Chapter 1 marciano

Terminology: iii. Micronutrients:

Nutrition: i. Vitamins:
 Sum of all interactions between an  Organic & cannot be manufactured
organism and consumed food by the body
 What a person eats and how they use it  Small quantities = catalyst
Nutrients: metabolism
 The organic & inorganic substances  Water-Soluble: A, D, E, K
found in food and required for body  Fat-Soluble: B & C
functioning ii. Minerals:
Caloric Value:  Organic compounds or inorganic &
 The amount of energy that nutrients or free ions
foods supply the body with.  Macronutrients: calcium &
Calorie: phosphorus
 Unit of heat energy  Micronutrients: iron & zinc
Metabolism:
 All biochemicals & physiologic process Dietary Guidelines:
by which the body gains & maintain 1. Consume nutrient dense foods in
itself. caloric needs
2. Fat intake at 20-35% of total calories &
Essential Nutrients: less than 10% of saturated fatty acid
i. Water: 3. Basic common sense
 Body’s most basic nutrient need.
 60-75% of body Monounsaturated Olive oil 20% Lower
ii. Macronutrients: heart
 Consist of energy providing disease
i. Carbohydrates: CHO
 Sugars: simple form Polyunsaturated Veg. oil 10% Lower
 Starch: insoluble, non-sweet heart
polysaccharides (grains & disease
potatoes)
 Fiber: complex, indigestible; Saturated Animal, <7% Increase
makes you full coconut heart
ii. Proteins: CHON, composed of Amino oil disease
Acids
 Essential: cannot be
manufactured by the body Trans Margarine Increase
 Non-Essential: produced by the <3% heart
body disease
iii. Lipids: insoluble, greasy. Container
higher hydrogen than CHO
 Fatty Acids: basic structural unit
 Unsaturated: carbons filled with
hydrogen (butter)
 Unsaturated: can accommodate
hydrogen (olive oil)
Water-Soluble Vitamins:
1. Vitamin B1: Thiamine
 Source: liver, meat
 Deficiency: peripheral neuropathy
2. Vitamin B2: Riboflavin
 Source: liver, meat
 Deficiency: glossitis, cheilosis
3. Vitamin B3: Niacin
 Source:
 Deficiency:
4. Vitamin B5: Pantothenic Acid
 Source: l
 Deficiency:
5. Vitamin B6: Pyridoxine
 Source: liver, meat
 Deficiency: brain development
6. Vitamin B7: Biotin
 Source:
 Deficiency:
7. Vitamin B9: Folate
 Source: green leafy vegetables
 Deficiency: anemia
8. Vitamin B12: Cobalamin
 Source: liver & meat
 Deficiency: anemia, neuropathy
Terminology:
Health:
 Absence of disease & illness
 State of complete physical, mental &
social wellbeing. Not merely the
absence of disease
Wellness:
 Lifestyle (patterns of behavior) that
enhances levels of health
Nutrition:
 Study of nutrients & their process by
which they are used by the body
Nutrients:
 Substances found in food
Six Dimensions of Health:
1. Physical Health:
 Efficiency of the body to meet the
daily energy requirement
 Depends on quantity & quality of
nutrients
2. Intellectual Health:
 Ability to learn & adapt to changes
in env’t
 Nutritional imbalance can affect
cognitive abilities
3. Emotional Health:
 Capacity to express or surpress
emotions
 Affected by poor habits
4. Social Health:
 Ability to interact with people in
an acceptable manner and sustain
relationship
 Nutritional status is affected by the
quality of relationships with family
& friends
5. Spiritual Health:
 Cultural beliefs, faith in the
teachings and understanding nature
and science
 Consumption of food (islam)
6. Environmental Health:
 External factors
Health Promotion:
 Strategies to promote health of the
three levels of clientele
 Individual, family,
group/community
 Knowledge: learning new info.
About the benefits & risks of health
related behaviours
 Techniques: apply new knowledge to
ADLs
Community Support:
 Availability of environmental or
regulatory measure to support new
health promoting behaviours
Disease Prevention Through Nutrition: Functions of Essential Nutrients:
 Recognition of dangers to health that 1. Providing Energy:
could be minimized through lifestyle  CHO, CHON, Lipids
changes  Vitamins & minderals serves as a
 Lifestyle catalysts
 Genetics 2. Regulatory Body Processes:
 Environment  CHON, Lipids, vitamins, minerals
& water
Three Levels of Prevention: 3. Adding Growth & Repair:
Primary:
 Activities that can stop development Types of Lipids:
of disease or poor health 1. Triglycerides:
 Healthy lifestyle  Saturated, monosaturated,
Secondary: polyunsaturated
 Early detection to reduce the effect 2. Phospholipids:
of disease  Liquid component that form cell wall
 Decreasing salt for cardio patient & act as emulsifier
Tertiary: 3. Sterols:
 Minimize complications after illness  Serve vital function
 Assist in restoration of health Vitamins:
 Diet therapy  Essential organic molecules needed
 Rehabilitation in very small amounts for cellular
metabolism
Health Literacy: Minerals:
 Ability to acquire, comprehend and  serves as structural purposes in the
communicate & apply basic health body (bones & teeth
info.  minimum daily requirement of
 Allow education to be more effective 100mg
 Can develop through education Trace Minerals:
Types of Education:  Chromium, cobalt, copper, fluorine,
1. Formal: iodine, iron, manganese, selenium, &
 Educational setting zinc
2. Non-Formal:
Carbohydrates:
 Organized teaching & learning
events in  Quick energy
hospital/clinic/community. Protein:
3. Informal:  Bine, muscle
 Educational experiences through  Essential amino acids
daily activities.  Unused protein stored as fat or
excreted
Fats/Lipids:
 Densest form of energy
 Components of all cell structures
 Production of hormone
 Padding for protection of organs
 Four Themes of MyPlate:
CHAPTER 2 1. Variety: To All Age Groups &
Subgroups
Personal Nutrition: 2. Proportionality
 We are responsible fort he quality of 3. Moderation
dietary intake 4. Activity
 Composed of dietary guidelines that
affect health & nutritional status Exchange List:
 Contains sizes or # of serving sizes
Food Selection:  Encourage variety & help control
Food Preferences: consumption of kCal grams of CHO,
 Choosing of food to eat available at CHON & Lipids
the same & quality  Meet need of weight reductional
 Media has indirect effect programs & nutritional planning
Food Choices:
 Specific foods convenient to choose Food Labelling:
when ready to eat  Assist consumer
Food Liking/Food Labelling:  Reveal ingredients
 Reflection of nutritional health of  Motivate food companies to enhance
individuals in the community products

