Nutrition & Diet Therapy

NUTRITION
 is the science of food and nutrients, their action and interaction, in
the relation to providing the body withe necessary substances to
maintain homeostasis.
 Nutritional imbalance impacts the health maintenance and disease
prevention and is essentialfor growthand optimal bodily fuction.

FOOD
 Is any substance, ORGANIC or INORGANIC, when ingested or eaten,
nourishes the body by BUILDING AND REPAIRING TISSUES, SUPPLYING
HEAT AND ENERGY, REGULATINNG BODY PROCESSES.
 According to the DFA (Food and Drug Administration), food includes
articles used as drink or food, and the articles used for the
component of such.

FOOD QUALITY
1. It is safe to eat
2. It is nourising or nutrious
3. Its palatability factors (color, aroma, flavor, texture,etc.) satisfy the
costumer.
4. It has safety value
5. It offer varriety and planned within socio-economical context
6. It is free from toxic substance

NUTRIENT
 Is a chemical component needed by the body achieve health
Three General Functions:
1. To provide energy (FUEL NUTRIENTS)
2. To build and repair tissueds (BODY BUILDING)
3. To regulate life processes (REGULATORY)

HEALTH
• State of compplete physical, mental and social well being and not
merely the absence of disease or infirmity (WHO) 1948
DIETITIAN
• Professional trained to assess nutrition status and recommend
appropriate diet therapy

NUTRITIONAL STATUS (NUTRITURE)
• Is the condition of the body resulting from the utilization of essential
nutrients.
A. Optimum or Good Nutrition - the body has an adequate supply of
essential nutrients that are efficiently utilized and maintained in
highest possible level.

B. Malnutrition - POOR NUTRITION (mal meaning “ BAD”)
can be either NUTRITIONAL DEFICIENCY or OVERNUTRITION and
HYPERVITAMINOSIS.
1. Primary - Faculty diet both in quantity and quality
2. Secondary - multiple and include all conditions within the body that
reduce the ultimate supply of nutrients to the cell after he food
goes beyond the mouth.

NUTRITIONAL ASSESSMENT
• A process of determining an individual nutritional status and the
nutritional deficiencies affecting health and wellness.

METHODS OF NUTRITIONAL
ASSESSMENT
A- ATHROPOMETRIC DATA
B- BIOCHEMICAL TEST
C- CLINICAL EXAMINATION
D- DIET ASSESSMENT

ATHROPOMETRIC DATA
• Determination of height , weight and body composition measurements

BODY MASS INDEX
• The nurse may calculate BMI by:
Body wt (Kg) or Body wt (lb) X 703.1
ht 2 in meters ht 2 in inches

BODY COMPOSISTION
MEASUREMENTS
• Waist circumference: smallest area below the ribcage and above the
umbilicus; measurements >40 for men and >35 for women are risk
factors for disease.

SKIN FOLD THICKNESS - measures
subcutaneous fat storages and is
an index of total body fats. For
men 11.3mm, for women
14.9mm. They use calipers of
other tools.

MID ARM CIRCUMFERENCE (MAC) - measures muscle mass and
subcutaneous fat.
MID ARM AND MUSCLE CIRCUMFERENCE (MAMC) - measure index of
muscle mass and indicates somatic protein stores
NOTE: both measures caloric status or energy reserves.
Measurement Standard 90%
MAC men: 29.3cm
women: 28.5
men: 26.4 cm
women: 25.7 cm
MAMC men: 25.3 cm
women: 23.3 cm
men: 22.8 cm
women: 20.9 cm

acsites commonly seen for patient with liver disease
(liver cirrhosis)

Gangrenous feet as a complication of
diabetes mellitus

BIOCHEMICAL TEST
A. Albumin - CHON deficiency due to liver and renal diseases, burn,
malnutrition etc.
• Edema, ascites
• Muscle wasting will accur (cachexia)
• Wounds heal very slowly
• People may lose appetite, strength anf weight
• Mental retardation

B. Creatinne Height index - 24 hours urine collection
C. Transferrin - reflects CHON status of patientb
 liver damage, renal disease, acute and chronic infection or cancer
 iron deficiency anemia

D. Hemoglobin (Hgb)
- Hemoconcentration (dehydration), polycythemia
- iron deficiency anemia, hemorrhage, CHO deficiency, overhydration.
E. Hematocrit (Hct) - same with Hgb
F. Renal Binding CHON

G. Total Lymphocyte (Leukocyte) count
BASOPHILS - Fights parasituc infection
EOSINOPHILS - Fights allergic and parasitic reaction
NEUTROPHILS - Fights pyogenic infection
LYMPHOCYTES - Fights viral infections
MONOCYTES - Fights severe infection

CLINICAL EXAMINATION
Signs of nutrient deficiencies are noted; physical observation
PALE - Iron, copper, zinc, B12, B6,and Biotin
EDEMA - Protein
Bumpy “ gooseflesh” Vitamin A

Lesions at the corner of the mouth - Riboflavin
Glossittis - Folic Acid
Numerous “ Black and blue sports” - vitamin C
Emaciation - CHO, CHON and calories
Poorly shape bones - vitamin D
Slow clotting time - vitamin K
Tetany - Calcium
Goiter - Iodine
Eczema - Fat

• Direct observation and nutrients analysis: can be used only in controlled
settings; doesnt represent usual intake; calorie count fall into this
category
• Food record or diar: prospective; asks client to complete a survey about
food intake over a speciefic time period
• 24 hours recall: retrospective tool; asks client about food intake during
the previous 24 hours

