Basic Nutrition-BSU.pdf

BASIC NUTRITION LECTURE Definitions NUTRITION - The science of foods and their components (nutrients and other substances) including the relationship to health and disease; processes within the body; and the social, economic, cultural and psychological implications to eating...

BASIC NUTRITION LECTURE Definitions NUTRITION - The science of foods and their components (nutrients and other substances) including the relationship to health and disease; processes within the body; and the social, economic, cultural and psychological implications to eating (Ruiz et.al, 2011) Definitions NUTRITION - The relationship of foods to the health of the human body and this concerns the actions, interactions, and balances of nutrients. The processes within the body include ingestion, digestion, absorption, metabolism of nutrients, and excretion of end-products Definitions NUTRITION -The study of how food nourishes the body. It is based on the food requirements of humans for energy, growth, maintenance, reproduction and lactation  Briefly stated, nutrition is the study of foods in relation to health FOOD  Any substance, organic or inorganic, when ingested or eaten, nourishes the body by building and repairing tissues, supplying heat and energy, and regulating bodily processes. Food sustains life, second to oxygen  Includes articles used as drink or food, and the articles used for the component of such (FDA) FOOD QUALITY Ideal Qualities of Food 1. Safe to eat 2. Nourishing or nutritious 3. Palatable (color, aroma, flavor, texture, etc. 4. Offers variety and planned within the socio-economic context 5. Free from toxic agents and does not contain substances deemed deleterious to health NUTRIENTS  Chemical substances that the body uses from the foods that are consumed  A nutrient is any substance, organic or inorganic, that can supply energy, build and repair cells and tissues, and regulate life processes. The Six Classification of Nutrients:  Carbohydrates  Proteins  Fats  Vitamins  Minerals  Water Classification of Nutrients  According to Function 1. Body-building- they form tissues or are structural components of the body - include water, protein, fat, carbohydrate, and minerals - water accounts for about 2/3 of body weight, protein constitutes about 20%, minerals about 4%, while carbohydrates amount to 1/3 kg or 1 % 2.Energy-giving nutrients- are carbohydrate, protein and fat which yield energy 3. Regulatory nutrients-include all the six groups of nutrients. - They maintain homoeostasis of body fluids and expedite metabolic processes Nutrients that provides energy (kcalories):  Carbohydrates 1 gram= 4 kcal  Proteins 1 gram = 4 kcal  Fats 1 gram =9 kcal  According to Chemical Nature 1. Organic nutrients- substances that are carbon-containing - include protein, fat, carbohydrate and vitamins 2. Inorganic nutrients-are minerals and water  According to Essentiality 1. Physiologically essential-all nutrients are physiologically essential to the body 2. Dietary essential –these are the nutrients that should be supplied from food because the body does not synthesize them e.g. essential amino acids, linoleic & linolenic- essential fatty acids, vitamins & minerals - about 45 nutrients are essential for human beings  According to Concentration 1. Macronutrients- present in relatively large amounts in the body -concentration in the body is above 50 parts per million or above 0.005% of body weight - include water, protein, fat, and carbohydrate, and macro-minerals 2. Micronutrients- include vitamins and trace or micro-minerals Nutritionist-dietitian (R.ND.)  A professional responsible for the nutritional care of individuals and groups.  The care includes application of the science and art of human nutrition in helping people select and obtain food for the primary purpose of nourishing their bodies in health or disease throughout the life cycle  The participation may be in single or combined functions: in foodservice systems management; in extending knowledge of food and nutrition principles; in teaching these principles for application according to particular situations; or diet counseling  The R.ND. has successfully passed the licensure examination for professional registration and maintains continuing education reqts. (RA 10862) NUTRITURE or NUTRITIONAL STATUS  Refers to the condition of how well- nourished the human body, depends on several criteria, such as physical signs and symptoms of good nutrition, medical history, blood and urine tests, anatomical changes seen in imaging or x-rays and other medical instruments, and a history of dietary intake up to current food habits  OPTIMUM or GOOD NUTRITION  Means that the body have adequate supply of essential nutrients that are efficiently utilized such that growth and good health are maintained at the highest possible level MALNUTRITION  Mal-means “bad”, thus malnutrition is an undesirable state of one’s health, which could either be an undernourished individual or someone who is overnourished -The former may be caused by starvation, inadequate supply of one or more nutrients or/and energy, or it could be a secondary effect of a metabolic disorder or a medical condition that interferes with nutritional processes in the body FORMS of MALNUTRITION  Undernutrition-pathological state resulting from the consumption of an inadequate quantity of food over an extended period of time e.g. Marasmus, Kwashiorkor  Specific deficiency- pathological state resulting from the consumption of a relative or absolute lack of an individual nutrient e.g. vit. A deficiency (Xeropthalmia), Iron deficiency anemia Kwashiorkor Marasmus Kwashiorkor Xeropthalmia Vit. A Def. (Bitot’s spots, Corneal Xerosis, Keratomalacia)  Overnutrition- pathological state resulting from the consumption of an excessive quantity of food over an extended period of time e.g. obesity  Imbalance-pathological state resulting from a disproportion among essential nutrients, with or without absolute deficiency Overnutrition  Pathogenesis of Nutritional Deficiency Primary (Dietary) Nutrient Inadequacy Tissue Depletion(Subclinical malnutrition starts such as loss of weight, stunted growth) Secondary Biochemical Changes (Detection by laboratory (Conditioning factors) examinations) Functional Symptoms (Specific subjective symptoms appear) Anatomical Lesions (Classical physical signs make their appearance) Types of Malnutrition  Acute Malnutrition- related to present state of nutrition. This is manifested by weight loss, low weight-for-height and normal height-for-age  Chronic malnutrition- related to past state of nutrition. This is manifested by stunting or nutritional dwarfism, low weight-for-height and low height-for-age  Primary malnutrition- caused by lack or inavailability of food, also referred to as dietary malnutrition  Secondary malnutrition-caused by certain conditioning factors other than food Figure 1. Primary and Secondary Determinants of Nutritional Status Dietary Requirement  Also called minimum requirement  The amount that will just prevent the development of a deficiency disease or its signs and symptoms, as differentiated from an allowance in which the amount of the nutrient has a margin of safety  The criterion or indicator of nutritional adequacy upon which EAR and AI are based for each nutrient  Recommended Dietary Allowance (RDA)  Are average daily dietary intake level sufficient to meet nutrient requirements of more than 97% of the healthy population in a life stage and gender group  Includes a margin of safety  The RDA is the goal for usual intake by an individual Estimated Average Requirement (EAR)  A daily nutrient intake value that is estimated to meet the requirement half of the healthy individuals in a life stage and gender group  The EAR is used to calculate the RDA.  