NUTRITION AND DIET THERAPHY

c. Regulate body processes

o all six major group of nutrients
DEFINITION OF TERMS:
FNRI-DOST- Food and nutrition Research Institute- Department of Science and
Technology SIX MAJOR NUTRIENTS
 Carbohydrates, Fats, Protein
NDAP-Nutritionist-Dietitians Associations of the Philippines
 major organic nutrients which are broken down to
Organic Compounds- composed of protein, lipids, carbohydrates, vitamins
supply energy
Inorganic Compounds- composed of water and minerals
 Vitamins, minerals and Water
BMR- Basal Metabolic Rate
 taken in the body without being broken down
DBW- Desirable Body Weight
 Helps regulate circulation, respiration, digestion and
RDA- Recommended Dietary Allowance elimination
Kcal- Kilogram calorie
Food- any substance organic or inorganic nourishes the body by building, 2. ACCORDING TO CHEMICAL NATURE
repairing tissue, supplying heat and energy and regulating bodily processes. a. Organic substances
 carbon containing compounds except carbonate and cyanide
NUTRITION
(protein, lipids, carbohydrates, and vitamins)
 The study of food in relation to health and how the body makes use of it.
b. Inorganic substances
 Not only concern with the quantity and quality of the foods one’s eat but
by the process how the food is receive and utilize  non carbon containing compounds
 Process by which food is taken into and used by the body and it includes  e.g. Minerals and water
digestion, absorption, transportation and metabolism
 Knowing its relationship with other basic need 3. ACCORDING TO ESSENTIALITY
 physiological role in the body
FUNCTION OF NUTRITION  the concentration of a nutrient is not related to its
 To maintain life by allowing one to grow and be in a state of optimum importance
health  e.g. 5 mcg is as important as 50 mg of vitamin C or 59
mg of protein
NUTRITION AS A SCIENCE AS APPLIED TO NURSING CARE: a. Dietary essentials
1. It prevents occurrence of diseases or illnesses  essential or indispensable nutrients should be supplied in
2. Adapting food patterns based on individual nutritional needs and within the diet; body does not synthesize these nutrients
the framework of their cultural, economic, psychological situation and style b. Semi-Essentials
3. Awareness on the need in specified disease states to modify nutritional  reduces the need for a particular nutrient or partially
factors or therapeutic purposes
spares it
 e.g. Cystine can reduce the need for methionine but it
NUTRIENTS
 Are chemical substances found in food. cannot completely replace it biochemically
 Role of nutrients: c. Non-dietary essentials
 To provide heat and energy  non-essential, also called dispensable nutrients
 To build and repair body tissues  it can be synthesized by the body as long as the materials
 To regulate body processes. in the body are adequate

SCOPE OF NUTRITION AS A SCIENCE 4. ACCORDING TO CONCENTRATION

The scope of nutrition covers the following fields:  termed as the macronutrients or micronutrients
1. Basic or fundamental nutrition a. Macronutrients
 a study of the physiologic needs in terms of specific nutrients  present in relatively large amounts in the body
2. Nutrition in growth and development or Child and maternal  e.g. Water, fats, protein carbohydrates
nutrition o water – 2/3 of the body
 a study of nutritional principles and application throughout the o fat – 1/5 or 20%
life cycle or it could be concentrated on infancy, childhood, o protein – 1/5 or 20%
pregnancy and lactation which are the most vulnerable groups. b. Micronutrients
3. Dietetics or Therapeutic Nutrition  are vitamins and trace minerals
 the adequacy of nutrient intake and diet to meet the individual’s
needs under normal or pathological conditions. QUALITIES OF GOOD FOOD
4. Clinical or Medical Nutrition  nourishes or nutritious
 a study of the effects on the body when the nutrition needs are not  It has satiety value
meet or when there is excessive intake  Prepared under sanitary conditions, aesthetically and scientifically
 Specialized fields under this are:  Free from toxic agents
 Human nutrition  Palatability satisfies the consumer
 Animal nutrition  Offers variety and planned within socio-economic context
 plant nutrition

5. Other areas of specialization
 the study nutrition is interrelated with allied fields since nutrition

CARBOHYDRATES
is a science as well as an art.

CARBOHYDRATES
 big group of organic compounds prominent in the plant kingdom
which contain the element of carbon, hydrogen and oxygen.
CLASSIFICATION OF NUTRIENTS
1. ACCORDING TO FUNCTION
a. Body building
o structural components of the body, forms tissues
o includes water, protein, fat, carbohydrates and minerals
b. Furnish energy
o yielding energy FUNCTIONS:
o carbohydrates, fats and protein
 NUTRITION AND DIET THERAPHY
1. Chief source of energy –glucose and its intermediate products, o Less sweet and less soluble than sucrose
major fuel used by muscles o Remains in the intestine longer than other sugar
2. Cheap and main energy source – low cost and widely distributed o Encourages the growth of certain useful bacteria
around the world 3. MALTOSE
3. Protein sparer – save or spare protein for its unique function of o Not found in free foods
body building o Produced by hydrolysis of starch
4. Regulator of fat metabolism – prevents accumulation of ketone o Converted to glucose in digestion
bodies and acidosis
o Occurs in malt products and in germinating cereals
5. Sole energy source for the brain and nerve tissue – prevent
o Found in certain infant milk formula, beer and malt
irreversible damage of the brain
6. Storage form of energy as glycogen – glycogen as immediate beverages'
source of energy o Less sweet compare to galactose and sucrose
7. Regulator of intestinal peristalsis and provider of bulk

CLASSIFICATION OF CARBOHYDRATES
A. MONONSACCHARIDES
 or simple sugars; the simplest form of carbohydrates
 they are sweet
C. POLYSACCHARIDES
 they require no digestion and can be absorbed directly into  Compound of many molecules of simple sugars (complex
the bloodstream from the small intestine sugar)
 Simple Carbohydrates are found in food such as fruits,
milk, and vegetables
 Cakes, candy, and other refined sugar products are simple
sugar which also provide energy but lack vitamins, minerals
and fibers

1. GLUCOSE (dextrose) 1. Starch

o The principal form in which carbohydrates is used by o Most significant polysaccharide in human nutrition.
the body o It is converted entirely to glucose upon digestion and
o It is moderately sweet sugar found naturally preformed are more complex than sugars
in a few foods, but is mainly created in the body from o Require longer time to digest, thus supply energy for
starch digestion longer period of time
o Abundant in fruits, sweet corn, corn syrup o Sources: cereal grains, potatoes, root vegetables,
o Can provide energy for the brain, other nerve cells and legumes
developing RBC
o Source: Corn syrup, Berries, grapes

2. FRUCTOSE (levulose)
o The sweetest of simple sugars.
o Found in Honey, fruits, some vegetables 2. DEXTRIN
o It is converted to glucose in the body o Not found free in foods
o Formed as intermediate products in the breakdown of
3. GALACTOSE starch
o Not found free in foods
o It is produced from lactose (milk sugar) by digestion
and converted to glucose in the body
o Source: Lactose

3. CELLULOSE
o Forms the framework of plants found to unrefined
GLUCOSE FRUCTOSE GALACTOSE grain, vegetables and fruits.
o Non-digestible by humans
B. DISACCHARIDES OR DOUBLE SUGARS o Provide important bulk in the diet which move
 Made up of 2 monosaccharide digestive food mass along and stimulates peristalsis
 They must be changed to simple sugars by hydrolysis before o Sources: stems, leaves of vegetables and fruits, seeds
they can be absorbed and grains coverings, skin and hulls
1. SUCROSE (ordinary table sugar –granulated powder or o -fibers are the structural parts o the plants, non-
brown) digestable because digestive enzyme are unable to
o Processed from cane and beet sugar break them down
o Found in fruits, vegetables, syrups and sweet food o lower blood glucose levels
products
o Converted to glucose and galactose upon digestion CLASSIFICATION:
o Source: sugar cane; candy; granulated sugar; jams and SOLUBLE
jellies  delay gastrointestinal transit and delays
2. LACTOSE (milk sugar) glucose absorption and lower cholesterol
o Found in milk and milk products  Sources: fruits, legumes, barley, and oats
o converted to glucose and and galactose in digestion INSOLUBLE
 NUTRITION AND DIET THERAPHY
 accelerate gastrointestinal transit, increase 1. Carbohydrate - for energy
fecal weight, slow down starch hydrolysis  Fat - for energy
and delay glucose abruption  Protein - for growth and repair of tissue
 Sources: wheat bran, corn bran, hole grain 2. Vitamins - for growth and repair of tissue
bread, cereals and vegetables  Minerals for regulation
 Dietary Fibre of body
4. PECTINS  Water processes
o Non-digestible, colloidal polysaccharides having a gel
quality
o Used in the treatment of diarrhea, it absorbs toxins and
bacteria in the intestine Health effects of starch and fibers
o Bind cholesterol reducing the amount the blood can a. weight control- fibers rich in complex carbohydrates tend to
be low in at and added sugar and can promote weight loss
absorb
b. Heart disease- high carbohydrates diet, rich in whole grains,
o Sources: fruits
may protect against heart disease and stroke
c. Cancer- high carbohydrates protects against types of cancer
5. GLYCOGEN (ANIMAL STARCH)
d. Diabetes- high CHO, low fat helps control weight
o Formed from glucose and stored in liver and muscle
e. GIT health-dietary fiber enhance the health of large intestine
tissue
o Converted glucose upon digestion
o The hormone glucagon help the liver convert glycogen
to glucose whenever energy is needed by the body.
o Sources: meat and sea foods 3. Minerals
 calcium – important constituent of bones and teeth
FOODS HIGH IN CARBOHYDRATE  its uptake by the body is facilitated by Vitamin D
 deficiency may results to rickets, osteoporosis, and
18. Quick-cooking rice, raw
1. Reprocessed sugar and all kinds of osteomalacia
19. Corn(corn grits) corn flour) o Vitamin C- deficiency may lead to tetany
sugar 20. Rice, Paddy rice grain
2. Tablet candy o 1 g/day normal dietary requirement
21. Wheat, Whole grain(imported,
3. Chewing gum  Sources: dairy products
soft, raw)
4. Butterscotch  iodine- adult body contains 30mg of iodine , mostly
22. Macaroni and Spaghetti
5. Wheat flour cracker concentrated in thyroid gland which requires iodine to
23. Precooked Chinese noodle synthesize thyroid hormone
6. Jelly bean 24. Bread crumbs
7. Rice starch, Rice cracker  Deficiency
25. Chinese style instant cup o Goiter
8. Tapioca pearls(dried, raw) noodle(dried by hot air)
9. Sago starch  Sources:
26. Corn(popcorn, oil-popped and o sea foods
10. Wheat starch salted)
11. Cassava starch o vegetables grown in soil containing iodide
27. Shao mai pastry o iodized salt
12. Quick-cooking rice, raw 28. instant cup noodle
13. Glucose syrup o Magnesium
29. French bread, Raisin bread o Manganese
14. Wheat flour cracker 30. Bread crumbs, Pizza crust
15. Corn(cornflakes) o Phosphorus
31. Rice cake
16. Potatoes/ Sweet potato o Zinc
32. Bread type rolls
o iron
17. Grape(raisins)
o fluoride

