NLiS Country Profile: Afghanistan


Nutrition Recommendations and Interventions for Diabetes
Equus Race features added fat, very soluble fiber in the form of beet pulp and starch from cereal grains. Uncontrolled diabetes is often associated with micronutrient deficiencies Care should be taken to avoid excess energy intake. Micronutrients in diabetes management Recommendations There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies. Nutrition is part of medical curricula.

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To begin to explore where nutrients come from, as well as their importance for particular tasks in the body. Students are starting to view the body as a system in these grades. One important thing they should start to understand is that in order for their "systems" to properly function, they need energy and materials from food as the benchmark states. Though students know they must eat to live, they may not have made the distinct connections between food and the body properly repairing itself, or food and growth; even a connection as simple as a lack of iron or carbohydrates making one tired.

This lesson will focus on the digestive system in order to address the latter part of the benchmark—that undigested food is eliminated. In addition, it will begin to explore where nutrients come from and their importance for particular tasks in the body.

This Science NetLinks lesson is the first of a three part series. It works in conjunction with Nutrition 2: Good Food, Good Health, a lesson that teaches about the food groups and how vitamins and minerals help the body function properly, and Nutrition 3: Younger elementary school students might think that the contents of the body is what they have seen being put into it or coming out of it.

Students know food is related to growing and being strong and healthy, but they are not aware of the physiological mechanisms. In upper elementary, students can list a large number of organs and by 5th grade, "students know that food undergoes a process of transformation in the body.

Students should naturally begin talking about the digestive system in response to the final question listed above. Let them know that food and the digestive system are the topics for this lesson.

Experience has shown that residents eat better when they are given less restrictive diets , Specialized diabetic diets do not appear to be superior to standard diets in such settings , Meal plans such as no concentrated sweets, no sugar added, low sugar, and liberal diabetic diet also are no longer appropriate.

These diets do not reflect current diabetes nutrition recommendations and unnecessarily restrict sucrose. These types of diets are more likely in long-term care facilities than acute care. Making medication changes to control glucose, lipids, and blood pressure rather than implementing food restrictions can reduce the risk of iatrogenic malnutrition.

The specific nutrition interventions recommended will depend on a variety of factors, including age, life expectancy, comorbidities, and patient preferences Major nutrition recommendations and interventions for diabetes are listed in Table 3. Monitoring of metabolic parameters, including glucose, A1C, lipids, blood pressure, body weight, and renal function is essential to assess the need for changes in therapy and to ensure successful outcomes.

Many aspects of MNT require additional research. Classification of overweight and obesity by BMI, waist circumference, and associated disease risk. Mooradian, and Madelyn L. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Diabetes Care Jan; 31 Supplement 1: This article has a correction. Errata - August 01, Department of Agriculture Medical nutrition therapy MNT is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications.

Goals of MNT that apply to individuals with diabetes Achieve and maintain Blood glucose levels in the normal range or as close to normal as is safely possible A lipid and lipoprotein profile that reduces the risk for vascular disease Blood pressure levels in the normal range or as close to normal as is safely possible To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence Goals of MNT that apply to specific situations For youth with type 1 diabetes, youth with type 2 diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutritional needs of these unique times in the life cycle.

B Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. A For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term up to 1 year.

A For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake in those with nephropathy , and adjust hypoglycemic therapy as needed. E Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. B The importance of controlling body weight in reducing risks related to diabetes is of great importance.

A Individuals at high risk for type 2 diabetes should be encouraged to achieve the U. B There is not sufficient, consistent information to conclude that low—glycemic load diets reduce the risk for diabetes. E Observational studies report that moderate alcohol intake may reduce the risk for diabetes, but the data do not support recommending alcohol consumption to individuals at risk of diabetes. B No nutrition recommendation can be made for preventing type 1 diabetes.

E Although there are insufficient data at present to warrant any specific recommendations for prevention of type 2 diabetes in youth, it is reasonable to apply approaches demonstrated to be effective in adults, as long as nutritional needs for normal growth and development are maintained.

E The importance of preventing type 2 diabetes is highlighted by the substantial worldwide increase in the prevalence of diabetes in recent years. Diabetes in youth No nutrition recommendations can be made for the prevention of type 1 diabetes at this time 1.

B Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control.

A The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. B Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. A As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. B Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration FDA.

A Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management. Amount and type of carbohydrate. A Intake of trans fat should be minimized. E Two or more servings of fish per week with the exception of commercially fried fish filets provide n-3 polyunsaturated fatty acids and are recommended.

B The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD. E In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations.

A High-protein diets are not recommended as a method for weight loss at this time. Optimal mix of macronutrients Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists.

Alcohol in diabetes management Recommendations If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount one drink per day or less for women and two drinks per day or less for men.

E To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. E In individuals with diabetes, moderate alcohol consumption when ingested alone has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol as in a mixed drink may raise blood glucose.

B Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia. Micronutrients in diabetes management Recommendations There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies.

A Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.

A Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended. E Uncontrolled diabetes is often associated with micronutrient deficiencies Antioxidants in diabetes management. Chromium, other minerals, and herbs in diabetes management. E Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks.

