MODULE 2

ANSWERS

NUTRITION
AND
DIET THERAPHY

Submitted to:
Ms. CHARI V. RIVO
Dela Cruz, Jonelvira C. September 20, 2020
BSN 2B

LESSON 1: CARBOHYDRATES

Concept Check

 Why carbohydrates considered our most valuable energy source?

Carbohydrates are your body's main source of energy: They help fuel your brain, kidneys, heart
muscles, and central nervous system. For instance, fiber is a carbohydrate that aids in digestion, helps
you feel full, and keeps blood cholesterol levels in check. Your body can store extra carbohydrates in
your muscles and liver for use when you're not getting enough carbohydrates in your diet. A
carbohydrate-deficient diet may cause headaches, fatigue, weakness, difficulty concentrating, nausea,
constipation, bad breath and vitamin and mineral deficiencies.

Review
Multiple choice. Select the letter that precedes the best answer.
C 1. The three main groups of carbohydrates are
a. fats, proteins, and minerals
b. glucose, fructose, and galactose
c. monosaccharides, disaccharides,
and polysaccharides
d. sucrose, cellulose, and glycogen

A 2. Galactose is a product of the digestion of

a. milk
b. meat
c. breads
d. vegetables

B 3. The simple sugar to which all forms of carbohydrates are ultimately converted is
a. sucrose
b. glucose
c. galactose
d. maltose

C 4. A fibrous form of carbohydrate that cannot be digested is

a. glucose
b. glycogen
c. cellulose
d. fat

B 5. Glycogen is stored in the

a. heart and lungs
b. liver and muscles
c. pancreas and gallbladder
d. small and large intestines

D 6. Glucose, fructose, and galactose are

a. polysaccharides
b. disaccharides
c. enzymes
d. monosaccharides

B 7. Before carbohydrates can be metabolized by the cells, they must be converted to

a. glycogen
b. glucose
c. polysaccharides
d. sucrase
C 8. The only form of carbohydrate that the brain uses for energy is
a. glycogen
b. galactose
c. glucose
d. glucagon

A 9. Substances to which fatty acids are broken down in the liver are
a. galactose
b. estrogen
c. thyroxin
d. ketones

A 10. Starch is
a. the form in which glucose is stored in plants
b. a monosaccharide
c. an insoluble form of dietary fiber
d. found only in grains

B 11. Insoluble dietary fiber

a. can increase blood glucose
b. can decrease blood cholesterol
c. commonly causes diverticular disease
d. is preferably provided by commercially prepared fiber products

B 12. The enzyme in the mouth that begins the digestion of starch is
a. salivary ptyalin
b. salivary amylase
c. sucrase
d. lipase

A 13. Cellulose is
a. not digestible by humans
b. not to be included in the human diet
c. a monosaccharide
d. an excellent substitute for dextrose

C 14. Carbohydrates
a. are rich in fat
b. are generally expensive
c. should provide approximately half of the calories in the our diet
d. frequently are an excellent substitute for proteins in the human diet

A 15. Glucose metabolism is

a. controlled mainly by the hormone insulin
b. not affected by any secretion of the islets of Langerhans in the pancreas
c. managed entirely by glucagon
d. not related to human energy levels

Laboratory Activity
Search the Web for information on carbohydrate-reducing diets and products. Is the information
provided at these sites accurate? If a client came to you with questions about a product such as these, how
would you respond? Create a fact sheet that lists myths surrounding carbohydrates and the facts that
dispel the myths.

Based on my research, some people go on a low-carb diet to try to lose weight. This usually means eating
25g and 150g of carbs each day. This kind of diet can be safe, but you should talk to your health care
provider before starting it. One problem with low-carb diets is that they can limit the amount of fiber you
get each day. They can also be hard to stay on for the long term.
https://medlineplus.gov/carbohydrates.html
If ever that client will come to me and question me about these kind of diet, I will not suggest it. I’ve
done that before, I don’t usually eat rice, no carbs, and the effect is worse. Instead of losing a weight, I
gained weight. So basically, it depends on your body or if ever they will do it, they can consult to
professionals.

CARBOHYDRATES

The MYTH The FACT

Carbohydrates are bad for you. You need carbohydrates to live.

“Carbohydrates make you gain weight,” says one
teen interviewed at a mall. Another teen cannot
even define what a carbohydrate is, and ventures a
guess that carbs are like fat.
The narrator addresses the common misperception
people have about carbohydrates. “There’s
probably no bigger nutrition myth than this one!
Carbohydrates are our body’s preferred energy
source, and going too long without them can
make you feel tired and grumpy.” The narrator
explains that there are two types of carbohydrates.
Complex carbohydrates found in whole-grain
wheat are healthy, while simple carbohydrates
like sugar have little nutritional value and are high
in calories. These should be limited in a healthy
diet plan.

LESSON 2: FATS

Concept Check

 From the groups of lipoproteins, which of them is considered the “good cholesterol” and the “bad
cholesterol”?
LDL (low-density lipoprotein), sometimes called “bad” cholesterol, makes up most of your body’s
cholesterol. High levels of LDL cholesterol raise your risk for heart disease and stroke.
HDL (high-density lipoprotein), or “good” cholesterol, absorbs cholesterol and carries it back to the
liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart
disease and stroke.

 What is the difference between fats and oils?

The main difference between Fats and Oils is that, fats are usually derived from animals, whereas oils are
usually derived from plants. Fats and oils are very important for every human body. It is mainly essential
for daily dietary plan. Fats and oils are totally different from each other. In simple terms, fats are animal
fats whereas oils are vegetable oils. The other difference is fats tend to be solids at room temperature; on
the other hand, oils tend to be liquid at room temperature. Remember, on the daily basis the two terms can
be used interchangeably because both, fats and oils contain 9 calories per grams.

 Now that you have learned about the unhealthy effects of fat intake, would you restrict fat in your
diet?
Not anymore. I’ve already said in lesson 1 laboratory activity that I’ve done it before. Not eating rice, no
carbs, and no exercise. That’s why instead of losing a weight, I gained so much weight. The best thing to
do right now is be responsible when eating. “Stop eating when you are already full” is my life motto. In
your free time, I can exercise, and I think that’s one of the best way to lose weight if you want.
Review
Multiple choice. Select the letter that precedes the best answer.
D 1. Margarine usually is made by a process called _____, in which hydrogen atoms are added to carbon
carbon double bonds in the polyunsaturated fatty acids found in vegetable oils.
a. saturation
b. esterification
c. isomerization
d. hydrogenation
A 2. Fatty acids that cause a decrease in blood clotting are
a. omega-3 fatty acids.
b. omega-6 fatty acids.
c. omega-9 fatty acids.
d. prostacyclins.
C 3. Cholesterol is
a. an essential nutrient.
b. found in foods of plant origin.
c. an important part of human cell membranes.
d. all of the above.
A 4. Which of the following groups of foods are rich sources of saturated fatty acids?
a. Olive oil, peanut oil, canola oil
b. Palm oil, palm kernel oil, coconut oil
c. Safflower oil, corn oil, soybean oil
d. All of the above
A 5. Lipoproteins are important for
a. transport of fats in the blood and lymphatic system.
b. synthesis of triglycerides.
c. synthesis of adipose tissue.
d. enzyme production.

