Nutrition and Diet Therapy

Lecture 1
Introduction
This module will help you assess the individual’s nutritional status and provide individual education.
Fundamentals of Nutrition provides nutritional informations based on facts such as the relationship of nutrition and
health, planning a healthy diet, digestion, absorption, and metabolism and discuss the six essential nutrient groups.

Objectives:
 To defi ne basic nutriti on concepts such as nutriti on, health, wellness and nutrients.
 To learn how nutrients are absorbed and pass along the body.
 To explain the of the six essenti als nutrients and provide examples of each class.
 To cite the Nutrition Tools-Standards and Guidelines
 To list the food sources for each nutrient.
 To describe the health eff ects of each nutrient
 Utilize nutrient recommendations to assess, plan and evaluate nutrient intake.

Lesson 1. Basic Concepts and Definition

Objective: To define basic nutrition concepts such as nutrition, health, wellness, nutrients and principles

Optimal health and well-being require that the body be supplied with food in adequate and balanced amounts
to provide the nutrients vital for normal organ development and functioning; for cell reproduction, growth, and
maintenance; for high energy and working efficiency; for resistance to infection and disease; and for the ability to repair
tissue damage or injury. No one nutrient works alone; each nutrient is dependent on the presence of others to bring
desired results.

Although everyone needs the same nutrients, each individual requires different amount of eachnutrient
depending on the age, gender, physiological make-up and physical activity. Knowledgeabout good nutrition is important
because the quality of people’s lives and health depend on it.

1. Nutrition - is the process by which food is converted by the body into simple substances needed to build
and repair tissues, supply energy for physical activity and to support various body functions such as respiration,
digestion and elimination. Adequate nutrition is essential for good health.
 The result of process (digestion, absorption, and metabolism) take in (foods) and use for growth,
development and maintenance
 The study of food in relation to health.
 The study of food, the nutrient and other substances there action , interaction, and balance in relation
to health.
 Proper nutrition by eating right kind, right amount, and right time

2. Health - is “a state of complete physical, mental, and social well-being and not merelythe absence of disease and
infirmity” according to the World Health organization (1947).A more recent definition states that health is the
dynamic, ever-changing process of achieving potential in the physical, social, emotional, mental, spiritual,
andenvironmental dimensions.

3. Wellness – involves the satisfaction of a wide array of factors that lead to positive health.It is defined as “the
achievement of the highest level of health possible in each of severaldimensions. To achieve high-level wellness,
a person needs to move progressively on acontinuum of positive health indicators.

4. Food - refers to any edible material which when taken into the body can provide nutrients needed to support the
various body functions.
 Qualities of Food
o Safe to eat
o It’s nourishing or nutritious
 o It’s palatability factor
o It has satiety value
o It offer variety and planned
o It is free from toxic agent

5. Nutrients - are chemical substances derived from food which the body uses to build andrepair tissues, generate
energy and regulate body processes
 Function of Nutrients
o To provide energy
o To build and repair tissues
o To regulate life processes

 Biosynthesis nutrient is a nutrient manufactured in the body.

 Man made nutrient – useful in research and therapeutic purposes.

 Classification of Nutrient
o According to function – energy giving, body building, regulatory nutrient
o Chemical properties
A. Organic – carbon containing compound (CHO, CHON, FAT, Vitamin)
B. Inorganic – Mineral and water
o According to Essentiality (Essential and Noneessential)
A. Essential nutrients - a person must obtain from food because the body cannot make them
for itselfin sufficient quantity to meet physiologic needs
B. Nonessential nutrient a nutrient that can be manufactured in the body by means of other
nutrients. Thus, it is not essential to consume this nutrient regularly in the diet.
o According to Concentration
A. Macronutrient – large amount
B. Micronutrient – measure in milligram or fraction
o Energy-yielding nutrient – nutrients that break down to yield energy within the body, including
carbohydrates (4 kcal/gram, fat(9 kcal/gram), and protein(4 kcal)
 Alcohol = 7 kcal

6. Calorie - is the amount of heat produced or released when food is burned by the body cells. Calorie also refers to
the amount of energy required to “do work” or to perform certain physical activities.

7. Fuel or energy values of foods - Energy is the ability to do work and is measured in terms of calories. Foods
containing carbohydrate, protein and fat provide the body with energy. A gram of either carbohydrate or
protein gives approximately four calories ,whereas a gram of fat yields nine calories. Fat is a concentrated source
of energy.

8. Nutritional Status - Is a condition of the body resulting from utilization of essential nutrient
 Optimum or Good nutrition – body has adequate supply of nutrient
 Malnutrition (bad nutrition) – cause by over nutrition and undernutrition

Nutritional Deficiency
 Primary factor – Faulty diet – Lacking of quantity and quality.
 Secondary factor – GI disorder, Lack of appitite, lack of digestive enzyme.
 Physilogic and pathologic factor – Pregnancy, lactation, Illness and surgery
 Environmental factor – climate
 Lifestyle factor – heavy smoker, alcoholism
 Example of Deficiency diseases
 Iron deficiency anemia – lack of iron
 Rickets – poor bone formation due lack of calcium and Vitamin D
 Osteomalacia/Osteoporosis
 Goiter – lack of iodine
 Blindness – lack of vitamin A
Overnutrition
 Overeating
 Megadoses of vitamin and minerals

Cumulative effect of over nutrition

 Atherosclerosis
 Obesity
 Hypertension
 DM
 Gallbladder disease
 Personality disorder

