Chapter 1

1. Chapter 1 The Art of Nutrition in a Family Context

2. Learning Objectives • Define terms used in the study of nutrition. • Identify biopsychosocial influences on nutritional intake and health. • Evaluate a daily diet for moderation, variety, and balance. • Explain the significance of nutrition labeling. • Recognize and differentiate among the various food guides available. • Discuss the role of the health care team. • Discuss interviewing and counseling strategies. • Describe the nutrition care planning process.

3. Basic Nutrition Terms in the Study of Nutrition Macronutrients: carbohydrates, proteins, & fats (kilocalorie sources) Kilocalorie (kcal): energy or amount of heat required to raise 1 kg water by 1 degree Celsius Micronutrients: vitamins, minerals, phytochemicals, and water Nutrient density: amount of micronutrients in relation to the amount of macronutrients; nutrient dense food is high in micronutrients for the amount of macronutrients; empty kilocalories is the opposite

4. Terms (continued) Nutrition: the science of how the body uses food for energy, maintenance, and growth Malnutrition: undernourished, as in vitamin or protein deficiencies; or overnourished, as in obesity Medical nutrition therapy: nutritional therapy provided by a registered dietitian with application of science of nutrition and food choices to achieve or maintain optimal health and well-being

5. Who is a Registered Dietitian? Registered Dietitian Nutritionist Nutritionists are not necessarily RD’s Varied requirements Most are qualified to provide wellness coaching but not MNT Colorado is one of only a few states where nutritionists can practice without being an RD • RD’s are also nutritionists • At least 4 year college degree plus specific nutrition requirements • Supervised internship • National exam • Can practice Medical Nutrition Therapy (MNT) • Continuing education to maintain RD status

6. Role of Genetics in Health and Disease Medical Genealogy: families or groups of people are at increased risk of obesity, diabetes, heart disease Nutrigenetics: genetic predisposition to disease is influenced by diet Nutrigenomics: diet influences gene expression A return to traditional diets and lifestyle is being promoted around the world to reduce many common health conditions.

7. Examples of Positive Traditional Ethnic Eating Habits French: small portions, slow pace of eating, emphasis on vegetables Mediterranean: emphasis on “beans & greens” and olive oil, low intake of meats, sweets limited to special occasions, salads served after main meal Asian: soybean products and/or tofu; high intake of rice, vegetables, and fish; low intake of desserts; sesame and peanut oil emphasized

8. Changing Food Habits Findings of National Health and Nutrition Examination Survey (NHANES) 1965-2002: Percentage of kilocalories from beverages doubled with extra 250 kcal/day.

9. Figure 1-1A Increased Portions of Sugar-Based Beverages • Middle front: traditional bottle of soda pop (7 tsp sugar) • Left front: typical individual size today (15 tsp sugar, 5 tbsp, or over ¼ cup) • Lower right: amount of sugar in 1 liter soda (26 tsp sugar, about 8 tbsp, or ½ cup sugar per liter) • Back row (right to left): traditional “baby mug,” “momma mug,” and “poppa mug” for root beer (only poppa size now available in mug, referred to as small)

10. Figure 1-1B Increased Portions of Juice • Left to right: • 32 oz (quart) of OJ equate to 8 oranges • 8-oz glass of OJ equates to 2 oranges • traditional juice-size glass for 1 orange when hand-squeezing was required to obtain juice

11. How Dietary Patterns Develop and Change What are the biopsychosocial factors that influence an individual’s food choices and habits? Bio: exposure to food flavors and taste preference, level of hunger and satiety, altered food intake based on disease conditions Psych: learned food aversion, stress-related eating, self-esteem impact on food choices Social: food availability within geopolitical issues (war, food insecurity, weather conditions for food growing), family and restaurant offerings, holidays

12. Food Idealism: Types and Impact of Vegetarianism on Nutritional Status Lacto-ovo vegetarians (include milk and eggs)—easiest to meet nutritional needs; use of low-fat milk with diet can help lower risk of heart disease. Lacto-vegetarians include milk but not eggs; pescetarians include fish Vegans (avoid all animal-based foods)—most difficult to meet nutritional needs but might be beneficial to health, such as reduced heart disease and obesity* All vegetarians benefit from intake of legumes, nuts, seeds, and whole grains to ensure adequate protein intake. *Vegans require vitamin B12 supplement and need a vitamin D source if there is inadequate sunlight. Calcium, iron, protein and zinc may be difficult to obtain and individuals might need supplementation.

13. Possible Reasons for Practicing Vegetarianism Social: for environmental reasons or animal rights issues or support of family and friends Health: (Positive) Goal aimed at reduced heart disease and obesity with foods high in fiber and low in saturated fats (Negative) Possible rationale given for masking an eating disorder, especially with a vegan diet Religious: Seventh-day Adventists, Hindus, some Muslims Also helps adherence to kosher diet, where meat and milk products not served at the same meal

14. History of Food Guides 1940s—Seven food groups: included butter (for a vitamin D source); science of nutrition rapidly developed as result of World War II and recognition of lack of military fitness from malnutrition in many young men who grew upduring the Great Depression of the 1930s 1950s—“Basic four” food groups: bread, vegetablesand fruits, dairy, and meat or protein source

15. History of Food Guides • 1990s—Food label changes, development of the food guide pyramid: the foundation ofthe diet (base of the pyramid) is plant-based;meat portrayed in smaller section; fats andsugars form the smallest part of the diet(tip of the pyramid) • 2005—The MyPyramid Food Guidance System: aimed at individualizing food guidance through the interactive website www.MyPyramid.gov,with physical activity being promoted in thenew symbol

16. History of Food Guides • 2010: MyPlate illustrates the five food groups that are the building blocks for a healthy diet using a familiar image—a place setting for a meal.

