chapter one is going to be an overview or introduction to nutrition in general so before we get started we want to understand what is nutrition in the first place in general nutrition is the study of food which is going to include how our body uses food for energy how we fuel our body with food as well as how food influences our health both positively and negatively one of the ways to really understand how important nutrition is when it comes to our health is to look at how it influences the causes of death here in this table you have the top 10 causes of death in the u.s and the ones in bold are the ones that are related to nutrition so you'll see that the top leading cause of death in the u.s is heart disease and that is one that is related to nutrition if you have a good diet you can decrease the risk of heart disease if you have a bad diet you can increase your chances of developing heart disease and eventually passing from that disease another way to look at it is to look at the factors that contribute to a death so not so much a certain disease that causes someone to pass away but certain lifestyle factors that can increase the chance of death and that can lead to a shorter life span so here we have the top 10 as well and you'll notice that the second one in the list number two is poor diet so now that we understand the importance of nutrition we can go ahead and take a look at the nutrients so we have our nutrients divided up into six main classes those are carbohydrates protein lipid which is the scientific word for fat vitamins minerals and water now we can also categorize these into other subcategories that we'll go ahead and look at the first way to categorize these nutrients is to divide them up as organic and inorganic when we say organic in this class we're not referring to the organic section of the grocery store we're referring to organic in the scientific term which means that the chemical structure contains carbon in it if it does contain carbon it's organic if the structure doesn't contain carbon it's inorganic so for example if you take a look at this table water is considered inorganic and that's because as you know water is h2o h stands for hydrogen the o stands for oxygen so water is made of only hydrogen and oxygen meaning it does not contain carbon in its structure therefore it is inorganic same thing goes for minerals minerals do not contain carbon so they are referred to as inorganic the rest of the nutrients will all be labeled as organic because they do contain carbon in their structure another way that we can categorize our nutrients is as micro and macro nutrients now this is exactly what it sounds like macro means large and micro means small so macronutrients are the ones that are found in large quantities when we look into food or looking to our bodies and they're also the ones that are required in larger quantities by our bodies so the ones that our body needs more of are the carbohydrates our lipids protein and water those nutrients are also found in larger quantities in our bodies and in foods and so they're going to be referred to as the macronutrients now the micronutrients are the opposite micro means small so these are going to be the ones that are found and required in smaller quantities which are the vitamins and minerals now one thing that i do want to mention is that depending on the book that you're looking at sometimes you might not see water included as part of the macronutrients and the reason for this is because the rest of the macronutrients besides water all share another characteristic which is that they all provide the body with energy in this class when we talk about energy energy is referring to calories calories is a measure of energy that the food provides so when i ask you guys how much energy does this food provide i'm asking how many calories does it provide you also might see it written as kilo calories or k cals these are just the technical terms they're all interchangeable in this class no reason to do convergence or anything like that so when i say that most of the macronutrients contain calories or contain energy i'm referring to the carbohydrates the lipids and the proteins that provide us with calories water is the exception it doesn't provide us with calories and that's why sometimes it's not included in the macronutrients but if we're talking about the straight definition of a macronutrient that's referring to quantity and since water is found in larger quantities it does does qualify to be as part of the macronutrients so for this class we are going to be including water as part of the macronutrients so we said that the nutrients that provide us with calories are the carbohydrates proteins and lipids but what we want to look at now are the differences in the amount of calories that each of the nutrient provides before we get into that one thing that i want to mention is you will notice that i have alcohol listed as providing us with calories even though we didn't mention it as one of the ones one of the nutrients that contain calories and the reason for that is because technically it is not a nutrient alcohol is classified as a toxin and so that's why it's not part of the energy yielding nutrients since it's not a nutrient itself but i did want you guys to know how many calories it provides so i have it up here for you again one gram of alcohol will give us seven calories now let's go back and look at the amount of calories we get from the ones that are actually nutrients so the way that we are comparing the calorie content is by looking at how many calories would we get for one gram of each of the different types of nutrients so we start off with our carbohydrates and carbohydrates provide us with four calories for each gram our protein is the same thing one gram of protein will provide us with four calories whereas when we look at our fats fats