PUROC, LIZA M.

BSN II

1. NUTRITION AND INTERVENTION

a. Food and Nutrient Delivery

b. Food Administration
 Oral Nutrition

Oral nutritional supplements (ONS) are nutrition support products that provide an effective
and non-invasive way for people to meet their nutrition needs or increase their nutritional intake.
People who take ONS may also be able to eat regular food but cannot meet all their nutritional
requirements through a regular diet alone and thus require supplemental nutrition. In other
instances, a patient can benefit from ONS if they require a liquid-based diet. ONS products are often
prescribed or recommended by a physician or registered dietitian. In some cases, people rely on
ONS as their sole source of nutrition.

 Enteral Nutrition

A way to provide food through a tube placed in the nose, the stomach, or the small intestine.
A tube in the nose is called a nasogastric tube or nasoenteral tube. A tube that goes through the
skin into the stomach is called a gastrostomy. It may be placed there using a technique
called percutaneous endoscopic gastrostomy. (PEG). A tube into the small intestine is called a
jejunostomy. It may be placed there using a technique called percutaneous endoscopic jejunostomy
(PEJ).

Some of the more common underlying reasons for enteral feeding include:

- a stroke, which may impair ability to swallow

- cancer, which may cause fatigue, nausea, and vomiting that make it difficult to eat

- critical illness or injury, which reduces energy or ability to eat

- failure to thrive or inability to eat in young children or infants
- serious illness, which places the body in a state of stress, making it difficult to take in
enough nutrients
- neurological or movement disorders that increase caloric requirements while making it
more difficult to eat
- GI dysfunction or disease, although this may require intravenous (IV) nutrition instead

The main types of enteral feeding tubes include:

- Nasogastric tube (NGT) starts in the nose and ends in the stomach.

- Orogastric tube (OGT) starts in the mouth and ends in the stomach.
- Nasoenteric tube starts in the nose and ends in the intestines (subtypes include nasojejunal
and nasoduodenal tubes).
- Oroenteric tube starts in the mouth and ends in the intestines.
 - Gastrostomy tube is placed through the skin of the abdomen straight to the stomach
(subtypes include PEG, PRG, and button tubes).
- Jejunostomy tube is placed through the skin of the abdomen straight into the intestines
(subtypes include PEJ and PRJ tubes).

There are some complications that can occur as a result of enteral feeding. Some of the most
common include:

- aspiration, which is food going into the lungs

- refeeding syndrome, dangerous electrolyte imbalances that may occur in people who are
very malnourished and start receiving enteral feeds
- infection of the tube or insertion site
- nausea and vomiting that may result from feeds that are too large or fast, or from slowed
emptying of the stomach
- skin irritation at the tube insertion site
- diarrhea due to a liquid diet or possibly medications
- tube dislodgement
- tube blockage, which may occur if not flushed properly
 Short Term Enteral Access
Short-term enteral access feeding tubes are mostly placed when in EN is expected to be of
less than 30 days in duration. Pre-pyloric tubes or nasogastric tubes are the most frequent type of
tubes used for short-term enteral feeding.
 Nasogastric tube (NG)
- NG tube placement
- Transnasal endoscopic tube placement
o Per oral endoscopic NG tube placement
o Transnasal endoscopic NG tube placement
 Nasoenteral tube (NET)
- Non-endoscopic post-pyloric tube placement
- Post-pyloric endoscopic post-pyloric tube placement
- Transnasal endoscopic post-pyloric tube placement
- Double-lumen nasoenteral tube
 Long Term Enteral Access

Long-term enteral access feeding requires establishment of permanent access to the stomach
or small bowel. The best way of doing this is normally by introducing a percutaneous endoscopic
gastrostomy (PEG) tube.

Long-term enteral feeding approach:

- Percutaneous endoscopic gastrostomy (PEG)

- Radiological or sonographical guided gastrostomy (PSG or RIG)
- Surgical gastrostomy (Stamm or Witzel fistula)
- Jejunal extended PEG (PEG-1)
- Direct percutaneous endoscopic endoscopicjejunostomy (D-PEJ)
 - Surgical jejunostomy (direct or fine needle catheter jejuostomy)
 Parenteral Nutrition
- Parenteral nutrition, often called total parenteral nutrition, is the medical term for infusing a
specialized form of food through a vein (intravenously). The goal of the treatment is to correct or
prevent malnutrition.
- Parenteral nutrition provides liquid nutrients, including carbohydrates, proteins, fats, vitamins,
minerals and electrolytes. Some people use parenteral nutrition to supplement feeding through a
tube placed into the stomach or small bowel (enteral nutrition), and others use it by itself.
- People whose digestive systems either can't absorb or can't tolerate adequate food eaten by
mouth use parenteral nutrition. When used outside the hospital, intravenous feeding is called
home parenteral nutrition. Using home parenteral nutrition may be necessary for weeks or
months, or in some cases for life.

