Introduction to

nutrition and
dietetics
C/DND JAN 2018
MRS. DOROTHY NYANCHWANIA
Introduction to the science of
nutrition and dietetics

DEFINITION OF TERMS
 Nutrition is the science of food, the nutrients and other
substances therein, their action, interaction and
balance in relation to health and disease and the
process by which the organisims,ingest,
absorbs,transports,utilizes and excretes food substances

 In simple terms nutrition is the science of nourishing

the body properly or the analysis of the effect of food
on micro-organisms
Definitions Cont’d…

 Dietetics is the Combined science and art of regulating

the planning, preparing and serving of meals to
individuals or groups under various conditions of health
and disease according to the principles of nutrition and
management, with due consideration for economic,
social and cultural and psychological factors
The science consist of knowledge of nutrition, food and
the dietary constituents needed in different states of
health and disease
Definition cont’d…

 Nutrients-are substances obtained from food and are

used in the body to provide energy and structural
material and to regulate growth maintenance and repair
of body tissue. They include carbohydrates, protein
lipids,minerals,vitamins and water
 Nutrients can either be micro-nutrients or macro-
nutrients.
 Macronutrients are nutrients needed in the body in
large amounts and they include carbohydrates, proteins
and lipids.
 They form the bulk of the diet and should supply all the
energy needed in the food.
Definitions cont’d…

 Carbohydrates are organic molecule with a basic ratio of

1C:2H:1O. found as monomers and polymers.

 Protein is an organic polymer made of amino acid subunits

They can be further divided into :
 Complete protein : contains all essential amino acids
 Incomplete protein: is missing in one or two essential
amino acids
Fats
 Total fat is the summation of saturated and unsaturated
fats in a food
 Unsaturated fat are lipids that are liquid at room
temperature and contain double bonds between carbons
 Saturated fat are lipids that are solid at room
temperature and contain single bonds between carbons.
 Cholesterol is a lipid with a ringed molecular structure
that is carried in the blood as HDL & LDL particles.
 Definitions cont’d..

 Micronutrients on the other hand are nutrients needed in our bodies in small
amounts.
 They include vitamins and minerals.
Vitamins are organic compound required in tiny amounts by an organism for normal
growth and development. are used as cofactors for enzymes, and as hormones and
antioxidants.
 They are divided into : fat soluble vitamins and Water soluble vitamins
Minerals are chemical elements that are required by living organisms
They are divide into :
 Microelements
 Macro elements
Definitions Cont’d…

 Fiber- the indigestible portion of plants (mainly

composed of cellulose) and commonly called "roughage
 Fiber can be classified into:
 Soluble fiber which absorbs water, turning into a gel-like
mush (think of what happens when you add water to
oatmeal) and insoluble fiber which does not absorb
water (think of what happens when you add water to
celery).
 Definitions cont’d …

 A Serving is the amount of a product normally eaten in one

sitting. sizes based on cups, tsp, tbs,
 Calorie is the amount of heat (energy) required to raise the
temperature of one gram of water by 1 degree Celsius it
measures a food's total energy available for use in the body
 Hydrogenated vegetable oil is liquid vegetable oils that have
been processed by adding hydrogen to create a solid or semi-
solid fats, such as those present in margarine
 Essential nutrients are nutrients that must be obtained from
food because they cannot be synthesized in the body in
adequate amounts to meet the bodies physiological need
Definition cont’d…

 Malnutrition refers to any condition

caused by an excess or deficiency of
energy or nutrient intake or an imbalance
between dietary intake and requirement.
 Good/normal/optimal nutrition- it refers
to a sufficiency of nutrient intake that
maintains normal growth and
development, optimum activity,
resistance to infection and ability to
repair the body after injury
Definitions cont’d…

Diet
 The usual foods and drinks regularly consumed. Diet can
be used to asses the nutrition status of a person. There
are two types of diets
 Normal diet-this is the diet that supplies all the
nutritional needs of a normal healthy individual with
due consideration for age sex activity and physiological
needs
 Therapeutic diet- diet that is manipulated as modified
to suit a certain disease condition. Example low
carbohydrate diet, sodium free diet, high protein diet,
low fat diet etc
Definitions cont’d…

 Nutritional status- is the condition of health of an

individual as influenced by the intake and utilization of
nutrients
 Nutritional deficiency- condition of the body that may
arise as a result of lack of one or more nutrients in the
diet or breakdown of one or more of the bodily
processes concerned with nutrient utilization
 Nutrition screening- process of identifying clinical
characteristics known to be associated with
malnutrition in order to identify persons at risk and to
plan appropriate nutrition therapy
 Nutrition assessment- is the comprehensive analysis of
a person’s nutrition status that uses health,
socioeconomic, drug, and diet histories; anthropometric
measurements; physical examinations; and laboratory
tests
Introduction to the
nutrition and
dietetics profession
Nutrition breakthroughs

 400 B.C. -- Hippocrates, the "Father of Medicine", said

to his students, "Let thy food be thy medicine and thy
medicine be thy food".
 He also said A wise man should consider that health
is the greatest of human blessings.
Nutrition breakthroughs

 400 B.C. -- Foods were often used as cosmetics or as

medicines in the treatment of wounds.
 In some of the early Far-Eastern biblical writings,
there were references to food and health.
 One story describes the treatment of eye disease,
now known to be due to a vitamin A deficiency, by
squeezing the juice of liver onto the eye. Vitamin A is
stored in large amounts in the liver.
Nutrition breakthroughs

 1500 Scientist and artist Leonardo da Vinci compared

the process of metabolism in the body to the burning
of a candle
 1747 Dr. James Lind, a physician in the British Navy,
performed the first scientific experiment in nutrition.
 At that time, sailors were sent on long voyages for
years and they developed scurvy (a painful, deadly,
bleeding disorder).
 Only nonperishable foods such as dried meat and
breads were taken on the voyages, as fresh foods
wouldn't last.
 Nutrition breakthroughs
 In his experiment, Lind gave some of the sailors sea water, others
vinegar, and the rest limes.
 Those given the limes were saved from scurvy.
 As Vitamin C wasn’t discovered until the 1930s, Lind didn’t know it was
the vital nutrient.
 As a note, British sailors became known as Limeys.
Nutrition breakthroughs

 1770 - Antoine Lavoisier, the Father of Nutrition and

Chemistry discovered the actual process by which
food is metabolized.
 He also demonstrated where animal heat comes
from.
 In his equation, he describes the combination of food
and oxygen in the body, and the resulting giving off of
heat and water.
Nutrition breakthroughs

 early 1800s - It was discovered that foods are

composed primarily of four elements: carbon,
nitrogen, hydrogen and oxygen, and methods were
developed for determining the amounts of these
elements.
 1840 -- Justus Liebig of Germany, a pioneer in early
plant growth studies, was the first to point out the
chemical makeup of carbohydrates, fats and
proteins.
 Carbohydrates were made of sugars, fats were fatty
acids, and proteins were made up of amino acids.
 Nutrition breakthroughs

 1897 - Christiaan Eijkman, a Dutchman working with natives in Java,

observed that some of the natives developed a disease called Beriberi,
which caused heart problems and paralysis.
 He observed that when chickens were fed the native diet of white
rice, they developed the symptoms of Beriberi.
 When he fed the chickens unprocessed brown rice (with the outer
bran intact), they did not develop the disease.
 Eijkman then fed brown rice to his patients and they were cured.
 He disovered that food could cure disease.
 Nutritionists later learned that the outer rice bran contains vitamin
B1, also known as thiamine.
Nutrition breakthroughs

 1912- E.V. McCollum, while working for the U.S.

