INTRODUCTION AND

IMPORTANCE OF NUTRITION
What come into your
mind when you
encounter the word
nutrition?
Nutrition is the science that
interprets the interaction of nutrients
and other substances in food in
relation to maintenance, growth,
reproduction, health and disease of
an organism.
Dietetics is the interpretation
and communication of the
science of nutrition where
individual can make practical
choices about food and life
style in terms of both health and
diseases.
Nutritionist &Dietitian
• A nutritionist is a qualified nutrition
professional that has the expertise to
provide a range of evidence based nutrition
services related to nutrition,
public health nutrition, policy and research,
and community health.
• A nutritionist is a person who advises on
matters of food and nutrition that
impacts on health.
•
Dietitian are the healthcare professionals
and experts who treats nutritional
problems and overview the patients by
providing dietary needs, plans
menus, and instructs patients and their families
about proper nutritional care.
Dietitians have the expertise to provide
individual dietary counselling,
medical nutrition therapy (MNT), group
dietary therapy and food service
management.
Education is the key factor in enabling
nurses to instigate nutritional care
appropriately. Nursing students need
be educated in the screening and
assessment, planning, implementation
and evaluation of nutritional care. A
firm grounding in the principles of
nutritional science is essential to
understand the rationale behind the
components of nutritional care.
Nutrition Education
Allows patients to learn about the
dietary factors that affect their particular
medical condition. Ideally, this knowledge
motivates them to change their diet and
lifestyle to improve their health status.
A nutrition education program should be
tailored to a person’s age. Level of literacy,
and cultural background. Learning style
should also be considered: some people learn
best by discussion supplemented with written
materials,
whereas others prefer visual examples such as
food models and measuring devices
Information can be provided in one on
one sessions or group discussions. The
meeting should also assess the person’s
understanding of the material and
commitment to making changes. Follow up
sessions can reveal whether the person has
successfully adopted a dietary plan. For
example, a dietician who counsels a woman
who is lactose intolerant and hesitant to use
milk products can proceed as follows:
• The dietician can provide sample menus of
a nutritionally adequate diet that limits milk
and milk products. Together the dietitian
and the woman can design menus that
consider her food preferences.
• *Using diet analysis software, the dietitian
can demonstrate how altering food choices
changes the calcium content of a meal.
• The dietitian can explain how to use the
Daily value on food labels to estimate the
calcium content of a packaged food.
* The dietitian can provide information
about the advantages and disadvantages of
different calcium supplements.
What do you think are the
importance of nutrition in
your nursing course?

Why nutrition is a part of your

of your curriculum?
Why is nutrition important?
Nutrition is essential for growth and
development, health and wellbeing. Eating
a healthy diet contributes to preventing
future illness and improving quality and
length of life.
As a future nurse, studying nutrition
is important in order to give the best
nursing care to your clients .
Knowing the right diet or food
required/prescribed to a certain
patients.
And enables you as the primary care giver
to impart health teaching about the
patient’s food intake thus leads to a faster
recovery or maintenance of health.
CONCEPTS OF NUTRITIONAL
SCIENCE
NUTRITION
- is all about food and how the body
uses it esp as a fuel for growth and
daily activities.
- according to the council of the
American Medical Assoc., it is the
science of food, the nutrients and the
substances therein
- study of all the processes (digestion,
absorption, metabolism, etc.)how the
body absorb and utilize food
substances.
Accdg to WHO
Nutrition is an input to and
foundation for health and
development.
◦ Better nutrition means stronger
immune systems, less illness and
better health.
◦ Healthy children learn better.
Healthy people are more stronger,
are more productive.
Specifically, if the body needs are met in
childhood and adulthood, the person can
normally expect:
Good health, vitality and energy
To mature at the proper time
To overcome the stresses of the
environment
To fulfill this biological life
To enjoy extended time of life
To withstand the many hazards of aging.
 In order to prevent obesity and
diet-related diseases, man must
know how to utilize the existing
food supply so as to derive
maximum nutritional benefit
from it.
As Nutrition is the foundation of
good health, …education is the
cornerstone of good nutrition
because to attain good nutrition,
the individual must be taught to
make good food selection and to
maintain an env’t conducive to
the utiilization of the nutrients
provided by the food.
According to Babcock (in
1961), “To establish good
food habits, people must be
able to learn, and nutrition
educators must be able to
teach.”
GOOD NUTRITION
- is the basis for good health. It enhances
appearance as it is exemplified by shiny hair,
clear skin, clear eyes, erect posture, alert
expression and firm flesh on well-developed
bone structures.
FOOD
isnecessary to our survival. it
sustain life and promote growth.
itacts as a body fuel that gives
energy required for bodily
functions.
are products derived from plants/
animals.
TYPES OF FOOD
PLANTS
- grains &cereal

corn, oats and

wheat
-pulses
Fruits and vegetables

Tubers

cassava sweet potato

Nuts

Oilseed
– olive, sesame, coconut,
soybean oil, etc…
Seaweed

 agar carageenan
ANIMALS
Meat and entrails

 Milk, eggs and shellfish

Poultry and fish

WHAT IS THE COMPONENT OF
FOOD?
NUTRIENTS
- it is the product of digestion of foods
which are the nourishing material
vital for human functioning.
- They are used to build and repair
tissues, regulate body processes and
are converted to and used as energy.
Substances that provide energy- Cho,
Chon and Fats
Substances that support metabolism –
dietary minerals, vitamins and water
There are some substances that are
useful, some are neutral and some are
detrimental to health, and they are called
as Non nutrient.
◦ Such as: such as alcohol, pigments, additives
and phytochemicals.
Food additives – such as the
preservatives, flavours and colors.
◦ -it makes the food safe if you keep it for
an extended period.
E.g. of preservatives - Acids like lemon
juice and vinegar.
-help preserve freshness by increasing the
acidity of a food. An acidic food creates a
hostile environment for microorganisms.
-Sugar - helps preserve foods by absorbing
excess water. Without water,
microorganisms cannot grow inside a food.

- Salt - has long been used to prevent meat

and fish from spoiling. Like sugar, salt
inhibits the growth of microorganisms by
reducing the amount of water available to
them.
-Oil - helps foods stay fresh by preventing
microorganisms from coming into contact with the food.
Oil also reduces the rate of oxidation in a food, which
helps prevent it from spoiling quickly.
-Spices- some spices seem to retard the growth of
microorganisms while also reducing the rate of
oxidation
These spices include cloves, mustard, sage, thyme,
rosemary and oregano.
Phytochemicals – compounds
produced by plants. They are found in
edible fruits, veg and other plant-
derived foods that have biological
activity in the body and according to
research that it is use in the prevention
of chronic diseases such as CA and
CVD
- some researches estimate there are up
to 4000 pythochemicals but only a small
fraction have been studied closely
Common names – flavones, isoflavones,
allyl sulfides, phytonutrients,
polyphenols, cathechins, carotenoids,
anthocyanidins and isothiocyanates
e.g. lycopene – cancer (prostate)), heart
health = tomatoes, grapefruit,
watermelon, red peppers
allylic sulphites - in garlic
lignans - in wheat
betacarotene – for immune system, vision,
skin health and bone health= yellow,
orange and dark green foods
resveratrol- heart & lung health, cancer &
inflammation = red wine, grapes,
peanuts
anthocyanidins – blood vessel health
blackberries, red berries, red onion,
blueberries, plum, strawberries, red
radishes, red potato
 isoflavones – menopause, breast cancer,
bone health, joint

inflammation, lower
cholesterol
Alcohol – though it provides energy but
no nutrients.
It is detrimental to health when too much
consumption of it.
Classification of Nutrients as to:

Funtions
Cho- provide energy
Protein- for growth repair and
maintenance of the body.
Fats – provide energy
Minerals – it regulates body
processes
 Vitamins – vital helpers in many
body processes
Water – it is a food as well as nutrient. It
helps regulate the various processes such
as circulation, digestion and elimination
and respiration.

