Energy Balance PDF

Energy Balance Dietary patterns should be adjusted to maintain a balance between caloric intake and energy expenditure 1 Basal metabolism  i s t he amo unt o f e ne rgy re q ui re d to c arr y o ut involuntary activities at rest (e.g., breathin...

Energy Balance Dietary patterns should be adjusted to maintain a balance between caloric intake and energy expenditure 1 Basal metabolism  i s t he amo unt o f e ne rgy re q ui re d to c arr y o ut involuntary activities at rest (e.g., breathing, circulating blood, maintaining body temperature).  Men usually have a higher basal metabolic rate (BMR) than do women because of their proportionally greater muscle mass.  Other factors, such as growth, infection, fever, stress, and extreme env ironmental temperatures, c an increase BMR.  Decreased BMR can occur as a result of aging, prolonged fasting, and sleeping. 2  To maintain body weight, dietary intake of calories must equal caloric expenditures. When caloric intake is greater than energy expended, weight gain occurs because energy is stored in body fat. When caloric intake is less than energy expended, weight loss occurs because body stores of energy are depleted.  For an average person, a daily def ic it of 500 cal (3500 cal/wk) will result in the loss of (0.37 kg)/week. 3 Method of Calculating Caloric Requirements

 Use the factor 1.0 kcal/kg of body weight per hour for men or 0.9 for women. The following is an example for a 170-lb men. 4 Change pounds to kilograms: 5  Multiply weight in kilograms by the basal metabolic rate (BMR) factor: 6  Multiply the kilocalories used in 1 hr by the hours in a day: 7  For sedentary (mostly sitting) activity (a typist), add 50% of the BMR.  For light activity (light exercise such as walking not more than 2 hours per day a teacher), add 60%.  For heavy work (intensive occupation such as construction work ), add 100% or more. 8  If the men in the previous example were a typist typist, estimate the energy she n e e d e d for p h ys i c al ac ti v i ti e s by multiplying her BMR kilocalories per day by 50%. 9 Providing Nutrition in Special  The diet
would progress from clear Situations
liquids to full liquids to a soft diet, then to a normal or modif ie d diet, based on their condition and tolerance. 10 Tolerance of diet  can be as s es s ed by th e followin g: ab s e n c e of n au s e a, v omi ti n g , an d diarrhea; absence of feelings of fullness; absence of abdominal pain and distension; feelings of hunger; and the ability to consume at least ½ to ¾ of the food on the meal tray. 11 Clear liquid diets  Contain only foods that are clear liquids at room or body temperature—gelatin, fat-free broth, ice pops, clear juices, carbonated beverages, regular and decaffeinated coffee, and tea.  Because clear liquid diets are inadequate in c a l o r i e s , p ro t e i n , a n d m o s t n u t r i e n t s , progression to more nutritious alternatives is recommended as soon as possible. 12 Full liquid diets contain all the items on a clear liquid diet. Additional items allowed include milk and milk drinks, puddings, custards, vegetable juices.  A full liquid diet contains liquids that can be poured at room temperature. High-calorie, high-protein supplements are recommended if a full liquid diet is used for more than 3 days. 13 Soft diets are usually regular diets that have been modified to eliminate foods that are hard to digest and to chew, including those that are high in f ib er, high in fat, and highly seasoned.  Soft diets may also be called bland or low-fiber diets. Soft diets are adequate in calories and nutrients and may be used on a long-term basis. 14 Vegetarian Diets Some patients may prefer a vegetarian diet for a variety of reasons, such as religious preference, ethical belief that killing animals for food is unjust, fear of contamination with pesticides, or health concerns about the cholesterol and saturated fats found in meats. There are many different forms of vegetarianism, ranging from avoidance of red meat to complete elimination of all animal products.  Meats are usually replaced with legumes, grains, and vegetables, and, if well planned, this type of diet can satisfy all nutritional requirements. 15  Because fewer or no animal products are consumed, vegetarians consume less saturated fat, cholesterol, and animal protein and greater amounts of carbohydrates, fiber, and other important nutrients.  Vitamin B12, vitamin A, and iron are nutrients that may require supplementation in some vegetarian diets, but most vegetarian diets are not deficient in any nutrients.  Support patients who follow a vegetarian diet by assisting them or their caregiver to select nutritious food items from the large variety of foods available within their dietary framework. 16 Nothing By Mouth  In some cases, such as before surgery to prevent aspiration related to anesthesia and after surgery until bowel sounds return, patients may be ordered nothing by mouth (NPO). NPO may also be necessary for patients undergoing certain medical tests; for patients experiencing severe nausea and vomiting, an inability to chew or swallow, or various acute or chronic GI abnormalities; for those who are comatose; and for women during labor and delivery.  The following measures may provide comfort to patients who are ordered NPO: 1. Encourage or provide good oral hygiene. 2. Provide the patient with ice chips or sips of water as allowed. 17 3. Urge the patient to avoid watching others eat. Suggest alternate activities at mealtimes.  Well-nourished patients can easily withstand the stress of NPO for a short period, but being NPO for an extended period of time poses a nutritional challenge for many individuals.  Patients with increased nutritional requirements and those who will be NPO for more than 2 days may require nutritional support from enteral, administering nutrients directly into the stomach, or parenteral, providing nutrition via IV therapy, nutrition. 18