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General Nutrition Kathaleen Briggs Early, PhD, RD, CDE Assistant Professor and Registered Dietitian kearly@pnwu PowerPoint Presentation
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General Nutrition Kathaleen Briggs Early, PhD, RD, CDE Assistant Professor and Registered Dietitian 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 kearly@pnwu

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General Nutrition

Kathaleen Briggs Early, PhD, RD, CDE

Assistant Professor and Registered Dietitian

learning objectives
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
  • 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
macronutrients carbohydrates
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
macronutrients fats
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
macronutrients fats6
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
macronutrients proteins
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
macronutrients proteins in vegetarian diets
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
micronutrients vitamins
Micronutrients: Vitamins



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
micronutrients major minerals and their common food sources
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
micronutrients trace minerals and their common food sources
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
micronutrient vitamin deficiency
Micronutrient (vitamin) Deficiency
  • 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
micronutrient vitamin deficiency13
Micronutrient (vitamin) Deficiency
  • Scurvy (vitamin C deficiency)
      • Collagen breakdown resulting in bleeding gums and petechiae
  • Rickets and Osteomalacia (vitamin D deficiency)
micronutrient mineral deficiency
Micronutrient (mineral) Deficiency
  • 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
dietary history
Dietary History
  • 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)?
optimizing nutrition
Optimizing Nutrition
  • 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
assessing physical activity
Assessing Physical Activity
  • 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?
  • 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
physical assessment of nutrition status
Physical Assessment of Nutrition Status
  • 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
physical assessment of nutrition status20
Physical Assessment of Nutrition Status
  • 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
physical assessment of nutrition status21
Physical Assessment of Nutrition Status
  • 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
  • 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
protein energy malnutrition pem
Protein Energy Malnutrition (PEM)
  • 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
  • “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
  • 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
assessing malnutrition
Assessing Malnutrition
  • Temples (temporalis muscles) should be visualized for evidence of wasting
  • Dull hair, easily plucked = protein energy deficiency
  • Brittle hair, breaks easily suggests micronutrient deficiencies

causes of malnutrition
Causes of Malnutrition
  • 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)
defining a healthy diet
Defining a Healthy Diet
  • 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
world health organization s five keys to a healthy diet
World Health Organization’s Five 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
benefits of breastfeeding
Benefits of Breastfeeding

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
recommendations for breastfeeding
Recommendations for Breastfeeding
  • 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


Kathaleen Briggs Early, PhD, RD, CDE