Planning the Nutrition Intervention: The Nutrition Prescription and Disease Management 69


trans fat: A; cholesterol: B; PA: A; energy restriction: A)5


• Nutrition therapy for very high TG levels (500 mg/dL or higher) and chylomicron clearing entails5


(A):


○ temporarily limiting total fat to 10% to 15% of kcal (typically 20 to 40 g/d during chylomicron clearing);


○ avoiding alcohol; ○ avoiding refined starches and partially replacing them with high-fiber, whole-grain foods;


○ avoiding added sugars and limiting fruit (no fruit juice or sugar-sweetened beverages);


○ spreading calories and carbohydrates evenly throughout the day;


○ limiting calories if weight loss is indicated; ○ adding medium-chain triglyceride oil and gradually increasing it if extra calories are needed;


○ exercising 30 to 60 minutes most days; ○ adjusting diabetes medications as appropriate to maintain glycemic control; and


○ once chylomicron particles have cleared and TG levels are less than 500 mg/dL, gradually advancing dietary fat to tolerance.


American Diabetes Lifestyle Intervention Rec- ommendations for Dyslipidemia and Lipid Management


• To improve the lipid profile in clients with diabetes, recommend lifestyle modification, focusing on weight loss (if indicated); reduce saturated and trans fat; increase omega-3 fatty acids, viscous fiber, and plant stanols and sterols; and increase PA. (A)8


• Intensify lifestyle therapy and optimize glycemic con- trol for clients with elevated TG levels (150 mg/dL or


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