Health Promotion; Nutrition

I. Nutrients
A. Carbohydrates
1. Carbohydrates are the preferred source of energy.
2. Each gram of a carbohydrate produces 4 kcal/g. Carbohydrates promote
normal fat metabolism; inadequate carbohydrate intake affects metabolism.
3. Carbohydrates serve as the main source of fuel, providing glucose for the
brain and for the skeletal muscles during exercise; carbohydrates also promote
erythrocyte and leukocyte production, and cell function.

4. Major food sources of carbohydrates include milk, grains, fruits, and

vegetables.
B. Fats
1. Fats provide a concentrated source and a stored form of energy.
2. Fats protect internal organs and maintain body temperature.
3. Fats enhance absorption of the fat-soluble vitamins.
4. Fats provide 9 kcal/g.

5. Inadequate intake of essential fatty acids leads to clinical

manifestations of sensitivity to cold, skin lesions, increased risk of infection,
and amenorrhea in women.

6. Diets high in fat can lead to obesity and increase the risk of
cardiovascular disease and some cancers.
C. Proteins
1. Amino acids, which make up proteins, are critical to all aspects of growth
and development of body tissues and provide 4 kcal/g.
2. Proteins build and repair body tissues, regulate fluid balance, maintain acid-
base balance, produce antibodies, provide energy, and produce enzymes and
hormones.

3. Essential amino acids are required in the diet because the body cannot
manufacture them.

4. Complete proteins contain all essential amino acids; incomplete

proteins lack some of the essential fatty acids.
 5. Inadequate protein can cause protein energy malnutrition and severe

wasting of fat and muscle tissue. Major stages of the life span with
specific nutritional needs are pregnancy, lactation, infancy, childhood, and
adolescence. Adults and older adults may experience physiological changes
related to aging that will influence individual nutritional needs.
D. Vitamins (Box 11.1 )
1. Vitamins facilitate the metabolism of proteins, fats, and carbohydrates and act as
catalysts for metabolic functions.
2. Vitamins promote life and growth processes and maintain and regulate body
functions.

3. Fat-soluble vitamins A, D, E, and K can be stored in the body, so an excess can

cause toxicity.
4. The B vitamins and vitamin C are water-soluble vitamins, are not stored in the body,
and can be excreted in the urine.
E. Minerals and electrolytes (Box 11.2 )
1. Minerals are components of hormones, cells, tissues, and bones.
2. Minerals act as catalysts for chemical reactions and enhancers of cell function.
3. Almost all foods contain some form of minerals.
4. A deficiency of minerals can develop in chronically ill or hospitalized clients.
5. Electrolytes play a major role in osmolality and body water regulation, acid-base
balance, enzyme reactions, and neuromuscular activity (see Chapter 8 for additional
information regarding electrolytes).
F. Water
1. Critical for cell function.
2. Makes up 60% to 70% of total body weight.
3. A person cannot survive without water for more than a few days.
II. Malnutrition Laboratory Markers
A. Hematological studies
1. Complete blood cell count with red blood cell indices and peripheral smear
2. These studies differentiate between anemias and nutritional deficiencies.
B. Studies evaluating protein balance
 1. Short-term protein status is best determined by evaluating retinol-binding
protein, prealbumin, transferrin, creatinine, and blood urea nitrogen (BUN)
levels.
2. Long-term protein status can be determined by evaluating serum albumin
levels.
3. Nitrogen balance is evaluated by measuring urea in the urine, which provides
information regarding protein loss

C. Serum electrolytes (see Chapter 8) Always assess the client's ability to eat and
swallow, and promote independence in eating as much as is possible.

III. 2020-2025 Dietary Guidelines for Americans

A. The Dietary Guidelines for Americans are designed for nutritional and health
professionals to assist all individuals and their families in consuming a healthy,
nutritionally adequate diet.
B. Guidelines: see Dietary Guidelines for Americans
at https://www.dietaryguidelines.gov/ and also
see https://dietaryguidelines.gov/sites/default/files/2020-12/

Dietary_Guidelines_for_Americans_2020-2025.pdf (Fig. 11.1 ).

