Nutrition Counseling

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Nutrient-deficiency diseases

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Nutrient-deficiency diseases

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Health problems related to poor nutrition

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Health problems related to poor nutrition

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Dietary excess and imbalance

• The four leading causes of death directly associated with diet are coronary heart disease (CHD), some types of cancer (breast, cervical, colon), stroke, and diabetes mellitus.

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• Dietary factors are responsible for at least 1/3^rd of all cases of cancer and CHD.

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• Many dietary components are involved in the relationship between diet and health. Chief among them is the disproportionate consumption of foods high in fats at the expense of foods high in complex carbohydrates and dietary fiber.

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Recommended Dietary Allowances…RDAs

• RDAs: the level of intake of essential nutrients judged to be adequate, based on scientific knowledge, to meet the known nutritional needs of virtually a healthy people.
• RDAs are specifically set for protein, vitamins (A, C, D, E, K, thiamin, riboflavin, niacin, B6, B12, and folate), minerals (calcium, phosphorus, , and magnesium), trace minerals (iron, zinc, iodine, and selenium).
• Consuming less than the RDAs does not necessarily mean getting inadequate amount of nutrients. But as percentage of RDA consumed decreases, risk of inadequate intake increases.

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Dietary guidelines

• Focus on obtaining a diet sufficient in protein, vitamins, and minerals.
• Guidelines for a healthy diet:
• Eat a variety of foods.
• Balance food you eat with physical activity-maintain or improve your weight.
• Choose a diet with plenty of grain products, vegetables, and fruits.
• Choose a diet low in fat, saturated fat, and cholesterol.
• Choose a diet moderate in sugar.
• Choose a diet moderate in salt and sodium.
• Do not drink alcoholic beverages.

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Food Guide Pyramid

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Fats, Oils,

and Sweets

Meat, Poultry, Fish,

Dry Beans, Eggs,

and Nuts Group

Milk, Yogurt, and Cheese Group

Fruits and Vegetables Group

Bread, Rice, and Pasta Group

Bread, cereal, grains, pasta

Meat, poultry, fish,

dry beans, eggs, nuts

Fats, oils, sweets

Food labels

• Must be easy to read and understand and be consistent with dietary recommendations.
• Labels should contain information such as:
• Serving size for the food.
• Number of servings in the container.
• Number of calories per serving.
• Amount of protein (in grams) per serving.
• Amount of fat (in grams) per serving.
• Amount of protein expressed as a percentage of the RDA.
• Percentage, for one serving, of the RDA of each of vitamin A, vitamin C, thiamin, riboflavin, niacin, calcium, iron, and sodium.
• Ingredients.
• Production and expiration date.

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Nutrition screening

• The process of discovering characteristics or risk factors that are known to be associated with dietary or nutrition problems.
• Purpose: identify individuals potentially at high risk because of complex and involved problems that touch on nutrition (elderly; poor clients).
• Also helpful in establishing priorities for the most efficient use of available and valuable time and money.

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Nutrition screening

• Screening tool “Determine Your Nutritional Health (DYNH).”

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Nutrition screening

• Total your nutritional score. If it’s:

- 0-2…Good! Recheck your nutritional score in 6 months.

- 3-5…You are at moderate nutritional risk. Improve your eating habits and lifestyle. Recheck your nutritional score in 3 months.

- 6 or more…You are at high nutritional risk. Ask for help to improve your nutritional health.

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Nutrition screening

• DYNH consists of two parts:
• Self-assessment/helps people identify aspects of their eating habits and lifestyles that may place them at nutritional risk.
• Provide basic education on nutritional risk factors and indicators; using the acronym “DETERMINE” to remind both the general public and health professionals about warning signs of poor nutritional health.

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Nutrition screening

• Disease
• Eating poorly
• Tooth loss/mouth pain
• Economic hardship
• Reduced social contact DETERMINE
• Multiple medicines
• Involuntary weight loss or gain
• Needs assistance in self-care
• Elder years above age 80

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Screening for malnutrition

• A dietitian or community nutrition program may be appropriate if any of the following are identified in the individual:

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• Inappropriate, inadequate, or excessive food intake.

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• Problems complying with a specialized diet.

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• Need for nutrient-specific counseling or counseling related to a specific disease.

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Screening for malnutrition

• Weight of more than 20% above what is desirable.
• Serum cholesterol at more than 240 mg/dl.
• Functionally dependent for eating or for food-related ADL.

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• The nurse should refer the client to physician if body weight is 20% above or below the desirable weight or if there has been involuntary decrease in weight of more than 10 pounds (≈5 kilograms) in the past 6 months.

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Nutrition and disease…Heart disease

• Major risk factors for heart disease—high blood pressure, high blood cholesterol levels, smoking.

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• Leading cause of death for both men and women.

