NURSING NR 228 Nutrition - Week 3 Nutrition edapt- Introduction to Fats-Chamberlain College of Nursi

Introduction to Fats Many individuals have a love-hate relationship with dietary fats. They love the way fats make food taste, but hate the impact eating fatty foods can have on their health. The key to a healthy diet is moderation of This concept will discuss the nutrition benefits and risks of lipids throughout the lifespan. By completing these active learning activities, the learner will gain the knowledge and skills needed to:  Explore the link between fats and health.  Identify risk factors and conditions contributing to fat related health alterations.  Recognize the complications from too much or too little fat in the diet.  Utilize knowledge of fats and health to promote a balanced diet.  Recommend how individuals can alter their lifestyle to decrease fat consumption.

Lecithin is a phospholipid that is essential in the cells of the body. It can be found in many foods, including soybeans and egg yolks. Lecithin is taken as a medicine and is also used in the manufacturing of medicines. Lecithin is used for treating memory disorders such as dementia and Alzheimer's disease.

Lecithin works as an emulsifier, meaning it suspends fats and oils and keeps them from mixing with other substances.

Lecithin supplements can be purchased to help treat high cholesterol, as a breastfeeding aid, and to treat ulcerative colitis, among other things.

-lecithin -dispersed -soy Your response is correct!

Function of Fats How does the body utilize fats? Select all that apply.

For temperature regulation Protein sparing effect Glucose regulation To protect organs Hormone synthesis The body uses fat (triglycerides) to protect organs, for temperature regulation, and hormone synthesis. The protein sparing effect is when carbohydrates prevent the body from breaking down proteins to use as an energy source. Fats do not play a role in glucose regulation.

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Total calories from fat should compose 30% or less of all calories consumed each day. Your total fat calories should be no more than 30% of all the calories you eat each day. If you have heart disease or a high level of LDL ("bad") cholesterol, you may need to restrict your saturated fat to 5% to 6%, the AHA says. Limiting fat shouldn't be the sole focus of a healthy diet, however. Total calories are also important. To not gain weight, you must balance the number of calories you consume with the number of calories you expend in exercise and other daily activity.

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Types of Fats

The main difference between lipids and fats is that lipids are a broad group of biomolecules whereas fats are a type of lipid. Fat is stored in the adipose tissue and under the skin of animals. It is mainly used as an energy-storage molecule

in the body. Most steroids in the body serve as hormones. It is interesting to note that one pound of adipose tissue yields about 3500 calories. In addition, fat provides 9 K-calories of energy per gram.

Triglycerides Saturated Fatty Acids Phospholipids Sterols

Know Your Fats!

When cooking with fats or adding them to uncooked foods such as sandwiches and salads, choose those that contain fewer saturated fats.

Parent Tips Learn more from the Department of Health & Human Services on Cooking with Healthier Fats and Oils.

Function of Sterols When providing client education on fats, the health professional should provide information on which functions of sterols? Select all that apply.

Sterols are not an essential nutrient since the liver can produce the cholesterol it needs to maintain good health. Sterols are used by the body for vitamin D synthesis and bile production.

The body uses phospholipids for cell membrane structure. The human body cannot synthesize vitamin C. Liver function and gallbladder health are not dependent on the presence of sterols in the diet.

-bile production -vitamin D synthesis Your response is correct!

Calories From Fat With 9 calories per gram, fat is the most calorie dense source of energy in the diet when compared to the 4 calories per gram in proteins and carbohydrates. To calculate the number of calories from fat in a food, multiply the grams of fat in the food by 9 calories.

For example, a one-half cup serving of vanilla ice-cream has 7.3 grams of fat. Multiply 7.3 by 9 to determine that 65.9 calories are from fat, which is almost half of the total calories! Not a very low-fat snack.

Nutrition Facts Serving Size ½ cup (69g) Servings Per Container 16 Amount Per Serving Calories 137 Total Fat 7.3g Sodium 53mg Total Carb. 16g Dietary Fiber 0.5g Sugars 14g Protein 2.3g

% Daily Value 47.9% 2% 46.7% 2%

To lose a pound of fat, a person needs to burn 3500 more calories than they consume. This means that an individual who wants to lose 20 pounds will need to burn 70,000 more calories than they consume (20 pounds times 3500 calories per pound). And that is a lot of calories!

While it seems to make sense that limiting fat intake is the best way to lose excess weight due to body fat, this must be done in moderation.

Lowering daily intake of fats to 10-15% of daily calories and consuming unsaturated fats is safer than eliminating fats altogether.

Calculating Daily Calories From Fat Goal To determine the number of calories and fat grams you need each day to lose, maintain, or gain weight, ask your healthcare provider or a registered dietitian. As a general guideline, to maintain your current weight, follow the 3-step formula below. Remember, everyone's body and metabolism are different, so these numbers could vary slightly for you and can change over time.  Step 1: Multiply total calories to be consumed each day by 30% to calculate calories from fat each day.  Step 2: Since each gram of fat has 9 calories, take calories from fat per day and divide by 9.