contain more calories so each gram of fat will provide us with nine calories now these are going to be numbers that you want to memorize you're going to need them when you perform your calculations on your assignment as well as your exam your exam might have some calculations on there for example i might tell you how many grams we have of carbohydrates protein and fat in a food product and you would need to calculate how many calories does this food product provide in order to be able to do that calculation you would need to have these numbers memorized so that you can know how to convert the grams into calories so let's go ahead and take a look at an example i'm just going to give you this food product here that contains 10 grams of carbohydrates 5 grams of protein and 2 grams of fat and my question is how many total calories do we get from this food product so what we need to do we have the nutritional information in grams but we need to convert it to calories so that we can add it up and figure out our total calorie content we can easily do that by looking at our key our key is what we have over here how many calories we get from each gram of the individual nutrients so if we start off with our carbohydrates for each gram of carbohydrate we are going to get four calories i in our food product we have 10 grams of carbohydrates if we know that each gram of carbohydrate provides us with 4 calories that's going to be 10 times 4 which will give us 40 calories of carbohydrates same thing with our protein we're going to come here and see how many calories we get for each gram which is four calories for each protein gram we have five grams of protein so each one of those protein grams will provide us with four calories that's going to be five times four which will give us 20 calories of protein lastly we have our fat our food product contains two grams of fat we want to know how many calories each of those grams will provide we come back to our key each gram of fat will provide us with nine calories since we have two of them we're going to go ahead and do two times nine that gives us 18 calories of fat all we have to do at this point is total them up and we get our total calories which is 78 calories in this situation now that we have the nutrients down we can go ahead and take a look at the nutrient recommendations and how we want to alter our diet if we do decide to do so now before we can do that we need to understand why we eat in the first place why we make the choices that we do so that if we do try to alter our diet we can make long lasting changes so some of the reasons that people choose to eat specific things can be due to social factors behavioral factors genetics those are just some of the overhead reasons of why someone might make some choices but we're going to go ahead and take a look at each one of them individually first and most common reason that people choose what they eat is based off of personal taste preference some people prefer things that are more salty some people have more of a sweet tooth and that is something that can be genetic some people just genetically are more salt sensitive or have more of a sweet tooth but it is something that can also be influenced based off of your diet that you had at an early age for example if you are someone who was fed a lot of salty foods you had a high salt diet as a child like it's likely that as an adult you're also going to have a high salt preference meaning that you're going to prefer a lot more salt in your foods whereas someone who was fed less salt as a child is not going to have as high of a salt preference it doesn't mean that they're used to eating bland foods it just means that their taste buds require less salt in order to basically get to that satisfying taste now that is something that can be changed if you do feel like you have a high salt preference you can allow your taste buds to re-adapt by cutting down on the salt initially it can be tough it can seem like foods are really bland but with time your taste buds will adapt and the salt will feel like it's enough reason that people make certain choices is based off of traditions ethnic heritage for example we have thanksgiving where most people will eat a turkey and all of the fixings along with that and that's just a tradition that we do in the us we also have social interactions that are another common reason why people choose to eat what they eat a lot of times when you meet up with somebody when you're in a social gathering food tends to be a common theme for example if you're celebrating you might go out to eat you might go out for drinks if you are going to a party or some kind of work function school function usually there is food that is present and people are eating in these functions so sometimes you may be eating things that are maybe not your typical diet but you're eating them because that is what's available in these settings or maybe you are eating just because it's a social setting where everyone is eating even though you're not necessarily hungry we also have things like availability and convenience that play a factor in the choices we make if something is readily available to you if you have stocked your pantry with healthy alternatives to snacks healthy items to snack on you're more likely to consume those than if you had your pantry stocked with unhealthier items also things like convenience if you feel like you're coming home late from work and you don't have the time or the energy to make yourself a home-cooked meal it might seem a lot more convenient to just run through the drive-through and pick something up really quickly on your way home so maybe not the best of choices but it is something that does influence the choices we make we also have things like emotions some people will eat when they're bored when they're stressed when they're depressed other people will