Dietary Equations 2qe2g

Alyia Martha B. Alcancia 2016 2012-10039 Gordoncillo

May 3, Prof.

COMPILATION OF EQUATIONS USED IN NUTRITION Equation DBW (g)=birthweight (g) + (age in months x 600) DBW (g)= birthweight (g) + (age in months x 500) DBW (kg)= (age in months / 2) +3 DBW (kg)= (age in years x 2) + 8 BMI= kg/ m

2

Tannha’s Method Ex. DBW= (157.48-100) -10%(157.48-100)

Adopted Method for 5 ft use 106 lbs. for every inch above 5 feet, add 5 lbs Infants: TER/day=95-80 kcal/DBW

Children: TER/day= 1000 + (100 x age in years) TER= DBW x value

Guideline If birthweight is not known, use 3000 g Infant’s weight doubles at 5-6 months infant’s weight triples at 12 months

Reference NDAP

Purpose Estimating the DBW for infants (first 6 months)

NDAP

DBW (For 7-12 months infants)

Infant’s weight quadruples at 24 months +2 kg every year

NDAP

DBW for infant

NDAP

18.5-24.9 is normal

NDAP

Measure height in centimeter. Deduct from this factor 100 and the answer is the DBW in kg. the DBW obtained to Filipino Stature by taking off 10% Adaptation of tannha’s formula

NDAP

DBW for children Body mass index DBW for adults

NDAP

DBW

NDAP

Narins & Weil

Estimating the Total Energy Requirement (TER)/day TER for children

NDAP

Adolescents

13-15: 55 (boys) 45 (girls) 16-18: 50 (boys) 40 (girls)

DBW (kg)= (age in years x 2) + 8 Method I Basal Metabolic Needs + %Physical Activity =BMR

Method II

Method III HBEE (males)= 66.47+ 13.75 (W) + 5.0 (H) – 6.75 (A) (females)=655.1 +9.56 (W) + 1.85 (H)-4.67 (A) NDAP formula TER= kg x activity level

TER/day=normal requirement + 300 kcal TER/day=normal requirement + 500 kcal Mifflin - St Jeor Formula Men 10 x weight (kg) + 6.25

+2 kg every year

NDAP

Basal Metabolic Needs= 1 kcal/DBW/hr for male =0.9 kcal /KDBW/hr for female

Cooper et al

Physical Activity = % above basal Bed rest= 10 Sedentary =30 Light=50 Moderate= 75 Heavy=100 Activity Bed rest= 27.5 Sedentary=30 Light=35 Moderate=40 Heavy=45 Where: W-Body weight (kg) H-Height (cm) A-age (yrs)

Activi ty In bed but mobil e Light Moder ate Heav y

Ma le 35

Fem ale 30

40 45

35 40

50

-

Krause

Kcal/KDBW/day

HarrisBenedict Energy ExpenditureFormula

TER

NDAP formula

TER

NDAP

Pregnant women Lactating women TER

NDAP Mifflin-St Jeor was found to be the most accurate.

DBW for children Total energy requirements

Mifflin - St Jeor

x height (cm) - 5 x age (y) + 5 Women 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161. Katch-McArdle Formula Men & Women 21.6 * Fat Free Mass + 370 Where Fat Free Mass = Weight - (Body Fat Percentage * Weight). Harris-Benedict Formula Men 66.5 + (13.75 X weight in kg) + (5.003 X height in cm) - (6.775 X age in years) Women 655.1 + (9.563 X weight in kg) + (1.85 X height in cm) - (4.676 X age in years) Conventional method Energy: Adults TER = ( 20 kcal x kdbw) + (70 kcal x % BSA) Children TER= (60 kcal x kdbw) + (35kcal x % BSA) Protein: Adults (1g x kdbw) (3g × %BSA) Children: (3g x kdbw) + ( 1g x %BSA) Fever Method 1 TER=dbw x 24 x 1 kcal (0.9 kcal for female) +