Chemical Properties:
Organic nutrients – it contains
hydrogen, oxygen and carbon( an element
found in all living things).
Organic – meaning “literally alive”
Before the body can use organic
nutrients, it must be broken down into
their smallest components.
Ex. CHO, CHON, fats and vitamins
CHON and vits. contain nitrogen.
Inorganic nutrients – they contain no
carbon.
They are already in their simplest
form when the body ingest them.
(dietary)Minerals are the simplest
nutrient. Each mineral is a chemical
element, its atom are alike. As a result,
its identity never changes.
E.g. Minerals – sodium, iron, calcium,
potassium, chloride, sulphate and
phosphate.
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.
Too much or too little of a mineral
may adversely affect a persons
health.
The next simplest nutrient is water,
a compound made of 2 elements –
hydrogen and oxygen
- Needed for metabolic reactions.
- Supplies the medium for
transporting materials to cells and
waste products away.
Essentiality
- refers to the important contribution
to the body’s physiological
functioning.

a. Essential nutrients – nutrients a

person must obtain from food bec the
body cannot make them for itself in
sufficient quantity to meet
physiological needs.
it is also called as “indispensable nutrients”.
And essential means more than just
“necessary”.
-these nutrients are required for life.
-it includes many amino acids, some fatty
acids, many vitamins and some minerals
and trace elements.
-ex. Amino acids = phenylalanine,
tryptophan, lysine, leucine, isoleucine,
valine, threonine, methionine.
-ex. Fatty acids – linoleic and linolenic
acids.
 b. Nonessential nutrients - are those
nutrients that can be made by the
body, they may often also be
absorbed from consumed food.
E.g. cholesterol
Concentration
- some nutrients are needed in large
amount than others.
CHO, CHON, fats and water are
collectively known as
 Macronutrients bec they are
needed by our body in relatively
large amounts bec they are essential
to provide energy and to regulate and
control the different functions of the
body.
In contrast to vits and minerals are
called as Micronutrients as the body
needs them in smaller amount or
quantity.
NUTRIENT DENSITY – refers to
the concentration of nutrients in a
given amount of food source relative
to its caloric content.
- consider calories from CHO, fats,
protein, vits and minerals and water.
The higher the nutrient density, the
greater the nutritional value in a small
amount of food.
CALORIE
- represents the energy measurement of
nutrients that foods provide.
- the energy released from CHO, fats
and proteins can be measured in
calories.
Energy is expressed in 1000 – calorie
metric units known as kilocalories
(shortended to kcalories/kcal, but
commonly called “calories”
Kilojoules (kj)- It is the international unit of
work energy.
1 kcal is equal to 4.2 kj.
When cho, fats and proteins completely broken
down in the body:(by the process of
metabolism):
The fuel factor of CHO- is 4 kcalories/gram.
Protein – also yields 4 kcal/gram
Fat -yields 9 kcal/gram.
Alcohol – yields 7 kcal/gram
Fat therefore, has a greater energy density
than either CHO or CHON.
Energy Density – is a measure of the
energy a food provide relative to the
amount of food. (kcalories per gram).
-Foods high in energy density help w/
wt.gain, whereas those w/ a low energy
density help w/ wt. Loss.
Alcohol is not considered a nutrient bec it
can interferes w/ growth, maintenance and
repair of the body but it does yield 7 kcal
per gram when metabolized in the body.
BOMB CALORIMETER
Bomb calorimeter can be used to
determine the calorie content of a
product.
It is used in food and metabolic
studies to examine the effects of
energy content in food on humans
and animals.
Energy in the body
- the body uses the energy-yielding
nutrients to fuel all its activities.

- sends electrical impulses thru the

brain and nerves.

- to synthesize body compounds and

to move muscles.
If the body does not use these nutrients to
fuel its current activities, it rearranges them
into storage compounds (such as body fat),
to be used between meals and overnight
when fresh energy supplies run low
If more energy is consumed than
expended, the result is an increase in
energy stores and weight gain.
If less energy is consumed than expended,
the result is a decrease in energy stores and
weight loss
If alcohol can be consumed in
excess can be converted to body
fat and stored.

To calculate the energy available

from food, multiply the number
of grams of CHO, CHON and fat
by 4, 4 and 9, respectively. Then
add the results together.
SEATWORK: Calculate the energy
available from foods.

1 slice of bread w/ 1 tbsp of

peanut butter
- which contains 16 grms CHO, 7
grms CHON and 9 gms fat.
From this you can calculate the
percentage of kcal each of the
energy nutrients contributes to
total. To determine the kcal from
fat, for example, divide the (kcal
from fat) by the total kcal (total
calorie of the snack)
ANS.
16gms CHO x 4 = 64kcal= 37%
7gms CHON x 4 = 28= 16%
9gms FAT x 9 = 81=47%
Total = 173 kcal
PERCENTAGE
- divide the 81kcal by the total 173 kcal:
81 fat kcal / 173 total kcal = 0.468
(rounded to 0.47) Then multiply by 100
to get the percentage: 0.47 x 100 = 47%
Dietary recommendations that urge
people to limit fat intake to 20-35 % of
kcal refer to the day’s total energy intake,
not to individual foods.
Still, if the proportion of fat in each food
choice throughout a day exceeds 35% of
kcal, then the day’s total surely ,will, too.
Knowing that this snack provides 47% of
its kcal from fat alerts a person to the
need to make lower-fat selections at other
times that day.
HOUSEHOLD MEASURES
-Cups, quarts and teaspoons
METRIC MEASURES
-Millilitres, liters, and grams
VOLUME
-1L = 1000 ml
-0.9L = 1 quart
-1ml =0.03 fld. Oz
-240 ml = 1 cup
WEIGHT : GRAMS (g)
1 g = 1000 mg
1 g = 0.04 oz
1 oz. = 28.35 g or 30 g
100 g = 3 ½ oz.
1 kg = 2.2 lbs
454 g = 1 lb
 NUTRITIONAL STATUS
- a measurement of the extent to
w/c an individual’s physiologic
need for nutrients is being met.
NUTRITIONAL ASSESSMENT
Provides the information needed for
identifying nutrition problems and
designing a nutritional care plan.
It identify clients at risk for
malnutrition/ those w/ poor nutritional
status
This information can be obtained from
the Medical, Social and Diet histories,
Anthropemetric data, Biochemical data
and Clinical data.
This is a part of routine exam done
by a RD/other health care
professionals trained in the diagnosis
of at risk individuals – doctors/
nurses.
DIETARY - SOCIAL HISTORY
dietary evaluation would provide
information w/ regards on client’s
food habit, usual food pattern, likes
and dislikes and type of meals eaten
for a long period of time, because
these information would help the
examiner to determine any nutritional
deficiencies or excesses.
 
