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Medical Nutrition Therapy
  Rosa Matonti, RN, MSN, CNS, CDE
        Hospital Sacre Cœur
            Milot, Haiti
         January 13, 2011




                                    1
Objectives
At the end of the presentation the participant
will be able to:
•  Describe the effectiveness of Medical Nutrition
   Therapy in controlling complications associated
   with diabetes.
•  Define the portion sizes associated with 15
   grams of carbohydrate.
•  Describe the plate method.
•  Define the various foods in the Haitian diet that
   are carbohydrates.                                  2
Medical Nutrition Therapy (MNT)
   An integral component of diabetes:

      •  revention
       P

      •  anagement
       M

      •  elf management education
       S

      •  verall healthy lifestyle
       O



                                        3
Effectiveness of MNT for Diabetes
   •  lycemic control
    G

   •  ipids
    L

   •  ypertension
    H




                                    4
Glycemic Control
•  0.25-2.9% decrease in HgA1C in type 2
   diabetes
•  1% decrease in HgA1C in type 1 diabetes
•  50-100 mg/dl decrease in fasting plasma
   glucose



                                             5
Lipid Management
•  10-13% decrease in total cholesterol
   (24-32 mg/dl)
•  16% decrease in LDL cholesterol (15-25
   mg/dl)
•  8% decrease in triglycerides (15-17 mg/dl)
•  With exercise, HDL cholesterol decreases
   by 7% (3 mg/dl)
  – Without exercise, no decrease noted
                                                6
Hypertension
•  Lowering sodium in diet to 2,400 mg
•  Modest weight loss of 5-7% of starting
   weight
•  5-mmHg decrease in systolic blood
   pressure
•  2-mmHg decrease in diastolic blood
   pressure
                                            7
Macronutrients
•  % of carbohydrates based on pre & post
   blood sugars
•  Carbohydrates
•  Protein
•  Fat
•  Fiber

                                            8
Carbohydrates (CHO)
•  Come from:
  – Whole grains, fruits, vegetables, legumes and
    low fat milk
  – Restricting carbs to <130 mg/day not
    recommended
  – CHO and monosaturated fats together should
    provide 60-70% of energy intake
  – Total amount of carbohydrates ingested is the
    primary determinant of post prandial response
    •  Type of carb does affect response        9
Fiber Intake & Glycemia
•  Daily Recommended Intake: 14 grams/1000
   kcal
•  Diets with 44-50 grams of fiber reported to
   improve glycemia




                                            10
Fiber Intake & Cholesterol
•  25-30 grams of total fiber per day with
   7-13 grams of soluble fiber can decrease
  – Total cholesterol by 2-3%
  – LDL cholesterol up to 7%




                                              11
Nutritional Needs of Hospitalized
              Patient
•  25-35 kcal/kg body weight
•  Protein needs for patients with
   nephropathy are < 1.0 gm/kg body weight
•  Protein (15-20% of energy intake)
  – Mildly stressed 1.0 gm/kg body weight
  – Moderately-severly stressed 1.5 gm/kg body
    weight

                                                 12
Carbohydrate Consistent Diet
•  Foods that contain carbohydrate, starch,
   fruit and milk
•  4 CHO (60 gms) choices served at each
   meal (180 gms/day)
•  Minimum of 3 CHO with each meal (135
   gms/day)
•  If using NPH may need bedtime snack
                                              13
Plate Method




               14
Serving Size of CHO
•  ½ cup the size of a ladle or cooking spoon
•  exception is rice 1/3 cup
•  1 piece the size of a tennis ball
•  If purchasing something in a box read the
   label
•  A snack should not be over 15-20 grams
   of carbohydrate
                                                15
Reading a Food Label




                       16
Balance Your Plate


                        ¼ with a starch:
                        sweet potatoe,
     ½ non starchy       pumpkin, rice
       vegetable:
  spinach, watercress,
     okra, cabbage     ¼ with lean meat,
                        fish or poultry;
                        chicken, lamb,
                           fish, pork
                                           17
Haitian Meals       What are the
                carbohydrates here?




