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4 Stages of Nutrient Deficiency
- 1. Food requirements are not met
- 2. Storage/Tissue Depletion
- 3. Clinical signs/symptoms
- 4. Morbidity/Mortality
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4 ways to asses the Deficiency
- 1. Diet Analysis
- 2. Biochemical/physiologic measures
- 3. Clinical examination
- 4. Vital statistics
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Why perform a nutrition assessment?
- - prevent/reduce health problems related to nutrition
- - to improve the quality of life
- - reduce health care costs
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Nutritional screening
- - identify characteristics associated with nutrition problems
- - identify high risk patients
- - focus on warning signs
- - cost effective
- - incorporates relevant data
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Assessment
- - measurement of food and nutrient intake
- - evalutation of nutrition-related health indicators
- - make sure data used has standards to compare to, use data that accurately reflects the needs of the patient
- - go backwards to get a 24 hour recall from patient to help them remember
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Medical nutrition therapy
used by dietition to treat symptoms of disease
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ABCD
- - Anthropometric measures
- - Biochemical indices
- - Clinical evaluation
- - Dietary data
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Data from?
- - medical record
- - patient interview
- - lab tests/results
- - anthropometric measurements
- - 24 hour recall
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Nutritional history
- - physical activity
- - culture
- - food allergies
- - dental/oral health (acid from bulima)
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Biochemical indices
- - most objective
- - sampled from serum, plasma, blood cells (red/white)
- - urine
- - feces
- - tissue samples
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Measure proteins/iron levels
- - proteins through nitrogen balance
- - iron: hemoglobin, ferritin
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Anthropometric measures
- - measurements of physical characteristics of the body
- - height, weight, skin fold thickness, head circumference
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Percent usual body weight
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BMI - body mass index
- - weight to height
- - does NOT take muscle into account
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Bioelectric impedance
- - most accurate
- - hook up electrodes to fingers and toes
- - lie down flat
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Underwater dunk tank
- - amount of water dispersed is equal to the body composition
- - mass by volume displacement
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Clinical examination
- - physical examination of the body
- - hair, eyes, skin, teeth, oral cavity, gums, tongue
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Signs and symptoms of nutrient deficiencies
- - focus on hair, eyes, skin, teeth, oral cavity, gums, tongue
- - epithelial cell turn over: obvious indicators through these cells
- - gums - can check for vitamin C (scurvy)
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Global assessment
- blood test, physical assessments, combination of all global assessments to make a decision about deficiency
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Physical activity
Some foods expend calories greater than their calorie intake
expend calories through digestion
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Basal metabolic rate
- - energy the body requires for basic life functions while at complete physical and mental rest
- - amount of E body expends based on no net movement (just lying there)
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Factors that increase BMR
- - leaner body mass
- - taller
- - younger age
- - increased levels of thyroid hormone
- - stress, fever, illness,
- - males
- - pregnancy/lactation
- - stimulant drugs (caffeine and tobacco)
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Decreasing BMR
- - shorter
- - older age
- - decreased levels of theyroid hormone
- - starvation/fasting
- - females!
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Factors that effect BMR
- - thyroid hormone and BMR have a direct relationship
- - illness (fever) weight loss because BMR increases 7%
- - muscle mass increases with BMR (direct)
- - boys have a faster BMR (higher)
- - as you age, BMR goes down, decreasing muscle mass
- - k cal diet influences BMR
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What age is your BMR the highest?
- - infant
- - growing so fast, double your body weight
- - can consume the most calories during adolesence
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Obesity
- having over a 30 BMI
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Ethnic groups that are most obese
Black and Mexican American women
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Heath risks associated with obesity
- - Heart disease
- - All cancers
- - Stroke
- - Pulminary disease
- - Diabetes
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Genetic factors
- - influence height, weight, body shape, metabolic rate
- - 25 % of one's body fat is accounted for by genetic influences
- - 2 theories: Thrifty gene v. set-point
- - thrifty gene = gene that causes some people to be energetically thrifty/expend less energy than other people
- - set- point = body weight stays within a narrow range
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Health Nation
- - obesity epidemic
- - cheap/fast food epidemic
- - TV/media weight images
- - on the go
- - watching TV: eating is a habit
- - diet is only short term: need to make lifestyle changes !
