Transcript Nutrition 2010

Fall 2010
The study of food and how
it affects the human body
and influences health
 Building
Blocks
Carbohydrates, Proteins, Fats supply
energy
Vitamins, Minerals (micronutrients)
help manufacture, repair and maintain
cells
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http://www.youtube.com/watch?v=bNpTPX5gylQ
Primary Energy Source-Stored as
glycogen in liver and muscles
 Spare Protein through glycogenolysis
 Insulin moves glucose into cells
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Simple/sugars
◦ (monosaccharides, disaccharides)
 sugar, corn syrup, honey, molasses, fruits
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Complex(polysaccharides)
◦ vegetables, breads, cereals, pasta, grains, legumes
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45%-65% of calories from CHO or 135 grams
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How many servings of carbohydrates did
you eat yesterday?
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How many were simple carbohydrates?
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How many were
complex
carbohydrates?
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Function-Tissue building, Metabolism (enzymes),
Immune system function, Secondary energy source,
Acid-base balance
Amino acids (20)
◦ Essential (10) & Nonessential (10)
Complete (animal sources)
◦ Meat, poultry, fish, eggs, milk
Incomplete (plant sources)
◦ Grains nuts, legumes, seeds, vegetables
10%-35% of calories or 1gram per kilogram
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Reflects how well body tissues are being
maintained
Breakdown of amino acids yields NH3
(ammonia) which is excreted in the urine as
urea.
Positive Nitrogen Balance-Intake exceeds
output-pool of amino acids available-Healthy
state
Negative Nitrogen Balance-Intake less than
output-IIlness, injury, and malnutrition
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How many servings of protein did you eat
yesterday?
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How many were complete proteins?
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How many were incomplete proteins?
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Did protein foods account for more than 10%
of your food intake yesterday?
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Functions- Back-up energy source, Organ
insulation/protection, Supply essential nutrients (fatty
acids), Flavor and satiety
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SaturatedFats: pork, beef, poultry, egg yolk, dairy
◦ Trans fats: hydrogenated oils, some margarines, baked goods,
processed foods
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Unsaturated Fats: olives, vegetable oils (peanut, soybean,
cottonseed, corn, safflower), nuts, avocados
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Essential fatty acids: (omega 6 & omega 3)
polyunsaturated vegetable oils, fatty fish
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Glycerides (mono-, di-, and triglycerides)
Sterols (cholesterol)-Formation of cell
membranes, Vitamin D, Estrogen, and
Testosterone
Phospholipids (lipoproteins)-Water solubleTransport lipids to cells by “wrapping”
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Low-density Lipoproteins (LDL)
High-density Lipoproteins (HDL)
20%-35% calories from fat (< 10% saturated)
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How many servings of fat did you eat
yesterday?
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How many were saturated fats?
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How many were unsaturated fats?
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How does your diet compare to the USDA
Food Guide Pyramid in terms of servings of:
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Bread, cereal, rice & pasta?
Vegetables?
Fruits?
Milk, yogurt, & cheese
Meat, poultry, fish dry beans, eggs, & nuts?
Fats, oil, & sweets?
What habits could you change to achieve
optimal nutrition?
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Manufacture, repair and maintain cells
Vitamins-Fat (A,D,E,K) and Water Soluble (C & B)
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Necessary for metabolism
Building & maintaining body tissues
Support immune system
Healthy vision
Help break down and use energy found in carbohydrates,
proteins, & lipids
Minerals-Major+>100 mg/day
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Assist in fluid regulations
Nerve impulse transmission
Energy production
Health of bones and blood
Disease prevention & treatment
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Makes up ½ of body weight
◦ 55-65% men, 50-55% in women
A solvent for chemical processes
Transports (as blood) oxygen, nutrients, and
metabolic wastes
Fills in spaces in body tissues
Helps maintain body temperature
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Body needs approximately 2.5-3 liters daily.
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1. What is the body’s most usable energy
source?
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2. Which nutrient’s primary function is growth
and repair of tissue?
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3. Which type of vitamin requires daily
consumption to maintain appropriate levels?
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4. What distinguishes a major mineral from a
trace mineral?
