Nutrition & Diet Therapy

Lecture Compilation

Study Guide

INTRODUCTION TO NUTRITION

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 Nutrition is a vital component to overall wellness and health. Diet affects energy, well
being and many disease states. There is a connection between lifetime nutritional habits and
the risks of many chronic diseases such as cardio vascular diseases, diabetes, cancer. A well
balanced diet can prevent such conditions and improve energy levels and over all health and
wellness. The basis of nutrition is FOOD

Definition of terms:
1) Nutrition – is the study of food in relation to health.
2) Food – is any substance when ingested or eaten nourishes the body.
3) Nutrient – is a chemical component needed by the body to provide energy, to
build and repair tissues and to regulate life process.
4) Digestion – it is a mechanical and chemical breakdown of food into smaller components.
5) Absorption – it is a process where the nutrients from foods are absorb by the body
into the bloodstreams.
6) Metabolism – is a chemical process of transforming foods into other substance to
sustain life.
7) Enzymes – an organic catalyst that are protein in nature and are produced by living cells.
A catalyst speeds up or slows down chemical reactions without itself
undergoing change.
8) Nutritional Status – is the condition of the body resulting from the utilization of
essential nutrients.
9) Calorie – fuel potential in a food. One calorie represents the amount of heat required
to raise one liter of water one degree Celsius.
10) Malnutrition – It is the condition of the body resulting from a lack of one or more
essential nutrients or due to excessive nutrient supply.

CHAPTER 1
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 The Digestive System

• Mouth: The digestive process begins in the mouth. Food is partly broken down by the
process of chewing and by the chemical action of salivary amylase (these enzymes are
produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach:
• Esophagus – After being chewed and swallowed, the food enters the esophagus. The
esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic,
wave-like muscle movements (called peristalsis) to force food from the throat into the
stomach. This muscle movement gives us the ability to eat or drink even when we’re
upside-down.
• Stomach – The stomach is a large, sack-like organ that churns the food and bathes it in a
very strong acid (gastric acid). Food in the stomach that is partly digested and mixed
with stomach acids is called chyme.
• Small intestine – absorption happens in the small intestine. Bile (produced in the liver
and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes
produced by the inner wall of the small intestine help in the breakdown of food.
• Large intestine – Undigested food passes in the large intestine. In the large intestine,
some of the water and electrolytes (chemicals like sodium) are removed from the food.
• The end of the process – Solid waste is then stored in the rectum until it is excreted via
the anus.

ENZYMES – an organic catalyst that are protein in nature and are produced by living cells.

3 Groups of Digestive Enzymes:

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 1. Amylase – carbohydrate splitters
2. Lipase – fat splitters
3. Proteases – protein splitters

PART SECRETION ENZYME SUBSTRATE PRODUCT

Mouth Saliva Ptyalin (salivary Cooked Dextrin and

amylase) Carbohydrate Maltose

Esophagus

Stomach Gastric juice Pepsin Protein and Branched chain

polypeptides amino acids
(acidic)

Milk Casein Calcium Caseinate

Rennin

Fats Long chain fatty

Lipase acids, glycerol

Small Intestine Pancreatic Juice Pancreatic Trypsin Branched chain polypeptide

amino acid amino acids
(alkaline)

Long chain fatty long chain fatty

Pancreatic Lipase acids, glycerol, acids, glycerides,
cholesterol
cholesterol

Dextrin and
Maltose Dextrin, lactose,
Pancreatic sucrose, maltose
Amylase

Facilitates fat and

Vit. A, D, E, K
Bile (alkaline) absorption

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 polypeptide Single chain
amino acids amino acid
Intestinal juice Aminopeptidase

(succus entericus)
long chain fatty Fatty acids
acids, glycerides,
Intestinal lipase cholesterol

maltose
Glucose

Isomaltase lactose
Glucose,
galactose
Lactase sucrose

Glucose, fructose
Sucrase

Large Intestine

Digestibility of an average person

CHO – 90%

Protein – 92%

Fats – 95%

Factors that affect digestion and absorption:

1. Crude fibers – skin and seed of fruit

2. Preparation and cooking
3. Disease – intestinal cancer, diarrhea
4. Surgery – gastrectomy
5. Parasitism
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 6. Presence of interfering substance

PHYSIOLOGIC VALUE OF FOOD

Food is good to eat when it fulfills the ff. qualities:

1) It is nourishing or nutritious
2) It has satiety value
3) It is prepared under sanitary conditions
4) Its palatability factors (color, aroma, flavor, texture)
5) Within the budget and suitable to the occasion.
Nutrition Classification
1) According to function
2) According to chemical nature
3) According to essentiality
4) According concentration

Classification of Nutrients
1) According to function:
- Function as energy giving, body building, body regulating.
2) According to chemical properties:
a) Organic – protein, lipids, carbohydrates and vitamins
b) Inorganic – water & minerals
3) According to concentration
a) Macro nutrients – Carbohydrates, Protein, Fats
b) Micro nutrients – Vitamins, Minerals & water

CHAPTER 2
BASIC TOOLS IN NUTRITION

Food Groups –group of foods that have similar nutritional properties and is part of the
hierarchy of the food pyramid, such as cereal group, milk group, meat and protein
group, fruit and vegetable group, fats and sweets group .

The 3 Main Food Groups:

1.Body-building foods - foods that supply good quality proteins, some vitamins and minerals.
2. Energy foods - mostly of rice and other cereals, starches, sugars and fats contribute
the bulk of Calories.
3. Regulating foods - composed of fruits and vegetables that provide vitamins and minerals,
particularly ascorbic acid and pro vitamin A.

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 Dietary Guidelines strategies to promote appropriate diets and related health practices
to achieve the goal of improving the nutritional condition.

10 Nutritional Guidelines For Filipinos

1. Eat a variety of foods everyday.
2. Breast-feed infants exclusively from birth to 4-6 months and then, give
appropriate foods while continuing breast-feeding.
3. Maintain children’s normal growth through proper diet and monitor their
growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products and other calcium-rich foods such as small
Fish and dark green leafy vegetables everyday.
8. Use iodized salt, but avoid excessive intake of salty foods.
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and
avoid drinking alcoholic beverages.

FOOD GUIDE PYRAMID -

FNRI (Foods & Nutrition Research Institute)

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 FOOD GUIDE PYRAMID
(USDA) United States Dept. of Agriculture

MyPyramid contains eight divisions. From left to right on the pyramid are six food groups:
• Grains, recommending that at least half of grains consumed be as whole grains
• Vegetables, emphasizing dark green vegetables, orange vegetables, and dry beans and peas
• Fruits, emphasizing variety and deemphasizing fruit juices
• Oils, recommending fish, nut, and vegetables sources
• Milk,, a category that includes fluid milk and many other milk-based products
• Meat and beans, emphasizing low-fat and lean meats such as fish as well as more beans, peas,
nuts, and seeds

RDA & RENI

Recommended Dietary Allowance (RDA) - is the information of nutrient allowance for the
maintenance of good health. A tool for assessing a dietary intake of the population group. This
emphasize the amount of foods or diet.

RENI – Recommended Energy Nutrient Intake

- A new standard replacing RDA, emphasizing on recommending on the nutrients rather than
food or diet.
- This tool serve as a guide for designing nutrition and health intervention towards an
improvement of the health of the Filipinos.

Food Exchange List

- A classification or grouping of common foods in terms of equivalent amounts of
Carbohydrates, Protein, Fat and Calories

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- The word exchange refers to the fact that each item on a particular list in the portion
listed may be interchanged with any other food item on the same list. An exchange can
be explained as a substitution, choice, or serving.

Nutritional Labeling
- Primary means of communication between the
producer or manufacturer and the consumer.

2 Components of Nutritional Labeling:

1. Nutrient Declaration – a standardized statement
or listing of the nutrient content of food.
2. Nutrition Claim – representation which
states or implies that a food has some
particular nutritional proponents.

Nutrient density is a measure of the nutrients a food provides compared to the

calories it provides. Foods low in calories and high in nutrients are nutrient
dense, while foods high in calories and low in nutrients are nutrient poor.

CHAPTER 3

MACRO NUTRIENTS
Macro nutrients - constitute the bulk of the food we eat, they provide energy and
chemical building-blocks for tissues.

3 Macro Nutrients:
1. Carbohydrates
2. Protein
3. Fats

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 CARBOHYDRATES

- Major source of energy

for the body.
- Consist of 60-100%of calories.
- 1 gram of carbohydrates
contains 4 calories.
- carbohydrates are made of carbon,
hydrogen and oxygen with the general
formula of Cm(H2O)n.

Classification of Carbohydrates
Simple Carbohydrates
1) Monosaccharide – “simple sugar”, is the simplest form of sugar.
a) Glucose – “blood sugar”
b) Fructose – sweetest of simple sugar. Found in honey, fruits and vegetables.
c) Galactose – not found in free foods. Galactose is a result when the lactose breakdown.

