Balance Diet, Dietary Planning and Eexchange Foods

Nutritionist: Khaled Ali Al-Gendari

Community Medicine Dept.

Nutrients: Almost all the foods are a mixture of nutrients needed to

maintain life. Nutrients can be defied to two groups, macronutrients which
included proteins, fat & oils and carbohydrate and micronutrients (vitamins
and minerals).

Essential nutrients: can be defined as “nutrients that must be provide by

food because the body cannot synthesize it at a rate sufficient to meet its
needs”. There are about 46 essential nutrients for human.

Although each of the essential nutrients is needed for normal body

functions, the amount needed bears no relationship to that nutrients
importance. For example, the nutritional needs of an adult man vary from
2µg of vitamin B12 to 56gm of protein, both are important for the body. A
deficiency of a nutrient needed in extremely small amounts may cause more
severe symptoms more rapidly than a deficiency of one needed in much
large amounts. For instance, iron deficiency is much more common than
calcium deficiency, yet the requirements of calcium are 80 times the
requirements of iron. Nutrient deficiency can result from inadequate intake,
increase needed, decreased absorption, or depressed utilization of the
nutrient.

The action, interaction, and balance of nutrients in relation to health

and disease:

Action: The main actions or functions of the nutrients in the body are:

1. Build tissues:
Besides water, the most important building nutrient is protein. Fat is
important too, both to build cells and energy stores, some minerals
are important, for example, calcium phosphorus to build bone and
teeth, and iron to build blood cells.

2. Source of energy:
Food is the only source of energy. Energy is mainly derived from
carbohydrate and fats. During starvation the body could use the
stores from fats and glycogen as energy sources and in some

1
 abnormal conditions protein could be used as a source of energy.
Vitamins and minerals do not supply energy, but they help to liberate
the energy locked in carbohydrates, fat and protein. The energy
liberated from nutrients is important for physical work, growth rate in
children and adolescents, athletic performance and recovery from
illness. Too much energy can cause overweight, while too little can
cause starvation.
3. Regulation of body processes:
The chemical processes carried out by the cells of the body are
metabolism. It is controlled by enzymes, coenzymes and hormones.
Protein, vitamins, minerals and water help in this action.
4. Protect body against infection:
The cells and fluids on body surfaces need enough protein and Vit A
to resist infection. Fiber helps to keep the gut health. Antibodies are a
special kind of protein, and white blood cells are made from protein
and other nutrients these essential to fight infections.
People burn more nutrients for energy when they fight infections.
Some micronutrients and protein destroy harmful chemical produced
during infection and prevent them from damaging tissues.

Interaction: Nutrient interaction follows the lows of chemistry and

physiology. Bone formation requires calcium, phosphorus and Vitamin D.
lack of any of these means bone will not form properly, because the three
nutrients interaction.

Balance: The diet should be balanced which mean that it should

consists of a wide variety of foods (from the six food groups). Unbalance
diet means lack or excess of a specific nutrient. Lack of specific nutrient (s)
can produce deficiency symptoms (for example, lack of iron can cause
anemia). Excess of a nutrient can cause problems as well (excess protein can
cause gout, excess fluoride can cause mottled teeth, excess energy cause
obesity).

Relation to health and disease: In the 1900, the main concern about
nutrition was about nutrition deficiencies. Nowadays, the main concern in
many developed countries and developing countries are diet related medical
disorders, such as hypertension, heart disease, stroke, diabetes mellitus,
obesity and cancer which are often called “diseases of affluence”. However,
many nutrient deficiencies are still prevalent in many parts of the world
mainly due to wars and unjustified conflicts.

2
Importance of good nutrition and the role of nutrition in public health

Throughout the last century and up to the present day, many studies and
the application of research demonstrated the importance of adequate diet
to health. Adequate nutrient and young children and to the protection of all
segments of society against deficiency diseases.

Examples of importance of adequate diet to health:

 Studies showed that there is an increase in the height and weight of

children than their fathers and partially attributed to improved
nutrition.
 Infants born to mothers, whose diet was rated good or excellent. The
majority of them (94%) were judged to be superior or good physical
condition at the time of birth.
 Levels of total cholesterol and specially low-density lipoprotein
cholesterol (LDL), which are risk factors in coronary heart disease, can
be reduced when the total fat, saturated fat, and cholesterol content
of the diet is lower and/or the content of the polyunsaturated fat is
higher. Each 1% reduction in the blood cholesterol level is associated
with a 2% reduction in coronary heart disease.
 Excessive fat intake is a risk factor for obesity, hence diabetes,
atherosclerosis and some types of cancer.
 Severe nutritional diseases such as pellagra (niacin deficiency),
beriberi (thiamin deficiency), scurvy (vitamin C deficiency) and goiter
(iodine deficiency) are now rare due to improvement in the diet.
 Fiber in the diet may reduce the risk of colon cancer.

