Nutrition and Diet Therapy Strategy: Patients with swallowing disorders

Introduction of nutrition - nourishments that can avoid choking.

Nutrition - Nurse may avoid choking. The nurse
has a treatment technique.
 is the science of food and its
relationship to health. Healthcare Providers in Nutrition
 involves the process of taking in and Delivery
utilizing nourishment, which
Registered Nurse - the first team member to
includes natural and artificial
interview the client and communicate
feeding.
important nutritional information - client's
Role of Nutrition response to food, intake, and tolerance. They
also provide nutritional information to
Nutrition can contribute to the prevention of clients.
disease:
Registered Dietitians - together with
1. Primary - implementation of practices physicians- are responsible for meeting the
that are likely to avert the occurrence of client's nutritional needs. They interpret the
disease. physician's diet order in terms of client's
Strategy: Motivating people to change them food habits and food choices, calculate
behavior and maintain a healthy body client's nutritional requirements, evaluate
weight. client's response therapeutic diets,
recommend the best route for
- Primary is to prevent the disease. administration, and provide in-depth
2. Secondary - the institution of monitoring nutrition education and counselling to
techniques to discover incipient diseases clients.
early enough to enhance the opportunity to - They are coordinating the health care
control their effects. team.
Strategy: Risk for Diabetes in Pre-diabetes - The nurse knows what the dieticians
stage - testing blood sugar levels, do.
noninvasive treatments such as weight loss Physicians - are responsible for the
and diet modification. diagnosis and treatment of medical
- Secondary is early detection and conditions. They manage medical care, order
needs the detection to have no laboratory tests and prescribe medications
further prevention. and diets.
- For strategy we need to monitor the Classification of Nutrients
Blood sugar level.
1. Function - those that form tissues in the
3. Tertiary - treatment techniques after a body are body-building nutrients while those
disease has occurred to prevent that furnish heat and energy are fats,
complications or promote maximum carbohydrates, and proteins.
adaptation.
2. Chemical properties - nutrients are either 3. Aid in the regulation of basic body
organic or inorganic. processes
3. Essentiality - nutrients are classified Sources of Energy
based on their significant contribution to the
Energy - capacity to do work. It cannot be
body's physiological functioning.
seen, heard, or felt. Exists in a variety of
4. Concentration - nutrients are either in forms: electric, thermal (heat), chemical,
enormous amounts or little amounts. mechanical, etc.
Note: ALL FOOD ENTERS THE BODY IN
CHEMICAL ENERGY AND IS
Nutrients
CONVERTED INTO OTHER ENERGY
Essential nutrient - one that the human FORMS. ENERGY NUTRIENTS:
body requires but cannot manufacture Carbohydrates, fats, and proteins.
enough to meet bodily needs.
Kilocalories – unit of measure of the energy
MUST BE SUPPLIED BY FOOD IN THE in food and in the body. (kcal)

DIET. Macronutrients

Ex. Vit A, Vit C and Calcium. 1. Required in enormous amounts

- Kailangan ng katawan pero hindi 2. Contribute to the bulk energy needed for
sufficient. the metabolic system

Nonessential nutrients - are not needed in Fundamentals of nutrition

the diet because the body can make them
- Relations between food and health
from other substances.
Nutrients
Ex. Alanine
Chemical substances necessary for life
- Not needed in the diet. The
Functions
conversion of the body does not need
computation.  Provide energy
 Build and repair tissue
Conditionally essential nutrients – are
those that a healthy body can manufacture in  Regulate body processes
sufficient quantities. The body cannot o Support the body processes.
produce in optimal amounts in certain Six classes
physiological statuses or disease situations.
 Carbohydrates
Ex. Tyrosine  Fats (lipids)
Life-sustaining Functions  Proteins
 Vitamins
1. Serve as a source of energy or heat
 Minerals
2. Support the growth and maintenance of  Water
tissue
 Inorganic compounds
 Regulate body processes
Examples: calcium, phosphorus, potassium,
Nutrients
sodium, chloride, iron, magnesium, zinc
Organic Inorganic
 Contains  In simplest Water
carbon, form when
hydrogen, ingested  Major constituent of all living cells
oxygen  Functions:  Composed of hydrogen and oxygen
 Carbon is regulate body
found in all processes The six essential nutrients and their
living things Example: Water and functions
Example: minerals ORAGANIC Function
Carbohydrates, NUTRIENTS
fats, proteins, and Carbohydrates Provide energy
vitamins. Fats Provide energy
Proteins Build & repair
Carbohydrates tissue
Vitamins Regulate body
Provides major source of energy. Examples: processes
cereal grains, vegetables, fruits, nuts, and INORGANIC Function
sugars NUTRIENTS
Minerals Regulate body
Fats (lipids
processes
Provides energy Highest kilocalorie value Water Regulate body
Sources of fat: meats, milk, cream, butter, processes
cheese, egg yolks, oils, nuts Case Study

Protein A client is at home recovering from surgery.

You ask the client what they have eaten over
 Builds and repairs body tissues the past 24 hours. The client states the
Provides energy. following:
 Only one of the six nutrients that
contains nitrogen  Breakfast: two doughnuts, orange
juice
Sources of protein: meats, fish, poultry,  Lunch: lettuce salad with oil &
eggs, milk, cheese, corn, grains, nuts, and vinegar, soda
seeds  Snack: pretzels, soda
Vitamins  Dinner: spaghetti with tomato sauce,
garlic bread; wine
 Organic compounds
 Regulate body processes Case Study

