PAST NutritionbyBetty

7/28/2019 PAST NutritionbyBetty

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NutritionforPhysiciansAssistants

PAST556:PreventativeMedicine& HealthPromotionC.BettyCrocker,MPH,[email protected]


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MyBIO

RegisteredDietitian MPH,Nutrition

LeCordonBleutrainedchef Doctoratestudent Professor:Nutrition,PublicHealth,andCulinary

Arts

ChefInstructor/Consultant PublicHealthWriter:LATimes [email protected]


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TrueNutri)onExperts

AmericanDiete)cAssocia)on(ADA www.eatright.org NowAcademyofNutri)onandDiete)cs(AND Registereddie))an(RD Cer)fieddiabeteseducator Publichealthnutri)onist Diete)ctechnician

Diete)ctechnicianregistered AmericanSocietyofNutri)on(ASN

www.nutri)on.org


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Nutritional

Assessment


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DietaryAssessment

24hourrecall 72hourrecall

Eatingpatterns Mealplans Lookingfordeficiencies Barriers:

Limitedrecalldueto______ OlderpatientsWomenvs.Men


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AnthropometricAssessment

BMI: Limitations Overestimate

bodyfatinathletes Highmuscularbuild

Underestimate Olderpersons Significantmuscleloss


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Biochemical

AssessmentofNutrition

MostsensitiveisPrealbumin:half-lifeis2days albumin:halflife~20days PABimprovednutritionincrease10mg/L/d

Inadequatenutritionalsupport Poorresponse Poorprognosis

LowPABindicates Proteinenergymalnutrition Inflammation+malnutrition


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Biochemical

AssessmentofNutrition Insulinlifegrowthfactor1(IGF1)

VerysensitivemarkerAssociatedwithincreasedmorbidityAssociatedwithproteinintake

Nosinglemarkerisevidenceofoverallnutritionalstatus


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OlderAdults

NutritionalScreening NutritionScreeningInitiative Projectof

AmericanAcademyofFamilyPhysiciansAcademyofDieteticsandNutritionNationalCouncilofAging

DetermineYourNutritionHealthchecklist


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D-E-T-E-R-M-I-N-EChecklisttohelpolderadultsIDsymptomsofNutritionalProblems

Table7.21. Disease:confusion,memoryloss,depression2. Eatingpoorly:toolittle/much,samepattern,

skipmeals

3. Toothloss/mouthpain4. EconomicHardship5. ReducedSocialContact:livingalone

6. MultipleMedicines:nausea,diarrhea7. InvoluntaryWeightLoss/Gain

8. Needsassistanceinself-care:eat,cooking,shopping

9. Above80years


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DoesNOTutilizeobjectivemeasurements BiochemicalAnthropometrics

DOESprovideScreeningtoolRequiresclinicaljudgment

InterpretinformationCollectedbyinterviews&observationsCorrelatedwellwithobjectivemeasurements

SubjectiveGlobalAssessmentTable7.3


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Table7.3


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NutritionCounseling


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DIET:foodsyouNORMALLYeatanddrink Cho0sewholefoods 3MacronutrientStrategies

Putfiberbehindyourcarbohydrates(CHO) LeanProtein(PRO) ChooseHealthyFat(Lipids)

MyPlateStrategiesplatefruits/veggrainswholegrainsLeanprotein

NutritionalCounselingHealthyMealPlanObjective


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MyPyramidisnow


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MyPlate


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ChooseMyPlateMenu

Balancingcalories

Enjoyyourfood,buteatless

Avoidoversizedpor)ons


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Another

namefor

nutrient-

densefoodsis

nutrient-

richfoods


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Nutrient-densevs.

notnutrient-dense


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Nutrient-densevs.

notnutrient-dense


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Nutrient-densevs.

notnutrient-dense


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24

Whole 2% 1% Fat-free

165calories

125calories

100calories

85calories

Calories

saved40 65 80

Switchingtofat-freeorlow-fat(1%

milkmakesadifference!


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MeettheNutrients

Energy-yieldingnutrients Carbohydrates4cal/g Fats9cal/g Proteins4cal/g Alcohol7cal/g

Vitaminsandminerals Providenoenergy Someareessen)al


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CalculateDAILY

CaloricNeeds

SexandAge NotPhysicallyAc8ve


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HowMuchDoINeedFromEach

FoodGroup?

