Macronutrient: Carbohydrates, Protein and Fats Fats and Water-Soluble Vitamins

MODULE 5
Macronutrient: Carbohydrates, Protein and Fats

Fats and Water-Soluble Vitamins
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MODULE 5
Macronutrient: Carbohydrates, Protein and Fats
Fats and Water-Soluble Vitamins
Overview
This learning module will introduce and discuss the preparation of different therapeutic
diets particularly in the laboratory activities following the principles and theories underlying in
the entire course. This will guide the student to calculate for the values of macronutrient like
carbohydrates, protein and fats; fats and soluble vitamins; food exchange distribution and regular
meal planning.
This course will help the student nurses to enlighten the skills, knowledge and attitude in
providing proper nutrition management for the client/patient. The discussion entails you on how
to calculate your normal diets with carbohydrates, protein and fats; fats and water-soluble
vitamins; the distribution of food exchanges with respective meals such as breakfast, lunch,
dinner and snacks; and planning regular menu using the food exchange list . With this course, the
learner should study the lessons eagerly and follow the instructions provided to complete and
accomplish each tasks.
Objevtives
1. Discuss the macronutrient: carbohydrates, protein and fats
2. Discuss the Fats and Water-Soluble Vitamins
3. Explain the pocedure in the computation of macronutrients and fats and water-soluble
vitamins content in the diet.
4. Compute for diet prescription, prepare the food exchange distribution and plan a diet for
each macronutrient, fats and water soluble vitamins.
Discussions
The discussion focused on the preparation of macronutrient as well as fats and water-
soluble vitamins to include in the daily diet. Macronutrients consist the most amount of the
carbohaydrates which is important as the energy giving food such as rice, bread, corn, sweet
potatoes , fruits and vegetables. Proteins are the body building foods which includes the best
sources from meat, fish and poultry but there also good sources from vegetables,nuts, grains,
breads and cereals. Fats is an essential nutrient for our body because it helps to regulate the
body’s functions. Some fats are visible such as fats from meat, butter, shortening and oils but
some are not visible like milk egg yolk and other food mixtures. The details of the
macronutrients carbohydrates, protein and fats will be discussed on your lecture.
As we go along with the discussion, you have to take note on the importance of the
computation of dietary needs, preparation of food exchange distribution and meal planning. In
the preparation of carbohydrates, you need to consider the necessary amount for the daily
requirement. Lack of carbohydrates may lead to malnutrition and may contribute to develop
certain carbohydrate-related diseases like diabetes mellitus . Though some people are afraid of so
much carbohydrates because of the fattening contents like sugar but this should be always
included in our daily diet. The best way to control too much carbohydrates is to cut down and not
totally avoiding them.
With protein, you need to consider the importance of the nutrient in the body, its
functions, the best sources, identify the different kinds of protein. Also, you have to identify the
different protein-related diseases like marasmus and kwasiorkor in children which is also known
as the Protein-Energy Malnutrition (PEM). Protein can also be given attention with other
diseases such as heart diseases, cancer, osteoporosis, weight control and kidney disease and othe
rdisease related to protein difficiency.
In fats, you need to know the importance and functions of fats in the body, the best
sources, identify the different kinds of fats, and identify disease conditions related to low intake
and excessive intake of fats. With fats, you to very careful in the planning and preparation of
foods that includes fats in the diet that requires modification for client/patient with fats or lipids
problems. Fats or lipids may contribute to heart diseases, blood cholesterol levels, cancer and
obesity but some fats or lipids that are good in our health like the benefits of Omega 3.
While fat and water-soluble vitamins are found in alsmost all foods like fruits and
vegetables, grains, legumes, fish, meat and poultry, eggs and dairy. Fats and oils are also good
sources of vitamins. Fat soluble vitamins consist of Vitamin A, D, E, K and water soluble
vitamins like Vitamin C and Vitamin B complex.
In the preparation of diet consisting of macronutrient carbohydrates, protein, fats and fat
and water-soluble vitamins, you need to do the procedure in the module 4. Calculate for the diet
prescription and consider the condition of the client/patient needing the precribed diet.
For example is a client whose BMI is above normal and wishes to manage his diet. His
height is 5 feet 5 inches and weighs at 85 kilograms at the age of 30 with moderate acitivity. Let
us calculate the diet prescription, make the food exchange and meal distribution and provide a
meal plan considering the appropriate amount of macronutrient to include in his diet.
Follow the procedure for diet prescription:
1. Determine your height = 5’ 5” and actual body weight = 85 kgs.
DBW = 60 + 5 = 65 inches x 2.54 = 165.1 m
= (165 1 – 100) – 10%
= 65.1 – 10% (65.1)
= 65.1 – 6.51
DBW = 58.59 kgs
2. Calculate your basal needs

Basal Needs = 1 × 58.59 kg (DBW) × 24
= 1, 406.16 kcal
Male = 1 Kcal per kg DBW/hour Female = 0.9 Kcal per kg DBW/hour
3. Estimate physical activities = 70% kcal
Physical Activity: use the lower limit for female
Bed rest 10-20 percent
Sedentary 30 percent
Light activity 50-60 percent
Moderately active 60-70 percent
Severely active 90-110 percent
Moderate activity (male) = 70 %

