Nutrition and diet therapy

INTRODUCTION AND IMPORTANCE OF  Education is the key factor in enabling

NUTRITION nurses to instigate nutritional care
appropriately. Nursing students need
Nutrition be educated in the screening and
Is the science that interprets the assessment, planning, implementation
interaction of nutrients and other and evaluation of nutritional care. A
substances in food in relation to firm grounding in the principles of
maintenance, growth, reproduction, nutritional science is essential to
health and disease of an organism. understand the rationale behind the
components of nutritional care.
Dietetics
Is the interpretation and Nutrition Education
communication of the science of Allows patients to learn about the
nutrition where individual can make dietary factors that affect their
practical choices about food and life particular medical condition. Ideally,
style in terms of both health and this knowledge motivates them to
diseases. change their diet and lifestyle to
improve their health status.
Nutritionist &Dietitian
Nutritionist A nutrition education program should
Is a qualified nutrition professional be tailored to a person’s age. Level of
that has the expertise to provide a literacy, and cultural background.
range of evidence based nutrition Learning style should also be
services related to nutrition, public considered: some people learn best by
health nutrition, policy and research, discussion supplemented with written
and community health. materials, whereas others prefer
A nutritionist is a person who advises visual examples such as food models
on matters of food and nutrition that and measuring devices
impacts on health.
Information can be provided in one on
Dietitian one sessions or group discussions. The
Are the healthcare professionals and meeting should also assess the
experts who treats nutritional person’s understanding of the
problems and overview the patients material and commitment to making
by providing dietary needs, plans changes. Follow up sessions can reveal
menus, and instructs patients and whether the person has successfully
their families about proper nutritional adopted a dietary plan. For example, a
care. dietician who counsels a woman who
Dietitians have the expertise to is lactose intolerant and hesitant to
provide individual dietary counselling, use milk products can proceed as
medical nutrition therapy (MNT), follows:
group dietary therapy and food  The dietician can provide
service management. sample menus of a
nutritionally adequate diet
that limits milk and milk
products. Together the

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Nutrition and diet therapy
dietitian and the woman can according to the council of the
design menus that consider American Medical Assoc., it is the
her food preferences. science of food, the nutrients and the
 *Using diet analysis software, substances therein
the dietitian can demonstrate
how altering food choices Study of all the processes (digestion,
changes the calcium content absorption, metabolism, etc.) how the
of a meal. body absorb and utilize food
 The dietitian can explain how substances.
to use the Daily value on
food labels to estimate the Accdg to WHO
calcium content of a Nutrition is an input to and
packaged food. foundation for health and
 The dietitian can provide development.
information about the Better nutrition means stronger
advantages and immune systems, less illness and
disadvantages of different better health.
calcium supplements. Healthy children learn better. Healthy
people are more stronger, are more
Why is nutrition important? productive.
Nutrition is essential for growth and Specifically, if the body needs are met
development, health and wellbeing. in childhood and adulthood, the
Eating a healthy diet contributes to person can normally expect:
preventing future illness and Good health, vitality and energy
improving quality and length of life. To mature at the proper time
To overcome the stresses of the
As a future nurse, studying nutrition is environment
important in order to give the best To fulfill this biological life
nursing care to your clients To enjoy extended time of life
To withstand the many hazards of
Knowing the right diet or food aging.
required/prescribed to a certain In order to prevent obesity and diet-
patients. related diseases, man must know how
to utilize the existing food supply so as
And enables you as the primary care to derive maximum nutritional benefit
giver to impart health teaching about from it.
the patient’s food intake thus leads to
a faster recovery or maintenance of  As Nutrition is the foundation of good
health. health, …education is the cornerstone
of good nutrition because to attain
CONCEPTS OF NUTRITIONAL SCIENCE good nutrition, the individual must be
taught to make good food selection
NUTRITION and to maintain an env’t conducive to
Is all about food and how the body the utiilization of the nutrients
uses it esp as a fuel for growth and provided by the food.
daily activities.

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Nutrition and diet therapy
 According to Babcock (in 1961), “To NUTRIENTS
establish good food habits, people It is the product of digestion of foods
must be able to learn, and nutrition which are the nourishing material vital
educators must be able to teach.” for human functioning.

GOOD NUTRITION They are used to build and repair

Is the basis for good health. It tissues, regulate body processes and
enhances appearance as it is are converted to and used as energy.
exemplified by shiny hair, clear skin,
clear eyes, erect posture, alert Substances that provide energy-
expression and firm flesh on well- Cho, Chon and Fats
developed bone structures.
Substances that support metabolism
FOOD dietary minerals, vitamins and water
Is necessary to our survival. It sustain
life and promote growth. There are some substances that are useful,
It acts as a body fuel that gives energy some are neutral and some are detrimental to
required for bodily functions. health, and they are called as Non nutrient.
Are products derived from plants/ Such as: such as alcohol, pigments,
animals. additives and phytochemicals.

TYPES OF FOOD Food additives – such as the preservatives,

PLANTS flavours and colors.
grains &cereal It makes the food safe if you keep it
corn, oats and wheat for an extended period.
pulses E.g. of preservatives - Acids like lemon
Fruits and vegetables juice and vinegar.
Tubers Help preserve freshness by increasing
 Cassava the acidity of a food. An acidic food
 Sweet potato creates a hostile environment for
Nuts microorganisms.
Oilseed Sugar
 Olive Helps preserve foods by
 Sesame absorbing excess water.
 Coconut Without water,
 Soybean oil, etc… microorganisms cannot grow
Seaweed inside a food.
 Agar Salt
 Carrageenan Has long been used to
prevent meat and fish from
ANIMALS spoiling. Like sugar, salt
Meat and entrails inhibits the growth of
Milk, eggs and shellfish microorganisms by reducing
Poultry and fish the amount of water
available to them.
WHAT IS THE COMPONENT OF FOOD?

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Nutrition and diet therapy
Oil resveratrol- heart & lung
Helps foods stay fresh by health, cancer &
preventing microorganisms inflammation = red wine,
from coming into contact grapes,peanuts
with the food. Oil also anthocyanidins – blood
reduces the rate of oxidation vessel health blackberries,
in a food, which helps red berries, red onion,
prevent it from spoiling blueberries, plum,
quickly. strawberries, red radishes,
Spices red potato
some spices seem to retard isoflavones – menopause,
the growth of breast cancer, bone health,
microorganisms while also joint inflammation, lower
reducing the rate of oxidation cholesterol
These spices include cloves, Alcohol – though it provides energy
mustard, sage, thyme, but no nutrients.
rosemary and oregano. It is detrimental to health
when too much consumption
Phytochemicals of it.
Compounds produced by plants. They
are found in edible fruits, veg and Classification of Nutrients as to:
other plant-derived foods that have
biological activity in the body and Functions
according to research that it is use in Cho- provide energy
the prevention of chronic diseases Protein- for growth repair and
such as CA and CVD maintenance of the body.
Some researches estimate there are Fats – provide energy
up to 4000 pythochemicals but only a Minerals – it regulates body processes
small fraction have been studied Vitamins – vital helpers in many body
closely processes
Common names – flavones, Water – it is a food as well as nutrient.
isoflavones, allyl sulfides, It helps regulate the various processes
phytonutrients, polyphenols, such as circulation, digestion and
cathechins, carotenoids, elimination and respiration.
anthocyanidins and isothiocyanates
e.g. lycopene – cancer Chemical Properties:
(prostate)) heart health = Organic nutrients – it contains
tomatoes, grapefruit, hydrogen, oxygen and carbon( an
watermelon, red peppers element found in all living things).
allylic sulphites - in garlic Organic – meaning “literally alive”
lignans - in wheat Before the body can use
betacarotene – for immune organic nutrients, it must be
system, vision, skin health broken down into their
and bone health= yellow, smallest components.
orange and dark green foods

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Nutrition and diet therapy
Ex. CHO, CHON, fats and It is also called as “indispensable
vitamins CHON and vits. nutrients”. And essential means more
contain nitrogen. than just “necessary”.
Inorganic nutrients – they contain no These nutrients are required for life.
carbon. It includes many amino acids, some
They are already in their fatty acids, many vitamins and some
simplest form when the body minerals and trace elements.
ingest them. -ex. Amino acids = phenylalanine,
tryptophan, lysine, leucine, isoleucine,
(dietary)Minerals are the simplest valine, threonine, methionine.
nutrient. Each mineral is a chemical
element, its atom are alike. As a -Ex. Fatty acids – linoleic and linolenic
result, its identity never changes. acids.
E.g. Minerals – sodium, iron,
calcium, potassium, chloride, b. Nonessential nutrients
sulphate and phosphate. Are those nutrients that can be made
Are not broken down and by the body, they may often also be
changed by the body. They absorbed from consumed food.
leave the body as they E.g. cholesterol
entered it. Ca is still Ca and
Fe is still Fe. Concentration
Too much or too little of a Some nutrients are needed in large
mineral may adversely affect amount than others.
a persons health. CHO, CHON, fats and water are
The next simplest nutrient is water, a collectively known as Macronutrients
compound made of 2 elements – bec they are needed by our body in
hydrogen and oxygen relativelylarge amounts bec they are
Needed for metabolic essential to provide energy and to
reactions. regulate and control the different
Supplies the medium for functions of the body.
transporting materials to In contrast to vits and
cells and waste products minerals are called as
away. Micronutrients as the body
needs them in smaller
Essentiality amount or quantity.
Refers to the important contribution
to the body’s physiological NUTRIENT DENSITY
functioning. Refers to the concentration of
nutrients in a given amount of food
a. Essential nutrients source relative to its caloric content.
Nutrients a person must obtain from Consider calories from CHO, fats,
food bec the body cannot make them protein, vits and minerals and water.
for itself in sufficient quantity to meet The higher the nutrient density, the
physiological needs. greater the nutritional value in a small
amount of food.

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Nutrition and diet therapy
CALORIE energy content in food on humans
Represents the energy measurement and animals.
of nutrients that foods provide.
The energy released from CHO, fats Energy in the body
and proteins can be measured in The body uses the energy-yielding
calories. nutrients to fuel all its activities.
Sends electrical impulses thru the
Energy is expressed in 1000 – calorie metric brain and nerves.
units known as kilocalories (shortended to To synthesize body compounds and to
kcalories/kcal, but commonly called “calories” move muscles.
If the body does not use these
Kilojoules (kj)- It is the international nutrients to fuel its current activities,
unit of work energy. it rearranges them into storage
1 kcal is equal to 4.2 kj. compounds (such as body fat), to be
When cho, fats and proteins used between meals and overnight
completely broken down in when fresh energy supplies run low
the body:(by the process of If more energy is consumed than
metabolism): expended, the result is an increase in
The fuel factor of CHO- is 4 energy stores and weight gain.
kcalories/gram. If less energy is consumed than
Protein – also yields 4 kcal/gram expended, the result is a decrease in
Fat -yields 9 kcal/gram. energy stores and weight loss
Alcohol – yields 7 kcal/gram If alcohol can be consumed in excess
Fat therefore, has a greater energy can be converted to body fat and
density than either CHO or CHON. stored.

Energy Density To calculate the energy available from food,

is a measure of the energy a food multiply the number of grams of CHO, CHON
provide relative to the amount of and fat by 4, 4 and 9, respectively. Then add
food. (kcalories per gram). the results together.
Foods high in energy density help w/
[Link], whereas those w/ a low SEATWORK: Calculate the energy available
energy density help w/ wt. Loss. from foods.
Alcohol is not considered a nutrient 1 slice of bread w/ 1 tbsp of peanut butter
bec it can interferes w/ growth,  Which contains 16 grms CHO, 7 grms
maintenance and repair of the body CHON and 9 gms fat.
but it does yield 7 kcal per gram when
metabolized in the body. From this you can calculate the
percentage of kcal each of the energy
BOMB CALORIMETER nutrients contributes to total. To
Bomb calorimeter can be used to determine the kcal from fat, for
determine the calorie content of a example, divide the (kcal from fat) by
product. the total kcal (total calorie of the
It is used in food and metabolic snack)
studies to examine the effects of

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Nutrition and diet therapy
ANS. NUTRITIONAL STATUS
16gms CHO x 4 = 64kcal= 37% a measurement of the extent to w/c
7gms CHON x 4 = 28= 16% an individual’s physiologic need for
9gms FAT x 9 = 81=47% nutrients is being met.
Total = 173 kcal
NUTRITIONAL ASSESSMENT
PERCENTAGE Provides the information needed for
divide the 81kcal by the total 173 kcal: identifying nutrition problems and
81 fat kcal / 173 total kcal = 0.468 designing a nutritional care plan.
(rounded to 0.47) Then multiply by It identify clients at risk for
100 to get the percentage: 0.47 x 100 malnutrition/ those w/ poor
= 47% nutritional status

Dietary recommendations that urge This information can be obtained from

people to limit fat intake to 20-35 % of the Medical, Social and Diet histories,
kcal refer to the day’s total energy Anthropemetric data, Biochemical
intake, not to individual foods. data and Clinical data.
Still, if the proportion of fat in each This is a part of routine exam done by
food choice throughout a day exceeds a RD/other health care professionals
35% of kcal, then the day’s total surely trained in the diagnosis of at risk
,will, too. individuals – doctors/ nurses.
Knowing that this snack provides 47%
of its kcal from fat alerts a person to DIETARY - SOCIAL HISTORY
the need to make lower-fat selections Dietary evaluation would provide
at other times that day. information w/ regards on client’s
food habit, usual food pattern, likes
HOUSEHOLD MEASURES and dislikes and type of meals eaten
Cups, quarts and teaspoons for a long period of time, because
these information would help the
METRIC MEASURES examiner to determine any nutritional
Millilitres, liters, and grams deficiencies or excesses.