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Is measured in calories [kilocalories (kcal)]
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Too few kcal = undernourished
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Too many kcal = obesity & increased risk for
◦ Carbohydrates = 4 kcal/g
◦ Protein=4 kcal/g
◦ Fat=9 kcal/g
◦ Weakens immunity
◦ Stunts growth
◦ Disrupts hormones
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Diabetes
Atherosclerosis
Hypertension
Hyperlipidemia
Cancer
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You have just eaten a food consisting of 4
grams of protein, 18 grams of carbohydrate,
and 1 gram of fat…..
◦ 1. What would your total kcal intake be?
◦ 2. What percentage of your kcal are from
carbohydrates?
◦ 3. What percentage of your kcal are from protein?
◦ 4. What percentage of your kcal are from fat?
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Body composition
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Growth periods
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Body temperature
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Environmental temperature
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Disease processes
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Prolonged physical exertion
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Highly emotional states of agitation & restlessness
A MEASURE OF THE AMOUNT OF ENERGY
REQUIRED BY RESTING TISSUE TO MAINTAIN
BASIC FUNCTION
 Body
Composition
 Growth Periods
 Body Temperature
 Environmental Temperature
 Disease Processes
 Prolonged Physical Exertion
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Men = 1 kcal/kg of body weight per hour
Women = 0.9 kcal/kg of body weight per hour
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Weight (in kilograms) x ____kcal x 24 =
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Number of kilocalories needed to replace
those used for basic metabolism plus those
used in physical activities (See page 593
Table 26-7)
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Estimates
◦ 1600 kcal/day
◦ 2200 kcal/day
◦ 2800 kcal/day
Sedentary women & older adults
Children, teenage girls, active
woman, and most men
Teenage boys, active men, and
very active women
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How would you classify his activity level?
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Is his intake sufficient or insufficient to
maintain his present daily energy
requirement?
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Men
106 lb. for first 5 ft., then 6lb/in.
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Women
100 lb. for first 5 ft. then 5lb/in.
Use weight standards and tables with caution
(Everyone is unique)
Lean body mass (muscle, bone and connective tissue)
weighs more than fat. Physical fitness matters!
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1. Why are the infant’s nutritional needs per unit
of body weight greater than any other time?
2. Why is it sometimes a challenge to meet the
nutritional needs of toddlers?
3. What is the challenge in meeting the nutritional
needs of school-age children?
4. Which age group experiences a growth spurt
second only to that of infants?
5. Why are energy (kcal) requirements less for
older adults?
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Folic acid critical 1st Tri. to prevent neural tube
defects
Adequate protein and calcium essential to fetal
growth
Iron essential to maintain maternal and fetal
blood supplies
Pregnant women need approx. 300 additional
kcal/day
Lactating women need approx. 500 additional
kcal/day
 Dietary
Patterns
 Oral
Contraception-Lowers Vit. C
and several B Vits.
 Using
food to cope
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Smoking-Can reduce Vit. C by 30%
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Alcohol-Adds calories; decreases rate of fat
metabolism; and, in excess, interferes with
adequate nutrition by replacing real food,
depressing appetite, decreasing absorption
of nutrients by toxic effect on intestinal
mucosa and, impairing storage of nutrients
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Semi-vegetarian-Eat fish, eggs, and dairy
Ovo-lacto vegetarian-Eat eggs and dairy
Lacto-vegetarian-Eat dairy
Vegan-Only foods of plant origin
Fruitarian-Only fruit, nuts, honey and
vegetable oil
At risk for deficiencies in:
◦ Vitamin B12, D
◦ Protein
◦ Iron
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Muslim
◦ No pork, fasting during Ramadan
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Judaism
◦ Fasting, strict dietary laws (Kosher)
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African American
◦ Lactose intolerance, often high fat diets
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Asian American
◦ Lactose intolerance, green tea
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European Americans
◦ Meat & potatoes
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Hispanic Americans
◦ Lactose intolerance, spicy foods
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Native Americans
◦ Preferences vary greatly
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1. List 3 nutrients that may be more difficult
to supply through a vegetarian diet.
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2. Why should you encourage clients from
various cultures to follow their traditional
diets?
