Basic Nutrition: Study Guide

NURSING FUNDAMENTALS DAY 10: BASIC NUTRITION

Introduction (Page 3)

• Food is a fundamental human need, integral to Maslow's hierarchy.

• Nutrition is defined as the study of nutrients and how the body utilizes them from food.

• It profoundly impacts human well-being, behavior, and the environment.

• The science of nutrition has significantly evolved, leading to advancements and improvements in life quality.

Nutrients (Page 4)

• Definition: Substances essential for the body's growth, maintenance, and repair.

• The body can synthesize some nutrients if necessary precursors are available.

• Essential Nutrients: These must be acquired through dietary intake.

• Classes of Nutrients: Carbohydrates, fats, proteins, water, minerals, and vitamins.

• Macronutrients: Provide energy (e.g., carbohydrates, fats, proteins).

• Micronutrients: Regulate various body processes (e.g., vitamins, minerals).

• Water: Indispensable for every bodily function.

Healthy Diet Characteristics (Page 5)

• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and dairy products.

• Includes lean meats, poultry, fish, beans and peas, eggs, and nuts.

• Is low in saturated fats, trans fats, cholesterol, salt, and added sugars.

• (Refer to Table 30-1 for detailed information).

Vitamin and Mineral Content in Food Groups (Page 6)

MyPlate Concept (Page 7)

Highly beneficial for nutritional education, MyPlate encourages clients to:

• Consume more foods rich in essential nutrients.

• Reduce intake of other foods.

• Ensure dietary variety.

• Balance calorie intake with energy expenditure.

• Practice moderation.

• Engage in daily physical activity.

Dietary References and Terminology (Page 8)

• Dietary Reference Intakes (DRIs):

  • Recommended Dietary Allowances (RDAs): Average daily intake to meet nutrient needs for most healthy individuals.

  • Adequate Intake (AI): Recommended nutrient intake when RDA cannot be determined, assumed to be adequate.

  • Tolerable Upper Intake Level (UL): Highest daily intake unlikely to pose adverse health risks.

  • Estimated Average Requirement (EAR): Daily intake estimated to meet the requirements of half the healthy individuals in specific life stage and gender groups.

Food Pattern and Food Group Terms (Page 9)

• Daily food intake pattern: Refers to the recommended daily amounts of foods from different groups.

• Estimated energy requirement (EER): The average dietary energy intake predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and level of physical activity.

• Discretionary calorie allowance: The remaining calories in a person's energy allowance after consuming foods to meet nutrient needs.

• Nutrient-dense foods: Foods that provide a high amount of nutrients relative to their calorie content.

• Ounce-equivalent: A standard measure for quantifying servings of grains and protein foods.

Mineral Supply from Fruit (Page 10-11)

• Question #1: Which mineral can be supplied by fruit?

• Answer: B. Potassium, as found in fruits like bananas. Iron is found in grains, vegetables, and protein. Calcium is in vegetables and dairy. Magnesium is in grains and vegetables.

Kilocalories and Energy (Page 12)

• Kilocalorie (kcal):

  • A unit measuring the heat energy content in food.

  • Defined as the amount of heat needed to raise the temperature of $1\ \text{kg}$ of water by $1^\circ\text{C}$.

• Kilocaloric Values of Energy Nutrients:

  • $1\ \text{g}$ carbohydrate = $4\ \text{kcal}$

  • $1\ \text{g}$ fat = $9\ \text{kcal}$

  • $1\ \text{g}$ protein = $4\ \text{kcal}$

Energy Requirements and Empty Calories (Page 13)

• Requirements: Individual calorie needs vary based on age, sex, weight, body composition, and activity level.

• Resting Energy Expenditure (REE): The total calories required to sustain basic body processes at rest.

• Empty Calories: Foods that provide calories but offer minimal or no nutrients.

  • Examples include candy, soft drinks, alcohol, and sugar.

  • Can lead to nutrient deficiencies if they replace nutrient-rich foods.

Activity Levels (Page 14)

Categorized to help determine individual energy needs:

• Sedentary

• Light intensity

• Moderate physical activity

• Vigorous physical activity

Enzymes and Digestion (Page 15)

• Enzymes: Biologic catalysts composed of proteins.

• Highly specific; each enzyme acts on particular chemicals.

• They form temporary bonds with substrates to facilitate the formation of new compounds.

• Activity is sensitive to changes in pH and temperature.

• Their primary role is in the digestive process.

Carbohydrates (CHO) (Page 16)

• Composition: Made of carbon, hydrogen, and oxygen.

• Classification: Simple or complex.

• Functions:

  • Major source of energy (glucose).

