UNIT 5: APPLICATION OF THE

BASIC PRINCIPLES OF DIETETICS

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Index

1. Dietetics. Concept and purpose.

2. Concept of metabolism.

3. Nutritional and energy needs in the different stages of life.

3.1 Recommendations by stages.
3.2 Pregnancy and lactation.

4. The Mediterranean diet.

5. Energy needs of the human being.

5.1 Study of body composition.
5.1.1. Body mass index.
5.2 Energy
5.2.1 Energy balance
5.2.2 Caloric profile
5.2.3 Components of energy expenditure
5.2.4 Calculation of energy needs

6. Food composition tables. Utilization

7. Diets

7.1 Diets for people with specific needs

8. Food allergies and intolerances

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1. Dietetics. Concept and purpose.

The diet is defined as the set and quantities of foods or mixtures of foods, composed of
substances called nutrients, that are usually consumed, although it can also refer to the
regimen that, in certain circumstances, healthy, sick or convalescent people carry out in
eating and drinking. We usually say: "being on a diet" as a synonym for a partial or
almost total deprivation of eating. Dietetics studies how to provide each person or group
of people with the necessary food for their proper development, according to their
physiological state and circumstances. That is to say, it interprets and applies the
principles and scientific knowledge of Nutrition, preparing an adequate diet for healthy
and sick men.

2. Concept of metabolism.

Our bodies obtain the energy they need from food through metabolism, a set of chemical
reactions that take place in the cells of the body that allows us to transform the energy
contained in food into the fuel we need for everything we do, from moving to think and
grow.

3. Nutritional and energy needs in the different stages of life.

The needs of each nutrient are quantitatively very different. Thus, proteins, carbohydrates
and fats, the only nutrients that provide us with energy or calories, must be consumed
daily in amounts of several grams, which is why they are called macronutrients. The
rest, vitamins and minerals, are needed in much smaller amounts (micronutrients),
however, all nutrients are equally important from a nutritional point of view and the lack or
excess consumption of any of them can lead to disease or malnutrition.

According to this, the general and theoretical scheme of nutrition is very simple: it is, on
the one hand, to know the energy and nutrient needs of an individual and, on the other
hand, their actual intake.

The needs are different for each individual depending on their age, sex, physical activity
(which mainly modifies energy needs) and in the case of women, depending on the
possible physiological state of pregnancy or lactation. For example, calcium or protein
needs are greatly increased during adolescence, as this is a stage of intense growth or
during pregnancy.

3.1 Recommendations by stages

Childhood

 It is important to eat everything, vary foods, try to make them attractive and initially
disguise the foods that the child rejects.
 Eat about five daily meals: three main ones (breakfast, lunch and dinner) and two
lighter ones (mid-morning and snack).
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 Maintain regular meal times.
 Avoid snacking based on snacks, candies, sweets, etc. they only provide calories and
virtually no nutrients
 Eat breakfast daily. Breakfast is one of the most important meals of the day and
should cover 25% of the child's energy needs. You should include foods from at least
three basic groups: dairy, grains, and fruits. Breakfast is an important source of energy
and nutrients; it contributes to greater physical and intellectual performance and helps to
improve the diet avoiding nutritional deficiencies.
 The mid-morning meal and snack are excellent opportunities to include foods of
great nutritional interest such as bread, cereals, dairy products, fruit, etc.
 It is important to supervise what they eat outside the home to avoid excesses,
monotony and meals with a large number of calories, fat and low nutritional density.
 Control the consumption of those foods with a high content of sugar, fat and salt. Do
not abuse sweets, trinkets, snacks and soft drinks.
 If the child eats at school, it is necessary to know the menu plan, especially to balance
the diet with the meals that are made at home. Within the total diet, the school meal is of
great importance not only for its nutritional contribution but also for being a good place for
nutritional education and the acquisition of good eating habits. The school can be an
important place for nutritional training, without forgetting that the child can also teach at
home what he has learned at school.
 Control the appropriate body weight for age and height.
 Do not restrict foods, nor encourage the consumption of "low-calorie or fat" products,
unless there is a medical justification or excess weight and, in any case, always under the
supervision of the specialist.
 Encourage physical activity, at least one hour a day, and preferably outdoors. Control
the time children spend sitting watching TV, with electronic games, with the computer, etc.
This not only contributes significantly to physical inactivity but can also encourage the
consumption of certain high-calorie, low-nutrient-dense foods.
 Take care of oral hygiene

