NCM 105

NUTRITION AND DIET THERAPY LECTURE

1 st SEMESTER | FINALS | A.Y. 2022-2023 CLASS SCHEDULE: MONDAY 10:00-12:00 A.M..
PROFESSOR: SHERIANNE AHARI

NUTRITION AND DIET THERAPY The placental size and the number of placental cells are 15
NUTRITION IN THE LIFE STAGES to 20% below normal when infants experience intrauterine
The human body constantly develops and changes growth failure.
throughout the human life cycle, and food provides the fuel EMBRYO
for those changes. The developing infant from 2 to 8 weeks after conception.
The major stages of the human life cycle include pregnancy, FETUS
infancy, the toddler years, childhood, puberty, older The developing infant from 8 weeks after conception until
adolescence, adulthood, middle age, and the senior years. term.
Proper nutrition and exercise ensure health and wellness at EPIGENETICS
each stage of the human life cycle. The study of heritable changes in gene function that occur
Nutrition in the life cycle is important in nursing care without a change in the DNA sequence (Rolfes, 2005).
because nurses promote healthy nutrition to prevent FETAL PROGRAMMING
disease, assist patients to recover from illness and surgery, The influence or substances during fetal growth on the
and teach patients how to optimally manage chronic illness development of diseases in later life (Rolfes 2005)
with healthy food choices. UTERUS
Healthy nutrition helps to prevent obesity and chronic The muscular organ within which the nfant develops before
diseases, such as diabetes mellitus and cardiovascular birth.
disease. AMNIOTIC SAC
The "bag of water", in the uterus, in which the fetus floats
PREGNANCY NUTRITION UMBILICAL CORD
DEFINITION OF TERMS The ropelike structure through which the fetus' veins and
CONCEPTION arteries reach the placenta. The route of nourishment and
The union of the male sperm and female ovum; Fertilization. oxygen into the fetus and the route of waste disposal from
PREGNANCY OR GESTATION the fetus. The scar in the middle of the abdomen that marks
Is the period in which the fertilized ovumn implants itself in the former attachment of the umbili cal cord is the
the uterus, undergoes differentiation, and grows until it can umbilicus, commonly known as the "belly button".
support extra-uterine life. PRIMIGRAVIDA
Human pregnancy lasts for a period of 266- 280 days or 37- Woman pregnant for the 1st time.
40 weeks. MULTIGRAVIDAE
IMPLANTATION Women who have had 2 or more pregnancies.
The stage of development in which the zygote embeds itself GESTATIONAL AGE
in the wall of the uterus and begins to develop. Stage of fetal growth and development at birth, varying from
OVUM a premature delivery to full term.
The female reproductive cell, capable of developing into a NEURAL-TUBE DEFECTS (NTDS)
new organism upon fertilization, commonly referred to as an Any of a number of serious birth defects involving the central
egg. nervous system that often results in long-term disability or
SPERM death. Both the brain and the spinal cord develop from the
The male reproductive cell, capable of fertilizing the ovum. neural tube.
ZYGOTE SPINA BIFIDA
The product of the union of ovum and sperm so called for One of the most common types of neural tube defects
the 1st two weeks after fertilization. characterized by the incomplete closure of the spinal cord
PLACENTA and its bony encasement; (Spina means spine and Bifida
The organ that develops inside the uterus early in pregnancy, means split)
through which the fetus receives nutrients and oxygen ANENCEPHALY
across the placenta and returns carbon dioxide and other An uncommon and always fatal type of neural tube defects
waste products to be excreted. characterized by the absence of a brain;
By exchanging oxygen, nutrients, and waste products, the 'An' means not or without and 'Encephalus' means brain.
placenta performs the respiratory, absorptive, and excretory MACROSOMIA
functions that the fetus's lungs, digestive system, and High birth weight (greater than 4,000 gms);
kidneys will provide after birth. High birth weight infants have an increased risk for perinatal
morbidity and mortality.
NEONATAL MORTALITY fruits usually controls these problems, but some women
Number of newborn deaths during the neonatal period (birth usually may also require a bulking type of laxative.
to one-month post partum per 1,000 live births. EDEMA
PERINATAL MORTALITY Mild physiologic edema is usually present in the extremities
Infant deaths in the perinatal period (before and after birth in the 3rd trimester and should not be confused with the
from approximately week twenty to twenty-eight gestation to pathologic generalized edema assoclated with pregnancy-
1 to 4 weeks postparturn per 1,000 live births. induced hypertonalon;
APGAR SCORE The swelling of the lower extremities may be caused by the
Number defining an infant's condition at one minute after pressure if the enlarging uterus on the veins returning fluid
birth by scoring the heart rate, respiratory effort, muscle from the legs;
tone, reflex irritability and color, named for its developer Extravascular fluid is often mobilized in the evening when
American anesthesiologists Virginia Apgar. the woman is lying down, resulting in a tendency to urinate
TRIMESTER during the night;
Three 13 to 14 week periods into which the normal This normal edema requires no sodium restriction or other
pregnancy of 37 to 41 weeks is divided somewhat arbitrarily dietary change.
for purposes of discussion and analyses (Wardlow, 2003). DIABETES MELLITUS
PARTURITION The incidence of pre-eclampsia is high in the pregnant
the act of giving birth, delivery of fetus from the mother woman with diabetes, and fetal morbidity and mortality are
significantly greater than in normal pregnancy;
DIET-RELATED COMPLICATIONS OF Infants born to women with diabetes are, as a rule, larger
PREGNANCY
than those of women who do not have diabetes;
NAUSEA AND VOMITING
This is most likely caused by exposure of the infant in utero
Morning sickness or nausea is common during the early
to supernormal levels of its own insulin, which is fact is a
months of pregnancy, and condition usually disappears as
growth hormone;
spontaneously as it appears;
High fetal insulin levels reflect the hyperglycemia of the
Cooking odors are problematic for some women;
mother,, which encourages high levels of glucose to cross
Simple treatment generally improves food tolerance:;
the placenta.
Small frequent dry meals of easily digested carbohydrate
GESTATIONAL DIABETES
foods are usually bettered tolerated;
Diabetes may exist only during the stress of pregnancy and
Fats are often a pblem and a low-fat diet should be followed
resolve itself after dellvery, a condition called gestational
until fats can be tolerated.
diabetes;
HYPEREMEIS GRAVIDARUM
This fom of diabetes, usually arlsing after 20 wooks
Prolonged, persistent vomiting develops in 2% of the
gestation, may affect as many as 5 to 10% of all
pregnant women;
pregnancies;
Hospitalization is usually indicated with intravenous fluid
Infants born to women who present with gestational
and electrolyte replacement required to prevent
diabetes are at increased risk of perinatal mortality, as well
complications of dehydration.
as prematurity with its accompanying complications;
HEARTBURN
The infant is at risk for macrosomia;
A common complaint during the latter part of pregnancy;
Gestational diabetes is treated largely through diet changes
This is an effect of pressure of the enlarged uterus on the
and moderate exercise to achieve weight control;
stomach in combination with the relaxed esophageal
