Welcome to Seminaron

Nutrition Assessment and Management in Family Medicine

Part-3

Meera Kaur, PhD, RDAssistant Professor, Family Medicine

kaur@cc.umanitoba.ca

Estimation of Energy and Protein Requirements

• Energy requirement are calculated based on height, weight, age, physical activity– Harris Benedict Equation (REE):

• Well-known and widely used.• Derived from healthy adults, calculates resting energy expenditure• Additional stress (SF) and activity factors (AF) added

– MEN» 66 + [13.7 x wt (kg)] + [5.0 x ht (cm)] - [6.8 x age] = kcal/day x SF X AF

– WOMEN» 655 + [9.7 x wt (kg)] + [1.8 x ht (cm)] - [4.7 x age] = kcal/day x SF x AF

• Mifflin Equation (out patient setting)• Practical and simple to use.• Derived from a sample representative of current Canadian population covering all weight

categories. • Least amount of error.

– MEN» 9.99 (wt) + 6.25(ht) – 4.92 (age) + 5 = kcal/day x SF x AF

– WOMEN» 9.99 (wt) + 6.25(ht) – 4.92(age) – 161 = kcal/day x SF x AF

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Mifflin Equation

MEN

9.99 (wt) + 6.25(ht) – 4.92 (age) + 5 = kcal/day x SF x AF

WOMEN

9.99 (wt) + 6.25(ht) – 4.92(age) – 161 = kcal/day x SF x AF

Wt = kg

Ht= cm

SF= Stress Factor

1.0

1.2 Infection or fracture

1.4 Multiple trauma

1.6 Sepsis, respiratory failure

AF= Activity Factor

1.0 Ventilated

1.2 Confined to bed

1.3 Able to transport self

1.4-1.6 Active individual

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Protein Requirements

0.8-0.9 g/kg Healthy adult

1.0- 1.5 Post-operative, cancer patients or heavy-weight trainer

1.8-2.5 Major burn victims

Based on ideal body weight.

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• How am I suppose to have time to

do all of this???

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What is the Family Physician’s role?

• Brief nutrition assessment should be done at every physical examination

• Problem Identification– As part of initial screening, assess for nutrition related problems

• Offer a separate meeting with the dietitian• Assess pts readiness to change.

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4 B’s for Better Eating

• Body Mass Index

• Blood pressure and HTN

• Balanced diet

• Breakfast

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Nutrition Checklist based on warning signs: DETERMINE assessment tool

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• Disease

• Eating poorly

• Tooth loss/mouth pain

• Economic hardship

• Reduced Social Contact

• Multiple medicine

• Involuntary weight loss/gain

• Needs assistance in self care

• Elder years above age 80

What if I hate using these tools?

• Do you look like an apple or a pear?• Do you eat breakfast everyday?• Do you eat vegetables and fruit everyday?

» WHO report estimated that increasing F/V consumption to 5 servings/day, would decrease global disease burden by 18% (Lock et al, 2005, Bulletin of the World Health Organization, Feb 83(2), 100-108).

• How many times do you eat out each week?• What do you drink? Water/pop/juice?

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How to contact me…

– Fill out referral form– Include patient’s name, chart #, phone #,

reason for assessment and submit to the front desk

– Phone call (3452)• You are most welcome at any time regarding

your nutrition related queries. Please give me call first to make sure that I am at KMC.

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RD’s Follow Up- What is my role?• Nutrition Assessment

– Establish nutrition focus of the meeting (reason they are there, pts expectations).

– 5A Model –• Assess at risk behaviours, What does the pt think requires change?

(pts interpretation)• Advise on specific goals,• Agree- negotiate an agreement that makes sense for both parties• Assist with nutrition plan

– Involve patients in planning. – Be specific and realistic.– Write goals down.– Include self-monitoring tools.

• Arrange- for follow-up

– Needs to be specific, measurable, verbal and written.

• Expect relapse (Stages of Change model).

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Eating Well with Canada’s Food

Guide –

NEW 2007

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http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html

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Canada’s Guidelines for Healthy Eating

• Enjoy a variety of foods– All can be enjoyed in moderation.

• Emphasize vegetables and fruits, and whole grains.

• Choose lower-fat dairy products, leaner meats, and foods prepared with little/no fat.

• Enjoy physical activity.

• Limit salt, alcohol, and caffeine.

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TerriTerri is a 59-year-old retired school teacher new to your clinic. She is here for a check-up. Her blood pressure measures 152/94.

After completing a thorough physical exam, which was normal in all respects, you repeat her blood pressure which is now 150/91.

Physical Exam: Height 160cm , Weight 69kg (gain of 4kg since retirement 4 years ago)

Diet Recall: 0730 hrs 2 cups black coffee 1 carrot muffin (Robins Donuts) (=2-3 Grains)

1030 hrs 10 Ritz crackers ( = 2 Grain)3 Tbsp Light Cheese Whiz ( = 1 Milk)1 cup tea with 2% milk1245 hrs 1 sandwich: corned beef thick rye (= 2 Grain, 2 Meat)1 cup Campbell’s Chicken Noodle soup (= ½ Grain)1 can Diet Pepsi1530 hrs 1 glass red wine (8oz)Peanuts (1/2 cup) (= 2 Meat)1800 hrs 1 vodka with Diet 7-upChicken-vegetable stir-fry (1.5 c veg + 50g chicken) (= 3 Veg, and ½ Meat)1 cup steamed rice, with soy sauce (= 2 Grain)½ cup frozen vanilla yogurt (=1 Milk)2 oatmeal cookies ( = 1 Grain)1 cup tea with 2% milk2200 hrs 1 pear (= 1 Fruit)2230 hrs 1 glass red wine (8oz)2 slices garlic sausage (= ½ Meat)1 thick slice of rye bread ( = 1 1/2 Grain)Mustard

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Questions??