Nutrition & Diet TherapyLecture Compilation

Ana Marie M. Somoray RND

1

INTRODUCTION TO NUTRITION

Nutrition is a vital component to overall wellness and health. Diet affects energy, well being and many disease states. There is a connection between lifetime nutritional habits and the risks of many chronic diseases such as cardio vascular diseases, diabetes, cancer. A well balanced diet can prevent such conditions and improve energy levels and over all health and wellness. The basis of nutrition is FOOD

Definition of terms:1) Nutrition – is the study of food in relation to health.2) Food – is any substance when ingested or eaten nourishes the body.3) Nutrient – is a chemical component needed by the body to provide energy, to build and repair tissues and to regulate life process.4) Digestion – it is a mechanical and chemical breakdown of food into smaller components.5) Absorption – it is a process where the nutrients from foods are absorb by the body into the bloodstreams.6) Metabolism – is a chemical process of transforming foods into other substance to sustain life.7) Enzymes – an organic catalyst that are protein in nature and are produced by living cells. A catalyst speeds up or slows down chemical reactions without itself undergoing change. 8) Nutritional Status – is the condition of the body resulting from the utilization of essential nutrients.9) Calorie – fuel potential in a food. One calorie represents the amount of heat required to raise one liter of water one degree Celsius.10) Malnutrition – It is the condition of the body resulting from a lack of one or more essential nutrients or due to excessive nutrient supply.

2

CHAPTER 1

The Digestive System

• Mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary amylase (these enzymes are produced by the salivary glands and break down starches into smaller molecules). On the way to the stomach:

• Esophagus – After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when we’re upside-down.

• Stomach – The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.

• Small intestine – absorption happens in the small intestine. Bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.

• Large intestine – Undigested food passes in the large intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food.

• The end of the process – Solid waste is then stored in the rectum until it is excreted via the anus.

ENZYMES – an organic catalyst that are protein in nature and are produced by living cells.

3

3 Groups of Digestive Enzymes:

1. Amylase – carbohydrate splitters2. Lipase – fat splitters3. Proteases – protein splitters

PART SECRETION ENZYME SUBSTRATE PRODUCT

Mouth Saliva Ptyalin (salivary amylase)

Cooked Carbohydrate

Dextrin and Maltose

Esophagus

Stomach Gastric juice

(acidic)

Pepsin

Rennin

Lipase

Protein and polypeptides

Milk Casein

Fats

Branched chain amino acids

Calcium Caseinate

Long chain fatty acids, glycerol

Small Intestine Pancreatic Juice

(alkaline)

Pancreatic Trypsin

Pancreatic Lipase

Pancreatic Amylase

Branched chain amino acid

Long chain fatty acids, glycerol, cholesterol

Dextrin and Maltose

polypeptide amino acids

long chain fatty acids, glycerides,

cholesterol

Dextrin, lactose, sucrose, maltose

Facilitates fat and Vit. A, D, E, K

4

Bile (alkaline)

Intestinal juice

(succus entericus)

Aminopeptidase

Intestinal lipase

Isomaltase

Lactase

Sucrase

polypeptide amino acids

long chain fatty acids, glycerides, cholesterol

maltose

lactose

sucrose

absorption

Single chain amino acid

Fatty acids

Glucose

Glucose, galactose

Glucose, fructose

Large Intestine

Digestibility of an average person

CHO – 90%

Protein – 92%

Fats – 95%

Factors that affect digestion and absorption:

1. Crude fibers – skin and seed of fruit2. Preparation and cooking3. Disease – intestinal cancer, diarrhea

5

4. Surgery – gastrectomy5. Parasitism6. Presence of interfering substance

PHYSIOLOGIC VALUE OF FOOD

Food is good to eat when it fulfills the ff. qualities:1) It is nourishing or nutritious2) It has satiety value3) It is prepared under sanitary conditions4) Its palatability factors (color, aroma, flavor, texture)5) Within the budget and suitable to the occasion.

Nutrition Classification1) According to function2) According to chemical nature3) According to essentiality4) According concentration

Classification of Nutrients1) According to function:

- Function as energy giving, body building, body regulating.2) According to chemical properties: a) Organic – protein, lipids, carbohydrates and vitamins b) Inorganic – water & minerals3) According to concentration a) Macro nutrients – Carbohydrates, Protein, Fats b) Micro nutrients – Vitamins, Minerals & water

CHAPTER 2

BASIC TOOLS IN NUTRITION

Food Groups –group of foods that have similar nutritional properties and is part of the hierarchy of the food pyramid, such as cereal group, milk group, meat and protein group, fruit and vegetable group, fats and sweets group .

The 3 Main Food Groups:1.Body-building foods - foods that supply good quality proteins, some vitamins and minerals.

6

2. Energy foods - mostly of rice and other cereals, starches, sugars and fats contribute the bulk of Calories.3. Regulating foods - composed of fruits and vegetables that provide vitamins and minerals, particularly ascorbic acid and pro vitamin A.

Dietary Guidelines strategies to promote appropriate diets and related health practices to achieve the goal of improving the nutritional condition.

10 Nutritional Guidelines For Filipinos

1. Eat a variety of foods everyday. 2. Breast-feed infants exclusively from birth to 4-6 months and then, give appropriate foods while continuing breast-feeding.

3. Maintain children’s normal growth through proper diet and monitor their growth regularly. 4. Consume fish, lean meat, poultry or dried beans. 5. Eat more vegetables, fruits and root crops. 6. Eat foods cooked in edible/cooking oil daily. 7. Consume milk, milk products and other calcium-rich foods such as small Fish and dark green leafy vegetables everyday. 8. Use iodized salt, but avoid excessive intake of salty foods. 9. Eat clean and safe food. 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking alcoholic beverages.

FOOD GUIDE PYRAMID - FNRI (Foods & Nutrition Research Institute)

7

FOOD GUIDE PYRAMID (USDA) United States Dept. of Agriculture

MyPyramid contains eight divisions. From left to right on the pyramid are six food groups: • Grains , recommending that at least half of grains consumed be as whole grains • Vegetables , emphasizing dark green vegetables, orange vegetables, and dry beans and peas • Fruits, emphasizing variety and deemphasizing fruit juices • Oils, recommending fish, nut, and vegetables sources • Milk,, a category that includes fluid milk and many other milk-based products • Meat and beans , emphasizing low-fat and lean meats such as fish as well as more beans, peas,

nuts, and seeds

RDA & RENI Recommended Dietary Allowance (RDA) - is the information of nutrient allowance for the maintenance of good health. A tool for assessing a dietary intake of the population group. This emphasize the amount of foods or diet.

RENI – Recommended Energy Nutrient Intake- A new standard replacing RDA, emphasizing on recommending on the nutrients rather than

food or diet.- This tool serve as a guide for designing nutrition and health intervention towards an

improvement of the health of the Filipinos.

Food Exchange List

8

- A classification or grouping of common foods in terms of equivalent amounts of Carbohydrates, Protein, Fat and Calories

- The word exchange refers to the fact that each item on a particular list in the portion listed may be interchanged with any other food item on the same list. An exchange can be explained as a substitution, choice, or serving.

Nutritional Labeling

Nutrient density is a measure of the nutrients a food provides compared to the calories it provides. Foods low in calories and high in nutrients are nutrient dense, while foods high in calories and low in nutrients are nutrient poor.

CHAPTER 3

MACRO NUTRIENTSMacro nutrients - constitute the bulk of the food we eat, they provide energy and chemical building-blocks for tissues.

3 Macro Nutrients:1. Carbohydrates2. Protein

9

- Primary means of communication between the producer or manufacturer and the consumer.

2 Components of Nutritional Labeling:1. Nutrient Declaration – a standardized statement

or listing of the nutrient content of food.2. Nutrition Claim – representation which

states or implies that a food has some particular nutritional proponents.

3. Fats

CARBOHYDRATES

Classification of CarbohydratesSimple Carbohydrates

1) Monosaccharide – “simple sugar”, is the simplest form of sugar. a) Glucose – “blood sugar” b) Fructose – sweetest of simple sugar. Found in honey, fruits and vegetables. c) Galactose – not found in free foods. Galactose is a result when the lactose breakdown.

** Simple sugar are water soluble, and quickly absorb in the bloodstream ***

2) Disaccharide – “double sugar”. Made up of 2 monosaccharide. a) Sucrose – ordinary table sugar (glucose & fructose) b) Lactose – “milk sugar” (glucose & galactose) c) Maltose –(malt sugar) is produced during the malting of cereals such as barley.

