NUTRITION AND DIET THERAPY

SECTION 1 Sources of protein: meats, fish, poultry,

eggs, milk, cheese, corn, grains, nuts, and seeds
Chapter 1: The Relationship of Food and Health Vitamins
- Organic compounds
Nutrients - Regulate body processes
- Chemical substances necessary for Examples: vitamins A, B, C, D, E and K
life Minerals
- Functions: - Inorganic compounds
• Provide energy - Regulate body processes
• Build and repair tissue Examples: calcium, phosphorus,
• Regulate body processes potassium, sodium, chloride, iron, magnesium,
Nutrients: Six classes zinc
• Carbohydrates Water
• Fats (lipids) - Major constituent of all living cells
• Proteins - Composed of hydrogen and oxygen
• Vitamins
• Minerals The Six Essential Nutrients and Their Functions
• Water
Nutrients Organic
• Contains carbon, hydrogen, Organic Nutrients Function
oxygen Carbohydrates Provide energy
• Carbon is found in all living
things Fats Provide energy
• Example: carbohydrates, fats, Proteins Build & repair
proteins, vitamins tissues
Inorganic
• In simplest form when ingested Vitamins Regulate body
• Function: regulate body processes
processes
• Example: water, minerals
Carbohydrates Inorganic Nutrients Function
- Provides major source of energy Minerals Regulate body
Examples: cereal grains, vegetables, processes
fruits, nuts, and sugars
Fats (lipids) Water Regulates
- Provides energy body processes
- Highest kilocalorie value
Sources of fat: meats, milk, cream, Stop and Share
butter, cheese, egg yolks, oils, nuts A client is at home recovering from surgery. You
Protein ask the client what they have eaten over the past
- Builds and repairs body tissues 24 hours. The client states the following:
- Provides energy • Breakfast: 2 doughnuts, orange
- Only one of the six nutrients that juice
contains nitrogen • Lunch: lettuce salad with oil &
vinegar, soda
 • Snack: pretzels, soda b. Weight
• Dinner: spaghetti with tomato c. Head circumference (children)
sauce, garlic bread; wine d. Upper arm measurement
Discuss the answers to the following questions: e. Skinfold
• What nutrients are missing in the 2. Clinical Examination
client’s diet? Clinical Signs Possible
• Why are these nutrients Deficiencies
important for this client? Pallor, blue half Iron, copper, zinc,
- The client is missing protein and circles beneath eyes B12, B6, biotin
water in the diet. Edema Protein
- Protein is needed to build and repair
body tissues after surgery. Bumpy Vitamin A
“gooseflesh”
- Water is needed to prevent
Lesions at corner of Riboflavin
dehydration.
mouth
Glossitis Folic acid
Malnutrition Numerous “black Vitamin C
Overnutrition and blue” spots and
• Excess energy or nutrient intake tiny, red “pin prick”
Undernutrition hemorrhages under
• Deficient energy or nutrient the skin
intake Emaciation Carbohydrates,
- Overnutrition is a larger problem in proteins; kcal
the United States than Poorly shaped Vitamin C
undernutrition. bones or teeth or
delayed appearance
Relation of Food to Health of teeth in children
Cumulative Slow clotting time Vitamin K
• Excess nutrients over time of blood
Unusual Niacin
• Examples: atherosclerosis,
nervousness,
obesity, hypertension, diabetes,
dermatitis, diarrhea
gallbladder disease, some in same patient
cancers Tetany Calcium,
Deficiencies potassium, sodium
• Nutrients lacking for extended Goiter Iodine
period Eczema Fat
• Examples: iron deficiency,
beriberi, scurvy, osteomalacia, 3. Biochemical Tests
osteoporosis, rickets, goiter Serum albumin level
• Measures main protein in blood
Nutritional Assessment • Determines protein status
1. Anthropometric measurements Serum transferrin level
2. Clinical examination • Indicates iron-carrying protein in
3. Biochemical tests blood
4. Dietary/social history •  indicates iron stores low
•  indicates body lacks protein
1. Anthropometric Measurements Blood urea nitrogen (BUN)
a. Height
 • may indicate renal failure, Chapter 2: Planning a Healthy Diet
insufficient renal blood supply,
or blockage of the urinary tract Balanced Diet
Serum creatinine - Includes all the essential nutrients in
• indicates amount of creatinine in appropriate amounts
blood - Preserves and promotes good health
• used to evaluate renal function Food Guide Pyramid
Creatinine excretion
• indicates amount of creatinine
excreted in urine over a 24-hour
period
• used in estimating body muscle
mass
• muscle mass depleted, as in
malnutrition; level will be low
Other tests
• Hemoglobin (Hgb)
• Hematocrit (Hct)
• Red blood cells (RBCs)
• White blood cells (WBCs)
• Lipid profile (high & low-
density lipoprotein, serum
triglycerides)
Food Labeling
• Urinalysis
- Mandatory labeling for nearly all
4. Dietary/Social History
processed foods started in May, 1994
Evaluation of food habits.
as a result of the Nutrition Labeling
• 24-hour recall: Client
and Education Act (NLEA).
interviewed by the dietitian and
- Primary objective is to ensure that
asked to give types, amounts,
labels on most foods provide
and preparation of all foods
consistent nutrition information.
eaten in past 24 hours
- Food and Drug Administration
• Food diary: written record of all
(FDA) sets health claims allowed
food and drink ingested in a
and serving sizes.
specified period
- Descriptive terms standardized
• Computer diet analysis to
determine nutrient deficiencies
Nutrition Facts Required:
or toxicities
Total calories Total fat
Social history
Calories from fat Saturated fat
• Consideration of financial
Cholesterol Sodium
resources to obtain needed food,
Total Carbohydrates Dietary Fiber
and properly store and cook food
Sugars Protein
• Food-drug interactions that can
Vitamin A Vitamin C
lead to malnutrition
Calcium Iron

