Concepts of Nutrition

8/14/2019 Concepts of Nutrition

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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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Concepts of Nutrition