Nutrition 411: Tips for Utilizing MyPlate with Patients with Wounds

  Although patients with wounds often benefit from nutrition education, they often do not have the opportunity to meet with a registered dietitian (RD) or nutrition professional. Other healthcare practitioners (HCPs) must fill the educational gaps. Fortunately, many credible resources are available online to obtain patient handouts, sample meal plans, and other tools. One of these sources is the MyPlate program from the US Department of Agriculture (USDA). Many HCPs are not aware of the MyPlate program and the variety of resources available for free.

USDA Food Guides Past and Present

  The USDA food guides were introduced between 1916 and the 1930s, with the publication of Food for Young Children and How to Select Food, which provided direction on the food groups and household measures, with a focus on “protective foods”. As the years passed, these guides were revised to account for new nutrition knowledge and changing times. Depending on your age, you may recall some of the various campaigns including: A Guide to Good Eating (Basic Seven) in the 1940s, Food for Fitness (Basic Four) from 1956 through the 1970s, the Hassle-Free Daily Food Guide in 1979, the Food Wheel in 1984, the Food Guide Pyramid in 1992, the MyPyramid Food Guidance System in 2005, and finally, in 2010, MyPlate.

  The Food Guide Pyramid and the MyPyramid system were criticized for being too complicated and difficult for people to apply at the grocery store and at the dinner table. In response, MyPlate was created, and although some experts now criticize it as oversimplified, it is much better than the pyramids.

MyPlate.gov — a Wealth of Information and Resources

  MyPlate was introduced along with the updated 2010 Dietary Guidelines for Americans and was designed as a symbol to provide a reminder to eat healthfully. The illustration or icon depicts the five food groups (protein, vegetables, fruit, grains, and dairy) using a place setting as the background. A website, www.ChooseMyPlate.gov, was launched at the same time to provide simple, practical tips and information to help the average American make wise food choices. The selected messages for consumers are: 1) Balance calories by enjoying food but watch portion sizes; 2) Increase consumption of fruits and vegetables, whole grains, and skim or 1% milk; and 3) Decrease consumption of sodium and sugary drinks.

  HCPs can print several useful handouts for patient education, including the Let’s Eat for the Health of It brochure, which highlights the messages above. Another great resource is the 10 Tips Series in which each of 15 topics is broken into 10 simple tips in an easy-to-read format. The handouts parallel advice typically given to patients with wounds by highlighting lean protein sources and foods rich in vitamin C and vitamin A and by emphasizing limited consumption of empty calories.

Individualized Dietary Advice for Patients

  General advice and broad nutrition principles may be the basis of nutrition education, but patients often want specific menus and recipes to help translate the information into meals. To meet that need, a sample 7-day, 2,000-calorie menu with recipes based on the food groups is available. Patients can log on to www.ChooseMyPlate.gov to receive individualized eating plans based on their lifestyle and food preferences. At the end of 2011, the USDA released a tool called the SuperTracker that facilitates personalized recommendations for what and how much to eat based on physical activity. Each user can track his or her food intake and physical activity utilizing a large database of foods and activities. Additional features such as goal setting, virtual coaching, weight tracking, and journaling are also available.

Specific Examples Utilizing MyPlate

  Case 1: Patrick is a 78-year-old who lives independently but has had a number of health scares requiring medical intervention. He developed a Stage II pressure ulcer on his sacrum during his recent hospitalizations. He experienced a loss of appetite and has lost 25 lb in the past 2 months. He is now 5 feet, 8 inches tall and 130 lb with a BMI of 19.8. Finances are a concern for him.

  Handouts that would be helpful to Patrick include:
    • Eating better on a budget: 10 tips to help you stretch your food dollars
    • Smart shopping for veggies and fruits: 10 tips for affordable vegetables and fruits
    • Eating on a Budget – the 3 Ps (Plan, Purchase, Prepare)
    • With protein foods, variety is key: 10 tips for choosing protein
    • Add more vegetables to your day: 10 tips to help you eat more vegetables
    • Focus on fruits: 10 tips to help you eat more fruits
    • Sample menus at 2,000-calorie level with recipes