You may need parenteral nutrition for one of the following reasons:

- Cancer. Cancer of the digestive tract may cause an obstruction of the bowels, preventing
adequate food intake. Cancer treatment, such as chemotherapy, may cause your body to poorly
absorb nutrients.

- Crohn's disease. Crohn's disease is an inflammatory disease of the bowel that may cause pain,
bowel narrowing and other symptoms that affect food intake and its digestion and absorption.

- Short bowel syndrome. In this condition, which can be present at birth or occur as the result
of surgery that has removed a significant amount of small intestine, you don't have enough
bowel to absorb enough of the nutrients you eat.

- Ischemic bowel disease. This may cause difficulties resulting from reduced blood flow to the
bowel.

- Abnormal bowel function. This causes food you eat to have trouble moving through your
intestines, resulting in a variety of symptoms that prevent enough food intake. Abnormal bowel
function can occur due to surgical adhesions or abnormalities in bowel motility. These may be
caused by radiation enteritis, neurological disorders and many other conditions.

2. MONITORING NUTRITIONAL STATUS

a. Strategies to Address Age-related Affecting Nutrition

AGE RELATED NURSING STRATEGIES

CHANGES
Altered ability to chew -Encourage and instruct patient to care for and retain own teeth and
related to loss of teeth, dentures.
ill-fitting dentures, and -Encourage proper tooth brushing and use of special toothpaste if gums and
gingivitis teeth are sensitive.
-Chop, shred, or puree foods that are difficult to chew.
-Select ground meat, fish, or poultry as protein sources more easily chewed.
Loss of Senses of smell -Serve food that is attractive and at proper temperature.
and taste -Serve one food at a time rather than mixing foods.
 -Serve foods with different textures and aromas.
Decreased peristalsis in -Avoid cold liquids.
the esophagus -Avoid emotional upsets and stress-producing situations.
-Take anticholinergic drugs as ordered by physician.
Gastroesophageal -Avoid overeating.
reflux -Avoid juices, chocolate, and fat.
-Avoid alcohol and smoking.
-Elevate the head of the bed 30 to 40 degrees when sleeping.
-Lose weight if necessary.
-Avoid bending over.
-Take antacids or other medications as ordered by physician.
-Avoid eating right before bed.

Decreased gastric -Chew food thoroughly.

secretions -Eat meals on a regular schedule.
-Use antacids or other medications as prescribed by physician.
-Be alert for symptoms of deficiency of nutrients, particularly iron, calcium,
fat, protein, and vitamin B12.
Lowered glucose -Eat more complex carbohydrates.
tolerance -Avoid sugar-rich foods.
Reduction in appetite -Offer fluids at regular intervals and at preferred temperature.
and thirst sensation -Be alert for symptoms of dehydration and electrolyte imbalance.
-Offer small meals at frequent intervals.
Nutritional deficiencies -Encourage diet high in protein and carbohydrates.
related to alcohol -Offer small, frequent meals to maintain calorie intake.
intake -Restrict sodium and fluids if enema is present.
-Take multivitamin supplements, as ordered by physician.
Loss of appetite -Promote mealtime as a social event.
associated with -Set an attractive table in a pleasant setting.
depression and -Eat outdoors whenever possible.
loneliness -Invite guests as often as possible.
-Participate in special programs for senior citizens.
Physical handicaps -Open cartons and assist with setup of meal.
-Arrange for home-delivered meals.
-Conserve energy when preparing meals (sit on a stool, etc.).
-Provide transportation and assistance to obtain food.
Malnutrition -Eat essential foods first.
-Select nutrient-dense foods.
-Monitor for signs of nutritional deficiencies.
-Encourage eating by planning special events.

Increased risk for drug- -Avoid unnecessary drugs; monitor for poly pharmacy.
nutrient interactions -Be aware of drug actions and interactions.
-Check with pharmacist to determine if medication may or may not be taken
with food.
-Assess for confusion and inability to manage medication regimen.
 b. Selected Therapeutic Diets

Therapeutic Diet
A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. It is
part of the treatment of a medical condition and are normally prescribed by a physician and
planned by a dietician. A therapeutic diet is usually a modification of a regular diet.

