Clinical Nutrition التغذية الاكلينكية

Objectives Define wellness Name the six classes of nutrients and their primary functions Recognize common characteristics of well-nourished people Recognize symptoms of malnutrition Describe ways in which food and health are related List the four basic steps in nutrition assessment

Wellness Achieving wellness that integrates body, mind, and spirit should be the main goal in life. This can be accomplished through lifestyle changes such as focusing on healthy food choices, not smoking, participating in regular physical activity, and maintaining a healthy weight.

Nutrients To maintain health and function properly, the body must be provided with nutrients. Nutrients: Chemical substances necessary for life Functions Provide energy, growth Build and repair tissue Regulate body processes

Nutrients Six classes Carbohydrates Fats (lipids) Proteins Vitamins Minerals Water

Nutrients Organic Inorganic Contains carbon, hydrogen, oxygen Carbon is found in all living things Example: carbohydrates, fats, proteins, vitamins Inorganic In simplest form when ingested Function: regulate body processes Example: water, minerals

Carbohydrates Provides major source of energy Examples: cereal grains, vegetables, fruits, nuts, and sugars

Fats (lipids) Provides energy Highest kilocalorie value (9 kcal per gm) Sources of fat: meats, milk, cream, butter, cheese, egg yolks, oils, nuts

Protein Builds and repairs body tissues Provides energy (4 kcal per gm) Only one of the six nutrients that contains nitrogen Sources of protein: meats, fish, poultry, eggs, milk, cheese, corn, grains, nuts, and seeds

Vitamins Organic compounds Regulate body processes Examples: vitamins A, B, C, D, E and K

Minerals Inorganic compounds Regulate body processes Examples: calcium, phosphorus, potassium, sodium, chloride, iron, magnesium, zinc

Water Major constituent of all living cells Composed of hydrogen and oxygen

The Six Essential Nutrients and Their Functions Organic Nutrients Function Carbohydrates Provide energy Fats Proteins Build & repair tissues Vitamins Regulate body processes Inorganic Nutrients Minerals Water Regulates body processes

Characteristics of Nutritional Status Good Poor Alert expression Apathy Shiny hair Dull, lifeless hair بشرة صافية Clear complexion Greasy دهني, بشرة غيرصافية blemished complexion Good color Poor color

Characteristics of Nutritional Status Good Poor Bright, clear eyes Dull, red-rimmed eyes Pink, firm gums and well-developed teeth Red, puffy, receding gums, and missing or cavity-prone teeth Firm abdomen Swollen abdomen Firm, well-developed muscles Underdeveloped, flabby muscles

Characteristics of Nutritional Status Good Poor Well-developed bone structure متقوسBowed legs Normal weight for height Over- or underweight Erect posture مترهلSlumped posture Emotional stability Easily irritated, depressed, poor attention span

Characteristics of Nutritional Status Good Poor Good stamina Easily fatigued Seldom ill Frequently ill Healthy appetite Excessive or poor appetite Healthy, normal sleep habits Insomnia at night, fatigued during the day Normal elimination Constipation or diarrhea

Malnutrition Overnutrition Undernutrition Excess energy or nutrient intake Undernutrition Deficient energy or nutrient intake Overnutrition is a larger problem in the United States than undernutrition.

Relation of Food to Health Cumulative Excess nutrients over time Examples: atherosclerosis, obesity, hypertension, diabetes, gallbladder disease, some cancers Deficiencies Nutrients lacking for extended period Examples: iron deficiency, beriberi, scurvy, osteomalacia, osteoporosis, rickets, goiter

Deficiency Diseases Deficiency Disease Nutrients Lacking Iron deficiency Iron-deficiency anemia Beriberi Night blindness Goiter Kwashiorkor Marasmus Nutrients Lacking Iron Thiamin Vitamin A Iodine Protein All nutrients

Deficiency Diseases Deficiency Disease Nutrients Lacking Osteomalacia Calcium, vitamin D, phosphorus, magnesium, and fluoride Osteoporosis Calcium and vitamin D

Deficiency Diseases Deficiency Disease Nutrients Lacking Pellagra Rickets Scurvy Exophthalmia (blindness) Nutrients Lacking Niacin Calcium and vitamin D Vitamin C Vitamin A

Nutritional Assessment Anthropometric measurements Clinical examination Biochemical tests Dietary-social history

Anthropometric Measurements Height Weight Head circumference (children) Upper arm measurement Skinfold

Anthropometric Measurements Height Weight

Anthropometric Measurements Head circumference Triceps skinfold

Clinical Examination Clinical Signs Possible Deficiencies Pallor, blue half circles beneath eyes Iron, copper, zinc, B12, B6, biotin Edema Protein قشعريرة “gooseflesh” Vitamin A Lesions at corner of mouth Riboflavin “Vit B2” Glossitis Folic acid

Clinical Examination Clinical Signs Possible Deficiencies Numerous “black and blue” spots and tiny, red “pin prick” hemorrhages under the skin Vitamin C Emaciation Carbohydrates, proteins; kcal

Clinical Examination Clinical Signs Possible Deficiencies Poorly shaped bones or teeth or delayed appearance of teeth in children Vitamin D Slow clotting time of blood Vitamin K

Clinical Examination Clinical Signs Possible Deficiencies Unusual nervousness, dermatitis, diarrhea in same patient Niacin Tetany Calcium, potassium, sodium Goiter Iodine Eczema Fat

Biochemical Tests Serum albumin level Serum transferrin level Measures main protein in blood Determines protein status Serum transferrin level Indicates iron-carrying protein in blood  indicates iron stores low  indicates body lacks protein

Biochemical Tests Blood urea nitrogen (BUN) Serum creatinine may indicate renal failure, insufficient renal blood supply, or blockage of the urinary tract Serum creatinine indicates amount of creatinine in blood used to evaluate renal function

Biochemical Tests Creatinine excretion indicates amount of creatinine excreted in urine over a 24-hour period used in estimating body muscle mass muscle mass depleted, as in malnutrition; level will be low

Biochemical Tests Other tests Hemoglobin (Hgb) Hematocrit (Hct) Red blood cells (RBCs) White blood cells (WBCs) Lipid profile (high & low-density lipoprotein, serum triglycerides) Urinalysis

Dietary/Social History Evaluation of food habits. 24-hour recall: Client interviewed by the dietitian and asked to give types, amounts, and preparation of all foods eaten in past 24 hours Food diary: written record of all food and drink ingested in a specified period Computer diet analysis to determine nutrient deficiencies or toxicities

Conclusion Nutrition and health are directly related. Effects of poor nutrition are cumulative. There are six essential nutrients: carbohydrates, fats, proteins, minerals, vitamins, and water. Nutritional assessment is the best way to determine deficiencies that may result from lack of nutrients.