Transcript Nutrition / Dietary - Effingham County Schools

NUTRITION / DIETARY
REGISTERED DIETICIAN
Manage food service systems, assess patients’
and residents' nutritional needs, plan menus,
teach others proper nutrition and special diets,
research nutrition needs and develop
recommendations based on the research,
purchase food and equipment, enforce sanitary
and safety rules, and supervise and/or train
other personnel.
 Dietetic technicians & dietetic assistants

DIETICIAN VS. NUTRITIONIST??

Registered Dietician: A healthcare professional
with a degree and supervised training in a
clinical setting. Covered by a professional
organization.

Nutritionist: A person who has studied nutrition
and titled themselves. This is not covered by
any governing body.
AVERAGE PAY
IAN: SCOPE OF PRACTICE (TOP)



Middle
Your favorite fast food
meal?
-calories, nutritional
values
Bottom
 How to Calculate BMI
and what is your BMI?
Are you considered…
- underweight
- normal weight
- overweight
- obese

DIETICIAN’S SCOPE OF PRACTICE


Only a dietitian can be licensed to provide nutrition care
including: assessment, goal setting, counseling, or
advice. If you have a Masters or above in human
nutrition, food and nutrition, dietetics, food systems
management, or nutrition education, or a doctorate in
nutritional biochemistry you are exempt from the
existing law and may provide nutrition services but may
not be licensed. If you are licensed to practice dentistry,
medicine, osteopathy, chiropractic, nursing, or pharmacy
you may provide nutrition services incidental to your
primary profession but may not use the title “dietitian”.
- www.nutritionadvocacy.org
NUTRITION
All body processes relating to food. Including
digestions, absorption, metabolism, circulation,
and elimination.
 These processes allow the body to use food for
energy, maintenance of health, and growth.

DEFINITIONS
Nutritional status: The state or condition of
one’s nutrition.
 Wellness: To be in a state of good health with
optimal body function.
 Essential nutrients: The chemical elements
found in food and used by the body to perform
many different body functions.

6 ESSENTIAL NUTRIENTS
Carbohydrates
Lipids
(fats)
Proteins
Vitamins
Minerals
Water
CARBOHYDRATES
Provide heat and energy
 Supply fiber for good digestion and elimination
 Commonly called: starches or sugars
 Cheap energy source
 Made of Carbon, Hydrogen, and Oxygen
 Mainly produced by plants
 Easily digested

CARBOHYDRATES
Breads
Peas
Cereals
Beans
Noodles/
Pastas Grains
Crackers
Fruits
Potatoes
Sugar
Corn
Syrup
CELLULOSE
Fibrous, indigestible form of plant
carbohydrate.
 Provides bulk in the digestive tract and causes
regular bowel movements.
 Best sources: bran, whole-grain cereals, fibrous
fruits and vegetables.

LIPIDS (FATS)
Organic compounds commonly called fats and
oils.
 3 common forms

 Triglycerides
(fats and fatty acids)
 Phospholipids (lecithin)
 Sterols (cholesterol)

Also made of carbon, hydrogen, and oxygen.
 However
contains more O2 than carbs
LIPIDS
Provide the most concentrated form of energy
and are more expensive than carbs.
 Fats maintain (1)body temperature (insulation),
(2)cushion organs and bones, (3)aid in the
absorption of fat soluble vitamins, and
(4)provide flavor to meals.
 Main source: butter, margarine, oils, cream,
fatty meats, cheeses, and egg yolk.

SATURATED / POLUNSATURATED
Saturated: Usually solid at room temp. Ex: fats
in meat, eggs, whole milk, cream, butter, and
cheeses.
 Polyunsaturated: Usually soft or oily at room
temp. Ex: vegetable oils, margarines, and other
products made from vegetable oils, fish, and
peanuts.

CHOLESTEROL
A sterol lipid found in body cells and animal
products.
 Used to produce steroid hormones, vitamin D,
and Bile Acid.
 Cholesterol is also a component of cell
membranes.
 Cholesterol is synthesized (manufactured) by
the liver.

