CHAPTER
55
Nutrition and Health
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55-2
Learning Outcomes
55.1 Relate daily energy requirements to the role
of calories.
55.2 Identify nutrients and their role in health.
55.3 Implement a plan for a nutritious, wellbalanced diet and healthy lifestyle using the
USDA's guidelines.
55.4 Describe methods used to assess a patient’s
nutritional status.
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55-3
Learning Outcomes
55.5 Explain reasons why a diet may be modified.
55.6 Identify types of patients who require special
diets and the modifications required for each.
55.7 Describe the warning signs, symptoms, and
treatment for eating disorders.
55.8 Educate patients about nutritional
requirements.
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55-4
Introduction
• Nutrition
– Utilization of food
and nutrients
• Medical assistant
should understand
relationship between
nutrition and health
– Five-part process
• Intake
• Digestion
• Absorption
• Metabolism
• Elimination
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55-5
Daily Energy Requirements
• The body requires nutrients
– To provide energy
– To build, repair, and
maintain body tissues
– To regulate body
processes
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55-6
Metabolism
• Build, maintain and supply energy
• Phases
– Anabolism ~ builds tissues
– Catabolism ~ forms energy
• Requires nutrients
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55-7
Calories
• Kilocalorie (calorie)
– Measurement of energy
• Produced by food
• Expended
– Excess calories stored as fat
– Monitor food intake ~ calories/day
– Calories burned during physical activity
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55-8
Apply Your Knowledge
What is the difference between anabolism and
catabolism?
ANSWER: Anabolism converts nutrients into complex
substances needed to build body tissues. Catabolism
converts complex substances into simpler forms and
converts them into energy.
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55-9
Nutrients
• Needed for
– Energy
– Growth
– Repair
– Basic processes
• Contain calories
– Proteins
– Carbohydrates
– Fats
• Nutrients are
provided by
– Proteins
– Carbohydrates
– Fiber
– Lipids
– Vitamins
– Minerals
– Water
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55-10
Proteins (cont.)
• Functions
– Building and repairing cells and tissues
– Maintaining water balance
– Antibody production and disease resistance
– Maintaining body heat
• 10% to 35% of total caloric intake daily
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55-11
Proteins
• Deficiency
– Weight loss/fatigue
– Malnutrition
– Dry skin
– Lower resistance to infection
– Interference with normal growth processes
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55-12
Proteins (cont.)
• Amino acids
– Used to make proteins
– Plant and animal sources
– Three types
• Essential amino acids
• Nonessential amino acids
• Conditional amino acids
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55-13
Carbohydrates
• Functions
– Energy (1gm = 4 calories) and heat
– Metabolize fats
– Keeps the body from using protein for energy
• 45% to 65% of total caloric intake daily
• Deficiency
– Weight and protein loss
– Fatigue
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55-14
Carbohydrates (cont.)
• Simple sugars
• Complex
carbohydrates
– Long chains of
sugar units
– Types
• Starch
• Fiber
• Converted to
glucose for energy
• Excess
– Stored in liver and
muscles cells
– Converted into and
stored as fat
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55-15
Fiber
• Functions
– Increases and softens the bulk of stool
– Absorbs wastes and toxins
– Decreases the rate of carbohydrate
breakdown and absorption
• 14 grams / 1000 calories
• Adequate water intake
• Soluble or insoluble
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55-16
Lipids
• Source of energy (1 gm = 9 calories)
• Triglycerides and compound lipids
• Functions – essential to growth and
metabolism
• 20% - 30% of daily calories
• Problems related to deficiency or excess
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55-17
Lipids (cont.)
• Saturated fats
– Animal sources
– Solid at room
temperature
• Unsaturated fats
– Liquid at room
temperature
– Vegetable oils
• Polyunsaturated
• Monounsaturated
• Trans fats
– Formed during
hydrogenation
– Zero consumption
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55-18
Lipids (cont.)
