A.

INTRODUCTION TO HUMAN NUTRITION

1. DEFINITION OF TERMS

NUTRITION
 The study of food in relation to health
 The science of food, the nutrients and other substances therein, their action,
interaction, and balance in relation to health & diseases and the process by
which an organism ingest, digests absorbs, transports, utilizes & excretes food
substances.
 The combination of processes by which a living organism receives and utilizes
materials or substances needed for the maintenance of its functions & for
growth & renewal of its components
 The study of essential nutrients and the processes by which nutrients are used
by the body.

FOOD
 Any substance, organic or inorganic, when ingested or eaten nourishes the body
by building & repairing tissues, supplying heat & energy & regulating bodily
processes.
 It includes articles used as drink or food & the articles used for the component of
such food.

*The study of food & nutrition is a science and art.

NUTRIENT
 A chemical component needed by the body for one or more of these functions:
to provide energy, to provide energy, to build & repair tissues & to regulate life
processes.
 Substances in foods required by the body for energy for energy, growth,
maintenance, and repair.
 Some nutrients are essential; they cannot be made by the human body and must
be provided by foods.

NUTRITIONAL STATUS (NUTRITURE) – a condition of the body resulting from the

utilization of essential nutrients.

OPTIMUM OR GOOD NUTRITION- means that the body has adequate supply of
essential nutrients that are efficiently utilized such that growth and good health
are maintained at the highest possible level.

MALNUTRITION- is the opposite of good nutrition (mal- “bad”). It is a condition of

the body resulting from lack of one or more essential nutrients (nutritional
 deficiency) or it may be due to an excessive nutrient supply to the point of
creating toxic or harmful effects (overnutrition & hypervitaminosis)

- an imbalanced nutrient and/or energy intake

UNDERNUTRITION – the under consumption of energy or nutrients based on RDA

and DRI values.

OVERNUTRITION – consumptions of too many nutrients and too many energy

compared w/ DRI levels
NUTRITION CONCEPTS

1. Essential nutrients are needed throughout life; only the amounts of nutrients
needed change. The client’s utilization of foods, eaten, stage of growth and
development, sex, body size, weight, physical activity, and state of health
influence nutrient requirements.

2. No single food contains all the essential nutrients in amounts needed for
optimum health.

3. Good nutrition is essential for the following:

 Growth
 Normal organ development and functioning
 Normal reproduction
 Maintenance and replacement of worn-out cells and tissues
 Optimum activity level and working efficiency
 Resistance to infection and disease
 The ability to repair bodily damage and injury

4. Proper nutrition means that all the essential nutrients are supplied and utilized in
adequate balance to maintain optimal health and well-being. Nutritional
deficiencies especially malnutrition may result in disease whenever inadequate
amounts of essential nutrients are provided to the tissue that must function
normally over long periods of time.

5. Most people are interested in how to be assured that they get the proper
nutrients in the amounts needed from daily meals and snacks. They probably
recognized the six classes of nutrients – protein, carbohydrate, fat, minerals and
vitamins and water although it may surprise some to learn that water is
considered a nutrient.

6. All of the nutrient most of us need can be obtained by eating a variety of

different types of foods. It is the nutrients in food, which are needed. However,
 in practice, nutrition educators speak in terms of foods that they can buy,
prepare and serve and not in terms of the name of nutrients.

7. Nutrients are important chemical substances that work together and interact with
the body chemicals to perform one or more of the following functions.
1) furnish fuel needed for energy
2) provide materials to build, repair, and maintain body tissues;
3) supply substances that function in the regulation of body processes

8. Water is the most important nutrient. Following water, the nutrients of highest
priority are those that provide energy, which must be supplied from foods or can
be supplied from quantities stored in the body.

The fundamental principles of nutrient interaction state that:

1. Individual nutrients have many specific metabolic functions, including primary

and supporting roles, and
2. No nutrient ever works alone.

Each nutrient has certain special jobs to do in the building maintenance, and
operation in the body. These jobs cannot be done by other nutrients – an extra supply
of one cannot make up for a change of another.
There are other jobs to be done in the body that require nutrients to work
together as teams. To build bones, the nutrients vitamin D, calcium, and phosphorous
interact. One member of the team cannot perform its job unless all the others are
present in the right amounts.