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3. Describe the effects on nutrition of:
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Smoking
Heavy alcohol use
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DISEASES
OTHER ISSUES
◦ Poor appetite-alcoholism, medications
◦ Impaired cognitive function-developmental delay,
mental illness, confusion, memory loss
◦ Ability to get food / poverty
◦ Ability to prepare food-fatigue, stamina
◦ Decayed / missing teeth
◦ Swallowing disorders
◦ Stomach function
◦ Peristalsis-slowed or increased transit time
◦ Drugs / chemotherapy / radiation
Regular / House
 NPO
 Modifications of consistency
◦ Clear liquid-lacking essential
nutrients
◦ Full liquid-difficult to get essential
nutrients-low in iron, vitamin B12,
vitamin A, and thiamine
◦ Mechanical soft-low in fiber
◦ Pureed-blenderized
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Modifications for Disease
◦ Calorie restricted-for weight loss
◦ Sodium restricted-hypertension or fluid balance
◦ Fat restricted-elevated cholesterol, triglycerides
◦ Diabetic
◦ Renal diet-to manage electrolytes and fluids
◦ Antigen-avoidance diets-Ex. Gluten free for celiac
disease
◦ Calorie-protein push-to heal wounds, maintain or
increase weight or promote growth
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Which nutrients are missing or difficult to
obtain from these diets?
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Clear liquid
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Full liquid
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Mechanical soft diet
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Anthropometric measurements
◦ Height and weight
◦ Skinfold measurement
◦ Circumferences
◦ Body mass index
◦ Imaging techniques
◦ Underwater weighing
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Screening
◦ Evaluate height, weight, brief dietary
history, and
body mass index-
◦ Current health
 Recent weight loss/gain, diet/appetite changes,
stress/trauma, medications
◦ Health history
◦ Dietary History by food diary
 24 hour recall
 Food frequency questionnaire
 3 day Food record
◦ Socioeconomic status
◦ Physical assessment
When risks are identified, perform further assessment!
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SKINFOLD
THICKNESS
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Use a caliper
Measure triceps in
children and women
Measure
subscapular area in
men
CIRCUMFERENCES
Mid-upper arm
Abdominal
◦ Waist-to-hip ratio >1
in men and >0.8 in
women indicates
obesity and =
increased risk for
HTN., DM,
Hyperlipidemia, and
CVD
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IMAGING
TECHNIQUES
◦ Dual-energy x-ray
absorptiometry
(DEXA)
◦ Computed
tomography (CT)
◦ Magnetic resonance
imaging (MRI)
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UNDERWATER
WEIGHING
Gold standard for
body composition
measures but
impractical for
children, elderly,
severely ill
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What are the most reliable locations for
skinfold measurement?
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What are the implications of an increased
WHR?
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BMI=weight in kilograms1 meter = 39.37 inches
1 kilogram = 2.2 pounds
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How do you measure up?
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Underweight
Normal
Obesity
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<18.5
18.5 – 24.9
>30
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General Survey
Alterations in vital signs
Poor skin turgor, wound healing
Concave abdomen / ascites
Change in muscle mass / wasting
Reduced activity tolerance
Laboratory results
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List 10 physical examination findings that
would lead you to suspect nutritional
problems.
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What factors would lead to poor wound
healing?
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Weight loss / gain
Reduction mid-arm circumference, decrease in
skin-fold
Alcoholism
Cognitive impairment
Malabsorption syndromes
Multiple medications
Fatigue, memory loss, loss of functional status
↡ Serum levels albumin, transferrin, prealbumin
Folate, iron, zinc deficiencies
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Blood Glucose-Fuel available for cellular energyNormal=70-110
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Serum Protein levels-Indicators of protein stores
◦ Albumin-1/2 life 18-21 days- Normal=3.5-5
◦ Pre-albumin-Fluctuates daily-Marker of acute
change-Normal=15-36
◦ Transferrin-Faster detection than albumin-Normal
=204-360 mg/dL
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Urea (BUN)-End product of protein metabolismIndicator of kidney and liver function-Normal=8-
20
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Creatinine (Cr)-End product of skeletal muscle
metabolism-Excellent indicator of kidney
function-Normal=0.5-1.2 mg/dL
Lymphocytes (WBCs)-Decreased in
malnutrition, protein deficiency, alcoholism,
bone marrow depression and anemia
Hemoglobin (Hg)-Indicator of inadequate iron
intake or chronic blood loss, insufficient
protein intake or excessive protein loss
◦ HEME-iron-rich compound
◦ GLOBULIN-protein
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Why is it important to identify the serum
albumin level?
