1. Unit 10 Nutrition and Diets

2. 10:1 Fundamentals of Nutrition
Most people know there is a relationship between food and good health
Many do not know what nutrients are needed to maintain good health
Because of this, many people are not able to choose proper foods for optimum health
Health care workers must understand basic nutrition

3. Fundamentals of Nutrition
Nutrition: all body processes relating to food
Include digestion, metabolism, circulation and elimination
Help the body to use food for energy, health and growth
Nutritional status: state or condition of one’s nutrition
Role of nutrition in physical, mental, emotional, and psychological affects
Goal is to maintain wellness – good health with optimal body function

4. Effects of Good Nutrition
Healthy appearance
Good attitude
Proper sleep and bowel habits
High energy level
Enthusiasm and freedom from anxiety
Large role in determining height, weight, strength, skeletal and muscular development, physical agility, resistance to disease, appetite, posture, complexion, mental ability, emotional and psychological health

5. Effects of BAD Nutrition
Hypertension
High blood pressure, caused by excess of fatty/salty food
Atherosclerosis
Narrowed arteries, caused by excess of saturated fats and cholesterol (LDL)
Osteoporosis
Porous, brittle bones, caused by deficiencies in minerals
Malnutrition
State of poor nutrition, caused by poor diet or illness
Hypertension can lead to diseases of heart, blood vessels and kidneys
Atherosclerosis fats build up on inner surface of blood vessels (plaque); can lead to heart attack or stroke
Osteoporosis caused by deficiencies in calcium, magnesium and vitamin d
Malnutrition symptoms include fatigue, depression, poor posture, weight issues, poor complexion, lifeless hair, irritability, deficiency diseases, poor muscular and skeletal development, reduced mental abilities, even death. Malnutrition most likely to affect individuals in extreme poverty, patients undergoing extreme drug treatments, infants, children, adolescents and elderly

6. 10:2 Essential Nutrients
Essential Nutrients – chemical elements in foods used by body to perform many different body functions
Carbohydrates
Major source of energy, easy to break down during cellular respiration
Ex – starches, sugars, bread, cereal, pasta, crackers
Cellulose – fibrous, indigestible carb, allows for regular bowel movements
Provides heat and energy, fiber for good digestion and elimination

7. Essential Nutrients Lipids
Storage form of energy for our body, difficult to break down
Provide insulation, cushioning, help maintain body temp, carry fat soluble vitamins to tissues
Ex – saturated and unsaturated fats, butter, margarine, cheese, egg yolk
Cholesterol – important lipid, used to make steroid hormones, vitamin D, cell membrane
Fat soluble vitamins – a, d, e and k
Provide fatty acids needed for growth and development, provide heat and energy, carry fat-sol vits to cells
Saturated – solid at room temp, eggs, whole milk, butter, cheese
Unsaturated – usually soft or liquid at room temp, veggie oil, margarine
Cholesterol – fat-like substance, part of cell membrane, helps to make steroid hormones, vit d and bile acids. Found in egg yolk, fatty meats, shellfish, butter, cream, cheese. Excess may contribute to artherosclerosis.
* Should limit intake of foods containing fats from animal sources

8. Essential Nutrients Vitamins Proteins
Structural component of body as well as enzymes
Build and repair tissue, regulate body functions, provides some energy and heat
Made up of amino acids
“Complete proteins” contain the amino acids our body doesn’t produce
Vitamins
Help enzyme activity, used for metabolism, tissue building and body process regulation
Can be water or fat soluble
See table 10-2 (pg 232)
Proteins
Build and repair tissue, provide hat and energy, help produce antibodies, make up part of cell membrane. Complete proteins usually animal foods. Incomplete proteins usually vegetable proteins  cereal, soy, beans, peas, corn, nuts
Vitamins
- Regulate body functions, build and repair body tissue, metabolism, allow body to use energy provided by carbs, fats and proteins. Only need a small amount of vitamins. An excess can be dangerous. Deficiency can cause poor health 8

9. Essential Nutrients Minerals Water
Inorganic compound essential for life
Regulate body fluids, contribute to growth and tissue building
Needed in small amounts
Table 10-3 (pg 232)
Water
Found in all body tissues
Needed for digestion, absorption, movement of wastes
Need to drink 6 – 8 glasses of water a day
Water
- Carries nutrients and wastes to and from body cells, regulates body functions, makes up blood plasma 9

10. 10:3 Utilization of Nutrients
Digestion – process where body breaks down food, changes food chemically, moves food through digestive system
Mechanical – food broken down by teeth & moved through GI tract by peristalsis
Peristalsis – wavelike motion of digestive tract muscles
Chemical – food broken down by digestive juices secreted by mouth, stomach, small intestine and pancreas
Absorption – nutrients absorbed into small intestine capillaries
Nutrients carried through body by circulatory system
Water, salts and some vitamins absorbed in large intestine
Before body is able to use the nutrients contained in food, our body must break down the food to obtain the nutrients, then absorb the nutrients into the circulatory system
Mouth – amylase changes starch to maltose
Stomach – hydrochloric acid, pepsin breaks down proteins. Lipase emulsifies fats.
SI – produces enzymes, prepares foods for absorption, lactase converts lactose, maltase converts maltose, sucrase converts sucrose, peptidases break down proteins (liver makes bile, gallbladder stores bile and releases it into si to emulsify fats)
Pancreas – releases enzymes into small I. Pancreatic amylase, lipase, pancreatic proteases (break down protein)
LI – absorbs water and electrolytes, collect food residue for excretion

