2. DIET MANAGEMENT
Goals:
1- to restore glycemic control and optimal
lipid levels
2- adequate needs for growth , pregnancy,
lactation
3- body weight management
4- keep overall health
5- coordinate with individual life style
3. UTILIZATION OF NUTRIENTS
Digestion- breakdown of ingested food into smaller
constituent units that can be absorbed
1. Mechanical breakdown and Peristalsis
2. Chemical breakdown
Absorption: taking in nutrients from GIT by the
body
1. Most absorption occurs in the small intestine
2. Water, salts and some vitamins are absorbed in
large intestine
5. Measuring Food Energy
•Calorie- the amount of heat produced during
metabolism
•Most people use an average of 3,500 calories/day
•To lose wt. a person must take in fewer calories
then are burned
•To gain weight, a person must take in more
calories than the body uses.
6. Caloric Intake
1. Calculate needs according to daily activity,
2. Decrease intake to manage body weight :
3. Increase intake to reach optimum BMI
4. Special considerations in growing children
5. Caloric restriction improves glycaemic control
Total caloric content = sum of calories/gram:
Carbohydrate and proteins provide 4 calories per
gram;
fat has 9 calories per gram
7. Total CHO content : 50-70% of total calories
Total protein content: 15 % of total calories
Total fat content: 20-25% of total calories
- polyunsaturated ( plant oil ) 10%
- monounsaturated (olive oil ) 10 %
- saturated : ( animal fat) <10%
Essential fatty acid supplements: soya beans, nuts,
Omega 3 fat (fish oil) prevents cardiac disease (2-3 fish
meals/week or fish oil caps 0.3 g)
CALORIC DISTRIBUTION ( %)
8. Fat restriction: helps control hyperglycemia;
Hypercholesteraemia; body weight
Protein restriction: In renal function impairment.
However, allow adequate intake for growth,
pregnancy, lactation, acute catabolic states, wound
healing
Fibre Recommendation: double the average
normal intake ( 13- 30 gm). Include both soluble
(cellulose, semi-cellulose) & insoluble (gums,
pectins, gel, mucilage). Increase should be gradual
to avoid flatulence
9. An Example in Diet Construction:
If a Patient needs daily requirement of 2500
calories and is overweight ( BMI = 35)
Goal: to lower body weight by 1kg/week
( 1 kg loss requires loss of 7000 calories
i.e. 1000 /day X 7 )
subtract from his intake 1000 calories / day
daily intake : 2500 -1000 = 1500 calories
10. An Example in Diet Construction:
To distribute the 1500 calories. Remember caloric
content should be
60% CHO + 24 % fat + 16 % protein = 100 %
(900 cal.) (360 cal.) (240 cal.)
↓ ↓ ↓
( 225 gm ) ( 40 gm ) ( 60 gm )
CHO fat protein
11. Standard Body Weight Control by Dietary
Restriction
* Goal: loose 1 Kg body weight per week
* plan / calculation:
1 kg/ wk = 7000 cal. deficit /week
= 1000 cal. deficit / day
lower caloric intake by 1000 cal/day less than
daily need e.g. : 2500-1000 = 1500 cal./ day
12. Stringent diet restriction:
Recommended only for patients with very high
BMI. total cal.
Intake should be 400-600 cal./day
Requires hospital monitoring (electrolytes, E.C.G.,
etc)
Note : Provide protein, vitamin and minerals
13. Body Weight Control by exercise
* Exercise supplements diet restrictions to control
body weight and has a more lasting effect
* Additional value for exercise :
1- ↓s hyperglycemia
2- ↓s CHD risk factors .
14. Body Weight Control by exercise ( cont.)
* Calculating expenditure of energy by walking:
- is related to “body weight” and “distance”
( not to speed of walking ).
- e.g.: a 70 kg person walking for one mile
spends 100 cal.
( increases if more body weight , or walking
uphill )
