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Home / Nutrition & Fitness / 11 tips for healthier eating habits

11 tips for healthier eating habits

A healthy diet can help reduce the risk of some health conditions. Picking up some beneficial habits now might help avoid having to make abrupt changes later.

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Eating habits often begin in childhood. Some are healthy, like grabbing your water bottle when you leave the house and layering lettuce and tomato on a sandwich. Some are not so healthy, like drinking soda throughout the day.

You might not think about those established habits — until you have a reason to. Sometimes a test result showing high cholesterol, blood pressure or blood sugar inspires change. Even without a diagnosis, it’s always a good time to adopt healthier eating habits. Making diet changes can help reduce the risk of chronic disease. Diet is linked to heart disease, type 2 diabetes and 13 kinds of cancer.

The majority of Americans don’t eat a healthy diet, according to the American Heart Association. Of course, it’s not all by choice. Systems are in place that make it easier and cheaper to grab a fast-food meal on the way home than it is to buy and prep ingredients for dinner. If you work two jobs, have kids who are picky eaters or don’t live near a grocery store, eating nutrient-rich foods can be even more challenging.

Making changes to diet habits isn’t always as easy as social media influencers might make it sound either. Research shows that the more often a person eats high-sugar or high-fat foods, the more they develop a taste for them. That makes habits even harder to break.

Here are some tips from Mayo Clinic experts for adding some healthy eating habits.

Learn the basics of a healthy diet

The diet you follow should fit your tastes, lifestyle and budget. It shouldn’t be so restrictive that you can’t follow it indefinitely. Here are some basics for a healthy diet:

Eat more vegetables and fruits. Most Americans don’t get the recommended five or more servings per day, so look for opportunities to add more fresh, frozen, or canned fruits and vegetables. When comparing canned options, look for low-sodium vegetables and fruit packed in juice or water rather than syrup.
Pick whole grains. When you look at the ingredients list on foods like bread and cereal, look for the words “whole wheat” or “whole grain.” An easy guideline is to pick the one with the most grams of fiber per serving. You also can include brown rice, quinoa, millet and oats in your diet.
Limit unhealthy fats. Saturated fats are mostly found in animal products like meat, cheese and butter. To help with healthy blood pressure levels , try to keep your intake of saturated fats to 13 grams per day. Avoid trans fats as much as possible.
Choose low-fat protein. Try to use fewer red and processed meats like bacon, sausage, and breaded chicken. Instead, choose eggs, beans, turkey, chicken, fish, lean beef and low-fat dairy.
Reduce salt intake. Healthy adults should try to limit their sodium to 2,300 milligrams of sodium a day, which is about a teaspoon of salt.

Make a plan

It might help to track your food for a few days. Use an app or write down what you ate and when. You could make notes about your mood or your hunger level when you ate. You might notice that you:

Snack while cooking.
Keep eating even if you’re full so you don’t waste food.
Eat while distracted, such as while scrolling social media.
Always crave something sweet after dinner.
Get tempted by the menu of pastry offerings when you stop for coffee.

With this information, you can start looking for patterns you want to break. Some of the following tips might work for you.

Start with an easy one. It’s hard to change everything at once, so start with the healthy habit that would be easiest for you. It might be adding a vegetable to dinner or using brown rice instead of white.

Make an impact. If you’re trying to reduce your sugar intake, for example, start with the biggest sources of sugar, like desserts and sweetened beverages. Don’t worry so much about the sugar in your condiments or salad dressings.

Add instead of subtract. Rather than making cuts, think about what you can add. You might have a serving of fruit with breakfast or enjoy a walk after lunch. Focus on what you can have. That might leave less time in your day or room in your belly for habits you want to break.

Cut your portion sizes. You can enjoy your favorite foods and still cut your sugar or saturated fat intake. Try switching to a small soda, sharing dessert with a friend or using less butter on your toast.

Drink water. Sometimes thirst is mistaken for hunger. Sipping water throughout the day helps keep you full and hydrated.

Sit at the table to eat. Stepping away from your desk or phone will allow you to focus on your food and internal cues for hunger or fullness.

Find a replacement. If you eat out of habit, can you find a different habit? Consider having fruit for dessert. Or go for a walk until the craving subsides. Cravings come like waves. If you ride them out, they will pass.

Relax. People don ‘ t always make the healthiest choices when tired or stressed. Sometimes improving your diet comes from prioritizing sleep or stress management.

Remember why. Think about why forming healthier habits is important to you. Maybe you want more energy to finish projects around the house or to keep up on the company softball team. Consider setting a picture of your healthy-habit motivation as the lock screen of your phone or writing a note to yourself.

Ask for support. Tell your loved ones about your goals and what you’re doing. Ask them to support your efforts. You might even inspire them to make their own healthy changes.

Accept imperfections. Having a doughnut in the breakroom or an extra slice of pizza at dinner doesn’t mean all progress is lost. No side order of guilt needed.

A dietitian can help

You don’t have to make diet changes on your own. Ask your health care team for a referral to a dietitian. The dietitian can help you find solutions that work for your lifestyle and budget. You also can find professional and community support with the Mayo Clinic Diet .

Relevant reading

The Mayo Clinic Diet Journal, Third Edition

This handy companion to The Mayo Clinic Diet is not your typical journal. The 224 pages of The Mayo Clinic Diet Journal will help you plan, track and review your progress over 10 weeks as you follow the program described in the #1 New York Times bestseller, The Mayo Clinic Diet.

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6 Tips to Create Healthy Eating Habits That Help You Feel Your Best

Rachel MacPherson is a health writer, certified personal trainer, certified strength and conditioning specialist, and exercise nutrition coach based in Halifax.

Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.

Verywell / Jiaqi Zhou

If you asked 10 people to define "healthy eating," you'd receive 10 different answers. While many of those answers may contain some truth, navigating what healthy eating means for you takes time, intuition, and many times, a game plan.

To begin, understand that "healthy" is often used as a catch-all phrase, intended to steer you toward products that may or may not actually help you achieve sustainable health. When you're looking for habits, tips, and ingredients to help you feel your best, get more specific—what vitamins, nutrients, and flavors do you want to add to your weekly meal plan? Those granular questions can provide a more clear focus than "healthy" sometimes does.

If you're looking to commit to an eating style that's focused on helping you feel your best, it's worth brainstorming some strategies that encourage certain habits to stick. Remember, eating should not feel restrictive or complicated. You can eat all of the foods you love while adding a variety of nutritious foods that fuel you and support the optimal functioning of your body.

Focus On the Positive

When you want to implement eating habits that work toward sustainable health , not a temporary "diet," it's essential to focus on the positive. People sometimes get caught up in what they cannot have now that they are eating "better." This mindset makes you feel that you're restricting yourself, which may lead to abandoning your new eating habits altogether.

Instead, try focusing on what you're adding to your menu, rather than what you feel you should avoid. For instance, try adding a new vegetable or fruit each week. Plan a meal with a new-to-you or rarely-eaten nutritious ingredient and experiment with new recipes.

Another example is to focus on adding more—such as increasing your water intake, eating more fruit, vegetables, whole grains , lean protein, and dairy. You don't have to eliminate any of your favorite foods; simply focus on adding more nutrient-dense ingredients at each meal.

Instead of self-talk that focuses on what you "shouldn't" have, the main objective of your eating choices is to increase your consumption of foods (and water!) that make you feel more energized, vibrant, and excited about meals.

Ditch the Labels

Similarly, ditching the labels that you and society at large may have put on ingredients ,such as "good" or "bad," can relieve anxiety associated with making new choices regarding food.

Knowing that all foods are acceptable in moderation and that if you are craving a piece of chocolate cake, for example, you can enjoy it without guilt as part of an overall nutritious diet, helps create more balance in your approach to healthy eating.

Labeling food as good or bad is an inherent part of diet culture —the pervasive belief that food is transactional and can be earned with strict eating behaviors or exercise.

Labeling food as good or bad often extends to labeling yourself as good or bad depending on whether or not you resisted the foods deemed off-limits. This way of viewing food and yourself is unhealthy and can lead to more significant food and body image issues.

Food is cultural, social, and pleasurable. Avoid a mindset that makes you believe you have to restrict foods you love in order to be considered healthy. There's room for all foods in a healthy diet.

Fuel Up on Nutrients

Choosing to create eating habits that make you feel good doesn't have to be complicated. Fad diets and restrictive eating patterns are not necessary! Instead, focus on getting enough nutrients so you can feel your best. Nutrients include:

Carbohydrates

Macronutrients are carbs, proteins, and fats and are the overarching building blocks of all foods. Each is necessary for fueling your body , repairing structures, regulating and producing hormones, transporting and absorbing micronutrients , and more.

Micronutrients are vitamins and minerals which each play a role in your body. Phytonutrients are chemical compounds that provide a wide range of health benefits to your body and are obtained by eating plenty of plant-based foods. These compounds include flavonoids, phytochemicals, flavones, isoflavones, catechins, and anthocyanidins.

Set Yourself Up for Sucess

Part of setting yourself up for success includes planning ahead and changing your environment to reflect your goals. With any lifestyle change, the more you can do ahead of time to help yourself be successful, the better.

Here are some ways you can set yourself up for success:

Buy a wide range of nutritious foods to have on hand (and keep in sight).
Set aside one or two days a week to prepare nutritious meals and snacks ahead of when you'll need them. Meal planning can increase the likelihood of consuming more nutrient-rich food .
Keep nutritious snacks in your bag or at your desk.
Fill a water bottle to keep at your desk during the day—set phone reminders to drink water, if necessary.
Cut up or bulk cook things like veggies and grains to make meals faster and easier to assemble.
Plan to enjoy foods you love! Understand that a well-rounded diet is a healthy one.

Make Changes that Stick

Making small changes instead of completely overhauling your entire eating style makes it more likely for those changes to stick and become a lifestyle. One way you can make changes that stick is to use SMART goals—specific, measurable, attainable, relevant, and time-bound.

Using SMART goals is a tried and true method of turning habits into a lifestyle. Here is how to set SMART goals.

Specific : Choose specific habits that support your desired outcome. Instead of saying, “I want to eat healthier,” try saying, “I want to eat a new vegetable at dinner three nights per week.”
Measurable : Whatever your goal, be sure that it is trackable and quantifiable. Whether that's how many days per week you bring lunch to work instead of eating out or how much water you drink each day, make sure you can measure it!
Attainable : Your goals should be realistic and achievable. To ensure this, make your goals short-term and reasonable for your current lifestyle. Don't overcommit. A goal such as such as “I will increase my serving of lean protein at breakfast ," is easy enough to achieve while still being challenging enough to work toward.
Relevant : Your goals and eating habits should be pertinent to your personal preferences. For instance, if you really dislike most vegetables, choose another eating goal that motivates you instead of forcing yourself to eat them. Perhaps you want to increase your daily fiber intake. Set a plan for how many grams per day and stick to it. Choose a goal that feels motivating to you.
Time-bound : Create a timeframe in which you commit to reaching your goal. Of course, the timeframe should be realistic and not too distant. Starting with a few weeks ahead is ideal. Once you've reached the time set, re-evaluate your success and continue to set goals.

Seek Out Support

Creating a support system through your social network of friends and family may help increase overall wellbeing and adherence to health goals, including nutritious eating practices. Letting your friends and family know that you are committing to some lifestyle changes—no matter how big or small they may be—could make it easier to stick to your goals.

Asking the other people in your home, for instance, to help with meal preparation, brainstorming nutritious foods to try, or grocery shopping might take some of the load off of you and get them involved.

Nutrition and fitness books also can help guide you through the process, and cookbooks can provide all the inspiration you need.

A Word From Verywell

Making healthy eating a lifestyle requires some mindset shifts, including how you view ingredients that society may have influenced you to think of as "good" or "bad." Focus on adding more nutrient-rich foods to your diet and supporting this focus with habit building and goal setting that fits into your current lifestyle.

Remember, with any lifestyle change, small steps that build up over time are perfectly acceptable and may increase adherence. There's no need to overhaul everything at once or commit to habits you dread. Seek the support of your social network to help you stay accountable and stick to the eating patterns that help you feel your best.

Rollins BY, Loken E, Savage JS, Birch LL. Effects of restriction on children’s intake differ by child temperament, food reinforcement, and parent’s chronic use of restriction . Appetite. 2014;73:31-39. doi"10.1016/j.appet.2013.10.005

Freeland-Graves JH, Nitzke S. Academy of Nutrition and Dietetics. Position of the academy of nutrition and dietetics: Total diet approach to healthy eating . J Acad Nutr Diet . 2013;113(2):307-317. doi:10.1016/j.jand.2012.12.013

Hogan MJ, Strasburger VC. Body image, eating disorders, and the media . Adolesc Med State Art Rev . 2008;19(3):521-xi.

Academy of Nutrition and Dietetics. How to explain basic nutrition concepts .

Gupta C, Prakash D. Phytonutrients as therapeutic agents . J Complement Integr Med . 2014;11(3):151-69. doi:10.1515/jcim-2013-0021

Ducrot P, Méjean C, Aroumougame V, et al. Meal planning is associated with food variety, diet quality and body weight status in a large sample of French adults . Int J Behav Nutr Phys Act. 2017;14(1):12. doi:10.1186/s12966-017-0461-7

Hills AP, Byrne NM, Lindstrom R, Hill JO. 'Small changes' to diet and physical activity behaviors for weight management . Obes Facts . 2013;6(3):228-238. doi:10.1159/000345030

American Psychological Association. Manage Stress: Strengthen Your Support Network . Updated October 2019.

By Rachel MacPherson, BA, CPT Rachel MacPherson is a health writer, certified personal trainer, and exercise nutrition coach based in Halifax.

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Health Capsule

How Your Eating Habits Affect Your Health

Young woman in grocery store looking at apples.

A new study shows how the things you eat can influence your risk of dying from heart disease, stroke, or type 2 diabetes. The findings suggest ways to change your eating habits to improve your health.

