Water and Electrolyte Balance-1 PDF

CHAPTER 6 Physiologic Value of Food Eat healthy food to live healthy 19  FOOD Food refers to solid and liquid materials taken into the digestive tract. Food is composed of various compounds, both organic and inorganic so that any food is either...

CHAPTER 6 Physiologic Value of Food Eat healthy food to live healthy 19  FOOD Food refers to solid and liquid materials taken into the digestive tract. Food is composed of various compounds, both organic and inorganic so that any food is either a chemical compound or a mixture of chemical compounds. 20  ORGANIC COMPOUNDS Proteins, lipids, carbohydrates and vitamins INORGANIC ELEMENTS Water and minerals 3 MAJOR NUTRIENTS: Carbohydrates Fats Proteins 21  METABOLISM Greek: metabolismos = to change or alter. The chemical process in the body that convert food and drink into energy. Energy is the force or power that enables the body to do its work. In nutrition, energy pertains to the chemical energy locked in foodstuffs brought about by metabolism. 22 ENERGY FROM FOOD Eat healthy food to live healthy 23  The Calorie The unit of energy commonly used in human nutrition is kilogram calorie (kcal) or simply calorie. It is the unit of measurement for the energy that the body gets from food 1,000 small calories = 1 kilocalorie or calorie 24 Calories are not eaten. They are by-products of carbohydrates, proteins and fats that are oxidized in the body. One kilocalorie is the amount of heat energy required to raise the temperature of 1 kilogram of water by 1 °C. 25 1. Fuel factor of carbohydrates = 4 calories per gram 2. Fuel factor of fat = 9 calories per gram 3. Fuel factor of protein = 4 calories per gram Bomb calorimeter -device that measures the total calorie content (total energy) available from food. 26  The Joule - is the measure of energy in the metric system. 1 calorie (kilocalorie) = 4.184 joule (kilojoules) Example: 1 cup of milk = 170 kcal 170 kcal x 4.184 kjoules = 711.28 kjoules 27 Calculation of Food Value Eat healthy food to live healthy 28 The energy value of one tablespoon of sugar (15 grams) is approximately 60 calories (15x4). Most foods, however, are complex and contain proteins, fats, and carbohydrates. 29  For example, one cup of milk contains approximately : 12 grams carbohydrates x 4 cal/gm = 48 kcal 8 grams proteins x 4 cal/gm = 32 kcal 10 grams fats x 9 cal/gm = 90 kcal Total = 170 kcal 30  From this information, the percentage of each nutrient can be calculated. To calculate the percentage of kcalories from fat, for example, divide the 90 fat kcal by the total 170 kcal. 90 fat kcal / 170 kcal = 0.529 or.53.53 = 53% 31  PONENTS OM O C XPEN F GY E DIT ER UR EN E 32  BASAL METABOLISM It is also known as the REQUIRED ENERGY EXPENDITURE (REE), is the measure of energy needed by the body at rest for all it's internal chemical activities which is approximately 1 calorie per kilogram of body weight per hour for an adult. 33  BASAL METABOLISM It is the minimum amount of energy needed by the body at rest in the fasting state. It also indicates the amount of energy needed by the body at rest in the fasting state. 34  BASAL METABOLISM It also indicates the amount of energy needed to suction the life process: Respiration, Cellular Metabolism, Circulation, Glandular Activity, and the Maintenance of body Temperature. It accounts for more than one-half of calorie requirements for most people. 35 BASAL METABOLIC RATE (BMR) It is the rate of Basal Metabolism in a given person at a given time and situation. It constitutes one-half of the calorie requirements of an individual. 36  2. The subject must be CONDITIONS awake, lying quietly, and free from physical fatigue, NECESSARY nervousness, or tension, or tension as this causes an FOR BMR TEST increase in heat production. TO ENSURE ACCURACY: 1. The subject must be in fasting or Post-absorptive 3. The environmental state, at least 12 hours after temperature should be the meal. (The test is usually between 20°C- 25°C so that taken in the morning.) the subject can maintain his/her body temperature. 