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291 terms

Nutrition 206 Final

The terms are not in order as per the syllabus (I dropped my notes at the bus stop). If you question some of the values let me know, I had to use other sources to fill in some of the blanks.
STUDY
PLAY
What is Nutrition?
-study of food, how it nourishes our body, how it influences our health
5 Aspects of Nutrition
1. Nutrients
2. Digestion
3. Absorption
4. Metabolism
5. Elimination
*all are affected by stress*
What are Nutrients?
def: chemicals in foods that are critical to human growth & function
6 Classes of Nutrients
1. Carbohydrates
2. Fats & Oils
3. Proteins
4. Vitamins/ Minerals
5. Water
6. Electrolytes
Energy is Measured in ...?
Kilocalories (kcal or C):
-the amt of energy required to raise the temp. of a litre (kg) of water one degree centigrade at sea level

1 kcal = 1000 calories
3500 cal = 1 lb
5 Dimensions of Health
1. Physical: following food guide
2. Mental: consumer decisions
3. Emotional: flexible w eating habits
4. Social: tests resolve in following food guide
5. Spiritual: caring for one's body
Integrating Nutrition Assessment (ABCD)
Anthropometric: BMI, head circumference (objective)
Biochemical: Bloodwork
Clinical: physical observations of S&S
Dietary Data: food consumption recall (subjective)
Nutritional Assessment
Undernutrition
Overnutrition
Malnutrition
Undernutrition
the consumption of not enough energy or nutrients based on DRI (dietary reference intakes) values
e.g. scurvy (Vit. C), rickets (Vit. D), anemia (Iron)
Overnutrition
the consumption of too many nutrients and too much energy compared with DRI levels
Malnutrition
imbalanced nutrient and/or energy intake
*at-risk: hospital patients, older adults, & chronic excessive alcohol/drug users
Medical conditions controlled by nutrition therapy:
-diabetes
-heart disease
-hypertension
-renal
Physical complaints that interfere with intake:
-difficulty chewing & swallowing
-anorexia "not eating"
-heartburn
-nausea
-vomiting
-pain
Increased needs:
-pregnancy
-fever
-sepsis (blood infection)
-thermal injuries (burn)
-skin breakdown
-cancer
-AIDS
-surgery
-trauma (MVA)
Losing nutrients:
-malabsorption
-diarrhea
-some renal disease
S&S of Malnutrition
-hair is dull, brittle, dry, falls out easily
-swollen glands of neck & cheeks
-dry, rough, spotty skin
-poor or delayed wound healing or sores
-thin appearance with lack of subcutaneous fat
-muscle wasting
-edema of lower extremities
-weakened hand grasp
-depressed mood
-abnormal heart rate/rhythm & BP
-enlarged liver & spleen
-loss of balance & coordination
DIET is a 4-letter word, instead use:
-eating patterns
-food intake
-eating style
-the food you eat
Factors that interfere with nutrition therapy
-client's prognosis
-outside support systems
-level of intelligence & motivation
-willingness to comply
-emotional health
-financial status
-religious or ethnic background
Accessory Organs of the Digestive System
-Pancreas
-Liver
-Gallbladder
Digestion
-involves macronutrients CHO, PRO, FAT
-Mechanical: mastication of bolus into chyme
-Chemical: digestive enzymes
Macronutrients involved in digestion:
-carbohydrate (CHO)--> glucose
-protein (PRO)--> amino acids
-fat (FAT)--> fatty acids
Absorption
-process which food molecules are taken up by the intestinal villi & distributed to body cells via the bloodstream
-minerals absorbed in duodenum
-glucose & water soluble vit. absorbed in jejunum
-protein, fats & fat-soluble vit. absorbed in ileum
-water absorbed in large intestine
Metabolism
-chemical rxns in body cells that convert fuel from food into energy
-catabolism: "cut" or "break-down"
glycogen→glucose (liver)
-anabolism: "add" or "build-up"
amino acids→PRO (DNA directs PRO building)
glucose(CHO)→glycogen
excess kilocalories→Lipogenesis
Elimination
-food molecules that can't be absorbed or digested are eliminated from the body
Mouth
-breaks down food: mastication (mechanical digestion)
-mixes food with saliva (chemical digestion) to form bolus, lubricate esophagus
-secretes salivary amylase to help digest CHO
Esophagus
-transports food to stomach
-passes to stomach via Esophageal sphincter
Stomach
-acts as food resevoir
-mixes food with gastric juices: HCL, Protease (pepsin), mucus, intrinsic factor
-breaks down food into chyme
-absorbs water, alcohol, & some drugs
-passes to duodenum of sml intestine via Pyloric sphincter
Small Intestine
-duodenum, jejunum, ileum
-stimulates secretion of pancreatic juices
-major site of digestive absorption (primarily in duodenum)
-nutrients & fluids pass through intestinal cells into the blood system --> transported to liver
-fats & fat-soluble vit. & some fluid enter lymphatic system from intestinal cells (via lacteals)
Pancreas (accessory)
endocrine: produces & secretes insulin and glucagon
exocrine: produces & secretes digestive enzymes: protease (PRO->amino acids), lipase (FAT->fatty acids), amylase (CHO->simple sugars), bicarbonate (neutralizes acidic chyme)
Gallbladder (accessory)
-concentrates & stores bile
-releases bile into the duodenum to emulsify fat
Liver (accessory)
-produces bile (stored in the gallbladder) to emulsify fats, & help regulate cholesterol
-metabolizes CHO, PRO, FAT
-stores nutrients (iron, vit. A, D, E, K & B12, glycogen)
-detoxifies drugs & waste products in the blood
Large Instestine
-chyme passes into lrg intestine via ileocecal sphincter
-food that is undigested, or unabsorbed is fermented by intestinal bacteria
-held for 12-24 hrs
-B complex, K & water are absorbed
-end result is eliminated via anus
Vitamins
-required for proper metabolism
-do not directly provide energy
-necessary for obtaining energy from macronutrients
-often fxn as coenzymes
-some are antioxidants
Enzyme
a protein that accelerates the rate of a chemical rxn
*required for all metabolic fxns
Coenzyme
a molecule that combines with an enzyme to facilitate enzyme fxn
*some metabolic rxns require coenzymes
Antioxidant
substances that donate electrons to free radical to prevent oxidation
*Vit. C, E, and beta-carotene are major antioxidants
Two categories of solubility
-Water-soluble are dissolved in water
e.g. B complex, choline & vit. C
-Fat-soluble are dissolved in fatty tissue (stored in body-> risk for toxicity)
e.g. Vit. A, D, E, K
B-Complex Vitamins
-especially important for energy metabolism
e.g.
thiamin (TPP) folate (THF)
riboflavin (FAD,FMN) vitamin B₁₂ (B₁₂)
niacin (NAD) biotin (biotin)
vitamin B₆ (PLP) pantothenic acid (CoA)
Wernicke-Korsakoff Syndrome:
Thiamine B1
-neuropsychiatric effect of chronic excessive alcohol intake
*S&S: memory loss, extreme mental confusion, ataxia (can't walk straight), DT's (delirium tremens - withdrawal symptoms)
those at risk: severe GI disease, HIV, improper parenteral glucose solutions
Thiamine
-needs increase during illness, stress & surgery
-"morale vitamin" due to beneficial effects on nervous system & mental attitude
-NSAIDS ie antacid, tobacco, caffeine, sugar & alcohol deplete thiamine
Vitamin B2-Riboflavin
-most common vitamin deficiency
-S&S: sore throat, cheilosis, stomatitis, glossitis, & dermatitis
-promotes healthy skin, nails & hair
-helps alleviate migrain headaches
-light, water, sulfa drugs & alcohol are destructive
-need more B2 if you are on the pill, pregnant, or lactating
Vitamin B6-Pyridoxine
-essential for proper nervous system fxn (involved in formation of neurotransmitters)
-coenzyme for fatty acid & CHO metabolism
-sources: whole grains & cereals, legumes, and chicken, fish, pork, and eggs
-supplement toxicity can result in nerve damage, skin lesions
-depleted by birth control
Vitamin B6-Pyridoxine benefits
-alleviates nausea
-reduce night muscle spasms (Mg helps this as well)
-heavy protein consumers need more B6
-lowers risk of heart disease when used in combo with folic acid to break down amino acid homocysteine
Folate (folic acid)
-critical for cell division of early embryos
role in proper formation of fetal neural tubes
-coenzyme involved in DNA synthesis, amino acid metabolism
-sources: leafy green vegetables, lentils, fortified grain products
-women of childbearing age should increase folate intake to 400 mcg
-excess folate can mask B₁₂ deficiency in older adults
Vitamin B₁₂
-required for metabolism of fatty acids and amino acids
-develops and maintains myelin sheaths around nerve fibres (reverse dementia?)
