Y khoa - Dược - Chapter 55: Nutrition and health

55Nutrition and Health55.1 Relate daily energy requirements to the role of calories.55.2 Identify nutrients and their role in health.55.3 Implement a plan for a nutritious, well- balanced diet and healthy lifestyle using the USDA's guidelines.55.4 Describe methods used to assess a patient’s nutritional status.Learning Outcomes55.5 Explain reasons why a diet may be modified.55.6 Identify types of patients who require special diets and the modifications required for each.55.7 Describe the warning signs, symptoms, and treatment for eating disorders.55.8 Educate patients about nutritional requirements.Learning OutcomesIntroductionNutrition Utilization of food and nutrientsFive-part processIntake DigestionAbsorptionMetabolismElimination Medical assistant should understand relationship between nutrition and healthDaily Energy RequirementsThe body requires nutrients To provide energyTo build, repair, and maintain body tissuesTo regulate body processesMetabolismBuild, maintain and supply energy PhasesAnabolism ~ builds tissuesCatabolism ~ forms energyRequires nutrientsCaloriesKilocalorie (calorie) Measurement of energyProduced by foodExpendedExcess calories stored as fatMonitor food intake ~ calories/dayCalories burned during physical activityApply Your KnowledgeWhat is the difference between anabolism and catabolism? ANSWER: Anabolism converts nutrients into complex substances needed to build body tissues. Catabolism converts complex substances into simpler forms and converts them into energy.Correct!NutrientsNeeded for EnergyGrowthRepairBasic processesContain caloriesProteinsCarbohydratesFats Nutrients are provided byProteinsCarbohydratesFiberLipidsVitaminsMineralsWaterProteins (cont.)Functions Building and repairing cells and tissuesMaintaining water balanceAntibody production and disease resistanceMaintaining body heat10% to 35% of total caloric intake dailyProteinsDeficiency Weight loss/fatigueMalnutritionDry skinLower resistance to infectionInterference with normal growth processesProteins (cont.)Amino acidsUsed to make proteinsPlant and animal sourcesThree typesEssential amino acidsNonessential amino acidsConditional amino acidsCarbohydratesFunctionsEnergy (1gm = 4 calories) and heatMetabolize fatsKeeps the body from using protein for energy45% to 65% of total caloric intake dailyDeficiency Weight and protein lossFatigue Carbohydrates (cont.)Converted to glucose for energyExcess Stored in liver and muscles cells Converted into and stored as fatSimple sugarsComplex carbohydratesLong chains of sugar unitsTypes Starch Fiber FiberFunctionsIncreases and softens the bulk of stoolAbsorbs wastes and toxinsDecreases the rate of carbohydrate breakdown and absorption14 grams / 1000 caloriesAdequate water intakeSoluble or insoluble LipidsSource of energy (1 gm = 9 calories)Triglycerides and compound lipidsFunctions – essential to growth and metabolism20% - 30% of daily caloriesProblems related to deficiency or excessLipids (cont.)Saturated fatsAnimal sourcesSolid at room temperatureTrans fats Formed during hydrogenation Zero consumptionUnsaturated fatsLiquid at room temperatureVegetable oilsPolyunsaturatedMonounsaturatedLipids (cont.)Cholesterol Sources ~ liver and dietaryEssential to healthCell membraneSteroid hormones and vitamin DConstituent of bileLipid levelsCholesterol and triglyceridesLipoproteins Low-density (LDL)High-density (HDL)VitaminsOrganic substances Essential for normal growth and maintenance Essential for resistance to infectionAbsorbed through digestive tractWater- or fat-solubleMineralsNatural, inorganic substancesBuild and maintain tissuesCarry out life functionsMajor– needed in large quantitiesTrace – needed in small amountsAbsorbed in the intestinesMineralsRDAsCalcium ~ 800 to 1200 mgIron ~ 10 to 15 mgIodine ~ 150 mcgZinc ~ 12 to 15 mgMagnesium 280 mg – women 350 mg – men Phosphorous ~ 800 mgSelenium 55 mcg – women10 mcg – menMineralsSafe and adequate intakeCopper ~ 1.5 to 3.0 mgFluoride ~ 1.5 to 4.0 mgChromium ~ 50 to 200 mgManganese ~ 2 to 5 mgMolybdenum ~ 75 to 250 mcgWater65% of body weightFunctionsMaintains fluid balanceLubricates moving partsDissolves chemicals and nutrientsAids in digestionTransports nutrients and secretionsFlushes out wastesRegulates body temperatureWater (cont.)Fluid balance – intake should equal outputDehydration Inadequate intakeIncreased loss Educate patients about when to increase fluidsPrincipal Electrolytes and Nutrients of Special InterestElectrolytesSodium ~ 2.4 G or lessPotassium ~ 1600 to 2000 mgChloride ~ 2.4 G or lessAntioxidants – chemical agents that neutralize free radicalsApply Your KnowledgeMatching:___ Bulk to stool A. Cholesterol___ Tissue repair B. Antioxidants___ Excess stored as glycogen or fat C. Proteins___ Concentrated source of energy D. Water___ Produced by liver E. Trans fats___ No caloric value F. Fiber___ Neutralizes free radicals G. Lipids___ Formed during hydrogenation H. CarbohydratesANSWER:HGFEDCBASUPERJOB!Dietary GuidelinesUSDA Dietary GuidelinesEncourage people to eat a balanced dietLimit consumption of less nutritious foodsIncrease physical activityConsistently make good nutritional decisionsKey – balance food intake with physical activityUSDA Choose MyPlate GuidelinesEat healthyBalance caloriesFoods to increaseFoods to reducePatient educationGuidelines Tools at www.choosemyplate.gov American Cancer Society GuidelinesAchieve and maintain a health weightAdopt a physically active lifestyleConsume a healthy diet – plant foodsLimit consumption of alcoholic beveragesVery Good!Apply Your KnowledgeWhat is the purpose of the MyPlate initiative?ANSWER: To remind Americans to eat healthfully by balancing calories and reducing portionsincreasing fruits, vegetables and whole grains and switching to fat-free or low-fat milkDecreasing sodium and sugary drinks and increasing waterAssessing Nutritional LevelsAge Health statusHeight/weightBody frameBody circumference% of body fatBody mass indexNutrition and exercise patternsEnergy needsAssessing Nutritional Levels (cont.)Body mass index (BMI) Measure of body fat based on height and weightBody mass index calculators Assessing Nutritional Levels (cont.)Measurement of fat as a % of body weightSkinfold test – measurement of a fold of skin with a caliperOptimal % differs between men and womenAging changes ratioApply Your KnowledgeWhat factors does the physician consider when assessing a patient’s nutritional status?ANSWER: The physician considers a patient’s age, health status, height and weight, body frame and circumference, percent of body fat, eating and exercise patterns, and energy needs. Culture, beliefs, lifestyle, and educational level should also be considered during the assessment.Well done!Modified DietsDiet effectsHealthAppearanceRecovery from diseaseModifications Based on patient’s nutritional statusPrevent or treat illnessModified DietsTextureClear-liquid dietSoft dietPureed dietHigh-fiber dietNutrient level Low-sodium dietLow-cholesterol dietReduced-calorie dietLow-tyramine dietHigh-calorie, high-protein dietHigh carbohydrateModified DietsFrequency and timing of mealsExclusion of certain foods Bland diets ~ diverticulosisExclusion dietsLactose Phenylalanine Gluten – severe intolerance  celiac diseasePatients with Specific Nutritional Needs (cont.)Food allergies – eliminate from dietAnemiaIron supplementsDietary ironCancerAdequate protein intakeVitamin intakeEncourage patient to follow dietPatients with Specific Nutritional Needs (cont.)DiabetesGoal ~ control of blood glucose level Food exchange systemSeven categoriesPortion sizesAvoid skipping or delaying mealsFiber ~ helps to prevent sharp rise in blood glucose after a mealPatients with Specific Nutritional Needs (cont.)Heart disease Reduce cholesterolLose weight if neededReduce consumption of fatsHypertension sodium,  potassium, adequate calciumEliminate or reduce alcohol consumption fatsPatients with Specific Nutritional Needs (cont.)Lactose sensitivity – avoid dairy productsOverweightDietary modificationBehavior modificationMotivation and educationPatients with Specific Nutritional Needs (cont.)Children 1st year Nutritional needsGrowth and maturationActivity levelsHunger regulates intakePregnancy and lactation – need for additional nutrientsSpecific Modified Diets (cont.)Specially formulated food supplementsParenteral nutritionBypasses the digestive systemNutrients must be in absorbable formDrug therapyDrugs may affectFood intakeAbsorptionAppetite or tasteFoods may interfere with metabolism and action of a drugApply Your KnowledgeMatching___ Eliminate foods from diet ___ Food exchange system ___ Hunger drives eating ___ Modification to a soft diet ___ Reduced sodium diet ___ Bypasses GI tract ___ May alter food intake and absorption ANSWER:GFEDCBAYippee!Change in textureChildrenFood allergiesParenteral nutritionDiabetesDrug therapyChange in nutrient levelEating DisordersExtremely harmful eating behaviorAnorexia nervosaSelf-starvationTreatmentRestore normal nutritionPsychotherapy