Nutrition reading guides
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Augusta University *
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Dec 6, 2023
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Chapter 4 – Carbohydrates
Discuss the functions of carbohydrates as a source of energy and dietary fiber.
• Energy Source
o What does the body do when there are not enough carbohydrates available?
When there is not enough carbohydrates available, fat is metabolized resulting in the formation of ketones, intermediate fat products of fat metabolism. The body can normally dispose of low levels of ketones. o What is a dangerous condition that may occur if carbohydrate levels continue to be insufficient
to meet energy demands?
Ketoacidosis occurs if the bodies demand for carbohydrates is still unmet. This affects the pH level in the body and can be lethal if uncontrolled. The brain needs carbohydrates and glucose for function.
• Lactose intolerance
o What nutrients usually consumed in lactose-containing dairy products are important for the patient to consume, and what are some diet changes they can make?
• Other Sweeteners
o What are some considerations when selecting products with “sugar free” on the label?
Products may be labeled sugar free but people still need to consider calories, fat content, trans fat, saturated fats. When sugar is removed, fats are added to improve the taste. This could be problematic for those with diabetes who monitor carbs and fat intake. o What are some advantages disadvantages of sugar alcohols?
A: less cariogenic, discourage bacteria growth in the mouth that causes tooth decay. Absorbed slowly and incompletely than real sugars, better for those with diabetes because they can control blood sugar easily if they rise slowly.
D: Ferments in the digestive tracts because its absorbed slowly. (causes gas and diarrhea), low energy sweeteners. o What is the relationship between aspartame and phenylketonuria (PKU)?
Those with phenylketonuria should not have aspartame because their bodies cannot break aspartame down, and the build up will cause health problems. Describe the differences and health benefits of soluble and insoluble fiber.
• What are the health benefits of soluble/insoluble dietary fiber?
Allow the body to function and improve physically more efficiently.
• What are the health risks of soluble/insoluble dietary fiber?
Too much fiber can overwhelm the GI tract and lead to blockages to the small intestine and colon.
• What are some sources of dietary fiber?
Whole grains, brown rice, whole wheat items, broccoli, peanut butter (Insoluble)
Beans, citrus fruits, apples, banana, oat bran, carrots, white potatoes. (soluble).
Compare the nutrient content of refined versus unrefined grains.
• What affect do these refined grains have on health?
They lead to deficiencies I.E refined flour. Thiamin, riboflavin, niacin, and iron vitamin deficiencies.
Chapter 5 – Fats
Discuss the function and sources of the linolenic and linoleic essential fatty acids.
• How does fat compare with energy density of other food types?
Fat is the densest form of stored energy in the body and in food.
EX: gram for gram food fat in the form of triglycerides can produce more than twice the energu in kcal that carbs or proteins can produce. 9kcal =fat, carb=4kcal.
• What is fat’s effect on satiety and satiation?
Satiety= full feeling
will feel satisfied and not eat more.
Satiation= increase our desire to eat more fatty foods.
leads to overeating.
• What are some of the health benefits of essential fatty acids (EFAs) such as Omega-3?
Necessary for regulating many body functions and making materials for the body.
• What are some food sources of essential fatty acids (EFAs)?
Fish (salmon, Canola oil walnuts, soybeans/oil, flaxseeds, wheat germ, green leafy vegetables.
• What is fat’s role is the transportation and absorption of nutrients?
Fats role in the transportation and absorption of nutrients is…
Describe the potential health concerns and benefits related to dietary fat intake.
• What are the main differences between the health effects of saturated vs. unsaturated fats? • What fat has the greatest influence on blood cholesterol?
Trans fat has the greatest influence on blood cholesterol because it increases the risk for cardiovascular diseases because of the increased LDL levels, which contribute to plaque formation in the body. It also decreases the HDL which is the good cholesterol.
Module 2.3 – Protein and Vitamins
Distinguish between complete proteins and incomplete proteins.
-
Complete protein: contains all 9 Essential amino acids.