Examples: vitamins A, B, C, D, E and K The client is missing protein and water in

the diet. Protein is needed to build and repair
Minerals
body tissues after surgery. Water is needed Overnutrition
to prevent dehydration.
 Excess energy or nutrient intake
Undernutrition
Characteristics of Nutritional Status
 Deficient energy or nutrient intake
Good Poor
Alert expression Apathy Overnutrition is a larger problem in the
Shiny hair Dull, lifeless hair United States than undernutrition.
Clear complexion The greasy, Deficiency Disease
blemished
complexion, Deficiency disease Nutrients lacking
Good color Poor color Excess nutrients Nutrients lacking
over time for an extended
period
Good Poor Examples: Examples: iron
Bright, clear eyes Dull, red-rimmed Atherosclerosis, efficiency, beriberi,
eyes Obesity, scurvy,
Pink, firm gums Red, puffy, hypertension, osteomalacia,
and well-developed receding gums, and diabetes, osteoporosis,
teeth missing or cavity- gallbladder disease, rickets, goiter
prone teeth some cancers
Firm abdomen Swollen abdomen Deficiency disease Nutrients lacking
Iron deficiency Iron
Firm, well- Underdeveloped,
Iron-deficiency Iron
developed muscles flabby muscles
anemia
Good Poor
Beriberi Thiamin
Well-developed Bowed legs,
Night blindness Vitamin A
bone structure “pigeon breast”
Goiter Iodine
normal weight for Over or
kwashiorkor Protein
height underweight
Marasmus All protein
Erect posture Slumped posture
Deficiency disease Nutrients lacking
Emotional stability Easily irritated, Osteomalacia Calcium, vitamin
depressed, poor D, phosphorus,
attention span magnesium, and
Good Poor fluoride
Good stamina Easily fatigued Osteoporosis Calcium and
Seldom ill Frequently ill vitamin D
Healthy appetite Excessive and poor Deficiency disease Nutrients lacking
appetite Pellagra Niacin
Healthy, normal Insomnia at night, Rickets Calcium and
sleep habits fatigue during the vitamin D
day Scurvy Vitamin C
Normal elimination Constipation or Xerophthalmia Vitamin A
diarrhea (Blindness)
Malnutrition
Digestion, absorption, and metabolism
Digestion
The breakdown of food in the body in
preparation for absorption. Mechanical
digestion: food is broken up by teeth and
moved along the GI tract by peristalsis.
Chemical digestion: carbohydrates, proteins,
and fats are broken down into nutrients
tissues can absorb and use.
Chemical changes occur through hydrolysis Mouth
(the addition of water and the breaking down
Digestion begins here Enzyme (salivary
of food molecules).
amylase) acts on starch. Starch is a complex
Enzymes act on food substances, causing carbohydrate. Teeth break up food, food
them to break down into simple compounds. mixes with saliva.

An enzyme can function as a catalyst, which "Bolus" formed. The length of time food is
speeds up the chemical reactions without in the mouth is brief small amounts of
itself being changed in the process. carbohydrates changed

Absorption Esophagus

The passage of nutrients into the blood or  Food travels through this muscular
lymphatic system. Nutrients must be in their tube Connects the mouth to the
simplest form stomach
 Peristalsis and gravity act to move
 Carbohydrates: simple sugars the bolus
 Proteins: amino acids  The cardiac sphincter opens at the
 Fats: fatty acids and glycerol lower end of the esophagus to allow
Most absorption occurs in the small passage of bolus into the stomach
intestine; some occur in the large intestine. Stop and Share
Water is absorbed in the stomach, small
intestine, and large intestine. What symptom results when the cardiac
sphincter does not close properly?
What is the name of the condition?
What prevents this condition from
occurring?
Stop and Share Chyme: semiliquid mass of food and gastric
juices
Indigestion or heartburn occurs because of
stomach acid flowing back into the Pernicious anemia: lack of intrinsic factor
esophagus.
Small Intestine
This is called gastroesophageal reflux. The
Hormones released
proper closing of the cardiac sphincter
prevents the acidic content of the stomach  Secretin causes the pancreas to
from flowing back into the esophagus. release sodium bicarbonate to
neutralize the acidity of chyme
Stomach
 Cholecystokinin triggers the
 The temporary storage of food gallbladder to release bile
 Mixing of food with gastric juices
Bile
 Regulation of a slow, controlled
emptying of food into the intestine  Emulsifier fat after it is secreted into
 Secretion of the intrinsic factor for small intestine
vitamin B12  Produced in the liver; stored in the
 Destruction of most bacteria gallbladder
inadvertently consumed
Small Intestine
 Hydrochloric acid prepares the
gastric area for enzyme action  Enzymes are found in the pancreatic
 Pepsin breaks down proteins juice that is secreted into the small
 In children, rennin breaks down milk intestine.
proteins  Pancreatic proteases (trypsin,
 Lipase acts on emulsified fats chymotrypsin, carboxypeptidases):
split proteins
Stop and Share
 Pancreatic amylase: converts
Complete the following objectives to starches (polysaccharides) to simple
prepare for your class: sugars
 Pancreatic lipase: reduces fats to
 Identify the 3 parts of the stomach fatty acids and glycerol
 Define chyme  Produces enzymes
 Identify the condition that results  Prepares foods for absorption
from a lack of the intrinsic factor in
 Lactase, maltase, sucrase convert
the stomach
lactose, maltose, sucrose to simple
Fundus: upper portion of the stomach. sugars
 Peptidases reduce proteins to amino
Body of the stomach: middle area
acids
Pylorus: end of the stomach near small  Twenty-two feet long
intestines  Villi, hairlike projections, increase
surface area for maximum absorption
Stop and Share
Metabolism
A patient with a duodenal ulcer asks you
The use of food by the body after digestion
where the ulcer is located. How do you
results in energy
respond?
Occurs after digestion and absorption;
 The small intestine is divided into nutrients are carried by the blood to the cells
three of the body
 sections.
 The duodenum is the first section of Oxidation
the small intestine. o Nutrients combine with oxygen
 The jejunum is the middle section, o Carbohydrates reduce to carbon
and the ileum is the last section. dioxide and water
Large Intestine o Protein to carbon dioxide, water,
and nitrogen
Colon walls secrete mucus to protect against o Also known as aerobic
acidic digestive juices in the chyme.
metabolism
Major tasks of the large intestine:  Energy is released as nutrients are
oxidized.
 Absorb water
 Anaerobic metabolism reduces fats
 Synthesize some B vitamins and without the use of oxygen.
vitamin K
 The complete oxidation of
 Collect food residue carbohydrates, proteins, and fats is
Stop and Share commonly called the Krebs cycle.
 Anabolism is the process of using energy
The cecum (blind pocket), colon and rectum from oxidation to create new
make up the large intestine. Contents travel compounds.
through:
 Catabolism is the breakdown of
 Ascending colon compounds during metabolism.
 Transverse colon  Controlled primarily by hormones
 Descending colon secreted by the thyroid gland:
Triiodothyronine (T3) and thyroxine Energy
(T4).
 1 gram of carbohydrate yields 4 kcal
Stop and Share  1 gram of protein yields 4 kcal
 1 gram of fat yields 9 kcal
What condition is associated with too much  1 gram of alcohol yields 7 kcal
thyroid hormone?
Stop and Share
What condition is associated with too little
thyroid hormone? If you eat a dessert with 19 grams of fat in it,
how many calories from fat does it have?
Hyperthyroidism: metabolism speeds up and
171 calories
the body metabolizes its food too quickly,
and weight is lost. Fat contains 9 kcal per gram

