what is Nutrition Therapy In Gestational Diabetes ?

Nutrition Therapy for a woman in Gestational Diabetes  

Body Mass Index (BMI)

Use pre pregnancy weight for calculations

Weight and height measurements to calculate BMI:

BMI = weight in kg/(height in m)2

Standard BMI normograms

 

	Asian	ADA norms
Underweight		<18.5 kg/m2
Normal BMI	18.0-22.9 kg/m2	18.5-24.9 kg/m2
Overweight	23.0-24.9 kg/m2	25.0-29.9 kg/m2
Obesity	>25 kg/m2	> 30 kg/m2

Composition of Food and Drinks

 Macro-nutrients

• protein
• carbohydrates
• fats

 Micro-nutrients

• vitamins
• minerals

 

• Nutrient	% of daily calorie intake
  Carbohydrates	45-65%
  Fats	20-35%
  Protein	10-35%

Proteins

• Provide amino acids
• Help to build muscle mass
• Animal sources
• Plant sources
• 1 g of protein gives 4 kcal energy

Protein Recommendations

• 1.1 g protein per kg bodyweight per day
• 10-35% of total energy per day
• Animal protein often high in fat, especially saturated.
• Attention must be paid to meeting the protein requirements of women who are vegetarians or vegans

Carbohydrates

• Provide main source of energy for the body (45-65%) – individualized
• Nutrient that most influences blood glucose levels
• Source of simple sugars – glucose, fructose
• 1 g of carbohydrate provides 4 kcal

Carbohydrates And Meal Planning

• Amount and source of carbohydrates is considered when planning meals
• Recommended source of carbohydrates is mainly from

-whole grains: wheat, rice, pasta, bread, rice, wheat, barley, oats, maize and corn

-legumes, beans, pulses (bengal gram, black gram, rajma)

-fruit and vegetables

-milk

Carbohydrate (CHO) content of common foods

Food	Amount	Serving	CHO (g)
Bread, whole wheat	28 g	1 slice	11
Rice (cooked)	75 g	0.3 cup	13
Pasta	125 mL	0.5 cup	16
Chappati	44 g	1 small	19
Corn meal	45 mL	3 tbsps	16
Potato	84 g	1 small	15
Couscous, cooked	125 mL	0.5 cup	17
Lentils	250 mL	1 cup	15
Banana	101 g	1 small	20

Benefits of Fibre

A high-fibre diet is healthy

Mixture of soluble and insoluble fibre

-slows absorption of glucose

-reduces absorption of dietary fats

-retains water to soften stool

-may reduce the risk of colon cancer

-may reduce the risk of heart disease

 

   Fibre Recommendations

Recommended amounts of total fibre : 28 g per day

Sources of insoluble fibre include: wheat bran, whole grains, seeds, fruits and vegetables

Sources of soluble fibre: legumes (beans), oat bran, barley, apples, citrus fruits

Glycaemic Index (GI)

Ranks carbohydrate-rich foods according to the increase in blood glucose levels they cause in comparison with a standard food (white bread/glucose).

Factors Affecting the Glycaemic Index

Type of sugar

-glucose, fructose, galactose

Nature of starch

-amylose, amylopectin

Starch-nutrient interactions

-resistant starch

Cooking/food processing

Glycaemic Index of Foods

Low glycaemic index foods	Intermediate glycaemic index	High glycaemic index
Oats	Multigrain bread	White Bread
Lentils/dhal	Some rice (long grain)	White Rice
Yogurt	Pasta	Processed breakfast cereal
Milk	Bananas	Glucose
Most Fruits and vegetables	Grapes	Mashed and baked potatoes

 

Vitamins

• Organic substances present in very small amounts in food
• Essential to good health
• A balanced meal automatically provides all necessary vitamins
• Either fat-soluble or water-soluble
• In some countries foods are “fortified” with vitamins and minerals

Vitamin  Recommendations

Daily multivitamin supplement should be added as they are often not met by diet alone.

Multivitamin content varies depending on the product used.

Women at higher risk for dietary deficiencies include  multiple gestation, heavy smokers, adolescents, complete vegetarians, substance abusers, and women with lactase deficiency.

Minerals

• Substance present in bones, teeth, soft tissue, muscle, blood and nerve cells
• Help maintain physiological processes, strengthen skeletal structures, preserve heart and brain function and muscle and nerve systems
• Act as a catalyst to essential enzymatic reactions
• Low levels of minerals puts stress on essential life functions

Sodium Recommendations

• Most people consume too much salt
• Sodium restriction may be advised in case of uncontrolled hypertension and edema
• Targets for daily sodium intake

Age	Adequate Intake (mg/day)	Upper limit (mg/day)
14-50	1500	2300
51-70	1300	2300
over 70	1200	2300

 

Lowering Salt Intake

• Sodium content is often high in restaurant foods

 

• Encourage meal plans with
• more fresh foods – fruits and vegetable
• less processed, fast, convenience or canned foods
• herbs and spices used when cooking instead of salt.
• Teach people to read food labels
• Choose salt free, reduced or low in sodium foods

 

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