VOLUME MOST COMMON METHOD USED

 1L = 1000 ml
 0.9L = 1 quart Diet History – a comprehensive record of
 1ml =0.03 fld. Oz eating-related behaviours and foods a person
 240 ml = 1 cup eat

WEIGHT: GRAMS (g) Contents of Diet History of Adults:

 1 g = 1000 mg Check appetite – good, poor, any
 1 g = 0.04 oz factors that affect appetite, taste and
 1 oz. = 28.35 g or 30 g smell perception
 100 g = 3 ½ oz. Ask for allergies, intolerances or food
 1 kg = 2.2 lbs avoidances – foods avoided and
 454 g = 1 lb reasons, length of time of avoidances

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Nutrition and diet therapy
Anthropometry – ht, wt, skin-fold, amount, frequency), Sleep ( hours/day
etc. ,uninterrupted?),handicaps.
Take 24 hour dietary recall or food Determine home life and meal
frequency checklist patterns – Number in household (eat
Consider ethnic and cultural together?), person who buy food,
background – eating habits and food person who does cooking, food
preferences and religion storage and cooking facilities (stove,
People eat the foods they refrigerator), type of housing (home,
grew up eating. Every apartment, room)
country or every region of a Assess gastrointestinal conditions –
country, has its own typical problems of heartburn, bloating,
foods and ways of combining diarrhea, vomiting,constipation,
them into meals. frequency of problems, antacid,
American diet or even laxative or other drugs.
Filipino diet includes many Consider presence of chronic disease
ethnic foods from diff – treatment, length of tx, dietary
countries, all adding variety modification including physician
to the diet. Ex. Chinese, prescription, date of modification,
Italian, Korean, Japanese. education, compliance w/ diet.
Consider religion = for examples, Evaluate recent weight change – loss
some religious sect forgo meat during or gain, how much, over what length
lent, the period prior to easter. of time,

Muslims fast between sunrise and sunset Food Frequency

during Ramadan. A record of how often the diff foods
Food preference = spicy foods, are eaten. The types (and sometimes
sweetness of sugar and the savoriness the amount, its preparation) of foods
of salt. High fat foods. curry spices of a person routinely consumed in a
Indian cuisine. week or a month can be taken.
Habits = choosing food out of habit =
ex. Eating cereal every morning, bec 24-hour recall
they always eat cereals for b-fast. Done by dietician. Listing the types,
Eating a familiar food makes them amounts and preparation of all foods
comfortable eaten in past 24 hours
Evaluate dental and oral health-
problems w/ eating, foods that cannot
be eaten, problems w/ swallowing, Food Diary
salivation Written record of all food and drink
Economic status –income, amount of ingested in a specified period- for
money for food each week or month.= about 3-4 day period.
people eat foods that are accessible, But some clients are not truthful and
quick and easy to prepare and w/ in tend to forget the food they had
their financial means. eaten.
Evaluate physical activity level – may include records of behaviours /
occupation(type, hours/week,shift, emotions and symptoms, physical
energy expenditure), Exercise(type activities and medications

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Nutrition and diet therapy
Medications may decrease the desire DESIRABLE BODY WEIGHT
of food, absorption of nutrients, Is also known as Ideal or reference
metabolism of nutrients . weight but it is more appropriately
e.g antihistamines-dec saliva called the healthy weight.
causing dry mouth and loss of It is the weight found statistically to
appetite. be most compatible w/ health
e.g aspirin (controls pain and longevity.
fever and for blood thinning)
– a gram of which increases TANNHAUSER’S METHOD
the taste perception of Procedure :
bitterness. Step 1: DBW (K) = HEIGHT (CM) – 100
Step 2: Deduct 10% - if a Filipino unless frame
ANTHROPOMETRIC MEASUREMENT size is known (either med or large)
The science of measuring the size, Example: Subject: 5’2”female (5’2”- 157.48cm)
weight and proportions of the human Step 1: DBW (K)=157.48cm – 100 = 57.48 kilos
body. Step 2: 57.48 kilos less 5.748(10%) = 51.7 or
may reveal a failure to thrive in 52kg
children
It reflects a nutrient deficiencies or CONVERSION AID:
excesses. 1 foot – 12 inches
Includes the height, weight, head 1 inch – 2.54 cm
circumference, upper arm, skin fold 1 m – 100cm
and chest circumference (for
children). ACTUAL BODY WEIGHT
May be influenced by changes in the
HEIGHT AND WEIGHT person’s fluid status.
useful in determining nutritional weight measurement obtained at the
status in adults time of examination
It is a good indicator of satisfactory
diet and recent food intake. OTHER PARAMETERS OF ASSESSING
NUTRITIONAL STATUS
HEIGHT BMI or BODY MASS INDEX
Is a less sensitive indicatorof current Or the Quetelet index is a good
nutritional status than weight – for – estimate of the degree of obesity or
age since height does not decrease amount of total body fat.
but simply slows down in times of It also helps to determine how much
nutrient deprivation. risk people have of developing certain
health problems because of their
WEIGHT weight (e.g. diabetes, heart problems)
Is a sensitive marker of current It can indicate over or under nutrition
nutritional status.
Reflects an immediate inability to
meet nutritional requirements and
this may indicate nutritional risk.

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Nutrition and diet therapy
BMI is computed thru METRIC FORMULA OBESITY CATEGORIES INTO 3 BMI GRADES:
FORMULA: BMI = W (in kilos) / H (in GRADE I – 25 to 29.9
meters)² GRADE II – 30 TO 40
Constant: 5 ft = 1.524m GRADE III – 40+
4 ft = 1.2192m
1 inch = 0.0254m IN GENERAL: OBESITY – IS BMI of 27 or more.
Example: H = 5’ 3” Indicates high risk of developing
W= 62kgs health problems.
62kg/(1.6)² = 62/2.56 = BMI = 24.22 Weight 20% above average.

Classification of Weight status in adults UNDERWEIGHT – BMI less than 18.5 – 10 to

according to BMI By WHO 15% below ave
Classification BMI Risk of c0-
(kg/m²) morbidities OVERWEIGHT - BMI between 25-29 – 10 to
Underweight < 18.5 Low (but risk of 20% above ave.
other clinical HEALTHY – BMI between 18.5 – 24.9
problems
increased) WAIST – TO – HIP RATIO
Waist to hip ratio (WHR) is a valuable
Normal ≥ 18.5 – Average indicator of body fat distribution and
Range 24.9 adiposity. It is also a valuable guide in
Overweight ≥ 25 evaluating health risk (heart disease,
diabetes, etc.)
Pre-obese 25 – Increased Alternatively it is called
29.9 abdominal/gluteal ratio or abdominal
Obese I 30.0 – Moderate girth measurement
34.9
Obtaining Correct Measurement:
Obese II ≥ 30 Severe
Use non stretchable tape measure (in
Obese III 40+ Very severe centimetre)
Subjet should stand erectly,
CLASSIFICATION OF MALNUTRITION IN abdominal muscles relaxed, arms at
ADULTS BY BMI the sides, and feet together. The
BMI VALUES CATEGORY measurer faces the subject and places
the tape measure. Measure waist at
>20 Normal the most narrow area below the rib
case above umbilicus.
– 20.0 Marginal
Measure hip circumference at the
>17 – 18.5 Mild malnutrition widest point around the hips or
16 – 17 Moderate Malnutrition buttocks with the subject standing.
<16 Severe Malnutrtion Read measurement to the nearest
0.1cm.

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Nutrition and diet therapy
Formula for Assessing Body Fat Distribution Harpenden
by WHR

WHR = Waist circumference (cm)/Hip

circumference (cm)

A WHR of 1.0 or greater in men or 0.8

or greater in women is indicative of
android obesity and an increased risk
for obesity-related diseases. This also
appears to be true in children.
GYNOID “pear-shaped”people, store Lange Caliper
more fat in the buttocks, thighs and
hips
ANDROID “apple-shaped” people,
carry their extra fat around the
abdomen/upper body-

The WHR may partially explain the

difference in high blood pressure
between men and women. Men are
more likely to be “apples” and women Different Sites for Skinfold Measurement
to be “pears”. Men have higher rates
of HTN and more complications. Triceps- commonly used

Waist Circumference
Serves as a marker of abdominal
fatness. Waist circumference alone
has been considered a valid indicator
for both men and women.
Interpretation: women with a waist
circumference greater than 35 inches
and men with waist circumference
greater than 40 inches have high risk
of central obesity-related health
problems.
Below the scapula

SKINFOLD THICKNESS
Assess body composition, fat
distribution and reserve calories by
using a calliper .
The most accurate way to measure
body fat.

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Nutrition and diet therapy
Biceps seen or felt in superficial tissues such
as the skin, hair and eyes.
In other words, its the physical
observation or assessment.
In here, signs of nutrient deficiency
are noted and some nutrient
deficiency diseases are observed such
as;

SCURVY
Gingival swelling

Above the iliac crest/ Suprailiac

Blue spots on the skin

Upper thigh

Rickets = lack of Ca and vit D s/s-

poorly shaped bones and teeth
Iron deficiency anemia(children
beyond 6 mons.) = lack in iron s/s-
pallor.
Dehydration = loss of water &
electrolytes.
s/s- sunken eyeballs, dry mucous
membranes, thirst, etc.

If it is more than 1 ½ inches – over wt. ASSESSMENT BY BIOCHEMICAL TEST

If less than ½ inch – under wt. Includes various blood, urine, saliva
and stool test.
ASSESSMENT BY CLINICAL METHOD According to Dellova, it provides
Clinical assessment of nutritional information on protein balance, vit,
status deals basically with the mineral, and fluid status, body
examination of changes that can be composition, organ function and
metabolic status.

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Nutrition and diet therapy
According to Roth a deficiency/ Low creatinine excretion – indicative
toxicity can be determined by of muscle mass depletion, as in
laboratory analysis of the samples. malnutrition.
These tests allow detection of
malnutrition before signs appear. Low creatinine excretion – indicative
of muscle mass depletion, as in
MOST COMMONLY USED TEST FOR malnutrition.
NUTRITIONAL EVALUATION
Serum Creatinine – indicates the
BLOOD TEST amount of creatinine in the blood and
Serum Albumin Level measures the is used for evaluating renal functions.
main protein in the blood and is used
to determine protein status..3. 5 – 5.0 -N.V. 60-132 mmol/L
g/dl or 35-50g/L
-↑= acute/chronic renal insufficiency,
Albumin is a protein found in plants urinary tract obstruction.
and animals.
Hgb- women-12-16g/dl,men-14-
Low levels – with malnutrition, burns, 18g/dl
infections, cancer and those taking
birth pills, chronic disease of liver, Hct – women – 42-52%,men- 37-48%
kidney and heart.
= decreased level would mean anemia
Serum Transferrin Level - -indicates
iron-carrying protein in the blood Lipid Profile – for clients w/ heart
abnormalities/ CAD (coronary artery
Transferrin is a glycoprotein that dse.)
binds and transport iron. Most is
produced in the liver. Total Serum Cholesterol – less than
- if result is below normal there would 200 mg/dl
be hepatic failure, nephrosis, cachexia
HDL – more than 35mg/dl
Blood Urea Nitrogen (BUN) –
Increased level may indicate renal LDL – less than 130mg/dl
failure, insufficient renal blood supply
or blockage in the urinary tract, Serum Triglycerides – 2.9 – 8.9
dehydration and GI bleeding. mmol/L or less than 200mg/dl

NV - 2.9 – 8.9 mmol/L Uric Acid, serum or plasma

Creatinine Excretion – indicates the men – 3-99mg/dl, women – 2.5-

amount of ceatinine excreted in the 7.7mg/dl
urine over a 24 hour period and can
be used in estimating body muscle High level - gout, toxemia of
mass. pregnancy, leukemia,
polycythemia,renal insufficiency,

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Nutrition and diet therapy
down’s syndrome, glycogen storage Urinalysis – can detect protein and
disease sugar in urine(indicative of kidney
disease and diabetes)
Low levels occasionally in acute
hepatitis. Color = normal is clear, straw-
All vitamins and minerals would cause colored/light [Link] than
a certain disease if there would be normal may result from excessive fld.
abnormalities on the intake, either Intake,diuretic.
low or high..but in water soluble
vitamins, no over dosage. = darker than normal – caused by liver
disease and certain drugs.
STOOL EXAM
Direct Stool Exam - checked for oily ODOR = depends on the food
materials. Excess fat in stool suggest intake/with concentration of urine
steatorrhea. (asparagus/onions), this depends with
how much fld. You drink.
Chemical analysis of fecal fat- fecal
fat greater than 7g/day when the diet Protein = presence of this is found on
includes 100 g of fat/day indicates kidney disease, multiple myeloma,
malabsorption. heart failure, stress or surgery

Serum Calcium – low levels seen in pH = this varies with diet, but usually
calcium and vit. D malabsorption, acidic w/ a range of pH 5-6.
(recall that steatorrhea can lead to
calcium and vit [Link]. = Alklaline urine is associated w/ a
vegetarian diet or fruit diet esp citrus,
D-xylose test – test of CHO vomiting, diuretics and excess taking
absorption. in antacids

Schilling test – identifies vit B₁₂ Specific gravity = it is high

malabsorption. (concentrated) in Dhn, DM or in
condition w/c it has an excess protein
URINE TEST in the urine.
Creatinine - ↑ - muscle wasting,
starvation and cachectic status, GLOBAL PROBLEMS OF NUTRITION
hyperthyroidism and febrile status. Malnutrition
↓- hypothyroidism, renal insufficiency Causes or Factors or People who are
Men – 0-50 mg/24 hour at risk
Women – 0-100 mg/24hour 1. Poor food availability and
preparation
Calcium - ↑- hyperparathyroidism, 2. Lack of nutritional education
elevated serum calcium 3. Recurrent infections - chronic
diseases such as AIDS,
50-150mg/24 hr. Or 1.05 – 1.3 mmol/L Cancer, Celiac disease (
gluten sensitivity –
malabsorption of all

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Nutrition and diet therapy
nutrients- diarrhea, wt loss & breastfeeding due to the presence of
malnutrition) the next baby to nurse.
4. Poverty, natural disaster, So the first child now will be switched
war. from Nutrient dense, protein-rich
breastmilk to a starchy, protein poor
FORMS OF MALNUTRITION IN DEFICIENCY OR cereal.
UNDERNUTRITION distinctive feature “moon face”
PEM (Protein- Energy Malnutrition) This is commonly precipitated by an
Undernourished children can suffer illness such as measles or dysentery
from PEM when there is: (infxn of the digestive tract result to
Rapid growth, infection or disease w/c diarrhea
increases the need for protein and The child has bulging belly w/ a fatty
essential nutrients. liver (due to lack of protein carriers
that transport fat out of the liver)
TWO DIFFERENT FORMS OF PEM With edema on face and limbs due to
1. MARASMUS lack of protein and hormones that
named also as the “drying away” maintains fluid balance. So fluid now
this is a chronic PEM wherein it will leak to the interstitial spaces. ( a
reflects a severe deprivation of food distinguishing feature
over a long time
There is severe wasting or the patient CLASSIFICATION OF NUTRIENT
is emaciated DEFICIENCY/UNDERNUTRITION
it occurs in children from 6-18 mons.
Of age in all over-populated urban 1. PRIMARY – caused by inadequate dietary
slums. intake
marasmic children looks like a little E.g. poverty
old people – just skin and bones. Poor food habit
Skin is dry and wrinkled Limited food supply due to over
Hair is thin and dry, easily pulled population
Spoon-shaped brittle nails
Due to Inadequate nutrition – there’s 2. SECONDARY– caused by a disease condition
inadequate energy – and the body will that may cause mal-absorption(steatorrhea),
use the protein as energy – if with accelerated excretion or destruction of
inadequate protein for growth and nutrients
maintenance – then there’s a failure E.g lack of appetite, diarrhea,
to thrive/ delayed dev’t/ stunted parasitism, alcoholism, liver disease
growth. etc.

