1 Diet Planning

8/2/2019 1 Diet Planning

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Nutrition And

Health

By

Prof. Drs

Asmaa Abdel Aziz Alla Hassan


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This chapter includes :

Section I: Diet PlanningSection II: assessment of NutritionalstatusSection III: Malnutrition


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Diet Planning

It is the determination of the

quantity & the quality of diet to

be consumed by individual.


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Factors

consideredduringdiet planning

Person EnvironmentConstituent

ofDiet


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Factors to be considered during diet planning:Factors related to the individuals themselves-A

Age and Sex

Body weight and surface area: which affect the BMR

Physiological conditions: which reflect the need during

growth of the children, pregnancy and lactation.

Level of activities.

Pathological conditions:

BMR decreases in starvation, malnutrition and

hypothyroidism

BMR increases infever (an increase in the body

temperature by one-degree increases BMR by 13%).


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Factors related to the environment:-B

In hot climate, individuals need less calories andmore salts and fluids than in cold ones.

In cold regions more caloric food is required.


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C-Factors related to the diet itself:

The food should:

- fulfill the qualitative and quantitative

requirements of the individual.

- be palatable and satisfy the food habits of the

individuals.

- be variable from meal to meal

- be free from infectious agents and toxins.

- be digestable and of sufficient size to allay

hunger.


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- Its nutrients should be of certain proportion to get

best benefit. Examples:

-Less fat intake affects the absorption of fat soluble

vitamins.

-Vitamin C facilitates iron absorption

-vitamin D facilitates calcium absorption..

- Excess sugar causes dental carries.


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Methods of diet Planning:

Quantitative Method

Qualitative Method.


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Quantitative Method of diet planning:

Determine the daily caloric requirements:

Energy is important for body function &growth.

There should be an energy balance between energy

intake and energy output.

Energy imbalance leads to malnutrition in the form ofunder nutrition or over nutrition.

The energy value of foods is expressed in terms of

kilocalories (Kcal).The dietary sources of energy are fats, carbohydrates

and proteins


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They supply energy at the following order:

One gm. Fat 9 kcal/gOne gmCarbohydrate 4 kcal/gOne gm Protein 4 kcal/g


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The energy requirement of an individual is defined as:

the amount of energy that an individual takes from

food in order to keep healthy and active.

Energy is required for:

1. The basal metabolism

2. Daily activities e.g. walking, sitting, standing,

dressing, climbing stairs etc.

3. Occupational work; light, moderate and heavy

work.


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Energy for basal metabolismThe basal metabolism is the energy expenditure of a

person who is completely at rest (relaxed and

comfortable) i.e. not moving at all, in the morning

soon after awaking and 14 hours after the last meal.

It is constant per square meter surface area per hour.

The average BMR:

- for adult man is 40 kcal /square meter surface

area / hour.

- for adult woman is 37 kcal / square metersurface area/ hour.

It can also be assessed by using body weight, where

the BMR is 1 kcal /one kg body weight / hour.


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Daily Energy requirement

For ages over 10 years

It is based on the levels of activity people or

occupation during 24 hours.

These are called Physical Activity Levels (PAL).

Daily energyrequirement= BMR x PAL


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Level of physical activity(PAL)

Light Moderate Heavy

Women 1.56 1.64 1.82

Men 1.56 1.78 2.10

Physical activity levels (PAL) for women

and men aged 18- 60 years


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PAL Typical occupation

Light People working in offices, students, andunemployed

Moderate Shop assistants, domestic servants,housewives, drivers

Heavy Farmers, fishermen, builders, laborers,forestry workers.

Examples of occupations for each physicalactivity level


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For children (0-10 years)

. Energy requirement can be calculated using

special tables which takes into account

energy needed for growth, play and energy

to fight infection.


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Qualitative Methods of diet planning:

A high quality diet is the balanced diet which

contains a variety of foods that provide energy,amino acids, vitamins, minerals, fats,

carbohydrates

.


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The best combination of foods for a

balanced diet is as follows:

65% of kcal comes from

carbohydrates

25% of kcal comes from fats

(a maximum of one third is saturated fat)

10% of kcal comes from proteins


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A balanced diet could be achieved through:

Food groups

1-Bone building group ( as milk and milk products

cheese and ice-cream)2-Tissue building group (as meat, poultry, fish, eggs

and legumes)

3-Energy group (as foods rich in carbohydrates, fats

and oils)

4-Vitality or protective group ( vegetables and fruits)

Food guide pyramid


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Food guide pyramid


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Dietary requirements

Protein

Proteins are needed for:

1-Tissue building (growth) and tissue repair

2-Formation of antibodies enzymes, hormones,

hemoglobin, glycoprotein etc

.


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Protein requirement depends on

Age:Children need more protein for growth. ( A Child

needs 2-3 gms protein/ one kg body weight/ day while

adult needs 1 gm protein /kg body weight /day)

Sex:Men have more muscle and less fat than women, so

they need more protein.