Lesson 2: Nutrition Tools-Standards and Guidelines

Objectives:
 To identify the basic guidelines in promoting good nutrition.
 To discuss the principles of moderation, balance and variety in the Food Guide Pyramid.
 Utilize nutrient recommendations to assess, plan and evaluate nutrient intake.
 Apply principles in offering practical advice on how to eat for good health.
 Identify the various nutrients, its functions and food sources that are essential to health

1. Nutrient Recommendations
Dietary Reference Intakes - are a set of nutrient intake values that can be used to plan and evaluate dietary
intakes for healthy people
o Estimated average requirement - a daily nutrient intake value that is estimated to meet the
requirement half of healthy individual.
o Recommended dietary allowance – which are average daily dietary intake level sufficient to meet
the nutrient.
o Adequate Intake - a recommended intake value base on observed or expirementally determined
estimated nutrient intake by group healthy people that assume to be adequate.
o Tolerable upper intake level – the highest level of daily nutrient intake to pose no risk or adverse
health effects.
 Acceptable Macronutrient Distribution Ranges (AMDR) - healthy ranges of intakes for the energy-
yielding nutrients— carbohydrate, fat, and protein
USDA Standard
o 45 to 65 percent of kcalories from carbohydrate
o 20 to 35 percent of kcalories from fat
o 10 to 35 percent of kcalories from protein
FNRI Standard
o CHO = 50% - 60%
o Fats = 25% - 30%
o CHON = 10% – 15%
  WHO Nutrition Recommendations
World Health Organization (WHO) nutrition recommendations for adults
o Energy intake: Balance with energy expenditure; sufficient to support growth, physical activity, and a
healthy body weight (BMI between 18.5 and 24.9)
o Total fat: 30 percent of total energy
 Saturated fatty acids = 10 percent of total energy
 Monosaturated and Polyunsaturated fatty acids 19 prcent
 Trans-fatty acids: 1 percent of total energy
o Total carbohydrate: 55 to 75 percent of total energy
 Sugars: 5 - 10 percent of total energy, preferably 5 percent of total energy
o Protein: 10 to 15 percent of total energy
o Cholesterol: 300 mg per day
o Salt (sodium): 5 g salt per day (2 g sodium per day), appropriately iodized
o Fruits and vegetables: 400 g per day (about 1 pound); potatoes, sweet potatoes, cassava, and other
starchy root vegetables do not count toward this goal
o Total dietary fiber: .25 g per day from foods
o Physical activity: one hour of moderate-intensity activity, such as walking, on most days of the week
o Avoid unhealthy weight gain (greater than 11 pounds) during adult life
2. Dietary Guidelines and Food Guides
 Nutrients for Filipino
o Eat variety of foods
o Breast feed infant exclusively from birth to 4 – 6 months.
o Maintain children’s normal growth through proper diet
o Consume fish, lean meat, poultry and dreid beans.
o Eat more vegestables, fruits and root crops.
o Eat food cooked in edibled oil daily.
o Consume milk and milk products.
o Use iodized salt, but avoid excessive intake.
o Eat clean foods or free from toxic substances.
o Do not smoke and avoid excessive intake of alcohol
 Dietary Guidelines for Americans
o Balancing calorie to manage weight
 Prevent overweight and obesity through proper diet and physical activity
 Control total calorie intake to manage body weight
 Reduce time spent in sedentary behaviors
Adequate nutrient within calories needs
o Foods and Food Components to avoid
 Reduce daily sodium intake to less than 2300 milligrams
 Consume less than 10 percent of kcalories from saturated fatty acids
 Consume less than 300 milligrams per day of dietary cholesterol
 Eat trans fatty acid consumption as low as possible
 Reduce the intake of kcalories from solid fats and added sugars
 Limit foods that contain refined grains (fats, sugar and sodium)
 Consumed alcohol with moderation (adults of legal drinking age)
o Foods and Nutrients to Increase
 Increase intake of variety vegetable and fruit intake
 increase whole-grain intake
 increase intake of fat-free or low-fat milk and milk products
 Choose a variety of protein foods
 Use oils to replace solid fats aspossible
  choose foods that provide more potassium, dietary fiber,
calcium, and vitamin D
o Healthy eating habit
 The Food Pyramid - The food pyramid is a graphic translation of the
current “ Your Guide to Good Nutrition”. Base on usual dietary pattern
in general

 MyPlate - Visual pattern of the current basic five food groups—grains, vegetables, fruits, dairy, and
protein—arranged on a plate to indicate proportionate amounts of
daily food choices.
10 Tips to a great plate
o Balance calories
o Enjoy your food, but eat less
o Avoid oversized portions
o Eat more vegetables, fruits, whole grains, and fat-free or 1%
milk and dairy products
o Choose red, orange, and dark-green fruit and vegetable
o Switch to fat-free or low-fat (1%) milk
o Eat more whole grains than refined product
o Eat less foods high in solid fats, added sugars, and salt
o Drink water instead of sugary drinks