Experts already know that a healthy eating plan includes vegetables, fruits, whole grains, and fat-free or low-fat dairy products. A healthy diet also includes lean meats, poultry, fish, beans, eggs, and nuts. It limits saturated and trans fats, sodium, and added sugars.

NIH-funded scientists analyzed how these 10 dietary factors affect your risk of death from heart disease, stroke, and type 2 diabetes. These are known as cardiometabolic diseases. The team relied on data from the CDC’s National Health and Nutrition Examination Survey (NHANES) and national mortality data.

The scientists found that risk of death from the 3 diseases was higher for those who consumed too much sodium, processed meat, sugar-sweetened beverages, and unprocessed red meat. Risk of death was also higher among those who didn’t eat enough nuts and seeds, seafood omega-3 fats, vegetables, fruits, whole grains, or polyunsaturated fats. According to the analysis, nearly half (45%) of deaths in 2012 from the 3 diseases was associated with too much or too little of these 10 dietary factors.

“This study establishes the number of cardiometabolic deaths that can be linked to Americans’ eating habits, and the number is large,” explains Dr. David Goff, a heart disease and public health expert at NIH. “Second, it shows how recent reductions in those deaths relate to improvements in diet, and this relationship is strong. There is much work to be done in preventing heart disease, but we also know that better dietary habits can improve our health quickly, and we can act on that knowledge by making and building on small changes that add up over time.”

How to Develop Healthy Eating Habits

Last Updated: February 7, 2024 Approved

This article was co-authored by Tara Coleman . Tara Coleman is a Clinical Nutritionist who has a private practice in San Diego, California. With over 15 years of experience, Tara specializes in sports nutrition, body confidence, and immune system health and offers personalized nutrition, corporate wellness, and online learning courses. She received a BS in Biology from James Madison University and spent six years in the pharmaceutical industry as an analytical chemist before founding her practice. Tara has been featured on NBC, CBS, Fox, ESPN, and Dr. Oz The Good Life as well as in Forbes, Cosmopolitan, Self, and Runner’s World. There are 17 references cited in this article, which can be found at the bottom of the page. wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 93% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 433,267 times.

Many people realize that healthy eating habits can help support a healthy weight, manage or improve chronic diseases and maintain overall good health. But a diet that contains more processed, less nutritious foods can lead to weight gain and poor health. [1] X Trustworthy Source National Health Service (UK) Public healthcare system of the UK Go to source If you want to develop healthy eating habits, make small changes over a longer period. You'll need to focus on eating consistent, well-balanced meals and eating a variety of foods. This will help ensure you're consuming enough nutrients to support your body and daily activities. Developing healthy eating habits is a great way to improve your health and can be just a few small changes away.

Getting Ready to Improve Your Eating Habits

Explain that you're interested in cleaning up your diet and eating better. Provide some information about why you're making these changes and what you hope to achieve.
Also ask your doctor if she has any suggestions for you. Many times if you are on certain medications, have a certain health condition or need to lose weight, your doctor may be able to give you a few tips to help you get started.

Ask your doctor for a referral to a local dietitian or someone she works with. You can also do an online search for a dietitian in your area.
Talk to your dietitian about your goal for improving your eating habits and what you hope to achieve with better habits.
Ask him about other changes they think would be helpful to you. He or she may be able to suggest additional changes outside of the ones you've thought of.

Keep track of all your food and beverages for at least one week. Try to be as accurate as you can when you're tracking your food. Even a few bites while you prepare meals should be accounted for.
Don't forget to track how many ounces of clear, hydrating fluids you drink. This is an area that's also an important part of healthy eating.
After you've kept your journal for a few days, star or highlight areas where you think you could make changes. For example, you might notice you don't drink enough water or typically skip breakfast. These are great areas where you can make healthy changes.

It might be helpful to start by writing a list of all the small changes you'd like to make to your diet and eating patterns.
Schedule or write in your calendar which changes you'll be making each week or few weeks. Keep track of how successful or unsuccessful you are after each change.

Talk to your friends, family members or coworkers about your plan for improving your diet. Ask if anyone would like to join you. Together, you may be able to collaborate on different healthy eating ideas, recipes or ideas when the going gets tough.
You can also sign up for online support groups or forums where others are also trying to improve their eating habits.

Changing How You Eat

Step 1 Eat regular, scheduled meals each day.

It's important to eat regular, consistent meals each day. [6] X Research source In general, it's important to eat about every three to four hours. Some people may prefer to have four or five small meals a day, whereas others may stick to three meals daily. This timeline may differ for everyone, but it's still not healthy to skip meals.
One study showed that when mice ate just one large meal per day and fasted the rest of the day, their insulin resistance and abdominal fat increased.
Plan for quick or easy-to-prepare meals to make it easier to stay consistent with your eating schedule. Foods like individual yogurts, fruit, nuts, hard-boiled eggs, cheese sticks, or a protein shake are easy to eat on the run and require minimal prep work.

Step 2 Eat a protein and fiber-rich breakfast.

Studies have shown that breakfasts that are high in protein help lead to better hunger management during the day. People felt more satisfied and showed reduced cravings during the day. [7] X Research source
Breakfasts that also contained a high amount of fiber have been shown to be beneficial as well. Fiber adds bulk to meals and takes longer to digest compared to low fiber foods. This helps increase satisfaction and manage hunger throughout the day.
Examples of high protein, high fiber breakfasts include a small whole wheat tortilla with scrambled eggs and cheese, cottage cheese topped with fruit, whole grain oats topped with dried fruit and nuts or a breakfast smoothie made with Greek yogurt and fruit.

Another appropriate time to snack would be before or after a workout. Snacks can help provide your body with the energy it needs for a good workout or help your body recover from exercise.
If you're trying to lose weight, snacks shouldn't be more than 150 calories. [10] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source Snacks should also only be eaten when you are truly hungry, and it's appropriate to snack.
Healthy snacks include: 1/4 cup of nuts, whole grain pita chips with hummus, apple with 2 tablespoon (29.6 ml) of peanut butter or a small Greek yogurt.

Step 4 Take at least 20 minutes to eat your meals.

Those who ate slower not only felt more satisfied but also consumed less food. [12] X Trustworthy Source Harvard Medical School Harvard Medical School's Educational Site for the Public Go to source This may be due to the fact they realized they were satisfied and didn't eat until they were overly full.
Try these tricks to help yourself slow down: set a timer for 20 minutes, put your fork down between each bite, drink more water between bites, talk to friends or family while you eat or count how many times you chew each bite.
Also do not get distracted while eating. Turn off TVs and cell phones while you're eating. Also, try not to read, check emails or do other work while you're eating. [13] X Trustworthy Source Harvard Medical School Harvard Medical School's Educational Site for the Public Go to source

Step 5 Stop eating when you're satisfied, not full.

It may be difficult to tell when you're only "satisfied." It takes about 20 minutes for your brain and stomach to communicate that feeling. [15] X Research source That's why it's important to eat slowly.
In general, satisfaction may feel like: a lack of hunger, disinterest in your food, a very slight stretching sensation or the feeling that you won't need to eat again for a few hours. When you're satisfied, you should leave some food on your plate.
When you're eating until you're full, you may feel: uncomfortable, bloated, sick, a significant stretching sensation in your stomach. When you're full, you most likely cleared your plate or had additional servings of food.

Step 6 Instill good eating habits in your kids.

Kids can be a difficult group to get to eat healthy. However, they are quick to learn and imitate behaviors they see in their parents. [16] X Research source
Cooking together with your kids and taking them to the grocery store can help them feel involved, more excited to try new foods and eat healthier. [17] X Research source
Introduce new foods slowly to kids. If you're just starting to eat better at home, your kids might not jump on the bandwagon so quickly. Be patient with them as they adjust their tastes to your new eating pattern.
Get creative with your meals and snacks. Making foods look fun and interesting can help kids feel more comfortable trying new items. [18] X Research source For example: make a smiley face out of cut-up fruit, or make "ants on a log" (celery spread with peanut butter and topped with raisins).

Changing What You Eat

In general, one serving of protein is about 3-4 ounces. This is the size of your palm or a deck of cards.
Most of your protein choices should be lean. These contain higher amounts of protein and less fat which can help support a healthy weight. Choose items like poultry, eggs, lean beef, seafood, legumes, pork, tofu or low-fat dairy products.
It's appropriate to eat higher fat protein sources on occasion. However, these types of foods should not be the main source of your protein.

Step 2 Eat five to nine servings of fruits and vegetables daily.

One serving of fruits is 1/2 cup or one small piece of fruit. [21] X Trustworthy Source USDA Center for Nutrition Policy and Promotion U.S. agency responsible for promoting good nutrition based on scientific research Go to source One serving of vegetables is one cup or two cups of leafy green vegetables. [22] X Trustworthy Source USDA Center for Nutrition Policy and Promotion U.S. agency responsible for promoting good nutrition based on scientific research Go to source Make half of your plate a fruit or vegetable to help you meet your daily goals.
Choose a variety of fruits and vegetables that are deep in color. These contain more nutrients compared to paler vegetables. For example, choose spinach over iceberg lettuce or choose butternut squash over yellow summer squash.
Also choose a wide variety of fruits and vegetables each day and week. You will limit your nutrition if you only eat one or two types of fruits and vegetables.

Step 3 Choose whole grains over refined grains.

Whole grains are less processed and contain the entire grain — bran, endosperm and germ. These foods are typically higher in fiber, protein and other essential nutrients. [24] X Trustworthy Source USDA Center for Nutrition Policy and Promotion U.S. agency responsible for promoting good nutrition based on scientific research Go to source Choose items like brown rice, quinoa, whole grain oats or 100% whole wheat bread.
Refined grains are those that are more processed and generally do not contain the nutrient containing parts of the grain. Refined grains are lower in fiber, protein and other nutrients. Items like white bread, plain pasta or white rice are refined grains.
One serving of grains is about 1 ounce. That could be one slice of bread or about 1/2 cup of pasta or rice. Include three to four servings of these foods each day.

Step 4 Limit highly processed junk foods.

Limit foods like candy, cakes, cookies, pastries, frozen meals, processed meats and chips or crackers.
Try to eat mostly whole, minimally processed foods like raw fruits and vegetables, frozen or canned fruits and vegetables without sauces or seasonings, fresh or frozen protein without added sauces or seasonings, whole grains and low-fat dairy products.

Everyone needs a different amount of hydrating fluids each day. New guidelines suggest this method to find out how many ounces to drink each day: divide your weight in half, and that will give you the number of ounces of fluids you should consume. [26] X Research source If you weigh 150 lbs. you should drink 75 oz or a little over nine cups. Try to drink this much as your initial goal. You may change this amount as you continue to work on your diet.
Choose fluids that are sugar-free and decaffeinated as they hydrate you the best. Items like water, flavored water, decaf coffee and tea are appropriate types of beverages.
Reduce or cut out sweetened beverages. The consumption of sweetened beverages may lead to weight gain. Cut out sodas, juices, sweet teas and alcohol.

Consider taking a multivitamin. This is a general supplement that contains a wide variety of vitamins and minerals. These are an excellent, all-purpose type of supplement.
Consider an additional iron supplement. Some people, especially females who are menstruating, may need additional iron.
Vitamin B12 is typically found in animal foods, and those who are vegetarian or vegan may need an additional B12 supplement. [28] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
Vitamin and mineral supplements are not to be relied upon heavily or used in place of real, whole foods. They are meant to be a supplement to a healthy, well-balanced diet.
Always check with your doctor before starting any vitamin or mineral supplement. Not all supplements are safe and appropriate for everyone.

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Treat yourself to an occasional discretion, such as a piece of chocolate. Limit the amount and frequency of the treat. Thanks Helpful 5 Not Helpful 0
Keep a food and exercise journal. It will help guide you with your daily goals through accountability. Baby steps make it livable. Thanks Helpful 6 Not Helpful 2
Try to eat more vegetables than meat. Fruits and vegetables have more nutrients than any other food group. Thanks Helpful 4 Not Helpful 1

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↑ Tara Coleman. Clinical Nutritionist. Expert Interview. 22 October 2020.
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↑ http://aje.oxfordjournals.org/content/158/1/85.full
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↑ http://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/healthy-diet/art-20046267
↑ http://www.health.harvard.edu/blog/why-eating-slowly-may-help-you-feel-full-faster-20101019605
↑ http://www.health.harvard.edu/blog/distracted-eating-may-add-to-weight-gain-201303296037
↑ https://health.usnews.com/health-news/blogs/eat-run/2012/08/08/stuffed-or-satisfied-when-to-stop-eating
↑ http://www.parents.com/kids/nutrition/healthy-eating/get-your-kids-to-eat-better/
↑ https://www.choosemyplate.gov/eathealthy/vegetables
↑ http://www.choosemyplate.gov/fruits
↑ http://www.choosemyplate.gov/grains
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↑ http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/supplements/art-20044894?pg=1

About This Article

To develop healthy eating habits, start by eating regular, scheduled meals each day to keep your energy levels up. Try to take at least 20 minutes to eat each meal so that you feel satisfied sooner, which can prevent overeating. Also, plan quick, easy-to-prepare meals and have healthy snacks on hand to keep your diet on track. Finally, remember to stay hydrated throughout the day and consider taking supplements to help you maintain your healthy eating patterns! For tips on specific foods you can incorporate into your healthy diet, read on! Did this summary help you? Yes No

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1.6 – Assessing Personal Health and Choosing an Eating Pattern

Learning objectives.

Discuss ways of assessing your personal health status and your diet.
Set a goal to adopt, maintain, or improve a nutrition-related practice.
Formulate an effective, long-term, personal health and nutrition plan.

You may remember that when you were younger your parents made you eat food or take a supplement because they said it was good for you. You don’t have to have a Ph.D. to know some of the basic ways you can adapt your life to be healthier. However, the mainstream media inundates the American population with health cures and tips, making it confusing to develop the best plan for your health. This section will equip you with tools to assess and improve your health. To find some other reliable sources on health see the video below.

