LW6 Energy Modified Diet

NE40102/NF40502 Diet Therapy 18 Nov 2021
Energy Modified Diets
Khor Ban Hock, PhD

Senior Lecturer & Dietitian
Nutrition Program
Faculty of Food Science and Nutrition
Lecture Outline
u Calorie controlled diet
u High calorie diet
1
Calorie-Controlled Diet
Calorie (Cal)
u Energy from food and beverages

u Energy expended during physical activity
u A calorie was defined as the amount of heat needed to
raise the temperature of 1 kilogram of water from 0 to 1
degree Celsius
u One calorie equals 4.18 joules
2
u Also known as weight reducing diet
u Modification of regular diet by reducing energy intake below what

is necessary for maintenance of body weight
u The portion size are decreased based on the patient’s nutritional

needs and weight management goals
u Intake of essential micronutrients is maintained by limiting the

amount of energy densed foods in the diet
u The goal of the calorie-controlled diet is to achieve weight

loss through a decrease in energy consumed
u Calorie-controlled diet should be implemented in

combination with physical activity and behavior therapy for
long term weight management
u Expected outcomes: promote weight loss and weight

maintenance
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4
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5
Health Consequences of
Overweight & Obesity
u Premature death
u Heart disease
u Diabetes
u Cancer
u Breathing problem
u Arthritis
u Reproductive complications
u Liver diseases
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12
6
Positive Energy Balance

Energy
Expenditure
Dietary
Intake
13
u Indications of calorie-controlled diet

u Overweight/obese individuals (those with underlying comorbidities
such as diabetes mellitus/hypertension/dyslipidemia require
additional therapeutic diets)
u Prescription of calorie-controlled diet for elderly and children
requires special precautions
14
7
u Contraindications
u Pregnant women
u Individuals with eating disorders such as anorexia nervosa
u Terminally ill patients
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u Not equivalent to low-calorie diet (LCD) or very low-calorie

diet (VLCD)
u Low calorie diet (LCD)

u Male: 1200 – 1500 kcal/day
u Female: 1000 – 1200 kcal/day
u Very low calorie diet (VLCD)
u 800 kcal/day
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8
Very Low-Calorie Diet

u VLCD is often in a form of liquid nutritional supplement
u Result in most rapid weight loss
u Should only be used when the patient faces a major health
risk and under medical supervision
u VLCD is usually not recommended for weight loss because:
u It is nutritionally inadequate and require supplementation with
vitamins and minerals/oral supplement with complete nutrition
u Not sustainable
u Increase uric acid concentration
u Muscle breakdown and protein loss
17
Low-Calorie Diet
u Calorie levels less than 1,200 kcal/day for most women and
1,500 kcal/day for most men should be discouraged
u A diet should be based on the individual’s nutritional needs

and anticipated energy output
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9
Terminologies
u Resting energy expenditure (REE) or Resting metabolic

rate (RMR)
u Energy expended in the activities necessary to sustain normal body
functions and homeostasis
u E.g., respiration, circulation, synthesis of organic compounds,
pumping of ions across membranes, energy used by the central
nervous system, maintenance of body temperature
u Does not include thermogenesis, activity, or other energy
expenditure
u Higher than BEE by 10% to 20%
19
Factors affecting REE
u Age
u Body composition
u Body size
u Climate
u Gender
u Hormonal status
u Temperature
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10
Thermic Effect of Food
u Energy expenditure associated with the consumption,

digestion, and absorption of food
u Energy required to digest, absorb, and metabolize
nutrients, including the synthesis and storage of protein, fat,
and carbohydrate
u ~10% of total energy expenditure
21
Activity Thermogenesis
u Energy is expended in physical activity, either exercise-

related or as part of daily work and movement
u Non exercise activity thermogenesis (NEAT) - energy
expended during activities of daily living
u Sport or fitness exercise
22
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Muscle is more dense and metabolic active than

adipose tissue.
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Adipose Tissue
u Metabolic active
u Producing hormones (adiponectin & leptin)
u Release molecules that influence blood pressure, insulin sensitivity,
lipid metabolism, and blood coagulation
u Release pro-inflammatory cytokines
u Hypertrophy – increase in size

u Hyperplasia – increase in number
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13
Quick Method
Overweight Normal weight Underweight
Sedentary 30 kcal/kg 35 kcal/kg
Moderate Activity 20 – 25 kcal/kg 35 kcal/kg 40 kcal/kg
Marked Activity 40 kcal/kg 45 kcal/kg
Add 500 kcal for weight gain or reduce 500 kcal for weight loss
27
Case Study 1
u A 30 years old woman, 70 kg, 160 cm, BMI = 27.3 kg/m2,

sedentary, and wish to lose some weight
u If 20-25 kcal/kg, the energy requirement = 1400 – 1750

kcal/kg
u Reduce 400 – 600 kcal for weight loss, therefore the energy
prescription from 1150 – 1350 kcal/day
28
14
Ideal Body Weight
u A 30 years old woman, 70 kg, 160 cm, BMI = 27.3 kg/m2,

sedentary, and wish to lose some weight
u At BMI 22.5 kg/m2, patients’ IBW is 58 kg.
u For IBW, use the normal weight category = 1740 kcal
u Reduce 500 kcal for weight loss, therefore the energy

prescription from 1240 kcal/day
29
Case Study 1
u A 30 years old women, 70 kg, 160 cm, BMI = 27.3 kg/m2, sedentary, and
wish to lose some weight
Calculation method Energy requirement Energy prescription

