chapter 1 – title of chapter -...

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Chapter 1 – An Overview of Nutrition

Learning ObjectivesAfter completing Chapter 1, the student will be able to:

1. Discuss the major reasons people make food choices. 2. List the six nutrients contained in food and a major use of each nutrient. 3. Identify the energy-providing nutrients and calculate the energy available from foods.4. Explain nutritional genomics and its role in the science of nutrition.5. List the types of research designs and the strengths and weaknesses of each.6. Discuss Dietary Reference Intakes and the 4 parts of the DRI including the Estimated Average Requirements

(EAR), Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL).

7. Explain the Estimated Energy Requirement (EER) and how it is used to maintain energy balance.8. Discuss the Acceptable Macronutrient Distribution Ranges (AMDR) and how they relate to a healthy diet. 9. Utilize the DRI in the assessment of a healthy individual. 10. List the 4 parts of a nutritional assessment and apply them to individuals to detect malnutrition. 11. List the major methods used to survey the nutritional status of populations.12. Identify the chronic diseases that are linked to diet or alcohol. 13. Identify accurate sources of nutrition information. 14. List the 8 red flags that identify nutrition misinformation.

Assignments and Other Instructional MaterialsThe following ready-to-use assignments are available in this chapter of the instructor’s manual: New! Case study Worksheet 1-1: Evaluation of Published Nutrition Information Worksheet 1-2: Research Project Using the Internet Worksheet 1-3: Influences on Food Choices1

Worksheet 1-4: Chapter 1 Crossword Puzzle New! Worksheet 1-5: Choosing Party Foods and Snacks (Internet Exercise)2

New! Worksheet 1-6: Analyzing Foods and Meals for Nutritional Value3

New! Worksheet 1-7: Unit of Measurement Conversions Practice New! Critical thinking questions with answers

Other instructional materials in this chapter of the instructor’s manual include: Answer key for How To (pp. 8, 9, 29) activities Classroom activities New! Handout 1-4: Converting Metric/English Units of Measurement Worksheet answer keys (as appropriate)

Log in to www.cengage.com/login and access the UNCN 9e companion site to download: Handout 1-1: DRI Terms and Nutrients Handout 1-2: Parts of a Research Article Handout 1-3: Sources of Reliable Nutrition Information

Chapter Outline/Summary

I. Food choicesA. Personal preferenceB. HabitC. Ethnic heritage or tradition

A person selects foods for a variety of reasons. Whatever those reasons may be, food choices influence health. Individual food selections neither make nor break a diet’s healthfulness, but the balance of foods selected

1 Worksheet 1-3 and Handouts 1-1, 1-2, and 1-3 contributed by Sharon Rady Rolfes.2 Contributed by Daryle Wane.3 Worksheets 1-6 and 1-7 and Handout 1-4 contributed by Kathryn Pinna, City College of San Francisco.

© 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

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2D. Social interactionsE. Availability, convenience, & economyF. Positive & negative associationsG. EmotionsH. ValuesI. Body weight & imageJ. Nutrition & health benefits

over time can make an important difference to health. For this reason, people are wise to think “nutrition” when making their food choices.

II. The nutrientsA. Nutrients in foods & in the body

1. Nutrient composition of foods2. Nutrient composition of the body3. Chemical composition of nutrients4. Essential nutrients

B. The energy-yielding nutrients: carbohydrate, fat, & protein1. Energy measured in kcalories2. Energy from foods3. Energy in the body4. Other roles of energy-yielding nutrients

C. The vitaminsD. The mineralsE. Water

Foods provide nutrients—substances that support the growth, maintenance, and repair of the body’s tissues. The six classes of nutrients include: carbohydrates, lipids (fats), proteins, vitamins, minerals, and water. Foods rich in the energy-yielding nutrients (carbohydrate, fat, and protein) provide the major materials for building the body’s tissues and yield energy for the body’s use or storage. Energy is measured in kcalories. Vitamins, minerals, and water facilitate a variety of activities in the body.

III. The science of nutritionA. Conducting research

1. Controls2. Sample size3. Placebos4. Double blind

B. Analyzing research findings1. Correlations & causes2. Cautious conclusions

C. Publishing research

Scientists learn about nutrition by conducting experiments that follow the protocol of scientific research. In designing their studies, researchers randomly assign control and experimental groups, seek large sample sizes, provide placebos, and remain blind to treatments. Their findings must be reviewed and replicated by other scientists before being accepted as valid.

IV. Dietary Reference IntakesA. Establishing nutrient recommendations

1. Estimated Average Requirements (EAR)2. Recommended Dietary Allowances (RDA)3. Adequate Intakes (AI)4. Tolerable Upper Intake Levels (UL)

B. Establishing energy recommendations1. Estimated Energy Requirement (EER)2. Acceptable Macronutrient Distribution

Ranges (AMDR)C. Using nutrient recommendationsD. Comparing nutrient recommendations

The Dietary Reference Intakes (DRI) are a set of nutrient intake values that can be used to plan and evaluate diets for healthy people. The Estimated Average Requirement (EAR) defines the amount of a nutrient that supports a specific function in the body for half of the population. The Recommended Dietary Allowance (RDA) is based on the Estimated Average Requirement and establishes a goal for dietary intake that will meet the needs of almost all healthy people. An Adequate Intake (AI) serves a similar purpose when an RDA cannot be determined. The Estimated Energy Requirement (EER) defines the average amount of energy intake needed to maintain energy balance, and the Acceptable Macronutrient Distribution Ranges (AMDR) define the proportions contributed by carbohydrate, fat, and protein to a healthy diet. The Tolerable Upper Intake Level (UL) establishes the highest amount that appears safe for regular consumption.


3V. Nutrition assessment

A. Nutrition assessment of individuals1. Historical information2. Anthropometric measurements3. Physical examinations4. Laboratory tests5. Iron, for example

B. Nutrition assessment of populations1. National nutrition surveys2. National health goals3. National trends

People become malnourished when they get too little or too much energy or nutrients. Deficiencies, excesses, and imbalances of nutrients lead to malnutrition diseases. To detect malnutrition in individuals, healthcare professionals use a combination of four nutrition assessment methods. Reviewing historical information on diet and health may suggest a possible nutrition problem. Laboratory tests may detect a possible nutrition problem in its earliest stages, whereas anthropometric measurements and physical examinations pick up on the problem only after it causes symptoms. National surveys use similar assessment methods to measure people’s food consumption and to evaluate the nutrition status of populations.

VI. Diet & healthA. Chronic diseasesB. Risk factors for chronic diseases

1. Risk factors persist2. Risk factors cluster3. Risk factors in perspective

Within the range set by genetics, a person’s choice of diet influences long-term health. Diet has no influence on some diseases but is linked closely to others. Personal life choices, such as engaging in physical activity and using tobacco or alcohol, also affect health for the better or worse.

VII. Nutrition information & misinformation—on the Net and in the newsA. Nutrition on the NetB. Nutrition in the newsC. Identifying nutrition experts

1. Physicians & other health-care professionals

2. Registered dietitian (RD)3. Dietetic technician, registered (DTR)4. Other dietary employees

D. Identifying fake credentialsE. Red flags of nutrition quackery

Much nutrition information on the Internet and in mass-audience publications is false or distorted, sometimes intentionally. Reliable sources of information include government agencies, dietitians and other health professionals with formal training in clinical nutrition, and nutrition departments at universities.

Case Study4

Mary P. is a 57-year-old operating room nurse who works full-time at a local hospital. She is 65 inches tall and weighs 160 pounds. She has a family history of diabetes and heart disease and was recently diagnosed with high blood cholesterol. She has declined the cholesterol-lowering medication her doctor prescribed, and says she would like to explore other methods for lowering her cholesterol first. For the past few weeks, Mary has been taking a tablespoon of coconut oil every day after reading on the Internet that this will lower her cholesterol. She admits she has little time or energy to exercise. Her diet history reveals she often skips breakfast or has a donut or bagel with cream cheese at work. She drinks several cups of coffee each morning with cream and sugar. Lunch is a salad with crackers and iced tea with sugar in the hospital cafeteria. She occasionally drinks one or two glasses of wine in the evening, especially after a stressful day at work. She lives alone and relies on frozen dinners or other convenience foods in the evening. An analysis of her diet reveals an average daily intake of 80 grams of fat, 200 grams of carbohydrate, and 50 grams of protein.

1. Taking into account her current lifestyle and personal food preferences, what eating habits might be difficult for Mary to change?

2. How might her emotions contribute to her food and drink choices?3. Using Table 1-2, calculate Mary’s average daily kcalorie intake.4. What percentage of her daily calories is provided by fat? Carbohydrates? Protein?4 Contributed by Barbara Quinn.


45. Compare the composition of Mary’s diet with the Acceptable Macronutrient Distribution Ranges (AMDR). 6. How would you use the information above to make dietary recommendations for Mary?7. How would you direct her to valid nutrition research for lowering blood cholesterol?

Answer Key: 1. Skipping breakfast, snacking on donuts at work, use of convenience foods, use of alcohol to calm emotions.

