Nutrition and Diet Therapy
LABORATORY
ACTIVITY 2 (Midterm)
Macronutrients-Proteins
Most people think of meat, fish, and poultry as good sources of protein. While they provide
most protein per serving portion in the daily diet, it is a mistake to assume that these are the only good
sources of protein. Legumes are also rich in proteins, as are nuts of many kinds. Breads and cereals
contain relatively small amounts of protein.
I. Objectives
Protein is indispensable to life and its deficiency can bring about damaging effects to one’s
health. Its excess, however, can also be harmful. Group 2 will be required to plan meals for
people with protein malabsorption, and the planned diet will play an important role in the
recovery from deficiency.
At the end of the 3-hour laboratory session, you should be able to:
1. Recognize the importance of protein in the Filipino diet; and
2. Plan and prepare meals for individuals requiring protein intake modification.
II. Procedures
Group 2: Case # 2. An individual suffering from gouty arthritis
1. Calculate and plan a 1,800 kcal low-purine diet. Prepare a sample menu plan for dinner.
Research about purine content of different food items.
Table 2-1: Meal Plan for a Low-Protein Diet
Food No. of CHO CHON FAT Energy Meal Distributions
Exchanges Exchanges g g g kcal B L D Sn
I. Veg A 1 47 19 6 318 ✓
Veg B 3 17 4 7 147 ✓
II. Fruits 1 25 1 0 104 ✓
III. Milk 1 1 1 3 35 ✓
IV. Rice 1 45 4 0 196 ✓
V. Meat 1 26 49 17 453 ✓
VI. Sugar 1 25 1 7 167 ✓
VII. Fat 1 0 0 8 72 ✓
VIII. Bread 2 62 11 2 310 ✓
Total 248g 90g 50g 1802
Require 270g 70g 50g 1,800
d
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Table 2-2: Sample Dinner Menu
Menu Household Measure
Veg A Dish:
Lemon and Garlic Broccoli
Broccoli 1 pound
Lemon 2 teaspoons lemon juice
Water 2 tbsp
Butter 1/2 tbsp
Garlic 2 cloves
Salt 1 pinch
Black Pepper 1 tsp
Veg B Dish:
Buttered Vegetables
Green Bean 1/4 cup
Chickpeas (Garbanzos) 30g
Salt 0.38g
Butter 1/2 tbsp
Carrot 1/4 cup
Water 1/2 tbsp
Fruit:
Apple 1 medium size
Milk:
Almond Milk 1 cup
Rice:
White Rice 1 cup of Rice
Chicken:
Tender Pan-Fried Chicken Breasts
Flour 2 cups
Salt 1 tsp
Ground Ginger 1 tsp
Ground Black Pepper 2 tsp
1 tbsp
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Garlic Powder 1 piece
Egg 1/4cup
Milk 2 pieces (108g)
Chicken Breasts 1/2 cup
Vegetable Oil
1 pack (28.5g)
Sugar:
Oreo Cookies
1/2 of an avocado (large size)
Fat:
Avocado
2 medium sized
Bread: 1 Slice
Pita Bread
Wheat Bread
2. Discuss the following and write the answers in Table 2-3.
a. Protein-related diseases
b. Symptoms
c. Causes
d. Prevalence
e. Dietary changes
Table 2-3. Worksheet for Protein-related Diseases
Diseases Symptoms Causes Prevalence Dietary Changes
1. Kwashiorkor Kwashiorkor is a The main cause of Kwashiorkor is most Kwashiorkor can be
condition resulting kwashiorkor is not eating common in countries prevented by including
from inadequate enough protein or other where there is a limited foods in your diet that
protein intake. Early essential vitamins and supply or lack of food. It
are rich in proteins,
symptoms include minerals. is mostly found in such as:
fatigue, irritability, children and infants in • Meat
and lethargy. Kwashiorkor is rare in sub-Saharan Africa,
• Fish
The symptoms of developed countries such Southeast Asia, and • Dairy Products
kwashiorkor include: as the UK, but it can Central America. • Eggs
occasionally happen as a • Soy
• Change in skin and result of severe neglect, The prevalence of • Beans
hair color and texture long-term illness, a lack of Kwashiorkor varied from
• Fatigue knowledge about good 0% to 32.9%, and Treatment involves
• Diarrhea nutrition, or a very children were more slow increases in
• Loss of muscle restricted diet. likely to have bilateral calories from
mass edema in Central and carbohydrates, sugars,
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• Failure to grow or South Africa. and fats, followed by
gain weight The omission of the protein.
