NDT LEC REVIEWER FINALS • They are sweet and must be changed to simple

sugars by hydrolysis before they can be absorbed.

MODULE 1: CARBOHYDRATES • Sucrose
- Is composed of glucose and fructose
Carbohydrates - It is the form of carbohydrates present in
• provide the major source of energy of our body granulated, powdered, and brown sugars
• Provides 80-100% of calories. and in molasses
• Carbohydrates is composed of carbon (C), hydrogen - It is one of the sweetest and cheapest
(H) and oxygen (O) sugars
Functions - Its sources are sugar cane, sugar beets, and
• Provides energy the sap from maple tree.
• Protein-sparer • Maltose
• Normal fat metabolism - It is an intermediary product in the hydrolysis
• Provides dietary fibers of starch
- It is produced by enzyme action during
Food Sources of Carbohydrates digestion of starch in the body.
Cereals Vegetables Fruits Sugars - It is also created during fermentation process
that produces alcohol.
Wheat Potatoes Apple Table sugar - It can be found in some infant formulas, malt
Corn Beets Orange Syrup beverage products and beer.
Bread Peas Rambutan Honey - It is less sweet than glucose and sucrose.
Cereal Starchy beans Papaya Desserts • Lactose
Pasta (lima beans) Candies - Is the sugar found in milk.
Rye Green leafy - It is distinct from most sugar because it is not
Oats vegetables found in plant.
- It helps the body absorb calcium.
- Is less sweet than monosaccharide and
Classification of Carbohydrates other disaccharides.
• Monosaccharides - Lactose Intolerance
• Disaccharides ▪ Is unable to digest lactose and
suffer from bloating, abdominal
• Polysaccharides
cramps, and diarrhea after drinking
milk or consuming a milk-based
Monosaccharides
food such as processed cheese. It
• Are the simplest form of carbohydrates. They are
is caused by insufficient lactase, the
sweet and require no digestion and absorbed directly
enzyme required for digestion of
from the bloodstream from the small intestine.
lactose.
• Glucose – also called dextrose. - Special Low-Lactose Milk Products
- Is the form of carbohydrates to which all
other forms are converted and metabolized. Polysaccharides
- It is found naturally in corn syrup and some
• are commonly known as complex carbohydrates
fruits and vegetables
because it is composed of many monosaccharides
- Central nervous system, the red blood cells
(simple sugar).
and the brain uses only glucose as fuel.
• Starch
• Fructose
- A polysaccharide found in grains and
- Also called levulose or fruit sugar
vegetables
- Is found with glucose in many fruits and
- It is the storage form of glucose in plants
honey.
• Glycogen
- It is the sweetest monosaccharides
- Is the storage form of glucose in the body
• Galactose
- Is stored in the liver and muscles
- Is the product of the digestion of milk.
- Glucagon: The hormone that helps the liver
- It is not found naturally.
convert glycogen to glucose as needed for
energy.
Disaccharides
• Fibers
• Are pairs of the three sugars
The Fibers Water Insoluble Fibers
Dietary Fibers All Vegetables Fruits Whole Grains
• Also called roughage Brown Rice Wild Rice Wheat Bran
• Is indigestible because it cannot be broken down by Nuts Seeds
digestive enzymes.
• Two types of fibers • The optimal recommendation for fiber intake is
a. Insoluble 20/35g/day
▪ it does not readily dissolve in water • The recommended intake amount of fruit is 2 cups
▪ Cellulose and 2 ½ cups vegetables for a day who needs to
o primary source of dietary consume 2000 calories
fiber. • Fiber intake should be increase gradually and should
o It is found in the skin of accompanied by an increase intake of water.
fruits, the leaves and stem • Eating too much fiber in a short time can produce
of vegetables and legumes discomfort, flatulence (abdominal gas) and diarrhea.
o Has no energy value • Insoluble fiber has binders (phytic acid or phytate)
o It provides bulk for the which is found in outer covering of grains and
stool vegetables.
▪ Some hemicellulose
o is found mainly in whole- SUMMARY
grain cereal. • Carbohydrates is the major source of energy.
▪ Lignins • It is composed of carbon, hydrogen and oxygen.
o are the woody part of
• One gram of carbohydrate provides 4 calories.
vegetables such as carrots
• Are least expensive and most abundant nutrient.
and asparagus or the small
seeds of strawberries. • The principal sources of carbohydrates are plant
o They are not carbohydrate. products such as grains and their products,
vegetables, fruits, legumes and sugars.
b. Soluble • Carbohydrates provides energy, spares protein and
▪ it partially dissolve in water provides fiber.
▪ Gums • Digestion of carbohydrates start in the mouth,
▪ Pectins continues to the stomach and is completed in the
▪ Some hemicelluloce small intestine.
▪ Mucilages • Although they are essential to health and well-being
o Are soluble in water and of the body, eating an excess of the wrong type of
form a gel that helps carbohydrates can cause dental caries, digestive
provide bulk for the disturbances and obesity.
intestines
o They bind cholesterol thus
reducing the amount of MODULE 2: LIPIDS (FATS)
blood can absorb.
Functions of Fibers Fats
• Is helpful to clients with diabetes mellitus because it • Is an organic compound called LIPIDS.
help lower blood glucose levels • Lipid is derived from lipos, a Greek word for fat.
• It prevents colon cancer by moving waste materials • Are greasy substances that are not soluble in water.
through the colon faster than normal thereby reducing • It is soluble in some solvent such as ether, benzene
the colon’s exposure to potential carcinogen. and chloroform.
• Helps prevent constipation, hemorrhoids and • It provides a more concentrated source of energy
diverticular disease by softening and increasing the than carbohydrates
size of stool. • Each gram of fat contains 9 calories.
• Fat-rich foods are more expensive than carbohydrate-
Water Soluble Fibers rich foods.
Fruit (Pectin) Grains Legumes • Like carbohydrates, fats is composed of carbon,
Apples Oats Dried Beans hydrogen, and oxygen but with lower proportion of
Peaches Barley Peas oxygen.
Plums and Prunes Lentils
Bananas
Functions • Triglycerides
• Provides energy - are composed of three (tri) fatty acids
• Carry fat-soluble vitamins attached to a framework of glycerol.
• Supply essential fatty acids - Glycerol is derived from a water-soluble
• Protect and support organs and bones carbohydrate.
• Insulate from cold • Phospholipids
• Provide satiety after meals & delays onset on hunger • Sterols
• Protein sparing because its availability reduces the
need to burn protein for energy
• Contributes flavor and palatability to diet Fatty Acids
• Are organic compounds of carbon atoms to which
Food Sources hydrogen atoms are attached.
• Fats are present in both animal and plant foods.
• Animal foods that provide richest sources of fats are: Classification Of Fatty Acids
- Red meats • Essential
- Higher-fat poultry cuts with skin such as - Essential Fatty Acids (EFA) are necessary
thigh and wings fats that human cannot synthesize.
- Whole, Low-fat and reduced fat milk - Must be obtained from food.
- Cream - Are long-chain poly-unsaturated fatty acids
- Butter derived form
- Cheese made of cream ▪ linoleic acid (OMEGA-6)
- Egg yolks ▪ linolenic acid (OMEGA-3)
- Fatty fish such as tuna and salmon • Non-Essential
• The plant foods containing the richest sources of fats - The body can manufacture a modest amount
are cooking oils made from: provided EFAs are present.
- Olives ▪ Omega-9 fatty acid
- Sunflower
- Safflower Classification Of Fatty Acids
- Sesame seeds • Saturated Fat
- Corn - Each of the fatty acids carbon atoms carries
- Peanut all the hydrogen atoms possible
- Canola oils - Animal food contain more saturated fatty
- Soybeans acids than unsaturated.
- Margarine - Example include meat, poultry, egg yolks,
- Salad dressing or mayonnaise which is from whole milk, whole milk cheese, cream, ice
vegetable oil cream, and butter.
- Nuts, seeds, avocado, coconut, cocoa butter - Foods containing a high proportion of
• Plant fats do not raise cholesterol and are good for saturated fats are usually solid at room
the heart. temperature.
- It is recommended that one consume no
Types of Fats more than 10% of total daily calories as
• Visible saturated fats.
- Fats that are purchased and used as fats - Considered a contributory factor in
such as butter, margarine, lard and cooking atherosclerosis.
oils.
• Invisible
- Are found in other food such as meats,
cream, whole milk, cheese, egg yolk, fried
foods, pastries, avocados and nuts.

Classification Of Lipids
• Are found in food and the human body.
• Most lipids in the body are 95% triglycerides.
• They are in the body cells and circulate in the blood.
• Monounsaturated Fats
- There is one place among the carbon atoms
of its fatty acids where fewer hydrogen
atoms attached than saturated fats.
 - Examples of foods containing
monounsaturated fats are olive oils, peanut
oil, canola oil, avocados and cashew nuts.
- Research indicates that monounsaturated
fats lower the amount of low-density
lipoproteins (LDL) – the bad cholesterol in
the blood but only when they replace
saturated fats in one’s diet.
- They have no effect in high-density
lipoproteins (HDL) – the good cholesterol.
- It is recommended to consume 20% of total
daily calories of monounsaturated fats.
• Polyunsaturated Fats
- There are two or more places among the
carbon atoms of its fatty acids where there
are fewer hydrogen atoms than saturated
fats.
- The point of which carbon-carbon double
bonds occur in polyunsaturated fatty acid is
the determining factor in how the body
metabolizes it.
- Two Major Fatty Acids
a) Omega-3 Fatty Acid
o Helps lower the risk of
heart disease
o Are found in fish oils, an
increase intake of fatty fish
is recommended.
b) Omega-6 Fatty Acids (Linoleic
Acid)
o Has a cholesterol-lowering
effect
- Examples of foods containing
polyunsaturated fats includes cooking oil
from sunflower, safflower, sesame seeds,
corn oil, soybeans. Soft margarines whose
major ingredients are liquid vegetable oil;
and fish.
- Polyunsaturated fats should not exceed 10%
of total daily calories.
• Trans-fatty Acids
- Are produced when hydrogen are atoms are
added to monounsaturated or
polyunsaturated fats to produce a semisolid
product like margarine and shortening.
- The Major source of trans fatty acids in the
diet are baked good and food eaten in
restaurants.
- Trans fatty acids raise LDL but decrease
HDL.
- Eating trans fatty can increase your risk of
developing heart disease and stroke.
- Trans-Fatty acids were required to be listed
on the label in 2006.
- Trans fat are associated with a higher risk of
developing type II diabetes.
• Hydrogenated Fats
- Are polyunsaturated vegetable oils to which
hydrogen has been added commercially to
make them solid at room temperature.
- The process is called Hydrogenation.
- It turns polyunsaturated vegetable oils into
saturated fats.
- Margarine is made this way.
STEROL
Cholesterol
• is a sterol.
• It is not a true fat but a fatlike substance that exists in
animal foods and body cells.
• It does not exist in plant ffoods
• It essential for the synthesis of bile, sex hormones,
cortisone, and vitamin D and is needed by every cell
in the body.
• The body makes 800-1,000 mg of cholesterol each
day in the liver.
• Is common part of one’s diet because it is found in
abundantly in egg yolk, fatty meats, shellfish, butter,
cream, cheese, whole milk and organs meats (liver,
kidney, brains and sweetbreads).
• Is a contributing factor in heart disease due to high
serum cholesterol known as Hypercholesterolemia
that is common among persons with atherosclerosis.
• Atherosclerosis is a cardiovascular disease in which
plaque (fatty deposit of containing cholesterol and
other substances) forms inside of the arterial wall,
reducing the space for blood flow.
- When the blood cannot flow through the
artery near the heart, a heart attack occurs.
If it is near the brain, a stroke occurs.
 • Cholesterol in the blood should not exceed 200mg/dl
of blood.
• A reduction in the amount of total fat, saturated fats
and cholesterol and an increase of in the amount
monounsaturated fats in the diet, weight loss, and
exercise will help to lower serum cholesterol levels.
• Soluble fibers is helpful in lowering blood cholesterol
because the cholesterol binds in fibers and is
eliminated through feces, preventing it to be absorbed
in the small intestine.
• Development of plaque is cumulative, it is advisable
to avoid or limit its development is to limit the
cholesterol and fat intake throughout life.
• “Good and bad” Cholesterol
- Not a type of cholesterol, but the way the
body transport cholesterol in blood
▪ LDL = “bad” cholesterol
▪ HDL = “good” cholesterol
- Harmful effects, its deposits in artery walls
atherosclerosis
- Children do not synthesize cholesterol in the
body
Lipoproteins
• Is the carrier of fats in the blood
Classification Of Lipoproteins
• Chylomicrons
- are the first lipoproteins identified after
eating.
- Are the largest lipoproteins and the lightest
in weight.
- It is composed of 80-90% triglycerides
- Lipoprotein Lipase acts to breakdown the
triglycerides into free fatty acids and glycerol.
Without this enzyme, fat could not get into
the cells.
• Very-Low Density Lipoproteins (VLDL)
- are primary made by liver cells and are
composed of 55-65% triglycerides.
- Carries triglyceride and other lipid to all cells.
- As the VLDL’s loses triglycerides, it picks up
cholesterol from other lipoproteins in the
blood and it becomes LDL.
• Low Density Lipoproteins (LDL)
- are approximately 45% cholesterol with few
triglycerides.
- It carries most of the blood cholesterol from
the liver to the cells.
- Elevated blood levels greater than
130mg/DL are thought to be a contributing
factors in atherosclerosis.
- Known as the “bad cholesterol”
• High Density Lipoproteins (HDL)
- carries cholesterol from the cells to the liver
for eventual excretion.
- The Level at which low HDL becomes a
major risk factor for heart disease is set at
40mg/DL.
- Research indicates that an HDL level of 80
mg/DL or more is considered protection
against heart disease.
- The “Good Cholesterol”
- Exercising, maintaining a DBW, and giving
up smoking are ways to increase HDL.
PHOSPHOLIPIDS
Lecithin
• Is a fatty substance classified phospholipids.
• It is found both in plant and animal foods and is
synthesized in the liver.
• It is a natural emulsifier that helps transport fat in the
bloodstream.
• It is use commercially to make food products smooth.
Digestion and Absorption of Fats
• The chemical digestion of fats occurs mainly in the
small intestine where gastric lipase emulsifies fats
that are found in cream and egg yolk.
• In the small intestine, bile emulsifies the fats and the
enzyme pancreatic lipase reduces them to fatty acids
and glycerol which the body absorbs through villi.
Metabolism and Elimination
• Fat metabolism is controlled by liver,
• It hydrolyzes triglyceride and form new ones from the
hydrolysis as needed. The metabolism of fats occurs
in the cells where fatty acids are broken down to
carbon dioxide and water, releasing energy. The
portions of fat that is not needed for immediate use is
stored as adipose tissue.
Fat Alternatives
• Olestra is an example of a fat alternative made from
sugar and fatty acids.
• Simplesse is made from either egg white or milk
proteins and contains 1.3 kcal/g. it can be used only
in cold foods such as ice cream because it becomes
thick or gel when heated. Not available for home use.
• Oatrim is carbohydrate-based and derived from fiber.
Oatrim is heat-stable and can be used in baking but
not in frying. Manufacturers have used carbohydrate-
based compounds for years as thickeners. Oatrim
does provide calories but significantly less fat.
Dietary Requirements
• 20-30% of TER
• Infants 30-40%
• PUFA 10% TER
• MUFA 10-15%
• SFA 7-10%
• Cholesterol - 200 - 240 mg/day

MODULE 3: PROTEINS
Proteins
• The word protein is a Greek word derived and means
“of first importance”
• Composed of carbon, hydrogen, oxygen and nitrogen.
• Are composed of chemical known as “amino acids.
• Amino acids is the building blocks of proteins. Nitrogen Balance
Functions
• Builds And Repairs Tissue
• Regulates Body Functions
• Provides Energy
Food Sources
• Proteins are found both in animal and plant foods.
• The animal food sources provides the highest quality
of complete proteins. It includes meat, fish, poultry,
eggs, milk and cheese.
• The plant food sources provides the incomplete Protein Excess
proteins and are of a lower biological quality than
those found in animal foods. Even though, plant foods
are important food sources of protein when a variety
of and are consumed within the day. Examples are
nuts, sunflower seeds, sesame seeds, legumes such
as soybeans, navy beans, pinto beans, split beans,
chick peas and peanuts. Grains like wheat, barley,
corn, and rice.
• Plant proteins is used to produce textured soy
proteins and tofu – known as “Analogues”.
• Meat alternatives (analogues) are made from soy
protein and other ingredient mixed together to create
various kind of meat. Protein-energy Malnutrition
Classifications of Protein
• Complete
- Contains all the EAA
- All animal protein except gelatin
• Partially Complete
- Contains all the EAA but in limited support
growth
- Gliadin, Hordein
• Incomplete
- Lack one or more EAA
- Cannt sustain life nor support growth
Classification of Amino Acids
• Essential AA
- That the body cannot make at all or cannot
make in sufficient quantity to meet its needs
- Isoleucine, leucine, lysine, methionine,
phenylalanine, threonine, tryptophan, valine
• Semi- essential AA Digestion and Absorption
- Are those whose rate of synthesis in the
body is inadequate to support growth and
are therefore needed by young animals
- Arginine, histidine
• Nonessential AA
- Can be synthesized in the body in sufficient
amounts
- Alanine, asparagine, aspartic acid, cystine,
cysteine, glutamic acid, glutamine, glycine,
hydroxyproline, proline, serine, tyrosine
• One ram nitrogen = 6.25 g dietary protein
• At nitrogen equilibrium: N intake = N output
• At positive N balance:
- N intake >N output
- Growth, pregnancy, rehabilitation from
illness
• At negative N balance:
- N intake < N output
- Illness, malnutrition
• Burden on liver for ammonia detoxification & kidneys
for nitrogen excretion
• Obesity
• Depressed calcium absorption
• Hypercholesterolemia
• Heart diseases – meat sources are high in saturated
fats correlated but no independent effect
• Cancer – correlation of cancer & protein intake from
meats
• Weight control – protein-rich sources are high fat
sources weight gain
• Protein energy malnutrition (PEM) is a type of
malnutrition that is defined as pathological conditions
arising from coincident lack of dietary protein and
energy (calories) in varying proportions.
• The mechanical digestion of protein begins in the
mouth, where the teeth grind the food into small
pieces.
 • Chemical digestion begins in the stomach.
Hydrochloric acid prepares the stomach so that the
enzyme pepsin can begin its task of reducing proteins
into polypeptides.
• After the polypeptides reach the small intestines, the
pancreatic proteases continue the chemical digestion.
• Intestinal peptidases finally reduce the proteins into
amino acids.
• After digestion, the amino acids in the small intestine
are absorbed by the villi and carried by the blood to all
body cells.
Metabolism and Elimination
• All essential amino acids must be present to build and
repair the cells is needed.
• When the amino acids are broken down, the nitrogen-
containing amine group is stripped off. The process is
called deamination.
• Deamination produces ammonia, which is released
into the bloodstream by the cells.
• The liver picks up the ammonia then converts it to
urea and return it to the bloodstream for the kidney to
filter out and excrete.
• The remaining parts are used as energy or are
converted to carbohydrate or fat and stored as
glycogen or adipose tissue.
Dietary Requirement
• 10-15% of TER
• Safe protein intake level for adults (balance losses of
nitrogen)
• Safe protein intake level for children (based on
reference protein (egg or milk) adjusted for protein
quality of Filipino rice-based diets of 70% protein
digestibility corrected AA score
MODUE 4: VITAMINS
Vitamins
• Are organic (carbon-containing) compounds that are
essential in small amounts for body processes.
• It enable the body to use the energy provided by
carbohydrates, fats and proteins.
• The name “vitamin” i,mplies their importance, as in
Latin “vita” means “life”.
• General term given to a group of organic substances
that are present in food in minute quantities but are
distinct from carbohydrates, lipids and proteins; it is
essential for normal health and growth (Jamorabo-
Ruiz, et. al., 2012)
• Non-caloric micronutrients
• The vitamins are also known as the “accessory
growth factors”.
• Of all the essential nutrients, vitamins were
discovered last
• Word “vitamin” was originated by Casimir Funk in
1912 when he was searching for constituent in rice
bran which could cure beri-beri
- Vitamine was coined from “vita” meaning
necessary for life and “amine” denoting that
the anti-beriberi factor contained nitrogen
- Not all dietary factors were amines, hence
the final letter “e” was dropped
General Characteristic
• Unlike the macronutrients, they are not catabolized as
a source of energy and are not used for structural
purposes. Many vitamins serve as cofactors and
coenzymes.
• Most vitamins cannot be used in the form in which
they are absorbed. Some vitamins absorbed from the
diet must first be converted into active form like
vitamin A. Some must undergo transformation before
performing their functions, like biotin that is covalently
bound to the biotin-requiring enzymes.
Reminder:
• A coenzyme is a small organic molecule that
associates closely with certain enzymes; manuy B
vitamins form an integral part of coenzymes
Reminder:
• A cofactor is a small, inorganic or organic substance
that facilitates the action of an enzyme
Terms associated with vitamins
• Provitamins or precursors
- compounds that can be changed to the
active vitamins
- Carotenes & cryptoxanthin are precursors of
Vitamin A
- 7-dehydrocholesterol is precursor of Vitamin
D. With the aid of UV light, it is converted to
Vitamin D in the skin and to the active form
in kidney.
• Antivitamins or antagonists
- substances chemically related to true
vitamins but cannot perform the biologic
function of true vitamins.
- An example is avidin present in raw and
dried egg white that prevents the utilization
of biotin.
• Preformed Vitamins
- are naturally-occurring that are in active form
and ready for its biological role
• Pseudovitamins/ Vitamin-like substances
- substances which fail to meet all the
necessary criteria to be classified as
 vitamins but still have some properties of
vitamins
• Avitaminosis
- a condition resulting from lack of a vitamin in
its later stage when more defined signs and
symptoms occur such that a nutritional
deficiency disease is recognizable
• Hypervitaminosis
- “vitamin toxicity”; a condition resulting from
excessive accumulation of a vitamin in the
body
• Synthetic vitamins
- man-made or synthesized in the laboratory
• Vitamers
- are the multiple forms of vitamins (as
analogues or isomers).
- Vitamers of Vitamin B6: pyridoxine,
pyridoxal, pyridoxamine

Classification According to Solubility

Fat Soluble Vitamins Water Soluble Vitamins
Vitamin A Thiamin (B1)
Vitamin D Riboflavin (B2)
Vitamin E Niacin (B2)
Vitamin K Vitamin B6
Vitamin C (Ascordbic Acid)
Vitamin B12 (Cobalamin)
Folate
Biotin
Pantothenic Acid

