ENERGY METABOLISM

Energy - is defined as the capacity to do work; the force or power that enables the body to
do its work.

The ultimate source of all energy in living organisms is the sun. Through the process of
photosynthesis, green plants intercept a portion of the sunlight reaching their leaves and
capture it within the chemical bonds of glucose. Proteins, fats, and other carbohydrates are
synthesized from this basic carbohydrate to meet the needs of the plant. Animals and humans
obtain these nutrients and the energy they contain by consuming plants and the flesh of other
animals. The body makes use of the energy from carbohydrates, proteins, fats, and alcohol in
the diet. Energy provided from the macronutrients is locked in chemical bonds within food and
is released when food is metabolized. Energy must be supplied regularly to meet the energy
needs for the body’s survival.

Energy has six forms: heat, chemical, mechanical, electrical, solar and nuclear. Four of these
are important to the human body. The body stores chemical energy that generates electrical
energy for the creation of nerve impulses needed to produce heat to keep the body
temperature at 37°C (98.6°F) even on cold days and to induce mechanical work through muscle
contraction for body movements (Williams, 2002).

When used in nutrition, energy deals mostly with the chemical energy locked in foodstuffs by
reason of the chemical process.

Metabolism – is derived from the Greek word “metabolismos” which means to change or alter.
Metabolism is the chemical process of transforming foods into complex tissue elements and of
transforming complex body substances into simple ones. It involves all types of changes that
occur in food nutrients after they have been absorbed from GIT and to the cellular activity
involved in utilizing these nutrients. It is the totality of the chemical processes in the body by
which substances are changed into other substances to sustain life, thus, the dynamic concept
underlying all life is change.

Energy from Foods

THE CALORIE

The unit of energy commonly used in human nutrition is the kilogram calorie (kcal). The
calorie is the standard unit in measuring heat. It is the unit of measurement for the energy
that our body gets from food. Calories are not eaten. They are by-products when
carbohydrates, protein and fats are oxidized in the body.
One calorie is the amount of heat required to raise the temperature of 1 kg of water to 1°C
at normal atmospheric pressure or in common measure, it is approximately the amount of heat
required to raise the temperature of 4 lbs. of water to 1°F.

1. Fuel factor of carbohydrate = 4 calories per gram

2. Fuel factor of protein = 4 calories per gram
3. Fuel factor of fat = 9 calories per gram
KILOCALORIE (kcal) or LARGE CALORIE

Food energy is measured in kilocalories (kilogram calorie or kcal), which is commonly used
in human nutrition.

Calorie is from the Latin word “calor” meaning heat. It is a measure of heat. The energy
required to do the work of the body is measured as the amount of heat produced by the body’s
work. The energy value of food expressed as the number of kilocalorie a specified portion of the
food will yield when oxidized in the body.

Kilocalorie is derived from the French word “chilioi” meaning thousand and “calor”
meaning heat. The general term calorie refers to a unit of heat measure and is used alone to
designate the small calorie or as a general term in common language for the large calorie
(kilocalorie). The calorie used in nutritional science and in the study of the metabolism is the
large calorie in order to be more accurate and to avoid the use of very large number in
calculations.
The calories in food represent stored energy. To produce energy, the body uses these
calories in a manner similar to the way of burning fire woods produces light and heat. The body
breaks apart complex chemical molecules and puts together new ones (Metabolism as known).

Question: In nutrition, why do we use kilocalorie (kcal) instead of calorie if the

latter is the standard unit for measuring energy?

Answer: Because the amount of energy involved in the metabolism of food is fairly large, the
kilocalorie (1000 calories) is commonly used to measure it. A popular convention is to designate
kilocalorie by Calorie (with a capital “C”). However in this text, kilocalorie is abbreviated as kcal.

