BASIC TOOLS IN NUTRITION

A healthy diet consists of a variety of foods eaten in moderation and in the right
proportion. It provides enough energy and nutrients to meet the nutritional needs of the
individual. A healthy diet is planned using the basic tools in nutrition. The basic tools in
nutrition serve as dietary guides in planning for a healthy diet.

Dietary Guides
 Tools devised to aid in planning, procuring, preparing and consuming meals for normal and
therapeutic diets of individuals or groups.
 The proper use of dietary guides assures that adequate diet is served according to an
individual’s or group’s physical state and need.

Commonly Used Tools in Nutrition:

FNRI & USDA Food Guide Pyramid

The Food Pyramid

The Food Pyramid Guide is the hierarchy of food groups in a person’s diet that helps to
put the Dietary Guidelines into action. It is not a rigid prescription, but simply a general guide
that let people choose foods right for them. It requires consumption of a variety of foods with the
right amount of servings to get the nutrients needed by the body, and to maintain or improve
weight.

FNRI (Food and Nutrition Research Institute)

The Food and Nutrition Research Institute (FNRI), the principal research arm of the
government in food and nutrition, is one of the research and development institutes of the
Department of Science and Technology (DOST).

The Food Pyramid formulated by the FNRI was modified by adding fluid at the base of
the pyramid. The pyramid provides guidelines on types and amount of foods to eat to meet the
current scientific standards for healthy living to help individual assess and improve their diets. It
specifies the recommended amounts needed by the body. The pyramid ranks the food groups
according to amounts to be consumed, from the most, which is situated at the base of the
pyramid to the least, which is located at the apex of the pyramid.

The FNRI has developed a food pyramid a simple and easy-to-follow daily eating guide
for Filipinos. The food guide pyramid is a graphic translation of the current "Your Guide to
Good Nutrition" based on the usual dietary pattern of Filipinos in general. The usual Filipino diet
consists mainly of rice. It contributes the major part of the carbohydrates in the diet together with
bread, corn and root crops such as sweet potato, cassava and "gabi".

Water and clear broth are at the base of the pyramid. The required 6-8 glasses per day is
probably adequate for a sedentary person, but may not be enough for a very active person.
 Carbohydrate foods make up the second level of the pyramid and are for liberal
consumption to meet 55 to 70% of energy needs. These are breads, cereals, rice and pasta. A
viand or "ulam" is a combination of vegetables and fish or other animal protein sources, capped
by fruits. Vegetables and fruits constitute the third level of the pyramid. Leafy greens and
vitamin C rich fruits are the best sources of vitamins and minerals, plus dietary fiber or roughage.
You are advised to eat more of these foods.

The fourth level consists of animal protein foods like fish, meat, poultry, seafoods, milk
and dairy products, as well as dried beans and nuts. These foods are recommended for moderate
consumption as they supply high quality protein, vitamins and minerals.

Finally, at the tip of the pyramid are the fats and oils that are to be taken just enough. In
general, however, the Filipino diet is lacking in fat. On the average, Filipinos are only taking
15% of the calories from fat, which is one of the reasons why the total caloric intake is very low.

We can improve the caloric intake by consuming enough visible fats such as margarine
and butter, as well as invisible fats contained in animal foods and some fruits and nuts. The Food
Guide Pyramid teaches the principle of eating a variety of foods every day at the right amounts.
Rice and other cereals occupy the major bulk in the diet, while fats and oils share the least in
volume and bulk. Vegetables take up a bigger area than fruits in volume and bulk. The guide
teaches moderation in some while emphasizing the importance of other foods. The Food Guide
Pyramid is but one of the many nutritional and dietary tools and guidelines developed by the
FNRI to help the Filipino achieve good health and nutrition.

The FNRI Food Pyramid

Launched by Dr. Rodolfo F. Florentino had the pleasure of introducing the FNRI Food Guide
Pyramid to the participants and guests of the 22nd FNRI Seminar Series held last July 1996

USDA (U.S. Department of Agriculture) developed in 1977 the Dietary Guidelines for
Americans, the guidelines revised in 2000, regarding food selection with recommendations that
are clustered in three groups of ABC:
- Aim for fitness
- Build a healthy base
- Choose sensibly
The USDA Food Guide Pyramid
- is a guide to the amounts and kinds of foods we should eat daily to maintain
health and to reduce the risk of developing diet-related diseases.
- pyramid depends on a person’s age and energy needs
- serving size is also adjusted for young children and adults

The USDA 1992 food pyramid diagram can still be found on much of the food packaging in the
United States

Five Major Food Groups in the USDA Food Guide Pyramid:

 1. Bread, cereal, rice, and pasta group – 6-11 servings/day
2. vegetable group – 3-5 servings/day
3. fruit group – 2-4 servings/day
4. milk, yogurt, and cheese group – 2-3 servings/day
5. meat, poultry, fish, dry beans, eggs, and nut group – 2-3 servings/day
( 6. fats, oil, and sweets – sparingly consumed )

Considerations:
1. The small tip of the pyramid is for fats, oils, and sweets. There is no serving number
suggested for this category because these should be consumed in small quantities only.
2. Each food groups is visually displayed to represent the number of servings we should eat
daily; the number is a range of servings. This range takes into account our different
energy needs and personal food preferences. Everyone should eat at least the minimum
number of servings for each group. By doing so, we consume an adequate quantity of
essential nutrients.
3. The pyramid allows us to choose between foods that contain different levels of fats, fiber,
and sodium. To use the pyramid as a guide for choosing a low-fat, high fiber meal
pattern, we also need to understand the effect of food preparation on the fiber content of
meals.