Community Nutrition: Food Description:

 Reflection on nutritional health of  Free
individuals in the community  Low
Dietary Guideline:  Lean/Extra lean
 Provides lifestyle of dietary patterns,  Reduced/Less
recommendations that ensure  Light/Lite
nutrient adequate & primary disease  Good Source Of
prevention.

Food Guides:
MyPlate:
 Interactive food guide to implement
dietary guideline recommendation.
 Replaces traditional food pyramid
 Internet based tool based on
 Age
 Gender
 Sex
 Activity Level

Benefits of MyPlate:
 Increase vitamins, minerals, dietary
fiber & essential nutrients
 Basal metabolic Rate:
CHAPTER 3  Amount of kCal required for body’s
daily processes of life
 Women: 1200-1400
Terminologies:  Men: 1600-1800
Digestion:
 Process of food as they are broken Catabolic Process:
down into smaller units  Breakdown process
Absorption:  Glyconeogenesis
 Process which substances pass through  Lipolysis
intestines & to the blood
Metabolism: Anabolic Process:
 Absorbed nutrients are used by the  Building process
body or stored (fat).  Liver reassembles to PRO
 DNA directs PRO building
Phases of Gastric Secretion:
 Glycogen from CHO or glucose
1. Cephalic (Psychic): mental factors
2. Gastric: gastrin  Lipogenesis from excess kCal
3. Intestinal: end product = chyme
Stages of Swallowing:
1. Oral: voluntary
Ingestion:
2. Pharyngeal: involuntary
 Food choices
3. Esophageal: involuntary
 Adequate chewing
 Ability to swallow
 Ability to digest food matter
 Ability to absorb digested foo in the
intestines

Digestion:
 Allows for intestinal absorption &
cellular metabolism for energy
 Occurs w/macronutrients, CHO,
proteins & fats