METABOLISM
• Is the use of food as fuel that will be converted to energy
TWO PARTS:
1. CATABOLISM - is the BREAKDOWN of complex substances into simpler
ones, resulting energy.
2. ANABOLISM - is the SYNTHESIS of simple substances into complex
substances. Provides energy for tissue growth, maintenance and repair

6 BASIC
NUTRIENTS
• Carbohydrates
• Protein
• Fats
• Vitamins
• Minerals
• Water

CARBOHYDRATES (CHO)
• Originally known as saccharides, a Greek word, meaning sugar.
• These are organic compounds composed of carbon,hydrogen, and
oxygen.
• Source of “ INSTANT ENERGY”
CHEMICAL NATURE:
• Ratio of hrdrogen to oxygen is 2:1
• CHO

CLASSIFICATION OF CARBOHYDRATES
A. COMPLEXITY - number of sugar unit
1. Monosaccharides - simple sugar (ones sugae unit)
• Glucose - also known as dextrose, grape sugar, and physiologic sugar.
• Fructose - also known as fruit sugar or levulose sweetest of all sugar.
• Galactose - also known as milk sugar. An impportant of the brain and
nerve tissue.
• Sugar alcohols - examples are mannitol and sorbitol.
• Pentose - (ribose ang ribulose) - meat and seafood

2. Disaccharides - composed of two monosaccharides (one of which is
glucose)
• Sucrose - also called as cane sugar, beet sugar, and table sugar.
• Maltose - also called as malt sugar because it is derived from the
digestion of starch with the aid of the enzyme, DIASTASE, found in
sprouting grain
• Lactose - also called as milk sugar - necessary in calcium absorption and
production of bacteria that is necessary in vitamin K production in the
intestines. LAXATIVE EFFECT.

3. Polysaccharides - complex carbohydrates, composed of many sugar
units.
• Starch - most abundant and cheapest, found primarily in plant foods.
• Dextrin - formed from the partial hydrosis of starch.
• Glycogen - called as animal starch - the staorage form of carbohydrates
in the body ( LIVER and MUSCLES)

Function of Carbohydrates
1.ENERGY SOURCE
-yields 4 kilocalories of energy.
-Protein sparring
-60% of diet (50-100 grams)
2.Helping to burn fat more efficiently and completely.
3.Aiding in normal functioning of thr intestines.(fiber)
4.Providing laxative action and aiding in the absorption of calcium.(lactose)
5.Cerebrosides- galactose and glucose.

TRACKING THE
GLUCOSE PATHWAY
Carbohydrate Digestions
Glycolysis
Glucose
Pyruvate
Addition of o2 Aceytal CoA
Krebs Cycle
Addition of o2
and Emzyes
ENERGY+H20
Co2
Aceytal CoA

1.Digestion-
carbohydrates should be in
the simplest forms.Begins in
the mouth.Fibers are not
digested.
Amylase CHYME
Periltasis
Small Intestine
Maltase Sucrase Lactase
Maltose Sucrose Lactose
Monosacchrides

2.Absorption
takes place in the
intestinal mucosa.
3. Metabolism
Takes place in the liver
conserves and releases
glucose.
Manosacchrides
Intestinal
Mucosa
Soluble fibers slow
the absorption of glucose
Some starch and fibers
(insoluble) are streached
in feces
LIVER (Portal Vein)
Maltose and
Sucrose
Lactose
Glucose
Insulin
Glucagon
Energy

Food Sources
Principal source: Plant foods
• Cereal grains
• Vegetables
• Fruits
• Nuts
• Sugars
The only substantial animal sources of the carbohydrates is Milk.

Fiber- polysacchrides
A. Soluble- dissolves in water and forms a gel. Reduce serum cholesterol
level.
Sources- Fruits,vegetables, oats, legumes, and grain psyllium.
A. Insoluble- Doesn't dissolve in water. Increases fecal bulk and decrease
free radicals in thr GI tract.
SOURCES: bran layers of cereal grains.

Fantastic Fiber Facts
1. Preventing and relieving constipation-insoluble.
2. Prevening colon and recal cancer-insoluble.
3. Reduce cholesterol-soluble.
4. Aiding weight management-insoluble.
5. Decreasing blood glucose-soluble.

Protein
• Comes from thefreek word proteinos meaning to hold
or is the prime importance.
• This are complex organic compounds composed of
amino as a building units by a peptide bonds.
Chemical Nature:
NH2
H－C－COOH
R

Classifications of Amino Acids
ESSENTIAL NON-ESSENTIAL
ARGININE* PHENYLALANINE ALANINE GLUTAMINE
HISTIDINE* THREONINE ARGININE* GLYCINE
ISOLEUCINE TRYPTOPHAN ASPARAGINE HISTIDINE*
LEUCINE VALINE ASPARTIC ACID PROLINE
LYSINE
CYSTEINE SERINE
METHIONINE GLUMATIC ACID TYROSINE
Amino Acids
*ESSENTIAL DURING CHILDHOOD ONLY.

CLASSIFICATION OF FOOD PROTEINS
COMPLETE INCOMPLETE
AMINO ACIDS Conatains all 9 amino acids. Contains come amino acids.
SOURCES Animal proteins.
*Soy is the only plant source.
Plant proteins.
BIOLOGIC VALUE High Biologic Value.
Supports growth and life.
Low biologic value.
Cannot support growth and life.
EXAMPLE Casein.(Milk)
Albumin(egg white)
Legumes,grains, nuts and seeds.

Complimentary Proteins
-Two incomplete
proteins combined
to make a complete
protein.
Examples:
1. munggo and rice.
2. soybean and wheat.
3. soybean and nuts
4. peanut butter and sandwich
5. cereal and milk
Grains
Seeds
Dairy
Products
Legumes

Functions of Proteins
1. Structional Role-
build and repair tissue.
-1/5 or 20% of an adult body weight is protein.
1/3 is in the muscles; 1/5 is in the bones and teeth.
1/10 is in the skin, and e rest in in the body fluids and
tissues.