4. FAT- SOLUBLE VITAMINS ADEK

a.
Vitamin A- (Retinol)
 Deficiency:
o
Vegetables High poor
in CHOadaptation or night blindness
 o fern
Royal eye lesions
 BITOT’S dried)
o pepper(fruit,
Red Spots- cheesy foamy grayish spot that forms
 Japaneseonradish
the surface of dry patches of conjunctiva at the sides
 Orientalo pickling
the eyes melon
o Xeropthalmia- progressive disease o the eye,
 Eggplant Pickle
conjunctiva become dry, thickened and wrinkled
 Pumpkin (fruit, boiled)
o (pls. refer on p 57-58) for deficiency and toxicity
 Sweet corn, Canned product(cream style), boiled)
 Sources: preformed Vitamin A
 Green pea(boiled)
o animal sources (liver, egg yolk, milk, cream, butter and
 Ginger(pickles, sweetened)
cheese)
 Peanut(immature beans, raw)boiled)
o fortified margarine or skim milk
o fishes- dilis, clams, tahong, shellfish
CARBOHYDRATES  Precursors or Provitamin A
Two main types of carbohydrates o green and yellow vegetables (malunggay, kamote,
1. COMPLEX kangkong,pechay, kalabasa, spinaka
 Breads, rice, cereals, pasta, biscuits, potatoes, peas, sweet o yellow fruits – apricots, peaches, nectarines
corn, parsnip, carrots, dried beans, lentils, fruit, milk and
yoghurt.
b. Vitamin D- (Calciferol)
2. SIMPLE
 enhances the absorption of calcium and phosphorus from the
 Sugar, honey, jams, marmalades, confectionary, cakes, soft
intestine and promote deposition in the bone formation of
drinks, cordials, sweet biscuits, toppings, flavoured mineral
normal bones and teeth
water.
 Deficiency
NUTRIENTS
 NUTRITION AND DIET THERAPHY
o tetany- abnormal muscle twitching, cramps, spasm of • blood lipids- fats in the blood
joints in wrist and ankles • Hyperlipidemia – high levels of fat in the blood
o rickets • Lipoproteins- carrier of fat in human blood
o delayed closing of fontanel • Constitute 34% of energy in the human body
o osteomalacia in adults • Some fat deposits are not used and are considered structural fat.
 Toxicity: They hold the body organs and nerves in position and protect them
o nausea against shock and injury
• includes substances such as fats, oil, waxes
o diarrhea
• greasy to touch and insoluble in water
o polyuria
• soluble in ether, benzene, and chloroform
o weight loss in early age
o bone demineralization CLASSIFICATION OF FATS
o renal damage and uremia A. Simple Lipids ( neutral fats)
o hypercalcemia  chemical name is triglycerides
 Food sources:  compose the 95% fats in the body
o animal sources- fortified margarine, butter, milk, cheese,  composed of three (tri) fatty acids attached to a framework of
fish, liver, and glandular organ , sardines, salmon, egg glycerol (derived from water soluble carbohydrate)
yolk
B. Compound Lipids
c. Vitamin E (Tocopherol)  combination of fats with other components
 antioxidant functions  3 types:
 enhance the activity of vitamin A o Phospholipids
 protect vitamin C o Glycolipids
 helps sustain tissue integrity o Lipoprotein
 Deficiency:
o hemolysis of RBC 1. Phospholipids – compounds of fatty acids, phosphoric acids and
o low blood levels of tacopherol nitrogenous base.
o decrease excretion of creatinine a. Lecithin ( liver, egg yolk, corn oil, cheese, margarine,
 Sources: confections to aid emulsification)
o plant- germ oils of wheat, corn, cotton seed or soy b. Cephalin – needed to form thromboplastin for the
bean, mayonaise, salad dressing, margarine, nuts, blood clotting process.
legumes c. Sphingomyelin- found in brain and other nerve tissue
o Animal- egg yolk, liver, butter, milk as component of myelin sheath.

2. Glycolipids-compounds of fatty acids combined with

carbohydrates and a nitrogenous bases
a. Cerebrocides- components of nerve tissue and cell
membranes and play vital role in fat transport.
b. Gangliosides – made up of certain glucose, galactose
and a complex compound

3. Lipoproteins – lipids in combination of protein.

They are insoluble in water and are combined in protein complex
for their transport and activity in aqueous medium. They contain
cholesterol, neutral fat and fatty acids.

d. Vitamin K (Phylloquinone, menadione) C. Derived Lipids

 maintain prothrombin level in blood plasma  simple derivatives from fat digestion or other more complex
 fairly resistant to heat, but sunlight destroys the K products
 Deficiency: 1. Fatty Acids
o hemorrhagic disease in ne born  are key refined fuel forms of fat that the cell burns for
o delayed blood clotting time in adults energy. They are basic structural units of fat and maybe
saturated or unsaturated
 Toxicity
 Sources of fatty acids
o Vomiting
a. Saturated Fats – palmitic and stearic (animal fats including
o Hemolysis
beef)
o Albuminuria b. Monounsaturated fatty acids – oleic acid is the most abundant
o Kernicterus (olive and peanut oils)
 Sources: c. Polyunsaturated fatty acids – linoleic acid is the most
o liver, dark green leaves, heat bran, vegetable oils, common and is abundant in most vegetable oil.
especially soy bean oil, and heat germ oil, tomatoes,
seeds, legumes, egg yolk 2. Glycerol

Fats
a water-soluble component of triglycerides and is convertible
with carbohydrate. It comes out 10% of the fats.
3. Steroids
OBJECTIVES:  a class of fat related substances that contain sterols. A main
At the end of the topic, you should be able to member of this group is cholesterol. Food rich in cholesterol
a. identify the function of fat. are egg yolk, organ meats, shell fish, dairy fats, and animal
b. identify the source of fat, fat products
c. differentiate the different kinds of fats, and
d. identify disease conditions associated with excessive fat intake. DIGESTION OF FATS

FATS
 Are organic compounds called lipids composed of carbon, hydrogen
and oxygen
 Fat related health terms:
 NUTRITION AND DIET THERAPHY
3. Cleanse, Rejuvenate and Supplement – regular colon cleansing,
periodic liver flushes and revitalizing multi vitamins

PROTEIN
OBJECTIVES
At the end of the topic, you should be able to:
1. Identify the function of protein,
FUNCTION OF FATS 2. Identify the sources of protein,
1. Important source of calories. 3. Differentiate the different kinds of protein,
2. Fat is protein sparing. 4. Identify disease conditions associated with deficiency of protein
3. Fat is essential to maintain the constant body temperature by intake.
providing effective insulation underneath the skin.
4. Fat cushions vital organs such as the kidney against injury.
5. 5. Fat facilitates the absorption of the fat-soluble vitamins A,D,E,
and K. PROTEIN
6. Fat provides satiety and delays the onset on hunger.  Came from Greek word “protos” meaning “primary” or “holding
7. Fat contributes flavor and palatability to the diet. first place” since it is the first substance recognized as vital part of
living tissue.
FOOD SOURCES  They are organic substances that on digestion yield their constituent
A. Visible Fats– lard, butter, margarine, shortenings, salad oils, visible unit building block- Amino Acids.
fats of meat.
B. Invisible Fats – are those available in milk, cheese, eggs, nuts, and CLASSIFICATION OF PROTEINS
meat. A. Simple Proteins – are those which yield only amino acids upon
High in Saturated Fatty Acids: hydrolysis.
 Whole milk, cream, ice cream, cheese 1. Albumins – soluble in water, coagulated by heat.
 Medium fat or fatty meats, beef, lamb 2. Globulins – insoluble in water, soluble in dilute salt solution and
High in Polyunsaturated Fatty Acids: coagulated by heat.
 Vegetable oils, safflower, corn, cotton seed, soybean, 3. Glutelins - insoluble in neutral solvents but soluble in weak acids
sesame, sunflower and alkalis, coagulated by heat.
 Salad dressings made from above oils,
 mayonnaise, French dressings 4. Prolamines – soluble in 70% to 80% alcohol, insoluble in
 Special margarine: liquid oil absolute alcohol, water and salt solutions.
 Fatty fish: salmon, tuna, herring 5. Albuminoids – insoluble in all neutral solvents and in dilute acids
Essential Fatty Acids: and alkalis.
 Linoleic Acid- Omega 6 family 6. Histones and Protamines – soluble in water, not coagulated by
o Found in vegetable oils ( corn, safflower, soybean, heat ( nuclei of cells).
cottonseed, poultry fats).
o it can be made into arachidonic acid which is B. Compound Proteins, Conjugated Proteins or Proteids- –
abundant in meats combination of simple proteins and some other non protein substance
 Linolenic Acid- Omega 3 family called a prosthetic group
o Found in oils ( flaxseed, canola, walnut, wheat germ, 1. Nucleoproteins – combination of simple proteins and nucleic
and soybean, nuts and seeds, human milk, shellfish acid.
and fish  Ex: Deoxyribonucleic nucleoproteins
o can be made into (EPA) eicosapentaenoic and (DHA) 2. Mucoproteins and glycoproteins – combination of protein and
docosahexaenoic acid which are essential for growth large quantities of complex polysaccharides.
and development, prevention or treatment of heart  ex: Mucin found in secretion from gastric mucus membranes.
dse, hypertension
3. Lipoproteins – compounds of proteins and a triglyceride or
other lipid such as phospholipids or cholesterol found in cell
and organelle membranes.
4. Phosphoproteins- compounds of phosphoric acid joined in
ester linkage to protein found in casein of milk.
HEALTH EFFECTS OF LIPIDS
5. Chromoproteins – compounds of proteins and nonprotein
1. Heart disease – elevated blood cholesterol
pigment found in flavoproteins, hemoglobin, and cytochromes.
2. Risks from saturated fats – lauric, myristic, and palmitic acids
6. Metalloprotein – are compounds or metals (Cu, Mg, Zn, and
raise blood cholesterol levels.
Fe ) attached to protein found in ferritin, hemosiderin, and
3. Benefits from monounsaturated fats – olive oil lowers risks of
transferrin.
heart disease.
4. Benefits from Omega 3 polyunsaturated fats- lower blood
C. Derived Proteins
cholesterol and prevents heart disease
 Products formed in the various stages of hydrolysis of a protein
5. Cancer – fat does not instigate cancer development but can
molecule.
promote it once it has arisen.
6. Obesity – High fat diets tend to store body fat ably.
CHEMICAL STAGES OF A PROTEIN
A. An amino acid has a chemical structure that combines both acid and
HOW TO LOWER FAT INTAKE
bases (amino) factors. This characteristics chain structure of amino acid
 Don’t deprive yourself of fatty food. Eat fatty food moderately
is called peptide linkage. Long chains of amino acids that are linked in
 Add more healthy food to your diet this manner are called polypeptides.
MAKING POSITIVE CHANGES B. Essential and Non-essential Amino Acids
1. Eliminating Trans Fat
2. Fighting Fat with Fats
 NUTRITION AND DIET THERAPHY
1. Essential amino acids cannot be synthesized by the body and
are necessary in the diet.
 Examples: Threonine, leucine, isoleucine valine, lysine,
methionine, phenylalanine, tryptophan