Metabolism:
 Cellular nutritional
 Hormones required:
 Insulin: blood glucose
 Thyroxine: tyrosine & iodine
affect the rate of metabolism
 Glycemic Index:
CARBOHYDRATES:  Ranking of food that raises BG
 Provide energy, fiber & sweetener (indicator)
 All CHO are organic compounds Glycemic Load:
 Total glycemic index effect of a fixed
meal
Sizes of CHO:  Accounts for the mixed consumption
1. Monosaccharide of food
2. Disaccharide  Measures quality and quantity of the
3. Polysaccharide effect; CHO in BG levels
*glycogen is a polysaccharide stored in the
liver & muscle Simple Carbohydrates (monosaccharide)
Glucose or blood sugar:
Processes Involving CHO:  Form of CHO easily used by the
Glycogenesis: body
 Glucose to glycogen Fructose:
Glucogenolysis:  Sweetest of all sugars “fruit”
 Glycogen to glucose Galactose:
Gluconeogenesis:  Part of lactose
 Glucose from fats  Converted in LIVER
CHO Metabolism:
 Maintaining blood glucose levels at Disaccharide:
70-100mg/dL Sucrose:
 Table sugar, glucose + fructose
Blood Glucose: Maltose:
 A source of energy for all cells  Glucose + glucose
Glucose: Lactose
 Essential for brain function &  Glucose + galactose
formation
Insulin: Complex (polysaccharide):
 Hormone that lowers BG levels Starch:
 Enhances the conversion of excess  Plant foods (grains, legumes, vegies,
glucose to glycogen fruits)
Glucagon & Somatostatin: Fiber:
 Two hormones that increase glucose  Simple sugars
 Cannot be broken down by the
Hypoglycemia: human GI
 Abnormally low BG  Passes through the body w/o kCal
Diabetes Mellitus: effect
 Abnormally high BG  Soluble: dietary fiber dissolves
 Type 1: in fluids
 IDDM  Insoluble: does not dissolve in
 Juvenile diabetes “inborn: fluids
 Type 2:
 NIDDM
Health Effects of Dietary Fiber:
Obesity:
 Increase fiber in food reduce or
prevent obesity
Constipation:
 Prevents dry, hard stools
Diverticular Disease:
 Affects the large intestine.
 Low fiber weakens intestinal mucosa
that results to the formation of
diverticula
Cancer:
 High fat dietary intake and other
carcinogenic substances
 Eating high fiver tends to eat less fat
Heart Disease:
 High cholesterol/lipids level
 Eating fiber can decrease cholesterol
Diabetes Control:
 Stabilize BG level

Dietary Recommendation for CHO:

 DRI (dietary reference intake) for
adults 19-30 y/o is 130 grams/day
 AMDR (acceptable macronutrient
distribution ranges): 45-65
kCal/day of CHO
 Women: 25 grams
 Men: 35 grams

Roles of Glucose & Carbohydrates:

 Absorption
 Glycemic loads
 Regulation of lipids
 Vitamin & mineral absorption
 Prebiotics & short chain of fatty
acids
FATS:
 Individual preference for fats are
developed at either infancy or early
childhood
 Children learn to prefer taste, flavor,
textures that are rich in fat or sweets
or both
 Aging maybe associated with
increasing acceptance of bitter taste
and consumption of more fruits,
veggies & whole grain
 Innate preferences for sweet taste are
observed at birth
Function of Fats:
1. Specific characteristics of foods
that arise from lipids
2. Maintenance of physiologic health
Food Functions:
1. Source of Energy:
 Densest for of stored energy
 Produces 2x of kCal of CHO &
CHON
 9kcal
2. Palatability:
 Gives pleasant smell & taste
3. Satiety & Satiation:
 Prevents hunger between meals
 Slows down digestion causing
feeling of fullness & satisfied
(satiety)
 Satiation: occurs during eating
4. Food Processing:
 Keeps the fat & fiid frin turning
rancid
5. Nutrient Source:
 Contains fats, soluble nutrients
(ADEK) and EFAS (linoleic)
Physiologic Functions:
1. Stored Energy:
 Body fat cells contains nearly
pure fats
2. Organ Protection:
 Padding & protection of organs
3. Temperature Regulation:
 Fat layer under the skin
4. Insulation:
 Myelin* covers nerve cells
 Provides electrical insulation
Functions of Phospholipids & Sterols:
 Acts as an emulsifier to keep fat
dispersed to body fluids
Lecithin:
 Main phospholipid
 Basic material to make bile
 Carries fat & cholesterol away from
plaque deposits in arteries
HDL (high density lipoprotein):
 Good cholesterol
LDL (low density lipoprotein):
 Bad cholesterol
Sterol:
 Fat like class of lipids
 Critical component of complex
regulatory compounds
 Provide basic materials to make bile
Fat Education:
Hydrogenated Vegetable Oil:
 Contains artificial transfat
 Cholesterol forming saturated fats
Palm Oil/Kernel/Coconut Oil:
 Only plant sources of naturally
saturated fats
Margarine:
 Cholesterol free if made from
vegetable
 Contains the same calorie as butter
 Both are 100% lipid
 Advise client to check the labels of
food regularly

