L5 Nutritional Requirements Team443 PDF

L5: Nutritional requirements GNT Block Color Index: • • • • • • Main text Female slides Male slides Important Doctor’s notes Extra notes Editing file: Objectives: Understand the basic terms of nutritional requirements that are important for establishing intake of a nutrient in a population. In...

L5: Nutritional requirements GNT Block Color Index: • • • • • • Main text Female slides Male slides Important Doctor’s notes Extra notes Editing file: Objectives: Understand the basic terms of nutritional requirements that are important for establishing intake of a nutrient in a population. Interpret the food pyramid that recommends daily serving size from each food group for vegetarians and non-vegetarians. Identify dietary guidelines and goals that are necessary for good health. Discuss energy requirement in humans including basic energy expenditure and the factors that affect it. Understand total parenteral nutrition (TPN) and its applications. Lecture presented by : Dr. Sumbul Fatma Dr. Usman Ghani What is nutrition? What is nutrition? Assessment of malnutrition Dietary reference intakes (DRIs) Estimated Average Requirement (EAR), Recommended Overview Dietary Allowance (RDA) & Adequate Intake (AI) Acceptable Macronutrient Distribution Ranges (AMDR) The Food Pyramid: dietary guidelines and goals Energy requirement and expenditure in humans Total parenteral nutrition (TPN) Composition and quantity of food intake by living organisms What is nutrition? (Quantity and quality of food) Biochemical utilization of food (Is it easily digestible food & How Much energy it’s producing) Human nutrition is divided into three areas: ● Undernutrition (nutrient deficiency) Will show symptoms ● Overnutrition (excessive nutrient intake) E.g: obesity & toxicity ● Optimal nutrition (balanced nutrient intake) taking the right amount that your body needs Assessment of malnutrition Malnutrition in humans is measured by: Dietary intake studies: identify people with deficient diets. E.g: 24-hour dietary recall but it is not accurate Biochemical studies: identify subclinical nutritional deficiencies E.g: no symptoms of a deficiency, a blood sample can reveal the deficiency (accurate) Clinical symptoms: identify clinical nutritional deficiencies Dietary Reference Intakes (DRIs) Definition More than required Quantitative estimates (not exact values) of nutrient intakes required to prevent deficiencies and maintain optimal health in populations Recommended by: Subclinical Less than required Clinical Food and Nutrition Board of the National Research Council, USA Dietary Reference Intakes Standards (four standards) Estimated Average Requirement (EAR) Recommended Dietary Allowance (RDA) (The most accurate) Adequate Intake (AI) (The least accurate) Tolerable Upper Intake Level (UL) The amount of nutrient intake estimated to meet the nutritional requirement of half of the healthy individuals 50% in an age and gender group The amount of nutrient intake that is sufficient to meet the nutritional requirement of nearly all healthy individuals 97-98% in a group ● RDA is two SD (Standard deviation) above EAR ● RDA = EAR + 2 SD Dr: you have to know how to calculate the RDA (see example next slide) It is used instead of EAR and RDA if: - a nutrient is considered essential but the experimental data are inadequate for determining EAR and RDA - (AI) covers the nutritional requirement of all individuals in a group with approximation due to insufficient data The highest level of daily nutrient intake that has no adverse health effects or toxicity in almost all individuals Dietary Reference Intakes (DRIs) cont.. Doctor's note: EAR-> The Average of your population data RDA-> Calculated from EAR SD-> The Standard Deviation Example: The requirement of X neutrint for 4 individuals is: 40/50/60/70 µg Calculate EAR? (40+50+60+70)÷4= 55 Calculate RDA? RDA = EAR + 2SD , -> SD = ± 15 (The difference between the mean and the lowest or highest value) (55-70) = 55 + 2(15) = 85 µg Dietary reference intakes. Normal requirement distribution of hypothetical nutrient showing percentile rank and placement of the estimated average requirement (EAR) and the recommended dietary allowance (RDA) on the distribution. SD, standard deviation. Only for your understanding Acceptable Macronutrient Distribution Ranges (AMDR) Range of adequate intake of a macronutrient associated with reduced risk of chronic diseases. AMDR for adults (% of total calories) : Fiber: >25 g Fats: 20-35 01 Carbohydrates: 45-65 02 03 Proteins:10-35 04 Food pyramid Food pyramid United States Department of Agriculture Center for Nutrition Policy and Promotion 4- Fats, oils and sweets have small serving size 1- Public