Diet and Nutrition

• Diet Therapy

  • modification of the food and drink of an individual who is suffering from a disease for the purpose of removing or at least alleviating the result of the disease process
• Diet Therapy Objectives

  • to main good nutrition or correct any deficiency
  • to help prevent or manage medical conditions, including their symptoms
  • to provide rest to the body or an organ
  • to adjust body weight to a desirable body level
  • to supply a dietary regiment (kind and amount of food and eating time) according to the patient's metabolism
• Diet Therapy: Factors to Consider in the study of diet therapy

  • underlying disease condition
  • possible duration of therapy
  • factors in the diet that must be altered to overcome these conditions
  • patient's tolerance for food by mouth
• Diet Therapy: Diet Modification

  • change in consistency of food
  • increase or decrease in the energy value of food
  • increase or decrease in the bulk of food
  • include or omit specific kinds of food
  • adjustment in the composition of nutrient
  • modify the flavor of food
• Diet Therapy: Basis of Modification

  • normal requirement - recommended dietary allowance (RDA), recommended energy and nutrient intake (RENI)
  • previous nutritional status of the individual
  • pathophysiology of disease
  • anticipated duration of disease and injury
  • dietary factors to be altered
  • amount and character of nutrients that are being lost from the body
  • patient's tolerance for food
  • socio-economic and other consideration such as religion and custom
• Diet Therapy: Principles of Dietary Management

  • Liberalization - meet the body's requirement for essential nutrients as generously as the condition permits
  • Individualization - diet regimen should take cognizance of the patient's food intake habits, preferences, economic status
  • Simplification - should vary from the adequate normal diet as little as possible
• Food Nutrient

  • carbohydrates
  • protein
  • lipid
• Food Nutrient: Carbohydrates

  • organic compound containing C, H, & O
  • Function:
  • chief source of energy (protein sparer)
  • regulator of fat metabolism and gastrointestinal peristalsis
  • body constituent
  • Provides the primary source of energy intake (40-80% of total energy intake)
  • RDA: 55-70% of Total Caloric Allowance (TCA)
  • Energy yield: 4Kcal/g
• Food Nutrient: Protein

  • elements that contain C, H, O & N
  • Function:
  • essential for growth and source of energy
  • regulator of body processes
  • Energy yield: 4Kcal/g
• Food Nutrient: Lipid

  • contain elements like C,H, & O but with different proportion and structural arrangement
  • lower proportion of oxygen than carbohydrate
  • water insoluble but soluble in organic solvents
  • functions:
  • concentrated source of energy and essential fatty acids
  • important constituent of body compounds
  • acts as insulator and padding
  • RDA: 20-30%
  • Energy yield: 9Kcal/g
• Nutritional Requirements (Adult)

  • Body Mass Index
  • Desirable Body Weight
• Nutritional Requirements (Adult): Body Mass Index

  • Number that shows body weight adjusted for height
  • for adults aged 20 years old and older, BMI fall into one of these categories
  • underweight
  • normal
  • overweight
  • obese
• BMI Categories

  • Emaciated = > 15
  • Underweight = 15 -18.5
  • Normal = 18.5 -24.9
  • Overweight = 25-29.9
  • Obese = 30-39.9
  • Morbidly Obese = 40<
• BMI Formulas

  • (lbs/in^2) x 703
  • (kg/m^2)
  • (kg/cm^2) x 10,000
• Nutritional Requirements (Adult): Desirable Body Weight

  • not the actual weight of the individual
  • used as the basis in the calculation of TER or TCA
  • Formulas
  • Height-Weight Table of FNRI
  • Modified Tannhausers method in the absence of height-weight tabel
  • NDAP Formula (Nutritionist- Dieticians Association of the Philippines
• Modified Tannhausers Method

  • DBW (kg) = {Height (cm) - 100} - 10% {height (cm) - 100}
• NDAP Formula

  Males 5ft = 112 lbs + 4lbs for every inch above 5ft, - 4lbs for every inch below 5ft

  Females 5ft = 106 lbs + 4lbs for every inch above 5ft, - 4lbs for every inch below 5ft
• Nutritional Requirements (Adult): Desirable Body Weight

  • Obese if BW is > 20% above the desirable weight
  • Overweight if weight is > 10-20% above the desirable weight
  • Normal if the weight is +,- 10% of the desirable body weight
  • Underweight if the weight is < 10% below the desirable weight
• Determination of Total Energy Requirements (TER) or Total Caloric Allowance (TCA)

  • Basal Metabolic Rate (BMR)
  • Minimum amount of energy needed to maintain the vital process of life under basal condition
  • BMR = 1Kcal/kg x DBW x 24 hours
• Determination of Total Energy Requirements (TER) or Total Caloric Allowance (TCA): Physical Activity

  • Hospital Patient - 10%
  • Sedentary - 30%
  • Light (Clerks, Typist) - 50%
  • Moderate (HW, Shoemaker, Fishermen, Driver, Student) - 75%
  • Heavy (Construction worker, athlete) - 100%

  PA = BMR x %PA Classification
• Determination of Total Energy Requirements (TER) or Total Caloric Allowance (TCA): Thermogenic Effect of Blood (Specific Dynamic Action) (SDA)

  • the energy required for digestion, absorption, transport, and utilization of food
  • SDA = (BMR + PA) x 0.06 adults (> 12 yo) or 0.15 child (< 12 yo)
• Determination of Total Energy Requirements (TER) or Total Caloric Allowance (TCA): NDAP Method

