Introduction:
“Healthy eating lowers the risk of developing chronic medical diseases such as diabetes, hypertension and heart disease”. “Diet is the biggest risk factor”
The key concept to a healthy nutritional lifestyle is consuming a variety of different foods including 5 fruits and vegetables a day, alongside moderate daily exercise. Also considering the intake of potentially harmful foods such as foods which a high in salt and sugar and drinks such as alcohol, minimising the intake of these foods will help you live a healthy life. However individuals who have a high intake of foods rich in salt, sugar and fat, drinking excessive amounts of alcohol have a greater chance of developing chronic diseases which have a direct like to obesity. Diabetes Militias is a disease which is common in individuals who suffer from obesity their lifestyle factors associate closely with the development of the disease.
Diabetes Militias is a metabolic disease which effects the production of insulin in the body. The disorder is quickly becoming prevalent worldwide and casing a worldwide epidemic (Abdulfatai B Olokoba, 2012). The disease can be associated with hyperglycaemia which is very high in patients who suffer with type 2 diabetes (A.Ramachandran, 2014), hyperglycaemia is the medical term for high glucose levels( NHS England 2012) this indicates that body is unable to produce insulin or unable to use insulin in the correct method.
Diabetes can be recognised as a heterogeneous and complex disease which effects people across the population at many different stages of life (Sobha Sivaprased, 2017). Type 1 diabetes refers to a genetic disease, whereas the onset for type 2 diabetes is obesity and unhealthy lifestyles, currently type 2 diabetes affects more than 2.6 million people and is on the rise (Bassett, 2005)Patients who suffer with type 2 diabetes will encounter macrovascular and microvascular complications which will lead to physical and psychological distress (Sudesna Chatterjee, 2017) hence there is a link between type 2 diabetes and depression (Square, 2016).
Type 2 diabetes which is also known as non-insulin depended develops due to the body becoming unable to respond to the action of insulin which is produced by the pancreas {add reference here} and is illustrated as metabolic syndrome (Abdulfatai B Olokoba, 2012). Currently studies have shown that around 366 million people have Diabetes Mellitus, with around 80% having type 2 (Abdulfatai B Olokoba, 2012). This indicates that diabetes is a worldwide medical issue which needs to be resolved as the incidence of diabetes will carry on increasing. The cause of type 2 diabetes links primary to lifestyle factors (Abdulfatai B Olokoba, 2012), one of the treatments include to eat a healthier more balanced diet which includes 5 fruits and vegetables as well as 2 litres of water which equates to around 11 cups and carry out daily moderate exercise.
Also to prevent the patient from experiencing symptoms of type 2 diabetes she has been provided with a new diet which is high in carbohydrates and low in fat intake, this will improve her health so that she can control the diabetes, as there is currently no cure for diabetes. You can manage the symptoms which will control the blood glucose level, patients would be advised to consume high fibre food, whole grains and fruit and vegetables, told to monitor blood sugar as well as regular exercise. Diet plays a role in the management of type 2 diabetes as a healthier diet and lifestyle will prevent the development of type 2 diabetes (L, 2009). A diet which is high in fat will increase calorie intake, taking in more calories will increase weight which after a period of time will cause the development of obesity. Body mass causes the onset of insulin resistance which is the cells not responding to insulin, thus the pancreas increases the production of insulin so that glucose can enter cells (Abdullah S Al- Goblan, 2014). Therefore it is vital that a healthy diet which is high in fibre, fruits and vegetables is emphasized in patients with diabetes militias.
The aim of the case study is to understand the effects diet has on type 2 diabetes and what can be done to help improve lifestyle for someone who suffers with the disease. The importance of the study is to understand the role a healthy diet plays in preventing the onset of vigorous life threating diseases.
Method:
A 3 day plan was recorded for a 40 year old women which included her food intake for 3 meals that were breakfast, lunch and dinner. Breakfast was eaten at 8am for the 3 days, lunch was eaten at 12pm and diner was eaten at 7pm, she also consumed 2 bottles of 500 ml water and on the third day she drank 2 cans of beer and 20 ml spirit. Diet plan 6 was used to analyse her dietary components from the software a dietary assay was produced.
