General Nutrition

Kathaleen Briggs Early, PhD, RD, CDE

Assistant Professor and Registered
Dietitian
kearly@pnwu.org
Learning Objectives
o Upon completion of this module, the student will
be able to:
1. Define macronutrients and identify what the
food sources are for the macronutrients
2. Define micronutrients and identify what the
food sources are for the major micronutrients
3. Identify the components of a healthy diet
4. Identify patients at nutrition risk
5. Identify the causes of malnutrition and those
who are malnourished
6. Explain the benefits of breastfeeding during
infancy

2
Definitions
o A nutrient is any substance in food that
the body can use to
obtain energy,
synthesize tissues, or
regulate body processes
o Macronutrients
Carbohydrates
Proteins
Lipids
o Micronutrients
Vitamins
Minerals
o Water
3
Macronutrients: CARBOHYDRATES
o Primary source of calories (energy) and glucose (4 kcal/gm)
Glucose is the bodys preferred fuel source
Most people get about half of all their calories from
carbohydrates
o Food sources
Breads, grains, cereals, rice and pastas are the biggest sources
Dairy/non-dairy alternatives (milk, yogurt, soy and rice milk)
Fruits in any form (fresh, frozen, juice, canned, dehydrated)
Vegetables also have some carbohydrates
Common vegetable-based carbs in Western diet are Peas, Corn and
Potatoes
Sweets
Cakes, cookies, ice cream, pastries, etc.
o No carbohydrates in meats or cheeses
o Carbohydrate-rich foods are also an important source of fiber and
antioxidants

4
Macronutrients: FATS
o Essential for health
Cellular membrane structure and function
Myelin sheath in nervous system
Fat tissue keeps us warm, provides some
protection to our organs
o Concentrated source of calories (9 kcal/gm)
Saturated dietary fats
Animal-based
butter, lard, whole and 2% milk, meat, skin
Plant-based
coconut and coconut oil, palm kernel oil, palm oil,
cocoa butter

5
Macronutrients: FATS
Unsaturated dietary fat
Monounsaturated fatty acids (MUFA)
Olive and canola oils
Polyunsaturated fatty acids (PUFA)
Corn, safflower, sunflower, fish oils
Trans fats
Very small amount of trans fats are naturally occurring
in dairy foods, meat, and darker-meat poultry
Cholesterol from the diet
Only found in animal-based foods
Whole fat dairy products, egg yolks, meat, poultry
skin and dark poultry meat
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Macronutrients: PROTEINS
o Primary role is to maintain structural and
functional integrity
Muscle tissue, skin, bone, organs, enzymes,
hormones, neurotransmitters, fluid and acid-
base balance, cellular transport, and blood
clotting
o Proteins are made up of amino acids
o Some amino acids are essential, others are non-
essential, and still others are conditionally
essentially
7
Macronutrients: PROTEINS in
Vegetarian Diets
o Vegetarian diets can be a very healthy option
o Complete vs. Incomplete
Complete proteins contain all 9 essential amino
acids (e.g., milk, egg, chicken, meat, fish)
Soy is the only plant-based complete protein
Incomplete proteins are lacking in 1 or more
essential amino acids
It is not necessary to combine incomplete
proteins at a meal
More important to eat a variety of foods consumed
throughout the day to provide the most diverse amino
acid and protein sources
8
Micronutrients: Vitamins
Water-soluble
o Not stored in the body
o Deficiencies may develop
quickly if inadequate
intake occurs
B vitamins
Folic acid (folate)
B12 (cobalamin)
Thiamin (B1)
Riboflavin (B2)
Niacin (B3)
Vitamin C
Fat-soluble
o Stored in liver and fat
tissue for long periods of
time
o Deficiencies develop very
slowly
Vitamin A
Vitamin D
Vitamin E
Vitamin K
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Micronutrients: Major Minerals and
their Common Food Sources
o Calcium
dairy products, dark leafy green vegetables, tofu
o Phosphorus
Animal proteins, dairy foods, legumes; wide-spread in
food supply
o Magnesium
Whole grains, hard water
o Sodium
Processed foods, preserved foods, added salt in
cooking and at the table
o Potassium
Fruits and vegetables

