NUTRITION AND DIET THERAPY LABORATORY

PREPARED BY
Janet Marquez Rafael

Reference:
Medical Nutrition Therapy for Filipinos Laboratory Manual
Adela Jamorabo-Ruiz, Virginia Serraon-Claudio, 2005, Manila
Philippines
A. Learning objectives

This laboratory class is designed to provide training for students in

calculations of BMR for menu planning modified diets, nutrition
assessments, and patient counseling.
To add knowledge and information on how to sustain a healthy,
sound body, mind & spirit.

B. Concepts and Terms

1. Diet Therapy – is the modification of the daily intake of 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.
2. Diets – are defined as the daily allowance of food and drink of
an individual for a day.
3. Dietary patterns- refer to the amounts allowed per meal or per
day and will depend on the therapeutic requirements.
4. Routine diets – refer to the full, soft, full liquid or clear liquid
diets and are the basis for other therapeutic modification.
5. Therapeutic diets- are those with one or more of the
modifications given as follows;
a. A change in consistency and or flavor
b. Increase or decrease in bulk, volume or frequency of meals
c. Increase or decrease in energy value
d. Inclusion of greater or lesser amount of one or more
nutrients.
e. Inclusion or exclusion of specific foods or food components
f. Modification intervals of feeding
 g. Adjustment in the level, ratio or balance between or among
nutrient constituents
h. Change in the route or delivery of nutrients

Lesson I

A. Planning therapeutic Diets

Points to consider
1. The diet should provide enough calories to maintain
desirable body weight.
2. The diet should provide for the loss in nitrogen which may
occur as a result of the disease process, thus enough protein
should be given.
3. The diet should provide necessary nutrients to clear up any
deficiency’s concomitant with the disease.
4. The diet should only be a modification of the usual normal
diet and, must be psychologically acceptable.
5. The diet must afford rest to the organ involved in the
disease.
6. The diet must be adjusted to the body’s ability to utilize the
nutrients.

B. Problems in Planning Therapeutic Diets

1. Diet patterns vary from individual to individual

2. Nutrient contents in foods vary from food to food.
 3. Requirement for specific nutrients vary because of genetics,
environmental factors, diet patterns, the nature and severity of
the disease, and the age and sex of the patient.
4. Individual problems of patient, such as, emotional, financial,
social and others.

C. Calculating and Planning Diets

The Basis for estimating the desirable intake of an individual

1. Caloric Allowances

a. Based on basal needs and activity (BMR)

Basal needs – 1 kcal. per kg desirable body weight per
hour for male or 0.9 kcal. per kg desirable body weight
per hour for female.

Physical needs – approximate percentage increase above

basal needs

Bed rest 10-20 percent

Sedentary 30 percent
Light activity 50-60 percent
Moderately active 60-70 percent
Severely active 90-110 percent

b. Based on caloric allowance per kg. desirable body weight

Bed rest 27.5 kcal. per kg.

Very light (sedentary) 30 kcal. per kg.
 Light 35 kcal. per kg.
Moderately active 40 kcal. per kg.
Very active 45 kcal. per kg.c.

c. Based on the Recommended Energy and Nutrient Intakes

of the FNRI

Activity:

Know your present weight.

What is your desirable body weight? Record.
Look for the recommended energy allowance based on
your age, sex, and activity and your desirable body
weight.
 2. Protein Allowances

a. Based on body weight: allow 1.14 g protein per kg.

desirable body weight
b. Based on the percentage of the caloric allowances
10 -15 percent of the total energy needs for adults
15-20 percent of total energy needs for children
c. Based on the Recommended Nutrient intakes of the FNRI

3. Carbohydrate allowances

Based on percentage of the non-protein calories 60-75

percent of non-protein calories

4. Fat allowances
Based on a percentage of non-protein calories

D. Sample Calculations of a Diet

Calculating the total Energy Allowance (TER) of a woman 5’3

whose desirable body weight is 120 pounds and engages in
light activity.

1. Convert lbs to kg. weight = 120/2.2 = 55kg

2. Calculate basal needs = 0.9 × 55 × 24 = 1188 kcal.
3. Estimate physical activities = 1188 × .05 = 594 kcal.
4. Add values from 2 and 3 to get TEA
 1188 + 594 = 1782 kcal.

5. Distribute Total Energy Allowance Among Carbohydrate,

Protein, Fat as follows;

a. By using the percentage contribution of CHO, Pro Fat,

allow for protein calories afterwards
b. By calculating protein calories first by using 1.1 g/kg
body weight, multiplying with4. Allow for the desired
percentage distribution for carbohydrate from the
non-protein calories and the rests for fats.

