Comparison of your average daily intake with recommendations
1. Energy, macro and micronutrients |
2. Your average daily intake |
3. Relevant Australian NRVs1 |
4. Difference between your average daily intake & NRV (be precise eg % difference) |
Energy (MJ)2 |
9.5723MJ |
13.4912MJ |
-29.0% |
Protein (g,%)3 |
131.1g, 23.3% |
10-25% |
Within the range |
Total fat (g,%)3 |
81.2g, 31.4% |
20-35% |
Within the range |
Saturated (g,%)3 Monounsat (g,%) 3 Polyunsat (g,%)3 |
30.3g, 11.7% |
<10% |
1.7% above the recommended range |
32.2g, 12.4% |
|||
11.8g, 4.6% |
|||
Carbohydrate (g,%)3 |
248.3g 44.1% |
45-65% |
-0.9% |
Dietary fibre (g) |
20.5g |
AI=30 |
-31.7% |
Alcohol (g, %)3 |
0g |
Less than two standard drink |
|
Retinol Equivalents (µg) Retinol (µg) B-carotene (µg) |
474.339 |
RDI=625 |
-24.1% |
348.289 |
|||
728.636 |
|||
Thiamin (mg) |
2.003mg |
RDI=1.2 |
+66.9% |
Riboflavin (mg) |
2.573mg |
RDI=1.3 |
+97.9% |
Niacin Equivalents (mg) |
64.841mg |
RDI=16 |
+305% |
Dietary folate equivalents (µg) |
595.395µg |
RDI=400 |
+48.8% |
Vitamin C (mg) |
88.091mg |
RDI=45 |
+95.8% |
Na (mg) |
1154.471mg |
UL=2300 |
-49.8% |
K (mg) |
2929.955mg |
AI=3800 |
-22.9% |
Ca (mg) |
784.820mg |
RDI=1000 |
-21.5% |
Fe (mg) |
11.107mg |
RDI=8 |
+38.8% |
Zn (mg) |
9.974mg |
RDI=14 |
-28.8% |
I (µg) |
160.946µg |
RDI=150 |
+7.3% |
1 National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. 2006. State appropriate RDI, AI, SDT or AMDR which are available for the nutrient. Cite reference if alternative source used. 2 For energy NRV, estimate individual requirements using Schofield equation. Choose energy with dietary fibre for intake. 3 Show average daily intake in g and calculate as a % of total energy. Use NHMRC Australian Guidelines to Reduce Health Risks from Drinking Alcohol (2009).
As observed from the above, it is evident that my daily intake of calcium, is grossly less as compared to the required values. Hence, one of the key nutrient changes which will prove to be a priority of change in my respective diet, is my intake of dietary calcium. One of the key short term benefits pertaining to the benefits of calcium intake, is its role in the provision of structural integrity to the human body. Calcium comprises of the major foundational substance in the bones and teeth of the human body, amounting to a percentage of over 1.6% to 2% (Lima et al., 2016). Hence, without calcium, I would lose my required strength and integrity of bones and teeth outlining my body, required for the optimum functioning of daily life tasks pertaining to basic weight bearing. Another additional beneficial functioning of calcium, is for the purpose of coagulation and clotting of blood. This is performed through the activation of the required coagulation factors via the functioning of enzymes pertaining to proteolytic activities (Kyle et al., 2018). Calcium is also beneficial in the functioning of digestion through the enhancement of the enzyme functioning such as nucleases, proteases and phospholipidases. The secretion of the gastrointestinal digestive juices is also activated through the expression of receptors pertaining to calcium ions (Ertan et al., 2015). Further, calcium benefits for the human body are the enhancement of transmission of nerve impulses and muscular contractions. This is conducted via the transmission of neurotransmitters from the respective neurons which is conducted via ion channels containing calcium (Banerjee et al., 2016). Hence, it is evident that the my intake of calcium is essential, not only for the maintenance of my bone, teeth and overall structural components, but also in the development and enhancement of basic strength, improve nervous system function, enhanced digestion and the resultant optimum absorption of nutrients and the finally, for the purpose of optimum blood clotting for mitigation of serious physical injuries. However, one of the key long term benefits of the calcium, is for the maintenance of optimum bone health. Calcium is one of the cornerstone nutrients pertaining to the functions of bone modelling and remodelling. The processes of bone modelling is outlined by the various concentrations of bone as well as serum calcium concentrations, where osteoblasts facilitate the repairing of bones, through the assimilation of calcium ion from the serum, via the functioning of the calcitonin and parathyroid hormone. Further, for the adjustment of the serum calcium concentrations, osteoclastic activity promptly engage in the resorption process through leeching of bone calcium. Hence, if my calcium intake needs are not met, there would be a gross imbalance between bone resorption and bone modelling functioning, further increasing my susceptibility to bone related disorders such as osteoporosis and the resultant loss in bone strength and increased rates of harmful fractures (Siddiqui & Partridge, 2016).
