NUTRITION EXAM 2

Biotin

Biotin ØFunction: important role in CHO, fat, and protein metabolism ØRecommended intake and sources •AI: 30 µg for adults. •Synthesized in lower GI tract by bacterial microorganisms (amount produced and bioavailability unknown) •Dietary sources recommended. •*Richest sources are liver, kidney, peanut butter, egg yolks, and yeast.* ØDeficiency •Unknown if typical North American diet is consumed, but possible with intravenous feedings and long-term antibiotic use •Deficiency possible with large intake of avidin from raw egg whites; avidin denatured by heat (cooking) •Symptoms: skin rash, hair loss, appetite loss, depression, glossitis ØToxicity: unknown

Chloride

Chloride 96-100 Function ØExtracellular anion that maintains fluid inside and outside cells ØComponent of hydrochloric acid in gastric juice Recommended intake and sources ØAI: 2300 mg for adults ØSources: table salt (sodium chloride), foods with sodium Deficiency ØVery rare Toxicity: UL of 3600 mg ØImbalance cause by dehydration

Choline

Choline ØFunction: synthesis of acetylcholine (a neurotransmitter) and lecithin (the phospholipid) ØRecommended intake and sources •Body makes choline from amino acid methionine, but not enough to meet body's need; food sources required •AI: 550 mg for men; 425 mg for women •*Sources: milk, eggs, peanuts* ØDeficiency: rare ØToxicity: UL of 3500 mg for adults •*Symptoms: sweating, fishy body odor, vomiting, liver damage, reduced growth, and low blood pressure (hypotension)*

Cobalamin (vitamin B12): cyanocobalamin

Cobalamin (vitamin B12): cyanocobalamin ØFunction •Modifies folate coenzymes to active forms. •Required for metabolism of fatty acids and amino acids. •Develops and maintains myelin sheaths around nerve fibers. •Role in folate metabolism by modifying folate coenzymes to active forms in order to support functions such as DNA and RNA synthesis. ØRecommended intake and sources •RDA: 2.4 µg daily •*Absorption requires intrinsic factor, produced by stomach mucosa* •Accounts for some liver storage of cobalamin •*Sources: only animal-derived foods (meat, fish, poultry, eggs, dairy)* •Vegans must supplement or use fortified products ØDeficiency •Usually secondary •*Results in megaloblastic anemia or pernicious anemia* •Additional neurologic or neuropsychiatric effects •Older adults at risk •May be masked by folate levels ØToxicity: unknown

vitamin

Divided into two categories based on solubility *Water-soluble: dissolve in water:* These pass through the body's water supply. The body cannot keep these vitamins, so they must be ingested for the body to maintain an appropriate level. Ø*B-complex vitamins (thiamin, riboflavin, niacin, pyridoxine, folate, cobalamin, biotin, and pantothenic acid), choline, and vitamin C* ØMinimal storage by body ØDeficiencies quick to develop -- within weeks so need to take these daily. ØUsually low risk of toxicity & secreted in urine *Fat-soluble vitamins: dissolve in fatty tissues or substances: vitamins A, D, E, and K* ØExcess stored in body -- liver & spleen for 3-6 weeks ØDeficiencies slower to develop ØGreater risk of toxicity FOOD SOURCES: Synthetic vitamins (supplements) perform some vitamin function. Ø*Vitamins are best consumed from food sources!!* ØSynthetic vitamins may lack other benefits found in foods. Fresh fruits and vegetables are particularly rich sources. Others are legumes, whole grains, and animal foods—meat, fish, poultry, eggs, and dairy products. Even the almost pure fats of vegetable oils and butter provide vitamins E and A, respectively. Phytochemicals are nonnutritive substances in plant-based foods that appear to have disease-fighting properties. (Broccoli)

Childhood: Stage II(Ages 4 to 6 Years) / Preschool

Eating characteristics ØIndependence ØVariable hunger and appetite levels ØContinued introduction of new foods ØFood jags Nutrition requirements ØEnergy: 1800 kcal ØProtein: 24 g ØDietary Guidelines for Americans:for children older than 2 years of age •Recommendations: Fat: 30% to 35% of kilocalories, ages 2 to 3 years Fat: 25% to 35% of kilocalories, ages 4 to 18 years •Acceptable Macronutrient Distribution Ranges (AMDR): Fats ≈ 30% of kilocalories; added sugars > 25% of total kilocalories Dietary fiber: >19 g/day for ages 1 to 3 years 25 g/day for ages 4 to 8 years 31 g/day for boys aged 9 to 13 years 26 g/day for girls aged 9 to 13 years

Nutritional education and screening related to food sources

Effects of drugs on food and nutrients ØDrug absorption rate may increase or decrease in the presence of food in the gastrointestinal tract. ØDrugs, including alcohol, may alter food intake, nutrient absorption, metabolism, and excretion. ØDrugs may alter mineral levels, causing depletion or overload. ØDrugs may act as appetite suppressants or stimulants. ØEffects of food on drug action may produce uncomfortable side effects. Effects of food and nutrients on drugs ØFood intake and composition: affect drug absorption ØTiming of drug administration in relation to meals: significant ØTube-feeding effects Effects of herbs on food, nutrients, and drugs ØHerbs may significantly affect bioavailability of foods, nutrients, and drugs ØHerb and drug interactions may occur Application to nursing ØUse of herbs medicinally as prescribed by knowledgeable health care professional ØQuestions to ask patients who may take herbal products

Food and Athletic Performance

Fat ØFat amount used depends on duration and intensity of exercise, prior training, and diet composition. ØAerobic activity promotes fat use as energy source. ØAerobic activity increases ability to burn fat as fuel and spares muscle glycogen. ØAccording to American College of Sports Medicine, 20% to 25% of energy used is from fat. Vitamins and minerals ØExcessive intake: common among athletes Ø"Thin-build" athletes: at risk for vitamin/mineral deficiencies; supplementation may be indicated (100% Dietary Recommended Intake) Ergogenic aids ØDrugs or dietary regimens believed to increase strength, power, and/or endurance ØHealth and efficacy concerns

