Nutrients are the substance which is not produced enough in the body. So, should be in the diet. Lack of nutrients leads to growth impairment, organ dysfunction, and disturbing nitrogen balance or status of protein and other nutrients.
Essential nutrient and diet requirements
Energy
Energy is the main component of weight balance. Therefore, we match energy intake and output patients . These depend on resting energy expenditure (REE) and physical activity. The average energy intake is ~2600 kcal/d for American men and ~1800 kcal/d for American women. roughly estimate of energy needs for stable weight.therfore, for male =900+10 m, and for female, REE = 700 +7m, where m means weight in kilogram. REE multiplying by 1.2 for sedentary, 1.4 for moderate activity,1.8 for the active individual.
Protein and diet
Protein consist of essential and non-essential amino acids. The essential amino acids are histidine, isoleucine, leucine, lysine, methionine or cysteine, phenylalanine, tyrosine, threonine or tryptophan, valine.
Alanine amino acids are required for energy production whenever the body needs. When the requirement is severely deficient in the body called protein-energy malnutrition. Adult recommends daily allowance is approximately 0.8 /kg/day and American diet contain 10-14 %. Biological value is highest in animal protein legumes and cereals and roots. Protein needs increase in pregnancy lactation and rehabilitation. tolerance to protein is seen in acute renal failure and liver failure.
Fats and carbohydrate diet
it is a highly dense energy source around thirty-four % in our diet. However, not more than thirty % of a diet. Saturated and transaturated fat should be less than 10 % and saturated fat is also less than 10% with monounsaturated fat reminders. 45 to 55% of calories are from carbohydrate. brain required glucose 100 grams per day for fuel and tissue requires 50 grams per day.
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Water for nutrition
1-1.5 ml /kg of water is sufficient for energy expenditure. If the external loss of water is more should intake more. Fever and diarrhea losses up to 5 lit/day the kidney can adjust to increase water intake. The infant has a high requirement for the water for its large surface area. thirty ml/d water is needed during pregnancy.
| group | Male 19-50 yr |
| Calcium (mg) | 1000 |
| Chromium µg/dl | 35 |
| Copper µg/d | 900 |
| Fluride mg/d | 4 |
| Iodine µg/d | 150 |
| Iron mg/d | 8 |
| Mangnesium mg/d | 400 |
| Manganese mg/d | 2.3 |
| Molybdenum µg/d | 45 |
| Phosphorus mg/d | 700 |
| Selenium µg/d | 55 |
| Zink mg/d | 11 |
| Potassium g/d | 4.7 |
| Sodium g/d | 1.5 |
| Chloride g/d | 2.3 |
Dietary reference intakes and RDAS for nutrients and diet
The nutrient has a wide range to maintain human life .however , too less and too much intake gives adverse effects. Guidelines produced for clinical practice. dietary reference intake (DRIs) referred to as quantitative estimates of nutrient intake. DRI also includes acceptable macronutrient distribution ranges for protein, fat, and carbohydrate.
Estimated average requirement diet and nutrients
Disease manifestations of dietary deficiency such as rickets( Vit D and calcium), survey ( Vit C deficiency), xerophthalmia ( vit A), and protein-calorie malnutrition were common. later biochemical markers are used for early detection of disease. EAR varies with nutrient, age, physiologic group, and nutrient is estimated to adequate for half of the healthy individuals of specific age and gender. see vitamin deficiency
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Recommended dietary allowances nutrient and diet
RDA is defined as the average daily intake level that meets nearly all healthy persons of a specific gender, age, life stage, physiologic condition. Statically as two standard deviations above the estimated average requirement (EAR) to ensure daily requirement. RDA is an overly generous criterion for evaluating nutrient adequacy. see USA nutrition
Adequate intake
It is not possible to set an RDA for some nutrients that lack an established EAR.
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Tolerable upper levels of nutrient intake
Healthy individuals who gain no benefit from above RDA infect cause acute, progressive, or permanent disabilities.UL does not mean that the high risk of adverse effects however, some fortified foods have highly concentrated nutrients so it may lead to adverse effects.
Accepatable macronutrient distribution range
It gives a rough range of macronutrients. The national academy of medicine’s food and nutrition board consider being healthy. These ranges are 10-thirty five % of protein,20-thirtyfive% fat, 45-65% carbohydrate provides calories. see Australian nutrition guideline
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| group | Male 19-50 yr |
| Total water L/d | 3.7 |
| Carbohydrate g/d | 130 |
| Total fiber g/d | 38 |
| Fat g/d | nd |
| Linoleic acid g/d | 17 |
| Alpha linoleic acid g/d | 1.6 |
| Protein g/d | 56 |
Factors altering nutrients and diet needs
DRIs affected by age, sex, growth, pregnancy, lactation, physical activity, disease, drugs, and dietary composition.
