Nutrition Lecture
-
Upload
matrixtrinity -
Category
Documents
-
view
220 -
download
0
Transcript of Nutrition Lecture
-
7/27/2019 Nutrition Lecture
1/147
NUTRITIONDIETETICSNUTR T ON
-
7/27/2019 Nutrition Lecture
2/147
Nutrition - the science of food, the nutrients
and other substances therein, their action,
interaction and balance in relation to health and
disease, and the processes by which organism
ingests, digests, absorbs, transports, utilizes
and excretes food substances.
Dietetics - refers primarily to the therapeutic
and food service aspects of the delivery ofnutritional services in hospitals and other
health care institutions (PD 1286).
-
7/27/2019 Nutrition Lecture
3/147
Physical and Psychological
Dimension Physical- efficiency of the body to function
appropriately and meet daily energy requirements.
Intellectual-Use of cognitive abilities to learn and
adapt to changes in the environment.
Emotional- capacity to express feeling appropriately
Social-Ability to interact with people in an acceptable
manner. Spiritual-Cultural beliefs that give purpose to human
existence.
-
7/27/2019 Nutrition Lecture
4/147
Classification of Nutrients
1.According to function
a. Body-building
b. Energy-giving
c. Regulate bodyprocess
2.According to chemicalnature
a. organic b. Inorganic
3.According to
essentialityEssential
or Non-Essential
4.According to
concentration
a. Macronutrientswater, protein, fats and
carbohydrates
b. Micronutrients
vitamins & minerals
-
7/27/2019 Nutrition Lecture
5/147
B SIC TOOLS INNUTRITION
-
7/27/2019 Nutrition Lecture
6/147
10 Nutritional Guidelines for Filipinos (2002) 1st edition in 1990Developed by: Clinical Nutrition Section
Medical Nutrition Division, FNRI-DOST
1. Eat a variety of foods everyday.
2. Breastfeed infants from birth to 4-6 months andthen give appropriate foods while continuing breastfeeding.
3. Maintain childrens normal growth through proper diet and monitor their
growth regularly.
4. Consume fish, lean meat, poultry or dried beans
5. Eat more fruits, vegetables and root crops
6. Eat foods prepared with edible oil/cooking oil daily.7. Consume milk, milk products or 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 foods.
10. Exercise regularly, do not smoke and avoid drinking alcoholic beverages.
-
7/27/2019 Nutrition Lecture
7/147
RECOMMENDED ENERGY AND NUTRIENT INTAKES (RENI)Philippines, 2002 Edition
RENI Comm ittee, Task Forc es, and t he FNRI-DOST Secretariat
-
7/27/2019 Nutrition Lecture
8/147
Food Exchange List the grouping of common foods according to their energy,carbohydrate, fat and protein values.
LIST FOOD
GROUP
EX Household MEASURE CHO
(g)
PRO
(g)
FATS
(g)
ENERGY
(Cals)
IA Veg A 1
2
1cup raw or 1/2cup cooked
2cups raw or 1cup cooked
-
3
-
1
-
-
-
16
IB Veg B 1 1/2cup raw or cup cooked 3 1 - 16
II Fruit 1 varies 10 - - 40
III Milk
Full cream
Low fat
skimmed
1
1
1
varies
4T
varies
12
12
12
8
8
8
10
5
tr
170
125
80
IV Rice 1 varies 23 2 - 100
V Meat &Fish
Low fat
Med fat
High fat
11
1
VariesVaries
varies
--
-
88
8
16
10
4186
122
VI Fat 1 1 teaspoon - - 5 45
VII Sugar 1 1 teaspoon 5 - - 20
-
7/27/2019 Nutrition Lecture
9/147
NUTRITION FACTS FOOD LABELING - a format on packaged foods that
gives nutrition information & a list of ingredients as required by law.
-
7/27/2019 Nutrition Lecture
10/147
Principles of Nutrition
DIGESTION- is the process by which food is
broken down in the gastrointestinal tract.
Mechanical Digestion- process of
physically breaking down food into smaller
pieces.
1. Mastication- tearing and grinding effort of
teeth and tongue on the food.
2. Peristalsis- rhythmic contractions of muscles
helps move food through the GIT
-
7/27/2019 Nutrition Lecture
11/147
3. Segmentation- the forward and backward
muscular action, assists in controlling the food
mass.
Chemical DigestionProcess of splitting
complex molecules into simpler ones.
HORMONES
Gastrin- signals the stomach to produce gastric
secretions for the protection of the mucosal
lining.
-
7/27/2019 Nutrition Lecture
12/147
Hormones
Secretin- stimulates the release of bile by the
liver and bicarbonate by the pancreas to aid in
digestion.
Cholecystokinin- causes the contraction of the
gallbladder for fat digestion as well as other
pancreatic enzymes for protein and
carbohydrate breakdown.
-
7/27/2019 Nutrition Lecture
13/147
Enzymes
Protein , specific in kind and quantity, for
breaking down specific nutrients.
1. Peptidase- for breakdown proteins into amino
acids.
2. Pancreatic lipase- digests fats molecules into
essential fatty acid compounds and glycerol.
3. Maltase,Sucrase,Lactase- aid in reduction of
sugars into fructose, glucose and galactose.
-
7/27/2019 Nutrition Lecture
14/147
ABSORPTION
The process by which nutrients are carried into
the bodys circulation system and delivered to
cells.
Specialized structures ensure maximum
absorption of essential nutrients primarily in
the small intestine.
Absorption process include diffusion and
pinocytosis.
-
7/27/2019 Nutrition Lecture
15/147
METABOLISM
Encompass the total chemical changes in the
body by which it maintains itself.
1. CATABOLISM breaking down of food
components into smaller molecular
particles(destructive phase).
2. ANABOLISM process of synthesis from
which substances are formed( Constructive
phase).
-
7/27/2019 Nutrition Lecture
16/147
EXCRETION
The elimination of waste by-products of food
breakdown.
CHYME-is a mixture of partially digested
food with digestive secretions found in the
stomach and small intestine.
By products of digestion normally include
cellular wastes, water, bile salts,mucous,
undigested food and dietary fiber and bacteria.
-
7/27/2019 Nutrition Lecture
17/147
Assessment of Nutritional Status
1. CLINICAL EXAMINATIONdistribution
of body fat, appearance of skin, hair, nails,
teeth and wound or lesions.
2. FOOD RECORD AND DIET HISTORY-
data on the food a person eats for a 24-hour
period.
3. FAMILY TREE
-
7/27/2019 Nutrition Lecture
18/147
4. BIOCHEMICAL ANALYSIS- samples of
body tissues such as blood and urine tests to
see how the body uses nutrients.
5. ANTHROPOMETRIC MEASUREMENTS-
height, weight and limb circumference.
6. SKIN-FOLD THICKNESS- using skin
calipers or other tools.
-
7/27/2019 Nutrition Lecture
19/147
7. WEIGHT-FORHEIGHT TABLES-
estimating body weight using the Metropolitan
Life Insurance Company Weight-for-Height
tables is one common way to determine apersons desired weight based on sex and body
frame size.
8. BMI ( body mass index)
bw(kg) or bw(lb) x 703.1
ht2 ( meters) ht2 ( inches)
-
7/27/2019 Nutrition Lecture
20/147
BMI- 18.5-24.9 healthy range
BMI- 25-29 mod. Overweight
BMI 30+ obesityBMI 40+ morbid obesity
-
7/27/2019 Nutrition Lecture
21/147
9. UNDERWATER WEIGHING- method for
estimating total body fat, weighing a person on
a standard scale and then again submerged in
water. The difference between the twomeasurements is an estimation of body fat.
10. BIOELECTRICAL IMPEDANCE- method
that uses low energy electrical current. Themore fat a person has, the more impedance to
an electrical flow will occur.
-
7/27/2019 Nutrition Lecture
22/147
11. INFRARED LIGHT TO BICEP- used to
assess the fat composition in proportion to
muscle
12. DUAL X-RAY PHOTON
ABSORPTIOMETRY ( DEXA) xray system
that separates body weight into fat , fat free,
soft tissue and bone
-
7/27/2019 Nutrition Lecture
23/147
Impact of Culture on Diet
Personal habits regarding food develop as part
of our social and cultural background as well
as, our lifestyle. All of our food habits are
related to our way of life, our values, beliefsand individual situations.