A 6. Which of the following foods is the best source of omega-3 fatty acids?
a. Fatty fish
b. Peanut butter
c. Lard and shortenings
d. Beef and other red meats
C 7. Immediately after a meal, newly digested and absorbed dietary fats appear in the lymph and then the
blood as part of which of the following?
a. LDL
b. HDL
c. Chylomicrons
d. Cholesterol
C 8. High blood concentrations of _____ decrease the risk for cardiovascular disease.
a. low-density lipoproteins
b. chylomicrons
c. high-density lipoproteins
d. cholesterol
B 9. Phospholipids such as lecithin are used extensively in food preparation because they
a. provide the agreeable feel of fat melting on the tongue.
b. are excellent emulsifiers.
c. carry fat-soluble vitamins.
d. impart delicate flavors.
C 10. The main form of lipid found in the food we eat is
a. cholesterol.
b. phospholipids.
c. triglycerides.
d. plant sterols.
LESSON 3: LIPIDS

Concept Check

 Considering your weight, how many grams of protein should you take every day?
My current is weight is 55kg. So, 55 × 0.8 = 44. I should take 44 grams of protein every day.

Review
Multiple Choice. Select the letter that precedes the best answer.
A 1. For which of the following functions of protein can other nutrients be substituted?
a. Energy source
b. Immunity
c. Maintenance and growth
d. Regulation of body processes
C 2. Which of the following foods is a complete protein?
a. Baked beans
b. Broccoli
c. Beef kabobs
d. Bread sticks
B 3. If a person has difficulty purchasing meat to serve every day, which of the following foods should
the nurse suggest as offering the best source of protein?
a. Bran muffins with raisins
b. Red beans and rice
c. Green bean, onion, and mushroom casserole
d. Sweet potatoes and cornbread
D 4. Which of the following people would the nurse regard as being in
a catabolic state?
a. Adolescent boy who is into bodybuilding
b. Lactating mother
c. Pregnant woman in the second trimester
d. Surgical client, first day after a stomach resection

Clinical Application
1. Considering the health effects of too little dietary protein, what suggestions would you have for a
teenage girl who reports the following information about her food intake?

 She never eats any meat or other animal-derived foods because she is a vegan. On a typical day,
she consumes toast and juice for breakfast; chips, a soft drink, and a piece of fruit for lunch; and a
small amount of plain pasta with tomato sauce or steamed vegetables for dinner, along with a
glass of water or tea.
Recommended daily allowance of protein for a teenager per kilogram of body weight per day is a
minimum of 0.8 grams. Based on the diet outlined, the teenager is consuming very less protein in the diet
which is insufficient. Since the teenager is vegan, she would be recommended to get adequate proteins by
including good sources of protein such as green peas, quinoa, nuts, beans, chickpeas, and tofu in every
day meal.
 b. She takes amino acid supplements because a friend told her that the only way to get amino
acids if she doesn’t eat meat is to take them as supplements.
Since protein and amino acid supplements are not among ergogenic aids, the teenager would be
recommended to meet the recommended daily protein intake by making changes to the diet.

2. Considering the health effects of excess dietary protein, what advice would you have for a college
athlete who tells you he wants to bulk up his muscles and reports the following information about his
food intake?

 He eats large portions of meat (usually red meat) at least twice a day. He drinks whole milk two
or three times a day and eats eggs and bacon for breakfast almost every day.
Over consumption of proteins leads to potential health risks such as heart diseases and weakened kidneys.
This athlete, by consuming certain animal derived proteins such as fatty red meat, processed meats, and
milk products, will lead to burdening of fat kilocalories and saturated fat. This high protein food regime
followed by the athlete will lead to certain health risks such as obesity, diabetes and heart disease.

 b. He avoids breads, cereals, and pasta in order to save room for protein rich foods such as meat,
milk, and eggs.
He can eat breads, cereals and pasta but just minimal servings. Especially when he is craving for those
foods, sometimes, we need to fulfill ourselves by eating the food that we want.

 c. He eats a piece of fruit once in a while but seldom eats vegetables because they are too time
consuming to prepare.
It’s a bad idea eating a minimize amount of vegetables. His an athlete so he need extra strength, that
strength will come from food he eats especially vegetables. In order for him to save time, he can cook
vegetables dishes, like pinakbet. Pinakbet can cook in just 30 minutes so I think it’s one of the best
vegetable dishes that can help him a lot.

LESSON 4: ENERGY BALANCE

Concept Check

CASE STUDY
You have a 32-year-old female patient with the following anthropometric measurements: Weight: 120 lb
Height: 5 ft 4 in BMI: 20.6 kg/m2 She has been keeping a diet record; and after analyzing it, you find that
her average energy intake for each meal/snack is as follows:

Breakfast: 450 kcal

Midmorning snack: 175 kcal
Lunch: 600 kcal
Afternoon snack: 250 kcal
Dinner: 610 kcal
Evening snack: 200 kcal
Thus, her total energy intake averages 2285 kcal/day.

You calculate her basal energy needs according to the Mifflin-St. Jeor equation and find that her BEE is
1240.5 kcal/ day. She reports a very active lifestyle. Therefore, you multiply her BEE by a physical
activity factor of 1.725. Her total energy expenditure is: 2140 kcal/day.
You explain to your patient that she eats more kcals than she is using in a given day; thus she has a
positive energy balance of 145 kcal/day.

Questions to consider:
1. If she continues to consume and burn the same amount of energy, how long will it take for her to gain a
pound of fat? (1 lb of fat = 3500 kcal)
So to gain one pound of fat that is
1 lb = 3500
Because she has a positive energy balance of 145 kcal/day
So to gain one pound of fat, she would take
3500
= 24 days
145

2. How would you recommend that she change her lifestyle to maintain her current weight?
In order for her to maintain her current weight, she should decrease her calorie intakes, she should also
burn more calories by doing some exercises that will give her the best outcome of her body that she wants
and also, drink plenty of water.
SUMMATIVE TEST

Questions for Discussion:

1. What is the importance of the following to the body:

a. Insoluble fibers
This is found in the seeds and skins of fruit (so always eat your peels) as well as whole-wheat bread and
brown rice.
The health benefits include:

Weight loss: Like soluble fiber, insoluble fiber can play a key role in controlling weight by staving off
hunger pangs.

Digestive health: Eating lots of insoluble fiber also helps keeps you regular, and if you do get constipated,
adding more of it to your diet can get things moving. Insoluble fiber can also improve bowel-related
health problems, like constipation, hemorrhoids, and fecal incontinence (problems controlling your bowel
movements.)

b. Soluble Fibers
Foods rich in this type of fiber include oatmeal, nuts, beans, apples, and blueberries.
The health benefits include:

Heart protection: Inside your digestive system, soluble fiber attaches to cholesterol particles and takes
them out of the body, helping to reduce overall cholesterol levels and the risk of heart disease. Oatmeal
may offer the most heart protection.

Diabetes protection: Because soluble fiber isn’t well absorbed, it doesn't contribute to the blood sugar
spikes that can put you at risk for type 2 diabetes and heart disease. If you already have diabetes (either
type 1 or type 2) soluble fiber can even help keep your condition under control.

Weight loss: Soluble fiber can also help you get to -- or stay at -- a healthy weight by keeping you feeling
full without adding many calories to your diet.

Healthy bowel movements: Soluble fiber soaks up water as it passes through your system, which helps
bulk up your stool and guard against constipation and diarrhea. In fact, most fiber supplements contain
mostly soluble fiber.

2. What is ketosis?
Ketosis increases water loss, necessitating attention to water intake. When glucose is in short supply,
amino acids are broken down to provide carbon skeletons for glucoses synthesis, yielding amino groups
that must be disposed of via the urine.

3. What are the harmful effects of excessive fiber intake?

Too much fiber in the diet can cause bloating, gas, and constipation. A person can relieve this
discomfort by increasing their fluid intake, exercising, and making dietary changes. These uncomfortable
side effects of excessive fiber can occur when someone eats more than 70 grams of fiber a day. This is not
uncommon, and it may be more likely in a person following a vegan, whole food, or raw diet.