Insulin is rarely used.
sphincter, resulting in occasional regurgitation of stomach
HYPERTENSION
contents into the esophagus;
Is a syndrome characterized by hypertension, protein- urea
This is usually be relived by limiting the amount of food
and edema;
consumed at one time, attention to adequate chewing, eating
The condition usually develops in the 3rd trimester, affecting
slowly, and avolding Iying in a reclining position after meals.
about 7 to 8% of the obstetric population, particularly those
CONSTIPATION AND HEMORRHOIDS
who are young, pregnant for the first time, or of low
Pregnant women often develop constipation, most frequently
socioeconomic status;
during the latter stages of pregnancy:
The terms preeclampsia and eclampsia refer to the nature
Causes of this problem include reduced gut motility, physical
and degree of the symptoms involved;
inactivity and the pressure exerted on the bowel by the
A systolic blood pressure of 140 mmHg or a diastolic
enlarged uterus;
pressure of 90mmHg, or both usually define PIH;
The weight of the fetus and downward pressure on the veins
The hypertensive diseases of pregnancy are Sometimes
often leads to the development of hemorrhoids during this
called toxemia.
period;
PRE-ECLAMPSIA
Increased consumption of fluid, fiber-rich foods, and dried
A condition characterized by HPN, fluid retention, and
 protein in the urine formerly known as pregnancy-induced Overweight
HPN. Excessive weight gain increases the incidence of
ECLAMPSIA toxemia and eclampsia.
Severe stage of pre-eclampsia characterized by convulsions. Can be prevented by careful adjustment of calorie intake
TRANSIENT HYPERTENSION OF PREGNANCY from time to time.
High blood pressure that develops in the 2nd half of Anemia
pregnancy and resolves after childbirth, usually without Due to iron deficiency brought about by the increased
affecting the outcome of the pregnancy. Recommended need have iron.
Weight Gain Based on Pre-pregnancy Weight Status Pre- This can be prevented by iron supplementation and by
pregnancy Weight Status Recommended Weight Gain including food rich in iron andprotein.
Underweight Normal Weight Overweight Obese Toxemia
Toxemia of pregnancy is characterized by the elevation
RECOMMENDED WEIGHT GAIN BASED in blood pressure, rapidweight gain due to edema.
ON PRE-PREGNANCY WEIGHT STATUS
PRE-PREGNANCY Convulsion and coma may arise in the eclamptic stage.
PRE-PREGNANCY WEIGHT STAUTUS : RECOMMENDED WEIGHT This is said to develop amongwomen on poor diets.
GAIN Treatment: A diet high in protein and low in sodium is
Underweight : 12.5-18.0 kg (28 to 40 Ib) recommended at early stage.
Normal Weight : 11.5 to 16.0 kg (25 to 35 Ib) RATIONALE FOR INCREASING SPECIFIC
Overweight : 7.0 to 11.5 kg (15 to 25 Ib) NUTRIENT REQUIREMENTS DURING
Obese : 6.8 kg minimum (15 Ib)
PREGNANCY
CALORIES +300 KCALS TO TER
NUTRITION IN THE LIFE STAGES Increase arises from several factors such as growth of the
NUTRITION IN PREGNANCY fetus, growth of theplacenta, normal increase in maternal
PREGNANCY body size, additional work of carrying thegrowing infant and
The state of the woman from conception to childbirth. the steady but slow rise in basal metabolism.
A condition of having a developing embryo or fetus in the PROTEIN +10 GRAMS
body after the union of an ovum andspermatozoa. The Increase in order to meet the needs of developing maternal
period of 40 weeks or 280 days. tissues and to supportthe growth of the fetus.
Reasons for Increasing the Nutritional Needs during CALCIUM
pregnancy. Amounts adequate for her own needs and that of the
To meet the normal requirements of the mother =300 kcals. skeletal framework of thegrowing fetus and for teeth
To meet the nutrient needs of the growing fetus and other formation.
maternal tissues. IRON
For building reserves in preparation for delivery and An adequate supply of iron is necessary for building blood
lactation. 10grams supply and reserves.
EFFECT OF GOOD NUTRITION ON PREGNANT MOTHERS: VITAMIN A
Mothers in a good state of nutrition prior to or at the time of Important in view of its specific function in epithelial cells
conception have more chances of normalpregnancy leading during organ formation, bone and tooth development.
to normal birth of healthy well-developed infant. IODINE
Mothers with adequate diets experience less complication Increased need for iodine due to the increase in metabolic
and given birth to infants with betterchances of survival after processes during pregnancy.
birth. ASCORBIC ACID
Mothers with adequate diets have infants of normal weights Necessary to maintain the integrity of fetal membranesh.
and lengths. THIAMINE, RIBOFLAVIN AND NIACIN
Good nutrition leads to decrease in still births, prematurity These are equally important during pregnancy particularly
and congenital malformations with reference to their relationship to calorie intake.
PROBABLE PROBLEMS OF PREGNANCY WITH NUTRITIONAL
PROBABLE PROBLEMS OF PREGNANCY IMPLICATIONS:
WITH NUTRITIONAL IMPLICATIONS:
Mild Nausea and Vomiting
Mild Nausea and Vomiting Loss of Appetite
During the first trimester of pregnancy due to excessive Constipation
hormone productionresulting in disturbed physiologic Heartburn
and biochemical processes. Hyperosmosis gravidarium or Severe and prolonged vomiting
Loss of Appetite Pica (refers to the compulsion for persistent ingestion of
High CHO foods such as crackers, jelly, and dry toast unnatural foods or non-food items)
before arising areprescribed.
 Anemia RIBOFLAVIN
Pregnancy induced hypertension A deficiency in the mother’s diet is reflected in the
Pre-eclampsia - production of milk low in this nutrient.
Eclampsia WATER
EFFECTS OF GOOD NUTRITION: Tends to increased milk volume 8 glasses/day.
On the mother
Increased chances of normal pregnancy leading to FACTORS AFFECTING MILK SECRETION
normal delivery. DIET
Absence or reduced chances of complications during the volume of milk secreted id affected by diet.
pregnancy NUTRITIONAL STATE OF THE MOTHER
Reduced incidence of premature deliveries. sufficient nutrient reserves in the mother’s tissue before
Reduced incidence of maternal depletion conception and during pregnancy influence milk secretion.
Reduced incidence of morbidity and mortality. EMOTIONAL AND PHYSICAL STATE
Increased chances of successful lactation attitudes affects milk secretion such as worries, frustration,
On the infant: and impatience.
Normal growth and development - normal birth weight SUCKLING
and length. the presence of the baby and suckling, immediately after
Reduced incidence of intrauterine growth retardation delivery, stimulate the milk producing glands. When nursing
(IUGR). becomes established, 15-20 minutes is sufficient.
Reduced chances to stillbirths, congenital USE OF CONTRACEPTIVES AND DRUGS
malformations, and neonatal deaths. - Adequate nutrient the use of contraceptives while breastfeeding infers that
reserves. pills depressed the flow, and the insufficiency of milk flow
triggers the cessation of lactation.
NUTRITION IN THE LIFE STAGES
NUTRITION IN LACTATION NUTRITIONAL REQUIREMENTS
Is the period of milk production initiated by the prolactin
OF LACTATION
hormone in the mammary glands. NUTRITIVE NEEDS
Factors Contributing to Successful Breastfeeding: The recommended increase over the normal nutrient need of
The mother’s positive maternal behavior towards the mother to the demands of lactation is shown in table 3:
breastfeeding.
The mother’s enthusiasm to breastfeed.
Encouraging experiences in pregnancy, labor, and
previous lactation.
Cultural attitudes towards breastfeeding.

