Nutrition: NURS 1115
Conversion
Large Unit
Small Unit
1 inch
2.54 cm
1kg
2.2 lbs
1 foot
12 inches
1 kcal
4.184 kj
1m
100 cm
NB:
From a larger unit to a smaller unit multiple.
From a smaller unit to a larger unit divide.
BMI calculations
 Weight (kg)/Height(m2)
John weighs 5 kg and is .5 m tall. What is his BMI?
Answer
 = 5/ .5 * .5
 = 5/ 0.25= 20kg/m2
BMI
calculations
 Weight(lbs)/ Height (inches ) * 703
2
 Peter weighs 180 lbs and is six feet tall. Calculate his
BMI?
Answer
 =180/ (72 *72)* 703
 = 180/5184 * 703
 = 0.0347* 703
 =24.39 lbs/inches2
http://www.cdc.gov/healthyweight/assessing/bmi/adult
_bmi/index.html
Caloric Requirements- BMR
 Harris Benedict Formula
 Women: BMR = 655 + ( 9.6 x weight in kilos ) + ( 1.8 x
height in cm ) - ( 4.7 x age in years )
 Men: BMR = 66 + ( 13.7 x weight in kilos ) + ( 5 x
height in cm ) - ( 6.8 x age in years )
Calculating BMR for Women: An
Example
 20 year old Shuana weighs 54kg, and is 1.2 m tall.
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Calculate her BMR.
BMR= 655+ (9.6 * 54) + (1.8 * 120) – (4.7 * 20)
655+ (518.4)+(216)- (94)
= 1389.4-94
=1295.4 calories
Calculating BMR for Men: An
Example
 22 year old Shuan weighs 68kg, and is 1.6 m tall.
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Calculate his BMR.
BMR= 66 + (13.7 x 68) + (5 x 160) - (6.8 x 22)
= 66+ (931.6)+ (800)-(149.6)
=1797.6-149.6
=1648 calcories
Calculating Physical Activity Level
 Total daily energy expenditure (TDEE)/ Basal Metabolic
Rate (BMR)
Category
PAL
Description
Sedentary
1.2
(little or no exercise, desk job)
Lightly active
1.375
(light exercise/sports 1-3 days/wk)
Moderately active
1.55
(moderate exercise/sports 3-5
days/wk)
Very active
1.725
(hard exercise/sports 6-7 days/wk)
Extra Active
1.9
(hard daily exercise/sports & physical
job or
2 X day training, marathon, football
camp,
contest, etc.)
Calculating Physical Activity Level
 If Sharon total energy expenditure for the last 24 hours
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is 1836.5 kcal and her BMR is 1479.8 kcal what is her
PAL? Categorise her PAL.
PAL= TDEE/BMR
= 1836.5/1479.8
= 1.24
PAL category: Low active
Calculating Total Daily Energy
Requirement
 Caloric Requirement- BMR * PAL
Shari has a BMR of 1524 kcal/day and is moderately
active. How much calories must she take in per day to
meet her caloric requirements
TER= 1524*1.55
= 2362.22 kcal
Atwater factors
Macronutrients and Alcohol
Energy contribution
Protein
4 kcal/g
Carbohydrate
4 kcal/g
Fat
9 kcal/g
Alcohol
7 kcal/g
Calculating energy contributionsMacronutrients
 Each 2gram dumpling consists of 0.5 g of carb and 0.3 g
of protein and 0.1 g of fat.
 Kerry consumes 3 ½ dumplings, 2 grams of salt fish
prepared in 2.25 grams of oil.
 She drinks a bottle of “Sprout juice” which reads 25 grams
of carbs and 30 grams of protein, and total fat is 13g per
serving.
Calculating energy contributionsMacronutrients
 Each bottle contains 1.5 servings.
 Calculate the number of calories Kerry receives from fat,
carbohydrates, and protein and the total caloric intake
for that meal.
Energy from carbohydrates
Answer
 Carb= 3.5 * 0.5 from dumpling= 1.75 g
 From juice= 25 * 1.5= 37.5 g
 Add all carbs consumed= 1.75 + 37.5= 39.25 g
 Energy from carb= 39.25g * 4kcal/ 1 g=
 157 kcal/g
Energy from Fats
 Fat from dumpling= 3.5 * 0.1= 0.35g
 Fat from oil= 2.25 g
 Fat from juice= 13g
 Add all the fat contribution= 0.35g + 2.25g+ 13g= 15.6g
 Energy from fat = 15.6g * 9kcal/1 g= 140.4 kcal
Energy from Protein
 Protein from dumpling = 3.5 * 0.3g= 1.05g
 Protein from juice = 30g* 1.5= 45g
 Add all the protein contribution= 1.05g + 45 g= 46.05g
 Energy from Protein= 46.05g * 4Kcal/1 g= 184.2 kcal
Total Energy consumed
 Total energy consumed= sum of fat, protein and
carbohydrate energy contribution
 = 184.2kcal+ 140.4 kcal+ 157kcal
 = 481.6 kcal
Malnutrition Universal Screening Tool
(MUST) for adults
 Step 1. BMI Score 0= > 20
1= 18.5 -20.0
2=< 18.5
Step 2. Unplanned weight loss score
0=<5%
1= 5-10%
2=>10%
MUST
 If wt or ht cannot be established, use documented or
recalled values.
