Nutrition and Hydration Notes

Terminology Related to Nutrition

  • Body Mass Index (BMI):
    • A measure of obesity using a formula that includes weight and height.
    • Calculates if an individual's fatness level is underweight, normal weight, overweight, or obese
  • Complex Carbohydrates:
    • Carbohydrates composed of starches and fiber (cellulose).
  • Digestion:
    • Process in the gastrointestinal (GI) tract where food is broken down.
    • Releases nutrients for the body's use.
  • Nitrogen Balance:
    • Equilibrium between nitrogen intake (protein), nitrogen utilization, and nitrogen excretion by the kidneys.
  • Simple Carbohydrates:
    • Simple sugars made of one or two sugar molecules.
    • Absorbed rapidly.

Classification of Nutrients

  • Macronutrients: Needed in large daily amounts.
    • Protein
    • Carbohydrates
    • Fats
    • Water
  • Micronutrients: Needed in smaller daily amounts.
    • Vitamins
    • Trace minerals

Dietary Guidelines for Americans 2010

  • Three Areas of Emphasis:
    • Eat in moderation.
    • Consume only the amount of food required for activity level.
    • Eat nutrient-rich, densely-loaded foods.
  • Specific Recommendations:
    • Reduce saturated fats to less than 10% of total daily calories.
    • Reduce calories from solid fats and sugar.
    • Reduce sodium intake to less than 23002300 mg daily. Reduce sodium intake to less than 15001500 mg for individuals with elevated blood pressure, diabetes, or renal disease, and all African Americans
    • Consume more whole grains than refined grains.
    • Use more reduced-fat dairy products.
    • Increase servings of fruits, vegetables, and seafood.

Digestion A&P Review

  • Mouth:
    • Digestion begins with amylase acting on fats and carbohydrates.
    • Mechanical chewing breaks down food size.
  • Esophagus:
    • Transports food to the stomach via peristalsis.
  • Stomach:
    • Carbohydrates are converted to maltose and sucrose.
    • Proteins and fats are broken down by enzymes and stomach contractions.
    • Little absorption occurs here, except for alcohol.
  • Small Intestine:
    • Peristalsis propels bolus into the small intestine.
    • Liver, gallbladder, pancreas, and small intestine digestive enzymes break down starches and proteins; fats reduced to free fatty acids and monoglycerides
    • Most macronutrients, minerals, vitamins, and some fluid are absorbed.
    • End products of digestion enter villi (containing capillaries) into the bloodstream to be carried to cells.
  • Large Intestine (Colon and Rectum):
    • Peristalsis moves remaining food components (mostly cellulose).
    • Absorption of most fluid and some electrolytes occurs.
    • Remaining bulk is expelled as fecal material.

Caloric Values

  • Carbohydrates: 44 calories per gram.
  • Protein: 44 calories per gram.
  • Fat: 99 calories per gram.

Water

  • Importance: Essential for life.
  • Body Composition: Accounts for 55-60% of body weight in average adult females, 60-65% in adult males, and 65-70% in newborns and infants.
  • Major component of blood and urine.
  • Individual cells depend on water for optimal functioning.
  • Functions:
    • Maintenance of body temperature.
    • Blood pressure maintenance.
    • Flushing out toxins.
    • Carrying nutrients to cells.
    • Lubrication for ear, nose, and mouth.
  • Intake Recommendations:
    • Most commonly recommended: Six to eight 8-ounce glasses per day (14401440 to 19201920 mL).
  • Factors Affecting Fluid Needs:
    • Activity/exercise/exertion (increase).
    • Health status/disease (increase or decrease).
    • Fever/vomiting/diarrhea/infection (increase).
    • Age: very young and elderly (lower needs).
    • Size (increase).
    • Body fat (more water required).
    • High environmental temperature (increase).
    • Pregnancy and lactation (increase).
  • Hyponatremia:
    • Decrease of sodium concentration in the blood caused by an excess of water (dilutional hyponatremia).
    • Symptoms include confusion, headache, nausea, and fatigue.

Protein

  • Body Functions Requiring Protein:
    • Produce energy and heat.
    • Build new tissue.
    • Manufacture hormones, enzymes, antibodies.
    • Maintain acid-base balance.
    • Assist in maintaining fluid balance between cells & bloodstream.
  • Nitrogen Balance:
    • Ingested nitrogen must balance with nitrogen utilized and excesses removed by kidneys.
    • For every 1 gram of urinary nitrogen excreted, 6.256.25 grams of protein must be ingested.
    • Positive nitrogen balance (more ingested than excreted): Needed for tissue growth.
    • Negative nitrogen balance (inadequate ingestion): Occurs in malnutrition; causes loss of muscle tone, weight loss, failure to heal/repair tissue, and growth retardation. Causes loss of muscle tone, weight loss, failure to heal/repair tissue.
  • Amino Acids:
    • Nine essential amino acids: Must be obtained from food; the body cannot produce them.
    • Nonessential amino acids: Produced by the liver; not essential in the diet.
    • Conditional amino acids: Become essential only when stressed or ill.
  • Protein Types:
    • Complete protein: Contains all nine essential amino acids; found in meat, fish, eggs, milk products, sesame, peanuts, whitefish, pork, beef, soy.
    • Incomplete protein: Lacks one or more essential amino acids; found in nuts, corn, wheat, beans, seeds, brown rice.
  • Commonly used combinations of incomplete proteins:
    • Red beans and brown rice
    • Peanut butter and whole wheat bread
    • Brown beans and cornbread

