dietary recommendations in selective cases.pdf

Dietary Recommendations in Some Disorders Dr. AHMED ABDEL-HALIM Clinical Nutrition Specialist Lecturer at Badr University in Cairo Diabetes mellitus Diabetes is a chronic degenerative disease Undetected/ untreated diabetes causes further complications Loss of limbs, vision etc The problem is i...

Dietary Recommendations in Some Disorders Dr. AHMED ABDEL-HALIM Clinical Nutrition Specialist Lecturer at Badr University in Cairo Diabetes mellitus Diabetes is a chronic degenerative disease Undetected/ untreated diabetes causes further complications Loss of limbs, vision etc The problem is in insulin: The body makes too little ( DM Type I – IDDM)  unable to use ( DM Type II – IDDM) Managing Diabetes Successfully Involves three things: Food Exercise Medication Dietary Management of Diabetic  Its an essential part of the treatment of diabetic patients  Diabetics do not need to follow a “special diet” with narrow restrictions (as was recommended in the previous years).  Eating well is important for good diabetes control.  The optimum healthy food choices for diabetics are the same as for the general population, and ideally should be:  Low in fat, sugar, and salt.  Include plenty of fruit and vegetables.  Starchy food: bread potatoes and rice. Nutritional requirements CARBOHYDRATE: • It is maintained to about 45-60% of total calories. • Should be in the form of polysaccharides • Rapidly absorbed mono & disaccharide should be avoided • Rich in dietary fiber & complex carbohydrates benefit diabetics. It lowers: • Insulin requirements • Serum cholesterol & triglyceride values • Aids in weight control and lowers blood pressure FAT: Total fat should be 20 to 30% of the total energy. Saturated fat (7-10%), monounsaturated (10-13%) & polyunsaturated (8-10%) of the total energy. •PROTEIN: It should be 0.8g/kg of ideal body weight increased intake up to 15 to 20 % of total energy in adolescent children, pregnant or nursing mothers Vitamins & minerals Similar to those of other individuals. There is no need for supplement Pregnant woman may need a vitamin & mineral supplement 2008 ADA Recommendations for General Meal Planning for Persons with Diabetes Meal plan should include fruits, vegetables, legumes, low-fat dairy products, lean meats, and whole grains. You can eat sugar containing foods, but your meal plan will be adjusted. Monitor carbohydrate intake. Consume 25-35 grams of fiber. Avoid Skipping meals. ADA = American Diabetes Association' Dietary Management of Diabetic Recommendations: Eat regular meals based on starchy food, use whole grain as possible such as whole-meal bread, oats Reduce fats especially animal. Replace fried with grilled, steamed or oven baked items. More fruits and vegetables: at least 5 serving per day Reduce sugar and sugary food. Strict sugar-free diet is not necessary Reduce salt. Use herbs and spices to provide food a good taste and flavor Lose weight if overweight in rate of 0.5 – 1kg/week Diabetic food products are not necessary and do not contribute to a healthy diet Metabolic syndrome: Three or more of the following five risk factors: Risk Factor Defining Level Abdominal obesity Men Women Triglycerides HDL cholesterol Men Women Blood pressure Fasting glucose Waist circumference >102 cm (>40 in) >88 cm (>35 in) ≥150 mg/dL <40 mg/dL <50 mg/dL ≥140/ ≥90 mmHg ≥100 mg/dL Cardiovascular Disease And Hypertension Cardiovascular disease includes: Coronary heart disease(angina and myocardial infarction) Cerebral infarction Peripheral vascular disease Hypertension: Systolic blood pressure ≥ 140 mmHg and/or Diastolic blood pressure ≥ 90 mmHg Dietary Management Cardiovascular Disease And Hypertension Dietary Approaches to Stop Hypertension: DASH diet They are nutritional recommendation for the general population to prevent the risk of cardiovascular disease and hypertension.     Eat oily fish at least once/week Eat at least 5 servings of fruits and vegetables/day Reduce amount of all fat eaten Reduce salt intake (3g/day)     Eat more starchy food Reduce alcohol intake Reduce weight if overweight or obese Increase physical activity to at least 30 minutes of moderate activity/day These recommendations are also suitable for those with established diseases Liver Diseases What are the liver functions that are related to nutrition?  Emulsification of dietary fat by bile before their digestion  Production of triglycerides and lipoproteins  Maintain blood glucose level and store glycogen)  Synthesis of amino acids  Storage of vitamins: A, B12, K, Folate Therefore, liver diseases with impairment of these functions will require nutritional support. The problem is aggravated by the loss of appetite that is associated with liver affection Dietary Management of Hepatitis Acute hepatitis: Patients usually have loss of appetite No dietary restriction (fat restriction that was performed in the past is no longer recommended) Encourage eating as tolerable by the patients Small frequent meals and nourishing drinks are better tolerable than large meals Dietary Management of Liver Cirrhosis An irreversible damage of liver cells Liver Cirrhosis is an irreversible damage of liver cells Energy and protein requirements may be increased Most patients are frequently undernourished requiring nutritional support. Dietary restrictions should not be routinely imposed Dietary Management of Liver Cirrhosis Low sodium diet or No-added sodium diet may be used according to the condition of the patients. High salt diet are better avoided: all canned and preserved foods, most of the fast foods, packet soups and stock cubes. Sufficient protein to meet the requirements. Vegetable and dairy proteins are better tolerated than meat and fish proteins High fiber diet to prevent constipation. Dietary Management of Liver Cirrhosis If there are ascites and edema:  No fat restriction unless intolerable  Encourage eating as tolerable by the patients  Small frequent meals every 1 – 2 hours are better tolerable than large meals  Increase intake of high energy food: sugar, honey, oil, salt-free butter Nutritional status should be monitored regularly. Body weight cannot be used; mid-arm muscle circumference and triceps skinfold thickness are most appropriate. Dietary Management of Renal diseases Acute Chronic Energy HD Hemodialysis 35 – 50 Kcal/kg 30 – 35 Kcal/kg 30 – 35 Kcal/kg Protein 0.6 – 0.8 g/ kg 0.6 – 0.8 g/ kg CHO and fat Same as normal Same as normal Same as normal Fluid Output + 500 cc unlimited < 1.2 g/ kg Output + 1000 cc Low potassium diet. Avoid/limit other high K+ foods: coffee, chocolate, toffee, liquorice, bran, nuts, fruit juices, ketchup, brown sauce. Reduce salt in the diet Multivitamin supplementation depend on deficient In chronic kidney disease: Supplementation of active form of vit D. Be Physically Active Guidelines  Fit into daily routine  Aim for at least 150 minutes/week of moderate aerobic exercise  Start slowly and gradually build intensity  Take stairs, park further away or walk to another bus stop, etc. Benefits of Exercise  Lower blood pressure  Weight control  Improved blood glucose control  Increased insulin sensitivity  Prevent/delay onset of type 2 diabetes  Improved lipid levels  Reduced risk of CVD Try to: Follow a healthy eating pattern. Be Active Not Smoke Control Your Weight Take Your Medicine