Nutrition Dr Firdous Jahan Consultant Family Physician Department of Family Medicine Aga Khan University
Nutrition
Dr Firdous JahanConsultant Family Physician
Department of Family MedicineAga Khan University
You are What you Eat
Nutrition is the study of how our body uses the food we eat to maintain our health.
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
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 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 cholesterolHigh Blood PressureHeart diseaseDiabetesStrokeCancer (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 circumferenceMen: <102cm (40 inches)
Women: <88cm (35 inches)
Ideal Body WeightMale: 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.
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
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 mercury-contaminated 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, legumesPrefer unsaturated fatTrim all visible fat and remove the skin from poultryBake and Barbeque is better than currySalt FiberWater
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).
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.
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
Frequency: Should be done at least once every other dayStart with 3 times a week and build up to a daily routine
Intensity:Start @ a comfortable speedIncreased the speed or distance
Time: Begin according to stamina
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
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
Steps in Behavior Modification
INSTEAD OF THIS HIGHCALORIES
TRY THIS LOWCALORIES
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)
300680400165400555
Roast Chicken (3oz)Plain Rice (2 cups)Baked Fish (4 oz)Boiled Egg Egg Sandwich Mutton Stew (3oz)
16532022075
240250
13536018090
160260
VEGETABLE GROUPVegetables Curry (1 cup)Russian Salad (1 cup)
140340
Stir VegetablesFresh Salad (1 cup)
7225
68315
STARCH GROUPParatha (60 gm)Sheermal (half medium)French toast (35 gm)Poori (58 gm)French Fries (20) (90 gm)Potato Cutlet (1 medium)
340325205260250170
Chapatti (60 gm)Nan (half med)Bread Slice (25 gm)Bun, half (35 gm)Boiled Potato (1 med)Baked Potato (1 med)
16010080908080
18013512916517090
INSTEAD OF THIS HIGHCALORIES
TRY THIS LOWCALORIES
CALORIES SAVED
SNACKSPeanuts (30 gm)Potato Chips (30 gm)Potato Samosa (1 med)Vegetable Patties (1 med)Ice Cream (6 oz)Mango Shake (8 oz)Cream Cheese (1 oz)Fruit Cake (43 gm)
135170250295250332100160
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)
408080
8012015225
100
9590
170
2151301807560
FRUIT GGOUPApple Juice (8 oz)Orange Juice (8 oz)Mix Fruit Chaat with Sugar Syrup (1 cup)
300180288
Apple (fresh) (1 med)Orange(fresh) 1 med)Guava (1 med)
606060
240120288