This document discusses medical nutrition therapy for various chronic diseases. It begins by defining medical nutrition therapy and outlining its two parts - nutritional assessment and treatment/intervention. It then covers specific MNT for conditions like obesity, cardiovascular disease, diabetes, cancer, and HIV/AIDS. Key aspects of MNT are identified for each condition, such as focusing on portion control and exercise for obesity or reducing sodium and increasing potassium for hypertension. The goal of MNT is to help manage diseases through therapeutic diets, counseling, and nutrition support.

1. Nutrition Fundamentals and Medical
Nutrition Therapy
Fundamentals of Medical Nutrition
Therapy for the CDM
Corresponds with
LEARNING PLAN 6
Copyright 2016 Association of Nutrition and Foodservice
Professionals

2. Objectives
 Identify basic medical nutrition terminology as related to
obesity, weight management, cardiovascular disease,
diabetes, cancer and HIV/AIDS
 Define the basic concepts of medical nutritional therapy as
related to obesity, weight management, cardiovascular
disease, diabetes, cancer and HIV/AIDS
 Relate basic concepts to nutritional deficiency and excess
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

3. Objectives
 Relate basic concepts of medical nutritional therapy as
related to obesity, weight management, cardiovascular
disease, diabetes, cancer and HIV/AIDS
 Compare basic concepts to current diet manual or other
accepted resources
 Explain utilization of medical nutritional therapy in long-term
care and acute care settings
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

4. Chronic Diseases
 Chronic diseases are degenerative diseases of the body
organs due in part to diet
» Diseases resulting from nutrition deficiency
- Less common now than 50+ years ago
» Diseases resulting from nutrition excess
- By far the most common cause of many chronic diseases
 Obesity, cardiovascular disease, hyperlipidemia
 Type 2 diabetes, some cancers, osteoporosis
 Hypertension
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

5. Medical Nutrition Therapy
 Nutritional assessment and treatment of a condition,
illness, or injury that places an individual at risk
» Two parts:
1. Assessment of the client’s nutritional status
2. Treatment/intervention
 Generally focuses on individuals at risk for nutritional
problems
» Begins with nutritional screening – identifying those clients
who are at risk
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

6. Medical Nutrition Therapy
 Treatments
» Therapeutic diet
- Adjust to meet a client’s special nutrient needs
» Counseling
» Nutrition Support
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

7. Overweight and Obesity
 When energy intake exceeds the amount of energy
expended
 No single cause and no single treatment for obesity
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

8. Overweight and Obesity
 Excess fat around the waistline increases health risk
» Woman with 0.8 or above is at a high risk
» Man with 0.95 or above is at a high risk
 3500 calories = 1 pound of body fat
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

9. Brain Break
 When exercising throughout one week, how many
calories would you have to expend each day to lose one
pound of fat?
» 500 each day for a total of 3500 in one week
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

10. Overweight and Obesity
 Many health professionals are adopting a non-dieting
approach to obesity
 Treatment options
» Nutrition education
» Exercise
» Behavior modification
» Attitude modification
» Social support and maintenance support
» Drugs and/or surgery
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

11. MNT and Obesity
Menu Planning for Weight Loss or Maintenance
 Most successful healthy eating options
» Protein
- 10-35% of total calories
» Carbohydrate
- 45-65% of total calories
» Fat
- 20-35% of total calories
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

12. MNT and Obesity
Nutrition Education
 Calorie restriction is limited
 No foods are forbidden
 Portion control is vital
 Variety, balance, moderation
 Weighing oneself weekly
 Food journaling
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

13. MNT and Obesity
Exercise
 Vital component to a weight loss program
 Benefits of physical activity (see textbook for full list)
» Burns extra calories
» Improves self-image
» Reduces fatigue; energizes the body
» Improves cardiovascular health
» Increases muscle; reduces fat
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

14. MNT and Obesity
Other Treatments
 Behavior modification
 Attitude modification
 Social support
 Drugs and surgery
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