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Recommendation
- - realistic goals
- - structured meals
- - small steps (achievable goal)
- - portion control
- - take note of times that normally you over eat
- - only eat when you're at the table
- - put the fork down between bites
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Proteins that affect the regulation of appetite and storage of body fat
- - leptin: reduces food intake
- - ghrelin: stimulates appetite
- - peptide YY: decreases appetite
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Increased satiety/decrease food intake
- - increase in blood glucose levels after meal
- - stomach expansion
- - nutrient absorption from the small intestine
- - hormones secreted serotonin and CCK
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Decreased satiety/increase food intake
- - hormomes (beta endorphins)
- - neuropeptide Y
- - decreased blood glucose levels
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Nutrition is affected by cultural and economic factors
- - religious beliefs
- - fast-food culture
- - sedentary lifestyle
- - economic status
- - access to healthcare
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Dietary recommendations
- -establish realistic health goals
- - obtain information from a reliable source
- - obtain medical supervision for weight loss
- - consume a variety of healthy foods
- - select an energy intake that would promote 1-2 lbs/week weight loss
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female athlete triad
- - osteoporosis
- - ammenorhea (stop menstruating)
- - eating disorder
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Questions to ask females:
- Are you menstruating?
- Do you take birth control?
- - low estrogen, low vitamin D
- - low vitamin D, decrease calcium absorption, do you have enough calcium
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anorexia
- - decreases 50 % of metabolism
- - become obsessive with food (no matter who is eating it and what they are eating)
- - talk about food all the time to compensate/cover up ?
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bulima
- - a silent disease
- - normal weight, abnormal dieting
- - acid on enamel of the teeth
- - induced vommitting
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Pre-conceptual health
- - important to stay healthy before pregnant
- - folic acid/folate (prevent spina bifida)
- - no drinking, smoking,....
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Critical period
- week 2 - week 8
- (1st trimester)
- - development of brain, eye, liver,
- - some women don't know they're pregnant during this period (this is a problem!!!!!! have to watch their eating/drinking habits)
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placenta
- - product of conception
- - how the baby is connected to the mother
- - anything mother ingests goes through the placenta
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teratogens
- - substances/chemicals that cause birth defects
- - drugs, alcohol, cigarettes
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What is a low birth weight?
anything below 5.5lbs
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Weight gain during pregnancy
- Normal: 25 - 35lbs
- Twins: 50 - 60 lbs
- Underweight/Teen: 28-40
- Overweight: 15-25
- Obese: 11-20
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Rate of weight gain
- 1st trimester: 1lb/month
- 2nd/3rd trimester
- Normal: 1 lb/week
- Overweight: .6lb/week
- Obese: .5lb/week
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abnormal weight gain
- - less than needed weight
- - can cause baby to have interuterine growth retardation
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Recommended kcal intake
- 1st trimester: normal kcal intake
- 2nd/3rd: and additional 350/400 kcal
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Nutrient recommendations during pregnancy
-** increase folate, iron, iodine, zinc
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Results of gastrointestinal problems
- - nausea/vomitting
- - constipation
- - heartburn
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Other weird food matters during pregnancy
- food cravings
- PICA: non-edible craving items (clay/chalk)
- ***deficiency in iron can cause cravings in non-food items
- (habits like chewing on ice)
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WIC
- - Women's Infant and Children's supplemental food program
- - USDA program
- - promote healthier pregnancy outcomes
- - vouchers for healthy cereals
- - low income families
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Characteristics of a high-risk pregnancy
- - low prepregnancy BMI
- - poor/excessive weight gain
- - short interval between pregnancies
- - HBP
- - diabetes
- - age
- -smoking, alcohol, drug use
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FAS
- - fetal alcohol syndrome
- - growth retardation
- - developmental delays
- - low birth weight infants
- - characteristics: flat nose bridge, wide space b/w eyes, thin upper lip, small head circumference
- - #1 cause of mental retardation in America
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Foods that can be a threat to health of mother and baby during pregnancy
- - raw fish, meat, poultry, eggs
- - unpasteurized milk/juice
- - large fish (swordfish, shark, tilefish, tuna)
