BSN 111 Applied Nutrition for Nurses PDF

BSN 111 Applied Nutrition for Nurses Energy Balance and How it is Supplied by the Diet 2023 / 2024 Semester 3 – Week 4-A By: Firas Qatouni, RN., M.Ed., 6/7/2024...

BSN 111 Applied Nutrition for Nurses Energy Balance and How it is Supplied by the Diet 2023 / 2024 Semester 3 – Week 4-A By: Firas Qatouni, RN., M.Ed., 6/7/2024 1  Learning Outcomes 1. Define energy. 2. Categorize how energy is supplied by the diet. 3. Summarize the components of energy expenditure. 4. Examine energy balance and factors that contribute to altered energy balance. 5. To formulate nursing interventions that target improving energy balance for weight loss or weight gain. 2  What is Energy? Food stores energy. Eating transfers the stored energy from the food to our body. The energy keeps us alive and allows us to carry out our activities. Energy is available usable power, whether it is in chemical, mechanical, electrical, or other form. Examples: Fossil fuel (eg. Petroleum) power an engine. Solar radiation to generate electricity. The chemical energy stored in the food we eat power our body and produce heat to maintain body temperature 3  What is Energy? The unit of measurement of chemical energy in food- kilocalories (kcals). A kilocalorie denotes the energy needed to raise the temperature of 1000 gm (1 kg) of water by 1oC. 4  Energy Balance Energy balance is the relationship between energy intake and energy used ( energy expenditure) by the body to perform physical functions such as respiration or digestion and physical activity. 5  Energy Intake The body derives energy from the metabolism of carbohydrates, protein, fat and alcohol that are contained in foods and beverages. The end products of metabolism are carbon dioxide, water and energy in the form of ATP ( Adenosine triphosphate). Carbohydrates – 4 kcal/gm Protein – 4 kcal/gm Fat – 9 kcal/gm Alcohol – 7 kcal/gm 6  Energy Expenditure Total energy expenditure (TEE) = All energy –requiring processes in the body + any physical activity Energy expenditure all the energy used by the body Basal metabolism Thermic effect of food Physical activity 7  Basal Metabolism Energy required for the vital functions of the body at complete rest. Also referred to as Basal Metabolic Rate (BMR). Includes Energy required to Sustain metabolic activity in cells and tissues Maintain respiration, circulation and the function of brain and other organs Production of heat to maintain core body temperature Synthesize new tissue as in growth and development When BMR is expressed as kcalories expended over 24 hours, it is called the basal energy expenditure (BEE) 8  Basal Metabolism Factors affecting BMR 1. Body size (specifically fat free body mass which includes muscles and organs such as brain, heart and liver). 2. Gender : due to larger skeletal muscle mass and organ weight. 3. Age : traditional belief- BMR declines by 1% to 2% per decade of adult hood with a greater decline from 5th decade. Metabolism declines following menopause in women and later in men. 9  Basal Metabolism Factors affecting BMR 4. Thermoregulation: -Infants and children have relatively greater loss of heat through skin due to higher body surface area- to-wt ratio. - Fever increases BEE as body responds by increased heart rate, respiration and heat production 5. Growth and Development : -infancy, childhood, adolescence, pregnancy, lactation- increased energy expenditure 10  Thermic Effect of Food Energy required for digestion, metabolism and storage of nutrients. The majority of this expenditure occurs within a few hours of a meal. On average it is approximately 10% of the energy value of food itself. Protein has highest thermic effect at 20-30% and fat 5%, carbohydrate 5-10%. Overall the thermic effect of food influences TEE in a minor way 11  Physical Activity Energy is required to perform physical work of any kind. Actual exercise Nonexercise activities (Nonexercise activity thermogenesis-NEAT) NEAT- any activity that involves some muscle contraction –ADL including talking and sitting, fidgeting. 12  Physical Activity Factors influencing the energy expenditure from physical activity Intensity : how strenuous the activity is , related to O2 consumption- the more intense the activity, the higher the energy expenditure is per minute Duration : the longer the duration, the higher the energy expenditure. 13  Physical Activity Physical activity level (PAL) : Energy expended from physical activity expressed as a percentage of BEE. PALs are categorized as: Sedentary activity ( e.g.: cooking, light house work, sitting ) Moderate activity (e.g.: gardening, golf, walking 4mph) Vigorous activity ( e.g. jogging, skating, swimming) Institute of Medicine (IOM) categorizes PAL as: Sedentary, low active, active, and very active. 