General Nutrition
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General Nutrition Kathaleen Briggs Early, PhD, RD, CDE Assistant Professor and Registered Dietitian [email protected] Learning Objectives Upon completion of this module, the student will be able to: Define “macronutrients” and identify what the food sources are for the macronutrients

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General Nutrition

Kathaleen Briggs Early, PhD, RD, CDE

Assistant Professor and Registered Dietitian

[email protected]


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Learning Objectives

  • Upon completion of this module, the student will be able to:

    • Define “macronutrients” and identify what the food sources are for the macronutrients

    • Define “micronutrients” and identify what the food sources are for the major micronutrients

    • Identify the components of a healthy diet

    • Identify patients at nutrition risk

    • Identify the causes of malnutrition and those who are malnourished

    • Explain the benefits of breastfeeding during infancy


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Definitions

  • A nutrient is any substance in food that the body can use to

    • obtain energy,

    • synthesize tissues, or

    • regulate body processes

  • Macronutrients

    • Carbohydrates

    • Proteins

    • Lipids

  • Micronutrients

    • Vitamins

    • Minerals

  • Water


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Macronutrients: CARBOHYDRATES

  • Primary source of calories (energy) and glucose (4 kcal/gm)

    • Glucose is the body’s preferred fuel source

    • Most people get about half of all their calories from carbohydrates

  • Food sources

    • Breads, grains, cereals, rice and pastas are the biggest sources

    • Dairy/non-dairy alternatives (milk, yogurt, soy and rice milk)

    • Fruits in any form (fresh, frozen, juice, canned, dehydrated)

    • Vegetables also have some carbohydrates

      • Common vegetable-based carbs in Western diet are Peas, Corn and Potatoes

    • Sweets

      • Cakes, cookies, ice cream, pastries, etc.

  • No carbohydrates in meats or cheeses

  • Carbohydrate-rich foods are also an important source of fiber and antioxidants


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Macronutrients: FATS

  • Essential for health

    • Cellular membrane structure and function

    • Myelin sheath in nervous system

    • Fat tissue keeps us warm, provides some protection to our organs

  • Concentrated source of calories (9 kcal/gm)

    • Saturated dietary fats

      • Animal-based

        • butter, lard, whole and 2% milk, meat, skin

      • Plant-based

        • coconut and coconut oil, palm kernel oil, palm oil, cocoa butter


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Macronutrients: FATS

  • Unsaturated dietary fat

    • Monounsaturated fatty acids (MUFA)

      • Olive and canola oils

    • Polyunsaturated fatty acids (PUFA)

      • Corn, safflower, sunflower, fish oils

  • Trans fats

    • Very small amount of trans fats are naturally occurring in dairy foods, meat, and darker-meat poultry

  • Cholesterol from the diet

    • Only found in animal-based foods

    • Whole fat dairy products, egg yolks, meat, poultry skin and dark poultry meat


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Macronutrients: PROTEINS

  • Primary role is to maintain structural and functional integrity

    • Muscle tissue, skin, bone, organs, enzymes, hormones, neurotransmitters, fluid and acid-base balance, cellular transport, and blood clotting

  • Proteins are made up of amino acids

  • Some amino acids are essential, others are non-essential, and still others are “conditionally” essentially


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Macronutrients: PROTEINS in Vegetarian Diets

  • Vegetarian diets can be a very healthy option

  • Complete vs. Incomplete

    • Complete proteins contain all 9 essential amino acids (e.g., milk, egg, chicken, meat, fish)

    • Soy is the only plant-based complete protein

    • Incomplete proteins are lacking in 1 or more essential amino acids

    • It is not necessary to combine incomplete proteins at a meal

      • More important to eat a variety of foods consumed throughout the day to provide the most diverse amino acid and protein sources


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Micronutrients: Vitamins

Water-soluble

Fat-soluble

Stored in liver and fat tissue for long periods of time

Deficiencies develop very slowly

Vitamin A

Vitamin D

Vitamin E

Vitamin K

  • Not stored in the body

  • Deficiencies may develop quickly if inadequate intake occurs

    • B vitamins

      • Folic acid (folate)

      • B12 (cobalamin)

      • Thiamin (B1)

