introduction for nutrition assignment

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1.1 – Introduction to Nutrition

Nutrition is an evidence-based science that studies how the nutrients and compounds in foods nourish and affect body functions and health .

Nutritional scientists continuously advance our knowledge of nutrition by building on prior research.

Video 1.1.1 : Nutrition Quiz: Listen to what Americans think 100 Calories looks like .

Let’s start out our journey into the world of health and nutrition, by demonstrating that nutritional science is an evolving field of study, continually being updated and supported by research, studies, and trials. Once we establish this, your confidence will be strengthened in nutritional science to help guide your eating habits. Let’s begin with the story of hurry, curry, and worry: the story of Helicobacter (H.) pylori.

Peptic ulcers are painful sores in the gastrointestinal tract and can cause symptoms of abdominal pain, nausea, loss of appetite, and weight loss. The cure for this ailment took some time for scientists to figure out. If your grandparents complained to their doctor of symptoms of peptic ulcer, they were probably told to avoid spicy foods, alcohol, and coffee, and to manage their stress. In 1915, Dr. Bertram W. Sippy devised the “Sippy diet” for treating peptic ulcers. Dr. Sippy advised patients to drink small amounts of cream and milk every hour in order to neutralize stomach acid. And then, increasingly, introduce soft bland foods with frequent mealtimes. For a while this diet sometimes worked, fooling both doctors and patients. However, the disappearance of peptic ulcer symptoms was likely the result of having a full stomach all the time, as the symptoms more often occur when the stomach is empty. Ultimately, the Sippy diet did not cure peptic ulcers and in the latter 1960s, scientists discovered the diet was associated with a significant increase in heart disease due to its high saturated fat content.

In 1994-The National Institutes of Health held a conference on the cause of peptic ulcers. There was scientific consensus that H. pylori cause most peptic ulcers and that patients should be treated with antibiotics.

In 1996-The Food and Drug Administration (FDA) approved the first antibiotic that could be used to treat patients with peptic ulcers. Nevertheless, the link between H. pylori and peptic ulcers was not sufficiently communicated to healthcare providers. In fact, 75 percent of patients with peptic ulcers in the late 1990s were still being prescribed antacid medications and advised to change their diet and reduce their stress.

In 1997-The Centers for Disease Control and Prevention (CDC), alongside other public health organizations, began an intensive educational campaign to convince the public and healthcare providers that peptic ulcers are a curable condition requiring treatment with antibiotics. Today, if you go to your primary physician you will be given the option of taking an antibiotic to eradicate H. pylori from your gut. Scientists have progressed even further and mapped the entire genome of H. pylori, which will hopefully aid in the discovery of even better drugs to treat peptic ulcers.

In 2005, Marshall and Warren were awarded the prestigious Nobel Prize in medicine for their discovery that many stomach ulcers are caused by H. pylori—not by hurry, curry, and worry.

Make a commitment to empower yourself with scientific evidence as a strategy for achieving a healthier diet.

In this chapter, you will see that there are many conditions and deadly diseases that can be prevented by good nutrition. You will also discover the many other determinants of health and disease, how the powerful tool of scientific investigation is used to design dietary guidelines, how to spot nutrition myths, quackery, and fraud, and how to locate nutrition experts and accurate nutrition information.

Nutrition 100 Nutritional Applications for a Healthy Lifestyle Copyright © by Lynn Klees and Alison Borkowska is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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An Introduction to Nutrition

(13 reviews)

Copyright Year: 2012

Publisher: Independent

Language: English

Formats Available

Conditions of use.

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Reviewed by Sheila Cook, Family and Consumer Sciences Instructor, Pittsburg State University on 1/16/23

For the intended audience, the text covers the necessary components of an introductory nutrition course. This text is a contender for an adopted online text for my nutrition and health course. It is easy to read and follow. read more

Comprehensiveness rating: 5 see less

For the intended audience, the text covers the necessary components of an introductory nutrition course. This text is a contender for an adopted online text for my nutrition and health course. It is easy to read and follow.

Content Accuracy rating: 5

The text is accurate concerning the basics of nutritional science and health. The author(s) present accurate relationships between nutrients, eating habits, good living, and overall health spanning the life cycle.

Relevance/Longevity rating: 4

Content is relatively accurate, but needs updating to stay current with trends, issues, and updated guidelines. The majority of the science content stays basic. Instructors can easily add supplemental materials if needed, especially in the areas of fad diets and trends, and new discoveries pertaining to research.

Clarity rating: 5

The text includes appropriate language and terminology necessary for an introductory nutrition and health course. The text contains appropriate content for students who are satisfying general education requirements.

Consistency rating: 5

The text is set up with an appropriate index. Content chapters flow easily from one topic to another, building on previous knowledge, making connects to new content. It would be easy for instructors to "jump around" the index per their liking.

Modularity rating: 5

The text is broken into appropriate sections, allowing for charts, figures, and links for further understanding. I feel there are no disruptions to the reader.

Organization/Structure/Flow rating: 5

The topics are organized in a logical and clear manner.

Interface rating: 2

The text has many significant interface issues. Although images and charts are displayed nicely, there were several navigational problems throughout including several articles and/or videos that have broken links. Overall, the text is visually appealing.

Grammatical Errors rating: 5

I did not observe any spelling or grammatical errors.

Cultural Relevance rating: 5

The text is not culturally insensitive or offensive in any way and provides diets from various cultures. It could be used by any student.

Reviewed by Beverly Moellering, Assistant Professor/Director Coordinate Program in Dietetics, University of Saint Francis on 5/20/22

The text covers the appropriate topics for an introduction course in nutrition. read more

The text covers the appropriate topics for an introduction course in nutrition.

Content Accuracy rating: 4

Nutrition is continually advancing. There are some topics that are outdated such as the dietary guidelines and reference to Healthy People 2020 to name a couple.

The logical nature of each chapter in the book as well as the progression of topics allow students to have a good understanding of nutrition. Updates just need to occur.

Clarity rating: 4

The book does a good job of explaining key terms and avoids any extreme terminology. Web links are provided to clarify information, but several of the links do not work.

Big ideas, key take aways, and discussion starters throughout each chapter are great tools to help students become engaged with the content.

Modularity rating: 4

The text is organized well and flows easily. At the end of each chapter there are end of chapter exercises which allows the reader to go through items to expand comprehension of topics discussed. Links just do not always work.

It is organized in presenting the key concepts and the six classes of nutrients.

Interface rating: 3

Links to videos, articles, etc. often did not work.

There were no grammar issues with this textbook

No cultural biases found.

While this text book has a good outline of topics covered and ways to engage the reader, the issues with current updates and accurate web links need to be improved. This would be a good supplement text for a course.

Reviewed by Shyanne Sansom, Instructor, Eastern New Mexico University on 1/13/22

The textbook covers all the important topics that a human nutrition text should cover. read more

The textbook covers all the important topics that a human nutrition text should cover.

The book was accurate in 2012, but knowledge of nutrition science changes so quickly that the book is quite outdated in 2022. This was the most challenging aspect of using this for a higher education class. I spent a great deal of time finding accurate, current information for my students.

Relevance/Longevity rating: 3

This textbook is so old that much of the content is obsolete. This makes using it as the primary source of information for a nutrition course extremely challenging.

The textbook is easy to read and accessible for most first year college students.

Chapters are easy to follow, and each chapter is organized so information can be found quickly.

One of the best things about this textbook is how well the sections are organized. Headings a clear, and each section has "key takeaways" and "discussion starters".

Organization/Structure/Flow rating: 3

I did not like the approach the authors used to organize the chapters in the book. Carbohydrates, Lipids and Proteins each had their own chapter, but the authors divided vitamins and minerals into function, rather than vitamin/mineral identity. It does not work as well as other nutrition textbooks, which dedicate individual chapters to vitamins and minerals separately.

None of the links to videos, articles, etc. work in this textbook. Students become very frustrated when they cannot access additional information to support the chapter. I tried to provide alternate sources for the links, but it was incredibly time-consuming.

There were not grammatical problems with this textbook.

Cultural Relevance rating: 4

The book does a good job in chapter 14 of providing multiple perspectives on nutrition. I wish all nutrition textbooks included this. However, the textbook would have been even better if they had included more cultural perspectives throughout every chapter, instead of putting it in just one near the end.

I would not recommend this book to professors hoping to find one good textbook for their human nutrition class. It does provide good basic nutrition information, but a lot of the science is so outdated that you will have to spend a good deal of time updating the information for you students. Additionally, none of the in-text links to videos and articles work. I also did not like the way the authors split the micronutrient chapters into function, rather than type. It is much better to have chapters dedicated to minerals and vitamins instead. Lastly, there are no instructor materials (test banks, PowerPoints, etc.) which also takes more of the instructor's time to create. This is a good supplemental book for a nutrition course, but I would not use this again as the only textbook in a college course.

Reviewed by Amanda Margolin, Adjunct faculty, Portland Community College on 5/26/21

I found that the text covered the subject matter in an appropriate way. I appreciated how there were videos included when more challenging concepts were being discussed such as digestion and absorption. I also found the images used to be effective... read more

Comprehensiveness rating: 4 see less

I found that the text covered the subject matter in an appropriate way. I appreciated how there were videos included when more challenging concepts were being discussed such as digestion and absorption. I also found the images used to be effective in enhancing the text. I found the organization of material to help with the comprehension of the material such as in the section devoted to carbohydrates, information about diabetes was included. If I were to implement this text I would expand on the "antioxidant" section in the chapter about vitamins as I found this section to be quite brief. Some of the sections on minerals do not provide food sources such as the section on the copper, I would include this information so the material is consistent and thorough. In chapter 10 I would include more information related to fuel sources during different types of exercise such as which fuel source our body turns to for jogging vs. sprinting. In 11.3 "Infancy Nutrition" I would include more up to date in formation related to food allergies such as the new science behind when to introduce peanut butter. Some of the chapters such as, chapters 11 and 12 were well written chapters in the text in terms of providing enough content to fully understand the subject where other chapters I feel I would need to expand on the content to provide a more thorough understanding of the material such as Chapters 10 (section 10.3) sports nutrition was quite brief.

The content presented in this text is accurate and references are provided throughout the text. The content did not present any bias issues.

Overall this information from this text is up to date. The current dietary guidelines focus on 2020-2025 which is our most up to date guidelines released from the government. This text uses information from the 2015 guidelines. This is something I would need to update for my course in order to have the most up to date information related to our guidelines. Similarly, we have information for Healthy People 2030, this text uses information from Healthy People 2020. The text also uses a picture of the old nutrition facts panel when discussing how to read a label. I would include the up to date nutrition facts panel if I implement this text for my course. I thought the section about sugar substitutes and added sugars was very relevant to today's culture. The progression of material will make it easy as an instructor for me to implement for my course.

The information is presented in a clear and logical way making it easy for the reader to follow along and move section to section through the material. At the end of each section there is a "Key Takeaway" section which provides nice summary points for the reader. At the end of each section there is also a "Discussion starter" section which provides the reader with thought-provoking questions to increase understanding of the material. I appreciated how within the text you will find references to material from previous chapters such as in 9.1 "Metabolism overview" there is a reference to material covered from chapter 6.

The text is consistent from chapter to chapter as well as section to section within each chapter. The same organizational structure is used for each section providing consistency throughout the text.

The text is organized and flows nicely for the reader from chapter to chapter. Each chapter is broken down into sections. Each section begins with learning objectives and ends with "key takeaways and discussion starters" to enhance the material presented in the text. At the end of each chapter there is a section "It's your turn" which allows the reader to go through example quiz questions and discussion questions to expand knowledge.

The book begins with more introductory topics such as "Nutrition and you" and "A healthy diet" which provides students terminology and some nutrition basics. From there the chapters are presented in a logical way, building on material as the text goes on. For example, chapter 3 delves into metabolism/digestion/absorption where the following chapters focus on macronutrients specifically as they relate to these processes.

Interface rating: 5

I did not notice any significant interface issues. The text was easy to navigate and all of the images and videos appeared appropriately free of distortion within the text.

I did not notice any grammatical errors when reviewing the text.

The text mentions cultural as it relates to food choices. There is also a section in chapter 2 about "diets around the world" focusing on food culture from other regions.

Reviewed by Chimene Castor, Associate Professor, Howard University on 4/29/21

It comprehensive for an introductory book in nutrition. The clinical nutrition information should be more comprehensive, but the instructor can additional reading materials read more

Comprehensiveness rating: 3 see less

It comprehensive for an introductory book in nutrition. The clinical nutrition information should be more comprehensive, but the instructor can additional reading materials

Nutrition is a progressive field and needs continuous revision - this textbook is updated

Yes, it is updated with necessary content

The book is well organized in the necessary material to review with students.

Missing food analysis component

Organization/Structure/Flow rating: 4

Yes, the materials are well presented but need to have a diverse groups

Grammatical Errors rating: 4

The book is clear for students to understand.

A more diverse group can be used to represent the global community.

Food analysis for nutrients and food frequency; missing global BMI for children to compare with CDC

Reviewed by Anne Goodwin, Professor, Massachusetts College of Liberal Arts on 6/30/20

This book provides a good overview of nutrition for the non-major; topics such as nutrition for athletes and global food security are largely omitted, and information about the current dietary guidelines for Americans will need to be provided as... read more

This book provides a good overview of nutrition for the non-major; topics such as nutrition for athletes and global food security are largely omitted, and information about the current dietary guidelines for Americans will need to be provided as supplemental information.

No errors were noted in the reviewed material.

Relevance/Longevity rating: 5

Since nutrition is a constantly evolving science, current information will always need to be added, but this book is formatted in a way that will allow this to be added.

I believe this text has clarity appropriate to the non-major student.

The organization is consistent and well-suited to the topic and audience.

The sections are easily accessed through the index and can be presented in an alternate order as desired by the instructor.

The topics are ordered in a fashion similar to that found in other nutrition textbooks.

In the book sections used so far, no interface issues were noted.

In the book sections used so far, no issues with grammar.

The section on international diets is a welcome addition; other cultural aspects may need to be addressed by the instructor in greater detail.

I am adopting this text for use, with supplemental materials, for my non-majors nutrition course.

Reviewed by Sharron Guillett, Full Professor, Shenandoah University on 6/18/20

The book is comprehensive and covers all aspects of nutrition across the life span as well as issues related to policy and sustainability. The chapters related to chronic diseases and eating habits around the world are particularly well done. read more

The book is comprehensive and covers all aspects of nutrition across the life span as well as issues related to policy and sustainability. The chapters related to chronic diseases and eating habits around the world are particularly well done.

Content Accuracy rating: 3

The book is accurate in content areas that address the basics of nutritional science. For example, the information about nutrients, how they are used to support health and the foods in which they can be found is accurate. Conclusions/opinions presented by the authors about relationships between nutrients and or eating behaviors and health are sometimes inaccurate, overly simplified or overly generalized. For example, the statement that diabetes is caused by diet is not true. Diet is only one of many contributing factors. Similarly, the statement that "to do all of the things that you like to do are dependent upon one factor—your health" is an over simplification that serves as bias toward nutrition as "the one" factor necessary for good health and good living

The factual components of the text are current and easily updated thanks to the modular format of the text. The real issue is that rather than having resources and references at the end of chapter sections, they are embedded in the text making it not only challenging to read but also challenging and cumbersome to update the links that are no longer working. Some material related to dietary trends and fads needs to be updated and some notions about age groups have changed over time. For example people aged 51 are no longer considered "older adults".

The prose is clear , free of jargon and based on the "SMOG method", written at an 11th to 12th grade level. Definitions are also provided where needed. No glossary.

The book is consistent in format, framework and terminology.

The book is designed as a modular text. There are assignments/activities at the end of each section within the chapters that make it easy to use the text in a variety of course delivery methods/timelines.

The book is organized in a logical fashion moving from simple to complex. Chapter divisions make it easy for the reader to assess their knowledge in manageable chunks.

The text integrates the narrative with both internal and external links . Most of the external links are broken and take the reader to pages that either don't exist or are "deep links" that require a great deal of searching to locate. Even the Appendix which is a link to dietary requirements is broken. Many of the internal links seem unnecessary or inappropriate. For example there is a discussion of the nutritional triad (social, physical, mental) and an internal link takes the reader to a picture of three women in yoga poses pointing at the words social, physical,mental.

The text is free of spelling and grammatical errors.

The book uses images of persons from a variety of races, genders and ages. No offensive language or cultural references were noted.

This book is like a classic car that no longer runs but still has value in its parts. There are segments, tables and charts that could be "harvested" and used to support learning about nutrients , their sources and and how healthy eating is life sustaining.

Reviewed by Nicole Stob, Instructor, University of Colorado Boulder on 6/11/20

All areas of the subject were covered appropriately. Terms were defined throughout the text, but a comprehensive glossary or index was not found. read more

All areas of the subject were covered appropriately. Terms were defined throughout the text, but a comprehensive glossary or index was not found.

The vast majority of the content was accurate, but some of the content needs to be updated and therefore not accurate.

The vast majority of the content was up-to-date, but some of the content needs to be updated. For example, content relating to the nutrition facts label is not updated.

The writing is clear and easy to understand. Adequate context is provided.

The text is internally consistent, using the same terminology and framework throughout.

The text is broken up appropriately, allowing for breaks in the reading with links to outside resources, figures, etc.

The topic are organized in a logical manner.

Several broken links to outside resources were found in chapters 1-3 (none of the other chapters' links were checked).

No grammatical errors were noted in the text.

The text is culturally sensitive and does a nice job of using examples from different cultures and exploring the diets of different cultures as well.

Reviewed by Mahdi Garelnabi, Associate Professor, University of Massachusetts Lowell on 6/7/20

The authors comprehensively covered the topics from all aspects. read more

The authors comprehensively covered the topics from all aspects.

Quite accurate information

The book is timely and relevant to the area of human nutrition

Authors used very easy and clear language to follow

pretty good consistency.

The text is very rich with background, at some point lay language is used for better understanding.

The book is well organized. It is divided into broader chapters and small topics with each chapters

The text is certainly free from from and interface issues. Figures and images are clear. The book is nicely displayed.

No grammatical mistakes was seen

No cultural sensitive item was observed.

This is a great book to adopt for human nutrition.

Reviewed by Clare McEnroe, Adjunct Professor, Raritan Valley Community College on 3/25/20

The textbook does cover the surface of many topics important for students to know and understand and can use. read more

The textbook does cover the surface of many topics important for students to know and understand and can use.

The information is unbiased. There needs to be some updating to some of the content. As in any science field, nutrition keeps changing and there would need to be some supplements added to this text to bring it up to date. This would definitely be possible to do by the instructor.

There are some links that no longer work and would need to be updated. Also there has been some new information that can be added in terms of fad diets and diet trends that are new since the text has been written.

The language/terminology used is appropriate for an introduction course and mainly taken by students who are not science majors and just want some background information about nutrition.

The set up of each chapter has a good flow and easy to understand.

The chapters are set up as if you can use them in that order but wouldn't matter if they were used out of order either. They are pretty much separate topics but can also be related.

Each topic is very clear and covers the majority of the information for an introduction course. Understandable and usable information is presented.

Interface rating: 4

Some links do not work and may need to replaced or updated with newer information.

I did not notice grammatical errors.

The textbook can be used by anyone, There is no cultural insensitivity at all.

This is a textbook to consider for an Introduction course. The updates and additional topics could be supplemented without a problem.

Reviewed by Caleb Bazyler, Assistant Professor, East Tennessee State University on 3/4/20

The textbook does an excellent job fulfilling its purpose of communicating nutrition content to a novice audience with a non-science background. The table of contents appropriately links content provided in each chapter including subtitles and end... read more

The textbook does an excellent job fulfilling its purpose of communicating nutrition content to a novice audience with a non-science background. The table of contents appropriately links content provided in each chapter including subtitles and end of chapter exercises.

The content was accurate and unbiased. Controversial topics were handled fairly with all opinions presented. I appreciated the functional approach discussing nutrition in the context of different bodily systems. This is very intuitive for an introductory level course.

Much of the basic science content will not need to be updated, and sections that will need to be updated (e.g. reference intakes, results from pending clinical trials, updates on controversial topics) should not be difficult to edit.

All key terms are in bold throughout the textbook and carefully defined. I also appreciated the external links to video explanations where relevant.

The text is internally consistent in regard to terminology and structure. The section and subsection layout was easy to follow throughout.

The chapter sections and subsections are easy to follow, and the authors do a great job building on content discussed in earlier chapters. The key takeaways and discussion segments at the end of each chapter are a great way to connect readers with the content, and provide topics of conversation in the classroom.

The topics are presented in a logical manner consistent with other nutrition textbooks.

While the text was mostly easy to navigate, I would have also appreciated a small table of contents at the beginning of each chapter with links to different parts of the chapter. This would make each chapter much easier to navigate. Also, some of the external links were broken, and some tables were not fully viewable (e.g. Tables 2.12 and 4.7).

I did not notice any grammatical errors.

The content at the end of the textbook on food industry, politics, cost and security was an excellent addition. I also appreciated the comparisons of diets across cultures, and pros/cons of popular dietary regiments.

Reviewed by Meagan Helmick, Assistant Professor of Public Health, Radford University on 1/6/20

This text does a good job at providing students with information about macro- and micro-nutrients and how they work in your body. It also covers nutrition at different life stages. The target audience is well thought about in this book, and is... read more

This text does a good job at providing students with information about macro- and micro-nutrients and how they work in your body. It also covers nutrition at different life stages. The target audience is well thought about in this book, and is needed for students that are not nutrition majors.