2. Fuel Nutrient - Supplies energy.
-1 gram of protein supplies 4 kcal.
-10-15 %of diet.
3. Regulator of the Physiologic Processes.
-regulates osmotic pressure.(plasma proteins)
-Maintaining a normal pH of the body.
-Hemoglobin and myoglobin, lipoproteins, insulin and
epinephrine, anti bodies and interferron, thromblin and digestion.

Kwashiorkor
Marasmus
Hair color Change-
Reddish color hair.
Old man's face.
Dry,Dull hair.
Moon face.
No Edema.
Fatty liver and/or
mocitis
Thin muscle.
Thin fat.
Thin muscle with edipose
tissue.
Edema.

Dietary Requirement
The average adult's daily requirement to be 0.8 gram of
protein each kilogram of the body weight.
1. Divide body weight by 2.2( the number of pounds
per kilogram)
2. Multiply the answer obtained in the step 1 by 0.8
(gram of protein per kilogram of the body weight.)

Fats and other Lipids
- Are organic compounds that dissolves in alcohol and other solvents
but don't dissolve in water.
-It is composed of carbon, hydrogen, and oxygen, in glyceride
linkage.
Chemical Nature:
CnH2nO2 or CH3(CH2)－COOH

CLASSIFICATION OF FATS
1. Visible Fats- used and purchased as fats.
-cooking oil -lard
-salad dressing -margarine
-butter -animal fats
2. Invisible Fats- not immediately noticeable.
-egg yolk -milk
-olives -avocado

Triglycerides
A. Salurated Fats(SFA)- animal source LDL bad. Not more 10% of diet.
Attributed to cancer and ATHEROSCLEROSIS.
H H H
l l l
H-C-C-C-OH
l l l
H H H
-Originate from animal source.
-Remain solid at room temperature.
-Hight melting points.
-are less likely to become rancid.
- meat, poultry, full fat dairy products,
palm and coconut.

B. Unsaturated
-plant source HDL good.
H H H
l l l
H-C-C=C-OH
l l l
H H HH H H
l l l
H-C-C=C-OH
l l l
H H H
-Originate from plant fat and oils.
-Are soft or liquid at room temperature.
-Have lower melting points.
-Can be rancid when exposed to light and
oxygen.
MUFA- vegetable oil such as olive ,canola
and peanut butter.
PUFA- nuts and vegetable oil such as
sunflower, safflower, and
soybean oils and fish oil.

Phospholipids
-phosphate group plus lipids.
-eggs, peants, and livers.
Sterols
-The most common type is CHOLESTEROL.
-Can be either ENDOGENOUS and EXOGENOUS.
-Ergosterol and calciferol.

CHOLESTEROL• Choleserol is a f-like substance found in some foods of animal origins.
• Cholesterol is also produced by the liver.
A. HDL Cholesterol
-good cholesterol(protects against heart disease)
B. LDL Cholesterol
-bad cholesterol causes plaque build up ,clogs
arteries,restricts the supply of the oxygenated
blood to the heart which can result in a heart
attack.

Cholesterol has several important functions.
-It's a vital component of bile salts.
-It's an essentail part of cell membranes.
-Necessary in the production of several
hormones, including cortisone,
adrenalin ,estogen and testosterone.

Functions of Fat
1. Concentrated source of energy-yields 9 calories per gram of
energy. Should be 25-30% of your diet.
2. Storage form of energy.
3. Protects and cushions vital organs in the body.
4. Carrier of fat solutable vitamins- ADEK
5. Sparer of Proteins, Thiamine and Niacin.
6. Lubrication- Sebaceous glands.

Digestions- begins in the mouth
mouth and stomach.
However true digestion
of fats begins in the
DUODENIUM.
DUODENUM
CHOLECYSTOKININ
GALL BLADER(BILE)
EMULSIFIES FAT
TRIGLYCERIDE
PHOSPHOLIPIDS
CHOLESTEROLUNALTERED
PHOSPHORUS AND
FATTY ACIDS
MONOGLYDERIDE, FATTY
ACIDS AND GLYCEROL
PANCREATIC
LIPASE
A
B
S
O
R
P
T
I
O
N

•95% of ingested fats are ingested.
•Allowable daily intake.
•7% saturated fats.
•8% polyunsaturated fats.
•15% monunsaturated fats.

Metabolism- controls by the liver. It hydrolyzes
triglycerides and forms new ones from this
hydrolysis as needed.
-Metabolism occurs in the cells , wehere
fatty acids are broken down to carbon dioxide
and water releasing energy.

Ketones> Energy
Fat is used as a fuel
source
Ketosis
Acid-Base
Acidosis
COMA

SOUCES OF FATS
Top Five source of Saturated Fats:
1.Beef
2.Butter or margarine
3.Salad dressings(mayonnaise)
4.Cheese
5.Milk

VITAMINS
AND
MINERALS-
for life

Vitamins
- Was originrated by Casimir Funk in 1912.
- vitamine-vita -necessary for life and amine- an antiberi
-veri factor contained nitrogen.
- Are organic compounds of carbon, hydrogen, oxygen
and occasionally, nitrogen and other elements that are
needed in small quantities.

Classification of Vitamins
• Water soluble- are absorbed directly into the
bloodstream and move freely within the cells .
They must be consumed in the diet.
• Fat soluble- are absorbed with fat into the lymphatic
system, and the bloodsteam. They attached into
the lipoproteins to be transported.

