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Clinical Nutrition and Dietetics Manual for Nurses
V Supriya
1:
Introduction
ABSTRACT
OBJECTIVES
HISTORY OF NUTRITION
NATURALISTIC ERA (400 BC TO 1750 AD)
CHEMICAL–ANALYTICAL ERA (1750–1900)
Biological Era (1900–1955)
CELLULAR OR MOLECULAR ERA (1955 TO PRESENT)
Thiamine (Vitamin B1)
Riboflavin
VITAMIN B6
Vitamin B12
Vitamin D
Vitamin E
Vitamin K
DEFINITIONS AND TERMS
Nutrition and Health
Health
Malnutrition
Five Food Group System (Table 1.2)
Importance of Five Food Group System
Food Pyramid (Fig. 1.1)
Foods and Food Groups
FUNCTIONS OF FOODS
Nutritional Classification (Flowchart 1.1)
Nutritional Balance
Nutrition and Growth
Nutrition and Infection
Reference Man
Reference Woman
Factors Affecting Food and Nutrition
Food Fads
Food Fallacies
Food Myths
Food Habits
Nutrition and Immunity
Nutrition and Cancer
National Health Policy
National Nutritional Policy
Nutritional Problems in India
Protein Energy Malnutrition
Anemia
Role of Food and its Medicinal Value
FUNCTIONAL FOODS (TABLES 1.4 AND 1.5)
CONCLUSION
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2:
Energy
ABSTRACT
OBJECTIVES
INTRODUCTION
CALORIES
MEASURING ENERGY
MEASUREMENT OF BODY COMPOSITION BY BMI
ENERGY EXPENDITURE
FACTORS AFFECTING TOTAL ENERGY REQUIREMENT
DETERMINANTS OF ENERGY REQUIREMENTS
Components of Total Energy Requirement
Basal Metabolic Rate
Thermic Effect of Foods
Physical Activity
METHODS FOR DETERMINATION OF ENERGY OUTPUT
Direct Calorimetry
Indirect Calorimetry
Advantage
MEASURING FOOD ENERGY
Bomb Calorimeter
Energy Calculations
Factorial Methods
Total Energy Requirement
Energy Requirements
Energy RDA by Body Weight
Calorific Value of Cooked Foods
CONCLUSION
BIBLIOGRAPHY
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3:
Carbohydrates
ABSTRACT
OBJECTIVES
INTRODUCTION
HISTORY
CLASSIFICATION OF MONOSACCHARIDES
FUNCTIONS
Energy
Liver
Central Nervous System
Heart
Muscle Contraction
Protein Sparing Effect
Ketosis and Carbohydrate Metabolism
Conversion of Carbohydrates into Fats
Part of Body Tissues
Stimulates Growth of Intestinal Bacteria
Aids in the Absorption of Other Nutrients
Carbohydrates Provide Fiber or Bulk
DIGESTION OF CARBOHYDRATES
In the Mouth
In the Stomach
In the Small Intestine
In the Large Intestine
Absorption
Factors Affecting Absorption
Storage and Metabolism
Maintenance of Blood Glucose Levels
Sources
Requirements
CHO Nutrition/Malnutrition
DISORDERS OF CARBOHYDRATE METABOLISM
Type I
Management
Type II
Management
Glycemic Index (GI)
Glycemic Load (GL)
GL of watermelon is 4
Excess/Over Consumption
Fibers
Classification of Fibers
Dietary Fiber Content of Foods
Sources of Fiber
Role of Dietary Fiber
Clinical Effects of Dietary Fiber
CONCLUSION
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4:
Proteins
ABSTRACT
OBJECTIVES
INTRODUCTION
CLASSIFICATION
Complete Protein
Partially Complete Proteins
Incomplete Proteins
Physical-Chemical Nature
Conformation of Proteins
FUNCTIONS
DIGESTION AND ABSORPTION OF PROTEIN
Digestion
Stomach
Small Intestine
Large Intestine
Absorption
METABOLISM
QUALITY OF PROTEINS
BIOLOGICAL VALUE
Digestibility Coefficient (DC)
Net Protein Utilization (NPU)
Protein Efficiency Ratio (PER)
Chemical Score
Protein Digestibility Corrected Amino Acid Score (PDCAAS)
MUTUAL SUPPLEMENTATION OF PROTEINS
DEFICIENCY
Protein Energy Malnutrition (PEM)
Factors Causing PEM
Treatment
Dietary Management
Effects of Protein Deficiency
Excess Intake
PROTEIN REQUIREMENTS
