CONCEPTS IN NUTRITION AND DIET THERAPHY Nutrition Education

The hardest working seven letter word. “SUCCESS” Achieve it. • learning about the dietary factors that affect a particular medical
The most powerful nine-letter word… “KNOWLEDGE “Acquire it condition change their diet and lifestyle to improve their health
NUTRITION status (age, level of literacy and culture)
• science that interprets the interaction of nutrients and other Role of a Nurse:
substances in food for the maintenance, growth, reproduction,
• To provide nutritional care appropriately (educated in the
health and disease of an organism.
screening and assessment, planning, implementation and
• is all about food and how the body uses it esp. as a fuel for
evaluation of nutritional care)
growth and daily activities.
• As a future nurse, studying nutrition is important in order to give
• is the science of food, the nutrients and the substances therein
the best nursing care to your clients.
(council of the American Medical Association)
• Knowing the right diet or food required/prescribed to a certain
• study of all the processes (digestion, absorption, metabolism,
patient.
etc.) how the body absorb and utilize food substances.
• Enables you as the primary care giver to impart health teaching
Why is nutrition important? about the patient’s food intake to a faster recovery or
maintenance of health.
• Nutrition is essential for growth and development, health and
wellbeing. Dietetics
• Eating a healthy diet contributes to preventing future illness and
is the science of nutrition where individual can make practical
improving quality and length of life.
choices about food and lifestyle in terms of both health and diseases
Accdg to WHO in 2009, Nutrition is an input to and foundation for
NUTRITIONIST & DIETITIAN
health and development.
Better nutrition means stronger immune systems, less illness Nutritionist
and better health. Healthy children learn better. Healthy people are
• a qualified nutrition professional that has the expertise to
stronger, are more productive
provide a range of evidence-based nutrition services related
Specifically, if the body needs are met in childhood and adulthood, to nutrition, public health nutrition, policy and research, and
the person can normally expect: community health.
o Good health, vitality and energy • A nutritionist is a person who advises on matters of food and
o To mature at the proper time nutrition that impacts on health.
o To overcome the stresses of the environment
Dietitian
o To fulfill this biological life
o To enjoy extended time of life • are healthcare professionals and experts who treats nutritional
o To withstand the many hazards of aging problems and overview the patients by providing dietary
 needs, plans menus, and instructs patients and their families 2. non-Nutrient – some substances that are useful, some are
about proper nutritional care. neutral and some are detrimental to health. Ex. alcohol, pigments,
• Dietitians have the expertise to provide individual dietary additives and phytochemicals.
counselling, medical nutrition therapy (MNT), group dietary
Nutrients
therapy and food service management.
• is the product of digestion of foods which are the nourishing
GOOD NUTRITION
material vital for human functioning.
• is the basis for good health. It enhances appearance as it is • They are used to build and repair tissues, regulate body
exemplified by shiny hair, clear skin, clear eyes, erect posture, processes and are converted to and used as energy.
alert expression and firm flesh on well-developed bone o Substances that provide energy- CHO, CHON and Fats
structures. o Substances that support metabolism – dietary minerals,
• In order to prevent obesity and diet-related diseases, man must vitamins and water
know how to utilize the existing food supply to derive maximum
FOOD GROUPS
nutritional benefit from it.
• Nutrition is the foundation of good health, … education is the Energy giving foods:
cornerstone of good nutrition, the individual must be taught to o Fats
make good food selection and to maintain an environment o Carbohydrates
conducive to the utilization of the nutrients provided by the food. Body building foods
• According to Babcock (in 1961), “To establish good food o Proteins
habits, people must be able to learn, and nutrition educators Protective food
must be able to teach.” o Vitamins
o Minerals
FOOD
Carbohydrates
• is necessary to our survival: it sustain life and promote growth.
• it acts as a body fuel that gives energy required for bodily • Carbohydrates provide energy to body to do work. It is the
functions. most easily available form of energy
• are products derived from plants/ animals Fats
• it comes from plants and animals
• are also energy yielding nutrients. Provides more energy than
What is the component of food? carbohydrates. Main storehouse of energy in our body.
1. Nutrients – essential component s of food Proteins
• Proteins are building blocks of body. Help in growth and repair
of damage in the body
 • Plant sources of protein • Calcium: milk, egg
o Pulses: soya bean, peas • Potassium: banana, apricot, almonds
o Nuts: walnut, ground nut • Iron: lettuce, gooseberry, walnut, brown sugar
o Cereals: wheat, maize
Water and fibers
• Animal sources of protein
o Milk • also form an important part of our diet as they help in proper
o Cheese functioning of digestive system
o Meat
o Egg DEFICIENCY DISEASES

Vitamins • occur due to the lack of intake of any of the nutrients over a long
period of time
• Vitamins are protective foods which are required in very small o Carbohydrate/Protein deficiency diseases: marasmus,
quantities kwashiorkor disease
• Vitamin A, B, C, D, E, K o Calcium/Phosphorus/Phosphorus: weak bones, teeth
Vitamin A: tomato, papaya, egg, fish, milk, carrot, mango, fish oil decay
Vitamin B: egg, milk, cheese, meat, vegetable and green leafy o Iodine: goiter
vegetable o Iron: anemia
Vitamin C: citrus fruits (orange, lemon), gooseberry, grapes, tomato, o Sodium/ Potassium: weak nerves, weak muscle contraction
guava
Vitamin D: egg, fish, butter, milk, sunlight Avitaminosis
Vitamin E: egg, spices, green leafy vegetable, sunflower oil • Deficiency of vitamins
Vitamin K: egg yolk, tomato, green leafy vegetables o Vitamin A: lack of vision
Minerals o Vitamin B: beriberi
• Minerals are also protective food which are required in small o Vitamin C: scurvy
amounts o Vitamin D: rickets
o Iron: manufacture of hemoglobin in blood o Vitamin E: anemia
o Calcium: proper growth of bones and teeth o Vitamin K: hemorrhage
o Phosphorus: proper growth of bones and teeth Water (the next simplest nutrient)
o Fluorine: proper growth of bones and teeth
o Iodine: secretion of thyroid hormone • a compound made of 2 elements – hydrogen and oxygen
o Sodium Potassium: proper functioning of nerves and muscles • Needed for metabolic reactions.
SOURCES OF MINERALS • Supplies the medium for transporting materials to cells and
• Iodine: seafood, garlic, iodize salt waste products away
• Phosphorus: milk, banana
Calories o Ex of high nutrient density food, fruits and veg, meat (not
fatty), cereals, legumes...etc.
• A measure of the energy in food, specifically the energy-yielding
• A nutrient-dense food is a food that is rich in nutrients (vitamins,
nutrients
minerals, compounds, etc).
• Based on 3 factors:
• These foods should comprise the vast majority (80% or more) of
o Basal metabolism
your daily calories for optimal health.
o Physical activity
o Thermic effect of food NUTRIENT DENSITY
• If it wants to perform any activity, your body needs energy. That
Σ Essential nutrients per serving
energy comes from food. 𝑛𝑢𝑡𝑟𝑖𝑒𝑛𝑡 𝑑𝑒𝑛𝑠𝑖𝑡𝑦 =
• The energy available in food is measured in Calories weight per serving

PHYSIOLOGIC FUEL VALUE Characteristics of a Nutritious Food

▪ 1 g carbohydrate = 4 kcal ▪ Adequate

▪ 1 g fat = 9 kcal ▪ Balanced
▪ 1 g protein = 4 kcal ▪ Moderate
▪ 1 g alcohol = 7 kcal ▪ Varied