-
Incomplete: does not contain all 9.
• What types of food would represent complete and incomplete proteins?
Complete protein foods are animal products like meat, dairy, fish, eggs, soybeans (only plant source to be a complete protein). Incomplete: Many plant foods are incomplete proteins. Only a problem for deficiency if you restrict the foods you eat and are not supplementing. • What are complementary proteins, and what are their function?
Complement proteins are proteins that are found in plant foods. Their function is to meet the complete protein amount without having to eat complete proteins from animal products. • What are limiting amino acids, and how does a diet avoid this effect?
Proteins that are incomplete proteins are called limiting amino acids because it reduced the value of protein In the food. A diet is restrictive and can lead to deficiency because not all the EAA;s are being consumed. Those who eat normally, should not have to worry about this deficiency because they should eat enough complete and incomplete.
Discuss how protein is digested, is absorbed as amino acids, and becomes available to cells.
• What is Nitrogen Balance, and what populations may be in a positive nitrogen balance?
Nitrogen is essential in proteins so the nitrogen balance studies can be used to determine the body’s use
of proteins through the amount of nitrogen that enters the body and leaves the body. Nitrogen (+): When more nitrogen is in the body than excreted. This occurs in growing children and pregnant women who require more protein intake. Additionally, in those recovering from illness or injury
as the body heals can be positive too. • Differentiate the processes of anabolism, catabolism, deamination, and hypermetabolism.
Anabolism: Protein synthesis
Catabolism: Protein breakdown
Hypermetabolism: Elevated resting energy expenditure.
Deamination: Breaking off an amino acid group (NH2) from an amino acid molecule, resulting in one molecule of ammonia (NH3) and a keto acid.
• What are the benefits and drawbacks of vegetarianism?
B: Reduce risk for obesity, diabetes type 2, CVD, hypertension, GI disorders, and some cancers like lung or colorectal. Lower costs (economic approach), spiritual approach (non-harming to animals)
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D: Vitamin deficiencies especially vitamin D. Others are B12, calcium, and omega fatty acids, iron deficiency, social health (vegetarians often must explain themselves to others about their diet.
• What are strategies that vegetarians can take to maintain essential nutrient intake?
Read vegetarian cookbooks with nutrition information in it, MyPlate has resources for vegetarians.
List the functions of protein.
• What is an appropriate portion size of grains, vegetables, fruit, dairy, and protein based on MyPlate?
Grains= 2 oz, vegetables = 4 cups, fruit = 1/2 cups, dairy = 1 cup (low or fat free) Protein= 3 0z meat and beans. • What is meant as Chaining?
o What are the dangers of chaining (ex. Eating wings and watching football)?
Link the two actions together and whenever that action takes place the other action needs to happen. So
when you watch football you need to eat wings.
o What are some ways that chaining can be used to improve eating habits?
Linking healthy food to eating other foods. Eating a sandwich, you eat a fruit too. Links those actions together. Weighing foods, have certain foods like milk to increase calcium at your miday meal.
• How does protein relate to these functions or substances?
o Collagen
o Wound Healing
o Insulin
o Blood Clotting
o Fluid Balance
o Buffering
o Transportation of vital substances
Describe the differences between water-soluble and fat-soluble vitamins. • List the main functions, recommended intake/sources, and consequences/causes of deficiency/excess?
o Water Soluble Vitamins ▪ Thiamin (B1) :
main functions: Serve as a coenzyme. A substance that activate an enzyme in energy metabolism, nerve function related to muscle actions too.
Recommended intake/sources: 1.2 mg (men), 1.1 mg (women) Lean pork, whole grains, legumes, seeds, nuts
consequences/causes of deficiency/excess: Alters the muscular, nervous, GI, CV systems.
S/S: ataxia (muscle weakness and loss of coordination, pain, anorexia, mental disorientation, and tachycardia.
