Nutrition Chapters:

CH 1

CH 1: Overview of Nutrition and HealthCH 1: Overview of Nutrition and Health

What causes people to choose food:

  1. Preferences

  2. Habit

  3. Associations

  4. Ethnic Heritage & Tradition

  5. Values

  6. Social Interaction

  7. Emotional State

  8. Availability, Convenience, Economy

  9. Age

  10. Occupation

  11. Body Weight & Image

  12. Medical Conditions

  13. Health and Nutrition

WHOLE FOODS: Foods not processed, fat and sugar added, fiber removed.
FORTIFIED FOODS: foods with nutrients added to increase nutritional value
MODIFIED FOODS: known as GMO’s have been genetically altered and not naturally occurring.

6 CLASSES OF NUTRIENTS: Carbohydrates, fats, protein, vitamins minerals, water.

  • CARBOHYDRATES, FATS, PROTEIN:

    • Organic(contain carbon)

    • Energy yielding nutrients

    • Major fuels: carbohydrates and fat.

    • Proteins are used last when other fuels aren’t available.

  • VITAMINS:

    • Organic

    • Are NOT energy yielding

    • Facilitate release of energy

  • WATER:

    • Inorganic medium where all body processes take place

  • MINERALS:

    • Inorganic

    • Are NOT energy yielding

    • Facilitate release of energy

kCalories: Measure of energy
- Carbohydrates: 4 kCal per gram
- Protein: 4 kCal per gram
-Fats: 9 kCal per gram

  • Alchohol:

    • Is not a nutrient

    • 7 kCal per gram

    • K cal from alcohol cause weight gain

MACRONUTRIENT DISTRIBUTION RANGES:
Carbohydrates: 45-65% daily kCal
Fat: 20-35% daily kCal
Protein: 10-35% daily kCal

  • LEADING CAUSES OF DEATH IN U.S:

    • Nutrition related

    • other(chronic disease, accidents, alzheimer’s, etc)

  • DIETARY GUIDELINES FOR U.S:

    • Adequate nutrients

    • Healthy Weight

    • Physical activity

    • Eat healthy foods

    • Reduce saturated and trans fat

    • Choose fiber rich fruits veggies and whole grains

    • Reduce sodium, consume potassium rich foods

    • Drink alcohol moderately

    • Keep foods safe(storing)

  • PHYSICAL ACTIVITY GUIDELINES:

    • 30 mins a day

    • 60 mins or more for maintaining body weight , better health benefits.

NUTRIENT DENSITY: measure of nutrients relative to energy it provides
- More nutrients than calories
- Foods from each group without added fat and sugar.

VEGETARIAN: Mainly relies on plant foods and animal products.

CH 2: Digestion and Absorption

Digestive Tract: Flexible muscular tube extending from mouth to anus.

  • Mouth to the Esophagus:

    • Teeth crush and food softens, tongue moves food, saliva moistens

    • Food swallowed is called a bolus

    • Food then passes through pharynx ,across epiglottis, into esophagus.

  • Esophagus to Stomach:

    • Bolus goes down esophagus, through cardiac sphincter, into stomach(adding gastric juice)

    • Gastric juice grinds bolus to liquid called chyme

    • Chyme is released through pyloric sphincter to small intestine

  • Small Intestine:

    • Chyme passes through in bile duct (fluids enter from gallbladder & pancreas)

    • Then travels through duodenum(first part of "SI”), jejunum(middle part of “SI”), and ileum(last part)

  • Large Intestine: Colon

    • Chyme goes through ileocecal valve into colon, to rectum.

    • Colon removes water from chyme

  • Rectum:

    • Chyme becomes semi-solid waste and anal sphincter opens to allow it to pass.

INVOLUNTARY MUSCLES & GLANDS:

  • GI Mobility: motion in GI tract that are helped by involuntary muscle contractions

    • Peristalsis: In esophagus, wavelike that push propelling/ pushing chyme forward. Using longitudinal & circular muscles.

    • Segmentation: In intestines, mixing chyme with a gradual push and often squeezing to to cause back and forth motion. It helps with mixing digestive juices and absorbing surface.

Stomach: uses 3 sets of muscles, gastric glands secrete juices, and pyloric sphincter opens sometimes to let portions of chyme into intestine.

Digestion Process:
- Initial breakdown of proteins occur
- Pancreatic juice contains enzymes to digest carbs, fats, and protein
- Bile is secreted from liver and stored in gallbladder(emulsifying fat so enzymes work)
- Faster digestion happens with simple sugars than fats
- MOST ABSORPTION HAPPENS IN SMALL INTESTINE.
- Beneficial food combos are Vitamin C from fruits(citrus) adds absorption of iron from meats.

  • VASCULAR SYSTEM:

    • Circulatory system(heart, arteries, capillaries, veins)

    • Digestive vascular system(heart, arteries, capillaries in intestine, vein, liver)

  • TRANSPORT OF LIPIDS: Travel bundled with a protein

    • Chylomicrons are a type of lipoprotein.

    • Chylomicrons remove the lipid contents and get smaller when they circulate.

  • VLDL, LDL,HDL:

    • The liver get chylomicrons and make VLDL(very low density lipoproteins)

    • Triglycerides are removed and become LDL(low density lipoproteins)

    • Lipids : to the liver are called HDL(high density lipoproteins)

    • High concentration of LDL cause risk of heart disease.

    • High concentration of HDL cause low risk of heart disease.

CH 3: Carbohydrates(bodys preferred energy source, needed for brain)

  • CARBOHYDRATES IN CHEMISTRY:

    • Simple sugars are either Monosaccharides(single sugars) or Disaccharides( double sugars)

    • Starch and fiber are Polysaccharides

  • MONOSACCHARIDES:

    • Glucose (needed by every cell, brain, nervous system. Blood glucose in homeostasis regulated by insulin & glucagon)

    • Fructose (sweetest sugar that is in fruits, honey, soft drinks)

    • Galactose (Part of double sugar lactose in milk)

  • DISACCHARIDES:

    • Sucrose(white sugar that has glucose and fructose)

    • Lactose(main carbohydrate of milk and has glucose and galactose)

    • Maltose( plant sugar that has 2 glucose molecules)

  • POLYSACCHARIDES:

    • Glycogen( glucose storage in humans that is stored in muscles and liver)

    • Starch (glucose storage in plants that have many fibers, protein, other nutrients. i.e grains legumes)

FIBERS:
- Mostly polysaccharides that can’t be broken by human digestion and rarely any energy

- Soluble: Dissolve in water, viscous, fermented in colon, low risk of chronic disease
- Insoluble: Doesn’t dissolve in water, not viscous, doesn’t easily ferment in colon, aids elimination

RESISTANT STARCHES:
- Classified as fibers and aren’t digested or absorbed in small ingesting, may support healthy colon.