Energy

Energy is defined as “capacity to do work.” Carbohydrates, fats and

protein in cells in most tissues in the body produce energy. Vitamins
and minerals do not provide energy in the form of calories, though
they help store and liberate energy in the body. This may explain why
people with vitamin or mineral deficiencies may feel tired. Increased
dietary energy from food is required under unusual conditions; during
pregnancy and lactation, recovery from illness or starvation and
strenuous physical activity like athletes. The intake and expenditure of

3
energy vary considerably from day to day, and the body is perfectly
able to handle such short-term changes.

Energy requirement:
The energy requirement (ER) of an individual is the level of energy from food
that will balance energy expenditure, when the individual has a body size
and composition, and level of physical activity, consistent with long term
good health.
The ER of a human being is affected by:
1. Basal metabolic rate (BMR).
2. Body size, age, and sex.
3. Activity and climate.
4. Pregnancy and lactation.
We can divide energy requirement into:
a. Energy for keep alive at rest. This is called metabolic rate (BMR).
b. Energy for physical activity (PA).

Units of energy measurements:

K. Calorie [kilocalorie, abbreviated Kcal] is the measure used to express

energy intake in the diet and energy expenditure. One kcal is defined as “the
amount of heat required to the raise the temperature of 1 kg of water to 1
C.”. In nutrition the kilo joule (KJ) is used, but the general public and most
health workers still prefer to express food energy in kcal than in k joule. The
equivalent of 1 kcal is 4.184 KJ.

Energy values of foods:

 1 gm. of CHO provide 4 kcal 1 gm. of protein provide 4 kcal
 1 gm. of fat provide 9 kcal 1 gm. of alcohol provide 7 kcal

Components of energy expenditure

Energy is needed for three important functions inside the body:

 Basal energy: the energy needed to maintain life [basal metabolic rate
(BMR).
 Physical activity.
 Dietary thermogenesis: the body heat produced in the metabolism of
food [thermic effect of food]

4
 Basal energy Physical activity Thermo-genesis
60-70 % 20-30 % 10%

A. basal metabolic rate:

It is the minimum amount of energy needed to carry the involuntary vital
body processes necessary to sustain life such as:

 Respiration
 Circulation
 Synthesis of organic constituents.
 Secretions of substances from glands and cells.
 Pumping ions across membranes.
 Maintaining body temperature.

Half of the energy expanded is used in meeting the metabolic requirements

of the nervous system. The liver uses 27% of the energy.

Factors affecting basal energy expenditure:

There are several factors that cause the metabolic rate to vary among
individuals. These factors are:

1. Body surface area: Tall large framed people have a large body surface
area and a greater proportion of lean tissue. Therefore they have a
high metabolic rate.
2. Body composition: Muscles, the brain, glands and organs such as liver
are relatively active metabolically. On the other hand, bones and
adipose tissue are relatively inactive tissues.
3. Body condition: An active person requires more basal metabolic
needs than a sedentary one because it has more muscles and less fat.
4. Sex: Women develop more adipose tissues and less musculature than
men and therefore have less basal metabolic rate than men by 5%.
5. Age: The metabolic rate is high at birth, increases until age 2, then
declines gradually except for a rise at puberty. The decline in basal
needs between ages 25-35 is only 35 Kcal/day, and between ages 35-
55 it is 145 kcal/ day.
6. Sleep: It causes a drop in energy needs due to both muscular and
emotional relaxation by about 10%.

5
 7. Hormone secretion: Hypothyroidism causes a decrease in metabolic
rate about 30%. Hyperthyroidism causes an increase in metabolic
rate by 50-70%.
- Epinephrine and adrenaline as during emotion increase the
metabolic rate.
8. Pregnancy and lactation: Metabolic rate increases 20% above normal
situation in the sixth to ninth months of pregnancy due to high
metabolic activity of the fetus, placenta and maternal tissues as well
as carrying the additional weight of unborn infant. Additional energy
needs containing milk for the sucking baby, long duration of B.F.
requires extra energy.
9. Under nutrition and starvation: Prolonged caloric under nutrition
lowers the metabolic rate by 20% of the predicted level. It is an
adaptive to conserve energy
10. Body temperature (fever): Fevers increase the metabolic rate by
about 13% for each degree above 37 C.
11. Environmental temperature: Metabolic rate is affected by extremes
in environmental temperature. A decrease in environmental
temperature will increase the metabolic rate by 20%.
12. Menstrual cycle: There is an increase in the energy expenditure
by 150 kcal/ day during the second half of the cycle.
13. Smoking: Nicotine increases metabolic rate by 10% this is why
people that stopped smoking gain weight.

How you can calculate your basal metabolic rate.

- For women……0.95 kcal/kg body weight (desirable)/hour
- For men………..1.0 kcal/kg body weight (desirable)/ hour

Or See attached table (1).

Resting energy expenditure:

It is the minimum amount of energy needed to maintain vital body

processes in addition to sufficient energy for sedentary activities and the
energy needed for digestion of food it is considered to be 10% above basal
energy needs.

B. Physical activity (PA):

It is the amount of energy needed for all muscles involved in the activity
plus a small amount of energy for the increase in the heart rate and

6
 breathing. The contribution of physical activity to total energy
expenditure (TEE) varies for different people. It may range from 10% in
the bedridden to as much as 50% in the athlete. The actual amount of
physical activity expended is determined by:
- Body weight.
- Type and intensity of the activity.
- Duration of the activity.

