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Welcome to Seminar on Nutrition Assessment and Management in Family Medicine Part-3

Welcome to Seminar on Nutrition Assessment and Management in Family Medicine Part-3. Meera Kaur, PhD, RD Assistant Professor, Family Medicine kaur@cc.umanitoba.ca. 18. Estimation of Energy and Protein Requirements.

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Welcome to Seminar on Nutrition Assessment and Management in Family Medicine Part-3

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  1. Welcome to SeminaronNutrition Assessment and Management in Family MedicinePart-3 Meera Kaur, PhD, RD Assistant Professor, Family Medicine kaur@cc.umanitoba.ca

  2. 18 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

  3. 19 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

  4. 20 Protein Requirements Based on ideal body weight.

  5. 26 • How am I suppose to have time to do all of this???

  6. 27 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.

  7. 28 4 B’s for Better Eating • Body Mass Index • Blood pressure and HTN • Balanced diet • Breakfast

  8. 30 Nutrition Checklist based on warning signs: DETERMINE assessment tool • 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

  9. 31 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?

  10. 32 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.

  11. 33 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).

  12. 34 Eating Well with Canada’s Food Guide –NEW 2007

  13. 35 http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html

  14. 36

  15. 37 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.

  16. 29 Terri Terri 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% milk 1245 hrs 1 sandwich: corned beef thick rye (= 2 Grain, 2 Meat) 1 cup Campbell’s Chicken Noodle soup (= ½ Grain) 1 can Diet Pepsi 1530 hrs 1 glass red wine (8oz) Peanuts (1/2 cup) (= 2 Meat) 1800 hrs 1 vodka with Diet 7-up Chicken-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% milk 2200 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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  18. Questions??

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