NUTRITION AND DIET THERAPY

transports, utilizes and excretes food

substances.”

REVIEWER “Nutrition is the study of food and how the

Introduction to Human Nutrition body makes use of it. It deals not only with
Nutrition plays a key role in disease the quantity of food consumed but also with
prevention and health promotion. As the process of receiving and utilizing it for
providers of holistic care and valuable growth and renewal of the body and for the
sources of health information, nurses must maintenance of the different body functions”
have adequate working knowledge about
the nutritional needs of healthy and sick Functions of Nutrition
individuals. Many lifestyle and Basic functions of nutrition is to maintain life
environmental factors influence health and by allowing an individual to grow and be in a
well-being, nutrition is major, modifiable, state of optimal health.
and a powerful factor in promoting health,
preventing and treating disease, and Reasons why nutritional science is applied
improving quality of life. Thus the study of to allied health courses:
Nutrition is indispensable for all healthcare
professionals. 1. recognition of the role of nutrition in
preventing diseases or illnesses.
Factors Influencing Food Choice at 2. concern for adapting food patterns
Different Levels and individual to their nutritional
1. Macro-Environment Level needs within the framework of their
● Economic policies cultural , economic, and
● Laws psychological situations and styles
● Government Policy 3. awareness of the need in specified
● Industry Relations disease states to modify nutritional
factors for therapeutic purpose
● Media
● Technology
NUTRIENTS
● Transportation
● chemical substances found in
2. Micro-Environment Level
food. They perform diverse roles in
● Local
the body such as to provide heat
● Community
and energy , to build and repair
● School Settings
body tissues and to regulate body
● Worksites
processes. Since nutrients are
● Restaurants & fast food
found primarily in natural foods,
outlets
adequate intake of these is
3. Family Environment Level
necessary to carry out physiological
● Role
functions.
● modeling
● Feeding
Nutrients Classifications
● Styles
1. Functions - those that form tissues
● Availability
in the body are body-building
● Oulture
nutrients, while those that furnish
● Etc.
heat and energy are fats,
carbohydrates, and protein.
NUTRITION
2. Chemical properties - nutrients are
either organic or inorganic
“Nutrition is the study of food in relation to
3. Essentiality - Nutrients are
health of an individual, community or
classified based on their significant
society and the process through which the
contribution to the body's
food is used to sustain life and growth”
physiological functioning.
4. Concentration- nutrients are either
“Nutrition is the science of food, the
in large amounts or in little amounts.
nutrients and other substance therein, their
action, interaction, and balance in relation to
health and disease, and the processes by
which an organism ingests, digest, absorbs,
MACRONUTRIENTS
Nutrients needed in a large amount of the
body. (fats, carbohydrates, proteins, and
water)
Aside from water, every macro-nutrient
provides energy that helps the body to:
1. Grow new cells and tissues.
2. Conduct nerve impulses that allow
us to sense and interact with our
environment.
3. Develop and repair new tissues.
4. Regulate vital bodily processes, like
fueling muscles, regulating the
central nervous system, creating
enzymes, eliminating waste, and
much more.
MICRONUTRIENTS
Nutrients needed in a small amount of the
body. (vitamins and minerals)
● Vitamins are vital for healthy growth,
metabolism, and development. They
also regulate cell function.
Fat-soluble vitamins (Vitamin K, E,
D, and A); water-soluble vitamins
(Vitamin C and B vitamins) .
● Macro-minerals are needed in
greater quantities, some of the
primary macro-minerals include
magnesium, sodium, iron,
potassium, and calcium
● Micro-minerals include zinc, copper,
chromium, cobalt, and fluoride.
While they are needed for proper
growth, development, and function,
minerals only make up about 4% of
your body’s mass.
FOOD
● When taken and digested nourishes
the body . It is a vital need without
which a person cannot live. It is
likewise culturally acceptable as it
supplies heat and energy, builds and
repairs body tissues and regulates
body processes. - Caudal (2019)
● According to the U.S FDA “Food
includes articles used as drink or
food and the articles used for the
component of such” (food groups)
● First Definition pertains to the
biological role of god and its three
general functions which are due to
nutrients.
● Second definition denotes that food
is simple or complex in its chemistry
and contains nutritional and/or
non-nutritional components (spices,
food coloring, preservatives)
DIET NOMENCLATURE
● The acceptable way of naming
diets to use in terms of denoting
changes, in nutritional level,
consistency, management program
or a combination of such changes.
DIET THERAPY
● Branch of science of dietetics
specializing in the use of food for
the treatment of a disorder or
disease. To be effective, the
planned diet must be eaten. To
achieve this, one has to apply
knowledge in biological science such
as anatomy, physiology, nutrition,
behavioral science like sociology,
psychology and education; artistic
principles of food preparation.
NUTRITIONAL STATUS
● Nutritional status or nutriture is the
condition of the body resulting
from the utilization of essential
nutrients.
OPTIMUM OR GOOD NUTRITION
● Means that the body has an
adequate supply of essential
nutrients that are efficiently
utilized such that growth and good
health are maintained at the highest
possible level.
MALNUTRITION/IMBALANCED
NUTRITION
● The opposite of good nutrition
(mal-meaning “bad”).
● It is a condition of the body resulting
from a lack of one or more
essential nutrients (nutritional
deficiency) or it may be due to
excessive nutrient supply to the
point of creating toxic or harmful