MODULE 5: MINERALS
Minerals
• An inorganic element that remains as ash when food
is burned.
Classification
• Macronutrient minerals- essential for human nutrition;
present in amounts greater than 5g; these include
calcium (Ca), sodium (Na), phosphorous (P),
potassium (K), sulphur (S), chloride (Cl) and
magnesium (Mg).
• Micronutrient minerals- essential for human nutrition;
present in amounts less than 5g; these include iron
(Fe), iodine (I), zinc (Zn), selenium (Se), manganese
(Mn), copper (Cu), molybdenum (Mo), cobalt (Co),
and chromium (Cr).
• Minerals for which essentiality has not yet been
established although there is evidence of their
participation in certain biologic reactions; these
include silicon (Si), vanadium (V), tin (Sn), barium MACROMINERALS
(Ba), nickel (Ni), arsenic (As), boron (Bo), fluoride (F),
bromine (Br), strontium (Sr) and cadmium (Cd).
• Minerals found in the body that have not been
assigned a metabolic role yet; these include gold (Au)
silver (Ag) aluminium (Al), mercury (Hg), bismuth (Bi),
gallium (Ga), lead (Pb), antimony (Sb), lithium (Li) and
20 others.
General Functions CALCIUM
• Components of essential body compounds Calcium
- Ca and P in bones and teeth A. Description
- Cl hydrochloric acid
- I in the hormone thyroxine
- Co in Vitamin B12
- Zn in insulin
- S in methionine
- Fe in hemoglobin
• Cofactors in biologic reactions
- Some minerals act as cofactors binding to
specific enzymes to catalyse chemical
reactions. Iron, zinc and copper form
complexes with enzymes called
metalloenzymes.
- Some ions act as cofactors for proteins that
are not enzymes, while others covalently
bond to proteins to influence their activities.
- Proteins are activated by phosphorylation
where a phosphate ion (PO43-) attaches to a
specific part of the protein.
- The protein Hb incorporates iron that binds
to oxygen.
- Facilitation of absorption, digestion and
transport.
▪ Sodium facilitates the absorption of
carbohydrates.
▪ Calcium facilitates the absorption of
Vitamin B12.
• Maintenance of acid-base balance.
- Acid-forming minerals: chloride, sulfur and
phosphorus can combine with H.
- Alkali-forming minerals: sodium, potassium,
magnesium and calcium can combine with OH.
• Maintenance of water balance
- Electrolytes (Na, K, Cl) greatly influence the
movement of water among the fluid
compartments.
• Transmission of nerve impulses
- The exchange of Na and K across the cell
membrane is responsible for the transmission of
a nerve impulse. The release of acetylcholine is
regulated by calcium
• Regulation of muscle contraction
- Ca stimulates muscle contraction, and Na, K and
Mg exert a relaxing effect.
• Calcium (Ca)
• Magnesium (Mg)
• Iron (Fe)
• Phosphorus (P)
• Zinc (Zn)
• Sodium (Na)
• Most abundant mineral in the body
 • Calcium makes up 1.5-2% of body weight
• About 99% of the mineral is present in bones, teeth
and hard tissues
• Most of it is in the form of a complex salt called
hydroxyapatite Ca10(PO4)6(OH2), with smaller
amounts being associated with carbonate and citrate
• Remaining 1% (about 1/3 of which is bound to
protein) not contained bones and teeth is present in
the blood, extracellular fluids and within the cells of
soft tissues where it regulates many important
metabolic functions
• It must be maintained within the narrow range of 9-11
mg/dL for the proper functioning of the cells.
B. Functions of calcium
a. Physiological Functions:
• Bone formation
- The development of bone, which contains Ca and
other minerals, start in fetal life and is
continuously being reshaped and remolded
throughout life according to body needs and
stresses. This bone remodeling takes place in 2
types of cells, namely:
▪ osteoblasts – which continually form
new bone matrix
▪ osteoclasts – which balance this
activity by absorbing bone tissue
- Adequate calcium is needed to permit optimal
gains in bone mass and density in the
prepubertal and adolescent years.
• Teeth formation
- Ameoblasts, specialized tooth forming cells in the
gums, deposit Ca and other constituents to form
teeth
b. Metabolic Functions:
• Blood coagulation
- Ionized Ca stimulates release of thromboplastin
from the blood platelet which catalyzes the
conversion of prothrombin to thrombin. In turn,
thrombin catalyzes conversion of fibrinogen in
blood plasma to fibrin or blood clot (blood
coagulum)
• Transmission of nerve impulses
• Regulation of contraction-relaxation of the heart
muscle (heartbeat)
• Regulation of cell membrane permeability by
controlling the passage of fluid through the cell walls
• Activation of enzymes such as ATP, lipase and some
protein-splitting enzymes
• Maintenance of acid-base and electrolyte balance
• Immunity
• Facilitates absorption of Vit. B12
• Protection against carcinogens, e.g. radiostrontium
• Protection against lead poisoning
C. Factors Influencing Calcium Absorption
1. Better absorption during increased needs (growth,
pregnancy, lactation)
2. Vitamin D enhances- increasing permeability of
intestinal membrane to calcium and activating system
3. Low gastric PH (acidic) favors absorption
4. Hypochlorhydrin (alkaline) precipitates calcium
5. Increase meat intake increases calcium excretion
6. If increase ratio of lactose to calcium- forming of a
soluble complex- transport to intestinal wall
7. Ratio of calcium: P
8. Oxalates (alagaw, alugbati, spinach) decrease
calcium absorb by forming insoluble salts
9. Phytates (cereals, wheat, oats)
10. Excess fats- insoluble soaps (in fatty stools) with
calcium
11. Laxatives food increase bulk- decrease calcium
absorption
12. Lack of exercise- loss of bone calcium and ability to
replace it
13. Mental stress/emotional instability
14. Alcohol intake decrease calcium
15. Caffeine decreases urinary calcium excretion
D. Calcium in Bones
• in bone formation- calcium salts form crystals
“hydroxyapatite” on a matrix of protein collagen
• in bone mineralizing- crystals become denser, gives
strength and rigidity to bones
• in remodelling- bones gain and lose minerals,
example: withdrawal, deposits, osteoporosis
• in teeth formation- slower rate than bone formation
and fluoride hardens and stabilizes the crystal of teeth
Calcium in Body Fluids
• 1% but vital in different functions
• activates calmodulin (inactive protein)- relays
messages from cell surface to inside of the cell and
maintains blood pressure
Calcium in Disease Prevention
• Lowers blood pressure if adequate calcium intake
since calcium supersedes effects on high sodium
intake
• Calcium Balance (intestines, bones, kidneys)
- Osteoblasts- builds
- Osteoclasts- breaks
• If increase blood calcium- thyroid gland secretes
calcitonin.
• Calcitonin inhibits vitamin D activation, prevents
calcium reabsorption in kidneys and inhibits
osteoclasts from breaking down bones.
• If decrease in blood calcium- parathyroid glands
secrete parathormone
• Parathormone stimulates vitamin D activation,
stimulates calcium reabsorption in kidneys and
stimulates osteoclasts
E. Recommended intake of Calcium
• Refer to PDRI 2015
• These allowances take into account the need to
protect children in whom skeletal needs are much
more important determinants of calcium requirement
than are urinary losses and in whim calcium
supplementation has been found to have a beneficial
effect in children accustomed to low calcium intakes
F. Conditions with increased risk for Ca deficiency
• Vitamin D deficiency
• long term dietary inadequacy
• High protein diets
• High fiber diets
• Fat malabsorption/steatorrhea
• Achlorhydria
• Immobilization/sedentary lifestyle
• Decreased gastrointestinal (GI) transit time
• Stress
• Long-term use of thiazide diuretics
G. Populations with increased risk for Ca deficiency
• Teenagers
• Older women
• Pregnancy and lactation
H. Food sources
• Dilis (dried and fresh), alamang (dried and fresh),
dried fish; shellfish and crustaceans, milk, cheese, ice
cream, soybeans, mongo and other dried beans, leafy
vegetables
I. Effects of deficiency
• Stunted growth and retarded calcification of bones
and teeth
• Rickets (due to lack of Ca or P, lack of vitamin D, or
an imbalance in Ca : P ratio)
• Osteoporosis (condition in which absolute amount of
bone in the skeleton has been diminished but which in
the remaining bone mass is of normal composition)
• Osteomalacia (decalcification of bone where there is
a reduction in the mineral content of the bone but not
in the total amount of bone)
• Tetany- reduction in circulating ionized Ca resulting in
increased excitability of the nerve and spasmodic and
uncontrolled contractions of muscle tissues
• High blood pressure
• Colon Cancer
J. Effects of toxicity
• Hypercalcemia (a condition characterized by an
excess of Ca in the blood and soft tissues); occurs in
infants with high intake of vitamin D
• Calcium rigor (a state of tonic muscle contraction that
results when Ca level rise above normal due to
abnormality in parathyroid functioning)
• Hypercalcuria/renal calculi
K. Interrelationship with other nutrients
• Vitamin D, phosphorous, sodium, protein and fiber
affect Ca absorption and metabolism.
• Magnesium (another divalent cation) competes with
Ca for absorption and is needed for the secretion of
PTH.
• Malabsorption of fat can interfere with Ca absorption
due to the formation of soaps
PHOSPHORUS
Phosphorous
A. Description
• Phosphorous is second to calcium in abundance in
the human body.
• Constitutes about 1% of total body weight, largely in
the form of phosphate (PO4)
• 85% of the mineral is found in the bones, 14% in cells
in soft tissues and 1% in extracellular fluid.
B. Function
• Calcification of bones and teeth
• Metabolism of energy by all cells
• Important in the absorption and transport of nutrients
• An essential component of nucleic acid (DNA and
RNA), adenosine triphosphate (ATP), adenosine
diphosphate, coenzymes and some vitamins
• A major component of cell membranes and
intracellular organelles
• Regulation of acid-base balance
C. Absorption and metabolism
• Released by the action of intestinal enzymes
phosphatases
• Absorbed into the blood with the help of Vitamin D.
Blood phosphorous level is regulated by the
parathyroid gland that interacts with Vitamin D to
control the absorption of the mineral.
• Factors affecting Ca absorption and metabolism are
the same with phosphorous.
D. Recommended intake
• For the recommended intake, please refer to the
PDRI
• Ability of the body to synthesize the vitamin makes it
difficult to estimate minimal dietary requirements.
Daily intake of 100 IU is adequate to protect against
rickets and promote normal bone growth, provided
that the diet is also sufficient in Ca and P.
 • The quantities of calcium and phosphorous are more
important than their ratios.
E. Conditions and populations with increased risk for
phosphorous deficiency
• Those with celiac disease, sprue, hyperthyroidism,
insulin injections, the alcoholics and premature
infants.
F. Food sources
• Meat, fish, poultry, glandular organs, egg yolk, milk,
cheese, beans, nuts and seeds, whole grain cereals
G. Deficiency
• Rare but may cause tetany and hypertension.
• Develops in alcohol abuse, alcoholism, kidney
disorders, prolonged vomiting or diarrhea.
H. Interrelationship with other nutrients
• Sodium is essential to ensure optimum phosphorous
absorption.
• An increase in Mg consumption decreases
phosphorous absorption.
MAGNESIUM
Magnesium
A. Description
• Half of the body’s magnesium is in the bones.
• 1% is in the extracellular fluid.
B. Functions
• Involved in bone mineralization
• ATP metabolism
• Synthesis of proteins, fats and glucose and cells
transport system
• Muscle contraction
• Clotting
• Immune function
• Prevents dental caries
• Nerve transmission of impulses
C. Absorption and metabolism
• Absorption of Mg from food ranges from 20% to 70%
• Transported by specific carrier and vitamin D
sensitive transport system
• Rate of absorption is decreased by the same factors
that affect Ca.
• Absorption is influenced by PTH.
D. Recommended intake
• For the recommended intake, please refer to the
PDRI. Recommended intake is based on a
requirement of 4mg/kg body weight/day for adults to
achieve a positive magnesium balance.
E. Food sources
• Nuts, legumes, whole grains, dark green leafy
vegetables, seafood, chocolate, cocoa
F. Deficiency disease: Low Magnesium Tetany
• Symptoms associated with low plasma Mg levels:
irritability, nervousness and convulsions due to
overstimulated nerves and increased muscular
contraction.
• Mg deficiency rarely occurs because of the efficiency
in which the kidneys reabsorb the mineral.
G. Conditions and populations with increased risk for Mg
deficiency
• Vomiting, diarrhea, alcoholism, protein
malnutrition, diuretic use, malabsorption, renal
disease, diabetes, parathyroid disease, stress
and postsurgical patients.
H. Toxicity
• Overconsumption of the mineral is not likely to
cause toxicity except in persons with renal
insufficiency.
I. Interrelationship with other nutrients
• Mg is antagonistic to Ca.
• Mg can influence the balance between
extracellular and intracellular K. the mechanism
of action is still not clear.
SULFUR
Sulfur
A. Description
• Present in every cell in the body, particularly in
cartilage and keratin of skin, nails and hair.
• Occurs in a number of forms in the body: as sulfur
within organic compounds such as amino acids, sulfur
within ions, sulphate ion (SO42-), and the sulphite ion
(SO32-).
• Any excess sulfur is excreted in the urine.
B. Functions
• A constituent of the sulfur-containing amino acids
(methionine, cysteine and cystine)
• A constituent of the vitamins thiamine, pantothenic
acid and biotin, vitamin-like lipoic acid, insulin,
heparin, glutathione, coenzyme A
• Participates in detoxification reactions
• A constituent of structural tissues
mucopolysaccharides and sulfate in lipids
• Needed in energy metabolism and enzyme activation
C. Recommended intake
• There is no recommended intake for the mineral.
Since allprotein food provides sulfur, the need for
the mineral is met when protein intake is adequate.
D. Food sources
• All protein-containing foods
E. Deficiency
POTASSIUM
• A deficiency in sulfur occurs only when there is
Potassium
severe protein deficiency.
F. Toxicity
• Toxicity occurs only if sulfur-containing amino acids
are taken in excessive amounts.
SODIUM
Sodium
A. Description
• About 50% of the total body sodium is found in the
extracellular fluids, 40% in the skeleton and 10%
inside the cells.
B. Functions
• Maintenance of normal extracellular fluid balance
• Maintenance of normal pH value of extracellular
fluids
• Needed in the absorption of glucose and in the
transport of other nutrients
• Aids in nerve impulse transmission and muscular
contraction
C. Absorption and metabolism
• Absorbed in the small intestine and is transported
by the blood throughout the body
• Blood passes the kidneys; it is filtered out and then
partially reabsorbed into the blood to maintain the
normal blood sodium levels.
• Concentration of sodium in the extracellular fluid is
determined by renin-angiotensin-aldosterone
system and sympathetic nervous activity.
• Aside from urinary losses, sodium is also lost via
the skin.
D. Recommended intake
• For the recommended intake, please refer PDRI.
E. Food sources
• Salt, soy sauce, processed foods
F. Deficiency
• Muscle cramps, mental apathy, loss of appetite,
persistent vomiting or diarrhea, heavy sweating, or
diuretic therapy can deplete body sodium resulting
in hyponatremia (low sodium blood levels)
G. Toxicity
• Edema, acute hypertension, osteoporosis
A. Description
• Concentrated in the intracellular fluids, about 250g
B. Functions
• Cell integrity
• Participates in many biochemical reactions inside
the cell, particularly those involved in the release of
energy from food and the synthesis of protein and
glycogen
• Maintains normal fluid balance
• Maintains acid-base balance
• Aids in nerve impulse transmission and muscular
contractions
• Acts along with Mg as a muscle relaxant opposing
the muscle-contracting stimulus of Ca
• Important in the release of insulin by the pancreas
• For regulation of heart rhythm
C. Absorption
• Distributed in the blood from the intestine mainly by
diffusion
• Enters the cell against a concentration gradients
and therefore requires an active transport
mechanism
• Potassium is excreted into urine.
D. Recommended intake
• Please refer to the PDRI.
E. Food sources
• Fresh foods, particularly fruits, vegetables and
legumes
F. Deficiency - Hypokalemia
• Muscular weakness, paralysis, confusion
• Prolonged vomiting or diarrhea, regular use of
certain drugs (diuretics, steroids and laxatives),
severe protein-energy malnutrition, and surgery
could result in potassium deficiency.
G. Toxicity
• Muscular weakness, vomiting, cardiac arrest,
hyperkalemia
 MICROMINERALS

IRON
Iron
A. Description
• An adult male contains 40-50 mg of iron per kilogram
body weight, while the adult female contains 35-50
mg.
CHLORIDE • More than two thirds of the body is in the form of
Chloride functional iron (perform specific role), which is bound
A. Description within the Hb molecule or within the myoglobin in
• Comprises about 0.15% of adult weight muscle tissues.
• Widely distributed • Non functional iron (storage form) is found in the liver,
• Concentration is high in cerebrospinal fluids, GI spleen and bone marrow.
secretions and gastric juices
B. Functions
B. Functions • As part of the protein Hb and myoglobin, iron binds to
• Maintains normal fluid and electrolyte balance oxygen molecules and transport O2 through the blood
• A constituent of hydrochloric acid (in Hb) or stores O2 within muscles in myoglobin.
• Helps maintain acid-base balance in body fluids • As part of Hb, it is involved in the formation of red
blood cells (RBCs).
C. Absorption • A cofactor of non-heme enzymes and other proteins
• Readily absorbed in the GI tract
• Excreted in the urine and sweat. C. Absorption and Metabolism
• Available to the body either in the heme form (present
D. Food sources only in animal products) or nonheme form (iron in
• Salt, soy sauce, meat, seafood, milk, eggs, processed plant foods)
foods • Absorption occurs primarily in the duodenum and
jejunum.
E. Deficiency • A variety of factors influence iron absorption.
• A diet deficient in chloride does not normally occur. a. Size of dose: the higher the intake of iron,
the lower the percentage of iron absorb.
F. Toxicity symptoms b. Body needs: those deficient in iron absorb
• Vomiting causing dehydration more the mineral.
c. Form of iron: ferrous form Fe2+ is better
Summary of associated disorders resulting from absorb than ferric form Fe3+.
deficiency or excessive intake of macrominerals • Factors enhancing the absorption of non heme
iron:
Macromineral
Calcium •
Deficiency
Stunted growth and •
Toxicity
Hypercalcemia a. Increase acidity
•
retarded
Rickets
•
•
Renal calculi
Depressing effect on b. Animal tissue protein
•
• Factors inhibiting the absorption of non heme
Osteomalacia utilization of fat,
• Osteoporosis phosphorous, iodine,
• Tetany iron, magnesium and

Phosphorous • Same as in Calcium •

zinc.
Hyperphosphatemia
iron:
Potassium •
•
Hypokalemia
Muscle irritability,
• Hyperkalemia a. Low gastric acidity
weakness
paralysis
and
b. High dietary calcium and phosphorous intake
• Heart may develop a
gallop rhythm and c. High manganese intake
•
cardiac arrest
Poor intestinal tone d. Dietary fiber
• Nausea and lack of
appetite e. Certain proteins
• •
f. Phytates and oxalates
Sodium Muscle cramps Hypertension
• Disturbed acid-base

g. Polyphenols
balance resulting
from diarrhea,
vomiting and profuse

Magnesium •
sweating
Hypomagnesemic • Hypermagnesemia
• After absorption, iron is carried to the blood bound to
tetany results to hypertension
and may cause
the protein transferrin.
decreased
reflexes
tendon
• Iron is stored in the liver in the form of ferritin and
• •
hemosiderin.
Chloride Endocrine disorders
such as hyperactivity

• 90% of iron is released in the breakdown of cells.

of the adrenal cortex
resulting in
hypochloremic
alkosis
D. Recommended intake • Heart disease- the attack of free radicals on ferritin
• For the recommended intake, please refer to the activates the oxidative role of iron against LDL.
PDRI (2015). The recommended intake for Filipinos is
based on the amount of dietary iron needed to meet
absorbed iron requirements. This would correspond to
the amount needed to cover basal losses plus growth
for children and menstrual losses for women of
reproductive age adjusted for bio availability of iron in
typical complete meals consumed by Filipinos
• For infants, it is assumed that the iron provided by
breast milk is adequate to meet the iron needs of
infants exclusively fed human milk from birth to six
months.
• Consumption of iron rich foods and iron fortified foods
is recommended for women from adolescence
onwards.
• Iron supplementation is recommended to meet the
needs of pregnant and lactating women.
• The estimated iron requirement during the first
trimester of pregnancy and the first six months of
lactation are actually higher than the requirements for
menstruating non-pregnant and non-lactating to allow
for build-up of iron stores during these periods.

E. Interrelationship with other nutrients

• Vitamin C enhances iron absorption by acting as a
reducing agent and forms a chelate with non heme
ferric iron at an acid pH. The chelate remain soluble in
the small intestine, thus improving intestinal
absorption of non heme iron.

F. Food sources
• Liver and glandular organs, fish, egg yolk, shell
fishes, leafy vergatables, except amplaya leaves, soy
beans.

G. Deficiency
• Microcytic, hypochromic anemia results in low Hb
stores, fatigue, weakness, pallor, poor resistance to
cold temperature, apathy.

H. Toxicity
• Caused by poor quality sources cookery; excessive
excretiondue to blood loss; inadequate form due to
lack of B12 caused by lack of IF.
a. Hemosiderosis or siderosis is a condition
with large deposits of iron deposit,
hemosiderin in the liver (use of supplement
failure to regulate iron absorption)
b. Hemochromatosis is a genetic disorder that
enhances absorption.

I. Issues
• Iron and cancer- iron may be involved in causing
cancer by damaging DNA through its free radical
activity.
ZINC
Zinc
A. Description
• Commonly found as the divalent ion
• Amount of mineral in an adult ranges from 1.5-3g
• Occurs in all cells,tissues, organs, fluids and secretion
but is mainly concentrated (about 90% of the body
zinc in muscle bone)
• Over 95% is bound within various metalloenzymes of
cells and cell membranes.
• Most of the zinc in the blood is in the RBCs, which
contain the zinc containing enzyme carbonic
anhydrase needed to convert carbon dioxide to
bicarbonate ions (HCO3).
B. Functions
• A component of more than 200 enzymes, participating
in a wide variety of metabolic processes such as
synthesis and degradation of carbohydrates, lipids,
proteins and nucleic acids.
• Interacts with insulin facilitating the uptake of glucose
by the cells of adipose tissue
• Needed for the normal development and maintenance
of the body’s immune system.
• Important in stabilizing membranes structure and in
guarding it against peroxidative damage.
• Important in night vision
• Important in mobilizing Vitamin A from liver stores
• Facilitates wound healing and blood clotting
a. Facilitating binding ligands in the intestinal
lumen
b. Receptor sites in the enterocytes; or
c. Intracellular binding ligands with mucosal
cells.
F. Food sources
• Zinc from animal foods is more readily absorbed than
that in plant foods. Sources include meat, poultry,
fish, grains and vegetables.
G. Deficiency Symptoms
• Deficiency manifestations are diverse: hair loss,
dermatitis and skin changes, growth retardation,
impaired taste acuity, delayed wound healing,
decrease dark adaptation (night blindness),
immunologic abnormalities, and delayed sexual
maturity.
H. Toxicity symptoms
• The following are some adverse effects of a
prolonged intake of dietary zinc supplements:
a. Zinc-induced copper deficiency anemia
b. Depressed levels of white blood cell
c. Increased low-density lipoprotein and
decreased high-density lipoprotein
d. Decreased serum ferritin and haematocrit
levels

C. Absorption and metabolism

• Absorbed in the small intestine and is carried into the
blood and goes to the pancreas where it is used in the
formation of some digestive enzyme
• The absorbed zinc binds to metallothionein, a sulfur-
rich protein that binds with metals such as zinc.
• Binds with another protein (cysteine-rich intestinal
protein) to transport the mineral to the blood
• Zinc that is carried within blood plasma is bound with
different carrier proteins, such as albumin and
transferrin.
• The liver takes up some 30-40% of absorbed zinc,
while the rest is distributed throughout the different
organs and tissues.
• Zinc loss from the body is via body surface, kidney
and the GI tract. Most of the zinc is excreted in the
feces.

D. Recommended intake COPPER

• Please refer to the PDRI
E. Interrelationships with other nutrients
• Zinc2+ absorption is impaired by the following
divalent cations: Cd2+, Cu2+, Ca2+, and Fe2+.
• The cations compete with one another for:
Copper
A. Description
• Occurs in the cuprous (Cu+) and cupric (Cu2+) states
• Involved in oxidation-reduction reactions
• Body’s copper content ranges form 50-120mg
 • Highest concentration of the mineral is in the liver,
with less amounts in the heart, kidneys, spleen and
brain
• Copper in the blood and tissues is normally bound to
proteins
B. Functions
• Copper is essential as an activator of key enzymatic
reactions. Some copper-containing enzymes and the
reactions they catalyse are:
- Cytochrome c oxidase: catalyzes the
oxidation of the cytochrome c, a, and a3
complex by oxygen in the respiratory chain
- Ceruloplasmin: (a) oxidizes ferrous ions; (b)
transports copper to Tissue sites; and (c)
acts as a scavenger of free radicals and
superoxide ions
- Superoxide dismutase: toxic oxygen removal
- Lysyl oxidase: collagen synthesis
- Dopamine beta-hydroxylases:
neurotransmitter synthesis
- Tyrosine oxidase: melanin synthesis
C. Absorption and metabolism
• About 25-40% of dietary copper is absorbed from all
parts of the GI tract, including the stomach and large
intestine.
• Binds with proteins such as metallothionein, which
slows down Cu absorption into the blood
• Removed from the plasma by the liver from where it is
excreted into the bile or used in the synthesis of
ceruloplasmin, the copper-containing enzyme
• Released from the liver under the control of the
adrenal gland. The body utilizes some of the plasma
copper in the synthesis of superoxide dismutase in
the bone marrow.
• Copper is excreted in both the feces and the urine.
D. Recommended intake
• Recommended intake for the mineral has not been
determined in the Philippines. The US RDA (2001) for
copper is 10mg/day or 900ug/day.
E. Interrelationship with other nutrients
• High intake of iron or vitamin C decreases the
absorption of copper.
• Zinc decreases copper absorption.
• Calcium is antagonistic to copper.
• Copper from complexes with molybdenum and sulfur,
decreasing copper absorption
F. Deficiency
• Copper deficiency is seen among children with
protein-deficiency and iron-deficiency anemia.
Deficiency symptoms include decreased serum
copper and anemia, impaired glucose tolerance, poor
wound healing, immune defects and central nervous
system and cardiovascular disorders.
• Menke’s kinky hair syndrome is an inherited
condition characterized by low serum copper and
ceruplasmin levels. This disease prevents the release
of Cu into the general circulation.
G. Toxicity
• Hereditary condition known as Wilson’s disease that
is associated with chronic copper toxicity due to a
failure to excrete copper in bile.
IODINE
Iodine
A. Description
• The body contains 20-30mg of iodine that is
concentrated in the thyroid gland.
• Dietary iodine is mainly in the form of iodine.
B. Functions
• As part of the thyroid hormones, it is essential in
regulating body’s growth, development and metabolic
rate;
• Essential in the conversion of carotene to Vitamin A
• Protein synthesis
• Carbohydrate absorption
• RBC production
• Nerve muscle function
C. Absorption and metabolism
• Absorbed mainly in the small intestine, distributed in
the extracellular fluids
• Reduced first to the absorbable iodide ions
• One third of the absorbed iodide in the blood plasma
is taken up by the thyroid gland for synthesis of the
thyroid hormones thyroxine (T4) and triiodothyronine
(T3).
• The rest of the iodide is excreted mainly in the urine,
while some amounts are lost via the skin and feces
D. Recommended intake
• For the recommended intake, please refer to the
PDRI (2015). The recommended intake for adults
corresponds to the intake necessary to maintain
plasma iodide level above the critical limit to be
associated with the onset of goiter.
• Pregnant and lactating mothers as well as
adolescents are at risk of developing a deficiency of
iodine.
E. Interrelationship with other nutrients
• Goitrogens (from cabbage, kale, cauliflower,
broccoli, turnips, brussel sprouts and mustard greens)
are substances that interfere with iodine metabolism
inhibiting hormonogenesis.
 • The following goitrogens may affect iodide uptake by
the thyroid gland, organification of the iodide or
hormone release from the thyroid cells; halide ions
such as Bromide (Br), astatide (At), and thiocyanate
(SCN). Cassava contains cyanogen glucosides, with
thiocyanates as metabolites.
F. Food source
• Iodized salt, seafoods, seaweeds
G. Deficiency
• Iodine deficiency disorders (IDD) include goiter,
hypothyroidism, impaired mental function,
spontaneous abortions, stillbirths, congenital
abnormalities and increased infant mortality.
• Cretinism is the developmental defect in infants
characterized by mental retardation, deaf-mutism, and
neuromuscular defects.
• Myxedema is a form of cretinism, seen in adults and
characterized by dry thick skin, puffy face and eyelids,
enlarged tongue , husky voice, decreased
reproductive ability and mental deterioration.
H. Toxicity
• Hyperthyroidism (also known as Grave’s disease
or exophthalmic goiter)
SELENIUM
Selenium
A. Description
• Found in minute amounts of the body, concentrated in
other glandular organs, blood, and muscles
• The two forms of Se mainly present in food are
selenomethionine (synthesized by plants) and
selenocysteine (synthesized by animals).
B. Function
• As part of the enzyme “glutathione peroxidase”, it
calatlyzes the breakdown of toxic hydroperoxides
making the mineral an essential component of the
body’s antioxidant defense system.
C. Absorption and metabolism
• Bound to proteins (globulins and lipoproteins)
• Taken up by the RBCs, liver, heart, spleen, nails and
tooth enamel
• Major routes of Se excretion are urinary (50-60% of
total amount excreted) and fecal (40-50% of total
excretory output).
D. Recommended intake
• For the recommended intake, please refer to the
PDRI
• FAO/WHO recommends 31 ug/day to provide
adequate reserves based on satisfactory levels of
plasma selenium and glutathione peroxidase activity.
E. Interrelationship with other nutrients
• Se is a vitamin E sparer.
• Se protects against the toxicity of Cd, Hg, and Ag.
• The potency of selenomethionine is reduced in
methionine deficiency.
F. Food sources
• Seafoods, liver, meats, whole grain and airy products
are good sources
G. Deficiency
• Clinical manifestations include muscle pain and
weakness, cardiomyopathy, and a loss of
pigmentation (pseudo-albinism)
• Keshan disease is a selenium deficiency condition
that causes heart enlargement
H. Toxicity
• Loss of hair and nails, dental carries, dermatitis,
peripheral neuropathy, irritability and fatigue and
lesions of the skin and nervous system
• Selenosis- selenium poisoning that can be caused by
an excessive intake of Se usually provided in
supplements. Se is toxic at levels 20-30 times the
requirements
MANGANESE
Manganese
A. Description
• Body contains 29mg concentrated Mn in the liver,
pancreas, kidneys, skin, muscles and bones.
B. Functions
• As a cofactor of various enzymes, it is involved in
glucose and fatty acid metabolism
• Required for the normal development of the skeleton
and connective tissues
• Required by mitochondrial superoxide dismutase,
which catalyzes the conversion of superoxide to
hydrogen peroxide. The HOOH formed by superoxide
is decomposed by catalase.
• Needed in the utilization of thiamine.
• Needed in the release of lipid from the liver.
• Urea synthesis.Amino acid inter-conversion
C. Absorption and Metabolism
• Carried by a manganese binding protein transferrin
• 3-4% of the body’s intake is absorbed, and 99% of the
body’s losses of Mn are fecal with some 0.7% via the
skin and 0.1% via the urine.
• Primary route of excretion is the bile.
D. Recommended intake
• No recommendations indicated in PDRI
E. Interrelationship with other nutrients
• Mn absorption decreases with high intakes of Fe
• Ca and Zn may affect the bio availability of Mn.
F. Food sources
• Whole grain cereals, nuts, legumes, tea and green
leafy vegetables
G. Deficiency
• Manganese deficiency does not usually develop
unless the mineral is deliberately eliminated from the
diet. High iron and calcium may prevent absorption.
H. Toxicity
• Caused reduction of Hgb regeneration and causes
increase absorption in liver, kidney and spleen
• Prolonged exposure to dust-containing manganese
causes extreme weakness apathy, anorexia and
fatigue
MOLYBDENUM
Molybdenum
A. Description
• Present in all parts of the body in minute amounts
concentrated in liver, bones, pancreas and kidney.
B. Function
• Participates on oxidation reduction reactions
• A cofactor for three enzymes (which catalyse redox
reaction) – xanthine oxidase, aldehyde oxidase and
sulphite oxidase
a. Xanthine oxidase - can
hydroxylate purines, pteridines,
pyrimidines, heterocyclic nitrogen-
containing compounds.
b. Sulfite oxidase - the mitochondrial
enzyme catalyzes the terminal step
in the metabolism of sulfur –
containing amino acids.
c. Aldehyde oxidase - participates in
the metabolism of purines.
C. Absorption and metabolism
• Absorption sites are the stomach and the small
intestines where 25-80% of dietary Mo is absorb.
• Urinary excretion is the major route of elimination but
is also excreted via the bile to a lesser extent.
 • Polycythemia (an increase in the number of RBCs) is
D. Recommended intake typical in Co toxicity related with excessive beer
• Based on USRDA of 45 per day. drinking.

E. Interrelationship with other nutrients

• Mo or sulfate has an antagonistic effect on copper
• In animal studies, Mo has been found to isolate the
reactive sulphide groups, which bind copper iron. A
high sulfate intake increases the urinary excretion of
mineral.
• Mn, Zn, Fe, Pb, Vitamin C, methionine, cysteine and
protein might affect Mo availability.
F. Food sources
• Milk and milk products, whole grains, legumes (peas
and beans) and meat
G. Deficiency
• Rare unless the diet is particularly rich in antagonistic
substances such as sulfate, copper and tungstate.
CHROMIUM
Chromium
A. Description
• Chromium differs from iron, zinc, copper and
molybdenum since it does not function in enzymes
system and is not part of the metalloprotein
complexes. It can, however, form a complex with
nicotinic acid and glutathione to form an organic
compound, the glucose tolerance factor (GTF).
• Chromium in food exists in the trivalent form (Cr3). It
can also occur in the more readily absorbable
biologically active organic complex.

H. Toxicity
• Rare; toxicity symptoms include diarrhea, slow growth
and anemia characterized by failure of RBCs to
mature.

COBALT
Cobalt
A. Description
• Highly concentrated in spleen, kidneys, and pancreas B. Functions
as a component of vitamin B12 (4%).
• As part of the GTF, chromium potentates the action of
insulin allowing the entry of glucose into the cells and
B. Function
facilitating the binding of insulin to the surface of cell
• Essential component of Vitamin B12 that is essential
• Plays a role in RNA synthesis
for the maturation of the RBCs
• Involved in amino acid transport and in the breakdown
• Cofactor for energy metabolism
of glycogen and lipids
• Activates arginase that converts arginine to urea
• Essential in lowering blood cholesterol levels
C. Absorption
C. Absorption and metabolism
• Absorbed mainly in the jejunum
• The absorption of inorganic Cr3+ is poorer than the
• About 85% of the absorbed Co is excreted in the biologically active organic complex.
urine, but small amount is excreted in the feces and
• Only a small percentage of dietary Cr is absorb in the
perspiration
small intestine (from less than 1%-3%).
• Its absorption is influenced by the following factors:
D. .Food sources
a. Amino acid
• Liver, kidney, oysters and clam
b. Phytates
c. Oxalate
E. Deficiency
d. Nicotinic acid and vitamin C
• There are no documented cases of Co deficiency,
• In the blood, Cr is bound to the proteins albumin,
except for its association with vitamin B12.
transferrin & globulin. It is excreted via the kidneys
• Consumption of diet high in simple sugars has been
F. Toxicity
found to raise urinary chromium
• Co can have toxic effects when taken in large doses
and may result to goiter, hypothyroidism, hypotension
and heart failure
D. Recommended intake F. Food sources
• There is no recommended intake for Filipinos. The • Drinking water (if fluoridated or fluoride containing
2001 US adequate intake recommended 25 (females) H2O), tea, seafoods and marine fish
to 35 (males) mg/day.
G. Deficiency
E. Food sources • Susceptibility to tooth decay
• Brewers yeast, meats, liver and whole grains
H. Toxicity
F. Deficiency • Fluorosis- mottled enamel due to high doses of
• Impaired glucose utilization, but the normal fluoride
concentrations of insulin in the blood • Other toxicity symptoms include nausea, diarrhea,
• Disturbed amino acid metabolism chest pains, itching and vomiting
• Elevated blood cholesterol levels leading to damage
to the wall of the aorta
• Impaired growth
• Increased mortality rates

G. Toxicity
• Chromium toxicity due to an excessive intake has
not been documented.
• Chromium poisoning includes allergic and
eczematous dermatitis and the systemic effects in
the liver and kidneys.

