Determining Individual Nutrient Needs
Determining Individual Nutrient Needs
Dietary Guidelines for Americans (DGA) 2010 – Key Recommendations Balancing Calories Enjoy your food, but eat less Avoid oversized portions Foods to Increase Make half your plate fruits and vegetables Switch to fat-free or low-fat (1%) milk Foods to Reduce Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers Drink water instead of sugary drinks
Energ y Needs: Indirect Calorimetr y o Gold standard for res-ng energy needs o Metabolic cart measures amount of heat energy produced by an individual by determining the amount of oxygen consumed & quan-ty of carbon dioxide eliminated
Energ y Needs: Predictive Equations Harris-‐Benedict Equa1on o Tradi-onally most widely used equa-on o Determines res-ng metabolic rate (RMR) o RMR is then mul-plied by an ac-vity factor (AF) and injury factor (IF) o HBE predicts RMR within 10% of measured RMR in 69% of individuals o More likely to overes-mate needs (27% of -me) than to underes-mate (4% of -me) American Diete,c Associa,on, Nutri,on Care Manual, 2005
Energ y Needs: Predictive Equations Harris Benedict Equa1on o Men: Res-ng metabolic rate (RMR) = 66.47 + 13.75(W) + 5(H) – 6.76(A) o Women: RMR = 655.1 + 9.56 (W) + 1.7 (H) – 4.7 (A) o Equa-on uses weight (W) in kilograms (kg), height (H) in cen-meters (cm), and age (A) in years o Online HBE calculator, Cornell: h]p://www-‐users.med.cornell.edu/~spon/picu/calc/ beecalc.htm American Diete,c Associa,on, Nutri,on Care Manual, 2005
Energ y Needs: Predictive Equations Mifflin-‐St. Jeor Equa1on o Most reliable, predicts within 10% of measured RMR in more nonobese and obese individuals than any other equa-on
Academy of Nutri,on & Diete,cs, Evidence Analysis Library, 2006
Energ y Needs: Predictive Equations Mifflin-‐St. Jeor Equa1on o Men: RMR = 9.99 X weight + 6.25 X height – 4.92 X age + 5 o Women: RMR = 9.99 X weight + 6.25 X height – 4.92 X age – 161 o Equa-on uses weight in kg, height in cen-meters o Online Mifflin-‐St. Jeor calculator: h]p://www.calculator.net/calorie-‐calculator.html Academy of Nutri,on & Diete,cs, Evidence Analysis Library, 2006
Energ y Needs: calories per kg Desired Outcome
Mul1ply
To lose weight
20-‐25 calories per kg body weight
To maintain weight
25-‐30 calories per kg body weight
To gain weight
30-‐35 calories per kg body weight
Macronutrient Distribution Ranges Macronutrient Distribu1on Range: Percent of Energy/Calories Macronutrient
Children, 1-‐3 years
Children, 4-‐18 years Adults > 18 years
Carbohydrate
45-‐65%
45-‐65%
45-‐65%
Fat
30-‐40%
25-‐35%
20-‐35%
Protein
5-‐20%
10-‐30%
10-‐35%
Application: Kcal Needs, Wt Loss o 40 year old male, new dx Type 2 Diabetes o Height: 5’8” (68 inches, 173 cm) o Weight: 200 lbs (91 kg) o BMI: 30.4 (obese category) o Desired outcome is weight loss o Using the kcal/kg method, determine how many calories per day he should consume
Solution: Kcal Needs, Wt Loss o For weight loss, mul-ply weight in kg by 20-‐25 kcal/kg o 91 kg X 20-‐25 kcal/kg = 1820-‐2275 kcal/day o Days with no exercise: use lower end of range o Days with exercise: use upper end of range o Midpoint of range: 2050 kcals
Application: Est. Carb, Fat, Pro o Gentleman from previous example needs roughly 2,050 kcal/day for weight loss o But what should those calories consist of? o Sample breakdown is: • 55% calories from carbohydrate • 25% calories from fat • 20% calories from protein
o How many grams of carb, fat, protein per day should he eat?
