The Food Exchange System
Have one to sell? The project has been effective in an overall upgrading of the professional capabilities, equipment and facilities of fish disease institutes and in an updating of the knowledge of fish disease diagnosis and corresponding procedures and methodologies of institute personnel, thus fostering verification of field findings and interchangeability of verified data. Control Clin Trials The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is being addressed in the expected outcomes and outputs in the UNDAF. I read this cover to cover.
Assessment & Accountability
To learn more about MyPlate, visit www. Try to use MyPlate as the basis for your main meal each day as a simple way to get started. Similar to the U. MyPlate eating plan, the food guide is evidence based and grounded in current nutrition science.
The food guide groups foods into four categories: Perhaps the biggest difference from MyPlate is the push for meatless proteins such as tofu, beans and lentils.
To learn more, go to Canada's Food Guide. TOPS has tools to help you learn more about the Food Exchange System in a variety of attractive, easy-to-understand formats. Members and non-members can check out our Real Life Book: Some State agencies may allow organic foods on their foods lists, but this will vary by State. The decision may be influenced by a number of factors such as cost, product distribution within a State, and WIC participant acceptance.
In many state programs, for a WIC certification and health screening process, the staff advises parents to bring their child's immunization records. For some state programs, the screening and referral will occur at either client check-in, food instrument distribution, or during referral part of certification.
They also provide the parents of their child's immunization status as well as provide educational materials on the different immunizations.
For families in the community, local WIC agencies should be able to identify providers who offer immunizations in the community. At the state level, the WIC agencies can choose to document immunization screening and referrals, along with many other optional activities.
These other activities include making appointments for immunizations, making copies of immunization records, entering immunization records into a registry, and providing other educational material. The WIC program is primarily funded through two separate federal grants: Total funding increased from —, but then began to decrease in The majority of WIC funding for state and local agencies comes from the federal government; however, some states find the need to supplement their funding with outside resources.
Since , total participation in WIC steadily increased from , to a peak of almost 9. After , participation began to drop as funding decreased and employment began to increase nationwide. Since , WIC has seen a rise and fall in the amount of spending. A woman, infant or child must meet two standards to be eligible to receive WIC benefits: They assert that the idea of "nutritional risk" is too broad of a concept. WIC's current definition of nutritional risk includes different medical conditions such as anemia and low or overweightness.
The definition also includes the mother's history, age, past pregnancy complications, and inadequate diet . While some of the nutritional risk standards are clear, Besharov and Germanis further point out that the majority of people on WIC do not clearly exhibit these symptoms or history.
They still might have nutritional risk, but they do not meet the definition outlined in the policy. Despite the definition of nutrition risk, the Institute of Medicine's Committee on Scientific Evaluation of WIC Nutrition Risk Criteria pointed out that many states have used "generous" cut-off points and "loosely defined risk criteria.
In Feeding the Poor: Assessing Federal Food Aid , P. Rossi states that these gaps are often a result of unreliable tools or methods to measure nutrition risk, along with a lack of clarity in the definition of risk. In the study, Rossi took what are called "street-level bureaucrats" and applied them for WIC. These people were either at marginal or no nutrition risk, yet they were accepted easily into the WIC program.
This practice essentially turns eligibility into solely a matter of income. The second eligibility standard for participation in the WIC program—income level—also allows for much subjectivity. While this definition seems straight forward, Besharov and Germanis describe many instances in which WIC participants with incomes above this level still received services.
This could be due to the rapid growth of WIC in the past 30 years. Many WIC staff members have reported that because of the rise in funding, local income testing procedures have become less thorough Besharov and Germanis aren't the only ones who have noticed discrepancies in the WIC income eligibility requirement. A USDA study demonstrated that 5. General Accounting Office , Because of this evidence, the USDA believes that WIC can reduce funding and still meet the needs of those who truly are in need of assistance .
Conversely, the same report explained that some members of the USDA have concluded that the current method for estimating eligibility is flawed and reports a much lower number of eligible citizens than actually exists.
The method is flawed because it measures income on an annual basis instead of a monthly basis. When the researchers compared monthly income to annual income, they found that the number of income-eligible people increased dramatically a monthly evaluation level. No mention of the effect on mothers was mentioned. They concluded that if income were measured monthly, then a larger number of families would be eligible to participate in WIC .
Other research suggests that instead of redefining WIC eligibility requirements, policymakers should better advertise how lenient the requirements are. In a study published in , Craig Gundersen, a professor in the Department of Nutritional Science at the University of Illinois at Urbana-Champaign, found that many parents stop using WIC funds to care for their children after their children reach the age of one year.
Only one in nine non-participating children nationwide are ineligible for WIC aid. To combat this phenomenon, Gundersen suggests that if policymakers want to reach those most in need, they need to target this group of people who were once on WIC and left, not new recipients. Eligibility for participation in the WIC program has been affected by a number of federal programs and policy changes since the s.
The federal government has gradually increased its control over WIC program policies, which has resulted in a move away from state program control. For instance, the nutritional risk criteria that had previously been instituted by the state cutoffs were standardized by the federal government in Allowing these groups to be eligible, in effect, raised the income eligibility threshold for WIC services.
