Learning Objectives

1. Define nutrition and explain the functions of each of the six classes of major
nutrients.
2. Discuss the concepts of the MyPlate Food Guidance System and the Nutrition
Facts Label.
3. List the major dietary sources of carbohydrates and differentiate among
monosaccharides, disaccharides, and polysaccharides.
4. Differentiate between saturated and unsaturated fatty acids. Explain cholesterol,
LDL, and HDL.
5. Define amino acid. Differentiate between complete and incomplete proteins.
6. Explain the body’s need for water and describe at least four functions of water.
7. List six major minerals and four trace minerals and state their functions.
8. Name the fat-soluble and water-soluble vitamins and list their main functions and
food sources.
9. Discuss BMI, obesity, and malnutrition and how they relate to a healthy diet.
10. Identify common special nutritional considerations related to infancy, childhood,
adolescence, early and middle adulthood, and the elderly.
IMPORTANT TERMINOLOGY

amino acid macronutrient polysaccharide

beriberi malnutrition prebiotics

cholesterol marasmus probiotics

disaccharide micronutrient protein

essential nutrient mineral rickets

glycogen monosaccharide saturated fat

hydrogenated nutrient scurvy

hyperglycemia nutrient density trans fat

hypoglycemia nutrition triglyceride

kwashiorkor pellagra

lipid phytochemical

Acronyms
AI kcal

BMI LDL

CHO MUFA

DRI PCM

DV PKU

EAR PUFA

EER RBC

FDA RDA

GDM REE

HCl UL

HDL USDA

HFCS USP

IBW
Food is vital to life. Humans eat to stay alive and to be healthy. In fact, food is one of
the most important items in Maslow’s hierarchy of human needs.Food is also enjoyable
and brings pleasure to life.
Nutrition is the study of nutrients and how the body utilizes the nutrients in food.
Nutrition has a great impact on human well-being, behavior, and the environment.

The science of nutrition continues to evolve as our understanding of its role has
shifted from simply preventing dietary deficiencies to reducing the risk of chronic
diseases, including osteoporosis, cancer, and heart disease. For instance, before the
Nutrition Labeling and Education Act of 1993, food labels were required to list the B
vitamins thiamine, riboflavin, and niacin because deficiencies in these nutrients were
once common. Today, current public health concerns are reflected in the order in which
mandatory dietary components must appear on food labels: total calories, calories from
fat, total fat, saturated fat, trans fat, cholesterol, and sodium. Listing the B vitamins is
now optional.
Results from many research studies have indicated that nutrients and other
compounds found in food may increase optimal health and even prevent specific health
problems. New discoveries about previously unidentified components in plant foods,
known as phytochemicals, suggest that thousands of naturally occurring chemicals in
foods may help protect against disease. Future recommendations for daily nutrient
intakes will likely be made from the perspective of optimizing health, rather than simply
preventing deficiencies.
This topic begins with the concept of basic nutrition and information about the functions
and sources of nutrients. Nutrient digestion is included where appropriate. With this
knowledge as a foundation, characteristics of a healthy diet are presented and common
nutritional problems are discussed. The topic concludes with a discussion of nutritional
concerns across the lifespan.

