Slides current until 2008 Nutrition - Aims and principles

Slides current until 2008

Nutrition - Aims and principles

Nutrition - Aims and principlesCurriculum Module III-5

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To help people with diabetes learn how to make the kind of lifestyle choices which will enable them to achieve optimum metabolic control and prevent diabetes complications.

The objective of nutritional therapy


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Principles of nutrition therapy /1

• Provide appropriate energy and nutrients for health, growth and development

• Maintain social and psychological well-being

• Reduce symptoms of diabetes

• Achieve and sustain acceptable body weight


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• Prevent, delay or treat complications

• Integrate diet, activity and pharmacological therapy

Principles of nutrition therapy /2


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Achieving the principles

Nutritional advice centered on:• Individual psychological, physical,

and social assessment • Age, sex, weight, lifestyle,

economic, social and cultural status

• Food preferences and eating habits

• Readiness to change

Nutrition – Aims and principlesCurriculum Module III-5

Slide 6 of 57ACTIVITY


What do you think are the factors

which influence eating habits?


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Nutrition therapy

A four-step model

• Assessment

• Identification of nutritional status

• Intervention

• Evaluation


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Composition of food and drinks

• Macro-nutrients

– protein

– carbohydrates

– fats

• Micro-nutrients

– vitamins

– minerals


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Nutrition recommendations for people with diabetes - a historical perspective

Distribution of calories (%)

Year Carbohydrate Protein Fat

Before 1921 Starvation diets

1921 20 10 70

1950 40 20 40

1971 45 20 35

1986 <60 12-20 <30

2004 45-65* 10-20 20-35†

* Based on individual assessment and treatment goals † <10% saturated fat

American Diabetes Association


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Dietary recommendations for adults with diabetes

• Carbohydrates: 45-65% (mostly starch)

• Dietary fibre: minimum 20g/1000 kcal

• Fats: 20-35%• Protein: 10-20% (0.8 g/kg/day)• Sodium: <3000 mg/day• Vitamins and minerals:

supplements not necessary with balanced diet


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Fluids

• Essential for all body functions

• 40-60% of body weight is water

• Important to drink adequate

amounts of fluid


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Energy

• Produced by utilizing food in the body

• Measurements of energy:

- usually measured in kilojoules (kJ)

- calories or kilocalories (kcal)

- 1 kcal = 4.2 kJ


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Energy recommendations

• Appropriate intake for acceptable body weight

• Lower-calorie diets recommended for overweight people with diabetes

• Increased-energy diets recommended - during pregnancy and lactation - during recovery from severe and prolonged illness


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Proteins

• Provide amino acids

• Help to build muscle mass

• Animal sources

• Plant sources

1 g of protein gives 4 kcal energy


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Protein recommendations

• 0.8 g protein per kg bodyweight per day

• 10-20% of total energy per day

• Higher amounts not encouraged for people with diabetes

• Animal protein often high in fat, especially saturated

• Vegetable protein sources should be encouraged – lower in fat


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Carbohydrates

• Should provide main source of energy for the body (>50%)

• Nutrient that most influences blood glucose levels

• Source of simple sugars – glucose, fructose

1 g of carbohydrate provides 4 kcal


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Carbohydrates and meal planning

• Amount and source of carbohydrates should be considered when planning meals

• Carbohydrates should mainly come from

- whole grains: wheat, rice, pasta, etc- potatoes- legumes, beans, pulses - fruit and vegetables- milk


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Carbohydrate recommendations

Sucrose – white sugar

• Permissible source for up to 10% of total daily energy needs

• Does not increase glycaemia more than starch

• Part of a balanced meal

• High sucrose contributes to obesity and dental caries

American Diabetes Association; Canadian Diabetes Association




Name some of the common carbohydrates and staple foods in your region.


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Carbohydrate content of common foods

Food Amount (g)

Serving Carbohydrate (g)

Bread 25 1 slice 12.4

Rice (cooked) 52 0.3 cup 14.7

Pasta 43 0.3 cup 12.6

Chappati 35 1 small 17.0

Corn meal 26 3 tablespoons 20.2

Potato 85 1 small 17.0

Couscous 52 0.3 cup 12.1

Lentils 99 0.5 cup 19.9

Banana 72 1 small 16.9


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Benefits of fibre

• High-fibre diet is healthy

• Mixture of soluble and insoluble fibre- slows absorption of glucose- reduces absorption of dietary fats- retains water to soften stool- may reduce the risk of colon cancer- may reduce the risk of heart

disease


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Fibre recommendations

• Recommended amounts of fibre for people with diabetes similar to those for the general public: – total fibre: 20-35 g per day – soluble fibre: 10-25 g per day

• Sources of insoluble fibre include: wheat bran, whole grains, seeds, fruits and vegetables

• Sources of soluble fibre: legumes (beans), oat bran, barley, apples, citrus fruits, potato

AHA


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Fats

• The most concentrated source of energy

• Foods may contain fat naturally or have it added during cooking

1 g fat provides 9 kcal


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Fat recommendations

• High in monounsaturated fats (>10%)

• Low in saturated fats (<10%)

• Low in polyunsaturated fats (up to 10%)

• Low in hydrogenated fat




Fats• What are rich sources of saturated fats?

