NUTRITION is the combination of processes by which the body utilizes food for growth, energy,

and maintenance

--it is concerned with the study of food and its relation to health and disease

MALNUTRITION results when the organism fails to receive or cannot utilize the essential
nutrients

DIETETICS is the application of the science of nutrition and food management to the feeding
of individuals or groups

*The DIETITIAN is particularly aware of the variation in nutrient needs determined by the sex,
age, activity, and physical condition of the individual or group. Psychology as well socioeconomic
factors play an important role in the functions of the dietitian.

BASIC CONCEPTS OF NUTRITION

1. Nutrition is the food you eat and how the body uses it. We eat food to live, to grow, to
keep us healthy and well, and to get energy for work and play.
2. Food is made up of different nutrients needed for growth and health.
a. All nutrients needed by the body are available through food.
b. Many kinds and combinations of food can lead to a well-balanced diet.
c. No food by itself has all the nutrients needed for full growth and health.
d. Each nutrient has specific uses in the body.
e. Most nutrients do their best work in the body when teamed with other nutrients.
3. All persons throughout life have need for the nutrients but in varying amounts
a. The amounts of nutrients needed are influenced by age, sex, size, activity, and the
state of health.
b. Suggestions for the kinds and amounts of food needed are made by trained scientist.
4. The way food is handled influences the amount of nutrients in food, its safety, appearance,
and taste.
a. Handling means everything that happens to food while it is being grown, processed,
stored, and prepared for eating.

NURSES ROLE IN DIET THERAPY

A. Assess nutritional status

B. Observe nutritional intake
C. Evaluate response to diet therapy
D. Support dietary teaching and regimen ordered

** The nurse plays an important part in the nutritional aspects of patient care

** Because of being close and continual contact with the patient, the nurse is able to evaluate
the patients nutritional status and provide input to the dietitian about the patients nutritional
needs and acceptance of the nutritional plan of care.

** Good nutrition is essential to good health throughout the life cycle and the nurse is an
excellent position to encourage sound nutritional practice whenever possible in each patient
encountered.

CLINICAL SIGNS OF NUTRITIONAL STATUS

FEATURES GOOD POOR

1. GENERAL APPEARANCE Alert, responsive Listless, apathetic, cachexia
2. HAIR Shiny, lustrous, healthy scalp Dull, brittle, dry, depigmented
3. NECK GLANDS No enlargement Thyroid enlarged
4. SKIN, FACE, AND NECK Smooth, slightly moist, good Greasy, discolored, scaly
color, reddish pink mucus
membranes
5. EYES Bright, clear, no fatigue circles Dryness, increased vascularity,
glassiness, thickened
conjunctiva
6. LIPS Good color, moist Dry, scaly, swollen, angular
lesions (stomatitis)
7. GUMS Good pink color, no swelling or Marginal redness or swelling,
bleeding, firm receding, spongy
8. TONGUE Good pink color, surface Papillary atrophy, smooth
 papillae present, no lesions
9. TEETH Straight, no crowding, well-
shaped jaw, clean, no
discoloration
10.SKIN, GENERAL Smooth, slightly moist, good
color
11.ABDOMEN Flat
12.LEGS, FEET No tenderness, weakness,
swelling; good color
13.SKELETON No malformations
14.WEIGHT Normal for height, age, body
build
15.POSTURE Erect, arms and leg straight,
abdomen in, chest out
16.MUSCLES Well-developed, firm
17.NERVOUS CONTROL Good attention span for age,
does not cry easily, not
irritable or restless
appearance, swollen, red,
beefy (glossitis)
Unfilled cavities, absent teeth,
worn surfaces, mottled,
malpositioned
Rough, dry, scaly, pale,
pigmented, irritated,
petechiae, bruises
Swollen
Edema, tender calf, tingling,
weakness
Bowlegs, knock-knees, chest
deformity at diaphragm,
beaded ribs, prominent
scapulae
Overweight or underweight
Sagging shoulders, sunken
chest, humped back
Flaccid, poor tone,
undeveloped, tender
Inattentive, irritable

