UNIT 3.2 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

good nutrition

Objectives of Diet Therapy:

• To maintain ________________ or correct any deficiency.

medical conditions

Objectives of Diet Therapy:

• To help prevent or manage ____________________, including their symptoms.

rest

Objectives of Diet Therapy:

• To provide _________ to the body or an organ.

body weight

Objectives of Diet Therapy:

• To adjust ______________ to a desirable body level

dietary regimen

Objectives of Diet Therapy:

• To supply a ______________ (kind and amount of food and eating time) according to the patient`s metabolism.

disease condition

Factors to Consider in the Study of Diet Therapy

• Underlying _________________________

duration

Factors to Consider in the Study of Diet Therapy

• Possible ________________ of therapy

altered

Factors to Consider in the Study of Diet Therapy

• Factors in the diet that must be __________ to overcome these conditions

food by mouth

Factors to Consider in the Study of Diet Therapy

• Patient’s tolerance for __________________

consistency

In diet modification, there is a/an:

• Change in ___________ of food

energy value

In diet modification, there is a/an:

• Increase or decrease in the _______________ of food

bulk

In diet modification, there is a/an:

• Increase or decrease in the ________ of food

Include or omit

In diet modification, there is a/an:

• ______________________ specific kinds of food

composition of nutrient

In diet modification, there is a/an:

• Adjustment in the __________________

flavor

In diet modification, there is a/an:

• Modify the ________________ of food

Recommended Dietary Allowance (RDA) and Recommended Energy and Nutrient Intake (RENI)

Basis of Diet Modification:

• Normal Dietary Requirement based on ___________________________

nutritional status

Basis of Diet Modification:

• Previous ___________________ of the individual

Pathophysiology

Basis of Diet Modification:

• ________________________ of disease

duration

Basis of Diet Modification:

• Anticipated ___________ of disease and injury

Dietary factors

Basis of Diet Modification:

• _____________________ to be altered

nutrients

Basis of Diet Modification:

• Amount and character of __________________ that are being lost from the body

tolerance

Basis of Diet Modification:

• Patient’s __________________ for food

Socio-economic factor and other considerations, such as religion and custom

Basis of Diet Modification:

• consider their ____________________________________

Liberalization

Principles of Dietary Management

• Meet the body’s requirement for essential nutrients as generously as the condition permits

Individualization

Principles of Dietary Management

• Diet regimen should take cognizance of the patient’s food intake habits, preferences, economic status

Simplification

Principles of Dietary Management

• Should vary from the adequate normal diet as little as possible

Carbon, Hydrogen, and Oxygen

carbohydrates are organic compounds that contain:

Carbohydrates

• Chief source of energy (protein sparer)

• Regulator of fat metabolism and gastrointestinal peristalsis

• Body constituent

• Provides the primary source of energy intake

40-80%

Carbohydrates are ___________ of total energy intake.

55-70%

Recommended Dietary Allowance of carbohydrates per total caloric allowance

4 Kcal/g

energy yield of carbohydrates

Carbon, Hydrogen, Oxygen, and Nitrogen

Proteins contains elements such as:

Protein

• Essential for growth and source of energy

• Regulator of body processes

4 Kcal/g

energy yield of protein

Carbon, Hydrogen, and a lower proportion of Oxygen

Lipids contains elements such as:

Lipid

• Lower proportion of oxygen than carbohydrate

• Water insoluble but soluble in organic solvents

• Concentrated source of energy and essential fatty acids

• Important constituent of body compounds

• Acts as insulator and padding

20-30%

Required Dietary Allowance for Lipids

9 Kcal/g

energy yield for lipids

Body Mass Index

Number that shows body weight adjusted for height

weight/height² x 703

formula for body mass index when:

wt: lbs

ht: in

weight/height²

formula for body mass index when:

wt: kg

ht: m

weight/height² x 10,000

formula for body mass index when:

wt: kg

ht: cm

>15

BMI Interpretation for Emaciated

15 - 18.5

BMI Interpretation for Underweight

18.5 - 24.9

BMI Interpretation for Normal

25.0 - 29.9

BMI Interpretation for Overweight

30.0 - 39.9

BMI Interpretation for Obese

> 40

BMI Interpretation for Morbidly Obese

Desirable Body Weight (DBW)

• used as the basis in the calculation of Total Energy Requirements (TER) or Total Caloric Allowance (TCA)

• can be determined by:

  • Height-Weight table of FNRI

  • Modified Tannhausers method in the absence of height-weight table

  • NDAP Formula (Nutritionist - Dieticians Association of the Philippines)

