIDS - such as fatty acids, glycerol, and
steroids
FATTY ACIDS
➔
➔
PRINCIPAL FUNCTIONS
Body-Building or Building of New Tissues:
➔ amino acids must be supplied in the diet for building new
tissues. Proteins provide the amino acids needed for the
formation of new cells. They also provide the material
from which nucleic acids are formed, e.g., DNA and
RNA, which carry the genetic code.
2. Maintenance of tissues
➔ The need for protein to maintain and repair the old
tissues continues throughout life.
3. Regulatory Functions
➔ Hemoglobin, a protein and iron complex, ensures the
smooth running of the respiratory cycle by being the vital
oxygen carrier in the red blood cells.
4. Proteins as Precursors of enzymes, Hormones and Antibodies
➔ A small amount of protein (or of amino acids) is needed
for synthesizing enzymes, hormones and antibodies
5. Transport of Nutrient
➔ proteins are ideal carriers of nutrients across cell
membranes
Fats constitute 34% of the energy in the human body
Includes substances such as fat, oil, waxes, and related
compounds that are greasy to touch and insoluble to water.
Provides a more concentrated source of energy compared
to carbohydrates.
A layer of fat beneath the skin acts as an insulation against
cold.
The vital organs (brain, heart, liver) are protected by a
sheath of fat and water, which holds them in place and
prevents injury
The fat around the joints acts as a lubricant and allows us to
move these smoothly.
Fats are the best known members of a chemical group
called, the LIPIDS
Food fats include solid fats, liquid oils and related
compounds such as fat-soluble vitamins and cholesterol.
Fat digestion takes the longest of all the macronutrients
requiring up to 4 hours
FATTY ACIDS, FATS and OILS, PHOSPHOLIPIDS, STEROLS
and LIPOPROTEINS are some of the groups of lipid
compounds
➔
1.
Fatty acids are the main building blocks of fats.
About twenty (20) fatty acids are found in foods and
body tissues.
Fatty acids have a methyl group (CH3) at one end and a
carboxyl group (COOH) at the other end with a chain of
carbon and hydrogen atoms in the middle
FATTY ACIDS IN FOODS
➔
➔
➔
➔
➔
➔
SATURATED FATTY acid has a single bond between its
carbon atoms, thus the molecule is saturated with hydrogen.
Eg: Stearic acid
UNSATURATED FATTY acids have one or more double
bonds in their molecule and are thus not saturated with
hydrogen.
MONOSATURATED FATTY acids (MUFA) have only one
double bond in the molecules. Eg: Oleic Acid
POLYUNSATURATED FATTY acids (PUFA) have two or more
double bonds in the molecules.Eg: Corn oil
The METHYL end of the fatty acid molecule is called the
omega end.
Eg:
◆ Oleic acid - Omega-9-fatty acid, which is a MUFA
◆ Linoleic acid - Omega-6-fatty acid, which is a PUFA
◆ Linolenic acid - Omega-3-fatty acid, which is also a
PUFA
FUNCTIONS OF FATS
➔
➔
➔
➔
ESSENTIAL FATTY ACIDS (EFAs)
Linoleic acid (omega-6 PUFA) and linolenic acid (omega-3
PUFA) are called essential fatty acids because
1. these are not synthesized in the human body
2. these are required for important functions in the body
and
3. these are available only through diet
FOOD SOURCES OF ESSENTIAL FATTY ACIDS (EFAs)
➔
➔
OMEGA 3: Green leafy vegetables, cabbage and lettuce,
tuna, sardines and salmon
OMEGA 6: vegetable oils (corn, sesame, sunflower,
cottonseed, soybean, safflower); in less amount-nut, seeds,
grains
TRIGLYCERIDES
➔
➔
➔
Fatty acids combine with glycerol to form a glyceride
Every time a triglyceride crosses a cell membrane, it must be
broken or deesterified and after it enters the cell it is
reesterified
In digestion, most triglycerides are hydrolysed to form free
fatty acids, monoglycerides and
glycerol, which are
absorbed into the intestinal cells and the majority of these
are rebuilt into triglycerides.
PHOSPHOLIPIDS
➔
➔
➔
➔
➔
➔
formed mainly in the liver from fatty acids, glycerol,
phosphoric acid and a nitrogenous base
LECITHIN, a phospholipid contains choline-phosphate
attached to one hydroxyl of the glycerol molecule
◆ Lecithin is an important component of all
membranes and it takes part in fat digestion
Eg: eggyolkT
Two other phospholipids –SPHINGOMYELINS
and
CEREBROSIDES –are found in the brain.
Phospholipids are important as components of active
tissues (brain, nervous tissue and liver).
They are powerful emulsifying agents and are essential
for the digestion and absorption of fats.
Phospholipids help to carry lipid particles across the cell
membrane in the bloodstream
STEROIDS
➔
➔
lipids with a multiringed (steroid)structure
CHOLESTEROL is an important sterol. It is a waxy
substance.
◆ CHOLESTEROL is a precursor of vitamin D,
hormones and bile acids.
LIPOPROTEINS
➔
➔
➔
Protein-sparing because its availability reduces the need to
burn protein for energy.
Fat forms the fatty centre of cell walls, helping to carry
nutrient materials across cell membranes.
Fats act as a cushion for certain vital organs. Nerve fibres
are protected by the fat covering and it aids relay of nerve
impulses.
source of two groups of essential nutrients —essential fatty
acids (EFA) and fat soluble vitamins A, D, E & K and their
precursors.
Layers of fat beneath the skin help to conserve body heat
and regulate body temperature.
Facilitates absorption of the fat-soluble vitamins, vit.A,D,E,K
The flavour, palatability and satiety value of foods is
increased by fats
HEALTH EFFECTS OF LIPIDS
➔
➔
➔
➔
➔
➔
HEART DISEASE - elevated blood cholesterol is a major risk
factor for cardiovascular diseases.
RISKS FROM SATURATED FATS - lauric, myristic, and palmitic
acids raised blood cholesterol levels. Stearic acid does not.
BENEFITS OF MONOSATURATED FATS - olive oil lowers risks
of heart disease
BENEFITS FROM OMEGA-3 POLYSATURATED FATS - lower
blood cholesterol and prevent heart disease. EPA sources like
fish, eaten once a week, can lower blood cholesterol and the
risk of heart attack and stroke.
CANCER - fat does not instigate cancer development but can
promote it once it has arisen.
OBESITY - High-fat diets tend to store body fat abruptly
DIGESTION OF FATS
➔
➔
➔
➔
➔
➔
➔
➔
digestion of fats starts in the stomach
The chemical changes necessary for fat digestion occur in the
small intestine. The entry of fat in the duodenum, the first
part of the small intestine, stimulates secretion of the bile
from the gallbladder.
Pancreatic lipase breaks off one fatty acid at a time from
the triglyceride.
The cholesterol esterase from pancreatic juice acts on the
free cholesterol to form a combination of cholesterol and
fatty acids for absorption first into the lymph vessels and
finally into the bloodstream.
Lecithinase, secreted by the small intestine, acts on lecithin to
break into its components for absorption.
The products of digestion are absorbed through the walls of
the small intestine and circulated through the lymph.
Some of these are used to synthesise important lipid
compounds needed for body function.
Some fat is used to supply energy. The rest is stored as fat in
the adipose tissues for future use.
ORGAN
ENZYME
Mouth
None
Mechanical
Digestion
Stomach
No major enzyme
Mechanical
separation of fats
as protein and
starch digested out
Small amount of
gastric lipase,
tributyrinase
Tributyria (butter
fat) to fatty acids
and glycerols
Gallbladder (Bile
Salts) Emulsifier
Emulsify Fats
Pancreatic Lipase
Triglycerides to
diglycerides and
monoglycerides in
turn, then fatty
➔
➔
synthesized in the liver
These serve as the major vehicle for fat transport in the
bloodstream
➔ The lipoproteins contain triglycerides, cholesterol and
other substances such as fat soluble vitamins.
➔ The density of lipoproteins is dependent on the amounts
of fat and protein in it
4 GROUPS OF LIPOPROTEINS
1.
2.
3.
4.
Chylomicrons
Low Density Lipoprotein (LDL)
High Density Lipoprotein (HDL)
Very Low Density Lipoprotein (VLDL)
ACTIVITY
Small Intestine
acids and glycerols
ENERGY BALANCE
➔
Change in energy stores equals the food energy taken in
(kcalories) minus the energy expended on metabolism and
physical activities
CHANGE IN ENERGY STORES =
ENERGY IN (KCALORIES) – ENERGY OUT(KCALORIES)
➔
ENERGY IN:
◆ Energy provided by food and beverages is the only
contributor to the side of the energy balance
equation.
➔
ENERGY OUT:
◆ The body expends energy in TWO MAJOR WAYS:
● BASAL METABOLISM
● to fuel its VOLUNTARY ACTIVITIES
➔
BASAL METABOLISM
◆ The result of chemical change that occurs in the cells
of an animal in the fasting and resting state using
just enough energy to maintain vital cellular activity,
respiration, and circulation
VOLUNTARY ACTIONS OR ACTIVITIES
◆ Are done because someone chooses to do them and
not because they have been forced to do them
◆ Is done by people who are not paid for it but who
do it because they want to do it
➔
24 HOUR DIETARY RECALL
➔
➔
➔
➔
➔
This method was designed to quantify the average
dietary intake for a group of people, although it can be
used to assess individual nutrition intake.