-intrinsic factor
-sources:meat, fish, poultry, eggs, dairy
Vitamin B₁₂ Deficiencies
Pernicious anemia:
-breakdown of myelin sheath synthesis
-damage to spinal cord affects brain, optic & peripheral nerves
Also:
-reduced intrinsic factor production
-neuropsychiatric symptoms (delusions, hallucinations, dementia)
Vitamin C functions
-fxn: as antioxidant and coenzyme
-holds structures together, provides "cement", ie collagen formation for bone matrix, teeth, cartilage, skin & connective tissue
-required for wound healing w new tissue formation
-sources: fruits (citrus, strawberries, tomatoes), veggies (red & green pepper, potatoes, broccoli, leafy greens)
-destroyed by light, air, heat
Vitamin C Deficiencies
AKA Hypocalcemia
Scurvy:
-inflammation & eventual hemorrhaging of connective tissue as vascular system weakens
Vitamin C Toxicity
AKA Hypercalcemia
-High dose of vitamin C negates local anesthesia
-body develops a mechanism that destroys excessive vit. C circulating in the blood ∴ no toxicity from foods high in vit. C
Vitamin C: the good
-accelerates healing
-aids in prevention of bacterial & viral infections
-reduces histamine in the blood by 40%
-Aspirin triples the excretion rate
Fat soluble Vitamins
Vitamins A, D, E, K
-sources: fat & oil portion of foods
-when consumed in excess stored primarily in liver & adipose tissue
-toxic in high dosages (ie supplements)
-does not have to be consumed daily as body retrieves it from storage when needed
Vitamin A
-maintains skin and mucous membranes
-fxn: vision, bone growth, immune system, & normal reproduction
-sources: natural preformed in whole milk, butter, liver, egg yolks, fatty fish, carotenoids in deep green, yellow, & orange fruits and veggies
-BEST sources: broccoli, cantaloupe, sweet potatoes, carrots, tomatoes, and spinach
Vitamin A: the good
-Provitamin A (Beta-carotene) is preferred b/c it does not have the same toxicity potential as vit. A
-Topical Retin A is used for acne & wrinkles
NEG: Oral forms (accutane) prescribed for skin problems is potent, and can cause birth defects, liver damage, depression, suicide & Crohn's
Vitamin D
-steroid synthesizing is stimulated by the sun under OPTIMAL cond. & liver and kidney fxn is normal
-∴acts like a hormone b/c it is synthesized in one place (skin) & stimulates functional activity elsewhere
-fxn: intestinal absorption of Calcium & Phosphorus, affects bone mineralization, affects mineral homeostasis by helping to regulate blood calcium levels
-souces: butter, egg yolks, fatty fish & liver
Vitamin D deficiency
-Rickets: a childhood disorder leading to insufficient mineralization of bone & tooth matrix (eg. malformed skeletons, bowed legs, oddly angled rib bones, and abnormal tooth formation.
-Osteomalacia: an adult disorder characterized by soft, demineralized bones (risk for fractures). Symptoms include weakness, rheumatic-like pain, awkward gait.
-Osteoporosis: multifactorial disorder in which bone density reduced & remaining bones brittle, breaking easily eg. ↑ risk of CAD, rheumatoid arthritis, cancers, type 1 diabetes, MS
Vitamin D deficiency: concerns
deficiency concern when lack of exposure to sunlight occurs as result of:
-environmental limitations
-cultural clothing customs concealing body
-inability of older adults or people with disabilities to get outdoors or to store, resulting in malnourishment
-sunscreen (SPF8 blocks by 95%)
→ fortified dietary sources, or supplements appropriate
Vitamin E
-acts as antioxidant in conjunction with selenium & ascorbic acid (vit. C)
-protects polyunsaturated fatty acids & vitamin A in cells from oxidative damage by being oxidized itself (particularly the integrity of lung & blood)
-sources: vegetable oils, margarine, whole grains, seeds, nuts, wheat germ, & greeny leaf (processing ↓ final vit. E content)
Vitamin E: the good
-prevents & dissolves blood clots
-accelerates healing of burns
-prevents thick scar formation externally (applied topically) & internally
-↑ doses can interfere w vit. K (promotes blood clotting)
-body absorbs natural sources 2x as well as synthetic ones
Vitamin K
-cofactor in synthesis of blood-clotting factors (incl. prothrombin)
-role in protein formation in bone, kidney & plasma
-sources: dietary sources & synthesized by microflora in the jejunum & ileum of digestive tract
dark green leafty vegetables, dairy products, cereals, meats & fruits
Vitamin K: deficiency
-inhibits blood coagulation
-may be observed in clinical settings related to malabsorption disorders or medication interactions
--effects of long-term intensive antibiotic therapy (kills microflora)
--barriers to fat absorption
--inability to produce vit. K by premature infants & newborns (no natural bacteria yet)
Vitamin K: toxicity
-medications affected ie anticoagulant medications like warfarin & other blood thinning drugs
-excess amts may ↓ clotting time, ↑ risk for stroke
-supplement only under advice from dietician or health care provider
Vitamin K: the good
3 kinds K1, K2, K3
-K2 can be formed by natural probiotic bacteria in the intestines
-K2 controls removal oc calcium from arteries & deposition of calcium into bones, thus providing benefits for bone health and CV health
Water
500 mL/day - to release toxins or 30 mL/hr
-kidneys regulate amt excreted
-relies on combo of brain, kidney, pituitary gland & adrenal gland
Sources of Water
-food
-beverages (coffee, tea & alcohol are diuretics - pee more; soda adds fluid to body, but contains solutes)
-metabolism (produced through breakdown of fat, carbs, protein - contributes to 10-14% RDI)
Lack of water→Thirst sensation
-↑ sodium
-Osmotic thirst
-↓in blood volume (hypovolemic thirst AKA pathological thirst)
Water losses
Sensible:
-excreted by kidneys as urine
-excreted in feces (sml amt)
Insensible:
-sweating (3-4 L/day)
-breathing (1-2 L/day)
Fluid Volume Deficit (FVD)
can occur from:
-diarrhea
-vomiting
-high fever
-sweating
-diuretics
-polyuria (↑ urination)
FVD characteristics
-infrequent urination
-↓ skin elasticity (ie tenting, or turgor)
-dry mucous membranes
-dry mouth
-unusual drowsiness
-lightheadedness or disorientation
-extreme thirst
-nausea
-slow or rapid breathing
-sudden weight loss
Dehydration
Early signs:
-headache, fatigue, anorexia, flushed skin, lightheadedness, dry mouth & eyes, dark urine
Increased risk:
- infants (do not concentrate urine as readily as adults or express thirst, ↑ proportion of body weight to water)
-elderly (↓ total amt of body water, thirst sensation ↓)
Fluid Volume Excess (FVE)
-↑ fluid retention & edema (ie compromised regulatory mechanism)
-water intoxication (dilution of electrolytes causing muscle cramps, ↓ BP, & weakness)
-occurs when intake ≠ output
Electrolytes
minerals that dissolve in water to rom electrically charged particles (ions) which can carry an electrical charge
Intracellular (+) charge: K (potassium) & Na (sodium)
Interstitial (-) charge: Ph (phosphorus) & Cl (Chloride)
Extracellular (ECF): plasma & watery components of body organs & substances
Sodium: function
-BP & volume maintained by sodium as major cation in ECF
-transmission of nerve impulses
-role in regulation of body fluid levels in & out of cells
Sodium
-RDI: 2300-2400 mg/day (≈6g or 1 tsp)
souces:
-table salt
-foods in which it naturally occurs
-widely used in processed foods
Sodium: deficiency
-depletion can develop from dehydration or excessive diarrhea or excessive sweating (hyponatremia)
symptoms: headache, muscle cramps, weakness, ↓ ability to concentrate, ↓ memory, anorexia
Potassium: function
-primary intercellular cation
-maintains fluid levels inside the cells
-crucial for nerve & muscle fxn ie heart
-RDI: 4600mg
-sources:
whole unprocessed foods, white potatoes w skin, sweet potatoes, tomatoes, bananas, oranges, other fruits & veggies, dairy products, & legumes
Potassium: deficiency
-aka hypokalemia
-dehydration (ie vomiting, diarrhea, diuretics, laxative misuse)
- long-term diuretic use
symptoms:
muscle weakness, confusion, anorexia, cardia dysrhythmias (severe cases)
Potassium: toxicity
-occurs only w supplements (hyperkalemia)
symptoms:
muscle weakness, vomiting, cardiac arrest (severe cases)
Minerals
-vitamins cannot fxn & cannot be assimilated w/out the aid of minerals
-the body cannot manufacture a single mineral
→Macro (major): Ca, Cl, K, Ph
→Micro (minor): Fe, I, Zn, Se, Fl, Cr, Mo, CuMn
*all are critical to life!*
Mineral: sources
plant foods: fruits, veggies, legumes & whole grains
animal foods: beef, chicken, eggs, fish, milk products
*found in all 4 food groups*
-indestructible inorganic substances: stable when foods containing them are cooked
Mineral: functions
-structure
-fluid balance
-acid-base balance
-nerve cell transmission & muscle contraction
-vitamin, enzyme & hormonal activity
Calcium
-most abundant mineral 99% in bones
sources:
-dairy products, green leafy veggies, small fish, legumes, processed tofu
deficiency:
-osteoporosis
Phosphorus
-widely available in processed foods & pop
-excessive consumption ↑ calcium excretion
ie renal disease
Magnesium
-often overlooked & is deficient in many diets
-↑ nerve fxn
-helps w sleep & stress
-assists 100s of enzymes
sources:
-unprocessed whole grains, legumes, broccoli, leafy green veggies, and others
deficiency:
-2° rather than 1° ie. ↑vomiting & diarrhea, or GI tract disorder affect absorption or kidney disease - retention
-malnutrition & alcoholism ↓Mg levels
Fluoride
-↑resistance to tooth decay
sources:
-fortified water, tea, seafood, seaweed
Toxicity:
-fluorosis (mottling or brown spotting of the tooth enamel, severe cases may see pitting)
Iodine
-part of hormone thyroxin (produced by thyroid gland)
sources:
-seafood, dairy products, eggs
deficiency:
-reduces amt of thyroxine produced (ie. goiter)
-symptoms incl. sluggishness & weight gain
-during pregnancy causes cretinism = permanent mental & physical retardation
Iron
-most common mineral DEFICIENCY
-↑risk for infants, young children, preteen girls, premenopause, & pregnant women
sources:
-meat, poultry, fish, clams, soybeans, enriched cereals & breads, lentils
Toxicity:
-overdose most common cause of poisoning deaths in children
-symptoms: nausea, vomiting, diarrhea, dizziness, confusion
-if tx delayed = severe damage to heart, CNS, liver, kidneys
Energy Use: 3 general purposes (+ 1 non-general purpose)
1. basal metabolism
2. physical activity
3. thermic affect of food
+1. non-exercise activity thermogenesis
Basal Metabolism
-min. energy expended in a fasting state (12 hrs) to keep a resting, awake body alive in a warm, quiet environment
-requires 60-70% of energy
-process involved in maintaining HR, Resp, temp
-amt of energy needed to maintain life when subject is at rest
BMR = healthy weight (lbs) X 10 (women) or 11 (men)
Other influences on Basal Metabolism
-↑ temp - ↑ BM
-↑ age - ↓ BM
-↓ eating - ↓ BM
-pregnancy - ↑ BM
-Caffeine & Tobacco - ↑ BM
-Thyroid hormones - ↑ or ↓ BM
-Nervous System activity - ↑ BM
Energy intake
-calories from:
carbs - 4 cal/g
protein - 4 cal/g
fat - 9 cal/g
alcohol - 7 cal/g
Calories in vs. Calories out
energy balance is the relationship btwn the amt of calories consumed & the amt of calories expended
(+) calorie in > calorie out
(-) calorie in < calorie out
When do you need (+) Energy Balance?
