NUTRITION AND DIET THERAPHY

LECTURE
PRELIM TRANSES

LESSON 1 - Strategy: risk for diabetes in pre- Enzymes An organic catalyst that
diabetes stages – testing blood sugar are protein in nature and
Basic Concepts in Nutrition and Diet levels, non-invasive treatments such as are produced by living
Nutrition weight loss and diet modification cells
 It is the science of food and its relationship to  Tertiary the use of treatment technique after a Nutritional Status is the condition of the
health. disease has occurred to prevent complications body resulting from the
utilization of essential
 Involves the process of taking in and utilizing or to promote maximum adaptation.
nutrients
nourishment, which includes natural and Calorie fuel potential in a food;
Terms Definition
artificial feeding. one calorie represents
Nutrition is the study of food in
 Pre-disposing relation to health the amount of heat
- non-modifiable factors like age, race, Food is any substance when required to raise one liter
etc. ingested or eaten of water one degree
 Precipitating nourishes the body Celsius
- Modifiable factors like lifestyle, food, Nutrient Is a chemical component
nutrition, exercise needed by the body to Malnutrition it is the condition of the
provide energy, to build body resulting from a
Role of Nutrition and repair tissues and to lack of one or more
regulate life process essential nutrients or
 Nutrition can contribute to the prevention of due to excessive nutrient
Digestion it is a mechanical and
disease supply
chemical breakdown of
 Primary implementation of practices that are food into smaller
likely to avert occurrence of diseases components
- Strategy: motivating people to change Classification of Nutrients
Absorption it is a process where the
their behavior and maintain a healthy nutrients from foods are Function
body weight absorb by the body into • Those that form tissues in the body are body-
 Secondary the institution of monitoring the bloodstream building nutrients while those that furnish heat
techniques to discover incipient diseases early Metabolism Is a chemical process of and energy are fats, carbohydrates, and
enough to enhance the opportunity to control transforming foods into proteins; body regulating; energy-giving
their effects other substance to
sustain life
Chemical properties • Aid in the regulation of basic body processes. • are peptides and amino acids that provide 4
• Nutrients are either organic or inorganic kcal/g of energy.
• Organic  proteins, lipids, carbohydrates, and Sources of Energy • are necessary for tissue repair and function,
vitamins Energy growth, energy, fluid balance, clotting, and the
• Inorganic  water and minerals • Capacity to do work production of white blood cells.
Essentiality • It cannot be seen, heard, or felt • Complete proteins must be ingested in the
• Nutrients are classified based on their • Exists in variety of forms: electric, thermal diet. They have enough amino acids to perform
significant contribution to the body’s (heat), chemical, mechanical, etc. necessary bodily functions, such as growth and
physiological functioning • Note: all food enters the body in chemical tissue maintenance
Concentration energy and is converted into other energy • Incomplete proteins do not contain enough
• Nutrients are either in large amounts or little forms amino acids to sustain life.
amounts • Energy nutrients: carbohydrates, fats, and • Partially complete proteins have enough
• Macronutrients  carbohydrates, proteins, fats proteins amino acids to sustain life, but not enough for
• Micronutrients  vitamins, mineral, water • Kilocalories – unit of measure of the energy in tissue growth and maintenance.
food and in the body (Kcal) Fats
Types of Nutrients Macronutrients • consist of fatty acids and glycerol and are
Essential nutrient • Required in large amounts essential for tissue growth, insulation, energy,
• one that the human body requires but cannot • Contribute to the bulk energy needed for the energy storage, and hormone production
manufacture in sufficient amounts to meet metabolic system • Fats provide 9 kcal/g of energy
bodily needs. Must be supplied by foods in the • Carbohydrates, Fats, Proteins • Fats are classified as saturated, unsaturated,
diet Carbohydrates and trans fatty acids.
• E.g. Vit A, Vit C, and Calcium • sugars and starches and are an important • Saturated fats come from animal products,
Non-essential nutrient energy source that provides 4 kcal/g of energy. such as butter and red meat (e.g., steak)
• Are not needed in the diet because the body • Simple carbohydrates are small molecules • Unsaturated fats come from oils and plants,
can male them from other substances (called monosaccharides or disaccharides) and although chicken and fish also contain some
• E.g. Alanine break down quickly. unsaturated fats. Unsaturated fats are healthier
Conditionally Essential nutrients • simple carbohydrates are easily digested and than saturated fats.