Recommended Dietary Allowance (RDA)
CONCLUSION
REFERENCE
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5:
Fats
ABSTRACT
OBJECTIVES
INTRODUCTION
CLASSIFICATION OF LIPIDS
Simple Lipids
Complex Lipids
Terpenoids and Sterols
Derived Lipids
CHEMICAL COMPOSITION
Fatty Acids
Medium Chain Triglycerides (MCTs)
Eicosanoids
Trans Fatty Acids
Cholesterol
FUNCTIONS
Digestion
In Mouth
Stomach
Small Intestine
Absorption
Metabolism
Essential Fatty Acids
EFA Deficiency
Deficiency-Phrynoderma
Excess Fat Consumption
Obesity
Fats and Atherosclerosis
AMERICAN HEART ASSOCIATION GUIDELINES
REQUIREMENT OF FAT
SOURCES OF FATS
Visible Fats
Invisible Fats
CONCLUSION
REFERENCE
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6:
Vitamins
ABSTRACT
OBJECTIVES
INTRODUCTION
HISTORY
CLASSIFICATION
FAT-SOLUBLE VITAMINS
Vitamin A
Sources
Functions of Vitamin A
Vitamin A and Vision
Epithelialization
Appetite Problems
Reproduction
Anti-infective Function
Bones
Degenerative Diseases
Cellular Functions
Other Roles
DEFICIENCY OF VITAMIN A AND ITS PREVALENCE
Night Blindness
Conjunctival Xerosis
Bitot's Spots
Corneal Xerosis
Corneal Ulcers
Keratomalacia
Scars (XS)
Xerophthalmic Fundus (XF)
Treatment
HYPERVITAMINOSIS A (EXCESS OF VITAMIN A)
Teratogenicity
Prevention
HIGHER INTAKE OF VITAMIN A THROUGH DIET
Eradication of Deficiency of Vitamin A
Educating/Creating Awareness
Dietary Implementations
Supplementation of Vitamin A through Diet
Fortification of Foods
Advantages
VITAMIN D
FUNCTIONS OF VITAMIN D
Calcium Metabolism in Intestine
Role of Vitamin D on Bone
Kidneys
Receptors of 1, 25-dihydroxy Vitamin D
ABNORMALITIES OF IMMUNOHEMATOPOIETIC SYSTEM
Sources
Diet
Deficiency (Rickets/Osteomalacia)
Causes-Vitamin D Deficiency
Signs and Symptoms of Rickets
Head
Osteomalacia
Treatment
HYPERVITAMINOSIS D (TOXICITY)
Vitamin E, an Essential Fat-soluble Vitamin
FUNCTION
Antioxidant Action
Vitamin E and Hemolytic Anemia
Vitamin E and Cancer
Vitamin E and Immune System Function
Vitamin E in Cardiovascular Disease
Vitamin E and Selenium
Sources
Deficiency
Vitamin E Supplementation
TOXICITY (HYPERVITAMINOSIS D)
VITAMIN K
Dietary Sources
Functions
Vitamin K Dependent Proteins in Blood Clotting
Anticoagulant-Dicumarol
Deficiency
Vitamin K Deficiency Bleeding (VKDB) in Infancy
Treatment
TOXICITY (HYPERVITAMINOSIS)
Water-soluble Vitamins
Vitamin B Complex
Thiamine
Sources
FUNCTIONS
Treatment
Toxicity (Thiamine)
RIBOFLAVIN
Sources
Functions
Deficiency-Ariboflavinosis
Treatment
Toxicity (Hypervitaminosis)
Niacin (Vitamin B3)
Relationship of Tryptophan with Niacin
FOOD SOURCES
FUNCTIONS
Deficiency Condition
Treatment
Toxic Effects (Hypervitaminosis)
Pyridoxine (Vitamin B6)
Functions
Sources
Factors that Lead to Pyridoxine Deficiency Include
Deficiency-clinical Features
Treatment
Toxic Effects (Hypervitaminosis)
Folic Acid
Sources
FUNCTIONS
Causes
CLINICAL DEFICIENCY
Folic Acid in Pregnant Women
Deficiency of Folic Acid and Perinatal Effects
Folic Acid and Congenital Malformations
Spina Bifida
Cleft Lip
Cancer and Folic Acid
Cardiovascular Disease
Toxicity (Hypervitaminosis)
Biotin (Vitamin H)
Sources
Functions
Deficiency
Treatment
Toxicity (Hypervitaminosis)
Pantothenic Acid (Vitamin B5)
Sources
Functions
Deficiency Condition
Toxic Effects (Hypervitaminosis)
Vitamin B12 (Cyanocobalamin)
Metabolism
FUNCTIONS
Dietary Sources of B12
Sources of B12 for Vegetarians/Vegans
Deficiency of Vitamin B12
Clinical Signs
Pernicious Anemia
Therapeutic Treatment
Hypervitaminosis (B12)
