1.2: Hospital Diets

Hospital diet is essential in modern therapy across departments, vital in treating diseases, considers patient food tolerance, and optimizes nutrition during hospital stay.

What is the importance of hospital diets in therapy?

Enumerate the routine hospital diets listed in the handout.

Full/Regular, Soft, Mechanical Soft, Clear Liquid, General/Full Liquid, Low Oxalate, Low Calcium, Low Purine, Low Sodium, Low Potassium, Low Phosphorus, Low-Fat/Low Cholesterol, Diets with Special Consideration, Hypoallergenic, G6PD, Vegetarian, Diet for Renal Patient, Diabetic Diet

Define Full/Regular Diet

All foods are allowed, with adequate nutrients and enough calories to meet energy needs.

Define Soft Diet

Tender foods (not ground/pureed), mildly flavored, easily digestible, used for post-surgical patients or those who cannot tolerate regular diet.

In Soft Diet, which vegetables are “Allowed”?

Well-cooked mild-flavored non-leafy vegetables

In Soft Diet, which vegetables are “Not Allowed”?

Raw vegetables, all corn, pickles, dried beans, peas, legumes

In Soft Diet, which fruits are “Allowed”?

Fruit juices without pulp and low fiber fruits (banana, watermelon, papaya, peaches)

In Soft Diet, which fruits are “Not Allowed”?

Juices with pulp, dried fruits, canned fruit cocktail, pineapple, coconut

In Soft Diet, which rice/cereal items are “Allowed”?

Refined wheat and cereals, refined breads, plain crackers

In Soft Diet, which rice/cereal items are “Not Allowed”?

Cereals with nuts/berries/dried fruits, whole grain cereals

In Soft Diet, which meats are “Allowed”?

Tender meat without tough connective tissues

In Soft Diet, which meats are “Not Allowed”?

Tough fibrous meat, meat with casings (sausage/hotdogs), shellfish, beans, nuts

In Soft Diet, which dairy items are “Allowed”?

Milk, cheese, plain yogurt, ice cream

In Soft Diet, which dairy items are “Not Allowed”?

Dairy mixed with fresh high fiber fruit/berries/nuts/seeds

When is Mechanical Soft Diet used?

For difficulty chewing due to poor dental condition, lack of teeth, sores/lesions; foods should be well-cooked and may be chopped/ground/minced.

Define General/Full Liquid Diet and when it is used?

Fluids and semi-solid foods liquid at body temperature; used post-operatively after clear liquid diet.

Give examples of foods in General/Full Liquid Diet.

Milk beverages, ice creams, plain pudding, plain gelatin, yogurt, popsicles, fruit juices

Define Clear Liquid Diet and typical use.

Used for pre-op and post-op patients; consists of clear liquids.

Give examples of Clear Liquid Diet items.

Plain tea, black coffee, ginger-ale, plain gelatin, strained fruit drinks, popsicles, clear fruit juices, clear broth.

What is oxalate and why is it restricted?

Oxalate is a stone-forming chemical in plant foods; common kidney stones contain calcium oxalate crystals.

Indications for Low Oxalate Diet?

Kidney stones, renal problems, high uric acid

What is the recommended oxalate limit in Low Oxalate Diet?

<50 mg/day

Tips for controlling oxalates in diet (as listed).

Drink plenty of fluids; avoid high doses of Vitamin C; eat recommended calcium; be aware of grams of oxalate consumed.

Indications for Low Calcium Diet (list all from handout).

Chronic renal disease, Hypercalciuria, Hyperparathyroidism, Hypercalcemia

What calcium intake reduction is mentioned for hypercalciuria?

<600 mg/day

Helpful tips to control calcium intake (list all).

Increase water to 8–10 glasses/day; read labels to limit foods with calcium >800 mg; consume variety of fruits/vegetables; do not over-restrict because it may cause negative calcium balance.

In the Low Calcium table, what is classified as “Foods to be avoided” with >100 mg Ca+/exchange for Rice/Rice Exchange?

Soy fortified flour

In the Low Calcium table, give examples of “Low calcium foods allowed” with 75 - 100 mg Ca+/exchange for rice/rice exchange.

Sweet potato

In the Low Calcium table, list the vegetables to be avoided with >100 mg Ca+/exchange.

Cabbage, leafy vegetables, horseradish, okra, mushrooms, chili red peppers

In the Low Calcium table, list the vegetables under 75–100 mg Ca+/exchange.

Chinese cabbage

In the Low Calcium table, list the vegetables under 50–70 mg Ca+/exchange.