 Nutritional Labeling
1. Food labeling are primary means of communication between the
producer or manufacturer and the purchaser or consumer.
2. This is a description intended to inform nitritional properties.
Two Components of Nutritional labeling
 Nutritional declaration – a standard statement or listing
of nutrient content of food.
Example: Nutrients quantities declared
 Nutritional claim – implies that the food has some
nutritional properties.
Example ; “good source of fiber” on a box of cereal or
“rich in calcium” on a package of cheese
Purposes
 To make a wise choice by reading the level
 To convey the nutrient content
 Manufacturer not to mislead or decieve consumers
  Food Exchange List - Is a grouping of common food that have practically same amount of protien, carbohydrates
and fats. It is a tool in nutrition and used in meal planning, diet instruction and estimating energy and
macronutrient content.
Summary of Seven Exchange List (FNRI-DOST)
Food Group Measurement Carbohydrates gram Protein gram Fat gram Kcalories/exchange
1 gm of CHO = 4 Kcal 1 gm CHON = 4 1 gm = 9 Kcal
Kcal
Vegetable A 1 cup raw - - - Trace
½ cup cooked - - -
Vegetable B ½ cup raw 3 1 - 16
½ cup cooked 3 1 -
Fruit Varies 10 - - 40
Milk
Whole milk Varies 12 8 10 170
Low fat milk 4 tablespoon 12 8 5 125
Skimmed Varies 12 8 - 80
Rice Varies 23 2 - 100
Meat and Fish
Low fat Varies - 8 1 41
Medium fat Varies - 8 6 86
High fat Varies - 8 10 122
Fat 1 teaspoon - - 5 45
Sugar 1 teaspoon 5 - - 20

Example:
Rice Exchange
The Rice, rice equivalents, bread and bakery products to use for one rice exchange Each exchange or equivalent
contains approximately 23 grams of carbohydrate, 2 grams of protein and 100 calories.

Rice and Rice equivalent Measurement Carbohydrates Protein Fats Calories

1 exchange of rice - ½ cup (80 gm) 23 gm X 4 Kcal = 2 gm X 4 Kcal = 100 Kcal
cooked 92 Kcal 8 Kcal
2 exchanges of rice - 1 cup (160 gm) 46 gms X 4 Kcal = 4 gm X 4 Kcal = 200 Kcal
cooked 184 16 Kcal
1 exchange of Pan 2 slices (40 gm) 23 gm X 4 Kcal = 2 gm X 4 Kcal = 100 Kcal
amerikano 92 Kcal 8 Kcal

Meat Exchange
Each exchange of meat and meat equivalent contain 8 grams of protein. Meat and meat product has three sub-
groups based on the amount of fat: low fat meat (1 gm), medium fat meat (6 gm) and high fat meat (10 gm)

Meatand Equivalent Measurement Carbohydrates Protein Fats Calories

1 Exchange of low fat 1 slice, matchbox size 8 gm X 4 Kcal = 1 gm X 9 Kcal = 41 kcal
meat – chicken meat (5x3-1/2x1-1/2 cm) 32 Kcal 9 Kcal
Or 30 gm
3 exchanges of low fat 3 slices, matchbox 24 gm X 4 Kcal = 3 gms X 9 Kcal = 123 Kcal
meat – beef size or 90 gms 96 Kcal 27 Kcal
3 exchanges of high fat 3 slices (3cm cube) 24 gm X 4 Kcal = 30 gms X 9 Kcal = 366 Kcal
meat – pork liempo Or 105 gms 96 Kcal 270
Laboratory

Lesson 3; Proper tray service

 Principles of preparing and serving sanitary, palatable, and attractive meals apply to hospital, family and
commercial food service
 Food is prepared and served in a manner as retain and enhance natural flavor and conserve nutrients,
attracttive, microbiologically and chemically safe.
 Place settings are the dishes, flatware (cutlery), and glassware used by an individual for formal and informal
dining
Checklist for proper tray service
 Tray correctly identified with the patient’s name, ward and room number and right diet prescriptions.
 Size of tray to amount and kind of diet.
 Cover clean and neat, free from spoilage.
 Silverware and glassware free from grease marks, chips, and cracks.
 Arrange dishes and cover the prescripted diet
 Meal serve on time
 Serving portion according to dietary prescription
 Seasoning and food adjuncts correctly included
 Hot food serves hot, cold foods serve cold

Table Set-Up
Table setting refers to the way to set a table with tableware such as eating utensils and dishes for serving and eating
Standard of table set-up
1. Completeness
a. Tableware
b. Tablecloth or place mat
c. Condiment set-up or coffee, tea , sugar and creamer set-up
2. Cleaanliness and condition of equipments
a. Equipment must be sanitized, clean, wipe dry, free of spot and water marks
b. No wobby table and chair
c. No stain or chipped glasses
d. No damage or destorted cutleries
e. Linen is fresh and clean or no stain not wrinkled
f. Place mat is clean and no foul odor

3. Order
a. All equipment are place on appropriate side
 Table cloth is place on the table with overhangs of equal length on the opposite side and opposite end.
 Place mats placed parallel to the edge of rectangular table and an inch back or not overhang on the edge
of the table
 Napkins is arranged just to the left of the fork , or centered dinner plate at each cover or Napkin placement
depends on your preference
 Knife is just to the rigth of the service plate
 Spoon is place just to the right of the knife
 Fork is at the left of dinner plate; Knife, spoon, and pork arrange perpendicular and one
 inch to the edge of the table
 Service plate is placed on the center of individual cover
 Salad plate is position just above the fork
  Bread plate is just the left side of folded napkin/fork (optional)
 Glass for water is placed aboved the tip of the knife
 Beverage glass is positioned to the right of water glass
 Cup and saucers is placed top right of the service plate with the handle in 5 o’clock position (to be set-up
as order for lunch and dinner)
 Appropriate center piece (optional) – for eye appeal such flowers, candles, fruits, etc

Other Methods
1. Top Row From Left to Right
 Bread plate with butter knife (top left of dinner plate)
 Coffee cup (top right of dinner plate)
 Water glass
 Wine glass
 Liqueur glass

