Journal of Clinical Nutrition & Dietetics

Introduction

The importance of following a healthy diet to have a healthier life, controlling diseases and improving the clinical stages of patients is well known [1]. However, clinical status can put the patients at a higher risk, losing weight and malnutrition, that nutritional interventions will be necessary [1,2]. At the first line of nutritional interventions, consultation and healthy-diet recommendations are suggested while by the severity of the clinical conditions, more interventions like planning diets (diet therapy) and using enteral meals are essential [1]. Currently, generally, Registered Dietitian Nutritionists (RDN) for designing the patients' diet plan, use the food groups and the list of food substitutes [1,3] while suitable databases of foods composition are available that could replace the food groups because of their more accuracy. By considering the advantages in past years and the importance of designing better diets, this review aims to introduce a possible suitable method to design individuals’ diets in the future.

Methods

After reviewing a total of 8791 foods, a statically method to calculate the nutrients of mixed foods as an inexpensive method was established. A total of 859 traditional mixed foods was recalculated using the new method with more accuracy than the last method. Additionally, methods of designing individuals’ diets are reviewed to design a suitable method of diet therapy with more accuracy and freedom for the patients in the future. The possible limitations were noticed and considered important to report.

Results and Discussion

Using food groups was a long-used method that RDNs are already used to it. My plate and food pyramids are also based on this method that shows its effect on public health nutritional policies [1]. The main setting in characterizing foods in groups is their percentage of lipids, protein and carbohydrates while the serving sizes of foods in each group are established based on the energy of each food. The food groups main strength is its ease to understand, however, when it comes to communities with mixed foods or patients with special conditions that nutrients would be critical, this method faced some complications that are not possible to cover. On the other hand, using nutrients and their balance as the reference for designing diets will remove these limitations. However, despite more accuracy of nutrients balance method than food groups especially in nutrients except for energy, lipids, protein, and carbohydrate (Table 1), the main limitation in using nutrients balance is the time consuming and detailed process of calculating the planned diet nutrients in compare with Total Energy Expenditure (TEE) and the individuals' required nutrients per day. These days, by the current advantages in computer science, the software can run these time consuming and detailed processes in a real-time process. The unexpected effect of the food processor and different cooking methods that could affect the density of nutrients (leaking or absorption from/ to the environment), digestibility and bioavailability of nutrients [4]. also remain as a limitation in both methods but it would have lessor effect in nutrient balance method.

Table 1: Comparison the estimated nutrients of two methods of designing diet plans for a normal 1500 kcal diet using food groups by referring to the USDA database (in both same foods are used).

Currently, some popular nutrition software are using the balancing method with the aim of nutritional self-management that could be good evidence that society is ready to replace food groups with nutrients balance (at least macronutrients) [5,6]. The other outcomes of using this software shown not only they are widely accepted tools but also could be effective in the community to control some eating disorders, weight control and depression [5,7,8]. However, their assessed effect is limited to public health, eating disorders and weight loss studies. This limitation also made these apps remove some nutrients that may be useful for designing the diet of cardiovascular, kidney, metabolic and allergic patients. However, a study in 2018 suggested the current top 5 applications in this field are tend to report nutrients lower than those from NDSR, a dietary analysis software developed for research purposes, but still possible to be used for the clinical purpose [6]. For more developments, still, a reliable, valid food composition database especially with mixed foods is required.

By providing a suitable database and a system to calculate the total of diet nutrients, not only the RDNs will be able to design their patients diet more accurate but also could adjust the minimum and maximum required nutrients/day according to clinical stages of their patients and Dietary Reference Intake (DRI) while leaving the food choosing option to the patients under adjusted limitations. As reported in Table 2, there are benefits and limitations for all these 3 methods of diet therapy but using the nutrient balancing method has good potential to replace food groups that could lead to a higher quality of diets in future diet therapies.

Table 2: Comparison of advantages between designing diets using food groups and the two methods that could use the nutrient balancing method.

Conclusion

Food groups because of their simplicity are suitable for public health and healthy diet educations but could not have enough accuracy to design a suitable diet for patients in comparison with nutrients balance especially in nations those have mixed food patterns. For this reason, as the first step, developing the mixed and traditional foods databases in all regions is required.

Acknowledgment

I want to acknowledge the departments of nutrition at Varastegan Institute for Medical Sciences and Mashhad University of Medical Sciences for their support during the last 3 years.

Funding

This article did not receive any fund.

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