Clinical nutrition

basic concepts  Health: The merging and balancing of five physical and psychological dimensions of health: physical, mental, emotional, social, and spiritual.  Nutrition: The study of essential nutrients and the process by which nutrients are used and quality of nutrients  Nutrients: Substances in food required by the body for energy, growth, maintenance and repair.

Role of nutrition:  Physical health of the body.depends on the quantity and quality of nutrients,  Intellectual health relies on a well functioning brain and central nervous system, (iron deficiency . anemia affects intellectual health),  Emotional health may be influenced by poor eating habits (hypoglycemia),  Social health often centers around food-related occasions, and  Spiritual health often has ties to food.

 Health promotion: increases the level of health of individuals, families, groups, and communities.  Role of nutrition:  Healthy people 2010, defines some objective nutrition as decreasing daily fat intake, and less total caloric intake.

 Wellness: is a lifestyle that enhance each of the five dimensions of health. Wellness nutrition approaches food consumption as a positive way to nourish the body. Consuming a diet based on lower fat/higher fiber and moderate caloric consumption is essential to convey competency to care for ourselves

 Disease prevention:  Is the recognition of a danger to health that could be reduced or alleviated through specific actions or changes in life style behaviors.  There are three levels of prevention,  Primary: activities to avert the initial development of a disease or poor health, low fat and high fiber diet is important;

 Secondary: early detection to halt or reduce the effects of a disease or illness, sodium intake restriction may control HTN, and consequently avoid HD;

 Tertiary: to minimize further complications or to assist in the restoration of health. Direct treatments of many disorders have a dietary components (ulcer, coronary heart disease  -Nutrition is consider as vital component in personal health care.  -Promotion of health, and prevention of disease for all people, rests on whole food supply. 

 -Human nutrition depends on attitudes toward food, and eating pattern through our life span, under influence of community, nation, and over all world.  -We need nutrition for maintenance of growth, activity,and reproduction.

 -The body need energy to carry out vital function as breathing, and the people need energy to perform physical activity, that could be met by food.

 -Dietetics is the health profession,having primary responsibility of application of nutritional care, in various state of health, and disease, with assistance of nurse and physician.

Definition of nutrition:  -Nourishment that sustain life, it begins from the moment of conception until death.  -The food people eat, and how it nourishes their bodies.   Kinds of nutrients:   1- Macro nutrients :  -Fats, carbohydrates ( CHO), proteins.  -Supply energy, build tissue.  2- Micro nutrients :  -Vitamins( vits ),minerals.

 NB:- water is the over all vital nutrients, enter in all of life process,  -Metabolism: sum of chemical process in the body, to sustain life, and health.  -Need in small amount.  -Regulate, and control body process.

-Source of energy:  1-Carbohydrates CHO :  -Primary source of energy.  -Sugar is simple CHO food, while starch is complex CHO food.  -The quick source of energy is glycogen.  -Each one gram of CHO, yield 4kilocalories.  -50to60% of energy taken from CHO diet.

2-Fats:  -Comes from plants and animals.  -Saturated fat from animals.  -Unsaturated fat from vegetables, and oil products.  -Each one gram of fat yield 9 kilocalories.  -25to30% of energy taken from fat.

3-Proteins:  -The body take energy from protein, when there is insufficient amount of CHO, and fat.  -Each one gram of protein yield 4kilo calories.  -15to29%of total energy taken from protein.  -The primary function of protein,are building and energy.   NOTE: caloric is unit of heat used in the nutritional science, each 1000 calories equal 1 kilocalorie.

*Tissue building  1-Protein the primary source:  -Responsible for tissue building.  -The necessary unit of building is called amino acid.  2-Minerals :  -Calcium and phosphorus help in building, and maintain bone tissue.  -Iron help in build of hemoglobin of red blood cell.   3-Vitamins:  -Vit C build tissue, and prevent bleeding in tissue.  4-Fatty acid. 

-Metabolic regulation,and control:  1-Vitamines:  -Many vits act as co-enzyme or cell enzyme, to govern chemical reactions in cell metabolism, example B-complex vits.  2-Minerals :  -Act as co-enzyme factors of cell metabolism.  Example: the trace element cobalt act with B12, to prevent occurrence of pernicious anemia, 

 3-Water and fiber :  -Regulate the passage of food through gastro intestinal tract (GIT), that help in absorption of different nutrient.  -Remember : water is the fundamental agent for life, provide the basis of metabolic process.

Nutritional assessment:  Nutritional assessment is the process of determining nutritional status. It may reveal nutrient deficiencies or excesses. The deficiency may be primary due to inadequate intake or secondary as a result of body inefficient use of nutrients. We can use two levels: evaluating the dietary intake, and evaluating the intake besides considering how the body uses the nutrients.

 Diet Evaluation: 24-hour recall, usual food intake, a food record, a food frequency checklist, or a diet history. One the data collected, they can be analyzed.

Assessment of nutritional status:  1. Clinical examination, observing eyes, mucous membranes, skin, hair, mouth, teeth, and tongue.  2. Biochemical analysis of body tissue, blood and urine tests, iron.  3. Anthropometric measurements, Ht, wt, limp circumference.

Levels of nutritional status  Ideal nutrition:  Positive nutrition  -Well developed body  Ideal weight  Good muscle development, and tone  -The skin is smooth, and clear, hair is glassy  -The eye clear, and bright.

 Posture is good.  -Facial expression is alert.  Appetite, digestion,and elimination are normal.  mentally and physically alert  Having essential nutrition, to resist infectious disease. -  -Sleep well at nigh

-Border line nutrition -  -Poor eating habits, Whose living in stress environment, with low income.  -Has no reservoir of nutrition.  -At risk of physical illness

3-Malnutrition :  Nutrients energy are not enough to meet day to day needs.-  Associated with poverty.--  Affect infants, children, pregnant women, and elderly. -  Increase infant mortality rate, because of poverty, low income and, un-educated mother.

 - Children and pregnancy,develop anemia result in,  Low resistance to infectious disease.  Impaired learning ability. -  Reduce activity level.-  -Apathy.  Elderly suffering of chronic disease.

Over nutrition.-  -Over weight and obesity.  -Excess energy intake.  Lead to chronic disease, as hyper tension, and DM.  Note: *  -Specific dietary factors lead to:  -Coronary heart disease( CHD). -  High blood pressure( HTN ).- -  Stroke( CVA).- -  Some type of cancer. -  -DM.  Obesity.

Recommendation for good nutrition :  Eat variety of food, Well balanced diet. -  Maintain ideal weight. -  -Avoid too much fat,saturated fat, and cholesterol.  Eat food with adequate starch, and fiber.-  -Avoid too much sugar.  -Avoid too much sodium.  Avoid alcohol intake. 