It is a variation1 on the basic Mifflin-St Jeor equation that will base the equation on Fat Free Mass (FFM) or Lean Mass. This is more accurate for those who are leaner This formula was created in 1919, and due to changing lifestyles, it tends to overstate calorie needs by 5%. The results tend to be skewed towards both obese and young people

nutrition in burns

-high kcal, 13% increase per increase in C or 7 if F

Katch-McArdle

TER

HarrisBenedict

Lactating women

Lifted from Bernardo, A.K Lecture

TER and protein requirement for patients with burns

Lifted from Bernardo, A.K Lecture

TER for patients with fever

increase in temp Kcal BMN x AF = kcal for activity

- high pro, 10% increase in BMR per increase in C or 5.5 if Fahrenheit

Total TER days= adjusted BMN + kcal for activity Polk TER= ( kcl x kg of body weight) + (35 × 1 burn) Adjusted weight= current weight/ (100%of amputation)

Lifted from Bernardo, A.K (2016) Lecture Lifted from Gordoncillo (2016) lecture

Percent desirable BW= (current weight/ reference weight) x 100

Lifted from Gordoncillo (2016) lecture

Percent usual weight= (current of it weight/ usual weight) x 100

Estimating TER Pol for formula for children <3 years old Estimating Body weight (amputated patient) Physical Examination: Percent desirable body weight

Percent usual weight

Percent weight change=[(usual weightcurrent weight)/ usual weight] x 100

Catabolic index = urinary urea nitrogen½ dietary nitrogen + 3

Serum osmolality (SO)

Where UUN and dietary nitrogen are in gram per day interpreted asCl of 1-5 = mild stress Cl of > 5= moderate to severe stress The extent to which the measured UUN exceeds 50% of nitrogen intake is an index to assess the degree of stress imposed by illness To interpret normal

Lifted from Gordoncillo (2016) lecture

Lifted from

Percent weight change Catabolic index

Hydration

Steps: 1.Obtain values* for - serum sodium, mEg/L - BUN mg/dl -BG concentrations, mg/dl 2. Calculate serum osmolality using the equation: SO mOsm/kg= (2 x serum Na) + (BUN/2.8) + (BG/1.8) Basal energy expenditure (BEE) BEE(m)= 66+13.7 W +5H-6.8A BEE(w)=655+9.6W+1. 7H-4.7A TDE(male)= (66+13.7W+5H-6.8A) (AF) (IF)

Nitrogen Balance Steps: 1. Estimate patient’s energy needs 2. Estimated desired ratio of kcal/g of dietary nitrogen Ex: 150:1 for amputation 200:1 for maintenance 3. Calculate nitrogen requirements using this eq: Nrequired(g)=kcal/k cal:N ratio 4. Calculate amount of protein which would

values 275-295 mOsm/kg for adults 270-285 mOsm/kg for children

Gordoncillo (2016) lecture

status

Were: W-body weight in kg H-height in cm A-age in years

Lifted from Gordoncillo (2016) lecture

Energy balance

Purposes: - To evaluate current intake relative to need - To plan for future nutritional - To plan for weight management Based on nitrogen excretion Based on estimated energy requirement

Lifted from Gordoncillo (2016) lecture

Total Daily Expenditure

Lifted from Gordoncillo (2016) lecture

Nitrogen Balance

contain 15 g nitrogen Protein (g)= nitrogen (g) x 6.25 Injury Factor Burns <20%BSA 20%-40% BSA >40% BSA Severe burn Fracture, long bone Respiratory/Renal failure COPD Cancer and Chemoteraphy or radiationCardiac cachexia Surgery, minor/elective Surger, major

1.2-1.4 1.5-1.7 1.8-2.0 2.1-2.3 1.2-1.3 1.4-1.5 1.4-1.6 1.5-1.6 1.1-1.2 1.2-1.3

Adjusted weight for amputation Body part Hand Arm and shoulder Below the knee Above the knee Forearm Foot At the knee Entire leg

% <5% 6.5% 6.0% 12.0% 3.0% 2.0% 9.0% 19%

Activity Factors (AF) Confined to bed Out of bed Bed rest Very light

1.2 1.3 1.0-1.1 1.2-1.3

light Moderate Heavy Strenuous or exceptional

Injury Factor No illness/non stress Convalescence,mild malnutrition Postoperative(no complication)