Water Soluble: Fat Soluble
1. Vitamin B1 (Thiamine) 1. Vitamin A (Retinol)
2. Vitamin B2 (Riboflavin) 2. Vitamin D (Calciferol)
3. Vitamin B3 (Niacin) 3. Vitamin E
4. Vitamin B6 (Pyridoxine) (Tocopherol)
5. Vitamin B12 (Cobalamin) 4. Vitamin K
6. Vitamin C (Ascorbic) (menadione)
7. Biotin
8. Folate (Folic Acid)
9. Pantothenic acid

FAT SOLUBLE FUNCTIONS DEFICIENCY TOXIC FOOD SOURCE
VITAMIN A RETINOL
1UG
-MAINTENANCE OF VISION
IN DIM
-GROWTH OF HAIR, NAILS ,
BONES AND GLANDS AND
EPITHELIUM.
-PREVENTS INFECTION
-NIGHT BLINDNESS
-XEROPHTHALMIA OR
BITOT'S SPOT
-RETARDED GROWTH
-TOAD SKIN
(PHRYDEDERMA)
-RESPIRATORY
INFECTION
-FETAL
MALFORMATION
-HAIR LOSS (ALOPECIA)
-SKIN CHANGES
-BONE PAIN
ANIMAL
-LIVER
-DAIRY PRODUCTS
-DILLS
-TAHONG
-FISH LIVER OIL
PLANT
-DARK GREEN AND YELLOW ORANGE
FRUITS AND VEGABLES.
VITAMIN D
CALCIFEROL 5UG
-CALCIUM AND
PHOSPHORUS ABSORPTION
-BONE MINERALIZATION
-PREVENTION OF TETANY.
-RICKETS (CHILDREN)
-OSTEOMALACIA
(ADULT)
-HYPOCALCEMIA
-OSTEOPOROSIS
-GROWTH
RETARDATION
-KIDNEY DAMAGE AND
STONES
-DEPOSITS IN SOFT
TISSUE
-HYPERCALCEMLA
ANIMAL
-DAIRY PRODUCTS
-EGG YOLK
-FISH LIVER OIL
PLANT
-NONE

XEROPHTHALMIA
AND
BITOT'S SPOT

FAT SOLUBLE FUNCTIONS DEFIENCY TOXICITY FOOD SOURCE
VITAMIN E
TOCOPHEROL
-ANTIOXIDANT
PREVENTS CELL
DAMAGE AND RBC'S
-RED BLOOD CELL
AND NERVE
DESTRUCTION
(HEMOLYSIS)
NONE ANIMAL
-NONE
PLANT
-VEGETABLES OIL
-NUTS AND SEEDS
-WHOLE GRAIN
VITAMIN K
MENADIONE 120
UG (MEN)
90 UG (WOMEN)
-BLOOD CLOTTING
CLOTTING FACTORS
10, 9, 7, 2
-HEMORRHAGE
(NEWBORN)
- PROLONGED BLOOD
CLOTTING
(ADULTS)
-HEMOLYTIC AMENIA
-KENICTERUS
ANIMALS
-LIVER AND MILK
-GREEN LEAFY
VEGETABLES
(BROCCOLI AND
CABBAGE)

WATER SOLUBLE FUNCTIONS DEFICIENCY TOXICITY FOOD SOURCE
VITAMIN B1
THIAMINE
1.1Mg(FEMALE)
1.2Mg(MALE)
-MUSCLE NERVE
FUNCTION
-CHO METABOLISM
-MAINTAINS GOOD
APPETITE
EARLY STAGE
-LOSS OF APPETITE
-COSTIPATION SECONDARY TO
GASTRIC STONY
LATER STAGE
-BERI-BERI
WET EDEMA ON LOWER
EXTREMETIES, CHF, ASCITES.
DRY PERIPHERAL NERVE ARE IN
PINS AND
NEEDLES.PARESTHESIA, TOE,
AND WRIST DROP.
WERNICKES-KORSOKOFF-
SYNDROME-
THIAMIN DEFIENCY IN
ALCOHOL.
-NONE ANIMAL
-MEATS
-FISH
PLANT
-GRAINS
-CEREALS
-GREEN LEAFY
VEGETABLES

VITAMIN B2
RIBOFLAVIN
1.1Mg(FEMALE)
1.3Mg (MALE)
ESSENTIAL FOR CHO,
CHON, COOH
METABOLISM
ARIBOFLAVI NOSIS,
CHELLOSIS,
GLOSSITIS,
SEBORRHEIC,
DERMATITIS,
PELLAGRA.
WHEN GIVEN BY
INJECTION
ANIMALS
-MEATS
-FISH
PLANTS
-GRAINS
-CEREALS
-GREEN LEAFY
VEGETABLES
VITAMIN B3 NIACIN
14 Mg (FEMALE)
16Mg (MALE)
Co- ENZYMES IN
ENERGY
METABOLISM
PELLARGA
D- DERMATITIS
D- DEMENTIA
D- DIARRHEA
D- DEATH
GLOSSITIS ANGULAR
STOMATITIS
VASODILLATION AND
LIVER DAMAGE,
HYPER MOTILITY
AND ACIDITY OF
STOMACH, PARALYSIS
OF RESPIRATORY
SYSTEM.
ANIMAL
-FISH
-MEATS
-EGS
PLANTS
-WHOLE GRAINS