I did not notice any inaccuracies.

This text is up-to-date, but will need to be updated when the new Dietary Guidelines are published. However, this is something that I, as an instructor, can supplement to my students. The logical nature of each chapter in the book as well as the overall progression allows for students to have a well rounded understanding of nutrition.

The textbook does a good job of explaining key terms as the person is reading (on the left side of the page), and avoids any extreme use of terminology that students might not be able to grasp.

The chapters are set up the same way, which helps the reader to know what to expect as they progress through the textbook. The key takeaways and discussion starters are great tools to help students understand what they are reading and can serve as prompts in class for discussion. The end of the chapter exercises also provide this opportunity to engage with the reading and make sure students comprehended the information.

The sections are broken down into appropriate sizes by topics. I like that the table of contents include the sections as well. This helps students quickly find the information they are looking for.

Overall the organization is well thought out. Each chapter has components that build on previous chapters, but not in such a way that doesn't allow you to skip chapters or reorder the readings.

The charts and for some of the chapters were cut off, I think this is likely because this was designed with a book-binding format, but I was still able to read the information and understand what it intended to state. Appendix A's link did not work when I clicked on it to see the DRI tables.

No issues that I noted.

Chapter 14 does a good job of highlighting "Diets Around the World" which provides different cultural takes on diets. I did not note anything insensitive.

Reviewed by Tina Moody, Biology Faculty, Northland Community and Technical College on 7/1/19

For the target audience, the book is right on track. It doesn't assume one has a chemistry or biology background - perfect for my nutrition course. read more

For the target audience, the book is right on track. It doesn't assume one has a chemistry or biology background - perfect for my nutrition course.

I didn't see any incorrect information.

The book is fairly up to date (available since the end of 2012) but with this level of textbook and its information it isn't likely to change much. Any new information is something that I try to incorporate into my class materials regardless of the textbook source. When the FNB publishes new guidelines in 2020, I will be able to update these for my students easily.

I like how important terms are defined on the left side of the page.

Each of the chapters is set up the same way making it very intuitive once a student becomes familiar with the textbook. I believe the 'Key Takeaways' and 'Discussion Starters' at the end of each section and the 'End-of-Chapter Exercises' will help students insure they truly understood what they just read.

The way each chapter is broken down into sections will work well for my class. Each section is listed in the Table of Contents as well, making it even easier for students to find what they need. The 'End-of-Chapter Exercises' are even in the TOC.

Occasionally there are topics I have tackled in a slightly different order in the past (vegetarianism after a discussion of protein structure and function for example) but that's just personal taste.

The only issue I had with some of the charts is that some of the acronyms in the chart were not explained in the description. Some of the writing was small as well, though I'm not sure how the authors could have dealt with that and still had a good flow of information rather than flipping back and forth between pages to see a larger chart.

I did not see any grammatical errors.

I feel the textbook did well in this area. Chapter 14 Politics and Perspectives covered the globe well in the 'Diets around the World' section.

Table of Contents

• Chapter 1: Nutrition and You
• Chapter 2: Achieving a Healthy Diet
• Chapter 3: Nutrition and the Human Body
• Chapter 4: Carbohydrates
• Chapter 5: Lipids
• Chapter 6: Proteins
• Chapter 7: Nutrients Important to Fluid and Electrolyte Balance
• Chapter 8: Nutrients Important As Antioxidants
• Chapter 9: Nutrients Important for Bone Health
• Chapter 10: Nutrients Important for Metabolism and Blood Function
• Chapter 11: Energy Balance and Body Weight
• Chapter 12: Nutrition through the Life Cycle: From Pregnancy to the Toddler Years
• Chapter 13: Nutrition through the Life Cycle: From Childhood to the Elderly Years
• Chapter 14: Nutrition and Society: Food Politics and Perspectives
• Chapter 15: Achieving Optimal Health: Wellness and Nutrition
• Chapter 16: Appendix A

Ancillary Material

About the book.

Welcome to Essentials of Nutrition: A Functional Approach! This book is written for students who are not majoring in nutrition, but want to learn about the fundamental aspects of nutrition and how it applies to their own lives. We have written this book with the assumption that you have little or no prior knowledge of college level chemistry, biology, or physiology. But that does not mean it’s not scientific! Nutrition is a science-based discipline, so all the material included is backed up by rigorous scientific research, but it is presented in a clear, easy-to-understand fashion without requiring a background in science.

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Introduction

University of Hawai‘i at Mānoa Food Science and Human Nutrition Program and Human Nutrition Program

ʻO ke kahua ma mua, ma hope ke kūkulu The foundation comes first, then the building

Learning Objectives

By the end of this chapter, you will be able to:

• Describe basic concepts in nutrition
• Describe factors that affect your nutritional needs
• Describe the importance of research and scientific methods to understanding nutrition

What are Nutrients?

The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet, since the human body does not synthesize or produce them. Nutrients have one or more of three basic functions: they provide energy , contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, respire (breathe), grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates , lipids , proteins, water , vitamins, and minerals . Foods also contain non-nutrients that may be harmful (such as natural toxins common in plant foods and additives like some dyes and preservatives) or beneficial (such as antioxidants).

Macronutrients

Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy that is then utilized to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie . On nutrition food labels the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (one thousand calories, denoted with a small “c”) is synonymous with the “Calorie” (with a capital “C”) on nutrition food labels. Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not yield calories.

Carbohydrates

Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates, but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates , often called simple sugars; and complex carbohydrates .

Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose , the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood.

Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates to simple sugars, mostly glucose. Glucose is then transported to all our cells where it is stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but it cannot be broken down by digestive enzymes in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down.

One gram of digestible carbohydrates yields four kilocalories of energy for the cells in the body to perform work. In addition to providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for proper functioning of the nervous system, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen , and in plants, it is known as starch. Glycogen and starch are complex carbohydrates.

Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but unlike carbohydrates, they are insoluble in water. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, and seeds, and in many processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other functions in the body.

Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and a variety of different plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however providing energy is not protein’s most important function. Proteins provide structure to bones, muscles and skin, and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins.

Figure 1.1 The Macronutrients: Carbohydrates, Lipids, Protein, and Water

There is one other nutrient that we must have in large quantities: water. Water does not contain carbon, but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is supremely important, a topic we will explore in detail in Chapter 4.

Micronutrients

Micronutrients are nutrients required by the body in lesser amounts, but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins (See Table 1.1 “Minerals and Their Major Functions” and Table 1.2 “Vitamins and Their Major Functions” for a complete list and their major functions). In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes ). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions from producing energy, to digesting nutrients, to building macromolecules. Micronutrients play many essential roles in the body.

Table 1.1 Minerals and Their Major Functions

Minerals are solid inorganic substances that form crystals and are classified depending on how much of them we need. Trace minerals , such as molybdenum, selenium, zinc, iron, and iodine, are only required in a few milligrams or less. Macrominerals, such as calcium, magnesium, potassium, sodium, and phosphorus, are required in hundreds of milligrams. Many minerals are critical for enzyme function, others are used to maintain fluid balance, build bone tissue , synthesize hormones, transmit nerve impulses, contract and relax muscles, and protect against harmful free radicals in the body that can cause health problems such as cancer.

The thirteen vitamins are categorized as either water-soluble or fat-soluble. The water-soluble vitamins are vitamin C and all the B vitamins, which include thiamine, riboflavin, niacin, pantothenic acid , pyridoxine, biotin , folate and cobalamin. The fat-soluble vitamins are A, D, E, and K. Vitamins are required to perform many functions in the body such as making red blood cells, synthesizing bone tissue, and playing a role in normal vision, nervous system function, and immune system function.

Table 1.2 Vitamins and Their Major Functions

Vitamin deficiencies can cause severe health problems and even death. For example, a deficiency in niacin causes a disease called pellagra , which was common in the early twentieth century in some parts of America. The common signs and symptoms of pellagra are known as the “4D’s—diarrhea, dermatitis, dementia , and death.” Until scientists found out that better diets relieved the signs and symptoms of pellagra, many people with the disease ended up hospitalized in insane asylums awaiting death. Other vitamins were also found to prevent certain disorders and diseases such as scurvy (vitamin C), night blindness vitamin A, and rickets (vitamin D).

Table 1.3 Functions of Nutrients

Learning Activities

Technology Note : The second edition of the Human Nutrition Open Educational Resource (OER) textbook features interactive learning activities.  These activities are available in the web-based textbook and not available in the downloadable versions (EPUB, Digital PDF, Print_PDF, or Open Document).

Learning activities may be used across various mobile devices, however, for the best user experience it is strongly recommended that users complete these activities using a desktop or laptop computer and in Google Chrome .

The capacity of a body or physical system for doing work. There are two fundamental forms: kinetic energy and potential energy.

A class of nutrients containing carbon, hydrogen, and oxygen atoms; most are commonly known as sugar, starches or dietary fibers.

A class of nutrients containing carbon, hydrogen, a little oxygen, and some other atoms. Commonly known as fats that include fatty acids, triglycerides, phospholipids, and sterols.

The universal chemical solvent in which most of the processes of life occur.

An element used in the body to promote chemical reactions and help form body structures.

A fundamental unit of energy, equal to 4.1855 joule; 1000 calories equals 1 kcal.

The sum of all processes involved in how organisms obtain nutrients, metabolize them, and use them to support all of life’s processes.

The standard unit of energy used in nutrition; the amount of heat required to raise temperature of 1 kg water 1℃ .

Essential nutrients that are needed by the body in large amounts

Carbohydrates known as sugars that contain monosaccharides and disaccharides.

Carbohydrates known as large sugar molecules linked together in straight or branching chains that include oligosaccharides, starches and fibers.

A disaccharide made of glucose linked to fructose and commonly known as table sugar.

A type of carbohydrate that is indigestible and cannot be broken down by human digestive enzymes.

A protein molecule that speeds up or accelerates specific chemical reactions without changing itself.

The storage form of a complex carbohydrate composed of multiple units of glucose linked together in a highly branched structure.

A class of compounds composed of linked amino acids. They contain carbon, hydrogen, nitrogen, oxygen, and sometimes other atoms in specific configurations.

A substance in food that can provide energy, contribute to body structure, and/or regulate body processes.

Essential nutrients that are needed by the body in small amounts. These include vitamins and minerals.

Chemicals required for enzymes to perform their acts of catalysts.

Chemical groups that bind to enzymes and assist in enzymatic catalysis.

An essential mineral required in the diet in an amount of 100 mg per day or less.

Minerals present in the body at concentrations of more than 50 ppm or 0.005% of body weight.

The major structural and supportive connective tissue of the body.

A highly reactive atom or molecule that causes oxidative damage.

One of the B vitamins needed for energy metabolism.

A B vitamin that is needed for energy metabolism.

Organic compounds that are needed in small amounts in the diet to support and regulate the chemical reactions and processes needed for growth, reproduction, and the maintenance of health.

A disease caused by niacin deficiency, characterized by inflammation of the skin, diarrhea, and eventually mental incapacity.

The deterioration of an individual’s mental state that results in impaired memory, thinking, and judgement.

A disease caused by a vitamin C deficiency characterized by bleeding gums, tooth loss, joint pain, bleeding into the skin and mucous membrane, and fatigue.

A condition due to a deficiency in vitamin A where the eye recovers very slowly from exposure to bright light.

A disease that is characterized by softening of the bones due to poor calcium deposition within them because of a lack of vitamin D in the body.

Introduction Copyright © 2020 by University of Hawai‘i at Mānoa Food Science and Human Nutrition Program and Human Nutrition Program is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Nutrition Introduction

Ch. 6 - Nutrition Copyright © by UGA PEDB Program is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Introduction

What comes to mind when you think of food? What does it mean to you? 

Maybe it is this morning’s breakfast, essential fuel grabbed as you ran out the door to make it to work or class on time.

Or perhaps it’s the smell of food cooking in your childhood kitchen, building anticipation for a meal to be shared with family.

Maybe it is the feeling of soil crumbling between your fingers as you prepare a garden bed for the first seeds of spring, each one a promise of fresh food for the months to come.

Or perhaps it is the thought of navigating your grocery cart down fluorescent-lit aisles at the grocery store, wondering what to choose and how to stay within your budget.

Maybe you think of food as a collection of nutrients, tiny molecules that will nourish and energize you, defend your health, and fuel your brain.

Or perhaps you think of the food traditions of your family’s culture, recipes shared for generation upon generation, over decades of change.

Maybe you think primarily of feeding yourself. Or perhaps you’re already planning what to cook for your large family tonight.

Maybe food is a collection of sweet memories for you. Or perhaps your relationship with food is more complicated, one of struggle and control.

Maybe the meaning of food is bigger than you and your family. Perhaps you think of how to best feed patients in a hospital, to nourish children in a school, or to get food to elderly shut-ins looking for a warm meal and a friendly face. Or maybe you think of how food production affects the environment, workers, and communities. Perhaps you wonder how we’ll feed the world as the population grows and the climate warms.

Food is all of these things and more. It is a basic human need that permeates every day of our lives. The choices we make about food can affect something as small as the cells in our body and as large as the environment around us. We can’t cover every facet of food in this book, but what we can do is give you a foundation on which to understand the science of food and nutrition and how to apply it in your everyday life.

We originally developed this book for our students in FN 225, our course in human nutrition at Lane Community College in Eugene, Oregon. Our students come from all walks of life, and we know they each carry their own meaning of food and come into our class with different goals. Many have their sights on careers in the health professions, and others choose our class to be better-informed as they feed themselves and their families.

We’re glad to share this book as an open educational resource, or OER, with students beyond our college. In developing this OER, we leaned heavily on the previous work of other OER authors. In the spirit of open education, we’ve built on the foundation that they provided, updating it and tailoring the material to the needs of our students. In that same spirit, we’re sharing it so that others can benefit and to help reduce costs for students.

This OER is divided into units that roughly correspond to one week of learning in our 10-week course, with each unit comprising six to eight sections of information on the unit’s theme. When possible, we’ve embedded videos to expand upon and enrich the content of the text. Each section of the unit also includes self-check questions to test your comprehension as you read.

To students: We hope you enjoy reading and learning through this resource, and we wish you a lifetime of eating well!

A note to educators interested in using this resource:

As this is an OER, you are welcome to adopt this material and modify it as needed for your own teaching needs. We welcome your feedback, suggestions, and corrections regarding the text. If you plan to use this OER, we ask that you please contact Tamberly Powell at the address below, so that we can track where the resource is being used and contact you if there are updates. Instructors may also contact us for access to ancillary materials for each unit, including a guided notes document for student use and a question bank for instructor use.  

Tamberly Powell, MS, RDN

Nutrition Coordinator, Lane Community College

Phone: 541-554-2196

Email: [email protected]

Image Credits:

Photo by Max D. Photography on Unsplash ( license information )

Nutrition: Science and Everyday Application Copyright © 2020 by Alice Callahan, PhD; Heather Leonard, PhD, RDN; and Tamberly Powell, MS, RDN is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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1.1 What Is Nutrition?

Learning outcomes.

By the end of this section, you should be able to:

• 1.1.1 Define nutrition.
• 1.1.2 Identify key events in the history of nutrition.

A Basic Definition of Nutrition

Nutrition is the intake of food to meet the needs of the body. Accordingly, nutrients are substances found in foods and beverages that are essential for survival. Nurses must understand the components of nutrition and its impact on bodily functions to provide effective nursing care.

Several food-related concepts are fundamental to understanding how nutrition affects the body. The term food refers to edible substances made of protein, carbohydrates , fat, or other nutrients. Food is comprised of macronutrients and/or micronutrients. Macronutrients are water and energy-yielding nutrients (carbohydrates, fats, and proteins) needed in large amounts by the body. Micronutrients include vitamins and minerals. Food is the building block of the diet , which describes the quantity and quality of food and drinks consumed.

Nutrition in Foods

Understanding calories is essential to understanding how the body uses nutrients for fuel. Calories, which measure the amount of heat it takes to raise 1 kg of water by 1ºC, are used to indicate the amount of energy needed or ingested daily. Human bodies need calories to function, digest food, grow, and move. The 2020-2025 Dietary Guidelines issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services recommend adult women consume an estimated 1,600 to 2,400 calories daily and adult men 2,000 to 3,000 calories daily based on age and activity level (USDA & USHHS, 2020).

The number of calories found in food varies based on food type. Table 1.1 lists the number of calories found in macronutrients. Food preparation can modify the number of calories present. For example, a raw tomato has fewer calories than a fried tomato. Water is classified as a macronutrient. Although it serves a vital role, it does not provide energy to the body.

Calorie Calculator

Counting calories is one way to determine if clients are consuming an appropriate amount of food to meet their needs. Calorie needs vary based upon client age, sex, and level of physical activity. Use this calorie calculator when working with clients to determine their individual caloric needs.

The History of Nutrition in the Provision of Client Care

Modern nutrition science advanced significantly during the 20th century (Mozaffarian, Rosenberg & Uauy, 2018). The identification of essential vitamins and minerals in the early 1900s launched the quest to identify and treat vitamin-deficient medical conditions such as beriberi. Subsequent nutritional discoveries led to the practice of fortifying certain foods to prevent deficiencies and setting the first recommended dietary allowances (RDAs).

During this same time frame, the federal government began to oversee and manage the food supply. In 1906, the Pure Food and Drugs Act was passed, which launched the federal regulation of foods by the agency later known as the U.S. Food and Drug Administration (FDA, 2018). The FDA was initially established to oversee how food was prepared for consumers. This became necessary because as more people moved from rural to urban areas, they depended on others to grow and produce the food they needed.

In 1938, the Food, Drug, and Cosmetic Act (FDCA) of 1938 was passed, significantly enhancing labeling requirements. The FDCA required food labels to include the product’s recognizable name and standardized information related to the identity, quality, and amount in the container (Lam & Patel, 2022).

Later, in the second half of the 20th century, the focus of nutrition shifted toward nutrition and its relationship to health (USDA & USHHS, n.d.). In 1977, the first-ever federal guidance related to diet quality was published in Dietary Goals for the United States . These goals were intended to improve the typical American diet to decrease the incidence of heart disease. The development of these goals prompted pushback from some members of the food industry. For example, the goals originally recommended to reduce the intake of red meat in the diet. However, groups such as the National Cattlemen’s Beef Association opposed this recommendation since it would negatively affect the beef industry. Consequently, the language in the federal guidelines was changed from minimizing red meat to selecting foods that will minimize saturated fat intake (Stillerman, 2019).

Continuing this new shift in perspective, in 1982 the Committee on Diet, Nutrition, and Cancer, National Research Council presented their findings on the relationship between diet and cancer. These findings served as a foundation to promote nutritional factors and dietary needs that decrease the incidence of cancer. Not only did the report discuss foods linked to the potential development of cancer, but it also identified foods that supported cancer prevention . This study specifically mentioned macronutrients and micronutrients found in the diet and their impact on cancer development and/or prevention. This introduction of macronutrients and micronutrients to the public facilitated several agencies to take active roles in promoting dietary agendas. For example, the Nutrition Labeling and Education Act of 1990 prompted all food packaging entities to label foods with nutritional information and serving sizes.

Through the years, visual displays of government food guides have been modified to reflect the changing perspectives. The first guide, released in the 1940s, divided foods into seven groups and encouraged people to eat foods from all groups as well as food not included in the seven groups without specifying amounts. The widely recognized Food Guide Pyramid was first introduced in the 1990s and underwent several revisions until it was replaced by MyPlate in 2011 (Davis & Saltos, n.d.; USDA, 2021). The most recent dietary guidelines for Americans, 2020–2025, uses the original MyPlate visual guide to recommend small, simple changes to improve diet quality.

Nutrition for Wellness

The Global Wellness Institute defines wellness as pursuing activities, choices, and lifestyles leading to holistic health. Multiple factors influence a person’s health, including nutrition. Good nutrition is essential for keeping the population healthy (CDC, 2021).

Origin of Nutrition Related to Wellness

The ancient Greek physician who influenced much of modern medicine, Hippocrates, is credited with saying, “Let food be thy medicine and medicine be thy food” (King, 2019). This appears to be one of the earliest statements acknowledging the role of nutrition in maintaining health. In 1948, the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, n.d.). This definition reflected a growing emphasis on a holistic perspective of health.

Weight Versus Body Mass Index

Several measurements are recognized and used to assess a person’s nutritional status and identify individuals at risk for illness or disease. These indicators go beyond simply measuring a person’s weight to assess body composition and weight distribution. Body mass index (BMI) is a formula that calculates the ratio of weight and height to classify individuals as underweight, healthy weight, overweight, or obese. The waist-to-hip ratio (WHR) calculates the ratio of the circumferences of the waist to the hip. Evidence has shown that individuals with excess weight around their midsection may be at higher risk for certain health conditions. These assessments can be done at home or with a health care provider to gain important information about an individual’s dietary-related health.

Special Considerations

Bmi and diverse populations.

