Chapter 1 An Overview of Nutrition - Amazon S3s3.amazonaws.com/prealliance_oneclass_sample/4lv9wbPML7.pdf · information serves as the basis for understanding all aspects of nutrition

Enriched Instructor’s Manual to Accompany Understanding Nutrition, First Canadian Edition 1-1

Chapter 1An Overview of Nutrition

I F N O T H I N G E L S E , M Y S T U D E N T S S H O U L D L E A R N …

1. That numerous factors will influence the food and dietary choices people make, and that generating sound nutritional guidelines will be influenced by such factors.

2. The basic six classes of nutrients and how they differ in terms of providing energy directly to the body (i.e., the macronutrients) or helping derive energy from the macronutrients.

3. The basic principles underpinning the scientific method and how they are utilized in studying the impact of nutrients on human health and disease.

4. The different dietary reference intakes (DRI) and how to interpret them when reading nutritional labels on various food items.

5. That a complete nutrition assessment by a registered dietitian involves numerous health screening tools.

L E A R N I N G O B J E C T I V E S

Students should be able to:

• LO 1.1: Discuss the various factors (e.g., personal preference, habit, ethnic heritage, etc.) that influence a person’s eating behaviour. [Understand]

• LO 1.2: Define nutrient, list the six nutrients contained in food, and a major use of each nutrient. [Remember]

• LO 1.3: Identify the energyproviding nutrients and calculate the energy available from foods. [Understand/Analyze]

• LO 1.4: List the types of research designs and the strengths and weaknesses of each. [Understand]

• LO 1.5: Describe and give an example of major types of research studies. [Understand/Analyze]

• LO 1.6: Understand the different elements of a research study that could have

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significant effects on its outcomes (e.g., sample size, placebo, etc.). [Understand]

• LO 1.7: Discuss Dietary Reference Intakes (DRI)and the four parts of the DRI, including the Estimated Average Requirements (EAR), Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL). [Remember/Understand]

• LO 1.8: Explain the Estimated Energy Requirement (EER) and how it is used to maintain energy balance. [Remember/Understand]

• LO 1.9: Discuss the Acceptable Macronutrient Distribution Ranges (AMDR) and how they relate to a healthy diet. [Remember/Understand]

• LO 1.10: List the four parts of a nutritional assessment and apply them to individuals to detect malnutrition. [Remember/Understand]

• LO 1.11: Explain the Estimated Energy Requirement (EER) and how it is used to maintain energy balance. [Remember/Understand]

• LO 1.12: Identify the chronic diseases that are linked to diet or alcohol. [Remember/Understand]

• LO 1.13: Identify accurate sources of nutrition information. [Understand]

• LO 1.14: List the eight red flags that identify nutrition misinformation. [Remember]

• LO 1.15: Explain the basic assessment tools used by a registered dietitian in performing a nutrition assessment. [Remember/Understand]

W H Y I S T H I S C H A P T E R I M P O R T A N T T O S C I E N T I S T S A N D H E A L T H C A R E P R A C T I T I O N E R S ?

“Of special interest to...” symbol key: = HealthCare Practitioners = Science Majors

• Healthcare practitioners typically incorporate numerous pieces of information when performing a nutrition assessment. One very important factor discussed in this chapter deals with the numerous factors that influence people’s feeding behaviour and food choices. These factors, such as habit, social interactions, and tradition, will affect the success of a dietarybased intervention to manage health or disease. As an example, university students are very often subject to numerous responsibilities and social interactions during the course of their studies that often times make it difficult to adhere to sound nutritional practices. Catching a quick bite in between classes, which often times means a high calorie food item,



followed by hours of sitting while studying, comes to be a strong influence on eating patterns because of its convenience.

• By understanding the basic science of the macronutrients (i.e., carbohydrates, lipids, and protein), the healthcare practitioner can make scientificbased recommendations on dietary intakes for individuals concerned with improving their health and/or physical fitness. For instance, dietary lipids are recommended to form one of the lowest proportions of macronutrient intake given that it carries over twice the amount of energy (9 kcal/g) than protein and carbohydrates (4 kcal/g). The food choices that a university student makes—due to convenience, for example—will have a significant effect on his or her health.

• From a scientific perspective, understanding the basic energy provision of macronutrients will provide a solid starting point for understanding the impact of nutritional strategies on overall health. As discussed throughout the textbook, it is important for students to understand that it is the quantity AND quality of the macronutrients that the healthcare practitioner considers in making dietary recommendations.

• As the scientific method is the fundamental basis guiding research in the area of nutrition, the scientist must have an understanding the various elements within a research design that gives a study credibility. Given the multitude of information available from both scientific and lay sources on nutrition, the scientist must be able to sift through the details and clearly evaluate the quality of research. For instance, a new study may suggest the importance of a novel type of dietary supplement on health, but important research elements such as sample size, doubleblinding, and placebos will indicate to the scientist whether or the study carries validity.

