Nutrient And Diet Has The Answer To Everything

nutrition and diet
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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.

groupMale 19-50 yr
Calcium (mg)1000
Chromium µg/dl35
Copper µg/d900
Fluride mg/d4
Iodine µg/d150
Iron mg/d8
Mangnesium mg/d400
Manganese mg/d2.3
Molybdenum µg/d45
Phosphorus mg/d700
Selenium µg/d55
Zink mg/d11
Potassium g/d4.7
Sodium g/d1.5
Chloride g/d2.3
nutrients and diet

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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groupMale 19-50 yr
Total water L/d3.7
Carbohydrate g/d130
Total fiber g/d38
Fat g/dnd
Linoleic acid g/d17
Alpha linoleic acid g/d1.6
Protein g/d56
nutrients and diet

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
dietLower 1600 kclModerate 2200 kclHigher 2800 kcl
fruits1.522.5
Vegitables233.5
grain5710
protien567
diatary333
Empty calorie120260400
Sodium (mg)<2300  
Physical activityAt least 150 min vigorous physical activity per week at all energy level
nutrients and diet

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 intake13-50 yr
Vitamin A (µg/d)900
Vitamin C mg/d90
Vitamin D mg/d15
Vitamin E mg/d15
Vitamin K µg/d120
THIAMINE mg/d1.2
REBOFLAVIN mg/d1.3
NIACINE mg/d16
Vitamin B6 mg/d1.3
FOLATE mg/d400
Vitamin B12 mg/d2.4
PANTOTHENICmg/d5
BIOTINµg/d30
CHOLINE(mg/d)550
nutrient and diet

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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