NUTRITION AND DIET THERAPY Note: approximately 452 kcal/day during

NUTRI LEC the third trimester, which is an increase

of about 15% to 20% over the energy
PREGNANCY needs of nonpregnant women.

● AKA: GESTATION Note: pre-pregnancy weight, health

● lasts for a period of 266 to status, and activity level.
180 days (37-40 weeks)
● consists of 3 trimesters-
● one additional snack per day
consisting of a medium
implantation, organogenesis
banana (105 kcal), an 8-oz
and growth
serving of whole milk yogurt
(138 kcal), and 1/8 cup of
NUTRITIONAL DEMANDS OF
mixed nuts (101 kcal).
PREGNANCY
● This snack provides 344 kcal.
● mother's and the child's health ● Providing examples of exactly
depend on the pregnant what "extra energy needs"
woman eating a well-balanced means is important so that
diet with adequate essential expecting mothers do not
nutrients misunderstand the message
● General guidelines are and assume that they need to
provided in the comprehensive "eat for two."
Dietary Reference ● Increased complex
● Intakes (DRIs) issued by the carbohydrates,
National Academy of monounsaturated fats, and
Sciences. polyunsaturated fats are the
preferred sources of energy,
Factors determining nutritional needs especially during late
pregnancy and throughout
lactation.
● Age, gravida, parity
Note:
ENERGY NEEDS

Note: pre-pregnancy weight, health ● active, large, teenage, or

status, and activity level. nutritionally deficient pregnant
women may require more
1.Reasons for Increased Need energy than the DRI
guidelines
Note: 2nd Trimester: the need for adequate kilocalories to
Kilocalorie increases secure the nutrient and energy
needs of a rapidly growing
● to supply the increased fuel fetus
demanded by the metabolic ● Sufficient weight gain is vital
workload for both the mother to a successful pregnancy
and the fetus; and ● Gestational weight gain is a
● to spare protein for the predictor of infant birth
added tissue building weight and birth weight is
requirements. associated with body mass
index (BMI) later in life both
too little and too much weight
gain during gestation have
2. Amount of Energy Increase implications for the overall
health of the infant
Note:
● inadequate gestational weight
gain increases the risk for
preterm deliveries, and for
low-birth-weight babies
● excessive weight gain poses
both short-term and potentially
long-term complications for the
mother and fetus
Reasons for Increased Need (Protein)
NOTE: building block for the tremendous
growth of body tissues during pregnancy
1. Development of the
placenta.
2. Growth of the fetus.
3. Growth of maternal tissues.
4. Increased maternal blood
volume.
● Note: hemoglobin and albumin
3. Amniotic fluid.
Note:
Placenta - life line of the fetus.
Growth of fetus - 3.5 kgs fats in 9 months
Normal weight of baby - 2.5 to 3.
Amount of Protein Increase
NOTE:
DRI (Dietary Reference Intake)
nonpregnant women- 46 g/day pregnant
women- 71 g/day
Sources:
● Eggs, milk, beef, poultry, fish,
pork, cheese, soy products,
and other animal products
● legumes and grains
contribute additional valuable
amounts of amino acids.
● Protein-rich foods also
contribute other nutrients,
such as calcium, iron, zinc,
and fat-soluble vitamins.
KEY MINERAL AND VITAMIN NEEDS
Minerals
Keshan disease, goiter, cretinism, fetal
growth restriction
Keshan disease is a congestive
cardiomyopathy caused by a combination
of dietary deficiency of selenium and the
presence of a mutated strain of
Coxsackievirus.
2 major minerals
CALCIUM
essential for the fetal development of
bones and teeth as well as for the
mother's own body needs
● blood clotting
● Sources: cups of milk or milk
substitute daily (e.g., calcium-
fortified soy milk), generous
amounts of green vegetables,
and enriched or whole grains
usually supplies enough
calcium.
● Calcium supplements may be
indicated for cases of poor
maternal intake or
pregnancies that involve more
than one fetus
IRON
essential for the increased hemoglobin
synthesis that is required for the greater
maternal blood volume as well as for the
baby's necessary prenatal storage of iron.
● SOURCES: grains, nuts,
seeds, legumes, and
vegetables
VITAMINS
NOTE: DRIs for pregnant women are
slightly higher for most vitamins
Folate
 ● Folate is important for both
mother and fetus throughout
pregnancy.
● Tetrahydrofolic acid (TH4)
participates in DNA synthesis,
cell division, and hemoglobin
synthesis.
● It is particularly relevant during
the early periconceptional
period (i.e., from
approximately 2 months
before conception to week 6 of
gestation) to ensure adequate
nutrient availability in the
endometrial lining of the uterus
for embryonic tissue
development.
● The neural tube forms during
the critical period from 21 to
28 days' gestation, and it
grows into the mature infant's
spinal column and its network
of nerves.
● Folate helps thwart neural
tube defects (NTDs) is
unknown
● Spina bifida - lower end of the
neural tube fails to close
● ANENCEPHALY - upper end
of the neural tube fails to
close. Brain fails to develop or
is entirely absent. End in
miscarriages or death soon
after delivery.
PREGNANT WOMEN: 600 mcg/day
NONPREGNANT WOMEN: 400 mcg/day
● Women who are unable to
achieve such dietary
recommendations by eating
foods that are fortified with
folate may do so with a dietary
supplement
SOURCES:
● All enriched flour and grain
products as well as fortified
cereals contain a well-
absorbable form of dietary folic
acid.
● Other natural sources of folate
include liver; legumes (e.g.,
pinto beans, black beans,
kidney beans); orange juice;
asparagus; and broccoli.
Vitamin D
● Recommend pregnant and
lactating women consume 15
mcg/d
(600 lU)
SOURCES:
1. vitamin D needs can be met
by the mother's intake of at
least 3 cups of fortified milk (or
milk substitute) in her daily
food plan.
2. Fortified milk contains 10 mcg
(400 IU) of cholecalciferol (i.e.,
vitamin D) per quart.
Weight gain during pregnancy
● Amount and Quality
● 10 to 16.7 kg (22 to 36.8 lb)
Approximate Weight Gain Distribution
during a Normal Pregnancy
Product Weight
(lb)
Fetus 7.5
Placenta 1.5
Amniotic Fluid 2
 Hyperemesis Gravidarum - Antiemetic
drugs
Uterus 2
Constipation

