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FIGURE 14.3 Example of a nutrition label.
Percent daily value
As depicted in Figure 14.3, required nutrition labeling includes the percent
daily value (% DV) for certain nutritional components to allow consumers
to compare the nutritional content between products. A percent daily value
≤5% for a nutrient is considered to be “low,” and ≥20% is considered to be
“high”.23 In order to calculate the % DV, the quantity of a nutrient in a
serving is compared to its daily value (DV) shown in Table 14.2 and
expressed as a percent. For example, in Figure 14.3, the total fat per serving
is 8 g and the DV for total fat in Table 14.2 is 78 g. Thus, 8 g/78 g × 100%
= 10.26% ≈ 10%, the labeled % DV for total fat.
TABLE 14.2 RECOMMENDED DAILY VALUE OF
NUTRIENTS
a
a
Based on 2000-calorie per day intake. Adapted with modification from
Daily Value on the New Nutrition and Supplement Facts Labels.
23
Serving size and servings per container
The labeled serving size reflects the amount that people generally eat at one
time and is indicated in common household units (e.g., 2/3 cup) and
approximate corresponding metric measure (e.g., 55 g). Items of discrete
size, such as cookies, are listed in both units and metric equivalent, for
example, “2 cookies (26 g).” The servings per container indicate the
number of servings in the package.
Calories
On the nutrition label, calories per serving are of special importance to
consumers, because high-calorie diets are linked to overweight and obesity
and the consequent illnesses.
A calorie (spelled with a small c) is the amount of energy needed to
raise the temperature of 1 g of water 1°C. A kilocalorie (kcal) equals 1000
calories. The kilocalorie, or Calorie (spelled with a capital C), is the unit
used in metabolism studies and in nutrition to describe the energy provided
by various foods. In common usage, the “small C” calorie is often used
interchangeably (albeit incorrectly).
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According to the Dietary Guidelines for Americans 2015–2020,19 the
caloric requirements as stated in Table 14.3 generally are suitable for most
persons.
TABLE 14.3 ESTIMATED DAILY CALORIE
REQUIREMENTS
a
a
Adapted with modification from Dietary Guidelines for Americans 2015–
2020.
19
b
Sedentary includes only light physical activity associated with daily life.
c
Moderately active includes walking 1.5 to 3 miles/day at 3 to 4 miles/h or
equivalent other activity in addition to light physical activity associated with
daily life.
d
Active includes walking more than 3 miles/day at 3 to 4 miles/h or
equivalent other activity in addition to light physical activity associated with
daily life.
Macronutrients: Carbohydrates, protein, and fats
Carbohydrates are important components of a healthy diet, as they provide
the fuel for energy and organ function. The generally recommended daily
amount of carbohydrate intake for adults is about 275 g based on a 2000calorie diet. Dietary fiber (a carbohydrate) is a food component providing
valuable “roughage” to the digestive tract. “Added Sugars” is required on
the new nutrition facts label to encourage consumers to limit the intake of
sugar-sweetened beverages, baked goods, desserts, and sweets. Added
sugars should be limited to <10% of total calories per day.
24
Protein intake is not considered a general health concern for adults and
children over 4 years of age.19 Consequently, a labeled percent of the daily
value is not required unless a protein claim is made for the product or if the
product is intended for use by infants or children under 4 years of age.
Guidelines suggest a daily protein requirement of 0.8 g/kg or 46 g for adult
females and 56 g for adult males, 46 g for 14- to 18-year-old females and 52
g for 14- to 18-year-old males, 34 g for 9- to 13-year-old children, 19 g for
4- to 8-year-old children, and 13 g for 1- to 3-year-old children.
In addition to the listing requirement for total fat, the nutrition label also
is required to contain the content of saturated fat and trans fat. Intake of
these components increases the body’s low-density lipoprotein (LDL)
cholesterol and the risk of developing coronary heart disease. Guidelines
suggest total dietary fat of <78 g/day with <20 g being saturated fat. It is
recommended that the intake of cholesterol be <300 mg daily.
For the calculations in this section, it is important to note that:
Carbohydrates yield 4 kcal/g
Protein yields 4 kcal/g
Fat yields 9 kcal/g
Sodium and potassium
The labeling of sodium and potassium content is required. Guidelines
suggest that sodium intake should be no more than 2300 mg daily and
reduced to 1500 mg for persons with hypertension.19 The adult requirement
of potassium is considered to be about 4.7 g/day.
Micronutrients: Vitamins and minerals
The nutrition label must specify the content of vitamin D, calcium, and iron.
Additional content of vitamins and minerals may be listed voluntarily by the
manufacturer.
