NUTR 2050 Nutrition for Nursing ProfessionalsClemson University – Fall 2016

Module 2 Exam Study Guide: Dietary Guidelines, Food Labels, Food Safety, Lifecycle Nutrition

Total Points on Exam: 90 Points, number of question TBDChapters Covered: Chapters 1, 11-13; Information on Blackboard

Dietary Guidelines and Diet Planning How are the Dietary Guidelines for Americans developed?

o Look at physical activity and diets of Americanso Based on scientific researcho Formulate a draft and open up for public an opinion but don’t have their

opinions in there (just so they can see it) What federal agencies are responsible for publishing the Dietary Guidelines for Americans?

o Department of Health and Human Serviceso United States Department of Agriculture

How often are the Dietary Guidelines for Americans updated, and when was the most recent update?

o The dietary guidelines are updated every 5 yearso Most recent was in 2015 (technically January of 2016 is when it was published

What ultimately serves as the foundation for the Dietary Guidelines for Americans?o Scientific research

What are the purposes of the Dietary Guidelines for Americans?o Provide evidence0based recommendation about the components of a healthy

and nutritionally adequate dieto Focus on disease PREVENTION rather than disease TREATMENTo Inform federal food, nutrition, and health policies and programso Not really meant for unhealthy, or diseased people o Promote health, prevent chronic disease, help people reach and maintain a

healthy weight What are the five key recommendations of the Dietary Guidelines for Americans, 2015?

o Follow a healthy eating pattern across the lifespan. Parents need to be sure that they are incorporating healthy foods into

their childs diet from the get goo Focus on variety, nutrient density and amounto Limit calories from added sugars and saturated fats and reduce sodium intakeo Shift to healther food and beverage choices

Replace typical food and beverage choices with nutrient-dense options. Be sure to consider personal preferences to maintain shifts overtime

o Support healthy eating patterns for all Per the Dietary Guidelines for Americans, what food groups and nutrients should be

increased in the diets of Americans and why?o Whole grains

o Refined grains (good source of folate and B vitamins) o Low-fat dairy, fat free, reduced fat o Vegetableso Fruito Lean meato Vegetable oils

Per the Dietary Guidelines for Americans, what nutrients should be decreased in the diets of Americans and why? Know specific amounts as discussed in class – added sugar, solid (saturated) fat, sodium, alcohol.

o Added sugar: no more than 10% of daily calorieso Inherent sugar: not really a cap on it o Saturated fatso Sodium o Potassium: no limito No limit on fiber

What are the physical activity recommendations given by the Dietary Guidelines for Americans? Know the difference between recommendations for children and for adults as well as for basic health benefits and substantial health benefits. Basic health benefits: 150 min/week moderate intensity physical activity OR 75

min/week of vigorous activity For additional health benefits (lose weight and maintain weight loss): 300min/week

moderate-itensity physical acivity or 150 min/week of VIGOUROUS activity CHILDREN ALWAYS NEED 60 MIN A DAY OF EXERCISE to maintain healthy

body weight and help with their health Moderate acitivities: burn 3.5-7 kilocalories per minuteVigorous activies: burn more than 7 kilocalories per minute

o Describe and apply the six principles of planning a healthy diet.

o Adequacy- making sure you’re getting the right amount of each nutrient (DRIs)o Balance: making sure that you are getting the right amount of nurtrients without

having too much/too little of another o Kcalorie control: making sure youre achieving your intake of calories based on

what your calorie expenditure is o Nutrient density: lots of nutrients for a small amount of calories o Moderation: all foods fit, not over eating or over restricting, similar to balance o Variety: eating different foods from different food groups

Know the 5 food groups, foods that fit into each food group, and serving size equivalents for each food group. If given a menu, would you be able to count serving sizes and categorize the foods in the food groups?

o Fruitso Grains: make half of your grains whole o Vegetableso Protein

o Dairyo 2 cups of fruit per dayo 2.5 cups of vegetableso 3 cups of dairy per dayo 6 ounces of grains o 5.5 ounces of protein o

How is a person’s total food group serving recommendations determined?o Age/weighto Height and weighto Physical activity

How many servings of each food group are recommended on a daily basis for someone following a 2000 kcal diet?

