Transcript Planning Healthful Menus

1
SERVING GUESTS WITH
SPECIAL HEALTH NEEDS
Obesity
Cardiovascular Disease
Hypertension
Diabetes
Digestive Disorders
Hospital Diet Orders
Chapter 13
Learning Objectives
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Explain nutritional meal planning for guests with special health needs
Plan menus for guests with special health needs
Describe nutrition recommendations to achieve weight loss
Describe nutrition recommendations to prevent and treat cardiovascular
disease
Explain the DASH diet for the control of hypertension
Describe the digestive process and contrast three digestive diseases
Describe general guidelines for diet management of GI tract conditions
List foods included in various types of hospital diet orders
Our Diet and Our Health
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Food affects our health
 Positively
 Negatively
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Guests have various special nutrition needs
Our Diet and Our Health
4
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Short-term effects
Long-term effects
2/3 adults are overweight or obese
1/3 children are overweight or obese
1/3 adults have cardiovascular disease
1/3 adults have high blood pressure
¼ population has diabetes or pre-diabetes
Leading Causes of Death in U.S.
5
0
Heart disease
Cancer
Chronic lower respiratory diseases
Stroke (cerebrovascular diseases)
Accidents (unintentional injuries)
Alzheimer's disease
Diabetes
Influenza and Pneumonia
Kidney disease
Intentional self-harm (suicide)
200,000
400,000
600,000
Weight Management - Obesity
6
Obesity Related Health Issues
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Hypertension
Heart Disease
Type 2 Diabetes
Gallbladder Disease
Pulmonary Disease and
Sleep Disorders
Bone and Joint Disorders
Infections
Liver damage
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Cancer risk
Surgical risk
Accident risk
Skin Disorders
Pregnancy risk
Menstrual irregularities
Infertility
Psychological
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Depression, low self-esteem,
discrimination
Weight Loss Basics
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CALORIES OUT
 Metabolism
 Physical
Activity
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CALORIES IN
 Food
and beverages
Calories Out- Physical Activity
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2010 Dietary Guidelines
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Adults 18-61 yo
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Children and Adolescents 6-17 yo
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2 hours and 30 minutes a week, moderate aerobic
1 hour and 15 minutes a week, vigorous aerobic
Strengthening activities 2 days week
Greatest benefit- 5 hours a week
60 minutes or more of physical activity a day
Duration/regular more important than intensity
10,000 steps a day
Increase activities of daily living
Calories In
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Reduce portions
Reduce added sugars, fats, alcohol
Determine current calorie intake; subtract 250-500
calories/day
OR
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Decrease 250 calories a day from diet, 250 calories more
physical activity
3500 calories in a pound of body fat
Body Mass Index (BMI)
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See text
One way to determine healthy body weight
Not perfect; men, athletes, genetically muscular,
short stature, health issues
 Healthy-
18.5-24.9
 Overweight- 25.0-29.9
 Obesity- 30- 39.0
 Severely Obese- > 40
Other Thoughts….
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BodPod (air displacement), DEXA, bioelectric impedance,
caliper measures to determine body fat
Waist Circumference
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Healthy-Fit Weight
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> 40” men, > 35” women
Abdominal fat affects liver function
Focus on fat weight vs muscle weight
Health benefits first 5-10% of weight lost
Weight Loss Program Components
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#1- Lower calorie, lower fat, sensible, long term
dietary intake, moderate protein
#2- Exercise
#3- Self Monitoring
 Food,
exercise, weight records
 Behavior modification
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#4- Breakfast
#5- Support
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Cardiovascular Disease
Cardiovascular Disease (CVD)
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Group of diseases related to the heart and blood
vessels
Factors that increase risk for CVD
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Heredity
Cigarette smoking
Physical inactivity
Obesity
High blood pressure
Diet
Cardiovascular Disease (CVD)
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Major dietary factors that increase risk for CVD
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High saturated fats
Trans fats
Dietary cholesterol
Obesity
Types of Cardiovascular Disease
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CVD
Description
Arteriosclerosis
A chronic disease in which thickening, hardening, and loss of elasticity
of the arterial walls result in impaired blood circulation. It develops
with age and with conditions such as hypertension, high blood
cholesterol and diabetes
Atherosclerosis
