Lec 2 estimated energy requirement among diabetic patients

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Lec 2 estimated energy requirement among diabetic patients

  1. 1. Postgraduate Diploma in Diabetes Education (PDDE Nutrition therapy: Dietary advice in case of complications 2-Estimated Energy Requirements among Diabetic Patients Dr. Siham Mohamed Osman Gritly
  2. 2. A health food with low Calories Dr. Siham Mohamed Osman Gritly the calorie content of the diet for all diabetics should be set at a level which will permit them to maintain their desired body weight and in children and adolescents allow for a normal rate of growth and
  3. 3. Calorie Requirement Based on Weight/age Category Calorie requirement Over weight 20 Kcals/Kg/day Ideal weight 30 Kcals/Kg/day Under weight 40 Kcals/Kg/day Elderly person above 50 years 10% less calories for each additional decade Children - Ist year 1000 calories For girls 1 – 12 years 1000 + 100 calories per year of age up to 12 years For boys 1 – 12 years 1000 + 125 calories per year of age after 12 years Dr. Siham Mohamed Osman Gritly
  4. 4. Guide to calorie allocation (calories/kg body weight) * Adapted from Meal Planning: American Dietetic Association 1997 BMI Inactive Moderately active Very active Overweight 20 20 - 25 30 Normal weight 20 25 35 – 40 Underweight 40 - 50 Dr. Siham Mohamed Osman Gritly
  5. 5. Carbohydrates and Diabetes Mellitus • The present recommendation is to provide complex carbohydrates and fiber and restricted fat. • Carbohydrates should provide 50 – 60 per cent of energy • Complex carbohydrates should account for approximately 2/3 of total carbohydrate. • 60 – 70% should be complex carbohydrate • 30 – 40% should be simple carbohydrate • adults with diabetes should eat no more than 200 grams per day Dr. Siham Mohamed Osman Gritly
  6. 6. Complex carbohydrates are composed of glucose monomers in long, complex chains Dr. Siham Mohamed Osman Gritly Advantages of complex carbohydrates Stimulates glucose use (glycolysis and glycogenesis) in many tissues. Increases tissue insulin sensitivity. Increases insulin receptor number.
  7. 7. Simple carbohydrates from commonly used food tend to raise blood glucose more than complex carbohydrates from starchy foods. • Simple carbohydrates are sugars found naturally in food. They can also be added to food. They include: • Candy • Fruit • Milk • Sugar-sweetened products • Table sugar • Vegetables • Fiber High fiber intake improves glycemic control and reduces insulin requirements Dr. Siham Mohamed Osman Gritly
  8. 8. The glycaemic index (GI) represents a ranking system relative to the effect that consumption of 50 grams of particular carbohydrates that influence blood glucose within 2 hours. • glycemic index; Carbohydrates which produce a large increase in blood glucose concentration, in response to a standard amount of carbohydrate (50g), are classified as having a high glycemic index • The carbohydrate in watermelon or grapes, for example, both have a high GI (food which have refined sugars). Foods high in fiber such as beans have low GI Dr. Siham Mohamed Osman Gritly
  9. 9. Glycemic Index values A glycemic index GI value tells only how rapidly a particular carbohydrate turns into sugar • The values that used to rank glycemic index of food as follows;- *70 or more------high GI *69-55------------medium GI foods *55 or less--------low GI foods Factors other than CHO might influence the GI;- *physical form (coarse or fine) *serving mode (raw or cooked) Dr. Siham Mohamed Osman Gritly
  10. 10. • Foods with low glycemic indexes include; • oats, barley, beans, lentils, legumes, pasta, bread, apples, oranges, milk, yogurt, and ice cream. • Fiber, fructose, lactose, and fat are dietary constituents that tend to lower glycemic response. Dr. Siham Mohamed Osman Gritly
  11. 11. Glycemic load (GL) • The glycemic load represents a ranking system relative to the effect that eating a carbohydrates food has on the blood glucose level, but also includes the portion size • The glycemic load (GL) is a relatively new way to assess the impact of carbohydrate consumption that takes the glycemic index into account, • glycemic load gives a fuller picture than does glycemic index alone Dr. Siham Mohamed Osman Gritly