• The healthcare practitioner will be acutely aware of the dietary reference intakes when making recommendations to individuals seeking to improve their nutritional profile. By considering the different intakes (i.e., AI, RDA, and UL), the healthcare practitioner can take an accurate view of such intakes to ensure that patients are fitting within a safe nutritional zone.

• The dietary reference intakes, as well as the estimated energy recommendations (i.e., the estimated energy requirement and the acceptable macronutrient distribution range), will serve as a basis for the healthcare practitioner in making nutrient recommendations. Coupled with information related to the link between nutrition and chronic diseases, and their risk factors, an effective approach of improving overall health and physical fitness of patients can be achieved.

W H Y S H O U L D S T U D E N T S C A R E ?



• Students should be aware that in addition to providing nutrients, our dietary patterns are heavily influenced by factors that we often do not think about (i.e., convenience, emotional satisfaction, peer pressure, etc.). These food choices will have a direct effect on the nutritional profiles of students and their health (positive and negative).

• It is important for students to be aware that cultural traditions and social values affect people’s food choices. In addition, many factors other than nutrition drive food choices. By understanding these, and additional motivators, such as availability, convenience, and economy, students will develop an overall appreciation of the factors influencing health and disease through nutrition.

• Learning how nutrients in food support the growth, maintenance, and repair of the body enable students to understand that deficiencies, excesses, and imbalances can lead to the development of some diseases, such as heart disease, diabetes, some cancers, dental disease, and adult bone loss (osteoporosis). Students should develop an understanding that these diseases develop over time and that their dietary patterns today will have a direct effect on their present and future state of their health.

• Personal life choices, such as staying physically active or using tobacco or alcohol, also affect health, for better or worse. Other harmful factors include lack of sleep, stress, and negative home and job conditions, including the condition of air and water and other environmental factors. Positive health choices can benefit health, including being physically active and eating well. The knowledge that students gain through a course in nutrition will empower them to make independent and wellinformed choices of maintaining a positive and healthy profile, physically, mentally, and emotionally.

• Students need to know that food supplies energy and nutrients. The energyyielding nutrients are the macronutrients: carbohydrates, fats (lipids), and protein. The micronutrients are vitamins and minerals. Food energy is measured in calories, while food and nutrient quantities are often measured in grams. This information serves as the basis for understanding all aspects of nutrition and how it plays a central role in a person’s health and wellbeing.

• Students should be able to identify the basic elements that constitute a healthy diet. A wellplanned diet is adequate in nutrients, is balanced with regards to food types, offers food energy that matches energy expended in activity, is moderate in unwanted constituents, and offers a variety of nutritious foods.

• As the popular media constantly reports healthrelated stories on new discoveries regarding the food we eat and disease on a daily basis, students should develop an appreciation of the basic elements of the scientific method from which these discoveries are based. Misleading information can be easily deciphered if students have a solid understanding the various elements of research studies and the factors



that can adversely affect their validity, such as the use of placebos, controls, and blinding.

• In order for students to make sound nutritionrelated choices, an understanding the dietary reference intakes should be established. Although not necessary to memorize, students should know that the macro and micronutrients carry a recommended amount for ingestion (i.e., through the RDA or AI), and that excessive amounts of some nutrients (i.e., above the UL) will lead to toxicity symptoms.

W H A T A R E C O M M O N S T U D E N T M I S C O N C E P T I O N S / S T U M B L I N G B L O C K S ?

1. Students often do not think about why they choose the foods to eat that they do. Most, if not all, students do have a general sense that nutrition plays an important role in the health and wellbeing of individuals. By understanding the numerous factors that influence eating patterns (e.g., habit, ethnic heritage, convenience) students can become more aware of how to develop more sound nutritional practices.

2. When new research is reported by the media, many people take the information as valid, including students. It is important for nutrition students to develop their understanding of the scientific method in order to be able to critically evaluate research findings for its validity. Providing links to scientific databases, such as PubMed, will be a good first step for students to quickly determine the magnitude of research available on various topics.

3. Firstyear undergraduate students typically present with mixed thoughts on the use of dietary supplements in general. In order to be able to evaluate the contents and claims of such supplements, a thorough understanding of the classes of nutrients in terms of energy provision (macronutrients) and energy supporting (micronutrients) is necessary.

4. Too much of a good thing isn’t always the best choice for people to make. If a nutritional supplement claims to help boost vision acuity (e.g., vitamin A), then taking lots of it will be better, right? Students should have a good understanding of the dietary reference intakes, which provide sound guidelines that protect people from nutritional toxicity and deficiency conditions.

W H A T C A N I D O I N C L A S S ?

There are a variety of activities that can be done in class. Listed below are some activities that will help introduce the topic of nutrition, and the students to each other.



Classroom Activity 11: Students’ Burning Questions1

The first day of class, give each student three “PostIt” notes. On each note, students are to write down a “burning” question they have about nutrition. While they are doing this, tape 15 large pieces of construction paper around the room, each with a title that roughly corresponds to chapters of the textbook.

