NUTRITION AND DIET

THERAPY
A.Y 2024-2025 MIDTERM

APRIL JANE S. PACETE, RN

 LESSON 1

PHYPHYSIOLOGIC
VALUE OF FOOD

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Page 2
A t the end o f the lecture, the
students will be able to:
 Describe how to supply
energy from food
 Determine body’s energy
needs and how to maintain
energy balance.
 Identify the energy of one
gram of each macronutrient
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• Chemical energy
derived from food is the
only source of energy
for humans.
• Energy that the body
uses is lost as heat
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 ENER
• Capacity for doing work
GYthat enables the
• Force or power
body to do its work.
• Body’s most basic need
• Sources: carbohydrates, lipids and
protein

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 Standard unit in measuring
heat (unit of measurement for the
energy that the body gets from
food)

Not eaten

In excess, stored in the

body in the form fat

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 Byproducts when CHO,
CHON and fats are oxidized in
the body

1 kcal is the heat energy

required to raise the temperature of
1 kg of water 1°C

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 FUEL
FACTORS
CH • 4 calories per
O gram
fat • 9 calories per
s gram
CHO • 4 calories per
N gram
 4 main purposes of energy
in the body
•
•
•

•
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 METABOLISM
Basal Metabolism-
Minimal amount of
energy needed to
maintain a body in a
resting state to
perform vital body
functions
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8
Measure o f energy needed by the
body at rest f o r all its internal
activities

Energy needed t o support

life processes

Constitutes 60-75% o f the

caloric requirement o f the
body 31
Factors that affect
BMR
A. Surface area
>body surface area = ↑BMR
–The greater the BSA or skin
area, the greater the
amount of heat loss, which
causes a necessary increase
in heat produced by the
body. 34
35
B. Sex
women (5 – 10%) < men
–Women have a 5-10% lesser
metabolic rate than men
even when they have the
same weight and height.
–This is also influenced by the
fact that most women have a
little more fat and lesser
muscles than men.
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C. Age
–BMR is highest during periods
of rapid growth.
–Growth is most rapid during the
first 2 years of life and reaches
a lesser peak through puberty
and adolescence in both girls
and boys.
–BMR slowly declines as an
individual grows older.
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39
D. Body composition

*Athletes: 5% ↑basal
metabolism
–BMR lowers when the body
has a large proportion of
inactive adipose tissue
–Athletes, who have greater
muscular development, have
a 5% increase in BMR over
non-athletes.
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41
E. State of Nutrition
–Undernourishment and starvation
is characterized by a decrease in
the mass of active tissues and
this can, in turn, cause a
decrease of up to 50% below
normal metabolism
–People who are overweight or
obese, on the other hand, usually
have a faster BMR. This is to
accommodate for extra fat and for
their body to work harder to 42
F. Sleep –
–During sleep, the
metabolic rate ↓10 to
15% below that of
waking levels. This is
due to muscular
relaxation and
decreased activity of the
sympathetic nervous 43
G. Endocrine Glands -
–Endocrine glands secrete
hormones in the bloodstream
that serve as principal
regulators of met. rate
–The secretion of male sex
hormones ↑BMR about 10 to
15% and the female sex
hormones a little less.

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H. Fever

↑BMR about 7% for each

degree rise in the body
temperature above 98.6°F.

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I. Pregnancy and Lactation
- During pregnancy and
lactation, the basal metabolic
rate ↑20-25

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Conditions
necessary for
BMR test:
Fasting / post absorptive
state – 12hrs after a meal
(usually taken in the
morning)
Awake, lying quietly, free
from physical fatigue,
nervousness or tension –
This can cause an increase in
heat production

Environmental
temperature (20-25°C) –
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so t h a t client can
 Physical Activity (PA)
PA expenditure –energy use for total body cell
metabolism above what is needed during rest.
- Energy spent on daily activities and physical
exercise.
- Increases our energy expenditure above and
beyond our basal needs by 15-40%
 Diet-induced thermogenesis
-called as thermic effect of food
(TEF)
-represents the energy needed
to digest, absorb, process
absorbed nutrients.
METABOLISM
Process of
changing food
from:
Simple to
complex
Complex to
simple 2
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LESSON 2:

DIETARY
COMPUTATIONS

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Page 2
 Learning Outcomes:
-calculate the following accurately using
standard formulas:
 Body Mass Index (BMI)
 Desirable Body Weight (DBW)
 Basal Metabolic Rate (BMR)
 Specific Dynamic Action of Food
 Total Energy Requirement (TER) based on
BMR, SDA, and physical activity level.
 Distribute TER
 Learning Outcomes:

-apply BMI and DBW calculations in assessing

individual health status and providing
nutritional counseling.
A. Body Mass Index

B. DESIRABLE BODY
WEIGHT

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3
 BODY MASS INDEX

ecalculation that estimates a

person's body fat based on
height and weight. weight.
 Body Mass
Index
classification BMI
Underweight Below 18.5
Normal 18.5 – 24.9
Overweight 25 – 29.9
Obese I 30 – 34.9
Obese II 35 – 39.9
Extremely obese 40 or greater
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Body Mass Index
= kg / ht m 2
Weight (kg)/
height (m)2