3) Polysaccharide – “ complex sugar” Composed of many molecules of simple sugar a) Starch – most important in human. They supply energy for longer period of time. Examples: rice, wheat, corn, carrots and potatoes. Starches are not water-soluble and require digestive enzymes called amylases to break them apart. b) Dextrins – formed by the breakdown of starch. obtained from starch by the application of heat or acids and used mainly as adhesives and thickening agents. c) Cellulose – Non-digestible by humans. They lower the blood glucose level of people with diabetes.

10

- Major source of energy for the body.

- Consist of 60-100%of calories.- 1 gram of carbohydrates

contains 4 calories.- carbohydrates are made of carbon, hydrogen and oxygen with the general formula of Cm(H2O)n.

that is composed of glucose units, forms the main constituent of the cell wall in most plants, and is important in the manufacture of numerous products, such as paper, textiles, pharmaceuticals d) Pectin – Sources from fruits and are often used as a base for jellies. e) Glycogen – “animal starch” f) Hemicellulose – also indigestible, found in agar, pectin, woody fibers, leaves, stems. g) Inulin – Important medicine and nursing as it provides test of renal function.

Functions of Carbohydrates:1) Main source of energy for the body.2) Protein sparing action3) Necessary for normal fat metabolism4) Cellulose stimulate peristaltic movement of the gastrointestinal tract. Absorb water to give bulk

to the intestines.5) Lactose encourage the growth of beneficial bacteria, resulting in a laxative action.6) Glucose is the sole source of energy in the brain. Proper functioning of the tissues

Sources of Carbohydrates1) Whole grains2) Sweet potatoes & white potatoes. Bananas, dried fruits. 3) Milk (lactose)4) Sugar , sweets, honey, maple sugar

“Empty Calories” - foods which do not contain any other nutrients except carbohydrates

Common Diseases:1. Overweight2. Diabetes 3. Tooth Decay4. Depressed appetite5. Fermentation causing gas formation6. Cancer

Deficiency1)Ketosis – disease caused by lack of carbohydrates, in which the acid level of the body is raised2)Protein _ Energy Malnutrition a) Kwashiorkor – Protein Def. b) Marasmus – Calorie Def.3) Low Blood Sugar Level

11

FATS or Lipids

- Most concentrated form of energy- Contains 9 calories per gram fat- It is recommended 15-25% fat in the diet- The basic unit of fat is called “triglyceride”, which consist of molecule of glycerol attached to the

3 fatty acids

3 Forms Fatty Acids1) Saturated Fats – Shown to raise blood cholesterol.

• Considered the most “dangerous” type of fat that lead to raise blood cholesterol may lead to coronary heart disease

• Difficult to metabolize causing weight gain Sources: butter, lard, meat, cheese, eggs, coconut oil, chocolate, cakes, cookies 2) Monounsaturated fats – lower level of “bad” cholesterol. Sources: Vegetable oil, peanut, soybean, corn, olive oil, canola oil 3) Polyunsaturated Fats – Lower levels of total cholesterol.

Classes:1) Omega 3 - have a positive effect on reducing mortality from cardiovascular disease. Reduced blood clotting tendency and reduced blood pressure.

2) Omega 6 – “Linoleic acid” polyunsaturated fatty acid. lowers cholesterol levels in the blood and helps in the prevention of heart disease. Sources of Polyunsaturated fats : unrefined safflower, corn, sesame, soybean, sunflower oil,

seeds, nuts, dark green vegetables.

12

- Fats, oils, and waxes belong to the group of naturally occurring organic materials called

- lipids. - Lipids are those constituents of plants or animals

which are insoluble in water but soluble in other organic solvents.

Fatty Acid Composition of Common Food Fats

OIL POLYUNSAT. F.A MONOUNSAT. F. TOTAL UNSAT. F.A SATURATED F.ASafflower Oil 75% 12% 86% 9%Sunflower Oil 66% 20% 86% 10%Corn Oil 59% 24% 83% 13%Soybean Oil 58% 23% 81% 14%Cotton seed Oil 52% 18% 17% 26%Canola Oil 33% 55% 88% 7%Olive Oil 8% 74% 82% 13%Peanut Oil 32% 46% 78% 17%Margarine Oil 18% 59% 77% 19%Palm Oil 9% 37% 46% 49%Coconut Oil 2% 6% 8% 86%Shortening 14% 51% 65% 31%

ANIMAL FATTuna fat 37% 26% 63% 27%Chicken fat 21% 45% 66% 30%Beef fat 4% 42% 46% 50%Butter fat 4% 29% 33% 62%Lard 11% 45% 56% 40%

Functions:1) Important source of calories to provide a continuous supply if energy.2) Protein sparing3) Maintain the constant blood temperature4) Cushions vital organs such as kidney against injury5) Facilitates the absorption of fat soluble vitamins (ADEK)6) Provides satiety and delays onset on hunger.7) Contributes flavor and palatability to the diet.

CholesterolCholesterol is a major component of all cell membranes. It is required for synthesis of sex hormones, bile acids, and vitamin D. It is also a precursor of the steroid hormones.

Cholesterol is also made in the body and is taken also thru foods But Cholesterol is a major factor in the development of heart diseases Daily intake should not exceed 300 mg./day

13

Source of Dietary Cholesterol• Richest: egg yolk, fish roes, mayonnaise and shell fish.• Moderate : Fat on meat, duck, goose, cold cuts, whole milks, cream, ice cream, cheese, butter

and most commercially made cakes, biscuits and pastries. • Poor : All fish and fish canned in vegetable oil, very lean meats, poultry without skin, skimmed

milk , low fat yoghurt and cottage cheese.• Cholesterol free : All vegetables, and vegetable oils, fruit (including avocados and olives), nuts,

rice, egg white and sugar.

Vocabularies:Lipid – Any of a group of organic compounds, including the fats, oils, waxes, sterols, and triglycerides, that are insoluble in water but soluble in nonpolar organic solvents, are oily to the touch.Fat - Any of various soft, solid, or semisolid organic compounds constituting the esters of glycerol and fatty acids and their associated organic groups.Oil – is liquid at room temperature soluble in various organic solvents such as ether but not in waterCholesterol – is a form of fat in animal origin that is a factor in the development of heart disease.Transfats - fatty acids that are produced when polyunsaturated oil are hydrogenated to make them more solid. Thus raise the level of blood cholesterol.Hydrogenated fats – unsaturated oil undergone hydrogenation to make them more solid and less resistant to heat.Low Density Lipoprotein (LDL) - A complex of lipids and proteins, with greater amounts of lipid than protein, that transports cholesterol in the blood. High levels are associated with an increased risk of atherosclerosis and coronary heart disease.High Density Lipoprotein (HDL) - A complex of lipids and proteins in approximately equal amounts that functions as a transporter of cholesterol in the blood. High levels are associated with a decreased risk of atherosclerosis and coronary heart disease.

10 Foods High Transfats1. Spreads – mayonnaise, margarine, butter2. Package foods – cake mixes, biscuits3. Soups – noodle soups4. Fast foods – Mcdonalds, Kentucky Fried Chicken5. Frozen foods – frozen pies, pizza, breaded fish sticks, breaded chicken6. Baked goods – cupcakes7. Cookies & cakes8. Donuts9. Cream Filled cookies10. Chips & Crackers

Sources of Fat1) Animal Fats – fat from meat, fish, poultry, milk, milk products and eggs.

14

2) Vegetable Fats – margarine, seed and vegetable oil, nuts3) Visible Fats – butter, cream, margarine, lard, fish liver oils, pork fat4) Invisible Fats – cheeses, olives, cakes, nuts, pastries

Diseases:1) Heart Disease2) Cancer3) Obesity

PROTEIN

AMINO ACIDSAmino acids are known as the building blocks of protein. They perform many important functions such as: building cells, protecting the body from viruses or bacteria, repairing damaged tissue and carrying oxygen throughout the body

There are 20 different amino acids. Amino acids are linked together to form peptides, which are small chains of amino acids. The peptides are then linked together to form larger proteins. There are thousands of different proteins that carry out a large number of jobs in the human body. Even though so many different proteins are at work in your body, you don't have to worry about consuming each individual protein from the foods you eat. Your body will make those proteins. All you need to do is to make sure your body has a healthy supply of all 20 of the different amino acid "building blocks." Having enough of those amino acids is easy because your body can make 11 of them from other compounds already in your body. That leaves eight amino acids that you must get from your diet.