2. Alcohol and foods high in carbohydrates tend to calm emotions in times of stress; caffeine (coffee) may help ease her feelings of tiredness.

3. (80 grams fat x 9 kcalories/gram = 720) + (200 grams carbohydrates x 4 kcalories/gram = 800 calories) + (50 grams protein x 4 kcalories/gram = 200 kcalories) = 1720 kcalories.

4. Fat: 720/1720 = 42%; Carbohydrates: 800/1720 = 46%; Protein: 200/1720 = 12%

5. Her diet is high in fat (42% versus 20-35% AMDR); adequate in carbohydrates (46% in an acceptable range of 45-65%); and adequate in protein (12% in a range of 10-35%).

6. Help her find major sources of fat in her diet to decrease or eliminate. Help her find lower-fat choices of usual foods such as lower-fat cream cheese and convenience foods.

7. Explain the evidence from peer-reviewed research publications for eating a diet lower in saturated fat for lowering blood cholesterol. Direct her to the “red flags of nutrition quackery” (Figure H1-2) and explain how to determine if a website is reliable (Highlight 1).

Suggested Classroom Activities

A nutrition course should begin on a note of excitement. The best classes involve students and help them to see nutrition’s importance to them. Once they are hooked on nutrition because they feel personally involved with it, they will be motivated to learn about nutrition topics.

Classroom Activity 1-1: Students’ Burning Questions5

Objective: Introduction to nutrition Class size: All sizesMaterials needed: Post-It notes (3 per student), 20 sheets construction paper, tapeInstructions: The first day of class, give each student three “Post-It” notes. On each note, students are to write down a “burning” question they have about nutrition. While they are doing this, tape twenty large pieces of construction paper around the room, each with a title that roughly corresponds to chapters of the text.

When they finish writing their questions, have them categorize their Post-It notes according to the twenty topics by placing their Post-It on the piece of construction paper that relates to their question. When they finish, ask them to take turns reading the questions that they have generated. Before the next class, check the categorization of their questions and rearrange the Post-It notes if necessary. As you begin a new chapter, bring the corresponding piece of construction paper to class, and read the questions aloud.

This activity helps reassure students, early on, that you will (or won’t) be covering some of their “burning” questions. It also helps show students the relevance of the information you’re covering in class, and helps show instructors the interests of the students.

Classroom Activity 1-2: “Find a Person Who” Introduction ActivityObjective: Enhancing emotional classroom environment Class size: All sizesMaterials needed: Copy of form described below (developed by instructor) for each studentInstructions: Students sometimes enjoy classes more when they are acquainted with other students. One way to assist this process is by providing students with a “Find a Person Who” form. Develop a form several columns wide and several rows long that lists a variety of traits in each square such as: enjoys cooking, recycles, has a pet, is a nutrition major, etc. Instruct students to walk around the class, introduce themselves to each other, and try to find a person who fits the categories described on the sheet. When they find someone who fits a category, have them write

5 Activity provided by: Caroline Roberts, R.D., M.P.H.—Nutrition Education Specialist for California Department of Education and Instructor at Sierra College


5person’s first name in that category. The goal is to complete the sheet. You may also suggest that they exchange e-mail addresses or phone numbers and form study groups. This activity works best for small to medium size classes.

Classroom Activity 1-3: Brown-Bag Introduction ActivityObjective: Establishing positive classroom environment Class size: Small to mediumInstructions: In the class period preceding this introduction activity, read the following list of categories: a hobby or interest that students enjoy, something that is a favorite (color, book, music, food), future plans or goals, something they would like to do better, a place they’d like to visit, something special about family or friends, the best part of their last vacation, a healthy activity they like to do, and a talent or special ability they have. From this list, students are to select one item that represents each of 3 categories and bring these 3 items to class in a small brown bag. They should try to select items that are 3 dimensional and unique. During class they will share the contents of their brown bags with the class. This is a good way for students to become acquainted with others. This activity works best with small classes.

Classroom Activity 1-4: Getting Acquainted ActivityObjective: Establishing positive classroom environment Class size: Small to mediumInstructions: This activity allows students to learn more about each other and can provide an environment in which people practice listening skills. Instruct students to pair off with someone that they do not know very well. Give the students 10-15 minutes to converse and ask some general questions about each other. Bring the group back together in a large circle with each student sitting next to his or her partner. Ask each student to introduce and speak about his or her new friend. This activity works best for small and medium sized classes.

Classroom Activity 1-5: “How Is Your Day Going?” ActivityObjective: Enhancing positive classroom environment Class size: Small to mediumInstructor: An instructor who displays sincere caring about students is likely to be effective at gaining student trust. At the beginning of class, tell students you want to find out how they are doing. Instruct students to individually introduce themselves to the class by stating their name, where they are from, and what type of day they are having (either A, B, or C day). Then they are to share why they are having that type of day. The next person repeats the process sharing information about themselves and their day, then repeats what the other students shared. This can be a challenging activity, especially in larger classes. This activity is most appropriate for small to medium size classes.

Classroom Activity 1-6: Who Are You? Introduction ActivityObjective: Establishing rapport Class size: AnyMaterials needed: 1 index card per studentInstructions: Instructors who know their students and can refer to them by name are better equipped to gain trust and be effective in the classroom. Distribute index cards to each student and instruct students to record information about themselves on each card. Write on the board the information you are interested in obtaining. Some suggestions include: name, address, phone, e-mail, major, year in college, home town, employment, professional goals, hobbies, what they hope to learn from the class, reason for taking the class, and something interesting and/or unique about themselves. After students have recorded this information, you may ask them to introduce themselves to the class or you may simply collect the cards to help you learn more about your students. Instructors may want to use the cards to learn student names.

Classroom Activity 1-7: Chapter Opening Quiz6

Objective: Introducing new material Class size: AnyInstructions: As a way of introducing any new chapter, give a “quiz” to the class. The students will moan initially, but they will enjoy the activity once you get underway and they realize that it is taken as a class and does not count towards their grade. The “quiz” asks ten true/false or multiple-choice questions projected on the overhead from a transparency. The students are not allowed to talk during the quiz, and must show their choice of answer by raising hands. Mark the answer chosen by the majority of hands on the transparency. Then go over the correct answers (their curiosity is piqued!) and seize the “teachable moment.” Generally, they score about 55% and realize there is a lot to learn.

6 Activity provided by: Lin Brown, Shasta College, Redding, CA


6This “pretest” is valuable because it creates interest in the subject matter, challenges students’ erroneously-held beliefs, and introduces new terms and concepts. It is valuable to instructors in assessing the level of knowledge and attitudes in the subject area and identifying the needs and the focus for the unit.

Classroom Activity 1-8: Using FAQs For Class Information7

Objective: Disseminating class information Class size: AnyInstructions: As many people know, a Frequently Asked Questions page is worthwhile to examine. The questions asked and answered are the type of questions a student may have about the class but may not have thought about until reading them. These questions should be designed carefully based on questions that are often received so they will be of high interest to students. These could be the top ten questions for surviving the nutrition class. A sample question is: “What is the best way for a student to learn nutrition well enough to ace this course?” If you can cover questions that students really have about the course, you’ll be showing them early on that you understand their concerns and can also provide some good advice.

Classroom Activity 1-9: Exploration of “MyPyramid.Gov” Web Site8

Key concepts: MyPyramid diet planning tools, Internet skills Class size: AnyObjective: The purpose of this assignment to help the student become familiar with the available resources offered on the MyPyramid web site provided by the United States Department of Agriculture (USDA). Since the majority of people have computer access (24/7), this activity will help the student to see what is available to both the health professional and health consumer on a daily basis.

Instructions:1. Divide the students in the class into 5 equal groups. This can be accomplished either through a lottery ticket

mechanism or use of a student roster list.

2. Secure online access and have each of the student groups go to the following URL address: http://mypyramid.gov/.

3. Assign each group to one of the following areas: (1) My Pyramid for kids, (2) Tour My Pyramid, (3) Inside the pyramid, (4) Tips & Resources and (5) My Pyramid Plan.

4. For each group assignment, have the student group enter into the assigned area and ascertain the following information:

a. Describe the content area of the link.b. Identify the resources available from the link.c. Describe how many steps are required to get to all of the information and the length of time involved in

accessing the information.

5. If the class is Web enhanced, post a MyPyramid Discussion Board to the course site. Have the student groups post their critical appraisal of each of the assigned links prior to coming to the next class session. If the course is not Web enhanced, then have the groups do a write-up of the assignment.

6. At the next class session, review the information posted on the Web, or in the case of the course not being Web enhanced, have the groups bring their written information to class and discuss the groups’ findings in terms of these criteria:

a. Was the information easy to access? (Yes or no.)b. If the information was not easy to access for you as a “college student,” then how do you think that others

who have less experience with either the subject matter or computer competency would be able to access the information?

c. Do you think that the information was representative across cultural lines? d. Overall, who do you think would be most likely to benefit from the information on this Web site?