  • SUGAR:

    • Lead to cavities due to supporting bacterial growth

    • Lead to obesity

  • Recommended Sugar Intake: 5-10% of ( energy

    • 3tsp for 1600 kCal

    • 8tsp for 2000 kCal

ARTIFICIAL SWEETENERS:
- Are not carbohydrates, don’t yield energy

  • GLYCEMIC INDEX:

    • System that ranks food form 1-100 based on effect of blood sigar levels (low= good for type 2 diabetes, etc.)

      Good low GI foods are nutrient dense

      Poor low GI foods are sweets w/ high fat, slowing digestion

    • Measured by how quick its digested and blood sugar levels rise after eating a certain food (measuring after 2-3 hours)

    • Helps people with diabetes, heart disease, appetite/weight loss.

CH 4: Lipids(fats and oils)

  • LIPIDS

    • compounds that have triglycerides(fats and oils), phospholipids, and sterols

  • FATS

    • Lipids that are solid at room temp

  • OILS

    • Lipids that are liquid at room temp

BODY FAT:
- It provides energy (unlimited) and stored in the adipose tissue.
- Insulates body from extreme temp
- Cushions organs
- Maintains structure & health of cells from phospholipid & sterols
- Can be converted to hormones, bile, vitamin D.

  • TRIGLYCERIDES:

    • Dominant id diet and body

    • 3 fatty acids attached to glycerol “backbone”

    • Sometimes needed for good health but can raise risk of heart disease.

  • FATTY ACIDS:

    • Saturated(bad): Stable and have no point of unsaturation and hard to breakdown causing it to get stuck in arteries.

    • Monounsaturated:(good) one point of unsaturation and easily broken down.(i.e Olive oil which lowers heart disease)

      -Replace saturated & trans fat helping prevent heart disease

    • Polyunsaturated(good): Have two points of unsaturation

HARD & SOFT FAT:
- Soft Fat: short chain, unsaturated, melts readily
- Polyunsaturates: Less stable, turns rancid, microbial growth
Preventing Rancidity: Sealing air-tight & refrigerate, add antioxidants and hydrogen
- Hard Fat: Saturated, stable, resistant to oxidation.

HYDROGENATION…

TRANS-FATTY ACIDS: are like saturated fats BAD
- Raises LDL, lower HDL, giving inflammation
- Found in fast foods, baked goods, meat/dairy, solid butter( 5g of trans-fat per serving)

  • ESSENTIAL FATTY ACIDS:

    • Only from foods

    • Linoleic & Linolenic

    • Help with blood pressure, clots, lipid concentration, immune responses, etc.

      1. Omega-6 Fatty Acid: Linoleic acid, lowers both blood cholesterol & LDL, found in plant seeds, oil seeds,

      2. Omega -3 Fatty Acid: Linoleic , metabolism (growth/development), disease prevention(heart disease, diabetes), found in fish oils

  • PHOSPHOLIPIDS(lecithins):

    • Glycerol backbone, 2 fatty acids

    • Emulsifiers, important for cell membrane, aren’t essential(made by liver), soluble in water and fat.

  • STEROLS: Large complex in plant/ animal foods

    • Cholesterol: Only in animal foods, NOT essential(made by body), manufactured in liver to make bile. Travels in the blood to cells.

      -Recycled cholesterol is bile let out to intestine aiding digestion/absorption of fat.

      -Some package with lipids and protieins(lipoproteins)

    • Vitamin D

    • Sex Hormones

FAT HEALTH EFFECTS:
- Saturated & Trans-fat cause cardiovascular disease, cancer, obesity

  • Heart Health

    • High Blood LDL( risk for heart disease)

    • Saturated Fat(animal source, less in veggies & hydrogenated fats)

    • So east lean meat, fat-free milk, non-hydrogenated margarine, & unsaturated oil.

CH 5: PROTEINS

  • PROTEINS: 10-35% of Daily energy

    • Carbon, Hydrogen, Oxygen, Nitrogen (carbs and lipids have all except nitrogen)

    • 20 amino acids are building blocks

    • Chains: amino acids linked end to end. Dipeptide(2), Tripeptide(3), Polypeptide(10>)

    • Intricate coil shape (shape determines the function)

    • Gives energy & glucose (last resort of energy)

      FUNCTIONS:

    • Structural component in muscles, bone, blood, vessels, tendons

    • Enzyme: Proteins that catalyze reaction and don’t change when used

    • Transporter: In Lipids, Vitamins, Minerals. Movement in cell membrane. (i.e hemoglobin Carrying oxygen from lungs to cell , lipoproteins transports lipids in blood)

    • Regulates Fluid and Electrolytes: Produce of more protiens when blood, cell, interstitial part needs more water.

    • Regulates Acid & Bases: Buffers for body fluid and blood for homeostasis of acidosis and alkalosis.

    • *Antibodies: Defending against bacteria and viruses( less protein means risk of disease)

    • *Hormones: like sterols, glucagon, insulin

ESSENTIAL AMINO ACIDS (only needed from food)
- 9 Essential

  • NITROGEN BALANCE( Nitrogen in has to be equal goin out)

    • Positive N Balance: Nitro is more in than out (children and pregnant women)

    • Negative N Balance: Nitro is less in than out(fasting, starving, trauma)

  • DISEASES:

    • Marasmus

    • Kwashiorkor effects first child when second is born, 18months-2years when weaned. ( Lack of protein that cause fluid to leak into interstitial spaces, plump of limbs/face, bulging belly.)

CH 5: VEGITARIAN DIETS

  • PROBLEMS?