Breast tissue 2 ● Latter part of pregnancy

● There is enlargement of uterus

Blood Volume Increase
Maternal Stores: Fat,
Protein, Water, and other
nutrients.
NSG Management
3
● No pharmacologic drugs
● Adequate exercises
11 ● Bedrest with diaper
● Increase fluid intake
● High fiber diet

Note: Avoid herbal/artificial laxatives

Total 29 Hemorrhoid

● Enlargement of the veins

Note: (anus)
● Can lead to protrusion of anal
● 1-2kg - 1st trimester sphincters
● .5-1lbs - average weight gain ● Caused: Increasing weight of
of the mother weekly basis the baby and the downward
pressure that this weight
produced.
● Resolved: after delivery (it
Concerns: takes time)
Gastrointestinal Problems NSG Management

● Nausea and Vomiting ● Enough rest, especially during

(Morning Sickness) the latter stages of pregnancy.
● Caused: HCG increased - 1st
Trimester Heartburn
● Peak: 9-11 weeks of
pregnancy ● "Full" feeling, after meals.
● Resolved: 14 weeks ● Caused: pressure of the
enlarging uterus, crowding of
NSG Management the stomach.

● Small and frequent feeding NSG Management

● No spices
● Dry and gland to manage
acidity of the stomach
● Drink between meals
● Check the triggers: Certain
smell, person etc.
● Avoid large amount of meals
● Small frequent feeding
● Comfort - lose outfits
Definition:
PICA:
Unusual Cravings During Pregnancy. Pica
is the practice of craving substances with
little or no nutritional value. Most
pregnancy and pica-related cravings
involve non-food substances such as dirt
or chalk. The word pica is Latin for magpie
which is a bird notorious for eating almost
anything.
PREECLAMPSIA:
a serious blood pressure condition that
develops during pregnancy. People with
preeclampsia often have high blood
pressure (hypertension) and high levels of
protein in their urine (proteinuria).
Preeclampsia typically develops after the
20th week of pregnancy.
ECLAMPSIA:
Eclampsia is when a person with
preeclampsia develops seizures
(convulsions) during pregnancy. Seizures
are episodes of shaking, confusion and
disorientation caused by abnormal brain
activity. Eclampsia typically occurs after
the 20th week of pregnancy. It's rare and
affects less than 3% of people with
preeclampsia.
PIH:
Pregnancy induced hypertension (PIH) is
hypertension that occurs after 20 weeks of
gestation in women with previously normal
blood pressure. The broad classification of
pregnancy-induced hypertension during
pregnancy is gestational hypertension,
pre-eclampsia and eclampsia.
Essential Nutrients
Macronutrients are nutrients that a
person needs in larger amounts.
Macronutrients include water, protein,
carbohydrates, and fats.
Classification by PREDOMINANT
FUNCTION
Nutrient
- is a chemical component needed
by the bodY.
- chemical substances found in
food
- some are manufactured in the
body (a process called
“biosynthesis”)
- while some are made in the
laboratory ( man made nutrients
useful for research or therapeutic
purposes a.
A. Body-building
- They form tissues or are
structural components of the
body.
Water - is most abundant in the body,
accounting for about 2/3 of body weight
Protein - 1/5th or 20% Minerals - 4%
Carbohydrates - less than one pound
about 1/3 kilogram or 1%
Vitamins - are not considered structural
nutrients since the total concentration in
the body is not even an ounce (less 28
gms b.

