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NUTRITION
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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
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NUTRITION Process by which the dietary components provide for growth, replacement and energy
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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
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ESSENTIAL DIETARY NUTRIENTS
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ENERGY REQUIREMENT (1) BMR / RMR – 60%
(2) Thermic effect of food % (3) Physical activity %
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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
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OVERSUPPLY OF NUTRIENTS
(↑ CVS disease and Cancers) Obesity Toxicity
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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
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PEPTIC ULCER
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DIETARY MODIFICATION PKU Hyperlipidemia Diabetes Mellitus
Invalid nutritional support
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EATING DISORDERS Anorexia nervosa Bulimia nervosa
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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
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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)
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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
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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
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MEASUREMENT OF RMR
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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
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RMR RANGE
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CLINICAL IMPORTANCE OF RMR
↑ in diseases e.g. fever ↑ cell activity (leukemia, polycythemia) ↑ Thyroid Cushing’s disease Acromegaly To calculate caloric requirement
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CALORIC REQUIREMENT Average dietary energy intake required to maintain energy balance Calories consumed = Energy expended Average ≈ 2000 – 2500 kcal / Day
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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
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ENERGY AVAILABLE FROM FOOD
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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
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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
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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)
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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)
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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
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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
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BODY MASS INDEX Weight in Kg / height in meters2 Optimum = 20 – 25
Underweight < Overweight = 25 – 30 Obese > 30
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CALCULATING BMI
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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)
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DRI
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1. EAR = ESTIMATED AVERAGE REQUIREMENT
Average daily nutrient intake estimated to meet the requirement of half the healthy individuals α age and gender
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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
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3. AI = ADEQUATE INTAKE If EAR / RDA is not available
Estimate of nutrient intake by a group of healthy people
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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
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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
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DIETARY REFERENCE INTAKES
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D.R.I.
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DRI
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NUTRITIONAL DEFICIENCIES
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BALANCED DIET Proportionate quantities of food items selected from different basic food groups to supply essential nutrients x requirement of body
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BALANCED DIET
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BALANCED DIET
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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
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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
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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
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PRACTICE QUESTIONS
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1. BMI of a healthy adult is:
c d Key: B
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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
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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
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KEY = A The normal RDA for protein in a balance diet for an adult is 1 G/Kg Body weight
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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
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KEY = B A balanced diet should have the ratio of carbohydrate: protein: Fat as: 60:20:20
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4) What Is the caloric requirement of a 60 Kg sedentary person.
b) 2000 c) 2500 d) 3000 KEY = A
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KEY = A the caloric requirement of a 60 Kg sedentary person is 1500 Cal/day
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5. What is the Energy yield from fat:-
4 Cal / gm 9 Cal / gm 10 Cal / gm 15 Cal / gm Key = B
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KEY = B the Energy yield from fat:-9 Cal / gm
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