15

• Known as the building blocks of the body• It contains the elements of carbon, hydrogen,

oxygen and nitrogen.• Protein is made up of amino acids which is the basic

component of protein

Types of Amino Acids1) Essential Amino Acids –are those that are necessary for good health but cannot be produced by the body and so must be supplied in the diet. Ex. Leucine, Isoleucine Lysine, Valine Typtophan, Phenylalanine, Methionine Serine

2) Non-Essential Amino Acids –are those that are produced by the body so not as necessary in the dietEx. Aspartic Acid Tyrosine Glycine Cysteine Arginine Glutamic Acid Histidine Glutamine Alanine Asparagine Proline Complete and Incomplete Protein

• Complete – contain all essential amino acid in sufficient quantities to supply the body’s need Sources: proteins from animals

• Incomplete – those deficient in one or more essential amino acids. Sources : Plant ( grains, legumes, seeds and nuts

Functions of Proteins1) Used in repairing worn out body tissue2) Source of heat and energy3) Contribute to numerous essential body secretions (mucus, milk, sperm cells)4) Keeping fluids and pH balanced in the body 5) Play a large role in the resistance of the body to diseases6) Contributing to enzyme activity that promotes chemical reactions in the body 7) Signaling cells what to do and when to do it 8) Transporting substances around the body 9) Serving as building blocks for hormone production 10) Helping blood clot 11) Serving as structural components that give our body parts their shapes

Sources: Complete Protein

16

1. Meat – beef, pork, lamb2. Poultry – chicken, turkey, duck3. Fish 4. Dairy Products – milk, yogurt, cheese

Incomplete ProteinGrains – beans, corn, oats, pasta, whole grain breadsLegumes, seeds & nuts – sesame seed, sunflower seed, peas, rice, peanuts, cashewVegetables – Brocolli

Common Diseases1) Heart Disease2) Cancer (prostate, pancreas, kidney, breast and colon)3) Osteoporosis4) Weight control5) Kidney Diseases6) Ketosis

Protein – Energy Malnutrition

CHAPTER 4MICRO NUTRIENTSVITAMINS & MINERALS

Vitamins Terminologies• Precursor or Provitamins – these are compounds that can be changed to the active

vitamins Ex. Carotene are precursors to Vit. A

• Preformed Vitamins – naturally occurring vitamins that are inactive form and ready for its biological use.

17

VITAMINS• Complex organic compound to regulate body

processes and maintain body tissue• “Vitamin” comes from the Latin word “vita”

meaning life, “amine” means nitrogen compound.

• Vitamins do not give the body energy.• Therefore, we cannot increase our physical

capacity by taking extra vitamins• Vitamins do not have calorie value.

Ex. Animal sources• Avitaminosis – severe lack of vitamins

Ex. Avitaminosis A leads to night blindness• Hypervitaminosis – “vitamin toxicity”

excessive accumulation of vitamins in the body• Vitamin Malnutrition – “too much or too little”

NOMENCLATURE OF VITAMINSVITAMIN NOMENCLATURE

Vitamin A Retinol D Calciferol E Tocopherol K PhylloquinoneVitamin B1 Thiamine B2 Riboflavin B3 Niacin B4 Panthotenic Acid B6 Pyridoxine B8 Biotin B12 Cyanocobalamin Vit. C Ascorbic Acid

FAT SOLUBLE VITAMINS (Vit. A D E K )• FAT Soluble Vitamins – can be absorbed in the presence of fat & stored in the body.• Fat Soluble vitamins generally have pre cursors or pro vitamins• They can be stored in the body, deficiencies are slow to develop.• Not absolutely needed daily from food sources• Stable especially in daily cooking

Vit. A (Retinol)

FUNCTIONS1) Vision Cycle – necessary component of visual purple (rhodopsia), a pigment to make

adjustments to light and dark.2) Necessary material for maintenance of epithelial tissues.3) Growth & Bone Development – 4) Reproduction – necessary for normal reproduction and lactation.5) Antioxidant

Food Sources1) Animal Sources – liver, yolk, milk, butter, cheese, fish, clams, tahong 2) Plant sources – deep green and yellow vegetables and fruits

DAILY DOSAGE:Male – 1000 microgram

18

Female – 800 microgram

Deficiency & ToxicityVitamin A (Retinol)Deficiency

• Night blindness• Eye lesions• Retarded growth• Lower resistance to infections• Faulty skeletal & dental development

Skin Lesions

Toxicity• Liver damage• Mild dermatitis• Thickening of the skin and peeling off• Course sparse hair• Hyper carotenimia

(harmless orange appearance

VIT. D (Calciferol)

Functions1) Absorption of Calcium & Phosphorus2) Essential for normal growth development.

Food Sources1) Synthesis with sunlight (10 mins/day)2) cod liver fish, halibut [type of flatfish], salmon, sardine, egg yolk3) Fortified Vit. A products

Deficiency• Tetany ( abnormal muscle twitching and cramps• Rickets (defective bones, retarded growth)• Osteomalasia • ( softening of the bones)

Toxicity• Stone formation on kidney• Demineralisation of the bone• Polyuria • Weight Loss• Hypercalcemia

Vit. E (Tocopherol)Functions

1. Maintenance of cellular membrane2. Anti oxidant

19

Food Sources Whole grain nuts, seeds, green and leafy vegetables, polyunsaturated fats

• No toxicity , this nutrient cannot be stored to a large extend in the body

Vit. K ( Phylloquinone)Functions Aids in blood clotting and bone mineralizationFood Sources Green leafy vegetables, soy beans

• Deficiency Hemmorhagic diseases

Toxicity• Vomitting • Albuminuria • Hemolysis

FYI• Anti oxidant - Any substance that reduces oxidative damage (damage due to oxygen) such as

that caused by free radicals. • Free Radicals - are highly reactive chemicals that attack molecules by capturing electrons and

thus modifying chemical structures• PHYTOCHEMICAL - natural bioactive compound found in plant foods that works with nutrients

and dietary fiber to protect against disease

WATER SOLUBLE VITAMINS• Water soluble vitamins are B-complex group and Vit. C• Dissolve in water and are not stored, they are eliminated in urine, so we need continuous supply

of this vitamins in the diet everyday.• Water-soluble vitamins are easily destroyed or washed out during food storage or preparation.• To reduce vitamin loss, refrigerate fresh produce, keep milk and grains away from strong light,

and use the cooking water from vegetables to prepare soups.

Vitamin C (Ascorbic Acid)Functions:

1. Maintenance of bones, teeth, connective tissue,cartilages2. Absorption of Calcium, Iron and Folacin3. Production of brain hormones, immune factors4. Antioxidant

Deficiency:1. Bleeding gums, scurvy, anemia2. joint pain, increase resistance to infections,3. rough skin, hair loss, loose teeth

20

ToxicityDiarrhea, bloating, cramps, formation of kidney stones

FOOD SOURCESCitrus fruits, Brocolli, strawberries, potatoes, mangoes, papaya, red and green bell pepper,Dark green vegetables

Vitamin B1 (Thiamine)Functions1. Helps release energy from foods,2. Promotes normal appetite3. Important in function of nervous system

Deficiency1. Mental confusion; muscle weakness2. wasting; edema; impaired growth; beriberi.

Toxicity (none) NoneFood Sourcespork, liver, whole grains, lean meats

Vit. B2 (Riboflavin)Functions1. Helps release energy from foods; 2. Promotes good vision, healthy skin

Deficiency1. Cracks at corners of mouth; 2. Dermatitis around nose and lips; 3. Eyes sensitive to light.

Toxicity (none)Food Sources

1. Liver, milk, dark green vegetables, whole and 2. enriched grain products, eggs

Vit. B3 (Niacin)Functions

1. Energy production from foods; 2. Aids digestion, promotes normal appetite; 3. Promotes healthy skin, nerves

Deficiency1. Skin disorders; diarrhea; weakness2. mental confusion; irritability.3. Pellagra

Toxicity1. Abnormal liver function;

21

2. Nausea; irritability

Food Sources1. Liver, fish, poultry, meat, peanuts,2. whole and enriched grain products.

Vit. B5 (Panthotenic Acid)Functions

1. Involved in energy production2. aids in formation of hormones.

DeficiencyUncommon due to availability in most foods; fatigue; nausea, abdominal cramps; difficulty sleeping.Toxicity (none)Food SourcesLiver, kidney, meats, egg yolk, whole grains, legumes

Vit. B6 (Pyridoxine)

FunctionsAids in protein metabolism, absorption; Aids in red blood cell formation; Helps body use fats.DeficiencySkin disorders, dermatitisCracks at corners of mouth; Irritability; anemia; kidney stones; Nausea; smooth tongue.

