Professional Documents
Culture Documents
FCM Nutrition
FCM Nutrition
Nutritional assessment
Diet history
Anthropometric measurements
PROMOTING HEALTHY
NUTRITION PART 2
Food Energy
Definition / terminology
Components of energy expenditure
Estimating energy requirements
Diet prescription
NUTRITIONAL ASSESSMENT
NUTRITIONAL ASSESSMENT
brief screen, if patient healthy
more in depth, if patient with nutritional
inadequacy/ malnutrition risks
Dietary History
patient's usual & recent diet
patient's usual pattern of food intake
any factors that may influence food
choices and availability
cultural
Dietary History
Physical Examination
Anthropometry
18.5-24.9
Risk of comorbidities
Weight implications
Significant weight loss 5% loss in 1
month or 7.5% loss in 3 months, or
10% loss in 6 months.
Severe weight loss any loss higher
than these percentages in the same
time interval.
Asia-Pacific Obesity
Guidelines
BMI
average
Overweight
25.0-29.9
increased
Normal BMI
18.6-22.9
Obesity class I
30.0-34.9
moderate
Overweight
23-24.9
Obesity class II
35.0-39.9
severe
Obesity class I
25-29.9
40
very severe
Obesity class II
30
Weight implications
Weight within 85% to 90% of usual
body weightmild malnutrition
Weight within 75% to 84% of usual
body weightmoderate malnutrition
Weight less than 74% of usual body
weightsevere malnutrition
Hammond 2004
Anthropometry
skin fold thickness
Anthropometry
Anthropometry
Waist circumference
correlates with abdominal fat content
increased waist circumference has been
associated with cardiovascular disease
risk factors ( Dalton et al, 2003 )
Abdominal ratio
Measures fat distribution
& adiposity
2005 )
Anthropometry
Anthropometry
Mid-Upper Arm Circumference
Formula:
Waist Circumference (cm)
Hip circumference (cm)
MUAC
Level of nutrition
MUAC
Level of nutrition
> 14
Normal
Male: > 23
Normal
12.5 - 14
Mild / moderate
malnutrition
Severe malnutrition
< 23
Malnourish
Female: > 22
Normal
< 22
Malnourish
< 12.5
ENERGY
CALORIE
energy needed to increase the
temperature of 1 kg of water by 1 C
about 4.184 Kj
Empty calorie - calories present in highenergy foods with poor nutritional
profiles, typically from processed
carbohydrates or fats
PHYSIOLOGICAL FUEL
VALUES OF FOOD
CALORIE
15g
COMPONENTS OF ENERGY
EXPENDITURE
1. Basal metabolic rate (BMR)
2. Energy expended in physical activity
3. Thermic effect of food (TEF)
amount
TEE
PHYSICAL ACTIVITY
second
ENERGY BALANCE
AMOUNT OF ENERGY INTAKE
DURING THE DAY
UNDERWEIGHT
ENERGY BALANCE
OVERWEIGHT
CALCULATE
Based on age:
7 months 1 year:
DBW = Birth weight (gm) + (age in mo. X 500)
QUICK ESTIMATION
Doubled at 5-6 months
Infants weight
Height /Length
At birth : 50 cm
Example:
At 1 yr : + 24 cm
50 + 24 = 74 cm
At 2 yrs : + 12 cm
74 + 12 = 86 cm
At 3 yrs : + 8 cm
86 + 8 = 94 cm
At 4-8 yrs: + 6 cm
94 + 6 = 100 cm
B. NDAP Method
DBW (men) = 5 ft is 112 lbs ;
add (subtract) 4 lbs for every inch above (below) 5 ft
DBW (women) = 5 ft is 106 lbs ;
add (subtract) 4 lbs for every inch above (below) 5 ft
Example: Compute the DBW of a 56 male student
5 ft
112 lbs
6x4
_+ 24__
DBW
136 lbs
1.
2.
3.
4.
Measure ht in cm
Deduct 100 from the measurement.
