Comprehensive Review of Nutrition Components for Occupational Health Nurses—Part 2

Abstract

This article, the second in a two-part series, reviews and examines the components of clinical nutrition. In Part 2, the authors discuss nutritional components of fats, proteins, vitamins, minerals, and water. A resource guide is provided for the occupational health nurse to assist in the implementation of employee education in the area of healthy nutrition. The intent of the articles is to acquaint and inform the occupational health nurse on the current guidelines for healthy eating so she or he can better appraise their employee population, thus creating a healthier workforce. The information provided is not all-inclusive on the topics discussed but it provides a foundation for a better understanding of the requirements for healthy eating.

This article is the second part of a two-part series. Both articles comprehensively review nutritional components and provide occupational health nurses with information needed to implement workplace programs which promote healthy lifestyles. Part 1 reviewed the recommendations and guidelines for nutritional health as well as discussed, the macronutrient carbohydrate (Toothaker & Chikotas, 2018). Part 2 discusses macronutrients (fat and protein), micronutrients (vitamins and minerals), and provide informational and educational resources that can be utilized by the occupational health nurse in assessing and educating workers about healthy eating.

Macronutrients

Fats

There are many uses to the macronutrient fat (lipids). We fry in it because it transfers heat to rapidly cook food, it creates the creaminess we all enjoy in things like ice cream and cream soups, and improves flavor while adding juiciness. Because it is insoluble in water, it is often used in foods such as salad dressing to provide a unique texture and flavor.

Fat is comprised of three classes of dietary lipids: triglycerides, phospholipids, and cholesterol. These fats are further broken down and classified as saturated and unsaturated fats. The degree of saturation depends on the amount of fatty acids contained within the fat, which assist in the breakdown and absorption of the fat into the bloodstream.

Saturated fats tend to be solid at room temperature. They are saturated with hydrogen molecules due to having no double bond between molecules. They are found mainly in animal products such as fatty red meats, cheese, butter, whole milk, ice cream, pastries, and cookies. Saturated fat, also known as the “bad fat,” can increase low density lipid (LDL) cholesterol levels which increases the risk of coronary heart disease (American Heart Association, 2018).

Unsaturated fats are usually liquid at room temperature due to double bonds which break up the chain of hydrogen molecules and create gaps, making them unsaturated. They are divided into either monounsaturated or polyunsaturated fats. Fats which are monounsaturated tend to be liquid at room temperature but will solidify if cooled in the refrigerator and are the predominant fat found in olives, olive oil, canola oil, peanut oil, avocado, cashews, almonds, and most other nuts. They are commonly known as the “good fats” because when they are eaten in place of saturated fats, they lower LDL cholesterol and raise high density lipids (HDL) cholesterol.

Polyunsaturated fats are liquid at room temperature but stay liquid even below room temperature and are the predominant fats found in fish, corn oil, soybean oil, and safflower oil (American Heart Association, 2017). Because polyunsaturated fats are more susceptible to spoiling food manufacturers may hydrogenate the fat to prolong shelf life. When the fat is partially hydrogenated synthetic trans fats (partially hydrogenated oils) are formed (American Heart Association, 2017). Trans fats are predominantly found in margarine, nondairy creamer, fried foods, pie crusts, ready-made frosting, crackers, and potato chips. Saturated and trans fats are commonly known as “bad fats” because they both raise blood cholesterol and LDL levels and the risk of coronary heart disease (American Heart Association, 2017).

Phospholipids are naturally produced in the human body and are commonly found in foods containing lecithin, which is a component of bile produced by the liver that aids in digestion. Lecithin is found in foods containing egg yolks, wheat germ, soy, milk, and lightly cooked meats. Some vegetable oils and fatty foods also contain phospholipids. The main functions of phospholipids in the body are to provide cell structure and transport fat-soluble substances across cell membranes (Dudek, 2018).