Food Customs
 - Food habits may be based on
nationality, culture, and religion.
- Foods available in a certain area may
be favored for economic reasons.
- Economic status and social status
contribute to food habits.
Chapter 3: Digestion, Absorption, & - Length of time food is in mouth is
Metabolism
Digestion
- The breakdown of food in the body
in preparation for absorption.
- Mechanical digestion: food is
broken up by teeth and moved along
GI tract by peristalsis.
- Chemical digestion: carbohydrates,
proteins, and fats are broken down
into nutrients tissues can absorb and
use.
- Chemical changes occur through
hydrolysis (the addition of water and
breaking down of food molecules).
- Enzymes act on food substances,
causing them to break down into
simple compounds.
- An enzyme can act as a catalyst,
which speeds up the chemical
reactions without itself being
changed in the process.
Absorption
- The passage of nutrients into the
blood or lymphatic system.
- Nutrients must be in their simplest
form
• Carbohydrates: simple sugars
• Proteins: amino acids
• Fats: fatty acids and glycerol
- Most absorption occurs in the small
intestine; some occurs in the large
intestine.
- Water is absorbed in the stomach,
small intestine, and large intestine.
The Digestive System
✓ Mouth
- Digestion begins here
- Enzyme (salivary amylase) acts on
starch
- Starch is a complex carbohydrate
- Teeth break up food; food mixes
with saliva
- “Bolus” formed
brief
- Small amounts of carbohydrates
changed
✓ Esophagus
- Food travels through this muscular
tube
- Connects mouth to stomach
- Peristalsis and gravity act to move
bolus
- Cardiac sphincter opens at lower end
of esophagus to allow passage of
bolus into stomach
✓ Stomach
- Temporary storage of food
- Mixing of food with gastric juices
- Regulation of a slow, controlled
emptying of food into the intestine
- Secretion of the intrinsic factor for
vitamin B12
- Destruction of most bacteria
inadvertently consumed
✓ Stomach
- Hydrochloric acid prepares the
gastric area for enzyme action
- Pepsin breaks down proteins
- In children, rennin breaks down milk
proteins
- Lipase acts on emulsified fats
✓ Small Intestine
- Hormones released
• Secretin causes pancreas to
release sodium bicarbonate to
neutralize acidity of chyme
• Cholecystokinin triggers
gallbladder to release bile
- Bile
• Emulsifies fat after it is secreted
into small intestine
 • Produced in liver; stored in • Also known as aerobic
gallbladder metabolism
- Enzymes are found in the pancreatic - Energy is released as nutrients are
juice that is secreted into small oxidized.
intestine. - Anaerobic metabolism reduces fats
• Pancreatic proteases (trypsin, without the use of oxygen.
chymotrypsin, - The complete oxidation of
carboxypeptidases): split carbohydrates, proteins, and fats is
proteins commonly called the Krebs cycle.
• Pancreatic amylase: converts - Anabolism is the process of using
starches (polysaccharides) to energy from oxidation to create new
simple sugars compounds.
• Pancreatic lipase: reduces fats to - Catabolism is the breakdown of
fatty acids and glycerol compounds during metabolism.
- Produces enzymes - Controlled primarily by hormones
- Prepares foods for absorption secreted by the thyroid gland:
- Lactase, maltase, sucrase convert Triiodothyronine (T3) and thyroxine
lactose, maltose, sucrose to simple (T4).
sugars Energy
- Peptidases reduce proteins to amino - Needed for involuntary and
acids voluntary activity
- Twenty-two feet long - Involuntary activity: maintenance of
- Villi, hairlike projections, increase body tissue, temperature, growth
surface area for maximum - Voluntary activity: walking,
absorption swimming, eating, reading, typing
✓ Large Intestine - Three groups of nutrients provide
- Colon walls secrete mucus to protect energy
against acidic digestive juices in • Carbohydrates
chyme. • Proteins
- Major tasks of the large intestine: • Fats
• Absorb water - Carbohydrates should be primary
• Synthesize some B vitamins and source of energy.
vitamin K - The unit used to measure the energy
• Collect food residue value of foods is the kilocalorie.
Metabolism - kcal: amount of heat needed to raise
- The use of food by the body after the temperature of 1 kilogram of
digestion water 1 degree Celsius.
- Results in energy - kcal is commonly called calorie.
- Occurs after digestion and ❖ 1 gram of carbohydrate yields 4 kcal
absorption; nutrients are carried by ❖ 1 gram of protein yields 4 kcal
the blood to the cells of the body ❖ 1 gram of fat yields 9 kcal
- Oxidation ❖ 1 gram of alcohol yields 7 kcal
• Nutrients combine with oxygen
• Carbohydrates reduce to carbon Stop and Share
dioxide and water If you eat a dessert with 19 grams of fat
• Protein to carbon dioxide, water, in it, how many calories from fat does it have?
and nitrogen 171 calories
Fat contains 9 kcal per gram
Dessert has 19 grams of fat
9 kcal/gram × 19 grams of fat = 171 kcal
Basal Metabolic Rate (BMR)
- The rate at which energy is needed
for body maintenance.
- The energy necessary to carry on all
involuntary vital processes while the
body is at rest.
- Also known as resting energy
expenditure (REE).
- Factors that affect BMR: lean body
mass, body size, sex, age, heredity,
physical condition, and climate.
❖ BMR is greater in men than women.
❖ BMR increases during growth and fever.
❖ BMR decreases with age and during
starvation.
Calculating BMR
1. Harris-Benedict equation
• Used by dietitians for persons
over age 18
• Uses height, weight, and age
Female BMR
655 + (9.6 × weight in kg) + (1.8 × height
in cm) – (4.7 × age)
Male BMR
66 + (13.7 × weight in kg) + (5 × height
in cm) – (6.8 × age)
2. Another method used to estimate BMR
• Convert body weight from
pounds to kilograms
• Multiply kilograms by 24 (hours
per day)
• Multiply the answer obtained by
0.9 for a woman and by 1.0 for a
man
Stop and Share
Calculate the BMR for a woman who
weighs 110 pounds.
Calculate the BMR for a man who weighs
170 pounds.
110 pound woman: BMR 1,080 kcal
110 pounds  2.2 (pounds per kg) = 50 kg
50 kg × 24 hours in a day = 1,200 kcal
1,200 kcal × 0.9 =1,080 kcal
170-pound man: BMR 1,854 kcal
170 pounds  2.2 (pounds per kg) = 77.27 kg
77.27 kg × 24 hours in a day = 1,854 kcal
1,854 kcal × 1.0 =1,854 kcal
Chapter 4: Carbohydrates
- Primary source of energy for the
body.
- Least expensive and most abundant
of the energy nutrients.
- Named for the chemical elements
they are composed of—carbon,
hydrogen, and oxygen.
- Functions:
▪ Providing Energy
- Each gram of carbohydrate provides
4 kcal.
- A body needs a constant energy
supply.
- A half day’s supply of carbohydrates
is stored in the liver and muscles for
use as needed.
- Stored form is called glycogen.
▪ Protein-Sparing Action
- The primary function of proteins is to
build and repair tissues.
- When enough carbohydrates (at least
50-100 g/day) are ingested, protein is
spared.
▪ Normal Fat Metabolism
- Without an adequate supply of
carbohydrates, fat is metabolized to
meet energy requirements.
- Ketones are produced as a byproduct
of fat metabolism.
- Ketosis may result.
▪ Providing Fiber
- Dietary fiber is found in grains,
vegetables, and fruits.
- Recommended intake is 20-35 g/day.
- Fiber lowers blood glucose levels;
may prevent some colon cancers; and
helps prevent constipation,
 hemorrhoids, and diverticular - Must be changed to simple sugars by
disease by softening stool. hydrolysis before absorption
Food Sources - Sucrose, maltose, and lactose
- Principal sources of carbohydrates a. Sucrose
are plant foods: • Composed of glucose and
• Cereal grains fructose
• Vegetables • Form of carbohydrate present in
• Fruits granulated, powdered, and
• Nuts brown sugar, and in molasses
• Sugars • One of the sweetest and least
- The only substantial animal source is expensive sugars
milk. • Sources: sugar cane, sugar
beets, maple syrup, candy, jams
CLASSIFICATION and jellies
1. Monosaccharides b. Maltose
• Simple sugars • Intermediary product in the
2. Disaccharides hydrolysis of starch
3. Polysaccharides • Also created during the
• Complex carbohydrates fermentation process that
produces alcohol
Monosaccharides • Found in some infant formulas,
- Simplest form of carbohydrates malt beverage products, and beer
- Absorbed directly into bloodstream • Less sweet than glucose or
from the small intestine sucrose
- Glucose, fructose, galactose c. Lactose
a. Glucose • Sugar found in milk
• Also called dextrose • Distinct from other sugars in that
• All other forms are converted to it is not found in plants
glucose for eventual metabolism • Helps body absorb calcium
• Berries, grapes, sweet corn, corn • Less sweet than
syrup monosaccharides or other
• Central nervous system, red disaccharides
blood cells and brain use only Polysaccharides
glucose as fuel - Complex carbohydrates
b. Fructose - Compounds of many
• Also called levulose or fruit monosaccharides
sugar - Important polysaccharides in
• Ripe fruits, honey, soft drinks nutrition:
• Sweetest of all the • Starch
monosaccharides • Glycogen
c. Galactose • Fiber
• Product of digestion of milk a. Starch
• Not found naturally • Found in grains and vegetables
• Source is lactose • Storage form of glucose in plants
Disaccharides • Supplies energy over a longer
- Pairs of monosaccharides period of time because it takes
the body longer to digest
 polysaccharides than - Carried to the liver; fructose and
monosaccharides or galactose changed to glucose
disaccharides - Glucose carried to cells
b. Glycogen Polysaccharides
• Sometimes called animal starch - More complex; digestibility varies
because it is the storage form of - Cellulose wall broken down, starch
glucose in the body changed to intermediate product
• Hormone glucagon helps liver dextrin, then maltose, and finally
convert glycogen to glucose as glucose
needed - Starch digestion begins in mouth
c. Fiber where the enzyme salivary amylase
• It is indigestible because it begins to change starch to dextrin
cannot be broken down be
digestive enzymes Metabolism
• Insoluble: does not readily - Islets of Langerhans in pancreas
dissolve in water (cellulose, secrete insulin
hemicellulose, lignins) - Insulin is the hormone that controls
• Soluble: dissolves in water glucose metabolism
(gums, pectins, some - Impaired or absent insulin secretion
hemicellulose, mucilages) results in high blood glucose level
Polysaccharides: Sources (hyperglycemia)
Starch - Low blood glucose level
• Cereals, grains, potatoes, corn, (hypoglycemia)
beans, yams Dietary Requirements
Dextrins - Food and Nutrition Board of the
• Starch hydrolysis National Research Council
Glycogen recommends:
• Glucose stored in liver and • Half of one’s energy requirement
muscles should come from carbohydrates
Cellulose • Complex carbohydrates
• Wheat bran, whole-grain cereals, preferred
fruits, green and leafy vegetables • Weight loss and fatigue can
result from a diet deficient in
Digestion and Absorption: carbohydrates