(TEE)
Quick method with actual 1750 1250
weight
Quick method with IBW 1740 1240
30
15
Weight Management
u Maintain a healthy body weight either by weight loss or

weight maintenance. A 10% loss of current body weight is
usually set a goal
u Prevent additional weight gain is critical for health
u Establish a pattern of safe weight loss of an average of
0.45 – 0.9 kg/week (by reducing energy intake 500-1000
kcal/day)
u Rapid weight loss leads to higher chance of regaining the
weight
u Support lifestyle, behavior modification, exercise, and diet
changes that are an ongoing process that last indefinitely
31
Weight Management
u Monitor food intake and weight by way of food dairy or

other means of recording
u For weight loss and weight maintenance, individuals
require 45 – 60 minutes per day of moderate intensity
activity or lesser amounts of vigorous intensity activity
u Spread meals and snacks throughout the day to prevent
hunger periods
u Increase dietary fiber, include protein and healthy fat with
meals to increase satiety and decrease between meal
hunger
u Drink calorie free beverages to keep hydration
32
16
Planning the Diet
1. Calculate the energy requirement and then determine the

macronutrient distribution. According to the Recommended
Nutrient Intake, the carbohydrate should be 50 – 65%
(preferably not exceed 55%), protein should be 10 – 20%,
while fat is 25 – 35%.
2. Reduce consumption of energy-densed foods (sugar and
fat, refined carbohydrate)
3. Include education in healthy eating habits such as
Malaysian Healthy Plate
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17
Planning the Diet
4. Reduce the total amount of food consumed by decreasing

portion size. Encourage eating at least 3 main meals with
healthy snacks in between
5. Employ behavior modification techniques to improve
control over the food selection process and the act of
eating
6. Establish self-management training techniques that will
enhance the satiety of meals but reduce the energy intake
u Eat slowly
u Eat more low-energy density foods such as vegetables
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36
18
Weight Maintenance
u Weight loss after 6 months is difficult

u Reduced REE
u Loss of lean body mass
u Restrict food intake
u Successful weight maintenance – regain weight <3kg in 2

years
u Permanent adoption of reduced energy diet and physical
activity level
37
Yo-yo Dieting
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19
Popular Weight Loss Diet
u Very low calorie diet (< 800 kcal/day)

u Meal replacement
u Intermittent fasting
u Atkin diet (High protein diet)
u Low carbohydrate diet & ketogenic diet
u Very low fat diet
39
Education Topics
u Energy value of different foods
u Food composition – fats, carbohydrate, and proteins
u Evaluation of nutritional labels
u Food purchasing
u Food preparation
u Avoid energy densed food
u Reducing portion size
u Limit alcohol
u Physical activity level
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In Practical
u Help clients to improve on what they are doing

u Not trying to eat a perfect “diet”
u Understand that overweight & obesity is a chronic problem
u Slow progress and difficult journey
u Lifetime habit
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Weight Management Is Simple, but

NOT EASY
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21
Obesity in Elderly
u Aging and body composition

u Loss of fat-free mass (skeletal muscle)
u Increase in fat mass
u Fat redistributed centrally to the trunk
u Sarcopenic obesity – loss of muscle mass and function
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44
22
Benefits of Weight Loss in

Obese Elderly
u Improve cardiometabolic markers such as glucose, insulin,
blood pressure, lipid profiles
u Improve physical functions
u Improve frailty
u Reduce pain for individuals with knee osteoarthritis
45
Dangers of Weight Loss
u Obesity paradox in elderly – those with greater BMI have

better survival
u Weight loss lead to loss of fat mass and fat-free mass
46
23
Nutrition Intervention
u Energy intake should be reduced by 500 – 1000 kcal/day
u Protein: 1.0 – 1.6 g/kg ideal body weight/day – halt muscle

loss
u Physical activity: aerobic, muscle-strengthening, flexibility,

and balance exercise – 150 minutes/week of moderate
intensity
47
High Energy Diet
48
24
BMI Categorization
BMI (kg/m2) Weight Status
< 18.5 Underweight
18.5 – 24.9 Normal range
25.0 – 29.9 Overweight
> 30 Obese
30.0 – 34.9 Obese class I
35.0 – 39.9 Obese class II
≥ 40 Obese class III
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Health Risks
u Nutritional deficiency – not eating a healthy balance diet

u Osteoporosis
u Anemia
u Low muscle mass
u Hair loss
u Weakened immune system
u Reproductive health issues
51
Negative Energy Balance
Dietary
Intake
Energy
Expenditure
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26
Etiologies
u Inadequate oral food and beverages intake

u Nutrients mal-absorption
u Excessive physical activity
u Wasting diseases (cancer, acquired immune deficiency
syndrome, tuberculosis)
u Psychological or emotional stress
53
Intervention
u Treat the underlying cause of underweight/unintentional

weight loss.
u Psychological
u Physiological
u Medical treatment induced
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Intervention
1. Identify and agree on a healthy weight target