Hypothyroidism: metabolism slows down Dessert has 19 grams of fat

and the body metabolizes its food too 9 kcal/gram x 19 grams of fat = 171 kcal
slowly; the patient tends to become sluggish
and accumulate fat. Basal Metabolic Rate (BMR)

Energy The rate at which energy is needed for body

maintenance.
 Needed for involuntary and voluntary
The energy necessary to carry on all involuntary
activity vital processes while the body is at rest.
 Involuntary activity: maintenance of
body tissue, temperature, growth Also known as resting energy expenditure
 Voluntary activity: walking, swimming, (REE).
eating, reading, typing - Energy needed by the body to carry out
the involuntary.
Three groups of nutrients provide energy
Factors that affect BMR: lean body mass, body
 Carbohydrates size, sex, age, heredity, physical condition, and
 Proteins climate.
 Fats
 BMR is greater in men than women.
Carbohydrates should be the primary source  BMR increases during growth and fever.
of energy.  BMR decreases with age and during
starvation.
The unit used to measure the energy value of
foods is the kilocalorie. Calculating BMR

kcal: the amount of heat needed to raise the Harris-Benedict equation

temperature of 1 kilogram of water 1 degree  Used by dietitians for persons over the
Celsius. age 18
 Uses height, weight, and age
kcal is commonly called a calorie.
Female BMR
655 + (9.6 x weight in kg) + (1.8 x height in cm) Functions
- (4.7 x age)
 Provide energy
Male BMR
 Protein-sparing action
66 + (13.7 x weight in kg) + (5 x height in cm) -  Normal fat metabolism
(6.8 x age)  Provide fiber

Another method used to estimate BMR Providing Energy

 Convert body weight from pounds to Each gram of carbohydrate provides 4 kcal.
kilograms A body needs a constant energy supply. A
 Multiply kilograms by 24 (hours per half day supply of carbohydrates is stored in
day) the liver and muscles for use as needed. The
 Multiply the answer obtained by 0.9 for stored form is called glycogen.
a woman and by 1.0 for a man
Protein-Sparing Action
Stop and Share
The primary function of proteins is to build
Calculate the BMR for a woman who weighs 1 and repair tissues. When enough
10 pounds. carbohydrates (at least 50- 100 g/day) are
110-pound woman: BMR 1,080 kcal ingested, protein is spared.
1 10 pounds + 2.2 (pounds per kg) - 50 Normal Fat Metabolism
kg
Without an adequate supply of
50 kg x 24 hours in a day = 1,200 kcal carbohydrates, fat is metabolized to meet
1,200 kcal x 0.9 =1,080 kcal energy requirements. Ketones are produced
as a byproduct of fat metabolism. Ketosis
170-pound man: BMR 1,854 kcal may result.
170 pounds + 2.2 (pounds per kg) - Stop and Share
77.27 kg
With a partner role-play the following: A
77.27 kg x 24 hours in a day = 1,854
patient asks the nurse about starting a high-
kcal
protein, low-carbohydrate diet. How should
1,854 kcal x 1.0 -1,854 kcal the nurse respond?
Carbohydrates Stop and Share
Facts Carbohydrates are necessary for energy.
Lack of adequate carbohydrate intake may
The primary source of energy for the body.
result in ketosis (a condition in which acids,
Least expensive and most abundant of the
called ketones, accumulate in the blood).
energy nutrients. Named for the chemical
Protein is best used for building and
elements they are composed of carbon,
repairing body tissues.
hydrogen, and oxygen.
 Central nervous system, red blood
cells, and brain use only glucose as
Providing Fiber
fuel
Dietary fiber is found in grains, vegetables,  Glucose is the central nervous
and fruits. Recommended intake is 20-35 system
g/day. Fiber lowers blood glucose levels;
Fructose
may prevent some colon cancers; and helps
prevent constipation, hemorrhoids, and  Also called levulose or fruit sugar
diverticular disease by softening the stool.  Ripe fruits, honey, soft drinks
Food Sources  Sweetest of all the monosaccharides

Principal sources of carbohydrates are plant Galactose

foods:  Product of digestion of milk
 Cereal grains  Not found naturally
 Vegetables  Source is lactose
 Fruits Disaccharides
 Nuts
 Sugars  Pairs of monosaccharides
 Must be changed to simple sugars by
The only substantial animal source is milk.  hydrolysis before absorption
Classification  Sucrose, maltose, and lactose

