RDA, MyPlate, and Healthy Eating Guidelines PDF

RDA Recommended Dietary Allowances (RDAs): the average daily dietary intake level su cient to meet the nutrient requireme...

RDA Recommended Dietary Allowances (RDAs): the average daily dietary intake level su cient to meet the nutrient requirement of 97% to 98% of healthy individuals Nutrition and in a particular life stage and gender group. Health Estimated Average Requirement (EAR): the nutrient intake estimated to Promotion meet the requirement of half of the healthy individuals in a particular life stage and gender group. Adequate Intake (AI): an intake level thought to meet or exceed the requirement of almost all members of a life stage and gender group. An AI is Dr. Ann C. Nery set when there are insu cient data to de ne an RDA. Estimated Energy Requirements (EERs): level of calorie intake estimated Tolerable Upper Intake Level (UL): the highest average daily intake level to maintain weight in normal-weight individuals based on age, gender, of a nutrient likely to pose no danger to most individuals in the group. height, weight, and activity. Acceptable Macronutrient Distribution Ranges (AMDRs): an intake range as a percentage of total calories for energy nutrients MyPlate a new graphic for translating Dietary Guidelines for Americans into food choices for healthy individuals over 2 years, focuses on meeting nutrient needs through food rather than supplements. It covers all aspects of the diet, including calories, fat, vegetable subgroups, and whole grains. MyPlate includes an interactive online guidance system, allowing visitors to enter their age, gender, weight, height, and physical activity level to nd the most appropriate Daily Food Plan for their estimated calorie needs. MDCON 105_UNIT 7&8 - October 18, 2024 ffi ffi fi  In 2011, MyPlate replaced Appropriate Calorie Level with a Daily Food Plan calorie level, which is an estimate of calories needed for an individual's weight, and weight should be monitored for adjustments to calorie intake. Empty calorie allowances, ranging from 8% to 19% of total calories, allow consumers to incorporate small amounts of nutrient-dense foods into their diet without exceeding total calorie constraints. In the US, over 35% of usual calorie intake comes from empty calories. HEALTHY EATING GUIDELINES Many government and health agencies issue healthy eating guidelines based on a food group approach to eating. For instance, Healthy People 2020 is a public health initiative that includes benchmarks for nutrition and weight. In practice, the most prominent tools to assist Americans in making wise food choices are the Dietary Guidelines for Americans and its companion tool, MyPlate. The American Heart Association, the American Cancer Society, and the American Institute for Cancer Research have also is- sued dietary recommendations to help Americans choose diets aimed at reducing the risk of chronic diseases. MDCON 105_UNIT 7&8 - October 18, 2024  Healthy People 2020 Under the jurisdiction of the USDHHS, Healthy People is a program that focuses on improving the health of all Americans and eliminating health disparities. Updated every 10 years after its inception 30 years ago, Healthy People sets public health goals and objectives and monitors the nation’s progress toward meeting those objectives. The guidelines were approved by the National Nutrition Council. The PHILIPPINES — FOOD BASED DIETARY GUIDELINES communication and dissemination is spearheaded by the National Nutrition Council and endorsed by various government agencies. O cial name - Nutritional guidelines for Filipinos (Filipino: Mga Gabay sa Wastong Nutrisyon Para sa Pilipino). Intended audience The guidelines are directed at the general population and also include messages on the feeding of infants and children. Publication year - The Philippines published its rst dietary guidelines in 1990. They were revised in 2000 and again in 2012. Food guide - The Philippines uses the daily nutritional guide pyramid and has developed pyramids for di erent population groups. The pyramid is Process and stakeholders - The Food and Nutrition Research Institute – divided into levels of recommended consumption. Messages about exercise Department of Science and Technology (FNRI-DOST) initiated and chaired and personal and environmental hygiene serve as support messages for the the inter-agency and multidisciplinary Technical Working Group on the pyramid. 2012 guidelines. The healthy food plate for Filipino adults (Pinggang Pinoy) completes the The guidelines were approved by the National Nutrition Council. The messages of the pyramid by showing adequate distribution of nutritious communication and dissemination is spearheaded by the National Nutrition foods in a meal. Council and endorsed by various government agencies. MDCON 105_UNIT 7&8 - October 18, 2024 ffi ff fi  Eat a variety of foods every day to get the nutrients needed by the body. Use iodized salt to prevent iodine de ciency disorders. Breastfeed infants exclusively from birth up to 6 months, then give Limit intake of salty, fried, fatty and sugar-rich foods to prevent appropriate complementary foods while continuing breastfeeding for 2 cardiovascular diseases. years and beyond for optimum growth and development. Attain normal body weight through proper diet and moderate physical Eat more vegetables and fruits every day to get the essential vitamins, activity to maintain good health and help prevent obesity. minerals and bre for regulation of body processes. Be physically active, make healthy food choices, manage stress, avoid Consume sh, lean meat, poultry, eggs, dried beans or nuts daily for alcoholic beverages and do not smoke to help prevent lifestyle-related growth and repair of body tissues. non-communicable diseases. Consume milk, milk products and other calcium-rich foods, such as small sh and shell sh, every day for healthy bones and teeth. Consume safe foods and water to prevent diarrhoea and other food and water-borne diseases. PINGGANG PINOY It is visual tool developed by the Food and