When they finish writing their questions, have them categorize their PostIt notes according to the 15 topics by placing their PostIt on the piece of construction paper that relates to their question. When they finish, ask them to take turns reading the questions that they have generated. Before the next class, check the categorization of their questions and rearrange the PostIt notes if necessary. As you begin a new chapter, bring the corresponding piece of construction paper to class, and read the questions aloud.

This activity helps reassure students early on that you will (or will not) be covering some of their “burning” questions. It also helps show students the relevance of the information you’re covering in class, and helps show instructors the interests of the students.

Classroom Activity 12: Getting Acquainted ActivityThis activity allows students to learn more about each other and can provide an environment in which people practise listening skills. Instruct students to pair off with someone that they do not know very well. Give the students 10–15 minutes to converse and ask some general questions about each other. Have students ask each other if they know anyone who is a nutritionist or dietitian or if they know someone who might have had to use the assistance of a nutritionist or dietitian. You may also suggest that they exchange email addresses or phone numbers and form study groups.

Bring the group back together in a large circle with students sitting next to their partners. Ask students to introduce and speak about what they have learned about their new friend. This activity works well for small class sizes.

Classroom Activity 13: Who Are You? Introduction ActivityDistribute index cards to each student and instruct students to record information about themselves on each card. Write on the board the information you are interested in obtaining. Some suggestions include: name, address, phone, email, major, year in university, home town, professional goals, what they hope to learn from the class, reason for taking the class, and something interesting and/or unique about themselves. After students have recorded this information, you may ask them to introduce themselves to the class or you may simply collect the cards to help you learn more about your students.

Classroom Activity 14: ChapterOpening Quiz2

As a way of introducing any new chapter, give a “quiz” to the class. The students will moan initially, but they will enjoy the activity once you get underway and they realize that it is taken as a class and does not count toward their grade. The “quiz” asks 10 true/false or multiplechoice questions projected in PowerPoint format or on an overhead

1 Activity provided by Caroline Roberts, RD, MPH—Nutrition Education Specialist for California Department of Education and Instructor at Sierra College.2 Activity provided by Lin Brown, Shasta College, Redding, CA.



from a transparency. The students are not allowed to talk during the quiz, and must show their choice of answer by raising hands. Record using iClickers or mark the answer chosen by the majority of hands on the transparency. Then go over the correct answers (their curiosity is piqued!) and seize the “teachable moment.” Generally, they score about 55 percent and realize there is a lot to learn.

This “pretest” is valuable because it creates interest in the subject matter, challenges students’ erroneously held beliefs, and introduces new terms and concepts. It is valuable to instructors in assessing the level of knowledge and attitudes in the subject area and identifying the needs and the focus for the unit.

Classroom Activity 15: Scheduled Interruption: Think/Pair/ShareExamination of student attention levels throughout class indicate that students’ attention levels are the highest during the first five minutes of class, then levels slowly decline throughout a lecture. To enhance students’ attentiveness, teaching authorities suggest scheduled interruptions. One planned interruption is think, pair, share. The purpose of this activity is to encourage the participation of all students, especially those who are quiet. Pose a statement, problem, or situation. Instruct students to quietly write their comments, including their thoughts and feelings regarding this topic. Next, pair students with a partner and instruct them to share their comments. Circulate while students are talking. After they have shared with their partner, ask for comments to be shared with the entire class.

Classroom Activity 16: Using the Internet as a Research ToolThe Internet can be used as a valuable research tool in nutrition. Students can become familiar with the diversity of Internet resources and can learn to participate in online discussions about nutrition topics in classbased and listserv groups.

Classroom Activity 17: Evaluation of a Published Research ArticleStudents need to learn how to critically evaluate the information they learn about. This takehome assignment requires students to evaluate an article with published nutrition information. Students can then share their findings with other students in class or in a seminar. During class, introduce students to the use of the widely used database, PubMed, in addition to the electronic journal subscription database of their institutional library system. Spend a few minutes in class to acquaint the student to the use of both systems to identify and locate an original, peerreviewed research article.

Classroom Activity 18: Using FAQs for Class Information3

As many people know, a Frequently Asked Questions page is worthwhile to examine. The questions asked and answered are the type of questions a student may have about the class but may not have thought about until reading them. These questions should be designed carefully based on questions that are often received so they will be of high interest to students. These could be the top ten questions for surviving the nutrition class. A sample question is: “What is the best way for a student to learn nutrition well enough to ace this course?” If you can cover questions that students really have about the course,

3 Activity provided by Dr. Neil Allison, University of Arkansas.



you’ll be showing them early on that you understand their concerns and can also provide some good advice.

Critical Thinking Questions4

These questions will also be posted to the book’s website so that students can complete them online and email their answers to you.

1. The following example was provided in your textbook regarding the importance of “nutrition”: “...your body uses the nutrients from (meals eaten) to make all its components, fuel all its activities, and defend itself against diseases....” Please expand upon this statement relative to the role of food in the lifestyle of the average North American consumer. If you were performing a dietary intake on a patient, what other questions might you be interested in regarding the patient’s diet and activities?