Department of Agriculture at the University of
Wisconsin, developed an approach that opened the
way to the widespread discovery of nutrients.
 He decided to work with rats rather than large farm
animals like cows and sheep.
 Using this procedure, he discovered the first fat
soluble vitamin, Vitamin A.
 He found that rats fed butter were healthier than
those fed lard, as butter contains more Vitamin A.
Nutrition breakthroughs

 1912 - Dr. Casmir Funk was the first to coin the term
vitamins as vital factors in the diet.
 He wrote about these unidentified substances
present in food, which could prevent the diseases of
scurvy, beriberi and pellagra (a disease caused by a
deficiency of niacin, vitamin B-3).
 The term vitamin is derived from the words vital and
amine, because vitamins are required for life and
they were originally thought to be amines --
compounds derived from ammonia.
Nutrition breakthroughs

 1930’s -William Rose discovered the essential amino

acids, the building blocks of protein.
 1940’s -The water soluble B and C vitamins were
identified.
 1940’s -- Russell Marker perfected a method of
synthesizing the female hormone progesterone from a
component of wild yams called diosgenin.
 1950’s to the Present -- The roles of essential nutrients
as part of bodily processes have been brought to light.
 For example, more became known about the role of
vitamins and minerals as components of enzymes and
hormones that work within the body.
Nutrition breakthroughs

 1968-- Linus Pauling, a Nobel Prize winner in chemistry,

created the term Orthomolecular Nutrition.
 Orthomolecular is, literally, "pertaining to the right
molecule". Pauling proposed that by giving the body the
right molecules in the right concentration (optimum
nutrition), nutrients could be used by people to achieve
better health and prolong life.
 Studies in the 1970's and 1980's conducted by Pauling
and colleagues suggested that very large doses of vitamin
C given intravenously could be helpful in increasing the
survival time and improving the quality of life of
terminal cancer patients.
HISTORY OF
NUTRITION AND
DIETETICS
 All recorded history shows that food has played an
extraordinarily vital role in the rise and growth or fall
and decline of nations.
 This is because of its effect on health and productivity.
 Since earliest times food has been considered in the
light of both cause and cure of diseases.
 The history of nutrition can be explained in three eras
as listed below
Chemical analysis era(1700-1900)

 Dr james lind a physician in the british navy , performed

the first scientific experiments in nutrition.
 At that time, sailors were sent on long voyages for years
and they developed scurvy (a painful deadly bleeding
disorder).
 Only non perishable foods such as dried meat and
breads were taken on the voyages, as fresh foods
wouldn’t last.
 In his experiment, lind gave some of the sailors sea
water, others vinegar and the rest limes.
 Those given lime were saved from scurvy.
 this was because the limes contained vitamin c which
its deficiency causes scurvy.
 Antoine Lavoisier, the father of nutrition and chemistry
discovered the actual process by which food is
metabolized.
 He also demonstrated where animal heat comes from.
 In his equation, he described the combination of food
and oxygen in the body and the resulting of heat and
water
 Justus Liebig of Germany , a pioneer in early plant
growth studies, was the first to point out the chemical
makeup of carbohydrates and proteins.
 Carbohydrates were made of sugars, fats were made of
fatty acids and proteins were made of amino acids.
Biological era(1900-1955)

 EV McCollum , while working for the U.S department of

agriculture at the university of Wisconsin, developed an
approach that opened the way to the widespread
discovery of nutrients.
 He decided to work with rats.
 Using this procedure, he first discovered the first fat
soluble vitamin , vitamin A. he found that rats fed on
butter were healthier than those fed on lard , as butter
contains more vitamin A.
 Dr Casmir Funk was the first to coin the term
‘VITAMINS’ as vital factors in the diet.
 He wrote about these unidentified substances present in
food , which could prevent diseases of scurvy, beriberi
and pellagra.
 The term vitamin is derived from the words vital and
amines, because vitamins are required for life and they
were originally thought to be amines- compounds
derived from ammonia.
 William Rose discovered the essential amino acids, the
building blocks of protein
Molecular/cellular era(1955-present)

 The roles of essential nutrients as part of bodily

processes have been brought to light.
 For example more became known about the role of
vitamins and minerals as components of enzymes and
hormones that work within the body
Introduction to
nutrition and
dietetics profession
 Nutrition is a professional which teaches or applies the
science of nutrition for the improvement of health and
control of diseases.
 it is important to note that there is a difference
between a nutritionist and a dietician
Difference between a nutritionist
and a dietician

 A dietician is a professional who has extensive

knowledge about foods and human nutrition and are
uniquely qualified to provide medical nutrition
therapy.
The following are the specific roles
of nutritionist

Roles of a nutritionist
 Helps us understand the functions of food, which
supply our nutritional and physiological needs
 Helps us know how to select foods to meet our need
for nutrients from available foods or basic food groups
 Helps us understand the composition of food and the
changes that occur during preparation, so that these
changes can be controlled to prepare acceptable food
products to meet our body's needs
 Help us to learn the methods of food preparation
which blend acceptability with retention of nutrients
 They work closely with patients, clients and a range of
health care professionals to determine the best
possible nutrition program for individuals, groups and
communities
 They help plan a healthy diet that can help prevent
diseases
 Promotion of capacity building for adopting healthy eating habits and
healthy lifestyle and the prevention of diet related chronic diseases- They
do health and nutrition education promotion
 Together with communities , they identify ,plan and implement monitor
and evaluate community nutrition and health program
Roles of a dietician

A dietician is a professional who has extensive knowledge

about foods and human nutrition and are uniquely qualified
to provide medical nutrition therapy.
 He/she is a specialist who translates the physician
written order into practice in terms of foods,
nutritional products and formulation
 He/she assess and evaluates the patients nutritional
status ,formulates the nutritional care plans and
designs individualized meal patterns according to
patient food habits and therapeutic need
 He/she recommends appropriate formulas for enteral
feeding and counsel patients and family regarding any
dietary modification mainly at the point of discharge
 He/she advises on the effect of drug therapy due to
drug nutrient interaction
 He/she evaluates patients response to the diet
 Branches of nutrition

1. Clinical nutrition
 Deals with the study of the relationship between food and a healthy
body.
 Most specifically it is the science of nutrients and how they are
digested, absorbed, transported metabolized, stored and eliminated
by the body.
 Besides studying how food works in the body, nutritionist are
interested in how the environment affects the quality and safety
of foods and what influence these factors have on health and
disease.
 Plan meals for hospital patients and others who have special dietary
needs.
 2. Community nutrition

 Involved in maintaining optimum nutritional health of the

whole population and high risk of vulnerable subgroups
within the population.
 Emphasizes health promotion and disease prevention but
may include therapeutic and rehabilitative services when
these needs are not adequately addressed by other parts of
the health care system is often used to reflect the wide
range of delivery settings and sponsoring organizations for
nutrition related programs and services.
 Community nutrition services tend to be directed to
individuals and groups in the community.
3. Research nutrition

 Performs scientific research on

food and human nutrition and
work in universities, medical
research centers and food
manufacturing plants
 4. Sports nutrition

 Itis a relatively new area of study involving

the application of nutritional principles to
enhance sports performance.
 Itis the application of eating strategies to
promote good health and adaption to
training to recover quickly after each
exercise training session and to perform
optimally during competition
 5. Food science /industrial nutrition

 Applied science devoted to the study of food.

