Fat diet - minimal total
This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.
Aim
To provide a diet with no more than 10g total fat per day, for patients with metabolic disorders affecting fat utilisation, or for patients who do not tolerate addition of medium chain triglyceride (MCT) fat in the minimal long chain fat plus MCT diet.
Characteristics
Very low in total fat. Skim dairy foods and very lean meats are used. Fat is not used in cooking or food preparation. Requires additional energy supplements from CHO or protein (if appropriate). May need to be combined with a minimal or reduced protein diet for some metabolic disorders.
Indications
For patients with metabolic disorders affecting fat utilisation such as MADD (glutaric aciduria type 2), HMGA Co lyase deficiency, or other disorders of fatty acid oxidation in which tolerance to MCT is a problem or unknown or for patients with pancreatitis.
Nutritional adequacy
Nutritionally inadequate.
This diet may not provide adequate energy and intake of fat soluble vitamins. Essential fatty acids may be compromised and should be assessed by a dietitian. Appropriate nutritional supplements (such as glucose polymers, clear high protein supplement drinks) will be required to meet the patient’s energy and/or nutrient needs. Adequate energy intake and avoidance of fasting is essential in the management of inborn errors of fatty acid oxidation to prevent hypoglycaemia. Adequate amounts of essential fatty acids must be provided to prevent deficiency, usually requiring supplementation with very long chain omega 3 fatty acid docosahexaenoic acid (DHA). Supplementation with fat soluble vitamins (A, D, E) may also be required.
Precautions
Must only be used when ordered by a physician and under the supervision of a dietitian.
Adequate energy intake is essential. Fat-soluble vitamins and essential fatty acid status should be supplemented and monitored regularly as patients may be vulnerable to deficiency, e.g. Vitamin D, E, A, DHA. Assessment and menu planning by a dietitian is essential. Should not be used long term without dietetic advice and regular follow-up.
Patients with pancreatitis should not continue on this diet for more than one week.
Patients with LCHAD deficiency, VLCHAD deficiency, TFP deficiency, chyle leaks/chylothorax, should use minimal long chain fat plus MCT diet code to ensure sufficient energy provision to meet requirements.
For patients with metabolic disorders involving fat and also protein, this diet can be combined with the metabolic minimal protein diet.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | All mains to be <5g total fat per serve (e.g. skinless chicken breast, white fish, very Soy products (e.g. TVP), legumes and dishes made from them Egg whites only | All other meats including fatty meats and smallgoods (e.g. bacon, sausages) Offal Fried foods, including foods fried in MCT oil Foods cooked with white sauces or coconut milk Egg yolks Pastry, pizza Dishes containing cheese MCT oil |
| Sauces, gravies | Low fat sauces/gravies <1g long chain fat per serve Tomato sauce, sweet and sour sauce | Cream- or milk-based sauces Sauces, gravies with MCT oil |
| Starchy vegetables/pasta/rice | All raw, steamed or boiled Potato mashed with water or skim milk | Fried/roasted/mashed vegetables with fat such as butter, cooking margarine, oil, cheese sauce |
| Vegetables | All raw, steamed or boiled without added fat | Fried/roasted/mashed vegetables with fat Vegetables served with cream- or cheese based |
| Soups | Low fat soups only with <2g fat per serve. Add 20mL glucose polymer syrup or 10g of glucose powder | All other soups including with added milk, cream, sour cream, coconut milk or cream |
| Sandwiches | <5g fat per serve Vegemite™, jam, honey Salad fillings Sliced chicken breast cooked without fat or skin Deli meat <3% fat Tuna canned in brine Egg white Cheese <3% fat (e.g. some very low fat cheese slices, cottage cheese, ricotta cheese) | Most cheese, higher fat meat fillings, egg yolk, peanut butter Avocado, olives Margarine, butter, cream cheese, mayonnaise Spread Paté |
| Salads, dressings | <5g fat per serve as main meal Salads containing lean meat, chicken breast, white fish, tuna canned in brine, low fat cheese with <3% fat Side salad vegetables Served with fat-free dressing or lemon wedge | Other cheese, higher fat meats Coleslaw or potato salad Full fat dressings, mayonnaise Olives, avocado |
| Breads, cereals | Breads, breakfast cereals, rice cakes, corn thins with <2% fat Rolled oats made on water or skim milk Raw muesli of rolled oats and dried fruit Serve with skim milk | Toasted muesli Raw muesli with nuts or seeds Rolled oats made with full cream milk Cereals with coconut |
| Spreads | Jam, honey, Vegemite™ | Butter, margarine Peanut butter, cream cheese, hazelnut spread |
| Hot breakfast choices | Spaghetti, baked beans (<2% fat) Egg white only Grilled plain or herbed tomato | Bacon, sausages, egg yolk |
| Fruit | Fresh/canned in syrup/dried fruits Serve with 20mL glucose polymer syrup (see recipe below) or 10g glucose powder Juices with added glucose polymer | Avocado |
| Yoghurt | Fat-free (skim milk) yoghurts (<1% fat) | Full fat or soy yoghurts |
| Desserts | Canned and fresh fruit Jelly Meringue, pavlova Desserts made using egg white (<1% fat) Low fat custard and skim milk dessert (<1% fat) If <700kJ/serve with 20mL glucose polymer | Cake, pastries, puddings Dairy/milk based desserts Desserts containing egg yolk Cream, ice-cream |
| Milk and cheese | Skim milk, Shape™ or milk with <1% fat Soy beverage with <1% fat Cottage cheese, ricotta cheese, some very low fat cheese slices (<3% fat) | Milk >1% fat (e.g. full-cream milks, reduced fat milks) Soy beverage with >1% fat Cream, sour cream All other cheeses |
| Beverages | Water Cordials, juices, soft drinks Skim milk or milk with <1% fat Low fat nutritional supplements – prescribed by dietitian Energy content of drinks to be fortified to | Milk >1% fat |
| Biscuits | <2 g fat per serve Fat-free only (e.g. rice crackers) | All others |
| Miscellaneous | Herbs and spices Sugar Lollies (e.g. boiled lollies, jelly snakes) Ice blocks Glucose polymers | Nuts and seeds Chocolate |
9kJ/mL Glucose polymer syrup recipe:
56g glucose polymer added to 60mL water (makes 100mL)
References
- Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
- Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
- Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
- American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
- Mahon LK and Escott-Stump S. 2008. Krause’s Food and Nutrition Therapy. 12th edition. St Louis: Saunders Elsevier.
- Shaw V and Lawson M. 2007. Clinical Paediatric Dietetics. 3rd edition. Blackwell Publishing.
- Acosta PB. 2010. Nutrition Management of Patients with Inherited Metabolic Disorders Jones and Bartlett Publishers.