2. KWASHIORKOR FORM OF MALNUTRITION IN

Reflects a sudden and recent EXCESS/OVERNUTRITION
deprivation of food
this is classified as Acute PEM 1. OBESITY
it sets in between 18 mons to 2 years generally, it is defined as an excessive
It is usually occurs when the mother amount of fat stored ( as adipose
suddenly wean the baby from tissue) in the body
- means “stout”, fat or plump

15
Nutrition and diet therapy
-the actual body weight is 20% above B. Gastric bypass – reducing the
the DBW. stomach by the stapling procedure,
-will result to many health problems connecting a small opening in the
suc as Htn, DM, CAD, CVD, upper portion of the stomach to the
atherosclerosis and even CA small intestine by means of intestinal
CAUSES: loop.. Capacity = 20-30 ml
1. Genetics – accdg to research Liposuction/ Lipo sculpture =
that a considerable aspiration of fat deposits
proportion of human obesity This is a cosmetic surgery not a wt
(50-79 %) has a genetic reduction technique bec only 5lb of
component. fat can be remove at a time.
2. Sedentary lifestyles – low Complications = death, severe
expenditures infectious cellulitis and hemorrhage
3. Abnormal absorption of
nutrients CLASSIFICATION OF MALNUTRITION IN
4. Over-eating / binge eating ADULTS BY BMI
disorder. BMI VALUES CATEGORY

>20 Normal
TYPES OF OBESITY
– 20.0 Marginal
1. UPPER BODY OBESITY – referred to as >17 – 18.5 Mild malnutrition
central, abdominal/male obesity 16 – 17 Moderate Malnutrition
apple-shaped people/Android obesity
<16 Severe Malnutrtion

2. LOWER BODY OBESITY – known as

peripheral, gluteal, femoral/ female obesity NUTRITIONAL PROCESSES
Pear-shaped people/ Gynoid obesity
1. DIGESTION
PREVENTION AND INTERVENTION Organs Involved: mouth, esophagus,
1. LIFESTYLE MODIFICATION – diet, stomach, small intestine, large
exercise/increase physical activity intestine (also called the colon and
2. PHARMACOTHERAPY anus.
A. Orlistat (xenical) – inhibit Another: pancreas, the liver, and the
absorption of fat soluble vitamins gallbladder.
 for 30 BMI The primary function of the Digestive
 120 mg PO TID w/ meals System to bring nutrients/essential
B. Reductil – it suppress appetite nutrients into the internal env’t.

3. SURGERY - Bariatric surgery for morbidly

obese
Surgically reduces the reservoir
capacity of the stomach by closing off
a part of it.
Gastroplasty – reduces the size of the
stomach leaving only a small opening
into the distal stomach

16
Nutrition and diet therapy
3 Pairs of Salivary Glands
1. Parotid
2. Submaxillary and
3. Sublingual
It produces 1.5 L of saliva/day
After a mouthful of food has
been swallowed, it is called a
BOLUS.

PHARYNX

MOUTH

When you swallow a mouthful of food, it

passes thru the pharynx, a short tube that is
shared by both the digestive system and
respiration system.

To bypass the entrance to your lungs, the

epiglottis closes off your air passages so that
you don’t choke when you swallow or to
prevent aspiration.
Digestion begins here, with the chewing of
food (mastication). Breaks down very large
ESOPHAGUS
aggregates of food molecules into smaller
particles and allows saliva and enzymes to
enter inside the larger food complexes . Saliva
is secreted by the salivary glands in your mouth
and moistens the food to improve the chewing
and grinding. Saliva also contains some
enzymes that begin the breakdown of starches
and fats.

It delivers the saliva-mixed food from the

mouth to the stomach thru peristalsis.

17
Nutrition and diet therapy
STOMACH

After a mouthful of food has been DIGESTIVE SECRETIONS:

swallowed, it is called a BOLUS.
Gastric Juices
When the Bolus enters the fundus and Are the digestive secretions of the
body of the stomach, the lining of the stomach,such as mucous, HCl,
fundus (called the gastric fundal pepsinogen, intrinsic factor and
mucosa) produces hydrocholoric acid gastrin .
(HCl). HCl - secretes by the parietal cells in
the walls of the stomach and it
Acidic environment is critical for activates the enzyme pepsin that will
destroying toxins in foods, such as breakdown protein.
bacteria, as well as to activate enzyme Gastrin (a hormone, produced by the
PEPSINOGEN into PEPSIN needed for antral mucosa of the stomach).It
untwisting the complex three- increases the release of gastric juices.
dimensional protein chains, a process Pepsin- the active form of pepsinogen
called denaturation of the proteins. resulting from exposure to acidic
env’t.(the hydrochloric acid). This
Food spends about 3-4 hours inside pepsin will breakdown protein.
the stomach Mucus- a thick, slippery, white
substance that coat the cells. It is
Little by little, the stomach transfer secreted by the cells of the stomach
the food to its lower portion ,add to protect itself from the harmful acid
juices to it and grinds it to a semi- and enzymes.
liquid mass called CHYME.
2 Additional enzymes in Children
When the chyme enters the pylorus , Renin – which acts on milk protein
it causes distention and the release of and casein
the hormone Gastrin which increases Gastric lipase – which breaks the
the release of gastric juices (aids in butterfat molecules of milk into
the digestion of food) smaller molecules.
No absorption takes place at the
CHYME- contains 50% water. This is a stomach except water, alcohol and
thick creamy, acid liquid expelled by ASA. Therefore, absorption of water
the stomach into the duodenum.

18
Nutrition and diet therapy
starts at the stomach and ends at the LIVER, PANCREAS AND GALLBLADDER
large intestine.

Once the food-acid-enzyme mixture

leaves the stomach, it is called chyme.
The movement of chime through the
pyloric sphincter stimulates the
intestine to release the hormones
secretin and cholecystokinin, which
signal the pancreas to release its
contents, the pancreatic juice, inside PANCREAS - produces and secretes many of
the lumen (the lining) of the the enzymes necessary for digestion, which
duodenum (the first segment of the include the enzymes that digest protein
small intestine). (trypsin, chymotryPsin, carboxypeptidase, and
elastase), enzymes that digest fat (lipase and
FYI: phospholipase), and the enzyme that digests
The stomach can hold up to 1 ½ pint carbohydrate (alpha-amylase).
of food and remains for 2-4 hours.
The LIVER is responsible for
An average of 2000-2500ml of gastric synthesizing most of the proteins that
juice is secreted daily. circulate in your blood, and it
produces bile.
Most of liquid meal empties in 1-2
hours. Bile -is important for the digestion of
fats and is used for the excretion of
Most solid food/ meal empties w/ in cholesterol and other fat-soluble
2-3hours molecules

When the chyme completely Can make cholesterol (800-1000/day)

liquefied, the pyloric sphincter opens and is the primary place where
briefly (about 3x a minute) to allow cholesterol is removed from the blood
small portions of chyme [Link]
this point, the chime no longer The liver eliminates cholesterol in the
resembles food in the least. form of bile acids. Every day, your
liver secretes about 500 ml. of bile
At the top of the Small Intestine, the acids, which are used during digestion
chyme bypasses the opening (pyloric of fats.
sphincter)from the common bile duct,
which is dripping fluid into the small The chyme travels on down the small
intestine from two organs outside the intestine thru the 3 segments –
GI tract – the gallbladder and the 1. Duodenum- top portions and
pancreas receives digestive juices from
the liver, gallbladder and
pancreas.

19
Nutrition and diet therapy
2. the jejunum- the 1st 2/5 of BILE - is produced in the liver but
the small intestine beyond stored in the gallbladder.
duodenum)and It is not an enzyme but an
emulsifier.
3. the ileum the last segment It emulsifies fat after it is
where most of the secreted in the small
absorption of food takes intestine.
place, site for B12 absorption It enables the enzymes to
digest the fats more easily.
The Intestine– is a 10 feet of tubing
coiled w/ in the abdomen. Emulsifier – a substance w/ both
water-soluble and fat-soluble portions
Final digestion will occur here at the that promotes the mixing of oils and
Small intestines. fats in a watery solution.

After digestion, ABSORPTION may ENZYME - is a protein that facilitates a

take place with the help of the chemical reaction, making a molecule,
Microvilli( minute cylindrical breaking a molecule, changing the
processes that are found on the arrangement of molecule or
surface of the intestinal cells greatly exchanging parts of molecule.
increase their absorptive surface area
) in the small intestine wall, in which The enzyme involved in the digestion
nutrients are absorbed into the blood facilitates a chemical reaction known
except fat which is absorbed by the as HYDROLYSIS , the addition of water
lymphatic system. (hydro) to break (lysis) a molecule into
smaller pieces.
In here, the hormone secretin causes
the pancreas to release NaH03 w/c is The chyme triggers also the pancreas
basic/alkaline- the opposite of to secrete its juice.
stomach’s acid to neutralize the
acidity of the chyme, so from this Pancreatic Juices are:
point on, the chyme remains at a Trypsin, chymotrypsin and
neutral or slightly alkaline pH. carboxypepetidases – splits
proteins into smaller
pH – the unit of measure expressing a substances. They are called
substance’s acidity/alkalinity. the pancreatic proteases.
Pancreatic Amylase –
Acidity of the gastric juice register converts starches
below “2” (polysaccharides)to simple
sugars.
And the hormone Cholecystokinin Pancreatic lipase – reduces
(CCK) will release the Bile. The fats to fatty acids and
gallbladder squirts the bile into the glycerol.
duodenum when fat arrives there.

20
Nutrition and diet therapy
Large Intestine Residue = is commonly called as
Having travelled the length of the Dietary Fiber.
small intestine, after absorption of E.g. outer hulls of corn kernels, grains
nutrients, what remains of the chyme of wheat, celery strings and apple
arrives at another sphincter, the skins.
ileocecal valve, at the beginning of the
large intestine in the lower right-hand Fiber – is important in the diet to produce soft
side of the abdomen. stools and move frequent bowel movement.

Had it slipped into this opening, it Undigested food is excreted as feces by way of
would have ended up in the appendix, the rectum and anus.
a blind sac about the size of your little
finger. In healthy people: 99 % CHO, 95% FATS, 92%
CHON are absorbed.
The chyme bypasses this opening,
however, and travels along the large ABSORPTION
intestine up the ascending colon, The passage of nutrients into the
across the transverse colon, down to bloodstream or lymphatic system.
the descending colon and finally to The inner surface of the small
the sigmoid colon, above the rectum. intestine has mucosal folds called villi
and microvilli.
During the chyme’s passage to the
rectum, the colon w/draws water Villi –
from it, leaving semisolid waste. is a tiny hairlike structures in the SI
through w/c nutrients are absorbed.
The strong muscles of the rectum and It has hundreds of microscopic hairlike
anal canal hold back this waste until it projection called MICROVILLI or brush
is time to defecate. Then the rectal border – these are very sensitive to
muscles relax and the 2 sphincters of the nutrient needs of our bodies.
the anus open to allow passage of the These villi contains numerous blood
waste. capilliaries (tiny blood vessels) and
lacteals (lymphatic vessels)
2 Anal Sphincters: Capilliaries
Internal anal sphincter – Absorbs glucose, fructose, galactose,
smooth muscle and amino acids, minerals and water-
involuntary soluble vitamins
External anal sphincter –
skeletal muscle and voluntary Lymphatic vessel/Lacteals
Carry fat-soluble particles and
The major task of Large Intestines: molecules that are too large to pass
Are to absorb water through the capillaries into the
To synthesize some B Vitamins and K bloodstream such as glycerol and fatty
(essential for blood clotting), acids (end product of digestion), in
And to collect food residue (part of addition to fat-soluble vitamins.
food that the body’s enzyme can’t
digest and can’t absorb by the body.

