Fact sheetDiet specifications

Published on 1 Nov 2012


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
lean meat, tuna canned in brine)

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
MCT oil, sour cream, full cream milk, cheese

Vegetables

All raw, steamed or boiled without added fat

Fried/roasted/mashed vegetables with fat
such as butter, cooking margarine, oil, MCT
oil, sour cream, full cream milk, cheese

Vegetables served with cream- or cheese based
sauces

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

Bread (white or wholemeal) with no standard margarine or butter

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
4.2kJ/mL with glucose polymer

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

  1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
  2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
  3. Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
  4. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
  5. Mahon LK and Escott-Stump S. 2008. Krause’s Food and Nutrition Therapy. 12th edition. St Louis: Saunders Elsevier.
  6. Shaw V and Lawson M. 2007. Clinical Paediatric Dietetics. 3rd edition. Blackwell Publishing.
  7. Acosta PB. 2010. Nutrition Management of Patients with Inherited Metabolic Disorders Jones and Bartlett Publishers.
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