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Concepts of Nutrition
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BASIC NUTRITION TERMSBASIC NUTRITION TERMS
Macronutrients: carbohydrates, proteins, & fats(kcalorie sources)
Kcalorie (kcal): energy or amount of heat required toraise 1 kg water 1 degree Celsius
Micronutrients: vitamins, minerals, phytochemicals,and water
Nutrient density: amount of micronutrients in relationto the amount of macronutrients
Nutrition: the science of how the body uses food forenergy, maintenance, and growth
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Terms continued:Terms continued:
Malnutrition: undernourished, as in vitamindeficiencies; or over-nourished, as in obesity
Medical nutrition therapy: nutritional therapy providedby a registered dietitian with application of science of
nutrition and food choices to achieve or maintainoptimal health and well-being
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HEALTH CARE TEAMHEALTH CARE TEAM
Health care provider: MD or nurse practitioner and, insome areas, physicians assistant; can prescribe
Nurse: RN, LPN, CNA
Social worker Physical therapist
Occupational therapist
Registered dietitian or licensed, certified nutritionist
Others: speech-language pathologist, pharmacist
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Assessment and Counseling StrategiesAssessment and Counseling Strategies
Assess Needs in Three Realms:
1) Cognitive: assess an individuals nutritionalknowledge and fallacies related to health needs;assess whether an auditory or visual learner;
check reading ability and level of terminologyneeded
2) Affective: attitudes toward nutrition and health
3) Psychomotor: nutritional behaviors
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Use Good Interviewing StrategiesUse Good Interviewing Strategies
ACTIVE LISTENING: nonjudgmental and open-ended line of questioning:
How do you feel about ______?
Can you tell me more about _____? I versus YOU STATEMENTS: less threatening and
final; promotes clarification of your statements:
It sounds to me like ____ versus You are _____
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Determine Learning ReadinessDetermine Learning Readiness
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 whathasnt?
Is the individual ready to try again or to learn moreadvanced skills or knowledge?
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Counseling StrategiesCounseling Strategies
Base nutritional advice on individual needs, learningstyle, and learning readiness; provide options thatmay work for the individual
Avoid an authoritarian approach; suggest, dont tell
Include the individual in the decision-making process;use active listening to verify that plans are realisticand appropriate for the individual
Use personal examples or experiences of others onlyto convey empathy or strategies that may work
Refer to other health professionals or disciplines asneeded and appropriate
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Effective Nutrition Care Starts with GoodEffective Nutrition Care Starts with GoodCommunication and Rapport DevelopmentCommunication and Rapport Development
Figure 1-1 Effective nutrition care starts with good communication and rapport development.
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Consider How Dietary Patterns DevelopConsider How Dietary Patterns Developand Changeand Change
What are the biopsychosocial factors that influencean individuals food choices and habits?
Can adverse factors be modified to promote positivehealth?
Follow-up assessment at a later date may best revealthese adverse factors as rapport is establishedbetween the client and counselor and attempts atchange have been tried.
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Consider How Dietary Patterns DevelopConsider How Dietary Patterns Developand Change-contdand Change-contd
Consider internal forces: biologic factors andemotions re food choices and habits
Consider external forces: environmental and socialfactors
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Assess Cultural Food HabitsAssess Cultural Food Habits
Is there frequent eating at fast-food restaurants with burgers,fries, and soda pop, or pizza slices from a deli store?
Is this due to convenience or preference?
Does the family eat sitting down together, or separately in frontof the television, in other rooms such as the bedroom, or in front
of the computer? Is this a positive environment with quiet conversation, or noisy with
the television on or family arguments happening?
Is there a clean the plate philosophy?
Are home-cooked meals emphasized?
Meat, potato, and vegetable type of meals or casseroles?
Are ethnic foods prepared?
Are convenience foods frequently used at home?
Do individual family members prepare their own meals?