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Adolescence

 Eat a varied and nutrient-dense diet. This is the best guarantee of nutritional
balance.
 Divide food into 4-5 meals throughout the day.
 Eat breakfast daily.
 A main meal should include:
o First course: pasta, rice, legumes, potatoes or vegetables.
o Second course: fish, meat or eggs with salad.
o Dessert: fruit.
o Bread.
o Water
 Maintain regular meal times.
 Avoid snacking based on snacks, candies, sweets, soft drinks, etc. they only provide
calories and virtually no nutrients.
 Moderate salt intake.
 Moderate the consumption of sugars, sweets and soft drinks.
 If the adolescent eats at school, it is necessary to know the menu plan, especially to
balance the diet with the meals that are made at home. Within the total diet, the school
meal is of great importance not only for its nutritional contribution but also for being a
good place for nutritional education and the acquisition of good eating habits.

Adulthood
 The diet must be healthy.
 Provide the energy and nutrients necessary to cover recommended intakes and
avoid nutritional deficiencies.
 Be appetizing, that is, pleasant to eat, appetizing and with a good preparation and
gastronomic presentation, since you also have to enjoy the food.
 It should include foods that the person for whom it is intended is used to eating,
because even for health reasons, it is very difficult to change eating habits.
 Adapt to current recommendations to help prevent diseases such as obesity,
cardiovascular disease, high blood pressure, osteoporosis, diabetes, etc.

Seniors
 Older people should pay special attention to their diet, since nutritional problems are
frequent and their repercussions are much more severe than at other stages of life.
 Enjoy food and eat in company.
 Divide food into 3 – 5 meals a day, making more than one hot meal a day.
 Consume a varied diet with a high density of nutrients.
 Encourage moderation to keep weight stable and within recommended limits, balancing energy
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intake with what is spent through daily physical exercise. Avoid both low weight and obesity. A
slight overweight may be a protective factor in the elderly, contrary to what occurs in young
people, as various studies have shown. Unintentional weight loss should be an alarm signal.
 Perform some type of physical activity daily to increase energy needs and food consumption.
In addition, it prevents obesity, maintains bone mass, independence and mobility, reduces the risk
of falls and promotes sun exposure, contributing to an adequate vitamin D status.
 Preserve the protein compartment to prevent further loss of muscle mass. The proteins have to
be of high biological value, of high quality.
 Take care of calcium intake. It is not advisable to eliminate dairy products from the diet as they
are the main suppliers of calcium, with the alternative of being able to use skimmed products for
those people who have to watch their fat intake. In people with lactose intolerance who have
discomfort after ingesting milk, the consumption of yogurt and fermented milk is recommended.
 Moderate your intake of salt and salty foods, if there are other risk factors, to less than 2,400
mg of sodium per day (less than 6 g of salt). Salt is essential for life but fresh products contain the
necessary amount.
 Avoid dehydration. Drink about two liters a day. The elderly should know that they have to
drink water at regular intervals even if they are not thirsty. They must display the amount of water
they have to drink daily.
 Moderate the consumption of alcoholic beverages.
 Take care of teeth and oral hygiene to be able to chew well and not have to eliminate any food
from the diet. The greater the restriction, the greater the risk of imbalances or deficiencies.
 Reduce smoking.
 In some situations it will be necessary to recommend the consumption of mineral and vitamin
supplements (vitamin D, B12, folate, potassium, etc.) to improve the nutritional status of the
malnourished or prevent deficiencies in those at risk.

3.2 Pregnancy and lactation

 Pregnancy and lactation are periods of higher nutritional requirements.

