Anthropometry, Energy Balance, and Dietary Reference Values PDF

Anthropometry, energy balance, dietary reference values Pr. Roberta FORESTI Professor of Biochemistry, Faculty of Health, UPEC [email protected] Anthropometry  Body composition normal adult male ~70 kg...

Anthropometry, energy balance, dietary reference values Pr. Roberta FORESTI Professor of Biochemistry, Faculty of Health, UPEC [email protected] Anthropometry  Body composition normal adult male ~70 kg Water 42 kg Glycogen (60% total mass) P Other Mg Ca Cl K Fe Zn Na Cu Women normally have more fat and less muscle and water than men Fat Protein 12 kg 12 kg (17% total mass) (17% total mass) Fat-free mass= muscle+water+bone  Anthropometry Definition = measurements of variations in physical dimension and body composition of human body Uses = growth measurements indicators of nutritional status (malnutrition, obesity) standardization of body size (growth curves) Advantages = simple, safe, non-invasive inexpensive (portable equipment, ex. scale, meter) unskilled personnel methods are precise and accurate identifies malnutrition evaluates changes over time Disavantages = relatively insensitive methods cannot detect short-term disturbances/changes unable to identify specific nutrient disturbances Changes over lifespan…. baby child teenager young adult adult elderly  excess weight excess weight obese obese normal weight skinny skinny  Other useful informations……. SECULAR CHANGES Mean adult hight has increased by 6.5-9.0 cm in developed countries in the last 100 years (from the beginning of the 20th century) This increase has now stopped in privileged classes in developed countries Differences in adult stature is evident in early life: five year old boy in developed country is 8-10 cm taller than 100 years ago Changes are more marked in lower socio-economic groups Large proportion of overweight. Trends are for adults and children to increase overweight and obesity  What can we measure? Weight Height/length Knee height Demispan Skinfolds (triceps, biceps, sub-scapular, suprailiac) Circumferences (head, arm, waist, hip)  Anthropometric Indices They help us to define groups (children, adults, elderly), assess growth or weight changes, detect overnutrition or undernutrition, % fat (skinfolds, bioelectrical impedance) weight for height weight for age height or length for age Example 1: BODY MASS INDEX (BMI) weight/(height)2 Normal 18.5-24.9 (< 18.5=undernourished, < 16 severely undernourished) Overweight 25-29.9 Obese class I 30-34.9 Obese class II 35-39.9 Morbidly obese III > 40  Example 2: Waist circumference Risk of metabolic complications Increased Greatly increased Males ≥ 94 cm ≥ 102 cm Females ≥ 80 cm ≥ 88 cm Example 3: Waist/hip ratio Risk of metabolic complications Males >1 Females > 0.8 Anthropometric Reference Standards: Example: Growth chart for children Energy Balance  Food is the only source of energy for humans Human body obtains energy from food Human spends energy from food 1st law of thermodynamics: energy cannot be created or destroyed but can can only be transformed from one font to the other (solar, chemical, mechanical, electrical, thermal) Units of energy Joule (recent unit)= energy used when 1 kg is moved 1 m by a force of 1 Newton (small unit) kJ (kilojoules) or MJ (megajoules) Kcal (old unit but still used in food labels together with kj) = amount of heat required to heat 1 g of water by 1 °C Kcal = kJ x 4.184  Human body 75% food energy HEAT Muscle contraction Maintaining ion gradient Synthesis of proteins Energy intake Slice of pizza ATWATER FACTORS (kcals/gram) Fat= 10.4 g Protein= 12.2 g Protein 4 Carbohydrate= 35.7 g Fat 9 + fibers etc. Carbohydrate (CHO) 4 Alcohol 7 How many calories?? Energy intake in humans Ultimate function of energy intake is to provide energy for metabolic processes and performance at work, to