Recently, the routine use of BMI as a lone indicator of obesity has been scrutinized as a result of research that shows BMI may not be a reliable indicator for diverse populations. The American Medical Association (AMA) has adopted a new policy clarifying the use of BMI as one means of identifying obesity. The policy states that BMI should not be used exclusively to identify obesity; instead, it should be used in conjunction with other assessment tools. The policy acknowledges the BMI assessment is based on data from non-Hispanic White populations and does not consider differences in body shape and composition across different race/ethnic groups, sexes, or age groups (AMA, 2023).

Calculating BMI

BMI is a screening tool used to identify clients who are overweight or obese. Considering the recent policy change by the AMA, nurses should stay abreast of new research to determine how to incorporate BMI measurements when working with diverse client populations. BMI does not measure body fat directly but correlates with other more direct measures of body fat such as skinfold thickness measurements. High BMI can be correlated with obesity-linked adverse health outcomes. To determine BMI, input the client’s height and weight into the Adult BMI Calculator . Use Table 1.2 to interpret the results.

Measuring WHR

Clients may be self-conscious about having body measurements taken. Provide privacy for your client when taking these measurements. To determine WHR , with the client standing upright, use a tape measure to measure the distance around the smallest part of the client’s waist (waist circumference) and then the largest part of the client’s hip (hip circumference). Then divide the waist circumference by the hip circumference or use this online calculator to determine the WHR. The result is determined using Table 1.3 .

Health Promotion

Healthy People 2030 is a framework of U.S. public health objectives designed to improve the health and well-being of the population (USHHS, ODPHP, n.d.). Since its initial release in 1980, it has been updated each decade to shape health promotion and disease prevention strategies in the U.S. (CDC, 2023). In terms of nutrition, Healthy People 2030 aims to help people get the recommended amounts of healthy foods to reduce their risk for long-term diseases and improve their health (USHHS, ODPHP, n.d.)

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food and nutrition

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Introduction

Nutrition begins with food. Nutrition is the process by which the body nourishes itself by transforming food into energy and body tissues. The science of nutrition concerns everything the body does with food to carry on its functions. Food provides essential substances called nutrients. The body needs these nutrients to help it make energy; to grow, repair, and maintain its tissues; and to keep its different systems working smoothly. Nutrition is important for all organisms. However, this article will focus on nutrition as it applies to the human body .

The term nutrition can also refer to the quality of someone’s food choices, or diet. A balanced diet is one in which foods eaten on a regular basis provide all the nutrients needed in the right amounts. A balanced diet has many benefits. It can help people feel and look their best. It can also help them stay energetic and healthy, both in the short term and later in life.

Calories and Energy Balance

The body’s most basic need is for energy. The energy in food is measured in units called kilocalories (commonly shortened to “calories”). One kilocalorie is the amount of heat energy needed to raise the temperature of 1 kilogram (2.2 pounds) of water 1° C (1.8° F). (More precisely, it is the energy required to raise that water from 14.5° C to 15.5° C at one atmosphere of pressure.)

Three major types of nutrients supply the body with energy, or calories: carbohydrates, proteins, and fats. One gram (0.035 ounce) of either carbohydrate or protein provides four calories. Fat is a more-concentrated source of energy, with each gram providing nine calories. Water, vitamins, and minerals supply no energy in and of themselves, though the body uses many of them in energy-releasing processes.

The body needs the energy in food to do everything from blinking an eye to running a race. It also needs energy to perform such essential functions as breathing, maintaining body temperature, growing new cells, and even digesting food . The total number of calories needed each day depends on many factors, including a person’s age, sex, weight, and especially level of activity. For example, a woman who weighs about 120 pounds (55 kilograms) might expend 1,850 calories on a day when she is fairly sedentary but may use more than 3,000 calories on a very active day.

If a person takes in more food than is required to meet the body’s needs, the excess calories are eventually converted to fat—a form of stored energy found mostly within adipose tissue. That causes weight gain. Eating too little causes weight loss over time, because the body must use stored fat for energy. One pound (0.5 kilogram) of adipose tissue is equal to about 3,500 calories.

Maintaining a healthy weight is a balancing act. Food provides energy, and physical activity uses up energy. If weight loss is advisable, experts recommend both reducing one’s daily calorie intake and getting more exercise.

The nutrients are divided into six major types: carbohydrates, proteins, fats, vitamins, minerals, and water. Each nutrient performs specific functions to keep the body healthy. All the nutrients work together to contribute to good health.

Carbohydrates

The body’s main source of energy is carbohydrates , which include starches, sugars, and dietary fiber. The body breaks down starches and sugars into the simple sugar glucose, the fuel used by red blood cells. Glucose is also the main energy source for the brain and nervous system and can be used by muscles and other body cells. Fiber does not provide energy.

Starches are complex carbohydrates. They are found in dry beans and peas, such as kidney beans, pinto beans, soybeans, chickpeas, lentils, and split peas; grains and grain products, such as breads and cereals; potatoes; and other vegetables. These foods can also be good sources of proteins, vitamins, minerals, and dietary fiber.

Sugars, or simple carbohydrates, also are a natural part of many foods. There are several types. Fructose, for example, is found in fruits, maltose in grain products, and lactose in milk. These sugars are part of foods that also provide other nutrients.

Refined sugars are sugars that are removed from plants and used as sweeteners, or added sugars. Sucrose , or table sugar, is produced commercially from sugarcane and sugar beets and is used to sweeten many foods, such as candy and desserts. Other sweeteners include high-fructose corn syrup, a refined sugar that is commonly added to soft drinks and packaged baked goods; honey; maple syrup; and molasses. All these sugars provide calories but little or no additional nutrients. In addition, eating large amounts of sweetened foods can lead to weight gain and tooth decay ( see dentistry ).

Dietary fiber likewise provides no essential nutrients. Fiber is the structural part of plants, and the human body cannot digest it. However, eating dietary fiber is beneficial to the body in many ways. Fiber aids digestive health and may protect against certain disorders and diseases .

There are two types of fiber: insoluble (which does not dissolve in water) and soluble (which dissolves or swells in water). Insoluble fiber, or roughage, speeds the passage of food—and potentially harmful substances in food—through the intestines. This type of fiber is thought to provide protection against some gastrointestinal diseases. Good food sources include whole-grain breads and cereals, wheat bran, and vegetables. Soluble fiber can help lower the level of harmful cholesterol in the blood and limit the rise in blood sugar levels after eating. Soluble fiber is found in apples and other fruits, dry beans and peas, oats, and barley.

Proteins are made of amino acids , small units necessary for growth and tissue repair. About one-fifth of the body’s total weight is protein. Hair, skin, muscles, internal organs, and bones are made primarily of protein. Foods from animal sources—such as meat, poultry, fish, eggs, and dairy products—supply all the essential amino acids. These are complete proteins.

Foods from plant sources are incomplete proteins, because they are low in or lack one or more of the essential amino acids. However, one can obtain all the essential amino acids by eating a variety of different protein-containing plant foods. Good plant sources of protein are legumes (including soybeans, tofu, and other soy products), nuts, and seeds. Plant sources supply all or much of the protein in the diets of vegetarians , who eat no meat, poultry, or fish. In addition, plant foods, which are often less expensive and lower in fat than meat, are an important supplementary source of protein for many nonvegetarians around the world.

Fats are a concentrated source of energy (having more than twice as many calories per gram as carbohydrates and proteins do). Fats in the diet are needed for healthy skin and normal growth. Fats also carry certain vitamins to wherever they are needed in the body and provide a reserve supply of energy. Because fats move through the digestive system slowly, they also delay hunger pangs.

The different fats found in food are made up of fatty acids. There are four basic kinds of fatty acids: saturated, polyunsaturated, monounsaturated, and trans. Each has a different effect on blood cholesterol levels. In general, saturated fatty acids and trans-fatty acids tend to increase one’s risk of heart attack and other cardiovascular disease . Polyunsaturated and monounsaturated fatty acids are thought to lower those risks. Studies have shown that a buildup of fatty deposits in one’s arteries, a common factor in heart disease and stroke, can begin in adolescence or earlier.

Saturated fats (fats with a high percentage of saturated fatty acids) are usually solid at room temperature and come primarily from animals. For example, saturated fats are found in meat, poultry skin, lard, and non-skim dairy foods such as butter, cheese, and milk. Such plant fats as coconut and palm oils and cocoa butter (in chocolate) are also high in these fats. Saturated fats raise the level of a substance called low-density lipoprotein (LDL) cholesterol in the blood. Higher levels of this type of cholesterol are associated with a higher risk of cardiovascular disease.

Unsaturated fats are typically liquid at room temperature and come mainly from plants. Both polyunsaturated and monounsaturated fats tend to lower one’s levels of LDL cholesterol. Polyunsaturated fats may also lower levels of high-density lipoprotein (HDL) cholesterol. High levels of HDL cholesterol can help protect against heart disease. Monounsaturated fats tend not to lower HDL levels, and they might raise them. Many vegetable oils, including corn, sunflower, and safflower oils, are rich in polyunsaturated fats, as are fatty fish such as salmon. Monounsaturated fats are found in canola oil, avocados, olives and olive oil, and most nuts and nut oils. Both types of unsaturated fats are considered healthier choices than saturated fats or trans fats (fats with a high percentage of trans-fatty acids).

Hydrogen is added to the vegetable oils in some food products in order to increase their shelf life. This alters the fats into a more solid form, called partially hydrogenated fats. These fats contain trans-fatty acids, which raise LDL cholesterol, lower HDL cholesterol, and may also have other harmful effects on one’s heart health. Trans-fatty acids are found in many packaged sweets and snacks, such as cookies, doughnuts, crackers, and potato chips; most deep-fried fast foods, such as french fries; many margarines; and shortening.

The discovery of vitamins began early in the 20th century. It is likely that some still are undiscovered. Although vitamins are needed in only small amounts, they are essential for good health. They help keep the body’s tissues healthy and its many systems working properly. Each vitamin has specific roles to play. Many reactions in the body require several vitamins, and the lack or excess of any one can interfere with the function of another.

Fat-soluble vitamins

Four vitamins—A, D, E, and K—are known as fat-soluble vitamins. They are digested and absorbed with the help of fats in the diet. Fat-soluble vitamins can be stored in the body, mostly in fatty tissue and the liver, for long periods. If one takes very large amounts of these vitamins in supplements, they can build up to toxic levels.

Vitamin A is needed for good vision, healthy skin, and proper functioning of the immune system. Dark-green leafy vegetables and many orange fruits and vegetables are excellent sources of beta-carotene, a substance that the body converts into vitamin A.

Vitamin D helps the body use calcium and phosphorus to build strong bones and teeth. With direct sunlight on the skin, the body can manufacture its own vitamin D. In the United States and Canada vitamin D is routinely added to milk during processing, and it is often added to cereals, margarine, and soy milk.

Vitamin E helps protect the body’s cells from damage by oxygen. It is found in vegetable oils, nuts, seeds, wheat germ, and whole grains.

Vitamin K is necessary for normal blood clotting. Food sources include green leafy vegetables, cabbage, cauliflower, eggs, and liver.

Water-soluble vitamins

The water-soluble vitamins dissolve in water. They include vitamin C and eight B vitamins. Except for vitamin B 12 , these vitamins are not stored in the body for long. Good sources should be eaten every day.

Vitamin C, or ascorbic acid, is essential for healthy teeth, gums, and blood vessels. It also helps the body heal wounds and resist infections. Good food sources of vitamin C include citrus fruits, berries, and green leafy vegetables.

The B vitamins are thiamin, riboflavin, niacin, vitamin B 6 , vitamin B 12 , folic acid (folate), pantothenic acid, and biotin. They help turn carbohydrates into energy. They also are needed for a healthy nervous system and muscle coordination. Most of the B vitamins occur in a variety of foods from both animal and plant sources. However, vitamin B 12 is found only in animal foods. Vegans—vegetarians who eat no animal products (no meat, fish, dairy, or eggs) need to eat foods fortified with vitamin B 12 (such as enriched cereals and soy milk) or take B 12 supplements to avoid a deficiency of this vitamin.

Many people rightly think of rocks when they hear the term minerals . Minerals are also found in soil, metals, and water. To one’s body, minerals are another group of essential nutrients, needed to regulate body processes and fluid balance. Minerals also give structure to bones and teeth.

Minerals can be divided into two categories—major and trace—depending on how much the body needs. Major minerals, which are needed in larger amounts, include calcium , phosphorus , magnesium , sulfur , sodium chloride , and potassium . Trace minerals, or trace elements, include chromium, copper, fluoride, iodine, iron, manganese, molybdenum, selenium, zinc, and cobalt. Almost all foods contribute to a varied intake of essential minerals.

Water takes an active part in many chemical reactions in the body. It is also needed to carry other nutrients, to regulate body temperature, and to help eliminate wastes. About 50 to 60 percent of the body is water. Requirements for water intake can be met in many ways, such as drinking plain water, fruit juices, milk, and soups. Many fruits are about 90 percent water.

Guidelines for Good Nutrition

Government agencies and scientific bodies around the world publish a variety of nutritional recommendations to promote good public health. These guidelines have changed over time to incorporate new scientific findings. They also vary by culture. Diets in different countries have developed differently, on the basis of varying cultural traditions and preferences as well as access to different kinds of foods. For instance, on average, people in Pakistan get nearly 10 percent of their calories from dairy products, while people in China get less than 1 percent of their calories from dairy. Diets vary within countries too. The wealthy, for example, can afford foods that the poor cannot. A country’s guidelines are often tailored to combat specific types of nutritional problems commonly found there.

Some guidelines provide the amounts of specific nutrients that people need each day. For example, the Dietary Reference Intakes of the United States and Canada detail the daily amounts of vitamins, minerals, and other nutrients that men and women at various stages of life should consume.

Other guides, such as the United States government’s Dietary Guidelines for Americans , provide general advice for healthy eating. Some dietary plans recommend eating a certain number of servings from different food groups each day. Foods that provide similar nutrients are grouped together—for instance, into a bread-and-cereals group, a milk group, or a vegetable group.

To make the plans easier to understand and remember, they often feature a visual aid. The United States Department of Agriculture (USDA) published its first food pyramid in 1992. It arranged six food groups into a pyramid according to how many daily servings were recommended. Since then many countries have developed such aids, including food pyramids in Mexico and the Philippines, plates in Australia and the United Kingdom, a rainbow in Canada, a square in Zimbabwe, a pagoda in China, and a bean pot in Guatemala.

In 2005 the USDA introduced a revised food pyramid that included guidelines for healthy eating as well as for physical activity. Called MyPyramid, it provided a visual reminder to eat a variety of foods in moderate amounts and to be active every day. The pyramid featured five major food groups plus liquid oils. The amount one needed from each group depended on one’s age, sex, and activity level. The plan actually included 12 different pyramids, tailored to the needs of different groups. One could visit the guide’s Web site, enter information about the above factors, and receive the appropriate pyramid. The pyramids showed people how many calories they needed daily to maintain their weight and the number of servings they should get from each food group each day.

Although the specific guidelines of the plans differ, there are some common basic themes. Most advise eating a wide variety of nutrient-rich foods, including generous amounts of fresh fruits and vegetables. Another common recommendation is to eat whole grains (such as brown rice and whole-wheat bread), which provide more nutrients than refined grains (such as white rice and white bread). Most plans recommend limiting the amount of saturated and trans fats, sodium (salt), and added sugars, especially high-fructose corn syrup, in one’s diet. Exercising regularly and maintaining a healthy weight are also emphasized.

While government-based dietary guidelines are based on sound principles and can be followed safely by relatively healthy people, special diets for people with health problems should be prescribed by a physician. Individuals with food allergies, heart disease, hypertension (high blood pressure), or diabetes require careful meal planning. Many doctors refer such patients to a registered dietitian, who develops a customized diet plan.

USDA MyPlate

In 2011 the USDA replaced MyPyramid with a new plan called MyPlate. The new plan uses the simple guideline of a place setting to illustrate the five food groups and how much of each should be served at mealtime. The visual guide has a plate divided into four sections—one each for fruits, vegetables, grains, and protein. The size of each section represents the relative amount of each food group that should be consumed. In addition, a circle at the edge of the plate shows the proportion of dairy products to include with the meal. Unlike MyPyramid and earlier plans, MyPlate does not include a section for fats and oils. The plan’s Web site includes interactive features that help visitors plan and track their food.

The MyPlate plan encourages people to be physically active, but it does not include specific guidelines on exercise. Instead, it is partnered with another U.S. government initiative called Let’s Move. Established by American first lady Michelle Obama in 2010, Let’s Move encourages individuals to engage in physical activity as part of an active and healthy lifestyle. The program encourages adults to be physically active for at least 30 minutes most days of the week. Children and teenagers should be physically active for 60 minutes every day or most days.

Grain group

The grain group includes all foods made from wheat, rice, oats, cornmeal, barley, rye, and other grains. These include bread, pasta, oatmeal, breakfast cereals, tortillas, and pitas. Grains should make up a little more than one-quarter of the food on one’s plate, and at least half of all grains eaten should be whole grains, such as whole-wheat bread, brown rice, and whole-grain cereal. Whole grains provide B vitamins, iron and other minerals, carbohydrates, fiber, and some protein.

Vegetable group

The vegetable group includes all fresh, frozen, canned, and dried vegetables and vegetable juices. The vegetable group is divided into five subgroups based on nutrient content: dark green; red and orange; starchy; legumes; and other vegetables. The plan encourages individuals to eat a variety of these foods each week. Most vegetables are excellent sources of essential vitamins and minerals. Most are also high in fiber and low in calories and fat. Vegetables should make up a little more than one-quarter of the food on one’s plate.

Fruit group

The fruit group includes all fresh, frozen, canned, and dried fruits and 100-percent-fruit juices. Fruits are rich sources of vitamins, minerals, and fiber and are usually low in calories and fat. Fruits should comprise a little less than one-quarter of the food consumed at a meal. Eating whole fruits is generally considered a better choice than drinking fruit juice.

Protein group

In this group are meats , legumes (including soy products such as tofu, soy milk, and many “veggie burgers”), eggs , poultry , nuts and nut butters, seeds, and fish. The MyPlate plan advises people who eat meat to choose low-fat or lean meats and poultry and to vary their routine by eating more fish, beans, peas, nuts, and seeds. The foods in this group are important sources of protein and may also provide B vitamins, vitamin E, iron, and other minerals. Food from the protein group should make up a little less than one-quarter of the food on one’s plate.

Dairy group

Milk , cheese , and yogurt are included in the dairy group. Foods made from milk that have little or no calcium, such as cream cheese, cream, and butter, are not part of this group. One should choose low-fat or fat-free products most often. Foods in the dairy group are rich in calcium. They also supply potassium, vitamin D, and protein. For individuals nine years of age and older, three servings of dairy products are recommended daily. Vegans and other people who do not eat dairy can get calcium and other nutrients from some legumes, including soy products; leafy greens; broccoli; and a variety of calcium-enriched products.

Oils include fats that are liquid at room temperature, such as canola, corn, olive, soybean, and sunflower oils. Foods that are made primarily of liquid oils, such as soft margarine, mayonnaise, and salad dressings, are also in this group if they contain no trans fats. While oils are not considered a food group, they do contain important nutrients that are essential to good health. However, because they are so high in calories, oils should be consumed in very small amounts.

Empty Calories and Fast Food

Dieticians in many countries often emphasize the problems of eating too many “empty calories.” These are foods that are high in calories (often from unhealthful fats and added sugars) but that provide few nutrients in return. For example, soft drinks, salty snacks, candy , and sweets often provide one-fourth or more of the calorie requirements for American teenagers. Just as smart shoppers get the most for their money, smart eaters select foods that provide the most nutrition for the lowest number of calories.

In the United States and increasingly in other developed countries, fast foods and convenience foods are major parts of many people’s diets. Convenience foods, such as frozen TV dinners and frozen pizzas, are prepared at home from foods already cooked or otherwise processed before reaching the retail store. Fast foods are prepared in quick-service restaurants.

It is possible to make healthy choices from among such foods, but it requires thought about nutrients and calories. Many of these foods are extremely high in sodium and unhealthful trans and saturated fats. They often do supply protein, iron, and B vitamins, but they tend to be low in fiber, vitamins A and C, and sometimes calcium and other minerals. Depending on the items ordered, the calorie content of a typical fast-food meal ranges from 900 to 1,800. A deluxe double hamburger with cheese and all the trimmings can have 600 or more calories. A smaller, plain cheeseburger has about half as many, and a plain hamburger has fewer than that. A serving of pizza can have from 300 to 600 or more calories. A milk shake provides calcium, but it can also be high in saturated fat and contain more than 800 calories. Even fast-food salads can be high in fats and calories, depending on what is included and the amount of salad dressing added.

Malnutrition

Malnutrition is an imbalance between the body’s demand for nutrients and its available supply of nutrients. Malnutrition can result from an unsatisfactory diet or from a disorder that interferes with the body’s use of food.

The most common type of malnutrition in the world is protein-energy (or protein-calorie) malnutrition, in which a person chronically gets too little protein, calories, or both. Kwashiorkor, which results from severe protein deficiency, is common among young children in developing countries. It can cause weakness, failure to grow, swelling of the belly from water retention, anemia, and other health problems.

Prolonged deficiencies of specific minerals and vitamins are responsible for various disorders. Insufficient iron, for example, can cause iron-deficiency anemia. Lack of iodine can cause goiter, an enlargement of the thyroid gland.

