NUTRITION

Is the sum of all the interaction between an organism and the food it consumes
Is what the person eats and how the body uses it
Function:
To MAINTAIN LIFE by allowing one to grow and be in state of optimum health
Food
Nutrients
Calorie
Carbohydrate  4 calories per gram
Protein  4 calories per gram
Fat  9 calories per gram

NUTRIENTS

Are organic or inorganic substances found in foods that are required for body functioning
Nutritive value – the nutrient content of a specified amount of food
NO FOOD provides all essential nutrients

6 Essential Nutrients

Nutrients
Organic Inorganic
CHO VIT H20 Minerals
CHON FATS

CARBOHYDRATES

Considered as the PRIMARY source of fuel for the brain and the rest of the body.
50% - 70% of total energy requirement
1 gram CHO= 4 calories upon complete hydrolysis
Has SUGARS (Composed mainly of SUGARS)
Organic compounds composed of carbon, hydrogen and oxygen

Derived from the Greek word “saccharide” meaning starches and sugars

Chiefly found in plants and produced by the process of photosynthesis from -

H2O, CO2 and sun

CLASSIFICATION OF CARBOHYDRATES
1. MONOSACCHARIDES
Simplest form of sugar

Glucose
-”physiologic sugar” or “blood sugar”, “dextrose”, “grape sugar” - principal form used by the body
- moderately sweet sugar works for the body’s brain, nerve cells, RBC
- stores last for only hours
- Gluconeogenesis – process where protein is converted to glucose
- Ketosis – less available CHO for energy – more fats to be broken down – form ketone bodies
- sources: abundant in fruits, sweet corn, corn syrup
Lycopene-red
Carotene-orange, yellow
Anthocyanin-blue, violet
Cruciferae – green, white
B. Fructose
- “fruit sugar”, sweetest of all sugar, “levulose”
- sources: ripe fruits and honey

C. Galactose
- not found in nature, not found in free foods
- produced from lactose (milk sugar) by digestion and is converted to glucose
- Galactosemia – Infants born with an inability to metabolize galactose

Republic Act 9288 – New born Screening Test

2. DISACCHARIDES-two sugar molecules

A. Sucrose-”cane sugar”, “table sugar”, “beet sugar”

Sucrose = glucose + fructose

B. Maltose-”malt sugar”
Derived from the digestion of starch
Maltose = glucose + glucose

C. Lactose-”milk sugar”
Least sweet among sugars
Lactose = glucose + galactose
Source: milk and milk products
3. COMPLEX CARBOHYDRATES OR POLYSACCHARIDES
-contains many monosaccharides linked together

A. Starch- storage form of carbohydrates in plants

- supply energy for a long period of time Source: cereal grains, rice, wheat

Derived from dextrose (glucose), dextrin is a low-molecular-weight carbohydrate produced from the

hydrolysis of starches. An intermediate product of starch digestion plus acid with application of heat
of 150-200 C.

Starch(dextrin) =maltose + 2 glucose units

Dextrin is used in many glue products due to its adhesive qualities and safety. The indigestible form
of dextrin is often used as a fiber supplement.

C. Glycogen- “animal starch”, storage form of CHO in the body found in the liver and muscle

Muscle glycogen supplies energy directly to surrounding tissues during work and exercise

Liver glycogen is converted to glucose to be used in the body through the process called
“glycogenolysis”
Source: liver, oysters, muscle meat
A glycogen storage disease (GSD, also glycogenosis and dextrinosis) is a metabolic disorder caused by
enzyme deficiencies affecting either glycogen synthesis, glycogen breakdown or glycolysis (glucose
breakdown), typically within muscles and/or liver cells. GSD has two classes of cause: genetic and
acquired.

Glycogen storage disease type I (GSD I) or von Gierke disease, is the most common of the glycogen
storage diseases. This genetic disease results from deficiency of the enzyme glucose-6-phosphatase,
and has an incidence in the American population of approximately 1 in 50,000 to 100,000 births.

Liver Biopsy – confirmatory test

D. Fibers
-”roughage”because they form bulk of the diet
- act as broom in our digestive tract
- indigestible part of food and primary constituent of plant cell wall
- not digested by human due to lack of enzyme that will split or break it
- Requirement: 20-35 g/day

FUNCTIONS OF CARBOHYDRATES
Chief source of energy, protein sparing
Supplies energy to the body
Takes part in building body tissues to some limited extent
Regulator of intestinal peristalsis and provider of bulk

LACK OF CARBOHYDRATE RESULTS TO:

Underweight and/or rapid weight loss
General weakness
Poor physical performance
Fainting or collapse in severe deficiency
Hypoglycemia in acute carbohydrate deficiency

EXCESSIVE CARBOHYDRATE MAY RESULTS IN:

Dental caries
Obesity/overweight
Diabetes mellitus
Gas formation

Health Effects of Starch and Fibers

1. Promote weight loss/ weight control – increase fibers, low fats and added sugar
2. Protect against heart disease and stroke – high in carbohydrates
3. Protect against cancer – high in carbohydrates
4. Fight against diabetes – high in carbohydrates and low fats control weight
5. Promote gastrointestinal health – increase fibers enhances healthy large intestine

PROTEINS
Complete and Incomplete Proteins
Has amino acids which serve as the building units of the body tissues
Organic compounds composed of carbon, hydrogen, oxygen and nitrogen
Normal osmotic relations in body fluids (albumin)

10%-15% of total energy needs is supplied by CHON

1 gram CHON= 4 calories upon complete hydrolysis

Simple proteins
- albumins – soluble in water, coagulated by heat
- globulins – insoluble in water, soluble in salt solution, coagulated by heat
ACCORDING TO ESSENTIALITY

A. ESSENTIAL AMINO ACID (EAA) OR INDISPENSABLE

AMINO ACID-is one that cannot be synthesized by the body
Histidine Phenylalanine
Isoleucine Threonine
Leucine Tryptophan
Lysine Valine
Methionine
B. SEMI-ESSENTIAL AMINO ACID OR SEMI-INDISPENSABLE AMINO ACID-
reduce a need for a particular EAA and partially spares it
 Arginine Tyrosine
Cystine Glycine
Serine

C. NON-ESSENTIAL AMINO ACID (NEAA)- is not dietary essential because the

body can synthesize it
Glutamic acid Aspartic acid
Alanine Proline
Norleucine Citrulline
Hydroxyglycine Hydroxyproline

Marasmus vs Kwashiorkor

Marasmus Kwashiorko
r
Food deprivatio Severe Semi-
n starvation

Onset 6 mon – 4 years 1 – 6 years

Deficiency Protein and Calorie Protein only

s

Appearance Old Man’s Face Moon’s Face

FUNCTIONS OF PROTEINS

Builds and repairs body tissue for growth and maintenance

Anabolism – repairing worn out body tissue
Catabolism – continued wear and tear going on in the body
Builds resistance to infection by helping form antibodies
Supplies additional energy
Contributes to numerous body secretions and fluids
Maintain water balance
SOURCES OF PROTEIN

ANIMAL SOURCE- egg, milk, milk products, meat, fish, poultry and seafoods
PLANT SOURCE- cereals (wheat, rice, corn), legumes (munggo beans, peas, peanuts, soybeans),
processed vegetable protein (vegemeat, tofu)

LACK OF PROTEIN RESULTS IN:

Retarded growth in children

Low resistance to infection at any age
Slow recovery from illness
Low birth weight
Protein energy malnutrition- Marasmus and Kwashiorkor
Loss of weight
Edema, skin lesions, mental sluggishness

EFFECTS OF EXCESSIVE PROTEIN INTAKE

Kidney function – high CHON diet - increase work of kidneys
Mineral losses – increase CHON diet - calcium excretion rises
Obesity – high CHON diet – increase intake rich fat foods
Heart disease – foods rich in animal protein – rich n saturated fats
Cancer – increase in CHON diet – increases rich saturated fats foods intake

FATS

Facilitates absorption of the fat soluble vitamins (A, D, E, K)

As insulator and protector
Two Fatty Acids – basic structural unit of fat. They are the key refined fuel forms of fat that the cell
burns for energy
Serve as the continuing supply of energy each and every hour

Organic nutrient containing C,H,O attached in a glycerol base.

