Matters of concern
For children, the daily calorie requirement is calculated based on the child's age, gender and activity status. For a child between 2 and 3 years old, the recommended daily calorie intake is 1000 to 1400 kcal/day; this requirement increases with the age of the child. Children during a growth spurt require greater amounts of calories to maintain the body and grow. The daily recommended calorie intake for children aged 11 to 12 years is between 1800 and 2200 kcal/day. Another way to generalize calorie needs is that a baby needs 100 kcal/kg/day, children 1 to 3 years need 80 kcal/kg/day, 4 to 5 years 70 kcal/kg/day, and 6 to 8 years 60 to 8 years. 65 kcal/kg/day. and 9+ need 35 to 45 kcal/kg/day. Growth charts are essential for guiding nutritional advice in children.
The daily recommended intake (DRI) of water depends on age, gender, weight, activity status, air temperature and humidity. Plain water is the best way to meet this requirement. A recent study shows that high-income children drink water more regularly, even though 75% of children do not meet the DRI.[1]For infants weighing between 3.5 kg and 10 kg, the daily fluid requirement is 100 ml/kg. For children from 11 kg to 20 kg, the daily water requirement is 100 ml/kg for the first 10 kg and 50 ml/kg for each kg over 10 kg. For children over 20 kg, fluid requirements are calculated as 1500 ml for 20 kg and 20 ml/kg for each kg over 20 kg, but no more than 2400 ml of fluid should be given at one time.
Another way to calculate daily fluid requirements is the 4-2-1 rule: 4 ml/kg/hour for the first 10 kg of weight and then 40 ml/hour +2 ml/kg/hour for kg 10 to 20 and then 60 ml/hour + 1 ml/kg for every kg >20. Using this formula, a 5 kg child would need 20 ml/hour or 480 ml/day, and a 25 kg child would need 65 ml/hour or 1.5860 ml/day. Globally, malnutrition is responsible for more than 3 million deaths among children < 5 years old per year. Factors that result in a low-quality diet include lack of knowledge, poverty, taste, lack of time and lack of availability.[2][3]
Adults
The daily recommended calorie intake for adult men and women is 2600-2800 kcal/day and 2000-2200 kcal/day, respectively. This requirement is not static and depends largely on the activity status and physical condition of the body. A nutritional imbalance leads to undernutrition and overnutrition, both of which are harmful to the body. The body's daily water requirement depends on age, weight, gender and air temperature. The DRI for water for men and women aged 19 to 30 is 3.7 L/day and 2.7 L/day, respectively. In an analysis conducted in the United States, the estimated median total water intake for men and women aged 19 to 50 years was 3.5 L/day and 3.0 L/day, respectively.[4]In a recent study, 83% of women and 95% of men ≥71 years could not meet the DRI for water.[5]
Pregnant woman
Nutrition plays a crucial role during pregnancy. Recommended weight gain during pregnancy depends on pre-pregnancy body mass index (BMI). Women who are underweight (BMI <18.5) before pregnancy are advised to gain 28-40 lbs during pregnancy, normal (BMI 18.5-24.9) 25-35 lbs, overweight (BMI 25-29, 9) 15-25 lbs and overweight (1-1 -30) 0BMI lbs. Pregnant women do not need to increase their daily calories during the first trimester. An additional 340 calories per day is recommended during the second trimester, and then an additional 450 calories per day in the third trimester.
Excessive weight gain during pregnancy can lead to complications for mother and fetus. Maternal complications include cesarean section, postpartum weight maintenance, and postpartum depression. An increased incidence of obesity, allergies, asthma and cancer is observed in children born to mothers who had obese weight gain during pregnancy. The National Research Council guidelines also recommend a range of weight increases for women carrying twin fetuses. Women of normal weight before pregnancy should gain 17kg to 25kg, while overweight and obese women should gain 14kg to 23kg and 11kg to 19kg, respectively. It is important to ensure that women become pregnant while they are in the normal weight range; preconception advice and appropriate contraception should be discussed. The doctor should monitor weight gain during pregnancy and guide pregnant women in appropriate dietary changes.
A prenatal vitamin should be taken before conception and then during pregnancy and lactation. An adequate intake of folic acid (400 mcg/day) in the first trimester reduces neural tube defects. Recommended iron intake is doubled to 30 mg/day to help with increased blood production. The vitamin D requirement increases to 600 IU per day and calcium intake remains at 1000 mg/day. The protein requirement increases from 0.8 g/kg/day to 1.1 g/kg/day. The fluid requirement also increases to 3 liters per day. Women should not avoid highly allergenic foods as a prophylactic measure during pregnancy. Women who follow certain diets can continue to do so with the help of their doctor to ensure all nutritional needs are met.
