ESSENTIALS OF NUTRITION & DIET

THERAPY









MARI A ROBI NSON, RN, MS
FALL 2014
BALTIMORE CITY COMMUNITY COLLEGE
ASOCIATE DEGREE NURSING PROGRAM

NUTRITION & HEALTH - Chapter 1
The Obesity Epidemic
Major problem in the United States & Worldwide
Changes in food and lifestyle over past 25 years
70% of men 61% of women are overweight or obese
Rise in obesity related to environmental rather than genetic
Energy intake rising, energy expenditure is falling
NUTRITION & HEALTH
Shifts in population
Advances in sanitation and public health raised life
expectancy 45 to 80 years old
Ethnic & racial diversity
Diverse racial and ethic groups make up one third of the
general population
Asian Americans & Hispanic Americans are increased
risk of diabetes
African American more salt sensitive like to develop
hypertension
NUTRITION & HEALTH
New product in the marketplace
Functional foods
Phytochemicals fruits & vegetables cancer fighting
properties
Dark chocolate contain phytochemicals prevent
cardiovascular
Nutrition and our genes
Nutrigenomics
Nutrigenetics

NUTRITION & HEALTH
The science of nutrition
Biochemistry & Physiological
Homeostasis
Working definitions
Nutrition to nourish
Good nutrition promotes health and reduces risk of
adverse conditions
Food supplies energy to carry out body functions
NUTRITION & HEALTH
Functions of food & nutrients
Nutrients substances the body requires
Approximately 50 nutrients found to be essential to human
life and health
Macronutrients carbohydrates, fats, and proteins
Supply energy and build tissue
Micronutrients vitamins and minerals
Regulate body process
Water sustains all life systems
Metabolism sum of all chemical reactions that use
nutrients

NUTRITION & HEALTH
Nutrients 3 general functions
To provide energy
To build and repair body tissues and structures
To regulate the metabolic process that maintain
homeostasis and support life
NUTRITION & HEALTH
Energy sources
Carbohydrates starch and sugars primary source of fuel for
heat & energy
Glycogen body storage form of carbohydrates for quick
energy
Each gram of carbohydrates when metabolized yields
4 kcal/g composed carbon hydrogen & oxygen CH2O
Healthy person 45% to 65% of total kcalories are supplied by
carbohydrates
Complex carbohydrates starch
Complex carbohydrates fiber yield no energy
Simple carbohydrates sugars

NUTRITION & HEALTH
Fats animal and plant sources 9 kcal/g
Supply no more than 20% to 30% of total kcalories
Less than 10% should be saturated fat
Remainder unsaturated fats

Proteins tissue building 4 kcal/g
Provide 10% to 35% of total kcalories in a well balanced
diet for healthy individuals
NUTRITION & HEALTH
Tissue building and repair
Protein food broken down into amino acids
Minerals - help build tissues with very specific functions
calcium & phosphorus give strength to bones and teeth
Vitamins complex molecules essential in certain tissues
vitamin C prevent tissue building, vitamin A for vision



NUTRITION & HEALTH
Metabolic regulation
Minerals cofactors in controlling cell metabolism
Vitamins components of cell enzyme
Water form blood, lymph and intercellular fluids
NUTRITION & HEALTH
Nutritional status health of an individual
Anthropometric Pg. 8, box 1-2
Optimal nutrition individuals have neither deficiency
nor an excess Pg. 9, table 1-1
Undernutrition marginal to famine kwashiorkor or
marasmus

NUTRITION & HEALTH
Overt Malnutrition nutrient intake is not sufficient to meet
day by day needs
Children with inadequate diet develop anemia reduced
resistance to infection
Hospitalized patients and residents of long term care facilities
Overnutrition excessive energy intake with low physical
activity unwanted weight gain

NUTRITION & HEALTH
Nutrition Policy and National Health Problems
1930 rickets and pellagra law passed to add vitamin D to
milk
First major policy linking nutrition and chronic disease -
The surgeon general report on Nutrition and Health 1988
Cut down on foods high in fat and salt and increase food
high in complex carbohydrates and fiber
NUTRITION & HEALTH
Healthy People 2020 U.S Department of Health and
Human Services introduced public health initiative
Health People 2000 national objectives promoting
health and preventing disease
- Objectives updated every 10 years
Healthy people 2020 focus on risk to health and wellness
and prevention of chronic disease

NUTRITION & HEALTH Pg. 13, table 1-3
Nutrition Guides for Food Selection 3 types
1. Nutrition standards
2. Dietary Guidelines
3. Food guides
Each have different purpose and target audience
Nutrition Standard
Dietary Reference Intake (DRI)
Recommended Dietary Allowance (RDA)
Adequate Intake (AI)
Tolerable Upper Intake (UL)
Estimated Average Requirement (EAR)
Acceptable Macronutrient Distribution Range (AMDR)


