Editing Nutrition (section)

== Macronutrients ==

=== Energy Yield ===

{| class="wikitable"
! Nutrient !! Calories per gram
|-
| Carbohydrate || 4 kcal/g
|-
| Protein || 4 kcal/g
|-
| Fat || 9 kcal/g
|-
| Alcohol || 7 kcal/g
|}

Acceptable Macronutrient Distribution Ranges for adults are roughly 45 to 65 percent of calories from carbohydrate, 20 to 35 percent from fat, and 10 to 35 percent from protein.

=== Carbohydrates ===

Carbohydrates are the body's preferred energy source and the only fuel the brain and red blood cells use efficiently under normal conditions. They are classified as simple sugars (monosaccharides and disaccharides) and complex carbohydrates (starches and fiber).

* Roughly 130 g/day of carbohydrate is needed to prevent ketosis from fat breakdown.
* '''Fiber''' is the indigestible carbohydrate fraction. Recommended intake is about 25 g/day for women and 38 g/day for men.
** '''Soluble fiber''' (oats, barley, legumes, apples, citrus, psyllium) slows gastric emptying, blunts postprandial glucose rise, and lowers LDL cholesterol.
** '''Insoluble fiber''' (wheat bran, whole grains, vegetable skins) adds bulk and speeds transit, relieving constipation.

'''Nursing application:''' When increasing dietary fiber, increase fluid intake at the same time and advance the fiber gradually. Adding bran to the diet of a dehydrated or fluid-restricted patient can precipitate impaction or obstruction.

=== Proteins ===

Proteins supply amino acids for tissue building, enzymes, hormones, immune globulins, and oncotic pressure.

* '''Complete proteins''' contain all nine essential amino acids: meat, fish, poultry, eggs, dairy, soy, and quinoa.
* '''Incomplete proteins''' are missing one or more essential amino acids. Plant proteins are combined over the course of the day (rice and beans, peanut butter and whole wheat bread, hummus and pita) to supply the full complement. They do not have to be eaten in the same meal.
* Baseline adult requirement is about 0.8 g/kg/day. Needs rise to roughly 1.2 to 2.0 g/kg/day with major burns, sepsis, trauma, large wounds, and pressure injuries.
* Protein is '''restricted''' in advanced chronic kidney disease that is not yet on dialysis, and in some cases of acute hepatic encephalopathy. Protein is '''increased''' once a patient starts hemodialysis or peritoneal dialysis because amino acids are lost into the dialysate.

'''Nursing application:''' A vegan patient is at particular risk for vitamin B12, iron, calcium, vitamin D, zinc, and omega-3 deficiency. Vitamin B12 occurs naturally only in animal foods, so supplementation or fortified foods are required, not optional.

=== Fats ===

Fats supply concentrated energy, carry the fat-soluble vitamins A, D, E, and K, and provide essential fatty acids.

* '''Saturated fat''' (animal fat, butter, coconut and palm oil) raises LDL cholesterol. Limit to less than 10 percent of calories, and less than 6 percent for patients with cardiovascular disease.
* '''Trans fat''' (partially hydrogenated oils) raises LDL and lowers HDL. Intake should be as close to zero as possible.
* '''Unsaturated fats''' are preferred. Monounsaturated fat comes from olive oil, canola oil, avocado, and nuts. Polyunsaturated fat includes the omega-3 fatty acids found in salmon, mackerel, sardines, walnuts, and flaxseed, which lower triglycerides.
* Dietary cholesterol comes only from animal sources. Plant foods contain no cholesterol.