NCMA215: NUTRITION AND DIET THERAPY
Basic Concepts in Nutrition and Diet "father" of modern dietetics.
Therapy
Terminologies
✓ Health - Is the extent to which an individual or group is able to
realize aspirations and satisfy needs and change or cope with
environment. It is the complete physical, mental and social well-
being and not merely the absence of disease or infirmity.
✓ Nursing - is a caring profession; practiced with an earnest
concern for the art of care and science of health.
✓ Nutrition - is defined as the processes by which an animal or
plant takes in and utilizes food substances.
✓ Nutritionist – is a professional primarily work with individual
clients with an expert in food and nutrition, advises people how
to live a more healthy lifestyle and achieve health-related goals.
Nutritionists and dietitians develop a diet and exercise plan for
individual.
✓ Nutrients - are compounds in foods essential to life and health,
providing us with energy, the building blocks for repair and
growth and substances necessary to regulate chemical
processes.
✓ Food - is any substance consumed to provide nutritional support
for an organism Nutrition Concepts
• Nutrition is the science that interprets the nutrients and other however, the body need adequate amount to ensure that all body
substances in food in relation to maintenance, growth, cells function properly.
reproduction, health and disease of an organism. It includes
food intake, absorption, assimilation, biosynthesis, catabolism
and excretion. It is a part of food that is used by our cells and
metabolized by the body to make all the contributions that our • It is an organic compound containing C, H, O, Derived from
body needs. In humans, nutrition is mainly achieved through the
process of putting foods into our mouths, chewing and
swallowing it.
• A career in nutrition is ideal for those seeking to promote a
balanced lifestyle and improve people's diets, while helping
them to keep a healthy weight, boost their immune system,
increase their energy levels, and reduce the risk of developing
certain diseases.
• Good nutrition is an important part of leading a healthy lifestyle.
Combined with physical activity, diet can help to reach and
maintain a healthy weight, reduce the risk of chronic diseases,
and promote the overall health. Also, Good nutrition is one of
the keys to a healthy life and can improve health by keeping a
balanced diet.
• Good nutrition can help reducing the risk of some diseases,
including heart disease, diabetes, stroke, some cancers, and
osteoporosis. It reduces the high blood pressure and lowers high
cholesterol. It can also improve the well-being, improve the
ability to fight off illness and to improve the ability to recover
from illness or injury.
• Nutrition plays a critical role in human resource development
since deficiencies in essential nutrients lead to malnutrition,
which affects an individual's mental and physical state, resulting
in poor health and poor work performance. A well-nourished,
healthy workforce is a precondition for sustainable
development.
Nursing Theories and discovery related to Nutrition
• The concept of metabolism, the transfer of food and oxygen into
heat and water in the body, creating energy, was discovered in
1770 by Antoine Lavoisier, the “Father of Nutrition and
Chemistry.” Carl von Voit is considered by many to be the
• Abraham Maslow who postulated the Hierarchy of Basic
Human Needs which consists of: 1. Physiologic Needs; 2.
Safety and Security; 3. Love and belonging; 4. Self-Esteem
Needs; 5. Self-Actualization Needs. He mentioned that under
Physiologic needs nutrition is third and explains that
physiologic needs must be filled up first before going to another
level of human needs.
• Virginia Henderson identified fourteen (14) components of
basic nursing needs and postulated that the unique function of
the nurse is to assist the clients, sick or well, in the performance
of those activities contributing to health or its recovery. Faye
Glenn Abdellah identified twenty one (21) key nursing
problems related to health needs of people that include nutrition.
Classification of Nutrients
Nutrients can be grouped into two categories: macronutrients and
micronutrients. Macro means big – big nutrients. Macronutrients
are the main nutrients that make up the foods we eat. Nutrients
required in large amounts that provide the energy needed to
maintain body functions and carry out the activities of daily life.
Micronutrients are essential elements needed by life in small
quantities. Micronutrients, just like water do not provide energy,
Macronutrients
Carbohydrates
the Greek word saccharide meaning starches and sugars and
chiefly found in plants. It is produced by the process of
photosynthesis from - H2O, CO2 and sun. The Total Energy
Requirement is ranging from 50% to 70% of body energy
needs is from CHO. CHO has one (1) gram of CHO which is
equivalent to 4 calories upon complete hydrolysis. The
building blocks are called monosaccharide. The digestion
begin in the mouth with salivary amylase released during the
process of chewing and are absorbed across the membrane of
the small intestine and transported to the liver distributed to the
rest of the body. The absorption process begins around 3-6
hours after eating.
• The classification of carbohydrates are the following: (A)
monosaccharide considered as the simplest form of sugar of
sugar which is small molecules that require little or no
digestion before they can be used by the body and the source
is the digestive end product of lactose hydrolysis. There are (3)
types of monosaccharide: (1) Glucose which is primarily
“physiologic sugar” or “blood sugar”, “dextrose”, “grape
sugar”, principal form used by the body, moderately sweet
sugar works for the body’s brain, nerve cells, RBC and stores
last for only hours. Gluconeogenesis is the process where
protein is converted to glucose. Ketosis is the process
converting lipids to glucose for energy use by the body with
less available carbohydrates that more fats to be broken down
to form ketone bodies. Some sources of glucose can be found
abundantly in fruits, sweet corn, corn syrup. Some fruits does
have Lycopene (red), Carotene orange and yellow,
Anthocyanin (blue and brown) and Cruciferae (white and
green). (2) Fructose is considered as fruit sugar, the sweetest
of all sugar, “levulose” and sources are ripe fruits and honey.
(3) Galactose is not found in nature and not found in free foods, but
produced from lactose (milk sugar) by digestion and is converted to
glucose. Galactosemia is the term to infants born with an inability to
metabolize galactose. (B) Disaccharide which has two sugar
molecules and has 3 types: (1) Sucrose considered as the ”cane
sugar”, “table sugar”, “beet sugar”, example is Sucrose = glucose +
fructose. (2) Maltose considered as ”malt sugar”, derived from the
digestion of starch wit example of maltose = glucose + glucose. (3)
Lactose known as milk sugar, least sweet among sugars with link two
molecules of glucose + galactose and sources as milk and milk
products. The last type is Complex Carbohydrates or Polysaccharide
that contains many monosaccharide linked together with the
following types: (1) Starch is the storage form of carbohydrates in
plants, supply energy for a long period of time and the sources are
cereal grains, rice, wheat. (2) Dextrin - not found in free foods but the
intermediate product of starch digestion with food source of toasted
bread + application of dry heat. (3) Glycogen is an animal starch,
storage form of CHO in the body found in the liver and muscle.
Muscle glycogen supplies energy directly to surrounding tissues
during work and exercise while liver glycogen is converted to glucose
to be used in the body through the process called “glycogenolysis”.
Food sources of glycogen are animal liver, oysters, muscle meat. (4)
Fibers considered as roughage because they form bulk of the diet, act
as broom in the digestive tract, indigestible part of food and primary
constituent of plant cell wall, not digested by human due to lack of
enzyme that will split or break it. The body requirement is 20 to 35
g/day.
• The following function of Carbohydrates are: (1) chief source of
energy, protein sparing; (2) takes part in building body tissues to
some limited extent; and (3) regulator of intestinal peristalsis and
provider of bulk. Lack of Carbohydrates resulted to: (1)
underweight and/or rapid weight loss; (2) general weakness; (3)
poor physical performance; (4) fainting or collapse in severe
deficiency; and hypoglycemia in acute carbohydrate deficiency.
Excessive Carbohydrates may result in: (1) dental caries; (2)
obesity/overweight; (3) diabetes mellitus and gas formation. The
health effects of starch and fibers are promote weight loss/ weight
control, protect against heart disease and stroke and cancer, fight
against diabetes and promote gastrointestinal health.
Fats
• Also known as Lipids, considerer as organic nutrient containing
C, H, O attached in a glycerol base. One (1) gram fat is
equivalent to nine (9) calories with Total Energy Requirement
of 20%-30% is from fat. It remains in the stomach for the
longest period of time. A good approach when it comes to
breaking up fat calories is to eat 40 percent of daily fat grams at
breakfast, 40 percent between midday meal, and 20 percent at
dinner. Avoid fatty foods at night. It can take 2-4 hours for fat
to digest, so if an individual eat it too late in the evening, the
body won't have as much time to utilize this energy before
storing it. Bile contains bile salts, which act as an emulsifier of
lipids. This breaks the large fat droplets into smaller droplets
that are then easier for the fat-digesting enzyme pancreatic
lipase to digest. Fats are mainly digested in the small intestine.
Steatorrhea is the presence of excess fat in feces.
• The fats are classified as: (A) Simple Lipids consider as neutral
fats with chemical name is triglycerides and glycerol is derived
from a water soluble form of CHO; and (B) Compound lipids
which is a combination of fats with other components; important in
human nutrition. The compound lipid has different types; (1)
Phospholipids which has fatty acids, phosphoric acids and
nitrogenous base. Examples are lecithin which is most widely
distributed, traces placed in liver, egg yolk and vegetable oil and
added to food products such as cheese and margarine to aid
emulsification. Cephalin is needed to form thromboplastin for blood
clotting. Sphigomyelin which is found in brain and other nerve tissue
that serves as insulator around nerve fibers. (2) Glycolipids which is
fatty acids combined with CHO and nitrogen. (3) Lipoprotein which
is lipids combination of protein with different sub-types
Chylomicrons that transport diet-derived lipids; mostly
triglycerides; Pre-beta lipoprotein consider as VLDL (very low
density lipoprotein); fat circulating in the blood during fasting state;
Beta lipoprotein consider LDL (low density lipoprotein); transport
in the artery wall; and Alpha lipoprotein consider as scavengers; also
known good cholesterol. (C) Derived lipids that is fat substances
produced from fats and fat compounds with fatty acids as basic
structural unit of fat. Divided into three forms: (1) Saturated fatty
acids – palmitic and stearic acids; examples are bacon, butter, grated
coconut, coconut cream, coconut oil, margarine, mayonnaise, cream
cheese, sandwich spread, whipping cream, chicharon; (2)
monounsaturated – oleic acid; examples are avocado, peanut butter,
peanut oil, pili nut, olive oil, shortening; and (3) polyunsaturated
fatty acids – linoleic acid, vegetable oil: examples are corn, soybean,
rapeseed, canola, sunflower, sesame seeds. Glycerol is water soluble
component of triglycerides; available for the formation of glucose in
the diet. Steroids are fat related substances that contain sterols; main
member is cholesterol – important constituent of body cells and
tissues.
• The functions of Fats are the following: (1) supplies food energy
in concentrated form for body activities; (2) protects vital body
tissue and insulates body; supplies essential fatty acids; (3)
serves as a carrier of the fat-soluble vitamins (ADEK); and (4)
adds palatability and satiety value (sense of fullness) to your
meals. The lack of fat in the diet rests in: underweight,
sluggishness, skin irritation similar to eczema in infants and
signs and symptoms of fat-soluble vitamin deficiency. The
excess intake of fat results in: obesity/overweight, and
cardiovascular diseases.
Protein
• It is an organic compound containing C,H,O,N and derived
from the Greek word “proteios” meaning to hold first place or
is the prime importance. The building blocks are called
‘’amino acid’’. The total energy requirement supplied by
CHON is 10%-15% with 1 gram CHON is equivalent to 4
calories upon complete hydrolysis. Protein digestion occurs in
the stomach and duodenum in which 3 main enzymes, pepsin
secreted by the stomach and trypsin and chymotrypsin secreted
by the pancreas, break down food proteins into polypeptides
that are then broken down by various exopeptidases and
dipeptidases into amino acids, protein is digested and absorbed
in the small intestine. It has simple proteins which comprises
of albumins that is soluble in water, coagulated by heat and
globulins that is insoluble in water, soluble in salt solution,
coagulated by heat.
• The essential amino acid (EAA) or indispensable amino acid
is one that cannot be synthesized by the body. Examples are
histidine, phenylalanine, ioleucine, threonine, leucine,
tryptophan, lysine, valine, and methionine. Semi-essential or
semi-indispensable amino acid reduces a need for a particular
essential amino acid and partially spares it like arginine, tyrosine, have precursors, stored in the body and deficiency develops slow;
cystine, glycine, serine. The non-essential amino acid (NEAA) is not with examples of Vitamins A, D, E, K. (2) Water soluble vitamins
dietary essential because the body can synthesize it such as glutamic that is dissolve in water and are not stored in the body; absolutely
acid, aspartic acid, alanine, proline, norleucine, citrulline, needed daily because excess excreted in the urine; do not have
hydroxyglycine, and hydroxyproline.
• The functions are the following: (1) builds and repairs body B complex and Vitamin C.
tissue for growth and maintenance such as anabolism – repairing
worn out body tissue and catabolism – continued wear and tear
going on in the body; (2) builds resistance to infection by
helping form antibodies; (3) supplies additional energy; (4)
contributes to numerous body secretions and fluids; and
maintain water balance. The sources of protein coming from
animal sources - egg, milk, milk products, meat, fish, poultry
and sea foods and plant sources - cereals (wheat, rice, corn),
legumes (munggo beans, peas, peanuts, soybeans), processed
vegetable protein (vegemeat, tofu). The lack of protein results
in: (1) retarded growth in children; (2) low resistance to
infection at any age; (3) slow recovery from illness; (4) low birth
weight; (5) protein energy malnutrition- Marasmus and
Kwashiorkor; (6) loss of weight; and (7) edema, skin lesions,
mental sluggishness.
• Kwashiorkor and Marasmus are protein-energy malnutrition.
Kwashiorkor is a protein deficiency, disease caused by severe
shortage of protein; associated with post weaning diets ↑ cereals
and ↓ in quality and quantity protein; usual onset is from 1-6
years old with signs and symptoms of edema, enlarged liver due
to accumulation of fat, altered skin and hair pigmentation and
moon’s face. Marasmus is a protein caloric deficiency, disease
caused by inadequate protein and calories, from semi-starvation
resulting from mother’s failure to nurse her infant. The onset is
from 6 months-4 years old with signs and symptoms of loss of
subcutaneous fat-very underweight and old man’s face.