Nutrition Research Institute of the Department of Science and Technology to help Filipinos acquire healthy eating habits. Food Guide that reminds us what should our meal look like each day. A properly balanced meal consists of three basic food groups - GO FOODS, GROW FOODS AND GLOW FOODS, accompanied by a glass of water or a nutritious beverage like MILK. MDCON 105_UNIT 7&8 - October 18, 2024 fi fi fi fi fi  Half of Pinggang Pinoy should have fruits and vegetables ( GLOW) but vegetables THE THREE FOOD GROUPS CALLED GO, represents larger portion in this group than GROW, AND GLOW BECAUSE THIS TERM fruits because more vegetables are needed to get proper amount of vitamins, mineral and DESCRIBES THE FUNCTION OF EACH bers. FOOD GROUP IN THE BODY. The other half of the plate is divided into (GO) GO FOODS foods like RICE, and (GROW) like Fish. And a glass of WATER, represents the importance Energy giving FOODS such as Rice, corn, bread, of drinking ample amounts of water and less (Root Crops)- gabi, kamote, kamoteng kahoy and sugary drinks. ubi provide energy to keep one going throughout the day. Sample meal: Go food - bowl of rice Choose a variety of Go foods that not only Grow food - sh like tilapia provide energy, but also provide additional vitamins, minerals and favors. Glow foods- Banana and malunggay leaves GROW FOODS Body building foods such as sh, meat, eggs, provide the protein and WATER minerals necessary for the growth and repair of tissues, muscles and bones. Always include water and a nutritious GLOW FOODS beverage with each meal and remember to drink water all Body regulating FOODS such as fruits and vegetables provide the vitamin and throughout the day, consumption of minerals to maintain healthy body functions, as well as ber for healthy digestion. sugary beverages should be EXAMPLE: VEGETABLE- malunggay, kalabasa, sitaw, amplaya, ad others. moderate to minimal because it can cause increase risk of dental caries FRUITS - like banana, mango, papaya and others. and diabetes. Choose Glow foods that have a wide variety of color. Eating a wide variety of color of fruits and vegetables ensures that we are getting a wide range of nutrients. MDCON 105_UNIT 7&8 - October 18, 2024 fi fi fi Healthy Eating for Healthy Babies Dr. Ann C. Nery MDCON 105_UNIT 7&8 - October 18, 2024  PRE-PREGNANCY NUTRITION 1. Evaluate a woman’s pattern and amount of weight gain during pregnancy based on her prepregnancy body mass index (BMI). Ideally, women enter pregnancy optimally nourished and at a healthy body 2 Assess a woman’s intake of folic acid for adequacy in the preconception weight. Dietary Guidelines key recommendations for women who are period and during pregnancy. capable of becoming pregnant, as well as those who are pregnant or breastfeeding, 3 Assess whether a woman may bene t from a multivitamin and mineral supplement during pregnancy. Healthy Eating 4 Plan a day’s intake for a pregnant woman based on her MyPlate food intake pattern. The basic principles of healthy eating that apply to healthy people are also 5 Give examples of nutrition interventions used for nausea, constipation, and appropriate before, during, and after pregnancy: eat plenty of fruits and heartburn during pregnancy. vegetables of various kinds and colors; whole-grain bread and cereals; lean protein foods; low-fat or fat-free milk and dairy products; and healthy fats in 6 Compare nutrition guidelines for healthy eating during pregnancy with the moderation. guidelines for lactation. 7 Identify risk factors for poor nutritional status during pregnancy. As with the general public, sodium, solid fats, added sugars, and re ned grains should be limited. 8 List bene ts of breastfeeding for mother and infant. Folic Acid: synthetic form of folate found in multivitamins, The Institute of Medicine (IOM, 1998), Centers for Disease Control and forti ed breakfast cereals, and enriched grain Prevention (CDC, 2012c), Dietary Guidelines for Americans, 2010 (U.S. products. Department of Agriculture [USDA], U.S. Department of Health and Human Services [USDHHS], 2010), and March of Dimes (MOD, 2012) Neural Tube Defect: recommend: a serious central nervous system birth defect, synthetic folic acid consumption before conception to prevent neural tube such as anencephaly (absence of a brain) and defects. spina bi da (incomplete closure of the spinal cord and its bony encasement). All pregnant women should consume 400g of synthetic folic acid daily from forti ed food or supplements, along with natural folate in a varied Folate: diet. natural form of the B vitamin involved in the Synthetic folic acid is better absorbed and available than natural folate. synthesis of DNA; only one-half is available to the body as synthetic folic acid. MDCON 105_UNIT 7&8 - October 18, 2024 fi fi fi fi fi Heme Iron Essential fatty acids, particularly the The CDC recommends that all women who are capable of becoming pregnant essential omega-3 fatty acids. Seafood be coun- seled to choose foods that provide heme iron, or other sources of recommendations are to consume 8 to 12 iron in the diet, and nonheme iron absorption enhancers, such as vitamin C oz of a variety of seafood per week and not (CDC, 2012c). more than 6 oz of canned albacore tuna weekly. Iron de ciency screening is recommended so that anemia can be treated prior to conception. Other Nutrients of Concern Iodine. An iodine de ciency during pregnancy can cause neurologic damage from fetal hypothyroidism; population studies correlate iodine de ciency with Other nutrients of concern in women who are capable of becoming pregnant impaired cognitive development in the fetus and in children (Ziesel, 2009). include (CDC, 2012c) Women should be advised to consume the recommended amount of iodine before, during, and after pregnancy. Iodized salt is an acceptable source. Calcium. Women should be counseled about the importance of consuming calcium in an adequate amount; calcium supplements may be an option if Dietary supplements. Screening should identify all supplements used, calcium intake is inadequate. including