Name: Christine B.

Valerio

Year and Section: 2C

Nutrition and Diet Therapy

Calculation for diets and Meal Planning.

In preparation for computation of different therapeutic diets, it is imperative that nursing students first
acquire knowledge in calculating diets for normal individuals and planning regular menus using the
FOOD EXCHANGE LIST. The Food Exchange List is one of the basic tools in nutrition and diet therapy. It is
used in meal planning and estimating the energy and macronutrients of normal and therapeutic diets.

I.OBJECTIVES
This laboratory session helps the students to compute their own calorie requirements and
plan their meals.

At the end of three hours, you should be able to:

1. Assess your nutritional status and compute for your calorie requirement
2. Plan a one-day menu based from your calculation
II. PROCEDURES

A. Following steps in estimating the desirable body weight, calculate your total Energy Allowance
(TEA)

1. Determine your height= 5’6” and actual body weight = 65kg

(Tannhauser’s Method)
Height: 5’6” = 66 inches Weight: 66” x 2.54 = 67.64 kg.
66 in. x 2.54 cm. 67.64 kg. – 6.76 (10% of 67.64)
= 167.64 DBW = 60.88 or 61 kg.

2. Calculate your basal needs= ____________x____________kg (DBW) x 24= _________kcal

= body wt. (kg) x 0.9 kcal/kg/hr x 24 hours

= 61 kg. x 0.9 kcal/kg/hr x 24 hours
= 1, 317. 6 kcal

BASAL NEED
Male= 1 kcal per kg DBW/hour Female= 0.9 kcal per DBW/hour
3. Estimate physical activities= _______________kcal

Estimating Total Energy Requirement (cooper, et. All)

Activity = light activity (student)

1, 317.6 = basal metabolic needs

1, 317.6 x .50 = 658.8 kcal (for activity)

 Physical Needs – approximate percentage increase above basal needs (use lower factor for women)
Bed rest 10-20 percent
sedentary 30 percent
Light activity 50-60 percent
Moderately active 60-70 percent
Severely active 90-110 percent

4. Add values from 2 and 3 and get TEA = ________ kcal + __________= kcal

Daily Kilocalorie requirement

1,317.6 + 50% (PAL)

1,317.6 + 658.8
= 1,976 kcal/day

5. Distribute Total Energy Allowance among carbohydrates, Protein, fat as follows:

Carbohydrates: 50-70%
Protein: 10-15 %
Fats: 20-30 %

Allowances for protein can also be provided based on the recommended Energy and Nutritional
Intakes for Filipinos (REN) as shown below.

6. For normal diet, allow 65% of the total energy allowance for carbohydrates, 15% protein and
20% fat. Thus, the corresponding energy contributions of the three nutrients in your diet are as follows:

Carbohydrate = 1,976 kcal x 0.65 = 1,284 kcal

Protein = 1,976 kcal x 0.15 = 296.4 kcal
Fats = 1,976 kcal x 0.20 = 395.2 kcal

7. Calculate the number of grams of CHO, Pro and Fats by dividing the calories for each nutrient by
the corresponding physiologic fuel values (4 kcal/g CHO, 4 kcal/g Pro, 9kcal/g fat)

Carbohydrate = 1,284 kcal / 4 = 321 or 320 gms

Protein = 296.4 kcal / 4 = 74 or 75 gms
Fats = 395.2 kcal / 9 = 44 or 45 gms

8. For simplicity and practicality of the diet prescription (Rx), round off calories to the nearest 50,
and carbohydrates, proteins and fats to the nearest 5 gms. Thus your diet prescription is:

Diet Rx: kcal- 1,976; CHO- 320gms; PRO- 75gms; Fats- 45gms
B. Using the Food Exchange List, design your meal plan taking into consideration your food habits, food
behavior and preferences, etc. Follow the steps in meal planning.