The current 2005 USDA food pyramid

Groups based on the Food Guide Pyramid:

1. Grain group
- Represented by a thick orange strip. Cereals, breads, pastas, crackers, and rice all fall
under this categorization. Bread, cereal, rice, and pasta are grown from cereal crops. Grains
supply food energy in the form of starch and carbohydrates. Breads made from refined
ingredients are not as highly recommended as whole grains. Whole grains can be found
especially in brown oatmeal
6-11 servings daily

2. Vegetable group
- A vegetable is a part of a plant consumed by humans that is generally savory (not
sweet) and not considered a grain, fruit, nut, spice, or herb. For example, the stem, root, flower,
etc. may be eaten as vegetables. Vegetables contain many vitamins and minerals; however,
different vegetables contain different spreads, so it is important to eat a wide variety of types. For
example, green vegetables typically contain vitamin A, dark orange and dark green vegetables
contain vitamin C, and vegetables like broccoli and related plants contain iron and calcium.
Vegetables are very low in fats and calories, but cooking can often add these. The dark green
vegetables and the orange color is caused by the vitamins and vegetables like carrots contain lots
of vitamin A which helps eye health.
3-5 servings of vegetables in a day. They may be fresh, frozen, canned, or juiced.

3. Fruit group
- Fruits are the sweet-tasting seed-bearing parts of plants, or occasionally sweet parts of
plants which do not bear seeds. These include apples, oranges, plums, bananas, etc. Fruits are
low in calories and fat and are a source of natural sugars, fiber and vitamins. Processing fruits
when canning or making into juices unfortunately may add sugars and remove nutrients. The
fruit food group is sometimes combined with the vegetable food group. It is best to consume 2-4
servings of fruit in a day. They may be fresh, frozen, canned, dried, pureed or juiced.
Note that many foods considered fruits in botany because they bear seeds are not
considered fruits in cuisine because they lack the characteristic sweet taste, e.g., tomato or
avocados.

4. Oil group
-Represented by a thin yellow strip between the Dairy and Fruits Groups. Oils include
cooking oils, fats and sweets, along with some good fats found in items like peanut butter and
fish. As the group is represented by a thin strip, it implies that you should eat less of this group
because if you eat too much it may cause diabetes, high blood pressure and even some cancers.

5. Dairy group
- Represented by a medium-thick blue strip between the Oil and Meat groups. Dairy
products are produced from the milk of mammals, most usually but not exclusively cattle. They
include milk, yogurt and cheese. Milk and its derivative products are a rich source of the mineral
calcium, but also provide protein, phosphorus, vitamin A, and vitamin D. However, many dairy
products are high in saturated fat and cholesterol compared to vegetables, fruits and whole
grains, which is why skimmed products are available as an alternative. For adults, 3 cups of dairy
products are recommended per day.
6. Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts group
- Meat is the tissue - usually muscle - of an animal consumed by humans. Since most
parts of many animals are edible, there are a vast variety of meats. Meat is a major source of
protein, as well as iron, zinc, and vitamin B12. Meats, poultry, and fish include beef, chicken,
pork, salmon, tuna, and shrimp, eggs, Spices and Herbs are also in this Group.

However, since many of the same nutrients found in meat can also be found in foods like
eggs, dry beans, and nuts, such foods are typically placed in the same category as meats, as meat
alternatives. These include tofu, products that resemble meat or fish but are made with soy, eggs,
and cheeses. The meat group is one of the major compacted food groups in the food guide
pyramid.

Although meats provide energy and nutrients, they are often high in fat and cholesterol,
and can be high in sodium. Simply trimming off fatty tissue can go a long way towards reducing
this negative effect. However, this tactic may prove to be ineffective, so large portions of meats
are not recommended; 2-3 ounces per day of meat or alternatives are recommended. This is 3-5
servings. For those who don't consume meat or animal products (Vegetarianism and Taboo food
and drink), meat analogues, tofu, beans, lentils, chick peas, nuts and other high-in-protein
vegetables make up this food group.

Explanation of the new food pyramid

A summary of the main things about this new food guide:
* The staircase and stick figure stresses the importance of exercise
* The length of the base of each triangular band represents the amount of each of the six
(colored) food groups
* ORANGE represents GRAINS
* GREEN represents VEGETABLES
* RED stands for FRUITS
* the thin YELLOW strip are OILS
* BLUE stands for MILK
* and PURPLE for MEAT and BEANS
* The new food pyramid does not have any labels.
* With the updated version, the USDA did away with "number of servings" criteria, and replaced
it with a web-based tool that features individualized plans and statistics. This tool also allows a
person to enter a daily food diary, analyze nutrient intake, and can compare an individual's diet
with the food pyramid recommendations. Other improvements to the pyramid include the
replacement of "serving size" with the more objective "cups." Following the food pyramid helps
ensure that a person gets a balanced and varied diet.

The USDA food guidance system, also known as the Food Pyramid, or MyPyramid, and
nutrition facts labels. These are valuable tools to eat low fat, offering us the means to measure
actual intake of various foods against what we should be eating.
 The first of these tools is the USDA Food Pyramid, known as MyPyramid, which debuted
in April 2005, reflecting the government's revised dietary guidelines published in January 2005.

MyPyramid is a visual illustration of suggested healthy eating habits and physical

activity. Like its predecessor, the Food Guide Pyramid, MyPyramid combines the government’s
dietary guidelines and recommended allowances into six food groups. But instead of illustrating
the number of servings based on a one-size-fits-all 2,000 calorie intake, the MyPyramid symbol
itself shows six vertical color bands, each representing varying proportions of the pyramid.
These colors represent the food groups.