maintain body size, to exert physical activity but…….. Humans are living in an environment that contributes to poor control of food intake (~30 years, overeating) Exogenous factors contributing to poor control of food intake in humans (affluent societies but not only) Large food diversity and high palatability diets High availability of food Television watching/internet (reduced activity, exposure to food adverts) Snacking rather than meals eating Fast rate of eating (fast foods) Food advert High energy density (e.g. high fat diets) Eating outside home and unsociable eating Technological development, less activity Urbanisation, more access to energy-dense food, less need to walk (Adapted from Human Nutrition, 11th edition)  Energy expenditure Body size Fat-free mass (high metabolic activity), 1. Basal metabolism (60-75% of energy) e.g. men > women and older people Genetics (up to 10%) Menstrual cycle Type and intensity of exercise 2. Physical activity (20-40%) Time spent during activity Speed, dexterity 3. Effects of food intake, cold, stress, drugs Pharmacological agents Stimulants (caffeine, nicotine) Disease (e.g. inflammatory processes) Anxiety?? Ingestion of food increases EE Shivering Energy used for digestion, transport, storage Heat loss due to inadequate clothing ~ 10% of total energy Energy requirements Definition ‘Energy intake which will balance energy expenditure when the individual has a body size and composition and levels of activity consistent with long term health. In children and pregnant or lactating women, the energy requirement includes the energy needs associated with the deposition of tissues or the secretion of milk consistent with good health’ WHO 1985 Dietary reference values “Dietary Reference Value (DRV)" covers a set of dietary nutrient intake values that vary according to age and gender, and also according to physical activity levels, physiological status (e.g. pregnancy) and eating habits. (Anses) These DRVs are useful to health professionals, particularly nutrition and dietetics specialists, for developing a balanced, varied diet covering the needs of different population groups in good health (infants, children, adolescents, adults, pregnant and breastfeeding women, the elderly), without leading to excess intakes. (Anses) They are not appropriate for people with disease or metabolic abnormalities.  Individual factors influencing requirements Body size Climate Gender Physiological state Growth Body store Physical activity Clinical problems Age Drug-nutrient interaction A range of factors have to be taken in consideration to see whether people are meeting their nutritional requirements. Nutrient requirements vary greatly within a population. Definition of the various types of dietary reference values (Anses) Average requirement (AR) The AR is the average requirement within the population, as estimated from individual intake data in relation to a criterion of nutritional adequacy in experimental studies. The criteria used for nutritional adequacy often relate to nutrient balance, metabolic renewal, change in the state of reserves, or markers of functions associated with the nutrient in depletion-repletion studies. In certain physiological situations, such as growth or pregnancy, the requirement can be calculated by the factor method on the basis of the previously described criteria and taking into account additional components related to these situations. Population Reference Intake (PRI) The PRI is the intake that theoretically covers the needs of almost the entire population under consideration (97.5% in most cases), as estimated from experimental data. The PRI is calculated from an estimate of the parameters of distribution of the need. Most often, the need in the population is assumed to follow a normal distribution. The PRI is estimated from the AR, to which are