© 2009 The McGraw-Hill Companies, Inc. All rights reserved Nutrition and Special Diets PowerPoint®...

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Nutrition and Special DietsNutrition and Special Diets

PowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson

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© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes

49.1 Explain why a medical assistant needs to understand the role of diet in health.

49.2 Describe how the body uses food.

49.3 Explain the role of calories in the diet.

49.4 Identify the seven basic food components and explain the major functions of each.

49.5 List the Dietary Guidelines for Americans.

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Learning Outcomes (cont.)

49.6 Explain how the Food Guide Pyramid can be used to plan a nutritious, well-balanced diet.

49.7 Describe the test used to assess body fat.

49.8 Identify types of patients who require special diets and the modifications required for each group.

49.9 Identify specific modified diets that may be ordered to treat or prevent certain conditions.

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Learning Outcomes (cont.)

49.10 Describe the warning signs, symptoms, and treatment for eating disorders.

49.11 Describe techniques the medical assistant can use to effectively educate different types of patients about nutritional requirements.

49.12 Explain the medical assistant’s role in educating patients about nutrition and describe the proper documentation of patient education.

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Introduction

Nutrition How the body takes

in and utilizes food and nutrients

Five-part process Intake Digestion Absorption Metabolism Elimination

Medical assistant Must understand

relationship between diet and health

Must recognize signs of illness related to diet

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Role of Diet in Health

Food Body’s source of nutrients needed to function properly Certain foods are needed to maintain or regain health Some conditions require special diets

Medical team works together to ensure that patients understand the role of diet in health

Registered dietitian (RD) – designs diets that are therapeutic and realistic for patients

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Daily Energy Requirements

The body requires nutrients To provide energy

To build, repair, and maintain body tissues

To regulate body processes

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Daily Energy Requirements: Metabolism

The sum of all cellular processes that build, maintain and supply energy to living tissue

Phases Anabolism – nutrients are changed into more complex

substances that are used to build body tissues Catabolism – complex substances are broken down into

simpler substances and converted to energy

Metabolism affected by age, weight, activity, state of health, and other factors

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Daily Energy Requirements: Calories

Kilocalorie (calorie) Measurement of energy produced by food Amount of energy needed to raise the temperature

of 1 kg of water by 1°C. Used to measure the energy expended during

activities and metabolic processes Excess calories stored as fat Count calories of food eaten and estimate

expenditure for activities

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Apply Your Knowledge

1. What is the role of diet in health?

ANSWER: Food is the source of nutrients the body needs to function properly. Sometimes a special diet is needed to stay healthy or regain health, and some conditions require special diets.

2. What is the difference between anabolism and catabolism?

ANSWER: Anabolism converts nutrients into complex substances needed to build body tissues. Catabolism converts complex substances into simpler forms and converts them into energy.

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Nutrients

Needed for Energy Growth Repair Basic processes

Energy is only provided by Proteins Carbohydrates Fats

Nutrients are provided by Proteins Carbohydrates Fiber Lipids Vitamins Minerals Water

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Nutrients: Proteins

Functions Building and repairing

cells and tissues Maintaining water

balance Antibody production

and disease resistance Maintaining body heat

10% to 20% of total caloric intake daily

1 gm = 4 calories

Deficiency Weight loss / fatigue Malnutrition Lower resistance to

infection Interference with normal

growth processes

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Nutrients: Proteins (cont.)

Complete proteins Contain all 9 essential

amino acids

Animal food sources

Recommend lean meats, low-fat or skim milk

Incomplete proteins Lack one or more

essential amino acids

Plant sources

Can be combined to provide all 9 essential amino acids

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Nutrients: Carbohydrates

Functions Provide 2/3 of daily

energy needs Provide heat Metabolize fats Preserve protein for uses

other than energy production

50% to 60% of total caloric intake daily

1 gm = 4 calories

Deficiency Weight loss Protein loss Fatigue

Excess contributes to fat stores

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Nutrients: Carbohydrates (cont.)

Complex carbohydrates Polysaccharides – long

chains of sugar units Types

Starch – major source of energy

Fiber

Simple sugars Fruits and some

vegetables Milk Table sugar

Excess Stored in liver and muscles cells as glycogen Converted into and stored as fat

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Nutrients: Fiber

Does not supply energy or heat

Functions Increases and softens the

bulk of stool Absorbs wastes and toxins Decreases the rate of

carbohydrate breakdown and absorption

20 – 30 gm per day for adults

Types Soluble

Absorbs fluid and swells when eaten

Slows absorption Helps control blood

glucose Lowers cholesterol

Insoluble – promotes regular bowel movements

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Nutrients: Lipids

Concentrated source of energy

1 gm = 9 calories Triglycerides

Simple lipids 95% of dietary lipids

Cholesterol Compound lipids 5% of dietary lipids

Functions Provide a concentrated

source of energy Transport fat-soluble

vitamins Store energy as body fat

– insulate and protect organs

Provide a feeling of fullness

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Nutrients: Lipids (cont.)