A type of arteriosclerosis in which plaque causes the clogging or
hardening of arteries or blood vessels. Plaque is an accumulation of
substances including cholesterol, fibrous tissue and calcium
Coronary heart
disease
The progressive reduction of blood supply to the heart muscle due to
narrowing or blocking of a coronary artery and can lead to heart
attack
Hypertension
High blood pressure. Blood pressure is the force of blood pushing
against the walls of arteries as it flows through them
Ischemic stroke
The sudden death of brain cells in a localized area due to
inadequate blood flow
Nutrition Goals of Cardiovascular
Disease
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Saturated fat and trans fat
<
7% of calories
 15 grams – 2000 calorie diet
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Cholesterol
<
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Increase soluble fiber
Add plant stanols/sterols
2
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200 mg/day
grams/day
Weight Management

Source: National Cholesterol Education Program
Plant Stanols and Sterols
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Modified triglyceride that prevents fat/cholesterol
absorption
Margarine
2 servings a day
Blood Lipid Goals
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Cholesterol
<
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200 mg/dL
LDL
 < 100 mg/dL if disease
 < 130 mg/dL if 2+ risk factors,
 < 160 mg/dL if 0-1 risk factors
Emphasis on Mediterranean- Type
Balance
Cardiovascular Disease Menu Ideas
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Low-saturated fat meatless appetizers, entrees
and side dishes
Include legumes, peas, beans, lentils and soy
products in the menu
Offer lean fish, poultry, lamb, bison, beef and pork
Serve moderate portions: 4-ounce entrees of lean meat
cuts; 5 to 6 ounces of poultry; 6 to 8 ounces of fish
Serve low-fat and nonfat dairy products and use them
liberally as ingredients
Cardiovascular Disease Menu Ideas
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Use canola or olive oil
Less butter, cream, bacon fat, meat drippings,
saturated margarines and shortenings, cheese
Greater variety of fruits and vegetables
Whole grains
Smaller portions
Reduce portions of fried foods
Grilled-baked-lightly sautéed fish and seafood
Moderate nuts and seeds
Egg whites
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Hypertension
Hypertension
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Blood pressure is the force of blood pushing against the walls of
arteries as it flows through them
Blood pressure is measured in two numbers:
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Systolic is the pressure created when the heart beats while pumping
blood
Diastolic is the pressure created when the heart is at rest between beats
High blood pressure can be caused by many factors including:
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Genetics
Smoking
Stress
Obesity
Diet
Inactivity
Hypertension
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Category
Systolic (top number)
Diastolic (bottom number)
Normal
Less than 120
Less than 80
Pre-hypertension
120-139
80-89
High blood pressure
Stage 1 140-159
Stage 2 160 or higher
90-99
100 or higher
DASH
(Dietary Approaches to Stop Hypertension)
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A heart healthy, nutrient-rich research based
diet supported by the National Heart, Lung
and Blood Institute
 High potassium, calcium, magnesium
 Low sodium
 Achieve with unprocessed, fresh/frozen foods
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Why Sodium, Potassium, Calcium
and Magnesium?
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Video on HTN
 http://www.youtube.com/watch?v=jvE6at_i_Tw&featur
e=related
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Summary
 Cardiac
Output (CO) volume
 sodium,
 Heart
potassium
Rate-Resistance
 calcium,
magnesium, potassium
DASH
(Dietary Approaches to Stop Hypertension)
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Daily Nutrient Goals Used in the DASH Studies (2,100 calorie eating plan)
Nutrient
Amount
Total fat
27% of calories
Saturated fat
6% of calories
Protein
18% of calories
Carbohydrate
55% of calories
Cholesterol
150 milligrams
Sodium*
1500 milligrams
Potassium*
4700 milligrams
Calcium*
1250 milligrams
Magnesium*
500 milligrams
Fiber
30 grams
The DASH Diet
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Foods
Recommended Servings
Whole grains
Fruits and vegetables
6-8 per day ( each is ½ cup or 1 slice bread)
8-10 per day ( 4 to 5 cups total)
Fat-free or low-fat dairy
2-3 per day ( 2 to 3 cups total)
Lean meat, poultry, fish
6 ounces or less per day
Nuts, seeds, beans
4-5 per week (1/2 cup bean or 1 ounce of nuts is 1 serving)
Fats and oils
2-3 small servings per day ( 2 to 3 teaspoons)
Sweets
5 or less per week
Sodium
1,500 or 2,400 milligrams per day (1,500 milligrams
recommended for individuals with hypertension)
Diet Effect on Systolic Blood Pressure
Long Term Effects of High Blood
Pressure
Sodium in Foodservice
Average consumption:
 Restaurants: 1925 mg sodium per 1000 calories
 Home: 1422 mg sodium per 1000 calories
National Salt Reduction Initiative
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Targets for sodium levels in various food categories
set for 2014:
 No
menu item should be over 1,200 milligrams
sodium/serving.