- - soft cheeses
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Nutritional requirements for Infants
- - 40 - 50 kcal/kg body weight
- - 600-650 kcal/day for 6 month olds
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Breastfeeding
- - benefits:
- - not processed
- - mother burns calories
- - less costly
- - immune system booster
- - bond with infant
- - decrease breast cancer risk
- - decrease uterine size
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colastrum
- - thick, yellow, liquid secretion
- - provides antibodies
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pituitary gland (in brain)
- - releases prolactin
- - prolactin: stimulates milk production
- - oxytocin: stimulates milk release
- - brain simulates an association with milk: if a mother hears a baby crying, they could release milk "unconsciously"
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Human milk
- - provides more energy in kcal than formula
- - if only breast fed, infants should receive iron, fluoride, and vitamin D supplements
- - breast milk is easier to digest
- - breast-feeding is a natural contraceptive
- - decrease SIDS: sudden instant death syndrome
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Scenarios when you don't want the woman to breastfeed
- - HIV +
- - contaminated H20
- - alcohol/drug abuse
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infant bottle syndrome
sugar degrades the teeth
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Infants (4 - 6 months)
- - iron-fortified rice cereals
- - single-grain cereals
- - mix with breast milk/formula/water
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Infants 6-8 months
- - strained fruits and veggies
- - limit juice intake to 8oz /day
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7 - 10 months
- - mashed veggies
- - chopped meat
- - finger foods
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9-12 months
- yogurt, soft cheese, macaroni, scrambled eggs
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Food allergies
- - immune response (IgE) to any food that the body perceives to be harmful
- - symptoms: inflammation, irritation, GI irritation, bronchial constriciton
- - anaphylaxic shock: occurs when histamine causes obstruction of airway (hypoxia)
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Common food allergens
- - shellfish
- - peanuts
- - tree nuts
- - eggs
- - soy
- - wheat
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Celiac Disease
- - Digestive disorder that damages the small intestinal wall
- - must avoid gluten, the protein found in wheat, rye, barley
- - genetic diease
- - causes nutrient malabsorption
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FALCPA
- food allergen labeling and consumer protection act
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Food jags
- consistency is common
- when a toddler is hung up on their one food
- no nutritional variety
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Toddler nutrition issues
- - sensitivity to green veggies (bitter taste/weird smell)
- - anemia
- - constipation
- - dental caries
- - food insecurity
- - obesity
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Recommendations for obesity
- - increase physical activity
- - involve the entire family
- - offer healthy meals and snacks
- - do not restrict kcal
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Critical nutrients for Teens
- - iron
- - calcium
- - vitamin A
- - vitamin D
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Physiological factors for the elderly
- - inability to drive
- - low E
- - brittle bones: osteoporosis
- - slow digestive function
- - arthritis
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Psychological factors
- - depression
- - forgetfulness
- - loss of independence
- - loneliness
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Factors that contribute to geriatric weight loss
- - drugs
- - diarrhea
- - depression
- - disease
- - dysfunction
- - dementia
- - dysphagia (altered swallowing)
- - dysgeusia
- - dentition
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Elderly nutritional issues
- - oral cavity (dentures)
- - weight loss
- - lack of exercise
- - lethargic
- - dry mouth, decreased saliva production
- - constipation (IBS)
- - increase of dehydration
- - diruetics: hypertension
- - senses change: less sensitivity to salt/sugar
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Older Americans Act
- - Meals on Wheels
- - Congregate meals program
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Government agencies that regulate food safety
- - USDA
- - FDA (labeling)
- - CDC: center for disease control and prevention (education of the public on disease)
- - EPA: environmental protection agency (pesticides and water quality)
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Risky foods (known for contamination/outbreaks)
- - leafy greens
- - eggs
- - tuna
- - oysters
- - potatoes
- - cheese
- - ice cream
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DANGER ZONE for meat temperatures
-do not keep at 40 - 140 F for more than 2 hours
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Symptoms of bacterial illness
- - gastrointestinal distress
- - vomitting, diarrhea, abdominal cramping
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Hemolytic Uremic Syndrome