4. How does the body make glucose from protein?

Your liver uses pyruvate, lactate, glycerol, and the amino acids alanine and glutamine to make new
glucose. The process is time consuming and it uses a lot of energy. It may take a week or two for your
body to become efficient at gluconeogenesis. During that time, ketones are keeping your system going. If
you are trying to get your body to burn fat and protein for fuel instead of carbs, it is important to eat
enough protein sources to avoid having your body scavenge your own muscle tissue.

5. Differentiate biological value (BV) from net protein utilization (NPU).

Since both NPU and BV are based upon estimates of "retained nitrogen", they should measure the
same thing except that in the calculation of NPU the denominator is the total protein eaten whereas in the
calculation of BV it is the amount absorbed. BV would be expected to be higher than NPU by the amount
of nitrogen lost owing to lack of digestibility (lack of absorption). In weanling rats, it is possible that total
carcass analysis is a more accurate measure of "retained nitrogen" that can be obtained from nitrogen
balance measurements although this has not been proven. It is certainly less tedious. Nitrogen balance
measurements must be used in large animals and in studies on man.

6. What are the health effects of protein?

Here are five compelling reasons why you should make sure you are getting enough protein every day:

 Build. Protein is an important building block of bones, muscles, cartilage and skin. In fact, your
hair and nails are comprised mostly of protein.
 Repair. Your body uses it to build and repair tissue.
 Oxygenate. Red blood cells contain a protein compound that carries oxygen throughout the body.
This helps supply your entire body with the nutrients it needs.
 Digest. About half the dietary protein that you consume each day goes into making enzymes,
which aids in digesting food, and making new cells and body chemicals.
 Regulate. Protein plays an important role in hormone regulation, especially during the
transformation and development of cells during puberty.

7. Differentiate acute protein-energy malnutrition (PEM) from chronic PEM.

Malnutrition may also be classified as either acute (shorter than 3 months in duration) or chronic
(longer than 3 months in duration).
The term “protein-energy malnutrition” (PEM) describes a general state of undernutrition and
deficiency of multiple nutrients and energy.
There are three clinical presentations of severe PEM: kwashiorkor, marasmus, and marasmic
kwashiorkor.
 Kwashiorkor results from relative protein deficiency in the setting of adequate energy intake and
is characterized by hypoproteinemia, pitting edema, varying degrees of wasting and/or stunting,
dermatosis, and fatty infiltration of the liver.
 Marasmus results from both energy and protein deficiency and is characterized by wasting,
fatigue, and apathy.
 Marasmic kwashiorkor is caused by acute or chronic protein deficiency and chronic energy
deficit and is characterized by edema, wasting, stunting, and mild hepatomegaly.
 The distinction between kwashiorkor and marasmus is frequently blurred, and many children
present with features of both conditions.

8. Why are ecosapentanoic acid (EPA) and docosexahexanoic acid (DHA) important?
Eicosapentaenoic acid is used in combination with docosahexaenoic acid (DHA) in fish oil
preparations for a variety of conditions, including preventing and reversing heart disease, and decreasing
irregular heartbeats; as well as asthma, cancer, menstrual problems, hot flashes, hay fever, lung diseases,
lupus, and kidney disease caused by an immune reaction. The combination is also used for migraine
headache prevention in adolescents, skin infections, Behçet's syndrome, high cholesterol, high blood
pressure, psoriasis, Raynaud's syndrome, rheumatoid arthritis, Crohn's disease, and ulcerative colitis.

9. What are the health effects of lipids?

Lipids are a necessary part of a healthy diet and the functions of lipids within your body are many.
Beyond the various roles they play in the proper functioning of the body organs, lipids act as a source of
energy, aid in the absorption of fat-soluble vitamins, insulate your body and provide the essential fatty
acids.
Essential fatty acids are a type of fat that cannot be made by the body, so it's essential that you
consume them through your diet. Omega-3 fatty acid is an example of an essential fatty acid that is
important to your health. It's found in flaxseeds, walnuts and fatty fish, such as tuna and salmon. Omega-3
fatty acids are needed by your body to help maintain proper brain function, and they are thought to reduce
inflammation in the body and help reduce your risk of heart disease and cancer.

10. What are the benefits derived from omega-3 polyunsaturated fats?
Omega-3 polyunsaturated fats (PUFAs), which are stored in membrane phospholipids, are responsible
for numerous cellular functions including the maintenance of the cell membrane structure, fluidity,
signaling, and cell-to-cell interaction.

11. Which is better, butter or margarine? Why?

Margarine usually tops butter when it comes to heart health.
 Margarine is made from vegetable oils, so it contains unsaturated "good" fats — polyunsaturated and
monounsaturated fats. These types of fats help reduce low-density lipoprotein (LDL), or "bad,"
cholesterol when substituted for saturated fat.

12. Define anorexia nervosa and bulimia nervosa. What is the difference between the two?
Anorexia and bulimia are both eating disorders. They can have similar symptoms, such as distorted
body image. However, they’re characterized by different food-related behaviors.
For example, people who have anorexia severely reduce their food intake to lose weight. People who
have bulimia eat an excessive amount of food in a short period of time, then purge or use other methods
to prevent weight gain.
Although eating disorders aren’t specific to age or gender, women are disproportionally affected by
them. About 1 percent of all American women will develop anorexia, and 1.5 percent will develop
bulimia, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).

Laboratory Activity

I. Using the food label on the right, compute the following:

1. Total calories from fat 8 × 9 = 72 kcalories
2. Total calories from carbohydrates 37 × 4 = 148 kcalories
3. Total calories from protein 3 × 4 = 12 kcalories
4. Total calories of one (1) serving 72 + 128 + 12 = 232 (230) kcalories
5. Total calories from one (1) container 1 container = 8
× 1 servings = 232
= 1856 (1840) kcalories

II. Computation. Compute according to your age, weight and height.

A. Calculate Your Total Energy Expenditure

Your total energy output per day is the sum of three uses of energy:
1. Resting metabolic rate (RMR).
2. Thermic effect of food (TEF). (The factors we are using to calculate physical activity include the TEF
so for this exercise we will not calculate it separately.)
3. Physical activity.

1. Resting Metabolic Rate

Calculate your RMR using one of the following
Women: 0.9 kcal/kg/hr
Men: 1.2 kcal/kg/hr
Convert your body weight from pounds (lb) to kilograms (kg): 1 kg = 2.2 lb.
Body weight in pounds: 121 ÷ 2.2 = 55 kg.
RMR (kcalories) = 0.9 (for women) or 1.2 (for men) × kg body weight × 24 (hours in day) = _______
= 0.9 × 55 × 24 = 1,188 kcalories

2. Physical Activity
Calculate your physical activity expenditure:
Calculate the energy cost of your physical activity using your RMR and the activity factor from physical
activity factors in page 46 that best fits your current activity level.
Physical activity kcalories = RMR × physical activity factor = _________
= 1,188 × 0.7 = 831.6 kcal/day

3. Total Energy Expenditure

To calculate your total energy expenditure (kcalories): RMR kcalories 1,188 + physical activity
kcalories 831.6 = 2,019.6 kcal/day