B8 (Biotin)FunctionsHelps release energy from carbohydratesAids in fat synthesis.DeficiencyFatigue; loss of appetite, nausea, vomiting; Depression; muscle pains; anemia.Toxicity – noneFood SourcesLiver, kidney, egg yolk, milk,Fresh vegetables

Vit. B12 – PhylloquinoneFunction: Synthesis of red blood cellsDeficiency - Anemia, fatigue, sore tongueFood Sources – all animal products

22

MineralsWhat is a mineral?

Minerals are elements that are not organic needed by the body in relatively small amounts to help regulate body process and maintain tissue structure

• Minerals do not broken down during digestion nor destroyed by heat or light.

Trace and Major Minerals• Trace Minerals – minerals that are required in our diet at amounts less than 100 mg/day.• Major Minerals - minerals that are required in our diet at amounts greater than 100 mg/day.

Primary Roles:• Metabolic health• Anti oxidant• Blood health• Bone health• Electrolyte balance

Major Minerals:1) Calcium2) Phosphorus3) Magnesium4) Potassium5) Sodium6) Chloride

Trace Minerals:

1) Iron2) Iodine3) Zinc4) Flouride 5) Selenium6) Manganese7) Chromium

Major Minerals

23

Mineral Symbol Function Deficiency Food SourcesCalcium Ca Maintenance of bones and teeth Osteoporosis,

convulsion, muscle spasm

Dairy products, green leafy veg, fish with bones

Phosphorus Ph Bone growth Milk,cereal, all foods

Magnesium Mg Muscle contraction,Bone & tooth structure

Green veg,,sea foods, legumes

Sodium Na Body fluid & acid-base balance Hypertension, edema

Salt, processed foods

Potassium K Body fluid balance All whole foodsChloride Cl Body Fluid Balance Salt, processed

food

Trace Minerals

Mineral Symbol Function Deficiency Food SourcesIron Fe Red Blood Cell structure Iron def. anemia Dark green leafy

vegetables, liver, legumes

Iodine I Thyroid hormone developmentEnergy metabolism

Goiter Sea foods, iodized sale

Zinc Zn Fetal development, wound healing Whole grain, meat, egg

Fluoride Fl Teeth maintenance Dental carries Fortified water, tea, fish bones

Goiter Angular stomatitis RicketsIodine deficiency Vit. C deficiency Vit. D deficiency

WATER

24

• Recommended to drink at least 8 glasses a day• If trying to loose weight 12-15 glasses a day is recommended• A high intake of water aids in fat loss• Caffeine & alcohol are both diuretics. Large intake of water is recommended• Hangover are generally cause by the dehydration action by alcohol• Match a bottle of beer with a glass of water to lessen the intensity of hangover• Vital Element, second only to oxygen• Vital every day• Things that dehydrate

– Aging process– Sweat from exercise– Medications– Caffeine

• Good general rule: for each glass of beverage with caffeine that you consume, drink one extra glass of water.

• Other Benefits– Helps utilize stored fat for energy– Helps body recover quicker after exercise– Aids healing process when you have been ill

CHAPTER 5

Ideal Weight, Total Energy Requirement,Body Mass Index

25

• Most important nutritional constituent is water

• The major component of the body is water

• 60 – 70% water• Water has no nutritional values and no

calories• Water is necessary to transport nutrients• regulate body temperature• Remove waste materials• Participate in chemical reaction & energy

production

Basal Metabolism –the amount of energy required by an individual in the resting state, for such functions as breathing and circulation of the blood.Basal Metabolic Rate – the minimum caloric requirement needed to sustain life in a resting individual. It can be looked at as being the amount of energy (measured in calories) expended by the body to remain in bed asleep all day.

Factors that affect BMR

1.Genetics. Some people are born with faster metabolisms; some with slower metabolisms. 2. Gender. Men have a greater muscle mass and a lower body fat percentage. This means they have a higher basal metabolic rate.3. Age. BMR reduces with age. After 20 years, it drops about 2 per cent, per decade.4. Weight. The heavier your weight, the higher your BMR. Example: the metabolic rate of obese women is 25 percent higher than the metabolic rate of thin women.5. Body Surface Area. This is a reflection of your height and weight. The greater your Body Surface Area factor, the higher your BMR. Tall, thin people have higher BMRs. If you compare a tall person with a short person of equal weight, then if they both follow a diet calorie-controlled to maintain the weight of the taller person, the shorter person may gain up to 15 pounds in a year. 6. Body Fat Percentage. The lower your body fat percentage, the higher your BMR. The lower body fat percentage in the male body is one reason why men generally have a 10-15% faster BMR than women.7. Diet. Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by up to 30 percent.Restrictive low-calorie weight loss diets may cause your BMR to drop as much as 20%.8. Sleep – BMR falls 10-15% below waking levels.9. Endocrine Glands – male sex hormones increase the BMR 10-15%10. Fever – increase 7% for each degree rise the body temperature above 98.6 F

COMPUTATION:

1. BMR = Wt. in lbs. X 10.9 (male) 9.8 (female)

Example : 125 lbs. x 9.8 = 1,225 Cal.

2. BMI = Is a measure of body fat based on height and weightBMI = weight (kg) = 47 kg_____ = 47 kg. = 20.25 = 20kg/m ₂ ( Normal)

( ht. meters) (1.524)(1.524) 2.32₂

3. DBW A . (TANHAUSSER’S METHOD) FOR ADULT

DBW = ( Ht. cm – 100 ) – 10% Ex. 5‘3“ = (63 inches x 2.54) = (160.02 – 100) = (60.02- 6.002 [10%]) = 54 kg.

26

Note: (+ / -) 10% of the value within the range of DBW

B. Infants: (0-6 months) a) DBW = birth weight (gms)+(age in mons.x 600)Note: if the weight is not known, use 3000 gms.Example: 4 month old infant DBW = 3000 + (4 x 600) = 3000 + 2400 = 5400 gms or 5.4 kg. b) DBW = (age in months ÷ 2) + 3 Ex: DBW = (4÷2) + 3 = 2 + 3 = 5 kg.

C. DBW (Children) =( No. of yrs. X 2) + 8Ex. 7 yr. old 1st grader DBW= (7x2)+8 = 14+8 = 22 kg.

4. TER = DBW x activity level Ex. 5’3” student = 54 x 35 = 1,890 Cal.

1) Infants= DBW x 120 Cals./Kg.Ex. 4 month old infantTER = 5.4 kg. x 120 Cals/kg = 648 or 650 Cals.

2) Children = 1000 + (100 x age in yrs.)Ex. 7 yr. old child TER = 1000 + (100 x 7) = 1000 + 700 = 1700 Cals.

2) Adult = DBW x activity level Ex. 5’3” student = 54 x 35 = 1,890 Cal.

CONVERSION: HT. WT.1 ft. = 12 inches 1 kg. = 2.2 lbs1 inch = 2.54 cm100 cm = 1 meter

ACTIVITY LEVEL :Bed rest = 27.5 (hospital patients) Sedentary = 30 (secretary, clerk, typist administrator, cashier, bank teller)

27

Light = 35 ( teacher, nurse, student, Lab.Tech, house wife with maid)Moderate = 40 ( housewife w/o a maid, vendor, mechanic, jeepney & car driver)Heavy = 45 ( farmer, laborer, cargador, laborer, coal miner, fisherman, heavy eqpt.optr )

BMI LEVEL:Obese = above 30Overweight = 27-30Normal = 18.5 – 27Under weight = below 18

4. DIET PRESCRIPTION:

Step 1 : Get the DBW of the patientStep 2 : Compute his/her TER (based on his occupation/activity)Step 3 : Identify his percentage requirement (based on his/her health condition or dietary Requirement

Step 4: Distribution of TER on CHO, PRO, FATS TER x % CHO

TER x % PROTER x % FAT

Percentage DistributionCHO 50-70%

60% (average)PRO 10% (infant/children)

10-15% (adolescent/adult)FAT 20-25% (adult)

30-35% (children)

Step 5 : Gram distribution

% CHO / 4 (fuel value) = ____gm.%PRO / 4 (fuel value) = ____ gm.% FAT / 9 (fuel value) = _____ gm.Step 5 : Meal Distribution