1 gram fat=9 calories
20%-30% of TER is from fat.
Remains in the stomach for the longest period of time
Classification of FATS
Simple Lipids - neutral fats
chemical name is triglycerides
glycerol is derived from a water soluble form of CHO
Compound lipids - combination of fats with other components
important in human nutrition

A. Phospholipids - fatty acids, phosphoric acids and nitrogenous base

1. Lecithin - most widely distributed
- traces placed in liver, egg yolk and vegetable oil; added to food products such as
cheese and margarine to aid emulsification
2. Cephalin - needed to form thromboplastin for blood clotting
3. Sphigomyelin - found in brain and other nerve tissue; serves as insulator around nerve fibers
B. Glycolipids - fatty acids combined with CHO and nitrogen

C. Lipoprotein - lipids combination of protein

1. Chylomicrons - transport diet-derived lipids

- mostly triglycerides
2. Pre-beta lipoprotein - VLDL (very low density lipoprotein)
- fat circulating in the blood during fasting state
3. Beta lipoprotein - LDL (low density lipoprotein)
 - transport in the artery wall
4. Alpha lipoprotein – scavengers; GOOD CHOLESTEROL
3. Derived lipids – fat substances produced from fats and fat compounds
A. fatty Acids – basic structural unit of fat
1. saturated fatty acids – palmitic and stearic acids

bacon butter
grated coconut coconut cream
coconut oil margarine mayonnaise cream cheese
sandwich spread whipping cream chicharon cholesterol rich foods
Trans Fat

2. monounsaturated – oleic acid (omega 9)

avocado peanut butter peanut oil pili
nut
olive oil shortening
3. polyunsaturated fatty acids – linolenic acid- Vitamin F, Omega 3, linoleic acid – Omega 6
vegetable oil
corn soybean rapeseed
canola sunflower sesame
POLYUNSATURATED

OMEG

B. Glycerol - water soluble component of triglycerides

- available for the formation of glucose in the diet

C. Steroids - fat related substances that contain sterols

- main member is cholesterol – important constituent of body cells and tissues.
FUNCTIONS OF FATS

Supplies food energy in concentrated form for body activities.

Protects vital body tissue and insulates body
Supplies essential fatty acids.
Serves as a carrier of the fat-soluble vitamins (A,D,E,K)
Adds palatability and satiety value (sense of fullness) to your meals.
LACK OF FAT IN THE DIET RESULTS IN:
Underweight
Sluggishness
Skin irritation similar to eczema in infants
Signs and symptoms of fat-soluble vitamin deficiency

EXCESS INTAKE OF FAT RESULTS IN:

obesity/overweight
cardiovascular diseases
 NUTRIENTS

VITAMINS

Fat Soluble Water Soluble

Not absolutely needed daily from food source Must be supplied everyday in the diet
s

Have precursors Do not have precursors
Stored in the body Not stored in the body, any excess is excreted in urin
e

Deficiency develops slow Deficiency develops fast
Vitamin content is highest in FRESH FOODS that are consumed as soon as possible after harvest

MINERALS

Calcium and Phosphorus

make up 80% of all mineral elements in the body

WATER – 60-70% total body weight

deprivation of 10% water – illness; 20% - death
next to O2 for maintenance of life
45 liters – water found in the body of normal adult
30 liters intracellular (inside or within the cells)
15 liters extracellular (outside the cells)
Functions:
Acts as solvent for all products of digestion (universal solvent)
Carries nutrients to the tissues
Removes waste products from the tissue
Helps regulate body temperature and the acid-base balance
Sends messages between cells so you can think, see, touch, hear, feel and move

Dietary Reference Intakes (DRIs)

1. Estimated Average Requirements (EAR)

2. Recommended Dietary Allowance (RDA) 
3. Adequate Intake (AI)
4. Tolerance Upper Intake Levels (UL)
 
COMPONENTS OF ENERGY EXPENDITURE
BASAL METABOLISM
 measure of energy needed by the body at rest for its internal chemical activities like
respiration, cellular metabolism, circulation, glandular activity and maintenance of
body temperature

 approximately 1 calorie per kg of body weight per hour

BASAL METABOLISM RATE (BMR)

 rate of basal metabolism in a given person at a given time and situation

Factors affecting BMR or Individuals Caloric Need

 Surface Area - the greater the body surface area or skin area, the greater the
amount of heat loss will be, increases heat - increases BMR. WHY? Muscle tissue
requires more O2 than adipose tissue.
 Sex/Gender - Men is higher BMR than women. WHY? Women have a little
more fat and less muscular development than men. So, men requires more calories
 Age - BMR is highest the periods of rapid growth; first 2 years of life,
adolescence, pregnancy requires more calories, BMR declines slowly with
increasing age, decrease age, increase BMR – increase age, decrease BMR.
WHY? Lowering muscle tone from lessened activity.
 Body composition - a large proportion of inactive adipose tissue lowers the
BMR. Athletes with greater muscular development increases BMR than non-
athletic individuals.
 Activity - increased muscular activity increase BMR. Greater energy
expenditure requires more calories.
 State of nutrition - a decrease in mass of active tissue like in malnutrition,
undernourished or starvation causes decrease BMR. Illness increases energy
requirements because of increased metabolic rate.
 Sleep - Less energy required during sleep, metabolic rate drops due to
muscular relaxation and decreased activity of the sympathetic nervous
system. Therefore, dinner is ideally the lightest meal.
 Endocrine glands - the secretion of the endocrine glands are the principal
regulators of the metabolic rate. Therefore, male sex hormones increase about 10-
15% the BMR and the female sex hormone a little less.
 Fever - increases the BMR about 7% for each degree rise in the body
temperature above 98.6F.
 Climate - cold climate causes higher BMR so people need more calories due
to increased thyroxine level in people who live in cold climate

PHYSICAL ACTIVITY (PA) – calorie requirements depend upon the type and
amount of exercise or work engaged into. The more vigorous the physical work, the
greater the calorie cost.
Food and Fluid Intake Regulating Mechanisms (Hypothalamus)

 Thirst – triggered by loss of body fluid of more than 2%

 Hunger – triggered by low blood glucose level, normal blood glucose level
(70-110 mg/dl),   DM: more than 140 mg/dl for 2 consecutive readings
 Appetite – triggered by sight, smell and thought of food
 Satiety – triggered by gastric distention.

Nutrition Tools, Standards and Guidelines Nutrient Recommendation

The Philippines is one of the countries in the world where a significant number of children remain
malnourished despite the economic growth and development in the country over the past decades.

Data from the 2013 National Nutrition Survey (2013 NNS) in the Philippines reported that among
children under 5 years old, the prevalence of malnutrition measured by underweight and stunting was
20% and 30%, respectively, and the prevalence starts to increase at 6–11 months.

Dietary Reference Intakes (DRIs)

Dietary Reference Intakes (DRIs) is a generic term for a set of nutrient reference values that includes
the Recommended Dietary Allowance (RDA), Adequate Intake (AI), Tolerable Upper Intake Level (UL),
and Estimated Average Requirement (EAR).

This is for planning and assessing diets of healthy groups and individuals. PDRI is the collective term
comprising reference value for energy and nutrient levels of intakes.

Estimated Average Requirement (EAR) is a daily nutrient intake level that meets the median or
average requirement of healthy individuals in particular life stage and sex group, corrected for
incomplete utilization or dietary nutrient bioavailability.

The estimated average requirement (EAR) is the amount of a nutrient that is estimated to meet the
requirement for a specific criterion of adequacy of half of the healthy individuals of a specific age, sex,
and life-stage.

The amount of the nutrient necessary to meet the appropriate criterion of adequacy varies from one
individual to the next, but the data are usually distributed normally or can be transformed to achieve
a normal distribution. A recommended dietary allowance (RDA) for a nutrient is derived from
an estimated average requirement (EAR), which is an estimate of the intake at which the risk of
inadequacy to an individual is 50%.
Recommended Energy/Nutrient Intake (RENI) also known as Recommended Daily Allowances is a
level of intake of energy or nutrient which is considered adequate for the maintenance of health and
well-being of healthy persons in the population.

The Recommended Dietary Allowance (RDA) is the average daily dietary intake level that is sufficient
to meet the nutrient requirement of nearly all (97 to 98 percent) healthy individuals in a particular
gender and life stage group (life stage considers age and, when applicable, pregnancy or lactation).

The 2015 Philippine Dietary Recommended Intake (PDRI) shall be used for planning and assessing
diets for individuals and groups, developing food-based dietary guidelines, formulating standards and
regulations on food fortification, nutrition labeling and claims, and food safety, designing and
evaluating food and nutrition assistance programs, determining food bundles, setting food production
targets, and other related uses that require consideration of nutrient and dietary intakes.  

RDA

Adequate Intake (AI) is a daily nutrient intake level that is based on observed or experimentally-
determined approximation of the average nutrient intake by a group (groups) of apparently healthy
people that are assumed to sustain a defined nutritional state.

Adequate Diet is composed of various nutrients which body needs for maintenance, repair, and for
growth and development.

The AI is based on observed or experimentally determined estimates of nutrient intake by a group (or
groups) of healthy people. For example, the AI for young infants, for whom human milk is the
recommended sole source of food for the first 4 to 6 months, is based on the daily mean nutrient
intake supplied by human milk for healthy, full-term infants who are exclusively breastfed.

The main intended use of the AI is as a goal for the nutrient intake of individuals. For example: if an
individual has a total calorie in a day of 1,500, that individual can take at least 75% of the total calorie
for a day which is 1,125 calorie is allowable. 

Tolerable Upper Intake Level or Upper Limit (UL) is a highest average daily nutrient intake level likely
to pose no adverse health effects to almost all individuals in the general population.

As intake increases above the UL, the risk of adverse effects increases. The term tolerable intake was
chosen to avoid implying a possible beneficial effect. Instead, the term is intended to connote a level
of intake that can, with high probability, be tolerated biologically.
COMPONENTS OF ENERGY EXPENDITURE

BASAL METABOLISM

measure of energy needed by the body at rest for its internal chemical activities like respiration,
cellular metabolism, circulation, glandular activity and maintenance of body temperature
approximately 1 calorie per kg of body weight per hour

BASAL METABOLISM RATE (BMR)

rate of basal metabolism in a given person at a given time and situation

Factors affecting BMR or Individuals Caloric Need

Surface Area - the greater the body surface area or skin area, the greater the amount of heat loss will
be, increases heat - increases BMR. WHY? Muscle tissue requires more O2 than adipose tissue.

