Definition of Terms hundreds of different fatty acids, but just a few

 Adenosine Triphosphate (ATP)- is a molecule that dozen that are commonly found in the foods we eat
serves as the universal energy source for all plants  Iron- is one of the human body’s essential minerals.
and animals. In your body, ATP breaks down into It forms part of hemoglobin, the component of the
adenosine diphosphate plus a separate phosphate blood that carries oxygen throughout the body
group. This releases energy, which is used to power  Macronutrients- refer to hose nutrients that form
your body’s cell. During periods of inactivity, the the major portion of your consumption and
reverse reaction takes place, and the phosphate contribute energy to your diet
group is reattached to the molecule using energy  Micronutrients- consumed in smaller amounts
obtained from food. In this way, the ATP molecule is  Protein- is one of the basic components of food and
continuously being recycled by your body makes all life possible. Amino acids are the building
 Aging- the degenerative processes undergone by a blocks of proteins. All of the antibodies and
cell or an organism with the passage of time enzymes, and many of the hormones in the body,
 Allowances- a general term for the amounts of food are proteins
or nutrients that are recommended per person per Equivalent and Measurements
day
 Anorexia Nervosa- a condition in which there is
marked loss of appetite and therefore loss of
weight, accompanied by neurotic symptoms of
varying degrees of severity
 Antioxidant- are chemical substances that help
protect against cell damage from free radicals. Well
known antioxidants include vitamin A, vitamin C,
vitamin E, carotenoids, and flavonoids
 Appetite- the desire for food, founded on learning
or memory and related to the agreeable taste,
smell, or appearance of food
 Body Mass Index (BMI)- is a standardized ration of
weight to height, and is often used as a general
indicator of health (weight(kg) x height(m 2))
 Calorie- is a unit of measurement for energy
 Carbohydrates- are a type of macronutrient found
in certain foods and drinks. Sugars, starches and
fiber are carbohydrates. Other macronutrients
include fat and protein. Your body needs these
macronutrients to stay healthy
 Cholesterol- is a soft, waxy substance present in all
parts of the body including the nervous system,
skin, muscles, liver, intestines, and heart. It is both
made by the body and obtained from animal
products in the diet
 Dietary fiber- comes from the thick walls of plants.
It is an indigestible complex carbohydrate. Fiber is
divided into two general categories: water-soluble
and water-insoluble
 Enzyme- are complex proteins that assist in or
enable chemical reactions to occur. “Digestive”
enzymes General Nutrition Assessment
 Essential amino acids- are amino acids that your 5 Components
body does not have the ability to synthesize. A. Anthropometry
Hundreds of different amino acids exist in nature,  Height
and about two dozen of them are important to
 Weight
human nutrition. Nine of these-histidine, isoleucine,
 BMI
leucine, lysine, methionine, phenylalanine,
 Waist Circumference
threonine, tryptophan, and valine are considered
 % Body Fat
essential, since they must be supplied by your diet
o Men: at-risk > 25% of total body weight
 Fatty acids- are individual isomers of what we more
 Healthy level 15%
commonly call “fats”. There are potentially
o Women: at-risk > 30-40% of body weight
  Healthy Level 25% gaining weight, brittle diabetics, emotional
Skinfold Body Fat % Body Fat % eaters
Thickness Men Women
6 mm 5-9 8-13 Assessing Nutrient Intake
13 mm 9-13 13-18  Assess energy requirements via Harris Benedict
19 mm 13-18 18-23 Equation
25 mm 18-22 23-28  Compare current caloric intake with calculated
38 mm 22-27 28-33 requirements
Estimated of Resting Energy Requirements (REE) for
Classification Women (% Fat) Men (% Fat) Adults
Essential Fat 10-12% 2-4%
 Harris Benedict Equation
Athletes 14-20% 6-13%
 derived from healthy adults
Fitness 21-24% 14-17%
 calculates resting energy expenditure
Acceptable 25-31% 18-25%
 additional stress and activity factors added
Obese 32% + 25% +
 REE for males: 66+[13.7 x wt (kg) ] + [5.0 x ht
(cm) ] - [6.8 x age] = kcal/day
B. Biochemical
 REE for females: 655 + [9.7 x wt (kg)] + [1.8 x ht
C. Clinical Examination
(cm)] - [4.7 x age] = kcal/day
D. Dietary Evaluation
Calculation to Estimate Caloric needs to Maintain Body
E. Energy Expenditure (Physical Activity)
Weight
 (Current Weight, in lbs) x (A) = Daily Caloric Needs.