• Are those that a healthy body can manufacture absorbed into the bloodstream, so they raise • Trans fats are fats that have been altered
in sufficient quantities. The body cannot blood glucose levels quickly through a hydrogenation process, so they are
produce in optimal amount in certain situations • Complex carbohydrates are larger molecules not in their natural state.
of physiologic status of disease (called polysaccharides) that break down more Micronutrients
• E.g. Tyrosine slowly, which causes slower release into the • Required in small amounts
bloodstream and a slower increase in blood • Helps various function of the body, growth, and
Life Sustaining Functions of Nutrients sugar over a longer period of time. disease prevention
• Serve as a source of energy or heat. Proteins • Vitamins and minerals
• Support the growth and maintenance of tissue.
Vitamins • The breakdown of food in the body in
• Vitamins are necessary for many bodily preparation for absorption.
functions, including growth, development, • Mechanical Digestion: food is broken up by
healing, vision, and reproduction. teeth and moved along GI tract by peristalsis
• Most vitamins are considered essential • Chemical Digestion: Carbohydrates, Proteins,
because they are not manufactured by the and Fats are broken down into nutrients tissues The Digestive System
body and must be ingested in the diet. can absorb and use.
• Vitamins are classified as water soluble or fat • Chemical changes occur through hydrolysis
soluble. (the addition of water and breaking down of
• Water-soluble vitamins are not stored in the food molecules).
body and include vitamin C and B-complex • Enzymes act on food substances, causing
vitamins them to break down into simple compounds.
• Fat-soluble vitamins are absorbed with fats in • An enzyme can act as a catalyst, which
the diet and include vitamins A, D, E, and K. speeds up the chemical reactions
They are stored in fat tissue and can build up in without itself being changed in the Esophagus
the liver. process. • Food travels through this muscular tube
Minerals Absorption • Connects mouth to stomach
• are inorganic materials essential for hormone • The passage of nutrients into the blood or • Peristalsis and gravity act to move bolus
and enzyme production, as well as for bone, lymphatic system. • Cardiac Sphincter opens at lower end of
muscle, neurological, and cardiac function. • Nutrients must be in their simplest form esophagus to allow passage of bolus into
• Minerals are needed in varying amounts and • Carbohydrates: simple sugars stomach
are obtained from a well-rounded diet. • Proteins: amino acids Stomach
• Minerals are classified as either macrominerals • Fats: fatty acids and glycerol • Temporary storage of food
or trace minerals. • Most absorption occurs in the small intestine; • Mixing of food with gastric juices
• Macrominerals are needed in larger amounts some occurs in the large intestine. • Regulation of a slow, controlled emptying of
and are typically measured in milligrams, • Water is absorbed in the stomach, small food into the intestine
grams, or milliequivalents. intestine, and large intestine. • Secretion of the intrinsic factor for vitamin B12
• Macrominerals include sodium, potassium, Mouth • Destruction of most bacteria inadvertently
calcium, magnesium, chloride, and • Digestion begins here consumed.
phosphorus. • Enzyme (salivary amylase) acts on starch • Hydrochloric acid prepares the gastric area for
• Trace minerals are needed in tiny amounts. • Starch is a complex carbohydrate enzyme action
• Trace minerals include zinc, iron, chromium, • Teeth break-up food; food mixes with saliva • Pepsin breaks down proteins
copper, fluorine, iodine, manganese, • “Bolus” formed • In children, rennin breaks down milk proteins
molybdenum, and selenium • Length of time food is in mouth is brief • Lipase acts on emulsified fats
Digestion • Small amounts of carbohydrates changed.
 3 Parts of Stomach Jejunum is the middle section, and the Ileum is • Assessing nutrient intakes and
1. Fundus: upper portion of the stomach the last section monitoring the nutritional health of the
2. Body of the stomach: middle area Large Intestine population
3. Pylorus: end of stomach near small intestines • Colon walls secrete mucus to protect against • Each type of DRI refers to the average daily
acidic digestive juices in chyme. nutrient intake for the general population over
• Chyme: semi-liquid mass of food and gastric • Major tasks of the large intestine: time.
juices • Absorb water • Definitions of the different DRIs provide further
• Pernicious anemia: lack of intrinsic factor • Synthesize some B vitamins and vitamin details about each of these values.