-growing kids
-breast feeding
-pregnancy
Normal Weight
- normal weight is statistically correlated to good health
3 criteria for assessing overweight & obesity:
-Body Mass Index (BMI)
-Waist Circumference
-Existing health problems

BMI= wt (kg)/ht (m²)
*does not consider body composition*
Ideal BMI ranges
Ideal Body Weight (IBW): 18.5-24.9
overweight: 25-29.9
Class I Obesity: ≥ 30
Class II Obesity: ≥ 35
Class III Obesity: ≥ 40
underweight: < 18.5
anorexia nervosa: < 16
Causes of Obesity
-energy intake > expenditure
-genetics
-hormones (menopause, thyroidism)
-emotional/ psychological factors (stress)
-environmental factors (how were they raised)
Macronutrients
CHO (carbohydrate) = 4 kcal/g
PRO (protein) = 4 kcal/g
Fats = 9 kcal/g
*Alcohol = 7 kcal/g (not considered a macronutrient)
-are organic & digestible
-they can break down into component molecules
Component Molecules
Carbon
Hydrogen
Oxygen
*Nitrogen (only in PRO)
Carbohydrates (CHO)
-majority of calories in almost all diets
-source of energy (4 kcal/g)
-required for normal body fxn e.g. 100 mg/day glucose: brain fxn
2 Types:
1. Simple
2. Complex
Simple Carbohydrates (2)
1. Monosaccharides (travel to the liver)
-Glucose = Dextrose (released for cell use)
-Fructose (converted to glucose)
-Galactose (converted to glucose)
2. Disaccharides
-Maltose (Maltase→Glucose+Glucose)
-Sucrose (Sucrase→Glucose+Fructose)
-Lactose (Lactase→Glucose+Galactose)
Complex Carbohydrates
Polysaccharides (not sweet)
-Starch (1-4 hrs to digest 95%)
-Glycogen (stored in liver, & muscles)
-Fibre (not digested, forments in lrg intestine)
--soluble: delays absorption of glucose, delays/blocks absorption of cholesterol
--insoluble: ↑ fecal wt, ↑ transit time in intestine, relieves constipation
---may ↓ risk of colon cancer, diverticulosis, & type II diabetes
Glucose Homeostasis
serum glucose kept at a constant level by 2 hormones (both are synthesized, stored & secreted by the pancreas):
-glucagon
--stimulated by ↓glucose levels
--stimulates liver to convert glycogen→glucose
--assists in breaking down PRO→AAs
--stimulates liver into producing glucose from AAs
-insulin
--stimulated by ↑glucose levels
--required for glucose transport
--stimulates liver & muscle to take up glucose
Glycemic Index
a measure of how the ingestion of a particular food affects blood glucose & insulin levels
-does not take into account how much sugar a particular food contains, only how quickly the sugar is absorbed
Glycemic Load
-the body's glycemic response depends on the type of food eaten & the amt of CHO calories consumed
-the ↑ concentrated a CHO is, the more sugar it dumps into the blood
e.g. sugar from carrots is absorbed quickly in the bloodstream (↑ Glycemic Index), but not a lot of sugar to begin with (↓ Glycemic Load)
Carbohydrates to eat
One serving = 15g of CHO
-5-12 servings: Whole grains & cereals
-1 serving: Legumes (dried peas & beans)
-5-10 servings: Fruits/Vegetables
-Milk (considered a CHO)
-2+ servings of fibre daily
-↑ water intake
CHOOSE more COMPLEX carbs
Risk Factors of ↑ Sugar Consumption
-dental caries
-empty cal - no substance or nutrients
-hyperactivity
-Obesity
-Diabetes
Artificial Sweeteners
intensely sweet synthetic compounds that sweeten foods without providing calories (nonnutritive)
-1.6 to 2.6 cal/g
-Saccharin, Aspartame (Aspartic Acid + phenylalanine), Acesulfame-K, Sucralose
-incompletely absorbed
-do not promote dental caries
-can have laxative effect (e.g. bloating, gas, & diarrhea)
Carbohydrate Metabolism Disorders (3)
1. Lactose intolerance
-insufficient lactase (not an allergy)
-ingestion of lactose causes bloating, cramping, gas, diarrhea, nausea
2. Diabetes Type I
-insufficient insulin produced by pancreas
-no known etiology
3. Diabetes Type II
-body becomes less responsive/resistant to insulin
-combination of genetics, obesity, sedentary lifestyle
-can improve with diet restrictions
Lipids (Fats)
an oily organic compound insoluble in water but soluble in organic solvents
-triglycerides (fats, oils), phospholipids (lecithin), steroids (cholesterol)
Lipid Function
-energy 9 cal/g (not preferred energy source)
-support & protection for internal organs
-Temp. regulation (insulation)
-Absorption of Fat-soluble vitamins
-improves food flavour
-tenderizing & moisture (in baked goods)
-provide essential fatty acids (EFAs)
Triglycerides
-95% of fats in foods (fatty acids)
-glycerol combo w 3 of 5 different fatty acids
-major storage form of fat in the body
-transported through bloodstream by VLDL
2 types:
1. Saturated
2. Unsaturated
Saturated Fats
-fatty acid chains are 'saturated' w H+ ions (more stable than unsaturated)
-solid at room temp.
-↑ melting point
-mostly animal origin, a few plant sources (e.g. butter, whole milk, beef, coconut oil, palm kernel oil)
-the more saturated = ↑ risk for ↑ bad cholesterol (LDL) levels in blood
Unsaturated Fats
-soft/liquid at room temp.
-often referred to as monounsaturated (olive oil, peanut oil) or polyunsaturated (corn oil, safflower oil)
-↓ melting point
-susceptible to becoming rancid when exposed to light or O₂ for long periods of time
Hydrogenated Fats
-unsaturated vegetable oils that have been altered to become more saturated (corn, soybean, safflower, canola)
-done to improve stability of of the fat or oil, change its texture, ↑ functionality (i.e. flakier pie crusts, reusable for deep frying)
-any health benefits are eliminated w hydrogenation
-similar to unsaturated but classified as saturated
-trans-fats ↑ LDL (lousy) & ↓ HDL (healthy)
Omega 3 & 6
-EFAs (polyunsaturated) as body cannot produce
-both highly concentrated in the brain & are important for cognitive & behavioural fxn
Omega 6 (linolenic acid): in veggie & nut oils
-do not need to supplement
Omega 3 (α-linolenic acid): leafy green veggies, fish & plants oils
-reduce inflammatory response, ↓ blood clotting & plasma triglycerides (↓ risk of heart attack)
-need to supplement
Phospholipids
-occur naturally in almost all foods (e.g. liver, eggs, wheat germ, peanuts)
-vital fxn:
--emulsifiers to keep fats suspended in blood & body fluids
--component of all cell membranes, provide structure & help transport fat-soluble substances across the membrane, precursors of prostaglandins
Sterols
-group of steroids (cholesterol, sex hormones, cortisol, bile salts, Vit. D)
-in plant & animal foods, & produced by the body
-some steroids are synthesized from cholesterol
-fxn depends on individual steroid
Blood Cholesterol
-found in eggs, dairy, beef, pork
-synthesized by Liver
--diets ↑ in fats - even those ↓ in cholesterol = ↑ serum cholesterol levels for 2 reasons:
1. stimulates reabsorption of cholesterol back into the blood (↓ the amt of cholesterol lost in faces)
2. saturated fats are broken down & the liver cells use some of the products to produce cholesterol
High Cholesterol Risk Factors
-Male > 40 yrs
-Female > 50 yrs
-Post Menopausal
-Have Heart Disease or Diabetes
-↑ BP
-Obese, especially around the middle
-Smoker or Hx of smoking
-Strong family Hx of heart disease/↑ cholesterol
Lowering Cholesterol
-maintain a healthy wt
-eat a healthy, reduced-fat diet
-be physically active on a regular basis (20-30 min every day)
-don't smoke
-have your blood pressure checked regularly (work w physician)
-be aware of risk factors & warning signs of diabetes (work w health care professional)
Digestion of Lipids
-lipids reach the stomach unchanged, mechanical digestion & gastric lipase chemically digests fats (minimal)
-presence of fat in sml intestine stimulates the release of bile from the gall bladder
-bile emulifies fats in order to ↑ surface area for digestive enzymes
-pancreatic lipase breaks up triglycerides into fatty acid & glyceride which are absorbed into the cells in the intestinal wall
Absorption of Lipids
-95% consumed fat is absorbed - 5% is excreted in faces
-sml fat molecules are surround by bile salts & dissolved in the sml intestine before being absorbed into intestinal cells→blood stream→liver
Metabolism of Lipids
-once in blood stream, lipids must be transported to body cells by lipoproteins (lipid+proteins produced by liver & sml intestine)
-used for ATP or stored in adipose tissue
-Lipoproteins are classified according to the ratio of lipids to protein
-4 major categories, chylomicrons, very low density (VLDL), low density (LDL), high density (HDL)
Fats & Healthy Eating
-20-35% cal in food/day
-limit saturated & trans-fat (less solid fat)
-choose oils not solid fat
--monosaturated
--omega-3 fats (2-3 times/week)
-minimize cholesterol intake
High Fat Diets...
can lead to:
-Cardiovascular disease
-Cancer
-Obesity
Low Fat Diets...
