Metabolism & Nutrition Basics of Nutrition & Obesity

Test 3

Why do nutritional requirements change?

Nutrient requirements change throughout the lifespan in relation to growth/development, activity, and changes in metabolism and body composition

Nurses’ role when it comes to nutritional requirements

• Assessment of patients’ usual patterns

• Health promotion

• Patient/family education

Pregnancy & Lactation

• Weight gain occurs during pregnancy

• Adequate nutrition during pregnancy is essential

• Pregnant women should avoid caffeine, alcohol, unpasteurized dairy (bacteria), raw eggs (bacteria), or undercook fish/processed meats (bacteria)

• When who are pregnant/lactating should ask their healthcare provider which medicines are safe to take during pregnancy

• The need for most vitamins and mineral (folic acid and iron) increases during pregnancy and lactation

  • Prenantal vitamins

Infants

• Most rapid period of growth

• Breastfeeding is recommended as the major source of nutrition for the first 6 months

  • Has all the essential the baby needs and antibodies

• Cow’s milk is not recommended for infants under the age of one year

  • Could cause GI bleeding

• Solid food introduced at about 6 months

• New food should be introduced one a t a time over a 5-7 day period to obese for indications of allergy to intolerance

  • Reduced allergies, asthma, or eczema as well as other things throughout life

Toddlers & Pre-Schoolers

• Growth rate slows

• Mobility, coordination, muscle mass, and bone density increase

• Can usually feed themselves and verbalize food like/dislikes (develop attitudes toward food)

  • Learn from parents

• Children this age often have inadequate intake of fruits and vegetables, and/or excessive intake of sweetened fruit drinks

  • Know normal schedule

  • Know normal intake

  • Encourage excesses throughout the day

School-aged Children

• Children have erratic growth patterns

• By about age 12 or 13, most kids have lost all their baby teeth and have a full set of permanent teeth

• Digestive system matures

• Pre-adolescent growth-spurt

• Socialization and independence increase

• Advertising had an impact on children’s food choices

Adolescents

• Period of rapid maturation (puberty/growth spurt)

• Girls: menstruation, fat deposition

• Boys: increase the muscle mass, lean tissue, bone growth

• Nutritional requirements increase during puberty

• Adolescents are likely to consume inadequate amounts of fruits, vegetables, and dairy products

• Exercise: sports, play outside, life weights (after hitting puberty)

Adults

• Growth ceases

• Decline in basal metabolic rate each decade

• Nutritional needs level off → few calories needed

• Weigh gain results if adjustments in caloric intake are not made

*Even if you are healthy, depending on your diet you can become obsess

Older adults

• Decrease in physical activity

• Loss of lean body mass

• Loss of teeth can make chewing more difficult

• Decrease in peristalsis can result in constipation

  • Increase fiber and water to avoid this

• Caloric needs decrease

• Need for nutrients increase

• Risk for malnutrition (chronic illness, limited income, islcaotion, age related physiologic changes)

Cultural & Religious Consideration when it comes to Nutritional Requirements

• Special food preparations (Kosher → Separate their dairy from their meat)

• Restrictions on meat intake (Islam, Orthodox Judaism)

• Fasting on religious holidays (Ramadan for Muslims, Ash Wednesdays/Lent for Catholics)

Cultural & Religious Consideration - Nursing Implications

• Assess patient’s dietary restrictions/food preferences

  • Picky eaters

• Ask patient about folk/home remedies

  • Onions = cold/respiratory

  • Garlic

  • Teas

  • Honey = vocal are, allergies, antibacterial properties

• Integrate cultural food preferences into the patient’s diet

• Encourage family involvement (may bring in food from home if prescribed diet and hospital policy permits)

Metabolism

Process of changing foods into energy to fuel body functions

Nutrients

Substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness or injury

Calories

1. Calories are the energy that is stored in food and used for body processes

2. A general guideline for the average adult is approximately 2000 calories per day to maintain their weight

Basal Metabolic Rate (BMR)