  • Provides dietary fiber.

  • Spares protein from being used for energy.

  • Excess carbohydrates are stored as fat.

• Energy Yield: Provides $4\ \text{kcal}$ per gram.

• Recommended Intake: $45\%$ to $65\%$ of total daily calories.

• Sources: Breads, cereals, pasta, rice, potatoes, lima beans, corn, dried beans and peas, fruits, vegetables, milk, sugar, syrup, jelly, jam, honey.

Carbohydrate Digestion (Page 17)

• Oral Cavity: Begins in the mouth with salivary amylase (ptyalin), breaking down starch into dextrins.

• Stomach: Hydrochloric acid (HCl) may further hydrolyze dextrins into glucose and fructose.

• Small Intestine: Pancreatic amylase converts carbohydrates into maltose. Intestinal wall enzymes (sucrase, maltase, lactase) complete the digestion.

• End Products: Glucose, fructose, and galactose.

• Absorption: Absorbed through the intestinal mucosa; the liver converts fructose and galactose into glucose.

Carbohydrate Classification (Page 18)

• Simple Carbohydrates:

  • Monosaccharides: Glucose (dextrose), fructose (levulose), galactose.

  • Disaccharides: Sucrose, lactose, maltose.

• Complex Carbohydrates (Polysaccharides):

  • Starch

  • Dextrin

  • Fructans

  • Glycogen

  • Dietary fiber

Fats (Lipids) (Page 19)

• A concentrated energy source readily stored by the body.

• Most dietary fat is in the form of triglycerides.

• Functions:

  • Provides a large amount of energy in a small quantity of food.

  • Excess fat is stored as adipose tissue.

  • Conserves body heat.

  • Maintains healthy skin by supplying essential fatty acids.

  • Transports fat-soluble vitamins (A, D, E, and K).

  • Crucial for the structure of nerve tissue.

  • Protects and insulates body organs.

• Energy Yield: Provides $9\ \text{kcal}$ per gram.

• Recommended Intake: $20\%$ to $35\%$ of total daily calories.

Fat Sources and Digestion (Page 20)

• Sources: Butter, cream, salad oils and dressings, cooking and table fats, fat in meats, olives, avocados, fried foods.

• Found as visible fat (e.g., butter) and invisible fat (e.g., within meats).

• Digestion:

  • Small Intestine: Bile, released from the gallbladder, emulsifies fat into tiny droplets.

  • Small Intestine: Pancreatic lipase further breaks down fat into fatty acids, glycerol, and monoglycerides.

Fatty Acids (Page 21)

• Saturated Fatty Acids:

  • Solid at room temperature; contain a full complement of hydrogen atoms.

  • Found in animal fats, coconut, palm, and palm kernel oils.

  • Hydrogenation is the process of adding hydrogen to liquid oil to make it solid.

• Unsaturated Fatty Acids:

  • Tend to be soft or liquid at room temperature.

  • Found in poultry, freshwater fish, and most plant oils (excluding coconut, palm, and palm kernel).

  • Monounsaturated Fats: Olive, canola, peanut oils.

  • Polyunsaturated Fats: Safflower, sunflower, soybean, corn oils.

Essential Fatty Acids (Page 22)

• Linoleic acid and linolenic acid are essential fatty acids that must be obtained through the diet.

• Arachidonic acid becomes essential if the diet is deficient in linoleic acid.

• Sources of Essential Fatty Acids: Vegetable oils, leafy vegetables, meat, fatty fish.

Cholesterol (Page 23)

• Source: Found exclusively in animal tissues.

• Functions: Essential for producing hormones, vitamin D, and bile acids.

• High-density lipoproteins (HDL): Known as "good cholesterol."

  • Helps lower serum cholesterol levels and reduces the risk of heart disease.

  • Can be increased through exercise, weight loss, smoking cessation, and moderate alcohol consumption.

• Low-density lipoproteins (LDL): Known as "bad cholesterol."

  • Strongly implicated in the development of atherosclerosis and coronary artery disease.

  • Increased by consuming saturated fats.

Protein (Page 24)

• Fundamental Component: The foundation of every cell in the body.

• Composition: Composed of amino acids, which contain carbon, hydrogen, oxygen, and nitrogen. Some also contain phosphorus, sulfur, cobalt, and iron.

• Functions:

  • Produces and repairs all major body constituents.

  • Helps maintain the body's fluid balance (e.g., albumins, globulins) and acid-base balance.

  • A key component of the immune system.

  • Can be converted to glucose and used for energy.

  • Produces hormones and enzymes.

