INTRODUCTION

It is through counseling where health practitioners can influence the

attitudes and health of many people. But, the practice of self-care must be

preceded by the acquisition of information about health; that is, both the

healthcare worker and the client need a solid background in the assessment

of nutritional status, the techniques of health promotion, and accurate

nutrition information.

Nutritional Assessment

 The information obtained is used to determine the condition of the

body resulting from the intake, absorption and utilization of food.

These status refers to severe, moderate, normal, mild, overweight and

obese for the weight measurement and either normal, tall, or stunted

for height.

 It refers to the evaluation of the nutritional status of individuals or

populations through various methods: anthropometry, biochemical,

clinical, and dietary measurements.

 However, the process is not only limited to those when we talk about

nutritional assessment it also includes the measurement and

 description of nutritional status of the population in relation to

economic, socio-demographic and physiological variables that can

affect the nutrition of the population.

 An important tool for systematic intervention.

Reason for Assessing the Nutritional Status

To establish the nature and ecology of the problem in order to provide the

appropriate treatment and prevent reoccurrence of the problem.

NURITIONAL STATUS AND DIETARY COMPUTATIONS

DBW (Desirable Body Weight)

 It is the optimal weight associated with maximum life expectancy for

a given height but modified by factors such as gender, age, build, and

degree of muscular development.

 Because, estimating usual and the desired body weight is another key

component in the nutrition assessment.

Tannhauser’s Method

Data Needed: Actual height in centimeter, Sex, Body Frame

Formula:

DBW = (Ht. in cm – 100) – Body Frame Size (in percentage)

 Body frame size is determined by a person's wrist circumference in

relation to his height.

 10 % for small frame, 5% for medium frame or as is for large

frame.

Example:

Data: Height = 5’7”; Sex = Male; Body Frame Size = 6” (Small Body Frame)
 1. Convert height in centimeter.

Ht. in cm. = (5’ x 12”) + 7”

= 60” + 7”

= 67” x 2.54 cm/inch

= 170.18 cm

2. DBW = (170.18 – 100) – 10% of Ht. in cm – 100

= 70.18 – 7.018

= 63.162 kg or 63 kg

NDAP Method

Data Needed: Actual height in feet, Sex

Formula:

Male: DBW = Allow 112 lbs for every 5ft

Female: DBW = Allow 106 lbs for every 5ft

 Add 4 lbs for every inch over 5 ft or Subtract 4 lbs for every inch

below 5 ft. for both sexes.

Example 1:

Data: Height = 5’7”; Sex = Male

DBW = 112 lbs + (4 lbs/inch x 7 inches)

= 112 lbs + 28 lbs

= 140 lbs or 63.64 kg or 64 kg

Example 2:

Data: Height = 4’11”; Sex = Female

DBW = 106 lbs – 4 lbs

= 102 lbs or 46.36 kg or 46 kg

BMI (Body Mass Index)

Body Mass Index (BMI) is a person’s weight in kilograms divided by the

square of height in meters. A high BMI can be an indicator of high body

fatness. BMI can be used to screen for weight categories that may lead to

health problems but it is not diagnostic of the body fatness or health of an

individual.

 Also known as QUETELET INDEX

Data Needed: Actual Weight (in kilograms); Actual Height (in meters)

Formula: BMI = Act Wt.

Ht (m)2

BMI Classification World Health Organization (WHO)

BMI CLASSIFICATION BMI RANGE

CED Grade III Less than 16
CED Grade II 16.0 – 16.9
CED Grade I 17.0 – 18.4
Low Normal 18.5 – 19.5
Normal 20.0 – 24.9
Obese Grade I 25.0 – 29.9
Obese Grade II 30.0- 39.9
Obese Grade III 40 and above

Example:

Data: Actual weight = 62 kg; Actual height = 5’7”

1. Convert height in meter

Ht. in cm. = (5’ x 12”) + 7”

= 60” + 7”

= 67” x 2.54 cm/inch

= 170.18 cm ÷ 100 cm/m

= 1.7018 m or 1.70 m

2. BMI = 62 kg ÷ (1.70m)2

= 62 kg ÷ 2.89m2

= 21.45 kg/m2 (NORMAL)

TER (Total Energy Requirement)

Energy requirement is the amount of food energy needed to

balance energy expenditure in order to maintain body size, body

composition and a level of necessary and desirable physical activity

consistent with long-term good health.