- - kidney failure and stroke
- - caused by undercooked ground beef, raw milk, salad, raw sprouts, swimming pools, petting zoos
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Prevention of food bourne illnesses
- - cook raw beef
- - drink only pasteurized milk, juice, cider
- - wash all fruits and veggies
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Listeriosis
- - found in water and soil
- - deli meat, soft cheeses
- - Animals are carriers
- - plants contaminated with manure
- - symptoms: infection of the brain and CNS, spontaneous abortion, high fever, nausea, severe headaches
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Salmonella
- - bacteria that pass from human/animal feces to other people or animals
- - diarrhea, fever, raw meat/eggs
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Botulism
- - low acid foods that may have come in contact with spores
- - serious illness that causes flaccid paralysis of muscles (coma)
- - neurotoxin
- - from a bacteria found in soil all over the world
- - spores from canned foods (low acid)
- - fermented fish
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norovirus
- - a virus that causes illnesses for a few days with diarrhea, fever, headache, nausea, vomitting (bad flu)
- - spread through feces/vomit
- - enters food through contaminated hands/surfaces
- - cruise ships = highly contagious
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Hep A
- - fecal contamination of food during growth, processing, or prep
- - water contamination, raw shellfish,
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Mad cow disease
- - high risk in Europe
- - cows that eat infected sheep
- - prion: a protein that destroys brain cells in cows
- - called downers !
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Food additives
- - unintentional v. intentional
- - intentional: sugar, salt, thiamin, niacin, Vitamin A/D, folic acid, iron
- - unintentional: animal feces, hair, lead, nut products
- - need to report certain additives with a purpose to FDA
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GRAS
- - generally recognized as safe list
- - do not need to be reported to the FDA or go through rigorous testing
- - salt, sugar, caffeine, spices
- - to remain on this list, the additive must not have been found to cause cancer in man or laboratory animal
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Sulfites
- - vino, dried fruits, vinegars,
- - food preservative, dough conditioner, antioxidant, antimicrobial, color stabilizer
- - **symptoms: asthma attacks, rashes, bronchi constriction
- - cannot be used in salad bars
- - must be indicated on label
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MSG
- - monosodium glutamate
- - people are sensitive to the glutamate
- - flavor enhancer for asian cooking
- - on GRAS list
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Caffeine
- - a psychostimulant
- - beans of coffee, tea, guarana, absrobed by the stomach/small intestine in 45 minutes
- - recommended 250mg/day
- - increases levels of epinephrine/adrenaline
- - increases heart rate, BP, and blood flow to muscles
- - pseudosober feeling
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Irradiation
- - use of low ionizing gamma rays to control food maturation and contaimination
- - creates free radicals which kill insects and bacteria
- - flour, potatoes, pork, fruits/veggies, poultry, meat
- - is approved for certain foods
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Pesticides
- - herbicides, fungicides, insecticides,
- - man made or natural (ladybugs)
- - health risks to farmers and applicators
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What does it mean to be Organic?
- - meat that have no antibiotics or growth hormones
- - promote the use of renewable resources
- - without most conventional pesticides
- - studies have shown that organic has a higher nutritional value, not definitive research though
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Environmental contaminants
- - methyl mercury
- - PBB and PCB
- - most dangerous to pregnant women and infants/children
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GMF
- - genetically modified food
- - combining genes of different foods to improve yield, decrease contamination and enhance quality
- - monsanto has a monopoly on farmers so that they are forced to use Monsanto products which are GMF seeds
- - winter tomatoes
- - gene from desired trait
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rBGH
- - recombinant bovine growth hormone
- - genetically engineered growth hormone used to produce more muscle tissue and less fat in beef heards
- - also used in cows to produce more milk
- - milk DOES NOT HAVE TO BE LABELED, unless its organic
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Food Disparangment/Veggie Libel law
- - CANNOT make a public statement about a particular food
- (Food Inc)
- - challenging the first amendment
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Ecotarian
- eats a plant based diet with small amounts of organic meat poultry and fish
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1 kcal food consumption, 7 kcal energy of expenditure
- - transportation
- - manufacture the food
- - grow the food
- - fuel costs
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