effects.(ex. over-nutrition and
hypervitaminosis)
BASIC CONCEPTS
1. Essential Nutrients are fixed, the
only thing that can be modified is
the amounts needed due to the
specific needs of the client/patient
2. No single food contains all the
essential nutrients in amounts
needed for optimum health
3. Good nutrition is essential for the
following:
 a. Growth
b. Normal organ development
and functioning
c. Normal reproduction
d. Maintenance and
replacement of worn-out cells
and tissues
e. Optimum activity level and
working efficiency
f. Resistance to infection and
disease
g. The ability to repair bodily
damage or injury
4. Proper nutrition means that all
essential nutrients are supplied in a
modest fashion. Any deviation (too
much or little) will result in
malnutrition
5. Most people are interested in how
to be assured that they get the
proper nutrients in the amounts
needed from daily meals and
snacks. They probably recognized
the six classes of nutrients - protein,
carbohydrate, fat, vitamins, minerals
and water
6. All of the nutrients most of us need
can be obtained by eating a variety
of different types of foods. However,
in practice, nutrition educators speak
in terms of foods that they can buy,
prepare and serve and not in terms
of the name of the nutrients.
7. Water is the most important nutrient.
The fundamental principles of nutrient
interaction state that:
1. Individual nutrients have many
specific metabolic functions,
including primary and supporting
roles, and
2. No nutrient ever works alone
● Each nutrient has certain special
jobs to do in the building
maintenance, and operation of the
body. These jobs cannot be done by
other nutrients - an extra supply of
one cannot make up for a
shortage of another
● There are other jobs to be done in
the body that require nutrients to
work together as teams. To build
bones, the nutrients Vit. D, calcium
and phosphorus interact. One
member of the team cannot perform
its job unless all the others are
present in the right amounts.
Nutrition Tools, Recommendations and
Guidelines
● Good Health starts with Good
Nutrition
● Good Nutrition starts with a
diet that provides the
necessary levels of energy
and essential nutrients
○ Diets based on the
reference values for
energy and nutrient
levels of intake
FOOD AND NUTRITION RESEARCH
INSTITUTE OF DOST (FNRI-DOST)
● PDRI (Philippine Dietary Reference
Intakes) 2015 was launched during
the 41st FNRI Seminar Series on
JULY 1, 2015
● This is for planning and assessing
diets of healthy groups and
individuals. PDRI is the collective
term comprising reference value for
energy and nutrient levels of intakes.
Philippine Dietary Reference Intake 2015
● Recommended Energy and Nutrient
intake (RENI) to a new set of
multi-level standards
● For planning and assessing diets of
healthy groups and individuals.
Components of PDRI:
1. Estimated Average Requirement
(EAR) - meeting requirements
● daily nutrient intake level
that meets the median or
average requirement of
healthy individuals in
particular life stage and sex
group, corrected for
incomplete utilization or
dietary nutrient bioavailability.
2. Recommended Energy/Nutrient
(REI/RNI) - good health
● level of intake of energy or
nutrient which is considered
adequate for the
maintenance of health and
well-being of healthy persons
in the population.
3. Adequate Intake (AI) - data is limited
● daily nutrient intake level that
is based on observed or
experimentally-determined
approximation of the average
nutrient intake by a group
 (groups) of apparently
healthy people that are
assumed to sustain a defined
nutritional state.
4. Tolerable Upper Intake Level or
Upper Limit (UL) - maximum safe
intake
● highest average daily nutrient
intake level likely to pose no
adverse health effects to
almost all individuals in the
general population.
Uses and Applications of PDRI
● For assessing and planning dietary
intakes for an individual, group,
population
● Appropriate DRI to use is hinged on
the concept that requirements
represent a distribution
● Assessment – determining
adequacy and inadequacy of
individuals and prevalence of
adequate or inadequate intakes of
the group or population. ( National
Nutrition Survey result compared
with DRI)
● Planning – setting intake targets
for individuals and determining
desirable intake distributions for
groups or populations. ( Meal
planning for individuals and groups,
like in hospitals, prisons) and
development of dietary guidelines,
feeding programs
● Individual consumers - as
reference as to what foods to eat
and how much
● Food and beverage industry – for
fortification and marketing of foods
● Government, NGO, private
institutions – to design, implement
and evaluate food and nutrition
assistance programs
● Scientific and regulatory bodies –
to formulate standards and
regulations
● Nutrition and health professionals
– to educate and counsel public
health
Estimating Recommended Intakes
● Review process – assessment of
published foreign and local studies
and unpublished important local
studies
● Review/adoption of
recommendations by expert
scientific bodies
● Requirement is defined – lowest
nutrient that maintains level of
nutriture among apparently healthy
individuals.
● Criterion – prevention of nutrient
deficiency or prevention of chronic
diseases for certain life stage ( e.g.
dental caries for fluoride)
Recommendation for infants 0-5 months
was based on AIs
● Estimated from nutritional
composition and average volume of
breastmilk (BM) of 780 ml
consumed daily by exclusively
breastfeed babies
● For protein, Vitamin D, Vitamin K,
selenium, iodine and electrolytes
–estimation done by using factorial
mode
Recommendation for older infants
● BM (650ml) and complementary
foods (CF).
● In the absence of CF data,
requirements for most nutrients was
extrapolated from either younger
infants or adults.
● For protein, requirements for infants
were estimated using a linear
regression model
● Lactating Mothers +500 kcal & +27g
protein
● Pregnant mothers +300 kcal & +27g
protein