NUTRIENT DENSITY
• A measure of the nutrients provided in a food per calorie of the
food
• refers to the concentration of nutrients in a given amount of food
source relative to its caloric content.
• consider calories from CHO, fats, protein, vitamins and minerals
and water. The higher the nutrient density, the greater the
nutritional value in a small amount of food.
• foods that are low nutrient density provide fewer nutrients per
kcal and thus a higher calorie intake is needed to obtain needed
nutrients.
o Ex. Low nutrient density foods – chips, candies, jam, cakes,
soda
• foods that are high in nutrient provide more nutrients per kcal and
are used to improve the diet for clients at risk for nutritional
deficiencies.
 CLASSIFICATION OF NUTRIENTS 2. Inorganic nutrients
Classification of nutrients as to: • they contain no carbon.
• They are already in their simplest form when the body ingest
A. CHEMICAL NATURE
them
• Carbohydrates (CHO)
a. (dietary)Minerals
• Proteins (CHON)
• Fats • are the simplest nutrient. Each mineral is a chemical element,
• Minerals its atom is alike. As a result, its identity never changes.
• Vitamins o E.g., Minerals – sodium, iron, calcium, potassium, chloride,
• Dietary fiber sulphate and phosphate.
• Water (H2O) • Are not broken down and changed by the body. They leave the
body as they entered it. Ca is still Ca and Fe is still Fe.
B. ACCORDING TO THEIR FUNCTION IN THE BODY
b. Water (the next simplest nutrient)
1. CHO- provide energy
2. CHON- for growth repair and maintenance of the body. • a compound made of 2 elements: hydrogen and oxygen
3. Fats – provide energy • Needed for metabolic reactions.
4. Minerals – it regulates body processes • Supplies the medium for transporting materials to cells and
5. Vitamins – vital helpers in many body processes waste products away.
6. Water – it is a food as well as nutrient. It helps regulate the
D. ACCORDING TO THEIR ESSENTIALITY
various processes such as circulation, digestion and
elimination and respiration. 1. Essential Nutrients
C, ACCORDING TO ITS CHEMICAL PROPERTIES • nutrients a person must obtain from food because the body
cannot make them for itself in sufficient quantity to meet
1. Organic nutrients
physiological needs.
• meaning “literally alive” • it is also called as “indispensable nutrients”. And essential means
• it contains hydrogen, oxygen and carbon (an element found in all more than just “necessary”.
living things). • these nutrients are required for life.
• Before the body can use organic nutrients, it must be broken • it includes many amino acids, some fatty acids, many vitamins
down into their smallest components. and some minerals and trace elements.
o Ex. CHO, CHON, fats and vitamins • CHON and vits. contain o ex. Amino acids = phenylalanine, tryptophan, lysine, leucine,
nitrogen. isoleucine, valine, threonine, methionine.
o ex. Fatty acids – linoleic and linolenic acids.
2. Nonessential Nutrients 2. Sugar. helps preserve foods by absorbing excess water. Without
water, microorganisms cannot grow inside a food.
• are those nutrients that can be made by the body, they may often 3. Salt. has long been used to prevent meat and fish from spoiling.
also be absorbed from consumed food. Like sugar, salt inhibits the growth of microorganisms by reducing
o E.g., cholesterol the amount of water available to them.
E. ACCORDING TO ITS MASS 4. Oil. helps foods stay fresh by preventing microorganisms from
coming into contact with the food. Oil also reduces the rate of
1. Macronutrients oxidation in a food, which helps prevent it from spoiling quickly.
• are required in large quantities daily because they are essential 5. Spices. some spices seem to retard the growth of
to provide energy and to regulate and control the different microorganisms while also reducing the rate of oxidation
functions of the body o These spices include cloves, mustard, sage, thyme, rosemary
• Include proteins, carbohydrates and fats. They are the basis of and oregano.
any diet. 2. PHYTOCHEMICALS
2. Micronutrients • compounds produced by plants. They are found in edible
• are needed in small quantities (usually in amounts less than fruits, vegetables and other plant-derived foods that have
milligrams). biological activity in the body. - according to research, it is use
• These nutrients are involved in regulating metabolism and energy in the prevention of chronic diseases such as CA and CVD
processes. • some researchers estimate there are up to 4000
• They are vitamins and minerals. phytochemicals but only a small fraction have been studied
closely
NON-NUTRIENTS • Common names: flavones, isoflavones, allyl sulfides,
phytonutrients, polyphenols, cathechins, carotenoids,
1. FOOD ADDITIVES anthocyanidins and isothiocyanates
• such as the preservatives, flavors and colors. a. lycopene – cancer (prostate)), heart health = tomatoes,
grapefruit, watermelon, red peppers
• it makes the food safe if you keep it for an extended period.
b. allylic sulphites - in garlic
Examples of PRESERVATIVES: c. lignans - in wheat
d. betacarotene – for immune system, vision, skin health
1. Acids.
and bone health= yellow, orange and dark green foods
• Like lemon juice and vinegar.
e. resveratrol- heart & lung health, cancer & inflammation =
• help preserve freshness by increasing the acidity of a food. red wine, grapes, peanuts
• An acidic food creates a hostile environment for
microorganisms
 f. anthocyanidins – blood vessel health = blackberries, red NUTRITIONAL ASSESSMENT
berries, red onion, = blueberries, plum, strawberries, red
Diet History – a comprehensive record of eating-related behaviours
radishes, red potato
and foods a person eat
g. isoflavones – menopause, breast cancer, bone health,
joint inflammation, lower cholesterol = legumes, nuts, Contents of Diet History of Adults:
soybeans
1. Check appetite – good, poor, any factors that affect appetite,
3. ALCOHOL taste and smell perception
• though it provides energy but no nutrients. It is detrimental to 2. Ask for allergies, intolerances or food avoidances – foods
health when too much consumption of it. avoided and reasons, length of time of avoidances
3. Anthropometry – ht, wt, skin-fold, etc.