Vitamin A deficiency can cause blindness or loss of vision in dim light. Vitamin D deficiency can lead to a faulty deposit of calcium in bones and teeth, resulting in rickets. A child with rickets may have bowed legs. Vitamin C deficiency can lead to scurvy. It causes infected and bleeding gums, painful joints, and impaired wound healing.

A prolonged deficiency of thiamin can result in beriberi, which damages the nerves and heart. Vitamin B 12 deficiency can cause blood disorders and affect the nervous system. It usually results from a defect of absorption in the digestive tract. Deficiencies of folic acid can cause anemia and other problems.

Obesity, the state of being excessively fat, is a form of malnutrition that can contribute to many health problems, including high blood pressure, heart disease, stroke, diabetes mellitus, and arthritis. It is broadly defined as having a body weight more than 20 percent above one’s ideal weight. The incidence of obesity, especially in children, rose dramatically in the late 20th century. According to the World Health Organization, which recognizes obesity as a worldwide epidemic, more than 300 million adults were obese in 2000, in both developed and developing countries.

Anorexia nervosa is an eating disorder characterized by extreme intentional dieting and weight loss. It requires professional treatment; if untreated, it can be life-threatening. This disorder occurs most often in young women in developed countries. An eating disorder called bulimia nervosa can also cause nutritional problems. This illness involves eating huge quantities of food at one sitting and then usually purging the food from the body by self-induced vomiting or other means.

Additional Reading

Clark, Nancy. Nancy Clark’s Sports Nutrition Guidebook, 3rd ed. (Human Kinetics, 2003). Duyff, R.L. The American Dietetic Association Complete Food and Nutrition Guide, 2nd ed. (Wiley, 2002). Hark, Lisa, and Deen, Darwin. Nutrition for Life (DK Publishing, 2005). Hess, M.A. Pocket Supermarket Guide, 3rd ed. (American Dietetic Association, 2005). Katz, D.L., and González, M.H. The Way to Eat (Sourcebooks, 2002). Litt, A.S. The College Student’s Guide to Eating Well on Campus (Tulip Hill, 2005). Pennington, J.A.T., and Douglass, J.S. Bowes & Church’s Food Values of Portions Commonly Used, 18th ed. (Lippincott, 2005). Warshaw, H.S. Eat Out, Eat Right!, 2nd ed. (Surrey Books, 2003).

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Nutrition resources made for RDs, by an RD

Writing the Nutrition Assessment Summary

Writing a nutrition assessment summary is one of the essential skills you’ll use every day as a clinical dietitian. Start here to learn how to write really good ones, fast.

How to Write a Nutrition Assessment Summary

A nutrition assessment summary is where everything important about your patient comes together for quick reference.

No matter if you choose to use bullet points or complete sentences. This is one of the most important parts of your notes. 

In this post, we’re going to go over:

• Why you need to know how to write an assessment summary
• Easy ways to write a nutrition assessment summary well
• Things to pay attention to when you’re writing the summary section of your nutrition assessment

Let’s start at the beginning and quickly talk about why we’re doing this in the first place. 

It's Not Just You

Trying to figure out how to write nutrition assessments and summaries that will make your preceptors proud is hard. 

Really hard.

And it’s SO MUCH harder when you’re trying to learn it at the same time you’re trying to learn everything else. 

When you’re starting your internship, you’re never just doing and learning one thing at a time.

You’re learning EVERYTHING. At the same time.

You’re navigating a new environment. And learning a new EMR system. Meeting new people and trying to remember names. You’re trying to be friendly and smart and organized. 

And that’s just Day 1.

You’re also seeing patients for the first time.

Which means you’re also starting to document on those patients, AND are expected to get so good at all of this in a few weeks that you can do it at lightning speed.

Let’s start by saying every facility you work in will have a slightly different template they use for nutrition assessments based on the EMR system they have in place.

This will directly impact things like:

• Where you’ll enter certain information
• If you use fill-in-the-blank boxes, click-box options, or drop down menus
• The way specific information is presented

What you’ll get here isn’t an exact replica of the EMR template your facility will use. Here, we’re taking about

The documentation you do for each patient you see will determine a few things:

• How fast you can see patients, which means it will determine if you can meet your internship’s requirements during staff relief.
• How well you can pull relevant information from the medical chart, which will be detailed in the assessment template you fill in AND the assessment summary you can free-write.
• How much you understand what the nutritional issues are and what you should do about them, which you’ll identify in your notes.

If you’re not able to do each one of these things, without question you’re going to have preceptors who will need you to learn them. 

You must be able to move quickly when reviewing patient care information and doing in-person evaluations.

You’ve got to be able to figure out what’s important and what’s not, then be able to organize and prioritize it all.

You’ve got to be able to take all the information you’ve pulled together and then create a summary that your preceptors will recognize as valuable.

It’s a lot on your plate. And it’s not easy.

So let’s talk about what you need to know how to do…and how to get that done.

Rather just get a full set of downloads so you can start writing better assessments, faster? The Clinical Evaluation Power Pack has everything you need to get started right now.

Why you need to know how to write a nutrition assessment summary.

The short answer is because it is ESSENTIAL to completing the documentation part of working as a clinical dietitian.

Which is exactly what you’ll be doing in your clinical rotations.

You know you’re supposed to know how to do the science part of clinical nutrition. Medical nutrition therapy is supposed to be the who point of being a clinical dietitian.

And it is. Mostly.

You cannot get through your clinical rotations without knowing your MNT basics .

You also CANNOT get through your clinical rotations without knowing how to chart on patients.

And because this isn’t taught –  there’s no class on how to write amazing nutrition assessment summaries – most dietetic interns start their clinical rotations without any understanding of how to do the documentation side of clinical.

Unfortunately, knowing all the MNT in the world means almost nothing if you can’t put that information into the document format that your facility is looking for.

But most specifically, the format that your each of your preceptors will approve of.

Before we dive into each of these, you’ve got to remember one more frustrating thing:

Every facility you work in will have a slightly different template they use for nutrition assessments based on the EMR system they have in place.

And as you feel more comfortable with the documentation you do, you’ll start to see changes in:

But we aren’t here to look at specific EMR nutrition assessment templates.

We’re here to help you get moving faster and more efficienctly, so you can use the assessment summary to your advantage and be able to:

• Move quickly when reviewing patient care information and doing in-person evaluations.
• Figure out what’s important and what’s not, then be able to organize and prioritize it all.
• Correctly compile all that information and to write a complete summary that your preceptor will love.

So, let’s get to it.

What exactly is the Nutrition Assessment Summary?

The nutrition assessment summary is the last part of each nutrition assessment, and are part of every template for new admissions and follow-ups, as well as quarterlies and annuals (if you’re in LTC).

This is where you can write whatever you want, in any kind of format you like.

The nutrition assessment summary is as important as you decide it is.

By the time you get to the summary section, you’ll have already entered all the most important information into the assessment template. 

The summary section is your chance to explain, expand, or reinforce anything you want to be able to quickly reference without reviewing the entire assessment for a single detail or fact. 

It’s also an opportunity to pull together everything relevant in a single spot. 

Every dietitian (which also means every preceptor) uses this space a little differently.

PRO TIP : There’s no right or wrong way to complete the assessment summary. And when you’re an RD, you can fill it out in any way you want.

But it does tend to be quite personal to the RD completing the assessment. So until then, the best advice to to follow your preceptor’s lead.

We’ll talk a lot more about that soon.

4 key parts to the nutrition assessment summary

There are 4 things you need to be able to do, in order to write a great nutrition assessment summary.

And learning to chart is always easier when you have a step-by-step guide.

Remember when talked about how every RD does their job just a little bit differently from each other?

Yea…that makes it really easy to quickly feel overwhelmed by what one preceptor says to do and what another tells you is a waste of time.

So let’s talk about the 4 things you need to be able to do:

• Know what to pay attention to in an EMR, and what you can ignore
• Combine what you learn from the chart with what you learn from your patient
• Write your notes and the assessment summary
• Use your preceptor’s language

Master these, and you’ll be THAT intern who always knows exactly how to handle everything that comes up.

How to complete each part of the nutrition assessment summary:

First: what to focus on in an emr.

The short answer is only what you need to know to complete the assessment.

The long answer is you’ve got to first decide what the most acute nutritional issue is. Then run that down through every key aspect of the medical chart including:

• Pertinent labs
• Relevant meds
• Current vs usual weight status, with a sprinkle of ideal reference in there
• Any ongoing, recent, or anticipated medical changes

What you don’t have to linger over are nursing notes that document a patient’s daily vitals or MedPass confirmations.

Get the Clinical Evaluation Power Pack for a complete bundle that includes what to focus on and what you can ignore.

Second: Adding to your EMR notes with patient answers

Going to see your patient, especially when they’re a new admit, is non-negotiable. 

Maybe you can’t speak to them because they’re intubated.

Maybe they don’t want anything to do with you and ignore you the second you enter their room.

It doesn’t matter.

The minute you lay eyes on your patients, you’re able to gather information that you’re not likely to find in their chart.

That might mean you can (or can’t) do a nutrition-focused physical exam. The answer to that goes in your note.

You might have a fantastic 4-minute conversation with them and learn exactly why they’re eating so much salt despite their CHF, their edema, and the cellulitis you noticed when you walked into the room. 

That goes in your note also.

Having that first conversation with your patient doesn’t have to take hours.

Think of it like a fact-finding mission. 

An opportunity to fill in some of the blanks you’ve discovered in the chart and make sure your final evaluation answers as many questions about your patient’s overall nutritional status as possible.

Things like:

• What your patient’s UBW is and how much they think it’s changed over the last 6 months or year
• If their CBW matches what you find in their physical or if they seem to have higher / lower risk for malnutrition (and what that’s based on)
• How much they’re really eating vs. how much the chart says they’re eating
• What they’re willing to eat and if they’re actually enjoying the ONS someone added

Need something to keep you focused on what’s most important in your assessments? The Clinical Evaluation Power Pack will keep you organized and focused.

Third: Writing the nutrition assessment summary

When you’re handed that first patient and told to “do their assessment”, where do you start?

The best thing you can do when you’re writing nutrition assessments for the first time is to be prepared. 

If you’ve collected all the information from the EMR that we talked about, and have a set of notes from when you talked to your patient, you’re ready to write your note.

But what about the nutrition assessment summary?

That intimidating, blank comment box at the end of the assessment template.

What goes into the assessment summary is a personal decision, and you’ll see every one of your preceptors write it in a slightly different way.

Some will keep it very simple and only include: 

• A bulleted list of what they’re going to monitor. 
• And another bulleted list of what interventions they’ll be using. 

Others will write out their patient’s goals. What they’ll be monitoring. And how they’ll be following up in a couple of very short sentences.

And then you’ll see other RDs use the box to summarize all or some of the information in the template in a few short sentences.

They’ll include all the information they consider relevant. And make sure it’s all easily accessible in one place, instead of having to scroll through a 7-page assessment.

Ultimately, it’s going to be your decision how you use that summary box when you’re an RD.

But if you’re stuck and you don’t know where to start, here’s a simple and very complete structure to follow for writing your nutrition assessment summary.

• The most acute nutritional issue (or whatever you’re intervention is based on)
• Any pertinent labs or medications relevant to their issue you’re focused on
• Detailing any wounds 
• Weight status, diet order, and how they might be related
• Goals, interventions, and monitoring objectives

This can be written out in complete sentences, bullet points, or a combination of both. You can add or subtract any amount of information to this shortlist.

As long as you’re completing the nutrition assessment template found in your facility’s EMR, you can write your assessment in your own way.

Need a detailed set of instructions on what actual sentences can look like in an assessment summary? The Clinical Evaluation Power Pack has mix-and-match phrases, along with a complete set of examples you can cut and paste to make life easier and writing a lot faster.

Fourth: Using your preceptor’s language

So now you know what to look for in an EMR.

You know what you’re going to find out from your patients when you visit them.

And you know have a solid format to follow when it’s time to write your nutrition assessment summary.

The final part of writing the assessment summary is just plain good advice for your dietetic internship.

As an intern, the best practice is to follow your preceptor’s lead.

If your preceptor likes to keep the summary box short and simple, then you keep the information you put in the summary section nice and short.

If your preceptor tends to lean more towards full nutrition summaries, that’s your cue to get more comprehensive.

Remember that as an intern, you’re charting under someone else’s credentials. 

It makes sense that they would be extremely particular with the language and phrasing you use in your notes.

True, it can make life pretty frustrating.

One preceptor will insist on you include certain items that another will consider completely irrelevant. 

This isn’t you not being smart enough. 

It’s about different RDs having different preferences. And that’s it. 

Make your life easier by reading one of their past assessments and using the exact same language refreshed for your new patient. 

If your preceptor likes listing out every single medication a patient is on and detailing the nutritional implications of every last one — then you do that too.

And if your next preceptor insists you only mention the “important ones”, then it’s time to switch it up.

No, this has nothing to do with learning nutrition.

Yes, you have to be able to do this no matter how annoying it is.

Maybe you have amazing preceptors who are patient and encourage you to develop your own voice.

That’s the dream, honey! You’ve won the internship jackpot.

But for the rest of you, you’re still going to have to write assessment summaries.

And you’re going to be evaluated on how well they match the voice and tone of the preceptor you’re charting under.

The best thing you can do for yourself is follow their lead. Give them what they want. And ask as many questions as you can fit into a day.

And That’s It!

Now you should have a really good sense about w hat to pay attention to in an EMR, and what you can ignore, h ow to combine what you learn from the chart with what you learn from your patient, w hat to include in your notes and the assessment summary, and w hy you’ve GOT to use your preceptor’s language

Looking for more posts about about how you can kill it in your internship? Check these out:

• How to Write a Nutritional Assessment: A complete guide
• 4 Nutrition Counseling Questions that Always Work
• Common Medical Nutrition Therapy: Tips for New RDs
• Clinical Nutrition Rotation: 4 Tips (that aren’t MNT)
• What is Clinical Bootcamp?

Want even more to help in clinical? Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.

Ready for More?

Clinical Nutrition Rotation: 4 Tips to Success (that aren’t MNT)

Clinical Nutrition Skills: Basics for Dietetic Interns

5 Online Tools for a Private Practice Dietitian

What Doctors Know About Nutrition

Cardiac Diet Education: Tips for RDs

Dietitian Confidence in Clinical Nutrition

Creating Liberalized Diets

Diabetes Diet Education: Tips for RDs

3 Surprising Dietitian Skills All RDs Should Have

Clinical Nutrition Resources: Toolkit for New RDs

Common Medical Nutrition Therapy: Tips for RDs

Get Matched to your dream dietetic internship

Health & Nutrition Unit: An Introduction to Nutrition Unit & Assignment

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Description

This unit is an introduction to nutrition. It has been created as a 5-6 lesson unit (at 70 mins a lesson), but each lesson has been designed to have multiple sections to allow for smaller lessons to be created.

Designed for diverse learning environments - students can complete it in a teacher-led class (the powerpoint is meant as a lecture aid) or use included scaffolding for independent learning at home (where students can work their way through the daily schedule).

This package includes:

- A Unit Outline with lessons planned

- A Nutrition Diagnostic quiz with answer sheet

- A WELL DESIGNED Interactive PowerPoint with activities, YouTube clips, definitions and examples, reflection and discussion questions, and MUCH more!

- Student Note-taking and Activity Package to accompany the PowerPoint

- A student Diet Tracking Activity , log, and assignment

- A Fast Food Menu Analysis activity

- A Unit Test with answer sheet

- BONUS : Create Your Own Nutritional Superhero Assignment

I also like to include watching the film Supersize Me, especially after students know the basics, as it really helps to drive home what's going on.

If you like this item, you might be interested in our other packages:

Personal Fitness Mini Unit: An Introduction

https://www.teacherspayteachers.com/Product/PERSONAL-FITNESS-Mini-Unit-Package-5122399

Wellness Research Presentations : https://www.teacherspayteachers.com/Product/Health-Wellness-Presentation-Assignment-4345937

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14.2 Nutrition Basic Concepts

Open Resources for Nursing (Open RN)

Before discussing assessments and interventions related to promoting good nutrition, let’s review the structure and function of the digestive system, essential nutrients, and nutritional guidelines.

Digestive System

The digestive system breaks down food and then absorbs nutrients into the bloodstream via the small intestine and large intestine. Because good health depends on good nutrition, any disorder affecting the functioning of the digestive system can significantly impact overall health and well-being and increase the risk of chronic health conditions.

Structure and Function

The gastrointestinal system (also referred to as the digestive system) is responsible for several functions, including digestion, absorption, and immune response. Digestion begins in the upper gastrointestinal tract at the mouth, where chewing of food occurs, called mastication. Mastication results in mechanical digestion when food is broken down into small chunks and swallowed. Masticated food is formed into a bolus as it moves toward the pharynx in the back of the throat and then into the esophagus. Coordinated muscle movements in the esophagus called peristalsis move the food bolus into the stomach where it is mixed with acidic gastric juices and further broken down into chyme through a chemical digestion process. As chyme is moved out of the stomach and into the duodenum of the small intestine, it is mixed with bile from the gallbladder and pancreatic enzymes from the pancreas for further digestion. [1]

Absorption is a second gastrointestinal function. After chyme enters the small intestine, it comes into contact with tiny fingerlike projections along the inside of the intestine called villi. Villi increase the surface area of the small intestine and allow nutrients, such as protein, carbohydrates, fat, vitamins, and minerals, to absorb through the intestinal wall and into the bloodstream. Absorption of nutrients is essential for metabolism to occur because nutrients fuel bodily functions and create energy. Peristalsis moves leftover liquid from the small intestine into the large intestine, where additional water and minerals are absorbed. Waste products are condensed into feces and excreted from the body through the anus. [2] See Figure 14.1 [3] for labeled parts of the gastrointestinal system.

In addition to digestion and absorption, the gastrointestinal system is also involved in immune function. Good bacteria in the stomach create a person’s gut biome. Gut biome contributes to a person’s immune response through antibody production in response to foreign materials, chemicals, bacteria, and other substances. [4] For example, clients may develop Clostridium difficile (C-diff) after taking antibiotics that kill these beneficial bacteria in the gut. Read additional details about our microbiome and immune response in the “ Infection ” chapter of this book.

Essential Nutrients

Nutrients from food and fluids are used by the body for growth, energy, and bodily processes. Essential nutrients refer to nutrients that are necessary for bodily functions but must come from dietary intake because the body is unable to synthesize them. Essential nutrients include vitamins, minerals, some amino acids, and some fatty acids. [5] Essential nutrients can be further divided into macronutrients and micronutrients.

Macronutrients

Macronutrients make up most of a person’s diet and provide energy, as well as essential nutrient intake. Macronutrients include carbohydrates, proteins, and fats. However, too many macronutrients without associated physical activity cause excess nutrition that can lead to obesity, cardiovascular disease, diabetes mellitus, kidney disease, and other chronic diseases. Too few macronutrients result in undernutrition, which contributes to nutrient deficiencies and malnourishment. [6]

Carbohydrates

Carbohydrates are sugars and starches and are an important energy source that provides 4 kcal/g of energy. Simple carbohydrates are small molecules (called monosaccharides or disaccharides) and break down quickly. As a result, simple carbohydrates are easily digested and absorbed into the bloodstream, so they raise blood glucose levels quickly. Examples of simple carbohydrates include table sugar, syrup, soda, and fruit juice. Complex carbohydrates are larger molecules (called polysaccharides) that break down more slowly, which causes slower release into the bloodstream and a slower increase in blood sugar over a longer period of time. Examples of complex carbohydrates include whole grains, beans, and vegetables. [7]

Foods can also be categorized according to their glycemic index , a measure of how quickly glucose levels increase in the bloodstream after carbohydrates are consumed. The glycemic index was initially introduced as a way for people with diabetes mellitus to control their blood glucose levels. For example, processed foods, white bread, white rice, and white potatoes have a high glycemic index. They quickly raise blood glucose levels after being consumed and also cause the release of insulin, which can result in more hunger and overeating. However, foods such as fruit, green leafy vegetables, raw carrots, kidney beans, chickpeas, lentils, and bran breakfast cereals have a low glycemic index. These foods minimize blood sugar spikes and insulin release after eating, which leads to less hunger and overeating. Eating a diet of low glycemic foods has been linked to a decreased risk of obesity and diabetes mellitus. [8] See Figure 14.2 [9] for an image of the glycemic index of various foods.

Proteins are peptides and amino acids that provide 4 kcal/g of energy. Proteins are necessary for tissue repair and function, growth, energy, fluid balance, clotting, and the production of white blood cells. Protein status is also referred to as nitrogen balance . Nitrogen is consumed in dietary intake and excreted in the urine and feces. If the body excretes more nitrogen than it takes in through the diet, this is referred to as a negative nitrogen balance. Negative nitrogen balance is seen in clients with starvation or severe infection. Conversely, if the body takes in more nitrogen through the diet than what is excreted, this is referred to as a positive nitrogen balance. [10] During positive nitrogen balance, excess protein is converted to fat tissue for storage.

