Nutrition and Health Promotion

Metabolism and Basal Metabolic Rate

• Metabolism is the comprehensive process the body uses to obtain or produce energy from ingested food. It is divided into two primary sub-processes:
  • Catabolism: The process of breaking down large molecules into smaller ones, which results in the release of energy.
  • Anabolism: The process of using smaller molecules to build larger, more complex molecules, which requires the use of energy.
• The total number of calories an individual burns each day is determined by three primary factors:
  • The frequency and intensity of physical exercise.
  • The ratio and total amount of fat and muscle tissue on the body.
  • The individual's Basal Metabolic Rate (BMR).
• Variables that directly affect the Basal Metabolic Rate (BMR) include:
  • Genetics
  • Gender
  • Age
  • Weight
  • Body surface area
  • Body fat percentage
  • Dietary habits
  • Body temperature
  • External environmental temperature
  • Thyroxin levels
  • Physical exercise and the presence of lean muscle tissue
  • Use of drugs or medications

Dietary Nutrients and Their Functions

• Dietary nutrients serve three main physiological functions:
  • Providing a source of energy or fuel for the body.
  • Supplying the necessary materials to build and repair body tissues.
  • Regulating metabolic processes.
• Nutrients are categorized as either Essential or Nonessential.
• The major components of nutrients include:
  • Carbohydrates
  • Protein
  • Fat
  • Minerals and electrolytes
  • Vitamins
  • Antioxidants
  • Water

Detailed Nutrient Breakdown

• Carbohydrates:
  • Divided into three groups based on molecular complexity: Simple sugars, Starches, and Fiber (both soluble and non-soluble).
  • Function as the body's primary energy source and regulate the metabolism of fats and proteins.
• Protein:
  • Composed of amino acids, categorized as essential, nonessential, and conditional.
  • Responsible for growing and repairing body tissue.
  • Aids the immune system by creating antibodies to fight disease.
  • Assists in breaking down food and regulating fluid and electrolyte balance.
  • Provides energy as a fallback when carbohydrate and fat stores are exhausted.
• Fat:
  • Serves as a concentrated storage form of fuel and a source of energy.
  • Necessary for healthy skin and nails and the absorption of specific vitamins.
  • Provides insulation for internal organs and maintains body warmth.
  • Essential for brain development, controlling inflammation, and the blood clotting process.
  • Types include Saturated, Unsaturated, and Trans fatty acids.
• Minerals and Electrolytes:
  • Minerals are naturally occurring inorganic substances.
  • Macrominerals (Major) are required in larger amounts; Microminerals (Trace) are required in smaller quantities.
  • Electrolytes are specific minerals in body fluids that carry an electrical charge.
• Vitamins:
  • Organic substances required in very small amounts for specific biological roles.
  • There are thirteen vitamins required to meet the Recommended Dietary Allowance (RDA).
  • Water-soluble vitamins dissolve in water, while fat-soluble vitamins ($A$, $D$, $E$, and $K$) are absorbed more easily by the body.
• Antioxidants:
  • Protect cells from damage caused by free radicals and limit cellular damage.
  • Key examples include vitamins $A$, $C$, and $E$, as well as beta-carotene, lycopene, lutein, and selenium.
• Water:
  • The human body is composed of approximately $80\%$ water.
  • Functions include maintaining normal body temperature via perspiration, lubricating and cushioning joints, and protecting the spinal cord, brain, and other sensitive tissues.
  • Assists in preventing and relieving constipation and eliminates waste products from the body.

Dietary Guidelines and Management Tools

• Evolution of Guidelines:
  • 1992: Food Guide Pyramid.
  • 2005: MyPyramid Food Guidance System.
  • 2011: MyPlate.
• MyPlate Recommendations:
  • Fill half of the plate with fruits and vegetables.
  • Ensure at least half ($1/2$) of daily grain intake consists of whole grains.
  • Vary protein sources and transition to low-fat or fat-free milk and yogurt.
  • Reduce consumption of saturated fats, sodium, and added sugars.
• 2015-2020 Dietary Guidelines for Americans:
  • Limit foods with saturated fats, trans fats, added sugars, and sodium.
  • Saturated fat intake should be less than $10\%$ of daily calories.
  • Individuals aged $14$ or older should consume fewer than $2300\,mg$ of sodium per day.
  • Alcohol should be limited to one drink per day for women and two for men.
  • Weekly physical activity should be incorporated.
• Food Label Analysis:
  • Check calories per serving and the total amount of fat.
  • Evaluate levels of cholesterol, sodium, total carbohydrates, and added sugars.
  • Review amounts of dietary fiber, protein, vitamin $D$, calcium, iron, and potassium.