Classroom Activity 1-10: Using the Internet as a Research ToolKey concept: Research process Class size: Any

7 Activity provided by: Dr. Neil Allison, University of Arkansas8 Contributed by Daryle Wane.


http://mypyramid.gov/

7Instructions: The Internet can be used as a valuable research tool in nutrition. The student can become familiar with the diversity of Internet resources and can learn to participate in online discussions about nutrition topics in class-based and listserve groups. Worksheet 1-2 provides assignments to help students acquire Internet skills.

How To “Try It” Activities Answer Key

How to Think MetricThe student should divide his or her body weight in pounds by 2.2 to determine weight in kilograms, and multiply his or her height in inches by 2.54 to determine height in centimeters. For example, a student who weighs 115 lb. and is 5’6” tall would convert this to 52.27 kg and 167.64 cm.

How to Calculate the Energy Available from FoodsThe bean/cheese burrito would provide 388 kcal and 56.7% of kcal from carbohydrate, 15.5% from protein, and 27.8% from fat.

How to Determine Whether a Website Is ReliableThe student should provide a URL for the website chosen, and then describe the group or individual that created the site, name the date it was most recently updated, discuss sources for the information presented, speculate on the motivation for presenting this information, and evaluate the overall message of the site.

Critical Thinking Questions9

These questions will also be posted to the book’s website so that students can complete them online and e-mail their answers to you.

1. The following example was provided in your text regarding the importance of “nutrition”: “...your body uses the nutrients from (meals eaten) to make all its components, fuel all its activities, and defend itself against diseases....” Please expand upon this statement relative to the role of food in the lifestyle of the average American consumer. If you were performing a dietary intake on a patient, what other questions might you be interested in regarding the patient’s diet and activities?

Answer: In this question, students are being asked to discuss the multiple factors that influence an individual’s food choices and eating patterns, beyond the single role of food as the body’s fuel. While the students can respond to this question in an individual manner, their response should include some combination of the following.

A thorough Dietary Intake should include:

1. Patient preferences – include value systems such as vegetarian, religious, environmental, or political beliefs.

2. Patient dietary habits & exercise habits – use multiple methods of assessment.3. Ethnic and cultural traditions & importance to the patient’s dietary preferences.4. Psycho-social assessment – Body image issues, eating disorders, social eating vs. preference to eat alone.5. Economic abilities – What is the patient’s ability to purchase food, what type of cooking utensils and

equipment do they have to use in cooking, where do they shop, and is the store reasonably priced? 6. Nutritional knowledge – What do they know about nutrition and food choices, serving sizes, and cooking

styles? Who does the cooking?

If the student makes reference to the idea that Americans often lose sight of the role of food as fuel to our bodies because food has taken on so many other roles in the lives of Americans, the student should get additional credit as this statement fully summarizes a complete response to the question.

2. Your text described six classes of nutrients and discussed the distinctions between them in several ways (i.e. caloric density, organic/inorganic, size, and essentiality). Discuss each class of nutrient important to the body

9 Contributed by Kathleen Rourke.


8and its unique distinction. Discuss your concerns for a patient that might be undernourished or over nourished in each category. For example, in a broad sense, what problems would that cause the patient?

Answer: Water is an essential nutrient that provides no energy. It is vital to the body for metabolic reactions, to carry waste away from the body, and to carry nutrients around the body. The body is over 65% water.

Patients that are undernourished can be dehydrated, resulting in them having a bodily environment that is inefficient in carrying out metabolic processes, removing waste, and carrying nutrients to the various organ systems. They might also have elevated levels of minerals and some vitamins that are stored in the body due to the dehydration. Undernourished patients need to break down protein for energy, given that glycogen and fat stores are not longer available. An undernourished patient’s risk for protein malnutrition, infection, and cardiac problems increases.

Over nourished patients may have difficulty circulating the water around their bodies because their heart has to work harder to pump the fluid around a bigger surface area.

Carbohydrate is an energy-yielding macronutrient that supplies 4 kcal/gram. Because carbohydrates contain carbon, they are considered an organic compound.

Undernourished patients’ bodies will turn to their body fat and then their body protein for energy and metabolic functions. Most undernourished patients have now consumed all their body glycogen from carbohydrates and their body fat and are now using their body protein for energy and are thus in protein-energy malnutrition.

Over nourished: Excess carbohydrates are stored as fat, leading to obesity.

Protein is an energy-yielding macronutrient that supplies 4 kcal/gram. Protein is also an organic compound that is important to the body for tissue repair, growth, and maintenance, its primary functions.

Undernourished: If the patient becomes too undernourished, protein stores (muscle) are used. If nourishment is the only issue with this patient, one hopes that nourishment is provided. Remember that many organs, such as the heart, are also muscle tissue; therefore, organ compromise can occur over time in situations of protein-energy malnutrition.

Over nourished: Many athletes seek to find the optimum amount of protein to take to enhance protein building and thus muscle mass. While research does demonstrate that protein needs are higher for athletes than sedentary individuals, there is an upper limit of protein intake. Beyond that, excess protein beyond the needs of the individual can be converted to fat, given there is an excess in caloric intake. High protein intake is also difficult on the kidneys and should be discouraged.

Fat is an energy-yielding macronutrient that supplies 9 kcal/gram. This organic compound retains two times the amount of energy as compared to other energy nutrients, given its density.

Undernourished individuals do not retain a protective layer of fat tissue, which is needed to protect the body organs as well as to provide the body with a thermal shield. Some body fat is also required for normal hormonal functioning. Undernourished individuals will need to be provided with a fatty acid source for hormonal synthesis and other body protections.

Over nourished: As we well understand in this country, overconsumption of fat means excess calories and excess weight.

Vitamins are organic compounds that facilitate release of energy and participate in many activities in the body. Each has a different function such as vision, controlling bleeding time, making hormones, etc. Vitamins need to be handled carefully as many environmental properties can destroy a vitamin, e.g. sunlight or heat.

Undernourished: There are two types of vitamins, fat soluble and water soluble. Fat-soluble vitamins are stored, while most water-soluble vitamins are not stored in the body to a significant extent. Depending on the degree of undernourishment, an individual may have some stored fat-soluble vitamins; however, he/she will probably not absorb an appreciable amount of fat-soluble vitamins because the presence of fat is necessary in the diet to absorb these types of vitamins. The person may be able to absorb appreciable amounts of water-soluble vitamins, depending on the situation. If the body is lacking some of the vitamins, its ability to absorb is enhanced. With others, there are dependent mechanisms for absorption.


9Over nourished: This individual does run the risk of excess storage of some of the fat-soluble vitamins. Given that most fat-soluble vitamins are found in more nutrient-dense foods, it is not likely that an over nourished individual is at risk of an excess of fat-soluble vitamins if consuming an energy-dense, nutrient-poor diet.

Minerals are inorganic substances that do not provide energy to the body but do serve as cofactors in many reactions in energy metabolism. Several minerals are essential. Minerals are found in fluids within the body and thus can influence the properties of fluids (e.g., sodium, potassium). Minerals are inert, so they are not easily destroyed; however, they can be bound to other substances such as phytates.

Undernourished: An undernourished individual does run the risk of missing many essential mineral elements in their diet and therefore could potentially not have sufficient quantities for metabolic functions.

Over nourished: Again, while the over nourished individual may gain more minerals in their diet from excess consumption, most minerals are found in nutrient-dense foods such as fruits and vegetables, which are not generally foods that result in overnourishment. Therefore, this individual may also run a risk of deficiency of some minerals.

3. As noted in Chapter 1, the science of nutrition is a young science but growing rapidly. Without scientific studies, nutrition could not grow and flourish as it does. It will be important for you not only to understand how to read scientific studies but to be involved in them. Tell me about a nutrition-related topic that you are interested in studying. Attempt to write a simple question that could be answered with a research study. How would you differentiate between the experimental and control groups, how many subjects do you think you would need for a good sample size, and what do you want to know before making conclusions? What other specifics should you know or integrate into your research design to optimize its validity? What should your readers know when it is published?

Answer: In this question, the students should select a research topic that they are interested in studying. That will help make the topic of research more interesting to them.

A simple research question should be a succinct as possible and include the following: the type of study, the study population, and the time period of the study. Think “measurable” when putting together a research question. For example:

The efficacy of vitamin D in relieving pain will be studied in 50 pain management patients over a one-year period.

The focus of the study: The efficacy of vitamin D in relieving pain

The study population: 40 pain management patients

The time period: One year

An experimental group is the group receiving the treatment; the control group is the placebo group or the group that does not receive treatment. A control group is needed to distinguish whether the treatment participants react differently than participants receiving no treatment.

A good sample size is determined by power statistics.

Before making any conclusions, the researcher wants to fully understand the research and how it relates to other researchers’ work in the same field of research. The researcher needs to fully understand the statistics and what they mean, what they don’t mean, and what the data may be “saying” relative to other work in the field.

To optimize the validity of a study, a researcher will take time to make sure that the study question is a measurable question and the study design is consistent with the study question and achievable over the determined study period.

