nfmnt chapter 11 modify diet plans
TRANSCRIPT
Nutrition Fundamentals and Medical Nutrition Therapy
Modify Diet Plans
Corresponds with LEARNING PLAN 11 Copyright 2016 Association of Nutrition and Foodservice Professionals
11
Objectives
Develop Menus
Implement nutrition plan to meals/foods to be served
Respect client needs and food habits
Use nutrition analysis data to modify menus for» Calories, carbohydrates, proteins, fats, and minerals» Fiber content, texture or feeding needs» Medical or other personal condition (including allergies)» Racial, cultural and religious differences
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Factors That Influence What Foods Are Chosen by Clients Availability of Food
Personal Taste
Aesthetic Influences
Aesthetic Concerns
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Brain Break
Availability of Food
Personal Taste
Aesthetic Influences
Aesthetic Concerns
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
» Food budget; proximity to grocery store
» Ability to taste and/or smell
» Color of food; how food is presented
» While the menu is the fundamental tool for planning diets, the CDM must ensure that menus are satisfying to clients
For each factor that affects what foods are selected by clients, provide an example
Menu Planning Guidelines
Must meet the nutritional needs of clients» DRI-RDA» choosemyplate.gov» Nutritional standards for specific meal programs
- Child Care Centers- Home Day Cares- Congregate Feeding Sites/Home Delivered Meals- Correctional Facilities
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Types of Menus
Fixed» Most commonly found in restaurants» Offers the same food every day
Cycle» Most commonly found in institutional settings» Menu that repeats itself over a defined period of time such as
five weeks
Single Use» Used in institutional settings for monotony breakers» Used only once
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Menu Options
Selective Menu» Adaptation of a cycle menu allowing more client choice» Additional monitoring may be needed to review menu
choices before they are served to clients» What happens if selected menu choices are not on a client’s
prescribed diet?- Adjustments may need to be made in portion sizes, consistency,
or addition of nutritional supplement- Additional training for staff to assist clients when foods not on the
diet are selected
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Menu Options
Non-selective menu» Clients do not make choices for main dishes» Typical in group dining experience such as assisted living» Substitutions for individualized food preferences will be
important- Substitutions must be of equal nutritional value and similar color
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Brain Break
If a client doesn’t like Brussels sprouts, what would be a good nutritional substitute?
» Steamed pea pods» Steamed broccoli
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningPregnancy
Pregnancy weight gain is dependent upon pre-pregnancy weight status
RECOMMENDED WEIGHT GAIN RANGES» Underweight: BMI < 18.5 28-40 lbs.» Normal Weight: BMI 18.5-24.9 25-35 lbs.» Overweight: BMI 25-29.9 15-15 lbs.» Obese: BMI > 30 11-20 lbs.
Energy (caloric) needs increase during pregnancy and lactation» During the second trimester consume an additional 300 calories per day» During the third trimester consume approximately an extra ~425 calories
per day
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningPregnancy Nutrient needs to asses during pregnancy
» Overall diet and use of PNV as prescribed» Protein needs increase during pregnancy » Important to add omega-3 fatty acids to diet» Iron status and intake is important» Calcium and folate intake is important» Vitamins C and A requirements increase» Vitamin B12 is a consideration if the mother is a vegan» Monitor for herbal supplements
Watch for nausea, vomiting, diarrhea, heartburn
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans• Learning Plan 11
Lifecycle Menu PlanningLactation All breastfeeding and postpartum women are encouraged
to continue use of prenatal vitamin/mineral supplements and maintain proper nutrition
During lactation, women may need 300-500 extra calories per day and hydration needs may increase
Continued increased nutrient needs for mom during lactation
Support mom during this time as breastfeeding can be difficult for some
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Lifecycle Menu PlanningInfants
Breastfeeding provides optimal nutrition for infants and is also deemed an important global health initiative for Healthy People 2020.
Mothers should be educated and supported during pregnancy and beyond
Breastfeeding can promote» normal tooth and jaw alignment, » decrease risk of ear infections and » may reduce the risk of sudden infant death syndrome (SIDS). » In addition, data suggests that breastfeeding may decrease the
risk of chronic health problems like obesity and some allergies
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningInfants
Formula-an alternate choice for mothers who cannot or choose not to breastfeed
3 Forms» Ready-to-feed» Liquid concentrate» Powdered
- Each must be handled using safety and sanitation guidelines
Cow’s milk formula alternates (soy) and specialty formulas are available for babies not tolerating formula
Place emphasis on no cow’s milk or milk alternative for the first year—only breastmilk and formula
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Lifecycle Menu PlanningInfants Vitamin D-
» Oral vitamin D supplementation is suggested for infants who are either breastfed or consuming less than ~34 ounces of formula per day.
