SERVING GUESTS WITH SPECIAL HEALTH NEEDS Obesity Cardiovascular Disease Hypertension Diabetes Digestive Disorders Hospit

1. SERVING GUESTS WITH SPECIAL HEALTH NEEDSObesityCardiovascular DiseaseHypertensionDiabetesDigestive DisordersHospital Diet Orders Chapter 13

2. Learning Objectives • Explain nutritional meal planning for guests with special health needs • Plan menus for guests with special health needs • Describe nutrition recommendations to achieve weight loss • Describe nutrition recommendations to prevent and treat cardiovascular disease • Explain the DASH diet for the control of hypertension • Describe the digestive process and contrast three digestive diseases • Describe general guidelines for diet management of GI tract conditions • List foods included in various types of hospital diet orders

3. Our Diet and Our Health • Food affects our health • Positively • Negatively • Guests have various special nutrition needs

4. Our Diet and Our Health • Short-term effects • Long-term effects • 2/3 adults are overweight or obese • 1/3 children are overweight or obese • 1/3 adults have cardiovascular disease • 1/3 adults have high blood pressure • ¼ population has diabetes or pre-diabetes

5. Leading Causes of Death in U.S.

6. Weight Management - Obesity 6

7. Hypertension Heart Disease Type 2 Diabetes Gallbladder Disease Pulmonary Disease and Sleep Disorders Bone and Joint Disorders Infections Liver damage Cancer risk Surgical risk Accident risk Skin Disorders Pregnancy risk Menstrual irregularities Infertility Psychological Depression, low self-esteem, discrimination Obesity Related Health Issues

8. CALORIES OUT Metabolism Physical Activity CALORIES IN Food and beverages Weight Loss Basics

9. Calories Out- Physical Activity • 2010 Dietary Guidelines • Adults 18-61 yo • 2 hours and 30 minutes a week, moderate aerobic • 1 hour and 15 minutes a week, vigorous aerobic • Strengthening activities 2 days week • Greatest benefit- 5 hours a week • Children and Adolescents 6-17 yo • 60 minutes or more of physical activity a day • Duration/regular more important than intensity • 10,000 steps a day • Increase activities of daily living

10. Calories In • Reduce portions • Reduce added sugars, fats, alcohol • Determine current calorie intake; subtract 250-500 calories/day OR • Decrease 250 calories a day from diet, 250 calories more physical activity • 3500 calories in a pound of body fat

11. Body Mass Index (BMI) • See text • One way to determine healthy body weight • Not perfect; men, athletes, genetically muscular, short stature, health issues • Healthy- 18.5-24.9 • Overweight- 25.0-29.9 • Obesity- 30- 39.0 • Severely Obese- > 40

13. Other Thoughts…. • BodPod (air displacement), DEXA, bioelectric impedance, caliper measures to determine body fat • Waist Circumference • > 40” men, > 35” women • Abdominal fat affects liver function • Healthy-Fit Weight • Focus on fat weight vs muscle weight • Health benefits first 5-10% of weight lost

14. Weight Loss Program Components • #1- Lower calorie, lower fat, sensible, long term dietary intake, moderate protein • #2- Exercise • #3- Self Monitoring • Food, exercise, weight records • Behavior modification • #4- Breakfast • #5- Support

15. Cardiovascular Disease

16. Cardiovascular Disease (CVD) • Group of diseases related to the heart and blood vessels • Factors that increase risk for CVD • Heredity • Cigarette smoking • Physical inactivity • Obesity • High blood pressure • Diet

17. Cardiovascular Disease (CVD) • Major dietary factors that increase risk for CVD • High saturated fats • Trans fats • Dietary cholesterol • Obesity

18. Types of Cardiovascular Disease

19. Nutrition Goals of Cardiovascular Disease • Saturated fatand trans fat • < 7% of calories • 15 grams – 2000 calorie diet • Cholesterol • < 200 mg/day • Increase soluble fiber • Add plant stanols/sterols • 2 grams/day • Weight Management • Source: National Cholesterol Education Program

20. Plant Stanols and Sterols • Modified triglyceride that prevents fat/cholesterol absorption • Margarine • 2 servings a day

21. Blood Lipid Goals • Cholesterol • < 200 mg/dL • LDL • < 100 mg/dL if disease • < 130 mg/dL if 2+ risk factors, • < 160 mg/dL if 0-1 risk factors

22. Emphasis on Mediterranean- Type Balance

23. Cardiovascular Disease Menu Ideas • Low-saturated fat meatless appetizers, entrees and side dishes • Include legumes, peas, beans, lentils and soy products in the menu • Offer lean fish, poultry, lamb, bison, beef and pork • Serve moderate portions: 4-ounce entrees of lean meat cuts; 5 to 6 ounces of poultry; 6 to 8 ounces of fish • Serve low-fat and nonfat dairy products and use them liberally as ingredients

