nutrition lecture

7/27/2019 Nutrition Lecture

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NUTRITIONDIETETICSNUTR T ON


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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).


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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.


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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


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B SIC TOOLS INNUTRITION


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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.


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RECOMMENDED ENERGY AND NUTRIENT INTAKES (RENI)Philippines, 2002 Edition

RENI Comm ittee, Task Forc es, and t he FNRI-DOST Secretariat


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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


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NUTRITION FACTS FOOD LABELING - a format on packaged foods that

gives nutrition information & a list of ingredients as required by law.


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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


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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.


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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.


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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.


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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.


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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).


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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.


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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


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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.


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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)


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BMI- 18.5-24.9 healthy range

BMI- 25-29 mod. Overweight

BMI 30+ obesityBMI 40+ morbid obesity


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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.


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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


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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.


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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.


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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.


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Jewish Orthodox

No eggs with a blood spot are used.

Representatives foods include bagels, blintzes,

knishes, lox and matzo.


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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.


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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.


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Peanut oil is the main cooking fat.

Sushi and any raw fish are carefully prepared.


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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.


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Greek

Rice is the main grain.

Rich pastries , like Baklava, are used for

special occasions.


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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.


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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.


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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.


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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


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Functions of Carbohydrates

1. Energy source2. Protein-sparing action

3. Anti-ketogenic effect

4. Control of fat oxidation5. Regulatory

6. Sweetening agents


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Summary of CarbohydrateDigestion and Absorption


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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


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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.


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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


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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


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Health Effects of Carbohydrates

1. Dental caries2. Obesity

3. Diverticular disease

4. Colon Cancer5. Heart Disease

6. Diabetes Control

7. Nutrient Deficiencies


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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.


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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


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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.


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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.


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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.


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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.


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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


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E ti l f tt id / O F tt


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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


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Summary of Fat Digestion &Absorption


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L ipid Transport


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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


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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


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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


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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


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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.


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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.


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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?


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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?


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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?


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PROTEINS

organic substances composed of amino

acids; contain the element C, H, O and N

20 kinds of amino acid

Amino Acids


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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


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Summary of Protein Digestionand Absorption


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M t b li f P t i


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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



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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



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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:


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g

riboflavin or other B

vitamins, iron

heilosisScarlet tongue inniacin deficiency

FAT - SOLUBLE VITAMINS


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VITAMIN FUNCTION

CLINICAL ISSUES


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)


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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


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Early conjunctival xerosis (X1A)

Bitots spot (X1B):Bitots spot (X1B)

Keratomalacia (X3B)

C l i (XS)


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Xerophthalmia fundus (XF)

Ectasia of cornea (XS)

Corneal scarring (XS)

FAT - SOLUBLE VITAMINS


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VITAMIN FUNCTION

CLINICAL ISSUES


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


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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


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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


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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


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MINERAL FUNCTIONCLINICAL ISSUES


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


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NUTRITION

& THE

LIFE CYCLE


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Nutr i tional Recommendations in Pregnancy


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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


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Problems of Pregnancy with Nutritional ImplicationsMild nausea and (1) Eat dry eat dry toast, dry cereals, or crackers (2) try


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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


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in

Benefits of Breastfeeding/Lactation


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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


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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


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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


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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.


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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


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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


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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


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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.


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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)


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PUBLIC HEALTH

NUTRITION

M l t iti t t f di


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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


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MEDICAL NUTRITIONTHERAPY

Meal Distribution System


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a. Centralized b. decentralized


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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


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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.


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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


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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


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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


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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


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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


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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


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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


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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


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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: ______________________


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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


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6. Low Cholesterol: amount & type of fat;


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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/


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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


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end...

c u

allxt

wk! Medical Nutrition Therapy for Surgical Conditions

The Surgical Process


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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


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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


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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


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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


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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


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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.


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Dietary Management of Specif ic Surgical Cond it ions

1. Gastr ic Surgery as Gastrectomy- production ofpepsin and HCl is impaired; reduced protein and


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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


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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 %


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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


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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


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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.


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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.


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(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


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Diverticular

Disease

1. AchalasiaLES fails to relax normally after swallowingso that food can enter the stomach.

Dietary Management: liquid foods + supplementary foods;


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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


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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


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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)


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Thank You!

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