Chapter 1 - Principles of Nutrition

Faculty of Nursing
Nutrition in Health
Course code 170111280
1 Chapter One: Introduction to Nutrition

Course contents
Chapter # Title Week #
1 Nutrition in Health and Health Care 1&2
2 Carbohydrates 2&3
3 Protein 4&5
4 Lipids 5&6
5 Vitamins 6&7
6 Water & minerals 7&8
7 Energy balance 8&9
11 Healthy eating for healthy baby 9 & 10
14 Hospital nutrition 11 & 12
15 Nutrition for obesity & eating disorder 13 & 14
17 Nutrition for patients with upper gastrointestinal disorders 14 & 15
Final exam 16
Reference: Nutrition essentials for nursing practice, 8th edition

Chapter One
Introduction to Nutrition

Nutrition:
Basic definitions
science of food (bread) and nutrients (CHO) & other
compounds (food additives), their action, interaction and balance in
relation to health & disease.
Nutrition : the sum of all processes involved in how organisms obtain

nutrients, metabolize them, and use them to support all of life’s processes
Nutrition Science: is the science that studies the physiological process of

nutrition (primarily human nutrition), interpreting the nutrients and other
substances in food in relation to maintenance, growth, reproduction,
health and disease of an organism.
Health: A state of complete physical, mental and social well-being , not

merely the absence of disease.
Disease is defined as any abnormal condition affecting the health of an

organism, and is characterized by specific signs and symptoms
Nutrients :substances essential for the health that
the body cannot make or makes in quantities too
small to support health.
Classification of nutrients:
1. Macronutrients are consumed in relatively large
quantities and include proteins, carbohydrates, and
fats and fatty acids.
2. Micronutrients – vitamins and minerals – are
consumed in relatively smaller quantities, but are
essential to body processes.

To be considered as a nutrient, a substance must
have these characteristics:
1. It has a specific biological function.
2. Removing it from the diet leads to decline in
human biological function, such as the normal
functions of the blood cells or nervous system
3. Adding the omitted substance back to the diet
before permanent damage occurs restoring
human biological function.

Nutrients can be assigned to 3 functional categories:
Provide energy Promote growth & Regulate body
development processes
Most carbohydrates
Proteins Proteins
1 g produce 4 Kcal
Proteins
Lipids Some lipids
1 g produce 4 Kcal
Most lipids
(fats & oils) Some vitamins Some vitamins
1 g produce 9 kcal
Some minerals Some minerals
Water Water
Health Pyramid & Food Groups

MyPlate choices

• Factors that Influence Food Selection:
1. Personal Preferences(sweetness of sugar, hot pepper)
2. Habit
3. Ethnic Heritage or Tradition
4. Social Interactions
5. Availability, Convenience, and Economy
6. Positive and Negative Associations(People tend to like particular
foods associated with happy occasions)
7. Emotional Comfort
8. Values
9. Body weight and Image
10. Nutrition and Health Benefits

• Many consumers make food choices that will benefit health.
• Foods that provide health benefits beyond their nutrient
contributions are called functional foods.
• Functional foods may include:
i. Whole foods : are the simplest of functional foods (oatmeal and
tomatoes)
ii. Modified foods : to provide health benefits (lowering the fat
content)
iii. Fortified foods: to provide health benefits (adding nutrients or
phytochemicals)
• Examples of functional foods include:
- orange juice fortified with calcium to help build strong bones
- margarine made with a plant sterol that lowers blood cholesterol

Optimal Nutrition : A person receives and uses
substances obtained from varied & balanced diet of
carbohydrates , fats , proteins , minerals , vitamins and
water in appropriate amounts
Malnutrition: impairment in health due to deficiency,

excess or imbalance of nutrients.
Food: animal or plant products needed by human to

get energy and maintain health and life
Diet : The foods and beverages a person eats and

drinks.

Nutritional status: nutritional health of a person as
determined by:
1. Anthropometric measures (weight, height,
BMI);
2. Biochemical measurements of nutrients or their
by-products in blood and urine;
3. Clinical (physical) examination;
4. Dietary analysis and
5. Economic evaluation.