MOST COMMON METHOD
USED
Diet History – a comprehensive record of
eating-related behaviours and foods a person
eat
Contents of Diet History of Adults:
Check appetite – good, poor, any factors that
affect appetite, taste and smell perception
Ask for allergies, intolerances or food
avoidances – foods avoided and reasons,
length of time of avoidances
Anthropometry – ht, wt, skin-fold, etc.
Take 24 hour dietary recall or food
frequency checklist
Consider ethnic and cultural
background – eating habits and food
preferences and religion
= 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.
 =American diet or even Filipino diet
includes many ethnic foods from diff
countries, all adding variety to the
diet. Ex. Chinese, Italian, Korean,
Japanese.
consider religion = for examples,
some religious sect forgo meat during
lent, the period prior to easter.
 Muslims fast between sunrise and
sunset during Ramadan.
Food preference = spicy foods,
sweetness of sugar and the savoriness
of salt. High fat foods. curry spices of
Indian cuisine.
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
Evaluate dental and oral health-
problems w/ eating, foods that
cannot be eaten, problems w/
swallowing, salivation
Economic status –income, amount of
money for food each week or
month.= people eat foods that are
accessible, quick and easy to prepare
and w/ in their financial means.
Evaluate physical activity level –
occupation(type, hours/week,shift,
energy expenditure), Exercise(type
amount, frequency), Sleep (
hours/day ,uninterrupted?),handicaps.
Determine home life and meal
patterns – Number in household (eat
together?), person who buy food,
person who does cooking, food storage
and cooking facilities (stove,
refrigerator), type of housing
(home, apartment, room)
Assess gastrointestinal conditions –
problems of heartburn, bloating, diarrhea,
vomiting,constipation, frequency of
problems, antacid, laxative or other drugs.
Consider presence of chronic disease –
treatment, length of tx, dietary modification
including physician prescription, date of
modification, education, compliance w/ diet.
Evaluate recent weight change – loss or
gain, how much, over what length of time,
intentional or non-volitional
Food Frequency – a record of how often
the diff foods are eaten. The types (and
sometimes the amount, its preparation) of
foods a person routinely consumed in a
week or a month can be taken.
24-hour recall – done by dietician.
Listing the types, amounts and
preparation of all foods eaten in past 24
hours
Food Diary – written record of all food
and drink ingested in a specified period-
for about 3-4 day period.
- but some clients are not truthful and tend
to forget the food they had eaten.
- may include records of behaviours /
emotions and symptoms, physical
activities and medications
- Medications may decrease the desire of
food, absorption of nutrients, metabolism
of nutrients .
e.g antihistamines-dec saliva causing dry
mouth and loss of appetite.
e.g aspirin (controls pain and fever and for
blood thinning) – a gram of which
increases the taste perception of
bitterness.

 
ASSIGNMENT
Make a Diet History of an In-patient/
an Individual with chronic diseases
Include the maintenance medications
Encoded.
Evaluate the History
And make a nutritional plan out of
your evaluation or simply writing
what particular nutrient the client is
needing basing on his/her evaluation.
SEATWORK
LIST 10 SIGNS OF GOOD NUTRITION
AND 10 SIGNS OF POOR NUTRITION
WITH IMAGES OR PICTURES .
SEATWORK
Do your 24- hour food recall.
Explain per meal if it is a balance
diet and if it is a nutrient dense
food and why?
ANTHROPOMETRIC MEASUREMENT
= the science of measuring the size, weight
and proportions of the human body.
= may reveal a failure to thrive in children
= it reflects a nutrient deficiencies or
excesses.
= includes the height, weight, head
circumference, upper arm, skin fold and
chest circumference (for children).
HEIGHT AND WEIGHT – useful in
determining nutritional status in adults
- It is a good indicator of satisfactory diet
and recent food intake.

HEIGHT – is a less sensitive indicator of

current nutritional status than weight – for
– age since height does not decrease but
simply slows down in times of nutrient
deprivation.
 
WEIGHT – is a sensitive marker of
current nutritional status.
- Reflects an immediate inability
to meet nutritional requirements and
this may indicate nutritional risk.
DESIRABLE BODY WEIGHT
– is also known as Ideal or reference
weight but it is more appropriately
called the healthy weight.

- It is the weight found statistically to

be most compatible w/ health
longevity.
TANNHAUSER’S METHOD
Procedure :
Step 1 : DBW (K) = HEIGHT (CM) – 100
Step 2 : Deduct 10% - if a Filipino unless
frame size is known (either med or large)
Example: Subject: 5’2”female (5’2”-
157.48cm)
 Step 1 : DBW (K)=157.48cm – 100
= 57.48 kilos
 Step 2: 57.48 kilos less 5.748(10%)
= 51.7 or 52kg
CONVERSION AID:
1 foot – 12 inches
1 inch – 2.54 cm
1 m – 100cm
ACTUAL BODY WEIGHT
May be influenced by changes in the
person’s fluid status.
weight measurement obtained at the
time of examination
OTHER PARAMETERS OF
ASSESSING NUTRITIONAL
STATUS
 BMI or BODY MASS INDEX
Or the Quetelet index is a good estimate of the
degree of obesity or amount of total body fat.
It also helps to determine how much risk
people have of developing certain health
problems because of their weight (e.g.
diabetes, heart problems)
It can indicate over or under nutrition
BMI is computed thru METRIC
FORMULA
FORMULA : BMI = W (in kilos)
H (in meters)²
Constant: 5 ft = 1.524m
4 ft = 1.2192m
1 inch = 0.0254m
Example : H = 5’ 3”
W= 62kgs
62kg/(1.6)² = 62/2.56 = BMI = 24.22
 
Classification of Weight status in
adults according to BMI By WHO
Classification BMI (kg/m²) Risk of c0-morbidities

Underweight < 18.5 Low (but risk of other

clinical problems
increased)

Normal Range ≥ 18.5 – 24.9 Average

Overweight ≥ 25
Pre-obese 25 – 29.9 Increased

Obese I 30.0 – 34.9 Moderate

Obese II ≥ 30 Severe

Obese III 40+ Very severe

 CLASSIFICATION OF MALNUTRITION IN ADULTS BY BMI

BMI VALUES CATEGORY

>20 Normal

– 20.0 Marginal

>17 – 18.5 Mild malnutrition

16 – 17 Moderate Malnutrition

<16
Severe Malnutrtion
OBESITY CATEGORIES INTO 3 BMI
GRADES:
GRADE I – 25 to 29.9
GRADE II – 30 TO 40
GRADE III – 40+
IN GENERAL : OBESITY - IS BMI of
27 or more.
- indicates high risk of developing
health problems.
- weight 20% above average.
 
UNDERWEIGHT – BMI less than
18.5 – 10 to 15% below ave
OVERWEIGHT - BMI between 25-
29 – 10 to 20% above ave.
HEALTHY – BMI between 18.5 –
24.9

BMI TEND TO INCREASE WITH

AGE.
WAIST – TO – HIP RATIO
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.)
Alternatively it is called
abdominal/gluteal ratio or
abdominal girth measurement
Obtaining Correct Measurement:
Use non stretchable tape measure (in
centimetre)
Subjet should stand erectly, abdominal
muscles relaxed, arms at the sides, and
feet together. The measurer faces the
subject and places the tape measure.
Measure waist at the most narrow area
below the rib case above umbilicus.
Measure hip circumference at the
widest point around the hips or
buttocks with the subject standing.
Read measurement to the nearest
0.1cm.

Formula for Assessing Body Fat

Distribution by WHR
WHR = Waist circumference (cm)
Hip circumference (cm)
A WHR of 1.0 or greater in men
or 0.8 or greater in women is
indicative of android obesity and
an increased risk for obesity-
related diseases. This also
appears to be true in children.
GYNOID “ pear-shaped”people,
store more fat in the buttocks, thighs
and hips.
ANDROID “apple-shaped”
people, carry their extra fat
around the abdomen/upper body-.
The WHR may partially explain the
difference in high blood pressure
between men and women. Men are
more likely to be “apples” and
women to be “pears”. Men have
higher rates of HTN and more
complications.
Waist Circumference
- serves as a marker of abdominal
fatness. Waist circumference alone has
been considered a valid indicator for
both men and women.
Interpretation : women with a waist
circumference greater than 35 inches
and men with waist circumference
greater than 40 inches have high risk
of central obesity-related health
problems.
SKINFOLD THICKNESS
Assess body composition, fat
distribution and reserve calories
by using a calliper .

The most accurate way to

measure body fat.
Harpenden
Lange Caliper
Triceps- commonly used
Below the scapula
Biceps

Biceps
Above the iliac crest/
Suprailiac
Upper thigh
Ifit is more than 1 ½
inches – over wt.