• Edema (swelling) of measurement of edema
the ankles, feet, and can have important
belly repercussions, especially
• Damaged immune at the nutrition program
system, which can level.
lead to more
frequent and severe
infections
• Irritability
2. Alzheimer’s • Memory Loss The exact causes of More than 6 million People with
• Disorientation Alzheimer's disease aren't Americans of all ages Alzheimer's do not
• Mood and fully understood. But at a have Alzheimer's. An need a special diet. As
behavioral changes basic level, brain proteins estimated 6.2 million the disease progresses,
• Difficulty in fail to function normally, Americans age 65 and loss of appetite and
speaking, swallowing, which disrupts the work of older are living with weight loss may
and walking brain cells (neurons) and Alzheimer’ in 2021. become concerns
triggers a series of toxic because they easily
events. Neurons areMore than 1 in 9 people forgot something and
damaged, lose connections (11.3%) age 65 and older the possible cause of
to each other andhas Alzheimer’s. The poor appetite is that
eventually die. Scientists percentage of people they no longer
believe that for most with Alzheimer’s recognize the food in
people, Alzheimer's disease increases with age: 5.3% their mouth.
is caused by a combination of people age 65 to 74,
of genetic, lifestyle, and 13.8% of people age 75 Medication can also
environmental factors that to 84, and 34.6% of affect the appetite of a
affect the brain over time. people age 85 and older person who has
have Alzheimer’s. Alzheimer's due to the
Less than 1% of the time, dosage of a medication
People younger than 65 and their senses are no
Alzheimer's is caused by
can also develop longer working. People
specific genetic changes
Alzheimer's dementia, who have Alzheimer's
that virtually guarantee a but it is much less are not eating food
person will develop the common and prevalence because they cannot
disease. These rare is uncertain. smell or taste it not
occurrences usually result good liked they used
to.
in disease onset in middle
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age. To make their diet
balanced the people
who are taking care of
The damage most often
a person who has
starts in the region of the Alzheimer's should give
brain that controls a calm and comfortable
memory, but the process mealtime away from
begins years before the distraction, simple
setting of a table,
first symptoms. The loss of
prepare food that is
neurons spreads in a
easy to distinguish and
somewhat predictable if ever follow the food
pattern to other regions of preference of the
the brain. By the late stage person.
of the disease, the brain
Be flexible in the food
has shrunk significantly.
preference of a person
with Alzheimer's, allow
Researchers trying to the person to eat with
understand the cause of others because this
Alzheimer's disease are encourages interaction.
focused on the role of two Also, when providing
food to a person with
proteins:
Alzheimer serve them
finger food so that it is
Plaques. Beta-amyloid is a easy for them to pick
fragment of a larger up.
protein. When these
fragments cluster together, • Leafy Greens
• Berries
they appear to have a toxic
• Nuts
effect on neurons and
• Omega-3s
disrupt cell-to-cell • Cruciferous
communication. These Vegetables
clusters form larger • Spices
deposits called amyloid • Seeds
plaques, which also include
other cellular debris.
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Tangles. Tau proteins play a
part in a neuron's internal
support and transport
system to carry nutrients
and other essential
materials. In Alzheimer's
disease, tau proteins
change shape and organize
themselves into structures
called neurofibrillary
tangles. The tangles disrupt
the transport system and
are toxic to cells.
3. Amyloidosis • Swelling, often in The bone marrow creates Approximately 1.2 per • Lean potein
the legs, caused by abnormal antibodies that 100,000 individuals per • Healthy Fats
fluid retention can’t be broken down by year worldwide are • Fiber
(Edema) the body. diagnosed with • Fruits
• Tiredness Amyloidosis. • Vegetables
• Weakness It results from chronic • Fish oil supplements
• Loss of Appetite infectious or inflammatory The Prevalence rate of
• Shortness of Breath diseases such as 1.6 per 100,000 in 2007
Reduce sodium (salt)
• An abnormal rheumatoid arthritis, jumped to 4.0 per intake to help the
heartbeat Crohn’s disease, or 100,000 in 2015 in the
swelling, and protect
• Feeling lightheaded ulcerative colitis. US alone. the heart and kidneys
or fainting, from further damage.
particularly after Dialysis-related deposits of Amyloidosis is more Only ingest a maximum
standing or sitting up beta-2 microglobulin that prevalent in older of 2300 mg of sodium
• Numbness or a builds up in the blood. people specifically 55-60 per day.
tingling feeling in the years old.
hands and feet This can be familial or Restrict fluid intake as
• Easy bruising hereditary. Approximately 4% of the too much can overload
black population has the kidneys, making
It can also be age-related amyloidosis. them unable to remove
(senile) systemic, deposits the buildup sufficiently.
of normal transthyretin Men are more common In most cases, about
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(TTR) in the heart and other to be affected by 1.5 liters, or six cups,
tissues. amyloidosis than per day is
women. recommended.