tend to eat very specific foods as comfort foods whereas some people tend to lose their appetite in these situations as well lastly we have our values and our views this includes your religious beliefs maybe you avoid certain foods because it is something that is restricted or prohibited in your religion also it could be that you view certain things as immoral for example you may think that eating something that comes from an animal is immoral so you choose to be a vegetarian or a vegan some people will have a certain perception of their body certain body image that makes them feel like losing weight they want to lose a few pounds and so they start eating in a specific way that they think will help them achieve their weight loss goal and lastly your view on particular foods this is referring to if you view a food as something that is bad or unhealthy you're likely to avoid that or if you view a food as really healthy you might be more likely to consume it for example maybe you hear dr oz talk about the next super food that's supposed to cure all of your health problems so you go out and buy it and start to eat it regularly because you have that view of that particular food as something that is really good for you now that we have the reasons for why we're making the choices that we make we can go ahead and take a look at what the recommendations are in case we do want to make changes to our diet but before we do that we want to learn how these recommendations came to place in the first place where does the government get this information that they use to put down recommendations for the us on how much you should get from each nutrient and that comes from research so we're going to go ahead and take a look at how that research needs to be conducted in order for the government to take it seriously to consider it valid and possibly put it into a recommendation for the public the first thing that needs to be included in the research is following the scientific method and let's go ahead and take a look at a picture of what the scientific method includes the scientific method is the same as it's always been so if you remember maybe doing a science fair project when you were younger you use the scientific method and it's still the same so we start off with an observation which is what we want to study and then you come up with your hypothesis what do you think is going to happen or what do you think is going on here then you're going to conduct research to test this hypothesis you could do an experiment or it could be an observation and we'll talk more on that in a minute but then you want to look at your research results and see if it lines up with your hypothesis did what you think was going to happen actually happen if not then you want to go back and revise your hypothesis think of what else might be going on here and adjust your research to test for this new hypothesis once you have results that actually line up with your hypothesis that's when you can put together a theory over basically what it is that you just discovered now i mentioned that there are two types of research that can be conducted as part of your scientific method those were your experimental and observational studies an experimental study is anytime you're conducting some kind of test it could be in a lab or it could be a test on humans or animals or you are influencing the environment or the subjects in some way whereas your observational studies or what we call epidemiological are the ones where you are not influencing or changing anything you're not conducting an experiment you're just standing on the outside and observing two different factors to see what relationship there is between them there are a few different ways that you can do this and i'm going to go ahead and go over a few examples with you i'm going to go ahead and go over a few examples of the different types of observational studies that we can conduct starting off with our cross-sectional studies cross-sectional studies are basically when we compare two different populations for example and look at the differences or similarities between them so for example one of the things that we discussed at the beginning of this chapter was that the american population has a very high incidence of heart disease and it's actually our leading cause of death so researchers wanted to try to figure out what is it that is causing the us to have such a high incidence of heart disease their hypothesis was that it was due to having a high fat diet and the way that they were going to confirm this is by doing an observational study where they compared the american diet to the diet of a population that has the least incidence of heart disease which was the mediterranean diet what they thought that they would find is that the mediterranean diet would have really low fat levels and because of this they don't have much heart disease but when they did their research they actually found that the mediterranean diet had nearly the same amount of fat as the american diet so they were wrong it wasn't that the amount of fat directly correlated with incidence of heart disease so they had to go back and adjust their hypothesis and figure out what else might be going on here they thought maybe it's not just the amount of fat maybe it's the type of fat that's being consumed so they had to adjust their research and dig a little deeper and compare the type of fat that is being consumed in the two different populations and that's where they found their difference in the american population the fact that we consumed primarily came from saturated fats saturated fats are typically what are referred to as our bad fats they increase our body's cholesterol levels and increase our risk for heart disease whereas the mediterranean population got most of their fat from the unsaturated type things like omega-3 omega-6 fatty acids