-are not for everyone!
-certain medical conditions require diets higher in fat e.g. renal failure pts, elderly, anorexia nervosa
-children under 2 yrs - require ↑ fat for development
Protein
-lrg complex molecules composed of amino acids (AA)
-20 common types (must be available for cells to synthesize proteins)
--9: essential via food
--11: synthesized by liver
-b/c of its nitrogen content, protein is used as a building source for new body cells
Digestion review
-begins in the stomach where:
--HCL denatures proteins
--enzyme pepsin breaks down protein into polypeptides & some AAs
-Then the sml intestine:
--site of most protein digestion
--pancreatic protease ↓ polypeptides to smller chains & AAs
--peptidases break the remaining peptide bonds to produce AAs
Absorption & Metabolism
-absorbed by intestinal mucosa w the aid of Vit B6
-released into the blood stream to the liver
-liver distributes AAs to the cells as required or stores them
Nitrogen Balance
-reflects the state of balance btwn protein breakdown & protein synthesis
Positive nitrogen balance: when protein synthesis exceeds protein breakdown
-too much nitrogen
Negative nitrogen balance: an undesirable state that occurs when protein breakdown exceeds protein synthesis
-deficit of nitrogen
Proteins to Eat
-energy 4 cal/g
-12-20% of total energy intake
-good sources: meats, poultry, seafood, dairy, eggs, soy, legumes, whole grains, nuts
-fruits & veggies have little protein
Complete: contain all 9 essential AAs
-all animal sources & soy
Incomplete: do not contain all 9 essential AAs
-plant proteins
-can be combined to ↑ overall nutrient value (complimentary proteins) e.g. black beans & rice
Vegetarian Diets (3)
1. Vegans: no animal products
2. Lacto-vegans: no animal products, except milk
3. Lacto-ovovegans: no animal products, except milk & egg
Health risks of Vegetarian Diets
-may lack essential nutrients
--deficit in: iron, protein, Vit. B12, Vit. D, Ca, Zn
-may consume excessive fat & cholesterol if relying heavily on dairy, eggs, nuts, etc.
↑ Protein Diets work b/c...
1. ↑ PRO foods stay in the stomach longer & promote feeling of fullness
2. Slow & steady effects on serum glucose levels, don't raise levels sharply like simple sugars so you don't feel as hungry
3. Body uses more energy to digest PRO than CHO
Health Risks of ↑ High Protein
-↑ PRO animal sources are usually ↑ in saturated fat & cholesterol
-↑ fat & cholesterol raise risk of CAD, stroke, CA
-Osteoporosis (digestion of PRO requires Ca+ - may be pulled from bones)
-do not provide some essential vitamins, minerals, fibre & other nutritional elements
-↑ risk for kidney & liver disorders
Protein Disorders (3)
1. Sickle cell anemia:
-recessive genetic disorder, missing protein causes RBCs to be misshapen, hard & sticky
-↑ clogging & breakage
2. Cystic Fibrosis:
-genetic disorder caused by an abnormal protein that prevents passage of Cl- in & out of certain cells (affects respiratory & GI)
3. PKU (phenylketonuria):
-genetic disease where a specific enzyme is missing that is required to break down the AA phenylalanine
-built up phenylalanine results in brain damage
Protein-Energy Malnutrition (PEM)
-d/t chronic & inadequate protein & energy requirements
-associated w developing countries
-In Canada, associated w AIDS, CA, homeless, eating disorders, drug & alcohol addicts
-reduced albumin (<3.5 mg/dL) related to impaired body processes
-Kwashiorkor: condition of PRO deficiency, results from acute critical illness
-Marasmus or protein-calorie malnutrition (PCM): occurs 2° to chronic diseases
Risk Factors for Obesity
-↑fatty & sugar foods
-↓fruit & veggies consumption
-↑portion sizes
-↓physical activity (sedentary lifestyle)
Complications of Obesity
-insulin resistance, type 2 diabetes, hypertension, dyslipidemia (↑blood cholesterol), CVD, stroke, gallstones & cholecystitis, sleep apnea, respiratory dysfunction, ↑incidence of certain CA
-a modest wt loss of 5% to 10% of initial body wt is associated w significant improvements in blood pressure, cholesterol & plasma lipid levels & blood glucose levels
Leading causes of death associated with Obesity (6)
1. Coronary Heart Disease
2. Cancer
3. Stroke
4. Chronic lower respiratory diseases
5. Diabetes
6. Accidents (unintentional injuries)
Body Fat Distribution
-Android obesity: fat is located largely in the waist & abdomen "apple-shaped"
--associated w ↑risk of heart disease, hypertension, & Type II diabetes
--fat goes straight to the liver via the portal vein & made into LDL (lousy) = ↑atherosclerosis
-- encouraged by ↑testosterone
-Gynecoid obesity: fat deposits are located primarily below the waist in the hips & thighs "pear-shaped"
--health risks are < than those associated w Android Obesity
--encouraged by Estrogen & Progesterone
Hunger
-controlled by internal body mechanisms
-organs such as the brain & liver interact w hormones, the nervous system, & other aspects of body physiology to influence eating behaviour
-hypothalamus: the satiety regulator
--the hormone leptin (linked to adipose tissue) regulates eating behaviour
--↑ adipose tissue = ↑leptin →satiety (full to satisfaction)
--Ghrelin (a protein) acts as a hormone to ↓energy expenditure & ↑appetite
--produce by the stomach cells
--triggers the desire to eat
Exercise
-essential to wt loss
-maintenance of wt
-lowers rates of morbidity/mortality
Drug therapy
-appetite suppressants
-nutrient absorption (blocking drugs)
-drugs will not cure obesity
-evaluation of other medical conditions
Surgical Intervention
-most effective Tx for severe obesity
-appropriate for clients whose BMI is 35-39.9
Works by:
1. Restricting the stomach's capacity
2. Creating malabsorption of nutrients & calories
3. A combination of both
Laparoscopic adjustable gastric banding (LAGB)
-inflatable band encircles the uppermost stomach & is buckled
-sml pouch of 15-30mL capacity is created w a limited outlet btwn the pouch
Gastric Bypass
-stapling stomach to create 30-45mL gastric pouch
-create upper & lower pouch & disconnecting pouches
-create upper pouch & removing lower pouch
-greatest rate of wt loss during 1st year (stabilizes after 18 months
-Dumping Syndrome (side effect): rapid emptying of the stomach contents into the sml intestine
--occurs 10-20min postprandially (after a meal)
--S&S nausea, & abdominal distention, flatulence, pain, diarrhea, &/or tachycardia, postural hypotension, weakness, syncope (fainting)
-deficiency of iron, calcium, vitamin B₁₂
Eating Disorders vs Disordered Eating
Eating Disorder: psychiatric condition involving extreme body dissatisfaction & long term eating patterns harming the body
-Anorexia Nervosa
-Bulimia Nervosa
Disordered Eating: variety of abnormal or atypical eating behaviours used to reduce wt
-Binge-Eating
-Chronic Dieting
Anorexia Nervosa
-↑ mortality: electrolyte imbalance
-medical disorder in which unhealthy behaviours are used to maintain a body wt < 85% of expected wt
S&S:
-extremely restrictive eating practices
-tooth decay
-self-starvation
-intense fear of wt gain
-amenorrhea: no menstrual periods for min 3 mths
-unhealthy body image
Anorexia Nervosa Health risks
-electrolyte imbalance
-cardiovascular problems
-gastrointestinal problems
-bone problems leading to osteoporosis
Bulimia Nervosa
-eating disorder characterized by binge eating followed by purging
-binge eating: eating a lrg amt of food in a short period of time
-purging: an attempt to rid the body of unwanted food by vomiting, laxatives, fasting, excessive exercise or other means
S&S:
-recurrent episodes of binge eating
-recurrent inappropriate behaviour to compensate for binge eating
-binge eating occurs on average at least twice a week for 3 mths
-negative body image
Bulimia Nervosa Health Risks
-electrolyte imbalance - caused by dehydration & loss of Na+ & K ions from vomiting
-Gastrointestinal problems
-dental problems
-calluses on backs of hands or knuckles
-swelling of the cheeks or jaw area
Binge-Eating Disorder S&S
-often overweight
-a sense of lack of control during binging
-chaotic eating behaviours (eating too fast, too much, in private)
-negative self-esteem, poor body image
-often associated w depression, substance abuse, anxiety disorders
Binge-Eating Disorder Health Risks
-↑ risk of overweight or obesity
-foods eaten during binging are often high in fat & sugar
-stress leads to psychological effects
Chronic Dieting S&S
-preoccupation w food, wt, calories
-strict dieting
-excessive exercise
-loss of concentration; mood swings
-↑ criticism of body shape
Chronic Dieting Health Risks
-poor nutrient & energy intakes
-Insufficient caloric intake causing low vitamin & mineral intake
-↓ energy expenditure d/t a reduced basal metabolic rate
-↓ ability to exercise
-↑ risk of eating disorder
Complementary & Alternative Medicine (CAM)
-Complementary medicine: non-western healing approaches used at same time as conventional medicine
-Alternative medicine: replaces conventional medical Tx
-Integrative medicine: merges conventional medical therapies w CAM modalities for which safety & efficacy
--hospital-based integrative medical centres available under direction of physicians & other conventional health professionals
Why use CAM?