Unsaturated fats Liquid at room

temperature Types

Polyunsaturated Monounsaturated

Saturated fats Primarily from

animal sources Solid at room

temperature

Trans fats Formed during hydrogenation of vegetable oils FDA recommends zero consumption

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Nutrients: Lipids (cont.)

Lipid levels High cholesterol

Heart disease / stroke Peripheral vascular

disease

Lipoproteins Carry lipids through the

bloodstream Low-density (LDL) High-density (HDL)

Cholesterol Fat-related substance

produced by liver Animal-based food

sources Essential to health

Part of cell membranes Structural basis for

steroid hormones and vitamin D

Component of bile

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Nutrients: Vitamins

Organic substances Essential for normal growth

and maintenance Essential for resistance to

infection Help the body use other

nutrients Assist with body processes

Absorbed through digestive tract

Types Water soluble – not stored by

the body Fat-soluble – stored by the

body

Well-balanced diet usually minimizes likelihood of vitamin deficiency

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Nutrients: Minerals

Natural, inorganic substances Build and maintain

tissues Carry out life functions

Major minerals – needed in large quantities

Trace minerals – needed in small amounts

Absorbed in intestines Established RDAs

Calcium Zinc Iodine Iron Magnesium Phosphorus Selenium

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Nutrients: Water

No caloric value 65% of body weight Functions

Maintains fluid balance Lubricates moving parts Dissolves chemicals and

nutrients Aids in digestion

Transports nutrients and secretions

Flushes out wastes Regulates body

temperature

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Nutrients: Water (cont.)

Fluid balance – intake should equal output

Patient education Explain the importance

of water List sources of water

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Nutrients: Principle Electrolytes and Nutrients of Special Interest

Electrolytes Sodium

Fluid and acid-base balance Maintains normal conditions

inside and outside of cells

Potassium Muscle contraction Fluid and electrolyte

balance

Chloride Fluid and electrolyte

balance Component of hydrochloric

acid

Antioxidants – chemical agents that neutralize free radicals (by-products of normal metabolism)

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Apply Your KnowledgeMatching:

___ Bulk to stool A. Cholesterol

___ Tissue repair B. Antioxidants

___ Excess stored as glycogen or fat C. Proteins

___ Concentrated source of energy D. Water

___ Produced by liver E. Trans fats

___ No caloric value F. Fiber

___ Neutralizes free radicals G. Lipids

___ Formed during hydrogenation H. Carbohydrates

ANSWER:

H

G

F

E

D

C

B

A

SUPER

JOB!

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Dietary Guidelines

Established to help people Get proper nutrition Reduce occurrence of disease Control weight

Designed to encourage healthy eating habits

Suggest types and quantities of foods

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Dietary Guidelines: USDA and U.S. Dept. of Health and Human Services

Recommendations Eat a balanced diet Limit consumption of

less nutritious foods Increase physical

activity Be consistent with good

nutritional choices

Food safety Disinfect food surfaces Wash hands Cook foods to safe

temperature Refrigerate foods Avoid raw eggs and

meats and unpasteurized milk or juices

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Dietary Guidelines: USDA Food Guide Pyramid

Revised in 2005 Emphasizes fruits,

vegetables, whole grains, beans, and nuts

Less emphasis on carbohydrates

Helps balance nutritional needs with physical activity needs

Color coded Orange – grains Green – vegetables Red – fruits Yellow – oils Blue – milk products Purple – meats / beans

Action figure – physical activity

Food Pyramid

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Dietary Guidelines: American Cancer Society

Eat more high-fiber foods

Five or more servings of fruits and vegetables daily

Limit consumption of processed and red meats

Adopt a physically active lifestyle

Achieve and maintain a healthy weight

Limit consumption of alcoholic beverages

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Apply Your KnowledgeMatch food group to appropriate color:

A. Vegetables

B. Oils

C. Meat and beans

D. Grains

E. Fruits

F. Milk productsOrange

Purple

Blue

Yellow Red

Green

ANSWER:

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Assessing Nutritional Levels

Age Health status Height / weight Body frame Body circumference % of body fat

Nutrition and exercise patterns

Energy needs Also

Culture Beliefs Lifestyle Education

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Assessing Nutritional Levels (cont.)

Measure fat as % of weight Skinfold test

Measurement of the thickness of a fold of skin with a caliper

Total % of fat Optimal % differs between men and women Aging changes ratio – fat replaces muscle tissue

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Modifying Diets

Factors affecting dietary needs Pregnancy Injury Disease Vegetarian diet Aging Genetic disorders Substance abuse

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Modifying Diets

Modifications Restriction of certain foods Emphasis on particular foods Change in daily caloric intake Change in the amount of a specific nutrient Change in the texture of foods Alteration in the number of daily meals Change in variables such as bulk or spiciness

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Modifying Diets: Patients with Specific Nutritional Needs

Food allergies Wheat, milk, eggs, and

chocolate Eliminate from diet

Anemia Iron supplements Dietary iron

Cancer Increase caloric intake Adequate protein intake

Diabetes Food exchange system Diabetes food pyramid

Elderly Energy and metabolic

requirements decrease Physical difficulties Medications Social factors Economic factors

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Modifying Diets: Patients with Specific Nutritional Needs (cont.)