Exercise 1.6.1: QuAckwatch!

With all of the false Nutrition information out there, we need to be able to figure out which websites are reliable and which ones are simply quackery (false nutrition information)! Here is a website that will help you figure out who is trying their best to give you good information on nutrition and health and who is lying!

Quackwatch.org Questionable Organizations

Personal Health Assessment

One of the easiest places to begin a personal health assessment is by examining the results from your last physical. Often a person will leave the doctor’s office without these results. Remember that the results belong to you and having this information on hand provides you with much of what you need to keep track of your health. During a physical, after obtaining weight and height measurements, a nurse will typically examine blood pressure. Blood pressure is a measurement of the forces in the arteries that occur during each heartbeat. It is a principal vital sign and an indicator of cardiovascular health. Desirable blood pressure is 120 over 80 mmHg. In most circumstances, a physical includes blood tests, which measure many health indicators, be sure to request the results. Once you have the results, it is good practice to file them either on your computer or in a binder so you can compare them from year to year. This way you can track your blood cholesterol levels and blood glucose levels. These are some of the more general measurements taken, but in many instances, blood tests also examine the liver and kidney function, vitamin and mineral levels, hormone levels, and disease markers. Your doctor uses all of these numbers to assess your health and you can use them to play a more active role in keeping track of your health.

Figure 1.6.1: Don’t forget to get the results of your physical the next time you visit your doctor. They will help you keep track of your health. Flickr Source Reference

Hearing and vision are additionally part of a general health assessment. If you wear glasses, contacts, or a hearing aid you already are aware of how important it is to know the results of these exams. If you have not experienced vision or hearing problems yet your likelihood of experiencing them markedly increases over the age of forty. Another component of overall health is oral health. The health of your teeth, gums, and everything else in your mouth is an integral component of your overall health. This becomes apparent when a person experiences a tooth infection, which if left untreated significantly impairs physical, mental, and social well-being.

Other indicators of health that you can measure yourself are body mass index (BMI) and fitness. BMI is simply a ratio of an individual’s weight and height. More specifically BMI is calculated using an individual’s body weight (in kilograms, or kg) divided by the square of their height (in meters) and the unit of measurement is kg/m2. You can calculate this yourself or use one of the many BMI calculators on the web (see Interactive). BMI is a standardized measurement that indicates if a person is underweight, of normal weight, overweight, or obese and is based on data from the average population. It has some limitations. One limitation is that it does not take into account how much of your weight is made up of muscle mass, which weighs more than fat tissue. BMI and other measurements of body composition and fitness are more fully discussed elsewhere.

Interactive 1.6.1

If you are honest about your habits, you can then use the results to set personal health goals for yourself. Consider your current eating patterns, sleep patterns, emotional, social, and physical health.

In general, how would you rate your health? Excellent Very Good Good Fair Poor
In the last 7 days, how often did you exercise for at least 20 minutes a day? Exercise includes walking, housekeeping, jogging, weights, or playing a sport. It can be done on the job, around the house, just for fun, or as a work-out. Every day 3-6 days 1-2 days 0 days
In the last 7 days, how often did you sleep at least 7 hours per night? Every day 3-6 days 1-2 days 0 days
In the last 7 days, how often did you eat 2 or more servings of fruits in a day? Every day 3-6 days 1-2 days 0 days
In the last 7 days, how often did you eat 3 or more servings of vegetables in a day? Every day 3-6 days 1-2 days 0 days
In the last 7 days, how often did you eat 3 or more servings of whole grains in a day? Every day 3-6 days 1-2 days 0 days

For each of the questions above, consider making a change if you answered less than 5-6 days per week.

In the last 7 days, how often did you have (5 or more for men, 4 or more for women) alcoholic drinks at one time? 1 drink is 12 oz beer, 5 oz wine, or 1 shot Never Once a week 2-3 times a week More than 3 times during the week
In the last 30 days have you smoked or used tobacco? Yes No
Do you want to quit smoking or using tobacco? Yes I am working on quitting or cutting back right now No
How often is stress a problem for you in handling everyday things such as your health, money, work, or relationships with family and friends? Almost every day Sometimes Rarely Never
Do you use drugs or medications (other than exactly as prescribed for you) which affect your mood or help you to relax? Almost every day Sometimes Rarely Never
How long has it been since you last visited a dentist or dental clinic for any reason? Never Within the last year Between 1-2 years Between 3-5 years More than 5 years
Do you need help with food, clothing, utilities, or housing? Yes No

During a physical, a doctor will ask how you are feeling. If you are depressed or are experiencing behavioral problems, these impact physical health as well. Be prepared to answer these questions truthfully, so that your doctor can develop a proper treatment plan to manage these aspects of health.

Taking charge of your health will pay off and equip you with the knowledge to better take advantage of your doctor’s advice during your next physical. Health calculators, such as those that calculate BMI, ideal weight, target heart rate among many others, and personal health assessments will help you to take charge of your health, but they should not take the place of visiting your doctor.

Current Eating pattern (BAseline)

The first step in assessing your diet is to find out if the foods you eat are good for your health and provide you with all the nutrients you need. Begin by recording in a journal what you eat every day, including snacks and beverages. There are several great methods for doing this. You can even snap pictures of the meals you eat so that you can more easily remember everything you consumed in the day.

Family Medical History

Because genetics play a large role in defining your health it is a good idea to take the time to learn some of the diseases and conditions that may affect you. To do this, you need to record your family’s medical history. Start by simply drawing a chart that details your immediate family and relatives. Many families have this and you may have a good start already. The next time you attend a family event start filling in the blanks. What did people die from? What country/countries did your grandparents come from? While this may be a more interesting project historically, it can also provide you with a practical tool to determine what diseases you might be more susceptible to. This will allow you to make better dietary and lifestyle changes early on to help prevent a disease from being handed down from your family to you. It is good to compile your information from multiple relatives.

Lifestyle Assessment

A lifestyle assessment includes evaluating your personal habits, level of fitness, emotional health, sleep patterns, and work-life balance. Many diseases are preventable by simply staying away from certain lifestyles. Don’t smoke, don’t drink excessively, and don’t do recreational drugs. Instead, make sure you exercise. Find out how much to exercise by reading the 2018 Physical Activity Guidelines for Americans. There is a wealth of scientific evidence that increased physical activity promotes health, prevents disease, and is a mood enhancer. Emotional health is often hard to talk about; however, a person’s quality of life is highly affected by emotional stability. Harvard’s Women’s Health Watch notes six reasons to get enough sleep: Sleep promotes healthy brain function, while lack of sleep can cause weight gain and increase appetite, decrease safety (falling asleep while driving), make a person moody and irritable, decrease the health of the cardiovascular system and prevent the immune system from functioning well. Finding a balance between work and life is a difficult and continuous process involving keeping track of your time, taking advantage of job flexibility options, saying no, and finding support when you need it. Work-life balance can influence what you eat too. 1

Dietary Assessment and Choosing a Plan of Eating

Taking into consideration your personal health assessment, your family’s medical history, your own current health, and your lifestyle assessment, you will want to pick a pattern of eating to compare to your current eating pattern. This paragraph from Chapter 1 of the 2015-2020 Dietary Guidelines for Americans, describes what is meant by the term, “eating pattern”.

“Over the course of any given day, week, or year, individuals consume foods and beverages in combination—an eating pattern. An eating pattern is more than the sum of its parts; it represents the totality of what individuals habitually eat and drink, and these dietary components act synergistically in relation to health. As a result, the eating pattern may be more predictive of overall health status and disease risk than individual foods or nutrients. Thus, eating patterns, and their food and nutrient components, are at the core of the 2015-2020 Dietary Guidelines for Americans.”

The eating patterns outlined in the 2015-2020 and the 2020-2025 Dietary Guidelines for Americans, specifically, the Healthy U.S-Style Eating Pattern, the Healthy Mediterranean Pattern, or the Healthy Vegetarian Eating Pattern will work well for most individuals. If you and your family do not typically eat a standard American diet, you may want to choose an eating pattern that is more similar to the foods you usually consume. See Chapter 3 Dietary Guidelines From Around the World for more information. If your family history revealed that you are at risk for cardiovascular disease, or hypertension, you may prefer to follow the Dietary Approaches to Stop Hypertension eating pattern or the Healthy Mediterranean Eating Pattern Table A3-5 on page 162 of the linked PDF. Click the text and go to page 32 to read more about Healthy Eating Patterns and how these patterns were developed.

By comparing what you consumed to one of these patterns of eating, you will be able to examine your current diet quality. If you choose to use the Healthy U.S.-Eating Pattern, you may use this calculator and click on the sample plan of eating that matches your results below the calculator. Be aware that most of the current programs are biased towards those interested in weight loss. The questions these tools can help answer include: How much food do you have to eat to match your level of activity? How many calories should you eat? What are the best types of food to get the most nutrients? What nutrients are contained in different foods? How do you plan a menu that contains all the nutrients you need? Take the first step and assess your diet. This book will provide you with interactive resources, videos, and audio files to empower you to choose or create a plan of eating that improves your health.

Key Takeaways

This section equips you with some tools to assess your lifestyle and make changes towards a healthier one.

Step 1. Take charge of tracking your personal health.
Step 2. Assess your eating pattern and identify where it can be changed to promote health and prevent disease.
Step 3. Start finding out the medical history of your family and identify the diseases you may be more susceptible to getting.
Step 4. Assess your lifestyle by evaluating your personal habits, emotional health, sleep patterns, and work-life balance.
Step 5. Start living a healthier life.

Discussion Starters

Did you find the website suggested in Interactive 1.6.1 to be helpful in the assessment of your health?
In analyzing your personal health, which aspect of health is the hardest for you to manage?

Nutrition 100 Nutritional Applications for a Healthy Lifestyle Copyright © by Lynn Klees and Alison Borkowska is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Healthy Eating

20 Top Healthy Eating Habits, According to a Dietitian

Simple healthy-eating tips can help you succeed when focusing on your overall well-being. Our 20 dietitian-approved healthy eating tips are evidence-based and easy to implement.

Lauren is an award-winning registered dietitian, author of three books and all-around lover of good food. After graduating with a bachelor's degree in food science and human nutrition and a master's degree in clinical nutrition, Lauren has worked in various nutrition-related settings, most currently writing nutrition-related content for online outlets including Verywell Health, PopSugar, The Kitchn, and EatingWell. Additionally, she manages the Instagram page @LaurenLovesNutrition, where people can receive evidence-based nutrition tips and updates.

Elizabeth Ward is a registered dietitian and award-winning nutrition communicator and writer. She has authored or co-authored 10 books for consumers about nutrition at all stages of life.

1. Skip Drinks with Added Sugars

2. include fermented food in your diet, 3. eat 2 to 3 servings of low-mercury non-fried fish every week, 4. swap out highly processed meat for fresher options, 5. have a glass of milk every day, 6. add fruit to your midday snack, 7. add more vegetables to your dishes.

8. Don't Eat in Front of the TV

9. Choose BPA-Free Canned Foods

10. plan your meals.

11. Don't Eat the Same Foods on Repeat

12. Prep Your Veggies

13. skip the diet soda, 14. limit fried foods, 15. swap cocktails for mocktails, 16. choose leaner cuts of beef, 17. use beans as a protein source.

18. Don't Skip Breakfast
19. Don't Deprive Yourself of Your Favorite Foods

20. Embrace Herbs and Spices Instead of Salt

Including healthy eating habits in your life is a must if you want to support your overall well-being. While trendy diets and lifestyle overhauls are all the rage, the truth is that simple changes and swaps can lead to big results in the health department.

As a registered dietitian, I have some go-to healthy-eating tips that I lean on when people want to eat more healthfully. All of my tips are simple to do and they won't require juice cleanses or expensive supplements to accomplish. To make implementing healthy eating habit changes more sustainable, I generally recommend that people choose two or three tips to kick-start their healthy eating journey. Once you master a few tips, you can add more.

For people who truly want to make positive changes in their eating routine, here are 20 top healthy eating habits that are dietitian-approved and incredibly impactful.

Added sugars are lurking in many seemingly healthy drinks, like fruit punch and sports drinks. Unfortunately, taking in too many added sugars has been linked to adverse outcomes including obesity, cardiovascular disease, type 2 diabetes, nonalcoholic fatty liver disease and metabolic syndrome, according to a 2019 European Journal of Paediatric Dentistry article.

The Dietary Guidelines for Americans recommend that people limit their added sugar intake to less than 10% of their total calories. For a 2,000-calorie diet, that means around 12 teaspoons of the sweet stuff. Yet, according to the Centers for Disease Control and Prevention , the average intake of added sugars among U.S. adults is about 17 teaspoons, far exceeding the suggested quota.

Swapping out beverages with added sugars—think regular soda, sweet tea, sports drinks, fruit punch, lemonade and fruit "drinks"—for no-sugar-added choices like water, seltzer water , unsweetened coffee or tea and even 100% fruit juice in moderation can give your body the hydration it needs without any added sugars.

Kimchi, sauerkraut and other fermented foods not only taste delish, but they also fuel the body with live probiotics that support our overall health in various ways. To give your body a boost of probiotics , start your day with plain yogurt, enjoy a miso soup at dinnertime or sip on a kombucha midday for some fermented goodness.

Although the Dietary Guidelines for Americans suggest that most Americans eat at least 8 ounces of fish every week, the majority of people are sorely missing the mark. Fish, especially oily fish like salmon, is a rich source of DHA omega-3 fatty acids, selenium, vitamin B12 and a slew of other important nutrients that support our health.

Eating fish is linked to a plethora of potential health benefits too, including a reduced risk for cardiovascular disease, according to a 2018 advisory published in Circulation .

Highly processed meats like lunch meats, bacon and sausage are certainly convenient and incredibly appetizing. But these meat choices can also be loaded with nitrates, additives that, when heated, can produce potentially cancer-causing compounds, according to a 2020 report in Antioxidants (Basel) . Many of these meat choices are loaded with sodium as well.