» Suggested that infants begin receiving 400 IU in the first few days of life
Iron- » Stores are generally sufficient for the 4-6 months of life for full-term infants.» Certain pre-term infants or those that are not consuming sufficient iron-rich
foods between 4-6 months may benefit from supplementation
Fluoride» Fluoride supplement is not generally recommended for infants less than six
months of age» For infants older than six months of age, water sources should be evaluated
for over or under consumption of fluoride, and determine if supplementation is necessary.
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Lifecycle Menu PlanningInfants
Infants grow rapidly in the first year of life-adequate nutrition is important
Breastmilk or formula for the first year of life
Complementary Feedings» Begin at approximately 4-6 months by spoon and progress
feeding stages as developmentally ready - Rice cereal is often a “first food”
» Cup may be used with water, breastmilk or formula- Infant juice is not necessary in the diet and shows no benefit over
fruits and vegetables. If given should be given by cup» Add new foods one at a time in case of an allergic reaction
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningInfants
Foods to avoid the first year» Honey» Potentially allergenic foods
- Milk, eggs, wheat, nuts, chocolate, shellfish, soy» Foods that may cause choking
- Hot dogs, nuts, raisins, popcorn, grapes, apple chunks
Whole milk should be offered after 12 months, but not before» Gradually switch to lower fat milk and fat-free by age 5
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningPreschoolers
Preschoolers may be subject to food jags
Offer child-friendly portions
Offer variety of preparations» Raw, cooked, mixed, separate
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningPreschoolers
Caution with hot or strongly flavored foods
Enhance cooked foods and mixed dishes with added cooked vegetables
Snacks are important because of limited intake at one time; finger foods are excellent choices
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Lifecycle Menu PlanningSchool-Age Children
Time of rapid growth rate, so nutritional needs are in high demand
Protein, calcium and iron are particularly in demand
Snack choices are important to fulfill nutritional needs
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Brain Break
What would be good menu choices for children 18 to 24 months and why?
» Finger foods such as slightly cooked vegetables or softer fruits such as strawberries cut into small pieces; no hot dogs. Children this age are still learning small motor skills and picking up finger foods are an important part of the child’s development.
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningSchool-Age Children
Overweight and obese children is an adverse health trend
Strategies to help » Eat a healthy breakfast» Eat fewer processed foods» Reduce sugar sweetened beverages» Limit intake of fruit juice and choose fruits and vegetables» Consume fewer fast food restaurant meals» Eat smaller portions of nutrient-rich choices
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Lifecycle Menu PlanningAdolescents
Time of rapid growth spurt
Adolescents begin exercising control over food choices
Many outside influences in food choices
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningAdolescents
Nutritional concerns» Anorexia nervosa» Bulimia» Binge eating disorder» Obesity
Nutrients of primary concern due to inadequate intake» Calcium, iron, vitamin A, vitamin C; sometimes calories and
protein
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Brain Break
What is the number one nutritional concern today for children and adolescents ages 2 through 19?