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Why would pre-albumin be a better indicator of
acute nutritional changes than albumin?
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With clear instructions you may delegate:
UAP’s
◦ Height
◦ Weight
◦ Intake and output
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LPN/LVN
◦ Collect nutritional history
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RN
◦ Reviews and interprets data
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Imbalanced Nutrition: Less Than Body Requirements
◦ R/T eating disorders, difficulty chewing, vomiting,
alcoholism, food intolerances, metabolic disorders,
absorption disorders
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Imbalanced Nutrition: More Than Body Requirements
◦ R/T overeating, lack of exercise, metabolic/endocrine
disorders
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Risk for Imbalanced Nutrition
Self Care Deficit (Feeding)
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Consuming nutrients in excess of metabolic
demands
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Activity
Gender
Height
Weight
Overweight = body mass index > 25 but < 29.9
Obesity = body mass index > 30
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Insufficient intake of protein, fat, vitamins,
minerals
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Consuming less calories than needed
according to:
◦ Activity
◦ Gender
◦ Height
◦ Weight
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Nutritional counseling / teaching
Support special nutritional needs
◦ Impaired swallowing
◦ NPO
◦ Older adults
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Assisting patients with meals
Weight weekly
Diet modifications / supplements
Dietitian consult
Methods to improve appetite
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Food Stamp Programs
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Commodity Distribution Programs
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Supplemental Food Programs for Women,
Infants and Children (WIC)
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National School Lunch and Breakfast
Programs
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Assess for functional
deficits
Assess intake for
adequacy
Demonstrate assistive
devices
Serve one food at a
time; serve small
amounts
Have casual
conversation with
patient during feeding
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Assist only as
necessary; encourage
independence
Serve finger foods
Provide privacy if pt. is
embarrassed
Use napkin, not a bib
Sit down while
providing assistance to
pt.-Do not rush
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Offer frequent, small meals
Restrict liquid intake with meals
Keep environment neat and clean
Provide or assist with oral hygiene
Provide a pleasant eating environment
Serve foods attractively and within easy reach
Position patient comfortably
Cater to patient likes as much as possible
(encourage family to bring food from home)
Control pain and avoid treatments during
meals.
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Definition-Delivery of nutrition through a tube
Requires a functional GI tract
Risk-Aspiration leading to infection, pneumonia,
abscess formation, ARDS
Complications-Diarrhea, alterations in drug
absorption, metabolic alterations
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Nasogastric
Nasoenteric
Percutaneous gastrostomy tube (PEG)-into the stomach
Jejunostomy tube-into the jejunum
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Definition-Delivery of nutrition through a
central venous catheter
Preferred method for patients without a
functioning GI tract or a GI tract needing rest
Total Parenteral Nutrition (TPN)
Excellent medium for bacterial growth-can
lead rapidly to sepsis-requires aseptic catheter
care and dedicated line
More info to come at a later date!
A.
B.
C.
D.
Using calipers to measure the skinfold on
the triceps
Obtaining the waist to hip ratio (WHR)
Hydrodensitometry
24-hour food recall
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A.
B.
C.
D.
Fasting serum glucose of 87 mg/dL
BUN of 16 mg/dL
Serum albumin level of 1.8 g/dL
Total white blood cell count of 6,000/mm³
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A. Mr. J, who weighs 180lb, is active, has a normal
weight and is taking in 3240 kcal per day.
B. Mrs. S who weighs 220 lb, is sedentary,
overweight, and taking in 1000 kcal per day
C. Susan, who weighs 100 lb, is slightly
underweight, plays soccer three times a week,
and is taking in 1500 kcal per day.
D. Mr. C, who works a desk job, weighs 190 lb (a
normal weight for his height) and is currently
taking in 2800 kcal per day.