Unit 10 Nutrition and Diets

10:1 Fundamentals of Nutrition Most people know there is a relationship between food and good health Many do not know what nutrients are needed to maintain good health Because of this, many people are not able to choose proper foods for optimum health Health care workers must understand basic nutrition

Fundamentals of Nutrition Nutrition: all body processes relating to food Include digestion, metabolism, circulation and elimination Help the body to use food for energy, health and growth Nutritional status: state or condition of one’s nutrition Role of nutrition in physical, mental, emotional, and psychological affects Goal is to maintain wellness – good health with optimal body function

Effects of Good Nutrition Healthy appearance Good attitude Proper sleep and bowel habits High energy level Enthusiasm and freedom from anxiety Large role in determining height, weight, strength, skeletal and muscular development, physical agility, resistance to disease, appetite, posture, complexion, mental ability, emotional and psychological health

Effects of BAD Nutrition Hypertension High blood pressure, caused by excess of fatty/salty food Atherosclerosis Narrowed arteries, caused by excess of saturated fats and cholesterol (LDL) Osteoporosis Porous, brittle bones, caused by deficiencies in minerals Malnutrition State of poor nutrition, caused by poor diet or illness Hypertension can lead to diseases of heart, blood vessels and kidneys Atherosclerosis fats build up on inner surface of blood vessels (plaque); can lead to heart attack or stroke Osteoporosis caused by deficiencies in calcium, magnesium and vitamin d Malnutrition symptoms include fatigue, depression, poor posture, weight issues, poor complexion, lifeless hair, irritability, deficiency diseases, poor muscular and skeletal development, reduced mental abilities, even death. Malnutrition most likely to affect individuals in extreme poverty, patients undergoing extreme drug treatments, infants, children, adolescents and elderly

10:2 Essential Nutrients Essential Nutrients – chemical elements in foods used by body to perform many different body functions Carbohydrates Major source of energy, easy to break down during cellular respiration Ex – starches, sugars, bread, cereal, pasta, crackers Cellulose – fibrous, indigestible carb, allows for regular bowel movements Provides heat and energy, fiber for good digestion and elimination

Essential Nutrients Lipids Storage form of energy for our body, difficult to break down Provide insulation, cushioning, help maintain body temp, carry fat soluble vitamins to tissues Ex – saturated and unsaturated fats, butter, margarine, cheese, egg yolk Cholesterol – important lipid, used to make steroid hormones, vitamin D, cell membrane Fat soluble vitamins – a, d, e and k Provide fatty acids needed for growth and development, provide heat and energy, carry fat-sol vits to cells Saturated – solid at room temp, eggs, whole milk, butter, cheese Unsaturated – usually soft or liquid at room temp, veggie oil, margarine Cholesterol – fat-like substance, part of cell membrane, helps to make steroid hormones, vit d and bile acids. Found in egg yolk, fatty meats, shellfish, butter, cream, cheese. Excess may contribute to artherosclerosis. * Should limit intake of foods containing fats from animal sources

Essential Nutrients Vitamins Proteins Structural component of body as well as enzymes Build and repair tissue, regulate body functions, provides some energy and heat Made up of amino acids “Complete proteins” contain the amino acids our body doesn’t produce Vitamins Help enzyme activity, used for metabolism, tissue building and body process regulation Can be water or fat soluble See table 10-2 (pg 232) Proteins Build and repair tissue, provide hat and energy, help produce antibodies, make up part of cell membrane. Complete proteins usually animal foods. Incomplete proteins usually vegetable proteins  cereal, soy, beans, peas, corn, nuts Vitamins - Regulate body functions, build and repair body tissue, metabolism, allow body to use energy provided by carbs, fats and proteins. Only need a small amount of vitamins. An excess can be dangerous. Deficiency can cause poor health 8

Essential Nutrients Minerals Water Inorganic compound essential for life Regulate body fluids, contribute to growth and tissue building Needed in small amounts Table 10-3 (pg 232) Water Found in all body tissues Needed for digestion, absorption, movement of wastes Need to drink 6 – 8 glasses of water a day Water - Carries nutrients and wastes to and from body cells, regulates body functions, makes up blood plasma 9

10:3 Utilization of Nutrients Digestion – process where body breaks down food, changes food chemically, moves food through digestive system Mechanical – food broken down by teeth & moved through GI tract by peristalsis Peristalsis – wavelike motion of digestive tract muscles Chemical – food broken down by digestive juices secreted by mouth, stomach, small intestine and pancreas Absorption – nutrients absorbed into small intestine capillaries Nutrients carried through body by circulatory system Water, salts and some vitamins absorbed in large intestine Before body is able to use the nutrients contained in food, our body must break down the food to obtain the nutrients, then absorb the nutrients into the circulatory system Mouth – amylase changes starch to maltose Stomach – hydrochloric acid, pepsin breaks down proteins. Lipase emulsifies fats. SI – produces enzymes, prepares foods for absorption, lactase converts lactose, maltase converts maltose, sucrase converts sucrose, peptidases break down proteins (liver makes bile, gallbladder stores bile and releases it into si to emulsify fats) Pancreas – releases enzymes into small I. Pancreatic amylase, lipase, pancreatic proteases (break down protein) LI – absorbs water and electrolytes, collect food residue for excretion