Protein Sources and Digestion (Page 25)

• Sources: Lean meat, fish, poultry, eggs, milk and cheese, dried beans and peas, peanut butter and nuts, fortified bread and cereals (refer to Tables 30-1 and 30-3).

• Digestion:

  • Stomach: Pepsin breaks down proteins into polypeptides.

  • Small Intestine: Pancreatic juices further split polypeptides into individual amino acids.

Amino Acids (Page 26)

• Building Blocks: Proteins are made up of about $100$ individual amino acid units.

• Known Amino Acids: There are $22$ known amino acids.

  • Essential Amino Acids: Must be obtained through the diet. These include valine, leucine, isoleucine, phenylalanine, threonine, methionine, lysine, tryptophan, and histidine.

  • Nonessential Amino Acids: Can be synthesized by the body if there is sufficient nitrogen and energy in the diet. Examples include alanine, cystine, glutamine, glycine, and serine.

Complete and Incomplete Proteins (Page 27)

• Complete or High-Quality Proteins: Provide all essential amino acids in sufficient quantities and proportions required by the body.

• Incomplete Proteins: Lack sufficient amounts of one or more essential amino acids. Plant proteins are generally considered incomplete, though the specific missing amino acid varies. Consuming a variety of plant proteins can ensure intake of all essential amino acids.

Vegetarian Diet and Amino Acids (Page 28-29)

• Question #2: Is the following statement true or false? A strict vegetarian diet lacks amino acids.

• Answer: False. While individual plant proteins may be incomplete, a varied vegetarian diet that includes a range of plant proteins throughout the day can provide all essential amino acids.

Water (Page 30)

• Body Composition: Constitutes approximately $60\%$ of an adult's body weight and about $80\%$ of an infant's body weight.

• Daily Loss: Adults typically lose around $2.5$ quarts of water daily through perspiration, urination, and exhalation.

• Fluid Balance: Lost fluid must be replenished to maintain fluid balance.

• Essential Functions:

  • A significant percentage of cellular makeup.

  • An essential component of blood.

  • The solvent for vital chemical reactions.

  • Crucial for controlling body temperature.

Minerals (Page 31)

• Vital Functions:

  • Building bones and teeth.

  • Maintaining muscle tone.

  • Regulating various body processes.

  • Maintaining acid-base balance.

• Absorption: The body's absorption of minerals varies significantly.

Electrolytes (Page 32)

• Composition: Minerals in the form of salts, acids, and bases.

• Essential Functions:

  • Maintaining osmotic pressure balance between cells and surrounding fluid.

  • Helping to maintain normal acid-base balance.

  • Facilitating normal nerve and muscle functioning.

• Major Electrolytes: Sodium, potassium, chloride, magnesium.

Sodium (Na) (Page 33)

• Functions: Fluid and electrolyte balance, acid-base balance, maintaining muscle irritability, regulating cell membrane permeability, and nerve impulse transmission.

• Deficiency: Symptoms include chronic diarrhea, excessive vomiting, renal disorders, nausea, dizziness, muscle cramps, apathy.

• Toxicity: Associated with hypertension, edema.

• Most individuals in the United States consume too much sodium, primarily from fast and processed foods.

Potassium (K) (Page 34)

• Functions: Fluid and electrolyte balance, acid-base balance, nerve impulse transmission, acts as a catalyst for many metabolic reactions, and is involved in skeletal and cardiac muscle activity.

• Deficiency: Manifests as muscular weakness, paralysis, anorexia, confusion (often with dehydration).

• Toxicity (usually from supplements/drugs): Can cause muscular weakness and vomiting.

Chloride (Cl) (Page 35)

• Functions: Fluid and electrolyte balance, acid-base balance, and is a component of hydrochloric acid (HCl) in the stomach.

• Deficiency: Secondary to chronic diarrhea or vomiting and certain renal disorders; symptoms include muscle cramps, anorexia, apathy.

• Toxicity: Normally harmless but can cause vomiting.

• Most intake comes from salt (chloride constitutes $60\%$ of salt).

Magnesium (Mg) (Page 36)

• Functions: Bone formation, nerve transmission, smooth muscle relaxation, protein synthesis, carbohydrate metabolism, and enzyme activity.

• Deficiency: Symptoms include weakness, confusion, growth failure in children. Severe deficiency can lead to convulsions, hallucinations, and tetany.

• Toxicity: None demonstrated from food sources. Supplemental magnesium can cause diarrhea, nausea, and cramping. Excessive magnesium from Epsom salts (magnesium sulfate) can cause diarrhea.

