Estimated Average Requirement (EAR) (GROUP1)

Definition

The amount of a nutrient that is estimated to meet the requirements for a particular requirement of adequacy of half of
the healthy individuals of a specific age, gender, and life stage

- Because it is based on a group estimate, the EAR is ineffective as an estimate of nutritional adequacy in
individuals
- Ear represents a nutrient intake value that is estimated to meet the requirement of half the healthy individuals
in a group
- Half of individuals consuming the ear will not meet their nutrients needs; the EAR is used to establish the RDA

Two Main Reasons

1. To serve as the foundation for determining an individual’s recommended intake

2. To assess the adequacy of intakes of similar population groups

Concept

- The concept of establishing an average requirement, and assuming that the requirements of individuals in a
population of similar people are symmetrically (or normally) distributed, is not new
 Recommended Dietary Allowance (RDA) (GROUP 1)

Definition

Recommended Dietary Allowance are the daily nutrient recommendations to satisfy the nutritional requirements of
nearly all healthy people in a specific age and gender group
Add. Info:
Importance > Child’s body absorbs nutrients faster
> Male adult = 2300 – 2900kcal
- Applies to vitamins and minerals from food and daily supplements > Female adult = 1900 – 2200kcal

- Informs how much of a specific nutrient a body needs on a daily basis

- It is important to meet daily recommended dietary allowances so that the body gets everything it needs to
function

Factors that Affect Nutritional Supplements Needs

1. Age – important determinant of nutritional needs

2. Gender – significant impact on nutrient requirements
3. Diet – provides a lot of information about potential nutrient shortfalls
4. DNA
5. Medications

Application of RDA

- To guide for advising healthy individuals to achieve adequate nutrient intake and on nutrition problems in
connection with national defense
- Underlying all uses of the RDAs is the recognition that humans are highly adaptable
x Throughout its existence, human species has developed regulatory and storage mechanisms that permit
it to survive in a variety of environments and withstand period of deprivation
 Adequate Intake (GROUP 2)

Definition

- Daily average nutrient intake level; based on approximations of mean nutrient intake level by group of healthy
people
- Average nutrient intake of healthy people is assumed to be adequate for the population’s requirement
- Individuals can meet their nutrient needs, which is required to maintain good health status, proper growth and
development and overall nutritional well-being
- Set in different ways for different nutrients and its relationship to the requirement for the nutrient is unknown,
it cannot be used to estimate the proportion of the population with inadequate intake

Importance

- In the lack of sufficient scientific data to determine an Estimated Average Requirement and set an RDA,
adequate intake becomes a critical guidance
- A nutrient’s adequate intake is established after extensive research and observation
- Adequate intake may therefore be used as a target for a person’s intake and to satisfy the body’s demand for a
particular nutrient in the lack of RDA
- When RDA is unavailable, an adequate intake is assumed to match the needs of people of the same gender and
life stage

Effects

- An adequate intake of minerals is essential for a high national quality of the diet and contributes to the
prevention of chronic nutrient-related disease and degenerative diseases including cancer, cardiovascular
disease, Alzheimer’s disease, and premature aging

Parameters of Adequate Intake

- Groups with mean intakes at or above the AI for nutrients with adequately determined Ais can be pressured to
have a low prevalence of insufficient intakes
- When the AI is based directly on intakes of healthy people, this may be applied with confidence
-
 Upper Tolerable Intake (GROUP 2)

Definition

Maximum daily food intake that is most likely to not put almost all members of the general population at risk for
negative health impacts

Exceeding the UL

 Infant
 Vitamin D – hypercalcemia and hypercalciuria
 Fluorine – neurological problems
 Children
 Phosphorus – hyperphosphatemia
 Magnesium – kidney disease, irregular heart rhythm
 Fluoride – dental fluorosis
 Male and Female
 Phosphorus – hyperphosphatemia
 Magnesium – magnesium overdose
 Fluoride – dental fluorosis, skeletal fluorosis
 Thyroid problems
 Pregnancy
 Niacin
 Iron
 ‘Hidden hunger’ – poor diet leads to a deficiency of micronutrients such as iron, iodine, and folic acid
 Lactation
 Calcium – hypercalcemia
 Magnesium – nausea, abdominal pain and diarrhea
 Vitamin D – nausea and vomiting, weakness and frequent urination

Conclusion

- Tolerable Upper Intake (IL) is not an acceptable intake level

- It is intended to specify the level above which the risk of harm begins to rise, and is defined as the highest
average daily intake of a nutrient that is likely to pose no risk of adverse health effects for nearly all people in
the general population
 Nutritional History (GROUP 3)

Definition

- Traditional method of analysis of food intake

- Consists of three components that provides an overall information of the usual food consumption pattern
- Information is collected in an interview and requires highly experienced qualified interviewers

