A nutrient deficiency occurs when a person lacks one or more

nutrients over a period of time. Nutrient deficiencies are classified as primary or

secondary. Primary deficiencies are caused by inadequate dietary intake. Secondary
deficiencies are caused by something other than diet, such as a disease condition
that may cause malabsorption, accelerated excretion, or destruction of the nutrients.
Nutrient deficiencies can result in malnutrition.
INDIVIDUALS AT RISK FROM POOR NUTRITIONAL INTAKE
Teenagers may eat often but at unusual hours. They may miss regularly scheduled meals,
become hungry, and satisfy their hunger with foods that have low nutrient density
such as potato chips, cakes, soda, and candy. Foods with low nutrient density provide
an abundance of calories, but the nutrients are primarily carbohydrates and fats and,
except for sodium, very limited amounts of proteins, vitamins, and minerals.
Teenagers are subject to peer pressure; that is, they are easily influenced by the
opinions of their friends. If friends favor foods with low nutrient density, it is difficult
for a teenager to differ with them. Crash diets, which unfortunately are common among teens,
sometimes result in a form of malnutrition. This condition occurs because some
nutrients are eliminated from the diet when the types of foods eaten are severely restricted.
SPOTLIGHT OF A LIFE CYCLE
Infants, toddlers, adolescents (teenagers), the elderly, and pregnant women
(especially teenagers) are at greater risk for malnutrition than the rest of the population.
Infants and toddlers whose parents lack knowledge of proper nutrition and portion sizes
will suffer the consequences of poor or inadequate nutrition choices. It may be difficult
for toddlers who are “picky” eaters to obtain all their needed nutrients from food.
Factors influence nutrition in the elderly:
Depression, loneliness, lack of income, inability to shop, inability to prepare meals,
and the state of overall health can all lead to malnutrition..
NUTRITION ASSESSMENT
That old saying, “You are what you eat,” is true, indeed; but one could change it a bit to read,
“You are and will be what you eat.” Good nutrition is essential for the attainment and
maintenance of good health. Determining whether a person is at risk requires completion
of a nutrition assessment, which should, in fact, become part of a routine exam done by
a registered dietitian or other health care professional specifically trained in the diagnosis
of at-risk individuals. A proper nutrition assessment includes anthropometric measurements,
clinical examination, biochemical tests, and dietary-social history. Anthropometric measurements
include height and weight and measurements of the head (for children), upper arm, and skinfold
(Figure 1-3). The skinfold measurements are done with a caliper.
FOOD FOR THOUGHT :
EATING BREAKFAST MAY BE GOOD FOR YOUR HEART Breakfast really is
the most important meal of the day. A small study in the United Kingdom found that women
who skip breakfast eat more calories during the rest of the day. This could be a contributing
factor to weight gain. Also, studies indicated that LDL, “bad cholesterol,” was high and insulin
sensitivity was poorer for those not consuming breakfast. (Source: Adapted from Farchi, Taylor,
and Macdonald, 2005.)
Key Concept Healthy diet—a diet that
• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Includes lean meats, poultry fish, beans and peas, eggs, and nuts
• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
FIGURE 30-1 · MyPlate . The proportions of food content and food groups
are suggested by the MyPlate diagram.