Monosaccharides Stop and Share

- Simple sugars absorbed directly into
bloodstream
- Carried to the liver; fructose and
galactose changed to glucose
- Glucose carried to cells
Disaccharides
- Enzymes sucrase, maltase, lactase
convert sucrose, maltose, lactose to
simple sugars.
- Simple sugars absorbed directly into
bloodstream
Solve the following problem:
A patient’s total energy requirement is 2,000
kcal a day. How many grams of carbohydrate
does this patient need per day?
If a patient’s total energy requirement is
2,000 kcal/day; ½ of these should be from
carbohydrates. 2,000  2 = 1,000 kcal
To figure out how many grams are needed, divide
1,000 by 4 (4 calories per gram of carbohydrate).
1,000 kcal  4 kcal/g = 250 grams
Chapter 5: Lipids or Fats • Composed of three fatty acids
- Fats belong to a group of organic attached to a framework of
compounds called lipids. glycerol
- Greasy substances that are insoluble Phospholipids
in water. Sterols
- Each gram of fat contains 9 kcal. • Cholesterol
- Composed of carbon, hydrogen, and
oxygen; lower proportion of oxygen Fatty Acids
than carbohydrates. - are organic compounds of carbon
Functions atoms to which hydrogen atoms are
▪ Provide energy attached.
▪ Carry fat-soluble vitamins - They may be classified in two ways.
▪ Supply essential fatty acids i. May be classified by the body’s need for
▪ Protect and support organs and bones them
▪ Insulate from cold • Essential
▪ Provide satiety to meals • Nonessential
Food Sources ii. May be classified by degree of saturation
Animal with hydrogen atoms
• Fatty meats • Saturated
• Lard • Unsaturated
• Butter Monounsaturated
• Cheese Polyunsaturated
• Cream; whole milk
• Egg yolk Essential Fatty Acids
Plant Cannot be synthesized by the body
• Vegetable oils Must be obtained from the diet
• Nuts Types:
• Chocolate • Linoleic acid
• Avocados • Linolenic acid
• Olives
• Margarine Non-essential Fatty Acids
Can be synthesized by the body
Visible and Invisible Fats Arachidonic fatty acid, previously
Visible fats thought to be essential, can be
• Fats in foods that are purchased synthesized in the body from linoleic
and used as fats, such as butter or fatty acid.
margarine, lard, cooking oils
Invisible fats Saturated Fats
• Fats that are not immediately Each of its carbon atoms carries all
noticeable such as those in egg the hydrogen atoms possible.
yolk, cheese, cream, and salad In general, animal foods contain
dressings more saturated fatty acids than
Classification: unsaturated.
Triglycerides Usually solid at room temperature.
• Most lipids in the body (95%) Examples: Meat, poultry, egg yolks, whole milk,
are triglycerides whole milk cheeses, cream, ice cream, butter,
chocolate, coconut, palm oil
Monounsaturated Fats
Fewer hydrogen atoms attached to
one place among the carbon atoms of
its fatty acids than saturated fats.
Lowers low-density lipoprotein
(LDL or “bad cholesterol”).
Examples: Olive oil, canola oil, avocados,
cashew nuts
Recommended: 15% of total daily
kcal
Polyunsaturated Fats
Fewer hydrogen atoms attached to
two or more places among the carbon
atoms of its fatty acids than saturated
fats.
Examples: Cooking oils made from sunflower,
safflower, sesame seeds or from corn or
soybeans, soft margarines whose major
ingredient is liquid vegetable oil, and fish
Foods containing high proportions of
polyunsaturated fats are usually soft
or oily.
❖ Omega-3 fatty acids (found in fish)
lower the risk of heart disease.
❖ Omega-6 (linoleic acid) has a
cholesterol-lowering effect.
Recommended: 10% of total daily
kcal
Hydrogenated Fats
Polyunsaturated vegetable oils to
which hydrogen has been added
commercially to make them solid at
room temperature.
This process, called hydrogenation,
turns polyunsaturated vegetable oils
into saturated fats.
Margarine is made in this way.
Trans-Fatty Acids (TFAs)
Produced when hydrogen atoms are
added to monounsaturated or
polyunsaturated fats to produce a
semi-solid product like margarine
and shortening.
TFAs raise low-density lipoproteins
(LDL) and total cholesterol.
Major source: baked goods and
restaurant foods
Phospholipid
Found in both plant and animal
foods, and is synthesized in the liver.
Natural emulsifier that helps
transport fat in the bloodstream.
Example: Lecithin
Cholesterol
Cholesterol is a sterol
Fatlike substance
Exists in animal foods and body cells
Does not exist in plant foods
Essential for the synthesis of bile, sex
hormones, cortisone, and vitamin D
Needed by every cell in the body
Digestion and Absorption
95% of ingested fats are digested
Complex process
Chemical digestion of fats occurs
mainly in the small intestine
No digestion of fats occurs in the
mouth
Slight digestion in stomach where
gastric lipase acts on emulsified fats
such as those found in cream and egg
yolk.
▪ Digestion in the small intestine
• Bile emulsifies the fats
• The enzyme pancreatic lipase
reduces the fats to fatty acids and
glycerol
• The body subsequently absorbs
through the villi of the small
intestine
▪ Lipoproteins
• In the initial stages of fat
absorption, bile joins with the
products of fat digestion to carry
fat.
 • Later, protein combines with the final
products of fat digestion to form special
carriers called lipoproteins.
• Lipoproteins carry the fat in the blood to
the body cells.
Classified according to mobility and density
Types
a. Chylomicrons
b. Very-low-density lipoproteins
(VLDLs)
c. Low-density lipoproteins (LDLs)
d. High-density lipoproteins (HDLs)
Chylomicron
First lipoprotein identified after
eating
Largest lipoprotein
Lightest in weight
Composed of 80-90% triglycerides
Very-low-density Lipoproteins (VLDLs)
Made by the liver to transport lipids
throughout the body.
Composed of 55-65% triglycerides.
Carry triglycerides and other lipids to
all cells.
As the VLDL lose triglycerides, they
pick up cholesterol from other
lipoproteins in the blood and they
then become LDL.
Low-density Lipoproteins (LDLs)
Composed of 45% cholesterol with
few triglycerides.
Carry most of the blood cholesterol
from the liver to the cells.
Elevated blood levels greater than
130 mg/dl of LDL are thought to be
contributing factors in
atherosclerosis.
“Bad cholesterol”
High-density Lipoproteins (HDLs)
Carry cholesterol from the cells to
the liver for eventual excretion.
Levels of HDL greater than 35 mg/dl
are thought to reduce the risk of heart
disease.
Exercise, maintaining a desirable
weight, and giving up smoking are
all ways to increase one’s HDL.
“Good cholesterol”
Metabolism and Elimination
The liver controls fat metabolism.
The metabolism of fats occurs in the
cells.
Fatty acids are broken down to
carbon dioxide and water, releasing
energy.
Portion of fat not needed for
immediate use stored as adipose
tissue.
Carbon dioxide and water are waste
products removed from the body by
the circulatory, respiratory, and
excretory systems.
Fat Alternatives
Olestra: Made from carbohydrates and fat
• FDA approved for use in snack
food
• Government requires that food
labels indicate olestra “inhibits
absorption of some vitamins and
other nutrients”
• Contains no calories; can cause
cramps and diarrhea
Simplesse: Made from egg white or milk protein
Oatrim: Carbohydrate-based; derived from oat
fiber
Dietary Requirements
The Food and Nutrition Board’s
Committee on Diet and Health
recommends that people reduce their
fat intake to 30% of total kcal.
Chapter 6: Proteins pea soup, bread and cheese, bread and baked
Of the six nutrient groups, only beans, macaroni and cheese, cereal and milk
proteins can make new cells and
rebuild tissue. Food Sources
Proteins are the basic material of Animal food sources
every body cell. o Complete proteins
Proteins are the only nutrient group o Meats, fish, poultry, eggs, milk, cheese
that contains nitrogen. Plant food sources
Proteins are composed of amino o Incomplete proteins
acids. o Corn, grain, nuts, sunflower seeds,
sesame seeds, and legumes
Amino Acid
Nitrogen containing compound of Analogues
which protein is composed. Meat alternatives made from soy
There are twenty amino acids. protein and other ingredients to
Nine are considered essential. simulate various kinds of meat
Essential Tofu is a soft cheeselike food made
Histidine Isoleucine Leucine from soy milk
Lysine Methionine Phenylalanine
Treonine Tryptophan Valine Functions
▪ Building and repairing body tissue
Nonessential ▪ Regulating body functions
Alanine Arginine Asparagine a) Metabolism and digestion
Aspartic acid Cysteine Cystine b) Fluid and electrolyte balance
Glutamic acid Glutamine Glycine c) Development of antibodies
Proline Serine Tyrosine ▪ Providing energy
Hydroxyproline Each gram of protein provides 4 kcal