• The effects of excessive protein intake: kidney function – high
CHON diet - increase work of kidneys; mineral losses – increase
CHON diet - calcium excretion rises; obesity – high CHON diet
– increase intake rich fat foods; heart disease – foods rich in
animal protein – rich n saturated fats; and cancer – increase in
CHON diet – increases rich saturated fats foods intake
Micronutrients
• Vitamins
- The word vitamin coming from a Latin word meaning vita –
life and amine means nitrogen compound. They do not give
energy but merely help convert food into energy. Bile is needed
for the absorption of fat-soluble vitamins. It acts as co-enzyme
for energy metabolism of CHO, CHON and fats. Precursors /
Provitamins is a compound that can be changed to active
vitamins. Preformed Vitamins is a occurring vitamins that are
inactive form and ready for biological use. Avitaminosis is a
lack of vitamins, deficiency. Hypervitaminosis is a vitamin
toxicity, excessive accumulation of vitamins in the body.
Vitamin malnutrition is bad (mal); too much or too little is not
good for the health. Vitamin like compounds are substances
have physiological roles like vitamins but in large amounts
partially synthesized in the body like inositol, choline etc.
Antivitamins or vitamin antagonist is a substance that interfere
the normal functioning of the vitamin like dicumerol against
Vitamin K, avidin against biotin.
- There are two classifications of Vitamins: (1) Fat soluble
vitamins that is dissolve in fat before they are absorbed in the
blood stream; not absolutely needed daily from food sources;
precursor and deficiency develops fast; and with example of Vitamin
Fat-Soluble Vitamins
• Vitamin A, also known as retinol with precursor of carotene,
absorbed through lymphatic system and portal blood to liver.
An antioxidant and never be given for pregnant mother for the
first trimester because causes teratogenic to the baby. The
following functions are: (1) helps maintain normal vision; (2)
helps keep lining of the mouth, nose, throat and respiratory tract
healthy; (3) helps skin and hair glossy, teeth strong; (4)
promotes growth; (5) maintains the stability of the cell
membrane; (6) assists in immune reaction. Lacking of vitamin
A results in: (1) Bitot’ s Spot a mild form and Xeropthalmia a
severe form of blindness; (2) inability to see in dim light or
“night blindness”; (3) eyes sensitive to bright light; (4) rough
dry skin and membranes of nose and throat; (5) low body
resistance to disease; and (6) affects health of skin, hair, nails
and poor growth. Excess intake of vitamin A results in: (1)
yellow discoloration of the skin or “carotenemia”; (2) dry, itchy
skin and coarse hair; (3) nausea and headache; (4) irritability;
and loss of appetite. Food sources are animal liver, egg yolk,
dairy product, green, yellow and orange fruits and vegetable.
• Vitamin D, also known as calciferol with precursor of
ergosterol, It is also produced endogenously when ultraviolet
rays from sunlight strike the skin and trigger vitamin D
synthesis. It can be warmed or kept for long period of time
without deteriorating. It is needed for calcium and phosphorous
absorption, bone mineralization. The functions of vitamin D are;
(1) helps build and maintain strong bones and sound teeth; (2)
absorbs calcium and phosphorus; and (3) promotes normal
growth and development. Lack of Vitamin D results in: (1)
tetany – muscle twitching; (2) malformed or soft bones (rickets
for children and osteomalmacia for adult); (3) poor development
of teeth; (4) stunted growth (osteoporosis); (5) lowered amount
of calcium and phosphorus in blood. Excess intake of Vitamin
D results in: (1) loss of appetite; (2) nausea and vomiting; (3)
intense thirst and frequent urination; (4) severe constipation
and/or diarrhea; (5) muscular weakness; and (6) headache and
drowsiness. Food sources are dairy products, eggs, yolks and
fatty fish.
• Vitamin E is an antioxidant vitamin with precursor of
tocopherol, stored in adipose tissue, aided by bile and fats and
stable to heat and acid. The functions of vitamin E are: (1)
maintains nerves, muscles and a healthy reproductive system;
(2) helps protect tissues and membranes against the damage of
oxidation; and (3) helps in the formation of red blood cells and
in the utilization of Vitamin K. The food sources are vegetable
oils, nuts, seeds, whole grains.
• Vitamin K, also known as menadione, pytomenadione and
phylloquinone. It is synthesized by normal intestinal flora and
maintenance of prothrombin level in blood plasma. The
functions of vitamin K are: (1) helps in the normal clotting of
the blood; (2) increases calcium absorption; and (3) maintains
strong healthy bones. Lacking of vitamin K results in: (1) slow
clotting of blood; (2) tendency to bleed easily; and (3)
hemorrhage following operations or in the umbilical cord of
newborn infants. The food sources are green leafy vegetables.
 Water-Soluble Vitamins
- fresh food vitamins
• Vitamin C is also known as ascorbic acid, anti-oxidant vitamin
and easily absorbed from small intestines. The functions of
vitamin C: (1) increases the body resistance to infection; (2)
helps keep gums and teeth healthy; (3) aids in the absorption of
iron and calcium in the body; (4) helps in the formation of red
blood cells; and (5) prevents scurvy. Lack of ascorbic acid
results in: (1) bleeding gums; loose teeth; (2) skin hemorrhages
(black and blue spots); (3) slow wound healing; (4) bone
changes; (5) anemia; and (6) scurvy in severe deficiency. The
food sources are citrus fruits, broccoli, cantaloupe, kiwi,
cabbage, strawberries, tomatoes, melons.
• Vitamin B Complex – short life that needs to be replaced
continually; if food rich in vitamin B complex especially
vitamin B2 and need to be boiled losses of Vitamin B is 15-40%.
When frying – 40-50% and roasting – 30-60%. That’s why lost
vitamins from cooking are transferred to the cooking liquids and
best turn these liquids to sauces and gravies.
• Vitamin B1 also known as thiamine and the functions of vitamin
B1 are: (1) prevents beri-beri / nutritional polyneuritis; (2) keeps
nerves in healthy condition, muscle nerve function; (3)
promotes good appetite and normal digestion; and (4) promotes
good growth. Lack of thiamine results in: (1) mental
confusion/depression; (2) poor appetite; (3) nervousness; (4)
loss of ankle and knee jerk reflexes; (5) painful calf muscles
(cramps); (6) constipation; (7) fatigue, weakness; and (8)
retarded growth. The food sources are whole grains, pork,
cereals, legumes, seeds and nuts. There are types of beri-beri
such as infantile - occurs in infant 2 to 5 months of age, gets the
disease from mother’s milk suffering from beri-beri and
symptoms like loss of voice (aphoria) and cyanosis. Wet -
edema on both extremities progress upwards to heart and lungs.
Dry – involves peripheral nerves causing paresthesia leading to
paralysis.
• Vitamin B2, also known as riboflavin, co-enzyme for energy
metabolism, essential for protein, fat and carbohydrates
metabolism and vitamin readily destroyed in cooking. The
functions of vitamin B2 are: (1) keeps eyes and skin healthy; (2)
aids in normal functioning of nervous system; and (3) promotes
growth. Lack of riboflavin results in: (1) sores in angles of
mouth and fold of nose, itching burning eyes; (2) sore, swollen
and chapped lips, swollen, fissured, and painful tongues; and (3)
retarded growth. The food sources such as pork, grains, cereal
products, meats, fish, green leafy vegetables.
• Vitamin B3 is also known as niacin or nicotinic acid and co-
enzyme for energy metabolism. The functions are: (1) promotes
normal digestion and keep nerve in healthy condition; (2) keeps
skin healthy; and (3) promotes growth. Lack of niacin results in:
(1) rough, red skin which later becomes pigmented; (2) sore
mouth, tongue and throat; (3) digestive and nervous
disturbances; (4) loss of appetite and weight; (5) pellagra or “3D
disease” (dementia, dermatitis, diarrhea) in severe deficiency;
and (6) irritability and mental confusion. The food sources of
vitamin B5 are whole grains, legumes, green vegetables, meats,
fish, nuts and eggs.
• Vitamin B5 is also known as panthothenic acid with the
following functions: (1) essential for carbohydrate, protein and
fat metabolism; (2) maintenance of normal growth, healthy skin
and integrity of CNS; and (3) co-enzyme for energy metabolism
Lack of Panthothenic acid resulted in insomnia, tingling sensation of
the extremities, muscle cramps and vomiting. The food sources are
liver, meats, eggs, milk cheese and legumes.
• Vitamin B6 also known as pyridoxine with functions of
metabolism of amino acids and protein; helps the body use
carbohydrate, fat and protein; neurotransmitter synthesis,
avoided to patient with parkinson’s; supplemented in anti-TB
therapy; and converts tryptophan to niacin and linoleic acid to
arachidonic acid. Lack of pyridoxine results in: (1) loss of
appetite, nausea and vomiting; (2) nervous irritability and
convulsions; (3) dermatitis around the eyes, mouth, on the nose
and behind the ears. The food sources are whole grains, spinach,
broccoli, legumes, vegetable oils of corn.
• Vitamin B9 is also known as folic acid or folate with functions
of aids in metabolism of genetic material (DNA, RNA); helps
cure a form of anemia, poor growth, and birth defects;
synthesizes DNA which control cell function, heredity and
tissue growth; and regenerates red blood cell and essential
formation of WBC in the bone marrow. Lack of folic acid
results in: (1) poor growth; (2) fatigue, depression and
confusion; (3) macrocytic anemia; (4) glossitis; (5) diarrhea; (6)
malformation in the offspring especially neural tube defect; (7)
gastrointestinal disturbances. The food sources are green leafy
vegetables, nuts, legumes, grain products.
• Vitamin B12 is also known as cyanocobalamin or cobalamin,
consider as folate metabolism, nerve function and problem with
intrinsic factor in pernicious anemia with lifetime treatment.
The functions are facilitates maturation of red blood cells;
protects the “myelin” the fatty material - transmit electrical
impulses (messages) between nerve cells; and metabolizes
carbohydrate, protein, fat, nucleic and folic acid in the body and
normal functioning of all cells. Lack of cobalamin results in: (1)
pernicious anemia; (2) changes in the nervous system; and (3)
retarded growth. The food sources are foods of animal in origin,
fermented foods.
Minerals
• These are the element in their simple inorganic form. Primary
function of the small intestine is the absorption of nutrients and
minerals found in food. The phytates, oxalates & tannins which
are compounds found in foods that can bind to calcium, iron,
zinc and other minerals and interfere with their absorption. The
following macronutrient minerals – Ca, Na, P, K, S, Cl, Mg
and the micronutrient minerals – Fe, I, Zn, Se, Mn, Cu, Mo,
Co, Cr.
• Calcium (Ca) is 99% present in the bone, major component of
renal calculi, with blood serum of normal value 4.5 to 5.5
mEq/liter. The following functions are: (1) build and maintain
strong bones and teeth; (2) promotes normal blood clotting,
regular heartbeat, cell metabolism and other muscle
contractions; (3) prevents rickets in children and osteomalacia
in adults; and (4) lowers risk to fracture. Lack of calcium
results in: stunted growth, defective structure of teeth and
bones called rickets in very young children, soft bones or
osteomalacia in adults, decreased bone density, increased
porosity (demineralization) of the bones; called osteoporosis.
low peak bone mass, increased risk to fracture. The food
sources are milk products, dark green leafy vegetable, salmon,
orange juice and tofu.
• Magnesium (Mg) has a blood serum normal value 1.5 to 3.0
mEq/liter. The following functions are; (1) helps regulate body
processes including regulation of normal heart rhythm;
; (2) aids in the normal functioning of the body enzymes; (3) relaxes
muscle after contraction; and (4) promotes resistance to tooth decay
by holding calcium in the tooth enamel. Lack of Magnesium resulted
to irritability, emotional tension, depression, and muscular weakness.
Excess in Magnesium resulted to nausea and vomiting and the food
sources are whole grain, nuts, legumes, soy beans, dark green leafy
vegetables.
• Sodium (Na) is a chief cat-ion in the extracellular fluid (ECF)
with blood serum normal value of 135 to 145 mEq/ liter. The
functions are maintains proper water balance within the body
and preserves the normal movement of the muscles, nerve
impulse transmission. Lacking of sodium resulted to nausea,
vertigo, mental apathy, muscular weakness and cramps,
Excessive sodium intake resulted to edema, hypertension, and
kidney disease. The food sources are spinach, celery, pickles,
canned soup, processed cheese, condiments
• Potassium (K) is a chief cat-ion in the Intra-cellular Fluid (ICF)
with blood serum normal value 3.5 to 5.5 mEq/ liter. The
following functions of potassium are helps in muscle
contraction, nerve impulses, and the proper functioning of the
heart and kidneys, regulates blood pressure and water balance
in the cells, important in CHO and CHON metabolism. Lacking
of potassium resulted to hypokalemia (decrease level of K),
muscular weakness, increased nervous irritability, mental
disorientation, and cardiac irregularities. Excessive potassium
will lead to hyperkalemia (increase level of K), and heart block.
The food sources are bananas, meat, milk, legumes, potato.
Bananas, oranges, cantaloupe, honeydew, apricots, grapefruit
(some dried fruits, such as prunes, raisins, and dates, are also
high in potassium), cooked spinach, cooked broccoli, potatoes,
sweet potatoes, mushrooms, peas and cucumbers. Some
lowpotassium foods include: berries, such as strawberries and
blueberries, apples, pineapple, cranberries and cranberry juice
and cauliflower.