Calorie

Level1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200

Grains 5 ounces6 ounces 6 ounces 7 ounces 8 ounces 9 ounces 10 ounces10 ounces10 ounces

Vegetables2 cups 2.5 cups 2.5 cups 3 cups 3 cups 3.5 cups 3.5 cups 4 cups 4cups

Fruits 1.5 cups1.5 cups 2 cups 2 cups 2 cups 2 cups 2.5 cups 2.5 cups 2.5 cups

Dairy 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups

Protein

Foods5 ounces5 ounces 5.5 ounces6 ounces 6.5 ounces6.5 ounces7 ounces 7 ounces 7 ounces


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CO

UNTINGBY

HAND


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MACRONUTRIENTSCARBOHYDRATES(CHOFAT(LIPIDSPROTEIN(PRO


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CARBOHYDRATES


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AMDRAcceptable Macronutrient Distribution Range

AMDR Recommendations*:CHO: 45-65%Protein: 10-35%Lipids: 20-35%

*Authored by the DRI Committee


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Basically FiberStructuralformofglucoseinplantleaves,stems,andseeds.

Cellwall=95%fiberHumandiges)veenzymescannotbreakthechemicalbondsholdingthesugar

unitstogether,i.e.indiges)bleinhuman

beings.


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Basically FiberPolysaccharideManysugarunits

Heldtogetherbyindiges)blebondsPassesthroughtheGIUndigestedUnabsorbedEXCEPTION:Somefiberisusedasanenergysourceforcolonicbacteria

causesgas


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Types of FiberDietaryFiber:Nondiges)bleintactplantcomponentsTwotype:SolubleFiberInsolubleFiber

Func8onalFiber:Nondiges)bleCHOthathavebeenextractedormanufacturedfromplants

Bothhavebeneficialphysiologicfunc)ons


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Doesntdissolveinwater

InsolublefiberpassesthroughtheGIalmostintact

Addsbulktostool

Actsasaspongetoabsorbwater

Aidsindiges8on&elimina8on

Reducescons8pa8on

IncreasesGItransit8me

Tough,fibrouspartofplants

Calledroughage Example=cellulose

StringsofceleryKernelsofcornBranlayerofwholewheatkernel

Insoluble Fiber

Sources:wheatbran,wholegrains,manyvegetablesandskinsoffruit


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Dissolvesinwater AZractswater&formsgelinGI(viscous) Slowsdiges8on

Slowsgastricemptying(stomach)PromotesfullnessSlowsbloodglucoseabsorp8on

Givesagummyorgel-likecharacteris8ctofood

Bindstocholesterolforelimina8on(lowersLDL)

Soluble Fiber

Sources:oats,soy,legumes,nuts,bananas,apples,orangescelery,cucumbers


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Addedtofood Extracted,isolatedor

manufacturedfromplants

Containbothsoluble&insolublefiber

Takesonsamephysiologicalbenefitsassolubleinsoluble

PassesthroughGI,nondigestable

Functional Fiber

Sources:availablethroughoutthefoodsupplyandincludedinthelistofingredientsandfibercontent.Nolabelingrequiredfunc8onalfiber.

hZp://www.aaccnet.org/

news/pdfs/DFreport.pdf


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Wherethereis

SOLUBLE.thereisalso

INSOLUBLE.Theygohandinhandinnature

Fig. 4-5, p. 115


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39s

Calorie values generally reflect industry practices

of calculating calories from 4-4-9 kcal/g for protein,

carbohydrate, and fat, respectively or from 4-4-9

kcal/g for protein, carbohydrate minus fiber, andfat. The latter method is frequently used for high-fiber foods.!

Notice that this presents an opportunity for

inconsistency in labeling among different food

products and companies. Some food items mayinclude the dietary fiber in the calculation of total

calories; others may not."

NLEANational Labeling & Education Act 1990


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ReducesCalorieconsump8onThinknutrientdenseDisplacesCalorie-densefats&sweets

PromotesafeelingoffullnessSlowsmovementoffoodfromthestomachtothesmallintes8neReducebloodglucosePostprandial(aerea8ng)

ContributesnoCalories

Benefits of Fiber


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PREVENTS:Cons8pa8onImpactedStool:hard,drybowelmovements

CanbepainfulPREVENTS:Straining

Difficulttopassimpactedstool

Mayresultinvaricoseveinsinrectum&hemorrhoids

Prevents:Hemorrhoidspainful,swollenveinsinthelowerpor8onofthe

rectumoranusPromotes:RegularityKeepsintes8nalcontents

moist

Easeselimina8onBulktriggersurgeto

defecate

Colonic Benefits of Fiber

HappyColon=HealthyColon:

Chroniccons3pa3onisassociatedwitha2xincreaseintherisk

ofcoloncancer.