10:3 Utilization of Nutrients Metabolism Actual use of nutrients Process in which nutrients are used by the cells for body functions Cellular respiration occurs to break down nutrients to produce ATP Basal Metabolic Rate (BMR) – amount of energy needed to maintain life Extra nutrients are stored to use in the future Body uses and needs energy continuously so the body stores nutrients for future use. Stored nutrients are used to provide energy when food intake is not adequate for energy needs. - Energy needed for voluntary work and involuntary work 11

Measuring Food Energy When the body metabolized nutrients to produce ATP, heat is also generated Amount of heat produced is how we measure energy content of the food Calorie – unit used to measure heat released Lipids – 9 calories per gram Carbs & proteins – 4 calories per gram Vitamins, Minerals and Water – 0 calories per gram Individual’s caloric requirements How many calories are needed in a 24-hour period Varies from person to person as well as age, activity, size

Measuring Food Energy General guidelines for weight maintenance 1 pound body fat = 3,500 calories To lose 1 pound – decrease of 3,500 calories or use 3,500 calories during exercise Decrease 500 calories per day, person would lose 1 pound in a week To gain 1 pound – increase 3,500 calories Increase 500 calories per day, person would gain 1 pound in a week Slow steady gain/loss of 1 – 2 pounds per week is an efficient and safe form of weight control 13

10:4 Maintenance of Good Nutrition Good nutrition is the best way of achieving and maintaining good health Balanced diet Table 10-4 and 10-5 (pg 235 – 236) If food is not appealing, people will not eat it even if it is healthy Consider variety, taste, color, aroma, texture, and general likes and dislikes

Guidelines for Good Eating Habits USDA has published a booklet on nutritional principles called Nutrition and Your Health: Dietary Guidelines for Americans Eat a variety of foods Maintain healthy weight Choose a diet low in fat, saturated fat, and cholesterol Plenty of vegetables, fruits, and grain products Sugars, salt, and sodium in moderation Alcohol, if consumed, in moderation

Food Habits Affect Nutrition Habits can be based on cultural or religious beliefs Table 10-6 (pg 237) Unusual habits are not necessarily bad; must be evaluated Suggesting changes takes tact, patience, and imagination Difficult to change since most habits are formed in childhood; change can be slow

10:5 Therapeutic Diets Modification of normal diet used to improve specific health condition Normally prescribed by physician and planned by dietitian May change nutrients, caloric content, and/or texture May seem strange and even unpleasant to patient

Regular or Standard Diet Balanced diet May have slight calorie reduction Omit: rich desserts, cream sauces, salad dressings, and fried foods Used for: ambulatory patients (outpatient)

Liquid Diet Clear and full liquids Liquid foods at body temperature Not nutritional, only for short term Liquid foods at body temperature Clear: carbohydrates and water Full: clear liquids plus other liquid items Uses – after surgery, acute infections, digestive problems, to replace lost fluids, and in preparation for X-rays of the digestive tract Clear: apple or grape juice, fat-free broth, plain gelatin, fruit ice, ginger ale, tea, black coffee (with sugar) Full: clear + strained soups, cerals, fruit and veggy juices, yogurt, hot cocoa, custard, ice cream, pudding, sherbet and eggnog

Soft Diet Similar to a regular diet, but foods require little chewing and are easy to digest Omit: meat, shellfish, coarse cereals, spicy foods, rich desserts, fried foods, raw fruits and veggies, nuts and coconut Uses – after surgery, patients with infections, digestive disorders, and chewing problems

Diabetic Diet Used for patients with diabetes mellitus (DM, type 2) Body doesn’t produce enough insulin (a hormone, protein produced in pancreas) to properly metabolize carbs (sugar) Omit: sugar-heavy foods Type 2 develops over life due to diet or enviro factors. Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body’s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.

Calorie-Controlled Diet Low-calorie – used for patients who are overweight; avoid or limit high-calorie foods High-calorie – used for patients who are underweight, have anorexia nervosa, bulimia, hyperthyroidism (over-active), or cancer Extra protein and carbohydrates Avoid high-bulk foods (fibrous foods) Avoid high-fat foods (fried, pastries, cheese)

Low-Cholesterol Diet Restricts foods containing cholesterol Limit foods high in saturated fats Beef, pork, egg yolk, cheese, shellfish Used for - patients with atherosclerosis and heart disease

Fat-Restricted Diet Also called low-fat diet Omit: foods high in fat Used for - patients with gallbladder and liver disease, obesity, and certain heart diseases

Sodium-Restricted Diet Also called low-sodium or low-salt diets Avoid or limit addition of salt; avoid salt-rich foods Pickles, olives, processed cheese, smoked fish Used for - cardiovascular diseases

Protein Diet Protein-rich foods: meats, fish, milk, cheese, and eggs High-protein for children and adolescents for additional growth, pregnant or lactating women, surgery, burns, fevers, or infections Low-protein for certain kidney or renal diseases and certain allergic conditions

Bland Diet Easily digested foods that do not irritate the digestive tract Omit: fried food, pastries, raw fruit and veggies, smoked and salted meats, olives, avocado, coffee Used for - patients with ulcers, colitis, and other digestive diseases

Low-Residue Diet Eliminate or limit foods high in bulk and fiber Omit: raw fruit and veggies, whole-grain breads, seeds, beans, fried foods Used for - patients with digestive or rectal diseases such as colitis (inflamed colon) or diarrhea

Other Therapeutic Diets Other diets may be ordered that restrict or increase certain nutrients Check prescribed diet and ask questions if foods seem incorrect Try to include patient’s likes if they are allowed on diet If patient will not eat the foods on diet, the diet will not contribute to good nutrition