RATIONALE FOR INCREASING SPECIFIC

NUTRIENT REQUIREMENTS DURING
LACTATION
CALORIES +500 KCALS TO TER
Necessary for the production of milk in adequate amounts,
to supply the energy content of the milk secreted plus the
mother’s own energy needs, activity of the mammary gland,
and physical activity in the care of the newborn.
PROTEIN +20 GRAMS
Necessary for the production and increased secretion of
milk.
CALCIUM
Necessary to replenish and avoid depletion of the mother’s
calcium stores.
IRON
Only a small amount of iron transferred to human milk and
this is well utilized by the infant.
IODINE
To increase milk flow
VITAMIN A
Human milk becomes the main source of both Vitamin A and
carotenoids.
 ANATOMY OF THE BREAST

OXYTOCIN
produced more quickly than prolactin
makes the milk in the breast flow for this feed
can start working when mother expects a feed, even before a
baby suckles
If oxytocin reflex does not work well, breast produce milk
BUT not flowing out
makes uterus contracts after delivery
Is there a difference between a small breast and a large breast? helps reduce bleeding
The FAT and other tissue gives the breast the shape. sometimes causes uterine pain and a rush of blood during a
Both contains the same amount of gland tissue. feed for the first few days.
PROLACTIN
SIGNS & SENSATIONS OF AN ACTIVE
Secreted during and after feed to produce next feed OXYTOCIN REFLEX
MOTHER MAY NOTICE:
Squeezing or tingling sensation in her breast
Milk flow from breast
Milk dripping from other breast when baby is suckling
Pain from uterine contraction, sometimes with rush of blood
Slow deep sucks and swallowing by the baby which shows
that milk is flowing into the mouth.

WHAT CAN WE SUGGEST TO A MOTHER SO SHE COULD

INCREASE HER MILK SUPPLY?
The more the baby suckles the more milk is produced
Mother to eat and drink enough
More prolactin is produced at night
Hormones related to prolactin suppresses ovulation so
breastfeeding can help delay a new pregnancy
OXYTOCIN REFLEX
Works before or during feed to make milk flow
 INHIBITOR
Controls production of milk from within the breast
If one breast stops production, the other continues
Protects breast from harmful effects of being too full
If BM is removed, inhibitor also removed… breast makes
more milk

ATTACHMENT TO THE BREAST

COLOSTRUM
PROPERTY
Antibody rich
ADVANTAGES OF BREASTFEEDING Importance: protects against allergy & infection
Many white cells
Importance: protects against infection
Purgative
Importance: clears meconium, helps to prevent jaundice
Growth factors
Importance: helps intestine to mature, prevents allergy,
intolerance
Rich in Vitamin A
Importance: Reduces severity of infection

PSYCHOLOGICAL BENEFITS OF
BREASTFEEDING
EMOTIONAL BONDING
close, loving relationship between mother and baby
mother more emotionally satisfied
baby cries less
baby may be more emotionally secure
DEVELOPMENT
children perform better on intelligence tests
 DISADVANTAGES OF ARTIFICIAL OPTIMAL AGE TO START
FEEDING COMPLEMENTARY FEEDING
Interferes with bonding Complementary feeding should be started when the baby no
More diarrhoea and persistent diarrhoea longer get enough energy and nutrients from the breast milk.
More frequent respiratory infections For most babies this is six completed months of age.
Malnutrition; Vitamin A deficiency
More allergy and milk intolerance
Increased risk of some chronic diseases Obesity
Lower scores on intelligence tests
Mother may become pregnantsooner
Increased risk of anemia, ovarian cancer, and breast cancer
in mother

After 6 completed months of age it becomes easier to feed

thick porridge & mashed foods because babies :
show interest in other people eating & reach for food
like to put things in mouth
can control their tongue better to move food around the
mouth
start to make up & down munching movements w/ their
RESULTS OF POOR ATTACHMENT jaws
Painful nipples
Damaged nipples STARTING OTHER FOODS TOO SOON
Engorgement Adding foods too soon may:
Baby unsatisfied and cries a lot take the place of breast milk
Baby feeds frequently and for a long time result in a low nutrient diet
Decreased milk production increase risk of illness
Baby fails to gain weight less protective factors
Mother may loose self confidence other foods not as clean
difficult to digest foods
increase mother’s risk of pregnancy.
STARTING OTHER FOODS TOO LATE
Adding foods too late may
result in child not receiving required nutrients
slow child’s growth and development
risk causing deficiencies and malnutrition

The nutritional status of a child affects the overall health.

Health is not only growth and development but also the
ability to fight off illness and recover from illness.
Health staff should promote good feeding practices to
achieve good nutritional status of children

