Diet Prescription

• “Let food be thy medicine and

medicine be thy food”
• ‘All diseases begin in the gut’
 Balanced Diet

• A balanced diet is defined as one

which contains a variety of foods in
such quantities & proportions that the
need for energy, amino acids, vitamins,
minerals, fats, carbohydrate & other
nutrients is adequately met for
maintaining health, vitality & general
well being & also makes a small
provision for extra nutrients to
withstand short duration of leanness.
 Indian reference man
• Age 19-39yrs
• Weight 65kg, Ht. 1.77m &
• BMI 20.75kg/m2
• Free from disease & fit for active work
• Sleeps 8hrs
• Moderate activities 8 hrs
• Sitting and moving about 4-6 hrs
• Walking and active recreation 2 hrs
 Indian reference woman
• Age 19-39 yrs
• Weight 55 kg, Ht. 1.62m
• BMI 20.95 kg/m2
• Free from disease & fit for active work
• 8 hrs bed
• Moderate activities 8hrs (housework)
• Sitting and moving 4-6 hrs
• 2 hrs active recreational work
 Energy requirements
Adult Sedentary Moderate Heavy
worker worker worker
kcal/day kcal/day kcal/da
y
Male 2110 2710 3470
(65 kg)
Female 1660 2130 2720
(55 kg)
Pregnanc +350
y
Lactation +600(0-6m)
+520(7-12m)
 HEAVY WORK/ACTIVITY
• These people engage regularly in strenuous work or in
strenuous leisure activities for several hours
 24 hr semi-quantitative dietary recall method
• Open-ended method
• Report detailed information about all foods and beverages
consumed by a respondent, in the preceding 24 h or over the
previous day.
• Time to administer is brief, respondents are illiterate, or when
there is no patience or motivation to answer food-related
questions
 HEAVY WORK/ACTIVITY
• Heavy lifting Digging Heavy construction work Chopping wood
Shovelling Hiking Jogging at 6 Kmph Carrying heavy loads
Bicycling fast (14-16 kmph) Basketball game Soccer game
Tennis singles Swimming (freestyle laps) Aerobics Weightlifting
(heavy weights)
 MODERATE WORK/ACTIVITY
• These people have occupations that are not strenuous in terms
of energy demands but involve more energy expenditure than
that described for sedentary lifestyles. Alternatively, they can
be people with sedentary occupations who regularly spend a
certain amount of time in moderate to vigorous physical
activities, during either the obligatory or the discretionary part
of their daily routine.
 MODERATE WORK/ACTIVITY
• Carrying light loads Sweeping Raking in the garden or yard
Walking very briskly (4 kmph) Cleaning heavy (washing
windows, vacuuming, mopping)Bicycling light effort (10-12
mph) Bad Minton recreational Tennis doubles walking briskly
(about 5-6 KM in an hour), Dancing Walking short distances
Weight training (a general light workout), Yogasanas, and
Pranayama Playing with children
 Sedentary work/ activity
• These people have occupations that do not demand much
physical effort, are not required to walk long distances,
generally use motor vehicles for transportation, do not exercise
or participate in sports regularly, and spend most of their
leisure time sitting or standing, with little body displacement
 Sedentary work/ activity
• Walking slowly Sitting using computer Standing light work
(cooking, washing dishes) Fishing sitting Playing most
instrument
 Energy requirement reduction
• After 40 yrs, reduce by 5% per each decade until 60 yrs
• After 60 yrs, reduce by 10% for each decade
 Source of energy
Protein 4 Kcal/g
Carbohydrate 4 Kcal/g
Fat 9 Kcal/g
Dietary fibres 2 Kcal/g
Non vegetarian
50% of the pulses can be replaced by one egg or
30gm meat

Measurements
1 cup =200ml
1 glass=200- 250ml
1 teaspoon=5ml
1 tablespoon=15ml
1 thavi=40ml
 Criteria for calculation of balanced diet
1. Energy from cereals comprises 70 % of total calorie requirement
2. Cereal protein: pulse protein 5:1
3. All vegetable together 400gm(GLV-100gm,others 200gm, roots
&tubers 100gm) & fruits 150gm
4. Fat should not exceed 15% of total energy
5. Food should be palatable
6. Minimum milk intake 300ml
7. Refined sugar and jaggery - 5% of energy
Diet for 38 yr old male who is a clerk in school
1. Total energy 2110 k cal& protein 54 gm
• 70% of total energy should come from Cereals
• 70% of the 2110 is from cereal=
• 2110x70 =1477(cereals)
100
Cereal 100gm---350kcal
350 kcal = 100gm Cereal
Calculation ctd…
To get amount needed for 1477 Kcal =(100x1477)
350
Hence to get 1477kcal = 422 gm cereal is required

Cereal protein: pulse protein 5:1

100gm cereal 10 gm protein
Calculation ctd…
Cereal protein: pulse protein 5:1
100gm cereal 10 gm protein
422 gm---------- 42.2 gm (422x10)
100
Cereal protein = 42.2 gms
Therefore, pulse protein=1/5 of cereal protein
42.2/5=8.4
Calculation ctd…
• 100gms pulse contain 20 gms protein

• Therefore, amount of pulses = 8.44x100/20= 42.2gms

• Energy from 42.2 gms of pulses=42.2 x350/100= 147.7 Kcal

Calculation ctd…

• Fat 15% of energy i.e.(15% of 2110)

– So, for getting 317 kcal

– (1gm fat---------9 Kcal)

