1. Nutrition N1037

2. Introduction • Key term: nutrition • IntegratedPan-Canadian Healthy Living Strategy goals: • Healthy eating • Physical activity • Healthy weight

3. Eating well with Canada’s Food Guide • Food groups: • Vegetables and fruit • Grain products • Milk and alternatives • Meat and alternatives

4. Dietary Guidelines • Directional statements: • Have vegetables and fruit more often than juice • Eat at least one dark green and one orange vegetable every day • Have at least half of daily grain products intake from whole grain • Have meat alternatives such as beans, lentils and tofu often

5. Dietary Guidelines • Directional statements: • Eat at least two food guide servings of fish every week • Satisfy thirst with water  • Drink skim, 1% or 2% milk each day – drink fortified soy beverages if you do not drink milk

6. Dietary Guidelines • Directional statements: • Reduce the total amount of fat in the diet, especially saturated and trans fats, however, a small amount of unsaturated fat is recommended each day (30-45 ml for an adult) • Lower salt and sugar intake

7. Dietary Guidelines • Directional statements: • Achieve and maintain a healthy body weight by enjoying regular physical activity - adults should get 30 to 60 minutes of moderate physical activity every day and children should get 90 minutes

8. Dietary Guidelines • Directional statements: • All women who could become pregnant should take 400 µg (0.4 mg) of folic acid a day to avoid neural tube defects in the unborn fetus • All adults over 50 years of age should, in addition to following the Food Guide, take a daily vitamin D supplement of 10 µg (400 IU) a day

9. Nutrients • Nutrients are the substances found in food that are nourishing and useful to the body. • Carbohydrates • Protein • Fats, • Vitamins and minerals • Water

10. Nutrients • Carbohydrates • Supply energy and fibre • 45% to 60% of daily caloric intake (continues)

11. Nutrients • Proteins • Supply nine essential amino acids • Repairs body tissues, maintain osmotic pressure, component of antibodies, and an ultimate source of energy. • 10% to 35% of daily caloric intake

12. Nutrients • Fats • Saturated, monounsaturated • Cholesterol, high-density lipoproteins, low-density lipoproteins, omega fatty acids, trans fats, triglycerides • Part of the structure of all cells • 20% to 35% of total caloric intake

13. Nutrients • Vitamins • Organic substances • Maintain body functions • Fat-soluble and water-soluble • Minerals • Inorganic substances • Help build body tissues and regulate body processes. • Macrominerals and microminerals

14. Nutrients • Water • Makes up 50% to 60% of body weight • Average adult needs 6–8 240 mL glasses of water/day • Signs of dehydration?

15. Nutrition Through the Life Cycle • Anticipatory guidance

16. Infant Feeding Guidelines • Assess reflexes—sucking, rooting, swallowing • Rapid growth and development • Breastfeeding is preferred for first 12 months • Assess physical development to determine readiness for solid food

17. Infant Feeding Guidelines • Introduction of solids • 6 – 9 months • Iron containing foods • Cereals • Meats and Egg Yolk • Vegetables and Fruit • Dairy : Cheeses, Yoghurt (Whole Cow’s milk after 9 months) • 9 months + • Introduction of finger foods, increased textures (mashed and soft)

18. Infant Feeding Guidelines • Introduce foods one at a time • Begin with foods that are least allergenic • Avoid egg whites and honey in infants under 12 months • No peanuts, nuts, or fish until age three

19. Nutritional Assessment of Infants • Breastfed? How often? How long? • Bottle-fed? How often? How much? • Formula preparation? Storage? • How does the infant respond to eating? • Constipation? Diarrhea? • Is the infant ever put in bed with a bottle?

20. Nutritional Guidelines for Toddlers • Physical growth slows • Increased independence • Small portions • Offer one new food at a time • No peanuts, nuts, or fish until age three • Routine mealtimes

21. Nutritional Guidelines for Preschoolers • Independence • May become a picky eater • Offer food choices • Offer small servings • Finger foods • Routine mealtimes • Discuss need for healthy snacks

22. Nutritional Guidelines for School-Age Children • Erratic growth and eating patterns • Strong food preferences • Encourage a balanced diet • Limit highly sweetened snacks and foods

23. Nutritional Assessment of Young Children • Concerns with child’s eating? • Child’s food preferences? • Involvement in sports? Physical activity? • Child’s meal schedule? • Balanced diet? • Intake of beverages with added sugar?

24. Nutritional Guidelines for Adolescents • Period of rapid growth and change • Fluctuating nutritional needs • Concerns with body image • Risks for eating disorders • Adjustment portion quantity based on physical activity level

25. Nutritional Assessment of Adolescents • Participation in physical activity? • Adhere to a specific diet or meal plan? • Skip meals? • Satisfaction with current weight? (continues)

26. Nutritional Assessment of Adolescents • Ever induced vomiting, used laxatives, diuretics, or diet pills to control weight? • Consumption of snacks?