Data Needed: BMI Classification; DBW or Actual Weight; and Physical Activity

Physical Activity

Physical Activity Kcal/kg DBW/day

Bed Rest but mobile (hospital patients) 27.5
Sedentary (mostly sitting) 30.0
Light (tailor, nurse, physician, jeepney driver) 35.0
Moderate (carpenter, painter, heavy house work) 40.0
Very Active (swimming, lumberman) 45.0

Formula:
TER= DBW x Physical Activity (if the BMI is Normal)

TER= Actual Weight x Physical Activity + 500kcal or 1000kcal (if the BMI is below Normal)

TER = Actual Weight x Physical Activity – 500 Kcal or 1000kcal (if the BMI is Above Normal)

 The ± of 500kcal or 1000kcal will allow 1lb. - 2 lb. weight gain or

weight loss per week.

Example 1:

Data: BMI Classification = Normal; DBW = 64 kg;

Physical Activity = 35 kcal/Kg/Day (Teacher)

TER = 64 kg x 35kcal/Kg/Day

= 2240 kcal or 2250 kcal (must be divisible by 50)

Example 2:

Data: BMI Classification = CED Grade I; Actual Weight = 45 kg;

Physical Activity = 35 kcal/Kg/Day (Teacher)

TER = 45 kg x 35 kcal/kg/day

= 1575 kcal + 500 kcal

= 2075 kcal or 2100 kcal

Example 3:

Data: BMI Classification = Obese Grade III; Actual Weight = 85 kg;

Physical Activity = 35 kcal/Kg/Day (Teacher)

TER = 85 kg x 35 kcal/kg/day

= 2975 kcal – 500 kcal

= 2475 kcal or 2500 kcal

Distribution of Total Energy Requirement per day to

Carbohydrates, Proteins and Fat

Data Needed: TER

NUTRIENT (in grams) NUTRIENT Percent Distribution

Carbohydrates (4kcal/gram) Allow 50 - 70 % of TER

Protein (4kcal/gram) Allow 10 - 15 % of TER

Fat (9kcal/gram) Allow 20 - 30 % of TER

Example:

Data: TER = 2250 Kcal

CHO = 2250 kcal x 70%

= 1575 kcal ÷ 4 kcal/gram

= 393.75 gms or 395 gms (must be divisible by 5)

CHON = 2250 kcal x 10%

= 225 kcal ÷ 4 kcal/gram

= 56.25 grams or 55 grams (must be divisible by 5)

Fats = 2250 kcal x 20%

= 450 kcal ÷ 9 kcal/gram

= 50 grams (must be divisible by 5)

Diet Prescription:

TER = 2250 kcal

CHO = 395 gms

CHON = 55 grams

Fats = 50 grams
NON PROTEIN CALORIE (NPC) METHOD

Protein Requirement /kg DBW/ day (for Adults) 1.1 grm/Kg. DBW

Carbohydrate % Distribution 70 %

Fat % Distributiom 30 %

Data Needed: Age; Protein Requirement; DBW and TER

Formula:

1. CHON Requirement in kcal = (DBW x CHON Requirement according

to age) x 4 kcal/gram

2. NPC = TER – CHON Requirement in kcal

3. CHO gms = (NPC x 70%) ÷ 4 kcal/gram

4. Fats gms = (NPC x 30%) ÷ 9 kcal/gram

Example:

Data: Age = 32 y.o.; CHON Req. = 1.1 gms/kg DBW; DBW = 64 kg; and

TER = 2250 kcal

 1. CHON Requirement in kcal = (64 kg x 1.1 gms/kg DBW) x 4 kcal/gram

= 70.4 gms or 70 gms x 4 kcal/gram

= 280 kcal

2. NPC = 2250 kcal – 280 kcal

= 1970 kcal

3. CHO gms = (1970 kcal x 70%) ÷ 4 kcal/gram

= 1379 kcal ÷ 4 kcal/gram

= 344.75 gms or 345 gms

4. Fats gms = (1970 kcal x 30%) ÷ 9 kcal/gram

= 591 kcal ÷ 9 kcal/gram

= 65.67 gms or 65 gms

Diet Prescription:

TER = 2250 kcal

CHO = 345 gms

CHON = 70 grams

Fats = 65 grams