Nutrition

1
Nutrition

• N1037

2
Introduction

• Key term nutrition
• Integrated Pan-Canadian Healthy Living Strategy
  goals
• Healthy eating
• Physical activity
• Healthy weight

3
Eating well with Canadas Food Guide

• Food groups
• Vegetables and fruit
• Grain products
• Milk and alternatives
• Meat and alternatives

4
Dietary Guidelines

• Directional statements
• Have vegetables and fruit more often than juice
• Eat at least one dark green and one orange
  vegetable every day
• Have at least half of daily grain products intake
  from whole grain
• Have meat alternatives such as beans, lentils and
  tofu often

5
Dietary Guidelines

• Directional statements
• Eat at least two food guide servings of fish
  every week
• Satisfy thirst with water 
• Drink skim, 1 or 2 milk each day drink
  fortified soy beverages if you do not drink milk

6
Dietary Guidelines

• Directional statements
• Reduce the total amount of fat in the diet,
  especially saturated and trans fats, however, a
  small amount of unsaturated fat is recommended
  each day (30-45 ml for an adult)
• Lower salt and sugar intake

7
Dietary Guidelines

• Directional statements
• Achieve and maintain a healthy body weight by
  enjoying regular physical activity - adults
  should get 30 to 60 minutes of moderate physical
  activity every day and children should get 90
  minutes

8
Dietary Guidelines

• Directional statements
• All women who could become pregnant should take
  400 µg (0.4 mg) of folic acid a day to avoid
  neural tube defects in the unborn fetus
• All adults over 50 years of age should, in
  addition to following the Food Guide, take a
  daily vitamin D supplement of 10 µg (400 IU) a day

9
Nutrients

• Nutrients are the substances found in food that
  are nourishing and useful to the body.
• Carbohydrates
• Protein
• Fats,
• Vitamins and minerals
• Water

10
Nutrients

• Carbohydrates
• Supply energy and fibre
• 45 to 60 of daily caloric intake

(continues)
11
Nutrients

• Proteins
• Supply nine essential amino acids
• Repairs body tissues, maintain osmotic pressure,
  component of antibodies, and an ultimate source
  of energy.
• 10 to 35 of daily caloric intake

12
Nutrients

• Fats
• Saturated, monounsaturated
• Cholesterol, high-density lipoproteins,
  low-density lipoproteins, omega fatty acids,
  trans fats, triglycerides
• Part of the structure of all cells
• 20 to 35 of total caloric intake

13
Nutrients

• Vitamins
• Organic substances
• Maintain body functions
• Fat-soluble and water-soluble
• Minerals
• Inorganic substances
• Help build body tissues and regulate body
  processes.
• Macrominerals and microminerals

14
Nutrients

• Water
• Makes up 50 to 60 of body weight
• Average adult needs 68 240 mL glasses of
  water/day
• Signs of dehydration?

15
Nutrition Through the Life Cycle

• Anticipatory guidance

16
Infant Feeding Guidelines

• Assess reflexessucking, rooting, swallowing
• Rapid growth and development
• Breastfeeding is preferred for first 12 months
• Assess physical development to determine
  readiness for solid
• food

17
Infant Feeding Guidelines

• Introduction of solids
• 6 9 months
• Iron containing foods
• Cereals
• Meats and Egg Yolk
• Vegetables and Fruit
• Dairy Cheeses, Yoghurt (Whole Cows milk after
  9 months)
• 9 months
• Introduction of finger foods, increased textures
  (mashed and soft)

18
Infant Feeding Guidelines

• Introduce foods one at a time
• Begin with foods that are least allergenic
• Avoid egg whites and honey in infants under 12
  months
• No peanuts, nuts, or fish until age three

19
Nutritional Assessment of Infants

• Breastfed? How often? How long?
• Bottle-fed? How often? How much?
• Formula preparation? Storage?
• How does the infant respond to eating?
• Constipation? Diarrhea?
• Is the infant ever put in bed with a bottle?