Her 3 day meal record was provided for (see appendix A) which was then placed into the diet plan 6 software where her dietary components were generated and results were used to create her assay. Using the eat well plate and the diet plan software an ideal healthier diet has been recommended for the women who suffers type 2 diabetes to ensure her energy requirements were meet for a women of her age and suffering with her condition.
Fig1: The software programme layout is shown, the patients data was entered (height and weight) this is key as this information will be used to generate the patients nutrients and energy intakes from the foods that she consumes over the course of the 3 days. Once this information has been entered, the next stage would be entering in the patient’s food intake. Also so that you can access the analysis at any time to modify and adjust it is vital that you input your registration number so that the data can be found when needed.
Fig 2: An example of how the meals were inserted onto the software can be seen by figure 2. You can see that there were 3 meals breakfast, lunch and dinner. This was carried out for the course of the 3 days and the amount of each food which was consumed has been added too. This information had then generated graphs and tables which will be very important when analysing the patient’s nutrient intake and suggesting a healthier diet for her.
Results:
Table 1: Table showing analysis of selected nutrients for original diet
The table shows the analysis of nutrients from the patient’s original diet and RDA was shown for some nutrients as well. The patient had a high energy intake of 9660 which per day was 3220 and per meal was 1073, her fat intake was high (416.2). Also the table shows that comparing her nutrient intake with the recommend daily allowance the patient had been getting a higher intake than she actually needed ie for potassium the RDA is 2000 whereas the women was in taking 5363 per day which shows her intake was well above the daily recommended allowance.
Table 1- Nutrient analysis for original diet
Nutrient
Unit
Intake
Per day
RDA
Per meal
Edible proportion
0.98 m
0.98
0.98
Water
g
60.96.0
2032.0
677.3
Total nitrogen
g
96.92 e
32.31
10.77
Protein
g
589.8
196.6
65.5
Fat
g
416.2
138.7
46.2
Available Carbohydrate (mse)
g
886.5
295.5
98.5
Energy
kcal
9660
3220
1073
Energy
kJ
40479
13493
4498
Starch(mse)
g
710.8 m
236.9
79.0
Total sugars(mse)
g
175.3 m
58.4
19.5
Non-milk extrinsic sugars
g
18.7 m
6.2
2.1
Glucose
g
15.6 m
5.2
1.7
Fructose
g
22.7 m
7.6
2.5
Sucrose(mse)
g
103.9 m
34.6
11.5
Maltose (mse)
g
10.8 m
34.6
1.2
Lactose (mse)
g
6.2 m
2.1
0.7
Non-starch polysaccharides
g
28.9 m
9.6
3.2
Total dietary fibre ( AOAC method)
g
37.7 m
12.6
4.2
Saturated fatty acids
g
123.8 m
41.3
13.8
Mono-unsaturated fatty acids
g
146.2 m
48.7
16.2
Poly-unsaturated fatty acids
g
74.3
24.8
8.3
Total trans fatty acids
g
12.54
4.18
1.39
Cholesterol
mg
2941.9 m
980.6
326.9
Sodium (Na)
mg
7780 m
2593
864
Potassium (K)
mg
16088 m
5363
2000
1788
Calcium (Ca)
mg
2376 m
792
800
264
Magnesium (Mg)
mg
1626 m
542
375
181
Phosphorus (P)
mg
7708 m
2569
700
856
Iron (Fe)
mg
59.90 m
19.97
14.00
6.66
Copper (Cu)
mg
6.12 m
2.04
1.00
0.68
Zinc (Zn)
mg
57.11 m
19.04
10.00
6.35
Chloride (Cl)
mg
10808 m
3603
800
1201
Manganese (Mn)
mg
13.26 m
4.42
2.00
1.47
Selenium (Se)
ug
374.5 m
124.8