added two standard deviations, in order to determine the intake that covers the needs of 97.5% of the population. As the standard deviation is most often estimated at 15% of the AR, the PRI therefore equates to 1.3 times the AR. This definition corresponds to that of the French term apport nutritionnel conseillé (ANC), which is no longer used today and which was also used by extension for adequate intake (AI). Adequate intake (AI) The AI is defined as the average intake of a population or sub-group whose nutritional status is considered adequate. The AI is the dietary reference value selected when: the AR and therefore the PRI cannot be estimated due to a lack of data; the PRI value can be estimated but is not considered satisfactory. When long-term population-based observational studies show effects on health, such as disease prevention, they can be taken into account to define an AI. The data used to estimate the nutritional status are often obtained by observational studies but sometimes come from experimental studies. Upper intake level (UL) The UL is defined as the chronic maximum daily intake of a vitamin or a mineral considered unlikely to present a risk of adverse health effects for the entire population. (97.5%)  Criteria for assessing adequate intakes Classically: the amount of nutrient to prevent signs of clinical deficiency. But now more precise criteria are used Nutrient intake required to maintain circulating level, enzyme saturation or tissue concentration Nutrient intakes that are associated with the absence of signs of deficiency disease Intakes of a nutrient required to maintain balance Intakes of nutrients needed to cure clinical deficiency Intake associated with an appropriate biological marker of nutritional adequacy In general, for most nutrients there are insufficient data to establish DRVs with great confidence (Anses Opinion report 2021) We will use this tool from the Anses website: https://ciqual.anses.fr/ Ex. Calcium. 25-35% of dietary calcium is absorbed. PRI= 1000 mg/d for women (18-24 years) and 950 mg/d (men 18-24 years). Calcium (mg/100 g) 117 in milk Calcium (mg/100 g) 27,5 in baguette Calcium (mg/100 g) 127 in yogurt Calcium (mg/100 g) 32,5 in sweet potatoes Calcium (mg/100 g) 8,4 in cooked salmon Calcium (mg/100 g) 68,2 in poached egg Calcium (mg/100 g) 29 in kiwi Most foods contain some calcium (mostly in dairy foods)..., adults generally match their requirements We will use this tool from the Anses website: https://ciqual.anses.fr/ Ex. Iron. ~ 25% absorption from of meat containing meals; in general, only ~10% is absorbed from diet! PRI= 16 mg/d for women (18 and over, heavy menstrual cycle) and 11 mg/d (men 18 and over) Iron (mg/100 g) 0,041 in milk Iron (mg/100 g) 1,5 in baguette Iron (mg/100 g) 0,2 in yogurt Iron (mg/100 g) 0,71 in sweet potatoes Iron (mg/100 g) 0,43 in cooked salmon Iron (mg/100 g) 1,75 in poached egg Iron (mg/100 g) 0,16 in kiwi Iron (mg/100 g) 1,75 in bœuf bourghignon Iron (mg/100 g) 1,44 in cooked lentils Most foods contain some iron (mostly in meat)….., men usually satisfy their requirements, while women do not  Uses of DRVs 1. Assessing individuals Not possible to know an individual requirement for a nutrient Imprecision of most estimates- caution in estimating individual diets, it is only a guide (ex. when assessing from food intake diaries) What we can say is: If intake < reference unlikely to be consuming sufficient nutrient to maintain biological function If intake > PRI virtually certain to meet requirements If intake is between lower reference and PRI cannot say whether it is adequate without some measures of biological status  Uses of DRVs 2. At risk subgroups DRVs can identify sub-groups within a population that are consuming inadequate diets These individuals can then be investigated further using nutritional and metabolic