 Soup 280 mg sodium/100 grams
 Hamburgers 330 mg sodium/100 grams
 Sandwiches 370 mg sodium/100 grams
 Cheese pizza 390 mg sodium/100 grams
Source: National Salt Reduction Initiative. www.nyc.gov/health/salt
DIABETES
Diabetes
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A chronic disease characterized by:
High blood glucose
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(also called blood sugar)
Insufficient Insulin
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or
Ineffective insulin
No cure
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CHO from diet, glycogen
Cells
Blood Glucose (blood sugar) + Insulin
Insulin
From pancreas or injection
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¼ population has diabetes or pre-diabetes
Blood Glucose and Diabetes
Diagnosis
70 mg/dl
Two Types: Type 1 and Type 2
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Both types test blood sugars with a glucometer
Both types count carbohydrates in food
 Some use specific guidelines for grams of carb
 Some use general portion control of foods
Type 1 Diabetes
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Generally occurs earlier in
life
Requires daily insulin injections
or an insulin pump
Carbohydrate grams
balanced with insulin
High risk for a low blood
sugar, treat immediately
Diabetic Hypoglycemia
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Blood glucose below 70
mg/dL
15:15 rule
15 grams carbohydrate every
15 minutes
 15 grams = ¼ cup juice,
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If Blood Glucose is too high….
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Look at amount of carbohydrate consumed
 Reduce
portions
 Substitute with lower CHO content or sugar
substitute
 Find food or food combinations that result in lower
blood sugar (glycemic index)
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Opposite if too low…
Pre-Diabetes
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Prevent diabetes!
Weight loss
Decrease 500-1000 calories and fat
 Exercise
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 150
minutes/week
Type 2 diabetes
 More
common than type 1
 Genetic cause (runs in families)
Overweight and inactivity increases
likelihood of developing type 2 diabetes
 Until recently generally occurred later in life
 1 in 3 children will develop type 2 diabetes
Type 2 Diabetes
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Insulin resistance and Insulin insufficiency
Weight loss
 Reverses insulin resistance
 Calorie control, exercise
Type 2 Diabetes
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May be controlled by a combination of:
 Carb controlled diet
 Calorie controlled diet
 Exercise
 Pills
 Injected Medications
 Insulin Injections
As diabetes progresses, people often need to
increase medications and/or add insulin
Diabetes Nutrition Goals
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Attain and maintain a blood glucose level as close to
normal as possible
Carbohydrate foods raise blood glucose levels
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monitor the carbohydrate eaten and balance intake with
physical activity (and often insulin or pills.)
Distribute carbohydrates fairly evenly though out the
day – some at each meal and with snacks
Diabetes- Key Nutrition Points
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Overall emphasis is on healthful eating
“Carbohydrate Controlled Diet”
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Manage portions and timing of consumption
Individualized consumption of
Limit sodium and fat
Limit added sugars
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Diabetes – Foods to Limit
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Some foods avoided because they are:
ꔷ easy to overeat ꔷ high in carbohydrate ꔷ no nutrition
 sugared beverages such as sodas, punches, juices and
sweet tea
 high-cal foods high in fat, especially sat. and trans fat
Diabetics may eat high sugar or high fat foods,
but they must be aware of how much
carbohydrate they are consuming and adjust for
either in diet or medication
Menu Considerations- Diabetes
Diabetics do not need special foods, they need
reasonable options from which to choose.
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Avoid hidden fat or carbohydrate so the guest can make
an informed choice
List the size or ounces of the piece of meat, chicken or
fish so that guests know how much they are getting
Menu Considerations for Diabetes
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Offer plenty of low-carbohydrate vegetables
 salads, side dishes, entrees and soups
Have delicious fruits available as a dessert option
Offer smaller portions
 Offer 3-4 oz. meat portions, half sandwiches, etc.
 Appetizers, such as crab cakes or chicken skewers, are
good entree choice
Menu Considerations - Diabetes
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Cook with as little fat and sugar as possible
 Offer low-fat, low-calorie side dishes and salad
dressings
 Serve sauces on the side
 Offer
at least one green salad
 Top with interesting vegetables and/or herbs
 without croutons, bacon and other high-fat
ingredients.
