DRIs
- 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
RDA
- 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
family
meals sufficient for infants, children, adul
AMDR
- Acceptable Macronutrient Distribution Range
- Includes carbohydrates, fats, and proteins
- Expressed as a percentage of calories
AMDR Range for Carbs
45-65%
AMDR Range for Protein
10-35%
AMDR Range for Fats
20-35%
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
EAR
- 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
COMMUNITIES
, in combina
Nutrition
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
Sugars
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
Beans
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?
Fiber
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
Low BMI
- 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?
10%
Examples:
- 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
Anthropometrics
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?
Malnutrtion
What do young adolescents have an increased need for relative to adults?
Thiamine
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
Breastfeeding
- 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
-
Not
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
PCP
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
Thiamine
Brain damage, intellectual impairment and goiters result from a deficiency of
Iodine
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
Calcium
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
Undernutrition
- 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
Hunger
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
and
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
- SNAP
- Child Nutrition Program
Food poisoning can be caused by
either primary infection by a microbe
OR
production of toxins by microbes
Botulism
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
Camphylobacter
Get from undercooked poultry
E.Coli
Get from foods contaminated with fecal matter
Mycotoxins
Get from molds
Glykoalkaloids
Get from potatoes exposed to light
Ciguatoxin
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
ULTRA-PASTEURIZED
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
not
make food radioactive
Should dented cans be discarded?
Yes. Dented cans may be compromised and may harbor contamination and should be discarded
Obesogen
- 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