Transcript Diet

Nutrition
Dr Firdous Jahan
Consultant Family Physician
Department of Family Medicine
Aga Khan University
You are What you Eat
Nutrition is the study of how our
body uses the food we eat to
maintain our health.
“It’s good to Eat When You are
Hungry”
Hunger is a physiological need for
food.
Appetite is the psychological desire
for food
Diet
A diet is a pattern of eating that
includes what a person eats, how
much a person eats, and when a
person eats
Effective counseling
Good communication skills
Trust
Suitable environment
Knowledge
Patients’ involvement & willingness
Communication Skills for
Counseling
Motivation
Practical, realistic & specific
Constrains
Small steps
Reinforcement
Use support material
Problem solving
Motivates behavior change (driven by an
inner need
Addresses the constrains (resources,
cultural, social, financial)
Practical and specific solution ,/alternative
Encourage the active involvement of
patients in problem solving
Identify and include key person involved in
decision making
Environment
Privacy
Comfort & Quite
Confidential
WHY WE
EAT ?
WHY WE
EAT ?
Maintain/Restore physiological function
Get energy
Survival
Prevent deficiency diseases
Health promotion
To meet the requirement in pregnancy
lactation, puberty, growth spurt, old age
Eating Habits
Eating Depends on
Taste
Habit
Environment
Available and convenient
Affordable
Social/Cultural/emotional
Religious
Eating is a behavior that is established
early in life and is not easily changed
Obesity
Obesity is a condition characterized
by a large percentage of body fat
High cholesterol
High Blood Pressure
Heart disease
Diabetes
Stroke
Cancer (certain forms)
Leading Causes of Death
Top 6 leading causes of death all
associated with obesity
• Heart Disease
• Cancer
• Stroke
• Chronic lower respiratory diseases
• Diabetes
• Accidents (unintentional injuries)
Assessment (anthropometric)
History, Physical Examination
Height
Weight
BMI: Wt in Kg
(18.5 – 22.9)
Ht in m2
Waist circumference
Men:
<102cm (40 inches)
Women:<88cm (35 inches)
Ideal Body Weight
Male: 5ft = 106 Lbs for every inch add 6 Lbs
Female: 5ft = 100 Lbs for every inch add 5 Lbs
Body Mass Index
Classification of Weight by BMI in Adult Asians
National Institute of Health
Classification BMI
Risk of
Co-morbidities