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Happy Colon = Healthy ColonYes, these are GI cookies

PATIENT READY

FANTASTIC STOOL:If LOVING you is WRONG, I dont want to be RIGHT!

8 glasses water daily


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Preventsbacterial

infec)onofthe

appendix



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KeepsGImuscleshealthy&toned

PreventsDiver3culosisOncediagnosed,highfiberdiet

paramounttoensurethesmooth

passageoffecalmaterial

Abnormalpocketsinthecolonwall

Causedbyweakeningofmusclessurroundingthecolon

PreventboutsofDiver3culi3sInflamma)onofdiver)culum

Lowfiberdietrequiredduringinflamma)on



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Slowsdiges)on/absorp)onofotherCHOSlowstheflowofglucoseintoblood Especiallygoodfordiabe)cs

Reducesriskofcardiovasculardisease(CVD

LowersbloodcholesterolFiberbindscholesterolinbilethatisexcretedfromtheliver

Overall Health Benefits of Fiber


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DRI:DietaryReferenceIntakeMen19-50:38g/dayWomen19-50:25g/day

Fiberintakeshouldbeincreasedgraduallybecauseitmaycausebloa)ngorgas

Thesesideeffectsdisappearwithin2-3weeks

FiberintakerecommendedfromFOODAdequatefluidintakewithhighfiberdiet:

8-8ozglasseswater/day

Fiber Recommendations

RecallDVonlabelis

usedasareference.

Labelbasedon25g/d

Fib S l t b


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MineraldeficienciesCanbindminerals&PreventAbsorp8oniron,zinc,andcalcium

Dehydra8onMalnutri8on Canreduceenergyintake

Bowelimpac8ons

Fiber Supplements can be

HARMFUL


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Examples of Fiber in

Foods


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51Fig. 4-15a, p. 126

PUNCHLINE:FIBERFOUNDINPLANTS

ONLY


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Fats


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TheBadFats


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SaturatedFats

Maximumnumberofhydrogenatoms

Nopointofsaturation(doublebondsbetweencarbon)

Triglyceridesthatcontain3saturatedfattyacids

Morestableathightemperature


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SaturatedFatsFoundsinAnimalProductssuchas:

Butter Cheese WholeMilk IceCream FattyMeats Coconut,Palm&KernelOil


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SaturatedFats

Whyaretheybad?


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SaturatedFats

HeartAttacks Strokes Atherosclerosisthenarrowingofarteries

Obesity HeartDisease CancerBreast&Colon


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SaturatedFats

CardiovascularBenefits BoneHealth OptimalLiverFunction StrongLungs HealthyBrain NerveCommunication ImmuneSystemFunction


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Transfatisanothernameforanunsaturatedfat Carriesatransisomerinthefattyacidchain. Ithasadoublecarbonbond Theyaresometimesmonounsaturatedand

polyunsaturatedbutneversaturated.

TheyareknownforraisingyourLDLlevels loweringyourHDLlevelscausingcoronaryheartdisease

TransFats


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LowFatandnonfatdietsmaynotbethehealthiestforyourbody

Takingthefatoutofyourdietoftenremovestheflavorsofthefoodyouconsume Somefoodsremovefatandaddsugarforflavor

FadDiets


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TheGoodFats


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GoodFats

Goodfatshelpfighttheverydiseasesthatconsumingexcessfatwassaidtocause.

goodfatsarebeneficialtocholesterol. Monounsaturatedfathelpstolowercholesterol. theyareagoodsourceofomega-3fattyacids(coldwater

fish,nuts,oils,seeds,darkleafygreens).

hp://www.med.umich.edu/umim/food-pyramid/fats.htm


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GoodFats

Omega-3fattyacidsisanessentialfattyacidwhichisNOTmanufacturedbyourbodies,soeatingthosefoodsistheonlywaytogetthem.

Omega-3fattyacidsarealsothoughttolowerbloodpressure,combatLDL(bad)cholesterol,fightinflammationandprotectthebrainandthenervoussystem.



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GoodFats

Eatingmonosaturatedfatsimprovesbloodcholesterollevelswhichcandecreaseyourriskofheartdisease.

ResearchshowsalsoshowsthatMUFASmaybenefitinsulinlevelsandbloodsugarcontrolwhichishelpfultopeoplewhohavetypetwodiabetes.