Dietary Fat Intake Related Disease:

 Cardiovascular Disease
 Cancer
 DM 2
 Hypertension

Food Sources of Fat:

 Food in germ portion of grains, some
fruits (coconut, avocado, olives), and
in whole milk (butter), meats, nuts,
seeds, egg yolks
 Omega 3 fatty acids found in
cold-water fish
 Monosaturated fats

Cholesterol:
 Fatlike substance produced in the
liver
 Found in animal fat
 Foes not provide energy

 Saturated fats: encourage excess

production of cholesterol in the liver
 Unsaturated Fats: suppress the
liver’s production of fats
PROTEINS:
 Organic compounds composed of
amino acids
 CHON
Functions of Protein:
1. Growth & Maintenance:
 Growth depends on sufficient
supply of AA
 AA supports muscle, tissue &
bone formation
 Protein collagen
 Forms connective tissue
(ligament & tendon)
 Acts as a glue to keep the
walls of the arteries intact
2. Creation & Communication &
Catalyst:
 Acts as communicator
(hormones) that alert changes
& regulate function of organs
 Blood clotting – 12 blood
clotting factors
 Immune system response
 Immune defense depends
on protein
 Resistance to disease
depends on protein
3. Fluid & Electrolyte Regulation:
 Maintain body fluid &
electrolyte balance
 Three compartments:
 Intravascular: w/in veins
& arteries
 Intracellular: inside cell
 Interstitial: between cella
4. Acid Base Balance:
 Buffering effect; regulate the
balace between acidic & basic
characteristics of fluid
5. Transportation:
 Assist in the movement of
nutrients in & out of cells
Protein Attributes & Functions:
 Protein is unique among nutrients
because it contains Nitrogen
 Because of its nitrogen content,
protein is used as a building source
for new body cells
 Protein is founf in all body cells and
constituents such as the immune
system, hormones & digestive
enzymes
 Dietary intake digested into amino
acids
Protein Sources:
 Found in muscle, eggs, nuts,
legumes, milk & milk products
 Limited amounts in grains &
vegetables
 Only fats and sugars do not contain
protein; fruit contains trace amounts,
generally considered to have none.
 Essential Amino Acids (EAA):
 Children: 9
 Adults: 8
 Certain quantitty need in the
diet within a 24hr period to
make protein
 Complete Protein Source: foon
containing all 8 EAAs (animal
products)
Protein Needs: Estimating Protein Content of Foods:
 Minimum of 50g daily with all  1oz meat (1.4 cup volume) = 7g PRO
EAAs  1 egg (1/4 cup volume) = 7g PRO
 Individualized needs based on age  ½ cup legumes, ¼ cup of peanut
and other factors butter are counted as alternative to
 Children: 1.5g/kg body weight 1oz of meat
(BW)  1 cup of milk = 8g of PRO
 Adults: 0.8g/kg BW
 Older Adults: 1.0-1.2g/kg BW
 Athletes: 1.0-2.0g maximum per
kg BW
 Increased needs also based on health
parameters
 Protein starus (albumin goal >3.5
mg/dL) or states of increased
demand, such as burns

Protein Deficiency Conditions:

 Reduced albumin (<3.5mg/dL)
related to impared body processes;
(<2.8mg/dL) related to poor surgical
outcomes with impaired wound
healing and compromised immune
system
 Kwashiorkor: condition of protein
deficiency
 Protein deficiency though
adequate energy is consumed,
swollen belly & full cheeks
caused by edema
 Marasmus or Protein-Calorie
Malnutrition (PCM):
 Malnutrition caused by a lack of
sufficient energy intake,
extremely thin, skin seems to
hang on skeletal bones
 Albumin: simple form of protein
that is soluble in water (egg white
and milk and blood serum)

Dietary & Clinical
Assessment:
Nutritional Status:
 A measurement of the extent to
which the individual’s physiological
need for nutrients are being met
Purpose of Screening:
 To quickly identify individuals who
are malnourished or at nutritional
risk
 To determine if a more detailed
assessment is warranted
Characteristics of a Nutritional Screen:
 Simple & completed quickly
 Routine data
 Early intervention goals
 Collection of relevant data on risk
factors
 Data interpretation for treatment
 Determines need for a nutrition
assessment
 Cost effective
Nutritional Assessment:
 Comprehensive approach, completed
by a registered dietitian, for defining
nutritional status using medical,
social, nutritional, and medication
historus, physical examination,
anthropometric measurements, and
lab data
Nutritional Histories:
 Medical & social histories
 Medication gistory
 Nutrition or diet history
Anthropometry:
 Involves obtaining physical
measurements of an individual and
relating them to standards that reflect
the growth and development of the
individual
Interpretation of Height & Weight:
 Length & height
 Weight
 BMI
Calculating BMI:
 Weight (kg) / height m2
 Weight (lb) / height (inches) / height
in inches x 703
Body Composition:
 Subsutaneous fat (skinfold thickness)
 Circumfrance measurements
Nutrition-Focused Physical Examination:
 Physical signs
 Immune function
Classifying Malnutrition:
 Body weight
 Body fat
 Somatic and visceral protein stores
 Laboratory values
Food-Drug
Patients at Risk for Food-Nutrient
Interactions: Interactions:
 Patient with chronic disease
Key Terms:  Elderly
Bioavailability:  Fetus
 Degree to which a drug ot other  Infant
substances reaches the circulation  Pregnant women
and becomes available to the target
 Malnourished patient
organ or tissue
Drug-Nutrient Interactions:
Drug Effects on Nutrition:
 The results of the action between a
 Decreased/Increased intake:
drug and a nutrient that would not
 Appetite
happen with the nutrient or drug
alone  Taste
Half-Life:  Nausea
 Amount of time it takes for the blood  Dry mouth
concentration of a drug to decrease  Alter metabolism:
by one half of its steady state level  Anti-vitamins
Side Effect:  Monoamine oxidase inhibitors
 Adverse effect/reaction or any  Change Absorption:
undesireable effect of a drug  GI pH
 Transit time or motility
Pharmacology Terms:  Bile acid secretion/activity
Pharmacokinetics:  Drug-nutrient complexes
 Movement of a drug through the  Mucosal damage
body by absorption, distribution,  Change secretion
metabolism, and excretion.
Pharmacodynamics: Nutrient Effects on Drugs:
 Physiologic & biochemical effects of  Absorption:
a drug or combination of drugs  Note if drug is take w or w/o
Pharmacogenomics: food
 Genetically determined variations  Note which foods to avoid
that are revealed solely by the effects  Metabolism:
of drugs  Changes in diet may alter drug
action
Therapeutic Importance:  Malnutrition alters albumin level
 Alter the intended response to the (blood binding) and MFOS
medication enzyme activity level
 Cause drug toxicity  Excretion:
 Alter normal nutritional status  Fluid status
 Urinary pH
Important Interactions: Drugs That May Affect Glucose Levels:
 Oral Contraceptives:  Antidiabetics
 Folate  Drugs that can cause hypoglycemia
 Antihypertensives:  Antiretrovirals, protease inhibitors
 Ca  Diuretics, antihypertensives
 K  Hormones
 Mg
Medical Nutrition Therapy for Food-
Key Information: Drug Interactions:
1. Physician’s Desk reference – food &  Prospective:
drug interaction  All MNT offered when the
2. Generic or chemical name differs patient first starts a drug
from brand name  Retrospective:
3. Drugs are classified by action,  Evaluation of symptoms to
manufactured, class, brand name, determine if medical problems
generic name might be the result of food-drug
4. Over the counter drugs may be interactions
bought without prescription
Enteral Nutrition & Drugs:
Drug Categoris That May Cause Loss of  Drugs put in feeding tubes:
Appetite:  Diarrhea
 Anti-infectives  Drug0nutrient binding
 Antineoplastics  Blocked tube
 Bronchodilators  Avoid adding drug to formula
 Cardiovascular drugs  When drugs must be given through
 Stimulants the tube:
 Stop feeding, flush tube, give
Drugs That Cause Diarrhea: drug, flush
 Laxatives  Use liquid form of drug
 Antiretrovirals  Avoid cvrushing tablets
 Antibioticvs
 Antineoplastics Summary:
 All drugs are metabolized ahead of
Drugs That Increase Appetite: nutrients
 Anticonvulsants  Most drugs have nutritional status
 Hormones side effects
 Psychotropic drugs:  Always look for potential
 Antipsychotics interactions
 Antidepressants, tricyclics,  Watch for use of multiple drugs
MAOIs (polypharmacy) especially among
the elderly
 Nutrition Requirements: Parenteral
Nutrition for Low-  Fluid
 Energy
Birth-Weight Infants  Glucose
 Amino acids
Low-Birth-Weight Infant:
 Lipid
 Less than 5 ½ lb
 Electrolytes
Very Low:
 Minerals
 Less than 3 1/3 lb
 Trace elements
Extremely Low:
 Vitamins
 Less than 2 ¼ lb
Nutritional Support: Prematurity:
Infancy:
 Medical management
 Birth-1 y/o
Premature:  Nutritional management
 Born before 37wks gestation
Methods of Feeding:
Gestational Age:
 Gastric gavage
 The age of the infant at birth, as
determined by the length of the  Nipple feeding
pregnancy  Breastfeeding
Small for Gestational Age: 
 weighs less than the 10th percentile
of the standard weight of GA
Large for Gestational Age:
 birth weight is above the 90th
percentile of the standard weight for
gestational age