vitamins, minerals, herbs, weight loss products, and home remedies so that safety and e cacy can be discussed. Healthy Weight NUTRITION AND LIFESTYLE DURING PREGNANCY Healthy Weight: BMI of 18.5 to 24.9. Obesity during pregnancy is linked to various High-risk pregnancy can lead to low birth weight infants, causing health issues, including gestational diabetes, complications during delivery and physical and mental defects. hypertension, preeclampsia, birth defects, cesarean delivery, fetal macrosomia, perinatal Monitoring is ongoing to identify high-risk criteria. deaths, postpartum anemia, and childhood obesity. Pregnant women are encouraged to adopt healthy lifestyle changes, including maintaining a healthy eating pattern and staying within calorie Achieving a healthy weight before conception is needs. bene cial for both mother and infant. This means they should Women with a BMI of 18.5 or lower or 25 or higher should be counseled about the risks of unhealthy Eat a variety of nutrient-dense food and beverages among the basic food weight, including infertility. groups. Treatment should focus on moderate weight loss through nutrition and physical activity. MDCON 105_UNIT 7&8 - October 18, 2024 fi fi ffi fi  Be sure to include enough Amount of Weight Gain vegetables, fruits, whole grains, and milk and milk products because these foods provide The International Organization for Migration (IOM) recommends weight gain nutrients of concern in the typical of 25-35 pounds for normal weight women, 28-40 pounds for underweight American diet—namely, women, 15-25 pounds for overweight women, and 11-20 pounds for obese potassium, ber, calcium, and women. vitamin D. Women pregnant with twins need to gain slightly more weight than single births but not double the amounts. Limit their intake of saturated fat, trans fats, cholesterol, added The IOM emphasizes the need for women to enter pregnancy with a normal sugars, and salt. BMI to reduce adverse pregnancy outcomes. Follow food safety guidelines to Excessive weight gain during pregnancy increases the risk of gestational reduce the risk of foodborne diabetes, hypertension, preeclampsia, cesarean deliveries, complications illness. during delivery, and postpartum weight retention. Inadequate weight gain during pregnancy increases the risk of low-birth weight (LBW) infants, high postnatal complications, mortality, cardiovascular disease, hypertension, type 2 diabetes, dyslipidemia, and obesity. Guidelines and ongoing monitoring are crucial to prevent postpartum weight retention. MDCON 105_UNIT 7&8 - October 18, 2024 fi  Calorie Requirements Assuming a 1.1- to 4.4-pound weight gain in the rst trimester of pregnancy, According to Dietary Reference Intakes normal- weight women are urged to gain approximately 1 pound per week (DRIs), pregnant women do not need any during the second and third trimesters additional calories until the second trimester. recommended amounts of weekly gain for underweight, overweight, and obese women are slightly di erent Even then, the increase is surprisingly small: an extra 340 cal/ day is Although slightly higher or lower rates of weight gain can be considered recommended during the second normal, obvious or persistent deviations warrant further investigation. trimester and an additional 452 cal/day in the third (IOM, 2005). Most pregnant women need a total of 2200 to 2900 cal/day (ADA, 2008). Throughout pregnancy, adequacy of calorie intake is measured by adequacy of weight gain. MyPlate Daily Food Plan for a pregnant woman who normally requires 2000 cal/day. A 2000-calorie meal plan is shown for the rst trimester, a 2400-calorie plan for the second trimester, and a 2600-calorie plan for the third trimester. The total calories in each of these plans slightly exceeds the actual estimated increase required (e.g., 2340 calories during the second trimester, 2452 calories in the third trimester) because these are general food group plans, not exact formulas. From the beginning to end of pregnancy, the increase in food recommended daily is: 3 oz of grains 1 cup of vegetables 1 oz of protein foods 2 tsp oils MDCON 105_UNIT 7&8 - October 18, 2024 ff fi  Nutrient Requirements 1. Folic Acid Nutrient requirements increase during pregnancy, but they are not - Folic acid has a vital role in DNA constant and do not increase proportionately. synthesis and thus is essential for the synthesis of new cells and Actual requirements vary among individuals and are in uenced by transmission of inherited previous nutritional status and health history. characteristics. Nutrient intake can alter one nutrient requirement, such as protein intake. - It is recommended that pregnant women increase their intake of Most low-nutritional risk women can meet their nutrient needs throughout dietary folate equivalents (DFE) to pregnancy from food alone. 600 g daily throughout pregnancy. - A daily supplement ensures an adequate intake. 2. Iron - The DRI for iron increases by 50% during pregnancy to support the increase in maternal blood volume and to provide iron for fetal liver storage, which sustains the infant for the rst 4 to 6 months of life. - Even with careful selections, women are not likely to consume adequate amounts of iron during pregnancy from food alone. - Infants born to women who have iron de ciency anemia have an increased risk of LBW and possibly preterm delivery and perinatal mortality (ADA, 2008). - It is recommended that pregnant women take an iron supplement of 27 mg of iron daily; women who are anemic may need 60 mg of iron daily until the anemia resolves (ADA, 2008). MDCON 105_UNIT 7&8 - October 18, 2024 fi fi Other Nutrient Supplements Vegans pregnant or breastfeeding should take vitamin B12 A multivitamin and mineral supplement is recommended for pregnant supplements if no reliable dietary women who (ADA, 2008) source is available. Have iron de ciency anemia Vegan foods forti ed with B12 are reliable. Consume a poor-quality diet A well-planned lacto-ovo vegetarian Do not consume enough foods from animal sources or vegan diet can