5. NUTRITION

6. LEARNING OBJECTIVES Nutrition and Nutrient Daily Caloric requirement
RMR
Nutritional disorders
Body Mass Index (BMI)
Dietary Reference Intakes(EAR, RDA,AI, UL)
Basic Food groups
Balanced Diet

7. NUTRITION
Process by which the dietary components provide for growth, replacement and energy

9. NUTRIENT
Dietary component essential for growth, replacement and energy needs of body
6 groups:-
A - Macronutrients:-
(1) Carbohydrate
(2) Lipid
(3) Protein
B – Micronutrients:-
(4) Vitamin
(5) Minerals
C – Vital requirement:-
(6) Water

10. ESSENTIAL DIETARY NUTRIENTS

11. ENERGY REQUIREMENT (1) BMR / RMR – 60%
(2) Thermic effect of food %
(3) Physical activity %

12. CLINICAL IMPORTANCE DEFICIENCY SYNDROMES:- (↑morbidity and mortality)
Marasmus/ PEM / Protein Energy Malnutrition
Kwashiorkor / Protein deficiency
Individual nutrient deficiency
(e.g. vitamin/mineral)
→ Under nutrition
Common in developing world
→ impaired growth, defective immune system,
→↓work capacity

13. OVERSUPPLY OF NUTRIENTS
(↑ CVS disease and Cancers)
Obesity
Toxicity

14. GIT DISORDERS
Peptic ulcers – due to excessive secretion of HCl due to Helicobacter pylori infection
Gall stones:- changes in composition of Bile
→crystallization of Cholesterol
Cystic fibrosis→ Steatorrhea, under nutrition
Lactose intolerance→ diarrhea, abdominal discomfort
Celiac disease→ allergy to wheat Gluten
Food allergy → intact peptides are absorbed

15. PEPTIC ULCER

17. DIETARY MODIFICATION PKU Hyperlipidemia Diabetes Mellitus
Invalid nutritional support

18. EATING DISORDERS
Anorexia nervosa
Bulimia nervosa

19. ESTIMATION OF ENERGY REQUIREMENT
RMR (Resting Metabolic rate)
/ BMR(Basal Metabolic rate)
Energy expenditure by body at rest, but not sleeping (10% < RMR ), 12 hours after a meal
Varies with weight, age, gender
Total energy required = RMR + Energy for physical activity + synthesis of reserves

21. FACTORS AFFECTING RMR Weight – RMR α weight (↑active tissue mass)
Age – ↓ with age (muscle replaced by adipose tissue which is less active)
- ↑in children (active growth) peak at 5 yr
Gender - ↓ in females (↑ adipose tissue)
Physical activity – sedentary = 1.1 – 1.2 x RMR
(30Kcal/Kg/Day)
vigorous exercise = 6 – 8 x RMR
(40Kcal/Kg/Day)

22. THERMIC EFFECT OF FOOD
Diet induced thermogenesis / ↑ heat production after meal
↑ metabolic rate after a meal for:-
(a) Synthesis of reserves(Glycogen, TAG, Protein)
(b) Secretion of enzymes
(c) Active transport
Specific dynamic action of food = activation energy to be supplied initially:
for Protein meal = 30%
for Carbohydrate = 5%
for Lipid = 15%
for mixed meal = 10%
Actual reduction (e.g. 10%) in useful work energy from the calculated value → extra 10% Cal should be provided

23. MEASUREMENT OF RMR DIRECT – Heat output from body
INDIRECT – Oxygen consumption
(Energy expenditure = 20 KJ/L of O2 consumed)
RESPIRATORY QUOTIENT – RQ
volume of CO2 produced:volumeofO2 consumed
RQ = 0.82 on a Mixed diet
1.0 on a Carbohydrate diet
0.7 on a Fat diet
0.8 on a Protein diet

24. MEASUREMENT OF RMR

25. NORMAL VALUE OF RMR Kcal/Hr/m2 of body surface
(α Height and weight) ≈ 1.8 m2
Adult male ≈ 34 – 37 Kcal/Hr/m2
Adult female ≈ 30 – 35 Kcal/Hr/m2
Adult ≈ 24Kcal/Kg weight/Day

27. RMR RANGE

28. CLINICAL IMPORTANCE OF RMR
↑ in diseases e.g.
fever
↑ cell activity (leukemia, polycythemia)
↑ Thyroid
Cushing’s disease
Acromegaly
To calculate caloric requirement

29. CALORIC REQUIREMENT
Average dietary energy intake required to maintain energy balance
Calories consumed = Energy expended
Average ≈ 2000 – 2500 kcal / Day

30. CALORIE Heat required to raise the temperature of 1 gm of water by 10C
Kilocalorie = 1000 calories = 4.2 KJ = Cal
Energy yield from Nutrients:-
Carbohydrates = 4 Cal / gm
Fat = 9 Cal / gm
Protein = 4 Cal / gm

31. ENERGY AVAILABLE FROM FOOD

32. USES OF ENERGY IN BODY RMR :- Normal body functions
e.g. respiration, blood flow, ion transport etc.
50 – 70 % of daily energy expenditure
Diet induced thermogenesis:-
Body produces 30% more heat during
digestion and absorption than at Basal state
5 – 10 % of daily energy expenditure
Physical activity :- Muscle activity
30% of daily energy expenditure
Sedentary worker requires 30 – 50 % > RMR
Active worker requires % > RMR

33. CALCULATION OF ENERGY REQUIRED
e.g. 50 Kg moderately active female requires
2200 Kcal total →
RMR ( 60%) = 1300 Kcal
Thermic effect of food ( 10%) = 210 Kcal
Physical activity (30%) = 630 Kcal