Prematurity:
Problems:
 Respiratory
 Cardiovascular
 Renal
 Neurologic
 Metabolic
 Gastrointestinal
 Hematologic
 Immunologic

Nutrition in
Adolescence
Growth & Development:
 Physiologic changes
 Early adolescence
 Middle adolescence
 Late adolescence
 Assessment of growth:
 CDC growth charts
 Sexual maturity rating
 Body image
Nutrient Requirements:
 Energy
 Protein
 Vitamins & Minerals
Supplement Use:
 Results from studies show that
adolescents consume less than 75%
of the RDA for important vitamins &
minerals
 Education programs need to be
implemented, aimed at the
improvement of dietary intakes
Physical Activity:
 Numerous health benefits from
physical activity
 Studies show that adolescents are not
nearly physically active enough to
benefit
Food Habits:
 Irregular meals & snacking
 Fast foods and the media
 Potential nutritional inadequacies
 Adolescents as food purchasers
Vegetarianism:
 Can meet the DRI/RDAs for
nutrients
 Adolescent vegetarians should be
informed that inappropriately
selected vegetarian diets can result in
significant malnutrition.
Eating Disorders:
 Third most coming chronic illness in
adolescent females
 Anorexia nervosa
 Bulimia nervosa
 Eating disorders not otherwise
specified
Obesity:
 Prevalence of overweight teenagers
is up to 21%
 Eating habits and physical inactivity
patterns contribute to the rise in
adolescent obesity
 Health, social & economic
consequences
Hyperlipidemias:
 Major adult cardiovascular disease
begin in childhood and adolescence
 To prevent:
 Screening & promotion of
healthy lifestyle behaviours
Sports Nutrition:
 Vulnerable to nutritional
misinformation & unsafe practices
that promise enhanced performance
 Prevention of dehydration
Substance Use:
 Tobacco
 Alcohol
 Marijuana
 Other drugs
Teen Pregnancy:
 Recommended weight gains during
pregnancy maybe slightly higher for
the teenager that for the adult
 Young gynecologic age or
undernourished at time of conception
= greatest nutritional needs
 Nutritional adequacy

Assessment of Nutritional Status:

 Age-specific database or standards
based on stage of maturity
 Nutritional assessment should
include an evaluation of the
nutritional env’t., parental, peer,
school, cultural & personal lifestyle
factors.