Ifless than ½ inch –

under wt.
ASSESSMENT BY CLINICAL
METHOD
Clinical assessment of nutritional status
deals basically with the examination of
changes that can be seen or felt in superficial
tissues such as the skin, hair and eyes.
In other words, its the physical observation
or assessment.
In here, signs of nutrient deficiency are
noted and some nutrient deficiency diseases
are observed such as;
 Gingival swelling
S
C
U
R
V
Y Blue spots on the skin
Rickets = lack of Ca and vit D
s/s- poorly shaped bones and
teeth
Iron deficiency anemia(children
beyond 6 mons.) = lack in iron
s/s- pallor.
Dehydration = loss of water &
electrolytes.
s/s- sunken eyeballs, dry mucous
membranes, thirst, etc.
ASSESSMENT BY BIOCHEMICAL
TEST
includes various blood, urine , saliva and stool
test.
According to Dellova, it provides information on
protein balance, vit, mineral, and fluid status,
body composition, organ function and metabolic
status.
According to Roth a deficiency/ toxicity can be
determined by laboratory analysis of the samples.
these test allow detection of malnutrition before
signs appear.
MOST COMMONLY USED TEST FOR NUTRITIONAL
EVALUATION
BLOOD TEST
 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
 Albumin is a protein found in plants and animals.
 Low levels – with malnutrition, burns, infections, cancer
and those taking birth pills, chronic disease of liver, kidney
and heart.
 Serum Transferrin Level - -indicates iron-carrying
protein in the blood
 transferrin is a glycoprotein that binds and transport iron.
Most is produced in the liver.
 - if result is below normal there would be hepatic
failure, nephrosis, cachexia
Blood Urea Nitrogen (BUN) -Increased
level may indicate renal failure, insufficient
renal blood supply or blockage in the urinary
tract, dehydration and GI bleeding.
NV - 2.9 – 8.9 mmol/L
Creatinine Excretion – indicates the
amount of ceatinine excreted in the urine
over a 24 hour period and can be used in
estimating body muscle mass.
low creatinine excretion – indicative of
muscle mass depletion, as in malnutrition.
low creatinine excretion – indicative of
muscle mass depletion, as in malnutrition.
Serum Creatinine – indicates the amount
of creatinine in the blood and is used for
evaluating renal functions.
 -N.V. 60-132 mmol/L
 -↑= acute/chronic renal
insufficiency, urinary tract obstruction.
Hgb- women-12-16g/dl,men-14-18g/dl
Hct – women – 42-52%,men- 37-48%
= decreased level would mean anemia
Lipid Profile – for clients w/ heart
abnormalities/ CAD (coronary artery dse.)
Total Serum Cholesterol – less than 200 mg/dl
HDL – more than 35mg/dl
LDL – less than 130mg/dl
Serum Triglycerides – 2.9 – 8.9 mmol/L or
less than 200mg/dl
Uric Acid, serum or plasma
 men – 3-99mg/dl, women – 2.5-7.7mg/dl
 High level - gout, toxemia of pregnancy,
leukemia, polycythemia,renal insufficiency,
down’s syndrome, glycogen storage disease
Low levels occasionally in acute
hepatitis.
all vitamins and minerals would cause a
certain disease if there would be
abnormalities on the intake, either low or
high..but in water soluble vitamins, no
over dosage.
STOOL EXAM
Direct Stool Exam - checked for oily
materials . Excess fat in stool suggest
steatorrhea.
Chemical analysis of fecal fat- fecal fat
greater than 7g/day when the diet includes
100 g of fat/day indicates malabsorption.
Serum Calcium – low levels seen in
calcium and vit. D malabsorption, (recall
that steatorrhea can lead to calcium and
vit D.malabsorption.
D-xylose test – test of CHO absorption.
Schilling test – identifies vit B₁₂
malabsorption.
URINE TEST
Creatinine - ↑ - muscle wasting,
starvation and cachectic status,
hyperthyroidism and febrile status.
↓- hypothyroidism, renal insufficiency
Men – 0-50 mg/24 hour
Women – 0-100 mg/24hour
Calcium - ↑- hyperparathyroidism,
elevated serum calcium
50-150mg/24 hr. Or 1.05 – 1.3 mmol/L
Urinalysis – can detect protein and sugar in
urine(indicative of kidney disease and
diabetes)
Color = normal is clear, straw-colored/light
yellow.Lighter than normal may result from
excessive fld. Intake,diuretic.
= darker than normal – caused by liver disease
and certain drugs.

ODOR = depends on the food intake/with

concentration of urine (asparagus/onions), this
depends with how much fld. You drink.
Protein = presence of this is found on kidney
disease, multiple myeloma, heart failure,
stress or surgery
pH = this varies with diet, but usually acidic
w/ a range of pH 5-6.
= Alklaline urine is associated w/ a
vegetarian diet or fruit diet esp citrus,
vomiting, diuretics and excess taking in
antacids
Specific gravity = it is high (concentrated) in
Dhn, DM or in condition w/c it has an excess
protein in the urine.
GLOBAL PROBLEMS OF NUTRITION
Malnutrition
Causes or Factors or People who are at
risk
1. Poor food availability and preparation
2. Lack of nutritional education
3. Recurrent infections - chronic diseases
such as AIDS, Cancer, Celiac disease
( gluten sensitivity – malabsorption of all
nutrients- diarrhea, wt loss & malnutrition)
5. Poverty, natural disaster, war.

FORMS OF MALNUTRITION IN DEFICIENCY

OR UNDERNUTRITION
1. PEM (Protein- Energy Malnutrition)
- Undernourished children can suffer from PEM
when there is:
 rapid growth, infection or disease w/c
increases the need for protein and essential
nutrients.
TWO DIFFERENT FORMS OF PEM
1. MARASMUS – named also as the “drying
away”
 - this is a chronic PEM wherein it reflects a
severe deprivation of food over a long time
There is severe wasting or the patient is emaciated
 - it occurs in children from 6-18 mons. Of
age in all over-populated urban slums.
 - marasmic children looks like a little old
people – just skin and bones.
 Skin is dry and wrinkled

Hair is thin and dry, easily pulled
Spoon-shaped brittle nails
 Due to Inadequate nutrition – there’s
inadequate energy – and the body will use
the protein as energy – if with inadequate
protein for growth and maintenance –
then there’s a failure to thrive/ delayed
dev’t/ stunted growth.
2. KWASHIORKOR
- reflects a sudden and recent
deprivation of food
- this is classified as Acute PEM
- it sets in between 18 mons to 2 years
It is usually occurs when the mother
suddenly wean the baby from breastfeeding
due to the presence of the next baby to
nurse.
So the first child now will be switched
from Nutrient dense, protein-rich
breastmilk to a starchy, protein poor cereal.
- distinctive feature “moon face”
 this is commonly precipitated by an illness
such as measles or dysentery (infxn of the
digestive tract result to diarrhea
The child has bulging belly w/ a fatty liver
( due to lack of protein carriers that transport
fat out of the liver)
With edema on face and limbs due to lack of
protein and hormones that maintains fluid
balance. So fluid now will leak to the
interstitial spaces. ( a distinguishing feature
CLASSIFICATION OF
NUTRIENT
DEFICIENCY/UNDERNUTRITIO
N
 1. PRIMARY – caused by
inadequate dietary intake
E.g. poverty
Poor food habit
Limited food supply due to over
population
2. SECONDARY– caused by a disease
condition that may cause mal-
absorption(steatorrhea), accelerated
excretion or destruction of nutrients
E.g lack of appetite, diarrhea, parasitism,
alcoholism, liver disease etc.
FORM OF MALNUTRITION IN
EXCESS/OVERNUTRITION
1. OBESITY – generally, it is defined as
an excessive amount of fat stored ( as
adipose tissue) in the body
- means “stout”, fat or plump
-the actual body weight is 20% above the
DBW.
-will result to many health problems suc as
Htn, DM, CAD, CVD, atherosclerosis and
even CA
CAUSES:
1. Genetics – accdg to research that a
considerable proportion of human
obesity (50-79 %) has a genetic
component.
2. Sedentary lifestyles – low
expenditures
3. Abnormal absorption of nutrients
4. Over-eating / binge eating disorder.
TYPES OF OBESITY
1. UPPER BODY OBESITY – referred
to as central, abdominal/male obesity
- apple-shaped people/Android
obesity
2. LOWER BODY OBESITY – known
as peripheral, gluteal, femoral/ female
obesity
Pear-shaped people/ Gynoid obesity
PREVENTION AND INTERVENTION
1. LIFESTYLE MODIFICATION – diet,
exercise/increase physical activity
2. PHARMACOTHERAPY
A. Orlistat (xenical) – inhibit absorption
of fat soluble vitamins
- for 30 BMI
- 120 mg PO TID w/ meals
B. Reductil – it suppress appetite
3. SURGERY - Bariatric surgery for
morbidly obese
- surgically reduces the reservoir capacity of
the stomach by closing off a part of it.
Gastroplasty – reduces the size of the
stomach leaving only a small opening into the
distal stomach
B. Gastric bypass – reducing the stomach by
the stapling procedure, connecting a small
opening in the upper portion of the stomach
to the small intestine by means of intestinal
loop.. Capacity = 20-30 ml
Liposuction/ Lipo sculpture =
aspiration of fat deposits
= this is a cosmetic surgery not a
wt reduction technique bec only 5lb
of fat can be remove at a time.
= Complications = death, severe
infectious cellulitis and hemorrhage
 CLASSIFICATION OF MALNUTRITION IN ADULTS BY BMI

