TOPIC: NUTRITION LABORATORY MODULE LECTURER: no one Review of the Computation As usual, if you know how to do the computation

, you may skip this part. Desirable Body Weight (DBW) using the Tannhauser s: Height in centimetres minus 100 (European) Minus another 10% for Asians Eg. 165-100=65-6.5=58.5 (nearest whole number) ~59kg Total Energy Requirement (TER) using the NDAP formula: BMR+PA Where: BMR is 1 kcal per kg weight per hour so when computing simply multiply kg DBW to 24 hours then add physical activity expressed as percentage Female: 30, 35, 40, 45 for bed rest, light, moderate, heavy respectively (for males just add 5) Eg. Female student: 59*24= 1416+495.6=1911.6 (nearest 50) ~ 1900kcal % Distribution to know how much carbohydrates, protein and fat to be given using the exact calories allowable If you use: 60-10-30 distribution and remembering there are 4,4,9kcal per gram of C,P,F the answer to the distribution in 1900 kcal is: 1900*.6=1140kcal/4= 285g Carbohydrates 1900*.1=190kcal/4=47.5 (nearest 5) ~ 50g Protein 1900*.3=570kcal/9=63.33 ~ 65g Fat

full. This is a serving and it is not the same for all individuals. An exchange is a nutritionist guide to identify the number of calories consumed since it is standard in size. Putting the example earlier to a nutritionist s language: I could eat 1 ½ exchange of rice and feel full but a male counterpart could probably eat 4 exchanges before feeling full. Next question: if this is already standard, what is the measurement of an exchange per food item? Well, this is the scary part, the entire nutrition module in our laboratory manual has most food items size to identify what an exchange is. Do not be alarmed, here are general information: -Vegetable A (those that when cooked seem smaller in size like leafy vegetables) have 1 cup and ½ cup size for uncooked and cooked vegetables. -Vegetable B since it does not change size has ½ cup as an exchange for both cooked and uncooked. -Fruits and Rice Exchanges, unfortunately vary, but it is best to identify common food items like cooked rice is ½ cup packed, bread is 2 slices per exchange, pasta is a cup, banana a piece with 10x4cm measurement, mangoes medium slice of 11x6cm and apples 1 piece with 6cm diameter. -Meats generally have a matchbox size as one exchange or as other protein lovers want to call it: palmsize (so it does not seem too small to imagine). -Sugar and Oils have a tsp as one exchange. Milk has a glass as an exchange To hone your skills, I urge you to identify how many exchanges you eat per meal. For example, I ate 1 cup rice and a serving of tinola! First step is to break the tinola into the parts: ½ cup papaya, ½ piece chicken breast, ¼ cup sili leaves. Your answer should be: 2 exchanges rice, 1 ex (exchange not example!) vegetable B, ½ ex vegetable B and 2 ex low fat meat. For guys who love tables: Food Item Measurement Exchanges Rice 1 cup 2 Papaya ½ cup 1 Chicken breast ½ piece 2 Sili leaves ¼ cup ½ Fat 1 tsp 1

From Nutrition 1 and 2 we have already identified how to compute our own desirable body weight, total caloric requirement and the distribution of the needed calories (your choice of 60-15-25 or 60-10-30, which is used more by Doc Uy.) What now that you know all these? The next step is to identify how many of the food items we should consume to identify if you have been following the distribution needed. To put it in the words of a dieter, am I following my diet prescription? To answer this, we should differentiate a serving from an exchange. I could eat 3/4 cup of rice and feel full but a male counterpart could probably eat 2 cups before feeling

Yes! Please never forget the oil, especially if it is a fried item! The reason why exchanges are important is because with standard size comes standard amount of carbs, protein and fat MEANING standard amount of calories per exchange. This is the most important to memorize. FOOD ITEM Veg A Veg B Fruit Milk -low fat -medium fat -high fat Sugar Rice Meat -LF -MF -HF Fat C 3 10 12 12 12 5 23 P 1 F kcal 16 40 trace 5 10 80 125 170 20

How many calories were consumed? 73g C * 4= 292kcal 21g P * 4= 84kcal 7g F *4= 28kcal +84+292= 404kcal In the laboratory, how do you make sure you consume 1800, 2000 or 2200kcal aside from making sure that the C, P, F is in its correct percentage? There is a reason for the arrangement of the food item in the table at the left. Notice that carbohydrates can be from the vegetable to rice. Protein until high fat meat and fat can be seen in almost all food items. In the diet prescription of 1900kcalC285P50F65 veg A, B, Fruits, Milk and Sugar are all dependent on either the normal intake of an individual or the general prescription. For example, if the patient does not eat vegetables, how will you give it? Remember, the suggestion in Nutrition 2 says that fibers should be 20-30g per day so there is a need to provide vegetables or fibrous fruit (pineapple). So as you can see it is subjective. If you like sugars you can give higher than normal. But rice, meats and fats/oils will depend on the computation. How?

