NUTRITION SUPPORT AND DIET MODIFICATIONS

Diet Therapy

It is the branch of dietetics that is concerned with the use of food for therapeutic purposes. Its practice involves hospitals, home situations, outpatient clinics, private clinics, public health centers and in homes. Diet therapy which is part of nutrition therapy is the treatment component for a patient that involves the modification of food intake

Routine Hospital Diets

Diets that are sometimes referred to as the “house” diet, constitute the majority of the diet orders in a general hospital. These are: the regular diet, the soft diet and the liquid diets. Being the most frequently served, it is regarded as the basis for special or therapeutic diets.

Osmolality

The concentration of a solution expressed as the total number of solute particles per kilogram.

Osmolarity

The concentration of a solution expressed as the total number of solute particles per liter.

Regular Diet

• The most frequently ordered among the house diet (other names: general diet, full hospital diet)

• Planned to meet the nutritional needs of a patient whose condition does not require any dietary modification.

• It is a sound practice to serve simply prepared foods not too spicy, fatty, rich and gas forming.

• Daily dietary guideline in the food guide pyramid provides an easy interpretation of the Recommended Energy and Nutrient Intake.

Soft Diet

• A regular diet modified in consistency and texture.

• For people who are psychologically and physically cannot tolerate a general diet.

• The transition between liquid and the regular diet.

• Requiring low in fiber foods and tough connective tissues. Fried and highly seasoned foods are avoided as it may cause gastric distress.

Clear Liquid Diet

• It consists of liquids without fiber or residue. Primary purpose is to relieve thirst and help maintain water balance.

• It is nutritionally inadequate, supplying only 600-900 kcal per day.

• It consists mainly of carbohydrates, some low biologic value protein, and very little fats.

• Feeding is preferably given every 2-3 hours not exceeding 300 ml, between 6 am to 10 pm.

Full Liquid Diet

• It is the transition between clear liquid to solid foods.

• Given to patients who generally cannot tolerate solid foods due to: fever, infections, lesions in the mouth, gastrointestinal disturbances, nausea, and vomiting.

• May be useful for the acutely ill patient or those with esophageal disorders and for those who are unable to chew or swallow food due to surgery of the face, neck area or dental surgery.

• More complete compared with the clear liquid and can be nutritionally adequate by proper planning.

Light Diet

often referred to as the soft diet, in some hospitals consists of foods that are easy to digest and readily emptied in the stomach. Given in 3 small meals with in-between feedings.

Mechanical Soft Diet

Also called a dental soft diet. Given to patients with difficulty in chewing due to poor dental condition, lesions and sores in the mouth following head and neck injury, for those debilitated and too ill to eat a regular diet.

Cold Diet

A diet referred to as the T & A diet (tonsillectomy adenectomy diet) consists of cold smooth liquids.

Tube feedings

Maybe normal diets, commercial or semi-commercial preparations requiring a consistency that can pass through a polyvinyl tube.

Dysphagia Diets

It requires alteration in food texture, fluid viscosity/consistency, incorporation of high protein, high energy recommendations as necessary, and use of alternative feeding routes (enteral or parenteral).

Purpose of Nutrition Care

to prevent malnutrition, choking, aspiration pneumonia, and dehydration that might result in immune function and pressure ulcers. As dysphagia is a difficulty in swallowing and as a symptom of a disease or dysfunction that results from a neurological, structural or behavioral disorder or condition.

Vegetarian Diets

Usually rely on fruits, grains, and vegetables as food sources. Consumption is for health, political, cultural or economic reasons.

Disadvantage of Vegetarian Diets

Low levels of Vit B12, iodine, calcium, zinc, riboflavin, and vitamin D thus require careful menu planning and vitamin-mineral supplementation.