As observed table outlining nutrient intake, it can be observed that there also a deficiency in the daily intake of dietary fibre. Dietary fibre, as is well known, is comprises of edible components of food products which are insoluble by the regular digestive processes outlining the human body. The purpose of dietary fibre is to add bulk to the stool formulation, leading to softening of stools and the resultant ease in faecal evacuation of the body (Grundy et al., 2016). Hence, one of the short-term benefits pertaining to the intake of dietary fibre, is the prevention of constipation. The negative health implication of constipation due to lack of treatment for prolonged periods can pose a detrimental impact on the daily life activities and overall well-being of any individual. High occurrence of constipation has been associated with the prevalence of stools which are hard, further leading to difficulty in evacuation. The resulting difficulty further leads to occurrence of tearing of the tissues of the anus due to the presence of hard stools. The occurrence of such anal fissures is also followed by the haemorrhoids, which is characterised by excessive swelling of the veins present in the anal area, caused due to exertion of difficult stool evacuation (Kovacic et al., 2015). Further lack of treatment can also result in the unwanted storage of stools which are hard and difficult to evacuate, known as faecal. Hence, it is of utmost importance on my behalf, to increase my consumption of dietary fibre, in order to reap the short-term benefits of removal of constipation and the occurrence of further problems pertaining to possible rectal prolapsed, where excessive straining and pressure for the purpose of stool evacuation can result in the protrusion of the intestine from the anus (Ihana-Sugiyama et al., 2016). It is also worthwhile to mention that the consumption of dietary fibre also results in beneficial long-term benefits. One of the key benefits is the reduction of serum cholesterol levels , the increase in which can lead to further long term health complications of cardiovascular diseases. Soluble fibre sources such as pectin from apples, beets and celery, along with beta-glucan from oats, exhibit considerable gelling properties in the intestinal tract, resulting in the accumulation and absorption of serum cholesterol, and their resultant excretion from the body (Nwachukwu et al., 2015). The consumption of high insoluble and soluble fibre food components have also been linked to the reduction in serum blood glucose levels, due to their high glycemic index – a beneficial implication for the long-term prevention of diabetes mellitus. This is due to the fact that the digestion and metabolism of fibre occurs without the absence of insulin, further reducing the chances of fluctuations in blood glucose levels. Improved consumption of dietary fibre is also an excellent way to maintain one’s weight in the long run, through provision of high satiety and reduced food cravings (Solah et al., 2016).
