Unit 10: Nutrition Flashcards
What is BMR?
Basal Metabolic Rate
What is the role of BMR?
The energy required during rest to carry out life-sustaining activities such as breathing, circulation, heart rate, and temperature.
What is REE?
Rest energy expenditure - is a measurement that accounts for BMR plus energy to digest meals and perform mild activity.
What factors effects energy requirements/metabolism?
age body mass gender fever environmental temperature pregnancy lactation starvation stress illness injury infection activity level thyroid function drugs
Approxiamately how much energy % does REE account for from our daily needs?
60-75%
When does weigh increase in terms of kcal ?
Stay Stable?
Lose weight?
Weight increases when kilo-calories ingested exceed energy demands over time.
It remains stable when energy requirements are met by kilo-calories.
A person loses weight if kcal’s ingested fail to meet energy requirements.
What is a kilocalorie (kcal)?
It is the unit of energy required to raise 1 kilogram by 1*C
What are the 3 categories of nutrients that provide energy?
Carbohydrates, proteins, fats.
What are 3 nutrients that do not provide energy but aid in metabolic processes?
Water, vitamins, and minerals.
What is nutrient density?
The proportion of essential nutrients to the number of kilocalories.
For example, fruits and veggies have high nutrients but low kcals, whereas fatty food has low nutrients and high kcals.
What are functional foods?
Foods that have biologically active ingredients that have health benefits (probiotic yogurt, chick pea pasta/bread)
What are fortified foods?
Foods in which additional vitamins and/or minerals are added (soy beverages, fruit juice with calcium), or are enhanced with bioactive components through plant breeding, genetic modification, processing or special livestock feeding techniques (eg. eggs, milk, meat with omega-3).
What are organic foods?
Food that is produced without synthetic (human-made) pesticides, herbicides, and fertilizers; GMOs, antibiotics or growth hormones; irradiation or ionizing radition (preserving food). (eg. vegetables, fruit, eggs, milk, meta)
What is Novel food (aka as genetically modified (GM))?
Food that undergo practice of inserting one organism into another organism (to resist disease and develop desired characteristics such as hardier texture, faser growth). As per reasearch, GM foods are safe and equivalent to their counterparts. (eg, corn, potato, peppers, milk, etc)
What is the main source of energy in our diet?
Carbohydrates
Function of carbohydrates?
Main source of fule (glucose) for brain, skeletal muscles during exercise, red and white blood cell production, and cell function in renal medula.
How many kcals in each gram of carbohydrates?
4 kcals
What are saccharides?
carbohydrate units - Simple carbohydrates and Complex Carbohydrates
Where are carbohydrates obtained from?
Plants - expect lactace (milk sugar)
What are the building blocks of carbohydrates?
Monosaccharides - such as glucose or fructose
What are simple carbohydrates made of?
Monosaccharides and disaccharides (both are sugards)
What are complex carbohydrates made of?
Polysacharrides - starch and glycogen
What is the differen between starch and glycogen?
Starch - stored from glucose in plants
Glucogen - stored glucose in animals and humans
What are insoluable fibers (carbs)? Name them?
polysaccharides that cannot be digest bc humans don’t have the enzyme.
Cellulose, hemicellulose, and lignin.
Name the soluble fibers?
Pectin, guar gum, and mucilage.
Why is dietery fibre important?
For disease prevention - it decreases low-density lipoprotein (LDL) cholesterol which is assosiated with development of heart disease.
How are carbohydrate rich foods ranked?
glycemic index
What is glycemic index?
It is used to rank carbohydrate rich foods according to their effect on blood glucose levels and insulin response.
Which foods have a high glycemic indec?
Food that release glucose rapidly into the bloodstream such as white bread, candy.
Which foods hae a low glycemic index and why are they important for health?
Food that produce small fluctuations in blood glucose - barley, lentils. Important because they have long-term health benefits such as sustaining weight loss, prolonging physical endurance, and reducing risks assosciated with heart disease and diabetes.
