restricted diet 3.pptx

8/11/2019 Restricted Diet 3.pptx

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Restricted DietDr Leong Lai Peng

S14-06-03

Food Science and Technology Programme

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Calorie Restriction (CR)

A diet that restrict Calorie intake (most areabout 30% less than unrestricted Calorie level)but adequate essential nutrients.

Subjects are normal and without any medicalconditions.

Found to increase median and maximumlifespan in rodents, fish, dogs and yeast.1

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1Toxicologic Pathology(2009) 37(1): 4751

http://www.pnas.org/content/106/47.cover-expansion
http://www.pnas.org/content/106/47.cover-expansionhttp://www.pnas.org/content/106/47.cover-expansionhttp://www.pnas.org/content/106/47.cover-expansionhttp://www.pnas.org/content/106/47.cover-expansion


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Calorie Restriction for longevity,anyone? SMS your answer to 77577,

Chmgek10 Message

Replace Message with y or n.

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Calorie restriction in primates1did not increaselongevity. Genetic and healthy diet may mattermore.

No human studies have shown CR to increaselife span. Average weight highest life

expectancy. Care should be taken when extrapolating results

from animal studies.

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1Nature 488, 569 (30 August 2012)


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Diet Restriction

Diet

Eating habits

Health

Reduce risk ofdisease Disease management

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Purpose of Diet Restriction:


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The Need for Restricted Diet

Medical Condition Obesity Weight management diet

Cardiovascular Diseases Healthy Fat Diet Diabetes High blood pressure Phenylketonuria (PKU)

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*Information given in this lecture cannot replace the need to seek

professional medical advise if you have a medical condition.


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Overweight and Obesity Abdominal fatness can be defined using waist to

hip ratio (WHR). >1.0 for men; >0.85 for

women. BMI is normally used to indicate the weightstatus of an individual. For Singapore:

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http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/1WHO Consultant, The Lancet, 363, 157-163

BMI cut off (kg/m2) Risk Level1

18.5 to 22.9

Acceptable risk23 to 27.4 Increased risk

27.5 High risk
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Obesity in Singapore

For population between 18 to 69 years1,

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1National Health Survey 2010, Ministry of Health

10.8% are obese (BMI > 30 kg/m2)

- 12.1%; - 9.5%

Malays 24.0%, Indians 16.9%, Chinese 7.9%

23.0% are high risk (BMI > 27.5 kg/m2)


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Obesity and Health Risk

Obesity is associated with:

Cardiovascular Disease

Diabetes

Atherosclerosis

Inflammation

Some cancers

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Causes of Obesity

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IncreaseCalories

ReducedPhysicalActivity

Genetic Susceptibility

Within ones control

Within ones control

Not within ones control


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Weight Loss Strategies

To maintain weight loss, one should:

Exercise regularly

Make small changes to diet and physical activity(300 to 500 kcal reduction from usual intake).

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Increase energy

expenditure

Reduce intake

= Weight Loss


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Ensure nutrient adequacy by taking foods with

high nutrient density but low energy density.

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Comparing energy density:

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Consume lower fat foods (30% of total kcalories)

Use less cooking oil.

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LowFat

Intake

LowEnergy= High

FatIntake

HighEnergy

=

http://www.dreamstime.com/stock-image-raw-meat-image17630391 http://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.html

100 g

164 kcal

100 g

272 kcal
http://www.dreamstime.com/stock-image-raw-meat-image17630391http://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391


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Weight Loss Strategy

Normal Diet

Lipid:Protein:CHO= 35:20:45

Weight Loss Diet Lipid:Protein:CHO =

30:15:55 Energy from fat is replaced by

protein and carbohydrate.

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Reducing % protein helps reduce fat intake andhigh energy density foods.

Increasing % carbohydrate helps increase fibreand low energy density foods.

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Weight Control


Increase high fiber food.

To promote satiety.

Lower energy density.

High in nutrient density.