Sex/Gender - Men is higher BMR than women. WHY? Women have a little more fat and less muscular
development than men. So, men requires more calories

Age - BMR is highest the periods of rapid growth; first 2 years of life, adolescence, pregnancy requires
more calories, BMR declines slowly with increasing age, decrease age, increase BMR – increase age,
decrease BMR. WHY? Lowering muscle tone from lessened activity.

Body composition - a large proportion of inactive adipose tissue lowers the BMR. Athletes with
greater muscular development increases BMR than non-athletic individuals.
Activity - increased muscular activity increase BMR. Greater energy expenditure requires more
calories.

State of nutrition - a decrease in mass of active tissue like in malnutrition, undernourished or

starvation causes decrease BMR. Illness increases energy requirements because of increased
metabolic rate.

Sleep - Less energy required during sleep, metabolic rate drops due to muscular relaxation and
decreased activity of the sympathetic nervous system.
Therefore, dinner is ideally the lightest meal.

Endocrine glands - the secretion of the endocrine glands are the principal regulators of the metabolic
rate. Therefore, male sex hormones increase about 10-15% the BMR and the female sex hormone a
little less.
Fever - increases the BMR about 7% for each degree rise in the body temperature above 98.6F.

Climate - cold climate causes higher BMR so people need more calories due to increased thyroxine
level in people who live in cold climate

PHYSICAL ACTIVITY (PA) – calorie requirements depend upon the type and amount of exercise or work
engaged into. The more vigorous the physical work, the greater the calorie cost.

Food and Fluid Intake Regulating Mechanisms

(Hypothalamus)
Thirst – triggered by loss of body fluid of more than 2%
Hunger – triggered by low blood glucose level
normal blood glucose level (70-110 mg/dl)
DM: more than 140 mg/dl for 2 consecutive readings
Appetite – triggered by sight, smell and thought of food
Satiety – triggered by gastric distention.
FOOD SUBTITLE

Dietary Guidelines and Food Guides

The Food Pyramid is designed to make healthy eating easier. Healthy eating is about getting the
correct amount of nutrients – protein, fat, carbohydrates, vitamins and minerals you need to maintain
good health. Grains should be taken as the major dietary source. Eat more fruit and vegetables. Have
a moderate amount of meat, fish, egg, milk and their alternatives.
The Philippines uses the daily nutritional guide pyramid and has developed pyramids for different
population groups. The healthy food plate for Filipino adults (Pinggang Pinoy) completes the
messages of the pyramid by showing adequate distribution of nutritious foods in a meal.

Pinggang Pinoy (Filipino Plate) is a new, easy to understand food guide that uses a familiar food plate
model to convey the right food group proportions on a per-meal basis, to meet the body’s energy and
nutrient needs of Filipino adults. Pinggang Pinoy serves as visual tool to help Filipinos adopt healthy
eating habits at meal times by delivering effective dietary and healthy lifestyle messages.

As its name suggests, Pinggang Pinoy is specially designed for Filipinos which features the three (3)
food groups GO, GROW and GLOW foods represented by food items commonly consumed by the
population. Go food represents carbohydrates, Grow food represents protein and Glow food
represents vitamins and minerals. Go or energy-giving foods, such as rice, grains and other starches,
provide energy to keep one going throughout the day.

Grow or body-building foods, such as meat, fish, dairy and eggs, provide the protein and minerals
necessary for the growth and repair of tissues, muscles and bones. Recognizing the different nutrient
requirements of the different age groups, the FNRI has developed the Pinggang Pinoy plates for
children, adolescents, pregnant women and lactating mothers and the elderly.  

10 kumainments
Food Exchange List
The Food Exchange Lists (FEL) for Meal Planning is one of the basic tools in nutrition and dietetics. It is
a tool for quick estimation of the energy and macronutrients for use in planning meals of individual
clients. Exchange lists provide a way of grouping foods together to help people on special diets stay
on track. Each group lists foods in a certain serving size.

In the food exchange list, commonly use foods are divided into seven groups or list. Each list or group
contains approximately the same amount of carbohydrates, proteins, fats and calories per exchange.
A food in any one group can thus be substituted for or exchange with another food in the same list or
sub-group. This food list can be use in meal plan but substituting each group in the same group. Nurse
can use this list to give more choices in planning a meal for a client.

GENERAL NUTRITIONAL GUIDLINES

Nutrient Guidelines for Filipino

The Nutritional Guidelines for Filipinos (NGF) is a set of dietary guidelines based on the eating pattern,
lifestyle, and health status of Filipinos. The NGF contains all the nutrition messages to healthy living
for all age groups from infants to adults, pregnant and lactating women, and the elderly.

The first NGF released in 1990 was composed of five messages called “Dietary Guidelines for
Filipinos.” In 2000, a revised nutritional guidelines composed of ten messages was released and it was
called the Nutritional Guidelines for Filipinos.

The 2012 NGF now includes the basis and justification for each of the ten nutritional and health
message. The following 2012 NGF:

Eat a variety of foods everyday to get the

nutrients needed by the body.

(2) Breastfeed infants exclusively from birth up

to six months and then give appropriate
complementary foods while continuing
breastfeeding for two years and beyond for
optimum growth and development.

(3) Eat more vegetables and fruits to get the

essential vitamins, minerals, and fiber for
regulation of body processes.

(4) Consume fish, lean meat, poultry, egg, dried beans or nuts daily for growth and repair of body
tissues.
(5) Consume milk, milk products, and other calcium-rich food such as small fish and shellfish, everyday
for healthy bones and teeth.

(6)Consume safe foods and water to prevent diarrhea and other food-and water-borne diseases.

(7) Use iodized salt to prevent Iodine Deficiency Disorders.

(8) Limit intake of salty, fried, fatty, and sugar-rich foods to prevent cardiovascular diseases.

(9) Attain normal body weight through proper diet and moderate physical activity to maintain good
health and help prevent obesity.

(10) Be physically active, make healthy food choices, manage stress, avoid alcoholic beverage, and do
not smoke to help prevent lifestyle-related non-communicable disease

USDA Food Guide

The Dietary Guidelines for Americans (Dietary Guidelines) is the cornerstone for Federal nutrition
programs and a go-to resource for health professionals nationwide. The Dietary Guidelines provides
food-based recommendations to promote health, help prevent diet-related chronic diseases, and
meet nutrient needs.
Serving Up MyPlate is a collection of classroom materials that helps elementary school teachers
integrate nutrition education into Math, Science, English Language Arts, and Health. This yummy
curriculum introduces the importance of eating from all five food groups using the MyPlate icon and a
variety of hands–on activities. Students also learn the importance of physical activity to staying
healthy.

C. Nutrition Intervention

 Food and Nutrient Delivery

 Food Administration
 Oral Nutrition
 Short-term enteral access
 Long-term enteral access

Enteral Nutrition
Tube Feeding

 Provide enteral nutrition for clients who cannot swallow, with esophageal
obstruction, unconscious, and cannot consume oral feeding.
 Rubber – ice; Plastic- warm (Levine-single; Salem sump-double lumen)
 High fowler’s, if contraindicated place right side lying position with head
slightly elevated to prevent aspiration.
 Measure the distance from the tip of the nose to earlobe through the bottom of
the xiphoid process (adult)
 Measure the distance from the tip of the nose to earlobe through the midway
of xiphoid process and umbilicus (children)
 Use water soluble jelly as lubricant
 Offer sips of water and advance tube forward, head bent forward closes the
epiglottis and trachea
 Inject 10 ml of air and auscultate for gurgling sound in the epigastrium.
 Aspirate for residual stomach content (ph 1-3 of yellow to green)
 Immerse tip of the NGT into water and observe for bubbling.
 X-ray confirms
 Flush with 30-60 ml of water after feeding
 If NGT is to removed, instruct client to exhale and remove tube with smooth,
continuous pull

NG TUBE
N- ever give without checking
G- ive warm(room temperature)
T- urn to right side during the feeding for the stomach to empty better  
U- se gravity, never force feeding
B- e sure to aspirate
E- nd with water and chart
Types of Enteral Formulation

1. Ready to Use Formulations

2. Tube feedings – prepared from regular foods

1. Standard tube feeding - fiber free, high in cholesterol, fat and sugar

                                                                   - milk based, sugar and soft cooked eggs

           2. Blenderized tube feeding - soft diet allowances which can be blenderized
easily
Complications:
Mechanical

 nasopharyngeal irritations – ice chips

 luminal obstruction – flush, replace tube
 mucosal erosions – reposition tube, ice water lavage, remove tube
 tube displacement – replace tube
 aspiration – discontinue tube feeding

Gastrointestinal

 cramping/distention – change formula, reduce infusion rate

 vomiting/diarrhea – dilute formula, reduce infusion rate
 constipation – promote sufficient, fluids and fibers, encourage patient activity

Metabolic
 hypertonic dehydration – increase water
 cardiac failure – reduce sodium content, fluid restriction
 renal failure – decrease phosphate, magnesium, potassium, CHON restriction,
amino acids solution
 glucose intolerance – reduce infusion rate
 hepatic encephalopathy – decrease amount of CHON