What is added sugar listed as on food labels?
glucose, fructose, dextrose, maltose, or sucrose
What medical consitions are linked with consuming too much sugar?
Heart disease, stroke, obesity, diabetes, high blod cholesterol, cancer and dental cavities
Functions of proteins?
Synthesis (building) of body tissue in growth, maintenance, and repair.
Blood clotting, fluid regulation, and acid-base balance all require protein.
Nutrients and pharmcological substances are also transported within the blood by proteins.
What key components in our body are made up of protein?
DNA, RNA, Collagen, hormones, enzymes, and immune cells.
What is the simplest form of protein?
Aminoacids
What is the diference between essential aminoacids and nonessential aminoacids?
Essential - can’t be synthesized by our body (but needed in diet)
Non-essential - can be synthesized
How are amino acids linked together and what do they form?
Linked by peptides and form polypeptides
Name 2 simple proteins that contain only amino acids?
Albumin, Insulin
What is lipoprotein?
Complex protein created by a joining a simple protein with a nonprotein substance (lipid (fat))
How is protein quality determined? Give examples of incomplete proteins and complete proteins?
Determined by balance of essential amino acids.
Incomplete = lack suffcient quantity of one or more essential amino acids (cereals, legumes, and vegetables).
Complete = contain all 9 essential amino acids in sufficient quantity to support growth and nitrogen balance (chicken, soybean, fish, and cheese)
What function do complete proteins serve in our body? What are they also referred as?
Support growth and nitrogen balance
High-quality proteins
What are complementary proteins?
Pairs of incomplete proteins, when combined, supply total amount of protein provided by complete proetin sources.
What major nutrient in our body contains nitrogen?
Protein
How is nitrogen balance achieved?
When intake and output of nitrogen are equal
How does negative nitrogen balance occur?
severe infections, burns, fver, starvation, head injury, trauma,
What does the increased nitrogen loss result in?
Body tissue destruction, loss of nitrogen containing fluids through urine, feces, sweat (sometimes bleeding, vomiting)
Although proteins role is growth, maintenance, and repair, what can it do if carbohydrates are inadequate in body?
Provide energy
What is the function of fats?
Fuel- supplies energy, cushions vital organs, lubricates body tissue, insulates, and protects cell membranes.
What are fats composed of?
Glycerol and fatty acids
What are triglycerides composed of?
3 fatty accids attached to a glycerol
What are fatty acids composed of?
Chains of carbon and hydrogen atoms with an acid group on one end of chain and a methyl group on other end of chain.
What is the difference between saturated fats and unsaturated fats in terms of their structure?
Saturated - each carbon has 2 hydrogen atoms
Unsaturated - unequal # of hydrogen atoms to carbon atoms that are double bonded (2 carbons)
What is the difference in structure between monounsaturated and polyunsaturated fatty acids?
Mono- one double bond of carbon
Poly - 2 or more double bonds of carbon
What kinds of foods have saturated fats?
Unsaturated fats (monounsaturated and polyunsaturated0?
Saturated - animal fats
unsaturated - vegetable fats
What are trans fatty acids formed by? Known for?
partial hydrogenation of vegetable oils
linked to coronary artery disease
What kinds of foods have trans fatty acids?
prepared foods
snack foods
margarines
What do impact do trans fatty acids have on our cholestrol levels?
Increase LDL (bad) cholesterol Lower HDL (good) cholesterol
What is HDL? Function?
What is LDL? Function?
High-density lipoprotein - protects against heart disease
Low-density lipoprotein - transports cholesterol
What other medical conditions have trans fatty acids been linked with?
DM
Infertility (F and M)
Prostate cancer (M)
What types of fats should we be avoiding or consuming in low amounts? How?
Saturated and trans fats
By choosing soft margarine over hard/butter, whole/natural foods, foods with low/zero trans fat, and foods made with unhydrogenated oil.
What is cholesterol?
It is a sterol. NOT a triglyceride (yet discussed with fats)
Where does cholesterol naturally come from?
Animal foods but is also synthesized by the liver
How does cholesterol play role in coronary artery disease?