37 CALCULATION OF BMR 1. A simple method for the calculation of BMR is to use the rule of thumb 1 kcal per kg per hour for adult and 0.9 kcal per kg per hour for adult female. This value, however, may not be applicable for obese or lean individuals. EXAMPLE: EXAMPLE: MALE, 75 KG FEMALE, 65 KG = 1 KCAL × 75 × 24 = 0.9 KCAL × 65 × 24 = 1, 800 KCAL = 1, 404 KCAL 38 CALCULATION OF BMR 2. Another method is the Harris- Benedict formula, developed in 1909, which uses information on weight, height, age, and sex. EXAMPLE: MALES REE = 66 + [ 13.7 × WT (KG) ] + [5 × HT (CM) ] - [ 6.8 × AGE (YR) ] FEMALES REE = 655 + [ 9.6 × WT (KG) ] + [ 1.8 × HT (CM) ] - [ 4.7 × AGE (YR) ] 39 CALCULATION OF BMR 3. One moremethod used in obtaining the metabolic or fat-free body size is called the Biologic body weight raised to the 3/4 power. The metabolic body size for the different body weights is given in the table. Once the metabolic body size is known based on weight in kilograms, the figure is multiplied by 70, a value which applies to all animals. 40 CALCULATION OF BMR EXAMPLE: A 50 KG MAN'S REE = 18.8 × 70 = 1, 316 KCAL Example: A 80 kg man's ree = 26.7 × 80 = 2, 136 Kcal 41 CALCULATION OF BMR 4. The last method is developed by WHO/FAO/UNU in 1985. It uses the following equation: 1.6 × wt (kg) + 897 = REE Example: Female, 55 kg Example: 1.6 × 55 + 897 = 985 Male, 85 kg 1.6 × 85 + 897 = 1,033 Thus, a 55 kg female has a ree of 985 kcal Thus, a 85 kg male has a ree 42 of 1,033 kcal FACTORS THAT AFFECT THE BASAL METABOLIC RATE (BMR) 1. Surface Area- The greater the body surface area or skin area, the greater the amount of heat loss, and, in turn, the greater the necessary heat produce by the body. Muscle tissue requires more oxygen than adipose tissue. 43 FACTORS THAT AFFECT THE BASAL METABOLIC RATE (BMR) 2. Sex - Women, in general, have a metabolism of about 5% to 10% less than of men even when they are of the same weight and height. Women have a little more fat and less muscular development than men 44 FACTORS THAT AFFECT THE BASAL METABOLIC RATE (BMR) 3. Age- The metabolic rate is highest during the periods of rapid growth, chiefly during the first and second years, and reaches a lesser peak through the ages of puberty and adolescence in both sexes. The BMR declines slowly with increasing age to lower muscle tone from lessened activity. 45 FACTORS THAT AFFECT THE BASAL METABOLIC RATE (BMR) 4. Body Composition - A large proportion of inactive adipose tissue lowers the BMR. Athletes with great muscular development show about 5% increase in basal metabolism over non- athletic individuals. 46 5. State of Nutrition - A decrease in the mass of active tissue such as in the case of undernourishment or starvation causes a lowered metabolism often as much as 50% below normal. 6. Sleep - During sleep, the Metabolic rate falls approximately 10% to 15% below that of waking levels. This decreased rate is due to muscular relaxation and decreased activity of the symphetic nervous system. 47 7. Endocrine Glands - It secretes hormones into the blood into the blood streams, are the principal regulators of the metabolic rate. The male sex hormones increases the BMR about 10 to 15% and the female sex hormones a little less. 8. Fever - It increases the BMR about 7% for each degree rise in the body temperature above 98.6° F. 48  COMPUTATION OF DBW ( Desired Body Weight) 1. Ador Dionisio’s Method 1. HEIGHT - For every 5 feet, allow 100 lbs for female and 110 lbs for male. Then multiply the additional inches by 2. AGE- Multiply any age between 25 and 50 by 2 then divide by 5 49  COMPUTATION OF DBW ( Desired Body Weight) 11.. Ador Dionisio’s Method EXAMPLE; Male, 45 years old, 5'4 tall Height = 5 feet = 110 lbs 4 inches x 2 = 8 lbs 118 lbs Age = (45 years)2 = 18 lbs 2 50 DBW= 118 lbs + 18 lbs = 136 lbs  COMPUTATION OF DBW ( Desired Body Weight) 1. Tannhauser’s Method 1. Measure height in cm and deduct 100. from the difference take off its 10% EXAMPLE; Male, 45 years old, 5'4 tall Height = 5'4 = 162.56 cm 162.56 - 100 = 62.56 cm 10% of 62.56 cm = 6.256 62.56-6.256 = DBW (kg) 51 DBW (kg) = 56.7 kg or 126 lbs  PHYSICAL ACTIVITY Calorie requirements depends on the type and amount of exercise. The more vigorouse the physical work, the greater the calory cost. 52 Calorie Expenditure for Various Types of Calorie TYPES OF Calories ACTIVITY Sedentary 80-100 Activities Light Activities 110-160 Moderate Activities 170-240 Heavy Activities 250-350 53  SPECIFIC DYNAMIC ACTION