Another commonly used unit of measurement is the joule. One joule is equal to the energy
expended when 1 kilogram is moved through a distance of 1 meter by a force of 1 Newton. The
relationship between calories and joules is as follows (Panlasigui, 1996):

1 kcal = 4.184 kilojoules (KJ)

1000 KJ = 1 megajoule (MJ)
1000 kcal = 4.184 MJ
1 MJ = 239 kcal

Measurement of Energy Values of Foods

The energy in foods is present as chemical energy; it can be measured by the heat evolved
when the food is oxidized or combusted. Although energy transformations normally involve
friction and heat conduction, which cause the changes of one form of energy to another to be
incomplete, various forms of energy normally can be converted completely to heat. The caloric
value of a food may be determined by burning weighed samples of the food in an oxygen
atmosphere in an apparatus called a calorimeter, which is designed to allow measurement of
the heat released by combustion of the fuel or food. The total amount of heat produced or
consumed when a chemical system changes from an initial state to a final state is independent
of the way this change is brought about (the law of Hess or the law of constant heat sums).
Thus the complete oxidation of a compound, such as glucose, to CO 2 and H2O produces the
same amount of heat whether the process is carried out in a calorimeter or by metabolism
within the body.
Heats of combustion are not accurate reflections of the amount of energy available to the
body, however, because the body does not completely absorb and metabolize ingested
nutrients. The energy lost in the excreta (feces and urine) must be subtracted from the total
energy value of the food to obtain the amount of energy available to the body from
consumption of the food. The caloric values of foods reported in food composition tables are
"physiological fuel values," also referred to as "available energy" or "metabolizable energy"
values. They are not total energy values.

Bomb Calorimeter - device used for measuring calories (stored fuel in food), designed for
measuring all the heat produced by the complete oxidation of an accurately measured
amount of any food. The apparatus is insulated thoroughly against loss of heat and the
amount of heat produced is measured by the change in temperature of a measured
amount of water.
Using a bomb calorimeter to burn food is a means of releasing all the food
sample’s available energy. (See page 24 of textbook)

Physiological Fuel Values of Foods

The physiological fuel value of a food or a food component may be determined by measuring
the heat of combustion of the food in a calorimeter and then multiplying the heat of combustion
by correction factors for incomplete digestion and incomplete oxidation of the food in the body.
In about 1900, Wilbur Olin Atwater and his associates at the Connecticut (Storrs) Agriculture
Experiment Station used this approach to determine the physiological fuel values of a number
of food components (i.e., the protein, fat, and carbohydrate isolated from various foods). They
determined factors appropriate for individual foods or groups of foods, and they proposed the
general physiological fuel equivalents of 4.0, 8.9, and 4.0 kcal per gram of dietary protein, fat,
and carbohydrate respectively for application to the mixed American diet. These factors are
commonly rounded to 4, 9, and 4 kcal per gram (17, 36, and 17 kJ per gram) respectively for
protein, fat, and carbohydrate. The conversion factors determined by Atwater and his
associates remain in use in the twenty-first century, and energy values of foods are calculated
using these factors. The energy values (physiological fuel values) reported in food composition
tables are commonly estimated by determination of the proximate composition of each food
(i.e., the water, protein, fat, carbohydrate, and ash contents) followed by multiplication of the
amount of each energy-yielding component by the appropriate conversion factor.

The Atwater System

The Atwater system (after Wilbur Olin Atwater) or derivatives of this system are used for the
calculation of the available energy of foods.

The calorie value of nutrients determined by the bomb calorimeter must be modified to take
account of losses in digestion and excretion.
 4 kcal/g for CHO (17J) Note:
9 kcal/g for Fat (38J) 1 kcal = 4.184 joules
4 kcal/g for CHON (17J)

Example for caloric value of food determination:

A slice of cake which contains 3 g CHON, 1 g fat and 15 g CHO will provide the following
kcal:

3 g CHON x 4 kcal = 12 kcal

1 g fat x 9 kcal = 9 kcal
15 g CHO x 4 kcal = 60 kcal
Total: 81 kcal

To get the percentage of Kcal from the nutrient:

12 kcal from CHON / 81 kcal = 14.8%

9 kcal from fat / 81 kcal = 11.1%
60 kcal from CHO / 81 kcal = 74%

COMPONENTS OF ENERGY EXPENDITURE

The amount of energy spent in a day differs for each individual. As expected, people spend
energy when they are physically active, but they also spend energy when they are resting
quietly. In general, there are three components of energy expenditure.

