Nutrition Assistant Sample Manual Chapter 12

User Manual Sampler

Chapter 12 BEE - Energy ____________________________________________________________________________________________

The "BEE -Energy" screen below (Figure 12.1) is for estimating a person's energy need / requirements. This screen allows for calculating these requirements in a number of ways with the "BEE"(Harris Benedict) equation being the main one. From this screen you can access the "Other Energy" screen for estimating energy needs using alternative methods. You get to this BEE-Energy screen from the main menu using the "Bee/Energy" button or you will normally get to this screen by selecting the button on the "Weight Change" screen.

     Figure 12.1 - BEE - Energy

Screen How to Use This Screen:

Note: The following sequence is for an energy estimation using the BEE. Using one of the alternative energy estimation method (accessed through the "Other" button) will alter this sequence slightly.
1) If not showing from entry on a previous screen enter sex, age and height in the fields on lines 1 thru 3. Normally these will be showing because you entered and/or set these on previous screens.
2) Enter or verify the weight showing at 3:J. See the note for line 3 below for more on using alternative weights.
3) Based on the values for sex, age, height and weight the "raw" or "unadjusted" BEE will show on line 4 if adult (over age of 18 years). If person is under 18 years of age, the long button to the right of BEE will be labeled Pediatric and the WHO BEE value will be shown.

4) Set appropriate Activity/Growth and/or Injury/Stress factors on line 5 and 6 using the drop down lists accessed by tapping the arrow.
5) If you have other calorie value adjustments you may enter those in the field at 7:K. You may also set the (+ or -) sign by tapping the button preceding the field.
6) Check the "BEE (Adjusted Total)" check box (8:A), if desired, to select this adjusted BEE as your estimated energy needs value. This will cause the value shown in the "Req'd Calories" field (at 12:K) to be that showing in the field at 8:K.
7) Record the value, if required for your paper document, and select the top right button to advance to the "Protein Needs" screen.

Field / Line Explanations
Line 0: See Chapter 3 "The Way Things Work” for details on the standard screen buttons .
Line 1: "Sex" field. Change the gender / sex by tapping the "M" or "F" button to the right of the field.
"Age" field. Enter or change the age by entering the age directly or by tapping the "yrs" button to access the "Age from Birthdate" screen.
Line 3: "Knee Height" field. Enter the knee height measurement in this field. To change entered values’ units tap the displayed unit button.
"Black Herit." & "Hispanic" check boxes. The calculation for height estimation based on knee height differs for individuals of Hispanic and Black heritage. If no box is checked Caucasian data is used. Check the appropriate box if applicable.
Line 5: "Estimated Ht" field. Estimated height based on knee height, sex, age, and heritage will show when available.
Line 8: "Mid Arm Circ" field. The "Mid-arm circumference" field is used to estimate a person's weight. Note that estimated weight based on mid-arm circumference is also dependent on an estimated height being available.
Line 10: "Estimated Wt" field. Estimated weight based on mid-arm circumference and estimated height fields.
Line 11: "Use Estimate and 'Actual Weight'" checkbox. If you want to use the "Estimated Wt" as the person's "actual weight" for later calculations then check this checkbox.
Line 12: "Req'd Calories" field. This field documents the selected estimated energy required for this person. You cannot change/edit this field directly but rather you set this field by checking one of the methods' checkboxes on lines 8, 10 or 11.

Obese / BEE Wt Screen ____________________________________________________________________________________________

The "Obese / BEE Wt" screen below is for calculation of an "adjusted" weight to be used in the energy estimation formulas on the "BEE - Energy" screen. You access this screen by selecting the button to the right of the "Wt" units label on the "BEE -Energy screen. Weights calculated on this screen only apply to the BEE calculation!

     Figure 12.2 - Obese/BEE Wt

How to Use This Screen

Note: This screen can be used to calculate an adjusted weight numerous ways. The following sequence is for the most likely "Adjust by" type.

1) If not showing from a previous screen, enter actual and estimated IBW weights on lines 2 and 3. Normally these will be showing because you entered this data on previous screens.
2) Check the "% of dif.(Act.-IBW)" checkbox, if not checked at 5:B.
3) The checkboxes in the "Adjust by" section (lines 4, 5 and 6) affect what shows in the fields on lines 8 and 9. If you check "% of dif…." checkbox on line 5 then the percent field on line 8 will automatically fill with a value (38 for male or 32 for female). You may change this percentage by tapping the appropriate "number" buttons on line 8 and 9. Note that most of these buttons set a value but that the "+1" and "+5" add to the existing value.
4) The resulting adjustment in terms of weight will show at 9:K and the "Adjusted BEE Wt" field will show at 11:K.If you want to use this adjusted BEE weight value for calculating energy needs then tap the "<<OK" button at 0:M. If you do not want to use any value you calculated on this screen then tap the "No Adj" at 0:J.

