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MEDICAL NUTRITION THERAPY (MNT)
Mrs. Sarah JacobMrs. Sarah Jacob
Rtd. Head, Department of DieteticsRtd. Head, Department of Dietetics
Christian Medical CollegeChristian Medical College
Vellore .Vellore .
Medical Nutrition Therapy (MNT) Replaces The earlier term of “Diet Therapy” and stresses aThe earlier term of “Diet Therapy” and stresses a
four pronged approach that includes….four pronged approach that includes….
Assessment of the individual’s metabolic and life Assessment of the individual’s metabolic and life style parametersstyle parameters
Identification of nutrition goalsIdentification of nutrition goals Intervention designed to achieve these goals.Intervention designed to achieve these goals. Evaluation of therapeutic outcome.Evaluation of therapeutic outcome.
Assessment
Involves assessment of habitual dietary pattern inInvolves assessment of habitual dietary pattern in
terms of nutrient content and eating behaviourterms of nutrient content and eating behaviour
HelpsHelps
- To identify goals- To identify goals
- To determine the type of intervention needed - To determine the type of intervention needed calorie intake, food pattern modification calorie intake, food pattern modification
of eating behaviour etc.of eating behaviour etc.
- Rapport building- Rapport building
- Gives information on clinical data. - Gives information on clinical data.
Goals
Treatment goals should be individualised, realisticTreatment goals should be individualised, realistic
and achievableand achievable
- Weight loss if necessary- Weight loss if necessary
- Blood glucose levels to be maintained as close to- Blood glucose levels to be maintained as close to
normal as possiblenormal as possible
- Blood lipid levels within desirable limits- Blood lipid levels within desirable limits
- Consistent and appropriate food intake- Consistent and appropriate food intake
- Regular meal timings- Regular meal timings
- Blood glucose monitoring- Blood glucose monitoring
Intervention - Education
- Appropriate meal plan suggested- Appropriate meal plan suggested
- Strategies for eating behaviour change- Strategies for eating behaviour change
- Food exchanges- Food exchanges
- Importance, source of dietary fibre- Importance, source of dietary fibre
- Adequate nutrient intake by including - Adequate nutrient intake by including varietyvariety
- Importance of exercise.- Importance of exercise.
Steps to individualised diet planning Step:1 - Determine past diet history, food habits,Step:1 - Determine past diet history, food habits, activity socio economic status, cultural andactivity socio economic status, cultural and religious practices etc. religious practices etc. e.g. Sex – male Age – 50 yrs e.g. Sex – male Age – 50 yrs Height – 170 cms or 5’ 7” Height – 170 cms or 5’ 7” Food habits - Non vegetarian Food habits - Non vegetarian Income – Middle IncomeIncome – Middle Income Activity – Sedentary Activity – Sedentary Type of Diabetes – Type 2 DiabetesType of Diabetes – Type 2 Diabetes
Step: 2 Determine ideal or desirable bodyStep: 2 Determine ideal or desirable body
weightweight
(a) Hamwi method (a) Hamwi method
IBW = 106+(7x6) = 148 lbsIBW = 106+(7x6) = 148 lbs
(b) Broca’s Index (b) Broca’s Index
IBW = 170-100 = 70 kgsIBW = 170-100 = 70 kgs
5 – 10% less for diabetics5 – 10% less for diabetics
= 63 – 67 kgs.= 63 – 67 kgs.
Step: 3 Calculate Energy RequirementStep: 3 Calculate Energy Requirement
Basal + activityBasal + activity
= (148 x 10) = (1480 x 20 / 100)= (148 x 10) = (1480 x 20 / 100)
= 1776 Kcal= 1776 Kcal
= Rounded off to 1800 Kcal.= Rounded off to 1800 Kcal.
Step: 4 Determine gm of carbohydrate,Step: 4 Determine gm of carbohydrate,
protein and fatprotein and fat
CHO = 60-65% of total calories = 270g- 292gCHO = 60-65% of total calories = 270g- 292g
Protein = 10-15% of total calories = 45g – 68gProtein = 10-15% of total calories = 45g – 68g
Fat = 20-25% of total calories = 40g – 50gFat = 20-25% of total calories = 40g – 50g
Step : 5 Carbohydrate – 60-65%Step : 5 Carbohydrate – 60-65%
Complex CHO is better than simple sugars Complex CHO is better than simple sugars as absorption is slower as absorption is slower
Amount of CHO in each meal to be Amount of CHO in each meal to be adjusted for each individual.adjusted for each individual.
Step: 6 Step: 6
Dietary fibre present in whole grain cereals, Dietary fibre present in whole grain cereals,
vegetables pulses and fruits delay digestionvegetables pulses and fruits delay digestion
and absorption may help in reducing bloodand absorption may help in reducing blood
sugars and lipids. Recommended intake –sugars and lipids. Recommended intake –
25 - 28g / 1000 Kcal.25 - 28g / 1000 Kcal.
Step: 7 Step: 7 Foods with high fibre content have lower Foods with high fibre content have lower glycemic indexglycemic index
Physical form of foodPhysical form of food Nature of cookingNature of cooking Nature of fibreNature of fibre Amount and composition of meal affect the Amount and composition of meal affect the
glycemic index of food.glycemic index of food.