14  How is Energy Intake and Expenditure Measured The kcalories in food and energy expended by the body can be measured in the laboratory research setting using a bomb calorimeter. Practical methods of measuring these include simple calculations Scientific databases exist that contain analysis of nutritional content of foods. Indirect calorimetry is used to measure energy expenditure by analyzing respiratory gases especially in critical care settings. Predictive equations are used to estimate energy expenditure when indirect calorimetry is not an available option. 15  Energy Balance Balance occurs when intake approximate expenditure. 16  Energy Balance For most healthy adults, energy balance fosters weight maintenance because there is neither an excess nor a deficit of kcalories to support gain or loss of body mass. 17  Negative Energy Balance Insufficient energy available to support the needs of the body and weight loss occurs. Causes Insufficient intake Increased expenditure Combination of Insufficient intake and Increased expenditure 18  Positive Energy Balance When energy intake exceeds energy expenditure Increased intake Decreased expenditure Combination of increased intake and decreased expenditure 19 Energy Balance 20  Energy Balance In reality, energy balance is more than a simple equation that compares intake and expenditure. Many factors influences this equation directly or indirectly 21  Energy Balance Examples (under research) Biology-genetics and hormones Food types-food behavior, liquid forms of intake, protein containing foods (greater effects on satiation and higher thermic effect) 22  Recommendations for Energy intake and Expenditure The Institute of Medicine (IOM) describes estimated energy requirements (EER) for adults and children with the goal of meeting the energy needs for important body functions growth and development physical activity good health These recommendations are for population groups as a whole. Not for managing energy imbalances 23  Estimated Energy Requirements (EER) PA : Sedentary-1, light active -1.16, active – 1.31, very active=1.56 The Physical Activity (PA) levels for different lifestyles are defined by the World Health Organization (WHO) as follows: 1.Sedentary: This refers to a lifestyle that involves little to no exercise or physical activity beyond what is required for daily living. The PA level for sedentary individuals is 1.0. 24  Estimated Energy Requirements (EER) PA : Sedentary-1, light active -1.16, active – 1.31, very active=1.56 2. Low active: This refers to a lifestyle that involves light physical activity such as walking or standing for at least 2 hours per day. The PA level for low active individuals is 1.16. 25  Estimated Energy Requirements (EER) PA : Sedentary-1, light active -1.16, active – 1.31, very active=1.56 3. Active: This refers to a lifestyle that involves moderate physical activity such as brisk walking, cycling, or gardening for at least 30 minutes per day. The PA level for active individuals is 1.31. 26  Estimated Energy Requirements (EER) PA : Sedentary-1, light active -1.16, active – 1.31, very active=1.56 4. Very active: This refers to a lifestyle that involves high levels of physical activity such as running, swimming, or engaging in sports for at least 60 minutes per day. The PA level for very active individuals is 1.56. 27 Estimated Energy Requirements (EER) 28  Physical Activity Recommendations Children At least 60min of moderate physical activity on most days Minimize sedentary behavior by limiting television watching and video viewing to 2hours or less per day. 29  Physical Activity Recommendations Adults At least 30min of moderate activity on most days Many adults may require up to 60min of moderate activity most days to prevent weight gain. Physical activity can be initiated slowly and increased over time to meet recommendations. Can be split into increments and combined to meet total time recommendation More activity can be incorporated into everyday life activities. 30  Energy Balance in Children Being a nurse how would you respond to the parents’/caregivers’ concern about whether a child is eating sufficiently? Normal growth and development is a positive indicator that the child’s energy needs are being met. Insufficient energy intake slowed growth rate (growth faltering) 31  Wellness Concerns Wellness concerns regarding energy balance include the effects of both negative and positive energy balance Assess reason for energy imbalance including: Medical reasons for altered balance Energy intake and expenditure Nutrition Assessment will be discussed in detail during next session. 