Lactose sensitivity Lactase not present to

break down lactose

Overweight Dietary modification Behavior modification Motivation and

education

Heart disease Reduce cholesterol Lose weight if needed Reduce consumption of

fats

Hypertension Decrease sodium /

increase potassium / adequate calcium

Eliminate or reduce alcohol consumption

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Modifying Diets: Patients with Specific Nutritional Needs (cont.)

Pregnant Additional protein Calcium Iron Folic acid Fiber

Lactating Additional calories and

protein Folic acid and calcium

Children 1st year

Breast milk or commercial formula

Cow’s milk inadequate

Nutritional needs change

Growth spurts Maturation Increasing activity

Hunger regulates intake

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Specific Modified Diets

For treatment or prevention of certain conditions

Modifications include changes in Texture

Liquid or soft High-fiber

Nutrient level Low sodium Reduced calorie

Frequency and timing Three smaller meals Timing in relation to a

procedure

Exclusions – for food intolerances

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Specific Modified Diets (cont.)

Supplements and parenteral nutrition Oral – specially

formulated to provide adequate nutrients

Parenteral – given IV to bypass the digestive system

Drug therapy Drugs

Change in food intake Change in absorption

Foods Interfere with

metabolism and action of a drug

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Apply Your Knowledge

1. What factors does the physician consider when assessing a patient’s nutritional status?

ANSWER: The physician considers a patient’s age, health status, height and weight, body frame and circumference, percent of body fat, eating and exercise patterns, and energy needs. Culture, beliefs, lifestyle, and educational level should also be considered during the assessment.

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Apply Your Knowledge

2. Matching

___ Eliminate foods from diet A. Change in texture

___ Food exchange system B. Children

___ Decreased metabolism C. Food allergies

___ Hunger drives eating D. Parenteral nutrition

___ Modification to a soft diet E. Diabetes

___ Reduced sodium diet F. Elderly

___ Bypasses GI tract G. Drug therapy

___ May alter food intake and absorption H. Change in nutrient

level

ANSWER:

H

G

F

E

D

C

B

A

Yippee! 2 for 2!

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Eating Disorders

Extremely harmful eating behavior Anorexia nervosa

Self-starvation Treatment

Restore normal nutrition Psychotherapy Education of nutrition concepts

Chronic condition – can be fatal

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Eating Disorders (cont.)

Bulimia Binge and purge by vomiting, diuretics, laxatives Usually easier to treat than anorexia Treatment

Medication Psychotherapy

Goals Establish a healthy weight Establish good eating patterns Resolve psychosocial triggers

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Eating Disorders (cont.)

Getting help – be alert to patient report of Skipping at least two meals per day Uncontrolled eating of large amounts of food Using laxatives or other purges to control weight Avoiding social situations that interfere with diet

or exercise Feeling disgust, depression, and guilt after binge Feeling that food controls life

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Apply Your Knowledge

A young female patient arrives at the clinic showing a 15 pound weight loss in the last two months. Her weight is 10 pounds under the average weight for her height. She states she “feels great.” What should you do?

ANSWER: Document the weight loss and report it to the physician. She may be suffering from anorexia nervosa or bulimia, two types of eating disorders that require medical care and psychotherapy.

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Patient Education

Reinforce nutrition instructions

Teach patient Role nutrition plays in

preventing illnesses How to be wise

consumers by reading food package labels

Factors Patient likes and dislikes Patient age and family

circumstances Diseases and disorders Patient’s psychological

condition

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Patient Education (cont.)

Guidelines Teach patient as an individual Teach a small amount at a time Keep explanations at patient’s level of

understanding Reinforce good eating behavior Let patient be an active learner Provide a written diet plan Suggest support groups

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Patient Education (cont.)

Cultural considerations Influence

Food purchases Like and dislikes Meal timing and

frequency Attitude toward

supplements Snacking

Adjust diet and recipes accordingly

Outside resources Patient education

materials Examples

American Diabetes Association

American Dietetic Association

American Heart Association

Overeater Anonymous (OA)

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Apply Your Knowledge

What do you need to consider when teaching patients about nutrition?

ANSWER: You need to consider patient likes and dislikes, age and family circumstances, diseases and disorders, and the patient’s psychological condition. In addition, you need to incorporate cultural considerations into nutritional education.

Excellent!

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In Summary

Nutrition – complex, technical topic

Medical assistant Knowledge of basic nutritional principles

Make good nutrition understandable and achievable Educate patients Recognize eating disorders

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End of Chapter

He that eats till he is sick must fast till he is well.  ~English Proverb