Body Mass Index – Based Formula.

Body mass index (BMI), computed as weight in kilograms divided by height in meter squared
(W/H2), has been found to be the relative weight index that shows the highest correlation with
independent measures of body fat. The BMI range of 20 to 24.5 is generally considered normal.
BMI = Weight in kg
Height (m)2

Conversion:
Weight - Lbs to kg = weight in lbs/2.2
Height - inches to meters = height in inches x 2.54
100
1 foot = 12 inches
Example: Hana weighs 125 lbs and stands 5 feet 6 inches. Compute for the BMI.
125/2.2 ----- 56.8
5’6 ( 5x12=60 +6=66 x 2.54 =167.6/100)

56.8 kgs
(1.67)2 = 2.78 the answer is 21.03

DETERMINING THE DESIRABLE BODY WEIGHT (DBW) – referred to as reference, ideal or

standard body weight. The calculation of diet prescriptions is usually based on desirable body
weight. Some are the methods used in determining desirable body weight.
1. FOR INFANTS:
a. first 6 months:
DBW (gms) = Birth weight (gms) + (age in mos. X 600)
If the birth weight is not known, use 3000 gms.
Example:
4 month old infant = (not known)
DBW (gms) = 3000 + 2400
= 5400 gms or 5.4 kg
7-12 months:
 DBW (gms) = Birth weight (gms) + (age in mos. X 500)
Example:8 month old infant
DBW (gms) = 3000 + (8 x 500)
= 3000 + 4000
= 7000 gms or 7 kg
b. DBW (kg) = (age in months/2) + 3
Example: 8 month old infant
DBW (gms) = (8/2) + 3
=4+3
= 7000 gms or 7 kg
INFANT’S WEIGHT:
- Doubles at 5-6 months
- Triples at 12 months
- Quadruples at 24 months
HEIGHT OR LENGTH:
- Increases by 24 cm first year
- Increases by 12 cm second year
- Increases 8 cm during third year
- Increases 6 cm every year thereafter up to eight years
Example:
At birth: 50 cm
At 1 year (+24 cm) = 50 + 24 = 74 cm
At 2 year (+12 cm) = 74 + 12 = 86 cm
At 3 year (+8 cm) = 86 + 8 = 94 cm
At 4-8 years (+6 cm every year) = 94 + 6 = 100 cm

2. CHILDREN
DBW (kg) = (Age in years x 2) + 8
Example: 7 year old child
DBW (kg) = (7x2) + 8
= 14 + 8
= 22 kg
+ 2 kgs for every year
3. ADULTS
Desirble Body Weight (DBW, or ideal body weight (IBW) as used in nutrition and diet
therapy refers to the weight for height found statistically to be the most compatible with the health
and longevity. There are several tables or nomograms which give the DBW of adults of given
height. However, in practice, it is often necessary to compute an individual’s DBW quickly. The
following formulas that can be used:

Method 1: NDAP Formula, which the rule of the thumb easy to remember:
For women: allow 106 pounds for 5 feet and add 4 pounds for every inch
Thereafter.
For men: allow 112 pound for 5 feet and add 4 pounds for every inch
Thereafter.
Using the formula:
6 feet tall man DBW = 160 pounds
(112 + [12 x 4]) = 160 pounds

5’4” tall female DBW = 122 pounds

(106 + [4 x 4]) = 122 pounds

Method 2: Hamwi’s Method (used by most clinicians)

For women: allow 100 pounds for 5 feet stature plus 5 pounds for each additional inch.
For men: allow 106 pounds for 5 feet stature plus 6 pounds for each additional inch.
The values obtained apply to adults with small frame. Add 5 pounds for medium frame and 10
pounds for large frame.
Method 3: The most easiest way to determine DBW, you can refer to the FNRI-DOST
Height and Weight Tables for Adults. If this table is not available, you can use NDAP Formula or
Hamwi’s Method.

ESTIMATING TOTAL CALORIE OR TOTAL ENERGY REQUIREMENT (TER) PER DAY – the
total energy needs of an individual is the composite energy necessary to replace basal metabolic
needs, energy expenditure for physical activities. The total energy needs of an adult may be
determined using one of the methods shown:

Method 1: the most practical and rapid method of estimating energy needs based on
desirable body weight (DBW) according to the activity level or physical activity.

Example of activities:
Sedentary – secretary, clerk, administrator, cashier, bank teller – mostly sitting.
Light – teacher, nurse, student, lab technician, housewife with maids.
Moderate – housewife without maid, vendor, mechanic, jeepney and car driver.
Heavy – farmer, laborer, cargador, fisherman, heavy equipment operator.

Example:
TER = ?
DBW = 50 kg
Activity = moderate (housewife without maid)
TER = DBW x ACTIVITY LEVEL (FEMALE)
TER = 50 kg x 40
TER = 2,000 Kcal/day

Method 2: Use the Recommended Energy and Nutrient Intakes for Filipinos. Note the
different age groups and physiologic conditions.