  12. 12. Glycemic index and glycemic load • glycemic index is the rate at which food is converted into glucose, glycemic load is the total amount (load) of glucose provided by the food. Glycemic index is an absolute value • while glycemic load depends on the serving size of the food. Glycemic load values are always quoted in reference to a serving size in grams. Dr. Siham Mohamed Osman Gritly
  13. 13. Glycemic load values • Values are used to rank the glycemic load food;- *20 or more----high GL *19-11----------medium GL food *10 or less------low GL foods Foods that have a low GL almost always have a low GI is more healthful source of CHO. Dr. Siham Mohamed Osman Gritly
  14. 14. The glycemic load of a food is calculated by multiplying the absolute GI value by the grams of available carbohydrate in the serving, and then dividing by 100. • The glycemic load can be calculated by the following equation;- • GL= GI gms of CHO in one serving 100 • Note that Available Carbs is equal to the total carbohydrate content minus the fiber content. • For example, a 225 g (1 cup) serving of Bananas with a GI of 52 and a carbohydrate content of 45.5 g (51.4 g total carbohydrate - 5.9 g fiber) makes the calculation GL = 52 * 45.5 / 100 = 24, so the GL is 24. • Adapted from; www.glycemicgourmet.com/how-calculate-glycemic-index.htmlDr. Siham Mohamed Osman Gritly
  15. 15. Exercise;- calculate the Glycemic Load of the following carbohydrates;- adapted from; Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. COH Glycemic index CHO in grams Gycemic loadL 1-baked potato 1 cup 85 57 ? 2-white bread 1 slice;- 70 10 ? 3-orange 1 medium 44 15 ? 4-fructose 1 tsp 23 5 ? 5-wafers (5 cookies) 77 15 ? Dr. Siham Mohamed Osman Gritly
  16. 16. Hormones that responsible for carbohydrate regulation; Response of hypothalamus to blood glucose level Dr. Siham Mohamed Osman Gritly If the sugar levels in the blood fall far below their usual range, the brain (hypothalamus) responds by stimulating; *the adrenal glands to release, 1- adrenaline or norepinephrine, 2-epinephrine and 3-cortisol, *-the pancreas to release glucagon and insulin, Insulin is a hormone produced in special cells in the pancreases which enables body cells to absorb glucose, for energy production, glucagon increase the rate of gluconeogenesis in the liver and help to increase blood glucose levels *- the pituitary gland to release growth hormone, all of which cause the liver to regulate glucose into the blood.
  17. 17. The pancreas insulin and glucagon from the pancreas Dr. Siham Mohamed Osman Gritly Glucose + Insulin  Inside Cells insulin: a hormone secreted by special cells in the pancreas in response to increased blood glucose concentration.
  18. 18. Dr. Siham Mohamed Osman Gritly The primary role of insulin is to control the transport of glucose from the bloodstream into the muscle and fat cells Insulin promotors Tissue glycolysis Fatty acid synthesis Intracellular deposition of glucose through stimulation of glycogen synthesis. Insulin accelerates hepatic glycolysis by increasing levels of the enzymes glucokinase
  19. 19. glucagon increase the rate of gluconeogenesis in the liver and help to increase blood glucose levels Dr. Siham Mohamed Osman Gritly glucagon: a hormone that is secreted by special cells in the pancreas in response to low blood glucose concentration and elicits release of glucose from liver glycogen stores
  20. 20. The Pituitary gland human growth hormone from pituitary gland Dr. Siham Mohamed Osman Gritly *- the pituitary gland to release growth hormone, all of which cause the liver to regulate glucose into the blood
  21. 21. The Adrenal Gland adrenalin, epinephrine and cortisol from the adrenal glands Dr. Siham Mohamed Osman Gritly the adrenal glands to release, 1-adrenalin or norepinephrine, is released in greater amounts during physical activity increased energy in the form of glucose and free fatty acids 2-Epinephrine stimulate the liver to release glucose and accelerates the use of glycogen in the muscle 3-cortisol, release of amino acids from muscle tissue to provide substrate to liver for gluconeogenesis