 The mother's diet provides the child with the necessary nutrients for her development and
meets the demands of her own body.
 The preconception nutritional status of the mother is as important as the diet to be followed
during pregnancy.
 A varied and balanced diet is recommended. Nutrient needs increase proportionally to energy
needs, so food selection should be made based on quality and not quantity.
 During pregnancy and lactation, the needs for energy, protein, vitamins and minerals increase.
 A folic acid supplement is recommended in the month prior to conception, at least during the
first trimester.
 The most compromised minerals in pregnancy are iron, iodine and calcium. It is
recommended to include foods of animal and dairy origin in the diet, and to use iodized salt. In
case of deficit situations, supplements will be recommended.
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 The main determinants of nutritional needs in lactating women are the composition and volume
of milk secreted and also the nutritional status of the mother at the beginning of this stage.
 Vitamin A needs are greater during lactation than during pregnancy due to its role in the child's
immune system.
 Excess weight gain during pregnancy and weight retention during lactation are risk factors for
obesity. Maintaining regular physical activity and monitoring caloric intake is recommended as
part of a healthy pregnancy and lactation.

4. The Mediterranean Diet.

The Mediterranean Diet is a valuable cultural heritage that represents much more than a simple
nutritional guideline, rich and healthy. It is a balanced lifestyle that includes recipes, ways of
cooking, celebrations, customs, typical products and various human activities.

Among the many health-promoting properties of this eating pattern, we can highlight the type of
fat that characterizes it (olive oil, fish and nuts), the proportions of the main nutrients contained in
its recipes (cereals and vegetables as a base of dishes and meats or similar as a "garnish") and the
richness in micronutrients that it contains, the result of the use of seasonal vegetables, aromatic
herbs and condiments.

Such is its importance that it was recognized as Intangible Cultural Heritage of Humanity by
UNESCO on November 16, 2010.

The most notable characteristics of the Mediterranean Diet are:

 Consumption of cereals, legumes, fruits and vegetables as the basis of food.
 Abundant consumption of fish.
 Use of olive oil.
 Moderate consumption of meat.
 Moderate consumption of dairy products.
 Moderate intake of wine with meals.

In 2010, a review of the Mediterranean Diet was7carried out, which also included:
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 Consumption of seasonal foods and the environment.
 Consumption of vegetable foods, both vegetables and fruits of different flavours, textures
and colours.
 Regular practice of physical activities.
 Socialization of meals, making them in a group or family.
 Orientation towards the consumption of three food groups: cereals, vegetables and fruits in
the main meals.
 Introduction of spices, herbs and condiments.
 Intake of 6 glasses of water a day.
 Decrease in salt intake.
 Reduction of the amount per serving, adapting it to the current pace of life, which means
less caloric expenditure.

5. Energy needs of the human being

Energy intake must cover caloric expenditure and allow the human being to maintain an
adequate body weight to perform optimally in life. Physical activity increases energy needs
and some nutrients, so it is important to consume a balanced diet based on a wide variety of
foods, with the correct selection criteria.

5.1 Study of body composition

The study of body composition is an important aspect of assessing nutritional status.

Thus, through the study of body composition, energy intake and different nutrients, growth
or physical activity can be judged and assessed.

Our body is made up of multiple substances (water, fat, bone, muscle, etc.) but, of all of
them, water is the majority component. Water constitutes more than half (50-65%) of the
body weight.

5.1.1. Body mass index

A very useful value that is used to check body composition is the Body Mass Index (BMI).

It is calculated by dividing weight (kg) by height (m) squared.

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The values obtained indicate:

o <18.5 : underweight
o 18.5-24.9 : normal
o 25-29.9 : overweight
o 30.0-34.9 : class I obesity
o 35.0-39.9 : class II obesity
o >=40: class III obesity

It is important to remember, however, that BMI is not a direct measure of fatness and is calculated
based on a person's weight, which includes both muscle and fat. Because of this, some people may
have a high BMI but not have a high percentage of body fat. For example, athletes who train hard
may have a high BMI because they have more muscle mass, rather than more body fat.

