WHAT ARE THE BASIC TERMS TO

UNDERSTAND IN THE STUDY OF NUTRITION

1. A nutrient is a chemical substance that is

present in food and needed by the
body. The macronutrients include the
energy nutrients carbohydrate, fat, and
protein. The micronutrients include
vitamins, minerals, and water. A nutrient
defense food is one that has a high
proportion of micronutrients in relation to
the macronutrients. Empty kcalories
implies the opposite.

2. Nutrition is the science of the processes

by which the body uses food for energy,
maintenance, and growth. Good
nutritional status implies
appropriate intake of the
macronutrients –
carbohydrates, proteins,
and fats –and the various
vitamins and minerals
often referred to as
“micronutrients” because
 they are needed in small quantities.

3. Malnutrition or poor nutritional status is a

state in which a prolonged lack of one
or more nutrients retards physical
development or causes the
appearance of specific clinical
conditions (anemia, goiter, rickets, etc.).

4. Optimal nutrition means that a person is

receiving and using the essential
nutrients to maintain health and well-
being at the highest possible level.

5. A kilocalorie (or kcal) is a unit of

measure used to express the fuel value
of carbohydrates, fats, and proteins. The
large Calorie (or kcal) used in nutrition
represents the amount of
heat necessary to raise the
temperature of 1 kg of
water 1°C. One pound of
body fat equates to
3500kcal. Carbohydrates,
proteins, fats, and alcohol
 are the only sources of kilocalories.
Once kcalorie equals approximately 4
kilojoules (kj) in the metric system.

6. Health is currently recognized as being

more than the absence of disease.

7. Public health is the field of medicine that

is concerned with safeguarding and
improving the health of the community
as a whole.

8. Holistic health is a system of preventive

medicine that takes into account the
whole individual.

9. Medical nutrition therapy (MNT)

(referred to in the past as “diet
therapy”) is the treatment of disease
through nutritional therapy by registered
dietitians. MNT may be necessary for
one or more of the following reasons:

➔ To maintain or improve nutritional status

➔ To improve clinical or subclinical
nutritional deficiencies

➔ To maintain, decrease, or increase

body weight

➔ To rest certain organs of the body

➔ To eliminate particular food

constituents to which the individual
may be allergic or intolerant

➔ To adjust the composition of the normal

diet to meet the ability of the body to
absorb, metabolize, and excrete
certain nutrients and other substances.

BASIC CONCEPTS IN
 NUTRITION

A Look at Nutrition:
Nutrition refers to the processes by which a
living organism ingests, digests, absorbs,
transports, uses and excretes nutrients (food
and other nourishing material). Nutrition as
a clinical area is primarily concerned with
the properties of food that build sound
bodies and promote health.

Because good nutrition is essential to good

health and disease prevention, any person
involved in health care needs a through
knowledge of nutrition and the body’s
nutritional requirements through the
lifespan. What’s more, the study of nutrition
must focus on health promotion.
Approaches to health promotion:

➔2 Main approaches to health

promotion:

1. Traditional approach is reactive; it

focuses on treating symptoms after
they present

2. Preventive approach involves

identifying and eliminating risk factors
to stop health problems for
developing.

➔ Three parts to prevention:

Health promotion and disease prevention

efforts can be categorized into three
groups.

➢ Primary prevention
Examples of primary prevention measures,
which focus on health promotion, include:

- conducting nutrition classes to

promote healthy eating patterns

- modifying menus in restaurants and

offering low-fat alternatives

- offering fresh fruit and vegetables in

workplace cafeterias.

➢ Secondary prevention

Secondary prevention, which focuses on

risk reduction, may include such measures
as:

- screening for potential diseases

(hypercholesterolemia, osteoporosis)

- nutritional counseling for people at

risk for cardiovascular
diseases and diabetes
 - immunizations.

➢ Tertiary prevention

Examples of tertiary prevention measures,

which focus on disease treatment and
rehabilitation, include:

- physical rehabilitation for the stroke

patient

- cardiac rehabilitation for the cardiac

patient

- diabetes education classes for the

patient with newly diagnosed type 1
or type 2 diabetes.

