C787 WGU Nutrition to Support Wellness


- Dietary Reference Intakes
- Set of nutritional reference values for the US and Canada that applies to healthy people
- Addresses prevention of chronic diet related issues.
- Differs depending on age and gender.

RDA (Recommended Dietary Allowance)

- the average daily intake level estimated to meet the needs of nearly all people in a certain group. Aim for this amount!
- Use this for planning family meals sufficient for infants, children, adults and elderly family members.

AMDR (Acceptable Macronutrient Distribution Range)

recommended range of carbohydrate, fat, and protein intake expressed as a percentage of total energy

AMDR Range for Carbs


AMDR range for protein


AMDR range for fats


UL (Tolerable Upper Intake Level)

- The highest level of daily consumption of a nutrient that current data has shown to cause no side effects in humans.
- Ensures people do not take harmful amounts
- Used a lot in supplements

EAR (Estimated Average Requirement)

- the average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage or gender group
- Used to guide recommendations & menu planning for COMMUNITIES, in combination with upper intake levels


The science of how foods affect the human body to promote health and prevent disease

6 classes of nutrients

1. Water
2. Vitamins
3. Minerals
4. protein
5. fats - lipids
6. carbohydrates

4 things that a healthy full diet contains

1. Adequate energy intake
2. Variety
3. Fiber
4. Adequate hydration

Choose My Plate

USDA food grouping system that guides nutrition and health

Nutritional Benefit of fruits & veggies

- Provide phytonutrients that reduce the risk of some types of cancer.
- High Fiber
- High vitamins/minerals
- low calories

Number of recommended serving of fruits and veggies per day

9 Servings

Increasing the amount of colorful veggies reduces the risk of __________


Strategies for balanced meal planning on a budget

- buying canned veggies in bulk
- buying only the amount of fresh veggies that can be eaten at the time
- buying veggies whole and preparing/trimming them at home (precut veggies are more expensive)
- Grow veggies and herbs at home
- buy only in season ve


Skim Milk has roughly the same amount of calcium and protein as whole milk

Dietary recommendations for whole grain intake

One half of all grain products should be whole grain products

Consider how the following meal can be improved:
Omelet with cheese
toasted English muffin
1 t. all-fruit preserves
1/2 large grapefruit
1 cup whole milk

- use egg whites for omlet
- replace cheese with veggies in the omelets
- replace English muffin with whole grain English muffin
- replace whole milk with fat-free milk


trans fat and added sugar intake should be minimized; there is no DRI value (T)

Recommended daily amount of protein intake

60 gm/day

Examples of proteins

- garbanzo beans
- egg
- chicken breast
- yogurt
- cheese
- ground beef
- peanut butter
- tofu


Adding a grain (whole grains are best) to a protein rich food, such as legumes, lentils, PB, etc, can help maximize healthy protein in a vegetarian diet.


ending in -ose
Honey is made up of sugars

What will cause a quick return to hunger?

A carbohydrate with a high glycemic index

What kind of proteins are high in Omega-3 oils?

Some seafoods

Some healthy fats

- fish
- nuts
- olive oil

Food that are a source of high levels of sodium

- manufactured breads
- processed foods
- canned soups and broths

Some foods that are rich in iron

- dark, leafy greens
- legumes
- red meat
- nuts

Best vegetarian source of iron


Foods that protect against heart disease

Fiber, HDL cholesterol

Foods that increase risk of heart disease

LDL cholesterol, trans fats, saturated fats

Ways to reduce the risk of heart disease

- LDL levels below 120 mg/dl
- limit cholesterol intake to <200 mg/day
- at least 30 min of activity in daily routine
- sodium levels below 1600 mg/day
- Increased intake of fiber, especially insoluble fiber
- limit alcohol intake to 1-2 drinks

What kind of diet would be good for someone with low albumin levels?