educational tool established in 1992 2-Recommends size of daily servings 3-Pyramid shape Female doctor: You should know what the highest/lowest recommendations are, and the numbers in the (Exercise) part will be given in the question; other numbers are NOT IMPORTANT. Dietary guidelines and goals Consume a variety of foods from the basic food groups. Control calorie intake to manage body weight. Be physically active everyday. Choose fats and CHOs (carbohydrates) wisely for good health. Increase daily intake of fruits, vegetables, whole grains, and non-fat or low-fat milk and milk product. Choose and prepare foods with little salt. Female doctor:You don’t have to memorize these numbers Energy requirement in humans 1 The dietary energy intake required to maintain energy balance in a healthy individual 2 Energy balance is maintained by calorie intake and energy expenditure 3 Energy content of food is measured in calories or kilocalories (heat energy) E.g: Fat -> 9 kilocalorie/g Proteins/carbs -> 4 kilocalories /g Female doctor: you don’t have to memorize the numbers Vegetarians Vegetarians and nutrient intake - Lower intake of iron, calcium and vitamin D -Long-term vegans may develop megaloblastic Anemia due to vitamin B12 deficiency -Most consume enough protein -Lower in total dietary fat Vegetarians and chronic disease -Lower -Lower -Lower -Lower Body Mass Index (BMI) death rate from ischemic heart disease blood pressure cancer rates compared to non-vegetarians Basic energy expenditure depends on: Resting metabolic rate (RMR) Physical activity Thermic effect of food - Energy expense at rest - Required for normal body function - Depends on age, sex, growth, body surface area, fever, fasting, stress - Men: 1800 kcal / Women: 1300 kcal - Sedentary person: 30-50% above RMR - Active person: 100%+ above RMR Important - Heat produced by the body due to food digestion and absorption - 5-10% of total energy expenditure Total parenteral nutrition (TPN) - A type of exogenous nutrition in which terminally-ill patients are provided with all essential nutrients intravenously or through tube feeding - TPN is particularly indicated in severe inflammatory bowel disease, coma, cachexia, prolonged ileus (terminal loss of intestinal peristalsis) and extensive burns - Nutrients are pumped into a large central vein to allow rapid dilution of the solution (3L/24 hr) - Tube feeding is only provided to patients whose GI tract is intact and supports this type of nutrition (Enteral nutrition) ● Standard composition of TPN feed (24 hr requirement) - Energy content: 2000 kcal -Nitrogen: 12–14 g -Fat: 900 kcal -Glucose: 1000 kcal -Electrolytes, trace elements, vitamins: present -Volume: 3 liters ● Individual nutritional requirements of patients may vary ● Continuous biochemical, hematological and immunological monitoring of patient on TPN is required Quiz MCQs Q1 : Energy balance maintained by: A- Energy expenditure B- Fats C- lipid D- Carbohydrates Q2: Human nutrition is divided into three areas, except ? A- Undernutrition B- Overnutrition C- Optimal Nutrition D- no nutrition Q3: The DRIs standard that covers the nutritional Q4: AMDR for adult regarding the proteins is ? A- 20-35 B- 25-35 C- 20-25 D- 10-35 requirement of all individuals in a group with approximation due to insufficient data is ? A- Adequate Intake (AI) B- Recommended Dietary Allowance (RDA) C- Tolerable Upper Intake Level(UL) D- Estimated Average Requirement(EAR) Q6: Malnutrition is assessed by the following ways, except ? A- Clinical symptoms B- Biochemical studies C- Biochemical methods D- Dietary intake studies Q5: TPN is particularly indicated in? A- Diarrhea B- Hemiplegia C- Mild burns D- Cachexia Answers:1:A, 2:D, 3:A, 4:D, 5:D,6:C SAQ Q: Define the Dietary Reference Intakes ? A: Quantitative estimates of nutrient intakes required to prevent deficiencies and maintain optimal health in populations Q: Basic energy expenditure depends on ? A: Resting metabolic rate (RMR), Physical activity & Thermic effect of food Q: Human nutrition is divided into three areas: A: • Undernutrition (nutrient deficiency) • Overnutrition (nutrient excessive intake) • Optimal nutrition (balanced nutrient intake) Members board Team Leaders Raghad Alhamid Remas Aljeaidi Mohammed Alqutub Team Members Leen Alduaij Zeyad Alotaibi Sultan Almishrafi Wafa Alakeel Mohammed Alarfaj Juwan Al Musma Madawi Alhussain Nazmi A Alqutub Wasan Alanazi Leen K Althunayan Faisal Alshowier Aishah boureggah Dana A Alkheliwi Osama Almashjari Mansour Alotaibi Aldanah Abdullah Nazmi M Alqutub Salma Alsaadoun Layan Al-Ruwaili Fahad Mobeirek Abdulrahman Alosleb Areej Alquraini Sarah Alajaji Waad alqahtani Special Thanks to Aleen Alkulyah for the Design! [email protected]