Omega-3fattyacidsfoundinsometypesoffattyfish,appeartodecreaseriskofcoronaryarterydisease.



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FLAXMEAL

NUTRITIONINFORMATIONTheGoodFat 1 Tablespoon of flax meal:

3 grams fiber 2 grams omega-3 (good fat)

Recipe: 1-2 Tablespoon/cup flour

http://www.youtube.com/watch?v=_1EbDdAeq7A


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CHIASEEDS

NUTRITIONINFORMATIONTheGoodFat 1 Tablespoon of CHIA SEED:

4 grams fiber 2.4 grams omega-3 (good fat)

Recipe: Gel: 1 cup water: 2T 2t chia seeds, mix,

store in refrigerator up to a week

http://www.youtube.com/watch?v=_L4wJ1vadUg


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Walnuts Soymilk Tofu Fattyfish(salmon,tuna,

mackerel,herring,trout,sardines)

PolyunsaturatedTheGoodFat

CornOil SoybeanOil Safflower Sunflower,Sesame,

pumpkinseedsandflaxseed


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Fat&You


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Cholesterol

bloodlevelindicatesincreasedriskofatherosclerosis

Reduceyourtotalbloodcholesterolby:1. Consuminglesssaturatedand transfat2. Consumingmorefiber3. Exercising


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LowDensityLipoproteins(LDL)

Badcholesterol Delivercholesterolfromthelivertoarteries bloodlevelsindicateincreasedriskofatherosclerosis

ReduceyourLDLby:Consuminglesssaturatedandtransfat


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HighDensityLipoproteins(HDL)

Goodcholesterol Scavengeexcesscholesterolfrom)ssuesfordisposal

bloodlevelsindicatedecreasedriskofatherosclerosis

IncreaseyourHDLby:Exercisingregularly


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RECIPESTOPROMOTEHEART

HEALTH1.REDUCESATURATEDFAT2.USEGOODFAT(OMEGA3)3. INCREASEFIBER:fruits,vegetables,and

wholegrains

4. REDUCECALORIES

GOOD/BAD EICOSINOIDS


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GOOD/BADEICOSINOIDS

PhysiologicalEvent GOODEICOSANOIDS

n-DRIVEN

BADEICOSANOIDS

n-6DRIVEN

BloodVessels Open Constrict

BloodClong Decrease Promote

HeartDisease Prevent Promote

HeartArrhythmia Decreased Increased

Pain Decreased Increased

Inflamma)on Decreased Increased

SmoothMuscle Relaxa)on Contrac)on

ImmuneFunc)on Increase Decreased

MenstrualCramps Decreased Increased

TumorCells Kill Promote

Gesta)on(Pregnancy Preventpretermbirth Promotepretermbirth


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AMDR


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AMDRAcceptable Macronutrient Distribution Range


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PROTEIN

I f PROTEIN


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AAmustbecon8nuouslyavailabletobuildPROofnew8ssuesforGROWTH&MAINTENANCE Embryo,athle8cmuscles,growingchild,newbloodcellslostinmenstrua8on,

scar8ssuetohealwounds,newhair&nails

ProteinTurnover Constantlymake&breakdownPRO

RecyclingAA Daily:25%AAareirretrievablydivertedtoother8ssuestobeusedforfuel

ImportanceofPROTEIN


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TheImportanceofPRO

2 ProvidingStructure/Movement:Muscle MUSCLEScontain40%bodyPRO MusclescanreleaseEMERGENCYAAforenergy

BuildingCompounds:enzymes&hormones ENYMES:1000sresideineverycell

Recall:enzyme=catalysttospeedupreac8ons HORMONES:messengermoleculesmadefromAA

Recall:Insulin&Glucagonforglucoseregula8on


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TheImportanceofPRO

3 BUILDINGANTIBODIES

An8bodiesarePROmadebyPRO Dis8nguishforeignPROfromtheirbodyPRO Whenintruderispresent,theyaZacktodestroy

Bacterium,virus,toxin,orpresentinfoodthatcausesallergicreac8on

Recallceliacdisease(autoimmuneresponsetogluten)Eachan8bodydesignedtodestroyspecificinvader

IMMUNITY:an8bodybuiltandsuccessful,availablefornextaZack

Differentstrainsofflurequiredifferentan8bodiesbuilt

Th I t f PRO


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TheImportanceofPRO

4 MAINTAININGFLUIDBALANCE PROregulatequalityoffluidsincompartmentsofbody Lifedependsoncellsmaintainingconstantamountoffluid

