Biology 45– Assessment, energyAnna Miller, MS, RDBiology 45Nutrition AssessmentAsks/Answers the question: Is a person well nourished or not?Biology 45Nutritional Status• Optimal Nutrition• Malnutrition – severe, borderline–Undernutrition –OvernutritionBiology 45Tools of Nutrition Assessment • Anthropometric measurements– Height– Weight– Waist Circumference– % Body FatBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45• Physical (clinical) Examination– Nurse or Doctor– What you can see• Hair, Skin, Eyes, Mouth, Gait, etc.Tools of Nutrition Assessment Biology 45• Laboratory tests– Blood or Urine is tested for:• The Nutrient • A Metabolite of the Nutrient• A Transport Protein of the NutrientTools of Nutrition Assessment Biology 45• Historical information– Health History– Drug History– Socioeconomic History– Diet HistoryTools of Nutrition AssessmentBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45Think, Pair & Share• Get a Partner. One of you be the “patient” and one of you be the health care worker. – The health care worker asks “What did you eat yesterday, from breakfast until you went to sleep? Tell me everything that you ate, and approximate quantities”. Write down what they ate.– If there is time, reverse roles.Biology 45Diet History• 24 Hour Recall• Food RecordWhat are their strengths and weaknesses?Biology 45Deficiency Terminology• Primary vs Secondary Deficiency– Primary: Inadequate intake is the cause– Secondary: Adequate intake – other problem leads to low levels of the active nutrient (Disease, drug-nutrient interaction, other.)• Subclinical vs Clinical Deficiency– Subclinical (Covert):no visible symptoms– Cinical (Overt): visible symptoms; Usually more advanced; possibly harder to successfully treatBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45Case Study • 22 year old female has bleeding gums from lack of vitamin C. Diet history reveals almost no fruit and vegetable intake.What categories of deficiency is this?Biology 45Case Study77 year old male has been on INH, a drug to treat TB, for 7 months, resulting in low erythrocyte transaminase activity, the only evidence of an inadequate vitamin B6status.What categories of deficiency is this?Biology 45Nutrition Assessment of Populations• National nutrition surveys– National Health and Nutrition Examination Survey (NHANES)– What We Eat in America– OthersBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45National Health GoalsBiology 45Food is a Source of FuelBiology 45Calorie• A unit of heat energy• A measure of potential energy in foods• Often used instead of kilocalorie (kcal)– Technically, 1 kcalorie (1 Calorie) = 1000 calories– In this class, we will say “calorie” but really mean kilocalorieBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45Figure out….1. How many calories are in a food that contains – 100 grams of CHO– 20 grams of protein– 20 grams of fat2. What percentage of the total calories comes from:– CHO – Protein– FatBiology 45Figure out…..• How many grams of fat would you have to eat if you want your diet to be one in which 30% of your calories come from fat, and your caloric intake is 2000 calories?Biology 45For Next Class!• Know WHAT the DRIs are, what they are used for, how they might help YOU! • Become familiar with: – The RDA– The AI– The UL – The AMDRs • Know how they are similar and how they are different• Bring your Textbook to classBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45What is a Healthy Diet?Biology 45Question!What are the obstacles that get in your way of eating more healthfully?Biology 45www.MyPlate.gov• Gives a basic eating plan for adequate nutrition. It’s a useful framework to build your “healthy diet”• Replaced the MyPyramid• Learning curve: knowing what counts as servings• Lots of good stuff on this site!Biology 45– Assessment, energyAnna Miller, MS, RDBiology 45Dietary Guidelines for Americans•Updated in 2010•Your text has older version •To see new ones go to http://www.health.gov/dietaryguidelines/2010.aspBiology 45Dietary Reference Intakes - DRIs• Standards for nutrients (lots of numbers),as recommendations or guidelines– Useful for evaluating your intake and/or planning your diet• Intended for healthy people (they are not therapeutic)• Updated regularly; based on research• They consist of the EAR, RDA, AI, UL, and AMDR• You can find them in the inside covers of your textBiology 45• The best we have as a guideline for “how much is nutritionally adequate”• NOT the minimum requirement (they are higher than the minimum requirements)• All vitamins and minerals have an RDA or an AI, but not both• Actual number depends on age & gender• The difference between them:– The Adequate Intake is like a Preliminary RDA; used like the RDA, but less research to back up the number RDA and AIRecommended Dietary AllowanceAdequate IntakeBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45UL• Tolerable Upper Intake Level– The upper level of what is safe– This level is safe but higher than this level pose potential health risk (toxicity)– A UL has not been set for all nutrientsBiology 45AMDRsAcceptable Macronutrient Distribution RangesRecommendations for the ratio of caloriesfrom CHO, fat and protein– Carbohydrate: 45% - 65% of the calories– Fat: 20% - 35% of the calories– Protein: 10% - 35% of the caloriesBiology 45Food Labels• Not covered in this class Not on any exams• FYI - Read on your own!! Helpful for understanding food labels (and for doing your diet assignment!)• Always check: what is a serving?• Note: Not all vitamins and minerals are listedBiology 45– Assessment, energyAnna Miller, MS, RDBiology 45A Healthy Diet is one that… • Provides enough of the “good stuff”:– CHO– Protein– Fat– Vitamins– Minerals– Water– Fiber – PhytochemicalsBiology 45and at the same time…• Is not high in the “not-so-good stuff”:– Saturated fat– Trans fat– Refined starch – Added sugar– Sodium– AlcoholBiology 45Key Concepts• Not exciting but true!– Balance• Of the Energy nutrients• Of the Food groups• Of Calories relative to need– Variety– Moderation• Let them guide you in your food