THERAPEUTIC DIET AND NUTRITION

DIET

Nutrition therapy interventions used in the treatment of a disorder or illness and includes diet therapy , nutrition counseling or the use of specialized nutrition therapies such as supplementation with nutritional or medical foods and nutritional support through enteral or parenteral methods

DIET - an allowance of food and drink consumed regularly by an individual.

Recommended Dietary Allowance - recommended levels of energy and nutrient intakes for a a specific population group.

Definition of terms

Based on average requirement It has plus allowance , called margin of safety to cover variations in individual requirements and incomplete utilization of food

Dietary history a record of the usual day to day food intake of an individual. It is part of the nutritional history and can be taken by means of recall or by food record Nutritional history record of events related to the act of nourishing the body. It includes dietary history, socioeconomic factors such as income, educational backround and other data relevant to nutritional status

Definition of terms

Therapeutic diet a diet modified or adopted from the normal diet to suit specific disease conditions, one designed to treat or cure disease , or to support medical management of a disease Dietary guidelines qualitative advice on healthy eating Food exchange lists gropuings of food with similar carbohydrate , protein and fat content designed to facilitate planning of computed diets and serve as basis for further classifying foods according to content of other components

Definition of terms

Desirable body weight Infants weight

Desirable body weight

Children : (Age in years x2 ) + 8 Adults : ( height in cm -100 ) 10 % Doubles at 5-6 mos. Triples at 12 mos. Quadruples at 24 mos.

INFANTS 120 110 KCAL / KDBW CHILDREN 100+ (100 x AGE IN YEARS) ADULTS 1 KCAL / KDBW/ HR + PHYSICAL ACTIVITY = % ABOVE BASAL

TOTAL CALORIE REQUIREMENT

BEDREST- 10 SEDENTARY -30 LIGHT 50 MODERATE -75 HEAVY 100KCAL

DISTRIBUTION OF TER

CHO 50-70 % OR AVERAGE OF 60 CHON 10-20% FATS 20-25 AND 30-45%

Modifications of the normal diet

Therapeutic diets

Change in consistency. Increase or decrease in energy values Greater or lesser amount of certan nutrients Increase or decrease in bulk

Alterations in flavor Include or exclude specific foods Modify intervals of feeding

Indication Characteristics Food selection

diets

Illness or surgery marked by intolerance to food, acute inflammatory conditions of the GIT, for conditions requiring:decreased fecal material. Inadequate in nutritional essentials, liquid at room temperature.use for 1 -2 days only.

Clear liquid diet

Clear fat free broths , strained juices,tea and coffee , salabat, plain gelatin , sugar plain, hard candies

Full liquid diet

Post op , acute infection, acute inflammatory conditions of the G.I.T. for patients too ill to eat solid or semi solid foods, impaired chewing and swallowing ability Liquid at room temp. and free from cellulose and and irritating spices and condiments. 6-8 small feedings recommended Strained cream or soups, pureed strained meat and fish,strained fruit juices ,plain ice cream and plain gelatin, constarch pudding and milk and cocoa

Patients who are unable to chew, swallow or digest foods included in the full diet.mild to moderate infectionSimple GI disturbances and convalescence Modification in consistenncy and texture Foods low in cellulose content low in fiber free from connective tissues and strong flavors, simple and easily digested

Soft Diet

Dysentery , diarrheas , pre-op and post op when it is desired to reduce fecal residue, as in colostomy, ileostony , and bowel resection. Made of foods which form the least anount of fecal matter, inadequate in vitamins and minerals therefore supplementation is instituted Cereals strained soups, chicken (no skin) LORES

Low residue diet

Gastric and duodenal ulcers, gastritis , ulcerative colitis, in some cardiac cases in order to provide rest to the heart Foods are non iiritating Mildly flavored foods without fiber, connective tissue, and should be non irritating and non stimulating ( avoid alcohol , coffee black pepper and chili powder

Bland diet

Poor dentures , lack of teeth, presence of sores and mouth lesions, mechanically unable to chew, masticate and digest foods. Foods given require little chewing Grinded, chopped , minced and pureed food

Mechanically soft diet

Atonic constipation, Atherosclerosis, diverticulosis, DM More than 10 grams Full diet with emphasis on long fibered vegetables , raw fruits and vegetables, whole grain cereals and coarse breads