See attached table (2) to calculate your PA.

C. Thermic effect of food:

It is the increase in energy expenditure associated with the
consumption of food. It is the energy required digesting, absorbing,
transporting and metabolizing nutrients. Consumption of
carbohydrates or fat increases the metabolic rate by about 5% of the
total calories consumed, while protein causes as much as 25%.
Consuming a liberal mixed diet, an additional 10% of the total energy
requirements for basal metabolism and voluntary activity, should be
added.

Recommended energy allowances:

The total amount of daily energy requirement can be calculated from BMR
in table (1) multiply physical activity in table (2).

ER = BMR X PA
The average daily energy allowances for:

- Reference man 79 kg, 176 cm is 2900 kcal/day.

- Reference woman 63 kg, 163 cm is 2200 kcal/day.

How to calculate the Recommended Daily Allowances for the protein,

fat & oil and carbohydrate:

 12 - 15% from the total daily energy requirement for protein

(12% for adults and 15% for pregnant & lactated women
and for children during growth).
 30% from total energy requirement for fat.
 The rest 55 – 58% from total energy requirement for
carbohydrate.

7
Recommended dietary allowances (RDA) and dietary reference intakes
(DRI):

The RDA and the DRI are the levels of essential nutrients that, based
on the available scientific knowledge are adequate to meet the
known nutrient needs of practically all healthy persons. See and fined
your RDA in attached table (3)

Dietary guidelines:

Dietary guidelines suggest what foods we should eat. These guidelines are
targeted to healthy general population to assist in the prevention of chronic
and degenerative diseases such as high blood pressure, heart disease, cancer
and diabetes, which may be “diseases of over nutrition” or “diseases of
affluence” they do not apply to individuals who need special diets because
of diseases or conditions that alter normal nutritional requirements.

These dietary guidelines are:

1. Eat a variety of foods.
2. Balance the food you eat with physical activity – maintain or improve
your weight.
3. Choose a diet with plenty of grains products, vegetables, fruits and
fiber.
4. Choose a diet low in fat, saturated fat and cholesterol.
5. Choose a diet moderate in salt and sodium.
6. Choose a diet moderate in sugar.

8
Food groups: There are four main food groups:

Bread and cereals • provides energy, plant protein, some

(6 - 11 servings) vitamins and minerals.

Fruits (2 - 4 servings) and • provides vitamins [A&C], some

minerals, fibers, simple sugar [fruits].
vegetables (3 - 5 servings)

Milk and milk products • provides calcium, phosphorus, B

complex, vitamin A and protein.
(2 - 4 servings)

Meat, fish, poultry, eggs • provides animal and plant protein, B

and pulses (2 - 4 servings) complex, iron and zinc.

 Fats (10% from saturated fatty acids) and sweets are to be taken
in moderation.

Each group contains foods of similar nutrition content. These food groups
are used to construct the food pyramid.

The food guide pyramid

The food guide pyramid illustrates healthful diet choices. It translates
the recommendations on nutrients intakes into recommendations for food
intakes [see figure].

9
Recommended dietary allowances [RDA] and dietary reference intakes
[DRI]:

The RDA and DRI are the levels of essential nutrients that based on
the available scientific knowledge are adequate to meet the known
nutrient needs of practically all healthy persons. See and fined your
RDA in attached table (3).

User of RDA:
1. Evaluation of dietary surveys data.
2. Food and nutrition information/education.
3. Food labeling.
4. Food fortification.
5. Food planning
6. Food programs
7. Therapeutic diets
8. Nutrient supplements and special dietary foods.
9. Developing new or modified food products
10. Guides for food selection.

10
 Food planning:

Try to complete the following table with your daily dietary you have
consumed yesterday and compare the total results with your daily
requirement. (use table 3).
meal Type of content quantity Prot. CHO Fat Energy
food of foods (gm) (gm) (gm) (Kcal)
Breakfast

Between

Lunch

Between

Dinner

Before
sleep
Total

Table (4): shows the Food groups and its Contents from Energy (E) and
Macronutrients.
food serving
Food groups CHO Prot. Fat Kcal
)‫(الحصة بالوحدة الغذائية‬
‫المجموعة الغذائية‬ (gm) (gm) (gm) (E)
‫كمية اإلستخدام بالتقريب‬
‫ الخبز والمعجنات‬Cereals 25gm
15gm 2gm ------ 70
)‫(ربع رغيف‬
Fresh Vegetables 200gm
----- ----- ----- -----
)‫(سلطات‬ ‫كما يشاء‬
Cooked Vegetables
100gm 7gm 2gm ------ 40
Fruits
)‫ (حسب الصنف‬100gm 10gm 40
Meats and pulses
30gm ------ 7gm 5gm 75
Milk and its products
240gm/ml (‫)كوب‬ 12gm 8gm 10gm 140
Fat & oils
5ml ----- ----- 5gm 45

11