Chapter 44 Nutrition

1. Amino Acids- The simplest form of a protein which is made up of H, O2, N. Are
anabolized into tissues, hormones, and enzymes
2. Anabolism- The building of more complex biochemical substances by synthesis of
nutrients. Occurs when individual adds lean muscle through diet and exercise
3. Anorexia- patients who are ill or debilitated often have poor appetite (anorexia).
Has many causes including pain, fatigue, and the effects of medications. Help
patients understand the factors that cause anorexia and use creative approaches to
stimulate appetite
4. Anorexia Nervosa- eating disorder that occurs during adolescence. Refuses to
maintain body weight over minimal normal weight for age and height (less than
85% of ideal body weight) or failure to make expected weight gain during period
of growth (which leads to body weight less than 85%); disturbed about the
appearance of body weight, size and shape feel fat when abnormally thin and
one area is too fat when underweight; Absence of at least 3 consecutive
menstrual cycles when otherwise expected to occur (primary/secondary
amenorrhea- period only occurs when estrogen hormone is given)
5. Anthropometry- measurement system of the size and makeup (proportions) of the
body; measurement of various body parts to determine nutritional and caloric
status, muscular development, brain growth, and other parameters (ex. Ration to
height to wrist circumference, Midupper Arm Circumference (MAC), Triceps
skinfold (TS), Mid Upper Arm Muscle Circumference (MUMC) dietician will
compare findings to standards. GREATER significance than isolated measurements
6. Basal Metabolic Rate (BMR) - energy needed to maintain life sustaining
activities (breathing, circulation, heart rate, and temperature) for a specific period
of time at rest. Amount of energy used in a unit of time by a fasting, resting subject
to maintain vital functions. Factors such as age, body mass, gender, fever,
starvation, menstruation, illness, injury, infection, activity level, or thyroid function
can affect energy requirements. BMR measures your basal energy expenditure, or
BEE. The BEE is a 24 hour estimation of the number of calories you burn
maintaining your most basic bodily functions, such as breathing, circulating blood
and growing and repairing cells.
7. Body Mass Index (BMI)-measures weight corrected for height and serves as an
alternative to traditional height weight relationships. Calculate BMI by dividing
patients weight in kilograms by height in meters squared. Overweight 20 to 30.

Obese greater than 30 and places patient at a higher risk of Coronary Heart
Disease, some cancer, Diabetes Mellitus, and Hypertension.
8. Bulimia Nervosa- eating disorder that occurs during adolescence. Recurrent
Episode of binge eating (rapid consumption of large amount of food in a discrete
period of time); a feeling of lack of control over eating behavior during eating
binges; regularly engages in self indices vomiting, use of laxatives/diuretics, strict
dieting/fasting, or vigorous exercise to prevent weight gain; Minimum average of
two binge eating episodes a week for at least 3 months
9. Carbohydrates- C, H, O2; main source of energy. Each gram of carbohydrate
produces 4kcal/g and serves as the main source of fuel (glucose) for the brain
skeletal muscles during exercise, erythrocyte and leukocyte production, and cell
function of the renal medulla. Obtain carbohydrates primarily from plant foods
except for lactose (milk sugar)
10.Catabolism- breakdown of biochemical substances into simpler substances and
occurs during physiological states of negative nitrogen balance (ex. Starvation is
wasting of the body tissues occur)
11.Chyme- an acidic liquefied mass. Flows into the duodenum and quickly mixes
with bile (manufactured in the liver and stores in the gallbladder), intestinal juices,
and pancreatic secretions. Happens after food leaves the antrum (distal stomach)
through the pyloric sphincter.
12.Daily Values- created for food labels. Referenced Daily Intakes- the first set,
compromising protein, vitamins and minerals based on the recommended dietary
allowance (RDA). The daily reference values (DRV) is the second set of reference
values consists of nutrients such as total fat, saturated fat, saturated fat, cholesterol,
carbohydrates, fiber, sodium, and potassium. Daily values did not replace RDAs
but provided a separate more understandable format for the public. Daily Values
are based on percentages of a diet consisting of 2000 kcal/day for adults and
children 4 years and older.
