Download Prevention and treatment of diabetes through dietary

Ex-Dean and Visiting Professor
Department of Human Nutrition
Agricultural University Peshawar
WHO 2011
Relationship between economic and health status
RELATIONSHIP BETWEEN
NUTRITION & HEALTH
NUTRITION
HEALTH
SOCIAL
DEVELOPMENT
&
PERFORMANCE
FOOD
SUPPORTIVE
ENVIRONMENT
NUTRITION CENTRAL TO HEALTH
& ECONOMIC DEVELOPMENT
HEALTH
NUTRITION
•IMMUNE FUNCTIONS
•MENTAL DEVELOPMENT
•BEHAVIORAL
•SCHOLASTIC
•PHYSICAL PERFORMANCE
•SOCIAL & ECONOMIC
DEVELOPMENT
IMBALANCE BETWEEN NUTRIENTS INTAKE
AND REQUIREMENTS
UNDERNUTRITION
&
OVERNUTRITION
MALNUTRITION TRENDS IN PAKISTAN
Source: NNS (2011)
Hattersley (1999) Lancet 353:1789
Poor Nutritional Status
During Pregnancy
“Brain Sparing”
Impaired Liver,
Kidney , Pancreas
Functions
Adverse
Pregnancy
Outcome
NCDs Later in
Life
Hormonal
Resetting
Insulin IGF GH
&
Corticosteroid
ids
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Dietary Management is essential for:
 Maintaining healthy weight and to prevent
overweight and obesity
 Maintaining blood glucose levels in the normal
range
 Maintaining lipid and lipoprotein profile in the
normal range
 Preventing or reducing the risk of diabetes
 Managing existing diabetes
 Preventing and reducing risk of micro and macro
vascular complications such as retinopathy,
neuropathy, nephropathy, amputation of lower
limbs and premature deaths
Meta-analysis of 70 randomized controlled trials shows
correlation between fall in LDL-C and amount of weight loss
 Weight loss reduces triglycerides, increases HDL-C, and
lowers LDL-C
 Weight loss reduces insulin resistance and improves
glycemic control and reduces the risk of cardiovascular
abnormalities
 7% weight loss in pre-diabetic patients resulted in a 58%
reduction in the risk of diabetes
 Combined programs of weight loss and exercise are
associated with greater increases in HDL-C and more
significant loss of weight and fat.
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Macronutrients

Micronutrients

All Macro and Micronutrients are required but need
modifications during illness
 Carbohydrates---Plants & Dairy --Simple & Complex -- Low and High Glycemic Index--- Source of Energy --cals---Essential role in Weight and Diabetes
Management
 Protein—Plants and Animals— Body Building, Enzymes,
Hormones, Immune System
 Fat---Plants and Animals-Rich Source of Energy—
saturated vs unsaturated fatty acids, omega 3 and
omega 6 fatty acids, cis and trans fatty acids
Vitamins ----Plants and Animals–- physiological and
metabolic functions
Minerals-----Plants and Animals—physiological and
metabolic functions
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The total amount of carbohydrates consumed is
the primary predictor of glycemic response and
has a direct effect on postprandial glucose levels
The primary macronutrient of concern in
glycemic management
Quantity and type of carbohydrates in a food
influence blood glucose level
Carbohydrates a potential source of energy
Monitoring carbohydrate portions is a useful tool
for improving postprandial glucose control
History dates back to 18th and 19th centuries-Era of
dietary restriction and fasting by clinicians
 J. Rollo (1797) emphasized increased consumption
of fat and protein for diabetic treatment
 Bouchardat (1871): Noticed disappearance of
glycosuria during food rationing and suggested
individualized diets to treat diabetes
 Joslin (1916): 20% reduction in case fatality rate by
fasting and physical activity
 Allen (1919): suggested strict dietary restriction
or “starvation treatment” for hyperglycemia
300
250
200
1930
1955
1970
1990
2014
150
100
50
0
CHO (g/d)
CHO%Kcal
Fat (g/d)
Fat%Kcal
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Mediterranean, vegetarian, low CHO, high protein and
high fat diets have been tried on diabetic individuals
over a period of time
Conflicting results on postprandial glucose levels, lipid
profile and weight loss
Insufficient evidence to recommend any specific diet
or amount of CHO, protein and fat for all diabetic
people
Weight loss has been associated with reduction in
insulin resistance, improved glycemic control and lipid
profile
Dietary management in combination with physical
activity has proven to be most effective in improving
glycemic control and reducing the risk of
cardiovascular abnormalities
Irregular Meals
 Small Frequency
Energy Dense
Small CHO
Refined/Processed
Animal Protein
Animal Fat
Saturated Fat
Regular Meals
Large Frequency
Nutrient Dense
Complex CHO
Whole Grain
Meat Protein
Meat Fat
Unsaturated Fat
Eat in moderation
or minimum
2-3 Servings
2-3 Servings
3-5 Servings
2-4 Servings
5-9
Servings
FOOD PYRAMID FOR PAKISTANI
POPULATION
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Appropriate meal planning is critical for the
prevention and treatment of diabetes
Nutrition education, counseling and meal planning
is a prerequisite for effective management of
diabetes
There is NO standard meal plan or eating pattern
that works universally for all people with diabetes
There are NO standard recommended dietary
allowances as well as the recommended amount or
percentage of each macro and micro nutrient for
diabetics
Individualized dietary approaches are needed in the
light of nutritional status, cultural, economic,
religious, dietary preferences and metabolic goals
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Consultation of Dietitian is must for developing an
individualized meal plan that focuses on weight,
glycemic and metabolic controls
Comprehensive diabetes management and awareness
programmes that includes nutrition education,
counseling, seminars, workshops at the community
levels shall be started
Diploma Courses in Nutrition/Dietetics focusing on
NCDs shall be started to produce technically skilled
human resource who may work at community level for
screening, prevention and treatment of NCDS
Periodic monitoring of metabolic parameters (e.g.,
glucose, lipids, blood pressure, body weight, renal
function) is recommended to ensure successful health
outcomes