20
Nutritional Guidelines for Toddlers

• Physical growth slows
• Increased independence
• Small portions
• Offer one new food at a time
• No peanuts, nuts, or fish until age three
• Routine mealtimes

21
Nutritional Guidelines for Preschoolers

• Independence
• May become a picky eater
• Offer food choices
• Offer small servings
• Finger foods
• Routine mealtimes
• Discuss need for healthy snacks

22
Nutritional Guidelines for School-Age Children

• Erratic growth and eating patterns
• Strong food preferences
• Encourage a balanced diet
• Limit highly sweetened snacks and foods

23
Nutritional Assessment of Young Children

• Concerns with childs eating?
• Childs food preferences?
• Involvement in sports? Physical activity?
• Childs meal schedule?
• Balanced diet?
• Intake of beverages with added sugar?

24
Nutritional Guidelines for Adolescents

• Period of rapid growth and change
• Fluctuating nutritional needs
• Concerns with body image
• Risks for eating disorders
• Adjustment portion quantity
• based on physical activity level

25
Nutritional Assessment of Adolescents

• Participation in physical activity?
• Adhere to a specific diet
• or meal plan?
• Skip meals?
• Satisfaction with current weight?

(continues)
26
Nutritional Assessment of Adolescents

• Ever induced vomiting, used laxatives, diuretics,
  or diet pills to control weight?
• Consumption of snacks?

27
Nutritional Guidelines for Young and Middle-Aged
Adults

• Growth and caloric needs stabilize
• Eating habits may be influenced by activity
  levels, life stressors
• Obesity often seen in this age group

28
Nutritional Guidelines for Young and Middle-Aged
Adults

• Consideration of diseases
• Atherosclerosis - Coronary artery disease
• Osteoporosis
• Type II diabetes
• Metabolic syndrome
• DASH Diet

29
Nutritional Guidelines for Pregnant and Lactating
Women

• Role of proper nutrition in development of
  healthy infant
• Target weight gain for pregnancy
• Adequate caloric intake
• Increased fluid consumption
• Prenatal vitamins
• Iron supplements
• Calcium
• Folic Acid

30
Nutritional Assessment of Pregnant Women

• Prepregnancy weight?
• Activity level?
• Use of supplemental vitamins?
• Consumption of caffeine, artificial sweeteners,
  alcohol?
• Presence of constipation, nausea, vomiting, or
  heartburn?
• Presence of food cravings?

31
Nutritional Guidelines for the Older Adult

• Decreased caloric requirements
• Encourage to eat in a sitting position
• Encourage adequate fluid
• intake and high-fibre diet

32
Nutritional Guidelines for the Older Adult

• Nutritional risk factors
• Difficulty chewing or swallowing
• Decreased appetite
• Decreased taste and smell
• Decreased ability to self-feed

33
Nutritional Assessment of Older Adults

• Presence of physical limitations that affect
  eating?
• Difficulty chewing or swallowing?
• Presence of dental problems?
• Difficulty obtaining or preparing foods?
• Do you eat alone?

34
Cultural Differences in Nutrition

• Cultural beliefs related to the consumption of
  food
• Religious beliefs related to the consumption of
  food
• Food restrictions
• Periods of fasting

35
Components of a Nutritional Assessment

• Nutritional history
• Physical assessment
• Anthropometric measurements
• Laboratory data
• Diagnostic data

36
Nutritional History

• General diet information
• Adherence to particular diet
• Food preferences
• Consumption of fast foods
• Ability to obtain and prepare foods
• Changes in past 12 months

37
Nutritional History

• Food intake history
• 24-hour recall
• 3-day diary
• Direct observation
• Evaluation of adequacy of diet

38
Physical Assessment

• Assess for subjective and objective signs and
  symptoms of poor nutritional status

39
Signs and Symptoms of Poor Nutritional Status

• Subjective data
• Fatigue
• Delayed wound healing
• Brittle hair, nails
• Mouth sores
• Changes in appetite
• Mood changes

40
Signs and Symptoms of Poor Nutritional Status

• Objective data
• Weight changes
• Dry, rough, scaly skin
• Edema
• Dry, cracked lips
• Swollen, bleeding gums
• Decreased muscle tone

41
Anthropometric Measures

• Height
• Weight
• Ideal body weight, percent IBW
• Percent weight change
• Body mass index