4. Take 24-hour dietary recall or food frequency checklist
5. Consider ethnic and cultural background – eating habits and
food preferences and religion
o people eat the foods they grew up eating. Every country or
every region of a country, has its own typical foods and ways
of combining them into meals.
o American diet or even Filipino diet includes many ethnic foods
from diff countries, all adding variety to the diet. Ex. Chinese,
Italian, Korean, Japanese.
o consider religion: for examples, some religious sect forgo
meat during lent, the period prior to easter.
o Jewish law includes an extensive set of dietary rules that
govern the use of foods derived from animals.
o Muslims fast between sunrise and sunset during Ramadan.
o Food preference- spicy foods, sweetness of sugar and the
savouriness of salt. High fat foods. curry spices of Indian
cuisine.
o Habits- choosing food out of habit. Ex. Eating cereal every
morning, bec they always eat cereals for b-fast. Eating a
familiar food makes them comfortable
 6. Evaluate dental and oral health- problems w/ eating, foods that ● Medications may decrease the desire of food, absorption of
cannot be eaten, problems w/ swallowing, salivation nutrients, metabolism of nutrients.
7. Consider economic status –income, amount of money for food o e.g., antihistamines-dec saliva causing dry mouth and loss of
each week or month. = people eat foods that are accessible, quick appetite.
and easy to prepare and w/ in their financial means. o e.g., aspirin (controls pain and fever and for blood thinning) –
a gram of which increases the taste perception of bitterness.
8. Evaluate physical activity level – occupation (type, hours/week,
shift, energy expenditure), Exercise (type amount, frequency), ANTHROPOMETRIC MEASUREMENT
Sleep (hours/day, uninterrupted?), handicaps.
• the science of measuring the size, weight and proportions of the
9. Determine home life and meal patterns – Number in household human body.
(eat together?), person who does shopping, person who does • may reveal a failure to thrive in children
cooking, food storage and cooking facilities (stove, refrigerator) • it reflects a nutrient deficiencies or excesses.
type of housing (home, apartment, room) • includes the ht, wt, head circumference, upper arm, skin fold and
10.Assess gastrointestinal conditions – problems of heartburn, chest circumference (for children).
bloating, diarrhoea, vomiting, constipation, frequency of problems, HEIGHT AND WEIGHT. Useful in determining nutritional status in
antacid, laxative or other drugs. adults. It is a good indicator of satisfactory diet and recent food
11. Consider presence of chronic disease – treatment, length of tx, intake.
dietary modification including physician prescription, date of o HEIGHT – is a less sensitive indicator of current nutritional
modification, education, compliance w/ diet. status than weight – for – age since height does not decrease
12. Evaluate recent weight change – loss or gain, how much, over but simply slows down in times of nutrient deprivation.
what length of time, intentional or non-volitional o WEIGHT – is a sensitive marker of current nutritional status.
Reflects an immediate inability to meet nutritional
Food Frequency – a record of how often the diff foods are eaten. requirements and this may indicate nutritional risk.
The types (and sometimes the amount, its preparation) of foods a
person routinely consumed in a week or a month can be taken. ESTIMATING DESIRABLE BODY WEIGHT – is also known as Ideal
or reference weight but it is more appropriately called the healthy
24-hour recall – done by dietician. Listing the types, amounts and weight.
preparation of all foods eaten in past 24 hours
• It is the weight found statistically to be most compatible w/ health
Food Diary – written record of all food and drink ingested in a longevity.
specified period- for about 3–4-day period. But some clients are not • Recently, authorities emphasize that the most important factor in
truthful and tend to forget the food they had eaten. May include weight is body composition.
records of behaviours / emotions and symptoms, physical activities
and medications
• Thus, the term Healthy Weight has replaced Ideal body weight, DESIRABLE BODY WEIGTH USED TO ASSESS DEGREE OF
indicating that a person’s body composition has a good balance MALNUTRITION
between lean body mass and fat tissue.
1. Mild Malnutrition – patients w/ weight w/ in 85-90% of usual body
TANNHAUSER’S METHOD weight = 10-15% wt. loss
Step 1: DBW (K) – HEIGHT (CM) – 100 2. Moderate Malnutrition – patients w/ wt. w/ in 75-84% of usual
body weight = 16-25%
Step 2: Deduct 10% - if a Filipino unless frame size is known (either
med or large) 3. Severe malnutrition – patients w/ wt. less than 74% of usual body
weight = 26% wt. loss
Example: Subject: 5’2” female (5’2”- 157.48cm)
OTHER PARAMETERS OF ASSESSING NUTRITIONAL STATUS
Step 1: DBW (K)157.48cm – 100 = 57.48 kilos
BMI or BODY MASS INDEX
Step 2: 57.48 kilos less 5.748(10%) = 51.7 or 52kg
• Or the Quetelet index is a good estimate of the degree of obesity
CONVERSION AID:
or amount of total body fat.
• 1 foot – 12 inches
• It also helps to determine how much risk people have of
• 1 inch – 2.54 cm
developing certain health problems because of their weight (e.g.
• 1 m – 100cm diabetes, heart problems)
GUIDELINES IN DBW ADJUSTMENTS • It can indicate over or under nutrition
• BMI is computed thru METRIC FORMULA
BUILD ADJUSTMENT DBW Range
𝑤 (𝑖𝑛 𝑘𝑖𝑙𝑜𝑠)
SMALL Less 10% of ± 10% of adjusted DBW FORMULA: BMI
computed DBW 𝐻 (𝑖𝑛 𝑚𝑒𝑡𝑒𝑟)^2
MEDIUM As computed ± 10% of adjusted DBW Constant: (5 ft = 1.524m) (4 ft = 1.2192m) (1 inch = 0.0254m)
Example: H = 5’ 3”
LARGE Add 10% of ± 10% of adjusted DBW W= 62kgs
computed DBW 62kg/ (1.6) ² = 62/2.56 = BMI = 24.22
ACTUAL BODY WEIGHT – weight measurement obtained at the
time of examination
• May be influenced by changes in the person’s fluid status.
INTERPRETATION OF BMI VALUES (ADULTS) IOTF-ASIA IN GENERAL:
PACIFIC GUIDELINES
OBESITY - IS BMI of 27 or more, indicates high risk of developing
BMI VALUES CATEGORY health problems – weight 20% above average.
< 18.5 Underweight UNDERWEIGHT – BMI less than 18.5 – 10 to 15% below ave