Cholesterol although listed as a fat is considered a sterol. High levels of cholesterol are found in egg yolk, dairy fats, meats, and poultry. Cholesterol is needed to form an integral part of the cell membrane. It is particularly important in the cellular structure of the central nervous system, brain, and an important component of the myelin sheath providing insulation to the nerves. It cannot be utilized for energy as it cannot be broken down within the body. Our livers produce anywhere from 1 to 2 grams of cholesterol per day (Dudek, 2018).

Recommended Intake of Fat

The American Dietary Guidelines (U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2015) recommend that the intake of saturated fats should be limited to less than 10% of calories per day by replacing them with unsaturated fats and while keeping total dietary fats within the age-appropriate range. Individuals 2 years of age and older therefore have no dietary requirement for saturated fats. See Table 1 for types of fats, sources of fats, and dietary reference intake of fats.

Table 1.

Fats

Saturated fats	Trans fats	Unsaturated fats			Cholesterol
		Monounsaturated fats	Polyunsaturated fats
			Omega-3	Omega-6
Sources
Animal fats (beef, lamb) and animal products (meat, butter, whole milk), chocolate, tropical oils (coconut).	Being phased out entirely, but still available sometimes in processed foods especially those with long shelf life.	Olive oil, sunflower oil, cashews, some beef fat, popcorn, oatmeal, avocados, many other plants and nut based oils.	Found in flax and hemp more than any other food/oil. Also found in soybean oil, sardines, salmon, mackerel, many other fishes, beans, eggs beans, strawberries, broccoli.	Poultry, nuts, cereals, durum wheat, whole-grain breads, most vegetable oils.	Egg yolks have approximately 213 mg of cholesterol. The cholesterol content of typical cuts of beef, pork, lamb, and poultry is generally around 70 mg/3 oz. Veal averages slightly more at about 90 mg/3 oz. The exceptions are organ meats, which are very high in cholesterol. Egg whites, dried peas, beans, and nuts are cholesterol free.
Amount
Consumption should be limited to no more than 16-20 grams of saturated fat/day (for daily 2,000 calorie diet) The recommended serving size for a meal is 3-4oz and baking, broiling, and grilling is the way to go.	Avoid entirely. Do not eat foods that list “hydrogenated” or “partially hydrogenated” oils in their ingredients.	Recommended over saturated fats.	Considered one of the good “fats” that helps metabolism, brain health, etc. Omega 3s are “essential fatty acids” meaning the body only attains them through diet	Essential “good” fatty acid but may be connected to health problems when consumed in excess when compared with omega-3s.	The additional macronutrient recommendation issued for cholesterol is that intake be as low as possible. Eat less saturated fat and keep trans-fat consumption as low as possible. Hydrogenated fats should be avoided. Limit total fat and go for unsaturated fats. Most effective way to limit total and saturated fat and increase unsaturated fats may be with a plant-based diet.
		Consume no more than 45 grams a day (for a daily 2,000 calorie diet)

Source. U.S. Department of Health and Human Services and U.S. Department of Agriculture (2015)

Proteins

Proteins are a component of every living cell and play many critical roles in the body. They do most of the work in cells and are required for the structure, function, and regulation of the body’s tissues and organs (National Institute of Health, 2018). There are 21 amino acids, the basic building blocks of protein, and nine of these are considered essential. As essential proteins cannot be made by the body they must be consumed through food. The main sources of essential proteins come from meat, poultry, seafood, milk, cheese, eggs, and soybeans. These essential proteins are considered complete proteins, as they contain all nine essential amino acids that are needed and have a high biologic value which supports tissue growth and repair (Tessari, Lante, & Mosca, 2016).

There are 12 amino acids which are produced by the body and are considered nonessential and incomplete proteins as they do not contain all of the essential amino acids. The main sources of nonessential proteins typically come from plants such as grains, nuts, fruits, legumes, and vegetables (Tessari et al., 2016).

Recommended Intake of Protein

The recommended daily allowance of protein for healthy adults is 0.8 g/kg. The Dietary Guidelines for Americans (U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2015) recommend that on average women should consume 46g/day and men should consume 56 g/day. The Acceptable Macronutrient Distribution Range for protein in adults is 10% to 35% of total calories.