BMI VALUES CATEGORY

>20 Normal

– 20.0 Marginal

>17 – 18.5 Mild malnutrition

16 – 17 Moderate Malnutrition

<16
Severe Malnutrtion
NUTRITIONAL
PROCESSES
1.DIGESTION
Organs Involved:
mouth, esophagus, stomach, small intestine,
large intestine (also called the colon) and
anus.
Another : pancreas, the liver, and the
gallbladder.
The primary function of the
Digestive System

- to bring nutrients/essential nutrients

into the internal env’t.
 MOUTH

MOUTH
Digestion begins here, with the chewing of food (mastication). Breaks
down very large aggregates of food molecules into smaller particles and
allows saliva and enzymes to enter inside the larger food complexes .
Saliva is secreted by the salivary glands in your mouth and moistens the
food to improve the chewing and grinding. Saliva also contains some
enzymes that begin the breakdown of starches and fats.
3 Pairs of Salivary Glands

1. Parotid
2. Submaxillary and
3. Sublingual
It produces 1.5 L of saliva/day
After a mouthful of food has been swallowed, it is
called a BOLUS.
PHARYNX
When you swallow a mouthful of
food, it passes thru the pharynx, a
short tube that is shared by both the
digestive system and respiration
system.
 To bypass the entrance to your
lungs, the epiglottis closes off your
air passages so that you don’t choke
when you swallow or to prevent
aspiration.
 ESOPHAGUS

It delivers the saliva-mixed food

from the mouth to the stomach
thru peristalsis.
STOMACH
After a mouthful of food has been
swallowed, it is called a BOLUS.

When the Bolus enters the fundus and

body of the stomach, the lining of the
fundus (called the gastric fundal mucosa)
produces hydrocholoric acid (HCl).

Acidic environment is critical for destroying

toxins in foods, such as bacteria, as well as
to activate enzyme PEPSINOGEN into
PEPSIN needed for untwisting the complex
three-dimensional protein chains, a process
called denaturation of the proteins.
Food spends about 3-4 hours inside the
stomach
Little by little, the stomach transfer the food to
its lower portion ,add juices to it and grinds it to
a semi-liquid mass called CHYME.

When the chyme enters the pylorus , it causes

distention and the release of the hormone
Gastrin which increases the release of gastric
juices (aids in the digestion of food)

CHYME- contains 50% water. This is a thick

creamy, acid liquid expelled by the stomach into
the duodenum.
DIGESTIVE SECRETIONS:

Gastric Juices
are the digestive secretions of the
stomach,such as mucous, HCl,
pepsinogen, intrinsic factor and gastrin .
HCl - secretes by the parietal cells in the
walls of the stomach and it activates the
enzyme pepsin that will breakdown
protein.
Gastrin (a hormone, produced by the antral
mucosa of the stomach).It increases the
release of gastric juices.
Pepsin- the active form of pepsinogen
resulting from exposure to acidic env’t.(the
hydrochloric acid). This pepsin will
breakdown protein.

Mucus-a thick, slippery, white subtsance

that coat the cells. It is secreted by the cells
of the stomach to protect itself from the
harmful acid and enzymes.
2 Additional enzymes in Children

Renin – which acts on milk protein and

casein

Gastric lipase – which breaks the

butterfat molecules of milk into smaller
molecules.
No absorption takes place at the
stomach except water, alcohol
and ASA. Therefore, absorption
of water starts at the stomach and
ends at the large intestine.
Once the food-acid-enzyme mixture
leaves the stomach, it is called
chyme. The movement of chyme
through the pyloric sphincter
stimulates the intestine to release the
hormones secretin and
cholecystokinin, which signal the
pancreas to release its contents, the
pancreatic juice, inside the lumen
(the lining) of the duodenum (the
first segment of the small intestine).
FYI:
The stomach can hold up to 1 ½ pint
of food and remains for 2-4 hours.
An average of 2000-2500ml of
gastric juice is secreted daily.
Most of liquid meal empties in 1-2
hours.
Most solid food/ meal empties w/ in
2-3hours
When the chyme completely liquefied,
the pyloric sphincter opens briefly (about
3x a minute) to allow small portions of
chyme through.At this point , the chyme
no longer resembles food in the least.
At the top of the Small Intestine, the
chyme bypasses the opening (pyloric
sphincter)from the common bile duct,
which is dripping fluid into the small
intestine from two organs outside the GI
tract – the gallbladder and the pancreas
 LIVER, PANCREAS AND GALLBLADDER

PANCREAS - produces and secretes many of the

enzymes necessary for digestion, which include the
enzymes that digest protein (trypsin, chymotryPsin,
carboxypeptidase, and elastase), enzymes that digest
fat (lipase and phospholipase), and the enzyme that
digests carbohydrate (alpha-amylase).
The LIVER is responsible for
synthesizing most of the proteins that
circulate in your blood, and it produces
bile.
Bile -is important for the digestion of fats
and is used for the excretion of
cholesterol and other fat-soluble
molecules.
can make cholesterol (800-1000/day )and
is the primary place where cholesterol is
removed from the blood.
The liver eliminates cholesterol
in the form of bile acids. Every
day, your liver secretes about 500
ml. of bile acids, which are used
during digestion of fats.
The chyme travels on down the small
intestine thru the 3 segments –
 1. duodenum- top portions and receives
digestive juices from the liver, gallbladder
and pancreas.
2. the jejunum- the 1st 2/5 of the small
intestine beyond duodenum)and 3. the
ileum the last segment where most of the
absorption of food takes place, site for B12
absorption
The Intestine– is a 10 feet of tubing coiled
w/ in the abdomen.
Final digestion will occur here at the
Small intestines .
After digestion, ABSORPTION may
take place with the help of the
Microvilli( minute cylindrical processes
that are found on the surface of the
intestinal cells greatly increase their
absorptive surface area )in the small
intestine wall, in which nutrients are
absorbed into the blood except fat which
is absorbed by the lymphatic system.
In here, the hormone secretin causes the
pancreas to release NaH03 w/c is
basic/alkaline- the opposite of stomach’s
acid to neutralize the acidity of the
chyme, so from this point on, the chyme
remains at a neutral or slightly alkaline
pH.
pH – the unit of measure expressing a
substance’s acidity/alkalinity.
Acidity of the gastric juice register
below “2”
And the hormone Cholecystokinin
(CCK) will release the Bile. the
gallbladder squirts the bile into the
duodenum when fat arrives there.
BILE - is produced in the liver but stored in
the gallbladder.
It is not an enzyme but an emulsifier.
It emulsifies fat after it is secreted in the
small intestine.
It enables the enzymes to digest the fats
more easily.
Emulsifier – a substance w/ both
water-soluble and fat-soluble portions
that promotes the mixing of oils and
fats in a watery solution.
ENZYME - is a protein that
facilitates a chemical reaction,
making a molecule, breaking a
molecule, changing the arrangement
of molecule or exchanging parts of
molecule.
The enzyme involved in the
digestion facilitates a chemical
reaction known as
HYDROLYSIS , the addition
of water (hydro) to break (lysis) a
molecule into smaller pieces.

