1 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Chapter 1 The Art of Nutrition in a Social Context

1Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Chapter 1Chapter 1

The Art of Nutrition in The Art of Nutrition in a Social Contexta Social Context


Role of Genetics in Role of Genetics in Health and DiseaseHealth and Disease

Medical Genealogy: families or groups of Medical Genealogy: families or groups of people are at increased risk of obesity, people are at increased risk of obesity, diabetes, heart diseasediabetes, heart disease

Nutrigenetics: genetic predisposition to Nutrigenetics: genetic predisposition to disease is influenced by dietdisease is influenced by diet

Nutrigenomics: diet influences gene Nutrigenomics: diet influences gene expression expression

A return to traditional diets and lifestyle is A return to traditional diets and lifestyle is being promoted around the world to being promoted around the world to reduce many common health conditions.reduce many common health conditions.


Basic Nutrition Terms in Basic Nutrition Terms in the Study of Nutritionthe Study of Nutrition

Macronutrients: carbohydrates, proteins, & fats Macronutrients: carbohydrates, proteins, & fats (kilocalorie sources)(kilocalorie sources)

Kilocalorie (kcal): energy or amount of heat Kilocalorie (kcal): energy or amount of heat required to raise 1 kg water by 1 degree Celsiusrequired to raise 1 kg water by 1 degree Celsius

Micronutrients: vitamins, minerals, Micronutrients: vitamins, minerals, phytochemicals, and waterphytochemicals, and water

Nutrient density: amount of micronutrients in Nutrient density: amount of micronutrients in relation to the amount of macronutrients; nutrient relation to the amount of macronutrients; nutrient dense food is high in micronutrients for the dense food is high in micronutrients for the amount of macronutrients; empty kilocalories is amount of macronutrients; empty kilocalories is the oppositethe opposite


Terms (continued)Terms (continued)

Nutrition: the science of how the body uses Nutrition: the science of how the body uses food for energy, maintenance, and growthfood for energy, maintenance, and growth

Malnutrition: undernourished, as in vitamin Malnutrition: undernourished, as in vitamin or protein deficiencies; or overnourished, as or protein deficiencies; or overnourished, as in obesityin obesity

Medical nutrition therapy: nutritional therapy Medical nutrition therapy: nutritional therapy provided by a registered dietitian with provided by a registered dietitian with application of science of nutrition and food application of science of nutrition and food choices to achieve or maintain optimal choices to achieve or maintain optimal health and well-beinghealth and well-being


Food Idealism: Types and Impact of Food Idealism: Types and Impact of Vegetarianism on Nutritional StatusVegetarianism on Nutritional Status

Lacto-ovo vegetariansLacto-ovo vegetarians (include milk and eggs) (include milk and eggs)——easiest to meet easiest to meet nutritional needs; use of low-fat milk with diet can help lower risk nutritional needs; use of low-fat milk with diet can help lower risk of heart disease. of heart disease. Lacto-vegetariansLacto-vegetarians include milk but not eggs; include milk but not eggs; pescetarians include fishpescetarians include fish

VegansVegans (avoid all animal-based foods) (avoid all animal-based foods)——most difficult to meet most difficult to meet nutritional needs; can be harmful nutritionally but might be nutritional needs; can be harmful nutritionally but might be beneficial to health, such as reduced heart disease and obesity*beneficial to health, such as reduced heart disease and obesity*

All vegetarians benefit from intake of legumes, nuts, seeds, and All vegetarians benefit from intake of legumes, nuts, seeds, and whole grains to ensure adequate protein intake.whole grains to ensure adequate protein intake.*Vegans require vitamin B*Vegans require vitamin B1212 supplement and need a vitamin D supplement and need a vitamin D

source if there is inadequate sunlight. Calcium is difficult to source if there is inadequate sunlight. Calcium is difficult to obtain, and individuals might need supplementation. Monitoring obtain, and individuals might need supplementation. Monitoring serum Bserum B1212 levels advised; monitoring homocysteine levels might levels advised; monitoring homocysteine levels might

also be appropriate.also be appropriate.


Possible Reasons for Possible Reasons for Practicing VegetarianismPracticing Vegetarianism

Social: for environmental reasons or animal Social: for environmental reasons or animal rights issues or support of family and friendsrights issues or support of family and friends

Health: Health: (Positive) Goal aimed at reduced heart disease (Positive) Goal aimed at reduced heart disease

and obesity with foods high in fiber and low in and obesity with foods high in fiber and low in saturated fatssaturated fats

(Negative) Possible rationale given for masking (Negative) Possible rationale given for masking an eating disorder, especially with a vegan dietan eating disorder, especially with a vegan diet

Religious: Seventh-day Adventists, Hindus, Religious: Seventh-day Adventists, Hindus, some Muslimssome Muslims Also helps adherence to kosher diet, where meat Also helps adherence to kosher diet, where meat

and milk products not served at the same mealand milk products not served at the same meal


Examples of Positive Examples of Positive Traditional Ethnic Eating HabitsTraditional Ethnic Eating Habits

