Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to NFMNT Chapter 6 Fundamentals of Medical Nutrition Therapy for the CDM
Similar to NFMNT Chapter 6 Fundamentals of Medical Nutrition Therapy for the CDM (20)
More from KellyGCDET
More from KellyGCDET (20)
Recently uploaded
Recently uploaded (20)
NFMNT Chapter 6 Fundamentals of Medical Nutrition Therapy for the CDM
- 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
Editor's Notes
- Behavior modification is helpful to make long-lasting lifestyle changes. Attitude modification needs to set realistic and measurable goals Social support may be found in partners who model good eating habits and/or social media. No perfect diet drug; surgery is an increasingly popular treatment for individuals who are very obese.
- While low carbohydrate dies are popular today, the Dietary Guidelines for Americans, 2010, says that dies with less than 45% carbohydrate or more than 35% protein are not any more effective that other calorie-controlled diets. URL will open in a new window.
- CAD is the top leading cause of death in the US. Sometimes LDL is referred to as bad cholesterol (higher number= higher risk), HDL is referred to as good cholesterol (higher number is better with HDL). TGs can be modified by diet changes and physical activity
- By 2018, food companies will need to reformulate products without the use of PHOs, the primary source of trans fat. Data has shown improvements in health outcomes when saturated fats are replaced with unsaturated options DGA/MyPlate is recommending that Americans consume fish at least twice a week.
- Data has shown that dietary cholesterol doesn’t impact blood cholesterol as much as previously thought. AHA has shifted a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes non-tropical vegetable oils. See the 2013 AHA/ACC guidelines for more information regarding medication and dietary. Become familiar with grocery shopping and food preparation tips to assist your clients in making better decisions regarding cholesterol in foods.
- Drug treatment is often the first response as noted by AHA/ACC report
- Another question: How would you improve this diet to make it more heart healthy- gives another point of view
- Stroke or cerebrovascular diseases are the 5th leading cause of death in the US. MNT can be effective in decreasing atherosclerosis (blockage of an artery)
- Diuretics increase urine output/decreasing fluid volume Beta blockers reduce the heart rate so that the heart puts out less blood.
- Most dietary sodium comes from processed foods. Review Figure 6.15 to see a comparison of the DASH diet guidelines to the usual US intake.
- Dietary Approaches to Stop Hypertension
- COPD is a group of diseases: Chronic bronchitis, emphysema, asthmatic bronchitis If fluid retention is a problem, dietary fluid restriction may be needed
- Terminology is important: Glycosuria – excess sugar in the urine Polyphagia – insatiable hunger Polydipsia – unquenchable thirst Polyuria – frequent urination, dehydration, weakness Diagnosis with plasma glucose criteria can be either fasting plasma glucose (FPG) or a 2 hour plasma glucose value after a 75 g oral glucose tolerance test.
- Exchange lists are used less often. Carbohydrate counting can be understood better and allows more freedom. Examples of each are in the book
- Medication therapies have a large impact