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           Lecture 2 – Nutritional Assessment of the Diabetic Patient


Components of treatment of the diabe...
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                           •   Female
                           •   Weight distributed on hips
            ...
Page 3 of 5


           o Assessing risk
           o Measuring fat loss
•   Increased risk of disease:
           o Male...
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Dietary assessment methods
•   There are several methods used to assess usual dietary intake
•   Choosing th...
Page 5 of 5


                    Use standard cup or spoon measures
•   These methods:
          o Produce fewer of the ...
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Wk 04 - Diabetic patient.doc

  1. 1. Page 1 of 5 Lecture 2 – Nutritional Assessment of the Diabetic Patient Components of treatment of the diabetic patient: • Diet • Exercise • Medication What? – a systemic review of: • Medical/drug history • Family/social history • Measurements: o Lab:  BGL = blood glucose level  Cholesterol  TAGs  HbA1c – blood glucose levels over 3 months  Microalbumin – to check for kidney damage o Weight o Height o BMI o Waist circumference • Weight history o Type one – may have lost a lot of weight o If they are obese – when did they put on the weight o Body shape:  Android: • Male • Fat at the front  Gynoid: /home/pptfactory/temp/20100509001032/wk-04-diabetic-patientdoc720.doc
  2. 2. Page 2 of 5 • Female • Weight distributed on hips o Check for muscle wasting • Physical activity level • Dietary intake • Android body shape: o Central fat distribution o Thin arms and legs Body mass index Weight (kg) BMI = ------------------ [Height (m)]2 <20 Underweight (thin) 20 –24.9 Normal (healthy weight) 25-29.9 Grade 1 – overweight (moderate) 30.39.9 Grade 2 – overweight (obesity) >40 Grade 3 – overweight (morbid) • These calculations are for caucasians: o Asians – should be lower boundaries for healthy o Togans – should be higher • 60% of Australian adults are overweight or obese • BMI – gives information about mortality: o Low – digestive and pulmonary disease o High – cardiovascular Waist circumference • Measured at the level of the navel • Useful for: /home/pptfactory/temp/20100509001032/wk-04-diabetic-patientdoc720.doc
  3. 3. Page 3 of 5 o Assessing risk o Measuring fat loss • Increased risk of disease: o Male - >102cm (100) o Female - >92cm (90) How? Information may be collected over several visits • Social history (to establish background): o Job/living situation o Social support o Emotional problems o Financial problems – important for medication and diet • Dieting/weight history: To establish the patient’s viewpoint o When weight was gained / lost:  After childbirth  Since childhood – suggests strong genetic influence o What was done about it (if anything) o What were the results (short and long term) o Highest/lowest adult weight o Family weight and chronic disease history  Establish any genetic influence • Physical activity: To establish interest and motivation o Type of exercise o How often, how long spent o Document barriers to exercise  Eg arthritis, blindness o Be aware of over-reporting /home/pptfactory/temp/20100509001032/wk-04-diabetic-patientdoc720.doc
  4. 4. Page 4 of 5 Dietary assessment methods • There are several methods used to assess usual dietary intake • Choosing the best method depends on: o The purpose of the assessment o The accuracy required o Co-operation of the subject o The time available Retrospective • Include: o Diet history o 24 hr recall o Food frequency  Good to use in conjunction with another method to cross check information • Generally, these methods: o Can result in errors in:  quantity – hard to remember  food type  memory recall o Are less time consuming o Don’t affect the patient’s habitual intake – doesn’t stop them from eating as they normally would, but beware that they may not tell the truth Prospective • Used most often: o Research o Demented patients • Full record of dietary intake: o Weighted  Weigh every piece of food, and the leftovers o Non-weighted /home/pptfactory/temp/20100509001032/wk-04-diabetic-patientdoc720.doc
  5. 5. Page 5 of 5  Use standard cup or spoon measures • These methods: o Produce fewer of the first 3 errors o May affect usual intake o Require much greater subject commitment Information about patient – dietary assessment • To establish usual eating habits • Quick method – 24 hour recall • This may require careful prompting • Be aware of under or over-reporting of foods and drinks • Food frequency questions • Check alcohol intake Useful nutritional websites • The Australian dietary guidelines and recommended daily intake tables: www.nhmrc.health.gov.au • Public health implementation group: The Strategic Inter-governmental Nutrition Alliance (SIGNAL) www.dhs.vic.gov.au/nphp/signal • Australian guide to healthy eating: Available from the Federal Department of Health and Family Services (DOH&FS) www.health.gov.au/pubhlth/food/guide /home/pptfactory/temp/20100509001032/wk-04-diabetic-patientdoc720.doc

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