Transcript No Slide Title

Chapter 1
The Art of Nutrition in
a Family Context
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Learning Objectives
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Define terms used in the study of nutrition.
Identify biopsychosocial influences on nutritional
intake and health.
Evaluate a daily diet for moderation, variety, and
balance.
Explain the significance of nutrition labeling.
Recognize and differentiate among the various
food guides available.
Discuss the role of the health care team.
Discuss interviewing and counseling strategies.
Describe the nutrition care planning process.
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Basic Nutrition Terms in
the Study of Nutrition
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Macronutrients: carbohydrates, proteins, & fats
(kilocalorie sources)
Kilocalorie (kcal): energy or amount of heat
required to raise 1 kg water by 1 degree Celsius
Micronutrients: vitamins, minerals,
phytochemicals, and water
Nutrient density: amount of micronutrients in
relation to the amount of macronutrients; nutrient
dense food is high in micronutrients for the
amount of macronutrients; empty kilocalories is
the opposite
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Terms (continued)
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Nutrition: the science of how the body uses
food for energy, maintenance, and growth
Malnutrition: undernourished, as in vitamin
or protein deficiencies; or overnourished, as
in obesity
Medical nutrition therapy: nutritional therapy
provided by a registered dietitian with
application of science of nutrition and food
choices to achieve or maintain optimal
health and well-being
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Who is a Registered Dietitian?
Registered Dietitian
 RD’s are also nutritionists
 At least 4 year college
degree plus specific
nutrition requirements
 Supervised internship
 National exam
 Can practice Medical
Nutrition Therapy (MNT)
 Continuing education to
maintain RD status
Nutritionist
 Nutritionists are not
necessarily RD’s
 Varied requirements
 Most are qualified to
provide wellness
coaching but not MNT
 Colorado is one of only a
few states where
nutritionists can practice
without being an RD
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Role of Genetics in
Health and Disease
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Medical Genealogy: families or groups of
people are at increased risk of obesity,
diabetes, heart disease
Nutrigenetics: genetic predisposition to
disease is influenced by diet
Nutrigenomics: diet influences gene
expression
A return to traditional diets and lifestyle is
being promoted around the world to
reduce many common health conditions.
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Examples of Positive
Traditional Ethnic Eating Habits
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French: small portions, slow pace of
eating, emphasis on vegetables
Mediterranean: emphasis on “beans &
greens” and olive oil, low intake of meats,
sweets limited to special occasions, salads
served after main meal
Asian: soybean products and/or tofu; high
intake of rice, vegetables, and fish; low
intake of desserts; sesame and peanut oil
emphasized
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Changing Food Habits
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Findings of National Health and Nutrition
Examination Survey (NHANES)
1965-2002:
Percentage of kilocalories from beverages
doubled with extra 250 kcal/day.
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Figure 1-1A Increased Portions
of Sugar-Based Beverages
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Middle front: traditional bottle of
soda pop (7 tsp sugar)
Left front: typical individual size
today (15 tsp sugar, 5 tbsp, or
over ¼ cup)
Lower right: amount of sugar in
1 liter soda (26 tsp sugar, about
8 tbsp, or ½ cup sugar per liter)
Back row (right to left): traditional
“baby mug,” “momma mug,” and
“poppa mug” for root beer (only
poppa size now available in mug,
referred to as small)
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Figure 1-1B
Increased Portions of Juice
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Left to right:
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32 oz (quart) of OJ equate to 8 oranges
8-oz glass of OJ equates to 2 oranges
traditional juice-size glass for 1 orange when
hand-squeezing was required to obtain juice
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How Dietary Patterns
Develop and Change
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What are the biopsychosocial factors that
influence an individual’s food choices and
habits?