2. Non-essential amino acids- can be manufactured by the body

 Examples : Glycine, Alanine, Aspartic acid, Glutamic Acid,
Proline, Hydroxyproline, Cystine, Tyrosine, Serine, Arginine, REQUIREMENT FOR HUMAN NUTRITION
Ristidine A. Quality of protein fundamental to health and life.
B. General daily recommendation of Food and Nutrition Board.
C. Complete and Incomplete Proteins 1. Adult – 0.9 g/kg BW
1. Complete proteins – are those that contain all the essential amino acids 2. Children – growth needs vary according to age and growth
in sufficient quantity and ratio to supply of the body’s needs. patterns
 Ex : animal origin meat, milk, cheese, cheese, milk, and eggs. 3. Pregnancy – rapid growth requires increase of 30g
4. Lactation – requires an increase of 20 g.

MEASURES OF PROTEIN QUALITY

A. Biologic Value (BV)- measures its effectiveness in supporting the
body’s needs.
2. Incomplete proteins – those deficient in one or more of essential B. Net Protein Utilization (NPU)- measures how capably a protein is
amino acids. used by the body.
 Ex: plant origin grains, legumes, seeds and nuts.
C. Protein Efficiency Ratio (PER)- measures the increase in weight
of a growing animal and compares it with the intake.

Health Effects of Protein

1. Heart disease
2. Cancer
DIGESTION OF PROTEIN 3. Osteoporosis
A. Mouth 4. Weight Control
1. Enzyme – none 5. Kidney Disease
2. Action – mechanical mastication
B. Stomach PROTEIN ENERGY MALNUTRITION (PEM)
1. Enzyme – pepsin, produce first as inactive precursor to  Protein-energy malnutrition is a condition resulting from
pepsinogen, then activated by the hydrochloric acid. insufficiency of protein, energy or both in the diet.
2. Action – converts protein to proteases and peptones 1. Marasmus – severe deprivation of food over a long period
3. In infants, enzyme rennin converts casein to coagulated curd. of time.
C. Small Intestine ( Alkaline) 2. Kwashiorkor - reflects an abrupt and recent deprivation of
1. Pancreas food which develop rapidly as a consequence of protein
a. Trypsin converts proteins, proteases and peptones to deficiency or cased by illness like measles.
polypeptides and peptides.
b. Chrymotrypsin converts proteases and peptones to
polypeptides and dipeptides, also coagulates milk.
c. Carboxypeptidase - converts polypeptides to simpler peptides,
dipeptides and amino acids.
2. Intestine
a. Aminopeptidase- converts polypeptides to peptides and amino
acids.
b. Dipeptidase – converts dipeptides to amino acids.

FUNCTIONS OF PROTEIN
1. Proteins are used in repairing worn out body tissue
proteins (anabolism) resulting from continued wear and
tear (catabolism) going on in the body.
2. Proteins are used to build new tissue
3. Protein are source of heat and energy
4. Proteins contribute to numerous essential body secretions
and fluids, enzymes and proteins
5. (hormones, mucus, milk, and sperm cells)
6. Protein are important in the maintenance of normal
osmotic relations among the various body fluids.
7. Proteins play a large role in the resistance of then body to
disease. ( Antibodies- plasma globulin and gamma
globulin)
8. Dietary protein furnish the amino acids for a variety of
metabolic functions.

SOURCES OF PROTEIN
1. Complete protein foods – meat, fish, poultry, egg, milk, cheese.
2. Legumes, nuts
3. breads and cereals
NUTRITION AND DIET THERAPHY

MICRONUTRIENTS
VITAMINS
 Are a group of unrelated organic compounds needed only in minute
quantities in the diet.
 These are organic compounds found in food, which are essential in
the growth, repair and healthy functioning of body tissues.
 Comes Latin word “Vita” meaning life and the suffix “amine”
which means a nitrogen compound.

TERMS ACCOUNTED WITH VITAMINS

1. Precursors or Provitamins – are compounds that can be changed
to the active vitamins. Example: carotenes, cryptoxanthin are
precursor of vitamin A. Ergosterol, when radiated becomes vitamin
D.
2. Preformed Vitamins – are naturally occurring vitamins that are in
inactive form and ready for its biological use.
3. Avitaminosis – a condition resulting from lack of a vitamin on its
later stage ( Xeropthalmia, Scurvy, Beri-beri)
4. Hypervitaminosis - referred to as “vitamin toxicity”; excessive
accumulation of vitamin in the body
5. Vitamin malnutrition – too much or too little
6. Vitamin-like compounds – substances that have physiologic role
like vitamins ( inositol, choline, lipoic acid, and ubiquinone.
7. Antivitamins or vitamin antagonists – substances that interfere
with the normal functioning of a vitamin ( dicumerol-vit K, avidin-
biotin, thiaminase- thiamin or vit B1.

TOXICITY SYMPTOMS FOR SELECTED VITAMINS

VITAMIN C
 diarrhea
 nausea, cramps
 formation of excess oxalic acid in the body
 acidification of urine
 interference with the use of therapeutic drugs
 conditioning to a higher requirements both infants and adults
 intestinal obstruction
 false positive urine diabetic test

NIACIN
 skin burning, flushing, and itching
 nausea, vomiting, diarrhea
 liver and eye damage

VTAMIN B12
 allergic shock, especially when vitamin is injected

VITAMIN A
 Liver damage
 Hair loss
 Bone mage
 Potential birth defects

VITAMIN D
 Severe high blood calcium
 Brain damage
 Heart damage
 Potential birth defects

VITAMIN E
 cramps diarrhea
 NUTRITION AND DIET THERAPHY
 dizziness, blurred vision, headaches d. PHYSIOLOGIC FUNCTIONS
 increased serum triglycerides in women  Vision Cycle
 decreased serum thyroid hormone in men and women o necessary component of visual purple
VITAMIN K (rhodopsia) light sensitive pigment in the retina
 formation of blood clots enabling it to make adjustments to light and
 jaundice in infants darkness
o Retinal is a prosthetic group of photosensitive
pigments of both rods ( rhodopsin), and cones
( iodopsin).
o When there is vit A deficiency the rods and
NOMENCLATURE OF THE VITAMINS cones can not adjust to light changes, resulting
VITAMIN A (anti-infective VITAMIN A (retinol) in night blindness.
VITAMIN B1(anti-beri-beri) VITAMIN B1(thiamine)  Epithelial tissue
Antineuritic Riboflavin o plays vital role in the proper synthesis and
VITAMIN B2 Niacin (nicotinic acid, niacinamide) maintenance of epithelial tissue, hence integrity
PELAGRA PREVENTIVE VITAMIN B6(Pyridoxine) of skin and internal mucosa, growth and
FACTOR- formation of tooth buds.
VITAMIN B COMPLEX  VITAMINB12(cyanocobalamin) o When vit A is lacking, there is keratinization
 Folasin (folinic acid, ( hardening and sloughing) of mucous
pteroylglutamic acid membrane lining of respiratory tract, digestive
 Biotin tract, urinary system, eyes and the skin.
VITAMIN C ASCORBIC ACID Keratinization of eye epithelium is the stigma of
VITAMIN D VITAMIN D (Calciferol) Xerophthalmia.
VITAMIN E VITAMIN E (tocopherol)  Growth and Bone Development
VITAMIN K VITAMIN K (menaquinone and o necessary for growth and development of
phylloquinone) skeletal and soft tissues through its effect upon
protein synthesis and differentiation of bone
CLASSIFICATION OF VITAMINS cells.
1. The fat soluble vitamins A, D, E, K o Excessive vit a , however causes complete
2. Water soluble vitamins are B complex and vitamin C. disintegration of the bone matrix
 Reproduction
o vitamin A intake must be increased to assure normal
reproduction and lactation