LIPOPROTEINS
Transported in the bloodstream mainly by two
carrier molecules called lipoproteins.
 HDL- high-density also known as “good”
cholesterol because it tends to transport
cholesterol back to the liver and prevents
plaque from building up on artery walls.
 LDL – low-density also known as “bad”
cholesterol because it contributes to plaque
buildup which leads to atherosclerosis.

PROTEINS
Basic components of all body cells.
 Essential building and repairing tissue,
regulating body functions, and providing energy
and heat.
 Made of carbon, hydrogen, oxygen, and
nitrogen (and some also contain sulfur,
phosphorus, iron, and iodine.)

PROTEINS (22 AMINO ACIDS)
9 amino acids are essential to life
 The proteins that contain these 9 are considered
complete proteins.
 Sources: meats, fish, milk, cheeses, and eggs.
 Incomplete proteins: contain any combination of
the 22 AAs but not those 9.
 Sources: cereals, soybeans, dry beans, peas, corn,
nuts
 Vegetarians need to understand how to combine

VITAMINS
Organic compounds that are essential to life.
 Important for: metabolism, tissue building,
regulating body processes.
 They allow the body to use the energy provide
by carbohydrates, fats, and proteins.
 Most can be consumed in a well balanced diet.
 Deficiencies and excessive amounts can cause
poor health.
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ANTIOXIDANTS
Organic molecules that help protect the body
from harmful chemicals called Free Radicals.
 Free radicals can damage tissues, cells, and
even genes in the same way that oxygen
causes metals to rust or apples to become
brown.
 Main antioxidants: Vitamin A, C, and E

WATER SOLUBLE

Water Soluble:
dissolve in water, not
normally stored in the
body, and are easily
destroyed by cooking,
air, and light.
Examples
 B1 – thiamine
 B2 - riboflavin
 Niacin
 B6
 B12
 Vitamin C
 Folic Acid
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FAT SOLUBLE

Fat Soluble: Dissolve
fat, can be stored in
the body, and are not
easily destroyed by
cooking, air, and light.
Examples:
 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K

MINERALS
Inorganic (nonliving)
 Regulates: body fluids, assist in various body
functions, contribute to growth , and aid in
building tissues.
 Examples: Calcium, Phosphorus, Magnesium,
Sodium, Potassium, Chlorine, Sulfur, Iron,
Iodine, Copper, Fluoride, Zinc, Selenium
 Selenium, Zinc, Copper, and Manganese are
antioxidants.

WATER
Found in all body tissues
 Essential for the digestion of food

BMI (BODY MASS INDEX)
BMI is a calculation that measures weight in
relation to height and correlates this with body fat.
 http://www.youtube.com/watch?v=TKnlUbM37yg
 Ideal Range: 18.5-24.9
 BMI < 18.5 indicates an individual is underweight.
 BMI > 25 is indicative of excess weight and more
health risks.

DEFINITIONS
Digestion: Process by which the body breaks
down food into smaller parts, changes the food
chemically, and moves the food through the
digestive system.
 Peristalsis: A rhythmic, wavelike motion of the
muscles.
 Absorption: the process in which blood or
lymph capillaries pickup the digested nutrients.

Metabolism: The process in which nutrients are
used by the cells for building tissue, providing
energy, and regulating various body functions.
 Basal Metabolic Rate (BMR): The rate at which
the body uses energy just for maintain in its
own tissue. (page 33 IAN w/ food diary)
 http://www.youtube.com/watch?v=6Gm7Nd32
Q5Y
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THERAPEUTIC DIETS
Modifications of the normal diet and are used
to improve specific health conditions.
 Usually prescribed by a Doctor or dietician.
 May change nutrients, caloric content, and/ or
texture of the normal diet.
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REGULAR DIET

A balanced diet usually used for the patient
with no dietary restrictions. At times, it has a
slightly reduced calorie content.