Energy is expended by the human body in the form of resting energy expenditure (REE) or
energy to meet basal metabolism (BM), energy expended for physical activity (PA) and energy
to cover the effects of food on metabolism, earlier known as specific dynamic action (SDA) of
food and now referred to as dietary-induced thermogenesis (DIT) or thermic effect of food
(TEF).
The amount of energy spent in a day differs for each individual. Except in extremely active
individuals, the REE or basal metabolism constitutes the largest portion (60% to 65%) of the
total energy expenditure (TEE). The TEF represents approximately the smallest component
(10%) of the total daily energy expenditure. The contribution of physical activity is the most
variable component of TEE, which may be as low as 100 kilocalories per day in sedentary
people or as high as 3000 kcal per day in very active people.

TOTAL ENERGY EXPENDITURE (TEE) – the energy expended by an individual in 24 hours.

Measuring Human Energy Expenditure

1. Direct Calorimetry – monitors the amount of heat produced by a person placed inside a
structure large enough to permit moderate amounts of activity. These structures are
referred to as whole-room calorimeters. Direct calorimetry provides a measure of energy
expended in the form of heat but provides no information on the kind of fuel being oxidized.
The method is also limited by the confined nature of the testing conditions. Hence the
measurement of TEE using this method is not representative of a free-living (i.e., engaged
in normal daily activities) individual in a normal environment because physical activity within
the chamber is limited. Itshigh cost and complex engineering and the scarcity of appropriate
facilities around the world also limit the use of this method. Its application is for scientific
research only.
2. Indirect Calorimetry – estimates energy expenditure by determining the oxygen
consumption and carbon dioxide production of the body over a given period. The equipment
varies, but the person usually breathes into a mouthpiece or ventilated hood through which
his or her expired gases are collected (respirometer or spirometer). Indirect calorimetry has
the advantage of mobility and low equipment cost.

BASAL METABOLISM
 Basal metabolism is the measure of energy needed by the body at rest to carry on vital
body processes; approximately 1 calorie per kilogram of body weight per hour for an adult. It is
the minimum amount of energy needed by the body at rest in the fasting state. It indicates the
amount of energy needed to suction the life processes; respiration, cellular metabolism,
circulation, glandular activity and the maintenance of body temperature. It accounts for more
than one-half of calorie requirements for most people.
Basal metabolic rate (BMR) is the rate of basal metabolism in a given person at a given
time and situation. It constitutes one-half of the calorie requirements of an individual.

BASAL METABOLIC RATE – is the rate at which the body spends energy for the maintenance
of physiological activities; i.e., metabolic activities of cells and tissues and to maintain
circulatory, respiratory, gastrointestinal, and renal processes (activities necessary to sustain
normal body functions and homeostasis).

BASAL ENERGY EXPENDITURE – the measurement of the basal metabolic rate; usually
expressed as kilocalories per 24 hours (kcal/24 hr).

Note: In practice, the terms REE (resting energy expenditure) and BEE (basal energy
expenditure) are often used interchangeably.