Underweight
<18.5
Low

Normal Range
18.5 – 22.9
Average

At risk
23 – 24.9
Increased

Obese I
25 – 29.9
Moderate

Obese II
30 – 39.9
Severe

Obese III
> 40
Extreme
Assessment
Laboratory : lipids, FBs, Hb, Albumin,
electrolyte
24 hr dietary recall
Food frequency questionnaire
Food diary
Behavioral assessment
What’s a Calorie?
Unit of measurement for energy
3 of the 6 nutrients provide us with
energy
Carbohydrate – 1 g = 4 calories
Protein – 1 g = 4 calories
Fat – 1 g = 9 calories
Calculating Energy Requirement
For basal metabolic need 22 cal/kg/day
add calories:
Sedentary (no planned physical activity) = 6-7
Cal.
Moderately active: (household /30 min walking)
= 10-11 cal.
Active: (Playing football, squash) = 14-15 cal.
Strenuous activity Labor, Athlete) = 20-22 cal.
Counseling : Nutrition care plan
Diet
Exercise
Behavior modification
Diet
A diet is a pattern of eating that
includes what a person eats, how
much a person eats, and when a
person eats.
Diet
Balance diet
50-60% carbohydrate (Bread, rice, cereals, corn,
potato, lobia, fruit, vegetable)
12-20% Protein (Cheese, Meat, fish, egg, milk,
dal, lobia,vegetable)
<30% Fat (Oil, cream, meat, butter, mayonnaise)
Micro nutrient
Fibers
water
Food Guide pyramid
GUIDE LINE( AHA 2006)
Consume an overall healthy diet.
To maintain a healthy body weight, balance
calories consumed with calories burned.
Increase awareness of calorie content of
foods for portions typically consumed and
of daily caloric requirements.
Set a goal of at least 30 minutes of
physical activity daily.
Consume a diet rich in a wide variety of
fruits and vegetables (not fruit juices),
especially those that are deeply colored
(spinach, carrots, peaches, and berries).
Prepare fruits and vegetables with little
added saturated or trans fat, salt, and
sugar.
Choose whole-grain, high-fiber foods.
Consume 2 servings of fish, especially
those relatively high in omega-3 fatty-acids
(eg, salmon, trout, and herring) at least
twice weekly
Children and pregnant women should
follow Food and Drug Administration (FDA)
guidelines for avoiding mercurycontaminated fish (eg, shark, swordfish,
king mackerel, and tilefish).
Limit intake of saturated fat, trans fat, and
cholesterol by choosing lean meats,
vegetable alternatives, and fat-free (skim)
and low-fat (1% fat) dairy products and
minimize intake of partially hydrogenated
fats.
Minimize intake of beverages and foods
with added sugars.
To consume no more than 2300 mg of
sodium daily, choose and prepare foods
with little or no salt.
Limit alcohol intake
When eating out, be aware of portion size;
select vegetables and fruits; and avoid
foods prepared with added saturated or
trans fat, salt, and sugar
General Guidelines : NIH
Eat at least 3 meals each day
Do not skip breakfast
Eat foods from each of the Four Food
Groups at every meal
Follow a balanced diet that is low in
saturated and trans fats, cholesterol, added
sugars, salt.
Eat variety of food including fruits,
vegetable whole grain, milk product,
meat, legumes
Prefer unsaturated fat
Trim all visible fat and remove the skin
from poultry
Bake and Barbeque is better than curry
Salt
Fiber
Water
Balance your calorie intake with exercise.
Slowly decrease your caloric intake while
increasing exercise to prevent gradual
weight gain over time.
Exercise regularly and reduce sedentary
activities
Carbohydrates – 1 Serving
1 slice bread = 1 small chapatti = 1/3 nan
= ½ cup cooked rice = 1 small potato = ¾
cup cereal = 1/3 cup dal/lobia = 80 cal, 15
gm CHO, 3 gm protein.
Vegetable
Vit A, C, K, Folic Acid, Iron, Calcium,
CHO, Protein, Fibers, Water)
½ cup cooked vegetable = 1 cup
uncooked vegetable = 25 cal, 5 gm CHO,
1 gm protein Tubers and beans 10 gm
CHO, 2 gm protein (45 cal).
7 25 07
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Fruits