» Overweight and obesity
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
National School Lunch Program (NSLP) Initiated in 1946
2010 Healthy, Hunger Free Kids Act sparked many changes
USDA supports free or low cost school breakfasts and lunches
School meals must meet the recommendations of the Dietary Guidelines for calories, protein, fat, and several vitamins and minerals (federal guidelines)
Each school determines their own menu based on meeting the federal guidelines, as well as providing foods that the students will enjoy
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Lifecycle Menu PlanningElderly
Older Americans are our fastest growing population group
Foodservice operations serving older adults or elderly will continue to increase
Elderly have specific nutritional needs that influence nutrition» BMR declines» Physiological factors» Psychosocial factors» Socioeconomic factors
Likely to be at nutritional risk
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Menu Planning Challenges for the Elderly Illness
Meeting DRI – RDA/caloric intake
Dentition
Functional disabilities
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Taste and smell
Changes in the GI tract
Medications
Thirst
CMS Regulations in LTC
Each client receives, and facility provides, at least three meals daily, at regular times comparable to normal mealtimes in the community
There must be no more than 14 hours between a substantial evening meal and breakfast the following day (or 16 hours if a nourishing snack is provided at bedtime)
An evening meal should provide at least 20 percent of the day’s total nutritional requirements
The facility must offer snacks at bedtime daily
Food is attractive and palatable, incorporating needs as identified through observation, client and staff interviews and review of client council minutes
If a food group is missing from the client’s daily diet, the facility has an alternative means of satisfying the client’s nutrient needs
Substitutes of similar nutritive value are offered to clients who refuse food served
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Brain Break What techniques can the CDM use to overcome meal
planning challenges for the elderly?» Add high-fiber foods that have a softer texture» Increase protein by adding nonfat dry milk to casseroles,
sauces, gravies» Increase the use of herbs and spices» Serve nutrient dense desserts (e.g. oatmeal cookies,
custards, puddings, pies with graham cracker crusts)» Serve moderately sized meals to avoid excessive calories
and wasted food
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Translate Nutrition Needs into Food Choices After nutrition screening and assessment, the CDM uses
this information to provide food to the client
Determine total amount of calories in food» Carbohydrate – 4 calories per gram of CHO» Fat – 9 calories per gram of fat» Protein – 4 calories per gram of protein» Alcohol – 7 calories per gram
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Translate Nutrition Needs into Food Choices Determine percent of calories of each food component to
equal 100%
Percent of calories from CHO, Pro and Fat will help shape the medical nutrition therapy for the client
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Calculating Total Calories
Use Figure 11.9 to calculate the total calories for one serving of crackers» Total fat - 4 gm» Total Carbohydrate - 22 gm» Total Protein - 3 gm
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
4 g fat x 9 cal/gm
= 36 calories
22 g CHO x 4 cal/gm
= 88 calories
3 g Pro x 4 cal/gm
= 12 calories
Total Calories = 136 calories per serving
Calculating Percent Calories
Continue to use Figure 11.9» Using the information from the previous slide, calculate the
percent of calories from carbohydrate
» 88 calories from carbohydrate ÷ total calories» 88 ÷ 136 = 65%
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Calculating Fluid Intake
Additional water may be advised» Dehydration» Risk factors when dehydrated
- Coma- Fluid loss- Increased fluid needs
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Calculating Fluid Intake
Water may be restricted» Renal failure, liver failure, congestive heart failure» Expressed as a specific ml. 1000 ml (milliliters)
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Calculating Fluid Intake
» Facility policy determines how much fluid is allowed from nutrition services, and how much is allowed from nursing
» 1 cup of water = 8 oz. = 240 ml» Count anything that ‘looks’ like a liquid at room temperature» Adjust menu to make meals palatable and reasonable» Nursing removes water pitcher from client’s room
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Brain Break
Calculate the fluid in the following menu in ml» 1 cup milk» 3 oz. pork chop with ¼ c gravy» ½ cup broccoli» ½ cup sherbet
» 1 cup milk + ½ c sherbet = 12 oz. or 360 ml
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Sources of Nutrient Information
Assurance of scientific research and standardization
USDA Nutrient Database
Nutrient Analysis Software – uses USDA data
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Sources of Nutrient Information
Nutrition Facts Label» Designed for consumers» On most foods except meat and poultry» Identifies portion size» Expresses % daily value» Provides information about specific nutrients» Uniform definitions and scientifically substantiated claims
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Calculation of Nutrients
Exchange Lists» Valuable method to quickly analyze a daily intake and
macronutrients for a client- Assign foods consumed to an exchange list group- Total exchanges for each group- Multiply total exchanges by the standard CHO, fat, protein and
caloric values for each group- Total values - 15 gm CHO = 1 CHO serving
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Calculation of Nutrients
Carbohydrate Counting» Concern is on carbohydrate intake» Foods distributed evenly throughout the day» Based upon Exchange Lists » Other parameters such as weight is monitored
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
Brain Break
A client is counting carbohydrates and is allowed 60 grams for breakfast, 50 grams for lunch, 60 grams for dinner and 35 grams for snacks. Using the exchange list information below, plan a lunch that meets the allowance for carbohydrate.
Nutrition Fundamentals and Medical Nutrition Therapy • Modify Diet Plans • Learning Plan 11
1 bread exchange = 15 grams
1.5 fruit exchange = 22 grams
1 vegetable exchange = 5 grams½ milk exchange = 6 grams