Nutrition and Diet Therapy

(Topic 4)
NCM 105 (LAB)
COURSE CODE: NCM 105
Nutrition and Diet Therapy

COURSE DESCRIPTION: This course deals with the study of food in relation to health and illness. It
covers nutrients and other substances and their action, interaction and
balance in relation to health and diseases and the process by which the
human body ingests, digests, absorbs, transports, utilizes, and excrete food
substances. It also focuses on the therapeutic and food service aspects of
the delivery of nutritional services in hospitals and other healthcare
institutions. The learners are expected to develop the competencies in
appropriate meal planning and education to a given client.

COURSE INTENDED At the end of this course, the students should be able to:
LEARNING OUTCOMES:
1. Apply knowledge of physical, social, natural and health sciences and
humanities in nutrition and diet therapy;
2. Provide safe, appropriate, and holistic care to individuals, families,
population group, and community utilizing the nutrition care process;
3. Apply guidelines and principles of evidence-based practice in nutrition
and diet therapy;
4. Practice nursing in accordance with existing laws, legal, ethical, and
moral principles related to nutrition and diet therapy;
5. Work effectively in collaboration with inter-, intra-, and multi-disciplinary
and multi-cultural teams in providing nutritional care
LEARNING MATERIAL FOR : Topic 4 (Lab)
I. TITLE: BMR; TCR based from BMR (Basal Metabolic Rate),
PA (Physical Activity), and SDA (Specific Dynamic Action of Food)
II. OBJECTIVES: At the end of this lesson, you should be able to:

 Identify methods in solving for basal metabolic rate (BMR);

 Explain the significance of basal metabolic rate, physical activity (PA),
and specific dynamic action (SDA) of food intake in determining total caloric
requirement (TCR) of a person/patient;
Compute for TCR considering BMR, PA, and SDA; apply guidelines
learned to one’s self and others, especially those in need of our service

III. INTRODUCTION: This lesson includes an overview about the of basal metabolic rate (BMR)
of a person/patient. The inclusion of basal metabolic rate (BMR) in the
computation of total caloric rate (TCR) of a person/patient in the dormant
stage plays a very significant role on the specific and calorie need of the
body. TCR requirements of a person depends upon BMR, physical activity
(PA) or voluntary activity, the influence of food (SDA), and needs for growth,
pregnancy and lactation.

All activities which we are continuously occurring in the body for which we
have no control like digestion, respiration, circulation, muscle tonus, etc.
contribute to the body’s basal metabolism. All of which are taken into
consideration when we are after of one’s TCR.
IV. CONTENT:

What is Basal Metabolic Rate? [1]

Basal Metabolic Rate, also known as BMR, is the amount of energy your body burns at rest on
a daily basis.

In other words: It is the number of calories required to keep your body function while you
are not doing any physical activities.

A deeper understanding of Basal Metabolic Rate [1]

Even when you are resting your body is using energy to function effectively.

 Your body is making your heart pump blood through your veins, for example.
 Or your stomach is processing the food you just ate. This process is better known as your
Basal Metabolic Rate.

Your body consumes almost 70% of the calories to function effectively.

 Calories are also the first metric people takes into consideration when losing weight.
 Here your BMR can come into play! Increasing your muscle mass helps your BMR. By
gaining more muscles the number of calories you burn increases. And this will help you to
decrease body fat.
Your BMR measurement can be used as a baseline for a diet program.

 Extra calories can be included depending on your level of activity.

 The more active you are the more calories you will burn.

 Next to this you will build more muscle mass.

 This means that you need to keep a close eye on the amounts of
calories you consume. to keep your body fit and healthy.
More on Basal Metabolism: [2]

otherwise known as the “Required Energy Expenditure” (REE), is the measure of

energy needed by the body at rest for all the internal chemical activities which is
approximately 1 calorie/kilogram of body weight (BW) /hour for an adult.

It is the minimum amount of energy needed by the body at rest in the fasting state.

It also indicates the amount of energy needed to suction the life processes:
respiration, cellular metabolism circulation, glandular activity, and the body
temperature maintenance.

All activities which are continuously occurring in the body for which we have no
control like digestion, muscle tonus, etc. contribute to body’s basal metabolism.

It accounts for more than ½ of the calorie requirements for most people.

The Basal Metabolic Rate (BMR) is the rate of basal metabolism in a given person
at a given time and situations. It constitutes ½ of the calorie requirements of an
individual.
Basal Metabolism Rate and Weight [3]

The basal metabolic rate (BMR) is the amount of energy that is expended at rest in a neutral
environment after the digestive system has been inactive for about 12 hours.