From the nurse’s perspective,the MyPlate concept is of benefit when teaching clients
about the interrelationships among nutrition, activity, and diet therapy. In general, the
concepts review balancing caloric intake, using appropriate amounts of fruits and
vegetables, whole grains and fat-free or low fat milk, and reducing the amounts of foods
containing higher amounts of sodium and sugar. More specifically, these recommendations
suggest that the individual:
• Eat more of some foods, such as fruits, vegetables, whole grains, and fat-free or low-fat milk
products that contain essential nutrients.
• Eat less of other foods, such as foods high in saturated or trans fats, added sugars,
cholesterol, salt, and alcohol.
• Provide variety in the diet—eat foods from all food groups and subgroups.
• Balance calorie intake with energy needs to prevent weight gain and/or promote a healthy weight.
• Eat in moderation.
• Be physically active every day.
Whole grains contain the entire grain kernel e.g. the bran, germ, and the endosperm.
*Refined grains have been milled which is a process that removes the bran and the germ.
Refined grains have a longer shelf life anc a finer texture but are often lacking in dietary fiber;
iron, and many B vitamins. Most refined grains are enriched which means that some B
vitamins (e.g. thiamin, riboflavin, niacin, folic acid) and iron are added back into the processed
product.
**Beans & Peasare considered unique foods because they are a good source of plant proteins,
minerals such as zinc and iron, and many B vitamins.
Food Pattern and Food Group Terms
The use of nutrition, as a basis of health and disease prevention, has grown to include
concepts related to daily food patterns, caloric intake, and other terms presented below.
• Daily Food Intake Pattern:Identifies the types and amounts of foods that are recommended
to be eaten each day and that meet specific nutritional goals.
• Estimated Energy Requirement (EER):Represents the average dietary energy intake that
will maintain energy balance in a healthy person of a given gender, age, weight, height,
and physical activity level. The calorie levels for the food intake patterns were matched to
age/sex groups using EERs for a person of average height, healthy weight, and sedentary
activity level in each age/sex group.
Discretionary Calorie Allowance: The balance of calories remaining in a person’s energy
allowance, or EER, after accounting for the number of calories needed to meet
recommended nutrient intakes through consumption of foods in low-fat or no-added-sugar forms.
• Nutrient-Dense Foods: Those foods that provide substantial amounts of vitamins
and minerals and relatively fewer calories.
• Ounce-Equivalent:In the grains food group, the amount of a food counted as equal
to a 1-ounce slice of bread. In the meat, poultry, fish, dry beans, eggs, and nuts food group,
the amount of food counted as equal to 1 ounce of cooked meat, poultry, or fish.
Key Concept Choose a diet with plenty of whole grain products, vegetables, and fruits.
Plant foods provide fiber, complex carbohydrates, vitamins, minerals, and other substances
important for good health. They are also generally low in fat.
Kilocalories and Energy
The unit of measurement that specifies the heat energy in a particular amount of
food is called a kilocalorie (kcal). A kilocalorie is defined as the amount of heat required
to raise the temperature of 1 kg of water 1°C. The caloric value of foods can be determined in
the laboratory. In this process, the heat that is given off by the burning of the test food raises the
temperature of a known amount of water. The calorie values of energy nutrients follow:
• 1 g carbohydrate yields 4 kcal
• 1 g fat yields 9 kcal
• 1 g protein yields 4 kcal
Calorie charts statingthe number of kilocalories in an average serving of various foods
are available without cost from a number of sources.
Requirements
From a nutrition standpoint, calories are synonymous with energy. The amount of energy
(calories) a healthy individual needs depends on his or her age, sex, weight, body composition,
and activity level. The energy requirements of an individual are the total calories needed to
maintain body processes or resting energy expenditure (REE). For most adults, REE accounts
for most of the energy used in a typical day. REE is higher for men than for women because men
have more muscle mass; likewise, younger adults have a higher REE than older adults because
people lose muscle mass as they age. Growth, pregnancy, lactation, and fever increase REE.