Monosaccharides Sucrose

 Simple sugars  Composed of glucose and fructose

 Form of carbohydrate present in
Disaccharides
 granulated, powdered, and brown
Polysaccharides sugar, and in molasses
 One of the sweetest and least
 Complex carbohydrates
expensive sugars
Monosaccharides  Sources: sugar cane, sugar beets,
maple syrup, candy, jams, and jellies
 The simplest form of carbohydrates
 Absorbed directly into the Maltose
bloodstream from the small intestine
 Intermediary product in the
 Glucose, fructose, galactose hydrolysis of starch
Glucose  Also created during the fermentation
process that produces alcohol
 Also called dextrose  Found in some infant formulas, malt
 All other forms are converted to beverage products, and beer
glucose for eventual metabolism  Less sweet than glucose or sucrose
 Berries, grapes, sweet corn, corn
syrup
Lactose Glycogen
 Sugar found in milk  Sometimes called animal starch because
 Distinct from other sugars in that it is is the storage form of the glucose in the
not found in plants body
 Helps the body absorb calcium  Hormone glucagon helps the liver
convert glycogen to glucose as needed.
Stop and Share
Fiber
Your patient complains of bloating,
abdominal cramps, and diarrhea after  It is indigestible because it cannot be
drinking milk or consuming a milk-based broken down by digestive enzymes
food such as processed cheese. What is the  Insoluble: does not readily dissolve in
likely cause of these symptoms? What water (cellulose, hemicellulose, lignins)
causes this condition? What
Polysaccharides: Sources
recommendations can be made?
Lactose intolerance is the likely cause. Starch Glycogen
Cereals, grains, Glucose stored in the
Caused by insufficient lactase, the enzyme
potatoes, com. liver and muscles
required for the digestion of lactose. Low- beans, yams
lactose milk products can be used instead of Cellulose
regular milk. Lactase-containing products Dextrin Wheat bran, whole
are also available. Starch hydrolysis grain cereals, fruits,
green and leafy
Polysaccharides
vegetables
Complex carbohydrates. Compounds of
many monosaccharides. Important Digestion and Absorption:
polysaccharides in nutrition: Monosaccharides
 Starch Simple sugars are absorbed directly into the
 Glycogen bloodstream. Carried to the liver; fructose
 Fiber and galactose changed to glucose. Glucose
Starch carried to cells
Digestion and Absorption: Disaccharides
 Found in grains and vegetables
 The storage form of glucose in plants Enzymes sucrase, maltase, lactase convert
 Supplies energy over a longer period sucrose, maltose, lactose to simple sugars.
because it takes the body longer to digest Simple sugars are absorbed directly into the
polysaccharides than monosaccharides bloodstream. Carried to the liver; fructose
or disaccharides and galactose changed to glucose. Glucose
 Too much sugar can cause carried to cells
hyperglycemia
Digestion and Absorption: Conclusion
Polysaccharides
Carbohydrates provide energy. They should
More complex; digestibility varies. The be the major source of energy. These
cellulose wall was broken down, starch nutrients spare protein, maintain normal fat
changed to intermediate product dextrin, metabolism and provide fiber. Excessive
then maltose, and finally glucose. Starch carbohydrate intake may lead to obesity,
digestion begins in the mouth where the dental caries, and digestive disturbances.
enzyme salivary amylase begins to change
Lipids or Fats
starch to dextrin
Facts
Metabolism
Fats belong to a group of organic
Islets of Langerhans in the pancreas secrete
compounds called lipids. Greasy substances
insulin. Insulin is the hormone that controls
that are insoluble in water. Each gram of fat
glucose metabolism. Impaired or absent
contains 9 kcal. Composed of carbon,
insulin secretion results in high blood
hydrogen, and oxygen, a lower proportion of
glucose levels (hyperglycemia). Low blood
oxygen than carbohydrates.
glucose level (hypoglycemia)
Functions
Dietary Requirements
 Provide energy
 Food and Nutrition Board of the
 Carry fat-soluble vitamins
National Research Council recommends:
 Half of one's energy requirement should  Supply essential fatty acids
come from carbohydrates  Protect and support organs and bones
 Complex carbohydrates preferred  Insulate from cold
 Weight loss and fatigue can result from a  Provide satiety to meals
diet deficient in carbohydrates Food Sources:
Stop and Share Animal Plant
Solve the following problem:  Fatty meats  Vegetable
 Lard oils
A patient's total energy requirement is 2,000  Butter  Nuts
kcal a day. How many grams of  Cheese  Chocolate
carbohydrates does this patient need per  Cream;  Avocados
day? whole  Olives
 milk  Margarine
If a patient's total energy requirement is
 Egg yolk
2,000 kcal/day; 1/2 of these should be from
carbohydrates. 2,000 + 2 = 1,000 kcal
To figure out how many grams are needed,
divide 1,000 by 4 (4 calories per gram of
carbohydrate). 1,000 kcal + 4 kcal/g = 250
grams
Visible and Invisible Fats  Essential
 Nonessential
Visible fats Invisible fats
Fats in foods that are Fats that are not May be classified by the degree of saturation
purchased and used immediately with hydrogen atoms
as fats, such as butter noticeable such as
or margarine, lard, those in egg yolk,  Saturated
cooking oils cheese, cream, and  Unsaturated
salad dressings - Monounsaturated
Stop and Share - Polyunsaturated
You are the nurse teaching a class about Essential Fatty Acids
nutrition. A client asks about ways to
decrease the amount of fat in the diet. What Cannot be synthesized by the body. Must be
are some suggestions you can give? obtained from the diet

Beware of hidden fats! Decrease the number Types

of fatty meats (bacon, sausage, luncheon  Linoleic acid
meats) and use lean meats instead. Use low-
 Linolenic acid
fat or skim milk. Use egg whites instead of
yolks when possible. (Egg white contains no Non-essential Fatty Acids
fat; it is almost entirely protein and water.)
Can be synthesized by the body.
Classification Arachidonic fatty acid, previously thought to
be essential, can be synthesized in the body
Triglycerides
from linoleic fatty acid.
 Most lipids in the body (95%) are Saturated Fats
triglycerides
 Composed of three fatty acids Each of its carbon atoms carries all the
attached to a framework of glycerol hydrogen atoms possible. In general, animal
foods contain more saturated fatty acids than
Phospholipids unsaturated. Usually solid at room
Sterols temperature. Examples: Meat, poultry, egg
yolks, whole milk, whole milk cheeses,
 Cholesterol cream, ice cream, butter, chocolate, coconut,
Fatty Acids palm oil

