Medical Nutrition Therapy
Medical Nutrition Therapy
Medical Nutrition Therapy
The goal of medical nutrition therapy is to help you get the best possible nutrition, even when you have a
gastrointestinal disorder.
The diet is the sum of food consumed by other person or other organism.
Side notes:
3 Principles of Dietary Management
1. Liberalization- the diet should meet the body’s requirement for essential nutrients generously as the
disease condition permits
2. Individualization- the diet regime should take cognizance of the patient’s food intake, habits,
preferences, economic status, religious practices and any environmental factor which has bearing on
the diet, such as where the meals are eaten and who prepares them.
3. Simplification- the therapeutic diet should vary from the adequate normal as possible.
Diet therapy is concerned with recovery from illness and prevention of disease.
A. Regular Diets
also called normal or house diets
Are used to maintain or achieve the highest For example, a pregnant woman may require
level of nutrition in patients who do not have more calories and different nutrients than a young
special needs related to illness or injury. child would need.
It is most frequently used in all hospitals.
While regular diets do not have portion or It is used for ambulatory and bed patients.
choice restrictions, they are altered to meet the Whose condition does not give a special diet of
needs of the patient's age, condition and personal one or the routine diets. Many special diets
beliefs. progress ultimately to a regular diet.
PRINCIPLE:
The diet should be well balanced one and nutritionally adequate. It should provide 1500 to
2000 kcal, 40 to 45 gram of protein and adequate vitamins and minerals.
B. Liquid Diets
The three types of liquid diets are clear liquid, full liquid and pureed.
Nutritionally inadequate and should only be used for short periods of time
Uses:
o After surgery or a heart attack
o Patient with acute infections or digestive problems
o To replace fluids lost by vomiting or diarrhea
o Before some Xrays of digestive tract liquid diet
a. CLEAR LIQUID DIETS
is made up of clear fluid liquids
is non residue FREE FROM FIBROUS or presence of any food particles. It is a non-residual diet.
include water, broth, clear juices
such as apple or grape, popsicles and gelatin.
PRINCIPLE:
o Non residue diet, non gas forming, non irritating, non stimulating diet.
o Clear fluid 30 to 60 ml of feed should be given at an interval of 2 hours.
o Given for acute infections when there is intolerance for food either as nausea,
vomiting, anorexia, distention and diarrhea.
o In acute inflammatory conditions of intestinal tract during post surgical conditions.
PRINCIPLE:
A non gas forming, non irritating, non stimulating full fluid diet.
30 to 60 ml of feed at an interval of 2 to 4 hours.
It is recommended for pre and post operative acute infections, diarrhea
it is suggested for convolving patients and patients.
c. PUREED DIET
allows all foods as long as they are converted to a liquid form in a blender.
C. Soft diets
transition patients from a liquid diet to a
regular diet.
The diet should be most frequently to hospital patient. It bridges gap between ACUTE ILLNESS AND
CONVALESCING PATIENTS.
Patients prescribed a soft diet are restricted to foods that can be mashed well.
This includes cooked fruits and vegetables, bananas, soft eggs and tender meats.
A mechanical soft diet allows most foods as long as they can be chopped, ground, mashed or pureed
to a soft texture.
This excludes most raw fruits and vegetables or foods containing seeds and dried fruits.
Similar to regular diet but foods must require little chewing and be easy to digest
Avoid meat and shellfish with tough connective tissue, coarse cereals, spicy foods, rich desserts,
fried foods, raw fruits and veggies, nuts, and coconuts
PRINCIPLE:
The diet must be nutritionally adequate. It should be a bland diet and should made
up simple easy to digest food without harsh fibre at seasonings.
Patients with dental problems.
It may be used in acute infections following surgery and those find it difficult to chew.
It is often modified for certain pathologic condition.
D. Restricted diets
encompass a variety of special diets that limit the amount of calories, fat, salt and
other substances based on the patient's medical needs
For example, a restricted-fat diet allows only low-fat versions of milk, cheese, cereal and ice cream
but does not place limits on the amount of fresh fruits and vegetables a patient may consume.
