Lecture 3 Dietary requirements and guidelines

Lecture 3:Dietary Requirements And Guidelines

DR. SHARIFAH WAJIHAH WAFA

[email protected]

Topic Learning Outcomes

Define the Dietary Reference Intakes (DRIs)

Present four (4) levels that represent five (5) food group in Malaysian Food Guide Pyramid

Read and understand a nutrition facts label.

Present the 14 key Messages of Malaysian Dietary Guidelines and 15 Key Messages Malaysian Dietary Guidelines for Children and Adolescents

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2

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Course Outline

Dietary reference intakes: Defining Nutrient Needs

The Food Guide Pyramid: A tool for Diet Planning

Food Labels: Knowing What you Choose

The Dietary Guidelines for Malaysians

I. Dietary reference intakes: Defining Nutrient Needs

What are DRIs?

• Standards to guide safe & adequate intakes of essential nutrients for healthy humans.– Sick individuals have different needs.

• Designed to promote optimal function & health for healthy people.

• Are specific for groups of people based on: life stage, gender, conditions of pregnancy & lactation.

• Are adequate for moderately active people.

• developed by the Institute of Medicine of The National Academies.

Malaysia RNI

• 20 September 2002: First meeting of the TWG with three Sub-committees– Technical Sub-committee for Energy

and Macronutrients,– Technical Sub-committee on Vitamins,

and – Technical Sub-committee on Minerals. – The

• The Sub-Committees were guided by several recent publications as a key source of reference namely, FAO (2004) for energy requirements, FAO/WHO (2002) and IOM-FNB (1997-2002) reports for vitamin and mineral requirements.

Components of the DRIs

• Four values instead of one

• These are:

– EAR: Estimated Average Requirement

– RDA: Recommended Dietary Allowance

– AI: Adequate Intake

– UL: Tolerable Upper Intake Level

• How derived? How Interpreted?

How are DRIs established?

• By scientific committee literature review.

• Nutrients are given an Recommended Dietary Allowance (RDA), Adequate Intake (AI), or Estimated Average Requirement (EAR) value by life stage & gender.

RDA: level to meet 97-98% of needsAI: average or mean intake level. EAR: average daily nutrient intake level

estimated to meet the requirement of half the needs.

Other DRI Components

• Tolerable upper intake levels (UL) for vitamins & minerals.– Highest intake level likely to pose no risk of

adverse health effects.• Acceptable Macronutrient Distribution Ranges

(AMDR) for energy producing nutrients & essential fatty acids.– % Calorie range.

• Estimated Energy Requirement (EER) for Calories. • DRI for physical activity.

ESTIMATED AVERAGE REQUIREMENT (EAR)

• represents a nutrient intake that is estimated to meet the requirement of half the healthy individuals in a population

• A value that is useful for evaluating the adequacy of, and planning for, the nutrient intake

• The prevalence of inadequate nutrient intakes can be estimated by looking at the population with intake below the EAR

RECOMMENDED DIETARY ALLOWANCE (RDA)

• The RDA represents the average daily dietary intake that is sufficient to meet the nutrient requirement of nearly all (97%-98%) healthy individuals in a population.

• The RDA is to be used as a guide for the individual

• RDA is ONLY a target

• Intake less than the RDA does not necessarily indicate that the need of that particular individual have not been met.

• However, the risk of deficiency is low if intake meets the RDA.

ADEQUATE INTAKES (AIs)

• AIs are estimates used when there is insufficient scientific evidence to set an EAR and calculate an RDA

• It is based on observed or experimentally determined approximation of the average nutrient intake by a healthy population

• When an AI value rather than an RDA is set, it targets the need for more research on the requirement of that nutrient

• Can be used as a goal for individual intake

TOLERABLE UPPER INTAKE LEVEL (UL)

• The UL is the highest level of daily nutrient intake that is likely to pose no risks of adverse health effects to most individuals in the general population.

• Consider it a maximum for daily intake of a specific nutrient on a long-term basis.