Folate: folacin, pteroylglutamicacid (PGA), folic acid (synthetic)

Folate: folacin, pteroylglutamicacid (PGA), folic acid (synthetic) ØFunction: •Coenzyme in one-carbon transfer during metabolism •Required for the synthesis of amino acids, deoxyribonucleic acid (DNA), ribonucleic acid (RNA) •*Consists of the heme portion of hemoglobin* •*Role in proper formation of fetal neural tubes, which affects brain and spinal cord development; helps prevent spina bifida and anencephaly* ØRecommended intake and sources •Adults: 400 µg Physiologic state affects folate needs: RDA of 600 µg during pregnancy; RDA of 500 µg for lactation needs •*Folic acid fortification of cereal grain products* •*Possible risks of fortification: masking cobalamin deficiency in elderly patients; benefits outweigh risks* Ø*Food sources: leafy green vegetables, legumes, some fruits, fortified cereal grains* •Affected by heat, oxidation, ultraviolet light, processing *Folate is found in many foods that contain ascorbic acid (vitamin C), such as oranges and orange juice*. Ascorbic acid protects folate from oxidation. *Diets deficient in folate often are deficient in vitamin C, and vice versa.* ØDeficiency •*Risk with conditions that increase cell division including infection, cancer, burns, blood loss, GI damage, growth, and pregnancy., limited food intake and variety, and chronic excessive alcohol ingestion* •Results in megaloblastic anemia, glossitis, diarrhea, irritability, absentmindedness, depression, anxiety •Drug-nutrient interactions: anticonvulsants, oral contraceptives, aspirin ØToxicity: UL of 1000 µg of folic acid •Excess folate or folic acid intake not recommended or warranted; *may mask cobalamin deficiency (pernicious anemia)* need to increase during pregnancy Before folic acid supplementation is administered, the absence of Vitamin B12 deficiency must be established.

Gallbladder Disorders

Gallbladder Disorders Common disorders: ØCholelithiasis, choledocholithiasis, cholecystitis Causes and predisposing factors Ø*High-fat diet* ØWomen: multiparity ØOral contraceptive or estrogen use ØObesity ØSedentary lifestyle ØRapid weight loss, very low-calorie diets ØOlder age *Symptoms of cholelithiasis (gallstones):* ØAfter eating: mild pain in midepigastrium ØColic attack: pain radiating to right upper quadrant and right subscapular area *Symptoms of cholecystitis (inflammation of gallbladder wall):* ØPain, tenderness, fever ØFat intolerance, nausea, heartburn ØJaundice, steatorrhea Nutrition therapy Ø*Pain control: avoid foods that cause discomfort; follow low-fat diet.* ØPostoperatively: start with clear liquids and progress to regular diet. ØMany patients follow low-fat diet, but individual tolerances vary. Treat pain

Diabetes Mellitus: Nutrition Therapy Goals

Goals of nutrition therapy ØAttain and maintain optimal metabolic outcomes: blood glucose, lipid, and lipoprotein profiles; and blood pressure ØPrevent and treat chronic complications ØImprove health through healthy food choices and physical activity ØAddress individual nutritional needs, personal and cultural preferences, lifestyle, and willingness to change. ØMedical team member responsible for providing nutrition therapy should be the registered dietitian. ØEmphasize importance of nutrition assessment and individualization. ØAddress use of fructose and other nutritive and nonnutritive sweeteners. Improper Diet Orders: "No concentrated sweets," "no sugar added," "low sugar," and "liberal diabetic" ØWhy unsuitable: •They do not reflect diabetes nutrition recommendations. •They pointlessly restrict sucrose. Sweeteners: *Nonnutritive sweeteners approved for use by the US Food and Drug Administration (FDA), such as saccharin, aspartame, and acesulfame potassium, are considered safe for consumption by individuals with diabetes.* *Blood Glucose Level Goals:* Before meals: 70 to 130 mg/dL Two hours after meals: less than 180 mg/dL (expect a 30- to 50-point rise from premeal glucose) Bedtime: 90 to 150 mg/dL Diabetes Self-Management Education Involves comprehensive nutrition assessment; self-care treatment plan; and client's health status, learning ability, readiness to change, and current lifestyle The goal: ØTailoring the meal-planning approach to each individual's needs When Ill: Effect on blood glucose concentration: elevates Effect on appetite: decreases How to manage: ØMonitor blood glucose level at least four times a day. ØTest urine for ketones. ØDo not omit medications to control blood glucose level (dose may need to be adjusted). If regular foods are not tolerated, replace carbohydrates in the meal plan with liquid, semiliquid, or soft foods. ØCarbohydrate: either of the following •15 g of every 1 to 2 hours •50 g of carbohydrate every 3 to 4 hours ØLess if blood glucose is greater than 240 mg/dL Drink 8 to 12 ounces of liquid every hour. Small amounts of salty foods may be needed after vomiting and diarrhea.

Major Minerals: Magnesium

Major Minerals: Magnesium 1.5-2.5 Function ØStructural and storage function in bones Ø*Assists enzymes; regulates nerve and muscle function, including heart* ØRole in blood-clotting process and immune system Recommended intake and sources ØRDA: 420 mg for men for 31 years and older; 320 mg for women for 31 years and older Ø*Sources: unprocessed foods, whole grains, legumes, leafy green vegetables, broccoli* Deficiency Ø*Secondary causes: excessive vomiting and diarrhea, gastrointestinal disorder, kidney disease, alcoholism, malnutrition* Ø*Symptoms: muscle twitching and weakness, convulsion* Toxicity: UL of 350 mg (nonfood sources) ØRare but serious 60% of the body's magnesium is held in the bones. Magnesium impacts the ways calcium is transported from the gastrointestinal (GI) tract and formed into bone, as well as the hundreds of enzymatic responses in cells that effect bone density. Additionally, this important mineral is necessary for protein formation that helps to form bone. The RDA for magnesium varies depending on age but for adults is 300 mg per day; food sources include fish, fruits, and dairy products.

