Transcript Nursing Presentationx

Nutrition: The Good, the Bad
and the Therapeutic
SHAUNA SALVESEN MS, RDN
Nutrition Professionals
 Nutrition vs. Food
 Credentialed nutrition professionals
 Registered dietician nutritionist (RDN)
 Licensed dietician (RDN, LD)
 Dietetic Technician, Registered (DTR)
 Credentialing requirements
 Accredited program
 Internship (1200 hours for RDN, 450 hours for DTR)
 Credentialing exam
Nutrition Professionals
 Employment
 Clinical
 Government
 Food service
 Public health
 Clinical
 Nutrition screening
 Nutrition assessments
 Management of enteral and parenteral nutrition
 Nutrition education
Meet the Macronutrients
Macronutrients
Carbohydrates
Simple
Complex
Fat
Unsaturated
Protein
Saturated
Carbohydrates
 Functions
 Energy source
 Blood glucose regulation
 Part of genetic DNA, RNA, ATP and other functional molecules
in the body
 Simple Carbohydrates vs. Complex Carbohydrates

Simple
Glucose, fructose, galactose
 Sucrose, lactose, maltose


Complex
Starch
 Fiber
 Glycogen

Carbohydrates
 Choose more:
 Fiber rich foods
Fruits, vegetables and beans
 Fresh vs. Frozen vs. Canned
 Whole grains and cereals
 Amaranth, barley, quinoa, farro, steel cut oats, wheat berries


Low fat dairy products like milk and yogurt
 Choose less:
 Cakes, cookies, chips, candy, muffins, doughnuts, brownies,
energy drinks, energy bars, soda, ice cream, frozen yogurt,
white rice, white bread
Carbohydrates
 Whole grains give you more nutritional bang for your buck.
Carbohydrates
 Carbohydrates and health
 Dental health
 Overweight and obesity
 Heart disease
 Diabetes
 Lactose intolerance
Liquid Calories
Protein
 What are they?
 Functions



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
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Growth, repair &
maintenance
Enzymes & hormones
Fluid & electrolyte balance
Acid−base balance
Immune system
Source of energy & glucose
Nutrient transport &
storage
Protein
Protein Needs
Protein Quality
 RDA
 0.8 g/kg body weight
 High quality
 Meat, poultry, fish, eggs, dairy,
soy
 Low quality
 Most grains; veggies, beans,
nuts
 Choose more
 Lean cuts of meat trimmed of
visible fat, low fat dairy, beans,
fish
 Choose less
 Red meat, fried foods, high fat
dairy
 Factors influencing
protein needs


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Stage of the lifecycle
Activity level
Health
Protein Recommendations
Condition
Protein Requirement
Recreational Gym-goer
1.0-1.2 g/kg
Athlete
Endurance
Strength
1.2-1.4 g/kg
1.4-1.7 g/kg
Older adults
1.0 g/kg
Pregnancy
+25 g
Renal disease
Predialysis
Hemodialysis
Peritoneal dialysis
0.6-0.8 g/kg
1.2-1.3 g/kg up to 1.5-1.8 g/kg
>1.5 g/kg-2.5 g/kg
Cancer
1.0-1.5 g/kg
Critical illness (burns, sepsis, TBI)
1.5-2.0 g/kg
Stroke
1-1.25 g/kg
Protein and Health
 Can you have too much?
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Heart disease
Bone loss
Kidney damage
 Can you have too little?

Common protein deficiency diseases
Kwashiorkor
 Marasmus


High risk populations
Individuals with malabsorptive conditions
 Critical illness
 Elderly
 Children
 Eating disorders