Infants and Early Childhood
● Requirements for macronutrients
and micronutrients are higher on a
per-kilogram basis during infancy
and childhood compared to later life
cycle.
● Energy – breastmilk sole source
until 6 months when
complementary food will be given for
optimal growth and development
● Protein – Provides amino acids for
the synthesis of membranes,
hormones, antibodies, other
proteins, and peptides.
Requirements per kilogram
decrease rapidly after the first year.
● Essential Fatty Acids - through
desaturation and elongation, linoleic
and alpha-linolenic acids are
converted to long-chain fatty acids
(arachidonic and docosahexaenoic
acids) – play key roles in CNS
Adolescence and Adulthood
● Adolescent – higher intake of
protein and energy for growth
● Most micronutrients, same as for
adults except for calcium and
phosphorus for bone growth.
● Iron requirements higher in
menstruating females
Dietary Guidelines and Food Guides
● Food guides are graphic
representations of all or some of the
messages of the dietary guidelines.
They typically represent the
recommended food groups in the
suggested proportions for a good
diet.
● The most common examples of food
guides are in the shape of a food
pyramid and food plate.
Daily Nutritional Guide Pyramid
Nutritional Guide Pyramid by the Food
and Nutrition Research Institute (FNRI) of
Department of Science and Technology
(DOST) to guide on how much of the ff:
1. fats and oils
2. sugar
3. meat and poultry
4. milk and milk products
5. vegetables
6. fruits
7. rice and rice products and
8. water or beverages
should a Filipino eat in one day. Aside from
that, this guide encourages Filipinos to
exercise and practice personal and
environmental hygiene for a healthy living.
Pinggang Pinoy
● a new, easy to understand food
guide that uses a familiar food
plate model to convey the right food
group proportions on a per meal
basis to meet the body’s energy and
nutrient needs of an adult. This is a
visual tool to guide Filipinos in
consuming the right amount of
food in every meal.
Food Exchange List
● Meal Planning is one of the basic
tools in nutrition and dietetics. It is a
tool for quick estimation of the
energy and macronutrients for use
in planning meals of individual
clients.
Food Labels
● Understanding the Nutrition Facts
label on food items can help you
make healthier choices. The label
breaks down the amount of
calories, carbs, fat, fiber, protein,
and vitamins per serving of the food,
making it easier to compare the
nutrition of similar products.
● In general, eat more foods that are
higher in vitamins, minerals
(such as calcium and iron), and fiber.
Eat fewer foods that are higher in
added sugars, saturated fat, and
sodium (salt), and avoid trans fat.