VITAMIN B6
PYRIDOXINE
SUPPLEMENTED IN
ANTI- TB THERAPY AS
DRUGS COMPLETE
WITH
ABSORPTIONOF B6
1.3-1.5 Mg (MALES)
1.3-1.7 Mg
(FEMALES)
-AMINDO ACID
METABOLISM
-IT CATALYZES UREA
PRODUCTION
-
NEUROTRANSMITTER
SYNTHESIS
-HEADACHE
-AMENIA
-CONVULSION
-NAUSEA
-PERIPHERAL
NEURITIS
NERVE DESTRUCTION
IF GIVEN 3gms/kg
WEIGHT
ANIMAL
-PORK
-FISH
-POULTRY
-LIVER
-KIDNEY
PLANT
-WHOLE GRAIN
-HIGH PROTEIN
FOODS
-SPINACH
-BROCCOLI
PATHOGENIC ACID-
FROM EVERYWHERE
OR FROM ALL SIDES
VITAMIN B5
4-7 mg
Co-ENZYMES OF
ENERGY
METABOLISM
-FATIGUE
-HEADACHE
-NAUSEA
-VOMITING
GENERALLY NON
TOXIC OCCASIONALLY
CAUSES DIARRHEA
LIVER
MOST FOODS OF
PLANTS AND
ANIMALS IN ORIGIN

VITAMIN B12
COBALAMIN
2-4ug
-FOLATE METABOLISM
-ERYTHROCITE
MATURATION
FACTOR(EMF)-
PREVENTS PERNICIOUS
ANEMIA MORE
APPROPRIATELY CALLED
MICROCYTIC
HYPERCHRONIC
ANEMIA
-NERVE FUNCTION
BECAUSE IT MAINTAIN
THE MYELIN SHEATH
-PERNICIOUS ANEMIA
-POOR FOOD FUNCTION
-NONE MOST FOOD OF
ANIMALS ORIGIN
BIOTIN
30ug
-COENZYME IN THE
SYNTHESIS OF FATTY
ACIDS AND AMINO
ACIDS
NAUSEA ANOREXIA
DEPRESSION PALLOR
DERMATITIS INCREASE
SERUM CHOLESTERAL
NOT DOCUMENTED ANIMALS
-LIVER
-MEATS
-EGG YOLK
-MILK
PLANTS
-WHOLE GRAINS

VITAMIN C ASCORBIC
ACID-ALSO KNOWN
AS ANTI SCORBUTIC
VITAMIN
75mg(FEMALE)
90mg(MALE)
-REQUIRED FOR IRON
ABSORPTION
-ANTIOXIDANT
PREVENTS CELL
DAMAGE CAUSES
COLLAGEBN
FORMATION;
AFFECTS HEALTH OF
TEETH AND GUMS
-CONVERSION OF
FOLLIC ACID
-HEALING OF
WOUNDS
-RESISTANCE
AGAINST INFECTION
-PREVENTS
HEMORRHAGE
-PREVENTS
MEGABLOSTIC
ANEMIA
-SCURVY
-POOR WOUND
HEALING
-WEAKNESS
-IMPAIRED IMMUNE
RESPONSE
-PINPOINT
HEMORRHAGE
POTENTIAL
RASHES
-BLEEDING GUMS
RARE- EASILY
EXCRETED
>2g/kg OF WEIGHT
CAN CAUSE
DIARRHEA KDNEY
STONE FORMATION
AND GI UPSETS
CITRUS FOODS
-PUERTO RICO
CHERRY ARECOLA
-KASUY
-BAYABAS
-DATILES
-KAMATSILE
-ORANGE
-SILI
-MUSTASA
-REPOLYO
COOKED
-MALUNGGAY
LEAVES
-GABI LEAVES
-AMPALAYA
LEAVES

WATER
SOLUBLE
FUNCTIONS DEFICIENCY TOXICITY FOOD SOURCE
FOLIC ACID
PTEROYGLUMATIC
ACID
FOLATE
FOLACIN
400ug
-IMPORTANCE
OF SYNTHESIS
OF DNA
PROTEIN
METABOLISM
AND
FORMATION OF
HEMOGLOBIN
-NEURAL TUDE
DEFECT
-
MEGALOBLASTI
C ANEMIA
-MENTAL
CONFUSION
-HEARTBURN
-GLOSSITIS
-DEPRESSION
ANECEPHALY
-MASK IT B12
DEFICIENCY
-UREMIA
ANIMAL
-LIVER
-GLANDULA
ORGANS
PLANTS
-LEGUMES
-CEREALS

MINERALS
MAJOR
AND TRACE
FOR LIFE

SIX CLASSES OF NUTRIENT
1. Carbohydrates
2. Protein
3. Fat
4. Vitamins
5. Minerals
6. Water

The Minerals
-small naturally occuring, inorganic chemical
elements
-inorganic: being or composed of matter other
than plant or animal.
-serve as structural components and in many vital
processes in the body

Major VS TraceMajor Minerals Trace Minerals
>Large quantities(>5g) >Smaller Quantities(<5g)
-Calcium -Iron
-Chloride -Zinc
-Magnesium -Copper
-Potassium -Flouride
-Sodium -Iodine
-Sulfur -Chronium
-Manganese
-Magnesium

STRUCTURAL
• Bone Health- (calcium, phosphorous, magnesium)
• Blood Health- ( IRON, zinc, copper)
• Digestion- (chlorine)
• Supports- Reproduction and growth
(Iodine)

Regulatory
> Acid- Base Balaance
-Acid forming
P-Phosphorous
C-Chlorine
S-Sulfur Base Forming
C-Calcium
P-Potassium
M-Magnesium
S-Sodium

Regulatory
• Catalyst of Metabolism
• Muscle Contractility
• (Magnesium, Potassium, Sodium, Calcium)
• Nerve Impulses
(Sodium and Potassium)

Normal Values of Electrolytes in the Body
•Sodium: 135-145 mEq/L
•Potassium: 3.5-5 mEq/L
•Calcium: 4.5-5.5 mEq/L
•Magnesium: 4.5-5.5 mEq/L
•Phosphate: 1.7-2.6 mEq/L
•Chloride: 98-108 mEq/L

