SERVING GUESTS WITH SPECIAL HEALTH NEEDSObesityCardiovascular DiseaseHypertensionDiabetesDigestive DisordersHospital Diet OrdersChapter 13

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Learning Objectives Explain nutritional meal planning for guests with special

health needs Plan menus for guests with special health needs Describe nutrition recommendations to achieve weight loss Describe nutrition recommendations to prevent and treat

cardiovascular disease Explain the DASH diet for the control of hypertension Describe the digestive process and contrast three digestive

diseases Describe general guidelines for diet management of GI

tract conditions List foods included in various types of hospital diet orders

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Our Diet and Our Health Food affects our health

Positively Negatively

Guests have various special nutrition needs

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Our Diet and Our Health Short-term effects Long-term effects 2/3 adults are overweight or obese 1/3 children are overweight or obese 1/3 adults have cardiovascular disease 1/3 adults have high blood pressure ¼ population has diabetes or pre-

diabetes

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Leading Causes of Death in U.S.

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Heart disease

Cancer

Chronic lower respiratory diseases

Stroke (cerebrovascular diseases)

Accidents (unintentional injuries)

Alzheimer's disease

Diabetes

Influenza and Pneumonia

Kidney disease

Intentional self-harm (suicide)

0 200,000 400,000 600,000

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Weight Management - Obesity

Obesity Related Health Issues

Hypertension Heart Disease Type 2 Diabetes Gallbladder

Disease Pulmonary

Disease and Sleep Disorders

Bone and Joint Disorders

Infections Liver damage

Cancer risk Surgical risk Accident risk Skin Disorders Pregnancy risk Menstrual

irregularities Infertility Psychological

Depression, low self-esteem, discrimination

Weight Loss Basics CALORIES OUT

Metabolism Physical Activity

CALORIES IN Food and

beverages

Calories Out- Physical Activity 2010 Dietary Guidelines

Adults 18-61 yo 2 hours and 30 minutes a week, moderate aerobic 1 hour and 15 minutes a week, vigorous aerobic Strengthening activities 2 days week Greatest benefit- 5 hours a week

Children and Adolescents 6-17 yo 60 minutes or more of physical activity a day

Duration/regular more important than intensity 10,000 steps a day Increase activities of daily living

Calories In Reduce portions Reduce added sugars, fats, alcohol

Determine current calorie intake; subtract 250-500 calories/day

OR Decrease 250 calories a day from diet, 250

calories more physical activity

3500 calories in a pound of body fat

Body Mass Index (BMI) See text One way to determine healthy body

weight Not perfect; men, athletes, genetically

muscular, short stature, health issues Healthy- 18.5-24.9 Overweight- 25.0-29.9 Obesity- 30- 39.0 Severely Obese- > 40

Other Thoughts…. BodPod (air displacement), DEXA,

bioelectric impedance, caliper measures to determine body fat

Waist Circumference > 40” men, > 35” women Abdominal fat affects liver function

Healthy-Fit Weight Focus on fat weight vs muscle weight

Health benefits first 5-10% of weight lost

Weight Loss Program Components #1- Lower calorie, lower fat, sensible,

long term dietary intake, moderate protein

#2- Exercise #3- Self Monitoring

Food, exercise, weight records Behavior modification

#4- Breakfast #5- Support

Cardiovascular Disease15

Cardiovascular Disease (CVD) Group of diseases related to the heart

and blood vessels Factors that increase risk for CVD

Heredity Cigarette smoking Physical inactivity Obesity High blood pressure Diet

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Cardiovascular Disease (CVD) Major dietary factors that increase risk

for CVD High saturated fats Trans fats Dietary cholesterol Obesity

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Types of Cardiovascular DiseaseCVD DescriptionArteriosclerosis A chronic disease in which thickening, hardening, and

loss of elasticity of the arterial walls result in impaired blood circulation. It develops with age and with conditions such as hypertension, high blood cholesterol and diabetes

Atherosclerosis A type of arteriosclerosis in which plaque causes the clogging or hardening of arteries or blood vessels. Plaque is an accumulation of substances including cholesterol, fibrous tissue and calcium