In adults, activity typically accounts for 25% to 30% of total energy used. The actual amount
of energy used for physical activity depends on the duration and intensity of the activity.
For instance, people at desk jobs need fewer kilocalories than do laborers,who use their
muscles a great deal. Also, heavier people use more energy than do lighter people
when performing the same activity because they move a greater amount of weight.
Empty Calories
The term empty calories is an imprecise term applied to foods that supply calories
with few or no nutrients. Examples of empty calorie foods are candy, soft drinks, alcohol,
and sugar. Empty calorie foods can contribute to nutrient deficiencies if they take the
place of other nutrient-rich foods, such as substituting soft drinks for milk or alcohol for food.
Although not considered a nutrient, 1 g of alcohol provides 7 kcal.
Activity Levels
An integral part of the MyPlate concept is the individual’s ability to use his or
her nutrients. In other words, activity levels influence the amount of calories/energy that an
individual needs. Moderate and vigorous intensity levels are used towards meeting physical
activity needs. The following are definitions used to delineate activity lifestyles.
Sedentary: A lifestyle characterized by little or no physical activity during leisure time.
Activities include only the physical activity of independent living.
• Light Intensity:A lifestyle that includes some physical exercise that does
not typically raise the heart or respiratory rates. Examples include casual
walking, grocery shopping, or doing light housework.
• Moderate Physical Activity:A lifestyle that includes exercise that promotes
some exertion but in which the individual has a minimal increase in heart
and respiratory rates. Examples of moderate physical activity include walking briskly,
general gardening, golf, water aerobics, canoeing, tennis (doubles), dancing, or bicycling
on level terrain.
• Vigorous Physical Activity:A lifestyle that includes exercise that promotes a
noticeable increase in heart and respiratory rates. Vigorous physical activity may
be sufficiently intense to represent a substantial challenge to an individual and it
results in a significant increase in heart and breathing rates. Examples include
running or jogging, heavy yard work, aerobics, swimming continuous laps, basketball
(competitive), or tennis (singles).
Key Concept Balance the foods you eat with physical activity to maintain or
improve your weight. Excess weight increases the risk of numerous chronic
diseases, such as hypertension, heart disease, and diabetes.
All of the processes involved in consuming and utilizing food for energy,
maintenance, and growth.
-These processes are ingestion, digestion, absorption, metabolism, and excretion.
-All of the processes involved in consuming and utilizing food for energy,
maintenance, and growth.
-These processes are ingestion, digestion, absorption, metabolism, and excretion.
Classification of Nutrients
NUTRITION BASICS
-Nutrients can be divided into 2 categories: macronutrients, and micronutrients.
-Macronutrients are those nutrients that the body needs in large amounts.
These provide the body with energy (calories).
-Micronutrients are those nutrients that the body needs in smaller amounts.
Click on the links below to discover the functions, recommended dietary intake,
and food sources of the different nutrients our bodies need.
All of the processes involved in consuming and utilizing food for energy,
maintenance, and growth.
These processes are ingestion, digestion, absorption, metabolism, and excretion.
All of the processes involved in consuming and utilizing food for energy, maintenance,
and growth.
These processes are ingestion, digestion, absorption, metabolism, and excretion
Classification of Nutrients
NUTRITION BASICS
Nutrients can be divided into 2 categories: macronutrients, and micronutrients.
Macronutrients are those nutrients that the body needs in large amounts.
These provide the body with energy (calories).
Micronutrients are those nutrients that the body needs in smaller amounts.
Click on the links below to discover the functions, recommended dietary intake,
and food sources of the different nutrients our bodies need.
MICRONUTRIENTS Water Soluble Vitamins
Vitamin B1 Vitamin B2 Vitamin B6 Vitamin B12 Vitamin C Folic Acid
Fat Soluble Vitamins
Vitamin A Vitamin D Vitamin E Vitamin K
Water-Water Minerals Calcium Potassium Sodium Iron Zinc