CLASSIFICATION Digestion and Absorption

Complete Mechanical digestion

High quality
Contains all nine essential amino
acids
Chemical digestion
Incomplete
Low quality
Lacks one or more amino acid
Cannot build tissue without help
Complementary Proteins
Occurs when a combination of
incomplete proteins is eaten in the
same day to make a complete
protein
Examples: corn and beans, rice and
beans, bread and peanut butter, bread and split
• Begins in mouth
• Teeth grind food into small pieces
• Begins in stomach
• Hydrochloric acid prepares stomach
• Enzyme pepsin reduces proteins to
polypeptides
• Digestion and Absorption
• Chemical digestion
• Polypeptides: ten or more amino acids
bonded together
• In the small intestine, three pancreatic
enzymes (trypsin, chymotrypsin,
carboxypeptidase) continue chemical
digestion and absorption through the villi
Metabolism and Elimination represent no more than 15-20%
of one’s daily kcal intake and not
Amino acids are broken down, the exceed double the amount given in
nitrogen-containing amine group is the table of Recommended Dietary
stripped off (deamination). Allowances.
Ammonia is produced.
Liver picks up ammonia and Nitrogen Balance
converts it to urea. Nitrogen intake equals nitrogen
Kidney filters out urea and excretes excreted.
it. Positive nitrogen balance exists
Remaining parts are used for energy when nitrogen intake exceeds
or converted to carbohydrate or fat amount excreted.
and stored as glycogen or adipose ✓ Pregnancy
tissue. ✓ Growth periods
✓ Building muscle
Dietary Requirements ✓ Rebuilding tissue after
Determined by size, age, sex, and trauma/illness
physical and emotional conditions. Negative nitrogen balance exists
The National Research Council of when more nitrogen is lost than taken
the National Academy of Sciences in.
considers the average daily ✓ Fever
requirement to be 0.8 g of protein ✓ Injury
for each kilogram of body weight. ✓ Surgery
To determine your requirement ✓ Burns
1) Divide body weight by 2.2 (the number ✓ Starvation
of pounds per kilogram) ✓ Immobilization
2) Multiply the answer obtained in the first
step by 0.8 (grams of protein per Protein Deficiency
kilogram of body weight) Muscle wasting occurs
Albumin (protein in blood plasma)
Stop and Share causes edema
Your client weighs 170 pounds. What is Loss of appetite, strength, weight
the client’s daily requirement for protein? Lethargy, depression, slow wound
healing
170 pounds  2.2 pounds/kg = 77.27 kg
77.27 kg  0.8 grams of protein = 61.81 g Protein Energy Malnutrition (PEM)
Answer: 62 grams of protein Lack protein and energy-rich foods.
Found in developing countries with
Protein Excess shortages of protein and energy-rich
Saturated fats and cholesterol may foods.
contribute to heart disease Stunted growth and mental
Connection to colon cancer retardation may occur.
Substitute for essential fruits and
vegetables Marasmus
Increased demand on kidneys Affects very young children.
National Research Council
recommends that protein intake
 Results from severe malnutrition • Vitamin B complex which
(lack of protein, vitamins, and includes: thiamin (B1), riboflavin
minerals). (B2), niacin, vitamin B6, folate,
Emaciated, no edema vitamin B12 (cobalamin),
Hair is dull and dry; skin thin and pantothenic acid, biotin
wrinkled. Requirements
Vitamin allowances given by weight in
Kwashiorkor milligrams (mg) or micrograms (mcg or g)
Sudden or recent lack of protein- Dietary reference intake (replacing
containing food; affects children recommended dietary allowance)
and adults. UL–tolerable upper limits–maximum level of
Fat accumulates in liver, and lack of daily intake unlikely to cause adverse effects
protein and hormones results in
edema, painful skin lesions, and Vitamin Deficiency
changes in pigmentation of skin and People prone to vitamin deficiency:
hair. • Alcoholics
High mortality rate • Poor and incapacitated elderly
Marasmus Kwashiorkor • Clients with serious diseases that
1. Weight 1. Weight affect appetite
decreased within • Mentally retarded
2. Visceral normal limits • Children receiving inadequate
proteins 2. Visceral care
within proteins Deficiency of Fat-soluble Vitamins
normal limits decreased
Chronic malabsorption diseases
3. Immune 3. Immune
function function • Cystic fibrosis
within decreased • Celiac disease
normal limits 4. Reddish color • Crohn’s disease
4. Dull, dry hair hair
5. Emaciated, 5. Edema, puffy Avoiding Vitamin Loss
wrinkled appearance - Buy fresh, unbruised vegetables and
appearance fruits and use them raw when
possible.
- Prepare fresh vegetables and fruits
just before serving.
Chapter 7: Vitamins - Heat canned vegetables quickly and
- Organic (carbon-containing) in their own liquid.
compounds that are essential in small - Follow package directions when
amounts for body processes. cooking frozen vegetables or fruit.
- Do not provide energy. - Steam, or use as little water as
- Enable the body to use the energy possible.
provided by fats, carbohydrates, and - Cover pan and cook for a short
proteins. period of time.
- Megadoses can be toxic. - Save cooking liquid for soups, stews,
Vitamin types (13) and gravy.
Fat soluble (4): A, D, E, K - Store in a cool, dark place.
Water soluble (9):
• Vitamin C FAT-SOLUBLE VITAMINS
Vitamin A Sources of Vitamin D
Preformed (retinol) • Sunlight
• Active form of vitamin A • Milk, fish liver oils, egg yolk, butter,
Carotenoids fortified margarine
• Inactive form of vitamin A found • Most milk in the U.S. has 10 g of
in plants vitamin D concentrate added per
quart.
Functions of Vitamin A
a. Antioxidant; protects cells from Vitamin D Requirements
destruction by oxygen. Newborns through 51 years
b. Maintains healthy eyes and skin, normal • 5.0 g (200 IU)
growth and reproduction, and a healthy 51-70 years
immune system. • 10.0 g (400 IU)
c. Helps prevent infection. 70+ years
• 15.0 g (600 IU)
Sources of Vitamin A Pregnant and lactating women
Preformed vitamin A (retinol): Fat-containing
• 5.0 g (200 IU)
animal foods: liver, butter, cream, whole milk,
cheeses
Excess
Carotenoids (provitamin A or beta-carotene):
• Deposits of calcium and
Green leafy vegetables & fruits, carrots, sweet
phosphorus in soft tissues,
potatoes, squash, spinach, broccoli, mango,
kidney and heart damage, and
cantaloupe, pumpkin
bone fragility
Deficit
Vitamin A Requirements
• Poor bone and tooth formation,
- Commonly listed as retinol
rickets which causes malformed
equivalents (RE)
bones and pain in infants
- A retinol equivalent is 1 g retinol or • Osteomalacia (softening of
6 g beta-carotene bones)
Excess • Osteoporosis (brittle, porous
• Birth defects, hair loss, dry skin, bones)
headaches, nausea, dryness of
mucous membranes, liver Vitamin E
damage, and bone and joint pain Tocopherols
Deficit • Alpha (most biologically active)
• Night blindness; dry, rough skin; • Beta, delta, gamma
increased susceptibility to Tocotrienols
infections; and blindness or
xerophthalmia Functions of Vitamin E
a. Antioxidant
Vitamin D b. Prevention of hemolytic anemia among
- Prohormone–converted to a hormone premature infants
in the body. c. Enhance immune system
- D2 (ergocalcifenol) is formed in d. Retard spoilage of commercial foods
plants.
- D3 (cholecalciferol) is formed in Sources of Vitamin E
humans from cholesterol in the skin.
 • Vegetable oils: corn, soybean, safflower, • Dairy products such as eggs, meats,
and cottonseed, and products made from fruits, and cereals.
them such as margarine • Bacteria in small intestine