• Used as a guide for limiting intake when planning diets and evaluating the possibility of over-consumption

Tolerable Upper Intake Levels: ULs

• For vitamins with DRIs

• For minerals with DRIs

• For arsenic, boron, nickel, silicon, vanadium

Interpreting the DRI

• Used to assess adequacy of dietary intake

• Designed to ensure adequate nutrition for most people in a population

• Does not inform us of what specific foods to eat

• Note: Another term, the Daily Value (DV) is used on food labels, discussed later.

Applications of the DRI

• Provide a set of standards that can be used to– plan diets– Assess the adequacy of diets– Make judgments about excessive intakes for individuals

and populations

• Example: they can be used as a standard for meals prepared for – Schools– Hospitals– health-care facilities– gov feeding program for the elderly – space-shuttle astronauts

Cont’d..

• Can be used to

– determine standards for food labeling

– develop practical tools for diet planning such as Food Guide Pyramid

– Interpret information gathered about the food consumed by a population to help identify potential nutritional inadequacies that may be of public health concern

DRIs Exist For:

• Vitamins:– A, D, E, K, B1 (thiamin), B2

(riboflavin), B3 (niacin), B6, B12, folate, vitamin C

– biotin, pantothenic acid, choline

• Minerals:– Ca, P, Mg, Fe, Zn, I, Se

– Cu, Mn, Cr, Mo, F

– Na, K, Cl

• Water: – Men ≥19 years: 3.7 L/day (approx.

15 cups)– Women ≥ 19 years : 2.7 L/day

(approx. 11 cups)

DRI for Protein

• The adult DRI for protein is set at 0.8 grams/Kg. This level is for inactive persons.

• See appendix for gram/Kg need for infants, children, and adolescents.

• Although not DRIs: Active persons need more than the DRI, approximately 1.2 - 1.6 grams/Kg. Endurance athletes need more than the DRI, approximately 1.8-2.0 grams/Kg.

DRI for Carbohydrate, Fiber & Fat

• Carbohydrate: At least 130 gm/day for adults

• Fiber: 38 gm/d 25 gm/d, [adults] • 1.4 gm/100 Calories consumed

• FAT: not determined for adults• Essential Fatty Acids:

• Linoleic Acid:

17 12 [adults, gm/d ]

• Alpha-Linolenic Acid:

1.6 1.1 [adults, gm/d ]

DRI for Exercise

• There is a DRI for exercise!

• It is 60 minutes cumulative moderate exercise per day.

• That means moving body parts and sweating while you are doing it.

Na, K, Cl & Water

• In 2004 the DRI was published for Water and the Electrolytes (Na, Cl, and K)

• Sodium (Na): 1.5 gm if 19-50 years Sodium

• Chloride (NaCl): 19-50 years 3.8 gm (3.8 gm NaCl –1.5 gm Na = 2.3 gm/day of Cl)

• Potassium (K): 4.7 gm/day if >18

• Water: 2.7 L/day if 3.7 L/day if

DRIs Do Not Exist For:

• Cholesterol

• Sulfur (sulfate)

• Cobalt

• Non-essential, nutritional supplements

Recap..

• DRIs are a collection of values to express a persons nutrient need based on their life stage & gender.

• The exact DRI value may be as an RDA, AI, EAR depending on scientific information available for each nutrient.

• DRIs are expressed as ULs and AMDRs.

• For Calories the DRI is called the EER.

• There is DRI recommendation for Physical activity.

• The DRIs are standards that have many important purposes and uses.

References for this presentation are the same as those for this topic found in module 2 of the textbook

II. The Food Guide Pyramid: A tool for Diet Planning

2. THE FOOD GUIDE PYRAMID: A TOOL FOR DIET PLANNING

• Malaysian Food Pyramid is a simple guide for individuals to vary their foods intake according to the total daily food serving recommended.

• A balanced diet contains the combination of foods that will provide all the nutrients needed by our body.

• The body needs many types of food in varying amounts to maintain health.

• A food pyramid consists of four (4) levels that represent five (5) food group. Indicated beside each food group is the recommended number of servings per day from each group.

