Contents

Nutritional assessment
Diet history
Anthropometric measurements

PROMOTING HEALTHY
NUTRITION PART 2

Food Energy
Definition / terminology
Components of energy expenditure
Estimating energy requirements

By Marialisa S. Dauigoy, MD, DPAFP

Diet prescription

NUTRITIONAL ASSESSMENT

Determining an individual's nutritional

status
Are adequate amounts of required
nutrients are available to and absorbed by
the body?
Does the person's nutrient intake balance
his/her requirement?

NUTRITIONAL ASSESSMENT
brief screen, if patient healthy
more in depth, if patient with nutritional
inadequacy/ malnutrition risks

grossly overweight or underweight

chronic or severe acute illness
growing infants & children
elderly
patients in poverty, nontraditional dieters (fad
dieters)

Dietary History
patient's usual & recent diet
patient's usual pattern of food intake
any factors that may influence food
choices and availability

cultural

or religious food practices, personal

preferences

number of daily meals and examples of

what is consumed

Food Exchange list

Dietary History

nutrient intake analysis

Measure food intake, nutritional composition
of foods, determine nutrient intakes, compare
w/ RDAs
food diary/journal: for a specific period of
time includes times, food and beverages
consumed, and activity
dietary recall: patients report foods and
beverages consumed over the past 24 to 48
hours.

Physical Examination

Anthropometry

important in evaluating nutritional

status
general inspection immediately reveal
obvious overweight or underweight
physical measurements of an individual
that are compared with reference
standards Anthropometry

Height & Weight

Both height and weight are needed to

calculate the body mass index (BMI).

Body Mass Index

WHO standard classification
BMI
Normal BMI

18.5-24.9

Risk of comorbidities

Weight implications
Significant weight loss 5% loss in 1
month or 7.5% loss in 3 months, or
10% loss in 6 months.
Severe weight loss any loss higher
than these percentages in the same
time interval.

Asia-Pacific Obesity
Guidelines
BMI

average

Overweight

25.0-29.9

increased

Normal BMI

18.6-22.9

Obesity class I

30.0-34.9

moderate

Overweight

23-24.9

Obesity class II

35.0-39.9

severe

Obesity class I

25-29.9

Obesity class III

40

very severe

Obesity class II

30

Weight implications
Weight within 85% to 90% of usual
body weightmild malnutrition
Weight within 75% to 84% of usual
body weightmoderate malnutrition
Weight less than 74% of usual body
weightsevere malnutrition

Hammond 2004

Anthropometry
skin fold thickness

Assesses subcutaneous fat

triceps, biceps, subscapular
tissue, above the iliac crest
Measurements with
calipers , compared with
standardized tables to
determine the percentage
of body fat

Anthropometry

Anthropometry

Waist circumference
correlates with abdominal fat content
increased waist circumference has been
associated with cardiovascular disease
risk factors ( Dalton et al, 2003 )

Waist to hip ratio

Waist measurements >40 inches (>90cm) in

men >35 inches (>80 cm) in women are
independent risk factors for disease ( NHLBI,

Abdominal ratio
Measures fat distribution
& adiposity

2005 )

Anthropometry

Anthropometry
Mid-Upper Arm Circumference

Waist to Hip Ratio

Formula:
Waist Circumference (cm)
Hip circumference (cm)

evaluate fat stores

measures the arm, muscle mass,
subcutaneous fat and bone
estimates wasting of an
individual

1 in men =android obesity

> 0.8 in women = android
obesity

Mid Upper Arm Circumference

(Children 1- 5)

Mid Upper Arm Circumference

(Adults)

MUAC

Level of nutrition

MUAC

Level of nutrition

> 14

Normal

Male: > 23

Normal

12.5 - 14

Mild / moderate
malnutrition
Severe malnutrition

< 23

Malnourish

Female: > 22

Normal

< 22

Malnourish

< 12.5

ENERGY

FOOD ENERGY & DIETARY

CALCULATIONS

The capacity to do work

mechanical, chemical, heat, electrical, light &
nuclear energies
Ultimate source of energy is the SUN
LAW OF THERMODYNAMICS:
each type of energy can be converted
from one form to another.
as our bodies function, chemical energy
from food is converted to mechanical energy
and heat.