• Phosphorous (P) is an important in pH regulation and principal
anion in the Intra-cellular cell (ICF). The following functions
are helps in proper bone and tooth development, facilitates quick
release of energy for muscle contraction, transports lipids and
fatty acid in the blood, transports nutrient in and out of the cell,
and prevents rickets, demineralization of bone, Lacking of
Phosphorous resulted to weakness of the muscles, stunted
growth and defective structure of teeth and bones. Excessive
intake of Phosphorus may lead to impairment of the body’s use
of iron and calcium. The following food sources are milk
products, meat and organ meat, poultry, sea foods, legume,
cheese, dried beans, sunflower and pumpkin seeds, nuts and
whole grains.
• Sulfur (S) plays an important role in crucial functions in body,
such as making protein, regulating gene expression, building
and repairing DNA, and helping body metabolize food. The
function of Sulfur is of the function of protein. Lacking of sulfur
is related sulfur-containing amino acid in cases of severe
deficiency and food sources are protein containing foods.
• Chloride (Cl) is a major anion in the Extracellular Fluid (ECF)
and serve as formation of gastric juice. The main functions are
helps maintain the osmotic pressure and acid-base equilibrium
in the body, helps balance the ph level of the blood and
maintains the strong acidity of the stomach as part of
hydrochloric acid. The effects of chloride in the body can be
alkalosis and acidosis. Alkalosis is an excessive loss of Chloride
ions from the gastric secretions; vomiting and gastric lavage or
suctioning. Acidosis is an excessive supply of Chloride ions
from the gastric secretions; diarrhea, during the state of NPO or diet.
The food sources are pickles, canned soup, processed foods,
condiments and canned foods.
• Iron (Fe) is a components of hemoglobin. Ferrous SO4 is taken
with meals and with orange juice (Vitamin C) for better
absorption. Watch out for any black tarry stools if given orally
and nothing to do because it is a normal assessment. The Z-track
method is being used if given IM injection and straw as not to
stain the teeth. Ferrous is better absorbed than ferric, iron in
green leafy vegetable is poorly absorbed and coffee taking iron
– iron absorption is reduced. There are two type of Iron: heme
iron that is found only in meat, fish and poultry and non-heme
iron and found in cereals and vegetables. The main functions are
helps build and maintain blood supply and give healthy red
color to the blood, and prevents simple anemia. Lacking of iron
may lead to nutritional iron deficiency anemia; easy fatigability;
general weakness; poor physical performance; paleness in the
face, conjunctiva, lips and fingernails, weight loss and
koilonychias which is spoon shaped nail, a nail deformity in
which the outer surface becomes concave. Excessive iron may
lead to high iron stores leading to iron toxicity like
hemochromatosis and hemosiderosis. The food Sources are
liver, red meat, organ meat, egg yolk, green and red mongo, soy
beans.
• Copper Cu) - essential trace mineral necessary for survival,
plays a role in making red blood cells and maintaining nerve
cells and the immune system. It also helps the body form
collagen and absorb iron, and plays a role in energy production.
The functions are helps the body to use iron; helps build
hemoglobin in the blood; takes part in the metabolism of
ascorbic acid in the body; and helps the body use fatty acids.
Lacking of this mineral will lead to anemia, anorexia,
hypotonia, edema and retarded growth (CNS abnormalities).
Excessive of copper will lead to wilson’s disease which is a
genetic disorder in which excess copper builds up in the body.
Symptoms are typically related to the brain and liver. Liver-
related symptoms include vomiting, weakness, fluid build-up in
the abdomen, swelling of the legs, yellowish skin and itchiness.
The food sources are organ meat, egg yolk, oysters, nuts,
cereals, whole grains.
• Iodine (I) is a mineral component of the hormone thyroxine.
The functions are helps in normal functioning of the thyroid
gland in regulating energy metabolism, helps in protein
synthesis, tissue growth and reproduction, and prevents goiter.
Lacking of Iodine resulted to enlarged thyroid gland (Goiter),
painful swallowing, cretinism (mental and physical retardation
accompanied by irreversible hearing and speech problem –
insufficient of iodine intake by the mother during pregnancy),
myxedema is experience by adults who had problem with low
iodine throughout their childhood and adolescence, and
increased risk of abortion, stillbirths, miscarriage and infant
deaths Excessive Iodine resulted to thyrotoxicosis, induced
acne-like skin lesions, worsening of pre-existing acne. The food
sources are seafood, seaweeds,and iodized salt.
• Manganese (Mn) is a mineral constituents of vitamin B1,
contributes to many bodily functions, including the metabolism
of amino acids, cholesterol, glucose, and carbohydrates. The
human body cannot produce manganese, but it can store it in the
liver, pancreas, bones, kidneys, and brain. A person usually
obtains manganese from their diet. The functions of manganese
are an essential constituent for bone structure, reproduction and
normal functioning of nervous system, and takes part in
enzymatic actions in the body. Lacking of manganese is having a
problem with skeletal abnormality and food sources are nuts, cereals,
legumes, dried fruits, green leafy and non-leafy vegetables.
• Cobalt (Co) is a mineral constituents of B12, with deficiency of
pernicious anemia and polycythemia vera for excessive intake.
They forms of cobalamin or vitamin B12 that helps treat a
certain type of anemia. Lacking of cobalt resulted to poor
growth, poor appetite, restlessness, and progressive emaciation.
The food sources are liver, oysters, clams, poultry, salt water
fish.
• Zinc (Zn) is an anti-oxidant mineral. The following functions
are helps the body use protein and carbohydrates; vital for
growth and development, synthesis of cell protein (formation of
DNA & RNA), proper functioning of the immune system; vital
for the development of male reproductive function, specifically
the formation of testosterone, making of sperm; helps hasten
wound healing; and taste acuity (geusia). Lacking of zinc
resulted to growth failure, impaired wound healing, impaired
sense of taste and smell, and sexual infantilism in teenagers.
Excessive intake of zinc may lead to nausea and vomiting,
abdominal cramps, diarrhea, and gastrointestinal irritation. The
food sources are meat, milk, legumes, nuts, poultry, fish, whole
grain cereals and breads.
• Fluoride (Fl) helps prevent tooth decay and favors deposition
of calcium thereby strengthening the bones. Lacking of fluoride
resulted to lowered resistance to dental caries and excessive
intake may lead to mottling of the tooth enamel (dental
fluorosis) and stained and corroded appearance of the teeth. The
sources are fluoridated water and toothpastes.
• Selenium (Se) is an anti-oxidant mineral, serves as an integral
component of certain enzymes, acts as an antioxidants which
help fight cell damage, helps prevent certain types of
proteinenergy malnutrition, regulates proper immune response,
and aids in proper functioning of the heart muscle. Lacking of
selenium cause keshan’s disease, cancer and less able immune
system to fight off diseases and excessive intake o selenium
causes liver damage. The food sources are organ meats, cereals
dairy products.
• Chronium (Cr) takes part in glucose metabolism, helps the
body use carbohydrates and fats, and stimulates synthesis of
fatty acids and cholesterol in the liver. Lacking of chromium
may lead to impaired action of insulin, and low blood glucose
level. The food sources corn oil, clams, cereals, vegetables and
meats.
• There are nutrients to take – or avoid taking together for best
absorption: Individual can take iron + vitamin C; vitamin D +
calcium; vitamin B12 + folate; vitamin D + Omega-3s and avoid
taking combination of iron and calcium.
• Water is 60-70% total body weight; deprivation of 10% water –
illness; 20% - death; next to O2 for maintenance of life; 45 liters
– water found in the body of normal adult; 30 liters intracellular
(inside or within the cells); 15 liters extracellular (outside the
cells); and large intestine absorbs water and changes the waste
from liquid into stool. The functions of water are acts as solvent
for all products of digestion (universal solvent); carries nutrients
to the tissues; removes waste products from the tissue; helps
regulate body temperature and the acid-base balance; sends
messages between cells so individual can think, see, touch, hear,
feel and move. Lack water results in: dehydration with the
following symptoms of fatigue decrease blood pressure increase
body temperature, headache, weight loss and collapse, and
decrease urine output.
There are three (3) possible sources of water for the body are:
water contained in foods; fluids taken as such and water formed by
the oxidation of foods in the body. Input can be fluids in the form
of water, juices, and parenteral and output are urine, vomitus,
feces, stomach content, drainage, bleeding, and perspiration. The
approximate average daily Intake and Output is 2200 to 2500
ml/day. The abnormality of water balance is over hydration versus
dehydration.
Nutrition Tools, Standards and Guidelines
Nutrient Recommendation
Terminologies
• Adequate Intake (AI) – is the recommended average daily
intake level based on observed or experimentally determined
estimates of nutrient intake by a group of apparently healthy
people that are assumed to be adequate.
• Dietary Reference Intakes (DRIs) – are reference values that
are quantitative estimates of nutrient intakes to be used for
planning and assessing diets for healthy people.
• Estimated Average Requirement (EAR) – The daily nutrient
intake level that meets the median average requirement of
healthy individuals in a particular life stage and sex group,
corrected for incomplete utilization or dietary nutrient
bioavailability.
• Philippine Dietary Reference Intake (PDRI) – collective
term comprising reference values for energy and nutrient levels
of intakes. PDRIs are to be used as references for assessing and
planning dietary intakes for an individual or for a group or
population. Estimated Average Requirement (EAR),
Recommended Energy/Nutrient Intake (REI/RNI), Adequate
Intake (AI), and Tolerable Upper Intake Level or Upper Limit
(UL) are the components constituting the PDRI.
• Recommended Dietary Allowance (RDA) – the estimated
amount of a nutrient (or calories) per day considered necessary
for the maintenance of good health.
Dietary Reference Intakes (DRIs)
- Dietary Reference Intakes (DRIs) is a generic term for a set of
nutrient reference values that includes the Recommended
Dietary Allowance (RDA), Adequate Intake (AI), Tolerable
Upper Intake Level (UL), and Estimated Average Requirement
(EAR). 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. The
components of PDRI are:
Estimated Average Requirement (EAR)
- is a 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.
- The estimated average requirement (EAR) is the amount of a
nutrient that is estimated to meet the requirement for a specific
criterion of adequacy of half of the healthy individuals of a
specific age, sex, and life-stage. The amount of the nutrient
necessary to meet the appropriate criterion of adequacy varies
from one individual to the next, but the data are usually
distributed normally or can be transformed to achieve a normal
distribution. The EAR is not useful as an estimate of nutrient
adequacy in individuals, because it is a mean requirement for a
group, and the variation around this number is considerable. A
recommended dietary allowance (RDA) for a nutrient is
derived from an estimated average requirement (EAR), which
is an estimate of the intake at which the risk of inadequacy to an
individual is 50%.
Recommended Energy/Nutrient Intake (RENI)
- also known as Recommended Daily Allowances is a 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. The 2015 Philippine Dietary Recommended Intake
(PDRI) shall be used for planning and assessing diets for
individuals and groups, developing food-based dietary
guidelines, formulating standards and regulations on food
fortification, nutrition labeling and claims, and food safety,
designing and evaluating food and nutrition assistance
programs, determining food bundles, setting food production
targets, and other related uses that require consideration of
nutrient and dietary intakes.
- The average amount of a nutrient a healthy person should get
each day. RDAs vary by age, gender and whether a woman is
pregnant or breastfeeding. For example, the RDA for vitamin C
is 80 mg a day for a pregnant teenager and 90 mg a day for men.
RDAs apply to vitamins and minerals from food and daily
supplements. The purpose of these guidelines is to inform you
how much of a specific nutrient your body needs on a daily
basis. It is important to meet the daily recommended dietary
allowances so that your body gets everything it needs to
function.
- The Recommended Dietary Allowance (RDA) is the average
daily dietary intake level that is sufficient to meet the nutrient
requirement of nearly all (97 to 98 percent) healthy individuals
in a particular gender and life stage group (life stage considers
age and, when applicable, pregnancy or lactation).
- The RDA for a nutrient is a value to be used as a goal for dietary
intake by healthy individuals. The RDA is not intended to be
used to assess the diets of either individuals or groups or to plan
diets for groups.
- PDRI 2015 updated the 2002 Recommended Energy and
Nutrition Intake (RENI) with the following changes: (1)
Adjustment of reference weights for infants and children based
on the World Health Organization Child Growth Standards
(WHO-CGS) and Growth Reference, and those for adults based
on the weight to achieve Body Mass Index (BMI) of 22 using
the 2013 National Nutrition Survey (NNS) height data; (2)
Revision of age groupings to reflect established biological
patterns and recent international feeding guidelines; (3)
Updating of reference values arising from new scientific
evidence on human milk volume and on nutrient requirements;
(3) Inclusion of additional nutrients like polyunsaturated fatty
acids and removal of manganese; (4) Inclusion of Acceptable
Macronutrient Distribution Ranges for protein, total fat, and
carbohydrates for the reduction of chronic disease risk; (5)
Recommendation on maximum intake levels of sodium and free
sugars for the reduction of risk of cardiovascular disease,
obesity and dental caries; and (7) Clarification on the
appropriate Dietary Reference Intakes (DRI) values for different
uses and applications.
Adequate Intake (AI)
- is a 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.
- The AI is based on observed or experimentally determined
estimates of nutrient intake by a group (or groups) of healthy
people. For example, the AI for young infants, for whom human
milk is the recommended sole source of food for the first 4 to 6
months, is based on the daily mean nutrient intake supplied by
human milk for healthy, full-term infants who are exclusively
breastfed. The main intended use of the AI is as a goal for the
nutrient intake of individuals. For example: if an individual has a
total calorie in a day of 1,500, that individual can take at least 75%
of the total calorie for a day which is 1,125 calorie is allowable.
- Adequate Diet is composed of various nutrients which body
needs for maintenance, repair, and for growth and
development. An essential of an adequate diet are milk group
that provide most of the calcium requirements; meat group
that provides generous amounts of protein in high quality;
bread and cereal group that furnishes carbohydrates, minerals
and vitamins at a relatively at low costs; and vegetable fruit
group that important supplier of fiber, vitamins and minerals
particularly Vitamin A and C.
