实习二、糖尿病病人的食谱设计与计算_营养与食品卫生学

实习二、糖尿病病人的食谱设计与计算

㈠目的要求

1．目的：巩固理论课中关于营养食谱制定的原则、方法，加强对不同人群进行食谱设计与计算的能力。

2．要求：掌握食谱制定的原则，熟悉食谱编制方法，对不同疾病患者能熟练进行食谱设计与营养素计算。

㈡实习内容

1．理论复习：营养食谱制定、糖尿病营养治疗的基本内容。

2．食谱制定：糖尿病病人食谱的制定。

⑴病例：某女性，52岁，身高160cm，体重55kg，轻体力劳动，近感乏力、多饮、多尿，检查见空腹血糖9.15mmol/L，餐后2h血糖13.2mmol/L，血压、血脂及肝肾功能未见明显异常，编制其营养食谱。

⑵体型确定：计算患者的标准体重(kg)=身高（cm）－105，确定其体型（用BMI值判断）。

⑶确定一日能量需要：根据劳动强度、体型、年龄因素，以标准体重确定其平均每日能量供给量（表1）。

⑷计算三大产热（能）营养素供给量：根据热能系数和供能比例计算出产热（能）营养素一日供给量。

⑸食物总量（含零食）确定：根据表2确定一日各类食物总量及交换份数。

⑹餐次及用量安排：血糖控制不好、餐后血糖较高时宜少量多餐（加餐但不加量），病情一般则可3～4餐/d，要定时定量；确定每餐用量，如为3餐则能量安排为早餐25％，中餐40％，晚餐30％，点心5％。

⑺食物选择：按每份食物等值交换份表选择食物，应多选GI较低的食物。

⑻食谱的评价与调整：确定食谱后应评价其是否科学合理，如食谱中所含五大类食品是否齐全？食物种类是否多样化？食物重量是否合适？各营养素供给是否适宜？餐次安排及配比是否合理？如食谱设计中有不足之处则需要进行调整。

⑼饮食注意：对常见的糖尿病饮食误区给予说明与指导。

3．实习报告：完成一份糖尿病病人的食谱设计与计算分析的报告。

表1. 成年糖尿病患者每日能量供给参考量kJ(kcal)/kg

全英班实习指导

Practice Dietary Investigation

(一): Objective

Enforcing the objective, meanings, and methods of dietary investigation further, studying the common steps and methods of diet calculation, be able to grasp diet value and give appropriate mending suggestions.

（二）: Diet investigation

1. Retrospect the methods of diet investigation together with the students, involving quantifying method, audit method, retrospect method and chemical analogy method, and review their character, advantages and disadvantages, the applying scopes as well.

2. Every practiser retrospects all his intakes including the sorts, character and quantity within the last 24 hours.

（三）: Diet calculation

1. Calculating calories and nutrients of the food supplement.

（1）. The quantity of the intakes:

①. The student retrospected within 24 hours intakes;

②. Specifying recipes as followings:

Breakfast: a cup of fresh milk(about 150ml); a piece of steamed bread (about 100g flour contained)。

Lunch: rice (200g rice); sauting pork with celery: pork (thin) 50g, celery 250g; soy 10g; botanic oil 6g; salt 2g。

Supper: rice(200g rice); spinach bean curd soup: spinach 50g , bean curd 50g , botanic oil 3g , salt 2g ; fillet: fish 150g , shallot 5g , starch 2g , sugar 2g , soy 3g , vinegar 3g , ginger bits 1g , (2). Calculating method

1). Filling how many times you dine , the intakes quantity (referring to raw materials) in the table 1。

2). Looking into food component table , calculating the calories and nutrients in every intakes respectively . Food component table consists of nutrients contents per 100g , so, your intakes must be transferred first then filled the related data in the table 1.

3). Subtotal and sum total : ①Subtotal is defined as collecting all kinds nutrients respectively according every deal , especially for intakes calories ; ②Sum total indicates calculating the whole day calories and nutrients and filling in the blank for sum total;

(4). Protein nutrients value: ①Intakes is valued accounting for 10%-12% of total calories; ②Qualitive protein should no less than 1/3 of total calories , the ratio should be higher if the total intakes deficient.

(5). Vitamin and minerals nutrients value: according to RNI or AI

2. Suggestions: Pointing out the primary questions in the food supplement and bring forward valid measures for improving food supplement .(table 2, 3, 4 , 5)。