Major Minerals: Sulfur

Major Minerals: Sulfur Function ØComponent of protein structures Recommended intake and sources ØNo Dietary Reference Intake (DRI) established Ø*Sources: all protein-containing foods* Deficiency: Does not occur Toxicity: Not a health issue

Common Nutrition-Related Discomforts of Pregnancy

Nausea and vomiting ØMorning sickness ØHyperemesis gravidarum: severe and unrelenting vomiting ØCauses ØStrategies: •Eat small frequent meals •Drink liquids between, rather than with, meals •Avoid fried and greasy foods •Reduce coffee intake •Avoid cooking odors Heartburn ØPossible contributors ØStrategies: •Eat small, frequent meals •Avoid foods high in fat •Drink fluids between meals •Limit spicy foods •Avoid lying down after a meal Constipation ØCommon during first and third trimesters ØStrategies: •Increase fluid and fiber consumption •Perform moderate exercise ØHemorrhoids

Niacin (vitamin B3): nicotinic acid and niacinamide

Niacin (vitamin B3): nicotinic acid and niacinamide: *Niacin deficiency can bring on a psychosis that dissipates once sufficient quantities are consumed.* ØFunction: coenzyme for many enzymes, especially energy metabolism; critical for glycolysis and tricarboxylic acid (TCA) cycle ØRecommended intake and sources •RDA (measured as niacin equivalents [NE]): 16 mg NE for men; 14 mg NE for women Amino acid tryptophan precursor of niacin 60 mg of tryptophan converts to 1 mg of niacin •*Diets adequate in protein: adequate in niacin* •*Sources: protein-containing foods (meats, poultry, fish, legumes, enriched cereals, milk, coffee, tea)* Ø*Deficiency: pellagra* •The 3 Ds: 1. Diarrhea: Gastrointestinal (GI) tract damage alters digestion, absorption, and excretion, which leads to glossitis, vomiting, and diarrhea. 2. Dermatitis: Symmetric scaly rash occurs only on skin exposed to sun. 3. Dementia: In severe deficiencies, confusion, anxiety, insomnia, and paranoia develop. •Risk increased by excessive alcohol consumption, malabsorption Ø*Toxicity: causes vasodilation and flushing effect* •UL: 35 mg NE per day •Therapeutic megadoses: may lower total cholesterol level, decrease low-density lipoprotein (LDL) level, and increase high-density lipoprotein (HDL) level Monitoring necessary to prevent liver damage, gout, and arthritis The incidence of pellagra decreased dramatically when refined wheat flour (white flour) was required to be enriched with niacin. Niacin is naturally found in whole wheat flour but is lost when processed into refined white flour.

Nutrition During Adolescence(Ages 13 to 19 Years)

Nutrition During Adolescence(Ages 13 to 19 Years) Responsibility for own behavior increases, but adult guidance still required ØPhysical and emotional support of adults •Guidelines for dietary patterns •Providing food for consumption ØAdjusting to demands of college environment ØInfluence of fast food Nutrition requirements ØEnergy: 2300 to 2900 kcal for male adolescents; 2200 kcal for female adolescents ØProtein: 45 to 59 g for male adolescents; 45 g for female adolescents ØCalcium: AI, 1300 mg Risk for diet-related disorders and eating disorders Knowledge ØHigh-energy needs for sports and growth ØCalcium for bone mineralization ØSchool-based curriculum on nutrient needs ØEffects of disordered eating and substance abuse on nutritional status Techniques ØMyPlate ØFruits & Veggies—More Matters ØScheduling of meals ØInclusion in meal planning and food preparation Community supports ØNo specific programs for adolescents ØComprehensive school health programs

Nutrition During Pregnancy

Nutrition During Pregnancy Successful pregnancy outcomes include ØViability and acceptable birth weight of infant ØNo congenital defects in infant ØFavorable long-term health outlook for mother and infant Body composition changes during pregnancy ØMany metabolic, anatomic, hormonal, psychologic, and physiologic changes in mother ØHormones of pregnancy •Placental hormones: human placental lactogen and human growth hormone •Progesterone •Estrogen Metabolic changes ØBasal metabolic rate (BMR) increases 15% to 20% by end of pregnancy Ø*Mother uses fat as fuel; fetus uses glucose* Anatomic and physiologic changes ØChanges in blood •Plasma volume doubles •Hemodilution ØRenal changes •Increase in glomerular filtration rate (GFR) •Possible serious problem: preeclampsia or pregnancy-induced hypertension ØGastrointestinal (GI) changes •Slower GI motility •Smooth muscle relaxation •Consequences of GI changes: constipation, heartburn, delayed gastric emptying Weight gain in pregnancy ØThree components of maternal weight gain •Changes in maternal body composition: increased blood and fluid volume •Maternal support tissues •Products of conception (fetus and placenta) ØConsequences of inadequate weight gain •Low birth weight •Small for gestation age (SGA) status ØCurrent weight recommendations based on body mass index (BMI) •Normal BMI (18.5 to 24.9): 25 to 35 pounds •Underweight BMI (<18.5): 28 to 40 pounds •Overweight BMI (25 to 29.9): 15 to 25 pounds •Obese BMI (≥30): 11 to 20 pounds ØPattern of weight gain ØOverweight and obese women •Weight gain still needed for fetus and support tissue •Increased risk for operative delivery, postpartum weight gain, gestational diabetes Increases in all nutrients except vitamins D, E, and K, phosphorus, fluoride, calcium, biotin Energy ØCurrent recommendation: extra 340 kcal/day during second trimester and 452 kcal/day during third trimester ØReason for increased needs ØImplications of inadequate calorie intake during pregnancy Nutrient needs increase during pregnancy to meet the demands of the mother and fetus. Although she appears to be eating for two, the expectant mother need not and should not double her food intake. The amount of increase for each nutrient varies. In most cases, the increases are not large and are relatively easy to obtain through the diet. The current recommendation is for a woman to consume an extra 340 kcal per day during the second trimester and 452 kcal per day during the third trimester of pregnancy. An extra sandwich, fruit, and a glass of milk can easily provide the additional kcal per day, provided that she was eating well before pregnancy. The energy cost of milk production is approximately 500 to 800 kcal per day.

