Geeta Final

8/8/2019 Geeta Final

http://slidepdf.com/reader/full/geeta-final 1/21

MANAGEMENT OF DIET INMANAGEMENT OF DIET IN

CORONARY ARTERY DISEASECORONARY ARTERY DISEASE

WITH DIABETES MELLITUSWITH DIABETES MELLITUS

GeetaGeeta AroraArora, Diabetes Educator, Diabetes Educator

Endocrine DepartmentEndocrine DepartmentA.I.I.M.S., New DelhiA.I.I.M.S., New Delhi



CAD is a condition in which the coronary CAD is a condition in which the coronary artetriesartetries

become narrowed due tobecome narrowed due to artherosclerosisartherosclerosis, coronary , coronary

artery spasm & the blood supply to the heart isartery spasm & the blood supply to the heart isobstructed & can damage the heart muscle .obstructed & can damage the heart muscle .

DM is a disease characterized by high blood glucoseDM is a disease characterized by high blood glucose

concentration resulting from defects in insulinconcentration resulting from defects in insulin

secretion, insulin action or both.secretion, insulin action or both.



Common Modifiable Risk FactorsCommon Modifiable Risk FactorsHypertensionHypertension

DyslipidemiaDyslipidemia

Being Being OverwieghtOverwieght B.M.I.>25Kg/mB.M.I.>25Kg/m22

Sedentary LifestyleSedentary Lifestyle

Smoking Smoking



Dietary Goals For CAD With DMDietary Goals For CAD With DM

To attain and maintain normal blood glucose, blood lipidsTo attain and maintain normal blood glucose, blood lipids

& blood pressure levels& blood pressure levels

To prevent degenerative complications (Macro and Micro)To prevent degenerative complications (Macro and Micro)

Improve health through healthy food choices & physicalImprove health through healthy food choices & physicalactivityactivity

To maintain appropriate weight and optimum nutrition.To maintain appropriate weight and optimum nutrition.



Targets for diet management in CAD Targets for diet management in CAD

with DM with DM ABC ABC

A A 11CC <6.5%<6.5%

Blood PressureBlood Pressure 130/90mmhg130/90mmhg

CholestrolCholestrol <200mg%<200mg%

LDLLDL <130mg%<130mg%

HDLHDL >50mg%>50mg%

TG TG <150mg%<150mg%



Recommended Kcal/kg of the Ideal body weight Recommended Kcal/kg of the Ideal body weight

for height or BMI for height or BMI

SedentarySedentary

activityactivity

ModerateModerate

activityactivity

StrenuousStrenuous

activityactivity

Normal weightNormal weight

Over weightOver weight

Under weightUnder weight

25 Kcals25 Kcals

20 Kcals20 Kcals

30 Kcals30 Kcals

30 Kcals30 Kcals

25 Kcals25 Kcals

35 Kcals35 Kcals

3535 KcalsKcals

3030 KcalsKcals

4040 KcalsKcals



Distribution of Macronutrient in NormalDistribution of Macronutrient in Normal

DiabeticDiabeticNutrientNutrient % of Total Calories% of Total Calories

CarbohydratesCarbohydrates 6060--6565

ProteinsProteins 1515

FatsFats 2525--3030



CarbohydratesCarbohydrates :: Individualized based on eating habits of Individualized based on eating habits of

patients patients

T ypes T ypes

Simple ComplexSimple Complex FiberFiber

MonosaccharidesMonosaccharides Whole wheat Whole wheat daliadalia,, Fruits,G

reen Leaf Fruits,G

reen Leaf DisaccharidesDisaccharides Flour,Bread,OatsFlour,Bread,Oats,, vegetables, vegetables, SoyabeanSoyabean

Pulses with HusksPulses with Husks Legumes, Beans, BarleyLegumes, Beans, Barley

GramsGrams



FiberFiber

Fiber Fiber :: 2525-- 40 g / day40 g / day

14 g TDF/ 1000 Kcal14 g TDF/ 1000 Kcal

Benefits of fiber

Reduces gastric emptyingReduces gastric emptying

Slow digestion, slow absorptionSlow digestion, slow absorption

Prolonged intestinal transitionProlonged intestinal transition

Reduction in the following:Reduction in the following:Blood glucoseBlood glucose

Triglycerides Triglycerides

Total Cholesterol Total Cholesterol

LDLLDL

Body weightBody weight

Colon cancerColon cancer



Glycemic Index (GI)Glycemic Index (GI)

Blood Glucose Response of FoodsBlood Glucose Response of Foods

Low G.I. Foods :Low G.I. Foods : Reduce insulin resistance Reduce insulin resistance

Prevent & control DM Prevent & control DM

Prevent cardiovascular disease Prevent cardiovascular disease

Factors affecting GIFactors affecting GI

Source of Starch (whole grains low G.I.)Source of Starch (whole grains low G.I.)

FiberFiber --Sources :Oats, legumes , rice bran, apples ,dried peas , beans, barley,Sources :Oats, legumes , rice bran, apples ,dried peas , beans, barley,fruits & vegetables are most effective.fruits & vegetables are most effective.

