Transcript MEDICAL NUTRITION THERAPY (MNT)

MEDICAL NUTRITION
THERAPY (MNT)
Mrs. Sarah Jacob
Rtd. Head, Department of Dietetics
Christian Medical College
Vellore .
Medical Nutrition Therapy
(MNT) Replaces
The earlier term of “Diet Therapy” and stresses a
four pronged approach that includes….
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Assessment of the individual’s metabolic and life
style parameters
Identification of nutrition goals
Intervention designed to achieve these goals.
Evaluation of therapeutic outcome.
Assessment
Involves assessment of habitual dietary pattern in
terms of nutrient content and eating behaviour
Helps
- To identify goals
- To determine the type of intervention needed
 calorie intake, food pattern modification
of eating behaviour etc.
- Rapport building
- Gives information on clinical data.
Goals
Treatment goals should be individualised, realistic
and achievable
- Weight loss if necessary
- Blood glucose levels to be maintained as close to
normal as possible
- Blood lipid levels within desirable limits
- Consistent and appropriate food intake
- Regular meal timings
- Blood glucose monitoring
Intervention - Education
- Appropriate meal plan suggested
- Strategies for eating behaviour change
- Food exchanges
- Importance, source of dietary fibre
- Adequate nutrient intake by including
variety
- Importance of exercise.
Steps to individualised diet
planning
Step:1 - Determine past diet history, food habits,
activity socio economic status, cultural and
religious practices etc.
e.g. Sex – male Age – 50 yrs
Height – 170 cms or 5’ 7”
Food habits - Non vegetarian
Income – Middle Income
Activity – Sedentary
Type of Diabetes – Type 2 Diabetes
Step: 2 Determine ideal or desirable body
weight
(a) Hamwi method
IBW = 106+(7x6) = 148 lbs
(b) Broca’s Index
IBW = 170-100 = 70 kgs
5 – 10% less for diabetics
= 63 – 67 kgs.
Step: 3 Calculate Energy Requirement
Basal + activity
= (148 x 10) = (1480 x 20 / 100)
= 1776 Kcal
= Rounded off to 1800 Kcal.
Step: 4 Determine gm of carbohydrate,
protein and fat
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CHO = 60-65% of total calories = 270g- 292g
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Protein = 10-15% of total calories = 45g – 68g
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Fat = 20-25% of total calories = 40g – 50g
Step : 5 Carbohydrate – 60-65%
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Complex CHO is better than simple sugars
as absorption is slower
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Amount of CHO in each meal to be
adjusted for each individual.
Step: 6
Dietary fibre present in whole grain cereals,
vegetables pulses and fruits delay digestion
and absorption may help in reducing blood
sugars and lipids. Recommended intake –
25 - 28g / 1000 Kcal.
Step: 7
Foods with high fibre content have lower
glycemic index
Physical form of food
 Nature of cooking
 Nature of fibre
 Amount and composition of meal affect the
glycemic index of food.
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(8) Protein – 15%
RDA of protein for adults – 1g/kg body weight.
Cereals, pulses, nuts, milk and its products, nonvegetarian items contribute to the protein content
in the diet.
(9) Fat – 20-25%
Type of fat – 7 – 10% SFA
- < 10% PUFA
- 10-15% MUFA
Step: 10
Translate in terms of food.
Use of exchange lists
- gives information on nutrient content
- provides variety in diet by giving
alternatives
(11) Sample meal plan:
Breakfast – Milk – 100 ml
Cereal preparation – from 75g cereal
e.g: 3 iddlies / chappathies
Mid morning – Fruit + Lime juice without
sugars.
Lunch – 250 g cooked rice or chappathies – 3
meat / fish / paneer
vegetables
curds
Dhal as sambar
Tea time: Milk – 100 ml
Whole gram or pulse – 15g
Dinner: 250g cooked rice or 3 chappathies
Meat / Fish / Dhal
Vegetables
Curds
Bedtime: Mild – 200 ml
Oil for cooking – 3-4 teaspoons
 To be adjusted to suit individual needs.
Eating modifications
Reduce cereal intake
Avoid simple sugars – Honey, Sucrose etc.
Avoid fried foods – chips, nuts etc
Increase use of vegetables – ensure adequate fibre
intake
Eat regular meals
Regular food and exercise
Balanced meal to ensure adequate Vitamins and
Minerals.
Type I Diabetes – in children
(a) Energy: 1000 kcal for the 1st year
+ 100 Kcal for every year upto 10yrs /
upto 200kcal
2000 + 50-100 kcal for girls between 12-15 yrs
2000 + 200 kcal for boys between 12-15 yrs
Above 15 yrs – 30-35 kcal / kg – sedentary
40 kcal / kg – moderation
50 kcal / kg – very active
(b) Distribution of CHO, Protein, Fat
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CHO – 50 – 55%
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Protein – 20 – 25%
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Fat – 20 – 25%
Gestational Diabetes
Pregnant women need extra 300 kcal and 15g
protein during the 2nd or 3rd trimester.
Frequent small meals to be given.
Diabetic Nephropathy
Depending on the function of the kidney.
 Energy – as for others with diabetes
 Protein – 0.6 – 0.8 g / kg IBW
 Fat – less than 30% of total Kcal preferably
20-25%
 CHO – to make up the rest of the calories
preferably from complex carbohydrates.
Evaluation…..,
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Monitoring medical and clinical outcomes
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Effectiveness of nutrition care plan etc
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Re-assess and review nutrition care plan
“Nutrition is a challenging aspect of diabetes
management. Attention to nutrition and meal
planning principles is essential for glycemic
control and over all good health”.