Seminar 8 Nutrition and Diet Therapy PDF

SEMINAR 8 Nutrition And Diet Therapy 3° MEDICINE Academic year: 2024/25 Professor: Vittoria Carrabs PhD INTRODUCTION  Consuming a healthy diet throughout the life-course helps to prevent malnutrition in all its forms as well as a range of noncommunicable dise...

SEMINAR 8 Nutrition And Diet Therapy 3° MEDICINE Academic year: 2024/25 Professor: Vittoria Carrabs PhD INTRODUCTION  Consuming a healthy diet throughout the life-course helps to prevent malnutrition in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions.  Theexact make-up of a diversified, balanced and healthy diet will vary depending on individual characteristics (e.g. age, gender, lifestyle and degree of physical activity), cultural context, locally available foods and dietary customs.  The basic principles of what constitutes a healthy diet remain the same.  DIETOTHERAPY It is the dietary treatment of diseases. The establishment of dietary guidelines in order to improve or prevent certain diseases: Diseases related to food (celiac disease, food allergy...) * Non-communicable diseases (NCD): cardiovascular diseases, diabetes, obesity…. “WE ARE WHAT WE EAT” Ludwig Feuerbach.  Alimentation VS Nutrition ALIMENTATION conscious, voluntary, educable and social act by which we provide our body with food NUTRITION involuntary, unconscious act. It includes the physiological processes of digestion, absorption, transport, utilization and elimination of nutrients. We cannot voluntarily influence nutrition processes, but we can influence our alimentation  NUTRIENTS They are the components of food that we need to develop our vital functions. Food also contain water and fiber, but since they do not provide calories, they are not usually classified as nutrients. MACRONUTRIENTS MICRONUTRIENTS PROTEINS VITAMINS CARBOHYDRATES OR GLUCIDS MINERALS LIPIDS OR FATS HEALTHY DIET for ADULTS CARBOHYDRATES Complex (e.g: starch, glucogen) Simple (e.g: glucose, fructose, saccharose) Fiber belongs to the complex carbohydrates and it is indigestible, can’t be processed to produce any energy  HEALTHY DIET for ADULTS. CARBOHYDRATES Recommended to account for 45 % to 65% of daily calories. ✓ Healthy Food Sources: Consume a variety of fruits, vegetables, legumes (like lentils and beans), nuts, and whole grains (such as unprocessed maize, millet, oats, wheat, and brown rice). ✓ Fruits and Vegetables: Aim to eat at least 400 g (five portions) of fruits and vegetables per day, excluding starchy roots like potatoes, sweet potatoes, and cassava. ✓ Free Sugars: Limit free sugars to less than 10% of total energy intake (about 50 g or 12 teaspoons in a 2000-calorie diet). For Free sugars include those added to foods and added health benefits, aim for less than 5% of total energy drinks by manufacturers, cooks, or intake. consumers, as well as sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates HEALTHY DIET for ADULTS WHY DO WE NEED CARBOHYDRATES? 1. Energy production 2. Source of glucogen 3. Homeostasis of blood glucose 4. Avoids metabolization of proteins 5. Biosynthesis of fatty acids and aminoacids 6. Constitution of more complex molecules 7. Detoxification via glucuronic acid HEALTHY DIET for ADULTS CARBOHYDRATES Glycaemic index (GI) is a rating system for foods containing carbohydrates. It measures how quickly foods containing carbohydrates raise blood glucose (sugar) levels. Choosing low GI foods as part of a balanced diet can help to minimise fluctuations in blood glucose levels. In the long term this can help reduce the risk of complications of diabetes such as heart and kidney problems. HEALTHY DIET for ADULTS CARBOHYDRATES Glycaemic index (GI) is a rating system for foods containing carbohydrates. Foods are categorized into three GI levels: Low GI (GI < 55): These foods cause a slow, gradual rise in blood sugar. Examples include most fruits, vegetables, legumes, and whole grains. Low- GI foods are often recommended for sustained energy and blood sugar stability. Medium GI (55 < GI < 70): These foods cause a moderate increase in blood sugar. Examples include whole wheat products, certain fruits, and quick oats. High GI (GI > 70): These foods cause a rapid spike in blood sugar, leading to quick energy that is often followed by a “crash.” Examples include white bread, white rice, and sugary foods.  