➔ Nutrition and a balance diet

You’re part of a health care team that’s

responsible for making sure the patient
maintains optimal nutritional health, even
though he may e battling illness or
recovering from surgery. It’s also your job to
stress to the patient the importance of
good nutrition in maintaining health and
recovering from illness, so that he can
continue sound nutritional practices when
he’s no longer under your care.

➢ Nutritional status

You must use your knowledge of nutrition to

promote health through education and
counseling of sick and healthy patients. This
includes encouraging patients to consume
appropriate types and amounts of food. It
also means considering poor food habits as
a contributing factor in a patient with
chronic illness. Therefore, assessing
nutritional status and identifying nutritional
needs to meet the requirements of a
balanced diet are primary activities in
planning patient care.

- Assessing nutritional
status
A patient’s nutritional status can influence
the body’s response to illness and
treatment. Regardless of your patent’s
overall condition, an evaluation of his
nutritional health is an essential part of your
assessment. Assessment of the patient’s
nutritional status includes determining
nutritional risk factors as well as individual
needs.

- Good nutrition

Good nutrition, or optimal nutrition, is

essential in promoting health, preventing
illness, and restoring health after an injury or
illness. To achieve good nutrition, a person
must eat a varied diet of carbohydrates,
proteins, fats, vitamins, minerals, water, and
fiber in sufficient amounts. Although
excesses of certain nutrients can be
detrimental to a
patient’s health, intake
of essential nutrients
should be greater than
minimum requirements
to allow for variations in health and disease
and to provide stores for later use.

- Poor nutrition

Poor nutrition, or malnutrition, is a state of

inadequate or excess nutritional intake. It’s
most common among people living in
poverty –especially those with greater
nutritional requirements, such as elderly
patients, pregnant women, children, and
infants. It also occurs in hospitals and long-
term care facilities, because the patients in
these situations have illnesses that place
added stress on their bodies, raising
nutritional requirements.

➔ Don’t under-estimate undernutrition

Undernutrition occurs when a patient

consumes fewer daily nutrients than his
body requires, resulting in a nutritional
deficit. Typically, undernourished patients
are at greater risk for physical illnesses. They
may also suffer from limitations in cognitive
and physical status.

Undernutrition can result from:

- inability to metabolize nutrients

- inability to obtain the appropriate

nutrients from food

- accelerated excretion of nutrients from

the body

- illness or disease that increases the

body’s need for nutrients.

➔ Don’t overdo it

In contrast, overnutrition occurs when a patient

consumes an excessive amount of nutrients. For
example, overnutrition may
occur in patients who self-
prescribe megadoses of
vitamins and mineral
supplements and in those
who overeat. These
practices can result in
damage to body tissue or obesity.
WHY DO YOU NEED TO TAKE IN PROPER AND
ADEQUATE NUTRITION?

➔ It provides energy and keeps you

vibrant

➔ Produces and keeps your cells alive

and repairs body tissues

➔ Prevents disease and good for the

heart

➔ Necessary during illness and in

recuperating

➔ Assists your body in eliminating wastes

 NUTRITION SITUATION IN THE PHILIPPINES
PREVALENCE OF UNDERNUTRITION, BY AGE AND PHYSIOLOGIC
AGE GROUP

POPULATION GROUP/INDICATOR PERCENT

0-5 years old

Underweight 24.61
Stunting 26.31
Wasting 4.81
6-10 years old
Underweight 22.81
Stunting 32.01
11-19 years old 15.52
Adults, 60 years and above 23.62
1-20 Pregnant women 26.62
2-6th National Nutrition Surveys, DOST-FNRF, 2005 Updating of NS
 Ten leading causes of morality, Philippines, 2002
Causes Rate per Percent of total deaths
100, 000
Population
1. Diseases of the heart 88.2 17.7

2. Diseases of the 62.3 12.5

vascular system

3. Malignant neoplasm 48.8 9.8

4. Pneumonia 43. 8.6

5. Accidents 42.3 8.5

6. Tuberculosis, all forms 35.9 7.2

7. COPD and allied 24.3 4.9

conditions

8. Certain conditions 17.9 3.6

originating in the
perinatal period
17.5 3.5
9. Diabetes mellitus

10. Kidney diseases 11.6 2.3

Source: Philippine Health Statistics, 2002

 FACTORS ASSOCIATED WITH CHILD MALNUTRITION
Child malnutrition Outcome

Inadequate Disease Immediate

food intake causes

Underlying
Inadequate Insufficient health cause at
Inadequate
care for women services and poor household
access to food
and children environmental family level
conditions
Inadequate or
inappropriate
knowledge and
discriminatory Quality and quantity of
attitudes limit resources –human, economic,
organizational –and how they
household access to are controlled
Basic causes at
Political, cultural, societal level
religious, economic,
and social systems,
including the status of Potential resources:
women limit the use environment, people
of potential resources technology
POOR INFANT AND YOUNG CHILD FEEDING

