Importance of vitamins
- vitamin c deficiency = scurvy - scurvy "browning of the plate" (lacks color, variety, diversity)
Nature of vitamins
- vitamins are organic (carbon containing) - do not provide energy - do not become part of the body - Specific functions are nontransferable
Are minerals organic or inorganic?
inorganic
Fat soluble vitamins (A, D, E, and K)
- absorbed with fat- stored in body fat- carries more of a risk of toxicity
Water soluble (B vitamins and C)
- dissolved in water - excreted through urine - exception is B12 stored in the liver
Vitamin A
- necessary for vision - bone growth - tissue growth - xerophthalmia (failure to produce tears)- nyctalopia foods: carrots, cantaloupe, liver, fish, sweet potatoes, fortified milk/cereal
Nyctolopia
night blindness
Prevention and treatment of Vitamin A deficiency
Prevention: - breastfeeding (rich in vitamin A) reduces infection - supplementation - food fortification Treatment: - high dose - diet rich in vit. A
Vit. A toxicity
Carotenemia: too many yellow vegetables; usually benign; yellowing of the skin; once carotene is discontinued, skin will return to normalHypervitaminosis A: excess intake Vitamin A. Can result in liver & kidney damage. Can be reversed when supplements are stopped
Vitamin D functions
- absorb calcium to promote bone growth - supports immune, brain, and nervous system health
Vitamin D deficiency
- rickets - osteomalacia; low intake, little sun exposure (softening of the bone)- osteoporosis: decreased bone density
Vit. D sources
- sunlight - milk - cod liver oil vitamin
Vitamin D toxicity
- vitamin most likely to cause toxicity - calcium deposits in heart, kidney, & brain - sunlight exposure not typical for toxicity
Vit. E
- antioxidant - prolongs bleeding time (don't combine w blood thinner) - reduces blood clotting - may need to discontinue for procedure or surgery
Vit. E deficiency
- nerve damage - muscle damage - weakened immune system
Vit. E sources
- veggie oils - nuts -seeds- green leafy veggies
Vit E toxicity
- not from food - excessive supplements - increased bleeding tendencies
Vit K functions
- blood clotting: necessary for liver to make prothrombin and other clotting factors - bone metabolism- consistency recommended - in past times vitamins K rich foods were prohibited - half life (doesn't last long, abt 3 days to leave system)
Vit K deficiency
- inability to clot
Vit K sources
- green leafy veggies - salad greens - spinach - broccoli
Number 1 concern for fat soluble vitamins
toxicity
water soluble vitamins
Vitamins B complex and C
Vit c functions (ascorbic acid)
- collagen synthesis - antioxidant - iron absorption- smokers can benefit
Vit C deficiency
s/s of scurvy - bleeding gums - petechiae - delayed wound healing - bone pain and fractures - tooth loss
Scurvy usually occurs in
- malnourished individuals - chronic alcohol abuse - chronic illness
Vit. C sources
fruits and veggies
Vit. C toxicity
- nausea - abdominal cramps - diarrhea - rare
Thiamin functions (B vitamins)
metabolism of carbs and amino acids
Thiamin deficiencies
- alcoholics - people subsisting on milled rice - beriberi affects the heart and circulation• S/S :• Difficulty walking• Loss of sensation in hands & feet• Mental confusion• Speech Difficulty
Thiamin sources
Meat/legumes: - pork - black beans - black-eyes peas- wheat germ, fortified foods
Thiamin Toxicity
none reported: can be excreted through urine
Riboflavin (vitamin B) function and deficiency
- helps in metabolism of protein and other vitamins - deficiency: none alone
Riboflavin sources and toxicity
- milk - eggs - fortified cereals - liver - unknown toxicity
Niacin (Nicotinic Acid) function
aids in energy metabolism - used to be given to cholesterol pts
Niacin deficiency
pellagra - dermatitis, diarrhea, dementia, death if not treated
Niacin sources
- meat - fish - poultry - whole, enriched, fortified grains
Niacin toxicity
- flushing - liver damage -
Vit. B6 function
aids in metabolism of amino acids
Vit. B6 deficiency
rare
Vit. B6 toxicity
- none from foods - pyridoxine - sensory neuropathy - ataxia
Folate/ folic acid
necessary for formation of DNA - works with B12 to make RBC
Folate (folic acid) deficiency
- spina bifida: spinal cord fails to develop properly
Folate recommendations
pregnant women: 400 mcg from fortified foods
Folate sources and toxicity
- liver - dried peas- beans - lentils - fortified grains toxicity: none reported
Vitamin B12 function
helps keep body and nerve cells healthy - helps make and regulate DNA
Vit. B12 deficiency
- pernicious anemia - gastric resection - crohns disease
Vit B12 sources and toxicity
- meat - fish - poultry - milk - cheese- eggs toxicity: none recorded
Minerals
- inorganic (lacks carbon)- become part of body composition - 4% of body weight - regulates bodily functions - essential to good health
