Applied Nutrition Flashcards
How can a calorie be defined?
A unit of measurement for the amount of energy a body can get from food.
How many joules are equivalent to 1 calorie?
4.18 joules (1 kcal is equivalent to 4.18 kJ).
Will each individual require the same number of kcal on a daily basis?
No, this will vary.
What does the amount of kcal a client needs depend upon?
Their metabolic rate (metabolism).
What does the term metabolic rate (or metabolism) refer to?
The energy required to maintain all the chemical processes that are constantly taking place within a body.
What 3 things affect metabolic rate (or metabolism)?
Weight, age and activity level.
What does an “average adult” refer to in terms of recommended daily amounts?
A healthy individual between 19-60 years old. Assumes they are of average weight and activity levels.
Which 3 groups of people does the term “average adult” exclude in terms of recommended daily amounts?
Pregnant and lactating females, any individual suffering illness, and those who are very active.
What is the estimated average energy requirement for an average adult aged 19-49 years old?
2550 kcals/day and 1940 kcals/day for men and women respectively.
What is the estimated average energy requirement for an average adult aged 50-59 years old?
2500 kcals/day and 1900 kcals/day for men and women respectively.
Reaching and maintaining a healthy weight for overall healthy and wellbeing involves learning how to balance what?
“Energy in” (calories from the food and drink consumed each day) with “energy out” (number of calories burned for basic bodily functions and physical activity).
What happens to fat reserves when energy intake = energy expenditure?
Fat reserves remain the same.
What happens to the extra energy when energy intake is greater than energy expenditure?
It is stored as fat and body weight will increase.
Where does the extra energy needed by the body come from when energy intake is less than energy expenditure?
It is provided by breaking down body fat stores which results in a loss in weight or body fat.
What is really meant by weight management?
Changing body fat, not weight. Focus on the excess energy stored as fat within a body rather than focusing on changing body weight.
Why focus on body fat rather than weight?
Body weight fluctuates constantly depending on a number of factors, including hydration status. A change in weight does not necessarily imply a change in fat stores.
In the 1995 study by Dr S Jebb and Dr A Prentice in attempt to establish why there is an obesity epidemic in the UK, was fat intake found to go up, down, or stay the same, over 50 years?
Surprisingly it was found to go down.
In the 1995 study by Dr S Jebb and Dr A Prentice in an attempt to establish why there is an obesity epidemic in the UK, was energy intake found to go up, down, or stay the same, over 50 years?
It had gone down slightly.
What did Dr Jebb and Dr Prentice look at to establish that energy expenditure had gone down over 50 years?
Indicators of inactivity, such as car usage and television watching, which had gone up.
What did the findings of the Jebb and Prentice study conclude?
The rise in obesity may be more due to an increase in inactivity (declining energy expenditure) rather than rising kcal intakes.
What has making modern life easier in the Western world led to?
Population changes in energy balance.
Name 4 things which have led to an energy imbalance.
Technology (mechanised and modernised), communication (can all be done from our desks), convenience (escalators and lifts), and gadgets (washing machines, tumble dryers etc do the work we used to do physically).
What happens to the excess energy that results due to doing less but not consuming less?
It is converted and stored as body fat.
What proportion of adults in the UK are classed as inactive (do less than 30 mins activity in a week)?
1 in 4.
Alongside declining activity levels the UK has seen a parallel rise in obesity in adults from what in 1993 to what in 2018?
15% in 1993 to 28% in 2018. A further 30% of women and 41% of men are overweight.
What does the latest Health Survey for England (HSE) show in terms of proportion of population which is obese?
1 in 4 adults.
What percentage of children (aged 2-15) are classified as overweight or obese?
31%.
How much weight loss should a client aim to achieve per week?
450g or 1lb
Why should a client only aim to achieve a weight loss of 1lb (450g) per week?
The weight loss will be as a result of losing body fat.
A pound of fat contains roughly how many calories?
3500 kcals.
To lose 1lb per week, what energy balance should be aimed for?
A negative energy balance of 3500 kcal per week, or approx 500 kcal per day. (Remember weight loss is not an exact science and is more complex than simply calories in versus calories out).
Why should an energy deficit of less or more than 500 kcals per day be avoided?
Less could lead to demotivation as weight is lost more slowly, and more than 700 kcals per day could lead to the body starting to utilise lean tissue for energy in addition to body fat. This is undesirable as the aim is to lose body fat while preserving muscle.
What does BMR stand for?
Basal metabolic rate.
What does PAR stand for?
Physical activity ratio.
What does PAL stand for?
Physical activity level.
What can BMR and PAR values help to calculate?
The energy (kcal) used for different activities.
