NUTRITION IN HOSPITALNUTRITION IN HOSPITALOurOur experienceexperience

Eva Pavić B.Sc.Dubrava University Hospital

Department of Dietetics and Nutrition

The European Heart Network (EHN)

Cardiovascular diseases represent the single most important cause

of death in the EU(over 2 million deaths per year, 42%

of all deaths in the EU).

“Heart disease before the age of 80, is not God’s will, it is consequence

of our own faults.”

Dr. Paul Dudley White –American cardiologist

The most important dietary goals forcardiovascular disease prevention

• Saturated fats and trans fats: an average intake of saturated fats and trans fats should be less than 10% of energy; intake from trans fats should be less than 1% of energy

• Fruit and vegetables: an average intake - more than 400g/day (five servings)

• Salt: an average intake - less than 5g/day

• Body Mass Index (BMI): an average BMI 23

Diet, Nutrition and the Prevention of Chronic Diseases, Report of a JointWHO/FAO Expert Consultation, WHO Technical Report Series 916,

Geneva 2003.

How much salt / sodium?

Salt (NaCl) Sodium 2,5= x

CALCULATION

Healthy adults should consume1.5 grams of sodium and 2.3 grams of chloride each day –or 3.8 grams of saltThe tolerable upper intake level (UL) for saltis set at 5.8 grams per day.

5,8 g NaCl/2,32 g Na/

13,75 g NaCl/5,5 g Na/

Sodium: Are you getting toomuch?

About 11 percent of thesodium in the averageU.S. diet comes fromadding salt or othersodium-containingcondiments to foodswhile cooking or eating.

Salt intake through food items• Bread and bakery products 34%• Meat and meat products 28%• Chese, sour cream and eggs 10%• Fats, sweet products and drinks 11%• Fish and fish products 7%• Dairy products 5%• Fruits and vegetables 5%

BUNDESFORSCHUNGSANATALT FÜR GETREIDE –UNDKARTOFFELVERARBEITUNG, 1989.

Be a savvy shopper: Find the sodium

• Monosodium glutamate (MSG)• Baking soda • Baking powder• Disodium phosphate• Sodium alginate• Sodium nitrate or nitrite

The taste for salt ?!The taste of salt is innately appealing to humansResponses to salty foods are stronglyinfluenced by enviromental factorsResctricted exposure for 8-12 weeks canenhance the appeal the appeal of reducedsodium foods in both normotensive and hypertensive individuals

Mattes,R.D., American Journal of Clinical Nutrition 1997,vol.65;692S-697S

Salt and soft drink consumptionin children and adolescents?

Dietery salt is a major determinant of fluid intake. A reduction in salt intake could play a role in helping to reduce childhood obesity throughtits effect on sugar-sweetened soft drinkconsumption.

He,F.J.Marrero, N.M.MacGregor,G.,Journal of Human Hypertension 2008;vol.17;310-314

Chips (100g)= 536 kcal

do 48% fats and oils

N.N.52/97

100g=386 kcal100g=386 kcalsalt=0gsalt=0g

do 3,5% salt

Ice tea Home made tea

50g sugar / 200kcal 15g sugar / 60kcal

Instead… Better...60 g Cheese 516 mg Na/

235 kcal100 g Cottage chese 406 mg Na/

78 kcal50 g Melted processed 625 mg Na/

cheese 141 kcal15 g Olive oil 0 mg Na/

135 kcal90 g Chicken hot dog 1233 mg Na/

232 kcal60 g Turkey breast 360 mg Na/

70 kcal200 g Beetroot tin 548 mg Na/

64 kcal 200 g Beetroot fresh 200 mg Na/

140 kcal20 g Catchup 280 mg Na/

28 kcal 100 g Tomato Pelatta 34 mg Na/

89 kcal

50 g Roasted peanuts 220 mg Na/280 kcal

50 g Unsalted peanuts 3 mg Na/280 kcal

50 g Milch chocolate 50 mg Na/270 kcal

50 g Almonds 3 mg Na/270 kcal

2 dl Carbonated soft drink 28 mg Na/84 kcal

2 dl Orange juice 2 mg Na/84 kcal

American Heart Association

How to readlabels?

