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
- Food labeling must include information about them
- Differs depending on age and

Nutrition labels always include

serving size


- Recommended Dietary Allowance
- Healthful diet contains nutrient intake near RDA
- the average daily intake level estimated to meet the needs of nearly all people in a certain group
- Used for planning
meals sufficient for infants, children, adul


- Acceptable Macronutrient Distribution Range
- Includes carbohydrates, fats, and proteins
- Expressed as a percentage of calories

AMDR Range for Carbs


AMDR Range for Protein


AMDR Range for Fats


Tolerable Upper Intake Level

- 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 in supplements


- Estimated Average Requirement
- 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
, in combina


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
- Half the plate should be fruits and veggies
- Make at least half of your grains whole grains
- Switch to fat-free or low-fat milk

Benefits of fruits & veggies

- Provide phytonutrients that reduce the risk of some types of cancer
- High in fiber, high in vitamins and minerals, and low in calories
- Increasing the amount of colorful veggies reduces the risk of stroke

Number of recommended serving of fruits and veggies per day

9 servings

Strategies for balanced meal planning on a budget

- Buy canned veggies in bulk
- Buy only the amount of fresh veggies that can be eaten at the time
- Buy veggies whole and prepare/trim them at home
- Grow veggies and herbs at home
- Buy only in season veggies

Does skim milk have roughly the same amount of calcium and protein as whole milk?

Yes, skim milk has roughly the same amount of calcium and protein as whole milk

Dietary recommendations for whole grain intake

At lease half of all grain products consumed should be whole grain products

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

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

Why should trans fat and added sugar intake be minimized?

Because there is no DRI value

Recommended daily amount of protein intake

60 grams or 0.8 grams per kilogram body weight

Examples of proteins

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

Best plant-based foods to maximize healthy protein in a vegetarian diet

legumes and whole grains


ending in -ose
Honey is made up of sugars

Which carbohydrate will cause a quick return to hunger?

one with a high glycemic index

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

Some seafoods

Some healthy fats

- fish
- nuts
- olive oil

Foods that are a source of high levels of sodium

- manufactured breads
- processed foods
- canned soups and broths

Foods that are rich in iron

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

Best vegetarian source of iron


Foods high in what protect against heart disease?

Fiber and HDL cholesterol

Foods high in what increase risk of heart disease?

LDL cholesterol, trans fats, and saturated fats

Ways to reduce risk of heart disease

- LDL levels below 120 mg/dL
- limit cholesterol intake to <200 mg/day
- saturated fat <7% of total daily calories
- at least 30 min of activity in daily routine
- sodium levels below 1600 mg/day
- Increase intake of fiber, especially insoluble fiber
- li

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 - some examples: fried eggs, hot dogs, steak

DASH diet

- Dietary Approaches to Stop Hypertension
- increase fruits, veggies, low fat dairy; k, mg, ca

Factors important for controlling hypertension

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

Ways to prevent cancer

- plant-based diet
- decreasing intake of well-done meat
- exercising
- diet low in saturated trans-fats
- limit alcohol to 1-2 drinks per day

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

- First, convert height to inches
- Square this number
- Then, divide the weight in pounds by above number
- Last, multiply that answer by 703

Diet least likely to result in obesity

Diet with a variety of fruits, whole grains, and veggies

Example of risk factors for heart disease that are modifiable

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

What are obese children and teenagers at an increased risk for?

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
- Type 2 Diabetes
- Osteoarthritis
- Sleep apnea

What is the genetic influence on body weight?

Body weight of parents often are predictive of body weight of children even when they do not raise them

How can you maintain weight in the long term?

Balance energy intake with energy expenditure, i.e., eat just enough calories for energy level

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?

- 180 lb person would need to lose 18 lbs
- 265 lb person would need to lose 26.5 lbs
- 430 lb person would need to lose 43 lbs

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 pounds 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 weight 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 healthy diets, 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 year 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 who are focused on weight loss should strive for

90 minutes of moderate physical activity at least 3 times a week

What are legal supplements for body builders to increase muscle mass and increase nitrogen retention?

Protein Powder


Measurement of the size, proportions, and range of motion of the human body. Examples: height, weight, waist size, etc.

How to calculate Physical Activity Level (PAL)

Total energy expenditure divided by basal metabolic rate. Also known as 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?

- Contributes 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

What behaviors 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 8 to 10 year olds about healthy meal planning

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

Good advice for parents of an obese 9 year 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 and 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 than the recommended daily value for adults

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


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


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

Permanent developmental disability (fetal alcohol syndrome)

What nutrient can reduce the risk of neural tube defects?

Folic acid/folate

Good sources of folate

lentils, spinach, oats

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 Diabetes


- 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
a reliable for of birth control

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

Different gastrointestinal 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 protein intake for infants 7-12 months of age

Adequate intake of protein has not been established for infants 7-12 months of age

Advice 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 - for example, labs show a deficiency

Statement that is required on the label of all supplements

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

What vitamins are water soluable and can be flushed out in urine stream?

Vitamins B and C

What soluable vitamins are stored in fat?

K, A, D, E

Some supplements and their uses

- Ergogenic aid - for athletic performance
- Nootropic - for cognition function
- Probiotic - for digestive problems
- Galactagogue - for breast milk production

Supplements may contain active ingredients and what else?

Extra ingredients unlisted that are similar to fillers in prescription drugs

Why should a patient tell their PCP about what supplements they are taking?

Because supplements can interact with medications and make the effects too strong or reduce the effects which can be life threatening.

Beriberi results from a deficiency of


Brain damage, intellectual impairment and goiters result from 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 that are 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

- Limited ability to acquire nutritionally adequate food in a socially acceptable way
- Lack of access to food

Contributing factors to global hunger

Food waste and overpopulation

Natural causes of famine

- Pests, drought, and flood
- Famine affects agricultural output on a large scale

What does the Economic Research Service do?

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

What are food deserts?

- 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

What is the main focus of the Food Security Survey Model?

- Financial limitations to adequate nutrition
- Measures sufficiency of food


- Consuming many calories but without adequate nutrients
- Too little food energy or too few nutrients to prevent disease or to promote growth
- A form of malnutrition

Child Food Security Survey Model

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

Household food security status

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

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

- Illiteracy
- 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

Program that teaches older adults how to shop, plan and prepare nutritious meals
conducts hypertension assessments

Senior Farmers' Market Nutrition Program

Provides elderly with coupons to use at farmer's markets for such things as 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
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

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
- Milk

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


Get from undercooked poultry


Get from foods contaminated with fecal matter


Get from molds


Get from potatoes exposed to light


Get from fish such as grouper

Monosodium Glutamate -- MSG

Flavor enhancer which can cause chest pain, facial numbness, edema and headache

E. Coli and Salmonella

Cause enteritis and diarrhea

Why should pregnant women only eat cheese if it has been pasteurized?

Because listeria in unpasteurized cheese increases the risk of spontaneous abortion and congenital infection of the newborn

Perishable Foods

Require freezing, preservation techniques or immediate use

Can pasteurized milk be stored at room temperature?

- No, pasteurized milk reduces the number of micro organisms but still requires refrigeration
- Only
milk can be stored at room temp

How long should contaminated water be boiled?

At least 5 minutes

Irradiated foods

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

Should dented cans be discarded?

Yes. Dented cans may be compromised and may harbor contamination and should be discarded


- Chemical that gives rise to obesity
- Bisphenol A is an example of an obesogen

USDA organic seal indicates

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