➢ Poor breastfeeding and complementary feeding

practices

➢ In 2003,

• Any breastfeeding - 87%

• Median duration

- any breastfeeding - 14.1 months

- exclusive breastfeeding - 0.8 months

Source: National Demographic and Health Surveys, 2003

Poor Infant and young child feeding

Reasons for not breastfeeding Percent

Not have enough milk 31

Mother is working 17
Nipple or breast problem 17
Child is ill 11
Mother is ill 9

Source: National Demographic and Health Surveys, 2003

Who are the malnourished?

Households headed by

➔ Subsistence fisherfolk

➔ Kaingineros

➔ Hired laborers

➔ Unemployed

➔ Urban poor

➔ Families in remote areas

➔ Families with poorly educated mothers

➔ Large-sized poor families

National Policies through the years:

➔ Philippine Constitution (1987)

“The State shall defend the right of children

to assistance, including proper care and
nutrition…”

➔ Local Government Code (1991)

- Local government units shall be

responsible for the delivery of basic
services including nutrition.

➔ National Milk Code (1988)

- Regulates the marketing of breastmilk

substitutes,
breastmilk
supplements and
related products
 to promote infant nutrition

➔ Consumer Ac of the Philippines (1992)

- Provisions along food labeling and

food safety

➔ Rooming-in and Breasfeeding Act (1992)

- Requires health institutions to practice

rooming-in and promote
breastfeeding

➔ ASIN Law (1995)

- Mandatory iodization of all salt for

human and animal consumption.

➔ Food Fortification Act (2000)

- Mandatory fortification of staples and

voluntary fortification of other food
products
 ➔ Early Childhood Care and Development
Act (2000)
- Institutionalizes an integrated and
comprehensive service delivery system
for the health, nutrition, education and
psychosocial needs of 0-6 year old
children.
Nutritional guidelines
NUTRITION – is the study of
food and how the body
uses it to be healthy,
socially active, and
economically productive.
NUTRIENTS –are chemical substances in food
that perform specific functions in
combination with each other.
Classification:

a. Macronutrients… are nutrients

needed in relatively large amounts
and provide energy.
 1. Carbohydrates
2. Facts
3. Proteins

b. Micronutrients… are nutrients

needed in relatively small amounts.

1. Vitamins

a) Fat- soluble vitamins… A D E K

b) Water-soluble vitamins … B1 (Thiamine),

B2 (Riboflavin), B3 (Niacin), Vit. C as
Ascorbic Acid… etc…

c) Minerals… as Ca, Fe, I, etc…

Food Groups According to Functions of

Nutrients

a. Go foods –Energy-Giving Foods rich

in carbohydrates and fats as rice &
 rice products, corn & corn products,
bread & bread products, noodles,
root crops as kamote etc… sugar…
cooking oil, butter… etc.
b. Grow Foods –Body-Building Foods
rich in protein as animal meat, milk &
milk products, eggs, fish etc…
legumes etc.
c. Glow Fods –Body-Regulating Foods
rich in vitamins & minerals that help
regulates body processes as
vegetables and fruits.
Note: No single food… except BREAST MILK when given
within 6 months of life can provide all the nutrients needed
by the body in right amount… thus there is a need to eat a
variety of foods everyday as in this NUTRITIONAL GUIDELINES
for FILIPINOS.

Gabay sa Wastong
Nutrisyon Para sa Pilipino
1. Kumain ng iba’t ibang
uri ng pagkain araw-
araw.
2. Pasusuhin ang sanggol ng gatas ng ina
lamang mula pagkasilang hanggang 6
na buwan at saka bigyan ng mga
angkop na pagkain habang
pinapasuso pa.

3. Panatilihin ang tamang paglaki ng bata

sa pamamagitan ng wastong pagkain
at palagiang pagsubaybay sa kanyang
timbang.