The number of calories necessary to maintain the body at rest

Get more coilers if you are active because you are burning more

Nutrition Facts

1. Servings : how many servings per that container

2. Calories : how much energy you get from a serving of that food

3. Nutrients : how much of every nutrient is in the package

4. Percent daily value (%DV) : 5% is low, 20% is high

Macro-Nutrients

Essential nutrients that supply energy/build tissue

• Carbohydrates

• Proteins

• Fats

Micro-Nutrients

Needed in smaller amounts to regulate and control body processes

• Vitamins

• Minerals

Carbohydrates

What are they:

• Composed of carbon, hydrogen, and oxygen

• Make up approximately 45-65% of total daily calories

Sources:

• Sugars

  • table sugars

  • fruits (sucrose)

• Starches

  • grains (bread, pasta)

  • beans

  • fiber (vegetables, oatmeal)

• Lactose

  • dairy products

Functions:

• Converted to glucose (stored in liver) in bloodstream for used as energy

Hyperglycemia = too much glucose in blood → give insulin

Excess glucose = sotred as fat

Protein

What is it:

• Composed of chains of amino acids (wound healing, muscle building)

• Vital component of every cell in the body

• Most adults require around 0.75g/kg/day of dietary protein

Sources:

• Animal sources: dairy products, meat, poultry, fish, eggs

• Plant-based: Peas/beans, nuts, soy products

• Supplemtens: shakes, pills

Functions:

• Provide energy

• Tissue growth/repair

• Regulate fluid balance

• Form antibodies

• Transport fats and other substances through the bloodstream

• Regulate acid/base balance

Increase protein intake when they came out of surgery or have pressure injury → wound healing

Fats (Lipids)

What are they:

• Lipids

• Make up approx. 20-35% of total daily calories

Sources:

• Triglycerides: Predominant form of fat in food. Major storage form of fat in the body

  • Snack and produced food

• Saturated fats: Found mainly in animal sources (i.e., meat, dairy products-butter)

  • Bad fats (LDL)

• Unsaturated fats: Usually found in plant sources (i.e., olive oil, avocado, nuts)

  • Good fats (HDL)

• Trans-fats: Man-made fats. Found in processed foods. Commercial food processors add hydrogen to unsaturated fats (hydrogenation); this changes the fats into a more solid and stable form (purpose is to extend shelf-life for processed foods)

  • Changes how the body breaks it down

  • High in cholesterol

Functions:

• Most concentrated source of energy in the diet

• Hormone production

• Form adipose tissue and protect internal nonagons

• Provide insulation to main body temperature

• Adi the body in absorption of fat-soluble vitamins

Cholesterol

What is it:

• Fat-like substance found only in animal products

• Component of cell membranes  (brain & nerve cells)

• It is not recommended to exceed more than 300 mg/day of dietary cholesterol

Functions:

• Used to synthesize bile acids

• Precursor of steroid hormones/Vitamin D

Types:

• High-density lipoprotein (HDL): carries cholesterol from tissues to the liver, which removes it from the body

  • Removed from out body

• Low-density lipoprotein (LDL): carries cholesterol to arteries and tissues

  • Build up causing atherosclerosis

Vitamins

What are they

• Organic compounds “Coenzymes” which facilitate chemical reactions in the body

Functions:

• Essential for the metabolism of carbohydrates, protein, and fat

Types:

• Water soluble: B-Complex, C

• Fat soluble: A, D, E, K

Vitamin A

Sources:

• liver

• carrots/egg yolks

• fortified milk

  • milk with vitamins added in

Functions:

• Important for vision, immune function, healthy skin

  • Elder adults need it most

Vitamin D

Sources:

• Dietary sources

  • fish oils

  • fortified milk

  • fortified cereals

• Non-food source

  • sunlight

Functions:

• Important for calcium and phosphorus metabolism, bone strength

  • Bone fractures, osteoporosis, osteoarthritis

Vitamin E

Sources:

• vegetable oils

• wheat germ

• whole grains

Functions:

• Antioxidant- which prevents or delays some types of cell damage from exposure to “free-radicals