1 small banana, orange, apple, guava, ½
grape fruit, ½ small mango, 2-3 date
1 cup cut fruit = 15 gm CHO, 1 gm protein
= 65 cal.
Add Color to your plate
Protein
a. 1 oz beef/mutton/chicken/fish/5 prawns/cheese,
1 oz kidney, liver = 7 gm protein, 3 gm fat, 55
cal
b. 1 oz qeema/1 oz dumba / 1 oz cheddar cheese,
2 oz brain = 7 gm protein, 8 gm fat , = 100 cal
c. 1 egg/1/4 cottage cheese, 1 oz low fat qeema =
7 gm protein, 5 gm fat = 75 cal
d. Legumes, chickpea, beans ½ cup boiled = 7 gm
protein, 1 gm fat, 20 gm carbohydrate = 115 cal
e. Milk (calcium, protein, fat, carbohydrate, vitamin
A, riboflavin), 1 cup cow or buffalo milk top
cream removed = 1 cup yogurt = 2 oz cottage
cheese = 8 gm protein, 8 gm fat, 12 gm
carbohydrate = 160 cal and 290 mg calcium.
Fat and Oil
1 tsf oil = 1 tsf ghee, butter or margarine or
mayonnaise, 1 tbs salad dressing or cream, 10
peanuts, 5-8 nuts = 5 gm fat = 45 cal
Saturated Fat
Butter, palm oil, coconut oil, animal fat, ghee
Mono unsaturated fat
Corn oil, canola and olive oil
Poly unsaturated fat
Soya
Iron
Red meat, green leafy vegetable, liver,
chickpea and legumes, dates
Vitamin C increases the absorption of
iron in the gut
Calcium
Milk
Yogurt
Cheese
Green leafy vegetable
A Sample Diet Plan=1500 cal
CHO/starch : 2 slices, 2 chapatis,2 cups
rice
540 cal
Vegetable :
70 cal
2 fruits
:
135 cal
Protein
: 3 oz meat, 1egg,1/2 cup dal
or bean
415 cal
Milk 250 ml :
160 cal
Fat 4 tsf oil :
180 cal
Exercise
Every morning my brain
tells me to exercise…
….. and my body
laughs at the idea
Exercise
Frequency:
Should be done at least once every other day
Start with 3 times a week and build up to a daily
routine
Intensity:
Start @ a comfortable speed
Increased the speed or distance
Time:
Begin according to stamina
Exercise
30 minutes brisk walking every day
5 days a week
Behavior Modification
Emotional
Anxiety / Depression
Snack obstacles
Control the environmental cues
Choose nutritious food every time
Keep record of your food intake
Practice of habit
Steps in Behavior
Modification
Establish a base line and maintain records
Pickup one or two habits to change
Practice these till they become second
nature
Add other habits to change to the list
Self monitoring
Slow eating
Nutrition education
Social and moral support
INSTEAD OF THIS
HIGH
TRY THIS
CALORIES
LOW
CALORIES
CALORIES
SAVED
MEAT GROUP:
Chicken Qorma
(3 oz)
Mutton Biryani
(2 cup)
Fried Fish
(4 oz)
Plain Omelette
(1 egg)
Beef Burger
(1 medium)
Chicken Pizza (8 in diam)
300
680
400
165
400
555
Roast Chicken (3oz)
Plain Rice (2 cups)
Baked Fish (4 oz)
Boiled Egg
Egg Sandwich
Mutton Stew (3oz)
165
320
220
75
240
250
135
360
180
90
160
260
VEGETABLE GROUP
Vegetables Curry (1 cup)
Russian Salad
(1 cup)
140
340
Stir Vegetables
Fresh Salad (1 cup)
72
25
68
315
STARCH GROUP
Paratha
(60 gm)
Sheermal
(half medium)
French toast
(35 gm)
Poori
(58 gm)
French Fries (20) (90 gm)
Potato Cutlet (1 medium)
340
325
205
260
250
170
Chapatti
(60 gm)
Nan
(half med)
Bread Slice (25 gm)
Bun, half
(35 gm)
Boiled Potato (1 med)
Baked Potato (1 med)
160
100
80
90
80
80
180
135
129
165
170
90
INSTEAD OF THIS
SNACKS
Peanuts
Potato Chips
Potato Samosa
Vegetable Patties
Ice Cream
Mango Shake
Cream Cheese
Fruit Cake
(30 gm)
(30 gm)
(1 med)
(1 med)
(6 oz)
(8 oz)
(1 oz)
(43 gm)
FRUIT GGOUP
Apple Juice
(8 oz)
Orange Juice
(8 oz)
Mix Fruit Chaat
with Sugar Syrup (1 cup)
HIGH
TRY THIS
CALORIES
135
170
250
295
250
332
100
160
Roasted Grams (2 oz)
Corn on Cob (3–4 in)
2 Whole Wheat
Biscuits (12 gm each)
Popcorn (1 ½ cup)
Ice Milk (6 oz)
Cottage Cheese (1 oz)
Sweet Bun (35 gm)
300
180
288
Apple (fresh) (1 med)
Orange(fresh) 1 med)
Guava
(1 med)
LOW
CALORIES
CALORIES
SAVED
40
80
80
95
90
170
80
120
152
25
100
215
130
180
75
60
60
60
60
240
120
288