tools Uses of DRVs 3. Prescribing diets? NO-limitations DRVs are only for healthy individuals DRVs for one nutrient presuppose that all other nutrient requirements are met The best is to prescribe diets containing nutrients at the PRI because the risk of deficiency will be very small  Uses of DRVs 4. Food labelling DRVs have been used for providing information on the nutrient content of food Public may prefer % of daily requirements rather than X mg/100 g of food Single value used for simplicity: not appropriate for different ages and sexes  Values for Energy The PRIs are set above the estimated requirements to minimize deficiencies For most nutrients the values are set at the upper range as moderate excess is not detrimental But we cannot do that for Energy!! Recommendations for energy are set at Average Requirements.  From EFSA website Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) derived dietary reference values for energy, which are provided as average requirements (ARs) of specified age and sex groups. For children and adults, total energy expenditure (TEE) was determined factorially from estimates of resting energy expenditure (REE) plus the energy needed for various levels of physical activity (PAL) associated with sustainable lifestyles in healthy individuals. To account for uncertainties inherent in the prediction of energy expenditure, ranges of the AR for energy were calculated with several equations for predicting REE in children (1-17 years) and adults. For practical reasons, only the REE estimated by the equations of Henry (2005) was used in the setting of the AR and multiplied with PAL values of: 1.4= sedentary 1.6= moderately active 1.8= active 2.0= very active lifestyle Energy requirements depend on energy expenditure. A person’s energy input should match the energy expenditure Energy expenditure= 3 components Basal metabolic rate (BMR) Thermogenesis Physical activity  BMR Thermogenesis Physical activity Energy needed to maintain body Energy used for digestion, Most variable component of functions absorption, transport and energy expenditure Major component of daily storage of nutrients Calculated from duration of energy requirements Difficult to distinguish metabolic various work and leasure Measured in the morning – 12- response from physical activity activities 14 h after a meal of sitting, eating, chewing etc. Energy cost is assigned to each Varies with sex, age and body Usually estimated to be ~10% of (activity diaries: slept 8 h, size Total Energy Expenditure walked 15 min etc.) Can be calculated using equations- Schofield/Henry  https://www.fao.org/3/y5686e/y5686e07.htm#TopOfPage. Food and Agriculture Organization fo the United nations (FAO) Daily average energy requirement for men aged 18 to 29.9 years* Height (m) for Daily energy requirement according to BMR factor (or PAL) and body weight indicated BMI values:b Mean BMR/kga weight 1.45 × BMR 1.60 × BMR 1.75 × BMR 1.90 × BMR 2.05 × BMR 2.20 × BMR kg kJ kcal MJ kJ/kg Kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg 24.9 21.0 18.5 50 121 29 8.8 175 2 100 42 9.7 195 2 300 46 10.6 210 2 550 51 11.5 230 2 750 55 12.4 250 2 950 59 13.3 265 3 200 64 1.42 1.54 1.64 55 116 28 9.2 170 2 200 40 10.2 185 2 450 44 11.1 200 2 650 48 12.1 220 2 900 53 13.0 235 3 100 57 14.0 255 3 350 61 1.49 1.62 1.72 60 111 27 9.7 160 2 300 39 10.7 180 2 550 43 11.7 195 2 800 47 12.7 210 3 050 51 13.7 230 3 250 55 14.7 245 3 500 59 1.55 1.69 1.80 65 108 26 10.1 155 2 400 37 11.2 170 2 650 41 12.2 190 2 900 45 13.3 205 3 150 49 14.3 220 3 450 53 15.4 235 3 700 57 1.62 1.76 1.87 70 104 25 10.6 150 2 550 36 11.7 165 2 800 40 12.8 185 3 050 44 13.9 200 3 300 47 15.0 215 3 600 51 16.1 230 3 850 55 1.68 1.83 1.95 75 102 24 11.1 145 2 650 35 12.2 165 2 900 39 13.3 180 3 200 42 14.5 195 3 450 46 15.6 210 3 750 50 16.8 225 4 000 53 1.74 1.89 2.01 80 