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SERVING GUESTS WITH SPECIAL HEALTH NEEDSObesityCardiovascular DiseaseHypertensionDiabetesDigestive DisordersHospital Diet Orders
Chapter 13
1
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
2
Our Diet and Our Health
Food affects our health Positively Negatively
Guests have various special nutrition needs
3
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
4
Leading Causes of Death in U.S.
5
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
6
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
16
Cardiovascular Disease (CVD) Major dietary factors that increase risk
for CVD High saturated fats Trans fats Dietary cholesterol Obesity
17
Types of Cardiovascular DiseaseCVD Description
Arteriosclerosis 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
18
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
14
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
24
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
26
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
27
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
28
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 Amount
Total fat 27% of calories
Saturated fat 6% of calories
Protein 18% of calories
Carbohydrate 55% of calories
Cholesterol 150 milligrams
Sodium* 1500 milligrams
Potassium* 4700 milligrams
Calcium* 1250 milligrams
Magnesium* 500 milligrams
Fiber 30 grams
Daily Nutrient Goals Used in the DASH Studies (2,100 calorie eating plan)
30
The DASH Diet
Foods Recommended Servings
Whole 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 week
Sodium 1,500 or 2,400 milligrams per day (1,500 milligrams recommended for individuals with hypertension)
31
Diet Effect on Systolic Blood Pressure
Long Term Effects of High Blood Pressure
Sodium in Foodservice
Average consumption: Restaurants: 1925 mg sodium per 1000
calories Home: 1422 mg sodium per 1000
calories
National Salt Reduction Initiative
35
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
Diabetes
A chronic disease characterized by: High blood glucose
(also called blood sugar) Insufficient Insulin
or Ineffective insulinNo cure
37
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
42
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 Diabetes
May 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 Points
Overall emphasis is on healthful eating
“Carbohydrate Controlled Diet” Manage portions and timing of consumption
Individualized consumption ofLimit sodium and fat Limit added sugars
51
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
52
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
54
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
55
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.