• What are rich sources of polyunsaturated fats?

• What are rich sources of monounsaturated fats?

• Which foods are rich in trans fats?

• Which foods contain visible and invisible fats?


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Fats

Common sources of different fats• Saturated – red meats, butter,

cheese, margarine, ghee (clarified butter), whole milk, cream, lard

• Polyunsaturated – safflower oil, sunflower oil, corn oil

• Monounsaturated – olive oil, canola oil, rape seed oil, groundnut oil, mustard oil, sesame oil

• Trans fats – baked products, biscuits, cakes


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Trans fats

• Formed when liquid fats, such as oils, are chemically hydrogenated

• Raise LDL cholesterol and lower HDL cholesterol


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Fats and oilsFat distribution in commonly used oils

Fatty acid (grams/100grams)

Saturated fatty acids

MUFA PUFA (ω-6) PUFA (ω-3)

Olive oil 13 76 10 1

Peanut oil 18 48 34 <0.5

Canola oil 6 58 26 10

Rapeseed oil 8 70 12 10

Sesame oil 15 42 42 1

Corn oil 12 32 55 1

Cottonseed oil 22 25 52 1

Soya bean oil 15 27 53 5

Sunflower oil 13 27 60 <0.5

Safflower oil 13 17 70 <0.5

Coconut 90 7 2 <0.5

Hydrogenated oil 24 19 3 <0.5

Ghee/butter oil 65 32 2 <1.0Ghafoorrunissa et al, NIN 1994


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Fish oils

• Balance of omega-3 and omega-6 fatty acids part of a healthy diet

• Fish oils good source of omega-3 fatty acids

• Two or three portions of fish are recommended per week

• Fish-oil supplements not recommended


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Foods rich in omega-3/alpha linolenic acid

Food group Food source

Cereals and millets Wheat, bajra

Pulses and legumes Blackgram, cowpea, rajmah, soya

Vegetables Green leafy

Spices Fenugreek, mustard

Nuts and seeds Walnut, flaxseed

Oils Mustard, soya bean oil, canola oil

a Long chain n3 PUFA (omega-3) – biologically active product of alpha linolenic acid

Ghafoorrunissa et al, NIN 1994


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Cholesterol

• Intake of cholesterol should be restricted

• People with diabetes should consume less than 300 mg of cholesterol a day

• Minimizing consumption of saturated fat will help decrease cholesterol




Identify major sources of cholesterol in foods in your region.


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Vitamins

• Organic substances present in very small amounts in food

• Essential to good health

• A balanced meal automatically provides all necessary vitamins

• Either fat-soluble or water-soluble


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Antioxidants and flavonoids

• Antioxidants help protect against heart disease and other health complications

• Good sources of antioxidants – including fruit and vegetables – should be eaten daily

• Recommended daily intake five portions


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A properly balanced diet will supply all the vitamins and antioxidants necessary; supplements are not necessary

Multivitamin supplements are needed for people in certain circumstances

Vitamins and antioxidants -recommendations


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Minerals and trace elements

A balanced diet supplies minerals and trace elements

• Inorganic - regulate vital body processes

• In blood, enzymes, hormones, bones, skeleton, teeth and tissue fluids

• Supplements not required for most; calcium and vitamin supplementation may be desirable for elderly people


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Minerals

• Minerals present in bones, teeth, soft tissue, muscle, blood and nerve cells

• Help maintain physiological processes, strengthen skeletal structures, preserve heart and brain function and muscle and nerve systems

• Act as a catalyst to essential enzymatic reactions

• Low levels of minerals puts stress on essential life functions


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Sodium recommendations

Most people consume too much salt• Daily intake should not exceed 6000

mg• Daily sodium intake should not

exceed 2400 mg• Salt intake should be restricted in

hypertension, heart disease, kidney failure

• Diet should be based on fresh foods


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Alcohol

• One standard alcoholic drink per day (14 units per week) for women

• Two standard alcoholic drinks (21 units per week) for men


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Alcohol

• To prevent delayed hypoglycaemia, alcohol should be consumed with a meal

• No alcohol in presence of pregnancy, pancreatitis, severe dyslipidaemia, neuropathy or alcohol abuse

1 g of alcohol provides 7 kcal


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Low-calorie sweeteners

• Contribute to weight control

• Offer flexibility in diet planning

• Do not influence insulin secretion, therefore do not influence blood glucose levels

• Do not contribute to dental caries




Name some low-calorie sweeteners available in your region

Diet soda

Low calorie sweeteners


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Food labels

Nutrition facts

• Serving size

• Nutrient content

• Ingredients

• Nutrition information


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Nutrition facts (per 100 g or serving)• Total carbohydrates – g of total carbohydrates– includes starch, sugars and fibre

• Sodium• Vitamins and mineralsDaily value, expressed as a percentage of recommendations for a diet of 2000 calories