It is also used to assess the adequacy of nutrient intakes, and can be used to plan the intake of groups Adequate Intake (AI)  A recommended intake value based on observed or experimentally determined estimates of nutrient intake by a group of healthy people that are assumed to be maintaining an adequate nutritional state  If sufficient scientific evidence is not available to establish an EAR on w/c to base an RDA, an AI is derived instead  The AI is expected to meet or exceed the needs of most individuals Tolerable Upper Intake Levels (UL)  The highest level of daily nutrient intake that is likely to pose no risk or adverse health effects in almost all individuals in the general population  The UL is not a recommended level of intake  As intake increases above the UL, the potential risk of adverse effects increases  Recommended Energy and Nutrient Intakes (RENIs)  The levels of energy and dietary components which, on the basis of current scientific knowledge, are considered adequate for the maintenance of health and well-being of nearly all healthy persons in the Philippine population Recommended Energy and Nutrient Intakes (RENIs)  Fornutrients, they are equal to the average physiologic requirement (AR) translated into dietary recommendation by correcting for incomplete utilization or dietary nutrient bioavailability, plus two SD to cover the needs of almost all individuals in the Philippines  Philippine Dietary Reference Intake (PDRI)  The 2015 Philippine Dietary Reference Intake (2015 PDRI) is a set of dietary standards that include 1)Estimated average requirement (EAR), 2) Recommended energy intake/ recommended nutrient intake (REI/ RNI), 3) Adequte intake (AI), 4) Tolerable upper intake/ upper limit (UL), and 5) Acceptable macronutrient distribution NUTRITION MILESTONES IN THE PHILIPPINES EARLY BEGINNINGS Dr. Presentacion Perez: The Pioneer -introduced the four-year degree program in Foods and Nutrition as head of the Department of Home Economics , College of Education at the University of the Philippines in 1939 -Dr. Perez was aided by Dr. Clara Ruth Darby whom she recruited to justify the offering of nutrition by her department EARLY BEGINNINGS 1948, the first graduates in foods and nutrition were graduated and recommended for dietetic internships in some hospitals in the US with Dr. Darby making contacts first with her own alma mater, the University of Indiana Dr. Presentacion Perez: The Pioneer  started university feeding and the organization of professional organizations  Organized a group that formed the Philippine Association of Nutrition (PAN) in 1947  Banded its members together and called on President Manuel Roxas in Malacańang to focus his attention on the need to promote better nutrition by recognizing trained nutritionists in an organized agency EARLY BEGINNINGS This call on the President led eventually to the creation of the Institute of Nutrition, now the Food and Nutrition Research Institute By 1950, the first nutrition graduates who had completed dietetic internships and masters studies in the US returned to the Philippines EARLY BEGINNINGS  Preciosa Irma Pineda Florentin was employed by the Institute of Nutrition where, with Dr. Conrado Pascual set up the first Nutrition Clinic  In 1952, Preciosa Irma Florentin was hired to reorganize the dietary department of the Philippine General Hospital separating the Dietetic Service from the Nursing Department, became the Head of Dietary Department, thus known to be the first Filipino dietitian EARLY BEGINNINGS  In1955, because of the need to professionalize dietetics, the Dietetic Association of the Philippines (DAP) was born with Dr. Perez as its first President  The most lasting achievement of the association was the recognition of dietetics as a profession  In 1960, the Association succeeded in securing the passage by Congress of a law Events Leading to the Recognition of Dietetics as a Profession 1946- U.P. reopened its four-year course in foods and nutrition. Classes were held in war-ravaged campuses. The major courses were taught by Dr. Presentacion Perez, Dr. Clara Ruth Darby and Mrs. Matilde de Guzman 1950- St. Scholastica’s College included an AB Nutrition in its curriculum, followed by PWU and CEU 1950- The first nutrition clinic was established in the Institute of Nutrition. Dr. Juan Salcedo, Jr., Director of the Institute, appointed Dr. Conrado Pascual and Preciosa Pineda (who became Mrs. Florentin) as medical nutritionist and clinical dietitian respectively 1952- Dr. Agerico B. M. Sison, newly appointed director of PGH, in the process of reorganizing the hospital, separated the Dietary from the Nursing Department - Foods and nutrition became a popular field of study giving an opportunity for students to go abroad for internship -Dietetic internship started at PGH whereby a new graduate “attached” herself to staff dietitian and learned by induction 1953- During the PAN Conference of 1953, a set of resolutions, numbered I to XII was passed for implementation by the newly elected officers headed by Dr. Joaquin Maraήon as president. on as president. Resolutions I,VII,VIII and XII were concerned with nutrition education 1955- This year saw the snow-balling of efforts to gain recognition for dietetics as a profession. Not only was the Dietetic Association formally organized, but several of the larger hospitals in Manila and suburbs began to employ dietitians who had internships abroad 1955- Dr. Perez drew the draft of a Bill that was to make the employment of qualified dietitians mandatory. 1956- Corazon de Leon, the president asked her husband, Atty. Primo de Leon to “polish” the daft. -With the help Senator Gil Puyat, the polished draft underwent a series of changes before it became ready for presentation in Congress in 1957 1958- the group succeeded in having Representative Tecla San Andres Ziga sponsor the bill in the Lower House where it passed the second reading June 18, 1960- the bill sponsored by Congresswoman Tecla San Andres Ziga and Senator Pacita M. Gonzales was signed into law by then President Carlos P. Garcia known Dietetics Law, R.A 2674 The Dietetics Law  Republic Act 2674, the law that regulated the practice of Dietetics in the Philippines from 1960 to 1977, defined a qualified dietitian as one who had passed a board examination.  To take the examination, a candidate must have a Bachelor’s degree with Foods and Nutrition (or equivalent) and must have completed a dietetic internship in an accredited hospital The Dietetic Internship  The dietetic internship was envisioned by the framers of the law to complete the preparation and training of the nutrition graduate.  As designed by the accredited hospitals, it was a period of training where the graduate could put theory into practice under the close supervision of qualified dietitians. It served as the graduate’s orientation to professional life  The internship has been described as a period of practical training in the various aspects of dietetics  But more than this, it was a period where a work ethic, discipline and dedication were inculcated  This was accomplished through strictly enforced rules and regulations on attendance, dress and even decorum Presidential Decree 1286: How it Came About PD 1286- the Nutrition and Dietetics Decree of 1977, regulates the practice of nutrition and dietetics and sets minimum requirements for nutritionist-dietitians for hospitals and nutrition agencies  Took effect on January 1978  The practical training became part of the four year program and it was expanded to include experiences not only in administrative and clinical dietetics but also in public health nutrition Republic Act No. 10862  The Nutrition and Dietetics Law of 2016  An act regulating the practice of Nutrition and Dietetics in the Philippines, repealing for the purpose PD 1286  Approved by President Benigno S. Aquino on May 25, 2016  HISTORICAL HIGHLIGHTS OF NUTRITION IN THE PHILIPPINES Five Periods in the History 1.1903-1923 -characterized by predominance of studies done by American and foreign scientists aided by Filipino workers -conducted studies on beri-beri and the proximate composition of foods, and on Filipino physiological standards Analyses on various foods were made by Gibbs and Agcaoili (1912), on Philippine fruits by Pratt (1913) and on varieties of rice by Wells (1923) In 1914- UP College of Agriculture published studies made by their investigators : Gonzales on coconut; Dacanay on Philippine bananas; Labayan on sweet potato Chamberlain, Vedder and R.R. Wiliams made significant contributions on their studies on the cause of beri-beri, making possible the large-scale manufacture of tiki-tiki extracts 2. 