DISTRIBUTION OF TOTAL ENERGY REQUIREMENTS (TER) INTO CARBOHYDRATES,

PROTEIN AND FAT
- Determine the distribution of TER into carbohydrates, protein and fats by percentage
distribution.
Carbohydrates - 55-70% of Total Energy Allowance (TEA)
Protein - 10-20% of Total Energy Allowance (TEA)
Fats - 15-30% of Total Energy Allowance (TEA)

NOTE: Percentage levels used may depend upon the diet description or usual food habits
of the patient. Assign a definite percentage of TER contributed by carbohydrates, protein, and fats.
Example: Distribution of TER into CHO, CHON and FATS by 1,500 Kcal
For normal diet, allot 60% of the total energy allowance for carbohydrates, 20% for protein
and 20% for fat. The corresponding energy contributions of three nutrients are:
CHO - 1,500 kcal x .60 = 900 Kcal
CHON - 1,500 Kcal x .20 = 300 Kcal
FAT - 1,500 Kcal x .20 = 300 Kcal
Calculate the number of grams of CHO, CHON and FAT by dividing the calories for each nutrient
by the corresponding physiological fuel value:
 CHO (carbohydrates) = 4 Kcal
 CHON (protein) = 4 Kcal
 Fat = 9 Kcal
Example:
CHO - 900 Kcal/4 = 225 grams CHO
CHON - 300 Kcal/4 = 75 grams CHON
 FATS - 300 Kcal/9 = 33.3 grams or 35 grams FATS

For simplicity and practicality of the diet prescription (Diet Rx), round off calories to the nearest 50
grams, and CHO, CHON and FATS to the nearest 5 grams.
Diet Rx: 1,500 Kcal; 225g CHO; 75g CHON, 35g FATS
- Calculate the non-protein and protein calories. NOTE: this computation is used when
there is specific/restricted protein requirement. There should be information on total
energy requirement (TER), DBW and protein requirement.
Example:
TER = 2,000 Kcal
DBW = 50 kg
CHON Req.= 1g/kg DBW

a. Determine protein calories:

CHON = 50 x 1g
= 50 g CHON
= 50 x 4 (physiological fuel value)
= 200 Kcal

b. Determine non-protein calories:

Given TER – CHON Kcal = NON-CHON Kcal
2,000 Kcal – 200 Kcal = 1,800 Kcal

c. Divide non-protein calories into CHO (70%) and FAT (30%).

CHO = 1,800 x .70
= 1,260 ÷ 4 (physiological fuel value)
= 345 g CHO

FAT = 1,800 x .30

= 540 ÷ 9 (physiological fuel value)
= 60 g FAT
The Diet Rx should be: 2,000 Kcal; 345g CHO; 50g CHON; 60g FAT

NUTRITION THROUGHOUT THE LIFESPAN

Nutrition for Adults and Older Persons
Factors Affecting Food Intake, Nutrient Utilization and Nutrient Needs
  Biological and environmental factors determine dietary intake, nutrient utilization and
requirement.
 The physiological changes that occur with age are major determinants of dietary intake and
nutrient use and need.
 Socio-cultural, psychological and economic factors are as important considerations as
physiological factors; includes:
 Food beliefs, preferences and habits
 Susceptibility to food fads and nutrition misinformation
 Social isolation and emotional stress
 Mental disorientation and depression
 Economic considerations
 Use of drugs and other therapy.

Nutritional Requirement of the Elderly

 Nutritive need: DRI divide the mature adult population into four age groups: those who
are 19-29 years; 30-49 years; 50-64 years, and those 65 years of age and older. Compared
with adults from 19-49 years of age, the only recommended intakes that differ from older
adults are those of energy, calcium, vitamin A, vitamin B, and Iron (for women only). The
recommended intakes for all other nutrients remain constant from age 19 throughout
adulthood.
 The daily recommended intake are intended to meet the needs of healthy people and do
not take into account effects of diseases or use of medications.
 The aim is to conserve health and delay the onset of degenerative diseases.
 Rationale for the nutritional requirements of the elderly

 Energy: the need for calories is decreased because of reduced BMR, body mass
and physical activity.
 Decrease in 5% of energy allowance is recommended for each
decade between 40 and 59 years and 10% for 60 years and
above.

 Protein: DRI is the same throughout adulthood.

