Role of Medical Nutrition Therapy in Prevention and Treatment Of Diabetes

1. Role of Medical Nutrition Therapy in Prevention and Treatment Of Diabetes By Hellen C Baliach Consultant Clinical Nutritionist

2. Objectives • Definition of terms • Outline of objectives of Medical Nutrition Therapy • Outline of nutritional assessment • Nutritional data from diabetes clinic andDiet Advicory Clinic (DAC) • What is the ideal diet • Challenges • Recomendations • Conclusion

3. What is on your Plate?

4. Definitions of Terms • ‘Diabetic diet’-A normal diet • is simply a healthy eating plan • Aim-is to control the blood sugar level • Diet forms one of the three cornerstones of good health-1. Exercise/diabetes education 2.medication 3. meal planning

5. Definitions of Terms • BMI-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 body • particularly in subcutaneous tissues that arises from intake of food in excess of the body energy requirements(WHO, 2004)

6. Terms • Stunting: 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 < -2 • Stunted-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 diabetes • managing existing diabetes • Preventing and slowing the rate of development of diabetes complications • Achieving 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 normal • Prevent Hypo and Hyperglycemia • Obtain optimum blood lipids and blood pressure control and reduce the risk of macro vascular disease. • Assess energy intake to achieve optimum body weight • Promote 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 symptoms • Individualize meal plan according to a person’s lifestyle and based on usual dietary intake

10. Prevalence of Diabetes by sex in the clinic

11. Disease Prevalence in Diabetes Clinic

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 Imbalance • The measurements vary with age,sex,race and degree of nutrition.

13. Body Mass Index Classification Wt(kg)/Ht(m)2(WHO,2006)

14. Classification by BMI(DAC)

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 adulthood • Prevalence 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 ratio • Measurement 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 greattrochanters 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.

17. Waist-Hip Ratio

18. Waist and Hip Ratio

19. Clinical • Observations – 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 profile • HBA1C • Blood sugar • Kidney and Hearth functions

21. Ecological factors • Are known to influence the nutritional status of individuals. • Variables include; household composition, education, literacy • ethinicity, religion, income, employment, material resources, water supply and household sanitation, access to health, and agricultural services as well as land ownership.

22. More cases have Diabetes(DAC)

23. Prevalence by Sex in DAC Clinic

24. Which diet? • Current choices • 1. low fat diet • 2. low carbohydrates • 3. Mediterranean diet

25. Standard modern diet consist of: • 55-60% carbohydrates • 20-30% fat • 15-20% protein

26. Why low carbohydrates -metabolic consequences • Rapid reduction in body weight due to increased lipolysis • Increased water loss at the beginning • Mild metabolic ketoacidosis • Decrease in appetite and eventually food intake • Improvement 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 diabetes • But only as a part of a structured permanent lifestyle modification

28. Major Challenges • Majority of the clients do not access the nutrition services. • Less than 5% of the total clients attending DC receive the Nutrition services • Clients have varied nutrition information/knowledge from other health workers,herbalists, relatives, bussinesmen/women • Undoing the information is a challenge.

29. Reccomendations • Refer healthy clients – Hospital protocol • Refer all clients to Dietician/ Nutritionist • Nutrition guidelines on management of diabetes to be improved. • Provision of optimal Nutrition should start before, after and during pregnancy • Proper feeding practices and growth monitering should start from birth

30. Conclusion • Glycemic control is achieved when Drugs and Nutritional Therapy are combined • Diabetes management involves multidisplinary approach. • Prevention is better than cure- through Intensifications of campaigns/education-Breastf eeding and HBV-proteins

31. How much food on your Plate