Parenteral Nutrition

1. Peripheral Parenteral Nutrition (PPN) – nutrients are given via small veins,
usually in the arms
2. Total Parenteral Nutrition (TPN) – also called Central Parenteral Nutrition
(CPN) or intravenous hyperalimentation (IVH); nutrients are given centrally into
the superior or inferior vena cava or the jugular vein

 TPN solutions are nutritionally complete based  on the patient’s weight  and
caloric/nutritional needs
 TPN is indicated in clients who need extensive nutritional support over an
extended period like CA and severe malnutrition
 Mixture of dextrose, amino acids, multivitamins, electrolytes and trace of
minerals
 The usual site is subclavian vein
 During TPN catheter insertion, Trendelenburg position – to engorge the vein
and facilitate insertion of the vein and prevent air embolism
 The primary purpose of TPN is to administer glucose
 PIC – basilic / cephalic; PPC - subclavian
 Administer TPN at room temperature
 Cold temperature of solution may cause chills
 Consume TPN formula for 24 hours to prevent contamination
 The TPN solution is hypertonic (25-35% of dextrose)
 Use infusion pump to maintain steady infusion this prevents abnormal shifting
of fluids from intracellular compartment to the extracellular compartment (cells
shrink)
 If infusion is delayed do not catch up – notify physician for calculation
 Monitor urine and glucose level. Glycosuria is expected.
 The client may need small amount of insulin as prescribed by the physician to
prevent glucose intolerance
 Prevent infection on the catheter site. Infection is the most common
complication of TPN.
 If TPN administration is interrupted or discontinued, administer D10W to
prevent hypoglycemia

A. Assessment of Nutritional Status

Responsibilities and Role of Nurses in Nutritional Care

Observing
Nurse - usually the first person who sees the patient’s eating problems
 has direct communication with the patient
 how well the patient’s eats his food
 what kinds and amounts of food are refused
 the patient’s attitude towards his food are readily determined
 must have a knowledge in diet therapy (food allowed / restriction)
 should immediately forward the diet prescription to the dietary department
 makes sure that the patient is ready to consume the food served on the tray

Listening
Nurse - shows his/her general interest and understanding of the patient

 helps the patient express his/her feelings

 learned from the patient some of his/her favorite foods and dislikes
 explains concerns on foods that cannot be eaten due to ethnic, cultural
background and religious beliefs
 becomes aware of what concerns the patient may have about the diet he will
have at home

Reporting
      Nurse – documents and chart all the problems related to food intake
 
Nutritional History
a. Dietary Intake Data
- Dietary Computations: Desirable Body Weight
                                                        Basal Metabolic Rate
                                                        Total Energy Requirement
                                                        Food Exchange List 
b. Nutrient Intake Analysis (NIA)
c. Food Diary
d. Food Frequency
e. 24 hour Recall
 
Physical Assessment
a. Anthropometric Measurements
b. Height and Weight
c. Body Mass Index
d. Body Composition
e. Mid-arm Circumference (MAC)
f. Fat-fold or Skin-fold Thickness

 Other Sources of Data

 Malnutrition Universal Screening Tool (MUST)
 Subjective Global Assessment (SGA)
 Mini Nutritional Assessment (MNA)
 Geriatric Nutritional Risk Index (GNRI)

NUTRITIONAL CARE PROCESS

(ADIME) PROCESS
Nutritional Assessment
Adequate Diet – is composed of various nutrients which body needs for maintenance,
repair, and for growth and development.
Essential of an Adequate Diet
Milk Group - provide most of the calcium requirements
Meat Group - provides generous amounts of protein in high quality
Bread and Cereal Group – furnishes carbohydrates, minerals and vitamins at a
relatively at low costs.
Vegetable-Fruit Group - important supplier of fiber, vitamins and minerals
particularly Vitamin A and C.
Assessment of Nutritional Status

Nutritional Status or Nutriture

- is the degree to which the individual’s psychological need for nutrients is being
met by food she or he eats.

- is the state of balance in the individual between the nutrient intake and the
nutrient expenditure or needs

Nutritional Status Assessment

Dietary History and Intake Data

A. 24 Hour Recall – patient or individual completes a questionnaire or maybe an
interview asking to recall everything that he or she ate within the last 24 hours.

B. Food Frequency Questionnaire – patient answers the questionnaire for frequency of

food use as accurately as possible
C. Dietary History

contains additional information about the patient’s income, physical activity, ethnic
and cultural background, influence s on eating habits and religion, home life and meal
patterns, factors that affect appetite, allergies, intolerances, food avoidance, dental and
oral problems in eating, gastrointestinal problems, chronic diseases, dietary
modifications and medication.

Ethnic and Religion

1. Christianity – holy week observances may restrict meat (Good Friday)
2. Seventh Day Adventist – no pork and shellfish, alcohol, encourages veges diet
3. Judaism – no pork, shellfish, blood products, mixing of milk or dairy products with
meat in one meal, Kosher diet, no cooking during Sabbath day (Saturday)
4. Mormon – no alcohol, tobacco and caffeine
5. Islam – no pork (Haalal diet), no alcohol, caffeine, practices Ramadam (fasting
from sunrise to sunset of the month)
6. Hinduism – all meats are prohibited
Food Avoidance

1. Phenylalanine (EAA) – low protein diet to avoid imbalance of brain amino acids in
Phenylketonuria
2. Purine – reduce uric acid producing foods in gouty arthritis and hyperurecemia
3. Tyramine – high protein foods that underwent protein breakdown by aging,
fermentation and smoking
4. Gluten – a protein found in wheat, rye, barley, and other starchy foods, except rice
and corn like in Celiac Disease
Medications

Monoamineoxidase Inhibitors (MAOI) –

antidepressants, AVOID tyramine containing
foods like alcoholic beverages, dairy products,
avocado, banana, meats, chocolates and
condiments causes HYPERTENSIVE CRISIS.

2. Warfarin Sodium (Coumadin) – anticoagulant, AVOID or instruct the patient to

decrease intake of green leafy vegetables

3. Methimazole (Tapazole) – antithyroid, uses for Hyperthyroidism, inhibits synthesis

of thyroid hormone by interfering with iodine. Teach the client to AVOID seafood
and iodine products.

4. Estrogen Replacement Therapy (HRT) – management of menopausal symptoms in

women. Estrogens increase risk of cardiovascular disease and cancer so instruct the
patient to AVOID or reduce alcohol, caffeine and smoking.
D. Food Diary or Record – this method involves time, understanding and motivation
on the part of the patient as she or he writes down everything he or she eats or drinks
for a certain period of time.

E. Observation of Food Intake – most and accurate method of dietary intake

assessment, because it requires knowing the amount and kind of food presented to the
patient and record the amount actually eaten.

General Rules for Menu Planning

Use the whole day as a unit rather than the individual meal.
Use some food from each of the food groups daily (energy giving foods, body
building foods and body regulating foods)
Use some raw fruits or vegetables at least once a day
Plan to have for each meal at least one food with staying power or high in satiety
value.
Combine or alternate bland form with those of a more pronounced flavor.
Combine and alternate soft and crisp foods.
Have a variety of color, food and food arrangement.
When more foods are served at one meal, decease the size of portions and use fewer
rich foods.
Meal or menu patterns are helpful in planning menu but consider the family’s habits
and needs. The traditional recommended patterns for breakfast like fruit, egg or
substitute, bread or rice, hot beverage and for lunch and dinner- meat, fish and
poultry, rice, vegetable and fruit or dessert
It is best to have a weekly menu plan.
Nutritional Survey – is an epidemiological investigation of the nutritional status of the
population.

Methods of Nutritional Assessment

DIRECT information
Clinical Examination
- advantages as more coverage in a short time, inexpensive, no sophisticated
equipments
disadvantages as non-specificity of signs, overlapping of deficiency states and bias of
the observer
-system of collecting data starts from the head to toe (cephalocaudal)
establishing data base

Methods of Collecting Data

Interview
Observation - IPPA

Sources of Data
Primary: Patient
Secondary: Family Members, Significant Others, Health team members and Chart
Biochemical Examination

- estimation of time desaturation, enzyme activity or blood composition

- tests samples are blood and urine and results generally compared to
standards
- advantages as objectivity and can detect easily states of nutritional deficiency
- disadvantages as costly and time consuming
factors affecting accuracy of results like standards of collection and method of
transport and storage of samples

Anthropometric Measurement – measurement of the variations of the physical

dimensions and gross composition of the human body at different age levels and
degrees of nutrition.

Weight for age – uses weighing scale, assess body mass

Height for age – uses statiometer, anthropometric steel rods fixed accurately and
vertically to the wall
Weight for height/length – most accurate indicator of present state of nutrition, an
expression of leanness or wasting

Skin fold thickness – uses reliable caliper

Body circumferences
Birth weight
What is the healthy waistline?
Women - <31 inches
Men - <35 inches
Methods that provide INDIRECT information
Food Consumption Studies
Studies on Health Condition and Vital Statistics
Studies on food supply situation
Studies on socio-economic conditions
Studies on cultural and anthropological influences
MALNUTRITION

it is a global problem.
a condition caused by sustained, deficient, excessive, or imbalanced supply of
calories, and nutrients.

