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NUTRIENTS and  ASSESSMENT Myrna D.C. San Pedro, MD, FPPS
Specific Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NUTRITION & GROWTH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NUTRITION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
METABOLISM ,[object Object],[object Object],[object Object]
NUTRIENT REQUIREMENT ,[object Object],[object Object],[object Object],[object Object]
ENERGY EXPENDITURE ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Thus, the energy requirement of the infant or child is the level of intake which can Maintain appropriate body size & composition As well as deposition of new tissues Meet the energy required for physical activity And the thermic effect of food
Daily Caloric Requirement ,[object Object],[object Object]
Energy Expenditure 6-12 Years ,[object Object],[object Object],[object Object],[object Object],[object Object]
Body Composition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MAJOR NUTRIENTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Macronutrients Micronutrients
Macronutrients Provide Energy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Carbohydrates’ Functions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Proteins’ Functions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Daily Protein Requirement 1.2 16-19 yr Males 0.85 (or 46 g/day of protein) 0.80 (or 46 g/day of protein) 14-18 yr (RDA) 19-30 yr (RDA) Females As point of reference: 3 ounces lean beef (the size of a deck of cards) or poultry = 25 g protein; 3 ounces fish or 1 cup soybeans = 20 g protein; 1 cup milk or yogurt = 8 g protein; 1 egg or 1 ounce cheese=6 g protein; 1 cup legumes=15 g protein; cereals, grains, nuts and vegetables = 2 g protein per serving 0.85 (or 52 g/day of protein) 0.80 (or 56 g/day of protein) 14-18 yr (RDA) 19-30 yr (RDA) 1.5 7-15 yr 0.95 (or 34 g/day of protein) 9-13 yr (RDA) 2 3-6 yr 0.95 (or 19 g/day of protein) 4-8 yr (RDA) 2.5 1-2 yr 1.05 (or 13 g/day of protein) 1-3 yr (RDA) 3 6-11 mo 1.2 (or 11 g/day of protein) 7-12 mo (RDA) 3.5 0-5 mo  1.52 0-6 mo (AI) 1978 FNRI Publications, Daily Requirements of Filipinos  (g/kg BW/day) 2005 Dietary Reference Intakes, U. S. Food and Nutrition Board, National Academy of Sciences  (g/kg BW/day)
Amino Acids ,[object Object]
Dietary Reference Intakes of  Essential Amino Acids 32 7 27 25 51 56 28 46 1-3 yr 42 10 36 32 66 71 36 61 7-12 mo 77 25 65 52 95 139 78 120 0-6 mo 4-8 yr Amino Acid (mg/kg/24 hr) 22 Threonine 27 Valine 6 Tryptophan 21 Sulfur amino acids 43 Lysine 47 Leucine 25 Isoleucine 38 Aromatic amino acids
Evaluating Protein Quality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluating Protein Quality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fats’ Functions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Essential Fatty Acids (EFAs) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Omega-3 and Omega-6 Fats ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
REQUIREMENT vs RECOMMENDED INTAKE vs REFERENCE INTAKE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Estimated Average Requirement  ,[object Object],[object Object],[object Object],[object Object]
Recommended Dietary Allowance ,[object Object],[object Object],[object Object]
Dietary Reference Intakes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
DRIs vs Former RDAs & RNIs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Estimated Energy Requirement ,[object Object],[object Object],[object Object],[object Object]
Equations to Estimate Energy Requirement 354 - (6.91 x age [y]) + PA x (9.36 x weight [kg]) + (726 x height [m]) Female 662 - (9.53 x age [y]) + PA x (15.91 x weight [kg]) + (539.6 x height [m]) Male Ages 19 years and older EER (kcal/day) = TEE 135.3 - (30.8 x age [y]) + PA x (10 x weight [kg])+ (934 x height [m]) + 25 kcal 9-18 yr 135.3 - (30.8 x age [y]) + PA x (10 x weight [kg])+ (934 x height [m]) + 20 kcal 3-8 yr Female 3-18 years EER = TEE + energy deposition 88.5 - (61.9 x age [y]) + PA x (26.7 x weight [kg]) + (903 x height [m]) + 25 kcal 9-18 yr 88.5 - (61.9 x age [y])+ PA x (26.7 x weight [kg]) + (903 x height [m]) + 20 kcal 3-8 yr Male 3-18 years EER = TEE + energy deposition (89 x weight [kg] - 100) + 20 kcal 13-36 mo (89 x weight [kg] - 100) + 22 kcal 7-12 mo (89 x weight [kg] - 100) + 56 kcal 4-6 mo (89 x weight [kg] - 100) + 175 kcal 0-3 mo Ages 0-36 months EER (kcal/day) = TEE + energy deposition
Water ,[object Object],[object Object],[object Object],[object Object]
 