High protein foods often come packaged with unhealthy fats and hidden salt. For example, a six-ounce broiled-bone steak is a great source of protein—about 41 grams. But, it also delivers about 17 grams of saturated fat (USDA National Nutrient Database, 2015). For someone who eats a 2,000 calorie per day diet, that’s more than 60% of the recommended daily intake for saturated fat.

In comparison six-ounces of wild salmon has about 34 grams of protein and is naturally low in sodium and contains only 1.7 grams of saturated fat (USDA National Nutrient Database, 2015). Salmon and other fatty fish are also excellent sources of omega-3 fats, a type of fat that is especially good for the heart. Alternatively, a cup of cooked lentils provides about 18 grams of protein and 15 grams of fiber, and it has virtually no saturated fat or sodium (USDA National Nutrient Database, 2015).

Water

Water is considered one of the macronutrients and is the single largest constituent of the human body, averaging 60% of total body weight. Water aids digestion, absorption, transport of nutrients, and oxygen throughout the body, and excretion of toxins. The occupational health nurse needs to be cognizant that the average adult loses approximately 1,750 to 3,000 ml of water daily (Gropper & Smith, 2013). There are two types of water loss: sensible and insensible water loss. Sensible water loss is measureable loss coming from urine, stool, and so on. Insensible water loss is not measurable and occurs during respirations and through the skin, so moments of excessive sweating can increase the total amount of loss. The importance of managing water loss lies in preventing dehydration. Signs of dehydration include poor skin turgor, low blood pressure, concentrated urine, and dry mucous membranes (Bailey, Sands, & Franch, 2014).

The body produces a small amount of water through the catabolism of carbohydrates, fats, and proteins, otherwise water is essential and must be consumed. Men need an adequate intake of water of 3.7 L/day and women need 2.7 L/day. To clear the body of toxins the average adult needs to secrete 500ml of urine a day. Daily outputs range from 1500 to 2000 ml per day (Dudek, 2018).

Micronutrients

Vitamins

The first vitamin, thiamine, was discovered in 1913 known as the “vital amine” necessary to prevent the deficiency disease beriberi. Today, 13 vitamins are identified as “essential” for human nutrition (Combet & Buckton, 2015). The quantities needed are micrograms or milligrams aligning with micronutrients and essential to one’s diet. With a few exceptions (vitamin A, D, and niacin), the body cannot make vitamins. Therefore, it is crucial that occupational health nurses educate workers on the quantities and sources of these essential vitamins, which are needed for numerous functions in the human body.

The absorption rate of natural and synthetic vitamins at times differs secondary to different chemical forms of the same vitamins (Lutz, Mazur, & Litch, 2015), however, the body cannot differentiate between natural and synthetic vitamins. Vitamins found in food are susceptible to destruction and subsequent loss of function and value. Destruction of vitamins occur mostly with heat, water, and oxidation. Oxidation is the natural chemical process of substances combining with oxygen, hence, the longer fruits and or vegetables are exposed to temperature and light the less nutrients and value they will have (Ioannou & Ghoul, 2013).

Classification of Vitamins

Vitamins are categorized due to distinctive characteristics in their solubility in either fat or water. This property helps to classify vitamins and aids in the storage and processing of foods that contain vitamins. Fat-soluble vitamins are A, E, D, and K, while water-soluble vitamins are B, 1, 2, 3, 6, and 12, folate, and C.

The occupational nurse needs to differentiate between the different vitamins and their value to assist workers in choosing healthy foods rich in vitamins to maintain good health. Lutz et al. (2015) denote that vitamins are “similar to keys in a lock, all the notches in a key have to fit the lock, or the key will not turn” (p. 97).

Fat-Soluble Vitamins

Fat-soluble vitamins are absorbed through the intestine and can be stored in the body for varying lengths of time. Toxicity of certain vitamins such as A and D can occur. There are two types of Vitamin A one of which the body performs conversion on. The two forms are: preformed vitamin A (retinol) and provitamin A (beta-carotene). Provitamin A (beta-carotene) converts to vitamin A (retional) when reserves are low and it is then stored as Vitamin A (retional) (Kono & Arai, 2015). For a listing of fat-soluble vitamins and their recommended daily allowance (RDA) and sources, please see Table 2.