A. Provides a description of a balanced diet that includes grains, vegetables, fruits,
dairy products, and protein foods (see U.S. Department of Agriculture
at http://www.choosemyplate.gov/ ).
B. A nutritionist should be consulted for individualized dietary recommendations
(see Box 11.3 for nutrition throughout growth and development).
C. The goal is to adapt a healthful eating pattern at an appropriate calorie level with a
variety of nutrient-dense foods and beverages among all the food groups.
D. MyPlate is based on 2020-2025 Dietary Guidelines for Americans.
E. Client Teaching
1. Find a healthy eating style and regularly eat a variety of foods to ensure
consumption of necessary nutrients and calories.
2. Fill half of the plate with fruits and vegetables.
3. Vary the types of vegetables and fruits eaten.
4. Select at least half of the grains as whole grains.
5. Drink milk that is fat-free or low fat (1%).
6. Vary protein consumption to include nonmeat sources.
 7. Drink and eat beverages and food with less sodium, saturated fat, and added
sugars.

8. Drink water instead of sugary drinks. Always consider the client's

cultural, spiritual, and personal choices when planning nutritional intake.
IV. Therapeutic Diets
A. Clear liquid diet
1. Indications
a. Provides fluids and some electrolytes to prevent dehydration
b. Used as an initial feeding after complete bowel rest
c. Used initially to feed a malnourished person or a person who has not had any
oral intake for some time
d. Used for bowel preparation for surgery or diagnostic tests, as well as
postoperatively
e. Used in gastroenteritis
2. Nursing considerations
a. Clear liquid diet is deficient in energy (calories) and many nutrients.
b. Clear liquid diet is easily digested and absorbed.
c. Minimal residue is left in the gastrointestinal tract.
d. Clients may find a clear liquid diet unappetizing and boring.
e. As a transition diet, clear liquids are intended for short-term use.

f. Clear liquids are relatively transparent to light; items considered “clear

liquids” include water, bouillon, fat-free clear broth, clear fruit juices,
carbonated beverages, gelatin, lemonade, ice pops, and regular or decaffeinated
coffee or tea. Hard candy without filling is also acceptable.
g. By limiting caffeine intake, an upset stomach and sleeplessness may be
prevented.
h. The client may consume salt and sugar.
i. Dairy products and nontransparent fruit juices are not clear liquids.
j. Instruct the client doing bowel preparation to avoid liquids that contain red or

purple dye, which can mask the normal color of the lining of the colon.
Monitor the client's hydration status by assessing intake and output, assessing
weight, monitoring for edema, and monitoring for signs of dehydration. Each
 kilogram (2.2 lb) of weight gained or lost is equal to 1 liter of fluid retained or
lost.
B. Full liquid diet
1. Indication: May be used as a transition diet after clear liquids following surgery or
for clients who have difficulty chewing, swallowing, or tolerating solid foods.
2. Nursing considerations
a. A full liquid diet is nutritionally deficient in energy (calories) and many
nutrients.
b. The diet includes clear and opaque liquid foods.

c. Foods include all clear liquids and items such as plain ice cream,
sherbet, breakfast drinks, milk, pudding and custard, plain yogurt, soups that
are strained, refined cooked cereals, fruit juices, and strained vegetable juices.
d. Use of a complete nutritional liquid supplement is often necessary to meet

nutrient needs for clients on a full liquid diet for more than 3 days.
Provide nutritional supplements such as those high in protein, as prescribed, for
the client on a liquid diet.
C. Mechanical soft diet
1. Indications
a. Provides foods that have been mechanically altered in texture to require
minimal chewing
b. Used for clients who have difficulty chewing but can tolerate more variety in
texture than a liquid diet offers
c. Used for clients who have dental problems, surgery of the head or neck, or
dysphagia (requires swallowing evaluation and may require thickened liquids if
the client has swallowing difficulties)
2. Nursing considerations
a. Degree of texture modification depends on individual need, including
pureed, mashed, ground, or finely chopped.
b. Foods include those that are part of a clear and full liquid diet, with the
addition of all cream soups, ground or diced meats, flaked fish, cottage cheese,
rice, potatoes, pancakes, light breads, cooked vegetables, canned or cooked
fruits, bananas, peanut butter, and nonfried eggs.