55.0
41.6
Iodine (I)
ug
680.9
227.0
150.0
75.7
Retinol
ug
1630 m
543
181
Carotene
ug
18084 m
6028
2009
Vitamin D
ug
43.76 m
14.59
5.00
4.86
Vitamin E
mg
46.44 m
15.8
12.00
5.16
Thiamin
mg
7.11 m
2.37
1.10
0.79
Riboflavin
mg
6.51 m
2.17
1.40
0.72
Niacin
mg
168.16 m
56.05
16.00
18.68
Tryptophan divided by 60
mg
110.254 m
36.751
12.250
Vitamin B6
mg
10.44 m
3.48
1.40
1.16
Vitamin B12
ug
47.9 m
16.0
2.5
5.3
Total Folate
ug
788 m
263
200
88
Pantothenic acid
mg
26.58 m
8.86
6.00
2.95
Biotin
ug
258.4 m
86.1
50.0
28.7
Vitamin C
mg
151 m
50
80
17
Key:
E- Value estimated
M- Missing value
Table 2: Showing analysis of selected nutrients for new diet
The table shows the analysis of nutrients for the suggested diet and RDA was shown for some key nutrients. The energy intake for the new diet is 1393 which was for the course of 3 meals. The fat intake for this diet is 38.2 and the carbohydrate intake was 187.0 suggesting that the new diet is better than her previous one. Also from the RDA it shows that the nutrient intakes were within the recommend daily allowance or they weren’t very high for example for potassium the RDA is 2000 and the intake for the new diet was 2048.
Table 2- Nutrient analysis for suggested/ new diet
Nutrient
Unit
Intake
Per day
RDA
Per meal
Edible proportion
0.98
0.98
0.98
Water
g
1288.0 m
1288.0
429.3
Total nitrogen
g
13.76 e
13.76
429.3
Protein
g
85.2
85.2
28.4
Fat
g
38.2
38.2
12.7
Available Carbohydrate (mse)
g
187.0 e
187.0
62.3
Energy
kcal
1393
1393
464
Energy
kJ
5867
5867
1956
Starch(mse)
g
81.5 m
81.5
27.2
Total sugars(mse)
g
41.9 m
41.9
14.0
Non-milk extrinsic sugars
g
13.9 m
13.9
4.6
Glucose
g
9.8 m
9.8
3.3
Fructose
g
11.7 m
11.7
3.9
Sucrose(mse)
g
19.3 m
19.3
6.4
Maltose (mse)
g
Lactose (mse)
g
0.7 m
0.7
0.2
Non-starch polysaccharides
g
9.3 m
9.3
3.1
Total dietary fibre ( AOAC method)
g
12.4
12.4
4.1
Saturated fatty acids
g
4.6 m
4.6
1.5
Mono-unsaturated fatty acids
g
6.9 m
6.9
2.3
Poly-unsaturated fatty acids
g
8.2 m
8.2
2.7
Total trans fatty acids
g
0.08 m
0.08
0.03
Cholesterol
mg
139.1 m
139.1
46.4
Sodium (Na)
mg
1912 m
1912
637
Potassium (K)
mg
2048
2048
2000
683181
Calcium (Ca)
mg
181 m
181
800
60
Magnesium (Mg)
mg
230 m
230
375
77
Phosphorus (P)
mg
1251 m
1251
700
417
Iron (Fe)
mg
7.47 m
7.47
14.00
2.49
Copper (Cu)
mg
0.67 m
0.67
1.00
0.22
Zinc (Zn)
mg
5.70 m
5.70
10.00
1.90
Chloride (Cl)
mg
2592 m
2592
800
864
Manganese (Mn)
mg
4.18m
4.18
2.00
1.39
Selenium (Se)
ug
79.6 m
79.6
55.0
26.5
Iodine (I)
ug
47.4 m
47.4
150.0
15.8
Retinol
ug
52 m
52
17
Carotene
ug
751 m
751
250
Vitamin D
ug
7.62 m
7.61
5.00
2.54
Vitamin E
mg
7.99m
7.99
12.00
2.66
Thiamin
mg
0.91 m
0.91
1.10
0.30
Riboflavin
mg
0.72 m
0.72
1.40
0.24
Niacin
mg
29.63 m
29.63
16.00
9.88
Tryptophan divided by 60
mg
14.565m
14.565
4.855
Vitamin B6
mg
1.53 m
1.53
1.40
0.51
Vitamin B12
ug
4.2 m
4.2
2.5
1.4
Total Folate
ug
129 m
129
200
43
Pantothenic acid
mg
3.49
3.49
6.00
1.16
Biotin
ug
25.6
25.6
50.0
8.5
Vitamin C
mg
86 m
86
80
29
Key:
E- Value estimated
M- Missing value
Table 3: Table showing source energy from original diet
The table shows the sources of energy from the original diet. Most of the calories had come from the fat that was consumed in the patient’s diet as the calories from fat were 3746 and this is where she had gained most of her energy from as fat gave her an energy source of 1249 per day which equates to 38%.