Food labels


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Food labels

Nutrition facts per 100 g or serving

• kJ/kcal: a measure of energy

• Total fat: g of total fat in a serving

• Saturated fat: g of saturated fat per serving

• Cholesterol: mg of cholesterol per serving




• How to read a food label

• How to calculate nutrients


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Summary of dietary recommendations

• Carbohydrates: 45-65% (mostly starch)

• Dietary fibre: min 20 g/1000 kcal

• Fats: 20-35%

-saturated <10%

-polyunsaturated <10%

-monounsaturated >10%

-cholesterol <300 mg/day

• Protein: 10-20% (0.8 g/kg/day)

• Sodium: <2400 mg/day

• Vitamins and minerals: with a balanced diet, supplements not needed


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Practical advice summary /1

• At least five servings of fruit and vegetables per day

• Whole grains, rice and potatoes

• Restrict fats, saturated fats and cholesterol

• Eat more– fish and lean meats– legumes– fat-free or low-fat dairy products

www.everydaychoices.org, WHO 2003


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Practical advice summary /2

• Use less fat in cooking

• Attain and regulate acceptable body weight by eating appropriate portion sizes

• Lose weight by consuming less energy and increasing physical activity


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Review question

1. Vegetables are rich sources of

a. Protein

b. Fat

c. Vitamins and minerals

d. Sugar


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2. Cholesterol content is lowest in which of these foods?

a. Egg yolk

b. Butter

c. Whole milk

d. Egg white

Review question


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3. How often should a person eat fruit?

a. Once a day

b. Several times a day

c. Once a week

d. Twice a week

Review question


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4. Foods rich in invisible fats are

a. Butter

b. Groundnut oil

c. Almonds

d. Sunflower oil

Review question


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5. Which of the following represents a basic diet tip for people with diabetes

a. No restriction on alcohol

b. Eat protein rich foods to excess

c. Eat whole grains and cereals

d. Eat plenty of fried foods like crispies, or fried nuts on a daily basis

Review question


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Answers

1. c

2. d

3. b

4. c

5. c


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References

1. American Diabetes Association. Nutrition Principles and Recommendations in Diabetes, 2005.

2. Canadian Diabetes Association, Diabetes Australia, Diabetes Study Group of the European Association for the Study of Diabetes, Diabetes UK.

3. Ghafoorunissa. Dietary lipids and heart disease - the Indian context. Natl Med J India 1994; 7(6): 270-6.

4. Every day Choices. Try our Health Tools page (accessed 2004, Nov 13) Available from www.everydaychoices.org

5. American Diabetes Association. Nephropathy in Diabetes. Diabetes Care 2004; 23: S76-78.

6. Canadian Diabetes Association Clinical Practice Guidelines. Expert Committee. Canadian Diabetes Association 2003.

7. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2003; 27 (Suppl 2): S66-71.

8. Felstinker L, Heins JM, Holler HJ. Commentary and translation: 1994 nutrition recommendations for diabetes. JAMA 1994; 94: 838-39.

9. Diet, nutrition and the prevention of chronic diseases, Report of the joint WHO/FAO expert consultation, WHO Technical Report Series, No. 916 (TRS 916). www.who.int/mediacentre/news/releases/2003/pr20/en/

10. Mann J, Lean M, Toeller M, et al. Recommendations for the nutritional management of patients with diabetes mellitus, Eur J Clin Nutr 2000; 54: 353-5. www.dsng.org/pdfs/ejen54.pdf


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11. Brand Miller J, Foster-Powell, Colagiuri S, Leeds A. The GI factor. Hodder 1998.

12. Wolever T, Mehling C. Long-term effect of varying the source or amount of dietary carbohydrate on postprandial plasma glucose, insulin, triacylglycerol, and free fatty acid concentrations in subjects with impaired glucose tolerance. Am J Clin Nutr 2003; 77(3): 612-21.

13. Garg A, Bantle JP, Henry RR, et al. Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. JAMA 1994; 271(18): 1421-8.

14. Wheeler M. Cycles: Diabetes Nutrition Recommendations – Past, Present and Future. Diabetes Spectrum 2000; 13(3): 116-9.

15. Chandalia M, Garg A, Luyjohann D, et al. Beneficial Effects of High Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus. NEJM 2000; 342: 1392-8.

16. Kapur A, et al. Novovare Interactive Nutrition Assistant - A computer aided Interactive Nutrition Management Program, Novo Nordisk Diabetes Update Proceedings 1997.

17. Kapur K, et al. Making Healthy Food Choices, Novo Nordisk Education Foundation, 2004 (www.diabeteseducation.org). http://www.diabeteseducation.org/signal1.htm

18. University of Cambridge. EPIC-Norfolk: nutritional methods (cited 2004 Nov 14) (2 screens). Available from www.sri.cam.ac.uk/epic/nutmethod/24hr.shtml

19. The Australian Guide to Healthy Eating. Australian Government Department of Health and Ageing, Population Health Division, Commonwealth Copyright 1998. www.health.gov.au/pubhlth/strateg/food/guide/guide2.htm

References

Documents

Slides current until 2008 Nutrition - Aims and principles