Ramadhan Nutrititional Plan IDF-DAR Guideline 2016
Ramadhan Nutrititional Plan IDF-DAR Guideline 2016
Ramadhan Nutrititional Plan IDF-DAR Guideline 2016
74
Figure 1. The RNP Ramadan map
Tunisia
Egypt Saudi
Arabia India
United
Arab
Emirates
Malaysia
Indonesia
South Africa
Access the online version at www.daralliance.org or www.idf.org and click on your country to view a
full nutrition plan. Print the plan and hand it to your patients
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7.3 Risk avoidance during Ramadan
For patients with diabetes, there are several potential risks associated with prolonged
fasting. It is therefore important to increase patient awareness of these and to reduce
risks while, if possible, enabling patients to participate in their spiritual experience
of fasting during Ramadan. Many diabetes-related risks can be minimised through
proper nutrition, including [2, 6]:
1. Hypoglycaemia, especially during the late period of fasting before iftar
2. Severe hyperglycaemia after each of the main meals
3. Dehydration, especially in countries with prolonged fasting hours and hot climates
4. Significant weight gain due to increased caloric intake and reduced physical activity
5. Electrolyte imbalance
6. A
cute renal failure in patients prone to severe dehydration, particularly elderly
patients and those with impaired kidney function.
76
8. F rying food, which is particularly unhealthy, especially when using trans-fat
margarine or oils rich in saturated fat (e.g. palm oil and coconut oil)
9. C
hanges in physical activity and sleeping patterns can affect metabolism and may
contribute to weight gain [10].
77
Figure 2. RNP caloric guide for weight reduction and weight maintenance (RNP algorithm 1)
selected (e.g. whole grain, legumes, temperate fruits, green salad and
most vegetables)
• Fibre intake should be approximately 20–35 g/day
(14 g/1000 kcal). This helps to provide satiety while fasting
• Fibre from unprocessed food, such as vegetables, fruits, seeds, nuts
and legumes is preferable
Not • Sugar, refined carbohydrates, processed grains and starchy foods
recommended should only be consumed in limited quantities, especially sugary
beverages, traditional sugar-heavy desserts, white rice, white bread,
low fibre cereals and white potatoes
Percentage • Protein intake should not be less than 1.2 g/kg of adjusted body
weight* and usually accounts for 20–30% of total caloric intake.
Protein is important as it enhances satiety. Protein also helps to
maintain lean body mass [13]
Protein†
Recommended • Fish, skinless poultry, dairy, nuts, seeds and legumes are
recommended
Not • Protein sources that are high in saturated fats (e.g. beef, lamb) should
recommended not be consumed in excess, as this increases the risk of cardiovascular
disease
Percentage • Fat should comprise less than 35% of the total daily caloric intake.
There is general agreement that the type of fat consumed influences
cardiovascular disease risk
• SFA should be limited to <10% of total daily caloric intake. PUFA and
MUFA should comprise the rest of the daily fat caloric allowance
Recommended • PUFA and MUFA (e.g. olive oil, vegetable oil or blended oil [PUFA and
Fat
palm oil]) are recommended. Oily fish (e.g. tuna, sardines, salmon) are
recommended as a source of omega-3 fatty acids
Not • Foods high in saturated fat, including red and processed meats (beef,
recommended lamb, hot dog, salami, luncheon meat), and ghee, and foods high in
trans-fats (fast food, cookies, margarines and butter made of partially-
hydrogenated oil) are not recommended
MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids; SFA, saturated fatty acids
*Adjusted body weight = Ideal body weight (IBW) + (0.25 x [Current weight – IBW])
†
Patients with renal issues may have different protein requirements and should receive individualised advice
79
Figure 3. Example of a Ramadan plate*
1 glass of
low fat milk
1−2 dates
1.5 cup of whole grain rice cup of beans/lentils/peas
1 small slice
2 teaspoons
of oil of watermelon
This meal provides: 770 kcal, 45% carbohydrate, 20% protein and 35% fat
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Summary
•• The RNP is a mobile and web-based application designed to help HCPs
individualise and implement MNT for patients with diabetes during Ramadan. It
also helps patients without access to HCPs to construct a healthy eating plan
for Ramadan.
•• The RNP helps patients with diabetes to plan a daily caloric target that may
help them to maintain body weight if they are lean, or to lose weight if they are
overweight or obese.