Selected Therapeutic Diet:

1. Therapeutic Lifestyle Changes (TLC)

The lifestyle changes include diet, exercise, weight loss, and other changes. Your doctor will
want you to follow TLC even if you are taking cholesterol-lowering medicine. And medicine will be
more effective if you have healthy eating and exercise habits.

 Diet. Diets to lower cholesterol are low in fat—especially saturated fat—and cholesterol. One of
the best things you can do is reduce the amount of saturated fat you eat.
 Exercise. You may need to change your exercise habits. Regular exercise, or no exercise, affects
your cholesterol level and your overall heart health. People who have an active lifestyle have a
lower risk for Coronary Artery Disease than do people who have a sedentary lifestyle.
 Weight loss. Excess weight tends to increase your LDL cholesterol level. Losing just 5 to 10
pounds (2.3 to 4.5 kilograms) can lower your cholesterol and triglyceride levels. Eating a diet low
in saturated fat and cholesterol, exercising regularly, and cutting calories will help you lose
weight.
 Other lifestyle changes to think about. There are a number of other lifestyle changes that
improve cholesterol levels, reduce your risk of atherosclerosis, and improve your general health.
- Stop smoking cigarettes. Cigarette smoking is the leading preventable cause of death.
Smoking decreases your HDL ("good") cholesterol. Smoking is believed to change LDL
cholesterol to a form that promotes the buildup of deposits in the walls of your coronary
arteries. Smoking significantly increases your overall chances of developing heart disease,
because it damages your heart and blood vessels.
- Reduce stress. Try to minimize stressful situations as much as possible at work, at home,
and elsewhere. You may also ask your doctor for advice on ways to reduce stress.

2. Diabetic diet

A diabetes diet is based on eating three meals a day at regular times. This helps you better
use the insulin that your body produces or gets through a medication.

Recommended foods:
A. Healthy carbohydrates
During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates)
break down into blood glucose. Focus on healthy carbohydrates, such as:
 Fruits
 Vegetables
  Whole grains
 Legumes, such as beans and peas
 Low-fat dairy products, such as milk and cheese

B. Fiber-rich foods
Dietary fiber includes all parts of plant foods that your body can't digest or absorb.
Fiber moderates how your body digests and helps control blood sugar levels. Foods high in fiber
include:
 Vegetables
 Fruits
 Nuts
 Legumes, such as beans and peas
 Whole grains

C. Heart-healthy fish
Eat heart-healthy fish at least twice a week. Fish such as salmon, mackerel, tuna and
sardines are rich in omega-3 fatty acids, which may prevent heart disease.
D. Good' fats
Foods containing monounsaturated and polyunsaturated fats can help lower your
cholesterol levels. These include:
 Avocados
 Nuts
 Canola, olive and peanut oils

3. DASH (Dietary Approaches to Stop Hypertension) Diet

The DASH diet is a lifelong approach to healthy eating that's designed to help treat or prevent
high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet
and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium
and magnesium.
What to eat:
 Grains: 6 to 8 servings a day
 Vegetables: 4 to 5 servings a day
 Fruits: 4 to 5 servings a day
 Dairy: 2 to 3 servings a day
 Lean meat, poultry and fish: 6 one-ounce or fewer a day
 Nuts, seeds and legumes: 4 to 5 servings a week
 Fats and oils: 2 to 3 servings a day
 Sweets: 5 servings or fewer a week
4. Bland Diet
A bland diet is made up of foods that are soft, not very spicy, and low in fiber. If
you’re on a bland diet, you shouldn’t eat spicy, fried, or raw foods. Avoid alcohol or caffeinated
drinks. A bland diet can be used to treat ulcers, heartburn, nausea, vomiting and gas. You may also
need to eat bland foods after stomach or intestinal surgery.

Foods to Eat Foods to Avoid

  Milk and other dairy products, low-fat only
 Cooked, canned, or frozen vegetables
 Fruit and vegetable juices
 Cooked or canned fruit with the skin and
seeds removed, such as applesauce or
canned peaches
 Breads, crackers and pasta made with
refined white flour
 Refined hot cereals, such as oatmeal and
cream of wheat
 Lean, tender meats, such as poultry,
whitefish, and shellfish that are steamed,
baked, or grilled with no added fat
 Creamy peanut butter
 Pudding and custard
 Eggs
 Tofu
 Soup, especially broth
 Weak tea
 Fatty dairy foods, such as whipped cream
or high-fat ice cream
 Strong cheeses, such as bleu or Roquefort
 Raw vegetables
 Vegetables that make you gassy, such as
broccoli, cabbage, cauliflower, cucumber,
green peppers and corn
 Fresh berries and other fresh fruit
 Dried fruit
 Whole-grain or bran cereals
 Whole-grain breads, crackers, or pasta
 Pickles, sauerkraut, and similar foods
 Spices, such as hot pepper and garlic
 Foods with a lot of sugar or honey in them
 Seeds and nuts
 Highly seasoned cured or smoked meats
and fish
 Fried foods