e. DEFICIENCY
 poor adaptation or night blindness
 eye lesions – BITOT’s Spot and Xeropthalmia.
GENERAL PROPERTIES AND STABILITY  retarded growth
Fat soluble vitamins  lower resistance to infection
1. Fat soluble vitamins generally have precursors or provitamins.  faulty skeletal and dental development.
2. Because they can be stored in the body, deficiencies are slow to  keratinization of epithelial lining
develop.  disturbances in the respiratory, GI, genitourinary tract.
3. They are not absolutely needed daily from food sources  Skin lesions – “food skin” (phrynoderma)
4. They are generally stable, especially in ordinary cooking methods.
Water soluble vitamins  bitot’s spot –the cornea of the eye is affected early and the
1. They must be supplied every day in the diet. lacrimal gland fails to function, followed by keratinization
2. They do not have precursors and rupture of the corneal tissues.
3. They are not stored significantly in the body and any excess is
excreted in the urine.  phyrnoderma – skin lesion appears as dry and rough skin
4. Deficiency symptoms develop relatively fast. with popular eruptions occurring around the hair follicle
5. Being water soluble, they are most likely to be destroyed in
ordinary cooking.
f. TOXICITY
FAT SOLUBLE VITAMINS  Violent headache
1. VITAMIN A (RETINOL)  nausea and vomiting
a. CHEMICAL AND PHYSICAL  thickening of skin with peeling off
NATURE  Swollen painful long bones
 Preformed Vitamin A- animal sources  coarse sparse hair
 Provitamin A – precursor carotene, pigment found in  enlargement of spleen and liver
green and yellow plants, body converts to vitamin A.  cessation of menstruation
 hypercarotenimia- ingestion of large amount of food
b. ABSORPTION AND STORAGE containing carotene
 absorption aided by bile salts, pancreatic lipase and dietary
fat g. FOOD SOURCES
 carotene converted to vit A in intestinal wall.  Preformed Vit A – animal sources (liver, egg yolk, milk,
 absorbed through lymphatic system and portal blood to cream, butter and cheese).
liver  Fortified margarine or skimmed milk fortified with vit A.
 large storage capacity in liver  Fishes, shellfish
 Precursors of Pro vit A- Green and yellow vegetables
c. STABILITY
 vitamin A is rather stable to light and heat, but prolonged 2. VITAMIN D (CALCIFEROL)
heating in contact with air destroys it. It is easily destroyed a. Chemical and Physical nature
by oxidation and ultraviolet light. A cool atmosphere and  Sterols, more hormone-like in source and action.
refrigeration tend to preserve it.
 Formed in skin by irradiation of cholesterol by sunlight.
 NUTRITION AND DIET THERAPHY
b. Absorption and Storage 4. VITAMIN K ( PHYLLOQUINONE, MENADIONE)
 absorption accompanies that of calcium and phosphorus in a. Chemical and Physical Nature
the small intestines.  Fat soluble
 It is formed by sunlight in the skin absorbed into systemic  Synthesized by normal intestinal bacteria.
circulation as hormones. b. Absorption and storage
 Storage in liver, but not as great as that of vitamin A.  absorbed by usual route for fats, lacteals, portal blood to liver.
c. Stability  stored in liver in small amounts.
 Vitamin D is stable, foods containing it can be warmed and or c. Physiologic Functions
kept for a long period without deteriorating.  Maintenance of prothrombin level in blood plasma.
d. Physiologic Function * The coagulation of blood is a series of reactions that depend on several factors. Vit K
is also needed in the synthesis of proconvertin
 absorption of calcium and phosphorus
 needed for phosphorylation- a chemical process that aides the
 essential for normal growth and development and is
phosphate radical to glucose so that its passage through the cell
important for formation of normal bones and teeth
membrane is hastened.
e. Deficiency
d. Stability
 Tetany- a syndrome characterized by abnormal muscle
 Vitamin K is fairly resistant to heat but sunlight destroy the Vit K.
twitching, cramps and sharp bilateral spasms of joints in
 All Vit K compounds are unstable in alkali.
the wrist and ankle
e. Deficiency
 Rickets - in children is the severe form manifested in
 hemorrhagic disease in newborn
defective bones and retarded growth. Bone become soft,
fragile and deformed, such as pigeon breasted, knock-  delayed blood clotting time in adults.
kneed, bow legged, malformed teeth, rachitic rosary-like f. Toxicity
chest (the ends of ribs are rounded or beaded  vomiting
 Infants – dentition and closing of fontanels are delayed.  hemolysis
 Osteomalacia – softening of the bone.(adult rickets)  albuminuria
f. Toxicity  kernicterus- a condition resulting from the accumulation of bile
 nausea pigments in the gray matter of the central nervous system
 diarrhea g. Food Sources
 polyuria • liver
• Dark green leaves
 weight loss in early stages
• Wheat bran
 demineralization of bone and deposits of minerals in the
• Vegetable oils (soybean & wheat germ)
soft tissues in the later stage. • Tomatoes
 renal damage and uremia • Tubers, seeds, legumes and egg yolk
 Hypercalcemia
g. Food Sources WATER SOLUBLE VITAMINS
 Animal sources – fortified margarine, butter, milk, 1. Vitamin C (Ascorbic Acid)
cheese, fish, liver and other glandular organs, sardines a. Chemical and Physical Nature
and salmon, egg yolk.  water soluble acid, easily oxidized unstable
 Plant Sources – not significant  other animal can synthesize vit C from glucose
b. Absorption and Storage
3. Vitamin E (Tocopherol)  easily absorbed by the small intestines
a. Chemical and Physical Nature  not stored in tissue depots; distributed to tissue saturation
 Resistant to oxidation (antioxidant) level, remainder is excreted, large amount in adrenal tissue
 Fat soluble, stable to heat and acids c. Physiologic Functions
b. Absorption and Storage  needed in the formation and maintenance of intercellular
 Absorbed with other fat-soluble vitamins, aided by bile and cementing substance - This cementing substance is simply explained as a
fats “binder” that holds cell in proper relation to each other as to cellular fluids
 stored especially in adipose tissue which bathe and nourish them
c. Physiologic Functions  converts folic acid to its active form, folinic acid
 Antioxidant Functions – it prevent formation of peroxides  healing of wound and bone fracture
from polyun- saturated fatty acids, thus preventing the  prevents megaloblastic anemia and petechiae hemorrhages.
oxidation of unsaturated fats.  building of bodily resistance against infections.
 Helps to sustain tissue integrity, especially structural parts  production of steroid hormone ( adrenocortical hormones)
containing unsaturated lipids, e.g. cell wall under severe stress and insulin synthesis
d. Stability  tyrosine and phenylalanine metabolism.
 Vitamin e is fairly stable to heat and acids and unstable to  improves iron absorption
alkalis, ultra-violet light, and oxygen. It is also destroyed  vital role in brain metabolism
when in contact with rancid fats, lead and iron. Storage by  antioxidant action
deep-freeze food processing and deep fat frying destroy d. Stability
Vitamin E.  Much ascorbic acid is lost in cooking or thrown out in the
e. Deficiency cooking water.
 hemolysis of RBC  Bruising, cutting and allowing fruit and vegetables to be exposed
 low blood levels of tocopherols to the air cause much loss of ascorbic acid. Quick freezing
 increase urinary excretion of creatinine preserve the vitamins. Refrigeration aids retention
f. Toxicity  Use of sodium bicarbonate in cooking vegetables to preserve and
improve color is very destructive of vitamin
 hypervitaminosis E has not been reported largely because the
e. Deficiency
nutrient could not be stored to a large extent in the body
 irritability
 general weakness
g. Food Sources
 lack of appetite
 Plant Sources – germ oil of wheat, corn, cotton seed, or soy  lowered resistance to infections
bean, and product from this oil such as mayonnaise, salad  pallor
dressing and margarine. Nuts and some legumes are good  scurvy ( bleeding, swollen gums, loose teeth, swollen tender
sources joints, internal hemorrhages, capillary fragility, megaloblastic
 Animal sources – egg yolk, butter, milk anemia)
f. Toxicity
 NUTRITION AND DIET THERAPHY
 No toxicity or hypervitaminosis C  0.2 mg/1000 caloric intake
g. Requirement or Allowance  Allowances are at least twice the minimum needs
 Males need more Vitamin C than female Vitamin C needs are (0.5mg/1000cal.)
also increased during the growth period, physiologic stress  Factors that increase thiamin req pregnancy,
(pregnancy and lactation), surgery, illness, infection, shock, lactation, fever, infection, alcoholism,
injuries.
hyperthyroidism and polyneuropathies.
2. VITAMIN B-COMPLEX
f. Food Sources
 Consist of B1, B6, B12, Niacin, Panthothenic Acid, Folic Acid, and  lean pork, pork liver, & other glandular organs of
Biotin. pork and some shellfish. egg yolk, unpolished rice,
 They provide energy necessary for muscle contraction. whole grains, legumes, and nuts.
 During exertion, they are also involve in production and repair of
tissues. Riboflavin (B2)
 Nutrients that play important roles in the normal growth and a. Functions
maintenance of body processes.  Essential component as coenzymes flavin
 Boiling meat results to about 15 to 40% loss of vitamin B. mononucleotide (FMN) and flavin adenine
 Frying – 40 to 50% loss Roasting – 30 to 60% loss dinucleotide ( FAD), riboflavin is essential for
protein, fat and carbohydrate metabolism.
A. Group I – Classic Disease Factors  needed for conversion of tryptophan into niacin.
Thiamine (B1)  helps maintain healthy skin, tongue, and mouth,
a. Functions normal vision, proper growth and development.
 integral part of co enzyme factor, thiamin b. Stability
pyrosphosphate or TPP, needed for carbohydrate  it is stable to heat, oxidation, and acid sensitive to
metabolism.
alkali
 Helps maintain good appetite, good muscle tone
c. Deficiency
especially of the GI tract and normal functioning of
nerves.  Ariboflavinosis – characterized by tissue changes
b. Stability particularly in the skin, eyes, mouth, nose, and
 Loss of vitamin in cooking is extremely variable, tongue
depending on the pH of the food, time, temperature,  The skin develops seborrheic dermatitis (scaly,
quantity of water used and discarded. greasy with burning sensation and corneal
 Freezing has little or no effect on the thiamin content of vascularization or extra blood vessels over the
foods. cornea, photophobia and dimness of vision).
c. Deficiency  Glossitis – tongue is swollen and becomes magenta
 loss of appetite red
 weakness  Cheilosis – lesion when lips are swollen
 easy fatigability d. Toxicity
 indigestion  toxicity does not occur from oral doses but is
 severe constipation possible when massive doses are given by injection.
 gastric atony e. food sources
 poor reflexes and irritability  Animal sources-cheese, milk, eggs, liver and other
 retarded growth glandular organs.
 numbness of extremities  Plant sources – whole grain, legumes, leafy green
 beri-beri ( nutritional polyneuritis) vegetables and sea weeds