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Biopsychosocial Health ConcernsBiopsychosocial Health Concerns
Bio includes physical problems that affect nutritional intakeand health, such as effect of high blood sugars on health (lossof eyesight or kidney damage) or food allergies
Psycho includes the psychologic effect of emotions onnutritional intake and health (e.g., the emotions experienced byan individual who has been diagnosed with diabetesdepression may occur that leads to overeating or undereating orsweets being used as rewards or comfort)
Social includes the effect of regional, cultural, ethnic, andreligious dietary habits (e.g., holiday foods or lack of accessowing to local food availability) on the control of health issues
such as diabetes
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Findings of NHANES (National Health andFindings of NHANES (National Health andNutrition Examination Surveys 1971-2000)Nutrition Examination Surveys 1971-2000)
Adults and adolescent girls increased their averagekcal intake
Eating away from home has increased
Larger portion sizes of foods and beverages arebeing consumed
Sweetened beverage intake has increased
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Examples of Traditional Ethnic EatingExamples of Traditional Ethnic EatingHabitsHabits
French: small portions, slowly paced eating,emphasis on vegetables
Mediterranean: emphasis on beans & greens andolive 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
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SLOW FOOD MOVEMENTSLOW FOOD MOVEMENT
Began in 1980s in recognition that themany diverse food varieties and flavors
are being replaced by a few foods withstandardized flavors
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VegetarianismVegetarianism
Lacto-ovo-vegetarians (include milk and eggs) easiest tomeet nutritional needs
Lacto-vegetarians (include milk but not eggs)
Vegans (avoid all animal-based foods) most difficult to
meet nutritional needs* All vegetarians benefit from intake of legumes, nuts,
seeds, and whole grains to ensure adequate proteinintake
*Vegans require vitamin B12 supplement and need a vitamin D source ifthere is inadequate sunlight. Calcium is difficult to obtain, andindividuals may need supplementation.
*Monitoring serum B12 levels advised; monitoring homocysteine levels
may also be appropriate.
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Possible Reasons for PracticingPossible Reasons for PracticingVegetarianismVegetarianism
RELIGIOUS: Seventh-day Adventists, Hindus, Muslims
Helps adherence to kosher diet, where meat and milkproducts not served at the same meal
SOCIAL: to support other family members and friends, forenvironmental reasons, or because of animal rights issues
HEALTH:
(+) Goal aimed at reduced heart disease with foods high infiber and low in saturated fats
(-) May be rationale given for masking an eating disorder,especially with a vegan diet
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Balance, Variety, ModerationBalance, Variety, Moderation
ALL FOODS CAN FIT
Occasional intake of high-fat, high-sugar foods canbe part of a healthy diet
Regular intake of high-fat, high-sugar foods isacceptable if portions are small
Variety of foods best ensures adequate intake ofnutrients needed for health
A balanced meal includes at least three of the foodgroups (e.g., grain + vegetable or fruit + proteinsource or milk product)
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History of Food GuidesHistory of Food Guides
1940s Seven food groups: included butter (for a vitamin Dsource); science of nutrition rapidly developed as result ofWorld War II and recognition of lack of military fitness frommalnutrition in many young men who grew up during theGreat Depression of the 1930s
1950s Basic four food groups: composed of bread,vegetables and fruits, dairy, and meat or protein
1990s The food guide pyramid: the foundation of the diet(base of the pyramid) is plant-based; meat portrayed insmaller section; fats and sugars 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 websitewww.MyPyramid.gov, with physical activity being promoted inthe new symbol
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2005 MyPyramid.gov2005 MyPyramid.gov
Unn Figure 1-1 MyPyramid food guidance system.
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2005 MyPyramid.gov2005 MyPyramid.gov
Unn Figure 1-1 MyPyramid food guidance system.
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Food LabelsFood Labels
Revised in the early 1990s to include percent-dailyvalues based on 2000 kcal reference diet
Percentages based on 30% total fat, 10% saturatedfat, 60% carbohydrate, minimum of 50 g protein, with
25 g/day recommended fiber and 2400 mg/daysodium
Marker nutrients (vitamins: A and C, and minerals:calcium and iron); 100% intake of these nutrients, as
found naturally in foods, promotes good intake ofother needed nutrients found in conjunction
2006 Food labels now include trans fatty acid contentof foods
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Figure 1-4 Reading the food label. CHO, Carbohydrates; PRO, protein.
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Dietary Guidelines for AmericansDietary Guidelines for Americans
1980 the Public Health Service of the Department ofHealth and Human Services and the USDA published thefirst guidelines
Changes are made every 5 years; revisions generallyhave 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 the2000 guidelines, with more specific guidance to include atleast three whole grains daily and increase fruits andvegetables to 4 cups for adults; the MyPyramid FoodGuidance System reinforces the revised dietary guidelines
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2005 Dietary Guidelines for Americans2005 Dietary Guidelines for Americans
Figure 1-5 Dietary guidelines for Americans for good health.
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The Food Exchange SystemThe Food Exchange System
A food guide originally developed by the AmericanDiabetes Association and the American DieteticAssociation for diabetes management
Generally no longer advised for diabetes
management, but useful to recognize themacronutrient content of foods (carbohydrate,protein, and fat)
Appendix 3 shows the latest food exchange system
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SummarySummary
Good nutritional status requires the appropriateintake of all essential nutrients for health (the scienceof nutrition)
Knowledge of nutritional needs is important, but the
art of good nutritional intake is related to thebiopsychosocial needs of the individual
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