What can PAL tables in Report 41 be used for?
To estimate daily kcal expenditure and energy needs in a day.
What are the 3 components to energy expenditure?
Basal metabolic rate, thermogenesis, and physical activity.
What is the energy expenditure side of the energy balance equations?
Energy expenditure = basal metabolic rate + thermogenesis + physical activity.
What is Basal Metabolic Rate?
The energy required to maintain the body’s normal function (at rest).
What does BMR depend on?
Gender, weight and age.
What percentage does BMR contribute to the total energy expenditure?
Around 75%.
What determines BMR (in part) in the body?
The amount of lean tissue (muscle) in the body. Then more lean tissue there is, the higher the BMR is likely to be.
Why does an indirect calculation of BMR need to be used to give an estimated value of BMR?
BMR can only be accurately measured in a lab.
What is the method used to calculate an estimation of BMR in an average healthy man or woman?
The Schofield equation.
Is the Schofield equation accurate?
Yes, very accurate for the average adult. However, as body composition is not taken into account, the kcal needs of a very lean and muscular person may be underestimated, and the kcal needs of a very obese person may be overestimated.
How do you convert lbs to kg?
Divide by 2.2
Why does BMR tend to decline with age?
People gradually lose lean tissue (muscle) with increased age unless they do activities that improve or maintain muscle.
Why do women have a lower BMR than men of the same age and weight?
Men tend to have greater lean tissue than women.
Why do heavier people tend to have a higher BMR?
The body has to work harder to carry the additional weight around.
What is thermogenesis?
The creation of hear, when the core temperature of the body is increased. It is defined as the generation or production of heat or the burning of kcal, through physiological processes i.e. it’s the process in which the body raises its temperature or energy output.
What causes thermogenesis?
Physiological processes e.g. digestion of food or undertaking physical activity.
Name 3 triggers of thermogenesis.
Eating a meal, induced by work, or as a result from exercising.
Why is is necessary for muscles to create heat?
Warm muscles work much more effectively than cold muscles.
What physiological processes are called spontaneous physical activity (SPA), and create what’s called non-exercise activity thermogenesis (NEAT)?
Things such as fidgeting, rubbing eyes, and other involuntary movements that tend to occur “spontaneously”. These can only be measured in a laboratory.
How much do spontaneous physical activities (SPAs) contribute to the total kcal burned in a day?
Only approximately 5% of total calories burned in a day and therefore not taken into account for the purpose of estimating total energy expenditure.
Which factor of the energy expenditure equation are you most able to influence?
Physical activity.
What defines physical activity?
All activity done on a daily basis, including eating and driving.
What are 4 ways of measuring what a client does on a daily basis?
Physical activity diary, physical activity recall, pedometers, or heart rate monitors.
How does a physical diary work?
Clients should write down every activity they do and how long they do it for. They should carry the diary with them throughout the day. Tracking should include bany exercise, walking, work, eating, and anything done during periods of inactivity e.g. watching television. The time spent should be recorded to the nearest 15 mins, so 0.25 hrs for 15 mins, 0.5 hrs for 30 mins and 0.75 hrs for 45 mins.
How does physical activity recall work?
The client recalls what they did over the last 24 hours or 1-2 days. As this approach relies heavily on memory, it can give less accurate information than an actual activity diary.
How do you work out the “calculated hourly rate” from the client’s BMR?
Divide the BMR by 24.
What are physical activity ratios (PAR)?
PAR summarise the relative intensity of everyday and common activities. The more intense the activity, the greater the PAR value.
What is the PAR value of sleep?
1.0. All other activities are relative to this.
Where can PAR tables be found?
In Report 41 at annex 3 and 4.
Why is it important to get a mean average of energy expenditure over a number of days, including weekend days?
The energy expenditure will vary from day to day.
Why do more obese or heavier people use more energy to do any activities?
They have a higher BMR and therefore a higher hourly rate, which means there will be a higher activity cost to that client for every activity.
What is used in a simpler method for making an estimation of total energy expenditure, without using an activity diary?
Assigning a physical activity level (PAL) value based on job and leisure activities.
Where can physical activity level (PAL) values be found?
Report 41.
What are the 3 levels of occupational activity (work) classified as, in regards PAL in Report 41?
Light, moderate and heavy.
What are the 3 levels of non-occupational activity (leisure) classified as, in regards PAL in Report 41?
Non-active (sedentary), moderately active, or very active.
What 3 bits of information about eating should be collected from a client?
How much they are eating, when they are eating it, and how they are preparing it.
What is the best way to complete a food diary?
As and when the food is eaten.
Why should a food diary not be completed from memory (e.g. at the end of the day)?
Certain things, such as portion size, may be difficult to remember.
