Assignment 2_MaryFraser

NUTR-UE 1185.002
Clinical Nutrition Assessment and Intervention

Assignment 1 Part 2: Estimating Energy and Nutrient Needs

I. Complete the following table based on your client interview (Total points=10)

Height 5’ 10”

Current weight 185 lb

Weight changes and Lost 15 lbs since January 2017 (over a 9 month span) – A
associated time period for the slow steady downward trend
weight changes

UBW 170 lb

Sex M

Age 36

Physical activity: Bikes to and from work

Description of activity 5 day/week.
Frequency Each Biking Day, he totals 9.6 miles for apx.1 hour
Duration Totals 48 miles/ week and 5 hours/week of exercise at
with a moderate-high cycling physical activity level

II. Assessment of weight status - SHOW ALL CALCULATIONS (Total=30 points)

a. Calculate BMI. What is the classification of this BMI? (5 points)

BMI = # lbs. / height in2 x 703; (185 / 702” ) x 703 = 26.5 BMI overweight

b. Calculate IBW and state what it is: (5 points)

IBW = 106 + (6 x 10) = 166 lbs.

c. What percent of IBW is this person? (5 points)

(ABW x 100) / IBW = (185 x 100) / 166 = 111.45 %

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d. Do you need to adjust the IBW for overweight/obesity? If yes, what is the adjusted IBW? (5
points)
[(ABW – IBW) x 0.25] + IBW = Adjusted Body Weight; [(185-166) x 0.25] + 166 = 170.75 lbs.

e. Are there any other adjustments needed for IBW/DBW? (2 points)

No. He is not an amputee and has no other impairments.

f. Calculate percent of UBW; calculate percent of weight change if applicable. Is there a

significant or severe weight decrease (yes or no, briefly explain how you made that
determination)? (8 points)
(ABWx100) / UBW = (185 x 100) / 170 = 108.8% of UBW
Percent weight change from UBW: 108.8 – 100 = 8.8% weight change from usual body
weight.
His current weight is still higher than his UBW. This was a gradually weight gain that
occurred over time, and one which he is currently trying to reverse.
Since January 2017, the client went from an actual weight of 200 lbs. to a current actual
weight of 185 lbs. This gradual weight decrease of 15 pounds over +9 months is:
200 lbs. -185 lbs. / 200 x 100 = 7.5% weight loss over + 9 months. This is a slow and
moderate weight loss and a way the client can lose the weight he wants in a healthy
manner.

III. Estimation of Energy Needs - SHOW ALL CALCULATIONS and BODY WEIGHT
USED (Total points=40)

a. Calculate energy expenditure using:

1) Mifflin St. Jeor Equation (8 points) (text: Chapt 2)
Using 1 kg = 2.2 lbs; 185 lbs. / 2.2 = 84 kg ABW
Using 1 cm = .3937 inches; 70inches/.3937 = 177.8 cm or 179 cm height
RMR = 10 (wt kg) + 6.25( ht cm) – 5(age) +5
RMR = 10 (84 kg) + 6.25 (179 cm) – 5(36) +5
RMR = 2143.75

2) Estimated energy requirement or EER (8 points) (text: Chapt 2)

(client currently has a BMI of 26.5 (overweight) and I will use RMR as BMR; and I
have calculated his physical activity level (PAL) to be apx. 1.7, which is at active,
& gives him a PA = 1.27)
Using the equation for overweight and obese men, over 19 years old;
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According to the book, pages 23-24, it has an equation for men with a BMI over
25 and so I am using that equation, as opposed to the standard one found for men
in general which would be: 662 -9.53 x yrs age + PA x (13.7 x wt kg + 416 x Ht m)

TEE = 1086-10.1 x yrs age + PA x (13.7 x wt kg + 416 x Ht m)

= 1086 -10.1 x 36 +1.27 x (13.7 x 84 + 416 x 1.79m)
EER = 3129.61 kcal/day

3) Kcal/kg method (8 points) (text: Chapt 2)

I did not find this in Chapter 2 – I used my notes from Nutrition assessment which
stated the kcal per kg method as multiplying weight in kg by 30 calories.
kg wt x 30 calories = 84 x 30 = 2520 estimated calories

4) If you need to use an activity factor in estimating needs for your client, what would
be an appropriate factor to use and why? (8 points)
(PAL references are from the book p. 25)
An appropriate activity factor would be Active: 1.27

Client bikes regularly and bikes to and from work 5 days a week. On those days,
he bikes a total of 9.6 miles for apx.1 hour, achieving a moderate-high physical activity
level = PAL of 0.27 for 1 hour & also at work, he is always on his feet, standing, lifting,
carrying, walking, and bending for 8+ hours 5 days/ week – Figuring this as “household
tasks” activity level, his PAL would be: 0.14 for 8 hours. Sleep would be 0 PAL for 8
hours. The remaining hours are apx.1.5 hours walking for 0.09, Watching TV or reading
3 hours for 0.03 PAL, and the remaining part of the day, of 2.5 hours, he puts at
household tasks at 0.19 PAL. This totals 1x 0.27 + (8x.14) + (0 x 8) +(1.5 x 0.09) + (3 x
0.03) + (2.5 x 0.19) = 1.87 PAL; this is an active PAL and gets a PA 1.27

b. How do these estimates differ? What would you use to estimate your client’s needs? (8
points)
The energy estimates differ between the different equations. As the client is probably
more active than the average individual,
RMR yielded 2143.75 calories is simply the resting Metabolic rate and only takes into
account weight, height, age and a co factor. It does not take into account activity level. It
is a base calorie number.
Kcal/kg method yielded 2520 estimated calories – only took into account height and
weight for a healthy male adult. It did not take physical activity or TEF into account
EER for overweight men yielded 3129.61 kcal/day – took physical activity or TEF into
account, and is probably the closest to estimating the client’s needs.
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IV. Estimation of Protein Needs - SHOW ALL CALCULATIONS and BODY WEIGHT
USED (Total points=10)
a. Estimate total protein needs (grams/day) (5 points)
0.8 x 84 kg = 67.2 g/day PRO per DRI

b. What did you base your estimate on? Why? (5 points)

Client is basically healthy, is not stressed or injured, and can metabolize and use
protein fine. I used the DRI reference of 0.8 PRO g/ body weight kg

V. Estimation of Fluid Needs - SHOW ALL CALCULATIONS and BODY WEIGHT

USED (Total points=10)
c. Estimate total fluid needs (mL/day) (5 points) (text: Chapter 6)
35 ml /kg x 84 kg wt. = 2940 mL/day fluid needs.
d. What did you base your estimate on? Why? (5 points)
There is no gold standard to access fluid status. We can estimate what fluid
requirements are, and one good way is to base it on body size, aka weight, if
there are no health complications. According to the textbook, chapter 6, adult
males, who are healthy should consume water in the amount of 35ml/kg x body
weight. This seemed like an appropriate number to use.