FOOD AND NUTRIENT DELIVERY: PLANNING THE

DIET WITH CULTURAL COMPETENCY

1

Chapter 12

Objectives2

Discuss the DRIs and be able to differentiate between EARs, RDIs, AI and UL

Define and know the recommendations for adults for the AMDR

List what nutrients must be in a food label

When and where labelling is required

Explain the cultural and religious aspects of diet

Determining Nutrient Needs

The Food and Nutrition Board recommends choosing a variety of foods to provide adequate nutrients Functional foods

Fiber

Carotenoids

Phytochemicals

Guidelines- DRIs

In the US the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM) has led to the development of nutrient recommendations since the 1940s.

Dietary Reference Intakes (DRIs) are a set nutrient-based reference value recommendations aimed at preventing nutritional deficiency. These DRIS also aim to improve the long-term health and well-being of a population by reducing the risk of chronic disease through nutrition.

Guidelines- DRIs

Apply to US and Canada –recs from the Food and Nutrition Board’

DRIs are set for about 40 nutrients

These recs should apply to a series of days (not just a single day)

There are DRIs for all life stages e.g. preg, lact, children to age 9, adults by gender

Micronutrients & Macronutrients

Guidelines- DRIs

EARs Set for 17 nutrients

EARs are only set for those nutrients that have functional markers. A functional marker: e.g. the measure of an enzyme or the ability of a cell to maintain normal functioning.

If no functional marker can be used, an EAR cannot be set.

Meets needs for 50% population group so used for groups not individuals

Used in nutrition research and policymaking and is the basis upon which RDA values are set.

Guidelines- DRIs

http://www.nutrition.gov/smart-nutrition-101/dietary-reference-intakes-rdas

Guidelines- DRIs

RDAs

Based on EARs so RDAs can only be set for nutrients that have an EAR.

Nutrient intake amounts that are sufficient enough to meet 97-98% population group (generally this is the EAR x 1.2)

Prevent deficiency and chronic disease

The RDA is the goal for usual intake (average over a few days)

Guidelines- DRIs

Guidelines- DRIs

Adequate Intake (AI)s are set for nutrients that do not have enough data about them to set an EAR.

These recs are based on observed or experimentally derived estimates on the level that would be adequate to maintain health.

Ideally meets more than RDA

The RDI and the AI can be used as goals for intake

Guidelines- DRIs

Guidelines- DRIs

Tolerable Upper Intake levels (UL)

The max amount of a nutrient one can consume daily without exhibiting negative health consequences.

The UL for vitamin C is 2000mg/day (too much C can cause GI

distress)

Based on nutrient intake from all sources

Exceptions: niacin, magnesium, zinc and nickel are only nonfood sources (b/c to become toxic in these nutrients

from food only is unlikely)

Intakes above the RDA and UL do not confer ANY health benefit

Guidelines- DRIs

http://www.nutrition.gov/smart-nutrition-101/dietary-reference-intakes-rdas

Guidelines- DRIs

http://www.nutrition.gov/smart-nutrition-101/dietary-reference-intakes-rdas

Guidelines

AMDRs

Range of intake, as a percentage of energy (for example fat is 20-35% of kcal)

Values

Carbohydrates (45-65%)

Fat (20-35%)

Protein (10-30%)

Food and Nutrient Intake data

Analysis of the American diet shows what we’re slowly eating more healthfully Total fat and sat fat ↓

Fruits and veg ↑4/day

We still have a long way to go

Obesity (energy)

Hypertension (Na)

CHD (sat fat, cholesterol)

Osteoporosis (Ca)

Alcohol intake

Food insecurity

Dietary Guidelines for Americans

First published in 1980 and are revised every 5 years

Developed to motivate consumer to change their eating and activity patterns via positive and simple messaging

Current: MyPlate, replaced MyPyramid

Food Labeling

Nutrition Labeling and Education Act passed in 1990- made labels mandatory in 1994.

