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FOOD AND NUTRITION LECTURE I NUTRITION  Is the science of food, the nutrients, and the substances they contain, their action, interaction, and balance in relation to health and disease. (Council of the American Medical Association). DIETETICS  Practical application of the principles of nutrition which includes planning of meals for the healthy as well as the sick. FOODS  Products derived from plants or animals that can be taken into the body to yield energy and nutrients for the maintenance of life and the growth and repair of tissues. 2 Main Sources of Foods: 1. Plants: grains, pulses, fruits, vegetables, tubers, nuts , oilseeds and seaweeds. 2. Animals: meat and entrails, milk, poultry, eggs, fish, and shellfish. ***Manufactured food, also convenience food are products of either of the two or a combination of them. a. b. Types of Foods: Grains & cereals –rice, corn, wheat, sorghum, barley, oats, rye, millet. Fruits 1. Tropical –pineapple, mango, papaya, banana. 2. Sub-tropical –citrus, olives, figs. 3. Deciduous –grapes, apple, and pears. 4. Berries –strawberries, blueberries. 5. Stone – apricot and peach. c. Vegetables 1. Fruits –cucumber, tomatoes. 2. Leaf and stem –cabbage, celery, swamp cabbage or kangkong, pechay. 3. Seeds –green peas, mongo, green beans. 4. Root –carrot, radish. 5. Flowers –cauliflowers, broccoli, squash flowers. d. Tubers –sweet potatoes, cassava, yam, potatoes. e. Nuts –pili nut, pistachio, cashew, almond. f. Oilseeds –coconut oil, soybean oil, peanut oil, sesame oil, olive oil. g. Seaweed – agar, carrageenan. h. Pulses –beans, peas, and lentils. i. Meat and entrails –beef, veal, pork, mutton, goat, rabbit, venison, seal, whale, and their internal organs. j. Milk –cow’s, carabao’s, goat’s, sheep’s, camel’s. k. Poultry – chicken, turkey, ducks, geese, quail. l. Eggs –chicken, duck, turtle. m. Fish –(including roe, liver): milkfish or bangus, sardine, tuna, mackerel, cod, catfish, shark, tilapia. n. Shellfish 1. Crustaceans – crab, lobster, shrimp, prawns. 2. Mollusks – clams, oysters, snail, octopus , squids. NUTRIENTS  Chemical substances present in food and is used in the body for one or more of the following functions: 1. to provide energy 2. to build and repair tissues 3. to regulate life processes

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2 Major Divisions of Nutrients: 1. Macronutrients – they are needed in the body in relatively large amounts. Ex: Carbohydrates, Protein, Fat, Major minerals and Water. 2. Micronutrients – the body needs them in smaller quantity Ex: Vitamins and trace minerals Six Main Groups of Nutrients 1. Carbohydrates – are plant-derived food s composed of sugars. Starch foods ( rice, pasta, root crops, bread ) and those concentrated in sugars are common sources. Fruits and vegetables contain dietary fiber, a complex form of CHO. 2. Protein – are made up of amino acids, which serve as the building units of body tissues. They are vital for growth, repair, and maintenance of the body. 3. Fats or Lipids – is a family of water-insoluble substances that include triglycerides (fats and oils), phospholipids (lecithin), and sterols (cholesterol and ergosterol). Of the lipids in food, 95% are fats and oils, and 5% are other lipids. 4 Minerals - are pure inorganic elements. They are not metabolized, nor do they yield energy. They are indestructible and need not be handled with the special care. a. Major –sodium, potassium, calcium, phosphorus, chloride, sulfur, magnesium. b. Trace – iron, zinc, copper, fluoride, iodine, selenium, manganese, molybdenum, chromium, cobalt. 5 Water soluble and fat soluble - these are organic but they do not provide energy. Instead, they facilitate the release of energy from CHO, CHON and fat and participate in numerous other activities throughout the body. Because they are complex organic molecules, they are vulnerable to destruction by heat, light, and chemical agents. Thus, food must be handled carefully to preserve them. a. Water-soluble –Thiamine(B1), Riboflavin(B2), Niacin, Biotin, Pantothenic acid, Folic acid, Pyridoxine(B6), Cobalamin(B12). b. Fat-soluble –Vitamins A, D, E, K. 6 Water - is a food as well as nutrient. It provides the environment in which nearly all the body’s activities are conducted. Classification of Nutrients according to its Chemical Nature 1. Organic nutrients - contain carbon. Ex: CHO, CHON, Fat and vitamins 2. Inorganic nutrients - they do not contain carbon. Ex: Water and minerals Classification of Nutrients according to its Sources 1. Natural nutrients - are obtained from plant and animal foods. 2. Synthetic nutrients - are man-made nutrients such as vitamin or mineral pill. Classification of Nutrients according to its Essentiality 1. Dietary essential nutrients - are those that the body cannot make in sufficient quantity to meet its requirement; they must be obtained from the diet. 2. Non dietary essential nutrients - are those that can be produced in the body in enough amounts. Among them are cholesterol and the amino acids. ENERGY-GIVING NUTRIENTS  CHO, CHON and fats are energy nutrients that fact that they yield calories when metabolized in the body.  Minerals, vitamins and water do not provide energy.  Alcohol is not a nutrient but it provides energy.  The energy content of food is measured in kilocalories (kcal) or kilojoules (kj) .  ONE CALORIE - it is the amount of heat required to raise the temperature of 1 kg of water to 1 degree centigrade.  When completely broken down in the body, a gram of CHO yields about 4 kcal of energy; a gram of CHON also yields 4 kcal; and a gram of FAT yields 9 kcal.  Alcohol contributes 29 kcal that can be used for energy. 2

 Fat, therefore, has a greater energy density than either CHO or protein.  CALORIE - a measure of the energy a food provides relative to the amount of food (kcalories per gram). Sample problem: Calculate the total energy available from the given food and the percentage of kcalories each of the energy nutrients contributes to the total. A. A sandwich having 23 g CHO, 5 g CHON and 5 gram of fat per serving. B. One slice of bread with one tablespoon of peanut butter on it contains 16 grams CHO, 7 grams protein, and 9 grams fat. Factors Affecting an Individual’s Calorie Need 1. Age and growth 2. Gender 3. Climate 4. Sleep 5. Activity 6. Fever 7. Illness NON-NUTRIENT COMPONENTS OF FOOD 1. Alcohol 2. Pigments 3. Additives – preservatives, flavors and colors 4. Phytochemicals – non-nutrient compounds found in plant-derived foods that have biological activity in the body. Ex: lycopene in tomatoes, allylic sulfites in garlic, and lignans in wheat. NEW FORMS OF FOOD 1. Pharmafoods - food or nutrient that claims medical or health benefits related to prevention and treatment of disease. 2. Functional foods - are foods or ingredients that have been modified to provide a health benefiting beyond their nutrient contributions. 3. Designer foods - are processed foods that are supplemented with food ingredients naturally rich in disease-preventing substances. This may involve genetic engineering of food. 4. Nutraceutical - are products that may be considered a food or part of a food and provides medical or health benefits. 5. Organic foods - are products that are grown without manufactured fertilizers or pesticides. DAILY FOOD SELECTION DIET – the food and drink that a person regularly consumed 2 Forms of Diet: 1. Special diet - a selection of food based on health conditions or disease management goals. Examples: low calorie diet for weight control, low salt diet for control of blood pressure. 2. Balance diet- provides the correct amount of essential nutrients. 1. 2. 3. Factors Influencing Food Habits and Selection of Food Stuffs Habit and preference- The selection of food is tied to a person’s routine and practices. Taste, texture, and appearance also mainly dictate an individual’s food options. Cost, availability, and convenience- People select foods which they can afford to buy, which are readily available, and do not require much time to prepare or cook. In today’s modern lifestyle, foods that are fast and delicious are frequently chosen. Culture and tradition- Each area of the world and every region of a country had own typical foods and ways of combining them into meals. Religious rules about foods can further dictate the composition of 3