Major minerals (macrominerals)
- calcium - sodium - potassium - phosphorus - magnesium - sulfur - chloride
Minor minerals (microminerals)
- iron - iodine - fluoride - zinc
Calcium functions
- bones and teeth - catalyst in muscle contractions - catalyst in blood clotting
What can lead to confusion
- calcium - sodium - UTI - blood sugar
catalyst
substance that speeds up the rate of a chemical reaction
Calcium sources
*Animal products - milk - sardines- clams - oysters- salmon *Plant products - fortified foods- spinach - greens - broccoli
Ca deficiency
- OSP: bone fragility - Osteopenia: body reabsorbs old bone quicker than it can be replaced - rickets in children - Chvostek: tapping over facial nerve - twitch of facial muscles- Trousseau: BP cuff pressure - spasms of forearm and hand
Tetany
* Ca deficiency - medical emergency - low ionized calcium in blood (hypocalcemia)
Ca toxicity
- Hypercalcemia - Alkali syndrome: over medicating
Sodium functions and sources
Function- maintains fluid balance - helps transmit impulses along nerves and muscle fibers Sources - table salt - 2g/tsp- milk, processed, veggies - soups
Sodium deficiency
hyponatremia: too much water - acute mental change- muscle weakness
Na toxicity
- excess sodium excreted by kidney - hypertension, heart disease, kidney disease
Potassium functions
- helps control fluid balance - helps transmit impulses along nerves and muscle fibers
Potassium sources
- plant and animal cells - unprocessed foods - salt substitutes
Potassium deficiency
- rt diet only - losses due to diarrhea, vomiting, laxative abuse - diuretics (lasix)
cardiac arrhythmia
check potassium bc could be too low or too high. Normal levels 3.5-5.5
Potassium toxicity
- diabetes, burns, crushing injuries - renal failure - blood transfusionstreatment focus on renal excretion
Chloride function, deficiency, toxicity
Function: maintain fluid & acid base balance Deficiency: excessive sweating, diarrhea, vomitingtoxicity: renal insufficiency and leads to fluid retention
Phosphorus functions
- Calcium phosphate provides hardness to bones and teeth- Component of DNA and RNA- maintains acid base balance
Phosphorus sources
animal: lean meat plant sources: nuts, legumes
Phosphorus deficiency
uncommon in the diet of a healthy person
Phosphorus toxicity
potassium phosphate laxatives and enemas- want to consider renal failure pt (diet restriction)
Magnesium functions
- ADP and ATP in energy metabolism - aids in transmission of nerve impulses- influences cardiac and smooth muscle contractility magnesium is a lot like potassium
Magnesium sources
- green veggies - nuts, beans, whole grains, wheat, and oat bran - avocados - spinach
Magnesium deficiency
often aligned w potassium - malabsorption- excessive alcohol use - chronic diuretic use - muscle spasm
magnesium toxicity
kidney disease
Sulfur function, sources, deficiency, and toxicity
Function: found in hair, skin, nails sources: animal based proteins, meat, fish, poultry Deficiency: lack severe protein toxicity: none
Trace minerals
- iron - iodine - fluoride - zinc
Iron function
- formation of hemoglobin - immune system
iron sources
- shellfish - organ meats- red meat- legumes - clams - oysters
iron deficiency
- 30-50% post bariatric patients (infants, child bearing, women)
Iron toxicity
- poisoning (pediatric)- hemochromatosis (iron metabolism)- alcoholism - cooking in iron pots
Iodine function and sources
synthesis of thyroid hormones sources: - iodized salt- plants and animals from the sea- dairy products
Iodine deficiency
- goiter - mental retardation (preventable) hypothyroidism - dry hair/skin- cold- tired- constipated - depressed Toxicity: unlikely in US, goiter
Fluoride function
- mineralization of bones and teeth - prevents dental caries
Fluoride sources
- US drinking water - toothpaste - tablets/dental treatments
Fluoride deficiency & toxicity
deficiency - dental caries - weak bones Toxicity: dental fluorosis
Zinc functions
- essential for good health - immune system - wound healing
Zinc sources
- cereal - meat - shellfish - nuts
Zinc deficiency
- correlates directly with protein consumption in children:- growth retardation - skeletal abnormalities - delayed sexual maturation In adults - alopecia - poor wound healing - impaired immunity
Zinc toxicity
- dietary supplements including MVI - Should be obtained through foods
Environmental risks: aluminum
found in pharmaceutical products for hemodialysis and TPN - lead-inhalation - ingestion - skin contact
Environmental risks: mercury
aquatic contamination
Classifications of weight
- underweight - normal weight - overweight - obese classification is becoming more important to insurers
benefit of bariatric surgery
reduces comorbidities
Percentage body fat
doesn't take into account hydration or hormonal abnormalities.