21
Nutrition and diet therapy
Organ/ Target Secre- Action
Gland Organ Tion Anaerobic metabolism – reduces fats w/o the
use of O2.
Salivar mouth saliva Fluid eases
y swallowing, The complete oxidation of CHO, CHON
Glands salivary and Fats is called as KREBS CYCLE.
enzymes
breaks down After oxidation of nutrients → energy is
CHO released and process of ANABOLISM will
Gastric Stomac Gastri Fluid mixes follow, wherein the released energy will be
glands h c juice w/bolus;hydr
use, whereby small molecules are put together
ochloric acid
uncoils to build larger ones
proteins, e.g. Formation of new body tissues
enzymes
breakdown Now when released energy is used to
proteins;
broken down large molecules to small
mucus
protects molecules, it is called CATABOLISM.
stomach cells
In order that the body has the energy,
Pancre Small Pancre NaHCO3 itmust have a continuos supply of
as intestin atic neutralizes
nutrients needed for building up
e juice acidic gastric
juices; (anabolism) and breaking down
pancreatic (catabolism) of substances.
enzymes
break down Metabolism is governed primarily by
Cho, fats and
the hormones secreted by the thyroid
proteins.
gland. The: Triiodothyronine (T3) – an
Liver Gallbla Bile Bile stored –iodine containing thyroid hormone
dder until needed
Thyroxine (T4)- an iodine- containing
Gallbla Small Bile Bile
hormone that regulate the rate of cell
dder intestin emulsifies fat
e so enzymes metabolism
can attack
If T3 and T4 are elevated, it may result
to HYPERTHYROIDISM – in w/c there is
METABOLISM quick metabolism of food and weight
it is a complex process after digestion loss.
and absorption, wherein nutrients are
carried by the blood to the cells of the If T3 and T4 is decreased,
body, whereby, nutrients w/ in the HYPOTHYROIDISM occur, wherein the
cells are changed into energy. thyroid gland is not producing enough
hormone. Metabolism here is too
OXIDATION process takes place during Aerobic slow and patient becomes sluggish
metabolism wherein nutrients are combined and there is fat acculmulation.
w/ oxygen w/ in each cell.
It reduces CHO to CO2 and H2O
Proteins to CO2, H2O and Nitrogen

22
Nutrition and diet therapy
After food passes the chemical factories of the The rate is slowest when a person is
body, either turn them into energy or use them sleeping undisturbed, but it is usually
to make body tissues. ENERGY measured in a room w/ a comfortable
Is defined as capacity to do work temperature when the person is
awake, but lying still, after a restful
Is constantly needed for the sleep and an overnight (12-14) fast.
maintenance of body tissue and
temperature for growth (involuntary Factors that affect BMR:
activity – process of respiration, 1. Growing (children and pregnant
circulation, regulation of body temp women)
and cell activity and maintenance) and 2. And in those w/ considerable lean
for voluntary activity such as walking, body mass (physically fit people and
running, gardening, swimming, etc. male)
bec. the larger the muscle mass
People expend energy when they are required and the heavier the weight
physically active, of course, but they of the body part being moved, the
are also expended when they are more energy is spent.
resting quietly. 3. People with fever ( increase the
metabolic rate by about 7% for each
Heat is released whenever the body degree Fahrenheit increase in body
breaks down CHO, CHON or Fat for temp.) or under stress
energy and again when that energy is 4. And in people w/ highly active thyroid
used to do work. glands.- bec the thyroid gland releases
hormones that travel to the cells and
The work itself, as it is done, influence cellular metabolism.
generates heat as well. The body’s Thyroid hormone activity can
generation of heat is known as speed up or slow down the
THERMOGENESIS, and it can be rate of metabolism by as
measured to determine the amount of much as 50%.
energy expended. 5. Environmental temperature = people
working in a cold climate require more
An ENERGY is expended by the body kcalories to maintain normal body
in the form of RESTING ENERGY temp.- the extent to w/c energy
EXPENDITURE(REE) and the THERMIC metabolism increases in extremely
EFFECT OF FOOD(TEF) cold environment depends on the
insulation available from the body fat
REE / BMR = is the rate of energy and protective clothing..
expended in the activities necessary Though both heat and cold
to sustain normal body functions and raise the BMR.
Homeostasis (means balance). Fasting/starvation/malnutriti
on-BMR/ REE slows down w/
The rate may vary a loss of lean body mass
dramatically from person to The activity’s duration,
person, also with a change in frequency and intensity also
circumstances or physical influence energy
condition expenditure: the longer, the

23
Nutrition and diet therapy
more frequent, and the more The thermic effect of food is greater
intense the activity, the more for high protein foods than for high fat
kcalories spent. foods.
And as people age, lean body The body requires energy to process
mass declines and also the food (digestion, absorption,
BMR/REE. BMR begins to transportation, metabolism and
decrease in early adulthood storage)
at a rate of 2%/decade Thermic Effect of Food:
a reduction in voluntary  Carbohydrate: 5-10%
activity as well brings the  Fat: 0-5%
total decline in energy  Protein: 20-30%
expenditure to 5% per  Alcohol: 20%
decade The percentages are calculated by
dividing the energy expended during
ESTIMATING BMR: digestion and absorption (above
Convert body weight from pounds to basal) by the energy content of the
kg by dividing pounds by 2.2 (2.2=1kg) food.
Multiply the kg. By 24hrs/day
Multiply the answer obtained in step 2 FACTORS AFFECTING THE TEF
by 0.9 for women, and 1.0 for men. 1. TEF varies w/ the composition of the
e.g. 110lbs = diet and is greater after consumption
50kg50x24 = 1200kcalories of CHO, CHON than after FAT. FAT is
1200 x 0.9 = 1080 kcalories metabolized efficiently w/ only 4%
(women) = BM requirement wastage, compared to 25% wastage
when CHO is converted to fat for
THERMIC EFFECT OF FOOD storage = these factors would
An estimation of the energy required contribute to the obesity – promoting
to process food. characteristics of FAT.
When a person eats, the GI tract
muscles speed up their rhythmic 2. Spicy foods enhances and prolong the
contractions, the cells that effect of the TEF
manufacture and secrete digestive meals w/ chilli and mustard
juices begin their tasks, and some may increase the metabolic
nutrients are absorbed by active rate as much as 33% more
transport. This acceleration of activity than unspiced meals and this
requires and produces heat; it is effect may last for more than
known as the Thermic Effect of Food. 3 hours.
The thermic effect of food is
proportional to the food energy taken 3. Caffeine and nicotine = also stimulate
in and is usually estimated at 10% of the TEF
energy intake. when ingested every 2 hours
Thus a person who ingest 2000 For 12 hours, the amount of
kcalories probably expends about 200 caffeine in 1 cup of coffee
kcalories on the thermic effect of (100mg) has been shown to
food. increase the TEF by 8% - 11%.
Nicotine has similar effect.

24
Nutrition and diet therapy
DIETARY GUIDE AND THEIR USES The EAR is use to calculate the RDA.
Dietary Recommended Intake – a Adequate Intake- represents an
nutrient guidelines in the US, estimate guidelines for intake of a
introduced since 1998. nutrient in an individual when no RDA
was established due to lack of
It represent a set of four standards scientific data on requirements.
used to provide a comprehensive
measure of nutrition and long term The latest Nutritional guidelines for Filipinos
guidelines that are utilized to both given by the Food and Nutrition Institute –
assess and plan diets for healthy DOST are:
individuals. 1. Eat a wide variety of foods everyday
a person should choose diff kinds of
Used to support both group and foods from all the food groups to
individuals diet planning. obtain all the impt nutrients needed
by the body. No single food provides
1. RDA – represent calculated nutrient needs all the nutrients the body needs.
for healthy individuals based on age, gender
and life-stage group. 2. Breast-feed infants from birth
It aims to supply an adequate nutrient 4 to 6 mons, and then give
intake to decrease the risk of chronic appropriate foods while continuing
diseases. breast-feeding.
In the PHILS, the 2002 revised edition Exclusive breast-feeding from birth to
of the RDA is now called as 4-6mons is encouraged. Breast-
RENI(recommended energy and feeding may be continued up to 2
nutrient intakes) years or longer.
this is the dietary standard for Complementary food may be given at
Filipinos about 6mons in addition to breast-
E. g Iron females 18 mg/men 8 mg. feeding.
Provides the public about the level of
essential nutrient that must be taken. 3. Maintain children’s normal growth through
proper diet and monitor their growth properly
2. Tolerable Upper Intake Levels/TUL Through weight and height
Refers to the highest amount of monitoring, etc.
nutrient that appears safe for regular
consumption and beyond w/c there is 4. Consume fish, lean meat, poultry or dried
an increase risk of adverse effects. Eg. beans
Vit. A , that can be harmful in large These foods supply not only good
[Link]. Vita A RDA 900 ug TUL 3000ug quality protein and calories but also
iron and zinc(assist in immune
3. EAR – The Estimated Average Req is the function and in growth and dev’t.)
intake level for a nutrient at which the needs of
50 percent of the population will be met. 5. Eat more fruits and veg and root crops.
Because the needs of the other half of the These foods are key sources of
population will not be met by this amount, the micronutrients and dietary fiber that
EAR is increased by about 20 percent to arrive are lacking in the Filipino diet.
at the RDA

25
Nutrition and diet therapy
6. Eat foods prepared w/ edible cooking oil
daily.
Consumption of these foods augment
the need for the calorie deficiency of
the ave Filipino diet.

7. Consume milk and milk products or other

calcium
Rich foods such as small fish and dark
green leafy veg everyday. – these
foods provide the nutrients for growth
like calcium and high quality protein.

8. Use iodized salt, but avoid excessive intake

of salty foods
Iodized salt prevents iodine deficiency
disorder. Excessive salt in the diet may
case HTN.

9. Eat clean and safe foods

To avoid food-borne illnesses

10. Exercise regularly, do not smoke and avoid

drinking alcoholic beverages.
Healthy lifestyle practices are related
to good nutrition.

FOOD GUIDE PYRAMID

My Pyramid contained eight divisions.

From left to right on the pyramid are a
person and six food groups:

Physical activity, represented by a

person climbing steps on the pyramid,
to illustrate moderate physical activity
every day, in addition to usual activity.
The key recommendations for 2005
(other specific recommendations are

26
Nutrition and diet therapy
provided for children and adolescents, Meat and beans, emphasizing low-fat
pregnant and breastfeeding women, and lean meats such as fish as well as
for older adults and for weight more beans, peas, nuts, and seeds
maintenance) are:
There is one other category:
Engage in regular physical Discretionary calories
activity and reduce sedentary represented by the narrow
activities to promote health, tip of each colored band,
psychological well-being, and including items such as
a healthy body weight. (At candy, alcohol, or additional
least 30 minutes on most, food from any other group.
and if possible, every day for
adults and at least 60 FOOD LABELS
minutes each day for children It helps the consumer to select food
and teenagers, and for most w/ less fat, saturated fat, cholesterol
people increasing to more and sodium and more complex CHO
vigorous-intensity or a longer and dietary fiber.
duration will bring greater
benefits.) It appears on all processed foods.

Achieve physical fitness by PARTS OF THE FOOD LABEL

including cardiovascular
conditioning, stretching The Ingredient List
exercises for flexibility, and Must be in descending order of
resistance exercises or predominance by weight.
calisthenics for muscle Knowing that the first ingredient
strength and endurance. predominates by weight, consumer
can glean much information.
Grains, recommending that at least Compare these products for example:
half of grains consumed be as whole A Cereal that contains
grains “puffed milled corn, sugar,
corn syrup, molasses,
Vegetables, emphasizing dark green salt…versus one that contains
vegetables, orange vegetables, and “100% rolled oats.”
dry beans and peas
A canned fruit that contains
Fruits, emphasizing variety and “sugar, apple, water versus
deemphasizing fruit juices one that contains simply
“apples, water.”
Oils, recommending fish, nut, and
vegetables sources In each comparison, consumer can tell
that the second product is the more
Milk, a category that includes fluid nutrient dense.
milk and many other milk-based
products

27
Nutrition and diet therapy
Serving Sizes Trans fat ( grams)
The FDA has established a specific Cholesterol ( milligrams and
serving sizes for various foods and percent Daily Value)
requires that all labels for a given Sodium (milligrams and
product use the same serving size. percent Daily Value)
Total CHO, including, starch,
Standard serving sizes are expressed sugar, and fiber grams (
in both household measurements grams and percent Daily
such as cups and metric measures Value)
such as milliliter, to accommodate Dietary fiber ( grams and
users of both types of measures. percent Daily Value)
Sugars ( grams), including
Consumer need to consider the both those naturally present
quantities accordingly. How the and in those added to the
serving size compares with the actual food
quantity eaten. If its not the same, Protein (grams)
they will need to adjust
And also the percentage of the Daily
Be aware that serving size on food values for Vitamins and Minerals:
labels are not always the same as  Vitamin A
those of the Pyramid  Vitamin C
For example, a serving size of  Iron
rice on a food label is 1 cup,  Calcium
whereas in the Pyramid is ½
cup. It creates now confusion
for consumers trying to
follow recommendations.

Nutrition Facts
the FDA requires the “Nutrition facts”
panel on a label should present
nutrient information

in two ways – in quantities (such as

grams)
and as Percentages of
standards called the Daily
Value or both, for the
following:
Total food energy (kcalories)
Food energy from fat
(kcalories)
Total fat ( grams and percent
Daily Value)
Saturated fats ( grams and
percent Daily Value)

28
Nutrition and diet therapy
TERMINOLOGY the DV for a given nutrient
The FDA has also standardized per serving.
descriptors (terms used by
manufactures to describe products)on Light/lite – must specify
food labels to help the consumer what is referring to (for
select the most appropriate and example, “Light in color” or
healthful [Link] ff are examples: “Lite in texture”).

Low calorie means 40 Kcalorie free - fewer than 5

calories/ less per serving kcal/serving

Calorie free means High fiber - 5g or more

<5cal./serving /serving

Low fat- it has no more than Lean - less than 10g of fat,
3gms of fat /serving or per 4.5g saturated fat and trans
100gms of the food fat combined, and 95mg of
cholesterol/serving and per
Fat free – food contains 100g of meat, poultry and
<0.5gm of fat / serving and seafood
no added fat or oil. Synonyms
include “zero-fat”, “no-fat”, Sugar-free - less than
and “nonfat” 0.5g/serving

Low saturated fat- 1gm or Less fat - 25% or less

less of saturated fat/ serving fat/serving than the
comparison food.
Low cholesterol- 20mg or
less of cholesterol/serving Less cholesterol – 25% or less
than the comparison food
Cholesterol free- less than (reflecting a reduction of at
2mg least 20 mg per serving), and
2 g or less saturated fat and
No added sugar- no trans fat combined per
sugar/sweetener added serving.
during
preparation/packaging Light in sodium - no more
than 50% of the sodium of
Low sodium-<140mg/serving the comparison food.