27. Nutritional Guidelines for Young and Middle-Aged Adults • Growth and caloric needs stabilize • Eating habits may be influenced by activity levels, life stressors • Obesity often seen in this age group

28. Nutritional Guidelines for Young and Middle-Aged Adults • Consideration of diseases • Atherosclerosis - Coronary artery disease • Osteoporosis • Type II diabetes • Metabolic syndrome DASH Diet

29. Nutritional Guidelines for Pregnant and Lactating Women • Role of proper nutrition in development of healthy infant • Target weight gain for pregnancy • Adequate caloric intake • Increased fluid consumption • Prenatal vitamins • Iron supplements • Calcium • Folic Acid

30. Nutritional Assessment of Pregnant Women • Prepregnancy weight? • Activity level? • Use of supplemental vitamins? • Consumption of caffeine, artificial sweeteners, alcohol? • Presence of constipation, nausea, vomiting, or heartburn? • Presence of food cravings?

31. Nutritional Guidelines for the Older Adult • Decreased caloric requirements • Encourage to eat in a sitting position • Encourage adequate fluid intake and high-fibre diet

32. Nutritional Guidelines for the Older Adult • Nutritional risk factors • Difficulty chewing or swallowing • Decreased appetite • Decreased taste and smell • Decreased ability to self-feed

33. Nutritional Assessment of Older Adults • Presence of physical limitations that affect eating? • Difficulty chewing or swallowing? • Presence of dental problems? • Difficulty obtaining or preparing foods? • Do you eat alone?

34. Cultural Differences in Nutrition • Cultural beliefs related to the consumption of food • Religious beliefs related to the consumption of food • Food restrictions • Periods of fasting

35. Components of a Nutritional Assessment • Nutritional history • Physical assessment • Anthropometric measurements • Laboratory data • Diagnostic data

36. Nutritional History • General diet information • Adherence to particular diet • Food preferences • Consumption of fast foods • Ability to obtain and prepare foods • Changes in past 12 months

37. Nutritional History • Food intake history • 24-hour recall • 3-day diary • Direct observation • Evaluation of adequacy of diet

38. Physical Assessment • Assess for subjective and objective signs and symptoms of poor nutritional status

39. Signs and Symptoms of Poor Nutritional Status • Subjective data • Fatigue • Delayed wound healing • Brittle hair, nails • Mouth sores • Changes in appetite • Mood changes

40. Signs and Symptoms of Poor Nutritional Status • Objective data • Weight changes • Dry, rough, scaly skin • Edema • Dry, cracked lips • Swollen, bleeding gums • Decreased muscle tone

41. Anthropometric Measures • Height • Weight • Ideal body weight, percent IBW • Percent weight change • Body mass index (continues)

42. Anthropometric Measures • Waist to hip ratio • Skinfold thickness • Mid-arm circumferences • Kwashiorkor • Marasmus

43. Laboratory Data • Hematocrit and hemoglobin • Cholesterol, LDL-C, HDL-C, total cholesterol:HDL-C ratio, triglycerides • Transferrin, TIBC, iron • Total lymphocyte count • Antigen skin testing (continues)

44. Laboratory Data • Albumin and prealbumin • Glucose • Creatinine height index • Nitrogen balance

45. Diagnostic Data • Radiographic studies • X Rays • Dual-energy X-ray Absorptiometry (DEXA) scan

46. Activities • Review your 24 hour food recall – compare to Canada Food Guide • Do health teaching depending on what you assess. • Do Calcium calculator • Do initial physical assessment • Complete Self – Assessment Tool

47. Interactive Food LabelAvailable athttp://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/inl_main-eng.php Contents:1. Nutrition Facts Table2. Specific Amount of Food3. % Daily Value4. Core Nutrients5. Nutrition Claims6. List of Ingredients

48. Nutrition Facts Table • Whole Kernel Corn • The Nutrition Facts table includes Calories and 13 nutrients: Fat, Saturated fat, Trans fat, Cholesterol, Sodium, Carbohydrate, Fibre, Sugars, Protein, Vitamin A, Vitamin C, Calcium and Iron.

49. Specific Amount of Food • The specific amount may be indicated by: • A phrase such as: a slice, one egg, two cookies, followed by the metric measure. • Familiar household units such as mL, cups, tablespoons, or a fraction or unit of food (e.g., 1/4 pizza), followed by the metric measure (g, mL) (e.g., 175 g yogourt). Whole Wheat Bread

50. % Daily Value • Use the % Daily Value to make food comparisons. • The % Daily Value provides a quick overview of the nutrient profile of the food, allowing product comparisons based on more than one nutrient. It puts nutrients on the same scale (0% - 100% Daily Value). You can quickly identify the strengths and weaknesses of a food product. Sirloin Burger Vs Chicken Burger