4. 5. 6. 7. 8.

diet. Many Muslims refrain from eating pork and beef of unknown origin. Some Jewish people do not eat pork or serve milk products and meat at the same meal. Social pressure- Social pressure operates in all circles and across all cultural lines. Close friends share similar food choices. Special occasions are associated with the serving of specific foods and it is often impolite to refuse food or drink offered by a host. Advertising- Commercial ads and packaging of the food industry are quite successful in enticing the public to choose certain foods. Medical conditions and health beliefs- There are medical conditions and their treatments limit the foods a person can select. A client with hypertension might need to adopt a low salt diet. The chemotherapy needed to treat cancer can interfere with the persons appetite. Body Image- People may opt for food that they link with ideals of body image. Emotional State- Some individuals eat in response to emotional stimuli such as boredom, anxiety, and depression. Principles of Planning a Healthy Diet: Carefully planned meals deliver sufficient amount of all vital nutrients. Elements of Nutritious Diet 1. Adequacy- The foods chosen provide enough of each important nutrients, fiber, and energy. 2. Proportionality- The choices do not overemphasized one nutrient or food type at the expense of another. 3. Calorie control- The foods provide the amount of calories a person needs to sustain appropriate weight. 4. Moderation- The foods do not provide extra fat, salt, sugar, or other unwanted constituents. 5. Variety 6. Nutrient-density- Select foods that deliver the most nutrients for the least amount of food energy. Tools in Designing a Healthy Diet A nutritionally satisfactory diet is based on a wise selection of a variety of foods in recommended amount. 1. U.S. Food Guided  This is a food group plan that assigns food to major groups. It suggests the proper combination of foods in a meal and serving sizes.  Ex: the U.S. Food Guide a. 6-11 servings of breads, cereals, and other grain products per day b. 3-5 servings of vegetables per day c. 2-4 servings of fruits per day d. 2-3 servings of meat, poultry, fish and alternatives per day e. 2 servings of milk, cheese and yogurt per day f. Fats, Sweets, and Alcoholic beverages: use sparingly 2. Your Guide to Good Nutrition  Is a practical guide in planning meals/diets for Filipinos; foods are classified into groups on the basis of similarity in nutrient content. a. Energy-giving foods – are high in CHO and fats such as rice & rice products, breads, corn, root crops, sugar and sweets, past and noodles; butter, margarine, mayonnaise, cooking oil, etc. b. Body-building foods - are rich in CHON and minerals such as meat, fish, poultry, eggs and dried beans. c. Body-regulating foods - are rich in vitamins, minerals, fiber and water like fruits & vegetables 3. Food Guide Pyramid  A pictorial form of the daily food guide; it teaches the principle of eating a variety of foods everyday, the need for moderation in some food groups while emphasizing the importance of other food items.  The broad base at the bottom conveys the message that the food group should form the foundation of a healthy diet and foods that belong in this level must be taken abundantly compared to other food groups. The apex indicates that foods belonging to this group should be eaten sparingly. 4

Ex: U.S. Food Guide Pyramid and Food Guide Pyramid for Filipinos

4. The Nutrition Guideline  These are most important recommendations to promote good health through proper food intake; they are short, simple statements that give advice on the consumption of foods and food components for which there are public concerns.  The guidelines aim to foster an adequate, balanced diet and desirable food and nutrition practices and healthy habits suitable for the general population. The latest NUTRIONAL GUIDELINES FOR FILIPINOS given by the Food and Nutrition Research Institute – DOST are: 1. Eat a wide variety of foods everyday. 2. Breast-feed infants from birth to 4-6 months, and then give appropriate foods while continuing breast-feeding. 3. Maintain children’s 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 cooking oil daily. 7. Consume milk, milk products, or other calcium-rich foods such as small fish and dark, green leafy vegetables every day. 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. 5. Recommended Dietary Allowances (RDA)  Is the average daily amount of a nutrient considered enough to meet the known nutrient needs of practically all healthy people.  These are set at levels higher than the requirements of most individuals.  In the Philippines (2002), it is now called the Recommended Energy and Nutrient Intakes (RENI). UNDERSTANDING FOOD LABELS  Food labels give information about the product’s contents, ingredients, and nutritional value.  They provide the consumers information so that they can make healthier food choices.  Information in the food label helps the consumers see how a food fits into their overall daily diet.  The Bureau of Food and Drugs of DOH - is the government’s major implementor of nutrition labeling in the Philippines.  Food and Drug Administration - in the USA. INFORMATION ON FOOD LABEL A. Mandatory Information on Food Labels; Every food label must prominently display and express in ordinary words. 1. Name of product- This tells the consumers what they are buying and must not give a false impression, ex. Strawberry yoghurt must contain strawberries where as “flavored” yoghurt don’t have. 2. Name & address of manufacturer, packer or distributor- This is shown for comments/ complaint/ or questions the consumer may wish to ask. 3. Place of origin- Some products may appear misleading if their place of origin is not stated. 4. Preparation Instructions- This should be shown especially on high-risk foods so all of bacteria are killed during cooking. 5. Weight or quantity- This data will help consumers compare products fairly. 6. Storage Instructions- The storage instructions should be given so that the date mark is valid. B. Open-date Markings: All foods should be date marked apart from very long life products. 1. Consume before or use before or expiration date - signifies the end of the estimated shelf life of a product beyond which certain quality attributes become significantly impaired. 2. Best use by - indicates the end of a period after which certain qualities of the product must be expected to deteriorate. After such date, the product may still be satisfactory for human 5