Niacin (nicotinic acid)

a. Functions
 Act as hydrogen and electron acceptors plays an
important role in energy metabolism fatty acid
synthesis/oxidation and protein
synthesis/catabolism
 need for photosynthesis in plants and fixation of
CO2 in animal cells
b. Stability
Types of Beri-beri:  More stable than Riboflavin and thiamin
a. Infantile Beri-beri  Resistant to heat, air, light, acids, alkalis,
 occur in 2 to 5 months, S/S – aphonia, cyanosis, whining cry, cyanosis,DOB, death  Small amount maybe lost in discarded cooking
b. Wet Beri-beri water.
 evidenced by edema, of both lower extremities which progress upward to body c. Deficiency
 anorexia
cavities (abdomen and chest). Heart is enlarged, DOB, irregular heart beat.
 indigestion
c. Dry Beri-beri
 skin changes
 involves peripheral nerves.
 pellagra ( 4D- dermatitis, dementia, diarrhea, and death )
 There is a feeling of pins and needles (paresthesia) in toes, gradual loss of touch glossitis angular stomatitis
sensation, muscle weakness, finally paralysis d. Toxicity
 hypermotility
APHONIA – loss of voice  acidity of the stomach
CYANOSIS – bluish discoloration of infant  paralysis in the respiratory center
e. Food Sources
 Animal sources – liver, glandular organs, lean meats,
fish and poultry, milk and cheese, egg
 Plant sources – legumes, nuts, whole grains, enriched
d. Toxicity
cereals and green vegetables.
 there are no toxic reactions of excessive thiamin
intake in the body B. Group II More Recently Co-enzyme Factors
Pyridoxine ( Vitamin B6 )
a. Functions
e. Requirement or Allowances
 NUTRITION AND DIET THERAPHY
 plays an essential role in many of the complex the enzymes which utilize felacin coenzymes are
biochemical processes by which foods are known as ptero proteins
metabolized by the body.  required for one-step conversion of histidine to
 found in the cells in active form. Pyridoxal glutamic acid
phosphate (PLP), a co-enzyme that function in  essential for formation of both RBC and WBC in the
protein, fat, and carbohydrate metabolism. bone marrow and for their maturation.
 Co-enzyme for many chemical reactions, related to b. Stability
protein metabolism.  It is unstable to heat in acid media and stable to
 essential for the formation of tryptophan and for the sunlight when in a solution.
conversion of tryptophan to nicotinic acid.  There is considerable loss of folic acid in vegetables
b. Deficiency during storage at room temperature and high temp.
 No deficiency state has been observed in adults. c. Deficiency
 In infants, deficiency state which results from  poor growth
feeding them milk formula lacking in pyridoxine for  megaloblastic anemia
several weeks causes irritability, poor growth,  glossitis
anemia, and convulsions.  GIT disturbances arising from inadequate dietary
c. Toxicity intake
 impaired absorption
 Observed only in rats  excessive demands by tissue of the body.
d. Food sources :  metabolic derangements
 vegetable oils of corn, cottonseed, linseed, olive, d. Sources
peanut, wheat germ, wheat and rice germ, lard  liver, kidney beans, fresh dark leafy vegetables
legumes (soybeans and nuts). (spinach, broccoli, asparagus).
 Lean beef, potatoes, whole wheat bread and dried
Panthothenic Acid beans.
a. Functions
 essential for carbohydrate, protein and fat Cobalamin (B12)
metabolism. a. Functions
 maintenance of normal growth, healthy skin, and  essential for normal metabolism and growth of all
integrity of the CNS cells, esp for those in the GI tract, bone marrow, and
 part of co-enzyme A, has many metabolic roles in nervous tissue
the cells.  participates with folic acid, choline and methionine
b. Stability in the transfer of methyl groups in the synthesis of
 Water soluble, stable in moist heat nucleic acids, purines and pyrimidine intermediates.
c. Deficiency  effects myelin formation
 insomnia  involve in carbohydrate, protein and fat metabolism,
 muscle cramps and associated with folic acid absorption and
 tingling sensation of the extremities metabolism.
 vomiting b. Stability
d. Toxicity  approximately 70% of the vitamin
 No toxic effects  activity is retained during cooking
e. Requirement or Allowances c. Deficiency
 5 mg a day  demyelination of the large nerve fibers of the spinal
f. Sources – liver, meat, eggs, milk, cheese, legumes cord.
 pernicious anemia
Lipoic Acid d. Toxicity
 This is a sulfur containing fatty acid and is not a true vitamin  No toxic effects
because it can be synthesized in adequate amount in the body. e. Sources
 It is a co-enzyme energy metabolism converting pyruvic acid to  Animal protein contains significant amount of B12
acetyl CoA. while plant sources have practically nothing
 The concentrated sources of lipoic acid are yeast and liver.
Biotin D. Group IV. Other Factors / (pseudo-vitamins)
a. Functions Inositol
 Co-enzyme factor in CO2 fixation  occurs in meat and meat extractive, muscle and glandular
 together with active acetate (CoA) it helps in the organs, brain, legumes and nuts, fruits and vegetables,
synthesis of purines, pyrimidines, fatty acids and grains.
carboxylation reactions.  abundant in diet and minimum requirement are not known.
b. Stability  chemistry is closely similar to glucose (muscle sugar).
 Stable to heat, soluble in water and alcohol and
susceptible to oxidation, to alkali and to strong acids.  is a lipotropic agent. It is linked with phospholipids as
c. Deficiency phosphoinositol which help in the transport and
 Biotin deficiency does not occur. metabolism of fats.
d. Toxicity Choline – is a lipotropic agent, i.e.
 No toxic effect  It mobilizes fat and prevents fatty acids.
e. Requirements or Allowances  lipotropic agent - mobilizes fat and prevents the build up of
 150 to 300 micrograms a day fatty acids
f. Food Sources – liver, meats, egg yolk, milk, molasses,  is needed for fat transport as a constituent of phospholipids,
whole grains, legumes and nuts.’ namely lecithin, cephalin, and sphingomyelin
 it helps in transmission of nerve impulses.
C. Group III – Cell Growth and Blood Forming Factors  deficiency results in fatty livers as seen in chronic
Folic Acid alcoholism & kwashiorkor
a. Functions  richest food source is egg yolk; other good sources are
 transfer of one-carbon units to appropriate metabolites liver, brain, kidney, heart, meats, legumes and nuts, yeast
in the synthesis of DNA, RNA, methionine and serine, and wheat germ.
 NUTRITION AND DIET THERAPHY
 Oxalic and phytic acids interfere with absorption of calcium.
 Fats in excess may form insoluble soaps with calcium as evidence
by presence of fatty acids, calcium and also fat soluble vitamin D in
feces (sprue and steatorrhea)
 Anything that may cause an increase in GI motility like laxatives
and foods high in bulk may reduce the rate of passage of food in
intestinal tract causing decrease in absorption of calcium.
 Lack of exercise may cause loss of bone calcium and reduced ability
to replace it.
 Mental stress or emotional instability reduces calcium absorption.
 Alcohol intake may cause decrease calcium absorption.
 Caffeine increases urinary excretion ( 1 cup=increase excretion of
6mg)
d. Food Sources
 Kuhol, Gamet-seaweed, malunggay leaves, saluyot, carabao’s milk,
dilis, hipon, tagunton, susong pilipit, talangka, silinyasi, cheese,
bagoong, dried fish, alakaak, bia, galunggong, sardines, dried
ayungin, dried dilis, dried hibi, evaporated milk
e. Effects of Deficiencies or Excess
 Retarded growth
 Rickets
 Osteomalacia
 Tetany