8
 Units of Measurement

1m= 100cm
1 foot= 12 inches
1 inch= 2.54 cm
1kg= 2.2 lbs
 ampl
• e:
•

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 Data:
Name: Amy
Gender: Female
Age: 25
Height: 5’8” = 68 inches = 172.72 cm = 1.7272m
Actual Weight: 65 kg

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BMI:
Kg/m2
= 65/(1.72)2
= 65 kg / 2.95 m2
= 22.03 (Normal)

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Desirabl
e Body
Weight
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 DBW
vary depending on individual
factors such as height, age,
gender, and body composition.
•
[ht in cm – 100 cm] – 10%
- method created to determine
dbw which makes use of
height as primary data.

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 Tannhauser’s (answer is in
kg)
(Ht in cm – 100cm) – 10%
(172.72 – 100) – 10%
72.72 – 7.27
65.45 kg

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•
ht: every 5 ft = 100 lbs (f); 110
lbs (M)
2 lbs each additional inch
Age : every 5 years = 2 lbs
- formulated by Saturnino ftdor-
Dionisio, a filipino nutritionist.
This formula puts in
consideration the average
filipino body. 17
 Ador Dionisio’s method
• Height:
5’8 = 5ft (female) = 100 lbs
8 inches x 2lbs/inch = 16 lbs
Age:
25 years x 2lbs/5 years = 10 lbs
Total = 126 lbs

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 Data:
Name: Amy
Gender: Female
Age: 25
Height: 5’8” = 68 inches = 172.72 cm = 1.7272m
Actual Weight: 65 kg
Desirable BW: 126 lbs = 57.27kg

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BASAL METABOLIC RATE
 metho
• Rule of thumb
ds
1. Male: 1 kcal / kg of body weight /
hour (24 hours)
2. Female: 0.9 kcal / kg of body
weight / hour (24 hrs)
- This may not be applicable to
obese or lean individuals.
- Ex: BMR of a 50kg man
1 kcal x 50 kg x 24 = 4
7
• Biologic Body Weight raised to
the ¾
- Done by multiplying the
metabolic body size (which is the
weight in kg raised to ¾ power)
and 70.
- 70 is a standard value which
applies to all animals.
Ex: BMR of a 50kg
man BMR
= 1316 = 4
8
Kilograms Metabolic Body Size (kg)3/4
5 3.3
10 5.6
15 7.6
20 9.5
25 12.1
30 12.8
35 14.4
40 15.9
45 17.4
50 18.8
65 21.6
70 24.2 49
• Harris Benedict Formula
- Another tool to compute for
Basal Metabolic Rate, which
makes use of information such as
weight, height, age and sex.

5
1
• BMR for men
BMR = 88.362 + ( 13.397 x
weight in kg ) + ( 4.799 x
height in cm ) - ( 5.677 x age
in years )

BMR for women

BMR = 447.593 + ( 9.247 x
weight in kg ) + ( 3.098 x
height in cm ) - (4.330 x age
 Data:
Name: Amy
Gender: Female
Age: 25
Height: 5’8” = 68 inches = 172.72 cm = 1.7272m
Actual Weight: 65 kg
Desirable BW: 126 lbs = 57.27kg
BMR for women
BMR= 447.593 + (9.247 x
57.27kg) + (3.098 x
172.72cm) - (4.330 x 25
y.o.)
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BMR for women
BMR= 447.593 + 529.57569 +
535.08656 – 108.250
= 1404.00 kcal

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Physical
activity

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6
 Physical
activity
•Sedentary or light activity
lifestyles.
>occupations that do not
demand much physical effort

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•Active or moderately
active lifestyles.
>occupations that are not
strenuous in terms of energy
demands, but involve more
energy expenditure than that
described for sedentary lifestyles
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•Vigorous or vigorously active
lifestyles.
>These people engage regularly in
strenuous work or in strenuous
leisure activities for several hours.

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 Specific Dynamic
Action of Food
= 6% of (BMR +
PA)
= 6% (1404.00
+ 1000) 60
TOTAL ENERGY
reqt /
= BMR + PA
NEED + SDA
= 1404.00+ 1000 +
144.24
= 2548.24kcal
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 Distribution of
TER
•Carbohydrates: 55-
70%
•Proteins: 10-15%
•Fats: 20-30%
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 Solution Distribution (kcal)
CHO 2548.24kcal x 0.65 = 1656.35 kcal
CHON 2548.24kcal x 0.15 = 382.23kcal
Fats 2548.24kcal x 0.20 = 509.64 kcal

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 Solution Distribution (g)
CHO 1656.35kcal x 1g/4 kcal = 414.08g
CHON 382.23kcal x 1g/4 kcal = 95.55g
Fats 509.64kcal x 1g/9 kcal = 56.62g

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 Diet Rx: 2550 kcal,
CHO:415g, CHON:95g,
fats:55g
•Round off TER to the nearest 50
kcal
•Round off CHO, CHON and Fat
requirements to the nearest 5g
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