Minerals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Macrominerals ,[object Object],[object Object],[object Object],[object Object],[object Object]
Microminerals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Vitamins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
ASSESSMENT OF NUTRITIONAL STATUS OF CHILDREN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANTHROPOMETRIC INDICATORS OF NUTRITIONAL STATUS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A 6-yr-old boy has an actual weight of 15 kg & height of 105 cm. Compute for the wt-for-ht%. Actual Wt = 15 kg Actual Ht = 105 cm IBW based on actual age (6 yr) =  20 kg IBW based on plotted Ht =  17 kg Wt-for-Ht% = 15/ 17  =  0.88 Wt-for-age% = 15/ 20   = 0.75 Ht-for-age% =  105 / 110   = 0.95
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Can you  see  risk? Age = 3 y 3 wks boy Height = 100.8 cm Weight = 18.6 kg Age = 4 y girl Height = 99.2 cm  Weight = 17.55 kg Age = 4 y 4 wks girl Height = 106.4 cm Weight = 15.7 kg C BMI=18.3  = >95 th % Overweight   A  BMI=13.9 = 10 th % Normal B BMI=17.8 = 90 th –95 th %  At risk for overweight
BMI-for-Age C A B
RELAX !!!
It is easier for a camel to pass through the eye of a needle if it is lightly greased.  Kehlog Albran THANK YOU!