TEA: 1976 kcal; CHO= 320gms; PRO= 75gms Fat= 45gms

List Food Measure CHO PRO FAT CALORIE

IA Veg A 3 - - - 48
IB Veg B 3 9
II Fruit 4 40 - - 160

III Milk 1 12 8 5 125

low fat sub: 86

(320-86) = 234
234/23 = 10

IV Rice 10 230 20 - 1000

sub: 28
(75-28) = 47
47/8 = 6

V Meat 6 - 48 36 516

medium fat sub: 16

(45-41) = 4
4/5 = 0

VI Fat 0 - - 0 0

VII Sugar 5 25 - - 80

316gms 76gms 41gms 1,929 kcal

 MEAL DISRIBUTION

FOOD BREAKFAST LUNCH DINNER AM SNACK PM SNACK

Veg A 1 1 1
Veg B 1 1 1
Fruit 1 1 1 1

Milk 1

Rice 2 2 2 2 2

Meat 2 1 1 1 1

Fat - - - - -

Sugar 1 1 1 1 1

Steps in Meal planning using the food exchange List

1. Use the table provided for the meal plans

2. Determine the amount of Vegetable A and B exchanges the patient can eat (allow 2-3
exchanges)
3. Determine the amount of fruit exchanges. ( A reasonable allowance of 3-4 exchanges can be
given, unless there is drastic restriction of simple carbohydrates).
4. Determine the amount of milk exchanges. Type and amount of milk depends upon needs, food
habits and economic considerations.
5. Determine the amount of sugar desired. (allow 5-9 teaspoons of sugar per day unless
contraindicated)
6. 6. Sub-total the amounts of CHO, PRO, and Fats and calories provided.
7. Subtract the amount of CHO so far provided by the vegetable, fruit, mil exchanges and sugar
allowed from the prescribed amount. Divide the result by 23, which is the amount of
carbohydrate in one rice exchange necessary to fill up the prescribed amount.
8. Sub- total the amount of protein, subtract from the total protein prescribed and divide result by
8 to get the number of meat exchanges required.
9. Sub- total the amount of fat, subtract from the total fat prescribed and divide result by 5 to get
the number of fat exchanges required.
10. The total number of exchanges obtained will be used for planning your menu. Distribute these
exchanges into BREAKFAST, LUNCH, SUPPER and snacks meal plan.
Questions for discussion:

1. What are the bases for estimating the desirable intake of an individual?

RDA and RENI

*Recommended Dietary Allowance (RDA)- is the information of nutrient allowance for the
maintenance of good health. A tool for assessing a dietary intake of the population group. This
emphasize the amount of foods or diet.

*Recommended Energy Nutrient Intake- A new standard replacing, RDA, emphasizing on

recommending on the nutrients rather than food or diet.

The Philippine Dietary Reference Intake (PDRI) is a comprehensive set of energy and nutrient
reference values for healthy Filipino population. It consists of four reference values:

1. EAR (Estimate Average Requirement)- is the average daily nutrient level estimated to meet
the requirements of half the healthy individuals in a particular life stage and sex group,
corrected for incomplete utilization of dietary nutrient bioavailability. It is the best estimate of
the requirement because it is the median requirement and is directly based on primary research
data.

2. REI/RNI (Recommended Energy Intake/ Recommended Nutrient Intake) – is the level of

intake of energy or nutrient which is considered adequate for maintenance of health and well-
being of healthy persons in the population.

3. AI (Adequate Intake) - is the daily nutrient intake level based on observed or experimentally-
determined approximations of the average nutrient intake by a group (or groups), of apparently
healthy people that is assumed to be adequate.

4. UL (Tolerable Upper Intake or Upper Limit) – is the highest average daily nutrient intake level
likely to pose no adverse health effects to almost all individuals in the general population. As
intake increases above the UL, the potential risk af adverse effect increases.

Apart from the four reference values, the AMDR (Acceptable Macronutrient Distribution
Range) is the range of intakes for a particular energy source (carbohydrates, protein or fat) that
is associated with reduced risk of chronic diseases while providing adequate intakes of essential
nutrients. It is expressed as percentage of total energy intake.

2. What are the pointers to consider in planning a normal diet?

  Choose Variety of foods from each major food group to ensure intake of adequate
amounts of calories, protein, vitamins, minerals and fiber. Choosing wide range of foods
also helps to make meals and snacks more interesting.
 Adapt the meal plan to meet specific tastes and preference. For example, a serving of
grains doesn’t only mean a slice of wheat bread. It can be wild rice, whole-wheat pasta,
grits, bulgur, cornmeal muffins or even popcorn.
 Combine foods from the different major groups.
 Select meals and snacks wisely and chose nutrient-rich foods within each group

3. What are the pointers to consider in planning a therapeutic diet?

The alteration of the normal diet requires an appreciation of

 The underlying disease conditions which require a change in the diet;

 The possible duration of the disease;
 The factors in the diet which must be altered to overcome these conditions; and
 The patient’s tolerance for food by mouth. In planning meals for a patient his economic
status, his food preferences, his occupation and time of meals should also be
considered.

The normal diet may be modified

 To provide change in consistency as in fluid and soft diets;

 To increase or decrease the energy value;
 To include greater or lesser amounts of one or more nutrients, for example,
high protein, low sodium, etc;
 To increase or decrease bulk-high and low fibre diets; and
 To provide foods bland in flavour.