 Itis the discipline in which the engineering,
biological and physical sciences are used to
study the nature of foods, the causes of
deterioration,the principles underlying food
processing and improvement of foods for the
consuming public.
 The activities include the
development of new food products,
design of processes to produce these
foods, choice of packaging material,
shelf life studies, sensory evaluation
of the product with panel or potential
consumers as well as microbiological
and chemical tests
 Types of Dietitians

1. Clinical
Clinical dietitians provide services to patients in
hospitals and nursing-care facilities.
 A primary health care physician may refer a patient
to a clinical dietitian who can assess nutritional needs
and provide an appropriate diet plan for the
individual.
 Clinical dietitians often specialize in obesity, diabetes
or renal failure, for example. There are also clinical
dietitians who conduct research on nutrition.
 2. Community.
Community dietitians work closely with at-risk
groups, such as senior citizens, pregnant women
and diabetics.
 dietitians consult these groups about the right
foods to eat and what to avoid.
 Community dietitians also counsel individuals
and groups about disease prevention and
improving quality of life.
 Often these programs are government-funded.
3. Management
Management dietitians administer
large-scale meal planning and
preparation in health care facilities,
company cafeterias, prisons and
schools.
 They are also responsible for
budgeting, purchasing and managing
personnel wherever food is served.
4. Consultant
Consultant dietitians work in private practice and may
counsel patients about issues such as weight loss and
cholesterol reduction.
 Others test new food products or develop recipes and
design menus for restaurants and businesses.
 And still others work with the media to promote
advertising campaigns.
 Many provide expertise to supermarkets and other food-
related businesses, planning sanitation and safety
procedures, for instance.
5. Sports
Sports dietitians work with athletes and professional
sports teams to optimize physical performance,
prevent injury, boost recovery, increase stamina and
manage body weight.
 Beyond organizing menus and supermarket visits,
they also advise and educate athletes about myths
concerning supplements and fad diets.
Skills and
competencies in
Nutrition and
dietetics
INTERACTIONS WITH OTHER PROFESSIONALS
 Individuals interested in becoming Registered Dietitians
should expect to study a wide variety of topics focusing
on food, nutrition, and management. These areas are
supported by the sciences: physical and biological,
behavioral and social, and communication.
 To successfully achieve the foundation knowledge and
skills, graduates must demonstrate the ability to
communicate and collaborate, solve problems, and
apply critical thinking skills.
 The following are the foundation knowledge and skills
applied in this profession
Content Area Basic Knowledge about Working Knowledge of Demonstrated Ability to
COMMUNICATIONS negotiation techniques, interpersonal present an educational
and technical writing, communication skills, session for a group,
media presentations counseling theory and counsel individuals on
methods, interviewing nutrition, demonstrate a
techniques, educational variety of documentation
theory and techniques, methods, explain a public
concepts of human and policy position regarding
group dynamics, public dietetics, use current
speaking information technologies,
work effectively as a
team member

PHYSICAL AND exercise physiology organic chemistry, interpret medical

BIOLOGICAL SCIENCES biochemistry, physiology, terminology, interpret
microbiology, nutrient laboratory parameters
metabolism, patho- relating to nutrition,
physiology related to apply microbiological and
nutrition care, fluid and chemical considerations
electrolyte requirements, to process controls
pharmacology: nutrient-
nutrient and drug-
nutrient interaction
Content Area Basic Knowledge about Working Knowledge of Demonstrated Ability to

RESEARCH research methodologies, needs scientific method, quality interpret current research,
assessments, outcomes based improvement methods interpret basic statistics
research

FOOD food technology, biotechnology, socio-cultural and ethnic food calculate and interpret nutrient
culinary techniques consumption issues and trends composition of foods, translate
for various consumers, food nutrition needs into menus for
safety and sanitation, food individuals and groups,
delivery systems, food and non- determine recipe/formula
food procurement, availability proportions and modifications
of nutrition programs in the for volume food production,
community, formulation of write specifications for food
local, state, and national food and foodservice equipment,
security policy, food production apply food science knowledge
systems, environmental issues to functions of ingredients in
related to food, role of food in food, demonstrate basic food
promotion of a healthy preparation and presentation
lifestyle, promotion of skills, modify recipe/ formula
pleasurable eating for individual or group dietary
needs
Content area Basic Knowledge about Working Knowledge of Demonstrated Ability to

NUTRITION alternative nutrition and the influence of age, growth, calculate and/or define diets
herbal therapies, evolving and normal development on for common conditions, i.e.,
methods of assessing health nutritional requirements; health conditions addressed by
status nutrition and metabolism; health promotion/disease
assessment and treatment of prevention activities or
nutritional health risks; chronic diseases of the
medical nutrition therapy, general population, e.g.,
including alternative feeding hypertension, obesity,
modalities, chronic diseases, diabetes, diverticular disease;
dental health, mental health, screen individuals for
and eating disorders; nutritional risk; collect
strategies to assess need for pertinent information for
adaptive feeding techniques comprehensive nutrition
and equipment; health assessments; determine
promotion and disease nutrient requirements across
prevention theories and the life span, i.e., infants
guidelines; influence of through geriatrics and a
socioeconomic, cultural, and diversity of people
psychological factors on food
and nutrition behavior
Content area Basic Knowledge Working Knowledge of Demonstrated Ability
MANAGEMENT about to
management theories; determine costs of
program planning, human resource services/operation,
monitoring, and management, prepare a budget,
evaluation, strategic including labor interpret financial
management, facility relations; materials data, apply marketing
management, management; financial principles
organizational change management,
theory, risk including accounting
management principles; quality
improvement;
information
management; systems
theory
HEALTH CARE health care policy and current reimbursement
SYSTEMS administration, health issues, ethics of care
care delivery systems
Core Competencies for Entry-
Level Dietitians

 Perform ethically in accordance with the values of The American

Dietetic Association
 Refer clients/patients to other dietetics professionals or disciplines
when a situation is beyond one's level or area of competence
 Participate in professional activities
 Perform self assessment and participate in professional development
 Participate in legislative and public policy processes as they affect
food, food security, and nutrition
 Use current technologies for information and communication
activities
 Provide dietetics education in supervised practice settings
 Supervise counseling, education, and/or other interventions in health
promotion/disease prevention for patients/clients needing medical nutrition
therapy for common conditions, e.g., hypertension, obesity, diabetes, and
diverticular disease
 Supervise education and training for target groups
 Develop and review educational materials for target populations
 Participate in the use of mass media for community-based food and nutrition
programs
 Interpret and incorporate new scientific knowledge into practice
 Develop and measure outcomes for food and nutrition services and practice
Standards and ethics
of professional
conduct
 Guiding principles/Ethical issues in
the nutrition and dietetics
profession
1. The dietetics practitioner conducts himself/herself with
honesty, integrity, and fairness.
2. The dietetics practitioner practices dietetics based on
scientific principles and current information.
3. The dietetics practitioner presents substantiated
information and interprets controversial information without
personal bias, recognizing that legitimate differences of
opinion exist.
4. The dietetics practitioner assumes responsibility and
accountability for personal competence in practice,
continually striving to increase professional knowledge and
5. The dietetics practitioner recognizes and exercises
professional judgment within the limits of his/her qualifications
and collaborates with others, seeks counsel, or makes referrals
as appropriate.
6. The dietetics practitioner provides sufficient information to
enable clients and others to make their own informed
decisions.
7. The dietetics practitioner protects confidential information
and makes full disclosure about any limitations on his/her ability
to guarantee full confidentiality.
8. The dietetics practitioner provides professional services with
objectivity and with respect for the unique needs and values
9. The dietetics practitioner provides professional services in a
manner that is sensitive to cultural differences and does not
discriminate against others on the basis of race, ethnicity, creed,
religion, disability, sex, age, sexual orientation, or national origin.
10. The dietetics practitioner does not engage in sexual
harassment in connection with professional practice.
11. The dietetics practitioner provides objective evaluations of
performance for employees ad coworkers, candidates for
employment, students, professional association memberships,
awards, or scholarships.
12. The dietetics practitioner is alert to situations that might
cause a conflict of interest or have the appearance of a conflict.
The dietetics practitioner provides full disclosure when a real or
potential conflict of interest arises.
13. The dietetics practitioner who wishes to inform the public
and colleagues of his/her services does so by using factual
information.
The dietetics practitioner does not advertise in a false or
misleading manner.
14. The dietetics practitioner promotes or endorses products in a
manner that is neither false nor misleading.
15. The dietetics practitioner permits the
use of his/her name for the purpose of
certifying that dietetics services have been
rendered only if he/she has provided or
supervised the provision of those services.
16. The dietetics practitioner accurately
presents professional qualifications and
credentials.
Disciplinary actions for unethical
behavior

