Dietetics I
ABU NURUDEEN
DEFINITION
• Dietetics - The branch of therapeutics
concerned with the practical application of
diet in relation to health and disease.
• Dietetics - the science of applying nutritional
principles to the planning and preparation of
foods and regulation of the diet in relation to
both health and disease.
Dietitians in practice
• Clinical dietitians
• Clinical dietitians work in hospitals, nursing care
facilities and other health care facilities to provide
nutrition therapy to patients with a variety of health
conditions, and provide dietary consultations to
patients and their families.
• They confer with other health care professionals to
review patients' medical charts and develop individual
plans to meet nutritional requirements. Some clinical
dietitians will also create or deliver outpatient or public
education programs in health and nutrition.
• Community dietitians
• Community dietitians work with wellness
programs, public health agencies, home care
agencies, and health maintenance organizations.
• These dietitians apply and distribute knowledge
about food and nutrition to individuals and
groups of specific categories, life-styles and
geographic areas in order to promote health.
• Foodservice dietitians
• Foodservice dietitians or managers are responsible for
large-scale food planning and service. They coordinate,
assess and plan foodservice processes in health care
facilities, school food service programs, prisons,
restaurants, and company cafeterias.
• These dietitians may perform audits of their
departments to ensure quality control and food safety
standards, and launch new menus and various
programs within their institution to meet health and
nutritional requirements.
• Gerontological /geriatric dietitians
• Gerontological dietitians are specialist in
nutrition and aging.
• They work in nursing homes, communitybased aged care agencies, government
agencies in aging policy, and in higher
education in the field of gerontology (the
study of aging).
• Neonatal dietitians
• Neonatal dietitians provide individualized
medical nutrition therapy for critically ill
premature newborns. They are considered a
part of the Neonatal Intensive Care Unit's
medical team.
• The neonatal dietitian performs clinical
assessment of patients, designs nutrition
protocols and quality improvement initiatives
with the medical team, develops enteral and
parenteral regimens.
• They also help to establish and promote
lactation/breastfeeding guidelines and often
oversees the management of infection
prevention in the handling, storage, and delivery
of nutritional products.
• Pediatric dietitians
• Pediatric dietitians provide nutrition and health
advice for infants, children, and adolescents.
• They focus on early nutritional needs, and often
work closely with doctors, school health services,
clinics, hospitals and government agencies, in
developing and implementing treatment plans for
children with eating disorders, food allergies, or any
condition where a child’s diet factors into the
equation, such as childhood obesity.
• Research dietitians
• Research dietitians are involved with dieteticsrelated research conducted in hospitals,
universities, government agencies, food and
beverage companies, and the pharmaceutical
industry.
• They may conduct research in clinical aspects of
nutrition, for example, the effects of diet on
cancer treatment.
• Administrative dietitians
• Administrative or management dietitians oversee
and direct all aspects of food policy and largescale meal service operations in hospitals,
government agencies, company cafeterias,
prisons, and schools.
• They recruit, train and supervise employees of
dietetics departments including dietitians and
other personnel.
• Consultant dietitians
• Consultant dietitian is a term sometimes used
to describe dietitians who work under
contract with health care facilities or in private
practice.
• Consultant
dietitians
are
contracted
independently to provide nutrition services
and educational programs to individuals and
health care facilities as well as sports teams,
fitness clubs, supermarkets, and other health
and nutrition-related businesses.
• The 6 Basic Principles of Diet Planning
• Ask most people what the word "diet" means and they
describe short-term weight loss goals and countless
food restrictions. However, the term "diet" simply
refers to what we eat.
• A good diet promotes positive change and helps you
incorporate sensible eating into your daily lifestyle.
• The six principles of diet planning include;
 Adequacy
 Nutrient density
 Moderation
 Variety
 Balance
 Calorie control
Adequacy
• An adequate diet provides the human body with
enough energy and nutrients for optimal growth,
maintenance and repair of tissue, cells and
organs.
• Water, carbohydrates, fats, proteins, vitamins and
some minerals comprise the six nutrient classes
relied upon for performance of essential
functions and activities.
• These nutrients must be replaced through diet
to keep the body working efficiently.
• An adequate diet includes foods containing
proper amounts of these nutrients to prevent
deficiencies, anemia, headaches, fatigue and
general weakness.
Balance
• A balance diet provides foods of a number of types in
proportion to each other such that foods rich in some
nutrients do not crowd out of the foods that are rich in
other nutrients.
• Balance in the diet helps to achieve adequacy.
• The essential minerals calcium and iron, taken together
illustrate the importance of dietary balance. Meat , fish
and poultry are rich in iron but poor in calcium.
• Similarly, milk and milk products are rich in calcium but
poor in iron.
• In fact, milk(except breast milk) and milk
products are so low in iron that overuse of these
foods can actually lead to iron-deficiency anemia
by displacing iron-rich foods from the diet.
• The art of balancing the diet involves using
enough of each type of food.
• Consuming the proper amount of servings
from each food group ensures a wellproportioned diet.
Calorie Control
• Once you know what to eat, the next factor is how
much. It is possible to eat healthy foods and still
overindulge.
• Clearly, the task of designing an adequate, balanced
diet requires some thought and skillful planning. Even
more thought and skill are required to create an
adequate and, balance diet without overeating.
• Therefore, a reasonable calorie allowance must be
established. The amount of energy the body receives
from incoming food needs to match the amount of
energy needed for the body to sustain its biological and
physiological activities.
• In other words, input needs to match output. An
imbalance leads to weight loss or gain.
Nutrient density
• Eating well without overeating is often challenging.
• Nutrient density is a measure of the nutrients a food
provides relative to the energy it provides. The more
nutrients and the fewer kcalories, the higher the
nutrient density. Nutrient density promotes adequacy
and kcalorie control
• You must select foods that pack the most nutrients into
the least amount of calories.
• For example, 1 oz. of cheese and 1 cup of fat-free milk
contain the same amount of calcium.
• While both foods are adequate sources of
calcium, the milk is more calcium-dense than the
cheese because you get the same amount of
calcium with one-half the calories and no fat.
• Designing a nutritionally sound diet requires
proper "budgeting" of calories and nutrients so
that you eat less while supporting good health.
Moderation
• Socrates once said "Everything in moderation;
nothing in excess." Though over 2,500 years
old, this adage still holds true.
