Topic 37 - Energy Balance_241230_110217 PDF

TOPIC 3 PRINCIPLE OF NUTRTITION IN HEALTH PROMOTION: ENERGY BALANCE It can be difficult to choose an apple over a candy bar 2 Habit of healthy eating is important 3 LEARNING OUTCOMES At the end of t...

TOPIC 3 PRINCIPLE OF NUTRTITION IN HEALTH PROMOTION: ENERGY BALANCE It can be difficult to choose an apple over a candy bar 2 Habit of healthy eating is important 3 LEARNING OUTCOMES At the end of the session, students should be able to: define nutrition, food and healthy diet; list the classification of nutrients; discuss the factors influencing diet and food choice; describe the five processes in physiology of nutrition; Describe the principle of energy balance; Define basal metabolic rate (BMR); Discuss the factors affecting the BMR. 4  INTRODUCTION Nutrition is the science that interprets the interaction of nutrients and the substances in food in relation to maintenance, growth, reproduction, health and disease of an individual. Adequate nutrition remains an important part of comprehensive patient/client care. Awareness of the contents of our food consumption is the first step towards a healthier life. As a nurse, you have unique roles to increase clients’ awareness on the positive health choices and behaviors, make good choices to enhance own health. 5  DEFINITION OF NUTRITION Nutrition is the science that interprets the interaction of nutrients and all substances in food in relation to maintenance, growth, reproduction, health and disease of an individual. The processes of consuming and utilizing food for energy, maintenance, and growth. 6  DEFINITION OF FOOD Material, usually of plant or animal origin, that contains essential body nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals, and is ingested and assimilated by an organism to produce energy, stimulate growth, and maintain life. (American Heritage Dictionary) 7  HEALTHY DIET A healthy diet needs to have a balance of macronutrients, calories to support energy needs, and micronutrients to meet the needs for human nutrition. 8 CLASSIFICATION OF NUTRIENTS Macronutrients Micronutrients Carbohydrates Vitamins Proteins Minerals Fats Note: Refer handouts from Ms. Water Chen. 9 FACTORS INFLUECING DIET & FOOD CHOICES An individual’s food preferences and habits are often the major factor influencing food intake. Understand the factors that may influence nutrition is essential in providing optimal nutritional care to the client. Nurses’ responsibility: assess and recognize factors influencing client’s eating habit. 10 FACTORS INFLUECING DIET & FOOD CHOICES Availability, Preference Habit Gender convenience and economy Body Association Occupation Values Image Health and Emotional Age Medical nutrition state condition Ethnic Religious heritage Social Advertising practice and interaction & culture tradition 11 Student’s Activity Explain the factors influencing individual’s diet and food choice. You may use any of the following resources to complete the activity: – Your own 24-hour diet recall – Interview family members & friends – Past experiences – Reference books – Online database/journals – Web search – ………. 12 13  PHYSIOLOGY OF NUTRITION Five processes are involved in the body’s use of nutrients: i. Ingestion ii. Digestion iii. Absorption iv. Metabolism v. Excretion 14 INGESTION The taking of food into the digestive tract, generally through the mouth. 15 DIGESTION The mechanical and chemical processes that convert nutrients into a physically absorbable state. Digestion includes: – Mastication (chewing) – Deglutition (swallowing) – Peristalsis (coordinated, rhythmic, serial contractions of the smooth muscles of the GI tract) 16  ABSORPTION The process by which the end products of digestion pass through the small and large intestines into the blood or lymph systems. 17 METABOLISM The body’s conversion of nutrients into energy. Basal metabolism is the amount of energy needed to maintain essential physiologic functions when a person is at complete rest, both physically and mentally. 18  METABOLISM Metabolism  process by which living systems acquire and use free energy to carry out vital processes/activities. Catabolism (degradation) – Nutrients and cell constituents are broken down for salvage and/or generation of energy – Exergonic oxidation Anabolism (biosynthesis) – Endergonic synthesis of biological molecules from simpler precursors – Coupled to exergonic processes through “high- energy” compounds 19 METABOLISM A + B  AB AB  A + B 20 EXCRETION The process of eliminating or removing waste products from the body. 21 Energy Balance: Input vs Output 22  BODY WEIGHT Body composition is the proportion of muscle, bone, fat and other tissues that make up body weight. Achieving and maintaining a healthy weight is about managing energy balance and increasing the proportion of lean to fat tissue. 