17. Dietary Guidelines for Americans 1980—the Public Health Service of the Department of Health and Human Services and the USDA published the first guidelines Changes are made every five years; revisions generally have been written to be more positive (e.g., what to do vs. what not to do) 2000 guidelines, “Aim for Fitness, Build a Healthy Base, and Choose Sensibly,” included a total of 10 strategies 2005 Dietary Guidelines for Americans very similar to the 2000 guidelines, with more specific guidance to include at least three whole grains daily and increase fruits and vegetables to 4.5 cups for adults; the MyPyramid Food Guidance System reinforces the revised dietary guidelines 2010 Guidelines very similar to 2005; switch to MyPlate

18. Dietary Guidelines for Americans Build a Healthy Plate Make half your plate full of fruits and vegetables Veggie Goal: 2 ½ cups/day Fruit Goal: 2 cups/day Switch to skim or 1% milk Make at least half your grains whole Vary your protein food choices Keep you food safe to eat Cut back on foods high in solid fats, added sugars and salt Eat the right amount of calories for you Be physically active your way

19. Balance, Variety, Moderation “All foods can fit” Occasional intake ofhigh-fat, high-sugarfoods can be part ofa healthy diet Variety of foodsbest ensuresadequate intake ofnutrients needed forhealth

20. Food Labels Revised in the early 1990s to include percent-daily values based on 2000 kcal reference diet Percentages based on 30% total fat, 10% saturated fat, 60% carbohydrate, minimum of 50 g protein, with 25 g/day recommended fiber and 2400 mg/day sodium Marker nutrients (vitamins A and C, minerals calcium and iron); 100% intake of these nutrients, as found naturally in foods, promotes good intake of other needed nutrients found in conjunction 2006: Food labels now include trans fatty acid content of foods

21. Amount of nutrients in g and mg based on serving size listed → ← Percentage of nutrients based on 2000 kcal and daily reference needs Marker nutrients → Daily Reference Values →

22. Approved Health Claims on Food Labels Foods high in fiber may reduce the risk of cancer and heart disease A low-fat diet may reduce the risk of cancer and heart disease A low-sodium diet may help prevent high blood pressure Soy protein reduces cardiovascular disease Foods high in calcium may help prevent osteoporosis Folate leads to decreased neural tube defects Sugar alcohols reduce dental caries

23. Health Care Team Health care provider: MD or nurse practitioner and, in some areas, physician’s assistant; can prescribe Nurse: RN, LPN, CNA Social worker Physical therapist Occupational therapist Registered dietitian or licensed, certified nutritionist Others: speech-language pathologist, pharmacist

24. Assessment Physiologic Physical Signs Hair, face shape, eyes, lips, tongue, teeth, gums, glands, nervous system Anthropometry: body measurements Height & Weight Tricept skinfold (fat stores) Midarm circumference (protein stores) Elbow breadth (frame size) Biochemical and Clinical Data (example iron, B12, vitamin D, Na, etc)

25. Anthropometrics (cont) • Body Mass Index (BMI) • Ratio of height to weight • Estimate of body fat • <19 is underweight • 19-24.9 is normal weight • 25-29.9 is overweight • >30 is obese • Ideal Body Weight • Women: 100 + (5 x # of inches > 5 ft) • Ex. IBW for 5’4” woman= 100+(5x4)= 120lb +/- 10% • Men: 106 + (6 x # of inches >5 ft) • Ex. IBW for 6’0” male= 106+(6x12)= 178lb +/- 10%

26. Weighing a Non-Ambulatory Person

27. Determine Learning Readinessfor Nutritional/Diet Changes Assess learning stage: Is the problem recognized by the individual? If so, have pros and cons of change been considered? If individual has tried or made changes to deal with the health problem, what has worked and what has not? Is the individual ready to try again or to learn more advanced skills or knowledge?

28. Assessment Areas All Health Care Team Members Can Help Assess Assess needs in three realms: Cognitive: assess individual’s nutritional knowledge and fallacies related to health needs; assess whether auditory or visual learner; check reading ability and level of terminology needed Affective: attitudes toward nutrition and health and willingness to make desired changes Psychomotor: current nutritional behaviors and ability to change

29. Summary Good nutritional status requires the appropriate intake of all essential nutrients for health (the science of nutrition) Knowledge of nutritional needs is important, but the “art” of good nutritional intake is related to the biopsychosocial needs of the individual

30. Study Guide • Vocabulary • Macronutrient • Kilocalorie (kcal) • Micronutrient • Nutrient density • Nutrition • Malnutrtion • Medical nutrition therapy • Nutrigenetics • Nutrigenomics • Vegetarian & Lacto-ovo vegetarians • Vegan • BMI

31. Study Guide (continued) • What is the difference between a registered dietitian and a nutritionist? • What are the biopsychosocial factors that influence intake? • According to MyPlate, what should your plate look like? • Know the Dietary Guidelines for Americans (slide 12) • What are food label percentages based on for calories, fat, saturate fat, CHO, protein, fiber and sodium? (i.e. fat 30%, etc.) • According to our discussion in class, what is the first thing to look at on a food label? • Know how to read a food label • Know how to calculate ideal body weight • Know the BMI categories