SAI RURAL DIABETES SPECIALITIES CENTRE. WDF-MDRF RURAL Diabetes Project BALANCED DIET

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2 SAI RURAL DIABETES SPECIALITIES CENTRE WDF-MDRF RURAL Diabetes Project BALANCED DIET A balanced diet is one, which provides all the nutrients in required amounts and proper proportion and can easily be achieved through a blend of four basic food groups. 1. Cereals,millets and pulses 2. Vegetables and fruits 3. Milk,milk products,egg, meat, fish 4. Oils and fats, nuts and oilseeds The quantity of foods needed to meet the nutrient requirements varies with age, sex, physical activity and physiological status. A balanced diet should provide around 60 to 70% of total calories from carbohydrate, preferably starch, about 10-12% from protein and 20-25% from fat. In addition, a balanced diet should provide other non-nutrients such as dietary fibre, antioxidant and physio chemicals, which bestow positive health benefits. Antioxidants such as vitamin C and E, beta-carotene, riboflavin and selenium protect the human body from free radical damage. Other physiochemical such as polyphenols flavour etc. also afford. Protection against oxidant damage. Spices like turmeric, ginger, garlic, cumin and cloves are rich in antioxidants. 1

3 Menu Plan for adult women (Sedentary Worker) (1800 calorie) Early morning: Tea/Coffee/Milk with sugar 100ml Breakfast: Idli 3 /Chappathi 3 /Dosa 2 Chutney, Sambar Lunch: Rice: 3K (Raw Weight: 100g) Sambar, Rasam Vegetable Curry 1K Vegetable salad 50g Curd 1cup Tea: Tea/ Coffee/Milk with sugar 100ml Idli-2/Dosa-2/Bread slice-2/biscuits 4 Chutney Dinner: Same as lunch (Or) Chappathi-6/wheat dosa-6 Dhal, Vegetables Curd 1 cup Fruit 1 Key: - Vegetables allowance per day 300g Milk allowance per day 300ml Cooking oil allowance per day 20g Sugar allowance per day 20g 2

4 Menu Plan for adult women (Sedentary Worker)(2000 calorie) Pregnant Early morning: Tea/Coffee/Milk with sugar 100ml Breakfast: Idli 4 /Chappathi 4 /Dosa 3 Chutney, Sambar Midmorning: Milk with sugar 100ml Lunch: Rice: 3K (Raw Weight: 100g) Sambar, Rasam Vegetable Curry 1K Vegetable salad 50g Curd 1cup Tea: Tea/ Coffee/Milk with sugar 100ml Idli-3/Dosa-2/Bread slice-3/biscuits 4 Chutney Mid evening: Fruit 1 Dinner: Same as lunch (Or) Chappathi-6/wheat dosa-6 Dhal, Vegetables Curd 1 cup Fruit 1 Bedtime: Milk with sugar 100ml Key: - Vegetables allowance per day 300g Milk allowance per day 500ml Cooking oil allowance per day 20g Sugar allowance per day 20g 3

5 Menu Plan for adult women (Sedentary Worker)(2300 calorie) Lactation Early morning: Tea/Coffee/Milk with sugar 100ml Breakfast: Idli 5 /Chappathi 5 /Dosa 3 Chutney, Sambar Lunch: Rice: 3K (Raw Weight: 100g) Sambar, Rasam Vegetable Curry 1K Vegetable salad 50g Curd 1cup Midmorning: Milk with sugar 100ml Tea: Tea/ Coffee/Milk with sugar 100ml Idli-3/Dosa-3/Bread slice-3/biscuits 7 Chutney Mid evening: Fruit - 1 Dinner: Same as lunch (Or) Chappathi-6/wheat dosa-4 Dhal, Vegetables Curd 1 cup Fruit 1 Bedtime: Milk with sugar 100ml Key: - Vegetables allowance per day 300g Milk allowance per day 500ml Cooking oil allowance per day 25g Sugar allowance per day 20g 4