Table 2.

Fat- and Water-Soluble Vitamins

Fat-soluble vitamins	Adult RDA	Functions	Sources
A	700mcg-900mcg5,000IU	-Dim light vision-Differentiation of epithelial cells-Red blood cell formation-Skin and bone formation	Preformed: Liver Fortified milkProvitamin A: Carrots Squash Cantaloupe Spinach Broccoli
D	15mcg-20mcg400IU	-Stimulates bone production-Increase intestinal absorption of calcium-Hormone production-Immune function-Nervous system function	SunlightFortified milkFortified cerealFortified OJSalmonTunaEggs
E	15 mg30 IU	-Antioxidant-Protects polyunsaturated fatty acids in red blood cell membranes from oxidation in lungs-Immune function	Vegetable oilsNuts and seedsBroccoliFortified cereals
K	80 mcg	-Used in synthesis of several clotting factors, including prothrombin-Assists Vitamin D to synthesize a regulatory bone protein	CollardsSpinachCabbageBroccoli
Water-Soluble Vitamins	Adult RDA	Functions	Sources
B1/Thiamine	1.5 mg	-Coenzyme in carbohydrate and amino acid metabolism-Nervous system function	PorkBeefLiverSalmonWhole grainsNuts
B2/Riboflavin	1.7 mg	-Coenzyme in protein metabolism, need increase as protein needs increase-Red blood cell formation	Milk and dairy productsEggsMeatsMushroomsEnriched grain productsFortified cereals
B3/Niacin	14 mg-16 mg	-Coenzyme in energy production-Participant in synthesis of fatty acids and steroid hormones-Cholesterol production-Digestion-Nervous system function	LiverTunaMeats, fish, poultryWhole grainsEnriched grain products (bread, rolls, etc.)
B6/Pyridoxine	1.3 mg-1.7 mg	-Coenzyme in metabolism of amino acids-Immune function-Nervous system function-Red blood cell formation	SalmonFruitsChickpeasChicken breastBananas
Folate/Folic Acid	400 mcg	-Essential to the formation of DNA	LiverDried peas, beansEndiveWheat germ
B12/Cobalamin	6 mcg	-Synthesis of DNA, RNA metabolism of amino and fatty acids-Red blood cell formation-Nervous system function	MeatFishPoultryMilkCheeseEggs
C/Ascorbic Acid	Women = 75 mgMen = 90 mg	-Formation of collagen-Antioxidant-Wound healing-Immune function	Citrus FruitStrawberriesBroccoliGreen and red PeppersTomatoes and tomato juice

Source. http://www.fda.gov/nutritioneducation.

Water-Soluble Vitamins

Vitamins that dissolve in water are known as water-soluble vitamins. These vitamins when compared with fat-soluble vitamins are not stored in the body but rather the body absorbs what is needed and excretes the excess in urination. Therefore, the body needs a continuous supply of water-soluble vitamins through a steady daily intake. Water-soluble vitamins are found in fruit, vegetables, and grains, and can be destroyed by heat, lost in water used for cooking, or by excessive exposure to air. For a listing of water-soluble vitamins and their RDA and sources please see Table 2.

Minerals

Minerals are inorganic elements that originate from the earth’s crust. Plants absorb minerals through their roots and animals also eat plants, so some minerals are obtained indirectly by consuming foods originating from animal sources. Therefore, minerals are found in dairy products, meats, fish, fruits, vegetables, and nuts. They are mainly absorbed in the small intestines and then utilized as needed for the numerous functions they assist with in the body. Some of the functions of minerals include assisting with acid-base balance, fluid balance, nerve cell transmission, structural support (bones, etc.), and hormone activity. They assist to regulate bodily functions without providing energy.