1923-1943 -Fleming, Santos and others (1923) worked on basal metabolic standards for Filipino students - emphasis on food composition - Adriano worked on calcium content of local foods - Orosa pioneered of food processing studies followed by Acena, Adriano and Sumulong  Siasoco and Goco published height and weight table  Concepcion et al and Icasiano and co-workers worked on growth standard determinations  In 1932- establishment of the National Research Council and creation of a section on nutrition under the chairmanship of Francisco O. Santos , considered as the Father of Nutrition in the Philippines Accomplishment of the section include: First RDA for specific nutrients by Concepcion, Hermano and Gutierrez in 1941 and its revision, which included niacin and riboflavin by Santos and Concepcion 3. From World War II to 1960 - Studies on the availability of nutrients and on the amino acid content of foods were interrupted when the war broke - After the war, the third period highlighted the creation of nutrition agencies and councils which worked on organized activities in nutrition and food research and the coordination of the activities of the govt. and private agencies involved in nutrition  The Philippine Institute of Nutrition (PIN) was created in 1947 and undertook researches in foods and nutritional biochemistry, basic and applied nutrition and nutrition surveys - In 1958, through R. A. 2067, the body was placed under the NSDB (now DOST) and renamed Food and Nutrition Research Center (FNRC now FNRI)  Majoraccomplishments of FNRC were the completion of the ten regional surveys throughout the Philippines (1957-68), which made possible the assessment of the problems and extent of malnutrition in the Philippines and the revision of the FCTs A notable contribution in the field of nutrition in the Philippines is the experiment on beri-beri where enriched rice given to patients reduced the mortality rate by Salcedo and co-workers This led to the passage of R.A. 832 known as the Rice Enrichment Law  In 1959, the Nutrition Foundation of the Philippines (NFP) was organized - a private agency, with the objective of helping improve the health of the people through assistance programs on foods and nutrition designed to complement and supplement government efforts 4. 1960-1980 - the fourth period were all attempts of the govt. and private sectors to coordinate all activities related to food, nutrition, and agriculture throughout the country to solve the malnutrition problems in the country *In 1960- the National Coordinating Council on Foods and Nutrition (NCCFN) was organized by Dr. Conrado Pascual  A pilot project of the Applied Nutrition Program (ANP) was set up in Bayambang which integrated school feeding, food production, nutrition education, and training of auxiliary workers  July 1, 1960-the DOH established the National Nutrition Program (now Nutrition Service) and through its Nutrition Mothercraft Centers helped prevent malnutrition among preschoolers  The Malnutrition Ward was first established by Dr. Florentino Solon at Southern Islands Hospital in Cebu in 1968  Executive Order 285 was issued by President Marcos on January 21, 1971 authorizing the National Food and Agriculture Council (NFAC) to coordinate all food and nutrition programs in the country and to make NCCFN a member of NFAC  P.D.491, the Nutrition Act was issued by President Marcos on June 25, 1974 a) Created the National Nutrition Council (NNC) charged with the task of formulating an integrated national nutrition plan and coordinating its implementation nationwide through the Philippine Nutrition Program b) Designated July as Nutrition Month c) Made nutrition a priority concern of the govt.  NutritionCenter of the Philippines (NCP) was established on July 2, 1974  P.D. 1596 was approved in 1978 that provided for a Barangay Nutrition Scholar (BNS) in every barangay 5. 1981 to present - A growing concern towards micronutrient deficiencies evolved -the National Nutrition Surveys showed significant proportions of the population with anemia, night-blindness and Bitot’s spots and goiter - In October 1993, the first National Micronutrient Day was conducted, providing vitamin A, iron and iodine supplements Every 6 months thereafter, the National Micronutrient Days (ASAP) were held In 1993, the Philippine Plan of Action for Nutrition (PPAN) for 1993-1998 was drafted and launched in consonance with the global call to eradicate malnutrition  During the latter part of the 1980s, the strengthening of the local communities and local government units (LGU) capabilities in nutrition planning and management was made an integral part of the PFNP  Models included the LAKASS (Lalakas Ang Katawang Sapat Sa Sustansiya) Project, and the UP-Los Baήon as president. os BIDANI (Barangay Integrated Development Approach for Nutrition Improvement) Philippine Nutrition Situation 1. Protein-energy malnutrition (PEM) 2. Vitamin A deficiency disorders (VADD) 3. Iron deficiency anemia (IDA) 4. Iodine deficiency disorders (IDD) Nutrition Situation 5. Overnutrition and obesity - Risk factor for non- communicable diseases Where and Who Are the Malnourished?  Groups more at risk to undernutrition 1. Among household members a. Infants and preschoolers especially those 1-2 years old b. Pregnant and lactating women c. School-aged children 2. Households headed by a. Subsistence or small fisherfolk b. Kaingeros or slash-and-burn farmers c. Hired laborers of food crop farmers d. Hired laborers of fishing industry e. The unemployed 3. Households with poorly educated mothers 4. Large-sized poor families 5. Those in remote rural areas 6. Urban poor THE PHILIPPINE PLAN OF ACTION FOR NUTRITION (2011-2016) (2017-2022)  T he country’s policy-making and National coordinating body on nutrition Nutrition Council  EO 234 The NNC = NNC Governing Board + NNC Secretariat + Nutrition Committees at sub-national levels  The NNC Governing Board Health Educatio Labor & (Chair) n Employme National nt Economic & Dev’t Authority Science & Technology Agriculture (Vice-chair) Trade & 3 private Industry sector representativ es Interior & Social Local Welfare & Budget & Government Developme Manageme – (Vice-chair) nt nt  The NNC Secretariat... serves as the executive arm of the NNC Governing Board Office of the Executive Director Executive Director 2 Deputy Executive Directors Nutrition Nutrition Nutrition Adminis- Finance Policy & Surveil-lance Information & trative Division Planning Division Education Division Division Division 14 Regional Offices NNC Mandate PD 491 1. Formulate national food & EO 234 nutrition policies & strategies AO 88 2. Coordinate the national food EO 472 and nutrition program 3. Coordinate funds for nutrition 4. Call on any government instrumentality for assistance NNC Mandate RA 8976  Determine need for continued mandatory food fortification NNC Mandate RA 8172  Salt Iodization Board  NNC Governing Board  DENR  PMA  Organization of salt producers  Formulate policies and coordinate salt iodization programs NNC Mandate EO 472  Prioritize hunger & malnutrition  Endorse project proposals  Generate and mobilize resources NEDA-SDC Res 1 S 2003  Lead agency to ensure achievement of MDG goal and target on hunger and malnutrition NNC Mandate  Formulate the Basic RA 8435 Needs Program under AFMA  Focal point for the Food Insecurity and Vulnerability DA SO 98 s '99 Information and Mapping Systems or FIVIMS Structure for Coordination National Nutrition Council Governing Board Technical Committee National Nutrition Council Secretariat Regional Nutrition Committee Chair: Regional Director Provincial Nutrition Committee Chair: Provincial Governor City Nutrition Committee Chair: City Mayor Municipal Nutrition Committee Chair: Municipal Mayor Barangay Nutrition Committee Chair: Barangay Captain  National Development Agenda PPAN MDGs/ SDGs (2017- 22) Right to Adequate  Goal Improved Improved produc- capacity Improved Better tivity quality of to learn nutrition life Improved health Improved food security Strategies Food-based interventions 1 Priority to adolescent females, 2 pregnant and lactating and 0-3 years old children Focus to nutritionally needier 3 areas Complementation of nutrition 4 interventions with other development interventions  2. Food Assistance 3. Micronutrient Supplementation 1. Home, School, and Community Food Production PPAN Programs 4. Nutrition Information, 5. Food Fortification Communication & Education  PPAN Programs 6. Livelihood Assistance 7. Nutrition in Essential Maternal and Child Health Services Facilitating Activities 1. Human Resource 2. Nutrition Advocacy Development 5. Resource Generation & Mobilization 3. Policy & Standards 4. Research and Formulation Development Home, School and Community Food Production  Establishment of kitchen gardens, demo centers and nurseries  Small animal dispersal  Provision of water supply system  Provision of