COMPLEMENTARY FEEDING
Complementary feeding means giving other foods in addition
to breast milk
These other foods are called complementary foods
Complementary foods must be nutritious foods and in
adequate amounts so the child can continue to grow
The term “complementary” is used to emphasize that this
feeding complements breast milk rather than replaces it.
During the period of complementary feeding, the young child
gradually become accustomed to eat family foods
As the young child gets older, breast milk continues to pot, but little of the food ingredientsare given to the
provide energy, however the child’s energy needs have child. It is mostly the watery part ofthe soup that is
increased as the child grows. given.
If these gaps are not filled, the child will stop growing or
grow only at a slow rate. The child who is not growing well
may also be more likely to become ill or to recover less
quickly from an illness.
As health workers, you have an important role to help
families use appropriate complementary foods and feeding
techniques to fill the gaps. NUTRITION IN THE LIFE STAGES
NUTRITION IN PRE-SCHOOL CHILD
IMPORTANT POINTS
the period between 2 – 6 years old.
All foods provide some energy. However, people generally
It is characterized byfluctuation in growth and by a fast rate
eat large amounts of these staples and they provide much of
of intellectual, social and emotionaldevelopment.
the energy needed.
Foods to give the Pre-School Child:
Staples also provide some protein and other nutrients, but
Pre-school children prefer mildly flavored foods than
they cannot provide all the nutrients needed on their own.
those of strong flavored or those which are spicy.
The staple must be eaten with other foods for a child to get
Plain foods are generally well-liked compared to mixed
enough nutrients.
dishes.
Staples generally need preparation before eating. They may
Fruits are well-liked and simple desserts like pudding,
just need to be cleaned and boiled or they may be milled into
custard, ice cream, gelatin desserts and cakes may be
flour or grated and then cooked to make bread or porridge.
given.
Sometimes staple foods are specially prepared for young
Most young children enjoy raw vegetables, but it should
children, for example wheat may be the staple and bread
be chopped to minimize chewing.
dipped in soup is the way it is used for young children.
RECOMMENDED DAILY AMOUNT OF FOOD FOR THE PRE-
It is important that you know what are the main staples that
SCHOOL CHILD:
families eat in your area. Then you can help them to use
Body –building foods (whole milk, fish, meat, poultry and
these foods for feeding their young children.
eggs) Necessary for:
In rural areas, families often spend much of their time
Proper growth and development
growing, harvesting, storing and processing the staple food.
Optimum mental development
In urban areas, the staple is often bought, and the choice
Strong bones and teeth
depends on cost and availability.
Increased resistance to infection
Often families are afraid that thick foods will be difficult
Energy – giving foods (rice, root crops, sugar, fats)
toswallow, be stuck in the baby’s throat, or give the
Necessary for:
babyconstipation. Therefore, they add extra liquid to the
Work
foods tomake it easier for the young child to eat. Sometimes
Play
extraliquid is added so that it will take less time to feed the
Regulating foods (green leafy and yellow vegetables, Vitamin
baby.
Crich fruits and fruits and vegetable) Necessary for:
If families use a blender to prepare the baby’s foods this
Clear eyes
may need extra fluid to work. It may be better to mash the
Glossy hair
baby’s food instead so that less fluid is added.
Smooth, healthy skin
Porridge or food mixtures that are so thin that they can be
Healthy gums and teeth
fed from a feeding bottle, or poured from the hand or that
Increased resistance to illness
the child can drink from a cup, do not provide enough energy
SIGNS OF GOOD NUTRITION:
or nutrients.
Alert, vigorous and happy
The consistency or thickness of foods makes a big
Endurance during activity
difference to how well that food meets the young child’s
Sleeps well
energy needs. Foods of a thick consistency help to fill the
Normal height and weight for age
energy gap.
Stand erect, arms and legs straight
So when you are talking with families, give this key message:
Clear, bright eyes, smooth healthy skin, lustrous hair
Foods that are thick enough to stay in the spoon give
Firm and well-develop muscles
more energy to the child.
Not irritable and restless • Good attention.
Similar to the porridge, when soups or stews aregiven to
HOW TO MEET FOOD ALLOWANCE OF THE PRE-SCHOOL CHILD:
young children, they may be thin and diluteand fill the
An ample amount of body-building, energy giving and
child’s stomach. There may be goodfoods in the soup
regulating foods, available in child’s diet.
 Providing meals with variety of foods to satisfy appetite. UNBALANCED PROGRAM ACTIVITIES AND REST
Incorporate milk in other foods. Stresses of school-work and class competition affects
Offering nutritious snacks in the middle of the morning and appetite
afternoon. Too little rest and sleep affects appetite
Too much play, distracts child’s interest away from food.
PRE-SCHOOLER FEEDING PROBLEM RECOMMENDED SOLUTIONS FOR FEEDING PROBLEMS:
EATING TO LITTLE OR FOOD JUGGING Allow sufficient time for meals (15-20 minutes)
whose appetite is lost because of too muchparental urging. Encourage the child to eat more fruits and vegetables
He could be too tired of the same food eaten every day. Proper selection of snacks
EATING TOO MUCH Balanced program or activities for class work, play and rest
due to heredity, temperament, appetite, or mother’s Proper food selection at home and in school to encourage
insistence in a“clean plate”. It leads to overweight, good food habits.
indigestion and obesity problems. SIGNS OF GOOD NUTRITION:
DAWDLING A well-developed body with normal weight for height.
a child who dawdles is one lingers or dilly dallies with his Firm and well-developed muscles
food duringmeal-time. Always getting attention or may not Good posture
be feeling well at all times. Healthy skin, no lesion and depigmention
GAGGING Smooth and glossy hair
a child who gags is one who feels like vomiting especially Clear eyes
when fed coarsefood. Alert facial expression, good disposition, full of life
AVERSION TOWARDS FOOD Sound sleep
unpalatable preparation of vegetables is to be blamed Good digestion and elimination
foraversion; taking of milk in which some children refuse to Good appetite
take, and that leads to plainmilk intolerance.
NUTRITION IN THE LIFE STAGES
ALLERGY
NUTRITION IN ADOLESCENTS
leads to appetite and diarrhea, due to food allergy like sea
foods, eggs andother foods. Nutrition describes the processes by which all of the food a
personeats are taken in and the nutrients that the body needs are
NUTRITION IN THE LIFE STAGES absorbed. Goodnutrition for adolescents can help prevent
NUTRITION IN SCHOOL CHILD disease and promote properhealth, growth, and development.
the period between 7 – 12 years is characterized by a ADOLESCENCE
slowsteady growth, increased body proportions, enhanced transitional phase of growth and development
mental capabilities andmore motor coordination. betweenchildhood and adulthood. The World Health
How to meet food allowances of the School Child: Organization (WHO) defines anadolescent as any person
Liberal amounts of body-building, regulating, and energy- between ages 10 and 19. This age range fallswithin WHO's
giving foodsin each meal. definition of young people, which refers to individuals
Every food eaten must carry some protein, minerals, betweenages 10 and 24.
vitamins, andcalories for continued growth and
DIETARY PROBLEMS THAT
increased activity. CONTRIBUTES TO THE INCIDENCE OF
Nutritious snacks NUTRIENTDEFICIENCIES AMONG
TEENAGERS
Well-planned home packed lunches or school lunches
Skipped breakfast
for childreneating their meals in school.
Due to lack of time
Pleasant experience with food which help in forming
Lack of appetite
good foodhabits.
Preference for sleep
FEEDING PROBLEMS IN THE For personal appearance
SCHOOL CHILD Availability of someone during meals
LIMITED TIME FOR EATING Availability of foods
An early or hurried breakfast, or no breakfast at all. Poor lunches
Taking lunch away from home Due to poor selection of foods eaten away from home
Hurried meals Eating hurried lunches at school
POOR EATING PRACTICES Fear of overweight
Too much in-between snacks Leads to pimples and acne
Too much soft drinks, candies and other sweets Availability of someone with whom to eat
Very little intake of fruits Acceptance of the no breakfast habit among peer group
 RISKS OF UNHEALTHY EATING SIGN OF GOOD NUTRITION:
HABITS IN TEENAGERS General appearance - alert and responsive
Unhealthy eating habits like eating too much, not eatingenough, Hair – shiny and lustrous