** Simple sugar are water soluble, and quickly absorb in the bloodstream ***

2) Disaccharide – “double sugar”. Made up of 2 monosaccharide.

a) Sucrose – ordinary table sugar (glucose & fructose)
b) Lactose – “milk sugar” (glucose & galactose)
c) Maltose –(malt sugar) is produced during the malting of cereals such as barley.

3) Polysaccharide – “ complex sugar”

Composed of many molecules of simple sugar
a) Starch – most important in human. They supply energy for longer period of time.
Examples: rice, wheat, corn, carrots and potatoes.
Starches are not water-soluble and require digestive enzymes called amylases to break them apart.
b) Dextrins – formed by the breakdown of starch. obtained from starch by the application of heat or
acids and used mainly as adhesives and thickening agents.
c) Cellulose – Non-digestible by humans. They lower the blood glucose level of people with diabetes.
that is composed of glucose units, forms the main constituent of the cell wall in most plants, and is
important in the manufacture of numerous products, such as paper, textiles, pharmaceuticals
d) Pectin – Sources from fruits and are often used as a base for jellies.

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 e) Glycogen – “animal starch”
f) Hemicellulose – also indigestible, found in agar, pectin, woody fibers, leaves, stems.
g) Inulin – Important medicine and nursing as it provides test of renal function.

Functions of Carbohydrates:
1) Main source of energy for the body.
2) Protein sparing action
3) Necessary for normal fat metabolism
4) Cellulose stimulate peristaltic movement of the gastrointestinal tract. Absorb water to give bulk
to the intestines.
5) Lactose encourage the growth of beneficial bacteria, resulting in a laxative action.
6) Glucose is the sole source of energy in the brain. Proper functioning of the tissues

Sources of Carbohydrates
1) Whole grains
2) Sweet potatoes & white potatoes. Bananas, dried fruits.
3) Milk (lactose)
4) Sugar , sweets, honey, maple sugar

“Empty Calories” - foods which do not contain any other nutrients except carbohydrates

Common Diseases:
1. Overweight
2. Diabetes
3. Tooth Decay
4. Depressed appetite
5. Fermentation causing gas formation
6. Cancer

Deficiency
1)Ketosis – disease caused by lack of carbohydrates, in which the acid level of the body is raised
2)Protein _ Energy Malnutrition
a) Kwashiorkor – Protein Def.
b) Marasmus – Calorie Def.
3) Low Blood Sugar Level

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FATS or Lipids
- Fats, oils, and waxes belong to the group of naturally
occurring organic materials called
- lipids.
- Lipids are those constituents of plants or animals
which are insoluble in water but soluble in other
organic solvents.

- Most concentrated form of energy

- Contains 9 calories per gram fat
- It is recommended 15-25% fat in the diet
- The basic unit of fat is called “triglyceride”, which consist of molecule of glycerol attached to the
3 fatty acids

3 Forms Fatty Acids

1) Saturated Fats – Shown to raise blood cholesterol.
• Considered the most “dangerous” type of fat that lead to raise blood cholesterol may lead
to coronary heart disease
• Difficult to metabolize causing weight gain
Sources: butter, lard, meat, cheese, eggs, coconut oil, chocolate, cakes, cookies
2) Monounsaturated fats – lower level of “bad” cholesterol.
Sources: Vegetable oil, peanut, soybean, corn, olive oil, canola oil
3) Polyunsaturated Fats – Lower levels of total cholesterol.

Classes:
1) Omega 3 - have a positive effect on reducing mortality from cardiovascular disease.
 Reduced blood clotting tendency and reduced blood pressure.
2) Omega 6 – “Linoleic acid” polyunsaturated fatty acid.
 lowers cholesterol levels in the blood and helps in the prevention of heart disease.
 Sources of Polyunsaturated fats : unrefined safflower, corn, sesame, soybean, sunflower oil,
seeds, nuts, dark green vegetables.

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 Fatty Acid Composition of Common Food Fats

OIL POLYUNSAT. MONOUNSAT. F. TOTAL UNSAT. SATURATED F.A

F.A F.A
Safflower Oil 75% 12% 86% 9%
Sunflower Oil 66% 20% 86% 10%
Corn Oil 59% 24% 83% 13%
Soybean Oil 58% 23% 81% 14%
Cotton seed Oil 52% 18% 17% 26%
Canola Oil 33% 55% 88% 7%
Olive Oil 8% 74% 82% 13%
Peanut Oil 32% 46% 78% 17%
Margarine Oil 18% 59% 77% 19%
Palm Oil 9% 37% 46% 49%
Coconut Oil 2% 6% 8% 86%
Shortening 14% 51% 65% 31%
ANIMAL FAT
Tuna fat 37% 26% 63% 27%
Chicken fat 21% 45% 66% 30%
Beef fat 4% 42% 46% 50%
Butter fat 4% 29% 33% 62%
Lard 11% 45% 56% 40%

Functions:
1) Important source of calories to provide a continuous supply if energy.
2) Protein sparing
3) Maintain the constant blood temperature
4) Cushions vital organs such as kidney against injury
5) Facilitates the absorption of fat soluble vitamins (ADEK)
6) Provides satiety and delays onset on hunger.
7) Contributes flavor and palatability to the diet.

Cholesterol
Cholesterol is a major component of all cell membranes. It is required for synthesis of sex hormones,
bile acids, and vitamin D. It is also a precursor of the steroid hormones.
 Cholesterol is also made in the body and is taken also thru foods
 But Cholesterol is a major factor in the development of heart diseases
 Daily intake should not exceed 300 mg./day

Source of Dietary Cholesterol

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 • Richest: egg yolk, fish roes, mayonnaise and shell fish.
• Moderate : Fat on meat, duck, goose, cold cuts, whole milks, cream, ice cream, cheese, butter
and most commercially made cakes, biscuits and pastries.
• Poor : All fish and fish canned in vegetable oil, very lean meats, poultry without skin, skimmed
milk , low fat yoghurt and cottage cheese.
• Cholesterol free : All vegetables, and vegetable oils, fruit (including avocados and olives), nuts,
rice, egg white and sugar.

Vocabularies:
Lipid – Any of a group of organic compounds, including the fats, oils, waxes, sterols, and triglycerides,
that are insoluble in water but soluble in nonpolar organic solvents, are oily to the touch.
Fat - Any of various soft, solid, or semisolid organic compounds constituting the esters of glycerol and
fatty acids and their associated organic groups.
Oil – is liquid at room temperature soluble in various organic solvents such as ether but not in water
Cholesterol – is a form of fat in animal origin that is a factor in the development of heart disease.
Transfats - fatty acids that are produced when polyunsaturated oil are hydrogenated to make them
more solid. Thus raise the level of blood cholesterol.
Hydrogenated fats – unsaturated oil undergone hydrogenation to make them more solid and less
resistant to heat.
Low Density Lipoprotein (LDL) - A complex of lipids and proteins, with greater amounts of lipid than
protein, that transports cholesterol in the blood. High levels are associated with an increased risk of
atherosclerosis and coronary heart disease.
High Density Lipoprotein (HDL) - A complex of lipids and proteins in approximately equal amounts that
functions as a transporter of cholesterol in the blood. High levels are associated with a decreased risk of
atherosclerosis and coronary heart disease.

10 Foods High Transfats

1. Spreads – mayonnaise, margarine, butter
2. Package foods – cake mixes, biscuits
3. Soups – noodle soups
4. Fast foods – Mcdonalds, Kentucky Fried Chicken
5. Frozen foods – frozen pies, pizza, breaded fish sticks, breaded chicken
6. Baked goods – cupcakes
7. Cookies & cakes
8. Donuts
9. Cream Filled cookies
10. Chips & Crackers

Sources of Fat
1) Animal Fats – fat from meat, fish, poultry, milk, milk products and eggs.
2) Vegetable Fats – margarine, seed and vegetable oil, nuts
3) Visible Fats – butter, cream, margarine, lard, fish liver oils, pork fat

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 4) Invisible Fats – cheeses, olives, cakes, nuts, pastries

Diseases:
1) Heart Disease
2) Cancer
3) Obesity

PROTEIN

• Known as the building blocks of the body

• It contains the elements of carbon, hydrogen,
oxygen and nitrogen.
• Protein is made up of amino acids which is the basic
component of protein

AMINO ACIDS
Amino acids are known as the building blocks of protein.
They perform many important functions such as: building cells, protecting the body from viruses or
bacteria, repairing damaged tissue and carrying oxygen throughout the body
There are 20 different amino acids. Amino acids are linked together to form peptides, which are
small chains of amino acids. The peptides are then linked together to form larger proteins.
There are thousands of different proteins that carry out a large number of jobs in the human body. Even
though so many different proteins are at work in your body, you don't have to worry about consuming
each individual protein from the foods you eat. Your body will make those proteins. All you need to do is
to make sure your body has a healthy supply of all 20 of the different amino acid "building blocks."
Having enough of those amino acids is easy because your body can make 11 of them from other
compounds already in your body. That leaves eight amino acids that you must get from your diet.

