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.
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
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
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
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
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
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:
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
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
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
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
NUTRITION IN PREGNANCY
Madras Diabetes Research Foundation
&
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.
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
Additional food and extra care
To improve the birth weight
To improve the birth weight
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
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
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
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
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
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.
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
General dietary problem
y p
Nausea & vomiting
Nausea & vomiting
Constipation
Pica
Pica
Management of Morning Sickness
Management of Morning Sickness
Causes
Rapid rise of human chorionic gonadotropin
Rapid rise of human chorionic gonadotropin
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
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
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
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
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
Complications
p
Anaemia
Anaemia
Toxemia
Diabetes mellitus
Diabetes mellitus
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
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
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