High LDL deposits in blood vessel wals and cause atherosclerosis which is the underlying cause of coronary artery disease
Why is water important for our body?
Cell function depends ona fluid environment
How much % of the body weight does water make up?
60-70%
Do lean people have more % of water weight o obese people? Why
Lean because muscle contains more water than any other tissue
What key functions does water play in the body?
Temperature regulation
Solvent for nutrients
Fluid intake vs. output in a healthy individual vs. unhealthy?
Healthy = intake and output are same
Unhealthy (fever or GI stress) = high intake but low output
What are vitamins?
What is the role of vitamins?
2 types of vitamins?
Organic substances
Essential to metabolism and Antioxidants.
Fat soluble vitamins and Water Soluble Vitamins
Difference between fat soluble vitamins and water soluble vitamins?
Fat soluble - can be stored in body (except vit D).
Water soluble - not stored in body. Destroyed by cooking. Must take supplements
What happens if you take consume/take vitamins in high doses? For fat soluble and water soluble?
Fat soluble = hypervitaminosis from megadoses.
Water soluble = toxicity may occur in megadoses
What are minerals?
Inorganic substances
Why are minerals important?
Catalysts in biochemical reactions. Become structural component of body and its enzymes.
How are minerals categorized? Daily requirements for each?
Macrominerals- 100 mg or more; and Microminerals - 100 mg or less
What are some macrominerals?
Calcium, sodium, potassium, phosporus, magnesium, sulphur and chloride
What are some microminerals?
Iron, iodine, fluoride, zinc, selenium, chromium, copper, manganese, molybdenum, and cobalt
What are DRIs? Abbreviation, role, considerations?
Dietery Reference Intakes- evidence informed criteria for an acceptable range of min to max nutrients, vitamins and minerals needed to avoid deficiences or toxicities.
Considers age, sex, pregnancy, and lactation.
4 components of DRIs?
- estimated average requirement
- recommended dietery allowance
- upper intake level
- the adequate intake
What is the purpose of food guidelines?
To inform daily food choices and promote optimal nnutritional health
What are consumers recommended to do as per ‘Eating Well with Canada’s Food Guide’ in terms of grains, greens, dairy and meat?
Grains - at least 50% of selection is whole grain
Greens - 1 dark green and 1 orange vegetable per day
Dairy - lower fat dairy products recommended
Meat - lower lean meats (including legumes and tofu); 2 fish servings per week
What recommendations does Canda’s Food Guide make in terms of exercising?
30-60 mins per day for adults
90 mins per day for children
Has the food guide adapted to indigenous people?
Yes
What does the Food Guide say about eating too much locally caught fish?
Limiting exposure to mercury from locally caught fish
What instructions are given to Indigenous ppl about local caught meat?
High fat contents in traditional diet - seal and whale oil, ooligan grease, and bacon fat.
What is a nutrition label?
Mandatory label on prepackaged foods in Canada. Lists nutritional facts: energy (calories) + 12 nutrients
What does a healthy diet low in sodium and high in potassium do?
Reduce high BP risk
Having adequate diet of calcium and Vit D prevents?
Osteoprosis
What does a healthy diet low in saturated fats and trans fat prevent?
Heart disease
What does a healthy diet rich in vegetables and fruit prevent?
Some types of cancer
What role to dietitians play in health promotion?
- Advocates for continued leadership commitment to nutrition labelling.
- Food Fortification
- Food Policy and Regulation
- National reduction of salt and trans fat content in packaged and prepared foods
- using Nutritious Food Basket Protocol in calculating the cost of a healthy diet to reduce poverty-related food insecurity.
What were the dietitians of Canada called to action for in 2012?
a: equitable access to adequate, healthy, and safe food
b: supportive environments for healthy eating
c: comprehensive surveillance and monitoring of food, diet and health
d: access to dietitian services in all sectors
Benefits of breast milk in infancy?
immunological and allergy protection economical and convenient bonding between mother and infant easier to digest than formula protects infant against sudden infant death syndrome protective effect against obesity
What additional supplements to breastfeeding infants need?