6 INFANT 0-6months Breast feeding for 0-6months Start within half an hour Give more number of times More duration at each times Monitor weight once in 15days Continue breast feeding 4-6 months Start with powdered or grounded rice or wheat or ragi porridge 2-3 teaspoon gradually increase to frequency over 3-4 weeks till the baby takes tsp or ½ cup or 50gm/day. Add oil/ghee ¼ to ½ tsp 2-3 times Fruit juice 20-30ml once or twice or mashed banana upto 1 gradually. Give food item preferably after breast feeding or at times before breast feeding (individual) 6-12 months Breakfast: ½ to 1 Idli/Dosa/Chappathi with Dhal/Sambar Lunch and Dinner: Rice - ½ cup Dhal tsp Milk - 1 cup (100ml) Roots & tubers - 3 to 5tsp Green Leafy Vegetables - 1 ½ to 2 tsp Other vegetables - 1 ½ to 2 tsp Fruit - 1 medium size Sugar - 1 tsp Fat and oil - ½ - 1 tsp 5

7 NOTE: - Supplement from cereal, pulses and others. Supplement should not be a substitute for regular meals. One or two food item can be cooked together and given (ex) Rice + Dhal as Kichadi (or) Chappathi softened with Dhal 4 to 5 feeds per day. Small frequent feeds with consistency initially as paste, subsequently as solids. Introduce new food item one by one (week apart) Ensure proper hygiene Give solids after breast-feeding (or) otherwise continue breast feeding. 1-3 years Toddler and Young children Breakfast: 1-2 Idly / Dosa / chappathi Dhal / Sambar Lunch & Dinner: Rice - 1 to 2 cups Dhal - 4 to 6 cups Milk - 1 ½ cup Roots & tubers - 3 to 5tsp Green Leafy Vegetables - 3 to 5 tsp Other vegetables - 3 to 5 tsp Fruit - 1 medium size Sugar - 1 ½ to 2 tsp Fat and oil - 1 ½ tsp Snack/Supplement from cereal, pulses and others. 6

8 4-6 years - Pre-school children Breakfast: 2-3 Idly/Dosa/Chappathi Dhal/Sambar Lunch & Dinner: Rice - 2 to 3 cups Dhal tsp Milk - 1 ½ Cup Roots & tubers - 7 to 10 tsp Green Leafy Vegetables - 5 tsp Other vegetables - 5tsp Fruits - 1 medium size Sugar - 2 tsp Fats and oil - 2 tsp NOTE: Snack/supplement should not be a substitute for meal One or more food items are cooked and taken together (ex) green with Dhal or greens stuffed with roti or paratha. Exchange 30gm (12 tsp Dhal) = 1 egg =30gm mutton or 30gm fish 3-5 feeds per day for 1-3 yrs old child Recommended: Sunflower oil/ Gingelly oil/ Groundnut oil. 7

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10 SAI RURAL DIABETES SPECIALITIES CENTRE WDF-MDRF RURAL Diabetes Prevention Project Recipes on balanced diet Green gram methi masala Ingredients: Sprouted green gram 50g Roasted fenugreek powder ¼ tsp Fenugreek leaves 100g Turmeric powder ¼ tsp Onion (small) 50g Red chillies - 6 Tomato 50g Coriander seeds 1tsp Garlic 4 flakes Bengal gram dhal 1tbsp Garam masala 1tsp Oil for seasoning 1tsp Method: Dry roast red chillies, coriander seeds and Bengal gram dhal and powder it. Cut onion, tomato and garlic into small pieces. Heat oil in a pan and fry onion till golden brown. Add turmeric powder, garlic, tomatoes and Saute for a minute. Add sprouted gram, fenugreek leaves, salt and water when cooked add the masala powders. Serve hot with rice or chappathi. Nutritive value per serving: Energy 79 Kcal No. of serving - 3 Carbohydrate 10.6 g Portion size 1 Katori Protein 4.3 g Fat 2.1 g

