10


Chapter 1


Prioritizing and Combining Medical Nutrition Therapy for a Healthy Eating Pattern


Regardless of the disease state, a healthy eating pattern is recommended. The 2015–2020 Dietary Guidelines for Americans28


recommends eating healthfully across the life


span with a focus on variety, nutrient density, and amount. A healthy eating pattern with an appropriate energy level is higher in vegetables, fruits, whole grains, seafood, and nuts; moderate in low- or nonfat dairy products and alco- hol (among adults); lower in red and processed meat; and limits sweets, sugar-sweetened foods and drinks (sugar- sweetened beverages), and refined grains. Added sugars should be less than 10% of calories per day, saturated fat less than 10% of calories per day, and sodium less than 2,300 to 2,400 mg/d. Eating patterns must be tailored to the individual’s biological and medical needs, as well as socio- cultural preferences.13,28 For persons with lipid disorders, initial MNT recommen-


dations are for 25% to 35% of energy intake from total fat, less than 7% of energy intake from saturated fatty acids and trans fatty acids, and less than 200 mg of food cho- lesterol per day (other recommendations from professional organizations have not recommended a specific restriction on food cholesterol).2


If HTN is a concurrent problem, a


sodium intake limited to no more than 2,300 to 2,400 mg/d (some individuals may benefit from a further reduction to 1,500 mg/d) and a DASH eating pattern are recommended.3 For people with T1D, T2D, or gestational diabetes mel-


litus, MNT begins with interventions shown to improve glycemic outcomes.4,6


Glucose control improves soon after


MNT is implemented, and these improvements encourage individuals to continue lifestyle interventions. A variety of interventions (individualized nutrition therapy, energy


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