4. Compute for your average energy intake.

To get started, keep a detailed record of everything you eat and drink for 3 days: 2 weekdays and 1
weekend day.
List the type and amount of food in household measures (e.g., cups, tablespoons, or dimensions), how it
was prepared, and brand name, if applicable.
Be specific: was your milk nonfat, 1% fat, 2% fat, or whole? Include butter, margarine, salad dressings,
condiments, and additions to coffee or tea.
 Breakfast Morning Lunch Afternoon Dinner Evening
Snack Snack Snack
Saturday 1 cup of rice, 2 None No rice, 1 2 hansel None None
pieces of hotdog, servings of biscuit, water
water bicol express, (300 kcal)
(206 kcal, 245 water
kcal) (377 kcal)
Sunday 3 pieces of None None 2 fita biscuit, None None
pandesal, Birch 1 bottle of c2
tree choco (70 kcal, 227
(100 kcal, 120 kcal)
kcal)
Monday 1 cup of rice, 1 None No rice, water 1 bottle of c2 None None
piece of fried Pinakbet (227 kcal)
chicken (153 kcal)
(206 kcal, 246
kcal)
Saturday:
206 + 245 + 377 + 300 = 1,128 kcal
Positive energy balance = 2,091.6 – 1,128
= 891.6 kcal
Sunday:
100 + 120 + 70 + 227 = 517 kcal
Positive energy balance = 2, 091.6 – 517
= 1, 574.6 kcal
Monday:
206 + 246 + 153 + 227 = 831 kcal
Positive energy balance = 2,091.6 – 831
= 1. 260.6 kcal

*If you want to check the chemical and nutritional composition of food, as well as their calorie content,
register first at http://i.fnri.dost.gov.ph/ and you may check the DOST FNRI PhilFCT database at
http://i.fnri.dost.gov.ph/fct/library.

Questions:
a. How does your energy intake compare with your estimated total energy expenditure completed above?
Are you taking in more kcalories, fewer kcalories, or about the same number of kcalories as you are using
each day?
Based on my 3-day meal record, it shows that I’m taking fewer calories than my body needs to have
every day. I’m shookt because it’s my first time seeing my intake and it’s so low. Like, I am not aware
that I’m not healthy anymore even though I am chubby.

b. What will be the effect on your body weight if you continue this pattern? What will be the effect on
your health status?
Based on the outcomes, it is a bad idea not eating rice in my lunch and dinner. This week, I stopped
doing these kind of diet because this is not good. So in order for me to lose weight, exercise, and more
water intake is my thing.

B. Evaluate Your Body Weight Using the Body Mass Index

Determine your body mass index (BMI) using the formula discussed in page 53.
55 kg
BMI = ×703 = 22.313
1.57 m 2

a. What is your assessment of your weight status using the BMI? Are you underweight, overweight, or in
the healthy range?
My BMI is 22.313 and it’s normal.
b. If you are not in the healthy range, how might you begin to improve your status? (Consider
underweight to be as needful of attention as overweight.)
First, change your food intakes. Eat more nutritious food and lessen the drinks of soda, coffee. Be
responsible when eating. If you are already full, stop eating.
C. Evaluate Your Health Status Using Waist Circumference
Measure your waist circumference (WC) using a non-stretch tape.
WC = 75cm
If you are a woman, then your waist circumference should not exceed 88 cm (35 inches); if you are a
man, it should not exceed 102 cm (40 inches).
a. What is your assessment of your chronic disease risk based on your waist circumference?
None
b. If you are not in the healthful range, how might you begin to improve your status?
Do some exercises that will help you to improve your status. Check chloe ting videos in youtube, I do
some of her exercises and I can say that it helps me a lo
MODULE 3
ANSWERS

NUTRITION
AND
DIET THERAPHY

Submitted to:
 Ms. CHARI V. RIV

Dela Cruz, Jonelvira C. October 8, 2020

BSN 2-B

LESSON 1: VITAMINS

CONCEPT CHECK 1

1. List the fat soluble vitamins and their precursors. What are their main sources?
The fat soluble vitamins – A, D, E and K – are usually occur together in the fats and oils of foods,
and the body absorbs them in the same way it absorbs lipids. Therefore, any condition that
interferes with fat absorption can precipitate a deficiency of the fat-soluble vitamins. Vitamin A
and its plant-derived precursor, beta-carotene, are the focus of much research around the world.
Carrots, sweet potatoes, pumpkins, cantaloupe, and apricots are all rich sources, and their bright
orange color enhances the eye appeal of the plate. Another colorful group, dark green vegetables,
such as spinach, other greens, and broccoli, owe their color to both chlorophyll and beta-carotene.
Vitamin D precursors from plants require the same two conversions by the liver and kidneys to
become active. The precursor of Vitamin D that made in the skin or taken as a supplement is
cholecalciferol. Also, calcitriol is the active form of vitamin D. This one of the body’s many good
uses for chemical. Only a few animal foods, notably, eggs, liver, butter, some fish, and fortified
milk, supply significant amounts of Vitamin D. For those who use margarine in place of butter,
fortified margarine is a significant source. Vitamin E precursor named tocopherol means
“offspring”. Vitamin E widespread in foods. Vitamin E in the diet comes from vegetable oils and
the products made from them, such as margarine, salad dressings, and shortenings. Vitamin K
precursor called quinone. Many foods contain ample amounts of Vitamin K, notably, green leafy
vegetables, members of the cabbage family, and liver. Other vegetables, milk, meat, eggs, cereal,
and fruits provide smaller, but still significant amount of sources.

2. Explain the role played by

(a) Vitamin A in vision.
Vitamin A plays two indispensable roles in the eye. It helps maintain a healthy, crystal clear outer
window, the cornea; and it participates in the events of light detection at the retina. When Vitamin
A is lacking, the eye has difficulty adapting to changing light levels.
(b) Sunlight in synthesis of Vitamin D.
The sun imposes no risk of Vitamin D toxicity. Prolonged exposure to sunlight degrades the
vitamins D precursor in the skin, preventing its conversion to the active vitamin.
(c) Vitamin K in the blood clotting process.
At least 13 different proteins and the mineral calcium are involved in making blood clot. Vitamin
K is essential for the activation of seven of these proteins, among them prothrombin, the
precursor of the protein thrombin. When any of the blood clotting factors is lacking, hemorrhagic
disease results. If an artery or vein is cut or broken, bleeding goes unchecked. But this is not to
say that hemorrhaging is always caused by a Vitamin K deficiency.

3. Why should an over dosage of vitamins A and D be avoided?

Overdoses of Vitamin A damage the same body systems that exhibit symptoms in Vitamin A
deficiency. Vitamin D in excess is the most toxic in all vitamins. The amounts of supplements
containing Vitamin D in concentrated are not safe.

4. Explain what happens when there is a deficiency of vitamin A in the diet

When beta carotene is converted retinol in the body, losses occur. Beta carotene from plant foods
is not converted to the active form of Vitamin A rapidly enough to be hazardous. It has, however,
been known to turn people bright yellow if they eat too much. Beta carotene builds up in the fat
just beneath the skin and imparts a yellow cast.
CONCEPT CHECK 2

1. List the main sources of

(a) Thiamin - sunflower seeds, sesame seeds, soybeans, wheat germ, peanuts, animal sources:
liver, kidney, pork
(b) Riboflavin – milk, cheese, wheat germ, yeast, liver and kidney
(c) Niacin – yeast, peanuts and peanut butter, soybeans, sesame seeds, sunflower seeds, animal
sources: beef, poultry, fish, organ meats especially high

