5-1. INTRODUCTION

Food is essential to life. To sustain life, the nutrients in food must perform three functions within the body: build tissue, regulate metabolic processes, and provide a source of energy. A proper diet is essential to good health. A well-nourished person is more likely to be well developed, mentally and physically alert, and better able to resist infectious diseases than one who is not well nourished. Proper diet creates a healthier person and extends the years of normal bodily functions. Diet therapy is the application of nutritional science to promote human health and treat disease.

5-2. FACTORS WHICH INFLUENCE EATING PATTERNS

We all eat certain foods for reasons other than good nutrition and health. Our eating patterns develop as part of our cultural and social traditions and are influenced by our life style and life situation. It is important for the nurse to understand factors, which influence food choice and eating patterns.

a. Social Aspects. Most people prefer to eat with someone, and the patient is probably used to eating meals with his family. In the hospital he is served his food on a tray and left alone. Poor nutrition may be the result.

b. Emotional Aspects. The patient may feel guilty for not eating all the food served, or may overeat just because the food is there. The patient may overeat because he or she feels sad, lonely, or depressed or may refuse to eat for the same reasons. Certain foods may be considered "for babies." Some foods may be used as rewards."

c. Food Fads and Fallacies. These are scientifically unsubstantiated, misleading notions or beliefs about certain foods that may persist for a time in a given community or society. Many people follow fad diets or the practice of eating only certain foods. Food fads fall into four basic groups: Food cures, harmful foods, food combinations that restore health or reduce weight, and natural foods that meet body needs and prevent disease.

d. Financial Considerations. The patient's financial status has a great bearing on eating patterns. Most people in the United States can afford a diet, which includes a variety of foods and a sufficient number of calories. However, many Americans consume an excessive amount of fat and sodium. Excess fat consumption has been shown to be related to the development of heart disease. Excess sodium consumption may be a problem for some patients with hypertension. Many Americans with lower incomes consume a great percentage of their calories in the form of fat, since fat is the least expensive nutrient (when compared to carbohydrate and protein) and provides for greater satiety (feeling of "fullness" after eating) than both carbohydrate and protein."

e. Physical Condition. The patient may not feel well enough or strong enough to eat. Encourage the patient to eat without forcing him to do so. Encourage him to feed himself, so that he will not feel helpless.

f. Cultural Heritage. Food preferences are closely tied to culture and religion. Understanding these preferences will enable you to assist the patient in reaching and maintaining good nutritional health.

(1) African-Americans. Food habits may be based on West Indian, African, or regional American influences. The majority of African-Americans are lactose intolerant and avoid milk but can tolerate cheese, yogurt, and ice cream. African-Americans who have been in the US for many generations have similar eating patterns to other Americans. Their diets are rich in fat, salt, sugar, and starches. Those who have recently immigrated to the US eat the staple rice and bean combination, yams, and tropical fruits.

(2) Hispanic-Americans. The Hispanic population is thought to be 60 percent Mexican, 18 percent Central and South American, 15 percent Puerto Rican, and 7 percent Cuban. They are a varied group having different food habits.

(a) Mexican-Americans eat tortillas, rice and beans with most meals. Meats are heavily spiced, and often chopped or ground. Adults use limited amounts of milk and milk products, but enjoy sweet baked desserts, sweetened beverages such as hot chocolate and carbonated drinks.

(b) Puerto Ricans tend to adopt American food habits. Traditional meals include white rice cooked with lard and served with beans. Some practice the "hot-cold" theory in the treatment of illness with food.

(c) Cuban-Americans use rice and beans extensively and meat is served if income is sufficient. Children drink milk but adults use milk only in coffee.

(3) Chinese-Americans. A common dietary principle is "Fan-tsai." Fan is the grain and tsai are the vegetables or other items served at the meal. Chinese-Americans obtain 80 percent of their calories from grains and 20 percent from vegetables, fruits, animal protein, and fats. Most adults dislike milk and cheese. Lactose intolerance is common.

(4) Japanese-American. Most Japanese-American's eating habits are Westernized. Traditional meals are light and little animal fat is used. The major starch used is rice. Meals contain fish, soup, fresh or pickled vegetables, and tea.

(5) Indian-Americans. Eating patterns vary, depending upon the religion, and the province and climate from which the Indian-American came. If from northern India, wheat is the primary grain used and meat dishes are popular. If from southern India, rice is the primary grain used, the food is highly spiced, and the person will usually be a vegetarian because of Hindu beliefs. Sweets are very sweet and eaten often. Most Indian-American's eat only two meals daily. Only the right hand is used for eating. Women eat only after men and children have eaten, even if they are ill. Traditional fads and fallacies result in a high rate of stillbirths, low birth weight infants, and a high maternal death rates.