• From the bottom to the top of the food pyramid, the size of each food group becomes smaller indicating that an individual should eat more of the foods at the base of the pyramid and less of the foods at the top of the pyramid.

Food Groups and Level

Level 1 :

Rice, noodles, bread, cereal,

cereal products and tubers

•Eat 4 to 8 serving in a day.•Example of one serving of grains :

• 1 cup (2 scoops) of cooked rice• 1 cup of yellow mee• 1 ½ cup of bihun and laksa (soaked)• 1 cup of breakfast cereals• 6 pieces biscuit (cream crackers)• ½ slice of capati• 2 slices of bread• 2 cup of plain rice porridge• 2 whole of potato

Cont’d..

Level 2 :

Fruits and vegetables

•Eat at least three (3) servings of vegetables and at least two (2)

serving of fruits a day

•Example of one serving of vegetables :

• ½ cup of dark green leafy vegetable , cooked

• ½ cup of fruit vegetables , cooked

• 1 cup of ulam, raw.

•Example of one serving of fruits :

• 1 whole of apple / pear / orange / mango

• 1 slice of papaya / watermelon / pineapple

• ½ whole of guava

• 2 whole small bananas (pisang emas)

• 1 whole medium banana (pisang berangan)

• 8 whole small of grapes.

Level 3 :Fish, poultry,

meat and legumes

•Recommended daily serving :

• ½ - 2 servings of poultry, meat, egg

• 1 serving of fish

• ½ - 1 serving legumes

•Example of one serving of fish, poultry, meat and eggs :

• 1 medium ikan kembung

• 2 pieces ikan tenggiri

• 2 pieces of lean meat

• 1 medium-sized chicken drumstick

• 2/3 cup of anchovies without head

• 2 whole eggs

•Example of one serving of legumes :

• 1 cup of chickpea / dhal

• 1 ½ cups canned baked bean

• 2 pieces of tempe / tauku / tauhu

• 1 ½ glasses of unsweetened soya bean milk.

Cont’d..

Level 3 :Milk and dairy

products

•Consume 1-2 servings a day.

•Example of one serving of dairy :

• 1 glass of milk (250 ml)

• 1 slice of cheese

• 1 cup yogurt

• 4 dessert spoons of milk powdered, heaped.

Level 4 :Fats, oils, sugar

and salt

•Located on the crest or top of the pyramid shows these foods

should be taken in small amounts only.

•Excessive intake of fats, oil, sugar and salt can contribute to

higher risk of chronic disease such obesity, diabetes mellitus,

cardiovascular diseases, hypertension and cancers.

•Limit intake of foods high in fats, oil, sugar and salt and

minimize the use of fats, oil, sugar and salt in food preparation.

Cont’d..

Number of servings recommended based on calorie needed

Food group 1500 kcal/day1

2000 kcal/day2

2500 kcal/day3

Cereals and grains 4 servings 6 servings 8 servings

Fruits 2 servings 2 servings 2 servings

Vegetables 3 servings 3 servings 3 servings

Meat/poultryFish

Legumes

½ serving1 serving½ serving

1 serving1 serving1 serving

2 servings1 serving1 serving

Milk and dairy products

1 serving 2 servings 3 servings

1 Suitable for sedentary women and older adult.2 Suitable for children, teenage girls, moderately active women and sedentary men.3 Suitable for teenage boys, active men, very active women and underweight men and women.

Cont’d..• Choosing for balance and variety

– When planning a diet, it must

• Meet nutrient needs

• Consider the nutrient density

• Be variety

• Be balance

What is the concept of nutrient density?

• Foods that contain a significant amount of a specific nutrient compared to its caloric content have a high nutrient density.

• Opposite of “empty calorie”

• i.e : both skim milk and ice cream in a same group. However, a 1 cup serving of skim milk provides 300mg of calcium in 90 kcal whereas a cup of ice-cream provides 168 mg of calcium in 265 kcal. Thus, skim milk have higher nutrient density because it provides more nutrients per kcal than the ice-cream

III. Food Labels: Knowing What you Choose

FOOD LABELS: KNOWING WHAT YOU CHOOSE

• Another tool that can be used in diet planning

• Designed to help consumers make healthy food choices by providing information about :

– the nutrient composition of foods

– How a food fits into the overall diet

Consumer Nutrition: Food Labels and Health ClaimsWhat nutrition information do food labels provide?