During a recall, a client is asked to remember in detail
every food and drink consumed during the previous 24
hours.
The method can be repeated on several occasions to
account for day-to-day variation in intake.
Health care providers may prompt clients to remember
what they ate or drank by time periods or activities (e.g.,
just after waking up, before going to bed) or to estimate
portion sizes by looking at household measures, food
models, household utensils, photographs, or actual food.
NACS, Nutrition Assessment and Classification
MICRONUTRIENTS AND WATER
MODULE 3 → Nutrition and Diet Therapy - Lecture
MINERALS
➔
➔
Minerals pertain to the elements in their simple inorganic
form. In nutrition , they are commonly referred to as mineral
elements or, in the case of those present or required in small
amounts, they are known as trace elements or trace minerals.
MINERAL COMPOSITION OF THE BODY
◆ There are 21mineral elements not known to be
essential in nutrition. The minerals of the body are:
1. calcium
2. Phosphorous
3. Potassium
4. Sulfur
5. sodium chlorine
6. Magnesium
7. Iron
8. Zinc
9. Selenium
10. Manganese
11. Copper
12. Iodine
13. Molybdenum
14. Cobalt
15. Chromium
16. Fluorine
17. Vanadium
18. Nickel
19. Tin
20. Silicon
MINERALS OF THE ADULT BODY
CLASSIFICATION
MINERALS
Micronutrients essential at
levels of 100mg or more
per day
Calcium,
Phosphorus,
Sulfur,
Potassium
Chloride,
Sodium,
Magnesium
micronutrients essential at
levels higher than a few
mg/day
Iron, Fluorine,
Zinc, Copper
Iodine,
Chromium,
Cobalt
micronutrients essential, but
amounts needed for humans
cannot be estimated at
present
Silicon,
Vanadium,
Tin, Selenium
Manganese,
Nickel,
Molybdenum
minerals present in humans ;
function not known
Strontium,
Bromine,
Gold, Silver
Aluminum,
Bismuth, Arsenic,
Boron
GROUP 1: MAJOR MINERALS
CALCIUM
➔
DISTRIBUTION
◆ Of the total body weight, approximately 1.5% to
2.2%is calcium. Of this, 99% is present mostly in the
bones and teeth and the remaining 1% is found on the
soft tissues and body fluids and serves important
functions unrelated to bone structure.
➔
UTILIZATION
◆ There are many factors which influence calcium
absorption:
1. Calcium absorption is better during periods of
increased body needs such as in growth,
pregnancy
2. Vitamin D enhances the optimum absorption of
calcium by increasing permeability of the
intestinal membrane to calcium and by activating
the active transport system
3. A low gastric pH (acidic) favors the absorption of
calcium whereas hypochlorhydria
(alkaline
medium) causes the precipitation of the mineral.
4. A normal protein diet does not have any effect on
calcium absorption but high intakes of meat as in
the diet of the Westerner's increase the excretion
of calcium in the urine even if lysine, arginine and
serine increase the absorption by 50%.
5. The ratio of calcium to phosphorus is important in
the absorption of both minerals in infants
6. A high ratio of lactose to calcium is necessary for
the formation of a soluble complex which can
easily be transported to and possibly across the
intestinal wall.
7. Oxalic and phytic acids interfere with the
absorption of calcium. Oxalic acid present in
several fruits and vegetables such as alagaw,
alugbati, camias, kutsarita, alasiman depresses
calcium absorption by forming insoluble salts
8. Fats in excess may form insoluble soaps with
calcium as evidenced by the presence of fatty
acids, calcium and also fat-soluble vitamin D in
the feces.
9. Anything that may cause an increase in GI motility
like laxatives and foods high in bulk may reduce
ability to replace it
10. Lack of exercise may cause a loss of bone calcium
and reduced ability to replace it.
11. Mental stress or emotional instability has been
found to decrease calcium absorption
12. Alcohol intake among alcoholics may cause
decreased calcium absorption
13. Caffeine increases urinary calcium excretion.
Approximately 1 cup of coffee can increase
calcium excretion by 6mg.
MAGNESIUM
➔
DISTRIBUTION
◆ About 50% of the magnesium in the body is present in
the bones in combination with phosphate and calcium.
The remaining is almost entirely inside the body cells
with only about 1% in extracellular fluid.
SODIUM
➔
DISTRIBUTION
◆ Sodium is a monovalent cation, 50% of which is found
in extracellular fluid, i.e. the vascular fluids within the
blood vessels, arteries, veins, capillaries and the
intracellular fluids surrounding the cells, 10% is found
within the cells, and the remaining 40% of body
sodium is found in the skeleton bound in the surface of
bone crystals. The total sodium in the body is about
1.8 mg/kg fat –free body weight.
SULFUR
➔
DISTRIBUTION
◆ Sulfur occurs in almost every protein cell and
compromises about 0.25% of body weight. Found
highest concentrations in the hair, skin and nails.
➔
RECOMMENDED DIETARY ALLOWANCES
◆ Allowances and requirements for sodium have not been
determined, but the amount should equal that of the
body’s needs for growth; for losses in sweat and
secretions, urine and stools and for non-sweat losses
from the skin.
POTASSIUM
➔
DISTRIBUTION
◆ Potassium is the principal cation present within the cells
or in the intracellular fluids. About 2.6gm/kg fat-free
weight in potassium (0.35% of body weight). It is also
present in relatively small amounts in the extracellular
fluid.
HYPOKALEMIA – is when blood’s potassium levels are too low.
Potassium is an important electrolyte for nerve and muscle cell
functioning, especially for muscle cells in the heart.
HYPERKALEMIA - is an elevated level of potassium in the blood.
Occasionally when severe it can cause palpitations, muscle pain,
muscle weakness, or numbness. Hyperkalemia can cause an
abnormal heart rhythm which can result in cardiac arrest and
death.
➔
RECOMMENDED DIETARY ALLOWANCE
◆ The diet should contain about 2-6 gm potassium so that
a deficiency is usually unlikely in a healthy person.
PHOSPHOROUS
➔
CHLORINE
➔
DISTRIBUTION
◆ The normal human body contains about 1% phosphorus
(12 gm/kg fat-free body weight). About 85% is in the
inorganic phase of bones and teeth in combination with
calcium and the remainder is chiefly in the cells in
combination with carbohydrate, protein, fat and as
complexes with cations such as Na, Ca and Mg.
DISTRIBUTION
◆ Chlorine is a major anion in the extracellular fluid. The
cerebrospinal fluid has the highest concentration of
chloride. A relatively large amount of ionized chlorine
is found in the GI secretion as HCL. It may also be
found to some extent within the cells.
GROUP 1: TRACE MINERALS
IRON
➔
DISTRIBUTION
◆ The body weight contains about 75 mg/kg fat-free
body weight of iron. This is about 3-5 gm. Of this
amount , 60% to 75% is present as part of the
hemoglobin and 5% as myoglobulin, the muscle
hemoglobin. About 26% is found in the liver , spleen
and bone marrow.
➔
UTILIZATION
◆ Iron in ferrous form is better absorbed than in ferric
form, although both forms may be absorbed
➔ TYPES OF IRON
◆ Heme iron is found only in meat (fish and poultry) and
is more efficiently absorbed by the body
◆ Non-heme iron comes from other iron-containing foods
like cereals, vegetables and eggs. Eating meat with
non-heme iron and vitamin C helps with the absorption
of nonheme iron by the body.
➔ BODY NEEDS
◆ If a person has a higher need for iron as in growth,
pregnancy, and lactation and when a person is in a
state of iron deficiency, then the level of iron absorbed
is high, compared with persons with normal levels of
hemoglobin.
➔ INTAKE OF COFFEE
◆ Whether coffee is taken an hour after a meal or with
the meal, iron absorption is reduced.
➔ PRESENCE OF ASCORBIC ACID
◆ 40-50mg of ascorbic acid added to a meal of bread,
egg and tea or coffee increases iron absorption
significantly from 3.7% to 10.4%.
COPPER
IODINE
➔
FLUORIDE
➔
➔
Dental fluorosis is a common disorder, characterized by
hypomineralization of tooth enamel caused by ingestion of
excessive fluoride during enamel formation.
Osteosclerosisis a disorder that is characterized by
abnormal hardening of bone and an elevation in bone
density.
VITAMINS
Vitamins are obtained from the different types of foods
that we consume. If a diet is lacking a certain type of nutrient, a
vitamin deficiency may occur. Vitamins are organic compounds that
are traditionally assigned to two groups: fat-soluble or
water-soluble This classification determines where they act in the
body. Water-soluble vitamins act in the cytosol of cells or in
extracellular fluids such as blood; fat-soluble vitamins are largely
responsible for protecting cell membranes from free radical
damage. The body can synthesize some vitamins, but others must be
obtained from the diet.
➔ Comes from the Latin word vita meaning life and the
suffix amine, which is a nitrogen compound.
➔ Vitamins are a group of unrelated organic compounds
found in food which are needed only in minute quantities
in the diet but essential for specific metabolic reactions
within the cell and necessary for normal growth and
maintenance of health.
➔ They are also crucial in the growth, repair and healthy
functioning of body tissues.
➔ Vitamins do not give energy to the body. They merely
help convert food into energy through many biochemical
reactions. Taking extra vitamins cannot increase one’s
physical capacity.
