King Abdulaziz University

Faculty of Applied Medical Sciences

Clinical Nutrition Department

Practical Guidelines
Nutritional Assessment

❖ Anthropometrical :
● Estimation of Height (1):

➢ knee height
female height in cm = 84.88 - ( 0.24 × age in years ) + (1.83 × knee height in cm)

male height in cm = 64.19 - ( 0.04 × age in years ) + (2.02 × knee height in cm)

➢ Demi-Span
female height in cm = (1.35 × demi-span in cm ) + 60.1

male height in cm = (1.40 × demi-span in cm ) + 57.8

● Weight :

➢ Body Mass Index for adults (2)

BMI (kg/m2) Weight Status

<18.4 Underweight

18.5 - 24.9 Normal

25 - 29.9 Overweight

30 - 34.9 Obesity 1

35 - 39.9 Obesity 2

>40 Obesity 3

➢ Body Mass Index for > 65 years (3)

BMI (kg/m2) interpretation

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
<24 maybe associated with health problems in some elderly

24 - 29 healthy weight for most elderly

> 29 may be associated with health problems in some elderly

adapted from the manual of clinical dietetics

➢ HAMWI method for estimating Ideal Body Weight in kg and cm (2):

female 45.5 kg for each 1.52 m plus 0.9 kg for every cm above 1.52 m

male 48.1 kg for each 1.52 m plus 1.1 kg for every cm above 1.52 m

➢ Adjustment for body frame size (2)

10% can be added or subtracted to the final value to accommodate variation in body frame size

➢ Estimating frame size using wrist circumference (1) :

female height <155 cm height 155 - 162 cm height >162 cm

small <13.75 cm <15 cm <15.6 cm

medium 13.75 - 14.37 cm 15 -15.5 cm 15.6 - 16.25 cm

large >14.37 cm >15.62 cm >16.25 cm

male height > 162 cm

small 13.75 - 16.25 cm

medium 16.25 - 18.75 cm

large > 18.75 cm

➢ Amputation Adjustments for Estimating Ideal Body Weight (2):

!""  !  %  !"#$%!%&'(  
× IBW for original height
!""

Hand 0.7%

forearm with hand 2.3%

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
forearm without hands 1.6%

entire arm 5%

upper arm 2.7 %

foot 1.5%

lower leg and foot (below knee) 5.9%

entire leg 16%

Trunk without limbs 50 %

thigh 10.1 %

➢ Spinal cord injury adjustments (1) :

❏ paraplegia : subtract 5-10% from IBW
❏ quadriplegia : subtract 10-15% from IBW

➢ Adjusting Body Weight for patients with Edema/Ascites (17) :

degree Ascites Oedema

Minimal 2.2 Kg 1 Kg

Moderate 6.0Kg 5 Kg

Severe 14Kg 10 Kg

➢ Adjusted Body Weight in kg (16) :

ABW - IBW × 0.25 + IBW

➢ percentage of ideal body weight and usual body weight (2) :

!"##$%&  !"#$  !"#$%&  
❏ %IBW = ×  100  %
!"#$%  !"#$  !"#$%&  
!"##$%&  !"#$  !"#$%&  
❏ %UBW = ×100%
!"#
❏ interpretation :

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
index mild deficit % moderate deficit% severe deficit %

ideal body weight 80-90 70-79 <70

usual body weight 85-95 75-84 <75

➢ percentage of weight change (2) :

!"#  !  !"#  
❏ % weight changes = ×  100
!"#
❏ interpretation :

time period of weight significant % weight loss severe % weight loss

changes

1 wk 1-2 >2

1 mo 5 >5

3 mo 7.5 >7.5

6 mo 10 >10

➢ waist circumference for assessing chronic diseases risk (4):

risk of chronic disease high risk of chronic diseases

female > 80 cm >88 cm

male >94 cm >102 cm

❖ Biochemical :
➢ Corrected calcium = total calcium mg\dL + 0.8 (4- serum albumin g\dL) (1)
➢ diagnosis of various types of anemia (3) :

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
adapted from the manual of clinical dietetics

➢ indications for various serum electrolytes (1) :

serum increased levels decreased levels
electrolyte

Phosphate Renal failure, hypoparathyrodism, Hyperparathyroidism, hypercalcemia,

(PO4), acromegaly, bone metastasis, rickets, malnutrition, gram-negative
Phosphorus hypocalcemia, Addison’s disease, sepsis, hyperinsulinism, alkalosis, IV
(P) rhabdomyolysis glucose administration (phosphorus
follows glucose into cells)

