MEDICAL NUTRITION THERAPY (MNT) <ul><li>Mrs. Sarah Jacob </li></ul><ul><li>Rtd. Head, Department of Dietetics </li></ul><u...
Medical Nutrition Therapy (MNT) Replaces  <ul><li>The earlier term of “Diet Therapy” and stresses a </li></ul><ul><li>four...
Assessment <ul><li>Involves assessment of habitual dietary pattern in </li></ul><ul><li>terms of nutrient content and eati...
Goals <ul><li>Treatment goals should be individualised, realistic </li></ul><ul><li>and achievable </li></ul><ul><li>-  We...
Intervention - Education <ul><li>- Appropriate meal plan suggested </li></ul><ul><li>- Strategies for eating behaviour cha...
Steps to individualised diet planning  <ul><li>Step:1 - Determine past diet history, food habits, </li></ul><ul><li>activi...
<ul><li>Step: 2  Determine ideal or desirable body </li></ul><ul><li>weight </li></ul><ul><li>(a) Hamwi method  </li></ul>...
<ul><li>Step: 3  Calculate Energy Requirement </li></ul><ul><li>Basal + activity </li></ul><ul><li>= (148 x 10) = (1480 x ...
<ul><li>Step: 4  Determine gm of carbohydrate, </li></ul><ul><li>protein and fat </li></ul><ul><li>CHO = 60-65% of total c...
<ul><li>Step : 5  Carbohydrate – 60-65% </li></ul><ul><li>Complex CHO is better than simple sugars as absorption is slower...
<ul><li>Step: 6  </li></ul><ul><li>Dietary fibre present in whole grain cereals,  </li></ul><ul><li>vegetables pulses and ...
<ul><li>Step: 7  </li></ul><ul><li>Foods with high fibre content have lower  </li></ul><ul><li>glycemic index </li></ul><u...
<ul><li>(8) Protein – 15% </li></ul><ul><li>RDA of protein for adults – 1g/kg body weight. </li></ul><ul><li>Cereals, puls...
<ul><li>Step: 10  </li></ul><ul><li>Translate in terms of food. </li></ul><ul><li>Use of exchange lists </li></ul><ul><li>...
<ul><li>(11) Sample meal plan: </li></ul><ul><li>Breakfast – Milk – 100 ml </li></ul><ul><li>Cereal preparation – from 75g...
<ul><li>Tea time:  Milk – 100 ml </li></ul><ul><li>Whole gram or pulse – 15g </li></ul><ul><li>Dinner:  250g cooked rice o...
Eating modifications <ul><li>Reduce cereal intake </li></ul><ul><li>Avoid simple sugars – Honey, Sucrose etc. </li></ul><u...
Type I Diabetes  – in children <ul><li>Energy: 1000 kcal for the 1 st  year </li></ul><ul><li>+ 100 Kcal for every year up...
<ul><li>(b) Distribution of CHO, Protein, Fat </li></ul><ul><li>CHO – 50 – 55% </li></ul><ul><li>Protein – 20 – 25% </li><...
Gestational Diabetes <ul><li>Pregnant women need extra 300 kcal and 15g </li></ul><ul><li>protein during the 2 nd  or 3 rd...
Diabetic Nephropathy <ul><li>Depending  on the function of the kidney. </li></ul><ul><li>Energy – as for others with diabe...
Evaluation….., <ul><li>Monitoring medical and clinical outcomes </li></ul><ul><li>Effectiveness of nutrition care plan etc...
<ul><li>“ Nutrition is a challenging aspect of diabetes </li></ul><ul><li>management.  Attention to nutrition and meal </l...