Use of special terms on the nutrition label
Descriptive terms as “light,” “free,” “low,” and “reduced,” as used with
reference to calories, fat, saturated fat, cholesterol, sodium, and sugars, are
defined and regulated by the FDA. The qualifying definitions are found in
the reference.
25
Example calculations involving the nutrition label
NOTE: In calculations of the labeled “% daily values,” the FDA allows
latitude in rounding.
1. Based on the “Nutrition Facts” depicted in Figure 14.3, calculate (a)
calories contributed by fat, carbohydrates, and protein separately and
(b) total calories contributed by the macronutrients.
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a.
b.
c.
d. 72 kcal + 148 kcal + 12 kcal = 232 kcal or 230 calories (rounded)
2. For a person on a sodium-reduced diet (i.e., 1500 mg/day), calculate the
% DV for the label in Figure 14.3.
3. One cup of pomegranate juice contains 533 mg of potassium.19 If a
patient drinks two cups of pomegranate juice each day, what
percentage of the daily value for potassium is he consuming?
4. A canned juice drink contains 12 g of total carbohydrates in each 8fl.oz. can. Calculate (a) percent daily value and (b) calories from total
carbohydrates.
a.
b.
5. A multiple vitamin and mineral tablet contains 162 mg of calcium. If the
minimum daily value for calcium is 1300 mg, what percentage of the
minimum daily value of calcium is contained in each tablet?
CALCULATIONS CAPSULE
Adult Nutrition
Basal energy expenditure (BEE):
The Harris-Benedict equations may be used to approximate the BEE,
in kcal:
The BEE is adjusted by activity and stress factors to yield the estimated
total daily energy expenditure.
Macronutrient values:
Carbohydrates: Enteral = 4 kcal/g; parenteral = 3.4 kcal/g
Proteins: Enteral and parenteral = 4 kcal/g
Fats (lipids): Enteral = 9 kcal/g; parenteral = 1.1 kcal/mL (10%), 2
kcal/mL (20%), and 3 kcal/mL (30%)
Fluid requirement:
30 to 35 mL/kg patient weight, or
1 mL/kcal, nutrition provided, or
1500 mL/m2 BSA
CASE IN POINT 14.2
A parent asks a pharmacist to explain the nutritional content of
PEDIASURE Enteral Formula, which has been recommended for her 12year-old daughter. The label indicates that 1500 mL of the product, taken
daily, provides complete nutrition for children 9 to 13 years of age. The
product is packaged in 237-mL cans containing 7 g protein, 9 g fat, 33 g
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1.
2.
3.
4.
5.
6.
7.
8.
carbohydrate, 200 g water, and more than 30 vitamins and minerals.
Calculate:
a. The kilocalories per milliliter of product
b. The grams each of protein, fat, and carbohydrate, consumed from a
daily intake of 1500 mL of product
c. The proportion, expressed in percentage, of daily kilocalories
derived from each of protein, fat, and carbohydrate
d. Whether or not the answers in (c) compare favorably with the
recommended parameters for a 9- to 13 year-old female as
follows19: Protein 10% to 30% of daily calories, Carbohydrates
45% to 65% of daily calories, Fat 25% to 35% of daily calories
PRACTICE PROBLEMS
Calculations of Body Mass Index and Percent of Ideal Body
Weight
Using Table 14.1, determine the body mass index for a person
measuring 62 inches in height and weighing 150 lb.
Calculate the body mass index for a person measuring 1.7 meters in
height and weighing 87 kilograms (round answer).
An investigational drug for obesity is being dosed at either of two
protocols: (a) 7.6 mg/0.5 BMI for persons with a BMI over 25 but
<30; or (b) 9.6 mg/0.5 BMI for persons with a BMI of 30 or greater.
In each protocol, the dose is equally divided and administered “t.i.d.
a.c.” What would be the divided dose for a male standing 5 feet 8
inches and weighing 230 lb?
Calculate the weight in pounds for a male patient who is 5 feet 10
inches tall to be considered “extremely obese” based on his IBW.
Calculate the IBW (in pounds) for a female patient who is 5 feet 5
inches tall and weighs 106 lb, determine the percentage of her ABW
compared to her IBW, and indicate the nutritional category into which
she falls according to her weight.
Calculations of Nutritional Requirements
From the information in this chapter, calculate the estimated daily
protein requirement, in g/day, for a 141-lb patient with liver failure.
A nutritional formula calls for 500 g of dextrose. How many
milliliters of a 70% w/v dextrose injection are needed to provide the
required amount of dextrose?
A patient requires 1800 kcal/day, including 60 g of protein. How
many kilocalories would be provided by the protein?
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
If the source of the protein in problem 8 is a 5% amino acid solution,
how many milliliters of the solution would be needed to provide the
requirement?