A published research article should include why it was important to study the topic, information on other researchers that have studied the topic, a brief outline on how to carry out the research to enable other researchers to replicate it, results of the study, and why your results or findings are important to nutrition and dietetics professionals.


104. What is the difference between a DRI and an RDA? Should you tell your client to take both? Does it mean that

everyone should take the same amount to achieve the same benefit from the nutrient? Are there DRI and RDA for macronutrients?

Answer: DRI stands for Dietary Reference Intake and RDA stands for Recommended Dietary Allowance. The RDA has been around for quite a long time (1940s) and was originally established for the military to prevent scurvy. Since that time, significant study has been undertaken on each micronutrient and macronutrient to establish the level of intake that is deemed appropriate for 98% of the population to prevent disease and optimize health. Generally, every ten years new RDA research is published and changes are made if needed. RDA are used to evaluate diets of populations.

DRI, which include the RDA, are relatively new and reflect collaborative work between the U.S. and Canada. They are a set of standards resulting from collaboration of many research scientists, and can be used to evaluate diets of healthy individuals. They include the Estimated Average Requirements from which RDA are derived, Adequate Intakes for nutrients for which RDA have not been established, and Tolerable Upper Intake Levels that identify potentially toxic levels of intake.

5. You are about to perform a nutrition assessment on a patient. State specifically, and in detail, what types of assessment information are you going to collect and why.

Answer: It is important to perform a historical review with the patient, in which the dietitian will ask the patient about their health history, including details about any medical conditions, problems, or medications. The dietitian also wants to know about the patient’s family background, cultural and ethnic background, work history, and living conditions, including where the patient and family shop and who cooks the meals. It will also be important to retrieve a detailed diet history and food frequency, and conduct some psychosocial assessment of the patient.

Next, the dietitian should collect anthropometric data regarding height, weight, body fat, bone mass, and lean body tissue.

The dietitian should compare her findings, including dietary analysis, with laboratory tests performed by the physician as well as the results of the physical examination.

The above nutrition assessment provides the dietitian with background on the patient’s past health history, which may have affected their present dietary intake. Medications previously and presently taken are important, as they affect intake and can result in drug-nutrient interactions. It is also important for the dietitian to know of any previous problems the patient has had with a practitioner, diagnosis, medication, or condition. In this regard, the dietitian can avoid unnecessary problems for the patient. As discussed earlier, the more one knows about a patient’s lifestyle, the more the dietitian can provide dietary advice, counseling, and recommendations to the patient that will allow him/her to stay within close parameters to his/her normal regime.

A thorough diet analysis from multiple perspectives provides the dietitian with the best picture of the patient’s intake. A single method of diet analysis can be unreliable; therefore, multiple methods increase the dietitian’s ability to accurately determine what the client is really eating.

Anthropometric measures are made to establish appropriate weight-for-height measures as well as body fat measures. These are compared with established norms and allow the dietitian to set goals for the patient.

Laboratory tests are objective measures that can be compared against some of the more subjective measures such as medical history to provide a complete picture to the dietitian of the patient’s overall health and dietary status.

6. Chronic disease is a significant health problem in the United States. Billions of health care dollars are spent on chronic disease, yet, in reality, little is done about the role of nutrition in the prevention of or recovery from chronic disease. If you were the Surgeon General, in charge of health care spending, what might be your first proclamation and why?

Answer: This is an open question for the students aimed at them exploring the role of nutrition in the prevention or treatment of chronic disease. Students can direct this question either way. I would expect the


11student to give specific examples of a chronic disease and the nutrients and dietary habits that would prevent the disease or help in its management. It would also be important for them to demonstrate that they understand that research is important to making any proclamation at the federal level. Therefore, any decision that they make must be supported by a sound evidence base.

7. Bonus: (a) Nutrition assessment is the diagnostic tool of the registered dietitian. In performing a nutrition assessment, an RD asks many specifics about diet—in detail. Why? (b) The RD also will ask for much detail about an individual’s behaviors, culture, financial status, etc. Why would the RD delve into one’s personal history in such detail, and what does this have to do with what one eats? (c) If an RD asks about the person’s health status, would that be appropriate? Why or why not? (d) If there were questions about a disease or issue that the RD was not familiar with, where might they go to find additional information?

Answer: (a) The RD needs a great deal of specific, detailed information about the patient’s diet because it is important to understand servings or volume, all condiments or extraneous items a patient might use on a specific food, cooking procedures, food preferences, and cultural or ethnic habits. Several different questions regarding food habits also allow the RD to assess the reliability of the dietary data that is being collected.

(b) Because one’s culture and finances have much to do with their dietary habits. Culture is the basis of one’s eating habits and one’s finances are critical to one’s ability to purchase food.

(c) Yes, as health status is the foundation for how the RD will counsel the patient. Perhaps problems with the patient’s health status sent the patient to the RD or perhaps there are new issues. Either way, the RD should know of the patient’s health background and medications to appropriately counsel him or her.

(d) It is important for the RD to be familiar with the medical library and professional journals where the RD can search for information on questions s/he may have. Clearly one can turn to a colleague for a quick question, but the RD should always follow up their inquiry with a review of the professional literature.

8. There are a variety of health professionals in addition to the physician and the nurse. Very frequently the health care consumer is confused as to who does what and whom to listen to. It seems like everyone is providing nutrition information these days, and other than the physician and the RN, why should I trust anyone else? You are an RD in a community hospital and your patient indicates when you come into his room that there have been several individuals that have already visited him to talk about diet. You find out that the respiratory therapist, physical therapist; speech pathologist, MD, and RN have all talked to Mr. X about his diet. Discuss the differences among the many health care professionals with regard to their nutrition training and scope of practice and then briefly discuss how you might approach your patient to help him understand how your skills are unique from those of the other health care professionals.

Answer: Many health care professionals are involved in patient care; therefore, when they are accessible, the patients will turn to them for nutrition advice, not knowing any different. It is important to understand that the public does not always understand the difference among all the different types of health care professionals. The majority of health science professionals do not receive any nutrition training, except for the occasional nutrition content specific to certain content areas. The exception to this is nursing, which does require one nutrition course in a four-year curriculum. Physicians may or may not receive a nutrition course in a four-year curriculum, as it is presently not mandated by the accrediting body. Therefore, it is really important for the RD to work with other health care professionals in collaboration for the best of patient care.

When talking to the patient, take a positive approach by indicating that you are glad that the patient is interested in finding out how they can improve their diet. Then explain your role in the hospital, clinic, etc. as the RD and health care professional that is the diet and nutrition expert, providing a business card and information for the patient to easily contact you as the RD. Finally, help the patient to understand all details of their dietary regime and answer all questions in full detail. Do not discuss any other health care professional negatively. This is unprofessional!

IM Worksheet Answer Key

Worksheets 1-1, 1-2, and 1-3 – Answers will vary.


12

Worksheet 1-4: Chapter 1 Crossword Puzzle1. foods 2. organic 3. nutrition

4. vitamins 5. risk factors 6. diet

7. malnutrition 8. compounds 9. phytochemicals

10. essential nutrients

Worksheet 1-5: Choosing Party Foods and Snacks (Internet Exercise)1. True2. True3. False

4. True5. False6. True

7. False8. True9. False

10. c11. True

Worksheet 1-6: Analyzing Foods and Meals for Nutritional ValueOverview example: a; a. cheddar = 9.40 g; b. mozzarella = 6.34 g (for whole-fat); c. Swiss = 7.88 g1. b 2. b

Data for 1 & 2: a. oranges = 87.3 mg vitamin C, 322 mg K; b. kiwifruit = 166.9 mg vitamin C, 562 mg K; c. strawberries = 89.4 mg vitamin C, 233 mg K; d. grapefruit = 76.6 mg vitamin C, 329 mg K; e. bananas = 13.1 mg vitamin C, 537 mg K

3. a; vitamin C in oranges = 87.3 mg; RDA for vitamin C = 90 mg; % of RDA in oranges = 97%; K in oranges = 322 mg; AI for K = 4700 mg; % of AI in oranges = 6.85%

4. c; a. wheat bran = 12.4 g; b. avocado = 7.8 g; c. brown rice = 1.75 g; d. black beans = 7.5 g

5. d

Meal #1 Energy (kcal)

Protein (g) Total Lipid (fat) (g)

Fiber (g) Calcium (mg)

Iron (mg) Sodium (mg)

Whopper with cheese

790 35.36 48.44 3.2 259 6.32 1431

French fries 387 4.09 20.36 3.4 11 1.51 532Vanilla shake 667 12.66 34.70 0.0 413 1.67 397Totals 1844 52.11 103.50 6.6 683 9.50 2360

Meal #2 Energy (kcal)




Caesar salad with grilled chicken

221 30.54 6.34 3.4 199 1.90 886

Fruit 'n Yogurt Parfait

156 4.07 1.94 1.5 128 0.67 86

Orange juice 224 3.38 0.30 1.0 45 0.50 5Totals 601 37.99 8.58 5.9 372 3.07 977

6. e 7. b 8. c 9. d 10. a

Worksheet 1-7: Unit of Measurement Conversions PracticeEnglish (U.S.) System Metric System

Weight 1 lb = 16 oz 1 kg = 1000 g1 g = 1000 mg

Volume 1 gallon = 4 quarts1 quart = 4 cups

1 L = 1000 mL

Length 1 yard = 3 feet1 foot = 12 inches

1 meter = 1000 mm1 meter = 100 cm

1. 25,000 mg 4. 48 oz 7. 70.4 lb 10. 196 g 13. 77.27 kg


132. 3000 g3. 50,000 µg

5. 4 lb6. 52.73 kg

8. 12.7 cm9. 19.7 in

11. 0.54 oz12. 140 g; 140,000 mg

14. 139,091 kcal

Canadian Information10

IntroductionNutrition instructors in Canada need to provide up-to-date and accurate Canadian information to their students about: food labelling; food, nutrition, and physical activity guidelines and recommendations; impacts of nutrition, health, and social programs on food intake; nutrition and physical activity education resources; and current nutrition-related research. Prior to and since the release of the first set of Dietary Reference Intakes in 1997, effort has been taken to harmonize nutrition-related policies and standards of Canada with those in the United States. Canadian nutrition educators and colleagues in the United States use a common research base for describing how nutrients function in the body and for planning nutrition interventions. However, differences in food intake patterns, health statistics, and health policies affect the content and format of national nutrition programs.