Athletes
Athletes' nutritional needs vary depending on the intensity and type of training. Doctors should consider body composition, not just body weight, when determining the needs of athletes. Special circ*mstances to consider include the desire to gain weight, lose weight, build muscle, exercise in extreme heat, exercise at high altitude, and how much time is spent exercising each day. Hydration is important for peak performance, so athletes should make sure they hydrate in the 24 hours before an event, in the hour before their event, during their event, and then recover after their event.[6]
Clinical significance
Lack of any of these nutrients can cause serious health problems. Therefore, it is important to consume a diet rich in both macronutrients and micronutrients.
Carbohydrates
About 50 to 55% of daily calories should come from carbohydrates, which are composed of monosaccharides including fructose, glucose and galactose. Each gram of carbohydrates contains energy equivalent to 4 kcal. Complex carbohydrates with a low glycemic index steadily increase blood sugar levels and are preferred over simple carbohydrates such as dextrose.[7]The restriction of simple sugars should be 5-10% of daily calorie needs. Legumes, whole grains, beans, fruits and vegetables should be consumed to meet daily carbohydrate requirements.[8]
Protein
Proteins are made up of subunits called amino acids. These subunits provide energy and are essential for the construction of the body's structural units, e.g. muscles, bones and ligaments. About 30% of dry body weight is attributed to proteins. About 20% of daily calories should come from protein-rich sources such as red and white meat, eggs and legumes. The daily recommendation for protein intake is 1.6 g/kg body weight for an adult. Some amino acids, e.g. leucine and valine are said to be essential; these are not produced by the body and must be consumed through the diet. A large prospective study found that plant proteins, when consumed as a replacement for animal proteins, reduce mortality from cancer and cardiovascular disease.[9]
Marasmus is a form of protein-energy malnutrition that results from a deficiency of energy-producing nutrients such as carbohydrates, proteins and fats. On physical examination, the patient exhibits general wasting, loss of subcutaneous fat and muscle mass. Another type of protein-energy malnutrition is kwashiorkor, which occurs in children who eat a diet rich in energy but deficient in protein. The presence of skin findings, e.g. Foot edema, dermatitis, skin depigmentation, hair loss and loosening of the teeth distinguish kwashiorkor from marasmus. However, a child with marasmus may develop pitting edema due to a protein deficiency; this is marasmic kwashiorkor.[10]
Fats
Fats are composed of glycerol and fatty acids; these are energy-rich molecules that help the body grow, keep it warm and act as an emergency inventory. Certain fatty acids (essential), e.g. omega-3 and omega-6 are necessary for the synthesis of eicosanoids such as prostaglandins and leukotrienes and must be consumed through the diet. About 25 to 30% of daily calories should come from fats, of which saturated fat should not exceed 10%.[11]
Cholesterol can be produced by the human body and is therefore not essential in the diet. But when consumed, it should not exceed 300 mg/day. A high-fat diet can lead to the development of obesity and is associated with an increased risk of cardiovascular disease.[12][11]Fat intake can be reduced by replacing red meat, fried foods and fatty dairy products with white meat and fat sources rich in monounsaturated fats, e.g. olive oil, avocado, nuts and linseed. A recent study reported that people who followed a diet rich in monounsaturated fats had a reduced risk of developing cardiovascular disease, diabetes mellitus type II and cognitive decline.[8]
Dietary fiber
Fiber improves digestion by creating volume in the stool and stimulating peristalsis. It prevents constipation and diarrhea and protects against colon cancer. Fruits and vegetables are the main sources of fiber and the recommendation is that you should consume at least five servings per day. The daily recommended amount of dietary fiber is 38 grams/day and 25 grams/day for men and women aged 19 to 50, respectively. For children, the target figure for fiber intake is age + 5 grams. Consuming a high-fiber diet can help improve the lipid profile, increase the tolerability of statins and reduce the risk of developing atherosclerosis, thus preventing cardiovascular disease.[13]
Minerals and trace elements
Calcium and phosphorus are necessary for healthy bone development, while potassium, sodium and chloride are the most important electrolytes in the intracellular and extracellular spaces. An imbalance of these electrolytes can lead to drastic fluid changes. Trace elements such as chromium, copper and selenium also play an important role in metabolic reactions, and their deficiency can lead to various diseases. The Recommended Daily Allowance (RDA) of calcium is 1000 mg for both male and female adults. Women require an increased amount of iron compared to men due to the cyclical blood loss during menstruation; therefore, the RDA for iron is 18 mg in women, compared to 8 mg in men. The RDAs for copper, zinc and selenium are 30 µg, 900 µg and 55 µg respectively. Salt intake should be limited to less than 6 grams per day, as an increased amount can lead to the development of hypertension.
The DASH diet, which is low in sodium and fat, helps improve high blood pressure and total cholesterol. In a recent study, consumption of the DASH diet led to a 13% reduction over 10 years in subjects' Framingham Risk Score for cardiovascular disease.[14]Iron deficiency can cause microcytic hypochromic anemia, as iron is an essential component of hemoglobin. In a study by Sehar et al. from research in Pakistan, an estimated 500 mg iron reserve is needed to meet the increased demands of pregnancy, yet only 20% of women have this reserve.[15]The thyroid gland uses iodine to form thyroxine and triiodothyronine. The lack of iodine causes decreased production of thyroid hormone, which leads to increased production of thyroid-stimulating hormone (TSH). Elevated TSH regulates the production of thyroid hormone and also causes the growth of the thyroid gland, resulting in goiter. Calcium and phosphorus are essential for healthy bones, and a calcium deficiency can lead to diseases such as osteoporosis and hypophosphatemic rickets.