ENERGY from FOOD

KILOCALORIES/CALORIES
(K calories or kcal)
unit of energy measurement
energy value of food may be derived
from CHO, CHON, FAT

CALORIE
energy needed to increase the
temperature of 1 kg of water by 1 C
about 4.184 Kj
Empty calorie - calories present in highenergy foods with poor nutritional
profiles, typically from processed
carbohydrates or fats

PHYSIOLOGICAL FUEL
VALUES OF FOOD

CALORIE

An "empty calorie" has the same

energy content of any other calorie but
lacks accompanying micronutrients
such as vitamins, minerals, or amino
acids as well as fiber such as is found
in whole grains but less so in white
flour

4 kcal/g for CHO (17 j)

4 kcal/g for CHON (17 j)
9 kcal/g for FAT (38 j)

Using these values, the caloric values of

foods may be determined.

FACTORS AFFECTING THE

CALORIC VALUE OF FOOD

FUEL VALUES OF FOOD

Example: A slice of cake which contains 3g of

THE COMPOSITION OF FOOD food

high in FAT & CHO are foods with high
caloric value
VARIATIONS IN RECIPES &
PROCESSING METHODS - a cup of plain
rice versus a cup of fried rice
AMOUNT & KIND OF INGREDIENTS
ADDED DURING PREPARATIONS such as
milk, eggs, flour, sugar, or butter

CHON, 1 g of FAT, 15 g of CHO will provide

the ff Kcal:
3g CHON X 4 Kcal/g = 12kcal
1g

FAT X 9 Kcal/g = 9 kcal

15g

CHO X 4 kcal/g = 60 kcal

TOTAL 81 or 80 kcal

BODYS ENERGY NEEDS

BODYS ENERGY NEEDS

COMPONENTS OF ENERGY
EXPENDITURE
1. Basal metabolic rate (BMR)
2. Energy expended in physical activity
3. Thermic effect of food (TEF)

amount

of energy required to maintain life

sustaining activities (breathing, heartbeat,
secretion of hormones) for a specific period
measured in the morning upon waking up
before any physical activity & again 12 to 18
hours after the last meal
also referred as RESTING ENERGY
EXPENDITURE (REE)
accounts for approximately 60% - 75% of our
total energy needs

TEE

* TEE-total energy expenditure

BODYS ENERGY NEEDS

FACTORS THAT INFLUENCE BMR

BODY SIZE
SEX = 6% TO 10% lower in women
Body temperature
Growth, pregnancy, lactation
Age: decreases by 5% to 10% as we
grow older
Body composition
Thyroid function

BASAL METABOLIC RATE

PHYSICAL ACTIVITY
second

largest component of energy

expenditure (20%-30% of total energy needs)
most variable component of TEE
ranges from 10% in a person who is bedridden
to as much as 50% of TEE in an athlete
Includes energy expended in voluntary exercise
and during involuntary activities (shivering,
maintaining postural control)

BODYS ENERGY NEEDS

THERMIC EFFECT OF FOOD (TEF)

increase

in energy expenditure associated with

the consumption of food
Approximately 10% of the TEE
Required to digest, absorb, metabolize nutrient,
including the synthesis and storage of protein,
fat and carbohydrate

ENERGY BALANCE
AMOUNT OF ENERGY INTAKE
DURING THE DAY

caloric intake in excess

of energy expenditure
positive energy
balance
excess calories from
CHO, CHON, or FAT is
converted to fat

UNDERWEIGHT

food intake or energy

value is less than
energy expenditure
negative energy
balance

Desirable body weight

Reasonable weight loss is to 2 lbs/week
For every 3500 kcal excess or expended
a lb of fat is stored or lost