For specific servings of a given food group, people are encouraged to create their own,
personal pyramid online, hence the name "MyPyramid." By keying in certain data, we can find
out how much we should eat from each food group based on our age, sex and level of activity.
The new dietary guidelines on which MyPyramid is based, promoted fruits and vegetables and
whole grains. At the 2,000 calorie level, here's what the guidelines would suggest.
 Fruit Group should provide 4 daily servings, or 2 cups.
 Vegetable Group should provide 5 servings, or 2.5 cups.
 Grain Group should provide 6 ounce-equivalents (1 ounce-equivalent means 1 serving),
half of which should be whole grains.
 Meat and Beans Group should provide 5.5 ounce-equivalents or servings.
 Milk Group should provide 3 cups/servings.
 Oils should provide 24g or 6 teaspoons.
 Discretionary Calories: These are the remaining amount of calories in each calorie level
after nutrient-dense foods have been chosen. Up to 267 calories can be consumed in solid
fats or added sugars if the other requirements have been met.

MyPyramid does not spell this out because 2,000 calories is not appropriate for everyone.
Instead, the color bands represent a visual clue about what proportion of our diet these foods
should form.

In acknowledging that a blanket statement on number of servings per food group simply
doesn't work for everyone, the government is encouraging individuals to take responsibility,
urging everyone to customize MyPyramid.

What is a Food Guide Serving?

A Food Guide Serving is simply a reference amount. It helps you understand how much
food is recommended every day from each of the four food groups. In some cases, a Food Guide
Serving may be close to what you eat, such as an apple. In other cases, such as rice or pasta, you
may serve yourself more than one Food Guide Serving.
Look at the examples below to find out how much food is equal to one Food Guide Serving.

Examples of one Food Guide Serving are:

Vegetables and Fruit

  125 mL (½ cup) fresh, frozen or canned
vegetable or fruit or 100% juice
 250 mL (1 cup) leafy raw vegetables or
salad
 1 piece of fruit
Grain Products
 1 slice (35 g) bread or ½ bagel (45 g)
 ½ pita (35 g) or ½ tortilla (35 g)
 125 mL (½ cup) cooked rice, pasta, or couscous
 30 g cold cereal or 175 mL (¾ cup) hot cereal
Milk and Alternatives
 250 mL (1 cup) milk or fortified soy beverage
 175 g (¾ cup) yogurt
 50 g (1 ½ oz.) cheese
Meat and Alternatives
 75 g (2 ½ oz.)/125 mL (½ cup) cooked fish, shellfish, poultry or lean meat
 175 mL (¾ cup) cooked beans
 2 eggs
 30 mL (2 Tbsp) peanut butter

Food portion sizes

Portion sizes are important for staying a healthy weight.

When a food scale of measuring cups aren't handy, you can still estimate your portions by using
this chart.

Three ounces of meat is about the size and thickness of a deck of

playing cards or an audiotape cassette.
 A medium apple or peach is about the size of a tennis ball.

One ounce of cheese is about the size of four stacked dice.

One-half cup of ice cream is about the size of a racquetball or

tennis ball.

One cup of mashed potatoes or broccoli is about the size of your

fist.

One teaspoon of butter or peanut butter is about the size of the tip
of your thumb.

10 NGF: The 2000 Nutritional Guidelines for Filipinos

Nutritional Guidelines
 Simple statements intended to provide the general public with recommendations about
proper diet and wholesome dietary practice to promote good health for themselves and
their families.
 Give advice on the consumption of foods and food components for which there are public
health concerns
 Aims to encourage the consumption of an adequate and well-balanced diet and promote
desirable food and nutrition practices as well as nutrition-related health habits in the
general population (FNRI-DOST, 2000)
 Serve as a handy reference for the counseling and educational services of people
concerned with nutrition information and education.
 Different from other tools because they do not provide quantitative recommendations,
instead, they give qualitative recommendations considered essential for nutritional health.
 Suggest not only what people should eat but also what they should limit, in
addition also refers to physical activity and weight maintenance.
10 NGF: The 2000 Nutritional Guidelines for Filipinos

1. Eat a variety of foods every day – no single food provides the body needs. Choosing
different kinds of foods from all food groups is the first step to obtain well-balanced diet.
2. Breast-feed infants exclusively from birth to 406months, and then give appropriate foods
while continuing breast-feeding – exclusive breast feeding from 4-6months and
continuance of breast-feeding for as long as two years or beyond ensure a complete and
safe food for the newborn. Also, guideline strongly advocates providing appropriate
complimentary food in addition to breast milk once the infant is ready for solid foods at
about 6 months.
3. Maintain children’s normal growth through proper diet and monitor their growth
regularly – the guideline advices on proper feeding of children and regular weighing to
monitor their growth, as it is a simple way to assess nutritional status.
4. Consume fish, lean meat, poultry, or dried beans – including fish, lean meat, poultry, or
dried beans in the diet will provide good quality protein and dietary energy, as well as
iron and zinc, key nutrients lacking in the diet of Filipinos as a whole.
5. Eat more vegetables, fruits and root crops – eating more vegetables, fruits and root crops
will supply the much needed vitamins, minerals and dietary fiber that are deficient in the
Filipino diet. They provide defense against chronic degenerative diseases.
6. Eat foods cooked in edible/cooking oil in daily meals – it will provide additional energy
as a partial remedy to caloric deficiency of the average Filipino.
7. Consume milk, milk products and other calcium-rich foods, such as small fish and dark
green, leafy vegetables every day – it will serve to supply not only calcium for healthy
bones but also high quality protein and other nutrients for growth.
8. Use iodized salt, but avoid excessive intake of salty foods – it helps to prevent iodine
deficiency which is a major cause of mental and physical underdevelopment in the
country. The guidelines warn against excessive intake of salty foods as a hedge against
hypertension.
9. Eat clean and safe foods – foods must be prepared with cleanliness to prevent acquiring
food-borne disease.
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid
drinking alcohol beverages – studies have shown that regular exercise and avoiding
smoking and avoiding alcoholic beverages promote a longer lifespan.

