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1 SERVING GUESTS WITH SPECIAL HEALTH NEEDS Obesity Cardiovascular Disease Hypertension Diabetes Digestive Disorders Hospital Diet Orders Chapter 13 Learning Objectives 2 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 Our Diet and Our Health 3 Food affects our health Positively Negatively Guests have various special nutrition needs Our Diet and Our Health 4 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 Leading Causes of Death in U.S. 5 0 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) 200,000 400,000 600,000 Weight Management - Obesity 6 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 Children and Adolescents 6-17 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 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 Healthy-Fit Weight > 40” men, > 35” women Abdominal fat affects liver function 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 15 Cardiovascular Disease Cardiovascular Disease (CVD) 16 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 Cardiovascular Disease (CVD) 17 Major dietary factors that increase risk for CVD High saturated fats Trans fats Dietary cholesterol Obesity Types of Cardiovascular Disease 18 CVD 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 Nutrition Goals of Cardiovascular Disease Saturated fat and trans fat < 7% of calories 15 grams – 2000 calorie diet Cholesterol < Increase soluble fiber Add plant stanols/sterols 2 200 mg/day 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 14 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 Cardiovascular Disease Menu Ideas 24 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 25 Hypertension Hypertension 26 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 Hypertension 27 Category Systolic (top number) Diastolic (bottom number) Normal Less than 120 Less than 80 Pre-hypertension 120-139 80-89 High blood pressure Stage 1 140-159 Stage 2 160 or higher 90-99 100 or higher DASH (Dietary Approaches to Stop Hypertension) 28 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 Why Sodium, Potassium, Calcium and Magnesium? Video on HTN http://www.youtube.com/watch?v=jvE6at_i_Tw&featur e=related Summary Cardiac Output (CO) volume sodium, Heart potassium Rate-Resistance calcium, magnesium, potassium DASH (Dietary Approaches to Stop Hypertension) 30 Daily Nutrient Goals Used in the DASH Studies (2,100 calorie eating plan) 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 The DASH Diet 31 Foods Recommended Servings Whole grains Fruits and vegetables 6-8 per day ( each is ½ cup or 1 slice bread) 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) 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 37 A chronic disease characterized by: High blood glucose (also called blood sugar) Insufficient Insulin or Ineffective insulin No cure CHO from diet, glycogen Cells Blood Glucose (blood sugar) + Insulin Insulin From pancreas or injection 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 42 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 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 increases likelihood 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 diet Calorie controlled diet Exercise Pills Injected Medications Insulin 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 51 Overall emphasis is on healthful eating “Carbohydrate Controlled Diet” Manage portions and timing of consumption Individualized consumption of Limit sodium and fat Limit added sugars Diabetes – Foods to Limit 52 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 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 54 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 Menu Considerations - Diabetes 55 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 56 Digestive Disorders Digestive Tract 57 Definitions 58 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 Enzymes Break movement apart carbohydrates, proteins, fats Absorption of nutrients Primarily Bacteria Probiotics small intestine Digestive Disorders 60 Disorder Details Dysphagia Difficulty swallowing Diet: 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 acids Diet: 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 Disorders 61 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 Cheese 1 oz 0.5gm 0.5-0.8 Cheddar/American Parmesan/Cream Doughnut, cake type Chocolate 1 oz Sherbet 1c Cottage cheese Ice Cream 1 c Milk 1c Yogurt 1c 1.2 2.3 4.0 7.5 9.0 12.0 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.