Fresh cuts of meat like turkey, chicken and beef are lower-sodium and nitrate-free meat options that can be just as satisfying to eat.

Milk isn't just for kids. As a staple food that is a perfect accompaniment to chocolate chip cookies, a glass of milk is loaded with 13 essential nutrients, including bone-building calcium, protein and magnesium. Yet, as nutrient-dense as milk is, most adults don't drink even one glass of this beverage a day.

In the U.S., only about 12% of us eat the recommended amount of fruit and 10% get the suggested servings of vegetables every day. And since a lower intake of fruit is linked to outcomes like increased risk of certain cancers, heart disease and stroke, sneaking in some fruit every day is a smart move.

When the 3 p.m. slump strikes, instead of reaching for sugary candy or caffeine-laden drinks, enjoying fruit as a part of your balanced snack can give you sustained energy along with some energy-supporting nutrients. Combining a serving of fruit with protein can help give your snack some staying power, so you will feel satisfied and avoid a potential sugar crash shortly after eating.

If you don't have fresh fruit at your fingertips, know that dried, freeze-dried and frozen fruit are all healthy options as well, as long as they don't contain added salt or sugar. So, from freeze-dried blueberries to dried mango slices, the fruit choices are endless.

Vegetables are one of the best sources of fiber, a nutrient that can help keep your body healthy by supporting gut health and possibly reducing the risk of developing certain cancers. Plus, many veggies are low in calories and can help make dishes a bit more satisfying and flavorful.

Adding vegetables to your dishes doesn't mean living off of salad every day of the week. Adding extra broccoli to your stir-fry or tossing a handful of spinach in your homemade soup can give your dishes a healthy boost in a simple way.

8. Don't Eat in Front of the TV

Your meals are meant to be enjoyed. And when you eat while watching TV, you can end up being distracted and ultimately eat more calories while feeling less satisfied.

Instead, enjoy your meals with friends and family. Or, at the very least, simply make sure you are not distracted by the TV while you are eating.

Canned foods like tuna, tomatoes and beans are convenient foods that can be easily included in a healthy diet. But if the cans that your food is stored in contain BPA, a chemical that helps prevent metal corrosion, you may not be eating as well as you think.

According to a 2020 review in Frontiers in Nutrition , some research has linked BPA exposure to cancers, endocrine disruption, and reduced immune function. However, there are many unanswered questions about BPA's metabolism and its toxic effects.

Most U.S. can manufacturers have voluntarily phased out BPA, but there's concern that similar substitute materials may carry risks as well. At this point, there's not enough known research to make a conclusion about the safety of these substitutes. Ultimately, if you're concerned about these materials, choose foods stored in glass or aseptic paper-based boxes.

Meal planning can help people eat a healthier diet and even may help them experience less obesity. Taking the time to plan out your meals for the week can help you navigate your healthy eating with ease. To meal-plan, figure out what you are going to eat for your meals throughout the week. Make yourself a shopping list and prep your ingredients for quick meals for the entire week.

11. Don't Eat the Same Foods on Repeat

To eat a healthy diet, variety is key. Eating a wide variety of foods will give your body different nutrients and may help prevent nutritional gaps. Plus, a 2022 Nutrients study suggests that focusing on a variety of healthy foods may reduce the risk of developing metabolic syndrome.

One strategy that many dietitians recommend is to "eat the rainbow", meaning that people should aim to eat foods that naturally contain a wide variety of colors throughout the week. Purple cabbage, orange carrots, red radishes and green spinach are all good-for-you foods, but each variety contains a different nutritional composition. Rotating your food can add some excitement to your plate as well as giving your body different important nutrients every day.

Before you put your groceries away after your shopping haul, prep your veggies before you store them in the fridge. Having chopped onions and sliced cucumbers on hand makes it incredibly easy to add good-for-you vegetables to your dishes.

Intuitively, it makes sense to believe that drinking diet soda is a healthy choice, thanks to the calorie-free sweetness that it provides. It turns out that drinking diet soda isn't as healthy a choice as we once thought, with a 2019 Circulation study suggesting that sipping on the bubbly sweet stuff is associated with an increased risk of developing cardiovascular disease. And for people with type 2 diabetes, results from a small, short-term 2021 study in Diabetes, Metabolic Syndrome and Obesity found an association between drinking diet soda on a regular basis and developing vision challenges.

There is nothing like biting into a crispy french fry or piece of fried chicken. But eating too many fried foods is linked to a slew of unsavory health outcomes.

To get that satisfying crunch without the added calories and fat, opt for air-frying or baking your dishes instead.

Consuming alcohol can increase risk of certain types of cancers. But for some people, doing without an evening cocktail can be a huge life change. Enjoying a mocktail instead of a cocktail is one way to limit or eliminate alcohol intake while still partaking in the ritual of sipping on a delicious beverage.

Beef lovers can rejoice when they learn that beef can be a part of a healthy diet: it's a natural source of iron, protein, zinc and many other important nutrients. And although some cuts of beef are on the higher side when it comes to saturated fat, leaner cuts, like flank steak, are perfectly appropriate to include in a wholesome diet.

Regardless of whether you are a carnivore or a strict vegan, beans can be one of the best foods to include in your healthy diet for many reasons. They're a plant-based and economical protein source that is versatile and delicious. Beans naturally contain total and soluble fiber, polyphenols (strong antioxidants) and resistant starch, all of which contribute to a lower risk for type 2 diabetes and heart disease according to a 2021 Nutrients study.

18. Don't Skip Breakfast

We have all been told that breakfast is the most important meal of the day. And newer research highlights exactly why this is. According to a 2021 study in Proceedings of the Nutrition Society , eating breakfast consistently is linked to a greater intake of many nutrients, including folate, calcium and iron. Plus, results showed that breakfast skippers consume significantly more calories, carbohydrates, total fat, saturated fat and added sugars during lunch, dinner and snacks than people who eat breakfast.

19. Don't Deprive Yourself of Your Favorite Foods

While it is true that you shouldn't be eating a dozen doughnuts or a gallon of ice cream every day if you want to live a healthier lifestyle, giving up your favorite foods cold turkey may lead to overindulging in the long run.

Treat yourself to a once-in-a-while indulgence to help keep you satisfied and on track. As long as you are eating an appropriate portion of the food and you are doing this in moderation, a little treat once in a while is A-OK.

Americans eat an average of about 3,400 milligrams of sodium per day , despite the Dietary Guidelines recommending a limit of fewer than 2,300 mg per day. Eating too much sodium on a daily basis may increase your risk of developing hypertension.

To reduce your sodium intake, a good start is to limit the amount of salt that is added to your dishes, as just 1 teaspoon of table salt contains over 2,000 mg of sodium. When you are limiting your added salt intake, add flavorful additions like herbs and spices that are sodium-free but pack a punch in the flavor department.

Calculators

Running events, running articles, triathlon events, cycling events, triathlon articles, cycling articles, fitness events, fitness articles, sports events, outdoor events, sports articles, nutrition articles, health & injury articles, 6 ways to develop healthy eating habits.

1. Get in balance.

Eat a diet that's 45 percent carbs, 30 percent protein, and 35 percent good-for-you fats—olive oil, fish, or nuts. "Eating too little fat makes you feel deprived," Forberg says. "Sprinkle almonds on your salad, put Parmesan cheese on your whole-wheat pasta, or slice avocado on your sandwich. Fat is a flavor carrier that helps other foods taste more robust."

2. Avoid anything artificial.

Stick with real foods, such as vegetables, fruits, nuts, lean meats, low-fat dairy, and whole-grain pasta, rice, and bread. "The idea is to get the biggest nutrient bang for the calorie buck. Processed foods contain a lot of junk. Real foods are antioxidant-rich and fiber-filled."

3. Pile on the green stuff.

"The bulk of your diet should be vegetables, such as tomatoes, mushrooms, zucchini, spinach, and other greens," says Forberg. Vegetables are high in fiber and water, which fill you up. "You'll be surprised by how much you can eat when you follow this plan."

4. Keep a food journal.

"People who write down what they eat after every meal lose twice the weight of those who don't."

5. Set healthy limits.

"On the show, we recommend women consume 1,200 to 1,500 calories a day and men 1,600 to 2,400, depending on their size," says Forberg. "If you're super-tired, eat a little more. This is about making a lifestyle change and doing something that's sustainable."

6. Never let yourself get famished—or too full.

"When you're super-hungry, you choose the wrong foods and eat too much. Stop when you're comfortably full. You should never have to unbutton your pants!"

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7.3: Tips for Establishing Healthy Eating Habits

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1. Don’t try to force your child to eat or fight over food. Of course, it is impossible to force someone to eat. But the real advice here is to avoid turning food into a power struggle so that food doesn’t become a way to gain favor with or express anger toward someone else.

2. Recognize that appetite varies. Children may eat well at one meal and have no appetite at another. Rather than seeing this as a problem, it may help to realize that appetites do vary. Continue to provide good nutrition at each mealtime (even if children don’t choose to eat the occasional meal).

3. Keep it pleasant. This tip is designed to help caregivers create a positive atmosphere during mealtime. Mealtimes should not be the time for arguments or expressing tensions. You do not want the child to have painful memories of mealtimes together or have nervous stomachs and problems eating and digesting food due to stress.

4. No short order chefs. While it is fine to prepare foods that children enjoy, preparing a different meal for each child or family member sets up an unrealistic expectation from others. Children probably do best when they are hungry and a meal is ready. Limiting snacks rather than allowing children to “graze” continuously can help create an appetite for whatever is being served.

5. Limit choices. If you give your preschool aged child choices, make sure that you give them one or two specific choices rather than asking “What would you like for lunch?” If given an open choice, children may change their minds or choose whatever their sibling does not choose!

6. Serve balanced meals. Meals prepared at home tend to have better nutritional value than fast food or frozen dinners. Prepared foods tend to be higher in fat and sugar content as these ingredients enhance taste and profit margin because fresh food is often more costly and less profitable. However, preparing fresh food at home is not costly. It does, however, require more activity. Including children in meal preparation can provide a fun and memorable experience.

7. Don’t bribe. Bribing a child to eat vegetables by promising dessert is not a good idea. First, the child will likely find a way to get the dessert without eating the vegetables (by whining or fidgeting, perhaps, until the caregiver gives in). Secondly, it teaches the child that some foods are better than others. Children tend to naturally enjoy a variety of foods until they are taught that some are considered less desirable than others. A child, for example, may learn the broccoli they have enjoyed is seen as yucky by others unless it’s smothered in cheese sauce! 4

USDA Meal Patterns for Young Children

The United States Department of Agriculture Food and Nutrition Service provides the following guidance for the daytime feeding of children age 3 to 5.

Meal Patterns 6

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Chapter 14 Nutrition

14.1. nutrition introduction, learning objectives.

Describe variables that influence nutrition
Identify factors related to nutrition across the life span
Assess a patient’s nutritional status
Outline specific nursing interventions to promote nutrition
Base your decisions on the action of nutrients, signs of excess and deficiency, and specific foods associated with each nutrient
Base your decisions on the interpretation of diagnostic tests and lab values indicative of a disturbance in nutrition
Give examples of appropriate vitamin use across the life span
Identify evidence-based practices related to nutrition

Nurses promote healthy nutrition to prevent disease, assist patients to recover from illness and surgery, and teach patients how to optimally manage chronic illness with healthy food choices. Healthy nutrition helps to prevent obesity and chronic diseases, such as diabetes mellitus and cardiovascular disease. By proactively encouraging healthy eating habits, nurses provide the tools for patients to maintain their health, knowing it is easier to stay healthy than to become healthy after disease sets in. When patients are recovering from illness or surgery, nurses use strategies to promote good nutrition even when a patient has a poor appetite or nausea. If a patient develops chronic disease, the nurse provides education about prescribed diets that can help manage the disease, such as a low carbohydrate diet for patients with diabetes or a low fat, low salt, low cholesterol diet for patients with cardiovascular disease.

Nurses also advocate for patients with conditions that can cause nutritional deficits. For example, a nurse may be the first to notice that a patient is having difficulty swallowing at mealtime and advocates for a swallow study to prevent aspiration. A nurse may also notice other psychosocial risk factors that place a patient at risk for poor nutrition in their home environment and make appropriate referrals to enhance their nutritional status. Nurses also administer alternative forms of nutrition, such as enteral (tube) feedings or parenteral (intravenous) feedings.

This chapter will review basic information about the digestive system, essential nutrients, nutritional guidelines, and then discuss the application of the nursing process to addressing patients’ nutritional status.

14.2. NUTRITION BASIC CONCEPTS

Before discussing assessments and interventions related to promoting good nutrition, let’s review the structure and function of the digestive system, essential nutrients, and nutritional guidelines.

Digestive System

The digestive system breaks down food and then absorbs nutrients into the bloodstream via the small intestine and large intestine. Because good health depends on good nutrition, any disorder affecting the functioning of the digestive system can significantly impact overall health and well-being and increase the risk of chronic health conditions.

Structure and Function

The gastrointestinal system (also referred to as the digestive system) is responsible for several functions, including digestion, absorption, and immune response. Digestion begins in the upper gastrointestinal tract at the mouth, where chewing of food occurs, called mastication. Mastication results in mechanical digestion when food is broken down into small chunks and swallowed. Masticated food is formed into a bolus as it moves toward the pharynx in the back of the throat and then into the esophagus. Coordinated muscle movements in the esophagus called peristalsis move the food bolus into the stomach where it is mixed with acidic gastric juices and further broken down into chyme through a chemical digestion process. As chyme is moved out of the stomach and into the duodenum of the small intestine, it is mixed with bile from the gallbladder and pancreatic enzymes from the pancreas for further digestion. [ 1 ]

Absorption is a second gastrointestinal function. After chyme enters the small intestine, it comes into contact with tiny fingerlike projections along the inside of the intestine called villi. Villi increase the surface area of the small intestine and allow nutrients, such as protein, carbohydrates, fat, vitamins, and minerals, to absorb through the intestinal wall and into the bloodstream. Absorption of nutrients is essential for metabolism to occur because nutrients fuel bodily functions and create energy. Peristalsis moves leftover liquid from the small intestine into the large intestine, where additional water and minerals are absorbed. Waste products are condensed into feces and excreted from the body through the anus. [ 2 ] See Figure 14.1 [ 3 ] for labeled parts of the gastrointestinal system.