The chyme triggers also the pancreas to
secrete its juice. 
Pancreatic Juices are:
Trypsin, chymotrypsin and
carboxypepetidases – splits proteins into
smaller substances. They are called the
pancreatic proteases.
Pancreatic Amylase – converts starches
(polysaccharides)to simple sugars.
Pancreatic lipase – reduces fats to fatty
acids and glycerol.
Large Intestine
Having travelled the length of the small
intestine, after absorption of nutrients,
what remains of the chyme arrives at
another sphincter, the ileocecal valve, at
the beginning of the large intestine in the
lower right-hand side of the abdomen.
 Had it slipped into this opening, it would
have ended up in the appendix, a blind
sac about the size of your little finger.
The chyme bypasses this opening,
however, and travels along the large
intestine up the ascending colon, across
the transverse colon, down to the
descending colon and finally to the
sigmoid colon, above the rectum.
During the chyme’s passage to the
rectum, the colon w/draws water from
it, leaving semisolid waste.
The strong muscles of the rectum and
anal canal hold back this waste until it is
time to defecate. Then the rectal muscles
relax and the 2 sphincters of the anus
open to allow passage of the waste.
  2 Anal Sphincters:
Internal anal sphincter – smooth
muscle and involuntary
External anal sphincter – skeletal
muscle and voluntary
The major task of Large Intestines:
 are to absorb water
 to synthesize some B Vitamins and K
(essential for blood clotting),
 and to collect food residue (part of food
that the body’s enzyme can’t digest and
can’t absorb by the body.
Residue = is commonly called as Dietary
Fiber.
e.g. outer hulls of corn kernels, grains of
wheat, celery strings and apple skins.
Fiber – is important in the diet to
produce soft stools and move frequent
bowel movement.
 
Undigested food is excreted as feces
by way of the rectum and anus.

Inhealthy people: 99 % CHO, 95%

FATS, 92% CHON are absorbed.
ABSORPTION – the passage of nutrients
into the bloodstream or lymphatic system.
The inner surface of the small intestine has
mucosal folds called villi and microvilli.
Villi - is a tiny hairlike structures in the SI
through w/c nutrients are absorbed.
It has hundreds of microscopic hairlike
projection called MICROVILLI or brush
border – these are very sensitive to the
nutrient needs of our bodies.
 
These villi contains numerous blood
capilliaries (tiny blood vessels) and
lacteals (lymphatic vessels)
Capilliaries = absorbs glucose, fructose,
galactose, amino acids, minerals and
water-soluble vitamins
 Lymphatic vessel/Lacteals = carry fat-
soluble particles and molecules that are too
large to pass through the capillaries into
the bloodstream such as glycerol and fatty
acids (end product of digestion), in
addition to fat-soluble vitamins.
 Organ/ Target Secre- Action
Gland Organ Tion
Salivary mouth saliva Fluid eases swallowing,
Glands salivary enzymes breaks down
CHO
Gastric Stomach Gastric Fluid mixes
glands juice w/bolus;hydrochloric acid
uncoils proteins, enzymes
breakdown proteins; mucus
protects stomach cells
     
Pancreas Small Pancreati NaHCO3 neutralizes acidic
intestine c juice gastric juices; pancreatic
enzymes break down Cho,
fats and proteins.
Liver Gallbladder Bile Bile stored until needed
Gallbladd Small Bile Bile emulsifies fat so enzymes
er intestine can attack
 
     
METABOLISM = it is a complex process
after digestion and absorption, wherein
nutrients are carried by the blood to the
cells of the body, whereby, nutrients w/
in the cells are changed into energy.
OXIDATION process takes place during
Aerobic metabolism wherein nutrients
are combined w/ oxygen w/ in each cell.
It reduces CHO to CO2 and H2O
Proteins to CO2, H2O and Nitrogen
Anaerobic metabolism – reduces fats w/o
the use of O2.
 The complete oxidation of CHO, CHON
and Fats is called as KREBS CYCLE.

After oxidation of nutrients → energy is

released and process of ANABOLISM
will follow, wherein the released energy
will be use, whereby small molecules are
put together to build larger ones
e.g. Formation of new body tissues
Now when released energy is used to
broken down large molecules to small
molecules, it is called CATABOLISM.
In order that the body has the energy, it must
have a continuos supply of nutrients needed
for building up (anabolism) and breaking
down (catabolism) of substances.
Metabolism is governed primarily by the
hormones secreted by the thyroid gland.
The:
 Triiodothyronine (T3) – an –iodine
containing thyroid hormone
 Thyroxine (T4)- an iodine- containing
hormone that regulate the rate of cell
metabolism
If T3 and T4 are elevated, it may result to
HYPERTHYROIDISM – in w/c there is
quick metabolism of food and weight loss.
If T3 and T4 is decreased,
HYPOTHYROIDISM occur, wherein the
thyroid gland is not producing enough
hormone. Metabolism here is too slow and
patient becomes sluggish and there is fat
acculmulation.
After food passes the chemical factories of the
body, either turn them into energy or use them
to make body tissues.
ENERGY
Is defined as capacity to do work
Is constantly needed for the maintenance of
body tissue and temperature for
growth(involuntary activity – process of
respiration, circulation, regulation of body
temp and cell activity and maintenance) and
for voluntary activity such as walking,
running, gardening, swimming, etc.
 
People expend energy when they are
physically active, of course, but they are also
expended when they are resting quietly.
 Heat is released whenever the body
breaks down CHO, CHON or Fat for energy
and again when that energy is used to do
work.
 The work itself, as it is done, generates
heat as well. The body’s generation of heat is
known as THERMOGENESIS, and it can be
measured to determine the amount of energy
expended.
An ENERGY is expended by the body
in the form of RESTING ENERGY
EXPENDITURE(REE) and the
THERMIC EFFECT OF FOOD(TEF)
REE / BMR = is the rate of energy
expended in the activities necessary to
sustain normal body functions and
homeostasis(means balance).
The rate may vary dramatically from
person to person, also with a change in
circumstances or physical condition
The rate is slowest when a person is
sleeping undisturbed, but it is usually
measured in a room w/ a comfortable
temperature when the person is awake,
but lying still, after a restful sleep and
an overnight (12-14) fast.
Factors that affect BMR :
1.Growing (children and pregnant
women)
2. and in those w/ considerable lean
body mass (physically fit people and
male)
 -bec.the larger the muscle mass
required and the heavier the weight of
the body part being moved, the more
energy is spent.
3. People with fever ( increase the
metabolic rate by about 7% for each
degree Fahrenheit increase in body
temp.)or under stress
4.And in people w/ highly active thyroid
glands.- bec the thyroid gland releases
hormones that travel to the cells and
influence cellular metabolism.
Thyroid hormone activity can speed up
or slow down the rate of metabolism by
as much as 50%.
6.Environmental temperature = people
working in a cold climate require more
kcalories to maintain normal body temp.-
the extent to w/c energy metabolism
increases in extremely cold environment
depends on the insulation available from
the body fat and protective clothing..
Though both heat and cold raise the
BMR.
 
Fasting/starvation/malnutrition-
BMR/REE slows down w/ a loss of
lean body mass
The activity’s duration, frequency
and intensity also influence energy
expenditure: the longer, the more
frequent, and the more intense the
activity, the more kcalories spent.