Example: An athlete wants 30% of their 2700 calories consumed each day to be from fat. How many grams of fat should they consume each day?  Step 1: 2700 x 0.3 = 810 calories from fat each day.  Step 2: 810 calories ∕ 9 calories per gram = 90 grams of fat per day.

Calories An individual wants to lose 13 pounds before getting married. When meal planning, the person should plan an overall reduction of 45,500 calories to achieve this goal?

To lose a pound of fat, a person needs to burn 3500 more calories than they consume. To lose 13 pounds of fat from the body, the individual would need to consume 45,500 calories fewer calories than they burn.

If the individual wants to lose the weight in two weeks (14 days) an overall calorie deficit of 3,250 per day is needed. That cannot be achieved by reducing calories alone, so exercise will be needed to burn more calories.

Change that time frame to two months (61 days) and the daily caloric deficit drops to 746 calories per day. Depending on their current diet, it is more likely the individual can achieve their goal with moderate changes to both diet and exercise.

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Why People Eat Fats Think about the last time you had a piece of chocolate. How did it taste?

How did it feel on your tongue? How did it make you feel? What properties does chocolate have that makes it so satisfying? Fat, in the form of cocoa butter, which is high in saturated fat. Chocolate also contains steric acid, a saturated fat that does not raise low density lipoprotein (LDL) cholesterol, making it relatively healthy when consumed in moderation.

Overall, fats help food taste great, and their smooth texture feels good on the tongue. Fats provide satiety, or fullness, and provide a sense of contentment, or calm. Since fats are slower to digest than other food components, the feeling of fullness lasts longer and helps to maintain a normal serum glucose level. Fats are used by the body for organ protection, hormone synthesis, and energy storage.

The key to health is to eat the right types of fats in moderation. Healthy fats are found in many foods, including:          

Avocados Cheese Dark chocolate Whole eggs Fatty fish Nuts Chia seeds Extra virgin olive oil Coconuts Full-fat yogurt

Omega-3 Fatty Acids Omega-3 fatty acids are contained naturally in which food items? Select all that apply.

Chia seeds Sardines Flax seed Pork Margarine Salmon Processed cheese Omega-3 fatty acids occur naturally in oily fish (salmon and sardines), flax seed, and chia seeds.

Dairy products (margarine and processed cheese) do not naturally contain omega-3’s, though they may be present if added during processing.

Current feeding practices give pork a high omega-6 (n-6) to omega-3 (n-3) fatty acid ratio and make it a poor source of omega-3 fatty acids (Dugan et al., 2015).

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Digestion of Fat

Fat digestion starts in the mouth and ends in small intestine. Bile, pancreatic lipase, and mechanical digestion all play a role in breaking down fat. Cholecystokinin (CCK) is a hormone released in the duodenum that controls bile secretion. Bile is important because it acts as an emulsifier that further breaks down (catabolizes; digests) fat so it can be absorbed into the blood and transported to cells. In addition, bile salts

assist with the absorption of fat into the body. The pancreas plays a role in fat digestion by releasing pancreatic lipase that further breaks down triglycerides.

Once absorbed, triglycerides are initially transported in the lymphatic system, then absorbed into the bloodstream to be used by cells. During this transportation process into the bloodstream, triglycerides are formed into chylomicrons. Glycerol and other short-chained fatty acids are absorbed.

As fats are delivered to individual cells, anabolism is used to create new structures (such as cell walls) and substances (like hormones) that contain fats.

Individuals with alterations of the small intestine that interfere with fat absorption are likely to experience symptoms such as abdominal pain, bloating, chronic diarrhea and steatorrhea (fatty stools) due to the high fat content. Since fats are not being absorbed, nutrients that rely on fat for absorption, such as vitamins, A, D E, and K, may also become deficient.

Catabolism is the breakdown of fats to create energy and anabolism is the use of fats to create hormones within the body. A client with an alteration in the function of the small intestine will absorb dietary fats poorly. Signs and symptoms of altered fat absorption include hair loss, fatty stools, and infection.

Individuals with alterations of the small intestine that interfere with fat absorption are likely to experience symptoms such as abdominal pain, bloating, chronic diarrhea and steatorrhea (fatty stools) due to high fat content. Since fats are not being absorbed, nutrients that rely on fat for absorption, such as vitamins, A, D, E, and K, may also become deficient, leading to hair loss (vitamin A) and bleeding gums (vitamin K). They are not likely to experience acne, foul breath, loss of hearing, weight gain, dermatitis, or dysmenorrhea due to fat malabsorption. The production of bile requires sterols (a type of lipid). When fat absorption is decreased, less bile (not excess) is available in the body.