COMPOSITION OF FOOD EXCHANGE LISTLIST FOOD MEASURE CHO PRO FAT CALIAIB

Veg AVeg B

1 c. raw, ½ c cooked½ c raw & cooked

-3

- - 16

II Fruit varies 10 - - 40III Milk

Full CreamLow FatSkimmed

Varies4 tablespoon4 tablespoon

121212

888

105-

17012580

28

IV Rice Varies 23 2 - 100V Meat

Low FatMedium FatHigh Fat

Varies ---

888

16

19

4186

122VI Fat 1 tsp. - - 5 45VII Sugar 1 teaspoon 5 - - 20

FOOD DISTRIBUTION

Example: 336g 84 g. 63 g. 2,240LIST FOOD MEASUR

ECHO PRO FAT CAL

IAIB

Veg AVeg B

33

-9

- - 48

II Fruit 5 50 - - 200III Milk 1 12

Sub: 71(336-71)=265265/23 = 11

8 5 125

IV Rice 10 230 20Sub : 28(84-28)=56(56/8)= 7

1000

V Meat 7 56 42Sub: 47(63-47)=16(16/5)=3

602

VI Fat 3 15 135VII Sugar 4 40 80

341 84 622,190

MEAL DISTRIBUTIONFOOD BFAST LUNCH DINNER AM SNACK PM SNACKVeg AVeg B

11

11

11

FRUIT 1 1 1 1 1MILK 1RICE 2 2 2 2 2

MEAT 2 1 1 1 1FAT 1 1 1

SUGAR 1 1 1 1

29

CHAPTER 6NUTRITIONAL ASSESSMENT

What is Nutritional Assessment?is an in-depth evaluation of both objective and subjective data related to an individual's

food and nutrient intake, lifestyle, and medical history.

Aims of Nutritional Assessment1. To identify certain specific nutritional problem.2. To map out magnitude and geographical distribution of malnutrition3. To determine ecological factors responsible for malnutrition.

Methods of Assessment:) Direct Assessment – based on physical sign

a) Diet History – This method evaluates the primary factor of nutritional inadequacy.b) Physical Method or Anthropometric– Taking weight & height datac) Medical History – record of the person’s past illnessesd) Clinical Examination – physical signs associated with malnutritione) Biochemical Tests – blood plasma, tissue biopsy, urinalysis

B. Indirect Assessment – use of data, statistics and other information. Includes food consumption, eating practices

1) Vital Statistics - a) age specific mortality – no. of death/age and sex group

ave. population of the same age b) Infant Mortality Rate – no. of deaths below 1 yr.

over the number of live births c) Maternal Morality Rate – no. of deaths among women due to pregnancy, labor / total live birth d) Morbidity Rate – no. of reported cases of a given disease present at a given time per 100,000 population

2. Conditioning infections – diarrhea, measles, tb 3. Food Balance Sheet – rough estimate of food supplies available for consumption4. Dietary Survey – 24 hr. food recall

30

5. Cultural and anthropological influences6. Socio economic factors- population, family, education7. Food production - 8. Health and educational services

Methods of Assessing Dietary Intake:

1. 24 Hr. Recall – recall of all what he/she had eaten within 24 hrs.2. Food Frequency Questionnaire3. Diet History- It is more complete than the two previous method. It contains the following:

Economic ( income, amount of money for food) Physical Activity (occupation, exercise, sleep) Ethnic & Cultural Background (religion, educ) Home life & Meal Patterns (no.per household,

person who does the cooking, type of house) Appetite (good, poor) allergies, intolerances, food avoidance Dental/Oral health Gastrointestinal ( heartburn, diarrhea, constipation) Chronic Diseases Medication

4. Food Diary - The subject is asked to write down everything that he eats for a certain time. It could be 3 days, two weeks5. Observation of food intake – most accurate but most time consuming. It requires knowing the amount and kind of food presented and the record of the amount actually eaten.

CHAPTER 7MALNUTRITION

Malnutrition – It is the condition of the body resulting from a lack of one or more essential nutrients or due to excessive nutrient supply.

31

2 Conditions of Nutritional Status

1) Optimum or Good Nutrition – body has adequate supply of essential nutrients for growth & health

2) Malnutrition – A condition of the body resulting from a lack of one or more nutrients or it may be due to an excessive nutrient supply creating toxic or harmful effects

Forms of Malnutrition1. Under nutrition – resulting fro inadequate quantity of food, over an extended period of time

(kwashirkor, marasmus)2. Specific Deficiency – resulting from a relative or absolute lack of an individual nutrient ( iron

deficiency)3. Over nutrition – resulting from the consumption of an excessive quantity of food, calorie excess

(obesity)4. Imbalance – resulting from a disproportion among essential nutrients, with or with out absolute

deficiency of any nutrient.

Types of Malnutrition1. Acute Malnutrition- related to present state nutrition

ex. Loss of weight 2. Chronic Malnutrition – related to the past state of nutrition 3. Primary Malnutrition – caused by lack or unavailability of food (dietary malnutrition) 4. Secondary Malnutrition – caused by certain conditioning factors other than food alone

Nutritional Deficiencies

1) Primary Factor- refers to faulty diet a. Poverty

b. Ignorance c. Poor food Habits d. Limited food supply e. Poor distribution of foods f. Cultural Taboos

g. Low level of education h. Urbanization i. Infectious diseases / parasitism

2. Secondary Factors: a) Interfere with normal digestion

1. Gastrointestinal disorder

32

2. Lack of appetite3. Poor teeth4. Lack of digestive enzymes

b) Factors that interfere with absorption1. Diarrhea2. Mal absorption Syndrome3. Intestinal Surgery4. Laxative5. Parasitism

Factors that affect metabolism & utilization in the cells 1) Liver diseases 2) Malignancy 3) Some drugs 4) Alcoholism 5) Toxins 6) Diabetes Mellitus

Pathogenesis of Nutritional DeficiencyPrimary (Dietary) Nutritional inadequacy tissue depletion (loss of weight)

biochemical changes (laboratory)

functional symptoms ( symptoms appear)

anatomical lesions (physical signs )

Effects of Malnutrition

1. Increase susceptibility to infections2. Inhibits mental development3. Imposes heavy social and economic burdens

Prevention &Treatment of Malnutrition

Prevention:1) Increase economic stability2) Educate the people3) Practice good sanitation and hygiene

33

4) Increase food production5) Eat balance diet 6) Exercise7) Social Awareness ( thin is not “in”)

CHAPTER 8FOOD & DRUG INTERACTION

Introduction

Medications, both prescription and over-the-counter, are used every day to treat acute and chronic illness. Research

and technology constantly improve the drugs we have available and introduce new ones. Medications can help

people live healthy lives for a prolonged period. Although medicines are prescribed often, it is important to realize that

they must still be used with caution.

Foods, and the nutrients they contain, can interact with medications we take. This can cause unwanted effects. A

food/drug interaction occurs when a food, or one of its components, interferes with the way a drug is used in the

body. A drug/nutrient interaction occurs when a drug affects the use of a nutrient in the body.

Risk Factors

Risk for food/drug and drug/nutrient interactions can be affected by many factors such as:

age

gender

medical history

body composition

nutritional status

number of medications used

How Drugs React in the Body

In order to understand food/drug and drug/nutrient interactions, it's important to understand how drugs work in the

body. There are four stages of drug action for medicines taken by mouth:

Stage 1. The drug dissolves into a useable form in the stomach.

Stage 2. The drug is absorbed into the blood and transported to its site of action.

34

Stage 3. The body responds to the drug and the drug performs a function.

Stage 4. The drug is excreted from the body either by the kidney or the liver, or both.

Not all medications are taken by mouth. Still, they are all transported to the site of action. Effects of drug/nutrient and

food/drug interactions vary according to:

type of medication

form of drug (pill, liquid, etc.)

dosage

site of absorption (mouth, stomach, intestine)

route of administration (oral, intravenous, etc.).

DefinitionsAbsorption: the passage of substances from the GI tract into the blood.

Excretion: removal of drugs or nutrients from the body.

Intravenous: within the blood.

Nutritional status: nutrition-related health.

Transport: movement of a substance from one site in the body to another.

Food/Drug Interactions

Foods can interfere with the stages of drug action in a number of ways. The most common effect is for foods to

interfere with drug absorption. This can make a drug less effective because less gets into the blood and to the site of

action. Second, nutrients or other chemicals in foods can affect how a drug is used in the body. Third, excretion of

drugs from the body may be affected by foods, nutrients, or other substances.

With some drugs, it's important to avoid taking food and medication together because the food can make the drug

less effective. For other drugs, it may be good to take the drug with food to prevent stomach irritation.

Alcohol can affect many medications. Always check with your pharmacist about possible effects of alcohol on your

medication.

Grapefruit Juice and Drugs

Grapefruit juice contains a compound that increases the absorption of some drugs. This can enhance their effects.

This compound is not found in other citrus juices.