A restricted diet can also modify the other types of diets.
For example, a post-operative patient with heart disease may be prescribed a low-fat full liquid diet.
E. Therapeutic diets
are used to treat disease or illness.
Like restricted diets, they can also be used to modify another type of hospital diet.
Types of therapeutic diets include modification of calorie intake, such as with patients that need a
high calorie diet to promote weight gain, modification of certain nutrients including protein and
carbohydrates; or diets that encourage an
increased fluid intake
Gastroesophageal Reflux
Achieve and maintain ideal body weight to Avoid foods that may irritate and cause
improve mechanical and postural status spasms: citrus juices, tomatoes, and tomato
(except pregnant women, who should not sauce.
try to lose weight). Stop smoking, if that is a habit.
Increase protein and reduce fat intake to Eat small meals four times a day.
increase sphincter pressure. Eat large meal at noon with a lighter meal
Avoid foods like chocolate, alcohol, in the evening.
peppermint, coffee, and carbonated drinks. Finish the evening meal at least two to four
hours before bedtime. Avoid late evening
snacks.
Peptic Ulcer
Individualized-approach
- A trend in nutritional therapy of peptic ulcer based on the individual patient’s tolerance for specific
foods.
To reduce or neutralize gastric acid secretion:
o Eat three meals daily; avoid skipping o Some fibers, especially the soluble
meals. forms, are beneficial.
o Avoid stomach distention with large o Citric acid juices may induce gastric
quantities of food at a meal. reflux and discomfort in some patients.
o Avoid drinking milk frequently. o Avoid bedtime snacks to prevent acid
o Limit caffeine intake by reducing secretion if symptoms often occur in the
consumption of coffee, tea, cola, middle of the night.
chocolate and other foods and o Avoid cigarette smoking, which may
beverages that contain caffeine. increase gastric acid secretion and
o Limit alcohol intake and avoid drinking delay the healing process and is also
on any empty stomach. associated with an increased frequency
o Limit intake of spicy, fatty or otherwise of duodenal ulcers.
bothersome foods and beverages.
GASTRITIS
The aim is to rest the stomach and reduce further irritation of the mucosa.
Acute type: NPO for 24 to 48 hours: give glucose parenterally, followed by liquids, then soft to full diet
as tolerated.
Chronic type: Bland, low fiber diet.
Correct faulty food habits.
Diarrhea
Clinical Implications
Fluids must be replaced to avoid dehydration, solids should be gradually added as tolerated.
A low-residue diet may be in order to decrease the intake of fibrous materials.
Evaluate the use of foods that may contribute to diarrhea, especially those high in fiber, caffeine, and
alcohol.
Encourage juices high in potassium
Remove milk products from the diet if there is a possibility of lactose intolerance.
Bananas, grated raw apples, or cooked apple-sauce contain pectin, which helps bind the fluid and
retard its transit time.
Extremely hot or cold foods increase peristalsis and may aggravate diarrhea.
Constipation
Clinical Implications
Ask patients about their use of cathartics or laxatives.
Gradually increase the amount of fiber or bulk in the diet (raw vegetables and fruits, whole-grain
breads, and cereals).
Force fluid intake; drink at least the equivalent of six to eight glasses of water a day.
Dried fruits, especially prunes, contain natural laxatives.
Any hot beverage upon arising, such as coffee, tea, or lemon water, may stimulate peristalsis because
duodenal-ileal or gastric colic is strongest in the morning. Breakfast is also important and should
contain some fiber.
Encourage activity and relaxation as much as possible allow sufficient time for bowel habits
Ulcerative Colitis
Clinical Implications
Patients with severe diarrhea or steatorrhea should be monitored for magnesium, which is usually
deficient in chronic inflammatory bowel disease (Philips & Garnys, 1981).
Low serum zinc levels are prevalent among children with chronic inflammatory bowel disease.