  22. 22. Protein • Minimum Daily Protein Requirement: W.H.O. recommends 0.45 grams of protein per kilogram of ideal body weight per day. • Maximum Daily Protein Requirement: US RDA recommends 0.8 grams of protein per kilogram of ideal body weight per day. Dr. Siham Mohamed Osman Gritly
  23. 23. Protein and Diabetes Mellitus • Protein should provide 12 – 20% of energy intake • An additional 30 g may be necessary during pregnancy and lactation • Protein requirement is increased in malnutrition, surgery or wound healing. • In insulin dependent diabetics adequate dietary protein (1 – 1.5g/kg body weight) is necessary for growth and development. • In diabetic nephropathy, protein restriction may vary between 0.4 – 0.6 g per kilogram • The source of protein is as important as amount. • Protein from vegetable source is preferable to that from animal sources Dr. Siham Mohamed Osman Gritly
  24. 24. Fat and Diabetes Mellitus • The amount and type of fat plays an important role in the diet of a diabetics. • Diabetes of all types have a greater incidence of hyperlipidemia and atherosclerosis Dr. Siham Mohamed Osman Gritly
  25. 25. • The present recommendation of total fat is • 20 – 30% of total calories. • Saturated, monosaturated and polyunsaturated fatty acids are given in the ratio of 1 : 1 : 1 • Saturated fats – less than 10% • polyunsaturated fats – 6 – 8% • Dietary cholesterol should be less than 300 mgs/day Dr. Siham Mohamed Osman Gritly
  26. 26. energy requirements; Estimate energy requirement from different nutrients for diabetic patient • total food energy • carbohydrate intakes should contribute 50 – 60 per cent of the total energy, • Energy from Fat 20 – 30% of total calories • Energy from Protein contributes to about 12 – 20% of energy intake Dr. Siham Mohamed Osman Gritly
  27. 27. Calculate food energy from different nutrients for diabetic small woman who exercises; • example of energy requirement for diabetic small woman who exercises is about 1200 – 1600 • calculate the requirements in terms of; • CHO, • protein • and fats • The energy yield per gram is as follows: • Carbohydrate - 4 Calories, • Fats - 9 Calories • Protein - 4 Calories. Dr. Siham Mohamed Osman Gritly
  28. 28. Estimated total calories intake from Carbohydrate • Carbohydrate; 50 – 60 % calories • 60% of 1600 = 960 Calories • at 4 Calories/gram = 240 4= about grams • If use minimal requirement; • 50%of 1600=800 calories • At 4 calories/gram=800 4= 200 gram Dr. Siham Mohamed Osman Gritly
  29. 29. Estimated total calories from fat • 20 – 30% of total calories from fat, • 30% of 1600 calories= 480 calories from fats • at 9 Calories/gram= 480 9= about 53 grams of fats/day Dr. Siham Mohamed Osman Gritly
  30. 30. Estimated energy intake from protein • 12 – 20% of energy intake from protein • 20% of 1600= 320 Calories from protein • At 4 Calories/gram= 320 4= 80 grams/day Dr. Siham Mohamed Osman Gritly
  31. 31. Unites for energy expenditure 1 kilojoule (kJ) = 1,000 joules 1 megajoule (MJ) = 1,000,000 joules 1 kilocalorie (kcal)= 1,000 calories or 1 Calorie (Cal) 1 kcal = 4.184 kJ 1 MJ= 239 kcal Dr. Siham Mohamed Osman Gritly
  32. 32. References • American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61 • Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human Metabolism, fifth ed. WADSWORTH • Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill • • Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and Ross A. Catharine eds. 9th edition • Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B. Company • FAO/WHO/UNU expert consultation (WHO, 1985) report • Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning Dr. Siham Mohamed Osman Gritly
  33. 33. • Name five foods which have low glycemic index ? • Mention five foods which can be consumed in unlimited amounts by a diabetic ? Dr. Siham Mohamed Osman Gritly

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