•• Use of the RNP may help patients with diabetes to avoid risks during Ramadan
fasting, such as hypoglycaemia, hyperglycaemia and dehydration.
•• The RNP provides examples of meal plans within the target caloric levels, tailored
for use in different countries.
•• The RNP website is designed to capture menus from across the globe, that match
the structure provided in this chapter.
References
1. Ali S, Davies MJ, Brady EM, et al. Guidelines for managing diabetes in Ramadan. Diabet Med 2016; Epub
ahead of print [doi: 10.1111/dme.13080].
2. Bravis V, Hui E, Salih S, et al. Ramadan Education and Awareness in Diabetes (READ) programme for
Muslims with Type 2 diabetes who fast during Ramadan. Diabet Med 2010;27:327-31.
3. Ley SH, Hamdy O, Mohan V, et al. Prevention and management of type 2 diabetes: dietary components
and nutritional strategies. Lancet 2014;383:1999-2007.
4. American Diabetes Association. 3. Foundations of care and comprehensive medical evaluation.
Diabetes Care 2016;39 Suppl 1:S23-35.
5. Al-Arouj M, Bouguerra R, Buse J, et al. Recommendations for management of diabetes during
Ramadan. Diabetes Care 2005;28:2305-11.
6. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of
adults with diabetes. Diabetes Care 2014;37 Suppl 1:S120-43.
7. Salti I, Benard E, Detournay B, et al. A population-based study of diabetes and its characteristics during
the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan
1422/2001 (EPIDIAR) study. Diabetes Care 2004;27:2306-11.
8. Yusof BN, Talib RA, Kamaruddin NA, et al. A low-GI diet is associated with a short-term improvement of
glycaemic control in Asian patients with type 2 diabetes. Diabetes Obes Metab 2009;11:387-96.
9. Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and
cardiovascular disease. JAMA 2002;287:2414-23.
10. Haghdoost AA and Poorranjbar M. The interaction between physical activity and fasting on the serum
lipid profile during Ramadan. Singapore Med J 2009;50:897-901.
11. Pi-Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk
factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care
2007;30:1374-83.
12. Hamdy O. Nonsurgical diabetes weight management: be prepared for sustainable and practical
interventions. Curr Diab Rep 2011;11:75-6.
13. Hamdy O and Horton ES. Protein content in diabetes nutrition plan. Curr Diab Rep 2011;11:111-9.
81
Ramadan nutrition plan Tool kit
(Algorithm 2) Ramadan nutrition application for Egypt
Target daily Macronutrient Caloric
calories composition distribution 1200 kcal/day 1500 kcal/day 1800 kcal/day 2000 kcal/day
• CHO: 45–50% Suhoor 300–480 kcal 450–600 kcal 540–720 kcal 600–800 kcal
Recommended: 30–40% • Beans (Foul), Ful: 0.3 cup • Beans (Foul), Ful: 1 cup • Beans (Foul), Ful: 1.5 cups • Beans (Foul), Ful: 1.5 cups
1200 kcal low GI, low GL, • Yoghurt: 1 tub • Yoghurt: 1 tub • Yoghurt: 1 tub • Yoghurt: 1.5 tubs
Weight reduction whole grain and • Cheese: 1 oz/1 slice • Cheese: 1 oz/1 slice • Cheese: 2 oz/2 slices • Cheese: 2 oz/2 slices
for women high fibre
• Small olives: 5 • Small olives: 5 • Small olives: 5 • Small olives: 10
<150 cm tall • Protein: 20–30% • Wholegrain bread: 1 thin slice • Wholegrain bread: 1 thin slice • Wholegrain bread: 2 thin slices • Wholegrain bread: 2 thin slices
Recommended: • Tomato & cucumber salad, with 1 egg • Tomato & cucumber salad, with 1 egg • Tomato & cucumber salad, with 1 egg • Tomato & cucumber salad, with 1 egg
fish, skinless
poultry, dairy,
• Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks
(430 kcal, CHO exchange = 3)† (500 kcal, CHO exchange = 3.5) (670 kcal, CHO exchange = 5) (765 kcal, CHO exchange = 5.5)