Coronary heart disease

The progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery and can lead to heart attack

Hypertension High blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them

Ischemic stroke The sudden death of brain cells in a localized area due to inadequate blood flow

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Nutrition Goals of Cardiovascular Disease Saturated fat and trans fat

< 7% of calories 15 grams – 2000 calorie diet

Cholesterol < 200 mg/day

Increase soluble fiber Add plant stanols/sterols

2 grams/day Weight Management

Source: National Cholesterol Education Program

Plant Stanols and Sterols Modified triglyceride that prevents

fat/cholesterol absorption Margarine 2 servings a day

Blood Lipid Goals Cholesterol

< 200 mg/dL LDL

< 100 mg/dL if disease < 130 mg/dL if 2+ risk factors, < 160 mg/dL if 0-1 risk factors

Emphasis on Mediterranean- Type Balance

Cardiovascular Disease Menu Ideas Low-saturated fat meatless appetizers,

entrees and side dishes Include legumes, peas, beans, lentils

and soy products in the menu Offer lean fish, poultry, lamb, bison, beef

and pork Serve moderate portions: 4-ounce entrees

of lean meat cuts; 5 to 6 ounces of poultry; 6 to 8 ounces of fish

Serve low-fat and nonfat dairy products and use them liberally as ingredients

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Cardiovascular Disease Menu Ideas Use canola or olive oil Less butter, cream, bacon fat, meat

drippings, saturated margarines and shortenings, cheese

Greater variety of fruits and vegetables Whole grains Smaller portions Reduce portions of fried foods Grilled-baked-lightly sautéed fish and

seafood Moderate nuts and seeds Egg whites

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Hypertension25

Hypertension Blood pressure is the force of blood pushing against

the walls of arteries as it flows through them Blood pressure is measured in two numbers:

Systolic is the pressure created when the heart beats while pumping blood

Diastolic is the pressure created when the heart is at rest between beats

High blood pressure can be caused by many factors including: Genetics Smoking Stress Obesity Diet Inactivity

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Hypertension

Category Systolic (top number)

Diastolic (bottom number)

Normal Less than 120 Less than 80

Pre-hypertension 120-139 80-89

High blood pressure

Stage 1Stage 2

140-159160 or higher

90-99100 or higher

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DASH (Dietary Approaches to Stop Hypertension) A heart healthy, nutrient-rich

research based diet supported by the National Heart, Lung and Blood Institute

High potassium, calcium, magnesium

Low sodium Achieve with unprocessed,

fresh/frozen foods

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Why Sodium, Potassium, Calcium and Magnesium? Video on HTN

http://www.youtube.com/watch?v=jvE6at_i_Tw&feature=related

Summary Cardiac Output (CO) volume

sodium, potassium Heart Rate-Resistance

calcium, magnesium, potassium

DASH (Dietary Approaches to Stop Hypertension)

Nutrient AmountTotal fat 27% of caloriesSaturated fat 6% of caloriesProtein 18% of caloriesCarbohydrate 55% of caloriesCholesterol 150 milligramsSodium* 1500 milligramsPotassium* 4700 milligramsCalcium* 1250 milligramsMagnesium* 500 milligramsFiber 30 grams

Daily Nutrient Goals Used in the DASH Studies (2,100 calorie eating plan)

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The DASH Diet

Foods Recommended ServingsWhole grains 6-8 per day ( each is ½ cup or 1 slice bread)Fruits and vegetables

8-10 per day ( 4 to 5 cups total)

Fat-free or low-fat dairy

2-3 per day ( 2 to 3 cups total)

Lean meat, poultry, fish

6 ounces or less per day

Nuts, seeds, beans 4-5 per week (1/2 cup bean or 1 ounce of nuts is 1 serving)

Fats and oils 2-3 small servings per day ( 2 to 3 teaspoons)Sweets 5 or less per weekSodium 1,500 or 2,400 milligrams per day (1,500

milligrams recommended for individuals with hypertension)

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Diet Effect on Systolic Blood Pressure

Long Term Effects of High Blood Pressure

Sodium in FoodserviceAverage consumption: Restaurants: 1925 mg sodium per 1000

calories Home: 1422 mg sodium per 1000

calories

National Salt Reduction Initiative

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Targets for sodium levels in various food categories set for 2014:

No menu item should be over 1,200

milligrams sodium/serving. Soup 280 mg sodium/100 grams Hamburgers 330 mg sodium/100 grams Sandwiches 370 mg sodium/100 grams Cheese pizza 390 mg sodium/100 grams

Source: National Salt Reduction Initiative. www.nyc.gov/health/salt

DIABETES

DiabetesA chronic disease characterized by: High blood glucose

(also called blood sugar) Insufficient Insulin

or Ineffective insulinNo cure

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InsulinFrom pancreas or injection

CHO from diet, glycogen

Blood Glucose (blood sugar) + Insulin

Cells

¼ population has diabetes or pre-diabetes

Blood Glucose and Diabetes Diagnosis

70 mg/dl

Two Types: Type 1 and Type 2 Both types test blood sugars with a

glucometer Both types count carbohydrates in food

Some use specific guidelines for grams of carb

Some use general portion control of foods

Type 1 Diabetes Generally occurs earlier

in life Requires daily insulin

injections or an insulin pump

Carbohydrate grams balanced with insulin

High risk for a low blood sugar, treat immediately

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Diabetic Hypoglycemia Blood glucose below

70 mg/dL 15:15 rule

15 grams carbohydrate every 15 minutes

15 grams = ¼ cup juice,

If Blood Glucose is too high…. Look at amount of carbohydrate

consumed Reduce portions Substitute with lower CHO content or

sugar substitute Find food or food combinations that

result in lower blood sugar (glycemic index)

Opposite if too low…

Pre-Diabetes Prevent diabetes! Weight loss

Decrease 500-1000 calories and fat Exercise

150 minutes/week

Type 2 diabetes

More common than type 1 Genetic cause (runs in families)

Overweight and inactivity increaseslikelihood of developing type 2 diabetes

Until recently generally occurred later in life

1 in 3 children will develop type 2 diabetes

Type 2 Diabetes Insulin resistance and Insulin

insufficiency Weight loss

Reverses insulin resistance Calorie control, exercise

Type 2 DiabetesMay be controlled by a combination of:

Carb controlled dietCalorie controlled dietExercisePillsInjected MedicationsInsulin Injections

As diabetes progresses, people often need to increase medications and/or add insulin

Diabetes Nutrition Goals

Attain and maintain a blood glucose level as close to normal as possible

Carbohydrate foods raise blood glucose levels

monitor the carbohydrate eaten and balance intake with physical activity (and often insulin or pills.)

Distribute carbohydrates fairly evenly though out the day – some at each meal and with snacks

Diabetes- Key Nutrition PointsOverall emphasis is on healthful eating

“Carbohydrate Controlled Diet” Manage portions and timing of consumption

Individualized consumption ofLimit sodium and fat Limit added sugars

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Diabetes – Foods to Limit

Some foods avoided because they are: ꔷ easy to overeat ꔷ high in carbohydrate ꔷ no nutrition

sugared beverages such as sodas, punches, juices and sweet tea

high-cal foods high in fat, especially sat. and trans fat

Diabetics may eat high sugar or high fat foods, but they must be aware of how much carbohydrate they are consuming and adjust for either in diet or medication

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Menu Considerations- Diabetes

Diabetics do not need special foods, they need reasonable options from which to choose.

Avoid hidden fat or carbohydrate so the guest can make an informed choice

List the size or ounces of the piece of meat, chicken or fish so that guests know how much they are getting

Menu Considerations for Diabetes

Offer plenty of low-carbohydrate vegetables salads, side dishes, entrees and soups

Have delicious fruits available as a dessert option

Offer smaller portions Offer 3-4 oz. meat portions, half sandwiches, etc. Appetizers, such as crab cakes or chicken

skewers, are good entree choice

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Menu Considerations - Diabetes

Cook with as little fat and sugar as possible Offer low-fat, low-calorie side dishes and salad

dressings Serve sauces on the side

Offer at least one green salad Top with interesting vegetables and/or herbs without croutons, bacon and other high-fat

ingredients. Dress salads lightly

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Digestive Disorders56

Digestive Tract57

Definitions58

Digestion The process by which food and drink are reduced to smaller nutrient molecules that can be absorbed into the blood and carried throughout the body to build and nourish cells and to provide energy

