NDT

VITAMINS

Vita = life, amine = nitrogen compound (Casimir Funk in 1912)
NOT ALL vitamins contain nitrogen
Group of unrelated organic compounds.
Crucial in growth, repair, and healthy functioning but do not give energy to the body.
Taking extra vitamins cannot increase one’s physical capacity. However, shortage of vitamins can cause fatigue.
The human body cannot make its own vitamins except vitamin D and Niacin.
Shortness of vitamins particularly A, B, and C may result in loss of appetite and can be restored by taking more.

TERMS ASSOCIATED WITH VITAMINS

PRECURSOR OR PROVITAMINS

Are compounds that can be changed to active vitamins.

PREFORMED VITAMINS

Are naturally occurring vitamins that are in inactive form and ready for biological use.

AVITAMINOSIS

Refers to a condition resulting from lack of a vitamin.
In a later stage of this condition, a nutritional deficiency disease is recognizable.

HYPERVITAMINOSIS

Referred to as “vitamin toxicity”.

VITAMIN MALNUTRITION

Too much or too little vitamin is not good for health.

VITAMIN-LIKE COMPOUNDS

Some substances have physiological roles like vitamins but are present in larger amounts and are partially synthesized by the body.

ANTIVITAMINS OR VITAMIN ANTAGONIST

Substances that interfere with the normal functioning of a vitamin.
Needs to be similar in chemical composition as the vitamin they “antagonize”.

VITAMIN (WATER-SOLUBLE) AND THEIR TOXICITY FROM OVERDOSE

NIACIN

Skin burning, Flushing, Itching, Nausea, Vomiting, Diarrhea, Liver and eye damage.

VITAMIN B12

Allergic shock, Especially when vitamin is injected.

CLASSIFICATION OF VITAMINS

Fat-Soluble Vitamins (A, D, E, K)

Absorbed with fats, stored in liver/adipose tissue.
Stable in heat light.
Deficiency develops slowly.

Water-Soluble Vitamins (B-complex, C)

Not stored significantly; excess excreted via urine.
Need daily.
Destroyed easily by cooking and oxidation.

FAT-SOLUBLE VITAMINS OVERVIEW

VITAMIN A (Retinol)

Functions: Vision (rhodopsin), epithelial maintenance, bone growth reproduction.
Deficiency: Night blindness, xerophthalmia (eye fails to produce tears), Bitot’s spot (a sharply defined, gray or white lesion involving the exposed portion of the bulbar conjunctiva), skin lesions (phrynoderma).
Sources: Liver, Dairy, Leafy vegetables, Yellow/orange fruits.
Toxicity: Liver damage, Hair loss, Bone damage, Potential birth defects.

VITAMIN D (Calciferol)

Functions: Calcium and phosphorus absorption, bone/teeth formation.
Deficiency: Rickets (children with weak bones), osteomalacia (adults with weak bones), tetany (involuntary contraction of muscles).
Sources: Sunlight, Fortified milk, Fish oil liver.
Toxicity: Severe high blood calcium (hypercalcemia), Brain damage, Heart damage, Potential birth defects.

VITAMIN E (Tocopherol)

Functions: Antioxidant, Protects vitamins A and C.
Deficiency: Hemolysis of RBCs, reproductive issues in animals.
Sources: Vegetable oils, nuts, green leafy vegetables.
Toxicity: Cramps, Diarrhea, Dizziness, Blurred vision, Headaches, Increased serum triglyceride level in women, decreased serum thyroid hormone level in men and women.

VITAMIN K (Phylloquinone/Menadione)

Functions: Blood clotting (prothrombin synthesis), bone metabolism.
Deficiency: Bleeding, Especially in newborns.
Sources: Leafy greens, liver, intestinal bacteria synthesis.
Toxicity: Formation of blood clots, Jaundice in infants.

