Nutrition Factors Affecting Nutrition

CHAPTER 33: Nutrition

FACTORS AFFECTING NUTRITION

Physiologic Factors

• Healthy body functioning promotes normal digestion and absorption of food.

• Importance of Oral Health:

  • Healthy teeth and gums or well-fitting dentures are important for chewing, necessary to break up food particles to facilitate digestion.

• GI System Functioning:

  • The gastrointestinal (GI) system must function properly for optimal use of ingested nutrients.

• Hormonal Regulation:

  • Hormone production, such as insulin and pancreatic digestive enzymes, is necessary for the effective utilization of food.

INTAKE OF NUTRIENTS

Ability to Acquire and Prepare Food

• Physical Limitations:

  • Physical factors can affect the ability to buy, transport, cook, and eat food; physical mobility and energy are necessary for shopping, cooking, and eating.

• Literacy in Nutrition:

  • Being able to read and understand food labels can facilitate healthy food choices. People who cannot purchase, transport, or prepare food may suffer from inadequate nutrient intake.

• Global Context:

  • In developing countries, starvation due to drought and famine is a common issue. Conversely, starvation or malnutrition can occur in developed nations when resources are lacking.

• Cognitive Limitations:

  • Confused or disoriented individuals might forget to eat or struggle with buying and preparing food independently.

Knowledge

• Lack of nutritional information can lead to unhealthy eating habits.

• People often choose appealing or convenient foods if they lack knowledge about healthy food practices.

• Poor nutrition's immediate consequences are not always observable, making motivation to change low.

Swallowing Impairment

• Difficulty in swallowing may lead to insufficient nutrient intake.

• Causes include:

  • Absent gag reflex (due to neurologic dysfunction like CVA).

  • Muscle weakness.

  • Obstructions from tumors or edema.

Discomfort During or After Eating

• Causes of discomfort include:

  • Sore throat.

  • Tonsillectomy.

  • Oral lesions.

  • Ill-fitting dentures.

• Discomfort may lead to decreased food intake.

Anorexia

• Anorexia (loss of appetite) can stem from:

  • Depression.

  • GI dysfunction.

  • Infections or illnesses.

  • Side effects of medications.

Nausea and Vomiting

• Nausea and vomiting disrupt normal food intake; causes include:

  • Motion sickness.

  • Viral or bacterial GI infections.

  • Gallbladder disease.

  • General anesthesia.

  • Inner ear dysfunction.

  • Pregnancy.

  • Unpleasant smells or sights may also induce these symptoms.

Excessive Intake of Calories and Fat

• Overconsumption of calories results in energy storage as adipose tissue leading to overweight or obesity.

• Statistics:

  • US self-reported obesity rates (2017) vary:

  • Colorado: 22.6%

  • West Virginia: 38.1%

• Regional Variation: Highest in the South (32.4%) and Midwest (32.3%), followed by Northeast (27.7%) and West (26.1%). (Source: CDC, 2017b).

• Health Implications:

  • Excess weight increases stress on body organs and predisposes individuals to chronic health problems like diabetes mellitus and hypertension.

• Dietary Considerations:

  • Obese individuals may lack essential nutrients despite high caloric intake. Americans tend to have a higher fat percentage in their diets, linked to obesity.

Ability to Use Ingested Nutrients

Inflammation of the Gastrointestinal Tract

• GI tract inflammation disrupts nutrient absorption.

  • Esophagitis: Inflammation due to burns, infections, or chronic vomiting leading to swallowing difficulties.

  • Gastritis: Mucosal stomach inflammation that can lead to ulcers.

  • Cholecystitis: Gallbladder inflammation, typically caused by gallstones, causing abdominal pain after high-fat meals.

  • Inflammatory Bowel Disease (IBD):

  • Conditions like Crohn’s disease and ulcerative colitis severely affect nutrient and water absorption, often leading to diarrhea requiring surgical intervention.

Obstruction of the Gastrointestinal Tract

• Obstruction from scar tissue, benign or malignant growths can lead to altered nutritional status.

  • Esophageal Obstruction: Limits intake; in cases of hiatal hernia, can cause reflux.

  • Intestinal Obstruction: May necessitate withholding oral intake.

Malabsorption of Nutrients

• Certain intolerances cause malabsorption syndromes, such as:

  • Gluten intolerance: Reduces mucosal villi, affecting absorption.

  • Lactose intolerance: Deficiency of lactase enzyme leading to digestion issues with milk products.

  • Pancreatic Disorders: Reduced enzyme production affects digestion of fats and proteins; cystic fibrosis can cause excessive mucus plugging.

  • Surgical Resection: Involves removal of segments of the GI tract, impacting absorption.

Diabetes Mellitus

• Diabetes Mellitus is characterized by:

  • Insufficient insulin production or ineffective use.

  • Resulting in impaired glucose transfer to cells and elevated blood glucose levels.

  • Monitoring blood glucose is crucial (see Procedure 33-1).

Metabolic Demand

• Conditions that elevate nutritional needs include:

  • Periods of rapid growth (infancy, pregnancy).

  • Increased BMR due to infection, exercise, or hyperthyroidism.

  • Stress from trauma, surgery, or illness.

  • Wasting diseases such as cancer and AIDS.

Lifestyle and Habits

• Eating patterns vary significantly, influenced by:

  • Individual preferences established from childhood.

  • Family habits surrounding mealtime.

  • Peer and societal influences on food choices.