  Case 2: Veronica is a 42-year-old who lives with her husband and three children. She has diabetes and a history of poor adherence to her medical regimen. She has developed a diabetic foot ulcer that has not healed in the past 5 months. She is 5 feet, 3 inches tall and 215 lb with a BMI of 38.1. She is concerned about the health of her children as well, because two of them are overweight and one has recently been diagnosed with insulin resistance. At this time, she is sedentary secondary to the wound, although she would like to be more active in the future.
  Handouts that would be helpful to Veronica include:
    • Choose MyPlate: 10 tips to a great plate
    • Make half your grains whole: 10 tips to help you eat whole grains
    • Kid-friendly veggies and fruits: 10 tips for making healthy foods more fun for children
    • Be a healthy role model for children: 10 tips for setting good examples
    • Cut back on your kid’s sweet treats: 10 tips to decrease added sugars
    • Enjoy your food, but eat less: 10 tips to enjoying your meal
    • The 1,800 calorie meal plan created on SuperTracker using her age, height, weight, and activity level

A Sample Menu

  Veronica should consume approximately 1,800 calories per day. The SuperTracker breaks this down into 6 oz grain, 2½ cups vegetables, 1½ cups fruit, 3 cups dairy, 8 oz protein, and 5 tsp of oil each day. Although these amounts are general recommendations, the HCP should determine if her medical conditions necessitate any adjustments, such as additional protein for wound healing or carbohydrate adjustments for blood glucose fluctuations. The plan also recommends that Veronica limit her empty calories to <161 a day. A day’s menu:
  Breakfast (1 oz grain, 1 cup dairy, 1 oz protein): 1 slice whole wheat bread, 1 Tbsp peanut butter, 1 cup yogurt
  Mid-morning snack (½ cup fruit, ½ cup dairy): 16 seedless grapes, ½ cup skim milk
  Lunch (2 oz grain, 1 cup vegetables, ½ cup dairy, 3 oz protein): 1 cup brown rice, 1 cup cooked stir-fry vegetables, 3 oz grilled chicken strips, ½ cup pudding made with milk
  Mid-afternoon Snack (2 oz grain, ½ cup vegetables): ½ cup baby carrots (about six), 3 cups low-fat popcorn
  Dinner (2 oz grain, 1 cup vegetables, 1 cup fruit, 1 cup dairy, and 4 oz protein): 2 small (6 inch) corn tortillas, 4 oz lean ground beef, 1½ ounces reduced-fat cheddar cheese, ½ cup chopped tomato on the tacos, ½ cup green beans as a side dish, 1 cup of diced melon

Tips for Presenting MyPlate to Patients

  MyPlate can appear deceptively simple. It is important that HCPs delve into the details of the recommendations behind the colorful graphic when presenting it. The handouts and other tips available on www.ChooseMyPlate.gov are intended to go along with the graphic, which was never intended to be used alone or to provide specific dietary advice. Things to make sure to review with each patient include:
    1. Your plate does not need to look like the picture at every meal. MyPlate can be used as a guide for what to eat in a day and the proportion that a specific food group should make up of your total intake.
    2. Protein is a nutrient, not a food group. It is found in a variety of foods, such as beef, poultry, fish, beans, tofu, meat replacement products, and eggs/egg replacements.
    3. Many foods actually bridge two food groups — eg, milk or yogurt count as a serving of dairy and also contain protein. Beans count as both protein and vegetables.
    4. Fat should be monounsaturated and polyunsaturated; people should strictly limit their intake of saturated fats and trans fats.
    5. Half of the grains a person consumes should be whole grains.
    6. Recommended portion sizes need to be described — the size of the plate matters.
    7. It’s important to choose from a wide variety of foods to ensure that nutrient needs are being met.
    8. People 51 years of age and older, African Americans, and people with hypertension, diabetes, or chronic kidney disease should consume no more than 1,500 mg of sodium/day. Everyone else should consume no more than 2,300 mg of sodium each day. One teaspoon of salt contains 2,300 mg of sodium.
    9. Desserts and snack foods have no place on this plate, which is not realistic for most people. It’s important to talk about making the best choices when someone wants to indulge.

Practice Points

  Just as there are many different types of wounds, there are many different types of patients. Some patients eat almost everything, while others have extensive food likes and dislikes. For others, financial constraints, depression, isolation, polypharmacy, cultural habits, and additional confounding factors interfere with proper nutritional intake. It is up to the provider to determine the level of information and education needed to aid wound healing and restore health. Educational programs like MyPlate are a start; in complex cases, a referral to a RD may be needed for optimal care.

Coming next month: More on vitamins!

Nancy Collins, PhD, RD, LD/N, FAPWCA, is founder and executive director of RD411.com and Wounds411.com. For the past 20 years, she has served as a consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Elaine Koontz RD, LD, resides in Ohio and works as an acute care clinical dietitian and an outpatient wellness dietitian. She also is a staff writer and member of the management team for RD411.com.

This article was not subject to the Ostomy Wound Management peer-review process.