Organ-specific, deposits of
amyloid protein in single It also helps to refrain
organs, including the skin from coffee, alcohol,
(cutaneous amyloidosis). and spices, as they can
all aggravate the
delicate
gastrointestinal tract.
4. Marasmus • Weight loss Poor diet. Marasmus is a serious Protein and calorie-rich
• Stunted growth problem among foods:
A nutrient-rich, balanced
• Dry skin and eyes developing countries. It • Lean meats: beef,
diet is important for
• Brittle hair growth, especially in is common in children in lamb, veal, pork.
• Diarrhea children. If you have a poor Africa, Latin America, • Poultry: chicken,
• Lower immunity diet that lacks essential and South Asia. turkey, duck, emu,
• Stomach infection nutrients, you may be at In the United States, goose, bush birds.
and lactose risk of developing marasmus has a 0.5% • Fish and seafood:
intolerance marasmus. overall prevalence fish, prawns, crab,
• Respiratory according to the UNICEF lobster, mussels,
Food shortages.
infections 2016 Global Nutrition oysters, scallops, clams.
Marasmus is more common
• Rickets due to Report. eggs.
in developing countries
calcium and vitamin • Dairy products: Milk,
that have high poverty and
D deficiency yogurt (especially
lack of food. These regions
• Anemia due to iron Greek yogurt), cheese
also have frequent famines
deficiency (especially cottage
and natural disasters,
• Impaired brain cheese)
resulting in food shortages.
function and • Vitamin supplements.
Children and adults living in
intellectual disability • Fresh fruits of any
these areas are at a higher
• Low blood pressure kind.
risk of getting marasmus.
or hypotension • Vegetables of any
• Low body kind.
Insufficient breastfeeding.
temperature or • Grains.
Mother's milk is rich in
hypothermia
nutrients that help children
• Slow heart rate or Foods rich in protein,
grow. If mothers are
bradycardia such as skimmed milk,
malnourished, they are
fish, eggs, and nuts are
unable to feed their infants
Children with severe ideal for energy and
enough milk
marasmus tend to growth, though any
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appear tired and during breastfeeding. This protein and calorie-rich
bored. They are can increase the chances of food can be used to
always low in energy protein-energy prevent marasmus,
and enthusiasm. malnutrition in children. depending on what is
Such children are available and desired.
often irritable, short- Infections and diseases.
tempered, and Infections and diseases
uninterested in caused by viruses, bacteria,
things. This symptom parasites, and other
can be confused as a pathogens can cause loss of
sign of kwashiorkor, appetite. This can lead to a
which is another type low intake of essential
of malnutrition. nutrients in infected
children and adults.
Diseases such as HIV/AIDS
and malaria in rural areas
can cause marasmus. It can
also be caused by poor
absorption of nutrients due
to celiac disease and
pancreatic problems.
Causes of marasmus
include:
• Not having enough
nutrition or having too little
food
• Consuming the wrong
nutrients or too much of
one and not enough of
another
• Having a health condition
that makes it difficult to
absorb or process nutrients
correctly
Older adults who live alone
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and find it difficult to
prepare food and care for
themselves may be at risk.
Sometimes marasmus can
affect an older adult who
has not eaten healthfully
for some months or years,
says the University of
Kansas Landor center on
Aging.
While consuming the
wrong nutrients and having
a health condition can
contribute to marasmus,
each of these alone would
probably not be enough to
cause it, as long as calories
are available.
In places where food can
be scarce, breastfeeding
infants for as long as
possible may help reduce
the risk of malnutrition.
However, if breastfeeding
continues for longer than 6
months without an infant
receiving solid food, the
risk of marasmus can also
increase, especially if the
mother is malnourished
herself.
References:
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Marasmus: Background, Pathophysiology, Body Composition. (2019, November 10).
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