2. Bottom Row From Left to Right
 Salad fork
 Dinner fork
 Dessert fork
 Dinner plate with salad or soup bowl on it
 Knife
 Small spoon
 Soup spoon

CALAMBA DOCTORS’ COLLEGE

Virborough Subdivision, Parian, Calamba City, Laguna

Lecture 2

Nutritional Assessment
Objective: To collect basic data or nutritional status of the population to be used in planning, formulation and
modification of action program. Jdentify nutrition problem and extent of malnutrition
Lessons 4
 General Health History
 Anthropometric assessment
 Biochemical assessment
 Clinical assessment
 Dietary assessment

Nutrition Assessment - evaluates a person’s health from a nutrition perspective. Nutritional status or nutriture
is the degree to which individual’s psychobiological needs for nutrient is being met by the food the person eats..
Evaluation of nutritional status involves examination of physical condition, growth and development, behavior,
laboratory procedures, quantity and quality nutrient intake.

General Health History

 Present Health Status
o Chronic illnesses are associated with nutritional problems or require special dietary measures and
referral to a registered dietitian
o Medications that affect nutritional status. Some medications affect appetite; GI discomfort
o Use of vitamins and/or nutritional supplements as health promotion measures or to manage nutritional
deficiencies.
o Changing of weight or unusual weight loss and weight gain
  Past Health History and Family History
o Excessive weight gain (such as during a pregnancy) or weight loss with an illness
o Obesity in one or both parents makes an individual at higher risk for excessive weight gain (prime risk
factor for type 2 diabetes mellitus)
o Eating disorders most commonly occur during adolescence and may cause lingering deficiency-related
or psychologicrelated problems in adulthood

 Personal and Psychosocial History

o Physical activity (Children and adults should avoid inactivity)
o Individuals prescribed dietary plan to manage a health condition (Food intolerance or allergic to food)
o Problem for low income groups, the elderly, or those with disabilities
o Drugs or alcohol can contribute to nutritional deficiencies

 Common related problems

o Weight loss (last 6 month)
o Weight gain
o Difficulty chewing or swallowing
o Loss of appetite or nausea

Method of Nutritional Assessment

1. Anthropometric Assessment - are compared to standard including height and weight measurement,
measurement of head, upper arm and skin fold.

Computation of Desirable Body Weight

Hamwi Method – determining desirable body weight for adult.
DBW for male = 106 pounds for 5 feet plus 6 pounds for every inch.
DBW for female = 100 pounds for 5 feet plus 5 pounds for every inch.
Add 10% for large frame or subtract for small frame.

 Body frame - Height (in centimeters) divided by wrist circumference (in centimeters) provides an estimate of
body frame size
FRAME SIZE MALE RATIO FEMALE RATIO
Small >10.4 >10.9
Medium 10.4 to 9.6 10.9 to 9.9
Large <9.6 <9.9
Example:
Height: 5 ft. and 4 = 64 in X 2.54 cm/in = 162.56 cm
Wrist circumference 15.8 cm

162.56 / 15.8 = 10.29 medium frame

Note:
Increase of 20% due to fat is an indication of obesity, and decrease of 20% is nutritional risk, Unplanned weight
loss of 10% in 30 days is risk factor of malnutrition. And increase weight loss to 20% is high risk factor of surgical factor.

Usual weight - present weight

Percentage weight loss/gain = X 100
Usual weight

Example: Male, 30 year old, 5 feet and 4 inches tall and average body frame. Usual weight was 60 kg and current weight
is 50 kg (weight loss in 4 weeks)

60 Kg - 50 kg
----------------------- X 100 = 20% weight loss
50 Kg

Example: Male 30 year old. 5 feet and 4 inches tall and average body frame
5 feet = 106 lbs
4 inches = 24 lbs
---------------
DBW 130 lbs or 59.09 Kg

Example: Female 20 year old, 4 feet and 10 inches tall and average body frame
5 feet = 100 lbs
4 inches = 20 lbs
-------------------
120 lbs or 54.54 Kg

Ador Dionisio’s Method – Determining desirable body weight by height with age consideration
Height
DBW for male = 110 pounds for 5 feet plus 2 pounds for every inch.
DBW for female = 100 pounds for 5 feet plus 2 pounds for every inch

Age
Multiply age 25 – 50 by 2 then divided by 5

Example: Male 30 year old. 5 feet and 4 inches tall and average body frame
5 feet = 110 lbs
4 inches = 8 lbs
30 X 2 / 5 = 12 lbs
--------------
DBW 130 lbs or 59.09 Kg

Example: Female 30 year old, 5 feet and 4 inches tall and average body frame
5 feet = 100 lbs
4 inches = 8 lbs
30 X 2 / 5 = 12 lbs
-------------------
120 lbs or 54.54 Kg

Tannhauser’s Method – Determining DBW of adult (25 years above) by height in centimeter and deduct 100. From the
difference takes off 10%
Example: Male 30 year old. 5 feet and 4 inches tall and average body frame
Height = 5 feet and 4 inches tall (64 inches X 2.54 = 162.56 cm)
= 162.56 cm – 100 cm
= 62.56 – 10% (6.256)
= 56.30 Kg
Body Mass Index - is a weight-to-height ratio that is significantly correlated with total body fat
Measure height and weight for body mass index (BMI).
BMI <18.5:  underweight
BMI 18.5-24.9. normal
BMI 25-29.9: overweight
BMI 30-34.9: obesity class I
BMI 35-39.9: obesity class II
BMI >40:  obesity class III (extreme obesity)

Calculation Using Kilograms and Meters

BMI Weight kg /Height M²
Example: A woman is 5 feet and 2 inches tall or 1.574 meters tall and weighs 50 Kg (110 lbs)
50 / 1.574² (2.477)
50 / 2.477 = 20.18 or Normal BMI

Calculation Using Pounds and Inches

BMI Weight (lb) X 705 / Height in Inches²
Example: A woman is 5 feet and 2 inches tall or 62 inches tall and weighs 110 pounds
110 X 705 = 77,550 / 62² = 3,844
77,550 / 3,844 = 20.17 or Normal BM!

