CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 49 Nutrition and Special Diets

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

49Nutrition and Special Diets


49-2

Learning Outcomes49.1 Describe how the body uses food.

49.2 Explain the role of calories in the diet.

49.3 Identify nutrients and their role in health.

49.4 Recall the Dietary Guidelines for Americans.


49-3

Learning Outcomes (cont.)

49.5 Explain how the Food Guide Pyramid can be used to plan a nutritious, well-balanced diet and healthy lifestyle.

49.6 Describe the test used to assess body fat.

49.7 Explain reasons why a diet may be modified.

49.8 Identify types of patients who require special diets and the modifications required for each.


49-4

Learning Outcomes (cont.)

49.9 Describe the warning signs, symptoms, and treatment for eating disorders.

49.10Educate patients about nutritional requirements.

49.11Document patient education about nutrition.


49-5

Introduction

• Nutrition – How the body

takes in and utilizes food and nutrients

– Five-part process• Intake • Digestion• Absorption• Metabolism• Elimination

• Medical assistant – understand relationship between nutrition and health


49-6

Daily Energy Requirements

• The body requires nutrients – To provide energy

– To build, repair, and maintain body tissues

– To regulate body processes


49-7

Metabolism• The sum of all cellular processes that build,

maintain and supply energy to living tissue

• Phases– Anabolism – nutrients are changed into more

complex substances that are used to build body tissues

– Catabolism – complex substances are broken down into simpler substances and converted to energy

• Metabolism affected by age, weight, activity, state of health, and other factors


49-8

Calories

• Kilocalorie (calorie) – Measurement of energy produced by food – Amount of energy needed to raise the

temperature of 1 kg of water by 1°C.– Used to measure the energy expended during

activities and metabolic processes– Excess calories stored as fat– Count calories of food eaten and estimate

expenditure for activities


49-9

Apply Your Knowledge

1. What is the role of diet in health?

ANSWER: Food is the source of nutrients the body needs to function properly. Sometimes a special diet is needed to stay healthy or regain health, and some conditions require special diets.

2. What is the difference between anabolism and catabolism?

ANSWER: Anabolism converts nutrients into complex substances needed to build body tissues. Catabolism converts complex substances into simpler forms and converts them into energy.


49-10

Nutrients• Needed for

– Energy– Growth– Repair– Basic processes

• Energy is only provided by– Proteins– Carbohydrates– Fats

• Nutrients are provided by– Proteins– Carbohydrates– Fiber– Lipids– Vitamins– Minerals– Water


49-11

Proteins• Functions

– Building and repairing cells and tissues

– Maintaining water balance

– Antibody production and disease resistance

– Maintaining body heat

• 10% to 20% of total caloric intake daily

• 1 gm = 4 calories

• Deficiency – Weight loss/fatigue– Malnutrition– Lower resistance to

infection– Interference with

normal growth processes


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Proteins (cont.)

• Complete proteins– Contain all 9 essential

amino acids

– Animal food sources

– Recommend lean meats, low-fat or skim milk

• Incomplete proteins– Lack one or more

essential amino acids

– Plant sources

– Can be combined to provide all 9 essential amino acids


49-13

Carbohydrates

• Functions– Provide 2/3 of daily

energy needs– Provide heat– Metabolize fats– Preserve protein for

uses other than energy production

• 50% to 60% of total caloric intake daily

• 1 gm = 4 calories

• Deficiency – Weight loss– Protein loss– Fatigue

• Excess contributes to fat stores


49-14

Carbohydrates (cont.)

• Complex carbohydrates– Polysaccharides – long

chains of sugar units– Types

• Starch – major source of energy

• Fiber

• Simple sugars– Fruits and some

vegetables– Milk– Table sugar

• Excess – Stored in liver and muscles

cells as glycogen– Converted into and stored as

fat


49-15

Fiber• Does not supply

energy or heat

• Functions– Increases and softens

the bulk of stool– Absorbs wastes and

toxins– Decreases the rate of

carbohydrate breakdown and absorption

• 20 – 30 gm per day for adults

• Types– Soluble

• Absorbs fluid and swells when eaten

• Slows absorption • Helps control blood

glucose• Lowers cholesterol

– Insoluble – promotes regular bowel movements


49-16

Lipids• Concentrated source

of energy • 1 gm = 9 calories• Triglycerides

– Simple lipids – 95% of dietary lipids

• Cholesterol – Compound lipids– 5% of dietary lipids

• Functions– Provide a

concentrated source of energy

– Transport fat-soluble vitamins

– Store energy as body fat – insulate and protect organs

– Provide a feeling of fullness


49-17

Lipids (cont.)