    • Health benefits to adults if planned right

    • Decreases risk of heart disease, hypertension, diabetes, cancer, obesity

  • VEGAN DIET: No animal products

    • High in fiber, rich vitamin minerals.

    • Lower saturated fat/ cholesterol

CH 6: ENERGY BALANCE & BODY COMPOSITION

ECONOMICS:

  • FEASTING: overeating

    • Carbs breakdown into glucose(build to glycogen/ stored in fat)

    • Fat broken down to components (stored to fat in the body)

    • Protein breakdown to amino acids, used to replace body proteins (some lose nitrogen & changed to triglycerides.) Not able to be reverted.

    • HAZARDS: obesity

  • FASTING/STARVING: choosing not to eat/ famine

    • Energy Deficit

    • No metabolic difference

    • Body wastes metabolism

    • HAZARDS: No lean tissue, risk of disease, low body temp, imbalance of fluid/electrolyte

  • BASAL METABOLISM: chemical activity in organs to sustain life

    • Large use of kCal (1,000- 1,300)

    • i.e breathing, digesting, homeostasis, heart beating

  • ENERGY TO MANAGE FOOD (PIE CHART)

    • Basal Metabolism: 50-65%

    • Physical Activity: 30-50%

    • Thermic food effect: 10%

  • BMR ENERGY REQUIREMENTS:

    • Faster: Youth, growth spurt, men, tall, exercise, muscle.

    • Slower: Older, women, fasting & malnutrition, fat

      BODY MASS INDEX (BMI): not accurate

      • Describes average relative weight for height

      • Healthy Weight BMI- 18.5-24.9

      • Overweight BMI- 25-29.9

      • Obesity BMI- over 30 (>30)

        FATFOLD MEASURE:

      • measures thickness of fat fold

        WAIST CIRCUMFERENCE:

        • Risk if over 35 inch(F) and >40(M)\

-Health risks come from “over fat” than weight
-Athletes have lower body fat.

  • FAD DIET: False diet

CH 7: WEIGHT MANAGEMENT/ OVERWEIGHT & UNDERWEIGHT

  • Causes of Obesity

    • Genetics: 2-3 times higher w/ family history

    • Lipoprotein Lipase: fat storage in fat and muscle cells

    • Leptin: obesity gene from fat cells increasing appetite

    • Adiponectin: Protein promoting less body fat in large amounts

    • Ghrelin: Protein opposite of leptin, starts appetite and increase energy storage.

    • Fat Development: amount of fat cells is equal to its number and size, from childhood and puberty, expanding in size and #.

    • Set Point theory: Proposes that body weight is physiologically regulated and body chooses a set weight & defends it. (making it harder to lose weight)

    • Environmental Stimuli: what people encounter

    • Overeating: Convenience, size of plate

    • Learned Behavior: hunger vs. appetite

    • Physical inactivity: electronics, cubical jobs, discouraging environment.

-Fat cells only decrease in size and not in number( explaining why obese people have skin flabs after weight loss)

  • OBESITY TREATMENT:

    • Most people cant get slender, not applying to all overweight people

    • Inappropriate Treatments: supplements/drugs, Herb/dietary products, etc.

    • Aggressive Treatments: Drugs(Sibutramine, phentermine, Orlistat) and surgery(gastric bypass, gastric banding,etc)

    • Helpful Treatments: Physical activity( moderate, regular, small),

  • UNDERWEIGHT:

    • Anorexia Nervosa: Disorder of starving intentionally( refusal to stay normal body weight, common in young girls).

      Characteristics: People pleasers(women),

    • Bulimia Nervosa: More widespread, deals w/compulsive overeating then vomiting(fear of getting fat)

  • WEIGHT GAIN STRATEGIES: Physical activity, energy dense foods(opposide of obesity treatment)

Eating DISORDERS:

  • Vulnerable groups

    • Youth (girls and women)

    • Athletes that need to stay specific weight, too much pressure to excel.

    • Behaviors Overtraining, pills, laxatives, fasting

  • Damage to the body cause:

    • No apparent growth, slow metabolic rate

    • ineffective heart, BP falls

    • Unbalanced minerals, brain loss

    • Bad immune system, Anemia

    • Bad digestion(Heart/Kidney)

  • Treatment

    • Health proffesional advice

    • Therapy, guidance

    • Diciplinary approaches for issues of food, weight, relationships

  • Binge Eating:

    • Lasts bout an hour of eating high sugar/fat and little fiber/water done in secret//night without vomiting(not nutritional).

      Can feel out of control, mentally ill(depression) and responds more to reaily treatment.

    • Consequences: Give phycological relief(cathartic), Vomiting/diarrhea w/low electrolyte imbalance,

    • Treatment: team approach, control, start eating patters, revert to good health.

CH 8: Vitamins and Minerals

  • Vitamins: Made of carbon, hydrogen, oxygen. are micronutrients cus they are only needed in small amounts.

  • Functions:

    1. Maintain health

    2. Prevent disease( organ weakness)

    3. Repair cells

    4. Combat aging process

    5. Help process carbs and release energy in body

  • WATER SOLUBLE: Cant be stored in the body(needs regular supply of it) and secreted in urine, unstable to heat and light(leach in cooking liquids)

    • Vitamins B, C

  • FAT SOLUBLE: Can be stored in the body(doesn’t need regular supply), can get toxic if ingested in big amounts, Fairly stable during normal cooking temp.

TYPES:

  • VITAMIN A: Retinol(animal foods) & Beta-Carotene(plant foods)

    • Action: regulates growth, promotes healthy skin, maintains healthy tissues, keeps eye adapt to dim light (MOISTURIZING VITAMIN)

    • Source:

      1. Retinol (Liver, Dairy, Herring, Egg yolk)

      2. Beta-Carotene (Dark green veggies, broccoli, carrots, orange fruits & veggies)

    • Deficiency: Bad growth(weak bone growth), Night blindness, Infection risk, Lots of carotene cause liver and bone damage)

  • VITAMIN D:

    • Action: Absorption(laying down calcium and phosphorus in bones and teeth), Regulate calcium balance in bones and blood, Prevents Rickets.

