UnitVII-2Nutrition and Diet

5/20/2018 UnitVII-2Nutrition and Diet

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Nutrition and Diet

UST Faculty of Pharmacy

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NUTRITION

Science that deals with the process bywhich components of food are madeavailable for an organism for:

- meeting energy requirements,

building and maintaining

- maintaining an optimum functionstate.

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I. CARBOHYDRATES

prime importance in thediet

Food sources:

- Starches (Plain cookedrice, maize, bihon, puto);

- root crops (camote,

cassava, gabi, potato);

- fruits; sugar;

- vegetable (upo, beets,

carrots, patani, batao)

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I. CARBOHYDRATES

providing the:

- major source of energy intake (40-80%of total energy intake for Filipinos) forwork and development because of the

following reasons:

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Reasons

1. Carbohydrates are readily available beingwidely distributed in a variety of easilygrown plants such as grains, vegetablesand fruits

2. The cost in the total food budget isrelatively small

3. Provides quick and sustained body fuel

from rapid oxidation of starches and sugarsyielding the needed body heat and energywith CO2and water as end products (TCA)

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I. Carbohydrates

RDA (reqd. daily allowance): 55-70% of TCA

Energy yield: 4kcal/g

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II. FATS

Food Source:

Saturated fatty acids animal source like meat,

eggs, milk fat

Unsaturated fatty acidsplant source like

vegetable oil (olive oil,peanuts, almonds,avocado oil)

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II. FATS

A. Functions

source of fuel for the body to store and

burn as needed for energy spares protein from being used for energy

(like carbohydrates)

Dietary vehicle for vitamins A, D, E and K Controls body temperature

Protection against injury

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II. FATS

RDA: 20-30%

Energy yield: 9 kcal/g

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III. PROTEINS

D. Food source:

Animal foods: fish, meat, poultry, and other internalorgans, seafoods (crabs, shrimps, shellfish)

Plant foods: dried beans, mongo, soybean,garbanzos, peanuts, beans, nuts, rice and bread

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ADULTS

Body Mass Index (BMI)

shows body weight adjusted for height.

calculated with simple math using inches andpounds, or meters and kilograms.

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Adults

For adults aged 20 years or older, BMIfall into one of these categories:

Underweight Normal

Overweight

obese

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BMI

wt (lbs)

h2 (in)x 703=

________

BMI =

BMI

BMI =wt (Kg)

wt (Kg)

________

________h2 (m)

h2 (cm)

x 10,000

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Interpretation

BMI Weight status

Below 15 Emaciated/skinny

15-18.5 Underweight18.6-24.9 Normal gaunt

25.0-29.9 Overweight

30.0-39.9 Obese40 or more Morbidly Obese

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DESIRABLE BODY WEIGHT(DBW)

DETERMINATION

The DBW, and not the actual weight of

the individual is used as the basis inthe calculation of TER or TCA.

TOTAL ENERGY REQUIRMENT (TER) OR TOTALCALORIC ALLOWANCE (TCA)

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DESIRABLE BODY WEIGHT(DBW)

It can be determined by:

a. Height-weight tables of FNRI

b. Modified Tannhausers method in theabsence of height-weight tables

DBW(kg) = (height in cm - 100) - (10%[ht in cm 100])

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DBW

c. NADP Formula

Males 5ft 112 lbs 4 lbs for every

inches above (below) 5ft

Female 5ft 106 lbs 4 lbs for every

inches above (below) 5ft

_Actual weight - DBW _ x 100

Actual weight

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Interpretation

Obese if body weight is more than 20%above the desirable weight

Overweight if the weight is >10%-20%above the desirable weight

Normal if the weight is 10% of thedesirable body weight

Underweight if the weight is >10%below the desirable weight

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DETERMINATION OF TOTAL ENERGY


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DETERMINATION OF TOTAL ENERGYREQUIREMENT (TER) OR TOTAL CALORIC

ALLOWANCE (TCA)

Factorial Method

TCA/TER = BMR + PA + SDASpecific Dynamic Action or SDA

Basal Metabolic Rate (BMR)

Physical Activity (PA)

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Basal Metabolic Rate (BMR)

Minimum amount of energy needed tomaintain the vital process of life under

basal condition 1 kcal/kg of body weight/hour

BMR = 1 kcal/kg x DBW x 24 hrs

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Physical Activity (PA)

Hospital patient - 10%

Sedentary - 30%

Light - clerks, typist (50%)