Cholesterol

  • Functions:
    • Forms body cell membranes.
    • Produces adrenal and sex hormones and bile.
    • Protects nerves.
    • Converts sunshine to vitamin D.
    • Helps metabolize fat-soluble vitamins.
  • Categories of Fats:
    • Trans fats: raise LDL.
    • Saturated fats: raise LDL.
    • Dietary cholesterol: raises LDL.
    • Monosaturated fats: May lower LDL.
    • Unsaturated fats
    • Polyunsaturated fats.

Fat

  • Functions:
    • Concentrated energy source: 99 kcal/gm.
    • Maintenance of healthy skin.
    • Absorption of fat-soluble vitamins.
    • Insulation of the body.
    • Support and cushioning of organs.

Carbohydrates Sources

  • Simple Carbohydrates:
    • Fruit
    • Milk
    • Table sugar
    • Syrup
    • Candy
    • Soda pop
  • Complex Carbohydrates:
    • Potatoes
    • Rice
    • Whole grain bread and cereals
    • Pasta
    • Broccoli
    • Corn, peas
    • Beans

Fiber

  • Sources of soluble fiber:
    • Oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries, and apple pulp
  • Sources of insoluble fiber:
    • Whole-wheat breads, wheat cereals, wheat bran, rye, rice, barley, most other grains, cabbage, beets, carrots, brussel sprouts, cauliflower, and apple skin
  • Functions:
    • Decreases LDL cholesterol, reducing coronary artery disease risk.
    • Promotes normal bowel function and prevents constipation.
    • Increases mineral absorption.
    • Lowers colon pH, discouraging pathogen and cancer cell growth.
    • Supports GI tract normal flora by providing a food source.
    • Promotes weight loss.

Vitamins

  • Water-Soluble vs. Fat-Soluble:
    • Water-soluble vitamins: Absorbed directly into the bloodstream; cannot be stored; must be consumed daily.
    • Fat-soluble vitamins: Absorbed from the small intestine into body fat; can be stored when intake exceeds need.
  • Sources:
    • Water-soluble vitamins: B vitamins (B1, B2, B3, B6, B12) and vitamin C; found in cereal grains, meat, eggs, fish, and citrus fruits.
    • Fat-soluble vitamins: A, D, E, and K; found in green leafy vegetables, dairy products, carrots, and liver.
  • Functions of B and C Vitamins:
    • B vitamins: Serve as coenzymes for metabolism, stimulate appetite, maintain nervous & integumentary systems.
    • Vitamin C: Immune system functioning, iron absorption, wound healing.

Antioxidants

  • Types:
    • Beta-carotene
    • Lycopene
    • Vitamins A, C, and E
    • Other substances

Additional Roles of Vitamins

  • Blood clotting
  • Synthesis of hemoglobin
  • Bone and collagen formation
  • New tissue growth and repair
  • Nerve impulse conduction

Minerals

  • Major vs. Trace:
    • Major: Present in amounts greater than 5 grams (Calcium, phosphorus, sodium, potassium, and magnesium).
    • Trace: Present in amounts of 5 grams or less (Iron, iodine, zinc, chromium, fluoride, copper, and selenium).
  • Functions:
    • Provide structure to bones, teeth, and nails.
    • Assist in fluid balance and acid-base balance.
    • Regulate nerve cell transmission and muscle contraction.
    • Assist in the activation of vitamins, enzymes, and hormones.

Nutritional Deficiencies and Excesses

  • Protein deficiency: Kwashiorkor
  • Excess fat: Overweight and obesity
  • Excess carbohydrates: Overweight and obesity
  • Mineral deficiencies
  • Vitamin deficiencies and excesses: Rickets and Scurvy

Nutritional Needs

  • Vary over the lifetime:
    • Toddlers and preschool-age children
    • School-age children
    • Adolescents
    • Adulthood
    • Pregnancy and lactation
    • Older adulthood

Food Labels

  • Food and energy content
  • Macronutrient content
  • Vitamin and mineral content
  • Daily reference value
  • Health claims
  • Labels for special needs