consumption and may remain marketable, but the makers presumably no longer guarantee its best quality. C. The Ingredient List – should be listed in descending order of predominance by weight and state on the label that they have done so. If water makes up more than 5% then it must be listed. Example : An orange powder that contains “sugar, citric acid, orange flavor”…. Versus a juice that contains “water, tomato concentrate, concentrated juice of carrots, celery… D. Serving Size - it reflects the amount that people customarily consume. E. Serving per container - this suggests the number of servings in the food package. F. Nutrition Facts panel - it provides information on certain nutrients. 1. The Percentage Daily Value (%) - this part of the panel tells whether the nutrients in a serving of food contribute a lot or a little to your total daily diet. Thus, the lower percentages indicate that the food provides less of the nutrient and higher percentages indicate that it gives more of the nutrient. They are based on recommendations for a 2000-calorie diet. 2. Daily Values (DV) - are reference values set by the government for food labeling purposes. They are based on Daily Reference Values (DRVs) and Reference Daily Intake (RDIs). G. Health Claims - claims about the relationship between a nutrient/food and the risk of a disease or health-related condition may also show up on the front of the package. It was authorized by Food and Drugs Administration. Example: 1-calcium and osteoporosis- must contain 20% (200mg) or more of the RDI for calcium per serving. 2- Sodium and Hypertension- Must meet low sodium descriptor requirements and must not exceed disqualifying level for fat, saturated fat and cholesterol. RELATION OF NUTRITION TO HEALTH 1. Growth and Development – good nutrition is essential for the attainment of normal growth and development. 2. Specific Deficiency – good nourishment is essential for the prevention of diseases and promotion of good health. 3. Resistance to Infection – malnutrition influences the course & outcome of many clinical disorders. 4. Mortality and Morbidity – malnutrition contributes to high general death rate, high IMR, high sickness rate & lower expectation of life. Over nutrition, in turn, is responsible for obesity, diabetes, HPN, CVD, renal diseases, liver and gallbladder disorders. NUTRITION- NURSE’S RESPONSIBILITIES  Be aware of patients who are at risk for malnutrition & provide preventive care.  Watch out for S/SX of malnutrition.  Know the patient’s medical history.  Know the patient’s social, economic & environmental limitations related to nutrition.  Verify, communicate and record findings.  Be familiar with different types of diets.  Encourage patient’s participation in feeding.  Be aware of the psychological impact of feeding assistance on the patient.  Promote factors that improve patient’s appetite such as pleasant & comfortable surroundings. ANATOMY & PHYSIOLOGY OF DIGESTIVE SYSTEM The Primary functions of Digestive System The basic role of the digestive system is to bring essential nutrients into the internal environment so that they are available to each cell of the body. The Various mechanism used to accomplish the primary functions of GIT include. 1. Ingestion- Food is taken. 2. Digestion- Breakdown of complex nutrients into simple nutrients. 3. Motility of the wall- Physically breaks down large chunks of foods material and moves food along the tract. 6

4. Secretion- Release of digestive enzymes allows chemical digestion. 5. Absorption- Movement of nutrients through the GI mucosa into the internal environment . 6. Elimination-Excretion of material that is not absorbed. The Gastrointestinal Tract The digestive system is composed of different parts through which food passes: 1. Mouth 2. Esophagus 3. Cardiac sphincter 4. Stomach 5. Pyloric sphincter 6. Small interstine (duodenum,jejunum and ileum). 7. Ileocecal valve 8. Large intestine (Ascending, transverse, descending, sigmoid colon) 9. Rectum 10. Anus The Mouth @ Composed of the lips, cheeks, teeth, tongue, salivary glands and palate @ Salivary glands (an exocrine glands) that include the parotid, submandibular and sublingual glands. @ Salivary amylase- An enzyme that splits amylose a(a form of starch) @ Subligual lipase- An enzyme that splits fats to a limited degree. The Pharynx @ Tube through which food passes when moves from mouth to esophagus @ Divisions: 1. nasopharynx, 2. oropharynx, 3. laryngopharynx. @Epiglottis is the cartilage structure in the throat that prevents fluid or food from entering the trachea when a persons swallows. The Esophagus @An elastic muscular tube about 25 cm long and lined with the mucus membrane that allows food to pass through easily. The tube that connects the pharynx to the stomach. This is where peristalsis starts. Peristalsis pushes the swallowed food, called bolus, along the digestive system: It is achieved through the successive waves of involuntary muscular contractions along the wall of the GIT. The Stomach @ A saclike organs that receives the food from the esophagus. @ Divisions: 1 Cardia – the part that immediately adjoins the esophagus, 2. Fundus- the upper domeshape part. 3. Body- the main central part, 4. Antrum- is the lower third of the stomach. @ Sphincter muscles 1. Cardiac sphincter – The sphincter muscle at the junction between the esophagus and the stomach. It keeps the entrance of the stomach closed and prevents gastric regurgitation. 2. Pyloric sphincter- the sphincter muscle separating the stomach from the small intestine ( also called pyloric valve). It is regulates the flow of chime to the small intestine. @ Chyme – A thick, creamy, acid liquid expelled by the stomach into the duodenum. @Gastric Mucosa – 1. epithelial lining (rugae), 2. gastric glands –release gastric juice, 3. Chief cells – secrete enzymes of the gastric juice and pepsin. 4. Parietal cells – secrete the very strong hydrochloric acid. @Functions: 1. Reservoir for food; Can hold up to 2 ½ pints of food which usually remains for 2 to 4 hours. 2. Produces the hormone gastrin which stimulates the secretion of gastric juice. 3. Secretes gastric juice (mixture of water, hydrochloric acid, enzymes and mucus) to aid in digestion of food. 7

a. Hydrochloric acid- secrete by parietal cells Functions; 1. activates pepsinogen to pepsin. 2. Kills pathogenic bacteria swallowed with food. 3. renders some minerals suitable for absorption in the intestine. 4. Breaks food into small particles and mixes them with gastric juice. 5. Begins the process of digesting protein and fats. The Small Intestine @ A 10-foot long coiled muscular tube of small diameter (1in) @ Divisions: 1. Duodenum – The top portion of the small intestine and receives digestive juices from the liver, gallbladder and pancreas. 2. Jejunum – The first two-fifths of the small intestine beyond the duodenum. 3. Ileum – the last segment where most of the absorption of food takes place, it is the site of absorption for Vit B12. @ Villi – Numerous fingerlike projections on the surface of intestinal wall; when magnified, a single villus turns out to be composed of several hundred cells called microvilli. Microvilli can trap nutrients particles and transport them into the cells. Once entered, nutrients are transmitted into the blood stream or the lymphatic system. In either case, the nutrients end up in the blood. @ Functions: 1. It serves as the major site of digestion of food and absorption of nutrients. 2. Through intestinal flora (bacteria), some amount of vital materials are manufactured like biotin and vitamin K: bacteria also protects the body from infection. @ Ileocecal valve – the sphincter muscle separating the small and large intestines. The Colon or Large Intestine @ The last portion of the GIT; Its length is about 1.5 to 1.8 m. @ Divisions: 1. Cecum – the large, primary section of the large intestine which accepts food byproduct from the ileum. 2. Apendix – A narrow blind sac at the apex of the colon. 3. Ascending Colon . 4. Transverse Colon 5. Desending colon 6. Sigmoid Colon – Connects the end of the descending colon to the rectum. 7. Rectum – The muscular terminal part of the GI tract extending from the sigmoid to the anus. It stores waste prior to the elimination. 8. Anus – Is a sphincter muscle that controls the elimination of feces. The Role of the Accessory Organs The Pancreas @ A gland that secrete enzymes and digestive juices into the duodenum through its pancreatic duct, this is the exocrine function of the pancreas. Its endocrine function is the secretion of hormone insulin and other hormones into the blood. The Liver @ Considered the largest of the body’s gland. @ Functions : 1. Aids in the digestion of fats by secreting bile into the duodenum. Bile is composed of cholesterol, bile salts, and bile pigments. 2. Destroy RBC. 3. Forms urea for the of nitrogenous waste. 4. Forms fibrinogen used in blood coagulation. 5. Stores glycogen. 6. Helps in the metabolism and storage of vitamins. 7. Produces protective and antioxidant substances. 8

