MEDICAL NUTRITION THERAPY ON DIABETES (AB) Flashcards
What is Medical Nutrition Therapy (MNT)?
A nutrition therapy for diabetes that involves diet modification and coordination with insulin, exercise, and weight loss.
What are the goals of nutrition therapy for adults with diabetes?
To promote healthful eating, achieve body weight goals, manage blood glucose, blood pressure, and lipids, prevent complications, and respect individual preferences.
Why is nutrition therapy challenging for diabetes patients?
Many patients are not adherent and resistant to diet counseling.
What should be avoided when advising patients about diet?
Unverified content from Facebook or social media and expensive foods they cannot afford.
What is Total Energy Requirement (TER)?
The amount of food energy needed to balance energy expenditure for maintaining body size, composition, and physical activity.
How does activity level affect energy requirements?
Higher activity levels require more calories; sedentary individuals need fewer calories.
What are the kcal/kg IBW/day energy requirements for sedentary individuals?
Obese: 20-25, Normal: 25-30, Underweight: 35.
What are the kcal/kg IBW/day energy requirements for moderate activity?
Obese: 30, Normal: 35, Underweight: 40.
What are the kcal/kg IBW/day energy requirements for heavy activity?
Obese: 35, Normal: 40, Underweight: 45-50.
How do you compute IBW (Ideal Body Weight)?
Use BMI of 23-25 kg/m² and multiply it by height in m².
What is the energy value of carbohydrates?
4 kcal/g.
What is the energy value of proteins?
4 kcal/g.
What is the energy value of fats?
9 kcal/g.
What is the simplest form of carbohydrates?
Glucose.
Where is glycogen stored in the body?
Liver, muscles, brain, and nerves.
What are examples of sugar-based carbohydrates?
Sucrose (table sugar), fructose (fruits, honey), maltose (malt sugar), lactose (milk sugar).
What are major sources of starch?
Grains (cereals, pasta, bread), potatoes, rice, corn, root vegetables.
What are sources of fiber?
Green leafy vegetables, fruits, legumes.
What is the recommended fiber intake?
25-30 gm/day or 40 gm per 1000 kcal/day.
What are the benefits of fiber in diabetes?
Increases fecal mass, binds bile acids and cholesterol, promotes beneficial gut bacteria, lowers glycemic index.
What are nutrient-dense foods?
Foods high in nutrients and low in calories, such as vegetables, fruits, whole grains, lean meats, and dairy.
What are empty-calorie foods?
Foods high in calories but low in nutrients.
What are ADA recommendations for carbohydrate intake?
Minimize sucrose-containing foods, increase whole grains, vegetables, fruits, legumes, and dairy.
How do carbohydrates affect blood sugar levels?
They are the primary determinant of postprandial glucose levels.
What is the biological value (BV) of proteins?
The proportion of protein retained for growth and maintenance, expressed as nitrogen absorbed.
What are high BV protein sources?
Animal sources like meat, poultry, fish, eggs, and dairy.
What are low BV protein sources?
Plant sources like peas, lentils, nuts, seeds, and beans.
What is the protein recommendation for non-CKD diabetes patients?
15-20% of total caloric intake.
What is the protein recommendation for CKD patients?
0.8 gm/kg BW/day.
How does excess protein intake affect diabetes patients?
May lead to weight gain and elevated cholesterol.
What are monounsaturated fatty acids (MUFA) and examples?
Healthy fats that improve glucose tolerance; found in olive oil, canola oil, and peanut oil.
What are polyunsaturated fatty acids (PUFA) and examples?
Essential fats important for immune function; found in corn oil, soya oil, fish oil, sesame oil.
What are saturated fats and why should they be limited?
Fats that increase LDL cholesterol and CVD risk; found in coconut oil, palm oil, and butter.
What are trans fats and why are they harmful?
Processed fats that raise LDL cholesterol and increase diabetes and CVD risk; found in margarine, packaged snacks.
What are omega-3 fatty acids and their benefits?
Lower triglycerides, improve lipid profiles, reduce CVD risk; found in fish oil and nuts.
What is the recommended omega-3 intake?
3000-4000 mg/day.
What are omega-6 fatty acids and their role?
Essential fatty acids that serve as precursors to eicosanoids, beneficial for heart health.
What is the ADA recommendation on dietary fat?
A Mediterranean-style diet rich in monounsaturated fats may improve glucose metabolism and lower CVD risk.
Why are omega-3 supplements not strongly recommended?