24. Cardiovascular Disease Menu Ideas • Use canola or olive oil • Less butter, cream, bacon fat, meat drippings, saturated margarines and shortenings, cheese • Greater variety of fruits and vegetables • Whole grains • Smaller portions • Reduce portions of fried foods • Grilled-baked-lightly sautéed fish and seafood • Moderate nuts and seeds • Egg whites

25. Hypertension

26. Hypertension • Blood pressure is the force of blood pushing against the walls of arteries as it flows through them • Blood pressure is measured in two numbers: • Systolic is the pressure created when the heart beats while pumping blood • Diastolic is the pressure created when the heart is at rest between beats • High blood pressure can be caused by many factors including: • Genetics • Smoking • Stress • Obesity • Diet • Inactivity

27. Hypertension

28. DASH (Dietary Approaches to Stop Hypertension) • A heart healthy, nutrient-rich research based diet supported by the National Heart, Lung and Blood Institute • High potassium, calcium, magnesium • Low sodium • Achieve with unprocessed, fresh/frozen foods

29. Why Sodium, Potassium, Calcium and Magnesium? • Video on HTN • http://www.youtube.com/watch?v=jvE6at_i_Tw&feature=related • Summary • Cardiac Output (CO) volume • sodium, potassium • Heart Rate-Resistance • calcium, magnesium, potassium

30. DASH (Dietary Approaches to Stop Hypertension) Daily Nutrient Goals Used in the DASH Studies (2,100 calorie eating plan)

31. The DASH Diet

32. Diet Effect on Systolic Blood Pressure

33. Long Term Effects of High Blood Pressure

34. Sodium in Foodservice Average consumption: • Restaurants: 1925 mg sodium per 1000 calories • Home: 1422 mg sodium per 1000 calories

35. National Salt Reduction Initiative Targets for sodium levels in various food categories set for 2014: • No menu item should be over 1,200 milligrams sodium/serving. • Soup 280 mg sodium/100 grams • Hamburgers 330 mg sodium/100 grams • Sandwiches 370 mg sodium/100 grams • Cheese pizza 390 mg sodium/100 grams Source: National Salt Reduction Initiative. www.nyc.gov/health/salt

36. DIABETES

37. Diabetes 37 A chronic disease characterized by: • High blood glucose (also called blood sugar) • Insufficient Insulin or • Ineffective insulin • No cure

38. CHO from diet, glycogen Cells Blood Glucose (blood sugar) + Insulin Insulin From pancreas or injection

39. ¼ population has diabetes or pre-diabetes

40. Blood Glucose and Diabetes Diagnosis 70 mg/dl

41. Two Types: Type 1 and Type 2 • Both types test blood sugars with a glucometer • Both types count carbohydrates in food • Some use specific guidelines for grams of carb • Some use general portion control of foods

42. Type 1 Diabetes Generally occurs earlier in life Requires daily insulin injections or an insulin pump Carbohydrate grams balanced with insulin High risk for a low blood sugar, treat immediately 42

43. Diabetic Hypoglycemia Blood glucose below 70 mg/dL 15:15 rule 15 grams carbohydrate every 15 minutes 15 grams = ¼ cup juice,

44. If Blood Glucose is too high…. Look at amount of carbohydrate consumed Reduce portions Substitute with lower CHO content or sugar substitute Find food or food combinations that result in lower blood sugar (glycemic index) Opposite if too low…

45. Pre-Diabetes Prevent diabetes! Weight loss Decrease 500-1000 calories and fat Exercise 150 minutes/week

47. Type 2 diabetes • More common than type 1 • Genetic cause (runs in families) • Overweight and inactivity increases likelihood of developing type 2 diabetes • Until recently generally occurred later in life • 1 in 3 children will develop type 2 diabetes

48. Type 2 Diabetes Insulin resistance and Insulin insufficiency Weight loss Reverses insulin resistance Calorie control, exercise

49. Type 2 Diabetes May be controlled by a combination of: • Carb controlled diet • Calorie controlled diet • Exercise • Pills • Injected Medications • Insulin Injections • As diabetes progresses, people often need to increase medications and/or add insulin

50. Diabetes Nutrition Goals • Attain and maintain a blood glucose level as close to normal as possible • Carbohydrate foods raise blood glucose levels • monitor the carbohydrate eaten and balance intake with physical activity (and often insulin or pills.) • Distribute carbohydrates fairly evenly though out the day – some at each meal and with snacks