Proteins are classified as complete, incomplete, or partially complete. Complete proteins must be ingested in the diet. They have enough amino acids to perform necessary bodily functions, such as growth and tissue maintenance. Examples of foods containing complete proteins are soy, quinoa, eggs, fish, meat, and dairy products. Incomplete proteins do not contain enough amino acids to sustain life. Examples of incomplete proteins include most plants, such as beans, peanut butter, seeds, grains, and grain products. Incomplete proteins must be combined with other types of proteins to add to amino acids and form complete protein combinations. [11] For example, vegetarians must be careful to eat complementary proteins, such as grains and legumes, or nuts and seeds and legumes, to create complete protein combinations during their daily food intake. Partially complete proteins have enough amino acids to sustain life, but not enough for tissue growth and maintenance. Because of the similarities, most sources consider partially complete proteins to be in the same category as incomplete proteins. See Figure 14.3 [12] for an image of protein-rich foods.

Fats consist of fatty acids and glycerol and are essential for tissue growth, insulation, energy, energy storage, and hormone production. Fats provide 9 kcal/g of energy. [13]  While some fat intake is necessary for energy and uptake of fat-soluble vitamins, excess fat intake contributes to heart disease and obesity. Due to its high-energy content, a little fat goes a long way.

Fats are classified as saturated, unsaturated, and trans fatty acids. Saturated fats come from animal products, such as butter and red meat (e.g., steak). Saturated fats are solid at room temperature. Recommended intake of saturated fats is less than 10% of daily calories because saturated fat raises cholesterol and contributes to heart disease. [14]

Unsaturated fats come from oils and plants, although chicken and fish also contain some unsaturated fats. Unsaturated fats are healthier than saturated fats. Examples of unsaturated fats include olive oil, canola oil, avocados, almonds, and pumpkin seeds. Fats containing omega-3 fatty acids are considered polyunsaturated fats and help lower LDL cholesterol levels. Fish and other seafood are excellent sources of omega-3 fatty acids.

Trans fats are fats that have been altered through a hydrogenation process, so they are not in their natural state. During the hydrogenation process, fat is changed to make it harder at room temperature and have a longer shelf life. Trans fats are found in processed foods, such as chips, crackers, and cookies, as well as in some margarines and salad dressings. Minimal trans-fat intake is recommended because it increases cholesterol and contributes to heart disease. [15]

Micronutrients

Micronutrients include vitamins and minerals.

Vitamins are necessary for many bodily functions, including growth, development, healing, vision, and reproduction. Most vitamins are considered essential because they are not manufactured by the body and must be ingested in the diet. Vitamin D is also manufactured through exposure to sunlight. [16]

Vitamin toxicity can be caused by overconsumption of certain vitamins, such as vitamins A, D, C, B6, and niacin. Conversely, vitamin deficiencies can be caused by various factors, including poor food intake due to poverty, malabsorption problems with the gastrointestinal tract, drug and alcohol abuse, proton pump inhibitors, and prolonged parenteral nutrition. Deficiencies can take years to develop, so it is usually a long-term problem for clients. [17]

Vitamins are classified as water soluble or fat soluble. Water-soluble vitamins are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid). Additional water-soluble vitamins include biotin and pantothenic acid. Excess amounts of these vitamins are excreted through the kidneys in urine, so toxicity is rarely an issue, though excess intake of vitamin B6, C, or niacin can result in toxicity. [18] See Table 14.2a for a list of selected water-soluble vitamins, their sources, and their function. [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27]

Table 14.2a Selected Water-Soluble Vitamins

Fat-soluble vitamins are absorbed with fats in the diet and include vitamins A, D, E, and K. They are stored in fat tissue and can build up in the liver. They are not excreted easily by the kidneys due to storage in fatty tissue and the liver, so overconsumption can cause toxicity, especially with vitamins A and D. [28] See Table 14.2b for a list of selected fat-soluble vitamins, their sources, their function, and manifestations of deficiencies and toxicities. [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37]

Table 14.2b Selected Fat-Soluble Vitamins

Minerals are inorganic materials essential for hormone and enzyme production, as well as for bone, muscle, neurological, and cardiac function. Minerals are needed in varying amounts and are obtained from a well-rounded diet. In some cases of deficiencies, mineral supplements may be prescribed by a health care provider. Deficiencies can be caused by malnutrition, malabsorption, or certain medications, such as diuretics.

Minerals are classified as either macrominerals or trace minerals. Macrominerals are needed in larger amounts and are typically measured in milligrams, grams, or milliequivalents. Macrominerals include sodium, potassium, calcium, magnesium, chloride, and phosphorus. Macrominerals are discussed in further detail in the “Electrolytes” section of the  “ Fluids and Electrolytes ” chapter of this book.

Trace minerals are needed in tiny amounts. Trace minerals include zinc, iron, chromium, copper, fluorine, iodine, manganese, molybdenum, and selenium. [38] See Table 14.2c for a list of selected macrominerals and Table 14.2d for a list of trace minerals. [39] , [40] , [41] , [42]

Table 14.2c Macrominerals

Table 14.2d Trace Minerals

Nutritional Guidelines

Nutritional guidelines are developed by governmental agencies to provide guidance to the population on how to best meet nutritional needs. These guidelines may vary by country. The National Academies of Sciences, Engineering, and Medicine set the Dietary Reference Intakes (DRIs) for the United States and Canada. Dietary Reference Intakes (DRIs) are a set of reference values used to plan and assess nutrient intakes of healthy people, including proteins, carbohydrates, fats, vitamins, minerals, and fiber. Nutrients included in the DRIs are obtained through a typical diet, although some foods may be fortified with certain nutrients that are commonly deficient in diets. [43]

Choose MyPlate Food Guide

The U.S. Department of Agriculture (USDA) issues dietary guidelines for appropriate serving sizes of each food group and number of servings recommended each day. The “Choose MyPlate” food guide is an easy-to-understand visual representation of how a healthy plate of food should be divided based on food groups. See Figure 14.4 [44] for a Choose MyPlate image. A little more than half of the plate should be grains and vegetables, with a focus on whole grains and a variety of vegetables. About one quarter of the plate should be fruits, with an emphasis on whole fruits. About one quarter of the plate should be protein, with an emphasis on consuming a variety of low-fat protein sources. All of these groups combined should make up no more than 85% of daily caloric intake based on a 2,000-calorie diet. Fats, oils, and added sugars are not included, but should make up no more than 15% of daily caloric intake. Foods should be selected that are as nutrient-dense as possible. Nutrient-dense foods mean there is a high proportion of nutritional value relative to calories contained in the food, such as fruits and vegetables. Conversely, calorie-dense foods should be minimized because they have a large amount of calories with few nutrients. For example, candy and soda are calorie-dense with few nutrients and should be minimized. [45] , [46] See Figure 14.5 for an image of MyPlate [47]

Figure 14.4 MyPlate Food Guide

Read more about USDA MyPlate guidelines at https://www.myplate.gov/ .

MyPlate information and images are also available in several other languages so that education can be tailored to the client’s preferred language. For example, Figure 14.5 [48] shows MyPlate in Vietnamese. This image would be accompanied with written information about food groups that include the client’s typical dietary choices.

Vegetable Group

For a well-rounded diet, a variety of vegetables should be consumed, including vegetables from all five vegetable groups: dark green leafy vegetables; red and orange vegetables; beans, peas, and lentils (formerly called the legumes group); starchy vegetables; and other vegetables. Vegetables can be fresh, frozen, canned, or dried. Dark green leafy vegetables include kale, Swiss chard, spinach, broccoli, and salad greens. Red and orange vegetables include carrots, bell peppers, sweet potatoes, tomatoes, tomato juice, and squash. The beans, peas, and lentils group includes dried beans, black beans, chickpeas, kidney beans, split peas, and black-eyed peas. (Note that this group does not include green beans or green peas.) This vegetable group also supplies some protein and can be included in the protein group as well. Starchy vegetables include root vegetables, such as potatoes, as well as corn. The “other vegetables” category includes any vegetable that doesn’t fit in the other four categories, such as asparagus, avocados, brussels sprouts, cabbage, cucumbers, snow peas, and mushrooms, and a variety of others.

Daily serving suggestions of vegetables for individuals with a 2,000 calorie diet are 2 ½ cup equivalents of vegetables per day. For example, a “one cup equivalent” equals 1 cup raw or cooked vegetables, one cup 100% vegetable juice, ½ cup of dried vegetables, or 2 cups of leafy green vegetables. Approximately 90% of Americans do not meet the recommended daily intake of vegetables. [49] See Figure 14.6 [50] for an image of vegetables.

Grain Group

Grains are classified as whole grains or refined grains. Whole grains include the entire grain kernel and supply more fiber than refined grains. Examples of whole grains include amaranth, whole barley, popcorn, oats, whole grain cornmeal, brown or wild rice, and whole grain cereal or crackers. Refined grains have been processed to remove parts of the grain kernel and supply little fiber. As a result, they quickly increase blood glucose levels. Examples of refined grains include white bread, white rice, Cream of Wheat, pearled barley, white pasta, and refined-grain cereals or crackers. Some grains are fortified to ensure adequate intake of folic acid. See Figure 14.7 [51] for an image of whole grain whole wheat bread.

The daily serving suggestions of grains for an individual with a 2,000-calorie diet are six-ounce equivalents per day, split equally between whole and refined grains. For example, a “one ounce equivalent” of grains equals ½ cup of cooked rice, pasta, or cereal or 1 cup of flaked cereal. Most Americans consume adequate amounts of total grains, although roughly 98% are deficient in recommended whole grain amounts, and 74% consume more than the recommended refined grain amounts. [52]

Fruit Group

Fruits can be frozen, canned, or dried, in addition to 100% fruit juice. A few examples of fruits include apples, oranges, bananas, melons, peaches, apricots, pineapples, and rhubarb. Daily serving suggestions of fruits for an individual with a 2,000-calorie diet are 2 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of raw or cooked fruit, 8 ounces of 100% fruit juice, or ½ cup of dried fruit. Approximately 80% of Americans do not consume the recommended daily intake of fruits. [53] See Figure 14.8 [54] for an image of fruits.

Dairy Group

Dairy products can be liquid, dried, semi-solid, or solid depending on the type of product. Dairy products include milk, lactose-free milk, fortified soy milk, buttermilk, cheese, yogurt, and kefir. Sour cream and cream cheese are not considered dairy items in terms of nutritional benefits. Daily serving suggestions of dairy products for an individual with a 2,000-calorie diet are 3 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of milk, soy milk, or yogurt; 1 ½ ounces of natural cheese, or 2 ounces of processed cheese. Approximately 90% of Americans consume less than the recommended daily intake of dairy products. [55] See Figure 14.9 [56] for an image of dairy products.

Protein Group

Proteins are categorized by the type of protein source. The meats, poultry, and eggs category consists of any type of animal or poultry meat, organ meat, or poultry egg. Lean meats should be selected to minimize fat and calorie intake from high-fat meats.

The seafood category includes any type of fish, clams, crab, lobster, oyster, and scallops. It is important to choose fish with low mercury levels to prevent negative effects of a buildup of mercury in the body. In general, large, fatty ocean fish, such as tuna, have higher levels of mercury due to their diet and storage of mercury in their fatty tissues.

The nuts, seeds, and soy products category includes tree nuts, peanuts, nut butters, seeds, or seed butters. Soy products include tofu and any other products made from soy. Unsalted nuts should be selected to avoid excess salt intake.

Protein is also contained in other food groups, such as dairy or the vegetable category of peas, beans, and lentils. Daily serving suggestions of proteins for individuals with a 2,000-calorie diet are 5 ½ ounce equivalents per day. Servings should total up to 26-ounce equivalents per week of meats, eggs, and poultry; 8-ounce equivalents per week of seafood; and 5-ounce equivalents per week of nuts, seeds, or soy products. A “one ounce equivalent” of protein equals 1 ounce of lean meat, one egg, ¼ cup cooked beans, or 1 tablespoon of peanut butter. Most Americans consume adequate amounts of protein, but many consume proteins high in saturated fat and sodium that contribute to diseases such as coronary artery disease. [57]

Oil/Fat Group

Examples of oils are vegetable oil, canola oil, olive oil, butter, lard, and coconut oil. Daily serving suggestions of fats or oils for individuals with a 2,000-calorie diet are 27 grams per day. While it is important to limit oils and fats due to their calorie-dense nature, some fat and oil intake is essential for nutrient absorption and overall health. It is best to select healthy unsaturated fats, such as avocados, nuts, or olive oil. [58]

A person’s gender affects their calorie and nutrient requirements. Males typically have higher calorie and protein needs related to increased muscle mass. Females typically require fewer calories to maintain their body weight due to a higher proportion of adipose (fat tissue) than muscle. Menstruating females also have higher iron requirements to offset losses that occur during menstruation.

Read Nutrition and Food Safety Information and Resources for Healthcare Professionals from the U.S. Food and Drug Administration.

Factors Affecting Nutritional Status

Now that we have discussed basic nutritional concepts and dietary guidelines, let’s discuss factors that can affect a person’s nutritional status. Many things that can cause altered nutrition, such as physiological factors, cultural and religious beliefs, economic resources, drug and nutrient disorders, surgery, altered metabolic states, alcohol and drug abuse, and psychological states.

Physiological Factors

Nutritional intake is affected by several physiological factors. Appetite is controlled by the hypothalamus, a tiny gland deep within the brain that triggers feelings of hunger or fullness depending on hormone and neural signals being sent and received. See Figure 14.10 [59] for an image of the hypothalamus indicated by the red arrow. Hunger causes a feeling of emptiness in the abdomen and is often accompanied by audible noises coming from the abdomen as the stomach contracts due to emptiness. Hunger can cause feelings of discomfort, nausea, and tiredness. Satiety is a feeling of fullness that often comes after eating, although it can also be caused by impairments of the hypothalamus. Electrolyte imbalances and fluid volume imbalances can also trigger hunger and thirst by sending signals to the hypothalamus. [60]

The five senses play an important role in food intake. For example, food with a pleasing aroma may induce mouth watering and hunger, whereas food or environments with displeasing aromas often suppress the appetite. Texture and taste of foods also play a role in stimulation of appetite.

Poor dentition or poor oral care has a negative effect on appetite, so adequate oral care is crucial for clients prior to eating. [61] Additionally, the condition of a client’s teeth and gums, the fit of dentures, and gastrointestinal function also play an important role in nutrition. Loose teeth, swollen gums, or poor-fitting dentures can make eating difficult.

Difficulty swallowing, called dysphagia , can make it dangerous for the client to swallow food because it can result in pneumonia from aspiration of food into the lungs. Special soft diets or enteral or parenteral nutrition are typically prescribed for clients with dysphagia. Nurses collaborate with speech therapists when assessing and managing dysphagia.

A poorly functioning gastrointestinal tract makes nutrient absorption difficult and can result in malnourishment. Diseases that cause inflammation of the gastrointestinal tract impair absorption of nutrients. Examples of these conditions include esophagitis, gastritis, inflammatory bowel disease, and cholecystitis. Clients with these disorders should select nutrient-dense foods and may require prescribed supplements to increase nutrient intake.

Cultural and Religious Beliefs

Cultural and religious beliefs often influence food selection and food intake. It is important for nurses to conduct a thorough client assessment, including food preferences, to ensure adequate nutritional intake during hospitalization. The nurse should not assume a particular diet based on a client’s culture or religion, but instead should determine their individual preferences through the assessment interview.

Cultural beliefs affect types of food eaten and when they are eaten. Some foods may be restricted due to beliefs or religious rituals, whereas other foods may be viewed as part of the healing process. For example, some cultures do not eat pork because it is considered unclean, and others eat “kosher” food that prescribes how food is prepared. Some religions fast during religious holidays from sunrise to sunset, where others avoid eating meat during the time of Lent. [62] , [63]

Economic Resources

If a client has inadequate financial resources, food security and food choices are often greatly impacted. Healthy, nutrient-dense, fresh foods typically cost more than prepackaged, heavily processed foods. Poor economic status is correlated with the consumption of calorie-dense, nutrient-poor food choices, putting these individuals at risk for inadequate nutrition and obesity. [64] Social programs such as Meals on Wheels, free or reduced-cost school breakfast and lunch programs, and government subsidies based on income help reduce food insecurity and promote the consumption of healthy, nutrient-dense foods. Nurses refer at-risk clients to social workers and case managers for assistance in applying for these social programs.

Drug and Nutrient Interactions

Some prescription drugs affect nutrient absorption. For example, some medications such as proton pump inhibitors (omeprazole) alter the pH of stomach acid, resulting in poor absorption of nutrients. Other medications, such as opioids, often decrease a person’s appetite or cause nausea, resulting in decreased calorie and nutrient intake.

Surgery can affect a client’s nutritional status due to several factors. Food and drink are typically withheld for a period of time prior to surgery to prevent aspiration of fluid into the lungs during anesthesia. Anesthesia and pain medication used during surgery slow peristalsis, and it often takes time to return to normal. Slow peristalsis can cause nausea, vomiting, and constipation. Until the client is able to pass gas and bowel sounds return, the client is typically ordered to have nothing by mouth (NPO). If a client experiences prolonged NPO status, such as after significant abdominal surgery, intravenous fluids and nutrition may be required.

Surgery also stimulates the physiological stress response and increases metabolic demands, causing the need for increased calories. The stress response can also cause elevated blood glucose levels due to the release of corticosteroids, even if the client has not been previously diagnosed with diabetes mellitus. For this reason, nurses often monitor post-op clients’ bedside blood glucose levels carefully.

Bowel resection surgery in particular has a negative impact on nutrient absorption. Because all or parts of the intestine are removed, there is decreased absorption of nutrients, which can result in nutrient deficiencies. Many clients who have experienced bowel resection require nutrient supplementation.

Bariatric surgery is used to treat obesity and reduce obesity-related cardiovascular risk factors. Bariatric procedures alter the anatomy and physiology of the gastrointestinal tract, which makes clients susceptible to nutritional deficiencies. [65] Read more about bariatric surgery and long-term nutritional issues in the following box.

Read more about bariatric surgery and long-term nutritional issues . [66]

Altered Metabolic States

Metabolic demands impact nutrient intake. In conditions where metabolic demands are increased, such as during growth spurts in childhood or adolescence, nutritional intake should be increased. Disease states, such as cancer, hyperthyroidism, and AIDS, can increase metabolism and require an increased amount of nutrients. However, cancer treatment, such as radiation and chemotherapy, often causes nausea, vomiting, and decreased appetite, making it difficult for clients to obtain adequate nutrients at a time when they are needed in high amounts due to increased metabolic demand.

Other diseases like diabetes mellitus cause complications with nutrient absorption due to insulin. Insulin is necessary for the metabolism of fats, proteins, and carbohydrates, but in clients with diabetes mellitus, insulin production is insufficient or their body is not able to effectively use circulating insulin. This lack of insulin can result in impaired nutrient metabolism.

Alcohol and Drug Misuse

Alcohol and drug misuse can affect nutritional status. Alcohol is calorie-dense and nutrient-poor. With alcohol use, the consumption of water, food, and other nutrients often decreases as clients “drink their calories.” This may result in decreased protein intake and body protein deficiency. Nutrient digestion and absorption can also decrease with alcohol consumption if the stomach lining becomes eroded or scarred. This can cause hemoglobin, hematocrit, albumin, folate, thiamine, vitamin B12, and vitamin C deficiencies, as well as decreased calcium, magnesium, and phosphorus levels. [67]

Misuse of stimulants, such as methamphetamine and cocaine, causes an increased metabolic rate and decreased appetite and contributes to weight loss and malnourishment.

Psychological State

Various psychological states have a direct effect on appetite and a client’s desire to eat. Acute and chronic stress stimulates the hypothalamus and increases production of glucocorticoids and glucose. This can increase the person’s appetite, causing increased calorie intake, fat storage, and subsequent weight gain. When a person feels stressed, their food choices are often nutrient-poor and calorie-dense, which further increases weight gain and nutrient deficiencies. In other individuals, the stress response causes loss of appetite, weight loss, and nutrient deficiencies. [68]

Depression can cause loss of appetite or overeating. Many people eat calorie-dense “comfort foods” as a coping mechanism. Additionally, many antidepressants can cause weight gain as a side effect.

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• “ MyPlate_blue.png ” by USDA is licensed under CC0 ↵
• USDA MyPlate. (n.d.). What’s on your plate? U.S. Department of Agriculture. https://www.myplate.gov/ ↵
• “ MyPlate_blue.png ” by  USDA  is licensed under  CC0 ↵
• “ MyPlate_Vietnamese.png ” by USDA is licensed under CC0 ↵
• “ Food-healthy-vegetables-potatoes_(23958160949).jpg ” by www.Pixel.la Free Stock Photos is licensed under CC0 ↵
•  “ front_en.3.400.jpg ” by   openfoodfacts-contributors is licensed under CC BY-SA 3.0 ↵
• “ Culinary_fruits_cropped_top_view.jpg ” by Bill Ebbesen is licensed under CC BY 3.0 ↵
• “ Good_Dairy_Sources.png ” by Brookepinsent is licensed under CC BY-SA 4.0 ↵
• “ Hypothalamus.jpg ” by Methoxyroxy~commonswiki is in the Public Domain ↵
• Human Nutrition by University of Hawai’i at Mānoa Food Science and Human Nutrition Program is licensed under CC BY 4.0 ↵
• Dindyal, S., & Dindyal, S. (n.d.). How personal factors, including culture and ethnicity, affect the choices and selection of food we make. Internet Scientific Publications, 1 (3). https://ispub.com/IJTWM/1/2/11779 ↵
• Stewardship. (n.d.). What is Lent? When does Lent start? What to do during Lent? https://www.stewardship.org.uk/blogs/what-is-lent ↵
• Alkerwi, A., Vernier, C., Sauvageot, N., Crichton, G., & Elias, M. (2015). Demographic and socioeconomic disparity in nutrition: Application of a novel correlated component regression approach. BMJ Open, 5 (5). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431064/ ↵
• Lupoli, R., Lembo, E., et al. (2017). Bariatric surgery and long-term nutritional issues. World Journal of Diabetes , 8 (11), 464-474. https://doi.org/10.4239/wjd.v8.i11.464 ↵
• Gramlich, L., Tandon, P., & Rahman, A. (2019). Nutritional status in patients with sustained heavy alcohol use. UpToDate. Retrieved February 21, 2021, from https://www.uptodate.com/contents/nutritional-status-in-patients-with-sustained-heavy-alcohol-use?csi=5c4a69dc-6adc-4ae0-a572-4be3ef0e325f&source=contentShar e ↵
• Ulrich-Lai, Y. M., Fulton, S., Wilson, M., Petrovich, G., & Rinaman, L. (2015). Stress exposure, food intake and emotional state. Stress (Amsterdam, Netherlands), 18 (4), 381–399. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843770 / ↵

The chewing of food in the mouth.