Below are the new messages of the 2012
NGF:
1. Serving Information
● Pay attention to the serving size,
especially how many servings there
are in the food package. For
example, you might ask yourself if
you are consuming ½ serving, 1
serving, or more.
2. Calories
● Calories provide a measure of how
much energy you get from a serving
of this food. In the example, there
are 280 calories in one serving of
lasagna. What if you ate the entire
package? Then, you would consume
4 servings, or 1,120 calories.
3. Nutrients
● It shows you some key nutrients that
impact your health. You can use the
label to support your personal
dietary needs - look for foods that
contain more of the nutrients you
want to get more of and less of the
nutrients you may want to limit.
Total Sugars - Natural Sugar Present
Added Sugars - added sugar during the
processing of the food (sucrose or dextrose)
Nutrients to get more of: Dietary Fiber, Vit
D, Calcium, Iron, Potassium
Nutrients to get less of: Saturated Fat,
Sodium, and Added Sugar
4. The Percent Daily Value (%DV)
● Daily Value of each nutrient in
serving of the food. Reference
amounts of nutrients to consume or
not exceed a each day
Nutritional Guidelines for Filipinos (NGF)
● A set of dietary guidelines based on
the eating pattern, lifestyle, and
health status of Filipinos.
● The NGF contains all the nutrition
messages to healthy living for all
age groups from infants to adults,
pregnant and lactating women, and
the elderly.
1. Eat a variety of foods everyday to
get the nutrients needed by the
body.
2. Breastfeed infants exclusively
from birth up to six months and
then give appropriate
complementary foods while
continuing breastfeeding for two
years and beyond for optimum
growth and development.
3. Eat more vegetables and fruits to
get the essential vitamins,
minerals, and fiber for regulation of
body processes.
4. Consume fish, lean meat, poultry,
egg, dried beans or nuts (protein)
daily for growth and repair of body
tissues.
5. Consume milk, milk products, and
other calcium-rich food such as
small fish and shellfish, everyday for
healthy bones and teeth.
6. Consume safe foods and water to
prevent diarrhea and other food-and
water- borne diseases.
7. Use iodized salt to prevent Iodine
Deficiency Disorders.
8. Limit intake of salty, fried, fatty, and
sugar-rich foods to prevent
cardiovascular diseases.
9. Attain normal body weight through
proper diet and moderate physical
activity to maintain good health and
help prevent obesity.
10. Be physically active, make healthy
food choices, manage stress, avoid
alcoholic beverages, and do not
smoke to help prevent
lifestyle-related non-communicable
disease.
● The revisions were made based on
the results of the 2008 National
Nutrition Survey (NNS) conducted
by FNRI-DOST.
● Based on the said survey, the
Filipino household diet fell below the
recommended levels except for
niacin, which is above the
recommended.
● Furthermore, all nutrients and
energy were below the 100 percent
 adequacy levels. This was the basis
of NGF messages no. 1, 3, and 4.
● There is no single food that contains
all the nutrients that our body needs
so eating a variety of food ensures
that daily nutritional needs are met.
● There was also a decrease in
consumption of fruits from 77 grams
in 2005 to 54 grams in 2008 and
also a decrease in milk consumption
from 44 grams to 42 grams. These
results were the basis of message
no. 3 and 5, respectively.
● Vegetables and fruits are the main
sources of vitamins, minerals, and
fiber, while milk is a good source of
calcium.
● Lowurinaryiodineexcretionisstillaprev
alentproblem among pregnant and
lactating mothers, indicating low
iodine intake. Iodine is important
during pregnancy because it is
needed for the brain development of
the infant while lactating mothers
must have adequate supply of iodine
in their breast milk. This is the
message of NGF no. 7.
● The total cholesterol level among
Filipino adults increased from 8.5
(mg/dL) in 2003 to 10.2 (mg/dL) in
2008.
● High cholesterol levels may be
attributed to the high consumption of
sodium rich foods by Filipinos.
● Salt and soy sauce were among the
top 10 widely used miscellaneous
food items used by Filipinos.
● In Addition,heart diseases ranked
first among the causes of death
based on the 2005 Department of
Health survey. This is the reason
