NUDIET HANDOUTS 2019 Page 1 of 7

DIET THERAPY
(see also chapter 12 of your textbook)

CLINICAL NUTRITION
The treatment of patient requiring modifications in their nutritional requirement.
The branch of the health sciences having to do with the diagnosis, treatment and prevention of
human disease caused by deficiency, excess or metabolic imbalance of dietary nutrients.

ROUTINE HOSPITAL DIETS

Refer to the regular, soft and liquid diets commonly used in the hospitals
Differ from one another in consistency and composition to suit individual needs.

REGULAR OR FULL DIET

Consists of all foods eaten by a person in health.
Planned to meet the essentials of an adequate diet.
Recommended for patient not requiring dietary modifications.

THERAPEUTIC DIET
A diet modified or adapted from the normal diet to suit specific disease conditions.
Designed to treat or cure disease.

DIETARY MODIFICATIONS
I. PURPOSE OF DIET THERAPY
To maintain and restore good nutritional status
To correct nutritional deficiencies which may have occurred.
To afford rest to a particular organ or to the whole body which may be affected.
To adjust the diet to the ability of the body to metabolize the nutrients
To bring about the changes in the body weight whenever necessary.

II. FACTORS TO CONSIDER IN THE STUDY OF DIET THERAPY

Underlying disease conditions which require a change in diet
The possible duration of the disease
The factors in the diet which must be altered to overcome these conditions
The patient’s tolerance for food by mouth.

III. THERAPEUTIC MODIFICATIONS OF THE NORMAL DIET

1. To provide change in consistency
e.g. fluids and soft diets
2. To decrease or increase energy values
e.g. high and low carbohydrates
3. To include greater or lesser amounts of one or more nutrients
e.g. High protein and sodium restricted diet
4. To increase or decrease bulk
e.g. high and low fiber diets
5. To provide foods bland in flavor
e.g. bland diet regimen
6. To include or exclude specific nutrient
e.g. elimination diet
7. To modify intervals of feeding
e.g. bland, diabetic and liquid diets

IV. BASES OF MODIFICATION

 Normal requirements: as the RDA, Guide to Good nutrition, Food Guide or
individual requirements
 Previous nutritional status of the individual
 Pathophysiology of the disease
 Anticipated duration of disease and injury
 Dietary factors to be altered
 Amount and character of the nutrient which is being lost in the body
 Patient’s tolerance for food
 Socio‐economic and other considerations such as religious beliefs, custom, etc.
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V. PRINCIPLES OF DIETARY MANAGEMENT

1. Liberalization
The diet should meet the body’s requirement for essential nutrients as generously as the
disease condition permits
2. Individualization
The dietary regimen should take cognizance of the patient’s food intake, habits, economic
status, religious practices and any environmental factors which have a bearing on the diet
such as where the meals are eaten and who prepares them.
3. Simplification
The therapeutic diet should vary from adequate normal diet as little as possible.