 Some disciplinary actions involve the terms of a

professional’s licensure. a regulating body may revoke
or suspend a professional’s license or registration, limit
or condition a person’s use of the license or
registration, or refuse to renew or grant a license or
registration if any provision of the licensing statute is
violated
 Monetary fines and costs of the proceeding may also
be imposed on the professional
Standards in
nutrition and
dietetics profession
standard 1: provision of service to a
client

 The dietitian uses a client-

centered approach to provide
and facilitate an effective
dietetic service
standard 2: unique body of
knowledge

 The dietitian has an in-depth

scientific knowledge of food and
human nutrition, and integrates
this knowledge with that from
other disciplines including health
and social sciences, education,
communication and management.
 standard 3: competent application
of knowledge

 Thedietitian competently applies the

unique body of knowledge of food and
human nutrition, and competently
integrates this knowledge with that
from other disciplines including health
and social sciences, education,
communication and management
 Standard 4: Continued competence

 The dietitian is responsible for life-long learning to

ensure competence in her/his area of practice
 Since dietetics is based on an ever-changing body of
knowledge, continuing competence ensures that
client service is based on current knowledge and
skills.
 Through self-assessment and other methods, the
dietitian makes changes to her/his practice which
result in service that is appropriate, effective and
based on current thinking in dietetics.
 standard 5: ethics

 The dietitian practices in accordance with the ethical guidelines of the

profession
 In determining client outcomes related to this standard the dietitian
must assure her/himself that her/his practice is in accordance with
current ethical guidelines such as protecting the client's rights to
1. autonomy-autonomy is the capacity to make an informed, un-coerced
decision.
2. respect
3. Confidentiality
4. dignity
5. access to information.
Information as to the client's perception of the ethical nature of the service
standard 6: professional
responsibility & accountability

 The dietitian is accountable to the public and is

responsible for ensuring that her/his practice meets
legislative requirements, and Standards of Practice for
the profession.
Contemporary issues in nutrition
and dietetics profession

 Contemporary means belonging to or occurring in the

present.
 Unlike in the past, several discoveries have been made
in the field of nutrition and dietetics.
 For example, the discovery of the relationships between
food and healthy, such as how some foods can manage
the diseases and health conditions such as obesity,
cardiovascular diseases and other diseases.
Assignment

 Read and make short notes on contemporary issues in

nutrition and dietetics
Principles of dietetics

THERAPEUTIC DIETS
Principles of diet therapy

 In general principles of nutrition relating to health

apply also to the treatment of patients suffering from
various diseases
 Diet in disease must be planned as part of the complete
care of the patient
 Many modifications may have to be made according to
the disease and the condition of the patient, but there
are certain general principles which may be used for
guidance
Therapeutic diets

Therapeutic diets can be grouped into two types namely:

 Normal diet
 Modified diet
NORMAL DIET

 This is a regular diet either vegetarian or non

vegetarian well balanced and adequate for nutrition.
 It is the foundation of all diets and is designed to
provide adequate nutrition for optimal nutrition and
health status in persons who do not require medical
nutrition therapy.
Normal diet

 This diet is used when there is no required diet

modification or restrictions.
 Individual requirements for specific nutrients may vary
based on age, sex, height, weight, activity level and
different physiological status.
Normal diet

 Foods from the seven basic food groups (water, cereals

and starch, vegetables, fruits, animal protein, plant
protein, fats and oils and sugars and sweets) are used to
make food choices in the design of the diet.
 Food choices should meet nutrient requirements,
promote health, support active lives and reduce chronic
disease risks.
Normal diet

 A normal diet consists of three (3) main meals and may

include various snacks depending on individual needs
 In planning the meal, there are six principles which
should be considered
The Pursuit of an
Ideal Diet
Diet planning principles

Characteristics of a good diet plan:

Adequacy in all nutrients- Provides all of the essential
nutrients, fiber & energy (calories) in amount sufficient to
maintain health.
 An adequate diet provides the human body with energy
and nutrients for optimal growth, maintenance and
repair of tissue, cells and organs.
 Water, carbohydrates, fats, proteins, vitamins and
some minerals comprise the six nutrient classes relied
upon for performance of essential functions and
activities.
Adequacy in all nutrients

 These nutrients must be replaced through diet to keep

the body working efficiently.
 An adequate diet includes foods containing proper
amounts of these nutrients to prevent deficiencies,
anemia, headaches, fatigue and general weakness.
 An adequate diet provides all nutrients to meet the
recommended nutrient intake of healthy people
Balance of foods and nutrients in
the diet

Provides a number of types of foods in

balance with one another, so that
foods rich in one nutrient do not
crowd out of the diet foods that are
rich in another nutrient.
 Nutrient Density

 A food that supplies large amounts of nutrients relative

to the number of calories it contains is nutrient dense.

 The higher the level of nutrients and the fewer the

calories, the more nutrient dense the food is.
Energy density

 This is the amount of energy in kilocalories in a food

compared with its weight.
 Examples of energy dense foods are nuts, cookies, and
fried foods.
 Low energy density foods include fruits, vegetables and
any food that incorporates a lot of water during
cooking.
 They contribute to satiety without giving many calories.
Moderation in the diet

 This mainly refers to portion size.