Sodium (Na) Increased Na intake ( dietary or IV ), Decreased Na intake (deficient

decreased Na loss ( Cushing’s dietary or IV sodium), increased Na
syndrome, hyperaldosteronism), loss (Addison’s disease,
excessive free body water loss (GI, diarrhea\vomiting, intraluminal bowel
excessive sweating, extensive burns, loss, diuretic administration, chronic
diabetes insipidus, osmotic diuresis ) renal insufficiency), increased free
body water ( excessive oral or IV
water intake , hyperglycemia, CHF,
peripheral edema, pleural effusion,
SIADH)

potassium (K) Excessive dietary or IV intake, acute Deficient dietary or IV intake,

or chronic renal failure, Addison’s burns\trauma\surgery,
disease, hypoaldosteronism, diarrhea\vomiting\sweating, diuretics,
aldosterone-inhibiting diuretics ( hyperaldosteronism, Cushing’s
spironolactone, traimterene), crash syndrome, Licorice ingestion,
or cell damaging injuries ( accidents, alkalosis, glucose administration,
burns, surgery, chemotherapy), cystic fibrosis
hemolysis, acidosis, dehydration

Calcium Hyperparathyroidism, cancer with Pseudohypocalcemia due to low

parathyroid hormone (PTH)- albumin levels, hypoparathyrodism,
producing tumors (metastatic bone renal failure, hyperphosphatemia
cancer, Hodgkin lymphoma, secondary to renal failure, rickets,
leukemia, and non-Hodgkin vitamin D deficiency, osteomalacia,

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 lymphoma), Paget disease of the malabsorption, pancreatitis,
bone, prolonged immobilization, malnutrition, alkalosis
milk-alkali syndrome, excessive
intake of vitamin D, milk, antacids,
Addison disease, granulomatous
infection (e.g., sarcoidosis,
tuberculosis)

➢ indications for various nutrition related labs (1) :

elevated levels decreased levels

albumin Dehydration Malnutrition, pregnancy, acute and

chronic inflammation and infection,
liver disease, alcoholism, cirrhosis,
nephrotic syndrome, renal disease,
Burns, protein-losing enteropathies
such as Crohn's disease, .
over hydration

prealbumin Hodgkin‘s Lymphoma, pregnancy Malnutrition, liver damage, burns,

inflammation

BUN Prerenal ( hypovolemia dehydration, Liver failure, acromegaly,

shock, burns, congestive heart failure malnutrition, overhydration, negative
(CHF), Myocardial infarction (MI), nitrogen balance, syndrome of
gastrointestinal bleeding (GI bleed), inappropriate secretion of antidiuretic
excessive protein ingestion, and\or hormone (SIADH), pregnancy,
catabolism, starvation, sepsis) nephrotic syndrome .
Renal ( renal disease or failure,
nephrotoxic drugs )
Postrenal ( urethral obstruction from
stones\tumors\congenital anomalies,
bladder outlet obstruction from
prostatic hypertrophy, cancer, or
congenital anomalies )

serum Impaired renal function (e.g., Debilitation, decreased muscle mass

creatinine glomeruloneprhitis, pyelonephritis, (e.g., muscular dystrophy,
acute tubular necrosis, urinary tract myasthenia gravis ), advanced and
obstruction), muscle disease severe liver disease
(gigantism, acromegaly),
rhabdomyolysis

cholesterol Familial hypercholesterolemia and\or Malabsorption, advanced cancer,

hyperlipidemia, hypothyroidism, malnutrition, hyperparathyroidism,
poorly controlled DM, nephrotic chronic anemias, severe burns,
syndrome, cholestasis, pregnancy, sepsis\stress, liver disease
obesity, high dietary intake, Werner

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 syndrome

➢ Nitrogen Balance to assess total body protein (1):

❏ Input : 24 hour dietary protein intake , then convert to Nitrogen Intake :
!"#$%&'  !"#$%&  !"  !"  
!"#$%&'!   =  
6.25  !"  !"#$%&'!  
❏ Output : collect 24 hour urine , urinary urine nitrogen (UUN)
!"#$%&'!  !"#$%&
❏ Nitrogen balance =
(!!"  !  !)
❏ interpret data :
➔ 0 , nitrogen balance ( normal adults )
➔ +ve balance (pregnant women , children , in growth)
➔ -ve balance (suggest malnutrition )