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Types of Amino Acids
1) Essential Amino Acids –are those that are necessary for good health but cannot be produced by the
body and so must be supplied in the diet.
Ex. Leucine, Isoleucine
Lysine, Valine
Typtophan, Phenylalanine,
Methionine Serine

2) Non-Essential Amino Acids –are those that are produced by the body so not as necessary in the
diet
Ex. Aspartic Acid Tyrosine Glycine
Cysteine Arginine
Glutamic Acid Histidine
Glutamine Alanine
Asparagine Proline

Complete and Incomplete Protein

• Complete – contain all essential amino acid in sufficient quantities to supply the body’s need
Sources: proteins from animals
• Incomplete – those deficient in one or more essential amino acids.
Sources : Plant ( grains, legumes, seeds and nuts

Functions of Proteins
1) Used in repairing worn out body tissue
2) Source of heat and energy
3) Contribute to numerous essential body secretions (mucus, milk, sperm cells)
4) Keeping fluids and pH balanced in the body
5) Play a large role in the resistance of the body to diseases
6) Contributing to enzyme activity that promotes chemical reactions in the body
7) Signaling cells what to do and when to do it
8) Transporting substances around the body
9) Serving as building blocks for hormone production
10) Helping blood clot
11) Serving as structural components that give our body parts their shapes

Sources:
Complete Protein
1. Meat – beef, pork, lamb
2. Poultry – chicken, turkey, duck

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3. Fish
4. Dairy Products – milk, yogurt, cheese

Incomplete Protein
Grains – beans, corn, oats, pasta, whole grain breads
Legumes, seeds & nuts – sesame seed, sunflower seed, peas, rice, peanuts, cashew
Vegetables – Brocolli

Common Diseases
1) Heart Disease
2) Cancer (prostate, pancreas, kidney, breast and colon)
3) Osteoporosis
4) Weight control
5) Kidney Diseases
6) Ketosis
Protein – Energy Malnutrition

CHAPTER 4
MICRO NUTRIENTS
VITAMINS & MINERALS

VITAMINS
• Complex organic compound to regulate body
processes and maintain body tissue
• “Vitamin” comes from the Latin word “vita”
meaning life, “amine” means nitrogen
compound.
• Vitamins do not give the body energy.
• Therefore, we cannot increase our physical
capacity by taking extra vitamins
• Vitamins do not have calorie value.

Vitamins Terminologies
• Precursor or Provitamins – these are compounds that can be changed to the active
vitamins
Ex. Carotene are precursors to Vit. A
• Preformed Vitamins – naturally occurring vitamins that are inactive form and ready for
its biological use.
Ex. Animal sources
• Avitaminosis – severe lack of vitamins

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 Ex. Avitaminosis A leads to night blindness
• Hypervitaminosis – “vitamin toxicity”
excessive accumulation of vitamins in the body
• Vitamin Malnutrition – “too much or too little”

NOMENCLATURE OF VITAMINS
VITAMIN NOMENCLATURE
Vitamin A Retinol
D Calciferol
E Tocopherol
K Phylloquinone
Vitamin B1 Thiamine
B2 Riboflavin
B3 Niacin
B4 Panthotenic Acid
B6 Pyridoxine
B8 Biotin
B12 Cyanocobalamin
Vit. C Ascorbic Acid

FAT SOLUBLE VITAMINS (Vit. A D E K )

• FAT Soluble Vitamins – can be absorbed in the presence of fat & stored in the body.
• Fat Soluble vitamins generally have pre cursors or pro vitamins
• They can be stored in the body, deficiencies are slow to develop.
• Not absolutely needed daily from food sources
• Stable especially in daily cooking

Vit. A (Retinol)
FUNCTIONS
1) Vision Cycle – necessary component of visual purple (rhodopsia), a pigment to make
adjustments to light and dark.
2) Necessary material for maintenance of epithelial tissues.
3) Growth & Bone Development –
4) Reproduction – necessary for normal reproduction and lactation.
5) Antioxidant

Food Sources
1) Animal Sources – liver, yolk, milk, butter, cheese, fish, clams, tahong
2) Plant sources – deep green and yellow vegetables and fruits
DAILY DOSAGE:
Male – 1000 microgram
Female – 800 microgram

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 Deficiency & Toxicity
Vitamin A (Retinol)
Deficiency
• Night blindness
• Eye lesions
• Retarded growth
• Lower resistance to infections
• Faulty skeletal & dental development
Skin Lesions

Toxicity
• Liver damage
• Mild dermatitis
• Thickening of the skin and peeling off
• Course sparse hair
• Hyper carotenimia
(harmless orange appearance

VIT. D (Calciferol)

Functions
1) Absorption of Calcium & Phosphorus
2) Essential for normal growth development.
Food Sources
1) Synthesis with sunlight (10 mins/day)
2) cod liver fish, halibut [type of flatfish], salmon, sardine, egg yolk
3) Fortified Vit. A products

Deficiency
• Tetany ( abnormal muscle twitching and cramps
• Rickets (defective bones, retarded growth)
• Osteomalasia
• ( softening of the bones)

Toxicity
• Stone formation on kidney
• Demineralisation of the bone
• Polyuria
• Weight Loss
• Hypercalcemia

Vit. E (Tocopherol)
Functions
1. Maintenance of cellular membrane
2. Anti oxidant

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 Food Sources
Whole grain nuts, seeds, green and leafy vegetables, polyunsaturated fats
• No toxicity , this nutrient cannot be stored to a large extend in the body

Vit. K ( Phylloquinone)
Functions
Aids in blood clotting and bone mineralization
Food Sources
Green leafy vegetables, soy beans
• Deficiency
Hemmorhagic diseases

Toxicity
• Vomitting
• Albuminuria
• Hemolysis

FYI
• Anti oxidant - Any substance that reduces oxidative damage (damage due to oxygen) such as
that caused by free radicals.
• Free Radicals - are highly reactive chemicals that attack molecules by capturing electrons and
thus modifying chemical structures
• PHYTOCHEMICAL - natural bioactive compound found in plant foods that works with nutrients
and dietary fiber to protect against disease

WATER SOLUBLE VITAMINS

• Water soluble vitamins are B-complex group and Vit. C
• Dissolve in water and are not stored, they are eliminated in urine, so we need continuous supply
of this vitamins in the diet everyday.
• Water-soluble vitamins are easily destroyed or washed out during food storage or preparation.
• To reduce vitamin loss, refrigerate fresh produce, keep milk and grains away from strong light,
and use the cooking water from vegetables to prepare soups.

Vitamin C (Ascorbic Acid)

Functions:
1. Maintenance of bones, teeth, connective tissue,cartilages
2. Absorption of Calcium, Iron and Folacin
3. Production of brain hormones, immune factors
4. Antioxidant
Deficiency:
1. Bleeding gums, scurvy, anemia
2. joint pain, increase resistance to infections,
3. rough skin, hair loss, loose teeth

Toxicity
Diarrhea, bloating, cramps, formation of kidney stones

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 FOOD SOURCES
Citrus fruits, Brocolli, strawberries, potatoes, mangoes, papaya, red and green bell pepper,
Dark green vegetables

Vitamin B1 (Thiamine)
Functions
1. Helps release energy from foods,
2. Promotes normal appetite
3. Important in function of nervous system

Deficiency
1. Mental confusion; muscle weakness
2. wasting; edema; impaired growth; beriberi.
Toxicity (none)
None
Food Sources
pork, liver, whole grains, lean meats

Vit. B2 (Riboflavin)
Functions
1. Helps release energy from foods;
2. Promotes good vision, healthy skin

Deficiency
1. Cracks at corners of mouth;
2. Dermatitis around nose and lips;
3. Eyes sensitive to light.
Toxicity (none)
Food Sources
1. Liver, milk, dark green vegetables, whole and
2. enriched grain products, eggs

Vit. B3 (Niacin)
Functions
1. Energy production from foods;
2. Aids digestion, promotes normal appetite;
3. Promotes healthy skin, nerves
Deficiency
1. Skin disorders; diarrhea; weakness
2. mental confusion; irritability.
3. Pellagra
Toxicity
1. Abnormal liver function;
2. Nausea; irritability

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 Food Sources
1. Liver, fish, poultry, meat, peanuts,
2. whole and enriched grain products.

Vit. B5 (Panthotenic Acid)

Functions
1. Involved in energy production
2. aids in formation of hormones.

Deficiency
Uncommon due to availability in most foods;
fatigue; nausea, abdominal cramps; difficulty sleeping.
Toxicity (none)
Food Sources
Liver, kidney, meats, egg yolk, whole grains, legumes

Vit. B6 (Pyridoxine)

Functions
Aids in protein metabolism, absorption;
Aids in red blood cell formation;
Helps body use fats.
Deficiency
Skin disorders, dermatitis
Cracks at corners of mouth;
Irritability; anemia; kidney stones;
Nausea; smooth tongue.