PRIMARY CAUSES OF NUTRITIONAL DEFICIENCY

1. Dietary lack of specific essential nutrients

a. Lack of proper food
b. Anorexia (due to a variety of causes)
c. Alcoholism
d. Poor food habits or eating nutritionally deficient foods
e. Inadequate or faulty therapeutic diets
2. Inability of the body to use a specific nutrient properly due to:
a. Disease of the digestive tract such as ulcerative colitis
b. Faulty absorption in intestinal tract (such as the way in which the excessive use of
mineral or impedes the absorption of fat-soluble vitamins)
c. Metabolic disorders such as diabetes

CLASSIFICATION OF NUTRIENTS

1. Nutrients are chemical substances present in food needed by the body to function
2. Six prime nutrients
a. Carbohydrates
b. Fats
c. Proteins
d. Vitamins
e. Minerals
f. Water

ASSIMILATION OF NUTRIENTS

A. DIGESTION
The process of changing foods so they can be absorbed and used by cells; mechanical and
chemical digestion occur simultaneously
1. Mechanical Digestion (chewing, swallowing, peristalsis)
- Breaks food into small pieces, mixes it with digestive juices, and moves it along the
digestive tract
2. Chemical Digestion occurs through the action of enzymes which break large food
molecules into smaller molecules
a. Carbohydrate digestion begins in the mouth and occurs primarily in the small
intestine, carbohydrates are reduced to simple sugars (monosaccharides such as
glucose, for absorption)
b. Protein digestion begins in the stomach and is completed in the small intestine.
Proteins are broken down into amino acids for absorption.
 c. Fat digestion begins in the stomach and occurs primarily in the small intestine. Fats
are reduced to fatty acids and glycerol for absorption.
B. ABSORPTION
The process by which breakdown products of digestion (fatty acids, glycerol, amino acids,
and glucose) are absorbed from the small intestine into circulation (blood and lymph) to be
distributed to the cells.
C. METABOLISM
1. Use of food by the body cells for producing energy and for building
2. Consists of two processes:
a. Catabolism the breakdown of food molecules into carbon dioxide and water, which
releases energy; carbohydrates are primarily catabolized for energy
b. Anabolism the process by which food molecules are built up into more complex
chemical compounds; proteins are primarily anabolized (used for building)

ENERGY

A. Energy is required for the metabolic processes of catabolism and anabolism; energy needs
of the body are based on three factors:
1. Physical Activity the type of activity and how long it is performed
2. Basal Metabolism the energy required for the body to sustain life while in a resting
state (1 calorie per kilogram of body weight per hour)
3. Thermic Effects of Food energy required for the digestion and metabolism of foods
B. MEASUREMENT OF ENERGY
1. The Calorie (kilocalorie) is the unit used to measure the energy value of food
2. Fuel values of basic nutrients
a. Carbohydrates 4 calories per gram
b. Fats 9 calories per gram
c. Protein 4 calories per gram
3. Total number of calories needed per day
a. Moderately Active Man 20.5 calorie per pound (0.45 kg)
b. Moderately Active Woman 18 calorie per pound (0.45kg)

NUTRIENTS

CARBOHYDRATES
A. Classification
1. Monosaccharides simple sugars which require no digestion and are easily
absorbed into the bloodstream
Ex. Glucose (dextrose), fructose, galactose
2. Disaccharides double sugars which must be broken down prior to absorption
Ex. Sucrose (table sugar), lactose, maltose
3. Polysaccharides complex carbohydrates composed of many sugar units
Ex. Starch, glycogen, fiber
B. Functions
1. Provide energy (the only source of energy for the brain)
2. Protein-sparing effect allows protein to be used for tissue building rather than
energy
3. Essential for completing metabolism of fats (incomplete leads to build up ketones
and acidosis)
C. Sources
1. Bread, cereals
2. Fruits such as bananas, pears, and apples
3. Vegetables such as peas, corn, and potato
4. Sugar such as honey, molasses, and candy
D. Excess carbohydrates in diet leads to:
1. Obesity
2. Tooth decay and gum disease
3. Malnutrition
PROTEIN organic compounds that may be composed of hundreds of amino acids
(4kcal/g); it contains nitrogen in addition to C-H-O
A. Classification
1. Complete Protein contains all the essential amino acids usually from animal food
sources
2. Incomplete Protein lacks one or more essential amino acids usually from plant
food sources
3. Complementary Protein foods that when eaten together, supply the amino acid
that is missing or in short supply in the other food
Ex. Peanut butter with bread, beans with rice, baked beans with brown bread
B. Functions
1. Necessary for growth and continuous replacement of cells throughout life
2. Play a role in the immune processes
3. Participate in regulating body processes such as fluid balance, muscle contraction,
mineral balance, iron transport, buffer actions
4. Provide energy if necessary
C. Deficiencies
1. Kwashiorkor
2. Hypoproteinemia
3. Marasmus (protein-kilocalorie malnutrition)