CUMULATIVE EFFECTS OF NUTRITION

Cumulative effects are the results of something that is done repeatedly over
many years. For example, eating excessive amounts of saturated fats for many years
contribute to atherosclerosis, which leads to heart attacks. Years of overeating without
increasing energy expenditure cause obesity and may predispose the individual to
metabolic diseases like hypertension, Type 2 diabetes mellitus, gallbladder disease,
gout, food problems, certain cancers, and even personality disorders.
Long-term studies are ongoing regarding the cumulative effects of dietary habits
of people. There is increasing concern among health professionals/practitioners to
teach students and clients about the latest recommendations of nutrition scientists.

CLASSIFICATION OF NUTRIENTS

1. According to FUNCTION: Nutrients may be body-building, energy-giving, &

body regulating.
 The 3 Food Groups:

BODY BUILDING FOODS – supply good quality CHON; to build & repair body
tissues and sole vitamins and minerals to help keep the blood red, nerves healthy,
makes the bones, teeth and nails hard & strong. Ex. Meat, fish, poultry, dairy products
and legumes.

REGULATING FOODS- fruits & vegetables provide vitamins & minerals

particularly ascorbic acid and provitamin A. Ex. Fruits and vegetables

ENERGY FOODS - rice & other cereals, starches, sugars, fats and oils

2. According to CHEMICAL NATURE: Nutrients are either inorganic or organic.

Organic substances are those carbon containing compounds with the
exception of carbonate & cyanide. The organic nutrients are CHON, fat, CHO &
vitamins. The inorganic compounds are minerals & water.

3. According to ESSENTIALITY: The six major nutrients are groups of individual

nutrients each of which has important physiological role in the body.

Known Essential Nutrients:

CHO Glucose
Lipids (fats) Linoleic acid, linolenic acid
Protein Amino acids: Histidine, isoleucine, leicine, lysine, methionine,
phenylalanine, threonine, tryptophan, valine
Vitamins Fat-soluble: A, D, E, K
Water-soluble: B Complex vits
Minerals Major: Ca, P, Na, K, S, Cl, Mg
Trace: Cr, Co, Cu, Fl, I, Fe, Mn, Se, Zn

Water

4. According to CONCENTRATION: nutrients may be termed macronutrients or

micronutrients.

MACRO – CHON, CHO, fats, & water – present in large amounts in body
MICRO – vitamins and trace minerals

 Classified as micronutrients – concentration in the body should be above

50 parts/ million or above 0.005 percent of body weight.

NUTRIENT DISTRIBUTION IN THE BODY

 An easy way to remember the relative distribution of the six groups of nutrients
is the “60-20-20 Rule.” The figures below are rounded and are averages for an adult
of normal weight.

 Water is about 60% of total body weight

 Fat/lipids are about 20% of total body weight
 About 20% of total body weight is a combination of mostly protein
(mainly muscle tissues or lean body mass) plus carbohydrates,
minerals and vitamins.

An infant has more water than the above average. An obese person has more fat
relative to the others. Women of the same age and height tend to have more body fat
than males of the same age and height.

THE SCOPE OF NUTRITION AND ITS RELATIONSHIP WITH OTHER

DISCIPLINES

Nutritional science comprises the body of scientific knowledge governing the

nutritional requirements of humans for maintenance, growth, activity, and reproduction.

For the most part, knowledge about nutrition builds on three fundamental areas
of science.

1. The physical sciences, particularly chemistry because the human organism is a

complex of interdependent systems, all of which operate using chemicals provided by
food.

2. The biological sciences of anatomy and physiology help us to see how growth and
development of cells and organs, physical fitness and well-being are affected by
nutrition – how nutrition relates with body functioni8ng to promote health and
wellness throughout the life cycle. Genetics explains the inherited traits of a person.
The study of genetic nutrition may explain the familial tendencies of some diseases
that may run in a family tree.

3. The behavioral sciences help us to better understand how nutrition is interwoven

with our unique nature as human beings. Anthropology, psychology and other social
sciences provide the background of the cultural diversity of people and how food
habits are formed. Attitudes toward food and eating patterns develop throughout our
life span from the acculturating influences of family, group, ethnic/regional group,
community, nation, even our world.
 How we perceive ourselves and our food, what we choose to eat, why we eat, what
we do, and in what manner, all become integral part of human nutrition. As one saying
goes, “Tell me what you eat and I can tell you who you are.”