High fiber diet

Underweight, protein energy malnutrition, fevers and infections, hyperthyroidism, burns, growth pregnancy and lactation 3 meals with inbetween feeding gradual rather than drastic. Vitamins and minerals at or above RDA. Contains greater amount of total energy Cereals, bread, butter , cream and other fats and sugar

High caloric

Obesity and those cases where excess weight is a complicating factor as DM, CVD, renal Dx , HPN , gout , gall bladder Dx and preceeding surgery Contains reduced amount of energy to effect a negative energy balance Sufficient bulk , low in calories . Avoid high fat foods and high CHO foods

Low caloric

VEGAN INCLUDES FRUITS VEGETABLES, NUTS , SEEDS. EXCLUDES ALL SOURCES OF ANIMAL PROTEIN, FORTIFIED FOODS AND NUTRITIONAL SUPPLEMENTS LACTOVEGETARIAN DIET- VEGAN DIET PLUS MILK AND MILK PRODUCTS OVOVEGETARIAN DIET- VEGAN + EGGS LACTOOVOVEGETARIAN DIET- VEGAN + FISH RED-MEAT ABSTAINERS CONSIDERED AS VEGETARIANS ABSTAIN FROM RED MEAT

VEGETARIAN DIET

VITAMIN B 12 RISK DEFICIENCY ASSOCIATED WITH MEGALOBLASTIC ANEMIA RISK TOXIC LEVELS OF VITAMIN A CAUSING ANOREXIA, IRRITABILITY,DRY SKIN AND HAIR LOSS

AMOEBIASIS-LIBERAL FLUIDS ,LIQUID TO BLAND,LOW RESIDUE, HIGH CALORIC AVOID RAW FOODS PARASITISM HIGH CALORIC ,HIGH PROTEIN INC. IN IRON AND VITAMIN C CDT HIGH CAL, HIGH CHON, HIGHVITAMIN AND MINERAL SUPPLEMENTS. SOFT, BLAND AND MOD TO LOW FAT TB SUFFICIENT CAL. HIGH PROTEIN, VIT. B6 ,CALCIUM, IRON, VIT A,C,K. CELLULOSE AND AGAR

DIETARY ADJUSTMENTS FOR SPECIFIC DISEASES

INFECTIOUS HEPATITIS HIGH CARB. F&E REPLACEMENT, SMALL , FREQUENT MEALS AIDS AND IMMUNOSUPRESSED PATIENTS FOOD SAFETY, NO RAW, UNDERCOOKED FOOD RABIES HIGH CALORIC AND BLENDERIZED FEEDING GASTRECTOMY SMALL FREEQUENT FEEDINGS

HIGH FAT AND PROTEIN, DRY SOLID,LOW FIBER AND LOW RESIDUE, NO ALCOHOL OR SWEET CARBONATED BEVERAGES,HIGH CALORIC, SIMPLE CHO RESTRICTED

ILEOSTOMY AND COLOSTOMY CLEAR FLUID AT FIRST, LOW RESIDUE AND BLAND, HI CALORIE AND HIGH PROTEIN, VIT. B SUPPLEMENTED JEJUNOILEOSTOMY LOW FAT, LOW CHO , LOW FIBER , HIGH PROTEIN AND SIX SMALL FEEDINGS PERITONITIS AND INTESTINAL OBSTRUCTION NPO AND CLEAR LIQUIDS TO LOW RESIDUE

BURNS HIGH CALORIC ,CHON , CHO, MAY REQUIRE TPN OR TUBE FEEDING, ORAL NUTRIENT SUPPLEMENTS, VIT. B1 AND C, ANTACIDS TO PREVENT CURLINGS ULCER. NGT TO PREVENT GASTRIC DISTENTION, EARLY ACUTE GASTRIC DILATION AND PARALYTIC ILEUS WITH BURN SHOCK.MONITOR BOWEL SOUNDS.

FIRST 24-48 HOURS ( LOW POTASSIUM) 48-72 HOURSHIGH POTASSIUM

IMMEDIATE SHOCK PERIOD(1-3)- FLUID THERAPY, ELECTROLYTES SODIUM AND CHLORINE BY USE OF SALINE SOLUTION RECOVERY PERIOD(3-5)-CAREFUL I AND O SECONDARY FEEDING PERIOD(6 15)

BURNS- EMERGENT,HYPOVOLEMIC AND DIURETIC

HIGH CHON , VIT C, HIGH CAL AND VIT B COMPLEX

TOTAL ENERGY REQUIREMENTS [ 25 KCAL X PRE BURN WEIGHT (KG.)] + [ 40 KCAL X % BSA BURNED] ADULT

BURNS

CHILDREN 30 KCAL TO 100 KCAL FLUIDS 2 4 ML. / KBW X BSA = TOTAL 24 HOURS

AGE CLEAR LIQUID AGN LOW NA , LOW CHON ADDISONS HIGH NA , LOW K ANEMIA , PERNICIOUS HIGH CHON , VIT. B. ANEMIA SICKLE CELL HIGH FLUID GOUT PURINE RESTRICTED ADHD AND BIPOLAR FINGER FOODS BURN HIGH CAL. HIGH CHON CELIAC GLUTEIN FREE CHOLECYSTITIS HIGH CHON, HIGH CARB, LOW FAT CHF LOW NA , LOW CHOL. CROHNS HIGH CHON AND CHO, LOW FAT

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

CYSTIC FIBROSIS HIGH CAL., HIGH NA LITHIASIS----ACID ASH FOR ALK. STONES------ALK. ASH FOR ACID STONES DECUBITUS ULCERS HIGH CHON , HIGH VIT C DIARRHEA HIGH K AND NA DUMPING SYNDROME HIGH FAT, HIGH CHON,DRY HEPATIC ENCEPHALOPATHY-LOW CHON HEPATITIS HIGH CHON,HIGH CAL. HIRSPRUNGS LOW RESIDUE, HIGH CHON AND CHO CIRRHOSIS LOW CHON MENIERES LOW NA MI AND HPN LOW CHOL.,FATS,NA HYPERTHYROIDISM- HIGH CAL. AND CHON HYPOTHYROIDISM LOW CAL. , LOW CHOL, LOW SAT. FAT

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

NEPHROTIC SYNDROME LOW NA, HIGH CHON , HIGH CAL. HYPERPARATHYROIDISM LOW CALCIUM HYPOPARATHYROIDISM HIGH CA, LOW PHOSPHORUS OSTEOPOROSIS HIGH CALCIUM AND HIGH VIT. D PANCREATITIS LOW FAT PUD HIGH FAT, HIGH CARB. LOW CHON

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

PKU LOW CHON / PHENYLALANINE PIH HIGH CHON PEDYA FOR CONS AND DIARR - BRAT

RENAL FAILURE (ACUTE) LOW CHON,HIGH CARB

LOW NA (OLIGURIC PHASE) HIGH CHON , HIGH CAL AND RESTRICTED FLUID (DIURETIC PHASE

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

RENAL FAILURE (Chronic) LOW CHON , LOW NA , LOW K

BREAD CEREAL PASTA RICE 6-11 VEGETABLES 3-5 FRUIT 2-3 MEAT,POULTRY, BEANS EGGS AND NUTS 2-3/4 MILK,YOGURT AND CHEESE 2-4 FATS OILS SWEETS SPAR.

EXAMPLES EXAMPLES EXAMPLES EXAMPLES DAILY SERVINGS

Transcultural Diet- dietary prohibitions( pg. 199)

HINDU- all meats and animal shortening ISLAM- pork , alcohol and beverages(extracts of lemon and vanilla) , animal shortening and gelatin made of pork JUDAISM pork , fowl , shellfish and scavenger fish( without scales or fins) , blood by ingestion(transfusion o.k.), packed fods kosher-properly presserved or fitting

KOSHER- no meat and milk altogether Pareve made without milk or meat items

MORMON alcohol, tobacco, beverages with caffeine stimulants 7TH DAY ADVENTIST pork , certain seafoods including shelfish, fermented beverages , vegetables are encouraged YIN AND YANG cold foods in hot illness , vice versa

Hot rash , fever , sorethroat , surgery , ulcer , infection Cold Ca , HA , stomach cramps and colds

