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Nutritional
Chapter 11 Management
Nutrition
components including
carbohydrates, protein and fat.
2. Introduce the importance of
carbohydrate intake in diabetes
management.
3. Present nutritional guidelines
for fat/cholesterol intake and
desired blood lipid ranges.
H. Peter Chase, MD
Gail Spiegel, MS, RD, CDE LEARNING OBJECTIVES:
Learners (parents, child, relative or
self) will be able to:
1. List three major food
TYPES OF NUTRIENTS components and give an
example of each.
Families of a newly diagnosed person with diabetes are usually
overly concerned and worried about what someone with diabetes 2. Explain the effect of
carbohydrate intake on blood
should eat. They shouldn’t be, as the ideal diet for someone
sugar levels.
with diabetes (type 1 or type 2) is really just a healthy diet
3. Describe a dietary method to
from which all people would benefit. This chapter is meant to
lower blood cholesterol/lipid
be a review of normal nutrition, which will help to improve the levels.
entire family’s nutrition. It will be a good introduction to
Chapter 12, Food Management and Diabetes. It will also make
some of the words used by the dietitian easier to follow.
Foods provide different nutrients necessary for growth and
health. If you know about these nutrients, you can help your
family eat the right foods. Learning to read food labels will
help you to know what you are buying at the grocery store.
The Dietary Guidelines for Americans, 2005 is available online
at: www.healthierus.gov/dietaryguidelines. Table 1 shows the
main recommendations.
There are six major nutrient groups:
1. protein
2. carbohydrate
3. fat
4. vitamins and minerals
5. water
6. fiber
Our bodies need some of all of these nutrients, but in
differing amounts.
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Table 1
2005 Dietary Guidelines:
Fruit and Vegetable Intake Dairy Intake
(Fruits = 2 to 4 and vegetables = 3 to 5 (3 servings per day)
servings per day) Consume 3 cups per day of fat-free or low-fat
milk or equivalent.
Consume enough fruits and vegetables while
staying within energy needs: 2 cups of fruit Bread, Cereal, Grain Intake
and 2 1/2 cups of vegetables per day for a (6-11 servings per day)
reference 2,000 calorie intake. Make Half of one’s intake of grains should be in the
adjustments for various calorie levels. form of whole grains.
Fat Intake Protein
Keep total fat between 20 percent and 35 (2-3 servings per day)
percent of calories, with most fats coming from 2-3 ounces poultry, fish or lean meat
sources of polyunsaturated and monounsaturated 1 1/2 cup cooked dry beans
fats such as fish, nuts and vegetable oils; limit 1 egg = 1 ounce meat,
saturated fats, trans-fats and cholesterol. 4 ounces or 1/2 cup tofu
Salt Intake Physical Activity
Consume less than 2,300 mg of sodium per Engage in at least 30 minutes of moderate
day (1 level teaspoon of table salt) and include physical activity on most days of the week.
potassium-rich foods such as fruits and To help manage weight, engage in about 60
vegetables. minutes of moderate to vigorous activity on
most days of the week, while not exceeding
Sugar Intake
calorie requirements.
Choose and prepare foods low in added sugars
or caloric sweeteners.
discussed as the sixth principle of food monounsaturated fats (e.g., olive oil and canola
management for a person with diabetes in the oil) can help prevent heart disease.
next chapter. Higher fat and cholesterol intakes
There are high amounts of polyunsaturated
may lead to elevated blood fat levels (cholesterol
and triglycerides: Table 2) and a higher risk for fat in most vegetable oils (coconut and palm are
heart disease. (People may consume as much as exceptions). Margarines made from vegetable
40-50 percent of calories from fat rather than oils are also polyunsaturated. In general, the
the recommended 20-35 percent.) Fried food softer or more liquid a fat is at room
eaten in fast-food restaurants is usually very high temperature, the less saturated it is. For
in fat. Fat has more calories (nine calories per example, liquid margarine is a better choice
gram) than protein or carbohydrate (four than stick margarine, and vegetable oil is better
calories per gram). Thus, it is more likely to than vegetable shortening. Stick margarine
lead to weight gain and obesity. Most effective contains more trans-fats. In general, the harder
long-term weight reduction programs the margarine, the more trans-fats.
emphasize limiting total fat intake.
The saturated fats include most animal fats
The main fats in the diet are divided into four such as the fat in meats, cheese, milk, butter
types: and lard. Chicken, turkey and fish are lower in
saturated fat than beef or pork, particularly
✔ monounsaturated (high in olive and canola
when the skin is removed. Chicken, turkey and
oils)
fish also contain some polyunsaturated fat.