Research has identified an increase in health benefits among WIC program participants that could offset the additional costs of Medicaid in the future.
Changes in welfare benefits are also estimated to increase the adjunctive eligibility rate. A state was allowed to match federal funds for meals in private schools.
Requirements to use certain WIC funds for the costs of nutrition services and administration were extended . WIC program participation can be affected by an introduction of new programs or changes to existing policy of programs that affect women, infants, and children.
If services increase under the TANF program, a specific segment of participants in the WIC program, such as infants, showed a decrease in participation. Implementation of the TANF program accounts for a 9. In addition to current programs that affect eligibility and participation in the WIC program, many states distribute waivers that extend program rules, change work requirements, and extend program timelines that affect eligibility and participation in WIC.
WIC's impact is affected by internal programs. Some scholars assert that the spending structure needs to be adjusted so a greater number of eligible individuals can receive WIC services.
Transferring some spending to other parts of the program is under consideration. Although there are similarities to those above for type 1 diabetes, MNT recommendations for established type 2 diabetes differ in several aspects from both recommendations for type 1 diabetes and the prevention of diabetes.
MNT progresses from prevention of overweight and obesity, to improving insulin resistance and preventing or delaying the onset of diabetes, and to contributing to improved metabolic control in those with diabetes. With established type 2 diabetes treated with fixed doses of insulin or insulin secretagogues, consistency in timing and carbohydrate content of meals is important.
However, rapid-acting insulins and rapid-acting insulin secretagogues allow for more flexible food intake and lifestyle as in individuals with type 1 diabetes. Increased physical activity by individuals with type 2 diabetes can lead to improved glycemia, decreased insulin resistance, and a reduction in cardiovascular risk factors, independent of change in body weight.
Resistance training is also effective in improving glycemia and, in the absence of proliferative retinopathy, people with type 2 diabetes can be encouraged to perform resistance exercise three times a week Adequate energy intake that provides appropriate weight gain is recommended during pregnancy.
Weight loss is not recommended; however, for overweight and obese women with GDM, modest energy and carbohydrate restriction may be appropriate. MNT for GDM focuses on food choices for appropriate weight gain, normoglycemia, and absence of ketones. 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. Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control.
Due to the continuous fetal draw of glucose from the mother, maintaining consistency of times and amounts of food eaten are important to avoidance of hypoglycemia. Plasma glucose monitoring and daily food records provide valuable information for insulin and meal plan adjustments.
MNT for GDM primarily involves a carbohydrate-controlled meal plan that promotes optimal nutrition for maternal and fetal health with adequate energy for appropriate gestational weight gain, achievement and maintenance of normoglycemia, and absence of ketosis. Specific nutrition and food recommendations are determined and subsequently modified based on individual assessment and self-monitoring of blood glucose.
A recent large clinical trial reported that treatment of GDM with nutrition therapy, blood glucose monitoring, and insulin therapy as required for glycemic control reduced serious perinatal complications without increasing the rate of cesarean delivery as compared with routine care Maternal health—related quality of life was also improved.
Hypocaloric diets in obese women with GDM can result in ketonemia and ketonuria. Insufficient data are available to determine how such diets affect perinatal outcomes. Daily food records, weekly weight checks, and ketone testing can be used to determine individual energy requirements and whether a woman is undereating to avoid insulin therapy. Carbohydrate should be distributed throughout the day in three small- to moderate-sized meals and two to four snacks.
An evening snack may be needed to prevent accelerated ketosis overnight. Carbohydrate is generally less well tolerated at breakfast than at other meals. Regular physical activity can help lower fasting and postprandial plasma glucose concentrations and may be used as an adjunct to improve maternal glycemia.
If insulin therapy is added to MNT, maintaining carbohydrate consistency at meals and snacks becomes a primary goal. Although most women with GDM revert to normal glucose tolerance postpartum, they are at increased risk of GDM in subsequent pregnancies and type 2 diabetes later in life. Lifestyle modifications after pregnancy aimed at reducing weight and increasing physical activity are recommended, as they reduce the risk of subsequent diabetes 26 , Breast-feeding is recommended for infants of women with preexisting diabetes or GDM; however, successful lactation requires planning and coordination of care In most situations, breast-feeding mothers require less insulin because of the calories expended with nursing.
Lactating women have reported fluctuations in blood glucose related to nursing sessions, often requiring a snack containing carbohydrate before or during breast-feeding 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.
A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. Physical activity is needed to attenuate loss of lean body mass that can occur with energy restriction. Exercise training can significantly reduce the decline in maximal aerobic capacity that occurs with age, improve risk factors for atherosclerosis, slow the age-related decline in lean body mass, decrease central adiposity, and improve insulin sensitivity—all potentially beneficial for the older adult with diabetes 89 , However, exercise can also pose potential risks such as cardiac ischemia, musculoskeletal injuries, and hypoglycemia in patients treated with insulin or insulin secretagogues.