  • “Free-radicals” →increase chances of getting cancer

• Red blood cell synthesis

Caution: if taking anticoagulants, don’t take vitamin E due to increase chances of bleeding

Vitamin K

Sources:

• green leafy vegetables (i.e., spinach, lettuce)

• synthesized in the intestines from gut bacteria

  • newborns are given a Vitamin K injection to prevent hemorrhagic disease

Functions:

• Important for blood clotting

Caution: if you have a DVT, TE, bypass, or stents don’t take Vitamin K because we don’t want them clotting → taking Warfarin (Coumadin)

Vitamin B Complex

B1 Thiamine-Energy/Metabolism (glucose) → given for alcohol withdraw

B2 Riboflavin- Energy/Metabolism

B3 Niacin- Energy/Metabolism (treats high cholesterol and triglyceride levels)

B5 Pantothenic Acid- Metabolism

B6 Pyridoxine- Metabolism, hormone regulation, brain development/function

B7 Biotin- Metabolism

B9 Folate- Synthesis/repair of DNA and RNA, RBC production → pregnant women need to take to help with fetal development

B12 Cyanocobalamin-Metabolism/RBC synthesis (hemoglobin) → anemia

Vitamin C

Sources:

• citrus fruits

• berries

• broccoli

• peppers

Functions:

• antioxidant

• enhances iron absorption

Minerals

What are they:

• Inorganic elements found in body fluids/tissues

Functions:

• provide structure within the body

• regulate body processes

Calcium

Sources:

• dairy products

• green (broccoli, spinach)

• soy products

Functions:

• important for bone formation, and muscle function (cardiac muscle contraction)

Phosphorus

Sources:

• dairy products

• meat

• poultry

• eggs

• breads/cereals

• soft drinks

Functions:

• important for acid-base balance, and bone/tooth formation

Works with calcium

Magnesium

Sources:

• green leafy vegetables

• grains

• beans/nuts

Functions:

• bone/tooth formation, protein synthesis, carbohydrate metabolism, regularity in cardiac muscle contraction

Helps with patients who have arrhythmia

Sodium

Sources:

• salt

• processed foods (snack items, fast food)

Functions:

• major role in acid-base balance, and fluid balance. when sodium levels are too high, it causes elevation in BP and fluid retention

Where sodium goes, water goes

Limit intake to less than 2,300 mg/day

Potassium

Sources:

• fruits (banana, tomatoes, avocado)

• leafy vegetables (spinach)

Functions:

• important role in fluid balance/acid-base balance, cardiac muscle contraction

Too high or too low = increase risk of arrhythmia

Kidney failure = restrict intake

Chloride

Source:

• Salt

Functions:

• acid-base and fluid balance (linked with sodium levels), important for respiratory function and cardiac function (BP regulation)

Saline solution = potassium chloride

Iron

Source:

• meats

• whole grains (commercially prepared breads and cereals are often fortified with iron)

• beans

• nuts

• seeds

• green leafy vegetables (spinach, broccoli)

Functions:

• binds with hemoglobin in the blood stream (oxygen transport)

Take with vitamin C

Iodine

Sources:

• iodized salt

• seafood

• food additives

Functions

• important for thyroid function

Zinc

Sources:

• oysters

• meats

• peas

• beans

• nuts

Functions:

• important for immunity

  • reduce length of cold when taking zinc

Water

Facts:

• accounts for 50% of an adult’s total weight

• 2/3 of body’s water is contained in the cells

Sources:

• beverages (80%)

• solid foods (20%)

• water intake should be 2-3 liters/day for adults

Functions:

• aids in digestion, absorption, circulation, excretion, and metabolism

• intake should equal output (fluid balance altered in server dehydration, GI illness, hemorrhage, sever burns, hypovolemia → when plasma is too low)

Promoting optimal intake

• Achieve adequate nutrients within energy needs

• Maintain calorie balance over time to achieve and sustain a healthy weight

• Focus on chiming nutrient dense foods and beverages (whole foods = fruits/vegetables)