✔ polyunsaturated (most vegetable oils)
✔ saturated (mainly animal fats; e.g., meats, Blood Lipids
cheese, butter)
High levels of the two main blood fats
✔ trans-fats (the 2005 guidelines recommend (lipids), cholesterol and triglyceride, can lead
keeping trans-fat intake as low as possible) to early aging of the large blood vessels. These
It is important to eat more of the vessels carry blood to the heart, legs and other
monounsaturated and polyunsaturated fats than body parts. Other causes of early aging of large
the saturated fats. Less than 10 percent of blood vessels are diabetes, tobacco use, high
total calories eaten per day should be from blood pressure, lack of exercise and being
saturated fat. Increasing the intake of overweight. As people with diabetes already
Eggs Egg yolks: If high blood Egg whites (two whites can be
(≤ 2 yolks per week) cholesterol, limit to two per substituted for whole egg in recipes),
week (includes eggs used in cholesterol-free egg substitute
cooking and baking)
Dairy Products Whole milk (fluid, evaporated, Milk – fat-free, 1/2%, or 1% fat
(2-3 servings per day) condensed), 2% fat milk (low- (fluid, powdered, evaporated)
fat milk), imitation milk, whole Yogurt – nonfat or low-fat yogurt or
milk yogurt, whole milk yogurt yogurt beverages
beverages, regular cheeses Cheese – low-fat natural or
(American, Blue, Brie, Cheddar, processed cheese
Colby, Edam, Monterey Jack,
whole-milk Mozzarella,
Parmesan, Swiss), cream cheese,
Neufchatel cheese
Cottage cheese (4% fat) Low-fat or nonfat varieties of
cottage cheese
Ice cream Frozen dairy dessert – ice milk,
frozen yogurt (low-fat or nonfat),
nonfat ice cream
Cream, half & half, whipped Low-fat coffee creamer, low-fat or
cream, nondairy creamer, sour nonfat sour cream
cream
Fats and Oils Coconut oil, palm kernel oil, Polyunsaturated oils – safflower,
(≤ 6-8 teaspoons per day) palm oils sunflower, corn, canola*, olive*,
peanut
Butter, lard, shortening, bacon Margarine – made from unsaturated
fat, hard margarine oils listed above, light or diet
margarine, especially soft or liquid
forms (e.g., Parkay Squeeze™)
D i s c re t i o n a r y C a l o r i e s
( sw e e ts , jun k f ood )
1 5 p e rc e n t
of daily calories
D a i r y : P ro t e i n :
2-3 2-3
s e rv i n g s s e rv i n g s
F ru i t :
Ve g e t a b l e s : 2-4 serv i n g s
3-5 serv i n g s
What does your plate for
G ra in s : a day look like?
6 -1 1 s er v i n g s
Look at the food guide to
E x e rc i s e see if you need to:
(a t l ea s t 3 0 m i n ut es da i l y)
• Eat more starch foods
(e.g., whole wheat
bread, brown rice,
potato and pasta)
The following is an example of how to complete your food record. Please record what
you eat on the forms in this chapter. The forms can then be faxed or mailed to your
diabetes care provider. An example for the start of a day follows:
Time Blood Sugar Dose: Insulin/ Food (include amounts) Carbs Activity/Other
Oral Meds (illness, stress,
menses, etc.)
✔ Sugar: Carbohydrates such as table sugar, ✔ Saturated fat: Fat found mainly in animal
honey, the four sugars listed below and others: foods.
1. Fructose: The type of sugar found in fruit. ✔ Trans-fatty acids: The fat formed when
vegetable oils are processed and made more
2. Glucose: The main type of sugar found in solid. They may raise the LDL (bad)
the blood and urine. It is this sugar that is cholesterol and lower the HDL (good)
elevated in people with diabetes. Table cholesterol.
sugar is half glucose.
Cholesterol and Triglyceride: Fats present in
3. Lactose: The main sugar found in milk. It foods and in our bodies. High cholesterol and
needs insulin to be used completely. triglyceride blood levels for many years are a
4. Sucrose: Table sugar or “granulated sugar” cause of “clogged” blood vessels and heart
– the body breaks it down to glucose and attacks.
fructose. The glucose needs insulin to be Fiber: The parts of plants in food that are not
used. absorbed by the body.
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