The World Health Organization (WHO) B. Regulatory

notes that essential nutrients are crucial in - they maintain normal
supporting a person’s reproduction, good - physiologic processes.
health, and growth. The WHO divides - include all the six groups of
these essential nutrients into two nutrients.
categories: micronutrients and - They maintain homeostasis of
macronutrients. body fluids and expedite
metabolic processes.
Micronutrients are nutrients that a
person needs in small doses. C. Furnish energy
Micronutrients consist of vitamins and - are carbohydrates, fat and
minerals. Although the body only needs protein.
small amounts of them, a deficiency can - sometimes referred to as the
cause ill health. “fuel nutrients”
 There are 16 essential minerals:
According to CHEMICAL NATURE/ ● Calcium
STRUCTURE ● Phosphorus
- nutrients are either organic or ● Potassium
inorganic. ● Sulfur
● Sodium
A. Organic nutrients are those that ● Chloride
come from anything food-based ● Magnesium
that contains carbon in its genetic ● Iron
makeup. This includes ● Zinc
carbohydrates, lipids, vitamins, ● Copper
and protein. ● Manganese
B. Inorganic Nutrients Inorganic ● Iodine
nutrients are different from ● Selenium
organic nutrients in one key way: ● Molybdenum
they do not contain carbon. - ● Chromium
There are only two groups of ● Fluoride
inorganic foods that you need to
be concerned about: minerals 6. Water:
and water. As a beverage and a component
of many foods, especially
According to ESSENTIALITY vegetables and fruits.
- The six major nutrients are a
group of individual nutrients each According to CONCENTRATION
of which has an important - Some nutrients are needed in
physiological role in the body. larger amounts than others.
- All nutrients are physiologically - nutrients may be termed
essential to the body, but some macronutrients or micronutrients.
are dietary essentials (these
should be supplied from food Macronutrients
because the body does not - Water, protein, fat and
synthesize them). carbohydrates (present
There are six major nutrients: in the body in large
Carbohydrates (CHO), Lipids (fats), amounts)
Proteins, Vitamins, Minerals, Water
Micronutrients
1. Proteins: - all vitamins and the
meat, dairy, legumes, nuts, trace minerals, which
seafood and eggs are measured in
milligrams or fractions.
2. Carbohydrates:
Glucose dietary fiber According to DIGESTIBILITY

3. Lipids (most commonly called Carbohydrates are simply grouped into:

fats): - Digestible
linoleic acid linolenic acid. sugars, starches, dextrin and
glycogen
4. Vitamins:
water soluble B group vitamins - Partially digestible
and vitamin C, galactogens, mannosans, inulin
fat soluble vitamins A, D, E and K and pentosans

5. Minerals - Indigestible carbohydrates

cellulose and Hemicellulose
 - Only the digestible A. Monosaccharide
carbohydrates Monosaccharides are
sugars and starches, supply simple sugars (glucose,
energy, upon complete fructose, and galactose)
hydrolysis- 1 gram yields 4 kcal. that do not need to be
further digested to be
Indigestible carbohydrates – like the absorbed.
dietary fibers (cellulose, hemicellulose) not
broken down by the human beings in the B. Disaccharides
intestine into glucose units due to lack of Are sugars formed from
specific enzymes so they do not yield two monosaccharides. -
energy. Ordinary cane sugar
(sucrose) is a
CARBOHYDRATES disaccharide composed
- Originally called saccharides, a of glucose and fructose
Greek word, meaning “sugars” monosaccharide units.
- Organic compounds abundant in
plants and widespread in nature. C. Polysaccharides
- About 50-60 percent of energy Starch, glycogen,
needs come from carbohydrates. cellulose and most
- It contains or is made up of types of fiber are
molecules carbon(C), polysaccharides.
hydrogen(H), and oxygen(O).
Carbohydrates are the most D. Oligosaccharides
widespread organic substances contain less than ten
and play a vital role in all life. monomer units to make
- The ratio of hydrogen to oxygen up the molecule. They
is 2:1 as in water molecule, are present in a number
hence the word carbo-hydrate of plant foods including
referring to “a hydrated carbon” leeks, garlic, onions,
Jerusalem artichokes,
FUNCTIONS lentils and beans.
● Energy
● Special Functions RECOMMENDED DIETARY INTAKE
● Glycogen-carbohydrate Storage
● Protein-Sparing Action While there is no (RDA) for
● Antiketogenic Effect carbohydrate, a level of 50 to 60% of total
● Heart Action caloric requirement should be provided by
● Central Nervous System carbohydrates.

TYPES/CLASSIFICATION ACCORDING DEFICIENCY

TO COMPLEXITY
1. COMPLEX CARBOHYDRATES
contain many more nutrients than
simple carbohydrates
2. SIMPLE CARBOHYDRATES
are usually refined foods such as
white sugar, white bread or cola.
These foods contain little else
besides energy (ie. empty
calories).
In severe deficiencies, in case of famine
and prolonged starvation, the ill effects of
a limited total food intake result in multiple
nutrient deficiencies, particularly protein
energy malnutrition (PEM).
The first clinical signs are decreased
blood sugar level, loss of weight, and
retarded growth for infants and children.
EXCESS
 4. Glycine
Obesity or adiposity becomes the
problem TYPES OF PROTEIN

SOURCES OF FIBER Complete proteins: These foods contain

● Beans all the essential amino acids. They mostly
● Broccoli occur in animal foods, such as meat,
● Berries dairy, and eggs.
● Avocados
● Popcorn Incomplete proteins: These foods
● Whole Grains contain at least one essential amino acid,
● Apple so there is a lack of balance in the
● Dried Fruits proteins. Plant foods, such as peas,
● Potatoes beans, and grains mostly contain
● Nuts incomplete protein.