35

It's best to not take medications with grapefruit juice. Drink it at least two hours away from when you take your

medication. If you often drink grapefruit juice, talk with your pharmacist or doctor before changing your routine.

Drug/Nutrient Interactions

It is also possible for drugs to interfere with a person's nutritional status. Some drugs interfere with the absorption of a nutrient. Other drugs affect the body's use and/or excretion of nutrients, especially vitamins and minerals. If less of a nutrient is available to the body because of these effects, this may lead to a nutrient deficiency.

Sometimes drugs affect nutritional status by increasing or decreasing appetite. This affects the amount of food (and nutrients) consumed. Some specific examples of drug/nutrient interactions are given in Table 2.

The Different Groups of Medicines

Drugs are grouped into classes based on illnesses for which they are prescribed. They can also be grouped in other ways, such as their chemical make-up or actions in the body. Different foods can interact with more than one class of drugs.

Table 3 is a list of 14 drug classes and the uses for each. If you take medication in one of these classes, be aware of potential food/drug and drug/ nutrient interactions. If you aren't sure which classes your medicines fall into, ask your doctor or pharmacist.

Analgesic

Analgesics are drugs that relieve pain. Analgesics often cause stomach irritation. It's a good idea to take analgesics, like aspirin, with food. A full stomach lowers the risk for stomach irritation.

Antacid, Acid Blocker

Antacids neutralize stomach acid, and acid blockers reduce stomach acid production. Long term use of these drugs may lead to certain nutrient deficiencies. This is because stomach acid is important in the digestion and/or absorption of nutrients.

Older people produce less stomach acid, which leads to low absorption of vitamin B 12 . Regular use of antacids or acid blockers lowers vitamin B 12 absorption even more. Vitamin B 12 supplements may be needed in this situation.

Antibiotic

Antibiotics are used to treat bacterial infections. There are many different types of antibiotics. Some antibiotics decrease the synthesis of vitamin K by the bacteria normally found in our intestines. Vitamin K is important for normal blood clotting.

Tetracycline antibiotics bind to calcium found in dairy products. This can decrease the absorption of the antibiotic.

Other drugs like penicillin and erythromycin are most effective when taken on an empty stomach. This is because they may be partially destroyed by stomach acid when taken with food. However, food can reduce the chance of stomach irritation from these drugs. Ask your pharmacist if you should take your antibiotic with or without food.

Anticoagulant

Anticoagulants slow the process of blood clotting. This can decrease risk of strokes in patients whose blood tends to clot too easily. These drugs, like warfarin (Coumadin), work by interfering with the use of vitamin K in blood clotting.

36

People taking these anticoagulants should be consistent in the amount of vitamin K they get from foods. It's very important to avoid eating large amounts of foods high in vitamin K. Rich sources of vitamin K include liver, and green vegetables such as broccoli, spinach, and other leafy greens.

Anticonvulsant

Anticonvulsant drugs help control seizures. Phenytoin (Dilantin), phenobarbital, and primidone may cause diarrhea and a decrease in appetite. This can decrease the availability of many nutrients.

These drugs also increase the use of vitamin D in the body. This means that less vitamin D is available for important functions such as calcium absorption. Vitamin D supplements may be needed.

Some anticonvulsants also interact with the B vitamin folic acid. When drug therapy is started, folic acid levels in the body decrease. Because folic acid supplements affect blood levels of the drug, folate supplementation must be supervised by a doctor.

Antihistamine

Antihistamines are used to treat allergies. Many of these drugs often cause drowsiness. They may also increase the appetite, which can lead to weight gain. Increased physical activity can help reduce weight gain. Alcohol can cause an even greater increase in drowsiness caused by antihistamines like diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), and other over-the-counter drugs containing antihistamines.

Anti-inflammatory

Anti-inflammatory medication is prescribed to patients for a number of problems such as chronic joint pain, headaches, and arthritis. Long-term use may lead to stomach irritation and eventually ulcers. These medications should be taken with food.

Blood Pressure Lowering Drugs

Antihypertensives are used to control high blood pressure. This group of medications is widely used throughout the United States due to the large number of people with high blood pressure.

These medications can affect body levels of minerals such as potassium, calcium, and zinc. For patients with diabetes, these drugs can cause problems in controlling blood sugar. In addition, natural licorice, found in some imported candies, causes salt and water retention. This can lead to an increase in blood pressure.

Cancer Drugs

Antineoplastic agents are used to treat different forms of cancer. These drugs can irritate the cells lining the mouth, stomach, and intestines. Many cause nausea, vomiting, and/or diarrhea. All of these can affect nutrient status.

Methotrexate reduces availability of the B vitamin folic acid. Supplementation of folate may be recommended for people taking this drug, but ask your doctor before starting folic acid.

Diuretic

Diuretics cause the body to excrete more urine and are often used to treat high blood pressure. Some diuretics increase urine losses of minerals such as potassium, magnesium, and calcium. Others limit mineral loss (especially potassium). It is important to talk with your doctor about whether you need to take or avoid mineral supplements.

37

Laxative

Laxatives speed up the movement of materials through the digestive tract. This reduces the time for nutrient absorption. Excessive use of laxatives can deplete vitamins and minerals needed for normal body function. Laxatives also increase fluid losses. This may lead to dehydration.

Lipid Lowering Drugs

Lipid lowering drugs, also called Antihyperlipemic drugs, reduce blood cholesterol levels. Medications such as cholestyramine (Questran) may decrease the absorption of the fat soluble vitamins (A, D, E, and K), vitamin B 12 , folic acid, and calcium. For long-term use, it may be helpful to take a multivitamin and a calcium supplement.

Mental Health Drugs

Psychotherapeutic drugs treat depression, anxiety, and other mental health conditions. Some of these drugs increase appetite while others decrease it. Either effect can impact weight in a significant way.

Avoid alcohol when using these drugs. Alcohol can intensify the drowsiness caused by this class of drugs. Some psychotherapeutic drugs are Monoamine Oxidase (MAO) inhibitors.

MAO Inhibitors

These drugs decrease the body's use of compounds called monoamines. MAO inhibitors can also react with tyramine (a monoamine) found in foods. This reaction can cause a dangerous rise in blood pressure. If not treated, this can cause death. Some aged and fermented foods are high in tyramine. They should be avoided by people taking MAO inhibitors. A few of these foods are:

aged cheese Brewer's yeast, yeast extracts

Chianti wine

pickled herring

fava beans

If you are not sure if you are taking a MOA inhibitor, ask your doctor or pharmacist.

Things to Keep in Mind

38

As you probably know, there are a wide variety of medications on the market today. Almost all medications have the

potential to cause side effects. Many people take more than one medication. This is especially true with older people.

When people take multiple medications, food and drug interactions are more likely to occur. The following tips can

help you avoid problems with your medication.

Always carry a list of all your medications and the dosing instructions.

When your doctor prescribes a new medication, tell him/her all the other drugs you already take. This

includes over-the-counter drugs and supplements that you use regularly. Also, remind your doctor about any

drug allergies you have.

Know how and when to take all of your medications. If you have any questions, ask your doctor or

pharmacist.

If you have any side effects from a medication, contact your doctor or pharmacist immediately. Do not wait

until your next appointment. If you are not sure if symptoms are related to your medication, be sure to ask.

It is usually best to take medication with a full glass of water. This may help to prevent stomach irritation and

improve absorption. Don't take medications with soft drinks or grapefruit juice.

Get your prescription refilled before you run out so that there are no missed doses.

Don't stir your medication into food or drink unless your doctor or pharmacist tells you to. Certain foods may

break down the drug, or limit its absorption.

Always read the directions and warning labels on your medication bottles and packages. If you don't

understand something, ask your doctor or pharmacist.

Table 1.

Table 1: Examples of Food/Drug Interactions

Drug Class Food that InteractsEffect of the

FoodWhat to Do

Analgesic

acetaminophen (Tylenol)Alcohol

Increases risk for liver toxicity

Avoid alcohol

Antibiotic

→tetracyclines

→amoxicillin, penicillin, zithromax, erythromycin

→nitrofurantoin (Macrobid)

→Dairy products; iron supplements

→Food

→Food

→Decreases drug absorption

→Decreases drug absorption

→Decreases GI distress, slows drug absorption

→Do not take with milk. Take 1 hour before or 2 hours after food/milk.

→Take 1 hour before or 2 hours after meals.

→Take with food or milk.