RECOMMENDED DAILY ALLOWANCE (RDA) OR RECOMMENDED ENERGY AND

NUTRIENT INTAKES (RENI)

 RENI is the revised RDA, defined as levels of intakes of energy and nutrient
which, on the basis of current scientific knowledge, are considered average for the
maintenance of health and well-being of nearly all healthy persons in the
population. It emphasizes that the standards are in terms of nutrients, and not
foods or diets.
  Dietary standards are tentative not final – they should be revised as research
unveils new data

 Established as quantitative tool in the assessment of nutriture for population

groups

 When applied to individuals, figures should be flexible; a person who fails to

meet the 100% RDA nutrient level does not mean he is malnourished; dietary
findings should be confirmed by other methods of assessment such as
biochemical, physical or medical examinations.

The RENI is meant to serve the following purposes and applications:

1. As a goal for energy and nutrient intakes of groups and nutrient intakes of individuals.
2. As a reference standard for the assessment of the habitual energy and nutrient intakes of
the population or population sub-groups.
3. As a goal for agricultural production.
4. As a reference standard for assessment of the adequacy of food supplies.
5. As a tool for nutrition education and advocacy.
6. As a basis for public health and food and nutrition policies, example, food importation,
food fortification, food and nutrition labeling, supplementation programs, etc.

Food Exchange Lists

 A list of common foods grouped in terms of equivalent amounts of carbohydrates,

protein, fats and calories. Each group may also contain foods with equal amounts of
vitamins and minerals.
 With the help of the FEL, diet prescriptions are translated into food exchanges which are
simple and easy to understand. Translation of the diet prescription involves the
conversion of the number of grams prescribes in terms of the exchanges which has
corresponding carbohydrate, protein, fats, and calorie numerical values.
 Commonly intended for planning diabetic diets, therefore the foods included are simple
and only those allowed in the diabetic diet are listed.
 Foods are divided into different groups or lists: carbohydrates, meat and meat substitutes,
and fats. Each group/list is subdivided into smaller listings (see summary of 7 exchange
list)
 The exchange lists encourage variety and help to control kcalories and grams of nutrients.
 The word “exchange” is coined because a certain food can approximately be substituted
for another food in the same group. For example, one exchange of rice measure ½ cup,
packed rice or eighty grams. One can substitute 3 pcs of pandesal measuring to 40grams
or 5x5cm each for one exchange of rice. Thus, serving portions are not identical and are
dependent on the specific food exchange substituted.
 The list is adapted to also meet the needs of weight reduction programs and medical
nutrition therapy planning.
 The Food Pyramid categorizes groups of foods based on nutrients they contain, whereas
the exchange list categorizes groups by proportion of carbohydrates, protein and fats.
Summary of the Seven Exchange Lists

List No. Food Group Calories/Grp CHO CHON FAT

1 Vegetable A 16 - - -
Vegetable B 40 3 1 -
2 Fruit 170 10 - -
3 Milk 100 12 8 10
4 Rice 23 2 -
5 Meat
a. low fat 50 - 8 2
b. medium fat 95 - 8 7
c. very high fat 122 - 9 10
6 Fat 45 - - 5
7 Sugar 20 5 - -

The Plate Model

 Illustrates the type of food needed for a healthy diet and the proportions that should be
eaten every day.
 The approach is simple and is designed so that the appropriate food selection can be
made visually without having to weigh or measure foods
 The method helps one to eat more fruits and vegetables, less fat and cholesterol, and
helps to control the amount of carbohydrate ingested at each meal.
 Uses a 9-inch diameter plate which is divided in 3the portions:

Lunch and dinner – first quarter of the plate is filled with 1/2inch deep of starchy
foods such as potato, corn, pasta and rice. The second quarter of the plate is filled with a
serving of neat or meat alternative. The best choices are lean meats, fish poultry or
legumes, prepared without oil or fats. The remaining half of the plate is filled with non-
starchy vegetables such as tomatoes, green leafy vegetables, carrots, etc. The foods
are low in carbohydrates and high in vitamins and minerals. Side dishes include a serving
of fruits (1cup fresh or 1 cup canned or 4 ounces juice) and a serving of low fat milk or
yogurt.

Planning a breakfast is slightly modified. Meat, meat alternatives and vegetables

are optional.

 The plate model’s simplicity makes it suitable as an instructional tool for nutrition
education. Some dietitians see its simplicity as a disadvantage because they
expect a more complex approach to planning a healthy or therapeutic diet. The
model’s basic portion size on the dinner plate instills the understanding of
adequate quantities of food to eat. The model can correct nutrient imbalances
through portion-size without the aid of measuring equipments such as dietary
scale.
Food Composition Table (FCT)

 A dietary tool which contains a list of foods with numerical values corresponding to the
amount of energy, nutrients, fibers and ash per 100grams of any particular food in the list.
 A means of knowing the chemical composition of a food. As newer nutrients are
discovered and more refined chemical techniques are developed, FCT values should be
revised from time to time because of tremendous progress on additional food products
commercially manufactured.
 It provides information regarding the chemical composition and nutrient contribution in
the sampled foods, as basis for planning food mixtures needed in food assistance
programs.
 Useful in prescribing diets with nutrient restriction or modification, and in interpreting
dietary histories,
 The table is handy in agricultural research, food industry and regulation, nutrition
education and consumer demand/action program.