B8 (Biotin)
Functions
Helps release energy from carbohydrates
Aids in fat synthesis.
Deficiency
Fatigue; loss of appetite, nausea, vomiting;
Depression; muscle pains; anemia.
Toxicity – none
Food Sources
Liver, kidney, egg yolk, milk,
Fresh vegetables

Vit. B12 – Phylloquinone

Function: Synthesis of red blood cells
Deficiency - Anemia, fatigue, sore tongue
Food Sources – all animal products

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Minerals
What is a mineral?

Minerals are elements that are not organic needed by the body in relatively small amounts to help
regulate body process and maintain tissue structure

• Minerals do not broken down during digestion nor destroyed by heat or light.

Trace and Major Minerals

• Trace Minerals – minerals that are required in our diet at amounts less than 100 mg/day.
• Major Minerals - minerals that are required in our diet at amounts greater than 100 mg/day.

Primary Roles:
• Metabolic health
• Anti oxidant
• Blood health
• Bone health
• Electrolyte balance

Major Minerals:
1) Calcium
2) Phosphorus
3) Magnesium
4) Potassium
5) Sodium
6) Chloride

Trace Minerals:

1) Iron
2) Iodine
3) Zinc
4) Flouride
5) Selenium
6) Manganese
7) Chromium

Major Minerals

Mineral Symbol Function Deficiency Food Sources

Calcium Ca Maintenance of bones and teeth Osteoporosis, Dairy products,

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 convulsion, green leafy veg,
muscle spasm fish with bones

Phosphorus Ph Bone growth Milk,cereal, all

foods
Magnesium Mg Muscle contraction, Green veg,,sea
Bone & tooth structure foods, legumes

Sodium Na Body fluid & acid-base balance Hypertension, Salt, processed

edema foods
Potassium K Body fluid balance All whole foods
Chloride Cl Body Fluid Balance Salt, processed
food

Trace Minerals

Mineral Symbol Function Deficiency Food Sources

Iron Fe Red Blood Cell structure Iron def. anemia Dark green leafy
vegetables, liver,
legumes
Iodine I Thyroid hormone development Goiter Sea foods, iodized
Energy metabolism sale
Zinc Zn Fetal development, wound Whole grain,
healing meat, egg
Fluoride Fl Teeth maintenance Dental carries Fortified water,
tea, fish bones

Goiter Angular stomatitis Rickets

Iodine deficiency Vit. C deficiency Vit. D deficiency

WATER

24
 • Most important nutritional constituent is
water
• The major component of the body is
water
• 60 – 70% water
• Water has no nutritional values and no
calories
• Water is necessary to transport nutrients
• regulate body temperature
• Remove waste materials
• Participate in chemical reaction & energy
production

• Recommended to drink at least 8 glasses a day

• If trying to loose weight 12-15 glasses a day is recommended
• A high intake of water aids in fat loss
• Caffeine & alcohol are both diuretics. Large intake of water is recommended
• Hangover are generally cause by the dehydration action by alcohol
• Match a bottle of beer with a glass of water to lessen the intensity of hangover
• Vital Element, second only to oxygen
• Vital every day
• Things that dehydrate
– Aging process
– Sweat from exercise
– Medications
– Caffeine
• Good general rule: for each glass of beverage with caffeine that you consume, drink one extra
glass of water.
• Other Benefits
– Helps utilize stored fat for energy
– Helps body recover quicker after exercise
– Aids healing process when you have been ill

CHAPTER 5

Ideal Weight, Total Energy Requirement,Body Mass Index

Basal Metabolism –the amount of energy required by an individual in the resting state, for such
functions as breathing and circulation of the blood.

25
 Basal Metabolic Rate – the minimum caloric requirement needed to sustain life in a resting
individual. It can be looked at as being the amount of energy (measured in calories) expended
by the body to remain in bed asleep all day.

Factors that affect BMR

1.Genetics. Some people are born with faster metabolisms; some with slower metabolisms.
2. Gender. Men have a greater muscle mass and a lower body fat percentage. This means they
have a higher basal metabolic rate.
3. Age. BMR reduces with age. After 20 years, it drops about 2 per cent, per decade.
4. Weight. The heavier your weight, the higher your BMR. Example: the metabolic rate of obese
women is 25 percent higher than the metabolic rate of thin women.
5. Body Surface Area. This is a reflection of your height and weight. The greater your Body
Surface Area factor, the higher your BMR. Tall, thin people have higher BMRs. If you compare a
tall person with a short person of equal weight, then if they both follow a diet calorie-controlled
to maintain the weight of the taller person, the shorter person may gain up to 15 pounds in a
year.
6. Body Fat Percentage. The lower your body fat percentage, the higher your BMR. The lower
body fat percentage in the male body is one reason why men generally have a 10-15% faster
BMR than women.
7. Diet. Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by up to 30
percent.Restrictive low-calorie weight loss diets may cause your BMR to drop as much as 20%.
8. Sleep – BMR falls 10-15% below waking levels.
9. Endocrine Glands – male sex hormones increase the BMR 10-15%
10. Fever – increase 7% for each degree rise the body temperature above 98.6 F

COMPUTATION:

1. BMR = Wt. in lbs. X 10.9 (male)

9.8 (female)

Example : 125 lbs. x 9.8 = 1,225 Cal.

2. BMI = Is a measure of body fat based on height and weight

BMI = weight (kg) = 47 kg_____ = 47 kg. = 20.25 = 20kg/m₂ (Normal)
( ht. meters)₂ (1.524)(1.524) 2.32

3. DBW
A . (TANHAUSSER’S METHOD) FOR ADULT
DBW = ( Ht. cm – 100 ) – 10%
Ex. 5‘3“ = (63 inches x 2.54) = (160.02 – 100) = (60.02- 6.002 [10%]) = 54 kg.

Note: (+ / -) 10% of the value within the range of DBW

26
B. Infants: (0-6 months)
a) DBW = birth weight (gms)+(age in mons.x 600)
Note: if the weight is not known, use 3000 gms.
Example: 4 month old infant
DBW = 3000 + (4 x 600)
= 3000 + 2400
= 5400 gms or 5.4 kg.
b) DBW = (age in months ÷ 2) + 3
Ex: DBW = (4÷2) + 3 = 2 + 3
= 5 kg.

C. DBW (Children) =( No. of yrs. X 2) + 8

Ex. 7 yr. old 1st grader
DBW= (7x2)+8 = 14+8
= 22 kg.

4. TER = DBW x activity level

Ex. 5’3” student = 54 x 35 = 1,890 Cal.

1) Infants= DBW x 120 Cals./Kg.

Ex. 4 month old infant
TER = 5.4 kg. x 120 Cals/kg = 648 or 650 Cals.

2) Children = 1000 + (100 x age in yrs.)

Ex. 7 yr. old child
TER = 1000 + (100 x 7)
= 1000 + 700
= 1700 Cals.

2) Adult = DBW x activity level

Ex. 5’3” student = 54 x 35 = 1,890 Cal.

CONVERSION:
HT. WT.
1 ft. = 12 inches 1 kg. = 2.2 lbs
1 inch = 2.54 cm
100 cm = 1 meter

ACTIVITY LEVEL :
Bed rest = 27.5 (hospital patients)
Sedentary = 30 (secretary, clerk, typist administrator, cashier, bank teller)
Light = 35 ( teacher, nurse, student, Lab.Tech, house wife with maid)

27
 Moderate = 40 ( housewife w/o a maid, vendor, mechanic, jeepney & car driver)
Heavy = 45 ( farmer, laborer, cargador, laborer, coal miner, fisherman, heavy eqpt.optr )

BMI LEVEL:
Obese = above 30
Overweight = 27-30
Normal = 18.5 – 27
Under weight = below 18

4. DIET PRESCRIPTION:

Step 1 : Get the DBW of the patient

Step 2 : Compute his/her TER (based on his occupation/activity)
Step 3 : Identify his percentage requirement (based on his/her health condition or dietary
Requirement

Step 4: Distribution of TER on CHO, PRO, FATS

TER x % CHO
TER x % PRO
TER x % FAT

Percentage Distribution
CHO 50-70%
60% (average)
PRO 10% (infant/children)
10-15% (adolescent/adult)
FAT 20-25% (adult)
30-35% (children)

Step 5 : Gram distribution

% CHO / 4 (fuel value) = ____gm.