Calcium (Ca) (Page 37)

• Functions: Bone and teeth formation and maintenance, blood clotting, nerve transmission, muscle contraction and relaxation, cell membrane permeability, and blood pressure regulation.

• Deficiency: Impaired growth in children; osteoporosis in adults.

• Toxicity: Constipation, increased risk of renal stone formation, and impaired absorption of iron and other minerals.

• It is the mineral most likely to be deficient in the adult diet.

• Hormones play a crucial role in maintaining blood calcium levels.

Calcium Absorption (Page 38)

• If dietary calcium is insufficient, the body will draw calcium from the bones to maintain blood levels.

• Vitamin D and phosphorus are important for aiding the body's absorption of calcium.

• Common supplemental forms include calcium carbonate and calcium citrate.

Phosphorus (P) (Page 39)

• Functions: Bone and teeth formation and maintenance, acid-base balance, energy metabolism, cell membrane structure, and regulation of hormone and coenzyme activity.

• Deficiency: Unknown (rare).

• Toxicity: Can lead to low blood calcium levels.

Sulfur (S) (Page 40)

• Functions: A component of disulfide bridges in proteins, and a component of biotin, thiamin, and insulin.

• Deficiency: Unknown (rare).

• Toxicity: In animals, excessive intake of sulfur-containing amino acids impairs growth.

Trace Minerals (Page 41)

• These are essential minerals required by the body only in small amounts, but they are crucial for various body processes.

• Examples: Iron, iodine, zinc, selenium, copper, manganese, fluoride, chromium, molybdenum.

Iron (Fe) (Page 42)

• Functions: Oxygen transport via hemoglobin (in red blood cells) and myoglobin (in muscle cells); a constituent of enzyme systems.

• Deficiency: Impaired immune function, decreased work capacity, apathy, lethargy, fatigue, itchy skin, pale nailbeds and eye membranes, impaired wound healing, intolerance to cold temperatures.

• Toxicity: Increased risk of infections, apathy, fatigue, lethargy, joint disease, hair loss, organ damage, enlarged liver, amenorrhea, impotence. Accidental poisoning in children can be fatal.

Iodine (I) (Page 43)

• Functions: A component of thyroid hormones, which regulate growth, development, and metabolic rate.

• Deficiency: Goiter (enlarged thyroid gland), weight gain, lethargy. In the fetus during pregnancy, it can cause cretinism.

• Toxicity: Enlarged thyroid gland, decreased thyroid activity.

Zinc (Zn) (Page 44)

• Functions: Tissue growth, wound healing, sexual maturation and reproduction, a constituent of many enzymes involved in energy and nucleic acid metabolism, immune function, vitamin A transport, and taste perception.

• Deficiency: Growth retardation, hair loss, diarrhea, delayed sexual maturation, impotence, eye and skin lesions, anorexia, delayed wound healing, taste abnormality, mental lethargy.

• Toxicity: Anemia, elevated LDL ("bad cholesterol"), lowered HDL ("good cholesterol"), diarrhea, vomiting, dizziness, fever, impaired calcium absorption, renal failure, muscle pain, reproductive failure.

Selenium (Se) (Page 45)

• Functions: A component of antioxidant enzymes, important for immune system functioning, and thyroid gland activity.

• Deficiency: Enlarged heart, poor heart function, impaired thyroid activity.

• Toxicity (rare): Nausea, vomiting, abdominal pain, diarrhea, hair and nail changes, nerve damage, fatigue.

Copper (Cu) (Page 46)

• Functions: Used in the production of hemoglobin, a component of several enzymes, and involved in energy metabolism.

• Deficiency: Anemia, bone abnormalities.

• Toxicity: Vomiting, diarrhea, liver damage.

Manganese (Mn) (Page 47)

• Functions: Involved in enzymes related to the metabolism of carbohydrates, protein, and fat, and bone formation.

• Deficiency: Rare.

• Toxicity (rare): Nervous system disorders.

Fluoride (Fl) (Page 48)

• Functions: Formation and maintenance of tooth enamel, promotes resistance to dental decay, and bone formation and integrity.

• Deficiency: Increased susceptibility to dental decay. May increase the risk of osteoporosis.

• Toxicity: Fluorosis (discoloration or pitting of tooth enamel), nausea, vomiting.

Chromium (Cr) (Page 49)

• Functions: Cofactor for insulin, enhancing its action.

• Deficiency: Insulin resistance, impaired glucose tolerance.

• Toxicity: Dietary toxicity is unknown. Occupational exposure to chromium dust can cause damage to the skin and kidneys.

Molybdenum (Mo) (Page 50)

• Functions: A component of many enzymes, and works with riboflavin to incorporate iron into hemoglobin.