 If none of the values can be obtained:
Use clinical impression (very thin, thin, obese) and
mid-upper arm circumference (<23.5 cm- thin) & (>32
cm = obese)
MUST
 Wt change: clothes, jewelry loose-fitting =wt loss, or
too tight=wt gain
 History of decreased food intake, loss of appetite or
dysphagia over 3-6 months
MUST
 Underlying disease or psychosocial/physical
disabilities likely to cause wt change
 Acute disease with negligible intake
MUST
 Step 3. Acute disease score:
2 = none or negligible intake for >5 days
 Step 4. Add the scores to calculate overall risk of
malnutrition
0 = low risk: routine clinical care
1 = medium risk: observe
2 or more= high risk: treat
Calculations of MUST score
 Jemma is 20 years old and weighed 45kg last month
and now weighs 41 kg. He is 155 cm tall. He has had
little appetite for the last month and has stage 3
cancer. Calculate his MUST score.
 Step 1
 BMI= 45/1.55 * 1.55=
 45/2.4025
 18.73kg/m2
Calculations of MUST score
 Step 2
 Percentage weight loss:
 Current percentage of usual weight- 41/45 *100= 91.11
 Percentage weight loss- 100- 91.11= 8.89 %
 Step 3
 Disease score= 2
 Step 4 compute the scores
 BMI score= 1
 Weight loss score= 1
 Disease score= 2
 Total score= 4
 Recommendation
 High Risk-Treat
Calculating Waist Hip Ratio
 Waist (unit)/hip (unit)
 NB units must be the same
 WHR is the ratio of the circumference of the waist to
that of the hip
 Recommendations
 WHO STEPS states that abdominal obesity is defined
as a waist–hip ratio above 0.90 for males and above
0.85 for females and increased cardiovascular risk
Calculating Waist Hip Ratio
 Freta has a waist circumference of 32 cm and a hip
circumference of 14.96 in
 What is her WHR and your recommendations for her?
 WHR = WC/HC in same unit
 Convert HC- cm= 14.96 in* 2.54cm/ 1 in= 38 cm
 Divide WC by HC=32/38
 = 0.84
 Low cardiovascular risk (normal)
Caloric intake from IV administration
Nurse Joy is caring for critically ill Koju. Koju is ordered to
receive 20% DW in 500 mls and 1L requirement.
 How many calories is Koju receiving daily? How many bags
of fluid are needed to meet a requirement of 1600 kcal?
 Volume of Dextrose in 500ml bag- 20/100 * 500= 100mls
 1ml = 1g Thus 100mls dextrose = 100g dextrose
 Number of calories provided by each bag of DW= volume of
dextrose per * 4kcal
 = 100 * 4kcal= 400kcal
 Number of calories in 1L=
 conversion of L= mls
 1L = 1000mls
Caloric intake from IV administration
 Number of 500ml bag in 1L= 1000/500= 2
 Multiply number of bags by kcals per bag= 2* 400kcal= 800
kcals
 Answer to number of calories that Koju is receiving
daily= 800 kcals
Ques 2.- Bags of fluid needed to meet 1600 kcal
requirement
 Divide TEE by calories per bag= 1600kcal/ 400kcal *1 bag=
4 bags
 Convert bags to mls= 1 bag = 500mls
 Thus 4 bags = 500 mls* 4bags/ 1 ml= 2000mls
 Convert to L= 2000ml/ 1000ml * 1L= 2L
Caloric Intake_ Macronutrients
 Square has a TEE of 1850 kcal per day? What is the
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expected contribution of the three macronutrients;
using the ratio of carbs – 55%, protein- 30%, fats- 15%.
Carb= 1850* 55/100= 1017.5 kcal
Protein= 1850 * 30/100= 555 kcal
Fats= 1850 * 15/100= 277.5 kcal
Total= ( 1017.5 + 555 + 277.5) kcal= 1850 Kcal
Caloric Intake_ Macronutrients
 Paige has a TEE of 1920 Kcal/d? What mass of
macronutrients should she consume to meet RDA; using
RDA values of 55% carb, 30% protein & 15% fats.
 Mass of Carbs required for 1 day
 Carb= 1920 kcal * 55/100= 1056 kcal
 Kcal to gram= 1056/ 4 kcal * 1 g= 264 g
 Mass of Protein required for 1 day
 Protein= 1920* 30/100= 576 kcal
 Kcal to gram= 576/ 4kcal * 1g= 144 g
 Mass of Fats required for 1 day
 Fat= 1920 * 15/100= 288 kcal
 Kcal to gram= 288/9 kcal * 1g= 32 g
Calculating Ideal weight
 Usual
 Frame size can be estimated using wrist circumference,
or elbow breadth measurement.
Growth charts and assessment of
children
 James is 6 months old and weighs 6.5 kg and is 22 cm
tall. Using the growth chart for boys identify his
percentile:
 Weight for age
 Weight for length
 Length for age
 BMI for age – weight for length for age
 Growth Charts\L_A and W_A growth charts (Boys).pdf
 Growth Charts\W_L growth charts.pdf
References
 Retrieved from
http://www.cdc.gov/healthyweight/assessing/bmi/adu
lt_bmi/index.html
 Xuereb, G. C. (2004). Healthy eating for better living:
A manual on nutrition and HIV/AIDS for healthcare
workers in the Caribbean. Cajanus, 37(4): 171-224.
Retrieved from www.paho.org/cfni
 Retrieved from http://www.who.int/childgrowth/en