– Amount of fat required is =317/9= 35.2gms

Calculation ctd…
• GLV -100g (100 gms -------------25 Kcal
• Other veg 200g = 50 kcal & 2gm protein
• Roots &tubers 100g (100gm=100kcal)
• Fruits 150g (100 = 50 kcal) (150g - 75Kcal)
• Sugar – 5% = 106 kcal (27g)
• Milk 300ml
 Food item quantity Kcal Protein

cereals 422 1470

pulses 42.2 147.7
fat 35.2 317
GLV 100 25
Other veg 200 50
Routs &tubers 100 100
fruits 150 75
sugar 27 106
milk 300ml 180
Total 2470
 Diabetes mellitus
NIDDM

increased appetite

overeating

obesity

Enlarged fat cells

decreased insulin receptors

 Criteria for calculation of diabetic diet
1. Energy from cereals comprises 40-45% of total
calorie requirement
2. Cereal protein: pulse protein 5:1
3. All vegetable together 400gm(GLV-200gm,others
200gm,) & fruits 200gm
4. Fat should not be more than 10- 20% of total
energy
5. Milk intake may up to 400ml
6. Intake of 25g of dietary fibre per 1000 calories
 Nutritional requirements- DM
Nutrients Sedentary Moderate Heavy
workers workers workers
Calories 1300 kcal 1600 kcal 1900 kcal

Protein 60 gm 66 gm 70 gm

CHO 170 gm 223gm 232 gm

Fats 33 gm 39 gm 39 gm
 Sample menu for a client with DM
6 am Tea/ coffee- 1 cup without sugar

Break fast 2 idly/2 dosa /2 chappathi

,sambhar/chutney,
Tea/ coffee- 1 cup without sugar
10 am Tea without sugar

Lunch rice 1 medium bowl, sambhar-1cup,

fish-1/egg without eggyolk, oil for cooking-
1 ½ tea spoon

4 pm tea without sugar, salted biscuits-3 or 4

Dinner Chapati-2, salad, vegetable curry-1 cup

Bed time Skim milk

Total approximate calories 1500

Foods to be included Foods to be avoided
Green leafy vegetables, Glucose, sugar, honey, all
tomatoes, cucumbers, sweets, chocolates
lemon, coffee and tea
without sugar, pickles
without oil

Foods to be restricted
Potatoes, jam, sweet potatoes, mangoes, grapes,
bananas, alcoholic beverages, deep fried vegetables,
saturated oils.
 The Diabetic patient
Should avoid:
• Sweet drinks & carbonated drinks, cakes, pastries, cream, sugar, potatoes & alcoholic drinks
• Restricted intake of beetroot, potatoes, refined cereals products like Maida flour, noodles and
vermicelli.
• Avoid Egg yolk

Should follow:
• The Diabetic patient should use Adequate intake of proteins and small but frequent balanced
meals
• No fasting and no feasting
• Unrestricted intake of leafy vegetables, dietary fibers
 4.Diet for Hypertension-DASH diet
(Dietary Approaches to Stop Hypertension)
• Low calorie
• Low fat
• Low sodium diet
• Normal protein intake is given.
Nutrients Sedentary worker Moderate
worker
Calorie 20kcal/kg 25kcal/kg
(1200 kcal) (1500kcal)
Protein 60gm 60gm
Fat 20gm - 36gm 20- 45 gm
Carbohydrate 55% of daily calories

Fiber 30gm 30gm

 Foods to be avoided in HT
1. Salt in cooking or at the table
2. Salt preserved foods – pickles
3. Potato chips
4. Salted butter
5. Dry fish
6. All processed and baked food
 HYPERTENSION - DIET
• The dietary changes for a Hypertensive patient should be as follows:
• Average consumption of salt to be reduced to less than 5g/per day(to
avoid pickles, salted nuts etc.
• Moderate fat intake (Avoid fats of animal origin, except Fish)
• Prudent Diet(diet rich in fruits & vegetables) to be encouraged like
banana, orange, carrot, spinach, beans etc
• Limit the consumption of alcohol to not more than Two drinks per day
for Men and one Drink for Women.
• (24oz of Beer, 10oz of Wine, 3oz of Proof Whisky) where 1oz is 30ml of
Ethanol
 HYPERTENSION - DIET
• To stop saturated fats
• To include monounsaturated fatty acids (Omega Nine fatty acids) such as Olive
oil
• To include polyunsaturated fatty acids (omega three fatty acids) which has anti-
inflammatory & anti –blood clotting effects.
• Reduce Dietary Sodium intake to not more than 100mEq/d
• DASH DIET: Dietary Approach to Stop Hypertension (DASH) is now an important
step to control blood pressure. It makes the following recommendations
• To consume a diet rich in fresh fruits, vegetables and low-fat dairy products with
a reduced content of saturated fat and total fat.
 Diet for Hypertension-DASH diet
• Moderate restriction of salt (1000 to 1500 mg). Not >2,300 mg
a day.
• Reduce saturated fat not > 6% of daily calories
• Dietary cholesterol not >150 mg /day
• Calcium-rich dairy products
• More potassium - 4,700 mg/day
• More Magnesium - 500 mg/day
• Prescribe a diet for a 26-year-old pregnant woman in the second
trimester of her pregnancy.
• Prescribe a diet for a 42-year-old woman who is a housewife.
• 50 yr old hypertensive female who is sedentary
• Prescribe a diet for a 45-year-old man who is a manual laborer.
• Prescribe a diet for a 28-year-old lactation mother with a 4-
month-old infant.
• Prescribe a balanced diet for a 34-year-old female who is a clerk
in MMCH
THANK YOU