• Wheat germ, nuts, green leafy vegetables synthesizes some vitamin K but must
be supplemented by dietary sources.
Vitamin E Requirements
• Given as -TE (alpha-tocopherol Vitamin K Requirements
equivalents) - Measured in micrograms.
• 1 mg of -TE = 1 IU 0-6 months
• 2 g/day
Excess 6-12 months
• Relatively nontoxic, fat-soluble • 2.5 g/day
vitamin. Excess stored in Men
adipose tissue. Avoid long-term • 120 g/day
megadoses. Women (same during pregnancy or lactation)
Deficit • 90 g/day
• Serious neurological defects can
occur from malabsorption. Excess
• Anemia can result from
Vitamin K excessive amounts of synthetic
- Made up of several compounds vitamin K
essential to blood clotting. Deficit
- Vitamin K1 (phylloquinone) • Defective blood coagulation,
- Vitamin K2 (menaquinone) which increases clotting time
- Synthetic Vitamin K (menadione) and makes client prone to
- Vitamin K is destroyed by light hemorrhage
alkalis.
WATER-SOLUBLE VITAMINS
Functions of Vitamin K ▪ Vitamin B complex
1. Formation of prothrombin; clotting of ▪ Vitamin C
blood
Vitamin B Complex: Thiamin (B1)
Candidates likely to receive Vitamin K - Essential for nerve and muscle
• Newborns immediately after action, and metabolism of
birth carbohydrates and some amino acids.
• Clients who suffer from faulty - Sources include unrefined and
fat absorption enriched cereals, yeast, wheat germ,
• After extensive antibiotic lean pork, organ meats, and legumes.
therapy
• Antidote for an overdose of Requirement
anticoagulant ❖ Average adult female requires 1.1
• Clients being treated for mg/day.
hemorrhage ❖ Average adult male requires 1.2
mg/day.
Sources of Vitamin K
• Green leafy vegetables such as Deficiency symptoms include loss of appetite,
broccoli, cabbage, spinach, and kale. fatigue, nervous irritability, and constipation.
Beriberi is a disease caused by extreme
deficiency of vitamin B1.
Vitamin B Complex: Riboflavin (B2)
- Necessary for: the metabolism of
carbohydrates, protein, and fats;
tissue maintenance (especially the
skin around the mouth); and healthy
eyes.
Sources
• milk, meats, poultry, fish, enriched
breads, cereals, broccoli, spinach, and
asparagus.
Requirement
❖ Average adult female requires 1.1
mg/day.
❖ Average adult male requires 1.3 mg/day.
Vitamin B Complex: Niacin
- Generic name for nicotinic acid and
nicotinamide.
- A coenzyme in energy metabolism.
Sources
- meats, poultry, fish, peanuts,
legumes.
- Milk and eggs are sources of
tryptophan (precursor).
Requirement
- Measured in niacin equivalents (NE).
- 1 NE = 1 mg of niacin or 60 mg of
tryptophan (an amino acid that is a
precursor of niacin).
❖ Average adult female requires 14
mg/NE.
❖ Average adult male requires 16 mg/NE.
-
Excess
- Excessive amounts of niacin may
cause flushing due to vascular
dilation, GI problems, itching, and
liver damage.
- May be used as a cholesterol-
lowering agent under close
supervision of a physician due to
adverse side effects, which include
liver damage and peptic ulcers.
Deficiency
• Deficiency symptoms include
weakness, anorexia, indigestion,
anxiety, and irritability.
• Pellagra is an extreme deficiency
causing sores on the skin, diarrhea,
anxiety, confusion, irritability, poor
memory, dizziness, and untimely
death.
Vitamin B Complex: Pyridoxine, pyridoxal,
pyridoxamine (B6)
• Essential for protein metabolism and
absorption, and aids in release of
glucose from glycogen.
• Serves as catalyst in conversion of
tryptophan to niacin; helps
synthesize neurotransmitters such as
serotonin and dopamine.
Sources
• poultry, fish, liver, kidney, potatoes,
bananas, spinach, and unrefined whole
grains (oats and wheat).
Deficiency
• symptoms include irritability,
depression, and dermatitis.
• Deficiency in infants can cause
various neurological symptoms and
abdominal problems.
Excess
• Toxicity is rare; may cause
temporary neurological problems.
Requirements:
• Measured in milligrams.
❖ Average adult female requires 1.3-1.5
mg/day.
 ❖ Average adult male requires 1.3-1.7
mg/day.
• Need increases as protein increases.
• Oral contraceptives interfere with
metabolism of vitamin B6 and can
result in a deficiency.
Vitamin B Complex: Folate
• folacin, and folic acid are
chemically similar compounds, and
names are used interchangeably.
• Needed for DNA synthesis, protein
metabolism, formation of
hemoglobin.
Sources
• cereals fortified with folate, green leafy
vegetables, legumes, sunflower seeds,
fruits such as orange juice and
strawberries.
Requiremment
• Measured in micrograms.
❖ Average adult female requires 400
g/day.
❖ Average adult male requires 400 g/day.
• Increased need during pregnancy and
growth.
❖ 600 g/day required one month before
conception through first six weeks of
pregnancy.
Deficiency
• Deficiency linked to neural tube
defects in fetus such as spina bifida
(spinal cord or spinal fluid bulge
through the back) and anencephaly
(absence of the brain).
• Other signs include inflammation of
mouth and tongue, poor growth,
depression and mental confusion,
problems with nerve functions,
megaloblastic anemia.
Excess
• Excess can mask vitamin B12
deficiency and inactivates phenytoin,
an anticonvulsant drug used by
epileptics.
• FDA limits amount in over-the-
counter supplements to:
❖ 100 g for infants
❖ 300 g for children
❖ 400 g for adults
• Cobalamin–contains mineral cobalt.
• Stored in body three to five years.
• Involved in folate metabolism,
maintenance of the myelin sheath,
and healthy red blood cells.
• To be absorbed, must bind with
intrinsic factor in stomach.
Pernicious anemia may result from
loss of intrinsic factor.
Vitamin B Complex: B12
Sources
• animal foods, especially organ
meats, lean meat, seafood, eggs,
dairy products.
Requirement
❖ Average adult requires 2.4 g/day.
❖ Increased need during pregnancy and
lactation.
• Amount absorbed will depend on
current need.
Deficiency
• Deficiency is rare and may be due to
congenital problems of absorption or
years of a vegetarian diet with no
animal foods.
• Symptoms inclued megaloblastic
anemia, pernicious anemia (if
intrinsic factor absent), anorexia,
glossitis, sore mouth, tongue, pallor,
depression, dizziness, weight loss,
neurological system damage.
Vitamin B Complex: Pantothenic Acid - symptoms include nausea, anorexia,
• Involved in metabolism of depression, pallor, dermatitis,
carbohydrates, fats, proteins. increase in serum cholesterol.
• Essential for synthesis of
neurotransmitter acetylcholine and Vitamin C or Ascorbic acid
steroid hormones. - Has antioxidant properties and
• Thought to be synthesized by the protects food from oxidation.
body. - Role in formation of collagen.
- Aids in absorption of nonheme iron.
Sources - May be involved with formation or
• meats, poultry, fish, eggs, whole functioning of norepinephrine, some
grain cereals, and legumes. amino acids, folate, leukocytes, the
immune system, allergic reactions.
Requirement
• Food and Nutrition Board has Sources
provided an estimated intake of 5 mg • Sources include citrus fruits, melon,
a day for normal adults. strawberries, tomatoes, potatoes, red
and green peppers, cabbage,
Excess broccoli.
• Toxicity from excess not confirmed.
Requirement
Deficiency ❖ Average female adult requires 75
• Natural deficiencies unknown. mg/day.
• Signs include weakness, fatigue, ❖ Average male adult requires 90 mg/day.
burning sensation in feet ❖ Stress and cigarette smoking increase
(deficiencies produced need.
experimentally). ▪ Stop and Share