PROTEIN AND AMINO ACIDS Complementary proteins: These refer to

Protein came from the Greek
word “protos' '/proteios meaning"primary
" " or "holding first place”/ “is of prime
importance” since it is the first substance
recognized as a vital part of a living tissue.
It contains nitrogen in addition to the basic
carbon, hydrogen and oxygen.
They are organic substances that
on digestion yield their constituent unit
building blocks amino acids.
a. There are 22 amino acids
b. All amino acids exist in nature as
alpha-amino carboxylic acids
c. Glycine is the simplest amino
acid identified in 1820.
d. Threonine was the last to be
identified in 1935
two or more foods containing incomplete
proteins that people can combine to
supply complete protein. Examples
include rice and beans or bread with
peanut butter.
RECOMMENDED INTAKE
ADULT – 0.9 gm/kgBW
CHILDREN – growth needs vary
according to age and growth patterns
PREGNANCY – rapid growth requires an
increase of 30 gms over that of the
nonpregnant woman
LACTATION - requires an increase of 20
gms

MULDER: a Dutch chemist proposed the DEFICIENCY AND EXCESS OF

name in 1840. PROTEIN INTAKE

FUNCTIONS OF PROTEINS AND Protein deficiency is when people

AMINO ACIDS do not get adequate amounts of protein
from their diet. Kwashiorkor, its most
1. Body building or Structural Role severe form, is most commonly seen in
2. Source of energy children in developing countries.
3. Regulator of bodily Processes
1. Edema
2. Fatty Liver
3. Skin hair problem
SOURCE OF ESSENTIAL AMINO ACIDS 4. Loss of muscle mass
5. Greater Risk of Bone Fractures
1. Methionin 6. Stunted Growth in Children
2. Phenylalanine 7. Increased Severity of Infections
3. Tryptophan
 8. Greater Appetite and Calorie - Visible fats and oils such as
Intake butter, margarine, lard, cooking
oils, fish-liver oils, pork fat,
TOXICITY OR TOO MUCH PROTEIN chicken fat.
INTAKE - Very good sources found in
nuts, such as oil seeds and some
1. Weight gain legumes.
2. Bad breath
3. Constipation RECOMMENDED DAILY ALLOWANCES
4. Diarrhea
5. Dehydration In the Philippines, it is suggested
6. Kidney damage that at least 20% of total caloric allowance
7. Increased cancer risk be supplied by dietary fat.
8. Heart disease
9. Calcium loss DEFICIENCY AND EXCESS

SOURCES Deficiency of fats reduce caloric

supply in the body and cause protein
1. grass-fed lean meats, catabolism.
2. pasture-raised poultry, and
organic dairy Signs of inadequate fat intake include:
3. wild fish 1. Dry and scaly skin
4. eggs from pastured hens 2. Dry eyes
5. legumes, nuts, and whole grains 3. Feeling constantly cold
4. Dry hair and/or hair loss
FATS/LIPIDS 5. Hormonal problems, including
loss of menstrual cycle
Fat is one of the three main 6. Inability to feel full/always feeling
macronutrients, along with the other two: hungry
carbohydrate and protein. Fats molecules 7. Issues concentrating and/or
consist primarily of carbon and hydrogen mental fatigue
atoms, thus they are all hydrocarbon 8. Deficiencies in fat-soluble
molecules. Examples include cholesterol, vitamins - Constant fatigue
phospholipids and triglycerides. 9. Excessive intake above the
normal levels resulting in extra
FIVE FUNCTIONS OF FAT IN OUR caloric supply leads to obesity.
BODIES
CHOLESTEROL is a waxy, fat-like
1. Promotes Absorption of Fat- substance that's found in all the cells in
Soluble Vitamins your body. Your body needs some
2. Supports Optimal Health cholesterol to make hormones, vitamin D,
3. Boosts Brain Function and substances that help you digest
4. Provides Energy foods.
5. Insulates the Body
Causes:
TYPES OF FAT 1. Low-density lipoprotein (LDL).
LDL, or "bad" cholesterol,
1. Unsaturated Fats transports cholesterol particles
2. Saturated Fats throughout your body. LDL
3. Trans Fat cholesterol builds up in the walls
of your arteries, making them
FOOD SOURCES hard and narrow.
2. High-density lipoprotein (HDL).
HDL, or "good" cholesterol,
 picks up excess cholesterol and
takes it back to your liver MINERALS

Risk Factors: These are groups of minerals

1. Poor diet which are needed by the body in minute
2. Obesity amounts to perform certain vital
3. Lack of Exercise functions. They are sometimes called
4. Smoking trace minerals. Ordinarily these minerals
5. Age can be supplied by an average mixed diet
6. Diabetes since the amounts needed are very small.

Prevention: 1. Iron
1. Eat a low-salt diet that 2. Zinc
emphasizes fruits, vegetables 3. Selenium
and whole grains 4. Copper
2. Limit the amount of animal fats 5. Iodine
and use good fats in moderation
3. Lose extra pounds and maintain WATER
a healthy weight
4. Quit smoking Water is defined as an essential
5. Exercise on most days of the nutrient because it is required in amounts
week for at least 30 minutes that exceed the body's ability to produce it.
6. Drink alcohol in moderation, if at
all Distribution of water in the body
7. Manage stress
It constitutes about 60-70% of the
VITAMINS AND MINERALS total body weight so that a body deprived
of water by as much as 10% will already
Vitamins were formerly called result in illness and a 20% loss of body
“accessory food factors” because their water may cause death. It is next to
presence in minute quantities is easily oxygen in importance for the maintenance
overlooked. of life.
The word “vitamin” was
originated by Casimir Funk in 1912 when FUNCTIONS
he was searching for a constituent in rice
bran which could cure beriberi. - flushing out waste from your
body
FAT-SOLUBLE VITAMINS - regulating body temperature
1. Vitamin A - helping your brain function
2. Vitamin D - it helps create saliva
3. Vitamin E - it regulates your body
4. Vitamin K temperature
- It protects your tissues, spinal
WATER SOLUBLE VITAMINS cord, and joints
1. Vitamin C (Ascorbic acids) - It helps excrete waste through
2. Vitamin B perspiration, urination, and
a. thiamine (B1) defecation
b. riboflavin (B2) - It helps maximize physical
c. niacin (B3) performance
d. pantothenic acid (B5) - It helps prevent constipation
e. pyridoxine (B6) - It aids in digestion
f. biotin (B7) - it helps with nutrient absorption
g. folate (B9) - It helps you lose weight
h. cobalamin (B12)
 - It improves blood oxygen
circulation
- It helps fight off illness
- It helps boost energy
- It aids in cognitive function
- It helps improve mood
- It helps keep skin bright
- It prevents overall dehydration