(6) Native-Americans. Because about 200 different tribes of Native Americans exist in the United States, each with its own language, folkways, religion, mores, and patterns of interpersonal relationships, caution needs to be taken in generalizing about Native American culture and food preferences. Various tribal groups differ in their traditional values and beliefs. Each tribe assigns symbolic meanings to foods or other substances. At least one-third of the Native American population is poverty-stricken. Associated with this income level are poor living conditions and malnutrition.

5-3. RELIGION

Cultural and religious practices are often intertwined. Many people refrain from eating certain foods, or eat specific foods in certain combinations, because of their religious beliefs. There are some major religious customs related to diet that, as a nurse, you must be aware of.

a. Hindu. Most Hindus are lacto-ovo vegetarians. They do not use stimulants such as alcohol or coffee.

b. Moslem (Islam). Meat and poultry must be slaughtered according to strict rules. Moslems do not eat pork or pork products. They do not drink alcoholic beverages. They do drink tea. Moslems fast for one month each year, avoiding food from dawn until after dark.

c. Jewish (Orthodox). Orthodox Jews do not eat pork, shellfish, or scavenger fish. They do eat beef, veal, lamb, mutton, goat, venison, chicken, turkey, goose, and pheasant. Meat must be slaughtered by a ritual method. Meat and milk may not be served at the same meal. Meat and dairy foods must be prepared in separate containers and with separate utensils. Certain days of fasting are observed, but a rabbi may excuse an elderly or ill patient.

d. Mormon. Mormons do not drink alcohol, coffee, tea, or caffeine containing carbonated beverages. They do not use extremely hot or cold foods (no ice in beverages).

e. Roman Catholic. Catholics may voluntarily abstain from eating meat on Fridays and during Lent. They do not eat or drink (except water) before taking Holy Communion. They fast on Good Friday and Ash Wednesday, but a priest may excuse the elderly or an ill patient.

f. Seventh Day Adventists. Seventh Day Adventists do not drink alcohol, coffee, or tea. They are usually lacto-ovo vegetarians.

5-4. THE VEGETARIAN

a. Because of the dangers of too much animal protein resulting in health problems or for ecological reasons, many people have chosen to be vegetarians. They do not eat any type of meat. Some vegetarian diets are stricter than others.

(1) Lacto vegetarians eat plant foods and dairy products. They do not eat eggs.

(2) Ovo vegetarians eat plant foods and eggs. They do not eat dairy products.

(3) Lacto-ovo vegetarians eat plant foods, dairy products, and eggs.

(4) Fruitarians consume a diet that consists chiefly of fruits, nuts, olive oil, and honey. They do not eat any animal products.

(5) Vegans eat only plant foods.

b. The greatest concern in the vegetarian diet is attaining adequate amounts of complete protein. This is easy in the lacto-ovo vegetarian diet, but difficult for the vegan. The most efficient protein available is that found in dairy products, eggs, and fish. Among the sources of protein that can be used most efficiently by the body, meat actually ranks third. The second best supply of efficient protein is legumes, soybeans, nuts, and brown rice.

c. Complete proteins are needed to sustain life and to promote growth. Incomplete protein sources can be combined to become a complete protein.

(1) Grain may be combined with brewer's yeast, with milk and cheese, with nuts and milk or legumes. Examples are cereal and milk, a peanut butter sandwich and milk or yogurt, a cheese sandwich; rice cooked in milk, and baked beans with nut bread.

(2) Grain with dried beans or wheat germ and nuts, grain with egg, and grain with cheese. Examples are a poached egg on toast, macaroni and cheese, and a tortilla with cheese.

(3) Beans, legumes (peas, lentils), rice or soybeans (tofu) with milk, nuts, or eggs.

d. Vegans should eat at least two of the following at the same meal in order to provide all essential amino acids:

(1) Grains or nuts and seeds.

(2) Dried beans or tofu.

(3) Wheat germ.

e. Whole-wheat grains and cereals are preferred in vegetarian diets. Other foods must be added to the protein sources to supply vitamins and minerals. Vegetarian diets are often deficient in calcium, iron, zinc, vitamin D, iodine, and riboflavin. Vitamin B12 is probably missing entirely. Supplements of these substances often need to be taken.