Canadian instructors and students have Internet access to Canadian information, as well as information for other countries around the world. Although access to a vast amount of information is available, students often feel challenged to discern unreliable from reliable and credible web-based nutrition information and resources. This Canadian Information section identifies Canadian food regulations, standards, programs, research, and resources to help instructors locate and use Canadian information in their introductory nutrition courses. Canadian information is provided according to the topics discussed in each chapter or highlight in Understanding Nutrition, Twelfth Edition.

1.1 How to Calculate the Energy Available from Foods in KilocaloriesEnergy values found in food composition tables and on food labels in Canada are expressed as Calories (kilocalories). To become more familiar with kilocalories, students can calculate the energy available in foods using the example in “How to Calculate the Energy Available from Foods” and the energy conversion factors for the macronutrients found in the “How to” box on page 9 in Chapter 1 of the textbook.

1.2 Dietary Reference IntakesAs Chapter 1 of the textbook indicates, Canada has participated in the development and implementation of the Dietary Reference Intakes (DRI). The DRI provide a set of nutrient and energy recommendations for both Canada and the United States, and support harmonization of trade-related issues and freer trade of food across the Canada-U.S. border. Health Canada provides current information about the DRI on its web site (www.hc-sc.gc.ca/fn-an/nutrition/reference/index-eng.php). This link will provide access to: (a) Dietary Reference Intakes FAQs, a link that instructors will find particularly helpful when planning lectures to explain the DRI; (b) Development of the Dietary Reference Intakes, which provides a historical perspective to development of the current DRI; (c) Using the Dietary Reference Intakes, a fact sheet that provides a brief introduction to appropriate uses of the DRIs for dietary assessment and planning, and provides direct links to Applications in Dietary Assessment and Applications in Dietary Planning, both reports providing guidelines to help instructors determine when specific uses would be inappropriate; (d) A Consumer's Guide to the DRIs to familiarize consumers with the current recommendations for nutrient intakes; and (e) the Dietary Reference Intake Report List, which provides a list of all DRI-related published reports. Instructors who want to gain an in-depth understanding of DRIs and their application can take an on-line course through the member’s side of the Dietitians of Canada web site www.dietitians.ca or at www.dieteticsatwork.com.

These two published articles explain the application of DRI to assess and plan diets.

Murphy SP, Barr SI, and Poos MI. 2002. Using the New Dietary Reference Intakes to Assess Diets: A Map to the Maze. Nutrition Reviews, 60(9):267-275.

Murphy SP, and Barr SI. 2005. Challenges in Using the Dietary Reference Intakes to Plan Diets for Groups. Nutrition Reviews, 63(8):267-271.

10 Contributed by Gail Hammond.


http://www.dieteticsatwork.com/

http://www.dietitians.ca/

http://www.hc-sc.gc.ca/fn-an/nutrition/reference/index-eng.php

14

1.3 Nutrition Assessment of the Canadian PopulationCanada does not have a formal, regularly cycled, systematic program of national food and nutrition surveillance, such as HANES (Health and Nutrition Examination Survey), NFCS (Nationwide Food Consumption Survey), and NHANES (National Health and Nutrition Examination Survey). Canada's first comprehensive national nutrition survey, the Nutrition Canada Survey, was conducted in 1970-1972. During the 1990s, provincial surveys were completed under the Canadian Heart Health Initiative. Methods of data collection varied with the different surveys; hence, the results of these studies have not been compiled nationally or used for comparisons between regions. Refer to Health Canada’s guide to provincial nutrition survey contacts and reports for dietary intake patterns and other survey-specific information (www.hc-sc.gc.ca/fn-an/surveill/nutrition/prov/index-eng.php).

The Canadian food intake survey, “Food Habits of Canadians,” collected data between August 1997 and July 1998 from five regions in Canada (Atlantic, Québec, Ontario, Prairies, and British Columbia). The intake of fat showed total fat represented 29 to 31% of energy intake, within the currently recommended Acceptable Macronutrient Distribution Range of 20-35%.11 Adult and adolescent intake of foods compared with recommendations in Canada’s Food Guide to Healthy Eating showed only males between the ages of 13 and 34 years met the recommended intake for all of the four food groups, and the mean intakes of milk products were below the minimum recommended servings for all age and gender groups.12 The other food groups showed variable intake results across age and gender.

Improving the Health of Canadians 2005-2006 Report Series provides a broad look at the health of Canadians and the impact of multiple determinants on health. Information from this report can be used when discussing issues of low income or food insecurity (Chapter 20), or during the appropriate stage of the life cycle. The report series examines what we know about factors that affect the health of Canadians, ways to improve our health, and relevant options for evidence-based policy choices. The series is produced by the Canadian Population Health Initiative, and is available from the Canadian Institute for Health Information web site (www.cihi.ca), an independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians. Reports in the 2005-2006 series include: Improving the Health of Young Canadians, which highlights research relevant to understanding adolescent health and development; Promoting Healthy Weights, which focuses on the role of the environments in which we live that promote healthy weights, using a population health framework; and the final report, An Introduction to Health in Urban Places, which explores the patterns of health within and between Canadian cities and looks at how the social and physical aspects of urban neighbourhoods and housing may be linked to people’s overall health. The more recent Improving the Health of Canadians 2007-2009 report series is comprised of three reports that focus on the determinants of mental health among Canada's vulnerable populations.

During 2004, the Canadian Community Health Survey (CCHS), Cycle 2.2 on Nutrition, collected 24-hour dietary recall data, and nutrient supplement use and related data on Canadians at a provincial level. This collaborative initiative between Health Canada and Statistics Canada represented the first national nutrition survey conducted by the Canadian government in over 30 years and was the largest and most comprehensive survey ever conducted of what Canadians eat. Trained interviewers directly measured height and weight data of a nationally representative sample of over 35,000 Canadians of all ages residing in private households in all ten provinces. The measured data differ from self-reported data used in previous surveys. Other data collected included: physical activities, chronic health conditions, smoking, alcohol use, food insecurity, and socio-demographic characteristics. Listed below are publications in reverse chronological order by date of release from the CCHS, Cycle 2.2.

Date Report from CCHS Data2009 *Nutrient Intakes from Food, Provincial, Regional and National Summary Data Tables, Volumes

2 and 32008 Nutrition – General Health (including Vitamin & Mineral Supplements) & 24-Hour Dietary

Recall Components – User’s Guide

11 Gray-Donald K, Jacobs-Starkey L, Johnson-Down L. 2000. Food habits of Canadians: Reduction in fat intake over a generation. Canadian Journal of Public Health, 91(5):381-385.12 Linda Jacobs Starkey, Louise Johnson-Down, Katherine Gray-Donald. 2001. Food habits of Canadians: Comparison of intakes in adults and adolescents to Canada's food guide to healthy eating. Canadian Journal of Dietetic Practice and Research, 62:61-69.


http://www.cihi.ca/

http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/prov/index-eng.php

15

Date Report from CCHS Data2008 *Nutrient Intakes from Food, Provincial, Regional and National Summary Data Tables, Volume

1 – Revised2007 *Income-Related Households Food Security in Canada: Supplementary Data Tables2007 *Income-Related Household Food Security in Canada2006 *A Guide to Accessing and Interpreting the Data2006 Overview of Canadians’ Eating Habits2005 Overweight Canadian children and adolescents2005 Adult obesity in Canada: Measured height and weight

Access to all reports labelled with an asterisk is available at www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php#p1.Access to the Adult obesity in Canada: Measured height and weight report is available at: www.statcan.gc.ca/pub/82-620-m/2005001/article/adults-adultes/8060-eng.htm.Access to the Overweight Canadian children and adolescents report is available at: www.statcan.gc.ca/pub/82-620-m/2005001/article/child-enfant/8061-eng.htm.Access to the Overview of Canadians’ Eating Habits report is available at: www.statcan.gc.ca/pub/82-620-m/82-620-m2006002-eng.htm.Access to the Nutrition – General Health (including Vitamin & Mineral Supplements) & 24-Hour Dietary Recall Components – User’s Guide is available at www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php#2. Scroll close to the bottom of the page.