5.2 Energy

Energy is the ability to do work. Man, to live, to carry out all his functions, needs a continuous
supply of energy: for the functioning of the heart, the nervous system, to carry out muscular work,
to carry out physical activity, for the biosynthetic processes related to growth, reproduction and
repair of tissues and also to maintain body temperature.

This energy is supplied to the body by the food we eat and is obtained from the oxidation of
carbohydrates, fats and proteins. The energy or caloric value of a food is the amount of energy that
is produced when it is completely oxidized or metabolized in the body.

The energy contribution of macronutrients is as follows:

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All foods are potential sources of energy but in variable amounts depending on their different
macronutrient content (carbohydrates, fats and proteins). For example, foods rich in fat are more
caloric than those consisting mainly of carbohydrates or proteins.

Alcohol, which is not a nutrient, also produces energy, 7 Kcal/g. Vitamins, minerals and water do
not supply energy.

The energy value in food is measured in kilocalories (Kcal), also known as "calories", and in
Kilojoules (Kj).

1 Kcal = 4,184 Kj
1 Kcal = 1.000 Calorías
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5.2.1 Energy balance

The energy balance is the relationship between the food we eat and the energy needs in
the form of calories, which our body needs.
This relationship is determinant of body weight, since when the diet provides more energy
than necessary; it is stored in the body as fat and gives rise to overweight. If, on the other
hand, the intake is less than the body's energy needs, the body consumes its fat and
protein reserves and there is a decrease in weight, which can lead to malnutrition in the
long run.

5.2.2 Caloric profile

The balanced or healthy diet will be one in which the contribution is:

Proteins. Between 10% and 15%.

Lipids. Between 30% and 35%.
Carbohydrates. Between 50% and 60%.

If there is alcohol consumption, its caloric intake should not exceed 10% of total calories.

5.2.3 Components of energy expendidure

Three important components contribute to daily energy expenditure -which logically

determines caloric needs:

• The Basal Metabolism Rate (BMR) includes the energy needed to maintain the body's
vital functions in resting conditions (blood circulation, breathing, digestion, etc. Unless
physical activity is very high, this is the largest component of energy expenditure.
There is an energy saving of the Basal Metabolism Rate at bedtime, called the Sleep
Rate.

• The Specific Dynamic Action (SDA) is the energy needed to carry out the processes
of digestion, absorption and metabolism of the components of the diet after the
consumption of food in a meal It can represent between 10 and 15% of energy needs,
depending on the characteristics of the diet.

• Physical Activity (PA) developed. The energy expended throughout the day for work
and physical activity is, in some individuals, what makes the biggest difference. Obviously,
an athlete who trains several hours a day or a lumberjack working in the mountains does
not need the same amount of energy as someone who has a sedentary life.

5.2.4 Calculation of energy needs

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A person's daily energy needs are those that maintain constant adequate body weight. In
growing children and in pregnant or lactating women, energy requirements also include
the amount associated with tissue formation or milk secretion at an adequate rate.

They can be estimated in two ways:

1. From the basal or resting metabolic rate (RMR) and average factors of physical activity.
2. From the TMR and an individual factor of physical activity.

6. Food composition tables. Utilizatión.

To know exactly the amounts of vitamins, carbohydrates, minerals, fibers, proteins and
calories that each food provides us, it is necessary to use the food composition table.

7.Diets

The diet, from the Greek diaita, means "way of life", referring to the set of foods
consumed in daily life that constitute a nutritional behavior. The diet is an eating habit that
is made up of the set of food substances that allows the human being incorporate the
essential nutrients for life.

7.1 Diets for people with specific needs

In hospital kitchens, there are diet guides prepared by experts in dietary and nutrition,
which must be applied according to the specific case of each patient.