MINERAL FUNCTION SOURCE
SODIUM Needed for proper fluid balance,
nerve transmission, and muscle
contraction
Table salt, soy sauce; large amounts
in processed foods; small amounts in
milk, breads, vegetables, and
unprocessed meats
CHLORIDE Needed for proper fluid balance,
stomach acid
Table salt, soy sauce; large amounts
in processed foods; small amounts in
milk, meats, breads, and vegetables
POTASSIUM Needed for proper fluid balance,
nerve transmission, and muscle
contraction
Meats, milk, fresh fruits and
vegetables, whole grains, legumes
CALCIUM Important for healthy bones and
teeth; helps muscles relax and
contract; important in nerve
functioning, blood clotting, blood
pressure regulation, immune system
health
Milk and milk products; canned fish
with bones (salmon, sardines);
fortified tofu and fortified soy
beverage; greens (broccoli, mustard
greens); legumes

PHOSPHORUS Important for healthy bones and
teeth; found in every cell; part of the
system that maintains acid-base
balance
Meat, fish, poultry, eggs, milk,
processed foods (including soda pop)
MAGNESIUM Found in bones; needed for making
protein, muscle contraction, nerve
transmission, immune system health
Nuts and seeds; legumes; leafy,
green vegetables; seafood;
chocolate; artichokes; "hard"
drinking water
SULFUR Found in protein molecules Occurs in foods as part of protein:
meats, poultry, fish, eggs, milk,
legumes, nuts

IRON Part of a molecule (hemoglobin)
found in red blood cells that carries
oxygen in the body; needed for
energy metabolism
Organ meats; red meats; fish;
poultry; shellfish (especially clams);
egg yolks; legumes; dried fruits; dark,
leafy greens; iron-enriched breads
and cereals; and fortified cereals
ZINC Part of many enzymes; needed for
making protein and genetic material;
has a function in taste perception,
wound healing, normal fetal
development, production of sperm,
normal growth and sexual
maturation, immune system health
Meats, fish, poultry, leavened whole
grains, vegetables
IODINE Found in thyroid hormone, which
helps regulate growth, development,
and metabolism
Seafood, foods grown in iodine-rich
soil, iodized salt, bread, dairy
products

SELENIUM Antioxidant Meats, seafood, grains
COPPER Part of many enzymes; needed for
iron metabolism
Legumes, nuts and seeds, whole
grains, organ meats, drinking water
MANGANESE Part of many enzymes Widespread in foods, especially plant
foods
FLOURIDE Involved in formation of bones and
teeth; helps prevent tooth decay
Drinking water (either fluoridated or
naturally containing fluoride), fish,
and most teas
CHRONIUM Works closely with insulin to regulate
blood sugar (glucose) levels
Unrefined foods, especially liver,
brewer's yeast, whole grains, nuts,
cheeses
MOLYDENIUM Part of some enzymes Legumes; breads and grains; leafy
greens; leafy, green vegetables; milk;
liver

The chemical reactions of life take place in aqueous solutions. The
dissolved substances in a solution are called solutes. In the human
body, solutes vary in different parts of the body, but may include
proteins—including those that transport lipids, carbohydrates, and,
very importantly, electrolytes. Often in medicine, a mineral dissociated
from a salt that carries an electrical charge (an ion) is called and
electrolyte. For instance, sodium ions (Na+) and chloride ions (Cl–) are
often referred to as electrolytes.

In the body, water moves through semi-permeable membranes of cells
and from one compartment of the body to another by a process called
osmosis. Osmosis is basically the diffusion of water from regions of higher
concentration to regions of lower concentration, along an osmotic
gradient across a semi-permeable membrane. As a result, water will move
into and out of cells and tissues, depending on the relative concentrations
of the water and solutes found there. An appropriate balance of solutes
inside and outside of cells must be maintained to ensure normal function.

Body fluids can be discussed in terms of their specific fluid
compartment, a location that is largely separate from another
compartment by some form of a physical barrier. The intracellular fluid
(ICF) compartment is the system that includes all fluid enclosed in cells
by their plasma membranes. Extracellular fluid (ECF) surrounds all cells
in the body. Extracellular fluid has two primary constituents: the fluid
component of the blood (called plasma) and the interstitial fluid (IF)
that surrounds all cells not in the blood

Intracellular Fluid
The ICF lies within cells and is the principal component of the
cytosol/cytoplasm. The ICF makes up about 60 percent of the total water
in the human body, and in an average-size adult male, the ICF accounts for
about 25 liters (seven gallons) of fluid. This fluid volume tends to be very
stable, because the amount of water in living cells is closely regulated. If
the amount of water inside a cell falls to a value that is too low, the cytosol
becomes too concentrated with solutes to carry on normal cellular
activities; if too much water enters a cell, the cell may burst and be
destroyed.

DISTRIBUTION OF BODY FLUIDS
>INFANTS: 80% OF THEIR BODY WEIGHT IS WATER.
>FEMALE: 50% OF THEIR BODY WEIGHT IS WATER.
>MALE: 60% OF THEIR BODY WEIGHT IS WATER.

PROCESS OF BODY FLUID AND SOLUTES
MOVEMNET
Hydrostatic pressure, the force exerted by a fluid against a wall, causes
movement of fluid between compartments. The hydrostatic pressure of
blood is the pressure exerted by blood against the walls of the blood
vessels by the pumping action of the heart. In capillaries, hydrostatic
pressure (also known as capillary blood pressure) is higher than the
opposing “colloid osmotic pressure” in blood—a “constant” pressure
primarily produced by circulating albumin—at the arteriolar end of the
capillary .