Nutrition Assessment

Nutrition care process: Academy of Nutrition and Dietetics ØConsists of nutrition assessment, diagnosis, intervention, monitoring, and evaluation. Nutrition screening ØRequired by the Joint Commission within 48 hours of hospital admission. ØIdentifies whether patients have malnutrition or nutritional risk. ØPersonnel involved. ØReferral if necessary for further assessment. ØComprehensive nutritional assessment: •ABCD (anthropometric, biochemical, clinical, and dietary assessment) approach ØConducted to determine appropriate nutrition therapy based on identified needs of patient Anthropometric assessment ØSimple, noninvasive techniques to measure height, weight, head circumference, and skinfold thickness Biochemical assessment ØLimitations: no single test is available for nutrition •Testing is inappropriate for some patients •Serial measurements are best •Use with other measurements ØMost important indicators: visceral protein status and immune function •Serum albumin; prealbumin; total lymphocyte count Body mass index (BMI) assessment ØDesired BMI range for healthy adults is 18.5 to 24.9 kg/m2. ØBMIs of 25 to 29.9 kg/m2 are approximately 20% above desirable levels. ØBMI of less than 18.5 kg/m2is classified as underweight and is associated with risk factors such as respiratory disease, tuberculosis, and some forms of cancer. Clinical assessment ØSources of data: medical history, social history, and physical examination ØFeatures associated with nutritional deficiencies Dietary intake assessment Ø24-hour recall ØFood records ØKilocalorie counts

Nutrition-Related Concerns of Childhood and Adolescence

Nutrition-Related Concerns of Childhood and Adolescence Food asphyxiation ØToddlers and elderly persons at higher risk ØFoods associated with choking ØPrevention and Heimlich maneuver Lead poisoning ØSources of lead ØConsequences of lead poisoning ØRelationship with iron-deficiency anemia ØRole of nurses •Awareness of high-risk factors •Lowering lead levels in the environment Obesity ØIncrease among children and adolescents ØEtiology: multifactorial ØClinical assessment and intervention •Health history •Intervention: motivation/weight-associative disorders •Physical symptoms such as sleep apnea Type 2 diabetes mellitus ØRisk factors: overweight during childhood and lack of physical activity ØGenetics and race: predispose some individuals ØPrevention approaches: individual and public health ØTreatment •Include the family •Goal: maintain current weight while growth continues •Goal: develop and maintain a healthy lifestyle ØRole of nurses •Sensitivity to emotional, social, and physical dimensions associated with weight and body composition Iron-deficiency anemia ØPoverty: risk factor •Lead poisoning and chronic hunger increase risk. ØAffects ability to learn ØPublic health issue ØRole of nurses •Educate teaching staff about relationship between iron deficiency and learning ability

Nutrition-Related Pregnancy Concerns

Nutrition-Related Pregnancy Concerns Alcohol ØFetal alcohol syndrome (FAS)/fetal alcohol spectrum disorder (FASD); causes specific anatomic and central nervous system defects; no safe level Foodborne illness High risk for acquiring infections from Listeria monocytogenes, Salmonellaspecies, and Toxoplasma gondii Maternal age ØRisk factors for adolescents •Growth pattern of mother; psychologic maturity •Lack of economic resources; delay in medical care •Nutrient intake: often poor ØRisk factors for women older than 35 •Distinct nutrient needs; longer medical history •Gestational diabetes Preeclampsia (pregnancy-induced hypertension) ØSome symptoms: sudden severe rise in arterial blood pressure; rapid weight gain; marked edema ØRisk factors ØCan progress to eclampsia ØNutrition support: well-balanced diet, generous protein and sufficient energy intake ØExperimental treatments Diabetes mellitus ØPreexisting diabetes (types 1 and 2 diabetes mellitus) necessitates specialized care ØRisks to fetus •Increased risk of birth defects, macrosomia, hyperbilirubinemia, and erythema •Risk of hypoglycemia after birth ØRisks to mother with diabetes Control/treatment ØDecreased risks when diabetes is controlled ØBlood glucose monitoring; adherence to diet; moderate exercise; prescribed insulin Gestational diabetes mellitus ØScreening during second trimester ØTreatment: dietary control with moderate exercise; insulin if needed ØRisk factors Maternal phenylketonuria ØInborn error of metabolism of phenylalanine ØMother: strict adherence to diet low in phenylalanine; infant: supplementation with tyrosine beginning in first week of life ØFailure to detect disease or lack of compliance with dietary therapy: results in irreversible mental retardation Human immunodeficiency virus (HIV) infection ØEffects on immune system: immunosuppressive effects of hormones and proteins of pregnancy ØNutritional considerations •Opportunistic infection increases need for kilocalories, protein, vitamins, and minerals ØWeight gain must be strictly monitored •No specialized weight gain recommendations

Pancreatitis

Pancreatitis Definition: Ø*Inflammatory process characterized by decreased production of digestive enzymes and bicarbonate* Causes: Ø*Excess alcohol consumption, gallbladder disease, genetics* Symptoms and complications: ØAutodigestion of the pancreas by enzymes; severe pain and elevated serum enzyme levels ØMalabsorption of fats and proteins Consequences: chronic pain, diabetes mellitus Nutrition therapy Ø*Goal: minimize pancreatic secretions; enteral or parenteral nutrition may be used; enteral nutrition is associated with better outcomes.* ØAssessment: affected patients may be malnourished because of protein and fat malabsorption; nutritional support is needed. ØWhen enteral feeding is appropriate, a low-fat elemental formula is recommended. ØPosition of tube into jejunum allows for feeding with minimal stimulation of the pancreas. ØGuidelines for parenteral nutrition: •Peripheral parenteral nutrition (PPN) may be used in nonstressedindividuals who are on nothing-by-mouth (NPO) status for less than 10 days. •Central parenteral nutrition (CPN) may be used for those who are on NPO status longer than 5 to 7 days. ØNutrient recommendations: •Fat: less than 50 g per day •Medium-chain triglyceride (MCT) oils may be used •Protein: at least 1.5 g of protein per day •Carbohydrates: remainder of kilocalories ØMeal planning: Six small meals per day are recommended. ØEnzyme replacement may be necessary to control malabsorption. Ø*Abstinence from alcohol is imperative.*

