NCM 105

Nutrition and Diet Therapy

Module 1
PREPARED BY :
FERKIYA A. ABDUWA, R.N
COURSE COACH

ACADEMIC YEAR 2020-2021

Nutrition and Diet Therapy

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 Lesson I-The Art of Nutrition in a Family context

1.1 Introduction
1.2 Basic Nutrition and Health Terms to Understand

Learning Objectives:
After studying this unit, you will be able to:
 Know the importance of Nutrition in the human body.
 Define terms used in the study of nutrition.

ACTIVATION OF PRIOR KNOWLEDGE

On your own words, answer the following questions

below; use yellow paper in answering. Don’t forget to write
your name on top.

1. Why is it essential to nursing students to study about

Nutrition and Diet Therapy?
2. Define Nutrition and tell me about its relationship to human
body and to human health?

ACTIVITY #1: READING SESSION

1.1

Introduction 2
 While most of us know that good nutrition is essential in helping us
feel our best and reach our optimal health; finding time to eat a balanced
diet on a daily basis seems a formidable task in this fast-paced, affluent
society. Yet, though your life may be hectic, there are still many good
tasting, healthy choices which can help you lose weight and improve your
health.
This information is designed to be a practical guide in finding those
choices whether you are at home, at work, on the road, or at friend’s
home. The good news is that by taking charge of your diet, you can
improve your health while reducing your risk of “lifestyle” diseases such
as a heart disease or a cancer.
A good place to start is defining what constitutes a “healthy” diet.
The “four food group” plan of yesteryear implied that foods in the meat,
dairy, breads and vegetable fruit group were equal in their contribution to
a healthy diet. Today, researchers show that diets rich in complex
carbohydrates and low in saturated fats may reduce our risk of chronic
disease. Health professionals designed the Food Pyramid” guide to
translate these recommendations into a food plan for daily living.

Complex Carbohydrates
Are present in whole grain breads, cereals, starches and fruits and
vegetables. These foods are not only rich in B vitamins and trace
minerals, but they also contribute dietary fiber which has been shown to
reduce risk for developing certain cancers, lowering cholesterol levels
and helping in weight control.
Six to twelve serving of breads, cereals and starches may sound
like lot of foods, but when you consider one cup of rice is three servings
of cereal, you can see that meeting these guidelines isn’t that difficult.

Fruits and Vegetables

Most people gag at the thought of eating four to seven servings per
day until they discover one medium piece of fruit is two servings. Your
typical salad is at least three servings and let’s not forget that lettuce and
tomato in your deli sandwich, that counts as one also.

Proteins
Proteins are found in dairies and meat group.
Foods in the dairy group not only provide protein, but they also
contribute calcium, Vitamin D and other essential nutrients required for

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synthesizing healthy bones and teeth. They can be a significant source of
saturated fat, so choose two to three servings of the low-fat (1% fat or
less) milks, yogurts and/or cheese.
The meat group includes chicken, fish, nuts, legumes or beans. A
deck of cards roughly approximates a here ounce serving and you need at
least two servings a day. These foods provide zinc, magnesium and iron
which, along with protein, are used by the body in creating hemoglobin
and lean body tissue. These foods can also contribute to elevate intake of
saturated fat, so choose lean cuts of meat like flank or round steak, pork
tenderloin, ham and a leg of lamb. Skip the skin on chicken and turkey
and you will miss much of the fat and cholesterol. Better yet, skip animal
protein altogether and try minestrone or split pea soup, chili or bean
burritos.

Fats and Sugar

Fats, sugar and alcohol have the least amount of surface area on the
pyramid for a reason. They contribute little more than calories to the diet
and your body will create another fat cell to harbor them until they are
burned.
Many health organizations, like the American Heart Association
and the American Cancer Society, agree that limiting your fat intake to
less than 30% of calories goes a long way to protect you from life
threatening diseases. As a gram of fat has a nine calories that isn’t much
fat. As there is some fat in dairy products and meat, chicken and fish; you
are better off to avoid adding fat to your food. Luckily, there are many
good tasting low-fat or non-fat salad and sandwich spreads which make
the task of avoiding added fat a lot easier.
Yes, certain Fats are essential to good nutrition (like linoleic acid), but
these are found in ample amounts in whole grain breads, cereals and
vegetables. Corn, for example, is where Mother Nature originally put
corn oil. Why not skip the margarine and just eat corn?

Summary
In short, good nutrition means eating a wide variety of foods from
each of the five food groups. The food pyramid shows us that by eating
more complex carbohydrates and less total fat and saturated fat, we can
become empowered by the good life and not fall victim to it.

ACTIVITY #2: Watching Video

Watch a video clip on Youtube:

https://www.youtu.be/trdAxMspVg

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 (Importance of Nutrition in Human Body) and
https://www.youtu.be/6vCfzEuEd6c
(Introduction to Nutrition)

1.2

Basic Nutrition and Health Terms to Understand

 Nutrition- is the science of the process by which the body uses food for
energy maintenance, and growth. Good nutritional status implies appropriate
intake of the macronutrients (carbohydrates, proteins and fats) and the
various vitamins and minerals often referred to as the micronutrients because
they are needed on a small quantities. If there is good digestion, absorption,
and cellular metabolism of these nutrients in the diet, a person can generally
achieve a good nutritional status.