▪ Riboflavin (B2) (sensitive to ultraviolet light)
Main functions: Coenzyme in the release of energy from nutrients in every cell of the body. recommended intake/sources: 1. 3 (men), 1.1 (women) Plant and animal foods, in the US milk, grains, broccoli, asparagus, dark leafy greens, whole grains, enriched breads, and cereals.
consequences/causes of deficiency/excess: Ariboflavinosis (swollen lips), Cheilosis (cracks in lip corners, glottis( swollen tongue), ▪ Niacin (B3) main functions: Coenzyme for energy metabolism. Critical for glycolysis, and TCA cycle
recommended intake/sources: 16 mg (Men) 14 mg (women). Protein containing food (meat, poultry, etc)
consequences/causes of deficiency/excess: Pellagra and the 3 D’s. (Dermatitis, Dementia, Diarrhea)
▪ B6.
main functions: Metabolism of amino acids, proteins, carbohydrates, and fatty acids. Proper function of the nervous system, hemoglobin synthesis, tryptophan into niacin.
recommended intake/sources: 1.3 mg (men and women). Whole grains, cereals, legumes, chicken, fish, pork, and eggs.
consequences/causes of deficiency/excess: Dermatitis, altered nerve function, weakness, poor growth, convulsions, microcytic anemia
▪ Folate main functions: Coenzyme in reaction involving the transfer of one-carbon units during metabolism> Required for synthesis of amino acids, DNA and RNA synthesis, blood synthesis (heme group), fetal neural tube deficits (spine abifida). recommended intake/sources: 400 mg (men and women) (600 mg for pregnant). leafy greens, vegetables, legumes, cereals, fruits, and juices.
consequences/causes of deficiency/excess: Spine abifida, (etc)
▪ Cobalamin (B12)
main functions: Folate metabolism, support RNA and DNA synthesis. Intrinsic factor must be present.
recommended intake/sources: 2.4 mg (men and women). Meat, fish, poultry, eggs, dairy.
consequences/causes of deficiency/excess: pernicious anemia, megaloblastic anemia. Older adults are more likely to be deficient due to the intrinsic factor.
▪ Vitamin C
main functions: antioxidant and coenzyme. Provides the cement that holds structures together (teeth, cartilage, bone matrix, etc).
recommended intake/sources: 90 mg (men), 75 mg (women) Minimum to prevent scurvy (10 mg/day) Fruits and vegetables. consequences/causes of deficiency/excess: Scurvy.
o Fat-Soluble Vitamins ▪ Vitamin A main functions: Maintain skin and mucous membranes throughout the body. Vision, bone growth, immune system, normal reproduction.
recommended intake/sources: 900 mg (men), 700 mg (women). Fat in animal related foods (whole milk, butter, liver, egg yolk, fatty fish. Yellow orange vegetables (sweet potatos, etc).
consequences/causes of deficiency/excess: night blindness, keratomalacia (hard dry cornea). Toxic: weakness, anorexia, vomiting, etc.
▪ Vitamin D
main functions: Absorption of calcium and phosphorus. Bone mineralization, growth and
CV function.
recommended intake/sources: 20 mg for adults (800 IU). Fat of animal products. ( not milk)
consequences/causes of deficiency/excess: Rickets, and osteomalacia, osteroporosis (bad bones). Toxic: hypercalcemia (kidney damage)
▪ Vitamin K
main functions: Cofactor in blood clotting like prothrombin, protein formation for bone, kidney and plasma.
recommended intake/sources: 120 mg (men), 90 mg (women). Dark leafy greens!
consequences/causes of deficiency/excess: Inhibits blood coagulation.
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▪ Vitamin E
main functions: Antioxidant that protects polyunsaturated fatty acids and vitamin A from
oxidative damage. Important for lungs and RBC membranes.
recommended intake/sources: 15 mg (men and women). Vegetable oils, and maragine. Whole grains, seeds, nuts, wheat germ, green leafy vegetables. consequences/causes of deficiency/excess: Secondary defiencys only (CF, blocked bile duct) liver problems, hemolytic anemia.