TOOMUCHrupture TOOLITTLEunabletofunc8on Recall:Watercandiffusefreelyin/outcells,PRO

Homeostasis:maintainingstoresofinternalPRO&minerals BLOODVESSELSmechanism

FluidkeptinsidebloodvesselsbyPROtoolargetomoveacrosscapillarywall

PROaZractwater&holditwithinvessels,preven8ngitfromflowingintothespacesbetweencells

WhenbloodPRO(albumin)islow:TOOmuchfluidwillbetweencellswillcollectEDEMA


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TheImportanceofPRO

5 EMERGENCYENERGYSOURCE PROwillbesurrenderedtoprovideenergyifneeded

Undercondi)onsofinadequateenergy:Starva)on,prolongedfas)ng,andseverecalorierestric)onNostorageofPROaswithCHO/LipidsPROonlypresentasac)veworkingmolecular&structural

componentofbody)ssue

OrderPROdismantledforenergy blood,musclePRO,liver&otherorgans

Goal:maintainsteadybloodglucoselevelforbrainAAbreakdown:

CarbonHydrogenOxygenusedforenergyneedsNitrogenexcretedorusedelsewhere


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PROTransportSummary WhendietsuppliesanoverabundanceofPRO:bodycannotstoreAA

ExcreteAA(aminegroupsanduseresiduefor1. Immediateenergyneeds2. Makeglucoseforstorageasglycogen3. Ormakefatforenergystorage

RECALL:

CHO=energy Lipids=concentratedenergy PRO=energy+N

W ) AA S


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Was)ngAASummary

WASTING:WhenAAnotusedtobuildPROormakeotherNitrogen-containingcompounds Whenwas8ngoccurs1. BodylacksenergyfromCHO/Lipids2. DietsuppliesMOREPROthanneeded3. BodyhasTOOmuchofanysingleAA(supplements)4. DietsuppliesPROofLOWquality(toofewessen8al

AA)


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PRO Labeling Must Include:PRO grams in bold printIncomplete PRO:

When food is for adults/children over 1 year of age :label should state "0%" in % DV columnor state "Not a significant source of protein.

Voluntary Labeling:%DV Protein

% Daily Value is not required when the food is foradults or children over 4 years of age unless a proteinclaim is made

Recall NLEANational Labeling & Education Act 1990

http://www.fda.gov/ICECI/Inspections/InspectionGuides/ucm074948.htm

RECALL: AMDR


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RECALL:AMDRAcceptable Macronutrient Distribution Range


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QUALITYAA

1. LIMITINGAA Anessen8alAAthatispresentindietaryPROinINUSUFFICIENT

amount,therebylimi8ngthebodysabilitytobuildprotein

Acuteshortage:inconsequen8alascellsresumenormalproteinac8vi8eswhenlimi8ngAAisprovidedinnextmeal(~24hours)

Chronicshortage:lackvarietyofplantbasedfoods Proteinsynthesisslows Cellsbegintobreakdownprotein-makingmachinery WastedAA:Aminegroupsexcreted,C,H,Ousedelsewhere Severecases:breakdownorgansforAA


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QUALITYAA

2 COMPLIMENTARYPRO Plant-baseddiet 2ormorePROwhoseAAassortmentscomplimenteachotherin

suchaawaythattheessen8alAAmissingformonearesuppliedby

another

AAlowinsomefoodsaresuppliedbyother Goal:toconsumeessen8alAAinsufficientamounttosupport

health

MUTUALSUPPLEMENTATION:strategyofcombing2incompletePROsourcessothattheAAinonefoodmakeupforthoselackinginthe

otherfood Example:Beans&Rice


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QUALITYAA

3 PRODiges8bility Methodtoevaluate:ProteinDiges8bilityCorrectedAminoAcidScore

(PDCAAS)

ReferenceAA=eggwhite(highbiologicalvalue) Animalbaseddietshavehighestdiges8bility

Milk(100%),Beef(92%) Plantbaseddietshaveless

Soyprotein(100%)Legumes(90-70%),Fruits(75%),vegetables(73%),cereals(59%),peanuts(52%),Grains(90-70%0

Cookingwithmoistheatimprovesdiges8bilityhttp://jn.nutrition.org/content/

130/7/1865S.full

Remember


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Remember

A variety of foods,

in moderation, canfit into a healthy

eating pattern if

nutrient needs

have been met

without exceedingcalorie limits.

Regular physical

activity helpsmaintain caloriebalance.


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Thankyou

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