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Nutrients And Assessment

  • 1. NUTRIENTS and ASSESSMENT Myrna D.C. San Pedro, MD, FPPS
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. Thus, the energy requirement of the infant or child is the level of intake which can Maintain appropriate body size & composition As well as deposition of new tissues Meet the energy required for physical activity And the thermic effect of food
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.  
  • 18.
  • 19.  
  • 20.
  • 21.  
  • 22. Daily Protein Requirement 1.2 16-19 yr Males 0.85 (or 46 g/day of protein) 0.80 (or 46 g/day of protein) 14-18 yr (RDA) 19-30 yr (RDA) Females As point of reference: 3 ounces lean beef (the size of a deck of cards) or poultry = 25 g protein; 3 ounces fish or 1 cup soybeans = 20 g protein; 1 cup milk or yogurt = 8 g protein; 1 egg or 1 ounce cheese=6 g protein; 1 cup legumes=15 g protein; cereals, grains, nuts and vegetables = 2 g protein per serving 0.85 (or 52 g/day of protein) 0.80 (or 56 g/day of protein) 14-18 yr (RDA) 19-30 yr (RDA) 1.5 7-15 yr 0.95 (or 34 g/day of protein) 9-13 yr (RDA) 2 3-6 yr 0.95 (or 19 g/day of protein) 4-8 yr (RDA) 2.5 1-2 yr 1.05 (or 13 g/day of protein) 1-3 yr (RDA) 3 6-11 mo 1.2 (or 11 g/day of protein) 7-12 mo (RDA) 3.5 0-5 mo 1.52 0-6 mo (AI) 1978 FNRI Publications, Daily Requirements of Filipinos (g/kg BW/day) 2005 Dietary Reference Intakes, U. S. Food and Nutrition Board, National Academy of Sciences (g/kg BW/day)
  • 23.
  • 24. Dietary Reference Intakes of Essential Amino Acids 32 7 27 25 51 56 28 46 1-3 yr 42 10 36 32 66 71 36 61 7-12 mo 77 25 65 52 95 139 78 120 0-6 mo 4-8 yr Amino Acid (mg/kg/24 hr) 22 Threonine 27 Valine 6 Tryptophan 21 Sulfur amino acids 43 Lysine 47 Leucine 25 Isoleucine 38 Aromatic amino acids
  • 25.
  • 26.
  • 27.
  • 28.  
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.  
  • 38.
  • 39.
  • 40. Equations to Estimate Energy Requirement 354 - (6.91 x age [y]) + PA x (9.36 x weight [kg]) + (726 x height [m]) Female 662 - (9.53 x age [y]) + PA x (15.91 x weight [kg]) + (539.6 x height [m]) Male Ages 19 years and older EER (kcal/day) = TEE 135.3 - (30.8 x age [y]) + PA x (10 x weight [kg])+ (934 x height [m]) + 25 kcal 9-18 yr 135.3 - (30.8 x age [y]) + PA x (10 x weight [kg])+ (934 x height [m]) + 20 kcal 3-8 yr Female 3-18 years EER = TEE + energy deposition 88.5 - (61.9 x age [y]) + PA x (26.7 x weight [kg]) + (903 x height [m]) + 25 kcal 9-18 yr 88.5 - (61.9 x age [y])+ PA x (26.7 x weight [kg]) + (903 x height [m]) + 20 kcal 3-8 yr Male 3-18 years EER = TEE + energy deposition (89 x weight [kg] - 100) + 20 kcal 13-36 mo (89 x weight [kg] - 100) + 22 kcal 7-12 mo (89 x weight [kg] - 100) + 56 kcal 4-6 mo (89 x weight [kg] - 100) + 175 kcal 0-3 mo Ages 0-36 months EER (kcal/day) = TEE + energy deposition
  • 41.
  • 42.  
  • 43.
  • 44.
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  • 46.  
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  • 48.  
  • 49.
  • 50.
  • 51. A 6-yr-old boy has an actual weight of 15 kg & height of 105 cm. Compute for the wt-for-ht%. Actual Wt = 15 kg Actual Ht = 105 cm IBW based on actual age (6 yr) = 20 kg IBW based on plotted Ht = 17 kg Wt-for-Ht% = 15/ 17 = 0.88 Wt-for-age% = 15/ 20 = 0.75 Ht-for-age% = 105 / 110 = 0.95
  • 52.
  • 53.
  • 54.
  • 55. Can you see risk? Age = 3 y 3 wks boy Height = 100.8 cm Weight = 18.6 kg Age = 4 y girl Height = 99.2 cm Weight = 17.55 kg Age = 4 y 4 wks girl Height = 106.4 cm Weight = 15.7 kg C BMI=18.3 = >95 th % Overweight A BMI=13.9 = 10 th % Normal B BMI=17.8 = 90 th –95 th % At risk for overweight
  • 58. It is easier for a camel to pass through the eye of a needle if it is lightly greased. Kehlog Albran THANK YOU!

Editor's Notes

  1. *For each centigrade degree of fever, basal metabolism increases approximately 10%. **The unit of heat in metabolism is the large calorie or kilocalorie (1 Cal=1 kcal); it is used to refer to the energy content of food.
  2. *FFM is usually measured as a definite index of body size whereas FM is usually expressed as a proportion of body weight, i.e., fatness. **Health risks may begin when percent body fat exceeds 25% in boys and 30% in girls ages 6-18 years of age (Williams et. al. 1992).
  3. Very-low density lipoproteins (VLDL) are large triacylglcerol-rich particles produced in the liver from endogenous fat, as opposed to chylomicrons which transport exogenous fat. VLDLs are the main carriers of triacylglycerols which are also processed by lipoprotein lipase and supply fatty acids to adipose and muscle tissues. Chylomicrons are lipoprotein particles derived from dietary fat and packaged by the mucosal cells.
  4. End-point = usually maintenance of satisfactory rates of growth and development and/or prevention of specific nutritional deficiencies For some, it may be excessive, but for others, it may be inadequate.
  5. For Males, 3-18 yr, where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be > 1.0 <1.4 (Sedentary) PA = 1.13 if PAL is estimated to be > 1.4 <1.6 (Low active) PA = 1.26 if PAL is estimated to be > 1.6 <1.9 (Active) PA = 1.42 if PAL is estimated to be > 1.9 <2.5 (Very active) For Females, 3-18 yr, where PA is the physical activity coefficient: PA = 1.00 if PAL is estimated to be > 1.0 <1.4 (Sedentary) PA = 1.16 if PAL is estimated to be > 1.4 <1.6 (Low active) PA = 1.31 if PAL is estimated to be > 1.6 <1.9 (Active) PA = 1.56 if PAL is estimated to be > 1.9 <2.5 (Very active)