≥ 18.5 – 22.9 Normal Range OVERWEIGHT - BMI between 25-29 – 10 to 20% above ave.

≥ 23.0 Overweight HEALTHY – BMI between 18.5 – 24.9

23.0 – 24.9 At risk BMI TEND TO INCREASE WITH AGE

25.0 – 29.0 Obese I WAIST – TO – HIP RATIO

≥ 30 Obese II • waist to hip ratio (WHR) is a valuable indicator of body fat

distribution and adiposity. It is also a valuable guide in evaluating
health risk (heart disease, diabetes, etc.)
CLASSIFICATION OF MALNUTRITION IN ADULTS BY BMI • Alternatively, it is called abdominal/gluteal ratio or abdominal
girth measurement.
BMI VALUES CATEGORY
Obtaining Correct Measurement:
>20 Normal
1. Use nonstretchable tape measure (in centimetre)
18.5 – 20.0 Marginal
2. Subjet should stand erectly, abdominal muscles relaxed, arms at
>17 – 18.5 Mild malnutrition the sides, and feet together. The measurer faces the subject and
places the tape measure. Measure waist at the most narrow area
16 – 17 Moderate Malnutrition
below the rib case above umbilicus.
<16 Severe Malnutrtion
3. Measure hip circumference at the widest point around the hips or
OBESITY CATEGORIES INTO 3 BMI GRADES buttocks with the subject standing. Read measurement to the
nearest 0.1cm.
1. GRADE I – 25 to 29.9
Formula for Assessing Body Fat Distribution by WHR
2. GRADE II – 30 TO 40
WHR = waist circumference (cm)
3. GRADE III – 40+
Hip circumference (cm)
• A WHR of 1.0 or greater in men or 0.8 or greater in women is ASSESSMENT BY CLINICAL METHOD
indicative of android obesity and an increased risk for obesity-
❖ Clinical assessment of nutritional status deals basically with the
related diseases. This also appears to be true in children.
examination of changes that can be seen or felt in superficial
• GYNOID “pear-shaped “people, store more fat in the buttocks,
tissues such as the skin, hair and eyes.
thighs and hips.
❖ In other words, it’s the physical observation or assessment.
• ANDROID “apple-shaped” people, carry their extra fat around the
abdomen/upper body-. ❖ In here, signs of nutrient deficiency are noted and some nutrient
• The WHR may partially explain the difference in high blood deficiency diseases are observed such as;
pressure between men and women. Men are more likely to be ❖ Scurvy: lack in vit C, numerous black and blue spots on the skin
“apples” and women to be “pears”. Men have higher rates of HTN ❖ Rickets: lack of Ca and vit D= poorly shaped bones and teeth
and more complications. ❖ Iron deficiency/anaemia (children beyond 6 mons.) lack in iron,
Waist Circumference pallor.
❖ Dehydration: loss of water, sunken eyeballs, dry mucous
• Waist circumference serves as a marker of abdominal fatness.
membranes, thirst, etc.
Waist circumference alone has been considered a valid indicator
for both men and women.
• Interpretation: women with a waist circumference greater ASSESSMENT BY BIOCHEMICAL TEST
than 35 inches and men with waist circumference greater
• includes various blood, urine, saliva and stool test.
than 40 inches have high risk of central obesity-related
health problems. • according to Dellova, it provides information on protein balance,
vit, mineral, and fluid status, body composition, organ function
SKINFOLD THICKNESS – Assess body composition, fat distribution and metabolic status.
and reserve calories by using a calliper (Harpenden or lange) • According to Roth = a deficiency/ toxicity can be determined by
Sites: laboratory analysis of the samples.
• These tests allow detection of malnutrition before signs appear.
● Triceps- commonly used
● Biceps
● Below the scapula MOST COMMONLY USED TEST FOR NUTRITIONAL
● Above the iliac crest EVALUATION
● Upper thigh
If it is more than 1 ½ inches – over wt. BLOOD TEST
If less than ½ inch – under wt. ● Serum Albumin Level – measures the main protein in the blood
and is used to determine protein status
● -3. 5 – 5.0 g/dl or 35-50g/L
Serum Transferrin Level LDL – less than 130mg/dl
● indicates iron-carrying protein in the blood Serum Triglycerides – 2.9 – 8.9 mmol/L or less than 200mg/dl
● transferrin is a glycoprotein that binds and transport iron. Most is
Uric Acid, serum or plasma – men – 3-99mg/dl, women – 2.5-
produced in the liver.
7.7mg/dl
● if result is below normal there would be hepatic failure, nephrosis,
cachexia (severe malnutrition and body wasting by chronic o High- gout, toxemia of pregnancy, leukemia, polycythemia,
diseases.) renal insufficiency, down’s syndrome, glycogen storage
disease.
Blood Urea Nitrogen (BUN)
o Low – occasionally in acute hepatitis.
• Increased level may indicate renal failure, insufficient renal blood
STOOL EXAM
supply or blockage in the urinary tract, dehydration and GI
bleeding. ● Direst Stool Exam – stools check for weight (greater than
• 2.9 – 8.9 mmol/L normal weight suggest malabsorption) and checked for oily
materials (excess fat in stool suggest steatorrhea).
Creatinine Excretion
● Chemical analysis of fecal fat- fecal fat greater than 7g/day
• indicates the amount of creatinine excreted in the urine over a 24- when the diet includes 100 g of fat/day indicates malabsorption.
hour period and can be used in estimating body muscle mass.
• low creatinine excretion – indicative of muscle mass depletion, as ● Serum Calcium – low levels seen in calcium and vit. D
in malnutrition. malabsorption, (recall that steatorrhea can lead to calcium and
vit Malabsorption.
Serum Creatinine
● D-xylose test – test of CHO absorption.
• indicates the amount of creatinine in the blood and is used for
evaluating renal functions. ● Schilling test – identifies vit B₁₂ malabsorption.
• N.V. 60-132 mmol/L URINE TEST
• acute/chronic renal insufficiency, urinary tract obstruction.
Creatinine
Hgb- women-12-16g/dl, men-14-18g/dl
• ↑ muscle wasting, starvation and cachectic status,
Hct – women – 42-52%, men- 37-48% (decreased level would mean hyperthyroidism and febrile status.
anemia) • ↓ hypothyroidism, renal insufficiency
Lipid Profile – for clients’ w/ heart abnormalities • Men – 0-50 mg/24 hour
• Women – 0-100 mg/24hour
Total Serum Cholesterol – less than 200 mg/dl
HDL – more than 35mg/dl
Calcium MINERALS AND TRACE ELEMENTS
MINERALS
• ↑- hyperparathyroidism, elevated serum calcium • it is an inorganic element that is necessary for the body to build
• 50-150mg/24 hr. Or 1.05 – 1.3 mmol/L tissues, regulate body fluids or assist in various body functions.
Urinalysis – can detect protein and sugar in urine (indicative of • They are found in all body tissues.
kidney disease and diabetes) • They can’t provide energy by themselves but in their role as body
regulators, they contribute to the production of energy w/in the
SUMMARY: After obtaining all the info needed or after all the steps / body
methods used are evaluated together. The dietician has the • They are found in water and in natural foods, together w/
opportunity to make an accurate nutritional assessment of the client. proteins, CHO, Fats and vitamins.
Whereby a proper treatment and management on the medical
• The specific mineral content of food is determined by burning the
condition of the client will be implemented.
food and then chemically analyzing the remaining ash.
divided into Two Groups:
1. Major Mineral – they require amounts greater than 100mg/ day.
● Also known as macrominerals
● Major minerals include: Sodium, Potassium, Calcium,
phosphorus, Magnesium, Chloride and Sulfur.
2. Trace Elements – w/c needed in amounts smaller than
100mg/day
● Also known as microminerals
● Trace elements include: Iron, Iodine, Zinc, Selenium, Copper,
manganese, Fluoride, Chromium and Molybdenum
SODIUM
• It is always found as a compound w/ other element in nature,
such as common salt.
• It is found mainly in blood plasma and in the fluids outside the
body cells.
• It is an electrolyte whose primary function is the maintenance of
fluid balance in and out of body cells in the body.
• It is found most in body secretions like, saliva, gastric & intestinal
secretions, bile and pancreatic fluid. What body secretions we
can see sodium?
Functions:
• Necessary for the regulation of water balance within the body,the
passage of substances in and out of each cell, and the
maintenance of a normal body pH.
• Also plays a role in the generation of normal electrical nerve o because of Na’s role in determining the osmolality of ECF,
signals, muscle contraction, and the regulation of blood pressure. water is drawn out of the vascular compartment into
• Helps muscles and heart to relax/for the regulation of muscle and interstitial tissues and cells.
nerve irritability o Causes: gastrointestinal fluid loss, sweating and use of
• Involved in the transmission of nerve impulses diuretics
• Essential for the production of hydrochloric acid in the stomach • S/S: lethargy, confusion, apprehension, muscle twitching.
• It controls the extracellular fluid and is essential for osmosis. Abdominal cramps, anorexia, N&V, headache, seizure and coma.
What is osmosis? Excess
Sources: • may cause edema
• primary dietary sources of sodium are table salt w/c is 40% • And excess sodium is frequently associated w/ CVD such as Htn
sodium and CHF- more Na means more water reabsorbed in the kidneys.
it is naturally available in animal foods. More water means increased blood volume and inc BP.
• It is present in fruits and vegs, milk, meats • Hypernatremia may occur – too much Na in the blood, Serum
• and even drinking water (softened water-high Na content than Na above 145mEq/L
hard water) o Excess Na in the ECF-bec the osmotic pressure of ECF is