WATER-SOLUBLE VITAMINS OVERVIEW

VITAMIN C (Ascorbic Acid)

Functions: Collagen synthesis, antioxidant, iron absorption, Immune support.
Deficiency: Scurvy - bleeding gums, loose teeth, poor wound healing.
Sources: Citrus fruits, Tomatoes, Green vegetables.
Toxicity: Diarrhea, Nausea, Cramps, Acids in urine, Intestinal obstruction, False positive urine diabetic test.

B-COMPLEX VITAMINS

Grouped by functions:
Group 1. Classic Disease Factors

Thiamine (B1): Prevents beriberi (low levels of thiamine), supports nerve and heart.

Carb metabolism, nerve function.

Deficiency: Beriberi, fatigue, nerve problems.
Sources: Pork, whole grains, legumes.

Riboflavin (B2): Energy metabolism, skin/eye health.

Deficiency: Glossitis, cheilosis, photophobia.
Sources: Dairy, leafy greens, liver.

Niacin (B3): Energy metabolism, skin health.

Deficiency: Pellagra (4 D’s: diarrhea, dermatitis, dementia, death).
Sources: Meat, fish, legumes, enriched grains.

Group 2. Coenzyme Factors

Pyridoxine (B6): Protein metabolism, brain function.

RBC production

Deficiency: Irritability, convulsions (infants), anemia.
Sources: Whole grains, bananas, nuts, legumes.

Pantothenic Acid (B5): Component of coenzyme A, metabolism.

Energy metabolism.

Deficiency: Rare; fatigue, GI upset.
Sources: Meats, eggs, whole grains.

Biotin (B7): Fat and carbohydrate metabolism.

Deficiency: Rare; scaly rash, hair loss.
Sources: Eggs, nuts, liver.

Lipoic Acid: Aids in energy production (not essential in diet).

Group 3. Blood and Cell Growth

Folic Acid (B9): DNA synthesis, RBC maturation.

Deficiency: Megaloblastic anemia, poor growth.
Sources: Leafy greens, legumes, liver.

Cobalamin (B12): Nerve function, RBC production; only found in animal products.

Deficiency: Pernicious anemia, nerve damage.
Sources: Animal products (meat, eggs, dairy).

Group 4. Related Compounds

Inositol & Choline: Cell membrane health, fat metabolism.

MINERALS

- Inorganic nutrients required in small (trace) or large (macro) amounts.

MACRO MINERALS (100mg/day)

Calcium: Bone/teeth health, muscle contraction, clotting.

Deficiency: Rickets, osteoporosis.
Sources: Dairy, green vegetables, fish bones.

Phosphorus: Works with calcium (Bone formation), energy metabolism.

Deficiency: Rare.
Sources: Dairy, meat, legumes.

Magnesium: Enzyme function, nerve/muscle health.

Deficiency: Muscle cramps, cardiac issues.
Sources: Nuts, whole grains, leafy greens.

Sodium: Fluid balance, nerve impulse transmission.

Deficiency: Hyponatremia, confusion, seizures.
Sources: Salt, processed foods.

Potassium: Muscle function, acid-base balance.

Deficiency: Weakness, arrhythmias.
Sources: Bananas, leafy greens, legumes.

Chloride: Electrolyte and fluid balance.

Deficiency: Alkalosis.
Sources: Table salt, seafoods.

Sulfur: Protein structure (disulfide bonds), Detoxication.

Sources: Protein-rich foods (meat, eggs).

TRACE MINERALS (<100mg / day)

Iron: Hemoglobin, myoglobin; deficiency leads to anemia.

Oxygen transport.

Deficiency: Anemia (fatigue, pallor).
Sources: Liver, meats, leafy greens, legumes.

Zinc: Wound healing, immune function, taste.

Growth

Deficiency: Poor growth, immune issues, taste loss.
Sources: Meat, eggs, legumes, whole grains.

Iodine: Thyroid hormone production; deficiency causes goiter.

Deficiency: Goiter, cretinism.
Sources: Iodized salt, seafood.

Copper: RBC formation, iron metabolism.

Enzyme cofactor.

