1 Essentials of Nutrition.docx

Essentials of Nutrition Learning Objectives Recognize classifications of and patient-specific risk factors for malnutrition Distinguish nutrition related complications and health outcomes Estimate ideal body weight (IBW) and adjusted body weight (AdjBW) Calculate a patient-specific calorie level ne...

Essentials of Nutrition Learning Objectives Recognize classifications of and patient-specific risk factors for malnutrition Distinguish nutrition related complications and health outcomes Estimate ideal body weight (IBW) and adjusted body weight (AdjBW) Calculate a patient-specific calorie level necessary to gain, maintain, or lose weight using the Harris Benedict equations Design an individualized dietary plan with recommended daily intake of carbohydrates, proteins, and fats in grams Introduction to Nutrition Malnutrition Malnutrition (Undernutrition or Overnutrition) is the result of nutrient imbalance due to inadequate: intake absorption utilization UNDERnutrition Risk Factors Nutrition Inadequate food supply Anorexia nervosa Major depression Post-gastric bypass Chronic Disease Cystic fibrosis IBS or Crohn’s Hyperthyroidism Active cancer Organ failure Type 1 Diabetes Laxative or diuretic use Injury Major infection Surgery Burns Traumatic brain injury OVERnutrition Risk Factors Nutrition Inadequate food supply Binge eating Diet high in carbohydrates Sedentary lifestyle Chronic Disease PCOS Hypothyroidism Dyslipidemia Organ failure Type 2 Diabetes Schizophrenia Depression Injury Foot fractures Joint dislocations Back injury Step 1: Assess Nutrition Status Assessment: Detailed Patient History Underlying pathology with nutritional effects Nutrition and dietary habits Medication and substance use End-organ effects Assessment: Anthropometric Measures Measures size, weight, and proportions Compares individuals vs. population Repeated at various intervals Adults: change slowly Pediatrics: change quickly Anthropometric Measures: Mass Body Mass Index (BMI): screens for weight categories that may cause complications and health risks $BMI = \ \frac{\text{weight~in~kilograms}}{\text{height~in~meters}^{2}}$ Anthropometric Measures: Weight Total Body Weight (TBW): measured on scale Ideal Body Weight (IBW): population reference to detect nutrition status Female IBW = 45.5 kg + (2.3 x inches over 5 feet) Male IBW = 50 kg + (2.3 x inchest over 5 feet) Adjusted Body Weight (AdjBW): rarely used, but usually determined on an institution-to-institution basis AdjBW = IBW + 0.4 (TBW−IBW) Anthropometric Measures: Waist Waist Circumference: measurement to assess abdominal (visceral) fat Female abdominal obesity :  > 35 inches Male abdominal obesity :  > 40 inches Anthropometric Measures: Lab Values Assessment: Nutrition Focused Physical Examination (NFPE) Step 2: Calculate Total Daily Calories Total Daily Energy Expenditure Diet Thermogenesis: Consistently ~10% Physical Activity INCREASES Pregnancy High activity Exercise Weight training Running Stress Surgery Infection Trauma Burns DECREASES Low activity Post-surgery Bedrest Desk Job Injury Resting Energy Expenditure Must be calculated No consensus on which equation is best REE is also known as basal energy expenditure (BEE) or basal metabolic rate (BMR) Step 1: Calculate REE with the Harris-Benedict Equation REE (males) : 66.47 + 13.75 (weight in kg) + 5 (height in cm) − 6.76 (age in years) REE (females) : 655.1 + 9.6 (weight in kg) + 1.85 (height in cm) − 4.68 (age in years) Step 2: Factor in activity & stressors Total Daily Energy Expenditure = REE x activity factor x stress factor Step 3: Find Energy Distribution Energy Sources: Macronutrients Energy Sources: Carbohydrates Kcal of carbs= Total Daily Energy Expenditure x (% of carbs) $$Grams\ of\ carbs\ = \frac{\text{Kcal~of~carbs}}{4\ calories}$$ Energy Sources: Proteins Kcal of protein= Total Daily Energy Expenditure x (% of protein) $$Grams\ of\ protein\ = \frac{\text{Kcal~of~protein}}{4\ calories}$$ Energy Sources: Fats Kcal of fat= Total Daily Energy Expenditure x (% of fat) $$Grams\ of\ fat\ = \frac{\text{Kcal~of~fat}}{9\ calories}$$ Alcohol Guidance Not metabolized like other carbs, so not included in macronutrient calculations Alcohol = 7 calories/gram Drink in moderation: Females ≤1 drink/day Males ≤2 drinks/day Example Calculation JF is a 17-year-old male patient with cystic fibrosis currently hospitalized with an exacerbation and sepsis. He is 5’6” tall and weighs 132 lbs. JF needs diet planning to maintain his current weight while he is sedentary in the hospital. Calculate his total daily energy expenditure using the Harris-Benedict Equation. Step 1: Calculate REE with the Harris-Benedict Equation REE (males) : 1616.5 kg/day Step 2: Factor in activity & stressors Total Daily Energy Expenditure = 2909.7 kcal/day JF is a 17-year-old male patient with cystic fibrosis being discharged from the hospital. The physician recommends 2500 calories daily to help JF gain weight, with the diet comprised of 45% carbohydrates, 15% protein, and 40% fat. JF requests your help calculating the goal daily intake of carbohydrates, proteins, and fats in grams. Step 1: Carbohydrates Grams of carbs  = 281.25 grams Grams of protein  = 93.75 grams Grams of fat  = 111.11 grams