1.0 1.1

1.4-1.5 1.6-1.7 1.9-2.1 2.2-2.4

Mild illness,non catabolic Confine to bed Ambulatory/out of bed Infections and stress, catabolic Mild Moderate Severe,hypercatabolic Sepsis Trauma (skeletal /blunt) Multiple head injury

1.2 1.3 1.1-1.2 1.3-1.4 1.5-1.7 1.8-2.0 1.3-1.4 1.5-1.6

State of health factor State of health Cancer malabsorption syndrome, tuberculosis Respiratory failure acute Renal failure , acute Hemodialysis Peritoneal dialysis Pressure sore Stage 1 Stage 2 Stage 3 Stage 4 Mild stress Moderate stress Severe stress Hypermetabolic stress Polytrauma infection Severe sepsis major burn head injury Surgery, minor/elective Surgery major Depleted protein stores Long bone fractures, draining wounds Hepatitis, cirrhosis

Protein needs (g/kg BW) 1.2-1.5 1.3-1.4 0.3-0.5 1.0-1.2 1.2-1.5 1.0-1.1 1.2-1.4 1.5-1.7 1.8-2.0 1.1-1.2 1.3-1.4 1.5-1.7 1.7-2.5 1.8-2.4 2.5-3.0 1.2-1.3 1.4-1.5 1.5-2.0 1.6-1.7 1.5-2.0

Nutritional Anthropometry Equation/Guideline For infants, a. 0-6 months

Reference Mariano-Bayna, R. (2015). Nutritional Anthropometry.

DBW (g) = BW + (age in months x 600) b. 7-12 months DBW (g) = BW + (age in months x 500) DBW (kg) =(age in months/2) + 3 Note: if BW is not known, use 3000g For Children, DBW (kg) = (age in years x 2) + 8

For adults, a. Body Mass Index-Based Formula BMI for men = 22 BMI for women = 21 DBW (kg) = Desirable BMI x ht(m 2) b. Tannha’s Method DBW (kg) = (height in cm - 100) – 10%

[Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines. Mariano-Bayna, R. (2015). Nutritional Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines. Mariano-Bayna, R. (2015). Nutritional Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

c. Adopted Method For every 5 ft, use 105 lbs for DBW For every inch above/below 5ft, add/subtract 5 lbs d. Ador Dionisio’s Method For 5 ft, 110 lbs Male 100 lbs Female For every inch above 5 fft, add 2 lbs For every 5 year complement between 25-50 y/o, add 2 lbs e. Dr. Fernando’s Method For 5 ft: 106 lbs Male 100 lbs Female For every inch above 5 ft, add 6 lbs, male 5 lbs, female f.

NDAP Formula For 5 ft: 112 lbs Male 106 lbs Female For every inch above/below 5 ft, add/subtract 4 lbs Calculating age in months 1. Obtain birth date. 2. Compute age in months of the child using the

Mariano-Bayna, R. (2015). Nutritional Anthropometry.

formula: Age = Date of weighing – Date of Birth 3. Convert age in years into months by multiplying it by 12. Add the age in months to the product; the total gives the age in months. Reminders:  Dates should be written in the sequence of the year – month – day (e.g., March 9 2013 should be written as 2013 – 03 - 09)  If the day of weighing is less than the day of birth, borrow one month and add 30 to the number of days  If month of weighing is less than month of birth, borrow one year and add 12 to the number of months Determining the nutritional status of children under 5 y/o using CGS 1. Weight – for – age a. Locate the point where the child’s age – in – months intersects with the actual weight of the child b. Use appropriate table for boy or girl c. Classify the weight of the child using the following categories  Normal  Underweight  Severely underweight  Overweight 2. Length/Height – for – age a. Locate the point where the child’s age in months intersects with the actual length/height of child b. Use the appropriate table for boy or girl c. Classify the length of the child using the following categories:  Normal  Short/Stunted  Severely short/stunted  Tall 3. Weight – for – length/height a. Locate the point where the child’s length/height intersects with the weight of the child b. Use the appropriate table for boy or girl c. Classify the weight of the child using the following categories:  Normal  Wasted/Thin

[Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Mariano-Bayna, R. (2015). Nutritional Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