• Nutrition Facts

How can I use this information to select a healthier diet?

• The Daily Value (DV)

– A nutrient reference value used on food labels to help consumers see how foods fit into their overall diet

– Based on some of the DRI values

– Those listed based on 2,000 Calorie intake (Adult female)• The % of the DV on the label is for a 2,000 Calorie intake

– Some information for 2,500 Calorie intake (Adult male)

Sections of a Food Label

1. Serving Size – at the top Green color

2. Calories- below serving size White color at the top

3. and 4. Nutrients Yellow and Blue color

5. Footnote White color at the bottom

6. % Daily Value On the far right Purple color

US Food and Drug Admin

Serving Size

• How much is the serving size?– Standard

– Compare similar foods

– Familiar units• Cups, pieces, tablespoons

– How much actually consumed

• Servings per container– Multiply if consuming more than one serving

– Total amount of calories and nutrients

Calories

Calories per Serving Amount of energy in each serving Must multiply calories per serving by number of servings

consumed

Calories from Fat Compare calories from fat to number of calories in each serving

Calculate %

Generally 40 is low 100 is moderate 400 is high

Nutrients

Limit These Be Sure to Get Enough of These

Total Fat Saturated

Trans

Cholesterol

Sodium

Adequate or too much

Can increase risk of chronic diseases

Dietary Fiber

Vitamin A

Vitamin C

Calcium

Iron

Usually don’t get enough

Can reduce risk of some diseases or conditions

Footnote

• The “*” symbol after the heading “%Daily Value” refers to the footnote

• “%DVs are based on a 2,000 calorie diet”

– Must appear on all food labels

• Footnotes are the same on all products

Percent Daily Value

• %DV– On right hand side of every food label

– Based on 2,000 calorie diet

• Great way to compare food products to each other– 5% or less is low

– 20% or more is high

Summary

• 6 sections to a food label– Serving size, calories,

nutrients to limit,

nutrients to get enough of,

footnote and %DV

• Start at the top

and work down

• Use %DV to quickly

compare one food product

to another

IV. The Dietary Guidelines for Malaysians

4. MALAYSIAN DIETARY GUIDELINES

• There are 14 key messages in these guidelines.

MDG 2010

• Key Message 1: Eat a variety of foods within your recommended intake.– Key Recommendations

1. Choose your daily food intake from a combination of foods based on the Malaysian Food Pyramid

2. Choose your daily food intake according to the serving size recommended

– Additional recommendations: nutrient supplements• Supplements are not necessary for most individuals.

Supplements of vitamins, minerals or fiber do not supply the nutrients and other essential components present in foods that are important to health

• Key Message 2: Maintain body weight in a healthy range.– Key Recommendations

1. Maintain body weight in the healthy range by balancing calorie intake with physical activity

2. Weigh yourself regularly, at least once a week

3. If you are an adult, prevent gradual weight gain over time

4. If overweight, aim for a slow and steady weight loss

5. If underweight, increase energy intake as recommended

MDG 2010

• Key Message 3: Be active physically every day.– Key Recommendations

1. Be active everyday in as many ways you can

2. Accumulate at least 30 minutes of moderate intensity physical activity on at least 5 to 6 days a week, preferably daily

3. Participate in activities that increase flexibility, strength and endurance of the muscles, ad frequent as 2-3 times a week

4. Limit physical inactivity and sedentary habits

MDG 2010

• Key Message 4: Eat adequate amount of rice, other cereal products (preferably whole grain) and tubers.

– Key Recommendations

1. Consume at least 4 servings of cereals foods daily

2. Choose at least half of your grain products from whole grains

3. Choose cereal products that are high in fiber, low in fat, sugar and salt

MDG 2010

• Key Message 5: Eat plenty of fruits and vegetables every day.


