Nutrition

Dr Firdous JahanConsultant Family Physician

Department of Family MedicineAga Khan University

You are What you Eat

Nutrition is the study of how our body uses the food we eat to maintain our health.

“It’s good to Eat When You are Hungry”

Hunger is a physiological need for food.

Appetite is the psychological desire for food

Diet

A diet is a pattern of eating that includes what a person eats, how much a person eats, and when a person eats

Effective counseling

Good communication skills

Trust

Suitable environment

Knowledge

Patients’ involvement & willingness

Communication Skills for Counseling

Motivation

Practical, realistic & specific

Constrains

Small steps

Reinforcement

Use support material

Problem solving

Motivates behavior change (driven by an inner need

Addresses the constrains (resources, cultural, social, financial)

Practical and specific solution ,/alternative

Encourage the active involvement of patients in problem solving

Identify and include key person involved in decision making

Environment

Privacy

Comfort & Quite

Confidential

WHY WE EAT ?

WHY WE EAT ?

Maintain/Restore physiological function

Get energy

Survival

Prevent deficiency diseases

Health promotion

To meet the requirement in pregnancy lactation, puberty, growth spurt, old age

Eating Habits

Eating Depends on

Taste

Habit

Environment

Available and convenient

Affordable

Social/Cultural/emotional

Religious

Eating is a behavior that is established early in life and is not easily changed

Obesity

Obesity is a condition characterized by a large percentage of body fat

High cholesterolHigh Blood PressureHeart diseaseDiabetesStrokeCancer (certain forms)

Leading Causes of Death

Top 6 leading causes of death all associated with obesity

• Heart Disease• Cancer• Stroke• Chronic lower respiratory diseases• Diabetes• Accidents (unintentional injuries)

Assessment (anthropometric)

History, Physical Examination

Height

Weight

BMI: Wt in Kg (18.5 – 22.9)

Ht in m2

Waist circumferenceMen: <102cm (40 inches)

Women: <88cm (35 inches)

Ideal Body WeightMale: 5ft = 106 Lbs for every inch add 6 Lbs

Female: 5ft = 100 Lbs for every inch add 5 Lbs

Body Mass Index

Classification of Weight by BMI in Adult Asians

National Institute of Health

Classification BMI Risk of

Co-morbidities

Underweight <18.5 Low Normal Range 18.5 – 22.9 Average At risk 23 – 24.9 Increased Obese I 25 – 29.9 Moderate Obese II 30 – 39.9 Severe Obese III > 40 Extreme

Assessment

Laboratory : lipids, FBs, Hb, Albumin, electrolyte

24 hr dietary recall

Food frequency questionnaire

Food diary

Behavioral assessment

What’s a Calorie?

Unit of measurement for energy

3 of the 6 nutrients provide us with energy

Carbohydrate – 1 g = 4 calories

Protein – 1 g = 4 calories

Fat – 1 g = 9 calories

Calculating Energy Requirement

For basal metabolic need 22 cal/kg/day add calories:

Sedentary (no planned physical activity) = 6-7 Cal.

Moderately active: (household /30 min walking) = 10-11 cal.

Active: (Playing football, squash) = 14-15 cal.

Strenuous activity Labor, Athlete) = 20-22 cal.

Counseling : Nutrition care plan

Diet

Exercise

Behavior modification

Diet

A diet is a pattern of eating that includes what a person eats, how much a person eats, and when a person eats.

Diet

Balance diet 50-60% carbohydrate (Bread, rice, cereals, corn, potato, lobia, fruit, vegetable)

12-20% Protein (Cheese, Meat, fish, egg, milk, dal, lobia,vegetable)

<30% Fat (Oil, cream, meat, butter, mayonnaise)

Micro nutrient

Fibers

water

Food Guide pyramid

GUIDE LINE( AHA 2006)

Consume an overall healthy diet.

To maintain a healthy body weight, balance calories consumed with calories burned.

Increase awareness of calorie content of foods for portions typically consumed and of daily caloric requirements.

Set a goal of at least 30 minutes of physical activity daily.

Consume a diet rich in a wide variety of fruits and vegetables (not fruit juices), especially those that are deeply colored (spinach, carrots, peaches, and berries). Prepare fruits and vegetables with little added saturated or trans fat, salt, and sugar. Choose whole-grain, high-fiber foods. Consume 2 servings of fish, especially those relatively high in omega-3 fatty-acids (eg, salmon, trout, and herring) at least twice weekly

Children and pregnant women should follow Food and Drug Administration (FDA) guidelines for avoiding mercury-contaminated fish (eg, shark, swordfish, king mackerel, and tilefish). Limit intake of saturated fat, trans fat, and cholesterol by choosing lean meats, vegetable alternatives, and fat-free (skim) and low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats. Minimize intake of beverages and foods with added sugars.

To consume no more than 2300 mg of sodium daily, choose and prepare foods with little or no salt.

Limit alcohol intake

When eating out, be aware of portion size; select vegetables and fruits; and avoid foods prepared with added saturated or trans fat, salt, and sugar

General Guidelines : NIH

Eat at least 3 meals each day

Do not skip breakfast

Eat foods from each of the Four Food Groups at every meal

Follow a balanced diet that is low in saturated and trans fats, cholesterol, added sugars, salt.

Eat variety of food including fruits, vegetable whole grain, milk product, meat, legumesPrefer unsaturated fatTrim all visible fat and remove the skin from poultryBake and Barbeque is better than currySalt FiberWater

Balance your calorie intake with exercise.

Slowly decrease your caloric intake while increasing exercise to prevent gradual weight gain over time.