Acid-ash diet Retards the formation of alkalinic renal stones Indicated to patients with renal calculi (Alkaline stones) E.g. cheese, cranberries, eggs, meat, plums, prunes, whole grains Alkaline ash diet Retards the formation of acid renal stones. Indicated to patients with renal stones (Acidic stones) E.g. fruits (except cranberries, plums, prunes), milk, vegetables Bland diet Low fiber, mechanical irritants, chemical stimulants Indicated for patients with gastritis, diarrhea, biliary indigestion, and hiatal hernia BRAT Diet Banana, Rice, Apple. Toast Indicated for patients with diarrhea Butterball diet Spare protein but high in carbohydrates Indicated for patients with liver disorders Clear liquid Diet To relieve thirst and help maintain fluid balance Indicated for post-operative patients and following vomiting and gastroenteritis Diabetic Diet Well balance diet The purpose is to maintain near to normal blood glucose level Indicated to patients with diabetes mellitus
Full liquid diet It serves to provide nutrition to patients who cannot chew or tolerate solid foods Indicated to patients with stomach upsets, post-surgical patients, after progression from clear liquid diet Giordano Diet Spare protein Indicated to patients who suffers from Chronic renal Failure Gluten free Diet No to B R O W Barley. Rye. Oat, Wheat This is the diet of a patient who suffers from celiacs Disease Halal Diet

No pork diet Diet of the Moslems High Fiber Diet Fruits and vegetable It speeds up the passage of food to the digestive tract, it softens the stool, Indicated to patients who are constipated, with diverticolosis, with hyperlipedemia

High Protein Diet Lean-meat, cheese, eggs, Indicated to patients with nephrotic syndrome Kosher Diet Meat ad milk cannot be served simultaneously Diet of the Orthodox Jews Low carbohydrate diet Indicated to patients with dumping syndrome Low fat/cholesterol Diet It serve the purpose of reducing hyperlipedemia, and to patients with intolerance to fats Indicated to patients with cardiovascular diseases, patients who underwent resection of the small intestines, hypertension cholecystitis and cholelithiasis
Low Residue diet Reduces the bulk of stools Indicated to patients with ulcerative colitis, diverticulitis, patients who will undergo surgery of the GI tract Low Sodium Diet Indicated to patients with cardiovascular and renal disorders Purine restricted diet To reduce uric acid Indicated to patients with gouty arthritis, renal calculi, and hyperuricemia Sodium-restricted diet Indicated to patients with heart failure, hypertension, renal diseases, PIH, and steroid therapy Soft diet Used to provide nutrition for those patients who have problems in chewing For patients with ill-fitting dentures; transition from full-liquid to general diet, patients with gastrointestinal disturbances such as gastric ulcers and cholelithiasis

Use to prevent hypertensive crisis for patients who are taking-in MAOI antidepressant.

Tyramine-free Diet

No to ABCs- Avocado, Banana, Canned and Processed Foods, and also, no to fermented foods

Vegan Diet

Diet of the Seventh Day Adventists

Yin Diet Cold deserts after a surgery. It is a Chinese belief.

Water Soluble Vitamins Vit. C. (Ascorbic Acid)
prolonged deficiency- scurvy

Vit. B Complex Vit. B1 (Thiamine)

Prolonged deficiency- Beri-beri

Vit. B2 (Riboflavin)
Prolonged deficiency- Skin Lessions

Vit. B3 (Niacin)
Prolonged deficiciency- Pellagra

Vit. B6( Prridoxine)

Peripheral Neuritis

Vit. B9 (Folic Acid/ Follacin)

Prolonged deficiency- Megaloblastic Anemia

Vit. B12 (Cobalamine/ Cyanocobalamine)

Prolonged deficiency- Pernicious Anemia

Panthotenic Acid
Deficiency- fatigue, sleeplessness, nausea, poor coordination

Biotin
Deficiency- fatigue, depression

Fat-Soluble Vitamins Vit. A. (Retinol)

Deficiency- Night Blindness and Opacity of the Lens

Vit, D( Ergocalciferol) Vit. E(Tocoferol)

Deficiency to Children: Rickets Deficiency to Adult: Osteomalacia Defieciency- Anemia

Vit. K( Menadione)
Deficiency- Bleeding

The following diseases need a high folic acid diet except

Malnutritional anemia and IDA Chronic Alcoholism and IDA Pregnancy

Lactation and chronic alcoholism Bleeding disorders of pregnancy