• Nutrients
 Is a chemical component needed by the body for one or more of these three
general functions:
1. To provide heat and energy
2. To build and repair body tissues
3. To regulate life process

6 essential nutrients needed by the body

1. Carbohydrates
2. Protein
3. Fats
4. Vitamins and Minerals
5. Water

Nutrient classification
I. According to function
 Body building nutrients – they form tissues or as structural components the
body
a. Water
b. Protein
c. Fat
d. Carbohydrate
e. Minerals

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  Regulatory nutrients
• They maintain normal physiologic processes. Includes all the six group of
nutrients (carbohydrate, fat, vitamin, minerals & water)
 Energy / Fuel nutrients
• Are nutrients that furnish energy which includes carbohydrates, fat and protein
are caloric nutrients.
II. According to chemical nature
1. Organic nutrients – those carbon containing compounds such as protein, fat,
carbohydrate and vitamins.
2. Inorganic nutrients – those that does not contain carbons such as mineral and
water.
III. According to essentiality
 The six major nutrients are groups of individual nutrients each of which has
important physiological role in body. A nutrient that performs one function is
equally as essential as another nutrient with all three functions. All nutrients are
physiologically essential to the body but some are directly essential since these
should be supplied from because the body does not synthesize them.
IV. According to concentration
a) Macronutrients – nutrients in relatively large amounts in the body such as water,
protein, fat and carbohydrate. The unit of measurement is expressed in grams.
b) Micronutrients – nutrients which includes all vitamins and the trace minerals.
The unit of measurement is expressed in milligrams or fractions thereof.

 All persons need the same kind of nutrients, but the amounts vary according to
factors like: age, sex, body size, physical activity, state of health and specific
physiological conditions.

Metabolism refers to the physical and chemical processes that occur

inside the cells and tissues of the body for the fulfillment of vital
functions of a living organism. there is continue balance between the
building up of complex tissues with the consumption of energy known as
anabolism and the breakdown of complex substances with the liberation
of energy known as catabolism.
Enzymes – are organic catalysts that are protein in nature and produced
by the living cells. They increase the rate of every food reaction, almost
all the reaction such as food digestion involve enzymes. Most enzymes
are recognized by the ending ase like amylase, maltase, lipase and
transaminase.
THE MACRONUTRIENTS
A. CARBOHYDRATES
 Were originally called saccharides, a Greek word meaning sugars.

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  Carbohydrates are macronutrients, meaning they are one of the three
main ways the body obtains energy, or calories.
 Carbohydrates are the body's main source of energy.
 They are called carbohydrates because, at the chemical level, they contain
carbon, hydrogen and oxygen.
 The word carbo-hydrate referring to a hydrated carbon.

CLASSIFICATION
• According to the complexity of the molecules and the number of sugar units in
its chemical nature, the main groups are monosaccharides (i.e, one sugar unit),
disaccharides (hydrolyzed into two sugar units), oligosaccharides (three to 10
sugar units) and polysaccharides (10 and more units of sugar).
• According to digestibility, carbohydrates are simply grouped into:
 Digestible (sugars, starches, dextrin and glycogen)
 Partially digestible (galactogens, mannosan, inulin and pentosans)
 Indigestible carbohydrates (cellulose and hemicellulose)
• Only the digestible carhohydrates, namely sugars and starches, supply energy.
Upon hydrolysis, 1 gram yields 4 kcal. indigestible carbohydrates like the
dietary fibers (cellulose, hemicellulose) are not broken down by the human
beings in the intestines into glucose due to lack of enzymes; there for they do
not yield energy.

I. Monosaccharides – has 1 unit of sugar

a. Glucose also known as dextrose or grape sugar is the most important sugar in
human metabolism, hence, the other name for it is the “physiologic sugar”.
o glucose found in free in nature in fruits, honey, corn syrup, sweet corn
and cetain roots. glucose is the principal product of hydrolysis from
starch and cane sugar.
o in the body, it is formed from starch digestion; in metabolism, glucose is
the circulating carbohydrate.
o all other sugars are converted into glucose and it is oxidized in the cells to
release energy.

b. Fructose is the sweetest of all sugar and is found performed in honey, ripe
fruits and some vegetables. it is hydrolyzed from sucrose and inulin. fructose is
also called levulose.
c. Galactose is not found free in nature but its hydrolyzed from lactose or “milk
sugar”.
 glucose can be converted to galactose to form milk sugar or lactose in
breastmilk.

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 d. Pentoses (ribose and revulose) are 5 carbon chain simple sugars or
monosaccharides that are found in nucleic acids of meat and seafoods in bound
form.
 in the body, they are the important components of nucleic acids and some
coenzymes and the backbone of the genetic molecule known as RNA &
DNA.