Calculate the following for enteral nutrition:
a. Grams of dextrose needed to supply 1400 kcal
b. Grams of protein needed to supply 800 kcal
c. Grams of lipid needed to supply 1000 kcal
Calculate the approximate daily water requirement for a/an:
a. 165-lb patient
b. Adult patient with a BSA of 1.6 m
2
c. Patient receiving 1500 kcal by TPN
JF is a 73-year-old male patient who is 6 feet 1 inch tall and weighs
155 lb. He is ambulatory (activity factor = 1.3) and has a severe
infection (stress factor = 1.6). Calculate (a) TDE, (b) grams of protein
(1.25 g/kg/day), (c) grams of lipid (30% TDE), (d) grams of
carbohydrate, and (e) milliliters of fluid (32 mL/kg) required for
enteral nutrition.
A TPN order calls for a liter of solution to contain 3.5% of amino
acids and 15% of dextrose. How many milliliters each of 8.5% amino
acid injection, 70% dextrose injection, and sterile water for injection
should be used to prepare the solution?
If a 50% dextrose injection provides 170 kcal in each 100 mL, how
many milliliters of a 70% dextrose injection would provide the same
caloric value?
Using the Harris-Benedict equation, calculate the TPN caloric
requirement for a hospitalized, bedridden, 60-year-old male surgical
patient, weighing 160 lb and measuring 5 feet 8 inches in height.
RJ is a 55-year-old female patient who is 5 feet 4 inches tall and
weighs 112 lb. She is bedridden (activity factor = 1.2) and has a
fractured pelvis due to an automobile accident (stress factor = 1.4).
For this patient, determine (a) TDE, (b) milliliters of 8.5% amino acid
solution, (c) milliliters of 20% lipid emulsion (30% TDE), (d)
milliliters of 50% dextrose solution, and (e) milliliters of fluid (1
mL/kcal) required for a TPN regimen to supply a balanced caloric
daily intake for this patient.
If amino acids have a caloric value of 4 kcal/g and the daily protein
requirement is 0.8 g/kg, calculate the kilocalories administered to a
patient weighing 180 lb.
A medication order for a TPN solution calls for additives as indicated
in the following formula. Using the sources designated in the
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19.
20.
21.
22.
23.
24.
following table, calculate the amount of each component required in
filling the medication order.
A solution of potassium phosphate contains a mixture of 164 mg of
monobasic potassium phosphate and 158 mg of dibasic potassium
phosphate per milliliter.
a. If a TPN fluid calls for the addition of 45 mEq of K+, how many
milliliters of the solution should be used to provide this level of
potassium?
b. How many millimoles of total phosphate will be represented in the
calculated volume of potassium phosphate solution?
Using the component sources as indicated, calculate the amount of
each component required in preparing 1000 mL of the following
parenteral nutrition solution:
If the parenteral nutrition solution in problem 20 is infused
continuously at a rate of 85 mL/h, how many kilocalories would the
patient receive in a 24-hour period? (Note: The electrolytes and
medications do not contribute significant calories.)
Calculations of Nutrition Label Information
If a person consumes 1800 calories per day, calculate the intake of fat,
in grams, based on dietary fat being 30% of caloric intake.
How many grams of fat are contained in a 2500-calorie diet if 450 of
those calories are derived from fat?
Refer to Table 14.2 to calculate the % DV of each nutrient listed
below:
a. % DV of dietary fiber in a high-fiber cereal containing 13 g of
dietary fiber in each 30 g of cereal
b. % DV of carbohydrate in a one-cup serving of cereal containing 14
g of sugar
c. % DV of calcium in an 8-oz pouch of yogurt containing 300 mg of
calcium
d. % DV of potassium in a food serving that contains 240 mg of
potassium
e. % DV of sodium in a single-serving package of snack mix
containing 140 mg of sodium
CALCQUIZ
14.A. A pharmacist is providing TPN for hospitalized patients. One
patient is a 75-year-old female weighing 115 lb and measuring 5 feet 1
inch in height. She is confined to her bed and is somewhat stressed
following a surgical procedure. Another patient is an 80-year-old male
weighing 162 lb and measuring 5 feet 10 inches in height. He is
ambulatory but stressed due to a severe infection. The pharmacist uses
the Harris-Benedict equations adjusted for activity and stress factors to
determine patients’ daily energy requirements. Perform the same
calculations.
14.B.a A TPN formula is as follows:
If the TPN fluid is to be administered over 24 hours, (a) how many
calories will be administered per hour, and (b) what would be the flow
rate, in drops/min, when using an IV set that delivers 10 drops/mL?
14.C.a A TPN formula is as follows:
a. How many milliliters of each of the following will be needed to
prepare the formula?
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