Figure 14.1

The Gastrointestinal System

In addition to digestion and absorption, the gastrointestinal system is also involved in immune function. Good bacteria in the stomach create a person’s gut biome. Gut biome contributes to a person’s immune response through antibody production in response to foreign materials, chemicals, bacteria, and other substances. [ 4 ] For example, patients may develop Clostridium difficile (C-diff) after taking antibiotics that kill these beneficial bacteria in the gut. Read additional details about our microbiome and immune response in the “ Infection ” chapter of this book.

Essential Nutrients

Nutrients from food and fluids are used by the body for growth, energy, and bodily processes. Essential nutrients refer to nutrients that are necessary for bodily functions but must come from dietary intake because the body is unable to synthesize them. Essential nutrients include vitamins, minerals, some amino acids, and some fatty acids. [ 5 ] Essential nutrients can be further divided into macronutrients and micronutrients.

Macronutrients

Macronutrients make up most of a person’s diet and provide energy, as well as essential nutrient intake. Macronutrients include carbohydrates, proteins, and fats. However, too many macronutrients without associated physical activity cause excess nutrition that can lead to obesity, cardiovascular disease, diabetes mellitus, kidney disease, and other chronic diseases. Too few macronutrients result in undernutrition, which contributes to nutrient deficiencies and malnourishment. [ 6 ]

CARBOHYDRATES

Carbohydrates are sugars and starches and are an important energy source that provides 4 kcal/g of energy. Simple carbohydrates are small molecules (called monosaccharides or disaccharides) and break down quickly. As a result, simple carbohydrates are easily digested and absorbed into the bloodstream, so they raise blood glucose levels quickly. Examples of simple carbohydrates include table sugar, syrup, soda, and fruit juice. Complex carbohydrates are larger molecules (called polysaccharides) that break down more slowly, which causes slower release into the bloodstream and a slower increase in blood sugar over a longer period of time. Examples of complex carbohydrates include whole grains, beans, and vegetables. [ 7 ]

Foods can also be categorized according to their glycemic index , a measure of how quickly glucose levels increase in the bloodstream after carbohydrates are consumed. The glycemic index was initially introduced as a way for people with diabetes mellitus to control their blood glucose levels. For example, processed foods, white bread, white rice, and white potatoes have a high glycemic index. They quickly raise blood glucose levels after being consumed and also cause the release of insulin, which can result in more hunger and overeating. However, foods such as fruit, green leafy vegetables, raw carrots, kidney beans, chickpeas, lentils, and bran breakfast cereals have a low glycemic index. These foods minimize blood sugar spikes and insulin release after eating, which leads to less hunger and overeating. Eating a diet of low glycemic foods has been linked to a decreased risk of obesity and diabetes mellitus. [ 8 ] See Figure 14.2 [ 9 ] for an image of the glycemic index of various foods.

Figure 14.2

Glycemic Index

Proteins are peptides and amino acids that provide 4 kcal/g of energy. Proteins are necessary for tissue repair and function, growth, energy, fluid balance, clotting, and the production of white blood cells. Protein status is also referred to as nitrogen balance . Nitrogen is consumed in dietary intake and excreted in the urine and feces. If the body excretes more nitrogen than it takes in through the diet, this is referred to as a negative nitrogen balance. Negative nitrogen balance is seen in patients with starvation or severe infection. Conversely, if the body takes in more nitrogen through the diet than what is excreted, this is referred to as a positive nitrogen balance. [ 10 ] During positive nitrogen balance, excess protein is converted to fat tissue for storage.

Proteins are classified as complete, incomplete, or partially complete. Complete proteins must be ingested in the diet. They have enough amino acids to perform necessary bodily functions, such as growth and tissue maintenance. Examples of foods containing complete proteins are soy, quinoa, eggs, fish, meat, and dairy products. Incomplete proteins do not contain enough amino acids to sustain life. Examples of incomplete proteins include most plants, such as beans, peanut butter, seeds, grains, and grain products. Incomplete proteins must be combined with other types of proteins to add to amino acids and form complete protein combinations. [ 11 ] For example, vegetarians must be careful to eat complementary proteins, such as grains and legumes, or nuts and seeds and legumes, to create complete protein combinations during their daily food intake. Partially complete proteins have enough amino acids to sustain life, but not enough for tissue growth and maintenance. Because of the similarities, most sources consider partially complete proteins to be in the same category as incomplete proteins. See Figure 14.3 [ 12 ] for an image of protein-rich foods.

Figure 14.3

Protein-Rich Foods

Fats consist of fatty acids and glycerol and are essential for tissue growth, insulation, energy, energy storage, and hormone production. Fats provide 9 kcal/g of energy. [ 13 ] While some fat intake is necessary for energy and uptake of fat-soluble vitamins, excess fat intake contributes to heart disease and obesity. Due to its high-energy content, a little fat goes a long way.

Fats are classified as saturated, unsaturated, and trans fatty acids. Saturated fats come from animal products, such as butter and red meat (e.g., steak). Saturated fats are solid at room temperature. Recommended intake of saturated fats is less than 10% of daily calories because saturated fat raises cholesterol and contributes to heart disease. [ 14 ]

Unsaturated fats come from oils and plants, although chicken and fish also contain some unsaturated fats. Unsaturated fats are healthier than saturated fats. Examples of unsaturated fats include olive oil, canola oil, avocados, almonds, and pumpkin seeds. Fats containing omega-3 fatty acids are considered polyunsaturated fats and help lower LDL cholesterol levels. Fish and other seafood are excellent sources of omega-3 fatty acids.

Trans fats are fats that have been altered through a hydrogenation process, so they are not in their natural state. During the hydrogenated process, fat is changed to make it harder at room temperature and have a longer shelf life. Trans fats are found in processed foods, such as chips, crackers, and cookies, as well as in some margarines and salad dressings. Minimal trans fat intake is recommended because it increases cholesterol and contributes to heart disease. [ 15 ]

Micronutrients

Micronutrients include vitamins and minerals.

Vitamins are necessary for many bodily functions, including growth, development, healing, vision, and reproduction. Most vitamins are considered essential because they are not manufactured by the body and must be ingested in the diet. Vitamin D is also manufactured through exposure to sunlight. [ 16 ]

Vitamin toxicity can be caused by overconsumption of certain vitamins, such as vitamins A, D, C, B6, and niacin. Conversely, vitamin deficiencies can be caused by various factors including poor food intake due to poverty, malabsorption problems with the gastrointestinal tract, drug and alcohol abuse, proton pump inhibitors, and prolonged parenteral nutrition. Deficiencies can take years to develop, so it is usually a long-term problem for patients. [ 17 ]

Vitamins are classified as water soluble or fat soluble. Water-soluble vitamins are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid). Additional water-soluble vitamins include biotin and pantothenic acid. Excess amounts of these vitamins are excreted through the kidneys in urine, so toxicity is rarely an issue, though excess intake of vitamin B6, C, or niacin can result in toxicity. [ 18 ] See Table 14.2a for a list of selected water-soluble vitamins, their sources, and their function. [ 19 ] , [ 20 ] , [ 21 ] , [ 22 ] , [ 23 ] , [ 24 ] , [ 25 ] , [ 26 ] , [ 27 ]

Table 14.2a

Selected Water-Soluble Vitamins

Fat-soluble vitamins are absorbed with fats in the diet and include vitamins A, D, E, and K. They are stored in fat tissue and can build up in the liver. They are not excreted easily by the kidneys due to storage in fatty tissue and the liver, so overconsumption can cause toxicity, especially with vitamins A and D. [28] See Table 14.2b for a list of selected fat-soluble vitamins, their sources, their function, and manifestations of deficiencies and toxicities. [ 29 ] , [ 30 ] , [ 31 ] , [ 32 ] , [ 33 ] , [ 34 ] , [ 35 ] , [ 36 ] , [ 37 ]

Table 14.2b

Selected Fat-Soluble Vitamins

Minerals are inorganic materials essential for hormone and enzyme production, as well as for bone, muscle, neurological, and cardiac function. Minerals are needed in varying amounts and are obtained from a well-rounded diet. In some cases of deficiencies, mineral supplements may be prescribed by a health care provider. Deficiencies can be caused by malnutrition, malabsorption, or certain medications, such as diuretics.

Minerals are classified as either macrominerals or trace minerals. Macrominerals are needed in larger amounts and are typically measured in milligrams, grams, or milliequivalents. Macrominerals include sodium, potassium, calcium, magnesium, chloride, and phosphorus. Macrominerals are discussed in further detail in the “Electrolytes” section of the “ Fluids and Electrolytes ” chapter of this book.

Trace minerals are needed in tiny amounts. Trace minerals include zinc, iron, chromium, copper, fluorine, iodine, manganese, molybdenum, and selenium. [ 38 ] See Table 14.2c for a list of selected macrominerals and Table 14.2d for a list of trace minerals. [ 39 ] , [ 40 ] , [ 41 ] , [ 42 ]

Table 14.2c

Macrominerals

Table 14.2d

Trace Minerals

Nutritional Guidelines

Nutritional guidelines are developed by governmental agencies to provide guidance to the population on how to best meet nutritional needs. These guidelines may vary by country. The National Academies of Sciences, Engineering, and Medicine set the Dietary Reference Intakes (DRIs) for the United States and Canada. Dietary Reference Intakes (DRIs) are a set of reference values used to plan and assess nutrient intakes of healthy people, including proteins, carbohydrates, fats, vitamins, minerals, and fiber. Nutrients included in the DRIs are obtained through a typical diet, although some foods may be fortified with certain nutrients that are commonly deficient in diets. [ 43 ]

Choose MyPlate Food Guide

The U.S. Department of Agriculture (USDA) issues dietary guidelines for appropriate serving sizes of each food group and number of servings recommended each day. The “Choose MyPlate” food guide is an easy-to-understand visual representation of how a healthy plate of food should be divided based on food groups. See Figure 14.4 [ 44 ] for a Choose MyPlate image. A little more than half of the plate should be grains and vegetables, with a focus on whole grains and a variety of vegetables. About one quarter of the plate should be fruits, with an emphasis on whole fruits. About one quarter of the plate should be protein, with an emphasis on consuming a variety of low-fat protein sources. All of these groups combined should make up no more than 85% of daily caloric intake based on a 2,000 calorie diet. Fats, oils, and added sugars are not included, but should make up no more than 15% of daily caloric intake. Foods should be selected that are as nutrient-dense as possible. Nutrient-dense means there is a high proportion of nutritional value relative to calories contained in the food, such as fruits and vegetables. Conversely, calorie-dense foods should be minimized because they have a large amount of calories with few nutrients. For example, candy and soda are calorie-dense with few nutrients and should be minimized. [ 45 ] , [ 46 ] See the following hyperlink to the MyPlate web site for further information on USDA dietary guidelines and patient educational materials

Read more about USDA dietary guidelines at https://www.myplate.gov/ . [ 47 ]

MyPlate information and images are also available in several other languages so that education can be tailored to the patient’s preferred language. For example, Figure 14.5 [ 48 ] shows MyPlate in Vietnamese. This image would be accompanied with written information about food groups that include the patient’s typical dietary choices.

Figure 14.5

MyPlate in Vietnamese

VEGETABLE GROUP

For a well-rounded diet, a variety of vegetables should be consumed, including vegetables from all five vegetable groups: dark green leafy vegetables; red and orange vegetables; beans, peas, and lentils (formerly called the legumes group); starchy vegetables; and other vegetables. Vegetables can be fresh, frozen, canned, or dried. Dark green leafy vegetables include kale, Swiss chard, spinach, broccoli, and salad greens. Red and orange vegetables include carrots, bell peppers, sweet potatoes, tomatoes, tomato juice, and squash. The beans, peas, and lentils group includes dried beans, black beans, chickpeas, kidney beans, split peas, and black-eyed peas. (Note that this group does not include green beans or green peas.) This vegetable group also supplies some protein and can be included in the protein group as well. Starchy vegetables include root vegetables, such as potatoes, as well as corn. The “other vegetables” category includes any vegetable that doesn’t fit in the other four categories, such as asparagus, avocados, brussels sprouts, cabbage, cucumbers, snow peas, and mushrooms, and a variety of others.

Daily serving suggestions of vegetables for individuals with a 2,000 calorie diet are 2 ½ cup equivalents of vegetables per day. For example, a “one cup equivalent” equals 1 cup raw or cooked vegetables, one cup 100% vegetable juice, ½ cup of dried vegetables, or 2 cups of leafy green vegetables. Approximately 90% of Americans do not meet the recommended daily intake of vegetables. [ 49 ] See Figure 14.6 [ 50 ] for an image of vegetables.

Figure 14.6

Grain group.

Grains are classified as whole grains or refined grains. Whole grains include the entire grain kernel and supply more fiber than refined grains. Examples of whole grains include amaranth, whole barley, popcorn, oats, whole grain cornmeal, brown or wild rice, and whole grain cereal or crackers. Refined grains have been processed to remove parts of the grain kernel and supply little fiber. As a result, they quickly increase blood glucose levels. Examples of refined grains include white bread, white rice, Cream of Wheat, pearled barley, white pasta, and refined-grain cereals or crackers. Some grains are fortified to ensure adequate intake of folic acid. See Figure 14.7 [ 51 ] for an image of whole grain whole wheat bread.

