NFMNT Chapter 6 Fundamentals of Medical Nutrition Therapy for the CDM

Nutrition Fundamentals and Medical Nutrition Therapy

Fundamentals of Medical Nutrition Therapy for the CDM

Corresponds with LEARNING PLAN 6Copyright 2016 Association of Nutrition and Foodservice Professionals

6

Objectives

Identify basic medical nutrition terminology as related to obesity, weight management, cardiovascular disease, diabetes, cancer and HIV/AIDS

Define the basic concepts of medical nutritional therapy as related to obesity, weight management, cardiovascular disease, diabetes, cancer and HIV/AIDS

Relate basic concepts to nutritional deficiency and excess

Nutrition Fundamentals & Medical Nutrition Therapy Fundamentals of Medical Nutrition Therapy for the CDM Learning Plan 6

Objectives

Relate basic concepts of medical nutritional therapy as related to obesity, weight management, cardiovascular disease, diabetes, cancer and HIV/AIDS

Compare basic concepts to current diet manual or other accepted resources

Explain utilization of medical nutritional therapy in long-term care and acute care settings


Chronic Diseases Chronic diseases are degenerative diseases of the body

organs due in part to diet» Diseases resulting from nutrition deficiency

- Less common now than 50+ years ago» Diseases resulting from nutrition excess

- By far the most common cause of many chronic diseases Obesity, cardiovascular disease, hyperlipidemia Type 2 diabetes, some cancers, osteoporosis Hypertension


Medical Nutrition Therapy

Nutritional assessment and treatment of a condition, illness, or injury that places an individual at risk» Two parts:

1. Assessment of the client’s nutritional status2. Treatment/intervention

Generally focuses on individuals at risk for nutritional problems» Begins with nutritional screening – identifying those clients

who are at risk


Medical Nutrition Therapy

Treatments» Therapeutic diet

- Adjust to meet a client’s special nutrient needs» Counseling» Nutrition Support


Overweight and Obesity

When energy intake exceeds the amount of energy expended

No single cause and no single treatment for obesity


Overweight and Obesity

Excess fat around the waistline increases health risk» Woman with 0.8 or above is at a high risk» Man with 0.95 or above is at a high risk

3500 calories = 1 pound of body fat


Brain Break When exercising throughout one week, how many

calories would you have to expend each day to lose one pound of fat?

» 500 each day for a total of 3500 in one week


Overweight and Obesity Many health professionals are adopting a non-dieting

approach to obesity

Treatment options» Nutrition education» Exercise» Behavior modification» Attitude modification» Social support and maintenance support» Drugs and/or surgery


MNT and ObesityMenu Planning for Weight Loss or Maintenance

Most successful healthy eating options» Protein

- 10-35% of total calories» Carbohydrate

- 45-65% of total calories» Fat

- 20-35% of total calories


MNT and ObesityNutrition Education

Calorie restriction is limited

No foods are forbidden

Portion control is vital

Variety, balance, moderation

Weighing oneself weekly

Food journaling


MNT and ObesityExercise

Vital component to a weight loss program

Benefits of physical activity (see textbook for full list)» Burns extra calories» Improves self-image» Reduces fatigue; energizes the body» Improves cardiovascular health» Increases muscle; reduces fat


MNT and ObesityOther Treatments

Behavior modification

Attitude modification

Social support

Drugs and surgery


MNT and ObesityMenu Planning

Protein» 10-35 percent of total calories

Carbohydrate» 45-65 percent of total calories

Fat» 20-35 percent of total calories

Use the online tool Choose MyPlate


http://www.choosemyplate.gov/

Brain Break

A friend just asked your opinion on a new diet he is interested in. The diet severely limits carbohydrates, including having no fruit. What advice would you offer?» A healthy eating plan does not severely limit or restrict any foods. A good

plan should include identifying why he eats what he does so he can change some problem food behaviors, if needed. A good plan may also include an exercise component. Suggest that he look at the Choosemyplate.gov for a personalized plan.


Cardiovascular Disease Heart Disease-Coronary Artery Disease

Atherosclerosis - plaque build-up in arteries

Myocardial infarction - heart attack

Risk Factors» Hyperlipidemia – high blood cholesterol» Low-Density Lipoproteins (LDL)» High Density Lipoproteins (HDL)» Triglycerides

- most common fat in humans; affected by excess sugars, starches, and alcohol in the diet


Cardiovascular DiseaseRelationship between Saturated Fats and Cardiovascular Disease

Critical issue is the type of fat in the American diet» Saturated fats» Trans fat

To lower LDL cholesterol with MNT» Substitute unsaturated fat for saturated fat» Increase complex carbohydrates» Consume omega-3 fatty acids


Cardiovascular DiseaseRelationship with Cholesterol

Dietary cholesterol data has changed over the years. A subset of the population (1/3) may be “hypersensitive” meaning dietary cholesterol may raise blood cholesterol.

Data shows saturated fat may raise blood cholesterol.

