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Percentage weight change calculation weight change over a specified time (1-2% in 1 wk or 7.5% in 3 months indicates significant weight loss) Ideal body weight based on height +/- 10% depending on frame size BMI 18.5-24.9 Body Fat Composition Methods: o Skin fold measurement o Waist-to-hip ratio o Densitometry (underwater weighing) Serum Albumin protein levels measure by serum albumin levels (3.5-5.5 g/dL normal; 2.1-2.7 g/dL moderate depletion) (renal disease or injury hamper this measure) Prealbumin (thyroxin-binding protein) more sensitive measure used to assess critically ill who are high risk for malnutrition, reflects more acute changes (23-43 mg/dL normal; 5-9 mg/dL moderate depletion) Risk factors for inadequate nutrition: o Biophysical (disease, condition, treatment, ex. Hypertension, surgery) o Psychological (excessive stress, mental illness, negative self-concept, clinical depression) o Socioeconomic (poverty, alcohol, drug abuse, fad diets, food preferences: cultural, ethnic, religious)  Osteoporosis has man modifiable risk factors (vitamin D intake, inactive lifestyle, cigarette smoking, alcohol intake) Nutritive sources: o Carbohydrates and fiber o Protein o Lipids (fats) o Vitamins o Minerals and electrolytes o Water Essential nutrients are those that the body can t manufacture (absence cause deficiency diseases) Energy-yielding nutrients carbohydrates, fats, proteins Dietary Reference Intakes most commonly used source on nutrient allowances for healthy people (RDAs, estimated average requirements (EARs), Adequate Intakes (AIs), and tolerable upper intake levels (ULs) Carbohydrates organic compounds composed of carbon, hydrogen, and oxygen; main function is to provide energy for the body Average minimum amount needed to fuel the brain is 130 g/day; acceptable macronutrient distribution range is 45-65% of calories (300-330 g/day average for men; 180-230 g/day for women) Provide energy for cellular work, regulate protein and fat metabolism, essential for normal cardiac and central nervous system (CNS) functioning Classified according to number of saccharide units making up their structure:

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Monosaccharides simple carbs (glucose, fructose) (basic energy for cells)  Glucose corn syrup  Fructose fruits  Galactose milk sugar broken down o Disaccharides simple carbs (sucrose, lactose) (energy, aids calcium and phosphorous absorption lactose)  Sucrose table sugar, molasses  Lactose milk sugar  Maltose - sweeteners o Polysaccharides comples carbs (starch, fiber, glycogen) (energy storage starches; digestive aid fiber)  Starches (grains, legumes, root vegetables)  Fiber (indigestible plant parts) Complex carbs are easily absorbed in the intestine and into the bloodstream; stored in the liver and muscles for energy work Body absorbs 80-95% of carbs (mainly in the small intestine using pancreatic and intestinal enzymes) Glycogen stored carbohydrate energy source found in the liver and muscles; vital source of backup energy Carbs widely available, easily grown, long storage times 4 cal/g of energy Fiber categorizes as carb, doesn t yield energy for the body o Substance in plant foods that is indigestible  Pectin  Gum  Cellulose  Mucilage o Adds bulks to the feces; stimulates peristalsis; lowers cholesterol; reduces risk of intestinal cancers Protein provided by plant/animal sources; formed by linking amino acids in various combinations for specific use by the body o Complete generally form animal sources, contain all of the essential amino acids (9) o Incomplete plants (grains, nuts, legumes, vegetables, fruits); don t contain all essential amino acids o Complementary when eaten together, provide all the essential amino acids Protein tissue building and maintenance, balance of nitrogen and water, backup energy, support of metabolic process (nitrogen balance, transportation of nutrients and other vital substances, support of the immune system) Need influence by tissue growth needs, quality of the dietary protein, added needs due to illness 10% of intake or 46 g/day for women and 56 g/day for men (4 cal/g of energy) o

