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  1. 1. Course: Nutrition and Funtional Food Lecturer: Dr Phan The Dong Group 2: Truong Kim Ngan Dang Thanh Truc John C. Sanford Nguyen Q Hai Yen
  2. 2. Contents • How insulin and diabetes works? • Type II diabetes ▫ Obese are at risk. Why? ▫ Treating by nutritional management • Gestational diabetes ▫ Characteristics ▫ Treating by nutritional management
  3. 3. When you eat, your body breaks down food into glucose An overview of metabolism
  4. 4. Overview of insulin • In pancreatic islets ▫ α-cells -> glucagon ▫ β-cells -> insulin
  5. 5. Roles of insulin • Stimulate glucose uptake by all cells • Liver and muscle cells ▫ Glucose glycogen ▫ Amino acids protein ▫ Prevent gluconeogenesis • Fat cells ▫ Fatty acid + glycerol fats • As such action, insulin stores nutrients right after a meal by reducing [glucose], [fatty acids] and [amino acids] in the bloodstream.
  6. 6. How insuline works?
  7. 7. What is diabetes mellitus? • A group of metabolic disease ▫ Disorder of carbohydrate metabolism • Characteristic: ▫ Inadequate production or utilization of insulin • Result: ▫ Excessive glucose in blood and urine (hyperglycemia) ▫ Diabetes mellitus = “sweet urine”
  8. 8. Symtomps polydipsia polyuria polyphagia
  9. 9. The lack of insulin or insulin resistance acts on many organs to produce a variety of effects
  10. 10. The high blood glucose in diabetes produces glucose in the urine and frequent urination through effects on the kidneys.
  11. 11. Serious long-term effect
  12. 12. Classification Type I Type II Gestational diabetes β-cells are damaged - Body fails to produce insulin Dysfunctional β-cells - Cells fail to use insulin (insulin resistant) - Insulin may be normal, elevated or depressed Same as type II - Insulin is blocked by hormones produced during prenancy Children, teens, young adults Gene related Mostly >40 yrs Some medicines and other sicknesses can cause diabete Risk factors: sedentary lifestyle, obesity, family history, aging… Pregnant women, around 24th week Go away after the baby is born
  13. 13. Diagnosis 3 common tests • Glycosylated hemoglobin (HbA1c) ▫ Detect type II ▫ The test measures % HbA1c in your blood ▫ This number corresponds to your average blood glucose level for the previous 3 months Diabetes HbA1c 4% - 5.6% Pre-diabetes 5.7% - 6.4% Noemal 6.5%
  14. 14. Diagnosis 3 common tests • Fasting plasma glucose (FPG) ▫ The test measures blood glucose in a person, who has fasted for at least 8 hours ▫ Often given in the morning.
  15. 15. Diagnosis 3 common testS • Oral glucose tolerance test (OGTT) ▫ Gestational diabetes Drink 75g glucose dissolved in water Diabetes > 200mg/dl Pre-diabetes 140 -200 Noemal < 140
  16. 16. • Next, we will focus on 2 kinds of diabetes related to nutrition ▫ Type II diabetes ▫ Gestational diabetes
  17. 17. Type II diabetes Type II Dysfunctional β-cells - Cells fail to use insulin (insulin resistant) - Insulin may be normal, elevated or depressed
  18. 18. • Most common Type II diabetes
  19. 19. Obesity • Definition ▫ Excessive fat accumulation in the body, to an extent that it increases risk of ill health, especially if fat stores in abdominal region • Measurement ▫ BMI (kg/m2): percentage of body fat correlates with mortality and morbidity ▫ Waist circumference: > 102 cm (men), 88 cm (women) Obese Severely obese Morbidly obese
  20. 20. • Epidemiological evidences: • Strong associations between type II diabete and obesity (overall obesity, central adiposity) • Men BMI > 35, 77 times greater to have diabetes (U.S. study) • 64% of new diabetes cases in women and 77% in men could be prevented if BMI < 25 • Population data shows strong correlation between central adiposity (waist:hip ratio) and glucose intolerance • Higher prevalence of diabetes found in populations exposed to the westernization of their lifestyle Obese at risk for type II diabetes
  21. 21. 3 main reasons • Fetal origins ▫ Malnutrition during pregnancy permanent impairment ▫ Low birth weight chronic adult diseases, such as diabetes ▫ Low birth weight from obese women Why are obese at risk of diabetes?
  22. 22. 3 main reasons • Visceral Obesity and Insulin Resistance ▫ Hyperinsulinemia = too much insulin in blood ▫ Hyperinsulinemia in obesity (e.g visceral adiposity, abdominal adiposity…), may lead to insulin resistant ▫ Future type II diabete Why are obese at risk of diabetes? Fat distribution in visceral obesity Central adiposity
  23. 23. 3 main reasons • Metabolic alterations in obesity that relate to diabetes ▫ Defects in Intracellular Glucose Transporters (GLUT 4) ▫ Less suppression of fat mobilization by insulin in visceral fat ▫ Reduction of hepatic insulin clearance, leading to hyperinsulinemia ▫ Dysfunction in endothelium of blood vessels ▫ Overproduction of specific adipocytes, blocking insulin’s effect Why are obese at risk of diabetes?