-catabolism -anabolism -small intestine -hair loss -fatty stools -infection Your response is correct!

Lipoproteins

A molecule of lipoprotein contains both lipids (lipo-) and proteins.

Lipoproteins are responsible for the transportation of fat particles in the blood which are measured as serum cholesterol. Since proteins weigh

more than lipids, lipoprotein molecules with a higher ratio of protein to lipids are dense, making them healthier. In the same manner, lipoprotein molecules with a higher proportion of lipid to proteins are less dense, and not as healthy.

Lipoproteins are categorized based on their density.

Chylomicrons, also known us ultra-low-density lipoproteins, are composed of triglycerides (85–92%), phospholipids (6–12%), cholesterol (1–3%), and proteins (1–2%). These molecules are primarily made up of triglycerides and a small amount of protein. Chylomicrons are responsible for transporting lipids from the intestinal tract to cells in the body.

The remaining lipoproteins, in descending order of fat content are verylow-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL).

Because increased levels of LDL are associated with the development of cardiovascular disease, LDL is also known as the “bad” cholesterol.

Essential Fatty Acids Essential fatty acids (EFA) are fats the body cannot make. These fats must be consumed from one's diet. Examples of these lipids are triglycerides that are unsaturated, such as omega-3 fatty acids. Signs and symptoms of EFA deficiency are dry scaly skin, hair loss, wight loss, and poor wound healing (Parrish, 2017).

Client's most at risk for EFA deficiency include:    

Any client on an extremely low-fat diet Clients with fat malabsorption Clients receiving treatment for protein malnutrition Clients recovering from serious burns and accidents

Fat Intake Across the Lifespan

To date, there is no golden rule guiding daily fat intake. Generally, some fat intake, particularly intake of unsaturated fats, can have beneficial effects on the human body. Children especially need some fat in their diets to promote healthy growth and development. However, any type of fat, including these healthier dietary fats, can have negative effects when consumed in excess. Below are some guidelines regarding the amount and types of fat a person should consume.

Fat Intake by Age Age

Suggested Fat Intake Limit

2-3 years

30% to 40% of Total Calories

4-18 years

25% to 35% of Total Calories

19+ years

20% to 35% of Total Calories

All ages are encouraged to follow these healthy guidelines for fat intake.  Consume less than 10% of daily caloric needs in the form of saturated fats (Zeratsky, 2019).  Limiting consumption to less than 7% has been shown to reduce the risk of heart disease.  Replace saturated fats with unsaturated fats whenever possible.  Minimize consumption of trans fats.  Consume less than 300 mg of dietary cholesterol each day.

References Zeratsky, K. (2019, May 3). What's an easy way to see how much fat I eat each day? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutritionand-healthy-eating/expert-answers/fat-grams/faq-20058496

Fats and Other Nutrients

Individuals on extremely low-fat diets are at risk for developing deficiencies of which nutrients? Select all that apply.

Fats are responsible for the transport of fat-soluble vitamins A, D, E, and K (ADEK). Clients that have fatty acid deficiency will have alterations absorbing vitamins ADEK. Vitamin C is a water-soluble vitamin. Iron and zinc are essential minerals needed to maintain good health.

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Heart Healthy Facts About Fat Whether lowering fat intake for heart health, weight loss, or to feel better, the principles are the same: increase unsaturated fats, limit saturated fats, and stop using trans fat, hydrogenated oils and tropic

Love It

Unsaturated (Poly & Mono)  Lowers rates of cardiovascular and all-cause mortality  Lowers bad cholesterol & triglyceride level  Provides essential fats your body needs but can’t produce itself

Limit It

Saturated  Increases risk of cardiovascular disease  Raises bad cholesterol levels

Lose It

Artificial Trans Fat, Hydrogenated Oils & Tropical Oils  Increases risk of heart disease  Raises bad cholesterol levels

Rethinking Fats Knowing the facts about facts is the first step toward meeting nutritional health goals. The knowledge must be followed with actions, which can be challenging. Here are some tips on how to start rethinking fats (MyPlate, n.d.).

Involve EveryoneWho Shops for Food and Prepares Meals Check the Label First Eat Foods with Healthy Fats Limit Saturated Fat Skimp on "Solid Fats" Swap the Spread Customize Your Order

Essential Fatty Acid Deficiency Mr. Henry is 87-years-old and lives alone. During a recent home health visit the client stated his diet consists of chicken broth and crackers

because that is all he could afford. Which symptoms of an essential fatty acid (EFA) deficiency might the client experience? Select all that apply.