FLUORIDE
Fluoride
A. Description
• Normally present in small amounts; in greatest
concentration 99% in bones and teeth Summary of Micronutrients
Minerals Functions Deficiency Toxicity
Iron • Carrier of • Nutritional anemia • Hemachromatosis
oxygen and • Hemorrhagic • Hemosiderosis
B. Function carbon dioxide
• Blood formation
anemia
• Postgastrectomy

• Involved in the mineralization of teeth and bones; • Anti

agent
ineffective anemia
• Milk anemia
• Other Functions:
formation of hydroxyapatite • Catalysing the

• Helps prevent dental carries

conversion of
beta carotene to
vitamin A
• Synthesis of
Purines,
C. Absorption Creatinine
Collagen
and

• Almost completely absorbed from the GI tract • Detoxification of

drugs in the liver
• Regulator • Goiter • Hyperthyroidism
• Carried in the blood in an organic form, non ionic and
Iodine of
growth and • Myxedema
development • Cretinism
as ionic fluoride • Synthesis
thyroxine
of

• Excreted via the urine, which accounts for about 90% Zinc • As part
metalloenzymes
of • Impairs growth
• Hypogonadism
• Atherogenic effect
(hardening of

of total excretion • Stabilization

membrane
of arteries)
• Zinc poisoning

• Remaining fluoride is eliminated in the feces with

• Protein results to increased
synthesizing losses of iron and
copper
minor losses occurring in sweat.
structure in cell
• As a cofactor in
many reaction
affecting
reproduction,
D. Interrelationship with other nutrients skin health, taste
and growth

• Aluminum, calcium, magnesium and chloride reduced • Aids in the

action of insulin
• Helps
the uptake and utilization of fluoride vitamin A
mobilize

• Facilitates
• Phosphate and sulfate increased the uptake of synthesis
RNA and DNA
of

fluoride necessary for cell

reproduction
• Essential for
metabolism of

E. Recommended intake alcohol

• For the recommended intake, please refer to the

PDRI (2015)
Copper • Essential • Hypocupremia • Inhibitor to Molybdenum • Essential • • Symptoms
component of • Menkes Kinky many enzyme
cofactor of include diarrhea,
many enzymes Hair Syndrome system
• Prevent anemia characterized by • Hereditary xanthine oxidase depresses
by aiding in iron slow growth condition called and aldehyde growth rate,
absorption, degeneration of Wilson’s oxidase anemia
stimulating the brain tissue and Disease
synthesis of the peculiarly stubby characterized by • Preventing of
heme of globin white hair the degenerative tooth decay by
fractions of the changes in brain promoting the
Hb molecule, and tissue, together retention of
releasing stored with cirrhosis of
iron from ferretin the liver fluoride
in the liver Chromium • Part of the • Reduced • Uncertain
• Synthesis of glucose tolerance tolerance to
phospholipids
essential for the
factor required glucose and
formation of for optimal increasing
myelin utilization incidence of
• Part of the diabetes
respiratory
enzyme
• Symptoms
cytochrome include decrease
oxidase necessary glycogen
for the release of reserves,
energy
• Maintains the
retarded growth,
activity of disturbed amino-
enzymes involve acid metabolism
in the synthesis and increase
of elastin and
collagen
aortic lesions
• Part of the
enzyme
tyrosinase needed
for the

OTHER MINERALS
conversion of
tyrosine to
melanine
Selenium • Essential part of the • Muscle • Hair and net
enzyme glutathione pain/weakness loss Silicon
• Cardio • Neuropathy
A. Function
peroxidase that
inactivates the myopathy • Dental care
enzyme that caused
oxidation in fats
• Loss
pigmentation
of • Irritability
• Fatigue
• Essential for the normal growth and development
• Anti-oxidant role
related to vitamin E of bone cartilage and connective tissue.
• Others:
• Associated with
B. Absorption
liver functions,
release of energy to
• Dietary forms are diverse, occurring as silica,
the cells, monosilicic and silicon
development of the
structural protein of • A silicic acid, it is freely diffusible throughout tissue
sperm cells
Manganese • Necessary for • Affects brain • Affects brain fluids and is easily excreted in the urine
normal skeletal and
connective tissue
function function
• Weakness and C. Recommended intake
development
• Acts as a catalyst or
psychological
and motor • The amount needed by humans is still unknown.
as part of the
essential enzymes
difficulties
D. Interrelationship with other nutrients
involved in
synthesis of fatty
the
• Molybdenum lowers the plasma concentration and
acids
cholesterol
and cellular uptake of silicon
• Formation of urea E. Food Sources
• Release of lipid
from the liver • Whole grain cereals and root crops
• Metabolism
F. Deficiency
of
carbohydrates
• In the structure and
the function of the • Silicon deficiency is associated with growth
mitochondrion
the cell, which is
of
retardation, disturbance on the development of
essential for the
release of energy
bone structure, and structural abnormalities with
• Synthesis
mucopolysaccharid
of ground matrix and connective tissues, skin and
es ligaments.
• Essential part of • Pernicious • Polycythemia or
Cobalt
vitamin B12 anemia over production Vanadium
necessary to of RBCs and • Animal studies show that it plays an important role
prevent hyperplasia of
pernicious bone marrow in growth; in the metabolism of glucose, iron, and
anemia
• Acts as a
• Goitrogenic
effect
lipids; in reproduction; and in bone development.
cofactor of
enzyme system
and energy
Nickel
metabolism • Functions as a cofactor or structural component of
• Activates
arginase some metalloenzymes
(hydrolizes
arginine to
ornithine and Arsenic
urea) • Possible roles in phospholipid metabolism and
methyl group (CH3) chemistry.
Boron
• Parathormone action, the metabolism of Ca, P and
Mg, and the formation of the active form of
Cholecalciferol.
Tin
• Growth-enhancing effect seen in animals.
Symptoms of tin deficiency include poor growth,
dermatitis and hair loss.
Distribution
• Body water is found in two major compartments:
a. Intracellular compartment with its
intracellular fluid (ICF). Approximately 30L,
potassium is the major cation, and
phosphate is the major anion.
b. Extracellular compartment with its
extracellular fluid (ECF). Approximately 15-
17L, sodium is the major cation, and chloride
is the major anion.
• This is subdivided into:
i. Intravascular fluid compartment: all
fluids within blood vessel-3L.
ii. Intercellular, interstitial or
extravascular fluid compartment
(fluids around and between the cells)
iii. Transcellular fluid compartment: the
fluid in the eyeball (vitreous humor),
around joints (synovial fluid) and within
digestive secretions
c. Homeostasis is the maintenance of normal
ECF or the external environment of the cells.

MODULE 6: WATER and ELECTROLYTES

WATER
General Description
• Water accounts for about 60% of the total body
weight of an adult, making it the most abundant
constituent of the body.
Functions
• Transports nutrients and waste products
throughout the body.
• Helps to form the structure of macromolecules.
• Participates in chemical reactions
• Serves as the solvent in which most of the
chemical reactions take place.
• Acts as lubricants around joints.
• Serves as shock absorber inside the eyes and the
spinal cord.
• Aids in the regulation of body temperature.

Sources of body water

• Fluids (water and beverages)
• Foods
• Metabolic water (water released in the body as an
end product of metabolism)
Loss of body water
• Kidneys
• Lungs
• Skin
• Feces
Water balance
Maintenance of water balance
• Water balance or fluid balance is achieved through
the:
- control of fluid intake
- control of the rate of fluid loss through the
kidneys
• Maintained through the actions of the following
hormones: angiotensin, antidiuretic hormone (ADH)
and aldosterone
• Water balance is disturbed in:
- Dehydration: a condition resulting from
excessive water loss, accompanied by
losses of electrolytes
- Overhydration (water intoxication): a
condition that results from excessive intake
of fluids without an equivalent amount of salt
Regulators of water balance
• Thirst – a conscious desire to drink
• Hormonal control- Renin-Angiotensin-Aldosterone
Mechanism
- Renin is an enzyme from the kidneys that is
secreted in response to low renal blood flow.
It converts the plasma proteins angiotensin I
to angiotensin II.
- Aldosterone is a hormone from the adrenal
cortex that stimulates sodium retention.
- Vasopressin or ADH is secreted by the
pituitary gland. It retains water.
Water requirements
• To compensate for water losses, the body must take
in daily at least 2.5L of water based on recommended
intake of 1ml per kcal of energy expenditure. Table
11.1 presents the minimum daily requirements for
water according to population group.
Table for Minimum Daily Requirements of Water
Population Group
Infants
Minimum daily requirement
Birth to < 6 months 800 mL
6 < 12 months
Children (1-8 years) according to weight
1000 mL
10-20kg 1000mL + 50mL/kg for each kg in excess
of 10
>20 kg 1000mL + 50mL/kg for each kg in excess
of 20
Adults (>18 years) 2500 mL
Older persons (>65 years) 1500 mL
Pregnant women Additional 300 mL
Lactating women (first 6 months) Additional 750-1000 mL
ELECTROLYTES
Description
• Electrolytes are products of ionization of salt, acid or
base dissolved in water, electrically charged particles;
and the anions and cations distributed throughout the
fluid compartments of the body.
a. Anions- negatively charged particles, e.g.
chlorides, bicarbonates, phosphates,
sulfates,
b. Cations- positively charged particles, e.g.
sodium, potassium, calcium, magnesium
Mechanism of electrolyte balance
• Sodium and chloride (both ECF electrolytes) and
potassium and phospates (both ICF electrolytes) are
the major electrolytes regulating the water movement.
a. When water loss excess electrolyte loss, the
ECF becomes hypertonic in relation to the
ICF, the water moves from the cells to the
ECF to restore equilibrium.
b. When water enters the ECF with insufficient
electrolytes to maintain the density of the
solution, the EC becomes hypotonic and
moves into the cell.
• Other mechanisms involve a balance between oncotic
pressure (exerted by the proteins in the plasma;
keeps the fluids inside the body) and hydrostatic
pressure (exerted by the pumping action of the heart
on the fluid in the blood vessels, keeps the fluid
outside the blood vessels).
Electrolyte requirement
• Minimum daily requirements for sodium, potassium
and chloride in your PDRI (2015)
Maintenance of Acid-base Balance Hard Water vs. Soft Water
• Acid-base balance or hydrogen ion concentration • Hard Water
must be controlled. • Contains calcium and magnesium
• Plasma pH is 7.4. • Leaves a ring on the tub, a crust of rocklike
• Optimal pH at which the body can operate ranges crystals in the teakettle, and a gray residue
from 7.35 to 7.45. in the laundry
• Body mechanisms that help maintain this normal pH • Soft Water
range are: • Contains sodium and potassium
- The buffer systems prevent a drastic change • Makes more bubbles with less soap
of the pH of the blood. • Easily dissolves certain contaminant
▪ Bicarbonate-carbonic system minerals (Cd & Pb) from old pumping pipes
▪ Phosphate system
▪ Hemoglobin-oxyhemoglobin system
▪ Proteins
- The lungs excrete CO2
- The kidneys excrete excess acids in the
urine.
 Dehydration

Osmotic Pressure
• The movement of water across a membrane toward
the more concentrated solutes is OSMOSIS
• The amount of pressure needed to prevent the
movement of water across a membrane is called
OSMOTIC PRESSURE

Bicarbonate
Regulation in the Lungs
• Lungs control the concentration of carbonic acid by
raising or slowing the respiration rate
• If too much carbonic acid, RR speeds up →
increases the amount of CO2 exhaled, thus lowering
the carbonic acid Quality Attributes of Functional Foods
• If too much bicarbonate, RR slows → CO2 is retained a. High fiber
and forms more carbonic acid b. Reduced fat
c. Reduced energy
Regulation in the Kidneys d. Low cholesterol
• Kidneys control the concentration of bicarbonate by e. Reduced caffeine
either reabsorbing or excreting it, depending on f. Low sodium/low salt
whether the pH needs to be decreased or increased g. Vitamin/mineral fortified
• Body’s total acid burden remains nearly constant
• Acidity of the urine fluctuates to accommodate that Examples of Functional Foods
balance a. Foods with benefits to the gastro intestinal system
b. Foods that afford protection to the cardiovascular
system
MODULE 7: PHYTOCHEMICALS AND FUNCTIONAL FOOD c. Foods that protect against degenerative diseases
d. Foods with sugar or fat alternatives
Phytochemicals e. Foods with optimal fat ratios for the elderly, people
• Plant compounds with biologic activity with health with diabetes, those at risk of heart disease and those
benefits with inflammatory disease
f. Foods designed for athletes
Health Effects g. Foods that enhance immune function
• The ability to prevent and treat diseases like cancer,
diabetes and heart diseases is attributed to: Factors to be altered in the production of functional foods
a. Metabolic detoxification of toxic substances a. Sensory quality
b. Prevention of oxidation b. Functional properties
c. Enhancement of immune function c. Handling costs/increased processing
d. Inhibition of proteases d. Packaging requirements
e. Shielding of protective structures of cells and
membrane stabilizing effect Factors to consider for health claims of functional food
f. Stimulation of DNA repair a. Identity of the active constituents the food and food
ingredients
Functional Foods b. Digestibility
• Modified food or food ingredient (may be natural or c. Bioavailabilty
formulated food) that may provide a health benefit d. Nutrient/food interaction
• Other terms: e. Physiologic effects
– Pharmafoods f. Pharmacologic effects
– Foodaceuticals g. Improvement in biologic function and/or protection
– nutraceuticals against disease
 h. Safety Monoterpene
limonene)
(include May trigger enzyme
production to detoxify
Citrus fruits peels and oils

i. Consistency of findings among many studies carcinogens and inhibit

cancer promotion and cell
j. Specificity of the outcome to the nutrient (food) proliferation
k. Presence or absence of a dose-response relationship Organosulfur compunds May speed production of
carcinogens-destroying
Chives,
onions
garlic, leeks,

l. Biologic plausibility of an association enzymes and slow

m. Significance of the association production of carcinogen-
activating enzymes
Phenolic acids May trigger enzyme Coffee beans, fruits
production to make (apples, blueberries,
Examples of Functional Foods carcinogens water soluble, cherries, grapes, oranges,
• Cranberries – protect against urinary tract infections facilitating excretion pears, prunes),
potatoes, soybeans
oats,

• Garlic – lower blood cholesterol Phytic acid Binds to minerals, which Whole grains
prevents free-radical
• Tomatoes – protect against some cancers formation and possible
• Yogurt – source of probiotics, good for digestion,
reduces cancer risk
Phytosterols (genistein and Estrogen inhibitions may Soybeans, soy flour, soy
increase immune system diadzein) produce thse actions; milk, tofu, textured
inhibit cell replication in vegetable protein, other
gastrointestinal tract; legume products
Name Possible effects Food sources reduce the risk of breast
colon, ovarian, prostate
Capsaicin Modulates blood clotting, Hot peppers and other estrogen-
possibly reducing the risk sensitive cancers; and
of fatal clots in heart and reduce cancer and cell
artery disease survival. Estrogen
Carotenoids (include beta- Act as antioxidants, Deeply pigmented fruits mimicking may reduce risk
of osteoporosis.
carotene, lycopene and possibly reducing risks of and vegetables (apricots, Protease inhibitors May suppress enzyme Broccoli sprouts, potatoes,
hundreds of related cancer and other diseases broccoli, cantaloupe, production in cancer cells soybeans and other
compounds) carrots, pumpkin, spinach, Protease inhibitors May slows
that suppressdown enzyme Broccoli soy
tumor legumes, sprouts, potatoes,
products
sweet potatoes, tomatoes) productioninhibit
growth; in cancer cells soybeans
hormone and other
binding;
that slows and down inhibit
tumor legumes, soy products
Curcumin Many inhibit enzymes that Turmeric, a yellow- malignant changes hormone
in cells
activate carcinogens colored spice growth; inhibit
binding; and inhibit
Flavonoids (include Act as antioxidants, Berries, black tea, celery, malignant changes in cells
flavones, flavonois) scavenge carcinogens, citrus fruits, green tea, Resveratrol Offsets artery-damaging Red wine, peanuts
bind to tirates in the olives, onions, oregano, effects of high fat diets
stomach for prevention purple grapes Saponins May interfere with DNA Alfalfa sprouts, other
replication preventing sprouts, green vegetables,
cancer cells from potatoes, tomatoes
Isoflavones, catechin and Conversion to Purple grape juice, multiplying and stimulate
others nitrosamines; inhibit cell soybeans and sot products, immune response
proliferation vegetables, whole wheat, Tannins May inhibit carcinogen Black-eyed peas, grapes,
wine activation and cancer lentils, red and white wine,
Indoles May trigger production of Broccoli and other promotion, and act as tea
enzymes that block DNA cruciferous vegetables antioxidants
damage from carcinogens (Brussels sprouts,
and may inhibit estrogen cabbage, cauliflower)
action horseradish,
greens
mustard
Current Nutrition-Related Issues
Isothiocyanates (including Inhibit enzymes that Broccoli and other • Fad Diets – Keto diet, Intermittent fasting, Low carbs
sulforaphane) activate carcinogen, cruciferous
triggers production of (Brussels
vegetables
sprouts,
diet
enzymes that detoxify cabbage, cauliflower) • Nutritional Supplements – can cause toxicity
carcinogens horseradish,
greens
mustard • Micronutrient Deficiencies – more on macronutrient
Lignans Block estrogen activity in Flaxseeds and its oils, • Overeating and lack of exercise
cells, possibly reducing whole grains • Food insecurity
the risk of cancer of the
breast, colon, ovaries and
prostate
NCM 105: NUTRITION AND DIET THERAPY
KANI MARYELLA M. NACIONAL, RND
WATER, VITAMINS & MINERALS VITAMIN D – “THE SUNSHINE VITAMIN”
 Essential for building and maintaining
VITAMINS bones and teeth
 Certain vitamins and minerals are needed  Responsible for absorption and utilization
for the body to function. of calcium
 13 vitamins
 Other health benefits:
 22 minerals
 May boost the immune system
 TWO TYPES OF VITAMINS:  May also help decrease certain cancers
 Water-soluble
 RDA: 5 micrograms until age 50
 Fat-soluble
 10 micrograms/day until 70; 15 mcg
FAT-SOLUBLE VITAMINS 70+
 Vitamin A, D, E and K
TOO LITTLE VITAMIN D
 Excess is stored in the liver and in body fat
 Vitamin D deficiency has been in the news
 It is possible to build up to a toxic level
a lot lately.
VITAMIN A (RETINOL)  Deficiency may occur from:
 Beta-carotene is converted into vitamin A  Inadequate diet
 VITAMIN A: o Vegetarianism, lactose
 Promotes good vision intolerance, milk allergy
 Promotes healthy skin  Body unable to absorb needed vitamin
 Helps with the growth and maintenance D
of bones, teeth, and cell structure  Limited exposure to sunlight
 RDA: 900 micrograms for males; 700 VITAMIN D DEFICIENCY
micrograms for females  May lead to osteomalacia and/or
TOO MUCH VITAMIN A osteoporosis
 May turn your skin orange
 May cause fatigue, weakness, severe
headache, blurred vision, hair loss, and
joint pain.
 TOXICITY:
 May cause severe liver or brain
damage
 Birth defects

TOO LITTLE VITAMIN A

 May cause night blindness
 Lowered immune system
GETTING VITAMIN D
FOODS RICH IN VITAMIN A  Sun exposure for 10 minutes a day
 FOODS:  FOODS:
 Only animal products  Fortified milk
o Liver  Tuna
o Eggs  Salmon
o Milk, butter, and cheese  May need a supplement
 CAROTENOIDS o Check with doctor first though
 Orange/Yellow fruits and vegetables
o Cantaloupes, carrots, sweet VITAMIN E
potatoes, winter squash  Important to red blood cells, muscles, and
 Leafy green vegetables other tissues
o Spinach, broccoli  Deficiency is rare
 Toxicity is rare
1|AMV
NCM 105: NUTRITION AND DIET THERAPY
KANI MARYELLA M. NACIONAL, RND
 But Vitamin E acts as a blood thinner
 FOODS:
 Vegetable oils, salad dressings, whole DEFICIENCY FOODS
grain cereals, green leafy vegetables, Rare but causes: Meat, poultry, liver,
diarrhea, dermatitis, eggs, brown rice,
nuts, seeds, peanut butter, and wheat
dementia, and death baked potatoes, fish,
germ. milk, and whole-grain
foods
VITAMIN K
 Important for blood clotting PYRIDOXINE OR B-6
 Also has a role in bone health  Involved in chemical reactions of proteins
 Mostly made in the intestines and amino acids
 FOODS:
 Turnip greens, cauliflower, spinach, DEFICIENCY FOODS
liver, broccoli, kale and cabbage Skin changes, Lean meats, fish,
dementia, nervous legumes, green leafy
WATER-SOLUBLE VITAMINS system disorders, and vegetables, raisins,
 Vitamins Bs and C anemia corn, bananas,
mangos
 Eight B vitamins:
 Thiamin (B-1)
COBALAMIN OR B-12
 Riboflavin (B-2)
 Helps with the nervous system, red blood
 Niacin (B-3)
cells, and DNA synthesis
 Pyridoxine (B-4)
 Cobalamin (B-12) DEFICIENCY FOODS
 Folic acid Nervous system Only found in animal
 Pantothenic acid disorders and products
 Biotin pernicious anemia  Meat, fish,
poultry,
THIAMIN OR B-1 eggs, milk
 Helps to convert carbohydrates to energy products
and clams
DEFICIENCY FOODS
Fatigue, nausea, Pork, beef, liver, peas, FOLIC ACID (FOLACIN, FOLATE)
depression, nerve seeds, legumes,  Key role in red blood cell formation and cell
damage whole-grain products, division
and oatmeal
DEFICIENCY FOODS
RIBOFLAVIN OR B-2 Anemia, digestive  Leafy, dark
 Key to metabolism and red blood cells disorders green
vegetables
DEFICIENCY FOODS  Also found in
Dry, scaly skin Milk, yogurt, cheese, liver, beans,
whole-grain slices of peas,
bread, green leafy asparagus,
vegetables, meat, and oranges,
eggs avocados

NIACIN OR B-3 PANTOTHENIC ACID AND BIOTIN

 Also involved with energy production  Help with metabolism and formation of
 Also helps with skin, nerves, and digestive some hormones
system  Deficiencies are rare

FOODS
Almost any food, plant-based or animal-based
2|AMV
NCM 105: NUTRITION AND DIET THERAPY
KANI MARYELLA M. NACIONAL, RND
SODIUM AND FOOD
VITAMIN C  On food labels:
 important to bone health, blood vessel  Monosodium glutamate (MSG)
health, cell structure, and absorption of iron  Baking soda
 Baking powder
DEFICIENCY FOODS  Disodium phosphate
 Rare Melons, berries,  Sodium alginate
 Too much tomatoes, potatoes,
 Sodium nitrate or nitrite
vitamin C broccoli,
fortified juices, kiwi,
REDUCING SODIUM IN YOUR DIET
mangos, yellow
peppers  Eat more fresh foods
and citrus fruits  Eat less processed foods
 Look for low-sodium products
MINERALS  Limit the salt you add to foods
 22 minerals are needed by the body  Experiment with other seasonings
 Use salt substitutes with caution
TWO MAJOR CATEGORIES
MAJOR TRACE CALCIUM
Include calcium, Include iron, zinc,  The most abundant mineral in your body
chloride, magnesium, iodine, selenium,
 99% is stored in the bones
phosphorus, copper,
potassium, sodium, manganese, fluoride,  Known for bone health
and sulfur chromium,  HOW MUCH DO YOU NEED?
molybdenum,  Males - 19-50 years old: 1,000 mg / day
arsenic, nickel, silicon,  Females - 19-50 years old: 1,000 mg / day
boron and cobalt
CALCIUM AND FOODS
SODIUM  Dairy products, fortified juices, sardines
 WHAT DOES SODIUM DO FOR YOU?
 Helps maintain fluid balance FOOD CALCIUM
 Helps transmit nerve impulses  Yogurt, plain  1 cup - 415 mg
 Influences contraction and relaxation of (low-fat)  1 cup – 345 mg
muscles  Yogurt,
flavored (low-
SODIUM AND HEALTH fat)
 TOO MUCH SODIUM  Milk, skim  1 cup – 302 mg
 Causes high blood pressure  Milk, 1-2%  1 cup – 300 mg
Ice cream ½ cup – 88 mg
 May lead to fluid retention
Broccoli, cooked ½ cup – 68 mg
SODIUM SAVVY Salmon, canned 3 oz – 165 mg
Fortified orange juice 8 oz – 300 mg
 The human body requires about 500 mg of
sodium per day, while the average
IRON
American usually ingests between 2,300-
 Iron deficiency is the most widespread
6,900 mg each day.
vitamin or mineral deficiency in the world.
 It is recommended to stay in a range of
 70% of your body’s iron is in your
1,500 to 2,400 mg / day.
hemoglobin
 WHERE ARE YOU GETTING SODIUM?  TOO LITTLE IRON = TOO LITTLE
 5% - added while cooking OXYGEN
 6% - added while eating
 12% - from natural sources IRON AND FOODS
 77% - from processed and prepared HEME IRON NON-HEME IRON
foods Found in animal Found in plant
products products

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NCM 105: NUTRITION AND DIET THERAPY
KANI MARYELLA M. NACIONAL, RND
 Red meats,
liver,  Beans,
poultry and nuts,
eggs seeds,
dried fruits,
fortified
breads and
cereals

IRON SUPPLEMENTS
 Check with your doctor first.
 HIGH-RISK GROUPS:
 Strict vegetarians
 Those who do not eat a balanced diet
 Those who are over 60
 Smokers and those who regularly drink
alcohol
 Chronic dieters
 Those who suffer from food allergies,
intolerances

WATER
 Essential for life
 It is possible to live without food than
without water
 Water makes up about 45-75% of your
body weight
 WHY IS WATER IMPORTANT?
 Aids with transport
 Mechanical functions
 Helps to break substances down
 Helps to maintain body temperature/pH
 HOW MUCH WATER DO YOU NEED?
 ADEQUATE INTAKE:
o For men: 125 oz / day
o For women: 91 oz / day
 Ideally 80% of water should coming
from drinking fluids.
o 20% of water intake should
come from food

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NCM 105: NUTRITION AND DIET THERAPY
MS. KANI MARYELLA NACIONAL, RND
CARBOHYDRATES
 an important part of a balanced, healthy
diet. Foods rich in carbohydrates serve as
the preferred energy source for most of the
body’s activities including brain and muscle
function.
 Fat, protein, and alcohol should not be
used as the major source of fuel since diets
high in any of them are associated w/
undesirable health problems.
 Simple Carbohydrates: includes
monosaccharide or single sugar (fructose,
glucose, and galactose) disaccharides are
pairs of monosaccharides (sucrose,
lactose, and maltose), and sugar alcohols
(sorbitol, mannitol, and xylitol)
 Single sugars
- Fructose occurs naturally in fruits,
honey, and vegetables; the amount
of fructose depends on the ripeness
of fruits.
- Glucose, also known as dextrose
sugar or grape sugar is the body’s
circulating sugar
- Galactose is a component of
lactose, the sugar in Milk.
 Double sugars
- Sucrose is the common table
sugar; lactose is the sugar in milk
- Maltose is the intermediate product
FORMS OF SUGAR IN FOOD PRODUCTS
 BROWN SUGAR
- Refined white sugar crystals w/c
manufacturers have added
molasses syrup w/ natural flavor
and color
 RAW SUGAR
- Sugar that has actually gone
through about half the refining
process
 CONFECTIONERS SUGAR
- Finely powdered sucrose
 CORN SYRUP
- Contain mainly glucose, produced
by the action of enzymes on
cornstarch
 GRANULATED SUGAR
- Crystalline Sucrose
 HIGH-FRUCTOSE CORN SYRUP (HCFS)
- Composed of nearly equal amounts
of fructose and glucose
 HONEY INVERTS SUGAR
- A mixture of glucose and fructose
formed by splitting sucrose in a
chemical process
 MOLASSES
- thick brown syrup that remains
when sucrose is made up from
sugar cane
 MAPLE SYRUP
- A sugar (chiefly sucrose) purified
from the concentrated sap of the
sugar maple tree.
SUGAR ALCOHOLS
 Also called nutritive sweeteners
 are sugar-like compounds that are sweet to
taste but yield fewer calories per gram.
 They are used as a sucrose substitute
(alternative sweetener) in candies, chewing
gum, beverages, and another foodstuff.
 Excess Intake = abdominal discomfort
since they are fermented to gases in the
large intestine by bacteria.
 Less dental carries than the common sugar
ARTIFICIAL SWEETENERS
 Make food taste sweet without promoting
damage to tooth enamel.
 Sometimes called non-nutritive
sweeteners, artificial sweeteners are
noncarbohydrate non- caloric synthetic
sweetening agents.
 Aspartame(Equal) - saccharin, Acesulfame
potassium, and sucralose (Splenda) -
Approved by the FDA
 COMPLEX CARBOHYDRATES - Are
polysaccharides (multiples of sugars)
starch, dextrin, glycogen, and dietary
fibers.
 DIGESTIBLE POLYSACCHARIDE –
these are complex carbohydrates that can
be broken down into sugar units; this group
includes starch and dextrin.
 NON-DIGESTIBLELE, NONSTARCH,
POLYSACCHARIDES - are complex
carbohydrates that contain sugar units held
together by bonds that the human digestive
system cannot break, thus, they yield little,
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NCM 105: NUTRITION AND DIET THERAPY
MS. KANI MARYELLA NACIONAL, RND
if any, energy. They are also known as
Dietary Fibers and include cellulose,
hemicellulose, pectin and gums. Dietary
fiber is the skeleton of plants.
RELATIVE SWEETNESS OF SUGAR AND
ARTIFICIAL SUGAR
NUTRITIONAL ROLES OF CARBOHYDRATES
1. Protein Sparer
2. Fat sparer
3. Sole energy source for the brain and nerve
tissue
4. Reserve fuel supply
5. Regulator of normal bowel movement,
6. Act as structural component
RECOMMENDED INTAKE OF CHO
 The suggested total amount of
carbohydrates in the diet varies and is
typically based on food habits.
 Filipino Diet - 55 to 70 percent of the daily
total calorie intake (FNRI)
Example:
A 5’4 individual needing 2000 kcal/ day will
have a carbohydrate allowance of 300g.
How?
2000x 0.60 = 1200kcal/ 4kcal= 300gram of
Carbohydrates per day
 Almost all experts agree that one’s
carbohydrate intake should be largely
coming from whole-grain bread and
cereals, root crops, fruits, and vegetables.
 Sugar intake must be moderate
 Recommended intake of dietary fiber is 25-
30 grams per day; men should aim for the
upper limit
DIGESTION
 MOUTH
- all monosaccharides require no
digestion while disaccharides are
not digested in the mouth.
- Starches are more complex than
simple sugar; they break down
more slowly and supply energy over
a longer period of time. Grinding or
cooking makes starch easier to
digest. Salivary amylase (formerly,
ptyalin) breaks down the starch into
smaller units and eventually into
maltose.
- While most starches are practically
digested, some starch is not broken
down and it is called resistant
starch. Legumes, in general,
contain more resistant starch than
do grains, fruits, and vegetables.
 STOMACH
- Wavelike contraction of the muscle
of the stomach wall continues the
mechanical digestion process (this
is called peristalsis).
- Note that gastric secretions contain
no specific enzyme for the
breakdown of carbohydrates.
- The HCL in the stomach stops the
action of amylase in the food mass.
As much as 20-30% of the starch
may have been changed to
maltose.
 INTESTINE
- Peristalsis continues to aid
mechanical digestion in the small
intestine.
- Much of the chemical digestion of
carbohydrates occurs in the small
intestine and is completed by
specific enzymes: amylase or
amylopsin (from the pancreas)
continues to breakdown starch to
maltose; disaccharides (from the
intestinal mucosal cells) sucrose,
lactase, and maltase covert
sucrose, lactose and maltose,
respectively, to single sugars ready
for absorption directly into the portal
blood circulation
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NCM 105: NUTRITION AND DIET THERAPY
MS. KANI MARYELLA NACIONAL, RND

- Lactose remains in the intestine

longer than other sugars and
encourages the growth of certain
useful bacteria. It also aids calcium
and phosphorus absorption.
- Single sugars (glucose, fructose,
galactose) are carried to the liver;
enzymes in the liver convert simple
sugars into glycogen when there is
no immediate demand for glucose.
Otherwise, sugars are used for
immediate energy needs.