❖ Clinical Examination (1) :

body system healthy abnormal implication

hair Normal distribution, Thin, dull, dry, brittle, Chemotherapy, protein or biotin
shiny corkscrew hairs deficiency, vitamin C deficiency

eyes Bright, clear, pink Sunken, dull, pale, dry Deficiency of: Vitamin A, zinc,
conjunctiva conjunctiva, photophobia, riboflavin
xerosis

lips Moist, good color Swollen, dry, red, cracked Deficiency of: riboflavin,
pyridoxine, niacin

gums Pink, firm Sore, spongy, red, swollen, Vitamin C deficiency

bleed easily

tongue Pink, presence of Purple, white or gray Deficiency of: riboflavin,

papillae coating, smooth, slick pyridoxine, folic acid, niacin,
vitamin B12, iron

teeth Clean, intact, all Dentures, missing teeth, Calcium deficiency, poor diet
present loss of tooth enamel

nick No swelling Presence of nodules, goiter Excess or deficiency of iodine

skin Smooth, slightly moist, Pale, dry, scaly, bruises Deficiency of: iron, vitamins A or
good color easily, pressure ulcers, C, zinc, essential fatty acid,
dermatitis protein; excess of niacin

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
legs Well developed, firm Calf tenderness, flaccid Deficiency of: protein; vitamins
musculature, no joint muscles, pain, edema, A, C, or D; calcium
or bone pain rickets, bone or joint pain

abdomen no swelling or pain mildly edematous, diarrhea deficiency of :protein, niacin ,

, ascites zinc

hands/nails smooth brittle nails ,atrophied fine deficiency of :protein , iron

muscles , spoon shaped
nails

muscoskelet normal bone , muscle, Calf tenderness, loss of deficiency of : thiamine , vitamin
al, adipose and fat development subcutaneous fat, c , energy or fluid deficit
emaciated appearance,
pain, decreased grip
strength, hollow cheeks,
fractures, osteoporosis

nuerologic normal reflexes CVA , limited reflexes Deficiency of: thiamin, niacin,
,disorientation , paralysis , vitamins B6 or B12, folic acid,
convulsions ,dementia iodine, phosphorus, calcium,
magnesium

➢ Classification of blood pressure for adults mmhg (1):

systolic diastolic

normal <120 and <80

prehypertension 120-139 or 80-89

stage 1 hypertension 140 - 159 or 90-99

stage 2 hypertension ≥ 160   or ≥ 100  

➢ heart rate (5) :

Normal pulse: 60 - 100 beats per minute
❖ Dietary History (2) :
➢ Components of a nutrition history :
● current diet order
● current dietary habits
● days on clear liquids, inadequate intake, or nothing by mouth ( NPO)
● dietary restrictions (past and present)
● recent dietary changes (intentional vs unintentional)

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 ● food consistency restrictions (soft,pureed, or liquid)
● appetite assessment (poor, fair, good, or excellent)
● satiety level
● snack consumption
● beverage consumptions
● alcohol consumption
● food intolerance
● food allergies
● taste changes or aversions
● ethnic, religious, and cultural influences
● fad diets
● vitamin and mineral supplements
● herbal supplements
● commercial dietary supplements, protein powders, meal replacements, etc.

➢ Methods of obtaining a diet history :

❏ 24- hour recall : food, beverage, and supplements consumption for the past 24 hours
provided.
❏ food frequency : patient select from a list which foods, beverages, and supplements are
frequently consumed.

Estimation of Nutritional Requirement

❖ Energy : Estimated Energy Expenditure Calculator Results Diagram: (6)

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 ➢ Harris-Benedict Equations (resting metabolic rate) :
male = 66.5 + 13.8 (W) + 5 (H) – 6.8 (A)

female = 655.1 + 9.6 (W) + 1.7 (H) – 4.7 (A)

Equation uses weight (W) in kilograms (kg), height (H) in centimeters (cm), and age (A) in years.

➢ Ireton - jones Equations 1992 :

Spontaneously breathing (s) = 629 – 11(A) + 25 (W) - 609 (O)

Ventilator dependent (v) = 1925 – 10 (A) + 5 (W) + 281 (S) + 292 (T) + 851(B)
Equations use age (A) in years, body weight (W) in kilograms, sex (S, male = 1, female = 0), diagnosis of
trauma (T, present = 1, absent = 0), diagnosis of burn (B, present = 1, absent = 0), obesity body mass
index (BMI) more than 27 kg/m2 (present = 1, absent = 0).