Vitamin B Complex: Biotin Deficiency

• Coenzyme in synthesis of fatty acids • Scurvy: disease characterized by
and amino acids. gingivitis, easy bruising, pinpoint
hemorrhages of the skin, poor wound
Sources healing, sore joints and muscles, weight
• liver, egg yolk, soy flour, cereals, loss. Extreme cases result in death.
yeast. • Found in sailors who lived without fresh
• Synthesized in intestine by fruits and vegetables.
microorganisms, amount available - Deficiency of Vitamin C: bleeding
for absorption unknown. gums, loose teeth, tendency to bruise
easily, poor wound healing, scurvy.
Requirement Excess
- Food and Nutrition Board suggests - diarrhea, nausea, cramps, excessive
absorption of food iron, rebound
adequate intake of 30 g for adults.
scurvy (when megadoses are stopped
abruptly) and possibly oxalate
Deficiency
kidney stones. Generally considered
nontoxic.
Vitamin Supplementation
- Balanced diet provides nutritional
needs of healthy people.
- No amount of vitamins will build
muscles.
- Vitamins do not provide energy; they
help to release the energy provided
by nutrients.
- Heart disease, cancer and the
common cold cannot be cured by
vitamin supplements.
Chapter 8: Minerals
- Human body made up of specific
chemical elements.
- Oxygen, carbon, hydrogen, and
nitrogen make up 96% of body
weight.
- Remaining elements, minerals,
represent 4% of body weight.
- Minerals are essential for good
health.
- Inorganic elements are necessary to
build tissues, regulate body fluids,
and assist in various body functions.
- Found in all body tissues.
- Cannot provide energy by
themselves.
- Contribute to production of energy
within the body.
- Enriched foods are foods to which
nutrients, usually B vitamins and
iron, have been added to improve
their nutritional value.
CLASSIFICATION
Major minerals
• Required in amounts greater than
100 mg a day
Trace minerals
• Needed in amounts smaller than
100 mg a day
Electrolytes
Ions
• Electrically charged atoms
resulting from chemical
reactions
• Positively charged called cations
• Negatively charged called
anions
• Must be balanced within body
• These ions are known as
electrolytes
- Maintain the body’s fluid balance,
contribute to electrical balance, assist
in transmission of nerve impulses
and contraction of muscles, help
regulate the body’s acid-base
balance.
Toxicity occurs when concentrated forms of
minerals are taken regularly over time.
- Excessive amount of one mineral
may lead to deficiency of another
mineral.
- Hair loss and changes in blood,
hormones, bones, muscles, blood
vessels, and nearly all tissues may
result.
- Concentrated minerals only if
prescribed.
Major minerals
1. Calcium (Ca)
- Human body contains more calcium
than any other mineral.
• 99% found in skeleton and teeth
• 1% found in blood
Functions
- In combination with phosphorus,
gives strength and hardness to bones
and teeth.
- Bones provide storage for calcium.
- Needed for normal nerve and muscle
action, blood clotting, heart function,
and cell metabolism.
Regulation
- Hormonal system regulates delivery
of calcium to cells.
 - Every cell needs calcium and normal Retards absorption
blood calcium levels are maintained • Lack of weight-bearing exercise
even if intake is poor.
- Parathyroid glands release a Requirements
hormone telling the kidneys to ❖ 0-6 months 210 mg
retrieve calcium before it is excreted ❖ 6-12 months 270 mg
when blood calcium levels drop. ❖ 1-3 years 500 mg
- This hormone, works with calcitriol ❖ 4-8 years 800 mg
causing increased release of calcium ❖ 9-18 years 1,300 mg
from bones by stimulating activity of ❖ 19-50 years 1,000 mg
osteoclasts. ❖ 51-70+ years 1,200 mg
- Both actions increase blood calcium ❖ Pregnant women
levels. • 14-18 years 1,300 mg
- Bones become increasingly fragile as • 19-50 years 1,000 mg
calcium is withdrawn from them. - Lactating women same as
- Osteoporosis may result from years nonlactating women of same age
of low calcium intake.
- Osteoblasts increase bone mass if Supplements
blood calcium level is high until one - Calcium carbonate, form found in
is age 30-35 years old. calcium-based antacid tablets, has
- Bone mass will remain stable in highest concentration of bioavailable
women until menopause with calcium.
adequate consumption of calcium, - Appear to be absorbed most
phosphorus, and vitamin D. efficiently when consumed in doses
of 500 mg.
Sources - Check for USP-approved products,
o Milk and milk products which are unlikely to contain lead.
o Dark green, leafy vegetables
• When vegetables contain oxalic Deficiency
acid, as spinach and Swiss chard - Rickets results in poorly formed
do, the calcium remains bone structure and causes bowed
unavailable because the oxalic legs, “pigeon breast”, enlarged wrists
acid binds it and prevents it from or ankles, and stunted growth.
being absorbed - “Adult rickets” (osteomalacia)
• Fiber causes bones to become soft.
• When the intake of fiber exceeds - Tetany, characterized by involuntary
35g a day, calcium will also bind muscle movement, results from
with phytates (phosphorus insufficient calcium in blood.
compounds found in some high- Excess
fiber cereal), which also limits its Excessive intake may:
absorption • Cause constipation
Enhances absorption of calcium • Cause kidney stones
• Vitamin D • Inhibit the absorption of iron and
• Calcium-to-phosphorus ratio zinc
that includes no more
phosphorus than calcium Phosphorus (P)
• Presence of lactose - Constituent of all body cells.
 - Necessary for the formation of • Vegetables–mushrooms, brussel sprouts,
strong, rigid bones and teeth; potatoes, tomatoes, winter squash, lima
metabolism of carbohydrates, fats, beans, carrots
and proteins; proper acid-base
balance; and effective action of Deficiency
several B vitamins. Hypokalemia
- Stored in bones, absorption is • Caused by diarrhea, vomiting,
increased in the presence of vitamin diabetic acidosis, severe
D. malnutrition, or excessive use of
laxatives or diuretics
Sources • Symptoms of deficiency include
• Protein-rich foods such as milk, nausea, anorexia, fatigue, muscle
cheese, meats, poultry, and fish. weakness, heart abnormalities
• Cereals, legumes, nuts, soft drinks Excess
Hyperkalemia
Requirements • Caused by dehydration, renal
Adequate Intake failure, excessive intake
❖ 0-6 months 100 mg • Cardiac failure can result
❖ 6-12 months 275 mg
Estimated Average Requirements Sodium
❖ 1-3 years 380 mg - Primary function is the control of
❖ 4-8 years 405 mg fluid balance in the body.
❖ 9-18 years 1,055 mg - Maintains acid-base balance.
❖ 19-70+ years 580 mg - Participates in the transmission of
❖ Pregnant and lactating women - Same as nerve impulses essential for normal
for nonpregnant and nonlactating women muscle function.

Deficiency Sources
- Deficiency is rare. - Table salt contains 40% sodium.
- Excessive use of antacids affect - One teaspoon of table salt contains
absorption. 2,000 mg of sodium.
- Symptoms of deficiency include - Naturally available in animal foods.
bone demineralization (loss of
minerals), fatigue, and anorexia. Requirements
❖ 0-5 months 120 mg
Potassium (K) ❖ 6-11 months 200 mg
- Found primarily in intracellular ❖ 1 year 225 mg
fluid. ❖ 2-5 years 300 mg
- Essential for fluid balance and ❖ 6-9 years 400 mg
osmosis. ❖ 10-18 years 500 mg
- Maintains fluid level within the cell. ❖ > 18 years 500 mg
- Necessary for transmitting nerve
impulses and muscle contractions. Deficiency
• Caused by severe vomiting, diarrhea, and
Sources heavy perspiration.