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Bio: exposure to food flavors and taste
preference, level of hunger and satiety, altered
food intake based on disease conditions
Psych: learned food aversion, stress-related
eating, self-esteem impact on food choices
Social: food availability within geopolitical
issues (war, food insecurity, weather
conditions for food growing), family and
restaurant offerings, holidays
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Food Idealism: Types and Impact of
Vegetarianism on Nutritional Status
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Lacto-ovo vegetarians (include milk and eggs)—easiest to meet
nutritional needs; use of low-fat milk with diet can help lower risk
of heart disease. Lacto-vegetarians include milk but not eggs;
pescetarians include fish
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Vegans (avoid all animal-based foods)—most difficult to meet
nutritional needs but might be beneficial to health, such as
reduced heart disease and obesity*
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All vegetarians benefit from intake of legumes, nuts, seeds, and
whole grains to ensure adequate protein intake.
*Vegans require vitamin B12 supplement and need a vitamin D
source if there is inadequate sunlight. Calcium, iron, protein and
zinc may be difficult to obtain and individuals might need
supplementation.
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Possible Reasons for
Practicing Vegetarianism
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Social: for environmental reasons or animal
rights issues or support of family and friends
Health:
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(Positive) Goal aimed at reduced heart disease
and obesity with foods high in fiber and low in
saturated fats
(Negative) Possible rationale given for masking
an eating disorder, especially with a vegan diet
Religious: Seventh-day Adventists, Hindus,
some Muslims
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Also helps adherence to kosher diet, where meat
and milk products not served at the same meal
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History of Food Guides
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1940s—Seven food groups: included butter (for a vitamin D source);
science of nutrition rapidly developed as result of World War II and
recognition of lack of military fitness from
malnutrition in many young men who grew up
during the Great Depression of the 1930s
1950s—“Basic four” food groups: bread, vegetables
and fruits, dairy, and meat or protein source
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History of Food Guides
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1990s—Food label changes, development
of the food guide pyramid: the foundation of
the diet (base of the pyramid) is plant-based;
meat portrayed in smaller section; fats and
sugars form the smallest part of the diet
(tip of the pyramid)
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2005—The MyPyramid Food Guidance System: aimed at
individualizing food guidance through the
interactive website www.MyPyramid.gov,
with physical activity being promoted in the
new symbol
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History of Food Guides
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2010: MyPlate illustrates the five food
groups that are the building blocks for a
healthy diet using a familiar image—a
place setting for a meal.
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Dietary Guidelines for Americans
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1980—the Public Health Service of the Department of
Health and Human Services and the USDA published the
first guidelines
Changes are made every five years; revisions generally
have been written to be more positive (e.g., what to do vs.
what not to do)
2000 guidelines, “Aim for Fitness, Build a Healthy Base, and
Choose Sensibly,” included a total of 10 strategies
2005 Dietary Guidelines for Americans very similar to the
2000 guidelines, with more specific guidance to include at
least three whole grains daily and increase fruits and
vegetables to 4.5 cups for adults; the MyPyramid Food
Guidance System reinforces the revised dietary guidelines
2010 Guidelines very similar to 2005; switch to MyPlate
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Dietary Guidelines for Americans
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Build a Healthy Plate
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Make half your plate full of fruits and vegetables
• Veggie Goal: 2 ½ cups/day
• Fruit Goal: 2 cups/day
Switch to skim or 1% milk
Make at least half your grains whole
Vary your protein food choices
Keep you food safe to eat
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Cut back on foods high in solid fats, added sugars
and salt
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Eat the right amount of calories for you
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Be physically active your way
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Balance, Variety, Moderation
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“All foods can fit”
Occasional intake of
high-fat, high-sugar
foods can be part of
a healthy diet
Variety of foods
best ensures
adequate intake of
nutrients needed for
health
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Food Labels
