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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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MEDICAL NUTRITION THERAPY (MNT)

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  1. MEDICAL NUTRITION THERAPY (MNT) Mrs. Sarah Jacob Rtd. Head, Department of Dietetics Christian Medical College Vellore .

  2. Medical Nutrition Therapy (MNT) Replaces The earlier term of “Diet Therapy” and stresses a four pronged approach that includes…. • Assessment of the individual’s metabolic and life style parameters • Identification of nutrition goals • Intervention designed to achieve these goals. • Evaluation of therapeutic outcome.

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. Step: 3 Calculate Energy Requirement Basal + activity = (148 x 10) = (1480 x 20 / 100) = 1776 Kcal = Rounded off to 1800 Kcal.

  9. Step: 4 Determine gm of carbohydrate, protein and fat • CHO = 60-65% of total calories = 270g- 292g • Protein = 10-15% of total calories = 45g – 68g • Fat = 20-25% of total calories = 40g – 50g

  10. Step : 5 Carbohydrate – 60-65% • Complex CHO is better than simple sugars as absorption is slower • Amount of CHO in each meal to be adjusted for each individual.

  11. 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.

  12. 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.

  13. (8) Protein – 15% RDA of protein for adults – 1g/kg body weight. Cereals, pulses, nuts, milk and its products, non- vegetarian items contribute to the protein content in the diet. (9) Fat – 20-25% Type of fat – 7 – 10% SFA - < 10% PUFA - 10-15% MUFA

  14. Step: 10 Translate in terms of food. Use of exchange lists - gives information on nutrient content - provides variety in diet by giving alternatives

  15. (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

  16. 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.

  17. 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.

  18. Type I Diabetes – in children • 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

  19. (b) Distribution of CHO, Protein, Fat • CHO – 50 – 55% • Protein – 20 – 25% • Fat – 20 – 25%

  20. Gestational Diabetes Pregnant women need extra 300 kcal and 15g protein during the 2nd or 3rd trimester. Frequent small meals to be given.

  21. 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.

  22. Evaluation….., • Monitoring medical and clinical outcomes • Effectiveness of nutrition care plan etc • Re-assess and review nutrition care plan

  23. “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”.

  24. Thank you

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