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http://www.fruitsinfo.com/uses_of_fruits.htmhttp://crazy-frankenstein.com/vegetables-wallpapers-3.html

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http://www.fruitsinfo.com/uses_of_fruits.htmhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://crazy-frankenstein.com/vegetables-wallpapers-3.htmlhttp://www.fruitsinfo.com/uses_of_fruits.htm


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Weight Loss Strategy


Increase water intake.

Increase fullness without adding calories.

Help in coping with high fiber diet.

Avoid empty calories e.g. sweetened drinks andalcohol.

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http://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.html

http://www.scientificamerican.com/article.cfm?id=beer-batter-is-better

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http://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://www.scientificamerican.com/article.cfm?id=beer-batter-is-betterhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.htmlhttp://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.html


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Weight Loss Strategy - Precautions Reducing calories without compromising on

nutrient adequacy.

Diet should also be well balanced. Nutrient supplements may be required.

Lower calories should not lead to feelings ofstarvation which may lead to irresistible urge.

Beware of fad diets normally focus on extremechanges and sudden weight loss.

Beware of weight loss products. E.g. consumesomething to loose weight without change in diet.

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Weight Management Weight loss Weight Management Weight loss is not useful if weight is regained.

Weight loss products and services thrivebecause: Success rate is low in retaining weight loss Social pressure to maintain normal weight

People are willing to try quick-fix solution People believe that if a product sells, it must be

effective. Some evidence in animal models. Explanation sounds good.

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Low Fat or Low Carbohydrate?

Low Fat Low Carb

Total Calorie intake less than total expenditure Adequate and balance?

Within recommended range of energy ratio?

Undesirable effect?

Possible to maintain healthy weight? ? ?

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Low Fat Low Carb

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Cardiovascular Diseases

Diseases of heart and blood vessels.

Includes:

Coronary heart disease (CHD)

Blood flow to the heart is affected.

Leads to heart attack

Stroke

Blood supply to brain is affected.

>30% of total deaths in Singapore is due toCardiovascular Diseases1.

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1http://www.myheart.org.sg/heart-facts/statistics/

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http://www.myheart.org.sg/heart-facts/statistics/http://www.myheart.org.sg/heart-facts/statistics/http://www.myheart.org.sg/heart-facts/statistics/http://www.myheart.org.sg/heart-facts/statistics/http://www.myheart.org.sg/heart-facts/statistics/http://www.myheart.org.sg/heart-facts/statistics/


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Risk Assessment of CHD

Blood lipid profile analysis.

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Functions of LDL and HDL

LDL transport TG,cholesterol and

phospholipid to cellsof all tissues.

HDL transport

cholesterol back to theliver for disposal.

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Healthy Fat Diet Purpose:

Weight loss or maintenance

Reduce LDL level and obtain blood lipid balance.

Recommendation: Total Fat 2035% of energy

Limit saturated fat to 7% of total energy. This can be done by Taking lower fat food.

Cut off fats from meat.

Reduce cream and butter.

Replace with carbohydrate (but maintaining between 50-60% totalenergy).

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How to Reduce Saturated Fats

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Healthy Fat Diet Recommendation:

Limit cholesterol to 200 mg.

Sources of cholesterol: Animal fats

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http://www.mrbigben.com/food/dairy.html

http://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.html

http://www.foodsubs.com/Eggs.html

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http://www.mrbigben.com/food/dairy.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://www.foodsubs.com/Eggs.htmlhttp://www.foodsubs.com/Eggs.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.htmlhttp://www.mrbigben.com/food/dairy.html


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Cholesterol

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Cholesterol is not essential. When absorbed, the body will reduce the synthesis. Some evidence shows that dietary cholesterol has little effect on blood

cholesterol.

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http://upload.wikimedia.org/wikipedia/commons/9/9a/Cholesterol.svghttp://upload.wikimedia.org/wikipedia/commons/9/9a/Cholesterol.svg


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Avoid trans fatty acid

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NUTRITION INFORMATION

SERVINGS PER PACK 50 SERVING SIZE 10g

QTY^ PERSERVING

% DAILYINTAKE*

QTY^PER100g

ENERGY 242 kJ 3 2420 kJ

PROTEIN


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Transfatty acid vscisfatty acid Oleic acid (cis18:1)

Elaidic acid (trans18:1)

Saturated fatty acid

Small quantities

are found

naturally in

meat and milk.