                                 18
Haitian Meals




                19
Thank you




            20
Questions




            21

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Nutrition Presentation - Diabetes Symposium - Haiti

  • 1. Medical Nutrition Therapy Rosa Matonti, RN, MSN, CNS, CDE Hospital Sacre Cœur Milot, Haiti January 13, 2011 1
  • 2. Objectives At the end of the presentation the participant will be able to: •  Describe the effectiveness of Medical Nutrition Therapy in controlling complications associated with diabetes. •  Define the portion sizes associated with 15 grams of carbohydrate. •  Describe the plate method. •  Define the various foods in the Haitian diet that are carbohydrates. 2
  • 3. Medical Nutrition Therapy (MNT) An integral component of diabetes: •  revention P •  anagement M •  elf management education S •  verall healthy lifestyle O 3
  • 4. Effectiveness of MNT for Diabetes •  lycemic control G •  ipids L •  ypertension H 4
  • 5. Glycemic Control •  0.25-2.9% decrease in HgA1C in type 2 diabetes •  1% decrease in HgA1C in type 1 diabetes •  50-100 mg/dl decrease in fasting plasma glucose 5
  • 6. Lipid Management •  10-13% decrease in total cholesterol (24-32 mg/dl) •  16% decrease in LDL cholesterol (15-25 mg/dl) •  8% decrease in triglycerides (15-17 mg/dl) •  With exercise, HDL cholesterol decreases by 7% (3 mg/dl) – Without exercise, no decrease noted 6
  • 7. Hypertension •  Lowering sodium in diet to 2,400 mg •  Modest weight loss of 5-7% of starting weight •  5-mmHg decrease in systolic blood pressure •  2-mmHg decrease in diastolic blood pressure 7
  • 8. Macronutrients •  % of carbohydrates based on pre & post blood sugars •  Carbohydrates •  Protein •  Fat •  Fiber 8
  • 9. Carbohydrates (CHO) •  Come from: – Whole grains, fruits, vegetables, legumes and low fat milk – Restricting carbs to <130 mg/day not recommended – CHO and monosaturated fats together should provide 60-70% of energy intake – Total amount of carbohydrates ingested is the primary determinant of post prandial response •  Type of carb does affect response 9
  • 10. Fiber Intake & Glycemia •  Daily Recommended Intake: 14 grams/1000 kcal •  Diets with 44-50 grams of fiber reported to improve glycemia 10
  • 11. Fiber Intake & Cholesterol •  25-30 grams of total fiber per day with 7-13 grams of soluble fiber can decrease – Total cholesterol by 2-3% – LDL cholesterol up to 7% 11
  • 12. Nutritional Needs of Hospitalized Patient •  25-35 kcal/kg body weight •  Protein needs for patients with nephropathy are < 1.0 gm/kg body weight •  Protein (15-20% of energy intake) – Mildly stressed 1.0 gm/kg body weight – Moderately-severly stressed 1.5 gm/kg body weight 12
  • 13. Carbohydrate Consistent Diet •  Foods that contain carbohydrate, starch, fruit and milk •  4 CHO (60 gms) choices served at each meal (180 gms/day) •  Minimum of 3 CHO with each meal (135 gms/day) •  If using NPH may need bedtime snack 13
  • 15. Serving Size of CHO •  ½ cup the size of a ladle or cooking spoon •  exception is rice 1/3 cup •  1 piece the size of a tennis ball •  If purchasing something in a box read the label •  A snack should not be over 15-20 grams of carbohydrate 15
  • 16. Reading a Food Label 16
  • 17. Balance Your Plate ¼ with a starch: sweet potatoe, ½ non starchy pumpkin, rice vegetable: spinach, watercress, okra, cabbage ¼ with lean meat, fish or poultry; chicken, lamb, fish, pork 17
  • 18. Haitian Meals What are the carbohydrates here? 18
  • 20. Thank you 20
  • 21. Questions 21