 
Forms of Malnutrition

Under nutrition - a pathological state resulting from the consumption of an inadequate

quantity of food, over an extended period of time.

Specific deficiency - a pathological state resulting from a relative or absolute lack of

an individual nutrient. (VAD, IDA,IDD)

Over nutrition - a pathological state resulting from the consumption of an excessive

quantity of food, a calorie excess over an extended period of time.
Types of Malnutrition

Acute malnutrition – related to the present state of nutrition like weight loss, low
weight for height and normal height for age

Chronic malnutrition – related to the past state of nutrition like nutritional dwarfism,
low weight for height and low height for age
 
Effects of Malnutrition
Increases susceptibility of infections
Inhibits mental development
Imposes heavy social and economic burdens

Causes of Malnutrition in the Philippines

Poverty
Poor distribution of food supply
Large family size
Low level of education among household member

Indicators for children below 10 years old

 BMI Interpretation

<18.5 Underweight

18.5 – 24.9 HEALTHY

25 – 29.9 Overweight

30 – 34. 9 Obese I

35 – 39.9 Obese II

>40 Extremely Obese

Waist Circumference
This alone is accurate measure of the amount of visceral fat (CENTRAL OBESITY)
Normal Findings
Men - < 90 cm / 35 inches
Women - < 80 cm / 31.5 inches
Waist Hip Ratio
Waist Circumference (cm) – narrowest point
Hip Circumference (cm) – widest point
Normal Findings Men -<1 Women - < 0.85
Equal to or greater than 1 (men), 0.85 (women) means android or central obesity
Weight for Age
Sensitive indicator of CURRENT nutritional status
Height for Age
Less sensitive and generally an indicator of PAST nutritional status (CHRONIC
MALNUTRITION)

Weight for Height

Most accurate indicator of present or current state of nutrition
Skinfold Thickness
Assess body composition and fat distribution
Mid-upper arm Circumference
Can be used for rapid diagnosis of PEM in children 1 – 4 years of age

<12.5 cm Undernutrition

12.5 to 13.5 cm Risk undernutrition

>13.5 to 16 cm Adequate nutrition

A. Nutrition In Pregnancy and Lactation

It ensures optimum nutrition before, during and after pregnancy and during lactation
Characteristics of Pregnancy:

 fertilized ovum implants itself to the uterus

 human pregnancy lasted for a period of 266 to 280 days (37-40 weeks)
 consists of three trimesters
 has three main phases – implantation, organogenesis, growth

Nutrition in Pregnancy:

1. Always start with diet history when it comes to giving nutritional instruction
to the mother.
2. PICA – persistent ingestion of inedible substances of little nutritional value
3. Vegetarians – lack essential protein and minerals, need Vitamin B12
supplement
4. Calorie Allowances

     Non-pregnant requirements – 1,800 to 2,200 Kcal/day

     Additional caloric requirement per day – 300 Kcal/day
     Usual daily caloric need in pregnancy – 2,100 to 2,500; never less than 1,800
Kcal/day

1. Maternal weight gain – 24 to 35 lbs

2. Maternal under weight causes having high risk of low birth weight, preterm
and infant deaths
3. Maternal over weight causes having risk of complications in labor and
delivery, hypertension, gestational DM, post partum infections.
4. Protein allowances - body-building food
                           - additional 30 g/day to ensure 74 to 76 g/day
                           - rich food sources includes milk, meat, fish, poultry and eggs
                           - provide for the storage of nitrogen
                           - protect the mother from any complications
                           - growth for maternal uterus, mammary tissues and placenta
                           - needs for fetal growth and repair
                           - hormonal preparation for lactation

1. Carbohydrates - sufficient intake is necessary for added energy

                                           - Avoid “empty” calories like soft drinks

1. Fiber - taken from fruits and vegetables to prevent constipation

2. Fats - high energy foods for absorption of vitamins ADEK

                    - AVOID too much fats to prevent vomiting and heartburn

1. Iron - most important mineral that must be taken in supplementary amount

                  - supplementary in pregnancy is 30-60mg per day

                  - needed to increase maternal RBC and for fetal liver storage in the third
trimester

1. Calcium - needed for maternal calcium and phosphorous metabolism and fetal
bone and skeletal growth

                         - 1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses)

1. Sodium - most abundant cation in extracellular fluid

                         - needed for tissue growth and development

                         - should not be restricted without serious indications

1. Folic Acid - for production of blood products and prevent fetal anomalies and
neural defect

1. Iodine – needs for fetal development and avoid cretinism

2. Vitamins – water and fat soluble vitamins

Vitamin A

Target Preparation Dose Duration Remarks

Pregnant Women 10,000 IU 1 capsule Start from NOT give if wom

 (10,000 IU) 4th month of is taking micronu
pregnancy until supplements with
TWICE a week delivery Vitamin A

Post-partum Wome 1 capsule 1 dose within 4 NOT given to

200,000 IU
n 200,000 IU weeks after delivery PREGNANT wom

Can be GIVEN
Pregnant women 1 capsule 4 weeks upon regardless of AO
10,000 IU
with Night blindness Once a day diagnosis the woman has n
blindness

 Vitamin B9

60mg 1 tablet 6 months or 180 A dose of 800 mcg

Pregnant Women iron/ 400mcg folic days during acid is still SAFE t
acid Once a day pregnancy period pregnant woman

60mg 1 tablet
Lactating
iron/ 400mcg folic 3 months or 90 days
Women Once a day
acid

  
Minerals

Calcium, Ca : 1,200 – 1,500 mg For fetal skeleton and teeth

Phosphorus Phosphorus – eat HIGH CHON formation

175 ug daily during pregnancy

Essential for
Iodine Iodized salt
formation of thyroxine
Serving of seafood at least once a week

30 mg - OB (Piliteri)
Iron Prevents IDA in pregnancy
60 mg – CHN (DOH)

Necessary for the synthesis of

Zinc 15 mg
DNA and RNA
Complication of Pregnancy and Dietary Modifications

1. Morning Sickness
2. Rapid weight gain or loss
3. Toxemia of Pregnancy
4. Anemia
5. Gestational DM
6. Constipation
7. Socio-economic and cultural factors
8. Alcohol, caffeine and nicotine

Nutritional Requirements for Lactating Mothers

 the nutritional requirements in lactation are greater than in pregnancy to

ensure enough supply of milk for the baby.

B. Nutrition in Infancy

Infancy

 refers to a person not more than 12 months

 weighs 2.7 to 3.2kg (6 to 7 lbs)
 measures 48 to 50 cm (19-20 inches) in length
 skin is moist, elastic and not wrinkled
 doubled the birth weight at 6 months
 tripled the birth weight at 12 months
 meet the oral needs of the infant (psychosexual-Freud’s Theory)
 provide safe and washable toy such as pacifier
 remove small objects that the infant can choke on
 burp the baby after each feeding to prevent colic
 alone in playing (solitary)
 sucking gives gratification

Mother’s milk is the best food for baby (Executive Order 51)
          If vaginal delivery – breastfeeding may done as early as 30 minutes after birth
         If CS delivery – 4 hours after delivery
         Demand feeding – best rule to observe when feeding the baby

 Provide a relaxed, warm and supportive environment as the letdown reflex is

affected by negative emotions of the mother. Provide reinforcement for positive
behavior or successful actions.

Breastfeeding benefits to the mother

1. Promotes maternal-infant bonding
2. Promotes uterine contraction and provided less incidence of thrombophlebitis
3. Reduces rate of ovarian cancer and premenopausal breast cancer
4. Decreases maternal morbidity and mortality
5. Save time, money, effort and economical
6. Delays fertility
7. Provide social and economic benefits

Breastfeeding benefits for the baby

1. Promote attachment
2. Provide perfect food that contains all necessary nutrients
3. Easily digested, has the right temperature and free from harmful bacteria
4. Provides passive antibody transfer to the newborn
5. It has colostrums, high protein content contains antibodies which help resist
infection
6. Causes fewer incidences of allergies, vomiting, diarrhea, constipation and
aspiration.
7. Enhances brain development because of taurine content
8. Decreases infant morbidity and mortality

Advantages of Breast milk than Cow’s milk

1. Breast milk is higher in CHO, fat and water content but lower in protein,
vitamins and minerals.
2. It has lactalbumin – human milk protein – easy to digest and hypoallergenic
and cow’s milk protein called casein causes allergy
3. Breast milk is higher in lactose than cow’s milk.

Breastfeeding Misconceptions:

1. A mother sick with PTB cannot breastfeed.

2. Breast milk is not good if the mother has stayed long under the sun
3. A mother cannot breastfeed during pregnancy
4. A mother cannot breastfeed with only one breast if the other breast is painful
5. A mother cannot breastfeed if she has a cold, flu or diarrhea
6. Breast milk is not good if the mother has been caught in a sudden shower

Breastfeeding Contraindications:

1. Breastfeeding may not be advisable when mother has syphilis, AIDS, DM or

any severe infections.
2. Breastfeeding is not encouraged when the mother is under emotional and
mental stress.
3. Mother who smokes.
4. Mother who takes contraceptive pills or drugs
5. Other contraindication includes metabolic abnormalities or severe prematurity
of the newborn which require the use of special therapeutic formulas.