Major minerals are present in the body in amounts greater than 5g and are needed in larger amounts. Major minerals include calcium, phosphorus, magnesium, sulfur, sodium, potassium, and chloride. Trace minerals (less than 5g) are needed in smaller amounts and include iron, iodine, zinc, selenium, cooper, manganese, fluoride, chromium, cobalt, and molybdenum. Both of these mineral groups are essential for life (U.S. National Library of Medicine, 2015).

Minerals stay better preserved than vitamins and are mainly lost in the cooking process of boiling, not due to the heat but of leaching that occurs into the boiling water. Therefore, steaming is the best way to preserve the essential minerals.

Trace minerals are difficult to measure and only four trace minerals have a RDA amount. The four assigned amounts are iron, iodine, fluoride, and zinc, while selenium, chromium, copper, manganese, cobalt, and molybdenum are defined by the label “trace.” See Table 3 for the recommended daily allowances, the function, and sources of major and trace minerals.

Table 3.

Vitamins

Vitamin	What it does	Where is it found	Daily value a
Biotin	• Energy storage• Protein, carbohydrate, and fat metabolism	• Avocados• Cauliflower• Eggs• Fruits (e.g., raspberries)• Liver• Pork• Salmon• Whole grains	300 mcg
Folate/Folic Acid Important for pregnant women and women capable of becoming pregnant	• Prevention of birth defects• Protein metabolism• Red blood cell formation	• Asparagus• Avocado• Beans and peas• Enriched grain products (e.g., bread, cereal, pasta, rice)• Green leafy vegetables (e.g., spinach)• Orange juice	400 mcg
Niacin	• Cholesterol production• Conversion of food into energy• Digestion• Nervous system function	• Beans• Beef• Enriched grain products (e.g., bread, cereal, pasta, rice)• Nuts• Pork• Poultry• Seafood• Whole grains	20 mg
Pantothenic Acid	• Conversion of food into energy• Fat metabolism• Hormone production• Nervous system function• Red blood cell formation	• Avocados• Beans and peas• Broccoli• Eggs• Milk• Mushrooms• Poultry• Seafood• Sweet potatoes• Whole grains• Yogurt	10 mg
Riboflavin	• Conversion of food into energy• Growth and development• Red blood cell formation	• Eggs• Enriched grain products (e.g., bread, cereal, pasta, rice)• Meats• Milk• Mushrooms• Poultry• Seafood (e.g., oysters)• Spinach	1.7 mg
Thiamin	• Conversion of food into energy• Nervous system function	• Beans and peas• Enriched grain products (e.g., bread, cereal, pasta, rice)• Nuts• Pork• Sunflower seeds• Whole grains	1.5 mg
Vitamin A	• Growth and development• Immune function• Reproduction• Red blood cell formation• Skin and bone formation• Vision	• Cantaloupe• Carrots• Dairy products• Eggs• Fortified cereals• Green leafy vegetables (e.g., spinach and broccoli)• Pumpkin• Red peppers• Sweet potatoes	5,000 IU
Vitamin B6	• Immune function• Nervous system function• Protein, carbohydrate, and fat metabolism• Red blood cell formation	• Chickpeas• Fruits (other than citrus)• Potatoes• Salmon• Tuna	2 mg
Vitamin B12	• Conversion of food into energy• Nervous system function• Red blood cell formation	• Dairy products• Eggs• Fortified cereals• Meats• Poultry• Seafood (e.g., clams, trout, salmon, haddock, tuna)	6 mcg
Vitamin C	• Antioxidant• Collagen and connective tissue formation• Immune function• Wound healing	• Broccoli• Brussels sprouts• Cantaloupe• Citrus fruits and juices (e.g., oranges and grapefruit)• Kiwifruit• Peppers• Strawberries• Tomatoes and tomato juice	60 mg
Vitamin D Nutrient of concern for most Americans	• Blood pressure regulation• Bone growth• Calcium balance• Hormone production• Immune function• Nervous system function	• Eggs• Fish (e.g., herring, mackerel, salmon, trout, and tuna)• Fish liver oil• Fortified cereals• Fortified dairy products• Fortified margarine• Fortified orange juice• Fortified soy beverages (soymilk)	400 IU
Vitamin E	• Antioxidant• Formation of blood vessels• Immune function	• Fortified cereals and juices• Green vegetables (e.g., spinach and broccoli)• Nuts and seeds• Peanuts and peanut butter• Vegetable oils	30 IU
Vitamin K	• Blood clotting• Strong bones	• Green vegetables (e.g., broccoli, kale, spinach, turnip greens, collards, Swiss chard, mustard greens)	80 mcg