Waist-to-hip ratio is an indication of risk of unhealthy fat distribution. Ratio that exceeds the desired ratio indicates
upper body obesity and increases the risk of developing health problems 
Waist-to-hip ratio for women is 0.8 or less and for men is 1 or less
Waist (inches or cm) /Hips inches or cm
Example, Female has a 42-inch (107 cm) waist and 37-inch (94 cm) hips,
107cm / 94cm – 1.14 waist-to-hip ratio

Measure triceps skin fold thickness

 Standard reference is 13.5 mm for men and 16.5 mm for women
o Less than 90% indicate a loss of fat or moderately malnourish
o Less than 60% indicates severe malnourishment.
o Greater than 130% indicate obesity

Biochemical Assessment
 Are routine blood, stool and urine test, a deficiency or toxicity can be determined by laboratory analysis
o Serum albumin level
o Serum transferrin level
o Blood urea nitrogen
o Creatinine excretion - Kidney
o Hgb/Hct - Hydration
o Serum creatinine – Kidney function,
o Lipid profile - Cholesterol
o Urinalysis – test glucose, protein
Advantages of chemical assessment
o Can detect early sub-clinical status
o Identify specific nutrient status
o Independent of emotional and subjective factors by the investigators
Clinical Assessment
 Clinical assessment is the physical examination of an individual for S/S by the physician, or clinical staff.
 Examination of anatomic changes, like skin, eyes, hair, buccal mucisa, or organ system.
Advantages
o Can be performed in large number of individuals
o Less expensive
Body parts Signs Deficiency
Hair Lusterless, thinness, easy pluck Severe protein deficiency
Face Moon face Riboflavin, Severe protein deficiency
Eye Pale conjunctiva Anemia
Xeropthalmia Vitamin A
Lips Cheilosis Riboflavin
Teeth Mottle enamel Fluorine
Gums Bleeding Ascorbic acid
Thyroid Enlargement of thyroid gland Iodine
Tongue Magenta tongue Riboflavin
Skin Dermatosis Vitamin A, Ascorbic Acid, Nicotinic acid, Riboflavin
Nail Koilonychia Iron
Subcutaneous Edema Severe protein deficiency

Dietary Assessment
 Is an evaluation of food habit intake.
o 24 hour food recall – Individual is asked by the interviewer to report all foods and beverages consumed
during past 24 hours
o Food frequency questionaire (retrospective) – easy form to follow a list of food and beverage to study food
habit and choices of a person.
o Food record (prospective) –All food items, beverages, snacks and supplements are recorded by the patient
usually over a period of 3 to 7 days
24 hour recall question pattern
1. What time did you go to bed the night before last?
2. What time did you get up yesterday
3. When was the first time you had anything to eat or drink. What did you have and how much?
4. When did you eat again, where, when and how much?
5. Was this day’s food intake different from usual. If yes why?
6. Is weekend eating defference. If yes, why?

Lessons 5

Energy Balance

Energy and Energy Balance

Energy is defined as the capacity to do work, and every cell needs energy for involuntary activity (circulation,
respiration, digestion, and absorption) and voluntary activity (ADL and Exercise). To obtain the potential energy fuel
from food, oxygen is needed.
 Bomb calorimeter used to measure the energy value of food derived from carbohydrates, fats, and proteins.
The energy is produced by oxidation of carbon to CO2, hydrogen to water, and nitrogen to nitrous oxide.

Measurement of Energy
Kcal– the unit of measuring energy in foods (Joule-metric system)
1 Kcal = 4.184 joule
1 gm of carbohydrates = 4 Kcal =17 J
1 gm of fats = 9 Kcal = 38 J
1 gm of protien = 4 Kcal = 17 J
Example: Cake contains 24 gms protein, 8 gm fat, and 120 gm carbohydrate will provide the following calories.
24 gms protein X 4 Kcal = 96 Kcal
8 gm fat X 9 Kcal = 72 Kcal
120 gm carbohydrate X 4 Kcal = 480 Kcal
Total 648 Kcal
Percentage of Kcal
Protein
96 Kcal
---------- = 0.15 X 100 = 15%
648 Kcal
Fats
72 Kcal
--------- = 0.11 X 100 = 11%
648 Kcal

Carbohydrates
480 Kcal
----------- = 0.74 X 100 = 74%
648 Kcal

Note: FNRI Standard

o CHO = 50% - 60% (70% for low income)
o Fats = 25% - 30%
o CHON = 10% – 15%

Energy Needs
Energy requirement depends upon 3 factors
1. Basal metabolism (BMR) or resting energy requirement (REE)
2. Physical activity
3. Thermal effect on food (TEF) or specific dynamic action of food (SDA)

Basal Metabolic Rate (BMR) or Resting Energy Expenditure is the rate at which your body burns calories. BMR is the
minimum calorific requirement needed to sustain life in a resting individual. Calories are burned by bodily processes
such as respiration, the pumping of blood around the body and maintenance of body temperature.