NURSING PROCESS IN NUTRITION

Care plans are an important aspect of the nursing process. Nutritional needs
must be addressed to meet a client's gestalt of overall health. Using the nursing process
in conjunction with a nursing diagnosis in accordance with the North American Nursing
Diagnosis Association, or NANDA, the professional nurse creates an evidenced-based
plan of action specific to each individual client or patient.
Nutritional assessment: A structured way to establish nutritional status and
energy-requirements by objective measurements and whereby, completed with
objective parameters and in relation to specific disease-indications, an adequate
(nutritional-) treatment can be developed for the patient. All this happens preferably in
a multidisciplinary setting.

The most important goals of Nutritional Assessment are:

 In time discovery of malnourished patients or patients at risk, so the dietician

can start her nutritional treatment as soon as possible.
 To determine the quantity of malnutrition, so an adequate definition of the
individual nutritional need is possible.
 Diagnostic purposes.
 Monitoring of changes in nutritional state during nutritional intervention.
 Collecting data for scientific research.
 Attention for the nutritional status of a patient in the hospital.
 Improvement of accomplishment of Nutritional Assessment measurements.

To find out how well a person is nourished needs a variety of methods, which
are under four categories called the ABCDs of Nutritional Assessment. The acronym
stands for Anthropometric, Biochemical, Clinical, and Dietary methods. There are
advantages and limitations for each technique, hence a combination is more effective
than asingle method to evaluate a person’s nutritional status.

1. Anthropometric Assessment

Anthropometric methods are measurements of the variations of the physical

dimensions and the gross composition of the body. There are two types of
measurement : growth and body composition. The latter can be further subdivided into
measurements of fat-free mass and body fat, the two major compartments of total
body mass. The procedures use simple and safe techniques, which can be used at the
bedside and are applicable to large sample sizes. Equipment required is inexpensive and
portable, that can be made or purchased locally. There is little training needed for
 personnel to perform the measurement. Anthropometric procedures can assist in the
identification of mild, moderate, as well as severe states of malnutrition.

2. Biochemical Assessment
Biochemical assessment is based on laboratory analyses of the blood and urine.
Common biochemical indices include serum albumin/globulin ratio, total iron binding
capacity, total lymphocyte count, complete blood cell profile, lipid profile, nitrogen
balance, creatinine-height index, urinary ketones, urinary nitrogen, and ot5her
constituents of the urine. Procedures need skilled personnel and analytical equipment
that are expensive. However, results are objective and useful for diagnoses and
therapy.
There is no single available test for evaluating short-term response to medical
nutritional therapy. Laboratory tests are to be conducted several times over a certain
period to give more accurate information compared to a single test. They should be
used in conjunction with anthropometric data, clinical data, and dietary intake
assessments.

3. Clinical Assessment
Clinical assessment includes medical history and physical examination. Risk
factors associated with nutrition from history-taking and interviewing include drastic
recent major surgery; chewing and swallowing difficulties; drug addiction; habitual
intake of oral contraceptives, catabolic steroids, antibiotics, and other drugs with
significant nutrient-drug interaction; and socioeconomic factors such as poverty, lack of
education, and inadequate or poor food habits. A nurse or physician’s assistant (PA)
may assist the client or patient in filling up the medical history form, taking vital
statistics (height, weight, blood pressure readings, pulse rate). The physician completes
the physical examination from head to foot.