• Those who place severe restrictions on what
they can or cannot eat often find it difficult to
stick to a pattern of sensible eating.
• Depriving yourself of foods rich in fat and
sugar is not necessary.
• When eaten on occasion, these treats are not
detrimental to your health and often provide
enough enjoyment to keep one motivated to
continue healthy eating practices.
Variety
• It's possible for a diet to have all the aforementioned
characteristics, but still lack variety if the person eats the
same foods day after day. People should vary their choices
within each class of foods from day to day for three
reasons.
• First, different foods in the same group contain arrays of
nutrients. Among the fruits for example, strawberries are
especially rich in vitamin C while bananas are rich in
potassium.
• Second, no food is guaranteed entirely free of constituents
that in excess, could be harmful.
• Third, as the adage goes, variety is the spice of
life. Even if a person eats beans frequently, the
person can choose red beans today, garbanzo
beans tomorrow, and baked beans on the
weekend.
• Good nutrition does not have to be boring.
Diet planning guides
• To plan a Diet that achieves all of the dietary ideals
just outlined, a planner needs not only knowledge
but tools.
• Four of the most used tools for diet planning are;
1. Food group plans
2. Food exchange lists
3. Food guide pyramid
4. WHO recommendations
Food group plans
• This is a food planning tool that sorts foods of similar
origin and nutrient content into groups and then
specify that people should eat certain numbers of
serving from each group.
• Of the diet –planning principles introduced earlier, food
group plans help the diet planner best to achieve
dietary adequacy, balance and variety

•
•
•
•
Four food group plan
4 servings of vegetables and fruits
4 servings of bread and cereals
2 servings of milk and milk products
2 servings of meat and meat products
Daily food guide
• The daily food guide differs from the four food group
plan by splitting vegetables from fruits, so that there
are five groups of foods.
• The numbers of serving suggested are also more
generous.
 6--11 servings of breads and cereals
 3– 5 servings of vegetables
 2--4 servings of fruits
 2– 3 servings of meats and meat products
 2 servings of milk and milk products
Food Exchange List
• This is a diet planning tool that organizes foods by
their nutrient and energy contents. Foods on any
list can be used interchangeably.
• Exchange list provide additional help in achieving
kcalorie control and moderation.
• Originally developed for people with diabetes,
exchange system have proved so useful that they
are now in general use for diet planning.
• Unlike the food group plan, which sort foods
primarily by their protein, vitamin, and mineral, the
exchange sorts foods by their proportions of
carbohydrates, fat and protein.
• Portion sizes are strictly defined so that the amount
of energy provided by any food item is the same as
that from any other item within a given list.
• All of the food portion in a given list provide
approximately the same amount of energy
nutrients(carbohydrates, fat and protein) and the
same number of calories.
• Any food on the list can be exchanged or traded for
any other food on that same list without affecting a
plans balance or total calories.
• The six exchange list are as follows:
Starch/bread- 1 slice bread(80 calories)
Meat-1ounce lean beef(55 calories)
Vegetables-1/2 cup cooked carrots(25 calories)
Fruits-1/2 banana(60 calories)
Milk- 1 cup nonfat milk(90 calories)
Fat- 1 teaspoon butter(45 calories)
Starch/bread exchange
• 1 slide of bread is like
• ¾ c ready-to-eat cereals
• ½ c cooked pasta
• 1/3 c cooked rice
• 1/3 c cooked beans
• ½ corn
• 1 small( 3oz) potato
(1 bread = 15g carbohydrate, 3g protein, trace of fat,
and 80 kcal)
Food Guide Pyramid
• The most recent food guide designed to provide sound
nutritional advice for daily food selection is the food
guide pyramid.
• It is designed to provide visual image of the variety of
foods that people should eat, the proportion of calories
that should come from each of the groups, and the use
of moderation in consumption of fats, oils and sweets.
• The food guide pyramid is result of years of
deliberation by renowned nutrition scientists.
• Although there are six categories of foods in the
pyramid,
• Nutritionists do not regard fats, oil and sweets as an
actual food group.
• The base of the pyramid, which should constitute
the majority of daily calories, is represented by the
bread, cereal, rice, and pasta group(6-11 serving)
and the fruit group(2-4 serving). These three foods
group are derived from grains and plants.
• Fewer servings are recommended from the milk,
yogurt, and cheese group(2-3 servings) and the
meat, poultry, fish, dry beans, eggs and nuts group
derived primarily from animals.
• Fats, oils and sweets(not classified as a group)
should be used sparingly.
• Typical serving sizes are defined for each food item
in each group. eg, a serving of milk is 1 cup while a
serving of cooked or chopped vegetable is ½ a cup.
WHO recommendation
• According to WHO recommendation on daily food
selection;
• 60 % of daily calorie should come carbohydrates.
• 30% from fat.
• 10% from protein.
HEALTHY DIET
• In the past most morbidity and mortality in the
developed nations were caused by nutrientdeficiency diseases and infectious diseases,
• But advances in nutritional and medical sciences
have almost eliminated most of the adverse health
consequences of associated with these disease.
• Today, most morbidity and mortality are associated
with various chronic diseases(e.g., coronary heart
disease, stroke, cancer, diabetes, obesity),
• And most dietary guidelines for healthful nutrition
are targeted to prevent these chronic diseases.
• An unhealthy diet is a major risk factor for a
number of chronic diseases including:
High blood pressure,
 Diabetes,
Abnormal blood lipids,
Overweight/obesity,
Cardiovascular diseases, and
 Cancer.
• The WHO estimates that 2.7 million deaths are
attributable to a diet low in fruit and vegetable
every year.
• Globally, it is estimated to cause about 19% of
gastrointestinal cancer, 31% of ischaemic heart
disease, and 11% of strokes, thus making it one of
the leading preventable causes of death worldwide.
• The essence of healthy diet is to promote good
health and significantly reduce the risk of
developing chronic diseases.
• The following dozen guidelines represent what is
called a healthy diet.
Healthy Diet
1. Balance the food you eat with physical activity to
maintain or improve your weight.
2. Eat a nutritional adequate diet consisting of a wide
variety of foods.
3. Choose a diet low in fat, saturated fat and cholesterol.
4. Choose a diet with plenty of whole grain products,
legumes, fruits and vegetables, which are rich in
complex carbohydrates and fiber.
5. Choose a diet moderate in sugars
6. Choose a diet moderate in salts and sodium
7. If you drink alcoholic beverages, do so in
moderation. Pregnant women should not drink any
alcohol.