c. Foods to be avoided in mechanically altered diets include nuts; dried

fruits; raw fruits and vegetables; fried foods; tough, smoked, or salted meats;
and foods with coarse textures.
D. Soft diet
1. Indications
a. Used for clients who have difficulty chewing or swallowing
b. Used for clients who have ulcerations of the mouth or gums, oral surgery,
broken jaw, plastic surgery of the head or neck, or dysphagia, or for the client
who has had a stroke
2. Nursing considerations
a. Foods include easily digestible foods such as pastas, casseroles, tender
meats, canned fruit, cooked vegetables, cakes, and cookies without nuts or
coconut.
b. Clients with mouth sores should be served foods at cooler temperatures.
c. Clients who have difficulty chewing and swallowing because of dry mouth
can increase salivary flow by sucking on sour candy.
d. Encourage the client to eat a variety of foods.
e. Provide plenty of fluids with meals to ease chewing and swallowing of
foods.
f. Drinking fluids through a straw may be easier than drinking from a cup or
glass; a straw may not be allowed for clients with dysphagia (because of the
risk of aspiration).
g. All foods and seasonings are permitted; however, liquid, chopped, or pureed
foods or regular foods with a soft consistency are tolerated best.

h. Foods that contain nuts or seeds, which easily can become trapped in
the mouth and cause discomfort, should be avoided.
i. Raw fruits and vegetables, fried foods, and whole grains should be

avoided. Consider the client's disease or illness and how it may affect
nutritional status.
E. Low-fiber (low-residue) diet
1. Indications
a. Supplies foods that are least likely to form an obstruction when the intestinal
tract is narrowed by inflammation or scarring or when gastrointestinal motility
is slowed
b. Used for inflammatory bowel disease, partial obstructions of the intestinal
tract, gastroenteritis, diarrhea, or other gastrointestinal disorders
2. Nursing considerations
a. Foods that are low in fiber include white bread, refined cooked cereals,
cooked potatoes without skins, white rice, and refined pasta.
b. Foods to limit or avoid are raw fruits (except bananas), vegetables, nuts and
seeds, plant fiber, and whole grains.
c. Dairy products should be limited to two servings a day.
F. High-fiber (high-residue) diet
1. Indication: Used for constipation, irritable bowel syndrome when the
primary symptom is alternating constipation and diarrhea, and asymptomatic
diverticular disease
2. Nursing considerations
a. High-fiber diet provides 20 to 35 g of dietary fiber daily.
b. Volume and weight are added to the stool, speeding the movement of
undigested materials through the intestine.

c. High-fiber foods are fruits and vegetables and whole-grain

products.
d. Increase fiber gradually and provide adequate fluids to reduce
possible undesirable side effects such as abdominal cramps, bloating,
diarrhea, and dehydration.
e. Gas-forming foods should be limited (Box 11.4 ).
G. Cardiac diet (Box 11.5 )
1. Indications
a. Indicated for atherosclerosis, diabetes mellitus, hyperlipidemia,
hypertension, myocardial infarction, nephrotic syndrome, and renal
failure
b. Reduces the risk of heart disease
c. Dietary Approaches to Stop Hypertension (DASH) diet:
recommended to prevent and control hypertension,
hypercholesterolemia, and obesity
d. The DASH diet includes fruits, vegetables, whole grains, low-fat
dairy foods, meat, fish, poultry, nuts, and beans; it is limited in sugar-
sweetened foods and beverages, red meat, sodium, and fats.
e. Plant-based diets are associated with lower risk of coronary vascular
disease (CVD).
 f. For information on plant-based diets
see https://www.ahajournals.org/doi/10.1161/JAHA.119.012865 and htt
ps://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-
basics/how-does-plant-forward-eating-benefit-your-health

