Role of Medical Nutrition Therapy in Prevention and Treatm

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Role of Medical Nutrition Therapy in Prevention and Treatment Of Diabetes

By

Hellen C Baliach

Consultant

Clinical

Nutritionist

Objectives

Definition of terms

Outline of objectives of Medical Nutrition Therapy

Outline of nutritional assessment

Nutritional data from diabetes clinic andDiet Advicory Clinic (DAC)

What is the ideal diet

Challenges

Recomendations

Conclusion

What is on your Plate?

Definitions of Terms

‘Diabetic diet’-A normal diet

is simply a healthy eating plan

Aim-is to control the blood sugar level

Diet forms one of the three cornerstones of good health-1. Exercise/diabetes education 2.medication 3. meal planning

Definitions of Terms

BMI-for-Age:

is a growth indicator that relates BMI to age. BMI for age is determined using gender-specific growth charts that place a child in a percentile relative to weight and height (WHO, 2006).

Obesity:

A condition of malnutrition where there is deposition of excess fats around the body

particularly in subcutaneous tissues that arises from intake of food in excess of the body energy requirements

(WHO, 2004)

Terms

Stunting:

Growth failure that occurs over a slow cumulative process caused by inadequate nutrition or repeated infections in a child. It is defined as

Weight-for-Height Z-scores < -2

Stunted-overweight/obesity

-co-existence of stunting and overweight/obesity(WFH Z-scores <-2 and BMI for age z-scores <-2)

Aim of Medical Nutrition Therapy (MNT)

MNT is important in preventing diabetes

managing existing diabetes

Preventing and slowing the rate of development of diabetes complications

Achieving nutrition-related goals requires involvement of the person with diabetes in the decision-making process

Objectives of Medical Nutrition Therapy

Attain and maintain blood glucose level as close as normal

Prevent Hypo and Hyperglycemia

Obtain optimum blood lipids and blood pressure control and reduce the risk of macro vascular disease.

Assess energy intake to achieve optimum body weight

Promote physical, social and

physiological

wellbeing.

Objectives of Medical Nutrition Therapy

Prevent, delay or minimize the onset of chronic degenerative complications such as hypertension and renal disease.

Achieve and maintaining optimal metabolic and physiological outcome.

Provide relief from symptoms

Individualize meal plan according to a person’s lifestyle and based on usual dietary intake

Prevalence of Diabetes by sex in the clinic

Disease Prevalence in Diabetes Clinic

Anthropometrical Assessments

Physical measurements- involves measurements of the physical dimensions and gross composition of the body (WHO 1995)

Provide information on the past nutritional history and degree of chronic protein Energy Imbalance

The measurements vary with age,sex,race and degree of nutrition.

Body Mass Index Classification Wt(kg)/Ht(m)2(WHO,2006)

CLASSIFICATION

Underweight

Normal range

Overweight

Preobese

Obese class 1

Obese class 11

Obese class 111

BMI

< 18.5

18.5 – 24.99

>25

25 – 29.99

30 – 34.99

35

– 39

> 40

DISEASE RISK

Low

(but risk of other clinical problems is increased

Average

Increased

Moderate

Severe

Very severe

Classification by BMI(DAC)

Prevalence of Stunted-Overweight

In children BMI> 75th percentile have increased risk of coronary heart disease, atherosclerosis and cerebrovascular diseases (Ellis, 2001)

Stunted-overweight puts the child at high risk of developing diabetes in adulthood

Prevalence of stunted-overweight was 3% at well Baby Clinic at KNH (CH. Hellen,AM Mwangi,2010)

19% children aged 3 years were both stunted and overweight SA

(

Mamabolo

, et al 2007).

Waist–hip ratio

Measurement of waist hip ratio: In a lean person (left), the waist can be measured at its narrowest point, while for a person with convex waist (right), it may be measured at about one inch above the navel. The hip is measured at its widest portion of the buttocks at left, and at the great

trochanters at right.

Waist–hip ratio

or

waist-to-hip ratio

(

WHR

) is the ratio of the circumference of the

waist

to that of the

hips

.

Waist-Hip Ratio

Waist and Hip Ratio

Waist to Hip Ratio Chart

Male

Female

Health Risk Based Solely on WHR

0.95 or below

0.80 or below

Low Risk

0.96 to 1.0

0.81 to 0.85

Moderate Risk

1.0+

0.85+

High Risk

Clinical

Observations – those who use raw carrot juice and raw beet root has elevated Blood Glucose.

Sweeterners, diet coke and ‘sugar free juices’

Biochemical assessments

Lipid profile

HBA1C

Blood sugar

Kidney and Hearth functions

Ecological factors

Are known to influence the nutritional status of individuals.

Variables include; household composition, education, literacy

ethinicity, religion, income, employment, material resources, water supply and household sanitation, access to health, and agricultural services as well as land ownership.

More cases have Diabetes(DAC)

Prevalence by Sex in DAC Clinic

Which diet?

Current choices

1. low fat diet

2. low carbohydrates

3. Mediterranean diet

Standard modern diet consist of:

55-60% carbohydrates

20-30% fat

15-20% protein

Why low carbohydrates -metabolic consequences

Rapid reduction in body weight due to increased lipolysis

Increased water loss at the beginning

Mild metabolic ketoacidosis

Decrease in appetite and eventually food intake

Improvement in insulin resistance, plasma lipids and plasma glucose- caveats

hypokalemia

(cramps, weak legs) and bowel obstructions

A low carbohydrate Diet?

Improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus

(a 1- year prospective randomized intervention study Abel V.S et al, 2010)

Long-term following of any low calorie diet is beneficial for patients with type 2 diabetes

But only as a part of a structured permanent lifestyle modification

Major Challenges

Majority of the clients do not access the nutrition services.

Less than 5% of the total clients attending DC receive the Nutrition services

Clients have varied nutrition information/knowledge from other health workers,herbalists, relatives, bussinesmen/women

Undoing the information is a challenge.

Reccomendations

Refer healthy clients – Hospital protocol

Refer all clients to Dietician/ Nutritionist

Nutrition guidelines on management of diabetes to be improved.

Provision of optimal Nutrition should start before, after and during pregnancy

Proper feeding practices and growth monitering should start from birth

Conclusion

Glycemic control is achieved when Drugs and Nutritional Therapy are combined

Diabetes management involves multidisplinary approach.

Prevention is better than cure- through

Intensifications

of campaigns/education-Breastf eeding and HBV-proteins

How much food on your Plate