Concepts Of Nutrition

Concepts of Nutrition

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BASIC NUTRITION TERMS 

Macronutrients: carbohydrates, proteins, & fats (kcalorie sources)

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Kcalorie (kcal): energy or amount of heat required to raise 1 kg water 1 degree Celsius

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Micronutrients: vitamins, minerals, phytochemicals, and water

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Nutrient density: amount of micronutrients in relation to the amount of macronutrients

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Nutrition: the science of how the body uses food for energy, maintenance, and growth

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Terms continued: 

Malnutrition: undernourished, as in vitamin deficiencies; or over-nourished, as in obesity

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Medical nutrition therapy: nutritional therapy provided by a registered dietitian with application of science of nutrition and food choices to achieve or maintain optimal health and well-being

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HEALTH CARE TEAM 

Health care provider: MD or nurse practitioner and, in some areas, physician’s assistant; can prescribe

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Nurse: RN, LPN, CNA

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Social worker

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Physical therapist

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Occupational therapist

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Registered dietitian or licensed, certified nutritionist

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Others: speech-language pathologist, pharmacist

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Assessment and Counseling Strategies 

Assess Needs in Three Realms: 1) Cognitive: assess an individual’s nutritional knowledge and fallacies related to health needs; assess whether an auditory or visual learner; check reading ability and level of terminology needed 2) Affective: attitudes toward nutrition and health 3) Psychomotor: nutritional behaviors

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Use Good Interviewing Strategies 

ACTIVE LISTENING: nonjudgmental and openended line of questioning: – “How do you feel about ______?” – “Can you tell me more about _____?”

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I versus YOU STATEMENTS: less threatening and final; promotes clarification of your statements: – “It sounds to me like ____” versus “You are _____”

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Determine Learning Readiness 

Assess learning stage: – Is the problem recognized by the individual? – If so, have pros and cons of change been considered? – If individual has tried or made changes to deal with the health problem, what has worked and what hasn’t? – Is the individual ready to try again or to learn more advanced skills or knowledge?

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Counseling Strategies 

Base nutritional advice on individual needs, learning style, and learning readiness; provide options that may work for the individual

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Avoid an authoritarian approach; suggest, don’t tell

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Include the individual in the decision-making process; use active listening to verify that plans are realistic and appropriate for the individual

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Use personal examples or experiences of others only to convey empathy or strategies that may work

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Refer to other health professionals or disciplines as needed and appropriate

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Effective Nutrition Care Starts with Good Communication and Rapport Development

Figure 1-1 Effective nutrition care starts with good communication and rapport development.

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Consider How Dietary Patterns Develop and Change 

What are the biopsychosocial factors that influence an individual’s food choices and habits?

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Can adverse factors be modified to promote positive health?

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Follow-up assessment at a later date may best reveal these adverse factors as rapport is established between the client and counselor and attempts at change have been tried.

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Consider How Dietary Patterns Develop and Change-cont’d 

Consider internal forces: biologic factors and emotions re food choices and habits

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Consider external forces: environmental and social factors

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Assess Cultural Food Habits 

Is there frequent eating at fast-food restaurants with burgers, fries, and soda pop, or pizza slices from a deli store? – Is this due to convenience or preference?

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Does the family eat sitting down together, or separately in front of the television, in other rooms such as the bedroom, or in front of the computer? – Is this a positive environment with quiet conversation, or noisy with the television on or family arguments happening? – Is there a “clean the plate” philosophy?

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Are home-cooked meals emphasized? – Meat, potato, and vegetable type of meals or casseroles? – Are ethnic foods prepared? – Are convenience foods frequently used at home? – Do individual family members prepare their own meals? 21

Biopsychosocial Health Concerns 

Bio – includes physical problems that affect nutritional intake and health, such as effect of high blood sugars on health (loss of eyesight or kidney damage) or food allergies

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Psycho – includes the psychologic effect of emotions on nutritional intake and health (e.g., the emotions experienced by an individual who has been diagnosed with diabetes— depression may occur that leads to overeating or undereating or sweets being used as rewards or comfort)

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Social – includes the effect of regional, cultural, ethnic, and religious dietary habits (e.g., holiday foods or lack of access owing to local food availability) on the control of health issues such as diabetes

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Findings of NHANES (National Health and Nutrition Examination Surveys 1971-2000) 

Adults and adolescent girls increased their average kcal intake

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Eating away from home has increased

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Larger portion sizes of foods and beverages are being consumed

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Sweetened beverage intake has increased

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Examples of Traditional Ethnic Eating Habits 