• It is added to condiments and other foods and can be listed in high, fluid moves out of the cells into the ECF-cells become
food ingredient label as sodium, sodium chloride, monosodium dehydrated.
glutamate (MSG), sodium nitrite, sodium bicarbonate (baking o Causes: by insensible loss ("Insensible" losses can neither
soda) and sodium benzoate. be perceived nor measured directly. You've lost it, but you
• it is added to commercially prepared foods by controlling growth don't know that you've lost it (and, of course, you do not know
of microorganism how much you have lost...)
• e. g. hyperventilation/fever, water from feces (can’t be measured
Deficiency or Excess: but it is estimated to be between 40 cc and 600 cc in an adult
● Either deficiency or excess of sodium causes upset in the body’s under normal circumstances)
fluid balance, drawing water and potassium out of the cells where • S/S: dry sticky mucous membrane, tongue, red dry
it is needed to maintain electrolyte balance. • swollen, weakness
Deficiency • "Sensible" loss is loss that can be perceived by the senses and
• can occur after severe vomiting (too much acid is lost during this can be measured. If you've lost it, you know you've lost it!
condition and tetany would result due to alkalosis), diarrhea or • e.g., urine, vomitus, increased sensible fluid loss thru
heavy perspiration w/c dehydration can result • diarrhea
• It can also upset the acid-base balance in the body. Cells
functions well in a neutral or slightly alkaline medium Chloride
• Athletes can lose so much sodium and drink so much water that • The element Chlorine is a poisonous gas. When chlorine reacts
they develop Hyponatremia-too little Na in the blood. with sodium or hydrogen, however, it forms the negative chloride
• Hyponatremia – is a sodium deficit/ serum Na level of less than ion. Chloride is an essential nutrient, required in the diet.
135 mEq/L
Functions: • For the synthesis of protein
• Major anion of the ECF, where it occurs mostly in association w/ • For the regulation of water balance in the body,
sodium • For proper nerve impulse transmission
• Helps maintain fluids and electrolyte balance • For skeletal and smooth muscle contraction,
• Chloride is a part of hydrochloric acid and it is necessary for • For regulation of blood pressure and for steady heartbeat.
proper digestion
Sources:
Sources:
table salt, seafood, tomatoes, rye, olives • potassium rich fruits and veg appears to reduce the risk of stroke
RDA: • Potatoes, peaches, avocado, spinach, banana, mushrooms,
Chloride is abundant in processed food tomato, dried fruits, peach, adzuki and lima beans, raisins, wheat
• The proportion of chloride in salt is greater than sodium, whereby bran, dairy products
its recommendations are slightly higher than sodium Deficiency
• Salt (Sodium chloride) is about 60% chloride • Potassium deficiency is the most common electrolyte
• 5g salt = 1tsp • imbalance due to excessive losses than by deficient
• 1tsp salt contributes 3000mg chloride • intakes.
• Adults: 19-50y/o = 2300mg/day • Conditions such as diabetic acidosis, dehydration, or prolonged
51-70y/o= 2000mg/day
Above 70 y/o = 1800mg/day vomiting or diarrhea can cause deficiency
• Upper Level • And even in taking diuretics, steroids and strong laxatives
Adults:3600 mg/day • Hypokalemia- Earliest symptom deficiency is muscle weakness
o Other symptoms – fatigue, muscle spasm, abnormal heart
Deficiency and toxicity.
rhythm.
• Diets rarely lack chloride
Toxicity
• Deficiency occurs during Chloride losses.
• High blood chloride concentration is caused by dehydration due • It can result from over consumption of K salts, supplements (
to water deficiency including some energy fitness shakes)
• Toxicity symptom – vomiting • Given more potassium than the body needs, the kidneys
accelerate their excretion.
POTASSIUM
• Hyperkalemia - Technically, hyperkalemia means an abnormally
• Like a sodium, potassium is a positively charged ion. In contrast
elevated level of potassium in the blood
to sodium, potassium is the body’s principal cation inside the
The normal potassium level in the blood is 3.5-5.0
body cells.
Functions: milliequivalents per liter (mEq/L).
• Essential part of every cell in the body and required for normal RDA:
growth. • K is abundant in all living cells, both plants and animals.
• Also involved in the release of energy from food,
• AI: need to increase intake of fruits and veg. to 5-9 stones in people with hypercalciuria (high urine calcium levels)
servings/exchanges daily. or those with calcium oxalate stones; avoid if stones are
phosphate-based
PHOSPHORUS 13. FDA-approved for treating occasional constipation, and to
• Second most abundant minerals in the body. And a major mineral restore bowel function after surgery
found mostly in bones and teeth. About 85% of it is found in
combination w/ calcium in the hydroxyapatite crystals of bones Sources:
and teeth. Meat, poultry, fish, eggs, milk, milk products, nuts, legumes
cereals, grains, chocolate, lettuce, tomato
Functions:
RDA:
1. main role is in binding with calcium to form healthy bones
o Diets that provide enough energy and protein also supply
and teeth adequate phosphorus.
2. needed for metabolism of carbohydrates and fats to produce o Adult: 700mg/day
energy o UL: 19-70y/0= 4000mg/day
3. important for production of ATP (Adenosine Tri Phosphate),
the molecule that the body uses to carry energy Deficiency:
4. required for synthesis of protein for growth and repair of
cells and tissues, including nucleic acids (DNA and RNA) • A reduced concentration of phosphate in the blood serum is a
5. needed to make phospholipids, such as disorder known as hypophosphatemia.
phosphatidylcholine, that are structural components of cell • Phosphorus deficiency may cause bone diseases such
membranes as rickets in children and osteomalacia in adults. An
impsroper balance of phosphorus and calcium may cause.
6. helps the body utilize the B-complex vitamins
7. needed for heart muscle contraction and to regulate Toxicity:
heartbeat
8. supports proper muscle and nerve function 1. Excess phosphorus can cause hyperphosphatemia or high
9. helps maintain normal acid-base (pH) balance in the body blood phosphate levels.
by acting as an important buffer • A common reason for this is, over-consumption of foods high
10. maintains calcium balance and helps prevent in phosphorus, such as canned, processed, or fast foods, or
hypercalcemia (high blood calcium levels) soft drinks. Many of these have phosphates added to extend
11. maintains kidney function shelf life or enhance flavors, especially in baked products,
12. potassium and sodium phosphate taken orally are FDA- cheeses, meats, and drinks.
approved for use to help prevent or treat calcium-based kidney • A deficiency in calcium or magnesium may lead to excess
blood phosphate.
2. At the same time, high levels of phosphorus interfere with calcium • Proper levels of calcium over a lifetime can help
uptake, which, if coupled with a low calcium diet over a long prevent osteoporosis.
period, increases the risks of bone density loss, hypertension, • Clotting blood
and bowel cancer. • Sending and receiving nerve signals
• Hyperphosphatemia can also occur in people with impaired • muscle relaxation and contraction
kidney function. • Releasing hormones and other chemicals
• As noted in the Journal of the American Medical Association, • Keeping a normal heartbeat
such patients need to avoid foods high in phosphorus and
especially fast foods and soft drinks. Sources:
milk, milk products, calcium fortified, orange juice, part-skim, ricotta
3. Too much phosphorus can cause serious electrolyte cheese, yogurt, cocoa, sardines, clams, oysters, turnip greens,
imbalances. It draws calcium out of bones and weakens them, mustard greens, broccoli, legumes, dried fruit
leading to brittle bones. RDA:
• Excess calcium and phosphorus together may result in • A cup of milk provides abt. 300mg of calcium
harmful calcium deposits or calcification, in soft tissues such • Adults need between 1000 and 1200 mg/day or 3-4 cups of milk
as the lungs, heart, muscles, eyes, blood vessels, and • 1000mg÷300mg/cup= 3 ½ cups
especially the kidneys. • 1200mg÷300mg/cup= 4 cups
• 14-18 y/o pregnant & lactating- 1300mg/day
CALCIUM
• 19-50y/o pregnant & lactating – 1000mg
• Calcium is the most plentiful mineral found in the human body.
The teeth and bones contain the most calcium. Nerve cells, body Deficiency:
tissues, blood, and other body fluids contain the rest of the • A low calcium intake during the growing years limits the bone’s
calcium. ability to reach their optimal mass and density
• Adults absorb about 25% of the calcium they ingest. Pregnant • Most people achieve a peak bone mass by their late 20’s
about 50% and growing children 50-60%. • Adults lose bone as they grow older, beginning between the ages
• Vitamin D helps in the absorption of calcium, deficiency of this of 30-40
may impair its absorption also the fiber, in general, and the • may result to Osteoporosis-a disease in w/c the bones become
binders phytate and oxalate interfere with its absorption. porous and fragile due to a loss of minerals, also called adult
• The stomach’s acidity helps to keep calcium soluble, and vitamin bone loss.
D helps to make calcium-binding protein needed for absorption • Hypocalcemia – low levels of calcium in the blood. It can cause
(This explains why milk is the best food for Vitamin D fortification) by vit. D deficiency and magnesium.
• And with problems in their parathyroid glands -, diet and kidney
