B A SI C NUT R IT ION

ENERGY
C L E O N A R A YA N U A R D I N I , S . G . Z . , M . S C . , R D
WHAT IS ENERGY?

• Energy may be defined as “the capacity to do work.”

• Quantity of work a particular system can perform.
• Energy helps us perform daily functions and tasks.
• Your body burns (metabolizes) food to produce energy in the form
of heat. This heat warms your body and (as energy) powers every
move you make.
 UNIT OF ENERGY
• The Calorie Is a Unit of Energy
• A calorie is the amount of energy in the form of
heat that is required to heat one gram of water
one degree Celsius
• A kilocalorie (Calorie) is the amount of heat
generated by a particular macronutrient that raises
the temperature of 1 kilogram of water 1degree
Celsius.
• The number of kcalories you need is based on three factors:

BASAL
METABOLISM

THERMIC
EFFECT OF
FOOD

Energy is expended in physical

PHYSICAL activity, either exercise-related
ACTIVITY or as part of daily work and
movement
• 1. BASAL METABOLIC RATE (BMR) and RESTING METABOLIC RATE (REE)

Resting energy expenditure (REE), or resting metabolic

rate (RMR) is the energy expended in the activities
necessary to sustain normal body functions and
homeostasis.

Include respiration and circulation, the synthesis of

organic compounds, and the pumping of ions across
membranes, energy required by the central nervous
system and for the maintenance of body temperature.
It does not include thermogenesis, activity, or other
energy expenditure and is higher than the BEE by 10%
to 20%
(Ireton-Jones, 2010).
 FACTORS AFFECTING RESTING ENERGY EXPENDITURE
1. Age. REE is highly affected by the proportion of lean
body mass (LBM)
2. Body composition.
• FFM, or LBM, makes up the majority of metabolically
active tissue in the body and is the primary predictor of
REE.
• Organs in the body contribute to heat production
(Figure 2-1).60% of REE can be accounted for by the
heat produced by high-metabolic-rate organs
(HMROs): the liver, brain, heart, spleen, intestines, and
kidneys (McClave and Snider, 2001).
3. Body size. Larger people generally have higher
metabolic rates than smaller people, but tall, thin people
have highermetabolic rates than short, stocky people.
 FACTORS AFFECTING RESTING ENERGY EXPENDITURE (2)

4. Climate. The REE is affected by extremes in environmental

temperature
5. Gender. Gender differences in metabolic rates are
attributable primarily to differences in body size and
composition.
6. Hormonal status. Hormones affect metabolic rate.
Endocrine disorders, such as hyperthyroidism and
hypothyroidism, increase or decrease energy expenditure,
respectively
7. Temperature. Fevers increase REE by approximately 7% for
each degree of increase in body temperature above 98.6° F or
13% for each degree more than 37° C.
8. Other factors. Caffeine, nicotine, and alcohol stimulate
metabolic rate.
 2. THERMIC EFFECT OF FOOD

• The TEF accounts for approximately 10% of TEE (Ireton-Jones, 2010).

• The TEF may also be called diet induced thermogenesis, specific dynamic action, or the specific
effect of food.
• Obligatory thermogenesis : energy required to digest, absorb, and metabolize nutrients,
including the synthesis and storage of protein, fat, and carbohydrate.
• Adaptive or facultative thermogenesis is the “excess” energy expended in addition to the
obligatory thermogenesis and is thought to be attributable to the metabolic inefficiency of the
system stimulated by sympathetic nervous activity.
• The TEF varies with the composition of the diet, with energy expenditure increasing directly
after food intake, particularly after consumption of a meal higher in protein compared with a
meal higher in fat (Tentolouris et al, 2008).
• Spicy foods enhance and prolong the effect of the TEF.
• Caffeine, capsaicin, and different teas such as green, white, and oolong tea also may increase
energy expenditure and fat oxidation and suppress hunger (Hursel and Westerterp-Plantenga,
2010; Reinbach et al, 2009).
• TEF decreases after ingestion over 30 to 90 minutes, so effects on TEE are small.
• For practical purposes, TEF is calculated as no more than an additional 10% of the
REE.
PHYSICAL ACTIVITY
• The most variable component of TEE, which may be as low as 100 kcal/day in sedentary people
or as high as 3000 kcal/day in athletes.
• Beyond REE and TEF, energy is expended in physical activity, either exercise-related or as part
of daily work and movement  activity thermogenesis
• NEAT: represents the energy expended during the workday and during leisure-type activities
(e.g., shopping, fidgeting, even gum chewing), which may account for vast differences in energy
costs among people
• Individual AT varies considerably, depending on body size and the efficiency of individual habits
of motion.
• AT tends to decrease with age, a trend that is associated with a decline in FFM and an increase
in fat mass.
PHYSICAL ACTIVITY