Vegan diet

called the strict or total vegetarian diet

Lacto-vegetarian

milk and its products are allowed in the diet

Ovo-vegetarian

egg and egg products are allowed in the diet

Semi-vegetarian

fruits, grains, legumes, nuts and seeds, vegetables, milk, and milk products, eggs, chicken and fish are included in the diet

Pesco-vegetarian

fish and fish products are included in the diet

Diet as tolerated o DAT

a type of diet that need not last for more than one day once ordered Immediate interview of the patient is necessary, dietary regimen may vary from full liquid to regular diet dependent on the discretion of the dietitian.

Test Meals or diagnostic diets

varied and according to the guidelines derived at each hospital’s laboratory.

Fecal fat determination test

measures fat globules in the feces. Consists of at least 100 gm fat ingested daily for 3 days before fecal specimen is collected.

Meat free-test

to determine gastrointestinal bleeding. Meat, fish and poultry are excluded for 3 days.

Calcium test

is used to determine urinary calcium excretion. 1000 mg Ca (400 mg from food/600 mg from oral supplementation of calcium gluconate.

Serotonin test diet

used to diagnose calcinoid tumors of the intestinal tract. Serotonin is excluded.

Nutrition Support

It is the delivery of formulated enteral or parenteral nutrients to appropriate patients for the purpose of maintaining or restoring nutritional status.

Parenteral Nutrition

Provision of nutrients directly into the bloodstream intravenously, consisting of:

• Carbohydrates in the form of glucose.

• Protein in the form of amino acids.

• Lipids in the form of triglycerides.

• Electrolytes.

• Vitamins and trace minerals.

Routes of Parenteral Nutrition

Central and Peripheral

Total Parenteral Nutrition (TPN)

• High glucose concentration (15%-25% final dextrose concentration)

• Provides a hyperosmolar formulation

• Must be delivered into a large-diameter vein through central line.

Peripheral Parenteral Nutrition (PPN)

• Similar nutrient components to TPN, but lower concentration 

• Osmolarity < 900 mOsm/L (maximum tolerated by a peripheral vein)

• May be delivered into peripheral vein

• Because of lower concentration, large fluid volumes are needed to provide a comparable calorie and protein dose as TPN

Enteral Nutrition

It is the provision of nutrients into the gastrointestinal tract through a tube when oral intake is inadequate.

General purpose/intact (polymeric)

inexpensive also known as house, general, meal replacement

Defined/hydrolyze (monomeric)

also known as chemically defined, peptide-based, elemental formula. For patients with GI problem.

Semielemental

for patients with limited GI function, hyperosmolar; low viscosity. Also known as free amino acid formula.

Disease-specific

designed for specific organ dysfunction or metabolic abnormality. Hyperosmolar.

Rehydration

for patients requiring an optimal ratio of simple carbohydrates to electrolyte absorption and rehydration.

Modular

formula providing protein, fat or carbohydrate as single nutrients to alter the nutrient composition of commercial formulas or food; may also contribute electrolytes and increase osmotic or renal solute load; increase cost, require labor and safe mixing technique.

Nasogastric Route

• 3 to 4 weeks

• nose to stomach

• with normal gastrointestinal function and gag reflex

Nasoduodenal or nasojejunal route

3 to 4 weeks in patients with gastric motility disorders, esophageal reflux, or persistent nausea and vomiting

Percutaneous endoscopic gastrostomy (PEG) or Jejunostomy (PEJ)

preferred for patients requiring tube feeding for more than 3 to 4 weeks due to short procedural time of insertion, limited need for anesthesia, and minimal wound complications.

Bolus tube feeding administration

Syringe bolus feeding; pump or gravity bolus feeding. A 60 ml syringe is used to infuse the formula which can be as high as 500 ml per feeding. Not for patients at high risk of pulmonary aspiration.

Intermittent Drip

Maybe given by pump or gravity drip. Four to six feedings per day at 20 to 60 minutes. Starting at 100 to 150 ml per feeding and increases as tolerated. Not for patients at high risk of pulmonary aspiration.

Continuous Drip

For patients who do not tolerate large-volume infusions. It require the use of a pump.