Desserts, cream sauces, salad dressings, and
fried foods may be decreased or omitted.
LIQUID DIET
Clear and full liquids
 Liquid foods at body temperature
 Clear: carbohydrates and water
 Full: clear liquids plus other liquids
 Uses such as the following: surgery, digestive
problems, to replace lost fluids, and in
preparation for X-rays of the digestive tract
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SOFT DIET
Similar to a regular diet, but foods are easy to
digest
 Avoid meat, shellfish, coarse cereals, spicy
foods, rich desserts, fried foods, raw
vegetables, fruits, and nuts
 Uses: after surgery, patients with infections,
digestive disorders, and chewing problems
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DIABETIC DIET
Used for patients with diabetes mellitus who
often take insulin
 Exchange lists are used to choose foods
 Avoid sugar-heavy foods
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CALORIE – CONTROLLED DIETS
Low-calorie—used for patients who are
overweight; avoid or limit high-calorie foods
 High-calorie—used for patients who are
underweight, have anorexia nervosa,
hyperthyroidism, or cancer
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LOW-CHOLESTEROL DIET
Restricts foods containing cholesterol
 Used for patients with atherosclerosis and
heart disease
 Limit foods high in saturated fats
 Avoid: beef, liver, pork, lamb, egg yolk, cream
cheese, natural cheeses, shellfish, whole milk.
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FAT-RESTRICTED DIETS
Also called low-fat diet
 Used for patients with gallbladder and liver
disease, obesity, and certain heart diseases
 Avoid foods high in fat
 Avoid: cream, whole milk, cheeses, fats, fatty
meats, rich desserts, chocolate, nuts, coconut,
fried foods, salad dressings.
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SODIUM-RESTRICTED DIETS
Otherwise known as low-sodium or
low-salt diets
 Used for cardiovascular diseases,
kidney disease, and fluid retention
 Avoid or limit addition of salt; avoid
salt-rich foods
 Avoid: smoked, processed meats & foods,
sauerkraut, pickles, olives, processed cheeses.
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PROTEIN DIETS
Protein-rich foods such as meats, fish, milk,
cheese, and eggs
 High-protein for children and adolescents for
additional growth, pregnant or lactating
women, surgery, burns, fevers, infections
 Low-protein for certain kidney or renal diseases
and allergic conditions

BLAND DIET
Easily digested foods that do not irritate the
digestive tract
 Used for patients with ulcers, colitis, and other
digestive diseases
 Avoid: fried foods, highly seasoned foods, pastries,
candies, raw fruits and veggies, alcoholic and
carbonated beverages, smoked and salted
meats/fish, nuts, olives, avocados, coconut,
whole-grain bread, cereals, Coffee, tea.
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LOW-RESIDUE DIET
Eliminate or limit foods high in bulk
and fiber
 For patients with digestive or rectal
diseases such as colitis or diarrhea
 Avoid: raw fruits, vegetables, whole-grain
breads, cereals, nuts, seeds, beans, peas,
coconut, and fried foods.
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OTHER DIETS
Other diets may be ordered that restrict or
increase certain nutrients
 Check prescribed diet and ask questions if
foods seem incorrect
 Include patient’s likes if allowed
 If patient refuses foods on diet, this will not
contribute to good nutrition
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EFFECTS OF GOOD NUTRITION
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Healthy appearance
Good attitude
Proper sleep and bowel habits
High energy level
Enthusiasm and freedom from anxiety
Diseases or conditions prevented or delayed through
good nutrition
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Hypertension
Atherosclerosis
Osteoporosis
Malnutrition
HYPERTENSION:
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high blood pressure; may be caused by an
excess amount of fat or salt in the diet; can
lead to diseases of the heart, blood vessels,
and kidneys
ATHEROSCLEROSIS:

condition in which arteries are narrowed by the
accumulation of fatty substances on their inner
surfaces; thought to be caused by a diet high in
saturated fats and cholesterol; can lead to
heart attack or stroke
OSTEOPOROSIS:

condition in which bones become porous (full
of tiny openings) and break easily; one cause is
long-term deficiencies of calcium, magnesium,
and vitamin D
MALNUTRITION:
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the state of poor nutrition; may be caused by poor diet
or illness. Symptoms include fatigue, depression, poor
posture, being overweight or underweight, poor
complexion, lifeless hair, and irritability. It can cause
deficiency diseases, poor muscular and skeletal
development, reduced mental abilities, and even death.
Malnutrition is most likely to affect individuals living in
extreme poverty, patients undergoing drug therapy such
as treatment for cancer, infants, young children,
adolescents, and the elderly. Obesity is also a form of
malnutrition, caused by excess food consumption.
BERIBERI
Beriberi is a disease whose symptoms include weight
loss, body weakness and pain, brain damage, irregular
heart rate, heart failure, and death if left untreated. It
was endemic in Asia for a long time. Strangely, Beriberi
occurred almost exclusively amongst the richer
members of society, and was unknown in the poor.
Although recognized to be a nutritional deficiency,
doctors were baffled as to why wealthy people with
plentiful and clean food would fall victim to beriberi
whereas the poor with limited food did not. As it turned
out, beriberi is a deficiency of vitamin B1 (thiamine)
which is found in cereal grain husks. The rich had been
washing their rice so well that they removed the husk
with its vitamin B1, whereas the poor did not wash their
food as well and consumed enough vitamin B1. White
bread can also potentially cause beriberi, so today
developed countries add extra vitamin B1 to it. Beriberi
is now found mostly in alcoholics whose bodies become
poor at absorbing vitamin B1.
PELLAGRA
After the discovery and exploration of the Americas,
corn was grown by settlers and all around the world.
The natives who had originally grown it would treat it
with lime, but the taste was unpleasant to the
Europeans and they omitted this part of the
preparation. As corn was increasingly farmed, the
disease pellagra began to spread. Symptoms included
diarrhea, dermatitis, dementia, and finally death. Many
people believed that corn was in some way toxic, but
could not explain the lack of pellagra among native
New Worlders. After thousands of deaths, it was
discovered that corn, although high in carbohydrates,
lacked vitamin B3 (niacin). Farmers would sometimes
eat little other than corn and succumb to the
deficiency. The Native Americans had actually been
using lime as a way of adding vitamin B3. Today it is
well known that by eating a variety of foods vitamin B3
is freely obtained and pellagra is easily treated.
BIOTIN DEFICIENCY
Biotin deficiency is caused by a lack of
vitamin B7 (biotin). It causes rashes, hair
loss, anemia, and mental conditions
including hallucinations, drowsiness, and
depression. Vitamin B7 itself is found in
meat, liver, milk, peanuts, and some
vegetables. Its deficiency is quite rare;
however, there was a brief spike in the
number of cases when it became popular for
bodybuilders to consume raw eggs. One of
the proteins found in raw egg white binds
vitamin B7 and makes it difficult for the body
to use, leading to a deficiency. Cooking egg
whites makes this protein inactive. Mild biotin
deficiency is also found is about half of all
pregnant women due to a higher use of
vitamin B7 in their bodies, and supplements
are recommended for such women by the
World Health Organization.
SCURVY
Scurvy was first noted among people who spent a
long time at sea. Boats would only carry nonperishable foods such as salted meats and dried
grain, so sailors ate few if any fruits or vegetables.
Scurvy causes lethargy, skin spots, bleeding
gums, loss of teeth, fever, and death. Ancient seafaring civilizations would cure it with various
herbs. In more recent times, these ancient cures
were not used consistently and their value was
not realized. In the 18th century horse meat and
citrus fruits were found to cure scurvy, and British
sailors consumed limes to the extent that they
were nicknamed ‘limeys’. It is now known that
these foods contain vitamin C, and in modern
times scurvy is rarely fatal as it once consistently
was. Today, there are groups who advocate
vitamin C megadoses of hundreds of times the
recommended daily requirement; although any
positive effects have not been firmly
demonstrated and harmful overdoses can occur.
RICKETS
Rickets causes muscles and bones to
become soft, which can cause permanent
deformities in children. It is most common in
children and infants who have a poor diet or
who are housebound, but is nowadays
relatively rare in developed countries. Breastfed babies are at higher risk if they or their
mothers do not take in enough sunlight, and
baby formula is now designed to prevent this.
Rickets is caused by a lack of vitamin D or of
calcium. Vitamin D is required for calcium to
be properly absorbed into bones to
strengthen them. Adults rarely develop
rickets because their bones are not growing
and do not need much calcium. Vitamin D
itself is obtained from many foods but the
body can only use it if it has been converted
into its active form via sunlight. In recent
years there has been a slight increase in
children with rickets possibly due to too many
of them staying indoors.
ARIBOFLAVINOSIS
This condition is present mostly in people
who suffer from malnutrition and in
alcoholics. It causes distinctive bright pink
tongues, although other symptoms are
cracked lips, throat swelling, bloodshot eyes,
and low red blood cell count. Ultimately it can
cause comas and death. It is caused by a
lack of vitamin B2 (riboflavin), but easily
treated by eating foods rich in vitamin B2,
including meat, eggs, milk, mushrooms, and
leafy green vegetables. Vitamin B2 is also
used as artificial orange color in foods. It is
absorbed through the liver, so alcoholics
might eat enough of it but be unable to use
it. True deficiencies are rare, but about 10%
of people in developed countries live in a
state of slight deficiency, thought to be from
a diet of highly processed foods. Constant
slight deficiencies can increase the risk of
mild health problems.
VITAMIN K DEFICIENCY