Deficiency: Anemia, neurological symptoms.
Sources: Organ meats, shellfish, nuts.

Cobalt: Component of vitamin B12.

Deficiency: Linked to B12 deficiency.
Sources: Animal products.

Manganese: Enzyme cofactor in metabolism.

Sources: Whole grains, nuts, leafy veggies.

Molybdenum: Enzyme cofactor (xanthine oxidase).

Sources: Legumes, grains.

Chromium, Selenium, Vanadium, Nickel, Tin, Silicon: Enzyme cofactors.

Various roles in bone health, metabolism, antioxidant function.

Sources: Vary widely depending on mineral.

Fluoride: Tooth enamel strengthening.

Sources: Vary widely depending on mineral.

IMPORTANT CONCEPTS

Deficiency and Toxicity: Both can impair body function and health.
Interactions: Vitamin and mineral absorption often interdependent.
Food Preparation: Cooking methods affect nutrient retention–prefer steaming or minimal cooking for vitamin-rich foods.

PROCESS OF METABOLISM

METABOLISM

is the sum of chemical processes that maintain life. It includes:

Catabolism: breaking down molecules (e.g., glucose) for energy.
Anabolism: synthesizing complex molecules like proteins and nucleic acids.

BIOENERGETICS

focuses on how cells obtain energy from nutrients.

NUTRIENTS

support metabolism by providing energy and building blocks. Essential nutrients include carbohydrates, proteins, fats, vitamins, minerals, and water.

CARBOHYDRATES:

Main energy source (starch, sugar, fiber).
Glucose is the primary fuel; its oxidation releases energy.

PROTEINS:

Build and repair tissues, form enzymes, and provide nitrogen for DNA/RNA.
8 essential amino acids must be obtained from the diet.
High biological value sources: eggs, milk, soy, meats.

FATS:

Provide twice the energy per gram as carbs/proteins.
Functions: energy reserve, organ protection, vitamin absorption.
Essential fatty acids (e.g., linoleic acid) must be consumed through diet.

VITAMINS AND MINERALS

Do not yield energy but are vital as coenzymes or regulators in metabolic pathways.

ENZYMES

Act as biological catalysts in metabolic pathways, increasing reaction efficiency and allowing regulation.

PHYSIOLOGIC VALUE OF FOOD

FOOD

provides essential compounds—proteins, fats, carbohydrates, vitamins, and minerals—used for body maintenance, energy, and regulation.

ENERGY FROM FOOD:

Measured in kilocalories (kcal). 1 kcal = heat needed to raise 1 kg of water by 1°C.

FUEL VALUES

Carbohydrate: 4 kcal/g
Protein: 4 kcal/g
Fat: 9 kcal/g

ENERGY CALCULATION

Multiply nutrient grams by their fuel factor.

Example: Milk (12g CHO × 4) + (8g protein × 4) + (10g fat × 9) = 170 kcal.

BASAL METABOLISM

Minimum energy required to sustain vital body functions at rest.
Affected by body size, age, sex, muscle mass, and endocrine factors.

METHODS TO ESTIMATE THE BMR

Rule of thumb: 1 kcal/kg/hr (men), 0.9 kcal/kg/hr (women)
Harris-Benedict Equation
Metabolic body size
FAO/WHO/UNU formula

DAILY ENERGY REQUIREMENT

Includes BMR + physical activity + SDA (specific dynamic action).
SDA accounts for digestion and nutrient processing (usually 10% of total).

DESIRED BODY WEIGHT (DBW)

Calculated using formulas like Ador Dionisio’s and Tannhauser’s.

ACTIVITY AND ENERGY NEEDS

Sedentary to very heavy activity alters calorie requirements.
Energy balance is achieved when intake = expenditure.

WATER AND ELECTROLYTE BALANCE

WATER

Vital for life; comprises 60–70% of body weight.

FUNCTIONS:

Universal solvent, catalyst in biochemical reactions, body temperature regulation, joint lubrication, nutrient transport.

