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1 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.

(3)

2 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

(4)

3

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

(5)

4 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

(6)

5

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

4-6 months

• Continue breast feeding

• 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 10-12 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 - 2-3 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

(7)

6

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

(8)

7 4-6 years - Pre-school children

Breakfast: 2-3 Idly/Dosa/Chappathi Dhal/Sambar

Lunch & Dinner: Rice - 2 to 3 cups Dhal - 6 – 10tsp 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:

(9)
(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

Soya adai Ingredients

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

(14)

NUTRITION IN PREGNANCY

Madras Diabetes Research Foundation

&

(15)

Balanced diet

Balanced diet

A balanced diet is one which provides all

the nutrients in required amounts and proper

the nutrients in required amounts and proper

proportions.

(16)

Key components of a healthy lifestyle

during pregnancy

during pregnancy

…

Appropriate weight gain

…

Appropriate weight gain

…

Consumption of variety of foods

…

Appropriate and timely vitamin and mineral

…

Appropriate and timely vitamin and mineral

supplementation

…

Plenty of fluids

…

Plenty of fluids

(17)

Additional food and extra care

…

To improve the birth weight

…

To improve the birth weight

(18)

Relationship between maternal and foetus nutrition

Relationship between maternal and foetus nutrition

Inadequate food intake & poor nutrient utilization

Maternal malnutrition

Reduced blood volume expansion

Reduced blood volume expansion

Inadequate increase in cardiac output

Decreased blood & nutrient supply to the foetus

R d

d l

t l i

Reduced placental size

Reduced nutrient transfer

Foetal growth retardation

(19)
(20)

Nutrient needs

…

Protein – additional 10gm /day

g / y

…

Calories – additional 300 during 2

nd

& 3

rd

trimester

…

Calcium – increased during 3

g

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

p

…

Rapid growth of the foetus

p g

…

Enlargement of the uterus, mammary glands and

placenta

…

Increase in maternal circulating blood volume

…

Formation of amniotic fluid

(22)

Calcium

…

Calcium is needed for growth and bone development.

g

p

…

Calcium prevents osteoporosis

…

Osteoporosis is more common in women

p

…

Pregnant and lactating women, children and the

elderly require more calcium

…

Milk, curds and nuts are rich sources of bioavailability

calcium

E

i

d

l i

l

f

b

(23)

Iron

…

Iron is needed for haemoglobin synthesis, mental function and body

defense

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.

y

…

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

…

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.

B

lik

bi d di

i

d

k i

il bl H

…

Beverages like tea bind dietary iron and make it unavailable. Hence

(24)

Vitamin

…

Normal diet to be wholesome and tasty should include

…

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

y

g

,

g

p

prevention of micronutrient malnutrition and certain chronic

disease.

…

Vegetables and fresh fruits are rich sources of

…

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

iron, vitamin C, folic acid, carotenoids and phytochemicals.

(25)

Folic acid

…

Folic acid is essential for the synthesis of

…

Folic acid is essential for the synthesis of

haemoglobin.

…

Folic acid deficiency leads to macrocytic anaemia.

y

y

…

Pregnant woman need more folic acid.

…

Folic acid supplements increase birth weight and

…

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

(26)

General dietary problem

y p

…

Nausea & vomiting

…

Nausea & vomiting

…

Constipation

…

Pica

…

Pica

(27)

Management of Morning Sickness

Management of Morning Sickness

…

Causes

†

Rapid rise of human chorionic gonadotropin

†

Rapid rise of human chorionic gonadotropin

(28)

Management Of Morning Sickness

Management Of Morning Sickness

…

Tips for controlling nausea

…

Tips for controlling nausea

†

Small frequent meals every 2 ½ - 3 hrs

†

Avoid strong / instant coffee

†

Avoid strong / instant coffee

†

Avoid fatty and spicy foods

†

Drink fluids between meals, not with meals

,

†

Take prenatal tablets as prescribed

(29)

Management Of Morning Sickness

Cont..

…

Approach to Decrease Pre-Meal Hypoglycemia and

…

Approach to Decrease Pre Meal Hypoglycemia and

Nausea

†

Decrease pre-meal insulin dosage

p

g

†

Shorten the insulin meal interval

†

Split insulin dose and food

p

(30)

Management Of Morning Sickness

Management Of Morning Sickness

Cont..

…

Precautionary Measures

†

Ad i d t

t j i b f

l

†

Advised tomato juice before a meal

†

Eat food when vomiting subsides

†

Check blood glucose levels frequently

†

Check blood glucose levels frequently

(31)

Warning sickness

g

…

Bleeding or leaking fluid from vagina

…

Blurry or impaired vision

…

Unusual or severe abdominal pain or backaches

…

Frequent severe and continuous headache

…

Frequent, severe, and continuous headache

…

Contractions

…

Decrease in baby’s movement

…

Dizziness

…

Excessive vomiting and diarrhea

…

Fever

…

Fever

…

Pain or burning with urination

(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

Ad

h

l

h d

f

2 3 h d

h d

…

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

p

…

Anaemia

…

Anaemia

…

Toxemia

…

Diabetes mellitus

…

Diabetes mellitus

(34)

Exercise during pregnancy

g p g

y

Consult a physician before exercise program

Exercise not safe under these conditions:

…

Preterm labor in current or past pregnancies

…

Vaginal bleeding

…

Vaginal bleeding

…

Cervical problems

…

Leaking of amniotic fluid

…

Shortness of breath

…

Dizziness and or fainting

…

Increased heart rate

…

Increased heart rate

…

Certain health problems such as hypertension and heart

(35)

Guidelines for working during pregnancy

Exposure

…

Metals

Effect

…

Birth defects,miscarriages

…

Solvents

…

Pharmaceutical agents

…

Fetal deformity

…

Miscarriage, low birth weight

d lf

ti

…

Infections

R di ti d di

ti

and malformation

…

Multiple problems

…

Fetal development and

…

Radiation and radioactive

…

Extreme heat

…

Fetal development and

miscarriage

…

Increase neural tube defects

(36)

Reflux during pregnancy

g p g

y

…

Avoid greasy and fried foods

g

y

…

Eat six to eight small needs instead of three large

meals

D ’t i

th

th

d d

t

f

…

Don’t gain more than the recommended amount of

weight

…

Take small sips of milk or eat small pieces of chipped

p

p

pp

ice to soothe burning

…

Eat slowly

A k

d t if

t k t id

di i

(37)

References

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