Download Nutrition Goals and principles

Nutrition - Aims and principles
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 2 of 57
The objective of nutritional therapy
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.
Slides current until 2008
Nutrition - Aims and principles
Principles of nutrition therapy /1
Curriculum Module III-5
Slide 3 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Principles of nutrition therapy /2
Curriculum Module III-5
Slide 4 of 57
• Prevent, delay or treat
complications
• Integrate diet, activity and
pharmacological therapy
Slides current until 2008
Nutrition - Aims and principles
Achieving the principles
Curriculum Module III-5
Slide 5 of 57
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
Slides current until 2008
ACTIVITY
Nutrition – Aims and principles
Curriculum Module III-5
Slide 6 of 57
What do you think are the factors
which influence eating habits?
Slides current until 2008
Nutrition - Aims and principles
Nutrition therapy
Curriculum Module III-5
Slide 7 of 57
A four-step model
• Assessment
• Identification of nutritional
status
• Intervention
• Evaluation
Slides current until 2008
Nutrition - Aims and principles
Composition of food and drinks
Curriculum Module III-5
Slide 8 of 57
• Macro-nutrients
– protein
– carbohydrates
– fats
• Micro-nutrients
– vitamins
– minerals
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 9 of 57
Nutrition recommendations for people
with diabetes - a historical perspective
Distribution of calories (%)
Year
Carbohydrate
Before 1921
Protein
Fat
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
Slides current until 2008
Nutrition - Aims and principles
Dietary recommendations for
adults with diabetes
Curriculum Module III-5
Slide 10 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 11 of 57
Fluids
• Essential for all body functions
• 40-60% of body weight is water
• Important to drink adequate
amounts of fluid
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 12 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Energy recommendations
Curriculum Module III-5
Slide 13 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 14 of 57
Proteins
• Provide amino acids
• Help to build muscle mass
• Animal sources
• Plant sources
1 g of protein gives 4 kcal energy
Slides current until 2008
Nutrition - Aims and principles
Protein recommendations
Curriculum Module III-5
Slide 15 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Carbohydrates
Curriculum Module III-5
Slide 16 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Carbohydrates and meal planning
Curriculum Module III-5
Slide 17 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Carbohydrate recommendations
Curriculum Module III-5
Slide 18 of 57
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
Slides current until 2008
ACTIVITY
Nutrition – Aims and principles
Curriculum Module III-5
Slide 19 of 57
Name some of the common
carbohydrates and staple foods
in your region.
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 20 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Benefits of fibre
Curriculum Module III-5
Slide 21 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Fibre recommendations
Curriculum Module III-5
Slide 22 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 23 of 57
Fats
• The most concentrated source
of energy
• Foods may contain fat naturally
or have it added during
cooking
1 g fat provides 9 kcal
Slides current until 2008
Nutrition - Aims and principles
Fat recommendations
Curriculum Module III-5
Slide 24 of 57
• High in monounsaturated fats
(>10%)
• Low in saturated fats (<10%)
• Low in polyunsaturated fats
(up to 10%)
• Low in hydrogenated fat
Slides current until 2008
ACTIVITY
Nutrition – Aims and principles
Curriculum Module III-5
Slide 25 of 57
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?
Slides current until 2008
Nutrition - Aims and principles
Fats
Curriculum Module III-5
Slide 26 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Trans fats
Curriculum Module III-5
Slide 27 of 57
• Formed when liquid fats, such as
oils, are chemically hydrogenated
• Raise LDL cholesterol and lower
HDL cholesterol
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 28 of 57
Fats and oils
Fat 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
<1.0
Ghafoorrunissa et al, NIN 1994
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 29 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 30 of 57
Foods rich in omega-3/
alpha linolenic acid
Food group
Food source
Cereals and millets
Wheat, bajra
Pulses and legumes Blackgram, cowpea, rajmah, soya
a
Vegetables
Green leafy
Spices
Fenugreek, mustard
Nuts and seeds
Walnut, flaxseed
Oils
Mustard, soya bean oil, canola oil
Long chain n3 PUFA (omega-3) – biologically active product of alpha linolenic acid
Ghafoorrunissa et al, NIN 1994
Slides current until 2008
Nutrition - Aims and principles
Cholesterol
Curriculum Module III-5
Slide 31 of 57
• 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
Slides current until 2008
ACTIVITY
Nutrition – Aims and principles
Curriculum Module III-5
Slide 32 of 57
Identify major sources of
cholesterol in foods in your
region.