13.Dietary Reference Intakes (DRIs) - a present evidence based criteria for an
acceptable range of amounts of vitamins and nutrients for each gender and age
group. It is composed of four components: estimated average requirements (EAR)
which is the recommended amount of a nutrient that appears sufficient to maintain
a specific body function for 50% percent of the population based on age and
gender; The recommended dietary allowance (RDA) is the average needs of 98%
of the population not the exact needs of the individual; Adequate intake (AI) is the
suggested intake for individuals based on observed and experimentally determined
estimates of nutrient intakes and is used when there is not enough evidence to set

the RDA; the tolerable upper intake level (UIL) the highest level that likely poses
no risk of adverse health events and it is not a recommended level of intake
14.Dispensable Amino Acids- amino acids made in the body (ex. alanine, asparagine,
and glutamic acid)
15.Dysphagia- difficulty swallowing. Complications include aspiration pneumonia,
dehydration, decreased nutritional status, and weight loss; can lead to disability or
decreased functional status, increased length of stay, and cost of care, increased
likelihood of discharge to institutionalized care, and increased mortality. BE
AWARE of warning signs: cough during eating; change in voice tone or quality
after swallowing; abnormal movements of the mouth, tongue, or lips; slow, weak,
imprecise, or uncoordinated speech. MORE SIGNS abnormal gag; delayed
swallowing; incomplete oral clearance or pocketing; regurgitation; pharyngeal
pooling; delayed or absent trigger of swallow; and inability to speak consistently.
Patients can also have Silent Aspiration: aspiration that occurs with neurological
problems that lead to decreased sensation. It often occurs without a cough and
symptoms usually do not appear for 24 hours. Silent aspiration accounts for most
of the 40% to 70% of aspiration in patients with dysphagia following a stroke.
16.Enteral Nutrition (EN): provides nutrients into the GI tract. It is the PREFERED
method of meeting nutritional needs if a patient is unable to swallow or take in
nutrients orally yet has a functioning GI tract. EN provides physiological safe, and
economical nutritional support. Patients with enteral feeding receive formula via
nasogastric, jejunal, or gastric tubes. Patients with low risk of gastric reflux receive
gastric feeding. HOWEVER if there is a risk of gastric reflux (which can lead to
aspiration) jejunal feeding preferred. Indications for EN: Cancer (head, neck, and
upper GI); critical illness or trauma, neurological and muscular disorders (brain
neoplasm, cerebrovascular accident, dementia, myopathy, Parkinsons disease);
respiratory failure with prolonged intubation; inadequate oral intake (anorexia
nervosa, difficulty chewing or swallowing, severe depression); gastrointestinal
disorders (enterocutaneous fistula, inflammatory bowel disease, mild pancreatitis)
17.Enzymes- protein like substances that act as catalysts to speed up chemical
reactions. Enzyme activity depends on the mechanical breakdown of food to
increase its surface area for chemical action
18.Fat Soluble Vitamins- (Vitamin A, D, E, and K) these vitamins dissolve in fat and
are stored in body tissues. They are stored in the fatty compartments of the body.
With an exception of Vitamin D, people acquire vitamins through dietary intake.
19.Fatty Acids- composed of chains of carbon and hydrogen atoms with an acid
group on one end of the chain and a methyl group at the other. They can be

saturated (in which each carbon group in the chain has two attached hydrogen
atoms) or unsaturated (in which an unequal number of hydrogen atoms are
attached and the carbon atoms attach to each other with a double bond). Can be
classified as essential or nonessential. Linoleic acid, an unsaturated fatty acid, is
the ONLY ESSENTIAL fatty acid in humans. Linoleic acid and arachnoid acid are
important for metabolic processes but are manufactured by the body when linoleic
acid available; DEFICIENCY occurs when fat intake falls below 10% of daily
nutrition. Most animal fats have high proportions of saturated fatty acids whereas
vegetable fats have higher amounts of unsaturated and polyunsaturated fatty acids.
