Presentation on theme: "By Hellen C Baliach Consultant Clinical Nutritionist"— Presentation transcript:
1 By Hellen C Baliach Consultant Clinical Nutritionist Role of Medical Nutrition Therapy in Prevention and Treatment Of DiabetesByHellen C BaliachConsultant Clinical Nutritionist
2 Objectives Definition of terms Outline of objectives of Medical Nutrition TherapyOutline of nutritional assessmentNutritional data from diabetes clinic andDiet Advicory Clinic (DAC)What is the ideal dietChallengesRecomendationsConclusion
4 Definitions of Terms ‘Diabetic diet’-A normal diet is simply a healthy eating planAim-is to control the blood sugar levelDiet forms one of the three cornerstones of good health-1. Exercise/diabetes education 2.medication 3. meal planning
5 Definitions of TermsBMI-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 bodyparticularly in subcutaneous tissues that arises from intake of food in excess of the body energy requirements(WHO, 2004)
6 TermsStunting: 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 < -2Stunted-overweight/obesity-co-existence of stunting and overweight/obesity(WFH Z-scores <-2 and BMI for age z-scores <-2)
7 Aim of Medical Nutrition Therapy (MNT) MNT is important in preventing diabetesmanaging existing diabetesPreventing and slowing the rate of development of diabetes complicationsAchieving nutrition-related goals requires involvement of the person with diabetes in the decision-making process
8 Objectives of Medical Nutrition Therapy Attain and maintain blood glucose level as close as normalPrevent Hypo and HyperglycemiaObtain optimum blood lipids and blood pressure control and reduce the risk of macro vascular disease.Assess energy intake to achieve optimum body weightPromote physical, social and physiological wellbeing.
9 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 symptomsIndividualize meal plan according to a person’s lifestyle and based on usual dietary intake
12 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 ImbalanceThe measurements vary with age,sex,race and degree of nutrition.
13 Body Mass Index Classification Wt(kg)/Ht(m)2(WHO,2006) UnderweightNormal rangeOverweightPreobeseObese class 1Obese class 11Obese class 111BMI< 18.518.5 – 24.99>2525 – 29.9930 – 34.9935 – 39> 40DISEASE RISKLow (but risk of other clinical problems is increasedAverageIncreasedModerateSevereVery severe
15 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 adulthoodPrevalence 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).
16 Waist–hip ratioMeasurement 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.
18 Waist to Hip Ratio Chart Waist and Hip RatioWaist to Hip Ratio ChartMaleFemaleHealth Risk Based Solely on WHR0.95 or below0.80 or belowLow Risk0.96 to 1.00.81 to 0.85Moderate Risk1.0+0.85+High Risk
19 ClinicalObservations – those who use raw carrot juice and raw beet root has elevated Blood Glucose.Sweeterners, diet coke and ‘sugar free juices’
20 Biochemical assessments Lipid profileHBA1CBlood sugarKidney and Hearth functions
21 Ecological factorsAre known to influence the nutritional status of individuals.Variables include; household composition, education, literacyethinicity, religion, income, employment, material resources, water supply and household sanitation, access to health, and agricultural services as well as land ownership.
24 Which diet? Current choices 1. low fat diet 2. low carbohydrates 3. Mediterranean diet
25 Standard modern diet consist of: 55-60% carbohydrates20-30% fat15-20% protein
26 Why low carbohydrates -metabolic consequences Rapid reduction in body weight due to increased lipolysisIncreased water loss at the beginningMild metabolic ketoacidosisDecrease in appetite and eventually food intakeImprovement in insulin resistance, plasma lipids and plasma glucose- caveats hypokalemia (cramps, weak legs) and bowel obstructions
27 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 diabetesBut only as a part of a structured permanent lifestyle modification
28 Major ChallengesMajority of the clients do not access the nutrition services.Less than 5% of the total clients attending DC receive the Nutrition servicesClients have varied nutrition information/knowledge from other health workers,herbalists, relatives, bussinesmen/womenUndoing the information is a challenge.
29 Reccomendations Refer healthy clients – Hospital protocol Refer all clients to Dietician/ NutritionistNutrition guidelines on management of diabetes to be improved.Provision of optimal Nutrition should start before, after and during pregnancyProper feeding practices and growth monitering should start from birth
30 ConclusionGlycemic control is achieved when Drugs and Nutritional Therapy are combinedDiabetes management involves multidisplinary approach.Prevention is better than cure- throughIntensifications of campaigns/education-Breastf eeding and HBV-proteins