1. Eat a variety fruits everyday

2. Eat a variety vegetables everyday

3. Eat at least 5 servings of fruits and vegetables everyday

MDG 2010

• Key Message 6: Consume moderate amounts of fish, meat, poultry, eggs, legumes and nuts.– Key Recommendations

1. Consume fish more frequently , if possible daily

2. Consume meat, poultry and egg moderately

3. Practice healthier cooking methods for fish, meat, poultry and egg dishes

4. Choose meat and poultry that are low in fat and cholesterol

5. Consume legumes daily

6. Include nuts and seeds in weekly diet

MDG 2010

• Key Message 7: Consume adequate amounts of milk and milk products.


1. Consume milk and milk products everyday

2. Replace sweetened condensed milk and sweetened condensed filled milk with unsweetened liquid or powdered milk

MDG 2010

• Key Message 8: Limit intake of foods high in fats and minimize fats and oils in food preparation.– Key Recommendations:

1. Limit the intake of UFA to less than 10%of total daily calorie intake

2. Increase the intake of MUFA and PUFA

3. Limit the intake of foods high in cholesterol

4. Limit foods containing TFA

5. Minimize the use of fat in food preparation in order to keep total daily fat intake between 20% to 30% energy

6. When eating out, choose low-fat foods

MDG 2010

• Key Message 9: Choose and prepare foods with less salt and sauces


1. Limit salt intake to 1 tsp a day

2. Reduce consumption of highly salted foods and condiments

MDG 2010

• Key Message 10: Consume foods and beverages low in sugar


1. Eat foods low in sugar

2. Drink beverages low in sugar

MDG 2010

• Key Message 11: Drink plenty of water daily.

– Key Recommendations:

1. Drink 6-8 glasses of plain water daily

2. Maintain fluid intake from other food sources

3. Avoid alcoholic beverages

MDG 2010

• Key Message 12: Practice exclusive breastfeeding from birth until 6 months and continue to breastfeed until two years of age– Key recommendations

1. Prepare for breastfeeding during pregnancy2. Initiate breastfeeding within one hour of birth3. Breastfeed frequently and on demand4. Give only breast milk to baby below six months with no

additional food or food5. Continue to give babies breast milk even if the baby is not with

the mother6. Introduce complementary foods to baby beginning at 6 months

of age7. Lactating mothers should get plenty of rest, adequate food and

drink to maintain health8. Husband and family members should provide full support to

lactating mothers.

MDG 2010

• Key Message 13: Consume safe and clean foods and beverages


1. Choose safe and clean foods and beverages

2. Store foods appropriately

3. Prepare foods hygienically

4. Cook foods thoroughly

5. Hold foods appropriately

6. When eating out, choose safe and clean premises

MDG 2010

• Key Message 14: Make effective use of nutrition information on food labels.


1. Use Nutrition Information Panel (NIP) as a guide in making food choices

2. Make use of nutrition claims wisely

3. Educate children on the use of NIP

MDG 2010

MDG for children and adolescents

• Key Message 1: Practice exclusive breastfeeding from birth until 6 months and continue to breastfeed until 2 years of age– Key Recommendations

1. Be mentally prepared during pregnancy for exclusive breastfeeding2. Start breastfeeding within one hour of birth3. Breastfeed frequently and on demand.4. Breastfeed with correct techniques.5. Avoid giving liquids or food other than breast milk to breastfed

babies below 6 months.6. Continue to give breast milk even when mother returns to work.7. Get enough rest, nutritious food and drinks to maintain health while

breastfeeding.8. Obtain full support to breastfeed from husband, family members

and community.9. Use cup feeding as an alternative to breastfeeding.

• Key Message 2: Give appropriate complementary foods to children between the age of 6 months to 2 years– Key Recommendations

1. Start baby on complementary food from 6 months of age.2. Feed children with enough food to meet their energy needs.3. Increase the feeding frequency of complementary foods

according to age.4. Change food texture and preparation methods gradually as the

baby gets older.5. Give a variety of food and gradually increase the quantity to

ensure that all nutrient needs are met.6. Consider your child’s stage of development and ability when

feeding.7. Give sick children extra fluids and offer small but frequent

meals.