Decreased appetite Dry, scaling skin Fever Hair loss Polyuria Poor wound healing Productive cough Weight loss Broth and crackers are extremely low-fat foods that provide few essential fatty acids. Symptoms an individual may experience that indicate an EFA deficiency include dry scaly skin, hair loss, weight loss, and poor wound healing (Parrish, 2017).

Fever, decreased appetite, and a productive cough may be a cluster of symptoms experienced by an individual with a respiratory infection.

Polyuria may indicate fluid volume excess, bladder infection, or an alteration in hormonal regulation.

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Known values: 1 gram of fat = 9 calories; total calories per day = 2000; and 20% of calories from fat each day.

Step 1: 2000 x 0.2 = 400 calories from fat each day.

Step 2: 400 calories ∕ 9 calories per gram = 44 grams of fat per day.

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Mr. Henry is eating out with friends. The restaurant menu indicated the french-fries are cooked in beef fat (tallow), which is high in saturated fats.

He selects the oven roasted potatoes with rosemary, salt, and extra virgin olive oil, which is higher in monounsaturated fats.

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Sorting Fats Mr. Henry is meeting with the registered dietician (RD) to review his knowledge of fats. How should Mr. Henry complete the chart? Drag the foods to the column that corresponds to the primary type of fat it contains. Not all food choices will be used.

Foods

Unsaturated Fat

Trans Fat

Saturated Fats

Salmon Avocados Peanut butter

Fried potatoes Partially hydrogenated vegetable oil Donuts

Ice cream Chicken thigh with skin Ground beef

Good fats are monounsaturated and polyunsaturated fats. They are heart healthy fats found in plant sources such as avocados and peanuts.

Consuming high levels of trans fats and saturated fats can raise cholesterol levels and causes diet related diseases such as stroke and heart diseases. Trans fat and saturated fats should be less than 10 % of an induvial daily diet calories intake. The amount of trans fat and saturated fats in a food item can be identified on food package labels.

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Family Meal Planning A single parent of three teen-aged children is scheduled for education on lowering the family’s daily fat intake. Which members of the family should be included in the education? Select all that apply.

It is recommended that all individuals involved with shopping for food and preparing meals should be involved with health education focusing on dietary changes. These are the individuals most likely to understand the

dietary needs and preferences of all family members, budget for foods, and amount of time that is spent cooking.

It is not necessary for every family member to attend the educational session if they are not all shopping for food and preparing meals. In a busy, single-parent household, the duties are often shared between the parent and an older child. Although it makes sense that anyone who is interested in learning about healthy fats should go, if one of the shoppers or cooks is not interested in learning, they should still attend the session.

-those who shop for groceries -those who prepare meals Your response is correct!

Omega-3 Fatty Acids Mr. Williams is a 67-year-old retired oil worker who wants to consume more Omega-3 fatty acids. Which foods should he include in his diet? Select all that apply.

Sardines Pork fat Shrimp Canola oil Salmon Omega-3 fatty acid is a polyunsaturated fat. Rich sources of this fat include oily fish (salmon and sardines), canola oil, flaxseeds, and chai seed.

Palm oil and pork are high in Omega-6 fatty acid. Shrimp is high in cholesterol.

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Fats After Bowel Surgery An individual who had had the duodenum removed should consume which foods in moderation? Select all that apply.

Bread Corn Mayonnaise Baked chicken Ice cream Lamb Cream sauces Fried fish Following a duodenal (first part of the small bowel) resection the individual will be unable to digest high fat food such as lamb, ice cream, mayonnaise, cream sauces, and fried fish. The client will have difficulty digesting high fat foods because the duodenum is where bile furthers the digestion of fats and bile salts promote absorption into the blood.

Low fat foods, such as bread, baked chicken, and corn can be eaten as tolerated.

Note: Following gastrointestinal surgery other dietary restrictions may be required.

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Calories Consumed as Fats After completing a 24-hour food diary, Ms. Wynters determines that she consumed 26 grams of fat and a total of 1483 calories. What percentage

of her total calories are from fat? Enter only a numeric value expressed as a whole number.

Total Calories from Fat: 16 This calculation is the opposite of planning how many grams of fat an individual can eat in a day. To get this percentage, divide calories from fat by total calories and then multiply by 100.

Known values: 1 gram of fat = 9 calories; total calories per day = 1483; and 26 grams of fat consumed were consumed in a 24-hour period.  Step 1: 26 grams of fat x 9 calories per gram = 234 calories from fat  Step 2: 234 calories from fat / 1483 total calories = 0.162 x 100 = 16.2 rounded to 16% of total calories came from fat  The answer is 16 (answer expressed as a whole number)

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Nursing Care of a Client with Imbalanced Fat Intake Fats plan an important role in maintaining good health. Unfortunately, not all fats promote health, especially when eaten in excess of the body’s needs. This lesson will review the nurse’s role in recognizing complications resulting from imbalanced fat intake and promoting health through a balanced diet including health fats.