CONDITION OF STORAGE (length of time, temperature, light)

 Are known to modify the nutritive value of foods
e.g. ascorbic acid rapidly lost when the temperature is high preparation
procedures

PREPARATION PROCEDURES
 The temperature used in cooking are best of the many variables that affect the nutritive
value of food

Example of a FCT:

ITEM Water (%) CHON(gm Fat(gm) CHO(mg) Ca(mg) K(mg)

)
Beverage
(Cola 12oz) 90 0 0 37 - -
Apple pie 48 21 105 360 76 756
(whole)
Apple 84 - 1 20 10 152
(raw,unpeeled
)
Eggs (raw, 75 6 6 6 1 65
whole)

IMPORTANCE OF FOOD COMPOSITION TABLE (FCT)

1. To compare the nutritive value of one food with another.

2. To calculate the nutritive value of any diet & to compare that diet with the RDA
3. To plan diet that must meet specific requirements.
4. To provide a ready reference to answer hundreds of questions that people ask about foods

LIMITATIONS OF FOOD COMPOSITION TABLE (FCT)

1. Only limited data are available for some nutrients such as amino acids, Vit B6, Vit. B12
2. For some foods there are no data, and for others the value must be regarded as tentative
until analysis have been made.
3. Tables of food composition give no indication of the BIOAVAILABILITY that is
actually absorbed and available for body use.

BIOAVAILABILITY depends upon:

a. chemical form in which the nutrient is present in food
b. the interactions that occur in the intestinal tract between two or more foods eaten
at the same time
c. the pH (acidity or alkalinity) of the intestinal tract.

FACTORS AFFECTING FOOD COMPOSITION

In general, the composition of foods of plant or animal origin is influenced by:

1. Genetic Origin
 plant origin – camote top
 animal species
2. Environment
 soil fertility
 climate & season
 processing techniques
 storage facilities
 preparation procedures
 plant variety
e.g. camote top ---- upo
calabasa-------- talong
malunggay---- patola

 animal species – beef is richer in iron than pork

 soil fertility – influences some of the nutritive values of foods grown on it.
e.g. low iodine content of the soil will naturally produce foods with a low
iodine content
  processing techniques – enhance or interfere with the nutritive
value of foods
eg. Dehydration, canning & freezing field foods of high nutritive value but
each process in certain ways, modifies somewhat contribution of a given.

Glycemic Index

 Defined as the area under the blood glucose response curve for each food, expressed as
percentage of the area obtained after taking the same amount of CHO as glucose.
 GI more than 70, between 55 and 70, and below 50 are considered high, intermediate
and low respectively.
 GI indicates the relative rate increase in blood glucose level following the ingestion of
CHO food compared with a standard which is either bread or glucose. The slower the
rate of increase in blood glucose level, the lower the GI, and vice versa. Low GI foods
have been shown to be beneficial in the dietary management of diabetes and
hyperlipidemia.
 Also a tool proposed for assessing and classifying the glycemic responses to foods and
supplementing the nutrient information about foods given in food tables. This tool can
help greatly in planning diabetic diets but sometimes the selection is limited and foreign.

The Use of Computers

The use of computers will continue to be important tools in nutrition education, dietary analyses,
diagnostic procedures and as therapeutic aids.
 In developing countries such as the Philippines, economic factors have limited the use of
computers to a few institutions and companies.

Food Labeling

 The best way for consumers to see how individual foods fit their nutritional needs, the
function of food labels is twofold:
1. to assist consumers to select foods with the most health-providing qualities.
2. to motivate food companies to enhance the nutritional value of food products because
labels reveals ingredient and nutrient content.

Foods processed in the US is based on standards established under the authority of the 1990
Nutrition Labeling and Educational Act.

The “Nutrition Facts” panel must list the quantities of energy (kcalories), fat and the following
other specific nutrients in a serving:
- Total food energy
- Total fat
- Saturated fat
 - Cholesterol
- Sodium
- Total carbohydrates
- Dietary fiber
- Sugars
- Protein
- Vitamin A and C
- Calcium
- Iron

Standards Used for Food Labeling:

Daily Values (DV) – standard nutrient-intake values developed by FDA and used as reference
for expressing nutrient content on nutrition labels. The DV include two types of standards: RDIs
(Reference Daily Intakes) and DRVs (Daily Reference Values)

Nutritional Labeling

Since 1973, the US Food and Drug Administration has made nutritional labeling
mandatory for all processed foods. The ruling requires that the label should have the following
format:

CALORIES, PROTEIN, CARBOHYDRATES, FAT, VITAMIN C, VITAMIN A,

THIAMIN, RIBOFLAVIN, NIACIN, CALCIUM, IRON, VITAMIN B6, VITAMIN B12, AND
SODIUM
The listing of other nutrient is optional.
In the Philippines, nutritional labeling is not yet a requirement but there has been some
proposals for such.

Reading Nutrition Fact Labels

As it is important to watch the amount you eat, it’s even more so to know what a person
eats. The Nutrition Fact Labels list all the ingredients, as well as the nutritional information of
each product. The Nutrition Fact Label is to help individuals make healthier food choices that
will nourish and fuel the body. From the label, one can also determine the serving size; at first, it
may be helpful to measure out serving sizes and get an “eye” for proper portion size.

Why Use Food Labels?