-
7/27/2019 Nutrition Lecture
24/147
Characteristics of Ethnic Diets
Food habits develop from personal, cultural,
social, economic and psychological influences.
Many foods in our culture take on symbolic
meaning related to major life experiences.
Since ancient times , ceremonies and religious
rites involving food have been important.
-
7/27/2019 Nutrition Lecture
25/147
Food Preferences/Preparations
Jewish Orthodox
Basic dietary law is the Rules of Kashruth.
Foods selected and prepared are calledkosher.
No pork is allowed, meat is cleansed of all
blood.
Combining of meat and milk is not permitted.
Only fish with fins and scales are allowed.
-
7/27/2019 Nutrition Lecture
26/147
Jewish Orthodox
No eggs with a blood spot are used.
Representatives foods include bagels, blintzes,
knishes, lox and matzo.
-
7/27/2019 Nutrition Lecture
27/147
Mexican
Follow food habits of early Spanish settlers
and Indians.
Dried beans, chili peppers, and corn are staple
items.
Small amount of meat and eggs are eaten.
Some fruits are consumed depending on
availability.
Coffee is main beverage.
Representative foods include tortillas and rice.
-
7/27/2019 Nutrition Lecture
28/147
Asian/Chinese/Japanese
Believe that refrigeration diminishes flavor,
use fresh foods and cook quickly.
Woks are used for cooking.
Vegetables are usually served crisp.
Meats are used in small amounts and in
combined dishes.
Fresh fruits are eaten often.
Rice is the staple grain.
-
7/27/2019 Nutrition Lecture
29/147
Peanut oil is the main cooking fat.
Sushi and any raw fish are carefully prepared.
-
7/27/2019 Nutrition Lecture
30/147
Greek
Meals are simple but family oriented, with
bread the center of the meal.
Cheese especially feta is used liberally in the
Greek diet.
Lamb is favorite meat.
Eggs are main dish but not used for breakfast.
Vegetables are used as main entrees.
Salad with cheese, olive oil and vinegar are
consumed in the Greek diet.
-
7/27/2019 Nutrition Lecture
31/147
Greek
Rice is the main grain.
Rich pastries , like Baklava, are used for
special occasions.
-
7/27/2019 Nutrition Lecture
32/147
Native American
Food preferences vary with each region/tribe.
Corn, cornmeal, blue corn breads are typical.
Corn is a status food for most tribes. Fried food are common.
Lard and shortening are main cooking fats.
-
7/27/2019 Nutrition Lecture
33/147
Moslem/Arabs
Dietary laws are based on Islamic teachings
Most meat are permitted except for pork.
Moslem diets prohibits fermented fruits andvegetables.
Beans, bulgur, rice are used in many ways as a
protein source.
Representative foods are bulgur and falafel.
-
7/27/2019 Nutrition Lecture
34/147
Indian
Many Hindu people do not eat beef because of
the belief in the cow as sacred.
Milk is not provided to children in some areas
because they believe that milk will hinder
growth.
Bananas are not given because of the belief
that they cause convulsions.
-
7/27/2019 Nutrition Lecture
35/147
Carbohydrate Type Common Names Naturally Occurring Food
Sources
SimpleMonosaccharide
Glucose
Fructose
Galactose
Disaccharides
Sucrose (glucose + fructose)
Lactose (glucose + galactose)
Maltose (glucose + glucose)
Blood sugar,
dextrose
Fruit sugar, laevulose
Milk sugar
Table sugar
Milk sugar
Malt sugar
Fruits, sweeteners
Fruits, honey, syrups, vegetables
Part of lactose, found in milk
Sugar cane, sugar, beets, fruits,
vegetables
Milk and milk products
Germinating grains
Complex
Polysaccharides
Starches (strings of glucose)
Fiber
Complex
carbohydrates
Roughage
Grains, legumes, potatoes
Legumes, whole grains, fruits,
vegetables
CARBOHYDRATES
-
7/27/2019 Nutrition Lecture
36/147
Functions of Carbohydrates
1. Energy source2. Protein-sparing action
3. Anti-ketogenic effect
4. Control of fat oxidation5. Regulatory
6. Sweetening agents
-
7/27/2019 Nutrition Lecture
37/147
Summary of CarbohydrateDigestion and Absorption
-
7/27/2019 Nutrition Lecture
38/147
-
7/27/2019 Nutrition Lecture
39/147
Stor ing Carbohydrates
Glycogen: muscles of an adult is 150g (600Cals);
90g (360Cals) are stored in the liver
Glycogenesisthe process of converting glucose to
glycogen
Metaboli sm
blood glucose homeostasis: 70-120 mg/dl.
Gluconeogenesisprocess of producing glucose from fat and protein
for protein structures)Lipogenesis: synthesis of fats in the abundance of carbohydrates
Lipolysis: ketone bodies used for energy
Ketone bodiescreated when fatty acids are broken down for energy
Blood Glucose RegulationInsulin: regulates blood glucose levelsGlucagon: a pancreatic hormone that releases glycogen from the liver
-
7/27/2019 Nutrition Lecture
40/147
Recommended Intake
Total CHO must comprise 50-70% of TERSimple CHO must only be 10% of the TER
Dietary fiber must be 20-35grams/daily.
-
7/27/2019 Nutrition Lecture
41/147
Fibercarbohydrates in plant foods
that cannot be digested by humans
Classif ication of F ibers
1. Soluble Fibersdissolve in fluids;thickens substances
2. Insoluble Fibersdonot dissolve in fluids;
provide structure andprotection for plants.
3. Functional fibers
4. Dietary fibers
Di Fib d F d
-
7/27/2019 Nutrition Lecture
42/147
Dietary Fibers and Food
Sources
Fibers Food Sources
Insoluble
Cellulose
HemicelluloseLignin
Soluble
PectinMucilage
Guar and
other gums
Whole grains, brown rice, whole wheat
flour, whole wheat pasta, oatmeal,
unrefined cereals, vegetables, wheat bran,seeds, popcorn, nuts, peanut butter, leafy
green vegetables such as broccoli
Kidney beans, lentils, garbanzo beans,soybeans, apples, pears, bananas, grapes,
citrus fruits, oat bran, oatmeal, barley, corn,
carrots, white potatoes
-
7/27/2019 Nutrition Lecture
43/147
Health Effects of Carbohydrates
1. Dental caries2. Obesity
3. Diverticular disease
4. Colon Cancer5. Heart Disease
6. Diabetes Control
7. Nutrient Deficiencies
-
7/27/2019 Nutrition Lecture
44/147
Issues:
A. Artificial sweeteners (nonnutritive
sweeteners)provide no energy.
Approved: saccharine, aspartame, acesulfame-
K, sucralose, neotame
Pending: alitame and cyclamate
B. Glycemic indexa method of classifying
foods according to their potential for raising
blood glucose.
-
7/27/2019 Nutrition Lecture
45/147
Peanuts
SoybeansCashews, cherries
Barley, milk, kidney beans, garbanzo beans
Butter beans
Yogurt, tomato juice, navy beans, apples,
pears, apple juice, bran cereals, black-eyedpeas, peaches, chocolate, pudding, grapes,
macaroni, carrots, green peas, baked beans,
rye bread, orange juice, banana, wheat bread,
corn pound cake, brown rice, cola, pineapple
Ice cream, raisins, white rice
Water melon, popcorn, bagel
Pumpkin, doughnut, sports drinks, jelly beans
Cornflakes
Baked potatoes
White bread
GLYCEMIC INDEX OF SELECTED FOODS
LOW GI
HIGH GI
-
7/27/2019 Nutrition Lecture
46/147
FATS / LIPIDS
It belongs to a group called lipids (chemically
called Triglycerides), lecithin (Phospholipids)
& cholesterol (Sterols)organic substances;
greasy; insoluble in water.
Of the lipids in food, 95% are fats and oil, and
5% are other lipids.