The Gallbladder @ The organs that stores and concentrates bile, an emulsifier that prepares fats and oils for digestion. Located in the underside of the liver. @ When gallbladder receives the signal that fat is present in the duodenum . It contracts and squirts bile through the bile duct into the duodenum.

ABSORPTION OF NUTRIENTS DUODENUM Vit.A and B1 Iron and Calcium Monoglycerides, glycerol, fatty acids Amino acids Monosaccharides Disaccharides JEJUNUM Glucose, galactose Amino acids,dipeptides Glycerol, fatty acids, mono/diglycerides Cu,Zn,K,Ca,Mg,P,I,Fe Fat/Water soluble vit Remaining alcohol Prepared by: Florenz chiong ILEUM Disaccharides Na, K, Cl, Ca, Mg, P, I Vit. D, E, K, B1, B2, B6, B12 and C Most of the water COLON Na, K, H2O Acids and gasses Some short-chain fatty acids produced from plant fibers Undigested starch Vitamins made by bacteria (biotin & K)

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B. CARBOHYDRATES AND SUGARS  Is the preferred (main) energy source for most of the body’s activities including the brain and muscle functions.  Compounds which contain carbon, hydrogen and oxygen. Classification 1. Simple CHO a. __________________ – single sugars. Ex: glucose, fructose and galactose. b. __________________ - sugars composed of pairs of monosaccharide. Ex: sucrose, maltose and lactose. 2. Complex CHO a. ___________________ - large molecules composed of chains of monosaccharide. Ex: starch, dextrins and glycogen. Monosaccharide These compounds cannot be hydrolyzed to simpler compounds.  Glucose, Galactose and Fructose have same formula (_______). But they differ in the arrangement and are distinctive in their physical properties such as solubility & sweetness. A. Glucose (a.k.a ________) It is white, crystalline, and easily soluble in water with sweet taste. It is readily absorbed from the stomach. It is also present in fruits and honey. B. Fructose (a.k.a.________)  It is sweeter than glucose.  It is obtained by the hydrolysis of sucrose. C. Galactose  It is not found free in nature.  Its only source being from hydrolysis of lactose.  It also occurs in cerebrosides present in brain and nervous tissue (nutritionally important). Disaccharides  Formed by the condensation of two monosaccharides with the elimination of one molecule of water. A. Sucrose  Occurs in sugarcane and beet root.  Formed by the condensation of one molecule of glucose and one molecule of fructose.  Easily hydrolyzed to glucose and fructose either by dilute mineral acids or by the enzyme SUCRASE present in intestinal juice.  Sucrose glucose + fructose B. Maltose  Present in malt.  Formed in cereal grains during germination by the hydrolysis of starch.  It is formed when starch present in the food is digested by salivary and pancreatic amylase. 10

  

 Maltose is also formed by the condensation of 2 glucose molecules.  It is hydrolyzed to glucose by the enzyme MALTASE.  Maltose glucose + glucose C. Lactose  Type of sugar present in milk of all mammals.  Formed by the condensation of one molecule of glucose and one molecule of galactose.  It is hydrolyzed to glucose and galactose by the enzyme LACTASE present in intestinal juice.  Lactose glucose + galactose Polysaccharides  large molecules composed of chains of monosaccharide. 2 Groups of Polysaccharides 1. ________________ - are complex CHO that can be broken down into sugar units. Ex: Starch & dextrins. 2. ________________ - are complex CHO that contain sugar units held together by bonds that human digestive system cannot break, thus, they yield little, if any, energy. - a.k.a Dietary Fibers 2 Classes of Dietary Fibers 1. __________________ - are the tough, fibrous structures of fruits, grains and vegetables. - They are so called because they do not dissolve in water. - Ex: cellulose, hemicellulose, lignin 2. __________________ - are indigestible food components that readily dissolve in water and often imparting gummy or gel-like characteristics of food. - Ex: pectin, gums, psyllium and algal polysaccharides OTHER FORMS OF SUGAR: Sugar Alcohols (___________________)  Are sugar-like compounds that are sweet to taste but yield less kcal per gram.  They are used as a sucrose substitute in candies, chewing gum, beverages & other foodstuffs.  Ex: Sorbitol, Mannitol and Dulcitol. Artificial Sweeteners (__________________)  Make food taste sweet without promoting damage to tooth enamel.  They are non-CHO, non-caloric sweetening agents.  Ex: Aspartame, Saccharin, Sucralose FOOD SOURCES There are three main sources of Carbohydrates:  ___________ – these are present in cereal, roots & tubers, etc. (rice, rice products, sweet potatoes, other root crops, corn, breads, pasta, noodles, refined grain products).  ___________ - monosaccharide & disaccharides. (sucrose – table sugar, candies, softdrinks, chocolates, etc.; fructose – honey, ripe fruits & some vegetables; lactose – milk & milk products)  ___________ - is a tough fibrous lining found in vegetables, fruits & cereals, etc. It is hard to digest and has no nutritive value. However, it acts as roughage and prevents constipation. ( stems/leaves of vegetables, apples, root vegetables, cabbage family, peas and beans, etc.) FUNCTIONS OF CHO  Protein sparer  Fat sparer (anti-ketogenic effect) 11

   

Sole energy source for the brain and nerve tissues. Reserve fuel supply Regulator of normal bowel movement Acts as structural component

RECOMMENDED INTAKE OF CHO (RDA) The suggested total amount of CHO in the diet varies & is typically based on the food habits:  American diet: ___ to ___ percent of the daily total calorie intake  RDA: 130 g/day  Filipino diet: ___ to ___ percent of the daily total calorie intake, majority should come from complex CHO such as starches and fibers.  Moderate sugar intake is encouraged amounting to maximum of ___% of total calories.  Recommended intake of dietary fiber is ___ to ___ grams per day. HEALTH EFFECTS 1. Sugars  Nutrient Deficiencies  Dental caries  Obesity  Atheroclerosis 2. Starch and Fibers  Weight loss  Satiety value  Lower risk of heart disease  Lower risk of diabetes  Enhanced health of the colon ISSUES & CONTROVERSIES ABOUT CHO 1. 2. 3. 4. 5. 6. 7. 8. Complex CHO are fattening Refined sugar (sucrose) and foods containing concentrated sugars are empty-calorie foods. Sugar causes dental caries. Sugar alcohols are calorie-free carbohydrates. Too much sugar causes diabetes. Use of artificial sweeteners poses health risks. Sugar causes hyperactivity or aggressiveness in young children. Honey is better sweeter than sugar.