Nutrition & Health Care
- Nutrition affects the practice of all health-care
professionals.
- Understanding & applying nutrition knowledge
& skills enables all members of the health care
team to effectively assess dietary intake &
provide appropriate guidance, counseling and
treatment to patients:
• Throughout the life cycle
• Through all degrees of health & illness

- Patient care is improved when nutrition care is
reinforced by all health professionals including
physicians, nurses, dentists …….. etc.
- Although the dietitian is the primary nutrition

authority, it takes an interprofessional)‫(المحترف‬
team to provide optimal nutrition care

• Throughout time , all civilizations have linked
nutrition with health.
• Across lifespan, good nutrition supports all aspects of

health:
 Healthy pregnancy outcomes
 Normal growth, development, and aging
 Healthy body weight
 Lower risk of diseases
 Helping to treat acute and chronic diseases

 Nutrition is intimately entwined (‫ )متشابكة بشكل وثيق‬with health
 In practice, health is subjectively and individually defined

along a continuum (‫ )سلسلة متصلة‬which is influenced by an
individual’s perception (‫ادراك‬،‫ ) فهم‬of health
Examples:
o A recent survey found that although 57% of respondents
ranked their health as very good or excellent, 55% of those are
overweight or obese.
o Older adults may consider themselves healthy despite having
arthritis because they consider it a normal part of aging, not a
chronic disease.

Chronic Diseases :
• The major public health concern globally.
• contribute to a large burden of diseases in developed
countries
• increasing rapidly in developing states
• known as non-communicable diseases (NCDs), are not
transmitted from one to one
• Known as the first leading cause of mortality, representing
more than 75% of all deaths worldwide.
• In US, chronic diseases are responsible for 7 of the top 10
causes of death and are the main causes of poor health and
disability.
• At all ages, chronic disease risk is linked to overweight and
obesity.
Chronic Diseases
Top ten causes of death in USA(2013) and Palestine(2019(
No. USA Palestine
1- Heart Disease Ischemic Heart Disease
2- Cancer Stroke
Chronic Lower
3- Diabetes
Respiratory Disease
4- Accidents Neonatal Disorders
5- Stroke Chronic Kidney Diseases
6- Alzheimer's Disease Hypertension
7- Diabetes Lung Cancer
8- Influenza and pneumonia Lower Respiratory infect
9- Chronic Kidney Diseases Congenital Defects
10- Suicide Colorectal Cancer
Chapter One: Introduction to Nutrition
22
• The mix of food consumed throughout the life cycle
can determine whether a chronic disease develops or
regresses .
• Prevent or minimizing morbidity and mortality related
to major chronic diseases (obesity, cardiovascular
disease, diabetes, and certain cancers) can be achieved
by:
1- Effective and timely nutrition
2- Lifestyle intervention
• Modifiable lifestyle factors that contribute to chronic
disease risk factors are:
- Smoking - Physical inactivity
23
- Obesity - Excessive alcohol intake
Healthy People
 Is a program that focuses on improving the health of all
Americans and eliminating health disparities (‫)الفوارق‬.
 Updated every 10 years after its inception 30 years ago.
 Sets public health goals and objectives and monitors the

nation’s progress toward those objectives.
 Healthy people 2020 has approximately 1200 objectives

organized into 42 areas ranging from cancer and diabetes to
substance abuse (‫ )تعاطي المخدرات‬and immunizations.

Healthy People 2020 Objectives
Goal: promote health and reduce chronic disease risk through
consumption of healthful diets and achievement and maintenance
of healthy body weight.
1. Healthier Food Access:
a) Increase number of states with nutrition standards for foods and
beverages provided to preschool-aged children in child care
b) Increase the proportion of schools that offer nutritious foods and
beverages outside of school meals
c) Increases number of states that have state-level policies that
incentivize food retail outlets to provide foods that encouraged by
Dietary Guidelines for Americans
2. Health Care and worksite Setting:

a. Increase the proportion of primary care physicians who regularly
measure the BMI of their patients.
b. Increase the proportion of physician office visits that include
counseling or education related to nutrition or weight.
c. (Developmental) Increase the proportion of worksite that offer
nutrition or weight management classes or counseling.
3. Weight Status:
i. Increase the proportion of adults who are at a healthy weight.
ii. Reduce the proportion of adults who are obese.
iii. Reduce the proportion of children and adolescents who are
considered obese
iv. (Developmental) Prevent inappropriate weight gain in youth and
adults.
4. Food and Nutrient Consumption:

1) Increase the contribution of fruits to the diets of the population aged 2
years and older.

2) Increase the variety and contribution of vegetables to the diets of the
population aged 2 years and older.
3) Increase the contribution of whole grains to the diets of the population
aged 2 years and older
4) Reduce the consumption of calories from solid fats and added sugars
in the population aged 2 years and older.
5) Reduce the consumption of saturated fats and sodium in the
population aged 2 years and older.
6) Increase the consumption of calcium in the population aged 2 years
and older.
5. Food Insecurity:
I. Eliminate very low food security among children .
II. Reduce household food insecurity and in doing so reduce hunger.

6. Iron Deficiency Anemia:

A. Reduce iron deficiency among young children and females of
childbearing age.
B. Reduce iron deficiency among pregnant females.