➢ Mifflin-St Jeor:

male (10 X weight) + (6.25 X height) – (5 X age) + 5

female ( 10 X weight) + (6.25 X height) – (5 X age) - 161

Equations use Actual body weight in kilograms and height in centimeters.

➢ penn - state ,PSU 2010 (Modified Penn State Equation):

RMR= Mifflin (0.71) = VE(64) + Tmax (85) - 3085
➢ penn - state ,PSU 2003b (penn state equation) :

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
RMR = Mifflin (0.96) + VE (31) + Tmax (167) - 6212
* VE = minute ventilation (L/min) , Tmax = maximum daily body temperature (degree celsius)

➢ Factors for calculating TEE (7):

❏ Activity factors :
comatose 1.1

confined to bed 1.2

out of bed 1.3

normal activities of daily living 1.5

❏ Injury Factors :
minor surgery 1 - 1.2

major surgery 1.1 - 1.3

Skeletal trauma 1.1 - 1.6

Head trauma 1.6 - 1.8

mild Infection 1 - 1.2

moderate infection 1.2 - 1.4

severe infection 1.4 - 1.8

Burns <20% BSA 1.2 - 1.5

Burns 20-40 % BSA 1.5 - 1.8

Burns > 40% BSA 1.8 - 2

❏ Fever factors :
Fahrenheit scale add 7% of REE for every 1º over normal

Centigrade scale add 13% of REE for every 1º over norma

➢ Quick method for calculating Energy and protein requirement (multiply by weight)
(8):

category of activity or illness Kcal/Kg/Day Grams

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 Pro/Kg/Day

Minor surgery 30 cal/kg 1.0-1.2 g/kg

Major surgery 35 cal/kg 1.5-2.0 g/kg

Major sepsis 40-45 cal/kg 1.5-2.0 g/kg

peritonitis 35-40 cal/kg 1.2-1.4 g/kg

Trauma, for example, severe burns 40-45 cal/kg 1.5-2.0 g/kg

Malnutrition with starvation 20-22 cal/kg 1.1-1.5 g/kg

significant weight loss 30-35 cal/kg 1.2-1.5 g/kg

crohn’s disease 30-35 cal/kg 1.0-1.2 g/kg

acute renal insufficiency 30-35 cal/kg 0.8-1.0 g/kg

Chronic kidney disease w/o dialysis 35 cal/kg 1.0 g/kg

chronic kidney disease w/ hemodialysis 35 cal/kg 1.2-1.4 g/kg

chronic kidney disease w/peritoneal dialysis 25-3- cal/kg 1.2-1.5 g/kg

diabetes type I,II 30 cal/kg 0.8-1.0 g/kg

paraplegia 28 cal/kg 0.8-1.0 g/kg

Quadriplegia 23 cal/kg 0.8-1.0 g/kg

AIDS 35 cal/kg 1.2-1.5 g/kg

AIDS, with wasting syndrome 40-50 cal/kg 1.5-2.0 g/kg

hepatic disease cirrhosis 30-35 cal/kg 1.2-1.5 g/kg

hepatic disease with encephalopathy 30-35 cal/kg 0.8-1.0 g/kg

acute pancreatitis 35-40 cal/kg 1.2-1.5 g /kg

chronic pancreatitis 30-35 cal/kg 1.0-1.2 g/kg

ICU patients on ventilator 25 cal/kg 1.2-1.4 g/kg

geriatrics 25-30 cal/kg 1.0-1.1 g/kg

pregnancy, using pre-pregnant IBW 36 cal/kg 1.0-1.2 g/kg

pneumonia 30-35 cal/kg 1.0-1.5 g/kg

pulmonary failure, if catabolic 35-40 cal/kg 1.5-2.0 g/kg

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
cancer, if severely stressed 35-40 cal/kg 1.5-2.0 g/kg

❖ Fluid Requirement (2):

➢ Factors that affect fluid requirement:
Factor increase in fluid requirement

fever 12.5 % for each 1∘ !  above normal

sweating 10 - 25 %

hyperventilation 10 - 60 %

hyperthyroidism 25 - 50 %

Extraordinary gastric or renal fluid losses varies , base adjustment on 24-hr output

➢ calculation of daily water requirement :

body weight water requirement

<10 kg 100 ml/kg

11 - 20 kg 1000 ml + 50 ml/kg >10 kg

> 20 kg 1500 ml + 20 ml/kg > 20 kg

➢ RDA method : 1 ml fluid/ 1 kcal of estimated needs

Food - Drug Interaction (11)