2. MAGNESIUM

MINERALS
 The term “minerals” means the elements in their simple inorganic
form. They are commonly referred to as mineral elements or, trace
elements or trace minerals. a. Distribution
 About 50% of magnesium in the body is present in the bones in
Mineral Composition of the Body combination with phosphate and calcium, 1% is in extra
• there are 21 mineral elements now known to be essential in cellular fluid.
nutrition. Mineral elements exist in the body and in food in  The plasma contains approximately 1.5 to 2 mEq/ liter of
organic and inorganic combination. magnesium.
b. Function
 essential part of many enzyme systems responsible for the
transfer of energy.
 It is the core of the chlorophyll molecule, thus making it
important in photosynthetic reaction in plants
 it is essential in cellular metabolism
 regulates blood phosphorus level
1. CALCIUM  It is necessary to promote the conduction of nerve impulses and
a. Distribution to allow normal muscle contraction.
 to 2.2 % of total body weight.  it may also increase the stability of calcium in the tooth enamel.
 99% is present in bones and teeth c. Food Sources
 1% is found in soft tissues and body fluids  nuts, soybeans, meat,
b. Function  milk, cocoa, sea foods,
 Calcium combines with phosphorus to form calcium phosphate,  whole grains, dried beans,
the hard material of the bones and teeth.  peas, green plants
 Calcium participates in muscular contraction and relaxation. d. Effects of Deficiency or Excess
 Calcium promotes blood coagulation.  Hypomagnesemia or Hypomagnesemic Tetany -
characterized by intestinal malabsorption, prolonged diarrhea
 Calcium affects the transport of cell membranes, possibly
or vomiting, and alcoholism
acting as a membrane stabilizer.
 Hypermagnesemia or toxic stage of magnesium – toxicity
 Calcium is required in nerve transmission and regulation of stage of magnesium results in hypotension, arrythmia or even
heart beat. cardiac arrest, ECG changes, decreased tendon reflexes, and
c. Utilization coma
 Factors that influence calcium absorption
 There is better absorption during increased body needs such as in 3. SODIUM (Na)
growth, pregnancy and lactation (60%). When the intake in take is a. Distribution
low, the body compensates by absorbing a high percentage. There is  a monovalent cation
decreased absorption in old age.  50% found in extracellular fluid (vascular)
 Vitamin D enhances the optimum absorption of calcium by  10% found in the cells
increasing permeability of the intestinal membrane to calcium and  40% found in skeleton bound in surface of bone crystals
by activating the active transport system. o total sodium in the body is 1.8mg/kg fat free body weight.
 Allow gastric pH (acidic) favors absorption of calcium whereas b. Functions
hypochloridria (alkaline medium) causes precipitation of mineral.  It responsible for maintaining fluid balance.
 A normal protein diet does not have any effect on calcium  It is responsible in maintaining acid-base balance.
absorption but high intakes of meat increase excretion of calcium in
 It also allows passage of materials like glucose through cell wall
urine even if lysine, arginine and serine increase the absorption by
and maintains normal muscle irritability or excitability.
50%.
c. Food Sources
 A high ratio of lactose to calcium is necessary for the formation of
 carrots, spinach, celery, peas, beets, vetsin, toyo, patis, catsup,
soluble complex which can easily be transported to and possibly
processed foods, NaCl (40%sodium), preservatives and additives,
across the intestinal wall
canned foods
 The ratio of calcium to phosphorus is important in the absorption of d. Recommended Dietary Allowances
both minerals in infants and a recommended level is a Ca:P ratio of
 Allowances and requirements for sodium should be equal the
1.5:1. In adults , a ratio of 1:1 is necessary for better absorption.
amount needed by the body for growth, for losses in sweat and
 NUTRITION AND DIET THERAPHY
secretions, urine, stools and through nonsweat losses from the  Normal range – 95-105 mEq/L or 340-370 mg/100ml
skin.  A relatively large amount of ionized chlorine is found in the GI
e. Effects of Deficiency or Excess secretions as HCl.
 Hyponatremia - occur in dehydration as in heat exhaustion, b. Functions
especially following an intake of large amount of H2O  it maintains fluid and electrolyte balance, and acid-base balance.
 Edema ( hypertension and kidney disorders  It contributes to necessary acidity in the stomach (HCl)
c. Effects of Deficiency
 Alkalosis
d. Sources
 Table salt (NaCl)
4. POTASSIUM
a. Distribution B. GROUP II : TRACE MINERALS
 Potassium is principal cation present within the cells or 1. IRON
intracellular fluids. a. Distribution
 2.6 g / kg fat free weight is potassium (0.35% of body weight)  The body weight contains about 75g/kg fat free body weight on
 present in small amount in extracellular fluid. iron (3-5gm).
b. Function  60-75% - hemoglobin
 it maintains fluid and electrolyte balance  5% - myoglobin ( muscle of hemoglobin)
 it exerts an influence upon acid-base balance and plays a  26% - liver, spleen and bone marrow
significant role in the activity of skeletal and cardiac muscles. b. Functions
 it acts as muscle relaxant in contrast to calcium which stimulates  as a carrier of oxygen
muscular contraction.  necessary for hemoglobin formation
 it is important in carbohydrate and protein metabolism.  active component of tissue enzyme involved in the conversion of
betacarotene to vitamin A, synthesis of purines, antibody
c. Food Sources production, collagen synthesis and other functions associated with
 Meat, legumes, milk, raw and dried fruits, fruit juice, dark green respiratory chain.
vegetables, unrefined cereals c. Utilization
d. Recommended Daily Allowance Factors that affect the absorption
 The diet should contain about 2 to 6 gm potassium so that a  Heme Iron is found only in meat ( fish and poultry) and is more
deficiency is usually unlikely in a healthy person. efficiently absorbed by the body.
e. Effects of Deficiency  None-heme comes from other iron containing foods like cereals,
 Hypokalemia vegetables and eggs. Vitamin C help with absorption of non-heme
 Apathy iron.
 Muscular weakness d. Body Needs
 Mental confusion  If a person has higher need for iron and in a state of iron
 Abdominal distention deficiency, then the level of iron is high
Effects of Excess
 Hyperkalemia – toxicity causes weakening of the heart action, e. Bulk in the diet
mental confusion, poor respiration, and numbness of extremities  increase fiber in the diet interferes with absorption of iron.
f. Intake of Coffee
5. PHOSPHORUS  Intake of coffee decreases the absorption of iron.
a. Distribution g. Presence of ascorbic acid
 The normal human body contains 1% of phosphorus = 12gm/kg  40-50 mg of ascorbic acid added to a meal of bread, egg iron and
fat free body weight. tea or coffee increases iron absorption from 3.7 to 10.4%.
 85% is in the inorgnanic phase of bones and teeth in combination h. Food Sources
with calcium.  organ meat, liver pork (14mg/100gm), Enriched rice, rice bran,
 15% is in cells in combination with carbohydrate, protein, fat, and saluyot, sitao leaves, spaghetti, dried beans, amplaya leaves,
as complexes with cation such as Na, Ca, and Mg. kamote leaves, kulitis, gabi leaves, seaweeds, malunggay,
b. Functions peanuts, green and red monggo, mustard leaves, petsay, etc.
 components of bones and teeth i. Effects of deficiency
 component of every cell  Anemia - characterized by a reduction in size or number of RBC
 important in pH regulation as a principal anion in the cell. or the quantity of hemoglobin or both resulting in decreased
 It is involve in great variety of chemical reactions as in capacity of the blood to carry oxygen,
phosphorylation o Causes:
c. Sources  inadequate intake of iron
 cheese, milk, dairy products, meat, poultry, fish, eggs, dried beans  excessive excretion of iron by blood loss in
d. Effects of excess pregnancy, parasitism and blood donation
 Erosion of the bone (match industry workers)  inadequate formation of RBC because of vit b12
deficiency
6. SULFUR o Symptoms: – pallor, fatigue, dizziness, insomnia, lack of
a. Distribution appetite
 Sulfur occurs in almost every protein cell and comprises about j. Effects of excess
0.25% of body weight. It is concentrated in cytoplasm but is  Hemosiderosis- excessive amount of iron
found highest concentration in the hair, skin, and nails.  Hemochromatosis - genetically transmitted dse, absorb
b. Functions unusually large amount of Fe and store them in tissues that
 Sulfur maintains protein structure normally do not store iron
 it activates the enzymes
 it participates in detoxification
 reactions
c. Food Sources
 Protein contains 1% sulfur, so diet adequate in protein contains
enough sulfur. 2. COPPER
d. Effects of deficiency or excess a. Distribution
 Cystinuria - – excessive excretion of cystine in the urine  all tissues in the body contain traces of copper. Large
 kidney stones amounts are found in the liver, brain, heart, and kidney.
b. Functions
7. CHLORINE  essential in formation of hemoglobin
a. Distribution  It promotes absorption of iron from the GIT and the
 Chlorine is a major anion in the extracellular fluid. The transportation of such from the tissues to the plasma.
cerebrospinal fluid has the highest concentration of chlorine.
 NUTRITION AND DIET THERAPHY
 valuable catalyst in oxidation-reduction mechanisms of living  The body contains about 2 to 5 gms of zinc.
cells  700-800mg- blood (80%in RBC, 4% WBC)
 helps maintain the integrity of the myelin sheath surrounding  Human milk contains 3-4mg/L
nerve fibers b. Functions
 part of tyrosinase which is involve in the formation of melanin  integral part of several metalloenzymes and also act as regulator
pigment of hair and skin. of activities of certain enzymes in the body.
 It helps in bone formation.  It is present in RNA
c. Food Sources  It is related to hormone insulin, glucagons, ACTH, growth
 (8ppm) organ meats, oysters, nuts, cocoa, cherries, mushroom, hormone, gonadotropin and testosterone.
whole grain, cereals  it plays role in the acceleration of wound healing and for normal
 moderate) leafy vegetables, eggs, muscle meat, fish, poultry, sense of taste.
beans, peas, fresh fruits, refined cereals c. Food Source
 milk, meat, nuts, legumes, liver, oyster, eggs, whole grain cereals,
d. Effects of deficiency and excess wheat , bran
 Deficiency : depigmentation of skin and hair, CNS abnormality, d. Effect of deficiency and Excess
hypotonia, hypothermia, chronic microcytic anemia, skeletal  Deficiency
mineralization in infants and children o Slow growth
 Excess : Wilson’s Disease – excessive accumulation of copper o Alopecia
o Disturbances in the keratinization process in the skin and
3. IODINE esophagus
a. Distribution o Hypospermia
 The adult body normally contains 20 to 30 mg of iodine. o Delayed sexual maturation
 70 to 80% (8mg) is concentrated in the thyroid gland and the rest o White cell defects
is widely diffused throughout all tissues, especially in the ovaries, o Night blindness
muscles and blood.
 Excess
b. Functions
o Nausea
 For the synthesis of thyroxin, a hormone in the thyroid gland.
o Vomiting
c. Food Sources
o Abdominal cramps
 sea foods, sea
o Diarrhea
 weeds, iodized salt
d. Effects of deficiency o Fever
 Goiter - enlargement of the thyroid gland
 Cretinism – insufficient iodine intake of a mother during 7. MOLYBDENUM
pregnancy. The child suffers from hypothyroidism, physically  Distribution
dwarfed, mentally retarded, and has thick pasty skin and  9 mg is present in the body
protruding abdomen  concentrated in liver, kidneys, adrenal glands, and blood cells.
 Myxedema –adults who had have problem with low iodine  Functions
intake throughout their childhood and adolescence  An integral part of xanthine oxidase, aldehyde oxidase, a
flavoprotein, for catalyzing the oxidation of aldehydes to
4. MANGANESE corresponding carboxylic acid.
a. Distribution b. Food Sources
 Only about 10 to 20 mg is present in the body. It is concentrated  dried peas, beans, lean meats, poultry
in the kidneys, and liver  Requirement : 50 to 100 micrograms
b. Functions c. Effects of deficiency
 activator of metabolic reactions  Headache
 acts as catalyst of a number of enzymes necessary in glucose and  Irritability
fat metabolism  Night blindness
 Increases storage of thiamin.  Lethargy
c. Food Sources  Coma
 nuts, whole grains, dried legumes, tea, green leafy vegetables,
dried fruits, fresh fruits, non-leafy vegetables. C. GROUP III: OTHER TRACE MINERALS
d. Effects of deficiency and 1. Fluorine
 excess a. Distribution
 *No incidence of deficiency or toxicity caused by diet.*  found in bones and teeth and trace amount in thyroid gland and
skin
5. COBALT b. Function:
a. Distribution  It forms a more stable compound in dentine and enamel of teeth
 Found only in trace amounts in the body. thus reducing dental carries and minimizing bone loss.
b. Functions  It is effective in the treatment of osteoporosis.
 constituent of B12 c. Food Sources:
 essential factor which is  water is the major source
 necessary for RBC formation  Water and toothpaste chief source
 essential for normal functions of all cells.  Seafood and tea leaves
c. Food Sources d. Effects of Deficiency
 liver, kidney, oysters, clams, lean beef, veal, poultry, salt water  dental carries
fish, milk e. Effects of Excess
d. Requirement  dental fluorosis - melting of the enamel
 The nutritional requirement is restricted to body’s need for  osteosclerosis
vitamin B12 as the body can not utilize cobalt to synthesize the  growth depression
vitamin.  fatal poisoning
e. Effects of Deficiency and Excess
 Deficiency: Pernicious Anemia - 2. SELENUM
 Excess: Polycythemia - increase in the number of RBC and a. Distribution
hyperplasia of bone marrow  depends on the soil content where the food was grown.
b. Functions
6. ZINC  It prevents or reduce the effect of vitamin E deficiency
a. Distribution  It is a component of glutathione peroxidase (GP)
 Occur in varying concentration in the eyes, the male sex glands, c. Food Sources
secretions, hair and skin and its appendages, liver, pancreas,  organ meats, muscle meats, cereals, dairy products
kidney, bones and teeth.
 NUTRITION AND DIET THERAPHY
d. Effects of Deficiency and Excess
 muscle pain and tenderness
 pancreatic degeneration
 hemolytic anemia