FATS (LIPIDS)

A. Types
1. Saturated Fats is completely filled with all the hydrogen it can hold; usually form
animal sources; usually solid at room temp
Ex. Fats in meat, dairy products, eggs, coconut oil, chocolate
2. Unsaturated Fats chemical structure has one or more places where hydrogen can
be added; they are less dense; usually liquid at room temp; chiefly from plant
sources (soybean, corn oil)
a. Monounsaturated Fats
b. Polyunsaturated Fats
c. Hydrogenation process of adding hydrogen to a liquid or poly unsaturated fat
and changing it to a solid or semisolid state
B. Functions
1. Most concentrated source of energy 9 kcal/g
2. Insulation and padding of body organs
3. Component of the cell membrane
4. Carrier of fat-soluble vitamins A,D,E,K
5. Help maintain body temp
C. Effects of excess fat intake
1. Obesity
2. Predispose to serious conditions such as heart disease and diabetes
3. Increase surgical risk

VITAMINS organic compounds needed in small amounts for growth and maintenance of
life

** Avitaminosis serious lack of particular vitamin

** Hypervitaminosis excess of one or more vitamins

** Synthetic man-made vitamins

** Enriched or Fortified the addition of synthetic vitamins to foods during processing

** Restored foods in which nutrients lost in processing are replaced

A. Classification
1. Fat-soluble Vitamins (A, D, E, K)
a. Sufficient fats needed in diet to carry fat-soluble vitamins
b. Stored in body so deficiencies are so to appear
c. Absorbed in the manner as fats so anything that interferes with absorption of
fats interferes with absorption of fat-soluble vitamins
d. Fairly stable in cooking and storage
2. Water-soluble Vitamins (Vit. C and B Complex)
a. Not stored in the body
b. Easily destroyed by air and cooking

B Complex
B Thiamine
B Riboflavin
B Pyridoxine
B Hydroxycobalamin
C Ascorbic Acid
** Cannot be stored in the body so must be ingested daily
 MINERALS inorganic elements essential for growth and normal functioning

A. Functions
1. Constituents of bone and teeth (Calcium and Phosphorus)
2. Transmission of nerve impulses and muscle function
3. Control water balance (Sodium and Potassium)
4. Maintain acid-base balance
5. Synthesis of essential body compounds (ex. Iodine or Thyroxine)
6. Catalyst for tissue reaction

WATER principal body constituent; most indispensable of all nutrients

1. Intracellular within cells

2. Extracellular outside the cells; in blood lymph, secretions, and fluid surrounding
the cells (interstitial fluid)
A. Functions
1. Essential components of all tissues and fluids
2. Transportation of nutrients from the digestive tract to the bloodstream and from cell
to cell; also removal of waste products from cells to outside the body
3. Lubrication of joints of the body

VITAMINS

VITAMIN SOURCES FUNCTIONS DEFICIENCY

SYMPTOMS
FAT-SOLUBLE
VITAMINS
-fish liver oil -regenerates visual -night blindness
1. Vitamin A -green leafy purple (necessary for -retardation of skeletal
(Retinol) vegetables good vision) growth
Precursor: -yellow vegetables -formation of bones -dry, scaly skin
Carotene (corn, carrots, sweet and teeth -dry mucus membrane
- potato) -maintains skin and -Xeropthalmia (corneal
antixeropthalmi -yellow fruits (apricots, mucus membranes cells become opaque,
c vitamin peaches) slough off, could lead
-egg yolk to blindness)
-whole milk
2. Vitamin D -sunshine -regulates calcium and -lowered levels of
(Calciferol) -fish liver oils phosphorus absorption calcium and
Activated -fortified milk and metabolism phosphorus in blood
Ergosterol -essential for normal -soft bones
formation of bones -rickets
Vitamin D
and teeth -malformed teeth
Activated
Dehydrocholest
erol