    • Source: Sunlight, Fish liver oil, Dairy, Oily fish, Margarine.

    • Deficiency: Rickets(children), Osteomalacia(adults), Osteoporosis, Dental Caries

  • VITAMIN E:

    • Action: Protects tissue from damage, promotes normal growth and development, helps red blood cell formation

    • Sources: Veggie oil, wheat, wholemeal bread, cereal, egg yolk, nuts, sunflower seeds

    • Deficiency: Rare, but can effect central nervous system

  • VITAMIN K:

    • Action: Needed for blood clotting (healing), Increases bone density(strong bones and teeth)

    • Sources: Green leafy veggies, veggie oil, cereals

    • Deficiency: Rare, but damage liver w/ new borns higher at risk

  • VITAMIN B1:

    • Action: Release of energy from carbs, appetite(good health), needed for normal function of nervous system.

    • Sources: Meat, oatmeal, cereals, wheat, fortified white flour, milk, eggs, veggies

    • Deficiency: Fatigue, depression, irritability(process of emotion), Beri-beri(Nervous system disease)

  • VITAMIN B2:

    • Action: Metabolism (of carbs, protein, fats), Growth repair/tissue development(Skin, eyes, tongue), promoting growth factor.

    • Sources: Offal, milk, cheese, eggs, yeast extracts, green veggies.

    • Deficiency: No appetite, Swollen tongue, Cracked lips, Eye infection

  • VITAMIN B3:

    • Action: Metabolism(of carbs, proteins, fat), normal functioning nervous system

    • Sources: Meat, offal, yeast extract, wheat, flour, pulses, dried fruit

    • Deficiency: Fatigue, depression, irritability, Beri-beri (nervous system disease)

  • VITAMIN B9: Folic Acid

    • Action: Red blood cell formation, Development(Brain, spinal cord, skeleton), reduce risk of neural tube defects(spinal bifida), preventing heart attacks, strokes, cancer

    • Sources: Fortified cereals, green leafy veggies, potatoes, bread, milk, wheat.

    • Deficiency: Fatigue, Anaemia, Neural tube defects

  • VITAMIN C: Absorbic Acid

    • Action: Immune system, Forms (Connective tissue and collagen), iron absorption, prevents scurvy, heals wounds(healthy blood vessels), Antioxidant (protects cholesterol)

    • Sources: Rosehips, green pepper, kiwi, citrus, strawberries, spinach, cabbage, broccoli

    • Deficiency: Weakens connective tissue, Infection risk, incomplete iron absorption, Delays healing wounds, Prevent scurvy(pale with spots, bleeding, soft gums)

  • SUMMARY:

    1. MICROnutrients are essential in small amounts, water soluble and need to be eaten everyday, eat enough fruits, veggies, red meat, and wholegrain cereals.

  • Minerals: Inorganic and found in rocks/soil (veggies absorb when they grow and animals digest it).

  • Functions:

    • Body building(teeth and bones)

    • Controls body processes(major in nervous system)

    • Essential for body fluids and cells

    • Forms parts of enzymes and some proteins needed for energy release

      • Trace Minerals- required in small amounts(Iron, Zinc, Iodine)

      • Major Minerals- required in larger quantities(Sodium, Potassium, Calcium, Phosphorus)

TYPES:

  • IRON:

    • Actions: Production of hemoglobin in red blood cells(carrying oxygen in blood)

    • Sources: Red meat, kidneys, liver, eggs, bread, green veggies

    • Deficiency: Anaemia

  • CALCIUM:

    • Actions: Teeth and Bones, Blood clotting, Nerve and muscle contraction, Heart regulation

    • Sources: Dairy, fortified white bread, oily fish, green veggies, nuts/seeds, citrus

    • Deficiency: Stunts growth, rickets, osteoporosis

  • PHOSPHORUS:

    • Actions: Bones/teeth with calcium, muscle contraction

    • Sources: Dairy, Nuts, Meat , fishm Rich calcium foods

    • Deficiency: Rare, but cause tiredness and depression

  • SODIUM:

    • Actions: Maintains water balance(controlling body temp, help to sweat when temp rises)

    • Sources: cheese, bacon, smoked meat, fish, processed foods, salt (No more than 6 g of salt a day)

    • Deficiency: Highly unlikely

  • POTASSIUM:

    • Actions: Muscle contractions(maintaining fluid), Building muscle, and normal growth

    • Sources: Banana, Celery, Turnips

    • Deficiency: Dry skin, acne, muscle spasms

  • ZINC:

    • Actions: From acne to diabetes, aiding immune system, needed for sense of smell and taste.

    • Sources: meat(lamb), oats, eggs, nuts

    • Deficiency: Dry skin, Acne, Muscle spasm

  • IODINE:

    • Actions: Thyroid gland function(controlling how quick body uses energy) and body metabolism

    • Sources: Animal and plant life from sea, milk, eggs, yogurt

    • Deficiency: Mainly in children(Fall in production of thyroid hormone)

FORTIFIES FOODS: Foods that have added nutrients

  • are cheap and packed with nutrients, effective for vulnerable groups of people(Homeless)

  • Folic Acid is a vitamin B vitamin called folate when its found in foods in natural form used to supplement or added to food.

    Some like breakfast cereals and spreads are fortified with folic acid and other vitamins and minerals.

CH 10: NUTRITION THROUGH LIFE (Pregnancy and Infancy)

  • Nutrition Prior to Pregnancy: should have maintained good body weight, balanced diet, physical activity, avoid harmful substances.

  • Pre-Pregnancy Weight:

    • Medical risks if under or over weight

    • Complication from overweight = premature delivery, large baby, complications and delivery.

  • Underweight Risks:

    • Low-birth weight = more risk of disease and to die in the first month.

    • Long term effects= Risk for obesity/hypertension later, low adult IQ, short stature, education disadvantages.

  • Low Birthweight Causes: Of mother

    • Mother had poor nutrition, hereditary, disease conditions, Smoking & Drug/alcohol use.

  • Overweight & Obesity: In baby and mom

    • Babies: larger, 2x likely to have neural tube defect, risk of heart defects.

    • Mom: likely to need labor induced, c-section, post-partum hypertension, infections, and gestational; diabetes.