Fatty acids are organic compounds of carbon Monounsaturated Fats

atoms to which hydrogen atoms are Fewer hydrogen atoms are attached to one
attached. They may be classified in two place among the carbon atoms of its fatty
ways. acids than saturated fats. Lowers low-
Fatty Acid Classification density lipoprotein (LDL or "bad
cholesterol"). Examples: Olive oil, canola
May be classified by the body's need for oil, avocados, cashew nuts. Recommended:
them 15% of total daily kcal
Polyunsaturated Fats  Does not exist in plant foods
 Essential for the synthesis of bile, sex
Fewer hydrogen atoms are attached to two
hormones, cortisone, and vitamin D
or more places among the carbon atoms of
its fatty acids than saturated fats. Examples:  Needed by every cell in the body
Cooking oils made from sunflower, Stop and Share
safflower, sesame seeds or from corn or
soybeans, soft margarine whose major Your client has been diagnosed with a high
ingredient is liquid vegetable oil, and fish cholesterol level greater than 209 mg/dl.
Answer the following questions. What risks
Foods containing high proportions of are associated with a high cholesterol level?
polyunsaturated fats are usually soft or oily. What can be done to lower a high
Omega-3 fatty acids (found in fish) lower cholesterol level?
the risk of heart disease. Omega-6 (linoleic
acid) has a cholesterol-lowering effect. Reduce the amount of total fat, saturated
Recommended: 10% of total daily kcal fats, and cholesterol. Increase
monounsaturated fats in the diet, lose weight
Hydrogenated Fats and exercise. Increase consumption of
Polyunsaturated vegetable oils to which soluble dietary fiber. Medication may be
hydrogen has been added commercially to prescribed in some cases. Daily cholesterol
make them solid at room temperature. This intake should not exceed 300 mg.
process, called hydrogenation, turns Digestion and Absorption
polyunsaturated vegetable oils into saturated
fats. Margarine is made in this way. 95% of ingested fats are digested. Complex
process. The chemical digestion of fats
Trans-fatty Acids (TFAs) occurs mainly in the small intestine. No
Produced when hydrogen atoms are added to digestion of fats occurs in the mouth. Slight
monounsaturated or polyunsaturated fats to digestion the in the stomach was gastric.
produce a semi-solid product like margarine lipase acts on emulsified fats such as those
and shortening. TF As raises low-density found in cream and egg yolk.
lipoproteins (LDL) and total cholesterol. Digestion in the small intestine
Major source: baked goods and restaurant
foods  Bile-emulsified the fats
 The enzyme pancreatic lipase
Phospholipid reduces the fats to fatty acids and
Found in both plant and animal foods and is glycerol
synthesized in the liver. Natural emulsifier  The body subsequently absorbs
that helps transport fat in the bloodstream. through the villi of the small
Example: Lecithin intestine

Cholesterol
 Cholesterol is a sterol
 Fatlike substance
 Exists in animal foods and body cells
other lipoproteins in the blood and they then
become LDL.
Low-density Lipoproteins (LDLs)
Composed of 45% cholesterol with few
triglycerides. Carry most of the blood
cholesterol from the liver to the cells.
Elevated blood levels greater than 130 mg/dl
of LDL are thought to be contributing
factors in atherosclerosis. "Bad cholesterol"
High-density Lipoproteins (HDLs)
Lipoproteins Carry cholesterol from the cells to the liver
In the initial stages of fat absorption, bile for eventual excretion. Levels of HDL
joins with the products of fat digestion to greater than 35 mg/dl are thought to reduce
carry fat. Later, protein combines with the the risk of heart disease. Exercise,
final products of fat digestion to form maintaining a desirable weight, and giving
special carriers called lipoproteins. up smoking are all ways to increase one's
Lipoproteins carry the fat in the blood to the HDL. "Good cholesterol"
body cells. Metabolism and Elimination
Classified according to mobility and density The liver controls fat metabolism. The
Types metabolism of fats occurs in the cells. Fatty
acids are broken down into carbon dioxide
 Chylomicrons and water, releasing energy. A portion of fat
 Very-low-density lipoproteins (VLDLs) not needed for immediate use is stored as
 Low-density lipoproteins (LDLs) adipose tissue. Carbon dioxide and water are
 High-density lipoproteins (HDLs) waste products removed from the body by
the circulatory, respiratory, and excretory
Chylomicron
systems.
 First lipoprotein identified after eating
Stop and Share
 Largest lipoprotein
 Lightest in weight Your client asks you about a new dietary
 Composed of 80-90% triglycerides supplement that advertisers claim provides
essential nutrients and lowers cholesterol
Very-low-density Lipoproteins (VLDLs) "naturally". How do you advise your client?
Made by the liver to transport lipids Any new dietary "supplement" for which a
throughout the body. Composed of 55-65% nutrition claim is made should be carefully
triglycerides. Carry triglycerides and other evaluated. If the item is not included in the
lipids to all cells. As the VLDL lose RDA or DRI, it is safe to assume that
triglycerides, they pick up cholesterol from medical research has not determined that it
is essential. Ingestion of dietary supplements
of unknown value could, ironically, be
damaging to one's health.
Classification
Fat Alternatives
Complementary Proteins
Olestra: Made from carbohydrates and fat
 Occurs when a combination of
 FDA-approved for use in snack food incomplete proteins is eaten on the same
 Government requires that food labels day to make a complete protein
indicate olestra "inhibits the  Examples: com and beans, rice and
absorption of some vitamins and beans, bread and peanut butter, bread
other nutrients" and split pea soup, bread and cheese,
 Contains no calories; can cause bread and baked beans, macaroni, and
cramps and diarrhea cheese, cereal, and milk
Simplesse: Made from egg white or milk Food Sources
protein
Animal food sources
Oatrim: Carbohydrate-based; derived from
 Complete proteins
oat fiber
 Meats, fish, poultry, eggs, milk, cheese
Dietary Requirements
Plant food sources
The Food and Nutrition Board's Committee
on Diet and Health recommends that people  Incomplete proteins
reduce their fat intake to 30% of the total  Corn, grain, nuts, sunflower seeds,
kcal. American Heart Association's newest sesame seeds, and legumes
recommendation is to consume </-7% of Analogues
saturated fats, 8-10% polyunsaturated fats
and 15% monounsaturated fats. At present,  Meat alternatives made from soy protein
36% of kcal in U.S. diets is derived from and other ingredients to simulate various
fats. kinds of meat
 Tofu is a soft cheese-like food made
Conclusion from soy milk
Fats provide energy, carry essential fatty Stop and Share
acids and fat-soluble vitamins, protect
organs and bones, insulate from cold, and Your client is concerned because her
provide satiety to meals. Composed of daughter is a vegetarian and does not eat
carbon, hydrogen, and oxygen and is found meat. Your client states, "My daughter does
in both animal and plant foods. not eat meat, so I know she doesn't get any
protein. She is ruining her body." How do
Each gram of fats provides 9 kcal. Digestion you respond?
occurs primarily in the small intestines. An
excess of fat in the diet can result in obesity Although animal foods are the best sources
and possible heart disease or cancer. of complete proteins, foods that provide
incomplete proteins can be combined to
make complete proteins. The best sources of
incomplete proteins are legumes, corn, Dietary Requirements
grains, and nuts. Soy protein and tofu are
Determined by size, age, sex, and physical
nutritious meat replacements.
and emotional conditions. The National
Functions Research Council of the
Building and repairing body tissue The National Academy of Sciences
Regulating body functions considers the average daily requirement to
be 0.8 of protein for each kilogram of body
 Metabolism and digestion weight.
 Fluid and electrolyte balance
 Development of antibodies To determine your requirement