• Cholesterol
• Lipid levels
– Sources ~ liver and
dietary
– Cholesterol and
triglycerides
– Essential to health
– Lipoproteins
• Cell membrane
• Steroid hormones
and vitamin D
• Constituent of bile
• Low-density (LDL)
• High-density (HDL)
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55-19
Vitamins
• Organic substances
– Essential for normal growth and maintenance
– Essential for resistance to infection
• Absorbed through digestive tract
• Water- or fat-soluble
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55-20
Minerals
• Natural, inorganic substances
– Build and maintain tissues
– Carry out life functions
• Major– needed in large quantities
• Trace – needed in small amounts
• Absorbed in the intestines
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55-21
Minerals
• RDAs
– Calcium ~ 800 to
1200 mg
– Iron ~ 10 to 15 mg
– Iodine ~ 150 mcg
– Zinc ~ 12 to 15 mg
– Magnesium
• 280 mg – women
• 350 mg – men
– Phosphorous ~ 800 mg
– Selenium
• 55 mcg – women
• 10 mcg – men
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55-22
Minerals
• Safe and adequate intake
– Copper ~ 1.5 to 3.0 mg
– Fluoride ~ 1.5 to 4.0 mg
– Chromium ~ 50 to 200 mg
– Manganese ~ 2 to 5 mg
– Molybdenum ~ 75 to 250 mcg
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55-23
Water
• 65% of body weight
• Functions
– Maintains fluid balance
– Lubricates moving
parts
– Dissolves chemicals
and nutrients
– Aids in digestion
– Transports nutrients
and secretions
– Flushes out wastes
– Regulates body
temperature
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55-24
Water (cont.)
• Fluid balance – intake should equal output
• Dehydration
– Inadequate intake
– Increased loss
• Educate patients about
when to increase fluids
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55-25
Principal Electrolytes and Nutrients of
Special Interest
• Electrolytes
– Sodium ~ 2.4 G or less
– Potassium ~ 1600 to 2000 mg
– Chloride ~ 2.4 G or less
• Antioxidants – chemical
agents that neutralize
free radicals
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55-26
Apply Your Knowledge
Matching:
ANSWER:
F Bulk to stool
___
A. Cholesterol
C Tissue repair
___
B. Antioxidants
___
H Excess stored as glycogen or fat
C. Proteins
___
G Concentrated source of energy
A Produced by liver
___
D. Water
D No caloric value
___
F. Fiber
___
B Neutralizes free radicals
G. Lipids
___
E Formed during hydrogenation
H. Carbohydrates
E. Trans fats
S
U
P
E
R
J
O
B
!
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55-27
Dietary Guidelines
• USDA Dietary Guidelines
– Encourage people to eat a balanced diet
– Limit consumption of less nutritious foods
– Increase physical activity
– Consistently make good nutritional decisions
• Key – balance food intake with physical
activity
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55-28
USDA Choose MyPlate Guidelines
• Eat healthy
– Balance calories
– Foods to increase
– Foods to reduce
• Patient education
– Guidelines
– Tools at www.choosemyplate.gov
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55-29
American Cancer Society Guidelines
• Achieve and maintain a
health weight
• Adopt a physically active
lifestyle
• Consume a healthy
diet – plant foods
• Limit consumption of alcoholic beverages
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55-30
Apply Your Knowledge
What is the purpose of the MyPlate initiative?
ANSWER: To remind Americans to eat healthfully
by
 balancing calories and reducing portions
 increasing fruits, vegetables and whole grains
and switching to fat-free or low-fat milk
 Decreasing sodium and sugary drinks and
increasing water
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55-31
Assessing Nutritional Levels
• Age
• % of body fat
• Health status
• Body mass index
• Height/weight
• Nutrition and
exercise patterns
• Body frame
• Body
circumference
• Energy needs
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55-32
Assessing Nutritional Levels (cont.)
• Body mass index (BMI)
– Measure of body fat based on height and
weight
– Body mass index
calculators
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55-33
Assessing Nutritional Levels (cont.)