HEALTHY DIET for ADULTS CARBOHYDRATES FIBERs SOLUBLE : Dissolves in water to form a gel-like substance in the gut, which helps slow digestion and stabilizes blood sugar levels. E.g. oats, barley, beans and lentils… INSOLUBLE: Does not dissolve in water; instead, it adds bulk to the stool and helps food pass more quickly through the stomach and intestines. E.g. whole grains ,nuts and seeds, vegetables, fruit skins FUNCTIONS Retention of H2O: increase in faecal volumen and peristaltism Satiating effect in the stomach Recommended daily ingestion of fiber in adults is 25 g Reduction in the absorption of lipids in the intestine Effect in the intestinal microbiote WHO Recommendations HEALTHY DIET CARBOHYDRATES HEALTHY DIET for ADULTS FATS Triglycerides 9 kcal/ gram: important source of energy Phospholipids Cholesterol Functions: Adipose tissue Cellular membranes Gastric empty and satiety Vehicle of lipo-soluble vitamins: A, D, E and K FATS and OILs TYPES SATURATED FATS: solids at ambient temperature Increase cholesterol levels UNSATURATED FATS: liquids at ambient temperature Decrease cholesterol levels TRANS FATS: fats that have been modified through a process called hydrogenation Increase cholesterol levels FATS and OILs TYPES X ✓. X  HEALTHY DIET for ADULTS FATS Recommendations Total Fat: Should be 20-30% of daily energy intake. Prefer Unsaturated Fats: Sources: fish, avocado, nuts, sunflower oil, soybean oil, canola oil, and olive oil. Limit Saturated Fats: Recommended intake: less than 10% of daily energy. Sources: fatty meats, butter, palm and coconut oil, cream, cheese, ghee, and lard. They are often used to extend the Avoid Trans Fats: shelf life of products and improve Recommended intake: less than 1% of daily energy. consistency, but are associated with Sources: industrial foods like baked goods, fried foods, an increased risk of heart disease, as packaged snacks, frozen pizza, cookies. they increase LDL-cholesterol and Industrial trans fats are unhealthy and should be avoided. reduce HDL-cholesterol. HEALTHY DIET for ADULTS PROTEINS Recommendations 10-15% of total daily energy intake from proteins Functions: Enzymes Antibodies Transport proteins Movement proteins in the muscle Structure proteins Coagulation  Healthy Diet for infants and young children In the first 2 years of a child’s life, optimal nutrition fosters healthy growth and improves cognitive development. It also reduces the risk of becoming overweight or obese and developing NCDs later in life. IMPORTANT INFORMATION Exclusive Breastfeeding: For the first 6 months, infants should be exclusively breastfed. Continued Breastfeeding: Breastfeeding should continue until at least 2 years of age or longer. Complementary Foods (from 6 months): Introduce a variety of safe, nutrient-rich foods to supplement breast milk. Do not add salt or sugars to these foods. For infants and young children BREASTFEEDING ADVANTAGES  Practical advice on maintaining a healthy diet FREE SUGARS Recommendation: Limit free sugars to less than 10% of total daily energy intake. A reduction to less than 5% provides additional health benefits. Health Risks: Increases the risk of dental caries (tooth decay). Contributes to unhealthy weight gain, leading to overweight and obesity. Ways to Reduce Sugar Intake: Limit sugary snacks, candies, and sugar-sweetened drinks. Choose fresh fruits and raw vegetables as snacks instead of sugary alternatives.  