NUTRITION & HEALTH Pg. 16, table 1-2
Food Guides -
USDA Food Guides first guide 1940
Advice on food intake and physical activity
My pyramid food guidance system remind consumers to make
healthy food choices and be physically active every day
NUTRITION & HEALTH
Safe & Healthy Food Supply contamination can occur
as food travel from the farm, to the processor to the
marketplace and finally to consumer
Between 250 million and 350 million Americans suffer
gastroenteritis each year
Foodborne illness often goes unreported
Groups particularly vulnerable to foodborne illness are
elderly adult, children (especially under age 5)
Pregnant women
Patient with compromised immune function
DIGESTION, ABSORPTION AND METABOLISM
Chapter 2
Human Body: The Role of Nutrition food are broken
down into simpler substances that can enter the metabolic
pathways to cells
The Gastrointestinal Tract also called alimentary canal

DIGESTION, ABSORPTION AND METABOLISM
Disease affecting the organs of the gastrointestinal tract or
absorbing surface of the intestinal wall have adverse
affects on nutritional status
Many functional systems operating in harmony with one
another is called homeostasis
Four major functions:
1. Receives food
2. Releases nutrients from food
3. Delivers nutrients into the blood
4. Excretes nondigestible waste

DIGESTION, ABSORPTION AND METABOLISM
Digestion first step of preparing food for use by the
body
Includes two type of actions muscular & chemical
Gastrointestinal secretions
1. Enzymes
2. Hydrochloride Acid
3. Mucus
4. Water & electrolytes


DIGESTION, ABSORPTION AND METABOLISM
Movement of food through the digestive tract
Taste & Smell
Mastication
Swallowing
Esophagus
Stomach
DIGESTION, ABSORPTION AND METABOLISM
Stomach: storage and initial digestion
Small intestine: major digestion, absorption and transport
Colon (large intestine): final absorption and waste
elimination
Water absorption
Mineral absorption
Vitamin Absorption

DIGESTION, ABSORPTION AND METABOLISM
Intestinal bacteria more than 500 species
Waste elimination
Gastrointestinal function and clinical applications
Chronic gastrointestinal distress
Lactose intolerance digestive problem facing 70% of the
world population
May have symptoms after taking 6g or 12 to 18g of lactose
1 cup of milk contain 12g of lactose
Deficiency of lactase, digestive enzyme in the microville of the
small intestine
Health promotion
Prebiotics undigested carbohydrates
Probiotics depend on particular strain

DIGESTION, ABSORPTION AND
METABOLISM
Metabolism
Carbohydrate Metabolism glucose immediate energy
source
Sources of blood glucose carbohydrate &
noncarbohydrate
Use of blood glucose normal range 70-140mg/dl
Hormonal controls - directly and indirectly influence
glucose metabolism
Protein Metabolism
Anabolism tissue building
Catabolism tissue breakdown

CARBOHYDRATES Chapter 3
Basic Fuels: starches and sugars
Dietary importance major portion of diet of people all
over the world
Fruits
Vegetable
Cereal
Grains
Dairy foods
Rice one of world most important source of carbohydrates
CARBOHYDRATES
Basic fuels: Digested carbohydrate starches & sugars
Monosaccharide's (simplest of all sugars) 3 important
Glucose (dextrose)
Fructose (fruit sugars)
Galactose (milk sugar)
Disaccharides (two linked monosaccharides)
Sucrose = one glucose + one fructose
Lactose = one glucose + one glucose
Maltose = one glucose + galactose


CARBOHYDRATES
Polysacchrides - complex carbohydrate - many (poly)
single glucose (saccharide)
Starch most important digestible polysaccharides
The storage form of glucose in plants
legumes , potatoes, grains and vegetables must be
cook to help softens and rupture the starch making
digestion easier
Glycogen & Dextrin - nondigestible
CARBOHYDRATES
Glycogen - the storage form of glucose in animals and
humans remaining store in the liver and the muscle
Dextrins breakdown of starch - starch + water > soluble
starch > dextrins>maltose>glucose
Oligosaccharides small fragment of partially digested starch
Simple sugars have to be converted to glucose in the liver
The liver releases glucose into the bloodstream , which causes the
pancreas to release insulin, which moves glucose out of the
bloodstream and into the cells


CARBOHYDRATES
Central Nervous System brain and central nervous
system depend on carbohydrate for energy
Low carbohydrate reserve 10-15 minutes
Hypoglycemic shock causes irreversible brain
damage
Brain function individuals who eat breakfast do
better in school
CARBOHYDRATES
Nonnutritive sweetener - sweetening power not efficiently
absorbed by the body or cannot provide energy (aspartame)
FDA approved 6
Carbohydrates and oral health periodontal disease result in
systemic infections worsen glucose control diabetes, increase
inflammatory responses and cardiovascular risk
dental carries most frequent and preventable infectious
diseases of oral cavity and major causes of tooth loss