How can I evaluate the amount ofsalt in food?

• High is more than 1.5g salt per 100g (or 0.6g sodium)

• Medium is 0,3g-1,5g salt per 100g (or 0,12-0,59g sodium)

• Low is 0.3g salt or less per 100g (or 0.1g sodium)

High (red) = eat small amounts, or eat occasionallyMedium (amber) = OK most of the timeLow = a healthier choice

Reference values for nutrition labeling: Nutrient Amount for adults

Determination of Standard hospitalnutrition (NN, 127/07) in Croatia

uniform code for each dietstandardized diets according to specific illnessequal level of food qualitysystematic development and controllingof hospital nutritioninformatization (Dietetics)

This standard is valid for all hospitals in Croatia but alsocould be applied in other health care institutions.

Code Name of Diet Energy (kcal) Na(mg) K (mg) Ca(mg) Mg (mg)

01 Diet with no restriction(Regular diet)

2 280 2 863 3 079 564 143

02 Light diet 2 150 1 998 4 056 821 20903 High energy diet 2 880 3 139 3 363 500 14705 Diet for weight reduction 1 050 1 152 2 876 465 19209 Diet for peptic ulcer 2 200 2 295 3 809 563 17612 Diet for pancreatitis 2 230 1 682 4 072 618 20818 Diet for diabetes 1 720 1 812 4 119 890 28419 Diet for hyperlipidemia 2 000 1 580 4 372 644 28727 Diet for nephrotic

syndroma2 420 1 963 3 500 487 144

28 Post surgery Diet 2 030 1 657 3 929 478 20030 Soft diet 2 130 1 486 3 519 987 19330 Diet for enteral feeding 1 920 856 3 237 900 198

Stare namirnice 589589izbačene iz baze 65novih uvedenih 156trenutno u bazi 680

Replace sodium with potassium

1 700 beans /white/ 431160 beans /colorful/ 62860 dried plums 12860 almonds 6700 spinach 25700 celery 8680 peanut /unsalted/ 6570 potatoes 7550 swiss chard 31470 champignons 9

Croatian National Institute of Public Health

K (mg) Food (100g) Na (mg)

200 kcal – how does it look?

43g

0,5 l

75 g0,3 l

60g

170g

26g

200g

330g

475g2/3kom

60ml

How to reduce sodium intake

• Eat more fresh foods and fewer processedfoods

• Choose low-sodium products• Remove salt from recipes whenever

possible• Use salt substitutes wisely• Use herbs and spices to enhance foods• Limit use of sodium-laden condiments

Dietary Approaches to Stop Hypertension (DASH)

fruits, vegetables, and grains, especially

whole grains,

reduce/quitsmoking , low alcohol

intake,physicalexercise

DASH

low-fat or nonfat dairy

productslean meats,

fish andpoultry

Fruits and vegetables• Intake of more than 400g/day (five servings)

/If every person in the EU(25) consumed 400 g of fruits and vegetables per day, 50 000 deaths peryear could be prevented.

• Intake of more than 600g/day/If every person in the EU(25) consumed 600g of fruit and vegetables per day, which is an average intake in some EU countries, more than 135 000 deaths/year from CHD and stroke could be prevented/

Lock, K and Pomerleau, J (2005). Fruit and vegetable policy in the European Union:its effect on the burden of cardiovascular disease. Brussels. European Heart Network

Instead of conclusion

Food safety

Food quality Human health

“We cannot do great thingson this Earth,

only do small thingswith a great love.”

Mother Teresa

““ThereThere is no is no treasuretreasure overover physicalphysical healthhealthneitherneither happynesshappyness overover happyhappy heartheart..””

SirachSirach 30,30,16;16;690690

Thanks for your attention!

epavic@kbd.hr

Thanks to colleagues:

Irena Martinis, M.Sc.,B.Sc., Dubrava University HospitalIrena Oreč, B.Sc., Dubrava University HospitalIvan Vrdoljak, B.Sc., Hospital “Dr.Josip Benčević” Slavonski Brod