High protein diet

Patients with kidney disease should not eat

high protein foods

DASH diet

- Dietary Approaches to Stop HTN
- increase fruit, vegetables, and low fat dairy; k, mg, ca

Factors important for controlling HTN

- Sodium below 1600 mg/day
- Healthy weight (BMI below 25)
- Daily exercise

What can protect spikes in blood sugars


Why is obesity considered a disease

because it affects many organ systems and hormones, impairing body functions

BMI considered obese

30 or greater, requiring counseling about a weight loss dietary plan

How to calculate BMI

1. Take patients height in inches and square it (ex. 5' 4" = 64 in; 64 ^2 = 4096)
2. Divide the weight in pounds by the number you get. (ex. 175/4096 = 0.043)
3. Multiply the answer to 2 by 703 (ex. 0.043 x 703 = 30)

What kind of diet is least likely to result in obesity

A diet with a variety of fruits, whole grains and vegetable

Example of risk factors for heart disease that are modifiable

- sedentary lifestyle
- BMI > 30
- diet high in trans-fats

Example of risk factors for heart disease that are NOT modifiable

- age 80 yrs
- male gender
- family member who died of a heart attack at age 55


Obese children & teenagers are at an increased risk of coronary disease


less than 18.5
- Can increase the risk of infertility, osteoporosis and premature death

Health risks that increase with higher BMI

- heart disease
- premature death
- DM2
- osteoarthritis


There is a genetic influence on body weight. Body weight of parents often are predictive of body weight of children even when they do not raise them

Maintaining weight in the long term

- patients should balance energy intake with energy expenditure

Advice for weight loss

- increase activity
- limit sugary drinks
- when you want food, ask yourself "am I hungry"
- reduce processed foods
- Eat 5 small meals to maintain energy throughout the day

What amount of reduction in total body weight has consistently been shown to improve health and decrease risks?

Example: 180 lb person would need to lose 18 lbs (down to 162 lbs)
265 lb would need to lose 26.5 lbs (down to 238.5)
430 lb person would need to lose 43 lbs (down to 397)

Examples of Appropriate, sustainable weight loss goals

- to reduce risk of chronic disease
- to increase energy level
- to be able to be more physically active with less joint pain

Motivational Interviewing regarding weight loss

- health behaviors have rewards separate from lbs lost
- don't focus on failure
- don't focus on negative images
- don't sugar coat or be dismissive

Drinking What amount of water each day has shown to support weight loss

48 oz or more

Examples of foods appropriate for consistent inclusion on a wt reduction dietary plan

-baked fish
- broiled skinless chicken breast
- steamed green veggies
- lean protein

Examples of societal factors in the obesity epidemic

- desk-based, low-activity jobs
- increasing size of food portions
- increased consumption of processed foods

Examples of obesity message to discuss with adolescents

- focus on health diet, not weight loss diets
- positively reinforce healthy behaviors in general
- don't give food as a reward
- media messages

Good advice to a family of a 14 yr old with anorexia

- avoid focusing praise and compliments on physical attractiveness
- Do not categorize specific foods as "good" or "bad"
- Remove monetary or reward incentives from meal time

Amount of weekly exercise patients should strive for

90 min moderate physical activity at least 3 x's/wk

Legal supplements for body builders to increase muscle mass and increase nitrogen retention

Protein Powder


The measurement of the size, proportions, and range of motion of the human body.
ex. height, weight, waist size, etc

How to calculate PAL (physical activity level)

Total energy expenditure/Basal metabolic rate (aka. basal energy expenditure)

Nutrition for Infants

- Human milk contains immune factors that infant formula does not
- Human milk does NOT need supplementation of vitamins & minerals, neither does infant formula
- There are not adequate intake levels for macronutrients for all infants of all ages

Why is juice not recommended for infants?

-contribute to tooth decay
- lacks fiber and may contribute to diarrhea
- It is a highly caloric source of fluid

What contributes to dental carries in infants?

Sharing utensils

Behaviors that may put a child at risk of having a poor relationship with food

- Not involving them in meal planning
-Not offering children choices

What does the CDC define as overweight in childhood?