French: small portions, slow pace of French: small portions, slow pace of eating, emphasis on vegetableseating, emphasis on vegetables

Mediterranean: emphasis on “beans & Mediterranean: emphasis on “beans & greens” and olive oil, low intake of meats, greens” and olive oil, low intake of meats, sweets limited to special occasions, salads sweets limited to special occasions, salads served after main mealserved after main meal

Asian: soybean products and/or tofu; high Asian: soybean products and/or tofu; high intake of rice, vegetables, and fish; low intake of rice, vegetables, and fish; low intake of desserts; sesame and peanut oil intake of desserts; sesame and peanut oil emphasized emphasized


Balance, Variety, ModerationBalance, Variety, Moderation

““All foods can fit”All foods can fit” Occasional intake of high-fat, high-sugar Occasional intake of high-fat, high-sugar

foods can be part of a healthy dietfoods can be part of a healthy diet Regular intake of high-fat, high-sugar Regular intake of high-fat, high-sugar

foods is acceptable if portions are smallfoods is acceptable if portions are small Variety of foods best ensures adequate Variety of foods best ensures adequate

intake of nutrients needed for healthintake of nutrients needed for health A balanced meal includes at least three of A balanced meal includes at least three of

the food groups (e.g., grain + vegetable or the food groups (e.g., grain + vegetable or fruit + protein source/milk product)fruit + protein source/milk product)


History of Food GuidesHistory of Food Guides

1940s1940s——Seven food groups: included butter (for a vitamin D source); Seven food groups: included butter (for a vitamin D source); science of nutrition rapidly developed as result of World War II and science of nutrition rapidly developed as result of World War II and recognition of lack of military fitness from malnutrition in many recognition of lack of military fitness from malnutrition in many young men who grew up during the Great Depression of the 1930s young men who grew up during the Great Depression of the 1930s

1950s1950s——“Basic four” food groups: bread, vegetables and fruits, “Basic four” food groups: bread, vegetables and fruits, dairy, and meat or protein sourcedairy, and meat or protein source

1990s1990s——Food label changes, development of the food guide Food label changes, development of the food guide pyramid: the foundation of the diet (base of the pyramid) is pyramid: the foundation of the diet (base of the pyramid) is plant-based; meat portrayed in smaller section; fats and sugars plant-based; meat portrayed in smaller section; fats and sugars form the smallest part of the diet (tip of the pyramid)form the smallest part of the diet (tip of the pyramid)

20052005——The MyPyramid Food Guidance System: aimed at The MyPyramid Food Guidance System: aimed at individualizing food guidance through the interactive website individualizing food guidance through the interactive website www.MyPyramid.gov, with physical activity being promoted in the www.MyPyramid.gov, with physical activity being promoted in the new symbolnew symbol


Food LabelsFood Labels

Revised in the early 1990s to include Revised in the early 1990s to include percent-daily values based on 2000 kcal percent-daily values based on 2000 kcal reference dietreference diet

Percentages based on 30% total fat, 10% Percentages based on 30% total fat, 10% saturated fat, 60% carbohydrate, minimum of 50 g saturated fat, 60% carbohydrate, minimum of 50 g protein, with 25 g/day recommended fiber and protein, with 25 g/day recommended fiber and 2400 mg/day sodium2400 mg/day sodium

Marker nutrients (vitamins A and C, minerals Marker nutrients (vitamins A and C, minerals calcium and iron); 100% intake of these nutrients, calcium and iron); 100% intake of these nutrients, as found naturally in foods, promotes good intake as found naturally in foods, promotes good intake of other needed nutrients found in conjunction of other needed nutrients found in conjunction

2006: Food labels now include trans fatty acid 2006: Food labels now include trans fatty acid content of foodscontent of foods


Marker nutrients →

Daily Reference Values →

Amount of nutrients in g and mg based on serving size listed →

← Percentage of nutrients based on 2000 kcal and daily reference needs


Approved Health Claims Approved Health Claims on Food Labelson Food Labels

Foods high in fiber may reduce the risk of cancer Foods high in fiber may reduce the risk of cancer and heart diseaseand heart disease

A low-fat diet may reduce the risk of cancer and A low-fat diet may reduce the risk of cancer and heart diseaseheart disease

A low-sodium diet may help prevent high blood A low-sodium diet may help prevent high blood pressurepressure

Soy protein reduces cardiovascular diseaseSoy protein reduces cardiovascular disease Foods high in calcium may help prevent Foods high in calcium may help prevent

osteoporosisosteoporosis Folate leads to decreased neural tube defectsFolate leads to decreased neural tube defects Sugar alcohols reduce dental cariesSugar alcohols reduce dental caries


Dietary Guidelines for AmericansDietary Guidelines for Americans

19801980——the Public Health Service of the Department of the Public Health Service of the Department of Health and Human Services and the USDA published the Health and Human Services and the USDA published the first guidelinesfirst guidelines

Changes are made every five years; revisions generally Changes are made every five years; revisions generally have been written to be more positive (e.g., what to do vs. have been written to be more positive (e.g., what to do vs. what not to do)what not to do)