1.     It highlights information on saturated fat, cholesterol, dietary fiber, and other nutrients that
are of major health concern.
2.    They give us % Daily Values. These % values help us see how a food fits into our overall
daily diets.
3.    They give us nutrition information about almost every food item.
4.    They are easy to use and they give us important information to make healthful food choices.
5.    Food Labels have consistent serving size amounts to make it easier to compare similar foods
and make healthier choices. 
Nutrition Facts Label Interpretation

People look at food labels for different reasons. But whatever the reason, many consumers would
like to know how to use this information more effectively and easily. The following label-
building skills are intended to make it easier for you to use nutrition labels to make quick,
informed food choices that contribute to a healthy diet.

The Nutrition Facts Label - An Overview:

The information in the main or top section (see #1-4 and #6 on the sample nutrition label below),
can vary with each food product; it contains product-specific information (serving size, calories,
and nutrient information). The bottom part (see #5 on the sample label below) contains a
footnote with Daily Values (DVs) for 2,000 and 2,500 calorie diets. This footnote provides
recommended dietary information for important nutrients, including fats, sodium and fiber. The
footnote is found only on larger packages and does not change from product to product.

In the following Nutrition Facts label we have colored certain sections to help you focus on those
areas that will be explained in detail. You will not see these colors on the food labels on products
you purchase.
1. The Serving Size
The first place to start when you look at the Nutrition Facts label is the serving size and the
number of servings in the package. Serving sizes are standardized to make it easier to compare
similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric
amount, e.g., the number of grams.

The size of the serving on the food package influences the number of calories and all the nutrient
amounts listed on the top part of the label. Pay attention to the serving size, especially how
many servings there are in the food package. Then ask yourself, "How many servings am I
consuming"? (e.g., 1/2 serving, 1 serving, or more) In the sample label, one serving of
macaroni and cheese equals one cup. If you ate the whole package, you would eat two cups. That
doubles the calories and other nutrient numbers, including the %Daily Values as shown in the
sample label.

Example
Single %D Double %D
 
Serving V Serving V
Serving Size 1 cup   2 cups  
(228g) (456g)
Calories 250   500  
Calories from
110   220  
Fat
Total Fat 12g 18% 24g 36%
Trans Fat 1.5g   3g  
Saturated Fat 3g 15% 6g 30%
Cholesterol 30mg 10%       60mg 20%
Sodium 470mg 20% 940mg 40%
Total
31g 10% 62g 20%
Carbohydrate
Dietary Fiber 0g 0% 0g 0%
Sugars 5g   10g  
Protein 5g   10g  
Vitamin A   4%   8%
Vitamin C   2%   4%
Calcium   20%   40%

2. Calories (and Calories from Fat)

Calories provide a measure of how much energy you get from a serving of this food. Many
Americans consume more calories than they need without meeting recommended intakes for a
number of nutrients. The calorie section of the label can help you manage your weight (i.e., gain,
lose, or maintain.) Remember: the number of servings you consume determines the number
of calories you actually eat (your portion amount).

 
In the example, there are 250 calories in one serving of this macaroni and cheese. How many
calories from fat are there in ONE serving? Answer: 110 calories, which means almost half the
calories in a single serving come from fat. What if you ate the whole package content? Then, you
would consume two servings, or 500 calories, and 220 would come from fat.

General Guide to Calories

 40 Calories is low
 100 Calories is moderate
 400 Calories or more is high

The General Guide to Calories provides a general reference for calories when you look at a
Nutrition Facts label. This guide is based on a 2,000 calorie diet.

Eating too many calories per day is linked to overweight and obesity.

3. & 4.  The Nutrients: How Much?

Look at the top of the nutrient section in the sample label. It shows you some key nutrients that
impact on your health and separates them into two main groups:

   Limit These Nutrients

 
The nutrients listed first are the ones Americans generally eat in adequate amounts, or even too
much. They are identified in yellow as Limit these Nutrients. Eating too much fat, saturated fat,
trans fat, cholesterol, or sodium may increase your risk of certain chronic diseases, like heart
disease, some cancers, or high blood pressure.
  Important: Health experts recommend that you keep your intake of saturated fat, trans fat
and cholesterol as low as possible as part of a nutritionally balanced diet.

   Get Enough of These

 
Most Americans don't get enough dietary fiber, vitamin A, vitamin C, calcium, and iron in their
diets. They are identified in blue as Get Enough of these Nutrients. Eating enough of these
nutrients can improve your health and help reduce the risk of some diseases and conditions. For
example, getting enough calcium may reduce the risk of osteoporosis, a condition that results in
brittle bones as one ages. Eating a diet high in dietary fiber promotes healthy bowel function.
Additionally, a diet rich in fruits, vegetables, and grain products that contain dietary fiber,
particularly soluble fiber, and low in saturated fat and cholesterol may reduce the risk of heart
disease.

Remember: You can use the Nutrition Facts label not only to help limit those nutrients you
want to cut back on but also to increase those nutrients you need to consume in greater
amounts.

5.  Understanding the Footnote on the Bottom of the Nutrition Facts Label

Note the * used after the heading "%Daily Value" on the Nutrition Facts label. It refers to the
Footnote in the lower part of the nutrition label, which tells you "%DVs are based on a 2,000
calorie diet". This statement must be on all food labels. But the remaining information in the full
footnote may not be on the package if the size of the label is too small. When the full footnote
does appear, it will always be the same. It doesn't change from product to product, because it
shows recommended dietary advice for all Americans--it is not about a specific food product.

Look at the amounts circled in red in the footnote--these are the Daily Values (DV) for each
nutrient listed and are based on public health experts' advice. DVs are recommended levels of
intakes. DVs in the footnote are based on a 2,000 or 2,500 calorie diet. Note how the DVs for
some nutrients change, while others (for cholesterol and sodium) remain the same for both
calorie amounts.