Calories from
Total
Per day
Per 100g
Percent (%)
UK Food (%)
UK Total (%)
Protein
2359
786
28
24.4
15
15
Carbohydrate
3324
1108
39
34.4
50
47
Fat
3746
1249
44
38.8
35
33
Alcohol
146
49
2
1.5
5
Fibre
75m
25
1
0.8
Total
9651m
3217
115
100.0
100%
100%
Table 4: Table showing energy source from suggested diet
The table shows the sources of energy from the suggested/ new diet. Most of the calories would come from the carbohydrates that would be consumed, the calories from the carbohydrates is 701 whereas fat is only 344, she would be gaining most of her energy from the carbohydrates which will be 234 which would equate to 49.7 of energy gained from carbohydrates compared to the rest of the nutrients.
Calories from
Total
Per day
Per 100g
Percent (%)
UK Food (%)
UK Total (%)
Protein
341
114
20
24.1
15
15
Carbohydrate
701
234
41
49.7
50
47
Fat
344
115
20
24.4
35
33
Alcohol
0
0
0
0.0
5
Fibre
25
8
1
1.8
Total
1411
470
83
100.0
100%
100%
Graph 1: Graph showing nutrient intake as percentage of RDA
Fig 3: The graph shows the amount of nutrients the patient was consuming as a percentage of RDA. From the graph it shows that chloride had the highest consumption of nutrients per RDA which was 450% and calcium which was the lowest at 99%.
Fig 4: The graph is a continuation from figure 3(graph 1). Vitamin C had the lowest intake which was 63% and vitamin B12 had the highest which was 639%.
Graph 2: Pie chart showing nutrient contribution to energy for her original diet
Fig 5: The pie chart shows the nutrients that gave the patient the most amount of energy where starch at 27.6%, protein and 24.4% and saturated fat at 11.5%. Thus showing the patient got most of her energy from starch.
Graph 3: Pie chart showing nutrient contribution to energy for her new/suggested diet
Fig 6: The pie chart shows the nutrients that gave the most energy were starch and protein, protein at 24.1% and starch at 21.1%, most of the energy had come from the protein which would be consumed.
Graph 4: Bar chart showing the sources of enegry intake from nutreints conusmed per day and per 100 grams for original diet
Fig 7: The bar chart shows that the patient had gained most of her energy from fats and the least from fibres, she had not consumed any fibres in her diet for the 3 days.
Graph 5: Bar chart showing the sources of enegry intake from nutreints conusmed per day and per 100 grams for suggested/new diet
Fig 8: The bar chart shows that the patient would gain most of her energy from carbohydrates and the least from alcohol as no alcohol would be consumed.