Of the lipids stored in the body 99% aretriglycerides.
-
7/27/2019 Nutrition Lecture
47/147
Fats
From the Greek word lipos which means fat.
Blood lipids= fats in the blood
Hyperlipidemia= high levels of fat in the blood
Lipoproteins= carriers of fat in human blood
Insoluble in water but soluble in some solvents
such as ether, benzene , and chloroform.
Each gram of fat contains 9 calories.
-
7/27/2019 Nutrition Lecture
48/147
Functions of Fat
Provide energy
Carry-fat soluble vitamins
Supply essential fatty acids
Protect and support organs and bones.
Insulate from cold.
Provide satiety to meals.
-
7/27/2019 Nutrition Lecture
49/147
Fats
Visible fats = fats that are purchased and used
as fats such as butter, margarine, lard and
cooking oils.
Invisible fats= are those found in other foods
such as meats, cream , whole milk, cheese, egg
yolk, fried foods, pastries, avocados and nuts.
-
7/27/2019 Nutrition Lecture
50/147
-
7/27/2019 Nutrition Lecture
51/147
Dietary Fats & Oils Sources
1. SaturatedFatsfats whose carbon atomscontain all of the hydrogen atoms they can;considered a contributory factor inatherosclerosis. Examples bacon, butter, gratedcoconut, coconut-cream, coconut oil, creamcheese, latik, margarine, mayonnaise, sandwich
spread, sitsaron, whipping cream (heavy/light)2. Polyunsaturated FatsOIL (corn, marine,
soybean, rapeseed, canola, rice, sunflower,safflower, sesame)
3. Monounsaturated FatsAvocado, peanut butter,pili nut, peanut oil, olive oil, shortening
-
7/27/2019 Nutrition Lecture
52/147
-
7/27/2019 Nutrition Lecture
53/147
E ti l f tt id / O F tt
-
7/27/2019 Nutrition Lecture
54/147
Essential fatty acids/ Omega Fatty
Acids
Omega-3 fatty acids: linolenic acid,eicosapentaenoic acid, and docosahexaenoicacid; PUFA; in fish and fish oils andvegetable oils which increases the
deformability of RBS and in turn reduce theviscosity of the blood
Omega-6 fatty acids: linoleic acid andarachidonic acid; PUFA
Omega-9 fatty acid: oleic acid; a MUFA
-
7/27/2019 Nutrition Lecture
55/147
Summary of Fat Digestion &Absorption
-
7/27/2019 Nutrition Lecture
56/147
L ipid Transport
-
7/27/2019 Nutrition Lecture
57/147
L ipid TransportLipoproteinsforms in which lipids are
transported in plasma; consist of lipid andprotein constituents
1.Chylomicrons: largest and least dense (floatthe fastest; transports diet-derived lipids
(mostly triglycerides) via intestinal lymphaticsto the blood and then to adipose tissue.
2.Pre-beta lipoproteins: they are VLDL; thelipids made in the liver and those collected
from the chylomicron remnants are packagedwith proteins as VLDL and shipped to otherparts of the body; major reservoir of fatcirculating in the blood during fasting state
-
7/27/2019 Nutrition Lecture
58/147
3.Beta lipoproteins: are LDL: transports most
of the total plasma cholesterol in the arterywalls.
4.Alpha lipoproteins: are the HDL; 50%protein, 30%phopholipids and 20%cholesterol; source of good cholesterol;scavengers
-
7/27/2019 Nutrition Lecture
59/147
Functions of Fats
A. Storage form of energyB. Transporter of fat-soluble vitamins
C. Sources of essential fatty acids
D. Thermal insulationE. Vital organ protection
F. Cell structure
G. Contribute to feeling of fullness, taste andsmell
H. Regulator of body functions
-
7/27/2019 Nutrition Lecture
60/147
Dietary Requirement and Allowance:
* Fats should constitute 20-30% of the TER
* 30-40% of the TER
* 20% might be ideal* PUFA: 10% MUFA:10-15% SFA:7-10%
* Cholesterol not more than 300mg/day
-
7/27/2019 Nutrition Lecture
61/147
Health Effects of L ipids/Fats
1. Cancer2. Heart disease
3. Weight control. Fats caneasily cause weight gainbecause of the following
reasons:a. high kcal value
9kcal/gram
b. low satietya high fatintake causes a decrease of
leptin level which causesincreased appetite and lowactivity
c. high food intake because ofincreased palatability
4. Efficient metabolismafter weight loss, there is
increased lipoproteinlipase which enables youto store more fats.
5. Gallbladder problemsdecrease in fat intake may
cause poor gallbladdermovement. Increase in fatintake may increasecholesterol deposition.
-
7/27/2019 Nutrition Lecture
62/147
Critical Thinking Exercise
Francesca is a 40 year old Italian
schoolteacher who has been heavy most of her
life. She is active and loves playing handball
and racquetball. She was always active duringschool and does not know why she cannot lose
her weight. She has about 100 pounds to lose.
She has an Italian mother who loves to cook.Francesca loves her mom and does not want to
offend her by not eating the food.
-
7/27/2019 Nutrition Lecture
63/147
She wants to lose weight and she asked her
doctor for a referral to a dietitian to discuss the
best way to lose weight.
QUESTIONS:
1. What data do you currently have about
Francesca?
What has contributed to her current problem?
-
7/27/2019 Nutrition Lecture
64/147
3. What is the cause of Francescas weight?
4. What basically an Italian diet composed of?
5. What are two reasonable, measurable goals for
Francesca and her weight loss program and
why?
6. What is the recommended percentage of fat in
the diet during weight loss?
-
7/27/2019 Nutrition Lecture
65/147
7. Give an examples of meals for Francescas
diet plan.
8. How often should Francesca weight herself?
9. What other signs will indicate that Francesca
is losing weight?
10. Who else could benefit from Francescas
change in diet and activity?
-
7/27/2019 Nutrition Lecture
66/147
PROTEINS
organic substances composed of amino
acids; contain the element C, H, O and N
20 kinds of amino acid
Amino Acids
-
7/27/2019 Nutrition Lecture
67/147
Amino Acids
Essential Amino
Acids
Non-essential
Amino AcidsHistidine
Phenylalanine
Isoleucine
Valine
Leucine
Tryptophan
LysineThreonine
Methionine
Alanine
Serine
Arginine
Tyrosine
Aspartic acid
Glutamic acid
CysteineCystine
Glutamine
Glycine
-
7/27/2019 Nutrition Lecture
68/147
Summary of Protein Digestionand Absorption
-
7/27/2019 Nutrition Lecture
69/147
M t b li f P t i
-
7/27/2019 Nutrition Lecture
70/147
Metabolism of Protein
1.Anabolism - involves the incorporation of
amino acids in the synthesis of tissue
proteins
2. Catabolism - involves the breakdown of
amino acids into their component parts
Nitrogen Balance
Nitrogen Equilibrium: N in = N out
Positive nitrogen: N in > N out
Negative nitrogen: N in < N out
-
7/27/2019 Nutrition Lecture
71/147
Quali ty of Protein Foods
Complete proteins
Sources:
* fish, shellfish *chicken,
turkey, duck *beef
*soybeans
*hard cheese, cheddar,
Swiss, soft cheese, cottage
cheese, ricotta
*milk, yogurt, ice milk/
reduced fat ice cream
*lamb, pork, egg
Incomplete proteins
Sources:
*cereals
*grains*vegetables
*legumes
-
7/27/2019 Nutrition Lecture
72/147
Functions of Proteins
1. Providing energy
2. Creation of Communicators and Catalysts:
enzymes and hormones
3. Immune system response: antibodies
4. Maintaining fluid and electrolyte balance
5. Maintaining acid-base balance6. Transportation: lipoproteins and
hemoglobin
H lth Eff t f P t i
-
7/27/2019 Nutrition Lecture
73/147
Health Effects of Protein
1. Excess: heart disease, cancer, adult bone loss
(osteoporosis), weight control, kidney disease
2. ProteinEnergy Malnutrition
a. Acute PEM: wasting (KWASHIORKOR)
*caused by recent severe food restriction
b. Chronic PEM: stunting (MARASMUS)
*caused by long-term food deprivation
Recommended Protein Intake: 10-15% of the TER
WATER serves as the solvent for nutrients
-
7/27/2019 Nutrition Lecture
74/147
WATER- serves as the solvent for nutrients
and waste product in the body.
