Medical Nutrition Therapy

• Objectives


  • Understand the basics of medical nutrition therapy and diet management for the following disorders:
  • Cardiovascular disease
  • Heart failure
  • Hypertension
  • Diabetes Melitus
  • Cancer
  • Renal disease
  • Clients with Special Needs
• Acute Cardiovascular disease


  Cardiovascular disease that develops and worsens rapidly
• Goals for patients after Myocardial Infarction

  • Promote recovery and strength
  • Lower LDL cholesterol and other known risk factors to prevent the progression of CVD
• Energy intake after heart attack

  1. Brief period of reduced energy intake during the first day

  2. Digestion, absorption and metabolism of food requires a generous cardiac output; to decrease the load on the heart

  3. Small meals should be spread out throughout the day
• Food Texture for Acute CVD


  • Foods that are relatively soft in texture or easily digested to avoid excess effort during eating or the discomfort of gas formation
• Fat for Acute CVD

  • Control types and amounts of fat
  • The Mediterranean diet reduces risk factors for CVD as it reduces inflammatory markers after an MI, and increases the lifespan
• Sodium for Acute CVD

  • General attention to reduced sodium content in food is important
  • If the patient has hypertension, reducing the sodium will help edema
• Heart Failure: Sodium restriction

  2g per day, No salt is served with meals
• Fluid restriction


  Fluid is limited to 2L per day for patients with mild symptoms of heart failure. For advanced stages, fluid is restricted to 1000-1500L per day
• Texture and Timing


  • Patients may tolerate soft foods better if eating laborious or uncomfortable
  • Frequent small meals are better suited than large meals to prevent fatigue from eating
• Nutritional Adequacy


  Care should be taken to ensure that diet restrictions do not result in nutrient inadequacies in the diet
• Alcohol


  Alcohol intake is limited or avoided if it contributes to heart disease
• Prediabetes


  Promote healthy food choices and at least 150 minutes per week of physical activity to promote and maintain weight loss of 5-10% of body weight
• Diabetes: Goals


  • Keep blood sugar levels normal, improve cholesterol and lipoprotein levels to lower heart disease risk, and maintain healthy blood pressure
  • Prevent or slow the rate of the development of the chronic complications by modifying nutrient intake and lifestyle
  • Address individual nutrition needs by taking into account personal and cultural preferences and willingness to change
  • Maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence
• Diabetes Mellitus: Additional considerations

  • Ensure proper nutrition for youth with type 1 or type 2 diabetes, pregnant and breastfeeding women, and older adults with diabetes, considering their specific needs at each stage of life
  • Provide self-management training for the safe conducting of exercise, including the prevention and treatment of hypoglycemia and diabetes treatment during acute illness
• Diabetes Mellitus: Total Energy Balance


  • Normal growth and weight management: Type 1 diabetes that starts during childhood so ensure they follow the correct growth charts. Type 2 typically occurs in overweight adults, so ensure that they change to a better weight
  • Energy Intake: The diet for someone with diabetes should provide enough energy to support normal growth, physical activity, and maintaining a healthy weight
• Diabetes Mellitus: Carbohydrate Balance

  • Starch and Sugar: Should not avoid them but rather monitor their carb intake
  • Glycemic Index: The glycemic index of a food is determined by comparing how much it raises blood sugar compared to a 50g sample of white bread or pure glucose, which are both known for their effects on blood sugar levels. Those with diabetes should avoid foods with high glycemic indexes
  • Fiber: Consume normal amounts of fiber
  • Sugar substitutes and sweeteners: Approved non-caloric sweeteners (saccharin, neotame, aspartame, acesulfame-K, and sucralose)
• Diabetes Mellitus: Nutrient Balance

  • Protein: Diabetic neuropathy is nerve damage from prolonged high blood sugar in diabetes. To prevent extra strain on the kidneys, diabetic neuropathy patients are advised to avoid excessive protein intake
  • Fat: No more than 7% of the diet's total calories should come from saturated fat. Lower cholesterol intake is also recommended
• Sugary foods


  If included in meal plan, consider how they affect insulin or medication dosage. But be careful not to overeat and consume too many calories.
• Fiber


  People with diabetes should eat foods with fiber, like everyone else. However, there isn't enough evidence to recommend a higher fiber intake specifically for diabetes.
• Sugar alcohols and non-nutritive sweeteners


  Safe when consumed within the daily intake levels established by the US Food and Drug Administration
• Nutrient Recommendations for Diabetes Management: Fats

  • Limit saturated fat to less than 7% of total calories
  • The intake of trans fats should be minimized
  • In individuals with diabetes, limit dietary cholesterol to less than 200 mg/day
  • Two or more servings of fish per week provide Omega 3 polyunsaturated fatty acids and are recommended
• Nutrient Recommendations for Diabetes Management: Alcohol

  • If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (1 drink/day for women, 2 drink/day for men)
  • To reduce the risk of nocturnal hypoglycemia (when blood sugar drops too low during sleep) among individuals who are using insulin, alcohol should be consumed with food.
  • Moderate alcohol consumption by people with diabetes doesn't directly affect blood sugar or insulin levels. However, if you consume alcohol with carbohydrates, it can raise blood sugar levels.
• Nutrient Recommendations for Diabetes Management: Micronutrients


  • No clear evidence demonstrates a benefit from vitamins or mineral supplementation in people with diabetes who do not have underlying deficiencies.
  • It's not recommended to regularly take antioxidants because there's not enough evidence that they work, and there are concerns about their long-term safety.
  • The benefits of chromium (mineral) supplementation for individuals with diabetes or obesity have not been clearly demonstrated and therefore cannot be recommended.
• Activity Level


  • Moderate (30 mins)
  • Moderate (1 hr)
  • Strenuous (30 mins)
  • Strenuous (1 hr)
• Exchange Needs for Moderate (30 mins)

  • 1 bread or 1 fruit
  • 1 bran muffin
  • 1 small orange
• Exchange Needs for Moderate (1 hr)

  • 2 bread + 1 meat
  • 1 bread + 1 fat
  • Tuna sandwich
  • 1/2 cup fruit salad + 1 cup milk
• Exchange Needs for Strenuous (30 mins)

  • 2 fruit
  • 1 bread + 1 fat
  • 1 small banana
  • 1/2 bagel + 1 tsp cream cheese
• Exchange Needs for Strenuous (1 hr)

  • 2 bread + 1 meat + 1 milk
  • 2 bread + 2 meat + 2 fruit
  • Meat and cheese sandwich + 1 cup milk
  • Turkey sandwich + 1 cup orange juice
• Daily Activity: Exercise


  1. Ensure normal body function before physical activity

  2. Monitor blood glucose levels before and after physical activity

  3. Monitor food intake
• Diet Management


  Everybody is unique, one plan does not fit everyone
• Carbohydrate counting


  Allows one to balance the carbohydrate intake with insulin injections
• Food exchange system


  The dietitian uses the food exchange system to calculate a patient's energy and nutrient needs as well as to distribute foods in a balanced meal and snack pattern
• Special diet foods: little need exists, those with diabetes should eat a well balanced diet
• Alcohol: can be planned but caution should be observed
• Hypoglycemia


  The brain needs a steady supply of glucose, so it's important to avoid low blood sugar
• Illness can change the insulin requirement
• Make sure to maintain a plan when travelling
• Plan ahead before going out to eat
• Any kind of stress, whether physical or emotional, can impact diabetes management because it triggers hormones that work against insulin