that are actually beneficial for our health and can even decrease our risk for heart disease so by just observing the differences and similarities in these two populations they were able to find that correlation between type of fat and incidence of heart disease the next type of observational study is our case control study and i'll give you guys an example of that one here we have an individual that seems to have a lump on their neck and this lump is actually what we call a goiter it's when your thyroid gland enlarges and so it protrudes like that as we see in the picture now researchers wanted to figure out why this population was all developing this goiter there was a lot of the individuals developing goiters and they wanted to go ahead go ahead and compare their diets their medical records their blood work to see if there was a common factor that might be causing them all to develop these goiters and when they did that they were able to see that one thing they had in common was that they all had extremely low levels of iodine and by looking at that they were able to associate the low levels of iodine with goiter development so after that they went ahead and did experiments where they would administer iodine and see if it would help with the goiter formation but their initial discovery that there is an association between iodine and goiter was just from observing the last type of observational study that we're going to cover is the cohort study this is when we have one individual factor or one individual thing that we're trying to figure out if it has any kind of association with something that might develop later on for example in the one that we have here we were trying to figure out if individuals have high levels of cholesterol does that increase their risk of developing heart disease later on in life so for example they went ahead and got the information of a certain amount of individuals they tracked their cholesterol levels and then followed them over a period of time to see which of them developed heart disease and by doing that they can go ahead and make a correlation between people who have high levels of cholesterol were more likely to develop heart disease later on in life than those who had lower levels of cholesterol so that's another way that you can make an association just from observing without doing any form of experiment whether you are conducting an experiment or an observational study the main thing that we're looking for is a correlation a correlation is an association between two things now the correlation could be either positive or negative when we hear these terms they're not telling us whether the study is a success or not it's just telling us how the factors relate to one another a positive correlation is when the factors relate directly to one another meaning they're moving in the same direction as one increases the other increases as well or as one decreases the other one will also decrease an example of that was the heart disease study that we discussed the higher the saturated fat intake the higher the incidence of heart disease so as one increases so does the other another one could be the amount of studying that you put in and how that relates to your grade where we can say the more that you study the higher your grade will be so as one increases so does the other they're moving in the same direction and that means it is a positive correlation a negative correlation means that they are going in the opposite direction of one another or they are inversely related so as one increases the other decreases an example of that was the goiter the goiter study that we just discussed in that one they found that the lower your iodine levels were the higher your risk of developing voider so that was inversely related or a negative correlation because as one decreased the other one increased now even though this is labeled as a negative correlation this was a success because it allowed us to discover that your iodine levels can affect your voider development and so again the term negative is not a bad thing here it's not telling us that the study was a failure it's just telling us how they relate to one another whichever type of correlation you find is success because we have discovered an association or relationship between two things and that is our goal so you've conducted your research and you found a correlation you found a relationship between two things and you want to go ahead and maybe publish your findings so at this point there are a few things that you want to consider to make sure that your research is considered to be valid and reliable the first thing is to make sure that you can replicate your results the reason for this is because if you just did your study once and found that correlation at one time it could have just been a coincidence but if you can repeat your study multiple times over and maybe even do it in different settings or different populations and still see that same correlation then that tells you that it wasn't a coincidence and it's going to make your research results be taken more seriously another thing that we want to include is a peer review a peer review is when we have other researchers other experts in the subject maybe take a look at the study and give their input on the study or the study design the subject matter maybe even let us know about certain things that could have impacted the results of the study this is going to be beneficial if we want to maybe go ahead and repeat the study using this advice and make the results more accurate by eliminating those things that could have impacted the results of our study so replicating our results and having a peer review are two components that we want to have whether we're conducting an experiment or an observational study but if you are conducting an experiment there is another component that you want to