Dietary Choices Influenced by Culture

  • African Americans:
    • May use lots of saturated fats for cooking.
    • Diets usually rich in: Collard, mustard and turnip greens, spinach, Yams, Beans
    • Emphasis on corn, beans, rice, and breads
    • More pork and fish than beef
    • Lots spices, herbs, and salt pork for intense flavoring
  • Latin Americans:
    • Diets typically concentrated in heavy spices
    • Vegetables
    • Whole grains
    • Beans
    • Fruits
    • Legumes and nuts
    • Fish and seafood, less beef
  • “Mediterranean-style” diet:
    • Centered around lots of fresh fruits and vegetables
    • Beans, seeds, and nuts
    • Cereals
    • Low-to-moderate size servings of poultry, pork and fish
    • Little red meat
  • Jewish dietary law:
    • Eat only Kosher foods
    • Must be killed and prepared according to Kosher specifications (all blood removed from meat before cooking; milk and meat cannot be prepared using same utensils)
    • Milk and meat utensils must be kept separate even when they have been cleansed
    • Never eat pork or shellfish
  • Jewish dietary law (cont.):
    • Only eat certain meats:
      • Fish with fins and scales
      • Cloven-hoofed animals that chew their cud, including cows, bison, deer, and goats
      • Limited fowl species
  • Asian Americans:
    • Varies based on whether they are of Chinese, Cambodian, Vietnamese, Loatian, Japanese, or Thai descent
    • Use less saturated fats than Americans
    • Usually eat less beef and more fish and shellfish
    • Protein often comes from soy products, nuts, legumes, and seeds
  • Asian Americans (cont.):
    • More grains, such as millet, corn, rice, and noodles than Americans and may constitute much of the daily diet
    • A lot of fruits and vegetables which are generally prepared in a wok using peanut oil, or steamed to preserve crispness and nutrient content
    • Milk products are used sparingly
  • Muslim Americans:
    • Use dietary laws from Quran
    • Only eat meat specifically slaughtered for food; no meat that died “of themselves”
    • No alcohol (includes vanilla)
    • Lots of figs, yogurt, dates, grapes, legumes, homey, pomegranates, olive due to religious connection
  • Muslim Americans (cont.):
    • Favored foods include fried pastries, nuts, breads, and salads
    • Fasting is a religious requirement at certain times

Special Diets

  • Cardiac Diet:
    • Low in fat and salt.
    • Less than 30 percent of calories from fat.
    • Egg substitutes and low-fat meats allowed.
    • Fried foods and caffeine not allowed.
    • Less than 20002000mg salt daily intake
  • Clear Liquid Diet:
    • Foods liquid at room temperature.
    • Leaves little to no residue after digestion.
    • Used when other liquids and solid foods are not tolerated.
    • May be ordered before tests and before or after surgeries.
    • No purple or reds!
  • Diabetic Diet:
    • Low-fat diet that varies in calorie level based on age, size, and activity level.
    • Limits carbohydrates, protein, and fat.
    • Choices vary depending on calorie level.
    • No concentrated sweets.
    • Sugar substitutes are allowed.
  • Full Liquid Diet:
    • Used when the patient may have problems with chewing, swallowing or digesting solid food.
    • Often ordered when going from a clear liquid diet to solid foods.
    • Includes clear liquids plus dairy.
  • High Fiber Diet:
    • Helpful with certain health problems.
    • Relieves constipation and helps reduce hemorrhoids.
    • Recommended for patients with diverticulosis and irritable colon.
    • May help people with diabetes or high cholesterol.
    • May prevent colon cancer and some forms of heart disease.
    • Eat more fresh fruits and vegetables each day.
    • Eat more whole grains, nuts, beans and peas.
    • Drink at least eight glasses of water every day.
  • Lactose-Free Diet:
    • Avoids milk or milk products and lactose.
    • Includes milk, ice cream, sherbet, yogurt and frozen yogurt, cookies, pies, cakes, or pastries made with milk, butter or margarine containing milk, or milk products.
    • Other foods that often contain milk are gravy, chocolate, pudding, cheese, cheese products, dressings, omelets, soufflés and scrambled eggs.
    • Avoid meat, poultry and fish that have been prepared with milk. This includes hot dogs, cold cuts and sausages that contain milk products
  • Low Fat/Low Cholesterol Diet:
    • Lowers total fat in the diet to 50 grams per day.
    • Eat less fat, oils, butter and margarine.
    • Fried foods are not allowed.
    • Do not eat fatty meats, whole milk products, rich desserts, sweetened breads and pastries.
    • Should eat egg substitutes and low-fat meats.
  • Low Sodium Diet:
    • Limits salt to 2 grams (2000 mg) per day.
    • Foods prepared without added salt.
    • Foods high in salt (such as bacon and sausage) will not be included.
  • Pureed Diet:
    • Used for patients who have trouble chewing or swallowing.
    • Solid foods are changed to the consistency of mashed potatoes.
    • Decreases the amount of chewing and helps foods be swallowed more easily.
    • Patients may season pureed foods unless instructed otherwise by the physician.
  • Renal Diet:
    • Limits potassium, salt, phosphorus, protein and fluids
    • Low protein to decrease the nitrogen
    • Low salt decreases water retention
    • Low phosphorus, raises the Calcium blood level for bone protection
    • Fluid restriction for renal insufficiency