Ch 18: Dietary Assessment and Body Composition Testing Flashcards
Assessing the client’s progress and transformation all begins with:
- Understanding where they started from. With an array of available assessment information, tools, and strategies
- The Nutrition Coach’s responsibility is to help the client navigate and understand guidelines and assessment tools that are most appropriate.
A resource produced by the U.S. Department of Health & Human Services (HHS) and the United States Department of Agriculture (USDA) that provides guidelines and key recommendations for healthy diets that may help prevent diet-related chronic conditions.
Dietary Guidelines for Americans
An entity within the National Academies of Sciences that establishes principles and guidelines of adequate dietary intake among other tasks.
The Food and Nutrition Board of the Institute of Medicine
The recommended intake of various nutrients as determined by the Food and Nutrition Board of the Institute of Medicine – the DRIs include recommendations like the Recommended Dietary Allowance (RDA) and Acceptable Macronutrient Distribution Range (AMDR).
Dietary Reference Intakes (DRIs)
The DRIs include limit recommendations for several types of intakes.
Contents of Dietary Guidelines for Americans 2015 - 2020 8th Edition
- Follow a healthy eating pattern across the lifespan.
- Focus on variety, nutrient density, and amount.
- Limit calories from added sugars and saturated fats and reduce sodium intake.
- Shift to healthier food and beverage choices.
- Support healthy eating patterns for all.
Important goal of the Dietary Guidelines for Americans 2015 - 2020 report
Provide simple guidelines and key recommendations that are understandable to the general public
Recommendations concerning which foods should be emphasized or discouraged in a healthy eating pattern are provided.
State the recommended percent of calories that adults should obtain from carbohydrates (45 to 65%), fat (20 to 35%), and protein (10 to 35%)
Acceptable Macronutrient Distribution Ranges (AMDRs)
The average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97 to 98%) healthy individuals in a particular life stage and gender group
Recommended Dietary Allowance (RDA)
The recommended average daily intake level based on observed or experimentally determined estimates of nutrient intake by groups of apparently healthy people that are assumed to be adequate – The AI is used when an RDA cannot be determined.
Adequate Intake (AI)
The highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population – As intake increases above the UL, the potential risk of adverse effects may increase.
Tolerable Upper Intake Level (UL)
The average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group
Estimated Average Requirement (EAR)
The range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients
Acceptable Macronutrient Distribution Range (AMDR)
3 Principles of Healthy Eating Patterns
- An Eating Pattern Represents the totality of all foods and beverages consumed
- Nutritional Needs should be Met Primarily through Nutrient-Rich Foods
- Healthy Eating Patterns are Adaptable
The regular food and beverage intake of an individual over time
Eating Pattern
Although specific food and beverage choices can vary substantially day-to-day, the eating pattern represents the typical intake of an individual when all days are taken into account.
While there are some common aspects among most healthy eating patterns, it is important to recognize that there is not one “best” pattern.
Healthy Eating Patterns are Adaptable
There is room for personal preference within the context of following guidelines for a healthy eating pattern.
The amount of energy (i.e., number of calories) an individual uses at rest in order to sustain basic processes in the body – this value is often considered for a 24-hour period.
Resting Metabolic Rate
Why Generic Calorie recommendations may not be best to use for individual clients, particularly active clients.
- The calorie intake recommendations do not take body size (e.g., height and weight) into account
- There are only three activity levels (sedentary, moderately active, and active) in the recommended calorie intakes. These activity levels do not distinguish between activity at work and activity during leisure time
- Some very-active individuals and athletes will exceed the definition of active provided by the guidelines, which is “a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to activities of independent living
It is recommended that individualized calorie intake recommendations be utilized with clients. These recommendations can be provided by:
Laboratory testing or through the use of prediction equations.
Estimate of the individual client’s daily calorie needs for weight maintenance
One frequently used method of estimating calorie intake is to estimate a client’s resting metabolic rate (RMR) and then multiply this number by an activity factor
Mifflin-St Jeor Equation
RMR (kcal / day) = (9.99 X weight (kg)) + (6.25 X height (cm)) - (4.92 X age (y)) + (166 X Sex Factor) - 161
Where body weight is in kilograms, height is in centimeters, and sex factor = 1 for males and 0 for females.
Physical Activity at Work/School and Physical Activity in Leisure Time* Activity Factor: Very Light
Light – Industrial work, sales, or office work that involves light activities
Very Light 1.5
Light 1.6
Moderate 1.7
Active 1.8
Very Active 2.0
Physical Activity at Work/School and Physical Activity in Leisure Time* Activity Factor: Light
Light – Industrial work, sales, or office work that involves light activities
Very Light 1.5
Light 1.6
Moderate 1.7
Active 1.8
Very Active 2.0
Physical Activity at Work/School and Physical Activity in Leisure Time* Activity Factor: Moderate
Moderate - Cleaning, kitchen staff, delivering mail on foot, etc.
Very Light 1.6
Light 1.7
Moderate 1.8
Active 1.9
Very Active 2.0
Physical Activity at Work/School and Physical Activity in Leisure Time* Activity Factor: Heavy
Heavy - Heavy industrial work, construction work, or farming.
Very Light 1.7
Light 1.8
Moderate 1.9
Active 2.1
Very Active 2.3
Physical Activity at Work/School and Physical Activity in Leisure Time* Activity Factor: Definitions
*Definitions: very light (almost no activity at all), light (walking, non-strenuous cycling or gardening approximately once a week), moderate (regular activity at least once a week, e.g., walking, bicycling or gardening), active (regular activities more than once a week, e.g., intense walking, bicycling or sports), very active (strenuous activities several times a week).