Reduction of protein intake to 0. MNT that favorably affects cardiovascular risk factors may also have a favorable effect on microvascular complications such as retinopathy and nephropathy. Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake. In several studies of subjects with diabetes and microalbuminuria, urinary albumin excretion rate and decline in glomerular filtration were favorably influenced by reduction of protein intake to 0.
Although reduction of protein intake to 0. In individuals with diabetes and macroalbuminuria, reducing protein from all sources to 0. Although several studies have explored the potential benefit of plant proteins in place of animal proteins and specific animal proteins in diabetic individuals with microalbuninuria, the data are inconclusive 1 , Observational data suggest that dyslipidemia may increase albumin excretion and the rate of progression of diabetic nephropathy Elevation of plasma cholesterol in both type 1 and 2 diabetic subjects and plasma triglycerides in type 2 diabetic subjects were predictors of the need for renal replacement therapy Whereas these observations do not confirm that MNT will affect diabetic nephropathy, MNT designed to reduce the risk for CVD may have favorable effects on microvascular complications of diabetes.
For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. In normotensive and hypertensive individuals, a reduced sodium intake e. In most individuals, a modest amount of weight loss beneficially affects blood pressure. 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 Adjustment for A1C explained most of the treatment effect.
The risk reductions obtained with improved glycemia exceeded those that have been demonstrated for other interventions such as cholesterol and blood pressure reductions.
There are no large-scale randomized trials to guide MNT recommendations for CVD risk reduction in individuals with type 2 diabetes. However, because CVD risk factors are similar in individuals with and without diabetes, benefits observed in nutrition studies in the general population are probably applicable to individuals with diabetes.
The previous section on dietary fat addresses the need to reduce intake of saturated and trans fatty acids and cholesterol. Hypertension, which is predictive of progression of micro- as well as macrovascular complications of diabetes, can be prevented and managed with interventions including weight loss, physical activity, moderation of alcohol intake, and diets such as DASH Dietary Approaches to Stop Hypertension.
The DASH diet emphasized fruits, vegetables, and low-fat dairy products; included whole grains, poultry, fish, and nuts; and was reduced in fats, red meat, sweets, and sugar-containing beverages 7 , , The effects of lifestyle interventions on hypertension appear to be additive. Reduction in blood pressure in people with diabetes can occur with a modest amount of weight loss, although there is great variability in response 1 , 7.
Regular aerobic physical activity, such as brisk walking, has an antihypertensive effect 7. Although chronic excessive alcohol intake is associated with an increased risk of hypertension, light to moderate alcohol consumption is associated with reductions in blood pressure 7.
Heart failure and peripheral vascular disease are common in individuals with diabetes, but little is known about the role of MNT in treating these complications. Alcohol intake is discouraged in patients at high risk for heart failure. Ingestion of 15—20 g glucose is the preferred treatment for hypoglycemia, although any form of carbohydrate that contains glucose may be used.
In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia. The acute glycemic response correlates better with the glucose content than with the carbohydrate content of the food 1.
Although pure glucose may be the preferred treatment, any form of carbohydrate that contains glucose will raise blood glucose Adding protein to carbohydrate does not affect the glycemic response and does not prevent subsequent hypoglycemia.
Adding fat, however, may retard and then prolong the acute glycemic response. During hypoglycemia, gastric-emptying rates are twice as fast as during euglycemia and are similar for liquid and solid foods. During acute illnesses, insulin and oral glucose-lowering medications should be continued.
During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important. Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis. During acute illnesses, with the usual accompanying increases in counterregulatory hormones, the need for insulin and oral glucose-lowering medications continues and often is increased.
In adults, ingestion of — g carbohydrate daily 45—50 g every 3—4 h should be sufficient to prevent starvation ketosis 1. Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations. Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals.
Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Optimizing glucose control in these patients is associated with better outcomes An interdisciplinary team is needed to integrate MNT into the overall management plan , Diabetes nutrition self-management education, although potentially initiated in the hospital, is usually best provided in an outpatient or home setting where the individual with diabetes is better able to focus on learning needs , There is no single meal planning system that is ideal for hospitalized patients.
However, it is suggested that hospitals consider implementing a consistent-carbohydrate diabetes meal-planning system , This systems uses meal plans without a specific calorie level but consistency in the carbohydrate content of meals.
The carbohydrate contents of breakfast, lunch, dinner, and snacks may vary, but the day-to-day carbohydrate content of specific meals and snacks is kept constant , Special nutrition issues include liquid diets, surgical diets, catabolic illnesses, and enteral or parenteral nutrition , Liquids should not be sugar free. Patients require carbohydrate and calories, and sugar-free liquids do not meet these nutritional needs. Care must be taken not to overfeed patients because this can exacerbate hyperglycemia.
After surgery, food intake should be initiated as quickly as possible. Progression from clear liquids to full liquids to solid foods should be completed as rapidly as tolerated. The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted. Residents with diabetes should be served a regular menu, with consistency in the amount and timing of carbohydrate.
An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management. In the institutionalized elderly, undernutrition is likely and caution should be exercised when prescribing weight loss diets.
Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , Older residents with diabetes in nursing homes tend to be underweight rather than overweight Low body weight has been associated with greater morbidity and mortality in this population , 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.
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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: