Group meeting feedback on Moderate Protein Moderate GI Plate picture and Protein Allocation

[Amy Liu]

Hi everyone,

We (NZ) are have just conducted the week 26 (visit 11), post CID 3 group meeting for our first cohort and week 20 (visit 10) for our second cohort.  

From the group meeting, the 'Moderate Protein Moderate GI' group provided these feedback:

1. The plate picture in the Mayer Meyers recipe book unrealistic as the two bread products is on top of one another with 4 potatoes.  

2. Referring to the exchange/servings page: The allocated 1.5 protein exchange e.g. 75g protein per day was too little and could easily go over this.  They said that they cannot even have a 90g tin of tuna for one meal, let alone the whole day.

Has anyone else observed this in your group meetings?

Many thanks and look forward to hearing from you.

Amy and Marta (NZ)

[Amy Liu]

Hi team,

Thank you for your reply... just found a problem with the Food Units Based systems exchanges allocated for the MPMGI group and trying to work out a solution...

The Food Units Based System provided is for the 6MJ + 12MJ plan. After putting the servings allowed through our foods analysis database (Foodworks) - this is what we got...

Higher protein (25%), lower CHO (45%) 6MJ food plan -
250g raw lean meat, 500ml reduced fat milk, 4 slices of bread, 30g toasted muesli, 2 fruit, 225g raw veges, 2 t olive oil, 20g chocolate
= 5418kJ (1294kcal), 92.6g protein (28.6% TE Protein), 33.4g fat (23%), saturated fat 12.5g, 140g CHO (43.3%TE CHO)

Higher protein (25%), lower CHO (45%) 12MJ food plan -
550g raw lean meat, 750ml reduced fat milk, 6 slices of bread, 90g toasted muesli, 2 fruit, 450g raw veges, 5 t olive oil, 50g chocolate
= 11103kJ (2652kcal), 192.3g protein (29% TE Protein), 77.6g fat (26.3%), saturated fat 27.3g, 266.4g CHO (40.3%TE CHO)

Moderate protein (15%), moderate CHO (55%) 6MJ food plan -
75g raw lean meat, 500ml reduced fat milk, 4 slices of bread, 45g toasted muesli, 2 fruit, 225g raw veges, 5 t olive oil, 20g chocolate
= 5661kJ (1352kcal), 60.4g protein (17.9% TE Protein), 47.2g fat (31.4%), 14.5g saturated, 154.7g CHO (45.8%TE CHO)

Moderate protein (15%), moderate CHO (55%) 12MJ food plan -
200g raw lean meat, 500ml reduced fat milk, 10 slices of bread, 90g toasted muesli, 2 fruit, 450g raw veges, 9.5 t olive oil, 50g chocolate
= 10485kJ (2505kcal), 118.6g protein (18.9% TE Protein), 90.6g fat (32.5%), 26.7g saturated, 271.6g CHO (43.4%TE CHO)

The HPLGI seems to be correct... however the MPMGI seems to be too high in fat (>30% TE) and low in CHO (around 45%?)

A few hours later ... working on the most achievable mix without allocating equiv. of 18 slices of bread (12MJ):

MPMGI 6MJ
50g raw lean meat, 500ml reduced fat milk, 6 slices of bread, 45g toasted muesli, 2 fruit, 225g raw veges, 2 t olive oil, 20g chocolate
= 5577kJ (1333kcal), 61.1g protein (18% TE Protein), 34.6g fat (23.4%), 12.4g saturated, 175g CHO (52.5%TE CHO)

MPMGI 12MJ
150g raw lean meat, 500ml reduced fat milk, 12 slices of bread, 120g toasted muesli, 5 fruit, 450g raw veges, 7 t olive oil, 50g chocolate
= 11883kJ (2839kcal), 118.5g protein (16.7% TE Protein), 85.4g fat (27%), 26.4g saturated, 358.2g CHO (51%TE CHO)

I didn't put this into Foodworks previously as I presumed it best fit the 55% TE CHO and 15%TE Protein (MPMGI) - of course it may depend on what is chosen e.g. protein in bread compared to potatoes etc

PS also I was a little concerned with the 3 small potatoes as a serve of CHO - if it's the carbohydrate content, one (bread and cereal) B+C serve is around 18g CHO. Therefore it is equivalent to a small/medium potato (around size 7 egg size). If we were using the 3 small potatoes, each potato must be the about the size of my thumb.

Thoughts? 

[Santiago Navas-Carretero]

Hi NZ and Aus teams,

You are quite ahead from us... :S So your feedback is great!

We have our first cohort on week 12, so they are just getting acquaintanced to their diets, but we have already had some feedback on the cookbook, the first of them, is the high number of times there is the reccommendation on adding salt, which it's easy to solve... don't follow these indications! 

Our volunteers are experiencing problems on finding LowGI bread, as it's not common in Spain, so the team ahve made some visits to supermarkets to try to advise on that.

With regards to the FBRS, I thought that the 6MJ exchanges were only for children and adolescents, we have encouraged our volunteers to try the 8MJ (S size), and they are more or less happy, excep the MP groups with regards to legumes!

