Nutrition - Agnes

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macronutrients are referred to as

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Carbohydrates, fats, protein, minerals, vitamins, and water

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Micronutrients are those

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vitamins and minerals that are required in small amounts to metabolize the energy-providing nutrients.

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Carbohydrates are of two basic types:

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simple carbohydrates ( sugars) and complex carbohydrates ( starches and fiber).

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Sugars are

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the simplest of all carbohydrates, are water soluble and are produced naturally by both plants and animals.

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Sugars may be

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monosaccharides ( single molecules) or disaccharides ( double molecules).

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monosaccharides

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glucose, fructose, and galactose

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the most abundant simple sugar

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glucose

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lactose

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combination of glucose and galactose, is found in animal milk

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Starches are

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the insoluble, nonsweet forms of carbohydrate, polysaccharides

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Starches exist naturally in

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plants, such as grains, legumes, and potatoes. Other foods, such as cere-als, breads, flour, and puddings, are processed from starches.

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glucose is used for

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energy.

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Excess of glucose is

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converted to glycogen and stored (in liver and skeletal muscle), used to make nonessential amino acids, specific CHO containing compounds ( such as ribose for DNA and RNA), converted to triglycerides and stored as fat

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Fiber is

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a complex carbohydrate derived from plants, supplies roughage, or bulk, to the diet. Cannot be di-gested by humans!!!!

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The desired end products of carbohydrate digestion are

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monosaccharides.

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all monosaccharides are absorbed by

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the small intestine

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hormone secreted by the pancreas

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Insulin,

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Insulin enhances

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the transport of glu-cose into cells.

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Glucose that cannot be stored as glycogen is converted to

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fat

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proteins are

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Amino acids, organic molecules made up primarily of carbon, hydrogen, oxygen, and nitrogen

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Amino acids are categorized as

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essential or nonessential

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Essential amino acids are those that

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cannot be manufactured in the body and must be supplied as part of the protein ingested in the diet.

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essential amino acids— are necessary for

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tissue growth and maintenance.

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Nonessential amino acids are those that

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the body can manufacture.

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Proteins may be

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complete or incomplete.

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Complete proteins contain

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all of the essential amino acids plus many nonessential ones.

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partially complete proteins.

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gelatin, milk protein casein,

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Incomplete proteins

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- lack one or more essential amino acids
- are usually derived from vegetables.

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complementary proteins

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balanced ratio of essential amino acids - combination of corn and beans; combinations of two or more vegetables

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Digestion of protein foods

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begins in the mouth, where the enzyme pepsin breaks protein down into smaller units. However, most protein is digested in the small intestine. The pancreas secretes the proteolytic enzymes trypsin, chymotrypsin, and carboxypepti-dase; glands in the intestinal wall secrete aminopeptidase and dipeptidase. These enzymes break protein down into smaller molecules and eventually into amino acids.

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Amino acids are absorbed by

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active transport through the small intestine into the portal blood circulation.

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The liver uses some amino acids to synthesize

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specific proteins ( e. g., liver cells and the plasma proteins albumin, globulin, and fibrinogen).

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Plasma proteins are a storage medium that

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can rapidly be converted back into amino acids

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protein is stored

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as body tissue. The body cannot actually store excess amino acids for future use. However, a limited amount is available in the “ metabolic pool” that exists because of the constant breakdown and buildup of the protein in body tissues.

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Nitrogen balance is a measure of the

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degree of protein an-abolism and catabolism; it is the net result of intake and loss of nitrogen.

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24-hour food recall

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client recalls all the food and beverages consumed during a typical 24-hour period

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Anemia

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a condition in which the blood is deficient in red blood cells or hemoglobin

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Bottle mouth syndrome describes

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the decay of the infant's teeth caused by constant contact with the sweet liquid in a bottle

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Calorie (c, cal, kcal)

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a unit of heat energy equivalent to the amount of heat required to raise the temperature of 1 kg of water 1 C

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Cholesterol

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a lipid that does not contain fatty acid but possesses many of the chemical and physical properties of other lipids

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Enteral

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through the gastrointestinal system

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Fad

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a widespread but short-lived interest, or a practice followed with considerable zeal

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Fat-soluble vitamins

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A, D, E, and K vitamins that the body can store

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Fatty acids

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the basic structural units of most lipids made up of carbon chains and hydrogen

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Glycerides

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the most common form of lipids consisting of a glycerol molecule with up to three fatty acids

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Iron deficiency anemia

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a form of anemia caused by inadequate supply of iron for synthesis of hemoglobin

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Kilojoule (kJ)

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a metric measurement referring to the amount of energy required when a force of one newton (N) moves one kilogram of weight one meter distance

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Lipids

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organic substances that are greasy and insoluble in water but soluble in alcohol or ether

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Lipoproteins

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soluble compounds made up of various lipids