The National Population Health Survey (NPHS) is a 20-year longitudinal survey started in 1993/1994, conducted by Statistics Canada, and designed to measure the health status of Canadians to add to the existing body of knowledge about the determinants of health. Self-reported data are collected on the same individuals every two years for up to 20 years, with the original sample selected to be representative of the Canadian population.13 Health Canada added a number of supplementary nutrition-related questions to the 1994-95 NPHS that focused on two key healthy eating concerns—increasing starch and fibre consumption, and decreasing fat consumption. In 1997, the report Canadians and Healthy Eating - how are we doing? was released. Although findings in this document were aligned to dietary guidance tools that are no longer in use (Canada’s Guidelines for Healthy Eating, Nutrition Recommendations for Canadians, and Canada’s Food Guide to Healthy Eating), the report does provide a snapshot of Canadians’ awareness of and action on key nutrient messages of the mid-1990s. The 1999 report, Toward a Healthy Future: Second Report on the Health of Canadians, used findings from the NPHS and is available at the Public Health Agency of Canada’s web site: www.statcan.gc.ca/bsolc/olc-cel/olc-cel?lang=eng&catno=82-570-X . Three recent nutrition-related reports also used data from the NPHS: Healthy Aging (2005) (available at: www.statcan.gc.ca/pub/82-618-m/82-618-m2005004-eng.htm), Obesity: A Growing Issue (2005) (available at: www.statcan.gc.ca/pub/82-618-m/82-618-m2005003-eng.htm), and Trends in weight change among Canadian adults: Evidence from the 1996/1997 to 2004/2005 National Population Health Survey (2006) (available at: www.statcan.gc.ca/pub/82-618-m/82-618-m2006005-eng.htm).

The National Institute for Nutrition has partnered with Health Canada and other organizations to conduct the Tracking Nutrition Trends series of surveys that assess adult Canadians’ knowledge, attitudes, and behaviour with respect to nutrition. In 2002, three reports were generated from this series of surveys: What Do Canadians Think About Nutrition, What Do Canadians Know About Nutrition, and What Do Canadians Do About Nutrition. Access to these reports is available at www.hc-sc.gc.ca/fn-an/surveill/facts-faits/index-eng.php.

Health Behaviour in School-aged Children is a cross-national study of the health behaviours of young people aged 11 to 15, started in 1986 by the World Health Organization. It consists of a series of regular cycle surveys conducted in 35 countries in Europe and North America, including Canada. The survey includes a core set of questions, including health-related behaviours such as dietary habits. More information can be obtained at www.phac-aspc.gc.ca/dca-dea/7-18yrs-ans/hbschealth-eng.php.

13 Health Canada. Canadians and Healthy Eating: How Are We Doing? Nutrition Highlights, National Population Health Survey, 1994-95. Ottawa: Health Canada, 1998.


http://www.phac-aspc.gc.ca/dca-dea/7-18yrs-ans/hbschealth-eng.php

http://www.phac-aspc.gc.ca/dca-dea/7-18yrs-ans/hbschealth-eng.php

http://www.hc-sc.gc.ca/fn-an/surveill/facts-faits/index-eng.php

http://www.statcan.gc.ca/pub/82-618-m/82-618-m2006005-eng.htm



http://www.statcan.gc.ca/bsolc/olc-cel/olc-cel?lang=eng&catno=82-570-X

http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php#2

http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php#2



http://www.statcan.gc.ca/pub/82-620-m/2005001/article/child-enfant/8061-eng.htm

http://www.statcan.gc.ca/pub/82-620-m/2005001/article/child-enfant/8061-eng.htm

http://www.statcan.gc.ca/pub/82-620-m/2005001/article/adults-adultes/8060-eng.htm

http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php#p1

16

1.4 Leading Causes of Death in Canada In 2004, the top 10 leading causes of death in Canada differed in rank order from those in the United States (Table 1-6 in the textbook). Causes listed as 1, 2, 3, and 6 have relationships with diet. This information is available at: www.statcan.gc.ca/pub/84-215-x/2008000/tbl/tblg1-eng.htm.

Canada United States1. Cancers 1. Heart disease2. Diseases of the heart 2. Cancers3. Cerebrovascular diseases (stroke) 3. Stroke4. Chronic lower respiratory diseases 4. Chronic lower respiratory diseases5. Accidents 5. Accidents6. Diabetes mellitus 6. Diabetes mellitus7. Pneumonia and influenza 7. Pneumonia and influenza8. Alzheimer’s disease 8. Alzheimer’s disease9. Suicide 9. Kidney disease10. Kidney disease 10. Blood infections

Highlight 1: Nutrition Information and Misinformation—On the Net and in the News

Dietitians’ Credentials in CanadaThe qualifications for admission to Dietitians of Canada are similar to those for the American Dietetic Association. Dietitians of Canada (www.dietitians.ca) assesses and accredits university undergraduate programs and dietetic internship programs, which qualify dietitians to practice. There is no single designation of title or initials for Canadian dietitians (see table below).

Provincial Regulatory BodiesProvincial government legislation determines the professional designation for health professionals who practise in each province. Many provinces have established colleges under their health professions legislation to ensure that the public receives quality care from dietitians. Dietitians are registered to practice through a college or provincial regulatory body. The public can take complaints about dietetic practice to the college or regulatory body. Provincial colleges and regulatory bodies exist for the purpose of ensuring public safety. These regulatory bodies:

• monitor the competence of members (e.g., mandatory continuing education);• protect the public from unsafe or unethical dietetic practice;• protect the use of regulated title designation and initials (e.g., RD); and• review the professional conduct of members based on complaints, and discipline members where appropriate.

All provinces include the word “dietitian” or “diététiste” in the title and protect these titles from use by unqualified individuals. The following list provides the designation for dietitians in each of the provinces and the respective contact information for each provincial college or regulatory body. For the most current contact information, go to the “Find a Nutrition Professional” section of the Dietitians of Canada web site (www.dietitians.ca), select “Qualifications of a Dietitian,” then choose “Provincial Regulatory Bodies.”

Province Designation Contact InformationAlberta RD (Registered Dietitian) or Registered

Nutritionist www.collegeofdietitians.ab.ca

British Columbia Dietitian or RD (Registered Dietitian) www.collegeofdietitiansbc.orgManitoba Dietitian or RD (Registered Dietitian) www.manitobadietitians.caNew Brunswick RD (Registered Dietitian) or RDN

(Registered Dietitian-Nutritionist)www.adnb-nbad.com

Newfoundland and Labrador

Dietitian or R.D. (Registered Dietitian) www.nlcd.ca

Nova Scotia Dietitian or Nutritionist or P.Dt. (Professional Dietitian)

www.nsdassoc.ca


http://www.nsdassoc.ca/

http://www.nlcd.ca/

http://www.adnb-nbad.com/

http://www.manitobadietitians.ca/

http://www.collegeofdietitiansbc.org/

http://www.collegeofdietitians.ab.ca/



http://www.statcan.gc.ca/pub/84-215-x/2008000/tbl/tblg1-eng.htm

17

Province Designation Contact InformationOntario RD (Registered Dietitian) or Dt.P. (diététiste

professionnelle)www.cdo.on.ca

Prince Edward Island P.Dt. (Professional Dietitian) PEI Dietitians Registration Board153 Spring StreetSummerside, PEC1N 3G2 Phone: 902-436-2438

Québec Dt.P. (diététiste professionnelle) or P.Dt. (Professional Dietitian) or R.D. (Registered Dietitian)

www.opdq.org

Saskatchewan P.Dt. (Professional Dietitian) or R.D. (Registered Dietitian)

www.saskdietitians.org

Canadian Web-Based Resources1. Most university libraries have on-line resources to help students critically assess the reliability and

credibility of information provided on web sites. Direct your students to these resources when accessing, extracting, and utilizing web-based nutrition information.

2. As of April 1, 2008, the Canadian Health Network ceased to exist. Instead, Canadians can turn to credible public health information through the Public Health Agency of Canada (www.phac-aspc.gc.ca/index-eng.php). Included at this site is the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention, a database of evidence-based interventions for health promotion and chronic disease prevention, available at: http://cbpp-pcpe.phac-aspc.gc.ca/index-eng.html.

3. The Nutrition Resource Centre (www.nutritionrc.ca) is part of the Ontario Public Health Association. The centre provides important resources for nutrition professionals in Ontario, and many resources that can apply to other areas of Canada.