  • TCA = DBW x 40
  • to lose 1-2 lbs/weel, subtract 500 Kcal from the calculated TCA respectively and add the same amount of Kcal/g to gain 1-2lbs/week
  • NDAP recommendation for overweight/obese adult
  • compute allowance based on DBW and subtract 500Kcal/day
  • if only moderately overweight, recommended exercise and avoidance of fats and sugar
• Determination of Total Energy Requirements (TER) or Total Caloric Allowance (TCA): Factorial Method

  • TCA or TER = BMR + PA + SDA
• Nutritional Requirement (Pedia)

  • Waterlow Classification for Wasting
  • Waterlow Classification for Stunting
  • Gomez Classification
• Nutritional Requirement (Pedia): Waterlow Classification for Wasting

  • (Actual weight/ ideal weight for height) x 100
  • Classification
  • Normal = >90%
  • Mild = 80-90%
  • Moderate = 70-80%
  • Severe: <70%
• Nutritional Requirement (Pedia): Waterlow Classification for Stunting

  • (actual height/ideal height for age) x 100
  • Classification
  • Normal = >95%
  • Mild = 90-95%
  • Moderate = 80-90%
  • Severe = <80%
• Nutritional Requirement (Pedia): Gomez Classification

  • (actual weight/ ideal weight) x 100
  • Classification
  • Normal = 91-100
  • First Degree Malnutrition = 76-90
  • Second Degree Malnutrition = 61-75
  • Third Degree Malnutrition = <60
• Protein Energy Malnutrition

  • Kwashiorkor
  • Marasmus
• Kwashiorkor

  • develops in children whose diets are deficient of protein
  • occurs in children between 6 months and 3 years of age
  • subcutaneous fat is preserved
  • Edema is present
  • enlarged fatty liver
  • ribs are not very prominent
  • lethargic
  • muscle wasting mild or absent
  • poor appetite
  • need adequate amounts of proteins
• Marasmus

  • due to deficiency of proteins and calories
  • common in infants under 1 year of age
  • subcutaneous fat is not preserved
  • edema is absent
  • no fatty liver
  • ribs become very prominent
  • severe muscle wasting
  • voracious feeder
  • needs adequate amount of proteins, fats, and carbohydrates
• Different Diets

  • Regular, Normal, or Full Diet
  • Clear Liquid Diet
  • Cold Liquid Diet
  • Full Liquid or General Liquid Diet
  • Tube Feeding Diet
  • Soft or Light Diet
  • Mechanical Soft Diet
  • Bland Diet
  • High Fiber Diet
  • Fiber Restricted Diet
  • Kilocalorie Restricted Diet
  • High-Calorie Diet
  • Lactose-Free Diet
  • High Protein Diet
  • Protein Restricted Diet (Giordano Giovanetti)
  • Phenylalanine Restricted Diet
  • BRAT Diet
  • Hypoallergenic Diet
• Regular, Normal, or Full Diet

  • food is normally eaten by a healthy person in good health
  • required good menu planning
  • to maintain an individual in a state of nutritive sufficiency
  • use as a basis for planning therapeutic diets
  • for patients whose condition does not require any modification
• Clear Liquid Diet

  • Highly restrictive
  • little nutritive value
  • with some electrolyte
  • food that leaves no residue in the GIT
  • oral source of fluid and a small amount of Kcal and electrolyte for preventing dehydration, relief of thirst, and reducing colonic residue
  • pre-op and post-op cases
  • diarrhea, vomiting, and acute inflammation of the GIT
• Cold Liquid Diet

  • served cold or iced
  • acidic fruit juices and hot soups are avoided
  • to minimize pain and swelling and reduce bleeding in the operated areas
  • post-tonsillectomy, dental extraction, minor operation of the mouth
• Full Liquid or General Liquid Diet

  • generally liquid or quickly liquefy at body temperature
  • free from cellulose or condiments
  • nutritionally adequate
  • oral nourishment that is well tolerated by patients who are acutely ill or who are unable to swallow or chew solid foods
  • oral surgery or plastic surgery of the face and neck
  • transition from clear liquid to a soft or full diet
• Tube Feeding Diet

  • pureed food that may be administered through a tube
  • complete nourishment in a form that will easily pass through a tube; oral feeding methods are contraindicated or not tolerated
  • enteral nutrition, comatose, following stroke, anorexia nervosa, head and neck surgery
• Soft or Light Diet

  • soft in consistency, easy to chew, no harsh fiber
  • nutritionally adequate
  • dietary steps between full liquid or regular diet
  • given to patients with acute infection, some GIT disturbance, fever
• Mechanical Soft Diet

  • soft in consistency, easy to chew, no harsh fiber
  • nutritionally adequate
  • provide food that requires minimal chewing
  • given to patients with poor dentures, oral surgery, elderly
• Bland Diet

  • soft in consistency, easy to chew, no harsh fiber
  • nutritionally adequate
  • provide a diet which is chemically, thermally, mechanically, and non-irritating
  • given to patients with acute infection, some GIT disturbance, fever
• High Fiber Diet

  • high in cellulose, lignin, and pectin
  • to increase the volume and weight of the residue that reaches the distal colon, to increase GIT motility
  • given to patients with constipation, Irritable bowel syndrome, DM