CARBOHYDRATES
Fiber the nondigestable carbohydrate
Insoluble fiber is nondigestible CHO that do not
dissolve in water but act like a sponge in the intestine
to soak up water
Examples: cellulose, hemicellulose Lignans, Psyllium
Functional fiber:
Nondigestible polysaccrides added to foods to increase fiber content
Insoluble fibers (cellulose, hemi-cellulose and lignan)
Dissolves in water and binds with cholesterol and bile acids
Example are whole grain cereals, wheat bran, root vegetables and fruits
with edible seeds


LIPIDS Chapter 4
Chemical name for fats and fat related compounds
cholesterol, lipoproteins and phospholipids
Fatty acids building block of fat
Polyunsaturated & monounsaturated fatty acids
positive effects
Saturated and trans fats add to heath risk
Adipose cells and tissue that store fat
LIPIDS
Health issues and lipids
Amount of fat
Excessive kcal
Increase adipose tissue
Associated with health problems: diabetes, hypertension, and
heart disease
Types of fat
Excessive saturated fats and cholesterol from animal sources
Lipids found in fatty fish or oil
Trans fats in processed foods

LIPIDS
Fatty Acids & Triglycerides
Saturated
Fats and oils coconut oil and kernel
Monounsaturated
Canola oil and olive oil
Polyunsaturated
corn oil an safflower

LIPIDS
Function of Body Lipids
Ready source of energy
Thermal insulation
Protection of vital organs
Transmission of nerve impulse
Membrane structure
Carries fat-soluble minerals
Promote satiety

LIPIDS
Roles in the body
Skin integrity
Blood cholesterol regulation
Growth
Gene expression
Immune function
Blood platelet aggregation
Synthesis of hormone like agents



LIPIDS
Classes of lipoproteins
Chylomicrons
Very low density lipoproteins (VLDLs)
Intermediate low density lipoproteins (ILDLs)
Low-density lipoproteins(LDLs) (bad cholesterol)
High-density lipoproteins (HDLs) (good cholesterol)

LIPIDS
Two major carries are LDLs and HDLs
Elevated LDL cholesterol is related atherosclerosis
Causes build up of fatty plaque on the walls of the vessels
supplying blood to the heart, which narrows the arteries
Can cause heart attack or stroke
HDLs slow or prevent atherosclerosis by removing cholesterol
from cells and returning it to the liver
PROTEINS Chapter 5
They are essential for synthesis (building) of body tissue
grow, maintenance and repair
Associated with all forms of life.
Major structural and functional component of every living
cell
Amino acids are the basic blocks for all proteins
Chemical elements C, H, O, and N
Provides 4Kcal
PROTEINS
Essential amino acids 20 amino acids to build body
protein
Nine indispensible (essential) amino acids
Histidine Phenylalanine
Isoleucine Threonine
Leucine Tryptophan
Methionine Valine
Lysine
Remember the body can not make these nine amino acids or
make them in adequate amounts


PROTEINS
Non Essential Amino Acids
11 amino acids are classified as nonessential or dispensable
Alanine Arginine Proline
Asparagine Cysterine Tyrosine
Aspartic acid Glutamine
Glutamic acid Glycine
Cells can make them as necessary
Types of Protein
Myosin
Collagen
Hemoglobin
Albumin





PROTEINS
Protein and Nitrogen Balance
Concepts of balance
Homeostasis (dynamic equilibrium)
Synthesis (anabolism)
Breakdown (catabolism)
Body protein reserves
43% body protein in skeletal muscle
Remainder in skin, blood, kidney, liver, brain, and
other organs
Protein balance
Protein turnover
Nitrogen balance

PROTEINS
Complete and Incomplete protein foods
Complete protein foods
Contain all the indispensible amino acids
Animal origin
Incomplete
Lack one or more indispensible amino acids
Plant origin
Mixture of plant proteins can supply required amount of
indispensable amino acids

PROTEINS
Factors influencing protein requirement
Tissue growth
Protein quality
Protein digestibility
Energy content of the diet
Health status
Critical illness
Trauma or surgery
Serious burns

PROTEINS
Health Promotion:
Health benefits of plants foods
Soy foods
Good quality protein
Help reduce cardiovascular risk
Legumes
Complex carbohydrates and fiber
Lower risk of CVD
Nutritional contributions of animal foods
Provide indispensible amino acids
Dairy foods are rich in calcium, riboflavin, and performed vitamin A
Vitamin B12 and Vitamin D occur only in animal foods


PROTEINS
Vegetarian diets
Ovolactovegetarin ( all plant foods, diary and eggs)
Lactovegetarin (all plant foods and diary )
Vegan (plant foods only)
Flexitarin (predominantly plant foods with occasional fish or
poultry)


PROTEINS
Nutritional implications of vegetarian diets
calcium can be a problem for vegetarians avoiding
dairy foods
Calcium well absorbed from broccoli, cabbage,
collards, kale and bok choy
Risk of bone fractures
PROTEIN
Vegetarian diets and chronic disease
Lower rate of coronary heart disease
Lower prevalence of obesity and lower risk of
hypertension and diabetes
LDL lower
Lower cancer risk
Lower rate of colorectal cancer