Education of nutrition conceptsEating Disorders (cont.)Bulimia Binge eating followed by purging Usually easier to treat than anorexiaGoals of treatmentEstablish a healthy weightEstablish good eating patternsResolve psychosocial triggersEating Disorders (cont.)Getting helpRate of recovery poor Disorders can become chronicRemission and relapseMay be fatalBe alert for patient eating or activity patterns during interviewsApply Your KnowledgeA young female patient arrives at the clinic showing a 15 pound weight loss in the last two months. Her weight is 10 pounds under the average weight for her height. She states she “feels fat.” What should you do?ANSWER: Document the weight loss and report it to the physician. She may be suffering from an eating disorder.Right!Patient EducationReinforce nutrition instructionsTeach patientRole nutrition plays in preventing illnessesHow to read food package labelsRefer questions to dietitian aboutMeal patternsFood selectionsPatient Education (cont.)Factors to considerAnything that affects food choices and behaviorsPatient age and family circumstancesDiseases and disordersPatient’s psychological conditionPatient must understand the reasons for the dietPatient Education (cont.)GuidelinesTeach patient as an individualTeach a small amount at a timeKeep explanations at patient’s level of understandingLet patient be an active learnerProvide a written diet planSuggest support groupsPatient Education (cont.)Cultural considerationsInfluenceFood purchases Like and dislikesMeal timing and frequencyAttitude toward supplementsSnacking Adjust diet and recipes accordingly Apply Your KnowledgeWhat do you need to consider when teaching patients about nutrition?ANSWER: You need to consider patient likes and dislikes, age and family circumstances, diseases and disorders, and the patient’s psychological condition. In addition, you need to incorporate cultural considerations into nutritional education.Excellent!In Summary55.1 The body uses food for three major purposes: to  provide energy; to build, repair, and maintain body  tissues; and to regulate body processes. Calories  provide energy for the body. Calories are measured in  the foods we eat. We also can estimate the amount of  calories used by the body during activity.53.2 The body needs a variety of nutrients for energy,  growth, repair, and basic processes. Several food  components provide nutrients. These are proteins,  carbohydrates, fiber, lipids, vitamins, minerals, and  water.In Summary (cont.)53.3 Dietary guidelines suggest the types and quantities of  food that people should eat each day. They also may  contain the recommendations about which types of  foods to limit and which types of foods to increase.  MyPlate provides recommendations for eating a  variety of nutrients and maintaining physical activity.  Using MyPlate recommendations promotes a well- balanced diet and healthy lifestyle. 53.4 Calipers are used to perform a skinfold test that  determines the percentage of body fat. BMI is the  body mass index. Both measurements, along with  other factors, maybe used to assess a patient's  nutritional status.In Summary (cont.)55.5 Dietary modifications may be used alone or in combination with other therapies to prevent or treat illness.55.6 Patients with allergies, anemia, cancer, diabetes, advancing age, heart disease, hypertension, lactose sensitivity, and obesity need special diets. In addition pediatric, pregnant, lactating, and debilitated patients as well as those undergoing drug therapy need modifications to their diet.In Summary (cont.)55.7 You should now the signs and symptoms of eating disorders in order to evaluate for these disorders during the patient interview. Some of the more common signs and symptoms for each includeanorexia nervosa – unexplained weight loss, self-starvation, and fear of weight gainbulimia – eating large quantities of food in a short period of time, going to the bathroom immediately after eating, and using laxatives to excessbinge eating – eating large quantities of food, not followed by purging, and weight gainIn Summary (cont.)55.8 Patients need to be educated about special diets and how to implement dietary changes as instructed by physicians and dietitians. Knowledge of basic nutritional principles and current nutritional findings are necessary. Documentation is required to help ensure payment by managed care and other health insurance companies.End of Chapter 55He that eats till he is sick must fast till he is well.  ~English Proverb