8. Maintain protein intake at a moderate, yet
adequate level, obtaining much of your daily
protein from plant sources.
9. Choose a diet adequate in calcium and iron
10. Children and others susceptible to tooth decay
should obtain adequate fluoride.
11. In general avoid taking dietary supplements in
excess of the RDA in any one day.
12. Eat fewer foods with questionable additives
1. Balance the food you eat with physical
activity to maintain or improve your
weight
• Preventing obesity helps to reduce the risk of
numerous chronic diseases such as heart disease
and cancer.
• To avoid becoming overweight, you should
consume only as many calories as you expend daily.
• An aerobic exercise program and adherence to the
concept of nutrient density, could serve as the basis
for sound weight-control program.
2. Eat a nutritionally adequate diet
consisting of a wide variety of foods
• Eating a wide variety of natural foods from within
and among the six food groups or Food Guide
Pyramid or the Food Exchange List will assure you of
obtaining a balanced and adequate intake of all
essential nutrients.
• Stress foods that are high in the key nutrients.
3. Choose a diet low in total fat, saturated
fats, and cholesterol
• Currently, fat comprises almost 35 percent of total
daily calories.
• The recommended dietary goal is to obtain less
than 30 percent of calories from fat.
• In addition, the amount of saturated fat in the diet
should be 10 percent or less, and cholesterol intake
should be limited to 300 milligrams or less per day.
• However, it should be noted that some healthful
diet plans recommend lower values, such as 10-20
percent total fat, less than 7 percent saturated fat,
and less than 200 milligrams of cholesterol.
• The following practical suggestions will help people
meet the recommended dietary goal.
Eat less meat with a high –fat content. Avoid hot
dogs, luncheon meats, sausage, and bacon. Trim of
excess fat before cooking.
Eat only lean red meat and more white meat, such
as turkey and chicken, which have less fat. Remove
the skin from poultry. Eat more fish.
Many fish, such as sardines, salmon, tuna, and
mackerel, are rich in omega-3 fatty acids.
White fish, such as flounder, is very low in fat
Calories. Eat no more than 6 ounce of animal meat
per day.
Eat only two to three eggs per week. One egg yolk
contain about 220-250 milligrams of cholesterol,
close to the limit of 300 milligrams per a day.
Egg whites have no cholesterol and are an
excellent source of high-quality protein.
Eat fewer diary products that are high in fat.
Switch from whole milk to skim or nonfat milk,
such as yogurt and cottage cheese.
If you like cheese, switch from hard cheese to soft
cheeses although most cheeses, except low-fat
cottage cheese are still high in fat and calories.
Some fat-free cheeses are now available.
Eat less butter, which is high in saturated fats, by
substituting
soft
margarine
made
or
polyunsaturated, such as corn oil
Avoid margarine made from hydrogenated or partially
hydrogenated oils, which basically are metabolized like
saturated fat.
Eat margarine sparingly. Some fat-free margarines are also
available.
Eat fewer commercially prepared baked goods made with
eggs and saturated or hydrogenated fats.
Limit your consumption of fast foods. Although fast-food
chains generally serve grade A foods, many of their
products are high in fat.
The average fast-food sandwich contains approximately 50
percent of its Calories in fat.
Some fast-food restaurant do serve nutrient-dense foods.
Wise choices, such as baked fish grilled skinless chicken,
lean meat, baked potatoes and salads can provide healthy
nutrition.
Use food labels to help you select foods low in total
fat, saturated fat and fat Calories, all of which are
listed on the food label for most products.
Broil, bake, grill, boil or microwave your foods.
Limit frying. If you must use in your cooking, try to
use monounsaturated oils such as olive or peanut
oil.
• In general, decrease your intake of cholesterol,
total fat, and saturated fat by substituting
monounsaturated,
polyunsaturated
and
omega-3 fatty acids for saturated or
hydrogenated fats
4.
Choose a diet with plenty of whole-grains
products, fruits and vegetables, foods
which are rich in fiber & complex
carbohydrates
• In general, about 60 percent or more of your daily
Calories should come from carbohydrates, about 50
percent from complex carbohydrates, and the other
10 percent from simple, naturally occurring
carbohydrates.
• To accomplish this, you need to eat more wholegrain products (breads and cereals), legumes (beans
and peas), and vegetables and fruits.
• Stress vegetables and fruits high in betacarotene and vitamin C ( the antioxidant
vitamins) such as carrots and sweet
potatoes.
• Deep yellow and orange fruits and
vegetables as well as dark-green leafy
vegetables are usually good sources of
these vitamins.
• Also increase intake of cruciferous vegetables, those
from the cabbage family.
• These fruits and vegetables contain various
phytochemicals which protect people against
several forms of cancers.
• Another benefit of complex carbohydrates is their
high fiber content. Whole-grain products and
numerous vegetables are excellent sources of water
insoluble fiber.
• The high fiber content of these foods is believed to
be important in the prevention of diseases such as
colorectal cancer and coronary heart disease.
• Food labels list the total carbohydrates and the
amount of dietary fiber per serving.
5. Choose a diet moderate in sugars
• The recommended dietary goal is to reduce consumption
of refined sugar from the current level of 24 percent of
daily Calories to 10 percent or less.
• Excessive consumption of refined sugar has been
associated with high blood triglyceride level. Sticky sugars
are a major contributing factor to dental cavities.
• Sugars also significantly increase the caloric content
of foods without an increase in nutritional value, so
they may contribute to body weight problems.
• To meet this goal you should reduce your intake of
common table sugar and products high in refined
sugar.
• Sugar is one of the major additives to processed foods, so
check the labels. If sugar is listed first, it is the main
ingredient.
• Use naturally occurring sugar to satisfy your sweet tooth.
Most fruits have high sugar content, but also contain
vitamins, minerals, and fiber as well.
• Also look for terms such as corn syrup, dextrose, fructose,
and malt sugar, which are also primarily refined sugars.
6. Choose a diet moderate in salt and
sodium
• Restrict sodium intake to less than 2,400 mg daily, which is
the equivalent of 6,000 milligram, or 6 grams, of table salt.
• This lower amount will provide sufficient sodium for normal
physiological functioning.
• Sodium is found naturally in a wide variety of foods,
so it is not difficult to get an adequate supply.
• The following key suggestions may help people
reduce the sodium content in their diets
Get rid of your salt shaker.
