DIET COUNSELLING

Nutrition plays an important role in health of an individual. Problem arises when the choice

of food and nutrition are not taken wisely thus leading to a risk of diseases. Impact of disease

is only visible after a lengthy exposure to wrong practices in lifestyle nutrition, until then they

are hidden from the time of entry of the disease.

Life of a human starts with one cell developing in mother’s womb. Health of that cell as

a future adult depends on nutrition before and after conception, before and after delivery. If it

is a female child, it’s all the more essential to build her health because she passes health or ill

health to the next generations. Considering importance of health of a population at large, diet

counselling is a key to prevention and cure for the diseases. Diet counselling is a factor of

promoting healthy eating habits as well as the process of applying scientific knowledge about

diet and health to an individual’s dietary behaviour to improve health literacy.

Main factors included in Diet Counselling are: -

[Link] of the patient’s knowledge regarding his/her

a) Health issues b) Past learnt information

2. Comprehend meaning

3. Application of information

4. Analysis the information and its result

5. Improving on modification/synthesizing

6. Evaluations
CHARACTERISTICS OF GOOD DIET COUNSELLOR: -

 Thorough knowledge about the diseases, foods, its preparation patterns, nutrients, its

requirements for individual and drug-nutrient interaction.

 Open style communication

 Unconditional acceptance of the patient (patient centred approach)

 Sincerity, non-defensive, good listening skills

 Empathetic

 Good in motivational interviewing and decision making

 Balancing for lifestyle changes

 Understands ‘applicable’ constraints from patient’s point of view.

 Recommends alternatives, practical/effective solutions for barriers/resistance

 Use of models, leaflets, other educational techniques suitable to patient

 Treat an individual rather than a disease.

If needed Dietitian must approach medical practitioners to emphasize importance of

nutritional aspects in overall treatment of an individual patient.

Diet counselling is a science as well an art. Being scientific person dietitian/nutritionist

should be able to successfully treat on individual patient which may lead to achievement of

higher quality of life and optimal health.

The nutrition care process is complete only with a complete nutritional assessment and

determination of nutrition needs. A review of current literature still demonstrates several

equations and methods to determine and recommendations for interventions are all key steps

in the process.

Anthropometrics: Anthropometric measurements are a series of quantitative measurements

of the muscle, bone, and adipose tissue used to assess the composition of the body. The core

elements of anthropometry are height, weight, body mass index (BMI), body circumferences

(waist, hip, and limbs), and skinfold thickness. These measurements are important because

they represent diagnostic criteria for obesity, which significantly increases the risk for

conditions such as cardiovascular disease, hypertension, diabetes mellitus, and many more.

There is further utility as a measure of nutritional status in children and pregnant women.

Additionally, anthropometric measurements can be used as a baseline for physical fitness and

to measure the progress of fitness.

Ideal body weight (IBW)

IBW (in kgs) = Height (in cms) - 100

Obesity adjustment: Adjusted ideal body weight (AIRW)

AIBW = (Actual body weight - IBW) × 0.25 × IBW

BMI Classification: Best Measure(s) for diagnosis of obesity

Normal BMI: 18.0-22.9kg/m2

Overweight: 23.0-24.9kg/m2

Obesity: >25kg/m2

Waist circumference: should be used as a measure of abdominal obesity with Asian Indian
Specific cut offs.
 ESTIMATION OF NUTRIENT NEEDS

1. Recommend Calorie intake based on body weight: -

Shortcut method for estimating adult energy needs per kilograms (kcals required)

The calculated calorie requirement should allow to lose or gain weight as required and

maintain body weight 10% lower that the ideal/desirable body weight.

If at ideal weight
Recommended calorie allowance: 30kcal/[Link] weight/day

If underweight (20% below IBW)

If overweight (20% above IBW)

To note -Diets below 1200kcal for women and 1400kcal for men are not prescribed.

2. Recommended protein needs:

The recommended safe protein intake at different ages is given per kg body weight as well as

total requirement for a normal individual.

-Use actual weight in estimating protein needs

-Total daily requirement recommended for normal population is 1.0gm/kg/body weight

3. Recommended dietary fats: -

The minimal visible fat intake: 20g/person/day (15-20% of energy intake)

- A Range of carbs from whole grains/legumes fruits/vegetables = 55% of energy

-Simple sugars < 10% of energy

-Dietary fiber : 40g/2000kcal diet

5. Vitamins and Minerals: -

The RDAs for Indian based on the age group and physiological condition needs to be
included.