Small Intestine K • Values related to meeting nutritional
• Hormones released • Collect food residue requirements are:
• Secretin causes pancreas to release Metabolism • Estimated average requirement (EAR)
sodium bicarbonate to neutralize acidity • The use of food by the body after digestion • Estimated energy requirement (EER)
of chyme • Results in energy • Recommended dietary allowance (RDA)
• Cholecystokinin triggers gallbladder to • Occurs after digestion and absorption; nutrients • Adequate intake (AI)
release bile. are carried by the blood to the cells of the • The value for preventing excessive intakes is
• Bile: emulsifies fat after it is secreted into small body. the:
intestine. • Tolerable upper intake level (UL)
• Enzymes are found in the pancreatic juice that LESSON 2
is secreted into small juices. Estimated Average Requirement (EAR)
Nutrition Tools, Standards, and Guidelines
• Pancreatic proteases (trypsin, • daily nutrient intake level that meets the
Nutrient Recommendations
chymotrypsin, carboxypeptidases): split median or average requirement of healthy
proteins. individuals in particular life stage and sex
Dietary Reference Intakes (DRI)
• Pancreatic amylase: converts starches group, corrected for incomplete utilization or
• Are a set of scientifically developed reference
(polysaccharides) to simple sugars dietary nutrient bioavailability.
values for nutrients
• Pancreatic lipase: reduces fats to fatty
• DRI values provide the scientific basis for
acids and glycerol
nutrition professionals, governments, and non-
• Produces enzymes
governmental organizations to carry out
• Prepares foods for absorption
activities such as:
• Lactase, maltase, sucrase convert lactose,
• Developing nutrition labels
maltose, sucrose to simple sugars.
• Developing dietary guidelines and food
• Peptidases reduce proteins to amino acids
guides
• Twenty-two feet long
• Ensuring foods and supplements
• Villi, hairlike projections, increase surface area
contain safe levels of nutrients
for maximum absorption
• Creating patient and consumer
• The small intestine is divided into three
counseling and educational programs
sections – The Duodenum is the first section,
 Recommended Dietary Allowance (RDA) approximation of the average nutrient intake by
• Average daily level of intake sufficient to meet a group (groups) of apparently healthy people
the nutrient requirements of nearly all (97– that are assumed to sustain a defined
98%) healthy individuals; often used to plan nutritional state.
nutritionally adequate diets for individuals.
Tolerable Upper Intake Level (UL)
• Recommended Energy/Nutrient Intake
(REI/RNI): level of intake of energy or nutrient • highest average daily nutrient intake level likely
which is considered adequate for the to pose no adverse health effects to almost all
maintenance of health and well-being of individuals in the general population.
healthy persons in the population.

Adequate Intake (AI)

• daily nutrient intake level that is based on
observed or experimentally-determined
LESSON 3 • At every life stage—infancy, toddlerhood,
childhood, adolescence, adulthood, pregnancy,
Dietary Guidelines and Food Guides lactation, and older adulthood—it is never too
early or too late to eat healthfully.
USDA FOOD GUIDE
• For about the first 6 months of life, exclusively
• The Dietary Guidelines for Americans (Dietary feed infants human milk. Continue to feed
Guidelines), jointly issued by USDA and the infants human milk through at least the first
Department of Health and Human Services, is year of life, and longer if desired.
the cornerstone of Federal nutrition policy and • At about 6 months, introduce infants to
nutrition education activities. nutrient-dense complementary foods. Introduce
infants to potentially allergenic foods along with
• The Dietary Guidelines provides a other complementary foods.
customizable framework for healthy eating that • From 12 months through older adulthood,
can be tailored and adapted to meet personal follow a healthy dietary pattern across the
preferences, cultural traditions, and budgetary lifespan to meet nutrient needs, help achieve a
considerations. healthy body weight, and reduce the risk of
• MyPlate replaced MyPyramid and the Food chronic disease.
Guide Pyramid in 2011. • Customize and enjoy nutrient- dense food and
• MyPlate illustrates the five food groups as the beverage choices to reflect personal
building blocks for a healthy diet. preferences, cultural traditions, and budgetary
considerations.