USDA Vegetable Consumption Recommendations
- Dark-Green (broccoli, Romaine, Spinach, Kale, Collard, Turnip and Mustard Greens)
- Starchy (White potatoes, corn, green peas, green Lima beans, plantains and Cassava)
- Legumes (Kidney beans, White beans, black beans, lentils, Chickpeas, pinto beans, Split peas and edamame
- Red and Orange (Tomatoes, Tomato Juice, Red Peppers, Carrots, Sweet Potatoes, Winter Squash and Pumpkin
- Other (Iceberg Lettuce, Green beans, Onions, Cucumbers, Cabbage, Celery, Zucchini. Mushrooms and Green Peppers
Vegetables provide:
Important nutrients, including fiber, water-soluble, and fat-soluble vitamins and minerals.
Whole-grain products:
Whole-grain products include whole-wheat bread, whole-grain cereals and pastas, oatmeal, brown rice, and quinoa
Refined-grain products
Refined-grain products include most white breads, refined-grain cereals and pastas, and white rice.
Often enriched - Vit B and Iron added
Dairy
Dairy products, such as milk, yogurt, and cheese, can help provide important nutrients. Dairy products are a good source of calcium, phosphorus, and a variety of other minerals.
Dairy Proteins: Whey and Casein
Fortified with Vitamin D
low-fat or nonfat dairy
Soy Milk = Dairy Protein
Almond milk < Dairy Milk
Highest-quality, plant-based protein
Soy protein
Factors for Protein Quality
Protein quality is determined by a variety of factors, including the digestibility of the protein and how similar the pattern of amino acids in a protein source is to the pattern required by the human body
Foods to Limit
Trans Fat, Saturated Fat, Added Sugars and Sodium
Increased intake of trans fats
Raises LDL cholesterol and increases the risk for heart disease.
The guidelines recommend the intake of saturated fats
Less than 10% of the overall daily calorie intake and that saturated fats in the diet be replaced with unsaturated fats.
A condition of being severely overweight or obese.
Adiposity
Guidelines recommends consuming less than ____ of calories per day from added sugars
10%
Recommended Daily Sodium Intake
No more than 2,300 milligrams/day of sodium
Does not apply to highly active individuals
Macronutrient Distribution
Carbs (45 -65%), Protein (10 - 35%) and Fat (25 - 35%)
Calorie recommendations for Men
2000 - 3000/day
Calorie recommendations for Women
1600 - 2400/day
What We Eat in America Survey Results Summary
1) About 3/4 of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
2) More than half of the population is meeting or exceeding total grain and protein foods recommendations but are not meeting the recommendations for the subgroups (i.e., whole grains and seafood) within each of these food groups.
3) Most Americans exceed the recommendations for added sugars, saturated fats, and sodium.
4) The eating patterns of many are too high in calories, as demonstrated by the high percentage of the population that is overweight or obese.
Seafood Recommendations
It is recommended that seafood (such as salmon or tuna) is utilized as a main protein source twice per week.
Wild is better than farmed
Relatively weak level of evidence
Expert Opinion
Strongest level of evidence
The highest levels of evidence are achieved when the results from multiple well-conducted studies are combined in order to allow for stronger conclusions to be made
First Priority
Focusing on eating patterns that are feasible for your client, while also helping them move toward their health-and-fitness goals
Analyzing a client’s food and beverage intake in order to determine their intake of calories and specific nutrients – specific forms of dietary assessment include 24-hour recalls, usual intake, diet records, and food frequency questionnaires.
Dietary Assessment
Important step in identifying eating-pattern changes that may help them reach their goals more effectively
Dietary Assessment
The overall goal of employing Assessment methods
Be able to provide clients with constructive feedback that helps promote their long-term health and well-being
What is a simple interview in which a client describes everything they have had to eat or drink the previous 24 hours?
24 hour recall
National Health and Nutrition Examination Survey (NHANES) Dietary Interviewer Procedures Manual: 24 Hour Recall Steps
- Quick list: Obtain a simple list of all food and drink items eaten within a 24-hour period of time without focusing on specific details and amounts.
- Forgotten foods: Ask the client about specific food categories that may have been forgotten such as nonalcoholic or alcoholic beverages, sweets/desserts, and snacks. This may be particularly important for those who graze.
- Time and occasion: Ask the client to think about his or her schedule during the 24-hour recall period and state what time foods were consumed. Remembering the activities of the day may help the client remember additional items.
- Describe the food: Now that the list of foods/drinks has been compiled, ask the client to provide the following information for each food item: where the food was obtained (home, restaurant, etc.), brand/restaurant associated with food, preparation method, how the food/drink was served (e.g., served with anything else), and the quantity of the food/drink.
- Final review/probe: Briefly review the 24-hour recall for completeness with the client and ask one final time if there are any items that could have been forgotten.
Obtain a simple list of all food and drink items eaten within a 24-hour period of time without focusing on specific details and amounts
Quick List
Ask the client about specific food categories that may have been forgotten such as nonalcoholic or alcoholic beverages, sweets/desserts, and snacks. This may be particularly important for those who graze.
Forgotten Foods
Ask the client to think about his or her schedule during the 24-hour recall period and state what time foods were consumed. Remembering the activities of the day may help the client remember additional items.
Time and Occasion
Now that the list of foods/drinks has been compiled, ask the client to provide the following information for each food item: where the food was obtained (home, restaurant, etc.), brand/restaurant associated with food, preparation method, how the food/drink was served (e.g., served with anything else), and the quantity of the food/drink.
Describe the food