II. Disaccharides – has 2 units of sugar

a. Sucrose is sometimes called cane sugar or beet sugar since it is commercially
prepared from sugar cane and sugar beets.
o also called the “table sugar” it is hydrolyzed into 1 glucose and 1
fructose. equal amount s of these 2 sugars are a mixture known as “invert
sugar”.
b. Maltose also called “malt sugar” it is derived from the digestion of starch w/
the aid of the enzyme, diastase, found in sprouting grains. A molecule of
maltose gives 2 molecules of glucose. usually maltose is combined with dextrin
(dextrimaltose) for infant milk formulas.
c. Lactose or milk sugar is found in and milk products. it is hydrolyzed to glucose
and galactose and slowly digested compared to the other discaccharides. it is
the least sweet among common sugar only 1/6 as sweet as sucrose or table
sugar.
o some person suffer from lactose deficiency/intolerance; thus instead of
being hydrolyzed in the small intestines into glucose and galactoce,
lactose passes to the colon and is fermented by bacteria. if fermentation is
limited, the action has a laxative effect, but if excessive, diarrhea will
result.

III. Polysaccharides - 10 or more units of sugar

o the chief polysaccharides important in the study of food and nutrition are
starch, dextrin, glycogen, hemicellulose, and cellulose.
a. Starch is the world’s most abundant and cheap form of saccharides. it is the
storage form of carbohydrate in plants; in grains, seeds, tubers, roots and unripe
fruits.
o starch molecules have two components: amylose which is a straight chain
of glucose units and amylopectin, a branch chain.
o the amylose starches are compact, have low solubility, and are less
rapidly digested.
o the amylopectin starches are digested more rapidly, presumably because
of the more effective enzymatic attack of the more open branched
structure.
b. Dextrin is an intermediate of starch digestion or formed from partial hydrolysis
of starch.

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 o the action of dry heat on starch (as in toasting bread or browning of cake
crust in the over) produces dextrin.
c. Glycogen is sometimes called “animal starch” because it is storage form of
carbohydrate in the body, chiefly in the liver and muscles.
o muscle glycogen is used directly to supply energy for surrounding tissues
as during exercise and work.
o liver glycogen may be changed to close and circulated as such by the
blood to other parts of the body.
o glycogen stores are readily converted into lactic acid. normally, only 355
grams (or closed to one-third kilogram) glycogen is present in the body,
hence a constant supply of carbohydrate is needed.
o excess amount of glucose beyond the limits of glycogen storage will be
converted into body fat and stored in adipose tissues.

 Carbohydrates are classified as simple carbohydrates and complex

carbohydrates. The difference between the two forms is the chemical structure
and how quickly the sugar is absorbed and digested. Generally speaking, simple
carbohydrates are digested and absorbed more quickly and easily than complex
carbohydrates.

a. Simple Carbohydrates (monosaccharides and disaccharides)

o also known as sugars. they also exist in either a natural or refined form.
b. Complex Carbohydrates (polysaccharides)
o they are found naturally in foods and also refined in processed foods.

DIETARY FIBER
o Fiber, also called roughage, is the indigestible part of food. it is derived
from plant sources and contains polysaccharides such as cellulose,
hemicellulose, pectin, gums, mucilages, and lignins. the most well-known
dietary fiber is cellulose.
function of fiber
 Dietary fiber provides bulk, act as broom in our digestive tract to prevent
constipation and recently has been shown to prevent diverticular diseases,
reduce incidence of colon cancer, reduce blood cholesterol level and
decrease mucosal absorption. RDA for fiber – 20-35g/day
 Insoluble fiber – indigestible fibers such as cellulose (can be found
in whole-wheat flour, bran, and vegetables), hemicellulose (can be
found in bran and whole grains) and lignin (woody fiber found in
wheat bran and the seeds of fruits and vegetables. they usually do
not dissolve in water.
 soluble fiber – pectins, mucilages, and gums classified as soluble
fiber because they dissolve or well in water.

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  Pectin and agag-agar –are soluble fibers composed wholly of
galactose units. their important in food is as thickening or
binding agents and to form food gels.
Carbohydrate derivatives
 organic acids, such as citric, malic and tartaric, which are naturally
present in fruits, are now classified with the carbohydrates. together with
alcohols.
 Ethyl alcohol is the product from fermentation of sugars. one gram of
ethyl alcohol yields 7 kcal.

Functions of carbohydrates in the body

1. Chief source of energy
 Body cells require a steady and constant supply of energy mainly glucose
and its intermediate products.
2. Cheap and main energy food
 carbohydrates foods are low cost and widely distributed around the world
3. Protein sparer
 The energy need of the body is given first priority over body-building
needs. thus if carbohydrate foods are not adequately supplied, protein will
be catabolized to provide heat and energy instead of being used for
building and repairing tissues.
4. Regulator of fat metabolism
5. Sole energy source for the brain and nerve tissues
 the brain and nerve tissues utilize only glucose for energy.
6. Source form of energy as Glycogen
 about one-third of a kilogram (355g) of glycogen is stored in the liver and
muscle tissues.
7. Regulator of intestinal peristalsis and provider of bulk
 commonly called fiber or roughage in the diet.