  • Health Implications: Families who regularly eat together generally make healthier food choices.

  • Social Media Impact: Perceptions of body weight and food intake can be influenced by online platforms, notably in adolescents.

Economic Resources

• Adequate diet often correlates with socio-economic status:

  • Financial resources affect food purchasing, transportation, and cooking facilities.

  • Lower economic levels usually lead to insufficient nutrition.

  • Food deserts limit access to affordable groceries.

Drug and Nutrient Interactions

• Certain foods can alter medication effectiveness.

  • For example: High sodium intake can hinder lithium's effectiveness, and vitamin K-rich vegetables can affect anticoagulants like Coumadin.

  • Reliable and updated references on food-drug interactions are vital for individualized patient care.

Gender

• Nutritional needs differ between genders:

  • Men generally require more calories and protein due to larger muscle mass.

  • Women need additional dietary iron to prevent anemia from menstrual losses.

  • Dietary Reference Intake (DRI) values and guidelines are segmented by gender and age.

Surgery

• Surgical procedures increase risk for nutritional deficiencies due to heightened metabolic demands and potential pre-existing malnourishment.

Cancer and Cancer Treatment

• Cancer increases metabolic demands and can lead to poor appetite, nausea, and vomiting due to treatment-related side effects, affecting food consumption.

Alcohol and Drug Abuse

• Chronic alcoholism impairs nutritional status by limiting nutrient intake and leading to deficiencies in B-complex vitamins.

• Drug abuse may decrease appetite or alter food intake patterns, complicating nutrition.

Psychological State

• Psychological factors significantly affect appetite:

  • Anxiety can either increase or decrease food intake.

  • Depression is linked to reduced appetite and energy for meal preparation.

Altered Nutritional Function

• Without proper nutrition, body tissues cannot be maintained, leading to reduced energy and impaired metabolic processes.

• Signs of altered nutrition include:

  • Underweight or overweight.

  • Significant weight fluctuations.

  • Alterations in energy levels or bowel patterns and appearance changes (skin, hair, teeth).

SIGNS OF POOR NUTRITION AND POSSIBLE NUTRIENT DEFICIENCIES

Overweight

• Defined as BMI between $25$ and $29.9 ext{ kg/m}^2$

• Causes of weight gain include excess caloric intake relative to daily energy needs.

Obesity

• A person is considered obese with a BMI of $30 ext{ kg/m}^2$ or more.

• Nearly 39.8 ext{%} of US adults are classified as obese, with significant health implications including heart disease and diabetes.

• Extreme obesity is defined as having a BMI over $40 ext{ kg/m}^2$ and associated with severe lifestyle implications.

Underweight

• Classified as BMI below $18.5 ext{ kg/m}^2$.

• Common causes include chronic diseases, substance abuse, or eating disorders.

• Increased risk for infections and poor health outcomes.

Recent Significant Weight Gain or Loss

• Minor fluctuations are normal; however, significant changes can indicate altered nutrition.

• Significant weight gain (e.g., 5 ext{%} in one month or 10 ext{%} in six months) could indicate excess caloric intake.

• Significant weight loss might suggest metabolic disorders or inability to absorb nutrients.

Decreased Energy

• Nutritional deficits may lead to inadequate energy levels, resulting in fatigue and activity intolerance.

Altered Bowel Patterns

• Nutritional insufficiency can lead to constipation (due to low fiber/fluid) or diarrhea (from excessive fruit consumption or malabsorption conditions).

Altered Skin, Teeth, Hair, and Mucous Membranes

• Skin, hair, and mucous membranes require proper nutrients for maintenance:

  • Poor nourishment can lead to hair and skin deficiencies.

ASSESSMENT

Normal Pattern Identification

• Assessing normal eating patterns helps understand the patient's usual practices with food. Key inquiry areas include appetite levels, usual intake, special diets, and any cultural or religious dietary aspects.

Risk Identification

• Identifying risks for nutritional deficits involves understanding the patient's knowledge about nutrition, dietary preferences, medications, and chronic illnesses affecting appetite.

Physical Assessment

• Observational methods help assess nutritional status, including weight, skin, mucous membranes, and dental condition.

Anthropometric Measurements

• Measurements include:

  • Height and weight, waist circumference, skinfold thickness, and arm circumference.

  • BMI calculations help identify underweight and overweight status.

Calorie Count

• Keeping track of caloric intake is essential; various digital apps aid in monitoring food consumption.

Mouth Inspection

• Inspect teeth, gums, and oral cavity for indications of nutritional deficiencies.

Swallowing Evaluation

• Essential when swallowing impairment is suspected. Evaluation involves identifying motor function and reflexes related to swallowing.

Diagnostic Tests and Procedures

• Biochemical Tests: Useful in diagnosing deficiencies based on blood and urine analysis using hematocrit, serum albumin, and prealbumin.

• Immunocompetence Testing: Advise on nutritional status impacting immunity.

NURSING DIAGNOSES

• Common nursing diagnoses associated with nutrition include:

  • Imbalanced Nutrition: Less Than Body Requirements

  • Obesity

  • Overweight

  • Impaired Swallowing

OUTCOME IDENTIFICATION AND PLANNING

• Establishing goals around adequate nutrition, understanding dietary modifications, maintaining energy levels, etc., are essential.

Nursing Interventions

• Education and interventions must be tailored to each patient; follow-up to ensure adherence and understanding is essential.