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Stability of body weight requires that energy intake and expenditures are balanced over time. The major categories of energy output are resting energy expenditure (REE) and physical activity; minor sources include the energy cost of metabolizing food (thermic effect of food or specific dynamic action) and shivering thermogenesis. The average energy intake is about 2600 kcal/d for men and about 1800 kcal/d for women, though these estimates vary with age, body size, and activity level. Basal energy expenditure (BEE), measured in kcal/d, may be estimated by the Harris and Benedict formula (Fig. 6-1).
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Dietary reference intakes (DRIs) and recommended dietary allowances (RDAs) have been defined for many nutrients, including 9 essential amino acids, 4 fat-soluble and 10 water-soluble vitamins, several minerals, fatty acids, choline, and water (see Tables 95e-1 and 95e-2 in HPIM-19). The usual water requirements are 1.0–1.5 mL/kcal energy expenditure in adults, with adjustments for excessive losses. The RDA for protein is 0.6-g/kg ideal body weight, representing 10-15% of total caloric intake. Fat should constitute ≤30% of calories, and saturated fat should be <10% of calories. At least 55% of calories should be derived from carbohydrates.
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Malnutrition results from inadequate intake or abnormal GI assimilation of dietary calories, excessive energy expenditure, or altered metabolism of energy supplies by an intrinsic disease process.
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Both outpatients and inpatients are at risk for malnutrition if they meet one or more of the following criteria:
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Unintentional loss of >10% of usual body weight in the preceding 3 months
Body weight <90% of ideal for height (Table 6-1)
Body mass index (BMI: weight/height2 in kg/m2) <18.5
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