[Meat, is it necessary in the diet of the elderly?].
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Although diet has always been recognized as the cornerstone in the management of diabetes, dietary recommendations are evolving continuously. There is now some consensus that the goals of medical nutrition therapy should be to attain and/or maintain a reasonable body weight, to ensure the best possible glycemic control and to reduce cardiovascular risk factors but the means to achieve these goals are still under discussion. Apart from caloric restriction which is, without any doubt, highly efficient but hardly applied in obese diabetic patients, the clinical benefits of the traditional measures to alleviate postprandial hyperglycemia (increasing meal frequency, consumption of carbohydrates with a low glycemic index and/or rich in fibers) are not unanimously acknowledged. The hotly debated issue regarding the ideal proportions of carbohydrates and fat advisable for diabetic individuals has lapsed progressively into disuse, all the arguments having run out. At the present time, there remain many unanswered important questions related to nutrition and diabetes because of the lack of long-term randomized studies evaluating the impact of a diet modification on morbidity and mortality. Considering the difficulties of changing our usual feeding patterns on a long term basis, these uncertainties will not readily be solved.
The theoretical dietary recommendations published by public health authorities and prescribed by the physicians to their patients must be translated in new meal habits. This is the dietician's role. He will be the link between the patient and his physician when a change in the patient's eating habits is forseen for the treatment of his health problems. From a quantitative point of view he will rely on a dietary evaluation and the pyramidal concept as a dietary guideline for an adequate food intake. In front of a diabetic patient, the dietician plays numerous roles. Health issues are important. A partnership with the general practitioner is essential. Their common message will make it possible for the patient to have an entire confidence in the team and so the patient will not be confronted with contradictory informations as it was the case in the past few years. The classification in simple sugars (or fast ones) and complex carbohydrates (or slow sugars) has changed to the glycemic index notion. The restriction of fat has gained increasing importance and therefore the choice of the dietary fats is essential. With all these new informations the patient is able to compound with varied foods real gastronomic meals. There is no more a so-said "diabetic diet" but a well-balanced normal or hypocaloric nutrition. Regarding all potential feeding mistakes, the dietician has an educational and a preventive role.
Children have specific and increased nutritional requirements in comparison with adults. A rapid growth and an enhanced energy expenditure explain these main differences. Any diet deviation will expose more rapidly to a risk of nutritional deficiency with health consequences. Whenever a diet restriction is required for medical reasons, a particular attention must be paid to the feeding regimen in order to avoid any health problem and mainly growth retardation.
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