• Focus on meeting food group needs with
nutrient-dense foods and beverages and stay
within calorie limits.
• Limit foods and beverages higher in added
sugars, saturated fat, and sodium, and limit
alcoholic beverages.

Key Recommendations
• Follow a healthy dietary pattern at every life
stage.
 • Vegetables – emphasizing dark green health care facilities, food service, and
vegetables, orange vegetables, and dry beans academic institutions.
and pease Composition of Food Exchange List
• Fruits – emphasizing variety • FEL includes seven food groups, namely:
• Oils – recommending fish, nuts, and vegetable vegetable, fruit, milk, rice, meat, fat, and sugar.
sources • Food items in the same list/group contain
• Milk – milk and milk-based products similar amounts of energy and macronutrients
• Meat and beans – emphasizing low-fat and (carbohydrate, protein, and fat).
lean meats such as fish as well as more beans,
peas, nuts, and seeds Vegetable Exchange
• Vegetables are naturally low in calories,
Food Exchange List sodium, and fat which can help maintain a
• A classification or grouping of common foods in healthy weight.
terms of equivalent amounts of carbohydrate, • Vegetables are nutrient-dense and are good
protein, fat, and calories sources of dietary fiber
• The word exchange refers to the fact that each • Dark green leafy and yellow vegetables are
item on a particular list in the portion listed may particularly rich in beta-carotene.
be interchanged with any other food item on • Vegetables are good sources of vitamin A,
the same list. An exchange can explained as a which is essential for night vision, cell growth,
substitution, choice, or serving. development, and immunity.
• The food exchange list is based on the • For Filipinos, vegetable consumption of ate
principle that good nutrition is applicable to least two to three servings per day is
everyone. encouraged.
• It is composed of seven (7) food groups • One vegetable exchange contains 3 grams of
containing approximately the same amounts of carbohydrates, 1 gram of protein, and 16
carbohydrate, protein, and fat within the group. calories.
• The unit of measure for FEL is referred to as Fruit Exchange
an “exchange” wherein each food within the list • Fruits are important sources if vitamins,
can be traded of substituted with another food minerals, and fiber in the diet.
for the same energy and macronutrient • Fresh or raw fruits are recommended than fruit
MyPyramid
contents. juices because the latter gave lower fiber
• Contains eight divisions
• Is primarily used by RNDs for dietary content.
• Grains – recommending that at least half of
counseling and nutrition education and by other • It is recommended to include three servings of
grains consumed be as whole grains
health professionals as a guide in medical fruit daily, one serving of which is a vitamin C-
nutrition therapy, and as a reference material in rich fruit.
clinics, hospitals, fitness center, and other
• Fruits may cause a temporary increase in • Seafood is an important source of mineral such serving of the food, making it easier to
blood glucose, thus meal plans for persons as iron, zinc, copper, and calcium. compare the nutrition of similar products.
with diabetes should allow not more than three • Legumes, nuts, and seeds are good sources of • Keep in mind that the % Daily Value of each
to five exchanges per day. protein, iron, and zinc. Legumes are also good nutrient, such as total fat of 10% in the
• One fruit exchange contains 10 grams of sources of carbohydrate, dietary fiber, and example below, is based on eating 2,000
carbohydrates and 40 calories. other nutrients. calories a day.
Milk Exchange • Meat exchange list is categorized as low fat, 1. Check the Serving size first. All the numbers on
• Milk is often regarded as nature’s most medium fat, and high fat. this label are for a 2/3-cup serving.
complete food. • Each exchange of meat contains about 8 2. This package has 8 servings. If you eat the
• The protein in milk is a complete protein that grams of protein. The amount of fat and whole thing, you are eating 8 times the amount
provides all of the essential amino acids. calories varies depending on the amount of fat of calories, carbs, fat, etc., shown on the label.
• Milk exchange list includes whole milk, low in meat. 3. Total Carbohydrate shows you types of carbs
fat/reduced fat, and non-fat/skim/fat-free milk. • One exchange of meat when fried will absorb in the food, including sugar and fiber.
