Caloric intake, recommended daily

Most CF patients have an increased caloric need due to increased energy expenditure through increased work of breathing and increased basal metabolism. Prevention of malnutrition requires early nutritional intervention. In patients with mild lung disease and well-controlled absorption, required caloric intake is approximately 100% to 120% of the recommended daily allowance (RDA) for age.15 As lung disease progresses, caloric requirements increase. 

The recommended daily carbohydrate intake for type 2 DM, and even type 1 DM, has become controversial since low-carbohydrate diets such as the Atkins, South Beach, and Carbohydrate Addict s Diets have become exceptionally popular. Currently, the ADA recommends that approximately 60% to 70% of daily caloric intake should come from carbohydrates and monounsaturated fat. Many clinicians are trying to increase the monounsaturated fat percentage and decrease the carbohydrate percentage in a patient s diet to accomplish improved glycemic control. Recent studies have also documented short-term success for weight loss on low-carbohydrate diets, without deleterious effects on the lipid panel. Weight loss can reduce cardiovascular risk factors in type 2 DM. 

Nonetheless, lipids serve a wide variety of functions essential to living systems and are required in our diet. Standards of fat intake have not been experimentally determined. However, the most recent U.S. Dietary Guidelines recommend that dietary fat not exceed 30% of the daily caloric intake, and no more than 10% should be saturated fats. 

The recommended daily caloric intake for a 20-year-old woman is 2000. How many Calories should her breakfast contain if she wants it to be 45% of her recommended daily total ... 

The effect of fats and oils on health has been widely debated. Some diets call for drastic reduction of daily intake of fats and oils whereas other diets actually call for an increase in fats and oils. The Food and Drug Administration (FDA) recommends that fats and oils compose less than 30% of total caloric intake. However, because fats and oils have a higher caloric content per gram than other food types, it is easy to eat too much of them. The FDA also recommends that of those fats that are consumed, no more than one-third (10% of total caloric intake) should be saturated fats. This is because a diet high in saturated fats increases the risk of artery blockages that can lead to stroke and heart attack. Monounsaturated fats, by contrast, may help protect against these threats. 

How much carbohydrate should you consume Nutrition experts in the United States and Canada have used thousands of nutrition studies to produce a set of standards caiied the Dietary Reference Intakes (DRI). The DRI for carbohydrates is that they should compose 45-65% of caloric intake. For a person on a 2000-Cai/day diet, that translates to 225-325 g of carbohydrates per day. To meet these requirements, choose a diet with plenty of vegetables, fruits, and grain products and avoid added sugars. Such a diet wiii naturally include the 20-30 g of recommended daily fiber. 

The effect of fats and oils on health has been widely debated. Some diets call for a drastic reduction of our daily intake of fats and oils, whereas others actually call for an increase in fats and oils. The U.S. Food and Drug Administration (FDA) recommends moderate consumption of fats and oils, less than 30% of total caloric intake. 

The basal diet was a measured, laboratory controlled diet based on ordinary foods fed in sufficient quantities to meet caloric requirements of the 127 subjects for weight maintenance and meeting or exceeding the National Research Council Daily Recommended Nutrient Intakes. 

It is recommended that about half of the energy intake should be in the form of carbohydrates, a third at most in the form of fat, and the rest as protein. The fact that alcoholic beverages can make a major contribution to daily energy intake is often overlooked. Ethanol has a caloric value of about 30 kj g (see p. 320). 

General recommendations include limiting total calories from fat to 20-25% of daily intake, saturated fats to less than 8%, and cholesterol to less than 200 mg/d. Reductions in serum cholesterol range from 10% to 20% on this regimen. Use of complex carbohydrates and fiber is recommended, and c/s-monounsaturated fats should predominate. Weight reduction, caloric restriction, and avoidance of alcohol are especially important for patients with elevated VLDL and IDL. 

The early phase of SBS is associated with large day-to-day variations in fluid and electrolyte losses. Strict output records should be assessed, as well as all intake including intravenous medications. Initially, it is recommended to start a standard PN solution that meets the patient s maintenance metabolic, fluid, and electrolyte needs, and a separate intravenous replacement solution is typically necessary to keep the patient euvolemic based on actual fluid losses. Insensible losses should be estimated between 300 and 800 mL/day above measured output, and daily urine output should be kept at least 1 L. As fluid and electrolyte losses stabilize over time it becomes possible to incorporate these replacement requirements into the PN solution. The PN solution typically is composed of standard crystalline amino acids, glucose, and intravenous lipids. A generic caloric breakdown for SBS patients based on a need of 30 to 40 kcaV kg per day may be 1.5 g/kg of protein per day, approximately 20% to 30% of calories from intravenous lipids, and the remainder of calories from carbohydrates. An example of a PN formula for the patient with SBS is given in Table 139-2. 

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