Vitamin C
Sources
Functions of Ascorbic Acid
Deficiency
Infantile Scurvy
Common Cold and Vitamin C
Hypervitaminosis C (Ingestion of Mega Doses of Ascorbic Acid)
CONCLUSION
REFERENCE
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7:
Minerals
ABSTRACT
OBJECTIVES
Macrominerals
Calcium
FUNCTIONS
MINERALIZATION
Other Roles
Blood Clotting
DIGESTION, ABSORPTION AND TRANSPORT
Digestion
Absorption
Transport
Toxicity
Phosphorus
Regulation
Functions
Sources
Absorption
Hyperphosphatemia
Magnesium
Functions
Deficiency
Toxicity
Sodium
Functions
Requirements
Causes
Causes
Potassium
Functions
Metabolism
Increased Risk of Deficiency
Signs and Symptoms of Deficiency
Deficiency: Hypokalemia
Chlorine
Dietary Sources
Daily Requirements
Absorption
Blood Chlorine
Deficiency-Hypochloremia
Sulfur
Functions
Sources
Absorption
Clinical Significance
MICROMINERALS
Iron
Functions
Absorption and Metabolism
Deficiency-causes
Signs and Symptoms of Deficiency
Iodine
Functions
Increased Risk of Deficiency
Deficiency
Toxicity
Zinc
Functions
Deficiency
Acrodermatitis Enteropathica
Signs of Zinc Deficiency
Metabolism of Zinc
Transport
Toxicity
Copper
Functions
Absorption
Signs and Symptoms of Deficiency
Requirements
Deficiency
Toxicity
Manganese
Functions of Manganese
Metabolism
Symptoms Include
Toxicity
Chromium
Functions
Absorption
Deficiency
Insulin Resistance
Toxicity
Fluorine
Functions
Food Sources
Absorption
Deficiency
Toxicity
Cobalt
Functions
Daily Requirement
Sources
Absorption
Deficiency
Toxicity
Selenium
Metabolism
Absorption
Deficiency
Signs and Symptoms of Deficiency
Requirements
Toxicity
Molybdenum
Functions
Sources
Daily Requirements
Absorption
Deficiency
Toxicity
CONCLUSION
REFERENCES
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8:
Water and Electrolytes
ABSTRACT
OBJECTIVES
INTRODUCTION
Body Water Distribution
Functions of Water
Membranes and Various Processes in Movement of Water
Mechanisms/Processes Involved in the Movement of Water
Composition of Body Fluids
Daily Requirement of Water
Fluid Requirements
FLUID REQUIREMENTS IN NEONATES
Water Intake
Reduced Intake
Increased Losses
Effects of Water Deprivation
Water Imbalances
Dehydration
Prevention
Oral Rehydration Solution
Overhydration or Edema
Intoxication of Water
Role of a Nurse in Maintaining the Fluid Intake and Output
Intravenous Solutions
Isotonic Solution
Hypertonic Solution
Hypotonic Solution
Electrolytes of the Body
Properties of Electrolytes
Types of Electrolytes
Sodium
Sodium Balance
Regulation of Fluid and Sodium Balance in the Body
Accumulation of Fluids—Edema and Sodium
Potassium
Cell Membrane-active Transport
Movement
Electrolyte Imbalances
Example
Fluid Resuscitation
CONCLUSION
9:
Cooking and Preservation of Food
ABSTRACT
OBJECTIVES
INTRODUCTION
Aim and Objects of Cooking Food
COOKING METHODS
Classification of Cooking Methods
Boiling
Simmering
Poaching
Stewing
Steaming
Pressure Cooker
DRY HEAT METHODS
Air as Medium of Cooking
Grilling or Broiling
Toasting
Roasting
Baking
Fat as a Medium of Cooking
Shallow Fat Frying
Deep Fat Frying
Combination of Cooking Methods
SOLAR COOKING
Advantages
Disadvantages
MICROWAVE COOKING
Advantages
Limitations
Changes in Cooking
Changes in Proteins
Changes in Carbohydrates
Changes in Lipids
Changes in Vitamins and Minerals
Changes in Color
Food Preservation
Need for Food Preservation
Principles of Preservation
Methods of Preservation
FOOD ADULTERATION
Incidental Adulterants
Metallic Contamination
Adulterants