VI. HOSPITAL ROUTINE DIET

 Full, house, general or regular diet – designed for patients who require no special
dietary modifications
 Soft Diet
 Liquid Diets – clear, full, cold, osteorized, blenderized, or tube feeding.
NUDIET HANDOUTS 2019
A. MODIFICATION IN CONSISTENCY:
TYPE OF DIET
1. Liquid Diet:
a. Clear Liquid Diet
b. Full Liquid Diet
c. Cold Liquid Diet or sometimes
referred to as T &A diet (after
tonsillectomy and adenoidectomy)
d. Tube Feeding (blenderized or
osteorized)
2. Soft Diet:
a. Minimum Residue Diet
I. THERAPEUTIC DIETS :
CHARACTERISTICS AND INDICATIONS FOR DIFFERENT THERAPEUTIC DIETS
INDICATIONS
Illness or surgery accompanied by marked
intolerance to foods; acute inflammatory
conditions when it is necessary to minimize
fecal material.
Post‐operatively; acute infections, acute
inflammatory conditions of the GIT; for patients
too ill to eat solid or semi‐solid foods; impaired
chewing and swallowing ability, face lifting,
radical mouth surgery
Tonsillectomy, dental extraction, adenoid
surgery and other minor throat and mouth
operations.
Esophageal obstruction, surgery of the mouth
and stomach, severe burns, coma, insanity,
severe malnutrition, paralysis of swallowing
muscles, acute and chronic infections, face
lifting; with functioning GIT but unable to
swallow/eat per orem.
Disease condition involving the bowel like:
dysentery and diarrhea, pre and post‐op periods
when it is desired to reduce fecal residue as in
cases like: colostomy, ileostomy and bowel
resection.
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CHARACTERISTICS
Provides no nutritional essential; foods
included are liquid at body temperature, leave
no residue, non‐distending, non‐irritating and
non‐stimulating to peristaltic action; should be
used for 1‐2 days only.
Intermediary between clear liquid and soft diet;
consists of liquids or strained semi‐liquid foods
and foods that liquefy at room temperature, free
from cellulose and irritating spices and
condiments.
Cold fluids given to prevent bleeding of the
post‐operative area; cooked soft and bland
foods which have been all allowed to cool may
also be given; use only for a limited period of
time.
Composed of food in the soft and liquid diet
blended and liquefied to enable the mixture to
pass thru a polyvinyl tube. Pectin or apple
sauce may be included to prevent diarrhea.
Ideally 1cc=1kcal.
Made up of foods which forms the least amount
of fecal matter; inadequate in Vitamins and
minerals therefore should be supplemented;
should be used for limited time only.
FOOD SELECTION
FOODS ALLOWED: Clear fat free broths, strained
juices, tea, black coffee, salabat, plain, hard candies.
Give small amounts every 1‐2 hours
FOODS ALLOWED: Those included in the clear
liquid diets plus strained cream soups, pureed
strained meat and fish, strained vegetables purees
and fruit juices, strained lugao and oatmeal, plain ice
cream and gelatin, custard or cornstarch pudding,
milk and milk drinks, cocoa, cream in moderation,
melted margarine or butter, 6‐8 small feedings
recommended.
FOODS ALLOWED: Plain ice cream, cold milk,
iced tea, iced coffee, soft drinks, cooked soft bland
foods which have been cooled.
FOODS ALLOWED: All foods included in the soft
and liquid diet which are easily blended, 100‐200 cc
of diluted formula given 2‐3 hours is recommended.
FOODS ALLOWED: Plain and strained soups; lean
and tender beef, liver, skinless chicken, fish and
other sea foods, soft cooked eggs, well-cooked
strained vegetables, strained fruit juices, rice and
other cereals, plain cakes and gelatins, refined
sugars, black coffee and tea.
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FOODS THAT MUST BE AVOIDED: Milk and

Milk drinks, cheese, raw eggs, vegetables and fruits
(except those that are strained) coarse breads, tough
meat, fried foods and rich desserts.
b. Low Residue Diet If this diet is ordered, a soft diet is given
c. Bland Diet Gastric and duodenal ulcers, gastritis, ulcerative An allowance of food and drinks which is FOODS ALLOWED: Those which are mild in
colitis, in some cardiac cases in order to provide chemically, mechanically, and non‐irritating; flavors, no coarse fibers and tough connective
rest to the heart. Foods more likely to cause dyspepsia are tissues, and non‐stimulating food that is tolerated by
omitted; Regularity as well as frequency of the patient.
meals is advised FOODS AVOIDED: Black pepper, chili powder,
strong coffee and alcohol.
d. Mechanical Soft Diet Poor dentures, lack of teeth, presence of sores Foods given requires little chewing FOODS ALLOWED: Foods included in the full diet
and lesions in the mouth maybe given but reduced to small portions by
grinding, chopping, mincing, etc.
e. Low Fiber Diet Spastic constipation, diverticulitis and other Contains a minimum of indigestible FOODS AVOIDED: Gristle and tough connective
gastro‐intestinal disturbances carbohydrates and tough connective tissues tissues in meats, seeds and skins of fruits, vegetables,
whole grains, cereals and coarse breads
2. High Fiber Diet Constipation; Atherosclerosis, diverticulosis, Normal diet with fiber increased to more than 6 FOODS INCLUDED: Those in the full diet with
diabetes g daily; Concentrated foods replaced by those emphasis on long fibered vegetables; raw fruits and
of greater bulk vegetables, whole grain cereals, coarse breads.