34. ESTIMATION OF CALORIC REQUIREMENT
( HARRIS – BENEDICT EQUATION) STEP I :- CALCULATE RMR ( from gender, age, weight, height) For Women: (4.35 x wt in lb / 9.6 x wt in Kg) +(4.7 x ht in inches / 1.8 x ht in cm) − (4.7 x age in years)

35. ESTIMATION OF CALORIC REQUIREMENT
( HARRIS – BENEDICT EQUATION) STEP I :- CALCULATE RMR ( from gender, age, weight, height) For Men: (6.23 x wt in lb / 13.7 x wt in Kg ) + (12.7 x ht in inches / 5 x ht in cm) − ( 6.8 x age in years)

36. ESTIMATION OF CALORIC REQUIREMENT
( HARRIS – BENEDICT EQUATION) STEP II :- CALCULATE CALORIC REQUIREMENT ( from RMR, activity ) ACTIVITY LEVEL RMR Rest = hrs RMR Very light = hrs (sitting/standing) RMR x 1.2 Light = hrs (walking/light exercise) RMR x 1.4 Moderate = hrs (fast walking) RMR x 1.55 Heavy = hrs (walking with load) RMR x 1.9 TOTAL 24 hours

38. CALCULATION
Calculate the Caloric requirement for a woman aged 55, weight 160 lb, height 66”
whose activity is very light
I. RMR:- 655+(4.35x160)+(4.7x66)−(4.7x55)
= – 259
= 1402
II. CAL. REQ : x 1.2
= 1682 Calories daily

41. BODY MASS INDEX Weight in Kg / height in meters2 Optimum = 20 – 25
Underweight <
Overweight = 25 – 30
Obese > 30

42. CALCULATING BMI

47. DIETARY REFERENCE INTAKES
Estimate of the amount of nutrients required to prevent deficiencies and maintain optimal health and growth
Long term average daily nutrient intake
(not necessary to consume it daily)

48. DRI

49. 1. EAR = ESTIMATED AVERAGE REQUIREMENT
Average daily nutrient intake estimated to meet the requirement of half the healthy individuals α age and gender

50. 2. RDA = RECOMMENDED DAILY ALLOWANCE
Average daily nutrient intake sufficient to meet nutrient requirement of
≈ 98% individuals α age and gender
Minimal requirement + safety margin
RDA = EAR SDEAR

51. 3. AI = ADEQUATE INTAKE If EAR / RDA is not available
Estimate of nutrient intake by a group of healthy people

52. 4. UL = TOLERABLE UPPER INTAKE
Highest average daily nutrient intake that is risk-free for health i.e. no adverse effects
Not recommended level
Applies to chronic daily use

53. USING D.R.I. Depends on age, gender and
special factors(e.g. pregnancy, lactation)
If intake < EAR = 50% adequacy → need to ↑
If intake EAR – RDA = 98% adequacy
→ + need to↑
If intake ≥ RDA = Adequate
If intake > AI = Adequate
If intake RDA – UL = x risk of side effects

55. DIETARY REFERENCE INTAKES

56. D.R.I.

57. DRI

58. NUTRITIONAL DEFICIENCIES

59. BALANCED DIET
Proportionate quantities of food items selected from different basic food groups to supply essential nutrients x requirement of body

60. BALANCED DIET

61. BALANCED DIET

62. BASIC FOOD GROUPS All essential nutrients, vitamins, minerals
required by body are distributed in varying
quantities in different food items:-
Milk and dairy products group
Meat group – meat, fish, eggs, pulses, beans,
nuts etc.
Green leafy vegetables and fruit group
Cereal group – bread, rice, wheat etc.
Water

63. PLANNING A BALANCED DIET
Factors to be considered:-
Age, gender, caloric requirement,
special needs e.g. pregnancy, lactation, growth
Select from all food groups to meet requirement for calories and protein
Economic consideration, locally available food,
according to culture and taste

64. ACCEPTABLE MACRONUTRIENT DISTRIBUTION RANGE (AMDR)
Range of intake of macronutrient which will provide adequate intake of essential nutrients
without the risk of chronic disease
For adults:-
Carbohydrates → 45 – 65 % of total calories
Fat → 20 – 35 % of total calories
Protein → 10 – 35 % of total calories

65. PRACTICE QUESTIONS

66. 1. BMI of a healthy adult is:c d
Key: B

67. KEY = B
According to WHO
For adults over 20 years old, BMI falls into one of the following categories.
 Table 1. Nutritional status
BMI Nutritional status Below 18.5
Underweight
18.5–24.9
Normal weight
25.0–29.9
Pre-obesity
30.0–34.9
Obesity class I
35.0–39.9
Obesity class II
Above 40
Obesity class III

68. 1 G/Kg Body weight 10 G/Kg body weight 50 G/Kg body weight
2. What is the normal RDA for protein in a balance diet for an adult?
1 G/Kg Body weight
10 G/Kg body weight
50 G/Kg body weight
100 G/Kg body weight
Key: A

69. KEY = A
The normal RDA for protein in a balance diet for an adult is 1 G/Kg Body weight

70. 3. A balanced diet should have the ratio of carbohydrate: protein: Fat as:
50:30:20
60:20:20
40:40:20
80:10:10
Key: B

71. KEY = B
A balanced diet should have the ratio of carbohydrate: protein: Fat as: 60:20:20

72. 4) What Is the caloric requirement of a 60 Kg sedentary person.
b) 2000
c) 2500
d) 3000
KEY = A

73. KEY = A
the caloric requirement of a 60 Kg sedentary person is 1500 Cal/day

74. 5. What is the Energy yield from fat:-
4 Cal / gm
9 Cal / gm
10 Cal / gm
15 Cal / gm
Key = B

75. KEY = B
the Energy yield from fat:-9 Cal / gm