CARBOHYDRATE DIGESTION & ABSORPTION DIGESTION The purpose of Carbohydrate digestion is to hydrolyze the disaccharides and polysaccharides of the diet to their simplest forms. This is accomplished by the enzymes of the digestive juices and yields the respective end products. ABSORPTION Most absorption of carbohydrates occurs in jejunum. The absorption of carbohydrates from the intestine is controlled by certain factors like condition of the intestinal tract and muscle tone, endocrine glands, etc.

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Prepared by: Romeo C. Tuazon Jr. RN LECTUERE III C. PROTEINS AND AMINO ACIDS  The word protein is derived from the Greek word “primary or holding or first place_” which means principal components of all living cells and are important in practically all aspects of cell structure and functions.  Proteins are vital for growth, repair and maintenance of the body.  Chemically, proteins contain the same atoms as carbohydrates and lipids – C, H, and O – but protein also contain nitrogen atoms.  Proteins are made up of about 20 common acids.  All amino acids have the same basic structure – a central carbon (C) atom, with an amino group (NH2), an acid group (COOH), hydrogen (H), and a side group attached. The side group is a unique chemical structure that differentiates one amino acid from another. Classification of Amino Acids 1. Essential amino acid - are those that cannot be synthesized in the body. Thus they can be attained from food alone. Ex: Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine. 2. Non-essential amino acid - are those that body can synthesize from an available source of nitrogen and carbon skeleton. and therefore are not as necessary for consideration in the diet. Ex: Alanine, Arginine, Asparigine, Aspartic acid, Cysteine, Glutamic acid, Glutamine, Glycine, Proline, Serine, Tyrosine. Classification of Proteins according to its origin 1. Complete protein - protein foods of animal origin, such as eggs, milk, fish, poultry, and meats. They provide all the essential amino acids in sufficient amount to meet the body’s needs. 2. Incomplete protein - plant protein foods, except soya. 3 Main Classifications of Proteins 1. Simple proteins - on hydrolysis by acid, alkali or enzymes yield only amino acids or their derivatives. - Ex: albumin & globulins found within all body cells (blood serum), keratin, collagen & elastin in supportive tissues of the body (hair and nails), globin (hemoglobin and myoglobin). 2. Compound protein or Conjugate protein or Proteids - these are composed of simple proteins combined with a non-proteinaceous substance. - Ex: Lipoproteins (carrier needed for the transport of fats in blood), Nucleoprotein (the protein of cell nuclei), Phosphoprotein (casein milk & ovovitellin in eggs), Metalloproteins (enzymes tha contain mineral elements), Mucoproteins (found in connective tissue). 3. Derived proteins- these are substances resulting from the decomposition of simple and conjugated proteins. Chemical Stages of Protein 13

As indicated by its name, an amino acid has a chemical structure that combines both acid and bases (amino factors). This important structure gives amino acids a unique buffering capacity. This acid-base nature of amino acids also enables them to join one another to form the characteristic chain structure of protein. The amino (base) group of one amino acid joins the acid (carboxyl) group of another.This characteristic chain structure of amino acids is called peptide linkage. Long chains of amino acids that are linked in this manner are called polypeptides.

FOOD SOURCES a. Sources of Complete Proteins (Animal sources)  Fish, shellfish  Chicken, turkey, duck  Beef  Soybeans (tofu)  Hard cheese, cheddar  Milk, yogurt, reduced fat ice cream  Lamb, pork, egg b. Sources of Incomplete Proteins (Plant sources)  Cereals: ready to eat, oatmeal, wheat  Grains: wheat, rice, corn, oats, barley, spaghetti, bread  Vegetables: broccoli, potatoes, green peas, leafy green vegetables  Legumes: beans, peanuts FUNCTIONS OF CHON  Protein are used in repairing worn out body tissue protein (anabolism) resulting from the body continued wear and tear (catabolism) going on in the body.  Proteins are used to build new tissue by supplying the necessary amino acids building blocks.  Proteins are source of heat and energy. They supply 4 calories per gram of protein.  Proteins contribute to numerous essential body secretions and fluids, enzymes and proteins. Some hormones have protein or amino acid components. Mucus and milk are largely protein. Sperm cells are large protein as is the fluid in which sperm cells are contained.  Proteins are important in the maintenance of normal osmotic relations among the body various body fluids.  Proteins play a large role in the resistance of the body to disease.  Dietary proteins furnish the amino acids for a variety of metabolic functions. RECOMMENDED INTAKE OF CHON (RDA) Daily protein allowance may be estimated based on desirable body weight. Protein allowance=DBW (kilo) x protein allowance per k DBW Group Protein Allowance per kilogram weight Infants 2.75-3.0 g Children 1.5-2.0 g Early adolescent 1.5 g Older adolescent 1.25 g Adults 1.12 g(Filipinos), 0.8 g (Americans) HEALTH EFFECTS of CHON  Heart Disease – Food rich in animal protein tends to be rich in saturated fats.  Cancer – Studies suggest a relationship between high intakes of animal protein and some types of cancer like cancer of the prostate gland, pancreas, kidneys, breast and colon. 14