Vit D (as not enough in breast milk)
What is formula?
Mimics mother’s breast milk but made from cows milk.
Can regular cow milk be used instead of formula? Why?
NO. May cause GI bleeding. Too concentrated for infant’s kidneys, increases risk of milk allergies, and poor source of iron, vit C and E.
Can Honey be given to infants (under 1)?
NO. Can cause infant botulism and be toxic/fatal.
Until approximately what age does an infant breastfeed?
6 mos, then can slowly transition to puree/solid foods.
Why are calcium and phosphorus important for toddlers?
Bone growth
Why is whole milk important for toddlers?
Adequate fatty acids to support brain and neurological development
What is the result of high milk consumption in toddlers in lieu of other foods?
Milk anemia - as milk is a poor source of iron
What does bottle feeding during bed time lead to in toddlers?
Tooth decay
What are health risks associated with being overweight or obese in childhood?
Hypertension/high cholesterol - cardiovascular disease
Impared glucose tolerance
insulin resistance
type 2 DM
breathing problems (sleep apnea and asthma)
joint problems and musculoskeletal discomfort
fatty liver disease, gall stones and GI reflux
social and psychological problems (discrimination and poor self-esteem which can continue into adulthood)
What are some strategies to reduce childhood obesity?
a - making it a collective priority by Ministers of Health to champion and encourage shared leardership and action from government departments and other sectors of Canadian society.
b - coordinating early policy priorities to identify and address the risk of overweight and obesity in children early, to make children’s social and physical environments more supportive of accesibilty of nutritious foods and decrease the marketing of foods and beverages high in fat, sugar, sodium to children
c- monitor progress in reducing childhood obesity
During adolescense, what mineral is lost during menstruation, and what should be done?
Iron
Take Iron supplements
How does Iodine support adolescent growth?
Supports increased thyroid activity
How does B-complex support adolescent growth?
Supports heightened metabolic activity
What is anorexia nervosa and bulimia nervosa?
Eating disorders
Anorexia Nervosa: restricted diet, fear of becoming fat
Bulimia nervosa: binge eating, and inappropriate compensatory behaviours (self-induced vomitting, laxatives)
- occur mainly in adolescense when individuals are establishing independence and autonomy.
What issues present with eating disorders in adolescents that nurses must be mindful of?
Difflicult emotions, issues of identity, low self-esteem, and autonomy
How can parents influence adolescent diet at home?
- limit unhealthy food kept at home
- change social norms that determine what foods are “cool”
- make healthy foods more convenient
- inhance appearance and taste of healthy foods
Why is pregnancy occuring within 4 years of menarche a risk? for who?
Risk for both mother and fetus due to anatomincal and physiological immaturity.
Malnutrition at the time of conception increases risk to adolescent and her fetus.
How do the demands of most nutrients change as growth period ends (entering young/middle adulthood)?
Reduced demands
Poor oral hygiene and peridontol disease are risk factors for what in young adults?
Bacteremia, endocarditis, cardiopulmonary disease, and DM.
Adverse effects in pregnancy as well.
What role does food poisoning play in pregnancy and what measures can be taken?
Food poisoning in first trimester = miscarriage
later trimesters = still birth, premature baby or very ill baby
Preganant feels should avoid non-dried deli meats, raw eggs or seafood, unpasteurized dairy products and fruit juices, raw sprouts, pates (meat ground), and meat spreads.
Why is nutriritional status of the mother important at conception?
fetal growth and development often occur before pregnancy is suspected.
How many extrakcals do pregnant women need?
100 extra in trimester
300 extra in 2-3 trimester
Which mineral is important in 3rd trimester for fetal growth and why?
Calcium because in 3rd trimester fetal bones are mineralized.
What is the importance of folic acid in pregnancy?
What happens if inadequate?
Important for DNA synthesis and the growth of Red blood cells.
Inadequate intake may lead to fetal neural tube defects, anencephaly (birth defect - parts of brain missing), or maternal pre-eclampsia (high BP in mother)
What can higher than recommended doses of folic acid do in pregnancy?
fetus at risk of asthma
What supplement tratogenic (harmful to embryo) in excess?
