There high-calorie diet is a diet that aims to increase the intake of all nutrients with the diet (energetic, plastic, mineral salts, vitamins, etc.), in order to favor a possible weight increase useful for restoring the physiological weight desirable, in a subject characterized by underweight, therefore potentially MAL-nourished.
Underweight and BMI
The term "underweight" is a name (or rather an evaluation) that indicates "a person with a body mass index (BMI) of 18.4 points or less", beyond which (from 18.5 upwards) normality is included (up to 24.9 points), then overweight (up to 30) and finally" obesity.
BMI is calculated using the formula: weight in kg / (stature in m) 2; it does not take into account the growth, the level of hydration and the ratio between lean mass / fat mass, therefore it is unsuitable for the evaluation of athletes, athletes, children under the age of 18 and subjects with pathologies that alter body composition in significantly (e.g. profuse interstitial edema, ascites, etc.).
High calorie diet: how much to eat MORE "?
The high-calorie diet must have the following requirements:
- Truthfulness and relevance: it is essential that the operator styles the high-calorie diet with accuracy and periodically evaluates the effects on the subject
- Nutritional balance: the high-calorie diet is divided in a classic way and, at the most, can determine an increase in the protein fraction up to the upper limits recommended by nutritional research institutes
- Well-calibrated overall energy surplus: the high-calorie diet requires an increase in total energy equal to and not more than 10% of the normal calorie; ultimately, assuming the need for 1800kcal of an underweight subject, the relative high-calorie diet will be equal to: 1800kcal + (10% * 1800kcal) "that is" 1800kcal + 180kcal = 1980kcal.
Applications in the clinic
As anticipated, the high-calorie diet is necessary to gain weight and avoid any malnutrition, both partial and general; in simple terms it is diametrically opposite at the low-calorie diet (advantageous in weight loss).
In our country, the high-calorie diet is less used than the low-calorie one because underweight is an infrequent pathological condition; usually, people with a BMI <18.5 fall into the following cases:
- Hypo-nourished and malnourished: aware and / or with disordered / disorganized nutrition, inappetent, physically impeded, sick with DCA (anorexia nervosa), economically and / or socially disadvantaged, etc.)
- Periodically depressed and / or emotionally unstable
- Third age (malnutrition often with multifactorial aetiology)
- Lean in constitution
- etc.
Unfortunately, the high-calorie FOOD diet (therefore without the aid of supplements, parenteral or enteral feeding with tube), while representing a potential cure in ALL the cases mentioned above, it is not always applicable; It certainly does NOT present any contraindications in the treatment of the lean of constitution and of the conscious or with disordered / disorganized nutrition but, by carefully observing the other cases, one can realize how demanding and problematic this nutritional intervention could be.
Those who lack appetite (or ignore it) are unable to sustain the "commitment" of a "normal diet, since it is already perceived as excessive! In these cases, the high-calorie diet is a real strain and is frequently accompanied by: bloating, constipation, protracted loss of appetite, asthenia, nausea, belching, etc.
In subjects with physical impediments, the application of the high-calorie diet does not depend on the will of the subject; if the handicap is motor or cognitive, it is sufficient to ensure (as if it were simple ...) that the subject is accompanied by a family member or by an auxiliary in charge to facilitate the management and consumption of meals; if the defect lies in chewing, the high-calorie diet will be mainly liquid and the intervention of third parties is not essential.
It is also inadvisable to prescribe a high-calorie diet in malnourished and / or underweight subjects if suffering from DCA (frequently dragged to the clinic by family or friends but NOT consenting or FITTIZI); they (usually suffering from anorexia nervosa or border-line) they spontaneously refuse food and sometimes, despite the success of psychiatric therapy, following the chronicization of the disorder, significant organic impediments to the digestive system (such as gastric restriction) can be found.
It is useless to describe what could be the obstacles of high-calorie dietary prescription to economically or socially disadvantaged people; in conditions of poverty, the purchasing power of families or individuals is drastically reduced (or eliminated), significantly affecting nutrition. It is not necessary to bring examples of the 3rd or 4th world (certainly of great interest but far from reality Italian): even in developed countries such as ours, the worsening economic discomfort tends to profoundly modify both the healthiness and the eating habits of families; let's start by specifying that the economic necessity it favors the increase of work commitments (at best ...) BUT consequently reduces the time dedicated to the supply and preparation of food. This implies "insufficient youth nutrition education and the possibility of hypo- or malnutrition. These young people should then be subjected to a high-calorie diet to restore the desirable physiological weight but, obviously, a question arises: if at first a control of the parents on the ordinary food management of their children ... with what conditions will they fulfill their duties during the high-calorie therapy?
It is therefore deducible that, where the problem is a concrete LACK of economic resources or the absence of a family unit, the high-calorie diet would be even more unsustainable, therefore inapplicable.
The depressed or emotionally unstable (for example following a bereavement) can manifest (similarly to DCA patients, but with different etiology) a refusal to eat; it follows that: the therapy of any malnutrition and consequent underweight must be based first of all on a correct psychological / psychiatric approach to which, at a later time or simultaneously, the hypercaloric diet useful for restoring the desirable physiological weight is approached.
Geriatric patients and the elderly in general are frequently affected by malnutrition, even if (for metabolic reasons) this occurs more rarely with underweight (muscle mass is reduced more rapidly than fat) but begins with symptoms and clinical signs attributable to deficiencies The elderly frequently fall into different situations among those mentioned above: depressed, economic and / or social disadvantaged, with physical impediments, inappetent, with disordered / disorganized nutrition, etc. Administering a high-calorie diet is undoubtedly indicated, albeit in compliance any related pathologies or clinical pictures (gastroesophageal reflux, hypochlorhydria, dysphagia, diverticulosis, diabetes, hypertension, etc.); it is also logical that, similarly to the single cases described above, from the beginning it is fundamental to focus on the cause of the eating disorder and (where possible) to resolve it before administering the high-calorie diet; otherwise, the result would (with a good probability) be bankruptcy.