• Fruits–especially melons, oranges, • Can upset the acid-base balance.
bananas, peaches • Tetany due to alkalosis may develop.
Excess • Green leafy vegetables, legumes, nuts,
- May cause edema and resulting whole grains, some fruits (avocados and
hypertension. bananas)
- Associated with hypertension and • Milk in sufficient quantities
congestive heart failure.
- Treatment includes sodium- Requirements
restricted diets; 3-4g (no-added salt, o Adequate Intake
or NAS) or 1-2g sodium-restricted ❖ 0-6 months 30 mg
diet. Diets below 1g rarely ❖ 6-12 months 75 mg
prescribed. ❖ Boys and girls 1-3 years 80 mg
4-8 years 130 mg
Chloride (Cl) 9-13 years 240 mg
- Essential for maintenance of fluid, ❖ Boys 14-18 years 410 mg
electrolyte, and acid-base balance. ❖ Girls 14-18 years 360 mg
- Found in hydrochloric acid, ❖ Men 19-30 years 400 mg
cerebrospinal fluid, and muscle and ❖ Women 19-30 years 310 mg
nerve tissue. ❖ Men 31-70+ years 420 mg
- Helps blood carry carbon dioxide to ❖ Women 31-70+ years 320 mg
the lungs and is necessary during ❖ Pregnant women
immune responses when white blood 14-18 years 400 mg
cells attack foreign cells. 19-30 ears 350 mg
- Found almost exclusively in table 31-50 years 360 mg
salt or in foods containing sodium ❖ Lactating women
chloride. 14-18 ears 360 mg
-30 ears 310 mg
Requirement 31-50 years 320 mg
- Estimated minimum requirement for
normal adults is 750 mg a day. Deficiency
- Deficiency among people on normal
Deficiency diets is unknown.
- Deficiency is rare. - Experimentally induced symptoms
- Can occur with severe vomiting, include nausea, mental, emotional,
diarrhea, excessive use of diuretics, muscular disorders.
and alkalosis. Sulfur (S)
- Necessary to all body tissue and is
Magnesium (Mg) found in all body cells.
- Vital to both hard and soft body - Contributes to the characteristic odor
tissues. of burning hair and tissue.
- Essential for metabolism. - Necessary for metabolism.
- Regulates nerve and muscle - Component of some amino acids.
function. - Found in protein-rich foods.
- Plays a role in the blood-clotting - Neither the amount of sulfur required
process. by the human body nor its deficiency
is known.
Sources
• Found primarily in plant foods. Trace minerals
Iron (Fe)
 - Delivers oxygen to body tissues.
- Component of hemoglobin.
- Component of myoglobin, a protein
compound in muscles that provides
oxygen to cells.
- Utilized by enzymes that are
involved in making amino acids,
hormones, and neurotransmitters.
Sources
• Meat, poultry, and fish are the best
sources of iron. Animal flesh contains
heme iron, which is absorbed more than
twice as efficiently as nonheme iron.
• Nonheme iron is found in whole grain
cereals, enriched grain products,
vegetables, fruit, eggs, meat, fish, and
poultry.
Factors that Affect Iron Absorption
Increase
▪ Acid in the stomach
▪ Heme iron
▪ High body demand for red blood cells
(blood loss, pregnancy)
▪ Low body stores of iron
▪ Meat protein factor (MPF)
▪ Vitamin C
Decrease
▪ Phytic acid (in fiber)
▪ Oxalic acid
▪ Polyphenols in tea and coffee
▪ Full body stores of iron
▪ Excess of other minerals (Zn, Mn, Ca)
▪ Some antacids
Requirements
- Men lose approximately 1 mg/day.
- Women lose approximately 1.5
mg/day.
- RDA for men is 10 mg, and for
women age eleven through
childbearing is 15 mg.
- RDA doubled during pregnancy;
difficult to meet by diet alone.
- Iron supplement commonly
prescribed during pregnancy.
- Heavy need during infancy and
teens.
Deficiency
- Caused by insufficient intake,
malabsorption, lack of stomach acid,
or excessive blood loss.
- Most common nutrient deficiency
worldwide is iron-deficiency
anemia.
- Symptoms include fatigue,
weakness, irritability, shortness of
breath, pale skin, and spoon-shaped
fingernails.
Excess
- Hemochromatosis is a condition
due to an inborn error of metabolism
and causes excessive absorption of
iron.
- Untreated, can damage liver, spleen,
heart.
- To control buildup of iron, patients
with this condition must give blood
on a regular basis.
Iodine (I)
- Component of thyroid hormones,
thyroxine (T4) and triiodothyronine
(T3).
- Necessary for the normal functioning
of thyroid gland, which determines
rate of metabolism.
Sources
• iodized salt, seafood, and some plant foods
grown in soil bordering the sea.
Requirement
- RDA for adults is 150 g a day.
- Additional amounts needed during
pregnancy and lactation.
Deficiency
- Lack of iodine results in decrease in
thyroxine and triiodothyronine.
- Gland grows, forming a lump on the
neck called a goiter.
 - Myxedema is a condition of
hypothyroidism in adults.
- Cretinism is low thyroid in a child;
retards physical and mental
development.
Zinc (Zn)
- Cofactor for more than 300 enzymes.
- Essential for growth, wound healing,
taste acuity, glucose tolerance, and
mobilization of vitamin A within the
body.
Sources
• meat, fish, eggs, dairy products, wheat
germ, and legumes.
Requirement
❖ RDA for normal adult males is 11 mg.
❖ RDA for normal adult females is 8 mg.
❖ Increased requirements during
pregnancy and lactation.
Deficiency
- Symptoms of deficiency include
decreased appetite, taste acuity,
delayed growth, dwarfism,
hypogonadism, poor wound healing,
anemia, acnelike rash, impaired
immune response.
Selenium (Se)
- Constituent of most body tissues.
- Concentrated in liver, kidneys, and
heart.
- Component of an enzyme that acts as
an antioxidant, thereby protecting
cells against oxidation and sparing
vitamin E.
Sources
• seafood, kidney, liver, muscle meats.
Requirement
❖ RDA for adult male is 70 g.
❖ RDA for adult female is 55 g.
- Selenium supplements appear to be
effective in treating Keshan disease
- High doses are toxic causing
vomiting, loss of hair and nails, and
skin lesions.
Copper (Cu)
- Found in all tissues; heaviest
concentration in the liver, kidneys,
muscles, and brain.
- Helps in formation of hemoglobin;
aids in transport of iron to bone
marrow for the formation of red
blood cells; and participates in
energy production.
Sources
• organ meats, shellfish, legumes,
nuts, cocoa, whole grain cereals, and
human milk.
Requirement
❖ No RDA; NRC’s estimated safe intake
for adults is 1.5-3 mg/day.
Deficiency
- Deficiency is rare.
- People with malabsorption
conditions and gross protein
deficiency such as premature infants;
clients on long-term parenteral
nutrition programs lacking copper;
and people taking excess zinc
supplements are candidates for
deficiency.
- Anemia, bone demineralization, and
impaired growth may result.
Excess
- Excess is highly toxic.
- Single dose of 10-15 mg can cause
vomiting.
- Wilson’s disease is an inherited
condition causing damage to liver
cells and neurons. Detected early,
copper-binding agents may be used
 to bind copper in bloodstream and ❖ Girls 14-18 years 3.0 mg
increase excretion. ❖ Males 19+ years 4.0 mg
❖ Females 19+ years 3.0 mg
Manganese (Mn)
- Constituent of several enzymes Chromium (Cr)
involved in metabolism. - Associated with glucose and lipid
- Important in bone formation. metabolism.
- Levels decrease with age except in
Sources lungs, where chromium accumulates.
• whole grains, tea, vegetables, and
fruits. Sources
• meat, mushrooms, nuts, yeast, organ
Requirement meats, and wheat germ.
❖ Adequate intake is 2.3 mg for men and
1.8 mg for women. Requirement
- Safe and adequate daily intake for
Deficiency or Excess men is 35 μg and women 25 μg
- No deficiency/toxicity from
ingestion known. Deficiency
- Inhalation linked to neurological - Deficiency related to disturbances in
problems. glucose metabolism.