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Undernutrition protein malnourisment kwashiorkor or marasmus; caused by lack of protein ingestion or metabolism resulting in a cachetic wasting state Lipids chemical group of fats (dark meat, poultry skin, dairy food, added oils) o Fat is an essential body nutrient; concentrated form of energy (2nd to carbs); supplies important tissue needs, such as hormone production, structural material for cell walls, protective padding, insulation, covering nerve fibers; absorption of fat-soluble vitamins  Triglycerides primary form of fat in the body; combine w/ glycerol to supply energy to the body, allow fat soluble vitamin transport, form adipose tissue  Phospholipids derived from triglycerides; cell membrane structure  Cholesterol sterols; membrane stability; production of hormones and bile salts for digestion; can build up in tissues causing congesting and increasing risk of cardiovascular disease  Saturated fats animal origin; unsaturated plant origin (reduce health risk exceptions are coconut and palm oil)  Essential fatty acid broken down fats; supplied by diet; omega-3 and omega-6; used to support blood clotting, BP, inflammatory response, metabolic processes  Linoleic acid essential fatty acid; polyunsaturated vegetable oils o No more than 20-35% of total calories (10% or less from saturated fat sources); a diet with <10% fat can t supply adequate amount of essential fatty acids and results in cachectic (wasting) state  Cardiovascular disease, hypertension, diabetes  VLDL very low density lipoproteins carry triglycerides to the tissues  LDL low density lipoproteins carry cholesterol to the tissues  HDL high density lipoproteins remove excess cholesterol from the tissues good cholesterol o Provide 9 cal/g of energy; densest form of stored energy Vitamins organic substances required for many enzymatic reactions; catalysts for metabolic functions and chemical reactions o 13 essential vitamins o 2 classes:  Water-soluble vitamin C and B-complex  Fat-soluble vitamins A, D, E, and K o Yield no usable energy for the body Vitamin C (ascorbic acid) tissue building and many metabolic reactions such as wound and fracture healing, collagen formation, adrenaline production, iron absorption, conversion of folic acid, and cellular adhesion o Citrus fruits (oranges, lemons), tomatoes, peppers, green leafy vegetables, strawberries o Stress and illness increase the need for o Severe deficiency causes scurvy (hemorrhagic disease) B-complex cell metabolism; energy, metabolism, and neurological function; green leafy vegetables and unprocessed or enriched grains

Thiamin (B1) digestion and peristalsis; energy for smooth muscles, glands, CNS, and blood vessels  Deficiency results in beriberi, gastrointestinal symptoms, and CV problems  Plant and animal tissues (meats, grains, legumes) o Riboflavin (B2) growth, vitality, tissue healing  Deficiency results in cheilosis (scales/cracks on lips/mouth), smooth/swollen red tongue, dermatitis  Milk, meats, green leafy vegetables o Niacin (B3) energy and protein metabolism  Deficiency can cause pellagra (sun-sensitive skin lesion and GI and neurologic symptons)  Beef liver, nuts, legumes o Pantothenic acid (B5) biological reactions production of energy, catabolism, synthesis of fatty acids, phospholipids, cholesterol, steroid hormones, neurotransmitter acetylcholine o Pyridoxine (B6) cellular function and synthesis of hemoglobin, neurotransmitters, and niacin  Deficiency causes anemia and CNS disturbances  High intake of supplements may cause sensory neuropathy  Organ meats, grains o Biotin coenzyme used in fatty acid synthesis, amino acid metabolism, formation of glucose  Deficiency rare (neurological symptoms depression, fatigue; rashes face)  Milk, eggs, dark green vegetables o Folate hemoglobin and amino acid synthesis, cellular reproduction, prevention of neural tube defects in utero  Deficiency causes megaloblastic anemia, CNS disturbances, fetal neural tube defects (spina bifida, ancephaly)  Liver, dark-green leafy vegetables, citrus fruits, whole-grain products, legumes o Cobalamin (B12) produce of RBCs  Deficiency causes pernicious anemia (strict vegetarians)  Beef liver, mollusks, fortified grains Fat-soluble vitamins possibility for toxicity due to their ability to be stored in the body for long periods; absorption depends on body s ability to absorb dietary fat; clients w/ cystic fibrosis, celiac disease, Crohn s disease, or intestinal bypasses are at risk for deficiencies o Clients with liver disease should be careful not to OD as levels can build up o Vitamin A (retinal, beta-carotene) contributes to vision health, tissue strength and growth, and embryonic development  Some forms have teratogenic effects on the fetus  Deficiency vision changes xerophthalmia (dryness and thickening of the conjunctiva), changes in epithelial cells (mouth and vaginal mucosa) o