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Revised in the early 1990s to include
percent-daily values based on 2000 kcal
reference diet
Percentages based on 30% total fat, 10%
saturated fat, 60% carbohydrate, minimum of 50 g
protein, with 25 g/day recommended fiber and
2400 mg/day sodium
Marker nutrients (vitamins A and C, minerals
calcium and iron); 100% intake of these nutrients,
as found naturally in foods, promotes good intake
of other needed nutrients found in conjunction
2006: Food labels now include trans fatty acid
content of foods
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Amount of nutrients in g
and mg based on
serving size listed →
Marker nutrients →
← Percentage of
nutrients based on
2000 kcal and daily
reference needs
Daily Reference
Values →
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Approved Health Claims
on Food Labels
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Foods high in fiber may reduce the risk of cancer
and heart disease
A low-fat diet may reduce the risk of cancer and
heart disease
A low-sodium diet may help prevent high blood
pressure
Soy protein reduces cardiovascular disease
Foods high in calcium may help prevent
osteoporosis
Folate leads to decreased neural tube defects
Sugar alcohols reduce dental caries
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Health Care Team
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Health care provider: MD or nurse
practitioner and, in some areas, physician’s
assistant; can prescribe
Nurse: RN, LPN, CNA
Social worker
Physical therapist
Occupational therapist
Registered dietitian or licensed, certified
nutritionist
Others: speech-language pathologist,
pharmacist
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Assessment
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Physiologic
 Physical Signs
• Hair, face shape, eyes, lips, tongue, teeth,
gums, glands, nervous system
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Anthropometry: body measurements
• Height & Weight
• Tricept skinfold (fat stores)
• Midarm circumference (protein stores)
• Elbow breadth (frame size)
• Biochemical and Clinical Data (example
iron, B12, vitamin D, Na, etc)
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Anthropometrics (cont)
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Body Mass Index (BMI)
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Ratio of height to weight
Estimate of body fat
<19 is underweight
19-24.9 is normal weight
25-29.9 is overweight
>30 is obese
Ideal Body Weight
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Women: 100 + (5 x # of inches > 5 ft)
• Ex. IBW for 5’4” woman= 100+(5x4)= 120lb +/- 10%
Men: 106 + (6 x # of inches >5 ft)
• Ex. IBW for 6’0” male= 106+(6x12)= 178lb +/- 10%
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Weighing a
Non-Ambulatory Person
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Determine Learning Readiness
for Nutritional/Diet Changes
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Assess learning stage:
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Is the problem recognized by the individual?
If so, have pros and cons of change been
considered?
If individual has tried or made changes to deal
with the health problem, what has worked and
what has not?
Is the individual ready to try again or to learn
more advanced skills or knowledge?
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Assessment Areas All Health Care
Team Members Can Help Assess
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Assess needs in three realms:
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Cognitive: assess individual’s nutritional
knowledge and fallacies related to health
needs; assess whether auditory or visual
learner; check reading ability and level of
terminology needed
Affective: attitudes toward nutrition and health
and willingness to make desired changes
Psychomotor: current nutritional behaviors and
ability to change
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Summary
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Good nutritional status requires the
appropriate intake of all essential nutrients
for health (the science of nutrition)
Knowledge of nutritional needs is
important, but the “art” of good nutritional
intake is related to the biopsychosocial
needs of the individual
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Study Guide
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Vocabulary
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Macronutrient
Kilocalorie (kcal)
Micronutrient
Nutrient density
Nutrition
Malnutrtion
Medical nutrition therapy
Nutrigenetics
Nutrigenomics
Vegetarian & Lacto-ovo vegetarians
Vegan
BMI
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Study Guide (continued)
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What is the difference between a registered dietitian
and a nutritionist?
What are the biopsychosocial factors that influence
intake?
According to MyPlate, what should your plate look
like?
Know the Dietary Guidelines for Americans (slide 12)
What are food label percentages based on for
calories, fat, saturate fat, CHO, protein, fiber and
sodium? (i.e. fat 30%, etc.)
According to our discussion in class, what is the first
thing to look at on a food label?
Know how to read a food label
Know how to calculate ideal body weight
Know the
BMI categories
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