Special function for the specific Carbohydrates

1. Galactose and glucose in the cerebroside are constituents of the brain and nerve
tissues.
2. Lactose has a special function in infant feeding
3. Glycosides are important in drug therapy
4. Inulin is important in medicine for the so called “inulin clearance test” a test for
kidney function
5. Ribose and Deoxyribose w/c are pentose important in constituent of nucleic
acid (RNA and DNA)

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  Optimum Nutrition- means that a person is receiving and using the
essential nutrients to maintain health and well-being at the highest possible
level.

 Malnutrition- is a state in which a prolonged lack of one or more nutrients

retards physical development or causes the appearance of specific clinical
conditions (anemia, goiter, rickets, etc.). This may occur because the diet is
poor or because of a digestion and metabolism problem. Excess nutrient
intake creates another form of malnutrition when it leads to conditions such
as obesity, heart disease, hypertension and hypercholesterolemia.
CARBOHYDRATE MALNUTRITION
 In severe deficiencies, as in the case of famine and prolonged starvation, the ill
effects of a limited total food intake result in multiple nutrient deficiencies,
particularly in Protein Energy Malnutrition (PEM).
 In excessive intake of calories, whether from carbohydrates, fats or proteins,
obesity or adiposity becomes the problem. if the intake of fat and protein is
normal, but the carbohydrates intake is lower than the recommended level
supply caloric requirements, ketosis o acidosis occurs.

FOOD SOURCES OF CARBOHYDRATES

The most common food sources of carbohydrates are:
 sugars, cereal grains and their products (rice, corn, oat,
breads and baked goods, noodles or pasta, etc)
 root crops, starchy vegetables and dried legumes.
 fruits and milk also contribute good amounts of
carbohydrates.

RECOMMENDED DAILY INTAKE OF CARBOHYDRATES

The WHO recommends 55-75% of energy intake be supplied by carbohydrates,
of which less than 10% should come from added sugars.

B. PROTEIN
 The word protein originated from a Greek word proteios meaning “to
hold first place” or “is of prime importance”. Mulder, A dutch chemist,
proposed the name in 1840 and until now, the word is used to its unique
function of building & repairing cells.
 Virtually every life process depends on proteins (e.g., enzymes,
hormones, muscle cells, blood cells, antibodies, etc.)
 amino acids are the building blocks of protein molecules.
 Protein have the element of Carbon, Hydrogen, Oxygen and Nitrogen.

CLASSIFICATION of amino acids:

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 Essential Semi-essential Non-essential
Histidine Arginine Glutamine Citruline
Isoleucine Tyrosine Glutamic acid
Taurine
Leucine Cysteine Alanine
Homocysteine
Lysine Glycine Aspartic acid
Cystein
Methionine Serine Phenylalanine
Norleucine
Threonine Proline
Tryptophan Ornithine
Valine Hydroxyglycine
Hydroxyproline

According to essentiality
 An essential amino acid (or indispensable amino acid) is one that cannot
be synthesized by the body from materials readily available, at a speed to
keep up with normal growth rate. Essential amino acids are referred to as
dietary essentials.
 A semi-essential amino acid (semi-indespensable) reduces the need for
particular amino acid or partially spares it. Semi-essential amino acid is
quoted as “an amino acid that can maintain life processes for an adult but
not enough for normal growth in children.
 Non-essential amino acid – is also called (dispensable amino acid)
because it is not a dietary essential. It can be synthesized by the body as
long as the materials for synthesis are adequate
 Protein may be classified into fibrous proteins, w/c consist of long coiled or
folded chain amino acids bound together in parallel line. they are found in the
protective tissues of animal such as skin, hair, tendons, feather, and the fins and
scale of fish.
 keratin – chief protein in hair
 collagen – connective tissue, in tendons and bone matrices
 myosin – of muscle
 elastin – in blood vessel walls.

Amino acids content of protein

 Complete protein – are protein containing all the essential amino acids in
amounts sufficient for growth & maintenance of life. Example. Casein in
milk.

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  Partially complete protein – are protein that maintain life but not support
growth. Ex. Gliadin in wheat.
Iincomplete protein - are proteins that cannot support life and growth. Ex. Zein
in corn

FUNCTIONS OF PROTEIN AND AMINO ACIDS

Protein perform 3 general functions:
1. build and repair cells and tissues (structural role)
 About 1/5 or 20% of an adult body weight is protein of this, 1/3 in the
muscles, 1/5 in the bones and teeth, 1/10 in the skin, and the rest in the
body fluids and other tissues.
 all enzymes are protein and only some hormones are protein
 all body fluids and secretions have protein, except bile.
 antibodies contain protein
 supply energy (a fuel nutrient)

2. supply energy (a fuel nutrient)

 1 gram of CHON supplies 4 kcal.Carbohydrates and fats must be the
primary sources of energy to spare or save CHON for its function of
building & repairing cells & tissues.
3. regulate body process (regulator of physiologic processes)
 CHON regulates osmotic pressure; hence helps maintain water balance &
acid base balance.