have and that is designing your experiment using the gold standard the gold standard means including the placebo and making sure the study is double blind in order for us to understand what is meant by placebo and double blind i first want to discuss how psychological effects can have an impact on the results of a study what i mean by psychological effect sometimes for example let's say somebody gave you this supplement that was supposed to help with pain and they told you how great it worked for them how great it worked for this or that person and so you have these really high expectations and when you take the supplement you're expecting that it's really going to make you feel better it might not really do anything for you physically or medically but because of these expectations because of what you were told you start thinking hey you know what i am feeling a little bit better when in reality it's just a psychological effect this is something that is actually very common and it can impact the results of the study if we are doing a study where the results are self-reported so in the example we just gave let's say that we were testing a supplement that was for pain and we told the individuals to rate their pain on a scale of one to ten before or after they took the supplement if we had a situation like the individual that we just gave an example about where their pain they thought their pain was lower when in reality it was just a psychological effect they're going to go ahead and rate it lower when there really wasn't any effectiveness of the supplement for them and that could sway the results of the study and make your results not as accurate so what we want to do is have a way to distinguish between what's a psychological effect and what is actual effectiveness of the treatment that we're testing and so in order to do that what we want to do is administer what we call a placebo to some of the participants a placebo is an inactive substance sometimes it's called a sugar pill or an empty pill but basically it's something that doesn't do anything and what we would do is give some of the participants the real thing and give some of them the placebo and tell all of them this is supposed to help with your pain go ahead and rate your pain on a scale of one to ten before and then rate it after you take the supplement and then we would look at the results what would probably happen is some of the individuals who took the placebo would still rate their pain lower just because of that psychological effect that we discussed now if you had a group that took the real thing and a group that took the placebo you could compare the results and see if there are any differences for example maybe the ones who took placebo would have rated their pain lower on the scale but maybe not all of them rated it lower on the scale whereas if we look at the treatment group all of the individuals in that group consistently rated their pain lower or maybe we look at the placebo group and they rated their pain a little bit lower on the scale whereas when we look at the real treatment group they rated their pain significantly lower on the scale if we can see a difference like that between the results of the placebo group and the results of the real treatment group then that tells us that there is something actually going on besides the psychological effect whereas if we didn't really see any significant difference between the results of both groups then maybe it really is just a psychological effect and that can help us determine the effectiveness of the treatment or the validity of our results now this is covering the placebo component of gold standard so again we want to make sure our study contains a placebo so that we can distinguish psychological effect from the real thing the other thing that we want to include is making the study double blind what i mean by that is neither the researchers nor the participants are going to know who receives what now if the participants were told this is just a placebo it's not really going to do anything but rate your pain on a scale that's kind of going to eliminate the whole point of giving them a placebo in the first place and so we don't want to do that we don't want the participants to know that they're getting a placebo but we also don't want the researchers to know because sometimes researchers can place their own bias it could be intentional it could be unintentional but when they're analyzing the results we don't want them to treat any of the data differently than the rest so we don't want them to put less significance on the group that receive the placebo just because they know that so if the researchers are unaware of whether this data is coming from an individual who received the placebo or an individual who received the real thing they're going to have to treat the data all equally and we would end up with a more accurate result a way that we could do this is having an assistant come in and administer placebo to some of the participants the treatment to the rest of the participants and only they would keep track of this so the researchers would not have access to this information when they are analyzing the results and coming up with whatever the outcome is for the study all right now that we know how we need to go about our research in order to have our results taken seriously and possibly be used to set up recommendations for the general public we can go ahead and take a look at how these recommendations are laid out for us and which ones we actually want to follow so in general the recommendations that are put out by the government have an umbrella term which we call the dri or dietary reference intakes now we're going to go ahead and take a look at all of the different dris or dietary reference intakes now these that you see listed are all different types of dietary reference intakes and