Functions: Carries nutrients and waste product
throughout the body.
Maintains the structure of largemolecules
Participates in chemical reaction
Acts as a lubricant and cushion.
Helps regulation of body temperature
Maintains blood volume
Water Balance
-
7/27/2019 Nutrition Lecture
75/147
Water Balance
1. Dehydration: resulting from excessive water loss,accompanied by loss of electrolytes.
2. Overhydration: water intoxication; resulting fromexcessive intake of fluids without an equivalentamount of salt.
Water Recommendations
Infants require 1.5L per 1000Cal intakeChildren (1-18 years): if weight is 10-20 kilos:
1000ml+50ml per kg excess of 10; if the weight ismore than 20 kls: 1500ml + 20ml per kg in excessof 20kls.
Adults: need 1L per 1000Cal intake.Older person:1.5L
Pregnant women: extra 300ml; lactating (1-6mos.):additional 750 to 1000ml.
VITAMINS
-
7/27/2019 Nutrition Lecture
76/147
VITAMINS
organic, essential nutrients required in small
amounts to perform specific functions that
promote growth, reproduction or maintenance
of health and life
Do not provide energy but they assist the
enzymes that release energy from energy-
yielding nutrients
Classification
-
7/27/2019 Nutrition Lecture
77/147
Classification
1. Water-soluble: C andB-complex
Thiamin (B1)
Riboflavin (B2)Niacin (B3),
Pantothenic acid (B5)
Pyridoxine (B6)Folate
Cobalamin (B12)
Biotin.
2. Fat-soluble
A, D, E, K
General Properties of fat and water-soluble vitamins
-
7/27/2019 Nutrition Lecture
78/147
General Properties of fat and water soluble vitamins
FAT-SOLUBLE WATER-SOLUBLE
Soluble in fat and fat solvents Soluble in water
Intake in excess of daily need stored in the
body
Minimal storage of dietary excesses
Deficiency symptoms slow to develop Deficiency symptoms often develop
rapidly
Small amounts excreted in bile Excreted in urine
Not absolutely necessary in the dieteveryday
Must be supplied in the diet everyday
Have precursors or provitamins Generally do not have precursors
Contain only elements C, H, O Contain C, H, O, N and others
Absorbed into the lymphatic system Absorbed into the blood through
portal vein
Needed only by complex organisms Needed by simple and complex
organisms
Some are relatively low levels (6-10x the
RDA)
Toxic only at mega dose levels (10>
the RDA)
WATER-SOLUBLE VITAMINS
-
7/27/2019 Nutrition Lecture
79/147
WATER-SOLUBLE VITAMINS
VITAMIN FUNCTION
CLINICAL ISSUES
(DEFICIENCY/TOXICITY) FOOD SOURCES
Thiamine
(B1)
Coenzyme energy
metabolism;muscle nerve
function
Deficiency: beriberi(ataxia,
disorientation,tachycardia); marginal
(headaches, tiredness);
wet beriberi (edema); dry
beriberi (nervous system):
Wernicke Korsakoff
syndrome(alcoholism)
Lean pork, whole or
enriched grainsand flours,
legumes, seeds,
and nuts
Riboflavin(B2) Coenzyme energymetabolism Deficiency: ariboflavinosiswith cheilosis, glossitis,
seborrheic dermatitis
Milk/dairy products;meat, fish, poultry,
and eggs; dark
leafy green
(broccoli); whole
and enriched
breads and cereals
Niacin (B3)
precursor
tryptophan
Cofactor to
enzymes
involved in
energy
metabolism;
glycolysis and
TCA cycle
Deficiency: pellagra
Toxicity: vasodilation, liver
damage, gout, and arthritic
reactions
Meats, poultry, and fish;
legumes; whole
and enriched
cereals; milk
WATER-SOLUBLE VITAMINS
-
7/27/2019 Nutrition Lecture
80/147
VITAMIN FUNCTION
CLINICAL ISSUES(DEFICIENCY/TOXICITY) FOOD SOURCES
Pyridoxine
(B6)
Forms coenzyme
pyridoxal
phosphate (PLP)
for energy
metabolism; CNS;
hemoglobin
synthesis
Deficiency: dermatitis,
altered nerve function,
weakness, anemia;
OCAs decrease B6
levels
Toxicity: ataxia, sensory
neuropathy
Whole grains/cereals,
legumes, poultry,
fish, pork, eggs
Folate
(folic
acid,
folacin,
PGA)
Coenzyme
metabolism
(synthesis of
amino acid,
heme, DNA,
RNA); fetalneural tube
formation
Deficiency: megaloblastic
anemia; many drugs
affect folate use
Toxicity: megadoses
may mask pernicious
anemia
Widely available
leafy green
vegetables,
legumes,
ascorbic acid-
containing foods
WATER-SOLUBLE VITAMINS
-
7/27/2019 Nutrition Lecture
81/147
WATER-SOLUBLE VITAMINS
VITAMIN FUNCTION
CLINICAL ISSUES
(DEFICIENCY/TOXICITY) FOOD
SOURCES
Cobalamin (B12) Transport/storage of folate;metabolism of fatty
acids/amino acids
Deficiency: pernicious anemia, CNSdamage Animal sources
Biotin Metabolism of
carbohydrate, fat, and
protein
Deficiency: produced by avidin and long
term antibiotics
Liver, kidney,
peanut
butter, egg
yolks,
intestinal
synthesis
Pantothenic acid Part of Coenzyme A Deficiency: not possible Widespread in
foods
Choline Synthesis of
acetylcholine and
lecithin
Deficiency: rare
Toxicity: body odor, liver damage,
hypotension
Widespread -
milk, eggs,
peanuts
Vitamin C Antioxidant, coenzyme,
collagen formation,
wound healing, iron
absorption, hormone
synthesis
Deficiency: scurvyToxicity: cramps, nausea, kidney
stone formation, gout (1 to 15g),
rebound scurvy
Friuts/vegetables
(citrus fruits,
tomatoes,
peppers,
strawberries
, broccoli)
Angular stomatitis:
-
7/27/2019 Nutrition Lecture
82/147
g
riboflavin or other B
vitamins, iron
heilosisScarlet tongue inniacin deficiency
FAT - SOLUBLE VITAMINS
-
7/27/2019 Nutrition Lecture
83/147
VITAMIN FUNCTION
CLINICAL ISSUES
(DEFICIENCY/TOXICITY) FOOD SOURCES
Vitamin A
Precursor:carotenoids
Preformed
vitamin:
retinoids
Maintains
epithelial tissues(skin and
mucous
membranes);
rhodopsin
formation for
vision; bone
growth;reproduction
Deficiency: xerophthalmia;
night blindness;keratomalacia;degeneration
of epithelial tissue; inhibited
growth (respiratory and GI
disturbances) Toxicity:
hypervitaminosis A (from
supplements) with blistered
skin, weakness, anorexia,vomiting, enlarged spleen
and liver
Deep green, yellow,
and orange fruits andvegetables; animal fat
sources: whole milk,
fortified skim, and low-
fat milk; butter; liver;
egg yolks, fatty fish
Vitamin D
Precursor: 7-
dehydrocholest
erol
Active form:
cholecalciferol
Calcium and
Phosphorous
absorption;
bone
mineralization
Deficiency: bone malformation,
rickets (children),
osteomalacia (adults)
Toxicity: hypercalcemia,
hypercalciuria
Animal (fat) sources:
butter, egg yolks, fatty
fish, liver, fortified milk;
body synthesis
Cl ifi ti f X th l i
Early conjunctival xerosis (X1A)
-
7/27/2019 Nutrition Lecture
84/147
Classification of Xeropthalmia
Classification of XeropthalmiaOcular Signs ClassificationNight Blindness XNConjuctival Xerosis X1A
Bitots Spot X1BCorneal Xerosis X2Corneal ulceration/keratomalacia 1/3 corneal surface
X3B
Corneal scar XSXerophthalmia fundus XF
Classification of XeropthalmiaOcular Signs ClassificationNight Blindness XNConjuctival Xerosis X1A
Bitots Spot X1BCorneal Xerosis X2Corneal ulceration/keratomalacia 1/3 corneal surface
X3B
Corneal scar XSXerophthalmia fundus XF
Ocular Signs Classification
Night Blindness XN
Conjuctival Xerosis X1A
Bitots Spot X1B
Corneal Xerosis X2Corneal ulceration/keratomalacia < 1/3 of
surface
X3A
Corneal ulceration/keratomalacia >1/3 corneal
surface
X3B
Corneal scar XS
Xerophthalmia fundus XF
Dryness, wrinkling, increased pigmentation
-
7/27/2019 Nutrition Lecture
85/147
Early conjunctival xerosis (X1A)
Bitots spot (X1B):Bitots spot (X1B)
Keratomalacia (X3B)
C l i (XS)
-
7/27/2019 Nutrition Lecture
86/147
Xerophthalmia fundus (XF)
Ectasia of cornea (XS)
Corneal scarring (XS)
FAT - SOLUBLE VITAMINS
-
7/27/2019 Nutrition Lecture
87/147
VITAMIN FUNCTION
CLINICAL ISSUES
(DEFICIENCY/TOXICITY) FOOD SOURCES
Vitamin E alpha
tocopherol
Antioxidant for
PUFA andvitamin A;
antioxidant
with
selenium
and ascorbic
acid
Deficiency: primary deficiency rare;
secondary deficiency (causedby fat absorption) neurologic
disorders
Toxicity: none, but supplements
contraindicated with
anticoagulation drugs
Vegetable oil, whole
grains, seeds,nuts, green leafy
vegetables
Vitamin K
Active form:
menaquinon
es
Cofactor in
synthesis of
blood
clotting
factors;
protein
formation
Deficiency: blood coagulation
inhibited; hemorrhagic
disease (infants)
Toxicity: therapeutic vitamin K
(menadione form) reactions in
neonates, causing hemolytic
anemia and hyperbilirubinemia
Green leafy
vegetables,
intestinal
synthesis
MINERALS i i l t th t i h h
-
7/27/2019 Nutrition Lecture
88/147
MINERALS - inorganic elements that remains as ash whenfood is burned; non-caloric; the body cannot synthesizethem
-about 1% to 6% of body weight is mineral.