Hydrostatic pressure is especially important in governing the
movement of water in the nephrons of the kidneys to ensure proper
filtering of the blood to form urine. As hydrostatic pressure in the
kidneys increases, the amount of water leaving the capillaries also
increases, and more urine filtrate is formed. If hydrostatic pressure in
the kidneys drops too low, as can happen in dehydration, the functions
of the kidneys will be impaired, and less nitrogenous wastes will be
removed from the bloodstream. Extreme dehydration can result in
kidney failure.

Passive transport of a molecule or ion depends on its ability to pass
through the membrane, as well as the existence of a concentration
gradient that allows the molecules to diffuse from an area of higher
concentration to an area of lower concentration. Some molecules, like
gases, lipids, and water itself (which also utilizes water channels in the
membrane called aquaporins), slip fairly easily through the cell membrane;
others, including polar molecules like glucose, amino acids, and ions do
not. Some of these molecules enter and leave cells using facilitated
transport, whereby the molecules move down a concentration gradient
through specific protein channels in the membrane. This process does not
require energy. For example, glucose is transferred into cells by glucose
transporters that use facilitated transport

WATER BALANCE
• WATER INTAKE= WATER OUTPUT
A. Water intake
1.direct intake
2.water bound in the food.
3. metabolic water

Water Requirement
1.Adult- 1ml/calorie
2. Infants- 1.5 ml/calorie
3. Some based it on the weight.
-infants 110ml/kg
-10 years old 40ml/kg
-Athelesthes 1.5 liter per additional activity.

Fluid Imbalance
Overhydration is an excess of water in the
body. People can develop overhydration if they
have a disorder that decreases the body's ability
to excrete water or increases the body's tendency
to retain water. Drinking too much water rarely
causes overhydration because normal kidneys
easily excrete excess water.

Anasarca is a severe and
generalized form of edema with
widespread subcutaneous tissue
swelling. It is usually caused by
liver failure (cirrhosis of the liver),
renal failure, right-sided heart
failure, as well as severe
malnutrition/protein deficiency.

NUTRITION IN PREGNANCY AND
LACTATION

PREGNANCY
Usually form 38 to 42 weeks.
A non pregnant woman needs 1500 - 2000 calories, but if pregnant she
needs additional 300 calories during the 1st and 2nd trimester.

PHYSIOLOGICAL BASIS
1. Brought by the three stages of pregnancy.
a. Implantation
b. ORGANOGENESIS - Malnutrition
c. Growth
2. Blood Volume and Composition
Bld, Vol. > Blood Component = Anemia

PHYSIOLOGIC BASIS
3. The Circulatory system
- Left Cardiac hypertrophy, leading to tachycardia and palpitations
- Bradycardia - after delivery
- Pregnancy Induced Hypertention.
4. Respiration - changes to estrogen and growing fetus.
5. Renal Function - Malnutrition and DHN.

PHYSIOLOGICAL BASIS
6. GIT Function - due to hormones progesterone, estrogen,
human chronic gonadatropin.
7. Weight Gain - Weight before and during Pregnancy should be
documented.
“ Low soduim intake should be observed by pregnancy women”
- Should be 2 to 4 lbs by the end of 1st trimester and approximately 1lb a
week there after
• Average weight gain ( 25 to 35 lbs )

WEIGHT GAIN
COMPONENTS WT. GAIN IN LBS.
FETUS 7.5
PLACENTA
AMNIOTIC FLUID
1
2
BREAST 1-3
MATERNAL BLOOD 4
UTERUS 2
MATERNAL FAT 4+

PREGNANCY WEIGHT GAIN DISTRIBUTION
WEIGHT STATUS RECOMEMDED GAIN COMPLICATION
Under weight
(BMI<19.8)
28 to 40 lbs LBW infant (< 5lb) pre-
term infant (<30
weeks)
Normal weight
(BMI 19.8 to 26)
25 to 35 lbs HTN, Gastational
Diabetes, TORCH of
Pregnancy
Overweight
(BMI 26 to 29)
15 to 25 lbs Infant born post-term
and weeks
Obese
(BMI >29)
at least 15 lbs Infant born post-term
and weeks
Twin Pregnant 35 to 45 lbs

PROBLEM DURING PREGNANCY
1. Nausea and Vomiting - also known “morning
sickness”
• Eat dry Crackers or dry toast before rising
• Ice Chips
• Eat small, frequent meals
• avoid food with offensive odors
• avoid liqiuds at mealtime
• Hyperemesis Gravidarum - life threatening -
REQUIRE HOSPITALIZATION

2. Hearthburn
- Burning sensation beneath the chest
- May be relieved by eating small frequent meals, avoid spicy of greasy
food, avoid liquids with meals waitig at least an hour after eating
before lying down and waiting atlast 2hours before exercising.

3. Constipation
- can result from relaxation of the cardiac sphinter and smooth muscles
related to peogesterone, may lead to haemorrhoids
- Can be relieved by eating high-fiber foods getting daily exercise,
drinking atleast 13 glasses of liquid each day, and respopnding
immediately to the urge of defecating
- DO NOT USE LAXATIVE

6. Rapid Weight Gain
- defiened as an increase on weight of 3kg or more during 2nd to 3rd
trimester.
7. Weight Loss
- <500 grams/mon (1st trimester)
- <250 grams/mon (2nd trimester)
- “at risk” - preterm deliveries, abortion and mental retardation

4. Edema - mild and PHYSIOLOGIC in the 3rd trimester, PATHOGOLIC if
accompanied with toxemia of pregnancy.
5. Leg Cramps - usually at night, manifested by sudden conttraction of
GASTROCNMIUS MUSCLE.
- may be due to calcium - phosphorous imbalance.

