Dietary Variations Among Hispanics and Latinos with Diabetes Nilda Benmaor , M.S.,R.D.N., C.D.E
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5/16/2018 “All Are Not The Same” Dietary Variations Among Hispanics and Latinos with Diabetes Nilda Benmaor , M.S.,R.D.N., C.D.E. ©Nilda Benmaor, RDN,CDE ‐2017 Learning Objectives After completing this course, nutrition professionals should be able to: . Select culturally appropriate foods for Hispanics and Latinos with diabetes. Identify the nutrient composition of traditional foods and the impact on post prandial blood sugar levels. Learn how to individualize a diabetic meal plan that includes patient’s preferred foods from country of origin. Apply diabetic dietary guidelines and carbohydrate counting to meal planning. Assess individual patient’s needs and beliefs in order to improve adherence to dietary recommendations and to achieve optimal glycemic control. CDR Learning Codes: 3000 Nutrition Assessment; 5000 Medical Nutrition Therapy; 5190 Diabetes Mellitus; 2020 Composition of Foods Nutrient Analysis ©Nilda Benmaor, RDN,CDE ‐2017 “It is easier to change a man’s religion than to change his diet.” Margaret Mead, Cultural Anthropologist ©Nilda Benmaor, RDN,CDE ‐2017 1 5/16/2018 Latin American Culture Place of Birth : The name of the province, territory or country in which the person was born. Ethnicity Mixed race ancestry: Colonization by Spain, Portugal and France. Immigration from Italy , Germany and Eastern Europe, Africa, China and Korea. Language Spanish, Portuguese ( Brazil), French ( Caribbean and French Guiana). Religion Primary is Roman Catholic. Also Protestant, Jewish, Evangelical, Buddhist, .Hindu ©Nilda Benmaor, RDN,CDE ‐2017 Definitions Hispanic* Refers to persons of Spanish–Speaking origin or ancestry from Latin Americans, but excludes Brazilians. Latino* Refers to persons of Latin American origin or ancestry ,including Brazilians, but excludes persons from Spain. What to use? Hispanic refers to language. Latino refers to geography. (Use language as your guide) Example: Mexican Americans are Hispanics AND Latinos Brazilian Americans are Latinos NOT Hispanics Spanish Americans are Hispanics NOT Latinos *www.Wikipedia.org ©Nilda Benmaor, RDN,CDE ‐2017 Hispanic/Latino Demographics Hispanic Population in U.S. 54 million, 17% of population* Nation’s largest ethnic or race minority Largest Hispanic Groups in the U.S. ‐2012 Mexicans‐64% Puerto Rican‐9.4% Salvadorans‐3.8% Cubans‐3.7% Dominicans‐3.1% Guatemalans‐2.3% Other Hispanic or Latino origins‐13.7% 2060 Projections 128.8 million,31% of the U.S. population by that date *U.S. Census Bureau –July 1,2013 ©Nilda Benmaor, RDN,CDE ‐2017 2 5/16/2018 Racial and Ethnic Differences in Prevalence of Diagnosed Diabetes • National Diabetes Statistics Data from the National Diabetes Statistics Report, 2014 (released June 10, 2014) ©Nilda Benmaor, RDN,CDE ‐2017 Targeting Hispanics for Better Diabetes Education The burden of diabetes is even heavier for Hispanics/Latinos due to a number of factors : Language Socioeconomic status Religious faith Educational attainment and acculturation Beliefs and perceptions about health care Legal documentation status Access to health insurance ©Nilda Benmaor, RDN,CDE ‐2017 Rates of Diagnosed Diabetes Breakdown Among Hispanic Adults . 