Dietary ManagementDietary Management

byby

Prof. Morsi ArabProf. Morsi Arab

Diet ManagementDiet ManagementGoals :Goals : 1- to restore glycaemic control and 1- to restore glycaemic control and optimal optimal lipid levels lipid levels 2- adequate needs for growth , pregnancy 2- adequate needs for growth , pregnancy , , lactation lactation 3- body weight management 3- body weight management 4- keep overall health 4- keep overall health

5- coordinate with individual life style 5- coordinate with individual life style

Total Caloric IntakeTotal Caloric Intake

1- Calculate needs acc. to 1- Calculate needs acc. to daily activitydaily activity . .2- and to manage 2- and to manage body weightbody weight : : ↓ ↓ or or ↑↑ to reach optimum BMI (< 25 ) to reach optimum BMI (< 25 )3- Special considerations in 3- Special considerations in growinggrowing children children --------------------------------------------------------------------------------------------------------------------------4- Caloric restriction improves 4- Caloric restriction improves glycaemic controlglycaemic control --------------------------------------------------------------------------------------------------------------------------------------

Total Caloric IntakeTotal Caloric Intake ( cont.)( cont.)

5- Total caloric content = sum of 5- Total caloric content = sum of cal/gm:cal/gm: (gm CHO x 4 ) + ( gm fat x 9) + ( gm protein x (gm CHO x 4 ) + ( gm fat x 9) + ( gm protein x 4)4)

6- Caloric distribution 6- Caloric distribution ( %) : CHO / Fat / Prot( %) : CHO / Fat / Prot ( CHO : 50-70%) / ( fat 20-25% ) / (protein 15 ( CHO : 50-70%) / ( fat 20-25% ) / (protein 15 %)%)

CHO Content CHO Content (quantity and quality)(quantity and quality)

* Total CHO ≈ 50-60 % of total * Total CHO ≈ 50-60 % of total caloriescalories - complex CHO = > 70 % - complex CHO = > 70 % - simple CHO = < 10 % - simple CHO = < 10 % * Example :* Example : If If total caloriestotal calories allowed = 1500 cal.:- allowed = 1500 cal.:- Then Then CHO contentCHO content = 1500 X 60% = 900 cal = 1500 X 60% = 900 cal..

CHO Content CHO Content (quantity and quality)(quantity and quality)

Complex CHO = 70 % x 900 = 630 cal ≈ 160 Complex CHO = 70 % x 900 = 630 cal ≈ 160 gmgm Sugars < 10 % x 900 = 90 cal ≈ 22 Sugars < 10 % x 900 = 90 cal ≈ 22 gmgm

Complex CHO :Complex CHO : with low G / l : with low G / l : grains-legumes-pasta-whole grain bread-boiled grains-legumes-pasta-whole grain bread-boiled ricerice

Simple CHO :Simple CHO : refined sugars , fruit sugars refined sugars , fruit sugars

Fat ContentFat Content

* Fat restriction : helps control displipidemia and * Fat restriction : helps control displipidemia and hyperglycemia. hyperglycemia. Control body Control body weightweight

* Total fat content : > 30% of total calories * Total fat content : > 30% of total calories - polyunsaturated ( plant oil ) 10% - polyunsaturated ( plant oil ) 10% - monounsaturated (olive oil ) 10 % - monounsaturated (olive oil ) 10 % - saturated : ( animal fat < 10%) - saturated : ( animal fat < 10%) * Essential fatty acid supplements * Essential fatty acid supplements ( soya beans, nuts, rapeseed oils) ( soya beans, nuts, rapeseed oils)* Omega 3 fat ( fish) anti athirogenic* Omega 3 fat ( fish) anti athirogenic ( 2.3 fish meals/wk or fish oil caps 0.3 g) ( 2.3 fish meals/wk or fish oil caps 0.3 g)

* Total Cholesterol (< 300 mg )* Total Cholesterol (< 300 mg )

ProteinProtein* Average * Average total proteintotal protein content: 15% of total content: 15% of total calories calories ( 12-20%) ( 12-20%) e.g. in total 2000 cal :15%= 300 cal.= 75 gm e.g. in total 2000 cal :15%= 300 cal.= 75 gm prot. prot. * Or ( 0.8-1.2 gm/kg body weight) * Or ( 0.8-1.2 gm/kg body weight)

* * AnimalAnimal and plant proteins ( essential amino and plant proteins ( essential amino acids)acids)-------------------------------------------------------------------------------------------------------------------------------------- * Protein restriction * Protein restriction in renal function in renal function impairmentimpairment * Allow for : growth , pregnancy , lactation, * Allow for : growth , pregnancy , lactation, acute acute catabolic states, wound healing catabolic states, wound healing

Fibre Fibre ( undigested parts of diet )( undigested parts of diet ) Types :Types : Soluble Soluble insolubleinsoluble

(pectins , gums ( cellulose, semi- (pectins , gums ( cellulose, semi-cellulose,cellulose, gel. , mucilage ) legnins gel. , mucilage ) legnins

↓ ↓ ↓ ↓ Effects: Effects: metabolic effect increase bulkmetabolic effect increase bulk ( CHO & lipid) ( CHO & lipid) --------------------------------------------------------------------------------------------------------------------------------------------------------Recommendation :Recommendation : - double the av. normal intake ( 13- 30 gm) - double the av. normal intake ( 13- 30 gm) - gradual increase to avoid flatulence - gradual increase to avoid flatulence - include both sol. & insoluble - include both sol. & insoluble

An Example in Diet Construction:An Example in Diet Construction:

1- if a Pt needs daily requirement = 1- if a Pt needs daily requirement = 2500 2500 caloriescalories 2- and is overweight ( BMI = 35 ) 2- and is overweight ( BMI = 35 ) Goal : to lower body weight by 1kg/ wk Goal : to lower body weight by 1kg/ wk ( 1 kg loss requires loss of 7000 calories ( 1 kg loss requires loss of 7000 calories i.e. 1000 /day X 7 ) i.e. 1000 /day X 7 ) 3- 3- subtract from his intake 1000 calories / subtract from his intake 1000 calories / day day 4- 4- daily intake : 2500 -1000 = daily intake : 2500 -1000 = 1500 calories1500 calories

An Example in Diet Construction:An Example in Diet Construction: 5- To distribute the 1500 calories :- e.g.5- To distribute the 1500 calories :- e.g. 60% CHO + 24 % fat + 16 % protein = 100 60% CHO + 24 % fat + 16 % protein = 100 %% (900 cal.) (360 cal.) (240 cal.)(900 cal.) (360 cal.) (240 cal.) ↓ ↓ ↓ ↓ ↓↓ ( 225 gm ) ( 40 gm ) ( 60 gm ) ( 225 gm ) ( 40 gm ) ( 60 gm ) CHO fat protein CHO fat protein

Standard Body Weight Control by Standard Body Weight Control by DietaryDietary RestrictionRestriction

* Goal : loose 1 Kg b. weight per week* Goal : loose 1 Kg b. weight per week * plan / calculation: * plan / calculation: 1 kg/ wk = 7000 cal. deficit /wk 1 kg/ wk = 7000 cal. deficit /wk = 1000 cal. deficit / day = 1000 cal. deficit / day

lower caloric intake by 1000 cal/day less than lower caloric intake by 1000 cal/day less than daily need e.g. : 2500-1000 = 1500 cal./ daily need e.g. : 2500-1000 = 1500 cal./ dayday

Stringent diet restriction :Stringent diet restriction : - - total cal. Intake : 400-600 cal./daytotal cal. Intake : 400-600 cal./day - only for patients with very high BMI - only for patients with very high BMI - requires hospital monitoring (electrolytes, - requires hospital monitoring (electrolytes, E.C.G., E.C.G., etc) etc) - note : provide protein content , vitamin and- note : provide protein content , vitamin and

mineral requirements mineral requirements . .

Body Weight Control by exerciseBody Weight Control by exercise

** Exercise supplements diet restrictions to control Exercise supplements diet restrictions to control body weight and → body weight and → more lasting effectmore lasting effect

* Additional value for exercise : 1- * Additional value for exercise : 1- ↓↓ hyperglycemiahyperglycemia 2- 2- ↓↓ CHD risk CHD risk factorsfactors. .

Body Weight Control by exercise Body Weight Control by exercise ( cont.)( cont.) * Calculating expenditure of energy by walking: * Calculating expenditure of energy by walking: - is related to - is related to ““body weightbody weight”” and and ““distancedistance”” ( not to speed of walking ). ( not to speed of walking ). - e.g.: a 70 kg person walking for one mile - e.g.: a 70 kg person walking for one mile spendsspends 100 cal. 100 cal. ( increases if more body weight , or walking ( increases if more body weight , or walking uphill )uphill )

Sugar Substitutes , SweetenersSugar Substitutes , Sweeteners

The Ideal :The Ideal : Sweetening power, taste, cost, Sweetening power, taste, cost, side side effects, consistency & form, heat effects, consistency & form, heat stability ,caloric content. stability ,caloric content.Types :Types : * Natural : fructose - sorbitol - manitol - * Natural : fructose - sorbitol - manitol - xylose xylose * Synthetic : saccharin - aspartame * Synthetic : saccharin - aspartame

Swt.Swt.pp

Cal/Cal/gmgm

costcostmaxmaxSide Side effectseffects

FructoseFructose

SorbitolSorbitol

ManitolManitol

1-21-2

½½

½½

44

44

44

ExpensivExpensivee..

LessLess

lessless

7575 gmgm

5050 gmgm

5050 gmgm

DiarrheaDiarrhea

Diarrhea Diarrhea DiarrheaDiarrhea

SaccharinSaccharin

AspartamAspartamee

300300

200200

00

v. lowv. lowCheapCheap

ExpensivExpensivee

1gm1gm

5050//kgkg

Most popularMost popular

Heat Heat unstableunstable

Sugar Substitutes , Sugar Substitutes , SweetenersSweeteners

Fat SubstituteFat Substitute

Alexandrie – Palais du Montazah

Thank You