  24. 24. Treatment • Intermediate goal: control blood glucose • Long-term goal: ▫ Alleviate symptoms ▫ Prevent progression ▫ Prevent complication ▫ Improve quality of life There is no cure for diabetes • Treatment: nutrition management, exercise, healthy lifestyle and medication
  25. 25. How to manage diabetes? Monitoring blood glucose Taking medication Following a meal plan Getting regular exercise
  26. 26. Nutritional therapy for type II • Principles ▫ High in nutrients ▫ Low in fat and carb ▫ Moderate in calorie • Goal ▫ Control glycemic ▫ Maintain body weight  Avoid weight loss  Reduce energy for obese ▫ Normal growth and development
  27. 27. Nutritional therapy for type II
  28. 28. Nutritional recommendation Carb > 55% Sugar < 10% Fiber - Soluble fiber 20-35g/day 10-25g/day Fat - Saturated, hydrogenated, trans fat - Cholesterol - PUFA < 30% < 10% < 300mg 10% Protein 10-20% Alcohol For 5% ethanol – 1.5 glasses per day • Same as for general population ▫ Salt < 6g/day
  29. 29. Nutritional recommendation Carbohydrates Eat starchy food regularly More fruits and vegetables • Choose high-fiber food ▫ Maintain blood glucose and cholesterol level ▫ Healthy gut
  30. 30. Nutritional recommendation Carbohydrates Green leafy vegetables: phytochemical, chromium, magnesium Especially intensive color
  31. 31. Nutritional recommendation Carbohydrates • Glycemic index
  32. 32. Nutritional recommendation Carbohydrates Cut down sugary food (not a sugar-free diet) Diet drink Artificial sweeteners
  33. 33. Nutritional recommendation Fats • Goal ▫ Lower total blood cholesterol ▫ Increase HDL ▫ Lower LDL and triglycerides ▫ Lower blood presure by: Reduce animal and saturated fat Cut down salt Limit alcohol Food rich in potassium
  34. 34. Nutritional recommendation Fats Reduce animal and saturated fat Less fat in cooking Use low-fat dairy products instead
  35. 35. Nutritional recommendation Fats Essential fatty acid
  36. 36. How to estimate the amount of food?
  37. 37. Each meal should contain: Carbohydrates (grains and starches): Choose an amount the size of your 2 fists. For fruit, use 1 fist Protein: choose an amount the size of the palm of your hand and the thickness of your little finger
  38. 38. Each meal should contain: Vegetables: choose as much as you can hold in both hands. Choose low-carb vegetables (e.g, green or yellow beans, broccoli, lecttuce) Fat: limit to an amount of the size of the tip of your thumb
  39. 39. Gestational diabetes Gestational diabetes Same as type II - Insulin is blocked by hormones produced during prenancy Pregnant women, around 24th week Go away after the baby is born Fetus makes more insulin to handle the extra glucose Extra glucose gets stored as fat Fetus becomes larger than normal
  40. 40. Will GDM hurt the baby? • Most women with GDM give birth to healthy babies • However, some complication may affect the baby if mother not control blood glucose
  41. 41. Complication of gestational diabetes • Fetal risks ▫ Excessive birth weight ▫ Jaundice: baby with yellow skin ▫ Hypoglycemia  Their own insulin production is high as mother gave them lots of glucose ▫ Higher risk of type II diabetes later in life  Breadfeeding may lower the risk
  42. 42. Complication of gestational diabetes • Maternal risks ▫ Preterm labor ▫ C-section ▫ High blood pressure ▫ Type II diabete later in life C-section
  43. 43. Who are at risk of gestational diabetes? ▫ Women > 25 yrs ▫ Overweight BMI > 25 kg/m2 ▫ Family history of diabetes ▫ High risk ethnic group: Hispanic, African American, Native American ▫ Who had a past stillbirth or a very large baby (over 4kg)
  44. 44. Treatment Control glycemic: • Nutritional management • Physical activity • If BG do not fall to normal after 2 weeks, insulin injection Fasting glucose level < 95 mg/ml One hour after eating < 140 Two hours after eating < 120
  45. 45. Medical nutritional therapy for GD • Goal ▫ Optimal nutrition for pregnancy ▫ Maintain normal weight gain, control blood glucose, and avoid ketosis  Ketosis: when consume little or no carbohydrates, so energy is obtained from break down of protein
  46. 46. Medical nutritional therapy for GD • Nutrition management similar to Type II ▫ However, diet tends to be slightly lower in carb and higher in protein and fat (30-40%) ▫ Divide carb (> 175g) into 3 meals and 2-4 snacks ▫ Evening snack is important to prevent ketosis overnight • Requires individualized approach
  47. 47. Medical nutritional therapy for GD
  48. 48. A very-short summary ▫ Type II diabetes ▫ Gestational diabetes • Obese have highest risk of type II diabetes • Use nutritional therapy to treat type II and gestational diabetes The end. Thank you for listening