NUTRITION FOR SPECIAL GROUPS ‘A. SUBSTANCE ABUSE ‘Sometimes referred to as “chemical dependency”. Addiction usually starts during adolescence continues throughout adulthood for many cases. This disorder collectively is characterized by repeated use of overindulgence to the non- medically indicated drugs or toxic substance to the stage when the addicted person ‘cannot control behaviour and other personally factors. ‘The most common chemical addictions are: 1. Alcohol 4. Cocaine 7. Nicotine and opiates 2. Caffeine 5. amphetamines 3. Cannabis 6. Hallucinogens Their effects involve the total perso! lity and general health of the addicted: "Physical, physiological, emotionalipsychological, behavioural and socioeconomic factors. Nutritional Problems include "Anorexia * Loss of taste a ‘= Inadequate food intake and interference with digestion, absorption and metabolism, all causing malnutrition, Alcoholism Almost all alcoholics suffer from malnutrition, because they eat inadequately. Alcoholic drinks as thelr main food and beverage displace the so called “protective foods" that supply essential nutrients for human beings. One gram of alcohol yields 7 Kcalories, which is not efficiently utilized for energy or as physiological fuel source. The B-vitamins needed for energy release are uilized rapidly to metabolize alcohol, Vitamin C is depleted at a faster rate and protein supply is greatly reduced. ‘The organ that is most affected is the liver, which is overworked in its function to metabolize and detoxify alcohol. ‘The metabolism of alcohol is more like fat and lipids. Liver hepatitis and cirrhosis are due fo damage from acetaldehyde, a toxic by-product of alcohol metabolism. Wemicke-Korsakoff syndrome is caused mainly by thiamine deficiency. ‘Magnesium, phosphorus, zinc, selenium are minerals depleted by alcoholism. Scanned with CamScannerProtoin-calorto malnutrition shouk! bo corractad, Good quality protein to provide 1.5 ahkg BW for adults wih adequate carbohydrate food rourcas and fowor fat Intako, Multiple vitaminmnineral supplements ns proscribed by the physician, espocialy vilamin B complex, Caution cliont not to wee herbal and botanical supplomonte without discussing with the physician, * Encourage fluid intake, unlosa there Is nead for corracting fluid and oloctrolyte inbatances, * Plan appatizing meals in 6 frequent foodings of anny-to-digost foods; no gas formers, Considor cultural and economic factorn In food cholcos of tho Individual, + Oral foading Is proforrod, but In chaos when tubo-ooding or parantoral nutrition te Foquirad, do Not use glulaming-ontichod formulas that incroase ammonia tovols. + Diract othr diatary modifications to rollave signe and symptoms euch as wator rotention In ascites, dabotes, and hyportonsion, * Tho main long-torm goal Is to maintain good nutritura that includos the acceptable body walght for the Individual, Tobaccolam (Nicotine Abuso) Cigarette smoking And alcohol and egal drug use aro additional nutritional concoms that adolesconts faco, Adolosconts aro naturally curlous, and most aro opon to oxperimonting with tobacco, aga! drugs, and alcohol Cigarette smoking diminishos appotita and can Interfore with nulriont absorption, It Is frequontly used by adoloscont girls to maintain a low body wolght, Tho short-term offacts of smoking Include damago to tho lungs and rosplratory system, faddlation to nicotina, and increased Inckdonce of participation In othor risky behaviours, ‘such as alcohol and drug abuso, fighting, and engaging In unprotoctod sox. Lung cancor Is tho top disoaso among thom; noxt aro tho respiratory discaso, Other disordora ausociatod with habitual smoking aro organs of digestion (tho mouth, pharynx, esophagus, stomach, pancrons), oxcrotion (kidneys) and the cardiovascular ‘syatom. De ronsod sense of taste and smoll aro common occurances, With matomal smoking during prognancy, highor Intant mortality rato, spontanoous Baborion, reduced bith walght, and birth dofect, Mothors who broastfoad should stop ‘smoking. ut 80 ~ 90% of nicotine In tha blood Is motabolizad by the liver and oxcretad by the: Inoys. Howover, blood nicotina may bo accumulated considerably ond can stay at nificant lovols in tho blood for 6 to 8 hour aftor smoking Is stopped. Thus, chain kare can roally store much nicotina In thair blood. pla who bogin smoking during adolescence continue to smoke throughout adulthood, g tholr rlak for lung cancer, hoart disease, osteoporosis, and emphysema, Scanned with CamScannerHistorically, nicotine addiction is one of the hardest habits to break. Smoke cessation classes in clinics or the use of nicotine patch and other medical advice are helpful, but personal cipline is the most effective. Other consequences of cigarette smoking for adolescents include: * Reduced physical fitness and poor exercise endurance Inhibition of normal lung growth and maximal lung function Increased incidence of respiratory illnesses Increased risk of addiction to nicotine Poor overall health Nutritional Interventions: Just like all other chemical addictions, withdrawal is the first step to treatment and rehabilitation. + The role of the nutritionist-dietitian is to give guidance in proper food habits that will ensure nutritionally adequate meals eaten at the proper time. Initially, offer small frequent meals and snacks