And as people age, lean body mass
declines and also the BMR/REE.
BMR begins to decrease in early
adulthood at a rate of 2%/decade

= a reduction in voluntary activity as

well brings the total decline in energy
expenditure to 5% per decade
ESTIMATING BMR:
Convert body weight from pounds to
kg by dividing pounds by 2.2 (2.2=1kg)
Multiply the kg. By 24hrs/day
Multiply the answer obtained in step 2
by 0.9 for women, and 1.0 for men.
e.g. 110lbs = 50kg
50x24 = 1200kcalories
1200 x 0.9 = 1080 kcalories (women)
= BM requirement
THERMIC EFFECT OF FOOD
- an estimation of the energy required
to process food.
-When a person eats, the GI tract
muscles speed up their rhythmic
contractions, the cells that manufacture
and secrete digestive juices begin their
tasks, and some nutrients are absorbed
by active transport. This acceleration of
activity requires and produces heat; it is
known as the Thermic Effect of Food.
The thermic effect of food is proportional
to the food energy taken in and is usually
estimated at 10% of energy intake.
Thus a person who ingest 2000 kcalories
probably expends about 200 kcalories on
the thermic effect of food.
The thermic effect of food is greater for
high protein foods than for high fat foods.
The body requires energy to process food
(digestion, absorption, transportation,
metabolism and storage)
Thermic Effect of Food:
Carbohydrate : 5-10%
Fat : 0-5%
Protein: 20-30%
Alcohol : 20%
The percentages are calculated by
dividing the energy expended during
digestion and absorption (above
basal) by the energy content of the
food.
FACTORS AFFECTING THE TEF
1. TEF varies w/ the composition of the diet
and is greater after consumption of CHO,
CHON than after FAT. FAT is
metabolized efficiently w/ only 4%
wastage, compared to 25% wastage when
CHO is converted to fat for storage = these
factors would contribute to the obesity –
promoting characteristics of FAT.
2. Spicy foods enhances and prolong the
effect of the TEF
= meals w/ chilli and mustard may
increase the metabolic rate as much as
33% more than unspiced meals and this
effect may last for more than 3 hours.
3. Caffeine and nicotine = also stimulate
the TEF
= when ingested every 2 hours
For 12 hours, the amount of caffeine in 1
cup of coffee (100mg) has been shown to
increase the TEF by 8% - 11%. Nicotine
has similar effect.
DIETARY GUIDE AND THEIR
USES
Dietary Recommended Intake – a
nutrient guidelines in the US ,
introduced since 1998.
It represent a set of four standards
used to provide a comprehensive
measure of nutrition and long term
guidelines that are utilized to both assess
and plan diets for healthy individuals.
Used to support both group and
individuals diet planning.
1. RDA – represent calculated nutrient needs
for healthy individuals based on age,
gender and life-stage group.
It aims to supply an adequate nutrient
intake to decrease the risk of chronic
diseases.
In the PHILS, the 2002 revised edition of
the RDA is now called as
RENI(recommended energy and nutrient
intakes)
= this is the dietary standard for Filipinos
E. g Iron females 18 mg/men 8 mg.
= provides the public about the level of essential
nutrient that must be taken.
2. Tolerable Upper Intake Levels/TUL
Refers to the highest amount of nutrient that
appears safe for regular consumption and
beyond w/c there is an increase risk of adverse
effects. Eg. Vit. A , that can be harmful in large
amt.eg. Vita A RDA 900 ug TUL 3000ug
3.EAR – The Estimated Average Req is the intake
level for a nutrient at which the needs of 50
percent of the population will be met. Because
the needs of the other half of the population will
not be met by this amount, the EAR is increased
by about 20 percent to arrive at the RDA
 The EAR is use to calculate the RDA.
Adequate Intake- represent an estimate
guidelines for intake of a nutrient in an
individual when no RDA was
established due to lack of scientific data
on requirements.
The latest Nutritional guidelines for
Filipinos given by the Food and
Nutrition Institute – DOST are:
1. Eat a wide variety of foods everyday –
a person should choose diff kinds of foods
from all the food groups to obtain all the
impt nutrients needed by the body. No
single food provides all the nutrients the
body needs.
2. Breast-feed infants from birth – 4 to 6
mons, and then give appropriate foods
while continuing breast-feeding.
- Exclusive breast-feeding from birth to
4-6mons is encouraged. Breast-feeding
may be continued up to 2 years or
longer.
- Complementary food may be given at
about 6mons in addition to breast-
feeding.
3. Maintain children’s normal growth
through proper diet and monitor
their growth properly – through
weight and height monitoring, etc.
4. Consume fish, lean meat, poultry or dried
beans – these foods supply not only good
quality protein and calories but also iron and
zinc(assist in immune function and in growth
and dev’t.)
5. Eat more fruits and veg and root crops. -
These foods are key sources of micronutrients
and dietary fiber that are lacking in the
Filipino diet.
6. Eat foods prepared w/ edible cooking oil
daily.- consumption of these foods augment
the need for the calorie deficiency of the ave
Filipino diet.
7.Consume milk and milk products
or other calcium-rich foods such as
small fish and dark green leafy veg
everyday. – these foods provide the
nutrients for growth like calcium and
high quality protein.
8.Use iodized salt, but avoid
excessive intake of salty foods –
iodized salt prevents iodine
deficiency disorder. Excessive salt in
the diet may case HTN.
9. Eat clean and safe foods – to avoid
food-borne illnesses

10. Exercise regularly, do not smoke

and avoid drinking alcoholic
beverages.- healthy lifestyle
practices are related to good nutrition.
FOOD GUIDE PYRAMID
MyPyramid contained eight divisions.
From left to right on the pyramid are a
person and six food groups:
Physical activity, represented by a person
climbing steps on the pyramid, to illustrate
moderate physical activity every day, in
addition to usual activity. The key
recommendations for 2005 (other specific
recommendations are provided for children
and adolescents, pregnant and breastfeeding
women, for older adults and for weight
maintenance) are:
Engage in regular physical activity and
reduce sedentary activities to promote
health, psychological well-being, and a
healthy body weight. (At least 30 minutes
on most, and if possible, every day for
adults and at least 60 minutes each day for
children and
teenagers, and for most people increasing
to more vigorous-intensity or a longer
duration will bring greater benefits.)

 ◦ Achieve physical fitness by including
cardiovascular conditioning, stretching
exercises for flexibility, and resistance
exercises or calisthenics for muscle
strength and endurance.
Grains, recommending that at least half
of grains consumed be as whole grains 

Vegetables, emphasizing dark green

vegetables, orange vegetables, and dry
beans and peas
Fruits, emphasizing variety and
deemphasizing fruit juices
Oils, recommending fish, nut, and
vegetables sources
Milk, a category that includes fluid
milk and many other milk-based
products
Meat and beans, emphasizing low-fat
and lean meats such as fish as well as
more beans, peas, nuts, and seeds
There is one other category:
Discretionary calories represented by the
narrow tip of each colored band, including
items such as candy, alcohol, or additional
food from any other group.
FOOD LABELS
It helps the consumer to select food
w/ less fat, saturated fat, cholesterol
and sodium and more complex CHO
and dietary fiber.
It appears on all processed foods.
PARTS OF THE FOOD LABEL
The Ingredient List
- must be in descending order of
predominance by weight.
-Knowing that the first ingredient
predominates by weight, consumer can
glean much information.
-Compare these products for example:
: a Cereal that contains “puffed milled corn,
sugar, corn syrup, molasses, salt…versus
one that contains “100% rolled oats.”
 : A canned fruit that contains “sugar, apple,
water versus one that contains simply
“apples, water.”
In each comparison, consumer can tell that
the second product is the more nutrient
dense.