As you complete the concept, you will gain the nursing knowledge and skills needed to:  Recognize assessment cues indicating a nutritional imbalance of fats.  Identify factors that influence a client’s choice of dietary fats, including lifespan, cultural, and socioeconomic factors.  Educate clients on improving their health through the selection of dietary fats.

Source of Triglycerides When evaluating the knowledge of a client learning about lipoproteins, the nurse determines that additional education is needed when the client identifies which items as the "good" cholesterol? Select all that apply.

Chylomicrons, also known us ultra-low-density lipoproteins, are composed of triglycerides (85–92%), phospholipids (6–12%), cholesterol (1–3%), and proteins (1–2%). These molecules are primarily made up of triglycerides and a small amount of protein. Chylomicrons are responsible for transporting lipids from the intestinal tract to cells in the body.

The remaining lipoproteins, in descending order of fat content are verylow-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL).

Because increased levels of LDL are associated with the development of cardiovascular disease, LDL is also known as the “bad” cholesterol.

Compared to LDL, HDL consists of less cholesterol and more protein, making these lipoproteins the densest. HDL is made in the liver and in the intestines. It is responsible for carrying cholesterol from cells back to the liver. Because of this, HDL is also considered the “good” cholesterol.

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Low-Fat Dietary Choices A nurse is teaching a client with pancreatitis about a low-fat diet. Which food should be included on a list of high-fat snacks to avoid?

Although plant-based, potato chips that are fried in oil have a high fat content, as much as 10 grams. The other choices, two plant-based (apple and broccoli) and the animal-based protein (salmon), are prepared using less fat and are healthier options.

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Bile is produced exclusively in the liver. It may then be stored in the gall bladder so that it can be released during digestion of a fatty meal. No bile is produced in the stomach, duodenum, or ascending colon. Most of the bile is cholesterol-derivatives that stick to dietary fiber and are excreted along with the fiber. Thus, increasing fiber is (mainly soluble) is an effective way to decrease cholesterol.

1.produces bile 2-4. does not produce bile Your response is correct!

The Deal With Fat

Fats are complex chemical structures that provide vital nutrients and energy to the body and make foods taste good. The downside of fats is that not all types of fat are good for the body.

The Deal With Fat Watch the video The Deal With Fat for a brief overview of the chemical of fats.

Lipid Profile A lipid profile is a blood test used to assess a person’s risk of developing cardiovascular disease (screening) and to evaluate treatment of unhealthy lipid levels (monitoring). Though most lipid profiles include total cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides, the exact fats measured on a lipid profile may vary by laboratory. Click on each value below to learn more about the specific test and normal ranges.

Nursing Process and Fats

Nursing Diagnosis It is imperative that nurses teach clients the health risk associated with consuming a high fat diet. Often clients will not have any early symptoms of hypercholesterolemia. Symptoms of hypercholesterolemia occur after the disease progresses and there is substantial plaque buildup in the arteries. Clients who have high cholesterol levels and do not modify their diets will be at risk of developing diet related diseases such as heart disease and diabetes mellitus.

Nursing diagnosis include:  Risk for alter altered tissue perfusion  Nutrition imbalance: more than body requirements

Planning The nurse is aware that the client's goals must be patient-centered for the client to reach their goals. The nurse also understands that the lifestyle and diet changes occur incrementally. The plan of care should allow the client to adjust and make mistakes.

During a family diet education session, the nurse will:

 Identify positive outcomes the patient wants to achieve. This allows the nurse to make goals incremental, measurable, and specific to the client.  Identify foods the family consumes on a regular basis. This approach allows the nurse to discuss the nutrient values of foods currently in the diet. This will also allow the nurse to make healthier comparable food suggestions based on the economic stability of the client.  Compare and contrast other food options that are comparable. This prevents the nurse from discussing foods as bad and good but instead focuses on food selection in reference to limiting the intake.  Provide resources and recommendations on selecting healthy foods at restaurants and grocery stores. This empowers the client to make healthy food selection decisions that will maintain health in their environment. Providing resources such as Apps and websites addresses the Social Determinants of Health (health literacy).

Providing clients resources that will increase the client's knowledge also addresses the client's health literacy.  Verify learning has occurred. This step allows the nurse to assess if further education is required. The nurse will refrain from asking the client if they understand not to consume a high fat diet. Rather, the nurse will ask specific, patient-centered questions that reflect the food items currently in the clients' diet of foods they will incorporate into their diet.

Fats and the Lifespan The client asks the nurse if they should limit the fat intake of their 10-yearold and 1-year-old. What is the nurse’s best response?