Body size:Large-sized people need more protein to

replace more cells & tissues

Pregnancy &Lactation:A pregnant woman needs extra

protein for the growth of the baby and placenta and to

increase her own blood and tissues.


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Carbohydrates

Carbohydrates are required because:

1-They provide the energy .

Eating less than 50 to 100 grams of

carbohydrates per day will make the body

utilizes protein for energy.

3-Carbohydrate intake is important for fat

metabolism by the liver.

Fat


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FatFat is needed for

1-Supplying energy where 25% of Kcal are supplied by

fats

2- Improve the taste of food, make meal less bulky but

more filling

3- It is essential for absorption of fat soluble vitamins (A-

D-E-K)

4- 7 dehydrocholesterol in the skin is the precursor of

vitamin D

5-Supporting the viscera


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Vitamins

Vitamins are substances necessary for the body in a

very little quantities.They are essential for growth and the integrity of tissues

and metabolism.

They are not synthesized in the body with fewexceptions:


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1- Vitamin D is synthesized in skin by the action of

ultraviolet rays on 7 dehydrocholesterol

2-Carotenes are the precursors of vitamin A

in the body

3-Vitamin K is synthesized in the intestines


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Minerals

Such as calcium, iron, iodine, fluorine etc.

Deficiencies of minerals produce diseases in man

Iron (Iron deficiency anemia)

Goiter (iodine deficiency).

Fluorine ( dental carries)Calcium ( osteoporosis)


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Water

It constitutes 70% of body weight.

It is the main constituent of all body fluids.

It has a role in all biological processes (digestion,

absorption, metabolism, excretion etc.)

The average intake is 2.5-4 liters or more according to

weather, activity, occupation and health status.


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Vulnerable groups

These are groups more liable to different nutritional

problems than the general population, due to theirphysiological status. They include

Pregnant and lactating women.

Infants and growing children.

Adolescents specially girls.

Some industrial workers.

Elderly& sick persons as they need special

nutritional attention.

P t d l t ti


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Pregnant and lactating women

They are considered the most vulnerable.

They share their nutrients with their children.

Their BMR increases by 20% and, consequently, their

requirements increase.

During pregnancy women need extra kcal

to build up their own tissues,

to build fat stores for making breast milk

to build the baby and the placenta..


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Lactating mother needs more calories, proteins,

vitamins, minerals

Two to three months after labor, mother should

be back to her pre-pregnancy weight


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The recommended dietary intakes

Folicacid

Ug/d

Ironmg/d

Calciummg/d

Fatg/d

Proteing/d

Netenergy

kcal/d

Bodyweight (kg)

ActivitiesGroup

100284002060242560Sedentarywork

Man

2875Moderatework

3800Heavy work

100304002050187550Sedentarywork

Woman

2225Moderatework

2925Heavy work

40038100030+15+30050Pregnantwoman

15030100045+25+50050Lactation 0-6months

+18+500Lactation 6-12 months

Health consequences of maternal malnutrition:


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Health consequences of maternal malnutrition:

A-Fetal effects:

Intrauterine growth retardation

Stillbirth

Low birth weight

B- Maternal effects

Maternal depletion syndrome

1- Iron deficiency anemia ,

2- protein energy malnutrition,

3-Iodine deficiency disorders

4-Osteomalacia

Maternal infection (puerperal sepsis)

Maternal mortality


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Indicators to assess maternal nutritionalstatus

1-Pre-pregnant weightand heightThis is a factor affecting the size of

placenta and hence the weight of the

baby.

2-weight gain during pregnancy: well-nourished women gain on average about

12kg during pregnancy.

3- Maternal mortality ratio

Industrial workers


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Industrial workers

Malnutrition of industrial workers may lead to manyhealth problems as:

Deterioration of the workers health.

Reduction of productivity.

Increased absenteeism. Decreased resistance to infections.

Susceptibility to to accidents, which is

related to deficiency in some nutrients

such as vitamin B1.

Factors to be considered in feeding of


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Factors to be considered in feeding ofindustrial workers1-Type of work whether light, moderate or heavy.Sedentary work requires fewer kcal, while heavy

activities require more kcal.

2. Climatic condition :

In hot climate, there is much sweating and

water loss, extra fluid and salt intake should be

stressed upon.

In cold environment more kcal are required, so,

more fats and carbohydrates, and more

frequent meals are needed.

3 Working condition ( indoor outdoor in mines or on


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3. Working condition ( indoor, outdoor, in mines or on

mountains)

4. Exposures to toxic materials and fumes:

Minerals, vitamins & proteins are needed as

detoxifying nutrients


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4. Social background.

Migratory workers need special attention.

workers are at lower socioeconomic

condition having improper food habits and

behavior. Thus, they require nutritional

education that may be provided in the

workplace/ restaurant and / or canteen.

5. Adolescents, working pregnant and lactating

women may need special attention as they are

vulnerable.


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1 Diet Planning