Figure 14.7

Whole Grain, Whole Wheat Bread

The daily serving suggestions of grains for an individual with a 2,000 calorie diet are six ounce equivalents per day, split equally between whole and refined grains. For example, a “one ounce equivalent” of grains equals ½ cup of cooked rice, pasta, or cereal or 1 cup of flaked cereal. Most Americans consume adequate amounts of total grains, although roughly 98% are deficient in recommended whole grain amounts, and 74% consume more than the recommended refined grain amounts. [ 52 ]

FRUIT GROUP

Fruits can be frozen, canned, or dried, in addition to 100% fruit juice. A few examples of fruits include apples, oranges, bananas, melons, peaches, apricots, pineapples, and rhubarb. Daily serving suggestions of fruits for an individual with a 2,000 calorie diet are 2 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of raw or cooked fruit, 8 ounces of 100% fruit juice, or ½ cup of dried fruit. Approximately 80% of Americans do not consume the recommended daily intake of fruits. [ 53 ] See Figure 14.8 [ 54 ] for an image of fruits.

Figure 14.8

Dairy group.

Dairy products can be liquid, dried, semi-solid, or solid depending on the type of product. Dairy products include milk, lactose-free milk, fortified soy milk, buttermilk, cheese, yogurt, and kefir. Sour cream and cream cheese are not considered dairy items in terms of nutritional benefits. Daily serving suggestions of dairy products for an individual with a 2,000 calorie diet are 3 cup equivalents per day. For example, “one cup equivalent” equals 1 cup of milk, soy milk, or yogurt; 1 ½ ounces of natural cheese, or 2 ounces of processed cheese. Approximately 90% of Americans consume less than the recommended daily intake of dairy products. [ 55 ] See Figure 14.9 [ 56 ] for an image of dairy products.

Figure 14.9

Dairy Products

PROTEIN GROUP

Proteins are categorized by the type of protein source. The meats, poultry, and eggs category consists of any type of animal or poultry meat, organ meat, or poultry egg. Lean meats should be selected to minimize fat and calorie intake from high-fat meats.

The seafood category includes any type of fish, clams, crab, lobster, oyster, and scallops. It is important to choose fish with low mercury levels to prevent negative effects of a buildup of mercury in the body. In general, large, fatty ocean fish, such as tuna, have higher levels of mercury due to their diet and storage of mercury in their fatty tissues.

The nuts, seeds, and soy products category includes tree nuts, peanuts, nut butters, seeds, or seed butters. Soy products include tofu and any other products made from soy. Unsalted nuts should be selected to avoid excess salt intake.

Protein is also contained in other food groups, such as dairy or the vegetable category of peas, beans, and lentils. Daily serving suggestions of proteins for individuals with a 2,000 calorie diet are 5 ½ ounce equivalents per day. Servings should total up to 26 ounce equivalents per week of meats, eggs, and poultry; 8 ounce equivalents per week of seafood; and 5 ounce equivalents per week of nuts, seeds, or soy products. A “one ounce equivalent” of protein equals 1 ounce of lean meat, one egg, ¼ cup cooked beans, or 1 tablespoon of peanut butter. Most Americans consume adequate amounts of protein, but many consume proteins high in saturated fat and sodium that contribute to diseases such as coronary artery disease. [ 57 ]

OIL/FAT GROUP

Examples of oils are vegetable oil, canola oil, olive oil, butter, lard, and coconut oil. Daily serving suggestions of fats or oils for individuals with a 2,000 calorie diet are 27 grams per day. While it is important to limit oils and fats due to their calorie-dense nature, some fat and oil intake is essential for nutrient absorption and overall health. It is best to select healthy unsaturated fats, such as avocados, nuts, or olive oil. [ 58 ]

A person’s gender affects their calorie and nutrient requirements. Males typically have higher calorie and protein needs related to increased muscle mass. Females typically require fewer calories to maintain their body weight due to a higher proportion of adipose (fat tissue) than muscle. Menstruating females also have higher iron requirements to offset losses that occur during menstruation.

Read Nutrition and Food Safety Information and Resources for Healthcare Professionals from the U.S. Food and Drug Administration.

View the infographic “ what’s myplate all about ” from the usda., factors affecting nutritional status.

Now that we have discussed basic nutritional concepts and dietary guidelines, let’s discuss factors that can affect a person’s nutritional status. Many things that can cause altered nutrition, such as physiological factors, cultural and religious beliefs, economic resources, drug and nutrient disorders, surgery, altered metabolic states, alcohol and drug abuse, and psychological states.

Physiological Factors

Nutritional intake is affected by several physiological factors. Appetite is controlled by the hypothalamus, a tiny gland deep within the brain that triggers feelings of hunger or fullness depending on hormone and neural signals being sent and received. See Figure 14.10 [ 59 ] for an image of the hypothalamus indicated by the red arrow. Hunger causes a feeling of emptiness in the abdomen and is often accompanied by audible noises coming from the abdomen as the stomach contracts due to emptiness. Hunger can cause feelings of discomfort, nausea, and tiredness. Satiety is a feeling of fullness that often comes after eating, although it can also be caused by impairments of the hypothalamus. Electrolyte imbalances and fluid volume imbalances can also trigger hunger and thirst by sending signals to the hypothalamus. [ 60 ]

Figure 14.10

Hypothalamus

The five senses play an important role in food intake. For example, food with a pleasing aroma may induce mouth watering and hunger, whereas food or environments with displeasing aromas often suppress the appetite. Texture and taste of foods also play a role in stimulation of appetite.

Poor dentition or poor oral care has a negative effect on appetite, so adequate oral care is crucial for patients prior to eating. [ 61 ] Additionally, the condition of a patient’s teeth and gums, the fit of dentures, and gastrointestinal function also play an important role in nutrition. Loose teeth, swollen gums, or poor-fitting dentures can make eating difficult.

Difficulty swallowing, called dysphagia , can make it dangerous for the patient to swallow food because it can result in pneumonia from aspiration of food into the lungs. Special soft diets or enteral or parenteral nutrition are typically prescribed for patients with dysphagia. Nurses collaborate with speech therapists when assessing and managing dysphagia.

A poorly functioning gastrointestinal tract makes nutrient absorption difficult and can result in malnourishment. Diseases that cause inflammation of the gastrointestinal tract impair absorption of nutrients. Examples of these conditions include esophagitis, gastritis, inflammatory bowel disease, and cholecystitis. Patients with these disorders should select nutrient-dense foods and may require prescribed supplements to increase nutrient intake.

Cultural and Religious Beliefs

Cultural and religious beliefs often influence food selection and food intake. It is important for nurses to conduct a thorough patient assessment, including food preferences, to ensure adequate nutritional intake during hospitalization. The nurse should not assume a particular diet based on a patient’s culture or religion, but instead should determine their individual preferences through the assessment interview.

Cultural beliefs affect types of food eaten and when they are eaten. Some foods may be restricted due to beliefs or religious rituals, whereas other foods may be viewed as part of the healing process. For example, some cultures do not eat pork because it is considered unclean, and others eat “kosher” food that prescribes how food is prepared. Some religions fast during religious holidays from sunrise to sunset, where others avoid eating meat during the time of Lent. [ 62 ] , [ 63 ]

Drug and Nutrient Interactions

Some prescription drugs affect nutrient absorption. For example, some medications such as proton pump inhibitors (omeprazole) alter the pH of stomach acid, resulting in poor absorption of nutrients. Other medications, such as opioids, often decrease a person’s appetite or cause nausea, resulting in decreased calorie and nutrient intake.

Surgery can affect a patient’s nutritional status due to several factors. Food and drink are typically withheld for a period of time prior to surgery to prevent aspiration of fluid into the lungs during anesthesia. Anesthesia and pain medication used during surgery slow peristalsis, and it often takes time to return to normal. Slow peristalsis can cause nausea, vomiting, and constipation. Until the patient is able to pass gas and bowel sounds return, the patient is typically ordered to have nothing by mouth (NPO). If a patient experiences prolonged NPO status, such as after significant abdominal surgery, intravenous fluids and nutrition may be required.

Surgery also stimulates the physiological stress response and increases metabolic demands, causing the need for increased calories. The stress response can also cause elevated blood glucose levels due to the release of corticosteroids, even if the patient has not been previously diagnosed with diabetes mellitus. For this reason, nurses often monitor post-op patients’ bedside blood glucose levels carefully.

Bowel resection surgery in particular has a negative impact on nutrient absorption. Because all or parts of the intestine are removed, there is decreased absorption of nutrients, which can result in nutrient deficiencies. Many patients who have experienced bowel resection require nutrient supplementation.

Bariatric surgery is used to treat obesity and reduce obesity-related cardiovascular risk factors. Bariatric procedures alter the anatomy and physiology of the gastrointestinal tract, which makes patients susceptible to nutritional deficiencies. [ 65 ] Read more about bariatric surgery and long-term nutritional issues using the hyperlink in the following box.

Alcohol and Drug Abuse

Alcohol and drug abuse can affect nutritional status. Alcohol is calorie-dense and nutrient-poor. With alcohol use, the consumption of water, food, and other nutrients often decreases as patients “drink their calories.” This may result in decreased protein intake and body protein deficiency. Nutrient digestion and absorption can also decrease with alcohol consumption if the stomach lining becomes eroded or scarred. This can cause hemoglobin, hematocrit, albumin, folate, thiamine, vitamin B12, and vitamin C deficiencies, as well as decreased calcium, magnesium, and phosphorus levels. [ 67 ]

Drug abuse of stimulants, such as methamphetamine and cocaine abuse, causes an increased metabolic rate and decreased appetite and contributes to weight loss and malnourishment.

Psychological State

Various psychological states have a direct effect on appetite and a patient’s desire to eat. Acute and chronic stress stimulates the hypothalamus and increases production of glucocorticoids and glucose. This can increase the person’s appetite, causing increased calorie intake, fat storage, and subsequent weight gain. When a person feels stressed, their food choices are often nutrient-poor and calorie-dense, which further increases weight gain and nutrient deficiencies. In other individuals, the stress response causes loss of appetite, weight loss, and nutrient deficiencies. [ 68 ]

Depression can cause loss of appetite or overeating. Many people eat calorie-dense “comfort foods” as a coping mechanism. Additionally, many antidepressants can cause weight gain as a side effect.

14.3. APPLYING THE NURSING PROCESS

Now that we have discussed basic nutritional concepts, dietary guidelines, and factors affecting nutritional status, let’s apply the nursing process to this information when caring for patients.

A thorough nutritional assessment provides information about an individual’s nutritional status, as well as risk factors for nutritional imbalances. Assessment starts with reviewing the patient’s medical record and initiating a patient interview, followed by a physical exam and review of lab and diagnostic test results.

Subjective Assessment

Subjective assessments include questions regarding normal eating patterns and risk factor identification. Subjective assessment data is obtained by interviewing the patient as a primary source or a family member or caregiver as a secondary source. While a wealth of subjective information can be obtained through a chart review, it is important to verify this information with either the patient or family member because details may be recorded inaccurately or may have changed over time. Subjective information to obtain when completing a nutritional assessment includes age, sex, history of illness or chronic disease, surgeries, dietary intake including a 24-hour diet recall or food diary, food preferences, cultural practices related to diet, normal snack and meal timings, food allergies, special diets, and food shopping or preparation activities.

A detailed nutritional assessment can also provide important clues for identification of risk factors for nutritional deficits or excesses. For example, a history of anorexia or bulimia will put the patient at risk for vitamin, mineral, and electrolyte disturbances, as well as potential body image disturbances. Swallowing impairments place the patient at risk for decreased intake that may be insufficient to meet metabolic demands. Use of recreational drugs or alcohol places the patient at risk for insufficient nutrient intake and impaired nutrient absorption. Use of nutritional supplements places the patient at risk for excess nutrient absorption and potential toxicity. Recognizing and identifying risks to nutritional status help the nurse anticipate problems that may arise and identify complications as they occur. Ideally, the nurse will recognize subtle cues of impending or actual dysfunction and prevent bigger problems from happening.

Objective Assessment

Objective assessment data is information derived from direct observation by the nurse and is obtained through inspection, auscultation, and palpation. The nurse should consider nutritional status while performing a physical examination.

The nurse begins the physical examination by making general observations about the patient’s status. A well-nourished patient has normal skin color and hair texture for their ethnicity, healthy nails, a BMI within normal range according to their height, and appears energetic.

Height and weight should be accurately measured and documented. Height and weight in infants and children are plotted on a growth chart to give a percentile ranking across the United States. The infant or child should show a trend of consistent height and weight increase.

Height and weight in adults are often compared to a Body Mass Index (BMI) graph. BMI can also be calculated using the following formulas:

BMI = weight (kilograms)/height(meters) 2
BMI = weight (pounds) x 703)/height(inches) 2

To calculate BMI using a BMI table, the patient’s height is plotted on the horizontal axis and their weight is plotted on the perpendicular axis. The BMI is measured where the lines intersect. See Figure 14.11 [ 1 ] for an image of a BMI table. BMI is interpreted using the following ranges:

Figure 14.11

Less than 18.5: Underweight
18.5-24.9: Desirable range
25-29.9: Overweight
Equal or greater than 30: Obese [ 2 ]

After completing the subjective and objective assessment, the data should be analyzed for expected and unexpected findings. See Table 14.3a for a comparison of expected versus unexpected assessment findings related to nutritional status on assessment, including those that require notification of the health care provider in bold font.

Table 14.3a

Expected Versus Unexpected Findings During Nutritional Assessment [ 3 ]

Review how to perform a physical examination on the body systems listed in Table 14.3a in Open RN Nursing Skills .

Diagnostic and lab work.

Diagnostic and lab work results can provide important clues about a patient’s overall nutritional status and should be used in conjunction with a thorough subjective and objective assessment to provide an accurate picture of the patient’s overall health status. Common lab tests include hemoglobin (hgb), hematocrit (HCT), white blood cells (WBC), albumin, prealbumin, and transferrin.

Anemia is a medical condition diagnosed by low hemoglobin levels. Hemoglobin is important for oxygen transport throughout the body. Anemia can be caused acutely by hemorrhage, but it is often the result of chronic iron deficiency, vitamin B12 deficiency, or folate deficiency. Iron supplements, B12 injections, folate supplements, and increased iron or folate intake in the diet can help increase hemoglobin levels.