Breaking food down into small chunks through chewing prior to swallowing.

Involuntary contraction and relaxation of the muscles of the intestine, creating wave-like movements that push digested content forward in the digestive tract.

Breakdown of food with stomach acids, bile, and pancreatic enzymes for nutrient release.

Nutrients that must be ingested from dietary intake. Essential nutrients cannot be synthesized by the body.

Nutrients needed in larger amounts due to energy needs. Macronutrients include carbohydrates, proteins, and fats.

Sugars and starches that provide an important energy source, providing 4 kcal/g of energy.

Small molecules of monosaccharides or disaccharides and break down quickly and raise blood glucose levels quickly.

Larger molecules of polysaccharides that break down more slowly and release sugar into the bloodstream more slowly than simple carbohydrates.

A measure of how quickly glucose levels increase in the bloodstream after carbohydrates are consumed.

Peptides and amino acids that provide 4 kcal/g of energy

The net loss or gain of nitrogen excreted compared to nitrogen taken into the body in the form of protein consumption; an indicator of protein status where a negative nitrogen balance equates to a protein deficit in the diet and a positive nitrogen balance equates to a protein excess in the diet.

Proteins with enough amino acids in enough quantities to perform necessary functions such as growth and tissue maintenance.

Proteins that do not contain enough amino acids to sustain life.

Proteins that have enough amino acids to sustain life, but not enough for tissue growth and maintenance.

Fatty acids and glycerol that are essential for tissue growth, insulation, an energy source, energy storage, and hormone production.

Fats derived from animal products, such as butter, tallow, and lard for cooking or meat products such as steak.

Fats derived from oils and plants, though chicken and fish contain some unsaturated fats as well.

Fats that have been altered through hydrogenation and as such are not in their natural state.

Vitamins that are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid, biotin, and pantothenic acid).

Vitamins that dissolve in fats and oils and are stored in fat tissue and can build up in the liver, resulting in toxicity.

Minerals needed in larger amounts and measured in milligrams, grams, and milliequivalents.

Minerals needed in tiny amounts.

Set requirements or limit amounts of a certain nutrient, including protein, carbohydrates, fats, vitamins, minerals, and fiber.

Foods with a high proportion of nutritional value relative to calories contained in the food.

Foods with a substantial amount of calories and few nutrients.

Grains with the entire grain kernel that supply more fiber than refined grains.

Grains that have been processed to remove parts of the grain kernel and supply little fiber.

Impaired swallowing.

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Chapter 14 Nutrition

14.1. nutrition introduction, learning objectives.

• Describe variables that influence nutrition
• Identify factors related to nutrition across the life span
• Assess a patient’s nutritional status
• Outline specific nursing interventions to promote nutrition
• Base your decisions on the action of nutrients, signs of excess and deficiency, and specific foods associated with each nutrient
• Base your decisions on the interpretation of diagnostic tests and lab values indicative of a disturbance in nutrition
• Give examples of appropriate vitamin use across the life span
• Identify evidence-based practices related to nutrition

Nurses promote healthy nutrition to prevent disease, assist patients to recover from illness and surgery, and teach patients how to optimally manage chronic illness with healthy food choices. Healthy nutrition helps to prevent obesity and chronic diseases, such as diabetes mellitus and cardiovascular disease. By proactively encouraging healthy eating habits, nurses provide the tools for patients to maintain their health, knowing it is easier to stay healthy than to become healthy after disease sets in. When patients are recovering from illness or surgery, nurses use strategies to promote good nutrition even when a patient has a poor appetite or nausea. If a patient develops chronic disease, the nurse provides education about prescribed diets that can help manage the disease, such as a low carbohydrate diet for patients with diabetes or a low fat, low salt, low cholesterol diet for patients with cardiovascular disease.

Nurses also advocate for patients with conditions that can cause nutritional deficits. For example, a nurse may be the first to notice that a patient is having difficulty swallowing at mealtime and advocates for a swallow study to prevent aspiration. A nurse may also notice other psychosocial risk factors that place a patient at risk for poor nutrition in their home environment and make appropriate referrals to enhance their nutritional status. Nurses also administer alternative forms of nutrition, such as enteral (tube) feedings or parenteral (intravenous) feedings.

This chapter will review basic information about the digestive system, essential nutrients, nutritional guidelines, and then discuss the application of the nursing process to addressing patients’ nutritional status.

14.2. NUTRITION BASIC CONCEPTS

Before discussing assessments and interventions related to promoting good nutrition, let’s review the structure and function of the digestive system, essential nutrients, and nutritional guidelines.

Digestive System

The digestive system breaks down food and then absorbs nutrients into the bloodstream via the small intestine and large intestine. Because good health depends on good nutrition, any disorder affecting the functioning of the digestive system can significantly impact overall health and well-being and increase the risk of chronic health conditions.

Structure and Function

The gastrointestinal system (also referred to as the digestive system) is responsible for several functions, including digestion, absorption, and immune response. Digestion begins in the upper gastrointestinal tract at the mouth, where chewing of food occurs, called mastication.  Mastication  results in  mechanical digestion  when food is broken down into small chunks and swallowed. Masticated food is formed into a bolus as it moves toward the pharynx in the back of the throat and then into the esophagus. Coordinated muscle movements in the esophagus called  peristalsis  move the food bolus into the stomach where it is mixed with acidic gastric juices and further broken down into chyme through a  chemical digestion  process. As chyme is moved out of the stomach and into the duodenum of the small intestine, it is mixed with bile from the gallbladder and pancreatic enzymes from the pancreas for further digestion. [ 1 ]

Absorption is a second gastrointestinal function. After chyme enters the small intestine, it comes into contact with tiny fingerlike projections along the inside of the intestine called villi. Villi increase the surface area of the small intestine and allow nutrients, such as protein, carbohydrates, fat, vitamins, and minerals, to absorb through the intestinal wall and into the bloodstream. Absorption of nutrients is essential for metabolism to occur because nutrients fuel bodily functions and create energy. Peristalsis moves leftover liquid from the small intestine into the large intestine, where additional water and minerals are absorbed. Waste products are condensed into feces and excreted from the body through the anus. [ 2 ]  See Figure 14.1 [ 3 ]  for labeled parts of the gastrointestinal system.

Figure 14.1

The Gastrointestinal System

In addition to digestion and absorption, the gastrointestinal system is also involved in immune function. Good bacteria in the stomach create a person’s gut biome. Gut biome contributes to a person’s immune response through antibody production in response to foreign materials, chemicals, bacteria, and other substances. [ 4 ]  For example, patients may develop  Clostridium difficile  (C-diff) after taking antibiotics that kill these beneficial bacteria in the gut. Read additional details about our microbiome and immune response in the “ Infection ” chapter of this book.

Essential Nutrients

Nutrients from food and fluids are used by the body for growth, energy, and bodily processes.  Essential nutrients  refer to nutrients that are necessary for bodily functions but must come from dietary intake because the body is unable to synthesize them. Essential nutrients include vitamins, minerals, some amino acids, and some fatty acids. [ 5 ]  Essential nutrients can be further divided into macronutrients and micronutrients.

Macronutrients

Macronutrients  make up most of a person’s diet and provide energy, as well as essential nutrient intake. Macronutrients include carbohydrates, proteins, and fats. However, too many macronutrients without associated physical activity cause excess nutrition that can lead to obesity, cardiovascular disease, diabetes mellitus, kidney disease, and other chronic diseases. Too few macronutrients result in undernutrition, which contributes to nutrient deficiencies and malnourishment. [ 6 ]

CARBOHYDRATES

Carbohydrates  are sugars and starches and are an important energy source that provides 4 kcal/g of energy.  Simple carbohydrates  are small molecules (called monosaccharides or disaccharides) and break down quickly. As a result, simple carbohydrates are easily digested and absorbed into the bloodstream, so they raise blood glucose levels quickly. Examples of simple carbohydrates include table sugar, syrup, soda, and fruit juice.  Complex carbohydrates  are larger molecules (called polysaccharides) that break down more slowly, which causes slower release into the bloodstream and a slower increase in blood sugar over a longer period of time. Examples of complex carbohydrates include whole grains, beans, and vegetables. [ 7 ]

Foods can also be categorized according to their  glycemic index , a measure of how quickly glucose levels increase in the bloodstream after carbohydrates are consumed. The glycemic index was initially introduced as a way for people with diabetes mellitus to control their blood glucose levels. For example, processed foods, white bread, white rice, and white potatoes have a high glycemic index. They quickly raise blood glucose levels after being consumed and also cause the release of insulin, which can result in more hunger and overeating. However, foods such as fruit, green leafy vegetables, raw carrots, kidney beans, chickpeas, lentils, and bran breakfast cereals have a low glycemic index. These foods minimize blood sugar spikes and insulin release after eating, which leads to less hunger and overeating. Eating a diet of low glycemic foods has been linked to a decreased risk of obesity and diabetes mellitus.  [ 8 ]  See Figure 14.2 [ 9 ]  for an image of the glycemic index of various foods.

Figure 14.2

Glycemic Index

Proteins  are peptides and amino acids that provide 4 kcal/g of energy. Proteins are necessary for tissue repair and function, growth, energy, fluid balance, clotting, and the production of white blood cells. Protein status is also referred to as  nitrogen balance . Nitrogen is consumed in dietary intake and excreted in the urine and feces. If the body excretes more nitrogen than it takes in through the diet, this is referred to as a negative nitrogen balance. Negative nitrogen balance is seen in patients with starvation or severe infection. Conversely, if the body takes in more nitrogen through the diet than what is excreted, this is referred to as a positive nitrogen balance. [ 10 ]  During positive nitrogen balance, excess protein is converted to fat tissue for storage.

Proteins are classified as complete, incomplete, or partially complete.  Complete proteins  must be ingested in the diet. They have enough amino acids to perform necessary bodily functions, such as growth and tissue maintenance. Examples of foods containing complete proteins are soy, quinoa, eggs, fish, meat, and dairy products.  Incomplete proteins  do not contain enough amino acids to sustain life. Examples of incomplete proteins include most plants, such as beans, peanut butter, seeds, grains, and grain products. Incomplete proteins must be combined with other types of proteins to add to amino acids and form complete protein combinations. [ 11 ]  For example, vegetarians must be careful to eat complementary proteins, such as grains and legumes, or nuts and seeds and legumes, to create complete protein combinations during their daily food intake.  Partially complete proteins  have enough amino acids to sustain life, but not enough for tissue growth and maintenance. Because of the similarities, most sources consider partially complete proteins to be in the same category as incomplete proteins. See Figure 14.3 [ 12 ]  for an image of protein-rich foods.

Figure 14.3

Protein-Rich Foods

Fats  consist of fatty acids and glycerol and are essential for tissue growth, insulation, energy, energy storage, and hormone production. Fats provide 9 kcal/g of energy. [ 13 ]  While some fat intake is necessary for energy and uptake of fat-soluble vitamins, excess fat intake contributes to heart disease and obesity. Due to its high-energy content, a little fat goes a long way.

Fats are classified as saturated, unsaturated, and trans fatty acids.  Saturated fats  come from animal products, such as butter and red meat (e.g., steak). Saturated fats are solid at room temperature. Recommended intake of saturated fats is less than 10% of daily calories because saturated fat raises cholesterol and contributes to heart disease. [ 14 ]

Unsaturated fats  come from oils and plants, although chicken and fish also contain some unsaturated fats. Unsaturated fats are healthier than saturated fats. Examples of unsaturated fats include olive oil, canola oil, avocados, almonds, and pumpkin seeds. Fats containing omega-3 fatty acids are considered polyunsaturated fats and help lower LDL cholesterol levels. Fish and other seafood are excellent sources of omega-3 fatty acids.

Trans fats  are fats that have been altered through a hydrogenation process, so they are not in their natural state. During the hydrogenated process, fat is changed to make it harder at room temperature and have a longer shelf life. Trans fats are found in processed foods, such as chips, crackers, and cookies, as well as in some margarines and salad dressings. Minimal trans fat intake is recommended because it increases cholesterol and contributes to heart disease. [ 15 ]

Micronutrients

Micronutrients include vitamins and minerals.

Vitamins are necessary for many bodily functions, including growth, development, healing, vision, and reproduction. Most vitamins are considered essential because they are not manufactured by the body and must be ingested in the diet. Vitamin D is also manufactured through exposure to sunlight. [ 16 ]

Vitamin toxicity can be caused by overconsumption of certain vitamins, such as vitamins A, D, C, B6, and niacin. Conversely, vitamin deficiencies can be caused by various factors including poor food intake due to poverty, malabsorption problems with the gastrointestinal tract, drug and alcohol abuse, proton pump inhibitors, and prolonged parenteral nutrition. Deficiencies can take years to develop, so it is usually a long-term problem for patients. [ 17 ]

Vitamins are classified as water soluble or fat soluble.  Water-soluble vitamins  are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid). Additional water-soluble vitamins include biotin and pantothenic acid. Excess amounts of these vitamins are excreted through the kidneys in urine, so toxicity is rarely an issue, though excess intake of vitamin B6, C, or niacin can result in toxicity. [ 18 ]  See Table 14.2a for a list of selected water-soluble vitamins, their sources, and their function. [ 19 ] , [ 20 ] , [ 21 ] , [ 22 ] , [ 23 ] , [ 24 ] , [ 25 ] , [ 26 ] , [ 27 ]

Table 14.2a

Selected Water-Soluble Vitamins

Fat-soluble vitamins  are absorbed with fats in the diet and include vitamins A, D, E, and K. They are stored in fat tissue and can build up in the liver. They are not excreted easily by the kidneys due to storage in fatty tissue and the liver, so overconsumption can cause toxicity, especially with vitamins A and D. [28]  See Table 14.2b for a list of selected fat-soluble vitamins, their sources, their function, and manifestations of deficiencies and toxicities. [ 29 ] , [ 30 ] , [ 31 ] , [ 32 ] , [ 33 ] , [ 34 ] , [ 35 ] , [ 36 ] , [ 37 ]

Table 14.2b

Selected Fat-Soluble Vitamins

Minerals are inorganic materials essential for hormone and enzyme production, as well as for bone, muscle, neurological, and cardiac function. Minerals are needed in varying amounts and are obtained from a well-rounded diet. In some cases of deficiencies, mineral supplements may be prescribed by a health care provider. Deficiencies can be caused by malnutrition, malabsorption, or certain medications, such as diuretics.

Minerals are classified as either macrominerals or trace minerals.  Macrominerals  are needed in larger amounts and are typically measured in milligrams, grams, or milliequivalents. Macrominerals include sodium, potassium, calcium, magnesium, chloride, and phosphorus. Macrominerals are discussed in further detail in the “Electrolytes” section of the “ Fluids and Electrolytes ” chapter of this book.

Trace minerals  are needed in tiny amounts. Trace minerals include zinc, iron, chromium, copper, fluorine, iodine, manganese, molybdenum, and selenium. [ 38 ]  See Table 14.2c for a list of selected macrominerals and Table 14.2d for a list of trace minerals. [ 39 ] , [ 40 ] , [ 41 ] , [ 42 ]

Table 14.2c

Macrominerals

Table 14.2d

Trace Minerals

Nutritional Guidelines

Nutritional guidelines are developed by governmental agencies to provide guidance to the population on how to best meet nutritional needs. These guidelines may vary by country. The National Academies of Sciences, Engineering, and Medicine set the  Dietary Reference Intakes  (DRIs) for the United States and Canada. Dietary Reference Intakes (DRIs) are a set of reference values used to plan and assess nutrient intakes of healthy people, including proteins, carbohydrates, fats, vitamins, minerals, and fiber. Nutrients included in the DRIs are obtained through a typical diet, although some foods may be fortified with certain nutrients that are commonly deficient in diets. [ 43 ]

Choose MyPlate Food Guide

The U.S. Department of Agriculture (USDA) issues dietary guidelines for appropriate serving sizes of each food group and number of servings recommended each day. The “Choose MyPlate” food guide is an easy-to-understand visual representation of how a healthy plate of food should be divided based on food groups. See Figure 14.4 [ 44 ] for a Choose MyPlate image. A little more than half of the plate should be grains and vegetables, with a focus on whole grains and a variety of vegetables. About one quarter of the plate should be fruits, with an emphasis on whole fruits. About one quarter of the plate should be protein, with an emphasis on consuming a variety of low-fat protein sources. All of these groups combined should make up no more than 85% of daily caloric intake based on a 2,000 calorie diet. Fats, oils, and added sugars are not included, but should make up no more than 15% of daily caloric intake. Foods should be selected that are as nutrient-dense as possible.  Nutrient-dense  means there is a high proportion of nutritional value relative to calories contained in the food, such as fruits and vegetables. Conversely,  calorie-dense  foods should be minimized because they have a large amount of calories with few nutrients. For example, candy and soda are calorie-dense with few nutrients and should be minimized. [ 45 ] , [ 46 ]  See the following hyperlink to the MyPlate web site for further information on USDA dietary guidelines and patient educational materials

Read more about USDA dietary guidelines at  https://www.myplate.gov/ .  [ 47 ]

MyPlate information and images are also available in several other languages so that education can be tailored to the patient’s preferred language. For example, Figure 14.5 [ 48 ]  shows MyPlate in Vietnamese. This image would be accompanied with written information about food groups that include the patient’s typical dietary choices.

Figure 14.5

MyPlate in Vietnamese

VEGETABLE GROUP

For a well-rounded diet, a variety of vegetables should be consumed, including vegetables from all five vegetable groups: dark green leafy vegetables; red and orange vegetables; beans, peas, and lentils (formerly called the legumes group); starchy vegetables; and other vegetables. Vegetables can be fresh, frozen, canned, or dried. Dark green leafy vegetables include kale, Swiss chard, spinach, broccoli, and salad greens. Red and orange vegetables include carrots, bell peppers, sweet potatoes, tomatoes, tomato juice, and squash. The beans, peas, and lentils group includes dried beans, black beans, chickpeas, kidney beans, split peas, and black-eyed peas. (Note that this group does not include green beans or green peas.) This vegetable group also supplies some protein and can be included in the protein group as well. Starchy vegetables include root vegetables, such as potatoes, as well as corn. The “other vegetables” category includes any vegetable that doesn’t fit in the other four categories, such as asparagus, avocados, brussels sprouts, cabbage, cucumbers, snow peas, and mushrooms, and a variety of others.

Daily serving suggestions of vegetables for individuals with a 2,000 calorie diet are 2 ½ cup equivalents of vegetables per day. For example, a “one cup equivalent” equals 1 cup raw or cooked vegetables, one cup 100% vegetable juice, ½ cup of dried vegetables, or 2 cups of leafy green vegetables. Approximately 90% of Americans do not meet the recommended daily intake of vegetables. [ 49 ]  See Figure 14.6 [ 50 ]  for an image of vegetables.

Figure 14.6

Grain group.

Grains are classified as whole grains or refined grains.  Whole grains  include the entire grain kernel and supply more fiber than refined grains. Examples of whole grains include amaranth, whole barley, popcorn, oats, whole grain cornmeal, brown or wild rice, and whole grain cereal or crackers.  Refined grains  have been processed to remove parts of the grain kernel and supply little fiber. As a result, they quickly increase blood glucose levels. Examples of refined grains include white bread, white rice, Cream of Wheat, pearled barley, white pasta, and refined-grain cereals or crackers. Some grains are fortified to ensure adequate intake of folic acid. See Figure 14.7 [ 51 ]  for an image of whole grain whole wheat bread.

Figure 14.7

Whole Grain, Whole Wheat Bread

The daily serving suggestions of grains for an individual with a 2,000 calorie diet are six ounce equivalents per day, split equally between whole and refined grains. For example, a “one ounce equivalent” of grains equals ½ cup of cooked rice, pasta, or cereal or 1 cup of flaked cereal. Most Americans consume adequate amounts of total grains, although roughly 98% are deficient in recommended whole grain amounts, and 74% consume more than the recommended refined grain amounts. [ 52 ]

FRUIT GROUP

Fruits can be frozen, canned, or dried, in addition to 100% fruit juice. A few examples of fruits include apples, oranges, bananas, melons, peaches, apricots, pineapples, and rhubarb. Daily serving suggestions of fruits for an individual with a 2,000 calorie diet are 2 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of raw or cooked fruit, 8 ounces of 100% fruit juice, or ½ cup of dried fruit. Approximately 80% of Americans do not consume the recommended daily intake of fruits. [ 53 ]  See Figure 14.8 [ 54 ]  for an image of fruits.