 Dress salads lightly
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Digestive Disorders
Digestive Tract
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Definitions
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Digestion
The process by which food and drink are reduced to smaller nutrient
molecules that can be absorbed into the blood and carried
throughout the body to build and nourish cells and to provide
energy
Absorption
The passage of these molecules through the walls of the digestive
tract so the substances can enter the bloodstream and then enter
cells
Metabolism
The chemical activity within cells that breaks down nutrients to
provide energy, uses nutrients to build necessary compounds and
tissues, and releases the end products
Unique Features of GI Tract
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Peristalic Movement
 Muscle
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Enzymes
 Break
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movement
apart carbohydrates, proteins, fats
Absorption of nutrients
 Primarily
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Bacteria
 Probiotics
small intestine
Digestive Disorders
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Disorder
Details
Dysphagia
Difficulty swallowing
Diet: Alter consistency, texture, temperature to adapt to swallowing ability.
GERD or Acid
Reflux
Acid reflux, heartburn, or GERD (gastroesophogeal reflux disease) occurs when the
sphincter between the esophagus and stomach relaxes and food comes back up
after it has been mixed with stomach acids
Diet: small meals, exercise, remain elevated after eating
Irritable Bowel
Syndrome (IBS)
A common “muscle movement” related disorder causing abdominal pain, bloating
and changes in bowel habits.
Diet: high fiber, regular meals, exercise, stress management
Digestive Disorders
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Disorder
Details
Crohn’s Disease
Inflammation of the small intestine that makes digestion and absorption of nutrients
difficult and painful. Causes bloating, diarrhea, abdominal pain and cramping. Can
lead to malnutrition, anemia and low levels of certain vitamins and folic acid.
Ulcerative Colitis
Ulcerations in the colon/large intestine.
Diverticulitis
Inflammation of small “out” pouches in the lining of the large intestine.
Diet: Low or high fiber
Lactose Intolerance
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Symptoms with dairy intake
 Abdominal
discomfort
 Bloating; Intestinal gas formation
 Diarrhea
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Causes
 Primary: Lactase deficiency
 Secondary: Mucosal damage
p. 122
Lactose Intolerance
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Prevalence (p. 111)
Ethnic <10% to >80%
<10% Northern Europeans (Scandinavians)
 20% Caucasians
 50% Hispanics
 70% Mediterraneans
 75% African Americans
 80% Native Americans
 >80% Southeast Asians
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Lactose Content of Food
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Whole wheat bread 1 slice
Cheese
1 oz
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0.5gm
0.5-0.8
Cheddar/American
Parmesan/Cream
Doughnut, cake type
Chocolate 1 oz
Sherbet
1c
Cottage cheese
Ice Cream 1 c
Milk
1c
Yogurt
1c
1.2
2.3
4.0
7.5
9.0
12.0
15.0
Lactose Intolerance
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Dietary changes
May not require the elimination of milk/milk
products, tolerance
 Lactaid Milk, Acidophilus milk
 Kefir, yogurt
 Soy, almond, rice, coconut milk
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Pages 343-344
 Adequate
calcium and vitamin D intake
 Lactaid or DairyEase enzyme with food
General Guidelines for GI Patients
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High or low fiber
Omit food irritants
Proper hydration
Small, frequent meals
Journal
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Food/fluid intake, stools, discomfort, exercise, stress
May benefit from limiting:
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Caffeine
Alcohol
“Gas” causing foods
Sugar alcohols
Live Cultures and Probiotics
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Live active cultures in buttermilk, yogurt and other
foods promote gut health and generally aid
digestion.
Probiotics
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Healthy bacteria in the GI tract
Found in yogurt, fermented foods
First line of immune function
 GI tract point of entry
 Strengthens intestinal lining
 Antimicrobial
 Improves peristalsis
Hospital Diet Orders
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Why?
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Tests, surgeries, inability to eat/chew/swallow
Clear Liquid
 Broth, bouillon, clear pop, clear fruit juices, fruit ice, popsicles, gelatin
Full Liquid
 Clear liquid, yogurt, pudding, milk, milk drinks, all fruit and vegetable
juices, refined hot cereals (cream of wheat, malt-o-meal), cream, butter,
margarine
Pureed
 Blenderized, thick it type foods
Soft
 Full liquid, pureed + soft cooked vegetables, canned fruits, banana,
mashed potatoes, cream soups, banana, chopped/ground meats,
cooked pasta, barley, rice, eggs, etc.