NS 270: NUTRITIONAL ASSESSMENT AND MANAGEMENTUnit 3: Assessing Food Intake for Nutrient Deficiencies

WHAT TO DO THIS WEEK?

Read Chapter 5 and 6 (Stanfield and Hui)

Participate in Discussion

Participate in Seminar

CASE STUDY

You should have accessed this case study already in order to be prepared

We will complete the case study in class, as a group, and partially as a field trip

When asked, please complete the question assigned to you.

www.fitday.com access using NS270KU as the username and password, go to data for 7/23/09

Use same password and username for www.mypyramid.gov under pyramid tracker

POSITION OF AMERICAN DIETETIC ASSOCIATION

To promote health and reduce risk of chronic disease, choose variety of foods.

Food provides all vitamins you need.

Fortified foods and supplements can help some meet their nutrition needs.

VITAMINS

Fat Soluble and Water Soluble What’s the difference?

What are vitamins? Are they organic or inorganic?

We have 13 essential vitamins? Essential here means what?

Where do we find vitamins?

VITAMIN DEFICIENCIES

Vitamin A: may result in xerophthalmia

Vitamin D: rickets and osteomalacia

Vitamin K: deficiency in newborns; made in intestines by good bacteria

Vitamin C: scurvy; delayed wound healing; decrease in iron absorption; capillary bleeding

VITAMINS

Vitamin C◦ Collagen, wound healing, aids in iron absorption,

antioxidant◦ Sources

Vitamin B1 (thiamin)◦ Releases energy from fat and carbohydrate,

transmits nerve impulses, breaks down ETOH◦ Sources

Vitamin B2 (riboflavin)◦ Release energy from CHO, fat, PRO; healthy skin

and growth, visual health◦ Sources

VITAMINS

Vitamin B6 (pyridoxine) Breaks down and rebuilds amino acids, produces

antibodies and red blood cells, function of nervous system

Sources

Vitamin B12 (cobalamin) Red blood cell formation, part of RNA and DNA,

bone marrow formation, prevention of pernicious anemia

Sources

PEOPLE >50 & VITAMIN B12

Most adults meeting recommended amounts

Deficiency most likely to occur as a result of an inability to absorb B12 from food.

B12 needs stomach acid & intrinsic factor to be absorbed; less gastric secretions over age 50, so decrease in absorption.

Recommend for >50 years old to eat fortified B12 foods or take supplement.

VIATMINS

Niacin Releases energy from CHO, PRO, fat; synthesizes

proteins and nucleic acids; synthesize fatty acids from glucose

Sources Folic Acid (Folate)

Synthesizes nucleic acids, essential for the breakdown of most amino acids, needed for red blood cell formation

Sources

WOMEN AND FOLIC ACID

Necessary for all women of

childbearing age and women

who are pregnant. Reduces the risk of neural tube defects and

Spina Bifida.Food fortificationRDA: 400 g (adults); 600 g (pregnancy)

VITAMINS

Pantothenic Acid Helps release energy from macronutrients, aids

in formation of cholesterol, hemoglobin and hormones

Sources Biotin

Coenzyme in metabolism of fat and carbohydrate Sources

VITAMINS

Vitamin A (Retinol) Helps maintain healthy skin, helps eye adjust to

changes in light, develops healthy teeth/bones, synthesizes glycogen in the liver, regulates fat metabolism in the formation of cholesterol

Sources Vitamin D

Promotes absorption of calcium and phosphorus in the intestine, helps maintain blood calcium and phosphorus levels, aids in formation of bone matrix

Sources (What makes this vitamin different?)

SPECIAL GROUPS & VITAMIN D

Fat-soluble; obtain from food and sunDeficiency diseases: Rickets & OsteomalaciaFood sourcesHigh risk of deficiency:

Breastfed infantsOlder adultsLimited sun exposureIndividuals with dark skin

VITAMINS

Vitamin E (Tocopherol) Antioxidant, assists in cellular repiration,

maintains intact cell membranes Sources

Vitamin K Prothrombin formation, blood clotting Sources What medication does this interact with?

MULTIVITAMINS

NIH Consensus and State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention (2006) with results indicating: There is not strong evidence for beneficial health-related

effects of supplements. There is insufficient evidence to recommend either for or

against the use of multivitamin/mineral supplements by the American public to prevent chronic disease.

NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and

Chronic Disease Prevention. Ann Intern Med. 2006;145:364–371.