• Saturated fats– Primarily from

animal sources– Solid at room

temperature

• Trans fats – Formed during

hydrogenation of vegetable oils

– FDA recommends zero consumption

• Unsaturated fats– Liquid at room

temperature– Types

• Polyunsaturated• Monounsaturated


49-18

Lipids (cont.)

• Lipid levels– High cholesterol

• Heart disease/stroke

• Peripheral vascular disease

– Lipoproteins • Carry lipids

through the bloodstream

• Low-density (LDL)• High-density (HDL)

• Cholesterol – Fat-related substance

produced by liver– Animal-based food

sources– Essential to health

• Part of cell membranes• Structural basis for

steroid hormones and vitamin D

• Component of bile


49-19

Vitamins• Organic substances

– Essential for normal growth and maintenance

– Essential for resistance to infection

– Help the body use other nutrients

– Assist with body processes

• Absorbed through digestive tract

• Types – Water soluble – not stored

by the body– Fat-soluble – stored by the

body

• Well-balanced diet usually minimizes likelihood of vitamin deficiency


49-20

Minerals

• Natural, inorganic substances– Build and maintain

tissues– Carry out life functions

• Major minerals – needed in large quantities

• Trace minerals – needed in small amounts

• Absorbed in intestines• Established RDAs

– Calcium Zinc – Iodine Iron – Magnesium Phosphorus – Selenium


49-21

Water

• No caloric value• 65% of body weight• Functions

– Maintains fluid balance– Lubricates moving

parts– Dissolves chemicals

and nutrients– Aids in digestion

– Transports nutrients and secretions

– Flushes out wastes– Regulates body

temperature


49-22

Water (cont.)

• Fluid balance – intake should equal output

• Patient education– Explain the importance

of water– List sources of water


49-23

Principal Electrolytes and Nutrients of Special Interest

• Electrolytes– Sodium

• Fluid and acid-base balance

• Maintains normal conditions inside and outside of cells

– Potassium• Muscle contraction• Fluid and electrolyte

balance

– Chloride• Fluid and electrolyte

balance• Component of

hydrochloric acid

• Antioxidants – chemical agents that neutralize free radicals (by-products of normal metabolism)


49-24


Matching:

___ Bulk to stool A. Cholesterol

___ Tissue repair B. Antioxidants

___ Excess stored as glycogen or fat C. Proteins

___ Concentrated source of energy D. Water

___ Produced by liver E. Trans fats

___ No caloric value F. Fiber

___ Neutralizes free radicals G. Lipids

___ Formed during hydrogenation H. Carbohydrates

ANSWER:

H

G

F

E

D

C

B

A

SUPER

JOB!


49-25

Dietary Guidelines

• Established to help people– Get proper nutrition– Reduce occurrence of disease– Control weight

• Designed to encourage healthy eating habits

• Suggest types and quantities of foods


49-26

USDA and U.S. Dept. of Health and Human Services Dietary Guidelines

• Recommendations– Adequate nutritional

intake– Healthy body weight– Regular physical

exercise– Increase fruits, low-fat

dairy, and whole-grains

– Limit fats– Limit alcohol

– Food safety• Disinfect food surfaces • Wash hands• Cook foods to safe

temperature• Refrigerate foods • Avoid raw eggs and

meats and unpasteurized milk or juices


49-27

USDA Food Guide Pyramid

• Revised in 2005– Emphasizes fruits,

vegetables, whole grains, beans, and nuts

– Less emphasis on carbohydrates

– Helps balance nutritional needs with physical activity needs

• Color coded– Orange – grains– Green – vegetables – Red – fruits– Yellow – oils– Blue – milk products– Purple – meats/beans

• Action figure – physical activity

Food Pyramid


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American Cancer Society Dietary Guidelines