Purpose

- To determine how much information to obtain and dispense at each visit based on patient’s condition, how
often the patient visits the office and how motivated the patient is to make changes
- A nutrition history will heighten patients’ awareness of nutritional health and indicate to them that their
physician is concerned about it
- A nutrition history also emphasize that diet is an important part of health maintenance

Importance

- A healthy diet can help prevent disease and lengthen one’s life

Categories of Nutritional Assessment

 Dietary Assessment
 Analyses of diets, food accessibility, and eating behaviors
 Collection of information on foods and drinks that an individual has consumed over a specific range of
time
 Anthropometric Assessment
 Measurements of the general composition and physical dimensions of an individual’s body
 Clinical Assessment
 Physical examination and medical history to examine for signs and symptoms of malnutrition
 Biochemical Assessment
 Nutrient reserves, functional forms, excretion forms, and/or metabolic processes
 Sociological Assessment
 Gathering of data on factors may have contributed to nutrition that are known to have an impact on or
to be connected to nutritional status

Assessment of Nutritional History

- A set of question is designed to identify major sources of saturated fat and give the physician an overall sense of
a patient’s eating habits
- Each question in the form has a corresponding explanation with its connection to nutrition and health of the
patient
 Dietary Intake Data (GROUP 3)

Definition

Information about an individual’s eating pattern which includes specific food consumption, total calories consumed, and
relative quantities

Purpose

- To help determine the nutritional needs of an individual and the best way to meet them
- Each individual will have specific nutritional needs based on eating patterns, amount of energy used in activities
of daily living, and overall health status

Importance

- Making choices at the state and municipal levels as well as the national level, requires the use of cumulative and
standardized data on dietary intake, nutritional status, and health indicators

Methods

 24-Hour Dietary Recall

 Dietary history
 Food Frequency Questionnaire
 Observation of Food Intake
 Nutrient Intake Analysis (GROUP 4)

Nutrition Assessment

- Thorough assessment performed by registered dietitian

- Determine nutrition status using a person’s medical, social, nutritional, and medication histories, physical
examination, anthropometric measurements, and laboratory data

Dietary Intake

- Assessed either by collecting retrospective intake data as with a 24-hour recall or food frequency questionnaire
or summarizing prospective intake data
- Each method has specific purposes, strengths and weaknesses

Methods

 Daily Food Record/Food Diary

 Food frequency questionnaire
 24-hr recall method
 Nutrient Intake Analysis (NIA)
 Checklist
 Diet histories
 Observed food consumption

Nutrient Intake Analysis

- Allows actual observation of food in clinical settings; it doesn’t account for possible variation in portion size and
hasn’t reflect intake of free-living individual
- A NIA should be recorded for at least 72 hours to reflect variations in intake that may occur from day to day
- May also be referred to as a nutrient intake record or calorie count; tool sued in various inpatient settings to
identify nutritional inadequacies by monitoring intakes before deficiencies develop
- It should be kept in mind that eating habits or meals consumed during the weekend and during the week may
differ
- Tribe feeding, either parenteral or enteral is also recorded

Steps of A Nutrient Intake Analysis

Step 1: Collection of the dietary intake data

- Through on this information has been useful in cardiovascular disease risk prediction and also consuming a
nutrient dense was associated with a low risk of all-cause mortality

Step 2: Analyzing the data using computer analysis

- The advantages of using data analysis software include being freed from manual and clerical tasks, saving time,
being able to deal with large amounts of qualitative data, having increased flexibility, and having improved
validity and auditability of qualitative research

Importance

- Many people treat their nutrition with a cavalier approach that involves a lot of guessing about what they should
and should not be consuming

Purpose

- To detect nutrition-related concerns, their causes, and their signific, data must be collected, verified, and
interpreted
 Food Diary (GROUP 4)

Definition

- A daily log of what you eat and drink each day

- A method of mindful eating
- A path to improved health

Importance

- Weight loss - Records food buddies

- Helps hold self, accountable to controlling - Increase awareness of food intake
intake of food - Controls food intake
- Help detects allergic reactions - Help compare perception to reality
- Eating healthy - Motive to accomplish goals
- Analyze eating habits - Diversify meals
- Keeps track of calories

Basic Rules

- Write everything down

- Do it now
- Be specific
- Keep track
- Estimate amounts

What should be in a food diary?