Condition necessary for determining basal metabolism

1. Be in a fasting atleast 12 hours after last meal
2. Be awake, lying, free from physical fatigue, nervousness or tension
3. Environmental temperature should between 20 -25 ⁰C
Calorimetry should be used for accurate measurement of BMR. Value obtained within + 10% are still considered normal.

Other methods
A. Rule of thumb
1 Kcal per kg (DBW) X 24 hours = for male
0.9 Kcal per Kg (DBW) X 24 hours = female
Example: 50 Kg (DBW) X 1 Kcal X 24 hours = BMR = 1200 Kcal/day

B. Harris-Benedict formula – using weight, height, age, and sex.

REE = 66 + [13.75 X wt. (Kg) ] +[5.0 X ht (cm)] - [6.75 X age (year)] = for male
REE = 655 + [9.56 X wt. (Kg) ] +[1.85 X ht (cm)] - [4.68 X age (year)] = for female
Example: Male, 50 kg, 158 cm, 25 years
REE = 66 + [13.75 X 50. (Kg) ] +[5.0 X 158 (cm)] - [6.75 X 25 (year)] = for male
REE = 66 + [687.5 ] +[790] - [168.75] = 1375 Kcal/day

C. Metabolic or Fat free body size

REE of Man’s wt = Metabolic body size X 70 = REE
Example: 50 kg
A 50 kg of male’s REE = 18.18 X 70 = 1316Kcal

D. WHO method
REE = 11.6 X wt (kg) + 897
Example: 50 kg
REE = 11.6 X 50 + 897 = 1459 Kcal

Factors that affect BMR

 Genetics. Some people are born with faster metabolisms; some with slower metabolisms.
 Gender. Men have a greater muscle mass and a lower body fat percentage. This means they have a higher
basal metabolic rate.
 Age. BMR reduces with age. After 20 years, it drops about 2 per cent, per decade.
 Weight. The heavier your weight, the higher your BMR. Example: the metabolic rate of obese women is 25
percent higher than the metabolic rate of thin women.
 Body Surface Area. This is a reflection of your height and weight. The greater your Body Surface Area factor,
the higher your BMR. Tall, thin people have higher BMRs. If you compare a tall person with a short person of
equal weight, then if they both follow a diet calorie-controlled to maintain the weight of the taller person,
the shorter person may gain up to 15 pounds in a year.
 Body Fat Percentage. The lower your body fat percentage, the higher your BMR. The lower body fat
percentage in the male body is one reason why men generally have a 10-15% faster BMR than women.
 Diet. Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by up to 30 percent.
Restrictive low-calorie weight loss diets may cause your BMR to drop as much as 20%.
 Body Temperature/Health. For every increase of 0.5C in internal temperature of the body, the BMR
increases by about 7 percent. The chemical reactions in the body actually occur more quickly at higher
temperatures. So a patient with a fever of 42C (about 4C above normal) would have an increase of about 50
percent in BMR.
 External temperature. Temperature outside the body also affects basal metabolic rate. Exposure to cold
temperature causes an increase in the BMR, so as to create the extra heat needed to maintain the body's
internal temperature. A short exposure to hot temperature has little effect on the body's metabolism as it is
compensated mainly by increased heat loss. But prolonged exposure to heat can raise BMR.
 Glands. Thyroxin (produced by the thyroid gland) is a key BMR-regulator which speeds up the metabolic
activity of the body. The more thyroxin produced, the higher the BMR. If too much thyroxin is produced (a
condition known as thyrotoxicosis) BMR can actually double. If too little thyroxin is produced (myxoedema)
 BMR may shrink to 30-40 percent of normal. Like thyroxin, adrenaline also increases the BMR but to a lesser
extent.
 Exercise. Physical exercise not only influences body weight by burning calories, it also helps raise your BMR
by building extra lean tissue. (Lean tissue is more metabolically demanding than fat tissue.) So you burn
more calories even when sleeping.

Physical Activity – Calorie requirement depend on the type and amount of exercise. The more vigorous the physical
workthe greatest calorie needs. The kind of physical activity and and amount of time spent determine the of energy the
body uses.
Calorie Expenditure for Type of Activity (Cruz-Caudal)
Type of Activity Calorie/hour
Sedentary – reading , writing, eating, watching TV, office work, sitting at work 80-100
Light Activity – cooking, washing dishes, ironing, welding, standing at work, rapid typing 110-160
Moderate Activity – Mopping, scrubbing, gardining, walking fast, sweepping 170=240
Heavy activity – heavy scrubbing, running, bowling, walking fast, boxing golf. 250-350

Specific dynamic action(SDA) or Thermal effectof food (TEF) - When food is ingested, digested, absorbed and
metabolized, basal metabolism is increase by 10% due to stimulating effect of chemical product of food. For mixed
filipino diet used 6% for SDA/TEF.