Anticoagulant

warfarin (Coumadin)

Foods rich in Vitamin K Decreases drug effectiveness

Limit foods high in Vitamin K: liver, broccoli, spinach, kale, cauliflower, and

39

Brussels sprouts

Anticonvulsant

phenobarbital, primidone

AlcoholCauses increased drowsiness

Avoid alcohol

Vitamin CDecrease in drug effectiveness

Avoid excess vitamin C

Antifungal

griseofulvin (Fulvicin)High-fat meal

Increases drug absorption

Take with high-fat meal

Antihistaminediphenhydramine(Benadryl),chlorpheniramine(Chlor-Trimeton)

AlcoholIncreased drowsiness

Avoid alcohol

Antihyperlipemiclovastatin (Mevacor)

FoodEnhances drug absorption

Take with food

Antihypertensivefelodipine (Plendil), nifedipine

Grapefruit juiceIncreases drug absorption

Consult your physician or

Pharmacist before changing diet.

Anti-inflammatory

naproxen (Naprosyn),

ibuprofen (Motrin)

→Food or milk→Decreases GI irritation

→Take with food or milk

→Alcohol

→Increases risk for liver

→Damage or stomach bleeding

→Avoid alcohol

Diuretic

spironolactone (Aldactone)

FoodDecreases GI irritation

Take with food

Psychotherapeutic

MAO inhibitors:

isocarboxazid (Marplan),

tranylcypromine (Parnate),

phenelzine (Nardil)

Foods high in tyramine: aged cheeses, Chianti wine, pickled herring, Brewer's yeast, fava beans

Risk for hypertensive crisis

Avoid foods high in tyramine

40

Table 2: Examples of Drug/Nutrient Interactions

Drug Class Food that Interacts Effect of the Food What to Do

Acid Blockerranitidine (Zantac),

cimetidine (Tagamet),famotidine (Pepcid),

nizatidine (Axid)

Vitamin B12Decrease vitamin

absorptionConsult your physician regarding B12

supplementation

Antihyperlipemiccholestyramine

(Questran),colestipol (Colestid)

Fat soluble vitamins

(A, D, E, K)

Decreases vitamin absorption

Include rich sources of these vitamins in the diet

Antineoplastic

methotrexate

Folic acid, vitamin B12

Decreases vitamin absorption

Consult your physician regarding supplementation

Diureticfurosemide (Lasix),

hydrochlorothiazide (HCTZ)

Many minerals Increases mineral loss in urine

Include fresh fruits and vegetables in the diet

Laxative

fibercon, Mitrolan

Vitamins and minerals

Decreases nutrient absorption

Consult your physician regarding supplementation

Table 3: Examples of drug classes and their uses.

Class Used to treat...

Analgesic Pain

Antacid, Acid Blocker Stomach upset, ulcers

Antibiotic Infection

Anticoagulant Blood clots

Anticonvulsant Seizures, epilepsy

Antihistamine Allergies

Antihyperlipemic High blood cholesterol

Antihypertensive High blood pressure

Anti-inflammatory Fever, inflammation

Antineoplastic Cancer

Diuretic Water retention

Laxative Constipation

Psychotherapeutic Depression, anxiety

41

CHAPTER 8NUTRITION IN THE LIFE CYCLE

PREGNANCY

• Nutrition in Pregnancy: • During the total pregnancy period, the basal metabolic rate increase from 6-14% • Calorie intake is increased – 10-20% increase ( if the woman is overweight it is necessary for her

o reduce) • Protein - Increase in nitrogen content of the fetus and its membranes and added protection of

the mother against complications• Increase of 9.5 gms./ day

• Calcium / Phosphorus / Vit. D – Increase , to calcify the fetal bones & teeth (0.5 – 0.9 of the RDA)

• Iron – Increase, 700-1000 mg. of Fe is absorbed during the pregnancy • Iodine – to help the mother and the child prevent goiter in the future and for brain

development • Folic Acid - women of childbearing age consume 400 micrograms (0.4 mg) of folic acid each day.

Folic acid, a nutrient found in some green, leafy vegetables, most berries, nuts, beans, citrus fruits, fortified breakfast cereals, and some vitamin supplements can help reduce the risk of birth defects of the brain and spinal cord (called neural tube defects).

42

• Pregnancy – (Gestation) is a period when the fertilized ovum implants itself in the uterus. Human pregnancy last for the period of 266 – 180 days ( 37-40 weeks)

BIOLOGICAL CHANGES:• 1. Implantation Period – 1st 2 weeks• Period of organ formation- next 6

weeks• Period of rapid fetal development –

remaining 7 months

Dangerous for pregnant women

• Alcohol, Caffeine & Nicotine – • Smoking – lowers the birth weight, increase the perinatal mortality, decrease oxygenation of

the fetus • Alcohol – mental retardation, growth deficiencies, facial deformities.

LACTATION

Factors Affecting Milk Secretion1)Diet – intake of meat & veg. soup (tahong, tulya, malunggay) “galactogue”

• Stimulate milk secretion• Water should not be drunk beyond the level of natural thirst. It suppress milk secretion

2. Nutritional State of Mother – Malnutrition and illnesses (cardiac and kidney diseases, anemia, beri-beri, tuberculosis) can lessen the quanity and quality of milk

• Emotional & Physical State – relax, pleasant surroundings, lots of rest and good sleep• Suckling - suckling right after delivery stimulate milk secretion• Contraceptives & Drugs – depress milk flow

Advantages of Breast FeedingCOLOSTRUM – thin yellowish fluid secreted during the first 2 days

1. Breast milk produces anti bodies, immunity against diseases2.Lactose is higher in breast milk, to produce beneficial bacteria in the GI tract.3.Calcium and Phosphorus level are regulated4. Prevent dental arch

5.Cow’s milk protein causes allergy6. Less incidence of lung cancer7. Fast return of the uterus to its original size8. Biologically complete

43

• Calories – additional 1000 calories – help to produce milk

• Protein – additional of 20 gms. , to compensate the protein lost in milk

• Calcium & Phosphorous – Increase of 0.5 mg., to prevent severe depletion of maternal calcium for milk production

• Iron – additional intake is recommended for blood lost

• Vit. A – additional 2000 IU, needed in the ilk secretion

• Riboflavin, Vit. C – increase

Fluids – 8 glasses or more

9. Easily digested10. Convenient and dependable11. Safe12. Emotional satisfaction between mother & child

INFANCY

• Growth – increase in size due to increase in the number of cells • Development – increase in functional ability • Behavioral Development of a Healthy Baby

0-1 month suckles & smiles2-3 months vocalize & controls head4-5 months controls hands & rolls over6-7 months sits briefly & crawls8-9 months grasps & pulls up10-11 months walks with support12 months stars to walk alone

Methods of Feeding the Infant:1) Breast Feeding2) Artificial Feeding – bottle feeding using infant formula3)Mixed Feeding – combination of breast & bottle

Milk Formula: A) Whole Cows Milk Formula1. Powdered whole cow’s milk – milk dried under controlled condition

(Nido, Birch Tree, Anchor Mik)2. Full Cream evaporated Milk – whole milk from which 50-60% of water content has been removed3. Recombined milk – skim milk powder reconstituted to normal fat content of the whole milk by adding butterfat4.Reconstituted milk – process milk to which water is added to restore its original water content (Frisian Girl, Alpine)

B) Other type of evaporated milk not recommended for infants 1. Sweetened condensed – High in sugar resulting in very diluted milk formula 2. Evaporated Filled Milk – cow’s milk from which butterfat has been removed and replaced with vegetable oil (94% coconut oil, 6% corn oil)3. Skim Milk – butter fat has been removed (Enfamil, Olac)4.Acidified Milk – increase digestibility ( Pelargon, Acidolac)5.Completely Modified Milk Formula – Protein & mineral content are adjusted to resemble human milk (SMA, S-26, Similac)6. Non- cows Milk formula – Soybase for infant’s allergy to cow’s milk ( Sobee, Mullsoy, Isomil) Note: goat’s milk has also been found effective as hypo allergenic milk

44

Baby’s Food During the 1st Year of Life:1. Cereal Foods – (3-4 months), milk is still continued2. Fruits – (3-4 months) , mashed

3. Vegetables – (3-4 months) , mashed (carrots, squash, sayote,) green leafy vegetables may be mashed and sieved and mix with other foods.4. Eggs –( 4- 5 months) , only eggyolk is given

5. ( 9-10 months) , can give the whole egg6. Munggo – ( 5 months) cooked well and strained7. Meat, fish or Poultry – ( 5-6 months) , ground and strained8. Other Foods – custards, puddings, plain ice cream, plain gulaman or jello