technical assistance Food Fortification  Addition of micronutrient to a food or seasoning widely consumed by specific target groups  Intensive implementation of ASIN law  Mandatory fortification of rice, flour, sugar, and cooking oil  Pursuit of the Sangkap Pinoy Seal program Micronutrient Supplementation  Provision of vitamin A capsules and iron supplements to cure specific deficiencies  Focus on infants, pregnant, lactating for vitamin A and iron, and adolescent women for iron Nutrition, Information, Communication and Education  Aims for adoption of desirable food and eating practices  Nutritional Guidelines for Filipinos as basis for specific behaviors to be promoted  Training of professionals and frontline workers  Development of protocols and guidelines on nutrition education activities Food Assistance  Provision of supplemental food to population groups vulnerable to hunger and malnutrition  Regular supplementary feeding  Food price discount  Emergency feeding Livelihood Assistance  Provision of credit and livelihood opportunities to poor households with malnourished children  Complementation of other interventions such trainings, health and nutrition education Nutrition in Essential Maternal and Child Health Services  Involves the delivery of essential and child health nutrition package of services Nutrition in Essential Maternal and Child Health Services  Newborn screening  Promotion of infant and young child nutrition  Promotion of breastfeeding  Mother and child-friendly hospitals  Implementation of Milk Code PPAN 2017-2022  Nutrition-specificPrograms -Those that were planned and designed to produce nutrition outcome 1. Infant and young child feeding 2. Integrated Management of Acute Malnutrition 3. National Dietary Supplementation Program PPAN 2017-2022  Nutrition-specific Programs 4. National Nutrition Promotion Program for Behavior Change 5. Micronutrient Supplementation (vit. A, iron-folic acid, multiple micronutrient powder, zinc) 6. Mandatory Fortification 7. Nutrition in Emergencies PPAN 2017-2022  Nutrition-specific Programs 8. Overweight and Obesity Management and Prevention Program PPAN 2017-2022  Nutrition-sensitive Programs 1. Farm-to-market roads and child nutrition 2. Target Actions to Reduce Poverty and Generate Economic Transformation (TARGET) and child nutrition 3. Coconut Rehabilitation Program 4. Gulayan sa Paaralan 5. Diskwento caravans in depressed areas PPAN 2017-2022 6. Family Development Sessions for Child and Family Nutrition Project 7. Mainstreaming Nutrition in Sustainable Livelihood 8. Public Works Infrastructure and Child Nutrition 9. Adolescent Health and Nutrition Development 10. Sagana at Ligtas na Tubig sa Lahat (SALINTUBIG) Facilitating Activities 1. Human Resource 2. Nutrition Advocacy Development 5. Resource Generation & Mobilization 3. Policy & Standards 4. Research and Formulation Development Human Resource Development  Capabilities  Specific to nutrition programs  Policy analysis  Plan formulation  Advocacy  Surveillance  Research and utilization  Targets  nutrition services providers and managers  policy and decision makers  Nutrition Advocacy  Passage of priority nutrition bills  Strengthening of the national nutrition program  Modernization of school health and nutrition program  Other nutrition-related bills  Incorporation of nutrition concerns in development plans and programs Policy and Standards Formulation  Formulation and passage of nutrition legislative agenda Research and Development  Provide information for food and nutrition policy and program formulation Resource Generation and Mobilization  Encourage all concerned to provide resources for PPAN implementation P P P P P P P P 125 Billion Operationalization NGA s ANNUAL OPERATIONAL PLANS LGU s  Monitoring and evaluation National Nutrition Survey Philippine Food and PPAN Reporting System Nutrition Surveillance MELLPI System FIVIMS BASIC CONCEPTS IN NUTRITION BASIC CONCEPTS OF NUTRITION  Essential nutrients are needed throughout life; only the amounts of nutrients needed vary according to age or state of growth and development, sex, body size, physical activity, state of health and specific physiologic conditions  No single food contains all the essential nutrients in amounts needed for optimum health  Good nutrition is essential for the following: * Growth * Normal organ development and functioning * Normal reproduction * Maintenance and replacement of worn- out cells and tissues * Optimum activity level and working efficiency *Resistance to infection and disease *The ability to repair bodily damage or injury  Proper nutrition means that all the essential nutrients are supplied and utilized in adequate balance to maintain optimal health and well- being  Most people are interested on how to be assured that they get the proper nutrients in the amounts needed from daily meals and snacks. They recognized the six classes of nutrients- protein, carbohydrate, fat, vitamins, minerals and water  All of the nutrients most of us need can be obtained by eating a variety of different types of foods  Nutrients are important chemical substances that work together and interact with the body chemicals to perform one or more of the following functions: 1. Furnish fuel needed for energy 2. Provide materials to build, repair, and maintain body tissues 3. Supply substances that function in the regulation of body processes  Water is the most important nutrient. Following water, the nutrients of highest priority are those that provide energy, which must be supplied from foods or can be supplied from quantities stored in the body  The fundamental principles of nutrients interaction state that: 1. Individual nutrients have specific metabolic functions, including primary and supportive roles, and 2. No nutrient ever works alone  Each nutrient has certain special jobs to do in the building, maintenance, and operation in the body. These jobs cannot be done by other nutrients- an extra supply of one cannot make up for a shortage of another.  There are other jobs to be done in the body that require nutrients to work together as teams. To build bones, the nutrients vitamin D, calcium, and phosphorus interact. One member of the team cannot perform its job unless all the others are present in the right amounts. Cumulative Effects of Nutrition  Years of overeating without increasing energy expenditure cause obesity and may predispose the individual to metabolic diseases like hypertension, Type 2 diabetes mellitus, gallbladder disease, gout, foot problems, certain cancers, and even personality disorders  Eating excessive amounts of saturated fats for many years contribute to atherosclerosis w/c leads to heart attacks Individuals at Risk from Poor Nutritional Intake Persons vulnerable to nutritional deficiency are:  Infants  Preschool children  Adolescents  Pregnancy  Elderly Summary and Highlights about Nutrition as a Science  Adequate nutrition is essential for health  A number of compounds and elements called nutrients are needed daily in the food of humans  An adequate diet is the foundation of good nutrition, and it should consist of a variety of natural wholesome foods  Many nutrients should be provided preformed in food, whereas a few may be synthesized within the body  Nutrients are interrelated, and there must be metabolic balance in the body  Body constituents are in a dynamic state of equilibrium (homeostasis)  Human requirements for certain nutrients are known quantitatively within certain limits  The effects of nutritional inadequacy are more than physical; behavioral patterns and mental performance are also affected  The nutritional status of populations and individuals can be measured for certain nutrients. However, for other nutrients, techniques of assessment have yet to be refined  The biologic meaning of food is attributable to the three functions of nutrients, i.e., source of energy, growth and repair of tissues and regulation of life processes  To an individual or family, food is eaten more than its physiologic and biologic value. Food is multi-dimensional and has other meanings that relate to religion, social, psychological and aesthetic values. Thus, one may speak about delicious, savory food, comfort food and ethnic food, food taboos because of religion and health beliefs  One dimension that is taken for granted, but is most important to health and life is food and water safety. A food may be nutritious and delicious, but useless if it causes