Function disorders & drugs such as rifampin, anticonvulsants,
• Calcium helps form and maintain healthy teeth and bones. corticosteroids.
• Also results when too much calcium is lost in urine or when not • Parathormone/parathyroid hormone – a hormone from the
enough calcium is moved from bones into the blood parathyroid gland that regulates blood calcium, by raising it when
levels fall too low
Symptoms
• Calcitonin - a hormone from the thyroid gland that regulates blood
• Calcium Tetany- char. By uncontrolled muscle contraction,
calcium by lowering it when levels rise too high.
caused by lack of vitamin D and abnormal secretion of the
regulatory hormones. MAGNESIUM
• Chronic deficiency is caused by poor absorption over the years,
Sources:
depletes the savings account in the bones.
nuts and seeds, legumes, green vegetables, tofu, wheat germ,
Toxicity: cereal grains, soybeans, chocolate, blackstrap molasses, corn, peas,
• Too much calcium supplements intake for a long period of time carrots, seafood, brown rice, parsley, lima beans, spinach
raises the risk of kidney stones
• Getting too much calcium can cause constipation. It might also
interfere with the body's ability to absorb iron and zinc. Functions:
• Hypercalcemia - Hypercalcemia is a condition in which the • Essential in hundreds of biochemical reactions and a wide range
calcium level in your blood is above normal. Too much calcium in of metabolic activities including the use of energy and the
your blood can weaken your bones, create kidney stones, and metabolism of carbohydrates, lipids, proteins, and genetic
interfere with the way your heart and brain works. material.
• Hypercalcemia most commonly results from overactive • Together with calcium it is necessary for proper nerve
parathyroid glands. These four tiny glands are each about the transmission, contraction of muscle, blood clotting, BP regulation
size of a grain of rice and are located on or near the thyroid • For the conversion of Vitamin D to its active form.
gland. • Helps prevent dental caries by holding calcium in tooth enamel
• Other causes of hypercalcemia include cancer, certain other • for functioning of the lungs and normal functioning of the immune
medical disorders, some medications, and excessive use of system.
calcium and vitamin D supplements. RDA:
• Calcium rigor – with blood calcium above normal. Muscles • Adult men 19-30 y/o – 400mg/day
contract and can not relax • Women 19-30 y/o – 310mg/day
Calcium Balance: SULFUR
• Whenever calcium falls too low or rises too high, three (3) organ • The body does not use sulfur as nutrient. It is a major mineral that
system respond: the intestines, bones and kidneys. occurs in essential nutrients such as B vitamin thiamin and the
• Vitamin D, parathormone and calcitonin return blood calcium too amino acids methionine and cysteine.
normal. • Sulfur plays a well-known role in determining the contour of
protein molecules.
• Skin, hair and nails contain some of the body’s rigid proteins, • It is also required by enzymes involved in the making of amino
which have a high content of sulfur. acids, collagen, hormones and neurotransmitters.
• There is no RDA for sulfur and no deficiencies are known. Only • Critical in making new red blood cells, immune defense cells,
when people have a severe protein deficiency will they lack the white blood cells, and normal brain function.
sulfur-containing amino acids. Iron is found in two (2) proteins
• Hemoglobin in the red blood cells- it is the oxygen-carrying
protein that transport oxygen from the lungs to the tissues
throughout the body. It accounts for 80% of the body’s iron.
• Myglobin in the muscle cells – the oxygen-holding protein of the
muscle cells
TRACE MINERALS
• Iron absorption depends partly on its source.
o Are so named because. they are present and needed in relatively • Iron occurs in 2 Forms:
small amounts in the body. Altogether, they would produce only a
bit of dust, hardly enough to fill a teaspoon. Sources:
o Deficiency and excess are equally fatal/deadly. People’s diet • Heme Iron – found in food. From the flesh of animals such as
normally supply enough of these minerals to maintain health. meat, fish, poultry
IRON o it has an iron about 10% from food/day but it is absorbed well
that accounts abt 25% of heme iron.
• Exemplifies the principle that both too little and too much of a • Nonheme Iron – found in both plant-derived and animal-derived
nutrient in the body can be harmful. foods.17% is absorbed by the body as nonheme iron.
• To support health optimally, one should eat enough iron • MFP factor (meat,fish,poultry)- not only as well-absorbed heme
containing food. iron but also a factor that promotes absorption of nonheme iron
• It has Two (2) Ionic state: from other foods eaten at the same meal.
1. Ferrous iron (reduced) fe++ HEME – the iron-holding part of the hemoglobin and myoglobin
2. Ferric iron (oxidized) fe+++ proteins. About 40% of the iron in meat ,fish, poultry is bound into
heme, the other 60% is nonheme iron.
FUNCTIONS
Factors that enhance Nonheme iron absorption:
• Because ferrous iron can be oxidized to ferric iron and ferric iron
1. MFP factor
can be reduced to ferrous iron, iron can serve as a cofactor to
2. Vitamin C (ascorbic acid)
enzymes involved in oxidation-reduction reactions.
3. Citric acid and lactic acid from foods and Hcl acid from
o Cofactor = a substance that works w/ an enzyme to facilitate
stomach
chemical reaction.
4. Sugars (including sugars in wine)
Factors that inhibit Nonheme iron absorption:
 1. Phytates and fibers (grains and veg.) • A person donating a pint of blood (about 500ml) losses about
2. Oxalates (spinach, beets, rhubarb) 2.5mg of Iron.
3. Calcium and phosphorus (milk)
Stages of Iron Deficiency:
4. EDTA (food additives)
5. Tannic Acid (and other polyphenols in tea and coffee.) 1. iron stores diminish
2. transport iron decreases
Sources:
3. hemoglobin production declines.
meat (provides iron in the heme form which is the easiest for the
body to absorb), blackstrap molasses, clams, oysters, tofu, legumes, TOXICITY:
nuts and seeds, red meats, dark green leafy vegetables (Vegetables
provide iron in the nonheme form, which is harder for the body to • Hemochromatosis- iron overload, caused by a genetic disorder
absorb. Consuming vitamin C with iron rich foods will help increase that enhances iron absorption
absorption), soybeans, pumpkin seeds, dried fruits, enriched and/or • Hemosiderosis – excess iron that characterized by large deposits
whole-grain breads and cereals of the iron storage protein hemosiderin in the liver and other
tissues.
Iron Deficiency • S/S – apathy, lethargy and fatigue, GI distress, joint pain, organ
• most common nutrient deficiency affecting 1.2 billion people. damage, skin pigmentation, infections.
• IDA – half of the population of preschoolers, pregnant and school RDA:
children in the US have this condition. • Adult male 8mg/day
• It is sevre depletion of iron stores that results in low hemoglobin • Women 19-50 y/o – 18mg/day
and small, pale rbc. • 51 + - 8 mg/day
• It is a microcytic hypochromic anemia • UL for adults 45mg/day
• Anemias that impair hemoglobin synthesis is called microcytic.
• S/S weakness, fatigue, headaches, pale skin, nailbeds, mucous ZINC
membranes and palm creases. Concave nailbeds, inability to Sources:
regulate temp. Significant sources – protein-containig foods:
Stages of life that are prone or high risk to IDA – red meats, shellfish, whole grains, oysters, wheat germ, beef
liver, dark meat of turkey and chicken, peanuts, whole grains, miso,
• Women in their reproductive years because of repeated legumes, sunflower seeds, blackstrap molasses, green, peas,
menstrual losses. spinach, broccoli
• Pregnancy – due to high demands of iron that support the added Functions:
blood volume, growth of the fetus and blood loss during childbirth.
• Infants and young children, because they receive little iron from • Essential for proper growth of skin, hair, and nails, healing
their high-milk diets wounds, and a healthy immune system.
• Iron content of Blood is about 0.5 mg/dl
• Necessary in many chemical reactions and for a normal sense of FUNCTIONS:
taste and smell.
Iodide is an integral part of the thyroid hormones that regulate body
• Also functions as a detoxifier of the body
temp, metabolic rate, reproduction, growth, blood cell production,
• and plays a role in the metabolism of carbohydrates. nerve and muscle function.
DEFICIENCY: DEFICIENCY:
• Severe growth retardation and arrested sexual maturation are the • Simple Goiter – an enlargement of the thyroid gland due to an
char. Of zinc deficiency iodine deficiency, malfunction of the gland or overconsumption of
• Hinders digestion and absorption causing diarrhea that worsens a goitrogen.
malnutrition • The earliest and most obvious sign of iodine deficiency
• Impairs immune response making infections likely (GI) • Causes poor performance in the school for children
• Damages CNS and brain lead to poor motor development and • A severe deficiency during pregnancy causes extreme and
cognitive performance irreversible mental and physical retardation is known as
• Impairs vit. A metabolism – vit. A deficiency appears. Cretinism.
• Disturbs thyroid function and metabolic rate Examples of Goitrogen-containing Foods:
• It alters taste, causes loss of appetite and slows would healing 1. cabbage, spinach, radishes, rutabagas
• snake like rash 2. soybeans, peanuts
TOXICITY: 3. peaches, strawberries