10
Micronutrients: Trace Minerals and
their Common Food Sources
o Copper
Liver, shellfish, lentils, mushrooms, cashews, sunflower
seeds
o Iodine
Iodized salt, seafood
o Iron
Most well absorbed: Beef, dark poultry meat, whole eggs,
tuna, salmon, legumes, iron fortified cereals, liver
Less well absorbed: prunes, raisins, apricots, dark leafy
green vegetables, brown rice
o Selenium
Brazil nuts, tuna, beef, brown rice
o Zinc
Oysters, meat, poultry, legumes, shellfish, whole grains

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Micronutrient (vitamin) Deficiency
o Pellagra (Niacin deficiency)
The 4 Ds: diarrhea, dermatitis, dementia and
death
o Pernicious Anemia (B12 deficiency)
Caused from autoimmune destruction for stomach
cells needed for intrinsic factor production
o Vitamin A deficiency
Leading cause of preventable blindness in
children
Increases the risk of disease and death from
severe infections

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Micronutrient (vitamin) Deficiency
o Scurvy (vitamin C deficiency)
Collagen breakdown resulting in bleeding gums
and petechiae
o Rickets and Osteomalacia (vitamin D
deficiency)

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Micronutrient (mineral) Deficiency
o Iodine
Regions at greatest risk include countries of the
former Soviet Union, south Asia and parts of
Africa
Thyroid enlargement (goiter) is an early and
visible sign of iodine deficiency
o Iron
Iron deficiency anemia
Fatigue, rapid heart rate, and rapid breathing on
exertion are the most common signs
o Selenium
Kashin disease
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Dietary History
o Questions the nurse can ask the patient directly
Do you eat a wide variety of foods?
Do you have difficulty obtaining adequate food?
Do you have any food allergies/intolerances?
Do you have family? Do you eat alone or with
others?
o Questions the nurse should consider in their
assessment
Is the patient obviously under or overweight?
Does the patient have any obvious warning signs
of nutrient deficiencies (see slides 18-27)?

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Optimizing Nutrition
o WHOs five keys to safer food
Keep clean
Separate raw and cooked
Cook thoroughly
Keep food at safe temperatures
Use safe water and raw materials
16
Assessing Physical Activity
o With the world-wide obesity epidemic,
addressing physical activity is essential
o Use the FITT principle
F: How many times per week does the
activity occur?
I: How vigorous is the activity?
T: What is the activity? What is its purpose?
T: How many minutes of the activity are
done per session?
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Anthropometrics
o Height
A key indicator of chronic malnutrition is stunted growth
o Weight
Recent weight loss is a very sensitive marker of a patients
nutritional status
Weight loss of more than 5% of usual body weight in 1
month or 10% in 6 months before hospitalization is clinically
significant
o Weight for height
BMI
o Body fat assessment
o Activities of Daily Living
o Strength
e.g., grip strength
18
Physical Assessment of Nutrition Status
o Orbital fat pads
should be present
o Triceps skinfold thickness
1 cm or less = malnourished
o Anterior lower ribs
Ribs should not be visible if adequately nourished
o Temples
should not be sunken
o Clavicle
should not be overtly prominent
o Shoulders
Should be rounded or sloped, not squared
19
Physical Assessment of Nutrition Status
o Interosseus muscle
Should be bulging when thumb and forefinger
pinch together
o Scapula
When hand presses against a wall, back
should be smooth if adequately nourished
o Thigh and Calf
Should be solid
Loose skin upon muscle massage indicates
severe deficit
20
Physical Assessment of Nutrition Status
o Edema
In ambulatory patients, no impression should
remain following pressure application
o Ascites
Should not be present in healthy individuals
Degree of fluid accumulation in abdominal
cavity can be indicative of nutrition status
21
Malnutrition
o When more than 20% of usual body weight is lost,
most physiologic body functions become
significantly impaired
o Malnutrition can also reduce cardiac output, impair
wound healing, and depress immune function
o Nutritional repletion can often reverse these
processes and significantly improve patient
outcomes
o Difficulty is identifying individuals at risk so that
appropriate interventions can be made