5. Vegetable Diet
The vegetarian diet involves abstaining from eating meat, fish and poultry. People often adopt
a vegetarian diet for religious or personal reasons, as well as ethical issues, such as animal rights.
Others decide to become vegetarian for environmental reasons, as livestock production increases
greenhouse gas emissions, contributes to climate change and requires large amounts of water, energy
and natural resources.
There are several forms of vegetarianism, each of which differs in their restrictions.

The most common types include:

 Lacto-ovo-vegetarian diet: Eliminates meat, fish and poultry but allows eggs and dairy products.
 Lacto-vegetarian diet: Eliminates meat, fish, poultry and eggs but allows dairy products.
 Ovo-vegetarian diet: Eliminates meat, fish, poultry and dairy products but allows eggs.
 Pescetarian diet: Eliminates meat and poultry but allows fish and sometimes eggs and dairy
products.
 Vegan diet: Eliminates meat, fish, poultry, eggs and dairy products, as well as other animal-
derived products, such as honey.
 Flexitarian diet: A mostly vegetarian diet that incorporates occasional meat, fish or poultry.

Health Benefits:
- May enhance weight loss.
- May reduce cancer risk.
- May stabilize blood sugar.
- Promotes heart health.
6. Fruit Diet
The fruitarian, or fruit, diet is a highly restrictive vegan diet. It excludes all animal products,
including dairy. People following this program eat a diet consisting primarily of raw fruits.
 Vegetables, dried fruits, nuts, and seeds can also be eaten in moderation.
Other types of food, such as grains, legumes, and tubers, are severely limited or eliminated
completely. Cooked food of any kind, including cooked fruit, is avoided.

Benefits:
 Fruits contain fiber, which can help lower your cholesterol and encourage regular bowel
movements. Apples, pears, blackberries, and raspberries are examples of fruits high in dietary
fiber.
 Oranges, red peppers, and strawberries are examples of fruits that contain lots of vitamin C.
This helps keep teeth and gums healthy. Vitamin C also supports the immune system.
 Bananas, guavas, cantaloupe, and mangos are examples of fruits higher in potassium.
Potassium can help maintain a healthy blood pressure and regulate fluid balance in the body.
 Oranges and tropical fruits such as mangos are high in folate. This can help the body produce
red blood cells. Folate also supports healthy fetal development. Black plums, prunes, and all
berries are examples of fruits rich in antioxidants. Antioxidants limit the production of free
radicals. They can protect your skin and fight off illness.

7. Lean Meats
Lean meat is a good source of protein with a lower fat content and therefore a lower calorie
content. It is generally regarded as a safe source of protein there have been some concerns about
antibiotic use in poultry farms.
Lean meats are meats with a relatively low fat content. Skinless chicken and turkey and red meat, such
as pork chops, with the fat trimmed off are examples of lean meat.

Health benefits of lean meat:

 Lean meats are a good source of protein and have fewer calories than non-lean meats.
 Lean meats are popular amongst people following low calorie and low fat diets

Fish Diet:
A pescatarian is someone who doesn't eat meat, but does eat fish. The term pescatarian was
coined in the early 1990s and is a combination of the Italian word for fish, "pesce," and the word
"vegetarian." Sometimes it's spelled "pescetarian," but this means the same thing. This diet is often
described as "pesco-vegetarian," and is lumped into the spectrum of vegetarianism
A pescatarian is someone who chooses to eat a vegetarian diet, but who also eats fish and other
seafood.

Pescatarians Do Eat Pescatarians Don't Eat

 Whole grains and grain products  Beef
 Legumes and their products, including beans,  Chicken
lentils, tofu and hummus  Pork
 Nuts and nut butters, peanuts and seeds  Lamb
 Seeds, including hemp, chia and flaxseeds  Turkey
 Dairy, including yogurt, milk and cheese  Wild game
 Fruits
 Vegetables
 Fish and shellfish
 Eggs
8. Dairy diet
Taking low fat dairy everyday contains of important vitamins and minerals like calcium,
Vitamin D, Vitamin B, and protein. Your body digests dairy the same way it digests other foods unless
you are intolerant to its main sugar, lactose. Dairy products that contain probiotics may help boost
your health and even make it easier to eat more dairy.