HEALTHY EFFECTS OF CARBOHYDRATES

INTAKE
 SUGARS
- Nutrient Deficiencies
- Dental carries
- Obesity
- Atherosclerosis
 STARCH AND FIBERS
- Weight loss
- Satiety value
- Lower risk of heart disease
- Lower risk of diabetes
- Enhanced health of the colon
- Nutrient deficiencies and intestinal
obstruction

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NCM-105 NUTRITION AND DIET THERAPHY
EATING HEALTHY ON A BUDGET
• As health care professionals, when you
take responsibility for your own health by
making daily choices and practicing
behaviors that enhance your well-being,
you prepare yourself physically, mentally,
and emotionally to meet the demands of
your profession.
• A healthy diet helps to protect against
malnutrition in all its forms, as well as
noncommunicable diseases (NCDs),
including such as diabetes, heart disease,
• stroke and cancer.
6 BASIC PRINCIPLES OF DIET PLANNING
• Adequacy
• Enough energy and nutrients (all)
are included in the diet to meet the
needs of healthy people.
• Balance
• Consuming the right amount of
each type of food. Not too much,
Not too little
• Energy
• Energy from foods
• Nutrient Density
• Choose foods that gives you the
most nutrients for the least food
energy
• Moderation
• "Everything in moderation; nothing
in excess."
• Variety
• variety is the spice of life, Vary your
choices
BALANCE DIET – inlcudes all six classes of
nutrients and calories in amounts that preserve
and promote good health.
DIETARY GUIDELINES – provide a science-
based advice to promote health and to reduce the
risk of chronic diseases through diet and physical
activity.
NUTRITIONAL GUIDELINES FOR FILIPINOS
(NGF) – a set of dietary guidelines based on the
CJPV
MODULE-2
eating pattern, lifestyle, and health status of
Filipinos.
– contains all the nutrition messages to
healthy living for all age groups from infants to
adults, pregnant and lactating women, and the
elderly.
NUTRIONAL GUIDELINES FOR FILIPINOS
1. Eat a variety of foods everyday to get the
nutrients needed by the body.
2. Breastfeed infants exclusively from birth uo
to six months, then give appropriate
complementary foods while continuing
breastfeeding for two years and beyond for
optimum growth and development.
3. Attain a normal body weight through proper
diet and modearte physical activity to
maintain a good health and prevent
obesity.
4. Consume fish, lean, meat, poultry, egg,
dried beans or nuts daily for growth and
repair of body tissues.
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
shellfish, everyday for healthy bones and
teeth.
8. Use iodized salt to prevent iodine
deficiency disorders.
9. Consume safe foods and water to prevent
diarrhea and other food and water borne
dieseases.
10. Be physically active, make healthy food
choices, manage stress, avoid alcoholic
beverages and do not smoke to help
prevent lifestyle-related non-
communicable diseases.
FOOD GUIDE PYRAMID
FOOD GUIDE PYRAMID – teaches the principles
of eating a variety of food everyday in proper
amounts of servings.
– teaches moderation in some food items,
while emphasizing the importance of others.
– renamed Daily Nutrional Guide Pyramid
for Filipinos
RICE AND CEREALS – take up the major bulk in
the diet
FATS AND OILS – take up the least volume and
bulk
VEGETABLES – have bigger space than fruits in
volume and bulk
PINGGANG PINOY (HEALTHY FOOD PLATE
FOR FILIPINO ADULTS)
The first Pinggang Pinoy food guide developed by
1
NCM-105 NUTRITION AND DIET THERAPHY
the FNRI-DOST was the Pinggang Pinoy for
Filipino adults. Since individual’s energy and
nutrient needs vary based on age and sex and
level of physical activity, Pinggang Pinoy food
guides for the different population and physiologic
groups (children, adolescents, elderly, pregnant
mother, and lactating women) were also
developed.
PINGGANG PINOY – a new and easy-to-
understand food guide that uses a familiar food
plate model to convey the right food group
proportions on a per-meal basis.
– This will help Filipinos acquire healthy
eating habits needed to attain optimum nutrition.
The guide shows the recommended proportion by
food group, Go, Grow and Glow on per meal basis.
By just looking at the plate, one will know right
away that half of the plate represents Glow foods
consisting of fruits and vegetables. One sixth of the
plate shows proportion for Grow foods such as
meats, eggs, poultry, fish, beans and legumes.
One third of the plate is Go foods like rice, corn,
bread, oatmeal, bread and rootcrops.
BENEFITS OF PINGGANG PINOY (NATIONAL
NUTRITION COUNCIL VII)
• Easy to understand food guide
• Uses a familiar food plate model to convey
the right food group proportions
• A visual tool to help filipinos adopt healthy
eating habits at meal times
• Delivers important dietary and healthy
lifestyle messages.
• Per-meal basis to meet the body’s energy
and nutrient needs of Filipino adults
• Answer the question of how much you
should eat in one eal in order to be healthy.
17% BAHAGI NG ISDA, KARNE AT IBA PA
33% BAHAGI NG KANIN, LAMANG-UGAT AT
IBA PA
17 % BAHAGI NG PRUTAS
33% BAHAGI NG GULAY
TUBIG
DIETARY STANDARDS
CJPV
MODULE-2
DIETARY STANDARDS – are compilation of
nutrient requirements or allowances in the specific
quantities.
– tentative and may be changed due to
newer findings from research unveils.
– a quantitative tool in assessing the
nutrional adequacy of diets
– also observe the principle of
individualization.
• DIETARY REQUIREMENTS INTAKE
• RECOMMENDED DIETARY
ALLOWANCE (RDAs)
• RECOMMENDED ENERGY AND
NUTRIENT INTAKE (RENI)
• DIETARY REFERENCE INTAKE (DRIs) –
USA and Canada
FOOD EXCHANGE LIST
The Food Exchange List (FEL) for Meal Planning
handbook simplifies the calorie counting process
by grouping together food items with
approximately the same amount of carbohydrate,
protein and fat content.
The FEL consists of seven (7) food lists namely
vegetables, fruit, milk, rice, meat, fat and sugar.
Food items belonging in the same food lists can be
exchanged with one another during meal planning
which allows for variations in meals for normal and
therapeutic diets. Other food items not covered by
the seven food lists are placed in other food lists
such as selected foods and beverage lists.
STEPS IN CALCULATING AND PLANNING
DIETS
• Determine the desirable body weight
• Estimate the Total Energy Requirement
(TER)
• Determine the amount of Macronutrients
for Diet Prescription
• Translate the Diet Prescription into
Exchanges
DETERMINE THE DESIRABLE BODY WEIGHT
DBW using Tannhauser Method (Broca’s Index)
Equation:
DBW = (HEIGHT – 100) – (10% (HEIGHT – 100) )
Example:
Calculate the DBW of an adult female who stands
5’1” tall.
a. Convert height to centimeter
5’1” = (5 feet x 12 inches/foot) + 1 inch
= 5 x 12 = 60 + 1
= 61 inches x 2.54 cm/inch
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NCM-105 NUTRITION AND DIET THERAPHY MODULE-2
= 154.94 cm

b. Deduct from the height the factor 100

DBW (Kg) = 154.94 – 100

= 54.94

c. To adjust body frame for Filipinos, Deduct

additional 10%.

DBW (Kg) = 54.94 – (10% of 54.94)

= 54.94 – 5.494
= 49.446 or 49 kg

TRANSLATE THE DIET PRESCRIPTION TO

EXCHANGES
Energy and Macronutrients Composition of Food
Exchanges

ESTIMATE THE TOTAL ENERGY

REQUIREMENT
TER is based on the estimate of energy
expenditure according to physical activity level
(PAL) and body weight (kg)

EXAMPLE:
Sample computation and Distribution
(1500 kcal, 245g Carbohydrate, 55g Protein, 35g
Fat)

PHYSICAL ACTIVITY LEVELS AND VALUES

(kcal/kg body weight) by Occupational Work
Intensity

DETERMINE THE AMOUNT OF

MACRONUTRIENTS FOR DIET
PRESCRIPTION
Determining the carbohydrate, protein and fat
requirement based of Acceptable Macronutrient
Distribution Range (AMDR) as suggested int the
2015 PDRI. DOST-FNRI, 2017

CJPV 3
NCM-105 NUTRITION AND DIET THERAPHY MODULE-2
FOOD LABEL
The information in the main or top section of the
sample nutrition label can vary with each food and
beverage product; it contains product-specific
information
• serving size
o The important starting point when
reading a label
o This shows you how much food is
equal to one serving
o It is the base volume for all the
nutrient values on the label, such as
FOOD LABELING the number of grams of protein and
FOOD LABEL – is any tag, brand, mark, pictorial the percentage of vitamins and
or other descriptive matter, written, printed, minerals
stenciled, marked, embossed or impressed on, or • Calories
attached to, a container of food or food product. o Calories are units of energy
Food labeling was pass by CONGRESS OF THE o In food, calories come from
NUTRITION LABELING AND EDUCATION ACT carbohydrate, protein and fat
(NLEA) in 1990, nutrition labeling regulatrions o Our bodies need calories to work
became mandatory in MAY 1994 for nearly all • Servings per container
processed foods. o This is the number of servings that
Primary objective of changes was to ensure that are in the entire package
labels will be on most foods and will provide o To find out the total amount of
consistent nutrition information. nutrients in the package, multiply
FOOD LABELS provide the consumer with more each nutrient amount by the
information on the nutrient contents of foods and number of servings per container
how nutrients affects health. o Example: If there are 3 servings per
Health claims allowed on labels are limited and is container and the serving size is 1
set by the Food and Drug Administration (FDA). cup, the whole package contains 3
• Serving sizes are determined by FDA and cups
not the individual food processor • nutrient information
• Descriptive terms are standardized. • fats
Example: Low fat means that each serving Saturated Fat
contains 3g of fat or less. o It is sometimes called the
Nutrition Label has a formatted space called “unhealthy” fat
Nutrition Facts o Eating too much saturated fat may
Food label information includes: lead to heart disease
• Total calories o Saturated fats are commonly found
• Calories from fats in animal sources such as meat and
• Total fat dairy
Polyunsaturated &
• Saturated fat
Monounsaturated Fats
• Trans fat
o These fats keep your heart healthy
• Cholesterol o Polyunsaturated fats include
• Sodium essential omega 3 and omega 6
• Total carbohydrates fats
• Dietary fiber o These can be found in fish such as
• Sugars salmon
• Protein Trans Fat
• Vitamin A o Is used to make many processed
• Calcium foods such as baked goods and fast
• Iron foods such as french fries
A new easier-to-understand food label is nearing o Eating trans fat may lead to heart
FDA approval. disease
20 years has been updated o Aim to limit trans fat from your diet

• cholesterol

CJPV 4
NCM-105 NUTRITION AND DIET THERAPHY MODULE-2
o Cholesterol is only found in animal number of calories used for general
products nutrition advice.
o Eating large amounts of cholesterol EXAMPLE LABEL FOR FROZEN LASAGNA:
rich foods may lead to heart
disease
• Sodium
o Sodium is found in salt
o Our hearts and kidneys need some
sodium to help stay healthy
o Consuming too much sodium may
lead to high blood pressure
• total carbohydrate
o Carbohydrates in food come from
fiber, sugars and other starches
o Carbohydrates are broken down
into sugar during digestion
o They are the main source of energy
for the brain
Fiber
o Creates “bulk” in our diet
o Is needed to help keep our bowels SERVING INFORMATION
regular When looking at the Nutrition Facts label
o Helps to keep us feeling full First take a look at the number of servings
Sugars in the package (servings per container) and the
o Sugars are found naturally in some serving size. Serving sizes are standardized to
foods and added to other foods make it easier to compare similar foods; they are
o They are found naturally in foods provided in familiar units, such as cups or pieces,
such as fruit, vegetables, and dairy followed by the metric amount, e.g., the number of
products grams (g). The serving size reflects the amount
o They are added to some foods such that people typically eat or drink.
as breads, cakes, and cookies It is not a recommendation of how much
• Protein you should eat or drink.
o Protein is used to build muscle and Pay attention to the serving size, especially
to fight infection how many servings there are in the food package.
o Protein is also a source of energy For example, you might ask yourself if you are
• % daily value consuming ½ serving, 1 serving, or more.
o This is based on an average
amount of 2,000 calories a day
o This number shows you the total
percentage of each nutrient
provided by one serving
CALORIES – provide a measure of how much
• Vitamins and minerals
energy you get from a serving of this food.
o The label tells you the percentage
In the example, there are 280 calories in one
of vitamins (vitamins A and C) and
serving of lasagna.
minerals (calcium and iron) that are
To achieve or maintain a healthy
in the product
body weight, balance the number of calories you
o These four nutrients are required to
eat and drink with the number of calories your body
be on the label, but other vitamins
uses. 2,000 CALORIES A DAY is used as a
and minerals may also be listed
general guide for nutrition advice. Your calorie
• Total Fat
needs may be higher or lower and vary depending
o Fat is an important nutrient
on your age, sex, height, weight, and physical
o It creates hormones, and helps you
activity level.
to feel full after eating
Remember: The number of servings you
o Total, saturated & trans fat will
consume determines the number of calories you
always be listed on the food label;
actually eat. Eating too many calories per day is
mono and poly unsaturated fat may
linked to OVERWEIGHT AND OBESITY.
also be listed
• The bottom section contains a footnote that
explains the % Daily Value and gives the

CJPV 5
NCM-105 NUTRITION AND DIET THERAPHY
NUTRIENTS – to get less of: Saturated Fat,
Sodium, and Added Sugars.
Saturated fat, sodium, and added sugars
are nutrients listed on the label that may be
associated with adverse health effects – and
Americans generally consume too much of them,
according to the recommended limits for these
nutrients. They are identified as nutrients to get
less of. Eating too much saturated fat and sodium.
For example, is associated with an
increased risk of developing some health
conditions, like cardiovascular disease and high
blood pressure. Consuming too much added
sugars can make it hard to meet important nutrient
needs while staying within calorie limits.
WHAT ARE ADDED SUGARS AND HOW ARE
THEY DIFFERENT FROM TOTAL SUGARS?
Total Sugars on the Nutrition Facts label
includes sugars naturally present in many
nutritious foods and bevergares such as sugar in
milk and fruit as well as any added sugars that may
be present in the product. No Daily Reference
Values has been established for total sugars
because no recommendation has been made for
the total amount to eat in a day.
Added sugars on the Nutrition Facts label
include sugars that are added during the
processing of foods (such as sucrose or dextrose),
food packaged as sweeterners (such as table
sugars), sugars from syrups and honey, and
sugars from concentrated fruit or vegetable juices.
Diets high in calories from added sugars can make
it difficult to meet daily recommended levels of
important nutrients while staying within calorie
limits.
Note: Having the word “includes” before added
sugars on the label indicates that added sugars are
included in the number of grams of total sugars in
the product.
For example, a container of yogurt with added
sweeterners, might list: Total sugars on sample
label
CJPV
MODULE-2
HEALTH CLAIMS
• Calcium and Osteoporosis
• Sodium and Hypertension
• Diets low in saturated fat and cholesterol
and high in fruits, vegetables and grains
containing dietary fiber and coronary heart
disease
• Diets low in fats and high in fruits and
vegetables containing dietary fiber and the
antioxidants, and vitamin A and C and
cancer
• Diets low in fat and high in fiber-containing
grains, fruits and vegetables and cancer
• Folic Acid and Neural Tube Defects
• Soy Proteins and Coronary Heart Disease
• Two additional criteria must also be met:
o A food whose label makes a health
claim must be naturally good
source (containing at least 10% of
the daily value) of at least one of the
following nutrients: protein, vitamin
A, vitamin C, iron, calcium or fiber.
o Health claims cannot be made for a
food if a standard serving contains
more than 20% of the daily value for
total fat, saturated fat, cholesterol
or sodium.
TERMINOLOGY
The FDA has standardized Descriptors – term
used by the manufacturers to describe products on
food labels to help the consumer select the most
appropriate and healthful foods.
Examples:
• Low calorie means 40 calories or less per
serving.
• Calorie free means less than 5 calories per
serving.
• Low fat means a food has no more than 3g
of fat per serving or per 100g of the food.
• Fat free means a food contains less than
0.5g of fat per serving.
• Low saturated fats 1g or less of saturated
fat per serving.
• Low cholesterol means 20mg or less of
cholesterol per serving.
• Cholesterol free means less than 2mg of
cholesterol per serving.
• No added sugar means that no sugar or
sweeteners of any kind have been added
at any time during the preparation and
packaging. When such a term is used, the
package must state that it is not low calorie
or calorie reduced (unless it actually is).
• Low sodium means less than 140mg of
sodium per serving,
6
NCM-105 NUTRITION AND DIET THERAPHY
• Very low sodium means less than 35mg of
sodium per serving.
FOOD CUSTOMS
FOOD CUSTOMS – are food habits originating in
small section of a particular country.
DIETARY LAWS – rule to be followed in meal
planning is some religions.
COMFORT FOODS – foods that were familiar to
them during their childhood.
CULTURAL DIETARY INFLUENCES
FOOD PATTERNS is based on:
Cultures
Regions and countries
FILIPINO CULTURAL DIETARY INFLUENCE:
Spanish
Japanese
Western
Chinese
Indian
The Pacific Islands
FOOD PATTERNS BASED ON RELIGION OR
PHILOSOPHY
JEWISH – persons who adhere to the Orthodox
view consider tradition important and always
observe the dietary laws.
– Food prepared according to these laws
are called Kosher.
– Conservative Jews are inclined to
observe the rules only at home.
– Reform Jews consider their dietary laws
to be essentially ceremonial and so minimize their
significance.
These Law requires the following:
• Slaughtering must be done by a qualified
person in a prescribed manner. The meat
or poultry must be drained of blood, first by
severing the jugular vein and carotid artery,
then by soaking in brine before cooking.
• Meat and meat products may not be
prepared with milk and milk products.
• The dishes used in the preparation and
serving of meat products must be kept
separate from those used for dairy foods.
• Dairy products and meat may not be eaten
together. At least six hours must elapse
after eating meat before eating dairy
products, and 30 minutes to one hour must
elapse after eating dairy products before
eating meat.
• The mouth must be rinsed after eating fish
and before eating meat.
• There are prescribed fast days: Passover
Week, Yom Kippur and Feast of Purim.
• No cooking is done on the Sabbath, from
sundown Friday to sundown Saturday.
CJPV
MODULE-2
Jewish dietary laws forbid the eating of the
following:
• The flesh of animals without cloven (split)
hooves or that do not chew their cud.
• Hindquarters of any animal
• Shellfish or fish without scales or fins.
• Birds of prey.
• Creeping things and insects.
• Leavened (contains ingredients that cause
it to rise) bread during Passover.
• In general, the food served in rich. Chicken
and fresh-smoked and salted are popular,
as are noodles, eggs and flour dishes.
These diet can be deficient in fresh
vegetables and milk.
ROMAN CATHOLIC - The dietary restrictions of
the Roman Catholic religion have liberalized, meat
is not allowed on Ash Wednesday and Good
Fridays, Pope request believers to abstain eating
meat in other Fridays during Lent.
EASTERN ORTHODOX – Includes Christians
from the Middle East, Russia, Greece
– Interpretation of the dietary laws vary
meat, poultry, fish, and dairy products are
restricted on Wednesdays and Fridays and during
Lent and Advent.
SEVENTH-DAY ADVENTIST – Seventh-Day
Adventist in general are Lacto-ovo vegetarians,
which means they use milk products and eggs but
no meat, fish or poultry.
– Use nuts, legumes and meat analogues
(substitutes) and tofu.
– Consider coffee, tea and alcohol to be
harmful.
MORMON (LATTER-DAY SAINTS) – The only
dietary restriction observed is the prohibition of
coffee, tea, and alcoholic beverages.
ISLAMIC – adherents of Islam are called Muslim.
– Dietary Laws prohibits the use of pork
and alcohol.
– Meats must be slaughtered according to
specific laws (Halal).
– During the month of Ramadan, Muslims
do not eat or drink during daylight hours.
HINDU – all life is sacred and animals contain the
souls of ancestors.
– Most Hindus are vegetarian.
– They do not use eggs because egg
represent life.
VEGETARIANS – there several vegetarian diets.
– The most common among them do not
include meat.
– Some include eggs, milk and cheese and
some do not.
– It is important to carefully planned these
diet could be nutritious and to include appropriate
combinations of essential amino acids.
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NCM-105 NUTRITION AND DIET THERAPHY MODULE-2
– Contributes to reduction of obesity and
reduced risk of high blood pressure, heart disease,
some cancer and diabetes.
– Vegetarians need to focus in ensuring to
get enough calcium, vitamin D, vitamin B12,
iron, zinc, and proteins.
Two types of vegetarians:
LACTO-OVO VEGETARIANS - use dairy
products and eggs but no meat, poultry or fish.
VEGANS - avoids all meat foods. They use
soybeans, chickpeas, meat analogues, and
tofu.
ZEN-MACROBIOTICS DIETS – Macrobiotic diets
is a system of 10 diet plans
– Developed by Zen Bhuddism
– Adherents progress from lower number
diet to higher, gradually giving up food in
the following order: desserts, salads, fruits,
animal foods, soups and ultimately
vegetables, until only cereals – usually
brown rice – are consumed.
– Beverages are kept in minimum.
– Only organically grown foods are used.
– Food are grouped as yang (male) or yin
(female). A ratio of 5:1 yang to yin is
considered important.
– Most macrobiotic diets are nutritionally
inadequate and can be dangerous
because avid adherents promise medical
cures from the diets that cannot be attained
and medical treatment maybe delayed
when needed.