New Adulterants
Food Additives
For Centuries
Unintentional Additives
Intentional Additives
Maximum Levels of Anti-microbials Permitted in Foods
FOOD LAWS AND STANDARDS
Prevention of Food Adulteration Act
Fruit Products Order (FPO)
ISI Standards
AGMARK Standard
ISO and HACCP
FOOD FORTIFICATION AND ENRICHMENT
Types of Food Fortification
FOOD SAFETY
Safe Handling of Foods and Personal Hygienic Practices
HYGIENE AND SANITATION
ENVIRONMENTAL HYGIENE AND SANITATION
FOOD HANDLING PRACTICES
FOOD STORAGE
JAMS AND JELLIES
Tests for Pectin
Preparation of Jelly
Preparation of Jam: Pineapple Jam
General Principles for Preparation of Squashes
General Procedure for Making Orange Squash
Conclusion
REFERENCES
10:
Balanced Diet and Nutrition at Different Stages of Life
ABSTRACT
OBJECTIVES
PLANNING OF A BALANCED DIET
DIET WITH INCLUSION OF EXPENSIVE FOODS
BALANCED DIET WITH MODERATE COST
BALANCED DIET WITH LOW COST
BUDGETING OF FOOD BALANCED DIET
Planning for Budgeting Foods
Extra Portions
FOOD GROUPS AND GUIDELINES FOR FOOD SELECTION
Planning of Meals
Recommended Dietary Intake
Food Guide Pyramid
Important Factors to be Considered while Planning Meals for a Family
Planning of Menus and Their Procedures
Use of Exchange Lists in Menu Planning
Infancy
Breastfeeding
Advantages
Nutritional Factors
Carbohydrates
Proteins
Lipids
Vitamins
Immunological Factors
Psychological Factors
Artificial Feeding
Nutritional Requirements of Infants
Micronutrients
B-vitamins
Complementary Foods
COMPLEMENTARY FEEDING SCHEDULE FOR INFANTS FROM SIX MONTHS OF AGE
Nutrition in Children
Early Childhood or Preschoolers
Nutritional Needs of Preschool Children
Energy
Proteins
Lipids
Micronutrients
Calcium
Iron
Fat and Water Soluble Vitamins
Food Alterations
Schoolgoers or Later Childhood
Dietary Requirements for School-going Kids
Calories
Growth
Micronutrients
Calcium
Iron
B-complex, A and C
Food Alterations
Concerns in Providing Food for School-going Children
Nutrition-related Diseases in Children
Childhood Obesity
ADOLESCENTS
Transformations During Puberty
Pubertal Changes with Regard to Hormones
Physiological Changes
Food Habits
Peer Influences
Selection of Foods
Factors Influencing Food Habits
Nutritional Requirements
Vitamin Requirements
Iron Deficiency
Changes Occurring before Menstrual Periods
Undernutrition due to Teenage Pregnancy
Adults
Dietary Recommendations for Adults
Micronutrients
REMEDIES
Diabetes
Anemia
Nutritional Requirements for a Pregnant Lady
Changes During Pregnancy
Nutritional Assessment
Clinical Examination
Macro-minerals
Common Nutritional Issues
Irregular Bowel Movements
Regurgitation
Difficulties During Pregnancy
Nutritional Requirements during Lactation Period
Calories
General Recommendations
Dietary Management of the Elderly
Nutritional Problems During Old Age
Excessive Body Weight
Deficiency of Iron and Folate
REFERENCES
Short Notes
Essay
11:
Assessment of Nutritional Status
ABSTRACT
OBJECTIVES
NUTRITIONAL STATUS
Nutritional Surveys
Nutritional Surveillance
Nutritional Screening
Nutritional Monitoring
METHODS USED
Anthropometric Assessment
Height
Stadiometer
Weight
Body Mass Index
Calculation of Body Mass Index (BMI)
WHO Standards
Obese
Mid-Arm Circumference
Interpretation
Arnold's Classification
Triceps Skinfold
Interpretation of MAMC
Anthropometric Measurements in Pediatrics
Interpretation
Biochemical Assessments
Total Lymphocyte Count
Clinical Assessment
METHODS OF PHYSICAL ASSESSMENT: WHAT A NURSE SHOULD DO
Inspection
Palpation
