Concept about Energy | CHAPTER 2 | Nutrition and Dietetics

Concept about Energy – This book covers the entire syllabus of “Nutrition and Dietetics” prescribed by BNMC-for all Diploma in Nursing Science and Midwifery students. We tried to accommodate latest information and topics. This book is examination friendly setup according to the teachers’ lectures and examination’s questions. At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.

Concept about Energy

Energy:

Energy is a prime requisite for body function and growth. When a child’s intake of food falls below a standard reference, growth slows, and if low levels of intake persist, adult stature will be reduced.

Or

Energy is defined as the capacity to do work. Through the process of digestion, we convert the food we eat to energy. This food energy is calculated as Calories (C) or kilocalories (kcal) or Joules (J).

(Ref by: TK Indrani’s “Nursing Manual of Nutrition and Therapeutic Diet/1/104)

Energy Requirement:

Energy requirements of an individual might be defined by as that level of energy intake in relation to expenditure which is least likely to result in obesity or heart disease or which is most likely to prolong active life.

(Ref by: TK Indrani’s “Nursing Manual of Nutrition and Therapeutic Diet/1/106)

Sources of Energy:

1. Protein: 4kcal/g.

2. Fat: 9 kcal/g

3. Carbohydrate: 4kcal/g.

4. Dietary fibre: 2kcal/g.

(Ref: K. Park/24/647)

Components of Energy Requirement:

1. Energy required for basal metabolism. This is about 1 kcal/hour for every kg of body weight for an adult.

2. Energy required for daily activities such as walking, sitting, standing, dressing and undressing etc. and

3. Energy expenditure for occupational work (light, moderate and heavy works)

Calculation of Calorie Requirement of a Person:

A formula for calculating approximate energy requirement in healthy adult is –

Daily energy requirement is = basal metabolic rate + activity expenditure

➤ BMR: Weight (kg) x 25 kcal

➤ Activity: Modest = 0.3 x BMR

➤ Moderate = 0.4 x BMR

➤ Heavy: 0.5 x BMR

The approximate energy requirement for a 70-kg person with moderate activity is estimated as follows:

➤70kg x 25 kcal/kg: 1750 kcal

➤0.4 x 1750 kcal: 700 kcal

➤Total requirement: 2450 kcal

Extra-calorie rich food is needed for pregnant women:

Pregnant woman needs extra calorie rich food because during pregnancy some nutritional problems are found such as birth weight decrease, increase incidence of low Birth Weight specially, Intra uterine Growth Retardation (IUGR), no reserve of vitamin-A increased incidence of abortion, stillbirth, neonatal death etc. Pre-eclampsia, Eclampsia, Anti-partum Hemorrhage and sepsis etc. are found.

The food selected for emphasis should normally those in the meat, milk and vegetables categories. Because calories need increase less than nutrient needs. The pregnant woman must select food high nutrient density. For most women, appropriate choices include food like milk, cheese, lean, meats, egg, liver, dark-green vegetables and legumes, whole grain breast and cereals. Pregnant mother needs more calorie rich food because she has to meet the additional nutritional requirement of growing fetus.

Nutritional Support is Important for the Patient Because:

Nutritional support is not merely administrating calorie and proteins. It also includes the provision of all nutritional substrates to facilitate the biological process of influences of inflammation and heating. It also controlled clinical traits on the usefulness of enteral nutrition in patient with clinical illness. Early detection and preventive intervention of malnutrition can be expected to result in improved outcome.

In addition to improvement in the patients sense of wellbeing and psychological status definite improvement of cellular chemistry and there for organ function as well as wound healing have been demonstrated.

1. CHO is limited or may be limited by the high frequently of glucose intolerance in critical ill patient. The patient whose glucose utilization rate is 4 gm/m may be need to limit CHO intake and supplement the calorie intake fat.

2. Protein helps the patient to maintain the total body water or osmotic pressure. It also concerned with body immune mechanism. It also synthesis antibodies, hormones, coagulation factors etc. In these ways protein helps the ill patient.

3. The volume of fluid provides with the nutrition should be supplied to the patients need.

4. Sodium, potassium, calcium, magnesium and phosphorus are administered at standard maintenance rate and monitored to avoid major imbalance.

5. Antibodies can suppress the growth of intestinal microbial flora.

6. Vitamin A keeps an important role to prevent night blindness, xerophthalmia, stomatitis disease.

7. Vitamin D is important/ essential to prevent rickets disease in infant.

8. Vitamin K prevents haematuria, E. coli infection.

9. Vitamin C prevents scurvy, malnutrition etc.

If nutritional support is provides over prolonged periods of time or in specific circumstances of a man that can prevent from many diseases. So nutritional support is important for the Patient.

Nutritional Requirement of a Burn Patient:

1. Burns cause extensive evaporation of water losses, metabolism increases 100 percent above normal. Glycogen store is depleted. Fluid, electrolytes, proteins and other nutrients are lost though bum areas.

2. First 12 to 24 hours replace fluid and electrolytes parentally. Requires 3 to 5 liters daily. For the first 24 hours half of the calculated volume is given within eight hours. Remaining fluid is given over the next 16 hours.

3. During recovery period 48 to 72 maintain fluid and electrolyte and minimize loss of lean body
tissues and body weight.

4. End of post burn period replace nutritional loss and promote wound healing. 4

5. Oral fluid is given only after the bowel sound is heard

6. Provide 2 gm per kilogram of weight protein.

7. Calorie requirement is calculated as 25 kcal x kilogram pre-burn body weight + 40 kcal x percent burns area. In severe burns nasogastric tube feeding is give after bowel sound is heard. Parenteral, central jugular, femoral, cut down is done to replace fluid.

(Ref: Onila Salirn’s Essential nutrition/1/162-163)

Calculation of Nutrient Content of Food:

1. To compare the nutrient content of different foods, and to decide which foods are good sources of nutrients and which give best value for money.

2. To find out the nutrient value of different weights of raw and cooked foods and meals.

3. To find out the amounts of nutrients a person or group of people eats and whether this is enough to cover their nutrient needs.

4. To plan meals and diets which provide particular amounts of nutrients.

Weight (kg) x one calorie x 24 hours = calorie

(Ref: Onila Salin’s Essential nutrition/1/55)

Recommended by FAO/WHO:

(Ref by: Onila Salin’s Essential nutrition/1/56)

Recommended Energy Requirement For Male And Female:

Problems Related to Energy Intake:

Healthy people can consume foods low in nutrition in moderation as these enhance palatability and give energy when required. However, the after effects of excessive consumption are:

1. Energy intake is greater than the output which can result in the conversion of carbohydrates to fat [adipose tissue] leading to obesity.

2. Reduced intake may consequently result in other nutritional deficiencies thus impairing the present nutritional status. Overweight is a major predisposing factor to various health problems, can be corrected by proper selection of foods and a little physical activity.

(Ref by: Molly Sam’s/1″/70)

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