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NCM-105 NUTRITION AND DIET THERAPHY
DIGESTION, ABSORPTION, AND
METABOLISM
DIGESTION – is the process whereby food is
broken down into smaller pieces, chemically
changed and moved through gastrointestinal
system.
Digestion begins in the mouth and ends at the
anus.
GASTROINTESTINAL TRACT – consists of the
structure that participate in digestion. Secretes
mucus to lubricates and protects the mucosal
tissues.
TWO TYPES OF DIGESTION ACTION:
- mechanical
- chemical
MECHANICAL DIGESTION – Food is broken
down into smaller pieces by the teeth.
– It is moved to the GI tract through the
esophagus, stomach and the intestines. This
movement is due to rhythmic contraction of the
muscular walls of the tract called Peristalsis.
– Mechanical digestion helps to prepare
food for chemical digestion by breaking it
into smaller pieces.
– Smaller pieces collectively have more
spaces than the large ones and are readily
broken down by the digestive juices.
• Gastrointestinal motility: Beginning in the
mouth, muscles and nerves in the (GI) tract
coordinate their actions to provide motility,
an automatic response to the presence of
food.
• Muscles
• Muscle tone/tonic contraction:
Ensures continuous passage of the
food mass and valve control along
the way.
• Periodic muscle contraction and
relaxation: Rhythmic waves that
mix the food mass and move it
forward.
• Nerves
• Specific nerves regulate muscle
action along the GI tract.
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• The intramural nerve plexus is the
network of nerves in the GI wall
extending from the esophagus to
the anus.
CHEMICAL DIGESTION – the composition of
carbohydrates, proteins and fats is changed.
• Digestive enzymes: Break down nutrients
• Hydrochloric acid and buffer ions:
Produce the correct pH necessary for
enzyme activity
• Mucus: Lubricate and protect the GI tract
tissues and help mix the food mass
• Water and electrolytes: Carry and
circulate the products of digestion through
the tract and into the tissues
• Bile: Divides fat into smaller pieces to
assist fat enzymes
HYDROLYSIS – is the process of chemical
changes occur through the addition of water and
the results in splitting or broken down of the food
molecules.
Food is broken down into nutrients that the
tissue can absorb or use.
Hydrolysis involves digestive enzymes that
act on food substances causing to break down into
simple compounds.
ENZYME acts as catalyst that speeds up the
chemical reactions without itself being change in
the process.
Digestive enzymes are secreted by the
mouth, stomach, pancreas and the small
intestines.
Enzyme is named for the substances on
which it acts.
Example: sucrase acts on sucrose; maltase acts
on maltose and lactase acts on lactose.
DIGESTION IN THE MOUTH
Digestion begins in the mouth where food
is broken down into smaller pieces by the teeth and
mixed with saliva.
Each mouthful of food that is ready to be
swallowed is called bolus.
Saliva is a secretion of the salivary glands
that contains water, salts, and digestive enzyme
called salivary amylase or known as Ptyalin that
acts on complex carbohydrates (starch).
A small amount of carbohydrates are
chemical change in the mouth.
The final chemical digestion of
carbohydrates occurs in the small intestine.
THE ESOPHAGUS
ESOPHAGUS – is a 10 inch muscular tube
through which food travels from the mouth to the
stomach.
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NCM-105 NUTRITION AND DIET THERAPHY
– The bolus food is moved down the
esophagus by peristalsis and gravity.
– The cardiac sphincter known as Lower
Esophageal Sphincter opens to allow passage of
the bolus into the stomach. And prevents the acid
content of the stomach to back flow to the
esophagus.
– If the sphincter malfunctions, it causes
acid reflux disease.
DIGESTION IN MOUTH AND ESOPHAGUS
• Mechanical digestion
▪ Mastication breaks down food.
▪ Food is swallowed and passes
down esophagus.
▪ Muscles at tongue base facilitate
process.
▪ Gastroesophageal sphincter at
stomach entrance relaxes, allowing
food to enter, then constricts to
retain food.
• Chemical digestion
▪ Salivary glands secrete material
containing salivary amylase or
ptyalin.
▪ Ebner’s glands at the back of the
tongue secrete a lingual lipase.
▪ Salivary glands also secrete a
mucous material to lubricate and
bind food particles, facilitating the
swallowing of the food bolus.
▪ Secretions from the mucous glands
in the esophagus help move food
toward stomach.
DIGESTION IN THE STOMACH
• Mechanical digestion
▪ Under sphincter control, the food
enters the upper portion of the
stomach as individual bolus lumps.
▪ Stomach muscles knead, store,
mix, and propel the food mass
forward.
▪ By the time the food mass reaches
the lower portion of the stomach, it
is a semi-liquid, acid/food mix called
chyme.
▪ Chyme is released slowly into the
first section of the small intestine
(duodenum) by the pyloric valve.
• Chemical digestion: three types of gastric
secretions
▪ Hydrochloric acid: Parietal cells in
stomach lining secrete acid to
promote gastric enzyme activity.
▪ Mucus: Secretions protect the
stomach lining from the erosive
effect of the acid, and also bind and
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mix the food mass and help move it
along.
Enzymes: Pepsinogen is secreted by stomach
cells and activated by acid to become pepsin, a
protein-splitting enzyme
Three parts of stomach:
• FUNDUS – upper portion of the stomach
• MIDDLE AREA – as the body of the
stomach
• PYLORUS – is the end nearest to the small
intestine.
Food enters the fundus and moves to the body of
the stomach, where the muscles in the stomach
wall gradually knead the food, tear it and mix it with
gastric juices and the intrinsic factor necessary for
the absorption of vitamin B12 before if propelled
forward in slow, controlled movements.
The food becomes a semiliquid mass
called CHYME.
Chyme enters pylorus causing it distention
and the release of the hormone gastrin, which
increases the release of gastric juices.
Gastric juices are digestive secretion of the
stomach that contains hydrochloric acid, pepsin
and mucus.
HYDROCHLORIC ACID – activates the enzyme
pepsin
– Prepares protein molecules for partial
digestion of pepsin
– Destroy most of the bacteria in the food
ingested
– Makes iron and calcium more soluble.
– As the hydrochloric acid is released, a
thick mucus is secreted to protect the stomach
from this harsh acid
Two additional enzyme for children
RENNIN – acts on milk protein,
CASEIN AND GASTRIC LIPASE – breaks the
butterfat molecules of milk into smaller molecules.
FUNCTIONS OF THE STOMACH
• Temporary storage of food
• Mixing of food with gastric juices
• Regulation of a slow, controlled emptying
of food into the intestine
• Secretion of the intrinsic factor for vitamin
B12
• Destruction of most bacteria
DIGESTION IN THE SMALL INTESTINE
• Mechanical digestion
▪ Peristaltic waves slowly push food
mass forward.
▪ Pendular movements sweep back
and forth.
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NCM-105 NUTRITION AND DIET THERAPHY
▪ Segmentation rings chop food
mass into successive soft lumps
and mix them with secretions.
▪ Longitudinal rotation rolls food in a
spiral motion, exposing new
surfaces for absorption.
• Pancreatic enzymes:
▪ Carbohydrate: Pancreatic
amylase converts starch to maltose
and sucrose.
▪ Protein: Trypsin and chymotrypsin
split large protein molecules into
small peptide fragments and
eventually into single amino acids.
▪ Fat: Pancreatic lipase converts fat
to glycerides and fatty acids.
• Intestinal enzymes
▪ Carbohydrate: Disaccharidases
convert disaccharides into
monosaccharides.
▪ Protein: Enterokinase activates
trypsinogen from the pancreas to
become trypsin; amino peptidase
removes end amino acids from
polypeptides; dipeptidase splits
dipeptides into amino acids.
▪ Fat: Intestinal lipase splits fat into
glycerides and fatty acids.
▪ Mucus: Large quantities of mucus
protect the mucosal lining from
irritation and erosion
▪ Bile: Emulsifying agent produced
by the liver and stored in the
gallbladder aids fat digestion and
absorption
▪ Hormones
• Secretin
• Cholecystokinin
ABSORPTION IN SMALL INTESTINE
• Three absorbing structures:
▪ Mucosal folds: Surface of small
intestine piles into folds
▪ Villi: Small finger-like projections
cover the mucosal folds, increasing
the area of exposed intestinal
surface
▪ Microvilli: Smaller projections
cover each villi (look like bristles on
a brush)
Chyme moves through the pyloric sphincter into:
• First section of the small intestine is the
duodenum
• Midsection of the small intestine is the
jejunum
• Last section of the small intestine is the
ileum.
When the food reaches the small intestines:
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• The hormone Secretin causes the
pancreas to release sodium bicarbonate to
neutralize the acidity of the chyme.
• Gallbladder is triggered by the hormone
cholecystokinin (CCK) that is produced by
intestinal mucosal glands when fat enters
to release bile.
• Bile is produced in the liver but stored in
gallbladder.
• Bile emulsifies fat after it is secreted into
the small intestine.
• The action enables the enzymes to digest
fats more easily.
• Chyme triggers the pancreas to secrete its
juices into the small intestine.
• Pancreatic Juices contains the following
enzymes:
o Pancreatic proteases are protein-
splitting enzymes produced by the
pancreas.
▪ Trypsin
▪ Chymotrypsin
▪ carboxypeptidases
• Pancreatic Amylase converts starches
(polysaccharides) to simple sugars.
• Pancreatic Lipase reduces fat and fatty
acids and glycerol.
SMALL INTESTINES – produces an intestinal
juices that contains enzymes lactase, maltase
and sucrase.
LACTASE – splits lactose
MALTASE – splits maltose
SUCRASE – splits sucrose
Into simple sugars.
PEPTIDASES – enzymes that break down
protein into amino acids.
THE LARGE INTESTINE
LARGE INTESTINE OR COLON – consist of the
cecum, colon and rectum.
CECUM – Is a pouch-like beginning of the colon in
the right lower quadrant of the abdomen.
APPENDIX – is a diverticulum that extends off the
cecum.
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NCM-105 NUTRITION AND DIET THERAPHY
The cecum is separated from ileum by the
ileocecal valve and is the beginning of the large
intestine (Colon)
ABSORPTION IN LARGE INTESTINE
• Water is taken up by large intestine
▪ Most water in chyme is absorbed in
first half of colon
▪ Only a small amount remains to
form and eliminate feces
• Dietary fiber is not digested
▪ Contributes bulk to food mass
▪ Helps form feces
FUNCTIONS OF LARGE INTESTINE (COLON)
• Its primary function is to absorb water and
salts from undigested food.
• It has a muscular wall that can knead the
contents to enhance absorption.
• One of the end-products of fermentation is
volatile fatty acids.
Major Volatile Fatty Acids
• Acetate
• Propionate
• Butyrate
• Are absorbed from large intestine and used
as source of energy
The digested food enters the ascending colon and
moves through the transverse colon and to the
descending colon, the sigmoid, the rectum and
finally the anal canal.
ABSORPTION
• ABSORPTION is the passage of nutrients
into the blood or lymphatic system
• The LYMPHATIC VESSELS carry fat-
soluble particles and molecules that are too
large to pass through the capillaries into the
bloodstream.
• Nutrients must be in SIMPLEST FORMS to
be absorb.
• CARBOHYDRATES is broken down into
simple sugars (glucose, fructose and
galactose), proteins to amino acids, and
fats to fatty acids and glycerol.
• Most absorption of nutrients occurs in the
small intestines and some occurs in the
large intestine.
• WATER is absorbed in the stomach, small
intestine and large intestine.
• Glucose, fructose, galactose, amino acids,
minerals and water-soluble vitamins are
absorbed by the capillaries in the small
intestine.
• Fructose and galactose are carried to the
liver and converted to glucose.
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• Lacteals absorb glycerol and fatty acids
(end products of fat digestion) and the fat-
soluble vitamin.
• When the chyme reaches the large
intestine, most digestion and absorption
have occurred.
• Its walls secrete mucus as a protection and
from the acidic digestive juices in the
chyme.
• The major task of the large intestine are
o Absorb water
o Synthesize some b vitamins and
vitamin k (essential for blood
clotting)
o Collect food residue
FOOD RESIDUE is the part of food that body’s
enzyme cannot digest and cannot absorb.
Such residue is called DIETARY FIBERS.
Examples:
Outer hulls of corn kernels
Grains of wheat
Celery strings
Apple skins
It is important that the diet contains adequate
fiber because it promotes the health of the large
intestine by helping to produce softer stools and
more frequent bowel movements.
ELIMINATION
• Undigested food is excreted as feces by
way of rectum.
• The urge to defecate happens when the
rectum becomes distended because of
accumulating waste residue.
• body waste comprises a variety of
substances including dietary fibers,
connective tissue from undigestible meat,
fats bound by minerals, bacteria, pigments,
mucus and water.
• Over-all transit time from food ingestion to
elimination range from 16-27 hours.
• Healthy people absorbed
o 99% carbohydrates
o 95% fats
o 92% protein
METABOLISM
• Metabolism is the process by which the
body changes food and drink into energy.
• Two metabolic processes:
o Catabolism: Breaking down of
large substances into smaller units.
Example: Breaking down a protein
chain into amino acids.
o Anabolism: Building of larger
substances from smaller particles.
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NCM-105 NUTRITION AND DIET THERAPHY
Example: Building a complex
protein from single amino acids.
• Metabolic processes ensure that the body
has energy in the form of adenosine
triphosphate (ATP).
• Metabolism of glucose from carbohydrates
yields less energy than metabolism of fat.
Still, glucose is the body’s primary source
of energy.
• Protein can be an energy source, but it is
relatively inefficient.
METABOLIC PATHWAYS
• Aerobic Metabolism or Oxidation is a
process of combining nutrients with oxygen
within the cell.
• Anaerobic Metabolism reduces fats
without the use of oxygen.
• Krebs Cycle is the complete oxidation of
carbohydrates, protein and fats.
• Metabolism is governed primarily by the
hormones secreted by the thyroid glands.
• Two hormones Secreted by thyroids
glands
o Triiodothyronine (T3)
o Thyroxine (T4)
• HYPERTHYROIDISM is a condition in
which the body secretes too much of these
hormones T3 and T4. It means the body
metabolizes its food to quickly and will
result to weight lose.
• Hypothyroidism happens when the thyroid
secretes too little of T3 and T4. Its means
the body metabolizes slowly and the body
become sluggish and accumulates fat.
• Energy is needed for the maintenance of
body tissue and temperature and for
growth (involuntary activity) and for
voluntary activity (example: walking,
running, swimming and gardening)
• Energy comes from carbohydrates, protein
and fats. But the primary source of energy
is carbohydrates.
ENERGY MEASUREMENT
Kilocalorie unit used to measure energy value of
foods.
Kilojoule is the metric system.
• 1 kcal is equivalent to 4.184 or 4.2
Kilojoule.
Bomb Calorimeter is the device use to
determined energy values of food
The inner part of a calorimeter holds a measured
amount of foods. The outer part holds water. The
food is burned and its caloric value is determined
CJPV
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by the increase in the temperature of the
surrounding water.
BASAL METABOLIC RATE
• Basal metabolism is the energy
necessary to carry on involuntary vital
processes while the body is at rest.
• These processes are respiration,
circulation, regulation of body temperature
and cell activity and maintenance.
• Basal Metabolic Rate (BMR) is the rate at
which energy is needed only for body
maintenance.
o Referred also as Resting Energy
Expenditure (REE).
o Determined by medical test. The
test is given is when the body is at
rest and performing only the
essential involuntary functions.
o Factors that affect BMR are lean
body mass, body size, sex, age,
hereditary, physical conditions and
climate.
• Lean body mass is muscle opposed to fat
tissue. There is more metabolic activity in
muscle tissue than in fat or bone tissue.
o Muscle requires more calories than
fat or bone tissue.
o People with large body frames
require more calories than people
with small frames.
o People with large frame have more
body mass to maintain and move.
• Men require more energy than women.
Men are larger and have more body mass
than women.
• Children require more calories per pound
body weight than adults because they
growing. As people age, the lean body
mass declines and the basal metabolic rate
declines.
• Hereditary is also a determining factor;
example: appearance of one’s BMR may resemble
that of the parent.
• Physical Condition;
example: women require more calories during
pregnancy and lactation than at other times.
• The basal metabolic rate increases during
fever and decreases during period of
starvation or severely reduced calorie
intake.
• People living and working to extremely cold
or warm climates require more calories to
maintain normal body temperature than
they would in a more temperature climate.
THE THERMIC EFFECT OF FOOD (TEF)
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NCM-105 NUTRITION AND DIET THERAPHY
TEF – measure of how much different foods
increase energy expenditure, due to the energy
required to digest, absorb and metabolized the
nutrients within that food.
• The higher the TEF
• The less efficient the process
• The more energy it takes to metabolize that
food
• The more heat is generated or calories are
burned in the process.
TEF FOR EACH MACRONUTRIENT:
• Fat: 0-3%
• Carbs: 5-10%
• Protein: 20-30%
PROTEIN – has a much higher TEF than fats and
carbs.
WHOLE FOODS – have a higher TEF than
processed foods.
ESTIMATING BASAL METABOLIC RATE
Dietitian commonly use the Harris-Benedict
equation to determine the BMR (REE) of person
above the age of 18. This equation uses height,
weight and age as factors and result in a more
individualizes estimate of the REE than other
methods.
For men: BMR = 66.5 + (13.75 x weight in kg) +
(5.003 x height in cm) - (6.75 x age)
MODULE-3
• Simple diffusion: The force by which
particles move outward in all directions—
from areas of greater to lesser
concentration.
• Facilitated diffusion: Similar to simple
diffusion, but uses a protein channel to
carry larger items.
• Active transport: The force by which
particles move from areas of greater to
lesser concentration using a carrier to
“ferry” particles.
• Pinocytosis: Penetration of larger
materials by attaching to cell membrane
and being engulfed by the cell.
TRANSPORT
• Nutrients must be transported to cells
• Vascular (blood circulatory) system
▪ Veins and arteries
▪ Transports waste, such as carbon
dioxide and nitrogen, to lungs and
kidneys for removal.
• Lymphatic system
▪ Route for fatty materials, which are
not water soluble
▪ Fat molecules pass into lymph
vessels in villi.

For women: BMR = 655.1 + (9.563 x weight in kg)

+ (1.850 x height in cm) - (4.676 x age)

W – weight in kilograms (kg) weight in pounds / 2.2

= Kg
H – height in centimeters (cm) height in inches x
2.54 = cm
A – age in years

Example:
Compute for the BMR of a female age 30 who INTESTINAL VILLI
stands 5’6” and weighs 180lbs.

Women = 655.1 + (9.563 x 82kg) + (1.850 x

167.64) – (4.676 x 30)
= 655.1 + 784.166 + 310.134 – 140.28
= 1,749.4 – 140.28
= 1,609.12 or 1,609

BIOAVAILABILITY
• Bioavailability refers to how well the body
can use the nutrients. It is the “gatekeeper”
that determines how much of a nutrient is
used by the body.
• All nutrients are not absorbed due to
differing bioavailability. ENERGY STORAGE: GLYCOGENESIS
• Glycogenesis: Anabolic process of
ABSORPTION PROCESSES converting extra glucose into glycogen.

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NCM-105 NUTRITION AND DIET THERAPHY MODULE-3
• Glycogen is stored in liver and muscles for
quick energy to be used at a later time.
• When glycogen reserves are full, additional
excess energy from carbohydrates, fat, or
protein is stored as fat in adipose tissue.
• Lipogenesis: The building up of
triglycerides for storage in adipose tissue.
• Excess protein is not stored as muscle, but
is further broken down.
• Nitrogen unit is removed.
• Remaining carbon chain can be
converted to glucose (if needed) or
to fat for storage.

METABOLIC PATHWAYS OF EXCESS ENERGY

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NCM-105 NUTRITION AND DIET THERAPHY MODULE-1
NUTRIENT DEFICIENCY – occurs when the
A. DEFINITION person lacks one or more nutrients over a period
NUTRITION – is the branch of science that studies of time.
nutrients in foods in relation to growth,
maintenance and health of the body. V. INDIVIDUAL AT RISK FROM POOR
FOOD – is the fuel that sustains human life and it NUTRITIONAL INTAKE
is for virtually all the body processes. • Individuals of all ages and from all walks of
NUTRIENTS – are components of food that are life
needed by the body in adequate amounts in order • Persons with recent illness, hospitalization
to grow, reproduce and lead a normal health life. or surgery
ESSENTIAL NUTRIENTS – nutrients found in • Meet or exceeds energy intake but
food. consume foods that are low nutrient quality
HEALTH – is a state of complete physical, mental • Individuals with budget concerns the
and social well-being and not merely the absence preclude purchasing nourishing foods
of disease or infirmity. • Lack access to healthy food due to
geographic location
II. SIX MAJOR NUTRIENTS • Individuals living in lower-income
A. ORGANIC NUTRIENTS & FUNCTION neighborhoods
CARBOHYDRATES Provide energy • Teenagers
• Pregnancy and young mothers to be.
FATS Provide energy • Elderly

PROTEINS Build and repair body tissues; VI. DEFICIENCY DISEASE

provide energy RICKETS – deficiency disease that causes poor
bone formation in children and is due to insufficient
VITAMINS Regulate body processes
calcium and vitamin D.
B. INORGANIC NUTRIENTS & FUNCTION OSTEOMALACIA (ADULT RICKETS) – in young
MINERALS Regulate body processes
adults and it causes the bones to soften and may
cause the spine and legs to become bowed.
WATER Regulate body processes OSTEOPOROSIS – a condition that causes bones
to become porous and excessively brittle.
GOITER – a enlarged tissue of the thyroid gland
III. DETERMINES WHEN TO EAT due to a deficiency of iodine.
HUNGER – the physiological need for food
APPETITE – psychological desire for food based VII. CLASSIFICATION OF NUTRIENT
on the pleasant memories DEFICIENCY
PRIMARY – caused by inadequate dietary intake
IV. CHARACTERISTICS OF GOOD AND POOR SECONDARY – caused by something other than
NUTRITION diet, such as disease condition that may cause
malabsorption, accelerated excretion, or
destruction of the nutrients.

VIII. NUTRITIONAL DEFICIENCY DISEASES

AND CAUSES
DEFICIENCY DISEASES & NUTRIENTS
LACKING
IRON IRON
DEFICIENCY

NUTRITION – is the result of the processes IRON- IRON

whereby the body takes in and uses food for DEFICIENCY
growth and development, and the maintenance of ANEMIA
health.
MALNUTRITION – a condition that results when BERIBERI THIAMIN
the body does not receive enough nutrients; the
NIGHT VITAMIN A
body cells do not receive an adequate supply of BLINDNESS
the essential nutrients due to poor diet intake and
poor utilization. GOITER IODINE

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NCM-105 NUTRITION AND DIET THERAPHY MODULE-1
KWASHIORKOR PROTEIN GOITER IODINE

MARASMUS ALL NUTRIENTS ECZEMA FAT (LINOLEIC ACID)

OSTEOPOROSIS CALCIUM AND VITAMIN D

X. NUTRITION ASSESSMENT
OSTEOMALACIA CALCIUM AND VITAMIN D, OLD SAYING: YOU ARE WHAT YOU EAT
PHOSPHORUS, MAGNESIUM “Good nutrition is essential for the attainment
AND FLUORIDE and maintenance of good health.”
ANTHROPOMETRIC MEASUREMENTS
PELLAGRA NIACIN • Height/Weight and Measurement of Head
• Calipher – chest and skinfold
RICKETS CALCIUM AND VITAMIN D
CLINICAL EXAMINATION
SCURVY VITAMIN C BIOCHEMICAL TEST
• Blood
XEROPHTHALMI VITAMIN A • Urine
A (BLINDESS) • Stool Test
DIETARY-SOCIAL HISTORY – involves
IX. CLINICAL SIGNS OF NUTRIENT evaluation of food habits.
DEFICIENCIES • 24-Hour recall – listing the types, amound
CLINICAL SIGNS & POSSIBLE DEFICIENCY and preparataion of all foods eaten in the
past 24 hours
PALLOR; BLUE IRON
HALF CIRCLES COPPER • Food History – written record of all food
BENEATH EYES ZINC and drinks ingested in a specific period.
B12
B6 BIOTIN XI. SIX STANDARDIZED CHARACTERISTIC TO
DIAGNOSE ADULT MALNUTRITION
EDEMA PROTEIN • Insufficient Energy Intake
• Weight Loss
BUMPY VITAMIN A
“GOOSEFLESH” • Loss of Muscle Mass
• Loss of Subcutaneous Fat
LESIONS AT RIBOFLAVIN • Localized or Generalized Fluid
CORNERS OF Accumulation (that sometimes mask
MOUTH weight loss)
• Diminished Functional Status as
GLOSSITIS FOLIC ACID
Measured by Handgrip strength.
NUMEROUS VITAMIN C SPOTS AND TINY
“BLACK AND RED “PINPRICK” XII. HEALTH AND NUTRITION
BLUE” HEMORRHAGES UNDER CONSIDERATION
SKIN • Nutrition is a fundamental part of an
individual’s well-being.
EMACIATION CARBOHYDRATES • Positive diet and lifestyle changes
PROTEIN
promote vibrant health and can reduce the
CALORIES
risk of chronic disease.
POORLY VITAMIN D OR CALCIUM • Health issues that result in nutrition
SHAPED BONES DELAYED APPEARANCE OF impairment, timely assessment and quality
AND TEETH TEETH IN CHILDREN nutrition intervention can improve
outcomes.
SLOW VITAMIN K • The health professional is obligated to
CLOTTING TIME have a sound knowledge of nutrition.
OF BLOOD
• Parents must have a good basic
UNUSUAL NIACIN knowledge of nutrition for the sake of their
NERVOUSNESS, DIARRHEA IN SOME CLIENT family.
DERMATITIS • Anyone who plans and prepares meals
should value, have knowledge of and be
TETANY CALCIUM able to apply the principles of sound
POTASSIUM nutrition practice.
SODIUM

CJPV 2
NCM-105 NUTRITION AND DIET THERAPHY MODULE-1
• Clients will have questions and complaints
about their diets.
• Some clients must undergo diet therapy,
prescribed by their physicians that
becomes part of their medical treatment in
the hospital.
• Nutrition is currently a popular subject. It is
important to recognize that some books
and articles concerning nutrition are not
scientifically correct.
• Food ads can be misleading.
• Nutrition information websites is not
always accurate or even factual.
• People with knowledge of nutrition
practices recognize Fads and distinguish
facts.

SUMMARY
• Nutrition is directly related to health, and
its effects are cumulative. Good nutrition is
reflected by good health.
• Poor nutrition can result in poor health and
even in disease and poor nutrition habits
contributes to atherosclerosis,
osteoporosis, obesity, diabetes, and some
cancers.
• To be well nourished, one must eat foods
that contain the six essential nutrients:
carbohydrates, fats, proteins, minerals,
vitamins and water. These nutrients
provide energy, build and repair body
tissues, and regulate body processes.
Severe lack of specific nutrients,
deficiency diseases develop. The best
way to determine deficiencies is to do
nutrition assessment.
• Sound knowledge of nutrition, the health
professional will be effective health
care provider and will be helpful to family, friends
and self.

CJPV 3
 NDT
SPECIALIZED NUTRITION SUPPORT:
ENTERAL & PARENTAL NUTRITION
NEED FOR NUTRITION SUPPORT
➢ Nutrition support may be required to meet
patient’s nutritional needs.
➢ Patients often too ill to obtain energy & nutrients
by consuming foods.
➢ Or illness may interfere with eating, digestion or
absorption
➢ Nutrition support: delivery of formulated
nutrients by feeding tube or intravenous
infusion
➢ Enteral nutrition: supplying nutrients using
GI tract, including tube feedings & oral diets
➢ Parenteral nutrition: intravenous provision
of nutrients, bypassing the GI tract
ENTERAL NUTRITION SUPPORT
➢ Insert meaning Wide selection of enteral
formulas, designed to meet variety of medical
& nutritional needs
➢ May be used alone or in conjunction with other
foods
➢ Many formulas can provide all of nutrient
requirements if consumed in sufficient volume
➢ Classified according to macronutrient
composition
➢ Preferred over intravenous feedings
➢ Enteral nutrition requires intact & normal GI
function
TYPES OF ENTERAL FORMULAS
Standard formula: for patients who can digest &
absorb nutrients without difficulty; contains protein
& carbohydrate sources
Hydrolyzed formulas: used for patients with
compromised digestive or absorptive functions—
macronutrients are partially or fully broken down &
require little, if any, digestion before absorption
CJPV
Disease-specific formulas: designed to meet
nutrient needs of patients with particular disorders:
liver, kidney, lung diseases, glucose intolerance,
metabolic stress
Modular formulas: contain only one or two
macronutrients; used to enhance other formulas
ENTERAL NUTRITION IN MEDICAL CARE
Oral use
• Supplement diet when food consumption
does not meet need
• Reliable source of nutrients & energy
• Taste important consideration
Tube feedings
• Used when patient cannot consume enough
food or formula orally
• Feeding delivered directly to stomach or
intestine
Patients can drink enteral formulas when they are
unable to consume enough food from a
conventional diet
Candidates for tube feedings:
• Severe swallowing difficulties
• Little or no appetite for extended periods,
especially if malnourished
• GI obstructions, impaired motility of the
upper GI tract
• After intestinal resection, beginning enteral
feedings
• Mentally incapacitated due to confusion,
dementia, neurological disorders
• Individuals in coma
• Individuals with extremely high nutrient
requirements
• Individuals on mechanical ventilators
Feeding routes
• Selected on basis of medical condition,
expected duration, potential complications
of a particular route
• Main routes:
• Transnasal (temporary)
▪ Nasogastric
▪ Nasoduodenal
▪ Nasojejunal
• Gastrostomy
• Jejunostomy
• Formula selected after assessment of the
diagnosis, patient’s age, medical problems,
nutritional status, ability to digest & absorb
nutrients
1
 NDT
• Nutrition-related factors influencing formula
selection
• Energy, protein & fluid requirements
• Need for fiber modifications
• Individual tolerances (food allergies
& sensitivities)
• Administration of tube feedings
• Safe handling
• Open feeding system
• Closed feeding system
• Safety guidelines
• Review of procedure with patient &
family
• Verification of tube placement (Xray)
• Formula delivery
• Intermittent feedings (bulk
over 20-40 min)
• Continuous feedings (pump)
• Bolus feeding (one or several
“shots”)
Open feeding system: requires formula to be
transferred from original packaging to feeding
container
Closed feeding system: formula prepackaged in
ready-to-use containers
Intermittent feeding: delivery of prescribed
volume over 20-40 minutes
Continuous feeding: slow delivery at constant rate
over 8-24 hour period
Bolus feeding: delivery of prescribed volume in
less than 15 minutes
• Formula volume & strength
o Procedures vary by institution
o Almost all patients can receive
undiluted isotonic or hypertonic
formulas
o Generally started slowly and volume
gradually increased
• Rate & amount of increase
depend on patient’s
tolerance
• Continuous feedings may be
better tolerated than
intermittent feedings
• Checking gastric residual volume (vol. of
formula in stomach after fdg.)
• Volume of formula remaining
in stomach from previous
feeding
• Evaluate if gastric residual
>200 mL
CJPV
• If tendency to retain persists,
physician may consider
intestinal feedings or drug
therapy to stimulate gastric
emptying
Meeting water needs
• Adults require about 2000 mL of water daily
– Fluid intake may be restricted for
patients with kidney, liver or heart
disease
– Fluid intake may be increased with
fever, high urine output, diarrhea,
excessive sweating, severe
vomiting, fistula drainage, high-
output ostomies, blood loss, open
wounds
• Standard formulas contain about 85% water
(about 850 mL/liter); nutrient-dense
formulas contain about 69-72% water
• Meet fluid needs with additional water
flushes
• Transition to table foods
– Volume of formula is tapered off as
condition improves
– Gradual shift to oral diet
• Begin drinking same formula
that is delivered by tube
• Oral intake should supply
about 2/3 of nutrient needs
before tube feedings
discontinued
• Giving Medication through feeding tubes
– Potential for diet-drug interactions
must be considered before
administration
– Continuous feeding halted for
approximately 15 minutes before &
15 minutes following medication
delivery (longer for some
medications)
– Type of medication may make tube
administration impossible—require
change to alternate route
• Generally best to administer medications
by mouth whenever possible
• Complications of tube feedings
2
 NDT
– Gastrointestinal problems: nausea,
diarrhea
– Mechanical problems related to tube
feeding process
– Metabolic problems: biochemical
alterations & nutrient deficiencies
• Many complications preventable with
appropriate feeding route, formula &
delivery method
• Close attention to patient’s medical
condition & medication use is important
(follow up/reassessment)
– Monitor weight, hydration status
– Verify lab test results
PARENTERAL NUTRITION SUPPORT
➢ Indicated for patients who do not have
functioning GI tract & who are malnourished (or
likely to become so)
➢ Used when enteral formulas cannot be used or
intestinal function is inadequate
➢ Life-saving option for critically-ill persons
➢ Two main access sites: central or peripheral
vein
VENOUS ACCESS:
• Peripheral parenteral nutrition (PPN)
– Can only provide limited amounts of
energy & protein
– Peripheral veins can be damaged by
overly concentrated solutions
– Limited to patients who do not have
high nutrient needs or fluid
restrictions
– Used most often for short-term
nutrition support (7-10 days)
– Rotation of vein sites may be
necessary
• Total parenteral nutrition (TPN)
– Can reliably meet complete nutrient
requirements
CJPV
– Provides nutrient-dense solutions for
patients with high nutrient needs or
fluid restrictions
– Preferred for long-term intravenous
feedings
– Inserted directly into a large central
vein
PARENTERAL SOLUTIONS
• Customized formulations to meet
patients’ nutrient needs
• Highly individualized; often recalculated
on daily basis until patient’s condition
stabilizes
• Contents:
– Amino acids (both essential and
non-essential for protein)
– Carbohydrates (dextrose)
– Lipid emulsions
– Fluid & electrolytes
– Vitamins & trace minerals
ADMINISTERING PARENTERAL NUTRITION
• Multidisciplinary nutrition support team
of health care professionals
– Physicians
– Nurses
– Dietitians
– Pharmacist
• Potential complications related to
venous line & metabolic problems
• Administration procedures
– Insertion & care of intravenous
catheters
– Administration of parenteral
solutions
• Continuous administration -
24 hours/day
• Cyclic administration – 10 to
16 hour periods
– Monitoring patient condition,
nutritional status, complications
– Discontinuing of feedings-when GI
function returns
• Continuation of nutritional support (tube
feedings or parenteral nutrition) after
medical condition has stabilized
• Candidates for home nutrition support
– Long-term nutrition care required for
chronic conditions
– Users intellectually capable of
learning procedures, monitoring
treatment & managing complications
3
 NDT
• Planning for home nutrition
– Involvement of users in decision
making to ensure long-term
compliance & satisfaction
– Assessment & evaluation of type of
feeding, equipment, resources,
ability to perform procedures
• Quality of life issues
– Lifestyle adjustments may cause
struggle for patients & families
– Economic impact
– Time & other demands associated
with treatment
– Physical difficulties, including
disrupted sleep
– Social issues
– Life-sustaining therapy associated
with serious complications
• Portable pumps & convenient carrying
cases allow people who require home
nutrition support to move about freely
NUTRITION IN PRACTICE-INBORN ERRORS
OF METABOLISM
➢ Inborn error of metabolism: inherited trait,
caused by genetic mutation
➢ Results in absence, deficiency or malfunction of
a protein that has a critical metabolic role
• Medical nutrition therapy is primary
treatment for many inborn errors that
involve nutrient metabolism
• Dietary intervention generally involves
restriction of substances that cannot be
metabolized or supplying substances that
cannot be produced
• Dietary changes may improve outcomes
– Preventing accumulation of toxic
metabolites
– Replacing deficient nutrients
– Providing a diet that supports normal
growth & development & maintains
health
• Some inborn errors may require treatment
other than or in addition to dietary changes
• Phenylketonuria (PKU)
– Metabolic disorder affecting amino
acid metabolism
– Missing or defective protein is liver
enzyme that converts the essential
amino acid phenylalanine to tyrosine
– Phenylalanine & metabolites
accumulate and damage developing
CJPV
nervous system—most debilitating
effect is on brain development
– Diagnosed within first few days
following birth—infants routinely
screened in all 50 states
– Treatment consists of lifelong diet
restricting phenylalanine & supplying
tyrosine; allowing blood levels of
these amino acids to be maintained
within safe ranges
• Managing PKU
– Central to PKU diet is enteral
formula that is phenylalanine-free &
supplies energy, amino acids,
vitamins & minerals
– Formula requirements must be
recalculated periodically to
accommodate growing infant’s
shifting needs for protein,
phenylalanine, tyrosine & energy
• Careful monitoring of foods
containing phenylalanine
• Monitoring of growth rates &
nutrition status
– Parents & children may need to
develop creative ways to make diet
enjoyable
• Galactosemia
– Inborn error of carbohydrate
metabolism
– Deficiency of enzyme needed to
metabolize galactose
– Accumulation of galactose can result
in damage to multiple tissues
• Reaction with severe
vomiting & jaundice within
days of initial feeding of
infant
• Serious liver damage may
result, progressing to
symptomatic cirrhosis
• Other complications: kidney
failure, cataracts, brain
damage
– Delay in treatment can result in
irreversible brain damage
• Managing galactosemia
– Main focus of diet is exclusion of
milk & milk products (elimination of
galactose)
– Avoidance or restriction of other
galactose-containing foods
4
 NDT
• Organ meats
• Some legumes, fruits &
vegetables
– Food lists help patients to identify
galactose content of common foods
– Complications may develop despite
compliance with diet therapy

5
CJPV
 Nutrition and Dietetics
Role of Nurses

1. Screening-in-patient to determine the risk

2. Liaison between the dietician and physician as well as with the other members of healthcare team
3. Nutrition resource when dieticians are not available
4. Basic Nutrition Counselling in hospitalized clients low to mid risk

ROLE OF DIETICIAN

1. Obtain history and usual diet prior to admission (difficulty in chewing, swallowing or self-feeding; chief
complaint; medications, and living situations)
2. Nutrition History – current habits, changes in appetite, food allergies and intolerance, cultural or religious
diet
3. Calculate calorie and protein requirement based on data
4. Determine nutritional diagnosis
5. Nutritional interventions – diet order change, requesting laboratory tests, performing nutrition counselling
or education

NURSING PROCESS

ASSESSMENT

● MALNUTRITION
- Impaired function that results from a prolonged nutrition deficiency
Anorexia and Bulimia Nervosa – Psychological
Rickets – Vitamin D deficiency
Scurvy – Vitamin C deficiency
Anemia – RBC
Goiter – Iodine deficiency

● NUTRITIONAL SCREENING
- Quick look at a few variables to judge a client’s risk for nutritional items;
✔ Height
✔ Weight
✔ Diet
✔ Albumin, haematocrit- (determines the hydration of the cells)
✔ Nausea and Vomiting
✔ Significant weight loss
✔ Change in appetite
✔ Difficulty eating
✔ Use of enteral or parenteral nutrition

1|Nutrition and dietetics

 ✔ Bowel habits
✔ Diagnosis
✔ *protein also releases Immunoglobulin

● COMPREHENSIVE NUTRITIONAL ANALYSIS

- An in depth analysis of nutritional status
- Focus: moderate-high risk with suspected or confirmed protein-energy malnutrition

● NUTRITIONAL CARE PROCESS – A B C D

ASSESSMENT

BIOCHEMICAL DATA

CLINICAL DATA

DIETARY DATA

● HEIGHT AND WEIGHT

𝑊𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔)
𝐵𝑀𝐼 =
𝐻𝑒𝑖𝑔ℎ𝑡 (𝑚)2

BMI – index of weight in relation to height

● PERCENTAGE OF “IDEAL” BODY WEIGHT (%IBW)

HAMWI METHOD

2|Nutrition and dietetics

 - For women: first 100 pounds – first 5ft of height
+ 5 pounds for each additional inch
- For men: first 106 pounds – first 5ft of height
+ 6 pounds per additional inch

𝐶𝑢𝑟𝑟𝑒𝑛𝑡 𝑤𝑒𝑖𝑔ℎ𝑡
%𝐼𝐵𝑊 = × 100
𝐼𝐵𝑊

DOES NOT MEASURE;

o Body composition
o Evaluation of body fat
o Oedema and dehydration

● CALCULATING PERCENT WEIGHT CHANGE

(𝑈𝑠𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 − 𝑐𝑢𝑟𝑟𝑒𝑛𝑡 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡)

× 100 = % 𝑊𝑒𝑖𝑔ℎ𝑡 𝑐ℎ𝑎𝑛𝑔𝑒
𝑈𝑠𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡

BIOCHEMICAL DATA

- Urinalysis and blood test (albumin & pre-albumin)

- Albumin – 3.5g/dL – 5.4g/dL
- Pre-albumin or thyroxin-binding protein – more sensitive indicator not specific for malnutrition.
Affected by metabolic stress and other condition

3|Nutrition and dietetics

 - More expensive and usually not available

CLINICAL DATA

SIGNS AND SYMPTOMS OF MALNUTRITION

✔ Hair – dull, brittle, dry, falls out easily
✔ Swollen glands of the neck and cheeks
✔ Skin – dry, rough, spotty (sandpaper feel)
✔ Poor or delayed wound healing or sores
✔ Thin appearance, with lack of subcutaneous fat
✔ Muscle wasting
✔ Oedema – lower extremities
✔ Weakened hand grasp

DIETARY DATA

o Do you avoid any particular foods?

o Do you watch what you eat in any way?
o How many meals and snacks do you eat in a 24-hour period?
o Do you have any food allergies?
o Do you drink vitamin, mineral, herbal or other supplements?
o What concerns do you have about what or how you eat?
o For acutely ill; how has illness affected your choice or tolerance of food?
o Who prepares the meals?
o Do you have enough food to eat?
o How much alcohol do you consume daily?