9. Breads and Other Carbohydrates Sources

The amount of carbohydrate in the diet- high or low- is less important than the type of
carbohydrate in the diet. Carbohydrates are found in a wide array of both healthy and unhealthy
foods—bread, beans, milk, popcorn, potatoes, cookies, spaghetti, soft drinks, corn, and cherry pie.
They also come in a variety of forms. The most common and abundant forms are sugars, fibers, and
starches.
Foods high in carbohydrates are an important part of a healthy diet. Carbohydrates provide
the body with glucose, which is converted to energy used to support bodily functions and physical
activity. But carbohydrate quality is important; some types of carbohydrate-rich foods are better than
others:
 The healthiest sources of carbohydrates—unprocessed or minimally processed whole grains,
vegetables, fruits and beans—promote good health by delivering vitamins, minerals, fiber, and
a host of important phytonutrients.
 Unhealthier sources of carbohydrates include white bread, pastries, sodas, and other highly
processed or refined foods.  These items contain easily digested carbohydrates that may
contribute to weight gain, interfere with weight loss, and promote diabetes and heart disease.
10. Soft Diet
A soft foods diet is one of the only diets that will encourage you to eat low-fiber foods
and refined, processed carbohydrates.
A soft foods diet is sometimes advised when you’ve had a medical procedure that affects your
digestive tract.
Common medical conditions that might be helped by a soft foods diet include:
 gastroenteritis
 diverticulitis
 inflammatory bowel disease (IBD) flare-ups

Foods to Eat Foods to Avoid

 pureed fruit (such as applesauce)  whole-wheat and whole-grain
 canned fish and canned poultry breads
 fruit juice and vegetable juice  raw vegetables, especially broccoli,
 white rice cauliflower, and carrots
 egg noodles  beans and nuts, including peanuts
 white bread  brown and wild rice
 mashed potatoes  berries
 bananas  high-fiber and fiber-enriched
 mangoes cereals
 avocados  carbonated beverages (such as
  cottage cheese soda and seltzer)
 tea

11. Liquid Diet

A liquid diet consists only of liquids instead of solid food. This includes homemade or store-
bought juices and smoothies, homemade protein shakes, premade protein shakes and store-bought
liquid meal replacements. You can replace all meals and snacks with liquids or do a partial liquid diet,
eating some solid foods as well. The more popular reasons for a liquid diet are weight loss and
"detoxes."

Benefits of Liquid Diet:

 Liquid diets can help you lose weight—at least in the short term.
 The benefits of a juice cleanse are increased vitamin, mineral and antioxidant intake
because of the amount of fruits and vegetables it takes to extract the juice
 Short-term weight loss
 Increased nutrient intake
 Convenient, portion-controlled meal option

12. Diet as Tolerated (DAT)

This particular diet is only giver when client can now tolerate any food she desires that is
nutritious, if this will not lead to any complications and if the client needs further monitoring for lab
test. Diet as tolerated is usually advised in relation to surgery. Once a surgical procedure is complete,
individuals are given only liquids, such as water. The diet progresses to solid foods in the form of
purees, chunks and finally a regular diet. Diet as tolerated is a term that indicates that the
gastrointestinal tracts is tolerating food and is ready for advancement to the next stage. Therefore,
this is most applicably in regard to the diet after throat, abdominal or gastrointestinal surgery,
signifying the patient’s tolerance of his diet.

13. Low Salt Diet

Sodium is an essential mineral involved in many important bodily functions, including cellular
function, fluid regulation, electrolyte balance and maintaining blood pressure. Because this mineral is
vital to life, your kidneys tightly regulate its levels based on the concentration (osmolarity) of bodily
fluids. Sodium is found in most foods you eat — though whole foods like vegetables, fruits and
poultry contain much lower amounts.
Plant-based foods like fresh produce generally have less sodium than animal-based foods, such as
meat and dairy products. Sodium is most concentrated in processed and packaged foods like chips,
frozen dinners and fast food where salt is added during processing to enhance flavor.
Another major contributor to sodium intake is adding salt to food when preparing meals in
your kitchen and as a seasoning before eating. A low-sodium diet limits high-sodium foods and
beverages. Healthcare professions typically recommend these diets to treat conditions such as high
blood pressure or heart disease.

14. Low Fat Diet

 A low-fat diet is an eating plan that is low in total fat, unhealthy fat, and cholesterol.
You may need to follow a low-fat diet if you have trouble digesting or absorbing fat. You may also
need to follow this diet if you have high cholesterol. You can also lower your cholesterol by
increasing the amount of fiber in your diet. Soluble fiber is a type of fiber that helps to decrease
cholesterol levels.