STEPS IN CALCULATING DIET

PRESCRIPTION

ENERGY BALANCE
OVERWEIGHT

AMOUNT OF ENERGY EXPENDED

DURING THE DAY

I. Calculate Desirable Body Weight (DBW)

II. Calculate Total Energy Allowance (TEA)
III.Calculate Carbohydrate, Protein, Fat
allowance/day

IV.Indicate Sodium + Cholesterol level per day

if needed

Desirable Body Weight

Step 1

Ideal body weight

Healthy weight
Indicates a persons body composition
has a good balance of lean body mass
and fat tissue

CALCULATE

DESIRABLE BODY WEIGHT (DBW)

DBW ESTIMATION FOR

CHILDREN

DBW ESTIMATION FOR

CHILDREN
Based on birth weight and age
First 6 months:

Based on age:

DBW (k) = (age in mo./2) + 3

DBW (k) = (age in years x 2) + 8

DBW = Birth weight (gm) + (age in mo. X 600)

7 months 1 year:
DBW = Birth weight (gm) + (age in mo. X 500)

QUICK ESTIMATION
Doubled at 5-6 months

Infants weight

Tripled at 12 months or 1 year

Quadrupled at 2 years

Height /Length
At birth : 50 cm
Example:
At 1 yr : + 24 cm

50 + 24 = 74 cm

At 2 yrs : + 12 cm

74 + 12 = 86 cm

At 3 yrs : + 8 cm

86 + 8 = 94 cm

At 4-8 yrs: + 6 cm

94 + 6 = 100 cm

DBW ESTIMATION FOR ADULTS

A. Use of Standard Tables:

FNRI Tables of Weight for Height for Filipinos 25-65 years
Ex: 5 ft female (152 cm) DBW 43.0 52.6 kg (95-116 lbs)

DBW ESTIMATION FOR ADULTS

C. Tannhausers Method:

B. NDAP Method
DBW (men) = 5 ft is 112 lbs ;
add (subtract) 4 lbs for every inch above (below) 5 ft
DBW (women) = 5 ft is 106 lbs ;
add (subtract) 4 lbs for every inch above (below) 5 ft
Example: Compute the DBW of a 56 male student
5 ft

112 lbs

6x4

_+ 24__

DBW

DBW ESTIMATION FOR ADULTS

136 lbs

1.
2.
3.
4.

Measure ht in cm
Deduct 100 from the measurement.
Difference is the DBW (kg)
Deduct 10% (for Filipino)

Example:

An adult sedentary female 5 1

Ht = 5 1 = 61 in 61in X 2.54 cm= 154.94 cm
DBW = 154.94 100 = 54.94 kg
54.94 5.94 (10% of 54.94)
49.95 kg or 50kg

DBW ESTIMATION FOR ADULTS

Exercises:

C. Use of BMI derived formula

1. Compute the DBW of a 56 male

5 ft
6x4
DBW

112 lbs
_+ 24_
= 136 lbs

DBW (kg) = Ht in meters2 x 22.0 (Men)

DBW (kg) = Ht in meters2 x 20.8 (women)

2. Compute the DBW of a 52 female

5 ft
106 lbs
2x4
+ 8_
DBW
=
114 lbs
3. Compute the DBW of a 410 female
5 ft
2x4
DBW

106 lbs
- 8_
=
98 lbs

Example: Compute the DBW of a 56 male student

56 male = 1.6764 m
DBW :

(1.6764)2

= 2.8103 x 22 = 61.8 kg (136 lbs)

DBW ESTIMATION FOR ADULTS

Overweight : 10% above IBW
BUILD
Small
Medium

Large

WOMEN
-10%

MEN
-10%

Obese : 20% above IBW

%Overweight = DBW AW

no addition nor subtraction

+10%

X 100

DBW

+10%

Desirable Body Weight

(Amputees)
Formula:
Compute DBW
Adjust DBW accdg to type of amputation
Estimated weight of the amputated part is
subtracted from the DBW to arrive at the adjusted
body weight.
Adjusted DBW = DBW - (DBW x % total wt. amputed)

Desirable Body Weight

(Amputees)
Body part

% of total body weight

Hand

0.3

Forearm and hand

2.6

Entire arm

6.2

Foot

1.7

Below knee amputation

7.0

Above knee amputation

11.0

Entire leg

18.6

Example:

Compute the DBW of a 54 male who has below the

knee amputation.