• Whole milk contains 3.25% milk fat. approximately one exchange of fat. 4. Choose foods with more fiber, vitamins, and
• Low fat milk has some of the fat removed and Sugar Exchange minerals.
has 1-2% milk fat. • Sugar usually refers to crystallized sucrose of 5. Choose foods with lower calories, saturated fat,
• Fat-free or non-fat/skim milk should contain no table sugar that provides 4 calories per gram. sodium, and added sugars. Avoid trans fat.
more than 0.52% milk fat. • Sugar provides essentially energy to the body.
Rice Exchange • Foods containing large amounts of sugar are
• Cereals such as rice, corn, and wheat are the low in nutrients and may contribute to an
major sources of carbohydrates. unbalanced diet by displacing other important
• Whole grain products are better sources of nutrients in the diet.
dietary fiber compare to refined grain products. • The most common sugars are sucrose,
• There is a misconception that rice is to be glucose, lactose, and fructose.
avoided by persons with diabetes because it • Sucrose, also called white sugar or table sugar,
has high sugar content; the key is to now how is the naturally occurring sugar form of glucose
much to eat from the food groups to keep the and fructose.
blood glucose levels in a safe range. • Lactose is the form of sugar found in dairy
• Rice exchange list is classified into three products.
groups based on protein content – Low protein, • Fructose, the sweetest of all sugars, is found in
medium protein, and high protein fruits and honey.
Meat Exchange Food Labels
• Foods under the meat exchange include meat, • Understanding the Nutrition Facts label on food
fish, seafood, eggs, poultry, and legumes. items can help you make healthier choices.
• Lean meats and poultry are good source of • The label breaks down the amount of calories,
protein, iron, thiamin, riboflavin, and niacin. carbs, fat, fiber, protein, and vitamins per
 Nutrient Guidelines for Filipinos • Consume fish, lean meat, poultry, egg, dried
• is a set of dietary guidelines based on the beans or nuts daily for growth and repair of
eating pattern, lifestyle, and health status of body tissues.
Filipinos. • Consume milk, milk products, and other
• NGF contains all the nutrition messages to calcium-rich food such as small fish and
healthy living for all age groups from infants to shellfish, everyday for healthy bones and teeth.
adults, pregnant and lactating women, and the • Consume safe foods and water to prevent
elderly. diarrhea and other food-and water-borne
• first NGF released in 1990 was composed of diseases.
five messages called “Dietary Guidelines for • Use iodized salt to prevent Iodine Deficiency
Filipinos.” Disorders.
• In 2000, a revised nutritional guidelines • Limit intake of salty, fried, fatty, and sugar-rich
composed of ten messages was released and foods to prevent cardiovascular diseases.
it was called the Nutritional Guidelines for • Attain normal body weight through proper diet
Filipinos. and moderate physical activity to maintain
• In 2012, the Technical Working Group (TWG) good health and help prevent obesity.
for the revision of the NGF, led by the Food • Be physically active, make healthy food
and Nutrition Research Institute of the choices, manage stress, avoid alcoholic
Department of Science and Technology (FNRI- beverage, and do not smoke to help prevent
DOST) developed a new set of the NGF, based lifestyle-related non-communicable disease.
on the 2000 edition. Pinggang Pinoy
• The 2012 NGF now includes the basis and • A visual food guide released by the Food and
justification for each of the ten nutritional and Nutrition Research institute of the Department
health message. of Science and Technology
• It provides information to Filipinos on the right
Below are the new messages of the 2012 NGF: kind and right amount of food that you need to
• Eat a variety of foods everyday to get the become healthy.
nutrients needed by the body. • The food guide shows that the recommended
• Breastfeed infants exclusively from birth up to Filipino meal must contain the following variety
six months and then give appropriate of healthy food from these food groups:
complementary foods while continuing • Go food: a cup of rice
breastfeeding for two years and beyond for • Glow food: a serving of green leafy Daily Nutritional Guide Pyramid for Filipino
optimum growth and development. vegetables Children (1- 6 years old)
• Eat more vegetables and fruits to get the • Grow food: a serving of meat and fish
essential vitamins, minerals, and fiber for
regulation of body processes.
 Daily Nutritional Guide Pyramid for Filipino Daily Nutritional Guide Pyramid for Pregnant
Children (13-19 years old) Women

Daily Nutritional Guide Pyramid for Filipino

Children (7-12 years old)
Daily Nutritional Guide Pyramid for Adults (20-39 Daily Nutritional Guide Pyramid for Filipino
years old) Lactating Women

Daily Nutritional
Guide Pyramid
Older Persons
(60-69 years old)
LESSON 4 • The bread and cereal group furnishes thiamine, • What did you have and how much?
protein, iron, niacin, carbohydrate. And cellulose • When did you eat again? Where? What and
ASSESSMENT OF NUTRITIONAL STATUS at a relatively low cost. How much?