 Osteoporosis – Calcium excretion rises as protein intake increases.  Obesity – Protein rich foods are also rich in fat which lead to obesity with associated health risks.  Kidney Disease – Excretion of end products of protein metabolism depends on a sufficient fluid intake and healthy kidneys. A high protein diet increases the work of the kidneys.  Protein Energy Malnutrition – This results when a person is deprived of protein, energy or both; manifested by poor growth in children, weight loss and wasting in adults. PROTEIN ENERGY MALNUTRITION (PEM)  A deficiency of protein, energy, or both, including kwashiorkor, marasmus and instances in which they overlap.  It is one of the most prevalent and devastating forms of malnutrition in the world.  It most often strikes early in childhood. 2 Stages of Protein Energy Malnutrition 1. Acute PEM - caused by recent severe food restriction; characterized in children by thinness for height (wasting). 2. Chronic PEM- caused by long-term food deprivation; characterized in children by short height for age (slunting). Classifications of PEM 1. Marasmus  Appropriately named from the Greek word meaning “drying away”.  A form of PEM that results from a severe deprivation, or impaired absorption of energy, protein, vitamins, and minerals. 2. Kwashiorkor  It was originally a Ghanian word meaning “the evil spirit that infects the first child when the second child is born”.  A form of PEM that results either from inadequate protein intake or, more commonly, from infections. FEATURES OF MARASMUS AND KWASHIORKOR IN CHILDREN MARASMUS Infancy (6 to 18 months of age) Severe deprivation or impaired absorption of protein, energy, vitamins and minerals Develops slowly (chronic PEM) Severe weight loss Severe muscle wasting, with no body fat Growth: <60% weight for age No detectable edema No fatty liver Anxiety, apathy Good appetite possible Hair is sparse, thin, and dry; easily pulled out Skin is dry, thin and easily wrinkles KWASHIORKOR Older infants & young children (18 months to 2 years old) Inadequate protein intake or, more commonly, infections Rapid onset (Acute PEM) Some weight loss Some muscle wasting, with retention of some body fat Growth: 60-80% weight for age Edema Enlarged fatty liver Apathy, Misery, Irritability, Sadness Loss of appetite Hair is dry and brittle; easily pulled out; changes color; becomes straight Skin develops lesions

Treatment and Prevention of PEM 1. In developing countries, breast feeding should be encouraged and it ensures adequate supply of nutrients and antigens. 15

2. Food stuffs that contain sufficient amounts of essential Amino acids should be provided. 3. Improvement of sanitation and program of immunization. 4. Fluids with electrolytes of sodium and potassium which will maintain electrolyte balance. PROTEIN DIGESTION & ABSORPTION DIGESTION The purpose of digestion is to hydrolyze proteins to Amino acids so that they can be absorbed readily by the body. There is no protein breaking enzyme in saliva. So the digestion (hydrolysis) os protein begins in the stomach. The enzyme PEPSIN secreted by gastric glands in the stomach breaks down protein to peptones and proteoses. In the case of milk, milk protein is first converted to casein by the enzyme called RENIN. Casein combines with calcium to form calcium caseinate. Pepsin converts this to peptones. Strong enzymes are needed to breakdown the peptide linkage. The stronger enzymes are found in pancreatic and intestinal juices. The pancreatic juice contains TRYPSIN and CHYMOTRYPSIN. The final breakdown of all proteins fractions to amino acids is brought about by ERPSIN secreted by intestinal mucosa. ABSORPTION Amino acids are absorbed by the small intestine and thereby carried to the liver by portal vein. The amino acids reach the respective tissues where the required metabolism occurs.

Prepared by: Roderick Magpantay

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LECTURE IV D. FATS AND OTHER LIPIDS LIPIDS  A family of compounds that includes triglycerides (fats and oils), phospholipids (lecithin), and sterol (cholesterol).  They are characterized by their insolubility in water. Classification of Lipids 1. Triglycerides  The chief form of fat in the diet and the major storage form of fat in the body.  Of the lipids in foods, 95 % is fats and oils (triglycerides).  Of the lipids stored in the body, 99% is triglycerides.  Composed of a molecule of glycerol with 3 fatty acids attached.  Glycerol – an alcohol composed of a three-carbon chain, which can serve as the backbone for a triglyceride. Ex: fats and oils FATS  It belongs to a group of substances called lipids.  It is a lipid that is solid at room temperature (250C).  The fat in foods is a combination of three different fatty acids. Classifications of Fats 1. Visible fats - include butter, oils, mayonnaise, fat attached to meat, are obvious fats that are plain to see. 2. Invisible fats - are present in avocado, peanuts, milk, sausages, cheese, egg yolk, seeds and even lean meats (about 6% of the total fat remains). FATTY ACIDS  An organic compound composed of a carbon chain with hydrogen attached and an acid group (COOH) at one end and a methyl group (CH3) at the other end.  Like CHO, fatty acids and triglycerides are composed of C, H and O. They differ from CHO in that they contain much less oxygen and much grater proportions of carbon. Classifications of Fatty Acids 1. Saturated - a fatty acid carrying the maximum possible number of hydrogen atoms – for example, stearic acid. A ___________ fat is composed of triglycerides in which most of the fatty acids are saturated. 2. ___________________ - a fatty acid that lacks hydrogen atoms and has at least one double bond between carbons. An _________________ fat is composed of triglycerides in which most of the fatty acids are unsaturated. 17

a. _____________________ - a fatty acid that lacks 2 hydrogen atoms and has 1 double bond between carbons – for example oleic acid. A ________________ fat is composed of triglycerides in which most of the fatty acids are monounsaturated. b. ____________________ - a fatty acid that lacks four or more hydrogen atoms and has two or more double bonds between carbons – for example, linoleic acid & linolenic acid. A ________________ fat is composed of triglycerides in which most of the fatty acids are polyunsaturated. Depending on the location of the double bonds, this may be: A1. ____________________ - first double bond 3 Carbons away from methyl end. A2. ____________________ - first double bond 6 carbons away from methyl end. OILS  It is a lipid that is liquid at room temperature (250C).

2. Phospholipids  A compound similar to a triglyceride but having a phosphate group (a phosphorus-containing salt) and choline (another nitrogen-containing compound) in place of one of the fatty acid.  The best-known phospholipid is lecithin.  Lecithin is used as an emulsifier to combine water-soluble and fat-soluble ingredients that do not ordinarily mix, such as water and oil.  The lecithins and other phospholipids are important constituents of cell membranes. 3. Sterols  Compounds containing a four-carbon ring structure with any of a variety of side chains attached.  The most famous sterol is cholesterol.  2 Types of Cholesterol a. _______________ - a.k.a high density lipoprotein (HDL), type of lipoprotein that transports cholesterol back to the liver from the cells; composed primarily of protein. b. _______________ - a.k.a low density lipoprotein (LDL), a type of protein derived from very low density lipoproteins (VLDL) as VLDL triglycerides are removed and broken down; It carries cholesterol back to the cells of all tissues. Composed primarily of cholesterol. FOOD SOURCES  Saturated Fatty Acids: mainly found in animal fats like butter, palm oil, coconut oil, beef, lard, meats, bacon & sausages, dairy fats, organ meats, milk & milk products, egg yolk  Monounsaturated fatty acids: are abundant in peanuts and peanut oil, pecans, canola oil, olive oil, avocado, and chicken fat.  Polyunsaturated fatty acids: - Omega-3 = are plenty in fresh tuna, pink salmon, king crab, cod liver oil, salmon oil, mackerel and herring - Omega-6 = are found mainly in corn oil, sunflower oil, cottonseed oil, soya oil.  Cholesterol-rich foods: high in egg yolk, internal organs of meat, sweetbreads, mayonnaise  Foods with moderate amount of cholesterol: crabs, lobster, shrimp, fats on meats, tinned or powdered milk, biscuits, butter, cheese, most commercial cakes, pastries, ice cream  Cholesterol-free foods: all types of vegetables, all vegetables oils, fruits including avocado and olives, pasta (without eggs), nuts, cereals, and unbuttered popcorn. FUNCTIONS OF FATS  Provides essential fatty acids  Contributes to feeling of fullness, taste and smell 18