Changes that I could make that would enable me to reach the NRC for the nutrients identified:
As observed from my dietary nutrient intake mentioned above, there is a need for me to improve my dietary calcium consumption, as evident from the resultant deficiency. For this purpose, I will be required to the undertake key modification in the food intake pertaining to my daily diet. As observed by my dietary recall, it is evident that my consumption of milk and milk products is significantly low as compared to the recommended 2.5 servings of milk and milk products suggested in the Australian Dietary Guidelines for the purpose of consumption on core food groups (Allman-Farinelli et al., 2014). As observed, the only milk product which I am consuming is full cream milk during breakfast. Hence, I must incorporate further sources of dairy products in my diet, due to them being major sources of dietary calcium (Keast et al., 2015). However, since I am already consuming milk every day in one meal, hence, I believe that inclusion of other dietary sources would be an advantageous dietary amendment in order to prevent boredom and add variety to my diet. Hence, I can consume dairy products like a 100 gram cup of yoghurt or a 20 gram slice of cheese for increasing my calcium intake. However, plain yoghurt may again be food choice which may cause boredom if consumed daily. Hence, to enhance is flavour, I believe that I can consume it with added fruits and nuts, like 10 to 12 almonds or a medium sized apples, bananas and handful of berries. This will not only turn out to be an interesting meal addition as a breakfast or snack, but will also be beneficial in enhancing my fruit intake, which I am also deficient in, as opined by the Australian Dietary Guidelines recommendation of two servings (Allaman-Farinelli et al., 2014). Opting for probiotic yoghurt would be good option, for the enhanced intake of calcium, as well as improved digestion and immunity exhibited by my gut microflora (Bosnia et al., 2017). Additional dietary changes which can be incorporated is the inclusion of cheese which will not only be a delicious addition to my diet, but also prove to be a good source of calcium (Aune et al., 2014). However, I must ensure that the consumption of cheese is limited since it is also a rich source of saturated fats, which may put me at a risk of increased serum cholesterol and the resultant cardiovascular diseases susceptibility (Thorning et al., 2015). Further considering fat intake, it is worthwhile to mention that the full cream milk which I am consuming daily, is also a high source of saturated fat, which may result in harmful health complications by increasing my dietary fat intake. Hence, there is a need to consume milk which is of reduced fat, which is mainly skimmed or double toned milk (Chen et al., 2016). This will meet my calcium needs, along with the reduced intake of harmful fat sources. However, due to my habit of consuming the richness and creaminess of full fat milk, adjusting to skimmed milk may pose to be a challenge due to its thinner texture. Hence, I believe gradually reducing my full cream milk intake and gradually increasing skimmed milk intake, would be beneficial in modifying my taste. The consumption of Vitamin D is to be taken under due consideration, since this vitamin is closely associated with the functioning of the parathyroid hormones and the resultant calcium absorption and functioning. Hence, exposure to increase sunlight, and incorporation of eggs and small amounts of fortified butter and mushrooms, would be a beneficial due to their enhancement of Vitamin D in the body, further enhancing calcium absorption (Cashman, 2015).
Additional dietary changes are required in my diet, as evident from my reduced intake of dietary fibre. It is to be noted that the recommended Australian Dietary Guidelines, place emphasis on the consumption of the core food groups of vegetables, legumes and pulses to a total of six servings (Allaman-Farinelli et al., 2014), which is grossly less in my diet, as evident in my dietary recall. Green leafy vegetables are excellent sources of dietary fibre of the insoluble type, which will aid in the prevention of constipation along with the enhancement of faecal movement (Dodevska, Šobaji?, & ?or?evi?, 2015). Hence, I must incorporate 5 to 6 servings of vegetables per day to meet my fibre requirements. Another way of enhancing my dietary fibre intake, is through the intake of fruits such as bananas, apples and citrus fruits to 2 servings, which are good a source of soluble fibre pectin (Oliveira et al., 2016). Incorporation of oats will also be a novel dietary strategy, due to is high reservoir of beta glucan – soluble dietary fibre associated with reduction in blood cholesterol and blood sugar, further resulting in reduced susceptibility towards metabolic disorders such as cardiovascular diseases and diabetes (Schloermann & Glei, 2017). However, since I have never consumed oats before, gradual changes are required in order to induce adjustment to its mushy texture. An additional dietary intake change would be the incorporation of whole grains in my diet in the form of multigrain breads and whole grain rice, in order to enhance my intake of dietary fibre (Buil-Cosiales et al., 2016). However, it is worthwhile to mention that with the enhancement in fibre, the textural qualities of the food product changes, resulting in whole grain breads and rice being tougher and difficult to digest, which may act as a barrier for me during dietary incorporation. Also, one of the major qualities of dietary fibre is the increase in satiety resulting in reduce food intake and the resultant weight maintenance. However, excessive dietary fibre intake can also reduce my water intake due to high satiety (Stephen et al., 2017). In addition, excessive intake of dietary fibre has also been observed to reduce the bioavailability of minerals such as iron, magnesium, zinc, phosphorous and calcium, by reducing their absorption (Baye Guyot & Mouquet-Rivier, 2017). In addition, excessive dietary fibre intake has also been associated with high incidences of flatulence, bloating and idiopathic constipation due to formation of dry stools (Christodoulides et al., 2016). Hence, such barriers can prove to be detrimental to my dietary fibre consumption and hence, I must incorporate fibre rich foods in my diet in controlled amounts.