Factors Influencing the BMR

1. BODY COMPOSITION – The major single determinant of REE or basal metabolism is

fat-free mass (FFM) of lean-body mass (LBM). FFM is the metabolically-active tissue in
the body. Because of their greater FFM, athletes with greater muscular development
have approximately a 5% higher basal metabolism than nonathletic individuals. On the
other hand, a large proportion of inactive adipose tissue lowers the BMR.
2. AGE – Because it is determined by the FFM, the REE is highest during periods of rapid
growth, chiefly during the first and second years of life, and reaches a lesser peak
throughout puberty and adolescence. The additional energy required for synthesizing
and depositing body tissue is about 5 kcal per gram of tissue gained (Roberts and
Young, 1988). Growing infants may store as much as 12% to 15% of the energy value
of their food in the form of new tissue. As a child becomes older, the caloric
requirements for growth is reduced to about 1% of the total energy requirement.
The loss of FFM with aging is associated with a decline in basal metabolism,
amounting to 2% to 3% decline per decade after early adulthood (age of 20). These
changes are attenuated by exercise; exercise can help maintain a higher lean body mass
and thus a higher BMR.

* For each decade between 40-58 years: decrease of 5% (FAO/WHO)

* For each decade between 60-69 years & 70 above: decrement is increased to 10%

3. BODY SIZE & SURFACE AREA (HEIGHT) – A tall lean man will have a higher basal
metabolism than a stout short person of the same weight because of the greater surface
area in the former.
 The greater the body surface area or skin area, the greater the amount of heat
loss will be, and in turn, the greater the necessary heat produced by the body. Muscle
tissue requires more O2 than does adipose tissue.

4. SEX – Sex differences in metabolic rates are primarily attributable to differences in body
size and composition. Women, who generally have more fat in proportion to muscle
than men, have metabolic rates that are approximately 5% to 10% lower than men of
the same weight and height.
5. ENDOCRINE GLANDS/HORMONAL STATUS – The secretion of the endocrine glands
are the principal regulators of the metabolic rate. Thyroid gland secretion has the
greatest effect on metabolism so does adrenals and pituitary. Hyperthyroidism causes
an increase in basal energy needs by about 50-75%. Hypothyroidism resulting from
decrease thyroxine secretion can depress basal energy needs by almost 30%.
Stimulation of the sympathetic nervous system (e.g., during periods of emotional
excitement or stress) causes the release of epinephrine, which directly promotes
glyconeolysis and increases cellular activity.
The metabolic rate of women fluctuates with the menstrual cycle. An average of
359 kcal/day difference in the BMR has been measured between the low and high point,
about 1 week before ovulation, just before the onset of menstruation. The mean
increase in energy expenditure is about 150 kcal/day during the second half of the
menstrual cycle (Webb, 1986).

6. PREGNANCY AND LACTATION – During pregnancy, the BMR seems to decrease in

the early stages, whereas later in pregnancy the metabolic rate increase by 20% to 25%
because of uterine, placental, and fetal growth, the mother’s increased cardiac workload
and an increase in metabolic activity of maternal tissues and energy expended during
lactation.
7. BODY TEMPERATURE – An increase in body temperature such as in fever will cause a
7% rise above normal (98.6°F) or 13% rise for each degree above 37°C. A cold external
temperature raises the BMR as the body tries to keep warm.
8. STATE OF NUTRITION/BODY CONDITION – BMR is low in obesity, in starvation,
fasting,hypothyroidism and undernutrition; it is increased in hyperthyroidism and
cardiorenal disease with difficult breathing.
9. ENVIRONMENTAL TEMPERATURE – BMR is also affected by extremes in
environmental temperature. People living in tropical climates usually have BMRs that are
5% to 20% higher than those living in temperate areas. Exercise in temperatures
greater than 86°F (30°C) also imposes a small additional metabolic load of about 5%
from increased sweat gland activity. The extent to which energy metabolism increases in
extremely cold environments depends on the insulation available from body fat and
protective clothing.
10.PHYSICAL OR MUSCULAR ACTIVITY – any form of muscular activity cause an
increase in BMR; the amount of energy used is dependent on the amount of muscles
used, the weight of the body involved and the length of time the activity is engaged in.
- 1 lb. of body fat represents 3,500 kcal. For every 3,500 kcal lacking in the diet, 1 lb. of
body weight will be lost and for every 3,500 kcal excess 1 lb. of weight will be gained.