Step 2

5 ft -------------------112 lbs
4x4------------------- +16

CALCULATE
TOTAL ENERGY ALLOWANCE (TEA) /
TOTAL ENERGY REQUIREMENT (TER)
PER DAY

DBW = 128 lbs

Below Knee Amputation:
= 128 lbs x .07

= 8.96 or 9 lbs
= 128 9 lbs

Adjusted Body Weight :

119 lbs or 54 kg

Total Energy Requirement

(Infants)

Total Energy Requirement

For muscular and metabolic activities of the
body which requires energy
Energy comes from oxidation of food
Measured in kilocalories / kilojoules
Consider: age, sex, physical activity and
health condition
TER is rounded off to the nearest 50 kcal

Total Energy Requirement

(Infants)

Narins and Weil

TER = 1000 + (100 x age in years)
Calorie Needs for age & DBW
TER = DBW (k) x calorie allowance accdg to age
Age

Suggested kcal / k DBW /day

13

105

46

90

79

75

10 - 12

65 (boys); 55 (girls)

1 6 months
TER (kcal /day) = 120 kcals
K DBW

7 months 1 year
TER (kcal /day) = 110 kcals
K DBW

Total Energy Requirement

(Adolescents)

TER = DBW (k) x calorie allowance based on age

Age

Suggested kcal / k DBW /day

13 15

55 (boys); 45 (girls)

16 19

45 (boys); 40 (girls)
Average

45

Total Energy Requirement

(Adults)

Energy Allowance Based on Activity Level

TEA = DBW (k) x Physical Activity
ACTIVITY

CALORIE EQUIVALENTS
Male

Female

Sedentary

35

30

Light

40

35

Moderate

45

40

Heavy

50

---

EXAMPLE OF ACTIVITIES
SEDENTARY those people whose work is
mostly sitting like cashier, secretary, using
computers, clerk typist , computer
programmer

LIGHT students, teachers, technicians,

engineers, wife with maid, nurse, doctor,
stewardess
MODERATE wife without maid, vendor running
on streets, jeepney drivers, carpenters
HEAVY cargador, coal miners, heavy equipment
operators

Example:
Calculate TER/TEA of an adult sedentary female 5 1

Step 3

1. Compute DBW (Tannhauser method):

CALCULATE CARBOHYDRATE,
PROTEIN AND FAT
ALLOWANCE/DAY

DBW = 154.94 100 = 54.94 kg

54.94 5.94 (10% of 54.94)
49.95 kg or 50kg
2. Compute TER/TEA:
50 kg x 30 =1500 kcal/day

CARBOHYDRATES

contribute 55%-70% of total dietary

energy
70% should come from complex
carbohydrates
not more than 10% should come from
simple sugars

RDA 55-70% of the TEA

Use

BARBA and CABRERA,

Recommended energy and nutrient intakes for Filipinos, 2002
Asia Pac J Clin Nutr. 2008;17(S2):399-404.

: 60-65% of the TEA

FATS

PROTEIN
Use : 10-15% of TEA

RDA: 20-30% of TEA

Use: 10-25% of TEA

Obese & individual with elevated lipid levels

Reduce saturated fat intake or fat from

animal source

Use: 10-15% of TEA

Saturated fats are needed for prostaglandin

synthesis

Pregnant

: + 9 grams to normal allowance

: + 16 grams to normal allowance
Children (1-3 yrs)
: 2 grams/KDBW
Children up to 12yrs: 1.5 grams /KDBW
Adolescents 13-19 yrs: 1.25 grams/KDBW
If with nephropathy: 6-8% of TEA or 0-8g/kg/DBW
Lactating

MUFA & PUFA are recommended

MUFA does not affect cholesterol in the body

Estimation of
CHO, PROTEIN & FAT needs
A good ratio of
carbohydrates to fat to
protein is 60-25-15 of TEA.