o 1 serving of grain equals 1 oz (so 6 servings a day) 1 slice of brain 1 cup of ready to eat cereal ½ cup of hot cereal ½ cup pastsa ½ cup rice 1 6 inch tortilla 3 cups popped popcorn 5-7 crackers

o vegetables: eat the color of the rainbow , 1 serving = ½ cup of vegetables (5x servings a day)

½ cup raw or cooked ½ cup vegetable juice 1 cup leafy veggies

o fruit: (1 serving =1/2 cupt) ¼ cup dry fruit ½ cup fruit ½ cup fruit juice

o dairy (1 serving = 1 cup) 2 oz processed cheese 1.5 oz natural cheese 1 cup yogurt (8 oz) 1.5 cups of ice cream 1 cup cows milk 1 cup calcium fortified soy milk 1 cup = 300 mg calcium

o protein: 1 oz protein 1 oz of meat at a time 1/2 oz of nuts (1/8 of cup) 1 egg

1 TBSP nut butter 2 TBSP hummus ¼ cup cooked legumes

How can a person determine if a juice product contains 100% juice?o If a label says 100% juice on the label, there is no added sugar o Juice drink/juice nectar= sugar/sweetener/ non-nutritive sweetener addedo Tell you on front of the label or above your nutrition facts panel

What principles should be followed regarding how 100% juice may fit into a healthy balanced diet?

o Watch your natural sugar content o Calorie counts

How can a non-dairy milk alternative contribute to meeting a person’s dairy needs?o Lose proteino Less potassium conteto More MUFA/PUFA out of nut based (soy, almond) milko Coconut milk has more saturated fat o Same amount of dairy in plant based milk

What are some nutritional pros/cons to using non-dairy milk alternatives as a replacement for cow’s milk?

o Cons: less protein content

Understanding Food Labels Nutrition Fact Panel and Ingredient List—Be sure that you are able to read a food label to

determine serving size, kcals, ingredients, nutrients, etc. Also, make sure that you would be able to identify ingredients that would be classified as solid fats (e.g. partially hydrogenated oils, palm oil, butter, etc.), nutritive sweeteners (e.g. sucrose, fructose, HFCS, etc.), non-nutritive sweeteners (e.g. aspartame, stevia, sucralose), whole grains, and sodium based on the ingredients listed on a food label.

How are ingredients listed on a food label (i.e., order of presentation)?o Listed in order from greatest amount to least amount

What are key changes to the food label – information that must be listed, information being removed, changes in presentation of information, etc. (look at charts in the powerpoints)

o Paty attention to whole grains vs refined grainso Multigrain does not mean whole grain, just means more than one grain

Whole grains: brown rice, buckwheat, bulgur o Pay attention to added sugar vs natural sugar o Solid fats vs liquid fat (solid = bad) o Added sodium

Specifically which micronutrients must be listed on a food label – per new label requirements?

o Vitamin D o Potassium o Calciumo Irono We include these micronutrients on the label because most American’s don’t get

enough of these micronutrients Vitamin d: bone health Potassium: lowering blood pressure

What does the term “sugar” mean on the current Nutrition Facts Panel? How does the current use of the term sugar differ from the requirements on the new Nutrition Facts Panel?

o Separating out the total sugar and the added sugar clearly definedo Also remember that the carbohydrates listed (minus the fiber) are eventually

going to be sugars What is the difference between a nutrient content claim vs. health claim vs. structure-

function claim?o Health claim: have to have scientific evidence behind them. Telling you an

association between an ingredient or nutrient and how it helps reduce risk of some type of disease

Ex: diets low in sodium may reduce the risk of high blood pressure a disease associated with many factors

Ex: soluble fiber from foods such as (blank) as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease

o Nutrient claim: claim that has to do with the amount of a nutrient in a food product

Ex: low in (blank) Ex: good source of (blank) No/free = doesn’t mean completely zero. Typically >.5g or mg of a

product Reduced/less = 25% fewer per serving than original High/rich source/excellent of = more than 20% of daily allowance per

day of a nutrient Good = 10%-19%

o Structure/function claims: just saying a fact Calcium maintains strong bones Fiver maintains bowel regularity Vitamin C helps support healthy immune system When using s/f claim, dietary supplements must state: “this product is

not intended to diagnose, treat, cure, or prevent any disease” What is the USDA definition of an organic food?