11. DRUGS – Certain drugs, such as barbiturates, narcotics, and muscle relaxants,
decrease the metabolic rate, as does sleep and paralysis.
 12.SLEEP – During sleep, the metabolic rate falls approximately 10% to 15% below that of
waking levels. This is due to muscular relaxation and decreased activity of the
sympathetic nervous system.

Calculation of BMR:

1. Rule of Thumb - not applicable for obese or lean individual.

Basal Needs: Male (1 kcal/kg/hr) Female (0.9 kcal/kg/hr)

Weight in kg x 24 hours = BMR in one day

Example: Male with 55 kg DBW

BMR = 55 x 1 kcal x 24 hours = 1,320 = 1,300 kcal

2. Harris-Benedict Formula - developed in 1909 using information on weight, height, age &
sex.

For Males:
REE = 66.5 + (13.5 x weight in kg) + (5 x height in cm) – (6.75 x age in years)

For Females:
REE = 655.1 + (9.56 x weight in kg) + (1.85 x height in cm) – (4.68 x age in years)

Example: 22 y.o. male with 56 kg body weight (DBW), 5’4” in height

BMR = 66.5 + (13.5 x 56) + (5 x 162.56) – (6.75 x 22) = 1486.8 = 1,500 kcal

PHYSICAL ACTIVITY

The second component of a person’s energy expenditure is physical activity (PA). Energy for PA
is the most variable and most changeable component of energy expenditure (Whitney et al.,
2002). It may range from as little as 10% in a person who is bedridden to as much as 50% of
TEE in an athlete. The amount of energy required for an activity depends on the number of
muscles involved, and the intensity and duration of the activity. PA includes energy expended in
voluntary exercise and during involuntary activities such as shivering, fidgeting, and maintaining
postural control.

Factors Affecting the Energy Expended in Physical Activity (EEPA)

EEPA varies considerably depending on body size and the efficiency of individual habits of
motion. The level of fitness also affects the energy expenditure of voluntary activity, probably
because of variations of muscle mass.
 EEPA tends to decrease with age, a trend that is associated with a decline in FFM and an
increase in fat mass. Men generally have a higher EEPA than women, primarily because of their
large body size and greater FFM.
Excess postexercise oxygen consumption (EPOC) affects energy expenditure. The
duration and magnitude of physical activity have been shown to increase EPOC, resulting in an
elevated metabolic rate even after exercise has ceased. Habitual exercise does not cause a
significantly prolonged increase in metabolic rate per unit of active tissue, but it does cause an
8% to 14% higher metabolic rate in men who are moderately and highly active, respectively,
because of their increased FFM. These differences seem to be related to the individual, not to
the activity.

THERMIC EFFECT OF FOOD (TEF) or DIET-INDUCED THERMOGENESIS (DIT)

DIT of TEF is the significant elevation of the metabolic rate following ingestion of a meal. The
muscles that move food through the intestinal tract and the cells that manufacture digestive
and other juices need energy to participate in the digestion, absorption and metabolism of food.
The expenditure of energy for this purpose results in thermogenesis or production of heat, thus
the term thermic. The thermic effect of food is greater for high-carbohydrate foods (8%) than
that for high-fat foods (3%) (Williams, 2002) because it takes less energy to transfer absorbed
fat into adipose than to convert glucose into glycogen or, or metabolize excess into fat. The TEF
is greater for a meal eaten all at once rather than spread out over a couple of hours. Some
possible mechanisms include changes in central nervous system activity, greater production and
release of hormones (such as insulin) and enzymes, and the rate of absorption and storage of
macronutrients (Wardlaw, 1999).