      • Riboflavin (B2)

      • Niacin (B3)

    • Vitamin C


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Micronutrients: Major Minerals and their Common Food Sources

  • Calcium

    • dairy products, dark leafy green vegetables, tofu

  • Phosphorus

    • Animal proteins, dairy foods, legumes; wide-spread in food supply

  • Magnesium

    • Whole grains, “hard” water

  • Sodium

    • Processed foods, preserved foods, added salt in cooking and at the table

  • Potassium

    • Fruits and vegetables


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    Micronutrients: Trace Minerals and their Common Food Sources

    • Copper

      • Liver, shellfish, lentils, mushrooms, cashews, sunflower seeds

  • Iodine

    • Iodized salt, seafood

  • Iron

    • Most well absorbed: Beef, dark poultry meat, whole eggs, tuna, salmon, legumes, iron fortified cereals, liver

    • Less well absorbed: prunes, raisins, apricots, dark leafy green vegetables, brown rice

  • Selenium

    • Brazil nuts, tuna, beef, brown rice

  • Zinc

    • Oysters, meat, poultry, legumes, shellfish, whole grains


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    Micronutrient (vitamin) Deficiency Sources

    • Pellagra (Niacin deficiency)

      • The 4 D’s: diarrhea, dermatitis, dementia and death

  • Pernicious Anemia (B12 deficiency)

    • Caused from autoimmune destruction for stomach cells needed for intrinsic factor production

  • Vitamin A deficiency

    • Leading cause of preventable blindness in children

    • Increases the risk of disease and death from severe infections


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    Micronutrient (vitamin) Deficiency Sources

    • Scurvy (vitamin C deficiency)

      • Collagen breakdown resulting in bleeding gums and petechiae

  • Rickets and Osteomalacia (vitamin D deficiency)


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    Micronutrient (mineral) Deficiency Sources

    • Iodine

      • Regions at greatest risk include countries of the former Soviet Union, south Asia and parts of Africa

      • Thyroid enlargement (goiter) is an early and visible sign of iodine deficiency

    • Iron

      • Iron deficiency anemia

      • Fatigue, rapid heart rate, and rapid breathing on exertion are the most common signs

    • Selenium

      • Kashin disease


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    Dietary History Sources

    • Questions the nurse can ask the patient directly

      • Do you eat a wide variety of foods?

      • Do you have difficulty obtaining adequate food?

      • Do you have any food allergies/intolerances?

      • Do you have family? Do you eat alone or with others?

    • Questions the nurse should consider in their assessment

      • Is the patient obviously under or overweight?

      • Does the patient have any obvious warning signs of nutrient deficiencies (see slides 18-27)?


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    Optimizing Nutrition Sources

    • WHO’s five keys to safer food

      • Keep clean

      • Separate raw and cooked

      • Cook thoroughly

      • Keep food at safe temperatures

      • Use safe water and raw materials


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    Assessing Physical Activity Sources

    • With the world-wide obesity epidemic, addressing physical activity is essential

    • Use the FITT principle

      • F: How many times per week does the activity occur?

      • I: How vigorous is the activity?

      • T: What is the activity? What is its purpose?

      • T: How many minutes of the activity are done per session?


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    Anthropometrics Sources

    • Height

      • A key indicator of chronic malnutrition is stunted growth

  • Weight

    • Recent weight loss is a very sensitive marker of a patient’s nutritional status

    • Weight loss of more than 5% of usual body weight in 1 month or 10% in 6 months before hospitalization is clinically significant

  • Weight for height

    • BMI

  • Body fat assessment

  • Activities of Daily Living

  • Strength

    • e.g., grip strength


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    Physical Assessment of Nutrition Status Sources

    • Orbital fat pads

      • should be present

  • Triceps skinfold thickness

    • 1 cm or less = malnourished

  • Anterior lower ribs

    • Ribs should not be visible if adequately nourished

  • Temples

    • should not be sunken

  • Clavicle

    • should not be overtly prominent

  • Shoulders

    • Should be rounded or sloped, not squared


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    Physical Assessment of Nutrition Status Sources