2. Your textbook described six classes of nutrients and discussed the distinctions between them in several ways (i.e., caloric density, organic/inorganic, size, and essentiality). Discuss each class of nutrient important to the body and its unique distinction. Discuss your concerns for a patient who might be undernourished or overnourished in each category. For example, in a broad sense, what problems would that cause the patient?

3. As noted in Chapter 1, the science of nutrition is a young science but growing rapidly. Without scientific studies, nutrition could not grow and flourish as it does. It will be important for you not only to understand how to read scientific studies but to be involved in them. Describe a nutritionrelated topic that you are interested in studying. Attempt to write a simple question that could be answered with a research study. How would you differentiate between the experimental and control groups, how many subjects do you think you would need for a good sample size, and what do you want to know before making conclusions? What other specifics should you know or integrate into your research design to optimize its validity? What should your readers know when it is published?

4. What is the difference between a DRI and an RDA? Should you tell your patient to take both? Does it mean that everyone should take the same amount to achieve the same benefit from the nutrient? Are there DRI and RDA for macronutrients?

5. You are about to perform a nutrition assessment on a patient. State specifically, and in detail, what types of assessment information are you going to collect and why.

6. Chronic disease is a significant health problem in Canada and the United States. Billions of healthcare dollars are spent on chronic disease, yet, in reality, little is done about the role of nutrition in the prevention of or recovery from chronic disease. If you were in charge of healthcare spending, what might be your first proclamation and why?

7. (a) Nutrition assessment is the diagnostic tool of the registered dietitian. In 4 Contributed by Kathleen Rourke.



performing a nutrition assessment, an RD asks many specifics about diet—in detail. Why? (b) The RD also will ask for much detail about an individual’s behaviours, culture, financial status, etc. Why would the RD delve into one’s personal history in such detail, and what does this have to do with what one eats? (c) If an RD asks about the person’s health status, would that be appropriate? Why or why not? (d) If there were questions about a disease or issue that the RD was not familiar with, where might the RD go to find additional information?

8. There are a variety of health professionals in addition to the physician and the nurse. Very frequently the healthcare consumer is confused as to who does what and to whom to listen. It seems like everyone is providing nutrition information these days, and other than the physician and the RN, why should they trust anyone else? You are an RD in a community hospital and your patient indicates when you come into his room that there have been several individuals that have already visited him to talk about diet. You find out that the respiratory therapist, physical therapist, speech pathologist, MD, and RN have all talked to Mr. X about his diet. Discuss the differences among the many healthcare professionals with regard to their nutrition training and scope of practice and then briefly discuss how you might approach your patient to help him understand how your skills are unique from those of the other healthcare professionals.

Case Study5

Mary P. is a 57yearold operating room nurse who works fulltime at a local hospital. She is 1.65 metres (65 inches) tall and weighs 73 kilograms (160 pounds). She has a family history of diabetes and heart disease and was recently diagnosed with high blood cholesterol. She has declined the cholesterollowering medication her doctor prescribed, and says she would like to explore other methods for lowering her cholesterol first. For the past few weeks, Mary has been taking a tablespoon of coconut oil every day after reading on the Internet that this will lower her cholesterol. She admits she has little time or energy to exercise. Her diet history reveals she often skips breakfast or has a doughnut or bagel with cream cheese at work. She drinks several cups of coffee each morning with cream and sugar. Lunch is a salad with crackers and iced tea with sugar in the hospital cafeteria. She occasionally drinks one or two glasses of wine in the evening, especially after a stressful day at work. She lives alone and relies on frozen dinners or other convenience foods in the evening. An analysis of her diet reveals an average daily intake of 80 grams of fat, 200 grams of carbohydrate, and 50 grams of protein.

1. Taking into account her current lifestyle and personal food preferences, what eating habits might be difficult for Mary to change?

2. How might her emotions contribute to her food and drink choices?

3. Using Table 12, calculate Mary’s average daily kcalorie intake.

4. What percentage of her daily calories is provided by fat? Carbohydrates? Protein?

5. Compare the composition of Mary’s diet with the Acceptable Macronutrient Distribution Ranges (AMDR).

5 Contributed by Barbara Quinn.



6. How would you use the information above to make dietary recommendations for Mary?

7. How would you direct her to valid nutrition research for lowering blood cholesterol?

W H A T O T H E R R E S O U R C E S A R E A V A I L A B L E ?