Pantothenic acid

Pantothenic acid ØFunction: part of coenzyme A for metabolism of carbohydrates, fats, and protein ØRecommended intake and sources •AI: 5 mg for adults •*Sources: widespread in foods, especially whole grain cereals, legumes, meat, fish, poultry* ØDeficiency: unknown ØToxicity: 10 to 20 g may produce diarrhea or water retention

Potassium

Potassium 3.5-5.0 Function ØPrimary intercellular cation that maintains fluid levels inside the cells Ø*Normal function of nerves and muscles (heart)* Recommended intake and sources ØAI: 4700 mg Ø*Sources: unprocessed foods, potatoes, tomatoes, bananas, oranges, other fruits, vegetables, dairy products, legumes* Deficiency Ø*Causes: dehydration from vomiting or diarrhea, diuretics, and misuse of laxatives* Ø*Symptoms: muscle weakness, confusion, appetite loss, and, in severe cases, cardiac dysrhythmias* Toxicity ØCaused by dehydration or supplement use Ø*Symptoms: muscle weakness, vomiting, and, at excessively high levels, cardiac arrest*

Pyridoxine (vitamin B6): pyridoxine, pyridoxal, and pyridoxamine

Pyridoxine (vitamin B6): pyridoxine, pyridoxal, and pyridoxamine ØFunction: As pyridoxal phosphate (PLP), acts as a coenzyme in metabolism of amino acids and proteins •Necessary for hemoglobin synthesis •Required for conversion of tryptophan to niacin •Coenzyme for fatty acid and carbohydrate (CHO) metabolism •Supplements of pyridoxine, folate, and cobalamin *may reduce risk of coronary artery disease (CAD)* ØDeficiency •*Deficiency rarely occurs alone.* *Accompanies low intake of other B vitamins* •Symptoms include dermatitis, altered nerve function, weakness, poor growth, convulsio'ns, and microcytic anemia (small red blood cells deficient in hemoglobin). ØRecommended intake and sources •Adults: 1.3 mg; based on protein intake •*Sources: widespread in foods, especially whole grains and cereals, legumes, chicken, fish, pork, and eggs* ØDeficiency: related to low intakes of all B vitamins •Some drugs affecting the bioavailability and metabolism of pyridoxine: oral contraceptives, isoniazid, penicillamine, cycloserine, and hydralazine ØToxicity: UL of 100 mg/day •Megadose supplementation may cause ataxia and sensory neuropathy. *Oral contraceptives interact!* has sometimes been prescribed to relieve the symp-toms associated with premenstrual syndrome (PMS); however, there are no adequate data to support this treatment.

Riboflavin (vitamin B2)

Riboflavin (vitamin B2) ØFunction: coenzyme in energy release ØRecommended intake and sources •RDA: 1.3 mg for men; 1.1 mg for women •Need related to total kilocalorie intake, energy needs, body size, metabolic rate, and growth rate •*Sources: milk, enriched grains and cereals, whole grains, vegetables, dairy, meats, fish, poultry, and eggs* •*Very light-sensitive; loss increases on exposure to artificial and natural light; and lost in cooking water* Ø*Deficiency: ariboflavinosis* •Cheilosis (swollen lips), glossitis (swollen tongue), seborrheic dermatitis (a skin condition characterized by greasy scales, may occur in the regions of the ears, nose, and mouth.) ØToxicity: nontoxic

Sodium

Sodium 135-145 Function Ø*Maintenance of blood pressure and volume* Ø*Transmission of nerve impulses* Ø*Fluid balance* Recommended intake and sources ØAI:1500 mg, or about 3/4 tsp salt (sodium chloride) ØAI lowers to 1300 mg for adults 51 to 70 years of age Ø*Sources: table salt (sodium chloride) and processed foods; occurs naturally in some foods* Deficiency Ø*Caused by dehydration or excessive diarrhea* Ø*Symptoms: headache, muscle cramps, weakness, reduced ability to concentrate, memory and appetite loss* ØHyponatremia Toxicity: UL of 2300 mg ØSodium-sensitive hypertension and edema

Stages of Adulthood: The Older Years (60s, 70s, and 80s)

Stages of Adulthood: The Older Years (60s, 70s, and 80s) Nutrition requirements ØDRIs for healthy adults; adjusted for acute or chronic illness ØRequirements constant from age 51, except for vitamin D •Synthesis reduced •After age 70, AI increases to 15 µg (10 µg for ages 51 to 70 years) ØDigestion and absorption may be reduced •Decreased production of intrinsic factor: may decrease amount of vitamin B12 absorbed •Recommendation: vitamin B12 supplementation or increased intake of vitaminB12-fortified foods ØOther factors affecting nutritional status •Dental health •Zinc: marginal deficiency alters taste receptors •Sugar, sodium, or both: diet-related disorders •Constipation: risk as GI tract muscularity decreases Stages of Adulthood: The Oldest Years (80s and 90s): Decreased ability to absorb or synthesize nutrients Nutrition requirements ØConcerns of malnutrition and underweight ØDehydration ØNutrition screening