 This requires planning the entire day’s diet so as not to
under/over consume any one food.
 Provides no unwanted food or nutrient in excess.
 Depriving yourself of foods rich in fat and sugar is not
necessary.
 When eaten on occasion, these treats are not
detrimental to your health and often provide enough
enjoyment to keep one motivated to continue healthy
eating practices
Variety in food choice

 This means choosing a number of different foods within

any given food group rather than eating the same food
daily.
 Different foods are used for the same purpose on
different occasions
 People should vary their choices of food within each
class of food from day to day.
 This makes meals more interesting, helps to ensure a
diet contains sufficient nutrients as different foods in
the same group contain different arrays of nutrients and
gives one the advantage of added bonus in fruits and
vegetables as each contain different phyto chemicals.
DIET PLANNING GUIDE

To achieve the dietary ideals outlined above, there are

several tools used for diet planning. Some of the commonly
used tools are:

 Dietary Reference Intakes (DRI)

 Daily Food Guide
 Food Guide Pyramid
 Exchange Lists
DIETARY REFERENCE INTAKE

Dietary Reference Intakes (DRI)

 Estimates the nutritional
requirements of healthy people
 Include separate recommendations
for different groups of people of a
specific age & gender
 Encompasses four sets of values:
Dietary reference intake

 Each of these reference values has a specific purpose

and represents a different level of intake.
 They are used to plan menus for specific populations in
different settings such as hospitals, nursing homes,
feeding programs, schools etc.
 DRIs are not suitable for teaching people how to make
healthy food choices.
 This is because people eat food not nutrients and
therefore the nutrition education and even counseling
should be in terms of food.
Dietary reference intake

RECOMMENDED DIETARY ALLOWANCES (RDA)

 This refers to the average daily dietary intake levels
sufficient to meet the nutrient requirement of 97-98%
of healthy individuals in a particular life stage and
gender group.
 Estimated Average Requirement(EAR) is the nutrient
intake estimated to meet the requirement of half of the
healthy individuals in a particular life stage and gender
group.
Dietary reference intake

 Adequate Intake (AI) is the level thought to meet or

exceed the requirements of almost all members of a life
stage/gender group. An AI is set when there are
insufficient data to define an RDA.
 Tolerable Upper Intake Level is the highest average
daily intake level of a nutrient likely to pose no danger
to most individuals in the group.
 Tolerable Lower Intake Level is the lowest average
daily intake level of a nutrient likely to pose no danger
to most individuals in the group
DAILY FOOD GUIDE

 Daily food guide helps the planner achieve dietary

adequacy, balance and variety.
 daily food guide includes most notable nutrients
within each food group, the number of servings
recommended, the size of servings, and the foods
within each group categorized by nutrient density.
 It also gives the average range of servings per day for
the different food groups
THE FOOD GUIDE PYRAMID

 The food pyramid translates the food guide into a graphic

image.
 The broad base of the pyramid displays water followed by
cereals; rice, pasta, bread and other foods made from
grains.
 It also includes the roots and tubers.
 Fruits and vegetables make the next layer.
 Dairy products such as milk and yoghurt are included in the
same tier as meats, poultry, eggs beans and nuts.
 The foods at the top of the pyramid which include fats,
oils, sugars and sweets are to be consumed sparingly.
 EXCHANGE LISTS

 A food exchange list is a simple grouping of common foods

according to generally equivalent nutritional values.
 This system is used for any situation requiring caloric and
food value control.
 All the foods listed together are approximately equal in
proteins, carbohydrates and fat value.
Exchange lists

 Exchange lists provide additional help in achieving

kilocalorie control and moderation.
 Originally developed for people with diabetes,
exchange systems have proved so useful that they are
now in general use for diet planning
 Unlike the food group plans which sort foods by their
proteins, vitamins and mineral contents, the exchange
list sorts’ food by their proportion of carbohydrates,
fats and proteins.
Food exchange lists

 Portion sizes are strictly defined so that the amount of

energy provided by any food item is the same as that of
any other item within a given list.
 All of the food portions in a given list provide
approximately the same amounts of energy, nutrients
(protein, fat and carbohydrates) and the same number
of kilocalories.
Food exchange lists

 Any food on a list can be exchanged or traded for any

other food on that same list without affecting a plan’s
balance or total kilocalories.
 The system organizes food into seven exchange lists
 The number of kilocalories associated with each food is
an average for the group.
Food exchange lists

 The number of kilocalories is calculated given the

number of grams of carbohydrates, fats and proteins in
a food (1g of carbohydrate or protein yields 4kcal while
1g of fat yields 9 kcal).
 To apply the system successfully, users must become
familiar with portion sizes.
MODIFIED DIETS

 In morbidity, nutritional homeostasis is altered.

 This creates special nutritional needs necessitating
nutritional modification. Modified diets are normal diet
qualitatively or quantitatively altered as per
patients’/clients’ special needs and in line with the
general principles of meal planning.
Factors that may determine
dietary modification

 Disease symptoms
 Severity of the symptom or disease (Condition of the
patient)
 Nutritional status of the patient
 Metabolic changes involved
 Physiological state
THERAPEUTIC
MODIFICATION OF
NORMAL DIET
MODIFICATION IN CONSISTENCY

1. CLEAR LIQUID DIET

Purpose
 This is a diet modified to provide oral fluids to prevent
dehydration and relieve thirst, small amounts of
electrolytes and calories in a form that requires minimal
digestion and stimulation of the gastrointestinal tract.
 It is indicated for short term use (24hrs to 48hrs )
 Nutritionally depleted patients should receive
additional nutritional support through use of
nutritionally complete minimal residue supplements or
parenteral nutrition.
 Examples:E.g.Black tea, broth, strained fruit/
vegetable juices etc.
Indications
 Pre- and Post-operation,
 As a transition from intravenous feeding to a full liquid
diet,
 When other liquids and solid foods are not tolerated,
 During bowel preparation prior to diagnostic
visualization or surgery
 In the initial recovery phase after abdominal surgery
Characteristics of the diet

 Composed of water and carbohydrates.

 Clear liquid at room temperature
 Leaves minimal amount of residue in the
Gastrointestinal (GI) tract.
 Provides approximately 400-500kcals, 5-10g proteins,
100-120g CHO and no fat.
 Should be of low concentration
 Milk and milk drinks are omitted
 Improve energy level by addition of sugar
 Are nutritionally inadequate in all nutrients
2. FULL LIQUID DIET

Purpose
 The full liquid diet is designed to provide nourishment in
liquid form and facilitate digestion and optimal utilization
of nutrients in acutely ill patients who are unable to chew
or swallow certain foods.
 The diet is often used as a transition between the clear
liquid diet and a soft regular diet.
 Patients with hypercholesterolemia, full liquid diet to be
modified to have low fat by substituting high saturated fats
with low fat dairy products and polyunsaturated fats and
oils.
 Increasing protein and caloric value of full liquid diet
becomes necessary when the diet is used for a period
extending over 2-3 weeks..
 Example: Soft desserts from milk and eggs,
Pureed and strained soups, ice creams, milk or yoghurt, etc
Indicators
 For post operative patients
 For acutely ill patients or those with esophageal/GIT
disorders and cannot tolerate solid foods
 Following surgery of the face-neck area or dental or jaw
wiring
Characteristics

 Foods should be liquid at room temperature

 Free from condiments and spices
 Provides between 1500-2000kcal/day
 Large percentage is milk based foods; lactose intolerant
individuals need special consideration.
 The diet may be inadequate in micronutrients and fiber
3. Thick Liquid Diet (Blended or
Semisolid Diet)

 This diet is moderately low in cellulose and connective

tissue to facilitate easy digestion. Tender foods are used
to prepare the diet. Most raw fruits and vegetables,
coarse breads, cereals, tough meats and nuts are
eliminated. Fried and highly seasoned foods are
omitted.
Purpose of the diet
 The blended liquid diet is designed to provide adequate calories, protein
and fluid for the patients who are unable to chew, swallow or digest solid
foods.
 The diet prescription should be individualized to meet medical condition
and tolerance.
 Patients with wired jaws may use a syringe, spoon, or straw to facilitate
passage of liquid through openings in the teeth, depending on the
physician’s recommendation.
 Frequent feedings (six to eight feeds per day) facilitate ingestion of
adequate calories and proteins..
Purpose

 Depending on individual choice and tolerance, the diet

can be used to provide adequate nutrients.
 Some patients experience palatability problems or may
have difficulty consuming adequate volume of liquids,
they may be unable to meet nutrient and fluid needs.
 In such situations supplementation may be necessary.
Blended foods should be used immediately but can be
refrigerated up to 48hrs or frozen immediately after
blending to prevent growth of harmful bacteria
Indications