Difference is the DBW (kg)
Deduct 10% (for Filipino)
Example:
Exercises:
112 lbs
_+ 24_
= 136 lbs
106 lbs
- 8_
=
98 lbs
(1.6764)2
Large
WOMEN
-10%
MEN
-10%
+10%
X 100
DBW
+10%
0.3
2.6
Entire arm
6.2
Foot
1.7
7.0
11.0
Entire leg
18.6
Example:
Step 2
5 ft -------------------112 lbs
4x4------------------- +16
CALCULATE
TOTAL ENERGY ALLOWANCE (TEA) /
TOTAL ENERGY REQUIREMENT (TER)
PER DAY
= 8.96 or 9 lbs
= 128 9 lbs
13
105
46
90
79
75
10 - 12
65 (boys); 55 (girls)
1 6 months
TER (kcal /day) = 120 kcals
K DBW
7 months 1 year
TER (kcal /day) = 110 kcals
K DBW
13 15
55 (boys); 45 (girls)
16 19
45 (boys); 40 (girls)
Average
45
CALORIE EQUIVALENTS
Male
Female
Sedentary
35
30
Light
40
35
Moderate
45
40
Heavy
50
---
EXAMPLE OF ACTIVITIES
SEDENTARY those people whose work is
mostly sitting like cashier, secretary, using
computers, clerk typist , computer
programmer
Example:
Calculate TER/TEA of an adult sedentary female 5 1
Step 3
CALCULATE CARBOHYDRATE,
PROTEIN AND FAT
ALLOWANCE/DAY
CARBOHYDRATES
FATS
PROTEIN
Use : 10-15% of TEA
Pregnant
Estimation of
CHO, PROTEIN & FAT needs
A good ratio of
carbohydrates to fat to
protein is 60-25-15 of TEA.
4kcal/g CHO
4kcal/g CHON
9kcal/g Fat
Example (continuation):
Calculate dietary allowance for carbohydrate, protein
and fats of an adult sedentary female 5 1
60% CHO
25% fat
15 % CHON
4kcal/g CHO
9kcal/g Fat
4kcal/g CHON
Example:
Calculate dietary allowance for carbohydrate, protein
and fate of an adult sedentary female 5 1
DBW
CHO requirement:
1,500 kcal/day x 0.60 = 900 kcal/day 4 kcal/g = 225 g
Fat requirement:
1,500 kcal/day x 0.25 =375 kcal/day 9 kcal/g = 41.67 or
42 g
Protein requirement:
1,500 kcal/day x 0.15 = 225 kcal/day 4kcal/g = 56.25 or
56 g
TEA =
5 ft --------
112 lbs
2 x 4 -----8
120 lbs 55 kgs
55 x 40 = 2200 kcal
Measure
CHO
(g)
PRO
(g)
FAT
(g)
Energy
(kcal)
Varies
Varies
varies
8
8
8
1
6
10
41
86
122
Fat
1 tsp
45
Sugar
1 tsp
20
Meat
low fat
med fat
hi fat
Measure
CHO
(g)
CHON
(g)
FAT
(g)
Energy (kcal)
Veg A
1 cup raw
cup
cooked
Veg. A
2 cups raw
1 cup cooked
16
Veg. B
cup raw
cup
cooked
16
Fruit
varies
10
40
Milk
whole
low fat
skimmed
Varies
4 tbps
varies
12
12
12
8
8
8
10
5
trace
170
125
80
Rice
varies
23
100
Diet Prescription:
TEA: 2200 Kcal
Rice: 23gCHO
2g CHON
100g kcal
Fat: 5g fat
45kcal
Vegetable: 3g CHO
1g CHON
16 kcal
FOOD
ITEM
Veg A
Meat:
low: 8g CHON/1g fat/
41kcal
med:8g CHON/6g fat/
86 kcal
high:8g CHON/10g fat/
122 kcal
Sugar: 1 tsp : 5g CHO
20 kcal
NO. OF
XCHANGE
S
CHO 330g
CHON 85g
FAT60g
BREAK
FAST
LUNCH
SUPPER
SNACKS
Veg B
Fruit
Milk
Rice
12
Meat
Fat