meet other nutrient needs. Smoke or abuse alcohol or drugs Supplemental vitamin D is recommended for women lacking Are carrying two or more fetuses adequate vitamin D or insu cient Have HIV, especially if access to antiretroviral treatment is limited sunlight exposure. Avoiding Food-borne Illness Alcohol Pregnant women are 20 times more likely to Alcohol use during pregnancy can cause contract listeriosis than healthy adults, which physical and neurodevelopmental can lead to miscarriage, stillbirth, premature problems, such as mental retardation, delivery, or neonatal infection. learning disabilities, and fetal alcohol syndrome. To reduce the risk, pregnant women should avoid unpasteurized milk, raw meat, pâtés, Alcohol does its damage by dehydrating soft cheeses, and leftover foods. fetal cells, leaving them dead or functionless, or by causing secondary Toxoplasmosis, transmitted during pregnancy, nutrient de ciencies. can cause mental retardation, blindness, and epilepsy. Because alcohol is a potent teratogen and a “safe” level of consumption is not known, Pregnant women should cook meat women are advised to completely avoid thoroughly, wash fresh fruits and vegetables, alcohol before and during pregnancy. avoid cross-contamination in the kitchen, and avoid changing cat litter. MDCON 105_UNIT 7&8 - October 18, 2024 fi fi fi ffi  PICA Non-nutritive sweeteners Pica is a craving for nonfood items, particularly earth, starch, and ice, often experienced by socioeconomically disadvantaged women in rural Nonnutritive sweeteners like Acesulfam potassium, aspartame, saccharin, and and immigrant communities. sucralose are safe during pregnancy when consumed within FDA guidelines. However, high intakes can increase the risk of preterm delivery. Causes are unknown, but cultural beliefs, hunger, and medicinal Herbal Plants purposes may in uence it. Iron de ciency is not a risk factor for pica, but it may interfere with iron absorption. Herbal supplements should not be used during pregnancy and lactation due to Exposure to metals in soil and clay can increase the risk of premature their potential teratogenic e ects. birth, spontaneous abortion, and permanent neurodevelopmental FISH impairments. Ca eine Fish and shell sh consumption during pregnancy is advised due to the risk of A high ca eine intake is associated with LBW but not with birth defects methylmercury contamination, which occurs naturally in the environment and (ADA, 2008) or preterm birth (Maslova, Bhattacharya, Lin, and Michels, accumulates in humans through eating sh. 2010). Little animal or human testing has been conducted to determine the safety and The ADA recommends pregnant women limit their intake of ca eine to 300 e cacy of herbal products during pregnancy. mg/day or less NUTRITION FOR LACTATION Mercury can be toxic to developing brains in fetuses and young children, leading to learning delays and severe problems like cerebral palsy, seizures, Breastfeeding is the optimal method for and mental retardation. infants, with the World Health Organization and American Academy of To reduce the risk of methylmercury poisoning, pregnant or lactating women Pediatrics recommending it for the rst 6 should avoid certain sh and seafood, such as shark, sword sh, king months and continuing with mackerel, and tile sh, and consume 8 to 12 oz of seafood per week from complementary foods until 1 year. lower-mercury sh and shell sh. Breastfeeding improves infant and child Pregnant women may be more likely to consume sh if given safe seafood morbidity and maternal morbidity. recommendations. Exercise should be encouraged, with focus on fall risk and avoiding supine Physical activity positions during the second and third trimesters. Physical activity is also advised for healthy pregnant women without medical or obstetric complications. MDCON 105_UNIT 7&8 - October 18, 2024 ffi ff ff fi fi fl fi fi ff fi fi fi fi Promoting Breastfeeding Maternal Diet Breastfeeding rates in the US have During lactation, a healthy diet should continue, with key recommendations for increased since the late 1970s, with a breastfeeding. current initiation rate of 76.9%. Preparation should begin prenatally with counseling and support for both the However, many women choose not to woman and her partner. breastfeed, partially breastfeed, or for short durations due to factors like unsupportive Women use approximately 500 calories above their normal daily calorie needs to hospital practices, lack of knowledge, produce breast milk, with 100-150 of these calories coming from fat stored during personal beliefs, and family attitudes. pregnancy. Social support and healthcare professional Calories guidance can positively impact breastfeeding success. An extra 330 calories/day are recommended for the rst 6 months of lactation and 400 calories for the second 6 months for exclusively breastfeeding women. Prenatal counseling and support should The calorie intake is evaluated by changes in a woman's weight, and those who begin prenatally and continue throughout the gestational period. failed to gain enough weight during pregnancy or lost too much weight while breastfeeding may need to increase their calorie intake. Breastfeeding overweight women can reduce their calorie intake by 500 calories/day, promoting postpartum weight loss. A 500-calorie de cit diet with fruits, vegetables, low-fat dairy, whole grains, legumes, and GROUP REPORT: healthy fats is recommended. 1. Nutrition for Infants, Children and Adolescents Fluids 2. Consumer Issues Breastfeeding mothers should drink a glass of uid every time the baby nurses and with all meals. Inadequate maternal diets during lactation 3. Nutrition for Older Adults decrease milk quantity, not quality. 4. Cultural and Religious In uences on Food Vitamins and minerals Prolonged inadequate intake of certain nutrients may compromise infant nutrition. While supplements can correct inadequacies, women should obtain nutrients from food. MDCON 105_UNIT 7&8 - October 18, 2024 fl fl  LEARNING OBJECTIVES Water and 1. Calculate a person’s uid requirement. Minerals 2. Evaluate the adequacy of uid intake in a healthy adult. 