Exercise regularly and reduce sedentary activities

Carbohydrates – 1 Serving

1 slice bread = 1 small chapatti = 1/3 nan = ½ cup cooked rice = 1 small potato = ¾ cup cereal = 1/3 cup dal/lobia = 80 cal, 15 gm CHO, 3 gm protein.

Vegetable

Vit A, C, K, Folic Acid, Iron, Calcium, CHO, Protein, Fibers, Water)

½ cup cooked vegetable = 1 cup uncooked vegetable = 25 cal, 5 gm CHO, 1 gm protein Tubers and beans 10 gm CHO, 2 gm protein (45 cal).

7 25 07 www.spaladytotherescue.com

Fruits

1 small banana, orange, apple, guava, ½ grape fruit, ½ small mango, 2-3 date

1 cup cut fruit = 15 gm CHO, 1 gm protein = 65 cal.

Add Color to your plate

Protein

a. 1 oz beef/mutton/chicken/fish/5 prawns/cheese, 1 oz kidney, liver = 7 gm protein, 3 gm fat, 55 cal

b. 1 oz qeema/1 oz dumba / 1 oz cheddar cheese, 2 oz brain = 7 gm protein, 8 gm fat , = 100 cal

c. 1 egg/1/4 cottage cheese, 1 oz low fat qeema = 7 gm protein, 5 gm fat = 75 cal

d. Legumes, chickpea, beans ½ cup boiled = 7 gm protein, 1 gm fat, 20 gm carbohydrate = 115 cal

e. Milk (calcium, protein, fat, carbohydrate, vitamin A, riboflavin), 1 cup cow or buffalo milk top cream removed = 1 cup yogurt = 2 oz cottage cheese = 8 gm protein, 8 gm fat, 12 gm carbohydrate = 160 cal and 290 mg calcium.

Fat and Oil

1 tsf oil = 1 tsf ghee, butter or margarine or mayonnaise, 1 tbs salad dressing or cream, 10 peanuts, 5-8 nuts = 5 gm fat = 45 cal

Saturated Fat

Butter, palm oil, coconut oil, animal fat, ghee

Mono unsaturated fat

Corn oil, canola and olive oil

Poly unsaturated fat

Soya

Iron

Red meat, green leafy vegetable, liver, chickpea and legumes, dates

Vitamin C increases the absorption of iron in the gut

Calcium

Milk

Yogurt

Cheese

Green leafy vegetable

A Sample Diet Plan=1500 cal

CHO/starch : 2 slices, 2 chapatis,2 cups rice 540 cal

Vegetable : 70 cal

2 fruits : 135 cal

Protein : 3 oz meat, 1egg,1/2 cup dal or bean 415 cal

Milk 250 ml : 160 cal

Fat 4 tsf oil : 180 cal

Exercise

Every morning my brain tells me to exercise…

….. and my body laughs at the idea

Exercise

Frequency: Should be done at least once every other dayStart with 3 times a week and build up to a daily routine

Intensity:Start @ a comfortable speedIncreased the speed or distance

Time: Begin according to stamina

Exercise

30 minutes brisk walking every day

5 days a week

Behavior Modification

Emotional

Anxiety / Depression

Snack obstacles

Control the environmental cues

Choose nutritious food every time

Keep record of your food intake

Practice of habit

Establish a base line and maintain records

Pickup one or two habits to change

Practice these till they become second nature

Add other habits to change to the list

Self monitoring

Slow eating

Nutrition education

Social and moral support

Steps in Behavior Modification

INSTEAD OF THIS HIGHCALORIES

TRY THIS LOWCALORIES

CALORIES SAVED

MEAT GROUP:Chicken Qorma (3 oz)Mutton Biryani (2 cup)Fried Fish (4 oz) Plain Omelette (1 egg)Beef Burger (1 medium)Chicken Pizza (8 in diam)

300680400165400555

Roast Chicken (3oz)Plain Rice (2 cups)Baked Fish (4 oz)Boiled Egg Egg Sandwich Mutton Stew (3oz)

16532022075

240250

13536018090

160260

VEGETABLE GROUPVegetables Curry (1 cup)Russian Salad (1 cup)

140340

Stir VegetablesFresh Salad (1 cup)

7225

68315

STARCH GROUPParatha (60 gm)Sheermal (half medium)French toast (35 gm)Poori (58 gm)French Fries (20) (90 gm)Potato Cutlet (1 medium)

340325205260250170

Chapatti (60 gm)Nan (half med)Bread Slice (25 gm)Bun, half (35 gm)Boiled Potato (1 med)Baked Potato (1 med)

16010080908080

18013512916517090

INSTEAD OF THIS HIGHCALORIES

TRY THIS LOWCALORIES

CALORIES SAVED

SNACKSPeanuts (30 gm)Potato Chips (30 gm)Potato Samosa (1 med)Vegetable Patties (1 med)Ice Cream (6 oz)Mango Shake (8 oz)Cream Cheese (1 oz)Fruit Cake (43 gm)

135170250295250332100160

Roasted Grams (2 oz)Corn on Cob (3–4 in)2 Whole Wheat Biscuits (12 gm each)Popcorn (1 ½ cup)Ice Milk (6 oz)Cottage Cheese (1 oz)Sweet Bun (35 gm)

408080

8012015225

100

9590

170

2151301807560

FRUIT GGOUPApple Juice (8 oz)Orange Juice (8 oz)Mix Fruit Chaat with Sugar Syrup (1 cup)

300180288

Apple (fresh) (1 med)Orange(fresh) 1 med)Guava (1 med)

606060

240120288

THANK YOU