LESSON 4 - BASIC TOOLS IN NUTRITION

1. THE FOOD PYRAMID

These are developed by nutrition educators or nutrition experts in a country as a qualitative tool
in planning nutritious diets for masses. Foods containing high levels of certain nutrients are
grouped together and the serving portions are stated in household measures for the layman to
understand. 

FOCUS ON FRUIT
- Eat a variety fruits whether fresh,
frozen canned or dried rather than
fruit juice for most of your fruit
choices. For 2000 kcal diet, you will
need 2 cups of fruit each day. (e.g.  1
small banana, 1 large orange)
MAKE HALF YOUR GRAINS WHOLE
- Eat at least 3 ounces of whole grain cereals, breads, crackers, rice, pasta everyday. One once
is about 1 slice of bread, 1 cup of breakfast cereal, or 1/2 cup of cooked rice or past.
VARY YOUR VEGGIES
- Eat more dark green veggies such as broccoli, kale and dark leafy green veggies. Orange
veggies such as carrots, sweet potatoes and beans and peas such as pinto beans, kidney
beans, split peas and lentils. 
 GO LEAN AND PROTEIN
- Choose lean meats and poultry. Bake it, broil it or grill it. Vary your protein choices- with more
fish, beans, peas, nuts and seeds.
  GET YOUR CALCIUM RICH FOODS
- Get 3 cups of low fat or fat free milk or equivalent amount of low fat yogurt and a low fat
cheese (1 1/2 ounces of cheese equals 1 cup of milk) every day. For kids aged 2-8, consume 2
cups of milk. If you don’t or can’t consume milk, choose lactose free milk products and/or
calcium fortified foods and beverages.

2. RECOMMENDED DIETARY ALLOWANCES (RDAs)

Ø  The Recommended Dietary Allowances (RDA) refer to the recommended daily levels of
nutrients to meet the needs of nearly all healthy individuals in a particular age and gender
group. These data consist of the minimum requirements plus a safety factor called “margin of
safety” to allow for individual variations of body storage, state of health, nutrient utilization, and
other day-to-day variations within a person. The RDAs are always higher than the minimum
dietary requirements as much as 100%.

3. FOOD COMPOSITION TABLES (FCTs)

Ø the chemical composition of a food, whether of animal or plant origin, varies according to
kind or breed, maturity or age, part of plant or carcass, soil fertility, climate, handling and
storage conditions, marketing and agricultural practices and a host of other uncontrollable
factors.
Ø This edition of the table of food composition includes a wide variety of foods. It is updated
with each edition to reflect current nutrient data for foods, to remove outdated foods, and to
add foods that are new to the marketplace.* The nutrient database for this appendix is
compiled from a variety of sources, including the USDA Standard Release database and
manufacturers’ data. The USDA database provides data for a wider variety of foods and
nutrients than other sources. Because laboratory analysis for each nutrient can be quite costly,
manufacturers tend to provide data only for those nutrients mandated on food labels.
Consequently, data for their foods are often incomplete; any missing information on this table is
designated as a dash. Keep in mind that a dash means only that the information is unknown
and should not be interpreted as a zero. A zero means that the nutrient is not present in the
food. Whenever using nutrient data, remember that many factors influence the nutrient
contents of foods. These factors include the mineral content of the soil, the diet fed to the
animal or the fertilizer used on the plant, the season of harvest, the method of processing, the
length and method of storage, the method of cooking, the method of analysis, and the moisture
content of the sample analyzed. With so many influencing factors, users should view nutrient
data as a close approximation of the actual amount.
Ø  TERMINOLOGIES
• Fats
Total fats, as well as the breakdown of total fats to saturated,
monounsaturated,           polyunsaturated, and trans fats, are listed in the table. The fatty acids
seldom add up          to the total in part due to rounding but also because values are derived
from a variety   of laboratories.
• Trans Fats
Trans-fat data has been listed in the table. Because food manufacturers have only     been
required to report trans fats on food labels since January 2006, much of the    data
is          incomplete. Missing trans fat data is designated with a dash. As additional     trans fat
data becomes available, the table will be updated.
• Vitamin A and Vitamin E
In keeping with the 2001 RDA for vitamin A, this appendix presents data for vitamin A          in
micrograms (μg) RAE. Similarly, because the 2000 RDA for vitamin E is based only     on the
alpha-tocopherol form of vitamin E, this appendix reports vitamin E data in    milligrams (mg)
alpha-tocopherol, listed on the table as Vit E (mg).
• Bioavailability
Keep in mind that the availability of nutrients from foods depends not only on the      quantity
provided by a food, but also on the amount absorbed and used by the          body—          the
bioavailability. The bioavailability of folate from fortified foods, for       example, is greater than
from naturally occurring sources. Similarly, the body can         make niacin from the amino acid
tryptophan, but niacin values in this table (and most databases) report preformed niacin only.
• Caffeine Sources
Caffeine occurs in several plants, including the familiar coffee bean, the tea leaf, and the cocoa
bean from which chocolate is made.