8 8 8 2 8 8 8

1 6 10 5

41 86 122 45

If you love computing and hate memorizing, just memorize CPF and compute for kcal using our 4,4,9 rule but of course it saves time during exams to know it then and there. Veg A does not mean there are no calories, but with the small amount of calories, you would need to consume 2 exchanges or more to be computed like a veg B. But in the case of Dra. Uy, I doubt she asks how many calories your vegetables give as she considers this as a free food. Free food meaning, consume x number and it will not cost any calories! (But, there is a calorie there, very minimal as vegetarians need calories too even if they get energy from beans, oils, etc!) In the example earlier, how many C, P and F does that have? Food Item Rice Papaya Chicken breast Sili leaves Fat Exchanges 2 1 2 (low fat) ½ 1 total C 46 3 24 73 P 4 1 16 21 F

FOOD ITEM Veg A Veg B Fruit Milk -low fat -medium fat -high fat Sugar

Exchange 2 2 4 1 0 0 5

C 3 6 40 12 0

P 1 2

F

8 0

Trace 0

2 5 7

25 86 285 (carbs needed) 86 (pre-total) = 199/23 (standard carbs per exchange) =8.6ex Rice 8.5 195.5 16 86+195.5= 281.5 27 50 (protein needed) 27 (pre total)=23/8 (std protein per exchange) =2.875 Meat -LF 1 8 1 -MF 2 16 12 -HF 27 + 16 + 8= 51 . 13 65-13=52/5=10.4 Fat 10.5 52.5 13 + 52.5 = 65.5

The numbers in bold is a good way to check if you had the correct number of carbs, protein and fat. See it s not far from needed right? Q and A Where did the values in C, P, F per exchange come from? Just memorize it... hehehe, it s from a series of chemical laboratory procedures. Where did the values in C, P, F in our computation come from? Remember the standard amount of CPF per exchange? Check the table, in our computation, it doesn t have an exchange only (not one but differing amounts). Just multiply the number of exchanges to the standard amount (eg. 8 exchanges of rice would have 23*8=184g of carbohydrates) Why use 23, 8 and 5 when rice, meat and fats were computed? Since 23 is the standard amount of carbs per exchange and the last food item to be computed that has carbohydrates is rice, 23 is used to determine how much more rice is to be given. Same goes for protein. If there is already 35grams protein, and the prescription calls for 50 grams how many more should you give? 15 grams. But in exchanges, how many more meat can you give? 2 exchanges since 15/8=2.something. Gets? Do the same for fats.

The only suggestion I can give on this is to imagine a food item already prior to placing the exchanges on a particular meal. People who cook can do this better and most often fails to forget ingredients. For example, in breakfast I imagined milk, bacon and eggs with 1 cup. Papaya fruit for AM dessert. For AM snack, pandesal with condensada(!! Used to this growing up, hehehe) Lunch is tinola but this time ¼ chicken breast only and more sili leaves or change the viand entirely as nilagang baboy with lots of cabbage, sitaw. Lesser rice to accommodate potato exchange. Snack is banana-que and camote-que. Dinner is baked potato salad cheese topping (medium fat meat) and bacon (1 strip an exchange of fat). Veggies would be chilled veggy sticks (carrots, celery, singkamas) served in glasses with ice. Use 2 tsp of mayonnaise for veggy sticks. hehehe. got hungry. Bye.

Email me for questions/clarification. marianetriabonita@gmail.com and text me before mailing 09175007617. God bless!! ADDED INFORMATION C Fruits milk Rice LF Meat MF Meat HF Meat Fat Sugar 10 12 23 P 8 2 8 8 8 F 10 2 7 10 5 Kcal 40 170 100 50 95 122 45 20

Last is converting to meals per day. Doing the TInola meal in reverse. Account exchanges on lunch but add more veggies and minus on meat so you have a viand in the evening. FOOF Ex BF AM S L PM S ITEM Veg A 2 2 Veg B 2 1 Fruit 4 2 2 Milk, LF 1 1 , MF 0 Sugar 5 2 3 Rice 8.5 2 1 2 1.5 Meat, LF 1 1 , MF 2 1 Fat 10.5 3 2 2.5 *BF= breakfast, S=Snack, L=Lunch, D=Dinner D

5

This is the CPF content per exchange as stated in the lab manual. Best to follow this than the one released earlier since it is not I who make the exams. Thank you!

1 MARIANE BONITA, RND Not I but Christ. 2 1 3