 How the Daily Values Relate to the %DVs

Look at the example below for another way to see how the Daily Values (DVs) relate to the
%DVs and dietary guidance. For each nutrient listed there is a DV, a %DV, and dietary advice or
a goal. If you follow this dietary advice, you will stay within public health experts' recommended
upper or lower limits for the nutrients listed, based on a 2,000 calorie daily diet.

Examples of DVs versus %DVs

Based on a 2,000 Calorie Diet

Nutrient DV %DV Goal

Total Fat 65g = 100%DV Less than
    Sat Fat 20g = 100%DV Less than
Cholesterol 300mg = 100%DV Less than
Sodium 2400mg = 100%DV Less than
Total
300g = 100%DV At least
Carbohydrate
    Dietary Fiber 25g = 100%DV At least

Upper Limit - Eat "Less than"...

The nutrients that have "upper daily limits" are listed first on the footnote of larger labels and on
the example above. Upper limits means it is recommended that you stay below - eat "less than" -
the Daily Value nutrient amounts listed per day. For example, the DV for Saturated fat (in the
yellow section) is 20g. This amount is 100% DV for this nutrient. What is the goal or dietary
advice? To eat "less than" 20 g or 100%DV for the day.<

Lower Limit - Eat "At least"...

Now look at the section in blue where dietary fiber is listed. The DV for dietary fiber is 25g,
which is 100% DV. This means it is recommended that you eat "at least" this amount of dietary
fiber per day.
The DV for Total Carbohydrate (section in white) is 300g or 100%DV. This amount is
recommended for a balanced daily diet that is based on 2,000 calories, but can vary, depending
on your daily intake of fat and protein.

Now let's look at the %DVs.

 6.  The Percent Daily Value (%DV):

The % Daily Values (%DVs) are based on the Daily Value

recommendations for key nutrients but only for a 2,000 calorie daily diet--not 2,500
calories. You, like most people, may not know how many calories you consume in a day.
But you can still use the %DV as a frame of reference whether or not you consume more
or less than 2,000 calories.

The %DV helps you determine if a serving of food is high or low in a nutrient. Note: a
few nutrients, like trans fat, do not have a %DV--they will be discussed later.

Do you need to know how to calculate percentages to use the %DV? No, the label (the
%DV) does the math for you. It helps you interpret the numbers (grams and milligrams)
by putting them all on the same scale for the day (0-100%DV). The %DV column
doesn't add up vertically to 100%. Instead each nutrient is based on 100% of the daily
requirements for that nutrient (for a 2,000 calorie diet). This way you can tell high from
low and know which nutrients contribute a lot, or a little, to your daily recommended
allowance (upper or lower).

 
Quick Guide to %DV:

   

5%DV or less is low and 20%DV or more is high 

This guide tells you that 5%DV or less is low for all nutrients, those you want to limit (e.g., fat,
saturated fat, cholesterol, and sodium), or for those that you want to consume in greater amounts
(fiber, calcium, etc). As the Quick Guide shows, 20%DV or more is high for all nutrients.

Example: Look at the amount of Total Fat in one serving listed on the sample nutrition
label. Is 18%DV contributing a lot or a little to your fat limit of 100% DV? Check the
Quick Guide to %DV. 18%DV, which is below 20%DV, is not yet high, but what if you ate
the whole package (two servings)? You would double that amount, eating 36% of your
daily allowance for Total Fat. Coming from just one food, that amount leaves you with
64% of your fat allowance (100%-36%=64%) for all of the other foods you eat that day,
snacks and drinks included.
 1 serving

2 servings

Using the %DV for:

Comparisons: The %DV also makes it easy for you to make comparisons. You can compare one
product or brand to a similar product. Just make sure the serving sizes are similar, especially the
weight (e.g. gram, milligram, ounces) of each product. It's easy to see which foods are higher or
lower in nutrients because the serving sizes are generally consistent for similar types of foods,
(see the comparison example at the end) except in a few cases like cereals.

Nutrient Content Claims: Use the %DV to help you quickly distinguish one claim from another,
such as "reduced fat" vs. "light" or "nonfat." Just compare the %DVs for Total Fat in each food
product to see which one is higher or lower in that nutrient--there is no need to memorize
definitions. This works when comparing all nutrient content claims, e.g., less, light, low, free,
more, high, etc.

Dietary Trade-Offs: You can use the %DV to help

you make dietary trade-offs with other foods
throughout the day. You don't have to give up a
favorite food to eat a healthy diet. When a food you like
is high in fat, balance it with foods that are low in fat
at other times of the day. Also, pay attention to how
much you eat so that the total amount of fat for the
day stays below 100%DV.

 Nutrie nts With a %DV but No Weight Listed -

Spotlight on Calcium:
Calcium:  Look at the %DV for calcium on food packages so you know how much one serving
contributes to the total amount you need per day. Remember, a food with 20%DV or more
contributes a lot of calcium to your daily total, while one with 5%DV or less contributes a little.

Experts advise adult consumers to consume adequate amounts of calcium, that is, 1,000mg or
100%DV in a daily 2,000 calorie diet. This advice is often given in milligrams (mg), but the
Nutrition Facts label only lists a %DV for calcium.

For certain populations, they advise that adolescents, especially girls, consume 1,300mg
(130%DV) and post-menopausal women consume 1,200mg (120%DV) of calcium daily. The
DV for calcium on food labels is 1,000mg.

Don't be fooled -- always check the label for calcium because you can't make assumptions about
the amount of calcium in specific food categories. Example: the amount of calcium in milk,
whether skim or whole, is generally the same per serving, whereas the amount of calcium in the
same size yogurt container (8oz) can vary from 20-45 %DV.