Healthy Support Tissues:
- Pre-pregnancy nutrition supports growth of placenta.
- Placenta- supply depot, removes waste
- Umbilical cord- pipeline from placenta to fetus
- Amniotic sac: Surrounds baby, cushions w/fluid.

  • Events of Pregnancy:

    • New fertilized ovum called zygote

    • Implants in uterine wall

    • Placenta grows

    • Crucial time

    • Most influential: smoking, drugs, malnutrition(lead to implant failure and neural tube defects.

    1. Embryo & Fetus:

      • Embryo develops to fetus

      • 8 weeks: complete CNS, beating heart, fully formed GI trract, defined toes and fingers, starts facial features.

      • 7 months: grows heavier & 20 times longer

      • Pregnancy: 38-42 weeks duration

      • Infant: Average weight is 6.8-7.9 pounds

    1. Critical Periods:

      • Each organ develops at certain time

      • Malnutrition effects are irreversible( impairs heart, brain and later lungs)

Malnutrition:
- Nervous system defect of embryo
- Poor dental health
- Vulnerable to infection(adolescent and adults)
- High risk of diabetes, hypertension, stroke, heart disease.

Nutrients Needed in Pregnancy:
- some nutrients increase
- ENERGY(kcal): Select nutrient dense food
340 in 2nd trimester/ 450 in 3rd
- CARBS: 175/more gms and fiber for constipation
- PROTEIN: 25 gms/day, supplements are discouraged
- FATS: Little room for oil, butter but need essential fatty acids

  • FOLATE:

    • cell reproduction

    • increased from 400-600 mcg

    • Supplements/ fortified foods

    • prevents: Neural tube deficits like

      SPINA BIFIDA

      ANECEPHALY

  • VITAMIN B12:

    • assists folate manufacture of new cells

    • found in animal products

    • vegans need fortified food supplements

  • HIGH RISK PREG FACTORS:

    • Maternal Weight( Prior/During pregnancy)

    • Maternal Conditions

    • Socioeconomic Status

    • Lifestyle Habits

    • Age

    • Previous Pregnancies(number interval, outcomes, # of births, birthweights)

    • Maternal health( high blood, diabetes, chronic disease)

Nutrients Needed in Bones:
- Vitamin D, calcium(intestinal absorption doubles in early pregnancy), phosphorus, magnesium
- > 300 mgs are transferred to fetus
- More milk, need supplements, calcium fortified soy milk/orange juice

  • FLOURIDE:

    • Teeth mineralization 5th month

    • Recommend supplements if no fluoride water & not if fluoride in water

  • IRON

    • Iron absorption increase (threefold)

    • fetus get heavy on mother’s stores

    • Daily supplement(30mg in 2nd & 3rd trimester)

    • Rich foods include(liver, oysters, red meat, fish, dried fruit, legumes, dark green veg)

    • Vitamin C-rich foods enhance absorption

  • ZINC

    • need for DNA RNA protein synthesis

    • Deficiency predicts low- birthweight

    • in foods w/ high protein content

    • Iron interferes with zinc absorption( may need zinc supplements)

  • SUPPLEMENTS

    • Prenatal: give more folate, iron, calcium

      - Reduces risk of Pre delivery, Low-birthweight, birthdefects

      - Used for those w/ poor diet, high-risk preg, twins, cigarette smokers, alcohol & druggies.

Food Assistance Program:
- Women, Infants, Children(WIC)
- Supplemental Nutrition Assistants Program(SNAP)

  • WEIGHT GAIN: essential for pregnancy

    • Normal-weight for woman: 3 ½ pounds first trimester
      1 pound/week thereafter

    • 1 fetus: 25-35 pounds

  • PHYSICAL ACTIVITY: Important (Low-impact activities)

    • Benefits: labor, helps gestational diabetes, reduce psychological stress

    • Avoid: activities w/potential fall or contact, saunas, steam rooms, whirlpools

  • Common concerns: food sensitivities, nausea, heartburn, constipation

  • Other Concerns:

    • MORNING SICKNESS: from hormonal changes in preg, queasiness-, smells trigger it

      HEARTBURN: fetus puts pressure to stomach, can backup acid

      CONSTIPATION: need high-fiber diet, exercise, plenty fluids

PREGNANCY PROBLEMS:
- Preexisting Diabetes: difficult glycemic control
- Gestational Diabetes:after birth, surgical birth
- Hypertension:pre-existing, low birthweight risk, separation of placenta
- Transient: after birth

  • Preeclampsia

    • symptoms: hypertension, protein urine

    • in 1st pregnancy

    • Convulsions(Eclampsia, medical attention) after 20 weeks

Food Craving: due to hormone induced changes in taste, sensitive smell
Non-food Craving: Pica-persistant eating of dirt w/ no nutritional value(relate to iron deficiency)

  • AVOID:

    • Cigarette smoking: toxic/problematic, restricts blood flow, low birthweight, behavior/intellectual problems later in life, sudden infant death syndrome, complications in birth.

    • Medicinal drugs( not prescribes, or aspirin/ ibuprofen in last 3 months)

    • Herbal Supplements

    • Drug abuse: can cross placenta, impair growth and development

    • Environment Contaminants: lead & mercury, types if fish

    • Food borne Illness: Listeriosis cause miscarriage, brain injury, infection to fetus & baby.

    • Vitamin-mineral megadoses: toxic, care w/vitamin A(defects)

    • Dieting

    • Sugar Subs

    • Caffeine

  • Alchohol: Fetal alcohol syndrome

    • brain damage

    • retardness

    • face abnormalities

    • vision abnormalities

  • Young Pregnancy

    • intense nutrient needs(deficient before preg)

    • Need to gain 35 pounds

    • risk of low-birthweight, miscarriage, stillbirth, infant death

Breastfeeding (Feeding)

  • feed for 6 months, feed w/ complementary foods 12 months

  • Tips:

    • 10-15 mins each breast & start on alternate breast

    • Feed on demand and show milk if a feeding is missed

  • Nutrition and Needs:

    • nutrient dense(lots of food & fluid frequently)

    • Energy: extra 330 kcal, 1 pound lose a week, 13 cups of liquid daily, vitamin/minerals, specific foods.