Practical advice on maintaining a healthy diet Salt, sodium and potassium Most people consume too much sodium through salt (corresponding to consuming an average of 9 –12 g of salt per day) and not enough potassium (less than 3.5 g). High sodium intake and insufficient potassium intake contribute to high blood pressure, which in turn increases the risk of heart disease and stroke Reducing salt intake to the recommended level of less than 5 g per day could prevent 1.7 million deaths each year. People are often unaware of the amount of salt they consume. Practical advice on maintaining a healthy diet Salt, sodium and potassium How to Reduce Salt Intake? Limit salt and high-sodium condiments (e.g., soy sauce, fish sauce, bouillon) when cooking. Avoid having salt or high-sodium sauces on the table. Limit consumption of salty snacks. Choose products with lower sodium content. Food Labeling: Encourage checking nutrition labels to identify sodium content before purchasing. Potassium and Blood Pressure: Potassium helps mitigate the negative effects of high sodium on blood pressure. Increase potassium intake by eating fresh fruits and vegetables.  Nutritional information in the packaging Nutri-Score front-of-pack label, which classifies the nutritional quality of products in one of 5 classes (A to E) Scoring system and include nutrients and other food components that should be encouraged, as well as nutrients and food components that should be discouraged  GOALS OF WEIGHT LOSS Importance of Setting Goals with the patient: Discuss the impact of weight loss on physical, mental, and functional health. Assist patients in developing a personalized action plan and provide ongoing support. Initial Weight Loss Goal: Aim for a 5-7% weight loss of total body weight. This amount provides significant health benefits. Health Benefits of Weight Loss: Reduces risk factors for cardiovascular disease, including: Dyslipidemia Hypertension Diabetes mellitus RATE OF WEIGHT LOSS FACTORS INFLUENCING WEIGHT LOSS 1. Energy Balance: Weight loss depends on the difference between energy intake and energy expenditure. 2. Factors Affecting Weight Loss Response: - Dietary adherence: Consistency in following the diet. - Genetic factors: Influence body composition and energy expenditure. Examples: Men vs. Women: Men tend to lose weight faster due to more lean body mass and higher energy expenditure. Age: Older individuals lose weight more slowly due to a lower metabolic rate (declines by ~2% per decade). 3. Energy Requirements: Maintenance: ~22 kcal/kg/day for a normal-weight adult. Example: A 100 kg woman requires ~2200 kcal/day, with a variability of ±20% (between 1860 and 2620 kcal/day). Expected Weight Loss: A 500 kcal/day deficit leads to approximately 0.5 kg/week (1 lb/week) weight loss. OBESITY IN ADULTS: Types Of Diets Conventional diets are defined as those with energy requirements above 800 kcal/day. These diets fall into the following groups: 1. Balanced low-calorie diets / Low-calorie versions of healthy diets 2. Low-fat diets 3. Low-carbohydrate and low glycemic index diets 4. High-protein diets 5. Very low-calorie diets Fad diets (diets involving unusual combinations of foods or eating sequences) are extremely popular but only for a short period of time. Most fad diets are not sustainable in the long term. Fad diets promise quick results, often without scientific backing or long-term sustainability (e.g. Ketogenic diet, paleo diet, detox diet…) OBESITY IN ADULTS: Types Of Diets BALANCED LOW-CALORIE DIETS Limit or Eliminate: Alcohol, sugar-containing beverages, and high-sugar sweets, as they provide energy without essential nutrients. Portion-Controlled Meals method: A simple method to control calorie intake is through individually packaged foods. Success Factors: Dependent on patient preferences, including: Willingness to try portion-controlled meals. Satisfaction with food taste and variety. Perceived sustainability of this eating routine. OBESITY IN ADULTS: Types Of Diets LOW-CALORIE VERSIONS OF HEALTHY DIETS Mediterranean Diet High in monounsaturated fats (e.g., olive oil) vs. saturated fats. Moderate alcohol intake, mainly wine. High in vegetables, fruits, legumes, nuts, and grains. Moderate consumption of milk and dairy (mostly cheese). Low intake of meat products. Health Benefits: Associated with cardiovascular risk reduction and diabetes prevention OBESITY IN ADULTS: Types Of Diets VERY LOW CALORIE DIETS (VLCDs) 200-800 kcal/day = Very low calorie diets.