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Nutrition

1. Nutrition Prof. Dr. Diaa A. Ibrahim Lecture 2 Dietary references and diet- planning Guides:

2. Dietary Reference Intakes (DRIs) : A re a set of nutrient-based reference values that are used for various purposes. The development of DRIs builds on the Recommended Dietary Allowances (RDAs), which have been published by the U.S. National Academies since 1941, And the Canadian Dietary Standards, known as Recommended Nutrient Intakes (RNIs), which have been published by the Canadian government since 1938. Dietary references and diet- planning Guides

3.   What are DRIs? Dietary Reference Intakes : The Dietary Reference Intake (DRI) is a set of nutrition recommendations created by the Institute of Medicine (IOM) of the National Academies in the United States. The DRI offers different types of reference values to guide safe and adequate intake of essential nutrients for healthy individuals. It's important to note that sick individuals have different needs . Dietary Reference Intakes

4. They are applied in various settings such as: N utrition assessment. M eal planning in schools and prisons. H ealthcare in hospitals and nursing homes. Research . T he food industry. N ational defense. F ood programs like Meals on Wheels and WIC, public policy.

5. ( Meals on Wheels)   Is a program that delivers meals to individuals at home who are unable to purchase or prepare their own meals).  WIC Supplemental Nutrition Program for Women, Infants, and Children  The program provides nutrition counseling, breastfeeding support, food assistance, and to help the person and his family live a healthy life.

6. Components of DRIs The DRI provides several types of reference values: ( RDA) = Recommended Dietary Allowances (RDAs) (EAR) = Estimated Average Requirement . Is defined as the average daily nutrient intake that to meet the requirements of 50% of the healthy individuals in a life stage and gender group. (AI ) = Adequate Intakes The average amount is adequate when there is not sufficient.

7. (UL) = Tolerable Upper Intake Levels The highest level of nutrient intake has no risk of adverse health effects for almost all individuals in the general population. As intake increases above the UL, the risk of adverse effects increases . (AMDR) = Acceptable Macronutrient Distribution Range A range of intakes for a particular energy source (Carbohydrate, Proteins, Fats) Estimated Energy Requirement (EER ) Expected intake to maintain body weight.

8. (RDA) = Recommended Dietary Allowances (RDAs) Are the levels of intake of essential nutrients that, are judged by the Food and Nutrition Board to be adequate to meet the known nutrient needs of practically all healthy persons . This mean the safety factor amounts to the estimated requirement to cover : Variation among individuals. Losses during cooking Lack of precision in the estimated requirement . Recommended Dietary Allowances = Requirement + Safety factor

9. Factors that determine RDA 1. Variations in nutrient requirements 2. Absorption ability Variations in nutrient requirements The requirement for various nutrients depends on the age, and gender of an individual. During infancy and childhood, nutrients are required for growth and development. In adulthood, these are calculated by height, weight, and special physiological needs like pregnancy and location. While in old age maintenance is an important function of nutrients   Absorption ability The amount of nutrients to be consumed also depends on the amount which our body easily absorbs. E.g. Animal proteins are absorbed more than 80% while plant proteins are poorly absorbed.

10. Factors that affect RDA RDA of an individual depends on many factors like: Age Sex Physical work which include: Sedentary . Moderate. Hard (Heavy). 4. Physical stress 5. Pregnancy. 6. Location . 7. Psychological stress

11. The Food Dome; dietary guidelines for Arab countries At this stage, the identification of food groups used in the region was focused on the food groups commonly used in the Arab countries. It was found that there is no single standard reference used for grouping food. Some countries used four groups and others used five and/or six food groups. This was mainly due to the educational background of the people advocating the food groups. For this project, five food group guidelines were selected.

12. These are: Cereals and their products Vegetables Fruit Milk and dairy products ; Meat , chicken, fish, eggs, legumes and nuts.

13. Specific recommendations for the intake of food from each food group Several recommendations related to the intake of the different food groups were suggested for those using the Food Dome and are summarized as follows: Milk and dairy products: 1. Consume low fat milk and dairy products. 2. Consume milk and dairy products fortified with vitamin D. Fruit : 1. Eat a variety of fruit. 2. Choose fruit when it is in season. 3. Drink fresh fruit juice.

14. Vegetables: Eat more dark green vegetables like spinach and more orange vegetables like carrots. Cereals and their products: 1. Eat at least half the cereals as whole grains. 2. Eat more fortified cereals and their products . Meat , eggs, legumes and nuts: 1. Choose low fat or lean meat. 2 . Consume legumes at least 3 times a week. 3. Consume fish on most days if possible. 4. Consume chicken and other poultry without the skin as and when possible.

15. Specific recommendations for the use of the food dome for vulnerable groups A. Women at reproductive age, pregnant and lactating women should: A.1 . Consume a sufficient quantity of food rich in iron. A.2.Consume a sufficient quantity of food that promotes the absorption of iron such as foods rich in vitamin C ( orange , guava , mango, etc.). A.3. Pregnant women should consume a sufficient quantity of food rich in folic acid or take folic acid tablets.

16. A.4. Consume a sufficient quantity of food fortified with vitamin D. A.5. Pregnant women should consume foods that are properly cooked . A.6. Pregnant women should monitor their weight and not undertake any kind of dieting . A.7. Pregnant women can participate in physical activity for 30 minutes on most days, but should avoid activities related to falling or those affecting the abdomen. A.8. Lactating women should consume appropriate quantities of food to provide for sufficient breast milk. Reducing weight may be safe at this stage but a restrictive diet should not be followed.

17. B. Infants and preschool children (below 6 years): B. 1. It is preferable that mothers continue breast feeding until the second year of their infant’s life as far as possible. B.2. For breast fed infants, supplementary foods should be introduced at the age of 6 months. B. 3. Children between 2 to 8 years should drink two cups of low fat milk or the equivalent of other dairy products per day and preferably milk fortified with vitamin D. B. 4. Breakfast should be eaten daily with an emphasis on a variety of different foods. B. 5. Children should consume daily sufficient amount of fruit and vegetables.

18. B. 6. Routine measurement of weight and height, to prevent overweight and obesity should be undertaken. B. 7. Energy from fat should not exceed 35% of total daily food intake. B. 8. The intake of food and drink rich in sugar, especially between meals should be minimized as far as possible. B . 9. Food should be thoroughly cooked before being given to children.

19. C. School children and adolescents should: C . 1. Eat sufficient quantities of fruit and vegetables daily. C. 2. Reduce the intake of food and drink rich in sugar, especially between meals . C. 3. Consume a sufficient quantity of whole cereals daily and of those fortified with micronutrients.

20. C. 4. Reduce intake of food rich in fat such as some western and local fast foods, some local sweets and dishes. C. 5. Brush and clean teeth daily using appropriate brush and toothpaste containing fluoride. C . 6. Drink a sufficient quantity of water and other liquids daily. C. 7. Consume 3 cups of low-fat milk or dairy products daily. C. 8. Energy from fat should not exceed 30% of total daily calories. C. 9. Maintain proper weight for height . C. 10. Participate in moderate physical activity for 60 minutes on most days.

21. People aged 50 years and above should: Take vitamin B12 and vitamin D tablets and foods fortified with these vitamins daily as possible and affordable. Drink a sufficient quantity of water and other liquids daily. Consume foods low in fat and low in salt. Most traditional foods and dishes contain high amounts of salt, therefore, reducing the salt used in cooking should be considered. Consume an adequate amount of fruit and vegetables daily . Practice physical activity daily as and when possible. Consume food and dishes that are properly cooked . 7. Reduce the intake of food and drink rich in sugar, especially between meals