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Macrominerals

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any of the minerals that people require daily in amounts over 100 mg

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Microminerals

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a vitamin or mineral

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Mid-arm circumference (MAC)

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a measure of fat, muscle, and skeleton

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Mid-arm muscle circumference (MAMC)

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calculated by using reference tables or by using a formula that incorporates the triceps skinfold and the MAC

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Minerals

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a substance found in organic compounds, as inorganic compounds and as free ions

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Monounsaturated fatty acids

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a fatty acid with one double bond

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Nutrition

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the sum of all the interactions between an organism and the food it consumes

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Obese (obesity)

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weight greater than 20% of the ideal for height and frame

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Oils

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lipids that are liquid at room temperature

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Overnutrition

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a caloric intake in excess of daily energy requirements, resulting in storage of energy in the form of adipose tissue

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Regurgitation

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the spitting up or backward flow of undigested food

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Resting energy expenditure (REE)

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the amount of energy required to maintain basic body functions

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Saturated fatty acids

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those in which all carbon atoms are filled to capacity (i.e., saturated) with hydrogen

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Skinfold measurement

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an indicator of the amount of body fat, the main form of stored energy

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Small calorie (c, cal)

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the amount of heat required to raise the temperature of 1 g of water 1 C

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Unsaturated fatty acid

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a fatty acid that could accommodate more hydrogen atoms than it currently does

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Vitamin

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an organic compound that cannot be manufactured by the body and is needed in small quantities to catalyze metabolic processes

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Water-soluble vitamins

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he body cannot store, so people must get a daily supply in the diet; include C and B-complex

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Acetylsalicylic acid effect on nutrition

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Decreases serum folate and folacin nutrition Increases excretion of vitamin C, thiamine, potassium, amino acids, and glucose May cause nausea and gastritis

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Antacids containing aluminum or magnesium hydroxide effect on nutrition

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Decrease absorption of phosphate and vitamin A Inactivate thiamine May cause deficiency of calcium and vitamin D Increase excretion of sodium, potassium, chloride, calcium, magnesium, zinc, and riboflavin

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Thiazide diuretics effect on nutrition

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May cause anorexia, nausea, vomiting, diarrhea, or constipation Decrease absorption of vitamin B12 May cause diarrhea, nausea, or vomiting

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Potassium chloride effect on nutrition

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Increases excretion of potassium, magnesium, and calcium May cause anorexia, nausea, or vomiting Is incompatible with protein hydrolysates

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Laxatives effect on nutrition

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May cause calcium and potassium depletion Mineral oil and phenolphthalein ( Ex- Lax) decrease absorption of vitamins A, D, E, and K

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Antihypertensives effect on nutrition

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Hydralazine may cause anorexia, vomiting, nausea, and constipation Methyldopa increases need for vitamin B12 and folate May cause dry mouth, nausea, vomiting, diarrhea, and constipation

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Anti- inflammatory agents effect on nutrition

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Colchicine decreases absorption of vitamin B12, carotene, fat, lactose, sodium, potassium, protein, and cholesterol Prednisone decreases absorption of calcium and phosphorus

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Antidepressants effect on nutrition

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Amitriptyline increases food intake ( large amounts may suppress intake)

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Antineoplastics effect on nutrition

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Can cause nausea, vomiting, anorexia, malabsorption, and diarrhea

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Grapefruit effect on nutrition

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Can cause toxicity when taken with a variety of medications including amiodarone, carbamazepine, cisapride, cyclosporine, diazepam, nifedipine, saquinavir, statins, terfenadine, verapamil

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Vitamin K effect on drug

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Can decrease the effectiveness of warfarin ( Coumadin)

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Tyramine ( found in aged cheeses, tap beer, dried sausages, fermented soy, sauerkraut) effect on drug

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n combination with monoamine oxidase inhibitor ( MAOI) medications, e. g., isocarboxazid ( Marplan), isoniazid, linezolid, phenelzine, tranylcypromine, creates sudden increase in epinephrine leading to headaches, increased pulse and blood pressure, and possible death

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Milk effect on drug

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Interferes with absorption of tetracycline antibiotics

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caloric value

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The amount of energy that nutrients or foods supply to the body

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calorie

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unit of heat energy

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small calorie ( c, cal)

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the amount of heat required to raise the tem-perature of 1 gram of water 1 degree Celsius

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large calorie ( Calorie, kilocalorie [ Kcal])

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amount of heat energy required to raise the temperature of 1 gram of water 15 to 16 degrees Cel-sius and is the unit used in nutrition

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kilojoule ( kJ)

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amount of work energy required when a force of 1 newton ( N) moves 1 kilogram of weight 1 meter distance.

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One Calorie ( Kcal) equals

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4.18 kilojoules.