Diet History
 A= activity level
 24-hour recall
 Not very active 12
Documents a patient’s intake of all food and
 Moderately active 15
beverages during the previous 24-hour period
 Very Active 20
Many patients do not remember what they ate
 Extremely Active 25
and cannot accurately estimate quantities
Calculation for Estimate of Basal Metabolic Rate
consumed
 Men = 1 x body weight (kg) x 24
Ideal for patients with diabetes-ability to assess
 Women = .9 x body weight (kg) x 24
timing of meals, snacks, and insulin injections
calculates basic expenditure of calories in a 24 hour
 Food frequency
period.
Estimate the frequency and quantity of foods
eaten during a weekly or monthly period
Macronutrients
Ideal method to estimate fat, sodium, sugar,
 Carbohydrates
dairy, fruit and/or vegetable intake
 Proteins
Ideal for patients with CVD, HTN, osteoporosis,
 Fats (lipids)
those that question whether they should take a
Major Functions of Macronutrients
vitamin supplement, and elderly who avoid food
 Important for growth and development
groups
 Act to keep body functioning normally
 Usual intake
 Provide energy (kcalorie)
Documents a patient’s usual intake, including
 Kcal: measure of the amount of heat needed to
breakfast, lunch, dinner, and snacks
raise the temperature of 1000 grams (1 liter) of
Many patients are not consistent with their
water to 1 degree C. (approximately the same as
eating habits and state that there is no usual
4 cups of water to 2 degrees F)
pattern
Ideal for elderly patients in order to assess
Assessment of Nutrient Intake
number of meals eaten (or skipped), and infants,
 Dietary Reference Intakes (DRIs)
children, and adolescents whose diets may not
 Reference values that are quantitative of
be as varied
nutrient intakes to be used for planning and
 Food record
assessing diets for healthy people.
Written record by the patient of everything they
 Recommended Dietary Allowance(RDAs)
ate and drank over a 2 to 7 day period
 Recommended nutrient intakes that meet the
Many patients are not motivated to write down
needs of essentially all people of similar age and
everything. (although those who do, may lose
gender.
weight)
 Estimated Average Requirement (EARs)
Difficult for physicians to take the time to review
 Estimated nutrient intakes that meet the needs
and comment, especially if not trained
of essentially all people of similar age and
Ideal for patients who have difficulty losing
gender.
weight, those who are eating out of control and
 Adequate Intakes (AIs)
  Adequate intake to maintain health  vegetables
 Estimated Energy Requirements (EERs)  starch/bread
 Set for daily energy requirements based on  meat
defined levels of activity (Different from RDA)  fat
 Upper levels (ULs)
 The maximum level of daily nutrient intake that Milk (serving size 1 cup)
is likely to pose no risk or adverse effects Carbohydrate Protein Fat Kcalories
(grams) (grams) (grams)
Current Filipino Dietary Guidelines
 Nutritional guidelines for Filipinos (Filipino: Mga
Gabay sa Wastong Nutrisyon Para sa Pilipino). 12 8 Skim: trace 90
 The Philippines published its first dietary guidelines Lowfat: 5 120
in 1990. They were revised in 2000 and again in Whole: 8 150
2012.