Providing energy  Divide body weight by 2.2 (the number

of pounds per kilogram)
 Each gram of protein provides 4 kcal  Multiply the answer obtained in the first
Digestion and Absorption step by 0.8 (grams of protein per
kilogram of body weight)
Mechanical digestion
Protein Excess
 Begins in the mouth
 Teeth grind food into small pieces Saturated fats and cholesterol may
contribute to heart disease. Connection to
Chemical digestion colon cancer. Substitute for essential fruits
and vegetables
 Begins in the stomach
 Hydrochloric acid prepares the stomach Increased demand for kidneys. National
 Enzyme pepsin reduces proteins to Research Council recommends that protein
polypeptides intake represent no more than 15-20% of
 Polypeptides: ten or more amino acids one's daily kcal intake and not exceed
bonded together double the amount given in the table of
 In the small intestine, three pancreatic Recommended Dietary Allowances.
enzymes (trypsin, chymotrypsin, Stop and Share
carboxypeptidase) continue chemical
digestion and absorption through the villi You are the nurse, and your client asks you
whether taking daily protein supplements
Metabolism and Elimination will help build muscles, strengthen nails,
Amino acids are broken down, the nitrogen- and control weight. How do you respond?
containing amine group is stripped off "Bulking up" athletes
(deamination). Ammonia is produced. The
liver picks up ammonia and converts it to  Lifting weights, not supplements, builds
urea. The kidney filters out urea and muscle
excretes it. The remaining parts are used for
Growing fingernails
energy or converted to carbohydrates or fat
and stored as glycogen or adipose tissue.  Fingernails have never been affected by
extra protein
Spare body protein in weight loss protein and energy-rich foods. Stunted
growth and mental retardation may occur.
 Dieters need a balanced diet using the
guidelines of the Food Guide Pyramid Marasmus
Nitrogen Balance Affects very young children. Results from
severe malnutrition (lack of protein,
Nitrogen intake equals nitrogen excreted. A vitamins, and minerals). Emaciated, no
positive nitrogen balance exists when edema. Hair is dull and dry; skin thin and
nitrogen intake exceeds the amount wrinkled.
excreted. A negative nitrogen balance exists
when more nitrogen is lost than taken in. Kwashiorkor
Stop and Share Sudden or recent lack of protein-containing
food; affects children and adults. Fat
What conditions cause a positive nitrogen accumulates in liver, and lack of protein and
balance? A negative nitrogen balances? hormones results in edema, painful skin
lesions, and changes in pigmentation of skin
Positive nitrogen balance and hair. High mortality rate
 Pregnancy Stop and Share
 Growth periods
 Building muscle Differentiate between marasmus and
 Rebuilding tissue after trauma/illness kwashiorkor by identifying three differences
between the two conditions.
Negative nitrogen balance
Marasmus Kwashiorkor
 Fever  Weight  Weight within
 Injury decreased normal limits
 Surgery  Visceral proteins  Visceral proteins
 Burns within normal decreased
limits  Immune function
 Starvation
 Immune function decreased
 Immobilization within normal  Reddish color
Protein Deficiency limits hair
 Dull, dry hair  Edema, puffy
 Muscle wasting occurs.  Emaciated, appearance
 Albumin (protein in blood plasma) wrinkled
causes edema appearance
 Loss of appetite, strength, and weight Conclusion
 Lethargy, depression, slow wound Proteins contain nitrogen. They build and
healing repair body tissues, regulate body processes,
Protein Energy Malnutrition (PEM) and supply energy. Each gram of protein
provides 4 kcal. Composed of amino acids.
Lack protein and energy-rich foods. Found Nine of the amino acids are essential for
in developing countries with shortages of growth and development.
Facts Stop and Share
Organic (carbon-containing) compounds are 1. Avitaminosis - Without vitamins
essential in small amounts for body 2. Hypervitaminosis - Condition caused
processes. Do not provide energy. Enable by ingestion of excess vitamins
the body to use the energy provided by fats, 3. Vitamin supplement - Concentrated
carbohydrates, and proteins. form of vitamins
Vitamin types (13) Avoiding Vitamin Loss
Fat-soluble (4): A, D, E, K Buy fresh, unbruised vegetables and fruits
and use them raw when possible. Prepare
Water soluble (9):
fresh vegetables and fruits just before
 Vitamin C serving. Heat canned vegetables quickly and
 Vitamin B complex which includes in their own liquid.
thiamin (B,), riboflavin (B,), niacin, Avoiding Vitamin Loss
vitamin B, folate, vitamin Biz
(cobalamin), pantothenic acid, biotin Follow package directions when cooking
frozen vegetables or fruit. Steam, or use as
Requirements little water as possible. Cover pan and cook
Vitamin allowances given by weight in for a short period of time. Save cooking
milligrams (mg) or micrograms (mcg or ug). liquid for soups, stews, and gravy. Store in a
Dietary reference intake (replacing cool, dark place.
recommended dietary allowance) UL- Fat-Soluble Vitamins
tolerable upper limits-maximum level of
daily intake unlikely to cause adverse effects  Vitamins A, D, E, K
Vitamin Deficiency Vitamin A
People prone to vitamin deficiency Preformed (retinol)

