1st Year MBBS -Food and nutrition (Cont. from previous)

Body Mass Index (BMI)

Weight in Kg

Height in sq.M

1.   Normal: 18.5-24.9

2.   Overweight: >25-30

3.   Obese: >30-40

4.   Grossly obese: >40

5.   Ideal: 22-23.5

Balanced diet: The approximation of all proximate principles of food proportionately is called a balanced diet.

1.   Contain sufficient energy.

2.   Protein: One-third 1^st class protein

3.   Fat: One third fat

4.   Energy: 50-60% CHO, 20-30% fat.

Lipid Profile

1.   Cholesterol: < 200 mg/dl

2.   HDL: >40 mg/dl

3.   LDL: <100 mg/dl

4.   TG : <150 mg/dl

Calculation of total energy equivalents

Following steps are necessary:

1.   Determine the IBW (ideal body weight).

2.   Calculation of REE(Resting energy equivalent)

3.   Substrate 0.1 kcal/kg/hr x IBW x sleeping hour.

4.   Add activity increment: 30% REE for sedentary,50% for lightworkers, 75% for moderate workers & 100% for heavy workers

5.   Add thermic effect of food, 10% of the total.

Resting energy equivalent calculation (REE)

For male: (IBW x 1 kcal/kg/hr) x 24

For female :( IBW x 0.95 kcal/kg/hr) x 24

Calculation of IBW (Ideal body weight)

Male IBW: 50 kg+ 2.3 kg (height in cm/2.54) - 60

Female IBW: 45.5 kg + 2.3 kg (height in cm/2.54) – 60

TEE = REE – Energy for sleeping hr + Activity increments + Thermic effect of food.

Example: Calculate the energy required for a woman (Height: 165 cm, weight: 55 kgs, activity: light)

Ans:

a)   REE = 55 x 0.95 x 24 = 1254 kcal.

b)   Sleeping hr for 8 hrs = 0.1 x 55 x 8 = 45 kcal

c)    For light activity = 50% of REE = 627 kcal

d)    Thermic effect of food = ( 1254 + 627 – 45) x 10% = 1836 x 10% = 184 kcal

e)   Grand total (TEE) = 1254- 45 + 627+ 184=2020kcal.

Properties of balanced diet

1.   It must be available

2.   Easily digestible

3.   Containing all the proximate principles at the right proportion to supply growth.

4.   Provide support kcal for energy; contain enough protein to supply essential amino acid for nitrogen balance.

5.   Carbohydrate is of 50-60%, protein 1-2 gm/kg body weight, fat 20-30%

6.   One-third of protein in the diet should be of animal source or 1^st class protein.

7.   Must contain enough fruit and vegetables to supply fiber, minerals & water-soluble vitamins.

  

Growth failure in children

Growth failure is defined as—

1. Crossing two major percentile lines of the NCHS growth chart over time.

2. For a child < 5^th percentile weight/age, failure to follow his/her own upward growth curve on the growth chart.

3. Loss of 5% or more of body weight.

Laboratory investigation for malnutrition

1. CBC

2. ESR

3. Total protein

4. S.Albumin

5. S.Proalbumin

6. Total iron

7. S.transferin

8. S.Epo

Causes of malnutrition

1.   Insufficient food production

2.   Climate irregularities

3.   Soil erosion

4.   War

5.   Insufficient forming

6.   Income and quality of food

7.   Ignorance.

Marasmus

1. Face: Old face

2. No edema.

3. Severe muscle wasting

4. Presence of subcutaneous tissue is very little

5. Standard wt/age is 60%.

Kwashiorkor

1. Moon face.

2. Generalized edema

3. Weight: 60%- 80%

4. Muscle wasting present

5. Presence of angry looking, dermatitis.

6. Hair loss

7. The family lives on a starchy diet.

Classification of PEM

	Body weight % of std.	Edema	Deficit in wt for height
Kwashiorkor	80-60%	+	+
Marasmic Kwashiorkor	<60%	+	++
Marasmus	<60%	0	++
Underweight	80-60%	0	+
Nutritional dwarf	<60%	0	Minimal