 Severely wasted/thin  Overweight  Obese Determining the nutritional status of school children and adolescents using the BMI-for-age table 1. BMI-for-age BMI is calculated using weight and height measurements. It is used to compare a child’s weight relative to stature with other children of the same age and gender. Because adiposity varies with age and gender during childhood and adolescence, BMI is age and gender specific. BMI = weight (kg) Height (m 2) 2. For the BMI – for – age tables, refer to the CGS book. Tables and charts may be ed from: http://www.who.int/growthref/who2007_bmi_for _age/en/index.html Interpreting Waist-Hip Ratio and Waist Circumferences Sex-Specific Waist Circumference that Denote “Increased Risk” and “Substantially Increased Risk” of Metabolic Complications Associated with Obesity in Caucasians

Gender

Risk of Obesity – Associated Metabolic Complications Increased Substantially Increased Men ≥94 cm (~37 ≥102 cm(~40 inches) inches) Women ≥80 cm (~32 ≥88 cm(~35 inches) inches) Waist – Hip Ratio cut-off points Gender Risk of Obesity – Associated Metabolic Complications Male >1.0 Female >0.85

Mariano-Bayna, R. (2015). Nutritional Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Mariano-Bayna, R. (2015). Nutritional Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Determining the Nutritional BMI (FAO) BMI Range Class/Cate gory <16 CED Grade III 16 – 16.9 CED Grade II 17 – 18.4 CED Grade I 18.5 – 19.9 Low Normal

Status of Adults using BMI BMI Range 20.0 – 24.9 25.0 – 29.9 30.0 – 39.9 ≥40

WHO Classifications WHO Classification Classification BMI Underweight

<18.50

Normal Range Overweight Preobese Obese Class I Obese Class II Obese Class III

18.50 – 24.99 ≥25.00 25.00 – 29.99 30.00 – 34.99 35.00 – 39.99 ≥40.00

Class/Cate gory Normal Obese Grade I Obese Grade II Obese Grade III

Risk of comorbidities Low (but risk of other clinical problem is increased) Average Increased Moderate Severe Very severe

Proposed Classification weight by BMI in adult Asians WHO Classification Classification BMI Risk of comorbidities Underweight <18.50 Low (but risk of other clinical problem is

Mariano-Bayna, R. (2015). Nutritional Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Normal Range Overweight

18.50 – 22.99 23.00 – 27.49

increased) Acceptable Risk Increased Risk

Obese I

≥27.50

High Risk

BMI Cut-off for Adults and Lactating Women (FNRI) Classification BMI Level Severe chronic <16.0 deficiency or 3rd CED Moderate chronic 16.0 – 16.9 deficiency or 2nd CED Mild chronic deficiency 17.0 – 18.4 or 1st CED Low Normal 18.5 – 19.9 Normal 20.0 – 24.9 1st Obese 25.0 – 29.9 nd 2 Obese 30.0 – 39.9 2rd Obese ≥40 Weight From Calf Circumference Formula: Female Weight (kg) = (1.27 x CC) + (0.87 x KH) + (0.98 x MUAC) + (0.4 x SSF) – 62.35 Male: Weight (kg) = (0.98 x CC) + (1.16 x KH) + (1.73 x MUAC) + (0.437 x SSF) – 81.69 Where: CC = Calf Circumference KH = Knee Height MUAC = Mid Upper Arm Circumference SSF = Subscapular Skinfold Thickness Procedure: 1. While the subject is sitting, place the tape around the right calf and move it up and down to locate the maximum circumference in a plane perpendicular to the long axis of the calf. 2. Take additional measurements above and below the point to ensure that the first measurement was the largest 3. Hold the zero end of the tape below the measurement value, snugly but not tight 4. An accurate measurement can only be obtained if the tape is at a right angle to the length of the calf, and should be recorded to the nearest 0.1 cm

Ilagan, J. (2016). Nutrition Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Height form Knee Height a. Nomogram to estimate stature from knee height (Chumlea et al.) Formula: Male: Height (cm) = (2.02 x knee height, cm) – (0.04 x age in years) + 64.19 Female: Height (cm) = (1.83 x knee height, cm) – (0.24 x age in years) + 84.99