8. Pregnancy - Induced Hypertension (PIH)
A. Pre - eclampsia
H - Hypertension
E - Edema
L - Low platelet
P - Proteinuria
B. Eclapmsia - all plus “ C “ - Coma

9. Amenia
- Condition caused by an Insufficiency of red blood cells, hemoglobin or
blood volume
- Iron deficiency is the most common form
- Folate deficiency can result in a form a megaloblastic amenia
10. PICA
- it is the craving for non food substances such as starch, clay (soll), or
ice

11. Gastetional Diabetes Mellitus - due to “stress”. Close monitoring
by health care provider.
Nursing Alert: CONTROL OF SUGAR !!!
CAN CAUSE:
1. IUFD - Intra uterine fetal demise
2. Premature Delivery
3. Macrosomia

NUTRIENT NEEDS REQUIRMENTS RATIONALE
Calories • Additional 300 cal/day during 2nd
and 3rd trimester.
For energy
Protein • Additional 10 g/day with HIGH
BIOLOGIC VALUE
Tissue building
Carbohydrates • Additional 100 g/day ENERGY SOURCE
Folate • Critical during 2 months before
pregnancy to 6 weeks gestation
• 600 mcg/day
To prevent neural tube defect (NTD) -
spina bifida
Calcium and Phoporous • Calcium 1,300 mg/day
(ages 14 to 18), 1000 mg/day (ages
18 to 50)
• Formation of fetal bone and teeth
• Prevent pre- eclampsia
Iron • Addition 41 mg/day • To prevent anemia
• Necessary for infant's iron storage
Sodium • Less than 2000 mg/day To prevent edema and PIH

PHYSIOLOGY OF LACTATION
OXYTOCIN PROLACTIN
ANTERIOR PITUITARY GLAND
LET DOWN
REFLEX
CONTRACTION
OF LABOR
GROWTH OF
MAMMARY GLANDS
MILK SYNTHESIS

B Best food for baby
R Reduce allergy
E Economical
A Always available
S Safe
T Temperature is right

F Fresh
E Encourage
E Ensure means of contraception
D Digestive
I Immunity
N Nutritious
G Good tooth and jaw

Calorie Requirment
• 85 calorie required to reduce 100ml milk
• Average daily milk production 750ml (640 calories)
• 6 mons. = 600ml =510 extra calories
• FNB= 500 calories a day during lactation
• 1 ounce of human milk - 20 calories
• Lactation specialist
• Experts on breastfeeding and help new mother who may be having
problem such as the baby not latching on properly

BREASTMILK
Room temperature (66 to 72 degree F) 8 to 10 hours
Refrigerator 8 days
Refrigerator freezer 3 to 4 months
Deep freezer 12 months

• INFANCY (0-1)
• TODDLERHOOD (1-3)
• PRESCHOOL (3-5)
• SCHOOL AGE(6-12)
• ADOLESCENT(13-20)
• YOUNG ADULTHOOD (18-40)
• MIDDLE ADULTHOOD(40-65)
• LATE ADULTHOOD/MATURITY(65-DEATH)

DIET DURING INFANCYINFANCY
Infant nutrition means making sure your baby is getting enough nutrients during his
first year. Nutrients are calories, protein, fat, vitamins, and minerals. Making sure your
baby has good nutrition can protect him against disease. It also helps him stay healthy
as he grows older. Every infant is different. Your baby may need more or less of the
items in each food group and may also need a special diet.
Your baby needs regular check-ups to make sure he is growing properly. Consult your
caregiver or dietitian if your child is not gaining weight. They can help you if he has
trouble nursing or is not eating enough formula each day. Talk with your caregiver if
your baby has diarrhea or vomiting, or can not take breast milk or formula for more
than 1 day. This may mean that they are not able to digest the feedings you are giving
them.

CALORIC REQUIREMENT
• 1ST YEAR OF LIFE- 98-108 CALORIES PER KILOGRAM OF BODY
WEIGHT.
• FEEDING ON DEMAND.

AGE PROTEIN
REQUIREMENT
0-6 MONTHS 2.2g kg PER DAY
6-12 MONTH 1.56g PER KG PER DAY

The frequency of breastfeeding varies amongst each mother-infant pair.
Contributing factors are the age, weight, maturity, stomach capacity, and
gastric emptying of the infant; as well as the storage capacity the mother
has of breast milk. Typically, feedings occur eight to twelve times per day
for breastfed infants. Early on, infants may not signal when they are
hungry, so parents are taught to feed the infant every three hours during
the day and every four hours during the night, even if waking the infant is
required. The feedings will last 30–40 minutes in the beginning, or 15–20
minutes per breast if breastfeeding. As the infant matures, the feeding
times shorten.[1] Feeding often is important to promote normal growth,
development, and milk production in mothers who are breastfeeding.

NUTRITION
>RECOMMENDED DIETARY INTAKE FOR INFANT
-HIGH PROTEIN AND HIGH CALORIE DIET
-CALORIE INTAKE SHOULD BE 98-108 cal/kg OF
THE BODY WEIGHT.

Breast milk or infant formula: Breast milk or infant formula are the only
nourishment needed by most healthy babies until they are 4-6 months
old. Cow's milk or other dairy products should not be given until at least
one year of age. Your baby's kidneys cannot handle the high protein and
mineral content well until that age.
0-3 months: 18-32 ounces

Nutrition & Diet Therapy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Nutrition & Diet Therapy

Similar to Nutrition & Diet Therapy (20)

Recently uploaded

Recently uploaded (20)

Nutrition & Diet Therapy