6. Adult Fluid Requirements: -

Hydration status as a part of nutritional status is often overlooked. This can affect

interpretation of biochemical measurements, anthropometry, and the physical exam.

Assessment of hydration is quick and easy and should include assessment of fluid intake.

Method I :
Wt(kg) × 30ml = Daily fluid requirements
Fluid requirements may differ for those clients with cardiac problems, renal failure,
dehydration or for those requiring fluid restrictions.

Method II :
-100ml/kg for 1st ten kg body weight
-50ml/kg for 2nd ten kg body weight
-15ml/kg for remaining kg body weight.

Shortcut method :
(kg body weight -20) × 15 + 1500 = ml fluid requirement

Basic Food Group in a Balanced Diet :-

The standard position sizes for normal adults as per RDA for Indians (NIN, ICMR, 2017) to

be used as a ready reckoner for calculation of allowance for each food groups.
 STEPS OF PLANNING DIET

 Identify the individual and his/her specific characteristics

 Age

 Sex

 Activity level

 Income

 Socio economic background

 Religion

 Religion residing

 Consult RDI

 Decide on total exchange for each group

 Decide on the meal pattern and distribute the above selected exchange according to

meal pattern

 Decide on the menu

 Select approximately quantities for each dish as per the exchange available and

calculate the nutrient content for detailed diet plan

 Compare the amount of nutrient provided through detailed menu plan with the RDI
 FOOD GROUPS

Foods have been classified into different groups depending upon the nutrient value for the
convenience of planning meals. “Food Group” like “Basic Flours”. “Basic five or Basic
seven” can be used for planning meals as per convenience.
FOOD GROUPS:
CEREAL AND GRAIN PRODUCT:
o Rice, Wheat, Ragi, Bajra, Maize, Jowar, Barley, Rice flakes, Wheat flour.
o MAIN NUTRIENTS: Energy, Protein, Invisible fat, Vit B1, B2, Folic acid, Iron, Fibre
PULSES AND LEGUMES:
o Bengal gram, Black gram, Green gram, Red gram, Lentil, Cow pea, Rajma, Peas,
Soybeans
o MAIN NUTRIENTS: Energy, Protein, Invisible fats, Vitamin B1, B2, Folic acid, calcium,
Iron, Fibre
MILK AND MEAT PRODUCTS:
o Milk, Curd, Skimmed milk, Cheese, Meat, Chicken, Liver, Fish, Egg
o MAIN NUTRIENTS: Protein, Fat, Vitamin B2, Calcium
FRUITS AND VEGETABLES:
o Fruits – Mango, Guava, Tomato, Papaya, Orange, Lemon, Watermelon
o MAIN NUTRIENTS: Carotenoid, Vitamin C, Fibre.
o Vegetables – Amaranth, Spinach, Drumstick, Fenugreek leaves, other vegetable – Carrot,
Brinjal, Lady’s finger, Capsicum, Beans, Cauliflower.
o MAIN NUTRIENTS: Invisible fat, Carotenoid, Vitamin B2, Folic acid, Iron, Calcium,
Fibre, Carotenoids, Folic acid, Calcium, Fibre
FATS AND SUGAR:
o Fats, Butter, Ghee, Hydrogenated oil, Cooking oil, Groundnut and Coconut oil
o MAIN NUTRIENTS: Energy, Fat, Essential fatty acids
o Sugar – Sugar, Jaggery; MAIN NUTRIENTS: Energy
 WEIGHTS AND MEASUREMENTS

 Current proportion of ingredient contribute to success in the preparation of number of food

product. These proportion are best achieved when measuring or weighing of each

individual ingredient in a recipe is done accurately and consistently.

 Use of metric system will affect food preparation generally by encouraging the weighing

in grams or kg of solid ingredient and measuring in ml of liquids.

 The volume of chopped foods such as mixed pieces of onions will also vary depending

upon the fineness and uniformity of chopping.

 The standard measuring cup is equal to approximately 237ml subdivision are marked on

majorly of cups for measuring of ¼, ½, ¾, 1/3, 2/3 cup.

 The measuring of cups does not show small division.

 In measuring liquids, a cup that extends about the largest measure mark should be used.

 The cup is placed on a flat surface and filled to the measure mark.

 The eye should be at the measure mark level when reading the contents.