Estimating Total Daily Energy Needs

Method 1.(Practical Method) Based on desirable body weight according to occupation or activity.
Example: A 50 Kg adult X 40 (moderate activity) = 2000 Kcal/day

Approximation for daily calorie needs according to physical activity (Jamorabo- Ruiz)
o Level of activity Male Female Average
o Bed patient 25
o Sedentary 31 30 30
o Light 38 35 35
o Moderate 41 37 40
o Heavy 50 44 45
o Strenuous 58 51 50

Method 2. BMR + PA + SDA

Step 1. Calculate the basal metabolism
Step 2. Calculate the energy needs for physical activity or making a record of all activities for a 24 hours period
Step 3. Add result of step 1 and step 2 result then add SDA/TEF

Total Energy = BMR + PA + SDA

Example: Male, 50 kg, 158 cm, 25 years, PA energy of 20 Kcal/hour and SDA/TEF is 6%
Step 1 Calculate the basal metabolism using Harris Benedict formula
REE = 66.+ [13.75 X wt. (Kg) ] +[5.0 X ht (cm)] - [6.75 X age (year)] = for male
66 + [687.5 ] +[790] - [168.75] = 1375 Kcal/day
Step 2 Calculate the energy needs for physical activity for a 24 hours period
20 (Total PA Kcal/24 hrs) X 50 kg = 1000 Kcal
Step 3 Add result of step 1 and step 2
1375 + 1000 = 2375 Kcal
SDA/TEF = 2375 X 0.06 = 142.48 Kcal
Total Energy = BMR + PA + SDA = 1375 + 1000 + 138.48 = 2517.48 Kcal/day or 2,500 Kcal/day
Method 3. Cruz-Caudal Method
Step 1 Determine your height and Desirable Body Weight (Convert pounds into kilogram)
Step 2 Calculate BMR by Rule of Thumbs
BMR = 1 kcal (male) or 0.9 Kcal (female) X DBW X 24

Step 3 Estimate physical activity (Cruz-Caudal)

Calculate approximate percentage according to basal metabolic needs
(lower factor for women)
Bed Rest 10 – 20 percent
Sedentary 30 - percent
Light Activity 50 – 60 percent
Moderately Active 60 – 70 percent
Severely Active 90 – 110 percent

Step 4: Add value from Step 2 and step 3. Round off the total calories to nearest 50

Example: Female, 20 year old, 5 feet and 2 inches tall with light physical activity. Use HAMWI method to calculate the
Desirable body weight.
Step 1 (DBW) 5 feet and 2 inches tall = 100 + 10 = 110 pounds and covert to Kilogram. 110 lbs / 2.2 = 50 Kg

Step 2 (BMR) 0.9 Kcal X 50 X 24 = 1,080 Kcal

Step 3 (PA) 1,080 Kcal X 50% = 540 Kcal

Step 4 (Total Energy) 1,080 Kcal + 540 Kcal = 1,620 Kcal

Method 4 MIFFLIN-ST. JEOR1

 Men TEE (kcal/day) = (10 × weight [kg] + 6.25 × height [cm] – 5 × age [yr] + 5) × PA
 Women TEE (kcal/day) = (10 × weight [kg] + 6.25 × height [cm] − 5 × age [yr] − 161) × PA

PA Coefficient for Men and Women Applicable to Both

 1.200 = Sedentary (little or no exercise; desk job)
 1.375 = Light active (light exercise/sports 1 to 3 days/wk)
 1.550 = Moderate active (moderate exercise/sports 3 to 5 days/wk)
 1.725 = Heavy exercise (hard exercise/sports 6 to 7 days/wk)
 1.800 = Injury factor

Energy Imbalance
The percentage of body fat and lean body mass varies with factors like age, sex, genetic make-up, and size of fat.
An adult male has 14-28% fat of total body weight, in women about 15-29%. Some methods of determining body fat
such skinfold, hip and height measurement for women, waist and weight measurement for women

Underweight a person body weight is 10% lower than IBW/DBW, The term overweight is DBW more than 10% of
weight or more in a form of body fats (obesity).

The principle of weight reduction is base on, a deficit of 3500 Kcal for 7 days (500 Kcal) sustain a weight loss of 1
lbs per week with increasing physical activity. To gain weight eats an additional 500 Kcal per day.
Energy expenditure per pound per hour during various activities
Calculating Diet and Meal Planning
Sample Only

Female, 20 year old, 5 feet and 2 inches tall, medium built and performing moderate activity

1. Calculate 5 feet and 2 inches tall for desirable body weight using Hamwi methods, then convert DBW in
kilogram.
a. 5 feet (100 pounds) plus 2 inches (2 x 5 =10 pounds, equals to 110 pounds divide by 2.2 pounds to
covert 50 Kgs

2. Calculate Basal needs using Rule of Thumbs, 0.9 Kcal X 50 Kg (DBW) X 24 hours = 1,080 Kcal

3. Calculate energy requirement for moderate physical activity 1,080 Kcal X 60% (0.6) = 648 Kcal

Calculate approximate percentage according to basal metabolic needs

(lower factor for women)
Bed Rest 10 – 20 percent
Sedentary 30 - percent
Light Activity 50 – 60 percent
Moderately Active 60 – 70 percent
Severely Active 90 – 110 percent

4. Calculate total energy allowance

Basal metabolic needs 1,080 Kcal + Physical activity 648 Kcal = 1,728 Kcal
1,728 Kcal Kcal round to the nearest 50 = 1,750 Kcal Kcal
5. Distribute the total energy allowance 55% carbohydrates, 15% for protein and 30% for fat (Macronutrient
distribution allowance is depends on client needs)
Carbohydrates (TEA) 1,750 Kcal Kcal X 0.55 = 962.5 Kcal
Protein (TEA) 1,750 Kcal Kcal X 0.15 = 262.5 Kcal
Fats CTEA) 1,750 Kcal Kcal X 0.30 = 525 Kcal
(Checking) = 1,750 Kcal