High dose (50-450mg) may cause vomiting, diarrhea, exhaustion TOXICITY:

and other symptoms • Can enlarge the thyroid gland
RDA: • Can damage the developing infant – esp from supplements.
o An infant exosed to toxic amounts during gestation may
• Adults Men – 11mg/day develop a goiter so severe as to block the airways and cause
• Women – 8 mg/day suffocation.
• UL – adults – 40mg/day
Sources:
Iodine Iodized salt, saltwater seafood, sunflower seeds, mushrooms, eggs,
beef, liver, peanuts, spinach, pumpkin, broccoli, chocolate, kelp
• Traces of the iodine ion (called iodide). Are indispensable for life.
RDA:
• It is called as iodine when it is referred to the nutrient in foods and
• Adult – 150 mcg/day
iodide when referring to it in the body.
• UL – 1000mcg/day
Copper • Is associated with heart disease that is prevalent in the regions of
the body contains about 100mg of copper. It is found in variety of CHINA where the soil and food lack of selenium. Cause by virus,
cells and tissues but selenium deficiency appears to predispose people to it and
adequate selenium seems to prevent it.
Functions:
• It is called the Keshan Disease – char by enlargement and
• Critical component of the outer coating of nerve fibers, collagen,
insufficiency; fibrous tissue replaces the muscle tissue that
and used in the production of skin pigments.
normally composes the middle layer of the walls of the heart.
• Also works with iron to make healthy red blood cells.
• Two copper and –zinc containing enzymes participate in the TOXICITY:
body’s natural defense against free-radicals
• -Causes loss and brittleness of hair and nails, garlic breath odor,
Sources: and nervous system abnormalities, fatigue, irritability, CNS
disorders
Liver, shellfish, whole grains, mushrooms, cherries, legumes
cocoa, nuts, eggs, muscle, meats, fish, poultry Sources:
grains, seeds, potatoes, meat, poultry, fish, garlic, brewer's yeast,
DEFICIENCY:
wheat germ
• Is rare but in Menkes Disease, the intestinal cells absorb copper RDA: Adults – 55 mcg/day
but cannot release it into circulation, causing a life-threatening o UL – Adults 400 mcg/day
deficiency.
• S/S anemia, bone abnormalities CHROMIUM

TOXICITY: Functions:

May cause liver damage • Necessary for blood sugar regulation and enhances insulin action
• for metabolism of fats and carbohydrates.
RDA:
• Adult -900mcg/day Sources:
• UL – 10,000 mcg/day (10mg/day) wheat germ, brewer's yeast, peas, chicken, corn oil, mushrooms,
prunes, nuts, asparagus, organ meats, whole-grain bread and
Selenium cereals
Functions: Deficiency: diabetes like condition
Important antioxidant that works with vitamin E to protect the body Toxicity: none reported
from free-radical damage. It is also associated with fat metabolism, a
healthy immune system, and important to male fertility. RDA: Men 35 mcg/day

DEFICIENCY: Women 25 mcg/day

MANGANESE Functions:
• Involved in the formation of bones and teeth
The human body contains a tiny 20mg of manganese. Most of it can
• Reduces dental caries and may minimize bone loss by
be found in the bones and metabolically active organs such as liver,
helping the body retain calcium.
kidneys and pancreas.
Sources:
Functions:
water is the best source (fluoridated water), mackerel, sardines, salt
Needed for normal utilization of several other vitamins, and a variety pork, salmon, shrimp, meat, sunflower seeds, kale, potatoes,
of other biochemical roles in the body. It also aids in proper fat watercress, honey, wheat, tea
metabolism, skeletal and connective tissues, production of energy,
Deficiency: dental caries
making cholesterol and DNA, proper brain function, and processing
Toxicity: Flourosis – discoloration and pitting of
blood sugar.
tooth enamel caused by excess fluoride during tooth development
Sources:
RDA: men 3.8mg/day
wheat bran, legumes, nuts, lettuce, leafy green vegetables,
women 3.1mg/day
blueberries, pineapple, seafood, poultry, meat, tea
UL adults 10mg/day

Deficiency: Rare NICKEL

Toxicity: CNS disorders
Sources:
RDA: Men 2.3mg/day
Nuts, legumes, shellfish, cocoa products, green beans, spinach, rice,
Women – 1.8mg/day
tea
MOLYBDENUM Functions:
Important in many biochemical reactions, and thought to play a role
Sources:
in the metabolism of fats and blood sugar regulation.
milk and milk products, soybeans, lentils, pasta, buckwheat, oats,
rice, wheat germ, sunflower seeds SILICON
Functions: Sources:
whole grains, root vegetables, unrefined cereal products
Important in many biochemical reactions, aids in the metabolism of
Functions:
iron, helps prevent gout by removing uric acid from the body, and
Needed for healthy body tissues.
helps the body burn fat. It is also part of healthy bones, teeth, kidney,
VANADIUM
and liver, and helps the body use its iron reserves.
Sources:
AI: 45 mcg, fulfilled with balanced diet shellfish, spinach, parsley, mushrooms, whole grains, dill seeds,
black pepper, parsley, soy, corn, olives
FLUORIDE
Functions:
Research has not documented exactly what vanadium does for the
body. It is likely that it plays a role in energy production, biochemical
reactions, blood sugar and fat metabolism, and bone and teeth
strength.
ARSENIC
Sources:
most foods contain less than 0.3ug/g, seafood is the richest source
Functions:
Precise function in the body is still unknown, but it is likely that it
plays a role in the metabolism of phospholipids.
Boron
Sources:
fruits
vegetables
legumes
nuts
Functions:
Required for normal bone integrity.
VITAMINS- are subs that your body needs to grow and develop normally.
- Formerly called “ACCESORY FOOD FACTORS”

- The missing subs he named VITAMINE was coined from:

VITA- necessary for life

AMINE – denoting that anti beri-beri factor containing nitrogen

VITAMIN E - adults should get between 400-800 IU of vitamin E daily. When looking for a supplement
the preferred form has mixed tocopherols (this should include d-alpha, d-beta, d-gamma, and d-delta
tocopherols) and w/ tocotrienols (it inhibits propagation of existing breast CA).

DEFICIENCY - • Hemorrhagic disease in newborn

TOXICITY - • Kennicterus – a condition resulting from the accumulation of bile pigments in the gray
matter of the CNS.

• Hemolytic anemia- caused by increase destruction of erythrocytes- a frequently fatal type

occurs in infants as a result of RH incompatibility w/ the mother’s blood.

VITAMIN C - RDA: men- 90 mg/day: women- 75mg/day; smokers- +35mg/day

Upper Level: adults – 2000mg/day

Thiamin
Sources: lean pork- richest source

Deficiency - • Beriberi – prolonged thiamin deficiency. beri means weakness. S/s: damage to heart
and other muscles and in nervous system.Types of beri-beri, wet, w/ edema and dry, w/ muscle wasting.

Riboflavin
•Can be destroyed by UV light and irradiation

•Stable to heat

•Does not destroy in cooking

Sources:

milk and milk products are the best sources

Niacin - also called Vitamin B3.
• The body can easily convert nicotinic acid to nicotinamide, which is the major form of
niacin in the blood.

Pantothenic acid - also called Vitamin B5. Part of coenzyme Involves in the energy
metabolism, synthesis of lipids,amino acid metabolism and glycogen synthesis.
Pantos = everywhere
• It is readily destroyed by freezing, canning and processing

Folic acid(B9) (synthetic form found in fortified cereals and supplements)

- also called Folate/ folacin (natural form found in food)
-easily destroyed by heat and oxygen.