Animal products contain cholesterol» Sources of high cholesterol foods

- Egg yolks, liver, fat in meats and poultry, shellfish, dairy fat in cream, whole milk and regular cheeses

Daily average cholesterol intake should be less than 300 mg

Drug treatment is appropriate for adults who have a high LDL level and/or if they also have other risk factors


Cardiovascular DiseaseChoosing Foods Low in Saturated Fat and Cholesterol

Consume more» High fiber foods, plant proteins, omega-3 fatty acids, garlic,

green tea, lean meat, low-fat dairy foods

Consume less» Saturated fats, trans fats, sugars

Drug treatment» Statins


Cholesterol Guidelines

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Brain Break

What foods should be substituted in the following menu to decrease the saturated fat content?» Grilled Cheddar Cheese Sandwich, Cream of Tomato Soup, Crackers, Ice

Cream

» Use low-fat cheddar, skim evaporated milk in the soup, whole grain crackers, fruit


Cardiovascular DiseaseStroke

Blockage of artery that supplies blood to the brain

Embolus (clot)

Cerebral hemorrhage

Aneurysm

Transient ischemic attack (TIA)

Prompt medical attention if a stroke is suspected is of utmost importance

Limit » saturated fats, trans fats


Cardiovascular DiseaseHypertension/High Blood Pressure

Lifestyle modifications» Weight loss» Increased physical activity» Medical nutrition therapy – current recommendation is to

reduce sodium intake to less than 1500mg per day» Moderation of alcohol intake» Tobacco avoidance» Medicine

- Diuretics- Beta blockers


Cardiovascular DiseaseMNT and High Blood Pressure

Reduce sodium (NaCl) in diet» No Added Salt – 4 gram (4000 mg)

- No salt added at table» Sodium controlled diet – 2 gram (2000 mg)

- More restrictive, limiting processed foods, milk, bread, and other starches

» Recorded as 2 gm NA diet» Current AHA recommendation is 1500 mg of sodium daily



Increase potassium» Recorded as K diet» DASH diet

- Reduces sodium; increases potassium- Focus on vegetables, fruits, low fat milk, whole grains, poultry,

fish, nuts- Limit red meat, sweets, sugar containing beverages



A sodium-controlled diet can be very challenging for a client to tolerate

Become familiar with grocery shopping and food preparation tips to assist your client in following this medical nutrition therapy approach

Focus on new and fresh flavors including sodium free herbs and spices

Recommend appropriate recipes and tools


Brain Break

If the recipe calls for adding 2 teaspoons of salt, how many milligrams of sodium are being added?

» 4600


Cardiovascular DiseasePulmonary Conditions

Chronic Obstructive Pulmonary Disease (COPD)» A group of diseases» Shortness of breath» 90% of the time is caused by smoking» Malnutrition due to loss of appetite and increased caloric

need

Nutritional approaches- Small frequent meals- Higher fat diet, lower carbohydrate diet- Potential for fluid restriction


Diabetes Mellitus

Metabolic Disorder – not caused by ‘sugar’» Lack of insulin (hormone) manufactured in pancreas, to

allow body to utilize the glucose it needs» Result is hyperglycemia or high blood sugar

7th leading cause of death in the U.S.

Excess sugar in the body due to lack of insulin can damage kidneys, heart, blood vessels, nerves, and eyes


Diabetes Mellitus

Diagnosis may be based on A1C criteria or plasma glucose criteria» Fasting plasma glucose of 126 mg/dl OR

- A1C > 65% OR Random plasma glucose of > 200 mg/dl with symptoms


Diabetes Mellitus

Type 1» Symptoms often begin in childhood» Insulin-dependent» Family history or caused by acute illness

Ketosis» Dangerous chemicals in the blood» Can lead to coma or death

Type 2 – Most Common» Symptoms begin in adulthood» Obesity is a primary factor» Not always insulin-dependent

Gestational Diabetes» Occurs during pregnancy


Diabetes Management

Maintain near-normal blood glucose level» Medication» Food» Exercise

Hypoglycemia – low blood sugar» Unpleasant side effects

Insulin » Several types to individualize each treatment approach

Oral hypoglycemic agents» Several types to individualize each treatment approach


Medical Nutrition Therapy for Diabetes

ChooseMyPlate.gov

Carbohydrate Counting

Exchange Lists» System to classify foods into similar groups according to

protein, fat, and carbohydrate» Seven exchange lists


Medical Nutrition Therapy for Diabetes

Exercise» Although not medical therapy, it is essential to therapy

Blood glucose monitoring» Blood sugar or Hemoglobin A1c (HbA1c)


Brain Break

Which method of controlling diabetes through diet may allow the client the most freedom?

» Carbohydrate Counting


Cancer

Malignant – life threatening

Benign – tumor not cancerous

Metastasis – uncontrolled growth throughout the body

Good baseline nutritional status is important prior to treatment» Chemotherapy» Radiation therapy

Use your knowledge and skills to offer nutritious foods that are well accepted, and take any accompanying symptoms into account


Medical Nutrition Therapy for Cancer Increased calories

» 35 – 50 Calories per kilogram of body weight

Offer smaller amounts of food, more often

Cater to special requests

Offer high-calorie, high-protein foods

Avoid foods with strong odors


Brain Break

A client who has cancer and weighs 75 kilograms would need how many calories?

» 2600 - 3800


HIV/AIDS Acquired Immunodeficiency Syndrome

Nutritional interventions include» Addressing malnutrition» High protein, high calorie foods» Supplements as appropriate» Alteration of textures and temperatures in the event of

mouth sores» Response to nausea, vomiting and diarrhea


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