that are easy to digest to help the patient or client get adjusted, instead of loading his stomach that has not been consumed to filing with solid foods. Street Drug Abuse ‘Sometimes called Illicit Drug or Narcotic Abuse the most common types used are: "Marijuana ( also called grass, pot, joint, hashish, weed, cannabis or Mary Jane) * Hallucinogens ( like LSD or lysergic acid diethylamide), psilocybin, peyote, phencyclidine (PCP or angel dust) Stimulants like speed, coke, crack, crystal, yellow jacket. Cocaine; or speedball, when mixed with heroine. Amphetamines Inhalants ( glue-sniffing, aerosols for deodorants or hair spray, spray paints, gasoline) Opiates, opioids (like morphine, codeine, heroin, oxycodone, methadone) ‘The harmful effects of ilicit drug abuse observed in a drug addict vary with the kind and dose, frequency of use, and how the drug is prepared and taken in the body. In general the central nervous system is most affected, thus behavioural problems which could ‘be contrasting like depression and on the other hand, joy or euphoria; decreased appetite or could be an increased appetite especially for sweets; insomnia; lack of orientation and iration and could be worse, like delirium, hallucinations, violent behaviour, severe gically, the active ingredients in a particular ilicit drug can cause narrowing of the respiratory problems [it sthma, sinusitis, bronchi bloodshot eyes, increased ssure, increased heart rate; and serious effects on the immune system in general. Nutrition Interventions: Complete withdrawal and immediate rehabilitation program are needed. Nutrition counselling is personalized and the general dietary guidelines listed under nicotine Scanned with CamScannerB. VEGETARIANISM Goals: to meet energy needs for healthy weight maintenance: to supply good quality protei and provide adequate vitamins, minerals, and fluids, Three key principles: balance, variety and moderation in food choices is a challenge, especially for the strict vegetarians or vegans", Vegetarian Dict People who follow vegetarian diets can get all the nutrients they need, The latest position Paper of the American Dietatic Association published in July 2009 stated thal: * appropriately Planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutilionalh Adequate and may provide health benefits in the prevention and treatment of certain diseas: and * well-planned vegetarian diets are appropriate for individuals during all stages of life ‘ycle: pregnancy, lactation, infancy, childhood, adolescence, adults and for athletes, 1, Semi-Vegetarian Diet Some but not all groups of animalderived products such as meat, poulty, fish, Seafood, eggs, milk, and milk products, are included in this diet, Red meals are excluded. Easy to plan nutritionally adequate diets. 2. Lacto- Vegetarian Diet Mik, and milk products, are included in this diet, but meat, poulty, fish, seafood, eggs are excluded, Possible limiting nutrient: ron Easy to plan nutritionally adequate diets. 3. Lacto-Ovo-Vegetarian Diet Milk, and milk products, and eggs are included in this diet, but meat, poulty, fish, seafood, are excluded. Possible limiting nutrient: iron Easy to plan nutritionally adequate diets. * This diet Includes plant foods and allows moderate use of dairy products, preferably low-fat, and infertile eggs (thus balutis not allowed). + The meal plan is similar to a regular diet except that a main dish of legumes or ‘meat analogues or textured vegetable protein (TVP) made from cereals, gluten, legumes, and/or nuts is substituted for meat, fish or poultry. * The diet includes fiberal amounts of fruits and vegetables, and well planned, meets the nutrient needs of normal adutts. ‘Growing children and pregnant and lactating women should take an iron supplement. |. Ovo-Vegetarian Diet This diet includes plant foods and allows the use of eggs, but milk and milk products, meat, poultry, fish, seafood, are excluded in this diet, Possible limiting nutrients: iron, vitamin D, calcium, riboftavin, Easy to plan nutritionally adequate diets. Scanned with CamScanner5. Total Vegetarian DietStrict Vegetarian Diot (VEGAN) This does not include al! foods of animal origin and is thus likely to be deficient in many nutrients. Possible limiting nutrients: iron, vitamin D, calcium, riboflavin, vitamin 812, high-quality protein, Easy to plan nutritionally adequate dots. C. FEEDING THE HANDICAPPED INDIVIDUAL, ‘Two general categories: 4, Physical disabiliti Which include blindness, amputated extremities, inability to self-feed due to paralysis or deformities, and other causes of Immobility, like a bedridden individual. 