3. Give examples of mechanisms by which the body maintains mineral homeostasis. Dr. Ann C. Nery 4. Identify sources of minerals. 5. Predict potential consequences of mineral de ciencies or toxicities. 6. Compare characteristics of minerals to those of vitamins. OVERVIEW OF WATER Water Balance Water balance is the dynamic state between water output and water Water is a vital component of the body, occupying every cell and intake. Under normal conditions, output and intake are approximately playing a signi cant role in various bodily functions. equal It provides structure to cells, regulates body temperature, aids in nutrient digestion and absorption, and transports nutrients and oxygen to cells. Water also serves as a solvent for vitamins, minerals, glucose, and amino acids, participates in metabolic reactions, and eliminates waste products. It is a major component of mucus and lubricating uids, reducing friction in joints and cushioning contacts between internal organs. Men generally have a higher percentage of body water than women. Presentation 7 - September 26, 2024 fi fl fl fi  Water Intake Water Output The average daily water intake is 21⁄2 liters, with 80% coming from Adults lose 1750-3000 mL of water daily due to extreme uids and 20% from solid food. temperatures, high altitude, low humidity, strenuous exercise, and skin evaporation. Fruits and vegetables are the most water-rich foods. Urine and feces contribute to the remaining water loss. The body also produces a small amount of water from normal metabolism, ranging from 250 to 350 mL daily. To maintain water balance, intake should approximate output, as the body excretes 500 mL daily. Method Insensible water loss —-measurable 30 mL/kg body weight Sensible water loss —-immeasurable Example: A 70-kg person needs 2100 mL/day. (70 kg 30 mL/kg 2100 mL/d) The average daily water intake is 21⁄2 liters, with 80% coming from uids and 20% from solid food. Fruits and vegetables are the most water-rich foods. The body also produces a small amount of water from normal metabolism, ranging from 250 to 350 mL daily. MAJOR ELECTROLYTES Sodium, chloride, and potassium are major minerals that are also major electrolytes in the body. Salient features for each electrolyte are presented in the following paragraphs. Sodium, a key component of the human body, is primarily obtained from salt or sodium preservatives added to food. In the American diet, 75% of sodium comes from salt, while only 12% comes from naturally occurring sodium in foods like milk, meat, poultry, vegetables, and tap water. Presentation 7 - September 26, 2024 fl  Potassium is a crucial cation in the body, found in cells and extracellular uids. It maintains uid balance, aids in metabolic reactions, and controls skeletal muscle contractility. It is naturally present in most foods, but processed foods have a higher sodium-to- potassium ratio. Chloride, a major anion in MAJOR MINERALS extracellular uid, maintains uid and electrolyte balance The remaining major minerals are calcium, phosphorus, magnesium, and alongside sodium. It's essential sulfur. in digestion and acid-base balance. Calcium, the most abundant mineral, makes up half of the Most cells have low chloride body's total mineral content. 99% concentration. is found in bones and teeth, providing rigidity and structure. The AI for chloride is equivalent to sodium, with younger adults Bones release calcium when having 2.3 g/day. Sodium and serum levels drop, maintaining chloride share dietary sources. blood calcium levels. The remaining 1% is found in plasma and uids. Presentation 7 - September 26, 2024 fl fl fl fl fl  Magnesium, the fourth most abundant mineral, is deposited in bone with Phosphorus is the most calcium and phosphorus, and is a abundant mineral in the body, cofactor for over 300 enzymes. with 85% combined with calcium in bones and teeth. Its role in preventing hypertension, managing cardiovascular disease, and It regulates acid-base balance, diabetes is growing. metabolizes energy, and provides cell membrane structure. Sulfur is a component of biotin, thiamin, and amino acids methionine and cysteine, making Phosphorus is essential for proteins in skin, hair, and nails more rigid. RNA and DNA, enzyme activation, and B vitamins. There is no RDA or AI for sulfur, and de ciency Absorption is enhanced by symptoms are unknown. vitamin D and regulated by PTH. Intake of sulfur amino acids is necessary for sulfur. TRACE MINERALS Trace mineral content in foods is highly variable, largely in uenced by soil mineral content. For example, grains, vegetables, and meat grown in certain states have higher selenium content, while those in southern states and the US coasts have less. Other factors like water supply quality and food processing also a ect the content. Food composition tables typically include data on iron, zinc, manganese, selenium, and copper, but not iodine, chromium, and molybdenum. Presentation 7 - September 26, 2024 fi  Bioavailability of trace elements Iron is found in the heme portion of hemoglobin, transferrin, and enzyme varies based on the total diet and is systems. It is stored in the liver, bone marrow, and spleen. in uenced by mineral interactions and other dietary factors. Iron is found in heme iron in meat, sh, and poultry, and nonheme iron in plants. The majority of iron in the diet is nonheme iron. Excessive intake of one trace mineral can hinder another's absorption, Iron absorption typically ranges from 10% to 15% of total intake, but during while de ciency can intensify toxic growth, pregnancy, or iron de ciency, it can increase to 50%. e ects. Heme and nonheme iron bioavailability is signi cantly di erent. Heme iron Reliable indicators of trace element absorption is about 15% and is in uenced by need, not dietary factors. status, such as serum levels or balance studies, are not always Nonheme iron absorption is enhanced or inhibited by various factors, such as available for all trace minerals, consumption with heme iron or