Synergy Diet Parameters

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1 Synergy Diet Parameters Parameters Each diet parameter is set in the Synergy Database to aid in meeting the Dietary Reference Intakes (DRI) for adults (males 51 to 70 years of age (average weight 175 lb or 80 kg 1 ); or >70 years of age if available). Although diets may be able to have more or less than the lower and upper limits, the parameters are utilized for menu planning and ensuring that each diet meets the below definitions. Regular Diet This diet is intended to meet the needs of healthy adults (age 51+). It incorporates recommendations from Canada's Food Guide to Healthy Eating (CFG) (2007), including the following 2 : Vegetable & fruits group: 7 servings Grain group: 7 servings Milk & alternatives group: 3 servings Meat & alternatives group: 3 servings The Regular diet is set to meet the minimal macronutrient requirements for healthy adults (males 51 to 70 years of age; or >70 years of age if available) including the following macronutrient distributions, which are based on 2,000 kcal consumption. The diet is assessed using Acceptable Macronutrient Distribution Ranges (AMDR), Dietary Reference Intakes (DRI), Adequate Intake (AI) or Recommended Dietary Allowance (RDA) established by the US Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences (NAS): Calories Carbohydrates % Proteins % Fats % Fibre g/day Sodium* 3, mg/day 1200 mg 2300 mg 3400 mg Calcium mg/day 1000 mg 1200 mg 2000 mg Vitamin D** 2, IU/day 400 IU 800 IU 4000 IU The lower, ideal and upper parameters are used to identify deficiencies, ideal intakes and toxicities based on Estimated Average Requirement (EAR), RDA and Tolerable Upper Intake Level (UL). *Sodium values have been changed to reflect Health Canada s Sodium Reduction Strategy for Canada (2010). The lower parameter is based on the EAR, the ideal parameter is set to Health Canada s average daily sodium intake target by 2016, and the upper parameter is the current Canadian daily intake average as of Most therapeutic diets will comply with the above regulations however due to the clinical natural of some of the below diets (i.e. HiPro/HiCal) the upper limit may be exceeded. **Vitamin D values are based on daily RDA standards and do not include CFG recommendation for adults over the age of 50 to consume vitamin D supplementation of 400 IU/day (10 µg/day). 2

2 In developing a menu, the CFG is used as a guide, but since the CFG was developed for well/healthy adults and the geriatric population was not the primary target, health issues that have diet considerations are priority. Synergy provides nutritional analysis so every menu type can be analyzed and reported against the appropriate DRI. This allows menu planning to also consider the other 'guidelines' of variety, avoiding repetition, color, costs, therapeutic and texture modification, production and labour, and client acceptance. This diet is used as the basis of all therapeutic and texture modified diets. All Therapeutic diets are to be used as guidelines in the diet planning process. The presentation of diseases will vary between residents, which may lead to modified and individualized care plans. Please ensure the following diets (i.e. renal, diabetic, heart healthy etc.) are tailored if need be, to meet the nutrition care goals of the individual residents. Allergy Diets Lactose Restricted This diet is for people with lactose intolerance or lactase enzyme deficiency. Lactose is restricted by providing substitutions for lactose containing foods and reducing the use of lactose containing ingredients in recipes. 5 Gluten Restricted This diet eliminates products containing gluten, which is generally present in wheat, rye, barley and sometimes oats. 5 Diabetic Diets 6 Diabetic Low Calorie (Diabetic LoCal) This diet is for people with diabetes who require reduced calories. Calories and carbohydrates are modified by utilizing reduced, beverages and condiments, providing substitutions for high fat items and serving smaller portions of carbohydrate containing foods, including desserts. Calories Carbohydrates % Proteins % Fats %

3 Diabetic Maintenance (Diabetic Maintain) This diet is for people with diabetes who are in a maintenance status. Carbohydrates are modified by reducing concentrated sweets, utilizing reduced calorie items (as necessary) and limiting high fat foods. Calories Carbohydrates % Proteins % Fats % Diabetic High Calorie (Diabetic HiCal) This diet is for people with diabetes who require increased calories. Carbohydrates are modified by reducing concentrated sweets and limiting high fat foods. Larger portions of protein and complex carbohydrate starches are utilized to increase the calories. Calories Carbohydrates % Proteins % Fats %