In addition to the above dietary changes and the possible barriers, a major hurdle for me is my busy academic life. Time constraints are a major factor which act as a barrier for me eat timely, healthy meals. Also, another importance barrier is financial constraint, making it further difficult for me to purchase food items like nuts, fruits, vegetables and the added whole grains and skimmed milk food sources.
Part B- Table 3. Comparison of student colleague intake with recommendations
1. Energy, macro and micronutrients |
2. Your average daily intake |
3. Relevant Australian NRVs1 |
4. Difference between your average daily intake & NRV (be precise e.g. % difference) |
Energy (MJ)2 |
5.8758MJ |
6.7564MJ |
-13.0% |
Protein (g,%)3 |
65.5g, 19% |
10-25% |
Within the range |
Total fat (g,%)3 |
25.1g, 15.8% |
20-35% |
-4.2% |
Saturated (g,%)3 Monounsat (g,%) 3 Polyunsat (g,%)3 |
6.2g, 3.9% |
<10% |
Within the range |
11g, 6.9% |
|||
5.5g, 3.5% |
|||
Carbohydrate (g,%)3 |
217.9, 62.1% |
45-65% |
Within the range |
Dietary fibre (g) |
18.1g |
AI=25 |
-27.6% |
Alcohol (g, %)3 |
0g |
Less than two standard drink |
|
Retinol Equivalents (µg) Retinol (µg) B-carotene (µg) |
83.885µg |
RDI=700 |
-88.0% |
41.630µg |
|||
200.458µg |
|||
Thiamin (mg) |
0.630mg |
RDI=1.1 |
-42.7% |
Riboflavin (mg) |
0.655mg |
RDI=1.1 |
-40.5% |
Niacin Equivalents (mg) |
29.912mg |
RDI=14 |
+113.7% |
Dietary folate equivalents (ug) |
322.902µg |
RDI=400 |
-19.5% |
Vitamin C (mg) |
203.485mg |
RDI=45 |
+352.2% |
Na (mg) |
422.800mg |
AI=460-920 |
-8.1% |
K (mg) |
2178.896mg |
AI=2800 |
-22.2% |
Ca (mg) |
545.465mg |
RDI=1000 |
-45.5% |
Fe (mg) |
4.750mg |
RDI=18 |
-73.6% |
Zn (mg) |
6.083mg |
RDI=8 |
-24.0% |
I (µg) |
36.045µg |
RDI=150 |
-75.97% |
1 National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. 2006. State appropriate RDI, AI, SDT or AMDR which are available for the nutrient. Cite reference if alternative source used. 2 For energy NRV, estimate individual requirements using Schofield equation. Choose energy with dietary fibre for intake. 3 Show average daily intake in g and calculate as a % of total energy. Use NHMRC Australian Guidelines to Reduce Health Risks from Drinking Alcohol (2009).
The subject so selected, is a female student of the age of 21 years. Despite the high deficiencies in Vitamin A, Folate, Iodine, Fibre and calcium absorbed, the chosen nutrient which has been selected for the purpose of evaluation and assessment is iron, for which the subject is displaying a deficiency of -73.6 %. This is due to the fact, that women who are a part of the reproductive age, require the consumption of sufficient amounts of iron, as outlined by the Ministry of Health, National Health and Medical Research Council of the Australian Government. This is due to the fact, that woman within the age group of 19 to 50 years, experience monthly loss of blood through the processes of menstruation, which leads to significant iron losses (Mishra et al., 2015). A reduced intake of iron has been associated with increased occurrences of tiredness and fatigue due to reduced haemoglobin concentrations and the resultant loss in cell to cell oxygen transport. Women experiencing deficiencies iron also exhibit reduced concentration, a feeling of giddiness, paleness in their skin, frequent incidences of headaches and a susceptibility to the occurrences of infection. Hence, since the subject is bound to encountering menstruation and subsequent monthly loss, the deficiency in her iron intake will impose detrimental impacts on her overall health and energy levels, further necessitating the need to mitigate the same (Lopez et al., 2016).