• Deficiency: Unknown (rare).

• Toxicity: Occupational exposure to molybdenum dust can cause gout-like symptoms.

Sodium Intake and Health Risks (Page 51-52)

• Question #3: Is the following statement true or false? Populations who have a high intake of sodium are at greater risk for hypertension and cardiovascular disease.

• Answer: True. High sodium intake is linked to hypertension and cardiovascular disease. It may also increase osteoporosis risk by promoting increased urinary calcium excretion. While some sodium comes from naturally occurring sources, a major portion is from processed and "fast" foods.

Vitamins (Page 53)

• Composition: Organic substances consisting of carbon, oxygen, hydrogen, and sometimes nitrogen or other elements.

• Nature: They can be converted to other forms and are susceptible to oxidation and destruction.

• Coenzyme Role: Most vitamins function as coenzymes, facilitating enzyme activity.

• Loss: Some vitamins are lost due to air exposure, prolonged food storage, or high temperatures.

• Food Preparation: Avoid discarding nutrient-rich portions of foods.

• Hypervitaminosis: A condition resulting from excessive vitamin intake, typically from supplements.

Vitamin Sources and Types (Page 54)

• Sources: Naturally found in food, supplements are also available.

• Variability: Each vitamin differs in solubility, absorption, blood transport, storage, and excretion properties.

• Two Basic Types:

  • Fat-Soluble: Vitamins A, D, E, K.

  • Water-Soluble: Vitamin C and B-complex vitamins.

Fat-Soluble Vitamins: Vitamin A (Retinol, Beta-Carotene) (Pages 55-57)

• Functions: Essential for the eye's adaptation to dim light, normal growth and development of bones and teeth, formation and maintenance of mucosal epithelium for healthy skin, membranes, hair, gums, and various glands, and has a role in immune function.

• Deficiency: Leads to night blindness, slow recovery of vision after bright light exposure, cessation of bone growth, changes in bone shape, malfunctioning enamel-forming cells in teeth (leading to cracks and decay), dry, scaly, rough, and cracked skin, keratinization or hyperkeratosis, flattening and hardening of mucous membrane cells, xerosis (irreversible drying and hardening of the cornea), decreased saliva and mucous secretion in the stomach and intestines, and increased susceptibility to respiratory, urinary tract, and vaginal infections.

• Toxicity: Symptoms include headaches, vomiting, double vision, hair loss, bone abnormalities, liver damage, and can cause birth defects during pregnancy.

Fat-Soluble Vitamins: Vitamin D (Calciferol) (Pages 58-60)

• Functions: Maintains serum calcium concentrations by stimulating gastrointestinal absorption of calcium, stimulating the release of calcium from bones, and stimulating calcium reabsorption from the kidneys.

• Deficiency: In children, causes rickets (retarded bone growth, bone malformations, enlargement of long bone ends, rib deformities, delayed fontanel closure, decreased serum calcium/phosphorus, malformed/decayed teeth, abdominal protrusion due to muscle relaxation, increased parathyroid hormone secretion). In adults, causes osteomalacia (softening of bones, decreased serum calcium/phosphorus, increased alkaline phosphatase, involuntary muscle twitching and spasms).

• Toxicity: Can lead to kidney stones, irreversible kidney damage, muscle and bone weakness, excessive bleeding, loss of appetite, headache, excessive thirst, calcification of soft tissues, and potentially death.

Fat-Soluble Vitamins: Vitamin E (Alpha-Tocopherol) (Page 61)

• Functions: Not fully understood, but acts as an antioxidant protecting vitamins A, C, and polyunsaturated fatty acids from destruction, and protects cell membranes.

• Deficiency: Rare. Can cause increased red blood cell hemolysis, and in infants, anemia, edema, and skin lesions.

• Toxicity: Relatively nontoxic. High doses can enhance the action of anticoagulant medications.

Fat-Soluble Vitamins: Vitamin K (Menadione) (Page 62)

• Functions: Essential for the synthesis of blood clotting proteins and the synthesis of bone protein that regulates blood calcium.

• Deficiency: Leads to hemorrhaging.

• Toxicity: No symptoms observed with excessive vitamin K intake.

• Clinical Note: Monitor diet if taking anticoagulants due to potential interaction.

Water-Soluble Vitamins: Vitamin C (Ascorbic Acid) (Page 63)

• Functions: Collagen synthesis, acts as an antioxidant, promotes iron absorption, involved in the metabolism of certain amino acids, thyroxin synthesis, and immune system functioning.