or restricted eating can be bad for your teenagechild’s health and Skin, face and neck – smooth, slightly moist, good color, not
wellbeing, now and in the future. But withhealthy eating habits in pale
adolescence, your child can mostlyavoid these risks. Eyes – bright, clear, no fatigue circles under
EATING TOO MUCH Lips – good color, not pale, moist
Eating too much food, particularly unhealthy food, puts your Gums – good, pink color, no swelling or bleeding
child at risk of overweight and obesity. – An overweight or Tongue – good pink color, no lesions
obese child is at an increased risk of type-2diabetes, sleep Teeth – straight, no crowding, well-shaped jaw, clean, no
apnea and hip and joint problems. Long-term risks include discoloration • Weight – normal for height, age and body-
heart disease and some cancers. build
NOT EATING ENOUGH
When teenagers go on fad or crash diets they can be at risk
NUTRITION IN THE LIFE STAGES
NUTRITION IN ADULTS TO ELDERLY
of not eating enough and not getting the nutrients they need
for healthy growth and development. ADULTHOOD
Severe dieting can lead to health and other problems like the period in the human lifespan in which fullphysical and
fatigue, poor concentration and loss of muscle mass and intellectual maturity have been attained. Agesbetween 21 or
bone density. 50 yrs. old. Proper nutrition needs emphasis inadulthood,
Some children develop eating disorders like anorexia, since it is the longest period of the life cycle andpossibly the
bulimia and avoidant restrictive food intake disorder. Some peak productive years. Nutritional management of theadult
signs and symptoms of an eating disorder include constant should include maintenance of the desirable body
or repetitive dieting, binge eating, excessive exercise, food weight.Ideally, one should reach adulthood with established
avoidance, repeated weighing and dizziness. sound eatinghabits.
RESTRICTED EATING ELDERLY
Child does not need to restrict foods like dairy foods or has been defined as a chronological age of 65 years oldor
foods with gluten unless they have a food allergy or food older, while those from 65 through 74 years old are referred
intolerance that has been diagnosed by a health toas “early elderly” and those over 75 years old as “late
professional. elderly.”
If the child is eating a restricted diet that is not well-planned AGING
and/orsupervised by a dietitian, it could lead to nutritional at the biological level, aging results from the impact of
deficiencies and otherhealth problems. theaccumulation of a wide variety of molecular and cellular
For example, a dairy-free diet over an extended period of damage over time.This leads to a gradual decrease in
time might meanthe child is not getting enough calcium, physical and mental capacity, a growingrisk of disease and
vitamin D, energy and protein forbone health and peak bone ultimately death.
mass. SENILE
A poorly planned long-term vegetarian diet can result in the often clinically co notated with an old man with mental
child notgetting enough nutrients, especially iron and vitamin andphysical weaknesses, not be attached to a normal aged
B12. This is aparticular risk for girls who have started having person.
periods. Both factorsincrease the risk of iron deficiency and ELDERLY
anemia. persons in the aged group 65-75 years old.
AGED
IMPORTANCE OF GOOD NUTRITION is a term used to cover both elderly and old.
Good nutrition is important because of the double demands OLD
of activity andgrowth during this period. a person beyond the aged of 75
Adolescent boys need more energy food because of an GERIATRICS
increase inphysical activities than adolescent girls is the branch of medicine concerned with prolonging full
The need for the body-building food is also high among growthand maturity, delaying the onsets of degenerative
teenagersbecause of the accelerated growth and aspects ofaging and treating the diseases of the aged.
development. REASON FOR MAINTAINING NUTRITIONAL ALLOWANCES
Adolescent girls need more iron than adolescent boys DURING ELDERLY PERIOD:
because ofmenstruation. To prevent the occurrence of chronic generative disease to
Calcium requirement for teenage boys and girls is the same. which an elderly is prone to, such as arthritis, rheumatism,
It isnecessary for bone growth. gout, coronary heart disease, and diabetes.
Several other nutrients are important to ensure good health. FACTORS AFFECTING ADEQUATE FEEDING:
It includesvitamin A, C, and B-complex vitamins. Long standing dietary habit
 Loss of teeth THERAPEUTIC DIETS ARE MODIFICATIONS OF THE NORMAL
Diminish sense of taste and smell, decreased interest in DIET
food develops with increase in age. All hospital diets are modifications of the normal diets and
Loss of neuromuscular coordination aim to accomplish one or more of the following:
Physical discomfort such as gastric distention and To maintain good nutritional status.
indigestion is more pronounce in older people To correct deficiencies that may have occurred.
Economic consideration – includes reduction in financial To provide rest to the whole body or to certain organs
resources, lack of money or low income due to retirement. that may be affected by the disease.
Social factors – leads to prey of food fallacies & To adjust the food intake to the body’s ability to
superstitions beliefs metabolize the nutrients.
Psychological factors – includes anxiety, depression, To bring about changes on body weight whenever
suspension and confusion. necessary.
SUGGESTION FOR BETTER ENJOYMENT OF MEALS, EASE OF To attain these goals, a normal diet may be modified
DIGESTION AND GOOD REST: according to these categories:
Eat a good breakfast to start the day right. Nutrient level., e.g., 500 mg. Sodium, 30 mg. Fat,
Eat four or five light meals instead of three heavy meals. 100 gm. Protein.
Include essential food first like meat, fish and poultry, Energy or caloric intake., e.g., 1000 calorie or 3000
vegetables and fruits calorie
Eat leisurely in pleasant surroundings. Specific non nutrient substance or metabolite, e.g.,
If sleeping is difficult, eat the heaviest meal at noon rather purine, cholesterol.
than at night. MEDICAL NUTRITION THERAPY
Fats may retard digestion. If there is discomfort, avoid fatty refers to the use of specific nutrition servicesto treat an
foods. illness, injury or condition. It consists of two phases:
Avoid coffee late in the day if insomnia is a problem. nutritionassessment and nutrition therapy.
Drink hot milk before going to bed. NUTRITION THERAPY
EFFECTS OF GOOD NUTRITION AMONG THE AGED: refers to interventions used in the treatment of adisorder or
Feeling better illness and includes diet therapy, nutrition counseling, and/or
Looking better theuse of specialized nutrition therapies such as
Moving and thinking better supplementation withnutritional or medical foods and
Living longer and more productive nutritional support through enteral orparenteral methods.
DIETETIC PRACTICE
DIET THERAPY is the integration and application of scientific principlesof
is a broad term for the practicalapplication of nutrition as a food, nutrition, biochemistry, physiology, management, and
preventative or corrective treatment ofdisease. behavioraland social sciences to achieve and maintain the
This usually involves the modification of an existingdietary health of the people.
lifestyle to promote optimum health. To be effective, DIETITIAN
thecorrectly planned diet must be eaten, and physiology, is the “translator of nutritional principles for an individual or
nutrition,behavioral sciences like sociology, psychology and group in health andillness”., A professional trained to be a
education; andartistic principles for food presentation. nutrient expert. Dietitians meet people of all ages,
A branch of dietetics concerned with the use of foodsfor culturesand economic level. In the Philippines, the title
therapeutic purpose. It is a method of eating a prescribed nutritionist-dietitian is preferred as stipulated inPD 1286.
dietby a physician or Nutritionist-Dietitian to improve health. REGISTERED NUTRITIONIST-DIETITIAN
is a professional responsible for the nutritional care
BASIC CONCEPTS AND
PRINCIPLES OF DIET ofindividuals and group. The RND has successfully passed
the licensure examination forprofessional registration and
Therapeutic diets are modified for nutrients, texture and
maintains continuing education requirements.
food allergies or food intolerances. Some
DIET
commontherapeutic diets are clear liquid diet, full liquid diet,
refers to food and drink regularly consumed according to
high fiber diet, renal diet, pureed/osterized diet, food
regimen of time and amount. Itmay be normal or “special”
allergymodification etc.
(sometime called “therapeutic” I.e., restricted or modified for
It is a branch of dietetics related with the use of food for
certainreasons.) A normal, adequate diet should meet all the
therapeutic purposes. It is ordered to maintain,restore and
nutrients of a particular individual, usingthe basic food