Among these we have several types of diets:

• Basal diet. The basal diet is a general diet or basic menu that patients have when they
do not require any type of special feeding. It is a normal, healthy and balanced diet.
 Bland diet. It is a diet in which the patient must eat foods that are easily digestible and
have a texture that makes them easy to chew and swallow.
• Liquid diet. This consists of totally liquid foods and is indicated for stomach and
intestinal conditions, in some postoperative or in cases of dehydration.
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• Semi-liquid diet. It is an intermediate diet between the soft and the liquid, it has a
greater supply of nutrients and the food can be crushed to facilitate intake. It is indicated
for patients with chewing difficulties.
• Astringent diet. It is applied to patients with diarrhea problems and, therefore, at risk of
dehydration. It must be made up of foods that regenerate water loss and slow down
intestinal transit, such as glucose serums or water from boiling rice or carrots. Also, in
moderate phases, boiled rice, boiled carrots, white fish, cooked ham, banana and apple
can be administered, but above all, no fats or foods rich in fiber.
• Hypocaloric diet. It is about reducing the intake of carbohydrates and fats and
suppressing sugars. It is applied to patients with obesity and diabetes problems.
• Hypercaloric diet. It consists of a supplementary intake of carbohydrates and is used in
cases of malnutrition.
• Gluten-free diet. It is indicated for celiac patients, that is, those who cannot assimilate
gluten or protein from cereals. In this diet you should avoid flour in all its forms: bread,
pastries, batters, breaded, etc.
• Low sodium diet. It applies to patients with problems with high blood pressure, kidney
failure or liver cirrhosis. It consists of eliminating salt from the diet and those

8. Food allergies and intolerances

Allergies cause a reaction from the immune system, while intolerances are a metabolic
and digestive problem. Food allergies are an exaggerated response of the immune
system to the consumption of a particular food.

Food that cause allergies

Almost any food that contains protein can cause a food allergy, but some cause them
more frequently in children: cow's milk, eggs, fish, shellfish, legumes, cereals, fresh fruits,
nuts.
 Milk allergy: Caused by casein, lactoglobulin and lactalbumin. The most common
symptoms are preferably cutaneous, but also digestive, such as vomiting and diarrhoea.
They can vary from one person to another. Not to be confused with lactose intolerance, in
which diarrhea occurs due to the inability to digest this component of milk.
 Egg allergy: It is due to an allergic reaction generally caused by ovalbumin and
ovomucoid, characteristic egg proteins that are present in the white.
 Allergy to fish: Due to the muscular proteins of the fish. Special care should be taken
in products enriched with omega 3 or fish fat that may contain small amounts of protein.
 Allergy to legumes: They have a great capacity to produce an allergic reaction. In
general, all are allergenic, especially lentils and soy.
 Cereals: In addition to their importance in celiac disease, immediate allergy to any type
of cereal can occur. However, it is less common than other vegetables.
 Allergy to nuts: Peanuts and almonds have a high risk of causing anaphylactic shock,
although if it is mild it only produces nausea, headache and swelling of the lips and
tongue. They can produce symptoms from even minimal skin contact.

Intolerances

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Food intolerance appears as a response to the body when it cannot properly assimilate a
food or one of its components.
 Gluten intolerance. Gluten is the protein of certain cereals such as wheat, barley, rye,
oats, spelled, etc. The problem that people with celiac disease mainly encounter is that
gluten is not only in these foods, but also that the industry has used gluten as a thickener
in multiple products. If a person with celiac disease consumes gluten or any food that
contains it, they will create an autoimmune response that will generate inflammation and
deterioration of the mucosa of the small intestine. The intestine has villi that help the
absorption of macro and micronutrients and, therefore, if they deteriorate due to the
consumption of gluten, a malabsorption of nutrients is created that can generate multiple
symptoms and complications. Children usually present symptoms such as nausea,
vomiting, diarrhea, low weight or growth problems, among others. In adults, most cases
have a more discreet symptomatology with symptoms such as slight diarrhea, weight loss,
anemia or, in some cases, constipation.

 Lactose intolerance. People who have lactose intolerance cannot digest the sugar
(lactose) in milk. As a result of this, they have diarrhea, gas, and bloating after eating
dairy products. Signs and symptoms of lactose intolerance usually begin 30 minutes to 2
hours after eating or drinking foods that contain lactose. Common signs and symptoms
are diarrhea, nausea, and sometimes vomiting, stomach cramps, bloating, gas, etc.

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