2. Nursing considerations
a. Restrict total amounts of sodium, cholesterol, and fat, including
saturated, trans, polyunsaturated, and monounsaturated.
b. Teach the client about the DASH diet or other prescribed diet, such
as plant-based.
H. Fat-restricted diet
1. Indications
a. Used to reduce symptoms of abdominal pain, steatorrhea, flatulence,
and diarrhea associated with high intakes of dietary fat and to decrease
nutrient losses caused by ingestion of dietary fat in individuals with
malabsorption disorders
b. Used for clients with malabsorption disorders, pancreatitis,
gallbladder disease, and gastroesophageal reflux

2. Nursing considerations
a. Restrict total amount of fat, including saturated, trans,
polyunsaturated, and monounsaturated.
b. Clients with malabsorption may also have difficulty tolerating fiber
and lactose.
c. Vitamin and mineral deficiencies may occur in clients with diarrhea
or steatorrhea.
d. A fecal fat test may be prescribed and indicates fat malabsorption
with excretion of more than 6 to 8 g of fat (or more than 10% of fat
consumed) per day during the 3 days of specimen collection.
I. High-calorie, high-protein diet
1. Indication: Used for severe stress, burns, wound healing, cancer, human
immunodeficiency virus, acquired immunodeficiency syndrome, chronic obstructive
pulmonary disease, respiratory failure, or any other type of debilitating disease

2. Nursing considerations
a. Encourage nutrient-dense, high-calorie, high-protein foods such as whole
milk and milk products, peanut butter, nuts and seeds, beef, chicken, fish, pork,
and eggs.
 b. Encourage snacks between meals, such as milkshakes, instant breakfasts, and

nutritional supplements. Calorie counts assist in determining the client's

total nutritional intake and can identify a deficit or excess intake.
J. Carbohydrate-consistent diet
1. Indication: Used for clients with diabetes mellitus, hypoglycemia, hyperglycemia,
and obesity

2. Nursing considerations
a. A carbohydrate-consistent diet focuses on maintaining a consistent amount of
carbohydrate, fat, and protein intake each day and with each meal; it is also
known as “carb counting.”
b. For additional information, refer to: https://www.diabetes.org/healthy-
living/recipes-nutrition
3. The Diabetes Plate Method may also be recommended.
a. No single eating pattern has emerged as being clearly superior to all others
for all diabetes-related outcomes; evidence suggests certain eating patterns are
better for specific outcomes.
b. Until evidence strengthens, primary health care providers should focus on
the key factors that are common among the patterns: emphasize nonstarchy
vegetables, minimize added sugars and refined grains, and choose whole foods
over highly processed foods to the extent possible.

4. Diabetes Plate Method

a. Fill half the plate with nonstarchy vegetables.
b. Fill a quarter of the plate with lean protein foods.
c. Fill a quarter of the plate with complex carbohydrate foods.
d. Drink water or a low-calorie drink.
e. See the American Diabetes Association Web site article titled What is the
diabetes plate method? at https://www.diabetesfoodhub.org/articles/what-is-
the-diabetes-plate-method.html
K. Sodium-restricted diet (see Box 11.5)
1. Indication: Used for hypertension, heart failure, renal disease, cardiac disease, and
liver disease