Tolerable Upper Intake Level or Upper Limit (UL)
- is a highest average daily nutrient intake level likely to pose no
adverse health effects to almost all individuals in the general
population.
- As intake increases above the UL, the risk of adverse effects
increases. The term tolerable intake was chosen to avoid
implying a possible beneficial effect. Instead, the term is
intended to connote a level of intake that can, with high
probability, be tolerated biologically. The UL is not intended
to be a recommended level of intake. There is no established
benefit for healthy individuals if they consume nutrient intakes
above the RDA or AI. ULs are useful because of the increased
interest in and availability of fortified foods and the increased
use of dietary supplements. ULs are based on total intake of a
nutrient from food, water, and supplements if adverse effects
have been associated with total intake. However, if adverse
effects have been associated with intake from supplements or
food fortification only, the UL is based on nutrient intake from
those sources only, not on total intake. The UL applies to
chronic daily use.
- For many nutrients, there are insufficient data on which to
develop a UL. This does not mean that there is no potential for
adverse effects resulting from high intake. When data about
adverse effects are extremely limited, extra caution may be
warranted.
Dietary Guidelines and Food Guides
Terminologies
• Food and Nutrition Research Institute (FNRI) – the
principal research arm of the government in food and nutrition,
is one of the research and development institutes of the
Department of Science and Technology (DOST).
• Nutritive value – the nutrient content of a specified amount
of food
• Pinggang Pinoy – is a nutrition tool for preparing healthy food
on a per meal basis. It was developed by the Department of
Science and Technology’s Food and Nutrition Research
Institute (DOST-FNRI).
• The 10 Kumainments – is the popular version of the revised
Nutritional Guidelines for Filipinos (NGF). The 10
Kumainments consists of shorter and simpler messages for
better recall and understanding.
 Food Pyramid
• The first pyramid was published in Sweden in 1974. The 1992
pyramid introduced by the United States Department of
Agriculture (USDA) was called the "Food Guide Pyramid" or
"Eating Right Pyramid". It was updated in 2005 to
"MyPyramid", and then it was replaced by "MyPlate" in 2011.
• The Food Pyramid is designed to make healthy eating easier.
Healthy eating is about getting the correct amount of nutrients –
protein, fat, carbohydrates, vitamins and minerals you need to
maintain good health. Grains should be taken as the major
dietary source. Eat more fruit and vegetables. Have a moderate
amount of meat, fish, egg, milk and their alternatives.
• The Philippines uses the daily nutritional guide pyramid and has
developed pyramids for different population groups. The
healthy food plate for Filipino adults (Pinggang Pinoy)
completes the messages of the pyramid by showing adequate
distribution of nutritious foods in a meal.
• Pinggang Pinoy, literally translated as Filipino Plate, is a visual
representation of what a person should consume on a per meal
basis. It is a plate-based food guide that features the right
proportion of food that contains the right nutrients needed by the
body of an average Filipino.
• Pinggang Pinoy is 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 Filipino adults. Pinggang Pinoy serves as
visual tool to help Filipinos adopt healthy eating habits at meal
times by delivering effective dietary and healthy lifestyle
messages.
• The FNRI’s vision is to provide innovative and timely food and
nutrition tools that will ensure a healthy and well-nourished
Filipino population. The FNRI recommends that each healthy
meal should be composed of 33% rice, 33% vegetables, 17%
meat, and 17% fruit. The Pinggang Pinoy aims to complement
and not replace the existing Daily Nutritional Guide (DNG)
Pyramid.
• The birth of Pinggang Pinoy or the Filipino food plate came as
a clamor from the nutrition community to develop a food guide
based on a per meal basis for a healthy adult. Contrary to what
others thought to be a replacement of the Daily Nutritional
Guide (DNG) Pyramid for Filipinos, Pinggang Pinoy serves as
a quick and easy guide for determining the amount of food from
the three basic food groups should a Filipino eat per meal. The
DNG Pyramid, on the other hand, shows at a glance the whole
day’s healthy food intake recommendation for Filipinos in order
to have a balanced diet. Both tools are based on the latest
scientific findings about how food, drink and activity choices
affect people’s health. Food guides themselves are not unique.
In fact, almost every country has its own version of a food guide.
• As its name suggests, Pinggang Pinoy is specially designed for
Filipinos which features the GO, GROW and GLOW foods
represented by food items commonly consumed by the
population. Go food represents carbohydrates, Grow food
represents protein and Glow food represents vitamins and
minerals. The three food groups are called Go, Grow and Glow
because these terms describe the function of each food group in
the body. Go or energy-giving foods, such as rice, grains and
other starches, provide energy to keep one going throughout the
day.
• Grow or body-building foods, such as meat, fish, dairy and
eggs, provide the protein and minerals necessary for the
growth and repair of tissues, muscles and bones. Recognizing
the different nutrient requirements of the different age groups,
the FNRI has developed the Pinggang Pinoy plates for
children, adolescents, pregnant women and lactating mothers
and the elderly.
• The “Pinggang Pinoy” can be used side by side with the
existing Daily Nutritional Guide (DNG) Pyramid for Filipinos
but it will not replace it. According to FNRI, Pinggang Pinoy
is a quick and easy guide on how much to eat per mealtime,
while the DNG Pyramid shows at a glance the whole day food
intake recommendation. Both the “Pinggang Pinoy” and the
DNG Pyramid for Filipinos are based on the latest science
about how our food, drink, and activity choices affect our
health.
• The Daily Nutritional Guide (DNG) Pyramid is a simple,
trustworthy guide in choosing a healthy diet. It builds from the
base, showing that we should eat more foods from the bottom
part of the pyramid like vegetables, whole grains and less from
the top such as red meat, sugar, fats and oils. When it’s time to
eat, most of us use a plate. So it is just appropriate to use the
“Pinggang Pinoy” as a guide for a typical balanced meal. Eat
the right amount of calories for the body based on age, sex,
height, weight, and physical activity level. The basic food
groups are that an individual needs in every plate are
alternation of breads, cereals, rice, pasta, noodles and other
grains, vegetables and legumes, fruit, milk, yoghurt, cheese
and/or alternatives, lean meat, fish, poultry, eggs, and nuts.
Food Exchange List
• The Food Exchange Lists (FEL) for 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. Exchange lists provide a
way of grouping foods together to help people on special diets
stay on track. Each group lists foods in a certain serving size.
• In the food exchange list, commonly use foods are divided into
seven groups or list. Each list or group contains approximately
the same amount of carbohydrates, proteins, fats and calories
per exchange. A food in any one group can thus be substituted
for or exchange with another food in the same list or sub-
group. This food list can be use in meal plan but substituting
each group in the same group. Nurse can use this list to give
more choices in planning a meal for a client.
• The Exchange Lists is basic tool in nutrition and used in mean
planning, diet instruction and estimating the energy and
macronutrient content of normal and therapeutic diets.
This tool was developed by the Food and Nutrition Research
Institute, DOST.
• The following sample menu for a 1200-calorie meal plan
includes a total of 5 starch exchanges, 2 fruit exchanges, 2 milk
exchanges, 3 non-starchy vegetable exchanges, 5 meat
exchanges, and 4 fat exchanges daily. The following sample
menu for a 1500-calorie meal plan includes a total of 6 starch
exchanges, 3 fruit exchanges, 3 milk exchanges, 4 non-starchy
vegetable exchanges, 6 meat exchanges, and 4 fat exchanges
daily. A diabetic exchange diet is a list of serving sizes of foods
that a client can choose to eat every day. A nurse can help
control the blood sugar by limiting the carbohydrate and total
calories in the diet.
Food Labels
• Food labels provide more than just nutrition facts, though. They
also tell the public what's in a packaged food (i.e., the
ingredients). Food manufacturers are required to list all
ingredients in the food on the label. But some ingredients can be
listed collectively as "flavors," "spices," "artificial flavoring," or
in the case of color additives exempt from certification,
"artificial colors", without naming each one.
• Some food labels also state which country the food came from,
whether the food is organic, and certain health claims. Food
labels are a legal requirement and they are important for many
reasons. They help consumers make informed choices about the
food they buy, help them to store and use it safely and allows
people to plan when they will consume it – all of which help to
reduce food wastage. Food labels carry useful information to
help the public make good choices about food. The food label
will tell if the food contains an additive that the public may want
to avoid. The nutrition information panel helps to compare the
nutrient profile of similar products and choose the one that suits
the needs.
• A label serves three primary functions: (1) it provides basic
product information including common name; (2) it provides
health, safety, and nutrition information including: allergen
information; (3) it acts as a vehicle for food marketing,
promotion and advertising. The first step in making food labels
work for the public is to look at the entire label. If the public
focus on only one part — like calories or vitamins — public may
not be getting the full story, like how much sugar or fat is in the
product.
• The following is a quick guide to reading the Nutrition Facts
label: Step 1: Start with the Serving Size; Step 2: Check Out
the Total Calories; Step 3: Let the Percent Daily Values Be a
Guide; Step 4: Check Out the Nutrition Terms; Step 5: Choose
Low in Saturated Fat, Added Sugars and Sodium.
• Always start with the serving size amount. That's because all
the information on the rest of the label from calories to
vitamins is based on that amount. Take note of how much a
serving is. Sometimes a serving size will be way less than
you're used to eating — like only half a cup of cereal. The label
will also list how many servings are in the package. Even
things that seem like they'd be a single serving, such as a bottle
of juice may contain more than one serving. If the public drink
the whole thing, they're getting more vitamins and minerals
but they're also getting way more calories, sugar, fat, and other
stuff that the public might not want. A calorie is a way to
measure how much energy a food provides to the body. The
number on the food label shows how many calories are in one
serving of that food. To get a rough idea of how many calories
you need to eat each day.
• Obviously, optimal health requires a person to eat clean the
majority of the time. Clean, meaning as close to the foods
natural state as possible.
Here are 10 ingredients to avoid whenever possible because they’re
pure garbage:
• (1) Trans fats (hydrogenated oils) - used in food to enhance
the taste and extend the shelf life, trans fats are dangerous
because they increase the body’s LDL (“bad”) cholesterol
while decreasing HDL (“good”) cholesterol; they also
heighten the risk of heart disease, diabetes, and a host of other
health problems.
• (2) High-fructose corn syrup (HFCS) is a highly refined
sweetener that’s found in most processed foods. This additive
is so calorie-dense it’s one of the major contributors to the
obesity epidemic.
• (3) Artificial sweeteners (sucralose, aspartame, and
saccharine) are made with chemicals known to be neurotoxins
and carcinogens, affecting brain function. Some of these
chemicals affect your weight by triggering the hormone that
instructs your body to store fat, and decreasing levels of
serotonin (which regulates your mood, sleep cycle, and
digestion).
• (4) Artificial colors (Red no. 40, Yellow no. 6, Blue nos. 1
and 2) has been linked to attention-deficit/hyperactivity
disorder (ADHD), chromosomal damage, and thyroid cancer,
among other conditions.
• (5) Sodium nitrites and nitrates food additives are used to
preserve, flavor, and add color to processed meats like bacon,
ham, and hot dogs. They’re carcinogenic and can negatively
affect the function of the liver and pancreas, the organ
responsible for insulin production.
• (6) Growth hormones (rBST and rBGH) studies have linked
growth hormones, which are given to conventionally raised
dairy cows and cattle, to early puberty and obesity.
• (7) Monosodium glutamate (MSG) a flavor enhancer often
found in soups, seasonings, frozen entrees, and many
restaurant foods, MSG is known to overexcite brain cells in
the hypothalamus. Studies have shown this may increase
hunger and trigger strong food cravings, leading an individual
to overeat.
• (8) Butylated hydroxyanisole (BHA) and butylated
hydroxytoluene (BHT) a preservatives in cereals, chewing gum,
and potato chips. In large quantities, both BHA and BHT can
wreak havoc in the body, from disrupting the endocrine system
to producing cancer-causing compounds.
• (9) Antibiotics can get from aating farm animals that have been
administered antibiotics passes along those drugs to our bodies.
Steady doses of antibiotics can affect our ability to break down
carbohydrates, absorb vitamins and minerals, and synthesize
hormones.
• (10) Pesticides with dichlorophenol or 2.5-DCP, in particular
has been linked to childhood obesity. These chemicals disrupt
the endocrine system, causing the body’s metabolic system to
malfunction.
Nutrient Guidelines for Filipino
• The Nutritional Guidelines for Filipinos (NGF) is 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. The first NGF released in
1990 was composed of five messages called “Dietary
Guidelines for Filipinos.” In 2000, a revised nutritional
guidelines composed of ten messages was released and it was
called the Nutritional Guidelines for Filipinos. In 2012, the
Technical Working Group (TWG) for the revision of the NGF,
led by the Food and Nutrition Research Institute of the
Department of Science and Technology (FNRI-DOST)
developed a new set of the NGF, based on the 2000 edition.
• The 2012 NGF now includes the basis and justification for each
of the ten nutritional and health message. The following 2012
NGF:
(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
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. 9*0
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 beverage, and do not smoke to help
prevent lifestyle-related non-communicable disease.
• 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. Vegetables and fruits are the main
sources of vitamins, minerals, and fiber, while milk is a good
source of calcium. Low urinary iodine excretion is still a
prevalent problem among pregnant and lactating mothers,
indicating to 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. High
cholesterol level 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. Excessive intake of salt and soy sauce can result to
high blood pressure especially to salt-sensitive individuals.
Persistent high blood pressure can result to 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%. People are always
encouraged to exercise at least thirty minutes a day, three to
five times a week. Limit 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.
• The Guidelines further enhances that all Filipinos must adhere
to follow a healthy eating pattern across the lifespan. All food
and beverage choices matter. Focus on variety, nutrient
density, and amount. Limit calories from added sugars and
saturated fats and reduce sodium intake. Shift to healthier food
and beverage choices and support healthy eating patterns for
all.