Figure 9: Calculation to show total energy expenditure by patient and extra energy intake:
Energy expenditure via daily activity = 1200 calories/day
Womens BMR = 65.6 + (9.6 x weight in kg) + (1.7 x height in centimetre) – (4.7 x age in years)
= 65.6 + (9.6 x 109) + (1.7 x 172) – (4.7 x 40)
= 65.6 + 1046.4 + 292.4 – 188
= 1216.4
Total energy intake per day = 3217 kcalories/ day (gained from table 3)
10% of total intake = 3217 – 10% = 321.7 k calories/day
Total energy expenditure by patient = energy expenditure via daily actvivity + BMR + 10% of total intake
= 1200 + 1216.4 + 321.7
= 2738.1 kcalories
Extra energy intake of patient = Total energy intake per day – total energy expenditure by patient
= 3217 kcalories – 2738.1 kcalories
= 478.9 calories
Discussion:
From the dietary analysis carried out on my diet plan software the original diet that the patient was consuming very high amounts of fats and proteins she had a nutrient intake on fat of 416.2 and protein intake of 589.9 (see table 1) which suggests that her diet was the main cause of the development type 2 diabetes this is supported by (Julie A, 2002) who conducted an animal study and found there is a link between impaired insulin action and high fat diets (Julie A, 2002). This is also supported by (Kinsell, 1959) who were one of the first to find a connection between fat consumption and insulin action. Therefore the new diet/ suggested diet will include less fats and protein and more carbohydrates this will control the patients symptoms of diabetes, as there is no cure patients are advised to eat healthier. This change can be seen in table 2 were the carbohydrate intake was the greatest at 187.0 whereas fat intake is 38.2. Also table 1 shows that for most nutrient the patient was consuming more than the recommended daily allowance (RDA) is, this can be toxic can cause damage to the organs for example from table 1 the patient had a high intake of potassium which was 5363 when the RDA was only 2000, therefore this can lead to hyperkalaemia which is high levels of potassium in the blood, this is a life threating disease (Lehnhardt, 2011).
Moreover as the diet is high in fat and protein implies that the energy will generally be high as protein and fats are high sources of energy, table 3 shows that the patient had an intake of 3217kcal of energy however the daily intake for women is 2000, therefore too much energy can lead to feelings of anxiety, palpitations and high blood pressure which can lead to heart attacks and heart disease as she has too much energy. Therefore the fat will build up in her blood the substances which are found in blood from fatty foods are triglycerides and cholesterols, if you have high amounts of these lipids in your blood it can cause heart attacks, thus the more fat you eat the greater the chances are for you to develop a heart attack. From graphs 4 and 5 you can clearly see her energy intakes and what food causes her to have higher energy intakes, thus from graph 5 you can see that the change in her diet has also changed her energy intakes as the fat ha reduced. Consequently it is very important for someone who already has type 2 diabetes and is obese to change or control their diet so that they do not develop high blood lipids thus the new diet for the patient had a daily energy intake of 470 per day. Comparing the patient’s energy percentages to the UK Food % you can see that her percentages for protein and fat were higher than then UK food percentages (see table 3). From table 4 you can see that the percentages were similar or lower than the UK food percentages thus showing that the new/ suggested diet will help improve the patients help and control her symptoms.
Graph one shows the RDA intakes for the nutrients that she was eating, we can see that her intake for vitamin B12 was very high, she had a percentage of 639% which shows that comparing her intake to the RDA it is too high and not needed, therefore showing that her original diet has been giving her a high intake of nutrients that she didn’t need or that aren’t as important as others, for example vitamin C is more important than V B12, yet her intake was only 63% for vitamin C thus implying that the nutrients that her body needed more off she was not getting, therefore when creating her new diet plan this factor was taken into consideration ( see appendix 1). Graph 2 shows that the patient was had high intakes of starch but she was also eating foods that would cause her symptoms to become worse for example she had consumed alcohol and saturated fats and mono unsaturated fats thus causing her blood sugar levels to increase therefore the inulin in her body will become impaired as the patient is continuing to eat food which is harmful to her. Graph 3 shows that the patient had an intake of all the key nutrients she needed including fibres which she lacked from her original diet and her intake of sugars and fats were greatly reduced and she had no consumption of alcohol.
Figure 9 shows that the patient had an extra calorie intake of 478.9 calories and for someone with type 2 diabetes this can be very harmful as extra food intakes leads to fat built up which in turn causes the onset of diseases such as heart disease and can lead to heart failure as the blood lipids will become blocked and if the blood cannot move around the body freely it will lead to blood clots which lead to heart attacks. In conclusion it is very important to control fat intake and reduce the intake if you have to especially for someone such as the patient in the case study who suffers type 2 diabetes.
References
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