Must be on all foods that contributed significant nutrients

Exclusions: restaurant foods (sort of if 20 or more locations must provide-same for vending), foods prepared on site (sandwiches, bakery)

Nutrition information on raw foods is voluntary- however the FDA and USDA have called for voluntary point-of-purchase programs which are in most grocery stores for 20 most popular fruits, vegetables and fish and 45 major cuts of fresh meat and poultry http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm063367.htm

Food Labeling- Nutrition Facts Panel

Standardized serving sizeBased on typical American serving sizes (really

though- look at labels at home)

Following nutrients must be listed Total calories, calories from fat, total fat, saturated

fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars, protein, Vitamins A and C, Ca and Fe

Fortified or nutrients listed in health claims must also be included.

Food Labeling- Daily Values (DVs)

Nutrition standards on food labels created because DRIs are age and sex specific

DV for food labels is standard set for over 4 years old regardless of sex –based on a 2000-calorie diet.

Separate DV for foods designed for infants, toddlers, pregnancy and lactation

Tells which foods contribute lightly or heavily to total daily nutrient needs

> 20% = High in nutrient

< 5% = Low in nutrient

Cultural Aspects of Dietary Planning

Essential for RDs and other health care providers to prescribe diets that are healthy but are also in alignment with the patient especially cultural, and religious

It can be tempting to simplify the role of culture by attempting to categorize dietary patterns by race, ethnicity or religion- however this is not always appropriate and can lead to misunderstanding.

Asian Diet Pyramid

Japanese Food Guide Spinning Top

Cultural Aspects of Dietary Planning

Ethnicity Food Preferences

Nutrition Shortcomings

Health Concerns

Cultural Considerations

Hispanic - corn and corn products, beans, rice, breads, meats, fried foods, carbonated/ sweetened beverages

- low in calcium, iron, vitamin A, folate, vitamin C- high in fat

- Obesity, heart disease, diabetes, cavities

- importance of family unit- traditional roles of male and female

Asian - fish, pork, poultry, nuts, beans, rice, vegetables, fruits

- low in calcium - Stomach cancer, lactose intolerance

- elderly, children and pregnant women respected

American Indian

- similar to American diet, fried foods

- high in fat - Obesity, heart disease, diabetes

- limited access to health care

Black - vegetables, meats, sauces, gravies, fried foods

- low in calcium- high in fat

- Obesity, heart disease, diabetes

- may have specific religious affiliations

Pacific Islander

- root vegetables, nuts, fruits, fruit juices

- low in calcium - Obesity, heart disease, diabetes, lactose intolerance

- Encourage to

return to food

traditions

Utah Dept of Health

Religious Aspects of Dietary Planning

Major Religions with Food LawsBuddhism. Many Buddhists are vegetarians, though some include fish in their

diet. Most do not eat meat and abstain from all beef products. The birth, enlightenment, and death of Buddha are the three most commonly recognized festivals for feasting, resting from work, or fasting. Buddhist monks fast completely on certain days of the moon, and they routinely avoid eating any solid foods after the noon hour.

Eastern Orthodox Christianity. An essential element of practicing an Orthodox life includes fasting,

since its intrinsic value is part of the development of a spiritual life. To practicing Orthodox believers, fasting teaches self-restraint, which is the source of all good.

Religious Aspects of Dietary Planning

HinduismHindus do not consume any foods that might slow down spiritual or physical growth. The eating of meat is not prohibited, but pork, fowl, ducks, snails, crabs, and camels are avoided. The cow is sacred to Hindus, Many Hindus are strict vegetarians. Those who do eat meat are forbidden

from eating beef, because cows occupy a sacred place in the Hindu religion and therefore no beef is consumed. Other products from the cow, however, such as milk, yogurt, and butter are considered innately pure and are thought to promote purity of the mind, spirit, and body.

Many devout Hindus fast on the eighteen major Hindu holidays, as well as on numerous personal days, such as birthdays and anniversaries of deaths and marriages. They also fast on Sundays and on days associated with various positions of the moon and the planets.