vitamin C-rich foods, co ee, calcium, phytates, making it di cult to assess their or oxalates. status. Tea is a potent inhibitor that can reduce nonheme iron absorption by 60%. Zinc, a small nutrient found in cells, plays a crucial role in various bodily When plant foods are consumed as a single food, only 1% to 7% of nonheme functions and immune system function. iron is absorbed. Iron requirements vary among individuals, with the It is essential for growth, metabolism, reproduction, and taste perception. RDA set at 8 mg for men and postmenopausal women and 18 mg for premenopausal women. Zinc de ciency is not easily diagnosed due to lack of a single test. Vegetarians have higher iron recommendations due Risk factors include poor calorie intake, alcoholism, and malabsorption to lower bioavailability. syndromes. Most adults consume adequate iron, but women of Vegetarians are at higher risk due to plant-based absorption. In childbearing age, pregnant women, and developing countries, iron de ciency is exacerbated by diseases like HIV breastfeeding women generally do not. Iron and tuberculosis. de ciency anemia, a microcytic, hypochromic anemia, a ects over 30% of the world's population and is exacerbated in developing countries by worm infections, malaria, and infectious diseases. Presentation 7 - September 26, 2024 ff fl fi fi fi ff ffi fi fi fl fi fi  Iodine is essential for thyroid hormone Selenium, a key component of glutathione regulation and is found in various peroxidases, is an antioxidant that disarms free tissues and organs. It is found in radicals during normal oxygen metabolism. vegetables, grains, milk, bread, and seafood. It regulates thyroid hormone actions and has potential roles in preventing cardiovascular disease, However, most foods are naturally neurodegenerative diseases, and certain cancers. low in iodine, with some being iodized for sanitization. Iodine Although the average American adult consumes de ciency is a major global issue, more than the recommended daily intake, many leading to mental retardation and consume high amounts through supplements. disorders like goiter, hypothyroidism, cretinism, stillbirths, and delayed Adverse e ects can occur even when selenium cognitive development. intake is below toxic levels. The e ect of goitrogens on iodine Selenium de ciency is rare in the US, often due to balance is clinically insigni cant severe gastrointestinal problems or surgical removal. except when iodine de ciency exists. Copper, found in muscles, liver, brain, bones, kidneys, and blood, plays a Fluoride aids in the mineralization of tooth enamel and remineralization of crucial role in hemoglobin synthesis, collagen formation, wound healing, nerve surface enamel in erupted teeth by inhibiting cariogenic bacteria's ber maintenance, and energy metabolism. metabolization of carbohydrates. Excess zinc intake can cause copper de ciency Fluoridation of municipal water in the second half of the 20th century has signi cantly reduced dental caries prevalence and severity in the U.S. Manganese, American adults consume a high amount of manganese, with no dietary The National Institute of Dental Health, the Academy of Nutrition and de ciencies. Dietetics, the American Medical Association, the National Cancer Institute, and the Centers for Disease Control and Prevention endorse Manganese toxicity is a risk for miners, uoridation. leading to central nervous system abnormalities similar to Parkinson's The CDC estimates that for every $1 spent on uoridation, $38 or more is disease. saved in treatment costs. Drinking water may also cause neuromotor Children under 8 years are susceptible to mottled tooth enamel if they de cits. The UL for adults is 11 mg/day, ingest more uoride than recommended, due to swallowing uoridated four times the usual intake. toothpaste. Presentation 7 - September 26, 2024 fi fl fi fi fi fi ff ff fi fl fi fi fi fl  Chromium, found in foods, helps regulate blood glucose levels and is essential for insulin action. Other Trace Elements A de ciency results in high blood glucose and Although de nitive evidence is lacking, future research may reveal that other impaired insulin response. trace elements are essential for human nutrition. However, evidence is di cult to obtain, and quantifying human need is even more formidable. In addition, as Despite its widespread presence, many foods with all trace minerals, the potential for toxicity exists. Consider the following: provide less than 1 to 2 μg per serving. Unre ned foods are higher in chromium than Nickel, silicon, vanadium, and boron have been demonstrated to have processed ones. bene cial health e ects in some animals and may someday be classi ed as essential for humans. Molybdenum, a crucial component of red blood cell Cobalt is an essential component of vitamin B12, but it is not an essential synthesis and enzymes, is widely nutrient and does not have an RDA. consumed in the American diet, but its potential dietary It is possible that minute amounts of cadmium, lithium, tin, and even arsenic de ciencies and toxicities remain are also essential to human life. unknown. WATER AND MINERALS IN HEALTH PROMOTION WATER The Dietary Guidelines for Americans, 2010 recommend consumers to drink water instead of sugary drinks, as they are linked to poor diet quality, weight gain, obesity, and type 2 diabetes. The American Heart Association recommends no more than 450 calories per week from sugar-sweetened beverages, or fewer than three 12-oz cans per week. Sugar-sweetened beverages are linked to poor diet quality, weight gain, obesity, and type 2 diabetes in adults. Soft drink consumption has increased over the last 30 years, with males and females consuming 175 and 94 calories per day, respectively. Presentation 7 - September 26, 2024 fi fi fi fi fi ff  The Beverage Guidance Panel MINERALS agrees that the current high intake of sweetened beverages The Dietary Guidelines for Americans, contributes to excess calorie 2010 recommend reducing daily sodium intake and obesity development. intake to less than 2300 mg and 1500 