32  Wellness Concerns: Positive Energy Balance When weight gain increases the risk for other diseases such as DM or hypertension, nutrition intervention is indicated. Nurse can explore with the client solutions to the energy imbalance issues. An imbalance of 3,500 kcalories will alter weight by 1 pound. This can occur over weeks, months or more. The nurse can brainstorm with the client ways to create a 3500 kcalorie deficit over weeks or months. By adjusting energy intake or expenditure. e.g., a 100 kcalorie deficit/day over 35 days will yield a 3,500 kcalorie negative energy balance. 33  Wellness Concerns: Positive Energy Balance Examples of contributors to energy imbalance: Portion size of food- serving more food will result in larger portion consumption. Caloric density (energy content) of food – amount of kcalories in a given weight or portion of food. Frequency of intake. Food form – liquid foods generally are less filling and can result in increased intake without notice. 34 Wellness Concerns: Positive Energy Balance Caloric density (energy content) of E.g. 12 –ounce soda has 150 food –Foods high in fat or sugar kcalories whereas an equal portion of water has zero; toast can result in more energy with butter has more calories consumption in a given portion. than toast with jelly. Empty calories – foods that contribute high-caloric value but have little or no nutrient value are sources of empty calories. Need to explore what foods contribute empty calories and ways to modify of these. 35  Wellness Concerns: Positive Energy Balance Address physical activity level and opportunities to be more physically active. Assess barriers to physical activity and brainstorm solutions to it E.g., almost 25% of school children do not participate in moderate to severe physical activity for 60 minutes on even one day of the week. The barriers can be: Unsafe neighborhoods Inability to walk or bicycle to school. The nurse can suggest safe indoor activities such as dancing or exercise video. 36 Wellness Concerns: Negative Energy Balance When weight loss increases health risks associated with poor nutrition or slowed growth occurs in children, nutrition intervention is indicated. Assess the amount, quantity, type and timing of foods consumed. Evaluate exercise type, intensity, frequency and duration In some cases when energy intake can not be modified sufficiently , exercise amount must be curtailed at least temporarily until balance can be achieved. 37  Wellness Concerns Refer clients with complicated energy imbalance (large weight gain, unplanned weight loss, or growth failure) to a registered dietitian. A full team approach is necessary when energy imbalance threatens overall health and to evaluate any medical contributors to energy imbalance like undiagnosed DM, gastrointestinal disease, medication side effect or an eating disorder. A pediatric health care team should be consulted for children experiencing growth faltering from negative energy balance. 38  Energy Balance in Critical Illness Hypermetabolic state: The body responds to the physiological stress of some situations by elevating energy expenditure through a metabolic response that involves a cascade of hormones and other substances. Examples of such situations Burns Fractures Trauma Surgery 39  Energy Balance in Critical Illness Consequences of physiologic stress Hyperglycemia Insulin resistance Skeletal muscle breakdown Weight loss 40  Energy Balance in Critical Illness No one set of nutrition recommendations exists for critically ill clients. Instead, each client should be individually assessed, and customized nutrition recommendations given. Fever causes elevated energy expenditure as the body responds with increased heart rate and respirations. The clinical nutrition practice is to increase the energy expenditure calculation by 7% for each 1-degree F. 41  Energy Balance in Critical Illness This has been shown to be especially helpful for an already critically ill patient with altered metabolic needs because of illness. 42  Energy Balance in Critical Illness Requirements for protein, calories and micronutrients are increased during physiologic stress and may continue to be elevated during rehabilitation. Nutrition intervention before and after surgery is essential for the surgical client. 43  MOHAP Projects and Initiative Supporting Energy Balance You Make the Change Campaign Keep on Beating Campaign MA’KOM Initiative Student Growth Record Initiative Healthy Restaurant Initiative Initiative to Raise Awareness About Healthy Lifestyle For more information visit the MOHAP website https://www.mohap.gov.ae/en/Aboutus/Pages/ProjectandInitiatives.aspx 44  References 1. Tucker, S., & Dauffenbach, V. (2011). Nutrition and Diet Therapy for Nurses. Pearson. 2. https://www.mohap.gov.ae/en/Aboutus/Pages/ProjectandInitiatives.aspx 45