dissatisfaction w health care providers & medical outcomes (looking for 'cures')
-side effects of drugs & Tx
-↑ health costs
-technology
-lack of control in their own health care practices (empowerment)
-Health care providers provide 3T's (touch, talk, time)
Biological cures
St. John's Wart- helps depression
Ginger- helps stomach irritation
Garlic- thins blood
Nutraceutical
"nutrition" & "pharmaceutical"
-a food or part of food or nutrient, that provides health benefits, including the prevention & Tx of a disease
Dietary Supplements
-substances consumed orally as addition to dietary intake (considered food, not drugs)
-supplements may include 1+ of the following:
--minerals, vitamins, AAs, herbs, plant extracts, enzymes, metabolites & organ tissues
--processed into tablets, liquids, capsules, extracts, powders, concentrates, gel caps
Regulation & labeling
-regulation controls identity, potency, contents & labelling
-free of contaminants or impurities, such as natural toxins, bacteria, pesticides, glass, lead or other substances
-state amt of dietary ingredient
-properly packaged
-ingredients are properly handled
-warnings are not required
-often supplements are self-prescribed
Common Herbals
Aloe vera: anti-inflammatory, wound healing
Evening Primrose oil: PMS, Tx of atopic eczema
Garlic: antibacterial, antifungal, antithrombotic, antiinflammatory
Ginger: carminative (relieves gas pain), antiemetic, Tx of dizziness
Ginseng: Adaptogen (immunity booster)
Green Tea: antioxidant, ↓ risk of CVD, enhances humoral & cell mediated immunity
Vegetables, fruits, whole grain, herbs, nuts & various seeds have been associated w protection/Tx of certain disease conditions
Risk Factors of drug-nutrient Interactions
-age (elderly & young)
-pregnant women & fetus (crosses placenta barrier)
-physiologic status
-multiple drug intake (polypharmacy)
-GI disorders & Hepatic & renal function (impaired absorption)
-Typical dietary intake
Dietary Reference Intakes (DRI)
series of 8 in-depth reports featuring a new set of references
-a group name that includes 4 separate reference values:
1. Updated RDAs
2. estimated average requirement (EAR)
3. adequate intake (AI)
4. upper intake level (UL)
Serving size
-specific amt of food listed under the "nutrition facts" title
-all nutrient information is based on this amt of food
-listed in common measures you use at home
% Daily Value
-can make it easier to compare foods
-helps you see if a food has a lot or a little of a nutrient
-provides a context to the actual amt of a nutrient
Organic Food standards and labels
100% organic:
-all ingredients meet or exceed USDA specifications for organic foods
Organic:
-at least 95% of ingredients meet or exceed USDA specifications for organic foods
Made with Organic ingredients:
-at least 70% of ingredients meet or exceed USDA specifications for organic foods
Food quality concerns
-eating plan won't help if the food has been improperly stored or overly processed
-the more that is done to a food, the greater the loss of naturally present nutrients
-vitamins, minerals, & fibre are vulnerable to the effects of food processing
Functional Food
A food that may provide a health benefit beyond basic nutrition
-"phoods": blend of food & pharmacy
-1+ functional ingredient added (e.g. vitamin water, energy drinks)
Genetically Modified Organism (GMO)
-food that has been altered using genetic engineering techniques (e.g. sustaining food using insecticides, fungicides, & rodenticides)
-improves nutrient content, ↑ crop or animal yields, inhibits spoilage, & enhances product
-does not require mandatory labelling unless it contains new allergens
Nutrition & Pregnancy
-Hormonal changes
-Metabolic changes
-Weight gain
-Energy needs
-Nutrient needs
Hormonal changes during Pregnancy (2)
1. GI tract slows down
-↑ absorption of nutrients (e.g. iron & Ca+)
- = constipation, heartburn, & delayed gastric emptying
2. ↑ excretion of Na+
-Na+ restriction during pregnancy can be harmful = ↓ plasma volume & CO
Metabolic changes during Pregnancy (2)
1. BMR ↑ by 15-20% (d/t ↑ O₂ needs)
- = need for ↑ macro & micronutrients
2. Altered metabolism of macronutrients
- fetus needs glucose so maternal glucose is spared for fetus & maternal break down of fat for energy ↑ to compensate
Weight Gain changes during Pregnancy (3)
1. Poor wt gain may lead to intrauterine growth retardation
-infant mortality is partially a reflection of maternal wt gain
2. Weight gain should be consistent throughout pregnancy, as each trimester is important to the development of the fetus
3. Being overweight ↑ risk for C-sections, gestational diabetes, ↑ post-partum wt
Energy Needs during Pregnancy (2)
1. An additional 300 kcal
-assuming mother is normal BMI prior to pregnancy
2. Not the time to lose wt
-especially problematic w teenage girls
Nutrient Needs during Pregnancy (6)
1. PRO needs ↑
-usually not a problem for women in NA
2. Vitamin D
-deficiency can result in preeclampsia, insulin resistance, low birth wt
3. Vitamin A
-deficiency is associated w ↑ morbidity & mortality
4. Folate Acid
-defects = spina bifida & anencephaly (forebrain & cerebrum are missing)
5. Iron
-difficult to take in w foods, supplementation recommended
6. Calcium
-does not ↑ during pregnancy
Teratogens During Pregnancy (4)
anything that adversely affects normal cellular development in the embryo or fetus
1. Caffeine:-may alter DNA, circulating numbers of neurotransmitters, ↑ blood pressure
2. Drugs
3. Alcohol:- there is no safe level during pregnancy
4. Tobacco:- ↑ risk for prematurity, low birth wt, placenta previa (implanted in lower uterine segment), abruptio placentae (premature detachment of placenta from uterine implantation site), SIDS
Nutrition Problems in Pregnancy (4)
1. N&V: common during 1st trimester, usually subsides w 2nd trimester
-occurs at any time
-caused by ↑ hormone
2. Hyperemesis gravidarum: severe N&V that persists into 2nd trimester = F&E imbalances
-IV replacements & parenteral nutrition may be necessary
3. Heartburn: usually late in pregnancy, caused by uterus pushing up on stomach & relaxation of GI smooth muscle
-eat sml frequent meals, avoid ↑ fat food, drink fluids btwn meals, limit spicy food, no napping for 1-2 hrs after eating
4. Constipation: 1st & 3rd trimesters
-↑ whole grains, fresh fruit, raw veggies, fluids, daily walks
Energy & Nutrient Needs During Lactation
-BMR returns to normal pre-prego state
-Milk production burns 500-800 kcal/day
-↑ needs for protein, vitamins, & minerals
-no specific food restrictions - trial & error as to what upsets baby
-the 750-1000mL/day of milk produced needs to be replaced w fluid
-Caffeine & alcohol pass into breast milk
Contraindications to Breastfeeding
-active TB, HIV, alcohol & drug addiction, Hepatitis C
-Instruct moms to discuss use of any drugs, including OTC & herbal w physician or pharmacist
Energy Needs During Infancy (3)
1. Wt triples, length ↑ 50%
2. organs & brain are still developing
3. adequate energy intake is shown by satisfactory wt & ht as measured on growth chart
Nutrient Needs During Infancy (4)
1. Fat- for brain & nervous system development, breast milk is ↑ in fat
2. Protein- needs ↑ during first 4 months
3. Iron- supplements not usually necessary for breast fed infants, choose formulas that are iron fortified
4. Vitamin D- breast fed or infants fed w rice or soy beverages should be supplemented
Foods During Infancy
Birth-6 months
-exclusive breastfeeding (10-12 times/24 hrs) or bottle (every 4 hrs)
-Vit. D supplements for breastfed babies
6-9 months
-Iron needs ↑ as stores depleted, breast milk changes & does not supply enough iron
-start w iron fortified cereals
-continue to breast/bottle feed
- introduce finger foods (e.g. cooked veggies & soft fruits)
9-12 months
-offer foods 6 times/day, & by 1 yr should be eating regular meals w the family
Special considerations for Foods During Infancy
-juice
-milk
-eggs
-cow's milk
-peanuts
-allergies
-jar foods (commercial)
Nutritional Concerns During Infancy (4)
1. Preemies (<37 wks) or low birth wt (<5lbs)
-immature GI, insufficient production of digestive enzymes, inadequate energy & mineral reserves
-suck-swallow reflex immature or absent
2. Require ↑ PRO, calories, calcium, phosphorus, sodium, iron, zinc, vitamin E, fluids
3. Breastmilk & special supplements
4. PKU
-hereditary disorder where unused phenylalanine builds up in the blood = CNS damage & mental retardation
-phenylalanine essential for synthesis of tyrosine, a non essential AA
-requires ↓ PRO diet, & limited phenylalanine intake
Nutritional Needs During Childhood
-growth patterns fluctuate (1-12 yrs)
-↑ PRO, iron, Ca+, Zn
-Adults determine what & when, children determine how much
-nutrient denses snacks are necessary
-↑ fat intake until 2 yrs old
Nutritional Needs During Childhood: 1-3 yrs
-mealtimes are driven by hunger, not schedule
-sml amts eaten at mealtimes, encourage healthy snacks
-average 1300 cal/day then 1800 cal/day at age 4-6, PRO needs jump from 16g to 24g
-no skim milk until age 2
-tend to fill up on fluids rather than foods, limit cups/bottles
Nutritional Needs During Childhood: 7-12 yrs
-growth may slow down
-normal to gain pre puberty wt, not a problem if child is active
-remind to stop eating if full, offer fluids regularly
-healthy after school snacks
-2000-2200 cal/day, PRO 28-46g (boys need more generally, girls need most post menarche)
-Iron & Zn needs ↑
Nutritional Needs During Adolescence: 13-19 yrs
-regular meal times/consistency equally important
-females require 2200 cal & 45g PRO
-males 2500-2900 & 45-59g PRO (muscle mass continues to develop)
-Ca+ 1300mg/day for both
Nutrition During Adulthood 20-50 yrs
20-30s
-energy needs 2200 (F) & 2900 (M)
-PRO needs ↑ 46-50g (F) & 58-63g (M)
-Ca+ needs ↓ to 1000mg
-after 30, cell metabolism slows down
40-50s
-energy needs 1900 (F) & 2300 (M)
-PRO needs stay the same
-Iron for women ↓ d/t menopause
-alterations in taste & smell, saliva secretions, swallowing difficulties, liver function, GI function all change nutritional status
Nutrition During Adulthood 60-90 yrs
60-80s
-food issues (physical, mental, emotional)
-Vit. deficiencies (B₁₂) & dehydration an issues
-Vit. D requirement ↑ as ability to synthesize ↓
-digestion & absorption ↓ d/t ↓gastric juices & intestinal enzyme production
-↓ intrinsic factor required for B₁₂ absorption, supplements recommended
-Zn deficiency: ↓ taste
-constipation is an issue
-dental health alters food intake
80-90s
-↑ inability to absorb & synthesize
-malnutrition & underweight are an issue
-dehydration an issue
Fluid Volume Imbalances
-an ↑ or ↓ in total body fluid or an altered distribution of body fluids
-Fluid volume deficit & fluid volume excess
Fluid Volume Deficit
ECF deficits = significant ECF loss or displacement into interstitial spaces
-can be d/t ↓ body water, excessive fluid loss or inadequate fluid intake, relative ↓ in fluid shifts from intravascular to interstitial (3rd spacing=edema)
-pts w gross edema can actually be clinically dehydrated
Fluid Volume Deficit Etiologies
-use of diuretics
-burns
-ascites
-hypovolemia (↓ blood volume)
-N/V
-loss of electrolytes (Na+ pulls H₂O w it)
-Diabetes
-Diarrhea
Fluid Volume Deficit Tx
-IV therapy to correct or prevent fluid & electrolyte disturbances
-Oral is preferable if tolerated by pt
-Isotonic solutions used (NS, RL)
Fluid Volume Deficit Nursing Diagnosis
-fluid volume related to...