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n-6 Polyunsaturated fatty acids (linoleic acid)* 510% energy

n-3 Polyunsaturated fatty acids (-linolenic acid)* 0.61.2%energy

* Approximately 10% of total can come from longer chain n-6 or n-3fatty acids

http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/

Replace meat with fish:

Low in saturated fat.

Suppress inflammation reducing

blood clotting, lowering TG levels.
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all-cis-7,10,13,16,19-docosapentaenoic acid (22:5, n-3)

all-cis-4,7,10,13,16-docosapentaenoic acid (22:5, n-6)

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Healthy Fat Diet Fat replacers

Replace the function of fats in foods (taste, texture

and/or cooking properties) with zero or lowercalories.

Do not contribute to hyperlipidemia.

Can be carbohydrate, protein or fat based.

Precaution

Fat based fat replacers is able to reduce theabsorption of fat soluble vitamin.

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Healthy Fat Diet Examples of fat replacers:

Fat replacers obtained from food components areGRAS. E.g.:

Avicel microcrystalline cellulose

Splendid derived from pectin

Simplese microcapsules of milk protein or egg white protein.

Benefat triacylglycerides with mixture of short chain fattyacids and stearic acid.

Fat replacers which are not natural occurring are testedvigorously for its safety before it is approved for use.E.g.

Olean hexa-, hepta-, and octa-esters of sucrose; can causediarrhea and oily stools if consumed in large quantities.

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Precaution Avoid deficiency of essential fatty acid e.g.

omega 3 (linolenic acid (18:3, -3),

eicosapentaenoic acid (20:5, -3) ,docosapentaenoic acid(22:5, -3) and omega 6(linoleic acid (18:2, -6), arachidonic acid (20:4,-6)) fatty acids

Supply and absorption of vitamin A, D, E and Kmay be affected.

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Healthy Fat Diet Dos and donts of healthy fat diet. What is your

say? Bread, cereal, rice and pasta group

Dairy products Fats, oils and sweets

Protein

Vegetables and fruits Snacks and desserts

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Healthy Fat Diet Food labels

Regulation in Singapore is published by AVA Food regulations

and, HPB Handbook of nutrient claims has guidelines on: Energy lite/light/lowenergy/calorie, less/lower/reduced

energy/calorie, more/fortified/added/enrichedenergy

Total fat fat free, no fat, low/light/litein fat, reduced/lower/lessinfat, leanmeat, extra leanmeat

Fatty acids Saturated fat free, low saturated fat, reduced saturatedfat, contains PUFA, high in PUFA, more/increased PUFA, containsMUFA, high in MUFA, more/increased MUFA

Cholesterol cholesterol free, low/light/litein cholesterol,lower/reducedcholesterol

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Diabetes Diabetes is a disease in which the body does not

produce or properly use insulin.

Muscle Cell

or

Fat Cell

Glycogen G-6-P Glucose

FA

SynthesisEnergy

VLDL

Blood Glucose

Starch, sugar

Digestion

Insulin

Liver

pancreas

Muscle

and fat

cell

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Diabetes - Type 1 (Insulin dependent

diabetes mellitus)

Due to damage of pancreatic cells unable toproduce insulin.

5-10% of cases.

Muscle Cell

or

Fat Cell

Glycogen G-6-P Glucose

FA

SynthesisEnergy

VLDL

Blood Glucose

Starch, sugar

Digestion

Insulin


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Diabetes Problems:

Cells suffer from lack of sugar (starvation).

Fat is used for energy instead, resulting ketoacidosis intype 1 diabetes. Insulin in type 2 diabetes inhibit fat breakdown.