Water-Soluble Vitamins: Thiamin B1

Thiamin (vitamin B1) ØFunction: coenzyme in energy metabolism •Role in nerve functioning related to muscle actions ØRecommended intake and sources: •RDA: 1.2 mg for men; 1.1 mg for women •*Sources: lean pork, whole or enriched grains and flours, legumes, seeds, nuts* Ø*Deficiency: beriberi disease* •Ataxia (muscle weakness/loss of coordination) and tachycardia (rapid heartbeat) •Wet (edema, weakening the heart) versus dry beriberi(nervous system, muscle wasting, paralysis) •Wernicke-Korsakoff syndrome: a cerebral form. From chronic alcohol intake. •Marginal: psychologic disturbances, headache, fatigue, irritability •Risk factors: alcoholism, renal dialysis, parenteral nutrition, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), persistent vomiting (as in hyperemesis gravidarum), anorexia nervosa, gastrectomy ØToxicity: nontoxic In the 1890s it was discovered that beriberi resulted from consumption of hulled (white) rice and that eating unhulled (brown) rice prevented or cured it. Lean pork, whole or enriched grains and flours, legumes, seeds, and nuts are good sources of thiamin. Very high intakes of raw fish can also produce beriberi.

Trace Minerals: Fluoride

Trace Minerals: Fluoride Function Ø*Increases resistance to tooth decay and is part of tooth formation* Ø*Bone mineralization for skeletal health* Recommended intake and sources ØAI: 4 mg for men; 3 mg for women Ø*Sources: fluoridated water (where available), tea, seafood, seaweed; other sources vary* Ø*Toothpaste ingestion* Deficiency Increases risk of dental caries and may alter bone health Toxicity: UL of 10 mg ØFluorosis Fluoride helps strengthen tooth enamel and is vital for the bone matrix. U.S. cities started adding it to their water sources 30 to 40 years ago. Pregnant women should be aware that they need fluoride for their unborn children's teeth buds and for bone development.

Trace Minerals: Iodine

Trace Minerals: Iodine Function Ø*Part of hormone thyroxin produced by thyroid gland* Recommended intake and sources ØRDA: 150 mcg for adults Ø*Sources: salt fortified with iodine (check label); seafood; other sources inconsistent* Deficiency Ø*Reduces thyroxine production:* •Deficiency during pregnancy causes cretinism of fetus Ø*Goiter:* •Lack of dietary iodine or by effects of goitrogens Toxicity: UL of 1100 µg Ø*Thyrotoxicosis: iodine-induced goiter* *Iodine promotes a healthy thyroid, and a lack of iodine may cause the thyroid to be unable to produce hormones, which will result in goiters.* Historically, there were deaths due to lack of iodine and the subsequent goiter development. Pregnant women should also be careful that they don't lack iodine, because it may cause birth defects, such as cretinism (intellectual disability)

Trace Minerals: Iron

Trace Minerals: Iron Function Ø*Distributes oxygen: component of hemoglobin (in red blood cells) and myoglobin(in muscle cells).* ØAssists enzymes in oxygen use by all cells. Recommended intake and sources ØRDA: 8 mg for men; 18 mg for women; 27 mg during pregnancy ØFactors affecting recommended intakes: •Iron recycled and reused •Lost through shedding tissue: cells in urine, sweat, bleeding •Unusual absorption rate of dietary iron (only 10% to 15% absorbed); higher rate absorbed during deficiency, pregnancy, growth Ø*Animal (heme) and plant (nonheme) sources:* •Heme iron (easier to absorb): meat, fish, poultry •Nonheme iron: vegetables, legumes, dried fruits, whole and enriched grains ØFactors favoring iron absorption •Consuming foods containing *ascorbic acid (vitamin C) enhances iron absorption.* •Consuming iron from several sources improves total iron absorption. •Absorption of nonheme iron increases in presence of heme iron. Recommended intake and sources, cont'd ØFactors inhibiting iron absorption: binders (oxalates), tannins, excessive antacids, pica Deficiency: US public health problem ØCommon among women of childbearing age, teenage girls, and young children Ø*Iron-deficiency anemia: a microcytic anemia* •Physical activity/work difficulties; reduced cognitive functioning or developmental delays (children); impaired immune system, cold sensitivities •Sports anemia Ø*Causes: internal loss of blood (i.e., bleeding ulcers, hemorrhoids, menses); lack of dietary intake (chronic dieting, poor dietary choices); pica* Toxicity: UL of 45 mg ØHemosiderosis; hemochromatosis •Symptoms: liver/heart damage, diabetes, arthritis, skin discoloration •At risk for iron overload: men; individuals with chronic alcohol consumption; individuals genetically at risk •Accidental iron poisoning: children We ingest iron by eating red meats, such as beef, venison, buffalo, and kangaroo. Iron is also found in spinach, broccoli, and dark green, leafy vegetables. There is some iron in pork. Beans and chickpeas are also a good source of iron. Be aware that caffeine blocks the absorption of iron and calcium. An iron-deficiency can lead to anemia. *Iron-deficiency anemia can cause the individual to be cold, tired, and fatigued.* Iron is needed to produce hemoglobin, which is essential in circulating oxygenated blood throughout the body. In persons with iron-deficiency anemia, the red blood cells appear smaller and paler than normal. Anemia can occur due to malnutrition. Malnutrition can occur when people don't get enough food or are not eating the right kinds of foods, such as eating too much fast food. Anemia can also occur if too much blood has been lost. Massive blood loss can occur in different ways, including menstruation (females only), ulcers, and intestinal parasitic infection.

Trace Minerals: Zinc

Trace Minerals: Zinc Function ØMore than 200 enzymes dependent on zinc Ø*Growth process, taste and smell, healing process, immune system, carbohydrate metabolism* Recommended intake and sources ØRDA: 11 mg for men; 8 mg for woman; 11 to 12 mg during pregnancy and lactation Ø*Sources: meat, fish, poultry, whole grains, legumes, eggs* ØBioavailability reduced in foods high in phytic acid *Deficiency* ØSymptoms: impaired growth and wound healing; reduced appetite, taste (hypogeusia), and smell (hyposmia); immunologic disorders ØSevere deficiency: may result in dwarfism and hypogonadism (reduced function of gonads) Ø*At risk in the United States: "picky" eaters; older adults* Toxicity: UL of 40 mg ØExcess supplementation produces gastrointestinal distress, leading to vomiting and diarrhea, fever, exhaustion (similar to flu). ØContinual excessive use decreases iron and copper levels and reduces high-density lipoprotein level. Zinc is needed to make enzymes for digestion and respiration and also for bone building and metabolism. Although it's not an antioxidant, zinc does help to repair the lining of the lungs. Zinc is concentrated in accessory organs, such as kidneys and the liver, and can be found in red meats, poultry, and shellfish. I t's unnecessary to consume more than the RDA, because the excess zinc is excreted.