PROTEIN MALNUTRITION
 Prolonged malnutrition of protein, as well as calories, results in the deficiency
disease known as Protein Energy Malnutrition (PEM), also sometimes called
Calorie-Protein Malnutrition (CPM). 2 forms are kwashiorkor and
marasmus.
 Excessive protein intake. The body is unable to store excess protein. Protein is
digested into amino acid which enter the bloodstream. Excess amino acid are
converted to the other usable molecules by the liver in a process called
Deamination. Deamination converts nitrogen from the amino acid into ammonia
which is converted by the liver into urea in the urea cycle. Excretion of urea is
perform by the kidneys.

PROTEIN REQUIREMENTS AND ALLOWANCE

The minimum amino acid requirement is 0.35 to 0.525g/kg desirable body
weight.

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The simplest and easiest guide to use 1g/kg DBW for normal adults. In the
Philippines, CHON allowance for adult man and woman is computed at
1.14g/kg body weight.
Another method of expressing protein intake is based on total caloric
requirement. For example 10% of a 2,220 kilocalories.

FOOD SOURCES OF PROTEIN AND AMINO ACID

Generally speaking, animal sources of proteins such as meat, fish, poultry and
dairy products contain complete proteins of high biologic value. Incomplete yet
good sources of protein foods that are lacking one or more of the essential
amino acids include whole grains, legumes nuts and seeds. Combining a variety
of the essential amino acids needed for adequate protein levels. Therefore
vegetarians can receive adequate proteins without eating meats if they make
wise food choices.

Fats
Fats are found in many foods containing proteins and are added through
cooking or flavoring foods. The amount of fats found in grains,
vegetables, and most fruits is generally insignificant. The exceptions are
coconut, avocados, and olives. Fats extracted from vegetable source (such
as corn, safflower, soybeans, and olives) are usually found in liquid form
and generally not harmful to health unless they are hydrogenated. Fats
that are solid (mostly found in animal products such as butter and red
meat) are referred to as saturated fats. Individuals lacking digestive
enzymes to break down fats for absorption through the intestinal tract will
lose significant source of kilocalories through loss in fecal material.
These individuals are generally thin or losing weight and can benefit from
the use of digestive enzymes consumed in pills form. Fat digestion takes
the longest of all macronutrients, requiring up to 4 hours.
Fatty Acids and their common Food Sources

Fatty Acids Common Food

Sources
Saturated
Lauric Coconut, palm kernel
oil
Myristic Coconut
Palmitic Palm oil, beef
Stearic Cocoa butter, beef
Monounsaturated Fatty Acid
Oleic Olive oil, grapeseed
(canola)oil, beef
Polyunsaturated Fatty Acids
Linoleic Corn oil, cottonseed

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 oil, safflower oil,
sunflower oil
Linolenic Green leafy vegetables,
soybean oil, soybean
products (tofu) canola
oil, flaxseed
Eicosapentaenoic Mackerel, sardines lake
trout
Docosahexaenoic Salmon, tuna, bluefish,
halibut

 Kilocalorie- is a unit of measure used to express the fuel value of a

carbohydrates, fats and proteins. The large calorie used in nutrition represent the
amount of heat necessary to raise the temperature of 1kg of water to 1degree
Celsius. One pound of body fat equates to 3500kcal. Carbohydrate, protein and
fats and alcohol are the only sources of kilocalories. 1kcal equals approximately
4 kilojoules (kj) in the metric system.
 Health- is currently recognized as being more than the absence of disease. High
level health and wellness are present when an individual is actively engaged in
moving toward the fulfillment of his or her potential. The art of nutrition,
includes the application of nutrition science to meet individual needs for the
goal of optimal health status.
 Public Health- is the field of medicine that is concerned with safeguarding and
improving the health of the community as a whole. Public health nurses may
work out of public health departments or private health organizations. Other
public health programs have been developed for various population groups such
as women who are pregnant or the elderly.
 Holistic health- is a system of preventive medicine that takes into account the
whole individual. It promotes personal responsibility for well-being and
acknowledges the total influences that affect health including nutrition,
exercise, and emotional well-being.
 Medical Nutrition Therapy- referred as diet therapy, is the treatment of disease
through nutritional therapy by registered dietitians. MNT may be necessary for
one or more of the following reasons:
-to maintain or improve nutritional status
-to improve clinical or subclinical nutritional deficiencies
-to maintain, decrease, or increase body weight
-to rest certain organs of the body
-to eliminate particular food constituents to which the individual may be
allergic or intolerant

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 -to adjust the composition of the normal diet to meet the ability of the
body to absorb, metabolize, and excrete certain nutrients and other
substances.

REFLECTION AND RESPONSE/ ACTION

In not less than 300 words, share with me your diet meal plan
and tell me if your diet is good enough for you. Why or why not?

SUMMATIVE ASSESSMENT #1

Multiple Choice
Encircle the correct answer. No erasures allowed.