correct nutritional status, to decrease calorie for weight
groups and the RENI Tables as planning guides.
control, provide extra calorie for weight gain. It alsobalances
DRUG-NUTRIENT INTERACTIONS
amount of carbohydrate, protein, fats and other nutrient for
Certain foods taken with certain drugs canaffect drug
diet modification and disease prevention.
 effectiveness. Conversely, certain drugs interfere with valuemay be made increasing (e.g. for males) or decreasing
theabsorption of some nutrients. (e.g. for bed patients) thesugar, fat or rice exchanges.
DIET NOMENCLATURE Depending on the specific food choices, the FoodPlan meets
The acceptable way of naming diets is to use termsdenoting the recommended allowances for vitamins and minerals for
changes, in nutritional level, consistency, management healthypersons.
program orcombination of such changes. In the case of INDICATIONS FOR USE:
nutritional level, it isrecommended that the quantitative level For ambulatory or bed patients whose conditions do not
be specified. For example, highprotein diet is better necessitate a modifieddiet.
described by stating the amount of protein, e.g., 100grams FOOD SELECTION GUIDE
protein. A low sodium diet is best described in terms of All foods are allowed
specificlevels of sodium such as 250, 500 or 700mg. CLEAR LIQUID DIET
Sodium. is made up of clear foods which leave no residue in the
TYPES OF TRAY SERVICE: gastric-intestinal tract. It is non distending, non-irritating,
The types of food service in the hospital are: and non stimulating to peristalsis action.
Centralized – all trays are prepared completelyfrom the The diet is also called non-residue diet. It is intended to
main kitchen and delivered to thepatients’ unit. supply fluid and energy food in a form that requires minimal
Decentralized – food is transported in bulkusing a digestion. It is used to relieve thirst, to provide fluid for
conveyor or food carts to the patients’units and the prevention of dehydration, to minimize stimulation of
individual trays are setup in wardkitchen. gastrointestinal tract, and to serve as the initial feeding after
TYPES OF MENU IN THE HOSPITAL: surgery or intravenous feeding.
Selective – the dietary technician or nursing aideshelp the The diet usually is inadequate nutritionally in all respects and
patient in checking his choices on the menucard. its use should therefore be limited to 24 to 48 hours.
Non-selective - patients have no choice but thedietary Otherwise, parenteral feeding is recommended.
department makes effort to interview patientswho are on INDICATIONS FOR USE:
special or therapeutic diets and considertheir food likes, Pre-operative and post-operative cases with normal GIT
dislikes, religion, allergy, etc. motor function.
CHECKLIST FOR PROPER TRAY SERVICE: Acute diarrhea, as initial diet.
Is the tray correctly identified with patient’s name ward and Vomiting, if tolerated.
room number and right diet prescription? Intestinal obstruction.
Is the size of the tray suitable to the amount and kind of Acute phase of fevers and infections before diagnosis.
diet? • Is the cover clean and neat, free from wrinkles and Acute inflammatory conditions of the gastrointestinal
from spoilage? tract.
Are the silverwares and glass wares free from grease marks, When it is necessary to reduce fecal material.
chips, and cracks?
Is the arrangement of dishes and cover appointments in
proper order?
Are the meals served on time?
Are the hot foods served hot and cold foods cold?
Are the serving portions according to the dietary prescription
and suitable to the patient’s appetite?
Are the color, texture, and flavor combinations pleasing?
Are the seasoning and other food adjuncts correctly
included? (restricted sodium diets should not have salt
packets and bland diets must not have pepper shakers?).
FULL LIQUID DIET
ROUTINE HOSPITAL DIETS is an allowance of foods which are liquid or whichreadily
REGULAR OR FULL DIET become liquid at body temperature. When carefully
is the most frequently used of all hospital diets, is planned,the diet may be made adequate in energy value and
designedto maintain optimal nutritional status. It follows the protein and cantherefore be used for several days. However,
principles of good mealplanning and permits the use of all prophylacticsupplementation with vitamins and minerals
foods. especially vitamin A andiron, is recommended.
Nutritional requirements vary depending on age, sex, size The diet is given six or more feedings per day.
and activity level.The food plan is usually adequate in protein INDICATIONS FOR USE:
for most adults and meets the energyallowance for a Post operative cases with normal gastro-intestinal
moderately active Filipino woman. Adjustments in caloric function.
 Fevers and infections, when solid foods cannot be CHARACTERISTICS:
tolerated. Nutritionally adequate
Difficulty in swallowing as in fractured jaw and oral Well tolerated by the patient so that vomiting is not induced•
surgery. Easily digested with no unfavorable reactions such as
Lesions in the mouth and gastrointestinal tract. distention,diarrhea, or constipation
Transition from clear liquid to soft regular diet. Easily prepared
COLD LIQUID DIET Inexpensive
is used after tonsillectomy, dentalextraction, or other minor
operations on the mouth andthroat. The proportion of protein, fat and carbohydrates should
All liquids are served cold or iced. Sharp and sour fruitjuices approximatethat of the normal diet. Adverse effects of excess
and hot soups are not given as they may cause pain. include azotemia,hypernatremia, dehydration, and death due to
SOFT DIET excessive proteinintake., and diarrhea as a result of high lactose
follows the regular diet pattern but is modified content. Adequatefluid intake is essential to prevent salt or
inconsistency. It is designed for patients who are physically protein overload.
orpsychologically unable to tolerate the regular diet.
Foods allowed are those which are easy to digest, such as INDICATIONS FOR USE:
fruitsand vegetables with low cellulose content, and meats Patients who are severely ill and could not take food
with little or notough connective tissue like elastin. Thorough bymouth.
cooking, cutting,mashing, pureeing and removal of skin and Those under comatose or semi-conscious state.
seeds from fruits andvegetables and gristle and elastin from Surgery of the neck, face, throat or gastrointestinal tract
meats can increase thedigestibility of these foods. Anorexia nervosa
Depending on food selection, the die can be nutritionally Esophageal obstruction
adequate,but prophylactic supplementation of the diet with Severe burns and trauma ( fractures, injuries, etc.)
vitamins andminerals is recommended if the diet with Persons with difficulties in chewing and swallowing
vitamins and minerals isrecommended if the diet is used for Certain neurological and mental disorders.
prolonged periods. Terminal illness; cachexia.
INDICATIONS FOR USE: Any condition that necessitates rapid rehabilitation
Post operative cases when patient can tolerate solid throughnutrients.
food but not a full diet. ADMINISTRATION:
Fevers and mild infections. Depending Upon Its Nature:
Gastro-intestinal disturbances. The feeding maybe heated over hot water to body
Convalescence. temperature• Taking care that curdling does not occur
Transition from fluid to regular diet. with certain mixtures.
TUBE FEEDING Initially, small amounts of a dilute formula (50ml.) are
is an introduction into the stomach or smallintestine of given at hourly intervals.
nourishment into the stomach through anasogastric tube or It is important that a feeding be given at a slow constant
a Levin tube. rate.
Nutrients, either a special liquid formula or pureed food,are A food pump is recommended for use with blenderized
delivered to a patient through a tube directly into feeding.
thegastrointestinal tract, usually In patients who do not have adequate swallowing
PURPOSE: mechanism or who are comatose , special care must be
To provide nourishment to the patient when he is unstable taken to avoid the aspiration of the vomitus.
toeat normally. When the small feedings are satisfactorily tolerated, the
When surgery or treatment for oral cancer affects the concentration and amount of the formula is gradually increased,
patient'sability to eat, a feeding tube is inserted to facilitate with feedings not exceeding 12 ounces per 3 to 4 hours interval.
meetingnutritional needs FOODS ALLOWED:
Tube feeding provides nutrition to patients who are unable Whole or skim milk
orunwilling to eat food. Conditions where tube feeding Eggs
isconsidered include protein-energy malnutrition, liver or Strained cooked cereals
kidneyfailure, coma, or in patients who cannot chew or Sugar or molasses
swallow(dysphagia) due to stroke, brain tumor, or head Vegetable oil or cream
injury.Patients who are receiving radiation therapy or Nonfat dry milk
chemotherapytreatments for cancer may also be candidates The commercial preparations possess the advantages of