TOXICITY SYMPTOMS FOR SELECTED VITAMINS
DISTRIBUTION
◆ The adult body normally contains 20 to 30 mg of
iodine. About 70%-80% is concentrated in the thyroid
gland
ZINC
➔
DISTRIBUTION
◆ Occurs in varying concentrations in all human cells in
the eyes, male sex glands, hair, skin. The body contains
about 2-5gm of zinc.
NOMENCLATURE OF THE VITAMINS
CLASSIFICATION OF VITAMINS ON THE BASIS OF SOLUBILITY
1.
2.
➔
The fat-soluble vitamins A, D, E and K in association with lipids are found infoods.
The water-soluble vitamins are B complex and vitamin C.
Fat-soluble vitaminsdiffer from water-soluble vitamins based from the following factual criteria:
A. Fat-soluble vitamins generally have precursors or pro-vitamins
B. Because they can be stored in the body, deficiencies are slow to develop.
C. They are absolutely needed daily from food sources.
D. They are generally stable, especially in ordinary cooking.
➔
Water-soluble vitamins have the following general
characteristics:
A. They must be supplied everyday in the diet.
B. They do not have pre-cursors
C. They are not stored significantly in the body and any
excess is excreted in the urine
D. Deficiency symptoms developed relatively fast
E. Being water-soluble, they are most likely to be destroyed
in ordinary cooking.
WATER-SOLUBLE VITAMINS
A.
B.
The water-soluble vitamins are vitamin C or ascorbic acid
and B complex vitamins.Vitamin C is called the “ fresh
food vitamin” since it is found in the growing parts of
plants. All raw fresh fruits and vegetables contain
ascorbic acid in varying amounts. Vitamin C performs a
number of biological roles as well as serves as an
antioxidant
The B complex vitamins important in human nutrition are
thiamine, riboflavin, vitamin B6, vitamin B12, niacin-folic
acid, pantothenic acid, choline, inositol and biotin. They
are found together in nature and generally have related
functions although they are chemically unrelated.
GROUP 1: CLASSIC DISEASES FACTORS
THIAMINE (B1)
➔
STABILITY
◆ Loss of vitamin in cooking is highly variable, freezing has
little or no effect on thiamine content of foods.
➔ TYPES OF BERIBERI
◆ Infantile beriberi usually occurs in infants 2 to 5 months of
age whose main food is milk from a mother suffering
from beriberi. Symptoms are loss of voice (aphonia),
whining cry, bluish discoloration of infant (cyanosis),
difficulty in breathing, and even death in a few hours
◆ Wet beriberi is evidenced by edema of both lower
extremities which progresses upwards to body cavities
such as the abdomen and chest. The heart is enlarged
and heart beats become irregular. There is also difficulty
in breathing.
◆ ​Dry beriberi involves the peripheral nerves. There is a
feeling of “pins and needles” (paresthesia) in the toes,
gradual loss of touch sensation, muscle weakness, and
finally, paralysis.
➔ REQUIREMENT OR ALLOWANCE
◆ Minimum thiamine requirement is 0.2mg per 1,000
caloric intake. Allowances are at lleast twice the
minimum needs (0.5mg/1,000 cal) and vary with sex,
body weight, muscular activity, and composition of diet
which are related to caloric requirements.
◆ Among the factors that will increase thiamine
requirements as long as caloric needs are increased
include pregnancy, lactation, fever, infections, alcoholism,
hyperthyroidism and polyneuropathies.
RIBOFLAVIN (B2)
➔
STABILITY
◆ It is stable to heat, oxidation, and acid. Due to its heat
stability and limited water solubility, very little is lost in
cooking and processing of foods.it is sensitive to alkali,
the addition of baking soda to soften dried peas or
beans for faster cooking destroys
much of their
riboflavin content.
➔
REQUIREMENT OR ALLOWANCE
a. In general, males need more vitamin C than females do.
Vitamin C needs are also increased during the growth
period with the older age groups requiring
more.Physiological stresses like pregnancy and lactation
and other stress factors such as surgery, illness, infection,
shock and injuries need higher vitamin C intakes.
VITAMIN B COMPLEX
The B complex consists of the vitamins B1, B6, B12, niacin,
pantothenic acid, folic
acid and biotin. It is a group of
water-soluble vitamins that need to be continually replaced
because of their short “life”. Though they all belong to one group,
each vitamin has its own unique function.
The B vitamins transform an increased amount of proteins,
carbohydrates and fats into extra energy. They provide energy
necessary for muscle contraction. But during exertion, they are also
involved in the production and repair of tissues, particularly
muscular tissues.
They are water-soluble nutrients that play important roles
in the normal growth and maintenance of body processes
NIACIN (NICOTINIC ACID)
GROUP 4: OTHER RELATED FACTORS (pseudo-vitamins)
INOSITOL
➔
➔
It is abundant in the diet, minimum requirements for inositol
are not known.
Its chemistry is closely similar to glucose, hence it is
alternatively called “muscle sugar”
WATER AND ELECTROLYTE BALANCE
➔
➔
GROUP 2: MORE RECENTLY DISCOVERED COENZYME
PANTOTHENIC ACID
➔
REQUIREMENT OR ALLOWANCES
◆ 5 mg of pantothenic acid a day is sufficient for an
adult. Daily mixed diets may contain as much 15mg
which is more than adequate.
➔
LIPOIC ACID
➔
This is a sulfur-containing fatty acid and is not a true vitamin
because it can be synthesized in adequate amounts in the
body. A coenzyme factor (thiamine –pyrophosphatase),
lipoic acid is a coenzyme in energy metabolism converting
pyruvic acid into acetyl CoA.
➔
WATER CONTENT OF THE BODY
◆ 60% of body weight in adult
◆ 45% to 55% in older adults
◆ 70% to 80% in infants
◆ Varies with gender, body mass, and age
FUNCTIONS
◆ Water is the universal solvent
◆ Many chemical reactions require water. It serves as a
catalyst in many biological reactions
◆ Vital component of tissues, muscles, glycogen and
others and is essential for growth
◆ Acts as lubricant of the joints and viscera in the
abdominal cavity
◆ Regulator of body temperature
WATER INTAKE
◆ The amount of water needed by the body may be
met by a direct intake of water, water ingested as
such, or from water bound with foods and from
metabolic water, which is a result of oxidation.
WATER OUTPUT
◆ Water leaves the body via several channels such as
through the skin as an insensible perspiration;
through the lungs as water vapor in the expired air,
through the GI tract as feces; and through the kidneys
as urine. Water may also be lost together with the
electrolytes through tears, stomach suction, breathing,
vomiting, bleeding, perspiration.
AVERAGE DAILY INTAKE AND OUTPUT OF WATER
NUTRITIONAL ASSESSMENT AND
NUTRITION CARE PROCESS
MODULE 4 → Nutrition and Diet Therapy - Lecture
NUTRITIONAL ASSESSMENT
➔
➔
➔
➔
Nutritional Assessment is a significant part in identifying an
individual's nutritional status.
Evaluating nutritional status will enable health care
members to identify their nutritional care needs.
It involves the examination of an individual's physical
condition, growth and development behavior, blood and
tissue levels of nutrients and the quality and quantity of
nutrient intake.
For easy recall, don't forget to perform the ABCDE
➔
➔
WAIST CIRCUMFERENCE
◆ Women >35 inches
◆ Men
>40 inches
◆ Have high risk of central obesity related
problems
BODY FRAME SIZE
◆ The subject’s right hand is extended
◆ Measure wrist circumference at the joint just distal to the
styloid process
◆ Calculate the ratio of height to wrist circumference with
this equation:
PURPOSE:
➔ To quickly identify individuals who are malnourished or
at nutritional risk and to determine if more detailed
assessment is warranted
ANTHROPOMETRY
measurement of variations of physical dimensions and gross
composition of the human body at different age levels and
degrees of nutrition
◆ WEIGHT - provides a crude evaluation of overall fat
and muscle stores
◆ HEIGHT - suggests linear dimension comprising of
legs, pelvis, spine and skull
◆ BODY MASS INDEX (BMI) - used to estimate
degree of obesity
◆ HIP CIRCUMFERENCE
◆ KNEE HEIGHT - used to determine stature of
patients whose standing height cannot be taken
accurately
◆ WAIST CIRCUMFERENCE – marker of abdominal
fatness; valid indicator for both men and women
◆ WAIST TO HIP RATIO (WHR) - valuable indicator of
body fat distribution and adiposity; valuable guide
in evaluating
health risk; also called
abdominal/gluteal ratio
◆ BODY FRAME SIZE - allows the weight to be
adjusted for height to reflect a more suitable
desirable weight range; body build (muscularity,
bone thickness and body proportions) affect body
weight
◆ MID-UPPER ARM CIRCUMFERENCE (MUAC) - used
to evaluate fat stores; measures the size of the arm
and all of
its components: muscle mass,
subcutaneous fat and bone; provides an estimate of
the arm soft tissue or wasting
BODY FAT DISTRIBUTION
r=
➔
➔
WAIST HIP RATIO
◆ Ratio of 1.0 or greater in men or 0.8 or greater in
women is indicative of android obesity (apple
shape) and an increased risk for obesity related
diseases
➔
Female: WC = 36 Inches, HC = 44 Inches
WHR = 36
44
= 0.82 → android obesity (apple shaped); increased risk
for obesity related illness
Height (cm)
.