Clinical trials suggest their benefits are dose-dependent, requiring high intake (3-4g/day) which is difficult to achieve with standard supplements.
What is the ideal macronutrient distribution for people with diabetes?
There is no single ideal macronutrient distribution; it must be individualized.
What is the first step in determining macronutrient distribution?
Total caloric requirements must first be calculated.
According to the American Diabetes Association (ADA), what percentage of total caloric intake should be from protein?
15-20% of total caloric intake.
How do you calculate daily protein requirements for a 1,600 kcal/day diet according to ADA recommendations?
Multiply 1,600 kcal by 0.2 (for 20% protein), then divide by 4 (as protein provides 4 kcal/g).
What is the recommended carbohydrate intake percentage for Filipinos?
45-65% of total caloric intake.
What is the commonly computed carbohydrate intake percentage for sedentary individuals in the Philippines?
50% of total caloric intake.
What is the carbohydrate intake percentage recommendation for weight loss?
Around 45% of total caloric intake.
How is fat intake calculated in a 1,600 kcal/day diet if the target fat intake is 30%?
Multiply 1,600 kcal by 0.3 (for 30% fat), then divide by 9 (as fat provides 9 kcal/g).
What is the American Diabetes Association (ADA) recommendation for fiber intake?
25-35 grams per day.
What are the primary sources of dietary fiber in the diet?
Fruits, vegetables, and leafy greens.
How much carbohydrate is typically found in one slice of fruit?
10 grams of carbohydrates.
Why is fruit intake included in carbohydrate computation?
Because fruits contain fructose, which contributes to total carbohydrate intake.
What is the recommended approach for medical nutrition therapy in diabetes?
An individualized medical nutrition therapy program provided by a registered dietitian nutritionist with experience in diabetes care.
What are the benefits of diabetes medical nutrition therapy?
Cost savings and improved cardiometabolic outcomes.
What percentage of weight loss is recommended for overweight or obese individuals to improve diabetes outcomes?
At least 5% of body weight within 3-6 months.
What is the ideal macronutrient pattern for people with diabetes?
There is no ideal macronutrient pattern; meal plans should be individualized.
What dietary approaches can be considered for type 2 diabetes management and prediabetes prevention?
Mediterranean diet, ketogenic diet, low-calorie diet, intermittent fasting.
What dietary change has the greatest impact on improving glycemic control in diabetes?
Reducing overall carbohydrate intake.
What type of carbohydrates should be emphasized in a diabetes diet?
Nutrient-dense, high-fiber, minimally processed carbohydrates (e.g., non-starchy vegetables, fruits, legumes, whole grains, dairy with minimal added sugar).
What beverages should people with diabetes replace sugar-sweetened drinks with?
Water or low/no-calorie beverages.
Why should carbohydrate sources high in protein be avoided when treating hypoglycemia?
Because protein increases insulin response without raising plasma glucose levels.
What types of fats should be emphasized in a diabetes diet?
Monounsaturated and polyunsaturated fats (e.g., Mediterranean diet, fatty fish, nuts, seeds).
What is the recommended intake of long-chain n-3 fatty acids for cardiovascular health?
Fatty fish (EPA, DHA), nuts, and seeds (ALA).
What is the recommendation regarding micronutrient and herbal supplementation for diabetes?
Not recommended unless there is a documented deficiency.
Why should β-carotene supplementation be avoided in diabetes patients?
There may be evidence of harm.
What is the guideline for alcohol consumption in adults with diabetes?
Moderation: 1 drink/day for women, 2 drinks/day for men.
What is the definition of one alcoholic drink for diabetes patients?
1 shot (1.5 oz) of liquor, 1 bottle (12 oz) of light beer, or 5 oz of wine.
What risk should people with diabetes be educated on regarding alcohol consumption?
Delayed hypoglycemia, especially when using insulin or insulin secretagogues.
What is the recommended daily sodium intake for people with diabetes?
Less than 2,300 mg/day.
What are the benefits of non-nutritive sweeteners for people with diabetes?
They may reduce overall calorie and carbohydrate intake if there is no compensatory increase in energy intake from other sources.
What is a potential issue with using artificial sweeteners like sucralose or aspartame?
They are extremely sweet, may lead to increased sweet cravings, and have potential health concerns with excessive intake.
How does Coke Zero compare to other beverages in terms of calories?
It still contains low calories, but water and tea are better alternatives.
What is the difference in calorie content between white and brown rice?
They have the same calories but different glycemic indices.
What is the difference in calorie content between muscovado and table sugar?
They have the same calories but different glycemic indices.