2. Describe the symptoms of deficiency of

(a) Thiamin
 Acute: beri-beri – major symptoms are paralysis, heart, and vessel impairment
 Subacute: loss of appetite, vomiting, leg cramps, mental depression, edema, weight loss
 Wernicke’s encephalopathy - Alcohol induced thiamin deficiency which affects mental
alertness, short-term memory, and muscle coordination
(b) Riboflavin –
 Ariboflavinosis
 lesions around the mouth and nose hair loss
 scaly skin
 failure to thrive (children)
 light sensitivity clouding of the cornea of the eye
 weight loss
 glossitis
 A deficiency of riboflavin will reduce the efficiency of glutathione
(c) Niacin
 Acute: Pellagra- 3 Ds of Pellagra symptoms: 1. Dermatitis (inflammation of the skin); 2.
Diarrhea (inflammation of the gastrointestinal tract); 3. Dementia (mental confusion); (if
untreated: add death)
 Subacute: weakness, indigestion, anorexia, lack of energy, cracked skin, sore mouth and
tongue, failure to thrive (children), insomnia, irritability, mental depression; damage to
the skin, gastrointestinal tract, and central nervous system

3. Discuss the functions of pyridoxine, folic acid and cyanocobalamin in the body.
Vitamin B6 is also called pyridoxine. Vitamin B6 helps form red blood cells and maintain brain
function. This vitamin also plays an important role in the proteins that are part of many chemical
reactions in the body. The more protein you eat the more pyridoxine your body requires.
Folate works with vitamin B12 to help form red blood cells. It is needed for the production of
DNA, which controls tissue growth and cell function. Any woman who is pregnant should be sure
to get enough folate. Low levels of folate are linked to birth defects such as spina bifida. Many
foods are now fortified with folic acid. Vitamin B12, like the other B vitamins, is important for
metabolism. It also helps form red blood cells and maintain the central nervous system.

4. Discuss the functions of vitamin C.

Vitamin C is involved in the metabolism of several amino acids. Some of these amino acids end
up being used to make hormones of great importance in body functioning, among them
norepinephrine and thyroxine.

5. What are the sources of vitamin C?

Citrus fruits are rightly famous for their vitamin C contents. Certain other fruits and vegetables
are also rich sources; cantaloupe, strawberries, broccoli, and brussels sprouts. No animal foods
other than organ meats, such as liver and kidneys, contain vitamin C.

6. Describe the symptoms of vitamin C deficiency.

 When intake of vitamin C is inadequate, the body’s vitamin C pool dwindles, and latent scurvy
appears. The blood vessels show the first deficiency signs. The gums around the teeth begin to
bleed easily, and capillaries under the skin break spontaneously, producing pinpoint hemorrhages.
Then the symptoms of overt scurvy appear.

LESSON 1: VITAMINS

LABORATORY ACTIVITY

Search and discuss the following and write the answers in table form.
1. Vitamin-related diseases
2. Symptoms
3. Causes
4. Prevalence
5. Dietary changes

Diseases Symptoms Causes Prevalence Dietary Changes

Xerophthalmia  drying and Caused by a lack of The overall prevalence The major risk for
thickening of the vitamin A. Your body of xerophthalmia was xerophthalmia is
conjunctivae and doesn’t produce 1.89 per cent. poverty and lack of
corneas vitamin A on its own. The prevalence of adequate diet,
 superficial foamy Instead, you have to nightblindness (XN), especially a lack of
patches composed of get vitamin A from the Bitot's spots (XIB), animal products.
epithelial debris and foods you eat. Vitamin severe comeal lesions Infants and
secretions on the A is essential for (X3A, X3B), and children are at
exposed bulbar vision because it’s an cornea scars (XS) greater risk.
conjunctiva develop element of the protein were 1.26, 0.44, 0.02, Children require a
 cornea becomes that absorbs light in and 0.68 per cent, lot of vitamin A in
hazy and can the receptors in your respectively. order to grow.
develop erosions, retina.
which can lead to its
destruction
Osteomalacia  Marked softening of Osteomalacia results Osteomalacia are bone Avoid:
your bones, most from a defect in the diseases that occur .-Avoid bony
often caused by bone-maturing worldwide; however, injuries, to prevent
severe vitamin D process. Your body in developed countries factures.
deficiency. uses the minerals they rarely occur as a
 The softened bones calcium and phosphate result of dietary
of children and to help build strong deficiency. The
young adults with bones. You might incidence of Consume:
osteomalacia can develop osteomalacia osteomalacia is . You should have
lead to bowing if you don't get approximately 1 in sun bath for at
during growth, enough of these 1000 people. least 1 - 2 hrs
especially in weight- minerals in your diet every day.
bearing bones of the or if your body doesn't . Consume foods
legs. Osteomalacia in absorb them properly. rich in vitamin D
older adults can lead - Plant foods are
to fractures. low in vitamin D.

Erythrocyte  Abnormal paleness Vitamin E deficiency Erythrocyte hemolysis Iron

hemolysis or lack of color of Destruction of red represents Eating an iron-rich
the skin. blood cells approximately 5% of diet can increase
 Yellowish skin, eyes, Caused by a large all anemias. Acute your body’s
and mouth (jaundice) number of medical AIHA is relatively production of
 Dark-colored urine conditions, including rare, with an incidence RBCs.
 Fever many Gram-positive of one to three cases Folic acid
 Weakness bacteria, some, some per 100,000 Adding certain B
  Dizziness autoimmune disorders, population per year. vitamins to your
 Confusion some genetic Hemolytic anemias are diet can also be
 Can't handle physical disorders, or blood not specific to any beneficial. Foods
activity with too low a solute race. high in vitamin B-
concentration 9 (folic acid)
Ariboflavinosis  Sore lips/throat Caused by deficiency Inheritance: Riboflavin
 Redness and of Vitamin B2 Autosomal dominant; naturally occurs in
swelling of the (riboflavin) Prevalence: some food such as
mouth and throat, Chronic diseases such <1/1000000 eggs, dairy
 Cracking of the lips as cancer, heart (Worldwide); Age of products, meats,
 Inflammation and disease and diabetes onset: Adult; green vegetables,
cracks on the corners are known trigger and grains. The
of the mouth Vitamin B12- main antioxidant
(angular stomatitis) deficiency riboflavin works as
 Tongue redness and is glutathione.
inflammation Glutathione works
(glossitis) to destroy free
 Itching and scaling radicals and detox
of skin particularly the liver, as free
affecting the scrotum radicals can cause
or vulva and skin to develop several
around nose, mouth, diseases.
forehead, ears, scalp Riboflavin
and lips deficiency can also
 Formation of blood result from chronic
vessels on the cornea diarrhea, liver
(clear part) of the eye disorder,
 Blood disorders such alcoholism, and
as anemia hemodialysis
 Eyes overly sensitive
to light and easily
tired
 Trembling
 Insomnia
Pellagra  Delusions or mental Caused by low levels 0.3% of women and Prescribe a
confusion. of niacin, also known 0.2% of children and protein-rich diet
 Diarrhea. as vitamin B-3. It’s niacin deficiency in with adequate
 Weakness. marked by dementia, 29.4% of women and calories. The
 Loss of appetite. diarrhea, and 6% of children related addition of meats,
 Pain in abdomen. dermatitis, also known to high untreated corn milk, peanuts,
 Inflamed mucous as “the three Ds”. If consumption leafy green
membrane. left untreated, pellagra vegetables, whole
 Scaly skin sores, can be fatal. or enriched grains,
especially in sun- and brewer's dry
exposed areas of the yeast can enhance
skin. niacin intake
 LESSON 2: MINERALS

LABORATORY ACTIVITY

Search and discuss the following and write the answers in table form.
1. Mineral related diseases
2. Symptoms
3. Causes
4. Prevalence
5. Dietary changes