- Time
- Place
- Kind
- Activity
- Amount
- Mood

Components of Food Diary

- Date quantities
- Food description
- Meal designation
- Time consumed
- Notes
 Physical Assessment (GROUP 5)

Anthropometric Measurements

Anthropometry Anthro – man

- pometry means measurements
- Science of obtaining systematic measurements of the human body
- Developed in 19th century as a method employed by physical anthropologists to study human variation and
evolution in living and extinct populations
- Historically been used to associate racial, cultural, and psychological attributes with physical properties
- Involves the size, structure, and composition of humans

Ancient Anthropometric Measurement

- Rome, Greece and Egypt used anthropometric measurements for cultural purposes to represent beauty, power,
and other desirable attributes of the human form
- Symmetry was particularly desirable, and units of measurement often consisted of the “width of a human hand”
or “length of a human foot”

Anthropomorphic Measurements during the Renaissance

- Artists during renaissance applied anthropometric measurements to artistic works by applying human
proportions
- Leonardo da Vinci – obtained measurements by analyzing cadavers
- Other artists relied on live models and historical achievements to obtain accurate anthropometric
measurements

Height and Weight

- Two measurements that are closest toe ach other should be averaged
- A stadiometer should be used with youngsters who are able to stand with feed at a 60-degree angle outward

Height

- Nutritional index with children

- Stunted growth is defined as height measurement two standard deviations below median height for age
- It is also required to calculate body mass index (BMI)

Weight

- A system of units for expressing heaviness or mass

- Overweight or obese = higher than what is considered normal
- Underweight = lower than what is considered normal

Body Mass Index (BMI)

- A person’s weight in kilograms derived by the square of height in meters

- Inexpensive and easy screening method for weight to know if it’s underweight, healthy weight, overweight, or
obesity
- BMI Categories:
 Underweight = <18.5
 Normal Weight = 18.5 – 24.9
 Overweight = 25 – 29.9
 Obesity = BMI of 30 or greater
 - A high BMI may or may not eb an indicator of high body fat, and is not a direct indicator of health
- Not a diagnostic tool nor it is a measurement of body fat percentage

How to Compute BMI Imperial BMI Formula

- BMI = Weight (kg) / Height (m)2 - BMI = [Weight (lbs) / Height (inch)2] x 703

Body Composition

Definition

- Relates to body’s fat, bone, and muscle percentages

- Body fat and muscle varies from person to person

How to Improve Body Composition

 Assess – start by measuring body composition and setting a body composition goal
 Nutrition – understand how many calories you need to achieve your personal goal
 Exercise – physical activity is important

Factors to Consider

 Age
 Genes
 Hormones
 Sex

Types of Fat – having too much stored fat can lead to chronic diseases

 Non-Fat Mass
 Fat Mass

Mid-Arm Circumference

Definition

- An essential indicator of nutritional status

- Monitoring a patient’s nutritional condition is essential to determining their suitability for hospice care
- Performed at time of admission and then every month or on a PRN basis after

How to Measure Mid-Arm Circumference Accurately

1. Instruct patient to relax their left arm at their side

2. Wrap the color-coded tape measure around the patient’s left arm
3. Record the value that shows in the window between the 2 arrows

When to use MAC

- Muscle and subcutaneous fat are the major determinants of MAC, and both are important determinants of
survival in malnutrition and starvation
- Mac is a good predictor of mortality
- Recommended for identifying young children with severe acute malnutrition or those at risk of developing it

Shakir Tape

- Fiber-glass tape with colors red, yellow, and green

- Green = not malnourished
- Yellow = risk of malnutrition Mid Upper Arm Circumference (MUAC) is a
useful tool for a fast assessment of nutritional
status
 - Red = severely malnourished
- Orange = moderately malnourished

Skin Fold Thickness

Definition

- Measurement of subcutaneous fat fold

- Most widely adopted field method for the assessment of body fat especially in children

Purpose

- To rank individuals in terms of relative total “fatness”, or to assess subcutaneous fat at various regions of the
body
- Population specific equations are used to derive estimates of percent body fat
- A skinfold caliper is used to assess the skinfold thickness, so that a prediction of the total amount of body fat can
be made
 The tester pinches the skin at the location site and pulls the fold of skin away from underlying muscle so
only the skin and fat tissue are being help
 Measured in millimeters
- This method is based on the hypothesis that the body fat is equally distributed over the body and that thickness
of the skinfold is a measure for subcutaneous fat

Target Population

- Can be sued to anyone with any age since SFT is a reliable, cheap, simple, noninvasive method of body fat
estimated including neonatal period

Pre-Test

- Explain to the client the test procedures

- Record basic client’s information – name, age, height, body weight, and gender
- Remove any restrictive jewelry, watches, bracelets, or hanging earrings
- Take resting heart rate and BP readings
- Keep tract of test conditions – date, weather, surface, and equipment used

Procedure

- Taken at three to nine different standard anatomical locations

- Only the right side is measured for consistency
- Tester pinches skin site, causing a double layer of skin and underlying adipose tissue to rice
- Calipers are placed 1cm beneath and at right angles to the pinch and a millimeter reading is taken 2 seconds
later
- If two measurements are significantly different, a third should be performed, and median value taken