Medication Side effects Nutrient implication

MAO Inhibitors (Nardil) Increase appetite and weight - Avoid tyramine containing
gain, dry mouth, N\V and foods.
constipation

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
Antitubercular (Isoniazid) Anorexia, dry mouth, N\V,
constipation and diarrhea
- Avoid high tyramine or
may cause Vitamin B6 histamine containing foods.
deficiency, or Pellagra

Diuretics (K+wasting) Anorexia, N\V, diarrhea, - Consume food high in K and

(Furosemide, Lasix) constipation, increase thirst, Mg.
and increase excretion of - low cal and Na diet may be
Mg, Na, K recommended.
- avoid restriction if
hyponatremia exist.

Diuretics (K+ sparing) Increase thirst, dehydration, - Avoid food high in K, K

(Spironolactone, anorexia, N\V, wt loss, dry supplements, and salt
Aldactone) mouth, gastritis, diarrhea substitutes.
- Low cal might recommended.
- Low Na diet, avoid restriction if
hyponatremia exist.

Anticonvulsant Altered taste,dysphagia, N\V, - May need Ca , vitamin D,

(Phenytoin) constipation, decrease thiamin supplement.
serum levels of folic acid, -Suspension-stop tube feeding
Ca, vitamin D, biotin, and for 2 hours or more and flush
thiamin with 30 ml or more of water or
saline before and after drug
administration.

Anticoagulants Altered taste, N\V, diarrhea, - Maintain consistent usual

Warfarin (Coumadin) prevent the conversion of vit intake of Vitamin K, caution
K to its active form with vitamin K supplements.
- Avoid or limit natural products
which affect coagulation such
as garlic, ginger, ginkgo,
ginseng, saw palmetto, or
horse chestnut.
- Avoid coenzyme Q10.

Corticosteriods Esophagitis, N\V, dyspepsia, - Low Na diet , increase Ca

(Prednisone, Cortisone) peptic ulcer, bloating, GI vitamin D, and protein intake.
bleeding/ perforation, cause - May increase K, P, vitamin A,
protein catabolism, increase vitamin C.
appetite, weight gain - Limit caffeine to decrease GI
effects.

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 Anti-psychotic (Lithium) Increase thirst, weight gain - Maintain consistent amount of
anorexia, dry mouth metallic Na and water.
taste, N\V, bloating diarrhea - Limit caffeine.
- Avoid iodine supplements.

Anti-Parkinson’s Anorexia, weight loss or - Limit Vitamin B6,

(Levadopa) weight gain, dry mouth,
- Redistribute protein to
taste loss, excessive
salivation, dark saliva, bitter evening
taste, dysphagia, N\V, meal.
constipation, diarrhea,
flatulence.

Antineoplastic Decrease absorption of - Increase fluid intake

(Methotrexate) folate, anorexia,
dehydration, - Folate supplement
decrease weight, stomatitis,
gingivitis, altered taste ,N\V,
diarrhea, hemorrhagic
enteritis

Antiarrhythmic (Digoxin) Anorexia, N\V, wt loss, - Maintain diet high in K and low
diarrhea in Na, adequate Mg and Ca.
- Caution with Ca and Vitamin D
supplement.

Ca antacids Anorexia, chalky taste , - Adequate fluid intake.

(Ca carbonate) decrease diarrhea

Mg antacids Diarrhea, chalky taste, N - High fiber with adequate fluid

(Mg hydroxide) intake to prevent constipation.

Na antacids Edema, increase thirst, - Consider the Na content with

(Na biocarbonate ) reduce Fe absorption low Na diet.

Inhibitor of HMG-CoA N, constipation, diarrhea, - Avoid grapefruit\ related

reductase dyspepsia citrus.
(Atorvastatin - "Lipitor") - Low fat, low cholesterol diet.
(Simvastatin - "Zocor")

ACE inhibitors May cause hyperkalemia, - Low Na, low cal may be
(Lisinopril) decrease wt, anorexia, recommended, avoid salt
N\V, dry mouth, constipation, substitutes.
diarrhea - Cautions with food high in K
and K supplement.

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 - Maintain adequate hydration.