Spinach, swamp cabbage

In the Low Calcium table, which fruit is listed under 75–100 mg Ca+/exchange?

Tamarind

In the Low Calcium table, list meats/meat substitutes to be avoided (>100 mg Ca+/exchange).

Balot, anchovies, salmon, clams, crabs, mussel, salted dried fish, sardines, tofu/soybeans

In the Low Calcium table, which item is listed around 50–70 mg Ca+/exchange for meat group?

Shrimps

In the Low Calcium table, list examples of foods allowed in meat group (low Ca items).

Corned beef, duck egg, peanuts, hen egg, beef, chicken, pork, ducks, octopus

In the Low Calcium table, list dairy products to be avoided.

Cow’s milk, buffalo milk, carabao’s milk, goat’s milk, buttermilk, whole dried milk, skimmed milk, evaporated milk, condensed milk, ice cream

In the Low Calcium table, which dairy product is listed under 75–100 mg Ca+/exchange?

Cottage cheese

In the Low Calcium table, what is listed as “Foods allowed” for dairy?

Human milk

In the Low Calcium table (Others), list items under >100 mg Ca+/exchange.

Betel nut, chickpea, cowpea, mungbean, pili nut, watermelon and sunflower seed, almonds, chia seeds, molasses/muscovado, brown sugar

In the Low Calcium table (Others), what is listed around 50–70 mg Ca+/exchange?

Rice wine

In the Low Calcium table (Others), list items under low calcium foods allowed.

White sugar, salted butter, oil, margarine, coconut and coconut products

What is purine and what does it produce in the body?

Purine is found in foods, broken down in the body, producing uric acid.

Indications for Low Purine Diet?

High uric acid, gout, arthritis, kidney problems

List the “High sources of purine” from the table.

Liver and other glandular organs, anchovies, sardines, shellfish, meat extractives, alcoholic beverages

List the “Moderate sources of purine” from the table.

Fish, meat, beans, peas, asparagus, cauliflower, spinach

List the “Purine-free foods” from the table.

Breads, cereals, low fat milk, eggs, fruits

In the therapeutic Low Purine diet table, what intake shift is written?

Limits “protein” to 120–150 mg/day instead of 600–1000 mg/day (as stated in the handout)

Therapeutic Low Purine: macronutrient pattern listed.

High in carbohydrates (>50% kcal) and low in fat (<30% kcal)

Therapeutic Low Purine: indications listed.

Gout, hyperuricemia, uric acid stones

Therapeutic Low Purine: foods allowed listed.

Refined grains; fruits and vegetables (except those noted); cream-style soups; low fat dairy; gelatin; sugars and syrups; moderation in meat/poultry, fish/seafoods, asparagus/spinach/mushroom/cauliflower, beans/lentils, oatmeal.

Therapeutic Low Purine: foods avoided listed

Alcoholic beverages; greasy and fried foods

Primary purpose of a Low Sodium Diet

Prevention/control of edema and control of hypertension.

Sodium restriction range required in Low Sodium Diet

2,000 - 3,000 mg/day.

Sodium classification cutoffs per serving (low/medium/high).

Low: <150 mg/serving; Medium: 151–250 mg/serving; High: >250 mg/serving.

Under sodium table, which meats are “low sodium” examples?

Beef, chicken, fish, clams, crabs, egg, pork

Under sodium table, which meat/seafood is listed as “medium sodium”?

Oysters

Under sodium table, which meat items are “high sodium”?

Processed meats (hotdog, corned beef, sausages, etc.).

Under breads/cereals sodium table, list “medium sodium” examples.

Biscuits, pancake, ready-to-eat cereals.

Under breads/cereals sodium table, list “high sodium” examples.

Bran flakes, muffins, instant noodles, waffles.

Under dairy sodium table, list “medium sodium” examples.

Cheese, cottage cheese.

Under dairy sodium table, list “high sodium” examples.

Buttermilk, parmesan, processed cheese and spreads.

Under fruits/vegetables sodium table, list “medium sodium” examples.

Canned vegetables, tomato juice

Under fruits/vegetables sodium table, list “high sodium” examples.

Frozen vegetables with special sauces, canned tomato sauce, sauerkraut, sweet pickle.

Under snacks/condiments sodium table, list “low sodium” examples.

Candies, cookies, marshmallow, jam and jellies, mayonnaise, salad dressing.

Under snacks/condiments sodium table, list “high sodium” examples.

Table salt, soy sauce, BBQ sauce, black olives, fish sauce, steak sauce.

What does “Salt/Sodium-Free” mean on a label?

Less than 5 mg sodium per serving.

What does “Very Low Sodium” mean on a label?