Factors Affecting the Thermic Effect of Food

The TEF varies with the composition of the diet and is greater after consumption of
carbohydrates and proteins than after fat. Fat is metabolized efficiently, with only $% wastage,
compared with 25% wastage when carbohydrate is converted to fat for storage. These factors
are thought to contribute to the obesity-promoting characteristics of fat.
Spicy foods enhance and prolong the effect of the TEF. Meals with chili and mustard
may increase the metabolic rate as much as 33% more than unspiced meals, and this effect
may last for more than 3 hours (McCrory et al, 1994). Caffeine and nicotine also stimulate the
TEF. When ingested every 2 hours for 12 hours, the amount of caffeine in one cup of coffee
(100 mg) has been shown to increase the TEF by 8% to 11%. Nicotine has a similar effect.

ESTIMATING ENERGY REQUIREMENTS

I. ADULT

ESTIMATING TOTAL ENERGY REQUIREMENTS

- Sum total of basal or REE plus energy expenditure for PA plus energy
expenditure due to the thermic effect of food.
- The total energy needs of an individual is the composite of energy necessary to
replace basal metabolic needs, energy expenditure for physical activities,
thermogenic effect of food and other factors.

Factorial Method
A factorial method of measuring total energy expenditure involves calculation of each of the
three categories of energy needs.

Note: The thermic effect of food is the “cost” of processing food. In a normal mixed diet, it is
estimated to be about 10% of the total calorie intake. For instance, people who consume 1800
kcal/day use about 180 kcal to process their food. The actual thermic effect of food varies with
the composition of food eaten, the frequency of eating, and the size of meals consumed.
Although it represents an actual and legitimate use of calories, the thermic effect of food in
practice is usually disregarded when calorie requirements are estimated because it constitutes
such a small amount of energy and is imprecisely estimated.

1. Calculate basal metabolism using any given method.

2. Calculate the energy needs for physical activity (PA) by making a record of all activities over
a 24-hr period and applying all energy activities, or by calculating the % increase above
BMR (Cooper, et al).

Physical Activity level % above basal

Bed rest 10-20
Sedentary 30
Light 50
Moderate 75
Heavy 100

3. Add basal energy costs and activity costs.

4. Basal Energy + physical activity = total energy requirement

Example: 22 y.o. male with 56 kg DBW, 5’4”, light activity

1. Using Harris-Benedict Formula:

BMR = 66.5 + (13.5 x 56) + (5 x 162.56) – (6.75 x 22) = 1486.8 = 1490 kcal

2. Total PA kcal = 1490 kcal x 50% (increase in BMR) = 745 kcal

3. 1, 490 + 745 = 2,235 kcal
TER = 2,200 kcal

Krause method

The most practical, frequently used and rapid method of estimating energy requirements is
based on desirable body weight (DBW) according to occupation; often used in clinics and
hospitals.

Activity level kcal/kg DBW/hr

Bed rest 27.5
Sedentary 30
Light 35
Moderate 40
Heavy 45
 Wherein:
Sedentary – secretary, typist, administrator, cashier, bank teller
Light – teacher, nurse, student, lab technician, housewife with maids
Moderate – housewife without maid, vendor, mechanic, jeepney and car driver
Heavy – farmer, laborer, “cargador”, coal miner, heavy equipment operator

Example:
52 kg, jeepney driver
TER = (40 kcal/kg DBW) x 52 kg = 2080 kcal
TER = 2,100 kcal

II. INFANTS & CHILDREN

DESIRABLE BODY WEIGHT

1. Infants

a. 1st six months

DBW (g) = Birthweight (g) + (age in months x 600)

*if birthweight is not known, use 3000 grams

Example: 4 month old infant

DBW (g) = 3000g + (4 x 600)
= 5400g
= 5.4kg

b. 7-12 months
1. DBW (g)= birthweight (g) + (age in months x 500)

Example: 8 month old infant

DBW (g) = 3000g + (8 months x 500)
= 7000g
= 7 kg

2. DBW (kg) = (age in months/2) + 3

Example: 8-month old infant

DBW (kg) = (8 months/2) + 3
= 7 kg

2. Children

DBW (kg) = (no. of years x 2) + 8

Example: 7 year old child

 DBW (kg) = (7yrs x 2) + 8 = 22 kg

ESTIMATION OF TOTAL ENERGY REQUIREMENTS

1. Infant

TER/day (0-6months) = 120 kcal/kg DBW

TER/day (7-12months) = 110 kcal/kg DBW

*TER rounded off to the nearest 50 kcal

Example: 4 month old infant

TER= 5.4kgs x (120 kcal/kg DBW)
= 648 kcal
= 650 kcal

2. Children

TER/day= 1000 + (100 x age in years)