You can look up information about government policy as well as any health condition that you are interested in learning more about. Consult the following websites to get reliable information on the following:

Government agencies responsible for nutrition and physical activity policies:• Canadian Fitness and Lifestyle Research Institute: http://www.cflri.ca

• Canadian Institutes of Health Research (CIHR): http://www.cihrirsc.gc.ca/

• Health Canada’s Office of Nutrition Policy and Promotion (ONPP): http://www.hcsc.gc.ca/ahcasc/branchdirgen/hpfbdgpsa/onppbppn/index_e.html

• National Research Council of Canada: http://www.nrccnrc.gc.ca/eng/index.html

• Natural Sciences and Engineering Research Council of Canada (NSERC): http://www.nserccrsng.gc.ca/Index_eng.asp

• Public Health Agency of Canada (PHAC) – Physical Activity Unit: http://www.phacaspc.gc.ca/hpps/hlmvs/paap/indexeng.php

• Social Sciences and Humanities Research Council of Canada (SSHRC): http://www.sshrccrsh.gc.ca/

• Statistics Canada (StatsCan): http://www.statcan.gc.ca

Websites focusing on chronic diseases (including some nutritional interventions):• The Canadian Cancer Society: http://www.cancer.ca

• The Canadian Medical Association: http://www.cma.ca

• The Canadian Public Health Association: http://www.cpha.ca

• Dietitians of Canada: http://www.dietitians.ca

• The Canadian Diabetes Association: http://www.diabetes.ca

• The Heart and Stroke Foundation of Canada: http://www.heartandstroke.ca

• The Public Health Agency of Canada: http:// www.publichealth.gc.ca

• Canadian Society for Exercise Physiology: http://www.csep.ca

• The Registered Nurses’ Association of Ontario: http://www.rnao.ca


http://www.rnao.ca/

http://www.csep.ca/

http://www.publichealth.gc.ca/

http://heartandstroke.ca/

http://www.diabetes.ca/

http://www.dietitians.ca/

http://www.cpha.ca/

http://www.cma.ca/

http://www.cancer.ca/

http://www.statcan.gc.ca/

http://www.sshrc-crsh.gc.ca/

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/index-eng.php

http://www.nserc-crsng.gc.ca/Index_eng.asp

http://www.nrc-cnrc.gc.ca/eng/index.html

http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/hpfb-dgpsa/onpp-bppn/index_e.html

http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/hpfb-dgpsa/onpp-bppn/index_e.html

http://www.cihr-irsc.gc.ca/

http://www.cflri.ca/eng/index.php


A N S W E R K E Y F O R A L L I N S T R U C T O R ’ S M A N U A L A C T I V I T I E S

Critical Thinking Questions6

1. Answer: In this question, students are being asked to discuss the multiple factors that influence an individual’s food choices and eating patterns, beyond the single role of food as the body’s fuel. While students can respond to this question in an individual manner, their responses should include some combination of the following.

A thorough Dietary Intake should include:

• Patient preferences—include value systems such as vegetarian, religious, environmental, or political beliefs.

• Patient dietary habits and exercise habits—use multiple methods of assessment.• Ethnic and cultural traditions and importance to the patient’s dietary preferences.• Psychosocial assessment—body image issues, eating disorders, social eating

versus preference to eat alone.• Economic abilities—what is the patient’s ability to purchase food, what type of

cooking utensils and equipment does the patient have to use in cooking, where does the patient shop, and is the store reasonably priced?

• Nutritional knowledge—what do the patient know about nutrition and food choices, serving sizes, and cooking styles? Who does the cooking?

If the student makes reference to the idea that Canadians often lose sight of the role of food as fuel to our bodies because food has taken on so many other roles in the lives of Canadians, the student should get additional credit as this statement fully summarizes a complete response to the question.

2. Answer: Water is an essential nutrient that provides no energy. It is vital to the body for metabolic reactions, to carry waste away from the body, and to carry nutrients around the body. The body is over 65 percent water.

Undernourished: Patients who are undernourished can be dehydrated, resulting in them having a bodily environment that is inefficient in carrying out metabolic processes, removing waste, and carrying nutrients to the various organ systems. They might also have elevated levels of minerals and some vitamins that are stored in the body due to the dehydration. Undernourished patients need to break down protein for energy, given that glycogen and fat stores are not longer available. An undernourished patient’s risk for protein malnutrition, infection, and cardiac problems increases.

Overnourished: Overnourished patients may have difficulty circulating the water around their bodies because their hearts have to work harder to pump the fluid around a bigger surface area.

Carbohydrate is an energyyielding macronutrient that supplies 4 kcal/g. Because

6 Contributed by Kathleen Rourke.



carbohydrates contain carbon, they are considered an organic compound.

Undernourished: Undernourished patients’ bodies will turn to their body fat and then their body protein for energy and metabolic functions. Most undernourished patients have now consumed all their body glycogen from carbohydrates and their body fat and are now using their body protein for energy and are thus in proteinenergy malnutrition.

Overnourished: In overnourished patients, excess carbohydrates are stored as fat, leading to obesity.

Protein is an energyyielding macronutrient that supplies 4 kcal/g. Protein is also an organic compound that is important to the body for tissue repair, growth, and maintenance, its primary functions.

