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Nutrition and Special Diets

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1 Nutrition and Special Diets
Chapter 49 Nutrition and Special Diets PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

2 Learning Outcomes 49.1 Explain why a medical assistant needs to understand the role of diet in health. 49.2 Describe how the body uses food. 49.3 Explain the role of calories in the diet. 49.4 Identify the seven basic food components and explain the major functions of each. 49.5 List the Dietary Guidelines for Americans.

3 Learning Outcomes (cont.)
49.6 Explain how the Food Guide Pyramid can be used to plan a nutritious, well-balanced diet. 49.7 Describe the test used to assess body fat. 49.8 Identify types of patients who require special diets and the modifications required for each group. 49.9 Identify specific modified diets that may be ordered to treat or prevent certain conditions.

4 Learning Outcomes (cont.)
49.10 Describe the warning signs, symptoms, and treatment for eating disorders. 49.11 Describe techniques the medical assistant can use to effectively educate different types of patients about nutritional requirements. 49.12 Explain the medical assistant’s role in educating patients about nutrition and describe the proper documentation of patient education.

5 Introduction Nutrition Medical assistant
How the body takes in and utilizes food and nutrients Five-part process Intake Digestion Absorption Metabolism Elimination Medical assistant Must understand relationship between diet and health Must recognize signs of illness related to diet

6 Role of Diet in Health Food
Body’s source of nutrients needed to function properly Certain foods are needed to maintain or regain health Some conditions require special diets Medical team works together to ensure that patients understand the role of diet in health Registered dietitian (RD) – designs diets that are therapeutic and realistic for patients

7 Daily Energy Requirements
The body requires nutrients To provide energy To build, repair, and maintain body tissues To regulate body processes

8 Daily Energy Requirements: Metabolism
The sum of all cellular processes that build, maintain and supply energy to living tissue Phases Anabolism – nutrients are changed into more complex substances that are used to build body tissues Catabolism – complex substances are broken down into simpler substances and converted to energy Metabolism affected by age, weight, activity, state of health, and other factors

9 Daily Energy Requirements: Calories
Kilocalorie (calorie) Measurement of energy produced by food Amount of energy needed to raise the temperature of 1 kg of water by 1°C. Used to measure the energy expended during activities and metabolic processes Excess calories stored as fat Count calories of food eaten and estimate expenditure for activities

10 Apply Your Knowledge Correct! What is the role of diet in health?
ANSWER: Food is the source of nutrients the body needs to function properly. Sometimes a special diet is needed to stay healthy or regain health, and some conditions require special diets. What is the difference between anabolism and catabolism? ANSWER: Anabolism converts nutrients into complex substances needed to build body tissues. Catabolism converts complex substances into simpler forms and converts them into energy. Correct!

11 Nutrients Nutrients are provided by Needed for
Proteins Carbohydrates Fiber Lipids Vitamins Minerals Water Needed for Energy Growth Repair Basic processes Energy is only provided by Proteins Carbohydrates Fats

12 Nutrients: Proteins Functions 10% to 20% of total caloric intake daily
Building and repairing cells and tissues Maintaining water balance Antibody production and disease resistance Maintaining body heat 10% to 20% of total caloric intake daily 1 gm = 4 calories Deficiency Weight loss / fatigue Malnutrition Lower resistance to infection Interference with normal growth processes

13 Nutrients: Proteins (cont.)
Complete proteins Contain all 9 essential amino acids Animal food sources Recommend lean meats, low-fat or skim milk Incomplete proteins Lack one or more essential amino acids Plant sources Can be combined to provide all 9 essential amino acids

14 Nutrients: Carbohydrates
Functions Provide 2/3 of daily energy needs Provide heat Metabolize fats Preserve protein for uses other than energy production 50% to 60% of total caloric intake daily 1 gm = 4 calories Deficiency Weight loss Protein loss Fatigue Excess contributes to fat stores

15 Nutrients: Carbohydrates (cont.)
Complex carbohydrates Polysaccharides – long chains of sugar units Types Starch – major source of energy Fiber Simple sugars Fruits and some vegetables Milk Table sugar Excess Stored in liver and muscles cells as glycogen Converted into and stored as fat

16 Nutrients: Fiber Does not supply energy or heat Functions
Increases and softens the bulk of stool Absorbs wastes and toxins Decreases the rate of carbohydrate breakdown and absorption 20 – 30 gm per day for adults Types Soluble Absorbs fluid and swells when eaten Slows absorption Helps control blood glucose Lowers cholesterol Insoluble – promotes regular bowel movements

17 Nutrients: Lipids Concentrated source of energy 1 gm = 9 calories
Triglycerides Simple lipids 95% of dietary lipids Cholesterol Compound lipids 5% of dietary lipids Functions Provide a concentrated source of energy Transport fat-soluble vitamins Store energy as body fat – insulate and protect organs Provide a feeling of fullness