WATER INTAKE SOURCES

Direct consumption, food content, and metabolic water (oxidation of macronutrients).

WATER LOSS

Occurs via urine, sweat, feces, respiration, and abnormal conditions (vomiting, burns).

FLUID REQUIREMENTS

Vary based on age, weight, and energy needs. Methods include:
- Holliday-Segar formula
- Body weight-based estimates

ELECTROLYTES:

Cations: Sodium (Na⁺), Potassium (K⁺), Calcium (Ca²⁺), Magnesium (Mg²⁺)
Anions: Chloride (Cl⁻), Bicarbonate (HCO₃⁻), Phosphate (HPO₄⁻)

BALANCE REQUIREMENTS

Dehydration: Risky if >10% water loss.
Overhydration: Can lead to water intoxication, especially with electrolyte imbalance.

ELECTROLYTE BALANCES

Maintained by kidneys and hormonal regulation (e.g., ADH, aldosterone).
Vital in nerve transmission, muscle function, pH balance.

NUTRITIONAL ASSESSMENT

NUTRITIONAL STATUS

Refers to the state of balance between nutrient intake and body needs.

ASSESSMENT STATUS

Dietary Intake:
- 24-hour recall
- Food frequency questionnaire
- Food diary
- Observation
Clinical Examination:
- Signs of nutrient deficiencies (e.g., Bitot’s spot, moon face, edema, goiter)
Anthropometry:
- Weight-for-age, height-for-age, weight-for-height, BMI, MUAC.
- Classifies degrees of malnutrition (e.g., underweight, stunted, wasted).
Biochemical Tests:
- Blood and urine analysis (e.g., hemoglobin, albumin, vitamin levels).
- Detects subclinical deficiencies before physical signs appear.
Psychosocial Factors:
- Income, education, food access, cultural practices.

COMMON NUTRITIONAL DISORDERS

PEM: Marasmus, kwashiorkor
Micronutrient Deficiencies: Vitamin A deficiency, anemia, goiter

SURVEY METHODS

Direct (clinical, biochemical, anthropometric)
Indirect (food supply, socioeconomic conditions, cultural influences)

PREGNANCY AND LACTATION

PREGNANCY

is a period of increased nutritional demand due to fetal development and maternal tissue growth.

TRIMESTERS

1st trimester: implantation and early organ formation.
2nd trimester: organ development and early growth.
3rd trimester: rapid fetal growth and nutrient storage.

NUTRITIONAL OBJECTIVES

Ensure adequate nutrition before, during, and after pregnancy.
Support maternal health and fetal development.
Prepare for successful lactation.

NUTRIENT NEEDS IN PREGNANCY

Energy: Additional ~300 kcal/day in 2nd and 3rd trimesters.
Protein: Increased for fetal/maternal tissue formation.
Folic acid: Crucial for neural tube development; prevents birth defects.
Iron: To support increased blood volume and prevent anemia.
Calcium & Vitamin D: For fetal skeletal development.
Other vitamins/minerals: B-complex, iodine, zinc.

COMMON ISSUES

Nausea and vomiting: Frequent small meals, avoiding triggers.
Heartburn: Smaller meals, avoiding spicy/fatty foods.
Constipation: High fiber diet and hydration.

LACTATION

Lactation requires even more nutrients than pregnancy to maintain milk production.
Energy needs: Increase by ~500 kcal/day during the first 6 months.
Protein, calcium, fluids: Higher demand to ensure high-quality milk production.
Micronutrient intake should be sufficient to avoid maternal deficiencies.

BREASTFEEDING INFANTS

For infant: Provides immunity, ideal nutrition, aids bonding.
For mother: Promotes uterine involution, burns extra calories, delays ovulation.

NUTRITION DURING INFANCY AND BABY

INFANCY (0 TO 12 MONTHS)

Exclusive breastfeeding for first 6 months.
Complementary feeding starts at 6 months: soft, mashed foods with continued breastfeeding.
Formula feeding: Used if breastfeeding isn’t possible; must be iron-fortified.
Common issues: colic, allergies, growth monitoring.