Wrist Circumference (cm)
Sex
Large
Medium
Small
Male
<9.6
9.6-10.4
>10.4
Female
<10.1
10.1-11.0
>11.0
MID-UPPER ARM CIRCUMFERENCE (MUAC)
Children aged 1 to 5 years old
MUAC (cm)
Level of Nutrition
>14
Normal
12.5-14
Mild/Moderate
<12.5
Malnutrition Severe
Adults
MUAC (cm)
Level of Nutrition
≥23
Normal
<23
Malnourished
≥22
Normal
<22
Malnourished
Male
Female
BIOCHEMICAL
➔
laboratory/diagnostic test results or values
◆ FBS
◆ Triglycerides
◆ HbA1c
◆ SGPT
◆ Lipid Profile
◆ Creatinine
CLINICAL
➔
manifestations seen on clients
◆ Polyuria
◆ Polydipsia
◆ Pruritus
◆ Weakness
◆ Weight loss
DIETARY
FORMULA
WHR = Waist Circumference (WC)
Hip Circumference (HC)
health
➔
24 hour food recall-type and amount of food eaten for the
past 24 hours
➔ Food frequency questionnaire - type, quantity and
frequency of eating listed food item
➔ Food preferences - the selection of one food item over the
other
FOOD AND NUTRIENT INTAKE RISK FACTORS
➔
➔
➔
➔
➔
➔
➔
➔
➔
Nutrient intake greater than required
Swallowing difficulties
Gastrointestinal disturbances, bowel irregularities
Impaired cognitive function or depression
Unusual food habits(pica)
Misuse of supplements
Restricted Diet
Inability or unwillingness to consume food
Increase or decrease in activities of daily living
ESTIMATES
➔
CALCULATION
◆ IBW/DBW (Ideal Body Weight/Desired Body
Weight)
◆ CBW (Corrected Body Weight)
◆ TEA/TER (Total Energy Allowance/Total Energy
Requirement) etc.
CORRECTED BODY WEIGHT
➔
IDENTIFYING NUTRITIONAL PROBLEMS AND NEEDS
➔
Available data is organized and interpreted to identify the
problems and needs of the patient
Professional clinical judgment must be used to analyze
information
Must be written in PES format
◆ P - Problem
◆ E - Etiology
◆ S - Signs/Symptoms
➔
➔
3 CLASSIFICATIONS OF NUTRITION DIAGNOSIS
1.
2.
Adjustment of Body Weight for Obese Patients (if BMI is
>25)
Corrected Body Weight (CBW) =
[(Actual Wt (kg) - IBW) x 0.25] + IBW(kg)
EXAMPLE:
ABW→ 70kg; Ht 5 ft 2 in;
IBW → 50kg (Hamwi) ; Female
3.
➔
➔
CBW = [(70kg –50kg) x 0.25] +50kg
= (20kg x 0.25) + 50kg
= 5 kg + 50kg
= 55kg
NUTRITIONAL REQUIREMENT - is the Total Energy Requirement
(TER) which represents the total amount of energy expended per
day
➔
➔
SEDENTARY
secretary, clerk, typist (using electric
typewriter), administrator, cashier, bank
teller
➔
LIGHT
teacher, nurse, student, lab technician,
housewife with maids
➔
MODERATELY
ACTIVE
housewife without maid, vendor,
mechanic, jeepney and car driver
VERY ACTIVE
farmer, laborer, cargador, coal miner
fishermen, heavy equipment operator
➔
➔
➔
➔
➔
➔
Involves the collection of information and database
Basis for designing a plan of action –nutrition care plan
Different approaches: biochemical data, clinical examination
findings, medical history, anthropometric data, psychosocial
data
Must be accurate, pertinent to the patient
and
appropriately interpreted
May be executed repeatedly after nutrition intervention to
check if a care plan is working
Specific nutritional interventions are established
May involve the following:
◆ Food and/or Nutrient Delivery
◆ Nutrition Education
◆ Nutrition Counseling
◆ Coordination of Nutrition Care
Should be specifically related to the problem and
objective, individualized
Must describe what, how, why and where as appropriate
EVALUATING THE NUTRITIONAL CARE OUTCOMES
(Monitoring and Evaluation)
➔
➔
NUTRITION CARE PROCESS
Strategy for meeting nutrient and nutrition education needs
of a person
5 interrelated steps
1. Assessing
2. Identifyingz
3. Planning
4. Implementing
5. Evaluating (Monitoring and Evaluation)
ASSESSING STATE OF NUTRITION
Setting of goals and objectives to meet needs
Consider the following:
◆ Educational level of client and family
◆ Need for modifying food intake or supplementing
current intake
◆ Other measures that will enable client to meet
nutritional needs
◆ Treat medical problems affecting nutritional status
IMPLEMENTING STRATEGIES TO MEET THE OBJECTIVES
ACTIVITY LEVEL
➔
INTAKE - actual problems related to intake of energy,
nutrients, fluids, bioactive substances through oral diet or
nutrition support
CLINICAL - nutritional findings/problems identified as
related to medical or physical conditions
● includes functional (e.g. swallowing difficulty),
biochemical (e.g. altered laboratory values),
weight (e.g. underweight)
BEHAVIORAL-ENVIRONMENTAL - nutritional
findings/problems identified as related to knowledge,
attitudes/beliefs, physical environment, or food supply
and safety
PLANNING AND PRIORITIZING OBJECTIVE
OF NUTRITIONAL CARE
➔
Determining the effectiveness of nutritional care and if
modification is necessary
Must assess the following:
◆ Food/Nutrition-Related History
◆ Anthropometric Measurements
◆ Biochemical Data, Medical Tests and procedures
◆ Nutrition Focused Physical Findings
Should include:
◆ Comparison (before and after intervention)
◆ Explanation of the effectiveness or ineffectiveness
of intervention
◆ Suggestions for revising the care plan
NUTRITION ACROSS THE LIFE CYCLE
MODULE 5 → Nutrition and Diet Therapy - Lecture
NUTRITION IN PREGNANCY AND LACTATION
➔
Pregnancy is the most unique and critical among the
periods in the human life cycle since the well-being of an
individual depends so much on the well-being of another.
The following are the definitions of pregnancy :
◆ The period from conception to birth and for human
aging 38 to 42 weeks.
◆ It is divided into 3 trimester: 1st, 2nd, 3rd
➔
c.
Increased likelihood of difficult labor &
delivery, birth trauma and cesarean section
(CS) for large babies
d. Double risk of neural tube defects
1.2 PROTEIN ALLOWANCES
●
●
3 STAGES OF PREGNANCY
1.
Implantation - period in which the fertilized ovum
implants itself to the uterus & begins to develop
2. Organogenesis - called the critical period since it is the
time during which cells of a tissue or organ are
genetically programmed to multiply
a. If malnutrition occurs at this stage, it may affect
organ development that may not be reversed
by subsequent refeeding
3. Growth - the remaining 7 months in the last stage where
the number of cell and in the size of the organ to support
extra-uterine life
NUTRITIONAL REQUIREMENTS DURING PREGNANCY
1.
CALORIE ALLOWANCES
During the course of pregnancy, the total energy cost of
storage plus maintenance (additional work for maternal
heart and uterus and a steady rise in basal metabolism)
amounts to approximately 80,000 kcal.
● The energy cost of pregnancy then is about 300 kcal per
day.
● The energy should be 36 kcal per kg of pregnant weight
per day.
● The following are the considerations for calorie
requirements during pregnancy:
1.1 WEIGHT GAIN
●
➔A small weight gain
observed during the first
trimester.
➔Rapid weight gain
happens in the 2nd
➔Slower weight gain is
recorded
during
3rd
trimester
➔An average weight
gain during pregnancy is
24
lbs
which
is
commensurate
with
a
better-than-average course
and outcome of pregnancy
➔A gain of 1.5-30 lbs.
during the first trimester
and a gain of 0.8lb per
week during the remainder
of the pregnancy should
be the guideline
➔The total weight gain for a normal pregnant woman is kept
ideally between 15-20lbs, the gain is divided into 3lbs, 7lbs
and 7lbs respectively in the three trimesters.
CONDITIONS RELATED TO WEIGHT GAIN IN PREGNANCY
1.
2.
Underweight – may result to high risk of having a
low-birth weight infants & higher rates of preterm deaths
& infant deaths
Overweight and Obesity – may result to the following
conditions :
a. High risk of complications like hypertension,
gestational diabetes, & postpartum infections
b. Complications of labor & delivery
●
Additional allowance of protein during pregnancy takes
into account the increased nitrogen content of the fetus
and its membranes, maternal tissues and the added
protection of the mother against
World Health Organization (WHO) recommends an
additional 9 grams of protein per day for the latter part
A normal pregnancy woman requires a total of 900-950
grams for the 9 months gestation period.
REASONS FOR ADDITIONAL PROTEIN INTAKE
DURING PREGNANCY
1. To provide for the storage of nitrogen
2. To protect the mother against many of the
complications of pregnancy
3. For the growth of the woman’s uterus, placenta, and
associate tissues
4. To meet the needs for the fetal growth
5. For the growth of mammary tissues
6. For the hormonal preparation for lactation
1.3 CALCIUM ALLOWANCES
●
●
1.
MORNING SICKNESS
This is commonly called the nausea and vomiting of
pregnancy (NVP).