-altered oral mucous membrane related to dehydration
-altered tissue perfusion
-risk of injury related to confusion
Fluid Volume Excess
-caused by expansion of the ECF
-usually d/t cardiac dysfunction
-always 2° to ↑ total body Na+ content (H₂O follows Na+)
Fluid Volume Excess Etiology
-excessive intake (oral or IV)
-excessive irrigation of body cavities
-pulmonary edema
-Cirrhosis
-endocrine dysfunction
-hypotonic fluids used to replace isotonic fluid losses
--aka water intoxication
Fluid Volume Excess Tx
-directed toward Na+ & fluid restriction
-administration of diuretics
-Tx of underlying causes
Major Components of IV therapy (3)
1. Water
2. Carbohydrates: glucose conserves PRO (PRO required to keep fluid in the intravascular spaces)
3. Electrolytes: most common are Na, K, Cl; most commonly used can include Mg, Ph, Ca, bicarbonate ions
-Hypotonic fluids: osmolarity is < blood, which shifts fluid from blood vessels into cells & interstitial spaces
--purpose is to hydrate cells & ↓ serum Na levels
-Isotonic fluids: osmolarity = blood, expands the intravascular space
--can cause circulatory overload as fluids don't shift to other compartments
-Hypertonic fluids: osmolarity is > blood, shifts ECF from the interstitial fluid into the plasma
--replaces electrolytes, but irritating to vein walls (may cause circulatory overload)
Medications that Cause Fluid & Electrolyte Imbalances (5)
1. Diuretics: hyperkalemia, hypokalemia
2. Potassium supplements: hyperkalemia, GI disturbances
3. Antibiotics: hyperkalemia, hypernatremia (↑ Na+)
4. Calcium carbonate: hypercalcemia
5. Magnesium hydroxide (milk of magnesia): hypokalemia
Measuring Intake & Output
Intake includes: all liquids by mouth (jello, juice, water, soup, ice cream), through any tubes (including flushes & meds in liquid form), IV fluids, blood & blood components
Output includes: urine (via catheter or toilet), diarrhea, vomit, gastric secretions, surgical wound drainage
-measured over 24 hrs
-identifies at risk clients for fluid & electrolyte disturbances
-used for clients post-op, febrile, fluid restricted, receiving diuretics or IV therapy, cardiopulmonary, renal conditions, deteriorating health status
-nursing & pt intervention
Health Care Professionals & Nutrition (4)
1. Nurses
-monitor, maintain, assess, document)
2. Registered Dietician
-Nutritional assessments, nutritional therapy, resource for staff
3. Doctor
-prescribe diets & nutritional therapy as suggest by RD
-only a Internist (internal medicine doc) can order TPN (Total Parenternal Nutrition)
4. Pharmacist
-prepare TPN, monitor medications, may write orders in specific circumstances
Nursing Assessment & Nutrition
-must be completed w/in 24 hrs of admission
-refer to pt database
-completed in any setting
-helps complete early intervention goals
-helps determine need for nutrition assessment
-cost effective
Hospital Patients become Malnourished b/c
-stress
-illness
-iatrogenic (caused by Tx e.g chemotherapy)
-psychiatric disorders (e.g. anorexia)
-limited food choices (cultural & personal preference)
-up to 40% of pt are malnourished
-recovery influenced by nutritional status
Hospital food refused b/c
-it is unfamiliar
-tasteless (e.g. cooked w/out salt)
-inappropriate texture (e.g. pureed meat)
-religiously or culturally unacceptable
-served at a time the pt is unaccustomed to eating at
-meals may be w/held or missed
-inadequate liquid diets may not be advanced timely enough
Nursing Process Review
Nutrition Assessment
-ABCD (Anthropometrics, Biochemical, Clinical, Diet)
Nutrition Diagnosis
Nutrition Intervention
Nutrition monitoring & evaluation

Nutritional Risk <5 yrs, & > 75yrs
Nutrition Assessment (ABCD)
A- ht, wt, head circumference (infants), BMI
B- routine lab work (e.g. blood, urine), serum albumin, prealbumin, WBC count
C- med Hx, social Hx, physical examination
D- 24 hr diet recall, intake & output
Nutrition Diagnosis
-actual or potential problems
-Fluid Volume Deficit
-Fluid Volume Excess
-infant feeding pattern, ineffective
-Nutrition: altered, < body requires, or > body requires
-Swallowing, impaired
-Diarrhea
....etc
Nutrition Interventions (4)
1. Health Promotion
-teaching, counselling, identifying strengths & willingness to make lifestyle changes
2. Advancing Diets
-careful assessment, involvement w Dr/dietician
3. Promoting Appetite
-eliminate odors, assist w mouth care, be aware meds can alter taste or metabolism
4. Assist with Feeding
-promote safety (alertness, dysphagia), protect dignity & independence
Types of Therapeutic Diets
-NPO: nothing by mouth
-ac
-pc
-DAT
-NKA
-GI: Gastroinstestinal
-TPN: Total Parenternal Nutrition
-NG tube: Nasogastric tube
-TF: Tube feeding
-Dysphagia: inability or difficulty to swallow
-CF: clear fluids (e.g jello)
-FF: full fluids (e.g. ice cream)
-Soft: bland diet, ↓ fibre
-Reg: modified texture, no raw foods
Enteral Nutrition by Nasogastric tube
nourishment provided through the stomach rather than by the oral route
-tube is passed through nose to the stomach
-pt unable or unwilling to take nutrition orally, but GI is still functioning
-inserted by physician
Enteral Nutrition by Nasoduodenal tube
nourishment provided through the small intestine rather than by the oral route
-tube is passed through nose to duodenum
-inserted by physician
Enteral Nutrition by PEG
Percutaneous Endoscopic Gastrostomy
-inserted through skin into the stomach (g-tube) or into the jejunum (j-tube)
-can have a dual lumen tube w one end in the stomach, the other in the jejunum (J-G tube)
-inserted by physician
Types of Enteral Formulas (3)
1. Intact: contain unaltered molecules of PRO, CHO, fats (best for those who can digest & absorb nutrients
2. Hydrolyzed (monomeric): contain predigested PRO & simple CHO, + sml amt of fat (good for those who lack ability to digest, or who have sml absorption area-tubes inserted in lower GI)
3. Modular: incomplete liquid supplement that contains specific nutrients, usually single macronutrient (CHO, PRO, fat)
-complex to design & may fail to meet pt nutritional needs
Enteral Feeding System
-prescribed by a physician as recommended by a Dietician
-Formulas at room temp. at ↑ risk for bacterial growth (b/c ↑ sugar content)
-systems changed completely every 24 hrs
-bags rinsed periodically & refrigerated when not in use
-feedings can be intermittent or continuous
Assess tolerance to feeds
-Bowel Sounds
-frequency & consistency of bowel movements
-S&S: N/V
-measure ABD girth
-abdominal bloating, cramping, distention
-measure residuals Q4-6h or before intermittent feed
S&S of Aspiration
-coughing
-gasping
-phlegm (color & consistency)
-↑ Temp, RR,
HOB elevated > or = 30°
Tube Feed Complications (3)
1. GI problems: diarrhea, N&V, cramping, distention, constipation
2. Mechanical: obstruction, displacement, aspiration, irritation
3. Metabolic: dehydration, over hydration, abnormal serum Na, K, Ph, Mg, hyperglycemia, rapid wt gain
Home Enteral Nutrition Criteria
-Nutritional needs cannot be met orally
-Tolerating TF
-Demonstrate ability to manage by self
-Stable disease process
-Affordable
Home care nursing monitors
Parenteral Nutrition
The administration of nutritional support via the intravenous route.