 After oral surgery or plastic surgery of the face or neck

area with chewing or swallowing dysfunctions
 For acutely ill patients and those with oral, esophageal or
stomach disorders who are unable to tolerate solid foods
due to stricture or anatomical irregularities
 Those progressing from full liquid to a general diet.
 Patients who are too weak to tolerate a general diet.
 Those whose dentition is too poor to handle foods in a
general diet.
 Those for whom a light diet has been indicated e.g. post
operative
characteristics

 Fluids and food blended to a liquid form

 Viscosity ranges from the thickness of fruit juice to that
of cream soup
 All liquids can be used to blend foods. However,
nutrient dense liquids with similar or little flavor are
preferable. Use of broth, gravy, vegetable juices, cream
soups, cheese and tomato sauces, milk and fruit juices
is recommended
 Multivitamin and mineral supplementation is
recommended
4. SOFT OR LIGHT DIET

 This diet is designed to provide nutrients for patients

unable to physiologically tolerate a general dieting
which mechanical ease in eating, digestion or both are
desired.
 The diet should be individualized based on the type of
illness or surgery and the patient’s appetite, chewing
and swallowing ability and food tolerance.
examples

 Fruit juices or cooked fruits,

 Well-cooked cereals, strained if necessary;
 Fresh spinach
 Amaranth (Terere);
 Pumpkin leaves;
 Managu
 Strained peas;
 Potatoes, baked, boiled, or mashed.
 Fats: butter, thin cream.
 Milk: plain, in scrambled egg, in cream soups, in simple desserts.
 Eggs: soft-cooked, omelettes, custards. Simple desserts; custards,
ice cream, gelatine desserts,
 Cooked fruits or cereal puddings
Indications

 Post operative patients

 Patients with mild gastro intestinal problems
 Non-surgical patients whose dentition is too weak or
whose dentition is inadequate to handle a general diet
 For transition from thick liquid to a general diet
Characteristics

 Moderately low in cellulose and connective tissues

 Tender foods
 Fluids and solid foods may be lightly seasoned
 Food texture ranges from smooth and creamy to
moderately crispy
 Most raw fruits and vegetables, course breads and
cereals gas producing foods and tough meats are
eliminated
 Fried and highly seasoned foods, strong smelling foods
should be omitted
MODIFICATION IN FIBRE CONTENT

 Fiber is the portion of carbohydrates not capable of

being digested by enzymes in the human digestive tract,
thus contributing to increased fecal output.
 There are two types of fiber; soluble and insoluble
fiber.
 Diseases affecting digestive system generally require
modification in fiber content. This can be high or low
fiber diet.
 1. FIBER RESTRICTED (LOW RESIDUE) DIET

 This diet is composed of foods containing low

amounts of fiber which leave relatively little
residue for formation of fecal matter. Residue is
the dietary elements that are not absorbed and
the total post digestive luminal contents present
following digestion. The diet excludes certain raw
fruits, raw vegetables, whole grains and nuts high
in fiber and meats high in connective tissue. The
diet is modified to meet the clients caloric,
protein, fat as well as vitamins and minerals
requirements.
Purpose of the diet

 The fiber (low residue) restricted diet is

designed to prevent blockage of an inflamed
gastrointestinal tract and reduce the
frequency and volume of fecal output while
prolonging intestinal transit time.
Indications

 Gastro-intestinal disorders colitis, colostomy

 Inflammatory bowel disease, diarrhea, hemorrhoids, etc
 Acute phase of diverticulosis
 Ulcerative colitis in initial stage
 Partial intestinal obstruction
 Pre and post-operative periods of the large bowels
 convalescents from surgery, trauma or other illnesses
before returning to the regular diet
Characteristics

 Low in complex carbohydrates

 Has refined cereals and grains
 Legumes, seeds and whole nuts should be omitted
 2. HIGH FIBER DIET

 This diet contains large amounts of fiber that cannot be

digested.
 Fiber increases the frequency and volume of stools while
decreasing transit time through the gastro-intestinal tract.
 This promotes frequent bowel movement and results in softer
stools.
 The recommended fiber intake for women aged 50 years and
below is 21-25g/day and for men aged 50 years and below is
30-38g/day. Men over 50 years should consume at least
30g/day while women above 50 years should consume
21g/day.
Purpose

 The diet is designed to prevent constipation and slow

development of hemorrhoids, reduce colonic pressure
and prevent segmentation.
 The diet also reduces serum cholesterol levels by
decreasing absorption of lipids, reduces transit time and
can be used to control- glucose absorption for diabetic
patients and overweight clients.
 Dietary fiber reduces the risk of cancer of the colon
and rectum.
Indications

 Gastro-intestinal disorders
 Diverticular disease
 Cardiovascular disease (hypercholesterolemia)
 Cancer prevention
 Diabetes mellitus
 Weight reduction
characteristics

 High in complex carbohydrates

 Has less of refined cereals

NB:Intake of excessive dietary fiber may bind and interfere

with absorption of calcium, copper, iron, magnesium,
selenium and zinc. This results in their deficiency.
Therefore, excessive intake of dietary fiber is not
recommended for children and malnourished adults
Modification in Energy Intake

 This may be high or low energy depending on the

metabolic activity patterns and the weight of a patient.
1. HIGH ENERGY DIET

 High energy diet is recommended to provide an energy

value above the total energy requirement per day in
order to provide for regeneration of glycogen stores and
spare protein for tissue regeneration.
 Energy dense foods are used to avoid complication of
bulky diet.
 For effective metabolism, an extra of 500kcal of the
RDA is recommended per day.
 If there is poor appetite small servings of highly
reinforced foods should be given
 The diet may be modified in consistency and flavor
according to specific needs.
 Excessive amounts of low calorie foods, fried foods or
others which may interfere with appetite are avoided
 Energy dense foods include butter, sugar, honey and
ghee which are added to the normal diet to increase
energy content
Indications

 Hyperthyroidism
 wasting
 Typhoid
 Malaria
 HIV/AIDS
 All cases of prolonged degenerative illnesses
Characteristics of the diet

 Increased kilocalorie energy 35-40kcal/kg/day in adults

2. CALORIE RESTRICTED DIET

 These diets are prescribed for weight reduction.

 The recommended kilocalorie level is 20-25kcal/kg/day.
 The diet should comprise of complex carbohydrates and
should provide 50-60% of the total calories.
 Fats should provide <30% of the total calorie
Purpose

 To provide adequate nutrition, maintain desirable body

weight, maintain normal glucose and lipid levels and to
prevent, delay and treat diabetic related complications.
Diet sources

 Vegetables,
 carbohydrates
Indication

 Overweight and obesity

 Hypertension with excess weight
 Hyper lipidemia
 Diabetes mellitus with excessive weight
 Gout
 Gall bladder diseases preceding surgery
Characteristics of the diet

 The diet should provide20-25kcal/kg/Bodyweight/day

 Complex carbohydrates
 High in dietary fiber
 Proteins should be within the DRI
MODIFICATION IN THE CONTENT OF ONE OR
MORE NUTRIENTS

There are various ways to modify the content of one or

more nutrients as listed below:
 Moderate fat diet/fat restricted diet
 High protein, high calorie diet
 High or low protein diet
 Low sodium diet
 High carbohydrates
1. FAT RESTRICTED DIET

