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Principles of Dietetics
An understanding of nutrition is important since a health worker is often required to help others whose eating habits require improvement. For example, certain patients, under medical care, require diet therapy and the consumption of prescribed foods in specified amounts. Furthermore, patients often have questions and complaints about a group of prescribed foods (diet) which are new to them. This could assume the following dimensions: (a) changing a nutritionally inadequate diet to a nutritionally adequate one and adding a subtracting certain nutrients of foods in specified amounts to or from a diet. Such diets are called therapeutic diets.
Since it is difficult to get patients to eat unfamiliar meals, based on the therapeutic diet, special efforts, which require special skill, should be made by the person serving the food to encourage or motivate the patient to overcome prejudices and eat the food being served., Unless prescribed foods are eaten, any diet is useless and a beautifully designed diet that is not consumed serves no purpose. Often the physician may be surprised that a patient is not sticking to his diet. Thus, having this basic understanding of the special skill of the dietitian is an important interrelationship between the physician and the other health workers, who are looking after the patient. When a patient dislikes a desirable food item, such item could be included in a disguised fashion when combined with other foods. For example, milk could be included in the more acceptable ice-cream or in custard.
Moreover, since most people have better appetites when they are rested, it is advisable to serve the most nutritious meals early in the day, while making the evening meals light.
Adequate nutrition is necessary for building and maintaining good health during and after an illness. Using nutrition to build good health is called diet therapy, which is a means by which the normal diet of a patient is modified or changed in order to meet his current requirements created by disease or injury. Describing an optimal diet is not as simple as it appears. For example, an African soup can be as varied as possible, depending on the type of vegetables used and the mode of preparation (cooking, frying which can destroy certain nutrients, etc.). Also, since excessive body fat, resulting from an imbalance between energy intake and expenditure, is one of the most important nutritional problems of the world, a definition of a healthy diet that fails to address this problem would be incomplete or deficient. Furthermore, the consumption of the healthiest combination of foods, consumed in slight excess, over an extended period will lead to weight problems. The problem is further compounded by the highly imprecise estimation of the quantities of foods, as serving sizes vary greatly. Therefore, a definition of a healthy diet needs to be linked with the importance of maintaining a healthy weight and the need to make adjustments in intake or physical activity if am imbalance exists.
Obesity, which is a state of having excess body fat, has become the most important nutritional problem in the developed countries and is rapidly becoming a global epidemic and a definition of a healthy diet should address this pandemic problem. However, a fundamental problem of addressing this issue is that even the healthiest combination of foods consumed in slightly excess by only a percentage or two, over an extended period will lead to over-weight.
In general, individuals differ in their response to nutrient intakes. For example, response of serum cholesterol to dietary cholesterol or of blood pressure to sodium intake vary greatly. The elucidation of the human genome and rapid identification of polymorphisms in almost all genes is creating new opportunities to individualized dietary guidance. Thus, the ability to identify individual persons with different requirements allows more detailed studies to ensure that their needs are being met.
2 Application of these Principles to Management of Diabetes
The objectives of a diabetic diet therapy include (a) the provision of nutritionally adequate diet; (b) the prevention of excessive postprandial hyperglycemia; (c) the prevention of hypoglycemia in the insulin-dependent patients; (d) the attainment and maintenance of ideal body weight; (e) the control of blood lipids and (f) the prevention or hindrance in development of pathologic changes associated with diabetes. Developing a prescription that is reasonably consistent with the patient’s preferences and situation can greatly increase the likelihood that it will be regularly followed. Even if the prescription is slightly sub-optimal, if well followed, it usually be preferable to a theoretically ideal prescription that is unattractive or unfeasible and will not be followed. Furthermore, since there is a much stronger relation between greater body mass index and insulin resistance, a person who is lean and active can better tolerate a high carbohydrate diet than one who is less active and overweight.
Thus, diabetes is an example of the body’s abnormal handling of glucose. What happens is that an inadequate or ineffective insulin levels leave blood glucose high and cells undersupplied with glucose energy. This causes blood vessel and tissue damage. Evidence-supported recommendation is that weight control and exercise, which are effective tools in preventing the predominant Type 2 diabetes and the illnesses that accompany it.. Therefore, a diagnosed case of diabetes must establish patterns of eating, exercise and medication to control blood glucose.
A person who has been diagnosed for diabetes usually show a condition of postprandial hypoglycemia (low blood glucose after meals), with symptoms of fatigue, weakness, irritability, rapid heartbeat, anxiety, sweating, trembling, hunger and headache.
Typically, health facilities usually have standard diets which are nearly normal diets based on the Food Groups available in the particular society. Patients on regular diets require nutrients for health maintenance only, and not for therapy. Although a regular diet includes a great variety of foods, its caloric value is usually lower than for normal diets, since patients on such diets are not normally active and consequently require fewer calories than the ordinary person. These diets are meant for ambulatory patients (those who walk).
The best way of constructing the prescription is to begin with the diet that the patient would follow if he did not have diabetes, but modifying this only to the degree necessary to meet the truly essential requirements imposed by the metabolic disorder. However, of great importance is the need for continuing review and adjustment of the initial prescription. This is necessary because the feasibility, appropriateness and effectiveness of the initial prescription can only be estimated. Subsequent experience will help determine how best to compromise the therapeutic objectives with the patient’s preferences and changing patterns of living. Usually, discrepancies between the diet consumed and the diet prescribed may largely determine failure to make appropriate adjustments to fit changing conditions.
Usually, written instructions should include a list of foods that may be taken in any amount as well as the list of those foods that must be avoided entirely. The best way to achieve this is to teach the patients the concentration of carbohydrate, protein and fat in the common foods available to the patient. This provides a wide range of attractive options than the simpler but less flexible standard hospital menus
Assignment
ASSIGNMENT : Formulation of Weaning and Therapeutic Diets Assignment MARKS : 10 DURATION : 1 week, 3 days