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 33 of 57
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 watersoluble
Slides current until 2008
Nutrition - Aims and principles
Antioxidants and flavonoids
Curriculum Module III-5
Slide 34 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Vitamins and antioxidants recommendations
Curriculum Module III-5
Slide 35 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Minerals and trace elements
Curriculum Module III-5
Slide 36 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Minerals
Curriculum Module III-5
Slide 37 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Sodium recommendations
Curriculum Module III-5
Slide 38 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Alcohol
Curriculum Module III-5
Slide 39 of 57
• One standard alcoholic drink
per day (14 units per week)
for women
• Two standard alcoholic drinks
(21 units per week) for men
Slides current until 2008
Nutrition - Aims and principles
Alcohol
Curriculum Module III-5
Slide 40 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Low-calorie sweeteners
Curriculum Module III-5
Slide 41 of 57
• 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
Slides current until 2008
ACTIVITY
Nutrition – Aims and principles
Curriculum Module III-5
Slide 42 of 57
Low calorie sweeteners
Name some low-calorie
sweeteners available in your
region
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 43 of 57
Food labels
Nutrition facts
• Serving size
• Nutrient content
• Ingredients
• Nutrition information
Slides current until 2008
Nutrition - Aims and principles
Food labels
Curriculum Module III-5
Slide 44 of 57
Nutrition facts (per 100 g or serving)
• Total carbohydrates
– g of total carbohydrates
– includes starch, sugars and fibre
• Sodium
• Vitamins and minerals
Daily value, expressed as a
percentage of recommendations for a
diet of 2000 calories
Slides current until 2008
Nutrition - Aims and principles
Food labels
Curriculum Module III-5
Slide 45 of 57
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
Slides current until 2008
ACTIVITY
Nutrition – Aims and principles
Curriculum Module III-5
Slide 46 of 57
• How to read a food label
• How to calculate nutrients
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 47 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Practical advice summary /1
Curriculum Module III-5
Slide 48 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Practical advice summary /2
Curriculum Module III-5
Slide 49 of 57
• 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
Slides current until 2008
Nutrition - Aims and principles
Review question
Curriculum Module III-5
Slide 50 of 57
1. Vegetables are rich sources of
a. Protein
b. Fat
c. Vitamins and minerals
d. Sugar
Slides current until 2008
Nutrition - Aims and principles
Review question
Curriculum Module III-5
Slide 51 of 57
2. Cholesterol content is lowest in which
of these foods?
a. Egg yolk
b. Butter
c. Whole milk
d. Egg white
Slides current until 2008
Nutrition - Aims and principles
Review question
Curriculum Module III-5
Slide 52 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Review question
Curriculum Module III-5
Slide 53 of 57
4. Foods rich in invisible fats are
a. Butter
b. Groundnut oil
c. Almonds
d. Sunflower oil
Slides current until 2008
Nutrition - Aims and principles
Review question
Curriculum Module III-5
Slide 54 of 57
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
Slides current until 2008
Nutrition - Aims and principles
Curriculum Module III-5
Slide 55 of 57
Answers
1. c
2. d
3. b
4. c
5. c
Slides current until 2008
Nutrition - Aims and principles
References
Curriculum Module III-5
Slide 56 of 57
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
Slides current until 2008
Nutrition - Aims and principles
References
Curriculum Module III-5
Slide 57 of 57
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
Slides current until 2008