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Treatment Principal (Emma, Kate, Jacinta)

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Treatment Principal (Emma, Kate, Jacinta)

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Obesity
- reduce overall energy intake
- reduce discretionary food intake
- weight loss
- consume foods high in protein and fiber (plant based foods and lean meats)
-limiting intake of foods high in fat, added sugar and alcohol

HTN
- low/reduced salt diet
- achieving and maintaining a healthy weight
- limit sat fat consumption
- increase fruit and veg intake

Hyperlipidaemia
- fat - reduce sat fats
-fiber - increase fiber intake from fruit, veg and whole-grains
-phytosterols- prod like fortified marg, weetbix and milk
-fish - increase intake to 2 serves/week
-fitness - increase to 30 min most days of the week

T2DM
- achieve and maintain a healthy weight
-watch timing and amount of CHO consumed (2xper meal, 1x per snack)
- Consume low GI foods to avoid spikes in BGL
-consume CHO with other foods (proteins and fats) so as to slow down digestion and reduce spikes in BGL.

T1DM
-watch timing and amount of CHO consumed (2xper meal, 1x per snack). Educate on insulin to CHO ratios and management
- monitoring BGL especially with exercise and alcohol.
- educate on hypo- and hyper-glycemic symptoms and management of.

Malnutrution
- high energy high protein meals and snacks
- oral nutrition support and/or supplementation as needed
- food fortification to increase protein and energy density
-syptom management (N&V, nutrition impact symptoms)
- consider refeeding syndrome

Diverticulitis
-reduce fiber intake during flare ups and increase fiber intake during periods of remission
- aim for 5-10 gram above the daily average rec of 25-30g fiber/day during remission
-aim for adequate fluid intake especially when the patient is on a high fiber diet
- during flare ups, reduce fat intake if pain and diarrhea is present and check for lactose tolerance

Coeliac Disease
- education on gluten and foods containing gluten
-label reading
-focus on what foods CAN be eaten and not on what CAN'T be eaten
-aiming for a generally healthy, balanced diet
-monitor for dairy tolerance

COPD
- achieve and maintain a healthy weight
-quite smoking immediately
-watch Na intake if presenting with oedema
-symptom management such as smaller meals more often to counteract breathlessness
- fortification of foods if need be
-encourage fluid consumption to keep fluids thin
- follow guidelines for fiber and Na
-allowing adequate time for meal consumption
-high energy high protein meals and snacks available
-energy, protein and fluid

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Obesity:
- reduce energy intake
- reduce saturated and trans fats
- increase fibre
- increase F&V intake
- eat wholegrains
- limit discretionary items and alcohol
- eat more lean protein
- eat a balanced diet
Hypertension:
- reduce salt intake
- reduce saturated and trans fats
- increasing fibre
eat a balanced diet
Hypercholesterolaemia:
- reduce saturated and trans fats
- increase fibre intake
- eat more fish
- eat more MUFAs and PUFAs
- eat foods containing phytosterlos
- eat more F&V
- eat more wholegrains
- eat a balanced diet
T2DM:
- spread carbs evenly throughout the day
- eat low GI
- limit intake of refined sugars
- eat wholegrains
- eat a balanced diet
T1DM:
- limit intake of refined sugars
- spread carbs evenly throughout the day
- treat hypos properly
- eat a balanced diet
COPD:
- high energy high protein
- eat a balanced diet
Malnutrition:
- high energy high protein
- eat a balanced diet
Coeliac:
- avoid all sources of gluten
- don't completely cut out carbs
- eat a balanced diet
Diverticular disease:
- eat low fibre during a flare up
- eat high fibre when not sick
- eat plenty of F&V
- drink plenty of water
- slowly increase fibre intake after a flare up
- eat a balanced diet

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Obesity
- reduce energy intake below EER
- aim for 5-10% weight loss (0.5-1.0kg p/w)
- Enjoy a wide variety of nutritious foods from the five food groups.
- drink plenty of water
- limiting intake of foods high in fat, added sugar, added salt
- limiting intake of drinks high in added sugars and added salts and alcohol
- Physical Activity >30 min/day
- Behaviour modification

Hypertension
- low/reduced salt diet (sodium free or 5mg per 100g serving / SDT 1600mg/day - 2300mg/day)
- 5-10% weight loss (if appropriate) through energy restriction
- DASH diet: rich in fruits, veg, low fat dairy & sat fats
- limit alcohol consumption
-Educate on overall management

Hyperlipidaemia
- fat - reduce sat & trans fats
- fiber - increase fiber intake from fruit, veg and whole-grains
- phytosterols - from fortified products like marg, weetbix and milk
- fish - increase intake to 2 serves/week
- physical activity - increase to >30 min/day
- Educate on overall management

T2DM
- achieve euglycaemia (via diet and/or medication and exercise)
- 5-10% weight loss (where appropriate) through energy restriction
- Eat regular balanced meals (according to ADGs)
- Reduce intake of foods high in added sugars
- Education around food containing CHO, portion sizes and GI/GL
- reduce alcohol intake and drinks with added sugars
- Limit sat fat intake

T1DM
- Synchronise insulin intake with food intake
- Spread CHO meals evenly over 6 meals over the day
- Educate on insulin to CHO ratios and CHO exchanges
- monitoring BGL especially with exercise and alcohol
- educate on hypo- and hyper-glycaemic symptoms and management

Malnutrution
- HPHE meals and snacks
- Achieve nutritional adequacy
- ONS and/or supplementation as needed
- food fortification to increase protein and energy density
- symptom management (N&V, nutrition impact symptoms)
- consider refeeding syndrome