 The Food and Nutrition Research Institute –
Department of Science and Technology (FNRI-DOST) Fruit (serving size 1 small)
initiated and chaired the inter-agency and Carbohydrate Protein Fat Kcalories
(grams) (grams) (grams)
multidisciplinary Technical Working Group on the
2012 guidelines.
 The guidelines were approved by the National
Nutrition Council. The communication and 15 60
dissemination is spearheaded by the National
Nutrition Council and endorsed by various
government agencies.
Content
 Eat a variety of foods every day to get the nutrients Vegetable (serving size ½-1 cup)
Carbohydrate Protein Fat Kcalories
needed by the body.
(grams) (grams) (grams)
 Breastfeed infants exclusively from birth up to 6
months, then give appropriate complementary
foods while continuing breastfeeding for 2 years
and beyond for optimum growth and development. 5 2 25
 Eat more vegetables and fruits every day to get the
essential vitamins, minerals and fibre for regulation
of body processes.
 Consume fish, lean meat, poultry, eggs, dried beans
or nuts daily for growth and repair of body tissues. Starch Bread (1 slice, 3/4c raw, ½ cooked)
 Consume milk, milk products and other calcium-rich Carbohydrate Protein Fat Kcalories
(grams) (grams) (grams)
foods, such as small fish and shellfish, every day for
healthy bones and teeth.
 Consume safe foods and water to prevent diarrhoea
and other food and water-borne diseases. 15 3 Trace 80
 Use iodized salt to prevent iodine deficiency
disorders.
 Limit intake of salty, fried, fatty and sugar-rich foods
to prevent cardiovascular diseases.
 Attain normal body weight through proper diet and Fat
moderate physical activity to maintain good health Carbohydrate Protein Fat Kcalories
and help prevent obesity. (grams) (grams) (grams)
 Be physically active, make healthy food choices,
manage stress, avoid alcoholic beverages and do
not smoke to help prevent lifestyle-related non- 5 45
communicable diseases.

ADA Exchange System

 Designed as a quick way to estimate total kcals,
carbohydrate, protein, and fat intake. Exchange food patterns (total Kcals: 55% CHO, 30% fat,
 Six different categories: 15% CHON)
 milk
 fruit
Food Guide Pyramid

Food Guide Pyramid VS ADA Exchange List

 Food Guide Pyramid
 recommendations based on approximately 2,500
kcal intake/day
 based on nutrient needs (vitamins/minerals)
 ADA Exchange List
 lists based on total kcal intake
 based on modulating carbohydrate, protein, and
fat intake
Carbohydrate Recommendations
 RDA: 130 g/day for adults
 50-100 g/day to prevent ketosis
 1 orange juice = 25g, 1 apple = 20
 DRI: 45-60% from total Carbohydrate
 Fiber: general recommendation 20-35 grams/day
 New guidelines:
 Under 50 yrs old: Men 38 g/day, Women 25
g/day
 Over 50 yrs old: Men 30g/day, Women 21
g/day
Calculation of Dietary Intake of Carbohydrate (Kcals)
1). Calculate total grams of Carbohydrate intake.
 Note: did you meet the RDA?
 Note: did you consume 50-100 g and prevent
ketosis?
2). Multiply total grams of carbohydrate x 4= total kcals
of carbohydrate intake
Typical Menu
 Breakfast: 4-5 ounces of beef, mutton, kidneys,
broiled fish, bacon, or cold meat of any kind but
pork.
 1 small biscuit or 1 ounce of dry toast, 1 large
cup tea without milk or sugar.
 Lunch: 5-6 ounces of any fish except salmon, any
meat except pork, any vegetable except potato
 Any kind of poultry or game. 1 ounce of dry
toast. Fruit 2-3 glasses of good claret, or sherry.
2-3 ounces of fruit. 1-2 rusks (cut from bread
and re-baked). 1 cup tea without milk or sugar.
 Supper: 3-4 ounces of any meat except pork, any
fish except salmon, 1-2 glasses of claret.