PA = 1, 406.16 Kcal × 70%
= 984.31 Kcal
4. Find the Total Energy Allowance (TEA), by adding the basal needs and estimated
physical activity
TEA = 1, 406.16 kcal + 984.31 Kcal
= 2, 390.47 Kcal
5. Distribute Total Energy Allowance among Carbohydrate, Protein, Fat as follows

Carbohydrates: 50-70 %
Protein: 10-15 %
Fats: 20-30 %
Allowances for protein can also be provided based on the Recommended Energy and Nutrient
Intakes for Filipinos (RENI)
6. For diet modification, allot 60% of the total energy allowance for carbohydrates, 20%
protein and 20% fat. Thus, the corresponding energy contributions of the three nutrients
in your diet are as follows:
Carbohydrate = 2, 390.47 kcal × 0. 60 = 1,434.282 kcal
Protein = 2, 390.47 kcal × 0. 20 = 478.094 kcal
Fats = 2, 390.47 kcal × 0. 20 = 478.094 kcal
2, 390.47 kcal
7. Calculate the number of grams of CHO, Pro and Fats by dividing the calories for each
nutrient by the corresponding physiologic fuel values (4 kcal/g CHO, 4 kcal/g Pro, 9
kcal/g Fat).
Carbohydrate = 1,434.28 kcal ÷ 4 = 358.57 grams
Protein = 478.09 kcal ÷ 4 = 119.52 grams
Fats = 478.09 kcal ÷ 9 = 53.12 grams
531.21 grams
8. To simplify the diet prescription (Rx), round off calories to the nearest 50, and
carbohydrates, proteins, and fats to the nearest 5 grams. Thus, your diet prescription is:
Diet Rx: 2, 400 Kcal; CHO – 360 grams, Protein – 120 grams, Fat – 55 gram
Note: In rounding off the diet prescription, you are allowed to round off to the
nearest 50 for the total Kcal and to the nearest 5 for the carbohydrates, protein and fats in
grams.
9. Provide the food exchange and meal distribution
Food Exchange and Meal Distribution

Food No. of CHO PRO FAT ENERG Meal Distribution
Exchange Exchange 360 g. 120 g. 55 g. Y kcal B L D Sn
s
I. Veg A 3 9 3 - 48 1 1 1
Veg B 3 9 3 - 48 1 1 1
II. Fruits 5 50 - - 200 2 1 1 1
III.Milk-LF 2 24 16 10 160+90 1 1
IV. Rice 11 253 22 - 1, 100 3 3 3 2
V. Meat-LF 9.5 - 76 9.5 304+85.5 3 3 2 1.5
VI. Sugar 3 15 - - 60 1 1 1
VII. Fat 7 - - 35 315 2 2 1 2
Total 43.5 360 120 54.5 2,410.5 14 12 11 6.5
To obtain the amount of rice, meat/fish and fats exchanges:

Rice: 360 - 107 Protein: 120 – 44 Fats: 55 – 19.5
= 253 ÷ 23 = 76 ÷ 8 = 35.5 ÷ 5
= 11 = 9.5 = 7.1 or 7
10. Provide a 24 hours diet including breakfast, lunch, dinner and snack.
Sample Meal Plan:
Please refer you sample meal plan from your meal distribution and food exchange list.
Breakfast Lunch
Steamed: ½ cup chayote fruit ½ cup kangkong
½ cup carrot ½ cup sting beans
1 slice ripe papaya and 1 pc. latundan 10 pcs grapes
1 cup low fat milk 1-1/2 cup rice
1 cup rice and 1 slice biko Sinigang: 2 slice bangus
Steak: 1 slice lapu-lapu 1 pastillas
1 slice beef sirloin 2 tsp latik
1 yema
1 ham and 1 tsp butter
Dinner Snack (AM/PM)

Vege: ½ cu lettuce 1 slice pineapple
½ cup singkamas pods 2 loaf bread
1 cup low fat milk 1 tbsp. sandwich spread
Rice: 1-1/2 cup thick lugaw
1 slice bibingka
1 chicken leg
1 chicken breast
1 tsp halaya
2 slice avocado
Evaluation
Assignment
1. Questions for discussion
a. Carbohydrates
b. Protein
c. Fats
d. Fat and water-soluble vitamins
Group Activity
1. What are the health benefits of carbohydrate, protein and fats?
2. Calculate the diet prescription for the client with problems in macronutrient. Choose only
one from carbohydrate, protein or fats.
3. Provide the food exchange distribution, meal distribution and sample meal plan. Please
see procedures and food exchange list.
References
Caudal, Maria Lourdes C., Basic Nutrition and Diet Therapy (Texbook and Laboratory Manual
for Nursing Students), C & E Publishing, Revised Edition 2019
Roth, Ruth A. et. Al., E-book: Nutrition and Diet Therapy, Thompson Asian Edition, 2019
https://www.slideshare.net/rozymea/nutrition-and-diet-theraphy

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MODULE 5

Macronutrient: Carbohydrates, Protein and Fats

2. Calculate your basal needs

Moderate activity (male) = 70 %

5. Distribute Total Energy Allowance among Carbohydrate, Protein, Fat as follows

Food Exchange and Meal Distribution

To obtain the amount of rice, meat/fish and fats exchanges:

Dinner Snack (AM/PM)

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