Vitamins
Water-soluble (B, C) and fat-soluble (A, D, E and K) vitamins play different vital roles. Vitamin A, also called retinol (RDA = 700 μg-900 μg retinol activity equivalents (RAE)/day), plays an essential role in the regeneration of epithelial cells and the development of rhodopsin, a photoreceptor pigment in the retina. Vitamin A deficiency can cause xerophthalmia, keratomalacia and night blindness. A cross-sectional study of pregnant and lactating women in Ethiopia found that 13.7% of women had night blindness and 0.4% had Bitot's spot.[16]
Thiamine (vitamin B1, RDA = 1.1 mg/day) in the form of thiamine pyrophosphate (TPP) serves as a coenzyme in catabolic reactions of sugars and amino acids. Vitamin B1 deficiency can cause wet beriberi, dry beriberi and Wernicke-Korsakoff syndrome. Wernicke syndrome has distinct features of ophthalmoplegia, gait disturbance, and confusion, while Korsakoff syndrome includes confabulation and memory loss. It is a medical emergency and should be treated with intravenous thiamine and dextrose.
Scurvy presents with symptoms of bruising, petechiae, loose teeth, bleeding gums, slow wound healing and mood swings. It is caused by a deficiency of vitamin C (RDA = 90 mg/day), which acts as a cofactor for both prolyl hydroxylase and lysyl hydroxylase, which help stabilize collagen. Collagen is a structural protein and is essential for healthy blood vessels, bones, cartilage and connective tissue.
Vitamin D (RDA = 600 IU/day) helps with the absorption of calcium from both the intestines and the kidneys. Vitamin D deficiency in childhood and adulthood can cause rickets and osteomalacia, respectively. On physical examination, children with rickets showed frontal bulging, pigeon chest deformities, bowed legs, and rickets.
Vitamin E (RDA = 33 IU/day [synthetic]) is an antioxidant and its deficiency can lead to neurotoxicity and anemia.
Vitamin K (RDA = 120μg/day) plays an important role in the clotting cascade. The intestinal flora helps convert vitamin K1 into vitamin K2, one of the most important sources of the vitamin.
Water
Dehydration can occur due to insufficient water consumption and is classified into three categories based on the percentage of body fluid loss. Losses of <5%, 5% to 10%, and >10% of body weight loss are categorized as mild, moderate, and severe dehydration, respectively. The WHO has classified dehydration into none, some and severe dehydration based on physical examination. Patients with severe dehydration are lethargic, have sunken eyes, skin folds slowly retract and the patient cannot drink independently.
Patients with some degree of dehydration are irritable, drink greedily, have sunken eyes and the skin tightness slowly withdraws. Those with normal physical characteristics are labeled as without dehydration. Mild to moderate dehydration can be treated with oral fluids, while patients with severe dehydration or shock should be treated with intravenous fluid replacement. A recent study reported that individuals who consume less than the recommended amount of water per day have persistently elevated levels of serum arginine vasopressin (AVP). This hormone promotes the reabsorption of water from the kidneys and constricts the arterioles to increase blood pressure.[17]
In a recent systematic review, reduced water intake was related to a higher incidence of urolithiasis. Although adequate water intake does not reduce the incidence of obesity or type II diabetes mellitus, it certainly reduces daily caloric intake.[18]Plain water is the ideal drink to consume to meet daily water needs.[19]
Nursing, paramedical care and interprofessional team interventions
Each patient should be interviewed, examined and screened for possible malnutrition or overnutrition. Patients with dehydration may have low blood pressure and an increased heart rate. Healthcare providers must use caution and work with the physician to administer the correct type and amount of fluid. In severely dehydrated patients it is necessary to place two wide cannulas. 0.9% normal saline is the preferred fluid.
In children, a bolus of 20 ml/kg 0.9% normal saline should be administered over 10 to 20 minutes. If vital functions do not improve, the bolus dose can be given again. In adults, a bolus of 500 ml of crystalloid fluid, e.g. 0.9% normal saline, administered over 10 to 20 minutes. If there is no improvement even after administering 2000 ml of fluid, seek professional help.
Primary care providers should monitor nutritional status and the development of new signs and symptoms in their patients. Doctors who practice emergency medicine often see patients with a history of alcohol abuse. They can diagnose nutritional deficiencies and related diseases. Gynecologists and general practitioners should pay special attention to women who are planning to become pregnant; multivitamin supplements, including folic acid, iron and calcium, should be prescribed. In severely malnourished children or the elderly, supplemental feeding should be initiated cautiously, electrolyte abnormalities should be corrected and the clinical team should initiate activities to prevent hypoglycaemia.