  • Infants:

    • need to eat frequent than formula(8-12 days, 10-15 duration)

    • Signs of hunger: Alertness, activity, suckling, crying(late signal)

  • Milk:

    • Energy nutrient carb(lactose calcium absorp)

    • Lipids: essenti fatty acid

    • Proteins:digest easy

    • Vitamin/mineral: vitamin D need supplements(if premature)

    • lower sodium

    • high absorbable iron and zinc.

      Benefits:

    • Immune protection: Colostrum, maternal imm… factors, enzymes

    • baby has less intestine disorders, ear infection, ill in respiratory, allergy protection

      Deterrents:

    • advertise publif of baby formula & fal to encourage by medical community

  • Formula feeding:

    • Offer closeness, warmth, stimuli

    • Comp: similar to bm, no immunity, standards, need to be iron fortified, special ones for allergies & lactose int-, over dilution & contamination risk.

      Bottle Tooth Decay:

    • dont put bottle during bed

    • causing dental carries, bucktooth profile

      Transition to Cow Milk:

    • not good in 1st year

    • whole milk 1-2 years

    • lower fat trans in 2-5 years

    • cow milk- poor iron source, high calcium, low vitamin C(no iron absorption)

  • Food Transition:

    • gives between 4-6 months

    • sit w/support & head control movements

      Food w/ Iron & Vitamin C:

    • breast milk

    • iron fortified cereal

    • meat/alternatives

    • Fruits, veggies(vitamin C)

  • FEEDIGN TIPS:

    • introduce food one at a time (alergy risk- cereal then wheat last)

    • Baby foods/blended table food

    • No to sweets, canned veg(high sodium), honey(risk of botulism, choking hazard types.

    • same food as family at 1 yr

    • Avoid food for: reward, comfort/unhappy, punishment

    • give variety of nutritious food

    • finish food and drink

INFANT NUTRITION: affects later development, start of eating habits, good environment
- Weight 2x by 4-5 months
- 3x by year
- High BMR

Physical Readiness: 4-6 months(can swallow), 8-12 (finger food, grow teeth, hard crackers)

CH11: CHILDHOOD & ADOLESCENCE

Nutrient Needs Change If...
- depend on growth rate, activity, other
- Sound nutrition(physical/ acedemic performance, prevents heart conditions/cancer/ diseases.)

  • Early-Middle Childhood: Growth rate slows at age 1, body changes fast, bones growth of bones, muscles

    • Child Appetite:

      - Decline around 1st Bday, fluctuating after

      - Food energy intake vary meal to meal

      - daily energy remain

      Energy: Depend on growth/activity

      - 1 year= 800/day

      - 6 year= 1600/day

      - 10 years= 2000/day

      - Inactive child= obese

      - Vegans= not meeting energy needs

    • Carbohydrates/Fiber:

      - Carb: Based on glucose use(brain), Glucose remain constant after age 1, within range in adults.

      - Fiber: Based on energy intake, low energy child require less then high energy child.
      Fiber Needs Per Age

      • Age 1-3= 19g/day

      • Age 4-8= 25g/day

      • Age 9-13= Boy 31g & Girl 26g/day

      • Age 14-18= Boy 31g & Girl 26g/day

    • Fat/Protein:

      - Fat: DRI recommends 30-40% energy(child 1-3) & 25-35% energy(child 4-18)

      - Protein: Increase alittle w/ age, recommend to maintain (nitrogen balance, be of good quality

    • Vitamins/Minerals: Increase w/ age

      - balance diet meets needs(more iron 7-10mg/day, don’t replace protein with too much milk, add iron rich foods)

      - Vitamin D(10 mcg/day, Vitamin D fortified milk, dried cereals, need supplements)

      - Supplements not needed by well nourished children except(fluoride, iron, vitamin D)

  • Food Patterns for Children:

    • MY PYRAMID:

      - Preeschool 2-5yr= 1200kcal

      - Kids 6-11yr= 1800kcal

      - diets of 88% of children 2-9 years need improvement

    • Child Food Choice:

      - Need to be nutritious/ appealing

      - Limit candy, cold, concentrated sweets(lead to nutrient deficiencies, obesity)

      - Underweight children have higher kcal foods(ice cream etc)

  • Malnutrition in Children:

    • Seen in low income families(12 mil are food insecure)

    • Help(WIC, School food programs)

    • Effects of Hunger:

      Long Term- impaired growth & immune system

      Short Term- Short attention span, Irritable, Apathetic and uninterested.

    • Hunger & School Performance:

      - Child that eats lunch function better

      - No Breakfast= poor concentration, short attention span, lower test scores, tardy/absent.

      - low blood glucose

Deficiency/ Poisoning/ Allergies:

  • IRON

    Deficiency and Behavior:

    • energy crisis, bad mood, attention span & learning ability, conduct disturbances, affect brain before anemia develop.

    Prevention: 7-10 mg/day, milk intake limited after infancy, eat(lean meat, fish, poultry, eggs, legumes), whole grain/ enriched bread & cereal.

  • OTHER:

    Any other missing nutrients cause behavior and physical symptoms

    • Irritable, aggressive, disagreeable, sad, withdrawn.

    • Labled hyperactive, depressed, unlikable

  • LEAD POISON: 300,000+ kids have increased lead concentration in U.S

    Malnourished kids are more vulnerable to lead and cause

    • Mild toxicity: Diarrhea, irritability, anemia & fatigue.

    • Severe Toxicity: Irreversible nerve damage, paralysis, mental retardation, death.

    Risk Factors:

    • Low socioeconomic background, lack shots, Pica( craving for nonfood items)

    Outcomes:

    • Smaller brain

    • Not secreted easily

    • Buildup in bones, brain, teeth & kidneys.

    • Neuromuscular system also affected

  • FOOD ALLERGIES:

    • 6-8% of kids under 4y/o

    • high peanut allergy

    • Diminishes w/age

    • whole food protein or large molecule enter body(acts like antigen)

    • Antibodies produce

    • Food intolerance(not involve immune system.