99 24 11.5 145 2 750 34 12.7 160 3 050 38 13.9 175 3 300 41 15.1 190 3 600 45 16.3 205 3 900 49 17.5 220 4 150 52 1.79 1.95 2.08 85 97 23 12.0 140 2 850 34 13.2 155 3 150 37 14.4 170 3 450 41 15.7 185 3 750 44 16.9 200 4 050 48 18.2 215 4 350 51 1.85 2.01 2.14 90 95 23 12.4 140 2 950 33 13.7 150 3 300 36 15.0 165 3 600 40 16.3 180 3 900 43 17.6 195 4 200 47 18.8 210 4 500 50 1.90 2.07 2.21 * Values rounded to closest 0.1 MJ/d, 50 kcal/d, 5 kJ/kg/d, 1 kcal/kg/d. a BMR calculated for each weight from the equations in Table 5.2. Values of BMR/kg are presented for ease of calculations for those who wish to use different PAL values or different weights. b Height ranges are presented for each mean weight for ease of making dietary energy recommendations to maintain an adequate BMI based on a population's mean height and PAL. For example, the recommended mean energy intake for a male population of this age group with a mean height of 1.70 m and a lifestyle with a mean PAL of 1.75, is about 11.7 MJ (2 800 kcal)/day or 195 kJ (47 kcal)/kg/day to maintain an optimum population median BMI of 21.0 (WHO/FAO, 2002), with an individual range of about 11.1 to 12.8 MJ (2 650 to 3 050 kcal)/day or 185 to 200 kJ (44 to 48 kcal)/kg/day to maintain the individual BMI limits of 18.5 to 24.9 (WHO, 2000).  https://www.fao.org/3/y5686e/y5686e07.htm#TopOfPage. Food and Agriculture Organization fo the United nations (FAO) Daily average energy requirement for women aged 18 to 29.9 years* Height (m) for Daily energy requirement according to BMR factor (or PAL) and body weight indicated BMI values:b Mean BMR/kga weight 1.45 × BMR 1.60 × BMR 1.75 × BMR 1.90 × BMR 2.05 × BMR 2.20 × BMR kg kJ kcal MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg MJ kJ/kg kcal kcal/kg 24.9 21.0 18.5 45 107 26 7.0 155 1 650 37 7.7 170 1 850 41 8.4 190 2 000 44 9.2 205 2 200 49 9.9 220 2 350 52 10.6 235 2 550 57 1.34 1.46 1.56 50 103 25 7.4 150 1 800 36 8.2 165 1 950 39 9.0 180 2 150 43 9.8 195 2 350 47 10.5 210 2 500 50 11.3 225 2 700 54 1.42 1.54 1.64 55 99 24 7.9 145 1 900 35 8.7 160 2 100 38 9.5 175 2 300 42 10.3 190 2 450 45 11.2 205 2 650 48 12.0 220 2 850 52 1.49 1.62 1.72 60 96 23 8.3 140 2 000 33 9.2 155 2 200 37 10.1 170 2 400 40 10.9 180 2 600 43 11.8 195 2 800 47 12.7 210 3 050 51 1.55 1.69 1.80 65 93 22 8.8 135 2 100 32 9.7 150 2 300 35 10.6 165 2 550 39 11.5 175 2 750 42 12.4 190 2 950 45 13.3 205 3 200 49 1.62 1.76 1.87 70 91 22 9.2 130 2 200 31 10.2 145 2 450 35 11.2 160 2 650 38 12.1 175 2 900 41 13.1 185 3 100 44 14.0 200 3 350 48 1.68 1.83 1.95 75 89 21 9.7 130 2 300 31 10.7 145 2 550 34 11.7 155 2 800 37 12.7 170 3 050 41 13.7 185 3 300 44 14.7 195 3 500 47 1.74 1.89 2.01 80 87 21 10.1 125 2 400 30 11.2 140 2 700 34 12.2 155 2 950 37 13.3 165 3 200 40 14.3 180 3 450 43 15.4 190 3 700 46 1.79 1.95 2.08 85 86 21 10.6 125 2 550 30 11.7 140 2 800 33 12.8 150 3 050 36 13.9 165 3 300 39 15.0 175 3 600 42 16.1 190 3 850 45 1.85 2.01 2.14 * Values rounded to closest 0.1 MJ/d, 50 kcal/d, 5 kJ/kg/d, 1 kcal/kg/d. a BMR calculated for each weight from the equations in Table 5.2. Values of BMR/kg are presented for ease of calculations for those who wish to use different PAL values or different weights. b Height ranges are presented for each mean weight for ease of making dietary energy recommendations to maintain an adequate BMI based on a population's mean height and PAL. For example, the recommended mean energy intake for a female population of this age group with a mean height of 1.70 m and a lifestyle with a mean PAL of 1.75, is about 10.1 MJ (2 400 kcal)/day or 170 kJ (40 kcal)/kg/day to maintain an optimum population median BMI of 21.0 (WHO/FAO, 2002), with an individual range of about 9.5 to 11.2 MJ (2 300 to 2 650 kcal)/day or 160 to 175 kJ (38 to 42 kcal)/kg/day to maintain the individual BMI limits of 18.5 to 24.9 (WHO, 2000).