Foods to Limit or Avoid:

 Grains:
o Snacks that are made with partially hydrogenated oils, such as chips, regular crackers,
and butter-flavored popcorn
o High-fat baked goods, such as biscuits, croissants, doughnuts, pies, cookies, and
pastries
 Dairy:
o Whole milk, 2% milk, and yogurt and ice cream made with whole milk
o Half and half creamer, heavy cream, and whipping cream
o Cheese, cream cheese, and sour cream
 Meats and proteins:
o High-fat cuts of meat (T-bone steak, regular hamburger, and ribs)
o Fried meat, poultry (turkey and chicken), and fish
o Poultry (chicken and turkey) with skin
o Cold cuts (salami or bologna), hot dogs, bacon, and sausage
o Whole eggs and egg yolks
 Vegetables and fruits with added fat:
o Fried vegetables or vegetables in butter or high-fat sauces, such as cream or cheese
sauces
o Fried fruit or fruit served with butter or cream
 Fats:
o Butter, stick margarine, and shortening
o Coconut, palm oil, and palm kernel oil
Foods to Include:
 Grains:
o Whole-grain breads, cereals, pasta, and brown rice
o Low-fat crackers and pretzels
 Vegetables and fruits:
o Fresh, frozen, or canned vegetables (no salt or low-sodium)
o Fresh, frozen, dried, or canned fruit (canned in light syrup or fruit juice)
o Avocado
 Low-fat dairy products:
o Nonfat (skim) or 1% milk
o Nonfat or low-fat cheese, yogurt, and cottage cheese
 Meats and proteins:
o Chicken or turkey with no skin
o Baked or broiled fish
o Lean beef and pork (loin, round, extra lean hamburger)
 o Beans and peas, unsalted nuts, soy products
o Egg whites and substitutes
o Seeds and nuts

 Fats:
o Unsaturated oil, such as canola, olive, peanut, soybean, or sunflower oil
o Soft or liquid margarine and vegetable oil spread
o Low-fat salad dressing

c. Recording and Reporting of Nutrition Status

Terminology for nutrition monitoring and recordingis organized in 4 domains (categories):

Food/Nutrition-Related Anthropometric Biochemical Data, Nutrition-Focused

History Outcomes Measurement Outcomes Medical Tests, and Physical Finding
Procedure Outcomes Outcomes
Food and nutrient intake, Height, weight, body Lab data (e.g., Physical appearance,
food and nutrient mass index (BMI), electrolytes, glucose) muscle and fat
administration, growth pattern and tests (e.g., gastric wasting, swallow
medication, indices/percentile ranks, emptying time, resting function, appetite, and
complementary/alternativ and weight history metabolic rate) affect
e medicine use,
knowledge/beliefs, food
and supplies availability,
physical activity, nutrition
quality of life

3. NUTRITION FOR HEALTH AND FITNESS

a. Nutrition in Weight Management

Healthy eating is one of the best things you can do to prevent and control health problems
such as heart disease, high blood pressure, type 2 diabetes, and some types of cancer.
Tips for weight management:

- Weigh regularly (for example, once a week), but do not weigh yourself daily.
- Don’t wait too long between meals.
- Join a support group and go to meetings during and after the weight loss.
- Eat slowly.
- Use a small plate and fill it two-thirds with fruits, vegetables, and whole-grain products and
just one-third with meat products.
- Use low-calorie garnishes.
- Eat whole, fresh foods that are low-calorie and nutrient-dense. Avoid processed foods.
- Treat yourself with something other than food.
- Anticipate problems (e.g., banquets and holidays). “Undereat” before and after.
- “Save” some calories for snacks and treats.
- If something goes wrong, don’t punish yourself by eating.
 - If there is no weight loss for 1 week, realize that lean muscle mass is being produced from
exercising or there may be retention of water.
- If a binge does occur, don’t punish yourself by continuing to binge. Stop it! Go for a walk, to a
movie, to a museum. Call a friend.
- Adapt family meals to suit your needs. Don’t make a production of your diet. Avoid the heavy-
calorie items. Limit yourself to a spoonful of something too rich for a weight loss diet.
Substitute something you like that is low in calories.
- Take small portions.
- Eat vegetables and bread without butter or margarine.
- Include daily exercise. Park further from work and walk.

b. Nutrition in Eating Disorders

Eating disorders are characterized by an abnormal attitude towards food that causes someone
to change their eating habits and behavior. A person with an eating disorder may focus excessively
on their weight and shape, leading them to make unhealthy choices about food with damaging
results to their health. Eating disorders are serious conditions related to persistent eating behaviors
that negatively impact your health, your emotions and your ability to function in important areas of
life. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating
disorder.
Most eating disorders involve focusing too much on your weight, body shape, and food,
leading to dangerous eating behaviors. These behaviors can significantly impact your body's ability to
get adequate nutrition. Eating disorders can harm the heart, digestive system, bones, and teeth and
mouth, and lead to other diseases.