Nutrition in Nursing
- Nutrition has been an integral component of
nursing care since Florence Nightingale noted
nutrition as the second most important area of
nursing.
- Until the profession of dietetics founded, nurses
were responsible for preparing and serving food
to the sick people.
- Nurses have a variety of nutrition care
responsibilities (table 1 – next page)

29
(Table 1 - Nurses nutrition care responsibilities )
Responsibility Examples
Recognize at- 1. Screen every patient for malnutrition

risk patients
Implement 1. Ensure that screening occurs within time frame
nutrition 2. Ensure that dietitian-prescribed intervention
intervention occur on time
3. Maximize food & supplement intake:
• Avoid disconnecting enteral or parenteral
nutrition for the patient
• Help the patient to select appropriate food
• Encourage patients who feel full quickly to eat
nutrient dense foods like meat & milk over juice
or soup

Table 1 - Nurses nutrition care responsibilities - continue )
Monitor 1. Observe intake of food & supplements
2. Document appetite & take action when
the client does not eat
3. Assess tolerance : absence of side
effects
4. Monitor weight
5. Request a nutritional consult
6. Order supplements if intake is low or
needs are high
7. Monitor progression of nothing by
mouth (NPO) status and restrictive diets
(Table 1 - Nurses nutrition care responsibilities – continue )
Communicate 1. Consult with dietitian about nutrition

concerns
2. Communicate changes in the patient’s
condition that may indicate malnutrition
Educate 1. Reinforce the importance of obtaining
adequate nutrition
2. Review basic principles of the eating plan
3. Counsel the client about drug-nutrient
interaction
4. Keep the message simple
5. Advice the client to avoid foods that are
32
not tolerated
Nutrition Screening
- Nutrition screening is a quick look at a few variables to
judge a client’s relative risk for nutritional problems.
- It is designed to detect actual or potential malnutrition
based on a few selected criteria that are readily
available.
- Nutrition screening can be specific for a particular
population like pregnant women or particular disorder
like cardiac disease.
- Patients identified as high or moderate risk are referred
to a dietitian for further nutrition assessment, diagnosis
and intervention.
• Nutrition screening should be conducted within 24 hours after
admission to a hospital or other health-care facility.
• Because the standard applies 24 hours a day, 7 days a week,

staff nurses are usually responsible for completing the screen
as part of the admission process.
• To be useful, screening tools should be simple, reliable, valid,
and specific.
• Most clinical screening tools address four basic questions:
 Recent weight loss
 Recent food intake
 Current BMI
 Disease severity
Determine Your Nutritional Health
 An example of validated screening tools used to determine the
person’s nutritional health is a nutritional score using a specific
checklist.
 Total your nutritional score . If it’s :
0-2 Good ! Recheck your nutritional score in sex month.
3-5 You are at moderate nutritional risk . Improve your eating

habits and lifestyle . Recheck your nutritional score in three months .
6 or more You are at high nutritional risk . See your doctor , dietitian
or other qualified health or social service professional . Ask for help
to improve your nutritional health .

• An example of a widely used validated tool for screening
older adults is the Mini Nutritional Assessment-Short
Form (MNA-SF).
• It is designed to identify Protein-Calorie malnutrition in
people 65 years and older.
• It consists of six questions with a maximum possible score

of 14.
a. A score from 12-14 indicates normal nutritional status
b. A score from 8-11 indicates at risk for malnutrition
c. A score of 7 or less indicates malnutrition
 A score less than 12 needs further assessment by a
dietician
Nutrition Assessment
- Nutrition assessment is a detailed analysis of a
person’s nutritional status.
- Patients found to be at a moderate or high risk

for malnutrition through screening are referred to
a dietitian for a nutrition assessment to identify
specific risks or diagnose and document
malnutrition.

Nutrition assessment
Table 2: General characteristics for the diagnosis of
adult malnutrition
Weight loss over time
Inadequate food and nutrition intake compared to
requirements
Loss of muscle mass
Loss of fat mass
Local or generalized fluid accumulation

Steps of Nutrition Care Process
Screening
Nutrition
Assessment
Nutrition Monitoring
Nutrition Diagnosis
& Evaluation
Nutrition
Intervention

Nutrition assessment data to identify malnutrition
A – Medical history & clinical diagnosis:
- Chief complaints & past medical history: may
suggest clues about nutrition status & nutrient
requirements.
- Medical conditions often associated with

malnutrition include: AIDS, cancer, alcoholism,
diabetes..etc.

B – Physical exam:
- Physical findings (signs) that may diagnose
malnutrition include:
1. Loss of muscle or subcutaneous fat
2. Fluid accumulation
3. Dry skin
4. Swollen glands around the nick

C – Anthropometric data
- Measuring weight & height to calculate body
mass index
- BMI < 18.5 may be used to diagnose
malnutrition.
- The percentage of unintentional weight loss

over time, such as >5% over 3 months, or more
than 10% of usual weight regardless of the time
frame.
D – Laboratory data
- Currently there is no universally agreed upon
biochemical indicators to diagnose malnutrition
because these indicators may be related to
malnutrition or related to illness.
- Example: serum albumin may be used to screen

or diagnose malnutrition , but the major cause of
low serum albumin or other proteins is
inflammation not malnutrition.
E – Food/nutrient intake data
- Information about food and nutrient intake can
be obtained through patient or caregiver
interview, food record or observation.
- These intake compared to estimated needs to

assess adequacy.

