Lec 1 guide to recommending a meal plan

1

Postgraduate Diploma in Diabetes Education (PDDE(

Nutrition therapy: Dietary advice in case of complications

lec. 1 Guide to recommending a meal plan

Prepared by; Dr. Siham M.O. Gritly

Dr. Siham M.O. Gritly 2

Course outline

• lec. 1 Guide to recommending a meal plan• lec. 2-Estimated Energy Requirements

among Diabetic Patientslec. 3 nutrition therapy that apply to specific situations

• lec. 4 Dietary advice in case of complications


Nutrition therapy

• Nutritional therapy should be individualized according to

• preferences, • age, • needs, • religion, • culture, • lifestyle


Goals of Nutritional therapy that apply to individuals with diabetes

• Achieve and maintain

Blood glucose levels in the normal range

A lipid and lipoprotein profile that reduces the risk for cardiovascular disease

Maintain blood pressure levels in the normal range


• modifying nutrient intake and lifestyle To prevent, or slow, the rate of development of the chronic complications

• To address individual nutrition needs,


Diabetes food pyramid

the Diabetes Food Pyramid divides food into six groups, which vary in size to show relative amounts of servings for each groupthe groups are based on protein content and carbohydrates instead of their food classification


A person with diabetes should eat more of the foods in the bottom of the pyramid (grains, beans, vegetables) than those on the top (fats and sweets).


Food pyramid: Food guide

Adopted from: Food Guide Pyramid: A guide to dairy food choices. Bulletin 259, Washington DC: US government printing

Food group Number of servings What is a serving?

Starches and breads

6-11 1 Slice bread

½ cup cooked rice, cereal

¼ cup dry cereal,

½ cup pasta

3 biscuits

(eat whole-grain, fortified or enriched

starches, bread, and cereals



Food group Number of servings

What is a serving?

Vegetables 3-5 ¼ cup vegetables cooked

1 cup vegetables rawFruits 2-4 1 cup fruit

½ cup fruit juice (fresh frozen or cannedwithout sugar1 medium piece fresh fruit



Food groupNumber of servings What is a serving?

Milk and milk products 2-3

1 cup skim / low fat milk

¾ cup plain or artificially sweetened yogurt.

Meat and meat substitutes

2-3 57-85 g cooked lean meat fish or poultry

28.5 g meat is equivalent to:

1 egg

28.5 g cheese

¼ cup tuna, salmon or cottage cheese

1 tablespoon peanut-butter



Food group Number of servings What is a serving?

Fat use carefully 1 teaspoon margarine

1 teaspoon salad dressing

1 teaspoon oil or mayonnaise


What is Serving Sizes

• Serving sizes are defined by the USDA Food Guide Pyramid as a standard amount used to help give advice about how much food to eat.

• It also helps us identify how many calories and nutrients are in a food


serving size guidelines

• Measure a serving size of dry cereal or hot cereal, pasta, or rice and pour it into a bowl or plate. The next time you eat that food, use the same bowl or plate and fill it to the same level.

• For one serving of milk, measure 1 cup and pour it into a glass. See how high it fills the glass. Always drink milk out of that size glass.


• Meat weighs more before it's cooked. For example, 4 ounces of raw meat will weigh about 3 ounces after cooking. For meat with a bone, like a beef chop or chicken leg, cook 5 ounces raw to get 3 ounces cooked.

• One serving of meat or meat substitute is about the size and thickness of the palm of your hand or a deck of cards.

• A small fist is equal to about 1/2 cup of fruit, vegetables, or starches like rice.

• A small fist is equal to 1 small piece of fresh fruit.• A thumb is equal to about 1 ounce of meat or cheese.• The tip of a thumb is equal to about 1 teaspoon.


• serving size guidelines of fruits and vegetables a day?• The National Cancer Institute defines a serving as:• One medium-sized fruit (ex. apple, orange, banana, pear)• 1/2 cup of raw, cooked, canned or frozen fruits or

vegetables• 3/4 cup (6 oz.) of 100 percent fruit or vegetable juice• 1/2 cup cut-up fruit• 1/2 cup cooked or canned legumes (beans and peas)• 1 cup of raw, leafy vegetables (ex. lettuce, spinach)• 1/4 cup dried fruit (ex. raisins, apricots, mango)


Serving size


Vegetables and fruits serving


Fruits package their sugars with fibers, vitamins, and minerals, making them a sweet and healthy snack.


Adapted from; Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning

A half-cup of vegetables weighs about 100 grams; one pea weighs about ½ gram

One cup is about 240 milliliters; a half-cup of liquid is about 120 milliliters

HIGHER ENERGY DENSITYThis 144-gram breakfast delivers 500 kcalories, for an energy density of 3.5 (500 kcal ÷ 144 g = 3.5 kcal/g).

