NCM 105 - NUTRITION AND DIET THERAPY
Food Guides/Food Labels
- qualitative tool in planning nutritious diets for the masses
- teaches the principles of eating a variety of foods everyday in proper amounts of servings
Cambodia - in the shape of Angkor Wat (temple complex that’s one of the largest religious monuments in the world);
schoolchildren were surveyed by the Ministry of Health about the foods they most commonly eat
Benin - a round traditional house with a thatch roof; drink a lot of water; nasa entrance yung water as a symbol of
hospitality and plenty of water should be consumed in a day
Antigua and Barbuda - uses pineapple kasi native fruit to sa kanila; more on fruits less on beans
Qatar - seafood shell
Korea - gives importance to physical activity; bike
Japan - same sa korea; shape of food guide is spinning top which is the traditional toy; may natakbong tao around a
glass
Canada - no rice but there’s bread; least canned goods
Philippines - eat more vegetables and fruits
China - uses the traditional five levels like temple; physical activity and water
India - more cereals less meats
Malaysia - more on fruits
Dash Diet - dietary approach to stop hypertension; expensive diet
Diabetic Diet - diabetic people does not have a special diet
The Asian-Pacific Type 2 Diabetes Policy Group has outlined the following simple reminders:
 eat most vegetables, legumes, lentils, noodles, rice, bread, grains, barley, wholegrain cereals, fresh fruit (lowsugar)
 eat moderately protein-rich food
 eat less sugars, salt, and alcohol
Nutritional Guidelines for Filipinos (NGF), 2000
- set of dietary guidelines based on the:
 eating pattern
 lifestyle
 health status of Filipinos
- provides the general public with easy and simple recommendations on proper diet and practices thet bring about
good health for every individual
1. eat a variety of foods everyday - no single food provides all nutrients
2. breast-feed infants exclusively from birth to 6 months, and then, give appropriate foods while
continuing breast-feeding – give suitable complementary food in addition to breast feeding at about 6
months or when the infant is ready. Start with small amounts when introducing new foods
3. maintain children’s normal growth through proper diet and monitor their growth regularly – weigh
children regularly. Maintain normal growth with proper diet
4. consume fish, lean meat, poultry or dried beans – these are intended to correct deficiencies in the current
dietary pattern of Filipinos. These include good quality protein, iron, and zinc.
5. eat more vegetables, fruits and root crops – these are intended to correct deficiencies in the current dietary
pattern of Filipinos. These include good quality protein, iron, and zinc.
6. eat foods cooked in edible/cooking oil daily – these are intended to correct deficiencies in the current
dietary pattern of Filipinos. These include good quality protein, iron, and zinc.
7. consume milk, milk products and other calcium-rich foods, such as small fish and ark green leafy
vegetables every day – these are intended to correct deficiencies in the current dietary pattern of Filipinos.
These include good quality protein, iron, and zinc.
8. use iodized salt, but avoid excessive intake of salty foods – use iodized salt to prevent iodine deficiency,
which is a major cause of mental and physical underdevelopment among Filipinos. Caution about the use of
excessive salty foods among persons at high risk for hypertension
9. eat clean and safe food – prevent food-borne diseases. Know the sources of contamination
10. for a healthy and good nutrition, exercise regularly, do not smoke, and avoid drinking alcoholic
beverages – observe a healthy lifestyle with regular exercise, abstinence from smoking and alcohol
consumption. If alcohol is consumed occasionally, drink in moderation
Terms Used on Food Labels
free - nutritionally trivial and unlikely to have a physiologic consequence
good source of - the product provides between 10 and 19 percent of the daily value for a given nutrient
healthy - food low in fat, saturated fat, cholesterol, and sodium
high - 20% more of the daily value
less - 25% less of a given nutrient or kcalories
light or lite - 1/3 fewer kcalories than normal, 50% or less of fat or sodium
low - amount that would allow frequent consumption without exceeding the daily value
more - 10% more of the daily value
organic (on food labels) - 95% of the product's ingredients have been grown and processed according to USDA
regulations
ENERGY
kcalorie free - fewer than 5kcalories per serving
low kcalorie - 40kcalories or less
reduced kcalories - 25% fewer kcalories
FAT AND CHOLESTEROL
percent fat free – if the product meets the definition of low fat or fat free; amount of fat in 100g
fat free – less than 0.5g of fat per serving; zero-fat, no-fat, nonfat
low fat – 3g or less fat
less fat – 25% less fat
saturated fat free – less than 0.5g of saturated fat
low saturated fat – 1g or less saturates fat and less than 0.5g of trans fat
less saturated fat – 25% less saturated fat and trans fat combined
trans fat free – less than 0.5g of trans fat and saturated fat
cholesterol free – less than 2mg cholesterol per serving
low cholesterol – 20mg or less cholesterol
less cholesterol – at least 25% less cholesterol
extra lean - less than 5g of fat, 2g of saturated fat and trans fat, and 95mg of cholesterol
lean – less than 10g of fat, 4,5g of saturated and trans fat, 95mg of cholesterol
CARBOHYDRTAES: FIBER AND SUGAR
high fiber – 5g or more of fiber
sugar-free – less than 0.5g of sugar
SODIUM
sodium free and salt free – less than 5mg of sodium
low sodium – 140 mg or less
very low sodium – 35mg or less
LABEL CLAIMS
Nutrient claims – the level of nutrient in food; ex, is fat free or less sodium
Health claims – relationship of food or food component to a disease or health-related condition; ex. Soluble fiber from
oatmeal