18 Nutrients: Lipids (cont.)
Saturated fats Primarily from animal sources Solid at room temperature Trans fats Formed during hydrogenation of vegetable oils FDA recommends zero consumption Unsaturated fats Liquid at room temperature Types Polyunsaturated Monounsaturated

19 Nutrients: Lipids (cont.)
Cholesterol Fat-related substance produced by liver Animal-based food sources Essential to health Part of cell membranes Structural basis for steroid hormones and vitamin D Component of bile Lipid levels High cholesterol Heart disease / stroke Peripheral vascular disease Lipoproteins Carry lipids through the bloodstream Low-density (LDL) High-density (HDL)

20 Nutrients: Vitamins A E D B12 C B6 Organic substances
Essential for normal growth and maintenance Essential for resistance to infection Help the body use other nutrients Assist with body processes Absorbed through digestive tract Types Water soluble – not stored by the body Fat-soluble – stored by the body Well-balanced diet usually minimizes likelihood of vitamin deficiency

21 Nutrients: Minerals Natural, inorganic substances
Build and maintain tissues Carry out life functions Major minerals – needed in large quantities Trace minerals – needed in small amounts Absorbed in intestines Established RDAs Calcium  Zinc Iodine  Iron Magnesium  Phosphorus Selenium

22 Nutrients: Water No caloric value 65% of body weight Functions
Maintains fluid balance Lubricates moving parts Dissolves chemicals and nutrients Aids in digestion Transports nutrients and secretions Flushes out wastes Regulates body temperature

23 Nutrients: Water (cont.)
Fluid balance – intake should equal output Patient education Explain the importance of water List sources of water

24 Nutrients: Principle Electrolytes and Nutrients of Special Interest
Sodium Fluid and acid-base balance Maintains normal conditions inside and outside of cells Potassium Muscle contraction Fluid and electrolyte balance Chloride Fluid and electrolyte balance Component of hydrochloric acid Antioxidants – chemical agents that neutralize free radicals (by-products of normal metabolism)

25 Apply Your Knowledge S U P E R J O B ! Matching:
___ Bulk to stool A. Cholesterol ___ Tissue repair B. Antioxidants ___ Excess stored as glycogen or fat C. Proteins ___ Concentrated source of energy D. Water ___ Produced by liver E. Trans fats ___ No caloric value F. Fiber ___ Neutralizes free radicals G. Lipids ___ Formed during hydrogenation H. Carbohydrates ANSWER: F C H G A D B E

26 Dietary Guidelines Established to help people
Get proper nutrition Reduce occurrence of disease Control weight Designed to encourage healthy eating habits Suggest types and quantities of foods

27 Dietary Guidelines: USDA and U.S. Dept. of Health and Human Services
Recommendations Eat a balanced diet Limit consumption of less nutritious foods Increase physical activity Be consistent with good nutritional choices Food safety Disinfect food surfaces Wash hands Cook foods to safe temperature Refrigerate foods Avoid raw eggs and meats and unpasteurized milk or juices

28 Dietary Guidelines: USDA Food Guide Pyramid
Revised in 2005 Emphasizes fruits, vegetables, whole grains, beans, and nuts Less emphasis on carbohydrates Helps balance nutritional needs with physical activity needs Color coded Orange – grains Green – vegetables Red – fruits Yellow – oils Blue – milk products Purple – meats / beans Action figure – physical activity Food Pyramid

29 Physical Activity Meat/Beans Grains Fruits Milk Products Vegetables
Back Vegetables Oils

30 Dietary Guidelines: American Cancer Society
Eat more high-fiber foods Five or more servings of fruits and vegetables daily Limit consumption of processed and red meats Adopt a physically active lifestyle Achieve and maintain a healthy weight Limit consumption of alcoholic beverages

31 Apply Your Knowledge Very Good! ANSWER:
Match food group to appropriate color: Vegetables Oils Meat and beans Grains Fruits Milk products Green Orange Very Good! Blue Purple Red Yellow

32 Assessing Nutritional Levels
Age Health status Height / weight Body frame Body circumference % of body fat Nutrition and exercise patterns Energy needs Also Culture Beliefs Lifestyle Education

33 Assessing Nutritional Levels (cont.)
Measure fat as % of weight Skinfold test Measurement of the thickness of a fold of skin with a caliper Total % of fat Optimal % differs between men and women Aging changes ratio – fat replaces muscle tissue

34 Modifying Diets Factors affecting dietary needs Pregnancy Injury
Disease Vegetarian diet Aging Genetic disorders Substance abuse

35 Modifying Diets Modifications Restriction of certain foods
Emphasis on particular foods Change in daily caloric intake Change in the amount of a specific nutrient Change in the texture of foods Alteration in the number of daily meals Change in variables such as bulk or spiciness