4. Dietary Assessment
Dietary methods include food frequency questionnaire, 24-hour food recall,
and/or keeping a food record for 3 to 7 days. A dietary method should be followed by a
nutritional intervention/plan of action to correct any deficiency and to aid in therapy.
A 24-hour recall is gathered by interview or by asking the client to recall actual
intake for the past 24-hours. The main purpose is to determine an overall usual eating
pattern of an individual. This method depends on the memory of the informant and the
ability to estimate serving portions. It is best followed by a food frequency
questionnaire to verify and clarify initial data.
Food frequency questionnaire uses a list of specific food items to record
intakes over a given period (day, week, month, year). Responses are obtained by
interview, or it may be a self-administered questionnaire. Questionnaire can be semi-
quantitative when subjects are asked to quantify usual portion sizes of food items, with
or without the use of food models.
Three, five, or seven day records are prepared by the client or patient for the
next day’s intakes. One advantage of several days is to cover also days when the
informant may have different meal patterns over the weekend or when not in school or
at work. A week’s records or even a month may be required of a patient whose dietary
regimen has to be stabilized as part of medical nutrition therapy (e.g. obesity, food
allergies or uncontrolled diabetes mellitus).
Weighed food record is a more involved method that needs care and
accuracy, because all food consumed over defined period is weighed. Food samples
may be saved individually, or as a composite, for nutrient analysis. Alternatively,
nutrient intakes calculated from food composition data. Its limitations is the possibility
or tendency of the subject to change their usual eating pattern to simplify weighing or
to impress investigator. Weighing food requires motivated and willing participants. The
expenses incurred for the weighed food records are higher than the other methods.
Hence this method is used more for metabolic balance studies or for controlled
laboratory experiments.
In general, the choice of dietary methods depends on factors like the purpose for
the collection of data, the skill of the interviewer/educator, level of literacy by
respondents, willingness, honesty, reliability of voluntary participants, and how
motivated they are. How much time is needed to accomplish the records should not be
overlooked and should not add stress to a busy or worried person.
After the dietary records are collected, results are analyzed and explained to the
respondents, followed by nutrition and education as needed, which is usually the case.
“A combination of methods is better than one single method.”

Diagnose
Using the nursing diagnosis definitions set forth by the North American Nursing
Diagnosis Association, decide which meet the patient's current needs. More than one
nursing diagnosis may be required. An example would be: "Nutrition-altered, less than
body requirements."

Plan
Using the nursing diagnosis as a guide, make a detailed plan of care in relation to the
patient's current needs. Include monitoring the fluid and food intake and output of the
patient throughout the day. Consider weighing the patient daily. If the patient has any
food allergies, ensure that these foods are not given. Discover any food preferences the
patient may have to increase the potential for completion of meals.

Implement
Implement the plan of care. Educate the patient on the current goals related to the care
plan. Include the patient and other staff on the plan of care so that the entire patient
care team is involved and in agreement with the course of action. Document the
outcome of the plan, in this case, what percentage of the meal was eaten and if the
patient tolerated the nutritional intake without difficulty, such as nausea or vomiting.
Evaluate
Evaluate the patient's tolerance of the plan of care. Adjust the plan according to specific
needs that are not being met, as well as to any preferences that the patient may have
or require. Reassess for any further nursing diagnosis that may be pertinent, including
them in the updated plan of care.
http://www.livestrong.com/article/311883-nursing-care-plans-and-nutrition/#ixzz2AQI6jWA1

DIETARY CARE PLAN

ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION

DIAGNOSIS
S > Dietary Hx & Altered Meal Actual Food Use of
Intake Data nutrition less Planning Presentation appropriate
 Diet Recall than body assessment tool
 Food Habits requirements
 Food Perception,
Preferences & Altered
Opinion nutrition
 Eating Attitude more than
Test body
requirements

O> Anthropometric Potential

Data alteration in
(MAC,TSF,MAMC,Ht nutrition less
& Wt, Wt for Age, than/ more
Body Wt, Bone Age, than body
BMI) requirements
 Biochemical data
 Clinical
assessment

ROLE OF THE NURSE IN THE PROMOTION OF NUTRITION

A. Nutrition Education / Care

1. In the Hospital – the nurse has the most constant and intimate association with
the patient

a. Maintaining lines of communication with the doctors and dietician

regarding patient’s dietary needs
b. Interpret the diet to the patient
c. Assisting patient at mealtimes
d. Observing, recording and reporting patient’s response
e. Planning for home care
2. Out Patient / Clinic Nurse- the nurse can help in the selection of inadequate and
appropriate diet by using seductional approach which the patient understand and
accepts.

3. In School – nutrition education must begin in kindergarten and continue

throughout the elementary and secondary school which affords the best
opportunity for helping the child to understand & establish attitudes and
practices concerning food selection.

4. CHN Nurse – she’s in the position to observe community nutrition problems more
closely provision of instructions in food

- she has an opportunity to carry practical nutrition to many homes by

evaluating family of individual food habits, discuss nutrition and
preparation.

- she can also be able to guide the house keeper in the selection of low
cost foods that will provide adequate nutrition for the members of the
family

FRAMEWORK OF NUTRITION EDUCATION