6. Calculate the numbers of grams for carbohydrates, protein and fats by dividing the calories for each nutrient
according to physiologic value. 1 gm of CHO = 4 Kcal, 1 gm of CHON = 4 Kcal, and 1 gm of Fats = 9 Kcal, Then
round off to the nearest 5.
Carbohydrates (55%) 962.5 Kcal / 4 = 240.62 grams 240 gm
Protein (15%) 262.5 Kcal / 4 = 65.62 grams 65 gm
Fats (30%) 525 Kcal / 9 = 58.33 grams 60 gms

7. For simplicity and practicality, round off the total energy allowance to the nearest 50 and carbohydrates, protein
and fats should be round off to the nearest 5.
Prescribed diet:
 Total energy allowance = 1,750 Kcal
 Carbohydrates = 240 grams
 Protein = 65 grams
 Fats = 60 grams

8. Design your meal plan using food exchange list and taking into consideration your food preferences
 Use table for the meal plan
 Determine the number of exchange you can eat for vegetables A and B (allowable 2-3)
 Determine the number of exchange for fruits (Reasonable 3 – 4)
 Determine the number of exchange for milk ( Depends on type, needs, habit, economic condition)
  Determine the amount of sugar desired (5-9 teaspoon per day if not contraindicated)

Food Group Measurement Carbohydrates gram Protein gram Fat gram

1 gm of CHO = 4 Kcal 1 gm of CHON = 4 Kcal 1 gm of Fats = 9 Kcal
Vegetable A 1 cup raw - - -
½ cup cooked - - -
Vegetable B ½ cup raw 3 1 -
½ cup cooked 3 1 -
Fruit Varies 10 - -
Milk
Whole milk Varies 12 8 10
Low fat milk 4 tablespoon 12 8 5
Skimmed Varies 12 8 -
Rice Varies 23 2 -
Meat and Fish
Low fat Varies - 8 1
Medium fat Varies - 8 6
High fat Varies - 8 10
Fat 1 teaspoon - - 5
Sugar 1 teaspoon 5 - -

Meal Plan
Food No. of CHO CHON FATS Energy Meal Distribution
Exchange Exchange gm gm gm Kcal Breakfast Lunch Dinner Snack
Vegetable A 1
Vegetable B 2 2X3=6 2X1=2
Fruits 4 4 X 10 = 40
Milk: Whole
Low fat 3 3 X 12 =36 3 X 8 =24 15
Skimmed
Sugar 8 8 X 5 = 40
Rice
Meat: Low fat
Medium
High fat
Fat
Total 122
 Subtotal the amount of carbohydrates, protein and fats
Carbohydrates – 122 grams, protein = 26 grams and fats = 15 grams
 Subtract the amount of carbohydrates provided by vegetable, fruits, milk and sugar from prescribed dietary
allowances. Divide the result by 23 which is the amount of carbohydrate in rice exchange
240 – 122 = 118 / 23 = 5.13 or 5
Food No. of CHO CHON FATS Energy Meal Distribution
Exchange Exchange gm gm gm Kcal Breakfast Lunch Dinner Snack
Vegetable A 1
Vegetable B 2 6 2
Fruits 4 40
Milk: Whole
Low fat 3 36 24 15
Skimmed
Sugar 8 40
Rice 5 5 X 23 = 5 X 2 =10
115
Meat: Low fat
Medium
 High fat
Fat
Total 237 36
Subtotal the amount of protein then subtract from the prescribed protein allowance and divide the result by 8 to get the
number of meat exchange prescribed
65 – 36 = 29 /8 = 3.6 ( 3 ½ or 4)
Food No. of CHO CHON FATS Energy Meal Distribution
Exchange Exchange gm gm gm Kcal Breakfast Lunch Dinner Snack
Vegetable A 1
Vegetable B 2 6 2
Fruits 4 40
Milk: Whole
Low fat 3 36 24 15
Skimmed
Sugar 8 40
Rice 5 115 10
Meat: Low fat
Medium 3½ 3 ½ X 8 = 28 3 ½ X 9 =21
High fat
Fat
Total 260 64 36
 Subtotal the amount of fats then subtract from the total fat prescribed and divide the result by 5 to get the
number of fat exchange prescribed
60 -36 = 24 /5 = 4.8 (4 ½ or 5)
 The number of exchange obtained will be used for planning your menu. Distribute these exchanges into
breakfast, lunch, dinner and snacks. Use table for sample menu

Final table
Food No. of CHO CHON FATS Energy Meal Distribution
Exchange Exchange gm gm gm Kcal Breakfast Lunch Dinner 2 Snacks
Vegetable A 1 1
Vegetable B 2 6 2 32 1 1
Fruits 4 40 160 1 1 1 1
Milk: Whole
Low fat 3 36 24 15 375 1 2
Skimmed
Sugar 8 40 160 1 2 2 3
Rice 5 115 10 500 2 1 1 1
Meat: Low fat
Medium 3½ 28 21 301 1 1½ 1
High fat
Fat 5 25 225 1 1 1 2
Total 31½ 237 gm 64 61 1,753 Kcal 7 7½ 7 8
(Checking) 948 256 549 1,753 Kcal

Sample Menu - Breakfast

Food Group No. of Menu
Exchange
Fruits 1  1 piece banana ( fruit exchange)
 Coffee, 4 tablespoons of powder low fat milk. 1 teaspoon of
sugar in mug or glass with hot water ( 1 milk, 1 sugar
exchange)
 4 slices of breads (2 rice exchanges)
 1 piece fried scramble egg ( 1 medium fat meat and 1
exchange of fat)