TODDLERS AND PRESCHOOLERS

Introduce varied textures and flavors.
Emphasize self-feeding, family meals, and food variety.
Nutrient-dense meals needed for growth, especially:
- Protein
- Calcium
- Iron
- Vitamins A, C, and D

SCHOOL-AGE CHILDREN

Balanced diet: Protein, whole grains, fruits, vegetables, dairy.
Avoid overreliance on junk food.
Physical activity should be encouraged to prevent obesity.

NUTRITION DURING ADOLESCENCE

ADOLESCENCE

is a period of rapid physical, hormonal, and emotional changes.

NUTRIENT NEED INCREASE TOP SUPPORT

Growth spurts
Muscle mass development
Menstruation (iron)

COMMON CONCERNS

Peer influence on eating habits
Skipping meals (especially breakfast)
Eating disorders (anorexia nervosa, bulimia)

KEY NUTRIENTS

Calcium and vitamin D (bone development)
Iron (especially for menstruating females)
Protein, B vitamins, and zinc

NUTRITION DURING ADULT (ADULTHOOD)

ADULTHOOD

spans from 21 to 50 years. This stage emphasizes maintaining health, preventing degenerative diseases, and sustaining desirable body weight (DBW).

NUTRITIONAL GOALS

Maintain DBW through balanced calorie intake.
Prevent chronic diseases like hypertension, diabetes, and hyperlipidemia.
Adjust caloric intake with age and physical activity—caloric needs decrease with age (approx. 3% per decade).

PROTEIN NEEDS

1.2 g/kg body weight to support tissue repair.

MICRONUTRIENTS:

Adequate intake of iron, calcium, vitamin D, and vitamin C is essential.

PREVENTIVE TIPS

Eat a variety of foods.
Minimize saturated fat, sugar, and sodium.
Maintain physical activity.
Moderate alcohol consumption.

NUTRITION IN AGING (ELDERHOOD)

ELDERHOOD

begins post-middle age. Physiological changes include:

Reduced salivation and taste perception.
Gastrointestinal changes (decreased stomach acid, enzyme production).
Slower metabolism and lower BMR.

DIETARY ADJUSTMENTS

Softer, easy-to-digest meals.
More fiber and water to combat constipation.
Less fat, sugar, and sodium.

COMMON ISSUE

Poor appetite, chewing/swallowing difficulty, nutrient deficiencies (especially calcium, vitamin D, iron, and B12).

HEALTHY AGING GAPES

Consume whole grains, legumes, and vitamin-rich fruits and vegetables.
Maintain hydration (6–8 glasses/day).
Engage in light physical activity.

INTRODUCTION OF THERAPEUTIC NUTRITION

THERAPEUTIC NUTRITION

is used to:

Supply optimal nutrition during illness.
Aid tissue repair.
Modify organ workload (e.g., low-protein diets for kidney disease).

FACTORS IN DIET PLANNING

Disease severity and type.
Required food consistency or nutrient modification.
Individual preferences and tolerances.
Nutritional adequacy and patient capabilities.

EFFECTS OF ILLNESS

Increases nutrient requirements.
Often reduces food intake due to anorexia, nausea, or pain.
Fever raises energy and protein needs.

NURSING ROLE

Assist with feeding and food planning.
Monitor intake and weight.
Reinforce diet education from the dietitian or physician.

NUTRITION AND DIET THERAPY IN INFECTION AND FEVER

Infection & Fever: Raise metabolic rate and nutrient needs.
Dietary Goals:
- High energy and high protein to compensate for catabolism.
- Extra vitamins and minerals—especially vitamin C and B-complex—for healing.
IV Therapy: Initially used for hydration and electrolytes in severe cases.
Transition to Oral Feeding:
- Begin with clear liquids, then full liquids, and gradually to soft and regular diets.
High-risk cases: May need hyperalimentation (parenteral nutrition) especially in severe infections or if GI tract is compromised.