Fat , LimeFat , Lime



Nutritive sweetenersNutritive sweeteners

**Fructose, honey, molasses, fruit juice, dextrose, maltose,Fructose, honey, molasses, fruit juice, dextrose, maltose, sorbitolsorbitol,, xylitolxylitol

* Fructose* Fructose(Fruits, vegetables & honey) 4 cal/g(Fruits, vegetables & honey) 4 cal/g ± ± slower bloodslower blood

glucose responseglucose response

** SorbitolSorbitol,, mannitolmannitol && xylitolxylitol 22--3 cal / g3 cal / g

* Tolerance level = 10 g / day* Tolerance level = 10 g / day

* Excess : Abdominal gas, discomfort, osmotic* Excess : Abdominal gas, discomfort, osmoticdiarrhoeadiarrhoea



Non Nutritive SweetenersNon Nutritive Sweeteners

Sweetener Safe marginSweetener Safe margin

**SucraloseSucralose -- ( (Splenda Splenda, Su gar Free , Su gar Free Nat ura Nat ura, , Kaltame Kaltame) ) -- 5 mg / kg B.W5 mg / kg B.W

*Aspartame*Aspartame -- (( N utra N utra sweet, Equal, Su gar Freesweet, Equal, Su gar Free )) -- 50 mg / kg B.W50 mg / kg B.W

*Saccharin*Saccharin -- (( S weet'N S weet'N Low, Su gar Twin Low, Su gar Twin))-- 5 mg /kg B.W5 mg /kg B.W

Do not use for children , pregnancy , lactation ,liverDo not use for children , pregnancy , lactation ,liver

& kidney disorders.& kidney disorders.



Individualized ,based on the nutrition assessment & treatment goalsIndividualized ,based on the nutrition assessment & treatment goals

Total Cholesterol < 300mg/day Total Cholesterol < 300mg/day

Fat

SourcesSources Function

Saturated fatSaturated fat

7%7%

Red Meat, butter, cheese, ghee,Red Meat, butter, cheese, ghee, whole milk cream whole milk cream

CholestrolCholestrol levellevel

and LDLand LDL

PU FAPU FA

10%10%

Sunflower Oil , Corn Oil, safflowerSunflower Oil , Corn Oil, safflowerOilOil

HDLHDL

& LDL& LDL

MUFAMUFA

1010--15 %15 %

Olive Oil, Canola Oil, Ground Nut Oil,Olive Oil, Canola Oil, Ground Nut Oil,Mustard Oil, Seasame Oil FishMustard Oil, Seasame Oil Fish

HDLHDL

LDLLDL

Trans fat Trans fat

<1%<1%

Baked Products , Biscuits cakesBaked Products , Biscuits cakes

processed cheeseprocessed cheese

HDL &HDL &

LDLLDL

Essential Fatty AcidsEssential Fatty Acids

OMEGA3OMEGA3

OMEGA 6OMEGA 6

Cold water, Fish, Nuts, Seeds,Cold water, Fish, Nuts, Seeds,

Fenugreek, Mustard, Corn Oil,Fenugreek, Mustard, Corn Oil,

SoyabeanSoyabean Oil, Cotton Seed,Oil, Cotton Seed,

Sunflower,Sunflower,

Makes cell membrane more flexibleMakes cell membrane more flexible

Blood Pressure and Cholesterol, TG LevelBlood Pressure and Cholesterol, TG Level

Mortality rate from heart diseaseMortality rate from heart disease



Recommended fats

* Cooking oil

* Moderate N6, more N3

Mixed Oil: Soya bean/ mustard + sunflower/ safflower,

Sesame /groundnut/corn/rice bran oil

* High MUFA :Olive ,canola , rice bran ,mustard oil

*Trans fats ± To be avoided



SodiumSodium : :

2.5 g/day2.5 g/day -- mild to moderate hypertensionmild to moderate hypertension

< 2 g/day< 2 g/day -- nephropathy, hypertension &nephropathy, hypertension &edemaedema

Salt: Less than 5 gm/daySalt: Less than 5 gm/day

Vitamins & MineralsVitamins & Minerals: : Normal populationNormal population



ALCOHOL ALCOHOL

Alcohol is not a recommendation.Alcohol is not a recommendation.

Alcohol has calories. (Beer & Wine)Alcohol has calories. (Beer & Wine)

Alcohol interacts with certain drugs.Alcohol interacts with certain drugs.

To be avoided when Triglycerides are high.To be avoided when Triglycerides are high.

However if allowedHowever if allowed

Moderate amountsModerate amounts ± ± 2 drinks per day, 42 drinks per day, 4--5 times a week for a man &5 times a week for a man &

1 drink per day for a woman1 drink per day for a woman



In addition to strengthening

& toning up the muscles

Consumes more energy

Sensitize the tissue

To the action of insulin



ExerciseExercise

Reverses insulin resistance & increases insulinReverses insulin resistance & increases insulin

receptorsreceptors

Reduces weightReduces weight

Lowers LDLLowers LDLIncreases HDLIncreases HDL

Reduces total cholesterolReduces total cholesterol

Psychological benefitsPsychological benefits



Guidelines for ExerciseGuidelines for Exercise

Test the blood sugar before and after exerciseTest the blood sugar before and after exercise

Maintain gap of at least 1 and half Maintain gap of at least 1 and half ± ± 2 hrs after meal2 hrs after meal

Snacks (10Snacks (10--15 g carbohydrate for < one hour of 15 g carbohydrate for < one hour of moderate exercise (fruit 100moderate exercise (fruit 100--150 g or 1 stuffed roti)150 g or 1 stuffed roti)

Extra snack for peak periods of insulinExtra snack for peak periods of insulin

Add 7Add 7--8 g protein for 1 or > 1 hour of exercise8 g protein for 1 or > 1 hour of exercise



Conclusion

1. Education to maintain healthy lifestyle

2. Maintain ideal body weight

3. Maintain normal blood lipid levels

4. Food should contain whole grains,legumes and green

vegetables (fiber)

5. Use low GI foods



Conclusion

6. Mixed oils should be used to achieve N6/N3 fatty acid ratio

7. MUFA is beneficial

8. Reduce SFA and avoid TFA

9. Small sized, frequently spaced meals

10. Regular exercise is essential

Geeta Final

Documents