o No synthetic pesticides and fertilizerso No genetically modified organisms o No hormones and antibiotics used

o No irradiationo If a product’s ingredients are 95% follow all 4 of these then they get the seal

from the USDA What is the food allergen labeling law?

o Required labeling of a food with a top 8 food allergeno Bolded in ingredients listo Or listed separately by “contains…”

What are the 8 most common food allergens?o Milko Soyo Eggso Wheato Peanutso Tree nutso Shell fisho Fin fish

Pregnancy Nutrition How does the nutritional status of both men and women prior to pregnancy affect

pregnancy outcomes and infant health?o Both male and female nutrition status are equally important

Know the order in which nutrients are used by the mother, placenta, and fetus during pregnancy – how could this impact the way you counsel a pregnant patient/client about her nutrition status?

o First: mother Important because you can’t have a “bun” without the “oven”

o Second: placenta Important because that’s where the blood supply of the mother and baby

cross o Third: fetus

Know the different kcal and nutrient needs during the stages of pregnancy and lactation, including specific nutrients that we talked about in class, amounts of those nutrients (RDAs), and purpose of those nutrients during pregnancy and lactation.

o Increased Calorie Needso Carbohydrate Needs and Metabolism= 175 gramso Protein Needs= RDA for 1st trimester: .8g/kg body wt@ minimum 46 g/day

RDA for 2nd and 3rd trimester=1.1 kg/body wt @ minimum 71 g/day (additional 25 grams)

o Lipid Needs and Metabolism – including key fatty acids and food sources 1st 20 wks lipogenisis

2nd 20 wks lipolysis and cholesterol synthesis ( breakdown of fat to release the fat to the baby when the baby is experiencing most of cell growth and organ systems)

o Folic Acid and Vitamin B12 Folic acid

Support fetal neural and cell development Find in fortified cereal grains Prevents neurotube defects Consume before and during pregnancy RDA: 400 mcg prior to and 600 mcg during pregnangy

B-12o Assist folate metabolism

o Iron Iron suppor larger blood vaolume and oxygen transport Iron deficiency anemia common in woman and infants Increase absorption with decreased iron stores; absorption increases after

30th week RDA 27 mg/day Iron and vitamin c rich foods UL during pregnancy is 45 mg/day

o Calcium For mother; increased absorption, decreased excretion, increased bone

turnover and reformation Fetal peak demand during 3rd trimester Adequate intake prior to, during, and after pregnancy will lead to repletion

after pregnancy DRIs during pregnancy same as priot to pregnancy

Adults 19-50 need 1000 mg (3 servings a day) Adolescents need 1300 (4 servings a day) Adults older than 50 years need 1200 mg a day (3.5-4 servings a day)

o Vitamin D Needed for fetal growth, bone, and teeth formation Women at risk for deficiency

Obese African americans Vegetarians/ vegans Norther climates during winter months

Dietary sources: dairy, milk, yogurt, chesse 600 IU RDA UL during pregnancy 4000 IU Deficiency may requires up to 2000 IU D3 cholecarlciferol = animal products D2 ergocalciferol = plants

o Fluid

At least 10 cups of fluid a day Can include water, juice, coffee, milk

o Fiber At least 28 g/day (insoluble and soluble)

o Caffeine, Alcohol, Non-Nutritive Sweetener Use FDA approved aspartame, acesulfame potassium, sucralose, saccharin,

neotame at normal levels during pregnancy Caffeine: <200 mg/day which is about 12 – 16 fl oz coffee/day No alcohol intake

What health risks are associated with low weight gain and excessive weight gain during pregnancy?

o Too litte weight gain= increase risk of pre-term and SGA infantso Too much weight gain=increase risk of post-partum weight retention

Know weight gain recommendations/guidelines during pregnancy (how much weight total as well as how much weight per trimester).

o 25-35 lbs for normal weighto 28-40 lbs for underweighto 15-25 lbs for overweighto 11-20 lbs for obese o first trimester: 2-4 lbs totalo 2nd and third trimester: about 1 lbs per week s

How and when should a multivitamin supplement be used during pregnancy?o MVM supplements should complement a healthy dieto Advised for:

Those who have a nutrient inadequate diet Those who smoke, drink, or use drugs Multifetal pregnancy Vegans Iron-deficiency anemia Other diagnosed nutrient deficiency

o Prenatal MVM recommended nutrients and doeses Folic acid: 400-800 mcg Calcium: 250 mg Iron: 30 mg Vitamin c: 30 mg Zinc: 15 mg Copper: 2 mg Vitamin b6: 2 mg Vitamin d: 400 IU

Know the following conditions that could occur during pregnancy, including cause of each, relationship to nutritional status, and prevention/treatment: listeriosis, toxoplasmosis, morning sickness, pica, GERD, constipation, mercury contamination, iron-deficiency anemia, neural tube defects, gestational diabetes, fetal alcohol syndrome

o Listeriosis Hot dogs & deli meats…unless cooked to 165 degrees Fahrenheit Soft cheeses…unless pasterurized Fresh fruit juice and raw milk…unless pasteurized Refrigerated smoked seafood..unless cooked to 165 degrees fahrenheit

o Toxoplasmosis Raw and undercooked meat and seafood Unwashed fresh fruits and vegetables Contaminated (unclean) drinking water Cat liter boxes and feces

o Morning sickness Typically begins at week 5 and ends at the end of the first trimester around

week 13 Can actually occur at any time during the day Associated with blood sugar levels and hormone changes (insulin and

glucagon) Associated with reduced risk of miscarriage Severe and persiste N/V=hyperemesis gravidarum Therapeutic interventions

Keep blood sugar stable Investigate use of vitamin B6 and ginger

Try eating lots of small meals throughout the day to make you feel bettero Pica

Eating disorder or nutrition deficiency Associated with iron Most commonly seen in

African americans Those residing in the souther us Nutrient deficient (fe, zn, ca) during pregnancy

Geophagia (want to eat dirt) , pagophagia (laundry detergent, ice chips, metal), amylophagia (starchy things, paper, chalk, baking powder)

o GERD Gastro esophageal reflux disease Avoid consuming large, high fat meals Avoid carminatives (spearmint oils), caffeine, chocolate Avoid garlic and onions, spicy, acidic food Avoid eating several hours before ved Stay upright and avoid vigorous activity after eating Increase proteins intake Consume beverages between meals Lose weight if overweight Avoid wearing tightly fitting clothing Reduce stress

o Constipationo Mercury contaminationo Iron0deficiency anemiao Neural tube defectso Gestational diabeteso Fetal alcohol syndrome

What are the benefit of exercise during pregnancy, and what are the guidelines for exercise during pregnancy?

o Reduce risk of BDM, preeclampsia, low back pain, excessive weight gain, blood clotso Not advised for poorly nourished or high-risk pregnancieso Recommendations for low-risk pregnancies

30 min @ 60-70% VO2 (volume of oxygen that is inhaled during physical activity) max 5x/week

low impact and low fall risk: walking, cycling, swimming

Infancy Nutrition Be familiar with key nutrient needs for an infant – why are each important, key principles

discussed in class, supplementation guidelines, special considerations with breast vs. formula feeding. You do not need to know specific amounts (DRIs).

o Energy Needs 80-120 kcal/kg body weight highest metabolic rate than any other point in life because of most rapid

growth period energy needs at its highest DRI 1st 6 months: 108 kcal/kg DR 2nd 6 months: 98 kcals/kg Inability to tolerate fasting because of very high kcal needs Factors affecting energy needs of infants similar to those affecting energy

needs of adultso Carbohydrate – Function and Main Form

Remains body’s primary metabolic feul Consumed as lactose (milk-based), sucrose, or corn syrup AI for Infants

Birth to 6 mo:: 60 g/day 6 mo to 12 mo: 95 g/day

lack of adequate glucose will lead to body using more AA for glucose production = degrease in infant growth

fiber: begin introduction with solid food (about 5 g/day by 1 Years) need carbs more than protein

o Protein Don’t have very high protein needs Needs impacted by body composition: if an infant is more muscular they will

need more protein

For formula-fed infants: make sure the baby is not under or over fed and formula is made correctly b/c if not, baby will be malnourished or overweight

o Lipids – Function and Best Types of Fatty Acids for Infant DHA needs to continue during breastfeeding (low mercury fatty fish) Fat is main source of baby’s energy needs Good absorption of human milk fat and vegetable oils Poor absorption of butter fat