11. 10:3 Utilization of Nutrients
Metabolism
Actual use of nutrients
Process in which nutrients are used by the cells for body functions
Cellular respiration occurs to break down nutrients to produce ATP
Basal Metabolic Rate (BMR) – amount of energy needed to maintain life
Extra nutrients are stored to use in the future
Body uses and needs energy continuously so the body stores nutrients for future use. Stored nutrients are used to provide energy when food intake is not adequate for energy needs.
- Energy needed for voluntary work and involuntary work 11

12. Measuring Food Energy
When the body metabolized nutrients to produce ATP, heat is also generated
Amount of heat produced is how we measure energy content of the food
Calorie – unit used to measure heat released
Lipids – 9 calories per gram
Carbs & proteins – 4 calories per gram
Vitamins, Minerals and Water – 0 calories per gram
Individual’s caloric requirements
How many calories are needed in a 24-hour period
Varies from person to person as well as age, activity, size

13. Measuring Food Energy General guidelines for weight maintenance
1 pound body fat = 3,500 calories
To lose 1 pound – decrease of 3,500 calories or use 3,500 calories during exercise
Decrease 500 calories per day, person would lose 1 pound in a week
To gain 1 pound – increase 3,500 calories
Increase 500 calories per day, person would gain 1 pound in a week
Slow steady gain/loss of 1 – 2 pounds per week is an efficient and safe form of weight control 13

14. 10:4 Maintenance of Good Nutrition
Good nutrition is the best way of achieving and maintaining good health
Balanced diet
Table 10-4 and 10-5 (pg 235 – 236)
If food is not appealing, people will not eat it even if it is healthy
Consider variety, taste, color, aroma, texture, and general likes and dislikes

15. Guidelines for Good Eating Habits
USDA has published a booklet on nutritional principles called Nutrition and Your Health: Dietary Guidelines for Americans
Eat a variety of foods
Maintain healthy weight
Choose a diet low in fat, saturated fat, and cholesterol
Plenty of vegetables, fruits, and grain products
Sugars, salt, and sodium in moderation
Alcohol, if consumed, in moderation

16. Food Habits Affect Nutrition
Habits can be based on cultural or religious beliefs
Table 10-6 (pg 237)
Unusual habits are not necessarily bad; must be evaluated
Suggesting changes takes tact, patience, and imagination
Difficult to change since most habits are formed in childhood; change can be slow

17. 10:5 Therapeutic Diets
Modification of normal diet used to improve specific health condition
Normally prescribed by physician and planned by dietitian
May change nutrients, caloric content, and/or texture
May seem strange and even unpleasant to patient

18. Regular or Standard Diet
Balanced diet
May have slight calorie reduction
Omit: rich desserts, cream sauces, salad dressings, and fried foods
Used for: ambulatory patients (outpatient)

19. Liquid Diet Clear and full liquids Liquid foods at body temperature
Not nutritional, only for short term
Liquid foods at body temperature
Clear: carbohydrates and water
Full: clear liquids plus other liquid items
Uses – after surgery, acute infections, digestive problems, to replace lost fluids, and in preparation for X-rays of the digestive tract
Clear: apple or grape juice, fat-free broth, plain gelatin, fruit ice, ginger ale, tea, black coffee (with sugar)
Full: clear + strained soups, cerals, fruit and veggy juices, yogurt, hot cocoa, custard, ice cream, pudding, sherbet and eggnog

20. Soft Diet
Similar to a regular diet, but foods require little chewing and are easy to digest
Omit: meat, shellfish, coarse cereals, spicy foods, rich desserts, fried foods, raw fruits and veggies, nuts and coconut
Uses – after surgery, patients with infections, digestive disorders, and chewing problems

21. Diabetic Diet Used for patients with diabetes mellitus (DM, type 2)
Body doesn’t produce enough insulin (a hormone, protein produced in pancreas) to properly metabolize carbs (sugar)
Omit: sugar-heavy foods
Type 2 develops over life due to diet or enviro factors. Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.
People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body’s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.

22. Calorie-Controlled Diet
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, bulimia, hyperthyroidism (over-active), or cancer
Extra protein and carbohydrates
Avoid high-bulk foods (fibrous foods)
Avoid high-fat foods (fried, pastries, cheese)

23. Low-Cholesterol Diet Restricts foods containing cholesterol
Limit foods high in saturated fats
Beef, pork, egg yolk, cheese, shellfish
Used for - patients with atherosclerosis and heart disease

24. Fat-Restricted Diet Also called low-fat diet Omit: foods high in fat
Used for - patients with gallbladder and liver disease, obesity, and certain heart diseases

25. Sodium-Restricted Diet
Also called low-sodium or low-salt diets
Avoid or limit addition of salt; avoid salt-rich foods
Pickles, olives, processed cheese, smoked fish
Used for - cardiovascular diseases

26. Protein Diet Protein-rich foods: meats, fish, milk, cheese, and eggs
High-protein for children and adolescents for additional growth, pregnant or lactating women, surgery, burns, fevers, or infections
Low-protein for certain kidney or renal diseases and certain allergic conditions

27. Bland Diet
Easily digested foods that do not irritate the digestive tract
Omit: fried food, pastries, raw fruit and veggies, smoked and salted meats, olives, avocado, coffee
Used for - patients with ulcers, colitis, and other digestive diseases

28. Low-Residue Diet Eliminate or limit foods high in bulk and fiber
Omit: raw fruit and veggies, whole-grain breads, seeds, beans, fried foods
Used for - patients with digestive or rectal diseases such as colitis (inflamed colon) or diarrhea

29. Other Therapeutic Diets
Other diets may be ordered that restrict or increase certain nutrients
Check prescribed diet and ask questions if foods seem incorrect
Try to include patient’s likes if they are allowed on diet
If patient will not eat the foods on diet, the diet will not contribute to good nutrition