Vitamin D

Vitamin D ØFunction •*Intestinal absorption of calcium and phosphorus depends on action of vitamin D.* •*Vitamin D affects bone mineralization and mineral homeostasis by helping to regulate blood calcium levels.* ØRecommended intake and sources •RDA is 15 µg (600 IU) •AI:10 µg (400 IU) newborns through 1 year •AI:20 µg (800 IU) for people ages 70 and older •Sources: body synthesis or from dietary sources •Synthesis: conversion of 7-dehydrocholesterol in skin to cholecalciferol, active form of vitamin D *Limited by length of exposure to ultraviolet radiation, atmospheric conditions, skin pigmentation, sunscreen, clothing, and age* •*Dietary sources: animal-related foods (butter, egg yolks, fatty fish, liver, fortified milk)* •Vegans: may need to supplement ØDeficiency •Children: *rickets* characterized by malformed skeleton, bowed legs, abnormal teeth •Adults: *osteomalacia* characterized by soft bones that fracture easily, weakness, rheumatism-like pain •At risk: older adults with diminished vitamin D and calcium intake •Risk increased by medication-food interactions such as sedatives, tranquilizers, and anticonvulsants •*Osteoporosis: multifactorial disorder with reduced bone density and brittle bones* •Increased risk of CAD, rheumatoid arthritis, cancers, type 1 diabetes, and multiple sclerosis •Assessment of dietary intake and blood levels reveal many Americans have marginal levels of vitamin D status ØToxicity: UL of 100 µg (4000 IU) •*Most toxic vitamin* •Hypercalcemia and hypercalciuria which affect kidneys and may cause cardiovascular damage Vitamin D is one of the few vitamins that can be made by the body (others have to be ingested). Vitamin D is built with the help of the sun. Even though it is important to use the sun as an aid for vitamin D production, it's still important to take precautions and not overexpose your body to the sun. Overexposure may cause a severe sunburn and radiation poisoning. Always wear a sunblock of SPF 15 or higher to stop the ultraviolet rays of the sun from damaging your skin. Remember that vitamin D synthesis is blocked if the SPF is 8 or higher. (SPF stands for sun protection factor) Melanocytes are pigmented cells in our skin that naturally block the ultraviolet rays of the sun, once acclimated. All people of the world have the same number of melanocytes; what differs is the amount of melanin (pigment) produced. People with darker skin produce more melanin and are therefore able to stay in the sun longer without causing damage to their skin cells. Also, it takes darker skinned people longer to synthesize the vitamin D than lighter skinned people. Therefore, lighter skinned people get the same amount of vitamin D synthesized in about 10 minutes as darker skinned people get in 3 hours. Vitamin D stimulates cell maturity and stimulates the immune system, acting on calcium and phosphorus to form a matrix (bone) to promote healthy bones. *It is important that children get enough vitamin D; otherwise they could develop a condition known as rickets, which is when leg bones bow outward.* Vitamin D deficiency may also cause a disease known as *osteomalacia in adult females who have had babies and possibly have breast fed but did not replenish the calcium in their bodies by eating cheese, butter, or other dairy products.* Osteomalacia is a condition in which holes form in the bones and make them weak. Osteomalacia is primarily affiliated with vitamin D, whereas osteoporosis is primarily linked to calcium absorption. *Osteoporosis* (more porous bones) occurs usually in postmenopausal females, because the hormone estrogen, now produced in lower quantities, decreases the absorption of calcium by the body. Even though we can get vitamin D naturally from the sun, we can also ingest it through certain foods. It can be found in such food sources as butter, cream, liver, cod liver oil, and egg yolks. Possible side effects of vitamin D excess are diarrhea, nausea, headaches, and calcium deposits in the heart, kidneys, and arteries.

Fat-Soluble Vitamins: Vitamin A

Vitamin A ØFunction •*Maintains skin and mucous membranes* •*Vision* •*Bone growth* •*Immune system function* •Normal reproduction ØRecommended intake and sources •RDA (measured as retinol activity equivalents [RAE]): 900 µg RAE for men; 700 µg RAE for women •*Sources: natural and preformed whole milk and butter, liver, egg yolks, fatty fish* •*Sources: precursor carotenoids (deep green, yellow, and orange fruits and vegetables)* •*Best sources: broccoli, cantaloupe, sweet potatoes, carrots, tomatoes, spinach* •Fortified foods: margarine, cereals, reduced-fat milk ØDeficiency •Xerophthalmia: night blindness to keratomalacia •Immune system impairment •Respiratory infections, diarrhea, and other GI disturbances •Inhibition of growth; limited bone growth •Risk factors: fat malabsorption disorders, limited food availability ØToxicity: UL of 3000 µg RAE •*Hypervitaminosis A; only from preformed vitamin A* •Symptoms: blistered skin, weakness, anorexia, vomiting, headache, joint pain, irritability, enlargement of spleen •Attributable to supplementation •Excess beta carotene results in orange tinting of skin; excess intake of foods or supplement The active form of vitamin A is called retinol. Retinol has a yellowish pigment. The precursor, beta carotene, has an orange pigment. *Pumpkins and carrots are high in vitamin A.* Vitamin A also helps with the growth of teeth and bone, boosts the immune system, keeps skin cells healthy, helps the rods and cones in the eyes stay healthy, helps with night vision, and may help decrease the probability of skin cancer and any cancer with the epithelial cells. Vitamin A can be absorbed to some extent in the form of a topical solution, such as soaps, or ingested and absorbed more easily by eating dark green, leafy vegetables, such as broccoli and spinach. In excess, vitamin A may cause hair to fall out. Foods containing high amounts of vitamin A content include carrots, pumpkin, sweet potatoes, apricots, and dark green, leafy vegetables, such as spinach and broccoli. Because this is a fat-soluble vitamin, it is stored within the fat molecules. Therefore, what you ate days or even weeks ago may still have value.