15. MNT and Obesity
Menu Planning
 Protein
» 10-35 percent of total calories
 Carbohydrate
» 45-65 percent of total calories
 Fat
» 20-35 percent of total calories
 Use the online tool Choose MyPlate
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

16. Brain Break
 A friend just asked your opinion on a new diet he is
interested in. The diet severely limits carbohydrates,
including having no fruit. What advice would you offer?
» A healthy eating plan does not severely limit or restrict any foods. A good
plan should include identifying why he eats what he does so he can change
some problem food behaviors, if needed. A good plan may also include an
exercise component. Suggest that he look at the Choosemyplate.gov for a
personalized plan.
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

17. Cardiovascular Disease
Heart Disease-Coronary Artery Disease
 Atherosclerosis - plaque build-up in arteries
 Myocardial infarction - heart attack
 Risk Factors
» Hyperlipidemia – high blood cholesterol
» Low-Density Lipoproteins (LDL)
» High Density Lipoproteins (HDL)
» Triglycerides
- most common fat in humans; affected by excess sugars,
starches, and alcohol in the diet
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

18. Cardiovascular Disease
Relationship between Saturated Fats and Cardiovascular Disease
 Critical issue is the type of fat in the American diet
» Saturated fats
» Trans fat
 To lower LDL cholesterol with MNT
» Substitute unsaturated fat for saturated fat
» Increase complex carbohydrates
» Consume omega-3 fatty acids
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

19. Cardiovascular Disease
Relationship with Cholesterol
 Dietary cholesterol data has changed over the years. A
subset of the population (1/3) may be “hypersensitive”
meaning dietary cholesterol may raise blood cholesterol.
 Data shows saturated fat may raise blood cholesterol.
 Animal products contain cholesterol
» Sources of high cholesterol foods
- Egg yolks, liver, fat in meats and poultry, shellfish, dairy fat in cream,
whole milk and regular cheeses
 Daily average cholesterol intake should be less than 300 mg
 Drug treatment is appropriate for adults who have a high LDL
level and/or if they also have other risk factors
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

20. Cardiovascular Disease
Choosing Foods Low in Saturated Fat and Cholesterol
 Consume more
» High fiber foods, plant proteins, omega-3 fatty acids, garlic,
green tea, lean meat, low-fat dairy foods
 Consume less
» Saturated fats, trans fats, sugars
 Drug treatment
» Statins
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

21. Cholesterol Guidelines
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

22. Brain Break
 What foods should be substituted in the following menu
to decrease the saturated fat content?
» Grilled Cheddar Cheese Sandwich, Cream of Tomato Soup, Crackers, Ice
Cream
» Use low-fat cheddar, skim evaporated milk in the soup, whole
grain crackers, fruit
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

23. Cardiovascular Disease
Stroke
 Blockage of artery that supplies blood to the brain
 Embolus (clot)
 Cerebral hemorrhage
 Aneurysm
 Transient ischemic attack (TIA)
 Prompt medical attention if a stroke is suspected is of utmost
importance
 Limit
» saturated fats, trans fats
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

24. Cardiovascular Disease
Hypertension/High Blood Pressure
 Lifestyle modifications
» Weight loss
» Increased physical activity
» Medical nutrition therapy – current recommendation is to
reduce sodium intake to less than 1500mg per day
» Moderation of alcohol intake
» Tobacco avoidance
» Medicine
- Diuretics
- Beta blockers
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

25. Cardiovascular Disease
MNT and High Blood Pressure
 Reduce sodium (NaCl) in diet
» No Added Salt – 4 gram (4000 mg)
- No salt added at table
» Sodium controlled diet – 2 gram (2000 mg)
- More restrictive, limiting processed foods, milk, bread, and other
starches
» Recorded as 2 gm NA diet
» Current AHA recommendation is 1500 mg of sodium daily
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

26. Cardiovascular Disease
MNT and High Blood Pressure
 Increase potassium
» Recorded as  K diet
» DASH diet
- Reduces sodium; increases potassium
- Focus on vegetables, fruits, low fat milk, whole grains, poultry,
fish, nuts
- Limit red meat, sweets, sugar containing beverages
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