French: small portions, slowly paced eating, emphasis on vegetables

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Mediterranean: emphasis on “beans & greens” and olive oil, low intake of meats, sweets limited to special occasions, salads served after main meal

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Asian: soybean products and/or tofu, high intake of rice, vegetables, and fish, low intake of desserts, sesame and peanut oil emphasized

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SLOW FOOD MOVEMENT Began in 1980s in recognition that the many diverse food varieties and flavors are being replaced by a few foods with standardized flavors

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Vegetarianism 

Lacto-ovo-vegetarians (include milk and eggs) – easiest to meet nutritional needs

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Lacto-vegetarians (include milk but not eggs)

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Vegans (avoid all animal-based foods) – most difficult to meet nutritional needs*

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All vegetarians benefit from intake of legumes, nuts, seeds, and whole grains to ensure adequate protein intake

*Vegans require vitamin B12 supplement and need a vitamin D source if there is inadequate sunlight. Calcium is difficult to obtain, and individuals may need supplementation.

*Monitoring serum B12 levels advised; monitoring homocysteine levels may also be appropriate. 26

Possible Reasons for Practicing Vegetarianism 

RELIGIOUS: Seventh-day Adventists, Hindus, Muslims – Helps adherence to kosher diet, where meat and milk products not served at the same meal

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SOCIAL: to support other family members and friends, for environmental reasons, or because of animal rights issues

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HEALTH: – (+) Goal aimed at reduced heart disease with foods high in fiber and low in saturated fats – (-) May be rationale given for masking an eating disorder, especially with a vegan diet

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Balance, Variety, Moderation 

“ALL FOODS CAN FIT”

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Occasional intake of high-fat, high-sugar foods can be part of a healthy diet

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Regular intake of high-fat, high-sugar foods is acceptable if portions are small

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Variety of foods best ensures adequate intake of nutrients needed for health

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A balanced meal includes at least three of the food groups (e.g., grain + vegetable or fruit + protein source or milk product)

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History of Food Guides 1940s – Seven food groups: included butter (for a vitamin D source); science of nutrition rapidly developed as result of World War II and recognition of lack of military fitness from malnutrition in many young men who grew up during the Great Depression of the 1930s  1950s – “Basic four” food groups: composed of bread, vegetables and fruits, dairy, and meat or protein  1990s – The food guide pyramid: the foundation of the diet (base of the pyramid) is plant-based; meat portrayed in smaller section; fats and sugars form the smallest part of the diet (tip of the pyramid)  2005 – The MyPyramid food guidance system: aimed at individualizing food guidance through the interactive website www.MyPyramid.gov, with physical activity being promoted in the new symbol 

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2005 MyPyramid.gov

Unn Figure 1-1 MyPyramid food guidance system.

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2005 MyPyramid.gov

Unn Figure 1-1 MyPyramid food guidance system. 31

Food Labels 

Revised in the early 1990s to include percent-daily values based on 2000 kcal reference diet

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Percentages based on 30% total fat, 10% saturated fat, 60% carbohydrate, minimum of 50 g protein, with 25 g/day recommended fiber and 2400 mg/day sodium

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Marker nutrients (vitamins: A and C, and minerals: calcium and iron); 100% intake of these nutrients, as found naturally in foods, promotes good intake of other needed nutrients found in conjunction

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2006 Food labels now include trans fatty acid content of foods 32

Figure 1-4 Reading the food label. CHO, Carbohydrates; PRO, protein. 33

Dietary Guidelines for Americans 

1980 – the Public Health Service of the Department of Health and Human Services and the USDA published the first guidelines

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Changes are made every 5 years; revisions generally have been written to be more positive (e.g., what to do vs what not to do)

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2000 guidelines, “Aim for Fitness, Build a Healthy Base, and Choose Sensibly,” included a total of 10 strategies

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2005 dietary guidelines for Americans very similar to the 2000 guidelines, with more specific guidance to include at least three whole grains daily and increase fruits and vegetables to 4½ cups for adults; the MyPyramid Food Guidance System reinforces the revised dietary guidelines

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2005 Dietary Guidelines for Americans

Figure 1-5 Dietary guidelines for Americans for good health. 35

The Food Exchange System 

A food guide originally developed by the American Diabetes Association and the American Dietetic Association for diabetes management

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Generally no longer advised for diabetes management, but useful to recognize the macronutrient content of foods (carbohydrate, protein, and fat)

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Appendix 3 shows the latest food exchange system

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Summary 

Good nutritional status requires the appropriate intake of all essential nutrients for health (the science of nutrition)

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Knowledge of nutritional needs is important, but the “art” of good nutritional intake is related to the biopsychosocial needs of the individual

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