illness from microbial, chemical and physical hazards that are food-borne  Proper education, technical expertise, and the use of all resources in applied nutrition and food technology will help upgrade the nutritional status of people  The study of nutrition as a subject or course has a broad scope and is interrelated with many allied fields such as physiology, biochemistry, food technology, dietetics, public health, behavioral science and many branches of medicine  Nutrition is an ever-changing field and a dynamic science  NUTRITION PHYSIOLOGY Structural Composition of the Human Body  Cell- the smallest unit, which performs the functions that characterize living organisms w/c include growth, reproduction, mobility, work, and sensitivity to stimulus - All cells need energy and nutrients in order to perform their various functions -These should be available continuously in adequate amounts and at the right time  Tissues, organs and glands within the human body are organized in such a way that bodily systems can be differentiated according to their functions or physiologic roles  There are eleven systems: skeletal, muscular, digestive, respiratory, circulatory, lymphatic, nervous, reproductive, urinary, endocrine and integumentary systems  An eleventh group is comprised of the special senses (seeing, hearing, tasting, smelling, and touching) that are particularly involved with food intake  The Digestive System  Thedigestive system consists of the gastrointestinal tract (GIT) and accessory organs (liver, gallbladder, pancreas) that provides hormones and enzymes Digestion, Absorption and Metabolism  The food must undergo several changes before it can be utilized by the tissues. Essentially five steps are involved in the breakdown and metabolism of macronutrients (carbohydrates, proteins, and lipids) 1. Ingestion-the initial process of eating the food 2.Digestion- the breakdown and cleavage of the complex food into simpler constituents in the digestive tract  Digestion in the mouth -The digestive process is initiated in the mouth. Major mechanical breakdown of food occurs in the mouth. The well-masticated food is moistened and softened by the saliva, facilitating its passage down the esophagus by peristalsis, caused by a wave of contraction followed by relaxation of the tract w/c propels the food forward -The salivary amylase begins to digest the starch ingested - Lingual lipase also digests emulsified fats  Digestion in the small intestine - The small intestine is the principal digestive organ of the body, and it is well adapted for the digestive process for the following reasons: * motility- it allows for good mixing and transport of food * secretion- the several secretions (e.g. enzymes, bile acids) provide the necessary chemical means and conditions for the breakdown of food * absorption- provides a highly selective absorptive mechanism Summary of Sites & Nature of Digestion Site Type of Action How Accomplished Mouth Mechanical Chewing Chemical Salivary amylase Lingual lipase Stomach Mechanical Peristalsis Chemical Action of HCl Gastric lipase Gastric protease Small intestine Mechanical Peristalsis Chemical Bile, pancreatic lipase, pancreatic amylase, pancreatic protease, intestinal sucrase, maltase, lactase 3.Absorption -The process by w/c the end products of digestion pass through the walls of the gastrointestinal tract -The end products of digestion are: * monosaccharides (from carbohydrates, starch and disaccharides) * monoglycerides, fatty acids, glycerol (from lipids) * dipeptides and amino acids (from proteins)  Sites of Absorption Materials Absorbed Sites of Absorption Amino acids, dipeptides Small intestine Sugars Small intestine Glycerol, glycerides, Small intestine fatty acids Vitamins Stomach & small intestine Inorganic salts entire GIT Water esp. the large & small intestine Mechanisms for Absorption  Passive diffusion- water and small water soluble nutrients diffuse through the mucosal membrane  Active transport –e.g. monosaccharides, amino acids, move across the mucosal membrane against a concentration gradient -The process is energy requiring and involves specific carrier systems  Pinocytosis- a process during w/c the cell membrane forms a pocket and engulfs the molecule incorporating it into the cell Metabolism -The absorbed nutrients are transported by the blood stream to the various tissues for utilization. The two phases of metabolism are:  Anabolism- involves the synthesis or building up of new cellular material for growth or replacement of worn out body substances (maintenance)  Catabolism-involves breakdown of substances to supply energy and other substances * The body is in state of dynamic equilibrium; that is at any given time, anabolism and catabolism occur simultaneously Elimination of waste products  Waste products occur during the process of metabolism  These include carbon dioxide w/c are eliminated by pulmonary ventilation, and urea excreted by the kidneys in the urine BASIC TOOLS IN NUTRITION A. Food Groups (Guide to Good Nutrition)  Classifies food according to body- building, energy-giving and regulating functions  A daily food guide which suggests the use of the recommended amounts and number of servings Food Guide Pyramid a graphic presentation of the dietary guidelines  designed to convey the dietary principles of variety, proportionality and balance, and moderation Food Guide Pyramid * qualitative tool in planning nutritious diets and in assessing nutritional adequacy of diets * foods containing high levels of certain nutrients are grouped together and the serving portions are stated in household measures Food Guide Pyramid for Filipinos USDA Food Guide Pyramid USDA Food Guide Pyramid The pyramid symbol has these components:  Activity, represented by a person climbing steps – a reminder of the importance of daily physical activity  Moderation, shown by the narrowing of each food group from bottom to top – the wider base represents foods to be selected more often (those with little or no solid fats or added sugars), and the narrower apex foods to be used infrequently (those containing more added sugars and solid fats). The more active you are, the more of these latter foods can be used in your diet.  Personalization, shown by the person on the steps USDA Food Guide Pyramid  Proportionality, shown by the differing widths of the food group bands. The widths suggest how much food to choose from each group as a general guide, not the exact proportions  Variety, symbolized by the 6 color bands representing the 5 food groups of the pyramid plus oils. These are the foods from all groups needed daily for good health.  Gradual improvement, encouraged by the slogan, and suggesting that small steps taken daily will improve the individual’s diet and lifestyle. USDA Food Guide Pyramid MyPyramid is based on the Dietary Guidelines for Americans, 2005, which describes a healthy diet as one that  emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products  includes lean meats, poultry, fish, beans, eggs, and nuts  is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars B. Nutritional Guidelines (NGF) a set of primary recommendations to promote good health through proper nutrition  seeks to foster an adequate and balanced diet as well as desirable food and nutrition practices and healthy habits suitable for the general population Ten Nutritional Guidelines for Filipinos (2012) 1. Eat a variety of foods everyday - No single food provide all the nutrients the body needs - Choosing different kinds of foods from all the food groups is the first step to obtain a well-balanced diet Ten Nutritional Guidelines for Filipinos 2. Breastfeed infants exclusively from birth to 6 months and then give appropriate food while continuing breastfeeding - ensures a complete and safe food for the newborn and imparts the other benefits of breastfeeding - advocates the giving appropriate complementary foods in addition to breast milk once the infant is ready for solid foods Ten Nutritional Guidelines for Filipinos 3. Eat more vegetables and fruits everyday to get the essential vitamins, minerals and fiber for regulation of body processes Ten Nutritional Guidelines for Filipinos 4. Consume fish, lean meat, poultry, egg, dried beans or nuts daily for growth and repair of body tissues - these foods provide good quality protein and dietary energy as well as iron and zinc Ten Nutritional Guidelines for Filipinos 5. Consume milk and other