Factors affecting milk secretion

1. Diet
2. Nutritional State of mothers
3. Emotional and Physical State
4. Suckling
5. Use of contraceptives and drugs

Daily caloric requirements: 1200 Kcal/day (100-115 kcal/kg/day)

Diet - breastfeeding / breast milk is best be given until 18 months to 2 years of age

 bottle feeding – artificial feeding with cow’s milk, costly, associated with
infantile obesity or “protein-calorie malnutrition plus”

 mixed feeding - complemented - insufficient supply of breast milk

                                                                              - supplemented - mother is away

from home for feeding
Two methods of formula preparation:

1. Aseptic method – equipment and ingredient are sterilized separately

2. Terminal method – formulas are poured into clean but unsterilized bottles and
are sterilized together

Feeding Time:

1. 5 to 2.7 kg baby usually feeds every 3 hours (8 feedings)

2. 6 to 4 kg baby usually feeds every 4 hours (6 feedings)
3. 2 to 3 months old, the baby is on 4 to 5 feedings, the baby sleeps through The
night after 10 pm feeding

Weaning:    6 months: breast to bottle

                         12 months: bottle to cup
Supplementary foods:
          2 months – liquids like rice water, calamansi juice may be introduced
depending upon infant’s tolerance and acceptance
         4 months – first solid foods (rice cereals)
         5-6 months – teething foods; full diet consisting of pureed meat, egg, strained
fruits and vegetables and chewy foods be given not only to soothe the sensitive gums
but also to teach the baby the art of self-feeding
          7-8 months – foods are mashed or chopped finely, not strained to teach
mastication, soft cooked egg with rice porridge, boiled fish, banana and camote mash
and the like.   
          9-12 months – whole tender foods or foods chopped coarsely are given, finger
foods like cottage cheese, crackers, plain meats and egg yolks
Foods to avoid in the first year of life
Infantile poisoning – honey (clostridium botulinum)
Choking hazards - hotdogs, grapes, hard candies, raw carrots, pop corns, nuts, peanut
butter
Insufficient calories - skim milk
Potential allergen – cow’s milk, egg whites
Cues to readiness to solids:

1. Sucking reflexes is intact

2. Ability to sit with support
3. Avoid feeding an infant lying supine to prevent aspiration
4. Present salivary glands and intestinal enzymes that aids in digestion
5. Fetal iron reserve in the liver usually consumed by 4-6 months

Rules to follow when introducing supplemental foods:

1. Introduce one food at a time

2. Show pleasure when giving new food at the same time, make gesture.
3. Give a small amount (1 tsp) at a time
4. Offer bland foods to the baby (not too salty, not too sweets)
5. Do not mix with formula
6. Feed when newborn is hungry after a few sucks of milk to increase his
patience for a new food
7. Never start two new foods at the same time
8. Allow an interval of 4-7 days between new foods
9. Feed baby only with freshly-cooked foods or fruits freshly peeled. Avoid
giving left-over foods to babies.
10. Do not bribe, plead, threaten or force the infant

Common Disorders:

1. Diarrhea – most frequently caused by bacteria and viruses

2. Vomiting
3. Allergy – milk intolerance
4. Constipation
5. Colic – most common

Health Problems with Infancy:

1. Galactosemia
2. Phenylketonuria (PKU)
3. Maple Syrup Urine Disease (MSUD)
4. Congenital Hypothyroidism

Nutrition in Toddler

 a period of life from 1-3 years old

 daily caloric requirement: 1,300 to 1,400 kcal/day or 100 cal/kg/day
 physiologic anorexia (decrease in appetite) because toddler is busy at play
 weight quadruple at 2 years old
 temper tantrum
 offer choices
 diet preference unpredictable, able to feed self
 dental examination at 2-3 years (2y/o -16 3y/o -30)
 safety is priority
 no-no-no Attitude
 ensures increase Ca, P and Fe
 elimination training (bladder training and bowel training)
 drinks 16-24 oz milk/day
 separation anxiety
 autonomy vs shame and doubt
 parallel play
 rituals, routines and dawdling
 accident – prone
 involve parents in child care
 sibling rivalry
 explain procedures

Nutrition in Pre-schooler

 3-6 years old

 larger requirements for growth so there is a greater need for protein, vitamins
and minerals
 period of food habits and preferences, selective, making him more vulnerable
to nutritional deficiencies
 won’t eat era - appears thinner than a toddler
 decrease in weight, desire for food is erratic
 parents must be careful not to foster poor eating habits by urging, forcing, or
even bribing the child to eat
 fear of punishment, family as significant others
 obesity is a risk
 kcal of 85/kg/day or daily calorie of 1,700 – 1,800
 eating junk food is a problem
 imaginative thinking; imaginary playmates
 fear of mutilation, abandonment and dark
 associative play
 growth rate slow
 initiative vs guilt
 no new teeth develops
 appetite is not large
 oedipus and electra complex
 needs explanation
 seen pleasures on touching of genitals
 Good nutrition – is important during pre-school years, needs adequate food for
growth and builds his body, gives plenty of energy for play, helps him to fight
common infections, helps keep the child healthy, happy and physically fit as well
as mentally alert.

Nutrient Allowances:


1. Calories – determined by his age, activity and BMR
2. Protein – 1.5 to 2 gm/kg of body weight is required
3. Vitamins and minerals – essential for growth and development
4. Fluids – total fluid requirements is 4-6 glasses, 1 to 1.5 liters/day

Feeding Problems:

1. Child is eating too little.

2. Child is eating too much.
3. Child is dawdling during mealtime.
4. Child is gagging especially when fed course foods.
5. Child has aversion towards some foods.
6. Child has allergies.

Nutrition and Pregnancy

Pregnancy and Lactation

It ensures optimum nutrition before, during and after pregnancy and during lactation
Characteristics of Pregnancy:
fertilized ovum implants itself to the uterus
human pregnancy lasted for a period of 266 to 280 days (37-40 weeks)
consists of three trimesters
has three main phases – implantation, organogenesis, growth
Nutrition in Pregnancy:
Always start with diet history when it comes to giving nutritional instruction to the
mother.
PICA – persistent ingestion of inedible substances of little nutritional value
Vegetarians – lack essential protein and minerals, need Vitamin B12 supplement
Calorie Allowances
Non-pregnant requirements – 1,800 to 2,200 Kcal/day
 Additional caloric requirement per day – 300 Kcal/day
Usual daily caloric need in pregnancy – 2,100 to 2,500; never less than 1,800
Kcal/day
Maternal weight gain – 25 to 35 lbs

Maternal under weight causes having high risk of low birth weight, preterm and infant
deaths

Maternal over weight causes having risk of complications in labor and delivery,
hypertension, gestational DM, post partum infections.
Protein allowances - body-building food
- additional 30 g/day to ensure 74 to 76 g/day
- rich food sources includes milk, meat, fish, poultry and eggs
- provide for the storage of nitrogen
- protect the mother from any complications
- growth for maternal uterus, mammary tissues and placenta
- needs for fetal growth and repair
- hormonal preparation for lactation

Carbohydrates - sufficient intake is necessary for added energy

- Avoid “empty” calories like soft drinks
Fats - high energy foods for absorption of vitamins ADEK
- AVOID too much fats to prevent vomiting and heartburn

Iron - most important mineral that must be taken in supplementary amount

- supplementary in pregnancy is 30-60mg per day
- needed to increase maternal RBC and for fetal liver storage in the third
trimester

Calcium - needed for maternal calcium and

phosphorous metabolism and fetal bone
 and skeletal growth
- 1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses)

Sodium - most abundant cation in extracellular fluid

- needed for tissue growth and development
- should not be restricted without serious indications

Iodine – needs for fetal development and avoid cretinism

Vitamins – water and fat soluble vitamins

Weight Gain 11. 2 – 16 kg (25 – 35 lb)
recommended as an average weight gain in pregnancy
1 lb per month during FIRST trimester
1 lb per week during 2nd and 3rd trimester
3 – 12 – 12
CALORIE NEEDS
2,200 women in childbearing age
+ 300 in pregnancy = 2,500 calories
CHO intake CHON breakdown

Mother – Ketoacidosis
Fetus – deprivation of essential CHON – Neurologic defects, Death
Even an OBESE pregnant should never consume LESS than 1,500 calories per day.
Weight is the most accurate indicator if the woman has adequate caloric intake
PROTEIN NEEDS
44g – 46g women in childbearing age
60g in pregnancy
 Iron
B complex especially B12
Calcium
Phosphorus

Cholesterol
DISCOMFORTS
Nausea and Vomiting
Eat dry crackers before rising in bed
High CHO, Low FAT diet
Small frequent feedings
NEVER self medicate esp. antacids
Antacids contains Na Fluid Retention Edema, HPN
Heartburn (Pyrosis)
Small frequent meals
Don’t lie down immediately after eating
Amphojel (Aluminum hydroxide) or Maalox may be prescribed
Maalox = Aluminum hydroxide + Magnesium hydroxide
Complication of Pregnancy and Dietary Modifications
1. Morning Sickness
2. Rapid weight gain or loss
3. Toxemia of Pregnancy
4. Anemia
5. Gestational DM
6. Constipation
7. Socio-economic and cultural factors
8. Alcohol, caffeine and nicotine
Nutritional Requirements for Lactating Mothers
the nutritional requirements in lactation are greater than in pregnancy to ensure
enough supply of milk for the baby.
Mother’s milk is the best food for baby (Executive Order 51)
If vaginal delivery – breastfeeding may done as early as 30 minutes after birth
If CS delivery – 4 hours after delivery
Demand feeding – best rule to observe when feeding the baby
Provide a relaxed, warm and supportive environment as the letdown reflex is affected
by negative emotions of the mother. Provide reinforcement for positive behavior or
successful actions.