Undernourished: If the patient becomes too undernourished, protein stores (muscle) are used. If nourishment is the only issue with this patient, one hopes that nourishment is provided. Remember that many organs, such as the heart, are also muscle tissue; therefore, organ compromise can occur over time in situations of proteinenergy malnutrition.

Overnourished: Many athletes seek to find the optimum amount of protein to take to enhance protein building and thus muscle mass. While research does demonstrate that protein needs are higher for athletes than sedentary individuals, there is an upper limit of protein intake. Beyond that, excess protein beyond the needs of the individual can be converted to fat, given there is an excess in caloric intake. Highprotein intake is also difficult on the kidneys and should be discouraged.

Fat is an energyyielding macronutrient that supplies 9 kcal/g. This organic compound retains two times the amount of energy as compared to other energy nutrients, given its density.

Undernourished: Undernourished individuals do not retain a protective layer of fat tissue, which is needed to protect the body organs as well as to provide the body with a thermal shield. Some body fat is also required for normal hormonal functioning. Undernourished individuals will need to be provided with a fatty acid source for hormonal synthesis and other body protections.

Overnourished: As we well understand in this country, overconsumption of fat means excess calories and excess weight.

Vitamins are organic compounds that facilitate release of energy and participate in many activities in the body. Each has a different function such as vision, controlling bleeding time, making hormones, etc. Vitamins need to be handled carefully as many environmental properties, such as sunlight or heat, can destroy a vitamin.

Undernourished: There are two types of vitamins, fat soluble and water soluble. Fatsoluble vitamins are stored, while most watersoluble vitamins are not stored in the body to a significant extent. Depending on the degree of undernourishment, an individual may have some stored fatsoluble vitamins; however, he she will probably not absorb an appreciable amount of fatsoluble vitamins because the presence of fat is necessary in the diet to absorb these types of vitamins. The person may be able to



absorb appreciable amounts of watersoluble vitamins, depending on the situation. If the body is lacking some of the vitamins, its ability to absorb is enhanced. With others, there are dependent mechanisms for absorption.

Overnourished: This individual does run the risk of excess storage of some of the fatsoluble vitamins. Given that most fatsoluble vitamins are found in more nutrientdense foods, it is not likely that an overnourished individual is at risk of an excess of fatsoluble vitamins if consuming an energydense, nutrientpoor diet.

Minerals are inorganic substances that do not provide energy to the body but do serve as cofactors in many reactions in energy metabolism. Several minerals are essential. Minerals are found in fluids within the body and thus can influence the properties of fluids (e.g., sodium, potassium). Minerals are inert, so they are not easily destroyed; however, they can be bound to other substances such as phytates.

Undernourished: An undernourished individual does run the risk of missing many essential mineral elements i and therefore could potentially not have sufficient quantities for metabolic functions.

Overnourished: Again, while the overnourished individual may gain more minerals in their diet from excess consumption, most minerals are found in nutrientdense foods such as fruits and vegetables, which are not generally foods that result in overnourishment. Therefore, this individual may also run a risk of deficiency of some minerals.

3. Answer: In this question, students should select a research topic that they are interested in studying. That will help make the topic of research more interesting to them.

A simple research question should be a succinct as possible and include the following: the type of study, the study population, and the time period of the study. Think “measurable” when putting together a research question. For example:

The efficacy of vitamin D in relieving pain will be studied in 50 pain management patients over a oneyear period.

The focus of the study: The efficacy of vitamin D in relieving pain

The study population: 40 pain management patients

The time period: One year

An experimental group is the group receiving the treatment; the control group is the placebo group or the group that does not receive treatment. A control group is needed to distinguish whether the treatment participants react differently than participants receiving no treatment.

A good sample size is determined by power statistics.

Before making any conclusions, the researcher wants to fully understand the research and how it relates to other researchers’ work in the same field of research. The researcher needs to fully understand the statistics and what they mean, what they don’t mean, and what the data may be “saying” relative to other work in the field.



To optimize the validity of a study, a researcher will take time to make sure that the study question is a measurable question and the study design is consistent with the study question and achievable over the determined study period.

A published research article should include why it was important to study the topic, information on other researchers that have studied the topic, a brief outline on how to carry out the research to enable other researchers to replicate it, results of the study, and why the results or findings are important to nutrition and dietetics professionals.

4. Answer: DRI stands for Dietary Reference Intake and RDA stands for Recommended Dietary Allowance. The RDA has been around for quite a long time (1940s) and was originally established for the military to prevent scurvy. Since that time, significant study has been undertaken on each micronutrient and macronutrient to establish the level of intake that is deemed appropriate for 98 percent of the population to prevent disease and optimize health. Generally, every ten years new RDA research is published and changes are made if needed. RDA are used to evaluate diets of populations.

DRI, which include the RDA, are relatively new and reflect collaborative work between the U.S. and Canada. They are a set of standards resulting from collaboration of many research scientists, and can be used to evaluate diets of healthy individuals. They include the Estimated Average Requirements from which RDA are derived, Adequate Intakes for nutrients for which RDA have not been established, and Tolerable Upper Intake Levels that identify potentially toxic levels of intake.

