Diabetes Medical Nutrition Therapy (MNT) PDF 2024

Diabetes Medical Nutrition Therapy (MNT) Katalin Z. Horvath college professor Dept. Dietetics and Nutrition Sciences Special Dietotherapy 2024  Diabetes is one of the most common non-communicable diseases, has high rates of both morbidity and mortality, and affect...

Diabetes Medical Nutrition Therapy (MNT) Katalin Z. Horvath college professor Dept. Dietetics and Nutrition Sciences Special Dietotherapy 2024  Diabetes is one of the most common non-communicable diseases, has high rates of both morbidity and mortality, and affects over 385 million people globally.  Diabetes mellitus (DM) is a metabolic disorder characterised by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both (WHO, 2006) Apart from the effects of diabetes in terms of health and quality of life, it imposes a financial burden on societies.  A diagnosis of diabetes can be made under any of the following circumstances: fasting plasma glucose of 7.0 mmol/L (126 mg/dL) or greater 2-hour glucose of 11.1 mmol/L (200 mg/dL) or greater after ingestion of a 75-g oral glucose load [oral glucose tolerance test (OGTT). Gylcated haemoglobin (HbA1c) of >48 mmol/mol (6.5%). Type 1 Type 1 diabetes is an autoimmune disease characterised by destruction of the insulin producing diabetes cells of the pancreas. Its cause is unknown, although genetic factors and certain viruses may play a part. Type 1 diabetes usually presents in children and young adults, although it can be diagnosed at any age. Type 1 diabetes accounts for approximately 10–20% of diabetes and is treated with a combination of insulin replacement by injection or pump therapy and lifestyle modification.  Type 2 diabetes is most frequently Type 2 diagnosed in middle aged or elderly people, and is caused by a combination diabetes of impaired insulin secretion and resistance to the action of insulin. Type 2 diabetes has a strong genetic Although type 2 diabetes is traditionally component, but is also associated with diagnosed in people over the age of 40 years, it is being increasingly diagnosed in obese lifestyle factors; it is more common in children and adolescents, and as many as societies with high levels of obesity and 1400 children may have type 2 diabetes in the low levels of physical activity. UK (Lobstein & Leach, 2004). Approximately 86% of people with type 2 diabetes are overweight or obese (Haslam, 2011). Type 2 diabetes accounts for approximately 80–90% of diabetes and is treated with a combination of diet, physical activity, oral medications and, increasingly, injectable therapies including insulin. Other There are other types of diabetes that are neither type 1 nor type 2, namely: types of diabetes Maturity onset diabetes of the young (MODY) – a hereditary form of diabetes caused by gene mutations that affect insulin production. Gestational diabetes – caused by increased insulin demand during pregnancy. It may resolve after birth of the child, but carries an increased risk of type 2 diabetes in later life. Secondary diabetes – occurs after surgical removal of the pancreas, as a result of pancreatitis, or can be induced by drugs, usually high doses of steroids.  The majority of people with type 1 diabetes in developed countries are encouraged to use multiple daily injection regimens (known as MDI or basal bolus), typically consisting of one injection of long acting insulin and three (or more) injections of rapid or short acting insulin with meals. This intensive insulin regimen has been shown to be associated with improved glycaemic control and allows for dietary flexibility (DCCT Study Group, 1993; DAFNE Study Group, 2002). https://www.researchgate.net/publication/348708472_Targeting_Insulin_Resistance_to_Treat_Cognitive_Dysfunction/figures?lo=1 Goals of dietary treatment Optimize blood glucose control. Maintain blood glucose levels as near to the normal range as possible in order to minimise both the short term (hypoglycaemia, ketoacidosis) and the long term ( macro- and microvascular) complications Targets for self-monitored glucose levels: before meals: 4-7 mmol/L, 2 hours postprandial 5 g fiber / serving)  Emphasize non-starchy vegetables. Minimize added sugars and refined grains. Choose whole grains over highly processed foods to the extent possible What the individual is able to follow  Plants, legumes, grains, nuts, seeds Include fish 1-3 times / week. and vegetables provide low Choose poultry without skin & biological value (LBV) proteins, fat, avoid wings & feet but combination of vegetable Choose lean cuts of meat sources of proteins in the same Legumes & lentils (LBV Protein) meal (e.g. legumes or pulses with good sources of fiber cereals), results often in a mix of contain carbs higher biological value Milk and dairy products contain natural sugar Animal sources of protein, such as (lactose) meat, poultry, fish, eggs, milk, good sources of calcium cheese and yogurt, provide high choose low fat variety biological value proteins. Dietary fat & cholesterol Major risk factor for CVD 50% of diabetic are dyslipidemic Recommended intake: 25 – 35% of total daily calories. Limit saturated fat to < 7 % total calories Minimize intake of trans fats, < 1 % total calories Limit dietary cholesterol to < 200 mg / day Identify sources of saturated fat (SFA) & ↓ intake. Found predominantly in animal products (lard, butter, fatty meat and dairy products) Plant sources are eg. coconut milk, tropical oils such as palm, coconut & cocoa butter Reducing (saturated)fat intake Steam the foods Avoid fried / processed foods Choose lean meat Choose low fat / skim milk Trim off fats and skin Stew, bake, grill foods Avoid palm oil, choose MUFA / PUFA oil Limit intake of trans fatty acids, found in: Commercial bakery products e.g. cakes, pastries, pies, puffs, doughnuts Packaged foods: biscuits, crackers, cookies, wafer, chocolates, etc Fast food: French fries, fried chicken, burgers Chips & crackers: e.g. potato chips, corn chips „Diabetic foods” Easily available now Cannot be classified as ‘free food’ Contain calories & fat, even more than usual product More expensive The plate method makes it easy to plan and eat healthy. Raidl M, Safaii S (2013) The Healthy Diabetes Plate Website Teaches Meal Planning Skills summary