It is the rate of one’s metabolism when waking in the morning after “fasting” during sleep.
The BMR is enough energy for the brain and central nervous system, heart, kidneys, liver,
lungs, muscles, sex organs, and skin to function properly.

People who are overweight or obese do not necessarily have a slow BMR. In fact, their BMR is
usually faster to accommodate for extra fat and for their body to work harder to perform normal
body functions.

Building lean muscle mass can increase BMR, but there is a limit for both men and women as to
how much lean muscle mass can be built.

Some supplements may increase BMR, but also only to a limit, and they may have serious
side effects.

Expending extra calories through increased physical activity is the most sensible way to increase
metabolism. When a person diets, BMR slows down to conserve energy and protect vital organs.

A regimen of reasonable dieting with increased exercise maintains or increases BMR and
promotes weight loss and weight maintenance. It all depends on calories and caloric balance.
Nutrition on Basal Metabolic Rate: [4]

The basal metabolic rate (BMR) is the rate of energy expenditure of a person
at rest; it eliminates the variable effect of physical activity.

The BMR accounts for approximately 60% of the daily energy expenditure.

Thus it includes energy used for normal body cellular homeostasis, cardiac
function, brain and other nerve function, and so on. It is related to body
weight by the calculation:

BMR(Cal/d) = 24×Body weight(kg)

A passive increase in energy expenditure occurs during digestion of food.

This is referred to as the thermic effect or, in the older literature, specific
dynamic action of food; it accounts for about 10% of the daily energy
expenditure.
BMR and RMR: [5]

Some experts use the terms basal metabolic rate (BMR) and resting metabolic
rate (RMR) interchangeably. These two terms are very similar. But there is a
slight difference in the definition of BMR and the definition of RMR that is helpful
to understand.

Basal metabolic rate is a measurement of the number of calories needed to

perform your body's most basic (basal) functions, like breathing, circulation and
cell production. BMR is most accurately measured in a lab setting under very
restrictive conditions.

Resting metabolic rate is a measurement of the number of calories that your

body burns at rest. Resting metabolic rate is usually measured in the morning
before you eat or exercise and after a full night of restful sleep.

As you can see, the definitions of RMR and BMR are almost identical. Your
resting metabolic rate should be an accurate estimate of your basal metabolic
rate. Because the terms are similar, some fitness and weight loss experts use
both terms to describe the same thing. But the term "resting metabolic rate" is
more common.
Physical Activity (PA) [2]

Calorie requirements depend on the type and amount of exercise. The

more vigorous the physical work, the greater the calorie cost. The kind
of physical activity and the amount of time spent determine the
amount of energy the body uses.

Specific Dynamic Action of Food (SDA) [2]

Carbohydrate or fat increases the heat production of about 5% of the

total calories consumed. It is the energy required to digest, transport,
and utilize food.
Factors the Affect BMR [2]

1. Surface area – The greater the body surface area or skin area, the greater
the amount of heat loss and, in turn, the greater the necessary heat produced
by the body. Muscle tissue requires more oxygen than adipose tissue.

2. Sex – Women, in general, have a metabolism of about 5%-10% less than

that of men even when they are of the same weight and height. Women have
a little more fat and less muscular development than men.

3. Age – During the periods of rapid growth, the metabolic rate is highest
during the periods of rapid growth, chiefly during the first and second years,
and reaches a lesser peak through the ages of puberty and adolescence in
both sexes. The BMR decreases slowly with increasing age to lower muscle
tone from lessened activity.

4. Body composition – A large proportion of inactive adipose tissue lowers

the BMR. Athletes with great muscular development show about 5% increase
in basal metabolism over non-athletic individuals.
5. State of nutrition – A decrease in the mass of active tissuelike in the
case of undernourishment or starvation causes a lowered metabolism
often as much as 50% below normal.

6. Sleep – When sleeping the metabolic rate falls approx. 10%-15% below
that of waking levels. This decreased rate is due to muscular relaxation
and decreased activity of the sympathetic nervous system.

7. Endocrine Glands – The endocrine gland, the principal regulators of

the metabolic rate secrete hormones into the blood stream, The male
sex hormones increase the BMR about 10%-15% and the female sex
hormones a little less.

