Calories
                                         •   A calorie is a measure of how much energy a food 
                                             provides.
                                         •   Different types of foods have different caloric values:
                                               – 1 gm of fat provides 9 calories
                                               – 1 gm of carbohydrate (CHO) provides about 4 calories
                                               – 1 gm of protein provides 4 calories if used for energy
                                               – 1 gm of alcohol provides 7 calories
                                                                     Serving Size
                                         • 1 serving = 
                                               – 15 grams of Carbohydrate
                                               – 7 grams of Protein
                                               – 5 grams of Fat
                                                       1 Carbohydrate Serving
                                                     Food                                    Amount              Food Group
                                                     Bread                            1 slice                 Starch
                                                     Cereal (cooked)                  ½cup                    Starch
                                                     Cereal (unsweet, dry)            ¾cup                    Starch
                                                     Pasta                            1/3 cup                 Starch
                                                     Rice (white or brown)            1/3 cup                 Starch
                                                     Baked Beans                      1/3 cup                 Starch
                                                     Corn                             ½cup                    Starch
                                                     Mashed potato                    ½cup                    Starch
                                                     Banana                           4 oz (1/2)              Fruit
                                                     Apple/Orange juice               ½cup                    Fruit
                                                     Milk (Skim, 1, 2, 4%, Soy)       1 cup                   Milk
                                                     Sugar                            1 tbsp                  Sugar
                                                                                                                                                                                                                                                                                          1
                                                              1 Protein Serving
                                                Food                                                         Amount
                                                Poultry, beef, pork, lamb, veal, fish,       1 oz. (about 1 slice of packaged 
                                                shellfish                                    meat)
                                                Cottage cheese                               ¼cup
                                                Cheese                                       1 oz. (1 slice)
                                                Egg                                          #1
                                                Egg whites                                   #2
                                                Egg substitute                               ¼cup
                                                Tofu                                         ½cup (4 oz)
                                                                    1 Fat Serving
                                                      Food                               Amount               Type of fat
                                                      Avocado                      2 Tbsp (1oz)          MUFA
                                                      Canola, Olive, Peanut oil    1 tsp                 MUFA
                                                      Olives                       10 large              MUFA
                                                      Almonds, cashews             #6                    MUFA
                                                      Margarine (stick/tub)        1 tsp                 PUFA
                                                      Mayonnaise                   1 tsp                 PUFA
                                                      Corn, Safflower oil          1 tsp                 PUFA
                                                      Salad dressing               1 Tbsp                PUFA
                                                      Bacon                        1 slice               Saturated fat
                                                      Half and half                2 Tbsp                Saturated fat
                                                      Cream Cheese                 1 Tbsp                Saturated fat
                                                      Sour Cream                   2 Tbsp                Saturated fat
                                     What Are Expected Outcomes from MNT on 
                                                                 Glycemic Control?
                                     • ~2% decrease in A1C in newly diagnosed type 2 
                                         diabetes
                                     • ~1% decrease in A1C with an average 4-yr duration of 
                                         type 2 diabetes
                                     • ~1% decrease in A1C in newly diagnosed type 1 
                                         diabetes or by adjusting insulin dose to carbohydrate 
                                         intake
                                     • 50-100 mg/dl decrease in FPG
                                     •   Outcomes will be known by 6 weeks to 3 months.
                                     UKPDS. Metabolism 1990 
                                     Franz et al. J Am Diet Assoc 1995 
                                     Kulkarni et al. J Am Diet Assoc 1998 
                                     DAFNE Study Group. BMJ 2002
                                     Pastors et al. Diabetes Care 2002
                                                                                                                                                                                                                                                                                       2
                        What Are Expected Outcomes from 
                              Maximal MNT on Lipids?
                        • MNT reduces LDL cholesterol by 15– 25 mg/dl 
                           (12-16% decrease)
                        • Evaluate outcomes in 6 wks, if goals not met 
                           intensify MNT and evaluate again in 6 wks
                        • If LDL goal is not achieved by 3 months, 
                           consider adding drug therapy
                           American Heart Association task force on risk reduction. Circulation 95:1683, 1997
                           NCEP Adult Treatment Panel III. JAMA 285:2486, 2001
                      What Are Expected Outcomes from MNT 
                                   on Blood Pressure?
                    • Dietary intake of sodium: 2400 mg 
                       –In hypertensive pts: 5 mm Hg decrease in 
                         systolic BP and 2 mm Hg decrease
                       –In normotensive patients: 3 mm Hg decrease 
                         in systolic BP and 1 mm Hg diastolic
                    • Modest weight loss (as little as 1.8 kg) associated 
                       with 22 to 26% risk reduction in hypertension
                    • Measure BP at every medical visit
                       Cutler et al. Am J Clin Nutr 65(suppl 1):643S, 1997; Staessen et al. J Hyperten 7 
                       (Suppl):S19, 1989; Moore et al. Arch Intern Med 165:1298, 2005. 
                       Effectiveness: Lifestyle Modifications and 
                                        Hypertension
                    Modification         Approximate SBP Reduction
                    Weight reduction     5–10 mmHg/10 kg weight loss
                    DASH eating plan     8–14 mmHg
                    Sodium reduction     2–8 mmHg
                    (2400 mg)
                    Physical activity (30  4–9 mmHg
                    min/day)
                    Moderate alcohol (2  2–4 mmHg
                    drinks, men; 1 drink, 
                    women)
                       JNC 7, 2003
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                               Prioritizing Nutrition Recommendations for 
                                                       Type 2 Diabetes
                              •  “Diet” doesn’t fail—the beta cells of the pancreas fail
                              •  Modest amounts of weight loss (and physical activity) can 
                                 prevent or delay type 2 diabetes
                              •  For persons with type 2 diabetes, focus is on nutrition strategies 
                                 for normalization of blood glucose levels, lipids and blood 
                                 pressure
                                   – Start with glucose control as effects of lifestyle changes on glycemia are 
                                     seen immediately; it takes longer for lifestyle to impact on lipids and 
                                     blood pressure so these issues can be addressed in follow-up session 
                                   – Changes in HbA1c will be known by 6 weeks to 3 months
                              •  Carbohydrate counting is used to provide flexibility in food 
                                 choices
                                            What About Carbohydrate?
                             • Foods containing carbohydrate from whole grains, 
                                fruits, vegetables, and low-fat milk are important 
                                components and should be included in a healthy diet. 
                                (Level of evidence: A)
                             • Both the amount (grams) of carbohydrate as well as they 
                                type of carbohydrate in a food influence BG levels.  
                                 – Monitoring total grams of carbohydrate is the key strategy for 
                                    achieving glycemic control. (Level of evidence: A) 
                                 – The use of low glycemic index/load may be helpful as adjunct 
                                    for selected individuals. (Level of evidence: B) 
                                                 What About Sugars?
                              • Because sucrose does not increase glycemia to 
                                 a greater extent than isocaloric amounts of 
                                 starch, sucrose and sucrose-containing foods do 
                                 not need to be restricted by people with 
                                 diabetes, however, they should be substituted 
                                 for other CHO sources or if added covered with 
                                 insulin or other glucose lowering medication. 
                                 (Level of evidence: A)
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