RECOMMENDED INTAKE

- about 15.5 cups of water (125

ounces) each day for men
- about 11.5 cups (91 ounces)
daily for women

DEFICIENCY

Dehydration may be serious if the

loss is about 10% of the total body body
water and fatal if the loss is from 20-22%.

TOXICITY

If the cells and tissues become

water-logged due to the entrance of the
accumulated water, symptoms which may
include anorexia, vomiting,
convulsions, coma and even death
result. Excess fluid also becomes
apparent as edema. Edema is defined as
the accumulation of water in the interstitial
fluids.
 Note: at least +2 kg every year

3. ADULTS

Hamwi Method:

Women: 100 for 5ft add 5lbs for additional

in.

Men: 106 for 5ft add 6lbs for additional in.

NUTRITION AND DIET THERAPY NDAP:

NUTRI LAB
Male: 112 lbs for 5ft, +- 4
Unit 4: Dietary Computation Female: 106 for 5ft. +- 4

CALCULATION OF IDEAL BODY 4. TANHAUSSER’S METHOD OR

WEIGHT (IBW) BROCCA INDEX
- This is used for under 5 children
in monitoring their weight to be DBW = Height cm - 100
compared with the standards
(*for filipino, deduct 10%)
Remember:
1 month = 30 day 5. ADOPT METHOD
1 year = 12 months
5ft for 105 lbs, +- 5
IBW = DOW - 2008 - 12 - 06
DOB - 2006 - 03 - 02 6. BMI = Weight kg/Height = m2
2 09 04
= 2 X 12 = 24 + 9 B. DIETARY CALCULATIONS
= 33 mos
BMR - 1kcal x weight x 24 hrs
A. Determining Ideal/Desirable Body
Weight (IBW/DBW) Infants: TEA (Total Energy Allowance)

1. INFANTS 0-6 mos: TER DBWkg x 120 kcal

7-12 mos: DBWkg x kcal/DBW/day
a. 1st 6 months
DBWgm = Birthweightgm + (Age mos x Children: TEA (Total Energy Allowance)
600)
M1 = TER = 1000 (age yr x 100 kcal)
b. 7-12 months M2 = TER = DBWkg x 110 kcal)
DBWgm = Birthweightgm + (Age mos x
500)
Age kcal/BDW/day
● Infant’s weight doubles at 5-6
months 1-3 105
● Triples at 12 months
● Quadruples at 24 months 4-6 90

2. CHILDREN 7-9 75

DBW kg = (Age in years x 2) +8 10-12 65 (b) 55 (g)

 heavy manual
activities, other
heavy manual
work

Cooper et al. Method

TEA = ___kcal (basal needs) ___ (%PA) =

___ kcal
Adolescents: TEA (Total Energy
Allowance)

TER = DBW x kcal/DBW/day % Total Calories

Consumed

Carbohydrate 40 - 65
Age kcal/DBW/day
Protein 10 - 35
13 - 15 55 (b) 45 (g)
Fat 20 - 35
16 - 19 45 (b) 40 (g)
Linoleic Acid (n-6) 5 - 10
KRAUSE METHOD
Alpha-linolenic 0.6 - 1.2
TER = DBW (kg) x Physical Activity Factor acid (n-3)

= round off to the nearest 50

Activity kcal/kg BDW day
Distribute TEA among CHO, CHON, &
Bedrest ( mobile ) 27.5 FAT

Sedentary/ Very 30 CHO = 50 – 70 %

Light – mostly CHON = 10 – 15 %
sitting down FAT = 20 – 30 %

Light – student, 35 Cooper et. Al Method: TER = BMR + PA

nurse, teacher, + SDA
engineer,
housewife w/ BMR = 1 kcal/kg DBW/ hour
maid, restaurant
trades, childcare, Note: 1 day = 24 hours PA = % above
table tennis, golf basal or BMR -

Bedrest = 10%
Moderate – wife 40
Sedentary = 30%
w/o maid, vendors
Light = 50%
running on the
Moderate= 75% Heavy = 100%
streets, jeepney
drivers, dancing