Figure 14.8

Dairy group.

Dairy products can be liquid, dried, semi-solid, or solid depending on the type of product. Dairy products include milk, lactose-free milk, fortified soy milk, buttermilk, cheese, yogurt, and kefir. Sour cream and cream cheese are not considered dairy items in terms of nutritional benefits. Daily serving suggestions of dairy products for an individual with a 2,000 calorie diet are 3 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of milk, soy milk, or yogurt; 1 ½ ounces of natural cheese, or 2 ounces of processed cheese. Approximately 90% of Americans consume less than the recommended daily intake of dairy products. [ 55 ]  See Figure 14.9 [ 56 ]  for an image of dairy products.

Figure 14.9

Dairy Products

PROTEIN GROUP

Proteins are categorized by the type of protein source. The meats, poultry, and eggs category consists of any type of animal or poultry meat, organ meat, or poultry egg. Lean meats should be selected to minimize fat and calorie intake from high-fat meats.

The seafood category includes any type of fish, clams, crab, lobster, oyster, and scallops. It is important to choose fish with low mercury levels to prevent negative effects of a buildup of mercury in the body. In general, large, fatty ocean fish, such as tuna, have higher levels of mercury due to their diet and storage of mercury in their fatty tissues.

The nuts, seeds, and soy products category includes tree nuts, peanuts, nut butters, seeds, or seed butters. Soy products include tofu and any other products made from soy. Unsalted nuts should be selected to avoid excess salt intake.

Protein is also contained in other food groups, such as dairy or the vegetable category of peas, beans, and lentils. Daily serving suggestions of proteins for individuals with a 2,000 calorie diet are 5 ½ ounce equivalents per day. Servings should total up to 26 ounce equivalents per week of meats, eggs, and poultry; 8 ounce equivalents per week of seafood; and 5 ounce equivalents per week of nuts, seeds, or soy products. A “one ounce equivalent” of protein equals 1 ounce of lean meat, one egg, ¼ cup cooked beans, or 1 tablespoon of peanut butter. Most Americans consume adequate amounts of protein, but many consume proteins high in saturated fat and sodium that contribute to diseases such as coronary artery disease. [ 57 ]

OIL/FAT GROUP

Examples of oils are vegetable oil, canola oil, olive oil, butter, lard, and coconut oil. Daily serving suggestions of fats or oils for individuals with a 2,000 calorie diet are 27 grams per day. While it is important to limit oils and fats due to their calorie-dense nature, some fat and oil intake is essential for nutrient absorption and overall health. It is best to select healthy unsaturated fats, such as avocados, nuts, or olive oil. [ 58 ]

A person’s gender affects their calorie and nutrient requirements. Males typically have higher calorie and protein needs related to increased muscle mass. Females typically require fewer calories to maintain their body weight due to a higher proportion of adipose (fat tissue) than muscle. Menstruating females also have higher iron requirements to offset losses that occur during menstruation.

Read  Nutrition and Food Safety Information and Resources for Healthcare Professionals  from the U.S. Food and Drug Administration.

View the infographic “ what’s myplate all about ” from the usda., factors affecting nutritional status.

Now that we have discussed basic nutritional concepts and dietary guidelines, let’s discuss factors that can affect a person’s nutritional status. Many things that can cause altered nutrition, such as physiological factors, cultural and religious beliefs, economic resources, drug and nutrient disorders, surgery, altered metabolic states, alcohol and drug abuse, and psychological states.

Physiological Factors

Nutritional intake is affected by several physiological factors. Appetite is controlled by the hypothalamus, a tiny gland deep within the brain that triggers feelings of hunger or fullness depending on hormone and neural signals being sent and received. See Figure 14.10 [ 59 ]  for an image of the hypothalamus indicated by the red arrow. Hunger causes a feeling of emptiness in the abdomen and is often accompanied by audible noises coming from the abdomen as the stomach contracts due to emptiness. Hunger can cause feelings of discomfort, nausea, and tiredness. Satiety is a feeling of fullness that often comes after eating, although it can also be caused by impairments of the hypothalamus. Electrolyte imbalances and fluid volume imbalances can also trigger hunger and thirst by sending signals to the hypothalamus. [ 60 ]

Figure 14.10

Hypothalamus

The five senses play an important role in food intake. For example, food with a pleasing aroma may induce mouth watering and hunger, whereas food or environments with displeasing aromas often suppress the appetite. Texture and taste of foods also play a role in stimulation of appetite.

Poor dentition or poor oral care has a negative effect on appetite, so adequate oral care is crucial for patients prior to eating. [ 61 ]  Additionally, the condition of a patient’s teeth and gums, the fit of dentures, and gastrointestinal function also play an important role in nutrition. Loose teeth, swollen gums, or poor-fitting dentures can make eating difficult.

Difficulty swallowing, called  dysphagia , can make it dangerous for the patient to swallow food because it can result in pneumonia from aspiration of food into the lungs. Special soft diets or enteral or parenteral nutrition are typically prescribed for patients with dysphagia. Nurses collaborate with speech therapists when assessing and managing dysphagia.

A poorly functioning gastrointestinal tract makes nutrient absorption difficult and can result in malnourishment. Diseases that cause inflammation of the gastrointestinal tract impair absorption of nutrients. Examples of these conditions include esophagitis, gastritis, inflammatory bowel disease, and cholecystitis. Patients with these disorders should select nutrient-dense foods and may require prescribed supplements to increase nutrient intake.

Cultural and Religious Beliefs

Cultural and religious beliefs often influence food selection and food intake. It is important for nurses to conduct a thorough patient assessment, including food preferences, to ensure adequate nutritional intake during hospitalization. The nurse should not assume a particular diet based on a patient’s culture or religion, but instead should determine their individual preferences through the assessment interview.

Cultural beliefs affect types of food eaten and when they are eaten. Some foods may be restricted due to beliefs or religious rituals, whereas other foods may be viewed as part of the healing process. For example, some cultures do not eat pork because it is considered unclean, and others eat “kosher” food that prescribes how food is prepared. Some religions fast during religious holidays from sunrise to sunset, where others avoid eating meat during the time of Lent. [ 62 ] , [ 63 ]

Read more about the impact of religious and cultural beliefs on food intake in the “ Spirituality ” chapter of this book.

Economic resources.

If a patient has inadequate financial resources, food security and food choices are often greatly impacted. Healthy, nutrient-dense, fresh foods typically cost more than prepackaged, heavily processed foods. Poor economic status is correlated with the consumption of calorie-dense, nutrient-poor food choices, putting these individuals at risk for inadequate nutrition and obesity. [ 64 ]  Social programs such as Meals on Wheels, free or reduced-cost school breakfast and lunch programs, and government subsidies based on income help reduce food insecurity and promote the consumption of healthy, nutrient-dense foods. Nurses refer at-risk patients to social workers and case managers for assistance in applying for these social programs.

Drug and Nutrient Interactions

Some prescription drugs affect nutrient absorption. For example, some medications such as proton pump inhibitors (omeprazole) alter the pH of stomach acid, resulting in poor absorption of nutrients. Other medications, such as opioids, often decrease a person’s appetite or cause nausea, resulting in decreased calorie and nutrient intake.

Surgery can affect a patient’s nutritional status due to several factors. Food and drink are typically withheld for a period of time prior to surgery to prevent aspiration of fluid into the lungs during anesthesia. Anesthesia and pain medication used during surgery slow peristalsis, and it often takes time to return to normal. Slow peristalsis can cause nausea, vomiting, and constipation. Until the patient is able to pass gas and bowel sounds return, the patient is typically ordered to have nothing by mouth (NPO). If a patient experiences prolonged NPO status, such as after significant abdominal surgery, intravenous fluids and nutrition may be required.

Surgery also stimulates the physiological stress response and increases metabolic demands, causing the need for increased calories. The stress response can also cause elevated blood glucose levels due to the release of corticosteroids, even if the patient has not been previously diagnosed with diabetes mellitus. For this reason, nurses often monitor post-op patients’ bedside blood glucose levels carefully.

Bowel resection surgery in particular has a negative impact on nutrient absorption. Because all or parts of the intestine are removed, there is decreased absorption of nutrients, which can result in nutrient deficiencies. Many patients who have experienced bowel resection require nutrient supplementation.

Bariatric surgery is used to treat obesity and reduce obesity-related cardiovascular risk factors. Bariatric procedures alter the anatomy and physiology of the gastrointestinal tract, which makes patients susceptible to nutritional deficiencies. [ 65 ]  Read more about bariatric surgery and long-term nutritional issues using the hyperlink in the following box.

Read more about  bariatric surgery and long-term nutritional issues . [ 66 ]

Altered metabolic states.

Metabolic demands impact nutrient intake. In conditions where metabolic demands are increased, such as during growth spurts in childhood or adolescence, nutritional intake should be increased. Disease states, such as cancer, hyperthyroidism, and AIDS, can increase metabolism and require an increased amount of nutrients. However, cancer treatment, such as radiation and chemotherapy, often causes nausea, vomiting, and decreased appetite, making it difficult for patients to obtain adequate nutrients at a time when they are needed in high amounts due to increased metabolic demand.

Other diseases like diabetes mellitus cause complications with nutrient absorption due to insulin. Insulin is necessary for the metabolism of fats, proteins, and carbohydrates, but in patients with diabetes mellitus, insulin production is insufficient or their body is not able to effectively use circulating insulin. This lack of insulin can result in impaired nutrient metabolism.

Alcohol and Drug Abuse

Alcohol and drug abuse can affect nutritional status. Alcohol is calorie-dense and nutrient-poor. With alcohol use, the consumption of water, food, and other nutrients often decreases as patients “drink their calories.” This may result in decreased protein intake and body protein deficiency. Nutrient digestion and absorption can also decrease with alcohol consumption if the stomach lining becomes eroded or scarred. This can cause hemoglobin, hematocrit, albumin, folate, thiamine, vitamin B12, and vitamin C deficiencies, as well as decreased calcium, magnesium, and phosphorus levels. [ 67 ]

Drug abuse of stimulants, such as methamphetamine and cocaine abuse, causes an increased metabolic rate and decreased appetite and contributes to weight loss and malnourishment.

Psychological State

Various psychological states have a direct effect on appetite and a patient’s desire to eat. Acute and chronic stress stimulates the hypothalamus and increases production of glucocorticoids and glucose. This can increase the person’s appetite, causing increased calorie intake, fat storage, and subsequent weight gain. When a person feels stressed, their food choices are often nutrient-poor and calorie-dense, which further increases weight gain and nutrient deficiencies. In other individuals, the stress response causes loss of appetite, weight loss, and nutrient deficiencies. [ 68 ]

Depression can cause loss of appetite or overeating. Many people eat calorie-dense “comfort foods” as a coping mechanism. Additionally, many antidepressants can cause weight gain as a side effect.

14.3. APPLYING THE NURSING PROCESS

Now that we have discussed basic nutritional concepts, dietary guidelines, and factors affecting nutritional status, let’s apply the nursing process to this information when caring for patients.

A thorough nutritional assessment provides information about an individual’s nutritional status, as well as risk factors for nutritional imbalances. Assessment starts with reviewing the patient’s medical record and initiating a patient interview, followed by a physical exam and review of lab and diagnostic test results.

Subjective Assessment

Subjective assessments include questions regarding normal eating patterns and risk factor identification. Subjective assessment data is obtained by interviewing the patient as a primary source or a family member or caregiver as a secondary source. While a wealth of subjective information can be obtained through a chart review, it is important to verify this information with either the patient or family member because details may be recorded inaccurately or may have changed over time. Subjective information to obtain when completing a nutritional assessment includes age, sex, history of illness or chronic disease, surgeries, dietary intake including a 24-hour diet recall or food diary, food preferences, cultural practices related to diet, normal snack and meal timings, food allergies, special diets, and food shopping or preparation activities.

A detailed nutritional assessment can also provide important clues for identification of risk factors for nutritional deficits or excesses. For example, a history of anorexia or bulimia will put the patient at risk for vitamin, mineral, and electrolyte disturbances, as well as potential body image disturbances. Swallowing impairments place the patient at risk for decreased intake that may be insufficient to meet metabolic demands. Use of recreational drugs or alcohol places the patient at risk for insufficient nutrient intake and impaired nutrient absorption. Use of nutritional supplements places the patient at risk for excess nutrient absorption and potential toxicity. Recognizing and identifying risks to nutritional status help the nurse anticipate problems that may arise and identify complications as they occur. Ideally, the nurse will recognize subtle cues of impending or actual dysfunction and prevent bigger problems from happening.

Objective Assessment

Objective assessment data is information derived from direct observation by the nurse and is obtained through inspection, auscultation, and palpation. The nurse should consider nutritional status while performing a physical examination.

The nurse begins the physical examination by making general observations about the patient’s status. A well-nourished patient has normal skin color and hair texture for their ethnicity, healthy nails, a BMI within normal range according to their height, and appears energetic.

Height and weight should be accurately measured and documented. Height and weight in infants and children are plotted on a growth chart to give a percentile ranking across the United States. The infant or child should show a trend of consistent height and weight increase.

Height and weight in adults are often compared to a  Body Mass Index (BMI)  graph. BMI can also be calculated using the following formulas:

• BMI = weight (kilograms)/height(meters) 2
• BMI = weight (pounds) x 703)/height(inches) 2

To calculate BMI using a BMI table, the patient’s height is plotted on the horizontal axis and their weight is plotted on the perpendicular axis. The BMI is measured where the lines intersect. See Figure 14.11 [ 1 ]  for an image of a BMI table. BMI is interpreted using the following ranges:

Figure 14.11

• Less than 18.5: Underweight
• 18.5-24.9: Desirable range
• 25-29.9: Overweight
• Equal or greater than 30: Obese [ 2 ]

After completing the subjective and objective assessment, the data should be analyzed for expected and unexpected findings. See Table 14.3a for a comparison of expected versus unexpected assessment findings related to nutritional status on assessment, including those that require notification of the health care provider in bold font.

Table 14.3a

Expected Versus Unexpected Findings During Nutritional Assessment [ 3 ]

Review how to perform a physical examination on the body systems listed in Table 14.3a in Open RN  Nursing Skills .

Diagnostic and lab work.

Diagnostic and lab work results can provide important clues about a patient’s overall nutritional status and should be used in conjunction with a thorough subjective and objective assessment to provide an accurate picture of the patient’s overall health status. Common lab tests include hemoglobin (hgb), hematocrit (HCT), white blood cells (WBC), albumin, prealbumin, and transferrin.

Anemia is a medical condition diagnosed by low hemoglobin levels. Hemoglobin is important for oxygen transport throughout the body. Anemia can be caused acutely by hemorrhage, but it is often the result of chronic iron deficiency, vitamin B12 deficiency, or folate deficiency. Iron supplements, B12 injections, folate supplements, and increased iron or folate intake in the diet can help increase hemoglobin levels.

Albumin and prealbumin are proteins in the bloodstream. They maintain oncotic pressure so that fluid does not leak out of blood vessels into the extravascular space. (Read more about oncotic pressure in the “ Fluids and Electrolytes ” chapter.) Albumin and prealbumin levels are used as markers of malnutrition, but these levels can also be affected by medical conditions such as liver failure, kidney failure, inflammation, and zinc deficiency. Low albumin levels can indicate prolonged protein deficiency intake over several weeks, whereas prealbumin levels reflect protein intake over the previous few weeks. For this reason, prealbumin is often used to monitor the effectiveness of parenteral nutrition therapy. [ 4 ] , [ 5 ]

Transferrin is a protein required for iron transport on red blood cells. Transferrin levels increase during iron deficiency anemia and decrease with renal or liver failure and infection.

A patient’s amount of muscle wasting due to malnutrition is measured by a 24-hour urine creatinine level. [ 6 ]  If insufficient calories are consumed, the body begins to break down its own tissues in a process called catabolism. Blood urea nitrogen and creatinine are released as a by-product. A 24-hour urine collection measures these by-product levels to assess the degree of catabolism occurring.

White blood cells will decrease with malnourishment, specifically with protein and vitamins C, D, and E and B-complex deficiencies. Low white blood cell counts place the patient at risk for infection because adequate white blood cells are necessary for a fully functioning immune system.

See Table 14.3b for a description of selected lab values associated with nutritional status. As always, refer to agency lab reference ranges when providing patient care.

Table 14.3b

Selected Lab Values Associated with Nutritional Status [ 7 ] , [ 8 ] , [ 9 ]

Various diagnostic tests may be ordered by the health care provider based on the patient’s medical conditions and circumstances. For example, a swallow study is a diagnostic test used for patients having difficulty swallowing. An abdominal X-ray is used to determine the correct placement of a feeding tube or to note any excess air or stool in the colon. A barium swallow is used in conjunction with a CT scan to note any blockages in the intestines.

Life Span and Cultural Considerations

Newborns and infants.

A crucial amount of growth and development happens between birth to age two. For proper growth, development, and brain function, this age group requires nutrient-dense food choices, primarily because they eat so little compared to adults, but also because of their rapid growth rate that is higher than any other time of development. Ideally, newborns through age 6 months should be fed exclusively human breast milk if possible to develop immunity. Vitamin D and iron supplementation may be needed. [ 10 ]  For the first two to three days after birth, human milk contains colostrum, a thick yellowish-white fluid rich in proteins and immunoglobulin A (IgA). Colostrum is lower in carbohydrates and fat than mature breast milk.  Colostrum  helps protect the newborn from infection and builds normal intestinal bacteria. As breast milk matures after two to three days postpartum, it becomes lower in proteins and IgA and higher in carbohydrates and fat. [ 11 ]  Human donor milk may be used in some situations when the mother cannot breastfeed. If human donor milk is given, it should be sourced through an accredited human milk bank and pasteurized to minimize risk of spreading infectious diseases.

There are many reasons infants may not be breastfed, including insufficient breast milk production, a personal choice not to breastfeed, or adoption of the newborn. If breastfeeding or donor milk is not an option, an iron-fortified commercial infant formula should be used exclusively through at least 6 months of age. Homemade or non-FDA approved infant formulas or toddler formulas should not be used because they may not meet the high nutritional needs of infants. Infants fed 100% commercial infant formula will not need vitamin D supplementation. [ 12 ]

After about six months of age, infants should begin to be introduced to additional nutrient-dense complementary foods that are developmentally appropriate. Foods should be introduced one at a time to monitor for food sensitivities. Introducing food at this time is to provide a varied diet, additional nutrients, and an introduction to different flavors and textures of food. Research shows that introduction to certain allergy-risk foods, such as peanut butter prior to one year of age, helps decrease the risk of developing a peanut allergy later in life. It is important to strictly avoid honey and other unpasteurized food and drink before one year of age to prevent botulism and other bacteria. Additionally, cow’s milk, fortified soy drinks, and fruit or vegetable juices should not be introduced before 1 year of age . [13]

Children and Adolescents

Growth rate continues to be rapid from ages one through five, requiring adequate nutrition to meet these growth and metabolic demands. Caloric and nutritional intake requirements increase proportionately with age, but unfortunately, the quality of diet tends to decrease proportionately with age. This is in part due to younger children being dependent on adults for nutritional choices and intake while older children and adolescents begin to make their own food choices as they enter school. Poverty can also negatively impact nutritional intake in children and adolescents. School lunch and breakfast programs help mitigate the effects of poverty on nutrition by providing free to low-cost, nutritionally-balanced meals. [ 14 ]

Healthy dietary habits formed in childhood through adolescence help prevent obesity, cardiovascular disease, diabetes mellitus, and other chronic diseases later in life. It is important to provide children with a variety of different foods prepared in different ways to increase the likelihood of children accepting and growing accustomed to different foods. It is common for children to become picky in their food choices or decide to only eat one or a few different food items over a period of time. Allowing children to help select and prepare food can increase their acceptance of different food choices. [ 15 ]

The adult life stage is ages 19 through 59. A major limiting factor to healthy nutrition in adults is development of poor nutritional habits early in life. These unhealthy diet habits can be very difficult to change due to food preferences, as well as lack of knowledge about proper nutrition. Metabolic rate and caloric needs decrease with increasing age. Females tend to require less caloric intake than males, though caloric and nutritional needs increase with pregnancy and breastfeeding. Without appropriate dietary intake or activity, weight gain will occur that can lead to obesity and other chronic diseases. Over 50% of Americans have one or more chronic diseases that are associated with poor diet and physical inactivity.

Education regarding a healthy diet, including appropriate calorie, saturated fat, sugar, and sodium intakes, helps improve health in adults. Roughly 73% of males and 70% of females in America exceed the recommended daily intake of saturated fat, and up to 97% of males and 82% of females exceed the recommended daily intake of sodium. Approximately 97% of males and 90% of women in America do not consume the recommended intake of dietary fiber, including underconsumption of fruits, vegetables, and whole grains, which contributes to diet-related chronic diseases.