11 Sathu Mavu Dosai Ingredients: Rice flour 100g Wheat flour 50g Ragi flour 25g Bajra flour 25g Onion 50g Green chillies 3 Ginger a small piece Chopped coriander - few Curry leaves few Cumin seeds 1 tsp Asafoetida powder ½ tsp Oil 50ml Method: Mix rice, wheat, ragi and bajra flour with salt, cumin seeds, asafoetida powder and prepare a batter adding water. Grind ginger, chillies, onion and mix with the batter. Add coriander leaves and curry leaves. Heat a non stick pan and spread a ladle full of batter into a circle with little oil around. Turn over and fry on both the sides. Serve hot with chutney. Nutritive value: Energy 117 kcal Portion size 1 Carbohydrate 15.5 g No.of serving - 10 Protein 1.8 g Fat 5.3 g Vegetable Varagu Uppuma Ingredients: Varagu - 100g Turmeric powder - a pinch Tomato - 50g Mustard - ¼ tsp Onion -50g Coriander leaves -a few Beans - 20g Green chillies - 3 Salt - to taste Oil - 2tsp

12 Method: Dry roast the varagu lightly in a pan. Cut the vegetables into small pieces. Heat oil in a pan and add mustard seeds. When mustard seeds crackle add the onion and fry for a minute. Add green peas and the cut vegetables. Add water and boil till the vegetables are cooked. Add salt and varagu and cook..stirr well. Garnish with coriander leaves and serve hot. Nutritive value: Energy 85 K cal Portion size 1 Protein 4g No.of serving 2 Carbohydrate 10g Fat 2g Ingredients Soya adai Soya beans -25g Chillies -2 Bengal gram dhal -25g Garlic-3Pod Red gram dhal -25g Onion -25g Rice -25g Curry leaves a few Coriander leaves few Salt to taste Oil -5ml Method: Slightly roast the soya beans. Soak the soya beans, Bengal gram dhal, red gram dhal and rice for three to five hours.grind the soaked ingredients with chillies.chop onion,garlic and coriander leaves. Mix the chopped items and add salt to the batter. Smear the pan with oil and cook the adai on both sides. Serve hot. Nutritive value Energy : 107 Kcal Portion size 1 Protein : 5.9g No. of serving - 4 Fat - 2.9g Carbohydrate: 11.7g Fibre : 0.4g

13 SAI RURAL DIABETES SPECIALITIES CENTRE WDF-MDRF RURAL Diabetes Project NUTRITION GUIDELINES FOR DIABETES MANAGEMENT Calories must be restricted especially if over weight Monitor portion sizes Eat at regular times Follow four meal pattern Breakfast, Lunch, Tea, Dinner Never skip a meal Blood sugar mainly depends on carbohydrate intake Choose foods that contain fibre Begin each meal with a raw vegetable salad Include atleast 100gms of green leafy vegetable in the daily diet Vegetables and fruits are a store house of vitamins and minerals Consume fruit as a whole rather than fruit juice Make a light snack of assorted sprouts Choose foods low in fat and cholesterol Beware of fat calories Steam or boil vegetable rather than fry Cut down deep fried foods from your diet Limit salt intake especially if you have high blood pressure Limit alcohol intake No fasting, No feasting.

14 NUTRITION IN PREGNANCY Madras Diabetes Research Foundation & World Diabetes Foundation

15 Balanced diet A balanced diet is one which provides all the nutrients in required amounts and proper proportions.

16 Key components of a healthy lifestyle during pregnancy Appropriate weight gain Consumption of variety of foods Appropriate and timely vitamin and mineral supplementation Plenty of fluids Avoid alcohol and sweeteners

17 Additional food and extra care To improve the birth weight To increase the body fat deposits

18 Relationship between maternal and foetus nutrition Inadequate food intake & poor nutrient utilization Maternal malnutrition Reduced blood volume expansion Inadequate increase in cardiac output Decreased blood & nutrient supply to the foetus Reduced d placental l size Reduced nutrient transfer Foetal growth retardation

19 Recommended Dietary Allowance

20 Nutrient needs Protein additional 10gm /day Calories additional 300 during 2 nd & 3 rd trimester Calcium increased during 3 rd trimester Iron increase 15g/day during 2 nd & 3 rd trimester Folate 400 mcg/day * Multivitamins and minerals supplements in special problem

21 Additional protein Rapid growth of the foetus Enlargement of the uterus, mammary glands and placenta Increase in maternal circulating blood volume Formation of amniotic fluid Transfer of amino acids from the mother to foetus.

22 Calcium Calcium is needed for growth and bone development. Calcium prevents osteoporosis Osteoporosis is more common in women Pregnant and lactating women, children and the elderly require more calcium Milk, curds and nuts are rich sources of bioavailability calcium Exercise reduces calcium loss from bones.