Vitamin C

Vitamin C ØFunction •*Antioxidant and coenzyme* •*Collagen formation* •*Wound healing* •As antioxidant, may prevent damage to vascular walls by free radicals, thereby limiting atherosclerosis •*Enhances absorption of nonheme iron* •Thyroid and adrenal hormone synthesis •Possible reduction in cancer development •Some conversion processes depend on vitamin C: tryptophan to serotonin; cholesterol to bile; folate to active form •Evidence does not support reduced incidence of common cold; supplements may decrease duration and severity of symptoms ØRecommended intake and sources •RDA: 90 mg for men; 75 mg for women; 125 mg for smokers •Minimum daily requirement to prevent scurvy: 10 mg •*Sources: fruits and vegetables; excellent sources include citrus fruits, red and green peppers, strawberries, tomatoes, potatoes, broccoli, green leafy vegetables, and fortified foods* •*Sensitive to light, heat, air, and cooking methods* Ø*Deficiency* •Populations at risk for vitamin C deficiency: chronic alcohol and illicit drug users, smokers, older adults •Scurvy: extreme vitamin C deficiency disease characterized by gingivitis, joint and limb aches, bruising, hemorrhages, plaques, and death •Marginal deficiency: poor wound health, gingivitis, inadequate tooth and bone growth/maintenance, increased risk of infection ØToxicity: UL of 2000 mg for adults; 400 mg to 1800 mg for young children through adolescents •Chronic supplement megadose intake of 1 to 15 g may result in cramps, diarrhea, nausea, kidney stones, and gout and may interfere with action of anticlotting medication. •Rebound effect may occuras a protective mechanism functioning to destroy excess vitamin C; symptoms of scurvy may manifest. •Withdrawal from megadoses should be gradual: over 2 to 4 weeks. Vitamin C is also known as ascorbic or citric acid, and besides its role as an antioxidant, vitamin C is essential for assisting in the growth and repair of tissues all over the body. It helps generate collagen, a protein used to make skin, cartilage, tendons, ligaments, and blood vessels. Vitamin C is also essential for wound healing and for the maintenance and repair of teeth and bone. One of the most important things to remember about vitamin C is that it is sensitive to light, air, and heat, so be careful when cooking or storing vitamin C-containing foods. *Also, it is always best to eat these fruits and vegetables raw or lightly cooked to maximize the nutrient intake*.

Vitamin E: alpha-tocopherol

Vitamin E: alpha-tocopherol ØFunction •*Antioxidant, particularly protecting lung and red blood cell membranes* •Antioxidant as part of system with selenium and ascorbic acid (vitamin C) ØRecommended intake and sources •RDA (measured as alpha-tocopherol equivalents [α-TE]):15 mg α-TE for adults •*Sources: vegetable oils (e.g., corn, soy, safflower, cottonseed) and margarine (adequate); whole grains, seeds, nuts, wheat germ, green leafy vegetables* ØDeficiency •Primary deficiency is rare. •Secondary deficiencies occur in premature infants and other people unable to absorb fat normally. •Symptoms include neurologic disorders and anemia. vitamin E deficiency is rare and may occur in people with diminished fat absorption through the gastrointestinal tract (due to surgery, Crohn's disease, or cystic fibrosis), malnutrition, extreme low-fat diets, and certain genetic conditions ØToxicity: UL of 1000 mg α-TE •Megadoses can exacerbate anticoagulant effect of drugs to reduce blood clotting. •Supplementation is contraindicated with anticoagulant drugs. Vitamin E is a fat-soluble vitamin that can be found in such foods as vegetable oils, nuts, leafy green vegetables, and fortified cereals. Vitamin E exists within nature in eight different forms: four from the tocopherol family and four from the tocotrienol family. Alpha-tocopherol is typically the most active form in humans and is the form of vitamin E that can be found in the largest quantities in our blood and tissue.

Vitamin K: menaquinone

Vitamin K: menaquinone ØFunction •*Cofactor in synthesis of blood-clotting factors* •Protein formation in bone, kidneys, and plasma ØRecommended intake and sources •AI: 120 µg for men; 90 µg for women •Amount provides sufficient liver storage •Synthesized by bacteria in GI tract; still essential nutrient •*Dietary sources: dark green leafy vegetables; less in dairy products, cereals, meats, fruits* ØDeficiency •Causes of deficiency: malabsorption disorders; drug-nutrient interactions; long-term antibiotic therapy •Inhibits blood coagulation •Newborns given intramuscular injection to prevent hemorrhagic disease •Possible role in osteoporosis ØToxicity •Excess amounts of supplements decrease effectiveness of anticoagulant medications and may increase stroke risk. . Vitamin K is involved with blood clotting and keeps the thrombocytes (platelets) healthy.

VITAMINS

Vitamins: organic molecules needed in very small amounts for cellular metabolism ØVitamin D synthesized by body but still considered vitamin Dietary Reference Intakes (DRIs): ØRecommended Dietary Allowance (RDA), Adequate Intake (AI) Tolerable Upper Intake Level (UL) A primary deficiency of a vitamin occurs when the vitamin is not consumed in sufficient amounts to meet physiologic needs. A secondary deficiency develops when absorption is impaired or excess excretion occurs, limiting bioavailability. AT RISK FOR VITAMIN DEFENCIES: pregnant homeless alcohol / drug abusers elders poverty AIDS liver/kidney disorders

BMI Ranges

underweight: <18.5 normal: 18.5-24.9 overweight: 25-29.9 obese: >30