I hope to hear more feedback to help us to anticipate issues... ;D

Regards,

Santiago

[Marianne Juhl]

Hi

 

The plate model is based on the principles of the dietary interventions for moderate protein (15 E% protein and 55 E% carbohydrate) described in the protocol. The participants need to consume a lot of carbohydrates such as; potatoes, bread, rice or other carbohydrates and, a small amount of meat, if the ratio between protein and carbohydrates has to be correct. If it is unrealistic for your participants to eat bread and potatoes they “just” have to eat another kind of carbohydratesJ

 

In June last year at the meeting in Copenhagen it was decided that legumes should be avoided in the “moderate protein group”.  In Copenhagen we point out to the participants, before they give their consent, that if they are randomized to the “moderate protein group” they have to eat a lot of carbohydrates, not so much meat and try to avoid legumes, as well as we tell them that if they are randomized to the “High protein group” they are not allowed to eat potatoes for 3 years even though Danes love potatoes. And so far it is not a problem J

 

And you are right; it is not much meat the participants are allowed. Maybe your participants are able to split up their tin of tuna over a couple of days?

 

About the Food Based Replacement System (FBRS) I think it is very useful, that you have calculated it on your own. I double checked to see if I had made a mistake but when I put the servings allowed in our foods database (Dankost Pro) I got this result:

 

 

Moderate protein (15%), moderate CHO (55%) 6 MJ food plan

75g raw lean meat, 500ml reduced fat milk, 4 slices of bread, 45g toasted muesli, 2 fruit, 225g raw veges, 5 t olive oil, 20g chocolate
= 5975 kJ, 16% Protein, 29% fat and 55% CHO

 

If I put your version in our foods analysis database (Dankost Pro) I got this result:

MPMGI 6MJ
50g raw lean meat, 500ml reduced fat milk, 6 slices of bread, 45g toasted muesli, 2 fruit, 225g raw veges, 2 t olive oil, 20g chocolate
 = 6156 kJ, 16% Protein, 20% fat and 64% CHO

And it was the same result with the 12 MJ moderate protein, moderate CHO plan.

So I think that this shows us that there are some national differences that we need to work with. Maybe it could be an idea that every country put the servings allowed in their foods analysis database to see if it’s ok (agrees) and if it’s not, you are allowed to make some changes. The result of the changes should still fit with the demands of the energy distribution in the protocol.

 

In the “new version” of 12 MJ I can see that you have 5 fruits. The official healthy guidelines in Denmark recommend max 2-3 fruits per day!

 

 Marianne

 

[Elli Jalo]

Hi,

we have also been wondering this unit based system. I put one combination of servings in our food analysis database and I got this result:

Moderate protein, moderate GI diet

75 g chicken, 500 ml skimmed milk, 200 g rye bread, 45 g natural muesli, 300 g apples, 225 salad, tomato and cucumber combined, 25 rapeseed oil and 20 g milk chocolate

=5,9 MJ, 57 % CHO, 17 % protein, 26 % fat

In this case the result agreed with study goals. Nevertheless I’m not sure if the result would be same if I would have been chosen different products. For example 1 unit natural muesli contains 18 g CHO, but 1 unit cooked oat porridge contains only 9 g CHO. It would be helpful to know, how much energy, carbohydrates or protein each unit should contain. Are there any calculations available? That would help us if we need to modify unit sizes according to national differences or add some new foods to our unit based system.

Any thoughts?

Elli

[Elli Jalo]

Hi again!

I have continued doing calculations and when I use the unit based system with MPMGI diet the result agrees with study goal. But I agree with Amy and Marta who started this discussion, that very little meat (and also milk products) is allowed for this group. I believe that this goal is difficult to achieve for our participants.

On the other hand when I calculated the HPLGI diet units, I got 31 % protein, 47 % CHO and 21 % fat. So when using Finnish food database, HPLGI diet seems to be quite high in protein and low in fat. I also thought that lower allowance of fat in HP group was because the HP group consumes more fat from meat and dairy products, but if participant selects these products low or non-fat they may need some extra fat. Or what do you think?

I also noticed that when the diet “size” goes up (8MJ, 10 MJ, 12 MJ) the allowance of milk products doesn’t change. Is this because we like to keep the intake of fat from dairy products low?

In HPLGI diet participants need to eat quite a lot of meat, fish and egg. The idea of the unit based system is that units from different food groups can’t be exchanged. What do you think, could meat, fish and egg still be exchanged to milk products especially if non-fat dairy products are selected in order to keep saturated fat intake low?

Elli

[Moira Ann Taylor]

Dear All

We are having similar issues.  I have referred queries to Ulla Pedersen and those working with her who undertook the major task of creating the units list.  She kindly has promised to get back to us with a information about how the units were created when she is able- being busy herself with subjects.

Best wishes

Moira

[Elli Jalo]

Thank you Moira for sending these questions forward!

Great to hear your comments Shannon, we have similar problems. Many our participants following MP diet plan are convinced that they will get too little protein from their diet. We don't currently use XS plan, but even the 100 g allowance of meat/chicken/fish (in S plan) feels too little for our participants. I think that combining meat and dairy groups could help with this issue because the total "protein" allowance would appear larger.

We have also noticed that many participants in MP group are worried about adding bread and potatoes to their diet. They seem to think that eating more carbohydrates will make them gain weight. So I think that at least for some of our participants the goal of 15 % protein and 55 % CHO will be hard to achieve.

Elli