22
Protein Energy Malnutrition (PEM)
o Most common form of malnutrition
o Most often seen in the western hospitalized patient
with
End-stage liver or renal disease
Cancer cachexia
HIV/AIDS wasting disease
Severe eating disorder
Neglect
Long-term recovery from multiple trauma
o Outside industrialized countries, more often seen in
areas of severe drought, infectious disease, and war
23
Kwashiorkor
o Pot Belly appearance due to hepatic edema
and fatty liver
o Increased extracellular fluid (edema) and low
plasma albumin levels
Increase in extracellular fluid may mask
underlying weight loss
o Rapid onset; may develop in a few weeks
24
Marasmus
o Significant deficit of total body fat and body
protein with a slight increase in extracellular
water
o Obvious body wasting
Skin and bones appearance
o Eyes may be sunken
o Skull and cheekbones may be prominent
o Plasma albumin is often in the low-normal
range
o Usually takes months or years to develop
25
Comparison of the features of
kwashiorkor and marasmus
Feature Kwashiorkor Marasmus
Growth failure Present Present
Wasting Present Present, marked
Edema Present (sometimes mild) Absent
Hair changes Common Less common
Mental changes Very common Uncommon
Dermatosis, flaky-paint Common Does not occur
Appetite Poor Good
Anemia Severe (sometimes) Present, less severe
Subcutaneous fat Reduced but present Absent
Face May be edematous Drawn in, monkey-like
Fatty infiltration of liver Present Absent
26
FAO/WHO
Assessing Malnutrition
o Temples (temporalis muscles)
should be visualized
for evidence of
wasting
o Dull hair, easily
plucked = protein
energy deficiency
o Brittle hair, breaks
easily suggests
micronutrient
deficiencies
http://meded.ucsd.edu/clinicalimg/head_temporal_wasting2.htm

http://meded.ucsd.edu/clinicalimg/index.htm
27
Causes of Malnutrition
o Hunger
Due to poverty and food insecurity
o Micronutrient or protein deficiency
More common in elderly
o Disease
Infectious disease (e.g., malaria, TB, see
next slide)
Chronic disease (e.g., HIV AIDS, cancer,
emphysema, etc)



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Defining a Healthy Diet
o Aids in maintaining a healthy body weight
o Promotes general well-being
o Satisfies hunger and appetite
o Culturally and age appropriate
o Suitable to personal preferences
o Prevents chronic disease
o Adequate in overall nutrition and balance
High consumption of fruits & vegetables
Low consumption of red meat & fatty foods
Whole and fresh foods are preferred to processed or
refined foods
Protein primarily from fish, dairy products, and/or legumes
Limited in added salt, sugar, and alcohol

30
World Health Organizations
Five Keys to a Healthy Diet
o Give baby only breast milk for the first six
months of life
o Eat a variety of foods
o Eat plenty of vegetables and fruits
o Eat moderate amounts of fat and oils
o Eat less salt and sugars

31
Benefits of Breastfeeding
For infants
o favorable balance of
nutrients
o improve cognitive
development
o protects against
infections
o protect against chronic
diseases
Impacts gene expression
o protects against food
allergies
For mothers
o contracts the uterus
o delays return of regular
ovulation (especially in
exclusively-breastfeeding
moms)
o conserves iron stores
o protects against breast
cancer (especially pre-
menopausal forms)
o aids in return of pre-
pregnancy weight

32
Recommendations for Breastfeeding
o World Health Organization:
Exclusive breastfeeding for first six months
Introducing age-appropriate and safe
complementary foods at six months
Continuing breastfeeding for up to two years
or beyond
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Contact Information
Kathaleen Briggs Early, PhD, RD, CDE
kearly@pnwu.org