• Deficiency: Symptoms include bleeding gums, pinpoint hemorrhages under the skin, scurvy, delayed wound healing, reopening of wounds, softening of bones, soft and loose teeth, anemia, increased susceptibility to infection, hysteria, and depression.

• Toxicity: Can cause diarrhea, abdominal cramps, nausea, headache, insomnia, fatigue, hot flashes, and aggravation of gout symptoms.

Water-Soluble Vitamins: Thiamin (Vitamin B1) (Page 64)

• Functions: Acts as a coenzyme in energy metabolism, promotes normal appetite, and supports nervous system functioning.

• Deficiency: Causes beriberi, characterized by mental confusion, decreased short-term memory, fatigue, apathy, peripheral paralysis, muscle weakness and wasting, painful calf muscles, anorexia, weight loss, edema, enlarged heart, and can lead to sudden death from heart failure.

• Toxicity: No toxicity symptoms have been reported.

Water-Soluble Vitamins: Riboflavin (Vitamin B2) (Page 65)

• Functions: Functions as a coenzyme in energy metabolism and aids in the conversion of tryptophan into niacin.

• Deficiency: Symptoms include dermatitis, cheilosis (cracking at the corners of the mouth), glossitis (inflammation of the tongue), photophobia (light sensitivity), and reddening of the cornea.

• Toxicity: No toxicity symptoms have been reported.

Water-Soluble Vitamins: Niacin (Vitamin B3) (Page 66)

• Functions: Serves as a coenzyme in energy metabolism and promotes normal nervous system functioning.

• Deficiency: Causes pellagra, characterized by the "4 Ds": dermatitis (skin inflammation), diarrhea, dementia (irritability, mental confusion), and eventually death.

• Toxicity (from supplements/drugs): Can lead to flushing, liver damage, gastric ulcers, low blood pressure, diarrhea, nausea, and vomiting.

Water-Soluble Vitamins: Pyridoxine (Vitamin B6) (Page 67)

• Functions: Coenzyme in amino acid and fatty acid metabolism, aids in converting tryptophan to niacin, and helps produce insulin, hemoglobin, the myelin sheath, and antibodies.

• Deficiency: Results in dermatitis, cheilosis, glossitis, abnormal brain wave patterns, convulsions, and anemia.

• Toxicity: Can cause depression, fatigue, irritability, headaches, and characteristic sensory neuropathy.

Water-Soluble Vitamins: Folate/Folic Acid (Vitamin B9) (Page 68)

• Functions: Acts as a coenzyme in DNA synthesis, vital for new cell synthesis, and the transmission of inherited characteristics.

• Deficiency: Leads to glossitis, diarrhea, macrocytic anemia, depression, mental confusion, fainting, and fatigue.

• Toxicity: Excessive intake can mask a vitamin B12 deficiency, making it harder to diagnose.

Water-Soluble Vitamins: Cobalamin (Vitamin B12) (Page 69)

• Functions: Serves as a coenzyme in the synthesis of new cells, activates folate, maintains nerve cells, and helps metabolize some fatty acids and amino acids.

• Deficiency: Causes gastrointestinal changes, glossitis, anorexia, indigestion, recurring diarrhea or constipation, weight loss, anemia, and neurological changes.

• Toxicity: No toxicity symptoms have been reported.

Water-Soluble Vitamins: Pantothenic Acid (Page 70)

• Functions: A component of coenzyme A, which is crucial in energy metabolism.

• Deficiency (rare): Can lead to a general failure of all body systems.

• Toxicity: No toxicity symptoms have been reported, although large doses may cause diarrhea.

Water-Soluble Vitamins: Biotin (Page 71)

• Functions: Acts as a coenzyme in energy metabolism, fatty acid synthesis, amino acid metabolism, and glycogen formation.

• Deficiency: Symptoms include anorexia, fatigue, depression, dry skin, and heart abnormalities.

• Toxicity: No toxicity symptoms have been reported.

Vitamin C Identification (Page 72-73)

• Question #4: Which vitamin is also referred to as ascorbic acid?

• Answer: C. Vitamin C. Vitamin A is retinol. Vitamin B2 is riboflavin. Vitamin D is calciferol. Vitamin E is alpha-tocopherol.

Prebiotics and Probiotics (Page 74)

• Prebiotics: Nondigestible food ingredients that selectively nourish beneficial probiotic bacteria.

  • Examples: Resistant starch found in raw potatoes and unripe fruits, such as bananas.

• Probiotics: Healthy live bacteria.

  • Sources: Kefir, yogurt, and certain cheeses.

• Combined Benefit: Prebiotics and probiotics work synergistically to maintain a healthy digestive system and may enhance immune function.