The 10-year-old should have low fat food items such as low-fat yogurt and soy milk. The one-year-old should continue to receive at least 30% of their total caloric intake from fat. The one-year-old needs the fat content for rapid growth and development and the 10-year-old should consume low fat food items to reduce consumption of empty calories (Nemours Foundation, 2017). It was found that American between the ages of 2-18

receive 40 % of their caloric intake from saturated fats (U.S. Department of Health & Human Services, 2017). It is important for nurses to educate each family member on the proper nutrients each person should consume. Educating each family member will reduce confusion and increase accountability.

The 10-year-old should have low fat food items. The 1-year-old should continue to receive at least 30% of their total caloric intake from fat.

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Lifestyle Changes to Reduce Fat Intake Recommendations nurses can make to help clients reduce saturated fats and increase healthy fats (Office of Disease Prevention and Health Promotion, 2016).

Tips for decreasing harmful fats in a client’s diet:  Read food labels and avoid trans fats and hydrogenated/ partially hydrogenated oils. It is important to read the label for ingredients as well as fat content.  Avoid fried products. Fried products contain more saturated fats.  Avoid fast food. Fast food contains increased amounts of saturated fats. In addition, fried fast food contains a lot of empty calories.  When eating out, ask that foods be prepared with olive oil. Olive oil is a monounsaturated fat and is healthier than saturated fat.

Tips for increasing healthy fats in a client’s diet:  Cook with olive oil.

 Plan snacks of nuts or olives. Nuts have high amounts of monounsaturated fats.  Eat more avocados. Avocados contain high amounts of monounsaturated fats. These fats are good to consume.  Dress your own salads instead of using commercial dressings. Use monounsaturated oils to make your own salad dressing.

Commercial salad dressings contain unhealthy fats and high amounts of sugar.

Case Study Let's follow the nurse as she educates William on healthy fats and oils to consume.  Patient Information

Name: William D. Height: 5′9” Weight: 200 pounds Total cholesterol 300 mg/dL, low-density lipoprotein (LDL) 220 mg/dL, high-density lipoprotein (HDL) 35 mg/dL, and triglycerides 200 mg/dL

Hyperlipidemia and hypercholesterolemia related to unhealthy diet and familial history as evidenced by total cholesterol of 300 mg/dL, LDL of 220 mg/dL, HDL of 35 mg/dL, and triglyceride level of 200 mg/dL William is a 35-year-old man who lives a sedentary lifestyle and admits to most of the meals he consumes are fast food. His father has heart disease and a stoke at 55 years old. William is married with two children, 10- and 11-month-old. William is very concerned about his health and well-being.

Client Education: Dietary Fats

During the education session, the nurse will use resources the client can access at home. These resources will allow the client to make informed decisions about food selection within their environment, such as when grocery shopping.

The nurse introduced William to the Fooducate app on his smart phone.

Now William scans UPS codes to find the nutrient value, including fats, in the food before he makes a purchase. Since he began scanning and comparing brands, William has discovered that many store-branded products are just as healthy as the name-brands. Switching to the lower cost options provided money to buy more fresh fruits and vegetables.

Healthy Lifestyle

William returned for a six-month follow-up visit. Which cues indicate he is following a healthy lifestyle and diet? Select all that apply.

Increased HDL level and eating low fat cheese are cues that indicate the client is following a healthy lifestyle and diet. Total cholesterol above 360 and increase LDL levels indicates the client is consuming too much cholesterol and/or too much saturated fat. The recommended total cholesterol intake should be 300mg per day. It is recommended the total cholesterol level from a cholesterol laboratory panel should be less than 200. William’s weight gain indicates he is not making progress on his diet and healthy lifestyle.

-"I discovered that low fat cheese tastes good."

-increased HDL Your response is correct!

Evaluation of Outcomes The nurse should allow adequate time for William’s family to incorporate healthy eating and lifestyle changes. It is important for the nurse to know that lifestyle changes should be introduced incrementally. This will allow time for the client to adapt and make mistakes.

Expected outcomes include:

Short Term:

 William identified foods high in saturated fat.  William will calculate fat from food labels  William will take his statin every day as prescribed

Long Term (at the end of 6 – 8 months):

 William states he consume a healthy diet XX % more than previous visits  William will lose 5 pounds  William LDL level decline  William verbalizes eating more baked salmon and other fish 3 days a week

Client Education: Types of Fats

Nurses must teach clients they should consume more polyunsaturated and monounsaturated fats. These types of fats are contained in products such as canola oil, peanut oil, and avocado oil.

Saturated fats should be consumed sparingly, and trans fat should be removed from the diet (AHA, 2017). Saturated fats are found primarily in meat products, palm oil, and coconut oil. It is important to note that trans fats are processed by the body like they are saturated fats. This is why trans fats are unhealthy and can lead to heart disease. It is important to note margarine can be consumed in moderations. Margarine is made from monounsaturated fats. It is important to mention that some margarines can contain high amounts of trans fat so it is vital to read the food labels.