 The diet is designed to restrict fat intake for patients

who experience symptoms of nutrient losses when high
fat foods are eaten.
 A fat restricted diet limits the amount of fat you can
consume each day and may be prescribed conditions
that make it difficult for the body to digest fat.
 Provision of fat restricted diet will minimize the
unpleasant side effects of fat malabsorption such as
diarrhea, gas and cramping
Indications

 Gall bladder diseases

 Biliary tract and lymphatic system
 Hepatic cirrhosis (liver cirrhosis)
 Pancreatic insufficiency
 Malabsorption syndromes
 Intestinal resections
 Overweight and obesity
 Cardiovascular diseases (CVDs
 bloating, diarrhea, steatorrhea
Characteristics of the diet

The diet provides overall fat between 25-50g/kg/day

This diet is tailored to provide <30% of total calorie and <
10% saturated fat acids. Levels of restriction are as
follows:
 Mild restriction-25-30% of total calories
 Moderate restriction-20-25% of total calories
 Severe restriction-15-20% of total calories
 The base of the diet should be composed of grains,
vegetables and fruits
 Meat fish, poultry and eggs should be limited to 180g
per day
Adequacy

 It is possible to meet nutrient requirements on this diet

depending on how long you follow it and how much fat
you can digest. A supplement may be recommended.
 Patients with prolonged steatorrhoea or diarrhea may
develop vitamin or mineral deficiencies.
 Vitamin A, D, E and K are fat soluble which means they
need fats to be absorbed and this requires advice from
the nutritionist/dietitian or doctor
2. HIGH PROTEIN-HIGH CALORIE DIET

 This diet is tailored to provide higher amounts of calorie

and protein than usual diet.
 It is prescribed where tissue regeneration is required.
 Its purpose is to help heal wounds, maintain or increase
weight, promote growth, decrease respiratory
complications, resist or fight infections and support the
immune system.
 For a high protein diet, adequate energy from
carbohydrates and fats must be supplied
Purpose

 The diet is designed to

1. maintain a positive nitrogen balance,
2. promote normal osmotic pressure,
3. promote body tissue repair,
4. prevent excessive muscle atrophy in chronic disease
states
5. build or repair worn out tissues of severely malnourished
individuals.
6. to meet increased energy and protein demands during
illness, during certain periods like pregnancy and
lactation
Indications

 Febrile conditions(having or showing symptoms of fever)

 Cancer
 Wounds
 Burns
 Tissue injuries and trauma
 After surgery
 Acute and chronic fever e.g. TB, Malaria and Typhoid.
 Certain physiological alteration - pregnancy and
lactation/infancy
Characteristics

 The diet must provide adequate protein carbohydrates

ratio of (2:1).
 The diet should provide i.e.35-40kcal/kg body
weight/day
 Consist more of high biological value protein
3. LOW PROTEIN DIET

 A low protein diet is temporarily indicated/ prescribed

to avoid breakdown of tissue protein which can lead to
undesirable levels of nitrogen constituents in the blood.
 It is essential that the calorie intake from carbohydrates
be sufficient to avoid excessive breakdown of tissue
protein.
 Low protein may range from (0.6g-0.8g/kg/day
 Low biological value protein can be used during this
time.
 The amount can be reduced to 20-35gms per day
Indications

 Hepatic coma
 Acute and chronic renal failure
 Liver cirrhosis
 Acute and chronic glomerulonephritis
4. LOW SODIUM DIET

 Sodium is a mineral that naturally occurs in some foods.

 However it can also added to food in form of salt to
help preserve them and add flavor.
 Limit sodium intake to less than 3000mg per day.
 RDI should be limited to 2400mg
 3000mg -Eliminate or eat sparingly processed foods and
beverages such as fast foods, salad dressings, smoked
and salted meats.
 2000mg -do not allow salt in preparation of food or
table.
 1000- eliminate processed foods and prepared foods and
beverages high in sodium.
 Omit many frozen foods and fast foods.
 Limit milk and milk products to 16 oz per day.
 Do not allow any salt in food preparation or table use.
 Omit vegetables containing high amounts of natural
sodium limit milk to 16 oz daily and meat to 5 oz daily
and meat products.
 Use low sodium bread and distilled water for cooking
where available.
 Allow up to ¼ tsp table salt in cooking or at the table
Purpose

 The purpose of a low sodium diet is to aid

control of blood pressure (BP) in salt sensitive
people
 to promote the loss of excessive fluids in
edema and assist and manage hypertension.
Examples

 Unprocessed foods and beverages

 Low sodium bread
Indications

 Impaired liver functions

 Cardiovascular diseases
 Severe cardiac failure
 Acute and chronic renal diseases
Characteristics

 A diet low in processed foods and beverages

 Diet should be low in canned foods, margarine, cheeses,
and salad dressings
5. BLAND DIET

 This is a diet modified to avoid irritation of any kind to

the alimentary tract.
 Such diets are chemically, mechanically and thermally
modified.
 In bland diet, strong spices, stimulants and strongly
flavored vegetables and fruits that irritates should be
avoided.
 The food should be served at room temperature
NUTRIENT
REQUIREMENTS/NEE
DS
 ASSIGNMENT: Define nutrient requirements

 There are several methods used in determining

nutrient needs of individuals-:
1. balanced studies
 Chemical balance
 Energy balance
2. Biochemical measurement of nutrients, nutrient
metabolites or related functional and structural
components
 Urinary excretion
 Blood level
3. clinical evaluation
 The objective for all methods for establishing
requirements is to ensure that the quantities of the
nutrients in tissues or in the body pool will be high
enough to protect against impairment of health even if
intake is inadequate for a short period
 The methods can be further classified into-:
1. direct methods
2. Indirect methods
Direct methods

 They are used for some nutrients-:

 It is possible to estimate directly the relationship among
intake, size and occurrence of signs of deficiency
eg in ascorbic acid, vit B12 and iron for others
especially those that pose public health problems, the
quantities required to prevent or cure defeciency have
been established within narrow limits through both survey
and experimental limits
eg niacin, vitamin A and iodine
Indirect methods

 Are used to estimate the body pool and the requirement

 Examples include balanced studies and biochemical
measurements
Balanced studies

 They consist of measuring intake and output of a

nutrient,
 calculating the difference and thus obtaining an
estimate of gain or loss from the body
Biochemical measurements

 This can be done by using surveys eg thiamine

deficiency has been done using this method
Characteristics of requirements

1. They change with increasing age between birth and

maturity , in periods of growth when new tissues are
being laid down.
2. Requirements are higher per unit of body weight than
they are after growth has ceased
3. In mature female requirements increase during
pregnancy as foetus grows, they also increase during
lactation in proportion to the amount of milk
produced
Characteristics of requirements

4. With increasing age beyond 40years, lean body mass and

activity decline .hence energy needs also go down however,
needs for essential nutrients do not decline
5. Requirements for males appear to be higher than for
female when requirements are reported per person, but
when expressed per unit of body weight values they are
generally similar
Estimation of energy requirements

 It is based on the expenditure , energy is expended in

the human body in form of
1. Resting energy expenditure
2. Voluntary activity
3. Thermic effect of food
 Except in extremely active subjects the REE constitutes
the largest portion of the total energy expenditure.
 The contribution of energy activities varies among
individuals
 REE is also BMR.
Basal metabolic rate/ R.E.E

 Is the energy required when the body is at complete

rest
 Relaxed but not asleep several hours after a strenuous
activity and in a comfortable temperature and
environment
 Energy for circulation and respiration constitute 60-70%
of total expenditure
Factors affecting BMR