● It occurs at any time and often lasts all
● It has no cure but symptoms can be reduced
● Management:
○ Eat small, frequent meals and snacks
○ Consume fluids between meals
○ Well-tolerated: frozen ice pops, gelatin desserts,
watermelon, and mild broths
GASTROESOPHAGEAL REFLUX/HEARTBURN
● This is due to pregnancy hormones relax lower esophageal
smooth muscle and enlarged uterus pushes on the stomach
● Management:
○ Avoid excessive weight gain
○ Eat small, frequent meals; chew food slowly
○ Wait 1 hour after eating before lying down
○ Sleep with your head elevated
CONSTIPATION
● This is due to pregnancy hormones causing smooth muscle
to relax and slow colonic movement of food residue
● Management:
○ Eat 25−35 g/day of fiber
○ Drink plenty of fluids
○ Keep physically active
GESTATIONAL DIABETES
● This is due to insufficient insulin production or insulin
resistance increases blood glucose levels
● It predispose to the risk of delivering a large baby, risk of
having type 2 diabetes even after the delivery of the
baby and overweight later in life
● Management:
○ Requires strict diet, physical activity, and/or
medication on uncontrolled blood sugar
HYPERTENSIVE DISORDERS
● Gestational hypertension: no symptoms
●
2.
3.
4.
5.
Some calcium and phosphorus deposition takes place
early in pregnancy, but the amounts are small.
It has been shown that the calcium and phosphorus
retained in the fetus during the last two months of
pregnancy are 65% and 64% respectively, of the total
body content of the full term fetus.
COMMON COMPLICATIONS IN PREGNANCY
●
6.
Preeclampsia: sudden increase in maternal blood
pressure
● Can be fatal if left untreated
● Deficiencies in vitamins C and E, calcium, magnesium
increase the risk
ALCOHOL, CAFFEINE, AND NICOTINE
● Smoking during pregnancy lowers the mean birth weight
and increases the risk of perinatal mortality
● Nicotine causes a decrease in the oxygenation of the
fetus
● Excessive maternal alcohol ingestion is linked to fetal
alcohol syndrome (FAS). Its major features are CNS
disorders, mental retardation, growth deficiencies and
facial deformities
● Caffeine crosses the placenta to the fetus
● The fetus can metabolize alcohol to a limited extent but
not caffeine.
● Alcohol, caffeine and nicotine dramatically increase the
circulating levels of catecholamine
ADOLESCENT PREGNANCY
● The full physical stature of the woman is not yet
● There is a higher needs for calories and bone-related
nutrients (calcium, phosphorus, magnesium)
● Inadequate maternal weight gain
● Poor prenatal care; higher rates of prenatal alcohol and
drug use
● It causes a higher rates of preterm births,
low-birth-weight babies, and other complications
PREGNANCY IN OLDER WOMAN
● The following condition may develop:
○ Hypertension and diabetes
○ Higher rates of premature birth and low birth
weight
○ Birth defects
○ Fetal death
REPEATED PREGNANCIES
● As parity increases, the tendency toward lower nutrient
intake increases
● Gestation in close intervals depletes the maternal
reserves of nutrients. Cases of replenishment of nutrients
does not take place, the mother’s nutritional status, and
consequently that of the infant are greatly affected
7.
8.
9.
LACTATION
➔
1.
defined as the preparation for assuring an adequate
supply of good quality breast milk must begin at the onset
of pregnancy
NUTRITIONAL REQUIREMENTS DURING LACTATION
CALORIE ALLOWANCE
➔ It is generally suggested that the extra food calorie should
be about twice those secreted in the milk of approximately
700 to 1,000 ml of the milk.
➔ An increase by 1,000 calories above the normal
requirement for an average production of 850ml of milk,
with an energy value of about 600 calories
2. PROTEIN ALLOWANCES
➔ Lactation makes large demands on the human stores.
➔ The food intake of a nursing mother must contain sufficient
proteins to supply both the maternal needs and the
essential amino acids to be transferred through her breast
for the baby’s growth.
➔ Additional protein in the diet tends to increase the yield of
breast milk while a decrease of protein lowers the amount
of milk secreted
3. CALCIUM, PHOSPHORUS AND VITAMIN D ALLOWANCES
➔ Calcium allowance is 1.0g daily for good milk production.
➔ If the protein requirement and other essentials of the diet
are fulfilled, the increased need for phosphorus will be
met.
➔ The vitamin D requirement of 400 IU remains the same as
during pregnancy.
4. IRON ALLOWANCES
➔ Baby is born with a relatively large reserve of iron.
➔
Since milk is not a good source of iron, a good allowance
of iron in the mother’s diet during lactation does not convey
additional iron to the infant.
➔ Iron-rich foods are essential for the mother’s own health
while supplements are included early in the infant’s diet.
5. VITAMIN ALLOWANCES
➔ There is an increased demand for Vitamin A, niacin,
riboflavin, thiamine and ascorbic acid above the
requirements of pregnancy during lactation.
The nutritional requirements in lactation are greater than in
pregnancy to ensure enough supply of milk for the baby.
Specifically:
1. Calories - most women who are breastfeeding need
about 500 calories more than moms who aren't –that's a
total of 2,000 to 2,500 calories per Energy giving foods
are good sources of calories.
2. Protein - nursing mothers need two to three servings, or
at least 65 grams, of protein per Breast-feeding moms
can meet their protein needs by making sure they have,
at a minimum, a healthy source of protein at each meal
3. Calcium and phosphorus = an increase of 0.5 mg to the
normal allowance is needed to prevent severe depletion
of maternal calcium reserve since this is used for milk
production
4. Iron –an additional intake is recommended for blood lost
in parturition, for milk iron and basal
5. Vitamin A – an additional 2,000 IU to the normal
allowance is needed to provide the amount of Vitamin A
6. Vitamin B1 – an additional allowance is needed for
thiamine secreted in milk. A mother whose diet is low in
thiamine may secrete a toxic substance called “gloxaline”
which accumulates in thiamine
7. Riboflavin, vitamin C. - an additional allowance is
needed for milk secretion.
8. Fluids = an intake of 8 glasses or more is recommended
to increase milk production.
NUTRITION FOR INFANCY, PRE-SCHOOL
AND SCHOOL AGE
NUTRITION IN INFANCY
➔
Infancy is described as the first year of life. It is
characterized by rapid physical growth , development and
maturation of oral, fine and motor skills. Adequate nutrition
is of prime importance to support this growth. The
requirements of protein, energy and other essential nutrients
are higher per unit of body weight than any other time in
childhood.
➔ Breast milk is still the best food for the infant.
NUTRITIONAL ASSESSMENT
➔ANTHROPOMETRY
◆ reflects nutritional well-being & major indicator of
nutritional status
● Wasting thinness- low Weight for height
● Stunting- low height for age
➔Measurement recommended:
A. WEIGHT - should be measured to the nearest 10g (112
oz) for infants
B. LENGTH measured in the recumbent position on a
measuring board w/ fixed headboard & movable
footboard
a. recorded as the distance between the
headboard & frontboard when the infant is
positioned properly
C. HEAD CIRCUMFERENCE - confirms that growth is
proceeding normally
a. detect protein-energy malnutrition & evaluate
impact on brain size
➔BIOCHEMICAL ASSESSMENT
◆ Assess iron status using Hb or hematocrit determination
◆ Anemia in infants 6-24 months of age - Hb
concentration of less than 11g/dl or hematocrit of less
than 33 %
➔DIETARY ASSESSMENT
◆ Provide information on adequacy of infant diet
◆ Use to develop plan to resolve problems on food &
nutrients patterns
NUTRIENT ALLOWANCES FOR INFANTS
1.
ENERGY
● Requirement for Infants - 3-6 months - breastmilk
● Infants - 6-12 months - breast milk & supplementary
foods
○ Upward or downward changes in weight
percentile occur w/out changes in lengthsuspected of over nutrition or over nutrition
2.
PROTEIN
● In early childhood-protein supplies amino acid for the
synthesis of new tissues & nitrogen for maturation of
existing tissues
● Human milk or formula - major protein source
● Requirements:
○ First 4 months - average 3.5 g/day
○ 4-8 months - 3.1 g/day
○ Increases requirement to 11-14.6 % in the first
year
3.
FATS or LIPID
● Requirement for Infants: fatty acids, linoleic acid,
arachidonic acid
● Linoleic - essential for growth & dermal health, provide
4-5% of total kilocalories
○ 4% total energy in human milk
○ 10% total energy infant formulas
○ 1% total energy cow's milk
4.
CARBOHYDRATES
● Requirement for Infants: 30-60% of energy intake
● Can be synthesized from amino acid & glycerol: no
specific dietary recommendation
○ 37% in human milk
○ 40-50% of energy from commercial milk
5.
WATER
● Essential component of body structure
● Transport nutrients & waste products from cell
● Regulate body temperature
● Requirement for Infant: determined by amount loss from
the skin, lungs, feces & urine
● Source for the 1" 6 months: Breastmilk or infant formula
● Boiled milk/formulas are not appropriate water
evaporates & solutes become concentrated
Rationale WHY infant can dehydrate very rapidly:
●
●
●
6.
Higher % of infant's body weight is water
Infant's fluid exchange rate 7X greater than adult
Metabolic rate 2X greater relative to body weight
VITAMINS
● Milk from a healthy lactating mother supplies all vitamins
needed except vit. D
● Breast-fed infants need vit. D supplement exposure to sun
at least 30 mins./week for those wearing only diaper. 2
hours/week for fully cloth. w/out hats
● Rickets: common in breast-fed infants w/ dark skin & w/
little exposure to sunlight
Commercially prepared formula:
● Evaporated & homogenized cow's milk: w/ vit. D but
little of vit. C
● Fresh goat's milk: deficient w/ vit. C, D, & folate
● B6 deficient: destroyed during production
● Breastmilk: vit. B12 deficient for lactating mothers who
followed strictly vegan diet
● Vit. K deficiency: more common for breast-fed
● Formula & cow's milk: vit. K 4X higher than breast milk
● Vit. K injection given as prophylactic at nursery
7.