The absorption of the iron is influenced by the interplay of a number of associated compounds. Components like ascorbic and citric acid play key roles in enhancing the absorption of iron in the human body. The absorption and metabolism of iron is primarily conducted in the duodenum of the human body, where the presence of this compounds aids in rapid solubilisation of iron in this organ (Lane & Richardson, 2014). The absorption of iron is also influenced by the presence of compounds such as tannins and phytic acids. These chelate or bind with the iron, further resulting in reduced absorption, bioavailability and the resultant unwanted excessive iron excretion. While tannins are prevalent in various herbal teas, coffee and berries, phytates are widely present in certain wheat and cereal based products (Kapil, 2017). The digestion and absorption of iron is also influenced by its physical characteristics along with the pH. Ferric iron is rapidly liable for digestion and absorption. Upon ingestion, iron in its ferrous from rapidly undergoes oxidation due to the functioning of the gastrointestinal digestive juices, leading to conversion of easily absorbable ferric iron. Hence, often imbalances in the gastric acid secretion of the human body, due to medication such as prilosec and proton pump inhibitors, often lead to interferences in iron absorption and the resulting deficiencies (Scheers et al., 2016).
For the purpose of management of the iron deficiency in the diet of the concerned subject, there is a need for the incorporation of certain dietary modifications. One of the first steps pertaining to increments in iron intake, is the elimination or reduction of foods which may contain components possessing the ability to reduce iron absorption. It is observed that the subject adequately consumes herbal teas, almost twice a day. Tea, especially black tea, are rich in tannins – compounds which are known to reduce the absorption of iron nutrient through conductance of chelation, reduction in iron bioavailability and increased excretion (Jaramillo et al., 2015). Hence, the subject can be asked to eliminate her black tea consumption, or reduce it to half a cup, if she feels uncomfortable to completely remove a food which she is strongly used to consuming. She may also be enlightened and educated on the importance of iron, the prevalence of her deficiency and the factors pertaining to its absorption.
Green leafy vegetables like spinach and legumes have been exhibited to contain good amounts of iron (Leonard et al., 2014), which are completely lacking in the subject’s diet as evident from the recall. Hence, instead of simply having cabbage for lunch and dinner, she may consume a big bowl of hearty vegetable and legume salads or curries which can improve her intake of iron. However, it is to be noted that legumes often contain phytates which may interfere with iron absorption. Cooking the legumes and vegetables thoroughly, or germinating the legume grains can be a beneficial step to eliminate these detrimental compounds and enhance availability of iron (Mihafu et al., 2017). Consequently, iron absorption is influenced by the consumption of vitamin C (Prentice et al., 2016). Hence, squeezing some lime juice into her vegetable dish would be a beneficial way to enhance her Vitamin C intake and the resultant increase in absorption of iron, since limes and lemons are good sources of this vitamin (Zou et al., 2016).
Nuts like almonds are also rich sources of iron (Zivoli, 2017), which is consequently lacking in the subject’s food intake, as evident from her dietary recall. Also, the subject only engages in consumption of three meals a day, and hence, the inclusion of a snack would be a beneficial implication for her diet. As a snack, the concerned subject can consume one serving, or 10 to 12 nuts in between meals, for the purpose of adequate iron intake. Consequently, whole grain products such as multigrain breads and whole grain rice, are also good sources of iron. However, care has to be taken and excessive consumption of these recommended options should be avoided by the concerned subject. This is due to the fact that whole grain cereal products are good sources of fibre, which have been known to reduce iron absorption. Cereal based products also contain phytates which have been known to exhibit reduced iron bioavailability, hence necessitating the need to carefully consider these options (Rebello, Green way & Finley, 2014).