Example: 7 year old child

TER= 1000 + (100 x 7)
= 1700 kcal

3. Adolescent

13-15 years
55 (boys) kcal/kg DBW
45 (girls) kcal/kg DBW

16-19 years
45 (boys) kcal/kg DBW
40 (girls) kcal/kg DBW

Average both sexes= 45 kcal/kg DBW

ENERGY BALANCE

Energy balance occurs when an individual’s total caloric expenditure equals the individual’s
total caloric intake. The amount taken in by an individual should be equal to the amount of
energy expended during the day thus, attaining a desirable body weight. Then the individual is
said to be in energy balance. There is no weight gain or loss.
If more energy is taken in than is expended, the person gains weight. If more energy is
expended than is taken in, the person loses weight. If food energy is restricted too severely,
individuals lose lean tissue and may not receive enough nutrients. In addition, restrictive eating
may set in motion the unhealthy cycle of restrictive dieting and binge eating.
 Desirable body weight (DBW) or ideal body weight (IBW) as used in nutrition and diet
therapy refers to the weight for height found statistically to be the most compatible with health
and longevity. There are several tables or nomograms which give the DBW of adults of given
height. However, in practice, it is often necessary to compute an individual’s DBW quickly.
The concept of ideal or desirable body weight (DBW) is still debatable because weight is
made up of different components. Weight is made up of fat, muscles, organs, bones, and fluid.
Difference may lie in these components between sexes, ages, and physiological condition. For
example, women would have more essential fat compared to males. As a result, frame size is
now a factor in determining DBW. The breadth of the elbow bone or wrist circumference as an
index for frame size has been employed for some years now.
The Food and Nutrition Research Institute and the Philippine Pediatric Society has come
out with “Anthropometric Tables and Chart for Filipino Children” which may be used as
reference in determining the DBW. For adults, the “Weight and Height Tables for Filipinos (25-
65 years)” may be utilized. If these references are not available, the following formulas may be
used:

A. Height & Weight Appropriations – used to determine the desirable body

weight (DBW) and % DBW.

1. Tannhauser’s Method
 Height (in cm) minus 100 (factor)
 Deduct 10% of answer to adjust to Filipino standard
 Example:
Given: Filipino male measuring 157 cm
Computation: = 157 cm – 100 = 57 kg (0.1)
= 57 kg – 5.7 kg = 51.3 or 51 kg

2. Hamwi Method
 For the first 5 feet (small frame):
100 – 105 lbs for females
105 – 110 lbs for males
 For each additional inch, add 5 lbs
 Add 5 lbs. for medium frame & 10 lbs for large frames
 Example: female, 5’2”, small frame
5 ft. = 105 lbs
2 in. x 5 lbs. = 10 lbs
105 lbs + 10 lbs = 115 lbs

3. Calculate the clients percentage of DBW by the following formula:

 Actual Weight / DBW x 100 = % DBW
 Normal finding: body weight is within 10% of ideal range
 Example: actual weight – 95 lbs, DBW – 115 lbs
95 lbs/115 lbs x 100 = 82.6% = 83%

A current weight that is 80% to 90% of DBW indicates a lean client and possibly mild
malnutrition. Weight that is 70% to 80% indicates moderate malnutrition; less than
70% may indicate severe malnutrition possibly from systematic disease, eating
disorders, cancer therapies, and other problems.
 To determine % underweight:
 DBW – actual weight / DBW x 100
 Example: actual weight – 98 lbs, DBW – 120 lbs
120 lbs – 98 lbs = 22 lbs
22 lbs/120 lbs x 100 = 18.33% = 18% underweight

Underweight is a condition where food intake or the energy value of a diet is less than
the energy value of a diet is less than energy expenditure, thus resulting in negative
energy balance. A person with body weight 10% or lower than his DBW is underweight.
Physical signs become obvious when adipose tissues beneath the skin are lacking and
the muscles are flabby.