Love It

Unsaturated (Poly & Mono)  Lowers rates of cardiovascular and all-cause mortality  Lowers bad cholesterol and triglyceride levels  Provides essential fats your body needs but can’t produce itself

Limit It

Saturated  Increases risk of cardiovascular disease  Raises bad cholesterol levels

Lose It

Artificial Trans Fat, Hydrogenated Oils & Tropical Oils  Increases risk of heart disease  Raises bad cholesterol levels

Client resources There will be instances when clients may have difficulty determining how much fat is in a food product. This may occur in restaurants or even at the grocery store.

Many phone apps and websites can identify the amount of fats and cholesterol in food. Nurses must be able to provide clients with resources that will help them make healthy diet and lifestyle decisions.

Resources These websites will provide nutrition information about whole foods and restaurant foods.  Nutritionix Database  Myfitnesspal References AHA. (2017). The facts on fats. https://www.heart.org/en/healthy-living/healthyeating/eat-smart/fats/the-facts-on-fats

Client Education: Types of Fats Nurses must teach clients they should consume more polyunsaturated and monounsaturated fats. These types of fats are contained in products such as canola oil, peanut oil, and avocado oil.

Saturated fats should be consumed sparingly, and trans fat should be removed from the diet (AHA, 2017). Saturated fats are found primarily in meat products, palm oil, and coconut oil. It is important to note that trans fats are processed by the body like they are saturated fats. This is why trans fats are unhealthy and can lead to heart disease. It is important to note margarine can be consumed in moderations. Margarine is made from monounsaturated fats. It is important to mention that some margarines can contain high amounts of trans fat so it is vital to read the food labels.

Love It

Unsaturated (Poly & Mono)  Lowers rates of cardiovascular and all-cause mortality  Lowers bad cholesterol and triglyceride levels  Provides essential fats your body needs but can’t produce itself

Limit It

Saturated  Increases risk of cardiovascular disease  Raises bad cholesterol levels

Lose It

Artificial Trans Fat, Hydrogenated Oils & Tropical Oils  Increases risk of heart disease  Raises bad cholesterol levels

Client resources There will be instances when clients may have difficulty determining how much fat is in a food product. This may occur in restaurants or even at the grocery store.

Many phone apps and websites can identify the amount of fats and cholesterol in food. Nurses must be able to provide clients with resources that will help them make healthy diet and lifestyle decisions.

Resources These websites will provide nutrition information about whole foods and restaurant foods.  Nutritionix Database  Myfitnesspal References

AHA. (2017). The facts on fats. https://www.heart.org/en/healthy-living/healthyeating/eat-smart/fats/the-facts-on-fats Margarine is better because it contains more monounsaturated and polyunsaturated fats than butter. Margarine is made from liquid fats that have been processed to be solid at room temperature. Margarine also contains less saturated fats than butter. In addition, margarine does not contain cholesterol since it is not a product from an animal. It is recommended clients consume margarine that doesn't have trans fats and has the least amount of saturated fat. Trans fat, like saturated fat, increases blood cholesterol levels and the risk of heart disease. In addition, trans fat lowers high-density lipoprotein (HDL) or "good" cholesterol levels (Zeratsky, 2020).

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Calculating Grams of Fat The client's cholesterol levels did not improve after one year of treatment.

The registered dietician recommended the client reduce their dietary intake of saturated fats to no more than 10% of their total daily caloric intake. The client routinely consumes 1800 calories per day. What is the maximum grams of fat this client should consume? Enter only a numeric value rounded to the whole number The client should consume no more than 20 grams fat (1800 calories /10%) = 180 total calories from fat.

(180 fat calories /9 calories per gram of fat) = 20 grams from fat The nurse will educate the client on how to read all food labels and ensure that the total fat content is less than 20 grams per day.

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Recognizing Cues: Fats When reviewing a client’s 24-hour dietary recall, the nurse identifies which sources of saturated fats? Select all that apply.

In general, fats from animal-based foods have higher proportions of saturated fats. These include butter, sausage, pastrami, and mayonnaise.

Processed foods, such as potato chips and microwave popcorn, may have unhealthy fats added during preparation.

Eggs are low in saturated fat, though high levels of cholesterol are found in the yolk. Most plant-based foods are lower in fat when compared to animal-based foods. For this reason, toast, orange juice, banana, strawberries, and pretzels will not contribute significant saturated fats to the client unless it has been added during preparation. Processed snacks that are baked, like pretzels, will be lower in fat than those that are fried, like potato chips.

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Analyzing Cues: Fats The patient has been diagnosed with cardiovascular disease and placed on a low-fat diet. The patient asks the nurse, "How much fat should I have? I guess the less fat, the better." What is the best response by the nurse?

Deficiency occurs when fat intake falls below 10% of daily nutrition.