2. An extra 500 – 1000 kcal/day
3. Weight training exercise – to build lean muscle
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Training
No
Training
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Intervention
u Not about eating anything without have to afraid of any
consequences
u Encourage energy- and nutrient-dense food:
u Nuts
u Dairies
u Dried fruits/juices
u Snacking between meals and at bedtime
u Follow the Malaysian Dietary Guideline
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29
75 kcal 75 kcal 60 kcal
Full cream milk 60 kcal

150 kcal 60 kcal
59
Case Study 2
u A 25 years old man, 45 kg, 160 cm, BMI = 17.6 kg/m2,

moderate active, and wish to gain some weight
u Energy requirement = 45 x 40 = 1800 kcal/day
u Additional 500 kcal/day for weight gain, so the energy

prescription = 2300 kcal/day
60
30
Health Risk of Unintentional

Weight Loss
u Functional decline in daily activities
u Greater risk of in-hospital mortality
u Greater risk of hip fracture in women
u Prone to infections
u Pressure ulcers
u Failure to respond to medical treatment
u Overall mortality
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Etiologies of Unintentional
Weight Loss
u Malignancy
u Psychiatric
u Non-malignancy gastrointestinal disease
u Endocrine
u Cardiopulmonary
u Infectious disease
u Neurological disease
u Unknown
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Treatment
u Treat underlying cause
u Multidisciplinary team approach: physician, dentist, speech

therapist, occupational therapist, social service worker
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Nutrition Intervention
u Diet modification
u Food consistency – chewing and swallowing
u Flavour enhancers
u Leisure eating environment
u Nutritional supplements
u Food assistance
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Questions?
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NE40102/NF40502 Diet Therapy 18 Nov 2021

Energy Modified Diets

Khor Ban Hock, PhD

u Calorie controlled diet

u High calorie diet

u Energy from food and beverages

u Modification of regular diet by reducing energy intake below what

u The portion size are decreased based on the patient’s nutritional

u Intake of essential micronutrients is maintained by limiting the

u The goal of the calorie-controlled diet is to achieve weight

u Calorie-controlled diet should be implemented in

u Expected outcomes: promote weight loss and weight

Positive Energy Balance

u Indications of calorie-controlled diet

u Not equivalent to low-calorie diet (LCD) or very low-calorie

u Low calorie diet (LCD)

Very Low-Calorie Diet

u A diet should be based on the individual’s nutritional needs

u Resting energy expenditure (REE) or Resting metabolic

Factors affecting REE

Thermic Effect of Food

u Energy expenditure associated with the consumption,

u Energy is expended in physical activity, either exercise-

Muscle is more dense and metabolic active than

u Hypertrophy – increase in size

u A 30 years old woman, 70 kg, 160 cm, BMI = 27.3 kg/m2,

u If 20-25 kcal/kg, the energy requirement = 1400 – 1750

Ideal Body Weight

u A 30 years old woman, 70 kg, 160 cm, BMI = 27.3 kg/m2,

u At BMI 22.5 kg/m2, patients’ IBW is 58 kg.

u For IBW, use the normal weight category = 1740 kcal

u Reduce 500 kcal for weight loss, therefore the energy

Calculation method Energy requirement Energy prescription

u Maintain a healthy body weight either by weight loss or

u Monitor food intake and weight by way of food dairy or

Planning the Diet

1. Calculate the energy requirement and then determine the

Planning the Diet

4. Reduce the total amount of food consumed by decreasing

u Weight loss after 6 months is difficult

u Successful weight maintenance – regain weight <3kg in 2

Popular Weight Loss Diet

u Very low calorie diet (< 800 kcal/day)

u Help clients to improve on what they are doing

Weight Management Is Simple, but

u Aging and body composition

u Sarcopenic obesity – loss of muscle mass and function

Benefits of Weight Loss in

Dangers of Weight Loss

u Obesity paradox in elderly – those with greater BMI have

u Weight loss lead to loss of fat mass and fat-free mass

u Protein: 1.0 – 1.6 g/kg ideal body weight/day – halt muscle

u Physical activity: aerobic, muscle-strengthening, flexibility,

High Energy Diet

u Nutritional deficiency – not eating a healthy balance diet

Negative Energy Balance

u Inadequate oral food and beverages intake

u Treat the underlying cause of underweight/unintentional

1. Identify and agree on a healthy weight target

75 kcal 75 kcal 60 kcal

Full cream milk 60 kcal

u A 25 years old man, 45 kg, 160 cm, BMI = 17.6 kg/m2,

u Energy requirement = 45 x 40 = 1800 kcal/day