Field / Line Explanations
Line 1: "Start with:" label. The "Start with:" label is to alert the user that the adjustment calculation can use as its "base" either the person's actual weight or their estimated ideal body weight.
Line 2: "Actual Weight" field and checkbox. Generally this will come filled in with an entered actual weight for the person. If not enter it here. Check this checkbox if this is the "base" weight to which you want the "adjustment" added as in for weight gain.
Line 3: "Estimated IBW" field and checkbox. Generally this will come filled in with a previously calculated "IBW" (ideal body weight) for the person. If not enter it here. Check this checkbox if this is the "base" weight to which you want the "adjustment" added as in obesity adjustments.
Lines 4->6: "Adjusted by: " checkboxes. You can use any number of different methods for calculating an adjusted BEE weight. This "Adjusted by:" section has three check boxes for specifying the alternatives.
a) Check the "% of dif." checkbox to use the most generally accepted technique. This technique use a percentage (generally 38% for men and 32% for women or the older 25%) of the difference between the actual and ideal weights added to the ideal body weight.
b) Check the "% of Wt." checkbox to take a percentage you specify at 8:K and add or subtract it (as you specify on line 8) from the "Start with" base weight selected on line 2 or 3.
c) Check the "Wt Amt" checkbox to take a weight amount you specify in 8:K and add or subtract it (as you specify) from the "Start with" weight checkbox selected on line 2 or 3. It will give you the percentage value this change represents on line 9.
Lines 8 & 9: Number buttons and adjustment field. The numbered buttons are used for changing the field to their right on the screen. The value in this field may represent a percentage or weight amount depending on the technique being calculated. Three of the buttons ("25", "32" and "38") are for ease of entering the generally accepted percentage adjustments as described under lines 4->6 a) previously.
Adjusted weight or percentage field (at 9:K) . This field will be either a calculated weight amount of the adjustment or a percentage that the weight adjustment specified in 8:K represents (when using technique outlined in Lines 4->6 c) above.
Lines 11: "Adusted BEE Wt" This is the "adjusted" weight you have calculated for this person. To select this weight for BEE calculations tap the "<<OK" button at O:M. To not use this weight tap "No Adj".

Other Energy Screen ___________________________________________________________________________________________

The "Other Energy" screen below (Figure 12.3) is for calculation/estimation of a number of alternative energy needs values. You access this screen by selecting the "Other" button on the "BEE -Energy" screen.

     Figure 12.3 - Other Energy

How to Use This Screen:Note:

This screen can be used to estimate energy needs six different ways. Each is described in the "Field / Line Explanation" section below.The important things to remember are:
1) To select a particular calculation, check the checkbox and then tap the button to return to the "BEE-Energy" screen.
2) Tap the "Cancel" button to select no method and value from this screen and to return to the "BEE-Energy" screen.
3) All these different techniques assume you have set sex, age, height and weight on the main "BEE-Energy" screen before accessing this screen.

Field / Line Explanations
Line 0: "Cancel" button. Use this button to cancel and return to the main "BEE - Energy" screen without selecting any of the alternatives on this screen. The "<<" button. Use this button to return to the main "BEE - Energy" screen having selected a "checked" alternative on this screen.
Line 1: "EEE" line and field. This line uses the Ireton-Jones energy estimation technique. The four checkboxes on this line correspond to:
"T" = Trauma; "B" = Burn; "O" = Obese; and "V" = On ventilator.
This equation uses checked information in addition to sex, age, and weight from the main "BEE-Energy" screen items to calculate an estimated adult energy needs. This uses the 1998 version of the Ireton-Jones equation.
Line 2: "cal/cm" line, field and checkbox. This is an alternative method for calculating energy needs. It displays RDA cal/cm or you can simply enter the desired cal/cm and the resulting answer will be shown. Check associated box to select.
Line 3: "User defined" line, field and checkbox. This line is used for entering an alternative "user defined" energy needs value. Then by checking the associated box you select it.
Line 5: "Para and Quad " line. This line is used for calculating an energy needs estimate for paraplegic or quadriplegic person. Tap one of the buttons and the resulting value will appear in the "cal" field. Note that this equation is for people 18 year or older and greater than 30 kilograms in actual weight. If they do not meet this criteria no value will show.
Line 7: "BSA " section. This section consists of three alternative calculations of body surface area (BSA). The one selected is used in the calculations of energy need described in line 11 below. Note that by tapping the label associated with "BSA", "Mn", "Du" and "Ha" you will get a pop-up window documenting the "meaning" of each type. This is a complex area and the user is cautioned to refer to specific references on these various calculations.
Line 9: "Burned " field. This field is for entering the "percent of body burned". This figure is used in the calculations of energy needs described in line 10.
Line 10: "c/%b" and "c/kg" line. This line uses information about weight and percent body burned along with the two figures entered on this line to calculate an estimated energy needs. This is only for use with burn patients. The first field "c/kg" is for entering and "calorie per kg" figure. The second field "c/%b" means "calories per percent of body burned."
Values shown can be changed/overwritten. This is the Curreri formula. See the 6th edition of the ADA Diet Manual.
Line 11: "c/m2" and "c/m2b" line. This line uses information about body surface area and percent body burned along with the two figures entered on this line to calculate an estimated energy needs. This is only for use with burn patients. The field "c/m2" means "calories per square meter of body surface area." The second field "c/m2b" is for entering and "calorie per square meter of body surface area burned". This is the Hildreth formula through age 18. After that age you can whatever values you wish to use.

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