This deficiency affects nearly half of all newborn infants
worldwide. In severe cases it causes uncontrolled
bleeding and underdeveloped faces and bones. Many
hospitals give newborns vitamin K injections to avoid the
more severe symptoms. Unfortunately babies born
outside hospitals are statistically at a much higher risk of
serious deficiencies. Vitamin K is found chiefly in leafy
green vegetables, although human gut bacteria help
produce it in humans. Newborns have not yet developed
gut bacteria which is why they are so prone to
deficiencies. Other than newborns, vitamin K deficiency
is found in alcoholics, bulimics, strict dieters, and people
with various severe diseases such as cystic fibrosis.
Adults who bruise or bleed easily sometimes have
vitamin K deficiency which itself may be indicative of one
of these more serious disorders.
HYPOCOBALAMINEMIA

This mouthful of a disease was first noticed as a symptom of an
autoimmune disease. It causes gradual deterioration of the spinal
cord and very gradual brain deterioration, resulting in sensory or
motor deficiencies. Mental disorders from the gradual brain damage
begin as fatigue, irritability, depression, or bad memory. As the
disease progresses over several years, psychosis and mania can
appear. This damage is irreversible and is caused by a deficiency in
vitamin B12. Fortunately, this vitamin is easily found in meat, dairy,
and eggs. Vitamin B12 is stored in the liver and can last for years
before deficiency sets in. Hypocobalaminemia is most common in
developing countries amongst people who eat few animal products.
The most at-risk groups in developed countries are vegans, as no
plant produces enough B12 for a human diet. Children need much
more B12 than adults because they are growing, so infants who are
only breast-fed can become deficient and suffer permanent brain
damage if their mother is only slightly deficient. Supplements are
recommended for people of all diet types as an easy way to avoid the
devastation of this disease.
PARAESTHESIA

Vitamin B5 is found in nearly every food, and
deficiencies are found in people who have been
starving, volunteers of particular medical studies, and
people on diets restricted to a very small number of
foods. A deficiency in vitamin B5 causes chronic
paraesthesia. Paraesthesia is most familiar to us as the
numbing sensation we feel as ‘pins and needles’ or a
limb ‘falling asleep’. This kind of paraesthesia is
perfectly normal; however, in vitamin B5 deficiencies it
occurs constantly. Malnourished prisoners of war
sometimes reported prickling and burning sensations in
their hands and feet which is now thought to have been
paraesthesia. As this is nearly unseen today, most
vitamin supplements do not include B5.
NIGHT BLINDNESS

The Ancient Egyptians and Greeks wrote about night blindness, or
‘nyctalopia’. This affliction makes it impossible to see in dim light, and
sufferers become completely blind when night falls. The Egyptians found
that they could cure sufferers by feeding them liver, which contains high
levels of vitamin A, the deficiency of which causes night blindness.
Vitamin A deficiency still affects one third of all children on Earth under
the age of five, resulting in over half a million deaths each year. Most
high dose vitamins obtain their vitamin A from liver, which is dangerous
at high levels and can cause various health complications. In the past,
starving Antarctic explorers would eat their dogs for food but became
sick when they ate too much liver. Vitamin A found in carrots is a slightly
different molecule to that found in liver and is not toxic in high doses,
although it can cause skin to turn yellow. During the Second World War,
the Allies announced that they ate carrots to see well, although carrots
only help maintain normal vision and do not improve it beyond this.
Actually they were lying to hide their development of radar.