Está en la página 1de 49

By Musfira Anjum

3 rd year
 Lifestyle such as hypertension, diabetes cardiovascular
diseases, behavioural problems, high cholesterol, obesity,
are becoming the major public health problems.
 These are called lifestyle disorder because they are limited
to people who adopt unhealthy and inappropriate lifestyles.
 According to the National Family Health Survey, 13 percent
of women and 9 percent of men in India are overweight or
obese. Obesity increases the chance of other lifestyle
 Death rate due to ischemic heart disease in India is
165.8 per 100,000 population. Around 116.4 per 100,
000 people in India die due to cerebro-vascular
diseases. Cardiovascular disease is the leading cause of
death among males as well as females.
 Lifestyle disorders are due to choices that people make
in their life. The good news is that most of the lifestyle
disorders are preventable and many are even
Management of lifestyle disorder
 The management of lifestyle disorder usually involves
a shift from unhealthy lifestyle to a healthy one.
 Few basic changes include quitting smoking, avoiding
alcohol, having a balanced diet that includes fresh
vegetables and fruits, regular physical activity and
leading a stress-free life.
 An expert consultation, early diagnosis, change in
lifestyle and medication specific to the underlying
diseases are very important in lifestyle disorders.
 Generalized accumulation of excess fat in the body.
 There is excessive weight gain in the body.
 10% to 20% above ideal or optimal weight is termed
 It is one of the most important public health problem
Ideal or desirable body weight
 Desirable range corresponds closely to the range of
quetelet’s index(QI) also known as body mass index
 BMI = weight in kg/ height in m2
 20 - 24.9 = desirable range
 25 – 29.9 = overweight
 ˃30 = obese
 ˃40 = very obese
Types of obesity:
 Based on fat distribution:
 Upper body obesity
 Men – nape of neck, shoulders, and abdomen
 women – waist , chest and arms
 High waist hip ratio
 Fat cells may be normal in number but are larger
 Greater risk of heart disease and diabetes
 Lower body obesity
 hips and thighs
 No risk for diabetes
 Finds difficulty in losing weight
 Fat cells greater in number but of normal size
 Based on onset:
 Recent obesity(adult onset):
 failure to adjust eating habits with age
 Quite responsive to treatment
 Long term obesity or developmental obesity(juvenile
 Early infancy and between 5 to 7 years of age.
 Overweight at age 7 should be managed by a very
modest restriction of energy intake in order to achieve
a normal weight for height at age 12 years
 If not managed and child becomes adult then this type
of obesity tends to be very resistant to treatement.
 Reactive obesity:
 Weight gain following a traumatic emotional
 May appear at any time of life
 Over eating to escape from problems
 Treatment involves psychological approach
 Obesity secondary to another condition:
 Metabolic disorders( hypothyroidism and praeder willi
1)Excessive calorie consumption
 Excessive intake of food
 Not only the quantity of food but also the quality of
food(i.e. its calorie equivalent)
 For example 100g of cucumber provides 16kcal but
the same amount of roasted groundnut provide
 Other examples : bread, butter, cheese and sweets
 Excess calorie accumulates as adipose tissues.
2.Reduced energy output
 less physical work and lack of exercise.
 When physical activities are reduced food
consumption must be reduced.
 but consumption pattern remains unchanged while
activities are reduced.
 This results in obesity.
3.Hormonal imbalance
 Constitutes less than 5%.
 Dysfunction of thyroid, pituitary or suprarenals
 Insulin
 Female sex hormones(after pregnancy, after removal of
ovaries or uterus or at menopause).
 Influence appetite
 The role of heredity is not well understood.
 Dietetic habits of the family rather than hereditary
factors are always responsible for obesity.
 Children imitate their parent’s dietary pattern.
 Eating to much or eating fattening foods are handed
over as food habits from generation to generation.
Predisposing factors:
 Age and sex:
 Prevalence of obesity increases with age.
 Most common after the age of 35.
 In every geographical region, in the age group 40-60
years, the prevalence is higher among women than
among men.
 Sedentary habits:
 Television viewing
 Less physical activities
 Spending more hours in sitting
 Socioeconomic status:
 Obesity is more in affluent societies
 Also in families with low educational level
 smoking:
 Smokers weigh a little less than non smokers
 On cessation there is a tendency to increase weight.
 It can be curbed by diet adjustment and exercise
Obesity: A gateway of diseases:
 Obesity is an important risk factor for many diseases.
 Cardiovascular diseases:
 Hypertension
 Coronary heart disease
 Congestive heart failure
 Stroke
 Cardiovascular disease is the main cause of increased
mortality among obese people
 Non – insulin dependant diabetes mellitus (NIDM):
 Another important contributor to morbidity and mortality
in obese people
 Creates insulin resistance
 Gall stones ( bile is supersaturated with cholesterol).
 Men: cancers of colon, rectum and prostrate
 Women : menstrual problems, cancers of breast, ovary,
endometrium and cervix
 Osteoarthritis of weight bearing joints (especially of back,
hips and knees)
 Gout
 Sleep apnea
Treatment of obesity:
 Principle of treatment:
decreasing energy intake and increasing energy output
 Components of treatment:
 exercise alone is not an effective method for achieving weight loss.
 But along with diet it results in greater weight loss
 Activities should be gradually increased in a healthful manner
 Maximum rate of work of the average non – athlete is about 6kcal/min over 1
 The average resting metabolism is about 1 kcal/min
 So the person engaged in 1 hour jogging used 360 kcal whereas the one who
remained at rest used 60 kcal
 This is the upper limit of the increase in energy expenditure
 In extremely obese individuals, in older adults and in
those obese who are afflicted with any cardiovascular
disease exercises must be mild
 Extremely obese individuals need close supervision
because problems in dissipating heat, tachycardia,
hyperventilation, elevated blood pressure and
dyspnoea can occur
 In secondary obesity the treatment of underlying cause is
effective in reducing weight. e.g. : thyroid extract in
 In primary obesity appetite reducing drugs such as
fenfluramine etc are used but has the following limitations:
 Meant only for the short term
 Maintaining lower body weight only when on drug
 Not effective after six months because the patient regains
appetite due to tolerance to drugs and the dosage too
cannot be increased due to toxicity
 Only applicable in severely obese patients.
 It is not an alternative to dieting but a method for
trying to enforce dieting
 Associated with many complications
Dietetic management:
 Dietetic management is by balanced reducing diet
which includes low calorie foods
 Aims at maintaining and restoring good nutrition
along with gradual restriction in body weight
 About 20 kcal/kg of ideal body weight is prescribed for
a sedentary worker and 25kcal/kg for a moderately
active worker
Principles of a reducing diet:
1. The total calorie intake should be within the range of 800 –
1500 kcal/ day. never go outside of this
2. Rate of weight loss should be 0.5 – 1.0 kg/ week
3. The reducing diet must provide essential nutrients
4. The diet must provide satiety value or a sense of satisfaction or
well-being to the patient
5. Fats should be restricted since they are concentrated source of
6. Vegetable oils (except coconut and palm) van de included in
adequate amounts for supply of essential fatty acids
7. Bulk producing carbohydrates like green vegetables are liberally
8. Starches with a high carbohydrate content like potatoes are
9. Protein intake should be adequate to avoid unnecessary
loss of lean tissue
10. 1g of protein /kg ideal weight is essential to meet the
protein requirements.
11.Restriction of sodium as common salt is helpful in a weight
reducing diet. excess sodium causes retention of fluid.
12. Fluids can be taken liberally if salt is restricted.
13.Nonveg items are rich in fat so must be included only in
small quantities.
Restricted foods Permitted foods
 Sweets, sugar chocolates,  All green leafy
jaggery , jam, honey, cakes, vegetables, other
pastries, puddings, fried
items vegetables, fruits,
 Roots like potato, tapioca,
vegetables soup,
yam, banana, whole milk, unsweetened lime juice
dried fruits, papad,  Prescribed amount of
chutney, pickles, nuts cereals and pulses
creams, coconuts, fatty
foods and oils, alcoholic
drinks and soft drinks
•With all theses guidelines a reducing diet can be planned