A. Macronutrient mineralsessential for human nutritionpresent in amounts greater then 5 grams.
e.g. Calcium, Sodium, Phosphorous, Potassium, Sulfur,Chlorine, Magnesium
B. Micronutrient mineralsessential for human nutrition
present in amounts less than 5 grams.e.g. Iron, Iodine, Zinc, Selenium, Manganese, Copper,Molybdenum, Cobalt, Chromium
MAJOR MINERALS
-
7/27/2019 Nutrition Lecture
89/147
MAJOR MINERALS
MINERAL FUNCTION
CLINICAL ISSUES
(DEFICIENCY/TO
XICITY FOOD SOURCES
ABSORPTION
ISSUES
Calcium
(Ca)
Bone and tooth
formation;blood clotting;
muscle
contraction/rela
xation; CNS;
blood pressure
Deficiency: reduced
bone density;osteoporosis
Toxicity:
constipation,
urinary stones;
reduced iron and
zinc absorption
Milk (whole, low-fat,
skim), milk-based
products,
green leafy
vegetables,
legumes
Absorption based
on need:increased by
vitamin D;
decreased by
binders,
inactivity
coffee/tea
Phosphoro
-us(P)
Bone and tooth
formation(component of
hydroxyapatite);
energy
metabolism
(enzymes); acid-
base balance
Deficiency: rare
Toxicity:increased
calcium
excretion
Dairy foods, egg,
meat, fish,poultry
Absorbed with
calcium
Magnesiu
m(Mg)
Structure/storage;
cofactor; nerveand muscle
function; blood
clotting
Deficiency: secondary
with muscletwitching,
weakness,
convulsions from
fluid volume deficit
(FVD)
Whole grains,
legumes,green leafy
vegetables
(broccoli),
hard water
Sulfur (S)
Component of
protein
structures
Deficency only if
protein
malnourished
Protein-
containing
foods
-
7/27/2019 Nutrition Lecture
90/147
MINERAL FUNCTION
CLINICAL ISSUES
(DEFICIENCY/TOXICITY)FOOD SOURCES
Sodium (Na) Major extracellular
electrolyte for fluid
regulation; body fluidlevels; acid-base
balance; nerve
impulse and
contraction; blood
pressure/volume
Deficiency: headache;
muscle cramps,
weakness, decreasedconcentration, memory
and appetite loss
Toxicity: sodium-
sensitive hypertension
Table salt; naturally
in many foods;
processedfoods
Potassium
(K)
Major intracellular
electrolyte for fluidregulation; muscle
function
Deficiency: muscle
weakness, confusion,decreased appetite,
cardiac arrhythmias
caused by FVD from
vomiting/diarrhea or
diuretics
Toxicity: from diet or
supplements if renaldisease present
Unprocessed
foods, fruits,vegetables,
dairy products,
meats,
legumes
Chloride (Cl) Acid-base balance; gastric
hydrochloric acid for
digestion
Deficiency: FVD caused by
vomiting/diarrhea
Table salt
TRACE MINERALS
-
7/27/2019 Nutrition Lecture
91/147
MINERAL FUNCTIONCLINICAL ISSUES
(DEFICIENCY/TOXICITY) FOOD SOURCES
Selenium
(Se)
Antioxidant cofactor with
vitamin E; prevents cell
and lipid membrane
damage
Deficiency: possible Keshansdisease/cancer
Toxicity: liver damage,
vomiting, diarrhea
Meat, fish, eggs,
whole grains
Copper
(Cu)
Coenzyme in antioxidant
reactions and energy
metabolism; wound
healing; nerve fiber
protection; iron use
Deficiency: bone
demineralization and
anemia
Toxicity: Wilson's disease or
with supplements producing
vomiting/diarrhea
Organ meats
(liver),
seafood,
green leafy
vegetables
Chromiu
m
(Cr)
Carbohydrate metabolism,
part of glucose
tolerance factor
Deficiency: possible link with
cardiovascular disorders;
hypoglycemia,
hyperglycemia, and
unresponsive insulin
Animal food,
whole grains
Manganese
(Mn)
Part of metabolic reactionenzymes Deficiency: unknown Whole grains,green leafy
vegetables,
legumes
Molybdenu
m
(Mo)
Coenzyme Deficiency: unknown Many foods
-
7/27/2019 Nutrition Lecture
92/147
NUTRITION
& THE
LIFE CYCLE
-
7/27/2019 Nutrition Lecture
93/147
-
7/27/2019 Nutrition Lecture
94/147
Nutr i tional Recommendations in Pregnancy
-
7/27/2019 Nutrition Lecture
95/147
Protein Intake
Nrequirement based on age and sex plus 9 to 10g/daythroughout the pregnancy.
Emphasize high-quality, complete protein foods.
Energy Requirements
Nrequirement based on age and activity w/ additional of
300kcal for the 2nd and 3rd trimester of pregnancyTeens aged 13 to 16 yrs old: recommended wt. gain is between
30 to 35 lbs.
Kcal adequacy: constant wt. gain of approx. 0.4kg/wk after the1st trimester.
Carbohydrate Intake
Generous amount; emphasize minimal processed foods,complex CHO and limit concentrated sweets
-
7/27/2019 Nutrition Lecture
96/147
Problems of Pregnancy with Nutritional ImplicationsMild nausea and (1) Eat dry eat dry toast, dry cereals, or crackers (2) try
-
7/27/2019 Nutrition Lecture
97/147
vomiting; called
morning sickness
chewing gum or candies (3) SFF (4) avoid greasy
foods and foods w/ o offensive odors; (5) omit juice,
water, milk, coffee, or tea; (6) dont d drink liquids w/
meals.Heartburn (1) SFF (2) Relax and eat slowly (3) Chew food
thoroughly (4) Drink liquids between meals (5) Avoid
spicy or greasy foods (6) Sit up while eating; elevate
the head while sleeping (7) Wait an hour after eating
before lying down; Wait two hours after eating
before exercising
Constipation (1) Drink at least 8glasses of water or other fluids that
are non-caffeine and non-alcoholic; (2) exercise
regularly (3) Respond promptly to the urge to
defecate
Lactose Intolerance Substitute soy milk; if milk is totally omitted for medicalreason, try to obtain calcium, phosphorous from
other foods.