Vitamin D
Antitrachitic
Vitamin
3. Vitamin E -wheat germ -inconclusive at -increase hemolysis
(Alpha- -vegetable oils present (breakdown of RBCs)
Tocopherol) -dark green, leafy -preserves integrity of -anemia
vegetables RBCs -breakdown of Vitamin
-antioxidant (protects A and essential fatty
materials that oxidize acids
easily)
4. Vitamin K -synthesis by -formation of -prolonged clotting
(Antihemorrhag intestinal bacteria prothrombin time (bleeding
e Vitamin, -green, leafy (necessary for blood tendencies)
Coagulation vegetables clotting) -hemorrhagic disease
Vitamin) -pork liver
WATER-SOLUBLE
VITAMINS
 -citrus fruits -formation and -scurvy
1. Vitamin C -tomatoes, broccoli, maintenance of -sore gums
(Ascorbic Acid) strawberry, capillary walls and -tendency to bruise
Antiscorbutic cantaloupe, potato collagen formation easily
Acid -aids in absorption of -poor wound healing
iron -anemia
2. Vitamin B -wheat germ -maintains CHO -beri-beri
(Thiamine) -whole or enriched metabolism -anorexia, fatigue,
Hydrochloride grains -maintains muscle and nerve disorders,
Antineuritic Vit, -legumes nerve functions irritability
Antiberi-beri -pork and organ meats -maintains appetite
3. Vitamin B -milk -maintains healthy -sensitivity to light,
(Rivoflavin) -organ meats eyes dim vision
-green, leafy -maintains color and -inflammation of lips
vegetables structure of lips and tongue
-enriched bread and -metabolism of -loss of appetite and
cereals nutrients weight
4. Vitamin B -red meats (especially -synthesis and -nausea and vomiting
(Pyridoxine) organ meats) metabolism of -anorexia, fatigue,
-whole grain cereals proteins nervous disorders,
-pork, lamb, veal -hemoglobin synthesis irritability
-maintenance of
muscles

5. Vitamin B -found only in animal -protein metabolism -pernicious anemia

(Cobalamin) products -production of RBC (resulting from lack of
Hydroxycobala -organ and muscle -normal function of intrinsic factor needed
min meats nervous system for B absorption
Cyanocobalami
-dairy products
n
6. Niacin -meats (organ meats) -essential for normal -pellagra
Niaculamide -poultry and fish functioning of -nervous disorders
Nicotinic Acid -peanut butter digestive and nervous -diarrhea and nausea
Antipellagra Vit.
system -dermatitis
-essential for growth
and metabolism
7. Folic Acid -organ meats, poultry, -essential in formation -anemia (macrocytic)
(Folacin) fish, eggs of all body cells -glossitis
especially RBCs -stomatitis
-protein metabolism
MINERAL

1. Calcium -milk and milk -bone and teeth -poor bone and teeth
Absorption products formation formation
aided by Vit. D -cheese -blood clotting -rickets
-some green, leafy -muscle (including -stunted growth
vegetables heart muscle) -osteoporosis
-nerve transmission -poor blood clotting
-cell wall permeasium -tetany
2. Phosphorus -milk, cheese, meat, -function as calcium -weakness
Absorption egg yolk, whole grain phosphate in the -anorexia
aided by Vit D calcification of bones
and teeth
-energy metabolism
-regulation and acid-
base balance
-cell structure and
enzyme activity
3. Sodium (Na) -salt -regulation of acid- -nausea and vomiting
-baking powder and base balance -apathy
 soda -fluid balance -exhaustion
-dairy products -nerve transmission -abdominal and
-meat, fish, and and muscle muscle cramping
poultry contraction
-glucose absorption
4. Potassium (K) -meat, fish, poultry -regulates nerve -abnormal heart beat
-whole grain breads conduction and -muscle weakness
and cereals muscle contraction -nausea and vomiting
-fruite (orange, -necessary for regular
banana) heart rhythm
-fluid and acid-base
balance
-cell metabolism
5. Chlorine -table salt -formation of HCl acid -deficiency results
maintaining gastric from fluid loss thru
acidity vomiting, diarrhea,
-maintenance of acid- sweating
base balance, osmotic
pressure, and water
balance