Protein
 Consequences of
undernutrition
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Slowed growth and
development in children
Poor repair and healing
Fluid & electrolyte
imbalances
Decreased immunity
Wasting (muscle and
organs)
Hair loss, poor skin
integrity
Fat
 Functions:
 Energy
 Structural component of cell membranes
 Regulates cell function
 Provides insulation and shock protection
 Provides essential fatty acids and fat soluble vitamins
 Keeps skin and hair healthy
 Words to live by:
 Fat doesn’t make you fat, just like peas don’t make you pee
Fat: The Good, the Bad & Ugly
Fatty acid
Food
Impact on Health
Monounsaturated
• Olive oil, canola oil, peanut oil,
avocado
• High intakes may
improve blood lipids
and lower heart
disease risk.
Polyunsaturated
• Nuts and seeds
• Vegetable oils (safflower,
sesame, soy, corn and
sunflower)
• High intakes may
improve blood lipids
and lower heart
disease risk.
Saturated
• Whole milk, cream, butter,
cheese, high-fat cuts of beef and
pork
• Coconut, palm and palm kernel
oils
• High intakes
associated with heart
disease, certain
cancers
Trans fatty acids
• Naturally occuring
• Partially hydrogenated
vegetable oils
• High intakes greatly
increase heart disease
risk
Fat in Foods
Fat
 Choose more:
 Nuts, seeds, avocado, salmon, skinless poultry, lower fat cuts
of beef, olive oil, canola oil
 Choose less:
 Deep-fried foods using vegetable shortening, cakes, cookies,
doughnuts, pastry, crackers, snack chips, margarine, imitation
cheese, and fatty meat and whole dairy products
Modifying Fat in Your Diet
Fat and Health
 Heart disease
 Cancer
 Obesity
Meet the Micronutrients
Water Soluble
B-vitamins,
choline and
vitamin C
Fat soluble
Vitamins A, D,
E and K
Vitamins
Micronutrients
Elecrolytes
Major
Minerals
Bone
Trace
Micronutrients
 Common causes of deficiency:
 Inadequate diet
 Increased needs
 Increased losses
 Impaired activation
 Best way to prevent deficiency in healthy
populations?
Micronutrients
Condition/Disease
Micronutrients
Pregnancy
Folic acid, vitamin B12, vitamin B6, vitamin C
Burns and severe wounds
Zinc, vitamin C, vitamin A
Anemia
Iron, folic acid, vitamin B12, vitamin B6
Renal disease
Potassium, sodium, phosphorus, magnesium, iron,
vitamin D
Liver Disease
Vitamin D, vitamin K, vitamin B6, riboflavin,
niacin, zinc
Alcoholism
Thiamin, riboflavin, niacin, vitamin B6
A Calorie
A measurement of energy measured in a bomb
calorimeter
 “the amount of heat it takes to raise the
temperature of 1 gram of water by 1 degree Celsius”
 Food is measured in kilocalories (kcal)
 “Calories” with a large “C” on nutrition label are in
kcal

Transformation of Energy
 1,000 calories = 1 kcal = 1(food) Calorie
CHO
PROTEIN
FAT ALCOHOL
ENERGY SOURCES
The Energy Nutrients
Energy Nutrients
(Energy=Calories in Nutrition)
The Total Makes Up Your Daily Caloric Intake
Alcohol is a Toxin Adding 7 Calories per Gram
Carbohydrates
4 Calories per Gram
60-70%of Calories
Type is Very Important
Protein
4 Calories per Gram
10-15%of Total Calories
Use Protein Calculation for Total
Fat
9 Calories per Gram
Less than 30%
Preferably 20%
The Standard American Diet (SAD)
~15% of kcals as proteins
2/3 from animal sources
~55% of kcals as CHOs
1/2 from simple sugars
Rest mainly refined flours
~30% of kcals as Fats
~2/3 from animal fats
Food Label Energy Nutrient Calculations
Nutrition Facts
Amount per Serving
Calories 80
Total Fat 1g
Total Carbohydrate 15g
Protein 3 g
 Per serving

CHO: 15g x 4 kcal/g = 60 kcal

PRO: 3g x 4 kcal/g = 12 kcal

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FAT: 1g x 9 kcal/g = 9 kcal
TOTAL: 81 kcal, rounded down to 80
Calculating Percent Kcal
CHO
Fat
Protein
Total
290 grams x 4 kcal/g = 1160 kcal
60 grams x 9 kcal/g = 540 kcal
70 grams x 4 kcal/g = 280 kcal
1980 kcal
% kcal from CHO = 1160 / 1980 = 59%
% kcal from fat = 540 / 1980 = 27%
% kcal from protein = 280 / 1980 = 14 %
The Non-Energy Yielding Nutrients
Vitamins:
 Compose of various
chemical elements
 Vital to life
 Needed in tiny amounts
 Fat soluble
 Water soluble
 Yields no energy
Minerals:
 Inorganic substances
 Needed in tiny amounts
 Trace minerals
 Major minerals
 Yields no energy
Water
 Compose of H2O
 Vital to life
 Is a solvent, lubricant, medium for transport, and
temperature regulator
 Makes up majority (2/3) of our body
 Yields no energy
General Functions of Nutrients in Foods
 Provide Water
 Provide Fuel for Entire Body
 Provide Building Blocks
 Provide Metabolic Regulators
Influences of Food Choices
Heredity
Childhood
experiences
Peer influences
Health belief
Ethnic
identity
Education
Health Status
Occupation
Nutr.
Knowledge
Income $$$$
Religious
belief
Flavor,
texture,
appearance
Rural-urban
residence
Convenience
72 Hour Dietary Recall or Calorie Counting
Documents a patient’s intake of all food and
beverages during the previous 72-hour period.
Many patients do not remember what they ate and
can not accurately estimate quantities consumed.
Ideal for patients with diabetes-ability to assess
timing of meals, snacks, and insulin injections
Calculation for Estimate of Basal Metabolic Rate
 Men = 1 x body weight (kg) x 24
 Women = .9 x body weight (kg) x 24
 Calculates basic expenditure of calories in a 24 hour
period.
Questions