Significant Sources:
• fortified grains, green leafy vegetables, legumes, seeds, liver.
• Folate deficiency symptom is anemia, char by large, immature RBC(due to its
large size and oval shape, they cant carry oxygen or cant travel thru the capillaries as
efficiently as normal RBC)
• Megaloblastic anemia / macrocytic anemia {Large immature red blood cell
anemia},
• Anemia = literally “too little blood”. A condition in w/c it has too few RBC w/c are
immature or too small or contain too little hemoglobin to carry the normal amount of
oxygen to the tissues.
Toxicity:
• folate from food alone appears to cause no harm.
• Excess folate from fortified foods or supplements, however, can reach high
enough levels to obscure{nakakubli or it mask} vit B 12 deficiency.

RDA: adult- 400mcg/day

Upper Level – 1000 mcg/day
VIT. B12 COBALAMINE
Deficiency :
• Most vit B12 deficiencies reflect inadequate absorption, not poor intake.
• Inadequate absorption typically occurs for 1 or 2 reasons: a lack of hydrochloric
acid or lack of intrinsic factor. W/o hydrochloric acid, the vitamins is not released from
the dietary proteins and so is not available for binding w/ the intrinsic factor. W/o the
intrinsic factor, the vit B12 cant be absorbed.
• Even if people will stop eating foods rich in vit B12 just like in the case of
vegetarians, may take several years to develop deficiency symptom, about 2-3 years.
Deficiency disease is the Pernicious Anemia ( a blood disorder that reflects a vit B12
deficiency caused by lack of intrinsic factor and char. By abnormally large and immature
redblood cells}.
WATER
Water serves as the solvent

ROLES AND FUNCTION IN THE BODY

1. Component of body weight
a. 60% of body wt in adult
b. Newborns have a larger percentage of water in the BW and
therefore are more likely to be affected by changes in the
diet and water balance.
c. 2/3 of body water is intracellular and 1/3 is extracellular
25% of fluids outside the cell is w/in the blood
vessels(intravascular ) while the 75% is in between the cells
(interstitial space)-included is water in CSF. IOF. GI
secretions and bone, etc.
2. Transport and participant in chemical reactions
a. Water will freely move (by osmosis) to equalize solute
concentration in the body to maintain balance.
b. Chemical reactions in the body exist in fluid medium
3. Carries nutrients and waste products throughout the body
4. Participates in metabolic reactions
5. Serves as the solvent for minerals, vits, amino acids, glucose
and many other small molecules.
6. Aids in maintaining the body’s BP and temp.
7. Maintains blood volume
8. Acts a s a lubricant and cushion around joints, inside the
eyes, spinal cord and amniotic sac surrounding a fetus in the
womb.
 To support these and other vital functions, the body actively
regulates its water balance.

WATER BALANCE
- The cells themselves regulate the composition of fluids w/in
and surrounding them.
- The entire system of cells and fluids remains in a delicate but
firmly maintained state of dynamic equilibrium(reversible
chemical reactions with a velocity of the same directions)
- Imbalances such as DHN and water intoxication can occur,
but the body quickly restores the balance to normal if it can
- The body controls both water intake and excretion.

FLUID INTAKE
- Is supplied to the body via 3 routes by :
⮚ Ingestion of fluids (Oral fluids);
⮚ from preformed fluid of foods esp. fruits and veg.(solid
food) and
⮚ from the production of water during metabolism of
energy nutrients (metabolic water).

Metabolic water - for every 100 gms of fat, CHO and

CHON, the estimated water produced is abt. 107 ml, 55 ml.
and 41ml., respectively.
Fluid excretion – fluids in the body may find its way out
through
● formation of urine (by the kidneys),
● part of the feces (via GIT),
● thru breathing (via lungs),
 ● and sweating (via the skin)

WATER INTAKE REGULATION

- The body can survive for only a few days w/o water. In
healthy people, thirst governs water intake.
- Thirst is finely adjusted to ensure a water intake that meets
the body’s needs.
- When the blood becomes too concentrated (having lost
water but not salt and other dissolved subs.).the mouth
becomes dry and the brain center (known as hypothalamus)
initiates drinking behavior.
- With aging, thirst sensation may diminish. DHN can threaten
elderly people who do not develop the habit of drinking
water regularly.

WATER EXCRETION REGULATION

- Water excretion is regulated by the brain and the kidneys.
- The cells of the brain’s hypothalamus w/c monitor blood
salts, stimulate the pituitary gland (its in the brain and known
as the “king Gland” w/c regulates the operation of all the
other glands in the body) to release anti-diuretic hormone
(ADH-a hormone released by the pituitary gland in response
to high salt concentrations in the blood. The kidneys respond
by reabsorbing water).Whenever the salts are too
concentrated or the blood volume or blood pressure is too
low, ADH stimulates the kidneys to reabsorb water than
excrete it.
- Thus the more water you need, the less you excrete.
 The enzyme rennin – released by the kidneys in response to
low BP, aids in the kidneys in retaining H20 thru the rennin-
angiotensin mechanism.

Water balance
Water Amount Water losses Amount
sources
Liquids 550-1500 Kidneys(urine) 500-1400
Foods 700-1000 Skin(sweat) 450-900
Metabolic 200-300 Lungs(breath) 350-500
H20
GI tract 150
(FECES)
Total 1450-2800 TOTAL 1450-2800

AI for total water

Men – 3.7L/day
Women – 2.7L/day
*1L = 1 qt. = 32 oz. = 4 cups

FLUID AND ELECTROLYTE BALANCE

- When mineral salts dissolve in water, they separate
(dissociate) into charged particles known as ions, w/c can
conduct electricity. For this reason, a salt that dissociates in
water is known as an electrolyte.
- The body fluids w/c contain water and partly dissociated
salts, are electrolyte solutions.
- The body’s electrolytes are vital to the life of the cells and
therefore must be closely regulated to help maintain the
appropriate distribution of body fluids.
- The major minerals form salts that dissolve in the body fluids;
the cells direct where these salts go; and the movement of
the salts determines where the fluids flow because water
follows salt.
- Cells use this force to move fluids back and forth across their
membranes. Thanks to the electrolytes, water can be held in
compartments where it is needed.
- Proteins in the cell membranes move ions in or out of the
cells. These protein pumps tend to concentrate sodium and
chloride outside the cells and potassium and other ions
inside.
- By maintaining specific amounts of sodium outside and
potassium inside, cells can regulate the exact amounts of
water inside and outside their boundaries.
- Healthy kidneys regulate the body’s sodium, as well as its
water, with remarkable precision.
- The intestinal tract absorbs sodium readily, and it travels
freely into the blood.
- But the kidneys excrete unneeded amounts.
- The kidneys actually filter all of the body needs to retain.
- Thus the body’s total electrolytes remain constant, while the
urinary electrolytes fluctuate according to what is eaten.
- Sudden loss of F&E – vomiting, diarrhea, heavy sweating,
fever, burns, wounds- require medical intervention.
ACID – BASE BALANCE
- The body uses ions not only to help maintain water balance,
but also to regulate the acidity (pH) of its fluid
- Like proteins, electrolyte mixtures in the body fluids protect
the body against changes in acidity, by acting as buffers –
substances that can accommodate excess acids or bases.
- The body’s buffer system serve as a first line of defense
against changes in the fluid’s acid-base balance.
- The lungs, skin, GIT and kidneys provide other defenses.
- Of these organ systems, the kidneys play the primary role in
maintaining acid-base balance, as well as its F&E balances.

SUMMARY
- Water makes up about 60 percent of the body’s weight
- Water helps transport nutrients and waste products
throughout the body, participates in metabolic reactions, acts
as a solvent, assists in maintaining blood pressure and body
temperature, acts as a lubricant and cushion around joints.
- To maintain water balance, intake from liquids, foods and
metabolism must equal losses from kidneys, skin, lungs and
feces
- Electrolytes help maintain the appropriate distribution of
body fluids and help to maintain acid-base balance as well.