%PRO / 4 (fuel value) = ____ gm.
% FAT / 9 (fuel value) = _____ gm.
Step 5 : Meal Distribution

COMPOSITION OF FOOD EXCHANGE LIST

LIST FOOD MEASURE CHO PRO FAT CAL
IA Veg A 1 c. raw, ½ c cooked - - - 16
IB Veg B ½ c raw & cooked 3
II Fruit varies 10 - - 40
III Milk
Full Cream Varies 12 8 10 170
Low Fat 4 tablespoon 12 8 5 125
Skimmed 4 tablespoon 12 8 - 80

IV Rice Varies 23 2 - 100

28
 V Meat
Low Fat Varies - 8 1 41
Medium Fat - 8 6 86
High Fat - 8 19 122
VI Fat 1 tsp. - - 5 45
VII Sugar 1 teaspoon 5 - - 20

FOOD DISTRIBUTION

Example: 336g 84 g. 63 g. 2,240

LIST FOOD MEASUR CHO PRO FAT CAL
E
IA Veg A 3 - - - 48
IB Veg B 3 9
II Fruit 5 50 - - 200
III Milk 1 12 8 5 125
Sub: 71
(336-71)=265
265/23 = 11
IV Rice 10 230 20 1000
Sub : 28
(84-
28)=56
(56/8)= 7
V Meat 7 56 42 602
Sub: 47
(63-
47)=16
(16/5)=3
VI Fat 3 15 135
VII Sugar 4 40 80

341 84 62
2,190

MEAL DISTRIBUTION
FOOD BFAST LUNCH DINNER AM SNACK PM SNACK
Veg A 1 1 1
Veg B 1 1 1
FRUIT 1 1 1 1 1
MILK 1
RICE 2 2 2 2 2
MEAT 2 1 1 1 1
FAT 1 1 1
SUGAR 1 1 1 1

29
 CHAPTER 6
NUTRITIONAL ASSESSMENT
What is Nutritional Assessment?
is an in-depth evaluation of both objective and subjective data related to an individual's
food and nutrient intake, lifestyle, and medical history.

Aims of Nutritional Assessment

1. To identify certain specific nutritional problem.
2. To map out magnitude and geographical distribution of malnutrition
3. To determine ecological factors responsible for malnutrition.

Methods of Assessment:
) Direct Assessment – based on physical sign
a) Diet History – This method evaluates the primary factor of nutritional inadequacy.
b) Physical Method or Anthropometric– Taking weight & height data
c) Medical History – record of the person’s
past illnesses
d) Clinical Examination – physical signs associated with malnutrition
e) Biochemical Tests – blood plasma, tissue biopsy, urinalysis

B. Indirect Assessment – use of data, statistics and other information. Includes

food consumption, eating practices
1) Vital Statistics -
a) age specific mortality – no. of death/age and sex group
ave. population of the same age
b) Infant Mortality Rate – no. of deaths below 1 yr.
over the number of live births
c) Maternal Morality Rate – no. of deaths among women due to pregnancy,
labor / total live birth
d) Morbidity Rate – no. of reported cases of a given disease present at a given
time per 100,000 population

2. Conditioning infections – diarrhea, measles, tb

3. Food Balance Sheet – rough estimate of food supplies
available for consumption
4. Dietary Survey – 24 hr. food recall

30
 5. Cultural and anthropological influences
6. Socio economic factors- population, family, education
7. Food production -
8. Health and educational services

Methods of Assessing Dietary Intake:

1. 24 Hr. Recall – recall of all what he/she had eaten within 24 hrs.
2. Food Frequency Questionnaire
3. Diet History
- It is more complete than the two previous method. It contains the following:
 Economic ( income, amount of money for food)
 Physical Activity (occupation, exercise, sleep)
 Ethnic & Cultural Background (religion, educ)
 Home life & Meal Patterns (no.per household,
person who does the cooking, type of house)
 Appetite (good, poor)
 allergies, intolerances, food avoidance
 Dental/Oral health
 Gastrointestinal ( heartburn, diarrhea, constipation)
 Chronic Diseases
 Medication
4. Food Diary - The subject is asked to write down everything that he eats for
a certain time. It could be 3 days, two weeks
5. Observation of food intake – most accurate but most time consuming.
It requires knowing the amount and kind of food presented and the record
of the amount actually eaten.

CHAPTER 7
MALNUTRITION

Malnutrition – It is the condition of the body resulting from a lack of one or more
essential nutrients or due to excessive nutrient supply.

31
 2 Conditions of Nutritional Status

1) Optimum or Good Nutrition – body has adequate supply of essential nutrients for growth &
health
2) Malnutrition – A condition of the body resulting from a lack of one or more nutrients or it may be
due to an excessive nutrient supply creating toxic or harmful effects

Forms of Malnutrition
1. Under nutrition – resulting fro inadequate quantity of food, over an extended period of time
(kwashirkor, marasmus)
2. Specific Deficiency – resulting from a relative or absolute lack of an individual nutrient ( iron
deficiency)
3. Over nutrition – resulting from the consumption of an excessive quantity of food, calorie excess
(obesity)
4. Imbalance – resulting from a disproportion among essential nutrients, with or with out absolute
deficiency of any nutrient.

Types of Malnutrition
1. Acute Malnutrition- related to present state nutrition
ex. Loss of weight
2. Chronic Malnutrition – related to the past state of nutrition
3. Primary Malnutrition – caused by lack or unavailability of food (dietary malnutrition)
4. Secondary Malnutrition – caused by certain conditioning factors other than food alone

Nutritional Deficiencies

1) Primary Factor- refers to faulty diet

a. Poverty
b. Ignorance
c. Poor food Habits
d. Limited food supply
e. Poor distribution of foods
f. Cultural Taboos
g. Low level of education
h. Urbanization
i. Infectious diseases / parasitism

2. Secondary Factors:
a) Interfere with normal digestion
1. Gastrointestinal disorder
2. Lack of appetite

32
3. Poor teeth
4. Lack of digestive enzymes
b) Factors that interfere with absorption
1. Diarrhea
2. Mal absorption Syndrome
3. Intestinal Surgery
4. Laxative
5. Parasitism

Factors that affect metabolism & utilization in the cells

1) Liver diseases
2) Malignancy
3) Some drugs
4) Alcoholism
5) Toxins
6) Diabetes Mellitus

Pathogenesis of Nutritional Deficiency

Primary (Dietary)

Nutritional inadequacy tissue depletion (loss of weight)

biochemical changes (laboratory)

functional symptoms ( symptoms appear)

anatomical lesions (physical signs )

Effects of Malnutrition

1. Increase susceptibility to infections

2. Inhibits mental development
3. Imposes heavy social and economic burdens

Prevention &Treatment of Malnutrition

Prevention:
1) Increase economic stability
2) Educate the people
3) Practice good sanitation and hygiene
4) Increase food production

33
 5) Eat balance diet
6) Exercise
7) Social Awareness ( thin is not “in”)

CHAPTER 8
FOOD & DRUG INTERACTION
Introduction
Medications, both prescription and over-the-counter, are used every day to treat acute and chronic illness. Research
and technology constantly improve the drugs we have available and introduce new ones. Medications can help
people live healthy lives for a prolonged period. Although medicines are prescribed often, it is important to realize that
they must still be used with caution.

Foods, and the nutrients they contain, can interact with medications we take. This can cause unwanted effects. A
food/drug interaction occurs when a food, or one of its components, interferes with the way a drug is used in the
body. A drug/nutrient interaction occurs when a drug affects the use of a nutrient in the body.

Risk Factors
Risk for food/drug and drug/nutrient interactions can be affected by many factors such as:

 age
 gender
 medical history
 body composition
 nutritional status
 number of medications used

How Drugs React in the Body

In order to understand food/drug and drug/nutrient interactions, it's important to understand how drugs work in the
body. There are four stages of drug action for medicines taken by mouth:

Stage 1. The drug dissolves into a useable form in the stomach.

Stage 2. The drug is absorbed into the blood and transported to its site of action.

Stage 3. The body responds to the drug and the drug performs a function.

Stage 4. The drug is excreted from the body either by the kidney or the liver, or both.

Not all medications are taken by mouth. Still, they are all transported to the site of action. Effects of drug/nutrient and
food/drug interactions vary according to:

 type of medication
 form of drug (pill, liquid, etc.)
 dosage

34
 site of absorption (mouth, stomach, intestine)
 route of administration (oral, intravenous, etc.).

Definitions
Absorption: the passage of substances from the GI tract into the blood.

Excretion: removal of drugs or nutrients from the body.

Intravenous: within the blood.

Nutritional status: nutrition-related health.

Transport: movement of a substance from one site in the body to another.

Food/Drug Interactions
Foods can interfere with the stages of drug action in a number of ways. The most common effect is for foods to
interfere with drug absorption. This can make a drug less effective because less gets into the blood and to the site of
action. Second, nutrients or other chemicals in foods can affect how a drug is used in the body. Third, excretion of
drugs from the body may be affected by foods, nutrients, or other substances.

With some drugs, it's important to avoid taking food and medication together because the food can make the drug
less effective. For other drugs, it may be good to take the drug with food to prevent stomach irritation.
Alcohol can affect many medications. Always check with your pharmacist about possible effects of alcohol on your
medication.