23 Iron Iron is needed for haemoglobin synthesis, mental function and body defense. Deficiency of iron leads to anaemia. Iron deficiency is common particularly in women of reproductive age and in children. Iron deficiency during pregnancy increases maternal mortality and low birth weight in infants. In children it increases susceptibility to infection and impairs learning ability. Plant foods like legumes, dried fruits and green leafy vegetables contain iron. Iron is also obtained through meat, fish and poultry products. Iron bioavailability is poor from plant foods but is good from animal foods. Fruits rich in vitamin C like amla, guava and citrus fruits improve iron absorption from plant foods. Beverages like tea bind dietary iron and make it unavailable. Hence they should be avoided before, during and soon after a meal.

24 Vitamin Normal diet, to be wholesome and tasty, should include fresh vegetables and fruits Vegetables/fruits are rich sources of micronutrients Fruits and vegetables also provide several non-nutritional factors like fiber and phytochemicals of vital significance. Green leafy vegetables, other vegetables and fruits help in prevention of micronutrient malnutrition and certain chronic disease. Vegetables and fresh fruits are rich sources of micronutrients such as vitamin and minerals and of complex carbohydrates/fiber. They contain abundant amounts of iron, vitamin C, folic acid, carotenoids and phytochemicals.

25 Folic acid Folic acid is essential for the synthesis of haemoglobin. Folic acid deficiency leads to macrocytic anaemia. Pregnant woman need more folic acid. Folic acid supplements increase birth weight and reduce congenital anomalies. Green leafy vegetables, legumes, nuts and liver are Green leafy vegetables, legumes, nuts and liver are good sources of folic acid.

26 General dietary yproblem Nausea & vomiting Constipation Pica

27 Management of Morning Sickness Causes Rapid rise of human chorionic gonadotropin Relaxation of smooth muscle cells of the stomach.

28 Management Of Morning Sickness Tips for controlling nausea Small frequent meals every 2 ½ - 3 hrs Avoid strong / instant coffee Avoid fatty and spicy foods Drink fluids between meals, not with meals Take prenatal tablets as prescribed Always carry food

29 Management Of Morning Sickness Cont.. Approach to Decrease Pre-Meal Hypoglycemia and Nausea Decrease pre-meal insulin dosage Shorten the insulin meal interval Split insulin dose and food Check food tolerance and continue

30 Management Of Morning Sickness Cont.. Precautionary Measures Advised d tomato t juice before a meal Eat food when vomiting subsides Check blood glucose levels frequently

31 Warning sickness Bleeding or leaking fluid from vagina Blurry or impaired vision Unusual or severe abdominal pain or backaches Frequent, severe, and continuous headache Contractions Decrease in baby s movement Dizziness Excessive vomiting and diarrhea Fever Pain or burning with urination Muscular convulsions

32 Additional care Optimal weight gain Avoid constipation Plenty of fluids Salt intake should not be restricted Undergo periodic health check up for weight gain, blood pressure and anaemia Receive tetanus toxoid immunization Adequate physical exercise with adequate rest for 2-3 hrs during the day. Drugs should not be taken without medical advice Smoking, tobacco chewing and alcohol consumption should be avoided. Wrong belief and taboos should be discouraged

33 Complications Anaemia Toxemia Diabetes mellitus

34 Exercise during gpregnancy Consult a physician before exercise program Exercise not safe under these conditions: Preterm labor in current or past pregnancies Vaginal bleeding Cervical problems Leaking of amniotic fluid Shortness of breath Dizziness and or fainting Increased heart rate Certain health problems such as hypertension and heart disease.

35 Guidelines for working during pregnancy Exposure Effect Metals Birth defects,miscarriages Solvents Fetal deformity Pharmaceutical agents Miscarriage, low birth weight and malformation Infections Radiation and radioactive Multiple problems Fetal development and miscarriage Extreme heat Increase neural tube defects

36 Reflux during gpregnancy Avoid greasy and fried foods Eat six to eight small needs instead of three large meals Don t gain more than the recommended d amount of weight Take small sips of milk or eat small pieces of chipped ice to soothe burning Eat slowly Ask your doctor if you can take an antacid medicine. i

37 Thank You