Ketoacidosis is less severe. Glucagon dominate andgluconeogenesis result in hyperosmolar hyperglycemic

state (dehydration). High blood sugar (hyperglycemic) may affect vision,

delay wound healing, heart disease, kidney failure,stroke, loss of limbs etc.

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Body Weight of Diabetics

Type 1

Normally notoverweight.

Weight gainmay be sideeffect of insulintreatment.

Type 2

Normallyoverweight.

Overweight canworsen insulinresistance.

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Diabetes Principles of diet management;

Balance diet with essential nutrients

Maintenance of ideal weight Meeting energy needs

Prevention of blood sugar variation and keeping itas close to normal level

Decrease of blood lipid levels, if elevated

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DiabetesNutrition Management

How is it achieved?

Consistent carbohydrate content in meals at timed

intervals to maintain blood sugar level. Overall calories eaten must be controlled to

manage weight over long term.

Consumption of carbohydrate must not be lower

than 130 g/day.

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Carbohydrate sources: Different foods has different glycemic effect*

E.g.

*Glycemic Effect rate of change in glucose in blood afterconsumption of food

Food Glycemic Index

Rice 76

Brown Rice 48

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DiabetesGlycemic Index

Glycemic index (GI): An index given to food base on itsability to increase blood sugar level compared to glucose

(sometimes white bread is used instead of glucose). Glycemic index = area under blue curve/area under red

curve x 100

50g glucose

50g carbohydrate

containing food

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http://upload.wikimedia.org/wikipedia/en/e/ec/Glycemic.pnghttp://upload.wikimedia.org/wikipedia/en/e/ec/Glycemic.pnghttp://upload.wikimedia.org/wikipedia/en/e/ec/Glycemic.pnghttp://upload.wikimedia.org/wikipedia/en/e/ec/Glycemic.png


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Glycemic index is affected by Cook or raw, cooking time, how the food is cut etc. Level of ripeness of fruits and vegetables Variations in digestion and absorption Possibly of other components in foods e.g. fibre.

For people with diabetes, low GI foods should beconsumed.

GI does not give the extent to which bloodglucose is raised by a consumption of aparticular amount of a food.

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Classification GI range Examples

Low 55 or less most fruit and vegetables (except

potatoes), wholegrains, basmati rice,

pasta

Medium 56 - 69 sucrose, candy bar, croissant, some

brown rices

High 70 or

more

corn flakes, baked potato, some

white rices (eg. jasmine), white

bread

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Glycemic Load Glycemic load (GL) represents blood-glucose-raising

potential of specific amount of food consumed.

GL = GI x mass of carbohydrate in food consumed/100 E.g. 1 baked potato has 34 g of carbohydrate. GI of

baked potato is 85. Therefore GL = 34 x 85/100 = 28.9

GL is a better indicator of the effect of a certain amount

food on blood glucose level.


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Is there a need to avoid sugar?


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Fiber Recommendation same as general population

i.e. 21 to 38 g per day. Fiber rich foods are encouraged and may improve

glycemic control.

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Fat intake Due to high risk of cardiovascular disease, healthy

fat diet is recommended. Protein

15 to 20 % of total kcalories. (withinrecommended range for general population).

Alcohol

Minimise. Consume with food to avoid hypoglycemia.

Alcohol interfere with glucose production in liver. May increase triglyceride level.

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DiabetesExchange Lists

Separation of foods into food groups: Bread/starch Vegetable

Milk Meat Fruit Fat

Foods in the same group should have approximatelysimilar number of calories, composition (carbohydrate,fats and protein) and effects on blood glucose levels.

Exchange list can be set up for each group.

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DiabetesExchange List

Example of exchange list:Sample Exchange List

Food group You can have..... Or exchange it for...