Grapefruit Juice and Drugs

Grapefruit juice contains a compound that increases the absorption of some drugs. This can enhance their effects.
This compound is not found in other citrus juices.

It's best to not take medications with grapefruit juice. Drink it at least two hours away from when you take your
medication. If you often drink grapefruit juice, talk with your pharmacist or doctor before changing your routine.

Drug/Nutrient Interactions
It is also possible for drugs to interfere with a person's nutritional status. Some drugs interfere with the absorption of a
nutrient. Other drugs affect the body's use and/or excretion of nutrients, especially vitamins and minerals. If less of a
nutrient is available to the body because of these effects, this may lead to a nutrient deficiency.
Sometimes drugs affect nutritional status by increasing or decreasing appetite. This affects the amount of food (and
nutrients) consumed. Some specific examples of drug/nutrient interactions are given in Table 2.
The Different Groups of Medicines
Drugs are grouped into classes based on illnesses for which they are prescribed. They can also be grouped in other
ways, such as their chemical make-up or actions in the body. Different foods can interact with more than one class of
drugs.
Table 3 is a list of 14 drug classes and the uses for each. If you take medication in one of these classes, be aware of
potential food/drug and drug/ nutrient interactions. If you aren't sure which classes your medicines fall into, ask your
doctor or pharmacist.
Analgesic
Analgesics are drugs that relieve pain. Analgesics often cause stomach irritation. It's a good idea to take analgesics,
like aspirin, with food. A full stomach lowers the risk for stomach irritation.

35
Antacid, Acid Blocker
Antacids neutralize stomach acid, and acid blockers reduce stomach acid production. Long term use of these drugs
may lead to certain nutrient deficiencies. This is because stomach acid is important in the digestion and/or absorption
of nutrients.
Older people produce less stomach acid, which leads to low absorption of vitamin B 12 . Regular use of antacids or
acid blockers lowers vitamin B 12 absorption even more. Vitamin B 12 supplements may be needed in this situation.

Antibiotic
Antibiotics are used to treat bacterial infections. There are many different types of antibiotics. Some antibiotics
decrease the synthesis of vitamin K by the bacteria normally found in our intestines. Vitamin K is important for normal
blood clotting.
Tetracycline antibiotics bind to calcium found in dairy products. This can decrease the absorption of the antibiotic.
Other drugs like penicillin and erythromycin are most effective when taken on an empty stomach. This is because
they may be partially destroyed by stomach acid when taken with food. However, food can reduce the chance of
stomach irritation from these drugs. Ask your pharmacist if you should take your antibiotic with or without food.

Anticoagulant
Anticoagulants slow the process of blood clotting. This can decrease risk of strokes in patients whose blood tends to
clot too easily. These drugs, like warfarin (Coumadin), work by interfering with the use of vitamin K in blood clotting.
People taking these anticoagulants should be consistent in the amount of vitamin K they get from foods. It's very
important to avoid eating large amounts of foods high in vitamin K. Rich sources of vitamin K include liver, and green
vegetables such as broccoli, spinach, and other leafy greens.

Anticonvulsant
Anticonvulsant drugs help control seizures. Phenytoin (Dilantin), phenobarbital, and primidone may cause diarrhea
and a decrease in appetite. This can decrease the availability of many nutrients.
These drugs also increase the use of vitamin D in the body. This means that less vitamin D is available for important
functions such as calcium absorption. Vitamin D supplements may be needed.
Some anticonvulsants also interact with the B vitamin folic acid. When drug therapy is started, folic acid levels in the
body decrease. Because folic acid supplements affect blood levels of the drug, folate supplementation must be
supervised by a doctor.

Antihistamine
Antihistamines are used to treat allergies. Many of these drugs often cause drowsiness. They may also increase the
appetite, which can lead to weight gain. Increased physical activity can help reduce weight gain. Alcohol can cause
an even greater increase in drowsiness caused by antihistamines like diphenhydramine (Benadryl),
chlorpheniramine (Chlor-Trimeton), and other over-the-counter drugs containing antihistamines.

Anti-inflammatory
Anti-inflammatory medication is prescribed to patients for a number of problems such as chronic joint pain,
headaches, and arthritis. Long-term use may lead to stomach irritation and eventually ulcers. These medications
should be taken with food.

Blood Pressure Lowering Drugs

Antihypertensives are used to control high blood pressure. This group of medications is widely used throughout the
United States due to the large number of people with high blood pressure.
These medications can affect body levels of minerals such as potassium, calcium, and zinc. For patients with
diabetes, these drugs can cause problems in controlling blood sugar. In addition, natural licorice, found in some
imported candies, causes salt and water retention. This can lead to an increase in blood pressure.

Cancer Drugs
Antineoplastic agents are used to treat different forms of cancer. These drugs can irritate the cells lining the mouth,
stomach, and intestines. Many cause nausea, vomiting, and/or diarrhea. All of these can affect nutrient status.
Methotrexate reduces availability of the B vitamin folic acid. Supplementation of folate may be recommended for
people taking this drug, but ask your doctor before starting folic acid.

36
Diuretic
Diuretics cause the body to excrete more urine and are often used to treat high blood pressure. Some diuretics
increase urine losses of minerals such as potassium, magnesium, and calcium. Others limit mineral loss (especially
potassium). It is important to talk with your doctor about whether you need to take or avoid mineral supplements.

Laxative
Laxatives speed up the movement of materials through the digestive tract. This reduces the time for nutrient
absorption. Excessive use of laxatives can deplete vitamins and minerals needed for normal body function. Laxatives
also increase fluid losses. This may lead to dehydration.

Lipid Lowering Drugs

Lipid lowering drugs, also called Antihyperlipemic drugs, reduce blood cholesterol levels. Medications such as
cholestyramine (Questran) may decrease the absorption of the fat soluble vitamins (A, D, E, and K), vitamin B 12 ,
folic acid, and calcium. For long-term use, it may be helpful to take a multivitamin and a calcium supplement.

Mental Health Drugs

Psychotherapeutic drugs treat depression, anxiety, and other mental health conditions. Some of these drugs increase
appetite while others decrease it. Either effect can impact weight in a significant way.
Avoid alcohol when using these drugs. Alcohol can intensify the drowsiness caused by this class of drugs. Some
psychotherapeutic drugs are Monoamine Oxidase (MAO) inhibitors.
MAO Inhibitors
These drugs decrease the body's use of compounds called monoamines. MAO inhibitors can also react with tyramine
(a monoamine) found in foods. This reaction can cause a dangerous rise in blood pressure. If not treated, this can
cause death. Some aged and fermented foods are high in tyramine. They should be avoided by people taking MAO
inhibitors. A few of these foods are:
 aged cheese
 Brewer's yeast, yeast extracts
 Chianti wine
 pickled herring
 fava beans
If you are not sure if you are taking a MOA inhibitor, ask your doctor or pharmacist.

Things to Keep in Mind

As you probably know, there are a wide variety of medications on the market today. Almost all medications have the
potential to cause side effects. Many people take more than one medication. This is especially true with older people.
When people take multiple medications, food and drug interactions are more likely to occur. The following tips can
help you avoid problems with your medication.

 Always carry a list of all your medications and the dosing instructions.
 When your doctor prescribes a new medication, tell him/her all the other drugs you already take. This includes
over-the-counter drugs and supplements that you use regularly. Also, remind your doctor about any drug
allergies you have.
 Know how and when to take all of your medications. If you have any questions, ask your doctor or pharmacist.
 If you have any side effects from a medication, contact your doctor or pharmacist immediately. Do not wait until
your next appointment. If you are not sure if symptoms are related to your medication, be sure to ask.

37
 It is usually best to take medication with a full glass of water. This may help to prevent stomach irritation and
improve absorption. Don't take medications with soft drinks or grapefruit juice.
 Get your prescription refilled before you run out so that there are no missed doses.
 Don't stir your medication into food or drink unless your doctor or pharmacist tells you to. Certain foods may
break down the drug, or limit its absorption.
 Always read the directions and warning labels on your medication bottles and packages. If you don't understand
something, ask your doctor or pharmacist.
Table 1. 

