Lesson 3 Nutrition, Diets and Enteral Feeding

Six classes of nutrients

Carbohydrates, protein, lipids (fats), vitamins, minerals, water

Nutrients that supply energy

Carbohydrates, protein, lipids (fats)

Nutrients that regulate body processes

Vitamins, minerals, water

Energy measurement

Measured in kilocalories (often called calories)

Nutrients that provide calories

Only carbohydrates, protein, and fat provide calories

Total daily energy expenditure

All calories used to perform physical activity, maintain metabolism, and digest, absorb, and metabolize food

Total daily energy intake

Total calories for each food item eaten

Weight determination

Daily intake and expenditure differences determine stable weight, weight loss, or weight gain

Basal Metabolic Rate (BMR) definition

Energy (number of calories) required to fuel involuntary activities of body at rest after 12 hours; energy needed to sustain metabolic activities of cells and tissues

BMR sex difference

Males have higher BMR due to larger muscle mass

Body Mass Index (BMI) definition

Ratio of weight in kilograms to height in meters squared

BMI purpose

Provides estimate of body fat; can be used as initial assessment of nutritional status

Adult BMI - underweight

Adult BMI - healthy weight

18.5 to 24.9

Adult BMI - overweight

25-29.9

Adult BMI - obesity

30-39.9

Adult BMI - extreme obesity

>40

BMI for age percentile ages

Measured heights and weights against growth charts; ages 2-19 years old

BMI for age - underweight

Less than 5th percentile

BMI for age - healthy weight

5th percentile to less than 85th percentile

BMI for age - overweight

85th percentile to less than 95th percentile

BMI for age - obese

95th percentile or greater

Body fat distribution significance

Location of where body fat is deposited is thought to be important and reliable indicator of disease risk

Waist-to-hip ratio (WHR)

Tool used to identify central obesity

Carbohydrates definition

Sugars and starches; organic compounds composed of carbon, hydrogen, and oxygen

Carbohydrates source

Serve as structural framework of plants; lactose is only animal source (sugar present in milk)

Carbohydrates abundance

Most abundant and least expensive source of calories in the world

Carbohydrates and income correlation

As income increases, carbohydrate intake decreases

Carbohydrates access issues

Health issue: access to food stores and not just quick marts/convenience stores; fruits/vegetables/lean meats are expensive

Carbohydrates classification

Classified as simple or complex sugars

Carbohydrates primary function

Supply energy

Carbohydrates recommended intake

45% to 60% of total calories for adults

Carbohydrates digestion speed

More easily and quickly digested than protein and fat

Carbohydrates ingestion percentage

90% of carbohydrate intake is ingested

Carbohydrates conversion

Converted to glucose for transport through blood

Carbohydrates as fuel

Efficient fuel that certain tissues rely on almost exclusively for energy (i.e., nervous system)

Carbohydrates transport

Transported from GI tract, through portal vein, to liver

Liver role in carbohydrates

Stores glucose and regulates entry into blood

Carbohydrates oxidation

Cells oxidize glucose to provide energy, carbon dioxide, and water

Protein definition

Vital component of every living cell; required for formation of all body structures

Protein variety

More than 1,000 different proteins made in body by combining various of the 22 amino acids

Complete proteins

Contain sufficient essential amino acids to support growth

Incomplete proteins

Deficient in one or more essential amino acids

Animal proteins

Complete proteins

Plant proteins

Incomplete proteins (except soy and quinoa are complete)

Vegetarian protein

Can combine different plant proteins to supply complete protein

Protein digestion

Dietary protein broken down into amino acids by pancreatic enzymes in small intestine which are absorbed and transported to liver

Liver role in protein

Amino acids recombined into new proteins or released for use by tissues and cells

Protein tissue state

Tissues continuously being broken down (catabolism) and replaced (anabolism)

Protein RDA for adults

0.8 g/kg of body weight, 10% to 35% total calorie intake

Fats definition

Insoluble in water and blood; composed of carbon, hydrogen, and oxygen

Triglycerides in diet

95% of lipids in diet are triglycerides

Saturated fatty acids

Raise cholesterol levels; most animal fats are saturated

Unsaturated fatty acids

Lower cholesterol levels; most vegetable fats are unsaturated

Fat digestion location

Occurs largely in small intestine

Bile role in fat digestion

Secreted by liver and stored in gallbladder; emulsifies fat so pancreatic enzymes can break it down for digestion