20.Fiber- a polysaccharide that is the structural part of plants that is not broken down
by the human digestive enzymes; BECAUSE fiber is not broken down, it does
NOT contribute calories to the diet. Insoluble fibers are not digestible and include
cellulose hemicellulose, and lignin. Soluble fibers dissolve in water and include
barley, cereal grains, cornmeal, and oats
21.Food Security- CRITICAL for all members of a household; all household
members have access to sufficient, safe, and nutritious food to maintain a healthy
lifestyle; sufficient food is available on a consistent basis; the household has
resources to obtain appropriate food for nutritious diet.
22.Gluconeogenesis- catabolism of amino acids and glycerol into glucose for energy
23.Glycogenesis- anabolism of glucose into glycogen for storage
24.Glycogenolysis- catabolism of glycogen into glucose, carbon dioxide, and water
25.Hypervitaminosis- of fat soluble vitamins results from megadoses (intentional or
unintentional) of supplemental vitamins, excessive amounts of fortified foods, and
large intake of fish oil.
26.Ideal Body Weight (IBW) - provides an estimate of what a person should weigh;
RAPID weight gain or loss is IMPORTANT to note because it usually reflects fluid
shifts; One pint/500ml pf fluid equals 1 pound. 2 pounds is 1000ml of fluid.
27.Indispensable Amino Acids- amino acids that the body does not synthesize
(make) and needs to be provided in in the diet. (ex. Histidine, lysine, and
phenylalanine)
28.Intravenous Fat Emulsions- added to parenteral nutrition (PN) to provide
supplemental kilocalories, prevent essential fatty acid deficiencies, and help
control hyperglycemia during periods of stress; Administer emulsions through a
separate peripheral line through the central line using Y connector tubing or as an
admixture to the PN solution; The addition of fat emulsion to PN solution is called
a 3 in 1 admixture or total nutrient admixture; Pt receives IV fat emulsions over a
24 hour period. DO NOT USE admixture if you observe oil droplets or an
oily/creamy layer on the surface of the admixture (this indicates that the emulsion

has broken into large liquid droplets that cause fat emboli if administered. IV fat
emulsions are white and opaque TAKE CARE TO AVOID confusing enteral
formula with parenteral liquids
29.Ketones- substances that are made when the body breaks down fat for energy; all
body cells EXCEPT red blood cells and neurons oxidize fatty acids into ketones
for energy when dietary carbohydrates (glucose) are not adequate
30.Kilocalories (kcal)- is a measurement of the amount of energy in the foods you
eat; when energy requirements are completely met kilocalorie (kcal) intake in food,
weight does not change; when the kilocalories ingested EXCEEDS a persons
energy demands, the individual gains weight; if the kilocalories ingested FAILS to
meet a persons energy requirements, the individual loses weight.
31.Lipids- or fats are the most calorie-dense nutrients providing 9 kcal/g. Composed
of triglycerides and fatty acids.
32.Macrominerals- minerals your body needs in larger amounts; when the daily
requirement is 100mg or more; they help balance the pH of the body and specific
amount are necessary in the blood and cells to promote acid balance base
33.Malabsorption- imperfect absorption of food material by the small intestines;
treatment of malabsorption syndromes such as celiac disease includes a gluten free
diet. Gluten is present in wheat, rye, barley, and oats. Short bowel syndrome results
from extensive resection of bowel after which patients suffer from malabsorption
caused by lack of intestinal surface area. These patients require LIFETIME feeding
with either elemental enteral formulas or PN.
34.Malnutrition Medical Nutritional Therapy (MNT)- the use of specific
nutritional therapies to treat an illness, injury, or condition; is necessary to help the
body metabolize certain nutrients , correct nutritional deficiencies related to the
disease, and eliminate food that may exacerbate (make a problem worse, worsen)
disease symptoms. It is most effective using a team approach that promotes
collaboration between the health care team and a registered dietician (RD).