o Fluoride Function: healthy tooth enamel and prevent cavities Fluoridated tap water is safe for lactating women and infants because the

amount in breast milk is low in fluoride Fluoride supplements may be needed for infants in an area with low fluoride Too much fluoride: dental fluorosis CDC and ADA recommendation: use low fluoride bottled water (i.e. distilled

or purified) or preparing powdered or concentrated infant formula for formula fed infants because tap water will results in fluoride toxicity

o Vitamin D Calcium absorption and bone mineralization Deficiency: rickets All infants: 400 IU/day Supplementation advised in breast-fed infants Or formula fed infants less than 1 L a day because breast milk is missing Vitamin D liquid drops

o Iron If a women when she was pregnant had adequate iron or supplementing (27

mg/day) the baby is going to store iron in its liver and be able to store iron in its liver in order to have enough iron in their liver for the first 6 months of their life

Breast milk is not a good source of iron but won’t be a problem if the baby had adequate iron stores while in the womb

For how long do the AAP and AND recommend that infants be exclusively breastfed? Breastfed with complementary foods?

o First 6 months of life should be breast feeding SOLE SOURCE OF NUTRITION INTAKE o Introduce complementary (in addition to breast feeding) foods by 6 months of life o Continue breastfeeding until at least 12 months of age o Breastfeeding past 12 months of age should be based on mutual decision between

mother and infant Know pros/cons to breast feeding vs. formula feeding – benefits of breast feeding for

mother and for infant.o Benefits for mother

Oxytocin release-uterine contraction and reduced post partum blood loss Prolactin release- delays ovulation (birth spacing) Post-partum weight loss

Reduction in breast cancer, ovarian cancer, and RA Psychological benefits: reduced post-partum depression and improved self

confidence Reduced food cost-aunual formula cost $1500

o Benefits for infant Nutritionally complete for 1st 6 months of life Immune support

T and b lymphocytes Immunoglobins Histocompatibility antigens Bifidus factors Nutrient carrier proteins: iron and vitamin B 12 Enzymes

Reduced infant mortality, particularly from SIDS Reduced occurrence infant acute illness Reduced risk of allergies Reduced risk chronic illness- DM, GI, CA

DM= diabetes GI= gastrointestinal CA= cancer

Reduced risk of childhood obesity Improved cognitive functionality

Know key differences in nutrient composition of breast milk vs. standard infant formula vs. cow’s milk.

o Human milk 22 kcal .32 g whey protein (more easily digested than casein 2.12 g carbs 1.35 fat g 10 mg calcium iron .01 mg (more bioavailable) 1.5 mg vitamin c vitamin d 1 IU

o infant formula 20 kcal .44 protein 2.4 g carbs 1 g fat 13.4 mg calcium .3 mg iron (start to interfere with the iron absorption) 2.0 vitamin c 12 IU vitamin D

o whole cow’s mllk SHOULD NOT HAVE BEFORE 1 19 kcal

1 g protein (casein) 2.4 g carbs 1 g fat 37.5 calcium .01 iron mg 0 vitamin c 16 IU vitamin D

Know nutrient(s) that breast milk is complete in and potentially deficient in.o Vitamin d pretty low in human milk

Know when an infant may receive cow’s milk and why it is advised they wait to consume.o Shouldn’t have this before one year of ageo Baby doesn’t have the enzyme to break down the protein casein that is present in

cow’s milk Know principles of infant formula preparation related to food safety.

o Prepare formula in CLEAN environmento Use refrigerated bottles of concentrated or ready to fee formula within 48 hours of

preparationns Know key material nutrient needs during lactation. Know specific DRIs for those provided on

slides in class.o Energy

Add 330 kcal/day from food to lose weight (DRI) (170 kcal/day) 500 kcals spent in the first 6 months of milk production 400 k cals spent thereafter research studies +450 kcal/day (170kcal day from stores)=620 kcal/day to

support milk production less than 1500 kcal/day reduces milk production

o Omega-3 DHA Consume 200-300 mg/day

o Micronutrients Ensure intake of nutrient dense foods to support adequate macronutrients

and micronutrient content of breast milk Routine supplementation not advised unless deficits noted

o Fluid 2.7-3.4 l/day (about 10 to 14 cups/day)

