Dietary Assessment, Energy and Protein Requirements Flashcards
Dietary Assessment Methods
24hr Recall: research, repeats 3+, populations
A: quick, cheap, good detail, low burden, multi-pass
D: memory-dependent, over/under reporting, limited representation, inter-interviewer variability
Usual typical daily food pattern:
A: Low burden, quick, interpret trends
D: Variable intake and portions, portion size description, under-reporting common
Food journal/record/diary: 3-7 days recorded
A: precise, no memory, multiple days, can weigh food
D: time consuming, behavior change, details/portion inaccuracy or omission
FFQ: survey of specific time with food list
A: specific nutrients, snapshot of usual intake, for large studies
D: Less accurate, memory dependent, some foods hard to quantify
Direct observation: controlled settings
A: more precise, no memory, can be aware or unaware
D: Observation burden on staff, intrusiveness
Components of TEE
2023 DRI IOM/NAS Energy Equations about
Thermic effect of food = 10%
PA = 20-30%
REE/BMR = 60-70%
Injury/stress increases REE/BMR and decreases PA and TEF
Equation split into activity levels and by sex
Requires age, height (cm) and weight (kg)
Methods to measure REE
TEE from REE
Indirect calorimetry: measures VO2 and VCO2 from substrate utilization
Respiratory quotient RQ = VCO2/VO2 and calculated using Weir equation
Predictive energy equations for REE:
1) Mifflin St-Jeor
2) Harris-Benedict predict within 10% of REE (tends to overestimate REE by 5-15%, or underestimate in males >65)
3) FAO/WHO equations split by sex and age categories
TEE = REE x activity factor x stress factor
*Overfeeding is detrimental, underestimate stress factor
Mifflin St-Jeor Equations and strengths/weaknesses
Men:
REE (kcal/d) = (9.99 x current kg) + (6.25 x cm) - (4.92 x age) + 5
Women:
REE (kcal/d) = (9.99 x current kg) + (6.25 x cm) - (4.92 x age) - 161
Strengths of Mifflin St-Jeor: most reliable in predicting RMR for obese and nonobese and NON-acutely ill
Weaknesses: underrepresents older and ethnic minorities
Simplistic weight based equation:
25-35 kcal/kg/day + reassessed often
Low activity or overweight or poor appetite: 25 kcal/kg
* use weight of healthy BMI for that person (25 or 29 >65 yo or realistic BMI)
Usual moderate activity/non-obese: 30 kcal/kg
Higher activity/higher needs/underweight: 35 kcal/kg
No activity or stress factor, adjusted range for stress/activity level
FAO/WHO Obesity Energy BEE equation
Simple equation for elderly in long term care homes
BEE for BMI 30-50: 11-14 kcal/kg
BEE for BMI >50: 22-25 kcal/kg IDEAL body weight (IBW)
Elderly REE: 21-23 kcal/kg
Protein recommendations for healthy adults, older adults and those with physiological/disease status
How to adjust for high/low BMI
Healthy: 1g/kg/day
Older (>65): 1-1.2g/kg/day
Higher need: 1.2-2g/kg/day
You can use higher protein or higher BMI if BMI is very low and client is >65
You can use lower protein + actual weight or weight for healthy BMI for person with high BMI
Fluid requirement calculation methods
1 ml/kcal energy requirement
Urine output + 500 mL/day
Elderly: no less than 1500 mL
Weight based: 100 ml/kg for 1st 10kg + 50 mL for next 10 kg + 20 ml/kg BW above 20kg
Weight + Age: Higher rec for younger (40 ml/kg) vs older (25ml/kg)
Symptoms of thirst and overhydration
Thirst (1-2% body water lost): dark urine, higher specific gravity, skin turgor ↓, dry mouth/lips, tachycardia, headache, ↓ body temp, restlessness, confusion, rapid weight loss, ↑ Na, albumin, BUN, creatinine, Hb and Hct
Overhydration: ↑ BP, ↓ pulse, edema, ↓ Na, K, albumin, BUN, creatitine, Hb and Hct, and rapid weight gain
Elements of screening for malnutrition
Current BMI 18.5-20 = risk, <18.5 indicates ↓ lean mass
Involuntary weight loss:
Severe >5% in 1 month or 10-15% in 6 months
Moderate >5% in 3 months
Prognosis deteriorating often means ↓ food intake and risk of malnutrition
Screening tool: CNST, MUST and MNA
CLIM criteria for diagnosis of malnutrition
1) Screening for risk
2) Phenotypic: weight loss, low BMI, reduced muscle
Etiologic: reduced intake/assimilation or disease/inflammation burden
3) Meets at least 1 phenotypic and etiologic criteria for diagnosis
4) determine severity of phenotypic criterion
Moderate/stage 1: 5-10% in 6 months or 10-20% beyond 6 months weight loss
(<20/<22 BMI if 70 yo)
Severe/stage 2: >10% within 6 mo or >20% beyond 6 mo
(<18.5/<20 BMI if 70 yo)