4 Diabetic Renal (DiabRe) This diet is a combination of the Diabetic Maintenance and Renal Diet. This diet addresses the needs of residents who are diabetic and require restrictions of nutrients including; protein, ( g/kg), sodium, potassium and phosphorus. Calories kcal/kg Carbohydrates % Proteins % Fats % Sodium 3, mg/day 1200 mg 2000 mg 2400 mg Phosphorus mg/day 800 mg 900 mg 1000 mg Potassium mg/day 2000 mg 2400 mg 3000 mg Diabetic Renal Liberalized (DiabReLib) This diet is a combination of the Diabetic Maintenance and Renal Liberalized Diet. This diet addresses the needs of the residents who are diabetic and CKD who can tolerate liberalized amounts of protein (1.2 g/kg), sodium, phosphorus and potassium 7,8,9,10,11. Calories kcal/kg Carbohydrates % Proteins % Fats % Sodium mg/day 1200 mg 2300 mg 3000 mg Phosphorus mg/day 800 mg 1000 mg 1200 mg Potassium mg/day 3000 mg 3500 mg 4000 mg

5 Renal (Renal) This diet is considered a low protein, electrolyte controlled diet to address the needs of residents with CKD. Protein intake is controlled by serving smaller portions of the entrée and limiting condiments/side items that would contribute extra protein. Phosphorus, sodium and potassium are modified by providing substitutions for high phosphorus, sodium and potassium foods 7,8,9,10,11. Calories kcal/kg Carbohydrates % Proteins % Fats % Fibre g/day Sodium 3, mg/day 1200 mg 2000 mg 2400 mg Phosphorus mg/day 800 mg 1000 mg 1200 mg Potassium mg/day 2000 mg 2400 mg 3000 mg Renal Liberalized (Renal Lib) This diet addresses the needs of the CKD residents, which may or may not be receiving dialysis treatments, which are allowed to receive liberalized amounts of nutrients. This diet is designed to provide kcal/kg, 1.2 g protein (or 16-20% protein), and moderated amounts of sodium, potassium and phosphorus to meet the needs of this population. Calories kcal/kg Carbohydrates % Proteins % Fats % Fibre g/day Sodium 3, mg/day 1200 mg 2300 mg 3000 mg Phosphorus mg/day 800 mg 1000 mg 1200 mg Potassium mg/day 3000 mg 3500 mg 4000 mg

6 Reducing Diet (Reduc) This diet is for people who do not have diabetes, but require reduced calories. Calories are modified by utilizing reduced calorie desserts, beverages and condiments, providing substitutions for high fat items and serving smaller portions. Calories Carbohydrates % Proteins % Fats % Fibre g/day Hi Calorie/Hi Protein Diet (Hi Pro/Hi Cal) This diet is set to provide at least 120% of the Recommended Dietary Allowances for energy and protein in order to improve the nutritional status of malnourished clients. This diet usually exceeds the 30% of total calories from fat, due to the addition of fat to increase the caloric density of foods. Calories and protein are modified by adjusting portion sizes, using fortified recipes, and utilizing high calorie-protein sources including: whole milk and milk products, peanut butter, margarine/butter, mayonnaise, gravy, sugar, etc. 5 Calories Carbohydrates % Proteins % Fats % Fibre g/day

7 Heart Healthy Diet (Heart) This diet modifies the fat, cholesterol, and sodium in the diet by providing substitutions for high fat/cholesterol/sodium foods 12 Calories Carbohydrates % Proteins % Fats % Fibre g/day Cholesterol 12 <200 mg/day 100 mg 200 mg 300 mg Sodium 3, mg/day 1200 mg 2000 mg 2300 mg Vegetarian Diet (Veggie) This diet excludes meat, fish, and poultry, but does allow eggs and dairy products. Calories Carbohydrates % Proteins % Fats % Fibre 6 30 g/day Iron mg/day 8 mg 16 mg 45 mg Vitamin B µg/day 2.0 µg 2.4 µg ND DIET ORDERS In Synergy the combination of a diet and texture creates a Diet Order. Please review the Valid/Invalid Diet/Texture Grid for Synergy. Some Diet Orders will be marked as Invalid as the addition of thickeners and products to make texture variations will exceed the Diet Parameters as outlined above.

8 References 1. Statistics Canada, Viewed Feb Health Canada, Viewed Feb aliment/view_eatwell_vue_bienmang-eng.pdf 3. Health Canada, Viewed Feb Health Canada, Viewed Feb Manual of Clinical Dietetics (ADA & DC, 2000). 6. Canadian Diabetes Association Critical Practice Guidelines Academy of Nutrition and Dietetics, Viewed April Cleveland Clinic - Reference for CKD Disease Progression, Viewed March British Dietetic association Nutrition Therapy for Haemodialysis, Viewed March nealdialysis.pdf 10. National Kidney Foundation (NKF/DOQI) Guidelines 2000, Viewed March The Renal Association, Viewed March Practice Evidence Based Nutrition (PEN), Viewed Jan 2013

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