One teaspoon of salt is 2,000mg of sodium; the average
well-salt meal contains about 3,000 to 4,000mg. Put less
salt on your food both in your cooking pot and on your
table.
Reduce the consumption of obviously high-salt foods such
as most “koobi” and potato chips, pickles and other such
snacks
Check food labels for sodium content, if salt or sodium is
one of the ingredients listed, you have a high-sodium food.
Salt is a major additive in many processed foods, often
disguised by terms such as monosodium glutamate and
others. Food labels list the sodium content per serving.
Use fresh herbs, spices that do not contain sodium, or little
salt as seasoning alternatives.
7
If you drink alcoholic beverages, do so in
moderation
• The current available scientific evidence does not
suggest that light to moderate daily alcohol
consumption will cause any health problems to the
healthy, nonpregnant adult.
• However, excessive alcohol consumption is one of
the most serious health problems in our society
today, and even small amounts may pose health
problems to some individuals.
• Light to moderate drinking is based upon a limit
one drink for nonpregnant woman and two drinks
for a man.
• A drink is defined as a dose of any alcoholic
beverage that delivers ½ oz of pure ethanol;
• one 12-oz bottle of beer,
• one 4-oz glass of wine, or
• 1.5 ounces of 80-proof distilled spirits.
8
Maintain protein intake at a moderate, yet
adequate level, obtaining much of your daily
protein from plant sources.
8.
• The recommended dietary intake is 0.8 grams of
protein per kilogram body weight, which average out
to about 50 to 60 grams per day or 10-12 percent of
daily calories.
• It appears that most people are staying within the
guidelines.
• However, most of the protein people eat is of animal
origin.
• Although animal products are an excellent source of
complete protein, they tend to be higher in
saturated fats and cholesterol compared with foods
high in plant protein.
• On the other hand, animal’s protein is usually a
better source of dietary iron and other minerals like
zinc and copper than plant protein is.
• Four ounces of meat, fish, or poultry, together with
two glasses of skim milk, will provide the average
individual with daily RDA for protein totaling about
45 grams.
• Combining this animal protein intake with plant
foods high in protein, such as whole-grain products,
beans and peas, and vegetables, will substantially
increase protein intake and more than meet your
needs.
9. Choose a diet adequate in calcium
and iron
• This is particularly important for women and
children. Skim or low-fat milk and other low-fat dairy
products are excellent source of calcium.
• For example, one glass of skim milk provides nearly
one-third the RDA for calcium.
• Iron is found in good supply in the meat and starch
exchanges.
• Lean or very-lean meat should be selected so as to
limit fat intake and whole-grain or enriched
products should be chosen over those made with
bleached, unenriched white flour.
10. Children and others susceptible to
tooth decay should obtain adequate
fluoride.
• This is particularly important during childhood
when the primary and secondary teeth are
developing, for fluoride helps prevent tooth
decay by strengthening the tooth enamel.
• Your water supply may contain sufficient
fluoride—naturally or artificially- to provide an
adequate amount, but if not, fluoride
supplements or use of fluoride toothpaste is
recommended.
11.
In general, avoid taking dietary supplements in
excess of the RDA in any one day
• Dietary supplements of most vitamins and minerals
are not necessary for individual consuming a
balanced diet.
• If you adhere to the recommendation listed here,
you are not likely to need any supplementation at
all, for the consumption of nutrient dense foods
should guarantee adequate vitamin and mineral
nutrition.
12. Eat fewer foods with questionable
additives.
• The general consensus is that most additives
used in processed foods are safe.
• But several health agencies, recommend
caution with additives such as saccharin and
nitrates, which have been linked to the
development of cancer in laboratory animals.
• And other substances such as sulfites and certain
food colours, which may cause allergic reaction in
some individuals.
• Eating fresh, natural foods is one of the best
approaches to avoiding additives.
• HEALTHY EATING STEPS
Healthy Eating Steps
• To help make healthy choices of food easy, all
food have been arranged into three food
steps.
Step 3
• Fats and oils-example – palm oil, all types of
vegetable oil, palm soup , margarine, planta,
sheabutter, avocado pear,
• Example of one serving/meal
• 1/3 small tomato tin of oil(3 dessertspoon)
• ½ match box size sheabutter
• 3 soup ladleful oily soup(palm soup/groundnut
soup
• avocado pear- 1/8 large , ¼ small,
• 2-3 servings daily
Step 2
• Animal and Vegetable protein
• Examples- all types of meat, fish, chicken, beans, cheese,
crab, eggs, milk, snails, groundnuts and all nuts and plant
seeds like agushie.
• Examples of one serving/meal
• 1 joint chicken- remove skin
• 1-3 match box size meat-lean meat
• 1 medium fish
• 2 eggs per week
• ¼ evaporated tin milk,
• 1 teaspoon- powdered milk
• 2-3 stewing spoons of beans
Step 1
• Starches, vegetables and fruit
• Starches- fufu, kenkey, banku, akpler, omo tou,
gari, bread, cassava, plantain, yam and rice( eat
enough to satisfy) 3-4 servings daily.
• Vegetables: okro, garden eggs, tomatoes, aleefu,
ayoyo, kontomire, cassava leaves, sweet potatoes
leaves, onion, pepper, green beans, cabbage,
carrots, lettuce, cucumber, bra, bito bitter leaves2-3 servings daily.
• Fresh fruits- orange, pawpaw, watermelon,
mango, pineapples, apple, grape fruit,
lemon(one slice of fresh fruit) 2-3 servings
daily.
Food labels
• Knowing how to interpret food label, to prepare
foods, and to avoid dietary contaminants may guide
you in developing a nutritious, safe, and healthful
diets.
• By law, food labels must contain the following
information:
List of ingredients-ingredients will be listed in
descending order by weight.
Serving size- serving sizes must be expressed
in both household measures such as cups and
metric measures such as milliliters to
accommodate
users of both types of
measure.
Servings per container.
Amount per serving of the following:





Total calories
Calories from fat
Total fat
Saturated fat
Cholesterol









Sodium
Total carbohydrates
Dietary fiber
Sugars
Protein
Vitamin A
Vitamin C
Calcium
Iron
The following may be listed voluntarily







Calories from saturated fat
Polyunsaturated fat
Monounsaturated fat
Potassium
Soluble fiber
Insoluble fiber
Sugar alcohols
How can people use this information
to select healthier diet
• To provide information to help consumers see
how foods may be part of a daily diet plan, a new
label reference value, the Daily Value(DV) has
been created.