mg among individuals aged 51 and older, While naturally calorie-free plain water can satisfy uid needs, African American, or those with other beverages o er nutrients, hypertension, diabetes, or chronic kidney phytochemicals, and interest to disease. This recommendation applies to the diet. about half of the U.S. population, including children and adults. Additionally, the guidelines recommend choosing foods with more potassium and calcium to prevent low levels of certain nutrients, which could pose a public health concern. SODIUM & POTASSIUM High potassium intake can counteract the e ects of high sodium intake, leading to a stronger association between cardiovascular disease and sodium High sodium or low potassium intake and potassium consumption ratios. increases blood pressure, a risk factor for coronary heart disease, stroke, congestive heart failure, and renal diseases. A diet rich in potassium, calcium, magnesium, and ber combined with reduced sodium intake can lower blood pressure in hypertensive and normotensive individuals. Blood pressure increases progressively and continuously over the continuum of sodium intake without an obvious threshold. Public health bene ts from increasing potassium include greater health bene ts than simply restricting sodium. The Daily Value (DV) for sodium used on Food sources, such as fruits and vegetables, are recommended over food labels does not reliably re ect a supplements, as potassium is better absorbed from these sources. food's contribution to recommended sodium intake levels. The Daily Reference Value for sodium on the "Nutrition Facts" label is 2400 mg, exceeding the current UL set at 2300 mg. Presentation 7 - September 26, 2024 fi fl ff fi fl ff CALCIUM is crucial for bone health and prevents chronic diseases. Consuming milk and milk products is linked to a lower risk of cardiovascular disease, type 2 diabetes, and lower blood pressure in adults. Studies show a decrease in colorectal cancer and adenomas at higher calcium and vitamin D intake. Dairy calcium intake may also help regulate weight and prevent obesity. Despite Americans being advised to meet their RDA for calcium through food, 43% of adults take calcium supplements, raising concerns about their safety. Presentation 7 - September 26, 2024  ENERGY INTAKE Calories in a diet are estimated by multiplying grams of carbohydrates, protein, fat, and alcohol by appropriate calories per gram. The total number of calories in a food or diet can be estimated by Energy multiplying total grams of these nutrients by the appropriate calories per gram—namely, 4 cal/g for carbohydrates and protein, 9 cal/g for fat, and 7 cal/g for alcohol. Balance However, counting calories is imprecise and requires accurate portion sizes and nutritional composition. Another method is to estimate servings from each food group, which involves multiplying the number of servings by the average amount of Dr. Ann C. Nery calories in a serving. This method depends on the quality of foods consumed and accuracy of portion size estimation. NCM 105_energy balance - October 5, 2024  ENERGY EXPENDITURE The body uses energy for involuntary activities and purposeful PA. The total of these expenditures represents the number of calories a person uses in a day. Basal metabolism is the amount of calories needed to fuel involuntary body activities after a 12-hour fast. It accounts for 60% to 70% of total calories expended, with less active individuals using more calories. A rule-of-thumb method for estimating BMR is to multiply healthy weight by 10 for women and 11 for men. However, this method does not account for other factors a ecting metabolic rate, such as body composition. Lean tissue contributes to a higher metabolic rate than fat tissue, resulting in higher metabolic rates in men. Aging causes calorie requirements to decrease, but strength training can increase BMR, even in frail, institutionalized individuals. Basal Metabolic Rate (BMR) or Basal Energy Expenditure (BEE): the amount of calories expended in a 24-hour period to fuel the involuntary activities of the body at rest and after a 12-hour fast. Resting Metabolic Rate (RMR) or Resting Energy Expenditure (REE): the amount of calories expended in a 24-hour period to fuel the involuntary activities of the body at rest. RMR does not adhere to the criterion of a 12- hour fast, so it is slightly higher than BEE because it includes energy spent on digesting, absorbing, and metabolizing food. NCM 105_energy balance - October 5, 2024 ff  Physical activity (PA) contributes to 30% of total calories used, with intensity Estimating Total Energy Expenditure and duration a ecting energy consumption. Heavier individuals burn more calories. Total calorie needs can be imprecisely estimated by using predictive equations, of which more than 200 have been published. The following are Estimating daily PA calories is easier by calculating the percentage increase di erent approaches for estimating calorie needs; all yield estimates, not above BMR based on estimated intensity of daily activities. Recording all precise measurements. activity for a 24-hour period is a tedious process. Add the results of the rule-of-thumb methods described earlier for Thermic e ect of food is an energy expenditure that represents the cost of estimating BMR and calories spent on activity (Box 7.1). processing food, estimated to be 10% of total calorie intake in a normal mixed diet. Use a simple formula of calories per kilogram of body weight, such as 25 cal/kg to 30 cal/kg, which is often used for nonobese adults. This formula is It varies with food composition, frequency, and meal size. Despite its adjusted upward or downward based on the client’s age, weight, or activity legitimate use of calories, thermic e ect is often underestimated when level. estimating calorie requirements due to its small energy content and imprecise estimation. Use a standard reference that lists estimated daily calorie needs based on gender, age, and activity. Table 7.3 lists estimated daily calorie needs. Healthy weight is statistically