-Can be administered centrally (TPN) into a large diameter vein (subclavian-superior vena cava)
-or peripherally through (PPN) or PICC into a smaller vein
-solutions & tubing change every 24hrs
TPN Components
Complete Nutrition
-CHO: 3.4 kcal/g
-AAs: essential & nonessential
-Fats: 1.1-2.0 kcal/mL
-Electrolytes: Mg, K, Ph needs ↑ w malnourished
-Vitamins: except Vit. K
-Trace elements: Zn, Cu, Cr, Mn
-specific nutrients: if deficiencies identified
TPN Complications (3)
1. Technical complications
-catheter placement
2. Septic complications
-blood infection, local or systemic, result of aseptic catheter care
3. Metabolic complications
-hyperglycemia
TPN at Home
-promotes independence
-specialized catheter to reduce risk of infection
-solutions & tubing must be changed every 24 hrs (pt must come into hospital)
Transitional Feedings
-from parenteral/tube to oral requires individualized weaning
-Parenteral to Oral or Tube
--long term PN results in atrophy of GI tract
--possible complications include delayed gastric emptying, N/V, diarrhea
--PN is tapered as oral/tube introduced
--strict intake/output assessment
Immune System
-impaired nutritional status affects the immune system→further impairs nutritional status
-malnutrition & infection caused by:
--severe medical problems
--major metabolic stress
--disease process - causes metabolic stress/impaired nutrition/impaired immune system
--poor nutritional status - usually related to poverty
Stress Response
-body's response depends on the magnitude & duration of the stressor
-uncomplicated stress: altered food intake or activity level
-complicated stress: trauma or disease (multi causal)
Severe Stress
-↑ BMR (hypermetabolic): ↑ need of PRO, Vit, Min., total calories
-Initial injury phase (acute, nutrition not a concern)
-W/in 36-48 hrs post initial stress/injury (↑N excretion, & breakdown of macronutrients to meet ↑BMR needs)
-Tissue repair relies on Vit. C, Zn, Ca, Mg, Mn, Cu
-fluid requirements ↑ (based on age)
Starvation
-involuntary
-body extracts macro nutrients from storage (muscles & organs)
-Glycogen stored in liver used for cellular energy is depleted after 12-24 hrs of fasting
-once glycogen stores are used up the body switches to fat (from adipose tissue) for energy for metabolism
-body requires glucose, will break down muscle PRO to form glucose (minimal)
-90% of calories come from fat stores & 5-8% from PRO
-BMR slows down to conserve energy (hypometabolic)
--↓body temp, ↓activity level, ↑sleep
Surgery & Nutrition
-for successful surgery malnourished pt needs to be identified to arrange corrective action
-Before surgery: pt typically limited to NPO to prevent aspiration (from vomiting)
-oral intake resumed when:
--Bowel sounds return (24-48 hrs post op)
-Post op diet usually progresses from clear liquid → solid foods as tolerated
Burns & Nutrition
1st 24-48 hrs:
-dedicated to fluid & electrolyte replacement (based on age, wt, extent of burn)
-Total body surface area (TBSA) used to estimate extent of burn
-wounds heal when pt is in a anabolic state
--feeding begun as soon as pt has been hydrated
-very early enteral feeding (w/in 6-8hrs of hospitalization)
--↓ hyper catabolic response
--↓ release of catecholamines & glucagon
--↓ wt loss
--↓ length of hospital stay
Nausea & Vomiting (emesis)
-prolonged vomiting = hyperemesis
--loss of nutrients, fluids, electrolytes
--dehydration, electrolyte imbalance, wt loss
-meds
--antiemetics e.g. gravol or dimenhydronate
N/V Dietary measures
-NPO for several hours
-clear liquids if tolerated, progress as tolerated
-IV fluids if liquids not tolerate
-Parenteral Nutrition if severe, though ↑ enteral nutrition is used for hyperemesis of pregnancy
Dysphagia
-chewing or swallowing difficulties
--generally the result of neurological damage
--SLP (Speech Language Therapist) evaluates swallowing ability
--thickened liquids are easier to swallow than thin d/t control
-aspects of concern:
--bolus consistency
--pt positioning (high-fowlers)
--feeding rate
--specific swallowing techniques (Lt side Stroke pt, eats on Rt side)
-Speech Therapist teaches pt compensating technique
GERD
Gastro Esophageal Reflux Disease
-backwards flow of the stomach &/or duodenal contents into the esophagus
S&S: burning/discomfort sensation during or after eating, especially in evening
Hiatal Hernia
-an out pouching of a portion of the stomach into the chest through the esophageal hiatus of the diaphragm
S&S: heart burn after heavy meals or with reclining after meals
Disorders of the Stomach (3)
1. Indigestion: epigastric discomfort following meals
-ABD pain, bloating, nausea, regurgitation, belching
2. Gastritis: not a single disease but several conditions that have inflammation of the stomach lining
-N/V, malaise, anorexia, hemorrhage, epigastric pain, melena (caused by stomach ulcer)
-promoted by NSAIDs, NSAs, Alcohol
3. Peptic Ulcer Disease: H. Pylori infection, Gastritis, stress ulcers, use of NSAIDs & corticosteroids
-involves ulcers in stomach & duodenal areas
Helicobacter Pylori (H. Pylori)
-bacteria, resistant to acid
-damages mucosa
-treat w bismuth, antibiotics, antisecretory agents
-causes 92% duodenal ulcers, 70% gastric ulcers
Peptic Ulcer Disease Diet Tx
-reduce reg. & decaf. coffee, cocoa, & tea intake
-no alcohol or pepper/spices
-avoid low pH juices (if they cause problems)
-avoid irritating foods
-avoid eating before bed
-eat at least 3 sml meals/day (6 is better)
Gastric Surgery
-indicated when ulcer complicated by:
--hemorrhage
--perforation
--obstruction
--Intractability (difficult to manage, cure)
Dumping Syndrome
complex physiologic response to the rapid emptying of hypertonic contents into the duodenum & jejunum
-symptoms occur 10-20 min postprandially (after meal)
-Nausea & ADB distention, flatulence, pain, diarrhea, &/or vasomotor symptoms (tachycardia, postural hypotension, weakness, syncope (fainting)
-reactive hypoglycemia 1-3 hrs
Causes of Constipation - Gastrointestinal
-diseases of the upper GI tract (Celiac, duodenal ulcer, gastric ulcer, cystic fibrosis)
-diseases of the large bowel = colonic inertia, outlet obstruction
-irritable bowel syndrome
-anal fissures or hemorrhoids
-laxative abuse
Causes of Constipation - Systemic
-side effect of medication (T3)
-lack of exercise
-prolonged bedrest
-ignoring urge to defecate
-vascular disease of the large bowel
-poor diet, low in fibre, low in fluid
-pregnancy
Diarrhea
-symptom, not a disease
-Acute: short duration, usually result of enteritis (inflammation of sml intestine), can also be side effect of meds, caused by change in diet, or emotional stress
-Chronic: longer than 1-2 wks, usually the result of GI irritation, malabsorption
-could be restricted to NPO, or BRAT diet (bananas, rice, apple sauce, tea)
Immune Mediated Food Allergies
-an immune response to PRO w release of antibodies & histamine
--immediate onset: most severe form (anaphylactic shock)
--delayed onset: disrupts quality of life, generally not life threatening, GI problems/intolerance
-Testing: RAST blood test (radioallergosorbent test), skin ****s, elimination diet; no test infallible, but helps predict
Celiac Disease
-gluten-sensitive enteropathy
-chronic autoimmune disorder
--mucosa of the sml intestine (esp duodenum & proximal jejunum)
--damaged by gluten
S&S: diarrhea, ABD distention, fat malabsorption (fatty, foul, floats - Steatorrhea), wt loss
Results of Malabsorption
-severe nutritional deficiency
-wt loss
-muscle cramping d/t ↓ Vit. D, Ca, K levels
-inadequate blood coagulation (vit. K deficit)
-macrocytic anemia of the pernicious anemia type (Vit. B₁₂ & folate malabsorption)
Lactose Intolerance
most common disaccharide disorder (lactase deficiency-enzyme the hydrolyzes lactose into glucose & galactose)
-undigested lactose remains in intestine = ABD cramping, flatulence, diarrhea
Irritable Bowel Syndrome
recurrent abdominal pain and diarrhea (often alternating with periods of constipation), & bloating
Diverticular Disease
-musculature of the bowel walls weakens (diverticula develop)
--develops as result of long-term, low-fiber eating habits, ↑ intracolonic pressure (from bearing down)
-usually remains undetected unless diverticula become infected & inflamed from trapped fecal material & bacteria in the colon
Colon CA & Polyps
-colon CA is the 2nd most common CA among US adults
-Polyps are considered precursors of colon cancer
Inflammatory Bowel Disease
Crohn's: affects mouth→anus (anywhere)
--diseased area alternates with healthy tissue
--lesions involve all layers of intestinal wall
Ulcerative Colitis: anus→mouth (spreads upward)
--lesions confined to mucosal & submucosal layers
-S&S: ABD pain, intestinal bleeding, PRO loss, fever
Ileostomies (sml intestine) & Colostomies (colon)
Ileostomies: all or a segment of the sml or leg intestine (including the rectum) may be removed
Colostomies: effluent (what comes out of ostomy/stoma) proportional to the length of the remaining bowel
-fluid & electrolyte replacement an important goal
-B₁₂, Vit. C supplement, avoid fibrous veggies
Short Bowel Syndrome
-follows removal of more than 2/3 of sml intestine
-causes wt loss, diarrhea, ↓ transit time, malabsorption, dehydration, loss of electrolytes, hypokalemia