What are the steps for designing and individualizing nutritional prescriptions?
- Calculate desirable body weight
- Calculate daily caloric needs
- Distribute macronutrient intake (carbohydrates, proteins, fats)
- Plan a meal pattern
- Educate the patient
How should caloric intake be adjusted for obese patients?
Subtract 500-700 kcal/day from total caloric intake to create an energy deficit of 500-750 kcal/day.
What are the realistic weight loss goals for obese patients?
Up to 2 lbs. per week; at least 5% weight loss is beneficial; 7% weight loss is optimal within 3-6 months.
What are the key components of the Mediterranean diet?
- Plant-based foods (fruits, vegetables, grains, nuts, seeds) 2. Minimal processed foods 3. Olive oil as primary fat source 4. Moderate dairy intake 5. Fish and poultry as protein sources 6. Minimal red meat consumption
What type of fats are emphasized in the Mediterranean diet?
Monounsaturated fats (olive oil) and polyunsaturated fats.
Why is the Mediterranean diet considered feasible in the local setting?
It is doable because the country has an abundance of fish and green leafy vegetables.
What is the daily caloric intake range for a low-calorie diet?
800-1200 kcal/day.
What is a very low-calorie diet defined as?
<800 kcal/day.
How can meal replacements help in a low-calorie diet?
They provide structured macronutrient intake, reduce problematic food choices, and simplify decision-making.
What are examples of diabetes-specific meal replacement formulas?
Glucerna®, GlucoBest®.
What is the purpose of Pinggang Pinoy?
To provide a food plate model guiding macronutrient proportions.
What are the recommended proportions in the Pinggang Pinoy plate?
1/4 plate for proteins (poultry, foods rich in MUFA/PUFA), 1/4 plate for carbohydrates, 1/2 plate for vegetables.
What is an example of a misconception about carbohydrates in Pinggang Pinoy?
Thinking that 2 cups of oatmeal with condensed milk has fewer calories or is healthier than rice.
How are food portions estimated using the hand method in Pinggang Pinoy?
1 cup = fist, 1 tbsp = thumb, 1 slice = palm.
Why should glow foods be given in high amounts?
They are fiber-rich and have a low glycemic index.
How should fruit intake be managed in diabetic patients?
1 fruit exchange per meal (e.g., 1 banana or 5 grapes per meal = 10g CHO).
Why is fruit intake limited in chronic kidney disease?
To reduce potassium intake since fruits contain potassium.
What is the macronutrient distribution of a ketogenic diet?
High in protein, very low in carbohydrates (approximately 10% carbohydrates).
Why is a ketogenic diet not recommended for diabetic patients?
High protein and fat intake increases the risk for kidney and cardiovascular disease.
What is portion distortion, and why is it problematic?
Upsizing meals unknowingly increases calorie intake beyond daily needs, contributing to obesity, especially in children.
What is mindful eating?
A practice that focuses on awareness of eating experiences, body sensations, thoughts, and feelings without judgment.
What are the seven practices of mindful eating?
- Honor the food 2. Engage all senses 3. Serve in modest portions 4. Savor small bites and chew thoroughly 5. Eat slowly to avoid overeating 6. Don’t skip meals 7. Eat a plant-based diet.
How can serving food in modest portions help?
It prevents overeating and food waste.
Why should meals not be skipped?
Skipping meals increases the risk of extreme hunger, leading to poor food choices.
Why is eating a plant-based diet recommended?
It benefits health and the environment; processed meat and saturated fat increase colon cancer and heart disease risk.
What is the Ayurvedic proverb about diet and medicine?
‘When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.’
What is the role of iodide in the body?
It is a precursor for thyroid hormone synthesis.
What are the normal iodine requirements for different age groups?
150 µg for adults, 200 µg for pregnant women, 90-120 µg for children.
What are the consequences of iodine deficiency?
Endemic goiter, hypothyroidism, and cretinism.
How is iodine deficiency prevented?
Using iodized salt; sometimes, a pinch of iodized salt is enough to prevent endemic goiter.
What are examples of goitrogens that interfere with iodine absorption?
Cassava and cabbage (contains thiocyanate).
How can goitrogens be safely consumed?
Cabbage should be eaten in small amounts and blanched to remove thiocyanate.
What is the Wolff-Chaikoff effect?
A physiological response where excess iodine temporarily suppresses thyroid hormone production.
When can excessive iodine intake be harmful?
In individuals with underlying thyroid disease, it can lead to hypo- or hyperthyroidism.