OF FOOD Carbohydrate or fat increases the heat production of about 5% of the total calories consumed. It is the energy required to digest, transport and utilize food. 54  ESTIMATION OF DAILY REQUIREMENT OF AN ADULT The daily energy requirement of an adult is commonly estimated by adding together the requirements for basal metabolism, physical or muscular activity, and the specific dynamic action (SDA) of food: 55 Determine the DBW in kg of the individual. Determine the basal needs: Male = 1.0 kcalorie/kilo of DBW/hr x 24 Female = 0.9 kcalorie/kilo of DBW/hr x 24 Subtract 1.0 kcalorie/kilo of DBW/hours of sleep. Add the activity increment. Add the SDA (10% of basal needs + activity increment). Sum equals the approximate daily calorie requirement. 56  ACTIVITY INCREMENT Kcalorie per day AVTIVITY MEN WOMAN Sedentary 225 225 Activities Moderate Activity 750 500 Heavy Work 1,500 1,000 Very Heavy Work 2,500 57  ESTIMATED OF TOTAL ENERGY NEED The total energy of an individual is the composite of energy necessary to replace basal metabolic needs, energy expenditure for physical activities, thermogenic effect of food, and other factors. The total energy need of an adult may be determined using one of the methods on the following pages. 58 The most practical and rapid method of estimating energy need is based on desirable body weight (DBW) according to occupation. This method is often used in clinics and hospitals. Example: 59 50 kg man x 40 (moderately active) =2,000 kcal/day 20 The second method of estimating the energy need is the factorial method. It uses the following equation: Basal energy (a) + physical activity (b) + thermogenic effect of food (c) = total energy need a) Calculate the basal metabolic rate using any of the four methods discussed earlier. b) Determine the energy need for physical activity (PA) by using the short method. c) Add the basal energy cost and activity cost. 60 d) Calculate the thermogenic effect of food. For a mixed diet adequate in protein, add 10% of the subtotal. For the average Filipino diet, use 6%. e) Add the basal energy, physical activity, and the thermogenic effect of food. Example: a) Basal metabolic rate using the harris & benedict formula REE = 66 + [13.7 x 50 kg] + [5.0 x 157cm] – [6.8 x 35(age)] = 66 + 685 +785 – 238 = 1,298 kcal 61 = basal metabolic needs Energy from PA = total PA kcal x 50 (wt in kg) = 17.24 kcal x 50 kg = 862 kcal for PA Basal energy cost and activity cost = 1,298 kcal + 862 kcal = 2,160 kcal Thermogenic effect of food = basal energy cost + activity cost x 6% = (1,298 kcal + 862 kcal) (0.06) = 2,160 x 0.06 62 = 129.6 Basal energy cost, activity cost, and thermogenic effect of food =1,298 kcal + 862 kcal + 129.6 kcal = 2,289.6 kcal 63 Aproximate Increase Above Basal Need for Selected Activities ACTIVITY PERCENT ABOVE CATEGORY BASAL NEED Sleeping, reclining 10% Very Light 30% Ligh 50% Moderate 75% Heavy 100% 64 3. Daily energy need can also be determined by referring to the recommended dietary allowances for Filipinos. AGE MEN WOMAN 20-31 2,580 1,920 40-49 2,450 1,820 50-59 2,320 1,730 60-69 2,060 1,540 70-79 1,810 1,340 65  4. The fourth method is recommended by FAO/WHO/UNU (1985). To get the energy need, multiply REE by the type of activity. TYPE OF MEN WOMAN ACTIVITY Example: Very Light 1.3 1.3 Basal metabolic needs of a Light 1.6 1.5 50 kg man is 1,459 x 1.7 (moderate) = 2,480 kcal Moderate 1.7 1.6 Heavy 2.1 1.9 Very Heavy 2.4 66 2.2  ENERGY BALANCE 1. Tannhauser's Method 1. Height in centimeter = 157cm Factor = 100 = 57kg To adjust body frame for Filipinos, deduct 10% from the answer obtained = 5.7 = 51.3 or 51kg 67  ENERGY BALANCE 2. For 5 feet, allow 100-105lbs (females) ; 105-110 lbs (males). For each additional inch, add 5 lbs. 5'2" = 105 + 10 = 115 lbs The values above apply to adults with small frame. Add 5 lbs for medium 68 frame and 10 lbs for large frame.  BODY MASS INDEX 1. The body mass index (BMI) is the ratio of 1. weight to height BMI = Weight in kg (Height in meters) ² Example: An individual who weighs 92kg and is 175cm tall would have a BMI of 69 92 kg/ (1.75 m)² = 30.  HOW TO COMPUTE FOR CALORIES IN IV FEEDING (DEXTROSE) 1g of dextrose contains 3.4 calories. Example: A D10W solution has 10g of dextrose per 100ml. 10g x 3.4kcal/g = 34 kcal 70