     

Dietary fat serves as conveyor for vitamins A, D,E, and K Energy reserve and emergency fuel Regulator of body functions Insulator Protector Cell structure

RECOMMENDED INTAKE OF FATS (RDA)  American diet: ___ to ___ percent of the daily total calorie intake  Filipino diet: ____ to ___ percent per day for infants and ___ to ____ % per day for all others.  SFA: <10% of daily energy intake  MUFA: 10-15% of energy intake  PUFA: < 10% of energy intake  Cholesterol: no more than 300 milligrams per day is ideal. HEALTH EFFECTS of FATS  Heart Disease (good and bad)  Cancer  Obesity  Fat-soluble vitamin deficiency LIPID DIGESTION, ABSORPTION AND TRANSPORT DIGESTION The digestion of fats begins in small intestine. The fats are emulsified to form CHYME. When the chyme enters duodenum, it stimulates the release of ENTEROGASTRONE. This hormone reduces the motility and stabilizes the flow of chyme in order to correspond to the availability of pancreatic secretions. The presence of fat in duodenum also stimulates the intestinal wall to secrete CHOLECYSTOKININ hormone which stimulates the contraction of gallbladder pouring bile into the small intestine after passing through common bile duct. ABSORPTION Most of the absorption of fat occurs in jejunum. TRANSPORT Lipoproteins – clusters of lipids associated with proteins that serve as transport vehicles for lipids in the lymph and blood. 4 Main Types of Lipoproteins 1. ____________________ - the class of lipoproteins that transports lipids from the intestinal cells to the rest of the body. 2. ____________________ - the type of lipoprotein made primarily by the liver cells to transport lipids to various tissues in the body; composed primarily of triglycerides. 3. ____________________ - the type of lipoprotein derived from VLDL as VLDL triglycerides are removed and broken down; composed primarily of cholesterol. 4. ____________________ - the type of lipoprotein that transports cholesterol back to the liver from cells; composed primarily of protein.

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Prepared by: Romeo C. Tuazon Jr. RN

LECTURE V E. MINERALS are Inorganic elements. Because the body cannot synthesize them, they have to be provided in the diet. About 1% to 6% of body weight is mineral. Because minerals are inorganic, they are indestructible and need not be handled with the special care that vitamins require.  They give no caloric value and remain as ash when completely burnt.     Classification of Minerals 1. MAJOR MINERALS  Essential mineral nutrients found in the human body in amounts larger than 5g.  They are so named because they are present, and needed, in larger amounts in the body. MINERAL & CHIEF FUNCTIONS SODIUM Maintains normal fluid & electrolyte balance; assist in nerve impulse transmission & muscle contraction CHLORIDE Maintains normal fluid and electrolyte balance; part of HCL found in stomach, necessary for proper digestion POTASSIUM Maintains normal fluid and electrolyte balance; facilitates many reactions; supports cell integrity; assist in nerve impulse transmission DEFICIENCY Muscle cramps, mental apathy, loss of appetite TOXICITY Edema, acute hypertension SOURCES Table salt, soy sauce; moderate amounts in meats, milks, breads and vegetables; large amounts in processed foods Table salt, soy sauce; moderate amounts in meats, milks, eggs; large amounts in processed foods All whole foods; meats, milks, fruits, vegetables, grains, legumes

Do not occur under normal circumstances

Vomiting

Muscle weakness, paralysis, confusion

Muscular weakness; vomiting; if given into a vein – can stop the heart

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and muscle contractions CALCIUM Mineralization of bones & teeth; also involved in muscle contraction & relaxation, nerve functioning, blood clotting, BP, immune defenses PHOSPHORUS Mineralization of bones and teeth; part of every cell; important in genetic material, part of phospholipids, used in energy transfer and in buffer systems that maintain acid-base balance MAGNESIUM Bone mineralization, building of protein, enzyme action, normal muscle contraction, nerve impulse transmission, maintenance of teeth, and functioning of immune system SULFUR As part of proteins, stabilizes their shape by forming disulfide bridges; part of the vitamins biotin and thiamin and the hormone insulin

Stunted growth in children; bone loss (osteoporosis) in adults and (osteomalacia) in pedia. Tetany

Constipation; increased risk of urinary stone formation & kidney dysfunction; interference with absorption of other minerals Calcification of nonskeletal tissues, particularly the kidneys.

Milk & milk products, small fish (with bones), tofu, greens (broccoli), legumes.

Muscular weakness, bone pain

All animal tissues (meat, fish, poultry, eggs, milk).

Weakness, confusion; if extreme, convulsions, bizarre muscle movements (especially of eye and facial muscles), hallucinations, and difficulty in swallowing and children, growth failure None known; protein deficiency would occur first

From nonfood sources only; diarrhea, alkalosis, dehydration

Nuts, legumes, whole grains, dark green vegetables, seafood, chocolate, cocoa

Toxicity would occur only if sulfurcontaining amino acids were eaten in excess; this (in animals) depresses growth

All protein-containing foods (meat, fish, poultry, eggs, milk, legumes, nuts)

Safe Upper Limit of Major Minerals for Adults (19-70 years old)       Calcium – 2500mg Phosphorus – 3000 mg (>70) and 4000 mg (<70) Sodium – 2400 mg (recommended maximum intake) Magnesium – 350 mg Chloride – not known Potassium – 4500 mg

Absorption Inhibitors of Major Minerals Many factors affect the availability of minerals for body absorption. Such factors may include drugs and certain food or its component.  Calcium – high phosphorus, salt, or protein intake; alcohol, oxalic acid, phytic acid, some laxatives, some diuretics, some antibiotics and large doses of B complex pills  Magnesium – alcohol, diuretics, calcium carbonate and antacid.  Phosphorus – excess magnesium and aluminum, aluminum and magnesium-containing antacids  Sodium – some diuretics and anti-gout drugs  Potassium – excess sodium intake, alcohol, coffee, some diuretics and anti-gout drugs 21