related to good health, but the relationship is more complex than just the number on the scale. Body fat, distribution, and health risks also in uence weight. Table provides standards for evaluating ideal body weight, body mass index, and waist circumference, but these values are arbitrary as risk exists on a continuum without absolute cuto s. Activity: compute for your ETEE Pass it in the Gclassroom NCM 105_energy balance - October 5, 2024 ff ff ff fl ff  Ideal Body Weight Body mass index (BMI) has replaced traditional height-weight measurements The Hamwi method is a quick and easy way to compute “ideal” body weight in clinical settings, as the U.S. Preventive Services Task Force (USPSTF) (IBW) based on an adult’s height and gender. The formula is as follows: concluded in 2003 that BMI is an acceptable measure for identifying adults For women: Allow 100 pounds for the rst 5 ft of height Add 5 pounds for each with excess weight. additional inch of height The formula to calculate BMI is weight in kilograms divided by height in For men: Allow 106 pounds for the rst 5 ft of height Add 6 pounds for each meters squared or weight in pounds divided by height in inches squared additional inch of height. multiplied by 703. Nomograms and tables that plot height and weight to determine BMI eliminate complicated mathematical calculations. Using this formula, a 5 ft 6 in tall women would have an “ideal” weight of 130 pounds and a man of the same height would have an “ideal” weight of 142 However, BMI levels de ning overweight and obesity are somewhat arbitrary pounds. IBW can be adjusted upward or downward by 10% based on estimation due to the continuous relationship between increasing weight and disease of a person’s frame size. Likewise, for people who are less than 5 ft tall, 21⁄2 risk. BMI does not take body composition into account, and ethnic pounds are subtracted for each inch under 5 ft. Although this formula is simple to di erences exist in the relationship between BMI and health risks. use, it does not take into account body composition or distribution of body fat, both of which impact health risk. Waist Circumference ENERGY BALANCE IN HEALTH PROMOTION Recent evidence suggests that waist circumference may be an acceptable Energy balance refers to the relationship between calorie intake and output, alternative to BMI measurement in some subpopulations. with a positive balance occurring when calorie intake exceeds output, leading to The location of excess body fat may be a more reliable indicator of disease weight gain. risk than the degree of total body fatness. Conversely, a negative balance occurs when output exceeds intake. In the US, Storing a disproportionate amount of total body fat in the abdomen 68.8% of adults and 35.7% of adults are overweight or obese, increasing the increases risks for type 2 diabetes and cardiovascular disease. risk of cardiovascular disease, hypertension, type 2 diabetes, and certain cancers. Men and postmenopausal women tend to store excess fat in the upper body, while premenopausal women store it in the lower body. Ethnic Poor food choices and physical inactivity contribute to this imbalance, with groups di er in where risk begins in relation to waist circumference. Americans consuming 35% of their total calories in empty form and fewer than 5% participating in 30 minutes of physical activity daily. NCM 105_energy balance - October 5, 2024 ff ff fi fi fi  State of energy balance: Eat Only to Relieve Hunger Choose Nutrient-Dense, Not Calorie-Dense Items Eating should not be a distraction from boredom or stress, and should be done Nutrient-dense items like fruits, vegetables, whole grains, legumes, nuts, mindfully, focusing on internal cues for satiety and not consuming excessive nonfat milk, and lean proteins are healthier alternatives to calorie-dense items calories, and not engaging in other activities. like fast foods. Maintain a Consistent Eating Pattern Eating out less, bringing healthy snacks home, and stocking the pantry with only healthy items can help maintain a healthy diet. Avoiding periods of hunger may help avoid bingeing; people become less discriminating in their food choices when they are “starving.” Avoid commercially pre-packaged "junk" foods that are modi ed to be "fat- free" or "sugar-free," as these foods still contain calories from protein and Breakfast is important for children and adults; observational studies show an carbohydrates. inverse relationship between the frequency of eating break- fast and the risk for obesity and other chronic diseases such as type 2 diabetes (Song, Chun, Obayashi, Cho, and Chung, 2005; Wyatt et al., 2002) NCM 105_energy balance - October 5, 2024  Activity Choices: Move More, Sit Less Right Portion Sizes Increased activity levels are dose-dependent and can range from 2 to 5 Over the past 20 years, portion sizes have increased signi cantly, with hours per week. grocery stores selling large food packages 10 times larger than regular ones. Muscle-strengthening activities, including strength training, resistance Restaurants consistently o er jumbo portions that are 250% larger than training, and endurance exercises, help build muscle, raise metabolic rate, regular ones. and increase weight loss and body fat loss. Even small changes in dishware size can increase calorie intake. This These activities also improve bone density and decrease the risk of "portion distortion" a ects people's perception of food intake, leading to osteoporosis. overconsumption and weight gain. Sedentary behavior increases the risk of weight gain, obesity, and chronic To combat this, strategies to make food less accessible include switching to diseases like type 2 diabetes and cardiovascular disease. smaller plates, buying smaller packages, buying prepackaged, portion- controlled items, storing food out of sight, ordering smaller portions at To reduce sedentary behavior, limit television viewing and replace it with restaurants, and using doggie bags. more physically active pursuits. NCM 105_energy balance - October 5, 2024 ff ff