for tube convenience, constant composition, minimal preparation time,
and ease of administration.
 VEGETARIAN DIET HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
Other types: (HIPAA):
Ovo-vegetarian – in this regimen, eggs and eggs products The Health Insurance Portability and Accountability Act of
are allowedbesides items of plant origin. 1996 (HIPAA or the Kennedy–Kassebaum Act was enacted
Semi-vegetarian – fruits, grains, legumes, nuts, and seeds, by the 104th United States Congress and signed by President
vegetable,milk and milk product, eggs, chicken and fish are Bill Clinton in1996. It was created primarily to modernize the
included in the diet. Allother animal meats are excluded. flow of healthcare information, stipulate how
Pesco-vegetarian – in this diet, fish and fish products are personallyidentifiable information maintained by the
added to thelist of items of plant origin, all animal meats are healthcare and healthcare insurance industries should
excluded. beprotected from fraud and theft, and address limitations on
Vegetarian diets are usually low in saturated fatty acids healthcare insurance coverage.
andcholesterol. It has high fiber content and is generally more PHILHEALTH
economical thatdiets with meats, fish and poultry. One The Philippine Health Insurance Corporation (PhilHealth) is a
disadvantage is the inadequate orlow level of Vit. B12, iodine, Government Owned and Controlled Corporation (GOCC)
calcium, zinc, riboflavin and vitamin D. created through the National Health Insurance (NHI) Act of
1995 or Republic Act 7875.
DIET COUNSELING the country's national health insurance provider.
Diet counseling is the act of providing individualizedprofessional It gives all of our private employees health coverage thanks
guidance to assist a person in adjusting his daily to the contributions we make that is acquired by
foodconsumption to meet his health needs. Proficiency in diet automatically deducting a certain percentage from our
counselingshould be a basic skill of the Nutritionist- salaries.
Dietitian/nurse, as acounselor, should have a well-organized idea National Nutrition Council of the Philippines (NNC):
of what counselingentails. National Nutrition Council, abbreviated as NNC, isan agency
The process of diet counseling actually involves three of the Philippine government underthe Department of Health
activities: responsible for creating aconducive policy environment for
Interviewing, (Gathering info/data) national and localnutrition planning, implementation,
counseling, (Listening, accepting, clarifying) monitoring andevaluation, and surveillance using state-of the
and consulting. (Plan/Proposal) arttechnology and approaches.
By keeping in mind these important factors in the process of
FILIPINO CULTURE, VALUES,
dietcounseling, effective methods may be readily developed PRACTICES, AND BELIEFS APPLICABLE
based on: IN NUTRITION
The reason for the session (i.e., therapeutic treatment, A. CULTURAL ASPECTS OF DIETARY
PLANNING
generalnutritional assessment, nutrition education, etc.);
The food and culture of the Philippines are largely influenced
The skills and resources of the counselor; and
by Spanish, Chinese andAmerican traditions. White rice is
The motivation, needs, and interest of the patient
the main food in the diet, and it is usually served three
LEGAL MANDATES RELATED TO timesper day. Fish is the primary protein source in the diet.
NUTRITION AND DIET THERAPY Vinegar, soy sauce, salt, fish sauce andfermented fish are
FOOD AND DRUG ADMINISTRATION (FDA) MANDATES: RA NO. traditional flavorings used in Filipino cuisine.
97111: Philippine adobo is often dubbed the national dish but varies
As a regulatory agency under the Department of Health, the from the adobo served inother cultures. In the Philippines,
Food and DrugAdministration, created under Republic Act adobo refers to foods stewed in a broth of garlic, vinegar,
No. 3720, series of 1963, as amended byExecutive Order bayleaf and peppercorns and is made with chicken, pork or
175, series of 1987, otherwise known as the “Food, Drugs both.
andDevices, and Cosmetics Act”, and subsequently Republic Current Food Practices:
Act No. 9711 otherwiseknown as “The Food and Drug Rice and fish are still the staple foods in the Philippines.
Administration Act of 2009”, is mandated to ensure Many families have gardens.Traditionally, a clay pot is used
thesafety, efficacy or quality of health products as defined for steaming rice and stewing other foods. A kawali (similar
by RA No. 97111, which includemeans food, drugs, to awok) is commonly used for sautéing. Courses of a meal
cosmetics, devices, biologicals, vaccines, in-vitro may be served consecutively, if Spanishin origin, or
diagnosticreagents, radiation-emitting devices or equipment, simultaneously, including dessert, if the dish is of Philippine
and household/urban hazardoussubstances, including origin.
pesticides and toys, or consumer products that may have Generally, the eldest male starts the meal, and others follow.
aneffect on health which require regulations as determined Because soups, stews andmixed dishes are common, spoon
by the FDA. and forks are frequently used, but knives may not be
 presenton the table. Typically, three meals and two snacks, around 10:00am. Since Filipinos are fond of sweet foods, a
one mid-morning and one mid-afternoon, areeaten daily. mixture of instant coffee,evaporated milk, and sugar may be
served. Coca-Cola is very popular. Sweet rolls, doughnuts,or
DAILY FOOD SELECTION a noodle dish may be available.
The food and drink that a person regularly consumedcomprised Lunch is traditionally the main meal of the day, and even
what is called diet. Occasionally, an individual follows aspecial today, in busy cities, it can still be anelaborate affair with
diet, which is a selection of food based on healthconditions or several courses-or it can be a simple noodle dish or fast
disease management goals. Low calorie diet forweight control food bolted down in amatter of minutes. Lunch can also be a
and low salt diet for managing blood pressure are afew light meal with rice and one other dish, often a fish or
examples. Ideally, whether it is typical food consumption or meatstew. Lunch is served from about 12:00noon to 1:00pm
aspecial diet, it should follow the principle of a balanced diet. and consists sour soup, cooked pork, meatstew, fish, and/or
Abalanced diet provides the recommended amounts of vegetables, served with rice and fruit or cakes. Many dishes
essentialnutrients. can be steamed, stirfried, or boiled in a variety of different
ways, either simply or more elaborately. Lechon, or pork,
B. FILIPINO DIETARY PRACTICES isusually roasted or barbecued, and is a very popular meat.
The Dynamics of Food Choices: Eating is more than just You will see adobo, a spice, just abouteverywhere. Filipinos
physiological. It is a means of meeting socialand emotional enjoy sweet pastries, so a very sweet dessert of fruits,
needs of individuals and families. Health care providers pudding, or cake isusually available for every meal. Typically,
whomake changes in their patients' food choices for health the drinks served with lunch and dinner are soft drinks,beer,
reason mustunderstand the numerous factors affecting the and/or tea or coffee.
way they eat. Food behavioris greatly influenced by his habit, Dinner is served from 6:00pm on, with 7:30pm the customary
Preferences, food availability,convenience, culture and late time and is usually a fish orseafood dish served with
upbringing, social pressure and advertising, healthbeliefs, rice and a vegetable dish. Even if the main meal of the day
medical conditions, body image, and emotional state. When was lunch,dinner is only slightly lighter-this is often the case
givingdietary advice, these factors must be kept in mind and with families at home. The dinner menu is oftensimilar to
recommendationsmust be tailored accordingly. that of the more formal lunch. Fish, pork, or chicken is
People select foods which they can afford to buy, which are served at dinner with a soup madeof lentils or vegetables.
readilyavailable, and do not require much time to prepare or Fatty pork is a favorite. Portions of small cubes of browned
cook. In today'smodern lifestyle, foods that are fast and pork fat areconsidered a special dish. Fresh fruit is a
delicious are frequently chosen. common dessert. It is almost always peeled. If alcohol
EATING HABITS IN THE PHILIPPINES isbeing served, predinner drinks may begin with beer or rice
A typical Filipino meal consists of a main seafood or meat wine, then move on to beer during themeal, and end with a
dish served with soup, vegetablesand rice, with tea or coffee. sweet wine and/or coffee or tea. Western liquors are served
Chicken often has bones in it. Fish often come with the in upscalerestaurants and at business dinners.
headsattached. In much of the Philippines breakfast, lunch EATING WITH YOUR HANDS IN THE PHILIPPINES