4kcal/g CHO
4kcal/g CHON
9kcal/g Fat

TEA (kcal) x % CHO = kcal / 4 = gm CHO

TEA (kcal) x % CHON = kcal /4 = gm CHON
TEA (kcal) x % fat
= kcal / 9 = gm fat

Example (continuation):
Calculate dietary allowance for carbohydrate, protein
and fats of an adult sedentary female 5 1

TEA = 1,500 kcal/day

60% CHO
25% fat
15 % CHON

4kcal/g CHO
9kcal/g Fat
4kcal/g CHON

Example:
Calculate dietary allowance for carbohydrate, protein
and fate of an adult sedentary female 5 1

1. Compute DBW (Tannhauser method):

DBW = 154.94 100 = 54.94 kg

54.94 5.94 (10% of 54.94)
49.95 kg or 50kg
2. Compute TER/TEA:
50 kg x 30 =1500 kcal/day

Compute the carbohydrate, protein and fat allowance

of a 52 male student

DBW

CHO requirement:
1,500 kcal/day x 0.60 = 900 kcal/day 4 kcal/g = 225 g
Fat requirement:
1,500 kcal/day x 0.25 =375 kcal/day 9 kcal/g = 41.67 or
42 g

Protein requirement:
1,500 kcal/day x 0.15 = 225 kcal/day 4kcal/g = 56.25 or
56 g

TEA =

5 ft --------

112 lbs
2 x 4 -----8
120 lbs 55 kgs

55 x 40 = 2200 kcal

CHO = 2200 x .60 = 1320 kcal 4 kcal = 330 gm

CHON =2200 x .15 = 330 kcal 4 kcal = 85 gm
Fats = 2200 x .25 = 550 kcal 9 kcal =61 or 60 gm

THE FOOD EXCHANGE LIST

Uses:
1. Facilitates the planning of meals with a prescribed
amount of carbohydrates, protein, fat and energy
2. Estimate the carbohydrate, protein, fat and energy
values of a meal

HOW TO USE THE FOOD EXCHANGE LISTS

IN MEAL PLANNING

List all the foods furnishing carbohydrates with

exception of rice
Determine how many rice exchanges (23 gCHO
furnished by 1 rice exchange)
Determine how many meat and fish exchanges are
allowed (8 g CHON per meat and fish exchange)
Follow the same procedure for fat (1 fat exchange
contains 5 g of fat)
Distribute the food allowance into breakfast, lunch,
supper and snacks

COMPOSITION OF FOOD EXCHANGES

Food

Measure

CHO
(g)

PRO
(g)

FAT
(g)

Energy
(kcal)

Varies
Varies
varies

8
8
8

1
6
10

41
86
122

Fat

1 tsp

45

Sugar

1 tsp

20

Meat
low fat
med fat
hi fat

COMPOSITION OF FOOD EXCHANGES

Food

Measure

CHO
(g)

CHON
(g)

FAT
(g)

Energy (kcal)

Veg A

1 cup raw
cup
cooked

Veg. A

2 cups raw
1 cup cooked

16

Veg. B

cup raw
cup
cooked

16

Fruit

varies

10

40

Milk
whole
low fat
skimmed

Varies
4 tbps
varies

12
12
12

8
8
8

10
5
trace

170
125
80

Rice

varies

23

100

Diet Prescription:
TEA: 2200 Kcal
Rice: 23gCHO
2g CHON
100g kcal

Milk: 12g CHO

8g CHON
w:10g fat/170kcal
lowf: 5g fat/125kcal
skim:tr/80g kcal

Fat: 5g fat
45kcal

Vegetable: 3g CHO
1g CHON
16 kcal

FOOD
ITEM

Fruit: 10g CHO

40g kcal

Veg A

Meat:
low: 8g CHON/1g fat/
41kcal
med:8g CHON/6g fat/
86 kcal
high:8g CHON/10g fat/
122 kcal
Sugar: 1 tsp : 5g CHO
20 kcal

NO. OF
XCHANGE
S

CHO 330g

CHON 85g

FAT60g

BREAK
FAST

LUNCH

SUPPER

SNACKS

Veg B

Fruit

Milk

Rice

12

Meat

Fat