we're going to go ahead and take a look at each one of them so the first one is what we call the ear or your estimated average requirements and this is basically an average of what a population needs for a certain nutrient so if you think about it an average is meeting in the middle for example if i had a need for 100 milligrams for let's say vitamin x and you had a need of 300 milligrams for vitamin x if we wanted to find out the average of our needs we would need in the middle which would be 200 so again my needs are 100 yours are 300 the average the in between is 200 so we would say the ear for this vitamin is 200. now thinking about that if we went ahead and followed that ear 200 we both wouldn't be able to meet our needs since i had a need of 100 my needs would be met if i followed that eel ear but since your needs were 300 if you followed the ear your needs actually wouldn't be met and again that's because it is only an average it is meeting in the middle so the higher half or the half on the higher end of the needs won't have their needs met if they follow the ear so it is really just an average of the needs and because of that it will only meet the needs of half of the population so it's not something that we want to follow the reason that we develop it is because it helps us figure out the rda or the recommended dietary allowance which covers pretty much all of the population and so what we do is we use the ear as a stepping stone we figure out the average of the needs of a population and then we basically double that to get an amount that is going to sufficiently cover a large population so rda or your recommended dietary allowance is the one that we want to follow the ear only covers half of the population but we develop the ear as a stepping stone to figure out the rda now going on to the next dris we have adequate intake or a i the a i is basically the same thing as the rda it's also supposed to cover pretty much all of the population but we say adequate intake when we don't have enough scientific data so it's basically the government telling us we're pretty sure this is how much you need of this nutrient we're pretty sure this amount will cover all of the population but we're still doing research if that's the case they will label it as a i once they have sufficient scientific evidence that ai will be changed to rda so they're the same thing except rda is when there is sufficient scientific evidence ai is when there is not sufficient evidence yet lastly we have our ul or your tolerable upper intake level sometimes you'll see it referred to as your upper limit and this is what we want to stay under we don't want to exceed the ul or the upper limit because this tells us the maximum that you can consume before it becomes bad for you so too much of a good thing can be a bad thing and this is usually the case in nutrition so we want to make sure that we are getting the rda but not going so much higher so much above that in our intake that we are exceeding the upward limit if we exceed the upper limit it is very likely that that nutrient has become toxic for us so again we want to follow the rda we want to meet the rda but we want to make sure that we are staying under the upper limit this over here gives you a visual of how these all all of these different dris work together and how the general public tend to view the needs and how your intake should be compared to how it should actually be viewed so if you take a look on the left hand side the bar on the left where it says inaccurate view this is how unfortunately a lot of the general public use nutrient needs and nutrient intake where you have the rda and anything under the rda is bad for you but anything above the rda is completely fine and the higher up the better you'll see that on that bar the green is at the very very top so people tend to think more is better now when we look at how it actually works the bar on the right hand side that says accurate view you have your ear which is on the border of danger some people will be fine at the ear some will not have their needs met so we don't want to be on the border there we want to move closer into the safety section which is our rda if there is not an rda then it will be your ai this is well into the safety section and so it means that if you follow this number you should be getting your needs met now unlike the bar that we just looked at you'll notice that the green doesn't go all the way up until the top and that's because of the upper limit that we mentioned you don't want to exceed the upper limit you don't want to go over the upper limit because then it can become as bad for you as it is if you didn't get enough so there is a bit of leeway between the rda and the upper limit but once you pass the upper limit that's when it can start being dangerous and can cause a toxicity now the next dietary reference intakes are ones that are more specific to certain nutrients so the ones that we just discussed are ones that are more general recommendations they can be applied to a variety of nutrients whereas the ones that we are going to go over now are more specific and the first one is our estimated energy requirement or your eer this tells you how many calories your body is going to use during the day remember energy and calories are interchangeable so it's basically saying your estimated calorie requirement so this is going to include anything that your body needs to function the amount of calories or energy your body needs to keep you alive the amount of calories that your body uses when you do any kind of physical activity and this is going to include just walking to your car or doing some actual exercise all of that is included in the eer your estimated energy requirement once you have figured out what your eer is you now know how many calories you need to consume in the day after that you want to know