•The patient must be educated on the calorific value of

Food items Calories suplied
 One thin chapatti  80kcals
 One slice of bread  60kcals
 One thin dosa  130kcals
 One idly  100kcals
 One bun  280kcals
 Two parathas(thin)  275kcals
 Two puris  245kcals
 Three table spoon rice cooked(60g)  70kcals
 Three tbs upma(100g)  230kcals
 Rawa puttu(100g)  230kcals
 One cup cofee with sugar  65kcals
 One cup cofee without sugar  25kcals
 One cup milk  100kcals
 Half cup sambar  105kcals
 1/3 cup dal  92kcals
 1 banana  153kcals
Time Meal Menu
6 am Bed coffee Coffee without sugar

8 am Breakfast Dry chapatti, spinach

curry 50g
10 am Mid time Butter milk

12:30 pm Lunch Rice or chapatti (50g rice

or flour), beans pugath,
dal curry, tomato-
beetroot salad, buttermilk
4 pm Evening snacks Coffee without sugar,
papaya, baked vegetable
8 pm dinner Chapatti 50g flour
cucumber salad fruit cup
 As per WHO diabetes mellitus is defined as a heterogeneous
metabolic disorder characterized by common features of chronic
hyperglycemia with disturbance of carbohydrate, protein and fat
 primary DM
 Type 1 DM
 Type 2 DM
 Secondary DM
 Other forms of DM
 Gestational DM
 maturity onset diabetes of the young(MODY)
 Primary
 Heredity
 Genetic disorder- gene abnormalities, insulin receptor
abnormalities, glycogen storage disease, genetic
 Obesity
 Stress
 Secondary
 Endocrine disorders – gigantism, acromegaly, Cushing's
 Damage of pancreas-chronic pancreatitis, cystic fibrosis
and hemochromatosis
 Pancreatectomy
 Liver disease-hep C, fatty liver
 Autoimmune diseases
 Excessive use of drugs like anti hypertensive drugs,
steroids, oral contraceptives, chemotherapy drugs etc
 Excessive intake of alcohol and opiates
 Polyphagia
 Polyuria
 Polydipsia
 General weakness
 Loss of body weight
 Macro vascular damage
 Coronary heart disease
 Thrombosis or hemorrhage in brain
 Gangrene in limbs
 Micro vascular damage
 Retinopathy
 Nephropathy
 Neuropathy
 Infections
 TB
 Pneumonia
 Pyelonephritis
 Diabetic ulcers