Physiological factors
Growth, strenuous physical activity, pregnancy, lactation all increase need for energy and several essential nutrients. Increase demand in pregnancy is due to fetal growth and milk production in lactation. An older person needs less energy due to lean body mass.
Dietary composition
It affects the biological availability and use of nutrients. Iron absorption may be affected by a large amount of calcium. Animal foods such as milk and eggs have high biological value with most amino acids present in the adequate amount. Plant proteins have low biological value so need to combine with other protein.
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| Energy level | |||
| diet | Lower 1600 kcl | Moderate 2200 kcl | Higher 2800 kcl |
| fruits | 1.5 | 2 | 2.5 |
| Vegitables | 2 | 3 | 3.5 |
| grain | 5 | 7 | 10 |
| protien | 5 | 6 | 7 |
| diatary | 3 | 3 | 3 |
| Empty calorie | 120 | 260 | 400 |
| Sodium (mg) | <2300 | ||
| Physical activity | At least 150 min vigorous physical activity per week at all energy level |
Route of intake
When nutrients are administered parenterally, the same value can be used for amino acid, glucose, fats, sodium, chloride, potassium, and most vitamin so the intestinal absorption rate is nearly 100%.
Disease of nutrients and diet deficiency
Dietary deficiency disease includes protein-calorie malnutrition, iron deficiency anemia, goiter(due to iodine deficiency), rickets and osteomalacia ( vitamin D deficiency), megaloblastic anemia ( vitamin b12 or folic acid deficiency, scurvy ( vitamin c ) beriberi (thiamine deficiency), and pellagra (niacin and tryptophan deficiency). Each deficiency disease is characterized by imbalance between cellular level and body need.
| Daily reference intake | 13-50 yr |
| Vitamin A (µg/d) | 900 |
| Vitamin C mg/d | 90 |
| Vitamin D mg/d | 15 |
| Vitamin E mg/d | 15 |
| Vitamin K µg/d | 120 |
| THIAMINE mg/d | 1.2 |
| REBOFLAVIN mg/d | 1.3 |
| NIACINE mg/d | 16 |
| Vitamin B6 mg/d | 1.3 |
| FOLATE mg/d | 400 |
| Vitamin B12 mg/d | 2.4 |
| PANTOTHENICmg/d | 5 |
| BIOTINµg/d | 30 |
| CHOLINE(mg/d) | 550 |
Dietary assessment
Nutrition assessment in clinical situations involves
- Screening for malnutrition
- Assessing the diet, assess the presence or absence of malnutrition, and find causes
- planning and implementing the most appropriate nutritional therapy
- reassessing intake to make sure.
Most health care facilities have nutritional screening processes for identifying possible malnutrition after hospital admission. Factors usually assessed weight loss or gain >5kg, metabolic disease, chronic poor appetite, chewing swallowing problem, need assistance with preparing and shopping food, eating, self-care and social isolation. A more complete dietary assessment is indicated for patients who exhibit a high risk of frank malnutrition.
Acute care setting
In the acute care settings, anorexia, various other diseases can compromise dietary intake, try to find and avoid inadequate intake, and to assure appropriate alimentation. Our objective is to find enough information about the patient diet.
Simple observation by health care staff can identify inadequate oral intake. a diseased condition that leads to diet disturbance indicates a need for further nutritional assessment. The most therapeutic diet offered in the hospitals is adequate if they are eaten.
Ambulatory setting
The aim of the dietary assessment in outpatient whether his/her diet is nutritionally adequate or not and coexisting condition is because of an inadequate diet. Dietary assessment should review the adequacy of usual food intake, including vitamin and mineral supplements, oral nutritional supplements, medical foods, medication, alcohol , because of all of these affect the health of the patient.
All should encourage a balance between calories and nutritional needs, encouraging increased intake of fruits and vegetables, whole grain, low-fat milk in conjunction with reduced intake of sodium and high sugary drinks.
Nutritional status assessment
Full nutritional status assessment is reserved for severely ill and high nutritional risk when the cause of malnutrition is uncertain need multidimensional approach
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Dr Manish Khokhar
MD
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