USDA Food Guide
• The Dietary Guidelines for Americans (Dietary Guidelines) is
the cornerstone for Federal nutrition programs and a go-to
resource for health professionals nationwide. The Dietary
Guidelines provides food-based recommendations to promote
health, help prevent diet-related chronic diseases, and meet
nutrient needs.
• Serving Up MyPlate is a collection of classroom materials that
helps elementary school teachers integrate nutrition education
into Math, Science, English Language Arts, and Health. This
yummy curriculum introduces the importance of eating from
all five food groups using the MyPlate icon and a variety of
hands–on activities. Students also learn the importance of
physical activity to staying healthy.
• The Healthy Eating Index is a summary measure of overall
diet quality. It provides a picture of the types and quantities of
food people eat and the degree to which diets comply with the
recommendations set forth in the Dietary Guidelines and the
Food Guide Pyramid.
• Half of Americans (53 percent) feel like food labels are
sometimes misleading, new research suggests. In fact, mistrust
in food labels extends to 11 percent of Americans who find
food labels to be completely untrustworthy. But it's not just
sugar that tops the list of concerns for Americans. The Food
and Drug Administration (FDA) is responsible for assuring
that foods sold in the United States are safe, wholesome and
properly labeled. This applies to foods produced domestically,
as well as foods from foreign countries.
 Nutrition Care Process (ADIME Process)
Terminologies
✓ Food Recall – is a method of collecting information on food
intake wherein trained researchers/interviewers ask the
respondent or sample subject to recall all food eaten and the
amount consumed for the past 24 hours, starting from wake-up
time in the morning until sleeping time at night, including in-
between meals and midnight snacks.
✓ Nutritional Assessment – Nutrition is the Care Process (ADIME
interpretation
anthropometric, biochemical (laboratory), clinical and dietary
data to determine whether a person or groups of people are well
nourished or malnourished (over-nourished or under-
nourished).
✓ Nutrition Intervention – Is the process the nurse then selects
the nutrition intervention that will be directed to the root cause
(or etiology) of the nutrition problem and aimed at alleviating
the signs and symptoms of the diagnosis.
✓ Nutrition Monitoring/Evaluation – Is the final step of the
process is monitoring and evaluation, which the RDN uses to
determine if the client has achieved, or is making progress
toward, the planned goals. Nutritional Status or
✓ Nutriture – is the degree to which the individual’s
psychological need for nutrients is being met by food she or he
eats. It is the state of balance in the individual between the
nutrient intake and the nutrient expenditure or needs.
✓ Nutritional Survey – is an epidemiological investigation of the
nutritional status of the population.
Nursing Care Process
nd Dietetics Law of 2016 was enacted to regulate and standardize the practice
and dietetics in the Philippines, with a provision on Medical Nutrition
MNT) through the application of Nutrition Care Process (NCP) for purposes
revention, treatment, and management.
sually the first person who sees and observes the patient’s eating problem,
irect communication with the patient on how well the patient’s eats his food,
ds and amounts of food are refused. A nurse is responsible for the patient’s
ards his food readily determined and must have knowledge in diet therapy
ed / restriction). A nurse should immediately forward the diet prescription
ry department and makes sure that the patient is ready to consume the food
he tray.
s and shows his/her general interest and understanding of the patient, helps
express his/her feelings, learned from the patient some of his/her favorite
dislikes, explains concerns on foods that cannot be eaten due to ethnic,
ckground and religious beliefs and becomes aware of what concerns the
have about the diet he will have at home. Nurse, also reports and documents
l the problems related to food intake
are process is synonymous with individual’s nutritional problem – solving
or discovering the healthcare, nursing and nutritional care needs of clients.
through the nutritional care process, nurses will be able to build its own
ody of knowledge to help those with nutritional needs.
on Care Process (NCP) is a systematic approach to providing high quality
are. The NCP consists of four distinct, interrelated steps: nutritional
nutritional diagnosis; nutritional implementation; and nutritional
and evaluation.
A. Assessment of Nutritional Status
• The purpose of nutritional screening is to rapidly identify
patients at high nutritional risk. The purpose of nutritional
assessment, however, is to define a patient's nutritional status,
to define clinically relevant malnutrition and to monitor
changes in nutritional status.
Diet History and Intake Data
➢ A. 24 Hour Recall – patient or individual completes a
of Process)
questionnaire or maybe an interview asking to recall
everything that he or she ate within the last 24 hours.
➢ B. Food Frequency Questionnaire – patient answers the
questionnaire for frequency of food use as accurately as
possible
➢ C. Dietary History – contains additional information about
the patient’s income, physical activity, ethnic and cultural
background, influence s on eating habits and religion, home
life and meal patterns, factors that affect appetite, allergies,
intolerances, food avoidance, dental and oral problems in
eating, gastrointestinal problems, chronic diseases, dietary
modifications and medication. Examples: Ethnic and Religion
- Christianity practices holy week observances may restrict
meat (Good Friday); Seventh Day Adventist do not eat pork
and shellfish, do not drink alcohol, and encourages vegetarian
diet; Judaism do not eat pork, shellfish, blood products, mixing
of milk or dairy products with meat in one meal, Kosher diet,
no cooking during Sabbath day (Saturday); Mormon - no
alcohol, tobacco and caffeine; Islam – no pork (Haalal diet),
no alcohol, caffeine, practices Ramadam (fasting from sunrise
to sunset of the month); and Hinduism – all meats are
prohibited. Examples of food avoidance: Phenylalanine
(EAA) – low protein diet to avoid imbalance of brain amino
acids in Phenylketonuria; Purine that needs to be avoided to
reduce uric acid producing foods in gouty arthritis and
hyperurecemia; Tyramine is a high protein foods that
underwent protein breakdown by aging, fermentation and
smoking. Avoid Gluten intake which is a protein found in
wheat, rye, barley, and other starchy foods, except rice and
corn in Celiac Disease. Taking medications must also be
cautious with taking food like Monoamineoxidase Inhibitors
(MAOI), an antidepressants, that must be to avoid tyramine
containing foods like alcoholic beverages, dairy products,
avocado, banana, meats, chocolates and condiments causes
hypertensive crisis. Warfarin Sodium (Coumadin) is an
anticoagulant, avoid or instruct the patient to decrease intake
of green leafy vegetables. Methimazole (Tapazole) is an anti-
thyroid, uses for Hyperthyroidism, inhibits synthesis of
thyroid hormone by interfering with iodine. Teach the client to
avoid seafood and iodine products. Estrogen Replacement
Therapy (HRT) that manages menopausal symptoms in
women. Estrogens increase risk of cardiovascular disease and
cancer so instruct the patient to AVOID or reduce alcohol,
caffeine and smoking.
➢ D. Food Diary or Record – this method involves time,
understanding and motivation on the part of the patient as she
or he writes down everything he or she eats or drinks for a
certain period of time.
➢ E. Observation of Food Intake – most and accurate method
of dietary intake assessment, because it requires knowing the
amount and kind of food presented to the patient and record
the amount actually eaten.
• The nurse must take into consideration the General Rules for
Menu Planning: (1) Use the whole day as a unit rather than the
individual meal. (2) Use some food from each of the food groups
daily (energy giving foods, body building foods and body
regulating foods). (3) Use some raw fruits or vegetables at least
once a day. (4) Plan to have for each meal at least one food with
staying power or high in satiety value. (5) Combine or alternate
bland form with those of a more pronounced flavor. (6)
Combine and alternate soft and crisp foods. (7) Have a variety
of color, food and food arrangement. (8) When more foods are
served at one meal, decease the size of portions and use fewer
rich foods. (9) Meal or menu patterns are helpful in planning
menu but consider the family’s habits and needs. The traditional
recommended patterns for breakfast like fruit, egg or substitute,
bread or rice, hot beverage and for lunch and dinner: meat, fish
and poultry, rice, vegetable and fruit or dessert. (10) It is best to
have a weekly menu plan.
Physical Assessment
• The assessment of the nutritional status involves two methods:
Direct which deals with individuals and measures the objective
criteria and indirect which uses community health indices
reflecting nutritional influences. A nurse can provide direct
information by performing clinical examination with the use of
system that collects data starts from the head to toe
(cephalocaudal) and interviewing the client as the primary
source of data and other significant others to establish data base.
It covers the examination of the client in a short time,
inexpensive, with no sophisticated equipments but it has a
disadvantage as non-specificity of signs, overlapping of
deficiency states and bias of the observer. The biochemical
examination is the estimation of enzyme activity or blood
composition; tests samples are blood and urine and results
generally compared to standards with advantages as objectivity
and can detect easily states of nutritional deficiency and
disadvantages as costly and time consuming.
Anthropometric Measurement
• It is the measurement of the variations of the physical
dimensions and gross composition of the human body at
different age levels and degrees of nutrition. Anthropometric
measurements included weight, height, body mass index (BMI),
body circumference (arm, waist, hip and calf), waist to hip ratio
(WHR), elbow amplitude and knee-heel length. It can be weight
for age that uses weighing scale, assess body mass by computing
the body mass index with formula of weight in kg over height in
meter squared in kg/meter squared. For most adults, an ideal
BMI is in the 18.5 to 24.9 range. Height for age can uses
statiometer, is an anthropometric steel rods fixed accurately and
vertically to the wall. Weight for height/length is the most
accurate indicator of present state of nutrition, an expression of
leanness or wasting with a formula of desirable body weight is
equal to height in centimeter minus 10%. Nurse can also
measure the skin fold thickness with the use reliable caliper and
an ideal and healthy waistline which is for women - < 31 inches
and for men -< 35 inches. Waist Circumference alone is accurate
measure of the amount of visceral fat (CENTRAL OBESITY).
• Body composition is the proportion of fat and non-fat mass in
the body. A healthy body composition is one that includes a
lower percentage of body fat and a higher percentage of non-fat
mass, which includes muscle, bones, and organs. People are
born with an inherited body type based on skeletal frame and
body composition.
Most people are unique combinations of the three body types:
ectomorph, mesomorph, and endomorph. Ectomorphs are long
and lean, with little body fat, and little muscle. Endomorph has a
big, high body fat, often pear-shaped, with a high tendency to store
body fat. Mesomorph has a muscular and well-built, with a high
metabolism and responsive muscle cells. Having a good body
composition has many benefits, including: (1) Decreased risk of
type 2 diabetes, hypertension, and heart disease; (2) Increased
functional ability, allowing us to move and exercise more freely,
which allows us to burn more calories; (3) A better calorie-burning
metabolism throughout the day; (4) A lean and toned body.
Nutrition and exercise are critical for improving body
composition. Keeping your calories, fiber and protein in check is
a good first step. All exercise can help with fat loss, but weight
training is the best way to increase muscle mass.
• Sample Body Composition Exercises are modified push-up,
traditional push-up, stability ball push-up, front lunge or
walking lunge exercise, lunge variations, overhead lunge,
squat exercise with an overhead press and abdominal plank
exercises. Waist Circumference (cm) the narrowest point
divided by hip circumference (cm) widest point. Then the
normal findings for men is - < 1 and for women is - < 0.85.
Equal to or greater than 1 (men), 0.85 (women) means android
or central obesity.
Mid-arm Circumference (MAC) or
Mid-Upper Arm Circumference (MUAC)
• It is the circumference of the left upper arm, measured at the
mid-point between the tip of the shoulder and the tip of the
elbow (olecranon process and the acromium). MUAC is used
for the assessment of nutritional status. It is easy to measure
MUAC even on very thin arms. In order to perform the
measurement, the client bends the left arm, find and mark with
a pen the olecranon process and acromium. Mark the mid-
point between these two marks. With the arm hanging straight
down, wrap a MUAC tape around the arm at the midpoint
mark. Measure to the nearest 1 mm.
• Wasting is used as an indicator for acute under nutrition, often
assessed by weight-for-height and Mid-Upper Arm
Circumference (MUAC). Over the years MUAC is being used
as an age independent criterion for assessing acute under
nutrition among children. It can be used for rapid diagnosis of
PEM in children 1-4 years of age. The results can be measured
as less than 12,5 cm classified as under nutrition; 12.5 to 13.5
cm classified as risk under nutrition; and more than 13.5 to 16
cm classified as adequate nutrition. In adult, a measure below
23.5 centimeters, or 9.25 inches, indicates that the person may
be underweight or borderline underweight with a BMI of 20
or lower. An upper-arm circumference of 32 centimeters, or
12.6 inches, indicates a BMI of 30 or greater, or obesity.
Meaning the normal is 24-31 centimeters. The MUAC tape
(Mid-Upper Arm Circumference) is a durable, sterilizable
bracelet that is wrapped around a child's arm to determine
malnourishment severity and appropriate treatment plan.
Fat-fold or Skin-fold Thickness
• It is an assessment of body composition and fat distribution.
Skin-fold thickness describes the amount of subcutaneous fat
when the fold is lifted and its thickness measured by
specialized calipers. The thickness of these folds is a measure
of the fat under the skin, also called subcutaneous adipose
tissue. Skin-fold thickness results rely on formulas that convert
these numbers into an estimate of a person's percentage of
body fat according to a person's age and gender.
The good skin fold measurement score is for male 81-90 and for
female is 91 -100 and for athletic male is 61-80 and for athletic
female is 71-85.
Malnutrition Universal Screening Tool (MUST)
• It is use to assess level of malnutrition. It also includes
management guidelines which can be used to develop a care
plan. It is for use in hospitals, community and other care settings
and can be used by all care workers. There are 4 broad sub-forms
of under nutrition: wasting, stunting, underweight, and
deficiencies in vitamins and minerals. Under nutrition makes
children in particular much more vulnerable to disease and
death. Low weight-for-height is known as wasting. It usually
indicates recent and severe weight loss, because a person has not
had enough food to eat and/or they have had an infectious
disease, such as diarrhea, which has caused them to lose weight.