Structure-function claims – effect that a substance has on the body structure or function of the body and so not
make reference to a disease; ex. Supports immunity and digestive health
*products containing sugar replacers may claim to “not promote tooth decay” if they meet FDA criteria for
dental plaque activity
*products containing aspartame must carry a warning for people with phenylketonuria
*products that claim to be “reduced calories” must provide at least 25% fewer kcalories per serving
*products containing less than 0.5g or sugar per serving can claim to be “sugarless” or “sugar-free”
Diabetes Mellitus
medical nutrition therapy - treatment for diabetes; continuous process of modifying nutrient intake
1. Goals of medical nutrition therapy
2. maintain near-normal blood glucose levels
3. normalize the serum lipoprotein levels and blood levels
4. allow and maintain reasonable body weight
5. promote overall health because of heterogeneous eme of diabetes
Nutritional goals, principles and recommendations
calories - for weight loss, either low-carb or low-fat calorie-restricted diets
protein - nephropathy decrease of kidney function; no more than 0.8 g/kg body weight
fat - saturated fat less than 7% of daily calories
cholesterol - less than 200mg/day
carbohydrates - glycemic control
sweeteners - use of non-nutritive sweeteners which are safe to consume
fiber - 25-35g per day
sodium - 2000mg/day
alcohol - 2 serving for boys 1 serving for girls
vitamins and minerals - chromium and vitamin E and C may benefit daw pero di proven na may effect sa diabetes
Diet principle
1. individualization - ability of patient, willingness to cooperate, health profession should be sensitive,
2. energy - weight reduction of about 10-20 lbs in obese patients; equal input and output for normal weight
patient; underweight patient meets the normal weight
3. carbohydrate - 50-60% of normal carbs
4. protein and fat - not the same as carbs na may limitation kasi walang effect sa blood sugar; does not need to
be consistent everyday
5. exercise - needed to improve the bodys response to insulin, to lower blood glucose levels, key factor in the
success in achieving lower body weight and normal weight
6. meal patterns – sunod-sunod na gagawin to minimize hypo- or hyperglycemia
7. measuring foods - when the food is cooked na yung pagmeasure ng pagkain
8. special foods - not necessary kasi expensive, low in calorie
CLASSIFICARIOM OF DIABETES MELLITUS
Type 1 - no insulin is produced; beta cell destruction
Type 2 - may insulin but hindi enough; progressive insulin secretory defect
gestational diabetes - occurs in pregnancy with multiple pregnancies; gave birth to more than 8lbs baby, increased
BMI prior to pregnancy
Other specific type of diabetes:
 genetic defects in beta cell function, insulin action
 disease of the exocrine pancreas
 drug- or chemical-induced
Clinical Symptoms of DB
pyloria -frequent urination
polydipsia - increased thirst
polyphagia -increased appetite
dehydration - not balanced by water intake
weight loss - eating more than usual to relieve hunger
blurred vision -when blood sugar is too high
slow healing sores of frequent infection - type 2 diabetes
areas of darkened skin - type 2 diabetes have velvety skin in the folds like armpits and necks
(acanthosisnigricans), may be sign of insulin resistance
Biochemical Symptoms of DB
glycosuria -presence of sugar in urine
hyperglycemia - elevated blood glucose due to lack of insulin
ketosis or acidosis - accumulation of ketone bodies due to rapid oxidation of fatty acids
ketonuria - presence of ketone bodies
Management of DM
NUTRITION
1. nutrition care process
2. individualized to keep nutritional needs
3. goals of nutrition therapy of DM:
 CARBS
 PROTEINS – don’t use protein to treat hyperglycemia
 FATS - minimize trans fat, 2 servings of fish every week
 Other recommendations:
 recommended dietary modifications
 maintain/achieved calories
 strategies in teaching meal planning
o carbs counting
o exchange list
o portion control
4. distribution of the TER for GDM are as follows
 breakfast - 10%
 AM Snack -10%
 lunch - 30%
 PM Snack - 10%
 dinner - 30%
 bedtime snack - 10%
Medications
sulfonylureas – taken before meals, increases insulin production in the pancreas
meglitinides - same as sulfonylureas but with rapid onset and shorter duration
incretins - inhibit the enzyme dipeptidyl IV in the gut that breaks down the hormones incretins which help the
pancreas to produce more insulin and your glucose to stop producing glucose
DPP 4 Inhibitor - used in type 2 DM
Glycemic effects of foods
- effect on the person’s blood sugar and insulin levels.
low glycemic effects - desirable one, slow absorption of carbs,
high glycemic - not desirable, may slow absorption pero may surge ng blood glucose and may over reaction,
promotes patients to over eat
gastric emptying and absorption - happen in small intestine
gastric emptying - delayed ang absorption
food factors
whole rice - slow to digest and results in low blood glucose
processing such as cooking - decrease of glucose response
glycemic index - measure how quickly a food can make your blood sugar rise
low in GI - pasta, legumes, rye bread
intermediate glycemic index -ice cream, rolled oats, sweet corn, white sugar, chico, and mango
high GI - white bread, baked potatoes, papaya, corn flakes, pineapples
food sources
carbs available - digestible- sugars, dextrin, starch, and glycogen; digests in gastrointestinal tract
unavailable indigestible - oligosaccharides, dietary fibers, resistant starch - cellulose, hemicellulose
animal food - milk contains lactose, animal food that contributes to carbs intake
diabetes - caused by sugar that will cause carbs, caloric control is needed not limitation in carbohydrates to prevent
diabetes
recommend high fiber foods (fiber - can prevent glucose surge which prevent diabetes; found in foods low in glycemic
index); can reduce the risk of type 2 diabetes