Pica (1) Correct calcium deficiency or IDA if present
through supplementation and emphasizing
balance diet (2) seek advice from health carerofessionals
-
7/27/2019 Nutrition Lecture
98/147
in
Benefits of Breastfeeding/Lactation
-
7/27/2019 Nutrition Lecture
99/147
Benefits of Breastfeeding/Lactation
For I nfants:Provides the appropriate composition and balance of
nutrients with high bioavailability
Protects against food allergies
breast milk contains less Pro and minerals that infantformulas, it reduces the load on the infants kidneys
never warm the breast milk in a microwave ovenbecause the antibodies will be destroyed
Newborns lack intestinal bacteria to synthesize Vit. K,so they are routinely given a Vit. K supplement
F M th
-
7/27/2019 Nutrition Lecture
100/147
For Mothers
Contracts the uterus
Delays the return of regular ovulation
Conserves iron stores (by prolonging
amenorrhea)May protect against breast and ovariancancer
Water: A sensible guideline is to drink aglass of milk, juice, or water at each mealand each time the infant nurses.
BOTTLE FEEDING
-
7/27/2019 Nutrition Lecture
101/147
the infant should be cuddled and held in an upright position during thefeeding to prevent middle ear infections
when an infant is extremely sensitive or allergic to infant formulas, a
synthetic formula (made from soybeans) may be given.
METABOLIC DISORDERS
-
7/27/2019 Nutrition Lecture
102/147
METABOLIC DISORDERS
1. galactosemialack of the liver enzyme transferasetransferaseconverts galactose to glucose
- suffers diarrhea, vomiting, edema, liver doesnot function normally, galactosuria, mental
retardationdiet therapy: exclusion of anything containing milkfrom any mammal; give lactose-free, commercially
prepared formula.
2. Phenylketonuria (PKU)lacks the liver enzymephenylalanine hydroxylase
diet therapy: commercial infant formula calledlofenalac.
-
7/27/2019 Nutrition Lecture
103/147
3. Maple Syrup Urine Disease (MSUD)congenital defect resulting in the inability to
metabolize three amino acid (leucine,
isoleucine and valine): hypoglycemia, apathy and convulsions
:diet therapyspecial formula and low-Pro
foods are used
Childh d d Ad l Child d t
-
7/27/2019 Nutrition Lecture
104/147
Childhood and Adolescence: Children aged one totwelve
Children should be offered nutrient-dense foodsFats should not be limited before the age of 2
years
Sensitive to and reject hot (temperature) foods andlike crispy, mild flavors, and familiar foods
Common Eating Problems
1. Food jags2. Food gag
3. food dawdling
Adolescence: tends to begin between the ages of 10 and 13 in
-
7/27/2019 Nutrition Lecture
105/147
Adolescence: tends to begin between the ages of 10 and 13 ingirls and between 13 and 16 in boys.
like foods that are popular but have low nutrient density.
Adolescent Problems Related to Nutr i tion
Anorexia Nervosa: a psychological disorder causes theperson to drastically reduce kcal.
hair loss, low BP, weakness, amenorrhea, brain damage
Bulimiaa syndrome in which the client alternately binges
and purges by inducing vomiting and using laxatives anddiuretics to get rid of ingested foods
-
7/27/2019 Nutrition Lecture
106/147
Marijuanamakes one hungry esp. for sweets
*One marijuana cigarette is as harmful as 4to 5 tobacco cigarettes.
Cocainehighly addictive and extremelyharmful
*cardiac irregularities, heart attacks, and
cardiac arrests.
-
7/27/2019 Nutrition Lecture
107/147
Adulthood
Young adulthood: 18 to 40 years of age: alive w/ plans,desires and energy
Middle adulthood: 40 to 65 years of age: decrease inphysical activities
Late adulthood: 65 years onwards
Nutrient Requirements
There is a general decrease in kcal due to:
slowing of metabolic rate; decreased physical activity;loss of muscle mass or lean body mass (sarcopenia)
-
7/27/2019 Nutrition Lecture
108/147
PUBLIC HEALTH
NUTRITION
M l t iti t t f di
-
7/27/2019 Nutrition Lecture
109/147
Malnutrition: a state of disease
caused by sustained deficiency,
excess, or imbalance of the supplies
of calories, nutrients, or both, that is
available for use in the body.
Causes of Malnutr iti on
Inadequate food intake
Large-sized family
Lack of education
Poor health statusFaulty food habits & practices
Poor environmental conditions
-
7/27/2019 Nutrition Lecture
110/147
MEDICAL NUTRITIONTHERAPY
Meal Distribution System
-
7/27/2019 Nutrition Lecture
111/147
a. Centralized b. decentralized
-
7/27/2019 Nutrition Lecture
112/147
Nutritional Care Services:
a. Assessment and screening
b. monitoringc. counseling
The Routine Hospital Diets
Th R l Di t l h f ll h it l di t
-
7/27/2019 Nutrition Lecture
113/147
a. The Regular Diet: general, house, full hospital diet.Highly spiced foods, rich fatty foods and gas formers shouldalso be avoided.
b. The Soft Diet: modifications in consistency and texture.Foods allowed are low in fiber diet and connective tissuesand are generally bland in flavor.
c. The Liquid diet: 2 types
a. Clear liquid dietwithout residue or fiber; to relieve thirstand help maintain water balance; 600-900 kcal/day.Preferably, feeding is done every 2-3 hours and each
feeding should not exceed 300ml of liquids, between6AM to 10PM.
Indications for use: used just immediately before and aftersurgery.
b. Full liquid dietliquid at room temperature or could beliquefied at body temperature.
-
7/27/2019 Nutrition Lecture
114/147
Indications for use: fever, infections, lesions in the mouth, GITdisturbances, nausea and vomiting, with esophageal disorders
Variations of the Routine Hospital Diets
a. The Light Diet: transition between the soft and regular diets; forelders who cannot tolerate rich and heavy foods.
b. The Mechanical Soft Diet: dental soft or mechanically altereddiet.
c. The Cold Liquid Diet: consists of cold smooth liquids.
d. Tube Feedings: requires a consistency that can pass through apolyvinyl tube.
Vegetarian Diets
-
7/27/2019 Nutrition Lecture
115/147
low in SFA and cholesterol; high fiber; disadvantage isinadequate or low level of Vit B12, iodine, calcium, zinc,riboflavin, and vitamin D.
a. Vegan Diet: total vegetarian or strict vegetarian diet. Foods
allowed are strictly of plant origin.b. Lacto-vegetarian: milk and milk products + items of plant origin.
c. Ovo-vegetarian: eggs and eggs products + items of plant origin
d. Lacto-ovo-vegetarian: eggs + milk and milk products + items ofplant origin
e. Semi-vegetarian: lacto-ovo-vegetarian foods + fish + chicken +items of plant origin
f. Pesco-vegetarian: fish and fish products + items of plant origin
g
Diet as To lerated : (D.A.T.) FL toregular diet; a temporary measurel ti th d f
-
7/27/2019 Nutrition Lecture
116/147
lasting no more than one day; fornewly admitted patient with problem in
digestion
Diet Orders: divided in qualitative and quantitative termsthat leave no room for misinterpretation
restricted diet amount or type of nutrient
e.g. Cholesterol restricted diet
Controlled adjustment of levels of nutrients from day-to-day as needed
e.g. controlled pro, potassium, sodium in client w/kidney failure undergoing dialysis
-
7/27/2019 Nutrition Lecture
117/147
Completeness of Diet Order
Case: (+) Type 2 Diabetes,(+) HPN
Low Sodium (2g/day)
Low Cholesterol (300mg/day)to be given in 5 to 6feedings/day
Carbohydrate: 300g
Protein : 75g
Fats : 55g
-
7/27/2019 Nutrition Lecture
118/147
Diets Modified inComposition
1. Low Calorie: an allowance of foods and drink with anenergy value below that is required for maintenance inorder to bring about weight reduction
-
7/27/2019 Nutrition Lecture
119/147
order to bring about weight reduction.