• Eat more high-fiber foods

• Five or more servings of fruits and vegetables daily

• Limit consumption of processed and red meats

• Adopt a physically active lifestyle

• Achieve and maintain a healthy weight

• Limit consumption of alcoholic beverages


49-30


Match food group to appropriate color:

A. Vegetables

B. Oils

C.Meat and beans

D.Grains

E. Fruits

F. Milk productsOrange

Purple

Blue

Yellow Red

Green

ANSWER:


49-31

Assessing Nutritional Levels

• Age • Health status• Height/weight• Body frame• Body circumference• % of body fat

• Nutrition and exercise patterns

• Energy needs• Also

– Culture– Beliefs– Lifestyle– Education


49-32

Assessing Nutritional Levels (cont.)

• Measure fat as % of weight– Skinfold test

• Measurement of the thickness of a fold of skin with a caliper

• Total % of fat

– Optimal % differs between men and women– Aging changes ratio – fat replaces muscle

tissue


49-33

Modified Diets

• Factors affecting dietary needs– Pregnancy– Injury – Disease– Vegetarian diet– Aging– Genetic disorders– Substance abuse


49-34

Modified Diets

• Modifications– Restriction of certain foods– Emphasis on particular foods– Change in daily caloric intake– Change in the amount of a specific nutrient– Change in the texture of foods– Alteration in the number of daily meals– Change in variables such as bulk or spiciness


49-35

Specific Modified Diets

• For treatment or prevention of certain conditions

• Modifications include changes in– Texture

• Liquid or soft• High-fiber

– Nutrient level• Low sodium• Reduced calorie

– Frequency and timing • Three smaller meals• Timing in relation to a

procedure

– Exclusions – for food intolerances


49-36

Specific Modified Diets (cont.)

• Supplements and parenteral nutrition– Oral – specially

formulated to provide adequate nutrients

– Parenteral – given IV to bypass the digestive system

• Drug therapy– Drugs

• Change in food intake• Change in absorption

– Foods • Interfere with

metabolism and action of a drug


49-37

Patients with Specific Nutritional Needs• Food allergies

– Wheat, milk, eggs, and chocolate

– Eliminate from diet

• Anemia– Iron supplements– Dietary iron

• Cancer– Increase caloric intake– Adequate protein intake

• Diabetes– Food exchange system– Diabetes food pyramid

• Elderly – Energy and metabolic

requirements decrease– Physical difficulties– Medications – Social factors– Economic factors


49-38

Patients with Specific Nutritional Needs (cont.)

• Lactose sensitivity– Lactase not present to

break down lactose

• Overweight– Dietary modification– Behavior

modification– Motivation and

education

• Heart disease – Reduce cholesterol– Lose weight if needed– Reduce consumption

of fats

• Hypertension– Decrease sodium/

increase potassium/ adequate calcium

– Eliminate or reduce alcohol consumption


49-39

Patients with Specific Nutritional Needs (cont.)

• Pregnant– Additional protein– Calcium– Iron– Folic acid– Fiber

• Lactating – Additional calories and

protein– Folic acid and calcium

• Children – 1st year

• Breast milk or commercial formula

• Cow’s milk inadequate

– Nutritional needs change

• Growth spurts• Maturation• Increasing activity

– Hunger regulates intake


49-40


1.What factors does the physician consider when assessing a patient’s nutritional status?

ANSWER: The physician considers a patient’s age, health status, height and weight, body frame and circumference, percent of body fat, eating and exercise patterns, and energy needs. Culture, beliefs, lifestyle, and educational level should also be considered during the assessment.


49-41


2. Matching

___ Eliminate foods from diet A. Change in texture

___ Food exchange system B. Children

___ Decreased metabolism C. Food allergies

___ Hunger drives eating D. Parenteral nutrition

___ Modification to a soft diet E. Diabetes

___ Reduced sodium diet F. Elderly

___ Bypasses GI tract G. Drug therapy

___ May alter food intake and absorption H. Change in nutrient level

ANSWER:

H

G

F

E

D

C

B

A

Yippee! 2 for 2!


49-42

Eating Disorders

• Extremely harmful eating behavior

• Anorexia nervosa– Self-starvation– Treatment

• Restore normal nutrition• Psychotherapy • Education of nutrition concepts

– Chronic condition – can be fatal


49-43

Eating Disorders (cont.)