23  ENERGY BALANCE If an individual maintains a healthy weight over time, he/she is said to have a balanced energy budget. A day’s energy balance is stated as change in energy stores equals to the food energy taken (kcalories) minus the energy spent on metabolism and physical activities. Energy balance = Energy in – Energy out 24 ENERGY BALANCE 25 ENERGY BALANCE 26 ENERGY BALANCE Energy in = calories consumed per day. Energy out = basal metabolic rate (BMR) + thermic effect of foods + physical activity per day. Small increments in calories consumed per day or week can contribute to weight gain over time. 27 ENERGY IN 1 pound of pure fat = 9 x 450g = 4,050 calories. Body fat consists of water, fat and protein = 3,500 calories. Calories in foods are obtained by measuring the heat energy released when foods are burned in a bomb calorimeter. Food composition tables or nutritional facts label on food products provide caloric content of commonly eaten foods. 28 ENERGY IN 10 Sausage bun 29 What make us eat? Hunger: physiological need to eat Appetite initiates eating. It is a desire to eat that accompanies sight, smell or thought of appealing foods. Appetite is learned behaviour. 30 What make us stop eating? Satiation: the perception of fullness that gradually builds throughout a meal. When the stomach stretches, chemical messengers are sent to the brain to indicate fullness. The brain releases neurotransmitters that suppress food intake in response. Satiation occurs, the persons feels full and stops eating. 31  What make us stop eating? Satiety continues to suppress hunger for several hours. Satiety determines the length of time between meals. Leptin, a hormone produced by the adipose tissue, controls satiety. Protein foods most satiating, CHO next especially if high in fiber. Foods high in fat have low satiety. Overriding satiety and satiation cues leads to overeating. 32 ENERGY OUT Thermic effect of food – is an estimation of energy required to process food – about 10% of total energy intake Basal Metabolic Rate (BMR) is the rate at which the body uses energy to support its basal metabolism. Physical activity 33 ENERGY OUT 34 Thermic Effect of Food Specific dynamic effect of food – estimated energy used in digestion and absorption of food. Diet induced thermogenesis -  energy due to  in metabolic rate, may lead to overeating – CHO 5-10% – Fat 0-5%, – Protein 20-30% – Alcohol 20% 35 ENERGY OUT Our body use energy in two major ways: i. Basal metabolism ii. Voluntary activities Individual can change his/her voluntary activities to spend more or less energy in a day, over time, can also change his/her basal metabolism 36 Basal Metabolic Rate (BMR) Basal metabolic energy required to support the basic processes of life, including circulation, respiration, temperature maintenance, etc. It excludes digestion and voluntary activities. BMR constitutes the largest proportion (2/3) of a person’s daily expenditure. 37  10 Sausage bun Energy balance = Energy in – Energy out 38 Factors Affecting Basal Metabolic Rate (BMR) Body size & Age composition Growth Fasting / Gender Activity Starvation Smoking / Fever/Stress Caffeine 39 Factors Affecting Basal Metabolic Rate (BMR) I. Age The BMR is greatest during first few years of life BMR decreases with advancing age In children it is high due to more surface area. Age Lean tissue 40 Factors Affecting Basal Metabolic Rate (BMR) II. Gender Males have more muscle mass, more lean tissue and lower body weight; females have lower muscle mass more body fat  lower BMR The difference is more significant in older age group The BMR of women undergoes change in relation to menstrual cycle – It is more prior to and less after menstruation 41 Factors Affecting Basal Metabolic Rate (BMR) III. Growth and pregnancy Children have higher BMR for growth and development BMR of pregnant mother increase in the third trimester of gestation. – Total of her own BMR as in the non pregnant state and the fetal metabolism 42 Factors Affecting Basal Metabolic Rate (BMR) IV. Body size and composition Body surface area depends on weight and height Greater the surface are, higher the BMR Tall, thin people has a higher BMR than short person Lean tissue BMR The more fat tissue, the lower the BMR 43 Factors Affecting Basal Metabolic Rate (BMR) V. Fasting/Starvation Fasting or starvation will lower the BMR BMR also lower in malnutrition and wasting diseases 44 Factors Affecting Basal Metabolic Rate (BMR) V. Activity Physical activities and exercise not only influence body weight by burning calories, it also helps to raise BMR by building more lean tissue Exercise lean tissue  BMR 45 Factors Affecting Basal Metabolic Rate (BMR) VII. Smoking/Caffeine Nicotine and caffeine increase energy expenditure  BMR However, nicotine and caffeine is unhealthy substance, affecting one’s general health and wellbeing 46 Factors Affecting Basal Metabolic Rate (BMR) VIII.Fever/Stress Illness, fever and high level of stress hormones in the body increase the BMR For every 0.5 degree rise in body temperature, there is 7% increase in BMR These are short term factors affecting the BMR 47 Factors Affecting Basal Metabolic Rate (BMR) IX. Hormones Thyroid hormone increase BMR In thyrotoxicosis, BMR  50 – 100% above normal; while myxedema, BMR  35 – 45% below normal Adrenaline, catecholamine, growth hormones BMR 48 Factors Affecting Basal Metabolic Rate (BMR) X. Environmental factors Temperature outside body also affect BMR Exposure to cold cause increase in BMR as to create extra need for heat for the maintenance of body temperature Short period of exposure to heat has little or no effect on BMR but prolong exposure to high temperature leads to compensatory heat loss  BMR 49 50