Very low sodium- Reading Label Lingo

<35mg/serving In addition to requiring that packaged
foods contain a Nutrition Facts label,
Good source of – the product the FDA also regulates the use of
provides b/n 10 and 19% of phrases and terms used on the
product packaging. Here's a list of

29
Nutrition and diet therapy
common phrases you may see on your
food packaging - and what they No salt or salt free: Contains less than
actually mean. 5 mgs of sodium per serving

No fat or fat free: Contains less than High fiber: 5 g or more per serving
½ gram of fat per serving (Foods making high-fiber claims must
meet the definition for low fat, or the
No calories or calorie free: Contains level of total fat must appear next to
less than 5 calories per serving the high-fiber claim)

Lower or reduced fat: Contains at Good source of fiber: 2.5 g to 4.9 g.

least 25 percent less per serving than per serving
the reference food. (An example
might be reduced fat cream cheese, More or added fiber: Contains at least
which would have at least 25 percent 2.5g more per serving than the
less fat than original cream cheese.) reference food

Low fat: Contains less than 3 grams of Daily Values

fat per serving Reference values developed by the
FDA specifically for use on food
Lite: Contains 1/3 the calories or 1/2 labels..
the fat per serving of the original It reflects dietary recommendation for
version or a similar product nutrients and dietary components
that have important relationships w/
Low calories: Contains 1/3 the health.
calories of the original version or a Daily Values (DV) – help consumers
similar product see easily whether a food contributes
“a little” or “a lot” of a nutrient
Sugar free: Contains less than 1/2 It provides an estimate of how
gram of sugar per serving individual foods contribute to the
total diet.
Reduced sugar: at least 25% less sugar It is established for adults and children
per serving than the reference food over 4 y/o. The values for energy
yielding nutrients are based on 2000
No preservatives: Contains no kcal/day, w/c is about right for
preservatives (chemical or natural) moderately active women, teenage
girls and sedentary men. 2500
No preservatives added: Contains no kcal/day is about right for active
added chemicals to preserve the women, many men and teenage boys.
product.

Some of these products may contain CALCULATE PERSONAL DAILY VALUES:

natural preservatives Daily values are designed for a 2000-
kcal (standard) intake but you can
Low sodium: contains less than 140 calculate your personal set of DV
mgs of sodium per serving based on your allowance.

30
Nutrition and diet therapy
Example: a person w/ 1500 kcal/day. The Percent Daily Values are based on
 What percentage of the DV a 2,000-calorie diet for healthy adults.
for energy does your intake
represent? Even if your diet is higher or lower in
 Divide your kcal intake by the calories, you can still use the Percent
DV: Daily Value as a guide. For example,
1500 kcal (your intake) / the Percent Daily Value can help you
2000 kcal (DV) = 0.75% determine whether a food is high or
low in specific nutrients:
 Multiply your answer by 100 to state
it as percentage: If a food has 5 percent or less of a
0.75 x 100 = 75% of the DV. nutrient, it's considered to be low in
that
Sometimes the percentage is more
than 100. Nutrient.

Suppose your daily intake of Vitamin C If it has 20 percent or more, it's

is 120mg and your RDA (male) is 90 considered to be high in that nutrient.
mg.
Note that the Food and Drug
What percentage of the RDA for Administration has not set Daily
Vitamin C is your intake? Values for sugar and trans fat. That's
120 mg (your intake) / 90 mg because experts recommend that
(RDA) = 1.33 Americans cut back on foods with
1.33 x 100 = 133% of the RDA added sugar and solid fats (including
trans and saturated fats). These foods,
And to calculate your goal for fat for such as cakes, cookies, pastries and
example: donuts, are high in calories but low in
1500 kcal x .20% kcal from fat nutrients.
= 450 kcal from fat
To get the most benefit from Percent
To count grams for fat: Daily Values, use them to choose
450 kcal from fat /9 kcal/g foods high in vitamins, minerals and
= 50g fat. fiber — and to limit foods high in fat
and sodium.
What does Percent Daily Value mean on food
labels? NUTRIENT CLAIMS
The Percent Daily Value on the Statements that characterize the
Nutrition Facts label is a guide to the quantity of a nutrient in a food.
nutrients in one serving of food. For
example, if the label lists 15 percent If the product meets specified criteria-
for calcium, it means that one serving example “ good source of fiber”on a
provides 15 percent of the calcium box of cereal or “rich in calcium”on a
you need each day package of cheese, these claims may
be used on labels as long as they meet
FDA definitions, w/c include the

31
Nutrition and diet therapy
conditions under w/c each term can
be used.

Example, a claim that a product

“contains no oil” implies that the food
contains no fat.
 If the product is truly fat-free, then it
may make the no-oil claim, but if it
contains another source of fat, such as
butter, it may not.

NUTRITIONAL PROCESS

32
Nutrition and diet therapy
Diet History Muslims fast between sunrise
 a comprehensive record of eating- and sunset during Ramadan.
related behaviours and foods a person
eat Food preference = spicy
foods, sweetness of sugar
Contents of Diet History of Adults: and the savoriness of salt.
1. Check appetite – good, poor, any High fat foods. curry spices of
factors that affect appetite, taste and Indian cuisine.
smell perception
Habits = choosing food out of
2. Ask for allergies, intolerances or food habit = ex. Eating cereal
avoidances – foods avoided and every morning, bec they
reasons, length of time of avoidances always eat cereals for b-fast.
Eating a familiar food makes
3. Anthropometry – ht, wt, skin-fold, etc. them comfortable

4. Take 24 hour dietary recall or food 6. Evaluate dental and oral health-
frequency checklist problems w/ eating, foods that
cannot be eaten, problems w/
5. Consider ethnic and cultural swallowing, salivation
background – eating habits and food
preferences and religion 7. Consider economic status –income,
People eat the foods they amount of money for food each week
grew up eating. Every or month.= people eat foods that are
country or every region of a accessible, quick and easy to prepare
country, has its own typical and w/ in their financial means.
foods and ways of combining
them into meals. 8. Evaluate physical activity level –
occupation(type, hours/week,shift,
American diet or even energy expenditure), Exercise(type
Filipino diet includes many amount, frequency), Sleep ( hours/day
ethnic foods from diff ,uninterrupted?),handicaps.
countries, all adding variety
to the diet. Ex. Chinese, 9. Determine home life and meal
Italian, Korean, Japanese. patterns – Number in household (eat
together?), person who does
Consider religion = for shopping, person who does cooking,
examples, some religious sect food storage and cooking facilities
forgo meat during lent, the (stove, refrigerator)type of housing
period prior to easter. (home, apartment, room)

Jewish law includes an 10. Assess gastrointestinal conditions –

extensive set of dietary rules problems of heartburn, bloating,
that govern the use of foods diarrhea, vomiting,constipation,
derived from animals. frequency of problems, antacid,
laxative or other drugs.

33
Nutrition and diet therapy
11. Consider presence of chronic disease ANTHROPOMETRIC MEASUREMENT
– treatment, length of tx, dietary  The science of measuring the size,
modification including physician weight and proportions of the human
prescription, date of modification, body.
education, compliance w/ diet.  may reveal a failure to thrive in
children
12. Evaluate recent weight change – loss  It reflects a nutrient deficiencies or
or gain, how much, over what length excesses.
of time, intentional or non-volitional  Includes the ht, wt, head
circumference, upper arm, skin fold
and chest circumference (for
Food Frequency children).
 A record of how often the diff foods
are eaten. The types (and sometimes HEIGHT AND WEIGHT
the amount, its preparation) of foods  useful in determining nutritional
a person routinely consumed in a status in adults
week or a month can be taken.  It is a good indicator of satisfactory
diet and recent food intake.
24-hour recall
 Done by dietician. Listing the types, HEIGHT
amounts and preparation of all foods  Is a less sensitive indicator of current
eaten in past 24 hours nutritional status than weight – for –
age since height does not decrease
Food Diary but simply slows down in times of
 Written record of all food and drink nutrient deprivation.
ingested in a specified period- for
about 3-4 day period. WEIGHT
 But some clients are not truthful and  Is a sensitive marker of current
tend to forget the food they had nutritional status.
eaten.  Reflects an immediate inability to
 may include records of behaviours / meet nutritional requirements and
emotions and symptoms, physical this may indicate nutritional risk.
activities and medications
Medications may decrease ESTIMATING DESIRABLE BODY WEIGHT
the desire of food,absorption  Is also known as Ideal or reference
of nutrients, metabolism of weight but it is more appropriately
nutrients . called the healthy weight.
e.g antihistamines-dec saliva  It is the weight found statistically to
causing dry mouth and loss of be most compatible w/ health
appetite. longevity.
e.g aspirin (controls pain and  Recently, authorities emphasize that
fever and for blood thinning) the most important factor in weight is
– a gram of which increases body composition.
the taste perception of  Thus the term Healthy Weight has
bitterness. replaced Ideal body weight, indicating
that a person’s body composition has

34
Nutrition and diet therapy
a good balance between lean body 2. Moderate Malnutrition – patients w/
mass and fat tissue. wt w/ in 75-84% of usual body weight
= 16-25%
TANNHAUSER’S METHOD
 Procedure: 3. Severe malnutrition – patients w/ wt
 Step 1 : DBW (K) – HEIGHT (CM) – less than 74% of usual body weight =
100 26% wt. losss
 Step 2 : Deduct 10% - if a Filipino
unless frame size is known (either OTHER PARAMETERS OF ASSESSING
med or large) NUTRITIONAL STATUS
 BMI or BODY MASS INDEX
Example:  Or the Quetelet index is a good
Subject: 5’2”female (5’2”- 157.48cm) estimate of the degree of obesity or
Step 1: DBW (K) 157.48cm – 100 = 57.48 kilos amount of total body fat.
Step 2: 57.48 kilos less 5.748(10%) = 51.7 or  It also helps to determine how much
52kg risk people have of developing certain
health problems because of their
CONVERSION AID: weight (e.g. diabetes, heart problems)
1 foot – 12 inches  It can indicate over or under nutrition
1 inch – 2.54 cm  BMI is computed thru METRIC
1 m – 100cm FORMULA

GUIDELINES IN DBW ADJUSTMENTS FORMULA : BMI = W (in kilos)

BUILD ADJUSTMENT DBW Range H (in meters)
SMALL Less 10% of ± 10% of
computed adjusted DBW Constant: 5 ft = 1.524m
DBW
4 ft = 1.2192m
MEDIUM As computed ± 10% of
1 inch = 0.0254m
adjusted DBW
LARGE Add 10% of ± 10% of
computed adjusted DBW Example : H = 5’ 3”
DBW W= 62kgs

ACTUAL BODY WEIGHT 62kg/(1.6)² = 62/2.56 = BMI = 24.22

 weight measurement obtained at the
time of examination INTERPRETATION OF BMI VALUES (ADULTS)
 May be influenced by changes in the IOTF-ASIA PACIFIC GUIDELINES
person’s fluid status. BMI VALUES CATEGORY
< 18.5 Underweight
DESIRABLE BODY WEIGTH USED TO ASSESS ≥ 18.5 – 22.9 Normal Range
DEGREE OF MALNUTRITION ≥ 23.0 Overweight
1. Mild Malnutrition – patients w/ 23.0 – 24.9 At risk
25.0 – 29.0 Obese I
weight w/ in 85-90% of usual body
≥ 30 Obese II
weight = 10-15% wt. loss

35
Nutrition and diet therapy
CLASSIFICATION OF MALNUTRITION IN the most narrow area below the rib
ADULTS BY BMI case above umbilicus.
BMI VALUES CATEGORY
>20 Normal 3. Measure hip circumference at the
18.5 – 20.0 Marginal widest point around the hips or
>17 – 18.5 Mild malnutrition buttocks with the subject standing.
16 – 17 Moderate Malnutrition Read measurement to the nearest
<16 Severe Malnutrtion
0.1cm.

OBESITY CATEGORIES INTO 3 BMI GRADES

Formula for Assessing Body Fat Distribution
1. GRADE I – 25 to 29.9
by WHR
2. GRADE II – 30 TO 40
 WHR = waist circumference (cm)
3. GRADE III – 40+
Hip circumference (cm)

IN GENERAL:
 A WHR of 1.0 or greater in men or 0.8
 OBESITY - IS BMI of 27 or more,
or greater in women is indicative of
indicates high risk of developing
android obesity and an increased risk
health problems – weight 20% above
for obesity-related diseases. This also
average.
appears to be true in children.

 UNDERWEIGHT – BMI less than 18.5 –

 GYNOID “ pear-shaped”people, store
10 to 15% below ave OVERWEIGHT -
more fat in the buttocks, thighs and
BMI between 25-29 – 10 to 20%
hips.
above ave.