8. Fever – The BMR is increased by about 7% for each degree rise in the
body temperature above 98.6 degrees Fahrenheit.
Computing for BMR

1. The rule of Thumb: [2]

1kcal/K (kilogram) BW (body weight)/hour for adult male

0.9 kcal/K BW/ hr.  for adult female

A male weighs 51K

BMR = 1kcal x 51 x 24 (hrs.)
= 1224 kcal = 1200 kcal
2. Harris Benedict formula [2]

Male: REE = 66 + [13.7 x wt. (K)] + [5 x ht. (cm)] – [6.8 x age (yr.)]
Female: REE = 65.5 [9.6 x wt. (K)] + [1.8 x ht. (cm)] – [4.7 x age (yr.)]

Example: Given: 50K; ht.: 165.1cm; age; 45 yr./old; Male

Male: REE = 66 + (13.7 x 50K) + 5 x (165.2cm) – 6.8 x (45 yrs old)

= 66 + 685 + 825.5 – 306
= 1270.5
= 1271kcal = 1300 kcal
3. The biologic body weight raised to the ¾ power – A method
used in obtaining the metabolic or fat-free body.

Once the metabolic body size is known based on weight in K., the
figure is multiplied by 70, a value which applies to all animals.

A 50 K. man’s REE = 18.8 x 70 = 1316 kcal

Body Weights in K. and metabolic Body Size (K) ¾

5K=3.3; 45K=17.4;
10K= 5.6; 50K=18.8;
15K=7.6; 65K=21.6;
20K= 9.5; 70K=24.2;
25K= 12.1; 80K=26.7;
30K=12.8; 90K=29.2;
35K= 14.4; 100K= 31.6
40K= 15.9;
Computing for TCR based BMR, Physical Activity (PA), and Specific Dynamic Action
(SDA)

TCR requirements of a person depends upon BM, the PA or voluntary Activity, the influence
of food (SDA), and needs for growth, pregnancy, and lactation.

TCR = BMR + PA (Physical Activity) + SDA (Specific Dynamic Action)

TCR = BMR + PA + SDA

Example: Given: 51K, moderate activity

BMR: 1 kcal x 51 x 24 (hrs.) = 1224kcal

0.1 x 51 x 8hrs (for sleep) = 40.8 = 41
1224 – 41 = 1183

PA: 1183 x .75 = 887. 25 = 887

1183 +887 = 2070kcal

SDA: 2070 x .06 (for the effect on food) =124.2= 124

TCR = 1183 + 887 + 124

TCR = 2194kcal 2200kcal
V. REFERENCES:
1. Tanita.eu/help-guide/understanding-your-measurement/basal-metabolic-rate/
2. Caudal, M.L.C., Basic Nutrition and Diet Therapy, Textbook for Allied Health, 2nd Edition, C & E Publishing, Inc. Quezon City,
2019
3. sciencedirect.com/topics/medicine-and-dentistry/basal-metabolic-rate, Weis R.O., Refetoff, S. volume II, 2016
4. sciencedirect.com/topics/medicine-and-dentistry/basal-metabolic-rate, Pelley, J.W., 2012
5. verywellfit.com/what-is- bmr-or-basal-metabolic-rate-3495380

VI. ASSESSMENT TASK:

(Activity/assignment will be sent to students’ respective teams)
Rubrics
Poor 1 Fair 2 Good 3 Excellent 4
Focus on No attempt has Some part of the work is Most part of the work is Entire work is related
Assigned Topic been made to relate related to the assigned related to the assigned to the assigned topic
the work to the topic, but a reader does topic. The work and allows the
assigned topic. not learn much about the wanders off at one reader to understand
topic. point, but the reader much more about
can still learn the topic.
something about the
topic.
20%
Reflection of Little or no Does not go deeply into Relates learning with Shows great depth
Personal explanation or the reflection of learning, research and project, of knowledge and
Learning reflection on generalizations and personal and general learning, reveals
learning, no or few limited insight, uses reflections included, feelings and
details to support some detail. uses concrete thoughts, abstract
reflection. languages. ideas reflected
through use of
specific details.
20%
 Poor 1 Fair 2 Good 3 Excellent 4
Mechanics Many grammatical A few grammatical Almost no grammatical No grammatical
spelling or spelling or punctuation spelling or punctuation spelling or
punctuation errors. errors. errors. punctuation errors.
20%
Organization Ideas seem to be The work is a little hard The work is pretty well The work is very well
randomly arranged. to follow. Paragraphs are organized. One idea organized. One idea
No effort at unclear. The transitions may seem out of place. or scene follows
paragraph are sometimes not clear. Clear transitions are another in a logical
organization. used. sequence with clear
transitions.
20%
Conclusion Incomplete and/or The conclusion does not The conclusion The conclusion is
unfocused. adequately restate the restates the learning. engaging and
learning. restates personal
learning.
20%
Total: 100%
Thank you.