Know principles related to caffeine, alcohol intake, allergen food consumption during lactation.

o caffeine Low levels in breast milk – 1% maternal plasma levels Infants ability to metabolize caffeine occurs @ 3-4 months leads to

accumulation in the infant prior to that point Short term SE to infant: hyperactivity, wakefulness, fussy Recommendation: < 300 mg/day (~ 3-8 fl oz cups coffee)

o Alcohol

Easily passes through breast milk to infant Levels in breast milk = amount in maternal plasma levels (clears from milk

once cleared from plasma) Peaks: 30-60 minutes post-consumption (without food) 60-90 minutes post-

consumption (with food) Clears of 1 standard drink is about 2 to 3 hours Basically you need to wait for the alcohol to clear your system before you

feed your baby breast milk Should not be used as a galatctogogue (meaning doesn’t stimulate breast

milk) May need to pump and save alcohol free breast milk Limited use of no more than .5 g of alcohol per kg maternal body weight per

day (about 2 drinks per 132 # female) Know when and what foods should be introduced to an infant at different growth periods

and why these foods are introduced at the various stages of growth.o 4 to 6 months

introduce solid foods with iron0fortified rice cereal o 6-8 months

add strained vegetables before fruits plain vegetables: green peas, potatoes, carrots, sweet potatoes, squash,

beans plain fruits: bananas, applesauce, apricots, pears, peaches, melon

o 8 to 12 months add strained and then chopped meats finger food

Know general principles related to feeding complementary foods to infants.o Add single food ingredients one at a time at intervals of 2 to 7 days between to

assess for allergies and intoleranceso Do not feed honey/ corn syrup to an infant less than 12 months old (risk of botulism) o Do not feed the baby caffeinated beverages, sugar-sweetened beverages, herbal

beverages & products, low calorie or non nutritive sweetener beverages and products , water should be used sparingly, even with illness

Know guidelines for juice intake in infants.o Begin offerin cup for water or 100% juice after 6 monthso Limit juice intake to no more than 4 fl oz to 6 fl oz day o Provide only in a cupo Provide only pasteurized juiceo Should be complementary to breast milk/infant formulao Provide only 1-2 fl oz at a time when a cup is introducedo Use of a sippy cup not the same as use of open cup ( so a cup is better because

doesn’t cause cavities like a sippy cup might Why should cow’s milk be avoided by infants until after age 1? Why should new foods be introduced to an infant one-at-a-time?

What foods serve as a choking hazard to infants?o Hot dogs should be small, not circular o Pieces of hard candyo Sticky substances

Older Adult Nutrition Old age

o Institute of Medicine: categories of 51-70 and greater than 70 years oldo World health organization says greater than 60 years oldo U.S > older adult nutrition programs greater than 60 years old o

What are the six key lifestyle behaviors that have the greatest influence on adult health?o Sleeping regularly and adequatelyo Eating well-balanced meals regularly o Engaging in physical activity regularlyo Not smokingo Not using alcoholo Maintaining a healthy body weight

What are the two main goals of health promotion and disease prevention for aging adults?o Maintaining health o Functional independence

Relate the physiological changes associated with the aging process to alterations in nutritional status and associated health implications in the older adult. Know nutrition prevention/intervention for each – key nutrients and nutrient sources.o Change in body composition – sarcopenia

Gradual decline in skeletal muscle mass Subsequent decline in strength and or performance Aging promotes decrease in LBM and in crease in lipogenesis (bisceral

Decline in protein synthesis and cell mass Decline in physical activity Increase in proteolysis (diminished sex hormones and increase

pro-inflammatory cytokines) o Change in metabolic rate related to changes in body composition – impact on energy

needs Decline in metabolic rate

Decline in LBM (lean body mass) –primary determinant of resting metabolic rate (RMR)

Decline in physical activity Decline as part of physiology of aging Decline in appetite (anorexia of aging) Focus on “frugal” use of kcals for nutrient-dense foods

o Anorexia of aging and weight loss

Lack of appetite o Fluid status and urinary tract infection risko Digestive tract function – constipation

