1. Nutrition N1037

2. Introduction Key term: nutrition Integrated Pan-Canadian Healthy Living Strategy goals: Healthy eating Physical activity Healthy weight

3. Eating well with Canada’s Food Guide Food groups: Vegetables and fruit Grain products Milk and alternatives Meat and alternatives

4. Dietary Guidelines Directional statements: Have vegetables and fruit more often than juice Eat at least one dark green and one orange vegetable every day Have at least half of daily grain products intake from whole grain Have meat alternatives such as beans, lentils and tofu often

5. Dietary Guidelines Directional statements: Eat at least two food guide servings of fish every week Satisfy thirst with water Drink skim, 1% or 2% milk each day – drink fortified soy beverages if you do not drink milk

6. Dietary Guidelines Directional statements: Reduce the total amount of fat in the diet, especially saturated and trans fats, however, a small amount of unsaturated fat is recommended each day (30-45 ml for an adult) Lower salt and sugar intake

7. Dietary Guidelines Directional statements: Achieve and maintain a healthy body weight by enjoying regular physical activity - adults should get 30 to 60 minutes of moderate physical activity every day and children should get 90 minutes

8. Dietary Guidelines Directional statements: All women who could become pregnant should take 400 µg (0.4 mg) of folic acid a day to avoid neural tube defects in the unborn fetus All adults over 50 years of age should, in addition to following the Food Guide, take a daily vitamin D supplement of 10 µg (400 IU) a day

9. Nutrients Nutrients are the substances found in food that are nourishing and useful to the body. Carbohydrates Protein Fats, Vitamins and minerals Water

10. Nutrients Carbohydrates Supply energy and fibre 45% to 60% of daily caloric intake (continues)

11. Nutrients Proteins Supply nine essential amino acids Repairs body tissues, maintain osmotic pressure, component of antibodies, and an ultimate source of energy. 10% to 35% of daily caloric intake

12. Nutrients Fats Saturated, monounsaturated Cholesterol, high-density lipoproteins, low-density lipoproteins, omega fatty acids, trans fats, triglycerides Part of the structure of all cells 20% to 35% of total caloric intake

13. Nutrients Vitamins Organic substances Maintain body functions Fat-soluble and water-soluble Minerals Inorganic substances Help build body tissues and regulate body processes. Macrominerals and microminerals

14. Nutrients Water Makes up 50% to 60% of body weight Average adult needs 6–8 240 mL glasses of water/day Signs of dehydration?

15. Nutrition Through the Life Cycle Anticipatory guidance

16. Infant Feeding Guidelines Assess reflexes—sucking, rooting, swallowing Rapid growth and development Breastfeeding is preferred for first 12 months Assess physical development to determine readiness for solid food

17. Infant Feeding Guidelines Introduction of solids 6 – 9 months Iron containing foods Cereals Meats and Egg Yolk Vegetables and Fruit Dairy : Cheeses, Yoghurt (Whole Cow’s milk after 9 months) 9 months + Introduction of finger foods, increased textures (mashed and soft)

18. Infant Feeding Guidelines Introduce foods one at a time Begin with foods that are least allergenic Avoid egg whites and honey in infants under 12 months No peanuts, nuts, or fish until age three

19. Nutritional Assessment of Infants Breastfed? How often? How long? Bottle-fed? How often? How much? Formula preparation? Storage? How does the infant respond to eating? Constipation? Diarrhea? Is the infant ever put in bed with a bottle?

20. Nutritional Guidelines for Toddlers Physical growth slows Increased independence Small portions Offer one new food at a time No peanuts, nuts, or fish until age three Routine mealtimes

21. Nutritional Guidelines for Preschoolers Independence May become a picky eater Offer food choices Offer small servings Finger foods Routine mealtimes Discuss need for healthy snacks

22. Nutritional Guidelines for School-Age Children Erratic growth and eating patterns Strong food preferences Encourage a balanced diet Limit highly sweetened snacks and foods

23. Nutritional Assessment of Young Children Concerns with child’s eating? Child’s food preferences? Involvement in sports? Physical activity? Child’s meal schedule? Balanced diet? Intake of beverages with added sugar?

24. Nutritional Guidelines for Adolescents Period of rapid growth and change Fluctuating nutritional needs Concerns with body image Risks for eating disorders Adjustment portion quantity based on physical activity level

25. Nutritional Assessment of Adolescents Participation in physical activity? Adhere to a specific diet or meal plan? Skip meals? Satisfaction with current weight? (continues)

26. Nutritional Assessment of Adolescents Ever induced vomiting, used laxatives, diuretics, or diet pills to control weight? Consumption of snacks?

27. Nutritional Guidelines for Young and Middle-Aged Adults Growth and caloric needs stabilize Eating habits may be influenced by activity levels, life stressors Obesity often seen in this age group

28. Nutritional Guidelines for Young and Middle-Aged Adults Consideration of diseases Atherosclerosis - Coronary artery disease Osteoporosis Type II diabetes Metabolic syndrome DASH Diet

29. Nutritional Guidelines for Pregnant and Lactating Women Role of proper nutrition in development of healthy infant Target weight gain for pregnancy Adequate caloric intake Increased fluid consumption Prenatal vitamins Iron supplements Calcium Folic Acid

30. Nutritional Assessment of Pregnant Women Prepregnancy weight? Activity level? Use of supplemental vitamins? Consumption of caffeine, artificial sweeteners, alcohol? Presence of constipation, nausea, vomiting, or heartburn? Presence of food cravings?