A young child who is moderately or severely wasted has an
increased risk of death, but treatment is possible. Low height-
for-age is known as stunting. It is the result of chronic or
recurrent under nutrition, usually associated with poor
socioeconomic conditions, poor maternal health and nutrition,
frequent illness, and/or inappropriate infant and young child
feeding and care in early life. Stunting holds children back from
reaching their physical and cognitive potential. Children with
low weight-for-age are known as underweight. A child who is
underweight may be stunted, wasted, or both.
Subjective Global Assessment (SGA)
• It is a type of clinical tool doctors use to determine a person's
overall state of health. It is most often used when assessing
chronic renal insufficiency. The Subjective Global Assessment
(SGA) is a type of clinical tool doctors use to determine a
person's nutritional status. It has been applied successfully to
assess nutritional status in a variety of patient populations,
including oncology patients, patients receiving gastrointestinal
surgery, dialysis patients, HIV/AIDS patients, lung transplant
recipients, liver transplant candidates, geriatric patients, and
post-Whipple procedure patients.
Mini Nutritional Assessment (MNA)
• It has recently been designed and validated to provide a single,
rapid assessment of nutritional status in elderly patients in
outpatient clinics, hospitals, and nursing homes. It has been
translated into several languages and validated in many clinics
around the world. The Mini Nutritional Assessment Short-
Form (MNA®-SF) is a screening tool used to identify older
adults (> 65 years) who are malnourished or at risk of
malnutrition. An in-depth assessment and physical exam
should be performed when patients are identified to be
malnourished or at nutritional risk.
Geriatric Nutritional Risk Index (GNRI)
• It is comparable to the mini nutritional assessment for assessing
nutritional status in elderly hospitalized patients. Patients at
risk of malnutrition and related morbidity and mortality can be
identified with the Nutritional Risk Index (NRI). However, this
index remains limited for elderly patients because of
difficulties in establishing their normal weight.
B. Nutrition Diagnosis and Plan of Care (GNRI)
• Nutritional diagnosing is a process which results to a diagnostic
statements or nutritional diagnosis. It is the clinical act of
identifying nutritional problems. It is a clinical judgment about
individual, family or community responses to nutritional health
problems or life processes.
It provides basis for the selection of nursing intervention to achieve
outcomes for which the nurse is accountable for the nutritional
needs of everyone. It is a judgment made only after through
systematic data collection and use of different nutritional tools. It
is also a clinical art of identifying nutritional problems after
analyzing nutritional assessment information and identifying the
client’s needs and to prepare diagnostic statements.
• Planning of nutritional care involves determining beforehand
the strategies or course of actions to be taken before
implementation of nutritional care. There must be formulation
and documentation of client focused goals on nutritional
problems or care to be rendered to client.
• To be effective, the nurse provide individualized nutritional
care by establishing priorities, promote client and significant
others for participation in planning nutritional needs of the
client pertaining to preparation and meal planning, allow
involvement of client support people in planning. There must
be a direct client care activities and allow for delegation of
specific activities to promote continuity of nutritional care.
There must be a short term goal and long term goal and a well
stated outcome criteria to identify appropriate nutrition
interventions.
C. Nursing Intervention
• Nutrition interventions or implementations are skills
performed competently by the nurse in performing
appropriate nutritional care environment that includes client’s
safety and carry out planned nursing interventions to help
attain goals and achieve optimal level of health and to
determine the order in which nutritional care are carried out.
There must be a relevant documentation should be done to
help client achieve the nutritional care goals and achieve
optimal level of health.
• It involves planning and implementation, prioritizing the
nutrition diagnoses, setting goals and defining the intervention
strategy and detailing the nutrition prescription. Collaborative
with counselor- patient relationship, to set priorities, establish
goals and create action plans for selfcare to treat an existing
condition and promote health. Make a referral to or
coordination of nutrition care with other health care providers,
agencies to assist in managing nutrition related problems.
Individualized approach for food/nutrient provision such as
meals, snacks, supplements. Instruct a pt/client in a skill or to
impart knowledge to help them manage or modify food
choices and eating
Foodbehavior to maintain
and Nutrient or improve health.
Delivery
• It is an individualized approach for nutrition support that can
be given orally, enterally or parenterally depending on clinical
status of the client. Diet manuals are institutional set meal plans
determined to address a variety of nutritional needs.
Food Administration
• Currently, a diet is a physician order with medical implications
for patient safety. Diet modifications are often needed for
chronic illness and food textures. Often diets must be held for
procedures, such as CT scan, MRI, and catheter laboratory but
not for surgery until the procedures are done. Clients on NPO
for greater than 4 days are considered are risk and will require
a nutrition consult.
Oral Nutrition
• Oral intake is always preferred and can be encouraged with
assistance, food quality, bed positioning, and
supplementations. Selected therapeutic diet can be done with
order from a doctor.
A therapeutic diet is a medically prescribed eating plan
recommended as a mode of treatment for a chronic disease. It usually
requires an individual to eliminate or limit certain types of foods, eat
more of certain types of foods, change the consistency of foods or
alter the eating pattern. There are measures to stimulate the appetite
to eat for the client. (1) serve food in pleasant and attractive manner;
(2) place patient in a comfortable position; (3) provide good hygiene
measures; (4) promote comfort - relieve pain, adequate ventilation
and humidity; (5) remove unsightly articles ,check very tight or very
loose dressing; (6) remember that colors affects appetite to eat
including yellow, green-colored foods; (7) engage in pleasant
conversation; and (8) curtain the unit of patients who are on NPO or
very ill.
Short-Term Enteral Access
➢ Enteral Nutrition/Tube Feeding
• Provide enteral nutrition for clients who cannot swallow,
with esophageal obstruction, unconscious, and cannot
consume oral feeding. Before inserting the tube to the client,
prepare rubber tube and put to ice; and if plastic put to warm,
it can be Levine with single lumen or salem sump with
double lumen. Put the client in high fowler’s, if
contraindicated place right side lying position with head
slightly elevated to prevent aspiration. Measure the distance
from the tip of the nose to earlobe through the bottom of the
xiphoid process (adult). Measure the distance from the tip of
the nose to earlobe through the midway of xiphoid process
and umbilicus (children). Use water soluble jelly as
lubricant. Offer sips of water and advance tube forward, head
bent forward closes the epiglottis and trachea. Then check
for patency by injecting 10 ml of air and auscultate for
gurgling sound in the epigastrium. Aspirate for residual
stomach content (ph 1-3 of yellow to green). X-ray confirms.
The nurse must flush with 30-60 ml of water before and after.
If NGT is to removed, instruct client to exhale and remove
tube with smooth, continuous pull. The nurse must
remember that never give without checking; give
warm(room temperature); turn to right side during the
feeding for the stomach to empty better; use gravity, never
force feeding; be sure to aspirate; and end with water and
chart. There are types of enteral formulation: (1) ready to use
formulations and (2) blenderized tube feeding with soft diet
allowances which can be blenderized easily.
• There are complications in enteral feeding: (1) mechanical -
nasopharyngeal irritations with ice chips; luminal
obstruction that needs to flush or replace tube; mucosal
erosions that needs to reposition tube, provide ice water
lavage, or remove the tube; tube displacement that needs to
replace tube; and aspiration that needs to discontinue tube
feeding. (2) gastrointestinal - cramping/distention that needs
to change formula, or reduce infusion rate; vomiting/diarrhea
that needs to dilute formula, or reduce infusion rate; and
constipation that needs to promote sufficient fluids and
fibers, and encourage patient activity, (3) metabolic -
hypertonic dehydration that needs to increase water; cardiac
failure that needs to reduce sodium content, fluid restriction;
renal failure that needs to decrease phosphate, magnesium,
potassium, CHON restriction, amino acids solution; glucose
intolerance that needs to reduce infusion rate; and hepatic
encephalopathy that needs to decrease amount of CHON.
Long-Term Enteral Access
➢ Parenteral Nutrition
Peripheral Parenteral Nutrition (PPN)
• is a way of providing nutrients that are given via small veins,
usually in the arms and Total Parenteral Nutrition (TPN) is
also called Central Parenteral Nutrition (CPN) or
intravenous hyperalimentation (IVH); nutrients are given
centrally into the superior or inferior vena cava or the jugular
vein. TPN solutions are nutritionally complete based on the
patient’s weight and caloric/nutritional needs. TPN is
indicated in clients who need extensive nutritional support
over an extended period like CA and severe malnutrition.
TPN consists of a mixture of dextrose, amino acids,
multivitamins, electrolytes and trace of minerals. The usual
site is sub-clavian vein. During TPN catheter insertion,
trendelenburg position is the best position to engorge the
vein and facilitate insertion of the vein and prevent air
embolism. The primary purpose of TPN is to administer
glucose. Administer TPN at room temperature and cold
temperature of solution may cause chills. Consume TPN
formula for 24 hours to prevent contamination. The TPN
solution is hypertonic (25-35% of dextrose). Use infusion
pump to maintain steady infusion this prevents abnormal
shifting of fluids from intracellular compartment to the
extracellular compartment (cells shrink). If infusion is
delayed do not catch up – notify physician for calculation.
Monitor urine and glucose level. Glycosuria is expected.
The client may need small amount of insulin as prescribed
by the physician to prevent glucose intolerance. Prevent
infection on the catheter site. Infection is the most common
complication of TPN. If TPN administration is interrupted
or discontinued, administer D10W to prevent hypoglycemia.
There must have thermometer, and glucometer in the
bedside.
D. Monitoring Nutritional Status
• Nutritional status or nurture is the degree to which the
individual’s psychological need for nutrients is being met by
the food the person eats. It is the state of balance in the
individual between the nutrient intake and the nutrient
expenditure or need. the evaluation of the nutritional status
involves examination of the individual’s physical condition
,growth and development, behavior ,blood and tissue levels of
nutrients and the quality and quantity of the nutrient intake in
a thorough nutritional status assessment all of the following
aspects are considered: (a) dietary history (b) biochemical data
(c) clinical examination (d) anthropometric data and (e)
psychosocial data.
E. Nutritional Evaluation
• The goals established in the planning phase are evaluated
according to specific desired outcomes, also established in that
phase. If the outcomes are not achieved, the nurse should
explore the reasons. The nurse might consider the following
questions: Was the cause of the problem correctly identified?
Was the family included in the teaching plan? Are family
members were supportive? Is the client experiencing
symptoms that cause loss of appetite (e.g., pain, nausea,
fatigue)?, Were the outcomes unrealistic for this person?, Were
the client’s food preferences considered?, Is anything
interfering with digestion or absorption of nutrients (e.g.,
diarrhea)
 Nutrition Across the Lifespan
(Pregnancy, Infancy, Toddler and Pre-school
Terminologies
✓ Dawdling – to spend time wastefully on eating, the child is
playing while eating
✓ Lactating women – women who are pregnant or recently gave
birth, lactation is normal with the process of producing breast
milk.
✓ Letdown Reflex – an involuntary reflex during the period of
time when a women is breastfeeding which causes the milk to
flow freely
✓ Newborn Screening Act – illustrates a procedure to detect a
genetic and metabolic disorder in newborns that may lead to
mental retardation and even death if left untreated.
✓ Supplementary foods – refer to the food that is used to
complement breast milk or the food that complements and / or
supplements other foods used during weaning period.
✓ Toxemia of Pregnancy – a condition in pregnancy, also known
as preeclampsia characterized by abrupt hypertension (a sharp
rise in blood pressure), albuminuria (leakage of large amounts
of the protein albumin into the urine) and edema (swelling) of
the hands, feet, and face.
✓ Total Energy Requirement – is the average dietary energy
intake that is predicted to maintain energy balance in healthy,
normal weight individuals of a defined age, gender, weight,
height, and level of physical activity consistent with good
health.
Nutrition Through Life Cycle
• From Pregnancy to the Pre-school Years", all people need the
same basic nutrients—essential amino acids, carbohydrates,
essential fatty acids, and twentyeight vitamins and minerals—
to maintain life and health. However, the amounts of needed
nutrients change as we pass from one stage of the human life
cycle to the next. Young children require a higher caloric intake
relative to body size to facilitate physical and mental
development. On the other hand, inactive senior citizens need
fewer calories than other adults to maintain their weight and
stay healthy. Psychological, emotional, and social issues over
the span of a human life can also influence diet and nutrition.
Therefore, it is important to weigh a number of considerations
when examining how nutrient needs change. In this course unit,
we will focus on diet, nutrition, and the human life cycle from
pregnancy to the remainder of childhood years.
A. Nutrition in Pregnancy and Lactation
• Nutrition is what the pregnant women eat and how the body
uses it to maintain life by allowing one to grow and be in state
of optimum health. It ensures optimum nutrition before, during
and after pregnancy and during lactation. The characteristics of
pregnancy started from the fertilization of ovum and
implantation in the uterus; human pregnancy lasted for a period
of 266 to 280 days (37-40 weeks); consists of three trimesters
and has three main phases – implantation, organogenesis,
growth.
• In Nutrition in Pregnancy, the nurse always starts with diet
history when it comes to giving nutritional instruction to the
mother. Ask for any PICA – persistent ingestion of inedible
substances of little nutritional value. If the pregnant mother is
vegetarians – there will be lack of essential protein and
minerals, need Vitamin B12 supplementation.
The calories requirements for non-pregnant requirements is 1,800
to 2,200 Kcal/day with additional caloric requirement per day is
300 Kcal/day for pregnant mother and 500/day for lactating
mother, and the usual daily caloric need in pregnancy – 2,100 to
2,500; never less than 1,800 Kcal/day. Even an obese pregnant
woman can never consume less than 1,500 kcal per day. The
nutritional requirements for lactating women are greater than in
pregnancy to ensure enough supply of milk for the baby. Weight
is the most indicator if the woman has adequate caloric intake. for
The nurse weighs the mother every clinic visits with 1 lb per month
during the first trimester and 1 lb per week during the second and
third trimester increasing per visit and the usual maternal weight
gain is 24 to 35 lbs. The maternal underweight causes having high
risk of low birth weight, preterm and infant deaths while the
maternal over weight causes having risk of complications in labor
and delivery, hypertension, gestational DM, post partum
infections. The pregnant must have a protein allowances and needs
to serve body-building foods. The nurse can provide additional 30
g/day of protein to ensure 74 to 76 g/day intake. The nurse can
give the pregnant mother with rich food sources includes milk,
meat, fish, poultry, eggs and legumes. This provides for the storage
of nitrogen, protects the mother from any complications, for
healthy growth of maternal uterus, mammary tissues and placenta,
needs for fetal growth and repair and hormonal preparation for
lactation.