o Total amount of protein declines only slightly with age.
o Intake in excess of the need is undesirable because of
the reduced efficiency of the kidneys to excrete waste
products of protein metabolism.
 Vitamins
o Studies indicate that high dietary and supplemental intakes vitamin C are associated with
reduced risk of coronary heart disease, cancer and cataract and an increased life
expectancy. (Blumberg 1992).
o Thiamine, riboflavin, and niacin are reduced since these are related to energy metabolism.
o Studies have consistently shown that there is a decline in plasma pyridoxine phosphate
among the elderly and their vitamin B6 intake is below DRI levels (Blumberg, J. 1992)
o Increase in vitamin B6 to 20-45% higher than DRI was necessary to restore immunologic
indices.
o Low vitamin B6 showed higher levels of fasting insulin and plasma glucose and lowered
brain functioning.
o Vitamin D has been recognized as an important differentiation factor for a variety of cell
types as well as immunoregulatory hormone.
o Older adults maintain lower levels of serum 1.25 dihydroxyvitamin D than do younger
people due to decrease in milk intake and outdoor activities.
 o Daily vitamin D intake of 5.5 to over 12 ug appear required by postmenopausal women to
maintain constant serum 25 hydroxyvitamin D and parathyroid hormone (Blumberg, 1992).
o Vitamin E needs may vary according to dietary fat content.
o Studies in animals indicate a relational increase in protection against free radical pathology
and increased Vit. E intake (Blumberg, 1992).
o High plasma levels of Vitamin E have been correlated with a reduced incidence of
infectious disease and pharmacologic dose of 800 mg of alpha tocopherol enhances
parameters of cellular immunity in healthy elderly.
 Minerals
o Calcium: scientific evidence from other countries indicate that menopausal and post
menopausal women may need more calcium than current DRI to minimize osteoporotic
changes.
o Iron: requirement of women is reduced after menopause; that of men remain the
same.
 Water and fiber
o Water requirement remains at 6-8 glasses/day; some studies indicate that thirst is not
always a good indicator of the amount of extra water needed to meet the daily requirement.
o Liberal intake of fruits, vegetables and whole grains in order to supply ample fiber to
prevent constipation which is a common problem due to reduced intestinal muscle tone and
reduced physical activity.

Feeding Older Adults

 Choose nutrient-dense foods.
 Provide wide variety of foods from all the food groups.
 Limit foods that are energy dense but provide few other essential nutrients, such as foods
high in sugar and fats.
 Give soft, easy to chew, smaller bite-sized are foods for those with chewing and swallowing
problems.
 Small frequent feedings may be preferred.
 Give 6-8 glasses of fluids.
 Increase fiber intake.
 Avoid excessive salt intake; use herbs and spices for seasoning.
 Discourage excessive or frequent use of alcohol.
 Unless prescribed, vitamin and mineral supplements may be unnecessary.

Major Nutrition Related Problems

 Osteoporosis: a bone disease in which the amount of bone is decreased but the
composition remains normal.
 Characterized by decrease in stature.
 Common among women in menopausal stage.
 Factors: interplay of hormones primarily estrogen and parathyroid, inactivity or
immobility; dietary; and metabolic aspects of calcium, phosphorus, protein, fluorine, and
vitamins A and D; genetics.

 Maturity-onset diabetes mellitus: often gradual in its development.

 Alteration in glucose metabolism is one of the changes observed in aging; the glucose
tolerance curve is slower in its return to normal after a glucose load, even when the plasma
insulin level is elevated.
 Complications are neuropathy, renal disorders and peripheral vascular disease.
 Can be controlled by dietary management, weight loss and oral drug treatment.
 Hypertension: more frequent among adults over 45 years old.
 If secondary to renal, endocrine or other disease, its treatment should be based on the
underlying cause.
 Treatment includes restriction of salt intake and administration of diuretics and drugs that
lower blood pressure; if diuretics are administered, potassium status should be monitored.

 Coronary heart disease and atherosclerosis: may result from the interplay of the
degenerative changes that occur particularly in the cardiovascular system.
 Cigarette smoking, obesity hypertension and diabetes increase the risk to both
atherosclerosis and coronary heart disease.
 Personality type and life style including dietary intake and physical activity may influence
the genesis and progress of the disease.
 Dietary factors that need to be considered include energy intake, amount and type of fat,
cholesterol and dietary fiber content.

 Anemia:
 Microlytic, hypochromic or iron deficiency anemia is characterized by feelings of fatigue,
anxiety and sleeplessness; may result from iron inadequacy due to low intake if impaired
absorption of heme iron and/or vitamin C.
 Megaloblastic anemia is due to folate deficicency and often occurs simultaneously with iron-
deficiency anemia.

 Food-induced malnutrition: results from use of large amounts of food with

substances that act as nutrient antagonist or increase nutrient need, e.g. high phytate
content of oatmeal reduces the absorption of iron and zinc while drinking excessive
amounts of tea and coffee increases the need for thiamine.
 Extensive use of alcohol not only limits intake of nutrients but also impairs nutrient
absorption and utilization.

 Drug-related malnutrition: a major concern among the elderly since the

prevalence of chronic disease increases with age.
 Extensive intake of drugs may affect food intake, interfere with nutrient absorption and
utilization and affect nutrient requirements, e.g.
 Oral diuretics such as penicillamine cause zinc depletion which in turn result to loss of
sense of taste and appetite.
 Aspirin, an analgesic may irritate the gastrointestinal wall and cause bleeding, hence
anemia.
 Antituberculosis drug, isoniazid, is an antagonist of pyridoxine.
 Prolonged use of certain steroids can cause bone calcium loss, leading to osteoporosis.
 Individuals on prolonged drug therapy (e.g. diabetes, hypertension, cancer, tuberculosis,
etc.) should be regularly monitored for untoward effects.