DIET PRESCRIPTION GENERATOR MANUAL

4. MEDICAL NUTRITION THERAPY

MEDICAL NUTRITION THERAPY SUITABLE FOR PRIMARY CARE PHYSICIANS
1) Identification of nutritional problems
2) Evaluation of nutritional problems
3) Educate patients on nutritional topics
4) Providing correct solution for the relevant nutritional problem
5) Motivating the clients to implement the solutions provided
6) Helping the clients to tide over the barriers encountered in the course of
the nutritional therapy
7) Educating the clients to get the money's value for a given food item by analyzing
the nutrient content of the food item
8) Educating the client about the nutritional myths

BENEFITS OF WEIGHT LOSS
1) Improve glycemic control (1.67% reduction of HbA1 and 59 mg/dL reduction in FBS)
2) Improve BP control
3) Reduce cardiovascular risk burden
4) Reduce obesity and overweight
5) Prevention of development of diabetes (Finnish DPS, US DPP)

PREVENTION OF DM IN FINNISH DPS
1) Overweight subjects with mean BMI 31, mean age 55, IGT +
2) Losing 5% of initial body weight
3) Exercise 30 min/day moderate intensity, resisted training exercises
4) Fat consumption < 30% of total calories
5) Saturated fat < 10% of total calories
6) Fiber 15 g/1000 kcals
7) More the goals achieved higher the chance that DM will not develop
8) There is a dose-response curve for number of goals and the end point titration
9) Weight loss was the most important predictor of prevention of diabetes 3 yrs later

PREVENTION OF DM IN US DPP
1) Overweight subjects with mean BMI 34, mean age 51, IGT +
2) Losing 7% of initial body weight (rate od loss - 0.5-1 kg/wk)
3) Exercise 150 min/wk moderate intensity (basically like brisk walking)
4) Fat less than 25% of total calories
5) One to one contact every 2 weeks for counselling and motivation
6) Weekly supervised exercise classes
7) Prevented (58%) incident Dm more than in placebo and even metformin
8) Metformin also reduced incident DM by 31%
9) weight loss was the most important predictor of prevention of diabetes 3 yrs later
10) Even in the absence of weight loss exercise also prevented diabetes although not to the extent of weight loss

DPP and DPS BASED FINDINGS TO PREVENT DEVELOPMENT OF DIABETES
1) Lifestyle modifications are extremely effective to prevent Dm
2) Reduction of risk for DM development is 58%
3) Most important factor the lifestyles is the weight loss
4) Effect of Weight loss is dose dependent
5) Effects of lifestyles changes are also dose dependent (more the changes more the reduction of DM)
6) Moderate exercise can also reduce the chance of development of DM in the absence of weight loss

LOOK AHEAD - INTENSIVE LIFESTYLE INTERVENTIONS' IMPACT
1) 7% reduction in body weight minimum but encouraged to lose > 10%
2) Contact frequency - weekly group sessions and monthly individual session
3) Dietary advice - calorie restriction, liquid meal replacements
4) Moderate intensity exercise at home - 175 min/week
5) 1 yr interim results are as follows :
6) Weight loss of 8.6%
7) Improved sense of fitness
8) Use of diabetes and hypertensive medication reduction
9) Increased use of lipid lowering
10)Better glycemic control
11)Better BP control
12)Increased HDL-C
13)Reduction in metabolic syndrome

WHO RECOMMENDED NUTRIENT COMPOSITION OF A WELL BALANCED DIET
FOOD => NUTRIENT PER CENTAGE FROM TOTAL CALORIES
Carbohydrates => 55-75%
Sugar and sweets => < 10%
Proteins => 10-15%
Oils/Fats => 15-30%
Saturated fatty acids => < 10%
Unsaturated fatty acids => 6-10%
Trans fatty acids => < 1%
Monounsaturated fatty acids => balance
Cholesterols => < 300 mg/day
Salt => < 5 G/day
Vegetables and fruits => > 400 G/day
Fibers
Non-carbohydrate polysaccharides