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 nutritionist (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’ diet in the future.
Method :
After reviewing a total of 8791 foods, a statical 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’ diet are reviewed to design a suitable method of
diet therapy with more accuracy and freedom for the patients in the
future. The possible limitations noticed and considered important to
report.
Result 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 carbohydrate while the serving sizes of foods in each group are
established based on the energy of each food. Currently, most diet
therapies are based on this tool and the works on this method made it
known better. 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
softwares can run these time consuming and detailed process 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 nutrient (4) also remain as a limitation in both
methods but it would have lessor effect in nutrient balance method.
Currently, some popular nutrition softwares 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 softwares shown not only they are widely accepted tool 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. The current main limitation about these softwares is
that there is neither a good study to assess these apps efficiency in
clinical studies nor any available information about their database,
especially for mixed foods. 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. However, it required
a high-quality double-side relationship through software that could
provide both self-management and telemedicine between the patients and
their RDN. 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 of diet therapies. However, there is
still a long way to assess its efficiency in improving the quality of
diet therapies. Currently, the limitation is the inadequate valid
database of mixed foods in different regions that may make this method
out of reach at the current stage for some countries.
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 compare
with nutrients balance especially in nations those have mixed food
pattern. Currently, applications made everything simpler and a
well-designed application that links self-management, designing diet
using balancing method and telemedicine is the future of diet plans.
However, the main limitation is still the needs for a big, validated,
and accurate foods composition database. 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 short-review did not receive any fund.
Conflict of Interest: the author declares no conflict of interest. However, the author is the deputy chairman and co-founder of Calorito® nutrition software Co. (Mashhad, Iran) that is assessing the best tool to design diets in the future for patients and obtained intellectual and financial property rights of current thesis. Calorito® because of importance of research and advance in health care system specially in nutrition has no conflict about publishing this short-review.
Contribution : We are currently working on the development of a statistical method to calculate the most accurate nutrients of mixed foods that will be published after final improvements. For those who interested but not able to calculate the nutrients of the food, we sincerely invite them to send their national mixed foods ingredients and recipe to calculate by referring to the USDA database.
Further information: This thesis is under assessment in cooperate with the Mashhad University of Medical science, Varastegan Institute for Medical Science and a group of registered dietitian and nutritionists (RDNs) as the referee board. The current provided information in tables are the important parts of rational aims of running this programme.