A For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount. C For planned exercise, insulin doses can be adjusted. E The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle. Nutrition interventions for type 2 diabetes Recommendations Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure.

E Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication s needs to be combined with MNT. E Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Nutrition interventions for pregnancy and lactation with diabetes Recommendations Adequate energy intake that provides appropriate weight gain is recommended during pregnancy.

E Ketonemia from ketoacidosis or starvation ketosis should be avoided. E Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended. A Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control.

Nutrition interventions for older adults with diabetes Recommendations Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight. E A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. B MNT that favorably affects cardiovascular risk factors may also have a favorable effect on microvascular complications such as retinopathy and nephropathy.

C Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake. B For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. C In normotensive and hypertensive individuals, a reduced sodium intake e. A In most individuals, a modest amount of weight loss beneficially affects blood pressure.

C In the EDIC Epidemiology of Diabetes Interventions and Complications study, the follow-up of the DCCT Diabetes Control and Complications Trial , intensive treatment of type 1 diabetic subjects during the DCCT study period improved glycemic control and significantly reduced the risk of the combined end point of cardiovascular death, myocardial infarction, and stroke B In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia.

Acute illness Recommendations During acute illnesses, insulin and oral glucose-lowering medications should be continued. A During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important. B Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis.

Patients with diabetes in acute health care facilities Recommendations Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations.

E Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals. E Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Patients with diabetes in long-term care facilities Recommendations The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted.

C An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management. B Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , View inline View popup.

Table 1— Nutrition and MNT. Table 2— Classification of overweight and obesity by BMI, waist circumference, and associated disease risk. Table 3— Major nutrition recommendations and interventions. Footnotes Originally approved Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications.

Nutrition principles and recommendations in diabetes Position Statement. Diabetes Care 27 Suppl. The evidence for the effectiveness of medical nutrition therapy in diabetes management. How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc Am J Clin Nutr When to start cholesterol-lowering therapy in patients with coronary heart disease: Whitworth JA, Chalmers J: Clin Exp Hypertens National Heart, Lung, and Blood Institute: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: Am J Prev Med Weight management through lifestyle modification for the prevention and management of type 2 diabetes: Efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus: Arch Intern Med Translating lifestyle intervention to practice in obese patients with type 2 diabetes: The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: Control Clin Trials Am J Public Health A randomized trial of a low-carbohydrate diet for obesity.

N Engl J Med The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: Ann Intern Med Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.

Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Dietary intake in the Diabetes Prevention Program cohort: Achieving weight and activity goals among Diabetes Prevention Program lifestyle participants. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program.

Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes.

Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: Whole-grain intake and insulin sensitivity: Dietary glycemic index and glycemic load, carbohydrate and fiber intake, and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance Atherosclerosis Study.

Dietary carbohydrate amount and type in the prevention and management of diabetes: Moderate alcohol consumption lowers the risk of type 2 diabetes: Effect of alcohol consumption on diabetes mellitus: Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women.

Int J Epidemiol Alcohol consumption and risk of stroke: Dietary Guidelines for Americans. Glycemic index of foods: Towards understanding of glycaemic index and glycaemic load in habitual diet: Br J Nutr Carbohydrates and increases in obesity: Obes Res 12 Suppl. Low-glycemic index diets in the management of diabetes: Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: Sucrose compared with artificial sweeteners: Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus.

Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Effect of a high-protein, high—monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diet and risk of type II diabetes: Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity. Dietary fat intake and risk of type 2 diabetes in women.

Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. Acute effects of monounsaturated fatty acids with and without omega-3 fatty acids on vascular reactivity in individuals with type 2 diabetes. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Fish intake and risk of incident heart failure.

J Am Coll Cardiol Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease. A phytosterol-enriched spread improves the lipid profile of subjects with type 2 diabetes mellitus: Eur J Nutr Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes.

J Clin Endocrinol Metab Effects of oral hypoglycemic agents and diet on protein metabolism in type 2 diabetes. Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes. Micronutrients in diabetes mellitus.

Drugs, Diet and Disease 2: Complementary therapies for diabetes: Arch Med Res The role of the optimal healing environment in the care of patients with diabetes mellitus type II. J Altern Complement Med 10 Suppl. Hasanain B, Mooradian AD: Antioxidant vitamins and their influence in diabetes mellitus. Curr Diab Rep 2: Effects of vitamin E on cardiovascular and microvascular outcomes in high-risk patients with diabetes: Antioxidant vitamin supplements and cardiovascular disease.

Selected vitamins and minerals in diabetes. Role of chromium in human health and in diabetes. Chromium as adjunctive treatment for type 2 diabetes. Glucose and insulin responses to dietary chromium supplements: Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: Chromium treatment has no effect in patients with poorly controlled, insulin-treated type 2 diabetes in an obese Western population: Chromium picolinate for reducing body weight: Systematic review of herbs and dietary supplements for glycemic control in diabetes.

Clin Geriatr Med Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal-bolus ultralente-regular insulin regimen.

Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen ultralente-lispro.

Wasserman DH, Zinman B: Exercise in individuals with IDDM. Care of children and adolescents with type 1 diabetes mellitus: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Predictors of postpartum diabetes in women with gestational diabetes mellitus.

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