• Measurement of fat as a % of body weight
– Skinfold test – measurement of a fold of skin
with a caliper
– Optimal % differs between
men and women
– Aging changes ratio
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55-34
Apply Your Knowledge
What factors does the physician consider when
assessing a patient’s nutritional status?
ANSWER: The physician considers a patient’s age,
health status, height and weight, body frame and
circumference, percent of body fat, eating and exercise
patterns, and energy needs. Culture, beliefs, lifestyle,
and educational level should also be considered during
the assessment.
Well done!
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55-35
Modified Diets
• Diet effects
– Health
– Appearance
– Recovery from
disease
• Modifications
– Based on patient’s
nutritional status
– Prevent or treat
illness
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55-36
Modified Diets
• Texture
• Nutrient level
– Clear-liquid diet
– Low-sodium diet
– Soft diet
– Low-cholesterol diet
– Pureed diet
– Reduced-calorie diet
– High-fiber diet
– Low-tyramine diet
– High-calorie, highprotein diet
– High carbohydrate
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55-37
Modified Diets
• Frequency and timing of meals
• Exclusion of certain foods
– Bland diets ~ diverticulosis
– Exclusion diets
• Lactose
• Phenylalanine
• Gluten – severe intolerance  celiac disease
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55-38
Patients with Specific Nutritional
Needs (cont.)
• Food allergies –
eliminate from diet
• Anemia
– Iron supplements
– Dietary iron
• Cancer
– Adequate protein
intake
– Vitamin intake
– Encourage patient
to follow diet
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55-39
Patients with Specific Nutritional
Needs (cont.)
• Diabetes
– Goal ~ control of blood glucose level
– Food exchange system
• Seven categories
• Portion sizes
– Avoid skipping or delaying meals
– Fiber ~ helps to prevent sharp rise in blood
glucose after a meal
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55-40
Patients with Specific Nutritional
Needs (cont.)
• Heart disease
– Reduce cholesterol
– Lose weight if needed
– Reduce consumption of fats
• Hypertension
–  sodium,  potassium, adequate calcium
– Eliminate or reduce alcohol consumption
–  fats
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55-41
Patients with Specific Nutritional
Needs (cont.)
• Lactose sensitivity – avoid dairy products
• Overweight
– Dietary modification
– Behavior modification
– Motivation and education
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55-42
Patients with Specific Nutritional
Needs (cont.)
• Children
– 1st year
– Nutritional needs
• Pregnancy and
lactation – need for
additional nutrients
• Growth and
maturation
• Activity levels
– Hunger regulates
intake
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55-43
Specific Modified Diets (cont.)
• Specially
formulated food
supplements
• Parenteral
nutrition
– Bypasses the
digestive system
– Nutrients must be
in absorbable form
• Drug therapy
– Drugs may affect
• Food intake
• Absorption
• Appetite or taste
– Foods may interfere
with metabolism and
action of a drug
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55-44
Apply Your Knowledge
Matching
ANSWER:
Yippee!
___
C Eliminate foods from diet
A. Change in texture
___
E Food exchange system
B. Children
___
B Hunger drives eating
C. Food allergies
D. Parenteral nutrition
___
A Modification to a soft diet
E. Diabetes
___
G Reduced sodium diet
F. Drug therapy
___
D Bypasses GI tract
G.Change in nutrient level
___
F May alter food intake and absorption
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55-45
Eating Disorders
• Extremely harmful eating behavior
• Anorexia nervosa
– Self-starvation
– Treatment
• Restore normal nutrition
• Psychotherapy
• Education of nutrition concepts
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55-46
Eating Disorders (cont.)
• Bulimia
– Binge eating followed by purging
– Usually easier to treat than anorexia
– Goals of treatment
• Establish a healthy weight
• Establish good eating patterns
• Resolve psychosocial triggers
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55-47
Eating Disorders (cont.)