4. THE FOOD EXCHANGE LISTS (FELs)

Ø  The food exchange list system is a grouping of common foods that have practically the same
amount of protein, carbohydrate and fat. Within a group, one food item can be exchanged with
another provided the specified serving portion is followed.
Ø  The Food Exchange Lists and Meal Planning for Filipinos is designed for the average normal
adults between the ages of 20-65 to encourage every Filipino people learn to have their meal
planning based on common Filipino foods.  Because meal planning has vital importance both in
the consideration of proper nutrition and in the family’s real enjoyment of food. Knowledge of
the food nutrients, their sources and functions will help ensure the choice of nutritionally
enough meals.
FOOD EXCHANGE LIST MyPyramid Guide  
Group foods primarily on the amounts of Places more emphasis on amounts of 5. 
macronutrients micronutrients NU
Counts cheese in the Meat group Counts equivalent amounts of milk and TR
cheese based on calcium content IE
NT
Counts legumes in the starch and bread Counts legumes in the meat group
group
Calculate 15 grams of CHO for one serving of Carbohydrate content of the fruit group is
fruit not considered
Counts fat serving as 5 grams of fat Does not specifically state portion sizes for
(equivalent to 1 tsp of added fat) fats and includes nuts in the meat group and
avocados in the fruit group
DENSITY
Ø  is a relative measure of nutrients in a food in proportion to its caloric content. When a
person says “this food is nutritious,” s/he is implying that the food contains more nutrients
other than calories or it is a food that has high nutrient density.
6. NUTRITION LABELING
Ø  description intended to inform the consumer of nutritional properties. It consists of two
components :nutrient declaration and supplementary nutrition information:
ü Nutrition declaration- a standardized statement or listing of the nutrient content of food.
ü Nutrition claim-representation which states or implies that a food has some particular
nutritional properties.
Ø  Mandatory Nutrition Labeling went into effect in 1994 with the goal of helping consumers
adhere to the Dietary Guidelines for Americans. The change is aimed at reducing the prevalence
and complications of chronic illnesses such as heart disease, hypertension, and diabetes.
Ø  Valuable tool for for learning to apply nutrition information in a practical way. A health
conscious shopper uses the percentages shown in the label to determine how well each serving
of the food fulfills recommended nutritional requirements .
Purposes of Nutrition Labeling - To ensure that nutrition labeling is effective,
ü consumers must make a wise choice by reading the label
ü manufacturer or producer must convey the nutrient content or information on the label.
ü manufacturer not to mislead or deceive consumers and that, no nutrition claims are made
without approval by appropriate authorities.
Example 1: If one serving of a food has 25% of a particular nutrient listed, it means that each
serving is good for one fourth of a person’s recommended daily intake for that nutrient.
Ingredients are also listed in order of content in a product. If sugar is listed as the first
ingredient, the amount of sugar in the product is greater than the amount of any of the other
ingredients.
Example 2: 1 tsp of sugar equates to 4 grams on the Food Label. A can of softdrink containing
40 grams of sugar contains the equivalent of 10 tsp of sugar.
To help the consumer calculate the kilocalories in a given food, the food label on larger food
packages also list the conversion factor to change the grams into kilocalories that i

FAT – 9 kcal/g           CARBOHYDRATE – 4 kcal/g           PROTEIN – 4 kcal/g

1 tsp of sugar = 4 grams x 4 = 16 kilocalories
1 tsp fat/oil = 5 grams of FAT (45 kilocalories)
1 tsp sugar = 4 grams SUGAR (16 kilocalories)
  ¼ cup sugar = 50 grams SUGAR/50 grams CARBOHYDRATE (200 kilocalories)
  IF FIBER IS less than 5 grams, subtract from CHO
Ø  15 grams CHO = 1 slice bread/ ½ cup fruit cup milk/       =    60 KILOCALORIES1
Ø  ½ cup beans = less than 8 grams fiber + 7 grams PROTEIN
Ø  ¼ cup meat (1 oz)/1 cup milk = 7 grams PROTEIN + 1-10 grams FAT
Ø  Chicken/Fish = 1 gram FAT (9 kilocalories)
Ø  ½ cup beans = 1 gram FAT (9 kilocalories)
Ø  Red meat = 5 grams FAT (45 kilocalories)
Ø  Cheese = 10 grams FAT (90 kilocalories)
Ø  Nuts = 20 grams fat (180 kilocalories)
Ø  A new addition to the Food Labels is the amount of Trans Fats. Trans Fats are found in
hydrogenated fats and shortenings. This type of fat is now known to contribute to
cardiovascular disease
Ø  If consumers use the food labels when making food purchases, they will be promoting their
health through the inclusion of appropriate nutrient intake (proteins, carbohydrates, vitamins
and minerals) while reducing their risk of chronic illness through a reduction of fat, salt and
sugar and increase in fiber. Food labels used in conjunction with MyPyramid can be a highly
effective and ultimately simple means to promote health.
Ø  The health claims that can be made on food labels under the labeling law are as follows:
1.     Foods high in fiber may reduce the risk of cancer and heart disease
2. A low fat diet may reduce the risk of cancer and heart disease
3.  A low sodium diet may help prevent high blood pressure
4.  Foods high in calcium may help prevent osteoporosis
5. Folate leads to decreased neural tube defects
6.  Sugar alcohols reduce dental caries
7. Soy protein reduces cardiovascular disease.