4. Kumain ng isda, karne, manok o tuyong

butong gulay.

5. Kumain ng maraming gulay, prutas at

lamang ugat.

6. Kumain araw-araw ng mga pagkaing

niluto sa langis/edible oil.

7. Uminom ng gatas araw-araw, at kumain

ng mga produkto nito mga pagkain
 mayaman sa kalsiyum gaya ng mga
maliliit na isda (hal. Dilis) at madahong
berdeng gulay.

8. Gumamit ng iodized salt (asin na may

yodo) subali’t iwasan ang masyadong
maalat na pagkain.

9. Kumain ng malinis at ligtas na pagkain.

10. Para sa malusog na pamumuhay at

wastong nutrisyon, mag-ehersisyo nang
palagian, huwag manigarilyo, at iwasan
ang pag-inom ng alak.
 HOW IS NUTRITION AN
ASPECT OF TOTAL HEALTH
CARE?
What is Health Care Team?
The health care team is
composed of all the health
care professionals who
work with a given person
and/or family toward the common goal of
optimal health. This includes the medical
part of the team (physician or other health
care provider, nurse, dietitian, physical
therapist [OT], and psychologist), and other
community resource personnel who play the
role of facilitating good health.
I. Medical Part
a. The Health Care Provider
Generally, the person with the most broad-
based knowledge related to heath care is
the medical doctor (MD), or the physician.
Health care providers include nurse
practitioners (NPs) and, in some areas,
physician assistants (PAs). Usually an NP or PA
works under the supervision of a physician. A
health care provider is the professional who
can prescribe medications.

b. The Nurse

The nurse can provide other members of the

health care team with good insight into an
individual’s needs because of in-depth
patient contact. Ongoing assessment and
monitoring of patient eating habits and
health status are important roles of the nurse,
whether a licensed practical nurse (LPN) or a
registered nurse (RN). Certified nursing
assistants (CNAs) also are central to this role.

c. The Physical Therapist

Assisting in promoting mobility and physical

movement, for instance, to control pain, is
part of the role of the PT. Physical therapy
may be required to help a person enhance
physical capabilities that have been
impaired by illness or trauma.

d. The Pharmacist

The registered pharmacist is responsible for

preparing the nutritional solutions that the
physician prescribes. Because of specialized
knowledge about medications and their
actions, the pharmacist is able to serve as a
resource person with regard to drug and
nutrient interactions.

e. The Registered Dietitian

The registered dietitian (RD) is the health

care professional best qualified to interpret
the science of how food is
used by the body in health
and disease states and to
evaluate how MNT can
promote a positive
nutritional status. The RD is trained to work
with culturally diverse populations in
adapting customary foods to meet ongoing
health concerns.
f. The Nutritionist
A nutritionist is an educator, as well as a
counselor, who usually works in a public
health setting and who typically has at least
a bachelor’s degree in nutrition.
II. Social Professionals
a. The Social Worker
The social worker is the health care
professional who has expertise in the area of
community resources including financial,
counseling, technical support, and
educational services.
b. The Occupational Therapist
The OT emphasizes the remaining strengths
of the individual and identifies adaptive
devices that would enhance independent
functioning, such as large-handled spoons
and reaching devices. Through
occupational therapy the goal is for the
individual to increase the amount or types of
activities of daily living (ADL) such as
personal hygiene and eating.
c. The Speech Language Pathologist
The professional to consult when assessing
the seemingly simple act of swallowing s the
speech language pathologist (SLP).
Swallowing, a series of interrelated steps, can
be seriously impaired by stroke or other
neurologic damage.
III. Other Community Resource
Personnel.
The Nutrition Care Planning
Process
The nutrition care process of
assessment, planning,
intervention, and evaluation is the
same as the nursing process with the
omission of nursing diagnosis. It is both a
science and an art. By following the steps of
nursing process you will be a more effective
health care professional.

How do food and dietary patterns develop?

Sound nutrition begins before birth, through

the influence of food culture and exposure
to food flavors through amniotic fluid in
utero. Persons of various cultural
communities consume different types and
amounts of foods. The family later affects the
growing child’s meal environment and
exposure to food.
What are biopsychosocial concerns in health
care?