3. CHROMIUM
a. Distribution
 The fatal body content of chromium is about 6 to 10 mg.
b. Functions
 It raises abnormally low fasting blood sugar levels and improves
faulty uptake of sugar by body tissues.
 It stimulates synthesis of fatty acids and cholesterol in the liver
c. Food Sources
 Corn oil, clams, whole grain cereals, vegetables, meats
 Requirement: Normal adults – 50-200 microgram/ day

4. VANADIUM
a. Distribution
 Constituents of human tissues
b. Functions
 it is involve in the appetite crystal formation of tooth enamel,
hence, may contribute to resistance to dental decay
 Requirement : 0.1 to 0.3 mg/day

WATER AND ELECTROLYTE BALANCE

 Water constitutes about 60 to70% of total body weight.
 Deprivation as much as 10% will result in illness.
 Loss as much as 20% may cause death.
 Water found in a normal adult human body totals 45 liters.
 30 liters-intracellular
 15 liters – extracellular
 Functions
 Water is universal solvent.
 It is catalyst to many biological reactions
 It is a vital component of tissues, muscles, glycogen, and others
and is essential for growth.
 Water acts as lubricant of the joints and the viscera in the
abdominal cavity
 It is a regulator of body temperature through its ability to conduct
heat.
 Water intake
 The water needed by the body may be met by direct intake of
water, from water bound with foods, and from metabolic water.
 Water Output
 Water leaves the body via several channels

 Abnormalities of Water Balance

NUTRITION
 Overhydration or water intoxication
o If water intake is increased with out corresponding increase in
the intake of sodium, water intoxication results.

 Signs / symptoms
o muscle cramps, weakness, or drop in blood pressure, Anorexia
CARE PROCESS
and vomiting, convulsion, coma, and even death.
NUTRITIONAL ASSESMENT (pages 166-196)
 Management
o providing sodium in small amount with the intake of solids. Objectives
 Dehydration At the end of the chapter, the student should be able to:
o This condition becomes serious if the loss is about 10% of the  Discuss the methods of assembling nutritional status
total body water, fatal if the loss is from 20 to 22%.  Explain the significance and purpose of nutritional assessment
o It is especially critical in babies
o S/Sx skin become loose and inelastic (poor skin turgor)
RECOMMENDED DIETARY ALLOWANCES AND ADEQUATE
DIET
ADEQUATE DIET
• Composed of various nutrients which the body needs for
maintenance, repair, living processes and growth and development
• The purpose of daily meals is to supply the essential elements
• Adequate diet is a diet which meets in full all the nutritional needs
of a person

FACTORS TO CONSIDER WHEN PLANNING NUTRITIOUS MEALS

• Regional availability of foods
• socio-economic conditions,
• taste preferences,
• food habits, age of family members,
• storage and preparation facilities, cooking skills
 NUTRITION AND DIET THERAPHY
Dietary standard is changed from RDA to RENI to emphasize that the
standard is in terms of nutrients and not foods or diet
• RDA – Recommended Dietary Allowance
• RENI – Recommended Energy and Nutrient Intakes
• AR – average physiologic requirement

RENI
• Are levels of intakes of energy and nutrients which on the basis of
current scientific knowledge are considered adequate for the
maintenance of health and well being of nearly all healthy persons
in the population
• Former RDA, to emphasize that the standard is in terms of
nutrients and not food or diet
• physical condition, growth and development, behavior, blood and
tissue levels of nutrients, and the quality and the quantity of the
nutrient intake.
• The evaluation of the nutritional status involves examination of the
individual’s physical condition, growth and development,
behavior, blood and tissue levels of nutrients, and the quality and
the quantity of the nutrient intake

ESSENTIAL OF ADEQUATE INTAKE

• Milk group – provide most of the calcium requirements; it
provides riboflavin, high quality protein, other vitamins and
minerals, carbohydrates and fats
• Meat group – provides generous amount of high quality protein; – SAMPLE 24-HOUR RECALL FORM

iron, thiamin, riboflavin, niacin, phosphorus, and zinc are supplied.

Name __________________________________________________________
There are several non-meat alternatives that provide the same Date _______ / _______ / _______
nutrients as animal flesh Day of Week (encircle) : Sun Mon Tue Wed Thu Fri Sat

• Bread and cereal group – furnishes thiamine, protein, iron, Time of Meal Food or Beverage Type of Preparation Amount

niacin, carbohydrate and cellulose at a relatively low cost

• Vegetable-fruit group – important supplier of fiber, minerals and
vit
Was this intake unusual? Yes_____ No_____
If so, how? ______________________________________________________
________________________________________________________________
Do you take any vitamin or mineral supplement?
Yes_____ No_____
ASSESSMENT OF NUTRITIONAL STATUS If yes, describe:

Nutritional status or nutriture Name or Type

_________________
Dose (if known)
_________________
How often
_________________
• is the degree to which the individual’s psychological need for _________________
_________________
_________________
_________________
_________________
_________________
nutrients is being met by the food the person eats.
All of the following aspects are considered:
1. Dietary history and intake data
2. Biochemical data 2. Food Frequency Questionnaire
3. Clinical examination  Questions, however, should be modified based on the information
4. Anthropometric data from the 24-hour recall.
5. Psychosocial data  Answers should be recorded as 1/day, 1/wk, 3/mo, for example, or
as accurately as possible. If may just have to be noted as
METHODS OF ASSESSING DIETARY INTAKE “occasionally” or “rarely
1. 24-hour Recall- The individual completes a questionnaire or is  For instance, if a patient said he/she had a glass of milk yesterday,
interviewed by a dietitian/nutritionist or a nurse experienced in dietary he/she should not be asked, “Do you drink milk?” but rather “How
interviewing and is asked to recall everything that he/she ate within the much milk do you drink?”
last 24 hours or the previous day:
24 hour Recall Form and Food Group Evaluation: The following question
pattern may be used for conducting the 24-hour recall. The information should
then be recorded in the chart at the end.
 NUTRITION AND DIET THERAPHY
 Food storage and cooking facilities
 Type of housing
 Ability to shop and prepare food
e. Appetite
 Good, poor, any changes
 Factors that affect appetite
 Taste and smell perception
f. Allergies, Intolerances, and Food Avoidances
 Foods avoided and reason
 Length of time of avoidance
g. Dental and Oral Health
 Problems with eating
 Foods that cannot be eaten
 Problems with swallowing, salivation, and food sticking
h. Gastrointestinal Concerns
 Problems with heartburn, bloating, gas, diarrhea,
constipation, distention
 Frequency of problems
 Home remedies
 Antacid, laxative, and other drugs used
i. Chronic Diseases
 Treatment
 Length of time of treatment
 Dietary modification
j. Medication
 Vitamin and/ or mineral supplement
 Medications

4. Food Diary or Record

 This method involves time, understanding, and motivation on the
part of the patient or client. The subject is asked to write down
everything he/she eats or drinks for a certain time period
 Three days, particularly two weekdays and one weekend day,
have been found to be a representative time period for more,
people.
 Observation of Food Intake- Observation of food intake is the
most accurate method of dietary intake assessment but also the
most time-consuming, expensive, and difficult. It requires
knowing the amount and kind of food presented to the person and
the record of the amount actually eaten.