Table 1: Examples of Food/Drug Interactions

Effect of the
Drug Class Food that Interacts What to Do
Food
Analgesic Increases risk for
Alcohol Avoid alcohol
acetaminophen (Tylenol) liver toxicity
Antibiotic →Decreases drug
→Do not take with milk.
absorption
→tetracyclines →Dairy products; iron Take 1 hour before or 2
supplements →Decreases drug hours after food/milk.
→amoxicillin, penicillin, absorption
zithromax, erythromycin →Food →Take 1 hour before or 2
→Decreases GI hours after meals.
→nitrofurantoin →Food
distress, slows drug
(Macrobid) →Take with food or milk.
absorption
Limit foods high in Vitamin
Anticoagulant Decreases drug K: liver, broccoli, spinach,
Foods rich in Vitamin K
warfarin (Coumadin) effectiveness kale, cauliflower, and
Brussels sprouts
Causes increased Avoid alcohol
Anticonvulsant Alcohol
drowsiness
phenobarbital, primidone Decrease in drug
Vitamin C Avoid excess vitamin C
effectiveness
Antifungal Increases drug
High-fat meal Take with high-fat meal
griseofulvin (Fulvicin) absorption
Antihistamine
diphenhydramine
Increased
(Benadryl), Alcohol Avoid alcohol
drowsiness
chlorpheniramine
(Chlor-Trimeton)
Antihyperlipemic Enhances drug
Food Take with food
lovastatin (Mevacor) absorption
Consult your physician or
Antihypertensive
Increases drug Pharmacist before
felodipine (Plendil), Grapefruit juice
absorption changing diet.
nifedipine
→Decreases GI
→Food or milk →Take with food or milk
Anti-inflammatory irritation
→Increases risk for
naproxen (Naprosyn), liver
ibuprofen (Motrin) →Alcohol →Avoid alcohol
→Damage or
stomach bleeding

38
Diuretic
spironolactone
(Aldactone)
Psychotherapeutic
MAO inhibitors:
isocarboxazid (Marplan),
tranylcypromine
(Parnate),
phenelzine (Nardil)
Decreases GI
Food Take with food
irritation
Foods high in tyramine: aged
cheeses, Chianti wine, Risk for Avoid foods high in
pickled herring, Brewer's hypertensive crisis tyramine
yeast, fava beans

Table 2: Examples of Drug/Nutrient Interactions

Food that
Drug Class Effect of the Food What to Do
Interacts
Acid Blocker
ranitidine (Zantac),
Decrease vitamin Consult your physician regarding B12
cimetidine (Tagamet), Vitamin B12
absorption supplementation
famotidine (Pepcid),
nizatidine (Axid)
Antihyperlipemic Fat soluble
cholestyramine vitamins Decreases vitamin Include rich sources of these vitamins in
(Questran), absorption the diet
colestipol (Colestid) (A, D, E, K)
Antineoplastic Folic acid, vitamin Decreases vitamin Consult your physician regarding
methotrexate B12 absorption supplementation
Diuretic
furosemide (Lasix), Increases mineral loss in Include fresh fruits and vegetables in the
Many minerals
hydrochlorothiazide urine diet
(HCTZ)
Laxative Vitamins and Decreases nutrient Consult your physician regarding
fibercon, Mitrolan minerals absorption supplementation

Table 3: Examples of drug classes and their uses.

Class Used to treat...
Analgesic Pain
Antacid, Acid Blocker Stomach upset, ulcers
Antibiotic Infection
Anticoagulant Blood clots

39
 Anticonvulsant Seizures, epilepsy
Antihistamine Allergies
Antihyperlipemic High blood cholesterol
Antihypertensive High blood pressure
Anti-inflammatory Fever, inflammation
Antineoplastic Cancer
Diuretic Water retention
Laxative Constipation
Psychotherapeutic Depression, anxiety

CHAPTER 8
NUTRITION IN THE LIFE CYCLE
PREGNANCY

• Pregnancy – (Gestation) is a period

when the fertilized ovum implants
itself in the uterus. Human pregnancy
last for the period of 266 – 180 days
( 37-40 weeks)
BIOLOGICAL CHANGES:
• 1. Implantation Period – 1st 2 weeks
• Period of organ formation- next 6
weeks
• Period of rapid fetal development –
remaining 7 months

• Nutrition in Pregnancy:
• During the total pregnancy period, the basal metabolic rate increase from 6-14%

40
• Calorie intake is increased – 10-20% increase ( if the woman is overweight it is necessary for her
o reduce)
• Protein - Increase in nitrogen content of the fetus and its membranes and added protection of
the mother against complications
• Increase of 9.5 gms./ day

• Calcium / Phosphorus / Vit. D – Increase , to calcify the fetal bones & teeth (0.5 – 0.9 of the
RDA)
• Iron – Increase, 700-1000 mg. of Fe is absorbed during the pregnancy
• Iodine – to help the mother and the child prevent goiter in the future and for brain
development
• Folic Acid - women of childbearing age consume 400 micrograms (0.4 mg) of folic acid each day.
Folic acid, a nutrient found in some green, leafy vegetables, most berries, nuts, beans, citrus
fruits, fortified breakfast cereals, and some vitamin supplements can help reduce the risk of
birth defects of the brain and spinal cord (called neural tube defects).

Dangerous for pregnant women

• Alcohol, Caffeine & Nicotine –
• Smoking – lowers the birth weight, increase the perinatal mortality, decrease oxygenation of
the fetus
• Alcohol – mental retardation, growth deficiencies, facial deformities.

LACTATION
• Calories – additional 1000 calories –
help to produce milk
• Protein – additional of 20 gms. , to
compensate the protein lost in milk
• Calcium & Phosphorous – Increase of
0.5 mg., to prevent severe depletion
of maternal calcium for milk
production
• Iron – additional intake is
recommended for blood lost
• Vit. A – additional 2000 IU, needed in
the ilk secretion
• Riboflavin, Vit. C – increase

Fluids – 8 glasses or more

Factors Affecting Milk Secretion

1)Diet – intake of meat & veg. soup (tahong, tulya, malunggay) “galactogue”
• Stimulate milk secretion
• Water should not be drunk beyond the level of natural thirst. It suppress milk secretion

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 2. Nutritional State of Mother – Malnutrition and illnesses (cardiac and kidney diseases, anemia,
beri-beri, tuberculosis) can lessen the quanity and quality of milk
• Emotional & Physical State – relax, pleasant surroundings, lots of rest and good sleep
• Suckling - suckling right after delivery stimulate milk secretion
• Contraceptives & Drugs – depress milk flow

Advantages of Breast Feeding

COLOSTRUM – thin yellowish fluid secreted during the first 2 days
1. Breast milk produces anti bodies, immunity against diseases
2.Lactose is higher in breast milk, to produce beneficial bacteria in the GI tract.
3.Calcium and Phosphorus level are regulated
4. Prevent dental arch
5.Cow’s milk protein causes allergy
6. Less incidence of lung cancer
7. Fast return of the uterus to its original size
8. Biologically complete
9. Easily digested
10. Convenient and dependable
11. Safe
12. Emotional satisfaction between mother & child
INFANCY
• Growth – increase in size due to increase in the number of cells
• Development – increase in functional ability
• Behavioral Development of a Healthy Baby
0-1 month suckles & smiles
2-3 months vocalize & controls head
4-5 months controls hands & rolls over
6-7 months sits briefly & crawls
8-9 months grasps & pulls up
10-11 months walks with support
12 months stars to walk alone

Methods of Feeding the Infant:

1) Breast Feeding
2) Artificial Feeding – bottle feeding using infant formula
3)Mixed Feeding – combination of breast & bottle

Milk Formula:
A) Whole Cows Milk Formula
1. Powdered whole cow’s milk – milk dried under controlled condition
(Nido, Birch Tree, Anchor Mik)
2. Full Cream evaporated Milk – whole milk from which 50-60% of water content has been
removed
3. Recombined milk – skim milk powder reconstituted to normal fat content of the whole milk
by adding butterfat

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 4.Reconstituted milk – process milk to which water is added to restore its original water content
(Frisian Girl, Alpine)

B) Other type of evaporated milk not recommended for infants

1. Sweetened condensed – High in sugar resulting in very diluted milk formula
2. Evaporated Filled Milk – cow’s milk from which butterfat has been removed
and replaced with vegetable oil
(94% coconut oil, 6% corn oil)
3. Skim Milk – butter fat has been removed (Enfamil, Olac)
4.Acidified Milk – increase digestibility ( Pelargon, Acidolac)
5.Completely Modified Milk Formula – Protein & mineral content are adjusted
to resemble human milk (SMA, S-26, Similac)
6. Non- cows Milk formula – Soybase for infant’s allergy to cow’s milk ( Sobee, Mullsoy, Isomil)

Note: goat’s milk has also been found effective as hypo allergenic milk

Baby’s Food During the 1st Year of Life:

1. Cereal Foods – (3-4 months), milk is still continued
2. Fruits – (3-4 months) , mashed
3. Vegetables – (3-4 months) , mashed (carrots, squash, sayote,) green leafy vegetables may
be mashed and sieved and mix with other foods.
4. Eggs –( 4- 5 months) , only eggyolk is given
5. ( 9-10 months) , can give the whole egg
6. Munggo – ( 5 months) cooked well and strained
7. Meat, fish or Poultry – ( 5-6 months) , ground and strained
8. Other Foods – custards, puddings, plain ice cream, plain gulaman or jello

HOW TO GIVE SUPPLEMENTARY FOODS

• Introduce one food at a time
• Give small amounts of foods
• Use thin, soft consistency. Gradually, modify the consistency
• Never force an infant to eat more of a food he can takes
• Omit the food if the infant refuse to eat several times
• slightly seasoned with small amt. of salt
• Variety of foods is important
• don’t show any dislikes for the food

