Your SlideShare is downloading. ×
0
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
D.diabetes and nutrition
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

D.diabetes and nutrition

594

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
594
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
30
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

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

×