• The DV for a nutrient represents the percentage
contribution one serving of the food makes to the
daily diet for that nutrient based on current
recommendation for healthful diets.
• A lower DV is desirable for total fat, saturated fat,
cholesterol, and sodium, while a higher DV is
desirable for total carbohydrates, dietary fiber, iron,
calcium, vitamins A and C
The diet history:
the technique of obtaining
dietary information
• A brief (assessment) diet history consists essentially
of the same steps but requires less detailed probing
for quantities.
• 24-hour recall. Take the patient through the
previous day meals noting times of all meals and
snacks and what was eaten.
• This is relatively easy to do, concentrates the
patient‘s mind on food and gives a guide to
meal patterns. If the respondent is an inpatient, establish the pattern of a typical day
at home .
• If the 24-hour recall is difficult, then a diet
history is probably impossible!
• Establish the quantities eaten on 24-hour recall.
• This relates to one specific day, and is therefore
less hypothetical than ‘what quantity might you
eat?
• Get the patient to describe quantities, which will
give a guide to appetite and a cross-check on
reliability of later answers. If possible, use
portion models.
• Establish the weekly pattern
• Is the specific 24-hour pattern different in any
way from the ‘usual’ pattern? Take the patient
through the day again.
• What other dishes might be eaten at each
meal? What happen on Saturday and Sunday?
What happen if the respondent is working a
different shift?
• How often does he go out? How often does he
have visitors? What dishes would be eaten?
• Probe specifically for sweets, and snack and
other items consumed between meals, also
alcoholic drinks.
• Establish likely quantities.
• Use portion models; it is easier for the respondent
to say ‘my portion looks like that ’than to search for
verbal descriptions, particularly if inarticulate.
• The interviewer’s interpretation is also likely to be
more accurate.
• Respondent who do their own shopping can also
provide information on quantities bought and for
how many people.
• Establish recipes for composite dishes. This is not
always possible with those who do not cook.
• Cross-checks the information already obtained
against a list of foods appropriate for the purpose of
the study.
• e.g. to assess vitamin C, only fruit and vegetable
(and composite dishes containing them) and
squashes, need to be include.
• The cross –checking can take the form of a set of
cards handed to the respondent, rather than the
interviewer questioning about each food
individually, for each food, ascertain how
frequently a ‘portion’ is eaten on a daily , weekly
or monthly basis.
• Particularly in a full diet history this section
demands the best of the interviewer’s
techniques, as it can be lengthy, repetitious
and boring.
Essential points to remember
• Do not assume anything about patient’s meal
patterns, recipes or portion sizes.
• It is all too easy to assume meal patterns for
people, e.g. ‘ Fridays we have fried fish ’, what
does the respondent mean by this? Is it cod
coated in butter and deep fried, or plaice
lightly of tossed in butter, or some thing else?
• Do not assume it actually means what you
think it means; check it. If there is not a full
description of the food, you may not be able
to complete the calculation later.
• Write every thing down. If information is
received from the respondent but not
recorded, then the interviewer’s memory
becomes a factor in the accuracy of the diet
history.
• Check that you have not made any obvious mistake like
recording 1000g instead of 10g of sugar in tea.
• Checking that you have recorded the respondent
accurately is as important as checking that the
respondent has reported fully.
• It should be possible for someone else to check and
calculate a diet history and get the same results as the
interviewer. Use pre-designed form and not scraps of
paper.
• Watch for non-verbal clues of boredom or
irritation as it is difficult to avoid the inquisitorial
aspect.
• To counteract this, break the flow of questioning
by making some comments on how much time is
needed to complete the interview or a humorous
reference to the number of questions being
asked.
Problems of the diet history
Holding all the points on which information is
needed in one’s head is difficult, particularly if
inexperienced.
Questions may be phrased inappropriately,
particularly while thinking of others points to
be covered.
It is easy to put words into the respondent’s
mouth. Beware of leading questions.
Verbal descriptions of quantity may be very
unreliable and may be mistranslated by the
interviewer.
Bias is introduced by the patient’s memory
and subjective impressions.
•
•
•
•
For instance
(a) A tendency to over –remember ‘proper’ meals.
(b)A tendency to under-remember snacks.
(c)I always have fish on Friday’s may in fact mean two
Fridays out of three.
• (d)Memory is weighted by the last seven days.
• (e)Cross –checking generally overestimates food used
infrequently, i.e. if liver is eaten ‘once a mouth; it is
probably in fact less frequencies are probably more
reliable.
The more irregular the pattern, the less
reliable a diet history tends to be.
Patients may not be entirely truthful.
Analysis and interpretation of
information
• Assessment of food intake
• Depending on the purpose of taking the diet history, the
food intake may be assessed or analyzed in a variety of
ways.
 By relating the food intake to a daily food guide.
 By using knowledge of food composition to make a
judgment about some aspects of the diet, e.g. the
adequacy of fiber intake or the likely contribution of the
diet to dental caries.
By using a table of approximate food values to
make a crude calculation of the intake of one
or more dietary constituents.
By using detailed tables of food composition
to calculate the intake of specific nutrients.
• Points1-3 above are relevant to the brief diet
history and point 4 to the full diet history.
Assessment of nutrient intake
• Nutrient intake =nutrient content of food ×
portion weight × frequency of consumption.
• For example, compare the relative contributions
of parsley and milk to vitamin C intake.
• Parsley provides 150mg/100g×1gportion
×once/week=0.2mg/day
• Milk provides 1.5mg/100g×30g portion
× eight/day=3.6 mg/day.
• Be careful to select from the tables the food
which best represents the food described by
the respondent. Similarly, care must be taken
in translating the respondent’s description of
portion sizes into weights.
Evaluation
The quality of the personal contact. Was the
respondent relaxed and talking at ease?
Validity: am I measuring what I think I am
measuring? Is the answer obtained the correct
answer?
Reality: Can I get the same answer on two
separate occasions (unless the respondent has
changed eating habits)?
Standardization of interview techniques and
of tools used in analysis (and methods of use)
is essential otherwise different interviews will
obtain different result.
Verbal communication skills
• During the presentation of questions the
following ideas should be considered.