Vitamina A if consumed in excess
How many + kcals do lactating women need?
500+ than usual
What items should be avoided by mother who is lactating?
Caffeine, alcohol, drugs bc it is excreted in breast milk.
What are some factors affecting nutritional status in older persons?
- GI related changes (teeth, reduced saliva, thirst sensations dimnish, etc)
- presence of other diseases (DM, dementia, depression, etc) increase risk of poor nutrition
- Malnutrition (low income, ow education level, physically cannot, loss, dependancy, loneliness, and lack of transportation)
- Medications (may cause anorexia (loss of appetitie), xerostomia (severe drynes of the mouth), early satiety, imparired smell/taste due to meds)
- vits and mineral deficiency due to aging and GI complications that present. (Low Calcium/Vit D = increase risk of osteoprosis; B12 deficient due to GI pathology)
- drug-nutrient interactions
Meats are avoided due to cost and difficulty chewing by older adults, so what alternatives should be recommended as protein sources?
Cheese, eggs, peanut butter. cream soups and vegetable soups (avoid prepackaged due to high content of sodium).
Milk to protect against osteoprosis
Use vitamins and mineral supplements
How does a vegeterian diet affect one’s body?
- lower BP
- improved cholesterol
- healthier weight,
- less incidents of DM
Adolescent girls and reproductive women who are vegetarian are at a lower risk for which mineral?
Iron
How can the rate of absorption be increased for Iron?
Taking it with Vit C
Why does dehydration common in older adults?
Their thirst sensations may diminish, leading to inadequate fluid intake or dehydration
What are some food patterns that are involved in people’s lives that are to be considered?
religion, cultural background, ethics, health beliefs, personal preference, or concern for the efficient use of land to produce food
How is meaning implemented in food?
candy as a reward therefore seen “good” creates a meaning of good vs. bad in a child’s head
How does lactose intolerance impact the body?
Affects nutrient absorption and calcium deficiency occurs.
What does “hot” vs. “cold” food mean and why is it important in diet?
Give examples:
Some cultures view hot food as warmth, strength, and reassurance. While cold food is seen as menace and weakness.
Mensturation, cancer, pneumonia, earache, colds, paralysis, headache and rheumatism are “cold” illnesses requiring hot foods (eg. rice, beef, lamb, peppers, choclate, cheese, peanuts, oil, onions, eggs, goat’s milk, radishes etc)
Pregnancy, fever, infections, diarrhea, rashes, ulcers, liver/kidney problems, sore throat are considered “hot” conditions requiring cold foods (eg. beans, fruits, dairy, vegetables, raisins, chickecn, fish, goat meat)
What foods do ovolacto or lacto vegetarians avoid?
Meats, poultry, fish, eggs (only lacto, ovo’s consume eggs)
What foods do vegan’s avoid?
meat, fish, poultry, eggs, dairy, and honey
What foods do fruitarians’ avoid?
everything but fruits
What are zen-macrobiotics?
avoid animal products. Eat locally grown foods that are in season and consume in moderation.
What suuplement/dietary modifications should pregnant women make?
Include an extra two to three food guide servings from any of the four food groups daily.
Consume at least 150 g of cooked fish each week to ensure adequate intake of mega-3 fatty acids and other important nutrients. Take multivitamins containing 0.4 mg of folic acid and 16-20mg of iron every day.
There is an increased need for which vitamins in lactation
Vitamin A and C
What role does food play in human biology?
- energy for daily activities
- repair tissue
- regulate organs
- prevents contraction of certain diseases
- aid in disease recovery
- also symbolic role in many cultures/communities
What populations are vulnerable to malnutrition
- Aging *****
- social isolation
- preschools/daycare (developing - see what adults do
- poverty ( poor diet is result of poverty not lack of education - filling hungry tummies vs nutritious food)
- Overweight and obesity (risk of other diseases)
Why are the 3 categories of nutrients (ceros, protein, fats) especially important during illness?