Diseases Symptoms Causes Prevalence Dietary Changes

Anemia  Extreme fatigue. Your body doesn't make Globally, anemia meat, such as lamb,
 Weakness. enough red blood cells affects 1.62 billion pork, chicken, and
 Pale skin. Bleeding causes you to people (95% CI: 1.50– beef
 Chest pain, fast lose red blood cells 1.74 billion), which beans, including
heartbeat or more quickly than they corresponds to 24.8% soybeans
shortness of can be replaced of the population (95% pumpkin and squash
breath. Your body destroys red CI: 22.9–26.7%). The seeds
 Headache, blood cells highest prevalence is in leafy greens, such as
dizziness or preschool-age children spinach
lightheadedness. (47.4%, 95% CI: 45.7– raisins and other
 Cold hands and 49.1), and the lowest dried fruit
feet. prevalence is in men tofu
 Inflammation or (12.7%, 95% CI: 8.6– eggs
soreness of your 16.9%). seafood, such as
tongue. clams, sardines,
 Brittle nails shrimp, and oysters
iron-fortified cereals

Goiter  A swelling at the Iodine deficiency is the Globally, the Total Get enough iodine.
base of your neck main cause of goiters. Goiter Prevalence To ensure that you
that may be Iodine is essential to (TGP) in the general get enough iodine,
particularly helping your thyroid population is estimated use iodized salt or eat
obvious when you produce thyroid to be 15.8%, varying seafood or seaweed
shave or put on hormones. When you between 4.7% in — sushi is a good
makeup. don’t have enough America to 28.3% in source of seaweed —
 A tight feeling in iodine, the thyroid Africa [3]. Prevalence about twice a week.
your throat. works extra hard to of goiter in children Shrimp and other
 Coughing. make thyroid hormone, aged 6–12 years varies shellfish are
 Hoarseness. causing the gland to in different studies in particularly high in
 Difficulty grow larger. the world. It was iodine.
swallowing. 22.3% in southern
 Sudan, 11.4%
Rajasthan, and 20.5%
in India [11-13]
Fluorosis  Stains ranging Inappropriate use of Fluorosis affects nearly Parental vigilance is
from yellow to fluoride-containing one in every four the key to preventing
dark brown dental products such as Americans ages 6 to fluorosis.
 Surface toothpaste and mouth 49. It’s most prevalent If your water comes
irregularities rinses. Sometimes, in those ages 12 to 15. from a public system,
 Pits that are highly children enjoy the taste The vast majority of your doctor or dentist
noticeable of fluoridated cases are mild, and -- as well as your
toothpaste so much that only about 2% are local water authority
they swallow it instead considered “moderate.” or public health
of spitting it out. Less than 1% are department -- can tell
 “severe.” But you how much
researchers have also fluoride is in it. If you
observed that since the rely on well water or
mid-1980s, the bottled water, your
prevalence of fluorosis public health
in children ages 12 to department or a local
15 has increased. laboratory can
analyze its fluoride
content

Hemochromatosis  Pain in your joints, Normally, your Hereditary The

especially your intestines absorb just hemochromatosis is the hemochromatosis diet
knuckles the right amount of iron most common is intended to meet
 Feeling tired from the foods you eat. autosomal recessive the unique nutritional
 Unexplained But in disorder in whites, with needs of a person
weight loss hemochromatosis, your a prevalence of 1 in with
 Skin that has a body absorbs too much, 300 to 500 individuals. hemochromatosis.
bronze or gray and it has no way to get Hereditary The diet consists of
color rid of it. So, your body hemochromatosis type fresh fruits,
 Pain in your belly stores the excess iron in 2, 3, and 4 are seen vegetables, whole
 Loss of sex drive your joints and in worldwide but Type 1 grains, an adequate
 Loss of body hair organs like your liver, form is mostly seen in intake of protein, and
 Heart flutter heart, and pancreas. people of northern a limited amount of
 Foggy memory This damages them. If European descent red meat, citrus fruits,
it’s not treated, sugars, and dairy.
hemochromatosis can Whole foods are
make your organs stop encouraged whenever
working. possible.

Hemosiderosis  coughing (with bleeding within an Hemosiderosis is very Fruits and vegetables
blood, in severe organ or area of tissue rare, but exact Grain and legumes
cases) red blood cells breaking prevalence numbers Eggs
 difficulty down within your are not known. It is Tea and coffee
breathing bloodstream estimated that Lean protein
 fatigue somewhere between
 shortness of 0.24 and 1.26 in one
breath, especially million people are
when exercising affected by the disease
 pain throughout
the body
 unexplained
weight loss
 wheezing
 slow growth in
children
LESSON 3: WATER AND ELECTROLYTES

LABORATORY ACTIVITY
1. List the seven major minerals and describe their (a) physiologic function, (b) problems related to
deficiency or excess, and (c) dietary sources.
Minerals Physiologic Function Problems related to Dietary sources
deficiency or excess
Sodium • Physiological function: Muscle cramps, mental • Salt, sodium compounds used
• Major cation in extracellular apathy, loss of appetite in baking and food processing,
 fluid, water balance, acid base milk, cheese, carrots, spinach,
balance. beets and celery.
• Cell membrane permeability.
• Energy-requiring absorption of
glucose
• Normal muscle irritability.
• Problems related to deficiency or
excess:
• Losses in gastrointestinal
disorders, diarrhea.
• Fluid-electrolyte and acid base
balance problems.

Chloride • Major anion in extracellular Growth failure in children; • Salt, sauce soy, moderate
fluid, water balance, acid base muscle cramps, metal apathy, quantities in whole unprocessed
balance, chloride-bicarbonate shift. loss of appetite; can cause foods, large amounts in
• Gastric hydrochloric acid- death (uncommon) processed foods
digestion.
• Problems related to deficiency or
excess:
• Losses in gastrointestinal
disorders, vomiting, diarrhea, tube
drainage.
• Hypochloremic alkalosis.
Potassium • Major cation in intracellular Deficiency accompanies • Fruits, vegetables, legume,
fluid, water balance, acid base dehydration; causes muscular nuts, whole grains and meat.
balance. weakness, paralysis, and
• Normal muscle irritability. confusion; can cause death.
• Glycogen formation.
• Protein synthesis.
• Problems related to deficiency or
excess:
• Losses in gastrointestinal
disorders, diarrhea.
• Fluid-electrolyte and acid base
balance problems.
• Muscle action, especially heart
muscle.
• Losses in tissue catabolism

• Treatment of diabetic acidosis:

rapid glycogen production reduces
serum potassium level.
• Losses with diuretic therapy.
Calcium • 99% of the body’s calcium is
present in the bone and teeth.
Calcium makes bones strong and
hard and prevents them from
breaking. The calcium present in
the bones act as calcium reservoir
for body requirements.
• Other general metabolic
functions include blood clotting,
nerve transmission, muscle
contractions and relaxation, cell
membrane permeability, and
enzyme activation.
• Tetany: A drop in serum • Calcium is highly available in
ionized calcium causes tetany, dairy resources such as milk,
marked by severe, and cheese. Other sources
intermittent spastic muscle include bok choy, broccoli,
contractions and muscular kale, spinach, collard greens,
pain, and sweet potatoes.
• Rickets and osteomalacia: A
deficiency of vitamin D
hormone causes rickets in
growing children and
osteomalacia in adults. When
exposure to sunlight is limited
and dietary intake of vitamin
D is poor, calcium absorption
is inadequate and bone
mineral is lost.
• Resorptive hypercalciuria
and renal calculi: Resorption
of bone calcium and its
excretion in the urine
accelerates during prolonged
immobilization. This will lead
to rise in urinary calcium
which in turn increase the risk
of calcium stones.
• Osteoporosis, a condition
caused due to calcium
deficiency is an abnormal loss
of bone mineral and matrix
leading to porous, fragile
bone tissue with enlarged
spaces that is prone to
fracture or deformity.
• Low calcium intake or
limited use of dairy foods has
been put forth as a possible
contributor to chronic
conditions unrelated to bone
health, including obesity,
hypertension, and certain
types of cancer.
 Phosphorus • Phosphorous plays critical role in
bone as part of the mineral
complex hydroxyapatite. Nearly
85% of the body’s supply of
phosphorous is stored in the bones.
• Phosphorous helps build boned
and teeth. As a component of
calcium phosphate, it is constantly
resorbed in the continuing process
of bone formation and remodeling.
• General metabolic activities
involving phosphorous include
absorption of glucose and glycerol,
transport of fatty acids, energy
metabolism, and buffer system.
• Hypophosphatemia: Low • Milk and milk products
serum phosphorous levels contain significant amounts of
occur with intestinal diseases phosphorous.
such as sprue and celiac
disease that hinder
phosphorous absorption. Low
serum phosphorous may
accompany the refeeding
syndrome often seen in the
first days of nutritional
repletion of a severely wasted
patient when glycogen stored
are being rapidly replenished.
If left untreated, then it will
lead to metabolic acidosis,
heart failure, and sudden
death.
• Hyperphosphatemia: In
renal failure and
hypoparathyroidism, excess
phosphate accumulated in the
serum. This results in the
drop of serum calcium level,
leading to tetany.