    • Interosseus muscle

      • Should be bulging when thumb and forefinger pinch together

    • Scapula

      • When hand presses against a wall, back should be smooth if adequately nourished

    • Thigh and Calf

      • Should be solid

      • Loose skin upon muscle massage indicates severe deficit


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    Physical Assessment of Nutrition Status Sources

    • Edema

      • In ambulatory patients, no impression should remain following pressure application

    • Ascites

      • Should not be present in healthy individuals

      • Degree of fluid accumulation in abdominal cavity can be indicative of nutrition status


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    Malnutrition Sources

    • When more than 20% of usual body weight is lost, most physiologic body functions become significantly impaired

    • Malnutrition can also reduce cardiac output, impair wound healing, and depress immune function

    • Nutritional repletion can often reverse these processes and significantly improve patient outcomes

    • Difficulty is identifying individuals at risk so that appropriate interventions can be made


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    Protein Energy Malnutrition (PEM) Sources

    • Most common form of malnutrition

    • Most often seen in the western hospitalized patient with

      • End-stage liver or renal disease

      • Cancer cachexia

      • HIV/AIDS wasting disease

      • Severe eating disorder

      • Neglect

      • Long-term recovery from multiple trauma

    • Outside industrialized countries, more often seen in areas of severe drought, infectious disease, and war


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    Kwashiorkor Sources

    • “Pot Belly” appearance due to hepatic edema and fatty liver

    • Increased extracellular fluid (edema) and low plasma albumin levels

      • Increase in extracellular fluid may mask underlying weight loss

    • Rapid onset; may develop in a few weeks


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    Marasmus Sources

    • Significant deficit of total body fat and body protein with a slight increase in extracellular water

    • Obvious body wasting

      • Skin and bones appearance

    • Eyes may be sunken

    • Skull and cheekbones may be prominent

    • Plasma albumin is often in the low-normal range

    • Usually takes months or years to develop



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    Assessing Malnutrition Sources

    • Temples (temporalis muscles) should be visualized for evidence of wasting

    • Dull hair, easily plucked = protein energy deficiency

    • Brittle hair, breaks easily suggests micronutrient deficiencies

    http://meded.ucsd.edu/clinicalimg/head_temporal_wasting2.htm

    http://meded.ucsd.edu/clinicalimg/index.htm


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    Causes of Malnutrition Sources

    • Hunger

      • Due to poverty and food insecurity

    • Micronutrient or protein deficiency

      • More common in elderly

    • Disease

      • Infectious disease (e.g., malaria, TB, see next slide)

      • Chronic disease (e.g., HIV AIDS, cancer, emphysema, etc)


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    Defining a Healthy Diet Sources

    • Aids in maintaining a healthy body weight

    • Promotes general well-being

    • Satisfies hunger and appetite

    • Culturally and age appropriate

    • Suitable to personal preferences

    • Prevents chronic disease

    • Adequate in overall nutrition and balance

      • High consumption of fruits & vegetables

      • Low consumption of red meat & fatty foods

      • Whole and fresh foods are preferred to processed or refined foods

      • Protein primarily from fish, dairy products, and/or legumes

      • Limited in added salt, sugar, and alcohol


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    World Health Organization’s SourcesFive Keys to a Healthy Diet

    • Give baby only breast milk for the first six months of life

    • Eat a variety of foods

    • Eat plenty of vegetables and fruits

    • Eat moderate amounts of fat and oils

    • Eat less salt and sugars


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    Benefits of Breastfeeding Sources

    For infants

    For mothers

    contracts the uterus

    delays return of regular ovulation (especially in exclusively-breastfeeding moms)

    conserves iron stores

    protects against breast cancer (especially pre-menopausal forms)

    aids in return of pre-pregnancy weight

    • favorable balance of nutrients

    • improve cognitive development

    • protects against infections

    • protect against chronic diseases

      • Impacts gene expression

    • protects against food allergies


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    Recommendations for Breastfeeding Sources

    • World Health Organization:

      • Exclusive breastfeeding for first six months

      • Introducing age-appropriate and safe complementary foods at six months

      • Continuing breastfeeding for up to two years or beyond


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    Contact SourcesInformation

    Kathaleen Briggs Early, PhD, RD, CDE

    [email protected]


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