35.Metabolism- all the biochemical reactions within the cells of the body; metabolic
processes are anabolic (building) or catabolic (breaking down)
36.Minerals- inorganic elements essential to the body as catalysts in biochemical
reactions. Can be Macrominerals or Trace elements
37.Monounsaturated Fatty Acids- fatty acids that have one double bond
38.Nitrogen Balance- balance that is achieved when the intake and output of nitrogen
are equal. When intake is GREATER than the output, the body is in positive
nitrogen balance. POSITIVE nitrogen balance is required for growth, normal
pregnancy, maintenance of lean muscle mass and vital organs, and wound healing.
The body uses nitrogen to build, repair, and replace body tissues. Negative nitrogen

balance occurs when the body loses more nitrogen than it gains (ex. infection,
burns, fever, starvation, head injury, and trauma). The increased nitrogen loos is the
result of body tissue destruction or loss of nitrogen-containing body fluids.
NUTRITION during this period needs to provide nutrients to put patients into
positive balance for healing
39.Nutrient Density- the proportion of essential nutrients to the number of
kilocalories; High nutrient dense foods such as fruits and vegetables provide a
large number of nutrients in relationship to kilocalories; low nutrient dense foods
such as alcohol or sugar are high in kilocalories but nutrient poor.
40.Nutrients- the elements necessary for the normal function of numerous body
processes. Energy needs are met from a variety of nutrients: carbohydrates,
proteins, fats, water, vitamins, and minerals
41.Parental Nutrition (PN) - a form of specialized nutrition support in which
nutrients are provided intravenously. A basic PN formula is a combination of
crystalline amino acids, hypertonic dextrose, electrolytes, vitamins and trace
elements. TPN administered through a central line, is a 2 in 1 formula in which fat
emulsions are administered separately from the protein and dextrose solution. Safe
administration depends on appropriate assessment of nutrition need, meticulous
management of the central venous catheter (CVC), and careful monitoring to
prevent or treat metabolic complications. Patients who are unable to digest or
absorb EN benefit from PN. Patients in highly stressed physiological states such as
sepsis, head injury, or burns are candidates for PN therapy. Indications for
parenteral nutrition include nonfunctional gastrointestinal tract (massive small
bowel resection/GI surgery/ massive GI bleed, paralytic ileus, intestinal
obstruction, trauma to abdomen/head/neck, severe malabsorption, intolerance to
enteral feeding (established by trial), chemotherapy, radiation therapy, bone
marrow transplantation), extended bowel rest (enterocutaneous fistula,
inflammatory bowel disease exacerbation, severe diarrhea, moderate to severe
pancreatitis), preoperative total parenteral nutrition (preoperative bowel rest,
treatment for co-morbid severe malnutrition in patients with nonfunctional GI
tracts, severely catabolic patients when GI tract nonusable for more than 4 to 5
days; clinical and laboratory monitoring by a multidisciplinary team is required
throughout PN is consistently reevaluated. The goal to move toward the use of the
GI tract is constant. Disuse of the GI tract has been associated with villus atrophy
and generalized cell shrinkage. As a result of the disuse of the GI tract, bacteria
may move from the unused gut into the bloodstream, resulting in gram negative
septicemia.

42.Peristalsis- a wave-like muscular contraction that move the food to the base of the
esophagus, above the cardiac sphincter; happens after swallowed food (bolus)
enters the esophagus
43.Polyunsaturated Fatty Acids- fatty acids that have two or more double carbon
bonds
44.Proteins- provide a source of energy (4 kcal/g) and are essential for synthesis
(building) of body tissue in growth, maintenance, and repair. Blood clotting, fluid
regulation, and acid base balance require proteins. These proteins transport
nutrients and many drugs in the blood. INGESTION of proteins maintains nitrogen
balance.
45.Resting Energy Expenditure (REE) - the resting metabolic rate; the amount of
energy that an individual needs to consume over a 24 hour period for the body to
maintain all of its internal working activities while at rest. Factors affecting
metabolism include illness, pregnancy, lactation and energy level. RMR measures
your resting energy expenditure. REE determines the number of calories you burn
in a 24 hour period maintaining basic bodily functions, but also includes the
number of calories burned eating and conducting small amounts of activity.