2. Mental disabled Persons with mental retardation (e.g., Down's syndrome, cerebral palsy), and cases of Aizhelmer's disease. Whether the afflicted person can partially self-feed with some assistance, or is totally dependent on someone depends on the kind and severity of the disability, ‘An accurate and complete evaluation of the ability to self-feed is needed, along with the capacity to swallow. Modifications of the diet will depend on the kind of disorder and results of the nutritional assessment. finger foods and the use of special feeding devices are Important tools. D. CULTURAL/EDUCATIONAL FACTORS Food fads fallacies ( false beliefs or misconceptions about certain foods), especially about treatment of a disease, or weaning from breast-feeding, may be harmful rather than beneficial to health and wellness. + Almost everyone likes to eat for pleasure, and not Just to satisfy hunger. Ealing serves as emotional outlet for life stresses, like tension and worries. For many, certain food is a symbol of security and level of income Food is used as git or rewards, Social functions of foods such as, town fiestas, family reunions and holidays or simply entertaining guests, as gestures of hospitality and friendship. RELIGIOUS INFLUENCES Fasting is common to many religions Certain foods may be substituted during fasting: ‘atholics : fish may substitute for meat or choose dairy products, or just be a itarian jome religions require abstinence from food at specific time or periods. lusiims: in remembrance of the handling down of the sacred scriptures, they abstain }m food, water and tobacco from sunrise to sunset. 1@ short perlod of fasting may not have a great affect or nutritional impact but when madan falls on summer, dehydration is a problem. Scanned with CamScannerCommon Religious Food Practices Eastem Hindu Jewish Mormo Muslim Roman Catholic Food/ Seventh Buddhist Orthodox Prohibited or Avcided by strongly most ‘but may be discouraged devout avcded at some observances Prohibit Avoided by edor most strong! devout y éiscour Scanned with CamScannerakan, Pres, Ayrcaches ad Sra, Mande & Marian & Webster Bocas F. EMERGENCY FEEDING ‘When a disaster strikes, activities of daily Ife are disrupted. Depending on the kind, ‘Severity and duration Of the disaster, the economic, emotional, and effects on health can be extensive. Objectives of Emergency Feedings are to: * Provide fluids and caloric needs first, on top of other nutrient needs, ‘* Maintain morale of people and thus avoid panic. + Relieve condition of casualties; and motivate emergency workers in their work, During the first few hours of an emergency, only water is of critical importance. At least 2 liters of safe water per person per day must be provided. Next in line of priority will be the carbohydrate foods for immediate basic ‘energy needs, To avoid Deficiencies for a disaster of longer duration, the diet should provide ample ts of the following: needed fo maintain efficiency in times of stress. @ for the normal functioning of the bones and teeth, capillaries, muscles and f organs; or normal growth and development, and maintenance of epithelial tissues; issium, and chloride for water balance, Scanned with CamScannerMeals that will be served depend upon the stage of emergency: 1. For early emergency period, characterized by stress and anxiety serve a stimulating warm rink and light snacks. Avoid very hot or iced beverages. Milk is best for infants and children. Coffee, fruit juice or soft drinks for adults. Easy to serve snacks which are high in carbohydrates are preferred. 2. For the intermediate period, when cooking facilities are avalable, a full meal may be prepared; usually a nourishing one-dish meal. 3. Consider the special food needs of infants, children and elderly. Provide for suitable foods for anyone on special diet (e.g., diabetes). Be sure to provide for serving foods safely, such as the use of disposable ware and sanitary disposal of garbage. Advice to Families: Before disaster strikes, the household must be prepared for emergency feeding by storing or having on hand basic foods and drinks. In case of typhoons, floods, brown-outs, one may not be able to heat or cook. Be ready for such an emergency! Always include non-food items like candles, matches, flashlight, manual ‘can opener, paperware ( spoons, forks, cups, napkins, towels), or plastic eating aids. Guidelines in Planning Disaster Meals 4. Stockpiling of Goods: ‘Stockpiling assures one’s self enough resources in time of scarcity. ‘Stockpile enough foods that: 1. Last for months without refrigeration 2. Canbe eaten with itle or no cooking 3. Cane stored in cans, jars, or sealed paper, or plastic containers. 4. Are within the storage faciliies of the household. Storage Procedure Storage should be kept clean, dry, cool and orderly. They should be adequate ventilation. Regular inventories and inspection should be done to guard against pilferage, damage, spoilage or infestation. Observed FIFO. plies in Emergencies v the location of water supplies outside of your establishment, if your regular indoor pted. Be sure to treat or boil the water before drinking. itis the safest method of purifying water. Bring water to a roling bol for 23 Let the water cool before drinking. on. Use only on regular household liquid bleach that contains 5.25% sodium >. Do not use scented bleaches, color safe bleacher or bleaches with added ‘Add 16 drops of bleach per galion of water, stir and let stand for 30 minutes. does not have a slight bleach odor, repeat the dosage and let stand for i - $f i Scanned with CamScannerDistillation. It involves boling water and then collecting the vapour that condenses back to water. The condensed vapour will not include salt and other impurities. To distil, fil a pot halfway with water. Tie a cup to the handle on the pot’ lid so that the Cup will hang right side up when the lid is upside-down and boil the water for 20 minutes. The water that drips from the lid into the cup is distilled. ‘Scanned with CamScanner