1500 kcal nuts, seeds
Weight and legumes
Snack 1‡ 120–240 kcal 150–300 kcal 180–360 kcal 200–400 kcal
maintenance
for women
• Fat: <35% 10–20% • Dates: 1–2* • Dates: 1–2 • Dates: 1–2 • Dates: 1–2
<150 cm tall and
Recommended:
SFA <10%,
• Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks
weight reduction choose low-fat (60 kcal, CHO exchange = 1) (60 kcal, CHO exchange = 1) (60 kcal, CHO exchange = 1) (60 kcal, CHO exchange = 1)
for women cooking methods
>150 cm tall e.g. grill, bake Iftar 480–600 kcal 600–750 kcal 720–900 kcal 800–1000 kcal
and steam 40–50% • Dates: 1–2* • Dates: 1–2/fruit: 1 whole piece • Dates: 1–2/fruit: 1 whole piece • Dates: 1–2/fruit: 1 whole piece
• Salad (tomatoes, cucumber & greens • Salad (tomatoes, cucumber & greens • Salad (tomatoes, cucumber & greens • Salad (tomatoes, cucumber & greens
1800 kcal Lifestyle with lemon/vinegar dressing): with lemon/vinegar dressing): with lemon/vinegar dressing or olive with lemon/vinegar dressing or olive
Weight maintenance 1 medium bowl 1 medium bowl oil dressing: 2 tsp): 1 medium bowl oil dressing: 2 tsp): 1 medium bowl
recommendations
for women • Soup (grilled or broiled chicken/ • Soup (grilled or broiled chicken/ • Soup (grilled or broiled chicken/ • Soup (grilled or broiled chicken/
>150 cm tall &
weight reduction
• Begin iftar with •
lentil/meat): 4 oz
Cooked vegetables: 1 cup
lentil/meat): 4 oz
• Cooked vegetables: 1 cup
lentil/meat): 4 oz
• Cooked vegetables: 1.5 cups
lentil/meat): 4 oz
• Cooked vegetables: 2 cups
plenty of water
for men to overcome • Rice (preferably wholegrain): 1 cup • Rice (preferably wholegrain): 1 cup • Rice (preferably wholegrain): 1.5 cups • Rice (preferably wholegrain): 1.5 cups
dehydration • Whole fruit: 1 small piece • Dessert: 1 small piece • Dessert: 1 small piece • Dessert: 1 small piece
from fasting • Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks
• Keep physically (600 kcal, CHO exchange = 4) (700 kcal, CHO exchange = 5) (900 kcal, CHO exchange = 6) (980 kcal, CHO exchange = 7)
active
2000 kcal
Weight maintenance
• Do not sleep for Snack 2 120–240 kcal 150–300 kcal 180–360 kcal 200–400 kcal
for women
longer than usual 10–20% • Walnuts: 1 handful/GTSN: 3 tbsp • Walnuts: 1 handful/GTSN: 6 tbsp • Walnuts: 1 handful • Walnuts: 1 handful
>150 cm tall & • Water/unsweetened drinks • Water/unsweetened drinks • Milk: 1 glass/GTSN: 6 tbsp • Milk: 1 glass/GTSN: 6 tbsp
for men (175 kcal, CHO exchange = 1) (285 kcal, CHO exchange = 2) • Water/unsweetened drinks • Water/unsweetened drinks
(340 kcal, CHO exchange = 2) (340 kcal, CHO exchange = 2)
(160 kcal, CHO exchange = 1) • Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks
(275 kcal, CHO exchange = 2) (350 kcal, CHO exchange = 3) (350 kcal, CHO exchange = 3)
*If dates are consumed during snack 1, no dates should be consumed during iftar. †One CHO exchange = 15 g CHO. ‡Increased consumption of green salad and vegetables is encouraged up to
3 cups daily; starchy vegetables should be measured (1 small potato = 1 exchange of CHO)
CHO, carbohydrate; GI, glycaemic index; GL, glycaemic load; GTSN, glycaemia-targeted specialised nutrition; SFA, saturated fatty acids; tbsp, tablespoon
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Ramadan nutrition plan Tool kit
(Algorithm 2) Ramadan nutrition application for South Africa
Target daily Macronutrient Caloric
calories composition distribution 1200 kcal/day 1500 kcal/day 1800 kcal/day 2000 kcal/day
• CHO: 45–50% Suhoor 300–480 kcal 450–600 kcal 540–720 kcal 600–800 kcal