Fats
Role in the Body, Energy reserve, Protects vital organs
Insulation Transport fat soluble vitamins Recommended
Allowance
20-35% of your total daily calories should come from fat
Less than 10% of total daily calories should come from
Saturated Fat (coconut and plam kernal oil, shortening,
butter, cream cheese, full fat dairy products)

Vitamin B1: Thiamin Function Needed to release energy in food

Prevents beriberi Food Sources Whole grains Dried beans Peas Peanuts
Animal proteins
Vitamin B2: Riboflavin Function Needed to build and maintain body tissues
Food Sources Whole grains Green and yellow vegetables Animal proteins

Vitamin B6: Pyridoxine Function Helps the development of the nervous system
Involved in the production of blood Helps break down protein and glucose to
produce energy for the body Food Sources Potatoes Chickpeas Yeast Nuts Bulgur
Fish Rice Bananas

Vitamin B12: Cobalamine Function Promotes proper growth and development

of the nervous system Food Sources Fortified cereals Nutritional yeast Algae Animal products

Vitamin C: Ascorbic Acid Function Helps form growth hormones Needed to

build strong gums, teeth, and bones Antioxidant Food Source Citrus fruits Cabbage Berries
Peppers

Folic Acid Function Helps build DNA and protein Helps maintain intestinal
tract Aids in bone growth Prevents nervous system birth defects Food Sources
Dark green leafy vegetables Yeast Wheat germFolic Acid Function Helps build DNA
and protein Helps maintain intestinal tract Aids in bone growth Prevents nervous system
birth defects Food Sources Dark green leafy vegetables Yeast Wheat germ

Vitamin A: Retinol Function Vision Healthy skin Healthy hair Food

Sources Animal products Body can make vitamin A from vegetables that
have carotene Carrots Sweet potatoes Other red-orange vegetables
Vitamin E Function Prevents damage to cell membranes Protects vitamin A
Aids in blood production Food Sources Seeds and Nuts Vegetable oi

Vitamin K Function Aids in blood clotting Food Sources Green leafy

vegetables Produced by bacteria in the large intestine

Sodium Function Regulates water balance Stimulates nerves Food

Sources Table salt Bread Almost everything

Calcium Function Maintains teeth and bones Helps blood clot Helps nerves and
muscles function Food Sources Dairy Milk & Fortified Non-Dairy Milks Dark
green vegetables Sardines Clams Oysters Legumes Almonds

Potassium Function Regulates water balance in cells Helps nerves function

Important for heart rhythm Food Sources Oranges Bananas Cereal Potatoes Dried beans

Consuming a healthy diet throughout the life-course helps to prevent malnutrition