Albumin and prealbumin are proteins in the bloodstream. They maintain oncotic pressure so that fluid does not leak out of blood vessels into the extravascular space. (Read more about oncotic pressure in the “ Fluids and Electrolytes ” chapter.) Albumin and prealbumin levels are used as markers of malnutrition, but these levels can also be affected by medical conditions such as liver failure, kidney failure, inflammation, and zinc deficiency. Low albumin levels can indicate prolonged protein deficiency intake over several weeks, whereas prealbumin levels reflect protein intake over the previous few weeks. For this reason, prealbumin is often used to monitor the effectiveness of parenteral nutrition therapy. [ 4 ] , [ 5 ]

Transferrin is a protein required for iron transport on red blood cells. Transferrin levels increase during iron deficiency anemia and decrease with renal or liver failure and infection.

A patient’s amount of muscle wasting due to malnutrition is measured by a 24-hour urine creatinine level. [ 6 ] If insufficient calories are consumed, the body begins to break down its own tissues in a process called catabolism. Blood urea nitrogen and creatinine are released as a by-product. A 24-hour urine collection measures these by-product levels to assess the degree of catabolism occurring.

White blood cells will decrease with malnourishment, specifically with protein and vitamins C, D, and E and B-complex deficiencies. Low white blood cell counts place the patient at risk for infection because adequate white blood cells are necessary for a fully functioning immune system.

See Table 14.3b for a description of selected lab values associated with nutritional status. As always, refer to agency lab reference ranges when providing patient care.

Table 14.3b

Selected Lab Values Associated with Nutritional Status [ 7 ] , [ 8 ] , [ 9 ]

Various diagnostic tests may be ordered by the health care provider based on the patient’s medical conditions and circumstances. For example, a swallow study is a diagnostic test used for patients having difficulty swallowing. An abdominal X-ray is used to determine the correct placement of a feeding tube or to note any excess air or stool in the colon. A barium swallow is used in conjunction with a CT scan to note any blockages in the intestines.

Life Span and Cultural Considerations

Newborns and infants.

A crucial amount of growth and development happens between birth to age two. For proper growth, development, and brain function, this age group requires nutrient-dense food choices, primarily because they eat so little compared to adults, but also because of their rapid growth rate that is higher than any other time of development. Ideally, newborns through age 6 months should be fed exclusively human breast milk if possible to develop immunity. Vitamin D and iron supplementation may be needed. [ 10 ] For the first two to three days after birth, human milk contains colostrum, a thick yellowish-white fluid rich in proteins and immunoglobulin A (IgA). Colostrum is lower in carbohydrates and fat than mature breast milk. Colostrum helps protect the newborn from infection and builds normal intestinal bacteria. As breast milk matures after two to three days postpartum, it becomes lower in proteins and IgA and higher in carbohydrates and fat. [ 11 ] Human donor milk may be used in some situations when the mother cannot breastfeed. If human donor milk is given, it should be sourced through an accredited human milk bank and pasteurized to minimize risk of spreading infectious diseases.

There are many reasons infants may not be breastfed, including insufficient breast milk production, a personal choice not to breastfeed, or adoption of the newborn. If breastfeeding or donor milk is not an option, an iron-fortified commercial infant formula should be used exclusively through at least 6 months of age. Homemade or non-FDA approved infant formulas or toddler formulas should not be used because they may not meet the high nutritional needs of infants. Infants fed 100% commercial infant formula will not need vitamin D supplementation. [ 12 ]

After about six months of age, infants should begin to be introduced to additional nutrient-dense complementary foods that are developmentally appropriate. Foods should be introduced one at a time to monitor for food sensitivities. Introducing food at this time is to provide a varied diet, additional nutrients, and an introduction to different flavors and textures of food. Research shows that introduction to certain allergy-risk foods, such as peanut butter prior to one year of age, helps decrease the risk of developing a peanut allergy later in life. It is important to strictly avoid honey and other unpasteurized food and drink before one year of age to prevent botulism and other bacteria. Additionally, cow’s milk, fortified soy drinks, and fruit or vegetable juices should not be introduced before 1 year of age . [13]

Children and Adolescents

Growth rate continues to be rapid from ages one through five, requiring adequate nutrition to meet these growth and metabolic demands. Caloric and nutritional intake requirements increase proportionately with age, but unfortunately, the quality of diet tends to decrease proportionately with age. This is in part due to younger children being dependent on adults for nutritional choices and intake while older children and adolescents begin to make their own food choices as they enter school. Poverty can also negatively impact nutritional intake in children and adolescents. School lunch and breakfast programs help mitigate the effects of poverty on nutrition by providing free to low-cost, nutritionally-balanced meals. [ 14 ]

Healthy dietary habits formed in childhood through adolescence help prevent obesity, cardiovascular disease, diabetes mellitus, and other chronic diseases later in life. It is important to provide children with a variety of different foods prepared in different ways to increase the likelihood of children accepting and growing accustomed to different foods. It is common for children to become picky in their food choices or decide to only eat one or a few different food items over a period of time. Allowing children to help select and prepare food can increase their acceptance of different food choices. [ 15 ]

The adult life stage is ages 19 through 59. A major limiting factor to healthy nutrition in adults is development of poor nutritional habits early in life. These unhealthy diet habits can be very difficult to change due to food preferences, as well as lack of knowledge about proper nutrition. Metabolic rate and caloric needs decrease with increasing age. Females tend to require less caloric intake than males, though caloric and nutritional needs increase with pregnancy and breastfeeding. Without appropriate dietary intake or activity, weight gain will occur that can lead to obesity and other chronic diseases. Over 50% of Americans have one or more chronic diseases that are associated with poor diet and physical inactivity.

Education regarding a healthy diet, including appropriate calorie, saturated fat, sugar, and sodium intakes, helps improve health in adults. Roughly 73% of males and 70% of females in America exceed the recommended daily intake of saturated fat, and up to 97% of males and 82% of females exceed the recommended daily intake of sodium. Approximately 97% of males and 90% of women in America do not consume the recommended intake of dietary fiber, including underconsumption of fruits, vegetables, and whole grains, which contributes to diet-related chronic diseases.

Alcohol consumption can be problematic for maintaining a healthy diet. Chronic alcohol abuse can interfere with vitamin and mineral absorption and result in general malnourishment. Alcohol should be limited to one drink per day or less for women and two drinks or less per day for men. Alcohol should be avoided by those who are pregnant, breastfeeding, younger than 21 years old, have a chemical dependency, or have other underlying health conditions such as diabetes mellitus. [ 16 ]

Pregnancy and Lactation

A well-balanced, healthy diet is essential during pregnancy and lactation to prevent maternal, fetal, and newborn problems. Nutritional requirements, such as calories, vitamins, and minerals, increase during pregnancy and lactation. Increased caloric needs should be met with nutrient-dense foods rather than calorie-dense foods that are higher in fats and sugars. Prenatal vitamins and mineral supplements are often prescribed during pregnancy and lactation, in addition to a nutrient-rich diet, to help ensure women meet requirements for folic acid, iron, iodine, choline, and vitamin D. Folic acid is necessary to prevent neural tube defects in the fetus during the first trimester of pregnancy. Iron requirements increase during pregnancy to support fetal development and prevent anemia. Iodine requirements increase during pregnancy and lactation for fetal neurocognitive development. Choline requirements also increase due to the need to replace maternal stores, as well as for fetal brain and spinal cord development. [ 17 ]

Older Adults

People aged 65 years and older are considered older adults. Older adults are more likely to suffer from chronic illness and disease. Older adults have lower calorie needs than younger people, though they still need a diet full of nutrient-dense foods because their nutrient needs increase. Caloric needs decrease due to decreased activity, decreased metabolic rates, and decreased muscle mass. Chronic disease and medication can contribute to decreased nutrient absorption. Protein and vitamin B12 are commonly under consumed in older adults. Protein is necessary to prevent loss of muscle mass. Vitamin B12 deficiency can be a problem for older adults because absorption of vitamin B12 decreases with age and with certain medications. Adequate hydration is also a concern for older adults because feelings of thirst decrease with age, leading to poor fluid intake. Additionally, older adults may be concerned with bladder dysfunction so they may consciously choose to limit fluid intake. Loneliness, ability to chew and swallow, and poverty can also decrease dietary intake in older adults. [ 18 ] Meals on Wheels, local senior centers, and other community programs can provide socialization and well-balanced meals to older adults.

The Mini-Nutritional Assessment Short-Form is a screening tool used to identify older adults who are malnourished or at risk of malnutrition. Use the hyperlink in the following box to download this tool.

Download the Mini-Nutritional Assessment Short-Form from The Hartford Institute for Geriatric Nursing. [ 19 ]

After the assessment stage is conducted, data is analyzed, and pertinent information is clustered together, nursing diagnoses are selected based on defining characteristics. When creating a care plan for a patient, review a current nursing care planning source for current NANDA-I approved nursing diagnoses and interventions related to nutritional imbalances. NANDA-I nursing diagnoses related to nutrition include Imbalanced Nutrition: Less than Body Requirements, Overweight, Obesity, Risk for Overweight, Readiness for Enhanced Nutrition, and Impaired Swallowing . [ 20 ] See Table 14.3c for additional information related to the diagnosis Imbalanced Nutrition: Less than Body Requirements . [ 21 ]

Table 14.3c

Sample NANDA-I Nursing Diagnosis Related to Nutrition [ 22 ]

A sample nursing diagnosis written in PES format is, “Imbalanced Nutrition: Less than Body Requirements related to insufficient dietary intake as evidenced by body weight 20% below ideal weight range and food intake less than recommended daily allowance.”

Outcome Identification

Goals for patients experiencing altered nutritional status depend on the selected nursing diagnosis and specific patient situation. Typically, goals relate to resolution of the nutritional imbalance and are broad in nature. An overall goal related to nutritional imbalances is, “ The patient will weigh within normal range for their height and age .” [ 23 ]

Outcome criteria are specific, measurable, achievable, realistic, and time-oriented. A sample SMART goal is, “The patient will select three dietary modifications to meet their long-term health goals using USDA MyPlate guidelines by discharge.” [ 24 ]

Planning Interventions

After SMART outcome criteria are customized to the patient’s situation, nursing interventions are selected to help them achieve their identified outcomes. Interventions are specific to the alteration in nutritional status and should accomodate the patient’s cultural and religious beliefs. The box below outlines selected interventions related to nutrition therapy.

Nutrition Therapy [ 25 ]

Monitor food/fluid ingested and calculate daily caloric intake, as appropriate
Monitor appropriateness of diet orders to meet daily nutritional needs, as appropriate
Determine in collaboration with the dietician, the number of calories and types of nutrients needed to meet nutritional requirements, as appropriate
Determine food preferences with consideration of the patient’s cultural and religious preferences
Encourage nutritional supplements, as appropriate
Provide patients with nutritional deficits high-protein, high-calorie, nutritious finger foods and drinks that can be readily consumed, as appropriate
Determine need for enteral tube feedings in collaboration with a dietician
Administer enteral feedings, as prescribed
Administer parenteral nutrition, as prescribed
Structure the environment to create a pleasant and relaxing meal atmosphere
Present food in an attractive, pleasing manner, giving consideration to color, texture, and variety
Provide oral care before meals
Assist the patient to a sitting position before eating or feeding
Implement interventions to prevent aspiration in patients receiving enteral nutrition
Monitor laboratory values, as appropriate
Instruct the patient and family about prescribed diets
Refer for diet teaching and planning, as appropriate
Give the patient and family written examples of prescribed diet

Patients may be prescribed special diets due to medical conditions or altered nutrition states. See Table 14.3d for commonly prescribed special diets.

Table 14.3d

Commonly Prescribed Special Diets

“Thickened liquids” are typically prescribed for patients with difficulty swallowing (dysphagia). Three consistencies of thickened liquids are:

Nectar-thick liquids: Easily pourable liquid comparable to apricot nectar or thick cream soups.
Honey-thick liquids: Slightly thicker liquid that is less pourable and drizzles from a cup or bowl.
Pudding-thick liquids: Liquids that hold their own shape. They are not pourable and usually require a spoon to eat.

Nurses often thicken liquids in the patient’s room using a commercial thickener. Most commercial thickeners include directions for achieving the consistency prescribed.

Enteral Nutrition

Enteral nutrition is administered directly to a patient’s gastrointestinal tract while bypassing chewing and swallowing. Enteral feedings are prescribed for patients when chewing and/or swallowing are impaired or when there is poor nutritional intake and/or malnutrition.

Examples of enteral tube access are nasogastric tubes (NG), orogastric tubes (OG), percutaneous endoscopic gastrostomy (PEG) tubes, or percutaneous endoscopic jejunostomy (PEJ) tubes. See Figure 14.12 [ 26 ] for an illustration of common enteral tube placement. Nasogastric tubes enter the nare and travel through the esophagus and into the stomach. Liquid tube feedings are infused through this tube and directly into the stomach. Orogastric tubes work in the same manner except they are inserted through the mouth into the esophagus and then into the stomach. Orogastric tubes are typically used with mechanically intubated and sedated patients and should never be used in conscious patients because they can induce a gag reflex and cause vomiting. PEG tubes are inserted through the abdominal wall directly into the stomach, bypassing the esophagus. PEG tubes are used when there is an obstruction to the esophagus, the esophagus has been removed, or if long-term enteral feedings are expected. PEJ tubes are inserted through the abdominal wall directly into the jejunum, bypassing the esophagus and stomach. PEJ tubes are used when all or part of the stomach has been removed or if the provider determines PEJ placement would best suit the patient’s needs.