 Body size- the larger the body size the higher the BMR
 Body composition- lean body mass has higher BMR than
adipose mass
 Age- energy expended per unit of body weight
decreases from birth to old age
 Climate cold temperatures result in higher BMR as a
compensatory mechanism
Factors affecting BMR

 Disease and infection-if infected with fever BMR

increase by about 7% for every 1% raise in temperature
while tumors as seen in cancer and burns on the skin
also increase BMR
 Physiological and hormonal status eg in endocrine gland
disorder such as hyper or hypothyroidisim .During
pregnancy and lactation BMR Iincreases
 Psychological state – acute anxiety stimulate energy
expenditure
Physical activity level

 Physical activity consist of 20-40% of body energy

expenditure and depends on body size.
 Extra energy is expended by larger persons
 Amount expended depends from one person to another
 When expressed as a % of BMR . The activity level is

Activity level Energy lost(%of BMR)

Sedentary 20%
Light 30%
Moderate 40%
Heavy/very active 50%
Energy calculation

 The total daily energy requirement is commonly

estimated by adding the REE and the energy required
for physical activity and TEE
Definitions

 Estimated Energy Requirement (EER) is the average

dietary energy intake that is predicted to maintain
energy balance in healthy, normal weight individuals of
a defined age, gender, weight, height, and level of
physical activity consistent with good health.
Total energy expenditure(TEE)

 TEE can be estimated by

1. Harris benedict equation(1919)
Men
REE(kcals)=66.5+(13.75xw)+(5.0xh)-(6.7xa)
Women
REE(kcals)= 655+(9.56xw)+(1.85xh)-(4.68xa)
Where w=weight in kgs
H=height in cm
A= age in years
Equation 2 for persons with normal
height and weight

 Men
Weight(kgs)x1kcal/kg body weightx24hrs
 Women
Weight(kgs)x 0.95kcals/kg bdy weightx 24hrs
Methods of estimating total body
expenditure

 1a determine the ideal body weight in kgs based on

kg/bmi
b. determine basal energy expenditure using equation 2(A)
c. determine activity level (B)
d. (REE+ activity level)10%(C)
e. TEE=A+B+C
example

 Determine the TEE for a 20 yrs old woman who is 165

cm and 55kg heavy with a light activity level
 1. ideal body weight= 55kgs
b. BEE = 0.95x55x24=1254(A)
c. Light activity is 30% x 1254=376.2(B)
d. 1254+ 376.2=1630.2
10%of 1630.2=163.02(C)
TEE=A+B+C=1254+376.2+163.02=1793.2 Kcals
Using Harris benedict equation

REE(Kcals)= 655+(9.56xw)+(1.88xh)-(4.68xa)
655+(9.56x55)+(1.88x165)-(4.68x20)
655+525.8+310.2-9.36
REE=1397.4(A)
30% OF 1397.4 = 417.7(B)
10%(A+B)= 10/100X(417.7+1397.4)=181.51
TEE=A+B+C
1397.4+417.7+181.51
1996.61
PRACTICE

 Determine the energy requirements for

1. 25 yr old male weighing 50 kgs, height 140 cm, heavy
activity level
2. 30 year old female , weight 57kgs, height 150cm ,
light activity
3. 60 year old male , weight 80kgs, height 160cm ,light
activity
Food exchange
system
 A food exchange list is a simple grouping of common
foods according to generally equivalent nutritional
values.
 This system is used for any situation requiring caloric
and food value control.
 All the foods listed together are approximately equal in
proteins, carbohydrates and fat value.
 Exchange lists provide additional help in achieving
kilocalorie control and moderation.
 Originally developed for people with diabetes,
exchange systems have proved so useful that they are
now in general use for diet planning
 The system organizes food into seven exchange lists.
 Starch
 Milk
 Meat
 Fruits
 Vegetables
 Fats
 sugar
 The number of kilocalories associated with each food is
an average for the group.
 The number of kilocalories is calculated given the
number of grams of carbohydrates, fats and proteins in
a food (1g of carbohydrate or protein yields 4kcal while
1g of fat yields 9 kcal).
 To apply the system successfully, users must become
familiar with portion sizes
Procedure for
calculating diets
using exchange lists
 Let us suppose that a 1200calorie diet is to be planned
with the following levels:
 Carbohydrate120g ,protein50g ,fat 50g.
 This data from table one can be used to calculate the
dietary plan shown in table 2.
Step 1

 Estimate the amount of milk, vegetables and fruits to

be included. The amount are dictated somewhat by the
preferences of the clients but the following are
minimum levels that should ordinarily be included:
 Milk-2cups for adults, 3-4 cups for children, pregnant
and lactating women, fruits 2exchanges , veges 2-
exchanges
Step 2

 Fill in the carbohydrate, protein and fat values for the

tentative amounts of milk, vegetables and fruits
Step 3

 Determine the number of bread exchanges

 Add up the carbohydrate value of milk, vegetables and
fruits.
 Subtract this total from the total amount of
carbohydrate prescribed.
 Then divide the reminder by 15(the carbohydrate value
for one bread exchange)
 Use the nearest whole number of bread exchanges
 Fill in the bread
Step 4

 Total the carbohydrate column.

 If the total deviates more than 3or 4 from the
prescribed amount, adjust the amount of vegetables,
fruits and bread.
 No diet should be planned with fractions or an
exchange, since awkward measurements of food would
be encountered
Step 5

 Determine the number of meat exchanges

 Add up the protein value of all foods so fat calculated.
 Subtract this total from the amount of protein
prescribed
 Divide the reminder by 7 (the protein value of one meat
exchange)
 Fill in the protein and fat values
Step 6

 Determine the number of fat exchanges

 Add up the fat values from the milk and meat
 subtract this total from the amount of fat prescribed
 Subtract this total from the amount of fat prescribed.
 Divide the reminder by 5(the fat content of one fat
exchange)
 Fill in the fat value
Step 7

 Check the entire diet from the accuracy of the

computations.
 Divide the days food allowance into a meal pattern
suitable for the client
 Table 2
list food measure carbohyd proteins fat total
rate
1 Milk,whol exchange
e
2 Vegetabl exchange
e s
3 Fruits exchange
s
4 Bread exchange
s
5 Meat,low exchange
fat s
6 Fat exchange
s
total
 120 g carbohydrate prescribed total
 64g carbohydrate from milk, vegetables ,fruit
 56g carbohydrates to be supplied from bread exchanges
 56/15=4 bread exchanges
 70g protein prescribed total
 -28g protein from milk, vegetables bread
 42g protein to be supplied by meat exchanges
 42/7=6 meat exchanges
 50g fat prescribed total
 -38g fat from milk and meat exchanges
 12 to be supplied from fat exchanges
 12/5= 2 exchanges
Table 1

Food measu Weight Carboh Protei Fat(g) Calorie

excha re (mg) ydrate ns(g) s(kcal)
nge (g)
Milk, 1 cup 240 12 8 5 125
whole
Vegeta Up to 1 - - - - --
ble A cup
Vegeta ½ cup 100 5 2 - 28
ble B or 2
cup of
A
fruit varies - 10 - - 40
bread varies - 15 2 - 68
 Using the rule of 60% carbohydrates, 25% fats and 15% protein
 Plan a days menu and shopping list using the exchange system
for the following total kcal requirements
 Group 1- 1550kcal
 Group2- 2000kcal
 Group3- 2100kcal
 Group 4- 2400kcal
 Group 5- 1200kcal
 Group 6-1400kcal
 Group 7-2250kcals