Magnesium • Around 50-60% of the body’s • Weakness; confusion if • Milk, cheese, meat, seafood,
magnesium is in bone which extreme, convulsions, bizarre whole grains, legumes, and
serves as a large reservoir in case movements (especially of nuts.
of deficiencies specifically in soft eyes and face), hallucinations,
tissue. and difficulty in swallowing.
• Constituent of bones and teeth. In children, growth failure.
• Coenzyme in general
metabolism, smooth muscle action,
neuromuscular irritability.
• Cation intracellular fluid.
• Problems related to deficiency or
excess:
• Low serum levels following
gastrointestinal losses.
• Tremor, spasm in deficiency
induced by malnutrition,
alcoholism.

Sulfur • Essential component of proteins. None known; protein • Meat, egg, milk, cheese, nuts,
• Detoxification reactions deficiency would occur first and legumes.
• Enzyme activity and energy
metabolism through free
sulfhydryl group (-SH)
• Problems related to deficiency or
excess:
• Cystine renal calculi
• Cystinuria

2. List the 10 trace elements with proven essentiality for humans.

The minerals that are required in smaller amounts are referred to as trace elements. Following are the
trace elements with proven essentiality for humans.
1. Iron – carries oxygen in the blood, makes oxygen available for muscle contraction; necessary for the
utilization of the energy
2. Iodine – help to regulate growth development, and metabolic rate
3. Zinc – involved in making genetic material and proteins, immune reactions, transport of vitamin A,
taste perception, wound healing, the making of sperm, and normal fetal development
4. Copper – necessary for the absorption and the use of iron in the formation of hemoglobin
5. Manganese – facilitator, with enzymes of many cell processes
6. Chromium – required for the release of energy form glucose
7. Selenium – assists a group of enzymes that breakdown reactive chemical that harm cells
8. Molybdenum – a working part of several metal-containing enzymes, some of which are giant proteins
9. Fluoride – involved in the formation of bones and teeth; helps to make teeth resistant to decay
10. Cobalt – found as components of vitamin B12.

Why has it been difficult to establish DRIs for these nutrients?

Essential as well as nonessential trace elements have been implicated in the risk of certain chronic
diseases in humans, but the evidence is weak in most instances. Some trace elements have been
associated with an increased risk of cancer at certain sites, most notably chromium with lung cancer and
arsenic with cancers of the lung and skin, but the evidence is based primarily on respiratory rather than
dietary exposure.
MODULE 4
ANSWERS

NUTRITION
AND
DIET THERAPHY

Submitted to:
Ms. CHARI V. RIVO
Dela Cruz, Jonelvira C. October 13, 2020
BSN 2-B

Laboratory Activity

Evidence-Based Practice: Iron and Postpartum Depression

Is it possible that clinical deficiencies of nutrients cause postpartum depression?
Yes, it can cause a postpartum depression because when a person did receive a deficiencies of
nutrients that her body needed, it can loss some important vitamins, and nutrients inside her body.
It can be also a reason to increased risk of depression. It is common to a pregnant women, and it
has a bad outcome to the mother and child. Consequences for mother include poor self-care,
compromised care-giving and increased morbidity from other causes. While for children,
malnutrition, poor physical and cognitive development and increased illness. Some mother
experiencing this depression because when they get pregnant, their lifestyle change. They cannot
eat what they want because they need to take care to the baby in their belly. So giving them a
food that has enough nutrients for the baby and mother can help.

Iron-deficiency anemia is common among women, particularly postpartum women because of iron losses
with delivery and mobilization of iron stores to support fetal growth, development, and iron storage
during the latter stages of pregnancy. An association between low hemoglobin concentration (less than 12
g/dL) and increased self-rated symptoms of depression were reported in eight postpartum women within
the first month after delivery. This was significantly different from lower self-rated symptoms of
depression in 29 postpartum women with hemoglobin concentration greater than 12 g/dL. In a separate
study, lower plasma ferritin concentration was present in women reporting symptoms of postpartum
depression. One randomized controlled trial found that self-reported depression ENn and stress
significantly decreased in 30 postpartum women with iron-deficiency anemia who were treated with 125
mg ferrous sulfate (along with folate and vitamin C), compared with 21 untreated anemic postpartum
women (supplemented with only folate and vitamin C) and 30 non anemic control women.

Questions for Analysis

1. Does this evidence suggest that postpartum women should routinely be supplemented with iron to
prevent postpartum depression?
Yes. Some nutrients also can help but iron is the best to prevent postpartum depression. We all
know that iron plays a big role in our body and in this case, all pregnant mothers should receive
iron supplements during pregnancy, regardless of ferritin or hb levels. Some pregnant woman can
affect their emotions regardless of their iron status in postpartum period. Considering the negative
consequences of depression on the mother, her offspring and whole family, diagnosis and
treatment of anemia should be an essential part of maternity care during pregnancy and after
delivery. So iron supplementation is a big help to reduce the risk or much better, prevent the
postpartum depression.

2. What additional evidence is required to establish practice guidelines regarding nutrition and prevention
or treatment of postpartum depression?
Treatment for perinatal depression is important for the health of both the mother and the baby, as
perinatal depression can have serious health effects on both. With proper treatment, most women
feel better and their symptoms improve. Treatment for perinatal depression can be
antidepressants, which are medications used to treat depression. They may help improve the way
the brain uses certain chemicals that control mood or stress. Women who are pregnant or
breastfeeding should notify their doctor before starting antidepressants so their doctor can work to
minimize the baby’s exposure to the medication during pregnancy or breastfeeding. A pregnant
women may need to try several different medications before finding the one that improves their
symptoms and has manageable side effects. It is also important to understand that depression is a
medical condition that impacts the mother, the child, and the family. Spouses, partners, family
members, and friends may be the first to recognize symptoms of perinatal depression in a new
mother. Treatment is central to recovery. Family members can encourage the mother to talk with a
health care provider, offer emotional support, and assist with daily tasks such as caring for the
baby or the home.
Laboratory Activity