NUTRIENTS
Nutrients are substances needed for growth, maintenance, and repair of the body.
The body can make some nutrients if adequate amounts of necessary precursors
(building blocks) are available. Essential nutrients are those that a person must obtain
through food because the body cannot make them in sufficient quantities to meet its
needs. The six classes of nutrients are carbohydrate, fat, protein, water, minerals, and
vitamins. Carbohydrate, fat, and protein provide energy and are called macronutrients.
Vitamins and minerals regulate body processes and are called micronutrients. Water is
necessary for virtually every body function.
The MyPlate guidelines initiated in June 2011 and the Dietary Guidelines for
Americans of 2010 provide specific recommendations for making food choices that will
improve the quality of an average American diet. This nutritional framework provides
practical health, activity, and nutritional guidance for the client. Guidelines for pregnant
and breastfeeding women, children, adolescents, adults, and other specific audiences
are included in the overall concepts of the plan.
The official government Website is a comprehensive source of information and is
useful for teaching nutritional concepts to clients. For more information, go directly to
MyPlate.gov. The Nutrition Facts Label found on food products should be used as a
complementary guide to the MyPlate Framework. Figure 30-1 shows the MyPlate
diagram and its relevant content. Food groups are listed in Table 30-1. Table 30-2
reviews nutrient content. Serving sizes are viewed on the MyPlate Website’s Food
Gallery. The Nutrition Facts Label is discussed later in this topic. You may also search
for United States Department of Agriculture (USDA) food and nutrition information for an
extensive list of resources and general nutritional data.
FIGURE 30-1 · MyPlate . The proportions of food content and food groups are
suggested by the MyPlate diagram.
Key Concept Healthy diet—a diet that
• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk
products

• Includes lean meats, poultry fish, beans and peas, eggs, and nuts

• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

From the nurse’s perspective, the MyPlate concept is of benefit when teaching clients
about the interrelationships among nutrition, activity, and diet therapy. In general, the
concepts review balancing caloric intake, using appropriate amounts of fruits and
vegetables, whole grains and fat-free or low fat milk, and reducing the amounts of foods
containing higher amounts of sodium and sugar. More specifically, these
recommendations suggest that the individual:
• Eat more of some foods, such as fruits, vegetables, whole grains, and fat-free or
low-fat milk products that contain essential nutrients.

• Eat less of other foods, such as foods high in saturated or trans fats, added sugars,
cholesterol, salt, and alcohol.

• Provide variety in the diet—eat foods from all food groups and subgroups.

• Balance calorie intake with energy needs to prevent weight gain and/or promote a
healthy weight.

• Eat in moderation.

• Be physically active every day.

TABLE 30-1. MyPlate.gov Food Groups

GRAINS VEGETABLES FRUIT DAIRY PROTEIN
Goal Goals Goals Goals

• Make / of plate fruits and • Include calcium-

vegetables. rich
• Include lean protein
foods.
• Whole grains • Include fresh, frozen, canned,
foods.
should be at least /2 or dried.
of total grain intake.
• Use fat-free • Include seafood
(skim) or low-fat that is rich in omega-
(1%) milk. 3 fatty acids.

EXAMPLES

Serving sizes: See Food Gallery examples at

MyPlate.gov.

Whole Grains* Dark Green • Apples Milk Meats

• Whole—wheat
• Bok choy • Apricots • Fat-free (skim) Lean cuts of.
flour

• Bulgur (cracked
• Broccoli • Bananas • Low fat (1%) • Beef
wheat)

• Reduced fat
• Oatmeal • Collard greens • Berries: • Ham
(2%)

• Dark green
• Whole cornmeal • Strawberries • Whole milk • Lamb
lettuce

• Brown rice • Kale • Blueberries • Lactose-reduced • Pork

• Millet • Romaine lettuce • Raspberries • Lactose-free • Veal

• Popcorn • Spinach • Cherries • Flavored milk Game meats:

• Milk-based
• Amaranth • Turnip greens • Grapefruit • Bison
desserts:

• Grapes • Puddings • Rabbit

• Some ready-to-eat
• Watercress
breakfast cereals
• Kiwi fruit • Ice milk • Venison

Red & Orange • Lemons • Frozen yogurt

Lean ground meats: •

Refined Grains* • Acorn squash • Limes • Ice cream
Beef

• Butternut
• White flour • Mangoes • Calcium-fortified
squash

soymilk/soy
• White bread • Carrots • Melons: • Pork
beverage

• Crackers • Hubbard squash • Cantaloupe • Lamb

 Lean luncheon or
• Grits • Pumpkin • Honeydew Cheese
deli

Hard natural
• Noodles • Red peppers • Watermelon meat
cheeses:

• Mixed fruits
• Pasta • Sweet potatoes • Cheddar Organ meats:
(fruit

0
• White rice • Tomatoes cocktail) • Mozzarella
• Liver

• Cornbread • Tomato juice • Nectarines • Swiss

• Giblets
• Oranges • Parmesan
Poultry
Starchy • Peaches

• Cassava • Pears Soft cheese: • Chicken

• Corn • Papaya • Ricotta • Duck

• Goose
• Fresh cowpeas,
• Some ready-to-eat • Pineapple • Cottage
field
breakfast cereals • Turkey

peas, or black- • Ground chicken

• Plums
eyed and

peas (not dry) • Prunes Processed cheeses:

• Green bananas • Raisins • American turkey

• Green peas • Tangerines Beans & Peas**

• Green lima • 100% fruit
Yogurt • Black beans
beans juice:

• Plantains • Orange • Fat-free • Black-eyed peas

• Potatoes • Apple • Low fat

• Chickpeas
(garbanzo beans)
• Taro • Grape • Reduced fat

• Water chestnuts • Falafel

• Kidney beans
Beans & Peas**
• Lentils

• Lima beans
• Black beans
(mature)

• Black-eyed peas • Navy beans

(mature, dry) • Pinto beans

• Garbanzo beans • Grapefruit • Whole milk • Soy beans

yogurt

(chickpeas) • Split peas

• Kidney beans Nuts and seeds

• Lentils • Almonds

• Navy beans • Cashews

• Pinto beans I I I //* 1 I 1 \

• Hazelnuts
• Soy beans
(filberts)
 • Mixed nuts

• Split peas • Pfiam i+c

1 v^dl 1U Lo

• Peanut butter

• Pecans

• Pistachios
• White beans
• Pumpkin seeds

• Sesame seeds

• Sunflower seeds

• Walnuts

TABLE 30-1. MyPlate.gov Food Groups Continued

GRAINS VEGETABLES FRUIT DAIRY PROTEIN
Other Seafood

• Artichokes Finfish such as:

• Asparagus • Catfish

• Avocado • Cod

• Bean sprouts • Flounder

• Beets • Haddock

• Brussels sprouts • Halibut

• Cabbage • Herring

• Cauliflower • Mackerel

• Celery • Pollock

• Cucumbers • Porgy

• Eggplant • Salmon

• Green beans • Sea bass

• Green peppers • Snapper

• Iceberg (head) lettuce • Swordfish

• Okra • Trout

• Onions • Tuna

• Parsnips Shellfish such as:

• Turnips • Clams

• Wax beans • Crab

• Crayfish

• Lobster

• Zucchini • Mussels

• Octopus

• Oysters
 • Scallops

• Squid (calamari)

• Shrimp

Canned fish such as:

• Anchovies

• Clams

• Tuna

• Sardines

E
ggs
• Chicken eggs

• Duck eggs

*Whole grains contain the entire grain kernel e.g. the bran, germ, and the endosperm.
*Refined grains have been milled which is a process that removes the bran and the
germ. Refined grains have a longer shelf life anc a finer texture but are often lacking in
dietary fiber; iron, and many B vitamins. Most refined grains are enriched which means
that some B vitamins (e.g. thiamin, riboflavin, niacin, folic acid) and iron are added back
into the processed product.
**Beans & Peas are considered unique foods because they are a good source of plant
proteins, minerals such as zinc and iron, and many B vitamins.
Key Concept Eat a variety of foods. No single food supplies all essential nutrients in
amounts needed. Variety also helps to reduce the risk of nutrient toxicity and accidental
contamination.

Dietary References and Terminology

In 1941, the Food and Nutrition Board of the National Academy of Sciences published
the first Recommended Dietary Allowances (RDAs) that set a standard for the intake of
specific nutrients to meet the needs of healthy Americans. Continued research has
shown that the RDA levels have limited value and are often misrepresented and
misused. The focus of RDAs has traditionally been the prevention of deficiency
disorders. The Food and Nutrition
Board of the National Academy of Sciences changed its approach to setting nutrient
reference levels. The study of nutrition has expanded to include the role of nutrients in
preventing chronic diseases.