• Getting help
– Rate of recovery poor
– Disorders can become chronic
• Remission and relapse
• May be fatal
– Be alert for patient eating or activity patterns
during interviews
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55-48
Apply Your Knowledge
A young female patient arrives at the clinic showing a 15
pound weight loss in the last two months. Her weight is
10 pounds under the average weight for her height. She
states she “feels fat.” What should you do?
ANSWER: Document the weight loss and report it to
the physician. She may be suffering from an eating
disorder.
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55-49
Patient Education
• Reinforce nutrition instructions
• Teach patient
– Role nutrition plays in preventing illnesses
– How to read food package labels
• Refer questions to dietitian about
– Meal patterns
– Food selections
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55-50
Patient Education (cont.)
• Factors to consider
– Anything that affects food choices and
behaviors
– Patient age and family circumstances
– Diseases and disorders
– Patient’s psychological condition
• Patient must understand the reasons for
the diet
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55-51
Patient Education (cont.)
• Guidelines
– Teach patient as an individual
– Teach a small amount at a time
– Keep explanations at patient’s level of
understanding
– Let patient be an active learner
– Provide a written diet plan
– Suggest support groups
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55-52
Patient Education (cont.)
• Cultural considerations
– Influence
• Food purchases
• Like and dislikes
• Meal timing and frequency
• Attitude toward supplements
• Snacking
– Adjust diet and recipes accordingly
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55-53
Apply Your Knowledge
What do you need to consider when teaching
patients about nutrition?
ANSWER: You need to consider patient likes and
dislikes, age and family circumstances, diseases
and disorders, and the patient’s psychological
condition. In addition, you need to incorporate
cultural considerations into nutritional education.
Excellent!
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55-54
In Summary
55.1 The body uses food for three major purposes: to
provide energy; to build, repair, and maintain body
tissues; and to regulate body processes. Calories
provide energy for the body. Calories are measured in
the foods we eat. We also can estimate the amount of
calories used by the body during activity.
53.2 The body needs a variety of nutrients for energy,
growth, repair, and basic processes. Several food
components provide nutrients. These are proteins,
carbohydrates, fiber, lipids, vitamins, minerals, and
water.
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55-55
In Summary (cont.)
53.3 Dietary guidelines suggest the types and quantities of
food that people should eat each day. They also may
contain the recommendations about which types of
foods to limit and which types of foods to increase.
MyPlate provides recommendations for eating a
variety of nutrients and maintaining physical activity.
Using MyPlate recommendations promotes a wellbalanced diet and healthy lifestyle.
53.4 Calipers are used to perform a skinfold test that
determines the percentage of body fat. BMI is the
body mass index. Both measurements, along with
other factors, maybe used to assess a patient's
nutritional status.
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55-56
In Summary (cont.)
55.5 Dietary modifications may be used alone or
in combination with other therapies to
prevent or treat illness.
55.6 Patients with allergies, anemia, cancer,
diabetes, advancing age, heart disease,
hypertension, lactose sensitivity, and obesity
need special diets. In addition pediatric,
pregnant, lactating, and debilitated patients
as well as those undergoing drug therapy
need modifications to their diet.
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55-57
In Summary (cont.)
55.7
You should now the signs and symptoms of eating
disorders in order to evaluate for these disorders
during the patient interview. Some of the more
common signs and symptoms for each include
• anorexia nervosa – unexplained weight loss, selfstarvation, and fear of weight gain
• bulimia – eating large quantities of food in a short
period of time, going to the bathroom immediately
after eating, and using laxatives to excess
• binge eating – eating large quantities of food, not
followed by purging, and weight gain
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55-58
In Summary (cont.)
55.8
Patients need to be educated about special diets
and how to implement dietary changes as instructed
by physicians and dietitians. Knowledge of basic
nutritional principles and current nutritional findings
are necessary. Documentation is required to help
ensure payment by managed care and other health
insurance companies.
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55-59
End of Chapter 55
He that eats till
he is sick must
fast till he is
well.
~English Proverb
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.