Part D – Table 4 Reflection on confidence in using the ready reckoner method
Reporting and responding |
For the purpose of assessing the dietary intake of the patients, a number of evaluation tools continue to be utilised. The usage of computerised analysis of the same, are usually recommended pertaining to their high levels of accuracy and detailed nutrient profile exhibition of a large range of nutrients. However, the usage of computerized analysis like ‘Foodworks’ often create hindrance due to the large amount of time required for nutrient assessment. Despite the presence of a vast database of food items, such applications are often expensive and require professional observation in order to derive the necessary data analysis and interpretation (Paciepnik & Porter, 2017). With respect to this, I believe that the Ready Reckoner method is a an effective tool which is highly simple due to its convenient evaluation of wide variety of food groups in the form of average food values. Hence, for future use, I believe that we can apply the Ready Reckoner method for nutrient analysis, since it financially feasible, requires less time in presenting the calculations and is also easy to interpret by any individual lacking sufficient knowledge in nutrition. However, I still lack sufficient confidence to use the Ready Reckoner method. This is because certain food groups such as Grains Group 1 and 2, do not specify the intake of specific cereal based products such as spaghetti or instant noodles. There is also no mention of beverages such as energy or coffee-based drinks, making it further difficult to use. There is also no specification of the vegetables since this group comprises of a vast array of items with varied weights and grouping them under ‘Moderate’ and ‘Low CHO’ is insufficient. Hence, despite the simplicity, I believe that changes such as inclusion of additional food groups and specifications under the grains and vegetables groups are required before applying full confidence in the Ready Reckoner method. |
Relating |
Based on the occurrences of my previous experiences, I faced certain advantages as well as limitations in my usage of various assessment methods such as 24 hour diet recall, weighed food record and the Ready Reckoner Method. With respect to the weight food record, it is considered as one of the most advantageous and comprehensive dietary assessment plan, as evident by the availability of the various detailed food ingredients, the weight and the cooking procedures used by the subject (Martin et al., 2014). However, while working with this assessment, I found it to be highly time consuming, and requires a lot of communication between me and my clients, often resulting in difficulties in understanding. Due to high effort and time required, I believe that this method may produce inaccurate results, since I have noticed difficulties recalling accurate measurements by the clients. With respect, I believe that the usage of a 24-hour recall is much easier, and participants are less likely to produce inaccurate information, due to recording of previous day’s foods. Despite its efficiency with literate as well as illiterate subjects, I still difficulty while interviewing, since careful questioning is required to elicit the requires responses. There is also great difficulty if am required to undertake a 3 day recall, since participants find it very difficult to remember. In my experience of Foodworks, I have found it to be highly accurate tool due to its large database including various food items. However, I find it very time consuming where I am required to explain clients in depth considering the results, since most of them lack sufficient nutritional knowledge. With this respect, the Ready Reckoner method is highly effective in terms of convenience and simplicity, as I can easily explain the results to the clients. However, I find it incomplete due to lack of specification of several groups. Hence, based on relation to my experiences, I feel that instead of focusing on one method, usage of multiple assessment methods would have been helpful for me in explaining the dietary needs of the client. |
Reasoning |
My confidence in the Ready Reckoner method, is due to its convenience, simplicity and reduced time consumption, followed by its easy understanding by clients who lack sufficient nutritional knowledge. Through the observation of these advantages, I believe that we can also observe the concerned limitations of lack of specification of food groups. While this method provides quick and simple data which is easy to comprehend, the presence of detailing in food groups such as grains, beverages and vegetables is compromised , for the sake of convenience. Hence, if viewed from the dimensions of expert and professional practice, the need of the hour is to not just rely on one quantitative dietary assessment method like Ready Reckoner, but to use multiple quantitative as well as qualitative tools. Hence, an expert would also interview the client and qualitatively observe the diet of the patient in detail to assess the diet quality and consumption pattern of various food groups, along with also the usage of quantitative methods such as Ready Reckoner (Paciepnik & Porter, 2016). |
Reconstructing |
If I am required to utilise the Ready Reckoner method for the purpose of formulating future dietary recommendations, I believe that I may be required to undertake further communication with the client in order to fully understand and as well as explain the results obtained from this method. The Ready Reckoner method groups non-starchy vegetables as ‘low CHO’ and ‘moderate CHO’, which I believe is highly unspecific since the group of vegetables consist of a vast array of micronutrients rather than simply limiting them to containing carbohydrates (Paciepnik & Porter, 2016). Further, as observed, the Ready Reckoner method does not take into account the various types of beverages which may be consumed by an individual, including drinks or soups. Hence, I believe that during usage of Ready Reckoner method in the future, one should discuss thoroughly with the client and obtain a detailed description of every food item that he or she is consuming. Further, I believe that rather than relying solely on Ready Reckoner Method, implementing a collaborative approach using various methods such a 24 hour diet recall and weighed food diary, would further be beneficial in explaining the dietary changes a concerned patient will be required to implement. |
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