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© 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
49-2
© 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.
49-3
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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.
49-4
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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.
49-5
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-9
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-10
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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.
49-11
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-15
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-17
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-18
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-19
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-20
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-21
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-22
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Nutrients: Water (cont.)
Fluid balance – intake should equal output
Patient education Explain the importance
of water List sources of water
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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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)
49-25
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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!
49-26
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-31
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-34
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Modifying Diets
Factors affecting dietary needs Pregnancy Injury Disease Vegetarian diet Aging Genetic disorders Substance abuse
49-35
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-41
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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.
49-42
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Eating Disorders
Extremely harmful eating behavior Anorexia nervosa
Self-starvation Treatment
Restore normal nutrition Psychotherapy Education of nutrition concepts
Chronic condition – can be fatal
49-44
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-46
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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.
49-47
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-48
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
49-49
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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)
49-50
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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!
49-51
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
End of Chapter
He that eats till he is sick must fast till he is well. ~English Proverb