Heavy – walking 45
activities w/ load,

NUTDTH1
INTRODUCTION TO NUTRITION
As HIPPOCRATES believed, ‘the body
must be treated as a whole and not just a
series of parts'; He also quoted, 'let thy
food be thy medicine and the medicine be
thy food.' Today Hippocrates is known as
the "Father of Medicine."
Antoine Laurent de Lavoisier is the
father of nutrition and chemistry; he
discovered metabolism in 1770. He
demonstrated that energy from food is
derived due to oxidation of it.
COMMON TERMS USED IN THE STUDY
OF NUTRITION
1. NUTRITION - The study of how your
body uses the food that you eat; It is
the science of food in relation to health
of an individual, community, or society
and the process through which food is
used to sustain life & growth.
2. MALNUTRITION - "Poor nutritional
status"; A state in which a prolonged
lack of one or more nutrients retards
physical development or causes the
appearance of specific clinical
conditions (anemia, goiter, rickets, etc.)
3. DIET - All-inclusive term referring to
food regularly eaten and liquids
regularly consumed; the sum of the
food consumed by an organism or
group.
● Dieting - the deliberate
selection of food to control
body weight or nutrient intake.
● Diet food - foods that aid in
dieting.
● Cuisine - the diet of a
particular culture.
● Fad Diet - a diet popular for a
time that often promises
unreasonably fast weight loss
or health improvements.
4. BALANCED DIET: - A diet in which
foods are chosen to provide kCalories,
essential nutrients, and fiber in the right
proportions.
5. ENZYMES - Are generally named by
adding the ending "-ase" to the name of
the substance on which the enzyme acts
(for example, protcase is an enzyme that
acts on proteins). Most enzymes are
recognized by the ending asc, like -
maltase, lipase and transaminase.
6. KILOCALORIES/CALORIES - The
term used to represent the amount of
energy required to raise the temperature
of a liter of water one degree centigrade at
sea level.
A bomb calorimeter is used to
determine the energy values of foods by
placing a sample of food in a chamber,
surrounding it with water, and then
burning it.
A calorie is the amount of heat
needed to raise the temperature of 1
kilogram of water 1 degree Celsius.

7. GOOD NUTRITIONAL STATUS -
Implies appropriate intake of the
macronutrients-carbohydrates, proteins,
and fats and the various vitamins and
minerals often referred to as
"Micronutrients" because they are needed
in small quantities.
8. MEDICAL NUTRITION THERAPY.
"DIET THERAPY" - Is the treatment of
disease through nutritional therapy by
registered dietitians (RDs)
9. FOOD-MATERIAL - Usually of plant or
animal origin, that contains or consists of
essential body nutrients, such as
carbohydrates, fats, proteins, vitamins, or
minerals, and is ingested and assimilated
by an organism to produce energy,
stimulate growth, and maintain life.
QUALITIES OF A GOOD FOOD
1. Nourishing or nutritious.
2. It has satiety value.
3. Prepared under sanitary
conditions, aesthetically and
scientifically.
4. Free from toxic agents.
5. Palatability satisfies the
consumers.
6. Offers variety and planned
within socio-economic context.
10.GOOD NUTRITION - Means eating the
right quantity, quality and diversity of foods
and getting the care we need to keep our
bodies strong and healthy and prevent us
from getting sick.
1. When a person is
undernourished, there are
usually numerous reasons.
2. Often, these reasons are
connected. If a child is
malnourished, the father may
blame the mother for not
feeding the child enough.
3. Yet the father may not be
giving the mother the right
variety of foods to cook.
4. Maybe he cannot afford it, or
he does not have enough land.
5. It is important to do a proper
analysis and not blame one
person.
6. In many cases, the solution to
one person's malnutrition will
involve the whole community.
11. NUTRIENTS - Consist of various
chemical substances in the food that
makes up each person's diet; (A nutrient is
a chemical substance in food that helps
maintain the body.) Some provide energy.
● All help build cells and tissues,
regulate bodily processes such
as breathing.
● No single food supplies all the
nutrients the body needs to
function.
● Deficiency Disease: failure to
meet your nutrient needs.
Nutrients are the components of
food which have a function in...
● Providing energy,
 ● Providing material for growth,
● Repair
● reproduction,
● starting and controlling various
processes immune system;
iron and red blood cells
12. NUTRIENT DENSITY - A measure of
the nutrients provided in a food per
kilocalorie of that food.
13. ESSENTIAL NUTRIENTS - Nutrients
that either cannot be made in the body or
cannot be made in the quantities needed
by the body; therefore, we must obtain
them from food.

14. HEALTH - Is a slate of complete

physical, mental and social well-being and
not merely the absence of disease or
infirmity.

15.HORMONES - A hormone is a
chemical produced in one part of the body
and released into the blood to trigger or
regulate particular functions of the body.

● For example, insulin is a

hormone made in the
pancreas that tells other cells
when to use glucose for
energy.
● Chemicals produced by cells
of the body stimulate or relard
certain life processes such as
growth and reproduction.