Biopsychosocial concerns address the

interplay between external environmental
(psychologic and social factors) and internal
forces (genetic or biologic requirements).
Religious impact on eating, such as giving up
chocolate for Lent or following a kosher diet,
occurs. During the month of Ramadan,
Muslims fast during daylight hours. Fasting for
religious reasons can be detrimental.

Cultural Consideration

An individual’s eating
habits can have strong
emotional reasons that
health educators need to
consider before providing
nutritional advice. Too
many individuals worry
excessively over what they
eat. We all need a variety of foods and
flavors for good emotional and physical
health.

The application of the science of nutrition

becomes an art form when various
biopsychosocial and interpersonal factors
are taken into consideration.

Many barriers to adequate nutrient intake

are external in nature and may stem from a
variety of causes:

➔ Economic (inadequate money to

purchase food)

➔ Physical (lack of food storage and

cooking facilities or physical impairments
that inhibit consumption of a variety of
foods)

➔ Cultural (lack of exposure to a variety of

foods because of limited parental
 offerings or overemphasis on excess
intake with large portions of food in
nationwide restaurants)
➔ Ecologic (droughts, floods, earthquakes)
➔ Emotional (television advertisements and
other media depicting nonnutritious
foods as appealing and healthy foods
such as spinach as unappealing)
➔ Religious (adherence to restrictive food
codes)
➔ Political (food boycotts, forced
starvation for military purposes)
How can the health care professional
facilitate positive meal environments?
➔ Focus on positive
conversation during
mealtimes around the
table; avoid points of
potential conflict and
friction.
➔ Use soft music, candles, or both to
facilitate a quiet, relaxed atmosphere.
➔ Eat as a family as much as possible, rather
than eating on the run.
➔ Eat slowly to promote satiety, and aim for
two or here different food groups in a meal.
➔ Encourage children to eat with the family,
but do not force them to eat. Encourage
the “one-taste rule”. And emphasize that
tastes are learned.
➔ Serve food that looks appealing by using a
combination of colors, textures, and sizes
(e.g., orange carrot “coins,” white chicken,
crisp lettuce wedges, warm biscuits, and
cold milk).
➔ Watch portion sizes; smaller portions are
useful for small appetites and for weight
control.
➔ Promote relaxing activities before
and after meals.
 INTERIEWING AND COMMUNICATION SKILLS
Strategies that are helpful to promote discussion
of personal health concerns:
1. Use warm, friendly, positive approach
2. Sit in comfortable proximity, either too
close not too far away
3. Use good eye contact, with eyes intent
but not staring
4. Face the person, and lean forward
5. Have arms unfolded and resting in relax
manner
6. Carefully listen to what a person is
saying, using affirming responses to
encourage further comments.
7. Allow praises in the conversation.
Some interviewing tips
➔ Three (3) realms to be considered in the
process of nutritional assessment:
1. cognitive (knowledge)
2. affectives (attitude)
 3. psychomotor or behavioral (behavior)
What is active listening?

- It is a manner of questioning and

responding to a person that promotes
disclosure of opinions, feelings, emotions,
and beliefs.

How can “I” versus “you” statements be used?

“I” versus “you” statements complement active

listening techniques. “You” statements can
sound judgmental and authoritarian, which can
cause a defensive reaction. Rephrasing “you”
statements to “I” statements will promote
enhanced interaction and communication.

How can learning readiness be assured?

By using good interviewing techniques and

assessment questions,
learning readiness can be
determined.
THE NUTRITION CARE PLANNING PROCESS

➔ The nutritional care process of

assessment, planning, intervention, and
evaluation is the same as the nursing
process with the omission of nursing
diagnosis

➔ It is both a science and an art.

➔ By following the steps of the nursing

process you will be a more effective
health professional.

➔ With practice and experience it will

become easier, but one’s own unique
style can either help or hinder the
process of providing nutrition health care

➔ Each step of the nursing process or

nutrition care process should be followed
in order.
➔ There is also a degree of integration
between each step of the process, and
the process is usually repeated several
times during the course of intervention.

➔ The development of rapport is essential

in this process and can be better
achieved by using good communication
skills in the process of assessment,
planning, intervention, and evaluation.
 - Prepared by: WILHELMINA G. BERNARDO, R. N., R. M., M. A. N. -