2000 guidelines, “Aim for Fitness, Build a Healthy Base, and 2000 guidelines, “Aim for Fitness, Build a Healthy Base, and Choose Sensibly,” included a total of 10 strategiesChoose Sensibly,” included a total of 10 strategies

2005 Dietary Guidelines for Americans very similar to the 2005 Dietary Guidelines for Americans very similar to the 2000 guidelines, with more specific guidance to include at 2000 guidelines, with more specific guidance to include at least three whole grains daily and increase fruits and least three whole grains daily and increase fruits and vegetables to 4.5 cups for adults; the MyPyramid Food vegetables to 4.5 cups for adults; the MyPyramid Food Guidance System reinforces the revised dietary guidelinesGuidance System reinforces the revised dietary guidelines

2010 Dietary Guidelines to be printed 2011 and available on 2010 Dietary Guidelines to be printed 2011 and available on Evolve at that timeEvolve at that time


MyPyramid.govMyPyramid.gov

.


The Food Exchange SystemThe Food Exchange System

A food guide originally developed by the A food guide originally developed by the American Diabetes Association and the American Diabetes Association and the American Dietetic Association for diabetes American Dietetic Association for diabetes managementmanagement

Generally no longer advised for diabetes Generally no longer advised for diabetes management but useful to recognize the management but useful to recognize the macronutrient content of foods macronutrient content of foods (carbohydrate, protein, and fat)(carbohydrate, protein, and fat)

Appendix 3 EVOLVE shows the latest food Appendix 3 EVOLVE shows the latest food exchange systemexchange system


Health Care TeamHealth Care Team

Health care provider: MD or nurse Health care provider: MD or nurse practitioner and, in some areas, physician’s practitioner and, in some areas, physician’s assistant; can prescribeassistant; can prescribe

Nurse: RN, LPN, CNANurse: RN, LPN, CNA Social workerSocial worker Physical therapistPhysical therapist Occupational therapistOccupational therapist Registered dietitian or licensed, certified Registered dietitian or licensed, certified

nutritionistnutritionist Others: speech-language pathologist, Others: speech-language pathologist,

pharmacistpharmacist


The Nutrition Care ProcessThe Nutrition Care Process

Begins with Begins with AssessmentAssessment of Needs of Needs Followed by Followed by PlanningPlanning based on based on

Assessment of NeedsAssessment of Needs InterventionIntervention adheres to the Plan adheres to the Plan

May include other members of the Health Care May include other members of the Health Care TeamTeam

EvaluationEvaluation is incorporated into the Plan, is incorporated into the Plan, using measurable outcomes; outcome using measurable outcomes; outcome measures after Planned Interventionmeasures after Planned Intervention


Assessment Areas All Health Care Assessment Areas All Health Care Team Members Can Help AssessTeam Members Can Help Assess

Assess needs in three realms:Assess needs in three realms: Cognitive: assess individual’s nutritional Cognitive: assess individual’s nutritional

knowledge and fallacies related to health knowledge and fallacies related to health needs; assess whether auditory or visual needs; assess whether auditory or visual learner; check reading ability and level of learner; check reading ability and level of terminology neededterminology needed

Affective: attitudes toward nutrition and health Affective: attitudes toward nutrition and health and willingness to make desired changesand willingness to make desired changes

Psychomotor: current nutritional behaviors and Psychomotor: current nutritional behaviors and ability to change ability to change


Assess Cultural Food Habits Assess Cultural Food Habits

Is there frequent eating at fast-food restaurants or deli Is there frequent eating at fast-food restaurants or deli store?store? Is this due to convenience or preference?Is this due to convenience or preference?

Does the family eat sitting down together, or separately in Does the family eat sitting down together, or separately in front of the television or computer, or in other rooms such front of the television or computer, or in other rooms such as the bedroom?as the bedroom? Is this a positive environment with quiet conversation or noisy Is this a positive environment with quiet conversation or noisy

with the television on or family arguments happening?with the television on or family arguments happening? Is there a “clean the plate” philosophy?Is there a “clean the plate” philosophy?

Are home-cooked meals emphasized?Are home-cooked meals emphasized? Meat, potato, and vegetable type of meals or casseroles? Meat, potato, and vegetable type of meals or casseroles? Are ethnic foods prepared?Are ethnic foods prepared? Are convenience foods frequently used at home?Are convenience foods frequently used at home? Do individual family members prepare their own meals?Do individual family members prepare their own meals?


SummarySummary

Good nutritional status requires the Good nutritional status requires the appropriate intake of all essential nutrients appropriate intake of all essential nutrients for health (the science of nutrition)for health (the science of nutrition)

Knowledge of nutritional needs is Knowledge of nutritional needs is important, but the “art” of good nutritional important, but the “art” of good nutritional intake is related to the biopsychosocial intake is related to the biopsychosocial needs of the individualneeds of the individual

Documents

1 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Chapter 1 The Art of Nutrition in a Social Context