 ANDROID “apple-shaped” people,

 HEALTHY – BMI between 18.5 – 24.9
carry their extra fat around the
abdomen/upper body-.
BMI TEND TO INCREASE WITH AGE
 WAIST – TO – HIP RATIO
 The WHR may partially explain the
 Waist to hip ratio (WHR) is a valuable
difference in high blood pressure
indicator of body fat distribution and
between men and women. Men are
adiposity. It is also a valuable guide in
more likely to be “apples” and women
evaluating health risk (heart disease,
to be “pears”. Men have higher rates
diabetes, etc.)
of HTN and more complications.
 Alternatively it is called
abdominal/gluteal ratio or abdominal
Waist Circumference
girth measurement.
 Waist circumference serves as a
marker of abdominal fatness. Waist
Obtaining Correct Measurement:
circumference alone has been
1. Use nonstretchable tape measure (in
considered a valid indicator for both
centimetre)
men and women.
2. Subject should stand erectly,
abdominal muscles relaxed, arms at
 Interpretation: women with a waist
the sides, and feet together. The
circumference greater than 35 inches
measurer faces the subject and places
and men with waist circumference
the tape measure. Measure waist at
greater than 40 inches have high risk

36
Nutrition and diet therapy
of central obesity-related health ASSESSMENT BY BIOCHEMICAL TEST
problems.  Includes various blood, urine, saliva
and stool test.
SKINFOLD THICKNESS – Assess body  According to Dellova, it provides
composition, fat distribution and reserve information on protein balance, vit,
calories by using a calliper (Harpenden or mineral, and fluid status, body
lange) composition, organ function and
Sites: metabolic status.
 Triceps- commonly used  According to roth = a deficiency/
 Biceps toxicity can be determined by
 Below the scapula laboratory analysis of the samples.
 Above the iliac crest  These test allow detection of
 Upper thigh malnutrition before signs appear.
If it is more than 1 ½ inches
– over wt. MOST COMMONLY USED TEST FOR
If less than ½ inch – under NUTRITIONAL EVALUATION
wt.
BLOOD TEST
ASSESSMENT BY CLINICAL METHOD  Serum Albumin Level – measures the
 Clinical assessment of nutritional main protein in the blood and is used
status deals basically with the to determine protein status -3. 5 – 5.0
examination of changes that can be g/dl or 35-50g/L
seen or felt in superficial tissues such
as the skin, hair and eyes.  Serum Transferrin Level
indicates iron-carrying
 In other words, its the physical protein in the blood
observation or assessment. Transferrin is a glycoprotein
that binds and transport iron.
 In here, signs of nutrient deficiency Most is produced in the liver.
are noted and some nutrient If result is below normal
deficiency diseases are observed such there would be hepatic
as; failure, nephrosis, cachexia (
severe malnutrition and body
 Scurvy = lack in vit C = numerous black wasting by chronic diseases.)
and blue spots on the skin
 Blood Urea Nitrogen (BUN)
 Rickets = lack of Ca and vit D= poorly Increased level may indicate
shaped bones and teeth renal failure, insufficient
renal blood supply or
 Iron deficiency/anemia(children blockage in the urinary tract,
beyond 6 mons.) = lack in iron = dehydration and GI bleeding.
pallor. 2.9 – 8.9 mmol/L

 Dehydration = loss of water= sunken

eyeballs, dry mucous membranes,
thirst, etc.

37
Nutrition and diet therapy
 Creatinine Excretion – indicates the STOOL EXAM
amount of ceatinine excreted in the  Direst Stool Exam – stools check for
urine over a 24 hour period and can weight ( greater than normal weight
be used in estimating body muscle suggest malabsorption ) and checked
mass. for oily materials ( excess fat in stool
Low creatinine excretion – suggest steatorrhea).
indicative of muscle mass
depletion, as in malnutrition.  Chemical analysis of fecal fat- fecal
fat greater than 7g/day when the diet
 Serum Creatinine – indicates the includes 100 g of fat/day indicates
amount of creatinine in the blood and malabsorption.
is used for evaluating renal functions.
-N.V. 60-132 mmol/L  Serum Calcium – low levels seen in
-↑= acute/chronic renal calcium and vit. D malabsorption,
insufficiency, urinary tract (recall that steatorrhea can lead to
obstruction. calcium and vit [Link].

 Hgb- women-12-16g/dl,men-14-  D-xylose test – test of CHO

18g/dl absorption.
Hct – women – 42-52%,men- 37-48%
decreased level would mean  Schilling test – identifies vit B₁₂
anemia malabsorption.

 Lipid Profile – for clients w/ heart URINE TEST

abnormalities  Creatinine - ↑ - muscle wasting,
starvation and cachectic status,
 Total Serum Cholesterol – less than hyperthyroidism and febrile status.
200 mg/dl ↓- hypothyroidism, renal
insufficiency
 HDL – more than 35mg/dl Men – 0-50 mg/24 hour
Women – 0-100 mg/24hour
 LDL – less than 130mg/dl
 Calcium - ↑- hyperparathyroidism,
 Serum Triglycerides – 2.9 – 8.9 elevated serum calcium
mmol/L or less than 200mg/dl 50-150mg/24 hr. Or 1.05 –
1.3 mmol/L
 Uric Acid, serum or plasma – men – 3-
99mg/dl, women – 2.5-7.7mg/dl  Urinalysis – can detect protein and
-High- gout, toxemia of pregnancy, sugar in urine(indicative of kidney
leukemia, polycythemia,renal disease and diabetes)
insufficiency, down’s syndrome,
glycogen storage disease. SUMMARY: After obtaining all the info needed
-Low – occasionally in acute hepatitis. or after all the steps / methods used are
evaluated together. The dietician has the
opportunity to make an accurate nutritional
assessment of the client. Whereby a proper

38
Nutrition and diet therapy
treatment and management on the medical  It is an electrolyte whose primary
condition of the client will be implemented. function is the maintenance of fluid
balance in and out of body cells in the
MINERALS body.
 It is an inorganic element that is  It is found most in body secretions
necessary for the body to build like, saliva, gastric &amp; intestinal
tissues, regulate body fluids or assist secretions, bile and pancreatic fluid.
in various body functions. What body secretions we can see
 They are found in all body tissues. sodium?
 They can’t provide energy by
themselves but in their role as body Functions:
regulators, they contribute to the  Necessary for the regulation of water
production of energy w/in the body balance within the body,the passage
 They are found in water and in natural of substances in and out of each cell,
foods, together w/ proteins, CHO, Fats and the maintenance of a normal
and vitamins. body pH.
 The specific mineral content of food is  Also plays a role in the generation of
determined by burning the food and normal electrical nerve signals, muscle
then chemically analyzing the contraction, and the regulation of
remaining ash. blood pressure.
 Helps muscles and heart to relax/for
MINERALS are divided into Two Groups: the regulation of muscle and nerve
irritability
1. Major Mineral  Involved in the transmission of nerve
 They require amounts greater than impulses
100mg/ day.  Essential for the production of
 Also known as macrominerals hydrochloric acid in the stomach
 Major minerals include: Sodium,  It controls the extracellular fluid and is
Potassium, Calcium, phosphorus, essential for osmosis. What is
Magnesium, Chloride and Sulfur. osmosis?

2. Trace Elements Sources:

 w/c needed in amounts smaller than  Primary dietary sources of sodium is
100mg/day table salt w/c is 40% sodium
 Also known as microminerals  It is naturally available in animals
 Trace elements include: Iron, Iodine, foods.
Zinc, Selenium, Copper, manganese,  It is present in fruits and vegs, milk,
Fluoride, Chromium and Molybdenum meats
 and even drinking water(softenend
Sodium water-high Na content than hard
 It is always found as a compound w/ water)
other elements in nature, such as  It is added to condiments and other
common salt. foods and can be listed in food
 It is found mainly in blood plasma and ingredient label as sodium, sodium
in the fluids outside the body cells. chloride, monosodium glutamate
(MSG), sodium nitrite, sodium

39
Nutrition and diet therapy
bicarbonate (baking soda) and sodium Excess: may cause edema
benzoate.  And excess sodium is frequently
 It is added to commercially prepared associated w/ CVD such as Htn and
foods by controlling growth of CHF- more Na means more water
microorganism reabsorbed in the kidneys. More
water means increased
Deficiency or Excess:  Blood volume and inc BP.
 Either deficiency or excess of sodium
causes upset in the body’s fluid Hypernatremia may occur
balance, drawing water and potassium  too much Na in the blood, Serum Na
out of the cells where it is needed to above 145mEq/L
maintain electrolyte balance.  Excess Na in the ECF-bec the osmotic
pressure of ECF is high, fluid moves
Deficiency out of the cells into the ECF- cells
 Can occur after severe vomiting(too become dehydrated.
much acid is lost during this condition  Causes: by insensible loss (Insensible
and tetany would result due to losses can neither be perceived nor
alkalosis), diarrhea or heavy measured directly. You’ve lost it, but
perspiration w/c dehydration can you don’t know that you’ve lost it
result (and, of course, you do not know how
 It can also upset the acid-base balance much you have lost...)
in the body. Cells functions well in a
neutral or slightly alkaline medium e. g. hyperventilation/fever, water from feces
 Athletes can lose so much sodium and (can’t be measured but it is estimated to be
drink so much water that they between 40 cc and 600 cc in an adult under
develop Hyponatremia-too little Na in normal circumstances)
the blood.
 Hyponatremia – is a sodium deficit/ S/S:
serum Na level of less than 135 mEq/L  dry sticky mucous membrane, tongue,
bec of Na’s role in red dry swollen, weakness
determining the osmolality of  Sensible loss is loss that can be
ECF, water is drawn out of perceived by the senses and can be
the vascular compartment measured. If you&#39;ve lost it, you
into interstitial tissues and know you’ve lost it!
cells.  e.g. urine, vomitus, increased sensible
Causes: gastrointestinal fluid fluid loss thru diarrhea
loss, sweating and use of
diuretics Chloride
S/S: lethargy, confusion,  The element Chlorine is a poisonous
apprehension, muscle gas. When chlorine reacts with
twitching. Abd’l cramps, sodium or hydrogen, however, it
anorexia, N&amp;V, forms the negative chloride ion.
headache, seizure and coma. Chloride is an essential nutrient,
required in the diet.

40
Nutrition and diet therapy
Functions: Potassium
1. Major anion of the ECF, where it  Like a sodium, potassium is a
occurs mostly in association w/ positively charged ion. In contrast to
sodium sodium, potassium is the body’s
2. Helps maintain fluids and electrolyte principal cation inside the body cells.
balance
3. Chloride is a part of hydrochloric acid Functions:
and its is necessary for proper 1. Essential part of every cell in the body
digestion and required for normal growth.
2. Also involved in the release of energy
Sources: from food,
 Table salt seafood tomatoes rye olives 3. For the synthesis of protein
4. For the regulation of water balance in
RDA: the body,
 Chloride is abundant in processed 5. For proper nerve impulse transmission
food 6. For skeletal and smooth muscle
 The proportion of chloride in salt is contraction,
greater than sodium, whereby its 7. For regulation of blood pressure and
recommendations are slightly higher for steady heartbeat.
than sodium
 Salt (Sodium chloride) is about 60% Sources:
chloride  Potassium rich fruits and veg appears
 5g salt = 1tsp to reduce the risk of stroke
 1tsp salt contributes 3000mg chloride  Potatoes
 peaches
 Adults : 19-50y/o = 2300mg/day  avocado
51-70y/o= 2000mg/day  spinach
Above 70 y/o = 1800mg/day  banana
 mushrooms
Upper Level  tomato
 Adults: 3600 mg/day  dried fruits
 peach adzuki and lima beans
Deficiency and toxicity.  raisins
 Diets rarely lack chloride  wheat bran
 Deficiency occurs during Chloride  dairy products
losses.
 High blood chloride concentration is Deficiency
caused by dehydration due to water  Potassium deficiency is the most
deficiency common electrolyte imbalance due to
 Toxicity symptom – vomiting excessive losses than by deficient
intakes.
 Conditions such as diabetic acidosis,
dehydration, or prolonged vomiting or
diarrhea can cause deficiency
 And even in taking diuretics, steroids
and strong laxatives

41
Nutrition and diet therapy
 Hypokalemia- Earliest symptom 4. Required for synthesis of protein for
deficiency is muscleweakness growth and repair of cells and tissues,
 Other symptoms – fatigue, muscle including nucleic acids (DNA and RNA)
spasm, abnormal heart rhythm. 5. Needed to make phospholipids, such
as phosphatidylcholine, that are
Toxicity structural components of cell
 It can result from over consumption of membranes
K salts, supplements ( including some 6. Helps the body utilize the B-complex
energy fitness shakes) vitamins
 Given more potassium than the body 7. needed for heart muscle contraction
needs, the kidneys accelerate their and to regulate heartbeat
excretion. 8. Supports proper muscle and nerve
 Hyperkalemia - Technically, function
hyperkalemia means an abnormally 9. Helps maintain normal acid-base (pH)
elevated level of potassium in the balance in the body by acting as an
blood The normal potassium level in important buffer
the blood is 3.5-5.0 milliequivalents 10. maintains calcium balance and helps
per liter (mEq/L). prevent hypercalcemia (high blood
calcium levels)
RDA: 11. Maintains kidney function
 K is abundant in all living cells, both 12. Potassium and sodium phosphate
plants and animals. taken orally are FDA-approved for use
 AI: need to increase intake of fruits to help prevent or treat calcium-
and veg. to 5-9 servings/exchanges based kidney stones in people with
daily. hypercalciuria (high urine calcium
levels) or those with calcium oxalate
Phosphorus stones; avoid if stones are phosphate-
 Second most abundant minerals in the based
body. And a major mineral found 13. FDA-approved for treating occasional
mostly in bones and teeth. About 85% constipation, and to restore bowel
of it is found in combination w/ function after surgery
calcium in the hydroxyapatite crystals
of bones and teeth. Sources:
 Meat
Functions:  Poultry
1. Main role is in binding with calcium to  fish
form healthy bones and teeth  eggs
2. needed for metabolism of  milk
carbohydrates and fats to produce  milk products
energy  nuts
3. important for production of ATP  legumes
(Adenosine Tri Phosphate), the  cereals
molecule that the body uses to carry  grains
energy  chocolate
 lettuce
 tomato

42
Nutrition and diet therapy
RDA: As noted in the Journal of the
 Diets that provide enough energy and American Medical Association, such
protein also supply adequate patients need to avoid foods high in
phosphorus. phosphorus and especially fast foods
 Adult: 700mg/day and soft drinks.
 UL: 19-70y/0= 4000mg/day
3. Too much phosphorus can cause
Deficiency: serious electrolyte imbalances. It
 A reduced concentration of draws calcium out of bones and
phosphate in the blood serum is a weakens them, leading to brittle
disorder known bones.
as hypophosphatemia .
 Phosphorus deficiency may cause Excess calcium and phosphorus
bone diseases such as rickets in together may result in harmful
children and osteomalacia in adults. calcium deposits or calcification, in
An impsroper balance of phosphorus soft tissues such as the lungs, heart,
and calcium may cause. muscles, eyes, blood vessels, and
especially the kidneys.
Toxicity:
1. Excess phosphorus can cause Calcium
hyperphosphatemia or high blood  Calcium is the most plentiful mineral
phosphate levels. found in the human body. The teeth
and bones contain the most calcium.
A common reason for this is, over- Nerve cells, body tissues, blood, and
consumption of foods high in other body fluids contain the rest of
phosphorus, such as canned, the calcium.
processed, or fast foods, or soft  Adults absorb about 25% of the
drinks. Many of these have calcium they ingest. Pregnant about
phosphates added to extend shelf life 50% and growing children 50-60%.
or enhance flavors, especially in baked  Vitamin D helps in the absorption of
products, cheeses, meats, and drinks. calcium, deficiency of this may impair
its absorption also the fiber, in
A deficiency in calcium or magnesium general, and the binders phytate and
may lead to excess blood phosphate. oxalate interfere with its absorption.
 The stomach’s acidity helps to keep
2. At the same time, high levels of calcium soluble, and vitamin D helps
phosphorus interfere with calcium to make calcium-binding protein
uptake, which, if coupled with a low needed for absorption(This explains
calcium diet over a long period, why milk is the best food for Vitamin
increases the risks of bone density D fortification)
loss, hypertension, and bowel cancer.