A combination of experts in several food and nutrition organizations had instituted an

expanded system called the Dietary Reference Intakes (DRIs). This system includes
four standards that list reference intake levels of essential nutrients for most healthy
population groups. The DRIs consist of Recommended Dietary Allowances, Adequate
Intake, Tolerable Upper Intake Level, and Estimated Average Requirement. These
standards are described below.
• Recommended Dietary Allowances (RDAs): Recommendations for average daily
dietary intake level that is sufficient to meet the nutrient requirement of nearly all healthy
individuals (97% to 98%) in a particular life stage and gender group.
TABLE 30-2. Food Groups with Vitamin and Mineral Content
MAJOR VITAMINS MAJOR MINERALS
FOOD GROUP PROVIDED WITHIN THIS PROVIDED WITHIN THIS
FOOD GROUP FOOD GROUP
• Thiamine • Magnesium

• Riboflavin • Potassium

• Niacin • Selenium

Grains • Folate • Zinc

• Pyridoxine • Iodine

• Vitamin E • Iron

• Chromium
 • Beta-carotene • Magnesium

• Vitamin C • Potassium
Vegetables
• Vitamin K • Calcium

• Folate • Iron

• Beta-carotene • Potassium
Fruits
• Vitamin C

• Vitamin A • Phosphorus

• Vitamin D • Potassium

Dairy • Pyridoxine • Calcium

• Cobalamin • Iodine

• Riboflavin

• Pyridoxine • Phosphorus

• Cobalamin • Selenium

• Niacin • Copper
Protein
• Riboflavin • Zinc

• Iron

• Potassium

Oils Vitamin E No minerals

• not a food group

• to be used with
discretion

• are a major source of

polyunsaturated fatty

acids, including the

essential fatty acids

• Adequate Intake (AI): Recommended nutrient intake that is assumed to be

adequate. It is based on observed or estimated nutrient intake by a group (or groups) of
healthy people and is used when an RDA cannot be determined.
• Tolerable Upper Intake Level (UL): The highest level of daily nutrient intake that is
likely to pose no risk of adverse health effects for almost all individuals in the general
population.
• Estimated Average Requirement (EAR): A daily nutrient intake value that is
estimated to meet the requirement of half the healthy individuals in a life stage and
gender group.

Food Pattern and Food Group Terms

The use of nutrition, as a basis of health and disease prevention, has grown to include
concepts related to daily food patterns, caloric intake, and other terms presented below.
• Daily Food Intake Pattern: Identifies the types and amounts of foods that are
recommended to be eaten each day and that meet specific nutritional goals.
• Estimated Energy Requirement (EER): Represents the average dietary energy
intake that will maintain energy balance in a healthy person of a given gender, age,
weight, height, and physical activity level. The calorie levels for the food intake patterns
were matched to age/sex groups using EERs for a person of average height, healthy
weight, and sedentary activity level in each age/sex group.
• Discretionary Calorie Allowance: The balance of calories remaining in a person’s
energy allowance, or EER, after accounting for the number of calories needed to meet
recommended nutrient intakes through consumption of foods in low-fat or no-added-
sugar forms.
• Nutrient-Dense Foods: Those foods that provide substantial amounts of vitamins
and minerals and relatively fewer calories.
• Ounce-Equivalent: In the grains food group, the amount of a food counted as equal
to a 1-ounce slice of bread. In the meat, poultry, fish, dry beans, eggs, and nuts food
group, the amount of food counted as equal to 1 ounce of cooked meat, poultry, or fish.
Key Concept Choose a diet with plenty of whole grain products, vegetables, and fruits.
Plant foods provide fiber, complex carbohydrates, vitamins, minerals, and other
substances important for good health. They are also generally low in fat.