 Alcoholics  Active form of vitamin A

 Poor and incapacitated elderly
Carotenoids
 Clients with serious diseases that affect
appetite  Inactive form of vitamin A found in
 Mentally retarded plants
 Children receiving inadequate care Functions of Vitamin A
Deficiency of Fat-soluble Vitamins Antioxidant; protects cells from destruction
Chronic malabsorption diseases by oxygen. Maintains healthy eyes and skin,
normal growth and reproduction, and a
 Cystic fibrosis healthy immune system. Helps prevent
 Celiac disease infection.
 Crohn’s disease
Sources of Vitamin A Vitamin D Requirements
Preformed vitamin Carotenoids Newborns through 51 years
A (retinol) (provitamin A or
Fat-containing beta-carotene)  5.0 μg (200 IU)
animal foods: liver,
Green leafy 51-70 years
butter, cream, whole
vegetables & fruits,
milk, cheeses carrots, sweet  10.0 μg (400 IU)
potatoes, squash,
spinach, broccoli, 70+ years
mango, cantaloupe,
 15.0 μg (600 IU)
pumpkin
Vitamin A Requirements Pregnant and lactating women
Commonly listed as retinol equivalents (RE)  5.0 μg (200 IU)
A retinol equivalent is 1 μg retinol or 6 μg
beta-carotene. Stop and Share

Stop and Share What are the signs and symptoms you may
expect to see with too much vitamin D? …
What are the signs and symptoms you may too little?
expect to see with too much vitamin A? …
too little? Excess Deficit
• Deposits of • Poor bone and
Excess Deficit calcium and tooth formation,
• Birth defects, hair • Night blindness; phosphorus in soft rickets which causes
loss, dry skin, dry, rough skin; tissues, kidney and malformed bones
headaches, nausea, increased heart damage, and and pain in infants
dryness of mucous susceptibility to bone fragility
membranes, liver infections; and  Calcium and phosphorus can cause
damage, and bone blindness or stool and low is
and joint pain xerophthalmia
Vitamin D Deficit

Prohormone–converted to a hormone in the  Osteomalacia (softening of bones)

body. D2 (ergocalcifenol) is formed in  Osteoporosis (brittle, porous bones)
plants. D3 (cholecalciferol) is formed in
Vitamin E
humans from cholesterol in the skin.
Tocopherols
Sources of Vitamin D
 Alpha (most biologically active)
Sunlight Milk, fish liver oils, egg yolk,
butter, fortified margarine Most milk in the  Beta, delta, gamma
U.S. has 10 μg of vitamin D concentrate Tocotrienols
added per quart.
Functions of Vitamin E  Clients who suffer from faulty fat
absorption
Antioxidant Prevention of hemolytic anemia
 After extensive antibiotic therapy
among premature infants Enhance immune
system Retard spoilage of commercial foods  Antidote for an overdose of
anticoagulant
Sources of Vitamin E  Clients being treated for hemorrhage
Vegetable oils: corn, soybean, safflower, Sources of Vitamin K
and cottonseed, and products made from
them such as margarine Wheat germ, nuts, Green leafy vegetables such as broccoli,
green leafy vegetables cabbage, spinach, and kale. Dairy products
such as eggs, meats, fruits, and cereals.
Vitamin E Requirements Bacteria in small intestine synthesizes some
Given as α-TE (alpha-tocopherol vitamin K but must be supplemented by
equivalents) 1 mg of α-TE = 1 IU dietary sources.

Stop and Share Vitamin K Requirements

Your client asks you if it is possible to take Measured in micrograms.

too much vitamin E. How would you advise 0-6 months
the client? What signs and/or symptoms can
result from too little vitamin E?  2 μg/day