17. NUTRITURE - The state of the

nutrition of the body. Nutritional status,
especially with regard to a specific
nutrient.
 information because food
habits change for most
persons
- used in conjunction w/
physical parameters of
health
- current & past health
history

a. DIET EVALUATION

A.1 DIET HISTORY

- through interview
- food preferences &
intolerances
- taste, appetite, recent wt.
UNIT 5: NUTRITION-FOCUSED Changes
NURSING CARE PLAN - desired wt. & usual wt.
- Applying the nutrition care - estimation of typical
process will vary to a kilocalorie & nutrient intake
degree depending on the
health care setting TOOLS:

A. NUTRITIONAL ASSESSMENT A.2. 24-HOUR food RECALL

- Data gathering with use of - quick & easy of evaluating
some intake
- person must be able to
TOOLS like: recount all the types &
- Interview medical charts, amounts of foods &
- Simple assessment beverages consumed
- Laboratory Values during a 24-hour period
- Physical signs of nutritional
status A.3 FOOD FREQUENCY
- Develop rapport & trust CHECKLISTS
- a checklist of particular
1. HISTORY foods that helps determine
- Dietary history what’s consumed & how
- no one approach can often
provide complete
 - may list the foods in one
column, & the person
marks off how often they
are eaten 266
- periods of time
- how often the food is
consumed (per day/ per
week, or per m0nth)
- if the food is eaten
frequently, seldom, never
- typically does not include
the serving size, & it may
only include specific foods
or nutrients suspected of
being deficient or
excessive in the diet.
A.4. CALORIE COUNT
- The ENERGY (CALORIE)
value of food is the amount
of energy produced in the
body as a result of food
metabolism. Calorie
- the most common term to
express energy a unit
measure of heat
A.5. FOOD DIARY
2. PHYSICAL
EXAMINATION/FINDINGS -
CLINICAL
- provide a clue to the
presence of malnutrition
- indicators of malnutrition
- appearance of hair, skin,
oral cavity, fingernails
- presence of edema
A. ANTHROPOMETRY
Anthropometry is the study
of the measurement of the
human body.
Anthropometric
measurements include
metrics such as height,
weight, or head
circumference. Height is
assessed using a
stadiometer. Length refers
to the measurement of
infants and children who
are 2 years or younger or
those 24–36 months who
are not able to stand
without assistance, or who
measure less than 30
inches while 267 lying
down.27 Growth charts
used for children age 0–36
months use recumbent
length, whereas stature is
used for those age 2–20
years.
Common Anthropometric
Measurements
A.1 WEIGHT
Types of Weighing Scale
1. Bar scale
2. Scalter Scale
3. Platform Scale
HEALTHY WEIGHT - defined by
3 criteria:
 1. A weight that is within the - uses a pt’s wt. & ht. to help
suggested range for height classify a person as
2. A fat distribution pattern underwt., normal, or obese
that is associated w/ a low - measures weight in relation
risk of illness & premature to height
death. - measure of adiposity or
3. A medical history that overfat, not simply
reflects an absence of risk overweight
factors associated w/ - should not be applied to
obesity, such as elevated children, adolescents,
blood cholesterol, blood adults over 65 y/o,
glucose, or blood pressure. pregnant & lactating
women, & highly muscular
individuals.
- determined by dividing
weight (kg) by the square
Wt. Gain Loss
of height (meter – 1m =
1 lb/ wk (1/2 - less 500 cal 39.37in)
kg) = add 500
kcal./ day FORMULA:
BMI = weight (kg)/Height(m²)
2 lbs/ wk ( 1 kg - less 1000 cal
) = add 1000
kcal./ day 18.5 – underwt.
18.5 – 24.9 – normal
25.0 – 29.9 – overwt.
● Bec. 35000 kcal equates to
30.0 – 34.0 – obese – class 1
approximately 1 lb of body
35 – 39.9 – class 2
fat.
40 or greater – morbid obesity
● Safe & permanent wt. loss
--- should lose a maximum
of 1 – 2 lb/ wk.
● Rapid wt. loss --- compel the
body to use protein (muscle)
instead of fat → ↓muscle
mass --- body fat percentage
increases

BODY MASS INDEX


UNIT VII: DIET THERAPY
1. Do not plan a completely
different diet because:
- Diets based on a person's
daily diet have better
acceptance. 417
- Such diet do not make a
patient feel that he/she is
eating something
completely different from
the family members.
- It is difficult to prepare.
2. Try to include only those
foods which are liked by
the patient, otherwise food
may not be eaten at all.
3. Serve the meal in an
attractive way to make
them feel like eating.
TYPES OF MODIFICATION OF A
NORMAL DIET

LESSON 1 GENERAL DIETS The types of modifications that

may have to be made are as
- The application of follows:
nutritional science to
promote human health and 1. In diet consistency
treat disease 2. In nutrient content
- involves the modification of 3. In interval and frequency of
food intake feeding
- A means of management
for such metabolic 1. Modifications in diet
diseases or it supports the consistency
overall therapeutic program
- In some diseases the
Some points to remember thickness of the food has to
be changed.
While modifying the diet of a - The food can then be
patient, keep the following points served in two
in mind: consistencies:
 - Diets used in the treatment
1. Liquid of disease are termed by
2. Semi solid specific names that show a
special composition and
2. Modifications in nutrient often indicate the purpose
content for which the diet is
intended.
- Depending on the nature of
the diseases, modifications General Diets
may need to be made in 1. Regular/ Normal/ Full Diet
one or more nutrients in 2. High Fiber
the diet. 3. Low Fiber
- The modifications can be in 4. Vegetarian
terms of an increase or 5. Therapeutic
decrease in the amount of
the nutrient.