HOW TO GIVE SUPPLEMENTARY FOODS• Introduce one food at a time• Give small amounts of foods• Use thin, soft consistency. Gradually, modify the consistency• Never force an infant to eat more of a food he can takes• Omit the food if the infant refuse to eat several times• slightly seasoned with small amt. of salt• Variety of foods is important• don’t show any dislikes for the food

NUTRITION FOR PRE-SCHOOL

• This is the most difficult stage in feeding a child since the appetite tapers off corresponding to the lower rate of growth. Foods to Give the Pre-School Child:1) Mildly flavored foods2) Plain foods is acceptable than mixed foods.3) Fruits, puddings, custard, ice cream and gelatin may be given

Sign of Good Nutrition in Pre-School Child– Alert, vigorous and happy– Endurance during activities– sleeps well– Normal height and weight for age– Stands erect, arms and legs straight– Clear, bright eyes, smooth healthy skin, lustrous hair– Firm and well developed muscles– Not irritable and restless– Good attention

NUTRITION FOR SCHOOL CHILDFeeding Problems Limited time for eatingPoor Eating practicesUnbalance program of activities & restRecommended Solutions:

45

allow sufficient time for mealsEncourage child to eat more fruits & vegetablesProvide child with properly selected snacksRegulate the activitiesGuidance in proper food selectionNUTRITION FOR ADOLESCENTSThe best nutrition advise to keep your adolescent healthy includes encouraging her to:

• Eat a variety of foods • Balance the food you eat with physical activity • Choose a diet with plenty of grain products, vegetables and fruits • Choose a diet low in fat, saturated fat, and cholesterol • Choose a diet moderate in sugars and salt • Choose a diet that provides enough calcium and iron to meet their growing body's

requirements.

NUTRITION IN THE ELDERLYNutritional Requirements:

• Energy (calories) – decreases in calories because of reduced basal metabolic rate and reduce in physical activities. A decrease of 7.5% intake after 45 yrs. Of age

• Protein – Protein allowance of 1.12 gms./kg. body weight is maintained• Necessary for the prevention and tissue wasting and susceptibility to diseases• Minerals (Calcium) – is maintained to prevent occurrence of osteoporosis• Iron – Iron allowand for women 50 and above is as low as 7.0 mg/day• Vitamins – Vit. C is needed for the absorption of calcium and iron. Intake of Vit. E to retard

cellular aging.• B complex – to maintain good appetite• Water & Fiber – 6-8 glasses a day. To prevent constipation

FACTORS AFFECTING ADEQUATE FEEDING

• Long standing dietary habits• Loss of teeth• Loss of taste and smell• Loss of neuromuscular coordination• Physical discomfort • Economic consideration• Social Factors• Psychological factors

Diet Recommendation1. Eat good breakfast to start the day2. Eat 4-5 light meals a day3. Include essential foods (fish, vegetables, fruits)4. Eat leisurely in pleasant surroundings5. Eat the heaviest at noon6. Avoid fatty foods

46

7. Avoid coffee 8. Drink hot milk before going to bed

CHAPTER 7

DIET THERAPY

Purpose of Diet Therapy:1. To maintain or restore good nutritional status2. To correct nutritional deficiencies which may occurred3. To afford rest to a particular organ4. To adjust the diet to the ability of the body to metabolize the nutrients5. To bring about the changes in the body weight

Hospital Routine Diet:1. Full, general or regular diet – designed for patients who require no special dietary modifications

or restrictions. 2. Soft Diet – patients who are unable to chew, swallow or digest foods3. Liquid Diet – Clear, full, cold, osterized, blenderized or tube feeding

Therapeutic Diet:

A. Modification in ConsistencyLiquid Diet1. Clear Liquid Diet

Indication : surgery, inflammatory on GI Tract, necessary to minimize fecal materialFood Selection : clear, fat-free broths, strained juices, tea, black coffee, gelatin, hard

candies, give small amount every 1-2 hrs2. Full Liquid Diet

Indication : Post operative, acute infection, impaired chewing and swallowing, mouth Surgery

Food Selection: strained cream soups, pureed fish and juices, plain gelatin, plain ice cream, custard, milk & mild drinks, 6-8 frequent feeding.

3. Cold Liquid Diet Indication : Tonsilectomy, dental extraction, throat & mouth operations

Food Selection : Plain ice creams, cold milk, iced tea, iced coffee

47

Soft Diet Patients who are unable to chew, swallow or digest foods

1. Minimum Residue Diet Indication : Dysentery, Diarrhea, Pre and post operation, colostomy, ileostomyFood Selection : plain, strained foods, lean, tender meats, chicken no skin, soft cooked egg, strained vegetablesAvoided: milk, cheese, raw eggs, vegetables, fruits, coarse bread, fried foods

2. Bland Diet Indications: Gastric, Doudenal ulcers, gastritis, ulcer, cardiac cases

Food Selections: mild in flavor, no coarse fiber and tough connective tissue Avoided: Black pepper, chili powder, strong coffee, alcohol

3. Mechanical SoftIndications : Poor dentures, lack of teeth, sores & lesions in the mouth

Spastic constipation, diverticulisis, other gastro-intestinal disturbancesFood Selections : full diet but reduced amount (grinding, chopping, mincing)

B. Modification in Composition

1. High Calorie Diet Indications: Underweight, PEM, fevers, infections, hypertyroidism, burns, growth,

pregnancy, lactation Food Selections: Normal diet , increase amount of cereals, breads, butter, cream , fats and sugar

Avoided: Excessive amount in bulky low calorie foods

2. Low Calorie Diet Indications : Obesity, diabetes, renal failure, gout, gallbladder, preceding surgery

Food Selections :Emphasize in bulk low in calorie for satisfied feeling

3. High Carbohydrates Indications : renal & liver disturbances, toxemia of pregnancy, Addisons's disease

Food Selections -Emphasize on rice and other cereals, root crops, noodles, sugar, native cakes

4. Low Carbohydrates Indications : Hyperinsulinism, dumping syndrome, obesity, epilepsy, celiac disease

Food Selections : Foods high in protein, adequate to high fat foods, in certain conditions

5. High Protein Indications : Growth, pregnancy, malnutrition, lactation, burns, surgery, fractures,

anemia, hepatitis, cirrhosis, hyperinsulinismFood Selections : With emphasis on meat, milk, eggs, cheese, poultry

6. Low ProteinIndications : Acute glomerunephritis, uremia, hepatic comaFood Selections : Avoided: protein foods in excess amounts, limit the intake of legumes, nuts

7. Zero Protein

48

Enteral & Parenteral Feeding

Parenteral feeding – (Total Parenteral Nutrition) describes the intravenous administration of nutrients.

• Designed for individuals who cannot accept nutrients enterally.• The person receives nutritional formulas containing salts, glucose, amino acids, lipids

and added vitamins.

Method of Administering TPN

49

GENERAL USAGE

• Is provided when the gastrointestinal tract is nonfunctional.

• When the patient is comatose• Patient’s digestive system has

shut down• To treat people suffering the

extended consequences of an accident, surgery, or digestive disorder.

TPN is administered by:

1) Medical infusion pump

2) A sterile bag of nutrient solution

Performed through a central intravenous catheter, usually through the subclavian jugular vein with the tip of the catheter at the superior vena cava without entering the right atrium. Another common practice is to use a PICC line, which originates in the arm, and extends to one of the central veins, such as the subclavian with the tip in the superior vena cava. In infants, sometimes the umbilical vein is used.

Complications:

1. Bacterial and fungal infections2. Liver failure due to excess glucose contained

in the solution.3. acute cholecystitis due to complete unusage of gastrointestinal tract

ENTERAL FEEDING:

Enteral Feeding – delivery of food and nutrients either orally or by tube feeding directly into GIT.

50

Types of Enteral Feeding

Types of Enteral Formulation

1. Ready to Use formulations2. Tube feedings – prepared from regular foods3. Blenderized Tube feeding – are soft diet which can be blenderized.4. Standard tube feeding – fiber free, high in cholesterol, fat and sugar. (milk, sugar and soft

cooked eggs)

51

Gastric feeding tube

• A gastric feeding tube (or "G-tube," or "button") is a tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition.

• Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach.

• Use to treat anorexia nervousa

Complications:

1. Mechanical a) Nasopharyngeal irritation b) Luminal obstruction c) Mucosal erosions d) Tube displacement e) Aspiration2) Gastrointestinal a) cramping/distention b) vomiting/diarrhea c) costipation 3) Metabolic a) Hypertonic dehydration b) Glucose intolerance c) Cardiac failure d) Renal failure e) Hepatic ecephalopathy

52