 Night-cap: 1 tumbler of grog(gin, whiskey or
brandy without sugar added) or 1-2 glasses of
claret or sherry.
DASH diet
 Dietary Approaches to Stop Hypertension
 Recommended in Dietary Guidelines for Americans,
2005
Nutrition Care Process (NCP)
• The Nutrition Care Process, also known as the NCP,
as defined by the Academy of Nutrition and
Dietetics as…
• “Systematic approach to providing high-quality
nutrition care”
• The Nutrition Care Process provides the structure
for customized care to be the most efficient plan in
the RD’s “toolbox”. The set framework of the model
allows the RD to “fill in the blanks” for each patient.
1. Nutrition Assessment- data collected during the
nutrition assessment guides in selection of the
appropriate nutrition diagnosis(es) (i.e., naming the
specific problem).
2. Nutrition Diagnosis- identify and describe a specific
nutrition problem that can be resolved or improved
through treatment/nutrition intervention
3. Nutrition Intervention- root cause (or etiology) of
the nutrition problem and aimed at alleviating the
signs and symptoms of the diagnosis
4. Monitoring & Evaluation- determine if the
patient/client has achieved or is making progress
toward the planned goals
Note:
~If patient/client reveals another piece of new
assessment data/information, that will cause to re-
assess, re-diagnose and perhaps modify the plan
that he/she had started discussing with the client.
A.D.I.M.E.
Assessment
• The assessment is a dynamic and ongoing
evaluation of data that includes medical,
medication, supplemental or herbal history. The
purpose is to make professional judgement about
nutrition status, and this is the foundation of
nutrition care.
ABCDE of Assessment
Anthropometrics
• Physical measurements that can be compared to
standards in order to reveal the nutritional
status, growth, and health of an individual.
• Ht., Wt., BMI, Waist Circumference, Age, and
Gender are commonly used.
• These data provide the means to establish
energy, protein, and fluid needs.
Biochemical
• Medical laboratory tests and procedures
• FBS
• Lipid Profile
• Na
• K
• Ca
• Creatinine
• Others
Chemical
• Physical exam conducted on the patient. The
exam is used to assess everything from eyesight
and reflexes to movement on the body and
medical history.
Dietary Reports
• Dietary reports begin with a 24hr recall on what
the patient has consumed. This assessment may
include questionnaires, surveys, and more to
 obtain an accurate amount of food related
history from the patient.
Energy/Environment
• Activity and access to food
Diagnosis
• The purpose of the nutrition diagnosis it to identify
and describe a specific nutrition problem that can
be resolved or improved through
treatment/nutrition intervention by a food and
nutrition professional.
Purpose:
• The purpose of a nutrition diagnosis is to identify
and describe a specific nutrition problem that
can be resolved or improved through
treatment/nutrition intervention by a food and
nutrition professional. A nutrition diagnosis (e.g.,
inconsistent carbohydrate intake) is different
from a medical diagnosis (e.g., diabetes).
Determining a Nutrition Diagnosis:
• Food and nutrition professionals use nutrition
assessment data to identify and label the
patient/client’s* nutrition diagnosis using
standard nutrition diagnostic terminology. The
NCPT provides a reference sheet for each
nutrition diagnosis that includes its definition,
possible etiology/causes, and common signs or
symptoms identified in the nutrition assessment
step.
Terminology for Nutrition Diagnosis is Organized in
3 Domains (Categories):
• Intake
• Too much or too little of a food or nutrient
compared to actual or estimated needs
• Clinical
• Nutrition problems that relate to medical or
physical conditions
• Behavioral-Environmental
• Knowledge, attitudes, beliefs, physical
environment, access to food, or food safety
Documenting a Nutrition Diagnosis:
• Food and nutrition professionals write a PES
(Problem, Etiology, Signs and Symptoms)
statement to describe the problem, its root
cause, and the assessment data that provide
evidence for the nutrition diagnosis.
P.E.S.