4. Canadian Council of Food and Nutrition (www.ccfn.ca) offers a listing of reliable food and nutrition links in its “In Action” section.


http://www.ccfn.ca/

http://www.nutritionrc.ca/

http://cbpp-pcpe.phac-aspc.gc.ca/index-eng.html

http://www.phac-aspc.gc.ca/index-eng.php

http://www.saskdietitians.org/

http://www.opdq.org/

http://www.cdo.on.ca/

18

Worksheet 1-1: Evaluation of Published Nutrition Information

Literature Critique: Critical Evaluation of Published Nutrition Information—“Should I Believe What I Just Read?”

Assignment for discussion: Carefully read a journal article and answer the following questions on a separate sheet of paper.

1. Summarize the basic idea of the article in a short paragraph.

2. a. What are the credentials of the author(s)? What do the abbreviations after the name(s) mean? Do they enhance the authors’ credibility? Explain.

b. Is the author affiliated with an organization or institution? Does the affiliation with the organization or institution enhance the authors’ credibility? Briefly explain.

c. Does the periodical have an editorial board? Do the editors’ credentials enhance the article’s credibility? Where does one look in a periodical for the editorial board?

3. a. Is scientific research being presented or discussed? Is the research current? b. If so, what specific kinds of research or data are presented or cited to support the ideas? c. Were references listed to allow readers to investigate the information’s original source?

Were full citations provided?

4. a. What is the underlying hypothesis (if/then, cause/effect, etc.)? b. What are the article’s conclusions/recommendations? c. Are the conclusions or recommendations supported by the research discussion? Explain

briefly why or why not.

5. a. Design and describe in depth additional research that could more decisively test the hypothesis identified. Pay particular attention to details and controls.

b. Indicate what will be measured. c. State the type of experimental design and type of experiment.

6. Identify the statements in the article that you believe and those that you do not believe, and discuss why or why not for each.

7. What sources other than those listed in the periodical would you refer to if you were to research the article’s topic further?

Source: Adapted with permission of: Deborah Fleurant, MOE Thesis, University of New Hampshire, 1989 (Thesis Advisor Sam Smith)


19

Worksheet 1-2: Research Project Using the Internet

This research project will employ the use of the Internet as a research tool. The student will be expected to become familiar with the diversity of Internet resources. The purpose of this project is to develop research skills using the Internet.

1. Access the world wide web. Access several search engines for locating publications in peer-reviewed journals.

2. Select a topic such as vitamin A, osteoporosis prevention, or obesity among children.

Topic chosen:

3. Search for articles using key words related to your topic.

Key words you used:

4. Print out the references of articles that you found.

5. Print out abstracts from selected articles that are most interesting.

6. Obtain entire articles for selected articles.

7. Discuss your findings (1-2 pages, typed).


20

Worksheet 1-3: Influences on Food Choices

We decide what to eat, when to eat, and even whether to eat for a variety of reasons. Examine the factors that influence your food choices by keeping a food diary for 24 hours. Record the times and places of meals and snacks, the types and amounts of foods eaten, and a description of your thoughts and feelings when eating. Now examine your food record and consider your choices.

1. Which, if any, of your food choices were influenced by emotions (happiness, boredom, or disappointment, for example)?

2. Was social pressure a factor in any food decisions?

3. Which if any, of your food choices were influenced by marketing strategies or food advertisements?

4. How large a role do availability, convenience, and economy play in your food choices?

5. Do your age, ethnicity, or health concerns influence your food choices?

6. How many times did you eat because you were truly hungry? How often did you think of health and nutrition when making food choices? Were those food choices different from others made during the day?

Compare the choices you made in your 24-hour food diary to the USDA Food Guide recommendations. To obtain a set of personalized recommendations, you can enter your age, sex and activity level under “MyPyramid Plan” at the MyPyramid website, www.mypyramid.gov.

Food Groups Suggested Amounts Amounts ConsumedGrains

Vegetables

Fruit

Milk

Meat and beans

7. Do you eat the suggested amounts from each of the five food groups daily?

8. Do you try to vary your choices within each food group from day to day?

9. What dietary changes could you make to improve your chances of enjoying good health?


http://www.mypyramid.gov/

21

Worksheet 1-4: Chapter 1 Crossword Puzzle

Across Down2. a substance or a molecule containing carbon-carbon

bonds or carbon-hydrogen bonds4. organic, essential nutrients required in small

amounts by the body for health6. the foods and beverages a person consumes9. nonnutritive compounds found in plant-derived

foods that have biological activity in the body.10. nutrients a person must obtain from food because

the body cannot make them for itself in sufficient quantity to meet physiological needs

1. products derived form plants or animals that can be taken into the body to yield nutrients for the maintenance of life and the growth and repair of tissues

3. the science of foods and the nutrients and other substances they contain, and of their actions within the body

5. factors associated with an elevated frequency of a disease but not proven to be causal

7. any condition caused by excess or deficient food energy or nutrient intake or by an imbalance of nutrients

8. a substance composed of two or more different atoms; for example, H2O


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Worksheet 1-5: Choosing Party Foods and Snacks (Internet Exercise)

Instructions: Go to the following website to answer questions 1-11: http://www.mypyramid.gov/podcasts/index.html. Do not close the window until you have finished answering the questions. Watch the Holiday Parties Video Podcast to answer questions 1-6.

1. When at a party you should only place 2 food items on your plate at any one time.a. Trueb. False

2. When selecting snacks, fruits are always a good choice.a. Trueb. False

3. When at a party it is better to start filling up with beverages (soda and fruit juices) first so that you will eat less.a. Trueb. False

4. Filling up on low-calorie food choices helps to increase your sense of fullness at parties.a. Trueb. False

5. It does not matter where you stand or sit at a party, as you are prone to eat more in order to be sociable.a. Trueb. False

6. If you stand near the food table, you are likely to eat more at a party.a. Trueb. False

Watch the Snack Attack Video Podcast to answer questions 7-11.

7. A good beverage selection would be one that contains fruit juice concentrate.a. Trueb. False

8. A good snack choice would be to select baked potato chips instead or fried chips or crackers.a. Trueb. False

9. Dried fruits would not be considered a healthy snack.a. Trueb. False

10. What comes out of the vending machine at the end of the video?a. Candy barb. Potato chipsc. Pyramidd. Bottled water

11. Products that contain whole grains are considered to be a healthy snack food choice.a. Trueb. False


http://www.mypyramid.gov/podcasts/index.html

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Worksheet 1-6: Analyzing Foods and Meals for Nutritional Value

OverviewThis assignment offers tools to help you answer questions about the nutrient-dense foods in your diet and the types of meals that are best for health.

Good resources for nutrient values in foods include the following: • USDA Nutrient Database: http://www.nal.usda.gov/fnic/foodcomp/search/• Another good food analysis website: www.nutritiondata.com• Nutrition textbooks: Appendix H in Understanding Normal and Clinical Nutrition

Preview of Part Ia: Using Food Composition TablesThis first section is an exercise in using food composition tables for finding the nutrient values in foods. Because students may have different editions of the textbook, we’ll use the online USDA website for this part of the assignment (see the first bullet in the list of resources above).

To orient yourself to the website, start by trying to answer this question: Which cheese has the highest amount of fat? a. cheddar b. mozzarella c. Swiss cheese

To help guide you, the data sheet has spaces for you to fill in your answers. As an example:

a. cheddar ________ g fat/oz.

b. mozzarella ________ g fat/oz.

c. Swiss cheese ________ g fat/oz.

To start, go to the USDA website, type in the term “cheddar” in the “Keyword” box (see below), and select “Dairy & Egg Products” from the pull-down menu. Click “Submit.”

On the next web page, select the bullet for “Cheese, cheddar” and click “Submit.” On the next page, place a check mark in the 5th box down (click in the box) to get information about 1 oz. of

cheese, de-select the first entry (click the first box to de-select), and click “Submit.” The results page has a list of nutrients for an ounce of cheddar cheese; note that the 5th listing [“Total lipid

(fat)”] indicates that an ounce of cheddar cheese has 9.40 grams of fat.

Following the same procedure for the other two types of cheese will allow you to make comparisons among foods.

Preview of Part Ib: Sorting Foods by Nutrient ContentQuestion #5 allows an opportunity for you to check the Nutrient Lists feature, which provides reports of foods that are sorted either by food description or in descending order by nutrient content. To use this feature, find this sentence on the USDA web page, and click on the link for “Nutrient Lists”:

To view reports on foods by single nutrients, such as calcium or niacin, go to Nutrient Lists.

The following page shows a long list of nutrients. The links to the right of each nutrient include an “A” for lists of foods sorted alphabetically and a “W” for lists of foods sorted in descending order by nutrient content. Select any nutrient you like and click on each of these links to compare the two types of reports.


http://www.nutritiondata.com/

http://www.nal.usda.gov/fnic/foodcomp/search/

24Preview of Part II: Comparing the Energy and Nutrient Density of MealsThe questions in Part II show you how to compare the energy and nutrient contents of a meal. The first step is to list the calories and nutrients provided by each food in the meal. After you find the exact values specified, you can compare the totals to recommended intake levels. Use the USDA Nutrient Database for this question as you did for Part Ia of this assignment.

