Dietary Management by Prof. Morsi Arab

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Dietary Managementby Prof. Morsi Arab
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Diet ManagementGoals 1- to
restore glycaemic control and optimal
lipid levels 2- adequate needs for growth ,
pregnancy , lactation 3- body weight
management 4- keep overall health 5-
coordinate with individual life style
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Total Caloric Intake1- Calculate
needs acc. to daily activity .2- and to manage
body weight ? or ? to reach
optimum BMI (lt 25 )3- Special considerations in
growing children --------------------------------
-----------------------------4- Caloric
restriction improves glycaemic control
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Total Caloric Intake (
cont.)5- Total caloric content sum of
cal/gm (gm CHO x 4 ) ( gm fat x 9) ( gm
protein x 4)6- Caloric distribution ( )
CHO / Fat / Prot ( CHO 50-70) / ( fat
20-25 ) / (protein 15 )
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CHO Content (quantity and
quality) Total CHO 50-60 of total
calories - complex CHO gt 70
- simple CHO lt 10 Example If
total calories allowed 1500 cal.- Then
CHO content 1500 X 60 900 cal.
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CHO Content (quantity and quality) Complex CHO
70 x 900 630 cal 160 gm Sugars
lt 10 x 900 90 cal 22 gmComplex CHO
with low G / l grains-legumes-pasta-whole
grain bread-boiled rice Simple CHO refined
sugars , fruit sugars
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Fat Content Fat
restriction helps control displipidemia and

hyperglycemia.
Control body
weight Total fat content gt 30 of total
calories - polyunsaturated ( plant
oil ) 10 - monounsaturated (olive
oil ) 10 - saturated ( animal
fat lt 10) Essential fatty acid
supplements ( soya
beans, nuts, rapeseed oils) Omega 3 fat ( fish)
anti athirogenic ( 2.3 fish
meals/wk or fish oil caps 0.3 g) Total
Cholesterol (lt 300 mg )
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Protein Average total
protein content 15 of total calories
(
12-20) e.g. in total 2000 cal 15 300
cal. 75 gm prot. Or ( 0.8-1.2
gm/kg body weight) Animal and plant proteins
( essential amino acids)------------------------
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Protein restriction in renal function impairment
Allow for growth , pregnancy , lactation,
acute catabolic states,
wound healing
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Fibre ( undigested parts of diet )

Types Soluble
insoluble
(pectins , gums ( cellulose,
semi-cellulose, gel. , mucilage
) legnins
? ?
Effects metabolic effect
increase bulk ( CHO lipid)
-------------------------
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-Recommendation - double the
av. normal intake ( 13- 30 gm) -
gradual increase to avoid flatulence
- include both sol. insoluble
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An Example in Diet Construction 1- if a Pt
needs daily requirement 2500 calories 2-
and is overweight ( BMI 35 ) ? Goal
to lower body weight by 1kg/ wk ( 1
kg loss requires loss of 7000 calories
i.e. 1000
/day X 7 ) 3- ? subtract
from his intake 1000 calories / day 4- ?
daily intake 2500 -1000 1500 calories
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An Example in Diet Construction 5- To
distribute the 1500 calories - e.g. 60
CHO 24 fat 16 protein 100
(900 cal.) (360 cal.) (240
cal.) ? ?
? ( 225 gm ) ( 40 gm )
( 60 gm ) CHO fat
protein
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Standard Body Weight Control by Dietary
Restriction Goal loose 1 Kg b. weight per
week plan / calculation 1
kg/ wk 7000 cal. deficit /wk
1000 cal. deficit / day? lower
caloric intake by 1000 cal/day less than daily
need e.g. 2500-1000 1500 cal./
day
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Stringent diet restriction - total cal.
Intake 400-600 cal./day - only for
patients with very high BMI - requires
hospital monitoring (electrolytes, E.C.G.,

etc) - note
provide protein content , vitamin and
mineral requirements.
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Body Weight Control by exercise Exercise
supplements diet restrictions to control
body weight and ? more lasting effect
Additional value for exercise 1- ?
hyperglycemia
2- ? CHD risk factors .
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Body Weight Control by exercise ( cont.)
Calculating expenditure of energy by walking
- is related to body weight and distance
( not to speed of walking ). -
e.g. a 70 kg person walking for one mile
spends 100 cal. ( increases
if more body weight , or walking uphill )
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Sugar Substitutes , SweetenersThe Ideal
Sweetening power, taste, cost, side
effects, consistency form, heat
stability ,caloric content.Types
Natural fructose - sorbitol - manitol -
xylose Synthetic saccharin - aspartame
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Sugar Substitutes , Sweeteners
Side effects max cost Cal/gm Swt.p
Diarrhea Diarrhea Diarrhea 75 gm 50 gm 50 gm Expensive. Less less 4 4 4 1-2 ½ ½ Fructose Sorbitol Manitol
Most popular Heat unstable 1gm 50?/kg Cheap Expensive 0 v. low 300 200 Saccharin Aspartame
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Fat Substitute
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Alexandrie Palais du Montazah
Thank You