LOWER ENERGY DENSITYThis 450-gram breakfast delivers500 kcalories, for an energy density of 1.1 (500 kcal ÷ 450 g = 1.1 kcal/g).


Portion Control

"Portion control" means: See how much you eat. Decide how much to eat Cut back on portion size


the difference between a portion and a serving size

• A serving size is a recommended standard measurement of food.

• A portion is how much food you eat, which could consist of multiple servings.

• knowing the size of a serving can help determine healthful portions


The plate methodIs a way to plan meals without measuring (a qualitative diet approach). fill your plate (20 cm diameter) to match the amount of vegetables, starches, and meat, and then add a piece of fruit and/or a glass of milk. Divide your plate in quarters. Amount of vegetables eaten, protein is optional


Filling a dinner plate (20 cm diameter) excluding snacks will provide 1200 – 1500 calories per day depending on serving size

The plate method is ideal for most non-insulin treated persons and some with type 2 diabetes on fixed insulin doses.Advantages: it is simple, adaptable, embodies principles of healthy eating, and promotes memory and understanding via visual messages. Disadvantages: not flexible, especially in insulin-treated persons with diabetes who need to vary carbohydrate intake/meals.


Guide to recommending a meal plan

Profile of person with diabetes Number of servings from each food group

Recommend about 1200 – 1600 calories a dayif the person is:• A small woman who exercises• A small or medium woman who wants to lose weight• A medium woman who does not exercise Much

To provide 1200 – 1600 calories6 starches

3 vegetables

2 fruit

• 2 milk and dairy

• 2 meat or meat substitute• Up to 3 fats




Recommend about 1600 – 2000 calories a dayif the person is:• A large woman who wants to lose weight• A small man at a healthy weight• A medium man who does not exercise much• A medium to large man who wants to lose weight

To provide 1600 – 2000 calories:8 starches 4 vegetables

3 fruit • 2 milk and dairy





Recommend about 2000 – 2400 calories a dayif the person is:• A medium to large man who does a lot of

exercise or has a physically active job

• A large man with a healthy weight• A large woman who does a lot of exercise

or has a physically active job

To provide 2000 – 2400 calories11 starches 4 vegetables

3 fruit

• 2 milk and dairy



Weight units conversion

Weight units Weight units1 kilogram= 2.2 pounds1kilogram= 1,000 grams454 grams= 1 pound1 pound= 16 ounces1 ounce= 28.4 grams3.5 ounces= 100 grams


Insulin Dependent Diabetes Mellitus (IDDM) or Type I Diabetes (Juvenile onset diabetes)

• In type 1 diabetes, the less common type, the pancreas fails to produce insulin.

• commonly occurs in childhood and adolescence, but it can occur at any age, even late in life


Nutrition therapy for type 1 diabetes

• Nutrition therapy for type 1 diabetes focuses on;• maintaining optimal nutrition status, basic

nutrient requirements • controlling blood glucose, • achieving a desirable blood lipid profile, • controlling blood pressure, • and preventing and treating the complications of

diabetes


• Nutrition therapy for type 1 diabetes• the diet must provide a fairly steady

carbohydrate intake from day to day and at each meal and snack to help minimize fluctuations in blood glucose


• To avoid hypoglycemia, the person must monitor blood glucose before and after activity

• Carbohydrate-rich foods should be readily available during and after activity


Non-Insulin Dependent Diabetes Mellitus (NIDDM) or Type II Diabetes.

• In type 2 diabetes, the more common type of diabetes, the cells fail to respond to insulin. This condition tends to occur as a consequence of obesity.

• It is important to eat the suggested amount of carbohydrate at each meal, along with some protein and fat.


• Complex carbohydrates are considered healthier mostly because they are digested by the body slowly, providing a steady source of energy

• Carbohydrates are mainly found in the following food groups:

• Fruit• Milk and yogurt• Bread, cereal, rice, pasta• Starchy vegetables like potatoes• They also contain valuable amounts of fiber


Recommendations for Type 2 Diabetes In overweight people with type 2

• Recommendations for Type 2 Diabetes In overweight people

• moderate weight loss (10 to 20 pounds) can help improve insulin resistance, blood lipids, and blood pressure.

• Together with diet, a regular routine of moderate physical activity not only supports weight loss, but also improves blood glucose control, blood lipid profiles, and blood pressure.


references

• American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61

• American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31:S61-S78.

• American Diabetes Association. Carbohydrate counting. Available at http://www.diabetes.org/food-and-fitness/food/planning-meals/carb-counting. Accessed December 8, 2012.


• American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61

• Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human Metabolism, fifth ed. WADSWORTH

• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill• • Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern

Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and Ross A. Catharine eds. 9th edition

• Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B. Company

• FAO/WHO/UNU expert consultation (WHO, 1985) report• Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition.

2011, 2008 Wadsworth, Cengage Learning

Lec 1 guide to recommending a meal plan

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Transcript of Lec 1 guide to recommending a meal plan