*mph: miles per hour

1 miles= 1,609 km
 ADDITIONAL CONSIDERATIONS IN ENERGY
EXPENDITURE

Excess postexercise oxygen consumption (EPOC)

• Influenced by the duration and magnitude of physical activity.
• In a study of high-intensity intermittent exercise, there was an increase in energy expenditure
during activity, although the effect on metabolic rate post-activity was minor (Kelly et al, 2013).
• Habitual exercise does not cause a significantly prolonged increase in metabolic rate unless FM
is decreased and FFM is increased, and then this increase in energy expenditure is mostly
during the activity itself.
ENERGI DALAM BAHAN MAKANAN

Energi dalam setiap bahan makanan menurut

golongan dapat dilihat dalam Daftar
Komposisi Bahan Makanan ( DKBM) atau
Tabel Komposisi Pangan Indonesia
DAFTAR KOMPOSISI BAHAN MAKANAN (DKBM)
ASEAN FOOD COMPOSITION (1)
ASEAN FOOD COMPOSITION (2)
MEASUREMENT OF ENERGY EXPENDITURE
1. Direct calorimetry
• is possible only with specialized and expensive equipment.
• An individual is monitored in a room-type structure (a whole-room
calorimeter) that permits a moderate amount of activity.
• It includes equipment that monitors the amount of heat produced by the
individual inside the chamber or room.
• Direct calorimetry provides a measure of energy expended in the form of
heat, but provides no information on the kind of fuel being oxidized.
• The method also is limited by the confined nature of the testing conditions.
• Therefore the measurement of TEE using this method is not representative of
a free-living (i.e., engaged in normal daily activities) individual in a normal
environment, because physical activity within the chamber is limited.
• High cost, complex engineering, and scarcity of appropriate facilities around the
world also limit the use of this method.
• Indirect calorimetry (IC) is a more
commonly used method for measuring
energy expenditure.
• An individual’s oxygen consumption and
carbon dioxide production are quantified
over a given period.
• The Weir equation (1949) and a constant
respiratory quotient value of 0.85 are used
to convert oxygen consumption to REE.
• The equipment varies but usually involves an
individual breathing into a mouthpiece (with
nose clips), a mask that covers the nose and
mouth, or a ventilated hood that captures all
expired carbon dioxide (Figure 2-3).
• Ventilated hoods are useful for short- and
long-term measurements.
• Strict protocol should be followed before performing IC measurement.
• For healthy people, a minimum of a 5-hour fast after meals and snacks is recommended.
• Caffeine should be avoided for at least 4 hours, and alcohol and smoking for at least 2 hours.
• Testing should occur no sooner than 2 hours after moderate exercise; after vigorous
resistance exercise, a 14-hour period is advised (Compher et al, 2006).
• To achieve a steadystate measurement, there should be a rest period of 10 to 20 minutes
before the measurement is taken.
• An IC measurement duration of 10 minutes, with the first 5 minutes deleted and the remaining
5 minutes having a coefficient of variation less than 10%, indicates a steady-state measurement
(Compher et al, 2006).
• When the measurement conditions listed here aremet and a steady state is achieved, energy
expenditure can be measured at any time during the day.
 RESPIRATORY QUOTIENT
• When oxygen consumption and carbon dioxide production are measured, the respiratory
quotient (RQ) may be calculated as noted in the following equation.
• The RQ indicates the fuel mixture being metabolized.
• RQs greater than 1 are associated with net fat synthesis, carbohydrate (glucose) intake, or
total caloric intake that is excessive, whereas a very low RQ may be seen under conditions of
inadequate nutrient intake (McClave et al, 2003).
ESTIMATING ENERGY REQUIREMENT
 EQUATIONS FOR ESTIMATING RESTING ENERGY EXPENDITURE

• Harris- Benedict
• Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) - ( 4.7 x age in years
)
• Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in years )

• The Harris-Benedict formulas have been found to overestimate REE in normal weight and obese
individuals by 7% to 27% (Frankenfield et al, 2003)

Mifflin- St. Jeor equations are used today to estimate energy expenditure of healthy individuals
and in some patients
 DETERMINING TEE
• The equations for estimating or measuring energy expenditure begin with resting energy
expenditure or REE.
• Additional factors for TEF and activity must be added. TEF may be considered as an overall
additive factor within activity thermogenesis in calculations of TEE.
• A simplified way of predicting physical activity additions to REE is through the use of estimates
of the level of physical activity, which are then multiplied by the measured or predicted REE.
• To estimate TEE for minimal activity, increase **REE by 10% to 20%; for moderate activity,
increase REE by 25% to 40%; for strenuous activity, increase REE by 45% to 60%.