2. Nursing considerations
 a. The American Heart Association recommends to eat no more than 2,300
mg/day, moving toward an ideal limit of 1,500
mg/day: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/
sodium/how-much-sodium-should-i-eat-per-day
b. Encourage intake of fresh foods rather than processed foods, which contain
higher amounts of sodium.
c. Canned, frozen, instant, smoked, pickled, and boxed foods usually contain
higher amounts of sodium. Lunch meats, soy sauce, salad dressings, fast foods,
soups, and snacks such as potato chips and pretzels also contain large amounts
of sodium; teach clients to read nutritional facts on product packaging
regarding sodium content per serving.
d. Effervescent medications contain significant amounts of sodium; these
include medications that contain the active ingredient sodium bicarbonate or
sodium citrate.
e. Salt substitutes may be used to improve palatability; most salt substitutes
contain large amounts of potassium and should not be used by clients with
renal disease.
L. Protein-restricted diet
1. Indication: Used for renal disease and end-stage liver disease
2. Critically ill clients with protein-losing renal diseases, malabsorption syndromes, and
continuous renal replacement therapy or dialysis should have their protein needs
assessed by estimating the protein equivalent of nitrogen appearance (PNA); a
nutritionist should be consulted.

3. Nursing considerations
a. Provide enough protein to maintain nutritional status but not an amount that
will allow the buildup of waste products from protein metabolism (40 to 60 g of
protein daily).
b. The higher the restriction of protein, the more important it becomes that all
protein in the diet be of high biological value (contain all essential amino acids
in recommended proportions).
c. An adequate total energy intake from foods is critical for clients on protein-
restricted diets (protein will be used for energy rather than for protein
synthesis).
d. Special low-protein products, such as pastas, bread, cookies, wafers, and
gelatin made with wheat starch, can improve energy intake and add variety to
the diet.
e. Carbohydrates in powdered or liquid forms can provide additional energy.
 f. Vegetables and fruits contain some protein and, for very-low-protein diets,
these foods must be calculated into the diet.
g. Foods are limited from the milk, meat, bread, and starch groups.
M. Gluten-free diet: A treatment for celiac disease and gluten sensitivity for clients needing the
protein fraction “gluten” eliminated from their diets. See Chapter 34 for information on this

diet. Fluid restrictions may be prescribed for clients with hyponatremia, severe
extracellular volume excess, and renal disorders. Ask the client about preferences regarding
types of oral fluids and temperature preference of fluids.
N. Renal diet (see Box 11.2)
1. Indication: Used for clients with acute kidney injury or chronic kidney disease and
for those requiring hemodialysis or peritoneal dialysis

2. Nursing considerations
a. Controlled amounts of protein, sodium, phosphorus, calcium,
potassium, and fluids may be prescribed; may also need modification in fiber,
cholesterol, and fat based on individual requirements; clients on peritoneal
dialysis usually have diets prescribed that are less restrictive with fluid and
protein intake than those on hemodialysis.
b. Most clients receiving dialysis need to restrict fluids (see Clinical Judgment:
Generate Solutions Box).

Clinical Judgment: Generate Solutions

A client with acute kidney injury exhibiting signs of fluid volume excess
has laboratory tests done that reveal decreased renal function and
glomerular filtration rate. The nephrologist prescribes a fluid restriction.
The nurse determines that a client need will be to alleviate thirst and
generates solutions to meet this client need. The nurse includes the
following measures in the plan of care to help relieve the client's thirst
while adhering to the fluid restriction.

Chewing on gum
Sucking hard candy
Freezing fluids so that they take longer to consume
Adding lemon juice to water to make it more refreshing
Gargling with refrigerated mouthwash
An initial assessment includes identifying allergies and food and
medication interactions.
 c. Monitor weight daily as a priority, because weight is an important
indicator of fluid status.
O. Potassium-modified diet (see Box 11.2)
1. Indications
a. Low-potassium diet is indicated for hyperkalemia, which may be
caused by impaired renal function, hypoaldosteronism, Addison's
disease, angiotensin-converting enzyme inhibitor medications,
immunosuppressive medications, potassium-sparing diuretics, and
chronic hyperkalemia.
b. High-potassium diet is indicated for hypokalemia, which may be
caused by renal tubular acidosis, gastrointestinal losses (diarrhea,
vomiting), intracellular shifts, potassium-depleting diuretics,
antibiotics, mineralocorticoid or glucocorticoid excess resulting from
primary or secondary aldosteronism, Cushing's syndrome, or
exogenous corticosteroid use.