Hyperphosphatemia can also occur in

people with impaired kidney function.

43
Nutrition and diet therapy
Function Deficiency:
1. Calcium helps form and maintain  A low calcium intake during the
healthy teeth and bones. growing years limits the bone’s ability
2. Proper levels of calcium over a to reach their optimal mass and
lifetime can help density
prevent osteoporosis .  Most people achieve a peak bone
3. Clotting blood mass by their late 20’s
4. Sending and receiving nerve signals  Adults lose bone as they grow older,
5. muscle relaxation and contraction beginning between the ages of 30-40
6. Releasing hormones and other  May result to Osteoporosis-a disease
chemicals in w/c the bones become porous and
7. Keeping a normal heartbeat fragile due to a loss of minerals, also
called adult bone loss.
Sources:  Hypocalcemia – low levels of calcium
 Milk in the blood. It can cause by vit. D
 Milk products deficiency and magnesium.
 Calcium fortified  And with problems in their
 orange juice parathyroid glands - , diet and kidney
 part-skim disorders &amp; drugs such as
 ricotta cheese rifampin, anticonvulsants,
 yogurt corticosteroids.
 cocoa  Also results when too much calcium is
 sardines lost in urine or when not enough
 clams calcium is moved from bones into the
 oysters blood
 turnip greens  Symptoms –
 mustard greens  Calcium Tetany- char. By
 broccoli uncontrolled muscle
 legumes contraction, caused by lack of
 dried fruit vitamin D and abnormal
secretion of the regulatory
RDA: hormones.
 A cup of milk provides abt. 300mg of
calcium  Chronic deficiency is caused
 Adults need between 1000 and 1200 by poor absorption over the
mg/day or 3-4 cups of milk years, depletes the savings
 1000mg÷300mg/cup= 3 ½ account in the bones.
cups
 1200mg÷300mg/cup= 4 cups Toxicity:
 14-18 y/o pregnant &amp;  Too much calcium supplements intake
lactating- 1300mg/day for a long period of time raises the risk
 19-50y/o pregnant &amp; of kidney stones
lactating – 1000mg  Getting too much calcium can cause
constipation. It might also interfere
with the body&#39;s ability to
absorb iron and zinc.

44
Nutrition and diet therapy
 Hypercalcemia - Hypercalcemia is a Magnesium
condition in which the calcium level in Sources:
your blood is above normal. Too much  Nuts and seeds
calcium in your blood can weaken  Legumes
your bones, create kidney stones, and  green vegetables
interfere with the way your heart and  tofu
brain works.  wheat germ
 cereal grains
 Hypercalcemia most commonly  soybeans
results from overactive parathyroid  chocolate
glands. These four tiny glands are  blackstrap molasses
each about the size of a grain of rice  corn
and are located on or near the thyroid  peas
gland.  carrots
 seafood
 Other causes of hypercalcemia include  brown rice
cancer, certain other medical  parsley
disorders, some medications, and  lima beans
excessive use of calcium and vitamin  spinach
D supplements.
Functions:
 Calcium rigor – with blood calcium 1. Essential in hundreds of biochemical
above normal. Muscles contract and reactions and a wide range of
can not relax metabolic activities including the use
of energy and the metabolism of
Calcium Balance: carbohydrates, lipids, proteins, and
 Whenever calcium falls too low or genetic material.
rises too high, three (3) organ system 2. Together with calcium it is necessary
respond: the intestines, bones and for proper nerve transmission,
kidneys. contraction of muscle, blood clotting,
BP regulation
 Vitamin D, parathormone and 3. For the conversion of Vitamin D to its
calcitonin return blood calcium too active form.
normal. 4. Helps prevent dental caries by holding
calcium in tooth enamel
 Parathormone/parathyroid hormone 5. For functioning of the lungs and
– a hormone from the parathyroid normal functioning of the immune
gland that regulates blood calcium, by system.
raising it when levels fall too low
RDA:
 Calcitonin - a hormone from the  Adult men 19-30 y/o – 400mg/day
thyroid gland that regulates blood  Women 19-30 y/o – 310mg/day
calcium by lowering it when levels rise
too high.

45
Nutrition and diet therapy
SULFUR FUNCTIONS
 The body does not use sulfur as 1. Because ferrous iron can be oxidized
nutrient. It is a major mineral that to ferric iron and ferric iron can be
occurs in essential nutrients such as B reduced to ferrous iron, iron can serve
vitamin thiamin and the amino acids as a cofactor to enzymes involved in
methionine and cysteine. oxidation-reduction reactions.
 Cofactor = a subs that works
 Sulfur plays a well-known role in w/ an enzyme to facilitate
determining the contour of protein chemical reaction.
molecules.
2. It is also required by enzymes involved
 Skin, hair and nails contain some of in the making of amino acids,
the body’s rigid proteins, which have a collagen, hormones and
high content of sulfur. neurotransmitters.

 There is no RDA for sulfur and no 3. Critical in making new red blood cells,
deficiencies are known. Only when immune defense cells, white blood
people has a severe protein deficiency cells, and normal brain function.
will they lack the sulfur-containing
amino acids. Iron is found in two (2) proteins
1. Hemoglobin in the red blood cells- it
TRACE MINERALS is the oxygen- carrying protein that
 Are so named bec. they are present transport oxygen from the lungs to
and needed in relatively small the tissues throughout the body. It
amounts in the body. Altogether, they accounts for 80% of the body’s iron.
would produce only a bit of dust,
hardly enough to fill a teaspoon. 2. Myglobin in the muscle cells – the
oxygen-holding protein of the muscle
 Deficiency and excess is equally cells
fatal/deadly. People’s diet normally  Iron absorption depends
supply enough of these minerals to partly on its source.
maintain health.  Iron occurs in 2 Forms:

Iron Sources:
 Exemplifies the principle that both too 1. Heme Iron – found in food. From the
little and too much of a nutrient in the flesh of animals such as meat, fish,
body can be harmful. poultry
 it has an iron about 10% from
 To support health optimally, one food/day but it is absorbed
should eat enough iron containing well that accounts abt 25% of
food. heme iron.

 It has Two (2) Ionic state: 2. Nonheme Iron – found in both plant-
1. Ferrous iron (reduced) fe++ derived and animal- derived
2. Ferric iron (oxidized) fe+++ foods.17% is absorbed by the body as
nonheme iron.

46
Nutrition and diet therapy
 MFP factor  Consuming vitamin C with iron rich
(meat,fish,poultry)- not only foods will help increase absorption)
as well-absorbed heme iron  Soybeans
but also a factor that  pumpkin seeds
promotes absorption of  dried fruits
nonheme iron from other  enriched and/or whole-grain breads
foods eaten at the same and cereals
meal.
Iron Deficiency: most common nutrient
HEME – the iron-holding part of the deficiency affecting 1.2 billion people.
hemoglobin and myoglobin proteins. About
40% of the iron in meat, fish, poultry is bound IDA
into heme, the other 60% is nonheme iron.  Half of the population of preschoolers,
pregnant and school children in the
Factors that enhance Nonheme iron US have this condition.
absorption:  It is sevre depletion of iron stores that
1. MFP factor results in low hemoglobin and small,
2. Vitamin C (ascorbic acid) pale rbc.
3. Citric acid and lactic acid from foods  It is a microcytic hypochromic anemia
and Hcl acid from stomach  Anemias that impair hemoglobin
4. Sugars (including sugars in wine) synthesis is called microcytic.
 S/S weakness, fatigue,
Factors that inhibit Nonheme iron absorption: headaches, pale skin,
1. Phytates and fibers (grains and veg.) nailbeds, mucous
2. Oxalates ( spinach, beets, rhubard) membranes and palm
3. Calcium and phosphorus (milk) creases. Concave nailbeds,
4. EDTA (food additives) inability to regulate temp.
5. Tannic Acid (and other polyphenols in
tea and coffee.) Stages of life that are prone or high risk to IDA
1. Women in their reproductive years
Sources: bec of repeated menstrual losses.
 meat (provides iron in the heme form 2. Pregnancy – due to high demands of
which is the easiest for the body to iron that support the added blood
absorb) volume, growth of the fetus and blood
 blackstrap molasses loss during childbirth.
 clams 3. Infants and young children, bec they
 oysters receive little iron from their high-milk
 tofu diets
 legumes 4. Iron content of Blood is about 0.5
 nuts and seeds mg/dl
 red meats 5. A person donating a pint of blood
 dark green leafy vegetables (about 500ml) losses about 2.5mg of
(Vegetables provide iron in the non- Iron.
heme form, which is harder for the
body to absorb.

47
Nutrition and diet therapy
Stages of Iron Deficiency: Functions:
1. Iron stores diminish 1. Essential for proper growth of skin,
2. Transport iron decreases hair, and nails, healing wounds, and a
3. Hemoglobin production declines. healthy immune system.
2. Necessary in many chemical reactions
TOXICITY: and for a normal sense of taste and
 Hemochromatosis- iron overload, smell.
caused by a genetic disorder that 3. Also functions as a detoxifier of the
enhances iron absorption body
 Hemosiderosis – excess iron that 4. And plays a role in the metabolism of
characterized by large deposits of the carbohydrates.
iron storage protein hemosiderin in
the liver and other tissues. DEFICIENCY:
 S/S – apathy, lethargy and fatigue, GI 1. Severe growth retardation and
distress, joint pain, organ damage, arrested sexual maturation are the
skin pigmentation, infections. char. Of zinc deficiency
2. Hinders digestion and absorption
RDA: causing diarrhea that worsens
 Adult male 8mg/day malnutrition
 Women 19-50 y/o – 18mg/day 3. Impairs immune response making
51 + - 8 mg/day infections likely ( GI)
 UL for adults 45mg/day 4. Damages CNS and brain lead to poor
motor dev’t. and cognitive
Zinc performance
Sources: 5. Impairs vit . A metabolism – vit. A
 Significant sources – protein-containig deficiency appear.
foods: red meats, 6. Distubs thyroid function and
 shellfish, whole grains metabolic rate
 oysters 7. It alters taste, causes loss of appetite
 wheat germ and slows would healing
 beef 8. Snake like rash
 liver
 dark meat of turkey and chicken TOXICITY:
 peanuts  High dose (50-450mg) may cause
 whole grains vomiting, diarrhea, exhaustion and
 miso other symptoms
 legumes
 sunflower seeds RDA:
 blackstrap molasses  Adults Men – 11mg/day
 green peas Women – 8 mg/day
 spinach  UL – adults – 40mg/day
 broccoli

48
Nutrition and diet therapy
Iodine Sources:
 Traces of the iodine ion (called  Iodized salt
iodide). Are indispensable for life.  saltwater seafood
 It is called as iodine when it is referred  sunflower seeds
to the nutrient in foods and iodide  mushrooms
when referring to it in the body.  eggs
 beef
FUNCTIONS:  liver
1. Iodide is an integral part of the thyroid  peanuts
hormones that regulate body temp,  spinach
metabolic rate, reproduction, growth,  pumpkin
blood cell production, nerve and  broccoli
muscle function.  chocolate
 kelp
DEFICIENCY:
Simple Goiter – an enlargement of the thyroid RDA:
gland due to an iodine deficiency, malfunction  Adult – 150 mcg/day
of the gland or overconsumption of a  UL – 1000mcg/day
goitrogen.
 The earliest and most obvious sign of Copper
iodine deficiency  The body contains about 100mg of
 Causes poor performance in the copper. It is found in variety of cells
school for children and tissues
 A severe deficiency during pregnancy
causes extreme and irreversible Functions:
mental and physical retardation is 1. Critical component of the outer
known as Cretinism. coating of nerve fibers, collagen, and
 Examples of Goitrogen-containing used in the production of skin
Foods: pigments.
 cabbage, spinach, radishes, 2. Also works with iron to make healthy
rutabagas red blood cells.
 soybeans, peanuts 3. Two copper and –zinc containing
 peaches,strawberries enzymes participate in the body’s
natural defense against free-radicals
TOXICITY: Sources:
1. Can enlarge the thyroid gland  Liver
2. Can damage the developing infant –  Shellfish
esp from supplements.  whole grains
 An infant exosed to toxic  mushrooms
amounts during gestation  cherries
may develop a goiter so  legumes
severe as to block the  cocoa
airways and cause  nuts
suffocation.  eggs
 muscle meats fish
 poultry

49
Nutrition and diet therapy
DEFICIENCY: Sources:
 Is rare but in Menkes Disease, the  grains
intestinal cells absorb copper but can  seeds
not release it into circulation, causing  potatoes
a life-threatening deficiency.  meat
 S/S anemia, bone abnormalities  poultry
 fish
TOXICITY:  garlic
 May cause liver damage  brewer yeast
 wheat germ
RDA:
 Adult -900mcg/day RDA: Adults – 55 mcg/day
 UL – 10,000 mcg/day (10mg/day) UL – Adults 400 mcg/day

