1. Clinical Nutrition التغذية الاكلينكية

2. 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

3. 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.

4. 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

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

6. 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

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

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

9. 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

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

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

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

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

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

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

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

25. Anthropometric Measurements
Height
Weight

26. Anthropometric Measurements
Head circumference
Triceps skinfold

27. 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

28. 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

29. 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

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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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.