How many days data is needed for a food diary?
2 or 3 weekdays and 1 weekend, should be logged. Any less than this runs the risk of basing advice on limited data, which means the advice could be flawed as it would not be addressing the true nutritional picture.
What things do you need to know about how a client’s food was cooked?
Was it fried, grilled, boiled, baked or microwaved. What butter or oil was used in preparation. Were any skins left on any meats.
How can a client meaure/record the weight of their food?
By recording the weight given on a packet, or weighing food. If they are unable to weigh it, then they could compare it to the size of a teaspoon, tablespoon, a cup full or a mug full.
What should you do if a client cannot record a portion size e.g. if they eat out?
Use an average portion size taken from a food portion size book.
What information do you need to know about fluids that a client has consumed?
The client must record all fluids they consume, including alcohol. Ask them if they have consumed alcohol if it’s not recorded in the diary. For tea and coffee, the type of milk used and how much needs to be known and whether sugar was added.
What extras/sides with a meal do you need to know about?
Any extras, including sauces, salt, pepper, and other condiments.
Aside from food intake, what 3 other things should a client record in their food diary?
How hungry they were when they ate on a scale of 1 (full) to 10 (ravenous), what mood they were in (stressed, bored etc), and where they ate.
Why is it a good idea to give clients a completed diary along with a blank one?
So that they get an idea of the level of detail required.
What 5 other things (aside from what the client ate) are you looking to gain from a food diary?
An insight into patterns and timings of meals, cooking techniques, food choices, alcohol intake, and influences on eating habits and portion sizes.
Clients may show a pattern of eating when bored - what can you do to help?
Offer alternative food choices e.g. fruit or a cereal bar instead of chocolate.
What could you advise clients when they rate themselves as very hungry?
Offer better food choices, alongside advice on adjusting the timings of meals so that they can avoid this level of hunger which can lead to poor food choices.
Why can a high GI mid-morning snack lead to a client being “starving” at lunchtime?
Sugar levels will have soared and then fallen dramatically a short time afterwards. Exchange the snack for a low GI option, and suggest less time between snacks and lunch.
Why can the format of food diary vary between clients?
Some clients may be put off by providing additional information and may be concerned it will be too time-consuming.
Why should you go through a client’s food diary with them?
To ensure you have the details needed for a detailed nutritional analysis and to encourage them to add the details needed next time.
If a client records bread/toast in their food diary, what addition information is required?
What type of bread e.g. white, brown, wholemeal, granary. Also what additions/toppings were on the bread, and how much of these.
If a client records salad in their food diary, what additional information is required?
How big the salad was i.e. main or side, what ingredients were in the salad, and what dressings and how much of the dressings were used.
What are the 6 disadvantages of food diaries?
Clients can underestimate their intake by as much as 10-50%. A client may modify their eating habits because they know they are being monitored. The client has to rely on memory unless they fill in the diary as they go along. The accuracy of the diary relies on the conscientiousness of the client. It relies on the ability to accurately estimate food portions. Clients are likely to forget certain foods or additions such as spreads or sweeteners or omit key info such as cooking methods.
How can a client use a smartphone to record the information required?
Apps such as MyFitnessPal and My Diet Coach can be used (find an app that suits both client and adviser). Or the client can photograph their meal and use the speech to text function to record what they have eaten. This is quick and easy for the client and having a photo with the description is good for the adviser to get a good insight into portion sizes.
How does the 24-hour recall method of collecting information on dietary intake work?
It should be done hour-by-hour starting with when the client got up.
What skills need to be acquired to use the 24-hour recall method of collecting information on dietary intake?
Be able to encourage the client to be forthcoming, without making them feel interrogated.
What 8 tips should be consider when conducting a 24-hour recall?
Be emphatic and supportive, record and transcribe the conversation rather than taking notes, maintain eye contact, conduct clear discussions to make it easier to transcribe later, remain impassive, avoid leading questions such as what did they have for breakfast (they may not have had breakfast), listen attentively, and use positive body language.
What are 4 advantages to the 24-recall method of collecting dietary and activity information?
It’s a good initial questionnaire when you first meet your client. It is helpful to monitor the client to validate their diaries. It is a good “spot check” to complement diary information. It is always good to use 2 methods of collecting information as no single method is entirely accurate.
What are 3 disadvantages of the 24-hour recall method?
It relies on the memory of the client. The time availability of both client and adviser needs to be considered. Some clients may find it quite intrusive and it is reliant on the skills of the interviewer to get accurate information.
What quantity information is needed to be calculated from the food diary?
Portion weight in grams of each food and drink consumed and then figures for the carbs, protein, fat, and kcals for each item.