Creating a Healthy Diet (Page 75)

• Goal: To provide adequate amounts of all essential nutrients for growth, development, physical activity, and health maintenance.

• Customization: Should satisfy personal, social, and cultural needs.

• Key Concepts: Variety, moderation, and balance.

• Available Resources for Clients:

  • Nutrition facts label.

  • Ingredients list.

  • MyPlate.com.

The Nutrition Facts Label (Page 76-78)

• Key Information:

  • Serving Size: Reflects actual consumption patterns. Single-serving packages are labeled as such (e.g., a $20$-ounce soda). Multi-serving packages may list amounts "per serving" and "per package."

  • Calories and Serving Sizes: Prominently displayed to help monitor intake, especially for conditions like diabetes, obesity, and cardiovascular disease.

  • Percent Daily Value (%DV): Indicates how much a nutrient in a serving contributes to a daily diet based on a $2,000$-calorie reference. It helps consumers understand nutrient content in context.

  • Fats: Nutrition science emphasizes the type of fat over total caloric fat. The label lists Total Fat, Saturated Fat, and Trans Fat.

  • Cholesterol: Listed due to its public health significance regarding cardiovascular disease and strokes. The body produces sufficient cholesterol, so dietary intake is not essential.

  • Public Health Nutrients: Required to be declared due to associations with common health concerns (diabetes, obesity, heart disease). These include Calcium, Iron, Potassium, and Vitamin D. Vitamins A and C may be voluntarily listed.

  • Dietary Fiber: Also known as roughage or bulk, a carbohydrate type the body can't digest. Assists food passage through intestines. Classified as soluble (dissolves in water; e.g., peas, beans, apples, psyllium) or insoluble (remains intact; e.g., whole-wheat flour, wheat bran, nuts, seeds, fruit/vegetable skins).

  • Added Sugars: Sugars added during processing, providing calories but no nutrients ("empty calories"). These are now explicitly listed.

  • Footnote: Explains the meaning of %DV in relation to calorie needs.

  • Ingredients List: Crucial to check for different names for common items like sugar (e.g., beet sugar, corn syrup, many others). Be aware if similar ingredients are listed multiple times, as the actual content may be higher than perceived. Use the list to avoid unhealthy ingredients or common allergens.

Diet Planning (Page 79)

• Nutritional Problems:

  • Most often stem from overconsumption and imbalances.

  • Contribute to chronic conditions: heart disease, certain types of cancer, stroke, diabetes mellitus.

  • Overnutrition also contributes to hypertension, osteoporosis, dental caries, gastrointestinal diseases, and obesity.

  • Diets high in calories, fat, cholesterol, and sodium, and low in complex carbohydrates and fiber are linked to high rates of chronic diseases.

Health and Body Weight (Page 80)

• Body Weight Assessment:

  • Ideal Body Weight vs. Healthy Body Weight: Distinguishing between an idealized aesthetic weight and a weight range conducive to good health.

  • Body Mass Index (BMI): Calculated as weight in kilograms divided by the square of height in meters: $\text{BMI} = \frac{\text{Weight (kg)}}{\text{Height (m)}^2}$.

    • Limitations: Does not account for body composition (e.g., muscle mass, higher bone density).

    • Obese BMI: $30$ to $40$ kg/m$^2$

    • Very Obese BMI: >$40$ kg/m$^2$

Overweight and Obesity (Page 81)

• Considered an epidemic.

• Overweight: Defined as being $10\%$ to $20\%$ over ideal weight.

• Obesity: Characterized by an excessive amount of body fat.

• Adolescent Obesity: A significant concern due to potential lifelong complications.

Malnutrition (Page 82)

• Undernutrition: May result from inadequate food intake, or alterations in nutrient digestion, absorption, or metabolism.

• Protein Deficiencies:

  • Protein–Calorie Malnutrition (PCM): A severe form of malnutrition.

  • Marasmus: Severe wasting of fat, muscle, and other tissues, typically due to prolonged inadequate intake of calories and protein.

  • Kwashiorkor: Characterized by edema, typically due to a severe protein deficiency despite adequate caloric intake.

• (Refer to Box 30-5 for further details).

Nutrition Across the Lifespan: Pregnancy (Page 83)

• Key Nutrients: Adequate intake of protein, iron, calcium, vitamin D, and folic acid is especially critical.

• Calorie Needs: Generally increase by only $300\ \text{kcal/day}$ during the second and third trimesters.

• Gestational Diabetes Mellitus (GDM):

  • Family history of diabetes increases risk.

  • Screening recommended between weeks $24$ and $28$.

  • If positive, requires close monitoring and a special diet.