36 Modifying Diets: Patients with Specific Nutritional Needs
Food allergies Wheat, milk, eggs, and chocolate Eliminate from diet Anemia Iron supplements Dietary iron Cancer Increase caloric intake Adequate protein intake Diabetes Food exchange system Diabetes food pyramid Elderly Energy and metabolic requirements decrease Physical difficulties Medications Social factors Economic factors

37 Modifying Diets: Patients with Specific Nutritional Needs (cont.)
Heart disease Reduce cholesterol Lose weight if needed Reduce consumption of fats Hypertension Decrease sodium / increase potassium / adequate calcium Eliminate or reduce alcohol consumption Lactose sensitivity Lactase not present to break down lactose Overweight Dietary modification Behavior modification Motivation and education

38 Modifying Diets: Patients with Specific Nutritional Needs (cont.)
Children 1st year Breast milk or commercial formula Cow’s milk inadequate Nutritional needs change Growth spurts Maturation Increasing activity Hunger regulates intake Pregnant Additional protein Calcium Iron Folic acid Fiber Lactating Additional calories and protein Folic acid and calcium

39 Specific Modified Diets
For treatment or prevention of certain conditions Modifications include changes in Texture Liquid or soft High-fiber Nutrient level Low sodium Reduced calorie Frequency and timing Three smaller meals Timing in relation to a procedure Exclusions – for food intolerances

40 Specific Modified Diets (cont.)
Supplements and parenteral nutrition Oral – specially formulated to provide adequate nutrients Parenteral – given IV to bypass the digestive system Drug therapy Drugs Change in food intake Change in absorption Foods Interfere with metabolism and action of a drug

41 Apply Your Knowledge What factors does the physician consider when assessing a patient’s nutritional status? ANSWER: The physician considers a patient’s age, health status, height and weight, body frame and circumference, percent of body fat, eating and exercise patterns, and energy needs. Culture, beliefs, lifestyle, and educational level should also be considered during the assessment.

42 Apply Your Knowledge Yippee! 2 for 2! ANSWER: Matching
___ Eliminate foods from diet A. Change in texture ___ Food exchange system B. Children ___ Decreased metabolism C. Food allergies ___ Hunger drives eating D. Parenteral nutrition ___ Modification to a soft diet E. Diabetes ___ Reduced sodium diet F. Elderly ___ Bypasses GI tract G. Drug therapy ___ May alter food intake and absorption H. Change in nutrient level C E Yippee! 2 for 2! F B A H D G

43 Eating Disorders Extremely harmful eating behavior Anorexia nervosa
Self-starvation Treatment Restore normal nutrition Psychotherapy Education of nutrition concepts Chronic condition – can be fatal

44 Eating Disorders (cont.)
Bulimia Binge and purge by vomiting, diuretics, laxatives Usually easier to treat than anorexia Treatment Medication Psychotherapy Goals Establish a healthy weight Establish good eating patterns Resolve psychosocial triggers

45 Eating Disorders (cont.)
Getting help – be alert to patient report of Skipping at least two meals per day Uncontrolled eating of large amounts of food Using laxatives or other purges to control weight Avoiding social situations that interfere with diet or exercise Feeling disgust, depression, and guilt after binge Feeling that food controls life

46 Apply Your Knowledge Right!
A young female patient arrives at the clinic showing a 15 pound weight loss in the last two months. Her weight is 10 pounds under the average weight for her height. She states she “feels great.” What should you do? ANSWER: Document the weight loss and report it to the physician. She may be suffering from anorexia nervosa or bulimia, two types of eating disorders that require medical care and psychotherapy. Right!

47 Patient Education Reinforce nutrition instructions Teach patient
Role nutrition plays in preventing illnesses How to be wise consumers by reading food package labels Factors Patient likes and dislikes Patient age and family circumstances Diseases and disorders Patient’s psychological condition

48 Patient Education (cont.)
Guidelines Teach patient as an individual Teach a small amount at a time Keep explanations at patient’s level of understanding Reinforce good eating behavior Let patient be an active learner Provide a written diet plan Suggest support groups

49 Patient Education (cont.)
Cultural considerations Influence Food purchases Like and dislikes Meal timing and frequency Attitude toward supplements Snacking Adjust diet and recipes accordingly Outside resources Patient education materials Examples American Diabetes Association American Dietetic Association American Heart Association Overeater Anonymous (OA)

50 Excellent! Apply Your Knowledge
What do you need to consider when teaching patients about nutrition? ANSWER: You need to consider patient likes and dislikes, age and family circumstances, diseases and disorders, and the patient’s psychological condition. In addition, you need to incorporate cultural considerations into nutritional education. Excellent!

51 In Summary Nutrition – complex, technical topic Medical assistant
Knowledge of basic nutritional principles Make good nutrition understandable and achievable Educate patients Recognize eating disorders

52 End of Chapter End of Chapter 49 He that eats till he is sick must fast till he is well.  ~English Proverb

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