What is there is a lack of nutrition?
Promotes wound healing and prevents infection
Delayed recovery, increased length of hospitalization and risk of mortality.
What other speciality of professionals should nurses work closely with to provide care for its facing malnutrition?
Dieticians
When assessing nutrition, what must the nurse integrate into his/her practice?
- knowledge from nursing and other disciplines
- previous experiences
- information gathered from patients and families about food preferences
- clinical observations
- dietary history.
Why is a nurse in an excellent role to assist patients with nutrition?
Close contact with patients and their families enables nurses to make observations about physical status, food intake, weight changes, and responses to therapy.
What is the purpose of nutritional screening?
Nutritional screening helps identify patients at risk of malnourishment. Because improper nutrition can affect all body systems, nutritional assessment includes total physical assessment.
How is nutritional assessment different than nutritional screening?
Assessment includes: anthropometry, lab tests. dietary and health history, clinical observation, physical examination, and assesment of an existing condition that interfere’s with the patient’s ability to ingest, digest, or absorb adequate nutrition.
Why are recent weight changes important to document?
Fluid retention - Could indicate renal failure or heart failure
What is BMI and how is it calculated?
Body Mass Index is a simple calculation using a person’s height and weight. The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in metres squared.
What are the healthy ranges of BMI?
A BMI of 25.0 or more is overweight (above 30 = obese), while the healthy range is 18.5 to 24.9. BMI applies to most adults 18-65 years.
– important to note that BMi can’t distinguish between fat and muscle –
Who doesn’t fit the BMI tables?
Seniors, teens, pregnant, body builders, elite athletes
How are lab tests used to diagnose Malnutrition?
common labs tests measures plasma proteins, such as:
- albumin (indicator for chronic illness)
- prealbumin (indicator for acute conditions)
- transferrin, tetinol-binding protein
- total-iron binding capacity
- heoglobin
Nitrogen Balance is important to establish serum proetin staus, as nitrogen is an essential part of protein building bocks - amino acids
During nursing nutrition assesment - dietary history and health history - what should be included?
Health staus, age, culture, religious food patterns, socioeconomic status, personal food preferences, psychological factors, use of alcohol/drugs, use of supplements, prescriptions or over-counter drugs, pt’s general nutritional knowledge.
What are some barriers that hinders nutrition in healthcare settings?
- Illness (poor appetite, sickess, pain, depression, anxiety)
- organizational (missed meals, noise, smell, disliked the food)
- eating difficulties (opening packages/unwrapping food, reaching their meal tary, uncomfortable position)
What are some strategies to support adequate food intake?
- position pt properly
- assist in opening packages
- avoid scheduling tests during meal time
- snacks/supplements to support intake
- clarify why not eating/find solutions
- look for pain, depression, anxiety, or need for meds/social support
What changes occur in older adults that need to be considered when assesing nutrition?
aging = decline in vision/hearing/taste/smell, tooth loss/bone thining, decreased thirst, sarcopenia (muscle wasting), chronic diseases: DM, heart disease, cancer, osteoprosis, dementia, depression
What should be included in clinical observation/examination of pts with stroke?
aspiration (choking) and dysphagia (difficulty when swallowing)
When performing a dietary history, questions should be asked based on what factors?
Food practices, allergies, symptoms, twenty-four hour recall, chewing/swallowing, hunger, elimination patters, chemical substances, knowledge
Signs of good/poor nutrition can be examined in which parts of the body?
General appearance, weight, posture, muscles, nervous system control (attention vs. irritability), GI function, Cardio function (high HR and BP in poor nutrition), general vitality (endurance vs. fatigues), hair, skin, face/neck, lips, mouth (swelling in poor nutrition), gums (spongy bleeding gums, receding gums in poor nutrition), tongue, teeth, eyes, neck(glands enlarged in poor n.), nails (spoon shaped, brittle in poor n.), legs/feet (edema, tingling, weakness in poor n.), skeleton (bowlegs, knock knees, chest deformity at diaphragm, prominent scapulae and ribs in poor n.)