calcium-rich foods such as small fish and shellfish, everyday for healthy bones and teeth Ten Nutritional Guidelines for Filipinos 6. Consume safe foods and water to prevent diarrhea and other food and water-borne diseases Ten Nutritional Guidelines for Filipinos 7. Use iodized salt to prevent Iodine Deficiency Disorders Ten Nutritional Guidelines for Filipinos 8. Limit intake of salty, fried, fatty and sugar-rich foods to prevent cardiovascular diseases - warns against excessive intake of salty foods to prevent hypertension, particularly among high-risk individuals Ten Nutritional Guidelines for Filipinos 9. Attain normal body weight through proper diet and moderate physical activity to prevent obesity and maintain good health Ten Nutritional Guidelines for Filipinos 10. Be physically active, make healthy food choices, manage stress, avoid alcoholic beverage and do not smoke to help prevent lifestyle-related non- communicable diseases C. Recommended Dietary Allowances (RDAs)/RENI  consists of the minimum requirements plus a safety factor called “ margin of safety” to allow for individual variations of body storage, state of health, nutrient utilization, and other day-to-day variations within a person  RDAs are always higher than the minimum dietary requirements C. Recommended Energy and Nutrient Intake (RENI)  a nutrient-based dietary standard on the recommended intakes of energy and nutrients for the maintenance of good health -aims to maintain health and prevent deficiency among healthy Filipinos 4. Food Composition Table  A table of foods with their equivalent nutritive values expressed in grams, milligrams, or other units of measure Uses: a. Facilitates the selection and choice of foods to meet nutrient intakes b. Provides data on edible portion of foods c. Facilitates planning of regular and therapeutic diets 4. Food Composition Table Uses: d. Facilitates calculation of nutrient content of diets from data on food consumption * The values are dependent on variety, breed, stage of maturity, season, geographical difference, production, storage, trimming, manufacturing, handling practices, other preparation Formula for calculating the nutrient content: Nutrient per E.P. (gms.) household measure = nutrient per 100g E.P.(FCT Value) x g. E.P. 100 5. Food Exchange Lists (FELs)  A grouping of common foods that have practically the same amount of protein, carbohydrate and fat  Foods within a group can be exchanged with another provided the specified serving portion is followed * Intended for planning diets and a quick method to calculate protein, carbohydrate, fat and calories for any given meal or diet 6. Nutrition Labeling  Food labels are the primary means of communication between the producer or the manufacturer and the purchaser or consumer  Nutrition labeling- is a description intended to inform the consumer of nutritional properties 6. Nutrition Labeling Consists of two components: a) Nutrient declaration- a standardized statement or listing of the nutrient content of food b) Nutrient claim- representation which states or implies that a food has some particular properties Purposes of Nutrition Labeling To ensure that nutrition labeling is effective, the Codex Alimentarius guidelines remind the: 1. Consumers to make a wise choice by reading the label 2. Manufacturer or producer to convey the nutrient content 3. Manufacturer not to mislead or deceive consumers and that, no nutrition claims are made without approval by authorities 7. Use of Computers/Softwares  Computers are important tools in nutrition education, nutrient/dietary analysis, diagnostic procedures, and as therapeutic aids ENERGY  DEFINTIONS  Energy – the capacity to do work * All vital processes of the human body require energy * The body derives energy from the heat produced when the carbohydrates, fats and protein in food are metabolized * Foods containing these macronutrients, in turn, store energy derived from the sun during the process of photosynthesis  Kilocalorie (kcal)- the amount of heat required to raise the temperature of one kg. of water by one degree centigrade at normal atmospheric pressure * It is a measure of chemical energy stored in foods; this chemical energy can be transformed into heat and mechanical work energy in the body * One kcal=1000 small calorie Joule- the unit of measure of energy in the metric system * One kilocalorie- 4.184 joules  Measurement of Energy  Calorimetry- measurement of heat or energy produced from food as amount of heat energy expended by the body  METHODS: 1. Direct calorimetry- measurement of the amount of energy expended by monitoring the amount of heat produced by a person inside a chamber large enough to permit moderate amounts of activity -makes use of a bomb calorimeter or a respiration chamber as instruments to measure heat production directly  a. Bomb calorimeter- a well-insulated box-like container about a cubic foot in size –used to measure the heat produced by a known amount of food when it is burned inside * The amount of heat released by the burning food is called the heat of combustion; also called the gross energy value of food  b. Respiration chamber- a small, well- insulated room that operates on the same principle as the bomb calorimeter (i.e., heat is directly measured to measure energy expenditure in humans Bomb Calorimeter Bomb Calorimeter Bomb Calorimeter Bomb Calorimeter 2. Indirect calorimetry- measurement of the amount of energy expended by monitoring the oxygen consumption and carbon dioxide production of the body over a period of time  a. Energy value of food 1. may be calculated from CHO, fat and protein content of food by applying the Atwater or physiologic fuel values (PFV) which are 4, 9, 4 kcal, respectively  May also be determined from the amount of oxygen used to burn a given amount of food  b. Energy expenditure of humans- may be calculated from oxygen consumption 1. Closed circuit- the source of oxygen is known, such as Benedict Roth Respiration Apparatus -suitable for measuring energy expenditure at rest Respiration Chamber Respiration Chamber 2. Open circuit- source of oxygen is outside is outside air, e.g. the Kofranyi-Michaelis Respirometer - exhaled air is collected in a bag and analyzed for carbon dioxide -Oxygen consumption is computed from the amount of CO2 - suitable for measuring energy expenditure during activity  c. Other indirect calorimetry methods 1.Heart rate monitoring method- continuous monitoring heart rate offers an alternative way to estimate total energy expenditure in a free living subject - based on the strong positive correlation between heart rate and oxygen consumption  2. Doubly-labelled water technique- stable isotopes of hydrogen and oxygen in water (2 H, 18 O) are ingested  Energy Expenditure  The body’s total energy needs can be divided into three components namely, needs for a) Basal metabolism- represents the minimum amount of energy required to carry out vital processes such as respiration, circulation and maintenance of body temperature and muscl tonus  Basal metabolic rate (BMR)- the amount of energy required for basal metabolic processes per unit of body weight per unit time (e.g. kcal/kg/hr) -measured under standard conditions of room temperature and subject is in post- absorptive state - constitutes about 60%-75% of total energy expenditure  Resting metabolic – similar to basal metabolism, but measured under actual (not standardized) conditions and subject does not have to be in post-absorptive state  (RMR)- the amount of energy required for the basal metabolic processes and thermic effect of food per unit weight pr unit time, called resting energy expenditure (REE) -higher than the basal metabolic rate Factors that Influence BMR  Body size- size and shape of an individual influences basal metabolism  Sex- women have 6-10% lower basal metabolic rate than men because of sex differences in body mass and hormones  Body temperature- an increase in body temperature as in fever by 1oF will cause 7 % or 13% rise for each degree above 37oC  Growth- an increase in BMR is noted with an increase in the rate of growth  Age- BMR declines during old age due to slowing down of body processes  Pregnancy and lactation- BMR is increased by 20-25% bec. of the development of the fetus and placenta; plus an increase in metabolic activity of the maternal tissues -production of breast milk needs extra calories  Body composition-water, bone and fat do not actively participate in