1. List six nutrients that are required in larger amounts during pregnancy. Describe their special role
during this period. Identify four food sources of each.
1. Energy – pregnant woman needs extra food energy, but only a little extra 300 kcalories above
the allowance for nonpregnant women and only during second and third trimester. A woman can
easily obtain 300 kcalories from just one extra serving from each of the food groups – a slice of
bread, a serving of vegetables, an ounce of meat, a piece of fruit, and a cup of fat-free milk.
2. Protein – Obtaining enough protein need not pose a problem, even if the diet excludes all foods
of animal origin. Pregnant vegetarian women who meet their energy needs by eating ample
servings of protein–containing plant foods such as legumes, whole grains, nuts, and seeds meet
their protein needs as well. Use of high-protein supplements during pregnancy can be harmful
and is discouraged.
3. Carbohydrate – Pregnant women need generous amounts of carbohydrates to spare protein they
eat. If added energy is needed, it is the best obtained from carbohydrate. Four cups of milk will
contribute, an apple also helps, a slice of bread, and intakes of fruit and grain products are clearly
beneficial.
4. Essential Fatty Acids – It is important to the growth of the fetus and are regarded by some as
essential nutrients in early human development. If a pregnant women eats a diet that regularly
includes seafood, she receives a balance of the essential fatty acids and their derivatives. This
benefit her pregnancy and later her infant by way of her milk. Supplements of fish oil are not
recommended, however, both because they may carry concentrated toxins and because their
effects on pregnancy remain unknown.
5. Vitamins – The vitamins required for rapid cell proliferation- folate and vitamin B12 are
needed in large amounts during pregnancy. Folate plays important role in preventing neutral tube
defects if the supplements taken one month before conception and continued. The foods that
naturally contain folate are important, however, because they are rich sources of vitamins,
minerals, fiber, and the phytochemicals thought to protect against heart disease, cancer, and other
diseases.
6. Vitamin D and Calcium for Bones – Vitamin D and the minerals involved as building the
skeleton – calcium, phosphorus, and magnesium – are in great demand during pregnancy.
Insufficient intakes may result in abnormal fetal bones development. It is needed to increase the
intakes of milk, cheese, yogurt, and the other calcium-rich foods. Alternatively, less preferably,
they may need a daily supplement of 600 milligrams of calcium.

2. Identify two common problems associated with pregnancy, and describe the dietary management of
each.
a) GESTATIONAL DIABETES – Pregnancy precipitates the onset of diabetes in some women
because placental hormones alter the way insulin works. This condition is known as gestational
diabetes. In many cases, blood glucose becomes abnormal during pregnancy but usually returns
to normal after the infant is born. To ensure that the problems of diabetes are dealt with promptly,
the American Diabetes Association recommends that most women receive glucose tolerance tests
during the sixth month of pregnancy.
b) PREECLAMPSIA – Hypertension may signal the onset of preeclampsia, a condition
characterized not only by high blood pressure but by protein in the urine and fluid retention
(edema). Preeclampsia which affects less than 10 percent of pregnant women, usually occurs with
first pregnancies and almost always after 20 weeks’ gestation. Fruit and vegetables intake during
pregnancy as well as a healthy diet counseling during early antenatal care follow up were
associated with reduction of preeclampsia or eclampsia.

3. What are the benefits of breastfeeding in infants and their mother?

The lactating woman needs enough energy and nutrients to produce about 25 ounces of milk a
day. She also needs extra fluid. Alcohol, caffeine, smoking, and drugs may reduce milk
production or enter breast milk and impair infant development. Breast milk excels a source of
nutrients for the young infant. With the possible exception of vitamin D, breast milk provides all
the nutrients a healthy infant needs for the first four to six months of life. It also provides many
other health benefits as well. Breast milk contains antibodies that help your baby fight off viruses
and bacteria. Breastfeeding lowers your baby's risk of having asthma or allergies. Plus, babies
who are breastfed exclusively for the first 6 months, without any formula, have fewer ear
infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalizations and
trips to the doctor.
4. Identify two common problems and their remedies in old adults.
As you age, your chances of conceiving begin to decline. An older woman who becomes pregnant
is also less likely to have a problem-free pregnancy.
Common issues include the following:
Underlying conditions - Older women are more likely to have conditions like high blood
pressure, diabetes, or cardiovascular disease that can complicate pregnancy. When these
conditions aren’t well controlled, they can contribute to miscarriage, poor fetal growth, and birth
defects.
Down syndrome - is the most common birth defect related to chromosomes. It causes varying
degrees of intellectual disability and physical abnormalities. Prenatal screening and tests can help
determine the likelihood of chromosomal complications.

5. Describe how healthy diet and physical activity increase longevity or life expectancy.
Physical activity is important to the pregnant woman, not only to help her carry the extra weight
of pregnancy without strain, but also to help ease her upcoming childbirth. Staying active during
the course of a normal, healthy pregnancy can improve the fitness of the mother-to-be, facilitate
labor, and reduce psychological stress. Women who remain active during pregnancy report fewer
discomfort throughout their pregnancies and gain less weight that those who are not physically
active. Pregnant should take care in choosing their physical activities, however. They should
participate in “low impact” activities and avoid sports in which they might fall or be hit by other
people or objects. As is true for everyone, the frequency, duration, and intensity of the activity
affect the likelihood of the benefits of risks. A pregnant woman should consult her health care
provider before taking up additional activity. A healthy pregnancy depends on a sufficient weight
gain. Women who begin their pregnancies at a healthy weight need to gain about 30 pounds,
which covers the growth and development of the placenta, uterus, blood, breasts and infant. By
remaining active throughout pregnancy, a woman can develop the strength she needs to carry the
extra weight and maintain habits that will help her lose it after the birth.

SUMMATIVE TEST

D 1. The fastest-growing age group is:

a. under 21 years of age.
b. 30 to 45 years of age.
c. 50 to 70 years of age.
d. over 85 years of age.

C 2. Which of the following lifestyle habits can enhance the length and quality of people’s lives?
a. Moderate smoking
b. Six hours of sleep daily
c. Regular physical activity
d. Skipping breakfast

D 3. Which of the following is among the better-known relationships between nutrition and disease
prevention?
a. Appropriate fiber intake helps prevent goiter.
b. Moderate sodium intake helps prevent obesity.
c. Moderate sugar intake helps prevent hypertension.
d. Appropriate energy intake helps prevent diabetes and cardiovascular disease.

D 4. A disease of the immune system that involves painful inflammation of the joints is:
a. sarcopenia.
b. osteoarthritis.
c. senile dementia.
d. rheumatoid arthritis

D 5. Examples of low-kcalorie, high quality protein foods include:

a. cottage cheese, sour cream, and eggs.
b. green and yellow vegetables and citrus fruits.
c. potatoes, rice, pasta, and whole-grain breads.
d. lean meats, poultry, fish, legumes, fat-free milk, and eggs.
D 6. For malnourished and underweight people, protein and energy-dense snacks include:
a. fresh fruits and vegetables.
b. yogurt and cottage cheese.
c. whole grains and high-fiber legumes.
d. scrambled eggs and peanut butter on wheat toast.

B 7. Which of the following does not contribute to dehydration risk in older adults?
a. They do not seem to feel thirsty.
b. Total body water increases with age.
c. They may find it difficult to get a drink.
d. They may have difficulty swallowing liquids.

B 8. Inadequate milk intake and limited exposure to sunlight contribute to older adults’ risk of:
a. vitamin A deficiency.
b. vitamin D deficiency.
c. riboflavin deficiency.
d. vitamin B12 deficiency.

A 9. Two risk factors for malnutrition in older adults are:

a. loneliness and multiple medication use.
b. increased energy needs and lack of fiber.
c. decreased mineral absorption and antioxidant intake.
d. high carbohydrate intake and lack of physical activity.

B 10. Strategies to improve nutrition status when growing old include:

a. increasing vitamin A intake and exercising 30 minutes daily.
b. choosing nutrient-dense foods and maintaining appropriate weight.
c. avoiding high-fiber foods and taking a daily vitamin-mineral supplement.
d. eating at least one big meal per day and drinking at least 10 glasses of water daily