DBW (kg) = {Height (cm) - 100} - 10% of {height (cm) - 100}

Modified Tannhausers Method Formula

± 10% of the DWB

range of DBW in Modified Tannhausers Method

5ft = 112 lbs
± 4 lbs for every inch above/below 5 ft

NDAP Formula for Males

5ft = 106 lbs

± 4lbs for every inch above/below 5 ft

NDAP Formula for Females

>20% above the desirable weight

Obese if weight is _______________________

> 10 - 20% above the desirable weight

Overweight if weight is _______________________

± 10% of the desirable body weight

Normal if weight is _______________________

< 10% below the desirable weight

Underweight if weight is _______________________

Basal Metabolic Rate (BMR)

Minimum amount of energy needed to maintain the vital process of life under basal condition

1 Kcal/kg x DBW X 24 hours

formula for Basal Metabolic Rate (BMR)

10%

Physical Activity classification for Hospital Patient

30%

Physical Activity classification for Sedentary

50%

physical activity classification for light (clerks, typist)

75%

physical activity classification for moderate (healthworker, shoemaker, fishermen, driver, student)

100%

physical activity classification for heavy (construction worker)

Basal Metabolic Rate (BMR) x %PA Classification

formula for Physical Activity (PA)

Thermogenic Effect of Blood (Specific Dynamic Activity or SDA)

energy required for digestion, absorption, transport, and utilization of food

(Basal Metabolic Rate + Physical Activity) x 0.06

Specific Dynamic Action (SDA) for adults (≥ 12 y/o)

(Basal Metabolic Rate + Physical Activity) x 0.15

Specific Dynamic Action (SDA) for children (≤ 12 y/o)

Desired Body Weight x 40

formula for NDAP method for Total Caloric Allowance

500 Kcal

To lose 1-2 lbs/week, subtract ___________ from the calculated TCA

500 Kcal

To gain 1-2 lbs/week, add ___________ from the calculated TCA

500Kcal/day

NDAP Recommendation for overweight/obese adult:

a. Compute allowance based on DBW and subtract ______________

b. If only moderately overweight, recommended _________________________

a = ?

exercise and avoidance of fats and sugar

NDAP Recommendation for overweight/obese adult:

a. Compute allowance based on DBW and subtract ______________

b. If only moderately overweight, recommended _________________________

b = ?

Basal Metabolic Rate + Physical Activity + Specific Dynamic Action

factorial method formula for Total Caloric Allowance (TCA) or Total Energy Requirement (TER)

Actual Weight/Ideal Weight for Height x 100

Nutritional Requirement (Pedia):

• formula for Waterlow Classification for Wasting

> 90%

Waterlow Classification for Wasting for Normal

80-90%

Waterlow Classification for Wasting for Mild

70 - 80%

Waterlow Classification for Wasting for Moderate

< 70%

Waterlow Classification for Wasting for Severe

Actual Weight/Ideal Weight for Height x 100

Nutritional Requirement (Pedia):

• formula for Waterlow Classification for Stunting

> 95%

Waterlow Classification for Stunting for Normal

90 - 95 %

Waterlow Classification for Stunting for Mild

80 - 90%

Waterlow Classification for Stunting for Moderate

<80%

Waterlow Classification for Stunting for Severe

Actual Weight/Ideal Weight for Height x 100

Nutritional Requirement (Pedia)

• formula for Gomez Classification

91-100

Gomez Classification for Normal

76-90

Gomez Classification for First Degree Malnutrition

61 - 75

Gomez Classification for Second Degree Malnutrition

<60

Gomez Classification for Third Degree Malnutrition

Kwashiorkor

• it develops in children whose diets are deficient of protein

• occurs in children between 6 months and 3 years of age

• subcutaneous fat is preserved

• oedema is present

• enlarged fatty liver

• ribs are not very prominent

• lethargic

• muscle wasting mild or absent

• poor appetite

• person suffering needs 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

• oedema is absent

• no fatty liver

• ribs become very prominent

• alert and irritable

• severe muscle wasting

• voracious feeder

• person suffering needs adequate amount of protein, fats, and carbohydrates

Regular, Normal, or Full Diet

• Food is normally eaten by a healthy person in good health

• Requires 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

• for 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

• for 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

• for 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

• for 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 fibers

• Nutritionally adequate

• Provide a diet which is chemically, thermally, mechanically, and nonirritating

• Given to patients with acute infection, some GIT disturbance, fever