 You credibility in the eye of the patient will
increase if you demonstrate expertise and show
concern and dedication. Try to be forceful but
not overbearing.
 Rapport is increased if the patient perceives
some similarity with you, eg. Physical similarityage, sex, race, ethnic features, dress, dialect, etc.
However, hidden barriers may be set up by
the lack of such similarities, e.g. Young
dietitian and older patient, slim dietitian and
fat patient.
Rapport is also helped if you begin with an
aspect that the patient would want to hear.
Show by your manner that you are interested and
that your attention is uninterrupted.
Your manners and your words should not indicate
shock or surprise at answer and should not imply
criticism or impatience towards what is being
said.
You have the power to reinforce many
behaviors of the patient.
It should be used judiciously, e.g. Attentive
listening; eye-contact; addressing the person
by name; saying ‘goodʹ, ‘that is interesting’,
reinforce specific behaviours.
Pause for a few seconds after the patient has
apparently finished and before more questions
are asked, in order to give him a chance to speak
further.
Remember that under normal circumstances
there is no time for the patient to be prepared
and there is the inevitable pressure of trying to
provide a quick reply when an interviewer is
waiting for your answer!
 Return to topics on which the patient ‘froze’ in order to
determine if lack of response is significant.
 Avoid bringing the patient abruptly back when he
digresses.
 Use appropriate wording for ‘probing’ question to
maintain a good relationship, e.g. ‘I am interested in
what you are saying could you tell me more about that?’.
• You could also adopt a questioning tone when
repeating key sentences of the patient to
indicate that you want elaboration.
Leave any personal or potentially embarrassing
question as near to the end as possible so that a
good rapport has already been established.
At the end of the interview, thank the respondent
and give a positive indication of the usefulness of
the interview.
DIET LABORATORY
Specific objectives
• Learn to use local foods to prepare nutritious meals.
• Learn to combine foods in a number of ways to
constitute a variety of meals to avoid monotony in
feeding any group of people.
• Learn the equivalents measures of the weights of
different foods items.
• To familiarise oneself with appropriate serving
portion for the various age groups in the family.
• Learn to use Food Composition Tables to calculate
the energy and nutrient contents of foods and
meals.
• Be able to evaluate the nutritional adequacy of
daily.
Assessment
• 10% for the paper work
• 10% for practical work
• Total = 20%
Uses Of The Composition Table
• The nutrients values are based on quantitative analysis
of the food samples so it is important that they
represent the average composition of typical foods.
• They are useful in clinical practice can be used to assess
nutritionally related disease and to accurately
prescribe diets containing known amounts of
nutrients.
• It can be used to determine the nutrients adequacy of
diets.
• It can be used to detect imitation or substitute food
Limitations
• No food composition can represent the exact
composition of food that is eaten.
• For prepared dishes the recipe used in the table might
not be same as the person whose dietary data you are
collecting.
• If adequate sampling was not done during compilation
of the table, you end up with food samples that are not
representative.
• There could also
determination
be
analytical
errors
in the
Assignment
• Plan, prepare and serve a suitable breakfast, lunch
and supper for a 10-year old boy from Eastern
region. Attempt to meet the RDA and cost the
meal.
• RDA for a 10- year old boy(FAO/WHO)
• Energy – 2200
• Protein- 34 gm
Meal planning steps
• Select the staple food item
• Select the vegetable that goes very well with the staple.
• Select a protein-rich item
• Select a oil if necessary
• Determine quantities of ingredients
• Lunch – jollof rice
2 slices of pawpaw
• List of ingredients
 Rice -- 1kg---10GHC
 Fresh tomatoes ----500grams----- 2GHC
 Oil(peanut)
 Onions
 Pepper
 Salt
 Smoked fish(salmon)
 Beef
• Weigh all ingredients and their prices on a sheet of paper.
Food item
Rice
Oil
Beef
Tomatoes
Onion
Mackerel
Cost (GHC) t Weight(oz/gm)
Energy (kcal)
Protein (gm)
Diabetic diet
• Globally, as of 2010, an estimated 285 million
people had diabetes, with type 2 making up about
90% of the cases. Its incidence is increasing rapidly,
and by 2030, this number is estimated to almost
double.
• Diabetes mellitus occurs throughout the world, but
is more common (especially type 2) in the more
developed countries.
• The greatest increase in prevalence is, however,
expected to occur in Asia and Africa, where most
patients will probably be found by 2030.
• The increase in incidence in developing countries
follows the trend of urbanization and lifestyle
changes, perhaps most importantly a "Westernstyle" diet.
Definition
• Diabetes is a metabolic disorder
characterised by high blood glucose
and either insufficient or ineffective
insulin.
Pathophysiology
• An understanding of the pathophysiology of diabetes rests
upon knowledge of the basics of carbohydrate metabolism
and insulin action.
• Following the consumption of food, carbohydrates are
broken down into glucose molecules in the gut. Glucose is
absorbed into the bloodstream elevating blood glucose
levels.
• This rise in glycaemia stimulates the secretion of insulin
from the beta cells of the pancreas. Insulin is needed by
most cells to allow glucose entry.
• Insulin binds to specific cellular receptors and facilitates
entry of glucose into the cell, which uses the glucose
for energy.
• The increased insulin secretion from the pancreas and
the subsequent cellular utilization of glucose results in
lowered of blood glucose levels.
• Lower glucose levels then result in decreased insulin
secretion.
• If insulin production and secretion are altered by
disease, blood glucose dynamics will also change. If
insulin production is decreased, glucose entry into cells
will be inhibited, resulting in hyperglycemia.
• The same effect will be seen if insulin is secreted from
the pancreas but is not used properly by target cells.
• If insulin secretion is increased, blood glucose levels may
become very low (hypoglycemia) as large amounts of
glucose enter tissue cells and little remains in the
bloodstream.
• Following meals, the amount of glucose available
from carbohydrate breakdown often exceeds the
cellular need for glucose.
• Excess glucose is stored in the liver in the form of
glycogen, which serves as a ready reservoir for
future use.
• When energy is required, glycogen stores in the
liver are converted into glucose via glycogenolysis,
elevating blood glucose levels and providing the
needed cellular energy source.
• The liver also produces glucose from fat (fatty acids)
and proteins (amino acids) through the process of
gluconeogenesis.
• Glycogenolysis and gluconeogenesis both serve to
increase blood glucose levels.
• Thus, glyceamia is controlled by a complex
interaction between the gastrointestinal tract, the
pancreas, and the liver.