Indications for Use: when weight reduction is desirable as inobesity or in OW, cardiac, hypertensive, arthritic ordiabetic individuals; when energy requirements arereduced as in hypothyroidism, prolonged bed rest or inelderly.
formula: TER: [ABW(kg) x PA value (using Krause Method)]250 to 1000Cals
to lose lb/wk: deduct 250Cals
to lose 1 lbs/wk: deduct 500Calsto lose 1 lbs/wk: deduct 750Cals
to lose 2 lbs/wk: deduct 1000Cals
2. High Calorie: to produce a gain in body weight,to meet increased energy needs, or to prevent or
i i i th t b li f ti
-
7/27/2019 Nutrition Lecture
120/147
minimize the catabolism of tissues.
Indications for use: underweight, hypercatabolicconditions: hyperthyroidism, injury, burns, feverand infections when a full diet can be tolerated.
formula: TER: [ABW(kg) x PA value (using KrauseMethod)] + 250 to 1000Cals
to gain lb/wk: add 250Cals
to gain 1 lbs/wk: add 500Calsto gain 1 lbs/wk: add 750Cals
to gain 2 lbs/wk: add 1000Cals
3. High Protein Diet: provides 1.5g or more/KDBW/day
-
7/27/2019 Nutrition Lecture
121/147
Indications for use: protein deficiency (1o 2); pre
& post surgery; hypercatabolic conditions (e.g.injury, burns, fever an infections), hepatitis, etc.
formula: step 1: g of Pro/day=ABW x 1.5g/KDBW2: Calories of pro=___g of Pro/day
(4Cals/g of Pro)
3: NPC Method: TER-Cals of Pro
4: CHO: NPC x % distribution/4
Fats: NPC x % distribution/9
5: Diet Rx: ______________________
4. Low Protein: provides about 30g of Pro/day, 2/3 ofwhich is HBV while 1/3 is LBV
-
7/27/2019 Nutrition Lecture
122/147
which is HBV while 1/3 is LBV
Indications for use: acute glumerulonephritis w/impaired function; CRF w/ impaired renal function w/oHPN; advanced liver disease w/ hepatic insufficiency.
formula: step 1: g of Pro/day=30g2: Calories of pro=120Cals
3: NPC Method: TER-120Cals of Pro
4: CHO: NPC x _____
Fats: NPC x _____5: Diet Rx: ______________________
-
7/27/2019 Nutrition Lecture
123/147
5. Low fat: provides no more than 15% of the
total calories
Indications for use: cholecystitis, cholelithiasis,atherosclerosis; hepatitis, pacreatitis, fatmalabsorption, weight reduction
formula: C: TER x .7 4Cals/g = ____gP: TER x .15 4Cals/g = ____g
F: TER x .15 9Cals/g = ____g
-
7/27/2019 Nutrition Lecture
124/147
6. Low Cholesterol: amount & type of fat;
-
7/27/2019 Nutrition Lecture
125/147
7. Low Carbohydrate: provide no more than 50% of totalCalories. Complex carbohydrates are preferred
Indications for use:
25% CHO: functional hyperinsulinism, dumpingsyndrome
40% CHO: fat- and CHO- inducedhyperlipoproteinemia; CHO inducedhyperlipoporteinemia, COPD
50% CHO: fat and CHO-induced
hyperlipoproteinemia
8. Sodium restricted
a. Mild: light salt in cooking, no salty Food Groups Na Content/
-
7/27/2019 Nutrition Lecture
126/147
a d g t sa t coo g, o sa typrocessed foods & condiments (2-3g)
b.Moderate: (1000mg) no salt in cooking,limit veggies that are high in naturalsalt; meat & milk in moderation.
c. Strict: (500mg) like moderate restriction,but strict limitations on milk, meat &
eggs. Delete commercial foods w/ milk
*regular Na diet: 2800 to 6000mg Na
*1T salt: 500mg Na
Indications for use: conditions of sodiumor saline excesses as in CHF; liverdisease w/ ascites, glumerulonephritis,nephrotic syndrome; ARF, CRF
Food Groups Na Content/
Exchange
Fruit
Vegetable
Rice
Pan de sal
Slice bread
Meat/fish/poultryEgg
Butter
Margarine
milk
2mg
2
2
135
120
2520
50
55
120
end
-
7/27/2019 Nutrition Lecture
127/147
end...
c u
allxt
wk! Medical Nutrition Therapy for Surgical Conditions
The Surgical Process
-
7/27/2019 Nutrition Lecture
128/147
Three Phases:1) pre-op 2) the surgery procedure itself, 3) postop
Two form s of su rgery based on the urgency of operat ion: 1)emergency 2) elective
Pre-operative Diet:
1) Diet for elective surgeryhigh protein high Calorie with vitamin andmineral supplementation; if obese, low Calorie diet2) Diet for emergency operationsparenteral feeding is recommended
(IV, subcutaneous, IM)
3) Diet immediately before surgery: light evening meal the day beforethe surgery then restricted to clear liquids and then all foods arewithheld for at least 8 hours.
Post-operative Diet: NPO immediately after the operation to CL diet toFL diet, a soft, and eventually to a regular diet. A high Calorie, highPro diet is recommended.
Enteral Nutrition Support
Characteristics of Tube Feeding and Preparation
-
7/27/2019 Nutrition Lecture
129/147
Characteristics of Tube Feeding and Preparation
a. the mixture should pass the 2 mm tube with relative ease
b. dilution is 1kcal/mlc. total volume should not exceed 2300ml/day or 100 ml/hr.
Indications for Use of Tube Feeding
1. Inability to ingest food normally
2. Physiologic deterrents to food intake3. Obstruction of GIT
4. Psychiatric illness
5. Impairment of digestion and or absorption
6. Protein-calorie malnutrition7. Intestinal surgery
8. Transition from TPN to conventional foods
9. Renal failure; hepatic failure
10. Inborn errors of metabolism
Types of Formula and Their Use
-
7/27/2019 Nutrition Lecture
130/147
a. Intact Formulas: polymeric formulas; unalteredmolecules of CPF;
i. standard formulations
ii. blenderized whole food formulations.
b. Hydrolyzed Formulas: monomeric formulas;predigested CHON and simple carbohydrates,plus a small amount of oil or a blend of mediumchain triglycerides (MCTs) and oil;
c. Modular Formulas: incomplete liquid supplementthat contains specific nutrients, usually a singlemacronutrient (carbohydrate, protein or fat).
Tube Feeding Administration
-
7/27/2019 Nutrition Lecture
131/147
1. Continuous drip method:administered via gravity
or a pump; total volumeshould not exceed 100mlper hour.
2. Bolus feeding: rapid
installation of feedinginto the GI tract bysyringe or funnel.
3. Combination: acombination of
continuous drip (at night)and bolus feedings(during the day) can beused
Enteral Feeding Complications and Suggestions
1 Diarrhea assess the administration of the formula the
-
7/27/2019 Nutrition Lecture
132/147
1. Diarrheaassess the administration of the formula, thehandling techniques, tubing, addition of medications and
fluids2. Aspirationelevate the head to 30-45 degrees3. Clogged Tubesflush tube with 50-150 cc of fluid; avoid
use of crushed medications
4. Constipationprovide adequate fluids; assess need for a
fiber-containing formula5. Abdominal distentionassess volume of formula
administered; assess for lactose intolerance andtolerance for fiber
6. Nausea and vomitingconsider holding feeding for 12
hours; assess volume of feeding; consider anti-nauseantor anti-emetic or anti-gas medication
7. Contamination of formulaclosed systems can hang for upto 24-48 hours; if open systems up to 4-8 hours; avoidtopping off the bag; use sanitary techniques
Parenteral Feeding
-
7/27/2019 Nutrition Lecture
133/147
1. Peripheral Parenteral Nutrition (PPN): viathe small veins, usually in the arms.
2. Total Parenteral Nutrition (TPN): also
called Central Parenteral Nutrition (CPN)
or intravenous hyperalimentation (IVH).
superior or inferior vena cava or the
jugular vein.