• The vegetable group is an important supplier of • When did you eat next? What did you eat and
Recommended Dietary Allowances and Adequate fiber, minerals, and vitamins particularly how much?
Diet vitamins A and C. • Did you eat or drink anything else?
• Adequate diet is composed of various nutrients • Anything from 1st to 2nd meal?
which the body needs for maintenance, repair, Assessment of Nutritional Status • Anything from 2nd to 3rd meal?
living processes, and growth or development. • Nutritional status is the degree to which the • Anything from 3rd meal to bed time?
• There is no ideal diet since it is a matter of individuals psychological need for nutrients is • Was this day’s food intake different from usual?
individual requirement. being met by the food the person eats. If so, why?
• The purpose of daily meals is to supply the • It is the state of balance in the individual • Is weekend eating different? If so, why?
essential elements. between the nutrient intake and the nutrient Food and Fluid Intake from Time of Awakening until the
• The dietary standard is changed from expenditure or need. next Morning 24-hour Recall
Recommended Dietary Allowance (RDA) to • In a thorough nutritional status assessment, all
Recommended Energy and Nutrient Intakes to of the following aspects are considered:
emphasize that the standard is in terms of • Dietary history and intake data
energy and nutrients and not foods or diet. • Biochemical data
• Clinical examination
Recommended Energy and Nutrient Intakes • Anthropometric data
• RENIs are levels of intakes of energy and • Psychosocial data
nutrients which are considered adequate for Methods of Assessing Dietary Intake
maintenance of health and well-being of nearly
all healthy persons in the population. 24-hour Recall
• The individual completes a questionnaire or is
Essential of an Adequate Diet interviewed by a dietitian/nutritionist or a nurse
• Proteins, carbohydrates, fats, vitamins, experiences in dietary interviewing and is aske
minerals, cellulose, and water should be to recall everything that he/she ate within the
provided in sufficient quantity through daily last 24hours.
meals to meet the needs of the body. 24 – Hour Recall Questions
• The milk group is counted on to provide most of • What time did you go to bed the night before
the calcium requirements. last? Was this the usual time?
• The meat group provides generous amounts of • What time did you get up yesterday? Was this
high-quality protein. the usual time?
• When was the first time you had anything to eat
or drink?
 Food Frequency Questionnaire c. Person who does cooking and
relationship with this person
d. Food storage and cooling facilities
e. Type of housing
f. Ability to shop and prepare food
 Appetite
a. Good, poor, any changes
b. Factors that affect appetite
c. taste and smell perception Observation of Food Intake
 Allergies, Intolerances, and Food Avoidances • Is the most accurate method of dietary intake
a. Foods avoided and reason assessment but also the most time-consuming,
b. Length of time of avoidance expensive, and difficult
Dietary History  Dental and Oral health • Requires knowing the amount and kind of food
• The dietary history is more complete than either a. Problems with eating presented to the person and the record of the
the 24-hour recall or food frequency b. Foods that cannot be eaten amount actually eaten.
questionnaire, although it usually includes both c. Problems with swallowing. Salivation, Evaluation by Food Group Method
of these sources. and food sticking • The simplest, fastest, yet crudest way to
• The dietary history contains additional  Gastrointestinal concerns evaluate food intake data is to determine how
information about the following: a. Problems with heartburn, bloating, gas, many servings from each of the four food groups
 Economics diarrhea, constipation, distention were consumed during the recorded day.
a. Income b. Frequency of problems
b. Amount of money for food each week or c. Home remedies Generals Rules for Meal Planning
month and individual perception of its d. Antacid, laxative, and other drugs used • Use the whole day as a unit t=rather than the
adequacy for meeting food needs  Chronic diseases individual meal. Make breakfast really simple
 Physical activity a. Treatment and standardized, then plan dinner. Lastly, plan
a. Occupation b. Length of time of treatment lunch and snacks to supplement the other two
b. Exercise c. Dietary modification meals.
c. Sleep – hours/day  Medication • Use some food from each of the food groups
 Ethnic and cultural background a. Vitamin and/or mineral supplement daily (energy-giving foods, body-building foods,
a. Influence on eating habits b. Medications and body-regulating foods).
b. Religion • Use some raw fruits or vegetables at least once
c. Education Food Diary or Record a day.