Lesson 5: Nutritional Assessment

Nutritional Assessment
Nutritional Screening-process of identifying characteristics known to be associated with
nutritional problems.
METHODS:
² Anthropometric Assessments-determination of height and weight.
² HAMWI METHOD-short cut in determining IBW for adults:
ü IBW for males-106 pounds for 5 feet plus 6 pounds per inch over 5 feet
ü IBW for females-100 pounds for 5 feet plus 5 pounds per inch over 5 feet
Note: Add 10% for large frame. Subtract 10% for small frame.

Percent of IBW=current weight/ideal weight x 100

Percent of Weight Loss=usual weight-present weight/usual weight x 100
- Unplanned and/or recent weight loss of 10% in a period of 30 days is a risk factor for
malnutrition, while weight loss exceeding 20% is a high risk factor for surgical patients

² Body Mass Index (BMI) - ratio of weight to height:

BMI =weight in kg____
(height in meters)2

CALCULATING DBW of INFANTS

METHOD 1:
First 6 months
DBW (gm) = birth weight(gm) + (age in mo. X 600)
7 months up to 1 year
DBW (gm) = birth weight(gm) + (age in mo. X 500)

NOTE: if birth weight is unknown, allow 3000gm (full term) and 2500 gm (premature)
Ex. 9-month old infant whose birth weight is 3.5kgs . Answer. 8000 gms or 8 kilos

METHOD 2:
DBW(k) = (age in mo. / 2) + 3
CALCULATING DBW OF CHILDREN
DBW(k) = (age in years x 2) + 8
Example:
6 month old infant = 6/2 +3=6kg
7 year old child = 7x2=14+8= 22kg

1. BIOCHEMICAL ASSESSMENT

Ø many of the routine blood and urine laboratory tests found in patients’ charts are useful in
providing an objective assessment of nutritional status. Care should be taken in interpreting test
results for a number of reasons:
Ø There is no single available test for evaluating short-term response to medical nutritional
therapy.

Ø Some tests are not applicable to a person, e.g., serum albumin cannot be used to evaluate
protein status in patients with liver failure, because this test assumes normal liver function.
Ø Lab tests are to be conducted several times over a certain period to give more accurate
information compared to a single test.
ADVANTAGES:
1) They can detect early sub-clinical status of nutrient deficiency.
2) They identify specific nutrient deficiency.
3) They are independent of the emotional and subjective factors that usually affect the
investigator or reliability of the patient’s recollection.
DISADVANTAGES
1) They are expensive and time-consuming
2) Standards could vary with wide range
3) There may be problems in interpreting results. The significance and accuracy of results of
biochemical tests are related to standards of collection, method of transport/storage and the
actual technique used.

2. CLINICAL ASSESSMENT

Ø is the physical examination (P.E.) of an individual for signs and symptoms suggestive of
nutritional health and/or clinical pathology. Signs usually come late in the pathogenesis of a
disease, unlike biochemical tests that can detect early malnutrition states.
ADVANTAGES:
1) They can be performed in a large number of individuals in a short period of time.
2) They are less expensive; do not require
3) special equipment or laboratory set up.
4) Other clinical staff may perform physical examinations, given the proper training.
DISADVANTAGES:
1) Deficiencies may not be clearly manifested and specific; thus, needing further
investigation
2) Overlapping of deficiency states: the signs and symptoms may not be directly attributable
to a specific nutritional deficiency disease but may be produced by others
3) Bias of the observer: the interpretation might not be reliable due to high inter and
intravariability.
4) Bias of the observed or person being examined.

3. DIETARY ASSESSMENT

Ø There are several methods for collecting information regarding actual and habitual dietary
intake. Most commonly used data collected are food recalls and food frequency questionnaire
(retrospective) and food records (prospective).

Ø THE 24 HOUR FOOD RECALL

Ø in this method, the individual is asked by the interviewer to report all foods and beverages
consumed during the past 24 hours.
ADVANTAGES:
1) It is quick, takes about half an hour and it can be used with any age group.
2) Since it is retrospective, the patient does not modify his or her actual intake.
3) The information can be obtained by interview, telephone, or by self-reporting.
DISADVANTAGES:
1) They rely on the memory, motivation, and awareness of the person.
2) It is limited to 24 hours of intake, which may be not typical of his/her daily diet.
3) FOOD FREQUENCY QUESTIONNAIRE(FFQ)-is an easy form to follow, although it could be
time-consuming, depending on the number of pages listing foods and beverages to study the
food habits and choices of a person.

4. FOOD RECORDS

Ø these can provide a more realistic picture of a patient’s usual intake. All food items,
beverages, snacks, and supplements are recorded by the patient, usually over a period of 3 to 7
days using household measures. This method cannot be used for quantitative analysis of daily
diets.
Ø A 7-day food record is considered to be optimal for gathering this kind of information,
because it includes weekends. However, it tends to be rather tedious. Shorter periods like a 3-
day record ( two weekdays and one weekend day) may be acceptable.