Moderate - housewives,shoemaker,jeepneydrivers,students, fishermen (75%)

Heavy construction workers (100%)

PA = BMR x % physical activity classification

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Thermogenic effect of blood(Specific Dynamic Action or SDA)

The energy required for digestion,absorption, transport, and utilization offood

SDA = (BMR + PA) x 0.06 adult (12 y/o)

0.15 child (


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NDAP method

TCA = DBW x 40

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TOTAL CALORIC ALLOWANCE


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To lose 1-2 lb/week, subtract 500 kcaldaily from the calculated TCA

add same amount of kcal to gain 1-2lb/week

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NDAP Recommendation

NDAP Recommendation foroverweight/obese adult

1. Compute allowance base on DBW andsubtract 500kcal/day

2. If only moderately overweight,recommend exercise and avoidance offats and sugar

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Example

EXAMPLE COMPUTATION FOR DBW, TCA ANDDISTRIBUTION of the TCA intoCARBOHYDRATES, PROTEINS AND FATS

Filipino female, moderately active adult, 5 ft1 inch (155cm) weighing 130 lbs (59kg)classify the nutritional status of your patient.

Compute for the dietary intake needed toloose or gain 2 lbs/week if adjusted intakefor carbohydrates is 60%, proteins is 10%and fats is 30%.

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1. DBW

a. Modified Tannhauser Method

DBW (kg) = (height in cm -100) (10%[height in cm-100])

= (155-100) (55 x 0.1)

= 50 kg

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NDAP Method

b. NDAP methodFemale 5 ft 106 lbs

1 inch 4 lbs

110 lbs (50 kg)

Actual weight DBW x 100

Actual weight

59kg 50kg x 100 = 15%

59 kg

***59 kg is between 10-20% above the DBW of kg =overweight

____________________

_________________

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TCA/TER


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TCA/TER

a. Factorial method

BMR= 1 kcal/kg x DBW x 24 hrs = 1 x 50 x 24 = 1200 kcal

PA = BMR x % activity = 1200 x 0.75 = 900 kcal

SDA= (BMR + PA) x 0.06 = 2100x 0.06 =126 kcal_____________

2226 kcal

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NDAP

b. NDAP method

TCA/TER= DBW x 40= 50 x 40= 2226

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Special Considerations

To lose 2 lbs, deduct 1000 kcal from TCA = 2226

1000 =1226 kcal

Carbohydrates = TCA x 0.60 = 736 kcal/4kcal/g = 184 gm

Proteins = TCA x 0.10 = 1226x0.10= 123 kcal/4g = 31 gm

Fats = TCA x 0.30= 1226 x 0.30= 368 kcal/9g = 41 gm

256 gm_________

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PEDIATRICS

1. Waterlow Classification for Wasting

Computation:

Actual weight

Ideal weight for actual length or height x 100 =___%

Classification:

Normal >90%

Mild 80-90%

Moderate 70-80%

Severe


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PEDIATRICS

2. Waterlow Classification for Stunting

Computation:

Actual height or length

Ideal height or length for age x 100 =___%

Classification:

Normal >95%Mild 90-95%

Moderate 80-90

Severe


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PEDIATRICS

Gomez Classification

Computation:

Actual weight

Ideal weight x 100 = __%

Classification:

Normal 91-100

First degree malnutrition 76-90

Second degree malnutrition 61-75

Third degree malnutrition


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PROTEIN-ENERGY MALNUTRITIONMARASMUS

*Balanced starvation

*Very low in both protein

and calories

*Caused by insufficientintake of milk

KWASHIORKOR

*Very low in protein, but

one in which contains

calories in the form of

carbohydrates

A. Usual age 0-2 y/o 1-3 y/o

B. Essential features

1. Edema None Lower legs, sometimes

face or generalized

2. Wasting Gross loss

all skin and bones

Sometimes hidden;

sometimes fat3. Muscle wasting Obvious Sometimes hidden

4. Growth retardation Obvious Sometimes hidden

5. Mental changes Usually apathetic, quiet Usually irritable,

moaning, also apathetic

C. Variable features

1. Appetite Usually good Usually poor

2. Diarrhea Often (past or present) Often (past or present)

3. Skin changes Seldom Occasional flaky paint

or enamel dermatosis

4. Hair changes Seldom Often sparse, straight,

silky, dyspigmentation;

gray or reddish

5. Moonface Seldom Often6. Hepatic enlargement Seldom Always

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UnitVII-2Nutrition and Diet

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