Kilocalories and Energy

The unit of measurement that specifies the heat energy in a particular amount of
food is called a kilocalorie (kcal). A kilocalorie is defined as the amount of heat required
to raise the temperature of 1 kg of water 1°C. The caloric value of foods can be
determined in the laboratory. In this process, the heat that is given off by the burning of
the test food raises the temperature of a known amount of water. The calorie values of
energy nutrients follow:
• 1 g carbohydrate yields 4 kcal

• 1 g fat yields 9 kcal

• 1 g protein yields 4 kcal

Calorie charts stating the number of kilocalories in an average serving of various

foods are available without cost from a number of sources. Printed sources can be
obtained from the National Dairy Council and the U.S. Government Printing Office. On-
line sources can be found at MyPlate.gov, and by searching for “USDA food values.”
Fast-food restaurants will provide kilocalorie charts on request.
NCLEX Alert Nutritional concepts and terminology are very important nursing
considerations for clients. On an NCLEX, the clinical scenario may include topics
related to different populations, such as children, the elderly or during pregnancy The
client may need to learn new dietary habits, have specific teaching concerns (e.g.,
diabetes or cardiovascular disease), or have existing knowledge reinforced or updated.

Requirements
From a nutrition standpoint, calories are synonymous with energy. The amount of
energy (calories) a healthy individual needs depends on his or her age, sex, weight,
body composition, and activity level. The energy requirements of an individual are the
total calories needed to maintain body processes or resting energy expenditure (REE).
For most adults, REE accounts for most of the energy used in a typical day. REE is
higher for men than for women because men have more muscle mass; likewise,
younger adults have a higher REE than older adults because people lose muscle mass
as they age. Growth, pregnancy, lactation, and fever increase REE.
In adults, activity typically accounts for 25% to 30% of total energy used. The actual
amount of energy used for physical activity depends on the duration and intensity of the
activity. For instance, people at desk jobs need fewer kilocalories than do laborers, who
use their muscles a great deal. Also, heavier people use more energy than do lighter
people when performing the same activity because they move a greater amount of
weight.

Empty Calories
The term empty calories is an imprecise term applied to foods that supply calories
with few or no nutrients. Examples of empty calorie foods are candy, soft drinks,
alcohol, and sugar. Empty calorie foods can contribute to nutrient deficiencies if they
take the place of other nutrient-rich foods, such as substituting soft drinks for milk or
alcohol for food. Although not considered a nutrient, 1 g of alcohol provides 7 kcal.

Activity Levels
An integral part of the MyPlate concept is the individual’s ability to use his or her
nutrients. In other words, activity levels influence the amount of calories/energy that an
individual needs. Moderate and vigorous intensity levels are used towards meeting
physical activity needs. The following are definitions used to delineate activity lifestyles.
• Sedentary: A lifestyle characterized by little or no physical activity during leisure
time. Activities include only the physical activity of independent living.
• Light Intensity: A lifestyle that includes some physical exercise that does not
typically raise the heart or respiratory rates. Examples include casual walking, grocery
shopping, or doing light housework.
• Moderate Physical Activity: A lifestyle that includes exercise that promotes some
exertion but in which the individual has a minimal increase in heart and respiratory
 rates. Examples of moderate physical activity include walking briskly, general
gardening, golf, water aerobics, canoeing, tennis (doubles), dancing, or bicycling on
level terrain.
• Vigorous Physical Activity: A lifestyle that includes exercise that promotes a
noticeable increase in heart and respiratory rates. Vigorous physical activity may be
sufficiently intense to represent a substantial challenge to an individual and it results in
a significant increase in heart and breathing rates. Examples include running or jogging,
heavy yard work, aerobics, swimming continuous laps, basketball (competitive), or
tennis (singles).
Key Concept Balance the foods you eat with physical activity to maintain or improve
your weight. Excess weight increases the risk of numerous chronic diseases, such as
hypertension, heart disease, and diabetes.

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 RELATED LINKS

o Nursing
 The Origins of Nursing (The Nature of Nursing) Part 1
 The Origins of Nursing (The Nature of Nursing) Part 2
 Beginning Your Nursing Career (The Nature of Nursing) Part 1
 Beginning Your Nursing Career (The Nature of Nursing) Part 2
 Beginning Your Nursing Career (The Nature of Nursing) Part 3