MINERALS
● Calcium
○ First 2-3 days of life: level of plasma calcium &
phosphorus fall significantly
○ 10th day of life: stabilized, greater in breast-fed
○ Formula fed: retains 25-30 % of Calcium in cow's
milk.
○ Breast-fed: ingest less Calcium (240 mg from 750
ml of milk), retain 2/3 of intake
● Iron
○ Normal infants adequate stores of Iron until 4
months
○ Iron deficiency anemia: uncommon before 4-6
months
○ Recommended intake: increases to 6 mg/day for
the first 6 months to 10 mg/day until 3 y/o
● Zinc
○ Human milk & infant formula provide adequate
zinc: 0.3-0.5 mg/kg body weight
○ Better absorption in human milk than infant
formula
○ Normal infants don't have zinc reserve
● Fluoride
○ Essential to prevent dental caries
○ Dental Fluorosis: intake levels of 4-1000 mg/dayopaque spots or streaks on the enamel of
permanent teeth
○ Milk formulas have higher concentration than milk
formula
BREASTFEEDING
BENEFITS FOR THE INFANTS
➔Optimal nutrition for infant
➔Strong bonding with mother
➔Safe fresh milk
➔Enhance immune system
➔Reduced risk for acute otitis media, gastroenteritis, severe lower
respiratory infection & asthma
➔Protection against allergies and intolerances
➔Promotion of the correct development of the jaw & teeth
➔Association w/ higher intelligence quotient
➔Reduced risk for sudden infant death
➔Reduced risk for chronic disease such as obesity, DM,
hypertension, heart disease, childhood leukemia
BENEFITS FOR THE MOTHER
➔Increased energy expenditure- lead to pre-pregnancy weight
➔Strong bonding with mother
➔Faster shrinking of the uterus
➔Reduced postpartum bleeding & delays menstrual cycle
➔Reduced risk for DM, ovarian & breast cancer
➔Improve bone density & decreased risk for hip fracture
➔Money & time saved from formula preparation
FORMULA-FED INFANT
➔
Commercial formulas
◆ Cow's milk or soy product
◆ Heat treated non-fat milk designed to provide the
necessary nutrients in a well absorbed form &
approximately close to the composition of human
milk
➔
➔
➔
➔
➔
Soy-based Formula
◆ Recommended for infants that don't tolerate cow's
milk-based formulas, and :
● Children of vegetarian families Children w/
galactosemia or primary lactase deficiency,
those recovering from secondary lactose
intolerance
● Infants who are potentially allergic to cow's
milk but have not shown clinical
manifestations of allergy.
FOODS FOR INFANT
Cereals fortified w/ iron
Strained & junior vegetables & fruits
Strained & junior meats
Dessert items such as pudding & fresh dessert
COMMON NUTRITION PROBLEMS
FOR INFANT
1.
CAUSES
➔Marasmus
◆ Prolonged
restriction
energy & protein
◆ Severe form of PEM
◆ Extreme muscle wasting
2.
➔
➔
➔
➔
➔
➔
➔
➔
3.
OBESITY
● Weight above the 95th
percentile in relation to
height, sex & body built
● Infantile obesity secondary
to excessive intake of food
●
2.
BABY BOTTLE TOOTH DECAY
● Decay of upper anterior &
sometimes the lower
posterior teeth
●
Giving of
sugar-sweetened
beverages or fruit
juices in a bottle at
bedtime
3.
COLIC
● Severe abdominal pain in
infants
●
Food allergy or
intolerance
●
Poor infant feeding
practices
Misuse of solid
foods such as
introducing it too
soon
➔
➔
➔
➔
➔
4.
Manifestations:
● Healthy well-fed infants
cry several hours a day
● Draw legs onto their
abdomen
● Pass large amount of gas
NUTRITION IN PRESCHOOL
➔
PRESCHOOL AGE
◆ 3-6 years of age
◆ Changes occur in child’s growth & development
◆ 1-2 y/0 → 2-4 kg/year
◆ 3-4 y/o → 1-2 kg/year
CHARACTERISTICS OF PRESCHOOL AGE
➔
➔
➔
➔
➔
Growth rate slows
Requires less food
Appetite decrease
“FOOD JAGS” Eat only favorite foods
Height relative to weight
◆ (Ages ¾-6 years) Chubby toddler, Learner
preschool
➔
➔
➔
➔
➔
➔
5.
PROTEIN-ENERGY MALNUTRITION (PEM)
➔Kwashiorkor
◆ Deficiency of protein but energy intake is adequate
◆ Growth failure
◆ Moon face
◆ Edema
◆ Skin lesions
◆ Hair changes
◆ Apathy
◆ Low resistance to infection
IRON-DEFICIENCY ANEMIA (IDA)
55.7% occurrence in the Phils.
Low Hgb or Hct In the blood
Lack of dietary iron
Paleness of the eyes, lips, fingernails, palm & skin
Shortness of breath
Easy fatigability
Reduced ability to learn
Irritability
VITAMIN A DEFICIENCY
Night blindness (inability to see in dim light)
Xerophthalmia (dryness of eyes)
Rough dry skin & membranes
Susceptible to infection
Poor growth
IODINE-DEFICIENCY DISORDERS
Inadequacy of dietary iodine
Goiter
Hot /cold intolerance
Mental retardation
Deaf-mutism
Difficulty in standing or walking
OBESITY
➔
➔
➔
Common in USA
Philippines - 10 to 30 % prevalence
Risk factor
◆ Hypertension
◆ Coronary Heart Disease (CHD)
◆ Diabetes
➔ Predisposing factors:
◆ Genetic or familial
◆ Metabolic hormonal abnormality
◆ Poor eating habits (sweets, sugar)
◆ Inactivity or sedentary lifestyle (too much TV
viewing)
6. DENTAL CARIES
➔
➔
➔
98 % prevalence in the Philippines
Cause: Intake of sticky sugar(e.g. Candies)
Dental Caries Prevention
1. Daily oral hygiene
2. Restrict sugary foods
3. Fluoridation of water
4. Use of fluoride in toothpaste
FACTORS INFLUENCING FOOD INTAKE OF PRESCHOOL
1.
COMMON NUTRITION PROBLEMS OF PRESCHOOL
1.
to
2.
3.
4.
Family
○ Role model for desirable eating habits
○ “The parent is responsible for what is offered; the
child is responsible for how much to eat“
Societal Trends
○ Employment of parents especially the mother
○ Rely on others to cook, purchase fast foods or
convenience foods
Media
○ Affects children’s request for & attitudes to foods
○ “Preschool are unable to distinguish commercial
messages to regular program “
Illness or Disease
○ Cause of decrease appetite & limited food intake
○ Management: Special diet
INFLUENCE OF TELEVISION TO PRESCHOOL AGE
1.
2.
3.
TV ads influences food purchases
Relationship TV watching & increased snacking
TV ads suggest inappropriate use of food has no impact
to health
TV encourages inactivity & passive use of leisure
4.
CHARACTERISTICS OF DIET FOR PRESCHOOL AGE
●
●
●
●
●
●
●
●
Food selection –good source of vitamin A & C, protein,
Iron & Calcium
Avoid hard, sticky foods w/c may plug to throat –e.g.
candy, popcorn
Foods-mildly flavored, cooked w/ moderate amount of
oils/fats, spread w/ butter or margarine, cut in small
pieces, lukewarm
Use seasoning in moderation
Excessive milk intake reduce the consumption of other
foods
Lower fat of milk for healthy children over 2 y/o
The Environment –appropriate chair, suitable dishes,
relaxed & pleasant
Give small frequent meals
FOOD PLAN (1-3 Y/0) 1070 CALORIES
➔
➔
➔
➔
➔
➔
MICRONUTRIENT MALNUTRITION
◆ Dietary inadequacies in minute amounts of key
vitamins and minerals
IRON DEFICIENCY ANEMIA (IDA)
◆ Lack of iron
● Common nutrient deficiency negative
changes in behavior & performance
in school
OBESITY
◆ Excessive accumulation of depot fat
◆ Psychosocial Difficulties /(-) self image RISK
-Disease
◆ Hypertension
◆ Glucose intolerance
DENTAL CARIES
◆ Presence of sugar, frequency of eating &
retentiveness of food to teeth
◆ Prevention: hard cheese nuts, egg, sugarless
chewing gum
LACTOSE INTOLERANCE
◆ Unable to digest ingested lactose (present in
milk) in the small intestine
● Diarrhea
● abdominal cramping
● Flatulence
FOOD ALLERGIES
◆ Specific reactions from abnormal
immunological response to food-severe or life
threatening
● shortness of breath
● stomach ache
● vomiting
● swelling of lips, tongue, face
FACTORS WHICH INFLUENCE FOOD INTAKE
1.
2.
NUTRITION IN SCHOOL AGE
CHARACTERISTICS OF A SCHOOL AGE CHILD
●
●
●
Ages 6-12 years
With consistent, steady and slow rate of physical growth
Continuous maturation of fine and gross motor skills
WEIGHT
● Annual ave.weight gain is 3-5 lbs.