 Diabetic coma
Diagnosis of DM
 Blood examination
 Fasting blood glucose
 Post prandial blood glucose
 Oral glucose tolerance test
 Glycosylated haemoglobin
 Urine examination
 Glucosuria
 ketonuria
Diagnosis Fasting Random OGT HbA1C
glucose glucose

Normal <100mg/dl - <140 mg/dl <5.7 %

Prediabtes 100-125 mg/dl - 140-199 mg/dl 5.7-6.4%

Diabetes >=126mg/dl >=200 mg/dl >=200mg/dl >6.5%

Management of diabetes involves 4 components
 Diet
 Exercise
 Insulin therapy
 Oral hypoglycemic drugs
Dietetic management
Principles of diets
 Calories
 Frequency of meals
 Distribution of nutrients
 Carbohydrates
 Proteins
 Vitamins
 Fluids
 Patients with IGT
 Target blood glucose level
 Use of exchange list
Dietary restrictions Dietary recommendations
 Pulses(dal), dried peas and beans
 Rich sweets
 Vegetables(tender) leafy vegetables
 Pastries  Root vegetables
 Vegetable salad
 Cakes  Fresh fruits (except bananas and
 Candy  Meat (mutton, beef, fish, chicken,
liver etc)
 Dry fruits
 Eggs, thin soups (meat or veg)
 Jam Strictly regulated foods
 Cereals(rice, wheat, barley etc)
 murabba  Potato, sweet potato, sugar, milk,
Planning of diet
 The diet varies according to whether the patient is
obese, normal weight or under weight
 First the total calories required should be calculated
 Then the ratio of carbohydrates, proteins and fats in
grams should be calculated
 Using an exchange list items can be selected for
various meals by a diabetic patient
 Hypertension is defined as systolic pressure above 140mm
Hg and diastolic above 90mm Hg
 It’s a common disease in industrialized countries and
accounts for 6% of death worldwide
Types of hypertension
Primary or essential hypertension
 Cause is unknown
 Constitutes about 80%-95%
Secondary hypertension
 Caused by diseases of kidneys, endocrines or some other
 Constitutes 5-20%
Pre disposing factors
 Heredity
 Obesity
 Stress and strain
 Atherosclerosis
 Hyper lipidemia
 Excess alcohol intake
 Diabetes mellitus
 Cardiovascular diseases
 Stroke
 Renal failure
 Lifestyle improvement
 Decrease obesity
 Restriction of salt intake
 Exercise
 Quitting smoking and alcohol
 Anti hypertensive drug treatment
Dietetic management
 Diet prescription involves low calories, low fat, low sodium
diet with normal protein in it
 In Obese hypertensives weight reduction is essential
 Proteins-a diet of 50g protein is necessary to maintain
 If kidney disease causes hypertension low protein diets of
20g – 30g are recommended
 Fats-about 40-50g fats partly as vegetable oil is permitted
 Carbohydrates- constitute main part of the diet
 Minerals- restriction of sodium intake
 Fluids-with the free flow of urine fluid restriction is not
 With water accumulation(edema) following heart failure
fluid intake is regulated according to urine output
Target blood pressure
 Systolic pressure of about 125mm Hg and diastolic of
about 85mm Hg may be the ideal goal
Permitted food items
Restricted food items
 Bread or chapattis of wheat, unsalted rice,
maize, jowar, bajra or ragi  Meat , fish or chicken
 Breakfast cereal of wheat, rice, unsalted
oatmeal or maize
 Eggs
 Rice cooked  Pastry
 pulses(dal) or beans
 Milk or milk products(2tbsp for tea or coffee)
 Papad, chutney, pickles
 Soup(only vegetable)  No salt or baking soda to be
 Vegetable salad and vegetables, cooked
(exclude radish, beetroot, carrot and spinach) used in cooking
 Potato, sweet potato, or yam  No salt permitted at the table.
 Fat for cooking or butter (partly as vegetable
oil; butter should be unsalted) If salt-free be used to bake
 Sugar, jaggery, honey bread or chapattis at home.
 Jam or murabba No canned product permitted
 Dessert
unless declared to be salt free
 Sweet or Sweetmeat
 Fruit , dried(exclude figs, raisins, sultana)
 Nuts(unsalted)
 Beverages
 Fluid(intake 1500ml if edema present)