• Multiple hormones may affect glycemia. Insulin is
the only hormone that lowers blood glucose levels.
• The counter-regulatory hormones such as glucagon,
catecholamines,
growth
hormone,
thyroid
hormone, and glucocorticoids all act to increase
blood glucose levels, in addition to their other
effects.
Classification
• There are three major types namely;
• Type 1
• Type 2
• Gestational diabetes
Type 1 Diabetes
• The underlying pathophysiologic defect in type
1 diabetes is an autoimmune destruction of
pancreatic beta cells.
• Following this destruction, the individual has an
absolute insulin deficiency and no longer
produces insulin.
• Autoimmune beta cell destruction is thought to be
triggered by an environmental event, such as a viral
infection.
• Genetically determined susceptibility factors
increase the risk of such autoimmune phenomena.
• The onset of type 1 diabetes is usually abrupt. It generally
occurs before the age of 30 years, but may be diagnosed at
any age.
• Most type 1 diabetic individuals are of normal weight or
are thin in stature.
• Since the pancreas no longer produces insulin, a type 1
diabetes patient is absolutely dependent on exogenously
administered insulin for survival.
Type 2 Diabetes
• The underlying pathophysiologic defect in type 2 diabetes
does not involve autoimmune beta-cell destruction.
Rather, type 2 diabetes is characterized by the following
three disorders:
 Peripheral resistance to insulin, especially in muscle cells.
 Increased production of glucose by the liver.
 Altered pancreatic insulin secretion.
• Increased tissue resistance to insulin generally occurs first
and is eventually followed by impaired insulin secretion
• The pancreas produces insulin, yet insulin resistance
prevents its proper use at the cellular level. Glucose cannot
enter target cells and accumulates in the bloodstream,
resulting in hyperglycemia.
• The high blood glucose levels often stimulate an increase in
insulin production by the pancreas; thus, type 2 diabetic
individuals often have excessive insulin production
(hyperinsulinemia).
• Over the years, pancreatic insulin production
usually decreases to below normal levels.
• In addition to hyperglycemia, type 2 diabetic
patients often have a group of disorders that
has been called "insulin resistance syndrome"
or syndrome X
• Obesity contributes greatly to insulin resistance,
even in the absence of diabetes. In fact, weight loss
is a cornerstone of therapy for obese type 2 diabetic
patients.
• Insulin resistance generally decreases with weight
loss.
• Obesity also may explain the dramatic increase in
the incidence of type 2 diabetes among young
individuals in the world in the past 10 to 20 years.
• Once considered a disease of adults, type 2
diabetes has increased among the youth in
direct correlation with the increase in the
average weight of children and young adults
during that time period.
Gestational Diabetes
• Gestational diabetes occurs in approximately 4% of
pregnancies.
• It usually develops during the third trimester and
significantly increases perinatal morbidity and
mortality.
• The proper diagnosis and management of
gestational diabetes improves pregnancy outcomes.
• As with type 2 diabetes, the pathophysiology of
gestational diabetes is associated with increased
insulin resistance.
• Most patients with gestational diabetes return to
a normoglycemic state after parturition;
• However, about 30 to 50% of women with a
history of gestational diabetes will develop type
2 diabetes within 10 years.
Impaired Glucose Tolerance and
Impaired Fasting Glucose
• The conditions known as Impaired Glucose Tolerance
(IGT) and Impaired Fasting Glucose (IFG) represent
metabolic states lying between diabetes and
normoglyceamia.
• People with IFG have increased fasting blood glucose
levels but usually have normal levels following food
consumption.
• Those with IGT are normoglycemic most of the time but
can become hyperglycemic after large glucose loads.
• IGT and IFG are not considered to be clinical entities;
rather, they are risk factors for future diabetes.
• The pathophysiology of IFG and IGT is related primarily
to increased insulin resistance whereas endogenous
insulin secretion is normal in most patients.
• Approximately 30 to 40% of individuals with IGT or IFG
will develop type 2 diabetes within 10 years after onset.
Symptoms
Polyuria (frequent urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger).
Physiological basis of symptoms of diabetes
• Without sufficient insulin, glucose accumulates in
the blood, resulting in hyperglycemia.
• Normally, the kidneys retain glucose rather than
excrete it, but when blood glucose rises too high,
the excess ‘spills’ into the urine (glucosuria).
• High blood glucose creates an osmotic effect,
drawing water from the cells into the blood.
• Furthermore, as glucose spills from the blood into
the urine, water leaves with it.
• Thus both the intracellular fluid and extracellular
fluid become depleted, and as a consequence,
people with uncontrolled diabetes can become
severely dehydrated.
• They produce excessive urine (polyuria) and being
dehydrated they may also experience excessive
thirst (polydipsia).
• These are early symptoms of diabetes.
• Both types of diabetes deprive cells of fuels they
need for energy.
• Amino acids and glucose may abound in the body
fluids, but the cells have little access to them and
therefore mobilize their own protein and fat
supplies for energy.
• They break down large amounts of fatty acids, and
liver responds by making ketones bodies, which
accumulates in the blood (ketonemia).
• Ketones in the blood lower its pH because they contain
acid groups in their their structure.
• Ketones may begin to appear in the urine (ketonuria)
• In addition, sodium and potassium become depleted
because the kidneys excrete them along with ketones.
The loss of sodium and potassium, both base formers,
worsens the acidosis.
• When acidosis becomes severe enough, a potential
fatal coma may follow(diabetic coma or insulin shock).
• Losses of glucose and ketone bodies(both energy
sources) in the urine, and protein breakdown, leads
to weight loss.
• The person with IDDM is likely to be thin and may
eat excessively(polyphagia).
Risk factors
Family history
Obesity
Lack of exercise
Poor diet
 Excess consumption sugar-sweetened drinks↑
 Saturated fats↑
 Monounsaturated and polyunsaturated ↓
Urbanization
Stress
Diagnosis
Condition
2 hour glucose
mmol/l(mg/dl)
Fasting blood glucose
mmol/l(mg/dl)
Normal
<7.8 (<140)
<6.1 (<110)
Impaired fasting glyceamia
<7.8 (<140)
≥ 6.1(≥110) & <7.0(<126)
Impaired glucose tolerance
≥7.8 (≥140)
<7.0 (<126)
Diabetes mellitus
≥11.1 (≥200)
≥7.0 (≥126)
Complications
• In uncontrolled diabetes, small arteries that feed
tissues become blocked or destroyed causing the
tissues to die from lack of nourishment. The end
result are;
 loss of circulation to the legs and feet, sometimes
leading to amputation;
 loss of circulation to the heart; sometimes leading
to heart attack or strokes;
loss of vision due to retina degeneration
(retinopathy)
loss of nerve function(neuropathy) causing loss
of sensation in the limbs; and
loss of kidney function (nephropathy)
sometimes requiring hospital care or kidney
transplant.