Response to zinc intake is abnormal and growth is retarded (Nishl et al, 1980).
The use of azulfidine requires a daily intake of eight to ten cups of fluid.
Hepatitis
During acute phase, 5-10% dextrose intravenously and/or protein parenterally
To minimize protein losses, prevent ketosis, to replace fluids and electrolytes.
High calories
To counteract weight loss and for maximum protein utilization.
High CHO:
To spare protein: Ensure glycogen reserve and maintenance of hepatic function.
High protein:
To repair hepatic cells; from cholic and other bile acids; to prevent hypothermia;
supply lipotropic factors which mobilize liver fat.
Side notes:
Hepatitis is when inflammation of the liver tissue occurs.
Causes: alcohol toxicity, virus, medication, fat deposition.
Types: Acute (viral, drug-induced toxic)
Chronic (active or persistent)
There are several viruses, A,B,C,D,E. Hepatitis is considered acute during the first 6 months. If not resolved by
6 months, it is considered to have developed into a chronic disease.
Cirrhosis
Action:
Moderate fat, MCT preferred over LC (restrict fat if there is biliary obstruction)
To meet high energy needs, at the same time preventing fatty liver.
High vitamins
To maintain liver function.
Frequent small feeding in cases:
For better tolerance of anorexia
Consistency
liquid to soft in acute attacks
Low sodium (<2,000mg.)
In cases of ascites.
Alcohol prohibited
Detoxification function of the liver is impaired by alcohol.
Side notes:
Chronic disease of the liver can cause fibrosis, which can proceed to permanent scarring of the liver known as
cirrhosis or end stage of liver disease.
Etiology:
• Alcoholism w/ long standing malnutrition: Laennec’s cirrhosis
Time to develop alcohol disease:
Men: 60-80g/day of alcohol for 10 years
Women: 20-40 g/day of alcohol for 10 years
• post necrotic cirrhosis-viral hepatitis
• Biliary cirrhosis
• Hemochromatosis-increased iron absorption
CHOLECYSTITIS
IV fluids and electrolytes; progress to clear liquid
To rest inflamed gallbladder, prevent and correct dehydration, volume depletion and
electrolyte abnormalities.
Low fat
Reduce discomfort by preventing stimulation of sphincter of Oddi, and contraction of Gall
Bladder.
Bland low fiber
Decrease mechanical and chemical stimulation.
Low calorie for obese patients
For weight loss, obesity is predisposing factor.
Small frequent feedings
To prevent dyspepsia.
PANCREATITIS
Acute attack: NPO
To rest the organ.
Low fat
To control steatorrhea and prevent stimulation for bile production.
Moderate CHO and protein
Prevention of hypoglycemia and creatorrhea.
Plus enzyme supplements
Utilization of nutrients.
Six small feedings, bland
Avoid undue distention and stimulation.
Avoidance of alcohol
Alcohol may precipitate attack.
Supplements of fat-soluble vitamins and calcium
To prevent deficiencies.
MCT oil
Better absorbed than LCT.
Pre-operative
To improve the nutrition of the patient.
To prepare the patient for nutrient losses during surgery.
To hasten post-operative recovery.
To build up glycogen reserves.
To strengthen bodily resistance to infections.
Pre-Operative Dietary Management in: Emergency Operation
If patient is in good nutritional status = NPO 8 hours prior to surgery
If patient is in poor nutritional status (protein deficient)= parenteral administration of whole blood or
plasma.
In addition, 5% glucose in water, saline solution, vitamins and potassium.
To avoid vomiting during anesthesia or recovery from anesthesia, and decrease the risk of post-
operative gastric retention since peristalsis is stropped
For adequate stores of serum protein to prevent hypoproteinemia and shock.
For adequate nutrition
High carbohydrates For glycogen stores and to spare protein for tissue synthesis.
Stores of glycogen exert a protective action on the liver and help to prevent post-operative ketosis
and vomiting.
