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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

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Page 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

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

Page 2: 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

Review theEnergy Nutrients

Energy is measured in Kilocalories (kcal)

• Carbohydrates 4 kcal / g• Fats 9 kcal / g• Proteins 4 kcal / g

Page 3: 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

Total Caloric Intake = Total Caloric Expenditure

1800 Calories Ingested 1800 Calories Burned

(Weight is Maintained)

Energy Balance

Page 4: 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

Total Caloric Intake > Total Caloric Expenditure

2500 Calories Ingested 1800 Calories Burned

(Weight Gain)

Energy Balance

Page 5: 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

Total Caloric Intake < Total Caloric Expenditure

1800 Calories Ingested 3000 Calories Burned

(Weight Loss)

Energy Balance

Page 6: 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

All excess Calories, no matter what the original source, is eventually stored as Fat!

3500 kcal = 1 lb body weight

Energy Balance

Page 7: 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

EnergyIngestion 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.

Page 8: 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

EnergyIngestion 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.

Page 9: 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

EnergyIngestion 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.

Page 10: 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

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?

Page 11: 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

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

Page 12: 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

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

Page 13: 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

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 cupCalories 249 kcal Carbs 36 g Proteins 6 g Fats 9 g

Serving Size ¾ cupCalories 116 kcal Carbs 28 g Proteins 1 g Fats 0 g

Page 14: 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

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 cupCalories 249 kcal Carbs 36 g Proteins 6 g Fats 9 g

Serving Size ¾ cupCalories 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?

Page 15: 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

Affected by

• Thermic Effect of Food (TEF)

• Basal Metabolic Rate (BMR)

• Physical Activity

Determining Caloric Needs

Page 16: 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

Energy Expenditure

Thermal Effect of Food (5-10%)+

Basal Metabolic Rate (60-70%)+

Physical Activity (10-40%)=

Total Energy Expenditure (100%)

Page 17: 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

• 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 FoodNah. I learned

about TEF. The more

calories I eat, the more I

burn.

Aren’t you worried about gaining weight

with all that food?

Page 18: 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

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

Page 19: 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

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

Page 20: 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

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

Page 21: 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

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

Page 22: 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

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

Page 23: 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

Measuring BMR with the Harris-Benedict Equation

Men BMR = 66.5 + (13.75 x kg + (5 x cm) -(6.78 x age)

WomenBMR = 655 + (9.56 x kg) + (1.85 x cm) – (4.68 x age)

Basal Metabolic Rate

Page 24: 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

Harris – Benedict Equation Example

Female, 132 lb, 5’ 4”, 36 yo132 lb = 60 kg5’ 4” = 162.5 cm

655 + (9.56 x 60) + (1.85 x 162.5) - (4.68 x 36)655 + 573.6 + 299.7 - 168.48BMR = 1360 kcalories per day (approx)

Basal Metabolic Rate

Page 25: 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

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

http://www.easycalculation.com/health/bmr.php
Page 26: 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

A Simpler Calculation to Predict BMR

Female0.9 kcal / kg body weight / hour132 lbs = 60 kg0.9 kcal x 60 kg x 24 hrs = 1296 BMR

Male1 kcal / kg body weight / hr165 lbs = 75 kg1 kcal x 75 kg x 24 hrs = 1800 BMR

Basal Metabolic Rate

Page 27: 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

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

http://www.easycalculation.com/health/bmr.php
Page 28: 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

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

http://www.easycalculation.com/health/bmr.php
Page 29: 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

Factors Affecting BMR

Temperature (Bodyand Environmental)

• Fever increases BMR 7% for every degree over 98.6o F (0.83o C)

• BMR rises in cold weather to generate more body heat

Basal Metabolic Rate

Page 30: 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

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

http://www.easycalculation.com/health/bmr.php
Page 31: 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

Factors Affecting BMR

Hormonal Status

• The thyroid regulates metabolism

• Hypothyroidism decreases BMR

• Hyperthyroidism increases BMR

Basal Metabolic Rate

http://www.easycalculation.com/health/bmr.php
Page 32: 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

• Voluntary (conscious) work done by the body

• Goes above and beyond BMR / RMR

• Categorized by activity level

Physical Activity

Page 33: 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

Physical Activity

Physical Activity Level (PAL) Categories

• Sedentary Studying, watching TV• Low Active Slow walking 30 min / day• Active Moderate Activity 60 min / day• Very Active Vigorous Activity 5-7 hrs / day

Activity ‘counts’ when the heart rate is increased

Page 34: 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

Physical Activity

Rate the Physical Activity Level (PAL) of these activities

Page 35: 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

Common Diseases that Increase BMR

• Cancer

• Heart Failure

• Emphysema

• Anxiety

Meeting the Energy Needs of Ill and Hospitalized Person

Page 36: 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

Used to described the nutritional status of patients

Less than IBW More than IBW

Ideal Body Weight (IBW)

Page 37: 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

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

Page 38: 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

Meeting the Energy Needs of Ill and Hospitalized Person

Did you eat lunch yesterday? No, I was at

Physical Therapy.

Page 39: 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

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.

Page 40: 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

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?

Page 41: 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

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?

Page 42: 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

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

Page 43: 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

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

Page 44: 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

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?


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