Ilagan, J. (2016). Nutrition Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

b. Tanchoco’s Formula Formula: Male: Height (cm) = 96.50 + (1.38 x knee height, cm) – (0.08 x age, years) Female: Height (cm) = 89.68 + (1.53 x knee height, cm) – (0.17 x age, years) Procedure: 1. To measure the recumbent knee height, have the subject bend the knee and ankle of the left leg at a 90 degree angle while lying supine 2. Place the fixed blade of the knee caliper under the heel of the left foot and the other is placed over the anterior surface of the left thigh above the condyles of the femur and just proximal to the patella 3. Be sure the shaft of the caliper is in line with and parallel to the long bone in the lower leg (tibia) and is over the ankle bone (lateral malleolus). 4. Apply gentle pressure to the blades if the caliper compress the tissue. 5. Record the measurement to the nearest 0.1 cm. Take at least two measurements in immediate succession. They should agree within 0.5 cm (5mm). Calculate the mean.

Height from Armspan Formula: Male: Height (cm) = 118.24 + (0.28 x armspan, cm) – (0.07 x age, years) Female:

Ilagan, J. (2016). Nutrition Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Height (cm) = 63.18 + (0.63 x armspan, cm) – (0.17 x age, years) Procedure 1. Position the horizontal scale just above the shoulders of the subject. 2. The individual should stand with feet together, back against the wall, with arms extended literally in with the wall, and with palms facing forward. 3. The arms must be kept at shoulder height and outstretched maximally. 4. Measure the arm span when the tip of the middle finger (excluding fingernail) of the right hand is kept in with the fixed marker board, while the movable arm is set at the tip of the middle finger 5. Take two measurements and record to the nearest 0.1 cm Percent Body Fat Can be calculated from one skinfold or sum of 2 or 4 skinfold measurements using Durnin and Womersely Equation Procedure: 1. Select and then measure one to four skinfold sites. If more than one skinfold is used, compute the sum of the skinfolds. 2. Calculate body density (D) based on the specific coefficient for sex, age group, and skinfolds measurement site using the formula: D (g/cm3) = c-m (log∑S) Where D = Density c = age in specific coefficient* m = sex-specific coefficient* ∑S = sum of all skinfold measurements (mm) 3. Once density is calculated, the Siri (1961) equation is used to estimate percentage body fat: |Fat% = [(4.95/D) – 4.5] x 100 Where D = density 4.95 and 4.5 are constants Fat-free Mass Formula: = 100 - % Body Fat OR = MUACMC – MUAC – (Π x TSK)

Ilagan, J. (2016). Nutrition Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Where MUACMC = Mid – upper- arm Muscle Circumference MUAC = Mid – upper arm Circumference TSK = Triceps Skinfold Thickness (mm) Mid-upper-arm Muscle Area (MUAMA) AMA = (MUAC – (Π x TSK)2 4Π Where : MUAC = Mid-upper-arm Circumference TSK = Triceps skinfold thickness (mm)

Ilagan, J. (2016). Nutrition Anthropometry. [Class handout]. Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines.

Correction of AMA* cAMA = AMA – 6.5 (women), AMA – 10.0 (men) Where: cAMA = corrected MUAMA MUAC = mid-upper-arm circumference TSK = triceps skinfold thickness (cm) *Correction is due to overestimation by 20-25% in adult’s arm muscle area based on axial tomorgraphy measurements Total body muscle mass from corrected MUAMA (cAMA) (Heysfield et al. 1982) Muscle mass (kg) = Height (cm) x (0.0264 + [0.029 x cAMA]) References: MD Mifflin, ST St Jeor, et al. A new predictive equation for resting energy expenditure in healthy individuals.J Am Diet Assoc 2005:51:241-247. Link Frankenfield DC, et al. Comparison of Predictive Equations for Resting Metabolic Rate in Healthy Nonobese and Obese Adults: A Systematic Review. J Am Diet Assoc. 2005;105:775-789. Link Frankenfield DC, et al. The Harris-Benedict studies of human basal metabolism: history and limitations. J Am Diet Assoc. 1998;98:439-445.