Solution: Est. Carb, Fat, Pro Macronutrient
Carbohydrate
Fat
Protein
% of Calories
To get calories from [carbohydrate, fat or protein] per day
To get grams of [carbohydrate, fat or protein] per day
55%
1,128 calories from 2,050 calories X 0.55 carb ÷ 4 calories per = 1,128 calories from g carb = 282 g carbohydrate carbohydrate/day
25%
2,050 calories X 0.25 = 513 calories from fat
513 calories from fat ÷ 9 calories per g fat 57 g fat = 57 grams fat/day
20%
2,050 calories X 0.20 = 410 calories from protein
410 calories from protein ÷ 4 calories per g protein = 103 grams protein/day
Solu1on
282 g carbohydrate
103 g protein
For More Infor mation o Na-onal Ins-tutes of Health Menu Planner: h]p://hp2010.nhlbihin.net/menuplanner/menu.cgi o Interac-ve DRI for Healthcare Professionals: h]p://fnic.nal.usda.gov/fnic/interac-veDRI/ o USDA SuperTracker: h]ps://www.supertracker.usda.gov/default.aspx o FAO Nutri-onal Requirements: h]p://www.fao.org/ag/agn/nutri-on/ requirements_pubs_en.stm
Dietary Guidelines for Americans (DGA) 2010 – Key Recommendations Balancing Calories Enjoy your food, but eat less Avoid oversized portions Foods to Increase Make half your plate fruits and vegetables Switch to fat-free or low-fat (1%) milk Foods to Reduce Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers Drink water instead of sugary drinks
Energ y Needs: Indirect Calorimetr y o Gold standard for res-ng energy needs o Metabolic cart measures amount of heat energy produced by an individual by determining the amount of oxygen consumed & quan-ty of carbon dioxide eliminated
Energ y Needs: Predictive Equations Harris-‐Benedict Equa1on o Tradi-onally most widely used equa-on o Determines res-ng metabolic rate (RMR) o RMR is then mul-plied by an ac-vity factor (AF) and injury factor (IF) o HBE predicts RMR within 10% of measured RMR in 69% of individuals o More likely to overes-mate needs (27% of -me) than to underes-mate (4% of -me) American Diete,c Associa,on, Nutri,on Care Manual, 2005
Energ y Needs: Predictive Equations Harris Benedict Equa1on o Men: Res-ng metabolic rate (RMR) = 66.47 + 13.75(W) + 5(H) – 6.76(A) o Women: RMR = 655.1 + 9.56 (W) + 1.7 (H) – 4.7 (A) o Equa-on uses weight (W) in kilograms (kg), height (H) in cen-meters (cm), and age (A) in years o Online HBE calculator, Cornell: h]p://www-‐users.med.cornell.edu/~spon/picu/calc/ beecalc.htm American Diete,c Associa,on, Nutri,on Care Manual, 2005
Energ y Needs: Predictive Equations Mifflin-‐St. Jeor Equa1on o Most reliable, predicts within 10% of measured RMR in more nonobese and obese individuals than any other equa-on
Academy of Nutri,on & Diete,cs, Evidence Analysis Library, 2006
Energ y Needs: Predictive Equations Mifflin-‐St. Jeor Equa1on o Men: RMR = 9.99 X weight + 6.25 X height – 4.92 X age + 5 o Women: RMR = 9.99 X weight + 6.25 X height – 4.92 X age – 161 o Equa-on uses weight in kg, height in cen-meters o Online Mifflin-‐St. Jeor calculator: h]p://www.calculator.net/calorie-‐calculator.html Academy of Nutri,on & Diete,cs, Evidence Analysis Library, 2006
Energ y Needs: calories per kg Desired Outcome
Mul1ply
To lose weight
20-‐25 calories per kg body weight
To maintain weight
25-‐30 calories per kg body weight
To gain weight
30-‐35 calories per kg body weight
Macronutrient Distribution Ranges Macronutrient Distribu1on Range: Percent of Energy/Calories Macronutrient
Children, 1-‐3 years
Children, 4-‐18 years Adults > 18 years
Carbohydrate
45-‐65%
45-‐65%
45-‐65%
Fat
30-‐40%
25-‐35%
20-‐35%
Protein
5-‐20%
10-‐30%
10-‐35%
Application: Kcal Needs, Wt Loss o 40 year old male, new dx Type 2 Diabetes o Height: 5’8” (68 inches, 173 cm) o Weight: 200 lbs (91 kg) o BMI: 30.4 (obese category) o Desired outcome is weight loss o Using the kcal/kg method, determine how many calories per day he should consume
Solution: Kcal Needs, Wt Loss o For weight loss, mul-ply weight in kg by 20-‐25 kcal/kg o 91 kg X 20-‐25 kcal/kg = 1820-‐2275 kcal/day o Days with no exercise: use lower end of range o Days with exercise: use upper end of range o Midpoint of range: 2050 kcals
Application: Est. Carb, Fat, Pro o Gentleman from previous example needs roughly 2,050 kcal/day for weight loss o But what should those calories consist of? o Sample breakdown is: • 55% calories from carbohydrate • 25% calories from fat • 20% calories from protein
o How many grams of carb, fat, protein per day should he eat?
Solution: Est. Carb, Fat, Pro Macronutrient
Carbohydrate
Fat
Protein
% of Calories
To get calories from [carbohydrate, fat or protein] per day
To get grams of [carbohydrate, fat or protein] per day
55%
1,128 calories from 2,050 calories X 0.55 carb ÷ 4 calories per = 1,128 calories from g carb = 282 g carbohydrate carbohydrate/day
25%
2,050 calories X 0.25 = 513 calories from fat
513 calories from fat ÷ 9 calories per g fat 57 g fat = 57 grams fat/day
20%
2,050 calories X 0.20 = 410 calories from protein
410 calories from protein ÷ 4 calories per g protein = 103 grams protein/day
Solu1on
282 g carbohydrate
103 g protein
For More Infor mation o Na-onal Ins-tutes of Health Menu Planner: h]p://hp2010.nhlbihin.net/menuplanner/menu.cgi o Interac-ve DRI for Healthcare Professionals: h]p://fnic.nal.usda.gov/fnic/interac-veDRI/ o USDA SuperTracker: h]ps://www.supertracker.usda.gov/default.aspx o FAO Nutri-onal Requirements: h]p://www.fao.org/ag/agn/nutri-on/ requirements_pubs_en.stm