 Home Life and Meal Patterns • This method involves time, understanding, and • Plan to have for each meal at least one food with
a. Number of household members motivation on the part of the patient of client. staying power or high in satiety value, one which
b. Person who does shopping • The subject is asked to write done everything contains roughage, and generally some hot food
he/she eats or drinks for a certain time period. or drink.
• Combine or alternate foods of bland form with • Significance of Nutritional Assessment LESSON 5
those of a more pronounced flavor. • It is the first essential in nutritional
• Combine and alternat soft and crisp foods. planning. PHYSICAL ASSESSMENT:
• Have a variety of color, food, and food • It provides data and information for ANTHROPOMETRIC MEASUREMENTS
arrangement. planning and evaluation.
• When more food are served at one meal, • It helps define priorities and Anthropometric Measurements
decrease the size portions and use fewer rich responsibilities of public health system at • Anthropometry is the measurement of variations
food. the national, regional, provincial. City, of the physical dimensions and gross
municipal, and barangay levels. composition of the human body at different age
Some Don’ts for Meal Planning Methods of Nutritional Assessment levels and degree of nutrition.
• Avoid using the same kind of food twice a day • Methods that provide direction information Common Anthropometric Measurements
without varying the form in which it is served • Clinical examination, biochemical Weight (for age)
except staples like rice, bread, and milk. examination, anthropometric • Uses weighing scale
• Do not use the same food twice in the same measurement, biophysical technique • Assess body mass
meal even in different forms. • Methods that provide indirect information • Sensitive indicator of current nutritional status
• Do not use the same food too often from day to • Studies on food consumption • Uses reference values for age or height or both
day. • Studies on health conditions and vital of population
Other Considerations statistics • Key anthropometric measurement
• Meal patterns. Meal or menu patterns are • Studies on food supply situation Height (for age)
helpful in planning but they must take into • Studies on socio-economic conditions • Assess liner dimensions of the following: legs,
account the family’s habits and needs. • Studies on cultural and antrhopological pelvis, spine, and the skull
• The traditional pattern for breakfast influences • Less sensitive and generally an indicator of past
recommended by nutritionists are: Factors considered in the selection of nutrition survey nutritional status (chronicity of malnutrition)
• Fruits, eggs or substitute, bread or rice, method • Uses stationmeter
hot beverage • Unit to be surveyed Weight for height/length
• The following is a good menu guide for lunch • Types of information required • Most accurate indicator of present or current
and dinner: • Degree of reliability and accuracy acquired state of nutrition
• Meat, fish, or poultry; vegetable; rice; fruit • Facilities and equipment available • An expression of leanness or wasting
or dessert • Human resources Skinfold Thickness
• Planning for the week. It is best to have a weekly • Time reference • Assesses body composition, fat distribution, and
menu plan. • Funding or financial support reserve of calories
Nutrition Survey • Must be compared against standards for age
• An epidemiological investigation of the and sex at all ages
nutritional status of the population by various • Uses a reliable caliper
methods together with an evaluation of the Body circumferences
ecological factors of the community.
 • Head/chest circumference ratio is of value in • Undernourished, severe
detecting PEM in early childhood.  75% of standard weight
• Mid-upper arm circumference (MUAC) has been • The weight-for-height and height-for-age
mainly used on children from 1 to 6 years old. combination of these anthropometric
Birth weight measurements permits further distinction
• Related to maternal nutrition and socio- between acute malnutrition and chronic
economic status malnutrition as well as simple stunting. Tannhauser’s Method
• Usually taken as cut-off point for “low birth • Measure height in cm and deduct 100. From the
weight babies” is 2,500 grams difference, take off its 10%.