Immunosuppressant Anorexia, N\V, hyperkalemia. - Avoid K supplements or salt

(Cyclosporine) substitutes.
- Avoid grapefruit\ related citrus.

pregnancy/lactation
➢ IBW during pregnancy (1) =
❏ HAMWI formula +
in 1st trimester 1-3 kg

from 2nd trimester 0.34 - 0.5 kg per week (slightly more if

underweight , slightly less if obese )

➢ Recommended weight gain during pregnancy (9) :

category (based on pre-pregnancy weight ) recommended total weight gain

under weight (BMI < 19) 12.5 - 18

Normal (BMI 19 - 24.9) 11.5 - 16

overweight ( BMI 15 - 29.9 ) 7 - 11.5

obese (BMI > 30 ) 7

Twin gestation (any BMI) 18 - 20.4

triple gestation ( any BMI) 22.5 - 27

➢ estimating pre-pregnancy weight (10):

an imputed weight was calculated using the measured weight at the first prenatal
visit (if taken prior to 16 weeks) minus the recommended amount of weight to be
gained in the first and second trimesters

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 ➢ Nutritional requirement (9) :
❏ BMR using Mifflin st. jeor
1st trimester 2nd trimester 3rd lactating
trimester

energy MBR+15% +10 +340 +452 -1st 6 mo=BMR+330

- 2nd 6 mo +400

❏ Protein 1.1 gm/kg/d + 25 gm/d throughout all pregnancy

❏ protein 1.1 gm /kg/d for during lactation

Enteral and parenteral (12)

➢ Enteral Nutrition:
Rate = Volume / Hours

➢ Parenteral Nutrition:

❏ Need to know:
Dextrose = 3.4 kcal/g protein = 4 kcal/g fat = 9-10 kcal/g

20% Lipids: 2 kcal/ml 10% Lipids: 1.1 kcal/ml

❏ To calculate Glucose Utilization Rate (GUR):

1- Gram Dextrose = Volume X Strength
2- mg Dextrose = Gram dextrose X 1000 mg/g
3- GUR (mg/kg/min)= mg Dextrose / kg(body wt)X 1440 minutes
The Desired range is 4-6 mg/kg/min

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 RENAL
➢ Stages of Chronic Kidney Diseases (13)
Stage Description GFR

1 Kidney damage with normal or increased GFR ≥90

2 Kidney damage with mildly decreased GFR 60-89

3 Moderately decreased GFR 30-59

4 Severely decreased GFR 15-29

5 Kidney failure < 15 or dialysis

➢ Nutrition Recommendations for Kidney Disease (14)

Acute CKD Nephrotic HD Peritoneal

Syndrome Dialysis

Protein 0.6-0.8 based on 0.6-0.75 0.8-1 ≥ 1.2 ≥ 1.2-1.3

g/kg renal ≥ 50% HBV ≥ 50% HBV ≥ 50% HBV
IBW or function/treatment
ABW

Energy 30-35 based on 35 (< 60 yrs) 35 unless 35 (< 60 35 (< 60 yrs)

kcal/kg stress/ nutrition 30-35 (>60 obese yrs) including
IBW or status yrs) 30-35 (>60 dialysate
ABW yrs) 30-35 (>60
yrs)

Na+ 1-2 based on BP, 1-3 1-2 2 2-4

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
g/day edema; replace
losses in diuretic
phase

K+ Maintain serum < 5 Unrestricted Unrestricte 2-3 3-4

g/day mEq/L; replace d
losses in diuretic
phase

PO4 Maintain WNL 800- Maintain 800- 800-

mg/kg 1000mg/day WNL 1000mg/da 1000mg/day
10-12mg/g y adjust to adjust to
pro meet pro meet pro
Maintain need; 10- need; 10-
serum P & 12mg/g pro 12mg/g pro
PTH WNL

Fluid 500 + output Unrestricted Maintain 1000 + Maintain

cc/day balance output balance

Done By :
● Eram Al-Bajri , MS, RD
● Manal Naseeb , MS , RD
● Abeer Al-Jahdali
● Atheer Attar
● Alaa Barahim
● Rehab Al-Yusuf
● Walaa Asaad

August , 2014

Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf
 REFERENCES
1. Width M,Reinhard T. The Clinical Dietitian's Essential Pocket Guide. Philadelphia, Pennsylvania,
Lippincott Williams & Wilkins;2009.
2. Charney P, Malone AM. Anthropometric assessment. ADA pocket guide to nutrition assessment.
Chicago, IL: American Dietetic Association; 2009.
3. Chicago Dietetic Association, The South Suburban Dietetic Association, and Dietitians of
th
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Created By: Atheer Attar

Assisted: Alaa Barahim; Eram Albajri, MS, RD; Manal Naseeb, MS, RD; Rehab Alyusuf