1. Regular Diet – “Normal

3. Modifications in interval diet”/ “full diet”/ house/ dat
and frequency of feeding (diet as tolerated)

- Normally you eat 3-4 meals - composed of all types of

a day, that is, breakfast, foods and is well balanced
lunch, tea and dinner. - capable of maintaining a
- In sickness, you find it state of good nutrition
difficult to eat the amount - It is intended for
you usually eat at one time. convalescing patients who
- However, your body must do not require a
get all the nutrients in therapeutic diet.
correct amounts.
- Small amounts of food at INDICATIONS
intervals of 2-3 hours and - When no dietary
as many as 8-10 small modification is needed and
meals in a day instead of solid foods can be
3-4 meals facilitates tolerated.
speedy recovery. - No dietary restrictions
Includes the basic food
TYPES OF DIETS groupS.
- For ambulatory patients
 - Bed patients not requiring
therapeutic diets
2. Vegetarian Diet
- Vegetarian diets are used
by individuals who abstain
from eating all or specific
foods of animal origin.
TYPES
Dietary restrictions based on
patients own restrictive practices.
1. Lacto-ovo vegetarian -
Diet includes milk products
& eggs will meet the
recommendations.
2. Lactovegetarian diets –
include milk products
3. Pure vegetarians/
Vegans- eat only plants
PURE VEGAN DIETS: benefits
- Low in fat
- High in fiber
- Cholesterol-free ↓
- Decreased risk of:
- Coronary heart disease
- obesity
- Type II diabetes
- Constipation
- Certain cancers – breast &
colon
3. THERAPEUTIC DIETS
- are modifications of the
regular diet and are
designed to meet specific
patient needs.
These include modifications in:
- method of preparation
(e.g., baking, boiling, or
broiling),
- consistency (e.g., ground
or chopped),
- total calories (e.g., high or
low calorie),
- nutrients (e.g., altering
carbohydrate, protein, fat,
vitamins, and minerals)
allowing only specific foods
(e.g., diabetic diet).
LESSON 2: DIETS MODIFIED IN
CONSISTENCY
1. CLEAR LIQUID
A short-term, highly
restrictive diet composed only of
clear fluids or foods that are fluid
at body temperature
It requires minimal digestion and
leaves a minimum residue.
- Non-stimulatinG
- Non-gas forming
- No-irritating diet
- 400 - 500 kcal
FOODS ALLOWED
- Allows visually clear and
minimum residue liquids.
- Water,
- Bouillon
 - Fat-free broth
- Carbonated beverages
- Tea, Coffee, regular &
decaf
- Gelatin (plain)
- Popsicles
- Sugar, honey, hard candy
- Fruit juices, strained &
clear
INDICATIONS
- Initial feeding after surgery
or parenteral nutrition
- In preparation for surgery
(pre-op) and various
diagnostic tests of the
bowel
- for acute episodes of
nausea and vomiting to
promote bowel rest.
CONTRAINDICATIONS
- Long-term use
- Intended for a very short
durations (3 days or less)
due to nutritional
inadequacies.
2. FULL LIQUID DIET
- Consists of foods that are
in a liquid state at body
temperature.
- A full liquid diet includes all
the liquids served on a
clear liquid diet
- with the addition of strained
cream soups, milk and milk
drinks, ice cream,
puddings, and custard.
- The full liquid diet is
inadequate in iron, folic
acid, niacin, fiber and
possibly Vitamin A and
thiamin.
- Can be supplemented to
approximate the nutritional
value of a regular or
highcalorie, high-protein
diet
FOODS ALLOWED
- includes regular foods
blended and strained in
liquid form
- all foods allowed on clear
and full liquid diets.
- All the foods in clear liquid
diet
- includes regular foods
blended and strained in
liquid form
- all foods allowed on clear
and full liquid diets.
- All the foods in clear liquid
diet
INDICATIONS
- As a transitional diet
between a clear liquid diet
and a soft diet
- some postoperative cases
- acute illnesses
- inflammatory conditions of
the gastrointestinal (GI)
tract
 - Clients who have difficulty
chewing or swallowing
- Important - feedings
consist of 6 to 8 ounces or
more be given every 2 to 3
hours while the patient is
awake.
CONTRAINDICATIONS
- Severe lactose intolerance
- for convalescents who
cannot tolerate a regular
diet
- in acute illnesses
- in some gastrointestinal
disorders
- To decrease peristalsis
and limit stimulation of the
GI tract, typically used with
PUD and GERD.

3. SOFT DIET FOODS ALLOWED

- Little or no spices are used
- Normal diet modified in in its preparation.
consistency to have limited - includes all liquids other
fiber than alcohol
- often called a low fiber diet - foods that may be
(free from most of the incorporated into a soft
fibers of a normal diet) poultry
- soft in texture (easily - vegetables (including
digestible) baked, mashed, and
- and consists of liquids and scalloped potatoes).
semi-solid foods.
- It contains only materials PERMITTED DESSERTS ARE:
and foods that are soft in - custards
consistency and easily - gelatin
chewable. - puddings
- soft fruits
INDICATION - simple cakes and cookies.
- serves as an intermediate - Foods prohibited in a soft
diet between liquid and diet include fried foods, raw
normal diet. vegetables, and nuts.
- helpful when you have
gastrointestinal problems MODIFICATIONS
- contain nutrition that is - Low residue
adequate and sufficient for - No fiber or tough
most people. connective tissue
- It is indicated in certain
postoperative cases
- Traditional bland – no
chemical, thermal, physical
stimulants
- Cold soft – tonsillectomy