To determine % overweight:
 Actual weight – DBW / DBW x 100
 Example: actual weight – 140 lbs, DBW – 115 lbs
140 lbs – 115 lbs = 25 lbs
25 lbs/115 lbs x 100 = 21.74% = 22% overweight
Weight exceeding 10% of the IBW range is considered over weight; weight exceeding
20% of IBW is considered obesity. Overweight means excessive positive energy balance.
It is a condition which results when energy intake is higher than energy output wherein
the excess energy is converted to fat.

B. The Body Mass Index (BMI) – the ratio of body fat to muscle mass as measured from
body density. It is used to assess a person’s body weight and to monitor changes over time.
BMI is the measure of adiposity or overfat, not simply overweight. It should not be applied
to children, adolescents, adults over 65 years old, pregnant and lactating women, and
highly muscular individuals.

Determine BMI using one of these formulas:

Weight in kg
Height in m2
= BMI

or

Weight in lbs x 703 = BMI

Height in in2

Normal finding: BMI is between 18.5 and 24.9

BMI <18.5 is associated with being under weight. BMI between 25.0 and 29.9 is
considered overweight and increase risk for health problems. A BMI of 33 or greater is
considered obese and places the client at a much higher risk for diabetes and
cardiovascular disease.

C. Determination of Body Composition

Differences in skeletal size and the proportion of lean body mass can contribute to body
weight variations among individuals of similar height. For example, muscular athletes may
be classified as overweight because their excess muscle mass, not their adipose mass,
increases their weight. Older adults tend to have lower bone density and may therefore
weigh less than younger adults of the same height.

Percentage of body fat or lean body mass.

Adult: 14-28% body fat of total body weight
Women: 15-29%

Indirect Methods:
a. Triceps skin-fold test (TSF), midarm muscle circumference (MAMC), and midarm
circumference (MAC).
b. Waist circumference – the presence of excess body fat around the abdomen out
of proportion to total body fat is considered a risk factor for ailments associated with
obesity and the metabolism syndrome.
c. Waist-hip ratio or Waist-to-hip ratio (WHR)

The WHR has been used as an indicator or measure of the health of a person, and the
risk of developing serious health conditions. Research shows that people with "apple-
shaped" bodies (with more weight around the waist) face more health risks than those
with "pear-shaped" bodies who carry more weight around the hips.

WHR is used as a measurement of obesity, which in turn is a possible indicator of other

more serious health conditio

Direct Methods:
a. Underwater Weighing
A more direct measure of determining whole-body density is densitometry, which
includes underwater (hydrostatic) weighing . Underwater weighing is based on
Archimedes’ principle: the volume of an object submerged in water equals the volume of
water the object displaces. Once the volume and mass are known, the density can be
calculated. Although this method is considered the gold standard, it is not always
practical, involves significant training to perform, and requires considerable cooperation
on the part of those being measured because they must be submerged under water and
remain motionless long enough for the measurements to be made.

b. Bioelectrical Impedance Analysis

Bioelectrical impedance analysis (BIA) is a body composition analysis technique based
on the principle that relative to water, lean tissue has a higher electrical conductivity and
lower impedance than fatty tissue because of its electrolyte content. BIA has been found
to be a reliable measurement of body composition (fat-free mass or FFM and fat mass)
when compared with BMI or skin-fold measurements or even height and weight
measurements. BIA involves attaching electrodes to the right hand, wrist, ankle, and
foot of a patient and passing a small electrical current through the body. The BIA
method is becoming very popular as a means of assessment because it is safe,
noninvasive, portable, and rapid.