energy metabolism, bec. the seat of energy exchange is in the active protoplasm or in the muscles. Thus, women have a lower BMR than men, non-athletes lower than athletes by about 5%  State of nutrition- BMR is low in obesity, in starvation, hypothyroidism and undernutrition -BMR is increased in hyperthyroidism and cardio-renal diseases  Hormone secretions- -Secretions of the thyroid gland have the greatest effect on basal energy needs - Hyperthyroidism causes an increase in the basal energy needs by about 50-75% -Hypothyroidism can depress basal energy needs by almost 30%  Sleep- Basal metabolism is reduced by about 10% during sleep bec. of the relaxation of muscle tension Energy Expenditure b) Physical activity (PA) expenditure- represents energy use for total body cell metabolism above what is needed during rest - the energy spent on daily activities and physical exercises (depends on the kind, the intensity and the duration of the physical activity) - PA increases energy expenditure above and beyond our basal energy needs by 15-40% Energy Expenditure c. Diet-induced thermogenesis (DIT), also called thermic effect of food (TEF), SDA- represents the energy needed to digest, absorb, and process absorbed nutrients - corresponds to about 5% to 10% of energy used for basal metabolism and physical activity - high protein diets elicits the greatest DIT (up to 15%)  Energy Balance= Energy intake-Energy expenditure  Energy Imbalance Undernutrition (reflected as underweight) Underweight- the body weight is 10% or lower than the IBW or DBW Overweight- actual weight is more than 10% - 20% over the DBW Obesity- actual weight is more than 20% over the DBW Note: An athlete may be 20% overweight but not obese because of his/ her lean body mass and muscle tissue DIETARY CALCULATIONS Steps in Calculating Diets Step 1. Estimate the individual’s Ideal Body Weight  In children, ideal weight is the midpoint of the recommended weight range at a specific age  In adolescents and adults, DBW refers to the average recommended weight range at a specified height for a given body frame Steps in Calculating Diets  DBW is the weight found statistically to be most compatible with health and longevity. It indicates the persons body composition with balance between lean body mass and fat tissue  Round off to nearest whole number except in the case of infants Steps in Calculating Diets Step 2. Determine the reasonable energy allowance  To simplify construction of daily food plan, the estimated energy allowance is rounded off to the nearest 50 kcal  Steps in Calculating Diets Step 3. Determine the CHO, CHON and Fat Allowance * The amount of macronutrient allowances is based on different factors. In healthy people, the recommended level is based on physiologic needs (e.g. pregnancy growing children, old age etc.) * During an illness, the persons health condition, medication used, etc. must be taken into account along with food habits  Estimating Desirable Body Weight 1. Infants Method I a. 1st 6 months Formula: DBW(g)= Birth weight (g) + (age in mos. X 600) b. 7 months- 12 months DBW (g) = Birth weight (g) + (age in mos. X 500) * If birth weight is not known, allow 3000 g (full term) or 2500 g (premature) Estimating Desirable Body Weight Example: Subject: 9 month-old infant; birth weight= 3,500 g Answer: DBW=3,500 + (9X500) = 3500 + 4500 = 8000 g or 8 kg Estimating Desirable Body Weight Method II Formula: DBW (kg)= (age in months /2)+ 3 Example: 6 month old infant Answer: DBW= (6/2) +3 = 6 kg Estimating Desirable Body Weight 2. Children 1.Formula: DBW (kg)= (age in years x 2) + 8 Example: Subject: 7 yr-old child DBW = (7x2)+ 8 = 14 + 8 = 22 kg + 2 kgs. increase in every succeeding year II. Use of Tables/Standards a. Use of Table-WHO Child Growth Standards a) Weight-for-age for 1-5 years old b) Body Mass Index for 5-19 years old * Use the median of the normal weight range as DBW Estimating Desirable Body Weight 3. Adults Method I. Body Mass Index (BMI) Based Normal Range 20-24.9 kg/m2 Desirable BMI for men 22 kg/m2 Desirable BMI for women 21 kg/m2 Formula: DBW (kg)= Desirable BMI x ht (m)2 Estimating Desirable Body Weight Example: Male 5’ 3” tall DBW (kg)= 22 kg/m2 x (1.6 m)2 = 22 (2.54) = 56.32 kg. or 56 kg. Estimating Desirable Body Weight 3. Adults Method II. Tannhauser’s (Broca) Method 1. Measure height in centimeters (cm) 2. Deduct from the measurement the factor 100 and the difference is the DBW in kilograms (kg.) To apply this DBW in Filipino stature, deduct 10% Estimating Desirable Body Weight 3. Adults Method III. NDAP Formula DBW for men 5 feet tall is 112 lb. Add (subtract) 4 lbs. for every inch above (below) 5 feet. DBW for women 5 feet tall is 106 lbs. Add (subtract) 4 lbs. for every inch above (below) 5 feet tall. Estimating Desirable Body Weight Method IV. Adopted Method For 5 ft., use 105 lbs For every inch above 5 ft, add 5 lbs Ex: Subject: Ht 5’2” DBW (lbs)= 105 + 2(5) = 105 + 10 lbs = 115 lbs = 52 kg. Estimating Desirable Body Weight Method V. Ador Dionisio’s Method For 5 ft: DBW = 110 lbs (male) = 100 lbs (female) For every inch above 5 ft, + 2 lbs For every 5 yr complement between 25-50 yrs, add 2 lbs.  Estimating Desirable Body Weight Method V1. Dr. Fernando’s Method For 5 ft height: DBW = 106 lbs (male) = 100 lbs (female) For every inch above 5 ft.,add: 6 lbs (male) 5 lbs (female) For large frame = + 10% For small frame = -10 % For medium frame = as computed Body Frame= ht.(cm)/wrist circumference (cm) Interpretation Male Female Small Frame 9.6 10.1 Medium Frame 9.7-10.4 10.2-11 Large Frame 10.5 11.1 Estimating Desirable Body Weight Method VII. Hamwi Method Female: 100 lbs for every 5 ft + 5 lbs for every inch above 5 ft Male: 106 lbs for every 5 ft + 6 lbs for every inch above 5 ft  Percentage of Total Body Weight of Amputated Body Part Body Part % of Total Body Weight Hand 0.3 Forearm and hand 2.6 Entire arm 6.2 Foot 1.7 Below-knee Amputation 7.0 (BKA) Above-knee Amputation 11.0 (AKA) Entire Leg 18.8  Estimating Desirable Body Weight Example: Subject : 5’2” woman, 25 y/o with BKA Step 1. DBW (NDAP) = 106 lbs (5 ft) + 8 lbs = 114 lbs Step 2. Adjusted DBW= 114 lbs- (114 lb x 0.07) = 114 – 7.98 = 106 lbs  Calculating Energy Allowances *Voluntary (muscular) and involuntary (metabolic processes) activities of the body require energy  Energy needs are estimated by considering the age, sex, physical activity and state of health such as pregnancy, pathologic condition, etc. * Estimated energy allowance is rounded off to the nearest 50 kcal Calculating Energy Allowances I. Infants TER/TEA/day: 0-6 mos. -120 kcal/kg DBW 7-12 mos.-110 kcal/kg DBW Example: 4 month old infant TER= DBW x 120 kcal/kg = 5.4 kg x 120 kcal/kg = 648 kcal or 650 kcal.  Calculating Energy Allowances Method 2. Based on Age and DBW Formula: TER/day= DBW (kg) x Calorie Allowance Recommended Calorie Allowance for Children Age (years) Kcal/kg/DBW 1-3 105 4-6 90 7-9 75 10-12 65 (boys) 55 (girls) Calculating Energy Allowances Children Example: 7 yr old child DBW = 22 kg TER = 22 kg x 75 kcal/kg = 1650 kcal  Calculating Energy Allowances III. Adolescents Formula: TER/day= DBW X Calorie Allowance based on age Recommended Calorie Allowance for Teens Age (years) Kcal/kg DBW 13 to 15 55 (boys) 45 (girls) 16 to 19 45 (boys) 40 (girls) Average (all ages, both 45 sexes) Calculating Energy Allowances IV. Adults Method I. Krause Method/NDAP: Energy allowance based on activity level Formula: TEA/TER= DBW (kg) x Energy Allowance depending on the Level Physical Activity  Calculating Energy Allowances Recommended Calories /kg DBW by Level of PA Activity NDAP (kcal/kg DBW) Krause Energy Expenditure--- Males Females (Both) Men Women Bed rest 27.5 Sedentary 35 30 30 31 30 Light 40 35 35 38 35 Moderate 45 40 40 41 37 Heavy 50 - 45 50 44 Exceptional 58 51 ---Based from the RDA, 10th Ed, 1989 by the Us  Calculating Energy Allowances Example: Krause Method Subject: DBW 52 kg.; Moderate activity TER= DBW x PA = 52 kg x 40 kcal/kg DBW = 2080 or 2100 kcal Example: NDAP Subject: 5’2” female bank teller; DBW 52 kg TER= 52 kg x 30 kcal/kg = 1560 or 1550 kcal  Calculating Energy Allowances Method 2. Cooper et al. TER/day= BMR + PA + SDA/TEF/DIT Steps: 1. BMR= 1 kcal/kgDBW/hr 2. Calculate energy for PA (% above basal) PA= BMR x% of BMR 3. Compute energy expenditure for SDA/TEF SDA/TEF= 10% of BMR + PA 4. TER= BMR +PA + SDA/TEF  Calculating Energy Allowances Physical Activity % Above Basal Bed Rest 10 Sedentary 30 Light 50 Moderate 75 Heavy 100 Calculating Energy Allowances Example: Subject: 5’2” , school nurse; DBW = 52 kg. 1. BMR= 1 kcal x 52 x 24 = 1248 kcal. 2. PA= 1248 x.50 (light) = 624 kcal. 3. SDA/TEF = 10 % (1248 + 624) =.10 (1872) = 187 kcal. TER= 1248 + 624 + 187 = 2059 or 2050 kcal.  