Nutrition

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Optimal Nutrition

achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness.

Undernutrition (30-59% of Americans)

occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands

Overnutrition

is caused by the consumption of nutrients, especially calories, sodium, and fat in excess of body needs.
- leads to obesity and risk for heart disease, type 2 diabetes, HPT, stroke, gallbladder disease, sleep apnea, cancers, osteoarthritis

Carbohydrates
- 1g = 4kcal

1. main source of energy
2. first breaks down as sugar (diabetics becareful)
3. 55-60% of calories should be carbs

Protein
- 1g = 4kcal
- 20 amino acids
- 10 essentials are not made in body but need in complete protein

1. essential for growth and repair of tissues
2. energy source
3. excess protein stored as fat
4. body needs 12-20% of calories from protein

Fat
- 1g = 9 kcal

1. hormone synthesis
2. impusle transmission
3. energy
4. insulation
5. metabolism
6. gluconeogenesis, fat into glucose
7. excess is stored as adipose tissue
8. body needs less than 30% of calories from fat

Vitamins: not needed if healthy diet is good
1. Water Soluble, take in urinate out
2. Fat Soluble, fat intake is too low not enough storage for fat soluble vitamin
Minerals supply structure and function to teeth and bones
3. Major Minerals
4. Trace Minerals

1. B's and C's
2. can become toxic, D, E, A, K
3. electrolytes, sodium, patassium, magnesium, calcium, phosphorus
4. iron, zinc, copper

Nutritional status is affected by?

1. physiologic
2. psychosocial
3. cultural
4. economic

Water

- 60-70% total body weight
- Cellular function
- 2 ½-3 L metabolized daily
- Increased needs in fever, infections, wounds, GI loss, respiratory disease

BMI

< 18.5 underweight
18.5-24.9 = normal
25-30 overweight
30-34.9 Class I obese
35-39.9 Class II obese
> 40 Class III obese severely obese (morbidly obese)

Anthropometric Measurements
1. Percent Ideal Weight
2. BMI

1. current weight/ideal weight x 100
80-90%=mild, 70-80%=moderate, <70% severe malnutrition
2. practical marker of optimal weight for height and indicator of obesity or protein calorie malnutrition

BMI=weight in kilograms/height in meters squared
BMI=weight in pounds/weight in inches squared x 703

Anthropometric Measurements - continued
3. Waist to hip ratio

3. waist circumference/hip circumference
> 1.0 for men or >.8 for women indicate android obesity

Desirable Body Weight
1. females
2. males

1. 100 lbs for first 5 feet +5 pounds for each inch +/- 10%
2. 106 lbs for first 5 feet +6 pounds for each inch +/- 10%

Triceps skin fold (TSF)
- estimate body fat stores
- most commonly used -- its easy
- pinch skin fold, back of left non-dominant upper arm, pull away from muscle, use calipers to measure
- measure 3 times and average
- TSF 10% below standard = malnutrition
- TSF 10% over standard = overnutrition

...

Mid-upper Arm circumference (MAC)
- estimates skeletal muscle mass and fat stores
- measurements below 10th percentile or above the 95th percentile warrant further medical and nutritional evaluation

- person stand or sit with arm hanging fully extended and relaxed by side of body
- loop the insertion tape or measuring tape around the arm at the midpoint
- position the tape horizontally at the midpoint, tighten it firmly around but not too tight to cause indentation or pinching
- record in cm and compare with norms

Pellagra

- pigmented keratotic scaling lesions resulting from deficiency of niacin

Follicular Hyperkeratosis

- dry, bumpy skin associated with vitamin A or linoleic acid deficiency

Bitot's Spots

Foamy plaques of cornea due to Vitamin A deficiency

Kwashiorkor

Occurs in children whose diets contain mostly carbohydrates and little or no protein

Rickets

Sign of vitamin D and calcium deficiency

Developmental Care
Infants and Children

- Birth to 4 months: most rapid growth in life cycle
- double birth weight by 4 months, triple in 1 year
- increase length by 50% 1st year
- by age 2 brain is 50% adult size and 100% by age 4

Developmental Care
Adolescents

- rapid physical growth + endocrine/hormonal changes
- increased calories for muscle growth and menarche
- girls double body weight between ages 8-14, boys 10-17

Developmental Care
Pregnancy + Lactation

- recommended weight gain of 25-35 pounds, 28-40 for underweight, 15-25 for overweight

Developmental Care
Adulthood

- growth and nutrient needs stabilize
- important time for education and about risk factors for heart disease, DM, obesity, HTN, osteoporosis, cancer

Developmental Care
Aging Adult
1. malnutrition
2. physiologic changes
3. socioeconomic factors

1. poor physical or mental health, social isolation, alcoholism, limited functional ability, poverty, polypharmacy
2. dentition,, visual acuity, slower GI motility, decreased GI absorption, decreased olfactory and taste sensitivity
3. decline of extended families, increased mobility of families, physical limitations, transportation, facilities for meal prep

Purpose of Nutritional Assessment

1. identify those who are malnourished or at risk for it
2. provide data for designing a nutrition plan of care that will prevent or minimize development of malnutrition
3. establish a baseline for evaluating efficacy of care

Nutrition Screening
- 1st step
- can be done in any setting
- quick and easy way of identifying those at risk
- parameters typically include weight loss, food intake, recent illness, BMI
- need to have a valid tool

...

Nitrogen balance
- 24 hour urine test
- index of protein status
- indicates anabolism (positive nitrogen balance)
- indicates catabolism (negative nitrogen balance)
- nitrogen should equal what goes in and goes out

...

Hemoglobin
- determination is used to detect iron deficiency anemia
- increased levels suggests hemoconcentration due to dehydration or polycythemiavera
Hematocrit
- measures cell volume and indicator of iron status
- a low value indicates insufficient hemoglobin formation so HH should be measured together

...

Cholesterol
- total cholesterol is measured to evaluate fat metabolism
Triglycerides
- serum triglycerides screen for hyperlipidemia
- assess risk of cardiovascular disease, coronary artery disease, peripheral vascular disease, MI, stroke
- LDL=bad (100-120), HDL=good (<200)

...

Total Lymphocyte Count (TLC)
- used to test cellular immune function
- derived from WBC and differential count
- normal is 1800 to 3000

...

Serum Proteins
1. serum albumin
2. serum prealbumin

1. visceral protein status, not early indicator 15 days half life normal is (3.5 to 5.5)
2. 3 day half life, more sensitive to recent changes in protein status (normal is 15-25)

CRP
C-reactive protein
- plasma protein marker of inflammatory status produced by the liver used to monitor metabolic stress and indicator of when to begin nutritional support in critically ill patients
- not detectable in the blood <0.6 mg/dL of healthy

if detectable would inidicate risk of atherosclerosis, RA, TB, oral contraceptives and pregnancy may produce detectable CRP levels

The balance between nutrient intake and nutrient requirements is described as?

nutritional status

To support sythesis of maternal and fetal what is appropiate weight to be considered?

depends on BMI of mother at start of pregnancy
if normal = 25-35
underweight = 28-40
overweight = 15-25

Patient cannot stand and you need to measure his height, what do you do?

measure his arm span

Skin testing or anergy panel has been ordered what test is this?

immunocompetence

Marasmus is?

low weight for height

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