Unit- Three

Nutritional requirement
By

Mohammed Zekeria (BSc, MPH)

Dec, 2020

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 Learning objectives
At the end of the session, the students will be expected
to:-
– Define what nutritional requirement means
– Calculate an estimation of nutritional requirement
– Identify factors that affect estimating the nutritional
requirements
– Identify the Nutritional requirements for special age
groups

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 Introduction
• What is nutritional requirement?
A nutritional requirement is defined as an
adequate continuing intake level of a nutrient
for a specified indicator of adequacy that will
maintain a defined level of nutrient for specified
age and groups.

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• Thus, Good nutrition must meet the needs of
varying ages, groups and activities and always
with an individual differences.
• Therefore, the planning of food to meet the
especial needs begins with:-
– Pregnant women
– Lactating mothers
– Infants and young children
– Adolescents
– Adults and
– Elderly age
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Method of Calculating Nutrient Intake

Nurses Nutrition Module II 5

 Dietary Reference Intake (values)
• Serve as a reference values that are quantitative
estimates of nutrient intake to be used for
planning and assessing diets for a healthy people
• It can be classified into:-
 Estimated Average Requirement (EAR)
 Recommended Dietary Allowance (RDA)
 Adequate Intake (AI)
 Tolerable Upper Intake Level (UL)

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 1. Estimated Average Requirement (EAR)
• The intake value is estimated to meet the requirement
defined by a specified indicator of adequacy in 50% of a
specified groups (age and gender)

• At this level, 50% of a specified group of people would

not have its required meet.

• Thus the EAR is designed only for setting a benchmark

for baseline nutrient requirements, not to evaluating
individual dietary intake level.
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 2. Recommended Dietary Allowance(RDA)
• Is the daily intake, which meets the nutrient requirement
of almost all (97.5 %) apparently healthy individuals in an
age and sex-specific population group.

• Thus RDA is not a minimum daily requirement, it is a

dietary recommendation, about how much of a nutrient
to consume through food on daily bases

• If every one consumed exactly the RDA level of nutrient,

very few people in that group would develop nutrient
deficiency.
• Thus, RDAs are used for healthy individuals
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The distribution of nutrient requirement within a
population

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 3. Adequate intake (Safe intake)
• Is set instead of RDA, if sufficient evidence is not
available to calculate EAR. These values are based on
observed or experimentally determined estimates of
nutrient intake by a group (s) of healthy individuals.

• At this level there is no risk of deficiency and is below

the level where there is a risk of undesirable effects

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 4. Tolerable Upper intake level

• Are the maximum level of daily nutrient intake that is

unlikely to pose risk of adverse health effects from
excess in almost all (97.5 percent) apparently healthy
individuals in an age and sex-specific population
group
• These values are helpful in determining whether the
doses of nutrients contained in nutritional
supplements represent safe intakes

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Distribution of requirements to prevent deficiency and
toxicity

Adequate intake

RNI UL

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 Principles of estimation of energy
requirement
• Energy requirement to be based on energy
expenditure, not energy intake
• Energy requirements estimates refers to
groups, not to individuals
• Energy requirement of a group is the mean of
the group and includes no safe margin

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 Dietary Recommendations
• What should be considered?
• Group of healthy individuals representing the
population
• Adequacy of nutrient intake
• Life stages: infants; toddlers; early childhood;
puberty & adolescence; adulthood & older adults;
elderly; pregnancy & lactation
• Lifestyle: physical activity
• Diet

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 Factors that affect the nutritional requirements
The energy requirements of an individual depend on:-
♦ Physical activities
♦ Body size and composition
♦ Occupation status
♦ Age may affect nutritional requirements in two ways:-
– the infant needs more energy because it is growing
– During old age, the energy need is less because aged people
are engaged with activities that requires less energy.
♦ Climate: Both very cold and very hot climate restrict
outdoor activities.