in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions.
However, increased production of processed foods, rapid urbanization and changing lifestyles
have led to a shift in dietary patterns. People are now consuming more foods high in energy, fats, free
sugars and salt/sodium, and many people do not eat enough fruit, vegetables and other dietary
fibre such as whole grains. The exact make-up of a diversified, balanced and healthy
diet will vary depending on individual characteristics (e.g. age, gender, lifestyle and degree of
physical activity), cultural context, locally available foods and dietary customs. However,
the basic principles of what constitutes a healthy diet remain the same.
•Eat a variety of foods.
•Maintain ideal weight.
•Avoid too much fat, saturated fat, and cholesterol.
•Eat foods with adequate starch and fiber.
•Avoid too much sugar.
•Avoid too much sodium.
•If you drink alcohol, do so in moderation.
For adults
A healthy diet includes the following:
Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains
(e.g. unprocessed maize, millet, oats, wheat and brown rice).
-At least 400 g (i.e. five portions) of fruit and vegetables per day(2),
excluding potatoes, sweet potatoes, cassava and other starchy roots.
-Less than 10% of total energy intake from free sugars(2, 7), which is equivalent to
50 g (or about 12 level teaspoons) for a person of healthy body weight consuming
about 2000 calories per day, but ideally is less than 5% of total energy intake
for additional health benefits (7). Free sugars are all sugars added to foods or
drinks by the manufacturer, cook or consumer, as well as sugars naturally present in
honey, syrups, fruit juices and fruit juice concentrates.
For infants and young children
In the first 2 years of a child’s life, optimal nutrition fosters healthy
growth and improves cognitive development. It also reduces the risk of becoming
overweight or obese and developing NCDs later in life.
Practical advice on maintaining a healthy diet Fruit and vegetables Eating at least
400 g, or five portions, of fruit and vegetables per day reduces the risk of NCDs (2)
and helps to ensure an adequate daily intake of dietary fibre.
Fats
Reducing the amount of total fat intake to less than 30% of total energy
intake helps to prevent unhealthy weight gain in the adult population
(1, 2, 3). Also, the risk of developing NCDs is lowered by:
-reducing saturated fats to less than 10% of total energy intake;
-reducing trans-fats to less than 1% of total energy intake; and
-replacing both saturated fats and trans-fats with unsaturated fats (2, 3) – in particular, with
polyunsaturated fats.
Salt, sodium and potassium
Most people consume too much sodium through salt (corresponding to consuming an
average of 9–12 g of salt per day) and not enough potassium (less than 3.5g). High
sodium intake and insufficient potassium intake contribute to high blood pressure, which in
turn increases the risk of heart disease and stroke (8, 11).
Reducing salt intake to the recommended level of less than 5 g per day could prevent
1.7 million deaths each year (12).
Sugars
In both adults and children, the intake of free sugars should be reduced to less
than 10% of total energy intake (2, 7). A reduction to less than 5% of total energy intake
would provide additional health benefits (7).Consuming free sugars increases the risk of
dental caries (tooth decay). Excess calories from foods and drinks high in free sugars
also contribute to unhealthy weight gain, which can lead to overweight and obesity.
Recent evidence also shows that free sugars influence blood pressure and serum
lipids, and suggests that a reduction in free sugars intake reduces risk factors for cardiovascular
diseases (13).
How to promote healthy diets
Diet evolves over time, being influenced by many social and economic factors
that interact in a complex manner to shape individual dietary patterns. These
factors include income, food prices (which will affect the availability and affordability
of healthy foods), individual preferences and beliefs, cultural traditions, and geographical
and environmental aspects (including climate change). Therefore, promoting a healthy
food environment – including food systems that promote a diversified, balanced and healthy
diet – requires the involvement of multiple sectors and stakeholders, including government,
and the public and private sectors.
Water - Your body can maintain itself for a week or two without access to food and
water and possibly even longer if you consume water.
myplate symbol is designed to help people make smart food choices,
is breakfast really important ? helping you burn calories throughout the day. It also gives you
the energy you need to get things done and helps you focus at work or at school.
is fast food and snacks really important? Eating a poor quality diet high in junk food is
linked to a higher risk of obesity, depression, digestive issues, heart disease and stroke,
is a vegetable diet helpful ? A diet rich in vegetables and fruits can lower blood pressure,
reduce the risk of heart disease and stroke, prevent some types of cancer,
A weight-control strategy might include. Choosing low-fat, low-calorie foods.
Eating smaller portions. Drinking water instead of sugary drinks. Being physically active.
Obesity is a complex disease involving an excessive amount of body fat.
Obesity is generally caused by eating too much and moving too little.
Anorexia is an eating disorder characterized by an abnormally low body weight,
an intense fear of gaining weight and a distorted perception of weight.
Bulimia a serious, potentially life-threatening eating disorder.
Malnutrition is a serious condition that happens when your diet does not contain
the right amount of nutrients.
Marasmus is a type of protein-energy malnutrition that can affect anyone but is mainly
seen in children
Kwashiorkor is a severe form of malnutrition.
The 2019 Philippine Food Composition Tables
The DOST-FNRI, then the Institute of Nutrition (IN), recognized the importance of nutritional
content of commonly-consumed foods in the Philippines as the scientific basis for crafting sound
programs and policies on food and nutrition since the 1920s. Thus in 1947, the early
compilation of Philippine food data on the proximate, minerals and vitamins was prepared.
In 1950, the program on food composition analysis was conducted.  And in 1951, the first Food
Composition Tables (FCT) Recommended for Use in the Philippines Handbook I was published.
From thereon, the FCT underwent six more revisions prompted by constant introduction of
new foods in the food supply; discovery of food components that are associated with health
and disease; and continuous improvement in analytical methods intervention and data
quality assurance measures. To date, the DOST-FNRI remains to be the sole generator of
food composition data in the Philippines.

