INTRODUCTION TO DITARY THERAPY
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INTRODUCTION TO DIETARY THERAPY DR. ABDULAZIZ AL-JOHANI MBBS, SBFM, ABFM NUTRITION
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INTRODUCTION Assessment of nutritional status has four components:- 1. Anthropometrics measurements 2. Biochemical or laboratory analysis 3. Clinical (physical) assessment 4. Diet or nutritional history
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ANTHROPOMETRICS MEASUREMENT The four building measures of anthropometry AGE HEIGHT SEX WEIGHT
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DITARY THERAPY: Nutrient intake has to be made to the Individual based on the age, sex, weight, height, physical activity and physiological needs of the patient. It is always better to prescribe and formulate a suitable individual diet. Nutrition recommendations for Patient are based on nutrition assessment, desired treatment outcomes, and modification of usual food intake.
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Diet modification in treatment of hypertension Suitable measures include: Stop smoking Lose weight - relate to BMI; aim to maintain normal weight for adults (body mass index 20-25 kg/m2) Review and advise on diet: - avoid foods high in cholesterol or animal fat - encourage greater intake of fruit, vegetables, fish, and foods with polyunsaturated and monounsaturated fats. - discourage excessive consumption of coffee and other caffeine-rich products
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Diet modification in treatment of hypertension Suitable measures include: Review alcohol consumption . Reduce salt intake: - reduce salt intake to < 100 mmol/day - reduce amount of salt used in food preparation - avoid foods which have a high salt content
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Dietary Approaches to Stop Hypertension ? Follow the DASH diet - This diet emphasizes fruits and vegetables (high in potassium) and low fat dairy foods (calcium may have a beneficial effect on blood pressure, too). It also includes whole grains, nuts, poultry and fish , red meat, and sugar. ?Several randomized controlled feeding trials found that this eating strategy significantly lowered blood pressure in as little as two weeks.
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DM and Diet The current nutritional recommendations for patients with diabetes are as follows: Energy: sufficient to maintain or achieve ideal weight. Modest weight loss can result in a fall in insulin resistance, hepatic gluconeogenesis and blood pressure . carbohydrate: Should provide about 50% of total daily energy intake. It is accepted that although the diabetic diet should be high in complex carbohydrate with a low glycemic index .
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DM and Diet Fat: - provide 30-35% of total daily energy intake. saturated fatty acids should provide less than 10% of total daily energy intake. - Protein: - Should provide 10 to 15% of total daily energy intake. - protein intake should be higher in children, the elderly and pregnant and lactating women and lower in patients with microalbuminaemia. Alcohol: should be excluded from the diet of diabetics who are overweight or who have hypertension or hypertriglyceridaemia.
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Diet in hypercholesterolemia The National Cholesterol Education Program (NCEP) Expert Panel on Detection and Treatment of Blood Cholesterol in Adults (Adult Treatment Panel III) recommend a multifaceted lifestyle approach to reduction of risk of coronary heart disease (CHD). This approach is designated therapeutic lifestyle changes (TLC). The targets are more rigorous than those stated by NICE. Essential features are: ? Reduced intakes of saturated fats (<7% of total calories) and cholesterol (<200 mg per day) . ?Therapeutic options for reducing LDL . ?Weight reduction . ?increased physical activity .
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Diet in hypercholesterolemia Nutrient Composition of the TLC diet:
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Treatment decisions based on LDL-cholesterol level
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Diet in Obesity The BMI of a person is the number obtained by dividing his weight (in kilograms) by the square of his height (in meters) : BMI = [Weight in kilograms] ______________________ [Height in meters]² There is a positive relationship between BMI and risks of cardiovascular, cerebrovascular, and metabolic (diabetes mellitus & hyperlipidemia) diseases.
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Diet in Obesity
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Treatment Approach Initial goal: 10% weight loss Significantly decreases risk factors Rate of weight loss 1 to 2 pounds per week Reduction of caloric intake 500-1000 per day Slow weight loss is more stable Rapid weight loss is almost always followed by weight gain Rapid weight loss increases risk for gallstones & electrolyte abnormalities
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Treatment Approach A multi-faceted approach is best: Diet Physical activity Behavior change “A” Recommendation
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Dietary Therapy Weight reduction with dietary treatment is in order for all patients with a BMI 25-30 who have co morbidities and for all patients over BMI 30. Strategies of dietary therapy include teaching about calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods.
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Low-Calorie Diet 1000 to 1200 kcal/day for women 1200 to 1600 kcal/day for men Adjust for current weight & activity Too hungry? increase kcal by 100 - 200/day Not losing? decrease kcal by 100 - 200/day
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How Much is 1200 Calories? Could you stick to 1200 per day? 1 Big Mac (580) 1 SMALL Fries (210) 1 SMALL shake (430)
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Diet in Obesity
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Weight Maintenance: How Much Should People Eat? Varies widely Some averages, below
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Diet in pregnancy ?During pregnancy there is an increased nutritional requirement. This is the result of an increase in the mother's basal metabolic rate and the demands of the growing fetus. ? There is a nutritional requirement of approximately (2,500 calories). The approximate intake of protein, fat and carbohydrate is approximately 100g of protein, 100 g of fat and 300 g of carbohydrate. ?Other increases in demand as a result of pregnancy include those of calcium, iron and folic acid.
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Diet in pregnancy Iron is depleted in pregnancy due to the increased requirements of fetus and placenta, and the rise in red cell mass. The patient may present with a picture of chronic tiredness and a haemoglobin concentration of 10 g/dl or lower. Pregnant women (and those intending to become pregnant) should be informed that dietary supplementation with folic acid, before conception and up to 12 weeks-gestation, reduces the risk of having a baby with neural tube defects (anencephaly, spina bifida). The recommended dose is 400 micrograms per day. - all women should be informed at the booking appointment about the importance for their own and their baby's health of maintaining adequate vitamin D stores during pregnancy and whilst breastfeeding.
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Diet in pregnancy In order to achieve this, women may choose to take 10 micrograms of vitamin D per day. Particular care should be taken to enquire as to whether women at greatest risk are following advice to take this daily supplement. These include: © Women who have limited exposure to sunlight, such as women who are predominantly housebound, or usually remain covered when outdoors. © Women who eat a diet particularly low in vitamin D, such as women who consume no oily fish, eggs, meat. © Women with a pre-pregnancy body mass index above 30 kg/m2.
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Diet modification in constipation © Diets with a high fiber content are effective in increasing stool weight and bowel movement frequency. The effects of a high fiber diet (e.g. approximately 30g per day) may occur after a few days. However a high fiber diet should be tried for at least a month before its effects are determined © It is important to ensure an adequate fluid intake (e.g. two liters of water/day) if a patient is on a high fiber diet. © There is evidence from observational studies suggest an association between constipation and reduced physical activity - therefore encouraging exercise is especially good health advice for patients with constipation, where lack of mobility may be a contributing factor.
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