and dinner are same: Filipino-style ricewith some pieces of According to etiquettescholar.com: “Food you eat with your
meat and vegetables in it. hands is known as "banana-leaf"food. “It includes wonderful
Filipinos tend to rise early, and breakfast is usually eaten vegetarian or meat curries, served with rice and sauce on a
between 6:30am and 8:00am. Atypical Filipino breakfast is largebanana leaf. No plates, no forks, no spoons, no
comprised of “danggit” (dried fish), rice, fruit and chopsticks. You reach into the rice, takesome with your
“ensaymada”(sugar buns), or eggs, sausage and “pan de sal” fingers, gently roll it between your index and middle fingers
(sourdough bread). In some places Spam is apopular and thumb (notyour palm!) into a kind of self-sticking ball,
breakfast treat. In other places breakfast is simply tea or dip it into the sauce on the banana leaf, mix it witha
coffee with rice or food leftover from the night before that is vegetable or a piece of chicken, then pop the whole thing in
not reheated. Rice is served either as a porridge-type your mouth.
cerealthat can be flavored with any number of ingredients, “Wash your hands before you sit down to eat. Many banana-
with eggs in a variety of styles, or withpickled vegetables. leaf restaurants havewashrooms and sinks out in the open
Tea may be drunk plain or with lemon, cream, milk, or sugar. specifically for this purpose. You will also need to washyou
Eggs andsausage are served on special occasions. Bread hands again at the end of the meal, especially after eating
often refers to toast. the saucy dishes, since youhave probably got a good bit of it
“Merienda” is the name of a midmorning and afternoon running down your arm. Do not worry, it is to be expected:do
snack that was introduced by theSpanish and was not dress up if you are eating banana-leaf style.
traditionally served around 3:00pm after a siesta. It usually “Dining etiquette for using your hands. Use your right hand
features cakes,tarts, fritters or sweets made with coconut when picking up and eating food.Keep your left hand at your
milk and palm sugar. Some people take a morning merienda side. Do not place your left hand on the table, and do not
 passfood with your left hand, as the left hand typically is distributional patternsof the natural vegetation often
considered the "unclean" hand in Muslimtradition, and many determining the kind of landscape as well as the species
banana-leaf restaurants are Muslim establishments. If you that willbe present. In the Philippines, water availability also
absolutelycannot eat without some kind of utensil, it's affects the selection of crops to be planted,for example, rice
usually all right to ask for spoons in suchestablishments. versus corn. Tropical soils are also greatly affected by
differences in theavailability of moisture.
SOCIAL PRESSURE
Social pressure operates in all circles and across all cultural C.CORE VALUES OF NURSING AS
APPLIED TO NUTRITION DIETETICS
lines. Close friends share similar foodchoices. Special occasions
are associated with the serving of specific foods, and it is often
Nutrition is a vital component of care and thus a programme of
impolite torefuse food or drink offered by a host.
nutritional educationshould be evident in all pre-qualifying
Culture and tradition. Each area of the world and every
educational programs. Relevant aspects of nutritionshould also
region of a country has own typical foods andways of
be included within post-qualifying programs. Nutritional care is a
combining them into meals. Religious rules about foods can
multidisciplinaryundertaking, and the roles of other health care
further dictate the composition ofdiet. Many Muslims refrain
professionals need to be emphasized. Indeed, apost-qualifying
from eating pork and beef of unknown origin. Some Jewish
program of nutritional care, open to all health professionals,
people do not eatpork or serve milk products and meat at the
would serve tounderline its importance to the improvement and
same meal. There are also areas of the world that
maintenance of health and patient care.
haveethnic taboos.
Registered Nurses: The registered nurse coordinates patient
Advertising. Commercial ads and packaging of the food
care, works with the dietitian and other healthcare team
industry are quite successful in enticing thepublic to choose
members to identify nutrition problems, and reinforces the
certain foods. Food producers spend enormous amount of
importance of nutritioninterventions. The registered nurse
money on marketing andpromotion in order to create
may also provide less complex nutrition care, such
demand for their merchandise.
ascounseling on preventing chewing and swallowing
Body image. People may opt for food that they link with
difficulties or contributing to the nutritionalassessment.
ideals of body image.
Nurses can be certified as a Certified Nutrition Support
Medical conditions and health beliefs. There are health
Nurse by the NationalBoard of Nutrition Support
conditions and their treatments that limit thefoods a person
Certification, associated with the American Society of
can select. A client with hypertension might need to adopt a
Parenteral andEnteral Nutrition. Depending upon their level
low salt diet. Thechemotherapy for treatment of cancer can
of preparation, experience, and practice area,research
interfere with the person's appetite.
indicates that nurses have variable amounts of nutrition
Emotional state. Some individuals eat in response to
knowledge.
emotional stimuli such as boredom, anxiety, anddepression. THE ROLE OF THE NURSE IN
NUTRITIONAL SUPPORT
FACTORS THAT AFFECT DIET The role of the nurse in the nutritional care of patients and
GEOGRAPHY clients is extremely diverse and canrange from promoting a
This is considered one of the most important factors that healthy diet in a client with learning disabilities to the provision
play a huge role indetermining what people eat, as it dictates of parenteralnutrition to a critically ill patient.
what they are able to access. The Philippines, beingan NURSE EDUCATION AND NUTRITION:
archipelago, is surrounded by different bodies of water Education is the key factor in enabling nurses to instigate
making seafood one of the maindishes in Filipino diet. There nutritional care appropriately. Nursingstudents need be
is also a great variety of land animals such as the water educated in the screening and assessment, planning,
buffalo(carabao) and pigs that were consumed due to the implementation and evaluation ofnutritional care. A firm
Philippine landscape. Vegetation and plantingwas also grounding in the principles of nutritional science is essential
possible due to rich tropical soils present. to understand therationale behind the components of
CLIMATE/TEMPERATURE nutritional care.
In the Philippines, even though temperature differences are Interdisciplinary education:
minimal, itstill produces significant differences. These The importance of joint education for health
include vegetational differences and difference inforest professionals from all disciplines is highlighted as
species distribution as well as some properties of wood. adesirable, as this helps to ensure consistency in
Vegetational differences involvetropical plants that tend to curriculum content and acts to promote
grow in lower altitudes and plants mostly found in middle interdisciplinaryworking. The presence of a nutritional
latitudes thatgrown in high altitudes such as Baguio. education can help to ensure that the issues raised and
PRECIPITATION addressedthat nutrition is integrated into the curriculum.
The quantity and seasonality of rainfall greatly affects the
 . Nutritional Education for All Nurses
All branches of nursing should receive the same basic
nutrition education. There is perhaps atendency to
ensure that aspects of nutritional care, and the skills
associated with this, feature in the adultand child branch
but not in others

D. ENTREPRENEURSHIP OPPORTUNITIES
ON NUTRITION AND DIET THERAPY
NUTRIPRENEURSHIP/ DIETITIAN ENTREPRENEURSHIP
Nutripreneurship is the practice and process that results in
creativity, innovation, development and growth of nutrition
businesses.
As we know, Entrepreneurship is a self willing and
approached business firm which starts with a limited
investment where they paved their own pathway with their
efforts and ideas in their corresponding field.
So, in the field of nutrition and dietetics entrepreneurship, a
person is termed as: NUTRIPRENEURS.
Nutripreneurs are nutritionists innovators who use a process
of changing the curent situation of the existing products and
services, to set up new products and new services.
Basically, Nutripreneurs are the trained and skilled
entrepreneurs who may engaged in a field such as:
Private Nutrition/ Diet Clinics.
Researcher firms.
School Nutrition Facilitators.
Gyms and Workout firms Nutrition Counselor.
Bloggers, Webinars.
Consultant.
Nutraceutical based firms.