Religious Aspects of Dietary Planning

Islam. To the Muslims, eating is a matter of faith for those who follow the dietary laws called Halal, a term for

all permitted foods. Those foods that are prohibited, such as pork and birds of prey, are known as Haram, while the foods that are questionable for consumption are known as Mashbooh. Muslims eat to preserve their good health, and overindulgence or the use of stimulants such as tea, coffee, or alcohol are discouraged. Fasting is practiced regularly on Mondays and Thursdays, and more often for six days during Shawwal (the tenth month of the Islamic year) and for the entire month of Ramadan (the ninth month). Fasting on these occasions includes abstention from all food and drink from sunrise to sunset.

Ramadan In the Muslim faith, the holy month of Ramadan is the ninth month of the Islamic year and is devoted to

prayer, fasting, and charity. Muslims believe that it was during this month that God first began to reveal the holy book of Islam, the Quran, to the prophet Muhammad. Most Muslims are required to refrain from food and drink during daylight hours for the entire month. The fast is broken in the evening by a meal called the iftar, which traditionally includes dates and water or sweet drinks, and is resumed again at sunrise. Fasting during Ramadan is one of the five Pillars of Faith, which are the most important religious duties in Islam. The practice is meant to remind Muslims of the poor, to cleanse the body, and to foster serenity and spiritual devotion. Ramadan ends with Eid al-Fitr, the "Festival of Breaking the Fast."

Religious Aspects of Dietary Planning

Judaism. The Jewish dietary law is called Kashrut, meaning "proper" or "correct." The term

kosher refers to the methods of processing foods according to the Jewish laws. The processing laws and other restrictions regarding to the preparation of food and drink were devised for their effects on health. For example, rules about the use of pans, plates, utensils, and separation of meat from dairy products are intended to reduce contamination. Other rules include:

A Jewish person must prepare grape products, otherwise they are forbidden. Jewish laws dictate the slaughter and removal of blood from meat before it can be

eaten. Animals such as pigs and rabbits and creatures of the sea, such as lobster, shrimp,

and clams, may not be eaten. Meat and dairy products cannot be eaten at the same meal or served on the same

plate, and kosher and nonkosher foods cannot come into contact with the same plates.

Religious Aspects of Dietary Planning

Mormonism.

The law of health—the Word of Wisdom—contains the laws for proper eating and the rules of abstinence for tobacco, alcohol, coffee, tea, chocolate, and illegal drugs. Mormons must choose foods that build up the body, improve endurance, and enhance intellect. Products from the land, such as grains, fruits, vegetables, and nuts, are to take the place of meats; meats, sugar, cheeses, and spices are to be avoided. Reason and self-control in eating is expected in order to stay healthy.

Roman Catholicism.

The dietary practices of devout Catholics center around the restriction of meat or fasting behaviors on specified holy days.

Religious Aspects of Dietary Planning

The Role of Fasting Many religions incorporate some element of fasting into their religious practices. Fasting has also been presented as a means to acquire the discipline required to resist

temptation, as an act of atonement for sinful acts, or as the cleansing of evil from within the body.

Fasting may be undertaken for several hours, at a specified time of the day (e.g., from sunrise to sunset, as practiced by modern Jews), for a specified number of hours (e.g., twelve, twenty-four, or more, as observed by Catholics or Mormons who fast on designated days), or for consecutive days, such as during the month of Ramadan for certain Muslims.

Those who fast without liquids increase their risk of a number of health problems. Symptoms of dehydration include headache, dry mouth, nausea , fever, sleepiness, and, in extreme cases, coma. When these symptoms occur, it is important to end the fast or add water to the fast. Depending on the extent of the symptoms, ending the fast may be the only alternative. In severe dehydration cases, medical care should be sought as soon as possible to restore proper health.

Source: http://www.faqs.org/nutrition/Pre-Sma/Religion-and-Dietary-Practices.html#ixzz3FOXzi2bY