nutrition chapter 1-5

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ESSENTIALS OF NUTRITION & DIETTHERAPY

MARIA ROBINSON, RN,MS

FALL 2014

BALTIMORE CITY COMMUNITY COLLEGE

ASOCIATE DEGREE NURSING PROGRAM



NUTRITION & HEALTH - Chapter 1

The Obesity Epidemic

Major problem in the United States & Worldwide

Changes in food and lifestyle over past 25 years

70% of men 61% of women are overweight or obeseRise in obesity related to environmental rather than genetic

Energy intake rising, energy expenditure is falling



NUTRITION & HEALTH

New product in the marketplace

Functional foods

Phytochemicals fruits & vegetables cancer fighting

properties Dark chocolate contain phytochemicals prevent

cardiovascular

Nutrition and our genes

Nutrigenomics

Nutrigenetics



NUTRITION & HEALTH

The science of nutrition

Biochemistry & Physiological

Homeostasis

Working definitions

Nutrition to nourish

Good nutrition – promotes health and reduces risk of

adverse conditions Food supplies energy to carry out body functions



NUTRITION & HEALTH

Functions of food & nutrients

Nutrients – substances the body requires

Approximately 50 nutrients found to be essential to humanlife and health

Macronutrients – carbohydrates, fats, and proteins

Supply energy and build tissue

Micronutrients – vitamins and minerals

Regulate body processWater sustains all life systems

Metabolism – sum of all chemical reactions that usenutrients



NUTRITION & HEALTH

Nutrients –

3 general functions

To provide energy

To build and repair body tissues and structures To regulate the metabolic process that maintain

homeostasis and support life



NUTRITION & HEALTH

Energy sources

Carbohydrates – starch and sugars primary source of fuel forheat & energy

Glycogen – body storage form of carbohydrates for quick

energyEach gram of carbohydrates when metabolized yields

4 kcal/g composed carbon hydrogen & oxygen CH2O

Healthy person 45% to 65% of total kcalories are supplied by

carbohydratesComplex carbohydrates – starch

Complex carbohydrates – fiber yield no energy

Simple carbohydrates – sugars



NUTRITION & HEALTH

Fats –

animal and plant sources 9 kcal/g

Supply no more than 20% to 30% of total kcalories

Less than 10% should be saturated fat

Remainder unsaturated fats

Proteins – tissue building 4 kcal/g

Provide 10% to 35% of total kcalories in a well balanceddiet for healthy individuals



NUTRITION & HEALTH

Tissue building and repair

Protein – food broken down into amino acids

Minerals - help build tissues with very specific functions

– calcium & phosphorus give strength to bones and teeth

Vitamins – complex molecules essential in certain tissues

– vitamin C prevent tissue building, vitamin A for vision



NUTRITION & HEALTH

Metabolic regulation–

Minerals – cofactors in controlling cell metabolism

Vitamins – components of cell enzyme

Water –

form blood, lymph and intercellular fluids



NUTRITION & HEALTH

Nutritional status –

health of an individual

Anthropometric – Pg. 8, box 1-2

Optimal nutrition – individuals have neither deficiency

nor an excess Pg. 9, table 1-1 Undernutrition – marginal to famine kwashiorkor or

marasmus



NUTRITION & HEALTH

Overt Malnutrition –

nutrient intake is not sufficient to meetday by day needs

Children with inadequate diet develop anemia reduced

resistance to infection

Hospitalized patients and residents of long term care facilities

Overnutrition – excessive energy intake with low physical

activity – unwanted weight gain



NUTRITION & HEALTH

Nutrition Policy and National Health Problems

1930 rickets and pellagra law passed to add vitamin D to

milk

First major policy linking nutrition and chronic disease -The surgeon general report on Nutrition and Health 1988

Cut down on foods high in fat and salt and increase food

high in complex carbohydrates and fiber



NUTRITION & HEALTH

Healthy People 2020 –

U.S Department of Health and

Human Services introduced public health initiative –

Health People 2000 national objectives – promoting

health and preventing disease

- Objectives updated every 10 years

Healthy people 2020 focus on risk to health and wellness

and prevention of chronic disease



NUTRITION & HEALTH Pg. 13, table 1-3

Nutrition Guides for Food Selection–

3 types1. Nutrition standards2. Dietary Guidelines3. Food guides

Each have different purpose and target audience Nutrition Standard

Dietary Reference Intake (DRI)Recommended Dietary Allowance (RDA)

Adequate Intake (AI)Tolerable Upper Intake (UL)Estimated Average Requirement (EAR) Acceptable Macronutrient Distribution Range (AMDR)