    Asymptomatic & Symptomatic Allergy:

    • May make allergies & have no symptoms

    • no antibodies= no allergy

    Reactions:

    • quick/ delayed reactions

    • Anaphylactic Shock: tingly mouth, tongue and throat swell

    • To peanuts, tree nuts, milk, eggs, wheat, soybeans, fish, shellfish

    Food Labeling:

    • Labels MUST indicate presence of 8 major food allergens

    • Equipment must be scrupulously cleaned to prevent cross-contamination

    • OTHER REACTIONS: Monosodium glutamate, natural laxatives(prunes), symptoms of GI problems, Lactose intolerant, Phycological reactions

Hyperactivity/Obesity:

  • HYPERACTIVITY:

    • Affects behavior & learning in 5-10% of young children

    • Provide behavior modification, special education, psych counseling, drug therapy.

    • Not caused by increase sugar

    • Additives can contribute and cause( lack sleep, overstimulation, too much TV/ Video Games, Too much caffeine, lack of physical activity

  • OBESITY:

    • Increased over past 30 years in U.S

    • 32% 2-10 yrs overweight

    • 16% obese( BMI of 30> or in 95th percentile

    • Under 2 yrs, 95th percentile=obese(no BMI)

  • Genetic Environmental Factors

    PARENTAL OBESITY:

    • double risk, one obese parent=80% risk

    DIET & PHYSICAL INACTIVITY:

    • Convenience foods, TV & Video Games

    HIGH FRUCTOSE CORN SYRUP:

    • soft drinks, 12oz= 10 t sugar

    GROWTH OF OVERWEIGHT CHILDREN:

    • Earlier puberty, shorter height, stocky build

    Other Characteristics:

    • high blood lipids, pressure

    • type 2 diabetes

    • respiratory disease(asthma)

    • discrimination & rejection

    • poor self image, sense of failure, passive life approach.

  • PREVENTION FACTORS:

    • Limit sugar sweetened bevs & punch

    • Eat fruits/veggies(watch portion size), low energy density foods, nutrient dense foods, calcium rich foods, eat breakfast, high fiber.

    • Eat as family

    • limit restaurants, TV/screen time(2 hours daily)

    • 60 mins of moderate- vigorous activity daily.

    Other Treatment: Surgery

Food Choices & Eating Habits of Children:

  • Mealtime at home:

    - should appeal to child taste & give needed nutrients

    - Nurture child self esteem & well being

    - Set stage for lifelong habits/attitude

  • Honoring Child Preferences:

    - favor brown peanut bitter, white bread, potatoes, apple wedges, & bread

    - Raw veggies, warm food, mild flavors w/no lumps

    AVOID POWER STRUGGLES:

    • Don’t force to try new food, offer rewards to try new foods, restrict them from eating favorite foods

    • Offer new food at a time, small amounts

    • 5-10 exposure to enhance preference

    • New food at beginning of meal.

    MEALTIME @ HOME:

    • Prevent choking (let child sit when eating)

    • Play first

    • Child participate(let them help plan and prepare meals)

    • Snacks: Introduce healthy snacks, pieces of (cheese, fruit, egg salad on cracker)

    • Prevent Dental Caries: Teach to brush/floss after meals, rinse w/water after snack, avoid sticky snacks, select crisp/fibrous foods.

    • Parents Need to Serve as Role Models:

    MEALTIME @ SCHOOL:

    • School Breakfast

    • School Lunch

    Competing Influences @ school: why some don’t eat lunch?

    • short time and long waits

    • competitive form fast food restaurants

Teen Years:
- Physical changes increase nutrient needs(emotional intellectual, social needs is hard)
- Make more choice for themsleves
- Social pressure(alcohol, extreme body ideals, will try latest fad diet to change)

  • Growth & Development:

    • Growth speeds quick and dramatic

    • Spurts: duration of 2 ½ years (12-13 in males & 10-11 in females)

    • Males: greater muscle mass, 8 inch taller, 45 pounds heavier

    • Females: more fat, 6 inch taller, 35 pounds heavier

  • ENERGY & NUTRIENT NEEDS

    - vary depending on growth rate, gender, body comp, & physical activity

  • OBESITY:

    • Highest in black females & hispanics of both

  • VITAMINS:

    • Need more vitamin D to increase calcium absorption 10 mcg/day

  • IRON:

    • Increases both genders @ age 14 or at adolescent growth spurt

  • CALIUM:

    • Peak requirement, more milk

- Teen Nutrition:
Eating away form home(1/3 meals aren’t eaten at home)
Other meals need to have fresh fruits & veggies, lean meats & legumes.
Peer influence(teens make their own nutrition decision) is great during this time

FOOD CHOICES/HEALTHY HABITS:
Choices:
- teens have irregular eating habits
- rely on quick snacks/ fast food( skipping breakfast)
- drink soft drink instead of milk or juice
- NEED to have nutritious, easy to grab food in fridge(meat for sandwiches, low-fat cheeses, fresh raw veggies and fruit, fruit juice/ milk)
Habits:
- Snacks are mostly too high in saturated fat/ sodium/ low fiber(1/4 daily energy).
Also low calcium/ iron/ vitamin A
- Beverages are usually soft drinks w/lunch, supper, and snack(linked to weight gain)
Caffine can become problem, milk consumption is decreased

Childhood Health Problems:

  • Obesity in children increase of type 2 diabetes and hypertension

  • Due to overeating, inactivity, & smoking

  • Leading to cardiovascular disease as adults

    POTENTIAL CAUSES:

    • Genetics( not the determining role, but permissive role)

    • Events during fetal development( Malnutrition theory during critical part of developments can promote of obesity later on)

    TYPE 2 DIABETES:

  • obesity is most important risk factor(other include sedentary life, fam history of diabetes)

  • Consequences(High blood pressure/ lipids, Atherosclerosis, Early CVD, Kidney disease, blindness, & miscarriage)

Child Blood Cholesterol:
- As blood cholesterol increase, atherosclerotic lesions increase
- Blood cholesterol rise as saturated fat intake does
- Blood cholesterol goes together with childhood obesity
Hypertension:
- Accelerates from develop atherosclerosis
- Need regular aerobic activity and weight loss
- restrict sodium

Dietary recommendations:
- Don’t limit fat & cholesterol for infants/children under 2
- Older children need to replace high-fat foods with (low- fat choices, more fruit and veggies, nuts, veggie oul, light canned tune or salmon, low- fat milk)

Change Tide of Obesity:
- Don’t Smoke
- Follow Dietary guidelines for Americans 2005 & USDA food guide
- Be physically active each day
- Adults need to role model healthy behaviors

CH12: NUTRITION THROUGH LIFE(Later adulthood)

Nutrition and Longevity:
- Food choices made in the past have an influence
- People over 85 are the fastest growing age group in the U.S.