NUTRITION SURVEY
• Is an epidemiological investigation of the nutritional status of the
population by various methods together with an evaluation of the
ecologic factors in the community
3. Dietary History - The dietary history is more complete than either the
24-hour recall or food frequency questionnaire, although it usually Significance of Nutritional Assessment
includes both of these sources. The dietary history contains additional • It is the first essential in nutritional planning
information about the following: • It provides data and information for planning and evaluation
a. Economics • It helps define priorities and responsibilities of public health
 Income system at the national, regionals, provincial, city, municipal and
barangay levels
 Amount of money for food each week or month and
individual perception of its adequacy for meeting food
Methods of Nutritional Assessment
needs
A. Methods that provide direct information
b. Physical Activity
1. clinical examination
 Occupation
2. biochemical examination
 Exercise 3. anthropometric examination
 Sleep-hours/day 4. biophysical technique
c. Ethnic and Cultural Background B. Methods that provide indirect information
 Influence on eating habits ` 1. studies on food consumption
 Religion 2. studies on health conditions and vital statistics
 Education 3. studies on food supply situation
d. Home Life and Meal Patterns 4. studies on socio-economic conditions
 Number of household members 5.studies on cultural and anthropological influences
 Person who does shopping
 Person who does cooking and relationship with this FACTORS CONSIDERED IN THE SELETION IN NUTRITION
person SURVEYMETHOD
 NUTRITION AND DIET THERAPHY
• Units to be surveyed-Example – household, individual, at-risk
group
• Types of information required- Example –food intake, height Classification of Goiter by palpation
and weight, hgb level, socio-economic conditions o Grade 0- no palpable or visible goiter
• Degree of reliability and accuracy required- None o Grade 1- palpable but not visible
• Facilities and equipment available- Example – reasonable o Grade 2- swelling in the neck is clearly visible,
number, type, practicality enlarged thyroid gland when palpated
• Human resources- nutritionist, med tech, medical nutritionist, 5. Vit B2 or Riboflavin deficiency
biochemist, local extension worker, auxiliary worker, training Symptoms
required o Magenta red tongue
• Time reference- season of the year, day(weekday or weekend),
o Sores at the angle of the mouth and folds of the nose
number of days of food record collection
• Funding or financial support o Itching and scaling of skin around nose, mouth , scrotum,
forehead, ears and scalp
CLINICAL ASSESSMENT
 It deals with the examination of changes that can be seen or felt in BIOCHEMICAL ASSESSMENT
superficial tissues such as skin, hair and eyes • Estimation of time desaturation, enzyme activity or blood
Advantages composition
• More coverage in a short time • Tests are confined to two fairly easily obtainable fluids: blood and
• Inexpensive, no need for sophisticated equipment urine
Disadvantages • Results are generally compared to standards ( normal levels for age
 Non specificity of signs (Signs may be due to non-nutritional cause) and sex
Advantages
 Overlapping of deficiency states (Dietary deficiencies are not
restricted to an isolated nutrient)  objectivity, independent of the emotional and subjective factors
that usually affect the investigator
 Bias of the observer (Observations of two examiners are most often
nit consistent with each other)  Can detect early subclinical states of nutritional deficiency\
Disadvantages
CLINICAL SIGNS (on table 45 page 182)  Costly
 Dyssebacea- disorder of the sebaceous gland marked by reddening  Time consuming
and accumulation of greasy flaky scales on affected areas Factors affecting accuracy of result
 Conjunctival xerosis – severe conjunctival dryness, appear dry,  Standards of collection
roughened, thickened  Methods of transport and storage samples
 Corneal xerosis – cornea gets cloudy and softens, tis is also known  Techniques employed
xerotic keratitis or corneal melting Common Biochemical Parameter
 Angular palbebritis  (Table 48. Page 188)
 Cheilosis – painful inflammation and cracking of the corners of the
mouth
 Xerosis – medical term for dry skin ….Continuation….
 Koilonychia – spoon nails, abnormally thin nails, lost their
Tests applicable and Interpretation
convexity, becoming flat or even concave
a. Protein
Clinical Symptoms of common nutritional problems
1. PEM Urea N/creatinine N ratio – index of dietary adequacy
 2-24hr urine sample
mild to moderate
 Index of 30 or lower in a random sample
Severe
o marasmus(dry form)  Indicative of malnutrition
o kwashiorkor(edematous form) Amino Acid ImbalanceTest – ratio of four
o marasmic kwashiorkor  Indispensable amino acid in serumby paper
chromatography
2. Xerophthalmia – it affects the eyes, gradually beginning with an
impairment of night vision  High (5-10) in kwashiorkor and low (less than 2) in
well-fed children
Symptoms
o Impaired night vision Hydroxyproline excretion
o Smokey conjunctiva  Low (0.5-1.5) in clinically malnourished children,
normal (2.0-5.0)
o Dry eyes
Serum Albumin
o Cornea softening and ulcers
 Lowered in severe protein depletion
3. Anemia Sole reliance on breastmilk for High 4.25
Symptoms children beyond six months leads
Acceptable 3.52-4.24
o Tiredness to anemia. Since blood cells
require both protein and iron for Low 2.80-3.51
o Paleness under the eyelid their formation, treatment should Deficient less than 2.80
o Breathlessness concentrate on supplementing
o b.
HeartIron
palpitations these nutrients in the diet
o Paleness Hgb
underDetermination
the nail
o edema  Cyanmethemoglobin method- spectrophotometry
4. 
Goiter – the enlargementA.O.
of hemoglobinometer
the thyroid is due to–itssimple
need technique,
for iodine handy
Goitrogenic agents equipment
– prevent the absorption of iodine
Symptoms  Others: Sahli’s method; Tallquist method; copper
o Swelling of thesulfate
neck specific gravity method
o Hematocrit –obtained from a finger prick measure of red cell
Difficulty in swallowing
volume
o Difficulty in breathing
6mos-6y.o 11gm
o Tight feeling in throat
6y.o-14y.o 12
Adult male13  If iodine is in short supply, the gland grows to try and offset the deficit.
Adult female 12(non pregnant) The obvious neck swelling makes the disease easy to diagnose
 It is more common in female, especially in puberty and during pregnancy
Adult female 11(pregnant)
 Goitrogenic agent – kale, turnips, some varieties of cabbage
 NUTRITION AND DIET THERAPHY
 Depending on how far a child’s weight compares with his/her
standard weight
c. Vitamin A  Normal- the child’s weight is between 91% and 110% of his/her ideal
Serum Vit A and serum carotene level – spectrophotometry weigh
Low serum Vit A reflects prolonged severe, dietary  First degree -76%-90%
deficiency probably up to  Second degree -61%-75%
1 year in adult and 4 months in young children  Third Degree or Severely underweight -60% or less
Serum carotene reflects recent ingestion of carotene
containing food 2. Weight for height-nutritional status by McLauren and Read
 Overweight 110% of standard weight
 Normal 90-109%
ANTHROPOMETRIC MEASUREMENTS  Mild underwt 85-89%
• Anthropometry- is the measurement of variations of the physical  Moderate 75-84% undernourished
dimensions and gross composition of the human body  Severe 75%
• At different age levels and degrees of nutrition

Common Anthropometric Measurement

1. Weight – uses weighing scale
 assess body mass
 sensitive indicator of current nutritional status
 uses reference values for age or height or both of population 3. weight-for-height and height-for-age – permits further distinction
 key anthropometric measurement between acute malnutrition and chronic malnutrition as well as simple
 Advantages stunting
o Simple and commonly used
o Weight can be determined fairly accurately by personnel with
Anthropometric measurements for
minimum training MALNUTRITION SCREENING TOOL
 Disadvantages
adults and • MUST' is a five-step screening tool to identify adults, who
o It depends on accurate age determination children https://www.youtube.co
are malnourished, at risk of malnutrition (undernutrition), or obese.
o Interpretation on individual basis may be complicated by edema m/watch?v=YvaBYDMyiu4
• It also includes management guidelines which can be used to develop a
o Does not distinguish between acute and chronic malnutrition care plan. It is for use in hospitals, community and other care settings
and can be used by all care workers
• Malnutrition Screening Tool is a useful tool for
2. Height – assess linear dimensions of legs, pelvis, spine, and the skull identifying malnutrition risk in residential aged care
 Less sensitive and generally an indicator of past nutritional status
subjective global assessment
 Uses statiometer, anthropometric steel rods fixed accurately and
• Presented and described in detail is a clinical technique
vertically to the wall, infantometer is used(below 2 years old
called subjective global assessment (SGA), which assesses nutritional
 Advantages
status based on features of the history and physical examination.
o Inexpensive tools may be used
Illustrative cases are presented.
o It is simple to do in the field
 Disadvantages Mini Nutritional Assessment
o Less sensitive to changes in growth rate •  is an effective, easily administered tool designed to identify older
o Errors in measurement are easily made adults who have or are at risk for developing malnutrition.
o Other factors • The MNA detects risk of malnutrition before severe change in weight
or serum proteins occurs.
3. Weight for height/length • NUTRITIONAL INTERVENTION: Intervention studies demonstrate
 Most accurate indicator of present or current state of nutrition that timely intervention can stop weight loss in elderly at risk of
 An expression of leanness or wasting malnutrition or undernourished and is associated with improvements in
 Advantage MNA scores.
o It is nearly independent of age from 1-10 years • validated nutrition screening and assessment tool that can identify
o it is probably independent of ethnic group especially in ages geriatric patients age 65 and above who are malnourished or at risk of
of 1-5 years malnutrition.
 Disadvantage – height for age is a disadvantage
geriatric nutritional risk index (GNRI)
4. Skinfold Thickness • is a widely used, simple, and well-established tool to assess nutritional
risk.
 Assesses body composition , fat distribution, and reserve calories
 Must be compared against standards for age and sex at all ages
NUTRITION DIAGNOSIS
 Uses a reliable caliper • use a complete NANDA statement
 Disadvantage – height for age is a disadvantage
The stem – For example, Nutrition Imbalanced, Less Than body
requirements
5. Body Circumference
 the head/ chest circumference ratio is of value in detecting PEM The Related To = why the above is happening in the specific client’s
condition
 The head and chest circumference are the same at six months of age.
• Lack of appetite secondary to recovery from surgery or increased calorie
after this age, the skull grows slowly and the chest grows more
requirements secondary to cancer/infection
rapidly
• A secondary to ___ is not essential. - The As Manifested by (AMB) or As
 The mid upper arm circumference (MUAC)has been mainly used on
Evidenced by (AEB) = what you see that leads you to the diagnosis.
children from 1-6 years old
6. Birth weight
Nutrition Imbalanced: Less Than Body Requirements
 it is related to maternal nutrition and socio-economic status • R/T: increased calorie requirements secondary to
 2500gm for low birth weight babies cancer/trauma/infection/dyspnea (specify appropriate choice for your
 Disadvantage client)
o births are often unattended by health personnel • R/T: decreased absorption of nutrients secondary to GI
o Other factors(gestational age, infectious and toxemic episode surgery/dysphagia (specify appropriate choice for your client)
during pregnancy • R/T: anorexia/nausea/vomiting secondary to _____
• R/T: increased nutrient requirements for healing secondary to (state
Reference/ Standards Used type of surgery)
1. Weight for Age • R/T: insufficient calories provided by the diet R/T: NPO status
 NUTRITION AND DIET THERAPHY
• R/T: unhealthy dietary patterns/lack of exercise (specify and elaborate
for client)

Nutrition: Readiness for Enhanced (This is a wellness diagnosis

for someone who already has good eating habits, but desires to improve

Health Maintenance, Ineffective

R/T: inadequate health teaching AMB/AEB: overeating; high-fat diet (state
specifics for client)

Constipation
 R/T: lack of fiber and fluid in diet
 Side effect of medication (specify)
 Decreased metabolic rate secondary to (specify) AMB/AEB: hard,
formed stool/infrequent stools
NUTRITION AND DIET THERAPHY