MEDICAL-PSYCHOLOSIAL HISTORY

o MEDICAL
✔ Medications
✔ Acute and Chronic disease
o PSYCHOLOGICAL FACTORS
✔ Depression
✔ Eating DO
✔ Psychosis
o SOCIAL
✔ Illiteracy
✔ Language barriers
✔ Limited knowledge on food
✔ Cultural
✔ Social isolation
✔ Cooking arrangements
✔ Low income
✔ Elderly
✔ Lack/extreme activity
✔ Use of tobacco or drugs

DIAGNOSIS

4|Nutrition and dietetics

 OBVIOUS DIAGNOSES LESS OBVIOUS (may be
part of the care plan)
Imbalanced Nutrition: Less Adult failure to thrive
than body requirements

Imbalanced Nutrition: More Acute/Chronic pain

than body requirements

Readiness for enhanced Deficient knowledge (of

nutrition food /nutrition)
Risk for Imbalanced Feeding self-care deficit
Nutrition: more than body
requirements
Impaired
swallowing/detention
Risk for
aspiration/constipation
Impaired oral mucous
membrane

PLANNING

● GUIDELINES IN PLANNING
1. Patient-centered outcomes
2. SMART
3. Commitment/Compliance
4. Short-term goals – alleviate symptoms, prevent complications

INTERVENTIONS

WAYS TO PROMOTE ADEQUATE INTAKE

✔ Encourage a big breakfast if appetite deteriorates throughout the day

✔ Advocate D/C of IV therapy (if feasible)
✔ Replace meals withheld for diagnosis test
✔ Out of bed when eating (if possible)
✔ Encourage good oral hygiene
✔ Solicit info on food preferences (cultural or religious)
✔ Display a positive attitude – education or serving food

WAYS TO FACILITATE CLIENT AND FAMILY TEACHING

✔ Listen to concerns and ideas

✔ Family involvement (if appropriate)
✔ Reinforce importance of nutrition
✔ Help in selecting appropriate foods

5|Nutrition and dietetics

 ✔ Counsel the client about drug-nutrient interation
✔ Keep message simple, emphasize things “to do”, not “not to do”
✔ Written hand outs
✔ Avoid if not tolerated

MONITORING AND EVALUATION

NURSING RESPONSIBILITIES

✔ Check intake
✔ Document appetite
✔ Order supplements if intake is low or needs are high
✔ Nutritional consult
✔ Assess tolerance
✔ Assess weight
✔ Monitor progression of restrictive diets (NPO, clear liquid, soft diet, Diabetic Diet)
✔ Monitor comprehensive of information and motivation to change

MACRONUTRIENTS

- Carbohydrates (CHO)
- Proteins (CHON)
- Fats

MICRONUTRIENTS

- Vitamins
- Minerals

● CARBOHYDRATES (CHO)
- A class of energy-yielding nutrients that contain CARBOHYDRATES, HYDROGEN, OXYGEN
- 45% - 65% of our food should come from carbohydrates
- > carbohydrates intake > use = storage in the liver or in the tissues as fat

FUNCTION:
1. Gives the body energy
2. Best source of fuel for the body
3. Helps digest proteins and fats

4. Glucose for energy – catabolism vs. anabolism

Catabolism – breaks down glucose for energy
Anabolism – builds up *amino acid
5. Protein sparing – 4cal/gram
6. Preventing lactosis/ lactic acidosis- a medical condition characterized by the build-up of lactate
in the body, with formation of excessively low pH in the bloodstream. Excessive acid accumulates
due to a problem with the body’s oxidative metabolism. BREAK DOWN OF FATS
7. Making other compounds (glycogen, nonessential amino acids, fats- building blocks of protein)

6|Nutrition and dietetics

 SIMPLE SUGARS
CARBOHYDRAT
ES - Quick energy sources
- They came from sugar
- They do not usually supply any other
nutrients or fibre
SIMPLE COMPLEX
SUGARS SUGARS MONOSACCHARIDES

- 1 sugar molecule
MONOSACCHARIDES DISACCHARIDES POLYSACCHARIDES
- Absorbed without undergoing
* GLUCOSE * SUCROSE * STARCH digestion
* FRUCTOSE * MALTOSE GLYCOGEN
* GALACTOSE * LACTOSE FIBRE
● GLUCOSE
- Circulates through the blood to provide energy for body cells
- “dextrose”
SOURCES

● FRUCTOSE
- Fat sugar
- Sweetest of all sugar
- Often added to food because it is both cheap and enhances taste
SOURCES:
✔ Fruit shake
✔ Dried cranberry
✔ Yogurt
✔ Pasta sauce
✔ Salad dressing
✔ Fruit pie

● GALACTOSE
- Galactose + Glucose = disaccharide or LACTOSE
- Doesn’t appear in appreciable amount in foods
- Added to glucose

DISACCHARIDE

- 2 linked monosaccharide (at least 1 glucose)

- Would split before being absorbed
7|Nutrition and dietetics
 ● SUCROSE
- Glucose + Fructose = “ TABLE SUGAR or SUGAR”
SOURCE
✔ Sugar beets
✔ Sugar cane

● MALTOSE
- Glucose + Glucose
- Not found naturally in foods
- Adde for flavouring

● LACTOSE
- Glucose + Galactose = “MILK SUGAR”
- Found naturally in milk
- Enhances absorption of calcium and promotes the growth of GI Flora
- Also enhances the production of vitamin K
- The least sweet of all sugar
- Produces RBC, calcium
- Animal source
SOURCES:

TYPES OF SUGAR

SUGAR OTHER NAME FOOD

SOURCES

GLUCOSE “BLOOD FRUIT,

SUGAR” VEGGIES,
GRAINS

8|Nutrition and dietetics

 SUCROSE “TABLE TABLE SUGAR,
SUGAR” SUGAR CANE

FRUCTOSE “FRUIT SUGAR” FRUIT

MALTOSE “MALT GRAINS

SUGAR”
LACTOSE “MILK SUGAR” MILK

NEGATIVE OUTPUT

Protein: Blood, Urea, Nitrogen

Fats: Ketones, Cholesterol, Creatinine

POLYSACCHARIDE | COMPLEX CARBOHYDRATES

- 100s – 1000s of glucose molecule linked together

- (X) sweet but sense sweetness by receptors
- Supply longer-lasting energy, as well as other nutrients and fibres that the body needs.

● STARCH

● GLYCOGEN
- Storage form of glucose in animals and humans
- Animals (we usually eat, mainly the protein not the sugar content) No dietary source
- Are easily converted to lactic acid
- Miniscule amount only – shellfish (scallops and oysters)
STORAGE:
✔ Liver
✔ Muscles

9|Nutrition and dietetics

 ● FIBRE
- “Roughage” – can’t be digested by human enzymes
- Found only in plants/fruits
SOLUBLE – good for those who are having diarrhoea
INSOLUBLE – constipated, because it breaks own easily

How do you know if a food has added sugar?

✔ Check out the Food Label:

Total Carbohydrate (g): Dietary Fiber,

Sugars, Other Carbohydrates (Complex)

List of ingredients: sugar, brown sugar, juice

fruit juices, molasses, honey, syrup, malted
corn sweetener, corn syrup, maltose,
fructose, lactose, glucose, dextrose

GLYCEMIC RESPONSE

Effect a food has on the blood glucose concentration

✔ How quick
✔ How high
✔ How long to return

Factors:

● Fat, fibre and acid In food

● Method of preparation
● Degree of processing
● The amount eaten
● Degree of ripeness
● Combination with other food

GLYCEMIC INDEX (GI)

- A numeric measure of the glycemic response of 50g of a food sample

- The higher the number, the higher the glycemic response

10 | N u t r i t i o n a n d d i e t e t i c s
GLYCEMIC LOAD

- GI X amount of carbs 🡪 impact on glucose level

- Not reliable

GLYCEMIC GLYCEMIC
INDEX LOAD

WHITE SPAGHETTI 58 28

WATERMELON 72 4

LOW FAT ICE 50 3

CREAM

PEANUTS 17 1

SNEAKERS BAR 68 23

CHO IN HEALTH PROMOTION

● Tips for Increasing whole grain Intake

● Way to limit added sugar 🡪 X soda, “sweet tooth”, “read labels”
● Sugar Alternatives 🡪 sugar alcohol, nonnutritive sweeteners
● Steps to Avoid Dental Caries

RECOMMENDATIONS
1. Eat less foods with added sugar.
2. Choose fiber-rich fruits, vegetables and whole grains more often.
3. Eat beans several times a week.
4. Brush teeth after eating foods with sugar and starch.

PROTEIN

- In Greek, “to take first place”

- CHON
- Adult – 20% of body weight
- 10% to 35 % of total calories/meal
- Every tissue and fluid in the body contains some protein except bile and urine

11 | N u t r i t i o n a n d d i e t e t i c s
AMINO ACIDS

9 ESSENTIALS OR 11 NONESSENTIAL OR
INDISPENSIBLE DISPENSIBLE
HISTIDINE ALANINE
ISOLEUCINE ASPARAGINE

LEUCINE ASPARTIC ACID

LYSINE GLUTAMIC ACID

METHIONINE SERINE

PHENYLALANINE *ARGININE
THREONINE *CYSTEIN

TRYPTOPHAN *GLUTAMINE,
*TYROSINE
VALINE *GLYCINE, *PROLINE

- Basic building blocks of protein and end product of protein digestion

- 10,000 -15, 000 vary in size, shape and function
- Some dispensable 🡪 indispensable when metabolic need is great and endogenous synthesis is not
adequate.

FUNCTION OF PROTEINS

1. Body Structure and Framework

- 40% found in the skeletal muscle
- 15% in skin and blood
- Tendons, membranes, organs and bones

2. Enzymes
- Protein that facilitate chemical reactions w/o changing themselves.
- DIGESTIVE ENZYMES – Some breakdown larger molecules
- ENZYMES FOR PROTEIN SYNTHESIS – Some combine molecules to form larger compounds

3. Other body secretions and fluids

- Neurotransmitters (serotonin, acetylcholine)
- Antibodies
- Some hormones (insulin, thyroxine, epinephrine)
- Breast milk, mucus,

4. Fluid Balance
- Attracts water 🡪 osmotic pressure
- Circulating proteins like albumin – maintain proper balance (intracellular, intravascular, interstitial)
- Edema

12 | N u t r i t i o n a n d d i e t e t i c s
 5. Acid-base Balance
- Act depending on the pH surrounding fluids
- Lipoproteins –transports fats, cholesterol, fat-soluble vitamins
- Hemoglobin

6. Transport Molecules
- Globular proteins transport through blood

7. Other compounds
- Opsin, light-sensitive visual pigment in the eye

- Thrombin, normal blood clotting

8. Some has specific functions within the body

- Tryptophan – precursor of the vit. Niacin; component of Serotonin
- Tyrosine – precursor of melanin

9. Fueling the body

- Not preferred fuel but source of energy if fat and CHO are inadequate

NITROGEN BALANCE

- Reflects the state of balance between protein breakdown and protein synthesis
- Comparing nitrogen intake with nitrogen excretion over 24 hours

EXAMPLE:

Mary is 25 yo woman who was admitted due to multiple fractures and traumatic injuries from a car accident. A
nutritional intake study indicated a 24-hr protein intake of 64 g. A 24-hr Urinary Urea Nitrogen (UUN) collection
results was 19.8 g.
13 | N u t r i t i o n a n d d i e t e t i c s
1. Determine nitrogen intake by dividing protein intake by 6.25.
- 64 / 6.25 = 10.24 g of Nitrogen

2. Determine Total Nitrogen Output by adding 4 to the UUN.

- 19.8 + 4 = 23.8 of Nitrogen

3. Calculate Nitrogen Balance by subtracting Nitrogen Output from intake.

- 10.24 – 23.8 = (-) 13.56g in 24 hours

4. Interpret results

Interpretation

● Neutral = balance
● (+) = synthesis > breakdown (growth, pregnancy, recovery from injury
● (-) = breakdown > synthesis (starvation or the catabolic phase after injury)

RECOMMENDED FOR DIETARY ALLOWANCE

● For Healthy adults (ONLY) is 0.8g/kg

Example 1:
Adult male who weighs 154 pounds
= 56 g protein per day

Example 2:
Adult female who weighs 65 kgs
= 52 g protein per day

CONDITIONS THAT NEED INCREASE PROTEIN

● INADEQUATE CALORIE INTAKE

- Very low calorie weight loss diets
- Starvation
- PEM

● WHEN BODY NEEDS TO HEAL ITSELF

- Hypermetabolic conditions (burns, sepsis, major infection, major trauma)
- Skin breakdown
- Multiple fractures
- Hepatitis

● REPLACE EXCESSIVE PROTEIN LOSS

- Peritoneal dialysis

14 | N u t r i t i o n a n d d i e t e t i c s
 - Protein-losing renal diseases
- Malabsorption – short bowel syndrome

● DURING PERIODS OF NORMAL TISSUE GROWTH

- Pregnancy
- Lactation
- Infancy to adolescence

PROTEIN RESTRICTION

- Severe liver diseases

- Impaired renal function

PROTEIN DEFICIENCIES

KWASHIORKOR

CAUSE
- Acute, deficiency of protein or critical infections 🡪 loss of appetite
- Stressors: measles or gastroenteritis; American Adults – Trauma or sepsis

ONSET
- Rapid, acute; develop in weeks
APPEARANCE
- May look well nourished because of edema and enlarged liver

WEIGHT LOSS
- Some

OTHER CLINICAL SYMPTOMS

- Poor appetite
- Irritability
- Patchy and scaly skin
- Hair loss / easy pluckability

MORTALITY
- HIGH

MARASMUS

CAUSE
- Severe deficiency or impaired absorption of calories, protein, Vitamins & Minerals
- Severe prolonged starvation
- Children – w/ chronic or recurring infections, marginal food intake
- Adults – secondary to chronic illness

15 | N u t r i t i o n a n d d i e t e t i c s
 ONSET
- Slow, chronic, months to years to develop

APPEARANCE
- Skin and bones

WEIGHT LOSS
- Severe

OTHER CLINICAL SYMPTOMS

- Hunger

MORTALITY
- Low, unless r/t underlying disease

PROTEIN EXCESS

- No potential adverse effects from a high protein intake from food or supplements (institute of
Medicine of the National Academics, 2005)

PROTEINS IN HEALTH PROMOTION

● According to the AHA and Heart and Stroke Foundation of Canada Emphasis on grains fruit and
vegetables

● Accdg to American Institute for Cancer Research,

- X eat > 18oz / week 🡪 red meats (pork, lamb, beef)

16 | N u t r i t i o n a n d d i e t e t i c s
 - X processed meat (ham, salami, bacon, hotdogs, sausages) 🡪 increase risk of colorectal cancer
(AIRC, 2007)

VEGETARIAN DIETS

● Complete elimination of animal products to simply

avoiding meat.

● Lower rate of obesity, CVD, HPN, DM II, Cancer,

dementia, renal disease, gallstones

● Food sources
- Dried peas, beans, nut, nut butters, soy products,
veggie burgers

● If not planned properly 🡪 lack essential nutrients

(Iron, zinc, calcium, Vit D and alpha-linoleic acid &
excessive fat & cholesterol due to poor choices

Nutrition and Dietetics (Midterms)

Vitamins and Minerals

 Vitamins
o Greek word which means “vital for life”
o Organic molecules essential for normal health and growth and they are required in small amounts,
 Form no structures
 No mass
o Deficiencies or excessive amounts can be dangerous
 Water soluble- all vitamins b (b complex), c, and non-b complex (choline)
o Vitamins are responsible for the movements of the macronutrients.
o Hematopoiesis- regulation and maturity of blood cells in the bone marrow.
o Others- Heme synthesis
 Fat soluble- Vitamins ADEK

17 | N u t r i t i o n a n d d i e t e t i c s
Difference of Water soluble and Fat soluble

 Water soluble are easier to be excreted and absorbed; fat soluble have larger structures.

Important Terms

 Hypovitaminosis- insufficiency of one or more essential vitamins

 Hypervitaminosis- abnormally high storage levels of vitamins, which can lead to toxic symptoms.

Water soluble vitamins

Energy-yielding vitamins

 Vitamin B1: Thiamine

 RDA- Men-1.2 mg/day; Women- 1.1 mg/day
o Functions:
o Cofactor of alpha-ketoglutarate dehydrogenase (TCA)- tricarboxylic acid
o Easily destroyed by heat
o Alcoholic/ chronic alcoholic- Thiamine deficiency
o Decrease thiamine/ glucose level
o 70-100 mg/dL- normal glucose level
o Priority- increase thiamin
o Because if glucose= glycolysis= pyruvate (end product); needs thiamin to move in the spindle= no use;
build up that will cause lactic acidosis; causes damage in liver and kidney.
 From bread, milk, cereals, egg, cauliflower, flax seeds, potato.
 For emergencies; fast- thiamin injections
 Dry and wet beriberi
o Dry- peripheral neuropathy
o Wet- peripheral neuropathy and heart failure, pitting edema, and cardiomegaly- increase in cardiac size.
 Wernicke’s Korsakoff’s syndrome
o Stress/ alcoholic=brain alterations due to thiamin deficiency (brain tissue ischemia+cell death)
18 | N u t r i t i o n a n d d i e t e t i c s
 o 1st stage- Wernicke’s
 wobbly and weird; confusional state; opthalmoplegia- weakeness of the eye muscles; still with
vision; ataxia- loss of control; muscle weakness
o 2 stage- Korsakoff’s
nd

 Amnesia; confabulation- altered reality; psychosis

 Vitamin B2: Riboflavin
 RDA- Men- 1.3 mg/day; Women- 1.1 mg/day
 Functions:
o Precursor of 2 coenzymes: Flavin mononucleotide(FMN) and Flavin adenine dinucleotide(FAD)
 Egg, tomatoes, cabbage, cereals, nuts, squash, lean meat, and milk.
 Ariboflavinosis
o Oral: Angular stomatitis- singaw, inflammation of the mucous membranes, cheliosis- drying of the
corner of the lips, glossitis- inflammation of the tongue.
o Facial- Dermatitis of nasolabial region.
o Ocular-vascularization of the cornea.
 Vitamin B3: Niacin
 RDA- Men- 16 Niacin Equivalent/day; women- 14 NE/day; upper level of 35 mg/day for adults.
 Functions
o For information of nicotinamide adenine dinucleotide(NAD) and nicotinamide adenine dinucleotide
phosphate(NADP) coenzymes.
 Dairy products, lean meat, nuts, egg, poultry, fish, vitamin b complex, and supplements.
o Supplements is good- due to frying vitamins are reduced; very sensitive to heat and light.
 The timed-release tablets and capsules- fewer side effects. However, the timed-release versions are more likely
to cause liver damage.
o Cannot be digested in the mouth but is also broken down when acidity is already high.
 Deficient when corn is staple diet
 Pellagra- can lead to death
o dermatitis- dryness of the skin; scaling,
o diarrhea
o demetia- starting point of Alzheimer’s
o Should have the triad (3Ds) to be diagnosed
o Rash when exposed to light
 Vitamin B5: Pantothenic Acid
 Functions:
o In order to synthesize coenzyme-A (COA)- metabolism of CHO, CHON, and fats.
 Does not have a deficiency but is needed.
 Vitamin B7: Biotin
 RDA: 30 mcg/day
 Deficiency of biotin= causes: Too many egg whites= alopecia
 Tomatoes, carrots, almonds, onions, salmon, romaine lettuce, eggs, walnuts, sweet potato, cauliflower, vitamin
b complex, and supplements

Hematopoietic vitamins

 Vitamin B9: Folic acid

 RDA: Adult: 400 mcg/day; Pregnant: 600 mcg/day (to ensure fetal development)
 Absorbed in the jejunum
 Beans and legumes, citrus fruits, whole grain, shell fish, poultry, and dark green leafy vegetables
 Spina bifida- accumulation of fluid in the spinal cord

19 | N u t r i t i o n a n d d i e t e t i c s
  Anoncephaly- no skull
 Vitamin B12: Cobalamin
 RDA: 2.4 mcg/day
 Absorbed in the ileum

Electrolytes

 Minerals circulating in blood and other body fluids that carry an electrical charge
 Effect on body: processes amount of water inside the body, blood ph, muscle action, and normal functioning of
the nerves and muscles

Sodium

 Major extracellular cation

 Transmission of nerve impulses
 Regulate water in intracellular and extracellular
 1,500 mg/day- RDA; 1,300 mg/day (51-70 years old)
 Hyponatremia-low blood sodium

Potassium

 Cation; maintains levels extracellularly

 Primary intercellular cation
 Muscle function
 Contractility of muscle (e.g: heart)
 Nerve impulses
 4,700 mg/day- RDA

Chloride

 Key anion of extracellular fluids

 Maintain fluid balance inside and outside the cell
 A component of hydrochloric acid, an indispensable gastric juice produced by the stomach
o Reacts with hydrogen ions—acid breakdown of food
 Acid- base balance
 2,300 mg/day; 2000 mg/day (>50 years old)

Electrolytes mEq/L (milliequivalent)

Sodium (Na) Potassium Chloride

(K) (Cl)
Normal 135-145 3.5-5 mEq/L 96-106
range mEq/L mEq/L
Hyponatremia
(decreased
sodium in
blood)
RDA Adult- 1500 4700 Adult- 2300
mg, 51-70 yo- mg/day mg/day,

20 | N u t r i t i o n a n d d i e t e t i c s
 1300 mg, >50 yo-
upper limit- 2000 mg,
2300 mg >70- 1800
mg
Sources Table salt, Unprocessed Foods w/
processed foods, white Na- contain
food potatoes w/ Cl as well
skin, sweet
potatoes,
tomatoes,
bananas,
oranges,
dairy
products
and legumes
Deficiency FVD w/ Muscle Rare, same
headache, weakness, as Na
muscle confussion, deficiency
cramps, decreased
weakness, appetite,
decreased cardiac
concentration, dysrhythmia
appetite loss from
vomiting
Toxicity Na sensitive From diet or Due to
hypertension supplements dehydration
if (+) renal ---
disease imbalance

 Fluid volume deficit/deficiency- vascular, cellular, or intracellular dehydration

o Occurs with diarrhea, vomiting, or high fever
o Other causes of excessive fluid loss- sweating, diuretics, and polyuria (excessive urination)
o Person with FVD less able to maintain blood pressure immediately= orthostatic hypotension
 Fluid volume excess-increased fluid retention and edema due to compromised regulatory mechanisms, or excess
fluid and sodium intake
o When there is increase in sodium intake= hypertension may occur
 Kwashiorkor- low protein levels
o Accumulation of fluids in the face, stomach, and extremities

Energy balance

 Consummation and expenditure of energy should be equal

 Ill patients= increase; due to the physiologic changes that needs adaptation
 For energy needs a more active person or of larger or smaller body size, further adjustments must be made
 Estimated calorie needs/day by age, gender, and physical activity level

Type of lifestyle Activities done

Sedentary Light physical
acitivity+ADL (activities of
daily living)

21 | N u t r i t i o n a n d d i e t e t i c s
 Moderately active Walking about 1.5-3
miles/day
Active >3 miles/day
 1.5 miles=1km

Factors for estimation according to level of physical activity for men and women

Level of activity Activity factor Energy

(xREE) expenditure
(kcal/kg/day)
Very light
Men 1.3 31
Women 1.3 30
Light
Men 1.6 38
Women 1.5 35
Moderate
Men 1.7 41
Women 1.6 37
Heavy
Men 2.1 50
Women 1.9 44
Exceptional
Men 2.4 58
Women 2.2 51

Components of total energy expenditure

 Basal metabolism- amount of energy needed to to maintain life-sustaining activities (breathing, circulation,
heartbeats, secretion of hormones)
 Basal metabolic rate (BMR)- rate which the body spends energy to keep all these life-sustaining processes going
 Thyroxine- key BMR regulator
o More thyroxine= higher BMR

Breakdown of human energy expenditure

 Resting energy expenditure (breathing, circulation etc)- 70.0%

o Energy spent on normal life situations while at rest
 Physical activity- 20.0%
o Body movement produced by the skeletal muscles
 Thermic effect of food (digest, absorb, metabolize, store food)- 10.0%
o Increase in cellular activity due to eating

Adaptive thermogenesis

 Energy use by the body to adjust changing physical and biologic environment situations
o Physical and emotional trauma
o Too much eating, extreme temps, and extreme emotions

Healthy weight

 Measuring body fatness

22 | N u t r i t i o n a n d d i e t e t i c s
 o Lean body mass- bone, muscle, and other nonfat tissues
o Sometimes not a good measurement of fatness
o Due to fluctuations in body fluids; fluid retention occurs before menstruation or during hot weather-
interpreted as fat gain, and losses in a sauna may appear to be fat losses
o Determine body composition (lean body mass+body fat)
 Interpreting BMI
o Weight-to-height ratios considered normal but levels of body fat are beyond what is recommended vice
versa
 Body fat distribution
o Differences are related to gender, age, and stage of development
o Fat that is visceral in the abdomen are more dangerous than subcutaneous fat
o Visceral fat- quickly lost and gained
o Subcutaneous- slowly lost and gained
 Determine your body shape
o Good estimate- compare waist to hip circumference
o Divide your waist measurement by your hip measurement
o Apple-man: >0.9-1
o Woman >0.8
o Pear-woman <0.8

Essential body fat and healthy level of total body fat

 Essential fats are healthy fats

o Men 3-8% of their body weight; needed: 15-20%
o Women 12-14%; needed 25%-30

Regulation of body fat levels

 Changes in body fatness

 Genetic influenes on body siz and shape- hormones leptin and ghrelin
 Leptins- produced by adipocytes/ cells in adipose tissue
o Function is to decrease appetite; inhibits hunger
 Ghrelins- produced in stomach
o prohibits hunger and eating

Set point and body fatness

 Set point is the neutral stage; usual or natural level

o How the body sways to maintain to the usual or natural levels
 May adjust or get higher or lower to return to the set point- defending the set point
 Can be physically adjusted (lifestyle, diet, activity, behavioral and emotional factors)

Food intake adjustments

 Activation of drive to eat, some people may learn how to ignore the drive but they are vulnerable to
disinhibition= greater food intake

Adjustments in energy use

 Adjustment of REE
 Reducing food intake produces an immediate and significant depression of REE

23 | N u t r i t i o n a n d d i e t e t i c s
  If reduction is not too great, the drop in REE may be sufficient to prevent weight loss; a successful defense of set
point

Restricted dietary patterns

 Moderate restriction of kcal -<500 kcal; not lesser than 1200kcal

 Very low calorie diets- for BMI >30 – 200 to 800 kcal
 Formula diets-900kcal+vits and minerals
o Protein shakes, osteorized feeding
 Pharmacotherapy- BMI >30 or patients with co-morbidities + BMI >27
o Supplements that boosts the appetite

Gaining, loosing, or maintaining: A wellness (non-diet) approach

Establishing realistic goals

 Assess the tolerance of food, time

 Changing behavior- due to external factors
 Food preparation, availability of food, fresh produce

Normalizing eating

 Enjoying eating – striving to retain the enjoyment of process

 Letting hunger and satiety guide eating- eating when hungry even if it is not a traditional mealtime

Minimizing the use of food to meet emotional need

 Use of food to express positive feelings, celebrate good fortune, reward hard work, and to create a sense of
companionship
 Handling negative emotions such as boredome, frustrations, anger, or loneliness
 Minimize emotional eating

Eating regularly and frequently

 Whatever pattern works best, it should be space food throughout active hours and should not produce
overwhelming hunger or the drive to consume excessively
o 3 main meals of small portion with snacks in between

Adopting an active lifestyle

 Maintaining a healthy body composition

o 30 mins of walking (maintain weight)
o More than 30 mins (weight loss)

Recommendations for adequate fluid replacement

What to do What to eat and

drink
Before exercise Hydrating Drink Na
(sodium) and/
or salted
snacks- helps
stimulate thirst

24 | N u t r i t i o n a n d d i e t e t i c s
 and retain
needed fluids
During exercise Weighing With
before and after electrolytes and
to determine CHO (carbs)
the amount of
fluid
replacement (1
lb= 2 cups of
h2O)
After exercise Consuming With Na
normal meals & (sodium)- helps
beverages speed recovery
restores by stimulating
average thirst and fluid
hydration retention

Water intoxication- water poisoning, hyperhydration, overhydration, or water toxemia is a potentially fatal disturbance
in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by
excessive water intake

Recovery fluids and foods

 Cheerios w/ milk
 Flavoured yogurt
 Pasta with meat sauce

Recommendations of macronutrient intake

Sedentary < 1 hr 90 mins Sources

exercise
CHO 5g x kg Do not 60-70 % As
carb of intake discussed
load (450 g in
3000
kcal/
day
CHON 0.8g x kg 1.5-2g x 1.5-2g x Animal
kg kg food, vegan
athletes
should plan
more
carefully

FATS None None 20-25% Lean

of intake meats, fish,
poultry and
low-fat
dairy fried
and high-
fat snacks

25 | N u t r i t i o n a n d d i e t e t i c s
 should be
in
moderation

Why exercise is important?