Aging of U.S Population:
- Now, life expectancy is 78 years
- Advances in science influence life expectancy
- Blue zone where the population is above 100

  • How do you slow aging process?
    - Healthy Eating Habits

    • Good sleep

    • Balanced meals and healthy weight

    • Physical activity

    • No smoking

    • Moderate to no alchohol

    - Restricting Kcalories to 80% of usual intake

    - Include fruits, veggies, whole rains, legumes, & olive oil.

Physical Activity:
- daily exercise influences mobility when older.
- promoting good weight, flexibility, balance, endurance
- Tones, firms, and strengthens
- Types of beneficial exercises: Aerobic, Strength(weight), Balance, Flexibility.

  • Nutrition and Disease Prevention:

    • Prevents obesity/diabetes/diseases

    • Prevents deficiency disease

  • Other Concerns:

    • Cataracts: Age related thickening of lens of eye, lead to blindness, risk of oxidative stress

    • Macular Degeneration: Leading cause of blindness over 65, risks of oxidative stress from sun, Omega 3 fatty acids may be protective.

    • Arthritis: two types

      - Osteoarthritis: Common, painful swell of joints, Intervention(weight loss, aerobic activity, weight training)

      - Rheumatoid Arthritis: Immune system, attacks bone covering, Intervention(veggies, olive oil, omega-3 fatty acids, low saturated fat)

  • Aging Brain:

    • Blood supply decrease, Number of neurons diminish

    • cerebral cortex affect hearing/speech, Hindbrain: affects balance & posture.

      FRONTAL: decision making

      OCCIPITAL: vision

      TEMPORAL: hearing

      PARIETAL: sensory processes, attention, language comprehension

    • Caused by Nutrient Deficiencies: need vitamins and minerals for neurotransmitter functioning( some losses may be diet related)

  • Alzheimer’s Disease: most prevalent form(senile dementia)

    • Gradually lose: memory/reasoning, communication & physical capabilities, life itself

      Risk Factors:

    • Free radicals

    • Evaluate blood homocysteine(stress level)

    • Obesity

    • High blood pressure

    • Diabetes

Energy & Nutrient Needs:
- DRI categories(51-70 yr & 71 and older)
- Standards are difficult to set( individual differences become pronounced, genetics, dietary history, chronic disease)
- Energy decline: 5% per decade, less lean body mass, BMR slow, Select nutrient-dense foods, Sarcopenia(Loss of muscle mass)

  • Nutrients:

    • PROTEIN:

      - needs are about same as younger adults(need low- calorie high quality)

    • FAT:

      - Moderate amounts

      - Need low, calorie, high quality

    • CARBOHYDRATE:

      - need abundant amounts to spare protein(whole grains)

    • FIBER:

      - Needed to prevent constipation

      - 25 or more grams/day

    • WATER:

      - Total body water decrease w/age

      - Dehydration is a risk

      - Not seem thirsty or notice mouth dryness(Need Fluid)

      - Women 9 cups/day & Men13 cups/day

      Dehydration Cause:

      - UTI, Pneumonia, Pressure ulcers, Confusion, Disorientation

    • VITAMINS:

      - Vitamin D deficiency(little milk, sun exposure, capacity of skin & kidney to make Vitamin D is decreased)

      - Vitamin B12 deficiency(stomach acid decreases, Atrophic gastritis/malabsorption of B12

      - Folate(medical conditions & medications can compromise status)

    • MINERALS:

      IRON:

      - Anemia less common than in younger adults

      - Deficiency(chronic blood absorption)

      ZINC:

      - Commonly low & depress appetite

      CALCIUM:

      - Needed throughout life to prevent osteoporosis

      OTHER:

      • Supplements (food is best source, balanced low dose vitamin & mineral supplement may be advised)

      • Effects of Drugs(number of drugs increase, meds interact w/nutrients, common is alcohol.)

Food Choices & Eating Habits:
- Most older people are … Independent, socially sophisticated, mentally lucid, fully participating members of society, spend more money on food for home, need easy to open and read products.
HABITS:
- Individual preferences are important for aults
- Meal Seting Need companions, men living alone are at risk of malnutrition.
OTHER:
- Depression: common w/ advancing age, affect food intake & appetite( lead to malnutrition)
- Risk factors: Disease, Eating poorly, Tooth loss, Economic hardship, Reduced, social contact, Multiple meds, Involuntary weight loss, Need assistance w/self-care,Elderly onler than 80.

Nutrition for Older Adults:
- Food Assistance Programs
- Meals for Singles

HUNGER: Worldwide 1 in 7 persons experience persistent hunger
- U.S: 1 in 9 households = to 13 mil children
- Food Insecurity(Not knowing when is their next meal & major problem)
- Pie Chart: Food Secure (89%), Very Low Food Security(4%), Low food security(7%)
Reasons for Hunger:
- Food poverty: lack of money alcohol & other drug abuse, lack of awareness of assistance programs, reluctance to accept chairity/welfare

FOOD PROGRAMS:
- Supplemental Nutrition Assistance Programs (SNAP)
- Women, Infant & Children(WIC)
- School Programs
- Meals on Wheels
- Food Recovery Programs
- Food pantries
- Emergency Shelters
- Soup Kitchen

CH 13: NUTRITION CARE AND ASSESSMENT

Nutrition in Health Care

  • Health problems ( alter nutrition needs, lead to malnutrition.)

  • Poor nutrition status(lead to disease & response to treatment)

  • Hospitalized patients( 38-62% W/ ACUTE ILLNESS ARE MALNOURISHED and poor nutrition)

Illness Affects in Nutrition

  • Reduce food intake

  • Nausea

  • Inflammation of mouth

  • Medications causing upset GI