Equivalencies
30% DV = 300mg calcium = one cup of milk
100% DV = 1,000mg calcium
130% DV = 1,300mg calcium
 Nutrients Without a %DV: Trans Fats, Protein, and Sugars:

Note that Trans fat, Sugars and, Protein do not list a %DV on the Nutrition Facts label.

Plain Yogurt Fruit Yogurt

Trans Fat: Experts could not provide a reference value for trans fat nor any other information
that FDA believes is sufficient to establish a Daily Value or %DV. Scientific reports link trans
fat (and saturated fat) with raising blood LDL ("bad") cholesterol levels, both of which increase
your risk of coronary heart disease, a leading cause of death in the US.

Important: Health experts recommend that you keep your intake of saturated fat, trans fat
and cholesterol as low as possible as part of a nutritionally balanced diet.

Protein: A %DV is required to be listed if a claim is made for protein, such as "high in protein".
Otherwise, unless the food is meant for use by infants and children under 4 years old, none is
needed. Current scientific evidence indicates that protein intake is not a public health concern for
adults and children over 4 years of age.

Sugars: No daily reference value has been established for sugars because no recommendations
have been made for the total amount to eat in a day. Keep in mind, the sugars listed on the
Nutrition Facts label include naturally occurring sugars (like those in fruit and milk) as well as
those added to a food or drink. Check the ingredient list for specifics on added sugars.

Take a look at the Nutrition Facts label for the two yogurt examples. The plain yogurt on the left
has 10g of sugars, while the fruit yogurt on the right has 44g of sugars in one serving.

Now look below at the ingredient lists for the two yogurts. Ingredients are listed in descending
order of weight (from most to least). Note that no added sugars or sweeteners are in the list of
ingredients for the plain yogurt, yet 10g of sugars were listed on the Nutrition Facts label. This is
because there are no added sugars in plain yogurt, only naturally occurring sugars (lactose in the
milk).

Plain Yogurt - contains no added sugars

Fruit Yogurt - contains added sugars

If you are concerned about your intake of sugars, make sure that added sugars are not listed as
one of the first few ingredients. Other names for added sugars include: corn syrup, high-fructose
corn syrup, fruit juice concentrate, maltose, dextrose, sucrose, honey, and maple syrup.

To limit nutrients that have no %DV, like trans fat and sugars, compare the labels of
similar products and choose the food with the lowest amount.

  Reviewing the ingredients list is important, especially if your kids have food allergies. Reading
the food label pictured above, you can see that this food has cow's milk, wheat flour, and eggs,
so wouldn't be a good idea for a child with a milk, wheat and/or egg allergy.

The ingredient list can also help you identify 'hidden' ingredients, like added sugars (bad), whole
grains (good), and trans fats (bad).

Added Sugars

Foods with added sugars will list corn syrup, fruit juice concentrates, honey, molasses, etc. on
their ingredient list. Other names for added sugars can include:

 brown sugar
 corn sweetener
 dextrose
 fructose
 glucose
 high-fructose corn syrup
 invert sugar
 lactose
 maltose
 malt syrup
 raw sugar
 sucrose
 sugar
 syrup
Whole Grains

The ingredient list can also help you find foods made with whole grains, which are healthier and
are preferred to refined grains. Whole grain foods should have one of the following whole grain
ingredients listed as their first ingredient:

 whole wheat
 whole oats
 brown rice
 bulgar
 graham flour
 oatmeal
 whole grain corn
 whole rye
 wild rice

On the other hand, a food is not made with whole grains if it is labeled with the words multi-
grain, 100% wheat, seven-grain, stone-ground, bran, or cracked wheat.

Trans Fats

Although the amount of trans fats isn't yet listed on most food labels, making them hard to avoid,
you can often identify that they are in a food if it lists 'partially hydrogenated vegetable oil' on
the ingredient list.

Comparison Example

Below are two kinds of milk- one is "Reduced Fat," the other is "Nonfat" milk. Each serving size
is one cup. Which has more calories and more saturated fat? Which one has more calcium?

REDUCED FAT MILK 2% Milk fat NONFAT MILK

   Answer: As you can see, they both have the same amount of calcium, but the nonfat milk has
no saturated fat and has 40 calories less per serving than the reduced fat milk.
Source: http://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm078889.htm2008
 

ROLE OF THE NURSE IN THE PROMOTION OF NUTRITION

A. Nutrition Education / Care

1. In the Hospital – the nurse has the most constant and intimate association with the patient

a. Maintaining lines of communication with the doctors and dietician regarding

patient’s dietary needs
b. Interpret the diet to the patient
c. Assisting patient at mealtimes
d. Observing, recording and reporting patient’s response
e. Planning for home care

2. Out Patient / Clinic Nurse- the nurse can help in the selection of inadequate and
appropriate diet by using seductional approach which the patient understand and accepts.

3. In School – nutrition education must begin in kindergarten and continue throughout the
elementary and secondary school which affords the best opportunity for helping the child
to understand & establish attitudes and practices concerning food selection.
 4. CHN Nurse – she’s in the position to observe community nutrition problems more
closely
- she has an opportunity to carry practical nutrition to many homes by
evaluating family of individual food habits, discuss nutrition and provision of
instructions in food preparation.

- she can also be able to guide the house keeper in the selection of low cost
foods that will provide adequate nutrition for the members of the family

UTILIZING NURSING PROCESS IN NUTRITION

ASSESSMENT NURSING PLANNING IMPLEMENTATIO EVALUATIO

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