Common signs of eating disorders:

 Frequent episodes of eating more than what may be considered a normal amount of food
 Rapid eating
 Eating until uncomfortably full
 Eating large amounts of food without being physically hungry
 Eating with excessive discretion due to feelings of embarrassment at the quantity of food
being consumed
 Feelings of guilt after overeating
 Weight fluctuation, usually gain
 Feelings of low self-esteem
 Loss of sexual desire
 Frequent dieting

 Monitor Intake

 Structured eating
Meal guidelines:
- Eat 5-6 times per day, 3 meals, 2-3 snacks no closer than 2 hours together, no longer than 4
hours apart.
- All meals should have all macro nutrients: CHO, protein and a source of fat
 Alternate Activities/Structured Time
- Go for a walk, Journal Scrapbook, Call a friend, Make a card, Write a letter
 - Look up fun stuff on the internet (YouTube “Cute Kittens”) Art,
- make it, look at it, plan it Plan a vacation or even a day trip to look forward to Read the
newspaper and plan weekend, day trips Read a book Get a massage Knit/Cross stitch
Volunteer

 Lifestyle and home remedies

- Stick to your treatment plan — don't skip therapy sessions and try not to stray from meal
plans. Follow your doctor's recommendations on physical activity and exercise.

- Talk to your doctor about appropriate vitamin and mineral supplements. If you're not eating
well, chances are your body isn't getting all of the nutrients it needs, such as vitamin D or
iron. However, getting most of your vitamins and minerals from food is typically
recommended.

- Resist urges to weigh yourself or check yourself in the mirror frequently. This may simply fuel
your drive to maintain unhealthy habits.

- Don't isolate yourself from caring family members and friends who want to see you get
healthy and have your best interests at heart

c. Nutrition in Exercise and Sports

Eating well for physical activity and sport can have many benefits including:

- allowing you to perform well in your chosen sport or activity;

- reducing the risk of injury and illness;
- Ensuring the best recovery after exercise or a training programme
- Sports and exercise nutrition focuses on what you need to be fueled and hydrated during
exercise, and to promote recovery after exercise

Tips for healthy eating:

 Increase complex carbohydrates

- Healthy sources: Whole grain cereals, breads, and pasta; fruits, vegetables, and beans
- Nutritional benefits: Major source of energy, vitamins, minerals, and fiber , regularity and the
maintenance of good health. Carbs are your major muscle fuel source for high- intensity
exercise 
 Decrease dietary fat
- Healthy sources: Vegetable oils like canola oil and olive oil, nuts, seeds, and fish
- Nutritional benefits Major source of energy; vitamins A, D, E, K; omega-3 fatty acids and other
essential fats Health benefits Support the maintenance of good health
- Fats are the major muscle fuel sources for low-intensity exercise
- Limit your intake of saturated fats and cholesterol by choosing lean meats and low-fat or
nonfat dairy foods and egg whites
- Keep trans fats intake as low as possible by reading labels and limiting your intake of fried fast
foods and commercially prepared baked goods
 Ensure adequate protein intake
 - Healthy sources: Fish, poultry, lean meats, low-fat and nonfat dairy foods, seeds, nuts, beans,
and eggs
- Nutritional benefits: Provides amino acids, the building blocks for making proteins, proteins
make up muscle and help build antibodies and it helps in the building and repair of muscle
tissue, and works with carbs to boost the rate of recovery after exercise 

 Increase dietary fibre

 Decrease / eliminate alcohol
 Decrease salt intake
 Increase water intake

d. Nutrition for Bone Health

The food that you eat can affect your bones. Learning about the foods that are rich in
calcium, vitamin D and other nutrients that are important for your bone health and overall health will
help you make healthier food choices every day. Use the chart below for examples of the different
types of food you should be eating every day.

Eat a well-balanced diet with plenty of dairy, fish, fruits and vegetables, you should get
enough of the nutrients you need every day, but if you’re not getting the recommended amount from
food alone, you may need to complement your diet by taking multivitamins or supplements.