• There must be sufficient intake of carbohydrates necessary for
added energy and avoid “empty” calories like soft drinks,
fiber can be taken from fruits and vegetables to prevent
constipation. Nurse can also recommended fats - high energy
foods for absorption of vitamins ADEK and avoid too much
fats to prevent vomiting and heartburn. Iron is the most
important mineral that must be taken in supplementary
amount which is 30-60mg per day to prevent iron deficiency
anemia and needed to increase maternal RBC and for fetal
liver storage in the third trimester.
• Calcium needs for maternal calcium and phosphorous
metabolism and fetal bone and skeletal growth which is 1,200
mg/day, equivalent to 1 quart of milk a day (4 glasses).
Provide sodium which is most abundant cat-ion in
extracellular fluid needed for tissue growth and development
and should not be restricted without serious indications. Folic
acid is for production of blood products and prevents fetal
anomalies and neural defect. Iodine is needed for fetal
development and avoid cretinism. Pregnant mother can also
provide vitamins – water and fat soluble vitamins. Vitamin A
can be given to pregnant mother with a preparation of
10,000IU a dose of 1 capsule twice a week starting from 4th
month of pregnancy until delivery and never be given on the
first trimester to prevent any complications from the baby.
Post-partum women can be given 200,000 IU 1 capsule within
4 weeks after delivery. Vitamin 9 can be also prescribed for
pregnant women 60 mg iron/400 mcg folic acid 1 tablet once
a day for 6 months or 180 days during the pregnancy period
and lactating women 60 mg iron/400 mcg folic acid 1 tablet
once a day for 3 months or 90 days.
• Aside from the vitamins, minerals can also be given to
pregnant women with phosphorous by eating high amount of
protein for skeletal fetal skeleton and tooth formation. Provide
iodine of 175 microgram daily during pregnancy with Iodized
salt and serving of seafood at least once a week for essential
for formation of thyroxine and zinc 15 mg necessary for the
synthesis of DNA and RNA.
 Some complication of pregnancy with dietary modifications are
(1) morning sickness; (2) rapid weight gain or loss; (3) toxemia of
pregnancy; (4) anemia; (5) Gestational DM; (6) constipation; (7)
socio-economic and cultural factors; and (8) alcohol, caffeine and
nicotine.
B. Nutrition in Infancy
• Early childhood encompasses infancy and the toddler years,
from birth through age three. The remaining part of childhood
is the period from ages four through eight and is the time when
children enter school. A number of critical physiological and
emotional changes take place during this life stage.
• Infancy refers to a person not more than 12 months; weighs 2.7
to 3.2kg (6 to 7 lbs); measures 48 to 50 cm (19-20 inches) in
length; skin is moist, elastic and not wrinkled; doubled the birth
weight at 6 months; tripled the birth weight at 12 months; meet
the oral needs of the infant (psychosexual-Freud’s Theory);
provide safe and washable toy such as pacifier; remove small
objects that the infant can choke on; burp the baby after each
feeding to prevent colic; alone in playing (solitary); sucking
gives gratification.
• If the baby is vaginal delivery, breastfeeding may be done as
early as 30 minutes after birth and CS delivery breastfeeding be
done 4 hours after delivery. Demand feeding is the best rule to
observe when feeding the baby. The mother must practice
exclusive breastfeeding for the first 6 months. When doing
breastfeeding, the mother should provide a relaxed, warm and
supportive environment as the letdown reflex is affected by
negative emotions of the mother. Provide reinforcement for
positive behavior or successful actions.
Benefits of breastfeeding to the mother
1. Promotes maternal-infant bonding;
2. Promotes uterine contraction and provided less incidence of
thrombophlebitis;
3. Reduces rate of ovarian cancer and premenopausal breast
cancer;
4. Decreases maternal morbidity and mortality;
5. Save time, money, effort and economical;
6. Delays fertility; and
7. Provide social and economic benefits;
Benefits of breastfeeding to the baby
1. Promote attachment;
2. Provide perfect food that contains all necessary nutrients;
3. Easily digested, has the right temperature and free from
harmful bacteria;
4. Provides passive antibody transfer to the newborn;
5. It has colostrums, high protein content contains antibodies
which help resist infection;
6. Causes fewer incidences of allergies, vomiting, diarrhea,
constipation and aspiration;
7. Enhances brain development because of taurine content; and
8. Decreases infant morbidity and mortality.
✓ Breast milk is higher in CHO, fat and water content but lower
in protein, vitamins and minerals. It has lactalbumin – human
milk protein which is easy to digest and hypoallergenic and
cow’s milk protein called casein causes allergy. Breast milk is
higher in lactose than cow’s milk.
Breastfeeding Misconceptions
1. A mother sick with PTB cannot breastfeed;
2. Breast milk is not good if the mother has stayed long under
the sun;
3. A mother cannot breastfeed during pregnancy;
4. A mother cannot breastfeed with only one breast if the other
breast is painful;
5. A mother cannot breastfeed if she has a cold, flu or diarrhea;
and
6. Breast milk is not good if the mother has been caught in a
sudden shower.
Breastfeeding Contraindications
1. Breastfeeding may not be advisable when mother has
syphilis, AIDS, DM or any severe infections;
2. Breastfeeding is not encouraged when the mother is under
emotional and mental stress;
3. Mother who smokes;
4. Mother who takes contraceptive pills or drugs;
5. Other contraindication includes metabolic abnormalities or
severe prematurity of the newborn which require the use of
special therapeutic formulas.
• Some of the factors affecting milk secretion are diet, nutritional
state of the mothers, emotional and physical state of the mother,
sucking of the baby and use of contraceptives and drugs
• The daily caloric requirement of infant is 1200 Kcal/day (100-115
kcal/kg/day). The diet is breastfeeding / breast milk is best be
given until 18 months to 2 years of age; can be given with bottle
feeding, considered as artificial feeding with cow’s milk, costly,
associated with infantile obesity or “protein-calorie malnutrition
plus”, or can be mixed feeding which is complemented with
insufficient supply of breast milk and supplemented if the mother
is away from home for feeding
• The feeding time being practice by the mother are if the baby
weighs 5 to 2.7 kg baby usually feeds every 3 hours (8 feedings);
6 to 4 kg baby usually feeds every 4 hours (6 feedings) and 2 to 3
months old, the baby is on 4 to 5 feedings, the baby sleeps through
the night after 10 pm feeding. Weaning can be done 6 months
from breast to bottle and 12 months: bottle to cup.
• The supplementary foods of the infant begins at 2 months with
liquids like rice water, calamansi juice may be introduced
depending upon infant’s tolerance and acceptance; then when the
infant reaches 4 months be given with first solid foods (rice
cereals). Then for the 5th to 6th months – teething foods; full diet
consisting of pureed meat, egg, strained fruits and vegetables and
chewy foods be given not only to soothe the sensitive gums but
also to teach the baby the art of self-feeding; at 7-8 months – foods
are mashed or chopped finely, not strained to teach mastication,
soft cooked egg with rice porridge, boiled fish, banana and camote
mash and the like; at 9-12 months – whole tender foods or foods
chopped coarsely are given, finger foods like cottage cheese,
crackers, plain meats and egg yolks
• There are foods that needs to avoid by the mother and be given to
the infant in the first year of life such as honey that causes
clostridium botulinum leading to infantile poisoning; choking
hazards like hotdogs, grapes, hard candies, raw carrots, pop corns,
nuts, peanut butter; insufficient calories like skim milk and
potential allergen like cow’s milk and egg.
 Infants has readiness to take solid foods when:
1. sucking reflexes is intact;
2. ability to sit with support;
3. avoid feeding an infant lying supine to prevent aspiration;
4. present salivary glands and intestinal enzymes that aids in
digestion;
5. fetal iron reserve in the liver usually consumed by 4-6 months.
✓ When the mother is trying to introduce supplemental foods,
there must be rules to follow such as:
1. introduce one food at a time;
2. show pleasure when giving new food at the same time, make
gesture;
3. give a small amount (1 tsp) at a time;
4. offer bland foods to the baby (not too salty, not too sweets);
5. do not mix with formula;
6. feed when newborn is hungry after a few sucks of milk to
increase his patience for a new food;
7. never start two new foods at the same time;
8. allow an interval of 4-7 days between new foods;
9. feed baby only with freshly-cooked foods or fruits freshly
peeled. Avoid giving left-over foods to babies and
10. do not bribe, plead, threaten or force the infant.
• The common disorders among infants are diarrhea which is the
most frequently caused by bacteria and viruses; vomiting;
allergy in infant with milk intolerance; constipation and colic
which is the most common. Some metabolic health problems
with infancy like Galactosemia, Phenylketonuria (PKU),
Maple Syrup Urine Disease (MSUD), and Congenital
Hypothyroidism that can be screen with Newborn Screening
Act (RA 9288).
C. Nutrition in Childhood
• Toddler is a period of life from 1-3 years old; with daily caloric
requirement of 1,300 to 1,400 kcal/day or 100 cal/kg/day;
physiologic anorexia (decrease in appetite) because toddler is
busy at play; weight quadruple at 2 years old; experience temper
tantrum; mother can offer choices; diet preference unpredictable
but able to feed self; dental examination at 2-3 years (2y/o -16
3y/o -30); safety is priority; with no-no-no attitude; ensures
increase Calcium, Phosphorus and Ferrous; elimination training
(bladder training and bowel training); drinks 16-24 oz milk/day;
experience separation anxiety; autonomy versus shame and
doubt; parallel play; performs rituals, routines and dawdling;
accident – prone; involve parents in child care; sibling rivalry;
and explain procedures.
• Nutrition is important at every age. The children need proper
nutrients stay healthy and strong, and grow up healthy and
strong. Nutrition for children can also help establish a
foundation for healthy eating habits and nutritional knowledge
that the child can apply throughout life. The toddlers require to
be fed every two to three hours or five to six meals in a day. The
nutrient allowances for toddlers: Calories – determined by his
age, activity and BMR; Protein – 1.5 to 2 gm/kg of body weight
is required; Vitamins and minerals – essential for growth and
development; and total fluid requirements is 4-6 glasses, 1 to 1.5
liters/day. It is important to avoid foods that may cause choking
such as slippery foods such as whole grapes; large pieces of
meats, poultry, and hot dogs; candy and cough drops; small and
hard foods such as nuts, seeds, popcorn, chips, pretzels, raw
carrots, and raisins; and sticky foods such as peanut butter and
marshmallows.
• Nutrition in Pre-school is period from 3-6 years old; larger
requirements for growth so there is a greater need for protein,
vitamins and minerals; period of food habits and preferences,
selective, making him more vulnerable to nutritional
deficiencies; won’t eat era - appears thinner than a toddler;
decrease in weight, desire for food is erratic; parents must be
careful not to foster poor eating habits by urging, forcing, or
even bribing the child to eat; fear of punishment, family as
significant others; obesity is a risk; kcal of 85/kg/day or daily
calorie of 1,700 – 1,800; eating junk food is a problem;
imaginative thinking; imaginary playmates; fear of mutilation,
abandonment and dark; associative play; growth rate is slow
and erratic; initiative versus guilt; no new teeth develops;
appetite is not large; oedipal and electra complex; needs
explanation; and seen pleasures on touching of genitals.
• Good nutrition – is important during pre-school years, needs
adequate food for growth and builds his body, gives plenty of
energy for play, helps him to fight common infections, helps
keep the child healthy, happy and physically fit as well as
mentally alert. The toddlers require to be fed every two to three
hours or five to six meals in a day. The nutrient allowances for
toddlers: Calories – determined by his age, activity and BMR;
Protein – 1.5 to 2 gm/kg of body weight is required; Vitamins
and minerals – essential for growth and development; and total
fluid requirements is 4-6 glasses, 1 to 1.5 liters/day. The pre-
school kids need about four meals in a day.
• The feeding problems with pre-school are: (1) child is eating
too little; (2) child is eating too much; (3) child is dawdling
during mealtime; (4) child is gagging especially when fed
course foods; (5) child has aversion towards some foods; and
child has allergies.
• The fluid need of the young children is water which is good
for thirst. Too much fruit juices may cause diarrhea and may
reduce child’s appetite for foods. Sodas are not suitable for the
children. Teas and coffee reduce iron absorption. A small
drink will satisfy a child’s thirst during meals. A non breastfed
child (6-24 months) needs 2-3 cups of water in a temperate day
or 4-6 cups in a hot climate.
• The computation for total energy requirement TER = 1000 +
(100 x no. of years). For example, if the age of a child is 6
years old so the computation will be TER = 1000 + (100 x 6)
= 1,600 kcal/per day which is around the normal range of
childhood TER which is 1,300-1,400 for toddler and 1,700-
1,800 for pre-school.
Nutrition Across Life Span
(School-Age, Adolescence, Adulthood and Aging)
Nutrition in School-age
• The period between 7 -12 years old is characterized by a slow,
steady growth, increased body proportions, with a daily caloric
requirement: 2,100 to 2,400 kcal/day. They expresses own
food choices and with strong urge to eat what his friends eat
(peer relationship) and eats what most adults do. Eats a wider
variety of foods and has more likes and dislikes, develops
fondness for food products of his movie idol.
• Improve the nutrition of school children by providing them
with wholesome food the lowest reasonable cost. Should foster
proper eating habit, Obesity is common, Wants simple and
plain dishes, likes competitive play, oral medications
preferred, observe and explain prepubertal changes. They
should ensure involvement in planning and preparing meals.