B. MODIFICATION IN COMPOSITION:
TYPE OF DIET INDICATIONS
1. Calorie:
a. High Calorie Underweight, PEM, Fever and infections,
hyperthyroidism, burns, growth, pregnancy and
lactation
b. Low Calorie Obesity and those cases where excess weight is
a complicating factor as Diabetes Mellitus,
CVD, Renal Diseases, HTN, Gout, Gall bladder
disease and preceding surgery
CHARACTERISTICS
Contains greater amount of total energy to
effect a positive energy balance; Minerals and
Vitamins remains at or above recommended
level; Gradual rather than drastic increase in
the amount of food given; 3 meals with
in/between feedings
Contain a reduced amount of total energy to
effect a negative energy balance; Protein,
Minerals and Vitamins remain at or above
recommended levels; Distribution of CHO and
fats may follow a normal pattern as long as
total calories are reduced; Drastic reduction
should be avoided
FOOD SELECTION
FOODS INCLUDED: All foods in the normal diet
with increased amount of cereals, breads, butter,
cream and other fats and sugars.
FOODS AVOIDED: Excessive amount of bulky low
calorie foods, fried foods or those which may hinder
with appetite.
FOODS INCLUDED: Protein foods emphasized;
sufficient bulk, low in calories for a satisfied feeling.
FOODS AVOIDED: High fat foods, high CHO
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2. Carbohydrates:
a. High CHO Renal and liver disturbances, Toxemia or
pregnancy, Addison’s disease, preparation for
surgery, hyperthyroidism
b. Low CHO Hyperinsulinism, dumping syndrome, obesity,
epilepsy, celiac disease
3. Proteins:
a. High CHON Growth, pregnancy, lactation, PEM, burns,
surgery, fractures, fever, debilitating conditions,
pernicious anemia, nephrotic syndrome, renal
disease without Azotemia, hepatitis, cirrhosis
w/o impending coma, hyperinsulinism, dumping
syndrome, celiac disease
b. Low CHON Acute glomerulonephritis, uremia, hepatic coma,
chronic glomerulonephritis with nitrogen
retention
c. CHON free or Zero CHON Hepatic coma, acute anuria
4. Fats
a. Low Fat Diet Malabsorption, Steatorrhea, acute attacks of
Pancreatitis and Cholecystitis in Type I
Hyperlipoproteinemia, Celiac disease
b. Modified Fatty Acid Ratio CAD, DM, hypercholesterolemia,
hypertriglyceridemia, atherosclerosis, type II‐V
hyperlipoproteinemia
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CHO in the diet are increased by 50% above
the normal
CHO in the diet are reduced by 50%. Proteins
and/or fats are increased.
A regular diet with proteins increased by 50‐
100% above the normal allowance; about 1/3‐
1/2 and
½‐2/3 of the total protein in diets of adults and
children, respectively, should come from
protein of HBV; enough CHO and fats should
be provided for protein sparing effect
Protein restricted to 50% below the normal
allowance or about 20‐30 g per day; about 2/3
of the total protein prescribed should come
from HBV proteins adequate CHO and fats to
spare protein; and Na and K may be restricted
Used only as emergency measures; high CHO
and fats to prevent tissue breakdown
Severely restricted fats diet allows from 10‐
15% of TEA as fat calories or approximately
20‐30 g fats/day; all foods rich in fats not
allowed or restricted; Foods cooked by method
not requiring addition of fat; Emphasis in
Vitamin A‐rich foods
Calories from fats approximately of normal
level but food sources of PUFA are
emphasized; intake of SFA reduced; Maintain
P/S ratio of 1:1 to 2:1
FOODS INCLUDED: Emphasis on rice and other
cereals, breads and bakery products, root crops,
noodles, sugars and sugar products, native cakes and
the like, fruits, dried beans and legumes.
FOODS INCLUDED: Foods high in proteins;
adequate to high fat foods in certain conditions
FOODS INCLUDED: All foods in the regular diet
with emphasis on milk, eggs, cheese, meat, poultry
and fish
FOODS INCLUDED: Fruit juices if K+ is not
restricted; sugar‐mixtures as buttered‐balls, butter
soups, butter pudding, etc…
FOODS INCLUDED: Fruit juices if K+ is not
restricted; sugar‐mixtures as buttered‐balls, butter
soups, butter pudding, etc…
FOODS INCLUDED: Skimmed milk, eggs, lean
meat, cottage cheese, cereals, fruits, vegetables,
sugars
FOODS AVOIDED: Fatty meat, rich desserts, fried
foods
FOODS AVOIDED: Fats of meat; butter,
hydrogenated margarine, whole milk, cream cheese,
coconut oil
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c. Low Cholesterol Diet Atherosclerosis, hypercholesterolemia, type II‐V