1. A chemical substance that is present in the food and is essential to

human body.

a. nutrition b. enzymes c. nutrients d. calories

2. What condition or state if a person has a prolonged lack of one or more
nutrients? This may occur due to poor diet.

a. malnutrition b. optimum health c. sick d.stable

3. What do you call a unit of measure used to express the fuel value of the
nutrients?

a. joules b. kilocalorie c. kilojoule d. kilogram

4. What is the other term for Diet Therapy?

a. nutrition b. feeding therapy c. medical nutrition therapy

d. none of the above

5. It is recognized as the absence of disease. What is it?

a. Heal b. health c. malnutrition d. marasmus

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 FEEDBACK TO IMPROVE LEARNING AND TEACHING

Share your insight about the learning packet. What difficulties

have you encountered? Is the learning packet easy to
comprehend? Please be honest. Provide yellow paper for your
feedback. Thank you ^_^

***Keep all the output in your Portfolio and submit to your Course
Coach on Week 2.***

***End of Week 1***

ACTIVATION OF PRIOR KNOWLEDGE

True or False

Write the word “fact” if the statement is true, and

“fallacy” if the statement is incorrect after the given
statements. Provide another sheet in answering.

1. When at around the table, no talking while eating.

2. It is better to let the little kids to eat first before the
adults.
3. Encourage member of the family to express their
preferred taste of foods.
4. Serve foods that are appealing.
5. Force kids to finish their foods

Lesson II
Nutrition as an aspect of total Health Care

Learning Objectives:
 At the end of this lesson, the students must be able to
understand the importance of Teamwork when
delivering healthcare services and the value of the
role of each member of the healthcare team.

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 Nutrition is considered an integral part of health care, with physical,
social, psychiatric, and economic aspects. Nutritional care may be aimed
at maintaining an already adequate nutritional status, or the goal may be
to promote positive nutritional status. For many persons contending with
an illness, food and the nutrients it provides are the most important
factors used to restore good health.
`

What is the Health Care Team?

The healthcare team is composed of all the healthcare professionals
who work with a given person and/or family toward the common goal of
optimal health. This includes the medical part of the team (physician,
nurse, dietician, physical therapist and pharmacist) and other community
resource personnel who play a role in facilitating good health.

 The
Healthcare Provider
Generally, the person with the most broad-based knowledge related
to healthcare is the medical doctor or the physician. Healthcare providers
include nurse practitioners and in some areas, physician assistant. Usually
an NP or PA works under the supervision
of a physician. A healthcare provider is the professional who can
prescribe the medication. The healthcare provider knows a person’s
medical history and has a general understanding of the relationship
between disease states and other concerns. Increasingly, healthcare
providers are making referrals to other health services provided. This may
occur through written documentation on a hospital chart, through
standardized written correspondence from a community agency or
another telephone contact when there is an urgent concerns. Final
healthcare decision often are the responsibility of the physician, who
should be kept informed of concerns of the healthcare team and their
recommendations for individual patient care.

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 The Nurse- the nurse can provide other members of
the healthcare team with good insight into an individual’s
needs because of an in-depth patient contact. Ongoing
assessment and monitoring of patient eating habits and
health status are important roles of the nurse, whether a
licensed practical nurse (LPN) or a registered
nurse, certified nursing assistant also are central to
this role.

 Physical Therapist- assisting in promoting mobility and physical movement, for

instance, to control pain, is part of the role of the PT. physical therapy may be
required to help a person enhance physical capabilities that have been impaired
by illness or trauma. The PT may suggest exercise that is appropriate for the
individual to promote weight loss or increase muscle strength.

 The Pharmacist- the registered pharmacist is responsible for preparing the

nutritional solutions that the physician prescribed. These solutions, are
administered through veins or via enteral routes. The dietitians often make
recommendations in consultation with the physician regarding the solution used
to provide appropriate amounts of nutrients for specific individual needs.
Because of specialized knowledge about medications and their actions, the
pharmacist is able to serve as a resource person with regard to drug and nutrient
interactions.

 The Registered Dietitian- the registered dietitian is the healthcare professional

best qualifies to interpret the science of how food is used by the body in health
and disease states and to evaluate how MNT can promote a positive nutritional
status. The RD is trained to work with culturally diverse populations in adapting
customary foods to meet ongoing health concerns.an Rd is of special
importance when there are complex factors or medical conditions that interfere
with nutritional status. The Medicare program (a health plan primarily in adults)
is increasingly recognizing prevention as a means to control spiraling health
cost. This focus allowed the addition of RDs as recognized Medicare providers
for diabetes and pre-dialysis renal disease in 2002. The American Dietetic
Association continues to develop research documenting benefits of MNT for
other chronic illnesses. The use of MNT can help minimize the other insurance
programs are based on Medicare policies, it is expected that broader coverage of
MNT will develop.

 The Nutritionist- a nutritionist is an educator, as well as counselor, who usually

works in a public health settings and who typically has at least a bachelor’s

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 degree in nutrition. The legal credential certified or licensed nutritionist is used
in some states to help indicate qualified nutritionists. All RDs are nutritionists.

 The Speech Language Pathologist- the professional to consult when assessing

the seemingly simple act of swallowing is the speech language pathologist.
Swallowing, a series of interrelated steps, can be seriously impaired by stroke or
other neurologic damage. Aspiration of food is of serious consequence and can
lead to partial or full airway obstruction or to pneumonia. A speech pathologist
can help determine the degree of risk for aspiration and make appropriate care
plans that other healthcare professionals can use in developing their plans. For
example, the PT may be enlisted to help suggest correct positioning needs for
good swallowing, the OT may promote the use of eating utensils designed for
special feeding needs, and the dietitian may need to plan certain food
consistencies to facilitate effective swallowing.