46.Saccharides- carbohydrate units (sugars) ex. Monosaccharide, disaccharide, and
polysaccharide.
47.Saturated Fatty Acids- in which each carbon group in the chain has two attached
hydrogen atoms. This is a type of fat that comes mainly from animal sources of
food, such as red meat, poultry and full-fat dairy products. Saturated fat raises total
blood cholesterol levels and low-density lipoprotein (LDL) cholesterol levels,
which can increase your risk of cardiovascular disease. Saturated fat may also
increase your risk of type 2 diabetes.
48.Simple Carbohydrates- monosaccharides and polysaccharides (glycogen and
starches) are found primarily in sugars. They are insoluble (incapable of being
dissolved) in water and digested to varying degrees.
49.Trace Elements-or Microminerals, small amounts of minerals your body needs;
less than 100 is needed daily. Interaction usually occur between trace minerals.
Excess of one mineral can cause deficiency of another.
50.Triglycerides- a component of fat that circulates in the blood and are composed of
three fatty acids attached to glycerol
51.Unsaturated fatty acids- in which an unequal number of hydrogen atoms are
attached and the carbon atoms attach to each other with a double bond.
Monounsaturated fats are found in a variety of foods and oils. Studies show that
eating foods rich in monounsaturated fats (MUFAs) improves blood cholesterol
levels, which can decrease your risk of heart disease. Research also shows that

MUFAs may benefit insulin levels and blood sugar control, which can be
especially helpful if you have type 2 diabetes. Polyunsaturated fats is mostly found
in plant-based foods and oils. Evidence shows that eating foods rich in
polyunsaturated fats (PUFAs) improves blood cholesterol levels, which can
decrease your risk of heart disease. PUFAs may also help decrease the risk of type
2 diabetes. Omega 3 are beneficial to the heart. Omega-3, found in some types of
fatty fish, appears to decrease the risk of coronary artery disease. It may also
protect against irregular heartbeats and help lower blood pressure levels. There are
plant sources of omega-3 fatty acids. However, the body doesn't convert it and use
it as well as omega-3 from fish.
52.Vegetarianism- the consumption of a diet consisting predominantly of plant foods.
Some vegetarians are ovolactovegetarian (AVOID meat, fish, and poultry but eats
eggs and milk), lactovegetarians (drink milk but avoid eggs), or vegans (consume
only plant foods). Through careful selection of foods, an individual following a
vegetarian diet CAN MEET recommendation for proteins and essential nutrients.
Zen Macrobiotic (eats primarily brown rice, other grains, and herb teas) and
Fruitarians (eats only fruits, nuts, honey, and olive oil) diets are NUTRIENT
POOR and frequently result in malnutrition. Children who follow a vegetarian diet
are especially at risk for protein and vitamin deficiencies (Vitamin B12). Careful
planning helps to ensure a balanced, healthy diet.
53.Vitamins- organic substances present in small amounts in foods that are essential
to normal metabolism; when there is enough of any specific vitamin to meet the
bodys catalytic demands, the rest of the vitamin supply acts as a free chemical and
is often toxic to the body. Certain vitamins are currently of interest as their role as
antioxidants. These vitamins neutralize substances called free radicals, which
produce oxidative damage to body cells and tissues. The researchers think that
oxidative damage increases a persons risk for various cancers. These vitamins
include Beta-carotene, Vitamin A, C, and E. The body is unable to synthesize
vitamins in the required amounts and depends of dietary intake. Vitamin content is
usually higher fresh foods that are used quickly after minimal exposure to heat, air,
or water. Vitamins are classified as either fat soluble or water soluble.
54. Water Soluble Vitamins- (Vitamin C and B complex (which of 8 vitamins)) the
body does not store water-soluble so they need to be provided in you daily food
intake. Water soluble vitamins absorb easily from the GI tract. Although they are
not stored, toxicity can still occur