Fish liver oils, egg yolks, butter, cream, dark yellow/orange fruits and vegetables (carrots, yams, apricots, squash, cantaloupe) o Vitamin D (calciferol) assists in utilization of calcium and phosphorous; aids in skin repair  Deficiency bone demineralization, rickets  Clients on glucocorticoid therapy may require additional amounts; excess consumption may cause hypercalcemia  Fortified milk, cod liver oil, eggs o Vitamin E (tocopherol) antioxidant, helps preserve muscle and red blood cells; maintains the myelin sheath that insulates nerve cells  Deficiency hemolytic anemia; affects nerve fibers that influence walking and vision  Vegetable oils, eggs, avocados, certain nuts o Vitamin K (menquinone, phylloquinone) assist in blood clotting and bone maintenance  Deficiency increased bleeding time  Someoils, liver, green leafy vegetables (spinach, broccoli, cabbage)  Antidote for excess anticoagulants Minerals & Electrolytes o Minerals available in abundance of food sources; used at every cellular level for metabolic exchanges  Major minerals occur in larger amounts in the body  Trace elements required by the body in amounts less than 100 mg/day (micronutrients) o 7 major minerals  Sodium fluid volume, muscle contractions, CV support (table salt) y Diaphoresis, vomiting, diarrhea, shock (deficiency) y Fluid retention, HTN, CVA (excess)  Potassium fluid volume in/outside cells, muscle action, BP, CV support (oranges, tomatoes, meats, broccoli, bananas) y Diuresis, some meds y dysrhythmias  Chloride bonds to other minerals to facilitate cellular action and reactions, fluid balance (table salt) y Diaphoresis, vomiting, diarrhea, shock y HTN  Calcium bones/teeth, CV support, blood clotting, nerve transmission (dairy, broccoli, grains, egg yolk) y GI surgery, parathyroid dysfunction, pancreatitis, renal failure y Constipation, kidney stones 

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magnesium (those 5 are most commonly monitored) bone nourishment, CV support, nerve/muscle function, catalyst for many enzyme reactions (green leafy vegetables, nuts, grains, meat, milk) y vomiting, diarrhea, renal failure y diarrhea, kidney stones, CV changes  phosphorous energy transfer of RNA/DNA, acid-base balance (dairy, peas, soda, meat, eggs) y Decreased calcium levels (excess)  Sulfur acid-base balance (water, dried fruit, meats, wines) o 10 trace elements that are essential iron, iodine, zinc, fluoride, copper, manganese, chromium, cobalt, selenium, molybdenum  Iodine synthesis of thyroxine (regulates metabolism); when lacking, causes thyroid gland to enlarge, causing goiter y Seafoods, grown food sources (depend on soil where grown), table salt  Iron hemoglobin formation/function, cellular oxidation of glucose, antibody production, collage synthesis y Body scavenges unused iron from dying RBCs and stores for later use y Constipation, nausea, vomiting, diarrhea (can be taken w/ food to avert GI symptoms) y Organ meats, egg yolks, whole grains, green leafy vegetables y Vitamin C increases absorption  Fluoride forms bond w/ calcium and accumulates in calcified body tissue (bones/teeth); protects against cavities Water most basic of nutrients; largest portion of our total body weight; crucial for all fluid and cellular function o Total I & O should be 1,500 mL/day each (minimum) o 3-4 L/day men; 2-3 L/day women o Leaves the body via kidneys, skin, lungs, feces (greatest is kidneys); bleeding, vomiting, rapid respirations o Proper Hydration assessment skin turgor, mental status, orthostatic BP, urine output and concentration, moistness of mucous membranes (thirst is late sign of need for hydration) o Fresh fruits, juice, flavored gelatin, frozen treats, soups Metabolism sum of all chemical processes that occur on a cellular level to maintain homeostasis of the body o Catabolism breaking down of substances w/ the resultant release of energy o Anabolism use of energy to build or repair substances Body cells 1st use available ATP for growth and repair and then utilize glycogen and stored fat BMR (REE) amount of energy used when the body is at rest; primarily affected by lean body mass and hormones (short overweight body build, starvation/undernutrition, over 60 years of age decreases BMR) 

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Men have higher BMR (higher body muscle and decreased fat) Acute stress increases metabolism, blood glucose levels, and protein catabolism o Protein deficiency delayed wound healing, infections o Protein requirements increased to 2 g/kg body weight o Inadequate protein intake prevents body from adapting to physiologic stress Alcoholics suffer from protein-energy malnutrition Catabolic illness (surgery, burns) increases the body s requirement for calories to meet demands of increased BMR (hypothyroidism and nortriptyline decrease metabolism) Nitrogen balance the difference b/t the daily intake of nitrogen and nitrogen excretion (indicator of tissue integrity) o Positive nitrogen balance intake exceeds excretion; building more tissue than it is breaking down; infancy, childhood, adolescence, pregnancy, lactation o Negative insufficient protein, body is breaking down more tissue than it is building (illness, trauma, immobility, undernutrition) (decreased muscle tissue, impaired organ function, increased susceptibility to infection are late signs) To increase protein: o Add skim milk powder to milk o Whole milk for water in recipes o Add cheese, peanut butter, chopped hard cooked eggs, or yogurt to food o Dip meats in eggs or milk and coat with bread crumbs before cooking