 The Occupational Therapist- the OT emphasizes the remaining strengths of the

individual and identifies adaptive devices that would enhance independent
functioning, such as large handled spoons and reaching devices. Through
occupational therapy the goal is for the individual to increase the amount or
types of activities of daily living such as personal hygiene and eating. This is
the particular importance after a person has suffered a stroke or other physical
injury that impairs or prevents independent living.

 The Social Worker- is the healthcare professional who has expertise in the area
of community resources including financial, counseling, technical support, and
educational services. The social worker often can help a person identify and
express barriers whether perceived or actual that may need to be addressed to
meet the goal of achieving health and wellness. Often a person is not ready to
hear healthcare advice because of the need to resolve and come to terms with a
chronic or acute illness.

How can the Healthcare Professional Facilitate Positive Meal

Environment?
The healthcare professional can help promote harmonious
family meal times, which will allow the innate satiety cues to function
more effectively and also promote the association of eating with
positive feelings, by making the following recommendations to family
members.

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  Focus on positive conversations during mealtimes
around the table; avoid points of potential conflict and
friction.
 Use soft music, candles or both to facilitate a quiet
relaxed atmosphere.
 Eat as a family as much as possible, rather than eating
on the run.
 Eat slowly to promote satiety, an aim for two or three
different food groups in a meal.
 Encourage children to eat with the family, do not force them to eat. Encourage
the one taste rule, and emphasize that taste are learned.
 Serve food that looks appealing by using a combination of colors, textures, and
sizes.
 Watch portion sizes; smaller portions are useful for small appetites and for
weight control.
 Promote relaxing activities before and after meals.

Refle
ction Fallacy: Children
and who do not clean their
Resp plates should not have
onse/ dessert.
Fact: this commonly
Actio
practiced principle may work in the short
n term to coerce children to eat their meals, but
the long term implications outweigh
any benefits. This approach implicitly
conveys to children that dessert have more value than other foods,
because dessert is being used as a reward. Parents should be reminded
that desserts can be nutritious, such as fresh fruits, a colorful fruit salad,
or a piece of pumpkin pie or a carrot cake. The “clean the plate”
philosophy can also contribute to over eating and excess weight gain.

Activity: Draw and Tell

Draw your sitting arrangement at around the
dining table and tell me the usual things you
do or you observed while having a meal with
your family. 21
 Children (and many adults) need to learn to stop eating when they are
comfortably full.

Summative Assessment

FEEDBACK TO IMPROVE LEARNING AND TEACHING

Share your insight about the learning packet. What difficulties

have you encountered? Is the learning packet easy to
comprehend? Please be honest. Provide yellow paper for your
feedback. Thank you ^_^
***Keep all the output in your Portfolio and submit to your Course
Coach on Week 3.***

***End of Week 2***

Lesson III
Food Guide
Learning Objective:
 At the end of this lesson the students will be able to explain the significance
of nutritional labeling.
 Recognize and differentiate among the various food guides available.

How Does Nutrition Labeling Aid the Consumer?

Mandatory nutrition labeling went into effect in 1994 with the goal
of helping consumers adhere to the dietary Guidelines for Americans.
The change is aimed at reducing the prevalence and complications of
chronic illnesses, such as heart disease, hypertension, and diabetes.
Nutrition labeling is a valuable tool for learning to apply nutrition
information in a practical way. A health-conscious shopper uses the
percentages shown on the label to determine how well each serving of the
food fulfills recommended nutritional requirements. For example, if one
serving of a food has 25% of a particular nutrient listed, it means that
each serving is good for one fourth of a person’s recommended daily
intake for that nutrient.
Ingredients are still listed in order of content in a product. If sugar
is listed as the first ingredient, the amount of sugar in the product is
greater than the amount of any of the other ingredients. It is easy now to
quantify exactly how much is included in a serving of food. For example,
1tsp of sugar equates to 4g on the food label; therefore a can of soft

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 drinks containing 40g of sugar contains the equivalent of 10tsp of sugar.
Consumers need to learn how to interpret food labels.
To help the consumer calculate the kilocalories in a given food, the
food label on larger food packages also lists the conversion factor to
change g into kcal, that is, Fat 9kcal, Carbohydrate 4kcal, Protein 4kcal.
Therefore, 1tsp of sugar is contain 16kcal (4g carbohydrate multiplied by
4).
A new addition on food labels is the amount of trans fat. Trans fat
are found in hydrogenated fats and shortenings. This type of fat is now
known to contribute to cardiovascular disease.
If the consumers used the food labels when making food purchases, they
will be promoting their health through the inclusion of appropriate
nutrient intake while reducing their risk of chronic illness. Through a
reduction of fat, salt and sugar and an increase in fiber. Food labels used
in conjunction with the MyPyramid can be a highly effective and
ultimately simple means to promote health.
The health claims that can be made on food labels under the
labeling law are as follows:
 Foods high in fiber may reduce the risk of cancers and heart disease.
 A low-fat diet may reduce the risk of cancer and heart disease.
 A low-sodium diet may help prevent hypertension.
 Foods high in calcium may help prevent osteoporosis.
 Folate leads to decreased neural tube defects.
 Sugar alcohols reduce dental carries.
 Soy protein reduce cardiovascular disease.