-
7/27/2019 Nutrition Lecture
134/147
Dietary Management of Specif ic Surgical Cond it ions
1. Gastr ic Surgery as Gastrectomy- production ofpepsin and HCl is impaired; reduced protein and
-
7/27/2019 Nutrition Lecture
135/147
pepsin and HCl is impaired; reduced protein andimpaired fat digestion; reduced utilization of iron and
vitamin B12; 50% of patients often lose weight aftergastric surgery. Ice held in the mouth or small sips of water. Some patients
tolerate warm water better than ice or cold water.
Increase in amounts of fluid given.
Bland foods/solid foods as tolerated.2. Dumping syndromestomach contents are emptied
into the jejunum at an abnormally fast rate. SFF; dry diet
Low fiber, high protein, high fat, low simple CHO with vitamin
and mineral supplementation. Learn to relax; rest before mealtime, eat slowly and chew food
well.
3. Cholecystectom ythe day after the operation,give low fat starting with liquids and gradually
i t l f t ft di t til l
-
7/27/2019 Nutrition Lecture
136/147
progressing to a low-fat, soft diet until a regulardiet is well tolerated.
4. Rectal su rgeryany operation done in therectum; clear liquid diet within the first 24 hoursafter the operation followed by a non-residuediet.
High-residue foods: milk, potatoes, raw to soft-cooked eggs, most cheeses except cottagecheese, butter, lard and lactose.
5. Burnstissue injury or destruction caused byexcessive heat, caustics (acids or alkalis),friction, electricity or radiation.
Classi f ication o f Burns
Child %
-
7/27/2019 Nutrition Lecture
137/147
Adult %
1. First degreesimple redness of theaffected areas.
2. Second degreeerythema + blisters; 15%for adults and 10% for children.
3. Third degreeactual destruction of theskin and underlying tissues.
Dietary Management: formula to calculate
-
7/27/2019 Nutrition Lecture
138/147
caloric requirements:
Adults: (25kcal) x preburn body weight in kg
+ (40 kcal x %BSA burned)
Children: 30 to 100 kcal [RDA for age] +
preburn body weight in kg + (40 kcal x
%BSA burned)
Medical Nutr i t ion Therapy for Infect ions and Respiratory
Disorders
-
7/27/2019 Nutrition Lecture
139/147
Class i f icat ion of Infect io ns: acute, chronic and recurrent.
1. Cholera(El Tor); disease of the intestines caused by Vibriocholerae. Symptoms consist of diarrhea, vomiting and severemuscle cramps.
Dietary Management: acute stagesNPO for 12 hrs w/ IVFand electrolytes; ORT + resistant starch. As stools areformed, start w/ broth, tea, toast to normal diet; Gatorade.
2. Dengue Feverby Aedes aegypti; the dengue virus causesincreased permeability that leads to bleeding known as DHF.
The liver may be enlarged, soft and tender.Dietary Management: high Calorie, liquid diet to soft high-calorie diet, moderate in fat w/ water and fruit juices toprevent dehydration. Candies may be given to stop vomiting.
3. Typhoid Feverby Salmonella typhosa; Diarrhea andPayers patches (i.e., ulceration and hemorrhaging of theintestinal walls) are common symptoms.
-
7/27/2019 Nutrition Lecture
140/147
Dietary Management: diet for fevers plus a low fiber diet.
4. Rheumatic Feverinflammatory conditions affecting theconnective tissue and causing joint pain, swelling, fever,rash, and carditis. Long-term effects results in RHD.
Dietary Management: high calorie, high protein, full liquid dietto soft then regular diet. In case the patient is using steroids,low sodium diet; high intake of Vitamin C and A.
5. Malariacaused by the genus Plasmodium, a parasiticprotozoan found in mosquitoes particularly the genus
Anopheles.Dietary Management: high calorie, high protein, moderate fatwith vitamin and mineral supplementation and liberal fluidintake.
6. Tuberculos istubercle bacillus(Mycobacterium tuberculosis and M.
-
7/27/2019 Nutrition Lecture
141/147
(Mycobacterium tuberculosis and M.
Africanum, and M. bovis from cattle)
Extrapulmonary tuberculosis (ETB)
Dietary Management: high calorie, high
protein, sufficient calcium, adequate iron and
vitamin C and B6; adequate fluids.
Medical Nutr i t ion Therapy for Diseases of the GIT
-
7/27/2019 Nutrition Lecture
142/147
Diverticular
Disease
1. AchalasiaLES fails to relax normally after swallowingso that food can enter the stomach.
Dietary Management: liquid foods + supplementary foods;
-
7/27/2019 Nutrition Lecture
143/147
Dietary Management: liquid foods supplementary foods;bland foods; avoid foods that reduce LES; tube feeding ifseverely malnourished
2. Esophagit isacute or chronic inflammation of theesophageal wall; H. pylori (HP) bacteria and excessiveuse of aspirin and other NSAIDs may cause esophagitis.
Dietary Management: diet modified in consistency, liquid tosoft diet; avoid foods with an acid pH, fatty meals andspicy foods; avoid foods which lower LES pressure.
3. GERD partially digested food in the stomach backs up
into the esophagus.Dietary Management: SFF; upright position 2hrs after
meals; lose weight; take medicines regularly; avoid foodsthat lower LES pressure; avoid smoking and wearingtight-fitting clothes.
4. Gast rit isinflammation of the mucous membrane of the stomachresulting in tissue damage and erosion, which expose the underlyingcells to gastric secretion and pathogens.
Di t M t t t iti ithh ld f d f 24 h th
-
7/27/2019 Nutrition Lecture
144/147
Dietary Management: acute gastritiswithhold food for 24 hours thenoral diets (CL to FL to SD to regular diet). Chronic gastritisfolate
and vitamin B12 supplementation.
5. PUD a chronic sore or crater extending through the protectivemembrane lining and penetrating the underlying tissue of the gut.
Pharmacologic treatment: use of antibiotics, antacids, H2 blockers
Dietary Management: if the ulcer is bleeding, NPO and IVF of dextrose
and amino acids then progress to FL then to regular diet.
6. Diarrh eathe passage of stools of liquid to semi-solid consistencyat frequent intervals along the digestive tract; common categoriesare: acute and chronic
Dietary Management: NPO for 12 hours with IVF and electrolytes thento oral fluids; TPN is sometimes needed; liberal fluids; vitamin andminerals supplementation;
Oral Rehydration formula (WHO): tsp table salt, 1 tsp baking soda, 1cup orange juice, 4 tbsp sugar and 1 liter (1.05 quarts) of cleanwater.
7. Cons t ipat ioninfrequent and difficult passage of small amounts of hard, drystools.
Atonic: lazy bowel because of loss of rectal sensibility; the feces are large andhard
-
7/27/2019 Nutrition Lecture
145/147
hard
Spastic: caused by an overstimulation of the intestinal nerve endings whichresults in irregular contractions of the bowel; the stools are dry, hard and small.
Dietary Management: atonic and spastic require a high fiber diet with liberal fluidintakes. However, acute attacks of spastic constipation, a low fiber diet is mostbeneficial.
Fiber: a high fiber diet is 20-35 g/day
8. Diverticulosisthe presence of diverticula (sacs or pouches) in the colonDietary Management: high fiber and adequate fluid intake
9. Diverticulitisinflammation of small pouches (diverticula) in the colon wall andlining due to chronic constipation.
Dietary Management: acuteoral feedings from CL to FL or an oral feeding withelemental formula.
10. Hemorroid senlarged veins (varicose) which occur in the lower part of therectum at the anal opening.
Dietary Management: high fiber diet (25-35 g) with plenty of water (8-10glasses/day)
-
7/27/2019 Nutrition Lecture
146/147
-
7/27/2019 Nutrition Lecture
147/147
Thank You!