– Bulimia • Binge and purge by vomiting, diuretics, laxatives• Usually easier to treat than anorexia• Treatment

– Medication – Psychotherapy

• Goals– Establish a healthy weight– Establish good eating patterns– Resolve psychosocial triggers


49-44

Eating Disorders (cont.)

• Getting help – be alert to patient report of– Skipping at least two meals per day– Uncontrolled eating of large amounts of food – Using laxatives or other purges to control

weight– Avoiding social situations that interfere with

diet or exercise– Feeling disgust, depression, and guilt after

binge– Feeling that food controls life


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A young female patient arrives at the clinic showing a 15 pound weight loss in the last two months. Her weight is 10 pounds under the average weight for her height. She states she “feels great.” What should you do?

ANSWER: Document the weight loss and report it to the physician. She may be suffering from anorexia nervosa or bulimia, two types of eating disorders that require medical care and psychotherapy.


49-46

Patient Education

• Reinforce nutrition instructions

• Teach patient– Role nutrition plays in

preventing illnesses– How to be wise

consumers by reading food package labels

• Factors – Patient likes and

dislikes– Patient age and family

circumstances– Diseases and

disorders– Patient’s psychological

condition


49-47

Patient Education (cont.)

• Guidelines– Teach patient as an individual– Teach a small amount at a time– Keep explanations at patient’s level of

understanding– Reinforce good eating behavior– Let patient be an active learner– Provide a written diet plan– Suggest support groups


49-48

Patient Education (cont.)

• Cultural considerations– Influence

• Food purchases • Like and dislikes• Meal timing and frequency• Attitude toward supplements• Snacking

– Adjust diet and recipes accordingly


49-49


What do you need to consider when teaching patients about nutrition?

ANSWER: You need to consider patient likes and dislikes, age and family circumstances, diseases and disorders, and the patient’s psychological condition. In addition, you need to incorporate cultural considerations into nutritional education.

Excellent!


49-50

In Summary

49.1The body uses food for three major purposes: to provide energy; to build, repair, and maintain body tissues; and to regulate body processes.

49.2Calories provide energy for the body. Calories are measured in the foods we eat. We can also estimate the amount of calories used by the body during activity.

49.3The body needs a variety of nutrients for energy, growth, repair, and basic processes. There are several food components that provide nutrients. These are proteins, carbohydrates, fiber, lipids, vitamins, minerals, and water.


49-51

In Summary (cont.)

49.4 Dietary guidelines suggest the types and quantities of food that people should eat each day. They may also contain recommendations about which types of foods to limit and which types of foods to increase.

49.5 The Food Guide Pyramid provides recommendations for eating a variety of nutrients and maintaining physical activity. Following the Food Guide Pyramid recommendations promotes a well-balanced diet and healthy lifestyle.

49.6 Calipers are used to perform a skinfold test that determines the percentage of body fat.


49-52

In Summary (cont.)

49.7 Dietary modifications may be used alone or in combination with other therapies to prevent or treat illness.

49.8 Patients with allergies, anemia, cancer, diabetes, advancing age, heart disease, hypertension, lactose sensitivity, and obesity need special diets. In addition, pediatric, pregnant, lactating, and debilitated patients, as well as those undergoing drug therapy, need modifications to their diet.


49-53

In Summary (cont.)

49.9 You should know the signs and symptoms of eating disorders in order to evaluate for these disorders during the patient interview. Some of the more common signs and symptoms for each include:

– anorexia nervosa – unexplained weight loss, self-starvation, and fear of weight gain

– bulimia – eating large quantities of food in a short period of time, going to the bathroom immediately after eating, and using laxatives to excess

– binge eating – not followed by purging and weight gain


49-54

In Summary (cont.)

49.10 You may play a major role in educating patients about special diets and in helping them to implement dietary changes as instructed by physicians and dietitians. Knowledge of basic nutritional principles and current nutritional findings will help you perform these tasks with confidence and competence.

49.11 Documenting nutritional education is part of preventative health care practice and is required to help ensure payment by managed care and other health insurance companies.


49-55

End of Chapter 49

He that eats till he is sick must fast till he is well. ~English Proverb

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CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 49 Nutrition and Special Diets