NUTRITION FOR PRE-SCHOOL

• This is the most difficult stage in feeding a child since the appetite tapers off corresponding to
the lower rate of growth.
Foods to Give the Pre-School Child:
1) Mildly flavored foods
2) Plain foods is acceptable than mixed foods.
3) Fruits, puddings, custard, ice cream and gelatin may be given

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 Sign of Good Nutrition in Pre-School Child
– Alert, vigorous and happy
– Endurance during activities
– sleeps well
– Normal height and weight for age
– Stands erect, arms and legs straight
– Clear, bright eyes, smooth healthy skin, lustrous hair
– Firm and well developed muscles
– Not irritable and restless
– Good attention

NUTRITION FOR SCHOOL CHILD

Feeding Problems
Limited time for eating
Poor Eating practices
Unbalance program of activities & rest
Recommended Solutions:
allow sufficient time for meals
Encourage child to eat more fruits & vegetables
Provide child with properly selected snacks
Regulate the activities
Guidance in proper food selection
NUTRITION FOR ADOLESCENTS
The best nutrition advise to keep your adolescent healthy includes encouraging her to:
• Eat a variety of foods
• Balance the food you eat with physical activity
• Choose a diet with plenty of grain products, vegetables and fruits
• Choose a diet low in fat, saturated fat, and cholesterol
• Choose a diet moderate in sugars and salt
• Choose a diet that provides enough calcium and iron to meet their growing body's
requirements.

NUTRITION IN THE ELDERLY

Nutritional Requirements:
• Energy (calories) – decreases in calories because of reduced basal metabolic rate and reduce in
physical activities. A decrease of 7.5% intake after 45 yrs. Of age
• Protein – Protein allowance of 1.12 gms./kg. body weight is maintained
• Necessary for the prevention and tissue wasting and susceptibility to diseases
• Minerals (Calcium) – is maintained to prevent occurrence of osteoporosis
• Iron – Iron allowand for women 50 and above is as low as 7.0 mg/day
• Vitamins – Vit. C is needed for the absorption of calcium and iron. Intake of Vit. E to retard
cellular aging.
• B complex – to maintain good appetite
• Water & Fiber – 6-8 glasses a day. To prevent constipation

FACTORS AFFECTING ADEQUATE FEEDING

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 • Long standing dietary habits
• Loss of teeth
• Loss of taste and smell
• Loss of neuromuscular coordination
• Physical discomfort
• Economic consideration
• Social Factors
• Psychological factors

Diet Recommendation
1. Eat good breakfast to start the day
2. Eat 4-5 light meals a day
3. Include essential foods (fish, vegetables, fruits)
4. Eat leisurely in pleasant surroundings
5. Eat the heaviest at noon
6. Avoid fatty foods
7. Avoid coffee
8. Drink hot milk before going to bed

CHAPTER 7

DIET THERAPY
Purpose of Diet Therapy:
1. To maintain or restore good nutritional status
2. To correct nutritional deficiencies which may occurred
3. To afford rest to a particular organ
4. To adjust the diet to the ability of the body to metabolize the nutrients
5. To bring about the changes in the body weight

Hospital Routine Diet:

1. Full, general or regular diet – designed for patients who require no special dietary modifications
or restrictions.
2. Soft Diet – patients who are unable to chew, swallow or digest foods
3. Liquid Diet – Clear, full, cold, osterized, blenderized or tube feeding

Therapeutic Diet:
A. Modification in Consistency

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 Liquid Diet
1. Clear Liquid Diet
Indication : surgery, inflammatory on GI Tract, necessary to minimize fecal material
Food Selection : clear, fat-free broths, strained juices, tea, black coffee, gelatin, hard
candies, give small amount every 1-2 hrs
2. Full Liquid Diet
Indication : Post operative, acute infection, impaired chewing and swallowing,
mouth
Surgery
Food Selection: strained cream soups, pureed fish and juices, plain gelatin, plain ice
cream, custard, milk & mild drinks, 6-8 frequent feeding.

3. Cold Liquid Diet

Indication : Tonsilectomy, dental extraction, throat & mouth operations
Food Selection : Plain ice creams, cold milk, iced tea, iced coffee

Soft Diet
Patients who are unable to chew, swallow or digest foods

1. Minimum Residue Diet

Indication : Dysentery, Diarrhea, Pre and post operation, colostomy, ileostomy
Food Selection : plain, strained foods, lean, tender meats, chicken no skin, soft
cooked egg, strained vegetables
Avoided: milk, cheese, raw eggs, vegetables, fruits, coarse bread, fried foods

2. Bland Diet
Indications: Gastric, Doudenal ulcers, gastritis, ulcer, cardiac cases
Food Selections: mild in flavor, no coarse fiber and tough connective tissue
Avoided: Black pepper, chili powder, strong coffee, alcohol

3. Mechanical Soft
Indications : Poor dentures, lack of teeth, sores & lesions in the mouth
Spastic constipation, diverticulisis, other gastro-intestinal disturbances
Food Selections : full diet but reduced amount (grinding, chopping, mincing)

B. Modification in Composition

1. High Calorie Diet

Indications: Underweight, PEM, fevers, infections, hypertyroidism, burns, growth,
pregnancy, lactation
Food Selections: Normal diet , increase amount of cereals, breads, butter, cream , fats and sugar
Avoided: Excessive amount in bulky low calorie foods

2. Low Calorie Diet

Indications : Obesity, diabetes, renal failure, gout, gallbladder, preceding surgery
Food Selections :Emphasize in bulk low in calorie for satisfied feeling

3. High Carbohydrates
Indications : renal & liver disturbances, toxemia of pregnancy, Addisons's disease
Food Selections -Emphasize on rice and other cereals, root crops, noodles, sugar, native cakes

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 4. Low Carbohydrates
Indications : Hyperinsulinism, dumping syndrome, obesity, epilepsy, celiac disease
Food Selections : Foods high in protein, adequate to high fat foods, in certain conditions

5. High Protein
Indications : Growth, pregnancy, malnutrition, lactation, burns, surgery, fractures,
anemia, hepatitis, cirrhosis, hyperinsulinism
Food Selections : With emphasis on meat, milk, eggs, cheese, poultry

6. Low Protein
Indications : Acute glomerunephritis, uremia, hepatic coma
Food Selections : Avoided: protein foods in excess amounts, limit the intake of legumes, nuts

7. Zero Protein

Enteral & Parenteral Feeding

Parenteral feeding –
(Total Parenteral Nutrition)
describes the intravenous administration of nutrients.
• Designed for individuals who cannot accept nutrients enterally.
• The person receives nutritional formulas containing salts, glucose, amino acids, lipids
and added vitamins.

GENERAL USAGE

• Is provided when the

gastrointestinal tract is
nonfunctional.
• When the patient is comatose
• Patient’s digestive system has
shut down
• To treat people suffering the
extended consequences of an
accident, surgery, or digestive
disorder.

Method of Administering TPN

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 TPN is administered by:

1) Medical infusion pump

2) A sterile bag of nutrient solution

Performed through a central intravenous catheter, usually through the

subclavian jugular vein with the tip of the catheter at the superior vena cava without
entering the right atrium. Another common practice is to use a PICC line, which
originates in the arm, and extends to one of the central veins, such as the subclavian
with the tip in the superior vena cava. In infants, sometimes the umbilical vein is
used.

Complications:

1. Bacterial and fungal infections

2. Liver failure due to excess glucose contained
in the solution.
3. acute cholecystitis due to complete unusage of gastrointestinal tract

ENTERAL FEEDING:

Enteral Feeding – delivery of food and nutrients either orally or by tube feeding directly into
GIT.

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Types of Enteral Feeding

Gastric feeding tube

• A gastric feeding tube (or "G-tube,"

or "button") is a tube inserted
through a small incision in the
abdomen into the stomach and is
used for long-term enteral
nutrition.

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 • Nasogastric intubation is a medical process
involving the insertion of a plastic tube
through the nose, past the throat, and
down into the stomach.
• Use to treat anorexia nervousa

Types of Enteral Formulation

1. Ready to Use formulations

2. Tube feedings – prepared from regular foods
3. Blenderized Tube feeding – are soft diet which can be blenderized.
4. Standard tube feeding – fiber free, high in cholesterol, fat and sugar. (milk, sugar and soft
cooked eggs)

Complications:

1. Mechanical
a) Nasopharyngeal irritation
b) Luminal obstruction
c) Mucosal erosions
d) Tube displacement
e) Aspiration
2) Gastrointestinal
a) cramping/distention
b) vomiting/diarrhea
c) costipation
3) Metabolic
a) Hypertonic dehydration
b) Glucose intolerance
c) Cardiac failure
d) Renal failure
e) Hepatic ecephalopathy

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