Note that the food items you select in the USDA database must exactly match the items listed in the question. If the item specified is a Burger King Whopper with cheese, don’t choose the Chicken Whopper or the Whopper without cheese. If the serving specified is 16 fluid ounces, you must make sure to enter the correct amount.

A review of calculations needed to answer the questions:

% of recommendations = total amount consumed (kcal, g, or mg) % kcal from fat = fat g 9 kcal/g amount recommended (same unit) total kcal

Part I: Using Food Composition TablesUsing data from the USDA Nutrient Database, look up the nutrient values for foods listed in questions 1 through 4, and fill in the appropriate blanks in the boxes to help you answer the questions (make sure you read the food descriptions carefully and choose the exact entries indicated).

1. Many people name oranges as a good source of vitamin C and bananas as a good source of potassium. They are correct, but there are other good sources as well. Which fruit below has the most vitamin C per cup of the fruit?a. oranges, raw (California, Valencia) b. kiwifruit, raw (green) c. strawberries, raw (halves)d. grapefruit, raw (white, California)e. bananas, raw (sliced)

2. Now compare the potassium content of these fruits. Which fruit in the list is highest in potassium per cup of fruit? a. oranges b. kiwifruit c. strawberries d. grapefruit e. bananas

Questions 1 and 2: Vitamin C (mg) per cup Potassium (mg) per cup

a. oranges ________ _______

b. kiwifruit ________ _______

c. strawberries ________ _______

d. grapefruit ________ _______

e. bananas ________ _______

3. How do the vitamin C and potassium values in oranges compare to the DRI for these nutrients?

To answer, fill in the blanks in the table below as follows: fill in the vitamin C and potassium values for oranges in the first line; then find the appropriate DRIs for vitamin C and potassium for 19- to 30-year-old males (see the textbook inside cover for these values) and fill in these values on the second line. Finally, determine the percentage of the DRI provided by the oranges (line 1 ÷ line 2 × 100).

Using this information, answer this question: What percentage of the potassium DRI is provided by a cup of oranges?a. 7% b. 12% c. 15% d. 69% e. 358%

Question 3: Vitamin C in oranges (1 cup) _________ Potassium in oranges (1 cup) _________

RDA for vitamin C _________ AI for potassium _________

% of RDA in oranges _________ % of AI in oranges _________


254. Now compare the fiber content of some common produce items. Which food below supplies the lowest amount

of fiber per ½-cup portion of the food?

(To find the correct data that can answer this question, you will need to do one of the following: select a 1-cup portion from the choices and divide by 2, select a ¼-cup portion and multiply by 2, or select “1 serving” of a ½-cup portion.)a. wheat bran b. avocado c. brown rice d. black beans

Question 4: Fiber (g) Appropriate Listing:

a. wheat bran ________ Use either of the two wheat bran listings

b. avocado ________ Raw, California, pureed

c. brown rice ________ Long-grain, cooked

d. black beans ________ Mature, cooked, boiled, without salt

Next: What are some of the top calcium sources in our diets? Follow the directions in the “Overview” regarding Part Ib: Sorting Foods by Nutrient Content to answer the following questions.

5. Using the Nutrient List tool, click on the “W” next to “Calcium” and read the foods on the first page of the list. Which green vegetable supplies 357 mg of calcium per cup?a. broccoli b. spinach c. kale d. collards e. turnip greens

Part II: Comparing the Energy and Nutrient Density of MealsCompare the energy (calories) and nutrient contents of two meals using data from the USDA Nutrient Database. To do this, first find the correct nutrient values for each food listed for Meal #1 and Meal #2 and fill in the values in the two tables below.

Meal #1: Lunch at Burger King• Burger King Whopper with cheese• Burger King French fries (1 medium serving)• Burger King vanilla shake (1 medium serving; 16 fl. oz.)

Foods Energy (kcal)




Whopper with cheeseFrench fries (medium)Vanilla shake (medium)Totals


26Meal #2: Lunch at McDonald’s• McDonald’s Caesar salad with grilled chicken• McDonald’s Fruit 'n Yogurt Parfait• Orange juice, frozen concentrate, unsweetened, diluted with 3 parts water (16 oz.)

Foods Energy (kcal)




Caesar salad with grilled chickenFruit 'n Yogurt ParfaitOrange juice (16 oz.)Totals

Now, answer the following questions, showing all calculations.

6. If your caloric needs are about 2000 kcal/day, about what fraction of the day’s intake would be provided by Meal #1?a. 22% b. 32% c. 52% d. 72% e. 92%

Show question #6 calculations:

7. The fiber Adequate Intake (AI) levels for college-age men and women are 38 and 25 grams, respectively. Considering that a nutritious meal is likely to provide about 1/3 of recommended fiber intakes, how would you rate the fiber content of Meal #1 and Meal #2? a. Both meals provide at least one-third of the fiber AI for men and women.b. Neither meal provides at least one-third of the fiber AI for men or women.c. Meal #1 provides one-third of a woman’s fiber AI, but not a man’s; Meal #2 has less fiber than Meal #1. d. Meal #2 provides one-third of a woman’s fiber AI, but not a man’s; Meal #1 has less fiber than Meal #2.


8. According to your data, which of the following statements is TRUE?a. Meal #1 provides over twice as much protein as Meal #2.b. Meal #2 provides over twice as much iron as Meal #1.c. Meal #1 provides over three times as many calories as Meal #2.d. Meal #2 provides over twice as much calcium as Meal #1.



279. Recall the Acceptable Macronutrient Distribution Range (AMDR) for dietary fat (see textbook if you’ve

forgotten). Do either meal or both of these meals fall into the suggested AMDR range?a. Yes, Meal #1 is in the correct AMDR for fat.b. Yes, Meal #2 is in the correct AMDR for fat.c. Yes, both meals are in the correct AMDR for fat.d. No, neither meal is in the correct AMDR for fat.


10. The Tolerable Upper Intake Level (UL) for sodium (the maximum intake without adverse effects) is 2300 mg of sodium per day. If the person eating one of these lunches wanted to limit sodium to no more than 1/3 of the UL per meal, how would you rate the sodium content of these meals?a. Both meals exceed 1/3 of the sodium UL.b. Neither meal exceeds 1/3 of the sodium UL.c. Meal #1 exceeds 1/3 of the sodium UL, but not Meal #2.d. Meal #2 exceeds 1/3 of the sodium UL, but not Meal #1.


Assignment over! I hope you’ve learned something about the use of nutrient databases from working through these questions!


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Worksheet 1-7: Unit of Measurement Conversions Practice

Common UnitsEnglish (U.S.) System Metric System

Weight pounds (lb), ounces (oz) kilograms (kg), grams (g), milligrams (mg), micrograms (μg)Volume gallons, quarts, pints, cups liters (L), milliliters (mL)Length yards, feet, inches meters (m), centimeters (cm), millimeters (mm)

Simple ConversionsEnglish (U.S.) System Metric System

Weight 1 lb = _______ oz 1 kg = _______ g

1 g = _______ mg

Volume 1 gallon = _______ quarts

1 quart = _______ cups

1 L = _______ mL

Length 1 yard = _______ feet

1 foot = _______ inches

1 meter = _______ mm

1 meter = _______ cm

Conversions within Systems – Convert:1. 25 grams to milligrams

2. 3 kilograms to grams

3. 50 milligrams to micrograms

4. 3 pounds to ounces

5. 64 ounces to pounds

Conversions between Systems – Convert:6. 116 pounds to kilograms

7. 32 kilograms to pounds

8. 5 inches to centimeters

9. 50 centimeters to inches

10. 7 ounces to grams

11. 15 grams to ounces

Word Problems12. How many grams are in 5 ounces? How many milligrams?

13. Express the weight of a 170-pound man in kilograms.

14. More advanced: A healthy 135-pound woman may have about 34 pounds of fat. How many kilocalories would that fat provide? (To answer, link several conversion factors in a row until “pounds of fat” can be converted to “kilocalories from fat.”)


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Handout 1-4: Converting Metric/English Units of Measurement

Metric and English Systems

Common metric units and their U.S. equivalents include:• grams vs. ounces• kilograms vs. pounds• meters and centimeters vs. yards and inches

Common metric units include grams, kilograms, milligrams, and micrograms. Note: “centi-” is less commonly used (as in meter, centimeter).

Steps in a Conversion Problem

1. Identify the weight or measure for which you want to change units. Write it down on the left of the page, including its units.

2. Identify a conversion (equality) you can use to solve the problem; it must contain both types of units—the original units, and the new units.

3. Make a fraction (a “conversion factor”) out of the equality that has the two units. The unit you want in your answer should be in the numerator (top); the unit you want to eliminate should be in the denominator (bottom).

4. Multiply the original weight or measure (step 1) times the conversion factor (step 3).

Examples: conversions between English and metric system

Pounds (lb) to kilograms (kg): 2.2 lb = 1 kg

_______ lb × 1 kg = ______ kg2.2 lb

Inches (in) to centimeters (cm): 1 in = 2.54 cm

_______ in × 2.54 cm = ______ cm 1 in


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