2. TRACE MINERALS  Essential mineral nutrients found in the human body in amounts smaller than 5g.  They are so named because they are present, and needed, in relatively small amounts in the body. MINERAL & CHIEF FUNCTIONS IRON Part of the protein hemoglobin, which carries oxygen in the blood; part of the protein myoglobin in muscles, which makes oxygen available for muscle contraction; necessary for energy metabolism ZINC Part of insulin and many enzymes; involved in making genetic material and proteins, immune reactions, transport of Vit. A, taste perception, wound healing, the making of sperm, & normal fetal development IODINE A component of the thyroid hormones that help to regulate growth, development, and metabolic rate SELENIUM Part of an enzyme that defends against oxidation; regulates thyroid hormone COPPER Helps form hemoglobin; part of several enzymes MANGANESE Cofactor for several enzymes FLUORIDE Helps form bones and teeth; confers decay resistance on teeth CHROMIUM Enhances insulin action rMOLYBDENUM DEFICIENCY Anemia; weakness, fatigue, headaches; impaired work performance; impaired immunity; pale skin, nail beds, mucous membranes, and palm creases; concave nails; inability to regulate body temperature, pica Growth retardation, delayed sexual maturation, impaired immune function, hair loss, eye and skin lesions, loss of appetite TOXICITY GI distress; iron overload: infections, fatigue, joint pain, skin pigmentation, organ damage SOURCES Read meats, fish, poultry, shellfish, eggs, legumes, dried fruits

Loss of appetite, impaired immunity, low HDL, copper and iron deficiencies

Protein-containing foods: red meats, fish, shellfish, poultry, whole grains

Underactive thyroid Underactive thyroid gland, goiter, mental gland, elevated TSH, and physical retardation goiter (cretinism) Associated with Keshan Nail and hair brittleness disease and loss; fatigue; irritability and nervous system disorders, skin rash, garlic breath odor Anemia, bone Liver damage abnormalities

Iodized salt; seafood; plants grow in iodinerich soil and animals fed those plants Seafood, organ meats; other meats, whole grains, and vegetables (depending on soil content) Seafood, nuts, legumes, whole grains, seeds

Rare Susceptibility to tooth decay Diabetes-like condition Unknown

Nervous symptom disorders Fluorosis (pitting and discoloration) of teeth None reported None reported

Nuts, whole grains, leafy vegetables, tea Drinking water if fluoride containing or fluoridated, tea, seafood Meats (liver), whole grains, brewer’s yeast Legumes, cereals, 22

Cofactor for several enzymes

organ meats

Safe Upper Limit of Trace Minerals for Adults (19-70 years old)  Iron – 65 mg  Chromium – 1000 mcg  Iodine – 1000 mcg  Fluoride – 10 mg  Copper – 9 mg  Manganese – 700 mg  Selenium – 200 mcg  Zinc – 30 mg Absorption Inhibitors of Trace Minerals  Iron – phytates (found in seeds, nuts, and grains), large quantities of tea/coffee, calcium supplements, aspirin, narcotics (codeine, morphine), and anti-gout drugs.  Zinc – alcohol, some diuretics, contraceptive pill, hormone replacement therapy, phytates, large amounts of coffee/tea, diet high in iron, and iron supplements  Copper – high zinc diet, zinc supplements, high intake of iron, manganese, molybdenum, and vitamin C, and antacids  Iodine – goitrogenic substances in foods (turnips, cabbage, cassava, and Brussels’s sprouts) Prepared by: Roderick C. Magpantay

NUTRITION ASSESSMENT  A comprehensive analysis of a person’s nutrition status that uses health, socioeconomic, drug, and diet histories; anthropometric measurements; physical examinations; and laboratory tests. Malnutrition – any condition caused by excess or deficient food energy or nutrient intake or by an imbalance of nutrients. 2 Types of Malnutrition 1. ____________________ - deficient energy or nutrients. 2. ____________________ - excess energy or nutrients. A. Historical Information 1. _______________________  Reflects a person’s medical record and may reveal a disease that interferes with the person’s ability to eat or the body’s use of nutrients.  The person’s family history of major diseases is also noteworthy, especially for conditions such as heart disease that have a genetic tendency to run in families.  Ex: current and previous health problems and family health history that affect nutrient needs, nutrition status, or the need for intervention to prevent health problems. 2. _______________________  A record of a person’s social and economic background, including such factors as education, income and ethnic identity.  Ex: personal, cultural, financial, and environmental influences on food intake, nutrient needs, and diet therapy options. 3. _______________________  A record of ell the drugs, over-the-counter and prescribed, that a person takes routinely.  Ex: medications, illicit drugs, dietary supplements, and alternative therapies that affect nutrition status. 23

4. _______________________  A record of eating behaviors and the foods a person eats.  Ex: Nutrient intake excesses or deficiencies and reasons for imbalances.  24-hour recall: a record of foods eaten by a person for one 24-hour period. B. Anthropometric Measurements  Are physical measurements that reflect body composition and development. 1. _______________________  Reflects abdominal fluid retention and abdominal organ size. 2. _______________________  Reflects over nutrition and under nutrition; growth in children 3. _______________________  Reflects brain growth and development in infants and children under age two. 4. _______________________  Reflects subcutaneous and total body fat. 5. _______________________  Reflects body fat distribution

C. Physical Examination  Used to search for signs of nutrient deficiency or toxicity.  Many physical signs are nonspecific; they can reflect any of several nutrient deficiencies as well as conditions not related to nutrition. BODY SYSTEM ACCEPTABLE FINDINGS Shiny, firm in the scalp Bright, clear pink membranes; adjust easily to light No pain or caries, gums firm, teeth bright Clear complexion without dryness or scaliness No lumps Red, bumpy, rough Smooth, firm, good color Firm, pink Regular heart rhythm, heart rate, and blood MALNUTRITION FINDINGS Dull, brittle, dry, loose; falls out Pale membrane; spots; redness; adjust slowly to darkness Missing, discolored, decayed teeth; gums bleed easily and are swollen and spongy Off-color, scaly, flaky, cracked skin Swollen at front of neck Sore, smooth, purplish, swollen Dry, rough, spotty. “sandpaper” feel or sores; lack of fat under skin Spoon-shaped, brittle, ridged, pale Abnormal heart rate, heart rhythm, or blood PEM Vitamin A, B, zinc and iron status Mineral and vitamin C status PEM, vitamin A and iron status PEM and iodine status Vitamin B status PEM, essential fatty acid, Vitamin A, B, and C status Iron status PEM and mineral status 24 WHAT THE FINDINGS REFLECT

pressure; no impairment of digestive function, reflexes, or mental status

Muscle tone; posture, long bone development appropriate for age

pressure; enlarged liver, spleen; abnormal digestion; burning, tingling of hands, feet; loss of balance, coordination; mental confusion, irritability and fatigue “wasted” appearance of PEM, mineral, and muscles; swollen vitamin D status bumps on skull or ends of bones; small bumps on ribs; bowed legs or knock knees

D. Laboratory Tests  It confirms suspicions raised by other assessment methods.  Taking samples of blood or urine, analyze them in the laboratory, and compare the results with normal values for a similar population.

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