2. Nursing considerations
a. Foods that are low in potassium include applesauce, green beans,
cabbage, lettuce, peppers, grapes, blueberries, cooked summer squash,
cooked turnip greens, pineapple, and raspberries.
b. Box 11.2 lists foods that are high in potassium.
P. High-calcium diet
1. Indication: Calcium is needed during bone growth and in adulthood to
prevent osteoporosis and to facilitate vascular contraction, vasodilation, muscle
contraction, and nerve transmission.

2. Nursing considerations
a. Primary dietary sources of calcium are dairy products (see Box
11.2 for food items high in calcium).
b. Lactose-intolerant clients should incorporate nondairy sources of
calcium into their diets regularly.
Q. Low-purine diet
1. Indication: Used for gout, kidney stones, and elevated uric acid levels

2. Nursing considerations
a. Purine is a precursor for uric acid, which forms stones and crystals.
 b. Foods to restrict include anchovies, herring, mackerel, sardines,
scallops, organ meats, gravies, meat extracts, wild game, goose, and
sweetbreads.
R. High-iron diet
1. Indication: Used for clients with anemia

2. Nursing considerations
a. The high-iron diet replaces iron deficit from inadequate intake or
loss.
b. The diet includes organ meats, meat, egg yolks, whole-wheat
products, dark green leafy vegetables, dried fruit, and legumes.
c. Inform the client that concurrent intake of vitamin C with iron foods
enhances absorption of iron.
V. Vegan and Vegetarian Diets
A. Vegan
1. Vegans follow a strict vegetarian diet and consume no animal meats or foods
that contain animal byproducts, such as chicken broth or beef broth.
2. Eat only foods of plant origin (e.g., whole or enriched grains, legumes, nuts,
seeds, fruits, vegetables). However, there are many processed vegan foods that
do not have nutritional value; it is best to eat whole foods.
3. The use of soybeans, soy milk, soybean curd (tofu), and processed soy
protein products enhance the nutritional value of the diet.
B. Lacto-vegetarian
1. Lacto-vegetarians drink milk and eat cheese and dairy foods but avoid meat,
fish, poultry, and eggs.
2. A diet of whole or enriched grains, legumes, nuts, seeds, fruits, and
vegetables in sufficient quantities to meet energy needs provides a balanced
diet.
C. Lacto-ovo-vegetarian
1. Lacto-ovo-vegetarians follow a food pattern that allows for the consumption
of dairy products and eggs.
2. Consumption of adequate plant and animal food sources that excludes meat,
poultry, pork, and fish poses no nutritional risks.
D. Ovo-vegetarians: The only animal foods that the ovo-vegetarian consumes are eggs,
which are an excellent source of complete proteins.
 E. Nursing considerations
1. Vegan and vegetarian diets are not usually prescribed but are a diet choice
made by a client.
2. Ensure that the client eats a sufficient amount of varied foods to meet
nutrient and energy needs.
3. Clients should be educated about consuming complementary proteins over
the course of each day to ensure that all essential amino acids are provided.
4. Potential deficiencies in vegetarian diets include energy, protein, vitamin B12,
zinc, iron, calcium, omega-3 fatty acids, and vitamin D (if limited exposure to
sunlight).
5. To enhance absorption of iron, vegetarians should consume a good source of
iron and vitamin C with each meal.
6. Foods eaten may include tofu, tempeh, soy milk and soy products, meat
analogs, legumes, nuts and seeds, sprouts, and a variety of fruits and
vegetables.