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 Harris Benedict equation

• To determine calorie requirement

• In men:
– REE (kcal/day) = 66.5 + (13.7 X Wt) + (5.0 X Ht) –
(6.8 X Age)
• In women:
– REE (kcal/day) = 655.1 + (9.65 X Wt) + (1.7 X Ht)
– (4.7 X Age)
• Where Wt = weight in kilograms, Ht = height
in centimeters and A = age in years.
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 Harris Benedict questions
• REE is multiplied by
– An activity factor and
– An Injury factor
• To predict total daily energy expenditure
– Confined to bed = 1.0-1.2
– Out of bed = 1.3
– Very light = 1.3
– Light = 1.5 (women), 1.6 (men)
– Moderate = 1.6 (women), 1.7 (men)
– Heavy = 1.9 (women), 2.1 (men)
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 Daily calorie requirements
• Daily calorie requirements of individuals
– Infants 1 - 3 years need 1,000 cal/day
– Children 3-5 years need 1,500 cal/day
– Children 5 – 8 years need 1,800 cal/day
– Children 10 – 12 years need 2,000 cal/day
– From 13 – 20 years of age: 2300-4000 cal/day
and above
– For adolescents and adults calorie
requirements depend on the degree of
physical activities
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 Daily calorie requirements
• For pregnant woman, the daily figure must be
increased by 150 calories for the first trimester
and 350 calories for the second and third
trimester.
• For the Lactate mother the daily figure must
be increased by 800 calorie.

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Nutritional Requirements during Critical
Periods
Special nutrient requirement during:-
• Pregnancy
• Lactation
• Infancy and early childhood
• adolescence
• Elderly age

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 Nutrition during pregnancy
• A baby weighing less than 2.5 kg has an
increased chance of both physical and mental
health problems.
• It may also suffer more from infection and
malnutrition compared with babies born with
normal weight.
• Non-pregnant woman 2200 kcal, pregnant
women 2,500 kcal and lactating mother 2600
kcal or feed her four times in a day.
• Pregnant women should gain an average of
11.5-16 kg weight during her pregnancy time
 During pregnancy period
Gaining weight in pregnancy
• A pregnant mother should gain weight smoothly
and steadily.
• If weight gain occurs suddenly, she should be
seen by a health professional.
• During the first three months, she should expect
to gain a total of 1–2 kg.
• During the last six months, she needs to gain
about 0.5 kg each week.

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 Weight gain during pregnancy

Pre pregnancy BMI Recommended

total gain (kg)

Under weight : BMI under 18.5 12.5- 18

Normal Weight : BMI 18.5 – 24.9 11.5 – 16
Over weight : 25 – 29.9 7 – 11.5
Obese : Greater or equal to 30.0 Less than 7

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 Nutrition During Pregnancy
• A pregnant woman needs extra foods,
especially those that are good sources of iron.
• Pregnant women need at least one additional
meal (200 Kcal) per day during the pregnancy.
• A pregnant woman should reduce her
involvement in strenuous household tasks that
lead to higher energy expenditure.
• Pregnant women should eat iodized salt in their
diet.

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 Nutrition during lactation
• A lactating woman needs at least two extra meals
(550 Kcal) of whatever is available at home.
• In addition a dose of vitamin A (200,000IU) should be
given once between delivery and six weeks after
delivery.
– This will enable the baby to get an adequate supply
of vitamin A for the first six months.
– But it is not routinely recommended by WHO!
• During the first six months the best way of feeding
the baby is breastfeed exclusively.

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 Proper Positioning and Attachment

• To stimulate the nipple and remove milk from

the breast, and to ensure an adequate supply
and a good flow of milk, a baby needs to be
well attached so that he or she can suckle
effectively.
• Poor attachment results in incomplete removal
of milk, which can lead to sore nipples,
inflammation of the breast, and mastitis.
 Good attachment
• Much of the areola and the tissues
underneath it, including the larger
ducts, are in the baby’s mouth;
• The mouth is wide open
• The infant’s chin touches the breast
• Both lips are turned outwards
Poor positioning and attachment
Good positioning and attachment
 Nutrition of infants and children
• The common feature of infancy, childhood and
adolescence is that all these age groups are
undergoing rapid growth and development.
• This in turn poses a heavy demand on their
nutritional requirements.
• Small children and infants do not have a well
developed body nutrient store, and are more
vulnerable to infection.
– At risk of nutrient deficiency