27. Cardiovascular Disease
MNT and High Blood Pressure
 A sodium-controlled diet can be very challenging for a
client to tolerate
 Become familiar with grocery shopping and food
preparation tips to assist your client in following this
medical nutrition therapy approach
 Focus on new and fresh flavors including sodium free
herbs and spices
 Recommend appropriate recipes and tools
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

28. Brain Break
 If the recipe calls for adding 2 teaspoons of salt, how
many milligrams of sodium are being added?
» 4600
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

29. Cardiovascular Disease
Pulmonary Conditions
 Chronic Obstructive Pulmonary Disease (COPD)
» A group of diseases
» Shortness of breath
» 90% of the time is caused by smoking
» Malnutrition due to loss of appetite and increased caloric
need
 Nutritional approaches
- Small frequent meals
- Higher fat diet, lower carbohydrate diet
- Potential for fluid restriction
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

30. Diabetes Mellitus
 Metabolic Disorder – not caused by ‘sugar’
» Lack of insulin (hormone) manufactured in pancreas, to
allow body to utilize the glucose it needs
» Result is hyperglycemia or high blood sugar
 7th leading cause of death in the U.S.
 Excess sugar in the body due to lack of insulin can
damage kidneys, heart, blood vessels, nerves, and eyes
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

31. Diabetes Mellitus
 Diagnosis may be based on A1C criteria or plasma
glucose criteria
» Fasting plasma glucose of 126 mg/dl OR
- A1C > 65% OR
 Random plasma glucose of > 200 mg/dl with symptoms
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

32. Diabetes Mellitus
 Type 1
» Symptoms often begin in childhood
» Insulin-dependent
» Family history or caused by acute illness
 Ketosis
» Dangerous chemicals in the blood
» Can lead to coma or death
 Type 2 – Most Common
» Symptoms begin in adulthood
» Obesity is a primary factor
» Not always insulin-dependent
 Gestational Diabetes
» Occurs during pregnancy
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

33. Diabetes Management
 Maintain near-normal blood glucose level
» Medication
» Food
» Exercise
 Hypoglycemia – low blood sugar
» Unpleasant side effects
 Insulin
» Several types to individualize each treatment approach
 Oral hypoglycemic agents
» Several types to individualize each treatment approach
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

34. Medical Nutrition Therapy for
Diabetes
 ChooseMyPlate.gov
 Carbohydrate Counting
 Exchange Lists
» System to classify foods into similar groups according to
protein, fat, and carbohydrate
» Seven exchange lists
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

35. Medical Nutrition Therapy for
Diabetes
 Exercise
» Although not medical therapy, it is essential to therapy
 Blood glucose monitoring
» Blood sugar or Hemoglobin A1c (HbA1c)
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

36. Brain Break
 Which method of controlling diabetes through diet may
allow the client the most freedom?
» Carbohydrate Counting
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

37. Cancer
 Malignant – life threatening
 Benign – tumor not cancerous
 Metastasis – uncontrolled growth throughout the body
 Good baseline nutritional status is important prior to
treatment
» Chemotherapy
» Radiation therapy
 Use your knowledge and skills to offer nutritious foods
that are well accepted, and take any accompanying
symptoms into account
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

38. Medical Nutrition Therapy for
Cancer
 Increased calories
» 35 – 50 Calories per kilogram of body weight
 Offer smaller amounts of food, more often
 Cater to special requests
 Offer high-calorie, high-protein foods
 Avoid foods with strong odors
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

39. Brain Break
 A client who has cancer and weighs 75 kilograms would
need how many calories?
» 2600 - 3800
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6

40. HIV/AIDS
Acquired Immunodeficiency Syndrome
 Nutritional interventions include
» Addressing malnutrition
» High protein, high calorie foods
» Supplements as appropriate
» Alteration of textures and temperatures in the event of
mouth sores
» Response to nausea, vomiting and diarrhea
Nutrition Fundamentals & Medical Nutrition Therapy  Fundamentals of Medical Nutrition Therapy for the CDM  Learning Plan 6