7. Soy protein is considered equivalent in quality to animal protein. Body

mass index (BMI) can be calculated by dividing the client's weight in kilograms
by height in meters squared. For example, a client who weighs 75 kg (165
pounds) and is 1.8 m (5 feet, 9 inches) tall has a BMI of 23.15 (75 divided by
1.82 = 23.15). From: Potter, P., Perry, A. G., Stockert, P. A., and Hall, A. M.
(2021). Fundamentals of nursing. (10th ed.). St. Louis: Mosby. p. 1112.
VI. Enteral Nutrition
A. Description: Provides liquefied foods into the gastrointestinal tract via a tube
B. Indications
1. Used when the gastrointestinal tract is functional but oral intake is not
meeting estimated nutrient needs
2. Used for clients with swallowing problems, burns, major trauma, liver or
other organ failure, or severe malnutrition

C. Nursing considerations
1. Clients with lactose intolerance need to be placed on lactose-free formulas.
2. See Chapter 70 for information regarding the administration of
gastrointestinal tube feedings and associated complications.
Box 11.1 Food Sources of Vitamins

Water-Soluble Vitamins

Folic acid: Green leafy vegetables, liver, beef, fish, legumes, grapefruit, oranges
Niacin: Meats, poultry, fish, beans, peanuts, grains
Vitamin B1 (thiamine): Pork, nuts, whole-grain cereals, legumes
Vitamin B2 (riboflavin): Milk, lean meats, fish, grains
Vitamin B6 (pyridoxine): Yeast, corn, meat, poultry, fish
Vitamin B12 (cobalamin): Meat, liver
Vitamin C (ascorbic acid): Citrus fruits, tomatoes, broccoli, cabbage

Fat-Soluble Vitamins

Vitamin A: Dairy products, fish, liver, green or orange vegetables, fruits

Vitamin D: Fortified milk, fish oils, most cereals
Vitamin E: Vegetable oils and products made with vegetable oil (margarine and salad dressing),
fruits, vegetables, grains, nuts (almonds and hazelnuts), seeds (e.g., sunflower seeds), and
fortified cereals
Vitamin K: Green leafy and cruciferous vegetables, such as turnip greens, spinach, cauliflower,
cabbage, and broccoli; and certain vegetable oils, including soybean oil, cottonseed oil, canola
oil, and olive oil

Box 11.2 Food Sources of Minerals

Calcium

Dairy products (milk, cheese, yogurt)

Tofu
Green leafy vegetables (broccoli, collards, kale, mustard greens, turnip greens, bok choy)
Salmon and sardines
Almonds, Brazil nuts, sunflower seeds, tahini, and dried beans
Blackstrap molasses
Chloride

Salt

Iron

Dried beans
Dried fruits
Egg yolks
Iron-fortified cereals
Liver
Meat (especially lean red meat, poultry)
Oysters
Salmon
Tuna
Whole grains

Magnesium

Dark green leafy vegetables

Fruits (such as bananas, dried apricots, and avocados)
Nuts (such as almonds and cashews)
Peas and beans (legumes), seeds
Soy products (such as soy flour and tofu)
Whole grains (such as brown rice and millet)
Milk

Phosphorus

Seeds (sunflower, pumpkin, and squash seeds))

Whey
Cheese
Cornmeal
Beans
Nuts, salt-free (almonds, peanuts)
Potassium

All meats (red meat and chicken) and fish (salmon, cod, flounder, and sardines)
Soy products and veggie burgers
Vegetables (broccoli, peas, lima beans, tomatoes, potatoes [particularly their skins], sweet
potatoes, and winter squash)
Fruits (citrus, cantaloupe, bananas, kiwi, prunes, and dried apricot)
Milk and yogurt
Nuts

Sodium

Sodium chloride (table salt)

Milk
Beets
Celery
Some drinking waters
Food products (Worcestershire sauce, soy sauce, onion salt, garlic salt, and bouillon cubes)
Processed meats (bacon, sausage, and ham)
Canned soups and vegetables
Processed baked goods
Fast foods

Zinc

Animal proteins (beef, pork, and lamb)