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Metabolism

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refers to all biochemical and physiological processes by which the body grows and maintains itself

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The basal metabolic rate ( BMR

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the rate at which the body metabolizes food to maintain the energy requirements of a person who is awake and at rest.

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Resting energy expenditure ( REE)

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is the amount of energy required to maintain basic body functions; in other words, the calories required to maintain life.

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The REE of healthy persons is generally about

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1 cal/ kg of body weight/ hr for men and 0.9 cal/ kg/ hr for women

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Ideal body weight ( IBW)

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is the optimal weight recommended for optimal health.

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body mass index ( BMI)

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is an indicator of changes in body fat stores and whether a person’s weight is appropriate for height, and may provide a useful es-timate of malnutrition.

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Examples of Food Fads and Myths

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Large amounts of yogurt and vitamin E retard aging.
¦ Honey is healthier than sugar, more readily digested, and a cure for the common cold.
¦ Eating cabbage and onions turns breast milk sour.
¦ Raw eggs, rare lean beef, and oysters increase sexual potency or fertility.
¦ Organic foods are always healthier than those exposed to pesticides.
¦ Stomach enzymes cannot work on vegetables and fish at the same time and therefore these foods should not be eaten together.

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Demand feeding

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means that the child is fed when hungry rather than on a set time schedule. This method tends to decrease the problem of overfeeding or underfeeding the infant.

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CLIENT TEACHING Nutrition for Older Adults

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- Reduce sodium consumption for clients who have hypertension or other cardiac problems
- Ensure adequate calcium intake
- Ensure adequate vitamin D intake
- Ensure adequate iron intake.
- Consume fiber- rich foods to prevent constipation and minimize use of laxatives

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Healthy People 2020 nutritional objectives,

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Reduce the incidence of overweight adults ( target 15%) and children ( target 5%).
¦ Increase the proportion of persons ages 2 years and older who consume no more than 2,400 mg of sodium daily to 65%.
¦ Prevent inappropriate weight gain in youth and adults.
¦ Reduce consumption of calories from solid fats and added sugars in the population ages 2 years and older.

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Malnutrition

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lack of necessary or appropriate food substances, but in practice includes both under nutrition and over nutrition

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Overnutrition

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caloric intake in excess of daily energy requirements resulting in storage of en-ergy in the form of adipose tissue.

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Undernutrition

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intake of nutrients insufficient to meet daily energy requirements because of inadequate food intake or improper digestion and absorption of food

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Protein- calorie malnutrition ( PCM)

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seen in starving children of underdeveloped countries, is now also recognized as a significant problem of clients with long- term deficiencies in caloric intake ( e. g., those with cancer and chronic disease). Characteristics of PCM are depressed visceral proteins ( e. g., albumin), weight loss, and visible muscle and fat wasting.

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Laboratory tests that provide objective data to the nutritional assessment

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- serum protein (hemoglobin, albumin, transferring, iron total binding capacity)
- urinary test
- total lymphocyte

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SIGNS ASSOCIATED WITH MALNUTRITION General appearance and vitality

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Apathetic, listless, looks tired, easily fatigued

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SIGNS ASSOCIATED WITH MALNUTRITION Weight

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Overweight or underweight

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SIGNS ASSOCIATED WITH MALNUTRITION Skin

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Dry, flaky, or scaly;
pale or pigmented;
presence of petechiae or bruises;
lack of subcutaneous fat; edema

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SIGNS ASSOCIATED WITH MALNUTRITION Nails

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Brittle, pale, ridged, or spoon shaped ( iron)

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SIGNS ASSOCIATED WITH MALNUTRITION Hair

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Dry, dull, sparse, loss of color, brittle

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SIGNS ASSOCIATED WITH MALNUTRITION Eyes

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Pale or red conjunctiva, dryness, soft cornea, dull cornea, night blindness ( vitamin A deficiency)

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SIGNS ASSOCIATED WITH MALNUTRITION Lips

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Swollen, red cracks at side of mouth, vertical fissures ( B vitamins)

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SIGNS ASSOCIATED WITH MALNUTRITION Tongue

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Swollen, beefy red or magenta colored ( B vitamins); smooth appearance ( B vitamins deficiency); decrease or increase in size

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SIGNS ASSOCIATED WITH MALNUTRITION Gums

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Spongy, swollen, inflamed; bleed easily ( vitamin C deficiency)

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SIGNS ASSOCIATED WITH MALNUTRITION Muscles

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Underdeveloped, flaccid, wasted, soft

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SIGNS ASSOCIATED WITH MALNUTRITION Gastrointestinal system

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Anorexia, indigestion, diarrhea, constipation, enlarged liver, protruding abdomen

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SIGNS ASSOCIATED WITH MALNUTRITION Nervous system

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Decreased reflexes, sensory loss, burning and tingling of hands and feet ( B vitamins), mental confusion or irritability