High proteinTo build reserves for anticipated blood losses during surgery and increased tissue
catabolism, to reduce the possibility of edema at the site of the wound which is a hindrance to wound
healing.
Increased vitamins, especially ascorbic acid, vitamin K; B- complexFor wound healing and
prevention of hemorrhage
increased minerals, especially phosphorus and potassium; Na and chlorideTo replace electrolyte
losses due to the break-down of body tissue; and due to vomiting, diarrhea, perspiration and diuresis.
Ironto correct anemia
Increased fluids to replace losses due to vomiting and diuresis
GASTRECTOMY
NPO first 24-48 hours; intravenous feedings
Day 2 to 4: iced water with intravenous feedings
Day 5: 1 to 2 oz. water every even hour, and 1 to 2 oz milk every odd hour between.
Day 6: Soft low fiber foods are used – eggs, custards, thickened soups, cereals, crackers, milk and
fruit purees are suitable.
Day 7: Tender meats, cottage cheese, and pureed vegetables are the next foods added to all the
foods allowed in the previous days.
Meats are divided into 5 or 6 small feedings daily with emphasis on foods high in protein and fat.
CHO is kept relatively low. If not liquids are taken with meals, and the diet continues to be low in CHO,
especially the simple sugars, many patients progress satisfactorily.
ALLERGY
Avoidance diet: An adequate diet which excludes the food(s) causing allergic reactions (e.g. milk-free,
egg-free diet, wheat-free diet, etc.)
Desensitization: The allergenic food is given in gradually increasing amounts over a long period of
time.
Definition of terms
1. Adverse reaction to foodclinically abnormal response believed to be due to an
ingested food or food additive.
2. Antibodiesproteins in the bloodstream or other body fluids that are produced in
response to foreign materials that enter the body
3. Anaphylaxisa severe systemic allergic reaction that is potentially fatal
4. Food Sensitivity a general term for an adverse reaction to an ingested food or food
additive
Most Common Food Allergens
o Chicken o Wheat o Soy products
o Cow’s milk o Peanuts/nuts o Fish, shellfish
DIETARY PRINCIPLES
Objectives of nutritional therapy in chronic failure
To maintain nutritional status
To minimize uremic toxicity
To prevent net protein catabolism
To stimulate patient’s well-being
To retard progression of renal failure
To postpone initiation of dialysis
Renal Disorders-1
ACUTE OR CHRONIC GLOMERULONEPHRITIS
Controlled fluid intake = fluid output
Kcal
Controlled protein -according to laboratory data & renal function
Sodium
Potassium
Nephritis
Treat symptomatically when there is significant uremia, hyperkalemia or edema. Replace all lost fluids
Renal Disorders-2
UREMIA
Adequate calories and controlled protein, fluid and electrolytes according to laboratory data and renal
function
Nephrotic Syndrome
Protein - 1.5 g/kg/day + 1 g Protein for each gram protein lost in urine
Kcal - increased kcal to spare protein
Sodium - low sodium (2 grams) to reduce edema
Renal Disorders-3
ACUTE RENAL FAILURE
Protein - not restricted below 1.0 – 2.0 g/kg DBW
Kcal - increased kcal to spare protein for a malnourished child, 1 ½ - 2 times normal requirements
Renal Disorders-4
CHRONIC RENAL FAILURE
Regulation of protein intake
Balance of fluid intake and output
Adequate calorie intake
Regulation of sodium, potassium and phosphorus intake
Supplementation of appropriate vitamins and minerals
*Restriction is not fixed dependent on patient’s clinical and biochemical status
THERAPEUTIC DIET FOR SPECIFIC DISEASE CONDITIONS
Acne Low fat
Acute gastroenterities (diarrhea) Clear liquid
Acute glomerulonephritisLow Sodium, Low Protein
Addisons’ diseaseHigh Sodium, Low Potassium
AngiSodium pectoris Low cholesterol
Arthritis, goutPurine restricted
ADHD Finger foods
Bipolar disorderFinger foods
Burn High calorie, High Protein