5. Answer: It is important to perform a historical review with the patient, in which the dietitian will ask the patient about his or her health history, including details about any medical conditions, problems, or medications. The dietitian also wants to know about the patient’s family background, cultural and ethnic background, work history, and living conditions, including where the patient and family shop and who cooks the meals. It will also be important to retrieve a detailed diet history and food frequency, and conduct some psychosocial assessment of the patient.

Next, the dietitian should collect anthropometric data regarding height, weight, body fat, bone mass, and lean body tissue.

The dietitian should compare his or her findings, including dietary analysis, with laboratory tests performed by the physician as well as the results of the physical examination.

The above nutrition assessment provides the dietitian with background on the patient’s past health history, which may have affected present dietary intake. Medications previously and presently taken are important, as they affect intake and can result in drug–nutrient interactions. It is also important for the dietitian to know of any previous problems the patient has had with a practitioner, diagnosis, medication, or condition. In this regard, the dietitian can avoid unnecessary problems for the patient. As discussed earlier, the more the dietitian knows about a patient’s lifestyle, the more he or she can provide dietary advice, counselling, and recommendations to the patient that will allow the patient to stay within close



parameters to his or her normal regime.

A thorough diet analysis from multiple perspectives provides the dietitian with the best picture of the patient’s intake. A single method of diet analysis can be unreliable; therefore, multiple methods increase the dietitian’s ability to accurately determine what the patient is really eating.

Anthropometric measures are made to establish appropriate weightforheight measures as well as body fat measures. These are compared with established norms and allow the dietitian to set goals for the patient.

Laboratory tests are objective measures that can be compared against some of the more subjective measures such as medical history to provide a complete picture to the dietitian of the patient’s overall health and dietary status.

6. Answer: This is an open question for students aimed at them exploring the role of nutrition in the prevention or treatment of chronic disease. Students can direct this question either way. Expect students to give specific examples of a chronic disease and the nutrients and dietary habits that would prevent the disease or help in its management. It would also be important for them to demonstrate that they understand that research is important to making any proclamation at the federal level. Therefore, any decision that they make must be supported by a sound evidence base.

7. Answer: (a) The RD needs a great deal of specific, detailed information about the patient’s diet because it is important to understand servings or volume, all condiments or extraneous items a patient might use on a specific food, cooking procedures, food preferences, and cultural or ethnic habits. Several different questions regarding food habits also allow the RD to assess the reliability of the dietary data that is being collected.

(b) People’s culture and finances have much to do with their dietary habits. Culture is the basis of one’s eating habits, and one’s finances are critical to one’s ability to purchase food.

(c) Yes, as health status is the foundation for how the RD will counsel the patient. Perhaps problems with the patient’s health status sent the patient to the RD or perhaps there are new issues. Either way, the RD should know of the patient’s health background and medications to provide appropriate counselling.

(d) It is important for the RD to be familiar with the medical library and professional journals where the RD can search for information on questions the patient may have. Clearly, one can turn to a colleague for a quick question, but the RD should always follow up an inquiry with a review of the professional literature.

8. Answer: Many healthcare professionals are involved in patient care; therefore, when they are accessible, patients will turn to them for nutrition advice, not knowing any different. It is important to understand that the public does not always understand the difference among all the different types of healthcare professionals. The majority of health science professionals do not receive any nutrition training, except for the occasional nutrition content specific to certain content areas. The exception to this is



nursing, which does require one nutrition course in a fouryear curriculum. Physicians may or may not receive a nutrition course in a fouryear curriculum, as it is presently not mandated by the accrediting body. Therefore, it is really important for the RD to work with other health care professionals in collaboration for the best of patient care.

When talking to the patient, take a positive approach by indicating that you are glad that the patient is interested in finding out how to improve his or her diet. Then explain your role in the hospital, clinic, etc. as the RD and healthcare professional—that is, the diet and nutrition expert—providing a business card and information for the patient to easily contact you as the RD. Finally, help the patient to understand all details of his or her dietary regime and answer all questions in full detail. Do not discuss any other healthcare professional negatively. This is unprofessional!

Case Study7

1. Skipping breakfast, snacking on doughnuts at work, use of convenience foods, use of alcohol to calm emotions.

2. Alcohol and foods high in carbohydrates tend to calm emotions in times of stress; caffeine (coffee) may help ease her feelings of tiredness.

3. (80 grams fat × 9 kcalories/gram = 720) + (200 grams carbohydrates × 4 kcalories/gram = 800 calories) + (50 grams protein × 4 kcalories/gram = 200 kcalories) = 1720 kcalories.

4. Fat: 720/1720 = 42%; carbohydrates: 800/1720 = 46%; protein: 200/1720 = 12%

5. Her diet is high in fat (42% versus 20–35% AMDR); adequate in carbohydrates (46% in an acceptable range of 45–65%); and adequate in protein (12% in a range of 10–35%).