 Aerobic exercises
o Fast walking
o Jogging or running
o Cycling
o Dancing
o Swimming
o hiking
 Muscle-strengthening activities
o Lifting weights
o hill walking
o Climbing stairs
o Push ups
o Sit ups
o squats
 Bone strengthening activities
o Jumping rope
o Hopping
o Volleyball
o Gymnastics
o Running
o gymnastics
 Balance and stretching activities
o Shoulder rolls
o Ankle rolls
o Heel-toe-walking
o Biceps curls

Role of nurses

 In collaboration with
o Physicians, dietitians, behavior and exercise therapists

Nutrition across the lifespan

 Progesterone- develops endometrium and relaxes

 Estrogen- downside: slowing GI; slow absorption of calcium in the body and Fe causing constipation and
increased renal sodium

Metabolic changes

 BMR increase 15-20% during pregnancy

 Fat is the primary source of a mother’s fuel permitting glucose to be available to the fetus
26 | N u t r i t i o n a n d d i e t e t i c s
  Increased macronutrient and micronutrient intake by the mother during pregnancy ensures the these higher
metabolic needs are met

Anatomic and physiologic changes

 Plasma volume doubles during pregnancy, beginning in the second trimester

o Failure to achieve plasma expansion may result to spontaneous abortion, stillbirth, or a low-birth-weight
infant
o Hemodilution effect- result of the increased plasma volume; measure components in the plasma such
as hemoglobin, serum proteins and vitamins will appear to be at lower levels during pregnancy because
there is greater solvent (plasma) in relation to the solutes (components)
o Cardiac hypertrophy occurs to accommodate increased blood volume, accompanied by an increased
ventilatory rate
 Glomerular filtration rates
o Increases to accommodate the expanded maternal blood volume being filtered and to carry away fetal
products
 Amino acids, water, and soluble vitamins
 Fetus use glucose as primary source; mother uses fats

Failure to gain weight may lead to:

 Small for gestational age- short in terms of

 Low birth weight- 2.5 g to 3 g

Recommendations

 Increased macro and micro nutrients

 Obese, minorities and low-oncome women, pcx who had gastric bypass (1-year post op)
 Increase all except vitiamins D, E, and K, phosphorus, fluoride, vitamin C, and biotin
 Increase extra 340 kcal/day- 2nd trimester; 452 kcal during 3rd trimester
 Do not eat for 2 people- instead extra sandwich, fruits, glass of milk
 Table 10.1- customizing of diet
o MyPlate an accessible source of information for pregnant and breastfeeding women
 Do not take supplements
 Consume small amounts of high-quality protein as tolerated; small-frequent feeding of protein
o Due to constipation
 Vitamins and minerals
 Vitamin A- 750-770 mcg; UL-2800-3000 mcg
 Folate- 600 mg/day and iron intake- 27 mg/day= ferrous daily 2nd tri prevent iron deficiency anemia
 Calcium-1000 mg/day- adult 1300 mg/day- adolescent: MOST IMPORTANT
 Pica
o Hunger and appetite for nonfood substances
o Ice, cornstarch, clay, and dirt

Nutrition related concerns

Alcohol

 NO ALCOHOL during pregnancy

 Factor: alcohol; fetal alcohol syndrome; no intake- effects: low nasal bridge, short nose, flat midface, and short
palpebral fissures

27 | N u t r i t i o n a n d d i e t e t i c s
Food borne illness

 During pregnancy, women and their unborn children are more likely to become very ill form food poisoning.
 Newborns are also at risk due to undeveloped immune system

Foods to avoid

 Raw or undercooked foods, contain undercooked eggs, deli salads, unpasteurized milk, fruits, and vegetable
juices, refrigerated pate or meat spreads

Diabetes mellitus

 Pregnancy significantly affects insulin requirements

 Complications: macrosomia, hypoglycemia, erythremia, hyperbilirubinemia

Maternal phenylketonuria

 Inborn error of metabolism

 Extremely low levels of phenylalanine hydroxylase- catalyzes conversion of phenylalanine to tyrosine
 Failure to detect the disease or lack or compliance with dietary therapy causes irreversible mental retardation

HIV (Human immunodeficiency virus)

 Additional strain to already fragile immune system

o Estrogen, progesterone, HCG, alpha fetoprotein, corticosteroids, prolactin, and a-globulin has
immunosuppressive effects

Common nutrition-related discomforts of pregnancy

 Nausea and vomiting

o Morning sickness
o 1st trimester
o Cause by hormonal factors such as rise in estrogen or placental hormone HCG
o Stress and fatigue may exacerbate the condition
o Hyperemesis gravidarum- severe and unrelenting vomiting
 Heart burn
o Rapid growth of fetus; pushes to the stomach; action or progesterone= relaxation of smooth muscles=
acts on the gastroesophageal sphincter= reflux of gastric contents of the stomach to the lower
esophagus= heart burn
 Constipation
o Common on the 1st and 3rd trimester
o Action of progesterone= slows GI motility may be responsible
o 3rd trimester- fetus crowds other internal organs

Nutrition during lactation

 Breast feed up to 6 months

 Ideally for 12 months with addition of weaning foods
 Complementary foods may occur at 4-8 months of age
 Protein- 71 g/day
 500-800 kcal/day- energy expenditure on milk production
 Avoid consumption of gas-producing vegetables such as cabbage, onions, and broccoli- infants become fussy
 Coffee (caffeine) and cola should be avoided- acts as diuretics

28 | N u t r i t i o n a n d d i e t e t i c s
 o Caffeine passes to the breast milk in small amounts
 Adequate fluid intake is important

Nutrition during infancy

Nutrition and Diet therapy (Finals)

Food-related Issues

Dietary guidelines

 Five key messages (office of disease prevention and health promotion)

o Follow a healthy eating pattern across the lifespan
o Focus on variety, nutrient density, and amount
o Limit calories from added sugars and saturated fats, and reduce sodium intake.
o Shift to healthier food and beverage choices
 Consider cultural and personal preferences
o Support a healthy eating pattern for all
 Healthy eating patterns limits saturated fats and trans fat, added sugar, and sodium
 One of the most important tools is the nutrition label

Dietary modifications

 Required to allow the body to heal, adjust to physical disability, or prepare for a diagnostic tests or
surgical procedures
 Therapy may require texture changes (liquefy or pureed foods)
 If a patient cannot or will not eat for a week or longer enteral (tube) feeding or parenteral (intravenous)
nourishment may be needed

Diet orders

 Specific disease or conditions require modification of the normal diet

o Normal diet: regular, general, and house
 Regular diet- designed to attain optimal nutritional status in people who do not require dietary
alterations
o Adjusted according to gender, age, height, weight, and activity level
 Quantitative and qualitative diets
o Qualitative diets- modification in the consistency, texture, or nutrients
o Quantitative diets- modification in number or size of meals served, or amounts of specific
nutrients

Teaching tools
Problem Solution
Illiterate or too ill to Read menu items to
read or write, has the patient and marks
reduced visual abilities his/ her selections
or a low literacy level
Does not understand Clarify for patient or ask
the items used on for clarifications from
menu dietitian
Often must select foods Remind patients that
from menu a day in they are selecting
advance, often foods for the next day.
resulting too much or If they have not
too little food selected enough food
offer them foods kept

29 | N u t r i t i o n a n d d i e t e t i c s

Poor appetite
Does not understand
why some of his/her
favorite foods are not
included on the menu,
why smaller amounts
are served, or why
textures are modified
in the nursing unit. If
they ordered to much
discard if not
consumed within 24
hours
Small frequent meals
and snacks every 2-3
hours. Choose energy
dense foods like meat,
dried fruits, buts, and
starches. Schedule
between-meal
supplement drinks
Discuss dietary
concerns of the
patient’s illness,
explaining why specific
foods are not included
or only limited amounts
are allowed.

Meals in long-term cared

 Repetition and monotony will influence a patient’s acceptance of foods and meals served

Basic hospital diets

Types of diets
Diet Indications Contraindications Sample
foods
Liquid diet Oral fluids before/after (x) >24 hours, Broths,
surgery, prepare bowel inadequate GI bouillon,
for diagnostic function, nutrient apple juice,
colonoscopy needs requiring grape juice,
examination, barium parenteral gelatin
enema, acute GI nutrition without fruit
disturbances
Full liquid After surgery, transition Dysphagia, wired Milk,
between clear and solid jaw icecream,
food, oral or plastic cooked
surgery to the face and eggs,
neck, mandibular eggnog, oral
fractures, chewing or supplements,
swallowing difficulties or milkshakes
Pureed diet Neurologic changes, Situations which Any food
inflammation/ulcerations ground or that can be
of the oral cavity, chopped foods blended
edentulous patients, are appropriate and served
fractured jaw, head, without
and neck abnormalities, particles
CVA
Mechanical Poor fitting dentures, Situations which Foods that
soft diet limited swallowing, regular foods are can be
chewing abilities, appropriate easily cut
stricture of the intestinal with a fork,
tract, radiation chopped, or
treatment of the oral blended
30 | N u t r i t i o n a n d d i e t e t i c s
 cavity, progression from (x) hard,
enteral or parenteral stringy,
nutrition to solid foods tough
foods=
choking
Soft diet Debilitated patients Situations where All foods
unable to consume a regular diet is served on
regular diet, mild GI appropriate general diet
problems except for
highly fibrous
fruits and
vegetables

 Diet as tolerated (DAT)- ordered post-operatively

 Vegetarian diet- normal diet by does not include meat, poultry, fish or seafood
o Ovo-lacto- consumes some animal products such as egg and dairy
o Lacto-vegetarians- consumes dairy products only

Other food considerations

 Food allergy- release of histamine and serotonin

o Most common symptoms: diarrhea, nausea, vomiting, cramping, abdominal distention, and
pain
o Major triggers: eggs, milk, wheat, soy, fish, shellfish, peanuts, and tree nuts
 Food intolerance- non-allergic reaction; caused by toxins, drugs, or conditions such as lactose and
gluten intolerances
o Dose responsive
o Lactose intolerant patients can use lactaid (treated milk), cheeses, and yogurt

Food safety and sanitation

 Food borne illness can occur in any setting

 Personal hygiene and handwashing are the most important factors for prevention
 Food temperature
o Maintained at <40°F or >140°F
 Hot foods should be served as soon as possible
 Protein-rich food should be discarded is left at room temperature longer than 2 hours
 Items that are not consumed should be labeled, dated, refrigerated, then use within 24 hours
 Prevent cross-contamination should not mix drugs, staff foods, and patient foods
 Foodborne outbreak- two or more individuals have the same symptoms over the same period

Complementary-alternative medicine: herbs and botanicals

 Biologically-based therapies- materials found in nature, include functional foods, botanicals, and herbs
 Functional foods- physiologically active (bioactive) substances, marketed as dietary supplements
 Dietary supplements- considered as foods not drugs
o Consumed orally as tablets, liquids, capsules, extracts, powders, gel caps,

Non-oral feeding

 When patient cannot eat for more than few days, non-oral method must be used

Teaching tool
Was hands for at least 20 seconds
Flush feeing with 1-5 ml of water before and after
feeding to prevent feeding tube from clogging

31 | N u t r i t i o n a n d d i e t e t i c s
 Never add new formula to formula already in the
feeding container
Change entire feeding setup every 24 hours
Place formulas: breast milk (4 hours), formula (8
hours) in containers
Make sure infant has pleasant sensations during
feeding; hold your child, allow him to suck a
pacifier
Head of the bed 30-45 degrees if child cannot be
held
 When GI tract is functional, accessible, and safe to use, enteral feedings are preferred over parenteral
feeding
o Physiologically beneficial in maintaining integrity and function of gut
 Severe dysphagia, major burns, short bowel syndrome after resection, and intestinal fistulas- warrant
tube feedings

Types of formulas

 Standard formula- polymeric; composed of intact nutrients that require a functioning GI tract for
digestion and absorption of nutrients
 Hypercaloric formula- (1.5-2 kcal/ml) designed to meet kcal protein demands in a reduced volume and
have moderate to high osmolality
 Elemental formula- (1-1.3 kcal/ml) partially or fully hydrolyzed nutrients that can be used for the patient
with partially functioning GI tract, impaired capacity to digest foods or absorb nutrients, pancreatic
insufficiency, or bile salt deficiency

Formula selection

 Based whether patient can digest and absorb nutrients

 Individual nutrient requirements determine the type and amount of tube-feeding formulas

Feeding routes

 Nasogastric- nose to the stomach

 Nasoduodenal- nose to the duodenum
 Nasojejunal- nose to the jejunum
 Esophagostomy- neck and extends to the stomach
 Gastrostomy- surgically inserted into the stomach
 Jejunostomy- surgically inserted into the small intestine
 Percutaneous endoscopic gastrostomy (PEG)

Parenteral nutrition

 Involves the provision of energy and nutrients intravenously

 Components: carbohydrates (dextrose monohydrate), amino acids (mixture of nonessential and
essential crystalline amino acids), fats (lipid emulsions), total nutrient admixture (lipid emulsions added to
dextrose and amino acid mixtures), electrolytes, trace elements (zinc, copper, manganese, chromium,
and selenium), vitamins, and bioactive substances (prebiotics and probiotics)

32 | N u t r i t i o n a n d d i e t e t i c s
 Intake

CHON Fats CHO

Insulin- storing of glucose for energy

 Glycolysis- glucose= ATP

Glucagon Glucose Insulin  Glycogenesis- storage of glucose- creation of
glycogens
Glycogenolysis Glycolysis o Store glucose in liver and muscles
o Used for short term only
 Lipogenesis- glucose stored in adipose tissues
Gluconeogenesis Glycogenesis
o For long term use

Lipogenesis
Glucagon- stimulate glucose production
Ketogenesis

 Glycogenolysis- related to glysogenesis, opens storage to release glucose

 Gluconeogenesis- turns amino acids and other molecules into glucose
 Ketogenesis- fats are broken down into ketones
o Sugar produced in this process are used by the brain and heart only

Nutrition for Diabetes Mellitus

 Diabetes mellitus- relative or complete lack of insulin secretions by the beta cells of the pancreas or by
defects of cell insulin receptors
 Diagnosed by elevated fasting blood glucose values (>126 mg/dl on at least two occasions)
 Vitamins D homeostasis
o Maintains normal release of insulin from the beta cells
o Maintains epigenome, lowers inflammation= insulin resistance
o Protects betal cells against destruction

2 major classes of diabetes

 T1DM- autoimmune disorder

 T2DM- lifestyle diabetes
 Fast 8-10 hour

Prediabetes and insulin resistance

 Blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes
o 70-110 normal glucose levels
o >110 mg/dl
 Insulin resistance
o Muscles, fat, and liver cells do not respond properly to insulin and cannot easily absorb glucose
from bloodstream
o Excess body fats increases risk

Effects of diabetes on systems

 Macrovascular effects- increase risk of coronary artery disease, peripheral vascular disease, and stroke
 Microvascular effects- include nephropathy, retinopathy, and neuropathy
o Nephropathy- Chronic kidney disease (CKD)
o Retinopathy- leading cause of blindness
o Neuropathy- decreased sensation in the extremities
 Impaired healing- effect of diabetes to the circulatory system= gangrene may develop

33 | N u t r i t i o n a n d d i e t e t i c s
  Autonomic effects- orthostatic hypotension, persistent tachycardia, gastroparesis, neurogenic bladder
(urinary bladder dysfunction due to neurologic damage), impotence, and impairment of visceral pain
sensation
o Impairment of visceral sensation may obscure symptoms of angina pectoris or myocardial
infarction

Classifications of diabetes

 T1DM, T2DM, latent autoimmune diabetes of adults (LADA), gestational diabetes mellitus (GDM), and
impaired glucose tolerance (IGT)

Criteria for diagnosing diabetes and prediabetes

𝐴1𝑐 Fasting Oral

plasma glucose
glucose tolerance
(mg/dl) test
Diabetes 6.5 or > 126 >200
above
Prediabetes 5.7-6.4 100-125 140-199
Normal About 5 <99 <139

Type 1 DM

 This type of diabetes is not curable

 Autoimmune disease resulting in beta cell destruction
 Autoantibodies to beta cell protein forms after autoimmune destruction of the beta cells
 Rate of beta cell destruction are rapid for infants and children and slow in adults
 T1DM usual in >20 years old

3Ps of T1DM

 Polyphagia, polyuria, and polydipsia

34 | N u t r i t i o n a n d d i e t e t i c s
 Body will send signals to
eat because cells are
hungry; consume large
amounts of food
(polyphagia)
Glucose cannot enter
cells; builds up in
bloodstream

Blood becomes Body will try to get rid of

hypertonic excess glucose

Increased urine output

Increasing urine output will increase thirst
(polyuria) (polydipsia) to replace
fluids

Treatment of T1DM

 Insulin- requires exogenous insulin to maintain normal blood glucose levels and to survive
 Insulin with nutrition therapy and exercise= mimic physiologic insulin delivery
 Types of insulin
o Classified into three groups
o Conventional or standard insulin therapy- constant dose of intermediate acting insulin combined
with short or rapid acting insulin or mixed dose of insulin
o Flexible or intensive insulin therapy- multiples daily injections (MDI); short or rapid-acting insulin
before meals; intermediate-acting insulins once or twice daily
o Continuous or subcutaneous insulin infusion- intensive therapy; rapid or short-acting is pumped
continuously in micro-amounts through an insulin catheter; boluses of rapid or short-acting
insulins are given before meals
 Exercise- lowers blood glucose levels, assists in maintaining normal lipid levels, and increases circulation

General guidelines for regulating glycemic response to exercise

 Do not exercise when fasting glucose levels are > or equal to 250 mg/dl
 Avoid exercise if ketosis is present (presence of ketones in urine)
 T1DM; should not exercise when insulin is at its peak
 Exercise when blood glucose levels are between 100-200 mg/dl or about 30-60 minutes after meals
 Food intake: 15 g of CHO only
o Consume CHO to avoid hypoglycemia

Type 2 DM

 Can be controlled
 Primary metabolic problem is insulin resistance or defect in insulin secretion
 Gradual onset of polyuria and polydipsia, easily fatigue, and have frequent infections

Treatment and management of T2DM

 Oral glucose lowering medications- when diet and exercise alone cannot control hyperglycemia

35 | N u t r i t i o n a n d d i e t e t i c s
 o Metformin- first line of therapy
 Vitamin D supplementation= improve glycemic control and 𝐻𝐵𝐴1𝑐 levels
Metabolic goals in diabetes management
Goal
Glycemic control <0.7%
 Hemoglobin 𝐴1𝑐
 Preprandial capillary 90-130
plasma glucose
(mg/dl)
 Peak postprandial <180
capillary plasma
Cardiovascular
 Blood pressure <139/80
(mmHg)
 Triglycerides <150
 Low density <100
lipoprotein cholesterol
(mg/dl)
 High density
lipoprotein cholesterol
 Males >40
 Females >50

 Glycemic control can be monitored by measurement of glycosylated hemoglobin or hemoglobin 𝐴1𝑐

along with self-monitoring of blood glucose (SMBG)
 T1 DM  Three times or
 Pregnant more every day
women that are
taking insulin
 T2 DM  BID, AC: 70-130
mg/dl
 Postprandial
(2hrs): <180
mg/dl
 Bedtime: 90-150
mg/dl

Hypoglycemia

 Low blood sugar (<70 mg/dl)

o Signs and symptoms: cool, clammy, pale skin
o Confusion
o Erratic behavior
o Hunger
o Trembling and shaking

Diabetic ketoacidosis

 Body cannot produce enough insulin

o Glucose cannot enter into the cells= breaks down fat for fuel= high levels of blood acids
(ketones)= ketoacidosis
 Severe DKA is defined by a pH <7.15
 Hyperglycemia causes osmotic diuresis, dehydration, and lactic acidosis
 Lowered pH stimulates respiratory center= deep, rapid respirations (Kussmaul’s respiration)
 > ketones in the body= fruity, acetone odor to breath= mistaken for inebriated (intoxicated)
36 | N u t r i t i o n a n d d i e t e t i c s
  Is an initial presentation of T1DM
 Best handled in the ICU for correction of fluid loss with IV fluids, hyperglycemia with insulin, and
electrolyte disturbances, and acid-base balance with appropriate solutions
 Drinking low-calorie fluids is recommended to maintain hydration

Hyperglycemic Hyperosmolar Nonketotic Syndrome

 Actual insulin deficiency resulting in severe hyperglycemia

 Triggered by trauma or infection
o Increases body’s demand for insulin
 If hyperglycemia is left untreated, serum becomes hyperosmolar
o Osmotic diuresis= significant loss of electrolytes via urine

Food and nutrition therapies

 Diabetes self-management education (DSME)

o Involve a comprehensive nutritional assessment, a self-care treatment plan, client’s health
status, learning ability, readiness to change, and current lifestyle
 Recommendations for total fat, saturated fat, cholesterol, fiber, vitamins, and mineral intakes are same
for individuals with diabetes as those for the general population
 Carbohydrate recommendations are based on individual’s eating habits, blood glucose, and lipid
goals
 Protein intake can range from 15%-20% of daily kcal from animal and vegetable protein sources
 If blood glucose levels are not affected by moderate alcohol intake, it is ought to be regarded as
additional energy
o Consumed with food to reduce risk of hypoglycemia
 No food should be omitted

Goals of nutrition therapy

 Glucose levels in normal range or close to the normal range

 Lipid or lipoprotein profile reduce risk for macrovascular diseases
 Blood pressure levels reduce risk for vascular diseases

Strategies for metabolic control

 Adequate meal plan; reduced total fat
especially saturated fats
 Meals spaced throughout the day
 Mild to moderate weight loss (5-10 kg)
 Regular exercise
 Monitoring of blood glucose levels, 𝐴1𝑐 ,
lipids, and blood pressure
 Oral hypoglycemic insulin if preceding
does not work
 Modify nutrient intake and lifestyle
 Enhance health using healthy food choices and physical activities
 Address individual nutritional needs
 Take prescribed medications
 Injection sites

Other guidelines

 Non-nutritive sweeteners- saccharin, aspartame, and acesulfame K

o Safe for DM patients
 Sucrose- occasional
 Plate methods- is an app that is used for diabetes meal management

37 | N u t r i t i o n a n d d i e t e t i c s
Role of nurses

 Help patient become aware and assess knowledge of, understanding of, and adherence to prescribed
diet
 Observing meals and food choices
 Monitoring glucose levels

Special considerations

 Illness- infection, injury, or stress

o > blood glucose values= diabetes control worsens; caused by increased hepatic production of
glucose (RAAS)
o Hyperglycemia increases insulin requirements
o Increase need for insulin but decreased appetite and food intake are common
 Gastroparesis- delayed gastrointestinal emptying
o Manifest as heartburn, nausea, abdominal pain, vomiting early satiety, and weight loss
o Occurs in vagal autonomic neuropathy and occurs more often in T1DM
o Treatment: gastric electric stimulation (GES)
o Carefully monitor intake
o Replace carbohydrates with foods that are soft or liquid consistency
o Six small meals are better tolerated then 3 large meals
o Low-fat diet= prevent delay in gastric emptying
o Metoclopramide (reglan)= increase gastric contractions and relax the pyloric sphincter
o Patients may experience dry mouth and nausea
 Increase fluids and moisten food with broth
o Match insulin with meals to regulate delayed absorption and glucose changes
o If constipation or diarrhea occurs alter fiber according to the needs of the patient
 Indigestible solid mass (bezoar)- after eating oranges, coconuts, green beans, apples,
figs, potato skin, Brussels sprouts, or sauerkraut
 Eating disorders
o Insulin initiated= weight gain
o Diabulimia- disordered eating from body image problems
 Metabolic disorders= DM2= disproportionate fat= excessive cytokinesis
 Management: food intake

Metabolic syndrome
Cluster of metabolic abnormalities along with
chronic low-grade inflammation and oxidative
stress

Criteria for metabolic syndrome (MetS) consist of

the presence of any three of the following:
 Enlarges waist circumference
 Low serum HDL (high-density lipoprotein):
<40 mg/dl- men and <50 mg/dl- women
 Blood pressure: >130/85 mmHg
 Fasting glucose value: >100 mg/dl
 T2D, coronary artery disease, and stroke
quickly develops with MetS

Diabetes management throughout the lifespan

Pregnancy

 Some hormones produced by the placenta during pregnancy are antagonistic to insulin
o Reduced effectivity
38 | N u t r i t i o n a n d d i e t e t i c s
  Insulin does not cross the maternal placenta but glucose does
o > glucose= fetal pancreas increases insulin production= macrosomia= large for gestational age
o LGA= experience respiratory difficulties, hypocalcemia, hypoglycemia, hypokalemia, or
jaundice
 Adequate calorie intake and nutrients must meet needs of pregnancy
 Minimal SMBG 4x/day
o For pregnancy, 8x/day
 Blood glucose goals during pregnancy:
o Fasting: <95mg/dl
o 1 hour postprandial- <140 mg/dl
o 2 hours postprandial- <120 mg/dl
 Desired weight goals are based on prepregnancy BMI and should be steady and progressive
 No calorie adjustments on the 1st trimester, but in the 2nd and 3rd trimester increased energy intake of
approximately 100-300 kcal/day
 High quality protein increased by 10 g/day
o Supplied easily by consuming 1 or 2 extra glasses of nonfat or skim milk. Or 2 ounces of meat or
meat substitute
 400 mcg of folic acid is recommended
o Prevent neural tube defects
 Minimum of 1,700-1,800 kcal/day from carefully selected foods
o Intake less than this is not advised

Preexisting diabetes and prepregnancy

 Women with preexisting diabetes who become pregnant are vulnerable to complications
 Optimal period of care is before conception
 Glycosylated hemoglobin levels should be normal or close to the normal range before conception
 Requirements increases during the 2nd-3rd trimester because of higher blood glucose levels
o Due to increased production of pregnancy hormones that are insulin antagonists
 Goals of preconception care programs:
o Before meals: capillary whole-blood glucose 70-100 mg/dl or capillary plasma glucose 80-110
mg/dl
o 2 hours postprandial- capillary whole-blood glucose <140 mg/dl or capillary plasma glucose
<155 mg/dl
 Three meals and three snacks are usually recommended
 Use of frequent blood glucose monitoring is necessary

Gestational diabetes

 Good glucose is accomplished by individualization of intake and graphing weight gain

 Insulin is prescribed with MNT to reduce risks of fetal macrosomia, neonatal hyperglycemia, and
perinatal mortality
 Treatment option: oral antidiabetic

Type 2 diabetes in the young

 Caused by childhood obesity

 BMIs >40 (morbidly obese) and >45
 Those who are diagnosed are mostly 10 and 19 year-olds, have a strong family history of T2DM, and
have insulin resistance
 Clinical signs:
o Acanthosis nigricans- hyperpigmentation and thickening of the skin into velvety irregular folds in
the neck and flexural areas- reflects chronic hyperinsulinemia
o Polycystic ovary syndrome (PCOS)- associated with insulin resistance and obesity
o Hypertension

39 | N u t r i t i o n a n d d i e t e t i c s
  Girls are more susceptible than boys to T2DM
 Due to poor glycemic control
 Nutritional therapy and exercise are first line treatments but most children diagnosed with T2DM will also
require drug therapy—oral agents
 Children with T2DM should receive comprehensive management education, including SMBG

Type 2 diabetes in the elderly

 At risk for macrovascular and microvascular complications

 Higher risk for cardiovascular diseases
 Key factors to consider:
o Elderly patients who are capable of activities of daily living without assistance and those who
have no cognitive impairment should have 𝐴1𝑐 and blood sugar goals that are similar to younger
people
o Avoiding low sugar is of paramount importance, and blood sugar goals and 𝐴1𝑐 should be
adjusted along with careful pharmaceutical management
o 𝐴1𝑐 and blood sugar goals may be relaxed
o Treat cardiovascular factors- hypertension
o Depression screening is important

Miscellaneous issues: fasting, bariatric surgery, ketogenic diets

 Fasting can be a problem for muslims especially during the long month of Ramadan
o Possible hypoglycemia, hyperglycemia, or diabetic ketoacidosis, and dehydration
 Pregnant women, children, and elderly who have diabetes should not be expected to fast
 Morbidly obese individuals who have prediabetes or T2DM may elect to have bariatric surgery
 Adolescents, in severe progressive form of diabetes with complications; in these patients bariatric
surgery is controversial
 Ketogenic diets which are very low in carbohydrates and high in fats and proteins are not totally safe
and may be associated with nonalcoholic fatty liver disease or insulin resistance
o Not currently promoted for diabetes management

Nutrition for Disorders of the Liver, Gallbladder, ad Pancreas:

Liver disorders

Hepatitis – Inflammation of the liver. Separated into 5 categories:

 Hep. A virus – transmitted through the fecal-oral route, but occasionally can be spread by transfusion of
infected blood. Onset of HAV is rapid, 4-6 weeks. Treatment for HAV is usually supportive, no antiviral
therapy. Is asymptomatic.
 Hep. B virus – exceptionally resistant virus of surviving extreme temperatures and humidity. HBV is
transmitted via blood, semen, vaginal mucus, saliva, and tears, IV drug users, patients with hemophilia,
etc. HBV vaccination is recommended. Incubation for HBV is 12 weeks. Is asymptomatic, no cure.
 Hep. C virus – can be transmitted through contaminated saliva and semen, but is predominantly
associated with blood exposure. Can develop into chronic liver disease and is a risk factor for liver
cancer. Are asymptomatic and infrequently detected.
 Hep. D virus – can only occur when an individual with HBV is subsequently exposed to HDV. Incubation
period is 21 to 45 days but may be shorter in cases of superinfection.
 Hep. E virus – an enterically transmitted, self-limiting infection. Incubation 15-60 days. Once infection
occurs, therapy is limited to support.