(continues)
42
Anthropometric Measures

• Waist to hip ratio
• Skinfold thickness
• Mid-arm circumferences
• Kwashiorkor
• Marasmus

43
Laboratory Data

• Hematocrit and hemoglobin
• Cholesterol, LDL-C, HDL-C, total
  cholesterolHDL-C ratio, triglycerides
• Transferrin, TIBC, iron
• Total lymphocyte count
• Antigen skin testing

(continues)
44
Laboratory Data

• Albumin and prealbumin
• Glucose
• Creatinine height index
• Nitrogen balance

45
Diagnostic Data

• Radiographic studies
• X Rays
• Dual-energy X-ray Absorptiometry (DEXA) scan

46
Activities

• Review your 24 hour food recall compare to
  Canada Food Guide
• Do health teaching depending on what you assess.
• Do Calcium calculator
• Do initial physical assessment
• Complete Self Assessment Tool

47
Interactive Food LabelAvailable
athttp//www.hc-sc.gc.ca/fn-an/label-etiquet/nutri
tion/cons/inl_main-eng.php
Contents 1. Nutrition Facts Table2. Specific
Amount of Food3. Daily Value4. Core
Nutrients5. Nutrition Claims6. List of
Ingredients
48
Nutrition Facts Table

• Whole Kernel Corn
• The Nutrition Facts table includes Calories and
  13 nutrients Fat, Saturated fat, Trans fat,
  Cholesterol, Sodium, Carbohydrate, Fibre, Sugars,
  Protein, Vitamin A, Vitamin C, Calcium and Iron.

49
Specific Amount of Food

• The specific amount may be indicated by
• A phrase such as a slice, one egg, two cookies,
  followed by the metric measure.
• Familiar household units such as mL, cups,
  tablespoons, or a fraction or unit of food (e.g.,
  1/4 pizza), followed by the metric measure (g,
  mL) (e.g., 175 g yogourt).
• Whole Wheat Bread

50
Daily Value

• Use the Daily Value to make food comparisons.
• The Daily Value provides a quick overview of
  the nutrient profile of the food, allowing
  product comparisons based on more than one
  nutrient. It puts nutrients on the same scale (0
  - 100 Daily Value). You can quickly identify the
  strengths and weaknesses of a food product.
• Sirloin Burger Vs Chicken
  Burger

Sirloin Burger Chicken Burger
                                                                                   
51
Calories and Core Nutrients

• Calories and the same core nutrients are always
  listed in the same order. A consistent look makes
  the Nutrition Facts table easy to find and use.
• Information on core nutrients available on Health
  Canada Website

52
Nutrition Claims

• The Government has rules in place that must be
  met before a nutrition claim can be made on a
  label or advertisement. The rules for nutrition
  claims apply to all foods, prepackaged and not
  prepackaged, no matter where they are sold.
• A manufacturer can choose whether or not to
  include nutrition claims on the label or in the
  advertisement of a food.
• Many products will have nutrition claims as these
  claims highlight a feature of interest to
  consumers.
• Source of Fibre
• Low Fat
• Cholesterol Free
• Sodium Free
• Reduced Calories
• Light

53
Ingredients List

• Bran Cereal
• Ingredients Whole wheat, wheat bran,
  sugar/glucose-fructose, salt, malt (corn flour,
  malted barley), vitamins (thiamine hydrochloride,
  pyridoxine hydrochloride, folic acid, d-calcium
  pantothenate), minerals (iron, zinc oxide).

54

• Case Study
• Questions

55
References

• Interactive Nutrition Label http//www.hc-sc.gc.c
  a/fn-an/label-etiquet/nutrition/cons/inl_main-eng.
  php
• Canadas Food Guide http//www.hc-sc.gc.ca/fn-an/
  food-guide-aliment/index-eng.php
• Estes, M.E., (2006). Health Assessment and
  Physical Examination. (3rd edition). Clifton
  Park,NewYork Thomson Delmar Leaning.
• Estes, M.E., Buck, M. (2009). Health Assessment
  and Physical Examination. (1st Canadian edition).
  Toronto, Ontario Nelson Education Ltd.