Eating for Good Bone Health

FOOD NUTRIENT
Dairy products such as low-fat and non-fat milk, yogurt and cheese Calcium. Some dairy products
are fortified with Vitamin D.
Fish:
- Canned sardines and salmon (with bones) Calcium
- Fatty varieties such as salmon, mackerel, tuna and sardines Vitamin D
Fruits and Vegetables:
- Collard greens, turnip greens, kale, okra, Chinese cabbage, Calcium
dandelion greens, mustard greens and broccoli
- Spinach, beet greens, okra, tomato products, artichokes, plantains, Magnesium
potatoes, sweet potatoes, collard greens and raisins
- Tomato products, raisins, potatoes, spinach, sweet potatoes,
papaya, oranges, orange juice, bananas, plantains and prunes. Potassium
- Red peppers, green peppers, oranges, grapefruits, broccoli,
strawberries, brussels sprouts, papaya and pineapples.
- Dark green leafy vegetables such as kale, collard greens, spinach, Vitamin C
mustard greens, turnip greens and brussel sprouts.

Vitamin K
Fortified Foods:
- Calcium and vitamin D are sometimes added to certain brands of Calcium, Vitamin D
juices, breakfast foods, soy milk, rice milk, cereals, snacks and
breads.
o Beans (Legumes): While beans contain calcium, magnesium, fiber and other nutrients, they are also
high in substances called phytates. Phytates interfere with your body’s ability to absorb the calcium
that is contained in beans. You can reduce the phytate level by soaking beans in water for several
hours and then cooking them in fresh water.
o Meat and Other High Protein Foods: It’s important to get enough, but not too much protein for bone
health and overall health. Many older adults do not get enough protein in their diets and this may be
harmful to bones. However, special high protein diets that contain multiple servings of meat and
protein with each meal can also cause the body to lose calcium. You can make up for this loss by
getting enough calcium for your body’s needs. For example dairy products, although high in protein,
also contain calcium that is important for healthy bones.
o Salty Foods: Eating foods that have a lot of salt (sodium) causes your body to lose calcium and can
lead to bone loss. Try to limit the amount of processed foods, canned foods and salt added to the
foods you eat each day. To learn if a food is high in sodium, look at the Nutrition Facts label. if it lists
20% or more for the % Daily Value, it is high in sodium. Aim to get no more than 2,300 mg of sodium
per day.
o Spinach and Other Foods with Oxalates: Your body doesn’t absorb calcium well from foods that are
high in oxalates (oxalic acid) such as spinach. Other foods with oxalates are rhubarb, beet greens and
certain beans. These foods contain other healthy nutrients, but they just shouldn’t be counted as
sources of calcium.
o Wheat Bran: Like beans, wheat bran contains high levels of phytates which can prevent your body
from absorbing calcium. However, unlike beans 100% wheat bran is the only food that appears to
reduce the absorption of calcium in other foods eaten at the same time. For example, when you have
milk and 100% wheat bran cereal together, your body can absorb some, but not all, of the calcium
from the milk. The wheat bran in other foods like breads is much less concentrated and not likely to
have a noticeable impact on calcium absorption. If you take calcium supplements, you may want to
take them two or more hours before or after eating 100% wheat bran.
o Alcohol: Drinking heavily can lead to bone loss. Limit alcohol to no more than 2 – 3 drinks per day.

e. Nutrition for Oral and Dental Health

- A poor diet can lead to gum disease and tooth decay. Foods high in carbohydrates, sugars and
starches greatly contribute to the production of plaque acids that attack the tooth enamel.
Eventually, these acids can cause tooth enamel to break down, forming a cavity.
- If you do eat foods high in sugar or starch, try to eat them during meals, rather than between
meals, and avoid any foods that stick to your teeth, because these can produce more plaque. Saliva
production rises during meals, which can help rinse food and acids from the mouth.
- Foods that contain sugars of any kind can contribute to tooth decay. Almost all foods, including milk
and vegetables, contain some type of sugar; however; these foods are a necessary part of a healthy
diet, because many of them also contain important nutrients. To help control the amount of sugar
you consume, read food labels and choose foods and beverages that are low in added sugars.
Added sugars are often present in soft drinks, candy, cookies and pastries.
- To maintain a balanced diet, eat a variety of foods from each of the five major food groups and limit
the number of snacks you eat. If you do snack, choose nutritious foods such as cheese, raw
vegetables, plain yogurt or a piece of fruit. And remember that foods eaten as part of a meal cause
less harm because the saliva released helps wash foods from the mouth and lessen the effects of
acids.