where those calories are going to come from remember we have three of our nutrients that provide us with calories carbohydrates lipids and protein so now we want to figure out how do we want to divide up those calories how many of them do we want to come from carbohydrates how many calories do we want to spend on protein and how many from fat or lipids and this is what this specific dri is about this is the acceptable macronutrient distribution range or your amvr this is remember macronutrients are the carbohydrates protein and fat so it's telling you how you want to distribute your calories among these three macronutrients so the ranges that we have is 45 to 65 of your calories should come from carbohydrates so for example if 50 or half of your calories came from carbohydrates then you are following the recommendation we also have for fat 20 to 35 of your calories and then lastly 10 to 35 percent of your calories should come from protein now this is divided up based off of the nutrient needs that your body requires in order for it to function at its best and most efficient so following these ranges is a good starting point for you to be able to figure out a good balance for how you want to set up your diet for the day first finding out the eer how many calories and then finding out in general how you want to distribute those calories by following the amdr now we have down all of the different dris we know which ones that we want to follow and which ones we want to avoid so now we can go ahead and take a look at how we're going to figure out if we are lacking in one of those dris or if we maybe are getting too much of them and that is what we're going to figure out when we do a nutrition assessment when we do a nutrition assessment we are looking for two things we want to find out if you are in good nutrition balance or if you are in a state of mal nutrition malnutrition basically means that your nutrition is off balance it could be in two different ways you could be in a state of under nutrition where you're not getting enough nutrients or you could be in a state of over nutrition where you're getting too many nutrients so when we say that somebody is in a state of malnutrition it's not necessarily that they're going to be skin and bones they could be obese and they are in the over nutrition part of malnutrition meaning they're getting too many calories too much food too many nutrients so they are in a state of over nutrition that counts as malnutrition as well and often the different sides the different spectrums of malnutrition have pretty similar symptoms for example fatigue is one that you'll see in someone who is in a state of under nutrition because their body doesn't have enough calories to function but sometimes fatigue is also seen in over nutrition because the body is just so overloaded and so it's having to work harder the way that we are going to figure out if someone is in a good nutrition balance or in a state of malnutrition is by looking at a few different things to get a big total picture so first thing that we want to look at is their history this includes their diet meaning have they been on any kind of restrictive diets are there certain things that they avoid they consume have they been trying to lose or gain weight but also their health history do they have any kind of health conditions that we need to be aware of we also want to get their anthropometric data which is their height and weight that will give us a good starting point to know if maybe their weight is too high or too low for their height then we also can do some physical examinations and this is looking at things like for example looking at their nails their skin their tongue looking at their eyes these are things that can often show a nutrition deficiency or a nutrition toxicity for example nails can develop things like ridges when there are certain deficiencies or toxicities the white of the eye can become discolored when there is nutrition imbalance as well the tongue can become extra rough or swollen so sometimes an individual might not know that they have a deficiency or toxicity but if we look at the physical symptoms that might be there we could possibly catch a deficiency or toxicity early on lastly we can do lab work or your blood tests this is going to be something that can be done to catch something really early on before it even starts to present itself outwardly in physical symptoms so maybe the physical symptoms aren't showing themselves yet because the deficiency has just begun but by doing blood work on a regular basis you can catch it early on before it gets to that point that is what we're going to do when we want to assess an individual so on a more individual smaller scale but there are also nutrition assessments that are done on larger scale so for a large population this is something that we do in the us there is a group called healthy people and this is a gov this is a government association that basically does a survey of the u.s to get an idea of where we are in general for our health for our nutrition status and puts out recommendations for what we should change in terms of our diet our health in order to be in a better place and they do the survey about every 10 years and then give us recommendations to meet for the following 10 years here are some examples of the most recent objectives that they want us to meet so they did a study in 2010 they went out and did a survey they found out on average how the american diet looks how the american health looks in terms of different kinds of health conditions and they came up with these different objectives that they want us to meet by the time 2020 comes around so for example one of the things that they found out is that less than a third of the us population is at a healthy weight some of them are underweight some of them are overweight some of them are obese and