Balancing Calories to Manage Weight

• control total calorie intake to manage body weight

  • increase exercise = increase calorie intake

• Increase physical activity

  • go for a walk

  • track in a watch

  • increase due to physicians recommendation

Foods & Nutrients to Increase

• Increase fruit and vegetable intake

• Increase whole-grain intake (replace refined grains)

  • White bread = bleach added to flour

  • Wheat bread = more grains and fibers

• Increase intake of fat-free/low-fat milk products

• Choose a variety of proteins

• Increase fiber intake

• Choose foods that provide more essential nutrients (potassium, calcium, vitamin D)

Food & Nutrients to Decrease

• Decrease daily sodium intake (read food labels, avoid adding salt to meals)

  • Don’t add extra salt

  • Less than 2g (200mg) per day

• Consume less that 10% of calories from saturated fats

  • Junk/fast food

• Consume less that 300 mg/day of dietary cholesterol

  • Meat, eggs, dairies

• Decrease intake of calories from solid fats and added sugars (fast food, snack foods)

• Limit alcohol consumption

Building Healthy Patterns

1. Select eating pattern that meets nutrient needs

2. Account for food/beverages: food dairy, health apps

3. Regular physical activity: at least 150 min/week (or 30 minutes, 5 days a week)

4. Track activity

5. Use of appropriate diets

ASSESS!!!

Body Mass Index (BMI)

Weight in kg divided by sure of heath in meter

Provides an estimation of body fat and can be used as an assessment of an individual’s nutritional status

What can produce incorrect BMI’s

• athletes

• anemia (retaining fluid)

• dehydration

• high muscle mass

• older people

• people who have lost muscle mass (ex. cachexia)

Underweight BMI

<18.5

Normal weight BMI

18.5-24.9

Overweight BMI

25-29.9

Obesity BMI

30 or greater

• diabetes, hypertension, and types of cancers

Morbid Obesity BMI

>40

Body Fat Distribution

• Apple vs. Pear shape

  • Apples are at a higher risk then pear

• Central obesity (apple): waist circumference of ≥ 40 in men and ≥35 in for women is indicative of increase cardio-metabolic risk (heart disease, diabetes)

  • Fat covering most abdominal muscles

Obesity

BMI over 30, body weight is over 20% then what it should be

Epidemiology:

• More than 20% of adults in the United States are obese

• Over 30% of young people (between 2-19) are overweight/obese

Etiology (related factors):

• Genetic → parents that are obsess = children are more likely to be obese (how you are grown up)

• Environmental → lack of available location to be active

• Biochemical → chronic system inflammation and stress

• Behavioral → high fat diet, number of calories consumed, lack of exercise

Obesity and Biopychosocial Health Problems

About half of all American adults—117 million individuals—have one or more preventable chronic conditions, many of which are related to poor quality eating patterns and physical inactivity (Examples: Cardiovascular disease, high BP, type 2 diabetes, some cancers, and poor bone health)

Nurses’ role: health promotion and patient/family education

Food/Drug Interactions: Absorption

• drugs taken by mouth are absorbed through the lining of the stomach or small intestine

• some drugs gave decreased effects when taken with food

• review dosage instructions:

  • “Must be taken on an empty stomach”

    • administer 30 minutes to 1 hour before or 2 hours after eating

    • example: thyroid replacement

Food/Drug Interactions: Gastric Irritation

• some drugs need to be taken with food to avoid gastric irritation, indigestion, or gastric ulcers

• review dosage instruction

  • “Must be taken with food”

    • administer during mealtime

    • examples: aspirin, non-steroidal anti-inflammatory drugs (ibuprofen)

Food/Drug Interactions: Food that Alter Metabolism/Action of Medications

1. Grapefruit juice:

   • interferes with the metabolism of certain medications resulting in an increased serum level of the medication

     • example: cholesterol lowering medication → Atorvastatin (Lipitor)

2. Foods with Vitamin K (green leafy vegetables):

   • decrease the anticoagulant effects of blood thinner medication warfarin (Coumadin)

3. Herbal supplements:

   • Cause potential interactions with prescribed medication (important to ask patients what over the counter meds/supplements that are taking)