Alcohol consumption can be problematic for maintaining a healthy diet. Chronic alcohol abuse can interfere with vitamin and mineral absorption and result in general malnourishment. Alcohol should be limited to one drink per day or less for women and two drinks or less per day for men. Alcohol should be avoided by those who are pregnant, breastfeeding, younger than 21 years old, have a chemical dependency, or have other underlying health conditions such as diabetes mellitus. [ 16 ]

Pregnancy and Lactation

A well-balanced, healthy diet is essential during pregnancy and  lactation  to prevent maternal, fetal, and newborn problems. Nutritional requirements, such as calories, vitamins, and minerals, increase during pregnancy and lactation. Increased caloric needs should be met with nutrient-dense foods rather than calorie-dense foods that are higher in fats and sugars. Prenatal vitamins and mineral supplements are often prescribed during pregnancy and lactation, in addition to a nutrient-rich diet, to help ensure women meet requirements for folic acid, iron, iodine, choline, and vitamin D. Folic acid is necessary to prevent neural tube defects in the fetus during the first trimester of pregnancy. Iron requirements increase during pregnancy to support fetal development and prevent anemia. Iodine requirements increase during pregnancy and lactation for fetal neurocognitive development. Choline requirements also increase due to the need to replace maternal stores, as well as for fetal brain and spinal cord development. [ 17 ]

Older Adults

People aged 65 years and older are considered older adults. Older adults are more likely to suffer from chronic illness and disease. Older adults have lower calorie needs than younger people, though they still need a diet full of nutrient-dense foods because their nutrient needs increase. Caloric needs decrease due to decreased activity, decreased metabolic rates, and decreased muscle mass. Chronic disease and medication can contribute to decreased nutrient absorption. Protein and vitamin B12 are commonly under consumed in older adults. Protein is necessary to prevent loss of muscle mass. Vitamin B12 deficiency can be a problem for older adults because absorption of vitamin B12 decreases with age and with certain medications. Adequate hydration is also a concern for older adults because feelings of thirst decrease with age, leading to poor fluid intake. Additionally, older adults may be concerned with bladder dysfunction so they may consciously choose to limit fluid intake. Loneliness, ability to chew and swallow, and poverty can also decrease dietary intake in older adults. [ 18 ]  Meals on Wheels, local senior centers, and other community programs can provide socialization and well-balanced meals to older adults.

The Mini-Nutritional Assessment Short-Form is a screening tool used to identify older adults who are malnourished or at risk of malnutrition. Use the hyperlink in the following box to download this tool.

Download the  Mini-Nutritional Assessment Short-Form  from The Hartford Institute for Geriatric Nursing. [ 19 ]

After the assessment stage is conducted, data is analyzed, and pertinent information is clustered together, nursing diagnoses are selected based on defining characteristics. When creating a care plan for a patient, review a current nursing care planning source for current NANDA-I approved nursing diagnoses and interventions related to nutritional imbalances. NANDA-I nursing diagnoses related to nutrition include  Imbalanced Nutrition: Less than Body Requirements, Overweight, Obesity, Risk for Overweight, Readiness for Enhanced Nutrition,  and  Impaired Swallowing . [ 20 ]  See Table 14.3c for additional information related to the diagnosis  Imbalanced Nutrition: Less than Body Requirements . [ 21 ]

Table 14.3c

Sample NANDA-I Nursing Diagnosis Related to Nutrition [ 22 ]

A sample nursing diagnosis written in PES format is, “Imbalanced Nutrition: Less than Body Requirements related to insufficient dietary intake as evidenced by body weight 20% below ideal weight range and food intake less than recommended daily allowance.”

Outcome Identification

Goals for patients experiencing altered nutritional status depend on the selected nursing diagnosis and specific patient situation. Typically, goals relate to resolution of the nutritional imbalance and are broad in nature. An overall goal related to nutritional imbalances is, “ The patient will weigh within normal range for their height and age .” [ 23 ]

Outcome criteria are specific, measurable, achievable, realistic, and time-oriented. A sample SMART goal is, “The patient will select three dietary modifications to meet their long-term health goals using USDA MyPlate guidelines by discharge.” [ 24 ]

Planning Interventions

After SMART outcome criteria are customized to the patient’s situation, nursing interventions are selected to help them achieve their identified outcomes. Interventions are specific to the alteration in nutritional status and should accomodate the patient’s cultural and religious beliefs. The box below outlines selected interventions related to nutrition therapy.

Nutrition Therapy [ 25 ]

• Monitor food/fluid ingested and calculate daily caloric intake, as appropriate
• Monitor appropriateness of diet orders to meet daily nutritional needs, as appropriate
• Determine in collaboration with the dietician, the number of calories and types of nutrients needed to meet nutritional requirements, as appropriate
• Determine food preferences with consideration of the patient’s cultural and religious preferences
• Encourage nutritional supplements, as appropriate
• Provide patients with nutritional deficits high-protein, high-calorie, nutritious finger foods and drinks that can be readily consumed, as appropriate
• Determine need for enteral tube feedings in collaboration with a dietician
• Administer enteral feedings, as prescribed
• Administer parenteral nutrition, as prescribed
• Structure the environment to create a pleasant and relaxing meal atmosphere
• Present food in an attractive, pleasing manner, giving consideration to color, texture, and variety
• Provide oral care before meals
• Assist the patient to a sitting position before eating or feeding
• Implement interventions to prevent aspiration in patients receiving enteral nutrition
• Monitor laboratory values, as appropriate
• Instruct the patient and family about prescribed diets
• Refer for diet teaching and planning, as appropriate
• Give the patient and family written examples of prescribed diet

Patients may be prescribed special diets due to medical conditions or altered nutrition states. See Table 14.3d for commonly prescribed special diets.

Table 14.3d

Commonly Prescribed Special Diets

“Thickened liquids” are typically prescribed for patients with difficulty swallowing (dysphagia). Three consistencies of thickened liquids are:

• Nectar-thick liquids: Easily pourable liquid comparable to apricot nectar or thick cream soups.
• Honey-thick liquids: Slightly thicker liquid that is less pourable and drizzles from a cup or bowl.
• Pudding-thick liquids: Liquids that hold their own shape. They are not pourable and usually require a spoon to eat.

Nurses often thicken liquids in the patient’s room using a commercial thickener. Most commercial thickeners include directions for achieving the consistency prescribed.

Enteral Nutrition

Enteral nutrition  is administered directly to a patient’s gastrointestinal tract while bypassing chewing and swallowing. Enteral feedings are prescribed for patients when chewing and/or swallowing are impaired or when there is poor nutritional intake and/or malnutrition.

Examples of enteral tube access are nasogastric tubes (NG), orogastric tubes (OG), percutaneous endoscopic gastrostomy (PEG) tubes, or percutaneous endoscopic jejunostomy (PEJ) tubes. See Figure 14.12 [ 26 ]  for an illustration of common enteral tube placement. Nasogastric tubes enter the nare and travel through the esophagus and into the stomach. Liquid tube feedings are infused through this tube and directly into the stomach. Orogastric tubes work in the same manner except they are inserted through the mouth into the esophagus and then into the stomach. Orogastric tubes are typically used with mechanically intubated and sedated patients and should never be used in conscious patients because they can induce a gag reflex and cause vomiting. PEG tubes are inserted through the abdominal wall directly into the stomach, bypassing the esophagus. PEG tubes are used when there is an obstruction to the esophagus, the esophagus has been removed, or if long-term enteral feedings are expected. PEJ tubes are inserted through the abdominal wall directly into the jejunum, bypassing the esophagus and stomach. PEJ tubes are used when all or part of the stomach has been removed or if the provider determines PEJ placement would best suit the patient’s needs.

Figure 14.12

Enteral Tube Access

There are several safety considerations for nurses to implement when enteral nutrition is being administered to prevent aspiration and dehydration. Tube placement must be verified after insertion, as well as before every medication or feeding is administered, to prevent inadvertent administration into the lungs if the tube has migrated out of position. Follow agency policy regarding checking placement. The American Association of Critical‐Care Nursing recommends that the position of a feeding tube should be checked and documented every four hours and prior to the administration of enteral feedings and medications by measuring the visible tube length and comparing it to the length documented during X-ray verification. Older methods of checking tube placement included observing aspirated GI contents or the administration of air with a syringe while auscultating (commonly referred to as the “whoosh test”). However, research has determined these methods are unreliable and should no longer be used to verify placement. [ 27 ] , [ 28 ]

In addition to verifying tube placement before administering feedings or medications, nurses perform additional interventions to prevent aspiration. The American Association of Critical‐Care Nurses recommends the following guidelines to reduce the risk for aspiration:

• Maintain the head of the bed at 30°- 45° unless contraindicated
• Use sedatives as sparingly as possible
• Assess feeding tube placement at four‐hour intervals
• Observe for change in the amount of external length of the tube
• Assess for gastrointestinal intolerance at four‐hour intervals [ 29 ] , [ 30 ]

Measurement of gastric residual volume (GRV) is often performed when a patient is receiving enteral feeding by using a 60-mL syringe to aspirate stomach contents through the tube. GRVs in the range of 200–500 mL have traditionally triggered nursing interventions, such as slowing or stopping the feeding, to reduce the patient’s risk of aspiration. However, according to recent research, it is not appropriate to stop enteral nutrition for GRVs less than 500 mL in the absence of other signs of intolerance because of the impact on the patient’s overall nutritional status. Additionally, the aspiration of gastric residual volumes can contribute to tube clogging. Follow agency policy regarding measuring gastric residual volume and implementing interventions to prevent aspiration. [ 31 ] , [ 32 ]

Patients receiving enteral nutrition should be monitored daily for signs of tube feeding intolerance, such as abdominal bloating, nausea, vomiting, diarrhea, cramping, and constipation. If cramping occurs during bolus feedings, it can be helpful to administer the enteral nutritional formula at room temperature to prevent symptoms. Notify the provider of signs of intolerance with anticipated prescription changes regarding the type of formula or the rate of administration.

Electrolytes and blood glucose levels should also be monitored for signs of imbalances. Carbohydrates in tube feedings are absorbed quickly, so blood glucose levels are monitored, and elevated levels are typically treated with sliding scale insulin according to health care provider orders.

Read about “ Enteral Tube Management ” in Open RN  Nursing Skills .

Parenteral nutrition.

Parenteral nutrition  is nutrition delivered through a central intravenous line, generally the subclavian or internal jugular vein, to patients who require nutritional supplementation but are not candidates for enteral nutrition. Parenteral nutrition is an intravenous solution containing glucose, amino acids, minerals, electrolytes, and vitamins. A lipid solution is typically given in a separate infusion in a hospital setting. This combination of solutions is called total parenteral nutrition because it supplies complete nutritional support. Parenteral nutrition is administered via an IV pump.

Because parenteral nutrition consists of concentrated glucose, amino acids, and minerals, it is very irritating to the blood vessels. For this reason, a large central vein must be used for administration. The patient’s lab work must also be closely monitored for signs of nutrient excesses. See Figure 14.13 [ 33 ]  for an image of home parenteral nutrition formula. In this image are three compartments: one with glucose, one with amino acids, and one with lipids. The three compartments are kept separate to enable storage at room temperature, but are mixed together before use.

Figure 14.13

Total Parenteral Nutrition

Parenteral nutrition is typically used when the patient’s intestines or stomach is not working properly and must be bypassed, such as during paralytic ileus where peristalsis has completely stopped, or after postoperative bowel surgeries, such as bowel resection. It may also be prescribed for severe malnutrition, severe burns, metastatic cancer, liver failure, or hyperemesis with pregnancy.

Implementing Interventions

When implementing interventions to promote good nutrition, it is vital to consider the patient’s cultural and religious beliefs. Encourage patients to make healthy food selections based on their food preferences.

If a patient has nutritional deficit, perform nursing interventions prior to mealtime to promote their appetite. For example, if the patient has symptoms of pain or nausea, administer medications prior to mealtime to manage these symptoms. Do not perform procedures that may affect the patient’s appetite, such as wound dressing changes, immediately prior to meal time. Manage the environment prior to the food arriving and remove any unpleasant odors or sights. For example, empty the trash can of used dressings or incontinence products. If the patient is out of the room when the meal tray arrives and the food becomes cold, reheat the food or order a new meal tray.

When assisting patients to eat, help them to wash their hands and use the restroom if needed. Assist them to sit in a chair or sit in high Fowler’s position in bed. Set the meal tray on an overbed table and open containers as needed. Encourage the patient to feed themselves as much as possible to promote independence. If a patient has vision impairments, explain the location of the food using the clock method. For example, “Your vegetables are at 9 o’clock, your potatoes are at 12 o’clock, and your meat is at 3 o’clock.” When feeding a patient, ask them what food they would like to eat first. Allow them to eat at their own pace with time between bites for thorough chewing and swallowing. If any signs of difficulty swallowing occur, such as coughing or gagging, stop the meal and notify the provider of suspected swallowing difficulties.

It is always important to evaluate the effectiveness of interventions implemented. Evaluation helps the nurse and care team determine if the interventions are appropriate for the patient or if they need to be revised. Table 14.3e provides a list of assessment findings indicating that alterations of nutritional status are improving with the planned interventions.

Table 14.3e

Evaluation of Alterations in Nutritional Status

14.4. PUTTING IT ALL TOGETHER

Patient scenario.

Mr. Curtis is a 47-year-old patient admitted to the hospital with increased weakness, fatigue, and dehydration. His skin appears dry, and tenting occurs when skin turgor is evaluated. He is currently undergoing chemotherapy treatment for multiple myeloma and has experienced weight loss of 10 pounds within the last two weeks. He describes that “nothing tastes good,” and he feels as if there is “metal taste in his mouth.” When he does eat small meals, he reports that he is often nauseous. The patient’s serum protein level is 3.1 g/dL.

Applying the Nursing Process

Assessment:  The nurse identifies that the patient is experiencing signs of imbalanced nutrition with the signs of increased weakness, fatigue, and signs of dehydration such as skin tenting and dryness. The patient has demonstrated a significant weight loss over the past two weeks and reports “nothing tastes good” and “a metal taste in the mouth.” The patient also reports nausea after eating. His serum protein level reflects signs of malnutrition.

Based on the assessment information that has been gathered, the following nursing care plan is created for Mr. Curtis:

Nursing Diagnosis:  Imbalanced Nutrition: Less Than Body Requirements r/t insufficient dietary intake as manifested by weight loss of 10 pounds in the last two weeks, skin tenting and dryness, reports of “nothing tastes good,” and serum protein of 3.1 g/dL.

Overall Goal:  The patient will demonstrate improvement in nutrition intake.

SMART Expected Outcome:  Mr. Curtis will eat 50% of offered meals and demonstrate dietary tolerance within 24 hours.

Planning and Implementing Nursing Interventions:

The nurse will validate the patient’s feelings regarding his current symptoms and provide emotional support. The nurse will determine the time of day when the patient’s appetite is highest and offer the highest calorie meal at that time. The nurse will offer high-calorie protein shakes to the patient at frequent intervals. The nurse will assess the patient’s food preferences and ensure that small frequent meals are offered that incorporate those preferences. The nurse will also encourage the use of plastic utensils and encourage the patient to eat mints or chew gum to minimize the metallic taste in the mouth.

Sample Documentation:

Mr. Curtis demonstrates signs of imbalanced nutrition: less than body requirements. He reported a significant weight loss of 10 pounds over the past two weeks associated with chemotherapy. He reports feeling nauseous following small meals. He also reports “nothing tastes good” and having “a metal taste in the mouth.” He demonstrates signs of weakness, fatigue, and dehydration. Interventions have been implemented to increase the patient’s nutritional intake.

Evaluation:

Twenty-four hours later, the nurse evaluates Mr. Curtis and finds he is able to consume 50% of breakfast with his preferred dietary items. Planned interventions will continue and the nurse plan to reevaluate his progress the following day.

14.5. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)

Mr. Jones is a 67-year-old patient on the medical surgical floor who recently underwent a bowel resection. He is post-op Day 2 and has been NPO since surgery. He has been receiving IV fluids but has been asking about when he can resume eating.

What assessments should be performed to determine if the patient’s diet can be progressed?

What are the first steps during dietary transition from NPO status?

Scenario 2 [ 1 ]

Mrs. Casey is a 78 year-old widow who recently had a stroke and continues to experience mild right-sided weakness. See Figure 14.14 for an image of Mrs. Casey. [ 2 ]  She is currently receiving physical therapy in a long-term care facility and ambulates with the assistance of a walker. Mrs. Casey confides, “I am looking forward to going home, but I will miss the three meals a day here.”

Figure 14.14

Her height is 5’2″ and she weighs 84 pounds. Her recent lab work results include the following:

Hgb: 8.8 g/dL, WBC 3500, Magnesium 1.4 mg/dL, Albumin 1.0 g/dL

What is Mrs. Casey’s BMI and what does this number indicate?

Analyze Mrs. Casey’s recent lab work and interpret the findings.

Describe focused assessments the nurse should perform regarding Mrs. Casey’s nutritional status.

Create a PES nursing diagnosis statement for Mrs. Casey based on her nutritional status.

Create a SMART outcome statement for Mrs. Casey.

Outline planned nutritional interventions for Mrs. Casey while she is at the facility, as well as when she returns home.

How will you evaluate if your nursing care plan is successful for Mrs. Casey?

“Nutrition Case Study” by Susan Jensen for  Lansing Community College  are licensed under  CC BY 4.0

• XIV GLOSSARY

A measure of weight categories including underweight, normal weight, overweight, and obese taking height and weight into consideration.

Foods with a substantial amount of calories and few nutrients.

Sugars and starches that provide an important energy source, providing 4 kcal/g of energy.

Breakdown of food with stomach acids, bile, and pancreatic enzymes for nutrient release.

Broken-down food that has undergone chemical digestion in the stomach.

A thick yellowish-white fluid rich in proteins and immunoglobulin A (IgA) and lower in carbohydrates and fat than mature breast milk secreted within the first 2-3 days after giving birth.

Proteins with enough amino acids in enough quantities to perform necessary functions such as growth and tissue maintenance. These must be ingested in the diet.

Larger molecules of polysaccharides that break down more slowly and release sugar into the bloodstream more slowly than simple carbohydrates.

Set requirements or limit amounts of a certain nutrient, including proteins, carbohydrates, fats, vitamins, minerals, and fiber.

Difficulty swallowing.

Liquid nutrition given through the gastrointestinal tract via a tube while bypassing chewing and swallowing.

Nutrients that must be ingested from dietary intake. Essential nutrients cannot be synthesized by the body.

Vitamins that dissolve in fats and oils and are stored in fat tissue and can build up in the liver, resulting in toxicity. Fat-soluble vitamins include vitamins A, D, E, and K.

Fatty acids and glycerol that are essential for tissue growth, insulation, energy source, energy storage, and hormone production. Fats provide 9 kcal/g of energy.

A measure of how quickly plasma glucose levels are released into the bloodstream after carbohydrates are consumed.

Proteins that do not contain enough amino acids to sustain life. Incomplete proteins can be combined with other types of proteins to add to amino acids consumed to form complete protein combinations.

Breast milk production.

Minerals needed in larger amounts and measured in milligrams, grams, and milliequivalents.

Nutrients needed in larger amounts due to energy needs. Macronutrients include carbohydrates, proteins, and fats.

The chewing of food in the mouth.

Breaking food down into small chunks through chewing prior to swallowing.

The net loss or gain of nitrogen excreted compared to nitrogen taken into the body in the form of protein consumption; an indicator of protein status where a negative nitrogen balance equates to a protein deficit in the diet and a positive nitrogen balance equates to a protein excess in the diet.

Foods with a high proportion of nutritional value relative to calories contained in the food.

An intravenous solution containing glucose, amino acids, minerals, electrolytes, and vitamins, along with supplemental lipids.

Proteins that have enough amino acids to sustain life, but not enough for tissue growth and maintenance. Typically interchanged with incomplete proteins.

Coordinated muscle movements in the esophagus that move food or liquid through the esophagus and into the stomach or coordinated muscle movements in the intestines that move food/waste products through the intestines.

Sources of peptides, amino acids, and some trace elements that provide 4 kcal/g of energy. Proteins are necessary for tissue repair, tissue function, growth, fluid balance, and clotting, as well as energy in the absence of sufficient intake of carbohydrates.

Grains that have been processed to remove parts of the grain kernel and supply little fiber.

Fats derived from animal products, such as butter, tallow, and lard for cooking, or from meat products such as steak. Saturated fats are generally solid at room temperature and can raise cholesterol levels, contributing to heart disease.

Small molecules of monosaccharides or disaccharides that break down quickly and raise blood glucose levels quickly.

Minerals needed in tiny amounts.

Fats that have been altered through hydrogenation and as such are not in their natural state. Fat is changed to make it harder at room temperature and to make it have a longer shelf life and contributes to increased cholesterol and heart disease.

Fats derived from oils and plants, though chicken and fish contain some unsaturated fats as well. Unsaturated fats are healthier than saturated fats, and some containing omega-3 fatty acids are considered polyunsaturated fats and help lower LDL cholesterol levels.

Vitamins that are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid, biotin, and pantothenic acid). Toxicity is rare as excess water-soluble vitamins are excreted in the urine.

Grains with the entire grain kernel that supply more fiber than refined grains.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

• Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 14 Nutrition.
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• NUTRITION INTRODUCTION
• NUTRITION BASIC CONCEPTS
• APPLYING THE NURSING PROCESS
• PUTTING IT ALL TOGETHER
• LEARNING ACTIVITIES

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Introduction to Nutrition

City College of San Francisco via California Community Colleges System Help

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