Minerals
CalciumNutrient of concern for most Americans	• Blood clotting• Bone and teeth formation• Constriction and relaxation of blood vessels• Hormone secretion• Muscle contraction• Nervous system function	• Almond, rice, coconut, and hemp milks• Canned seafood with bones (e.g., salmon and sardines)• Dairy products• Fortified cereals and juices• Fortified soy beverages (soymilk)• Green vegetables (e.g., spinach, kale, broccoli, turnip greens)• Tofu (made with calcium sulfate)	1,000 mg
Chloride	• Acid-base balance• Conversion of food into energy• Digestion• Fluid balance• Nervous system function	• Celery• Lettuce• Olives• Rye• Salt substitutes• Seaweeds (e.g., dulse and kelp)• Table salt and sea salt• Tomatoes	3,400 mg
Chromium	• Insulin function• Protein, carbohydrate, and fat metabolism	• Broccoli• Fruits (e.g., apple and banana)• Grape and orange juice• Meats• Spices (e.g., garlic and basil)• Turkey• Whole grains	120 mcg
Copper	• Antioxidant• Bone formation• Collagen and connective tissue formation• Energy production• Iron metabolism• Nervous system function	• Chocolate and cocoa• Crustaceans and shellfish• Lentils• Nuts and seeds• Organ meats (e.g., liver)• Whole grains	2 mg
Iodine	• Growth and development• Metabolism• Reproduction• Thyroid hormone production	• Breads and cereals• Dairy products• Iodized salt• Potatoes• Seafood• Seaweed• Turkey	150 mcg
IronNutrient of concern for young children, pregnant women, and women capable of becoming pregnant	• Energy production• Growth and development• Immune function• Red blood cell formation• Reproduction• Wound healing	• Beans and peas• Dark green vegetables• Meats• Poultry• Prunes and prune juice• Raisins• Seafood• Whole grain, enriched, and fortified cereals and breads	18 mg
Magnesium	• Blood pressure regulation• Blood sugar regulation• Bone formation• Energy production• Hormone secretion• Immune function• Muscle contraction• Nervous system function• Normal heart rhythm• Protein formation	• Avocados• Bananas• Beans and peas• Dairy products• Green leafy vegetables (e.g., spinach)• Nuts and pumpkin seeds• Potatoes• Raisins• Wheat bran• Whole grains	400 mg
Manganese	• Carbohydrate, protein, and cholesterol metabolism• Cartilage and boneformation• Wound healing	• Beans• Nuts• Pineapple• Spinach• Sweet potato• Whole grains	2 mg
Molybdenum	• Enzyme production	• Beans and peas• Nuts• Whole grains	75 mcg
Phosphorus	• Acid-base balance• Bone formation• Energy production andstorage• Hormone activation	• Beans and peas• Dairy products• Meats• Nuts and seeds• Poultry• Seafood• Whole grain, enriched, and fortified cereals and breads	1,000 mg
Potassium Nutrient of concern for most Americans	• Blood pressure regulation• Carbohydrate metabolism	• Bananas• Beets• Greens• Juices (e.g., carrot, pomegranate, prune, orange, and tomato)	3,500 mg
	• Fluid balance• Growth and development• Heart function• Muscle contraction• Nervous system function• Protein formation	• Milk• Oranges and orange juice• Potatoes and sweet potatoes• Prunes and prune juice• Spinach• Tomatoes and tomato products• White beans• Yogurt
Selenium	• Antioxidant• Immune function• Reproduction• Thyroid function	• Eggs• Enriched pasta and rice• Meats• Nuts (e.g., Brazil nuts) and seeds• Poultry• Seafood• Whole grains	70 mcg
SodiumNutrient to get less of	• Acid-base balance• Blood pressure regulation• Fluid balance• Muscle contraction• Nervous system function	• Breads and rolls• Cheese (natural and processed)• Cold cuts and cured meats (e.g., deli or packaged ham or turkey)• Mixed meat dishes (e.g., beef stew, chili, and meat loaf)• Mixed pasta dishes (e.g., lasagna, pasta salad, and spaghetti with meat sauce)• Pizza• Poultry (fresh and processed)• Sandwiches (e.g., hamburgers, hot dogs, and submarine sandwiches)• Savory snacks (e.g., chips, crackers, popcorn, and pretzels)• Soups• Table salt	2,400 mg
Zinc	• Growth and development• Immune function• Nervous system function• Protein formation• Reproduction• Taste and smell• Wound healing	• Beans and peas• Beef• Dairy products• Fortified cereals• Nuts• Poultry• Seafood (e.g., clams, crabs, lobsters, oysters)• Whole grains	15 mg

