Ch 2 clinical nutrition & dietetics

• Nutrition is the science of food nutrients and other substances, their digestion, absorption, and utilization by the body
• Optimum nutrition is important for providing immunity, protection from infection, promoting recovery from illnesses, and managing chronic diseases
• When nutrient intake is inadequate, the body struggles with maintaining immune defenses, healing wounds, utilizing medication, and supporting organ functions
• Nutrition plays a major role in the management and treatment of diseases, complementing medical treatment in some cases
• Health and nutrition are intimately interlinked, poor nutrition not only to health problems but can also make existing problem worse
• The specialized area of nutrition dealing with nutrition during illness is known as clinical nutrition or medical nutrition therapy
• Significance

  Prelevance of non communicable diseases such as obesity, heart disease, hypertension, and diabetes is increasing at a much younger age. India is likely to be the diabetes capital of the world, older persons require special attention thus the proportion of population, which requires nutritional care support and diet counseling is increasing. The clinical nutritionist or medical nutrition therapist plays an important role in prevention of diseases and promotion of good health, Besides recommending therapeutic diets for management of various diseases
• Antioxidants like beta-carotene, selenium, vitamin e and c have a protective role
• Nutraceuticals - Foods which have health benefits or some nutrition is added and has a direct influence on your health
• Phytochemicals/bioactive compounds-  Foods which do not have any nutrient in itself but plays a role on the physiological or biological functions of the body. example Fiber, vitamins, minerals
• Medical foods- foods which are specialized for a particular purpose for Medically required individuals.

  Example lactose free Milk
• Objectives of diet therapy

  Modifying diet based on food habits. such as vegetarian and non vegetarian, place, religion

  Aims to keep the decease under control through diet

  Correction of nutritional deficiencies

  Preventing long term or short term diseases

  Counsel or advise the patient regarding why he or she should follow the prescribed diet
• Factors

  • Nutritional stress
  • Psychological stress
  • Effect of illness on food acceptance
  • Acceptability of modified therapeutic diet.
• Activities done by a nutritionist

  • Assessing nutritional status
  • Diagnosis of nutritional problems through reports
  • Planning a diet to meet the requirements of an individual
  • Monitoring and evaluating nutritional care outcomes, and making changes if necessary.
• Study of clinical and diet to take enables professionals to

  • Plan diets to meet nutritional requirements at various stages of life cycle
  • Modifying diseases at various daisies conditions
  • Plan diets for individuals in special situations such as military sports space
  • Planning Diet for impatient or outpatients
  • Planning diets for institutions Like workplace canteens hostels
  • Helps individuals with lifestyle diseases like hypertension, diabetes, obesity.
• Information required by a dietitian to prescribe a diet:

  • Needs to know your medical reports
  • Personal info: eating habits, frequency of eating out, etc.
  • Anthropometric measurements: height, weight, and other relevant measurements
  • Interrelate everything come to a conclusion and then a meal plan is prepared and suggested.
• Normal/Regular diet consists of all the 5 food groups and is balanced
• Modified diet - are those that are adjusted to meet the medical needs of a patient. It includes :

  • change in consistency
  • increase or decreasing calories,
  • increase or decrease In particular nutrients
  • change the number of meals
• Change in consistency

  1. Full Liquid diets - fluid in consistency at room temperature. Given when there is a swallowing difficulty. They are free from fiber and nutritionally adequate. Advantage: nutrients are easily absorbed.
  2. Clear Liquid diets - it is very thin in consistency. It is only given for a short period of time usually post operation to check the tolerance for food. It includes coconut water, clear soup, lemon juice etc disadvantage: it is not nutritionally adequate
• Change in consistency

  1. Soft diets - they are semi solid foods that are lightly seasoned and do not contain much fibrous or gas forming foods. They are easy to chew. Given when rest to digestive system is recommended. Example: khichdi, kheer etc
  2. Mechanical soft diet - Modifications made for normal adults in the older age group. Includes soft mashed and pureed foods.
• Feeding routes:

  1. Orally or mouth- the best and most preferred route for feeding patient
  2. Tube feeding- nutritionally complete foods are delivered through a tube which is introduced through the nose into the stomach (chew or swallowing difficulty)
  3. Intravenous feeding- the patient is nourished with special solutions which are given through a drip in a vein. (Unconscious)
• Prevention of chronic diseases

  Nutrition is required to prevent or postpone chronically deceases

  having good Diet and nutrition can control and delay the age of one set of chronic diseases.
• Preparing for a career

  Basic knowledge about nutrition, food science, composition, clinical nutrition and dietetics

  Needs to study biology, physiolog, biochemistry, microbiology and food microbiology and safety.

  Have a habit of record keeping

  To work in a hospital as a clinical nutritionist you will also need epidemiology
• Required qualifications for a career

  Pass 12th followed by a BSc degree in homescience with a major in food science

  Undergo an internship in a reputed hospital for 6 months to 1 year or get an MSc after BSc

  To be a registered dietitian you have to pass RD

  To teach have to clear NET (national eligibility test)for government colleges and SET for government schools conducted by UGC (University grants commission)
• Career avenues:

  Dietitian in hospitals

  Freelance dietitian

  Teaching and academics

  Technical writing

  Nutrition marketing