Absorption The passage of these molecules through the walls of the digestive tract so the substances can enter the bloodstream and then enter cells

Metabolism The chemical activity within cells that breaks down nutrients to provide energy, uses nutrients to build necessary compounds and tissues, and releases the end products

Unique Features of GI Tract Peristalic Movement

Muscle movement Enzymes

Break apart carbohydrates, proteins, fats Absorption of nutrients

Primarily small intestine Bacteria

Probiotics

Digestive Disorders60

Disorder Details

Dysphagia Difficulty swallowingDiet: Alter consistency, texture, temperature to adapt to swallowing ability.

GERD or Acid Reflux

Acid reflux, heartburn, or GERD (gastroesophogeal reflux disease) occurs when the sphincter between the esophagus and stomach relaxes and food comes back up after it has been mixed with stomach acidsDiet: small meals, exercise, remain elevated after eating

Irritable Bowel Syndrome (IBS)

A common “muscle movement” related disorder causing abdominal pain, bloating and changes in bowel habits. Diet: high fiber, regular meals, exercise, stress management

Digestive Disorders61

Disorder Details

Crohn’s Disease

Inflammation of the small intestine that makes digestion and absorption of nutrients difficult and painful. Causes bloating, diarrhea, abdominal pain and cramping. Can lead to malnutrition, anemia and low levels of certain vitamins and folic acid.

Ulcerative Colitis

Ulcerations in the colon/large intestine.

Diverticulitis Inflammation of small “out” pouches in the lining of the large intestine.Diet: Low or high fiber

Lactose Intolerance Symptoms with dairy intake

Abdominal discomfort Bloating; Intestinal gas formation Diarrhea

Causes Primary: Lactase deficiency Secondary: Mucosal damage

p. 122

Lactose Intolerance Prevalence (p. 111) Ethnic <10% to >80%

<10% Northern Europeans (Scandinavians) 20% Caucasians 50% Hispanics 70% Mediterraneans 75% African Americans 80% Native Americans >80% Southeast Asians

Lactose Content of Food Whole wheat bread 1 slice 0.5gm Cheese 1 oz 0.5-0.8

Cheddar/American Parmesan/Cream

Doughnut, cake type 1.2 Chocolate 1 oz 2.3 Sherbet 1 c 4.0 Cottage cheese 7.5 Ice Cream 1 c 9.0 Milk 1 c 12.0 Yogurt 1 c 15.0

Lactose Intolerance Dietary changes

May not require the elimination of milk/milk products, tolerance

Lactaid Milk, Acidophilus milk Kefir, yogurt Soy, almond, rice, coconut milk

Pages 343-344

Adequate calcium and vitamin D intake Lactaid or DairyEase enzyme with food

General Guidelines for GI Patients High or low fiber Omit food irritants Proper hydration Small, frequent meals Journal

Food/fluid intake, stools, discomfort, exercise, stress May benefit from limiting:

Caffeine Alcohol “Gas” causing foods Sugar alcohols

Live Cultures and Probiotics Live active cultures in buttermilk,

yogurt and other foods promote gut health and generally aid digestion.

Probiotics Healthy bacteria in the GI tract Found in yogurt, fermented foods First line of immune function

GI tract point of entry Strengthens intestinal lining Antimicrobial Improves peristalsis

Hospital Diet Orders Why?

Tests, surgeries, inability to eat/chew/swallow

Clear Liquid Broth, bouillon, clear pop, clear fruit juices, fruit ice,

popsicles, gelatin Full Liquid

Clear liquid, yogurt, pudding, milk, milk drinks, all fruit and vegetable juices, refined hot cereals (cream of wheat, malt-o-meal), cream, butter, margarine

Pureed Blenderized, thick it type foods

Soft Full liquid, pureed + soft cooked vegetables, canned

fruits, banana, mashed potatoes, cream soups, banana, chopped/ground meats, cooked pasta, barley, rice, eggs, etc.