BMI and weight circumference
most used
Women body fat
25- 31%
Men body fat
18-24 %
BMI classifications
underweight: <18.5normal: 18.5-24.9overweight: 25-29.9obese: >30
BMI is more meaningful when
done in conjunction with other nutritional assessments
Waist circumference is used
to classify fat distribution and central obesity
women waist circumference
>35 inches- higher risk
men waist circumference
>40= higher risk
When did the prevalence of obesity in the US increase?
mid 1970s
Energy imbalance occurs when
number of kilocalories eaten does not equal the number used for energy
What will occur is more kilocalories are eaten than used?
weight gain
How can you determine if food intake = energy needs?
monitoring weight
to lose one pound of body fat per week
eat 500 kcal fewer per day
to gain one pound of body fat per week
eat 500 kcal more per day than the body uses
Weight loss is independent of
diet composition
What does excess kcal store as?
body fat in adipose tissue which can accumulate in unlimited amounts
Most people can lose about how many lbs overnight by eating less ?
2 lbs, any loss beyond that is probably due to water loss or lean muscle tissue
the greater the rate of weight loss
the more lean body mass is lost
What can protect loss of lean body mass during weight loss?
physical activity
Consequences of obesity
- social - cultural - prejudicial - psychological - medical
Social consequence of obesity
- connected to cultural expectations and documented prejudice - many Americans perceive leanness as being attractive and being fat as the opposite - most people regain weight, perpetuating a self defeating cycle - health and wellness are even more important than body weight
Who often has biases towards obese patients in healthcare?
- physicians and nurses- need to learn to understand their own feelings about fatness and obesity - treat obese patients with respect, kindness, and patience
Psychological consequences of obesity
body image disturbances
What is body image?
mental picture a person has of himself or herself
How can body image manifest itself?
1. distorted body images are usually dissatisfied with their bodies 2. people with distorted body images do not view their bodies realistically
Medical consequences of obesity
Overweight - HTN- dyslipidemia - type 2 DM - CAD - CVA - gallbladder and liver disease - OSA - sleep apnea
Variety
the greater the variety the more kcal consumed
Taste
the better the food tastes the more is eaten
Weekend activity
eating at regular times and planning non food related activated weekends
Skipping breakfast
more likely to be obese. Those eating four or more times daily are less likely to be obese. the fourth meal should be a small snack
Eating out
eating meals away from home is associated with increased intake and lower nutritional quality
Speed
the faster food is eaten the more is consumed bc it takes longer for the satiety signals to reach the brain
Soda intake
excess added sugar
Federal guidelines
advantages of weight loss - lower blood pressure - lower cholesterol - low BG levels Determining overweight and obesity - BMI - waist circumference
Daily calorie consumption
1,00-1,500 45% CHO20% fat 10% protein 25% negotiable 25-35 g of fiber
Physical activity
- modest contribution to weight loss in overweight and obese adults - may decrease abdominal fat - increase cardiopulmonary fitness - increases lean body mass
Exercise per week
150 minutes or 2 hours and 30 min per week
What should you add to physical activity?
resistance training 2-3 days per week
How much exercise should be done for individuals who want to lose weight?
300 minutes per week
behavior modification
useful adjunct to weight loss and maintenance plans
surgery treatment of energy imbalances
option for selected patients with clinically extreme or severe obesity when everything else has failed
FDA approved devices for treatment of obesity
- gastric band - electrical stimulation system - gastric balloon - gastric emptying system
Complications of surgery
its should be followed carefully postoperative bc of risk of deficiencies such as iron, folic acid, and vitamin B 12, risk for maladaptive eating behavior
Weight loss maintenance findings
- low calories - low fat - eat breakfast - weight weekly - watch less than 10 hrs of TV per week - exercise 1 hr per day
Some roles of nutrition educators
- provide accurate info - warn against dangerous practices - teach clients to evaluate risks and benefits - refer to health care professionals - help clients set realistic goals
Reduced body mass
- equally or even more difficult to treat as overweight/obese pt - usually loss of lean body mass
risks of reduced body mass
- women cease to ovulate and menstruate - cardiac abnormalities - prone to infections - risk for OSP
Classification for reduced body mass
BMI <18.5 - men body fat <15%- women body fat <18% - nutritional risk
Reduced body mass causes
- genetics - long term/ recent weight loss- medical - psychological diagnosis - socioeconomic issues
reduced body mass consequences
- increased mortality - decreased life expectancy - TB - sensitive to cold weather - infections of GI tract - fragile bone structure and OSP changes
Anorexia
- combination of biological, socio-cultural and psychological causes - self imposed starvation- starvation, vomiting, laxative use
Bulimia
- binging and purging - food restriction before and after binging
Binging
consumption as much as 5-10,000 cals per day
Purging
intentional clearing of food out of the system
More common than anorexia
- bulimia - during adolescence and young adulthood - 1.1.-4.2% of females - rare in males
binge eating disorder
- large amounts of high-fat and high sugar food in short periods of time - no purge - most common in US - during stress/emotional distress- lack of control - uncomfortably full- obesity