BMI - for - age over the 85th percentile

What is an educational strategy for teaching Kindergartners about Choose my Plate

Teach them a rhyme with the concepts

What is an educational strategy for teaching an 8-10 yr old about healthy meal planning

Have them write out a description of a healthy menu with different food groups

Good advice for patent of an obese 9 yr old

- increased levels of family stress can contribute to poor eating habits
- Limit portion sizes
- Avoid frequent restaurant meals
- Encourage physical active play and not just desk-based study
- Provide and model choices of healthy plant-based snacks and c

Examples of teaching strategies for high school students about nutrition

- Provide recommendations & the reasons behind them
- Encourage attainable goal setting
- Focus on healthy weight maintenance & healthful, gradual weight loss
- Don't focus on physical appearance

Daily Value for Calcium for an adolescent female

130% - adolescent females would need more calcium that the recommended DV for adults

What is a dietary cause of short stature, poor bone development and cognitive delay


What do young adolescents have an increase need for relative to adults?



Alcohol should be avoided during all trimesters of pregnancy

What is an effect of alcohol consumption during pregnancy on the fetus

Permanent developmental disability (fetal alcohol syndrome)

What vitamin can reduce the risk of neural tube defects

Folic acid/folate

Examples of sources of folate

lentils, spinach, oats

Examples of advice for a pregnant patient to minimize the risk of pre-term delivery

- abstain from alcohol and drugs prior to conception and throughout pregnancy
- discontinue all alcohol
- maintain healthy weight
- maintain healthy diet to help prevent gestational DM


- burns extra calories and can promote return to pre-pregnancy weight
- requires extra fluid consumption
- promotes oxytocin release
- may reduce the risk of childhood obesity
- is not a reliable for of birth control (it can delay return of fertility but

Why are adults over 70 more vulnerable to inadequacy of dietary nutrients?

Because different GI physiology interferes with absorption

Benefits of prebiotics and probiotics for older adult

- decreases total cholesterol
- controls IBS
- supports immune system function
- rebuilds bone density


Adequate Intake of protein have not been established for infants 7-12 months of age

Advise for adapting to older adulthood

- to avoid obesity, remain active and realize your overall caloric needs may decrease

Where to find info for adding dietary supplement to your diet


Supplements should be recommended for

people who need them - labs show deficiency

Statement that is required on the label of all supplements

Not intended to diagnose, treat, cure or prevent heart disease

Vitamins that are water soluable and can be flushed out in urine stream

B vitamins; vitamin C

Fat soluable vitamins that are stored in fat

K, A, D, E

ergogenic aids

Supplements used to benefit athletic performance or exercise.


a class of drugs that enhance cognitive function


live microbes applied to or ingested into the body
Improves digestive problems


Increases breast milk production

supplements may contain

- active ingredients
- extra ingredients unlisted and are similar to fillers in Rx drugs


Supplements can interact with medicine and make it's effects too strong or reduce it's effects. This can be life threatening.

Beriberi results from a deficiency of


brain damage, intellectual impairment and goiters result for a deficiency of


Blindness in young children result for a deficiency of

Vitamin A

Rickets result from a deficiency of

Vitamin D

Supplements for women to reduce the risk of osteoporosis


Vitamin K

Fat soluble vitamin that aids in blood clotting.
- Should be avoided while on coumadin/warfarin

Supplements that may be needed for vegetarian

Vitamin B12 because it is unavailable in plant foods

Nutrients available in plant foods but may require special consideration in a vegetarian diet

- Iron (dark, leafy greens)
- Vitamin D
- protein (can be the hardest MACRONUTRIENT on a vegetarian)
- Calcium (must be in a bioavailable form

Food Insecurity

- A limited ability to acquire nutritionally adequate food in a socially acceptable way.
- lack of access to food

Contributing factors to global hunger

- food waste
- overpopulation

Natural causes of famine

- pests
- drought
- flood
Famine affects agricultural output on a large scale

The Economic Research Service

Assists in providing research and analysis on food security issues in developing countries

Food Desert

An area in a developed country where healthy food is difficult to obtain
Characterized by
- lack of availability and accessibility of healthful foods
- fast foods are more affordable
- markets in the area do not have a good selection of produce