Involve in problem solving develops industry, hangs out with same
sex. In school age behavior problems are common (bullying) and
assume death as punishment.
Nutrition Allowances
1. Calories - 80 to 90 kcal/kg for children aged( 7-9 year) , 70 to
80 kcal/kg for children aged (10-12 years)
2. Protein - 37 gm daily for children (7-9 years old), 43 to 48 gm
daily for children to (10-12 years old)
3. Vitamins and minerals – essential for growth and
development like iron, ascorbic acid and calcium
Feeding Problems
1. Inadequate meals
2. Poor appetite
3. Sweet tooth
D. Nutrition in Adolescence
• It is a transition period of human development that occurs
between childhood and adulthood. Girls go through this
period earlier than boys do.
• Teenagers lead and active like with gang or “barkada”.
Parents always wonder where the teenager gets their energy
and vitality so prepare mostly body builders and energy foods.
• Daily caloric requirement: Girls - 2,200 kcal/day, Boys –
2,700 kcal/day. This is the time when the adolescence needs
more body building and energy boosting foods. Need to add
more foods rich in protein, calories, irons, and vitamin C, and
also provide Iron and Zinc.
• Adolescence need to teach stress management and coping
technique. Exercise is important, acceptance through peers is
needed, growth spurt, encourage decision making.
Attachment to opposite sex, need guidance by the parents, and
substance abused early pregnancy must be addressed, respect
independence but minimally, identity vs role confusion.
• Anorexia Nervosa, commonly called anorexia, is a
psychological disorder more common to women than men. It
can begin as early as late childhood, but usually begins during
the teen years or early twenties.
E. Nutrition in Adult Years
• It is the period of life when one has attained full growth and
maturity between 21-50 years of age. It includes maintenance
of the desirable body weight. To prevent overweight and
obesity.
Feeding the Adult
• To stay healthy, the following must be observed and
followed: Eat variety of foods, Maintain ideal weight, Avoid
too much fat, saturated fat and cholesterol, Eat food with
adequate starch and fibers, Avoid too much sugar; avoid too
much sodium, Avoid alcohol, drink alcohol in moderation.
Nutritional Issues:
• Osteoporosis is a silent enemy. It is a bone disease that leads
to an increased risk of fracture. It is less common in men than
in women. Women at risk in developing osteoporosis include
thin small bonded women; women with a family history of
the disease; women whose ovaries were removed at an early
age. For proper bone mass to be maintained, bones must be
stressed as they are exercised. To prevent bone loss, experts
recommend 30 minutes of exercise 3 to 6 times a week and
calcium supplements if the diet is not rich in foods containing
calcium such as milk and dairy products, spinach and
broccoli.
• Arthritis is a disease that causes the joints to become painful
and stiff. It results in structural changes in the cartilage of the
joints. A client arthritis should be especially careful to avoid
overweight because the extra weight adds to joints.
F. Nutrition in Aging
• Elderly – refers to the period being past middle age.
• Aging – is a continuous process that starts in the womb ends
in the tomb.
• Aging are believed to be caused by loss in the number of cells.
Collagen in the connective tissues undergoes chemical
changes with aging. Sense of taste and sense of smell are less
acute causing loss of appetite. Less saliva is secretes so
swallowing of food is difficult. Digestion is affected due to
reduction acidity and pepsin content and fats are poorly
tolerated because they retard gastric evacuation.
Nutrition Requirements:
1. Calories – reduction of calories is recommended because of
reduced BMR and physical activity
2. Proteins – 1.1 gm/kg body weight is required for prevention
of progressive tissue wasting and ability to disease and
infection
3. Vitamins and Minerals – calcium, iron, Vitamin A, B
complex and Vitamin C 4. Water and Fiber – 6 to 8 glasses
or more consumed daily – eliminates waste products,
stimulates peristalsis and combating constipation
Common Problems among the Elderly
• Difficulty in chewing due to loss of teeth and not getting used
to dentures. Need to shop meat or flake fish or chop vegetable
in small bite-sized pieces for easy chewing. Lack of Appetite.
Make food attractive by varying color, shape and size.
• Unwanted weight and due to lack of physical activity and/or
to overeating. Need to take in any moderate amounts of
energy food, avoid rich sauces salad dressings. And pastries
or cake with heavy icing. Anxiety, confusion, insecurity or
loneliness. Start the day right with a good breakfast. Keep up
with a group, join a club and participate in community
activities.
• Poor digestion leading to constipation, gas pains, or diarrhea.
Need too include fruits and vegetables in their daily meals to
prevent constipation. Have four light meals. East the heaviest
meal at noon. Need to drink 6-8 glasses of water and fruit
juices everyday. If suffering from diarrhea, take simple foods
like tea, crackers, broth of boiled banana and kamote. Avoid
fibrous fruits and vegetables
• Poor absorption leading to anemia and other vitamin
deficiencies. Iron-rich foods like liver lean meat, egg yolk,
saluyot, and seaweed are recommended to avoid anemia.
Vitamin C rich foods like papaya, mango and dalanghita help
absorb iron and speed up healing. Take in foods like milk,
milk products, dilis, alamang, and other leafy vegetables.
These food contain calcium needed for strong bones.
Exposure to sunlight helps maintain the bone structure.
• Difficulty in sleeping. Need to drink warm milk just before
going to bed to assure a restful night. Avoid tea or coffee late
in the day, if any of these cold/hot drinks affect one’s sleep.
Foods needed daily by the elderly
• An elderly persons need to eat certain foods in the adequate
amounts for good health. Usually, the elderly needs less
energy foods due to less physical activities but more protein
food to repair worn out tissues.
 Nutrition for Health and Fitness
Nutrition and Weight Loss
• There are huge number of factors which contribute towards
weight. however, regardless of the factors it should ideally be
within a healthy range. Being either underweight or overweight
can affect your physical and psychological well being
• Obesity is one of the fastest growing health concerns in the
world today and is determine by a person carrying too much
body fat for their height and sex. Growth in obesity can be partly
attributed to lifestyle being less physically active than it used to
be body weight is determined by the amount energy obtained
from food in relation to the amount of energy uses. Any excess
energy is then taken and stored in the body as fat
• Being obese increases the risks of certain serious diseases such
as:
1. Heart disease
2. Diabetes
3. Cancers
• Being underweight also poses serious health risks:
1. Irregular periods
2. Fertility issues
3. Osteoporosis
4. Anemia
5. Depleted energy levels
• Body weight is determined by the amount of energy obtained
from food in relation to the amount of energy your body uses.
Any excess energy is then taken and stored in the body as fat.
With these basic formula in mind it may seem like losing weight
is a simple case of eating less so your body stores less fat and
gaining weight may seem as easy as increasing your food intake
so the body is able to store more.
• Eating disorders describes illnesses that are characterized by
irregular eating habits and severe distress or concern about body
weight and shape.
• Eating disturbances, may include inadequate or excessive food
intake which can ultimately damage an individual wellbeing.
• Disordered eating issues can develop during any stage of life
but typically appear during the teen years or young adulthood
and they are much more common in women.
Cause of Eating Disorder
1. Family relationships
2. Dieting
3. Depression, anxiety, anger
4. History of being teased or ridiculed based on sized or weight
Types of Eating Disorders
1. Anorexia Nervosa
• This is characterized by weight loss often due to excessive
dieting and exercise, sometimes to the point of starvation.
People with anorexia feel they can never be thin enough and
continue to see themselves as fat despite extreme weight loss.
Symptoms
1. Weight loss
2. Wearing loose, bulky clothes to hide weight loss
3. Preoccupation with food, dieting, counting calories. etc.
4. Refusal to eat certain foods, such as carbs or fats.
5. Avoiding mealtimes or eating in front of others
6. Exercising excessively
7. Stopping menstruation.
2. Bulimia Nervosa
• Have episodes of eating large amounts of food (called
bingeing) followed by purging (vomiting or using laxatives),
fasting, or exercising excessively to compensate for overeating
1. Binge eating
2. Evidence of purging
Treatment
1. Cognitive - behavioral therapy
2. Anticonvulsant medicines
3. Antidepressants
Nutrition Exercise and Support
• Eating well for physical activity and sport can have many
benefits including:
1. Allowing you to perform well in your chosen sport or activity.
2. Reducing the risk of injury and illness.
3. Ensuring the best recovery after excercise or a training
programme.
• A healthy diet for exercise should contain plenty of starchy
foods, plenty of fruit and vegetables, some protein foods and
some dairy foods, It is also important to stay hydrated.
Foods for fuel and exercise
1. Carbohydrates - The main role of carbohydrates is to
provide energy. The most important form of fuel for exercise
and sports activities. It is stored in the muscle and liver as
glycogen, and use the stores as source of fuel for the brain and
muscles during physical activity.
2. Protein
3. Fat - Sufficient fluid intake is essential for exercise and
optimum recovery. Exercising causes the body tries to cool
down by sweating. This causes the loss of water and salts
through the skin. Eating well for physical activity.
Nutrition and Bone Health
Tips to keep your bones healthy
• Protecting your bone health is easier than you think.
Understand how diet, physical activity and other lifestyle
factors can affect your bone mass.
• Bones play many roles in the body — providing structure,
protecting organs, anchoring muscles and storing calcium.
While it's important to build strong and healthy bones during
childhood and adolescence, you can take steps during
adulthood to protect bone health, too.
• A number of factors can affect bone health.
o The amount of calcium in your diet. A diet low in
calcium contributes to diminished bone density, early bone
loss and an increased risk of fractures.
o Physical activity. People who are physically inactive have
a higher risk of osteoporosis than do their more-active
counterparts.
o Tobacco and alcohol use. Research suggests that tobacco
use contributes to weak bones. Similarly, regularly having
more than one alcoholic drink a day for women or two
alcoholic drinks a day for men may increase the risk of
osteoporosis.
o Gender. You're at greater risk of osteoporosis if you're a
woman, because women have less bone tissue than do men.
o Size. You're at risk if you are extremely thin (with a body
mass index of 19 or less) or have a small body frame
because you might have less bone mass to draw from as
you age.
 o Age. Your bones become thinner and weaker as you age. • Smart snacking also can keep your mouth in good shape.
o Race and family history. You're at greatest risk of Resist the urge to snack frequently — the more often you eat,
osteoporosis if you're white or of Asian descent. In addition, especially between meals, the more likely you are to introduce
having a parent or sibling who has osteoporosis puts you at acid attacks on your teeth. If you do snack, choose wisely.
greater risk — especially if you also have a family history Forgo sugary treats such as hard or sticky candy and opt for
of fractures. nutritious choices such as raw vegetables, fruits, plain yogurt
o Hormone levels. Too much thyroid hormone can cause and popcorn. Remember to brush after snacking to keep
bone loss. In women, bone loss increases dramatically at cavities at bay. If you can't brush, rinse your mouth with water
menopause due to dropping estrogen levels. Prolonged to get rid of food particles.
absence of menstruation (amenorrhea) before menopause • Caring for a baby? Avoid pacifying your infant, toddler or
also increases the risk of osteoporosis. In men, low young child with a bottle of juice, formula or milk. Sucking
testosterone levels can cause a loss of bone mass. on the bottle bathes the teeth and gums in liquid which can
o Eating disorders and other conditions. People who have contribute to tooth decay.
anorexia or bulimia are at risk of bone loss. In addition, • In addition to healthful eating, oral health problems can be
stomach surgery (gastrectomy), weight-loss surgery, and prevented by practicing good oral hygiene, such as brushing
conditions such as Crohn's disease, celiac disease and teeth with fluoridated toothpaste twice a day, flossing once a
Cushing's disease can affect your body's ability to absorb day, drinking fluoridated water and seeking regular oral
calcium. health care.
o Certain medications. Long-term use of corticosteroid
medications, such as prednisone, cortisone, prednisolone
and dexamethasone, is damaging to bone. Other drugs that
might increase the risk of osteoporosis include aromatase
inhibitors to treat breast cancer, selective serotonin reuptake
inhibitors, methotrexate, some anti-seizure medications,
such as phenytoin (Dilantin) and phenobarbital, and proton
pump inhibitor.
Steps to Prevent Bone Loss
• Include plenty of calcium in your diet. Good sources of
calcium include dairy products, almonds, broccoli, kale,
canned salmon with bones, sardines and soy products, such as
tofu. If you find it difficult to get enough calcium from your
diet, ask your doctor about supplements.
• Pay attention to vitamin D. Good sources of vitamin D
include oily fish, such as salmon, trout, whitefish and tuna.
Additionally, mushrooms, eggs and fortified foods, such as
milk and cereals, are good sources of vitamin D. Sunlight also
contributes to the body's production of vitamin D. If you're
worried about getting enough vitamin D, ask your doctor
about supplements.
• Include physical activity in your daily routine Weight-
bearing exercises, such as walking, jogging, and climbing
stairs, can help you build strong bones and slow bone loss.
• Avoid substance abuse. Don't smoke. If you are a woman,
avoid drinking more than one alcoholic drink each day. If you
are a man, avoid drinking more than two alcoholic drinks a
day.
Oral Health
• Eating a variety of nutrient-rich foods from all the food groups
promotes healthy teeth and gums. A balanced diet of fruits,
vegetables, protein foods, calcium-rich foods and whole
grains provides essential nutrients for optimum oral health as
well as overall health.
• Foods for Optimum Oral Health
o Calcium-rich foods, such as low-fat or fat-free milk,
yogurt and cheese, fortified soy drinks and tofu, canned
salmon, almonds and dark green leafy vegetables help
promote strong teeth and bones.
o Phosphorus, found in eggs, fish, lean meat, dairy, nuts and
beans is good for strong teeth.
o Vitamin C promotes gum health, so eat plenty of citrus
fruits, tomatoes, peppers, broccoli, potatoes and spinach.