Selenium Chromium
Functions: Functions:
 Important antioxidant that works with 1. Necessary for blood sugar regulation
vitamin E to protect the body from and enhances insulin action
free-radical damage. It is also 2. for metabolism of fats and
associated with fat metabolism, a carbohydrates.
healthy immune system, and
important to male fertility. Sources:
 Wheat germ
DEFICIENCY:  brewer yeast
 Is associated with heart disease that is  peas
prevalent in the regions of CHINA  chicken
where the soil and food lack of  corn oil
selenium. Cause by virus, but  mushrooms
selenium deficiency appears to  prunes
predispose people to it and adequate  nuts
selenium seems to prevent it.  asparagus
 It is called the Keshan Disease – char  organ meats
by enlargement and insufficiency;  whole-grain bread and cereals
fibrous tissue replaces the muscle
tissue that normally composes the Deficiency: diabetes like condition
middle layer of the walls of the heart.
Toxicity: none reported
TOXICITY:
 Causes loss and brittleness of hair and RDA: Men 35 mcg/day
nails, garlic breath odor, and nervous Women 25 mcg/day
system abnormalities, fatigue,
irritability, CNS disorders

50
Nutrition and diet therapy
Manganese Molybdenum
 The human body contains a tiny 20mg Sources:
of manganese. Most of it can be found  milk and milk products
in the bones and metabolically active  soybeans
organs such as liver, kidneys and  lentils
pancreas.  pasta
 buckwheat
Functions:  oats
 Needed for normal utilization of  rice
several other vitamins, and a variety  wheat germ
of other biochemical roles in the body.  sunflower seeds
It also aids in proper fat metabolism,
skeletal and connective tissues, Functions:
production of energy, making  Important in many biochemical
cholesterol and DNA, proper brain reactions, aids in the metabolism of
function, and processing blood sugar. iron, helps prevent gout by removing
uric acid from the body, and helps the
Sources: body burn fat. It is also part of healthy
 Wheat bran bones, teeth, kidney, and liver, and
 Legumes helps the body use its iron reserves.
 nuts
 lettuce AI: 45 mcg, fulfilled with balanced diet
 leafy green vegetables
 blueberries Fluoride
 pineapple Functions:
 seafood 1. Involved in the formation of bones
 poultry and teeth
 meat 2. Reduces dental caries and may
 tea minimize bone loss by helping the
body retain calcium.
Deficiency: Rare
Sources:
Toxicity: CNS disorders  water is the best source (fluoridated
water)
RDA: Men 2.3mg/day Women – 1.8mg/day  mackerel
 sardines
 salt pork
 salmon
 shrimp
 meat
 sunflower
 seeds
 kale
 potatoes
 watercress
 honey

51
Nutrition and diet therapy
 wheat  parsley
 tea  soy
 corn
Deficiency: dental caries  olives
Toxicity: Flourosis – discoloration and pitting
of tooth enamel caused by excess fluoride Functions:
during tooth development  Research has not documented exactly
what vanadium does for the body. It is
RDA: men 3.8mg/day women 3.1mg/day likely that it plays a role in energy
UL adults 10mg/day production, biochemical reactions,
blood sugar and fat metabolism, and
Nickel bone and teeth strength.
Sources:
 nuts Arsenic
 legumes Sources:
 shellfish  Most foods contain less than 0.3ug/g
 cocoa products seafood is the richest source
 green beans
 spinach Functions:
 rice  Precise function in the body is still
 tea unknown, but it is likely that it plays a
role in the metabolism of
Functions: phospholipids.
 Important in many biochemical
reactions, and thought to play a role Boron
in the metabolism of fats and blood Sources:
sugar regulation.  Fruits
 Vegetables
Silicon  Legumes
Sources:  Nuts
 whole grains
 root vegetables Functions:
 unrefined cereal products  Required for normal bone integrity.

Functions: WATER
 Needed for healthy body tissues.  Water serves as the solvent

Vanadium ROLES AND FUNCTION IN THE BODY

Sources: 1. Component of body weight
 Shellfish a) 60% of body wt in adult
 Spinach b) Newborns have a larger
 Parsley percentage of water in the
 Mushrooms BW and therefore are more
 whole grains likely to be affected by
 dill seeds changes in the diet and water
 black peppe balance.

52
Nutrition and diet therapy
c) 2/3 of body water is  The entire system of cells and fluids
intracellular and 1/3 is remains in a delicate but firmly
extracellular 25% of fluids maintained state of dynamic
outside the cell is w/in the equilibrium(reversible chemical
blood vessels(intravascular ) reactions with a velocity of the same
while the 75% is in between directions)
the cells (interstitial space)-  Imbalances such as DHN and water
included is water in CSF. IOF. intoxication can occur, but the body
GI secretions and bone, etc. quickly restores the balance to normal
if it can
2. Transport and participant in chemical  The body controls both water intake
reactions and excretion.
a) Water will freely move (by
osmosis) to equalize solute FLUID INTAKE
concentration in the body to  Is supplied to the body via 3 routes by:
maintain balance.  Ingestion of fluids (Oral
b) Chemical reactions in the fluids);
body exist in fluid medium  From preformed fluid of
foods esp. fruits and
3. Carries nutrients and waste products veg.(solid food) and
throughout the body  From the production of water
during metabolism of energy
4. Participates in metabolic reactions nutrients (metabolic water).

5. Serves as the solvent for minerals, Metabolic water - for every 100 gms of fat,
vits, amino acids, glucose and many CHO and CHON, the estimated water produced
other small molecules. is abt. 107 ml, 55 ml. and 41ml., respectively.

6. Aids in maintaining the body’s BP and Fluid excretion – fluids in the body may find its
temp. way out through
 formation of urine (by the kidneys),
7. Maintains blood volume  part of the feces (via GIT),
 thru breathing (via lungs),
8. Acts an s a lubricant and cushion  and sweating (via the skin)
around joints, inside the eyes, spinal
cord and amniotic sac surrounding a WATER INTAKE REGULATION
fetus in the womb.  The body can survive for only a few
days w/o water. In healthy people,
To support these and other vital functions, the thirst governs water intake.
body actively regulates its water balance.  Thirst is finely adjusted to ensure a
water intake that meets the body’s
WATER BALANCE needs.
 The cells themselves regulate the  When the blood becomes too
composition of fluids w/in and concentrated (having lost water but
surrounding them. not salt and other dissolved subs.).the
mouth becomes dry and the brain

53
Nutrition and diet therapy
center (known as hypothalamus) AI for total water
initiates drinking behavior. Men – 3.7L/day
 With aging, thirst sensation may Women – 2.7L/day
diminish. DHN can threaten elderly *1L = 1 qt. = 32 oz. = 4 cups
people who do not develop the habit
of drinking water regularly. FLUID AND ELECTROLYTE BALANCE
 When mineral salts dissolve in water,
WATER EXCRETION REGULATION they separate (dissociate) into
 Water excretion is regulated by the charged particles known as ions, w/c
brain and the kidneys. can conduct electricity. For this
reason, a salt that dissociates in water
 The cells of the brain’s hypothalamus is known as an electrolyte.
w/c monitor blood salts, stimulate the
pituitary gland (its in the brain and  The body fluids w/c contain water and
known as the “king Gland” w/c partly dissociated salts, are electrolyte
regulates the operation of all the solutions.
other glands in the body) to release
anti-diuretic hormone (ADH-a  The body’s electrolytes are vital to the
hormone released by the pituitary life of the cells and therefore must be
gland in response to high salt closely regulated to help maintain the
concentrations in the blood. The appropriate distribution of body
kidneys respond by reabsorbing fluids.
water).Whenever the salts are too
concentrated or the blood volume or  The major minerals form salts that
blood pressure is too low, ADH dissolve in the body fluids; the cells
stimulates the kidneys to reabsorb direct where these salts go; and the
water than excrete it. movement of the salts determines
where the fluids flow because water
 Thus the more water you need, the follows salt.
less you excrete.
 Cells use this force to move fluids back
The enzyme rennin – released by the kidneys and forth across their membranes.
in response to low BP, aids in the kidneys in Thanks to the electrolytes, water can
retaining H20 thru the rennin- angiotensin be held in compartments where it is
mechanism. needed.
Water Amoun Water losses Amoun
sources t t  Proteins in the cell membranes move
Liquids 550- Kidneys(urine 500- ions in or out of the cells. These
1500 ) 1400 protein pumps tend to concentrate
Foods 700- Skin(sweat) 450-
sodium and chloride outside the cells
1000 900
and potassium and other ions inside.
Metaboli 200- Lungs(breath) 350-
c H20 300 500
GI tract 150  By maintaining specific amounts of
(FECES) sodium outside and potassium inside,
Total 1450- TOTAL 1450- cells can regulate the exact amounts
2800 2800

54
Nutrition and diet therapy
of water inside and outside their  Of these organ systems, the kidneys
boundaries. play the primary role in maintaining
acid-base balance, as well as its F&E
 Healthy kidneys regulate the body’s balances.
sodium, as well as its water, with
remarkable precision. SUMMARY
 Water makes up about 60 percent of
 The intestinal tract absorbs sodium the body’s weight
readily, and it travels freely into the
blood.  Water helps transport nutrients and
waste products throughout the body,
 But the kidneys excrete unneeded participates in metabolic reactions,
amounts. acts as a solvent, assists in
maintaining blood pressure and body
 The kidneys actually filter all of the temperature, acts as a lubricant and
body needs to retain. cushion around joints.

 Thus the body’s total electrolytes  To maintain water balance, intake

remain constant, while the urinary from liquids, foods and metabolism
electrolytes fluctuate according to must equal losses from kidneys, skin,
what is eaten. lungs and feces

 Sudden loss of F&amp;E – vomiting,  Electrolytes help maintain the

diarrhea, heavy sweating, fever, appropriate distribution of body fluids
burns, wounds- require medical and help to maintain acid-base
intervention. balance as well.

ACID – BASE BALANCE VITAMINS

 The body uses ions not only to help  Are subs that your body needs to
maintain water balance, but also to grow and develop normally.
regulate the acidity (pH) of its fluid  Formerly called “ACCESORY FOOD
FACTORS”
 Like proteins, electrolyte mixtures in  The missing subs he named VITAMINE
the body fluids protect the body was coined from:
against changes in acidity, by acting as  VITA- necessary for life
buffers – substances that can  AMINE – denoting that anti
accommodate excess acids or bases. beri-beri factor containing
nitrogen
 The body’s buffer system serve as a
first line of defense against changes in VITAMIN E
the fluid’s acid-base balance.  Adults should get between 400-800 IU
of vitamin E daily. When looking for a
 The lungs, skin, GIT and kidneys supplement the preferred form has
provide other defenses. mixed tocopherols (this should include
d-alpha, d-beta, d-gamma, and d-delta
tocopherols) and w/ tocotrienols (it

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Nutrition and diet therapy
inhibits propagation of existing breast Vitamin B3 - Niacin
CA).  The body can easily convert nicotinic
acid to nicotinamide, which is the
DEFICIENCY major form of niacin in the blood.
 Hemorrhagic disease in newborn
Vitamin B5- Pantothenic acid
TOXICITY  Part of coenzyme Involves in the
 Kennicterus – a condition resulting energy metabolism, synthesis of
from the accumulation of bile lipids,amino acid metabolism and
pigments in the gray matter of the glycogen synthesis.
CNS.  Pantos = everywhere
 Hemolytic anemia- caused by  It is readily destroyed by freezing,
increase destruction of erythrocytes- a canning and processing
frequently fatal type occurs in infants
as a result of RH incompatibility w/ Vitamin B9- Folic acid
the mother’s blood.  (synthetic form found in fortified
cereals and supplements)
VITAMIN C  Also called Folate/ folacin (natural
RDA: form found in food)
 men- 90 mg/day:  Easily destroyed by heat and oxygen.
 women- 75mg/day;
 smokers- +35mg/day Significant Sources:
 Upper Level: adults – 2000mg/day  Fortified grains, green leafy
vegetables, legumes, seeds, liver.
Thiamin
Sources:  Folate deficiency symptom is anemia,
 lean pork- richest source char by large, immature RBC(due to its
large size and oval shape, they cant
Deficiency carry oxygen or cant travel thru the
 Beriberi – prolonged thiamin capillaries as efficiently as normal
deficiency. beri means weakness. S/s: RBC)
damage to heart and other muscles
and in nervous [Link] of beri-  Megaloblastic anemia / macrocytic
beri, wet, w/ edema and dry, w/ anemia {Large immature red blood
muscle wasting. cell anemia},

Riboflavin  Anemia = literally “too little blood”. A

 Can be destroyed by UV light and condition in w/c it has too few RBC
irradiation w/c are immature or too small or
 Stable to heat contain too little hemoglobin to carry
 Does not destroy in cooking the normal amount of oxygen to the
tissues.
Sources:
 milk and milk products are the best
sources

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Nutrition and diet therapy
Toxicity:
 folate from food alone appears to
cause no harm.
 Excess folate from fortified foods or
supplements, however, can reach high
enough levels to obscure{nakakubli or
it mask} vit B 12 deficiency.

RDA: adult- 400mcg/day

Upper Level – 1000 mcg/day

VIT. B12 COBALAMINE

Deficiency:
 Most vit B12 deficiencies reflect
inadequate absorption, not poor
intake.

 Inadequate absorption typically

occurs for 1 or 2 reasons: a lack of
hydrochloric acid or lack of intrinsic
factor. W/o hydrochloric acid, the
vitamins is not released from the
dietary proteins and so is not available
for binding w/ the intrinsic factor.
W/o the intrinsic factor, the vit B12
cant be absorbed.

 Even if people will stop eating foods

rich in vit B12 just like in the case of
vegetarians, may take several years to
develop deficiency symptom, about 2-
3 years.

Deficiency disease
 Pernicious Anemia ( a blood disorder
that reflects a vit B12 deficiency
caused by lack of intrinsic factor and
char. By abnormally large and
immature redblood cells}.

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