Fluoride (F) Molybdenum (Mo)

- Increases resistance to dental caries, - Constituent of enzymes, and thought
and may strengthen teeth and bones. to play a role in metabolism.

Sources Source
• fluoridated water, fish and tea. • milk, liver, legumes, and cereals
Commercially prepared foods with
fluoridated water. Requirement
- Safe and adequate daily intake for
Deficiency adults is 45 g.
- Deficiency can result in increased
tooth decay. Deficiency or Excess
- No deficiencies noted.
Excess - Excess inhibits copper absorption.
- Excess can cause discoloration or
mottling of children’s teeth.
Chapter 9: Water
Requirements - Humans can live about 8 weeks
▪ 0-6 months .01 mg without food.
▪ 6-12 months 0.5 mg - One can live only a few days without
▪ 1-3 years 0.7 mg water.
▪ 4-8 years 1.0 mg - Water is in all body cells.
▪ 9-13 years 2.0 mg - 50-60% body weight of normal
❖ Boys 14-18 years 3.1 mg adults.
 - Percentage is highest in newborns;
decreases with age.
- Two basic compartments
• Intracellular fluid (ICF): within
cells; 65% of total body fluid.
• Extracellular fluid (ECF):
outside cells; 35% of total body
fluid.
Divided into intravascular fluid (in blood stream)
and interstitial fluid (between cells)
Body Fluid Compartments
Functions
- Major component of blood plasma.
- Solvent for nutrients and waste
products.
- Necessary for hydrolysis of
nutrients.
- Essential for metabolism.
- Lubricant in joints and digestion.
- Cools the body through perspiration.
- Provides some mineral elements.
Sources
- Drinking water is the best source.
- Beverages are second-best source.
- Other sources include fruits,
vegetables, soups, milk, and gelatin
desserts.
- Energy metabolism produces water.
Estimated Daily Fluid Intake for an Adult
❖ Ingested liquids 1,500 ml
❖ Water in foods 700 ml
❖ Water from oxidation 200 ml
Total 2,400 ml
Fluid and Electrolyte Balance
- Electrolytes are measured in
milliequivalents (mEq/L).
- Sensible (noticeable) water loss is
water lost through urine.
- Insensible (unnoticeable) water loss
is in feces, perspiration, and
respiration.
- Waste products of metabolism
excreted in the form of urine (500
ml of water each day).
o Solute: substance dissolved in a solution.
o Osmosis: water flows from the side with
the lesser amount of solute to the side
with the greater solute concentration.
o Sodium, chloride, and potassium
maintain the balance between
intracellular and extracellular fluids.
Potassium is the principal electrolyte in
intracellular fluid.
Sodium is the principal electrolyte in
extracellular fluid.
Osmolality measures particles in a solution.
- When electrolytes in extracellular
fluid are increased, ICF moves to
the ECF to equalize the
concentration of electrolytes on
both sides of the membrane.
Reduces the amount of water in the
cells.
- Hypothalamus stimulates pituitary
gland to excrete ADH (antidiuretic
hormone).
- ADH causes kidneys to reabsorb
water.
 - Thirst causes healthy person to drink
fluids.
- When sodium in ECF is reduced,
water flows from ECF into cells,
causing cellular edema.
- Adrenal glands secrete aldosterone,
which triggers kidneys to increase
the amount of sodium reabsorbed.
- When the missing sodium is replaced
in the ECF, excess water moves back
to the ECF and edema is relieved.
- Amount of water use varies,
depending on age, size, activity,
environmental temperature, and
physical condition.
- Average adult requirement is 1 ml
for every kcal in food consumed.
Stop and Share
How many glasses of fluid would be
required for an adult eating 1,800 kcal/day?
1 ml × 1,800 kcal = 1,800 cc
1,800 cc  240 oz = 7.5 glasses of water
It is recommended that adults drink eight
8-ounce glasses of fluid a day.
• Youth, fever, diarrhea, unusual
perspiration, and hyperthyroidism
increase the requirement.
Dehydration
- Amount of water in the body is
inadequate.
- Caused by inadequate intake or
abnormal loss.
- Loss can occur from severe diarrhea,
vomiting, hemorrhage, burns,
diabetes mellitus, excessive
perspiration, excessive urination, or
the use of certain medications such
as diuretics.
- Symptoms of dehydration include
low blood pressure, thirst, dry skin,
fever, and mental disorientation.
- As water is lost, electrolytes are also
lost.
- Treatment involves replacement of
electrolytes and fluids.
- 10% loss can cause serious
problems.
- Blood volume and nutrient
absorption are reduced, and kidney
function is upset.
- 20% loss can cause circulatory
failure and death.
- Infants are at high risk for
dehydration when fever, vomiting,
and diarrhea occur.
- Treatment involves IV fluids.
- Thirst sensation lags behind the
body’s need for water, especially in
the elderly, children, athletes, and
the ill.
- Feeling thirsty is not a reliable
indicator of when the body needs
water.
- Fluids should be drunk throughout
the day to prevent dehydration.
- Failure to replace water lost through
perspiration could lead to one of the
four stages of heat illness:
• Heat fatigue
• Heat cramp
• Heat exhaustion
• Heat stroke
Signs of Dehydration
✓ Health history reveals inadequate intake
of fluids
✓ Decrease in urine output
✓ Weight loss
✓ Eyes appear sunken
✓ Tongue has increased furrows and
fissures
✓ Oral mucous membranes are dry
✓ Decreased skin turgor
✓ Changes in neurological status
Excess Water Accumulation
Positive water balance - more water
taken in than excreted; edema results.
Hypothyroidism, congestive heart
failure, hypoproteinemia, some
infections, some cancers, and some
renal conditions can cause water
 retention because sodium is not
being excreted normally. Fluids
and sodium may then be restricted.
Acid-base Balance
Regulation of hydrogen ions
Acid gives off hydrogen ions
Base picks up hydrogen ions
▪ Acidic substances–pH 1 to 7
▪ Alkaline substances–pH 7 to 14
▪ pH 7 is considered neutral
▪ Blood plasma–pH 7.35 to 7.45
▪ Intracellular fluid–pH 6.8
Kidneys maintain acid-base balance
What a person eats affects the acidity
not of the body but of the urine.
Buffer Systems
Regulate hydrogen ion content in
body fluids
Mixture of a weak acid and a strong
base
Normal buffer system–ratio of base
to acid 20:1
Carbonic acid and sodium
bicarbonate forms the body’s main
buffer system.
Carbonic acid moves easily to buffer
a strong alkali, and sodium
bicarbonate moves easily to buffer a
strong acid.
Amounts are easily adjusted by the
lungs and kidneys to suit needs.
End products of metabolism are
carbon dioxide and water, and
together they can form carbonic acid.
The medulla oblongata in the brain
causes the breathing rate to increase
if the amount of carbon dioxide is
more concentrated than it should be.
This increases the rate at which the
body rids itself of carbon dioxide.
Excess sodium bicarbonate is
excreted via the kidneys.
The kidneys can excrete urine from
pH 4.5 to pH 8.
The pH of average urine is 6.
Acidosis and Alkalosis
Renal failure, uncontrolled diabetes
mellitus, starvation, or severe
diarrhea can cause acidosis.
Alkalosis can occur when the body
has suffered a loss of hydrochloric
acid from severe vomiting or has
ingested too much alkali, such as
too many antacid tablets.
SECTION 2: Maintenance of Health Through
Good Nutrition
Chapter 10: Food-Related Illnesses and
Allergies
Food-related Illnesses
Pathogens are disease-causing
agents.
Pathogens or certain chemicals can
contaminate food.
Bacteria, viruses, molds, worms,
and protozoa are pathogens that can
contaminate food.
Chemicals may be a natural
component of specific foods,
intentionally added during
production or processing, or
accidentally added through
carelessness or pollution.
Food poisoning is a general term for
foodborne illness.
When food poisoning develops as a
result of a pathogen’s infecting
someone, it is a foodborne
infection.
When it is caused by toxins
produced by the pathogen, it is
called food intoxication.
Symptoms of food poisoning
include vomiting, diarrhea,
headache, and abdominal cramps.
 Many never know they are suffering Fatality rate in the US is about 65%.
from food poisoning and assume Great care must be taken to prevent
they have the flu. botulism when canning foods at
Young children, elderly or home.
immunocompromised may become
very ill and even die. Clostridium Perfringens
The “cafeteria” or “buffet” germ
Bacteria that Cause Foodborne Illness Transmitted by eating heavily
• Campylobacter jejuni contaminated food.
• Clostridium botulinum Symptoms include nausea, diarrhea,
• Clostridium perfringens and inflammation of the stomach
• Cyclospora cayentanensis and intestine.
• Escherichia coli (E. coli 0157:H7) Onset is 6 to 24 hours.
• Listeria monocytogenes
• Salmonella Cyclospora Cayentanensis
• Shigella A parasite that causes
• Staphylococcus aureas gastroenteritis.
Transmitted by poor hygiene and
Campylobacter Jejuni contaminated water.
One of the most prevalent causes of Symptoms include watery diarrhea,
diarrhea. abdominal cramps, decreased
Found in intestinal tracts of pigs, appetite, and low-grade fever.
sheep, chickens, turkeys, dogs, and Onset is one week.
cats.
Onset is 2 to 5 days. Escherichia Coli
Symptoms include diarrhea, fever, - Escherichia coli, commonly called
headache, muscle and abdominal “E. coli,” is a group of bacteria that
pain, and nausea. can cause illness in humans.
Transmitted via unpasteurized milk, - E. coli 0157:H7 is a very infectious
contaminated water, and raw or strain of this group.
undercooked meat, poultry and - Found in intestines of some
shellfish. mammals, raw milk, and
contaminated water.
Clostridium Botulinum - Transmitted through contaminated
Botulism water, unpasteurized milk or apple
Found in soil and water, on plants, juice, raw or rare ground beef
and in the intestinal tracts of animals products, unwashed fruits or
and fish. vegetables, and directly from
Can be produced in sealed containers person to person.
such as cans, jars, and vacuum- - Onset is 3 to 9 days.
packaged foods. - Symptoms include severe
The rarest but most deadly of all food abdominal cramps, diarrhea that
poisonings. may be watery or bloody, and
Onset is 4 to 36 hours after eating. nausea.
Symptoms include double vision, - Complications: hemorrhagic
speech difficulties, inability to colitis, hemolytic uremic
swallow, and respiratory paralysis. syndrome in children
 - Control by careful choice and
cooking of food.
Listeria Monocytogenes
Bacteria often found in human and
animal intestines, and in milk, leafy
vegetables, and soil.
Transmitted by unpasteurized dairy
foods; leafy, raw vegetables; and
processed meats.
Onset is 12 hours to 8 weeks after
ingestion.
Symptoms include fatigue, fever,
chills, headache, backache,
abdominal pain, and diarrhea.
To prevent infection, meats and
poultry should be thoroughly cooked
and salad greens carefully washed.
Make sure dairy products are
pasteurized.
Salmonellosis
Salmonella
- Found in raw meats, poultry, fish,
milk, and eggs.
- Transmitted by eating contaminated
food or by contact with a carrier.
- Symptoms include headache,
vomiting, diarrhea, abdominal
cramps, and fever.
- Onset is 6 to 48 hours.
Shigella
Typically transmitted by an infected
food handler with poor hand
washing.
Cold foods are common carriers.
Onset is 1 to 7 days.
Symptoms include diarrhea, fever,
chills, headache, nausea, and
abdominal cramps.
Staphylococcus Aureus
Found on human skin.
Transmitted by carriers and by eating
foods that contain the toxin these
bacteria create.
Onset is 30 minutes to 8 hours.
Symptoms include vomiting,
diarrhea, and abdominal cramps.
Other Substances that Cause Food Poisoning
▪ Mold
▪ Trichinella spiralis
▪ Protozoa
Mold
A type of fungus.
May cause respiratory problems.
Can cause cancer.
Symptoms include abdominal
pain, vomiting, and diarrhea.
Onset is 1 day to several months
after ingestion.
Trichinella spiralis
A parasitic worm that causes
trichinosis.
Transmitted by eating
inadequately cooked pork from
infected pigs.
Onset is 24 hours.
Symptoms include abdominal
pain, vomiting, fever, chills, and
muscle pain.
Cook all pork to an internal
temperature of at least 170 degrees
Fahrenheit.
Protozoa (Dysentery)
Introduced to food by carriers or
contaminated water.
Symptoms include severe diarrhea
that can occur intermittently.
Prevention of Foodborne Illnesses
✓ Cleanliness of kitchen and equipment.
✓ Proper hand washing.
✓ Wear gloves if cooking with any hand
wound.
✓ Cover and store foods to prevent
microbes or animals from reaching it.
✓ Cook foods to appropriate temperatures.
✓ Prevention of Foodborne Illnesses
 ✓ Limit standing time at temperatures Common Food Allergens
between 40 and 140 degrees Fahrenheit. Milk Wheat Corn
✓ Prevent known carriers from preparing Eggs Citrus fruit Strawberries
foods. Tomatoes Legumes Tree Nuts
✓ Select only packages and jars that were Peanuts Chocolate Soybeans
sealed by the manufacturer. Pork Fish Shellfish
✓ Avoid bulging cans, foods that look or
smell odd, and foods showing signs of Teaching Considerations
mold. Avoid microbial contamination of
food supplies at home.
Miscellaneous Food Poisoning Read food labels.
o Ingestion of plants or animals that Ask about ingredients of foods in a
contain poison (mushrooms, rhubarb restaurant and at another person’s
leaves, fish from polluted water) home.
o Cleaning agents
o Insecticides
o Drugs

Food Allergies
A food allergy occurs when the
immune system reacts to a food
substance, usually a protein.

Types of Allergic Reactions

• Hay fever
• Urticaria
• Edema
• Headache
• Dermatitis
• Nausea
• Dizziness
• Asthma

Treatment of Allergies
• Removal of allergen
• Food diary
• Laboratory tests
• Elimination diet
• Patient education

Elimination Diet
A limited diet in which only certain
foods are allowed in an attempt to
pinpoint the food allergen causing
the reaction. Additional foods are
introduced slowly until an allergic
reaction occurs.