List of Food Substitutes vs Nutrients Balance: Which one is the Future of Designing Diets in the 21st Century?

Mohammad Reza Shadm and Foumani Moghadam*

1Department of Nutrition Sciences (Med-Sci), Varastegan Institute for Medical Sciences, Mashhad, Iran

*Corresponding Author:
Mohammad Reza Shadm, Department of Nutrition Sciences (Med-Sci), Varastegan Institute for Medical Sciences, Mashhad, Iran, E-mail: [email protected]

Received Date: February 12, 2021; Accepted Date: February 26, 2021; Published Date: March 05, 2021

Citation: H Shadm MR, Moghadam F (2021) List of Food Substitutes vs Nutrients Balance: Which one is the Future of Designing Diets in the 21st Century? J Clin Nutr Diet Vol.7 No.7:3.

 
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Abstract

 

Context: One of the first lines in controlling diseases and malnutrition is diet therapy and currently, due to tool limitations, for designing the patients' diet plan, the food groups and the list of food substitutes are being used while suitable databases of foods composition are available.

Objective: comparison of List of Food Substitutes vs Nutrients Balance to design a better diet therapy system in future

Design: Methods of designing individuals’ diet and total of 8791 foods are reviewed to calculate the nutrients of mixed foods and design a suitable method of diet therapy with more freedom for the patients in the future.

Results: Food groups because of their simplicity are suitable for public health educations but have limitations that could be better covered using nutrient balances. The main cause of developing the list of food substitutes was the limitations in calculating nutrients in a designed diet that currently could be run using applications. Patients also by using self-management nutrition applications that are based on the nutrient balancing method shown they are ready to accept this method.

Conclusion: According to the behavior changes of society, a well-designed application that can make using nutrient balancing method which is the future of diets possible as well as providing the telemedicine for both patients and nutritionist/dietitians could be the future of this field. However, the main limitation is still the need for a big, validated, and accurate mixed foods composition database that needs to be developed.

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.

  Using food groups Using nutrient balance food groups/ nutrient balance (%)
Energy (Kcal) 1565 1580.041 99
Protein (gr) 84.5 78.1494 108
Carbohydrate (gr) 218.5 232.197 94
Lipid (gr) 35 39.79703 87
Fibre (gr) 31 19.29789 160
Fatty acids, total saturated (g) - 11.33484 -
Cholesterol (mg) - 219.8 -
Fatty acids, total trans (g) - 0.196462 -
Vitamin A, (IU) - 19876.85 -
Iron, Fe (mg) - 10.97359 -
Potassium, K (mg) - 3084.311 -
Calcium, Ca (mg) - 1128.089 -
Sodium, Na (mg) - 1054.395 -
The current diet is one of thousand diets that had comparable different between two methods. This diet is a close diet to the simple food containing diet pattern and only has one fixed food (Kheer). In most cases, the majority of diets are mixed foods.
The current normal 1500 Kcal diet that was designed by a RDNs for weight loss includes 3 loaves of Baguette bread (90 gr), 4 spatulas baked rice (262 gr), 1 glass of low-fat cow-milk (244 cc), 1 glass low-fat yoghurt, 1 glass of Kheer (180 gr), 2 boxes of matches size fried chicken (60 gr), 2 boxes of matches size grilled chicken, a banana (118 gr), a cucumber (251 gr), an apple (100), a cluster of grape, 2 carrots (110 gr), and a glass of Sabzi Khordan (Raw mint, parsley, young leek leaves, and radish) (75 gr) equal to 7.5 units grains, 3 units low-fat dairies, 4 units low-fat meats, 3 units fruits, and 5 units vegetables.

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.

Criteria Food groups diet design Nutrient balancing diet design Nutrient balancing adjustment
Need any specific tool No (just the list of food substitutes) Software that calculates the nutrients for the RDN A double-side software for both patient and RDN that provide self-monitoring, telemedicine and calculate the nutrients at the same time
The accuracy to provide the requirements Acceptable High High
Can consider macronutrients Yes Yes Yes
Can consider micronutrients No (or few) Yes Yes
Database requirement Not necessary required required
Need education Need to educate the list of food substitutes Don’t need any specific education Need to educate the nutrients and the way of using software
 Duration of education 10-20 minutes Less than 5 minutes 10-20 minutes
Can consider mixed foods No Yes Yes
Freedom to choose the foods According to the list of food substitutes Between suggested foods Entirely
Can be used for special diets that require limitation in some nutrients No (the list of food substitutes will be changed) Yes Yes
Time to review patients records and design a 1-week diet 45-120 minutes (without using prepared diets) 45-120 minutes (without using prepared diets) 5-10 minutes
Best usage Public health and healthy diet educations Designing a diet for patients who are not able to choose between foods and need a fixed diet (elder population) Designing a diet for patients who can choose between foods (younger population)

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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