so there is a very very small amount of us that are actually in the healthy weight category and so their first objective is to increase the proportion of adults who are at a healthy weight another thing that they found is that a lot of pregnant women were still suffering from iron deficiencies so that's another thing that you'll see listed there reducing iron deficiency among pregnant females one more that i want to mention they did studies that found that children from as young as two years old weren't getting enough fruits and vegetables in their diet and the ones who were getting enough fruits and vegetables weren't getting a variety so they were only eating carrots on a daily basis for example or only bananas as their fruit and so you'll notice here there are two objectives that cover that we have increased the contribution of fruits to the diet as well as vegetables for the population aged two years and older and then we also have increased the variety of fruits and vegetables in the diets of two years older so these are just some examples of what is included in these studies here you have a few more that you can look at if you're interested you don't need to memorize these but if you're interested in the goals that we are trying to meet by 2020 they are all listed here for you now that is the end of the chapter but we do have a highlight or focus section at the end we won't always cover these but if i do go over them in the audio then that is something that i do want you to know for your exams so this one is just a short little highlight about where you want to get your nutrition information from and how to prevent being misled so when you are getting your nutrition information you want to make sure that it is valid so the first thing that you want to do is figure out who is providing this information if you are looking at an article look at the author of the article what qualifications do they have what experiment what experience what degrees those types of things that would make them qualified to give you this nutrition information if you're looking on the internet you want to make sure that you go to sites that end with dot gov dot edu these are ones that are government and government websites or else college or university websites so they will tend to be more reliable and that is going to at least give you a start to make sure that you are getting reliable information on the internet so keep in mind especially with websites that end in dot com anyone can publish anything on a dot com website so avoid those if you can and look for websites that end with dot gov and edu you then want to look at still who is providing this information what qualifications do they have but also how recent is this information maybe the information that you're looking at is out of date the subject of nutrition is actually a fairly new science we are finding out more and more about it every day and so you want to make sure that it is fairly recent another thing that you want to avoid is just going off of what you hear on the news a lot of times the news will really exaggerate a story about nutrition because it makes it more interesting or they'll leave out part of the story and make it so that you're only getting really part of the picture and it doesn't really apply to everybody and so when you do hear something on the news make sure that you are doing your own research afterwards to see the validity of that information and whether it actually applies to you if you are going to go to someone to help you with your diet you want to make sure that you are going to the nutrition experts which are the registered dietitians registered dietitians take a bunch of college courses in different nutrition subjects they are required to do an internship where they are working in the right under the supervision of other nutrition experts and doctors in various nutrition fields they also have to pass a national exam as well as submit continuing education credits on a regular basis to maintain their credentials so that is going to guarantee that not only have they had the educational knowledge from the courses they also have the experience and they also are up to date on their nutrition knowledge when it comes to a doctor that would be probably your next best bet but if you can go to a dietitian a registered dietitian that is going to be better off for you because doctors actually don't have much basically much time spent in the field of nutrition they take a couple of courses in nutrition in their training and that is about it and so someone who is a registered dietitian is going to be a lot more knowledgeable and a lot more up-to-date on the nutrition information lastly we want to make sure that we are not misled by manufacturers especially when it comes to supplements a lot of manufacturers will try to mislead the customer as a way of marketing their product and basically selling more of their product unfortunately for example one thing that a lot of manufacturers will do is put the word natural on their product to make you think that it's good for you just because something is natural doesn't mean it's effective it also doesn't mean that it's good for you natural things can be bad for you when taken in large quantities like they are in supplement form another thing that you want to avoid or try to look out for is meaningless medical jargon so for example on the one on the right in green it says that it beats the hunger stimulation point or hsp this is something that they put on there to make it seem more scientific so that you can take it more seriously when in reality there is no such thing as hsp or the hunger stimulation point so a lot of times they'll make these things up and slap them on the label to make them seem more legit so you do want to watch out for these things do your own research before you allow these labels to mislead you