• What are some of the benefits of phytochemicals?
They have disease fighting properties. (reduce risk of CVD, block tumor growth, anti-
inflammatory effects.)
• What are some advantages and disadvantages to vitamin supplements?
Improves the nutritional status of at-risk groups. Too much vitamins can be dangerous. Chapter 20 – Nutrition in Cancer and HIV/AIDS
Describe common characteristics of cancer and HIV/AIDS in terms of their effects on the GI tract, on which nutrition therapy focuses.
• What is considered unexplained weight loss and what can this indicate?
Weight loss greater than 10 percent in 6 months and can indicate malnutrition.
• What is cachexia and what are some common treatments?
Severe body wasting with lean body mass and weight loss from anorexia associated with cancer.
Discuss the individualized nature of nutrition support in the management of cancer.
• What are the goals of nutrition during cancer treatment?
Decrease risk of surgical complications, patient meets increased energy and protein requirements, helps repair and rebuild normal tissues, promote increased tolerance, assist in quality of life.
• What are the nutritional side effects of cancer surgery?
Malnutrition is often a side effect. (table 20.2)
• What are some nutritional approaches to nutrition-related problems in cancer therapy?
PG-SGA screening, eat foods that are tart and spicy, early education for anorexia (small and frequent meals wit high calories content, cold foods (N/V), diets rich in fiber, avoid smoked meats, etc.)
Explain the basis of interventions to achieve the goals of HIV nutrition therapy.
• What is AIDS-related wasting syndrome?
Involuntary weight loss of greater than 10 percent in 1 month with S/S of diarrhea, weakness, of fever.
• What are some ways to maximize food intake in HIV/AIDS patients?
Use nutrient dense foods, offer five or six small meals, high calories condiments, diet to tolerance of pt, offer supplements, drink lots of liquids, no caffeine, use a straw for beverages.
• What is steatorrhea and what are some interventions that can improve malabsorption?
Too much fat in your stool. Restriction of fat and lactose is common.
• What are Cryptosporidium infections, and how can HIV/AIDS patients attain safe water?
Drink only filtered water or boiled for 1 min water. NO PUBLIC Water or taps.
Identify indicators that are key to effective nutrition support and related medical therapies for cancer and HIV/AIDS.
• What are the nutritional implications for the immunocompromised patient?
Wasting and malnutrition. • What are some important points to make when educating about food safety for immunocompromised patients
Prevent dehydration and monitor intake and output. Must avoid public foods especially waters from public places or foods washed with water from public places.
Chapter 13 - Nutrition for Disorders of the Gastrointestinal Tract
Anti-Inflammatory Diets
• What are some common anti-inflammatory diets?
Traditional Mediterranean and DASH diet. Nutritional Concerns and Therapies for Esophageal, Stomach, and Intestinal Disorders:
• Dysphagia
o What issues are related to swallowing difficulties?
Regurgitation, choking, etc.
o What approaches do nurses use to maintain nutrition and hydration?
Thickening agents, record I and O strictly, consult with dietitian, monitor food intake. • Heartburn and Gastroesophageal Reflux Disorder
o What type of meals are best to avoid GERD?
Foods like chocolate, alcohol, peppermint, caffeine, vinegar based foods will irritate the lining of the stomach.
o What are some ways the nurse can educate the patient on reducing symptoms?
Straining to defecate needs to be limited, preventing, and managing constipation.
• Esophagitis and Hiatal Hernia
o What are some factors that may decrease sphincter pressure?
Smoking, alcohol, chocolate, caffeine and some medications.
o What foods can these patients avoid to minimize symptoms?
Foods high in fat.
• Vomiting
o What disorders may lead to excessive vomiting?
Virus or toxin has entered the GI tract, motion sickness, pregnancy, cancer, eating disorders.
o What damage can occur with excessive vomiting?
Wear tooth enamel and damage the esophagus.
o What are some strategies to maintain hydration with vomiting?