Calculating Energy Allowances Method III. Harris-Benedict Equation Formula: BEE Male=66.5+13.75(W)+5.0(H)-6.78(A) Female=655.0+9.56(W)+1.85(H)-4.68(A) Where: W=actual weight in kilograms H=Height in centimeters A=Age in years Step 1. Estimate the basal or resting energy expenditure (BEE or REE) using the above equation For obese, adjust weight first before computing the REE: (ABW-DBW) x 0.25 + DBW= wt. to be used for calculating BEE Note: 0.25 is the % of excess body weight that is metabolically active Step 2.Multiply the activity and injury factor from the reference table to the BEE. Weight maintenance: TEE= BEE ( activity factor x injury factor) Weight gain: Add 500 kcal/day  Activity Factor in Harris Benedict Formula Type of Activity Factor Bed Rest 1.0-1.1 Very Light 1.2-1.3 Light 1.4-1.5 Moderate 1.6-1.7 Heavy 1.9-2.1 Streneous 2.2-2.4 Note: Use lower factor for females; higher factor for males  Stress and Injury Factor in Harris-Benedict Type of Stress or Injury Factor No illness/no stress 1.0 Convalescence, mild malnutrition, 1.1 post-operative (no complication), mild illness, noncatabolic Infection and stress, catabolic 1.1-1.2 Mild 1.3-1.4 Moderate 1.5-1.7 Severe, hypercatabolic 1.5-1.7 Sepsis 1.8-2.0 Burns, 40% body surface area 1.8-2.0 Fracture long bone 1.2-1.3 Respiratory/renal failure 1.4-1.5  Cont.. Stress and Injury Factor in Harris- Benedict Type of Stress or Injury Factor COPD 1.4-1.6 Cancer with chemotherapy or 1.5-1.6 radiation, Cardiac cachexia Surgery, minor/elective 1.2-1.3 Surgery major 1.2-1.3 Trauma, skeletal 1.3-1.4 Trauma, multiple/head injury 1.5-1.6 *Use lower factor for females; higher factor in males Example: Mr. Cruz is a 28-yr old obese male, medium framed, 5’8” tall with an actual body weight of 200 lbs. The patient is currently being treated at St. John Hospital for head injury sustained during a vehicular accident. Answer: DBW (Tannhauser) = 73 kg Adjusted Wt. =(90.90 kg-73 kg) x 0.25 + 73 =17.9 x 0.25 + 73 =77.48 kg Step1.BEE=66.5 +13.75 (77.48)+ 5.0 (172.72) – 6.78(28) =66.5 +1065.35+863.6-189 =1995.45-189 =1806.45 kcal Step 2. Activity factor -1.1; Injury factor- 1.6 Step 3. TEE=BEE (activity factor x injury factor) =1806. 45 (1.1x1.6) =3179.352 or 3200 kcal Method 1V. Mifflin-St. Jeor Formula Step 1. Determine BMR Male: BMR = 10 x wt (kg) + 6.25 x ht (cm)-5 x age (years) + 5 Female: BMR=10 x wt (kg) + 6.25 x ht (cm)- 5 x age (yrs)-161 Step 2. Multiply BMR and “activity factor” Activity Factor: 1.3= sedentary 1.4=walking/standing, no exercise 1.5=exercise 1.6= walking and exercise 1.8= heavy lifting & exercise Example: Male, 6’1”, 230 lbs, 30 years with exercise Step 1. BMR = 10 x wt (kg)+ 6.25 x ht (cm)- 5 x age (years) + 5 = 10 x (85) + 6.25 x (185)- 5(30) + 5 =850 + 1156.25 – 150+ 5 =1851.25 kcal Step 2. TEE= BMR x PA (activity factor) = 2061.25 x 1.5 = 2776.88 or 2800 kcal Adjustment of Energy Allowance for Elderly  The adjustment below is for healthy elderly and with no special conditions that increase the demand for extra calories Guidelines:  50-59 y/o, decrease by 10%  60-69 y/o, decrease by 20%  70 and over, decrease by 25% Adjustment of Energy Allowance of Pregnant and Lactating Women  Pregnant Women 1st trimester: no additional 2nd and 3rd trimester: + 300 kcal/day *Lactating Women + 500 to normal allowance /day DETERMINATION OF CARBOHYDRATE (CHO), PROTEIN AND FAT METHOD I. PERCENTAGE METHOD  ACCEPTABLE MACRONUTRIENT DISTRIBUTION RANGE (PDRI 2015,)  For Adults, > 19 yrs. Old Carbohydrates – 55-75% Proteins - 10-15 % Fats - 15-30% METHOD I. PERCENTAGE METHOD  ACCEPTABLE MACRONUTRIENT DISTRIBUTION RANGE (PDRI 2015, FNRI-DOST) -Refer to table Example: TER= 2050 Kcal CHO(gms.)= 2050 kcal x 70% = 1435 kcal ÷ 4kcal/gm = 358 g.= 360 g. CHON(gms.) = 2050 kcal x 10% = 205 kcal ÷4kcal/gm = 51.25 g. = 50 g. Continuation… Example Fat = 2050 kcal x 20% = 410 kcal ÷ 9 kcal/gm = 45.56 g. =45 g. Diet Rx: Energy 2050 kcal, CHO 360 g., CHON 50 g, Fat 45 g. Method II. Non-Protein Calorie (NPC ) Step 1. Determine the CHON allowance/day based on recommended level of intake Step 2. Compute the CHON calories by multiplying the CHON allowance by 4 kcal/g Step 3. Calculate the non-protein calories Step 4. Distribute NPC into CHO and Fat allowing 55-80% (average of 70%) for CHO 20-45% (average of 30%) for Fat Step 5. Compute the amount in grams and round off to the nearest 5 grams Example:  CHON Reqt. = 1.14 g/kg. DBW (adult) CHON (g) = 1.14 g. x 52 kg = 59.28 g = 60g CHON calories = 60 g x 4 kcal/g = 240 kcal NPC= 2050 kcal-240 kcal = 1810 kcal Continuation… Example CHO(g) = 1810 kcal x 70% = 1267 ÷ 4 kcal/g = 316.75 g.= 315g. Fat (g) = 1810 kcal x 30% = 543 kcal ÷ 9kcal/g = 60g Diet Rx: Energy 2050, CHO 315g, CHON 60g, Fat 60g  OTHER CONSIDERATIONS IN DIETARY COMPUTATIONS A. Energy and Protein Needs of Burn Patients  Burn is a tissue injury caused by excessive heat, caustics (acids or alkalis), friction, electricity or radiation. The basal metabolic rate is often twice the normal requirement and protein is about 3 times the recommended intake.  Regardless of method used for TER, CHO should be the main source of calories, supplements include Vit.C at 3x RNI, Vit.A, D and B-complex, zinc and iron at 2x RNI, Vit. K and B 12 once a week. CHON needs are 20-25% of the TEA. Children should receive about 2.5 to 3.0 g CHON per kg weight.  TPN is suggested in patients with persistent or recurrent paralytic ileus or intractable diarrhea and those who are not able to receive enteral nutrition for 3 days or longer  Determination or Energy Allowance I. Adults Method 1. Harris-Benedict Equation Method 2. Curreri Method Formula: TEA/day (adult) = (25 kcal x kg pre-burn body wt.) + (40 kcal x % TBSA burned) or = (24 x kg usual body wt.) + (40 kcal x % TBSA burned) II. Children Method 1. Polk Equation (for pediatric burn patient, especially under 3 yrs old) Formula: TER = (60 kcal x kilogram body weight) + (35 kcal x %burn) Method 2. TER = [kcal RENI for age/kg x preburned body wt (kg)] + [40 kcal x % TBSA] Determination of Protein Allowance I. Adults Method 1. Pro g x kgDBW + 3g x % BSA Method 2. [1.1 g x % preburned body wt (kg)] + [3 g x % TBSA burned] Method 3. 20-25% of TER II. Children Method 1. 3g x kgDBW + 1g x %BSA Method 2. Pro RENI for age/kg + (1g x TBSA burned) Method 3. 2.5-3.0g CHON/kg body weight  B. Fevers and Infections a. Use BEE or method 1 to determine BMR. b. Determine the % increase of BMR per 0C of 0 F to adjust BMR  13% - 10C  7% - 10F c.TER = DBW x 24 = kcal for BMR + increase of temperature Kcal BMR x (AF) = kcal for activity BMR + kcal for activity = kcal/day  C. Surgery Formula: TER(kcal/day) = BEE x activity factor x injury factor D. Edema  To determine dry weight a. Elevate leg 450 from bed b. Actual weight = height elevated leg reading x 10 + 8  E. Weight Loss Method 1. TER = actual wt. x PA – (500- 1000kcal) Method 2. Calculate current energy intake through calorie counting per day and reduce 500 kcal/day. Method 3. Compute TER based on DBW at one activity level lower than actual. Thus, a person with an actual light activity level will be regarded sedentary instead.  F. Weight Gain Method 1. TER = actual wt x PA + (500-1000 kcal) Method 2. Compute allowance based on DBW at one activity level above actual Method 3. Compute current intake and add 500 BMI CLASSIFICATIONS (ADULTS)  QUETELETS INDEX CLASSIFICATION (QI) CLASS /CATEGORY BMI RANGE CED Grade III Less than 16 CED Grade II 16.0- 16.9 CED Grade I 17.0-18.4 Low Normal 18.5 – 19.9 Normal 20.0 – 24.9 Obese Grade I 25.0- 29.9 Obese Grade II 30.0 – 39.9 Obese Grade III 40.0 and over  FAO/WHO (1998) Classification BMI (wt. kg/ht. m2) Risk of Co- morbidities Underweight 25 Increased Preobese 25-29.9 Increased Obese Class I 30-34.9 Moderate Obese Class II 35-39.9 Severe Obese Class III >40.0 Very Severe  BRAY MEDICAL RISKS BMI (weight in kg/height in Medical Risk m2) 20-25 Very Low 26-30 Low 31-35 Moderate 36-40 High >40 Very High  PROPOSED ASIA PACIFIC GUIDELINES Classification BMI (kg/m2) Risk of Co- morbidities Underweight 0.005% of body weight -Calcium, phosphorus, magnesium, potassium, sodium, chloride and sulfur  Micro-minerals required in amounts less than 100 mg a day (