● Major weight gain: 10-12 years for boys & 9-12 years
for girls
HEIGHT “GROWTH SPURT” (before puberty)
● Girls 10-12 years old
● Boys 12-14 years old
MORE MATURE BODY PROPORTION
● Little head growth
● Trunk growth slows
● Limbs lengthen
COMMON NUTRITION CONCERN
➔
MALNUTRITION & LEARNING
◆ Undernutrition-easily fatigued
◆ Unable to sustain prolonged physical effort
◆ Risk for infection
◆ school attendance
➔
UNDERWEIGHTNESS & RETARDED GROWTH
◆ Less consumption of nourishing foods
◆ Incidence of parasitic infections
◆ Diarrhea - unavailable potable water
3.
4.
➔
➔
➔
FAMILY
● Role model for food acceptance and feeding
behavior that children imitate
PEERS
● Food attitudes and choices are beginning to be
more influenced by those outside the home
SCHOOLS
● Play a role in educating the child on good
eating habits
● Incorporate nutrition in subjects
MEDIA
● TV ads influence responsive children
● Ads on nutrient-poor like soda, snacks, fast
foods, snacks
CHARACTERISTICS OF DIET
Adequate source of calcium & iron
Provide foods to furnish energy for vigorous activity
At all times, PARENTS –encourage child to eat varied
foods :
◆ Good breakfast
◆ Nutritious lunch & snacks
FOOD PLAN FOR 7-9 Y/0 (1600 CALORIES)
SIGNS OF GOOD NUTRITION
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
➔
Normal weight for height
Firm and well developed muscles
Good posture
Healthy skin
No lesions
Smooth and glossy hair
Clear eyes
Alert facial expression and good disposition
Sound sleep
Good digestion & elimination
Good appetite
NUTRITION FOR ADOLESCENCE, ADULT
AND OLDER PERSON
NUTRITION IN ADOLESCENCE
➔
Adolescence is a transition period between childhood and
adulthood. The nutritional needs and concerns of this stage
are considered as challenging which is synonymous with
their characteristics.
The following are the characteristics of this stage related to their
nutrition needs:
1. accelerated growth and development ;
2. changing lifestyle, food habits and physical activities ;
3. psychological concerns resulting to eating disorders;
4. emotional stress associated with personal and academic
responsibilities;
5. health concerns and vices that demands special nutrition
such as smoking, alcoholism and pregnancy.
PUBERTY STAGE
HEIGHT
Girls:
●
●
2-8 inches (ave.3 inches)
Full height by onset of Menarche
●
●
4 –12 inches
Continual growth
BONE GROWTH
●
●
Increased muscle mass
Increased body fat
GROWTH SPURT
Girls :
●
●
Boys :
●
●
Boys:
10 to 11 y/o
Linear growth until 19 y/o
NUTRITIONAL NEEDS
➔
CHO - 50 to 60% of total calorie
10-12 y/o
●
●
●
2800 kcal
2840 kcal
Female
1920 kcal
2250 kcal
2050 kcal
CHON
13-15 y/o
16-18 y/o
Male
63-71 grams/day
73 grams/day
Female
63-71 grams/day
59 grams/day
MINERALS
➔ Ca & Fe –lacking for Filipino teenagers
10-18 y/o
Male
Female
PRE
PUBERTY
● First stage 10-12 y/o
● Awareness to peer relationship
● Consciousness: body parts & body
image
● Trust parents & adult
LATE
ADOLESCENCE
● Decide for personal & vocational
decisions
● Establish:
○ body image & independence
○ Intimacy & body image
○ Plans for future
Ca 1000mg/day
Fe 15 mcg
VITAMINS
➔ Males (16-18 y/o) –increase needs of Vit. A C & B
➔ B Vitamins –thiamin, niacin & riboflavin
WATER (H2O)
➔ 12 glasses/day
➔ Accelerated growth & devt of body cells
➔ Increased energy utilization
➔ Active exercise & sports
FEEDING PROBLEMS
➔
Evidences :
◆ 64.5 % (13-19 y/o) - Normal weight
◆ 31.2% Underweight
● boys 40.3 %
● girls 21 %
◆ 4.3% Overweight
● girls 4.5 %
● boys 4.2%
1.
Irregular Meals & Snacking
● Skipping meals
● Late meals in school/work
● Food of choice
● Health Education
● Guide in time management
● Prepare brown bag / lunch kit
● Teach on proper food choices
● Involve in meal planning
Establishing body image.
● Anorexia Nervosa
○ Eating disorder
○ Immoderate food restriction
○ Irrational fear of gaining weight
○ Distorted body image
○ High level of GHRELIN in blood
● Bulimia
○ Binge and Purge Cycle
Average age : 16-18
Maturation of secondary sex organ functions
Cessation of growth for girls
Emotional, mental & social changes
Affects total personality & food habits
FRAMEWORK: Health education
16-18 y/o
2140 kcal
12 to 13 y/o
Linear growth until 20
PSYCHOLOGICAL CHANGES
13-15 y/o
Male
CHARACTERISTICS AT POST PUBERTY
●
●
●
Recommended Energy and Nutrient Intake (RENI)
◆ Guides for planning meal to adolescence
2.
3.
4.
Food Dislikes & Idiosyncrasies
● Fast food habits as result of advertisement
● Peer influence
Influence of Substance abuses
● Characteristics of being curious & adventurous
● Peer pressures
●
●
ENERGY AND MACRONUTRIENTS
➔
CHALLENGES IN FOOD AND ACTIVITY CHOICES
➔
➔
➔
➔
➔
➔
Little knowledge of good nutrition negative effect of food
Opportunity to be physically active
Lack of food selection & preparation skills
Availability of low cost high fat high sugar foods
limited access to safe physical activity options
Bombardment of advertisement w/ unhealthy foods
HEALTH EDUCATION FOR ADOLESCENCE
➔
➔
➔
➔
Encourage RENI
Involve in meal planning
Keep variety of food at home
Motivate to do regular physical activity
Energy requirements are:
◆ Women → 1,800 to 2.200 calories
◆ Men → 2,200 to 3,000 calories
Note: This depends on the activity level.
MICRONUTRIENTS
➔
Recommended micronutrients of magnesium for:
◆ Men - 420 milligrams per day
◆ Women - 320 milligrams per day
Other key vitamins needed:
◆ Folate
◆ Vitamins B6 & B12 to prevent elevation of homocysteine
(a byproduct that can damage arterial walls and lead
to atherosclerosis)
NUTRITION IN EARLY ADULTHOOD
PREVENTIVE/DEFENSIVE NUTRITION
Early Adulthood
➔ Characterized by exploration and marked by shifts in
lifestyle which may affect meal patterns and eating habits
➔ Healthful diet is still significant as good nutrition continues to
play key role in supporting the completion of growth and
maintaining physical health
➔ Food intake during adulthood also impacts risk for future
illness and plays a part in the prevention of excess weight
gain
➔ Research suggests that ease and convenience are highly
valued by young adults and that lack of time can be a
common obstacle to preparation of meals at home
NUTRITIONAL RECOMMENDATIONS
➔
Energy needs - vary depending on body size and physical
activity
Physical Activity
➔
➔
➔
➔
➔
➔
➔
Preventive Nutrition
➔ dietary practices directed toward reducing disease and
promoting health and well-being.
➔ can promote wellness and help organ systems to function
optimally throughout aging.
SUGGESTED DIET
◆
◆
◆
◆
◆
◆
Male
Female
Sedentary
35
30
Light
40
35
Moderate
45
40
Heavy
50
Encourage young adults to improve their food preparation
skills and regularly prepare meals at home to enhance
nutrient intake
Eat more vegetables, fruits and root crops
Consume calcium containing foods every day
Limit intakes of salty and fatty foods.
Use iodized salt instead of plain salt
Consume recommended amounts of CHO
Include high fiber foods
Alcohol should be taken in moderation, about 1-2
drinks/day. 1 drink = 1 (12 oz beer) or 1 small glass (4 oz)
wine or 1 jigger gin
LIFE CYCLE NUTRITION: MIDDLE ADULTHOOD
To maintain health and wellness during the middle-aged years and
beyond, it is important to:
● maintain a healthy body weight.
● consume nutrient-dense foods
● drink alcohol moderately. It should be taken in
moderation, about 1-2 drinks/day. I drink = 1 (12 oz
beer) or 1 small glass (4 oz) wine or I jigger gin (3/4
ounces)
Unrefined carbohydrate
Avoid trans fats and saturated fats
Food high in antioxidants like fruits and vegetables
Food high in lycopene
Food rich in Omega 3 fatty acids
Food rich in monosaturated fat
MENOPAUSE
●
Suggested Kcal/Kg DBW
OTHER IMPORTANT GUIDELINES
➔
be a nonsmoker
engage in moderate physical activity at least 150
minutes per week.
In this stage, women undergo a specific change that has
major effect on their health.
○ Ovaries slowly cease to produce estrogen and
progesterone, which result in the end of
menstruation.
○ Hormonal changes can lead to number of
physiological changes such as:
■ Weight gain
■ Bone thinning increases the risk of fractures
DIETARY NOURISHMENT RECOMMENDATIONS FOR WOMEN
EXPERIENCING MENOPAUSE
◆
◆
◆
◆
◆
Consuming a variety of whole grains, and other
nutrient-dense foods.
Maintaining a diet high in fiber, low in fat and low in
sodium
Avoiding caffeine, spicy foods, and alcohol to help
prevent hot flashes
Eating food rich in calcium, or taking
physician-prescribed calcium supplements and vitamin D.