Fruit (Each serving contains about 15

grams carbohydrates)

1 small or medium piece

of fresh fruit

1/2 cup fruit juice,or

canned or chopped fruit

Vegetable (Each serving contains about 5


1 cup raw vegetables 1/2 cup cooked vegetables

or vegetable juice

Starch(Each serving contains about 15


cup of rice 1/2 cup noodles

Sugar, honey, molasses 1 teaspoon 4 grams carbohydrates

Milk 1 cup low fat milk 1 cup of low-fat yogurt

Meat 1 ounce meat 1 ounce of fish or poultry

Fat (includes nuts, seeds and small

amounts of bacon & peanut butter)

1 teaspoon oil, butter or

margarine

5 grams fat

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Hypertension

Blood Pressure Systolic Pressure (when theheart beats)/Diastolic Pressure (when the

heart relaxes between beats) Blood Pressure levels for Adults:

Category Systolic (mm Hg) Diastolic (mm Hg)

Normal < 120 < 80

Prehypertension 120-139 80-89

Hypertension 140 90

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Hypertension Salt contain 400mg of sodium in 1000mg of salt!

Na+ causes dehydration of cell and increase in blood

pressure. Na+ can be reduced by reducing intake of food

containing sodium as well as salt.

Water

Blood vessel

Na+

Cell


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DASH Diet

Daily nutrient goals (for 2100 kcal eating plan)

Total Fat 27% kcal Sodium* 2300 mg

Saturated Fat 6% kcal Potassium 4700 mg

Protein 18% kcal Calcium 1250 mg

Carbohydrate 55% kcal Magnesium 500 mg

Cholesterol 150 mg Fiber 30 g

*1500 mg lower goal is better for lowering blood

pressure

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DASH Diet

Food Groups

Servings/Day*

1600 kcal/d 2000 kcal/d 2600 kcal/d 3100 kcal/d

Grains (preferably whole grain) 6 6-8 10-11 12-13

Vegetables** 3-4 4-5 5-6 6

Fruits** 4 4-5 5-6 6

Fat-free or low fat milk and milk

products

2-3 2-3 3 3-4

Lean meats, poultry and fish 3-6 6 6 6-9

Nuts, seeds and legumes 3/wk 4-5/wk 1 1Fats and oils 2 2-3 3 4

Sweets and added sugar 0 2 2 2

*To lose weight, aim for lower caloric intake level

**Larger servings of vegetables and fruits are recommended

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DASH Diet Tips to reduce Salt and Sodium

Choose low- or reduced-sodium or no salt alternatives. Choose fresh or frozen food. If canned, no salt added. And if

possible, rinse the salt from the food before using.

Choose processed food carefully some processes involvesthe addition of salt. E.g. cured (bacon, ham), preserved withbrine (tuna, salted vegetables), condiments (tomato sauce,BBQ sauce, steak sauce)

Soy sauce, teriyaki sauce also contains sodium. Choose lowsalt versions. Use condiments and table salt sparingly.

Other words that may show the addition of salt: Smoked,corned, pickled. Cooked food normally has salt added. Many snack foods also contain added salt. Check nutrition labels for information on sodium content.

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DASH Diet Change gradually. For example:

Reduce sodium intake by reducing the use of table salt

and salt during cooking. Increase intake of fruits and vegetables at one meal.

Choose the easiest change. E.g. drinking fruit juice.

Introduce high potassium vegetables or fruits slowly.

Cut down on saturated fat and trans fat.

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Other Examples Gluten Restricted Diet

Who is affected: Celiac sprue

Foods to avoid: all wheat, rye, oats, barley andbuckwheat products. Watch out for hidden gluten: e.g. sausage soy sauce,

sauce and gravy mixes etc.

Assignment: Prepare an exchange list for bread

and cereal, fat, fruit, meat and meat substitutesuitable for a celiac. State in each category whatfoods they should avoid.

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Other Examples Lactose Restricted Diet

Who is affected: Lactose intolerant Foods to avoid: Foods with lactose, casein, caseinate,

whey, whey products, or non-fat dry milk solids. Foods containing very low level of lactose is possible

for the less sensitive. E.g. yoghurt, aged-cheese,buttermilk

Caution: lack of Ca2+

Can consider adding lactase in milk Assignment: What foods with hidden lactose

should be avoided? What is the best food toreplace milk?

restricted diet 3.pptx

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