Various types of fatty acids have significance for health and for the incidence of disease and are referred to in dietary guidelines. Linoleic acid and arachidonic acid are important for metabolic processes but are manufactured by the body when linoleic acid is available. Most animal fats have high proportions of saturated fatty acids, whereas vegetable fats have higher amounts of unsaturated and polyunsaturated fatty acids.

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Prioritizing Hypotheses: Fats The patient with cardiovascular disease must be taught how to reduce the risk of cardiovascular disease by balancing calorie intake with exercise to maintain a healthy body weight. In addition to this, the nurse instructs the patient to: Although a healthy diet limits saturated fat to less than 10% of fat intake, the American Heart Association recommends limiting saturated fat to less than 7% for individuals with cardiovascular disease. Diet therapy includes eating fish at least 2 times per week and eating whole grain high-fiber foods.

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Generating Solutions: Fats William returned to the clinic a year later. William stated to the nurse, “ I have reduced my intake of saturated fats. I do not eat processed breakfast meat and I exercise 3 days a week.” What outcome would the nurse expect?

Processed breakfast meat is high in saturated fats. Saturated fats increase LDL levels and decrease HDL levels. The nurse would expect the client's LDL and VLDL levels to decrease. In addition, the nurse may also see a rise in the HDL levels.

Processed breakfast meat is high in saturated fats. Saturated fats increase LDL levels and decrease HDL levels. The nurse would expect the client's LDL and VLDL levels to decrease. In addition, the nurse may also see a rise in the HDL levels.

Taking Action: Health Promotion – Dietary Fats

When working with William on a plan to remain on a heart healthy, low-fat diet, the nurse takes into consideration that the he will not be able to control his fat intake 100% of the time and provides knowledge on the healthiest options. In what order should the nurse place these cooking fats and oils, starting with the healthiest and ending with the least healthy?

Order the fats from healthiest to least healthy.

 Canola oil  Olive oil  Peanut oil  Lard  Palm oil With only 7% saturated fats (saturated fat, trans fat, and cholesterol), canola oil is the best option of those presented. Olive oil, with a more distinctive taste is next healthiest at 15% saturated fats.

Peanut oil, the last of the plant-based oils listed, has 19% saturated fats. The only animal-based fat, lard, has 43% saturated fats.

Although palm oil is plant-based, it is the highest in saturated fats with 51%.

Because the properties and flavor of oil can impact how the food cooks and tastes, individuals often prefer to use more than one oil for food preparation. Olive and sesame oils may be used when making salad dressings, marinades, and sautéing foods, while corn or canola oil is used for frying. The nurse should encourage all clients to try different oils to find a substitute that adheres to their daily fat intake goal while adding to their enjoyment of food.

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Evaluating Outcomes: Fats

The client is on a low-fat diet. He stated to the nurse he wants to start using coconut oil for cooking and baking. What should be the nurses next response?

Coconut oil is unhealthy because it's considered a saturated fat. Saturated fats are the unhealthiest fats to consume because they can raise LDL levels and cause heart disease. Polyunsaturated fats are found in foods such as nuts and flaxseeds. It is important to note that sterols are only contained in animal meat and cheese.

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Evaluating Outcomes: Client Education on Dietary Fats The nurse determines that William has incorporated healthy cooking oils into his diet when he shares that he deep fried the family turkey in fat?

The healthiest fats and oils contain the least amount of saturated fat, trans fat, and cholesterol. Since plants contain less of these fats, they are the healthiest options. Of the options listed, safflower oil is lowest in fat (10%) followed by corn oil (13%). Animal fats are high in the unhealthy fats (chicken fat has 30% and butter has 68%) and should be avoided.

The nurse should keep in mind that the use of fats for cooking can have cultural, social, and economic influences. When working with clients who wish to switch to healthier options, these influences often act as barriers.

For more information review cooking with healthier fats and oils from the U.S. Department of Health & Human Services.

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Snacks

The nurse asked a client to select the best low-fat snack by looking only at the nutritional information. Which snack should the client select?

Since the goal of a low-fat diet is that 20% or fewer calories come from fat, assuring all meals and snack adhere to that amount is a good plan. To get this percentage, divide calories from fat by total calories (this information appears on the food label) and then multiply by 100. For example, if a 300calorie food has 60 calories from fat, you divide 60 by 300 and then multiply by 100. That food has 20% of its calories from fat.  With a total of 250 calories per serving, it has the lowest calories from fat (37). This means that 15% of the calories come from fat.

This is the best choice.  200 calories per serving with 70 calories from fat = 35% of calories are from fat. This is not the best choice.  150 calories per serving with 45 calories from fat = 30% of calories are from fat. This is not the best choice.  125 calories per serving with 50 calories from fat = 40 % of calories are from fat. This means this is the least health snack of those listed.

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