a

The Daily Values are the amounts of nutrients recommended per day for Americans 4 years of age or older.

Nutritional Supplements

Unlike drugs, nutritional supplements are not permitted to be marketed for the purpose of treating, diagnosing, preventing, or curing diseases. That means supplements should not make disease claims, such as “lowers high cholesterol” or “treats heart disease.” Also, dietary supplements are not reviewed by the government before they are marketed, but the Food and Drug Administration (FDA) has the responsibility to take action against any unsafe dietary supplement product that reaches the market. If the FDA can prove that the claim on a marketed dietary supplement are false and misleading, they can take action against the producer of the supplement (U.S. FDA, 2017). Employees should be taught that the price of the supplement is not a way to gauge its effectiveness and that supplements should not be used to replace nutrient complete meals, which are needed for a healthful diet.

Resources

Resources exist to aid the occupational health nurse in educating their employees on healthy eating and nutrients. Table 4 displays resources and associated web-links for quick resources on dietary guidelines, healthy eating, and dietary reference indexes. The resources provide user-friendly websites with health information for individuals and families.

Table 4.

Nutritional Resource Guide for the Occupational Health Nurses

Name of resource	Website link	Description
Dietary Guidelines	www.dietaryguidelines.gov	The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) have jointly published the Dietary Guidelines every 5 years since 1980. This website includes information for the 2015 Dietary Guidelines as well as archives of the previous Dietary Guidelines.
ODPHP	http://odphp.osophs.dhhs.gov/	Created by Congress in 1976, ODPHP plays a vital role in developing and coordinating a wide range of national disease prevention and health promotion activities. This website includes ODPHP resources, initiatives, opportunities, and evaluation reports.
Healthy People 2020	www.healthypeople.gov	Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. The leading health indicators and the 2020 topics can be found here. In addition, the objectives and data are here, as well as the resources to help learn how to use and implement HP2020.
HP 2020 Nutrition and Weight Status Objectives	https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/ebrs	The Nutrition and Weight Status objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. This link will provide the objectives, interventions and resources, as well as a National Snapshot and the National Data information for HP2020 nutrition and weight status.
HP 2020 Food Safety	https://www.healthypeople.gov/2020/topics-objectives/topic/food-safety	Food-borne illnesses are a burden on public health and contribute significantly to the cost of health care. A food-borne outbreak occurs when 2 or more cases of a similar illness result from eating the same food. This link will provide the objectives, interventions and resources, as well as a National Snapshot and the National Data information for HP2020 food safety.
Health.gov	www.health.gov/	health.gov includes health information and resources for individuals and families. This website is also a resource for healthfinder.gov, health communication, health literacy and e- health, the Physical Activity Guidelines, the Dietary Guidelines, the Dietary Reference Intakes, and the National Health Information Center.
Eat Healthy × Be Active Community Workshops	www.health.gov/dietaryguidelines/workshops	Download and teach the full six complete 1-hr workshops that were developed—based on the Dietary Guidelines for Americans, 2010 and 2008 Physical Activity Guidelines for Americans.
Physical Activity	www.health.gov/paguidelines	The Midcourse Report, the Midcourse Report graphic, the 2008 Physical Activity Guidelines and the Physical Activity Blog are all located on this website. The Physical Activity Guidelines provide science-based guidance to help Americans aged 6 and older improve their health through appropriate physical activity.