behind no. 8 of NGF
● Excessive intake of salt and soy
sauce can result in high blood
pressure especially to salt-sensitive
individuals. Persistent high blood
pressure can result in cardiovascular
diseases.
● There is also a decreasing trend of
physical inactivity among Filipinos
and also a large percentage of
Filipino smokers at 31.0% and
drinkers at 26.9%. These situations
were the basis of messages no. 9
and 10 of the NGF.
● People are always encouraged to
exercise at least thirty minutes a
day, three to five times a week.
● Limiting alcohol drinking to one drink
per day for women and two drinks
for men is also advised.
● One alcoholic drink is equivalent to
one and half ounce distilled
beverage such as gin or 12 ounces
or a bottle of beer or four ounces
wine or half glass wine or an ounce
of 100 proof whiskey
10 Kumainments
● The “10 Kumainments” — a
campaign to promote the Nutritional
Guidelines for Filipinos — was
launched by the NNC at the “3rd
National Conference of Nutrition
Action Officers” held at the SMX
Convention Center in Pasay City on
October 23, 2014.
● The 10 Kumainments are the
popularized versions of the
Nutritional Guidelines for Filipinos
(NGF) approved by the NNC
Governing Board to promote a
healthy lifestyle among Pinoys.
● The Kumainments are simple and
easy to remember guidelines that
can be easily followed by ordinary
citizens to improve their nutritional
status.
Nutrition Care Process Assessment of
Nutritional Status
Nutrition Assessment is the first step in
the nutrition care process.
To implement a successful nutrition plan,
the assessment must include key elements
of the patient’s:
● Clinical or medical history
● Current situation
● Anthropometric measurements
● Biochemical and laboratory values
Information on medication and
herbal supplement
 ● use for potential food-drug
interactions
● Food and nutrition intake history.
Nutrition assessment often begins with
collection of dietary intake data, the
information on the food, drink, and
supplements consumed.
This personal dietary intake is influenced by
factors such as;
● Economic situation
● Availability of food
● Eating behavior
● Emotional climate
● Cultural background
● Effects of disease
● Ability to acquire and absorb
nutrients
Once the dietary intake data are
collected, they are analyzed for nutrient
and phytonutrient content (from plants).
This is compared with dietary
recommendations and requirements
particular to that individual
These requirements depend on
● Age
● Gender
● Periods of growth such as
pregnancy or adolescence
● Presence of chronic disease or
inflammation
● Coexistence of stressors such as
injury or psychological trauma
● Medical treatments or medications
A diet history is perhaps the best means
of obtaining dietary intake information
and refers to a review of an individual’s
usual patterns of food intake and the food
selection variables that dictate the food
intake.
Dietary intake data may be assessed either
by collecting retrospective intake data
(e.g., a 24-hour recall or food frequency
questionnaire) or by summarizing
prospective intake data (e.g., a food
record kept for a number of days by an
individual or the caretaker).
Each method has specific purposes,
strengths, and weaknesses. Any
self-reported method of obtaining data can
be challenging because it is difficult for
people to remember what they ate, the
content, and the amounts (Thompson et al,
2010).
The choice of data collection depends on
the purpose and setting, but the goal is to
determine the food and nutrient intake
that is typical for that individual.
Screening and assessment are integral
parts of the nutrition care process (NCP),
which has four steps:
1. assessment of nutrition status;
2. identification of nutritional
diagnoses;
3. interventions such as food and
nutrient delivery, education,
counseling, coordination of care;
4. monitoring and evaluation of the
effectiveness of the interventions
Nutrition Screening
● to quickly identify individuals who
are malnourished or at nutritional
risk and determine whether a more
detailed assessment is warranted.
● the process of identifying patients,
clients, or groups who may have a
nutrition diagnosis and benefit
from nutrition assessment and
intervention by a Registered Nurse
(RN)/Registered Nutritionist-Dietitian
(RND)
Nutrition risk is determined through a