Prerequisites for Change:

 Assessment of the teen’s desire to
change is essential.
 Knowledge, attitude, and behaviours
must be addressed.
 Studies show that adolescents are not
nearly physically active enough to
benefit
 Nutritional Needs:
Nutrition in Aging:  Energy
 Protein
Aging Issues:  Lipids
 Life expectancy  Minerals
 Percent of population  Vitamins
 Life span  Water

Physiologic Changes: Dietary Planning:

 Body composition  Nutrient density
 Sensory losses  Vitamin/mineral supplementation
 Oral health status  Consistency of food
 GI function
 CV function Nutritional Issues:
 Renal function  Dysphagia
 Neurologic function  Pressure ulcers
 Immunocompetence  Alzheimers Disease
 Parkinsons
Multidisciplinary Assessment:  Failure to thrive
 Requires a team of health
professionals Supportive Services:
 Community nutrition programs
 Assisted living & skilled care
facilities – long-term

Nutritional Screening:
 Older adults at risk for malnutrition
 Benefits of screening
 Screening tools
 Nutrition screening initiative (NSI)

Nutrition in
Childhood:
Childhood Growth & Development:
 Pattern of growth
 Catch-up growth
 Assessing growth
Growth Charts:
 CDC growth charts
Nutrient Requirements:
 Energy
 Protien
 Vitamins & minerals
Dietary Reference Intakes for Energy &
Protein:
 Energy needs determined on the
basis of basla metabolism, rate of
growth, and energy expenditure
 The need for protein per kilogram of
body decrease from approximately
1.1g in early childhood to 0.95g in
late childhood.
Minerals & Vitamins:
 Children between 1-3 y/o are at high
risk for iron deficiency
 Calcium is needed for adequate
mineralization and maintenance of
growing bone
 Zinc is essential for growth
 Vitamin d is needed for calcium
absorption
Childhood Obesity:
 Overweight prevalence of 11% in 6-
11 y/o
 Increases CV risk factors, such as
hyperlipidemia, hypertension, and
hyperinsulinemia
 Type 2 DM
Iron Deficiency:
 One of the most common nutrient
disorders of childhood
 Affects approximately 9% of
toddlers
 Linked to lower test scores
Dental Carries:
 Composition of the diet &
individuals eating habits are
significant factors in developing
dental carries
 Fewer cariogenic snacks should be
emphasized
 Protein foods such as cheese, nuts &
meat should be eaten with sticky
foods to help protect against cavities
Allergies:
 Food allergies usually manifest in
infancy & childhood
 Allergic responses include
respiratory or GI symptoms, skin
reactions, fatigue or behavioural
changes
Attention Deficit Hyperactivity Disorder:
 ADHD
 Dietary factors have been suggested
as the cause
 Omission of sugar, allergy
elimination diets, megavitamin
therapy
Autism Spectrum Disorders:
 1 out of 500 children
 Affects nutrition & feeding with
typical behaviours of very restricted
food acceptance, hypersensitivities,
and difficulty in making transitions

Preventing Chronic Disease:

 Roots of chronic diseases in adults
such as heart disease, cancer,
diabetes & obesity are often based in
childhood
 Dietary fat
 Calcium
 Fiber
 Physical activity
Nutrition During
Pregnancy &
Lactation: Key Minerals in Pregnancy:
 Ca
Factors Affecting Conception:  Ph
 Health status  Fe
 Age  Zinc
 Prior pregnancy outcomes  Cu
 Obesity  Na
 Extreme underweight  Magnesium
 Others  Fluoride
 Iodine

Summary of Nutritional Care for the

Pregnant Women:

Factors Affecting Pregnancy Outcome:

 Historical perspective
 Perinatal mortality & birth weight
 Maternal size
 Maternal weight gain during Non-Nutrient Effects/Issues:
pregnancy  Alcohol
 Obesity  Caffeine
 Adolescence  Artificial Sweeteners
 Multiple births

Key Macronutrients in Pregnancy:

 Protein
 Carbohydrate & fiber
 Lipids

Key Vitamins in Pregnancy:

 Folic acid
 Vitamin B6
 Ascorbic Acid
 Vitamin A, D, E, K
Physiologic Changes of Pregnancy:
 Blood volume & composition:
 Blood volume increase
 Red cell volume increase
 Nutrient concentration changes
 Cardiovascular & pulmonary
function:
 Increased cardiac output
 Increased PR
 Cardiac hypertrophy
 Decrease BP
 Increased oxygen requirements
 Enhanced gas exchange
efficiency
 GI Function:
 Nausea & vomiting
 Anorexia
 Constipation
 Heartburn
 Renal Function:
 Higher glomerularl filtration
rate
 Increased nutrient excretion
 Leg & ankle edema
 Placenta:
 Surface size affects infant
nutriture & BW
Diet-Related Complications of Pregnancy:
 Nausea & vomiting
 1st trimester
 Heart burn
 Late in pregnancy
 Constipation & hemorrhoids
 Latter stages
 Physiologic edema & leg cramps
 3rd trimester
Higher-Risk Complications of Pregnancy:
 Hyperemesis gravidarum:
 Incidence: 2% of obstetric
population
 Signs and symptoms
 Management
 Pregnancy & Preexisting DM:
 Incidence: 5%-10%
 Diagnosis
 Management
 Pregnancy-induced hypertension
(PIH):
 Incidence: 7%-8%
 Preeclampsia
 Eclampsia
 Diagnosis
 Management
Lactation Overview:
 Physiology of lactation
 Nutritional requirements of lactation
Advantages of Breastfeeding:
Breastfeeding: Special Nutrients:
 Energy
 Protein
 Carbohydrates
 Lipids
 Vitamins & minerals
Nutrition in the Adult
Years:
Defensive Nutrition Paradigm:
 Emhpasises making food choices to
promote wellness & to support organ
systems for optimum functioning
during agig
 More plant based foods
 Less red meat
Phytochemicals:
 Found in a wide variety of plant
foods; powerful antioxidants
 Subclasses of: carotenoids &
limonoids
 Carotenoids: yellow, orange & red
plant pigments (lycopene is a
carotenoid in tomatoes)
 Limonoids: citrus fruits
Phytochemicals: Phenols:
 Protect plants from oxidative damage
 Includes subclass flavonoids which
are the blue, blue-red, and violet
plant pigments
 Isoflavenes are a phenol subclass
found in beans & other legumes,
especially soybeans & soy foods
 Some isoflavones are phytoestrogens
Phytochemicals: Thiols:
 Sulfur-containing phytonutrients
found in cruciferous vegetables
(broccoli & cabbage)
 Contains subclasses of thiols
identifies as indoles, dithiolthiones,
and isothiocyanates
Phytochemicals: Lignans:
 Found in flaxseeds, wheat bran,
oatmeal, etc.
 Researched for thei anticancer and
phytoestrogen properties
Gastrointestinal Integrity:
 Intestinal mucosa:
 Major function is its barrier
activity, which prevent antigenic
or pathogenic molecules or
microorganisms from entering
the systemic circulation
 Intestinal microflora:
 Barrier against invading
organisms, improve gut
immunity and to help digest food
 Prebiotics
 Probiotics
Detoxification Systems:
 Immune tissue (in the gut)
 Detoxification enzymes in the liver
Guidelines: Defensive Nutrition
Paradigm:
 Maximise support for organ systems
 Optimize GI integrity &
immunologic function
 Ensure maintenance of a healthy
body weight & level of adiposity
 Help prevent metabolic syndromes
Physiologic Changes:
 Increase in weight & change in body
composition results in an increase
risk for comorbid diagnoses
associated w obesity:
 Type 2 DM
 Impaired glucose tolerance
 Hyperinsulinemia
 Dyslipidemia
 CV diseases
 Hypertension
 Sleep apnea
 Gallbladder disease
 Osteoarthritis
 Reduced fertility
 Some cancers
Dietary Sources of Omega-3 Fatty Acids:
 Flaxseed
 Canola & soybean oils
 Walnuts
 Butternuts
 Red & black currant seeds
 Fatty marine fish (salmon makerel)