Contraindications

 Skinfold measurements should not be taken when skin is wet or after exercise
 Age, size and state of hydration may affect skin measurement

Sites

- Chest or pectoral skinfold:

 For men, get a diagonal fold halfway between the armpit and the nipple
 In women, a diagonal fold is 1/3 of the way from the armpit to the nipple.
- Mid-Axillary: A vertical fold on the mid-axillary line which runs directly down from the center of the armpit
 - Supra-iliac or flank: A diagonal fold just above the front forward protrusion of the hip bone (just above the
iliac crest at the midaxillary line)
- Abdominal: A horizontal fold about 3 cm to the side of the midpoint of the umbilicus and 1 cm below it.
- Quadriceps or mid-thigh: A vertical fold midway between the knee and top of the thigh (between the
inguinal crease and the proximal border of the patella)
- Triceps: A vertical fold midway between the acromion process and the olecranon process (elbow)
- Biceps: A vertical pinch mid-biceps at the same level the triceps skinfold was taken
- Subscapular: A diagonal fold just below the inferior angle of the scapula
- Medial Calf: The foot is placed flat on an elevated surface with the knee flexed at a 90° angle. A vertical fold
took at the widest point of the calf at the medial (inner) aspect of the calf
Results (Average Body Fat Percentage)

 Male
 >30 = 9-15% Measuring Tape
 30 – 50 = 11-17% > Non-stretch fiberglass or plastic
 <50 = 12-19% measuring tape is used to allocate the
 Female anatomical midpoints on the body
where the skinfold measurement is
 >30 = 14-21%
taken
 30 – 50 = 15-23%
 >50 = 16-25%

Measuring Tape

- Non-stretch fiberglass or plastic measuring tape is used to allocate the anatomical midpoints on the body where
the skinfold measurement is taken
ADDITIONAL INFO for DIETARY REFERENCE INTAKE

MS. IDURIA

DRI: Dietary Reference Intake – (healthy individuals only)

 Recommended level for specific nutrients

1. EAR – estimated average requirement
2. RDA – recommended dietary allowances
3. AI – adequate intakes
4. UL – tolerable upper intake level

1. Estimated Average Requirements

 Determined by a committee of nutrition – experts who will review the scientific literature to determine a value
that meets requirements according to age and sex group
 50% will go up, 50% will go down
 EAR and RDA will go together
 Have to increase 35% - 50% to cover the healthiest people in population

2. Recommended Dietary Allowances

 Does not need to follow the recommended in RDA
 Value of RDA: 97 – 98% of target healthy population
 Meant as a recommendation, and meeting means it is very unlikely to meet the actual needed nutrients
 Categorized in age, sex, lactation and pregnancy
 Only 19 nutrients of the approximately 45 essential nutrients have an RDA = need to eat variety of foods to get
all the nutrients needed
 Can be time consuming of followed that is why food guide pyramid and dietary guidelines is created

DRI are intended to use only for healthy individuals

DRI and its four standards can be changed when scientific evidences reveal the findings

MS. BABIERRA

DRI – sets of recommendations with the amount of energy, nutrients and other dietary components that best support
health

RDA  Foundation of DRI  To set goals for an individual to have

AI  Innovation if RDA is not available proper nutrient
 Established as scientific evidence is insufficient to
generate RDA  Daily requirement do not harm
 Prevent chronic and acute disease/infection *Averaging*
 Provide adequate nutrient
 Decrease daily requirement everyday
Ex. Calcium *Health problem – deficiency = poor
 Prevent osteoporosis: prevent fracture health*
Ex.
 Fiber: 14g/1000cal
 Newborn: adequate intake breastmilk
 Pregnant: AI + supplements
 Self: calcium and ferrous sulfate
 Fetus: folic acid
  Healthy eating plate: vegetable, whole grains, fruits,
CHON
EAR  Focuses on life stages and gender groups Ex.
 Group of populations -> to make diet recommendations  School children: physically active
 More specific needing more carbohydrates
 Military personnel: training needing
more carbohydrates
 Sailors: vit C deficiency
UL  For nutrients posing a hazard when excess  To keep nutrient intake below
amounts of toxicity
Prevent negative health impacts:  To reduce risk of toxicity

Infant:
 Vit D = (-) hypercalcemia
 Fluoride = (+) neurologic problem

Children
 Mg: kidney disease, irregular heart rate

Adult
 Thyroid problem
 MG: muscle weakness

Special considerations

1. Recommendations: safe intakes (not minimum requirements)

2. Daily intake: to average over time (compensate what is lacking)
3. Reference of inadequacy
 Blood nutrient
 Normal growth
 Decrease chronic diseases
 Prevent deficiency
4. Meet needs of healthy people
NOTE: If with problems: different needs
5. Recommendations
a. Based on gender: male or female
b. Stage in life: infant to adulthood, pregnant and lactating