nutrition screening process.
Factors to consider in determining whether
an individual is at nutritional risk are:
● Food
● Nutrient
● Botanicals intake patterns
● Psychosocial and economic factors
● Physical conditions
● Abnormal laboratory findings
● Medication
● Treatment regimens.
Key considerations for nutrition
screening include:
1. Tools should be quick, easy to use,
and able to be conducted in any
practice setting.
2. Tools should be valid and reliable for
the patient population or setting.
3. Tools and parameters are
established by RNDs, but the
screening process may be
 performed by dietetic technicians,
registered (DTRs), registered nurses
(RNs) or other trained personnel.
4. Screening and rescreening should
occur within an appropriate time
frame for the setting
Nutrient Intake Analysis
● A nutrient intake analysis (NIA)
also may be referred to as a
nutrient intake record analysis or
calorie count, depending on the
information collected and the
analysis done.
● The NIA is a tool used in various
inpatient settings to identify
nutritional inadequacies by
monitoring intakes before
deficiencies develop.
● Information about actual intake is
collected through direct observation
or an inventory of foods eaten based
on observation of what remains on
the individual’s tray or plate after a
meal.
● In many cases, photographs taken
by smartphones are useful in
documenting the amount of food
consumed (LaGesse, 2011). Intake
from enteral and parenteral tube
feedings is also recorded.
Daily food Record or Food Diary
● involves documenting
● dietary intake as it occurs
and is often used in
outpatient clinic settings.
The food diary is usually
completed by the individual
client.
● A food diary or record is
usually most accurate if the
food and amounts eaten
are recorded at the time of
consumption, minimizing
error from incomplete
memory or attention.
● The individual’s nutrient
intake is then calculated and
averaged at the end of the
desired period, usually 3 to 7
days, and compared with
dietary reference intakes
(DRIs), government dietary
guidelines as in the MyPlate
guide, or personalized
dietary recommendations for
disease management or
prevention.
The food frequency questionnaire
● is a retrospective review of intake
based on frequency (i.e., food
consumed per day, per week, or per
month).
● For ease of evaluation, the food
frequency chart organizes foods
into groups that have common
nutrients.
● Because the focus of the food
frequency questionnaire is the
frequency of consumption of food
groups without portion sizes, the
information obtained is general, not
specific, and cannot be applied to
certain nutrients.
● During illness, food consumption
patterns can change, depending on
the stage of illness. Therefore it is
helpful to complete food frequency
questionnaires for the period
immediately before hospitalization or
before illness to obtain a complete
and accurate history.
●
● The 24-hour recall method of data
collection requires individuals to
remember the specific foods and
amounts of foods they consumed
in the past 24 hours.
● The nutrition professional asks the
person to recall his or her intake
using a specific set of questions to
gain as much detailed information as
possible.
E.g.
● When told that the person had
cereal for breakfast, the
 nutritionist-dietitian may ask, “What
kind of cereal?” The next question
may be, “How much did you have?”
at the same time that the person is
being shown a bowl or measuring
cup to jog the memory on portion
size.

Problems commonly associated with this

method of data collection include
1. an inability to recall
accurately the kinds and
amounts of food eaten,
2. difficulty in determining
whether the day being
recalled represents an
individual’s typical intake
or was exceptional, and
3. the tendency for persons to
exaggerate low intakes and
underreport high intakes of
foods.

Concurrent use of food frequency

questionnaires with 24 hour recalls or food
diaries (i.e., doing a cross-check) improves
the accuracy of dietary intake data.

Reliability and validity of dietary recall

methods are important issues. When
attention is directed toward the diet, people
may consciously or unconsciously alter their
intake either to simplify recording or impress
the interviewer, thus decreasing the
information’s validity.