35 mg sodium or less per serving.

What does “Low Sodium” mean on a label?

140 mg sodium or less per serving.

What does “Reduced Sodium” mean on a label?

At least 25% less sodium than the regular product.

What does “Light in Sodium/Lightly Added” mean?

At least 50% less sodium than the regular product.

What does “No-Salt-Added/Unsalted” mean?

No salt added during processing, but may not be sodium-free unless stated.

What potassium range is targeted in Low Potassium Diet?

1.0–1.8 grams per day

Indications for Low Potassium Diet?

Hyperkalemia, Addison’s disease, certain renal and heart conditions

Foods low in potassium content listed as examples.

Eggplant, carrot, celery, white rice, peach

Low potassium diet: vegetables to avoid (table list).

Cauliflower, celery, mushroom, nangka, malunggay, squash, broccoli, spinach, kidney beans, all leafy vegetables.

Low potassium diet: fruits to avoid (table list).

Banana, guava, langka, orange, strawberry, santol, anonas, balimbing, melon, grapefruit, guyabano, cashew, lanzones, dried fruits (prunes, raisins).

Low potassium diet: rice and rice substitutes to avoid (table list).

Enriched rice, raisin bread, misua, oatmeal, bran, wheat germ, potato.

Low potassium diet: fats to avoid (table list).

Coconut milk, coconut, avocado, peanut butter.

Low potassium diet: meat/meat substitutes to avoid (table list).

Alimango, alimasag, dried beans, legumes, lentils, sardines, oysters, kesong puti, cottage cheese, tokwa, frankfurters.

Low potassium diet: desserts and beverages restrictions (table list).

Desserts: cakes, pastries, cookies except when exchanged for rice; beverages: chocolate, cocoa, beer; limit coffee/tea to 1 cup.

Low phosphorus diet is commonly given to which patients?

Patients with kidney disease.

Foods high in phosphorus listed in the table.

Meat, fast food, cheese, seeds, milk, canned fish, cola.

Foods to be avoided in low phosphorus diet (as stated).

No beef/no red meats; no nuts, avocado, cocoa, dried fruits; no dairy products; beans/bean products; internal organs.

Low-fat or low cholesterol diet: fat limit and key emphasis.

Limits fat to 10–15% of total calories; emphasize unsaturated fats; avoid saturated fats and trans-fatty acids.

Indications for Low-Fat/Low Cholesterol diet (list all)

Blood lipid disorder, gallbladder problem, hyperlipidemia, heart disease.

What is Low-Fat Diet

Allows a minimal amount of dietary fat particularly saturated fats, which comprises 15% of the total calorie requirement of the person.

What is Low Cholesterol Diet

Intended to regulate the type and the amount of fat. The diet aims to reduce cholesterol level in the blood, more specifically the low- density lipoproteins (LDL).

What is G6PD and why does deficiency matter?

G6PD protects RBCs; deficiency increases anemia risk; some foods can cause hemolysis.

G6PD diet: foods to avoid

All legumes (peas, lentils, peanuts), no soya, no mushroom, no choco-colored food, no soy sauce.

Hypoallergenic diet: main purpose and target patients.

Minimizes allergic reactions; given to patients with hypersensitivity to certain foods.

Hypoallergenic diet: foods to avoid (complete list).

Squash, eggplant, okra; pineapple, mango, citrus fruits; wheat; milk and milk products (okay for pedia); chicken, eggs, seafood; tree nuts (almonds, pistachios, walnuts, cashews, hazelnuts), peanuts.

Total vegetarian diet includes which food groups?

Only plant foods: fruits, vegetables, legumes (dried beans/peas), grains, seeds, nuts.

Semi-vegetarian diet excludes what, and includes what?

Excludes red meat; includes plant foods plus chicken, fish, dairy, eggs.

Lacto-vegetarian diet includes what?

Plant foods plus cheese and dairy products.

Lacto-ovo vegetarian diet includes what?

Plant foods plus cheese, dairy products, eggs.

Diabetic diet: what key principle is emphasized?

Highly individualized; depends on caloric goal plus other dietary restrictions.

Renal patient diet: what intake adjustments are emphasized?

Protein, sodium, potassium, phosphorus, and fluid adjustments.

Muslim diet: pork restrictions and examples scrutinized.

No pork/pork products; scrutinize sausage, hotdogs, ham, bacon, meatballs, potted meat, “meat” sauce.

SDA diet restrictions listed in the table.

No pork/pork products (sausage, hotdogs, ham, bacon, meatballs, potted meat, “meat” sauce); no seafoods; no fish without scales.