NUTRITION IN SURGERY AND BURNS

SURGERY

PRE- AND POST-OPERATIVE CARE

focuses on:

Meeting increased protein and energy needs.
Managing electrolyte and fluid balance.
Starting oral nutrition as soon as tolerated.

SPECIAL CASES
- Gastric resection: risk of dumping syndrome.
- Cholecystectomy: requires low-fat diets.
- Colostomy/ileostomy: may begin with low-residue diets.

BURNS

Immediate phase (days 1–3): Fluid resuscitation is key.
Recovery phase (days 3–5): Gradual shift to oral hydration and nutrition.
Feeding phase (days 6–15):
- High-protein (150–400 g), high-calorie (3,500–5,000 kcal) diets.
- Increased vitamin intake—especially vitamin C for healing and B-complex for metabolism.
Reconstruction phase:
- Long-term nutritional support for tissue regeneration and plastic surgery outcomes.

THERAPEUTIC DIETS FOR CARDIOVASCULAR DISEASE

ATHEROSCLEROSIS

Cause: Accumulation of cholesterol and fatty materials narrowing arteries, risking clot formation.
Risk Factors: Males 45–64, obesity, diabetes, hypertension, high saturated fat intake, smoking, sedentary lifestyle.
Diet Therapy:
- Low in saturated fat and cholesterol.
- Increase omega-3 (fish oils) and omega-6 (plant oils).
- Limit cholesterol intake to 300 mg/day.
- High in complex carbohydrates and dietary fiber (25–30 g/day).
- Calorie restriction based on gender and activity level.

CONGESTIVE HEART FAILURE

SYMPTOMS

Edema, shortness of breath.

DIET

Sodium-restricted, fluid-limited, low-fat.

HYPERTENSION

DIET

Mild to strict sodium restriction (as low as 1,000 mg), weight reduction, low-fat diet with unsaturated oils.

MYOCARDIAL INFARCTION

DIET

Progress from liquid to regular diet. Limit caffeine, sodium, fat, and cholesterol. Encourage omega-3 intake.

DIABETES MELLITUS

TYPES

Type 1 (Juvenile): Requires insulin.
Type 2 (Adult-Onset): Often linked with obesity and can be diet-controlled.

Symptoms: Polyuria, polydipsia, polyphagia, weight loss.
Diet Therapy:
- Consistent daily carbohydrate intake.
- Emphasis on complex carbs, fiber, and low glycemic index foods.
- Fat and cholesterol moderation.
- Regular meals/snacks to avoid hypo/hyperglycemia.
- Weight management, exercise encouragement.

KIDNEY DISEASES

ACUTE GLOMERULONEPHRITIS

DIET

Adequate protein (unless edema), high-calorie, fluid and sodium regulated.

NEPHROTIC SYNDROME

DIET

High protein (100–150g/day), high-calorie, sodium restriction (~500 mg).

ACUTE RENAL FAILURE (ARF)

PHASES

Oliguric → Diuretic → Recovery.

DIET

Low/moderate protein, high carbohydrates, controlled electrolytes, careful fluid monitoring.

CHRONIC RENAL FAILURE (CRF)

DIET

Protein: 30–50g/day
Carbs: 300–400g/day
Sodium, potassium, and water based on lab values.
Essential amino acid diets for uremia.

RENAL CALCULI (KIDNEY STONES)

DIET

High fluid intake, adjust urinary pH, avoid oxalate-rich foods.

LIVER, GALLBLADDER, AND PANCREATIC DISORDERS

HEPATITIS (A-E)

DIET

High protein (1–2 g/kg BW), energy (2,000–4,000 kcal), moderate fat, vitamin-rich foods.

CIRRHOSIS

COMPLICATIONS

Hepatic coma from excess ammonia.

DIET

Protein-controlled depending on stage, sodium-restricted (ascites), calorie-dense for tissue repair.