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D.diabetes and nutrition

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D.diabetes and nutrition

  1. 1. MEDICAL NUTRITION THERAPY (MNT) <ul><li>Mrs. Sarah Jacob </li></ul><ul><li>Rtd. Head, Department of Dietetics </li></ul><ul><li>Christian Medical College </li></ul><ul><li>Vellore . </li></ul>
  2. 2. Medical Nutrition Therapy (MNT) Replaces <ul><li>The earlier term of “Diet Therapy” and stresses a </li></ul><ul><li>four pronged approach that includes…. </li></ul><ul><li>Assessment of the individual’s metabolic and life style parameters </li></ul><ul><li>Identification of nutrition goals </li></ul><ul><li>Intervention designed to achieve these goals. </li></ul><ul><li>Evaluation of therapeutic outcome. </li></ul>
  3. 3. Assessment <ul><li>Involves assessment of habitual dietary pattern in </li></ul><ul><li>terms of nutrient content and eating behaviour </li></ul><ul><li>Helps </li></ul><ul><li>- To identify goals </li></ul><ul><li>- To determine the type of intervention needed </li></ul><ul><ul><ul><ul><li>calorie intake, food pattern modification of eating behaviour etc. </li></ul></ul></ul></ul><ul><li>- Rapport building </li></ul><ul><li>- Gives information on clinical data. </li></ul>
  4. 4. Goals <ul><li>Treatment goals should be individualised, realistic </li></ul><ul><li>and achievable </li></ul><ul><li>- Weight loss if necessary </li></ul><ul><li>- Blood glucose levels to be maintained as close to </li></ul><ul><li>normal as possible </li></ul><ul><li>- Blood lipid levels within desirable limits </li></ul><ul><li>- Consistent and appropriate food intake </li></ul><ul><li>- Regular meal timings </li></ul><ul><li>- Blood glucose monitoring </li></ul>
  5. 5. Intervention - Education <ul><li>- Appropriate meal plan suggested </li></ul><ul><li>- Strategies for eating behaviour change </li></ul><ul><li>- Food exchanges </li></ul><ul><li>- Importance, source of dietary fibre </li></ul><ul><li>- Adequate nutrient intake by including variety </li></ul><ul><li>- Importance of exercise. </li></ul>
  6. 6. Steps to individualised diet planning <ul><li>Step:1 - Determine past diet history, food habits, </li></ul><ul><li>activity socio economic status, cultural and </li></ul><ul><li>religious practices etc. </li></ul><ul><li>e.g. Sex – male Age – 50 yrs </li></ul><ul><li>Height – 170 cms or 5’ 7” </li></ul><ul><li>Food habits - Non vegetarian </li></ul><ul><li>Income – Middle Income </li></ul><ul><li>Activity – Sedentary </li></ul><ul><li>Type of Diabetes – Type 2 Diabetes </li></ul>
  7. 7. <ul><li>Step: 2 Determine ideal or desirable body </li></ul><ul><li>weight </li></ul><ul><li>(a) Hamwi method </li></ul><ul><li> IBW = 106+(7x6) = 148 lbs </li></ul><ul><li>(b) Broca’s Index </li></ul><ul><li>IBW = 170-100 = 70 kgs </li></ul><ul><li>5 – 10% less for diabetics </li></ul><ul><li>= 63 – 67 kgs. </li></ul>
  8. 8. <ul><li>Step: 3 Calculate Energy Requirement </li></ul><ul><li>Basal + activity </li></ul><ul><li>= (148 x 10) = (1480 x 20 / 100) </li></ul><ul><li>= 1776 Kcal </li></ul><ul><li>= Rounded off to 1800 Kcal. </li></ul>
  9. 9. <ul><li>Step: 4 Determine gm of carbohydrate, </li></ul><ul><li>protein and fat </li></ul><ul><li>CHO = 60-65% of total calories = 270g- 292g </li></ul><ul><li>Protein = 10-15% of total calories = 45g – 68g </li></ul><ul><li>Fat = 20-25% of total calories = 40g – 50g </li></ul>
  10. 10. <ul><li>Step : 5 Carbohydrate – 60-65% </li></ul><ul><li>Complex CHO is better than simple sugars as absorption is slower </li></ul><ul><li>Amount of CHO in each meal to be adjusted for each individual. </li></ul>
  11. 11. <ul><li>Step: 6 </li></ul><ul><li>Dietary fibre present in whole grain cereals, </li></ul><ul><li>vegetables pulses and fruits delay digestion </li></ul><ul><li>and absorption may help in reducing blood </li></ul><ul><li>sugars and lipids. Recommended intake – </li></ul><ul><li>25 - 28g / 1000 Kcal. </li></ul>
