The Micronutrients Vitamins Minerals Electrolytes
Resting energy expenditure (REE ) Uses the largest proportion of total energy expenditure by the body
Physical activity Constitutes the second largest proportion of total energy expenditure by the body
CategorySymptomsDiseases Decreased caloric intake Loss of appetite o early satiety Change in taste/dry or sore mouth & tongue Difficulty chewing or swallowing Nausea or vomiting Self imposed diet Social isolation/depression Dysmobility Gingivitis/poor dentition Gastroparesis Obstruction Eating disorder Malignancy Maldigestion/malabsorption Diarrhea Fatty, malodorous stools Change in bowel habits Food particles in stool Pancreatic insufficiency Crohn’s disease Short bowel syndrome Lactose intolerance Celiac disease Impaired metabolism/increased requirements Fever Increased or decreased appetitie AIDS Pneumonia/sepsis Major surgery or trauma Hyperthyroidism Chronic liver, renal, or pulmonary disease Increased losses/excretion Draining fistulas or open wounds Diarrhea Increased urination Excessive vomiting Burns Occult GI bleeding Hemodialysis Diabetes (glucosuria) Physiologic categories associated with weight loss Swartz, M.H. (2006) Textbook of Physical Diagnosis and History Examination (8 th ed.) Saunders: Philadelphia, PA
HerbCommon UseSide Effects & Interactions EchinaceaTreatment and prevention of URI’sRash, pruritus, dizziness St. John’s wortTreatment of mild to moderate depression GI upset, photosensitivity Gingko bilobaTreatment of dementiaMid GI distress, headache, possible anticoagulant effects GarlicTreatment of hypertension; hypercholesterolemia; atherosclerosis GI upset, gas, reflux, nausea, allergic reaction, antiplatelet effects Saw palmettoTreatment of benign prostatic hyperplasia Uncommon GinsengGeneral health promotionHigh does may cause diarrhea, hypertension; insomnia; nervousness. Siberian ginseng may alter digoxin level GoldensealTreatment of URI’sDiarrhea, hypertension, vasoconstriction AloeTopical application for dermatitis, herpes May delay wound healing after topical application; diarrhea and hypokalemia with oral use ValerianTreatment of insomnia, anxietyFatigue, tremor, headache Commonly Used Herbs and Their Side Effects Swartz, M.H. (2006) Textbook of Physical Diagnosis and History Examination (8th ed.) Saunders : Philadelphia, PA
Questions to guide nutritional assessment Does nutrition contribute to the cause, severity, or treatment of the illness? How has the illness affected the patient’s diet and nutritional status? Does the patient see a relationship between diet and disease? Was the patient ever advised to follow a special diet or use other nutritional therapy?
Components of a nutritional assessment Nutritional health History Dietary Assessment Anthropometric measurements Biochemical & laboratory assessment Physical examination
Red Flags suggesting an eating disorder Weight preoccupation Poor-self-esteem, perfectionist personality Chronic medical illness Family history of eating disorders Use of appetite suppression and/or laxitives Cultural pressure for thinness or outstanding performance Athlete driven to excel Food cravings, restrictions Compulsive/binge eating Difficulties with communication
Special groups of people Infants & Children Adolescents Pregnant Women Older Adults
Food practices of some ethnic groups 1. 2. 3. 4.
“Hot” & “Cold” foods from a cultural perspective Depending on the “hot” and “cold” nature of the illness, some foods may be avoided.
Body Mass Index BMI = weight (kg)/height (meters) 2 or BMI = weight (pounds)/height (inches) 2 x 703 Obesity defined as a BMI of 25 kg/m 2 or higher
Waist-to-Hip Ratio Waist-to-hip ratio = Waist circumference ___________________________________________________________ Hip circumference A waist-to-hip ratio of 1 or greater in men or.8 or greater in women is indicative of android (upper body obesity) and increasing risk for obesity-related diseases and early mortality