NUTRITION & HEALTH Pg. 16, table 1-2

Food Guides - USDA Food Guides – first guide 1940

Advice on food intake and physical activity

My pyramid food guidance system – remind consumers to make

healthy food choices and be physically active every day



NUTRITION & HEALTH

Safe & Healthy Food Supply –

contamination can occur

as food travel from the farm, to the processor to the

marketplace and finally to consumer

Between 250 million and 350 million Americans suffergastroenteritis each year

Foodborne illness often goes unreported

Groups particularly vulnerable to foodborne illness are

elderly adult, children (especially under age 5)

Pregnant women

Patient with compromised immune function



DIGESTION, ABSORPTION AND METABOLISM

Chapter 2

Human Body: The Role of Nutrition –

food are broken

down into simpler substances that can enter the metabolic

pathways to cells

The Gastrointestinal Tract also called alimentary canal




Disease affecting the organs of the gastrointestinal tract or

absorbing surface of the intestinal wall have adverse

affects on nutritional status

Many functional systems operating in harmony with oneanother is called homeostasis

Four major functions:

1. Receives food

2. Releases nutrients from food

3. Delivers nutrients into the blood

4. Excretes nondigestible waste




Digestion –

first step of preparing food for use by the

body

Includes two type of actions muscular & chemical

Gastrointestinal secretions1. Enzymes

2. Hydrochloride Acid

3.Mucus

4. Water & electrolytes




Movement of food through the digestive tract

Taste & Smell

MasticationSwallowing

Esophagus

Stomach




Stomach: storage and initial digestion

Small intestine: major digestion, absorption and transport

Colon (large intestine): final absorption and waste

elimination Water absorption

Mineral absorption

Vitamin Absorption




Intestinal bacteria –

more than 500 species Waste elimination

Gastrointestinal function and clinical applications

Chronic gastrointestinal distress

Lactose intolerance –

digestive problem facing 70% of theworld population

May have symptoms after taking 6g or 12 to 18g of lactose

1 cup of milk contain 12g of lactose

Deficiency of lactase, digestive enzyme in the microville of thesmall intestine

Health promotion

Prebiotics – undigested carbohydrates

Probiotics – depend on particular strain



DIGESTION, ABSORPTION ANDMETABOLISM

Metabolism

Carbohydrate Metabolism – glucose immediate energysource

Sources of blood glucose – carbohydrate &noncarbohydrate

Use of blood glucose – normal range 70-140mg/dl

Hormonal controls - directly and indirectly influenceglucose metabolism

Protein Metabolism

Anabolism – tissue building

Catabolism – tissue breakdown



CARBOHYDRATES Chapter 3

Basic Fuels: starches and sugars

Dietary importance – major portion of diet of people all

over the world

FruitsVegetable

Cereal

Grains

Dairy foods

Rice one of world most important source of carbohydrates



CARBOHYDRATES

Basic fuels: Digested carbohydrate starches & sugars

Monosaccharide's (simplest of all sugars) 3 important

Glucose (dextrose)

Fructose (fruit sugars) Galactose (milk sugar)

Disaccharides (two linked monosaccharides)

Sucrose = one glucose + one fructose

Lactose = one glucose + one glucose

Maltose = one glucose + galactose



CARBOHYDRATES

Polysacchrides - complex carbohydrate - many (poly)

single glucose (saccharide)

• Starch – most important digestible polysaccharides

The storage form of glucose in plants

legumes , potatoes, grains and vegetables must be

cook to help softens and rupture the starch making

digestion easier• Glycogen & Dextrin - nondigestible



CARBOHYDRATES

Glycogen - the storage form of glucose in animals and

humans – remaining store in the liver and the muscle

Dextrins breakdown of starch - starch + water > soluble

starch > dextrins>maltose>glucose

Oligosaccharides –

small fragment of partially digested starch

Simple sugars have to be converted to glucose in the liver

The liver releases glucose into the bloodstream , which causes the

pancreas to release insulin, which moves glucose out of the

bloodstream and into the cells



CARBOHYDRATES

Nonnutritive sweetener - sweetening power not efficiently

absorbed by the body or cannot provide energy (aspartame)

FDA approved 6

Carbohydrates and oral health – periodontal disease result in

systemic infections worsen glucose control –

diabetes, increase

inflammatory responses and cardiovascular risk

dental carries most frequent and preventable infectious

diseases of oral cavity and major causes of tooth loss



CARBOHYDRATES

Fiber the nondigestable carbohydrate–

Insoluble fiber is nondigestible CHO that do notdissolve in water but act like a sponge in the intestine

to soak up water Examples: cellulose, hemicellulose Lignans, Psyllium

Functional fiber:

Nondigestible polysaccrides added to foods to increase fiber content

Insoluble fibers (cellulose, hemi-cellulose and lignan) Dissolves in water and binds with cholesterol and bile acids

Example are whole grain cereals, wheat bran, root vegetables and fruits

with edible seeds



LIPIDS Chapter 4

Chemical name for fats and fat related compoundscholesterol, lipoproteins and phospholipids

Fatty acids – building block of fat

Polyunsaturated & monounsaturated fatty acidspositive effects

Saturated and trans fats add to heath risk

Adipose – cells and tissue that store fat



LIPIDS

Health issues and lipids

Amount of fat

Excessive kcal

Increase adipose tissue Associated with health problems: diabetes, hypertension, and

heart disease

Types of fat

Excessive saturated fats and cholesterol from animal sources Lipids found in fatty fish or oil

Trans fats in processed foods



LIPIDS

Fatty Acids & Triglycerides

• Saturated

Fats and oils – coconut oil and kernel

• Monounsaturated

Canola oil and olive oil

Polyunsaturated

corn oil an safflower



LIPIDS

Function of Body Lipids

Ready source of energy

Thermal insulation

Protection of vital organs

Transmission of nerve impulse

Membrane structure

Carries fat-soluble mineralsPromote satiety



LIPIDS

Roles in the body

Skin integrity

Blood cholesterol regulation

Growth

Gene expression

Immune function

Blood platelet aggregationSynthesis of hormone like agents



LIPIDS

Classes of lipoproteins Chylomicrons

Very low density lipoproteins (VLDLs)

Intermediate low density lipoproteins (ILDLs)

Low-density lipoproteins(LDLs) (bad cholesterol)

High-density lipoproteins (HDLs) (good cholesterol)



LIPIDS

Two major carries are LDLs and HDLs

Elevated LDL cholesterol is related atherosclerosis

Causes build up of fatty plaque on the walls of the vessels

supplying blood to the heart, which narrows the arteries

Can cause heart attack or stroke

HDLs slow or prevent atherosclerosis by removing cholesterol

from cells and returning it to the liver



PROTEINS

Essential amino acids –

20 amino acids to build body

protein

• Nine indispensible (essential) amino acids

Histidine Phenylalanine

Isoleucine Threonine

Leucine Tryptophan

Methionine Valine

Lysine• Remember the body can not make these nine amino acids or

make them in adequate amounts



PROTEINS

Non Essential Amino Acids• 11 amino acids are classified as nonessential or dispensable

Alanine Arginine Proline

Asparagine Cysterine Tyrosine

Aspartic acid GlutamineGlutamic acid Glycine

• Cells can make them as necessary

Types of Protein

Myosin

Collagen

Hemoglobin

Albumin



PROTEINS

Protein and Nitrogen Balance• Concepts of balance

Homeostasis (dynamic equilibrium)

• Synthesis (anabolism)

• Breakdown (catabolism)Body protein reserves

• 43% body protein in skeletal muscle

• Remainder in skin, blood, kidney, liver, brain, and

other organsProtein balance

• Protein turnover

Nitrogen balance



PROTEINS

Complete and Incomplete protein foods

Complete protein foods

Contain all the indispensible amino acids

Animal origin

Incomplete

Lack one or more indispensible amino acids

Plant origin

Mixture of plant proteins can supply required amount ofindispensable amino acids



PROTEINS

Factors influencing protein requirement

Tissue growth

Protein quality

Protein digestibility

Energy content of the diet

Health status

Critical illness

Trauma or surgerySerious burns



PROTEINS

Health Promotion:

Health benefits of plants foods Soy foods

Good quality protein

Help reduce cardiovascular risk

Legumes

Complex carbohydrates and fiber

Lower risk of CVD

Nutritional contributions of animal foods

Provide indispensible amino acids

Dairy foods are rich in calcium, riboflavin, and performed vitamin A

Vitamin B12 and Vitamin D occur only in animal foods



PROTEINS

Vegetarian diets Ovolactovegetarin ( all plant foods, diary and eggs)

Lactovegetarin (all plant foods and diary )

Vegan (plant foods only)

Flexitarin (predominantly plant foods with occasional fish or

poultry)



PROTEINS

Nutritional implications of vegetarian diets–

calcium can be a problem for vegetarians avoidingdairy foods

Calcium well absorbed from broccoli, cabbage,collards, kale and bok choy

Risk of bone fractures



PROTEIN

Vegetarian diets and chronic disease

Lower rate of coronary heart disease

Lower prevalence of obesity and lower risk of

hypertension and diabetes LDL lower

Lower cancer risk

Lower rate of colorectal cancer

nutrition chapter 1-5

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