Medically Ordered and Specialized Diets

• Standard Medical Diets:
  • Clear liquid and Full liquid.
  • Soft, mechanical soft, and Bland.
• Weight Control and Obesity Treatment:
  • Requires lifestyle changes, food tracking, exercise, and realistic goal setting.
  • Clinical treatments include prescription medications, Vagal nerve blockade, and surgeries such as Gastric bypass, Laparoscopic adjustable gastric band (LAGB), and Gastric sleeve.
• Diabetic Eating Plans (Create Your Plate Method):
  • Fill half of the plate with nonstarchy vegetables.
  • Divide the remaining half into two equal quarters: one quarter for protein and one quarter for grains/starchy vegetables.
  • Supplement with a serving of fruit, a serving of dairy, and a non-sweetened beverage.
• Sodium and Heart Health:
  • Low-Sodium Diet: Recommended limit of $2300\,mg$ per day, especially for patients with hypertension, heart disease, or kidney disease.
  • DASH (Dietary Approaches to Stop Hypertension): Designed to reduce blood pressure, LDL (bad cholesterol), and triglyceride levels.
  • Heart-Healthy Diet: Limits sugary drinks, sweets, fatty meats, and highly processed or salty foods.
• Fiber Diets:
  • Low-Fiber: Indicated for intestinal narrowing (tumors), flares of intestinal disease, post-surgery, or prior to intestinal procedures.
  • High-Fiber: Used to reduce constipation, lower risk of hemorrhoids, lower cholesterol, control blood glucose, and assist in weight loss.
• Special Restrictions:
  • Elimination Diet: Addresses the eight common allergens: Milk, Eggs, Fish, Crustacean shellfish, Peanuts, Tree nuts, Wheat, and Soybeans.
  • Gluten-Free Diet: Required for Celiac disease; avoids barley, malt, rye, triticale, and wheat.
  • Lactose-Intolerance: Involves avoiding milk products or using oral enzyme (lactase) replacement supplements.

Nutritional Needs for Specific Populations

• Pregnancy and Lactation:
  • Small, frequent meals can help manage morning sickness.
  • Avoid raw fish or fish containing high levels of mercury.
  • Breastfeeding mothers require a healthy diet and potential vitamin supplementation.
• Epilepsy:
  • The Ketogenic diet (very low carbohydrates, high fat, adequate protein) is sometimes used to force the body to metabolize fat into ketones for energy.
• HIV and AIDS:
  • Nutritional support for the immune system is vital.
  • Increase fluid intake for diarrhea and constipation, restrict milk products, and utilize frequent small meals and nutritional supplements.
• Cancer:
  • Follow a soft, bland diet consisting of $6$ to $8$ small meals per day.
  • Drink most liquids between meals rather than during them; limit caffeine and alcohol.
  • Avoid strong-smelling, overly sweet, spicy, greasy, or fried foods.
  • Take small bites, chew well, and use straws or pureed food as necessary.

Professional Instruction and Communication

• The Role of the Medical Assistant:
  • The provider orders the dietary change, and the medical assistant delivers the instructions to the patient.
  • Assistants must gather resources (brochures) and understand cultural dietary traditions and the reasons behind patient food choices.
• Therapeutic Communication Techniques:
  • Reflection, restatement/paraphrasing, and summarizing.
  • Awareness of nonverbal behaviors such as position, posture, facial expressions, gestures, and mannerisms.
• Understanding Patient Barriers: Factors like cost, convenience, background, emotional comfort, and routine influence dietary choices.
• Patient Coaching for Compliance:
  • Compliance is higher if the patient can modify (not completely eliminate) special foods, has family support, and can transition slowly to the new diet.
• Legal and Ethical Documentation:
  • Medical assistants must document patient education and dietary changes, reflecting the provider's order, the topics taught, and the evaluation of the patient's learning.
  • Referrals to registered dieticians should be made when dietary changes conflict with cultural practices or when extra support is needed.