Food and nutrition therapies for hepatitis:

 Periods of nausea and vomiting in patients with hep. Needs hydration via IV fluids.
 Afterwards oral feedings should be initiated asap
 Diets should be frequent and high in energy and high-quality protein to minimize loss of muscle mass.
40 | N u t r i t i o n a n d d i e t e t i c s
  Protein should be 1.0-1.2 g/kg of body weight
 Dietary fats should not be limited unless they are not well tolerated.
 Fluid intake should be adequate to accommodate the high protein intake unless otherwise
contraindicated.
 Supplementation includes vitamin b complex (especially B12- cobalamin, due to decreased absorption
and hepatic uptake), vitamin K (to normalize bleeding tendency), vitamin C, zinc for poor appetite
 Abstinence from alcohol is imperative.

Treatment goals

 Decrease viral replication or eradicate the infection

 Delay fibrosis and progression cirrhosis
 Decrease incidence of liver cancer
 Ameliorate fatigue and joint pain
 Prevent hepatic decompensation and the need for liver transplantation

Coping with hepatitis

 An adequate diet that excludes
alcohol is recommended
 For many individuals, loss of appetite
weight loss, and fatigue are common
problems. Recommend rest periods
before and after meals
 Offer guidance tips for increasing
proteins and calories without adding
more total volume. Sauces, gravies,
desserts, milkshakes, and similar
enhancements will help

Fatty Liver and Nonalcoholic Fatty Liver Disease (NAFLD):

 An early form of liver disease can be caused by alcoholism, obesity, complications of drug therapy
(corticosteroids and tetracyclines), excessive parenteral nutrition, pregnancy, DM, inadequate intake of
protein, infection, or malignancy

Food and Nutrition Therapies:

 Thorough diet history is essential, and a nutrition plan should be developed according to the etiology of
the condition.
 If the problem is related to DM, glucose management requires carbohydrate counting.
 If it occurs after parenteral nutrition, the amount of administration should be altered.
 In general, high-fat and high-fructose intakes are problematic.
 Lifestyle interventions are the first line of treatment: vitamins, amino acids, prebiotics, probiotics,
polyunsaturated fatty acids, and polyphenols are often used and show great promise.
 Weight loss may be needed, but meals should not be skipped
 Choline, fiber, coffee, green tea, and light alcohol drinking might be protective.
o Antioxidants= digestion
 Morbidly obese (BMI >40) bariatric surgery may be required
 Adequate racking of glucose and lipid levels will be needed

Coping with fatty liver or nonalcoholic

steatohepatitis (NASH))
 A balanced diet is important.
Eliminate alcohol and limit total fat
intake and fructose

41 | N u t r i t i o n a n d d i e t e t i c s
  Assistance of a registered dietitian will
be needed to guide this nutrition care
plan successfully
 Probiotics/prebiotics may be
beneficial. They affect gut flora;
certain forms may alleviate liver injury
Probiotics- live bacteria in foods e.g. lactobacillus

Prebiotics- serves as fertilizer for the healthy gut flora; special dietary fibers

Cirrhosis:

 Intestinal bacterial overgrowth and increased bacterial translocation of gut flor

 Liver cells replaced by fibrous connective tissue and fat infiltration
 Liver cell scarring may cause congestion of the hepatic circulation which results in further decline of liver
function and portal hypertension.
 Esophageal varices can occur as a result of collateral circulation that develops around the esophagus
when normal blood flow through the liver is blocked
 Ascites is the accumulation of fluid in the peritoneal cavity
o Blood is shunted from portal circulation to systemic circulation, causes blood to bypass the liver,
leading to hepatic coma
 Hepatic encephalopathy- changes in the level of consciousness, concentration, and memory due to
ammonia
o Cerebral intoxication- intestinal contents have not been metabolized by the liver
o Thus, ammonia is not excreted
 Neomycin- used to reduce the number of bacteria in the GI tract

Food and Nutrition therapies:

 Individual nutritional needs must be addressed and are different per patient.
 0.8 g protein per kg body weight per day is essential.
 To promote positive nitrogen balance and avert breakdown of endogenous protein stores.
 1.2 g protein/kg dry or appropriate body weight is recommended.
 Protein restriction should be avoided, because it can worsen malnutrition
 Patients with esophageal varices should eat soft, low-fiber foods.
 For ascites, a dietary sodium restriction (2000 mg) is used, usually with fluid restriction.

Liver Transplantation:

 For end-stage liver disease

Food and Nutrition therapies:

 Primary objective- provide enough calories and protein to decrease protein catabolism and correct
any nutritional deficiencies.
 Immediately post-transplantation (4-8 weeks after surgery) – require individualization of nutritional
therapy according to patient’s needs.
 Adequate calories and protein are necessary for the stresses that result from surgery and high doses of
glucocorticoids.
 Early enteral nutrition with new immunomodulating diets enriched with hydrolyzed whey protein can
prevent post-transplant bacteremia and post-transplant hyperglycemia
 Between meal feedings and supplements should be used in order to meet calorie and protein goals

Gallbladder Disorders:

42 | N u t r i t i o n a n d d i e t e t i c s
Gallstones & Cholecystitis:

 Mild, aching pain in the midepigastrium

 Nausea, vomiting, tachycardia, and diaphoresis

Food and Nutrition therapies:

 During acute attacks, nothing per Orem and is to receive IV fluids.

 Intake of omega-3 polyunsaturated fatty acids influences bile composition, decreasing biliary
cholesterol saturation.
 Avoiding fat is often advised, but no strong evidence supports this recommendation.
 Increase intake of fatty fish such as salmon, herring, mackerel and tuna.

Pancreatic Disorders:

 Pancreatitis- inflammatory process characterized by decrease production of digestive enzymes and

bicarbonate with malabsorption of fats and proteins
o Sodium bicarbonate (NaHCO3)- regulated the blood pH
o Has alkalotic effects

Food and nutrition therapies:

 Feeding into the lower small bowel, in the jejunum distal to the ligament of Treitz, bypasses the areas
associated with pancreatic stimulation.
 Pancreatic stimulation should be decreased.
 Low-fat, elemental formulas are recommended.
 Patients with enteral feedings should be closely monitored for increases in pancreatic enzyme levels.

Coping with pacreatitis

 Consume small meals in six
feedings may facilitate adequate
nutritional intake
 Pancreatic enzymes taken orally
with meals to control maldigestion
and malabsorption
 Complete abstinence from
alcohol is essential
 Eat high-protein, nutrient-dense
that includes fruits, vegetables,
whole grain, low-fat dairy, and
other lean protein sources

Nutrition for disorders of the gastrointestinal tract

 Anti-inflammatory Diets that has protective qualities

o Traditional Mediterranean diet
o DASH diet (Dietary Approaches to Stop Hypertension)
 Both diets encourage the use of antioxidant foods rich in carotenes, vitamin C and E, and selenium.
 Examples of foods rich in those mentioned above: Avocados, blueberries, cherries, green team coffee,
dark chocolate and cocoa powder, whole grains, strawberries, raspberries, etc.
 Foods rich in zinc, copper, iron and manganese – protect against free radical damage from pollution,
radiation, burned food, or excessive sunlight.
 Omega-3 fatty acids & eicosapentoic acid – anti-inflammatory; found in salmon, tuna, mackerel and
sardines.
 Extra-virgin olive oil – reduces inflammation; is a fundamental food in the world’s healthiest diet
(Mediterranean diet).

43 | N u t r i t i o n a n d d i e t e t i c s
  Mediterranean diet – promotes EVOO, fruits, vegetables, whole grains, legumes, herbs, and spices. Also
recommends lean proteins from fish and poultry and red wine in moderate amounts.
 Resveratrol – a phytochemical that promotes longevity and is seen in red wine and red grape skins.
 Supraglottic swallow – appropriate for patients with reduced laryngeal function. Deep breath before
swallowing and coughing or exhaling after.
 Mendelsoh maneuver – helpful for individuals with cricopharyngeal dysfunction. Elevate larynx
voluntarily to maximum level during swallowing to allow food to pass.
 Safest eating position for client with dysphagia
o upright position

Heartburn and gastroesophageal reflux disorder nutrition:

 Patients with GERD should avoid large or high-fat meals.

 Patients should avoid overeating.
 Foods that can irritate the esophagus and cause heartburn include: chocolate, peppermint, alcohol,
spearmint, liqueurs, caffeine, etc.

Esophagitis and Hiatal hernia

 Damage of esophageal mucosa due to reflux of the acidic gastric contents results to esophagitis
 Hiatal hernia- condition in which a part of the stomach bulges upward through the diaphragm.
o Patients with this disorder may experience pneumonitis, chronic bronchitis, and asthma

Food therapies & nutrition:

o Avoid high fat meals or foods

Stomach Disorders

 Vomiting- reverse peristalsis, one way of the body protects itself from intruding viruses or toxins
o Dehydration - a concern when vomiting is continual; which causes a lot of fluid and electrolyte loss.
o Small cold meals are better tolerated when clients are experiencing nausea or vomiting.
o Examples of food to give clients with nausea and vomiting: crackers and cheese, gelatin, fruit, or
lemonade.
o Foods to avoid: Hot, fried spicy, strong-smelling foods.
o Offer small frequent meals at frequent intervals is a good place to start.
o Breathing exercises and repositioning may be helpful.
o Good oral health is important, and patients may be prescribed antiemetics, 30 to 60 mins. Before
meals

Recommendations for managing nausea and

vomiting
 Chew foods slowly and thoroughly
 Use ice chips
 Sip on cool, carbonated (allow to
become flat) beverages such as 7 up or
ginger ale
 Avoid the caffeine of colas unless
tolerated
 Limit or omit acidic fruit juices
 Rest before and after meals, but keep the
head elevated to avoid reflux

44 | N u t r i t i o n a n d d i e t e t i c s
Peptic Ulcer Disease:

 Is the term used to describe a break or ulceration in the protective mucosal lining of the lower
esophagus, stomach, or duodenum
 Heliobacter pylori & use of NSAIDs are a major cause of duodenal ulcers.
 Any dietary modifications must be individualized to include avoidance of foods that a patient can
associate with symptoms.
 Some individuals avoid: red and black pepper, chili pepper, coffee, other caffeinated beverages, and
alcohol.
 Foods and spices that are irritants, cause superficial mucosal damage, or worsen existing disease should
be omitted.

Dumping syndrome:

 Gastrectomy, can cause the impairment of the normal stomach reservoir which causes a large volume
of particles to be dumped rapidly into the small intestine.
 Liquids should be consumed between meals rather than with meals.
 Simple carbohydrates are limited because they may worsen the syndrome.

Intestinal Disorders:

 Intestinal Gas (Flatus):

o Intestinal gas can be decreased through some simple changes of food-related behaviors. Increase
fluid intake, and consume sufficient amounts of fiber to prevent constipation.
o Patients should omit alcoholic beverages and products containing fructose as needed.
o If there are effects after drinking milk, drink small quantities over several weeks, working up to an 8-
ounce glass.

Diarrhea:

 Passing of loose, watery bowel movements that result when the contents of the GI tract move through
too quickly to allow water to be reabsorbed in the colon.
 Adequate hydration is essential in the high-risk population.
 Recommendations for managing diarrhea:
o Eat small frequent meals
o Chew with a closed mouth to avoid swallowing too much air
o Get plenty of rest – lie down for 30 to 60 min after meals
o Include foods that are low in fiber, such as, bananas, rice, applesauce, dry toast and crackers.
o Drink liquids 30 mins. Before or after meals.

Constipation:

 Normal functioning ranges from 3 times a day to every 3 days. Constipation means having fewer than 3
stools per week.
 Water helps lubricate the intestines, making bowel movements easier to pass.
 Patient should use fiber-rich products such as whole-grain breads & cereals, fruits, and vegetables.
 Recommendations for managing constipation:
o Listen to body’s signals and follow a schedule that allows time for bowel movement to occur.
o Exercise regularly
o Relax, stress tightens muscles throughout the body and may inhibit proper bowel functions
o Consume regular meals. Skipping meals should be avoided

Celiac Disease and Gluten Sensitivity:

45 | N u t r i t i o n a n d d i e t e t i c s
 o A chronic autoimmune disorder in which the mucosa of the small intestine, especially the
duodenum and proximal jejunum, is damaged by dietary gluten
 Remove gluten from diet

Lactose intolerance:

o Limit lactose-containing foods or in severe cases no lactose diet is indicated. This all depends on the
RDA of lactose for the person as it differs.

Irritable bowel syndrome – FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and

polyols) diet is applied.

o Depending on the individual’s symptoms and food dairy, lactose, gluten, or sugars may be
eliminated from the diet

Inflammatory bowel disease:

 2 inflammatory conditions of the intestines:

o Ulcerative colitis – an inflammatory process confined to the mucosa of the large intestine.
o Chron’s disease – an inflammatory disorder that involves all layers of the intestinal wall and may
affect the small intestine, large intestine, or both.
 Goal of nutrition therapy is to replace lost nutrients, correct deficits and achieve energy, nitrogen, fluid
and electrolyte balance.
 Acute IBD has an individualized nutrition therapy based on food tolerance and affected portions of the
GI tract.
 High protein diet divided into small frequent meals are often recommended.

Ileostomies and Colostomies:

 Is done when a disease or obstruction cannot be resolved, all or a segment of the colon including the
rectum is removed
 Appropriate nutrition therapy depends on the type of ostomy performed. Goals are related to the
liquidity of the effluent.
 Ileostomy = more liquid effluent
 Colostomy = depending on the length of the remaining bowel effluent is liquid
o Effluent = liquid waste
o Liquid stools have greater loss of fluid and electrolytes. Any restrictions placed on the patient should
be based solely on individual tolerance.

Short Bowel Syndrome:

 Nutrition management of a patient with SBS should take into consideration the individual’s digestive and
absorptive capabilities
 Patients require parenteral nutrition, or IV fluids in the immediate postresection period
 Diet and enteral nutrition should be reintroduced as soon as possible.
 Complex carbohydrates from whole grains, fruits and vegetables should be used, but simple sugars
should not.
 Patients with end-jejunostomies can tolerate a higher proportion of calories from dietary fat than
patients with a remnant colon.

Diverticular Disease:

 Bowel walls are weakened, diverticula (pouchlike herniations protruding from the muscle layer of the
colon) develop.
 When diverticula are inflamed, patients are given nothing by mouth and then progress to liquids. After
inflammation, a high-fiber diet is recommend to reduce straining during defecation.

46 | N u t r i t i o n a n d d i e t e t i c s
Nutrition for diseases of the kidney

Nephrotic syndrome

 Complex of symptoms that can occur after damage to the capillary walls of the glomerulus
 Often results from primary glomerular disease (glomerulonephritis), nephropathy secondary to
amyloidosis (accumulation of waxy starchlike glycoprotein)

Food and nutrition therapies

 Primary goal- control hypertension, minimize edema, decrease urinary albumin losses, prevent protein
malnutrition and muscle catabolism
 Consume adequate proteins and energy- 1g/kg/day of protein and 35g/kg/day of energy
o Prevent malnutrition and catabolism of lean body tissue
 Good sources of protein- lean meats, well-trimmed poultry, eggs (limit 2 per week), fish, shellfish, beans,
and nuts
 Sodium intake should be limited
 Intake of cheese, canned foods, dried pasta and rice mixes, and canned or dried soups should be
controlled
 Fruits and vegetables are highly recommended

Hidden sources of sodium

 Baking powder, drinking and cooking water,
medications (antacids, antibiotics, cough
medicines, laxatives, pain relievers, sedatives,
mouthwash, and toothpastes
Role of nurses

 Monitor and document patient weights, intake and output should be recorded at least every shift

Acute renal failure

 Abrupt loss of renal function, may or may not be accompanied by oliguria or anuria
 Most common cause of ARF- acute tubular necrosis (ATN)- injury after decreased blood supply, or
nephrotic cause, such as certain medications
 Reduction of urine output stages:
o Oliguric phase (24-48 hours after initial injury; lasts 1-3 weeks)- retention of excessive amounts of
nitrogenous compounds in the blood, acidosis, high serum potassium phosphorus levels,
hypertension, anorexia, edema, and risk of water intoxications
o Diuretic phase (lasts 2-3 weeks)- urinary output is gradually increased
o Recovery phase (lasts 3-12 monts)- kidney functions gradually improves

Food and nutrition therapies

 Nonprotein calories (30-40 kcal/kg) should be provided for weight maintenance and to meet extra
demands
 Fats, oils, simple carbohydrates, and low-protein starches are given
 When dialysis is not part of the treatment- 0.6-0.8 g of protein per kilogram of body weight is often
prescribed
 If dialysis is part of the treatment- 1.0-1.4g/kg of protein is required
 Supplements of niacin, riboflavin, thiamine, calcium, iron, vitamin B12, and zinc may be given due to
protein deficiency
 During oliguric phase, sodium is restricted to 1000-2000 mg/day and potassium to 1000g/day
 High phosphorus intake should be controlled
o High phosphorus levels disrupts the hormonal regulation of phosphate, calcium, and vitamin D,
leading to impaired kidney function

Chronic kidney disease

47 | N u t r i t i o n a n d d i e t e t i c s
  Progressive, irreversible loss of kidney function over days, months, or years

Food and nutrition therapies

 Medical nutrition therapy (MNT)- goals is to slow or prevent progression to the need for dialysis
Treatments and major concerns for pre-
end stage renal disease, hemodialysis,
and peritoneal dialysis
Pre- ESRD Hemodia Peritoneal
lysis dialysis
Trea Diet+med Diet+me Diet+medi
tme icaton dication+ cation+peri
nt hemodial toneal
mo ysis, dialysis,
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access membrane
for waste for waste
product product or
removal fluid
removal
Dur Indefinit, 3-4 3-5
atio hypernte hours/3 exchanges
n nsion, days/we /7
con glycemic ek, bone days/week
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with DM, sion weight
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hyperfiltra acid loss, mia,
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in BUN, tic control in
bone electrolyt patients
disease, e and with DM,
anemia, fluid protein loss
cardiovas changes, into
cular anemia, dialysate,
disease cardiova glucose
scular absorption
disease form
dialysate,
anemia,
and
cardiovasc
ular
disease

Hemodialysis

 Blood is shunted from the patient’s body by way of special vascular access or shunt, thinned with
heparin, cleansed form excess fluid and waste products through a semipermeable membrane, and
then returned to the patient’s circulation
 Dialysate- is an electrolyte solution similar in composition to normal plasma

Food and nutrition therapies

48 | N u t r i t i o n a n d d i e t e t i c s
  Protein- 1.2 g/kg/day, with at least 50% being of high biologic value (animal sources)
 Energy- <60 years old and of standard body weight (35 kcal/kg), for obese and adults >60 years old (30
kcal/kg)
 Fats- use fish oils and olive oil because it reduces damage from inflammatory cytokines
 Sodium and fluids- recommended fluid gain between dialysis treatment is less than 5% of the patient’s
dry (nonedematous) weight.
o Fluid output >1 L/day- 2-4 g/day sodium and 2 L/day of fluid
o Fluid output <1 L/day- 2g/day sodium and 1-1.5 L/day of fluids
o Anuria: 2g/day of sodium and 1 L/day of fluids
 Potassium- 2.5 g/day
 Phosphorus and calcium- restricted in patients receiving hemodialysis
o Intake of 12 mg/kg/day is recommended
o Foods high in phosphorus such as milk, milk products, cheese, beef liver, nuts and legumes are
severely limited
 Iron and trace minerals- adequate iron supply is needed due to anemia and is necessary for normal
erythropoiesis to take place
o Trace minerals are not necessary unless a deficiency is suspected
 Vitamin D- due to loss of production of calcitriol, the active form off vitamin D. supplementations are
recommended
 Other vitamins- water-soluble vitamins especially vitamin B6 and folic acid.

Peritoneal dialysis

 Removal of excess fluid and waste products from the blood by using the lining of the abdominal cavity
as the dialysis membrane
 Intermittent peritoneal dialysis- involves infusion of approximately 2L of dialysate over 20-30 minutes
 Continuous ambulatory peritoneal dialysis- entails infusion of dialysate in four or five exchanges in to the
peritoneum over 24 hours
 Continuous cycling peritoneal dialysis- combination of IPD and CAPD

Food and nutrition therapies

 Daily vitamin supplements are recommended especially folic acid and vitamin D
 Recombinant EPO and iron supplements to manage anemia
 During PD- Na, K, an fluids are continually removed, making severe dietary restrictions unnecessary
 Restriction of dietary phosphorus is critical to prevent osteodystrophy (defective bone development)
 Restricting and eliminating dairy products will be necessary to control phosphorus intake
 Calcium supplementation is recommended

Kidney transplantation

 Best renal replacement option for people with ESRD

Food and nutrition therapies

 Pretransplantation

Nutrition guidelines for chronic renal failure without

dialysis, CRF with hemodialysis, or peritoneal dialysis
Nutrient CRF w/o hemodialysis Peritoneal
dialysis dialysis
Energy 30-35 kcal/kg 35 kcal/kg 30-35
(ideal body IBW if <60; kcal/kg IBW
weight) 30-35
kcal/kg IBW
if >60

49 | N u t r i t i o n a n d d i e t e t i c s
 Protein 0.6-1.0 g/kg 1.2 g/kg IBW 1.2-1.2 g/kg
IBW IBW
Sodium Individualized, 2-3 g/day 2-4 g/day
2-3 g.day
Potassium Individualized 2-3 g/day 3-4 g/day
to cover
losses with
diuretics
Phosphorus 8-12 mg/kg 0.8-1.2 0.8-1,2
IBW or 0.6-1.2 g/day or g/day
g/day <17 mg/kg
IBW
Fluids As desired 750-1000 ml Unrestricted
+ urine if weight
output/day and blood
pressure is
controlled
and
residual
renal
function is
2-3 L/day
 Immediately after transplantation- energy needs are increased (30-35 kcal/kg)
o Saturated fats are limited if dyslipidemia occurs
o Increase intake in omega-3 fatty acids
o Fluids are generally unrestricted and limited only by graft function

Kidney stones

 Renal calculi, formation of kidney stones (urolithiasis). Due to low urine volume from inadequate fluid
intake, alkaline urine ph, etc.

Food and nutrition therapies

 Comprehensive diet history is essential to identify the necessary diet modifications

Dietary recommendations for kidney stones

 Tailor diet to specific metabolic
disturbance and individual dietary habits
 Include a high fluid intake to produce at
least 2 L/day of urine (2-3 L/day intake)
 Avoid dietary calcium restriction.
Consume calcium-rich foods instead of
supplements
 Limit oxalate- rich foods; spinach,
rhubarb, beets, nuts, chocolate, tea,
wheat bran, and strawberries
 Limit supplemental vitamin C and D to
recommended dietary allowance for
gender and age
 Choose plant-based proteins over animal
proteins several times a week
 Limit salt intake
 Use 5 or more servings of fruits and
vegetables per day for potassium sources
 Calcium oxalate stones- too much calcium in the urine
 Uric acid stones- metabolic product of purines
o Key therapy- weight loss + urinary alkalization
50 | N u t r i t i o n a n d d i e t e t i c s
  Cysteine stones- hereditary disorder that causes the kidneys to excrete excessive amount of amino acid
cysteine (cystenuria)
o Treatment- reduce urinary cysteine concentration

Nutrition for Cardiopulmonary Diseases:

Cardiovascular diseases:

- Coronary artery disease:

 3 types of preventive strategies:
1. Primary prevention – a public health effort
2. Secondary prevention – behaviors to reduce the effects of heart disease.
3. Tertiary prevention – is designed to minimize further complications or to restore health.
- For CVD, these efforts may involve significant lifestyle changes combined with medication.
- Atherosclerosis:
 Chronic inflammatory process in which damage to the arterial wall can lead to coronary artery disease.
 This condition begins in early life.
 Vitamin D deficiency is associated with an increased risk for CVD and HTN.
- Cholesterol and Dyslipidemia:
 Cholesterol is an essential component of cell membranes and a precursor of bile acids, steroid
hormones, and vitamin D.
 Dyslipidemia is caused by unbalanced LDL and HDL levels.
 Low HDL levels for men is less than 40 mg/dl and 50 mg/dl in women

Food nutrition therapies:

- Intake of better types of fats, plant-based proteins, and soluble fiber.

- Weight loss may also be needed.
- Mediterranean diet is cardioprotective
- Daily intake of 2 to 3 grams of plant stanols or sterol esters are an additional therapeutic action.
(isolated from soybean and tall pine tree oils.
- Substitute plant-based proteins for animal proteins (legumes, dry beans, nuts, whole grains, etc.)

Myocardial Infarction:

- Food and nutrition therapies:

 Purpose of nutrition therapy for MI patients is to reduce workload of heart.
 Sodium, saturated fats, fluid and calories are controlled according to patient’s needs.
 Small frequent meals are better than 3 large meals.
 Large meals raise myocardial oxygen demand by increasing visceral blood flow.
 Mediterranean diet should be initiated as it can prevent further coronary events.
 Omega-3 fatty acids appear to reduce the risk of blood clots (Tuna, salmon, halibut, sardines, mackerel,
and lake trout)
 Whole grain intake lowers risk for future heart attacks (rye and oats)
 Caffeine-containing beverages may be temporarily restricted to avoid myocardial stimulation.

Peripheral Artery Disease:

- A healthy diet to prevent PAD includes unsaturated fats like fish, nuts, and seeds and excludes saturated
fats.
- Sodium should be cut back

Hypertension:

- Food and Nutrition Therapies:

 Weight loss is the most effective means of lowering blood pressure.
 Weight reduction facilitates lower blood pressure even when it is only a loss of 10 to 15 pounds.

51 | N u t r i t i o n a n d d i e t e t i c s
  Weight reduction and sodium restriction also augment the effects of antihypertensive medication.
 Diet for weight loss ad control should include an energy restriction and an aerobic exercise prescription.
 Decrease alcohol consumption
 Increase physical activity
 Terminate cigarette smoking
 Decrease sodium intake
 Increase intake of potassium, magnesium, and calcium.
 A diet rich in fruits, vegetables, and low-fat dairy products along with reduced saturated and total fats
has been found to significantly lower blood pressure.
 DASH diet is recommended.

Heart Failure

- Food and Nutrition Therapies:

 Most dietary measures will not be effective.
 If etiology saw excessive sodium intake, restriction of sodium should be focused on
 Patients with mild to moderate HF are often prescribed a sodium restriction of 3000 mg/day
 Incase of severe HF patient’s sodium restriction is brought to 2000 mg/day
 Fluid restriction of 1 to 2 L is sometimes indicated with low serum sodium.
 Include high fiber foods such as cooked dried peas and beans, whole-grain foods, bran, cereals, pasta,
rice and fresh fruits
 High fiber foods contain antioxidants that are cardioprotective.

Cardiac Cachexia:

- Food and Nutrition therapy:

 Energy requirements are 20% to 30% greater than basal needs because of increased cardiac and
pulmonary energy demands and metabolic rate.
 Protein and energy intake should be sufficient to maintain body weight.
 Use volume-concentrated formulas if fluid restriction is necessary
 Calorie-dense (1.5 kcal/mL) nutritional supplements help to increase energy and protein intake.

Pulmonary Diseases:

- COPD:
 Malnutrition of individuals with COPD is multifactorial.
 Energy expenditure is usually elevated but will vary according to person’s level of physical activity.
 Adequate protein stimulates the ventilatory drive.
 Patients require 1.2 to 1.9 g protein per kg of body weight for maintenance and 1.6 to 2.5 g/kg for
repletion.
 Offer foods such as milk, eggs, cheese, meat, fish, poultry, nuts, beans, and legumes.
 Higher serum a-carotene and b-carotene concentrations, reflect greater intake of orange and dark
green leafy fruits and vegetables are associated with better pulmonary functions.
 Include vitamin d and other antioxidants.
 High fat and low carbohydrates are recommended.
 Offer 4 to 6 small meals a day to reduce sodium intake.
 Too much sodium may cause edema and discomfort.

Cystic Fibrosis:

- Food and Nutrition therapies:

 Primary goal of nutritional therapy for patients with CF is to exceed the Dietary reference intakes for kcal
and all other nutrients by 1.2 to 2 times.
 Improvements in pancreatic enzyme replacement therapy now allow higher amounts of dietary fat
intake.
 Sodium requirements may be considerably higher.

52 | N u t r i t i o n a n d d i e t e t i c s
  Fat-soluble vitamins may be prescribed in a water-miscible form if fat malabsorption is severe.

Acute Respiratory Failure and Respiratory Distress Syndrome:

- Most patients in ARF require mechanical ventilation, which is why nutrition support may be provided via
enteral or parenteral nutrition.
- Nutrition support should be initiated as soon as possible to help wean the patient from the ventilator.
- Nutritional recommendations re the same as COPD guidelines: high calorie, high protein, moderate to
high (50% nonprotein kcal) fa, with moderate (50% nonprotein kcal) carbohydrate.
- Enteral nutrition is recommended in several guidelines for mechanically ventilated patients.
- Commercial formulas that provide 40% to 50% of total kcal from fat are available.
- Higher caloric density formulas may be necessary when fluids are restricted
- Parenteral nutrition may be needed in the treatment of acute respiratory failure.
- High glucoe concentration can lead to excess CO2 production, which should be avoided.

Asthma:

- Oxidative stress plays a rolein asthma; antioxidant dietary approaches are suggested.
- A variety of fruits, vegetables, and whole-grains other than wheat and rice provide dietary fibers,
iron,magnesium and phosphorus from natural sources and should be used often.
- A healthy diet and avoidance of obesity during pregnancy, childhood and aging may reduce asthma
exacerbations.
- Vitamin D, fish oil and vitamin C are important nutrients.

Tuberculosis:

- Obesity and type-2 diabetes are risk factors for TB

- No special diet for TB
- A high calorie, high protein, nutrient rich meal plan is suggested with small, frequent feedings.

53 | N u t r i t i o n a n d d i e t e t i c s