6. Help her find major sources of fat in her diet to decrease or eliminate. Help her find lowerfat choices of usual foods such as lowerfat cream cheese and convenience foods.

7. Explain the evidence from peerreviewed research publications for eating a diet lower in saturated fat for lowering blood cholesterol. Direct her to the “red flags of nutrition quackery” and explain how to determine if a website is reliable.

7 Contributed by Barbara Quinn.



Handout 13: Crossword Puzzle by Mary A. Wyandt, PhD, CHES

The answer key is provided below.



W O R K S H E E T A C T I V I T I E S

Handout 11: Research Assignment Using the Internet

This research project will employ the use of the Internet as a research tool. Students will be expected to become familiar with the diversity of Internet resources. Students will also be expected to participate in online discussions about nutrition and related topics in classbased listserv groups. The purpose of this project is to develop Internet and online participation skills.

1. Obtain your name and password. Change your password (if necessary) to one that cannot be hacked. Log onto to your email. Send your instructor an email message. Print it off and attach it to the assignment.

2. Log in to your class listserv (WebCT, Blackboard, or other server). Demonstrate that you have made at least three comments over the semester. Print these off and attach to your assignment.

3. Access the World Wide Web to find a site related to nutrition. Document how you accessed the Web and the address of the website accessed. Print off and discuss what you found. Attach this to the assignment.

4. Enter your library computer system. Use a system to conduct a literature search regarding a topic (for example, vitamin A). Discuss your findings (1–2 pages).

5. Once in your library website, download a recent edition of an Internet journal (related to nutrition). Browse through it and report on what you found.

6. Borrow a book about the Internet from your library. List 10 items that are most important for education and research and explain why (1–2 pages).



Handout 12: Evaluation of Published Nutrition InformationLiterature Critique: Critical Evaluation of Published Nutrition

Information—“Should I Believe What I Just Read?”

Assignment for discussion: Carefully read a journal article and answer the following questions:

1. Summarize the basic idea of the article in a short paragraph.

2 a. What are the credentials of the author(s)? What do the abbreviations after the name(s) mean? Do they enhance the authors’ credibility? Explain.

b. Is(Are) the author(s) affiliated with an organization or institution? Does the affiliation with the organization or institution enhance the authors’ credibility? Briefly explain.

c. Does the periodical have an editorial board? Do the editors’ credentials enhance the article’s credibility? Where does one look in a periodical for the editorial board?

3 a. Is scientific research being presented or discussed? Is the research current?b. If so, what specific kinds of research or data are presented or cited to support the

ideas?c. Were references listed to allow readers to investigate the information’s original

source? Were full citations provided?

4 a. What is the underlying hypothesis (if/then, cause/effect, etc.)?b. What are the article’s conclusions/recommendations?c. Are the conclusions or recommendations supported by the research discussion?

Explain briefly why or why not.

5 a. Design and describe indepth additional research that could more decisively test the hypothesis identified. Pay particular attention to details and controls.

b. Indicate what will be measured.c. State the type of experimental design and type of experiment.

6. Identify the statements in the article that you believe and those that you do not believe, and discuss why or why not for each.

7. What sources other than those listed in the periodical would you refer to if you were to research the article’s topic further?

Source: Adapted with permission of: Deborah Fleurant, MOE Thesis, University of New Hampshire, 1989 (Thesis Advisor Sam Smith)



Handout 13: Chapter 1 Crossword Puzzle

Across Down

2. A substance or a molecule containing carboncarbon bonds or carbonhydrogen bonds

4. Organic, essential nutrients required in small amounts by the body for health

6. The foods/beverages a person consumes9. Nonnutritive compounds found in plant

derived foods that have biological activity in the body

10. Nutrients a person must obtain from food because the body cannot make them for itself in sufficient quantity to meet physiological needs

1. Products derived form plants or animals that can be taken into the body to yield nutrients for the maintenance of life and the growth and repair of tissues

3. The science of foods and the nutrients and other substances they contain, and of their actions within the body

5. Factors associated with an elevated frequency of a disease

7. Any condition caused by excess or deficient food energy or nutrient intake or by an imbalance of nutrients

8. A substance composed of two or more different atoms; for example, H20

Handout 14: Why Do You Eat What You Eat?

Record what you eat and drink for one day in the spaces provided below. Note what helped you decide to pick a particular food. Some examples are convenience, taste, familiarity, cost, or other reasons.

Food Preparation Level Amount ReasonBreakfast:

Snack:

Lunch:


1

2 3

4 5

6 7

8

9

10


Snack:

Dinner:

Snack:

Do you see any patterns in the food types that you choose?

Do you eat any one type of food type more than others?

How could you adjust your diet such that you can included more whole foods or enriched foods?

Contributed by Mary Ellen Clark


Documents

Chapter 1 An Overview of Nutrition - Amazon S3s3.amazonaws.com/prealliance_oneclass_sample/4lv9wbPML7.pdf · information serves as the basis for understanding all aspects of nutrition