 The format for the PES statement is “[Nutrition
diagnosis term (problem)] related to [Etiology] as
evidenced by [Signs/Symptoms].”
Problem or Nutrition Diagnosis Term
 Describes alterations in the patient/ client’s
nutritional status.
Etiology Cause/Contributing Risk factors
• Linked to the nutrition diagnosis term by the
words “related to.”
Signs/Symptoms
• Data or indicators used to determine the
patient/client's nutrition diagnosis.
• Linked to the etiology by the words “as
evidenced by.”
• No nutrition diagnosis at this time (NO-1.1) may be
documented if the assessment indicates that no
nutrition problem exists to justify a nutrition
intervention or if further nutrition assessment data
are needed to identify a nutrition diagnosis.
Guidelines for Selecting the Nutrition Diagnosis and
Writing a Clear PES Statement
• Select the most important and urgent problem to
be addressed. When writing the PES statement,
food and nutrition professionals can ask a series of
questions (identified in the critical thinking skills
section below) that help clarify the nutrition
diagnosis.
Critical Thinking Skills:
• P – Can the nutrition professional resolve or
improve the nutrition diagnosis of the
patient/client? When all things are equal and
there is a choice between stating the PES
statement using two nutrition diagnoses from
different domains, consider the Intake nutrition
diagnosis as the one more specific to the role of
the RDN.
• E – Evaluate whether the etiology is the specific
“root cause” that can be addressed with a
nutrition intervention. If addressing the etiology
cannot resolve the problem, can the RDN
intervention at least lessen the signs and
symptoms?
• S – Will measuring the signs and symptoms
indicate if the problem is resolved or improved?
Are the signs and symptoms specific enough that
the RDN can monitor
(measure/evaluatechanges) and document
resolution or improvement of the nutrition
diagnosis?
• PES Overall – Does the nutrition assessment data
support the nutrition diagnosis, etiology, and
signs and symptoms?
Notes:
*Patient/client refers to individuals, groups,
populations, family members, and/or caregivers.
Intervention
• The intervention is the purposeful action of the
Health Professional/ RDN aimed at improving the
condition of the patient’s nutrition diagnosis. They
include interventions, such as, “nutrition related
medication management,” “nutrition education,”
and “nutrition counseling.”
Goals Must Be:
• S- specific
• M- measurable
• A- attainable
• R- realistic
• T- time-bound
• Related to P.E.S. Statements in order to create
unification throughout the NCP.
 Choose the Correct Verbiage for Setting Patient
Goals for the Intervention:
 Pt agrees to do everything I say because I said
so.
 Pt will walk out of office and forget everything
discussed.
 Pt agrees to try to….
 Pt is clearly not in the correct stage of change
and will fail
 miserably at any goal set.
Monitoring and Evaluation
• Monitor and Evaluate whether the goals and plan
set in motion is appropriate and how to adjust it as
time passes.
Nutrition Monitoring:
• preplanned review and measurement of
selected nutrition care indicators of
patient/client’s status.
Nutrition Evaluation
• the systematic comparison of current findings
with the previous status.
Monitoring & Evaluation Components
• Monitoring: Provide evidence that the nutrition
intervention is changing/not changing patients.
• Measuring: Measure outcomes by collecting
data on nutrition outcome indicators
• Evaluating: Compare current findings to decide
whether to discharge patient/ continue
counseling.
Monitoring
• Ensure patient understands goals and their
importance. Not doing it “just because” -Discuss
problems, questions, and concerns with patients
regarding goals.
• Adhering? Continue on path or Needs to
change
• Continue to document, update data to patient’s
file and continue to measure in order to assess
progress
Evaluating:
• Compare new data to old & Compare the
obtained results to the desired goals.
• Assess whether goals are being obtained, and if
they are truly helping to improve the health of
the patient.
• If not, discuss alternatives.
Don’t Forget…
• Monitor Progress
• Measure Outcome
• Evaluate Outcomes
• Document