ed2 - nutrition

7/30/2019 ED2 - Nutrition

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Nutritional Assessment and

Counseling, ,

Department of Family Medicine


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Goal: To increase comfort level in assessin

nutrition and counseling about nutritionalconcerns during various life stages.

ect ves:

Define important aspects of a nutritional history. .

Review literature on common nutritional healthconcerns.


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, ,

Social history

Diet assessment


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Eating Disorders

es y

Oral health Xanthomas


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BMI---risk factor reduction

Estimate caloric requirement Assess readiness for chan e

Individualize recommendations

Dietary guidelines Food groups

Portion sizes

v se a ou supp emen s Physical activity


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Calculate BMR Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x heightin inches ) - ( 4.7 x age in years )

en: = . x we g n poun s . x e g ninches ) - ( 6.8 x age in year )

Harris Benedict Formula

Multiply BMR by the appropriate activity factor: 1.2 sedentary (little or no exercise)

1.375 lightly active (light exercise 1-3 days/week)

. - 1.725 very active (hard exercise 6-7 days a week)

1.9 extra active (very hard exercise & physical job or 2xtraining)


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Address nutritional issues at all visits

Nutritional needs vary with life stage Infants

Adolescents

Adults

Elderly

Consider nutritional issues for hospitalized and peri-

surg ca pa en s Collaborate with registered dieticians


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Growth charts

emog o n assessmen

Lead risk assessment/screening Intake

-


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Feeding skills development

ommon ee ng pro ems

Oral health and preventive care Nutrition supplements


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Types of foods

or ons

Progression


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Modified adult diet

o ng azar s

Cows milk FITS study


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Vitamin D

uor e

Other


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Calcium

uor e

Dental care/ visits


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-

Frequency

or ons

Snacks Breakfast


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u u u

Diet history---food groups

ssess or common ee ng concerns

Quantity- total calories, restrictive behaviors

-

Sweetened beverages

.

Nutrient recommendations


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TV/computer use

s re uc on counse ng

Screening tests


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Fiber

Children older than 2 years: >= age + 5 g/day

20 to 35 g/day

10 to 13 g of dietary fiber per 1000 kcal.


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-

Cholesterol

Digestion and satiety

reven on managemen o a e es

Diverticulosis

Cancer prevention


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. .

Diets rich in whole grains protect against

ar ovascu ar sease .

Stroke (RR 0.79) Diabetes (RR 0.62)

All-cause mortality (RR 0.83)


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67% of consumers say they

products more often if they

believed they could decrease

disease.


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Obesity by 24% He et al.

- eng e . a

Ischemic Heart Disease by 15% Law et al.

ancer r s y Jansen et al.

Cognitive decline

rov e essen a nu r en s


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=

63% of Americans eat


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Decreases fiber by 80%

Increases Calories by 10%


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calcium vitamin D

9-18 years 1300 mg 200 IU

19-50 years 1000 mg 200 IU

51-70 years 1200 mg 400 IU

>70 years 1200 mg 600 IU


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# dairy servings x 300 mg One servin =

8 oz milk/yogurt

16 oz cottage cheese (2 cups) 1 oz hard cheese


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calcium citrate (Citracal) well absorbed with orwithout food

calcium (500 mg Tums has 200 mg Ca++)

hi h dietar calcium intake associated with lowerrisk of nephrolithiasis

high supplemental Ca++ intake associated with


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commonly available calcium

supplementsproduct (% elemental ca) elemental calcium (mg)/tablet vitamin D(IU)/tabletcalcium carbonate (40%)

500 mg 200 01260 m 500 0

Caltrate 600 + D 600 200

Os-Cal 500 + D 500 200Tums

E-X 300 0Ultra 400 0

Rolaids 220 0v

One-a-Day for Women 450 400Centrum Silver 200 400

calcium citrate (21.2%)

Citracal Tablets 200 0Citracal Caplets + D 315 200Citracal Liquitab 500 0Citracal Neutravescent 400 0

tricalcium phosphate (38%)Posture-D 600 125


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Diet history

upp emen use

Physical activity- FITT BMI


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Nutrition Facts Labels

upp emen s

Risk reduction Physical activity


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Weight gain

e s ory

Supplement use


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Recommend ortion size

Recommend food groups/supplements to meetnutrient needs:

Iron

Zinc Calcium

Protein

Fiber

Dietician referrals


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Substance use

Listeria


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Standardized tools

Diet history: food pyramid for 70+

http://commentator.tufts.edu/archive/nutrition/pyramid.html

- Living environment

Functional status epress on

Oral health

Physical exam

Screening


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Recommend appropriate supplements

ys ca ac v y an ex y ra n ng

Food-drug interactions Work with dietitians in care facilities


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