Essential to life Provides no energy Component of all cells Lubricant Transport medium Extracellular fluid Intracellular fluid Solvent

WATER

Only 4% of the human body Inorganic Macrominerals and microminerals (trace

minerals) Functions

Part of cell structure Components of enzymes, hormones, blood and

other body compounds Regulators of

Acid base balance of body Nerve response to stimuli Muscle contractions Cell membrane permeability Osmotic pressure and water balance

MINERALS OVERVIEW

CALCIUM NEEDS Calcium (Ca) – mineral in largest

amount in the body Bone and teeth formation, maintains serum

serum Ca levels, muscle contraction and relaxation, aids in nerve impulse transmission, maintains normal heart rhythm

Sources: dairy, green leafy veggies Deficiency?

%DV= 1000 mg/day Adequate Intake=

1000-1200 mg/day for adults Adequate Intake= 1300 mg/day

for adolescents (9-18 yrs. old) U.L.= 2500 milligrams/day

Increases risk of kidney stones

OSTEOPOROSIS

Decreased bone density “A pediatric disease w/ geriatric consequences”

Peak bone mass complete at ~ 20 y.o.Small increases 20-30 y.o.; loss begins ~30 y.o.

Women experience increased bone loss after menopause (age ~50-70) then levels off

Affected by gender, race, familial pattern, other genetic factorsSlender, inactive women who smoke are most at

risk (Caucasian & Asians highest risk)

Phosphorus (P) - Bone and teeth formation, maintains metabolism

of fats and carbs, role in controlling pH of blood Sources: dark cola (who knew this?), dairy,

grains Sodium

Water balance, osmotic pressure, regulates nerve impulses, muscle contractions, aids in carb and protein absorption

Sources What organ regulates Na? What other disorders

need to watch sodium intake?

ESSENTIAL MINERALS

Potassium Protein and carb metabolism, water balance,

normalizes osmotic pressure, regulates muscle activity

Sources: mostly fruits and veggies (which fruits are really high in K)

Intracellular

ESSENTIAL MINERALS

Magnesium (Mg) Body fluid regulation, activates enzymes,

regulates metabolism of macronutrients, needed for ATP formation

Sources: grains, green veggies, soybeans, milk, poultry

Chlorine (Cl) Maintains fluid and electrolyte balance, aids in

digestion (HCl) Sources: table salt (NaCl), protein foods

ESSENTIAL MINERALS

Sulfur – component of some amino acids Iodine

Source? Deficiency? Zinc – promotes wound healing, affects

sensitivity to taste and smell, aids in protein synthesis

Iron (only a small amount needed) Part of what body component? Deficiency?

ESSENTIAL MINERALS

IRON-DEFICIENCY ANEMIA

Most common form of anemia Insufficient intake and stores

Iron supplements may be needed (by MD only) Body cannot eliminate excess iron- can be toxic Heme vs. Non-Heme iron Food Sources: organ meats, beef, pork,

chicken, fish, turkey, prunes/dried fruit, whole grains, beans, molasses, spinach

Vitamin C enhances iron absorption

Others Fluoride (F)– Source Copper (Cu) Cobalt (Co) Manganese (Mn) Selenium (Se)

ESSENTIAL MINERALS

DIFFERENCES IN SUPPLEMENTS AND RX:

Manufacturer does not need FDA approval before marketing.

FDA does not approve vitamins, minerals, & supplements for safety before reaching consumers.

Prescription drugs must be proven safe and effective for their intended use before marketing.

Extensive research and studies.

Vitamins, Minerals, Supplements

Prescription Drugs

FDA MONITORING

Post-marketing responsibilities:Monitoring safety (voluntary dietary supplement

adverse event reporting)Product information such as labeling, claims,

package inserts, and accompanying literature. FDA has the responsibility for showing that a

dietary supplement is "unsafe," before it can take action to restrict the product's use or removal.

ARE VITAMINS, MINERALS, & DIETARY SUPPLEMENTS SAFE?

Many safe and consumed daily without adverse effects; some beneficial for health conditions.

Reasons for recalls include: Microbiological, pesticide, & heavy metal contamination Absence of dietary ingredient claimed to be in product Presence of more or less than the amt of dietary ingredient

claimed on the label

Recall of Balanced Health Products, Inc. Starcaps dietary supplement capsules (11/26/08).

WEBLINKS

Dietary Reference Intakes http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=2&tax_subject=256&topic_id=1342&placement_default=0

Iron Deficiency Anemia http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm

Office of Dietary Supplements http://ods.od.nih.gov/

QUESTIONS