hyperlipoproteinemia, cholelithiasis with
cholesterol esters, CAD
5. Minerals:
a. Na++ restricted Restrictions depend on individual needs; less
severe restrictions when diuretics are used
Levels of Restriction
1. 200‐250 mg Na Severe hypertension intended primarily for
(9‐11 mEq) hospitalized patient whose salt tolerance is low;
Caution is employed to avoid Na depletion,
Azotemia, Refractory heart failure
TYPE OF DIET INDICATIONS
2. 500 mg Na Severe CHF; in renal disease with edema and in
(20 mEq) cirrhosis with ascites and pulmonary edema
3. 1000 mg Na Serious CHF; used as maintenance diet for
(43 mEq) Nephritis, toxemia of pregnancy; for patients
who had a tendency to develop edema
4. 2000‐3000 mg Na Patients with moderate heart damage,
(87‐130 mEq) maintenance diet in renal diseases; steroid
edema; edema of hepatic origin, premenstrual
tension, mild CHF
Eggs limited to 2‐3 per week; Dietary
cholesterol reduced to less than 300 mg/day
Diets where the Na content is limited to a
specific level which may range to mild
restrictions to severe restrictions; provides an
adequate diet with a prescribed level of Na
according to To individual needs
Lowest level of Na restriction
CHARACTERISTICS
Strict Na restriction
Moderate Na restriction
Mild Na restriction. Essentially normal diet;
moderate use of salt in food preparation
FOODS ALLOWED: Lean meat only or fish, 2‐3
egg yolks/week, egg white as desired, skimmed milk,
cottage cheese, vegetables and fruits, corn starch or
rice pudding prepared with skimmed milk; Honey
sugar
FOODS AVOIDED: Glandular organs, oysters, roe,
caviar, animal fats, cream cheese, whole milk,
cream, butter, ice cream
FOODS ALLOWED: Special attention given to the
choice of foods which are naturally low in Na
content
FOODS AVOIDED: Canned, cured, processed foods
which uses salt and Na containing flavoring agent
and preservatives; salts, patis (fish sauce), vetsin and
toyo (soy sauce) are omitted from the table or the
tray
FOODS ALLOWED: Rice or oatmeal as substitute
for regular bread at breakfast. Ham used instead of
butter and margarine; Meat limited to 4 exchanges
per day, unsalted vegetables, oils for cooking; only
low Na milk.
FOODS AVOIDED: Butter, margarines, commercial
products. Other foods not stated above.
FOOD SELECTION
FOODS ALLOWED: Ordinary evaporated milk is
used but no more than 2x/day. Include the food plan
in a 200mg Na diet plus two exchanges of butter and
margarine/day. Other foods not stated above.
FOODS ALLOWED: Include the food plan in the
500 mg diet plus ¼ tsp. NaCl/day. In a Na restricted
High protein diet, this additional salt is omitted
FOODS ALLOWED: May allow moderate use of
salt in preparation.
FOODS AVOIDED: Further addition of salt, toyo,
patis or other salty condiments at the table or on the
tray. Highly salted foods.
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b. K+ restricted Diet Renal Failure, Hyperkalemia, Addison’s The K+ content of the diet is reduced to about FOODS ALLOWED: Cereals and bread; sugars,
Disease, Oliguria, Anuria 1.0‐1.5 g/day fats, protein foods, fruits and vegetables in the
prescribed amounts.
FOODS RESTRICTED: Milk, cream, eggs, meat,
fish, poultry, fruits, vegetables
c. Ca++ restricted Diet Calcium stones, hypercalcemia, recurrent The calcium content of the diet is reduced to FOODS RESTRICTED: Milk, cheese, eggs, nuts,
pancreatitis, diagnostic test for approx. 150 and 350 mg/day in adults and meat, and other high Ca++ foods
hyperparathyroidism children respectively
6. Ash Content:
a. Acid Ash Diet Kidney stones, Ca++ and Mg++, phosphates, Acid ash foods are emphasized; neutral foods FOODS INCLUDED: meat, fish, poultry, eggs,
carbonates and oxalates used as desired. Usually formed by chlorine, whole grain cereals, bread, noodles, prunes, corn,
sulfur, and phosphates. NEUTRAL FOODS: Butter, sugar, plain candies, oil
and fats, coffee, tea
b. Alkaline Ash Diet Kidney stones, uric acid and cysteine calculi Alkaline ash foods are emphasized; acid ash FOODS INCLUDED: Large amount of fruits,
foods limited to those necessary for good vegetables, milk
nutrition. Neutral foods used as desired. NEUTRAL FOODS: Butter, sugar, plain candies, oil
Usually formed by Na, Ca, Mg, and K. and fats, coffee, tea
FOODS AVOIDED: meat, poultry, fish, cheese,
noodles, cereals bread, prunes and corn.