Breastfeeding benefits to the mother

Promotes maternal-infant bonding

Promotes uterine contraction and provided less incidence of thrombophlebitis
Reduces rate of ovarian cancer and premenopausal breast cancer
Decreases maternal morbidity and mortality
Save time, money, effort and economical
Delays fertility
Provide social and economic benefits

Breastfeeding benefits for the baby

Promote attachment
Provide perfect food that contains all necessary nutrients
Easily digested, has the right temperature and free from harmful bacteria
Provides passive antibody transfer to the newborn
It has colostrums, high protein content contains antibodies which help resist infection
Causes fewer incidences of allergies, vomiting, diarrhea, constipation and aspiration.
Enhances brain development because of taurine content
Decreases infant morbidity and mortality
Breastfeeding Misconceptions:

A mother sick with PTB cannot breastfeed.

Breast milk is not good if the mother has stayed long under the sun
A mother cannot breastfeed during pregnancy
A mother cannot breastfeed with only one breast if the other breast is painful
A mother cannot breastfeed if she has a cold, flu or diarrhea
Breast milk is not good if the mother has been caught in a sudden shower
Breastfeeding Contraindications:
Breastfeeding may not be advisable when mother has syphilis, AIDS, DM or any
severe infections.
Breastfeeding is not encouraged when the mother is under emotional and mental
stress.
Mother who smokes.
Mother who takes contraceptive pills or drugs
Other contraindication includes metabolic abnormalities or severe prematurity of the
newborn which require the use of special therapeutic formulas.
Factors affecting milk secretion

Diet
Nutritional State of mothers
Emotional and Physical State
Suckling
Use of contraceptives and drugs
Child Health Programs
(NEWBORNS, INFANTS, CHILDREN)
Infant and Young Child Feeding
Newborn Screening
EPI
IMCI
Micronutrient Supplementation
Dental Health
Early Child Development
Child Health Injuries
INFANT AND YOUNG CHILD FEEDING
Initiate breastfeeding WITHIN 1 HOUR after birth
EXCLUSIVE BREASTFEEDING for the first 6 months

COMPLEMENTARY FEEDING for age 6 months up to 2 years or beyond.

TIMELY
ADEQUATE
SAFE
PROPERLY FED
Diet - breastfeeding / breast milk is best be given until 18 months to 2 years of age

bottle feeding – artificial feeding with cow’s milk, costly, associated with infantile
obesity or “protein-calorie malnutrition plus”

mixed feeding
complemented - insufficient supply of breast milk
supplemented - mother is away from home for feeding
Two methods of formula preparation:

Aseptic method – equipments and ingredient are sterilized separately

Terminal method – formulas are poured into clean but unsterilized bottles and are
sterilized together

Weaning: 6 months: breast to bottle

12 months: bottle to cup

Feeding Time:

2.5 to 2.7 kg baby usually feeds every 3 hours (8 feedings)

3.6 to 4 kg baby usually feeds every 4 hours (6 feedings)

2 to 3 months old, the baby is on 4 to 5 feedings, the baby sleeps through the night
after 10 pm feeding
Supplementary foods:

2 months – liquids like rice water, calamansi juice may be introduced depending upon
infant’s tolerance and acceptance

4 months – first solid foods (rice cereals)

5-6 months – teething foods; full diet consisting of pureed meat, egg, strained fruits
and vegetables and chewy foods be given not only to soothe the sensitive gums but
also to teach the baby the art of self-feeding
7-8 months – foods are mashed or chopped finely, not strained to teach mastication,
soft cooked egg with rice porridge, boiled fish, banana and camote mash and the like.

9-12 months – whole tender foods or foods chopped coarsely are given, finger foods
like cottage cheese, crackers, plain meats and egg yolks

Sequence of introducing solids

cereal, fruit, vegetable, meat, fish
Foods to avoid in the first year of life
Infantile poisoning – honey (clostridium botulinum)

Choking hazards

hotdogs, grapes, hard candies, raw carrots, pop corns, nuts, peanut butter
Insufficient calories - skim milk
Potential allergen – cow’s milk, egg whites
Cues to readiness to solids:
Sucking reflexes is intact
Ability to sit with support
Avoid feeding an infant lying supine to prevent aspiration
Present salivary glands and intestinal enzymes that aids in digestion
Fetal iron reserve in the liver usually consumed by 4-6 months
Rules to follow when introducing supplemental foods:

Introduce one food at a time

Show pleasure when giving new food at the same time, make gesture.
Give a small amount (1 tsp) at a time
Offer bland foods to the baby (not too salty, not too sweets)
Do not mix with formula
Feed when newborn is hungry after a few sucks of milk to increase his patience for a
new food
Never start two new foods at the same time
Allow an interval of 4-7 days between new foods
Feed baby only with freshly-cooked foods or fruits freshly peeled. Avoid giving left-
over foods to babies.
Do not bribe, plead, threaten or force the infant
Common Disorders:
Diarrhea – most frequently caused by bacteria and viruses
Vomiting
Allergy – milk intolerance
Constipation
Colic – most common

Health Problems with Infancy:

Galactosemia
Phenylketonuria (PKU)
Maple Syrup Urine Disease (MSUD
Fluid needs of the YOUNG CHILD
WATER is good for thirst.
Too much FRUIT JUICE may cause diarrhea and may reduce child’s appetite for
foods
SODAS are not suitable
TEAS and COFFEE reduce iron absorption.
A SMALL DRINK will satisfy a child’s thirst during meals
A non breastfed child (6-24 mons) needs 2-3 cups of water in a temperate day or 4-6
cups in a hot climate
Feeding the CHILD WHO IS ILL

Encourage to eat and drink with lots of patience

Feed small amounts frequently
Give food that the child likes
Give a variety of nutrient rich foods
Continue to breastfeed
NUTRITION PROGRAM
Common nutritional deficiencies
❶Vitamin A ❷Iron ❸Iodine

Micronutrient supplementation
Araw ng Sangkap Pinoy / Garantisadong Pambata / Child Health Week – twice a year
distribution of Vitamin A capsule.
Food Fortification (RA 8976)
mandatory fortification of staples: (flour, cooking oil, refined sugar, rice and
processed foods) through SANGKAP PINOY Seal
VITAMNS A
Gluconeogenesis – converting protein (glucogenic amino acids) to carbohydrates a
release of cortisol, the so called "stress" hormone.

Glycogenesis – formation of glycogen to glucose

Glycogenolysis – breakdown of glycogen to glucose; The process is caused by the
hormones glucagon and epinephrine which stimulate glycogenolysis and which are
produced in response to low blood glucose levels. It takes place in the muscle and
liver tissue which is where glycogen is stored.
Total Energy Requirement

Carbohydrates (CHO)
– 50 to 70 %

Protein (CHON)
– 10 to15 %

Fats (CHO with glycerol base)

– 20 to 30%
NUTRITIONAL GROWTH AND DEVELOPMENT

INFANTS
refers to a person not more than 12 months
remove small objects that the infant can choke on
burp the baby after each feeding to prevent colic
daily caloric requirements: 1200 Kcal/day
Nutrition through breast milk
Finger foods at 10-12 months
Alone in playing (solitary)
Note for weight 2x at 6, 3x at 12 months
Teething begins at 6 months
Sucking gives gratification
Length X 50% at 1 year
Only mother as significant others
Estranger Anxiety around 6-8 months
Stands alone at 12 months
Trust vs Mistrust
Pincer grasp at 10th month
Lower incisors erupt before upper incisors
Allow cruising at 12 months
Yells (cries) without parents (parent preference)
TODDLERS

a period of life from 1-3 years old

daily caloric requirement: 1,300 to 1,400 kcal/day or 100 cal/kg/day
physiologic anorexia (decrease in appetite) because toddler is busy at play
weight quadruple at 2 years old

Temper tantrum
Offer choices
Diet preference unpredictable, able to feed self
Dental examination at 2-3 years (2y/o -16 3y/o -30)
Safety is priority
No Attitude
Ensures increase Ca, P and Fe
Elimination training (bowel training)
Drinks 16-24 oz milk/day
Separation anxiety
Autonomy vs shame and doubt
Parallel play
Rituals, routines and dawdling
Accident – prone
Involve parents in child care
Sibling rivalry
Explain procedures
PRESCHOOLERS

3-6 years old

larger requirements for growth so there is a greater need for protein, vitamins and
minerals
period of food habits and preferences, selective, making him more vulnerable to
nutritional deficiencies
won’t eat era - appears thinner than a toddler
decrease in weight, desire for food is erratic
parents must be careful not to foster poor eating habits by urging, forcing, or even
bribing the child to eat
Fear of punishment, family as significant others
Obesity is a risk
Kcal of 85/kg/day or daily calorie of 1,700 – 1,800
Eating junk food is a problem
Imaginative thinking; imaginary playmates
Mutilation, abandonment and dark, fear of
Associative play
Grow rate slows and erratic
Initiative vs guilt
No new teeth develops
Appetite is not large
Oedipus and electra complex
Needs explanation
Seen pleasures on touching of genitals
Good nutrition – is important during pre-school years, needs adequate food for growth
and builds his body, gives plenty of energy for play, helps him to fight common
infections, helps keep the child healthy, happy and physically fit as well as mentally
alert.