8.5% for Central and South Americans . 9.3% for Cubans . 13.9% for Mexican Americans . 14.8% for Puerto Ricans. • National Diabetes Statistics Data from the National Diabetes Statistics Report, 2014 (released June 10, 2014) ©Nilda Benmaor, RDN,CDE ‐2017 3 5/16/2018 Hispanic Diets Weaknesses Food preparation methods tend to add animal fats in the form of lards, cheeses, and creams. Preference for high fat meats, such as pork and organ meats Strengths Contains complex carbohydrate staples Has vegetable protein (such as beans) Great reliance on stews and mixed dishes ©Nilda Benmaor, RDN,CDE ‐2017 Bilingual Label ©Nilda Benmaor, RDN,CDE ‐2017 Nutrition Facts Labels Whole Wheat Bread Corn Tortillas Serving Size: 2 Serving Size:2 Calories: 110 Calories:100 Total Fat: 1.5 g Total Fat: 1.5g Carbohydrates: 20 g Carbohydrates: 20g Sugar: 2g Sugar:2g Dietary Fiber: 3g Dietary Fiber: 3g Protein: 5 g Protein: 2g Sodium: 230 mg Sodium: 10 mg ©Nilda Benmaor, RDN,CDE‐2018 4 5/16/2018 Nutrient Content of Traditional Foods from Country of Origin MEXICO ©Nilda Benmaor, RDN,CDE ‐2017 Mexico ‐Traditional Foods Corn Tortillas : Treated corn kernels called “nixtamal “are pulverized on a tone slab. The masa (harina) is combined with water to make the tortilla dough. Serving size :1 =Calories 58, Carbs 12g, Protein 1 g, Fat 1 g (Sodium 3 mg) Flour tortillas: Wheat flour Serving size: 1( 7‐8”) = Calories 144, Carbs 24 g, Protein 4 g, Fat 4g (Sodium 290 mg ) Caldos:Hearty soups or stews with chicken, beef, or fish. Serving size : 1 cup = Calories 86, Carbs 8g, Protein 6g, Fat 3g Choose your Food Exchange List for Diabetes ( ADA& AND) ©Nilda Benmaor, RDN,CDE ‐2017 Mexico‐ Traditional Foods Tacos: Mexican equivalent of sandwiches. Soft or crispy filled with meats, vegetables, beans, and sauces. Serving Size: 1 taco (beef) =Calories 257, Carbs 23, Protein 13g, Fat 12g Burritos Large , thin wheat tortilla folded around beans, cheese, meats, and added salsa Serving Size : 1 (5oz)= Calories 302,Carbs 45g, Protein 7g,Fat 10g Quesadillas (cheese) : Tortillas filed with leftover meat, vegetables, cheese, and sausage. Serving Size: 1 (5oz) = Calories 370, Carbs 37g, Protein 21g, Fat 15g Choose your Food Exchange List for Diabetes ( ADA & AND) ©Nilda Benmaor, RDN,CDE ‐2017 5 5/16/2018 Mexico –Traditional Foods Boiled Beans (out of the pot) Serving size : 1/2 cup= Calories 80‐100, Carbs 15, Protein 21g, Fat 1g Refried Beans: Fried with lard Serving size : 1/2 cup = Calories 190, Carbs 15g , Protein 21g , Fat 5g Chilaquiles: Stale tortillas broken up and softened in a sauce as side dish Serving size: 1 cup= Calories 205, Carbs 17g , Protein 11 g, Fat 11g ©Nilda Benmaor, RDN,CDE ‐2017 Mexico ‐Traditional Foods Enchiladas: White or yellow corn tortilla softened in lard or sauce then filled with meat, poultry, seafood , cheese or egg mixture then baked. Sauce is made with green or red chilies, vinegar and spices. Serving size : 1 = Calories 280, Carbs 33‐34 g , Protein 24g, Fat 6 g Chicharrones: Fried pork rind TamalesServing size: Made : 9 pc with= Calories masa 70 (harina)‐80, Carbs or 0.5 lefover g, Protein pozzole 7g, Fat (hominy) 4‐6 g that is placed in corn husks or young leaves of avocados. Folded, filled with meat or vegetable mixture, then baked or boiled. After cooking, the husk or leaf is unfolded, and