-enteral feedings ASAP, Parenteral Nutrition support is indicated
-eventually remaining bowel ↑ absorptive surface, & problems ↓
Prebiotics vs Probiotics
-intervention tools to improve GI fxn
Prebiotics: indigestible CHO that promote the growth of lactobacilli & bifidobacteria (bacteria w positive health affects)
-inulin-soluble dietary fibre in asparagus, garlic, leek, onion, artichoke
Probiotics: nutritional supplements made up of living micro-organisms w health advantages (depend on the strain of bacteria & active substance)
-commonly used fermented foods include cultured milk & yogurt
Diseases of the Liver (3)
1. Hepatitis
2. Cirrhosis
3. Cancer
Manifestations of Liver Disorders
-Jaundice
-hemorrhage/bleeding problems
-pruritis & itching
-ascites
-generalized edema (insufficient albumin)
-intolerance of Sedation (most are metabolized in the liver except phenobarbital)
Hemorrhage
d/t inadequate prothrombin & other clotting factors
-management:
--bile salts
--Vit K, p.o. & parenternal
--use of sml needle w injection
--use of soft toothbrush
--check urine & stool for blood
Pruritis
caused by bile pigment deposited to skin
-management:
--bathing w tepid water & use of oil-based lotion
--use soft linen
--short fingernails
Ascites
Management:
-daily wt & ABD girth measurements
-low Na+ diet (2000mg, even 1000mg), fluid restriction (1500mL/day), diuretics (K levels should be monitored)
-relieve symptoms from pressure of ascites (high fowler's, turning & positioning, paracentesis - aspiration of fluid from w/in peritoneum)
Liver Disease Nutrition Tx
-limit meds or hepatotoxic drugs d/t impaired liver fxn
-fluid & Na+ restrictions
-bed rest & proper nutrition (↑ calorie, ↓ to moderate P, ↑ C, ↓ fat, Vit A, B comp, C, D & K)
-no alcohol, opiates or sedatives
-during N/V, hydration via IV fluids may be necessary
Gallbladder Disorders (3)
1. Cholelithiasis
2. Choledocholithiasis
3. Cholecystitis
Cholelithiasis
major constituent of gallstones is cholesterol
-amt of cholesterol in bile determined in part by amt of dietary fat consumed
-gallstones may form if gallbladder does not contract often enough to empty out bile
-S&S:
RUQ pain (usually postprandially), epigastric pain, N/V
-Risk factor 4 F's:
1. Fat
2. Female
3. Forty
4. Fertile
Cholecystitis
gallbladder inflammation
-occurs when gallstones block cystic duct, as a result of stasis, bacterial infection, ischema of the gallbladder
-associated pain, tenderness, fever
-fat intolerance may manifest as:
--regurgitation, flatulence, belching, epigastric heaviness, indigestion, heartburn, chronic upper ABD pain & nausea
-jaundice & steatorrhea (↑ fat secretion from skin glands) may also be present
Cholecystectomy
-bile enters the sml intestine continually rather than in response to food in the GI tract
-immediately after open laparotomy cholecystectomy
--nothing orally or clear liquids until they can tolerate a regular diet
-some pt need to follow a low-fat diet for several wks after surgery
--total Amt of fat in the diet more important than type of fat consumed
Diseases of the Pancreas (2)
1. Pancreatitis
-Acute
-Chronic
2. Cancer
Pancreatitis
inflammatory process characterized by:
- ↓ production of digestive enzymes & bicarbonate
-malabsorption of fats & PRO
acute inflammation causes blood vessels that supply pancreas to become exceptionally permeable
-leak fluid & plasma PRO into spaces btwn pancreatic cells (causing localized edema & damage)
if pancreas is damaged:
-enzymes retained & activated w/in pancreas = autodigestion & severe pain
-when enzymes amylase & lipase cannot be secreted serum levels become high
Acute Pancreatitis
predisposing factors:
-binge alcohol drinking
-biliary tract disease
-duodenal obstruction
-infection
-trauma
-nutritional deficiency
Chronic Pancreatitis
predisposing factors:
-alcohol ingestion
-gallbladder disease
-autoimmune factors
Cancer of the Pancreas
S&S:
-Anorexia
-wt loss
-Weakness
-Nausea
Late signs: pain, jaundice, ascites, palpable mass
Surgery: Whipples Procedure: removal of the head of the pancreas, distal stomach, CBD & dudenum
Diabetes Mellitus (DM)
group of conditions characterized by:
-relative or complete lack of insulin secretion by beta cells of pancreas or defects of cell insulin receptors = disturbances of CHO, PRO, & lipid metabolism & hyperglycemia (↑ glucose)
Types of Diaabetes Mellitus (4)
1. Type I (5-10%)
2. Type II (90-95%)
3. Gestational
4. Impaired glucose tolerance (pre-diabetes)
Type I DM vs Type II DM
Type I: adolescents (peak at 6-11yrs), generally thin, NO insulin produced
3 P's:
Polyuria: ↑ urination
Polydypsia: ↑ thirst
Polyphagia: ↑ hunger
Type II: adults (30% children & rising), obesity, insulin intolerance
2 P's:
Polyuria: ↑ urination
Polydypsia: ↑ thirst
#1 cause of death effecting diabetic pt
= MI (heart disease)
Macrovascular Complications of Diabetes (3)
1. Coronary Artery Disease
-adults w diabetes have heart disease death rates about 2-4x higher than adults w/out diabetes
2. Cerebrovascular Disease (stroke)
-risk for stroke is 2-4x higher among people w diabetes
3. Peripheral Vascular Disease
->60% of non traumatic lower limb amputations occur in people w diabetes
Microvascular Complications of Diabetes (3)
1. Retinopathy
-diabetes is the leading cause of new cases of blindness among adults 20-74yrs
2. Nephropathy
-diabetes is the leading cause of kidney failure, account for 44% of new cases in 2005
3. Neuropathy
-60-70% of people w diabetes have mild to severe forms of nervous system damage
Hypoglycemia
abnormally low blood sugar usually resulting from excessive insulin, a poor diet, too much exercise
-normal blood sugar is 4-7mmol
-BG<4 can be fatal
S&S of Hypoglycemia
-shakiness
-slurred speech
-sweating
-palpitations
-Nausea
-Headache
-Confusion
-Vision changes
-Irritability
-Hunger
Treating Hypoglycemia
-check blood glucose (BG) when S&S appear
-treat any glucose result <4mmol
-give pt 15g of simple CHO (e.g. 180ml of OJ, 1tbs honey, 3 glucose tabs) to raise 2mmol
-recheck in 15 min
-repeat until BG btwn 4-7mmol, then they can have a complex CHO
Diabetic Ketoacidosis (DKA)
-life threatening condition caused by insulin deficiency
-body breaks down fats & PRO for energy
-this causes ketosis (an abnormal accumulation of ketones)
-produces fruity or acetone odor on breath
-treat slowly to avoid diabetic coma
Hyperglycemia
abnormally high concentration of glucose in the blood
-causes osmotic diuresis
-leads to dehydration
-precipitates lactic acidosis
--stimulates respiratory center, produces deep, rapid respirations known as Kussmaul's Respirations
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
-life threatening emergency
-relative or actual insulin deficiency = severe hyperglycemia
-triggered by stress (trauma, infection) that ↑ body's demand for insulin
Goals of Diabetes Tx
-alleviate symptoms
-prevent complications
-prevent progression of current complications
-improve quality of life
Collaborative Management
Include family in health promotion w pt
-nutritional therapy (no one "diabetic" diet)
-activity
-monitoring of blood glucose
-medication - insulin or oral agents
-education
Nutrition goals for Type I DM
-↑ in energy intake possible
-diet & insulin necessary to control BG
-equal distribution of CHO through meals for insulin activity
-consistency in daily intake - control BG
-Timing of meals-crucial
-Frequent snacks necessary
-additional food for exercise - CHO 20g/h for moderate physical activity
Nutrition goals for Type II DM
-↓ of energy intake for obese
-diet alone may control BG
-equal distribution of CHO desirable, not essential; low fat desirable
-consistency in daily intake - control wt
-Timing of meals not essential
-Snacks not recommended
-additional food for exercise if on sulfonylurea or insulin
Exercise
-improves insulin sensitivity
-↓ BG
-uses Glycogen stores from muscle & liver
-Type I DM monitor BG:
--before and after exercise
--throughout longer duration or very intense exercise
---identify need to ↑ food or ↓ insulin
---learn how various exercise alter glycemic response
Weight Loss
-improves Glucose control
-↑ sensitivity to insulin
-↓ lipid levels & BP
-corresponding lowering of the dosage of pharmacologic agents
Pregnancy & Women w Preexisting Diabetes
-vulnerable to fetal complications
-maternal health can be compromised when complications of diabetes occur
-ideally excellent glycemic control should be achieved 3 months before conception
Gestational Diabetes
-good glucose control usually accomplished by individualization of intake & graphing of wt gain
-to reduce risks of fetal macrosomia (big babies), neonatal hyperglycemia, & perinatal mortality, insulin may be prescribed in addition to nutrition therapy
-glucose levels usually revert to normal following delivery
--20-50% eventually develop T2DM
Insulin Resistance
refers to the diminished ability of cells to respond to the action of insulin in promoting the transport of glucose from blood into muscles & other tissues
= Pre Diabetes
Metabolic Syndrome
a cluster of metabolic abnormalities defined as any combination of three of the following: abdominal obesity (BMI>30kg/m²), glucose intolerance, hypertension (BP 140/90mmHg), and abnormal blood lipid levels (>150mg/dl or HDL <35mg/dl)
= Diabetes & Heart Disease