Recommended: 30–40% • Wholegrain bread: 1 slice, with egg: • Wholegrain bread: 2 slices, with egg: • Wholegrain bread: 2 slices, with egg: • Wholegrain bread: 2 slices, with egg:
low GI, low GL, 1 large 1 large 1 large 1 large
1200 kcal whole grain and • Milk: 4 tbsp, with oats: 3 tbsp, and • Milk: 4 tbsp, with oats: 3 tbsp, and • Milk: 4 tbsp, with oats: 3 tbsp, and • Milk: 4 tbsp, with oats: 6 tbsp, and
Weight reduction high fibre almonds: 0.5 handful almonds: 0.5 handful almonds: 1 handful almonds: 1 handful
for women • Protein: 20–30% • Apple: 1 small • Apple: 1 small • Yoghurt: 0.5 tub • Yoghurt: 0.5 tub
<150 cm tall Recommended: • Water/unsweetened drinks • Water/unsweetened drinks • Apple: 1 small • Apple: 1 small
fish, skinless
poultry, dairy,
(400 kcal, CHO exchange = 3)† (475 kcal, CHO exchange = 4) • Water/unsweetened drinks • Water/unsweetened drinks
(555 kcal, CHO exchange = 4.5) (640 kcal, CHO exchange = 5.5)
nuts, seeds
and legumes
Snack 1 120–240 kcal 150–300 kcal 180–360 kcal 200–400 kcal
1500 kcal
• Fat: <35% 10–20% • Dates: 1–2* • Dates: 1–2 • Dates: 1–2 • Dates: 1–2
Weight
Recommended:
SFA <10%,
• Badam milk (milk, ground almonds: • Badam milk (milk, ground almonds: • Badam milk (milk, ground almonds: • Badam milk (milk, ground almonds:
maintenance 0.5 handful and cardamom powder): 0.5 handful and cardamom powder): 0.5 handful and cardamom powder): 0.5 handful and cardamom powder):
choose low-fat 1 glass 1 glass 1 glass 1 glass
for women cooking methods
<150 cm tall and (210 kcal, CHO exchange = 2) (210 kcal, CHO exchange = 2) (210 kcal, CHO exchange = 2) (210 kcal, CHO exchange = 2)
e.g. grill, bake
weight reduction and steam
for women Iftar 480–600 kcal 600–750 kcal 720–900 kcal 800–1000 kcal
>150 cm tall
Lifestyle 40–50% • Dates: 1–2* • Dates: 1–2 • Dates: 1–2 • Dates: 1–2
recommendations • Baked mince samosas: 2–3 cocktail • Baked mince samosas: 2–3 cocktail • Baked mince samosas: 2–3 cocktail • Baked mince samosas: 2–3 cocktail
• Haleem (wheat, oats and meat • Haleem (wheat, oats and meat • Haleem (wheat, oats and meat • Haleem (wheat, oats and meat
• Begin iftar with broth): 0.5 cup broth): 1 cup broth): 1 cup broth): 1.5 cups
1800 kcal plenty of water • Basmati/parboiled rice: 0.5 cup/ • Basmati/parboiled rice: 0.5 cup/ • Basmati/parboiled rice: 1 cup/ • Basmati/parboiled rice: 1 cup/
to overcome roti: 1 small roti: 1 small roti: 2 small roti: 2 small
Weight maintenance
for women
dehydration • Grilled or curried lean chicken/fish: • Grilled or curried lean chicken/fish: • Grilled or curried lean chicken/fish: • Grilled or curried lean chicken/fish:
from fasting 4 oz 4 oz 4 oz 4 oz
>150 cm tall &
weight reduction • Keep physically • Green salad/vegetables‡ • Green salad/vegetables • Green salad/vegetables • Green salad/vegetables
for men active • Water/unsweetened drinks • Water/unsweetened drinks • Water/unsweetened drinks • Fruit: 1 whole piece
• Do not sleep for (490 kcal, CHO exchange = 3) (635 kcal, CHO exchange = 4) (710 kcal, CHO exchange = 5) • Water/unsweetened drinks
longer than usual (850 kcal, CHO exchange = 6)
*If dates are consumed during snack 1, no dates should be consumed during iftar. †One CHO exchange = 15 g CHO. ‡Increased consumption of green salad and vegetables is encouraged up to
3 cups daily; starchy vegetables should be measured (1 small potato = 1 exchange of CHO)
CHO, carbohydrate; GI, glycaemic index; GL, glycaemic load; GTSN, glycaemia-targeted specialised nutrition; SFA, saturated fatty acids; tbsp, tablespoon
83