Percussion
Auscultation
Dietary Assessment
Group Method
Food Frequency Method
Questionnaire Method
Role of Nurse in Nutritional Assessment
SUMMARY
REFERENCES
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12:
Therapeutic Diets
ABSTRACT
OBJECTIVES
INTRODUCTION
Modification of Nutrients
Modifications in Diet Consistency
Regular Diet
CLEAR LIQUID AND SOFT SOLID DIET
Therapeutic Diets
FEVER
MENU PLAN
LIVER DISEASE
MENU PLAN (LIVER)
DIABETES MELLITUS
MENU PLAN (DIABETES MELLITUS)
HYPERTENSION
MENU PLAN (HYPERTENSION)
Cardiovascular Diseases
CVD
RENAL DISEASE
NEPHROTIC SYNDROME
ACUTE RENAL FAILURE
CHRONIC RENAL FAILURE
End Stage Renal Disease
Causes of Renal Diseases Include
HEMODIALYSIS
Peritoneal Dialysis
Treatment Modalities Include Mainly
MENU PLAN (RENAL)
OBESITY
OBESITY (MENU PLAN)
BURNS
Goal of Medical Nutrition Therapy
DIARRHEA
NUTRITION THERAPY
MEDICAL NUTRITION THERAPY
CONSTIPATION
NUTRITION THERAPY
INFLAMMATORY BOWEL DISEASE
ULCERATIVE COLITIS
CROHN'S DISEASE
MEDICAL NUTRITION THERAPY
Nutrient Deficiencies seen in Crohn's Disease
DUMPING SYNDROME
NUTRITION THERAPY
PEPTIC ULCER DISEASE
Clinical Symptoms
GOALS
NUTRITION THERAPY
CANCER
MEDICAL NUTRITION THERAPY
NUTRITION SUPPORT TEAM
What is Nutrition Support?
Significance of the Team
ROLE OF A NURSE IN NUTRITION SUPPORT SERVICES (NSS)
Nutrition Support
Enteral Nutrition
Different Routes for Enteral Feeding
Long-term Enteral Feedings
Parenteral Feeds
History
Conditions Favoring Parenteral Nutrition
Central Parenteral Nutrition
Indications of Central Parenteral Nutrition
Role of a Nurse
Peripheral Parenteral Nutrition (PPN)
Parenteral Nutrition—Significance
Conclusion
REFERENCE
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13:
Role of Nurses in Nutrition Education and National Nutrition Programs
ABSTRACT
OBJECTIVES
Significance of Nutrition Education by Nurses
OBJECTIVES OF NUTRITION EDUCATION
MEANS OF NUTRITION EDUCATION
Methods of Nutrition Education of the Community
ROLE OF COMMUNITY HEALTH NURSE IN NUTRITION
COMMUNITY NUTRITION PROGRAMS IN INDIA
National Nutrition Programs
Applied Nutrition Program
Supplementary Feeding Programs
Integrated Child Development Program
Objectives
Budgetary Allocation
National Institute of Public Cooperation and Child Development (NIPCCD)
MIDDAY MEAL PROGRAM (MDMP)
Tamil Nadu Government Nutritious Meal Program
Fund Flow Mechanism
Tamil Nadu Integrated Nutrition Program (TINP)
Main Objectives
Tamil Nadu ICDS Project III Aided by World Bank
Expectant Women
Infants and Children (0–3 Years)
Goiter Eradication Program
Prophylaxis against Vitamin A Deficiency
Anemia Prophylaxis Program
UNITED NATIONS INTERNATIONAL CHILDREN'S FUND (UNICEF)
Medical Support
Food Supply
Welfare of People
World Health Organization (WHO)
Cooperative Assistance and Relief Everywhere (CARE)
Food and Agricultural Organization
Objectives of FAO
NATIONAL INSTITUTE OF NUTRITION (NIN)
Stepping Stones
Objectives
NUTRITION FOUNDATION OF INDIA (NFI)
FOOD AND NUTRITION BOARD
CFTRI
Vision
Operations/Duties of CFTRI
NATIONAL NUTRITION MONITORING BUREAU (NNMB)
Origin of NNMB
Goals
CHILD SURVIVAL AND STAFF MOTHERHOOD (CSSM) PROGRAM
INDIAN SOCIETY OF NUTRITION
HEADQUARTERS
Actions
Supervision and Nutrition Surveillance/Inspection
ICDS Supervision
Supervision/Observation and Appraisal of Education Programs
Appraisal of Integrated Child Development Services Programs and Outcomes
Summary and Conclusion
REFERENCES
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