Reference/ Standards Used • Example: Male, 45 years olf, 5’4” tall
Weight-for-age – Philippine classification of
undernutrition (FNRI)
• Depending on how far a child’s weight compares
with his/her standard weight, child is classified
as:
• Normal – if weight is between 91% and
Body Mass Index Estimated of Daily Energy Requirement of an
110% of ideal weight
• Ration of weight to height Adult
• First degree or moderately underweight – 𝑤𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑘𝑔
if weight is only 76% to 90% of ideal • 𝐵𝑀𝐼 = • The daily energy requirement of an adult is
(ℎ𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚𝑒𝑡𝑒𝑟𝑠)2 commonly estimated by adding together the
weight
• Example: an individual who weighs 92kg and is requirements for basal metabolism, physical or
• Second degree or moderately
15cm tall would have a BMI of 30. muscular activity, and the specific dynamic
underweight – if weight is only 61% to 92𝑘𝑔
75% of ideal weight 𝐵𝑀𝐼 = = 30 action of food:
(1.72𝑚)2
• Third degree or severely underweight – if  Determine the DBW in kg of the individual
Computation of Desired Body Weight
weight is only 60% or less of ideal weight  Determine the basal needs:
 Male = 1.0 kcalorie/kilo of DBW/hr x 24
Ador Dionisio’s Method
Weight-for-height – classification of nutritional status  Female = 0.9 kcalorie/kilo of DBW/hr x 24
• Height – for every 5 feet, allow 100 lbs. for
by McLaren and Read  Subtract 0.1 kcalorie/kilo of DBW/hours of sleep
female and 110 lbs. for male. Then multiple the
• Overweight  Add activity increment
additional inches by 2.
 110% of standard weight  Add the SDA (10% of basal needs + activity
• Age – multiply any age between 25 and 50 by 2
• Normal increment)
then divide by 5.
 90%-109% of standard weight  Sum equals the approximate daily calorie
• Example: Male, 45 years old, 5’4” tall
• Underweight, mild requirement.
 85—89% of standard weight  Table: Activity Increment
• Undernourished, moderate
 75%-84% of standard weight
 STEP 2 WEIGHT LOSS SCORE

Basal Metabolism Malnutrition Universal Screening Tool (MUST)

• Also known as the required energy expenditure, • ‘MUST’ is a five-step screening tool to identify
is a measure of energy needed by the body at adults, who are malnourished, at risk of
rest for all its internal chemical activities which is malnutrition (undernutrition), or obese. It also
approximately 1 calories per kilogram of body includes management guidelines which can be
weight per hour for an adult. used to develop a care plan.
• Minimum amount of energy needed by the body The 5 “MUST” steps
at rest in the fating state • Step 1 - Measure height and weight to get a BMI
• Indicated the amount of energy needed to score using chart provided.
suction the life processes: respiration, cellular • Step 2 - Note percentage unplanned weight loss
metabolism, circulation, glandular activity, and and score using tables provided.
the maintenance of body temperature • Step 3 - Establish acute disease effect and
Basal Metabolic Rate score
• Rate of basal metabolism in a given person at a • Step 4 - Add scores from steps 1, 2 and 3
given time and situation together to obtain overall risk of malnutrition
• Constitutes one-half of the calorie requirements • Step 5 - Use management guidelines and/or
of an individual. local policy to develop care plan.

Calculate of BMR STEP 1 BMI score (and BMI)

 Subjective Global Assessment
• a nutrition assessment tool that refers to an Mini Nutritional Assessment (MNA)
overall evaluation of a patient's history and • a validated nutrition screening and assessment
physical examination and uses structured tool that can identify geriatric patients age 65
clinical parameters to diagnose malnutrition. and above who are malnourished or at risk of
• The SGA is known to be a reliable and valid tool malnutrition.
that predicts morbidity and mortality associated
with malnutrition.
• objective of SGA is to identify patients likely to
benefit from nutrition intervention and therefore
to identify persons in whom inadequate nutrition
intake or absorption explain features of
malnutrition, including body wasting.
 Geriatric Nutritional Risk Index (GNRI)
• a valid and reliable tool for detecting
hospitalized elderly at risk of malnutrition, based
on serum albumin and the ratio between the
present weight and the ideal body weight of the
patient.
• GNRI has also shown high predictive value in
terms of mortality or postoperative
complications, in cases other than hospitalized
elderly, including hemodialysis, heart diseases,
some cancers, and critical limb ischemia.
• GNRI=[14.89×albumin (g/dL)]+[41.7×(body wei
ght/ideal body weight)]