As a nutrition tool, the Philippine FCT is widely used in dietary assessment to define the
nutritional status of Filipinos. The handbook also finds useful application in the conduct of
cost-effective and doable nutrition intervention programs; manufacture of food products;
development of recipes, meals and menus for therapeutic diets and institutional catering;
for commercial food service industry, in agricultural researches towards improving the food
supply; and, in food trade and regulations, among others.
Tips on proper use of FCT :
1.Read carefully the preliminary pages of the handbook or table of values
2. Distinguish between values of husehold portion or 100 gram EP ( Edible portion)
3. Fine prints could be hard on the eyes
4.Knowledge of equivalent weights and measure is essential
5.Review decimal Placements.
Food Exchange Lists (FEL) for Meal Planning, 4th edition
THE FOOD EXCHANGE SYSTEM
WHY?
Prior to the development of the food exchange system in 1950, meal planning for persons
in the US with diabetes was chaotic, with no agreement among major organizations involved
with diabetes and nutrition.
WHO?
The food exchange system was created by the American Diabetic Association,
American Dietetic Association, and the US Public Health Services, as a meal planning guide
primarily for diabetics.
WHAT?
The goal was to develop an educational tool for persons with diabetes that would provide
uniformity in meal planning and allow for the inclusion of a wider variety of foods.
The food exchange system is based on principles of good nutrition that apply to everyone.
The food exchange system is updated as necessary.
The food exchange systems help people learn how to eat more balanced and nutritious,
while providing a wide variety of foods.
HOW?
To solve this problem, the concept of “exchange”, or “substitution”, of similar foods was
developed.
Scientist took foods in standard amounts and analyzed them for their nutrient content and
calories. The results were averaged out and foods with similar nutrients and caloric content were
placed in the appropriate food exchange group.
Nutrient Guidelines for Filipino
•The Philippines uses the daily nutritional guide pyramid and has developed pyramids for different
population groups. The pyramid is divided into levels of recommended consumption. Messages
about exercise and personal and environmental hygiene serve as support messages for the pyramid.
•The healthy food plate for Filipino adults (Pinggang Pinoy)
Nutrition Care Process
A. ASSESSMENT OF NUTRITIONAL STATUS
LEARNING OBJECTIVES
By the end of this lecture the reader should be able to:
-To know the different methods for assessing the nutritional status
-To understand the basic anthropometric techniques, applications, & reference standards
•Indirect Methods of Nutritional Assessment
•These include three categories:
-Ecological variables including crop production
-Economic factors e.g. per capita income, population density & social habits
-Vital health statistics particularly infant & under 5 mortality & fertility index
CLINICAL ASSESSMENT
-It is an essential features of all nutritional surveys
-It is the simplest & most practical method of ascertaining the nutritional status of a
group of individuals
-It utilizes a number of physical signs, (specific & non specific), that are known to
be associated with malnutrition and deficiency of vitamins & micronutrients.
CLINICAL ASSESSMENT/2
-Good nutritional history should be obtained
-General clinical examination, with special attention to organs like hair, angles of the mouth,
gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland.
-Detection of relevant signs helps in establishing the nutritional diagnosis
CLINICAL ASSESSMENT/3
•ADVANTAGES
–Fast & Easy to perform
–Inexpensive
–Non-invasive
•LIMITATIONS
–Did not detect early cases
Measurements for adults
Height: The subject stands erect & bare footed on a stadiometer with a movable head piece.
The head piece is leveled with skull vault  & height is recorded to the nearest 0.5 cm.
WEIGHT MEASUREMENT
Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable.
*Weigh in light clothes, no shoes
*Read to the nearest 100 gm (0.1kg)
*Nutritional Indices in Adults
•The international standard for assessing body size in adults is the body mass index (BMI).
•BMI is computed using the following formula: BMI = Weight (kg)/ Height (m²)
•Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality
BMI (WHO – Classification)
ØBMI < 18.5 = Under Weight
ØBMI 18.5-24.5= Healthy weight range
ØBMI 25-30 = Overweight (grade 1 obesity)
ØBMI >30-40 = Obese (grade 2 obesity)
ØBMI >40 =Very obese (morbid or grade 3 obesity)
Nutritional Indices in Adults
•The international standard for assessing body size in adults is the body mass index (BMI).
•BMI is computed using the following formula: BMI = Weight (kg)/ Height (m²)
•Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality
•BMI (WHO – Classification)
BMI < 18.5 = Under Weight
BMI 18.5-24.5= Healthy weight range
BMI 25-30 = Overweight (grade 1 obesity)
ØBMI >30-40 = Obese (grade 2 obesity)
ØBMI >40=Very obese (morbid or grade 3 obesity)