the inside filling is ready to eat . Very popular during the holidays. Serving size: 1 = Calories 280, Carbs 26 g, Protein 15g, Fat 17 g ©Nilda Benmaor, RDN,CDE ‐2017 Mexico ‐ Traditional Foods Menudo: Traditional Mexican soup (also known as “pancita”) made with beef stomach (tripe) in broth, with a red chili pepper base, lime, choppe ,onions, and chopped cilantro, as well as crushed oregano, and crushe red chili peppers. Suppose to cure hangovers. Serving size: 1 cup = Calories 130, Carbs 1 g, Protein 21 g, Fat 5g Flautas (chicken): Tortillas tightly rolled around the filling and fried until crispy Serving size: 1 = Calories 180, Carbs 7g, Protein 18g, Fat 9g Tortas : Sandwich with French bread with beans, cheese or beef Serving size: 1 = Calories 475, Carbs 63g, Protein 17g, Fat 18g Choose your Food Exchange List for Diabetes ( ADA & AND) ©Nilda Benmaor, RDN,CDE ‐2017 6 5/16/2018 Mexico‐ Traditional Foods Pozole (green) :“hominy” soup or stew with pork, chili peppers, salsa, cabbage, and lime. Serving size: 1 cup= Calories 220, Carbs 17g, Protein 22g, Fat 7g Nopales : Nopal cactus also known as prickly pears are one of the favorite vegetables. Contains fiber and pectin, which may decrease carbohydrate absorption. Serving size: 1 cup= Calories 16, Carbs 3g,Protein 1g,Fat 0 g Sweets Pan Dulces : Variety of sweet and savory breads Serving Size: 1 ( small round) = Calories 147, Carbs 16g, Protein 1g, Fat 9g ©Nilda Benmaor, RDN,CDE ‐2017 Mexico‐ Traditional Foods Drinks Atole : Masa corn flour, milk, and sugar Serving size: 1 cup= Calories 209, Carbs 40g, Protein 4g, Fat 3.8g AGUAS FRESCAS Horchata : White long grain rice with cinnamon, sugar, and water Serving size: 1 cup= Calories 98, Carbs 25g , Protein 0.2g, Fat 0.5g Tamarind drink or soda: Is a fruit juice with sour taste that is sweetened with sugar or honey .Also sold as a natural flavor soda . Serving size: 1 cup= Calories 116, Carbs 29g,Protein 0g,Fat 0g ©Nilda Benmaor, RDN,CDE ‐2017 Nutrient Content of Traditional Foods from Country of Origin Central America EL SALVADOR ©Nilda Benmaor, RDN,CDE ‐2017 7 5/16/2018 El Salvador –Traditional Foods Pupusas : Thick corn tortillas stuffed with cheese, meat, squash and/or other fillings; Served with pickled cabbage Serving size: 2 = Calories 600, Carbs 43g ,Protein 12g, Fat 16g Sopa de Pata :a hearty soup made from cow’s feet, tripe, yucca, sweet corn and green beans. Serving Size: 1 cup = Calories 241, Carbs 8, Protein 18g, Fat 15 g Yuca Frita: Fried yucca, often served with chicharron Serving size : 5 pc = Calories 170, Carbs 22g, Protein 1g , Fat 9g Choose your Food Exchange List for Diabetes ( ADA & AND) ©Nilda Benmaor, RDN,CDE ‐2017 El Salvador‐ Traditional Foods Loroco: a small green unopened flower bud used as an herb for flavoring in Central America. Loroco tastes "green" with overtones of nuts. Taste like a cross between mild broccoli and squash. Loroco con queso** with cheese as a filling in pupusas Serving Size: 1 (28g)= Calories 12, Carbs 2g, Protein 1g, Fat 0g Pacalla: A pacaya vegetable is the flower of tepejilote palm or date palm. It is a common ingredient in Guatemalan and Salvadorian cuisine, which is where the palm is primarily grown. The flower is then coated in a beaten batter of egg whites, maize flour, chili powder, salt, and fried in oil.