General Characteristics for Diagnosis of Adult Malnutrition
1. Weight loss overtime
2. Inadequate food and nutrition intake compared to
requirements
3. Loss of muscle mass
4. Loss of fat mass
5. Local or generalized fluid accumulation
6. Measurably reduced hand grip strength

(2) Diagnosis :
 Diagnosis is made after assessment data are interpreted .
 Diagnosis : 1- Provide written documentation of the client’s status .
2- Serve as a framework for the plan of care that follows
 The diagnosis relate directly to nutrition when the pattern of
nutrition and metabolism is the problem .
 Nutrition diagnosis is organized in three domains:
i. Intake: too much or too little of a food or nutrient compared to
actual or estimated needs
ii. Clinical: nutrition problems that relate to medical or physical
conditions
iii. Behavioral/Environmental: knowledge, attitude, beliefs,
physical environment, access to food or food safety

 PES Statement: a statement that describes each problem, the root
causes, and the assessment that provide evidence for the nutrition
diagnosis.
 It refers to nutrition diagnosis term (Problem) related to (Etiology)

as evidenced by (Signs/Symptoms)
 P (Problem):
• Describes alterations in the client’s nutritional status
 E (Etiology):
- Cause/Contributing Risk Factors
- Linked to the nutrition diagnosis term by the words “related to.”
 S (Signs/Symptoms):
 Data or indicators used to determine the client's nutrition
diagnosis.
 Linked to the etiology by the words “as evidenced by.”

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Faculty of Nursing

1 Chapter One: Introduction to Nutrition

2 Chapter One: Introduction to Nutrition

3 Chapter One: Introduction to Nutrition

Nutrition : the sum of all processes involved in how organisms obtain

Nutrition Science: is the science that studies the physiological process of

Health: A state of complete physical, mental and social well-being , not

Disease is defined as any abnormal condition affecting the health of an

5 Chapter One: Introduction to Nutrition

7 Chapter One: Introduction to Nutrition

Some minerals Some minerals

9 Chapter One: Introduction to Nutrition

11 Chapter One: Introduction to Nutrition

13 Chapter One: Introduction to Nutrition

14 Chapter One: Introduction to Nutrition

Malnutrition: impairment in health due to deficiency,

Food: animal or plant products needed by human to

Diet : The foods and beverages a person eats and

15 Chapter One: Introduction to Nutrition

16 Chapter One: Introduction to Nutrition

17 Chapter One: Introduction to Nutrition

- Although the dietitian is the primary nutrition

18 Chapter One: Introduction to Nutrition

• Across lifespan, good nutrition supports all aspects of

19 Chapter One: Introduction to Nutrition

 In practice, health is subjectively and individually defined

20 Chapter One: Introduction to Nutrition

 Updated every 10 years after its inception 30 years ago.

 Sets public health goals and objectives and monitors the

 Healthy people 2020 has approximately 1200 objectives

24 Chapter One: Introduction to Nutrition

2. Health Care and worksite Setting:

4. Food and Nutrient Consumption:

26 Chapter One: Introduction to Nutrition

27 Chapter One: Introduction to Nutrition

6. Iron Deficiency Anemia:

28 Chapter One: Introduction to Nutrition

Chapter One: Introduction to Nutrition

Recognize at- 1. Screen every patient for malnutrition

30 Chapter One: Introduction to Nutrition

Communicate 1. Consult with dietitian about nutrition

• Because the standard applies 24 hours a day, 7 days a week,

3-5 You are at moderate nutritional risk . Improve your eating

35 Chapter One: Introduction to Nutrition

• It consists of six questions with a maximum possible score

- Patients found to be at a moderate or high risk

39 Chapter One: Introduction to Nutrition

40 Chapter One: Introduction to Nutrition

41 Chapter One: Introduction to Nutrition

- Medical conditions often associated with

42 Chapter One: Introduction to Nutrition

43 Chapter One: Introduction to Nutrition

- The percentage of unintentional weight loss

- Example: serum albumin may be used to screen

- These intake compared to estimated needs to

46 Chapter One: Introduction to Nutrition

48 Chapter One: Introduction to Nutrition

49 Chapter One: Introduction to Nutrition

 It refers to nutrition diagnosis term (Problem) related to (Etiology)

50 Chapter One: Introduction to Nutrition

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