Figure 14.12

Enteral Tube Access

There are several safety considerations for nurses to implement when enteral nutrition is being administered to prevent aspiration and dehydration. Tube placement must be verified after insertion, as well as before every medication or feeding is administered, to prevent inadvertent administration into the lungs if the tube has migrated out of position. Follow agency policy regarding checking placement. The American Association of Critical‐Care Nursing recommends that the position of a feeding tube should be checked and documented every four hours and prior to the administration of enteral feedings and medications by measuring the visible tube length and comparing it to the length documented during X-ray verification. Older methods of checking tube placement included observing aspirated GI contents or the administration of air with a syringe while auscultating (commonly referred to as the “whoosh test”). However, research has determined these methods are unreliable and should no longer be used to verify placement. [ 27 ] , [ 28 ]

In addition to verifying tube placement before administering feedings or medications, nurses perform additional interventions to prevent aspiration. The American Association of Critical‐Care Nurses recommends the following guidelines to reduce the risk for aspiration:

Maintain the head of the bed at 30°- 45° unless contraindicated
Use sedatives as sparingly as possible
Assess feeding tube placement at four‐hour intervals
Observe for change in the amount of external length of the tube
Assess for gastrointestinal intolerance at four‐hour intervals [ 29 ] , [ 30 ]

Measurement of gastric residual volume (GRV) is often performed when a patient is receiving enteral feeding by using a 60-mL syringe to aspirate stomach contents through the tube. GRVs in the range of 200–500 mL have traditionally triggered nursing interventions, such as slowing or stopping the feeding, to reduce the patient’s risk of aspiration. However, according to recent research, it is not appropriate to stop enteral nutrition for GRVs less than 500 mL in the absence of other signs of intolerance because of the impact on the patient’s overall nutritional status. Additionally, the aspiration of gastric residual volumes can contribute to tube clogging. Follow agency policy regarding measuring gastric residual volume and implementing interventions to prevent aspiration. [ 31 ] , [ 32 ]

Patients receiving enteral nutrition should be monitored daily for signs of tube feeding intolerance, such as abdominal bloating, nausea, vomiting, diarrhea, cramping, and constipation. If cramping occurs during bolus feedings, it can be helpful to administer the enteral nutritional formula at room temperature to prevent symptoms. Notify the provider of signs of intolerance with anticipated prescription changes regarding the type of formula or the rate of administration.

Electrolytes and blood glucose levels should also be monitored for signs of imbalances. Carbohydrates in tube feedings are absorbed quickly, so blood glucose levels are monitored, and elevated levels are typically treated with sliding scale insulin according to health care provider orders.

Read about “ Enteral Tube Management ” in Open RN Nursing Skills .

Parenteral nutrition.

Parenteral nutrition is nutrition delivered through a central intravenous line, generally the subclavian or internal jugular vein, to patients who require nutritional supplementation but are not candidates for enteral nutrition. Parenteral nutrition is an intravenous solution containing glucose, amino acids, minerals, electrolytes, and vitamins. A lipid solution is typically given in a separate infusion in a hospital setting. This combination of solutions is called total parenteral nutrition because it supplies complete nutritional support. Parenteral nutrition is administered via an IV pump.

Because parenteral nutrition consists of concentrated glucose, amino acids, and minerals, it is very irritating to the blood vessels. For this reason, a large central vein must be used for administration. The patient’s lab work must also be closely monitored for signs of nutrient excesses. See Figure 14.13 [ 33 ] for an image of home parenteral nutrition formula. In this image are three compartments: one with glucose, one with amino acids, and one with lipids. The three compartments are kept separate to enable storage at room temperature, but are mixed together before use.

Figure 14.13

Total Parenteral Nutrition

Parenteral nutrition is typically used when the patient’s intestines or stomach is not working properly and must be bypassed, such as during paralytic ileus where peristalsis has completely stopped, or after postoperative bowel surgeries, such as bowel resection. It may also be prescribed for severe malnutrition, severe burns, metastatic cancer, liver failure, or hyperemesis with pregnancy.

Implementing Interventions

When implementing interventions to promote good nutrition, it is vital to consider the patient’s cultural and religious beliefs. Encourage patients to make healthy food selections based on their food preferences.

If a patient has nutritional deficit, perform nursing interventions prior to mealtime to promote their appetite. For example, if the patient has symptoms of pain or nausea, administer medications prior to mealtime to manage these symptoms. Do not perform procedures that may affect the patient’s appetite, such as wound dressing changes, immediately prior to meal time. Manage the environment prior to the food arriving and remove any unpleasant odors or sights. For example, empty the trash can of used dressings or incontinence products. If the patient is out of the room when the meal tray arrives and the food becomes cold, reheat the food or order a new meal tray.

When assisting patients to eat, help them to wash their hands and use the restroom if needed. Assist them to sit in a chair or sit in high Fowler’s position in bed. Set the meal tray on an overbed table and open containers as needed. Encourage the patient to feed themselves as much as possible to promote independence. If a patient has vision impairments, explain the location of the food using the clock method. For example, “Your vegetables are at 9 o’clock, your potatoes are at 12 o’clock, and your meat is at 3 o’clock.” When feeding a patient, ask them what food they would like to eat first. Allow them to eat at their own pace with time between bites for thorough chewing and swallowing. If any signs of difficulty swallowing occur, such as coughing or gagging, stop the meal and notify the provider of suspected swallowing difficulties.

It is always important to evaluate the effectiveness of interventions implemented. Evaluation helps the nurse and care team determine if the interventions are appropriate for the patient or if they need to be revised. Table 14.3e provides a list of assessment findings indicating that alterations of nutritional status are improving with the planned interventions.

Table 14.3e

Evaluation of Alterations in Nutritional Status

14.4. PUTTING IT ALL TOGETHER

Patient scenario.

Mr. Curtis is a 47-year-old patient admitted to the hospital with increased weakness, fatigue, and dehydration. His skin appears dry, and tenting occurs when skin turgor is evaluated. He is currently undergoing chemotherapy treatment for multiple myeloma and has experienced weight loss of 10 pounds within the last two weeks. He describes that “nothing tastes good,” and he feels as if there is “metal taste in his mouth.” When he does eat small meals, he reports that he is often nauseous. The patient’s serum protein level is 3.1 g/dL.

Applying the Nursing Process

Assessment: The nurse identifies that the patient is experiencing signs of imbalanced nutrition with the signs of increased weakness, fatigue, and signs of dehydration such as skin tenting and dryness. The patient has demonstrated a significant weight loss over the past two weeks and reports “nothing tastes good” and “a metal taste in the mouth.” The patient also reports nausea after eating. His serum protein level reflects signs of malnutrition.

Based on the assessment information that has been gathered, the following nursing care plan is created for Mr. Curtis:

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements r/t insufficient dietary intake as manifested by weight loss of 10 pounds in the last two weeks, skin tenting and dryness, reports of “nothing tastes good,” and serum protein of 3.1 g/dL.

Overall Goal: The patient will demonstrate improvement in nutrition intake.

SMART Expected Outcome: Mr. Curtis will eat 50% of offered meals and demonstrate dietary tolerance within 24 hours.

Planning and Implementing Nursing Interventions:

The nurse will validate the patient’s feelings regarding his current symptoms and provide emotional support. The nurse will determine the time of day when the patient’s appetite is highest and offer the highest calorie meal at that time. The nurse will offer high-calorie protein shakes to the patient at frequent intervals. The nurse will assess the patient’s food preferences and ensure that small frequent meals are offered that incorporate those preferences. The nurse will also encourage the use of plastic utensils and encourage the patient to eat mints or chew gum to minimize the metallic taste in the mouth.

Sample Documentation:

Mr. Curtis demonstrates signs of imbalanced nutrition: less than body requirements. He reported a significant weight loss of 10 pounds over the past two weeks associated with chemotherapy. He reports feeling nauseous following small meals. He also reports “nothing tastes good” and having “a metal taste in the mouth.” He demonstrates signs of weakness, fatigue, and dehydration. Interventions have been implemented to increase the patient’s nutritional intake.

Evaluation:

Twenty-four hours later, the nurse evaluates Mr. Curtis and finds he is able to consume 50% of breakfast with his preferred dietary items. Planned interventions will continue and the nurse plan to reevaluate his progress the following day.

14.5. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)

Mr. Jones is a 67-year-old patient on the medical surgical floor who recently underwent a bowel resection. He is post-op Day 2 and has been NPO since surgery. He has been receiving IV fluids but has been asking about when he can resume eating.

What assessments should be performed to determine if the patient’s diet can be progressed?

What are the first steps during dietary transition from NPO status?

Scenario 2 [ 1 ]

Mrs. Casey is a 78 year-old widow who recently had a stroke and continues to experience mild right-sided weakness. See Figure 14.14 for an image of Mrs. Casey. [ 2 ] She is currently receiving physical therapy in a long-term care facility and ambulates with the assistance of a walker. Mrs. Casey confides, “I am looking forward to going home, but I will miss the three meals a day here.”

Figure 14.14

Her height is 5’2″ and she weighs 84 pounds. Her recent lab work results include the following:

Hgb: 8.8 g/dL, WBC 3500, Magnesium 1.4 mg/dL, Albumin 1.0 g/dL

What is Mrs. Casey’s BMI and what does this number indicate?

Analyze Mrs. Casey’s recent lab work and interpret the findings.

Describe focused assessments the nurse should perform regarding Mrs. Casey’s nutritional status.

Create a PES nursing diagnosis statement for Mrs. Casey based on her nutritional status.

Create a SMART outcome statement for Mrs. Casey.

Outline planned nutritional interventions for Mrs. Casey while she is at the facility, as well as when she returns home.

How will you evaluate if your nursing care plan is successful for Mrs. Casey?

“Nutrition Case Study” by Susan Jensen for Lansing Community College are licensed under CC BY 4.0

XIV GLOSSARY

A measure of weight categories including underweight, normal weight, overweight, and obese taking height and weight into consideration.

Foods with a substantial amount of calories and few nutrients.

Sugars and starches that provide an important energy source, providing 4 kcal/g of energy.

Breakdown of food with stomach acids, bile, and pancreatic enzymes for nutrient release.

Broken-down food that has undergone chemical digestion in the stomach.

A thick yellowish-white fluid rich in proteins and immunoglobulin A (IgA) and lower in carbohydrates and fat than mature breast milk secreted within the first 2-3 days after giving birth.

Proteins with enough amino acids in enough quantities to perform necessary functions such as growth and tissue maintenance. These must be ingested in the diet.

Larger molecules of polysaccharides that break down more slowly and release sugar into the bloodstream more slowly than simple carbohydrates.

Set requirements or limit amounts of a certain nutrient, including proteins, carbohydrates, fats, vitamins, minerals, and fiber.

Difficulty swallowing.

Liquid nutrition given through the gastrointestinal tract via a tube while bypassing chewing and swallowing.

Nutrients that must be ingested from dietary intake. Essential nutrients cannot be synthesized by the body.

Vitamins that dissolve in fats and oils and are stored in fat tissue and can build up in the liver, resulting in toxicity. Fat-soluble vitamins include vitamins A, D, E, and K.

Fatty acids and glycerol that are essential for tissue growth, insulation, energy source, energy storage, and hormone production. Fats provide 9 kcal/g of energy.

A measure of how quickly plasma glucose levels are released into the bloodstream after carbohydrates are consumed.

Proteins that do not contain enough amino acids to sustain life. Incomplete proteins can be combined with other types of proteins to add to amino acids consumed to form complete protein combinations.

Breast milk production.

Minerals needed in larger amounts and measured in milligrams, grams, and milliequivalents.

Nutrients needed in larger amounts due to energy needs. Macronutrients include carbohydrates, proteins, and fats.

The chewing of food in the mouth.

Breaking food down into small chunks through chewing prior to swallowing.

The net loss or gain of nitrogen excreted compared to nitrogen taken into the body in the form of protein consumption; an indicator of protein status where a negative nitrogen balance equates to a protein deficit in the diet and a positive nitrogen balance equates to a protein excess in the diet.

Foods with a high proportion of nutritional value relative to calories contained in the food.

An intravenous solution containing glucose, amino acids, minerals, electrolytes, and vitamins, along with supplemental lipids.

Proteins that have enough amino acids to sustain life, but not enough for tissue growth and maintenance. Typically interchanged with incomplete proteins.

Coordinated muscle movements in the esophagus that move food or liquid through the esophagus and into the stomach or coordinated muscle movements in the intestines that move food/waste products through the intestines.

Sources of peptides, amino acids, and some trace elements that provide 4 kcal/g of energy. Proteins are necessary for tissue repair, tissue function, growth, fluid balance, and clotting, as well as energy in the absence of sufficient intake of carbohydrates.

Grains that have been processed to remove parts of the grain kernel and supply little fiber.

Fats derived from animal products, such as butter, tallow, and lard for cooking, or from meat products such as steak. Saturated fats are generally solid at room temperature and can raise cholesterol levels, contributing to heart disease.

Small molecules of monosaccharides or disaccharides that break down quickly and raise blood glucose levels quickly.

Minerals needed in tiny amounts.

Fats that have been altered through hydrogenation and as such are not in their natural state. Fat is changed to make it harder at room temperature and to make it have a longer shelf life and contributes to increased cholesterol and heart disease.

Fats derived from oils and plants, though chicken and fish contain some unsaturated fats as well. Unsaturated fats are healthier than saturated fats, and some containing omega-3 fatty acids are considered polyunsaturated fats and help lower LDL cholesterol levels.

Vitamins that are not stored in the body and include vitamin C and B-complex vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12 (cyanocobalamin), and B9 (folic acid, biotin, and pantothenic acid). Toxicity is rare as excess water-soluble vitamins are excreted in the urine.

Grains with the entire grain kernel that supply more fiber than refined grains.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 14 Nutrition.
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NUTRITION INTRODUCTION
NUTRITION BASIC CONCEPTS
APPLYING THE NURSING PROCESS
PUTTING IT ALL TOGETHER
LEARNING ACTIVITIES

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HS 2611 Written Assignment UNIT 6
However, the most important factors to take into account are proper eating habits, regular exercise, and getting enough sleep and rest (Zimmerman & Snow, 2012). Eating problems, a lack of physical activity, and technological advancement are all caused by not adhering to and implementing these techniques successfully.