Healthfinder.gov	www.healthfinder.gov	Healthfinder.gov is a government Website where you will find information and tools to help you and those you care about stay healthy.
Health care.gov	www.healthcare.gov	A federal government website managed by the U.S. Department of Health & Human Services.
Center for Nutrition Policy and Promotion	www.cnpp.usda.gov	The USDA Center for Nutrition Policy and Promotion (CNPP) website houses MyPlate, SuperTracker, the 2010 Dietary Guidelines Advisory Committee Report, the 2010 Dietary Guidelines for Americans policy document, archived Dietary Guidelines and other Dietary Guideline information, MyFoodapedia, Know Your Farmer, Know Your Food, and the Cost of Raising a Child Calculator, as well as many other resources related to Food and Nutrition.
Healthy Eating Index—2010 Report	http://www.cnpp.usda.gov/HealthyEatingIndex.htm	The Healthy Eating Index (HEI) is a measure of diet quality that assesses conformance to federal dietary guidance. The website includes the 2010, the 2005 HEI reports, as well as all of the original HEI reports.
USDA Food Patterns	http://www.cnpp.usda.gov/USDAFoodPatterns.htm	The USDA Food Patterns were developed to help individuals carry out Dietary Guidelines recommendations. USDA Food Patterns, sample meal patterns for the USDA Food Pattern at the 2000 calorie level, technical tables for the 2010 USDA Food Patterns, and technical tables for Food Patterns based on “Typical” rather than “Nutrient-Dense” Food Choices are included on this website.
MyPlate	www.choosemyplate.gov	MyPlate illustrates the five food groups that are the building blocks for a healthy diet using a familiar image—a place setting for a meal.
Supertracker	https://www.supertracker.usda.gov	Access USDA’s SuperTracker to get personalized nutrition and physical activity plans, track foods and physical activities to see how they stack up. Get tips and support to make healthier choices and plan ahead.
Ten Tips Nutrition Education Series	http://www.cnpp.usda.gov/Publications.htm	Download the Ten Tips Nutrition Education Series that provides consumers and professionals with high quality easy-to-follow tips in a convenient, printable format.
Nutrition Insights	http://www.cnpp.usda.gov/NutritionInsights.htm	The Nutrition Insights link will provide brief examinations of current food or nutrition topics through publications originated at CNPP.
Economic Research Service	http://www.ers.usda.gov/	The Economic Research Service (ERS) mission is to inform and enhance public and private decision making on economic and policy issues related to agriculture, food, the environment, and rural development. The ERS is a primary source of economic information and research in the U.S. Department of Agriculture.
Agricultural Research Service	http://www.ars.usda.gov/	The Agriculture Research Service (ARS) works to ensure that Americans have reliable, adequate supplies of high-quality food and other agricultural products. ARS accomplishes its goals through scientific discoveries that help solve problems in crop and livestock production, protection, human nutrition, and the interaction of agriculture and the environment.
Beltsville Human Nutrition Research Center	https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/	The Beltsville Human Nutrition Research Center (BHNRC) is the oldest and most comprehensive of six human nutrition research centers within the Agricultural Research Service. BHNRC laboratories conduct multidisciplinary basic science and applied human nutrition research. BHNRC research is important to policy-makers, food producers, educators, other scientists and consumers in better understanding the relationships between agriculture, diet, and health.

Occupational health nurses can aid their employees with wellness in nutrition by supplying their workers with websites and online resources for quick reliable access. The table exemplifies a wide range of resources that can play a vital role in aiding workers to lead a more nutritious lifestyle.

Summary

This article, the second in a two-part series, reviewed the recommendations and guidelines for both macronutrients (carbohydrates, proteins, and fats) and micronutrients (vitamins and minerals). Educational resources are provided in Part 2 to assist the occupational health nurse in educating their employees.