Feeding Problems (Causes and Remedies):

Child is eating too little.

Child is eating too much.
Child is dawdling during mealtime.
Child is gagging especially when fed course foods.
Child has aversion towards some foods.
Child has allergies.
Cystic Fibrosis
Mucus produced by the exocrine glands is abnormally THICK causing obstruction to
small passageways of affected organs
Common Problems
Pancreatic enzyme deficiency
Chronic lung diseases
High Na and Cl SWEAT concentration
Infant tastes SALTY when kissed
Dietary Management
Administer pancreatic enzyme with meals to enhance palatability
High CHON, High Calorie diet
Vitamins A, D, E, K supplementation
Salt supplements during hot weather or fever
Celiac Disease
Intolerance to GLUTEN, the protein component of Barley, Rye, Oat, Wheat
Common Problems
Accumulation of amino acid GLUTAMINE is toxic to intestinal mucosal cells
Dietary Management
Gluten FREE Diet
Foods allowed:
RICE, CORN, Meat, Dairy products

Not Allowed: BROW

Pudding, Breads, Cookies, Cakes, Crackers, Cereals, Noodles, Beer and Ale
Phenylketonuria
Genetic disorder that results in CNS damage from toxic levels of phenylalanine in the
blood
Dietary Management
LOFENALAC
Avoid high CHON – meats and dairy products
Breastmilk contains LOW phenylalanine levels
Galactosemia
An inborn error of CARBOHYDRATE metabolism
Galactose 1-phosphate uridine transferase is absent
Enzyme necessary for conversion of GALACTOSE to GLUCOSE
Dietary Management
Eliminate ALL milk and lactose containing foods including BREASTMILK
Avoid PENICILLIN because it contains lactose as filler
NUTRITION IN SCHOOL- AGED
NUTRITION IN SCHOOL - AGED
Growth during the school age period is paralleled by a constant increase in food
intake.
Nutrition plays a role in:
Furnishing energy needed for the vigorous activity of this age
Helping to maintain resistance to infection.
Helping to maintain resistance to infection.
Nutrient Allowances:

Feeding Problems:

1. Inadequate meals - breakfast is often missed or hurriedly eaten by school children.

Causes:
A. Nothing to eat
B. Late bed riser
C. Fear of being late for school
D. Rush is preparing oneself for school

2. Poor Appetite
Causes:
1. Demanding school work
2. Tiring extracurricular activities
3. New outdoor experiences
4. Soft drinks in school
The child has sweet tooth
Causes:
1. Parents give sweets as rewards or pasalubong to kinds
NUTRITION IN ADOLESCENCE

NUTRITION IN ADOLESCENCE

Nutrient Allowances:
Calories - needs higher energy expenditure brought about by intense physical activity
Protein – Protein needs are high among teenagers because of the accelerated growth
and development
Vitamins - Vitamin C allowance is constantly higher among boys than among girls
aged 16 to 19 years old. Compared to female counterpart, the older male adolescenets
have higher recommended allowance for vitamin A,
Minerals - allowances for calcium, iron and iodine for increased thyroid activity
associated with growth
Possible Nutritional Problems
1. Low intake of Calcium, Vitamin A and C
2. Low intake of iron for girls
3. Anorexia nervosa / Bulimia – Psychologic eating disorders more common to
women than men. Anorexia nervosa is food restricting and Bulimia purging behavior
4. Obesity or underweight
5. Skin problems

SPECIAL NUTRITIONAL CONCERN DURING ADOLESCENCE

1. Nutritional concern during adolescence are eating disorders, inappropriate food
patterns including skipping of meals, practice of food fads and crash diets and used of
alcohol and drugs.
2. Adolescent girls are also prone to dieting for fear of becoming fat. A well-
balanced varied diet spread over three meals and small snacks will ensure adequate
nutrition.
HEALTH PROBLEMS:
Smoking
Alcoholism
Drug Addiction
Sexually Trasmitted diseases
Adolescent Pregnancy
Nutritional deficiencies related to:

A. Psychological factors – food aversions and emotional problems

B. Fear of overweight or crash diets
C. Food diets
D. Poor choice of snack foods
E. Irregular eating pattern
 F. Additional stress of pregnancy
Regular Screening:

Hemoglobin and hematocrit – detect Iron Deficiency Anemia

Urinalysis – detect Urinary Tract Infection
Physical Assessment and X-ray – detect scoliosis
Breast examination for females – detection of breast CA
Testicular examination for males – detection of testicular CA
Gynecologic care for females
NUTRITION IN ADULT YEAR
It is the period of life when one has attained full growth and maturity between 21-50
years of age

FEEDING THE ADULT:

To stay healthy, the following must be observed and followed:

NUTRITIONAL ISSUES:

1. OSTEOPOROSIS is a silent enemy.

It is a bone disease that leads to an increased risk of fracture.
It is less common in men than in women.
Women who are at risk in developing osteoporosis are women whose ovaries are
removed at an early age, and sedentary women.
Smokers and drinkers are also at risk.
To prevent bone loss experts recommend 30 minutes of exercise 3 to 6 times a week
and calcium supplement.
2. CANCER - Because of high incidence of cancer in adulthood.
Here are the recommended foods to fend off cancer:

NUTRITION IN AGING
ELDERLY– refers to the period being past middle age.
AGING
NUTRITION IN WEIGHT MANAGEMENT

There are huge number  of factors which contribute towards weight. However,
regardless of the factors it should ideally be within a healthy range. 
Being either underweight or overweight can affect your physical and psychological
wellbeing.
Obesity - is one of the fastest growing health concerns in the world today and is
determined by a person carrying too much body fat for their height and sex. 
- Growth
in obesity can be partly attributed to lifestyle being less physically active than it used
to be.
Body weight is determined by the amount of energy obtained from food in relation to
the amount of energy uses.  Any excess energy is then taken and stored in the body as
fat.
Being obese increases the risks of certain serious diseases such as: 
Heart Diseases
Diabetes
Cancer
Being underweight also poses serious health risks:
Irregular periods
Fertility issues
Osteoprosis
Anemia
EATING DISORDERS
Describes illnessess that are characterized by irregular eating habits and severe
distress or concern about body weight and shape
Eating disturbances: may include inadequate or excessive food intake which can
ultimately damage an individuals well being.

CAUSE OF EATING DISORDER:

1.  FAMILY RELATIONSHIPS

2.  DIETING
3.  DEPRESSION, ANXIETY, ANGER 
 4.  HISTORY OF BEING TEASED OR RIDICULED BASED ON SIZED OR
WEIGHT
TYPES OF EATING DISORDERS
1.  ANOREXIA NERVOSA
This is characterized by weight loss often due to excessive dieting and exercise,
sometimes to the point of starvation.
People with anorexia feel they can never be thin enough and continue to see
themselves as fat despite extreme weight loss
SYMPTOMS  COMMON IN PEOPLE WITH ANOREXIA

1.  Weight loss

2.  Wearing loose, bulky clothes to hide weight loss
3.  Preoccupation with food, dieting, counting calories,etc.
4.  Refusal to eat certain foods, such as carbs or fats.
5.  Avoiding mealtimes or eating infront of others
6.  Exercising excessively
7.  stopping menstruationn.

2.  BULIMIA NERVOSA - Have episodes of eating large amounts of food (called
bingeing) followed by purging (vomitting or using laxatives), fasting, or exercising
excessively to compensate for overeating.
1.  Binge eating
2.  Evidence of purging

TREATMENT:
Cognitive -behavioral theraphy
Anticonvulsant medicines
Antidepressant
C. Nutrition Exercise and Sports
       
Eating well for physical activity and sport can have many benefits including:

FOODS FOR FUEL AND EXERCISE

1.  CARBOHYDRATES - The main role of carbohydrates is to provide energy.  The

most important form of fuel for exercise and sports activities.  It is stored in the
muscle and liver as glycogen and use these stores as source of fuel for the brain and
muscles  during physical activity.
2.  PROTEIN – is important in sports performance as it can boots glycogen storage,
reduce muscle soreness and promote muscle repair
3.  FAT – provides the main fuel source for long-duration, low-to-moderate Intensity
exercise.
CAUSES OF DEHYDRATION
D. NUTRITION AND BONE HEALTH

FACTORS THAT CAN AFFECT BONE HEALTH

STEPS TO PREVENT OR SLOW BONE LOSS
STEPS TO PREVENT OR SLOW BONE LOSS

STEPS TO PREVENT OR SLOW BONE LOSS

E. Nutrition for Oral and Dental Health

FOODS FOR OPTIMUM ORAL HEALTH