*Foods exempt from nutrition labeling include those

sold in restaurants, cafeterias and airplanes, unless a
health claim is made .Coffee, tea, spices and foods
produced by small business or package in small
containers are not required to carry a nutrition label.

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 Sample of a nutritional label
How Does the MyPyramid Food Guidance System Relate to the Food
Labels and the Dietary guidelines?

The USDa’s MyPyramid Food Guidance System has replaced the

earlier Food Guide Pyramid and portrays more individualized guidance
aimed at meeting the dietary guidelines for Americans. The new
MyPyramid symbol was designed to promote physical activity and
variety and moderation in the diet.

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 The MyPyramid continues to promote intake of grains, with the
new stated goal of a minimum of three whole grains daily as per 2005
Dietary Guidelines. Vegetables and Fruits recommendation amounts have
increase from five servings to nine servings, or 4 and ½ cups specifically.
Low-fat milk products are recommended, with three servings daily. The
MyPyramid.gov website provides individualized guidance on amounts of
food for consumption based on age, gender and usual activity level. There
are 12 kcalorie levels of food intake patterns that consumers can print for
individual needs. A worksheet is available to help track progress and
chose short term and long term nutritional goals through
www.MyPyramid.gov.

Other countries have similar guides that vary with cultural food
habits and the availability of foods. Canada’s food guide is represented as
a rainbow. Similar guides have been developed around the world,
including the Mediterranean and Asian Pyramids, which emphasize
legumes and oils as basic part of a healthy diet, with the Greek’s Columns
food guide specifically recommending legumes be eaten 6 days a week.

A useful analogy to use with children is to explain that some foods (those
high in fat and sugar shown in the small yellow section of MyPyramid to
indicate a small amount) help us grow outward, whereas plant and protein
foods (in larger portions of MyPyramid) help us grow upward. Using hands
to describe these changes graphically is very effective in aiding children’s
understanding.

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What is the Food Exchange System, and How Does It Compare to
MyPyramid?

The exchange lists for meal planning, developed by the American

Dietetic Association and the American Diabetes Association, is a food
guide aimed at managing diabetes and weight. The exchange list group
foods primarily on the amounts of the macronutrients that they contain.
The MyPyramid places more emphasis on amounts of micronutrients in
the diet.
The exchange lists for meal planning counts legumes in the starch
and bread group based on the comparable carbohydrate content. Because
of the high protein content of legumes, the MyPyramid includes legume
in the meat group.
Carbohydrate content of the fruit group is not considered in the
MyPyramid. The exchange list calculates 15g of carbohydrate for 1
serving of fruit.
The exchange list counts a fat serving as a 5g of fat, which is
equivalent to 1tsp of added fat. Foods that are naturally high in fat, such
as avocados, nuts and bacons are found in the fat group of the exchange

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 list. The MyPyramid does not specifically state portion sizes for fats and
include nuts in the meat group and avocados in the fruit group.
What is the Role of the Nurse or the other Healthcare Professional in
the family meal Environment?

Family eating behaviors fall in a spectrum from ideal to poor. The

ideal diet consists of a balance of a high-quality, nutritionally dense foods
in appropriate quantities and variety to support normal growth and repair
while inhibiting the development of chronic disease. Most families have a
combination of ideal and poor food habits. All healthcare professionals
can reinforce the positive food habits by giving ideas about how to
incorporate well-liked nutritious foods into daily lifestyle.
The nurse or other health professional should be aware of
nutritional inadequacies or excesses as represented in MyPyramid. For
application of MNT, the nurse or other healthcare professional can
emphasize that any alterations in diet should still include the minimum
foods needed for health. Guidelines can be provided, such as a nothing
that fresh and frozen vegetables are low in sodium whereas canned
vegetables are high in sodium. When learning readiness is not at the level
needs for achieving necessary health outcomes, use of active listening
techniques can help identify the barriers to change.
The nurse play a vital role in assessing and identifying individual
and family needs while facilitating solutions using a counseling approach.
Meal planning can be relatively simple when few or no negative forces
are influencing a family. The more likely scenario, however the
combination of internal and external barriers to good nutrition, which can
best be overcome through a total healthcare team approach. Many
community services are available that can complement the skills of the
healthcare team.
The nurse or the other healthcare professional’s own dietary habits,
attitudes, and state of nutrition are reflected in his or her interest and
approach in helping individuals understand the importance of a basic
normal or therapeutic diet. By having a good basic knowledge of nutrition
and how food habits are developed and changed, the nurse or other
healthcare professional can do much to combat the misinformation forced
on the public by slanted advertising, food faddists, quacks, and untrained
self-termed “health specialist”, among others.

REFLECTION AND RESPONSE/ ACTION #3

Discuss reasons why a person may not want to change food

habits and assessment questions that may be used to reveal
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such concerns.
***End of Week 3***

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