Diverticulitis
- Bland low fibre diet - white bread etc. during flare up
- Clear fluid diet if severe
- Aim for 25-30g fiber/day during remission + 6-10g/day above
- Aim for adequate fluid intake
- During flare ups, reduce fat intake if pain and diarrhea is present and check for lactose tolerance
- Eat a balanced diet

Coeliac Disease
- education on gluten, foods containing gluten and food contamination)
- label reading
- focus on what foods CAN be eaten and not on what CAN'T be eaten
- aiming for a generally healthy, balanced diet
- monitor for dairy tolerance
- be wary of highly processed gluten free foods
- supplement with iron, folate, vit C & D where necessary

COPD
Stable COPD:
- Maintain or improve nutritional status through a HPHE diet / ONS if necessary
Acute exacerbation:
- HPHE diet for inflammation (1.5g/kg/day)
- achieve and maintain a healthy weight

- quit smoking / avoid environmental allergens
- monitor sodium intake if presenting with oedema
- management symptoms with small meals more often to counteract breathlessness - make every mouthful count.
- texture modification where dysphagia is present
- fortification of foods if need be
- follow guidelines for fiber and Na

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Obesity:
Assess knowledge
Reduce energy intake
Reduce saturated and trans fats
Increase fruit and vegetable intake
Increase fibre
Eat lean meats
Limit discretionary foods
Reduce alcohol intake
Increase physical activity.
Consume low fat dairy instead of full fat.

Hypertension:
Reduce salt intake
Limit alcohol consumption
Eat a high fibre diet
Eat a low-fat diet
Exercise regularly
Maintain a healthy BMI

Hypercholesterolemia:
Eat fish 2 to 3 times a week
Reduce trans and saturated fats and eat MUFAs and PUFAs
Have fortified products with phytosterols (eg.proactiv)
Increase fibre intake.
Increase physical activity

T2DM
Limit intake of refined sugars
Spread CHO intake throughout the day
Eat a variety of fruits, veg & wholegrains
Reduce alcohol consumption
Maintain a healthy BMI
Stop smoking
Increase physical activity

T1DM
Ensure a balanced diet
Spread CHOs evenly throughout the day
Avoid refined sugars
Medication
Increase physical activity

Malnutrition:
Increase intake (oral or EN or TPN as required)
HPHE - fortify foods
Make every mouthful count
Address nutrition impact symptoms
Educate

Diverticular:
Increase fibre intake
Probiotics
Avoid nuts and seeds if pt feels necessary (not scientifically proven)
When severe clear fluid diet & bowel rest

Coeliac:
No gluten
Avoid oats also
Reduce risk of cross-contamination

COPD:
HEHP if malnourished
May require texture modified
Reduce risk factors (stop smoking)
Manage associated illnesses

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Obesity

Restrict overall calorie intake (weight loss)

Increase physical activity levels aiming for 30 minutes per day, most days of the week

Behaviour change

Limit intake of alcohol

Facilitate healthy weight loss

Limit intake of discretionary foods

Hypertension

Limit sodium containing foods

Cessation of smoking

Increase physical activity levels aiming for 30 minutes per day, most days of the week

Reduce overall fat intake and improve fat quality

Weight management/weight loss if appropriate

Include Phytosterols

Manage NIS

Hyperlipidaemia

Reduce overall fat intake

Reduce saturated and trans fats in diet

Eat more MUFA, omega 3 and PUFA sources

Weight management/weight loss if appropriate

Increase physical activity levels aiming for 30 minutes per day, most days of the week

Improve diet quality/nutritional adequacy

Malnutrition

High protein/high energy snacks

Facilitate healthy weight gain/weight maintenance if appropriate

Ensure electrolyte balance (re-feed risk)

Manage NIS (nausea, fatigue etc)

ONS, EN or TPN if indicated

Behaviour change

Diverticular Disease

Manage NIS

Low fibre during flare ups

Slowly increase fibre when appropriate

Encourage fibrous foods when in remission (fruit, veg, whole grains)

Adequate fluid intake

Education on diet-disease

T2DM

Reduce intake of discretionary foods

Reduce intake of high sugar foods

Increase fruit and vegetables

Increase physical activity levels aiming for 30 minutes per day, most days of the week

Manage BSL within normal ranges

Education on diabetic diet

Achieve healthy weight (eg facilitate weight loss or gain)

Consume foods with a low GI to avoid spikes to BSL

Type 1 diabetes

Be aware of CHO intake and distribution throughout day

Ensure adequate CHO quality (reduce intake of refined CHO)

Educate on CHO counting and exchanges (including CHO recognition and label reading)

Ensure regular monitoring of BGL

Educate on CHO to insulin ratio

Emphasis general healthy eating

Incorporate low GI foods into diet to lower risk of Â BGL spikes

Educate on management strategies of hyper/hypo - glycaemic symptoms

Coeliac disease

Strict life-long gluten free diet (after diagnosis has been confirmed)

Educate on recognising gluten containing foods (gluten in wheat, rye, barley and oat products)

Educate on label reading (allergen warnings, wheat/rye/barley derivatives, checking products regularly for changes)

Ensure understanding of avoiding cross contamination with utensils, appliances, spreads and dips

Consume an overall balanced diet

Emphasis a normal happy life can be lived with coeliac disease

COPD

Cease smoking

Prevent weight loss and malnutrition by ensuring adequate energy/protein intake

Incorporate HPHE meals and snacks

Have small, frequent meals

Use food fortification or oral nutrition support if experiencing early satiety/anorexia

Have ready prepared/easy meals and snacks on hand

Eat away from times of airway clearance to avoid being too fatigued to eat

Use soft foods to reduce shortness of breath