• Infections are likely because bacteria strive in
glucose-rich blood and can advance undetected
in limbs already made insensitive by loss of
nerve function.
Objectives of dietary treatment
To achieve optimal blood glucose concentration.
To achieve optimal lipid concentration.
To prevent, delay,
complications.
and
treat-diabetes-related
To improve health through balanced nutrition.
To achieve weight loss in the overweight diabetic
To minimize the risk of hypoglycemia in diabetics
treated with insulin and certain oral hypoglycemic
agents.
General dietary guidelines
• Modern dietary management of diabetes
essentially involves modification of the quality
and quantity of food to be taken by the
diabetic patient.
• The following guidelines are applicable to
diabetes irrespective of type, weight, status,
age, gender, or occupation
Separate meals or specially prepared foods are not
necessary
Eat three meals a day about the same volume at the
same time everyday. Snacks(small meal may be added
if necessary).
Allow 4-5 hours between meals. Take 10-20 minutes to
eat a meal.
Insulin injection and diabetes tables except metformin
should be taken 30 minutes before meals. Metformin
should be taken with meals.
No fasting
Most of the carbohydrates consumed should be in
the form of starch(polysaccharides) such as maize,
rice, beans, bread, potatoes, yam, cassava, plantain.
All refined sugars such as glucose, sucrose, and
their products(soft drinks, malt drinks, sweets,
toffees and honey should be avoided except during
severe illness or episodes of hypoglyceamia.
These foods contain sugars in simple form which is
easily absorbed causing rapid rise in blood sugar.
Non-nutritive sweetener, e.g. canderel, saccharine,
nutrasweet, aspartame are suitable sugar substitutes
for diabetics subjects.
Animal fat such as butter, lard, egg yolk, and other
foods high in saturated fatty acids and cholesterol
should be reduced to a minimum and replaced with
polyunsaturated fats such as vegetable oils.
Salt should be reduced whether hypertensive or
not.
Protein (fish, meat, beans, crab, crayfish, soybean
and chicken) and salt are restricted for those with
diabetic nephropathy.
The items allowed for free consumption include;
(a)water, green vegetables, tomatoes, onions,
cucumber peppers, vegetable salad without cream.
(b)Any brand of tea, coffee or drinks that contain
very low or no calories
For patients too ill eat solid food, a fluid or semi solid
diet should be substituted . The following should be
given;
• Any soup plus one of the following : 2 egg size of fufu,
banku, TZ, apkle, potatoes or agidi
• 2 laddleful of mpotompoto
• ½ yogurt or ice cream or ½ bottle of soft drink
• ½ cup porridge, mashed kenkey or fula plus milk and ½
dessertspoon of sugar if desired.
Patients treated with insulin or certain oral
hypoglyceamic agents e.g, sulphonylureas, must be
advised to eat regularly and often to prevent
hypoglyceamia.
Cigarettes smoking should be avoid by diabetics
patients. Alcohol should be taken in moderation.
Small meals spaced over the day rather than
one or two big meals are helpful in avoiding
postprandial peaks in blood sugar.
The diet should be varied to avoid monotony
and provide a wider range of nutrients for
healthy living.
In case of on coming hypoglycaemia (low blood
sugar level), Patients may feel shaky, sweaty, dizzy,
weak and fainting: patients should be advised to
take one of these:
• 1 dessertspoon(eating spoon) of sugar or honey( in
water if possible)
• 3 cubes of sugar dissolved in water
• ½ bottle of soft drink or ½ refresh.
• Regular insulin has an onset of action (begins
to reduce blood sugar) within 30 minutes of
injection, reaches a peak effect at 1-3 hours.
Anthropometrics and dietary
recommendations
• The broad principle of daily energy
recommendation for diabetics is based on
maintaining the ideal body weight for the
height of the individual.
Underweight(BMI<18.5kg/m²)
The goal here is to gain or regain weight. To gain
weight the patient must take in more calories than
needed to meet the body’s physical requirements.
Emphasis should be on balance diet
Keeping to his or her favourite foods
Regular meals
Increasing serving sizes to about twice what the
patient is already consuming.
• Weight gain is gradual and the patient should be
regularly reviewed (at 2 to 4-week intervals) and
further increase in ‘serving sizes’ made when deem
necessary.
Overweight (BMI>25kg/m²)
The aim here is to reduce weight while
optimising drug therapy.
Weight reduction must be gradual over a
period of time-the target should be about 1.01.5kg loss every 1 to 2 weeks
In limiting the number of calories calories
consumed per day, the patients does not need
to abstain from his/her favourites foods
 What is needed is to know how much to cut
back on portion sizes(portion control)
The target initially is to cut down to half the
previous serving sizes per meal with a monthly
review and subsequent reduction when
deemed necessary.
The serving size reduction should affect
particularly the complex carbohydrates, which
constitute the main staple foods in the tropics.
Many type 2 diabetes patients find portion
control an important aspect of the solution to
losing weight.
By monitoring the ‘serving sizes’
combining it with regular exercise
drugs(especially metformin), patients
enjoy a wider variety of meals including
favourites foods and still lose weight.
and
and
can
their
Portion control can also help overcome the
biggest challenge, which is maintaining
healthy weight.
When overweight diabetic patients shed some
weight by trimming down ‘serving sizes’ and
calories, insulin sensitivity improves, thereby
optimising drug therapy.
Normal weight(18.5-24.9kg/m²)
• The
fundamental
principle
behind
maintenance of body weight is the energy
balance.
• This group should encouraged to maintain
their weight by:
Maintaining current ‘portion sizes’
Eating about the same amount of food each
day
Taking their drugs at the same time each day
Exercising at the same time each day
These patients should endeavour to choose
their daily foods from starches, vegetables,
fruits and protein while limiting the amount of
fat.
Ethical issues in
dietetics practice in
Ghana
REFER TO PATIENT’S CHARTER