Doing stretching exercises to improve balance and
flexibility and reduce the risk of falls and fractures.
NUTRITION IN OLDER PERSON
●
●
●
●
Gerontology – phenomena of aging
Geriatrics – treatment of accompanying diseases of
older person
Elderly/Senior citizen - person belongs to this age
Senile - clinically associated w/ mental & physical
weakness
CHANGE
EFFECT
Sensory Impairment
Decreased sense of taste
Reduced appetite
Decreased sense of smell
Reduced appetite
Loss of vision and hearing
Decreased ability to prepare
food
Oral health/ Dental Problem
Difficulty chewing,
inflammation
Altered energy need
Diet lacking in essential
nutrients
Decreased physical activity
Progressive depletion of lean
body mass
Loss of appetite
Muscle loss (sarcopenia)
Decrease functional ability ADLs
Psychosocial (isolation)
Decreased appetite
Environmental (financial)
Limited access to food
Poor quality diet
INTERVENTION FOR FEEDING RELATED PROBLEMS
➔
➔
➔
➔
➔
Inability to suck:
◆ Use squeeze bottle –express liquids into the mouth
◆ Place spoon on center of the tongue & apply pressure
to stimulate sucking
◆ Apply rhythmic slow strokes on tongue
◆ alter tongue position & improve sucking
Inability to Chew
◆ Place foods between gums & teeth.
◆ Improve chewing skills w/ different textured foods
◆ EX.: fruit leathers stimulate jaws
◆ Foods that require minimal chewing.
Inability to Swallow
◆ Provide thickened liquids, pureed foods & moist foods.
◆ Serve frozen fruit juice bars & ice cold
◆ Make sure patient’s jaw & lips close to facilitate
swallowing action
◆ Correct posture & head position if interfere w/
swallowing
Inability grasp or coordinate movements
◆ Provide utensils w/ modified handles.
◆ Encourage use of hands for feeding
◆ Use plates w/ food guards to prevent spilling
Impaired vision
◆ Place foods in similar locations on the plate at meals.
◆ Provide plates w/ food guards to prevent spilling
DIET THERAPY
MODULE 6 → Nutrition and Diet Therapy - Lecture
FLATULENCE (INCREASED INTESTINAL GAS)
DIET THERAPY
➔
➔
➔
➔
Diet Therapy is the use of appropriate foods as a tool in the
recovery from illness. (Mudambi, S., & Rajagopal, M.V.,
2007, p. 261)
Our patient's adherence to the prescribed diet after medical
or surgical treatment has a high relationship to his/ her
recovery. In some medical problems and diseases diet
therapy and modification is the most important intervention to
help the patient recover fast.
Therapeutic diet is planned to meet or exceed the dietary
allowances of a normal person as the aim of diet therapy is
to maintain health and help the patient to regain nutritional
wellbeing.
Side effects of consuming high fiber diet
◆ Undigested fiber pass into the colon
◆ Fermented by bacteria
◆ Produce GAS as by-product
➔ Fiber-containing food that cause intestinal gas –added
gradually & portion increased as tolerance improves
Foods that increase intestinal gas:
MEDICAL NUTRITION THERAPY
➔
➔
➔
➔
➔
According to the Center for Disease Control & Prevention
(CDC), the term Medical Nutrition Therapy or MNT is a key
component of diabetes education and management.
Defined as “nutrition-based treatment provided by a
registered dietitian nutritionist.”
It includes “a nutrition diagnosis as well as therapeutic and
counselling services to help manage diabetes.”
CDC stated that Medical Nutrition Therapy must be provided
by a registered dietitian to the client. MNT is described by
the organization as:
◆ An intensive, focused, and comprehensive nutrition
therapy service.
◆ Involves in-depth individualized nutrition assessment.
◆ Relies heavily on the follow-up to provide repeated
reinforcement to aid with behaviour change.
◆ Establishes goals, a care plan, and interventions.
◆ Plans for follow-up over multiple visits to assist with
behavioural and lifestyle changes relative to each
individual’s nutrition problems and medical condition
or disease(s)
In the hospital setting, the patients have been prescribed a
diet ranging from a normal diet to a bland diet depending
on the client's needs.
THERAPEUTIC DIET
➔
➔
All Therapeutic Diets are modifications of the normal diet
made in order to meet the altered needs resulting from
disease. (Mudambi, S., & Rajagopal, M.V., 2007).
Therapeutic Diet is planned to meet or exceed the dietary
allowances of a normal person as the aim of Diet Therapy is
to maintain health and help the patient to regain nutritional
wellbeing. (Mudambi, S., & Rajagopal, M.V., 2007).
FIBER INTAKE
➔
➔
●
●
●
●
Consumption of whole grains, legumes, nuts and seeds ,
fruits & vegetables
Two kinds of fiber:
◆ Soluble Fiber & Insoluble Fiber
SOLUBLE FIBER
INSOLUBLE FIBER
Viscous fibers
Slow passage of food through
the GI tract
Increase satiety & delays
glucose absorption
Lowers blood cholesterol levels
(Fibers bind reducere-absorption
of bile acids)
●
Increase the
fecal weight &
spread the
passage of
wastes through
the large
intestines
CONSTIPATION
➔
➔
➔
Difficulty of passing stools
Infrequent bowel movements (fewer than 3/week)
Common side effects of medications
CONSTIPATION: DIET THERAPY
➔
➔
Gradual increase in fiber intake
High fiber : increase stool, weight & promote more rapid
transit of materials through the colon
DIARRHEA
➔
➔
➔
Passage of frequent watery stools
Complications of various medical problems
Severe/persistent diarrhea can cause dehydration
electrolyte imbalance
DIARRHEA: DIET THERAPY
➔
➔
➔
➔
Treatment depends on cause, severity & duration
Rehydration therapy
Low fiber may improve symptoms
Fiber restriction during active intestinal inflammation
Foods that worsen Diarrhea:
&
NUTRITION THERAPY FOR DIABETES MELLITUS
Goals:
●
●
●
●
Maintain near blood glucose level
Normalize serum lipoprotein levels &BP
Allow & maintain reasonable bodyweight
Promote overall health
Total CHO Intake:
● More grams of CHO intake-the greater glycemic response
● Basis for CHO recommendations : type of DM, degree of
glucose tolerance, individual preferences
IRRITABLE BOWEL SYNDROME
➔
➔
Chronic & recurring intestinal symptoms
Associated w/ abdominal pain & alternating diarrhea &
constipation
IRRITABLE BOWEL SYNDROME: DIET THERAPY
➔
➔
➔
➔
Increase fiber diet to reduce constipation
Fiber containing foods should be added gradually to
minimize intestinal gas
Avoidance of milk products (lactose intolerance)
Avoid caffeine & alcohol
HIGH FIBER DIET MENU
BREAKFAST
● 1 c multigrain cereal
● ½ strawberries
● 1 c fat free milk
● 2 slices whole wheat toast
● 2 tbsp peanut butter
● 1 c coffee
LUNCH
● 1 c black bean soup
● 3 oz broiled chicken
● ½ c steamed broccoli
● ½ baked sweet potatoes
● 1 fresh pear
● 1 whole wheat dinner roll
● 1 tsp margarine
DINNER
● 3 oz steamed fish
● ½ c brown rice
● ½ c peas
● 1 whole wheat dinner roll
● 2 tsp margarine
● 1 piece carrot cake
● 1 c fat-free milk
SNACK
● 3 c popcorn
● 1 c pineapple juice
DIABETES MELLITUS CHO CONTROLLED DIET
Prevalence of Diabetes in the Philippines
➔ Diabetes is the 6th leading cause of death among Filipinos
based on the data from 2013 Philippine Health Statistics
➔ ”Diabetes keeps on increasing in prevalence, but we
shouldn’t give up the fight against the disease. It may be
chronic and incurable, but diabetes can be managed. We
need to strengthen multi-stakeholder collaboration in
increasing awareness of this disease and for people to
follow a healthy lifestyle,” Health Secretary Francisco Duque
III emphasized.
➔ Clinical manifestations
➔ Management
CHO Sources:
● High fiber whole grains product than high processed
starchy foods
Fiber:
● Fiber -rich such as legumes cereals, fruits & vegetables
● Very high intake of fiber (50 grams or more)
● 25-35 g/day (14 g per 1000kcal)
Sugars:
● Table sugar (sucrose)-from glucose & fructose lower
glycemic effect
● Artificial sweeteners ( aspartame, saccharin) safe to use,no
digestible CHO
Sugar & sugary foods –counted as part of CHO allowance
Dietary Fiber:
● Diabetic high risk of CVD
● Saturated fat intake limit to less than 7 % of total kcal
● Trans fat minimize
● Cholesterol limited to 200 mg daily
CHON:
● Intake ranges from 15 to 20 % of total kcal
● No more than 0.8g/kg body weight = w/ nephropathy
● High protein –detrimental to kidney function
Fat:
●
●
Saturated fat < 7 % of daily calories
Intake of trans fat should be minimized
Cholesterol:
● < 200 mg/day
Sodium:
● <2300 mg/day for HPN & normotensive
Vitamins & Minerals:
● Same as gen. Population
● Chromium & Vit E and C -recommended
Alcohol use in Diabetes:
● Daily limit for women –1 serving & 2 drinks for men
● Alcohol Cause hypoglycemia-interfere w/ liver production
● Excessive alcohol –cause hyperglycemia
FOOD PLAN FOR 1,800 cal
Suggested Meal Pattern and Menu for DM