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Protein
 Still the highest period in human life in terms of
protein requirement
 1.98g/kg of BW is required for proper growth
to occur
 RDA for infants is 2.2g/kg for the first 6 months
and then reduced to 2g/kg in the second 6
months
 (Tyrosine, Taurine, and Cysteine) amino Acids
are required

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CHOs
 Major energy contributor during infancy
 Lactose should be the primary CHO at least in
the first half of infancy
 5g/kg of CHO is required to prevent ketosis

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Fat and fatty acids
 More than half of the energy in BM is derived
from fat
 Essential fatty acids are required in larger
amount during infancy (>30% of total energy)
 Mainly for neurological development
 Milk is a better source of both Omega-3 and 6
PUFAs

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Vitamins and Minerals
 Consumption of 700-800 ml of BM provides twice
RDA of Vitamin A but same intake will not allow the
acquisition of RDA of Vitamin D
 BM is not also a good source of Vitamin K , it is
recommended to be given routinely at birth
 If the mother was taking enough Fe during pregnancy
, the iron store in the infant is enough for the first 6
months of life
 Fe supplementation is needed after 6 months of life

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 Nutrition for adolescents
• Adolescents also undergo a very rapid growth
during their puberty (called the pubertal growth
spurt).
• During the pubertal growth spurt, they increase
rapidly both in weight and height.
• Therefore, they need a nutrient intake that is
proportional with their rate of growth.
• The growth rate is very high right after birth
(infancy).

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 Continued….
• Energy needs are influenced by:
-activity level
-basal metabolic rate (BMR)
-pubertal growth & development
-gender
• Because males have greater increases in ht, wt, &
lean body mass (LBM) & higher BMR, they have a
higher caloric need than females
 Protein Requirements in Adolescents

• Protein requirements influenced by protein

needed:
-to maintain existing Lean Body Mass (LBM)
-for growth of new LBM
• DRI is 0.8 g/kg body weight

• Low protein intakes linked to:

-reductions in linear growth and LBM
-delays in sexual maturation
 Nutritional requirements for elderly people

• Elderly people are especially vulnerable to

nutritional problems due to age related
changes in their body (impaired
physiological and anatomical capacity
– Problems of procuring and preparing foods
– Psychosocial problems
– Digestion problems
– Nutrient absorption problems

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 Specific nutrient requirements in old age
• An elderly person requires less energy than a
younger individual due to reductions in muscle
mass and physical activity
• They need fewer calories than younger people,
but about the same amount of protein and other
nutrients.
– But need micronutrients like zinc, iron, vitamins,
iodine
– Increased Vitamin D requirement
– Vitamin A, B9,B12….

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 Nutritional needs of elderly
• Energy
 Requirement decreases with age
 Body composition changes
 BMR decreases
 Physical activity decreases
• Protein
 1-1.5 gm/ kg body weight
 Help blunt loss of lean body mass
 Lower efficiency of dietary protein utilization

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• Carbohydrate
Abundant carbohydrates
Increase intake complex carbohydrates
65 % or more total calories from carbohydrates
• Fat
 25 to 35 % of total calories
Vitamins
• Vitamin A
Slower uptake by peripheral tissues - higher circulating
levels
Increased absorption because of changes in lining of small
intestine

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• Vitamin D
 10 -20 microgram
 Limited exposure to direct sunlight
 Reduced dermal synthesis
 Reduced conversation to active hormone

• Vitamin B-6
Increase requirement
Falling blood concentration due to age
Utilization diminished

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• Vitamin B-12
 3 microgram
 Reduced absorption caused by fall in gastric acid
 Vitamin B 12 injection recommended if intrinsic
synthesis is inadequate

• Folate

Folate deficiency is linked to elevated plasma

homocystein ( risk factor for heart disease and stroke,
Alzheimer’s disease)
 Good source of folate is needed

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Minerals
• Calcium
 700 mg for adults over 50 years
 Slows bone loss
• Iron
 Increase intake is recommended
 Reduced absorption in elderly
• Sodium
 Needs to be restricted
 2-4 mg/day

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 Thank you !
for
your Attention