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• Goal: lower average population levels of blood cholesterol in people over 2 years old by low-saturated fat, low-cholesterol eating pattern.

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Nutrition and disease…Heart disease

• Diet intervention (step 1):

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• Total fat-an average of no more than 30% of total calories.
• Saturated fatty acids-less than 10% of total calories.
• Polyunsaturated fatty acids-up to 10% of total calories.
• Monounsaturated fatty acids-remaining total fat calories (i.e., up to 20%).

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Con…

• Diet intervention (step 1):
• Carbohydrates-about 55% of total calories.
• Protein-about 15% to 20% of total calories.
• Dietary cholesterol-less than 300 mg per day.
• Energy (calories)-adequate in children to support growth and development and to reach and maintain desirable body weight and adequate in adults to maintain desirable weight.

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Nutrition and disease…Heart disease

• Follow-up (step 2):

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• Refer to a registered dietitian (RD) if lipid levels have not been reduced in 3-6 months.
• Attempt a second Step 1 trial period.
• Immediately prescribe a diet limited in saturated fats to 7% of total caloric intake.
• Lipoprotein analysis to be repeated after 3 months.
• For patients older than 10 years of age, drug therapy is considered if diet therapy alone is not effective.

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Nutrition and disease…Stroke

• Modifiable nutrition-related risk factors:– obesity, habitual high alcohol intake, high intake of sodium.
• Diet intervention: recommend salt intake limited to 6 g or less per day for adults; sodium chloride is approximately 40% sodium by weight, therefore a diet with 6 g salt contains about 2.4 g sodium (mild sodium restriction).

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Nutrition and disease…Stroke

• Three major sources of sodium in diet:
• Salt added to food during cooking or at the table.
• Salt added as an ingredient to almost all processed foods (such as baked goods, which do not taste salty).
• Salt that occurs naturally in foods, such as water and all animal products.
• Salty, highly processed salty, salt-preserved, and salt-pickled foods should be eaten sparingly.

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Nutrition and disease…Cancer

• It is estimated that 1/3^rd of cancer deaths are diet related; 40% of cancer incidence among men and 60% among women is related to diet.

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Nutrition and disease…Cancer

• Diet intervention: recommend that adult diets contain 20-30 g of fiber daily (not to exceed 35 because of possible adverse effects); for children older than 2 years of age “age plus 5” (add 5 g of fiber per day to the child’s age in years); for children with obesity and/or hypercholesterolemia, fiber recommendation = (“age plus 10”).
• Guidelines for reducing risk of breast cancer: breast self-examination, stress reduction, physical activity, weight control, diet.

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Nutrition and disease…Osteoporosis

• Risk factors:
• Gender:- women are more at risk than men.

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• Age:- all individuals gradually lose bone mass after 3^rd or 4^th decade of life.

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• Low bone mass:- one of the strongest predictors of osteoporosis.

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• Early menopause (before 40 years of age):- results in a shorter exposure to the protective effect of estrogen.

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Con…

• Risk factors:
• Thin, small-framed body:- a petite, thin person may have a relatively low peak bone mass.

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• Lack of physical activity:- immobilized, bedridden, or extremely inactive individuals may have low muscle and bone mass.

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• Cigarette smoking and use of alcohol or caffeine:- linked to developing osteoporosis.

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Nutrition and disease…Osteoporosis

• Diet intervention:
• Increase calcium intake during puberty: low-fat and fat-free milk, yogurt, low-fat cheeses, sardines, canned vegetables (collard greens), orange juice, milk fortified with calcium.
• Calcium absorption is enhanced by lactose and vitamin D; calcium balance is enhanced by exercise.
• Calcium supplements: calcium carbonate, calcium citrate, calcium lactate, and calcium gluconate.

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Nutrition and disease…Obesity

• Body mass index (BMI):- preferred means of expressing weight relative to height; BMI = weight (kg) ÷ height (m²)

= kg/m²; BMI (19-25; good for adults).

• More common in women than men.
• Diet intervention:- balanced diet; exercise.

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Nutrition and disease…Diabetes

• Purpose of nutrition therapy for people with NIDDM is to delay or prevent development of diabetes complications:- blindness, CHD, nephropathy, and neuropathy.
• Diet intervention:– encourage regular exercise; refer to a dietitian clients with acute complications, such as hypoglycemia, exercise-related problems, renal failure, autonomic neuropathy, hypertension, or CVD.

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Nutrition and disease...HIV and AIDS

• Diagnosis of HIV-positive leads to depression. Depression leads to loss of appetite. So, attention to nutrition is critical as soon as a positive diagnosis is made.
• Diet intervention:- nutritional assessment is necessary; a nutrient-dense, protein-rich, well-balanced diet including a vitamin and mineral supplement should be stressed; information on food sanitation should also be provided.

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برنامج حماة المستقبل – الجامعة الهاشمية

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