  12. 12. <ul><li>Step: 7 </li></ul><ul><li>Foods with high fibre content have lower </li></ul><ul><li>glycemic index </li></ul><ul><li>Physical form of food </li></ul><ul><li>Nature of cooking </li></ul><ul><li>Nature of fibre </li></ul><ul><li>Amount and composition of meal affect the glycemic index of food. </li></ul>
  13. 13. <ul><li>(8) Protein – 15% </li></ul><ul><li>RDA of protein for adults – 1g/kg body weight. </li></ul><ul><li>Cereals, pulses, nuts, milk and its products, non- </li></ul><ul><li>vegetarian items contribute to the protein content </li></ul><ul><li>in the diet. </li></ul><ul><li>(9) Fat – 20-25% </li></ul><ul><li>Type of fat – 7 – 10% SFA </li></ul><ul><li>- < 10% PUFA </li></ul><ul><li>- 10-15% MUFA </li></ul>
  14. 14. <ul><li>Step: 10 </li></ul><ul><li>Translate in terms of food. </li></ul><ul><li>Use of exchange lists </li></ul><ul><li>- gives information on nutrient content </li></ul><ul><li>- provides variety in diet by giving </li></ul><ul><li>alternatives </li></ul>
  15. 15. <ul><li>(11) Sample meal plan: </li></ul><ul><li>Breakfast – Milk – 100 ml </li></ul><ul><li>Cereal preparation – from 75g cereal </li></ul><ul><li>e.g: 3 iddlies / chappathies </li></ul><ul><li>Mid morning – Fruit + Lime juice without </li></ul><ul><li>sugars. </li></ul><ul><li>Lunch – 250 g cooked rice or chappathies – 3 </li></ul><ul><li>meat / fish / paneer </li></ul><ul><li>vegetables </li></ul><ul><li>curds </li></ul><ul><li>Dhal as sambar </li></ul>
  16. 16. <ul><li>Tea time: Milk – 100 ml </li></ul><ul><li>Whole gram or pulse – 15g </li></ul><ul><li>Dinner: 250g cooked rice or 3 chappathies </li></ul><ul><li>Meat / Fish / Dhal </li></ul><ul><li>Vegetables </li></ul><ul><li>Curds </li></ul><ul><li>Bedtime: Mild – 200 ml </li></ul><ul><li>Oil for cooking – 3-4 teaspoons </li></ul><ul><li>To be adjusted to suit individual needs. </li></ul>
  17. 17. Eating modifications <ul><li>Reduce cereal intake </li></ul><ul><li>Avoid simple sugars – Honey, Sucrose etc. </li></ul><ul><li>Avoid fried foods – chips, nuts etc </li></ul><ul><li>Increase use of vegetables – ensure adequate fibre </li></ul><ul><li>intake </li></ul><ul><li>Eat regular meals </li></ul><ul><li>Regular food and exercise </li></ul><ul><li>Balanced meal to ensure adequate Vitamins and </li></ul><ul><li>Minerals. </li></ul>
  18. 18. Type I Diabetes – in children <ul><li>Energy: 1000 kcal for the 1 st year </li></ul><ul><li>+ 100 Kcal for every year upto 10yrs / </li></ul><ul><li>upto 200kcal </li></ul><ul><li>2000 + 50-100 kcal for girls between 12-15 yrs </li></ul><ul><li>2000 + 200 kcal for boys between 12-15 yrs </li></ul><ul><li>Above 15 yrs – 30-35 kcal / kg – sedentary </li></ul><ul><li>40 kcal / kg – moderation </li></ul><ul><li>50 kcal / kg – very active </li></ul>
  19. 19. <ul><li>(b) Distribution of CHO, Protein, Fat </li></ul><ul><li>CHO – 50 – 55% </li></ul><ul><li>Protein – 20 – 25% </li></ul><ul><li>Fat – 20 – 25% </li></ul>
  20. 20. Gestational Diabetes <ul><li>Pregnant women need extra 300 kcal and 15g </li></ul><ul><li>protein during the 2 nd or 3 rd trimester. </li></ul><ul><li>Frequent small meals to be given. </li></ul>
  21. 21. Diabetic Nephropathy <ul><li>Depending on the function of the kidney. </li></ul><ul><li>Energy – as for others with diabetes </li></ul><ul><li>Protein – 0.6 – 0.8 g / kg IBW </li></ul><ul><li>Fat – less than 30% of total Kcal preferably 20-25% </li></ul><ul><li>CHO – to make up the rest of the calories preferably from complex carbohydrates. </li></ul>
  22. 22. Evaluation….., <ul><li>Monitoring medical and clinical outcomes </li></ul><ul><li>Effectiveness of nutrition care plan etc </li></ul><ul><li>Re-assess and review nutrition care plan </li></ul>
  23. 23. <ul><li>“ Nutrition is a challenging aspect of diabetes </li></ul><ul><li>management. Attention to nutrition and meal </li></ul><ul><li>planning principles is essential for glycemic </li></ul><ul><li>control and over all good health”. </li></ul>
  24. 24. Thank you

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