(8) Protein – 15%(8) Protein – 15%
RDA of protein for adults – 1g/kg body weight.RDA of protein for adults – 1g/kg body weight.
Cereals, pulses, nuts, milk and its products, non-Cereals, pulses, nuts, milk and its products, non-
vegetarian items contribute to the protein contentvegetarian items contribute to the protein content
in the diet.in the diet.
(9) Fat – 20-25%(9) Fat – 20-25%
Type of fat – 7 – 10% SFAType of fat – 7 – 10% SFA
- < 10% PUFA- < 10% PUFA
- 10-15% MUFA- 10-15% MUFA
Step: 10 Step: 10
Translate in terms of food.Translate in terms of food.
Use of exchange listsUse of exchange lists
- gives information on nutrient content- gives information on nutrient content
- provides variety in diet by giving- provides variety in diet by giving
alternativesalternatives
(11) Sample meal plan:(11) Sample meal plan:
Breakfast – Milk – 100 mlBreakfast – Milk – 100 ml
Cereal preparation – from 75g cereal Cereal preparation – from 75g cereal
e.g: 3 iddlies / chappathiese.g: 3 iddlies / chappathies
Mid morning – Fruit + Lime juice withoutMid morning – Fruit + Lime juice without
sugars.sugars.
Lunch – 250 g cooked rice or chappathies – 3Lunch – 250 g cooked rice or chappathies – 3
meat / fish / paneermeat / fish / paneer
vegetablesvegetables
curdscurds
Dhal as sambarDhal as sambar
Tea time: Milk – 100 mlTea time: Milk – 100 ml
Whole gram or pulse – 15gWhole gram or pulse – 15g
Dinner: 250g cooked rice or 3 chappathiesDinner: 250g cooked rice or 3 chappathies
Meat / Fish / DhalMeat / Fish / Dhal
VegetablesVegetables
CurdsCurds
Bedtime: Mild – 200 mlBedtime: Mild – 200 ml
Oil for cooking – 3-4 teaspoonsOil for cooking – 3-4 teaspoons To be adjusted to suit individual needs.To be adjusted to suit individual needs.
Eating modifications
Reduce cereal intakeReduce cereal intakeAvoid simple sugars – Honey, Sucrose etc.Avoid simple sugars – Honey, Sucrose etc.Avoid fried foods – chips, nuts etcAvoid fried foods – chips, nuts etcIncrease use of vegetables – ensure adequate fibre Increase use of vegetables – ensure adequate fibre intakeintakeEat regular mealsEat regular mealsRegular food and exerciseRegular food and exerciseBalanced meal to ensure adequate Vitamins andBalanced meal to ensure adequate Vitamins and Minerals.Minerals.
Type I Diabetes – in children
(a)(a) Energy: 1000 kcal for the 1Energy: 1000 kcal for the 1stst year year
+ 100 Kcal for every year upto 10yrs /+ 100 Kcal for every year upto 10yrs /
upto 200kcalupto 200kcal
2000 + 50-100 kcal for girls between 12-15 yrs2000 + 50-100 kcal for girls between 12-15 yrs
2000 + 200 kcal for boys between 12-15 yrs2000 + 200 kcal for boys between 12-15 yrs
Above 15 yrs – 30-35 kcal / kg – sedentaryAbove 15 yrs – 30-35 kcal / kg – sedentary
40 kcal / kg – moderation40 kcal / kg – moderation
50 kcal / kg – very active50 kcal / kg – very active
(b) Distribution of CHO, Protein, Fat(b) Distribution of CHO, Protein, Fat
CHO – 50 – 55%CHO – 50 – 55%
Protein – 20 – 25%Protein – 20 – 25%
Fat – 20 – 25%Fat – 20 – 25%
Gestational Diabetes
Pregnant women need extra 300 kcal and 15gPregnant women need extra 300 kcal and 15g
protein during the 2protein during the 2ndnd or 3 or 3rdrd trimester. trimester.
Frequent small meals to be given.Frequent small meals to be given.
Diabetic Nephropathy
Depending on the function of the kidney.Depending on the function of the kidney. Energy – as for others with diabetesEnergy – as for others with diabetes Protein – 0.6 – 0.8 g / kg IBWProtein – 0.6 – 0.8 g / kg IBW Fat – less than 30% of total Kcal preferably Fat – less than 30% of total Kcal preferably
20-25%20-25% CHO – to make up the rest of the calories CHO – to make up the rest of the calories
preferably from complex carbohydrates.preferably from complex carbohydrates.
Evaluation…..,
- Monitoring medical and clinical outcomesMonitoring medical and clinical outcomes
- Effectiveness of nutrition care plan etcEffectiveness of nutrition care plan etc
- Re-assess and review nutrition care planRe-assess and review nutrition care plan
““Nutrition is a challenging aspect of diabetesNutrition is a challenging aspect of diabetes
management. Attention to nutrition and mealmanagement. Attention to nutrition and meal
planning principles is essential for glycemicplanning principles is essential for glycemic
control and over all good health”.control and over all good health”.