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
体型卧床轻体力中等体力重体力
消瘦84~105 146 167 188~209 (20~25) (35) (40) (45~50)
正常63~84 125 146 167
(15~20) (30) (35)
(40)肥胖
V 63 84~105 125 146
(V 15) (20~25) (30) (35)表2.不同能量饮食的食物交换份表
能量
kJ (Kcal) 主食类g
（交换份）
蔬菜类g
（交换份）
鱼肉类g
（交换份）
乳类g
（交换份）
油脂类g
（交换份）
4185 (1000) 150 (6) 500 (1) 100 (2) 220(2) 9(1) 5021 (1200) 200 (8) 500 (1) 100 (2) 220(2) 13.5(1.5) 5858 (1400) 225 (9) 500 (1) 150 (3) 220(2) 13.5(1.5) 6694 (1600) 250 (10) 500 (1) 200 (4) 220(2) 13.5(1.5) 7531 (1800) 300 (12) 500 (1) 220( 4) 220(2) 18(2)
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全英班实习指导
Practice Dietary In vestigati on
(一):Objective
Enforcing the objective, meanings, and methods of dietary investigation further, studying the com mon steps and methods of diet calculati on, be able to grasp diet value and give appropriate mending suggesti ons.
(二): Diet in vestigatio n
1.Retrospect the methods of diet investigation together with the students, involving qua ntify ing method, audit method, retrospect method and chemical an alogy method, and review their character, adva ntages and disadva ntages, the appl ying scopes as well.
2.Every practiser retrospects all his in takes in cludi ng the sorts, character and qua ntity with in the last 24 hours.
(三)：Diet calculati on
1.Calculat ing calories and nu trie nts of the food suppleme nt.
(1) . The qua ntity of the in takes:
①. The stude nt retrospected with in 24 hours in takes;
②. Specify ing recipes as follow in gs:
Breakfast: a cup of fresh milk(about 150ml); a piece of steamed bread (about 100g flour contain ed)。
Lun ch: rice (200g rice); sauti ng pork with celery: pork (th in) 50g, celery 250g; soy 10g; bota nic
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 , vin egar 3g , gin ger bits 1g , (2). Calculati ng method
1). Filli ng how many times you dine , the in takes qua ntity (refe rring to raw materials) in the table
1。
2). Look ing in to food comp onent table , calculat ing the calories and nu trie nts in every in takes respectively . Food comp onent table con sists of nu trie nts contents per 100g , so, your in takes must be transferred first then filled the related data in the table 1.
3). Subtotal and sum total :① Subtotal is defined as collecting all kinds nutrients respectively accord ing every deal , especially for in takes calories ; ② Sum total in dicates calculat ing the whole day calories and nutrients and filling in the blank for sum total;
(4). Protein nu trie nts value:① In takes is valued acco un ti ng for 10%-12% of total calories;② Qualitive protein should no less than 1/3 of total calories , the ratio should be higher if the total
in takes deficie nt.
(5). Vitamin and mi nerals nu trie nts value: accord ing 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)。
Table 1 The table of food nutrients components calculation Serial nu mber:
Un it:
Date month year
Table 2 The table of dietary value Table 4
Nutrie nts
and sources
assig nment
Table 3 The distribution of calories source。