31. Nutritional Guidelines for the Older Adult Decreased caloric requirements Encourage to eat in a sitting position Encourage adequate fluid intake and high-fibre diet

32. Nutritional Guidelines for the Older Adult Nutritional risk factors Difficulty chewing or swallowing Decreased appetite Decreased taste and smell Decreased ability to self-feed

33. Nutritional Assessment of Older Adults Presence of physical limitations that affect eating? Difficulty chewing or swallowing? Presence of dental problems? Difficulty obtaining or preparing foods? Do you eat alone?

34. Cultural Differences in Nutrition Cultural beliefs related to the consumption of food Religious beliefs related to the consumption of food Food restrictions Periods of fasting

35. Components of a Nutritional Assessment Nutritional history Physical assessment Anthropometric measurements Laboratory data Diagnostic data

36. Nutritional History General diet information Adherence to particular diet Food preferences Consumption of fast foods Ability to obtain and prepare foods Changes in past 12 months

37. Nutritional History Food intake history 24-hour recall 3-day diary Direct observation Evaluation of adequacy of diet

38. Physical Assessment Assess for subjective and objective signs and symptoms of poor nutritional status

39. Signs and Symptoms of Poor Nutritional Status Subjective data Fatigue Delayed wound healing Brittle hair, nails Mouth sores Changes in appetite Mood changes

40. Signs and Symptoms of Poor Nutritional Status Objective data Weight changes Dry, rough, scaly skin Edema Dry, cracked lips Swollen, bleeding gums Decreased muscle tone

41. Anthropometric Measures Height Weight Ideal body weight, percent IBW Percent weight change Body mass index (continues)

42. Anthropometric Measures Waist to hip ratio Skinfold thickness Mid-arm circumferences Kwashiorkor Marasmus

43. Laboratory Data Hematocrit and hemoglobin Cholesterol, LDL-C, HDL-C, total cholesterol:HDL-C ratio, triglycerides Transferrin, TIBC, iron Total lymphocyte count Antigen skin testing (continues)

44. Laboratory Data Albumin and prealbumin Glucose Creatinine height index Nitrogen balance

45. Diagnostic Data Radiographic studies X Rays Dual-energy X-ray Absorptiometry (DEXA) scan

46. Activities Review your 24 hour food recall – compare to Canada Food Guide Do health teaching depending on what you assess. Do Calcium calculator Do initial physical assessment Complete Self – Assessment Tool

47. Interactive Food Label Available athttp ://www.hc-sc.gc.ca/fn-an/label- etiquet/nutrition/cons/inl_main-eng.php Contents: 1. Nutrition Facts Table 2. Specific Amount of Food 3. % Daily Value 4. Core Nutrients 5. Nutrition Claims 6. List of IngredientsNutrition Facts TableSpecific Amount of Food% Daily ValueCore NutrientsNutrition ClaimsList of Ingredients

48. Nutrition Facts Table Whole Kernel Corn The Nutrition Facts table includes Calories and 13 nutrients: Fat, Saturated fat, Trans fat, Cholesterol, Sodium, Carbohydrate, Fibre, Sugars, Protein, Vitamin A, Vitamin C, Calcium and Iron.

49. Specific Amount of Food The specific amount may be indicated by: A phrase such as: a slice, one egg, two cookies, followed by the metric measure. Familiar household units such as mL, cups, tablespoons, or a fraction or unit of food (e.g., 1/4 pizza), followed by the metric measure (g, mL) (e.g., 175 g yogourt). Whole Wheat Bread

50. % Daily Value Use the % Daily Value to make food comparisons. The % Daily Value provides a quick overview of the nutrient profile of the food, allowing product comparisons based on more than one nutrient. It puts nutrients on the same scale (0% - 100% Daily Value). You can quickly identify the strengths and weaknesses of a food product. Sirloin Burger Vs Chicken Burger Sirloin BurgerChicken Burger

51. Calories and Core Nutrients Calories and the same core nutrients are always listed in the same order. A consistent look makes the Nutrition Facts table easy to find and use. Information on core nutrients available on Health Canada Website

52. Nutrition Claims The Government has rules in place that must be met before a nutrition claim can be made on a label or advertisement. The rules for nutrition claims apply to all foods, prepackaged and not prepackaged, no matter where they are sold. A manufacturer can choose whether or not to include nutrition claims on the label or in the advertisement of a food. Many products will have nutrition claims as these claims highlight a feature of interest to consumers. Source of Fibre Low Fat Cholesterol Free Sodium Free Reduced Calories Light

53. Ingredients List Bran Cereal Ingredients: Whole wheat, wheat bran, sugar/glucose-fructose, salt, malt (corn flour, malted barley), vitamins (thiamine hydrochloride, pyridoxine hydrochloride, folic acid, d-calcium pantothenate), minerals (iron, zinc oxide).

54. Case Study Questions

55. References Interactive Nutrition Label: http://www.hc- sc.gc.ca/fn-an/label- etiquet/nutrition/cons/inl_main-eng.phphttp://www.hc- sc.gc.ca/fn-an/label- etiquet/nutrition/cons/inl_main-eng.php Canada’s Food Guide :http://www.hc-sc.gc.ca/fn- an/food-guide-aliment/index-eng.php Estes, M.E., (2006). Health Assessment and Physical Examination. (3 rd edition). Clifton Park,NewYork: Thomson Delmar Leaning. Estes, M.E., Buck, M. (2009). Health Assessment and Physical Examination. (1 st Canadian edition). Toronto, Ontario: Nelson Education Ltd.