1. Energy Balance “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Hippocrates

2. Review the Energy Nutrients Energy is measured in Kilocalories (kcal) Carbohydrates4 kcal / g Fats9 kcal / g Proteins4 kcal / g

3. Total Caloric Intake = Total Caloric Expenditure 1800 Calories Ingested 1800 Calories Burned (Weight is Maintained) Energy Balance

4. Total Caloric Intake > Total Caloric Expenditure 2500 Calories Ingested 1800 Calories Burned (Weight Gain) Energy Balance

5. Total Caloric Intake < Total Caloric Expenditure 1800 Calories Ingested 3000 Calories Burned (Weight Loss) Energy Balance

6. All excess Calories, no matter what the original source, is eventually stored as Fat! 3500 kcal = 1 lb body weight Energy Balance

7. Energy Ingestion and Expenditure 1 Bagel with Cream Cheese Provides 330 kcal To expend (‘burn up’) 330 kcal, you would need to brush your teeth for 2 hours and 24 minutes. That’s enough energy to power an electric toothbrush for 37 hours and 8 minutes.

8. Energy Ingestion and Expenditure 1 Power Bar Provides 240 kcal To expend (‘burn up’) 240 kcal, you would need to pedal a bicycle at 10 mph for 5.7 miles. That’s enough energy to power a 34 hp motorcycle going 40 mph a distance of 0.36 miles.

9. Energy Ingestion and Expenditure 1 Big Mac (without the Fries) Provides 560 kcal To expend (‘burn up’) 560 kcal, you would need to clean the house for 124 minutes. That’s enough energy to power an electric vacuum cleaner for 138 minutes.

10. Represents the amount of Calories the food will produce when used or stored by the body. Found on the Food Label Food Energy Value What is the food energy value of 1 slice of this bread?

11. Represents the amount of Calories the food will produce when used or stored by the body. How many Calories per serving? Food Energy Value Food Energy Value = 50 kcalories

12. Foods that are higher in Caloric content per weight (measured in grams) of food. Which cereal is more calorically dense (contains more kcalories in a ¾ cup serving)? Calorically Dense Foods

13. Foods that are higher in Caloric content per weight (measured in grams) of food. Which cereal is more calorically dense (contains more kcalories in a ¾ cup serving)? Calorically Dense Foods Serving Size ¾ cup Calories 249 kcal Carbs 36 g Proteins 6 g Fats 9 g Serving Size ¾ cup Calories 116 kcal Carbs 28 g Proteins 1 g Fats 0 g

14. Foods that are higher in Caloric content per weight (measured in grams) of food. Which cereal is more calorically dense (contains more kcalories in a ¾ cup serving)? Calorically Dense Foods Serving Size ¾ cup Calories 249 kcal Carbs 36 g Proteins 6 g Fats 9 g Serving Size ¾ cup Calories 116 kcal Carbs 28 g Proteins 1 g Fats 0 g What accounts for the increased Calories in the granola cereal? What do you think is the main source of calories in the frosted flakes cereal?

15. Affected by Thermic Effect of Food (TEF) Basal Metabolic Rate (BMR) Physical Activity Determining Caloric Needs

16. Energy Expenditure Thermal Effect of Food (5-10%) + Basal Metabolic Rate (60-70%) + Physical Activity (10-40%) = Total Energy Expenditure (100%)

17. Increased energy expenditure after a meal Calories are burned to provide the energy needed to digest and absorb nutrients An ingested meal of 800 calories burns 40 to 80 kcalories Thermic Effect of Food Nah. I learned about TEF. The more calories I eat, the more I burn. Aren’t you worried about gaining weight with all that food?

18. Basal Metabolic Rate The amount of energy required for bodily functions to sustain life at rest All organ functions (‘involuntary work’) Accounts for 60-70% of energy requirements

19. Energy Essential for Life Support (Involuntary Work) Circulation Respiration Temperature Maintenance Nerve Transmission Kidney Function Liver Function and other Involuntary Life Functions Basal Metabolic Rate

20. BMR is also called the Resting Metabolic Rate (RMR) because it is a measurement of the energy required by resting tissue to maintain basic function. Basal Metabolic Rate

21. Measuring BMR Directly Calorimeter -rarely used due to time and expense -requires 12 hours of fasting -requires an environmentally controlled room or chamber Basal Metabolic Rate