  • Increased risk of developing type 2 diabetes later in life.

Nutrition Across the Lifespan: Infants (Page 84)

• Growth Rate: The most rapid growth occurs during the first year of life.

• Breast Milk: Provides all essential nutrients in optimal amounts and is easily digestible.

• Infant Formulas: Designed to resemble breast milk, though they typically lack docosahexaenoic acid (DHA), which promotes cognitive brain development.

• Feeding: Should be on demand.

• Solid Foods: Introduce after $6$ months of age, one new item at a time for $5$ to $7$ days. Decrease milk intake as solid food consumption increases.

Nutrition Across the Lifespan: Childhood (Pages 85-86)

• Eating Habits: Permanent eating habits typically form during childhood.

• Appetite: Fluctuates widely.

• Food Preferences: May change; avoid bribing children to eat.

• Meal Environment: Minimize distractions and noise during meals.

• Fat Intake: Fat is an important energy source for children due to small stomach capacities and high energy demands.

• Portion Control: Children should not be required to "clean their plates" but rather stop eating when no longer hungry.

• Common Nutritional Problems: Iron deficiency anemia and obesity.

• Obesity Treatment: Focus on reducing junk food and fast food intake, providing smaller servings of nutritious food, and increasing physical activity.

Nutrition Across the Lifespan: Adolescence (Page 87)

• Growth: A period of rapid growth accompanied by an enormous appetite.

• Nutrient Needs: Requires extra food to meet the demands of growth and development.

• Recommendations: Encourage nutritious snacks and meals, and avoid skipping meals.

• Autonomy: Allow adolescents to make food choices to foster healthy habits.

• Iron Deficiency Anemia: Problematic for girls after the onset of menses and for boys during growth spurts; supplements may be necessary.

Nutrition Across the Lifespan: Early and Middle Adulthood (Page 88)

• Physiological Changes: Beginning in young adulthood, muscle and bone mass decline, and the proportion of fat tends to increase.

• Activity Levels: Physical activity may decrease, leading to a reduction in calorie requirements.

• Weight Management: Being overweight can become a significant issue.

• Dietary Focus: Important to prioritize nutrient-dense foods to prevent overeating and maintain health.

Nutrition Across the Lifespan: Older Adulthood and Aging (Page 89)

• Impact of Lifelong Habits: Poor eating habits over a lifetime contribute to many degenerative disorders, such as diabetes, osteoporosis, hypertension, and atherosclerosis.

• Risk Factors for Nutritional Problems: Older adults are at increased risk due to various changes:

  • Physiologic: Difficulty chewing, changes in taste and smell, decreased thirst sensation, constipation.

  • Economic: Limited income affecting food choices.

  • Psychosocial: Social isolation, depression.

  • Medical: Impaired mobility, various medications affecting appetite or nutrient absorption.

Special Considerations: Lifespan #1 (Page 90)

• Vitamin B12: Adults older than $50$ years may require supplements.

• Common Deficiencies in Adults: May consume adequate calories but still be deficient in calcium, potassium, fiber, magnesium, carotenoids, and vitamins C and E.

• Common Deficiencies in Children/Adolescents: May have insufficient intake of calcium, potassium, fiber, magnesium, and vitamin E.

• Pregnant Women - Iron: Should consume foods high in heme iron and/or iron-rich plant foods or iron-fortified foods alongside a vitamin C-rich enhancer for optimal absorption.

• Pregnant Women - Folic Acid: Adequate synthetic folic acid intake daily is crucial during the first trimester.

Special Considerations: Lifespan #2 (Page 91)

• Vitamin D: Older adults, individuals with dark skin, and those with insufficient exposure to ultraviolet (UV) radiation (e.g., limited sunlight) should ensure extra vitamin D intake.

• Dietary Fat for Older Adults: Should choose a diet low in total fat, saturated fat, trans fat, and cholesterol.

• Calcium Supplements: Should be considered for individuals older than $35$ years to help prevent osteoporosis.

• Taste Changes in Older Adults: May experience decreased ability to differentiate tastes like salts and sugars. They might compensate by increasing intake, which elevates risks of hypertension, dental caries, displacement of nutrient-dense foods, and weight gain.

Patient Education and Chronic Conditions (Page 92-93)

• Question #5: Is the following statement true or false? The nurse should provide education to each client to ensure proper nutrition is achieved to help prevent chronic conditions.

• Answer: True. Practicing good nutritional habits across the lifespan is fundamental for maintaining a healthy body and reducing the risk of chronic conditions. Education is the cornerstone of good nutrition, and good nutrition is the cornerstone of good health.