Chapter 2 : Nutrition Guidelines and Assessment
Topics covered in this snack-sized chapter:
Good nutrition plays an essential role in gaining and maintaining health and vitality.
The Dietary Guidelines provide concrete action steps to help people live healthier, more physically active and longer lives.
An assessment is an in-depth evaluation of both objective and subjective data related to an individual's food and nutrient intake, lifestyle, and medical history.
Valid and timely nutrition assessment is the foundation on which effective interventions and programs can be built to improve the food and nutrition situation of people.
An optimal scheme of nutritional assessment enables the clinician to quickly detect the presence of malnutrition and provides guidelines for nutritional therapy.
The Dietary Guidelines for Americans, 2010 emphasize three major goals for Americans:
- Balance calories with physical activity to manage weight
- Consume more fruits, vegetables, whole grains, fat-free and low-fat dairy products and seafood
- Consume fewer foods with sodium, saturated fats, trans fats, cholesterol, added sugars, and refined grains
These key recommendations are the most important in terms of their implications for improving public health
- Balance calories to manage weight
- Reduce certain foods and food components
- Increase certain foods and nutrients
- Build healthy eating patterns
Balancing Calories to Manage Weight
Prevent and/or reduce obesity through improved eating and physical activity behaviors.
Control total calorie intake to manage body weight.
- For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.
Increase physical activity and reduce time spent in sedentary behaviors.
Maintain appropriate calorie balance during each stage of life-childhood, adolescence, adulthood, pregnancy and breastfeeding, and old age.
Foods and Food Components to Reduce
Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older.
Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
Consume less than 300 mg per day of dietary cholesterol.
Keep trans-fatty acid consumption as low as possible.
Reduce the intake of calories from solid fats and added sugars.
Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.
If alcohol is consumed, it should be consumed in moderation.
Foods and Nutrients to Increase
Increase vegetable and fruit intake.
Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas.
Consume at least half of all grains as whole grains.
- Increase whole-grain intake by replacing refined grains with whole grain.
Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.
Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, and unsalted nuts and seeds.
Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry.
Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils.
Use oils to replace solid fats where possible.
Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets.
Building Healthy Eating Patterns
Select an eating pattern that meets nutrient needs over time at an appropriate calorie level.
Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern.
Follow food safety recommendations when preparing and eating foods to reduce the risk of food-borne illnesses.
Women Capable of Becoming Pregnant
Choose foods that supply heme iron, which is more readily absorbed by the body; additional iron sources; and enhancers of iron absorption such as vitamin C-rich foods.
Consume 400 micrograms (mcg) per day of synthetic folic acid.
Women who are Pregnant or Breastfeeding
Consume 8 to 12 ounces of seafood per week from a variety of seafood types.
Due to their high methyl mercury content, limit white (albacore) tuna to 6 ounces per week.
If pregnant, take an iron supplement, as recommended by an obstetrician or other health care provider.
Individuals ages 50 years and Older
Consume foods fortified with vitamin B12, such as fortified cereals, or dietary supplements.
Nutritional status is the current body status, of a person or a population group, related to their state of nourishment.
Clinically-relevant nutritional assessment should determine whether the patient's nutritional status will decline in the absence of nutritional support.
Nutritional Assessment (NA) is the first step in the treatment of malnutrition.
The goals of NA are to:
- Identify patients who have, or are at risk of developing malnutrition.
- Quantify a patient's degree of malnutrition.
- Monitor the adequacy of nutrition therapy.
- Measure the effectiveness of the nutritional programs and interventions once initiated.
The data for a nutritional assessment falls into four categories:
- Anthropometric measurements
Anthropometric Measurements
Anthropometry is the measurement of body height, weight, and proportions.
Anthropometrics are used to estimate subcutaneous fat and skeletal muscle stores objectively.
Anthropometry
They are used to:
- Compare growth in the young
- Assess weight loss or gain in the mature individual
Laboratory tests based on blood and urine can be important indicators of nutritional status, but they are influenced by non-nutritional factors as well.
Lab results can be altered by medications, hydration status, and disease states or other metabolic processes, such as stress.
Clinical data provides information about the individual's medical history, including acute and chronic illness diagnostic procedures, therapies, or treatments that may increase nutrient needs or induce malabsorption.
Physical signs of malnutrition can be documented during the nutrition interview and are an important part of the assessment process.
There are many ways to document dietary intake.
The accuracy of the data is frequently challenged, however, since both questioning and observing can impact the actual intake.
Food frequency questionnaires are used to gather information on how often a specific food or category of food is eaten.
Practitioners can train individuals on completing a food diary, and they can request that the record be kept for either three days or one week.
The practitioner uses the anthropometric data to assess ideal and desirable weight, as well as skin fold measurements to determine body fat.
Using the clinical, biochemical, and dietary data, influences on the nutritional status can be determined.
A nutritional intervention, which usually includes dietary guidance and exercise recommendations, is then formulated and discussed with the individual.