Excess Deficit 6-12 months

• Relatively • Serious
 2.5 μg/day
nontoxic, fat-soluble neurological defects
vitamin. Excess can occur from Men
stored in adipose malabsorption.
tissue. Avoid long-  120 μg/day
term megadose.
Women (same during pregnancy or
Vitamin K
lactation)
Made up of several compounds essential to
 90 μg/day
blood clotting.
Stop and Share
 Vitamin K1 (phylloquinone)
 Vitamin K2 (menaquinone) What signs and/or symptoms can result from
 Synthetic Vitamin K (menadione) too much vitamin K? … too little?
 Vitamin K is destroyed by light
Excess Deficit
alkalis. • Anemia can result • Defective blood
Functions of Vitamin K from excessive coagulation, which
amounts of increases clotting
Formation of prothrombin; clotting of blood synthetic vitamin K time and makes
Candidates likely to receive Vitamin K client prone to
hemorrhage
 Newborns immediately after birth
Water-soluble Vitamins Measured in niacin equivalents (NE).
▪ Vitamin B complex 1 NE = 1 mg of niacin or 60 mg of
tryptophan (an amino acid that is a precursor
▪ Vitamin C
of niacin). Average adult female requires 14
Vitamin B Complex: Thiamin mg/NE. Average adult male requires 16
mg/NE.
Thiamin B1 is Essential for nerve and
muscle action, and the metabolism of Excessive amounts of niacin may cause
carbohydrates and some amino acids. flushing due to vascular dilation, GI
Sources include unrefined and enriched problems, itching, and liver damage. May be
cereals, yeast, wheat germ, lean pork, organ used as a cholesterol-lowering agent under
meats, and legumes. close supervision of a physician due to
adverse side effects, which include liver
Average adult female requires 1.1 mg/day. damage and peptic ulcers.
Average adult male requires 1.2 mg/day.
Deficiency symptoms include loss of Deficiency symptoms include weakness,
appetite, fatigue, nervous irritability, and anorexia, indigestion, anxiety, and
constipation. Beriberi is a disease caused by irritability. Pellagra is an extreme deficiency
extreme deficiency of vitamin B1. causing sores on the skin, diarrhea, anxiety,
confusion, irritability, poor memory,
Vitamin B Complex: Riboflavin dizziness, and untimely death.
Riboflavin B2 is Necessary for: the Vitamin B Complex: B6
metabolism of carbohydrates, protein, and
fats; tissue maintenance (especially the skin Pyridoxine, pyridoxal, and pyridoxamine are
around the mouth); and healthy eyes. Essential for protein metabolism and
Sources include milk, meats, poultry, fish, absorption, and aid in the release of glucose
enriched bread, cereals, broccoli, spinach, from glycogen. Serves as a catalyst in the
and asparagus. conversion of tryptophan to niacin; helps
synthesize neurotransmitters such as
The average adult female requires 1.1 serotonin and dopamine.
mg/day. The average adult male requires 1.3
mg/day. Deficiency can result in cheilosis (a Sources include poultry, fish, liver, kidney,
condition characterized by sores on the lips potatoes, bananas, spinach, and unrefined
and cracks at the corners of the mouth); whole grains (oats and wheat). Deficiency
glossitis (inflammation of the tongue); symptoms include irritability, depression,
dermatitis; and eye strain in the form of and dermatitis. Deficiency in infants can
itching, burning, and eye fatigue. cause various neurological symptoms and
abdominal problems. Toxicity is rare; may
Vitamin B Complex: Niacin cause temporary neurological problems.
Generic name for nicotinic acid and Measured in milligrams. Average adult
nicotinamide. A coenzyme in energy female requires 1.3-1.5 mg/day. Average
metabolism. Sources include meats, poultry, adult male requires 1.3-1.7 mg/day. Need
fish, peanuts, legumes. Milk and eggs are increases as protein increases. Oral
sources of tryptophan (precursor).
contraceptives interfere with metabolism of myelin sheath, and healthy red blood cells.
vitamin B6 and can result in a deficiency. To be absorbed, must bind with intrinsic
factor in stomach. Pernicious anemia may
Vitamin B Complex: Folate
result from the loss of intrinsic factors.
Folate, folacin, and folic acid are chemically
Sources include animal foods, especially
similar compounds, and names are used
organ meats, lean meat, seafood, eggs, and
interchangeably. Needed for DNA synthesis,
dairy products. The average adult requires
protein metabolism, formation of
2.4 μg/day. Increased need during pregnancy
hemoglobin. Sources include cereals
and lactation. The amount absorbed will
fortified with folate, green leafy vegetables,
depend on current need.
legumes, sunflower seeds, fruits such as
orange juice and strawberries. Deficiency is rare and may be due to
congenital problems of absorption or years
Measured in micrograms. Average adult
of a vegetarian diet with no animal foods.
female requires 400 μg/day. Average adult
Symptoms include megaloblastic anemia,
male requires 400 μg/day. Increased need
pernicious anemia (if intrinsic factor absent),
during pregnancy and growth. 600 μg/day
anorexia, glossitis, sore mouth, tongue,
required one month before conception
pallor, depression, dizziness, weight loss,
through first six weeks of pregnancy.
neurological system damage.
Deficiency linked to neural tube defects in
Vitamin B Complex: Pantothenic Acid
fetus such as spina bifida (spinal cord or
Involved in metabolism of carbohydrates,
spinal fluid bulge through the back) and
fats, proteins. Essential for synthesis of
anencephaly (absence of the brain). Other
neurotransmitter acetylcholine and steroid
signs include inflammation of mouth and
hormones. Sources include meats, poultry,
tongue, poor growth, depression and mental
fish, eggs, whole grain cereals, and legumes.
confusion, problems with nerve functions,
Thought to be synthesized by the body.
megaloblastic anemia.
Food and Nutrition Board has provided an
- Folic need for dna synthesis
estimated intake of 5 mg a day for normal
Excess can mask vitamin B12 deficiency adults. Toxicity from excess not confirmed.
and inactivates phenytoin, an anticonvulsant Natural deficiencies unknown. Signs include
drug used by epileptics. FDA limits amount weakness, fatigue, burning sensation in feet
in over-the-counter supplements to: (deficiencies produced experimentally).

• 100 μg for infants Vitamin B Complex: Biotin

• 300 μg for children Coenzyme in synthesis of fatty acids and

amino acids. Sources include liver, egg yolk,
• 400 μg for adults soy flour, cereals, yeast. Synthesized in
Vitamin B Complex: B12 intestine by microorganisms, amount
available for absorption unknown. Food and
Cobalamin–contains mineral cobalt. Stored Nutrition Board suggests adequate intake of
in body three to five years. Involved in 30 μg for adults.
folate metabolism, maintenance of the
Toxicity from excess unknown. Deficiency Vitamin Supplementation
symptoms include nausea, anorexia,
Balanced diet provides nutritional needs of
depression, pallor, dermatitis, increase in
healthy people. No amount of vitamins will
serum cholesterol.
build muscles. Vitamins do not provide
Vitamin C energy; they help to release the energy
provided by nutrients. Heart disease, cancer
Ascorbic acid Has antioxidant properties and
and the common cold cannot be cured by
protects food from oxidation. Role in
vitamin supplements.
formation of collagen. Aids in absorption of
nonheme iron. May be involved with the Conclusion
formation or functioning of norepinephrine,
Organic compounds that regulate body
some amino acids, folate, leukocytes, the
functions and promote growth. Each vitamin
immune system, and allergic reactions.
has a specific function. Well-balanced diet
Sources include citrus fruits, melon, provides sufficient vitamins to fulfill body
strawberries, tomatoes, potatoes, red and requirements. Fat-soluble vitamins: A, D, E,
green peppers, cabbage, and broccoli. The K Water-soluble vitamins: B complex, C
average female adult requires 75 mg/day.
The average male adult requires 90 mg/day.
Stress and cigarette smoking increase need.
Stop and Share
What disease results from a deficiency in
vitamin C? What are the associated signs
and/or symptoms? What results from
excess? Scurvy: a disease characterized by
gingivitis, easy bruising, pinpoint
hemorrhages of the skin, poor wound
healing, sore joints and muscles, and weight
loss. Extreme cases result in death. Found in
sailors who lived without fresh fruits and
vegetables.
Deficiency of Vitamin C: bleeding gums,
loose teeth, tendency to bruise easily, poor
wound healing, scurvy. Excess: diarrhea,
nausea, cramps, excessive absorption of
food iron, rebound scurvy (when megadose
are stopped abruptly) and possibly oxalate
kidney stones. Generally considered
nontoxic.