Strategies to reduce food deserts

- implement urban farmer market
- support public policy to reduce costs of fresh foods

The Food Security Survey Model

- Measures sufficiency of food
- Financial limitations to adequate nutrition are a main focus of this diagnostic tool


Too little food energy or too few nutrients to prevent disease or to promote growth; a form of malnutrition
- Consuming many calories but w/o adequate nutrients

Child Food Security Survey Model

A tool to help determine if a child is experiencing hunger at home

household food security status

A outcome measure to examine the public's ability to secure adequate food

food security

All or most people in a country have daily access to enough nutritious food to lead active and healthy lives

Low food security is characterized by

reduced quality, variability, and desirability of diet

National Nutrition Monitoring and Related Research Act of 1990 resulted in

The development of standardized questionnaires for measuring household food security status


uneasy or painful sensation caused by lack of food

Problems/Factors associated with food insecurity

- poor nutrition
- trouble obtaining food
- obesity
- poorer health status
- lower cognitive and academic performance

Supplemental Nutrition Assistance Program (SNAP)

helps low-income individuals and families purchase food. More than half of food stamp recipients are children. Formerly known as Food Stamps.

Meals on Wheels

a community-supported nutrition program in which prepared meals are delivered to elders in their homes, usually by volunteers
- Most appropriate for elderly persons with low income, transportation issues and nutritional deficiencies

Women's, Infant's, and Children's program (WIC)

Provides supplemental food and education for families in need of assistance
- Most appropriate for pregnant females with low income who have difficulty obtaining medical care

Things to consider when address the nutritional needs of a homeless person

- is food ready to eat or do they have to prepare it on equipment
- is food non-perishable or will it require refrigeration
- is the food nutritionally adequate

Barrier to nutritional education

- screen for problems with written materials and provide verbal or picture-based instruction

Recommendations for nutrition education for patients who speak limited English

-avoid using text only to teach
- avoid using only traditional American food
- use pictures and food from the patients culture

Elderly Nutrition Program

A program that teaches older adults how to shop, plan and prepare nutritious meals and conducts HTN assessments

Senior Farmers' Market Nutrition Program

provides elderly with coupons to use at farmer's markets
unprepared fruits, veggies, herbs, and honey

Nutritional Assistance programs available in every US community for those who meet income eligibility criteria

- Child Nutrition Program

Food poisoning can be caused by

either primary infection by a microbe OR production of toxins by microbes

Thought to be the most lethal bio terrorism agent


Infections commonly disseminated by ingestion (fecal-oral)

- cholera
- shingellosis

Food Systems Security

a system to focus on locating the source of a bio terrorism incident and notifying affected facilities

Foods that have been common sources of food contamination in recent years

-Bean sprouts
- spinach

Increased risk of spreading microbial foodborne illness

- undercooked chicken
- unwashed veggies
- eating bean sprouts
- defrosting a steak on a counter
- storing cooked and raw veggies together
- Not cooking or freezing poultry within 2 days of purchase


Undercooked poultry


Foods contaminated with fecal matter




potatoes exposed to light


Fish such as grouper

monosodium glutamate (MSG)

flavor enhancer which can cause CP, facial numbness and HA

E. Coli and Salmonella

Cause enteritis and diarrhea


Pregnant women should only eat cheese if it is pasteurized because listeria in unpasteurized cheese increases the risk of spontaneous abortion and congenital infection of the newborn

Perishable Foods

Foods that require freezing, preservation techniques or immediate use


Pasteurized mile reduces the number of micro organisms but still requires refrigeration
Only ULTRA-PASTEURIZED milk can be stored at room temp

How long should contaminated water be boiled

at least 5 min

Irradiated foods

helps control e. coli and salmonella but does not drastically affect taste and texture and does not make food radioactive


Dented Cans may be compromised and may harbor contamination and should be discarded


a chemical that gives rise to obesity
Bisphenol A is an example of an obesogen

USDA organic seal indicates

- that a food is 100% organic according to current standards
- that food is not genetically engineered, no synthetic fungicides or insecticides were used
- Food, cosmetics and fabric can be certified organic