Small cold meals, no fried, hot, or spicy foods. Broth based foods will be beneficial for these patients.
Offer Zofran 30-60 mins before meals too.
• Peptic Ulcer Disease
o What nutritional strategies can be used to help meet the treatment goals?
Some avoid red and black pepper, and caffeine and alcohol. Encourage patients to take prescribed meds and triple therapy for H. Pylori is often required more than one round to treat.
• Dumping Syndrome
o What are some important nursing interventions to prevent this syndrome?
Discuss foods to avoid, ensure the patients are consuming adequate fluids between meals to prevent dehydration and record I and O.
• Intestinal Gas (Flatus)
o What are common foods to avoid preventing gas?
Increase the fiber gradually. Omit alcohol, and products that contain fructose as needed. Potentially milk if lactose causes problems.
• Diarrhea
o What are some strategies to maintain hydration with diarrhea?
Give electrolytes or carbohydrates via IV. Enteral therapy 1-2 days ad low fat, low fiber, low lactose diet.
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• Constipation
o What nutritional strategies can be used to avoid constipation?
Increase physical activity, and fluid intake. 8-10 glasses per day. Fiber rish products. o What are some pharmacological and non-pharm strategies to treat constipation?
Bulking agents, stool softeners, laxatives and probiotics may work. Increasing activity and fluid intake 8-
10 glasses per day.
• Celiac Disease and Gluten Sensitivity
o What are some foods to include and avoid for these conditions?
Grains, breads, flour, etc. Anything wih gluten in it.
• Irritable Bowel Syndrome & Inflammatory Bowel Disease
o What is a low-FODMAP diet?
The diet limits fermentable oligosaccharides, disaccharides, monosaccharides, polyols. So it limits sugar intake because it increases the osmolarity. ( foods with fructose, sucrose, and polyls sorbitol and mannitol and those related carbohydrates are avoided.
o What benefits do high protein and fiber have in IBD, and when are they each effective?
During the acute stage of IBD to help with deficits and nutrition diets high in protein and fiber help.
• Ileostomies and Colostomies
o What are the functional differences between these concerning fluid loss?
Ileostomy: fluid and electrolyte replace it important because the effluent is more liquid and those are lost to the effluent in the ileostomy. Colostomy: the effluent is more proportional.
Chapter 14 - Nutrition for Disorders of the Liver, Gallbladder, and Pancreas
Hepatitis
• What are the most important nutritional strategies for a patient with hepatitis?
IV fluids, and oral feedings should be initiated as soon as possible. With frequent feeding high in energy and high quality protein to minimize muscle loss and body weight. Don’t limit fat intake unless not tolerated well. NO ALCOHOL!!!
• What is the importance of protein while dealing with a poor appetite?
To minimize muscle loss and body weight. Additionally, it promotes faster and better healing. Cirrhosis
• How do you promote a positive nitrogen balance for these patients?
By administering neomycin which kills off the bacteria that make urea. More protein can be absorbed which promotes a higher nitrogen balance because protein is high in nitrogen. • What are some important nursing interventions?
Fluids with I and O, Daily weights, electrolytes monitoring, fluid restrictions 1500 mL per day. Give suggestions on how to cope with the thirst. Gallbladder Disorders
• What is the connection between very low-calorie diets (VLCDs) and gallstones?
The diet too low in fat disabled the gall bladder from contracting and it won’t empty out the bile which the gallstones will then form.
• What is the role of omega-3 polyunsaturated fatty acids (PUFAs) in Cholecystitis?
It influences bile composition which decreases biliary cholesterol saturation.
Pancreatitis
• What are the complications of bowel rest, and what nutritional strategy can avoid them?
Bowel rest can lead to atrophy of the intestinal mucosa and bacterial translocation. Nutritional strategies
that can be used to avoid them are Early enteral feedings.
• How do enteral and parenteral feeding work concerning nutritional support?
Enteral feedings should be used for those on it for longer than 30 days. The paternal feedings should only be used for those where enteral feedings is contraindicated.