Serving Sizes
- The FDA has established a specific
serving sizes for various foods and requires
that all labels for a given product use the
same serving size.
◦ - Standard serving sizes are expressed
in both household measurements such
as cups and metric measures such as
milliliter, to accommodate users of
both types of measures.
◦ - consumer need to consider the
quantities accordingly. how the
serving size compares with the actual
quantity eaten. If its not the same,
they will need to adjust
◦ - Be aware that serving size on food
labels are not always the same as
those of the Pyramid
 : for example, a serving size of
rice on a food label is 1 cup,
whereas in the Pyramid is ½ cup.
It creates now confusion for
consumers trying to follow
recommendations.
Nutrition Facts
◦ - the FDA requires the “Nutrition facts”
panel on a label should present nutrient
information
◦ in two ways – in quantities (such as
grams)
 - and as Percentages of standards
called the Daily Value or both, for
the following:
 Total food energy (kcalories)
 Food energy from fat (kcalories)
 Total fat ( grams and percent Daily Value)
 Saturated fats ( grams and percent Daily Value)
 Trans fat ( grams)
 Cholesterol ( milligrams and percent Daily
Value)
 Sodium (milligrams and percent Daily Value)
 Total CHO, including, starch, sugar, and fiber
grams ( grams and percent Daily Value)
 Dietary fiber ( grams and percent Daily Value)
 Sugars ( grams), including both those naturally
present and in those added to the food
 Protein (grams)
And also the percentage of the Daily
values for Vitamins and Minerals:
Vitamin A
Vitamin C
Iron
Calcium
 TERMINOLOGY – The FDA has also
standardized descriptors (terms used by
manufactures to describe products)on food
labels to help the consumer select the most
appropriate and healthful foods.The ff are
examples:
Low calorie means 40 calories/ less per
serving
Calorie free means <5cal./serving
Low fat- it has no more than 3gms of fat
/serving or per 100gms of the food
 
Fat free – food contains <0.5gm of fat /
serving and no added fat or oil. Synonyms
include “zero-fat”, “no-fat”, and “nonfat”
Low saturated fat- 1gm or less of saturated
fat/ serving
Low cholesterol- 20mg or less of
cholesterol/serving
Cholesterol free- less than 2mg
No added sugar-no sugar/sweetener added
during preparation/packaging
Low sodium-<140mg/serving
Very low sodium-<35mg/serving
Good source of – the product provides b/n
10 and 19% of the DV for a given nutrient
per serving.
Light/lite – must specify what is referring
to (for example, “Light in color” or “Lite
in texture”).
Kcalorie free - fewer than 5 kcal/serving
High fiber - 5g or more /serving
Lean - less than 10g of fat, 4.5g saturated
fat and trans fat combined, and 95mg of
cholesterol/serving and per 100g of meat,
poultry and seafood.
Sugar-free - less than 0.5g/serving
Less fat - 25% or less fat/serving than
the comparison food.
Less cholesterol – 25% or less than the
comparison food (reflecting a reduction of
at least 20 mg per serving), and 2 g or less
saturated fat and trans fat combined per
serving.
Light in sodium - no more than 50% of
the sodium of the comparison food.
Reading Label Lingo
In addition to requiring that packaged foods
contain a Nutrition Facts label, the FDA
also regulates the use of phrases and terms
used on the product packaging. Here's a list
of common phrases you may see on your
food packaging - and what they actually
mean.
No fat or fat free: Contains less than 1/2
gram of fat per serving
No calories or calorie free: Contains less
than 5 calories per serving
Lower or reduced fat: Contains at least 25
percent less per serving than the reference
food. (An example might be reduced fat
cream cheese, which would have at least
25 percent less fat than original cream
cheese.)
Low fat: Contains less than 3 grams of fat
per serving
Lite: Contains 1/3 the calories or 1/2 the
fat per serving of the original version or a
similar product
Low calories: Contains 1/3 the calories of
the original version or a similar product
Sugar free: Contains less than 1/2 gram of
sugar per serving
Reduced sugar: at least 25% less sugar
per serving than the reference food
No preservatives: Contains no
preservatives (chemical or natural)
No preservatives added: Contains no
added chemicals to preserve the product.
Some of these products may contain
natural preservatives
Low sodium: contains less than 140 mgs
of sodium per serving
No salt or salt free: Contains less than 5
mgs of sodium per serving
High fiber: 5 g or more per serving
(Foods making high-fiber claims must
meet the definition for low fat, or the level
of total fat must appear next to the high-
fiber claim)
Good source of fiber: 2.5 g to 4.9 g. per
serving
More or added fiber: Contains at least 2.5
g more per serving than the reference food
Daily Values
- reference values developed by the FDA
specifically for use on food labels..
- It reflects dietary recommendation for
nutrients and dietary components that
have important relationships w/ health.
- Daily Values (DV) – help consumers see
easily whether a food contributes “a
little” or “a lot” of a nutrient
- It provides an estimate of how individual
foods contribute to the total diet.
- It is established for adults and children
over 4 y/o. The values for energy
yielding nutrients are based on 2000
kcal/day,
w/c is about right for moderately active
women, teenage girls and sedentary
men.
2500 kcal/day is about right for active
women, many men and teenage boys.
CALCULATE PERSONAL DAILY
VALUES:
◦ Daily values are designed for a 2000-kcal (standard)
intake but you can calculate your personal set of DV
based on your allowance.
 Example: a person w/ 1500 kcal/day.
 What percentage of the DV for energy does your
intake represent?
 Divide your kcal intake by the DV:
1500 kcal (your intake) / 2000 kcal (DV) = 0.75%
Multiply your answer by 100 to state it as
percentage:
0.75 x 100 = 75% of the DV.
Sometimes the percentage is more
than 100.
Suppose your daily intake of Vitamin
C is 120mg and your RDA (male) is
90 mg.
What percentage of the RDA for
Vitamin C is your intake?
 120 mg (your intake) / 90 mg
(RDA) = 1.33
 1.33 x 100 = 133% of the RDA
And to calculate your goal for fat
for example:
1500 kcal x .20% kcal from fat
= 450 kcal from fat
To count grams for fat:
450 kcal from fat /9 kcal/g
= 50g fat.
What does Percent Daily Value mean on
food labels?
The Percent Daily Value on the Nutrition
Facts label is a guide to the nutrients in one
serving of food. For example, if the label
lists 15 percent for calcium, it means that
one serving provides 15 percent of the
calcium you need each day.

The Percent Daily Values are based on a

2,000-calorie diet for healthy adults.
Even if your diet is higher or lower in
calories, you can still use the Percent
Daily Value as a guide. For example, the
Percent Daily Value can help you
determine whether a food is high or low
in specific nutrients:

Ifa food has 5 percent or less of a

nutrient, it's considered to be low in that
nutrient.
If it has 20 percent or more, it's considered
to be high in that nutrient.
Note that the Food and Drug Administration
has not set Daily Values for sugar and trans
fat. That's because experts recommend that
Americans cut back on foods with added
sugar and solid fats (including trans and
saturated fats). These foods, such as cakes,
cookies, pastries and donuts, are high in
calories but low in nutrients.
To get the most benefit from Percent
Daily Values, use them to choose foods
high in vitamins, minerals and fiber —
and to limit foods high in fat and sodium.
NUTRIENT CLAIMS
- statements that characterize the
quantity of a nutrient in a food.
- if the product meets specified criteria-
example “ good source of fiber”on a
box of cereal or “rich in calcium”on a
package of cheese, these claims may be
used on labels as long as they meet
FDA definitions, w/c include the
conditions under w/c each term can be
used.
Example, a claim that a product
“contains no oil” implies that the
food contains no fat.
- If the product is truly fat-free, then it
may make the no-oil claim, but if it
contains another source of fat, such
as butter , it may not.
ASSIGNMENT
Bring labels from two brands of
the same food next meeting.
CLASSROOM ACTIVITY
Using the labels from two brands
of the same food, categorize the
ingredients found in each,
according to the six classes of
nutrients. Compare and contrast
for nutritional quality.
N
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