Fat absorption

Absorbed into lymphatic circulation and transported to liver

Fat energy density

Most concentrated source of energy in diet

Fat recommended intake

Limit saturated fats to less than 10% of daily calories and intake of trans fats to as low as possible

Vitamins definition

Organic compounds needed by body in small amounts; do not provide calories

Vitamins function

Needed for metabolism of carbohydrates, protein, and fat

Vitamins in fresh vs processed foods

Fresh foods are higher in vitamins than processed

Water soluble vitamins

C, B-complex vitamins; not stored in body

Fat soluble vitamins

A, D, E, K

Water soluble vitamins list

Ascorbic acid (C), thiamine, riboflavin, niacin, pyridoxine, biotin, pantothenic acid, folate, cobalamin

Water soluble vitamins absorption

Absorbed through intestinal wall directly into bloodstream; not stored in body

Fat soluble vitamins absorption

Absorbed with fat into lymphatic circulation; must be attached to protein to go through blood

Fat soluble vitamins storage

Stored excess in liver and adipose tissue

Fat soluble vitamins daily intake

Daily intake not needed

Fat soluble vitamin deficiency cause

Can occur if fat digestion or absorption is impaired/altered

Fat soluble vitamin toxicity

Excessive intake of Vitamin A and D can be toxic

Minerals definition

Organic elements found in all body fluids and tissues

Minerals function

Some provide structure in body, others help regulate body processes

Macrominerals (major)

Calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium

Microminerals (trace)

Iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine

Water percentage of adult weight

Accounts for between 50% and 60% of adult's total weight

Intracellular fluid (ICF)

Two thirds of body water is contained within cells

Extracellular fluid (ECF)

Remainder of body water; body fluids (plasma, interstitial fluid)

Water functions

Provides fluid medium necessary for all chemical reactions; acts as solvent and aids digestion, absorption, circulation, and excretion

Dietary Guidelines for Americans

Science based strategies compiled by U.S. dept. of health and human services and U.S. dept. of agriculture; updated every 5 years

Dietary Reference Intakes (DRIs)

Set of reference values including RDA, AI, UL, EAR, CDRR

DRI components

Recommended dietary allowance (RDA), Adequate Intake (AI), Tolerable Upper Intake Level (UL), Estimated average requirement (EAR), Chronic disease risk reduction (CDRR)

DRI basis

Provides estimates of nutrition needs for healthy people based on biologic sex and life stages

Factors affecting nutrition - physiologic

Stage of development, state of health, medications

Factors affecting nutrition - social determinants

Economic stability, health care access and quality, social and community context, education access and quality, neighborhood and built environments

Factors affecting nutrition - cultural

Culture, religion, food ideology, and learned aversions

Growth and nutrition

Infancy, adolescence, pregnancy, and lactation increase nutritional needs

Activity and nutrition

Activity increases nutritional needs

Age-related changes

Changes in metabolism and body composition; nutritional needs level off in adulthood

Adulthood calorie needs

Fewer calories required because of decrease in BMR

Factors influencing nutritional requirements

Sex assigned at birth, state of health, alcohol use disorder, medications, megadoses of nutrient supplements

Factors influencing food choices

Social determinants of health, religion, meaning of food, culture

Decreased food intake

Anorexia (lack of appetite)

Increased food intake

Obesity (BMI ≥30)

Components of nutritional assessment

History taking, physical assessments, biochemical data

Nutritional assessment - history

Dietary, medical, socioeconomic data

Nutritional assessment - physical

Anthropometric and clinical data

Nutritional assessment - biochemical

Protein status, body vitamin, mineral, and trace element status

Dietary data methods

24-hour recall method, food diaries/calorie counts, food frequency record, diet history

Nursing interventions for nutrition

Teaching nutritional information, monitoring nutritional status, stimulating appetite, assisting with eating, providing oral nutrition, providing long-term nutritional support