• Key Message 3: Eat a variety of foods within your recommended intake


1. Choose and ensure that the daily diet consists of foods based on the Malaysian Food Pyramid.

2. Choose and ensure the number of servings consumed are based on caloric needs.

• Key Message 4: Attain healthy weight for optimum growth– Key recommendations

1. Monitor the growth of children and adolescents using appropriate growth standards or charts to ensure healthy growth.

2. Children and adolescents should consume adequate amount of calories and nutrients needed for healthy growth.

3. For children and adolescents who are overweight or obese, reduce weight gradually by adopting a healthy diet and increase physical activity.

4. If the child is underweight or having growth failure, increase calorie intake as recommended.

5. Instill a healthy body image in children and adolescents.

• Key Message 5: Be physically active everyday


1. Be physically active everyday in as many ways as you can.

2. Accumulate at least 60 minutes of moderate-intensity physical activity daily.

3. Participate at least 3 times a week, in activities that increase muscle and bone strength.

4. Limit physical inactivity and sedentary habits.

• Key Message 6: Eat adequate amount of rice, cereals or tubers

– Key recommendations

1. Ensure an adequate intake of cereals and cereal based foods according to age.

2. Ensure that at least half of daily cereal intake includes whole grain.

3. Prepare and choose healthier tubers and cereal products.

• Key Message 7: Eat fruit and vegetables everyday


1. Eat a variety of fruits and vegetables everyday.

2. Eat adequate amount of fruits and vegetables everyday.

• Key Message 8: Consume moderate amounts of fish, meat, poultry, egg, legumes and nuts– Key recommendations

1. Eat fish daily.

2. Consume meat, poultry and egg moderately.

3. Practice healthier cooking methods for fish, meat, poultry and egg dishes.

4. Choose meat and poultry that are low in fat and cholesterol.

5. Consume legumes daily.

6. Include nuts and seeds in weekly diet.

• Key Message 9: Consume milk and milk products everyday


1. Consume 2 to 3 servings of milk and milk products everyday.

2. Use milk and milk products creatively.

3. Choose milk and milk products appropriate to physiological needs.

4. Encourage milk consumption through education and promotion.

• Key Message 10: Include appropriate amounts and types of fats in the diets


1. Limit total daily fat intake to 25 and 30% of energy.

2. Limit the intake of saturated fats (SFA).

3. Increase the intake of polyunsaturated fatty acids (PUFA).

4. Limit foods containing trans fatty acids (TFAs).

5. Choose low-fat foods when eating out.

• Key Message 11: Limit intake of salt and sauce


1. Choose and prepare foods with less salt and sauces

2. Instil preference for low-salt foods.

• Key Message 12: Consume foods and beverages low in sugar

– Key recommendations:

1. Eat foods low in sugars.

2. Drink beverages low in sugars.

3. Instil a preference for less sweet taste.

4. Choose sugar-free or less sugary products.

• Key Message 13: Drink plenty of water daily


1. Drink an adequate amount of plain water daily.

2. Avoid alcoholic beverages.

• Key Message 14:Consume safe and clean foods and beverages– Key recommendations

1. Keep clean.2. Prepare food hygienically.3. Cook food thoroughly.4. Keep food appropriately.5. Use safe water and safe raw materials.6. Read the product label.7. Choose clean and safe foods.8. Use safe foods containers.9. Choose clean and safe premises to eat.

• Key Message 15: Educate children on the use of nutrition information on food labels– Key recommendations

1. Educate children on the nutrition information found on food labels.

2. Create various opportunities to educate children about the nutrition information on food labels.

3. Explain the components in the Nutrition Information Panel (NIP) for older children.

4. Explain the meaning of ‘Nutrient Content Claim’ and ‘Nutrient Comparative Claim’.

5. Make nutrition labeling education as part of school activities.

Thank you for listening…

Lecture 3 Dietary requirements and guidelines

Health & Medicine

Transcript of Lecture 3 Dietary requirements and guidelines