22. Measuring BMR Indirectly Measuring oxygen and carbon dioxide levels Blood work to measure thyroid function tests (the thyroid regulates basal metabolic rate) Estimate mathematically with formulas like the Harris-Benedict Equation Basal Metabolic Rate

23. Measuring BMR with the Harris- Benedict Equation Men BMR = 66.5 + (13.75 x kg + (5 x cm) - (6.78 x age) Women BMR = 655 + (9.56 x kg) + (1.85 x cm) – (4.68 x age) Basal Metabolic Rate

24. Harris – Benedict Equation Example Female, 132 lb, 5’ 4”, 36 yo 132 lb = 60 kg 5’ 4” = 162.5 cm 655 + (9.56 x 60) + (1.85 x 162.5) - (4.68 x 36) 655 + 573.6 + 299.7 - 168.48 BMR = 1360 kcalories per day (approx) Basal Metabolic Rate

25. Measuring BMR with the Harris- Benedict Equation Harris -Benedict Equation got your head spinning? Don’t try to memorize the equation. Instead, use an Online Tool. Basal Metabolic Rate

26. A Simpler Calculation to Predict BMR Female 0.9 kcal / kg body weight / hour 132 lbs = 60 kg 0.9 kcal x 60 kg x 24 hrs = 1296 BMR Male 1 kcal / kg body weight / hr 165 lbs = 75 kg 1 kcal x 75 kg x 24 hrs = 1800 BMR Basal Metabolic Rate

27. Factors Affecting BMR Body Composition Greatest factor affecting BMR is muscle mass Increased BMR in lean, muscular bodies Women generally have lower BMR’s than men Basal Metabolic Rate

28. Factors Affecting BMR Growth Periods Growth hormones stimulate cell metabolism, raising BMR BMR rises first 5 years, levels off, then declines with age BMR rises with puberty, pregnancy and lactation Basal Metabolic Rate

29. Factors Affecting BMR Temperature (Body and Environmental) Fever increases BMR 7% for every degree over 98.6 o F (0.83 o C) BMR rises in cold weather to generate more body heat Basal Metabolic Rate

30. Factors Affecting BMR Illness and Disease Diseases causing increased cell activity (e.g., cancer) increase BMR Starvation and malnutrition states decrease BMR Basal Metabolic Rate

31. Factors Affecting BMR Hormonal Status The thyroid regulates metabolism Hypothyroidism decreases BMR Hyperthyroidism increases BMR Basal Metabolic Rate

32. Voluntary (conscious) work done by the body Goes above and beyond BMR / RMR Categorized by activity level Physical Activity

33. Physical Activity Level (PAL) Categories SedentaryStudying, watching TV Low ActiveSlow walking 30 min / day ActiveModerate Activity 60 min / day Very ActiveVigorous Activity 5-7 hrs / day Activity ‘counts’ when the heart rate is increased

34. Physical Activity Rate the Physical Activity Level (PAL) of these activities

35. Common Diseases that Increase BMR Cancer Heart Failure Emphysema Anxiety Meeting the Energy Needs of Ill and Hospitalized Person

36. Used to described the nutritional status of patients Less than IBW More than IBW Ideal Body Weight (IBW)

37. Factors Contributing to Decreased Caloric Intake During Hospitalization Side Effects of Medications NPO and Dietary Restrictions Stress and Anxiety Personal Preferences (including Ethnic) Physical Barriers (unable to feed self) Meeting the Energy Needs of Ill and Hospitalized Person

38. Did you eat lunch yesterday? No, I was at Physical Therapy.

39. Meeting the Energy Needs of Ill and Hospitalized Person The nurses tell me you refused supper last night. They lost my teeth. I couldn’t chew the meat.

40. Meeting the Energy Needs of Ill and Hospitalized Person You have to try to eat or you won’t get better. Can I have my breakfast now?

41. Meeting the Energy Needs of Ill and Hospitalized Person Not until we take a few tests. Maybe this afternoon. Why are they blaming ME for not eating?

42. What can you do to help? What conditions interfere with people eating adequately in the hospital? What can the nurse do to improve dietary intakes? Meeting the Energy Needs of Ill and Hospitalized Person

43. What can you do to help? Oral Care before and after meals Limit care during mealtimes Provide snacks when possible Discuss personal preferences Remove barriers Meeting the Energy Needs of Ill and Hospitalized Person

44. Discussion Break into small (3 or 4) person groups (rearrange desks or move into lab) Answer Review Questions bpnutrition.wikispaces.com Complete your Nutritional Analysis Next Class is Test 1 – are you ready?