TEE= REE +TEF*+ PAL**

*TEF 10% REE
ESTIMATING ENERGY REQUIREMENTS FROM ENERGY INTAKE

• Recommendations for energy requirements were based on self-recorded estimates (e.g., diet
records) or self-reported estimates (e.g., 24-hour recalls) of food intake.
• However, these methods do not provide accurate or unbiased estimates of an individual’s
energy intake.
• Many online programs are available in which an individual can enter the food and quantity
consumed into a program that estimates the macronutrient and micronutrient content.
 OTHER
PREDICTION
EQUATIONS
 ESTIMATING ENERGY EXPENDITURE OF SELECTED ACTIVITIES USING
METABOLIC EQUIVALENTS (METS)

• METs are units of measure that correspond with

a person’s metabolic rate during selected physical
activities of varying intensities and are expressed
as multiples of REE.
• A MET value of 1 is the oxygen metabolized at
rest (3.5 ml of oxygen per kilogram of body
weight per minute in adults) and can be
expressed as 1 kcal/kg of body weight per hour.
• Thus the energy expenditure of adults can be
estimated using MET values (1 MET= 1 kcal/
kg/hr).
• For example, an adult who weighs 65 kg and is
walking moderately at a pace of 4 mph (which is a
MET value of 4.5) would expend 293 calories in 1
hour (4.5 kcal x 65 kg x 1= 293)
ESTIMATING A PERSON’S ENERGY REQUIREMENTS USING
THE INSTITUTE OF MEDICINE’S EER EQUATIONS

• Requires identifying a PAL value for that person.

• A person’s PAL value can be affected by various activities performed throughout the day and is
referred to as the change in physical activity level (∆ PAL).
• To determine ∆ PAL, take the sum of the ∆ PALs for each activity performed for 1 day from
the DRI tables (IOM, 2002; 2005).
• To calculate the PAL value for 1 day, take the sum of activities and add the BEE (1) plus 10% to
account for the TEF (1+0.1=1.1).
FOR EXAMPLE
To calculate an adult woman’s PAL value,
take the sum of the ∆ PAL values for
activities of daily living:
• walking the dog (0.11) for 1 hour
• vacuuming (0.14) for 1 hour
• sitting for 4 hours doing light activity
(0.12),
• walking for 1 hour at 4 mph (0.20)
• ice skating for 30 minutes (0.13)
• Total of 0.7.
• To that value add the BEE adjusted for the
10% TEF (1.1)
• For the final calculation: 0.7 + 1.1 = 1.8
• For this woman, the PAL value (1.8) falls
within an active range.
• The PA coefficient that correlates with an
active lifestyle for this woman is 1.27.
• To calculate the EER for this adult woman,
age 30, use the EER equation for women
19 years and older (BMI 18.5-25 kg/m2);
see Box 2-1
The following calculation estimates the EER for a
30-year-old active woman who weighs 65 kg, is
1.77 m tall, with PA coefficient (1.27):
 HEALTHY PROBLEM RELATED ENERGY METABOLISM
MALNUTRITION

Overweight Marasmus
Obese Kwasiorkor
Marasmus-
Kwasiorkor
‘According to the World Health Organization (WHO), malnutrition is the ‘cellular imbalance
between supply of nutrients and energy and the body’s demand for them to ensure growth,
maintenance and specific functions’, and is the greatest risk factor for illness and death
worldwide. It can be associated with both undernutrition and overnutrition.
MARASMUS KWASIORKOR
 PROTEIN ENERGY MALNUTRITION
(PEM)
The most common physical signs of protein and energy
malnutrition (PEM) are:
• Weight loss and cachexia
• Decreased subcutaneous tissue and reduction in
muscle and body tissue mass, which can be most often
observed in the legs, arms, buttocks and face
• Oedemas
• Neurological problems and abnormalities
• Oral changes (red and usually swollen mouth, lips and
gums)
• Muscle cramp and pain
• Skin changes (dry and peeling, frail, swollen, pale, loss
of elasticity and poor healing)
• Hair changes (dry and discoloured).
OBESITY
TAKE HOME
1. Hitunglah kebutuhan energi Anda dalam sehari !
REE menggunakan Harris Benedict dan Mifflin- St. Jeor
TEE menggunakan rumus
a. TEE= REE +TEF*+ PAL**
b. EER prediction equation at 4 level activity (box 2.1)
c. METS

2. Hitunglah berapa energi yang masuk ke dalam tubuh anda dalam 3 hari (boleh berturut-turut,
boleh tidak berturut2) !
 USEFULL RESOURCES
• Mahan, L.K& Janice, L.R. 2017. Krause’s: Food and The Nutritional Care Process
14th Edition. Missouri: Elsevier
• Rinzler, Caroll Ann. 2006. Nutrition for Dummies. Indiana; Wiley Publishing Inc.
• Zimmerman, Auren& Beth Snow. 2012. An Introduction to Nutrition.
• Fundamentals of Nutrition and Foods Part One
• Katsilambours, N et al. 2010. Clinical Nutrition in Practices. Oxford: Blackwell
Publishing