Inadequate fiber intake and hydration Lack of physical activity Declining muscle tone Use of medications (narcotics can ve very constipating Diet 25-35 grams fiber/day and adequate fluids Daily exercise Bowel medications as needed

o Protein status Hard to get adequate source because meat is expensive and many elderly

people are on social security checks Needed to support a healthy immune system Maintenance of lean body mass and functional status Promote wound healing and recovery from illness

o Anemia—both microcytic and macrocytico Polypharmacy and nutritionally relevant side effects of medicationso Oral complications

Dentures and partials, tooth loss, endentulous Avoid hard to chew , crunchy foods, need soft foods Tooth loss, gum disease, and reduced salivary output impede chewing

and swallowing Discomfort and pain associated with eating may reduce food intake

Define key nutrient requirements during older adulthood including rationale (importance to the body/function), good dietary sources, DRIs, and appropriate use of supplementation.o Calories

Decline in metabolic rate and therefore energy needso Fluids

Lack of thirst and decreased today body water make dehydration likely Mild dehydration is common cause of confusion Difficulty obtaining water or getting to the bathroom may compound the

problem 1 ml/kcal for adults or 30 ml/kg UBW for adults minimum 1500 ml/day or 6 cups a day

o Fiber 25-35 g days

o Protein RDA for older adults = .8g/kg body weight OR suggested 1 to 1.6 g/ kg body weight Protein has to be obtained from low kcalorie sources of high quality

protein such as lean meats, poultry, fish, and eggs; fat free and low fat milk products and legumes

Underweight adults need protein and energy dense snacks such as hard boiled eggs, tuna fish and crackers, peanut butter on wheat toast, and hearty soups.

o Iron Prevention of iron-deficiency anemia

o Vitamin B12 & Folic Acid Prevent macrocytic anemia 2.4 micrograms of vitamin b12 and vitamin b 12 fortified foods such as

fortified cereals are used to meet much of the DRI recommended intake o Vitamin D & Calcium

600 IU/day and 1200 mg/dayo Antioxidants

Vitamin A, E, C, selenium Aim to achieve through adequate dietary intake Caution with mega-dosing via dietary supplements

o Vitamin K Considerations with anti-coagulant therapy (i.e. Coumadin or warfarin)

o Sodium No more than 1500 mg/day

o Potassium 4700 mg/day

Food Safety What is the definition of a foodborne illness?

o A disease carried or transmited to people by food; any illness or injury that results from something that has been eaten

How do people contaminate food/modes of foodborne illness transmission?o

What are the 5 most common factors that influence risk of food-borne illness? How could each of these factors be controlled to reduce risk?

o 1. Purchasing food from unsafe sourceso 2. Failing to cook food adequatelyo 3. Holding food at incorrect temperatureso 4. Using contaminated equipmento 5. Poor personal hygiene

What populations are at highest risk for food-borne illness?o Elderly peopleo Preschool-age childreno People with compromised immune systems

Know definitions: pathogen, infection, intoxication, biological causes, physical causes, chemical causes

o Pathogen: a disease-causing microorganisms such as Viruses, bacteria, fungi, parasites

o Infection: illness resulting from live disease-causing or pathogenic microorganisms (viruses & protozoa do not reproduce in food)

o Intoxication: illness caused by eating toxins (poisons) produced by microorganisms

What is the temperature danger zone? What foods are most likely to become unsafe and be mediums for foodborne illness

transition? Be able to identify key foods or health concerns with each of the pathogenic bacteria and

viruses presented in the PPT slide set on food safety. How does handwashing help prevent the spread of food-borne illness and what is the

proper technique for handwashing?1. Wet hands and arms

a. Use running water as hot as you can comfortably stand, it should be at least 100 degree F

2. Apply soap a. Apply enough to build up a good lather

3. Scrub hands and arms vigorouslya. Scrub them to 10 to 15 seconds clean them uner fingernails and

between fingers4. Rinse hands and arms thoroughly

a. Use running warm water5. Dry hands and arms

a. Use a single-use paper towl or hand dryer, consider using a paper towel to turn off the faucet and open the restroom door

Be able to recognize and define key principles of food safety – Clean, Chill, Cook, Separate. What are proper methods to thawing foods? What are some considerations with microwave cooking? What is a food recall? What should consumers do if a food is recalled? What are some specific nursing applications discussed in the BB readings and audio PPT

related to food safety?