Nuts
Whole grains
Legumes
Yeast
References: MedlinePlus, Vitamins, updated July 2021
at https://medlineplus.gov/ency/article/002399.htm

Box 11.3 Nutrition Throughout Growth and Development

Infant

The American Academy of Pediatrics recommends breast/chest-feeding for the first 6 months of
life and breast/chest-feeding with additional foods from age 6 to 12 months. The average 1-
month-old infant consumes approximately 18 to 21 ounces of milk or formula per day.
Introduce new foods one at a time, 4 to 7 days apart, to identify allergies.
Infants should not have cow's milk before the age of 1 year.
Children under 1 year of age should not ingest honey or corn syrup products due to the risk of
botulism toxin.

Toddlers and Preschoolers

Milk is a poor source of iron, and children who consume more than 24 ounces of milk per day
are at risk for developing milk anemia. Whole milk should be consumed until 2 years of age to
ensure adequate fatty acid intake.
Avoid foods that pose choking hazards, such as hot dogs, candy, nuts, grapes, popcorn, and raw
vegetables.
Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for
independence and control.
Nutritional requirements for the preschooler are similar to those of the toddler. The average
daily intake is 1800 calories. Finicky eating habits are characteristic of the 4-year-old; engaging
preschoolers in meal preparation will promote the likelihood of their trying new foods.

School-Age

Children in this age-group have better appetites with a more varied intake. Assess for adequate
intake of protein and vitamins A and C.
This age-group is at risk for high intake of fats, sugar, and salt related to snack foods.
Childhood obesity is a concern, which can lead to serious health problems such as diabetes and
cardiovascular disease; a potential for psychological problems is also a concern. Promote
healthy lifestyle habits, including nutrition programs.
Encourage physical activity.

Adolescent

Energy needs increase to meet the increased metabolic needs of growth.

This age-group has increased requirements of daily protein, calcium for bone growth, and iron
to replace menstrual losses and to promote muscle development.
Increased intake of iodine and B-complex vitamins is necessary to support thyroid development
and metabolism.
 Fast-food consumption is common and puts the adolescent at risk for malnutrition and obesity.
The onset of eating disorders commonly occurs during adolescence.

Young and Middle Adults

Energy needs decrease as the growth period ends. Lack of physical activity and access to
certain foods increases the risk of obesity and insulin resistance and other health problems such
as cardiovascular disease.
Women who use oral contraceptives often need extra vitamins.
Iron and calcium intake are important components of the diet.

Pregnancy

During pregnancy, protein requirements increase to 60 g per day.

Calcium needs increase to promote fetal bone mineralization.
Iron supplements support increased blood volume.
Folic acid intake is required for DNA synthesis and red blood cell production.

Breast/chest-feeding

Encourage intake of protein, calcium, and vitamins A, B, and C. Promote adequate fluid intake.
Consume an additional 500 kilocalories per day to support adequate production of breast milk.
Avoid alcohol, caffeine, and certain drugs, as these are absorbed into milk.

Older Adults

Energy needs are decreased due to slowed metabolic rate.

Age-related changes that affect nutrition include changes in teeth and saliva production,
reduced taste and smell, decreased thirst sensation, and decreased gag reflex.
Maintaining good oral health is important.
If the individual is taking prescription medications, discourage the consumption of grapefruit
and grapefruit juice because they alter absorption of many medications.
Ensure adequate calcium and vitamin D intake to prevent osteoporosis, especially in
postmenopausal women.
Box 11.4 Gas-Forming Foods

Apples
Artichokes
Barley
Beans
Bran
Broccoli
Brussels sprouts
Cabbage
Celery
Figs
Melons
Milk
Molasses
Nuts
Onions
Radishes
Soybeans
Wheat
Yeast

Box 11.5 Sodium-Free Spices and Flavorings

Allspice
Almond extract
Bay leaves
Caraway seeds
Cinnamon
Curry powder
Garlic powder or garlic
Ginger
Lemon extract
Maple extract
Marjoram
Mustard powder
Nutmeg