6. To obtain the grams of CHO, Pro, Fats use the

corresponding physiological fuels values (4 kcal/g CHO or
Pro, 9 kcal/g, Fat)
7. One rule to follow in writing the diet, kilocalories are
rounded off to the nearest number exactly divisible by 25;
and CHO, Pro, Fat the nearest number exactly
divisible by 5.
Activity:
Compute your TEA
E. Using the Exchange List in Meal Planning

1. Use the table provided for meal Plans

2. Determine the amount of vegetable A and B exchanges the
patient can eat.
3. Determine the amount of fruit exchanges the patient would
like for the day.
 4. Determine the amount of milk exchanges the patient can
tolerate.
5. Determine the amount of sugar desired (only on the diets
6. when sugar is allowed)
7. Sub total the amounts of carbohydrate, protein, fats and
calories so far provided.
8. Subtract the amount of carbohydrate so far provided by the
vegetable, fruit, milk, exchanges and the sugar allowed from
the prescribed amount and divide the result by 23, which is the
amount of carbohydrate in one rice exchange necessary to fill
up the prescribe amount.
9. Sub total the amount of protein, subtract from the total
protein prescribed and divide the result by 8 to get the number
of meat exchange required.
10. Sub total the amount of fat, subtract from the total fat
prescribed and divide the result by 5 to get the number of fat
exchanges required.
11. The total number of exchanges obtained will be used for
planning the menu.

Activities:

1. Compute your basal needs and activity

2. Calculate your total Energy Allowance (TER)
3. Prepare the exchange list based on your computed TER for meal
planning.
4. Plan a full meal
 Laboratory 2
ROUTINE HOSPITAL DIETS

PURPOSE
To be able to plan and prepare the routine hospital diets;
- Full regular diet/Normal diet
- Soft diet
- Light or Liberal soft diet
- Full Liquid diet
- Clear liquid diet
- Cold liquid diet

Description of Diets
1. Regular or Normal Diet. Also called house or general or full diet, it
is the most frequently used of all hospital diets. It is planned to
provide the Recommended Energy and Nutrient Intakes (RENI) for
essential nutrients with caloric adjustment for bedridden
individuals. All foods are allowed. However, it should be carefully
planned for hospital use avoiding too much spices, gas formers
and rich, hard to digest foods.

2. Soft Diet. This follows the regular diet pattern but is modified in
consistency, free from harsh fivers and connective tissues, soft in
texture, bland in flavor allowing minimum seasonings, simply
prepared and easy to digest. It is not necessarily pureed diet,
therefore it is necessary to select foods carefully. It is a transition
diet between full liquid and regular diets. It is used in post
 operative cases when the patient cannot tolerate the normal diet.
It is also indicated for mild infections, fevers, gastrointestinal
disturbance and convalescence.

3. Liberal soft or Light Diet. This is a transition between the soft and
regular diets. It is more liberal than the usual soft diet in that
short-fibered fruits and vegetables are allowed. Moderate
seasonings are used. It should be used as tolerated.

4. Full Liquid Diet. This consist of foods that are liquid or can liquify
in the mouth or is prescribed allowance of foods which melt at
body temperature. The ingredients used should be easy to digest
and absorb. The should be high in calories and protein, hence, it
can be used for a relatively longer period of time. Feedings should
be at least six times a day; the volume and frequency of feeding
should be on case to case basis as some patients may not have
the appetite to take in more liquid foods in one setting.

Milk based foods form an important part of the diet.

Flavoring is helpful, natural or vanilla is best tolerated for long
term use. The full liquid diet easily provides adequate calories,
protein and essential fatty acids but not certain vitamins
especially vitamin C and B unless fruit juices and cereals are
routinely included.
The Full liquid diet bridges the gap between the clear liquid
and soft diets. It used in acute conditions, following surgery and
for patients too ill to eat solid foods. It is also indicated for those
who can not swallow or masticate food, such as in fractured jaws
and oral surgery or when the esophagus is narrowed and solid
foods cannot pass.
 5. Clear Liquid Diet. This diet is made up of clear liquids, (no milk and
milk drinks or opaque fluids) which do not leave any residue in the
gastro intestinal tract. It is a diet that does not irritate nor
stimulate peristalsis and therefore allows rest to the GI tract. It is
to relieve thirst and help maintain water balance. Since it is
nutritionally inadequate diet, the clear liquid diet should not be
used over 2 days or 48 hours.

It is indicated for patients of pre- and post -surgery; acute

infections and fevers acute gastrointestinal disorders, nausea and
vomiting. It is especially used for patients whose fecal material
must be reduced.
6. Cold liquid Diet. This is also called T & A diet for tonsillectomy and
adenectomy and made up of cold liquids and cold soft foods that
liquefy in body temperature given to patients after tonsillectomy,
adenectomy and other mouth and throat surgery.

LABORATORY: LESSON 2

Objective
To be able to plan and prepare the routine hospital diets
The types of Diet
1. Full, regular or normal diet
 2. Soft diet
3. Light or liberal soft diet
4. Full liquid diet
5. Clear liquid diet
6. Cold liquid diet

Description of Diets

1. Regular/normal Diet. Also called house or general /full diet, it is

the most frequently used of all hospital diets. It is planned to
provide the Recommended Energy and Nutrient Intakes (RENI) for
essential nutrients with caloric adjustment for bed ridden
individuals. It is the basis for all dietary modifications for
therapeutic purposes. Like the normal diet eaten at home, all
foods are allowed. However, it should be carefully planned for
hospital use avoiding too much spices, gas formers and rich, hard-
to-digest foods.

Activity: plan a regular/normal diet for 1 week.

2. Soft diet. This follows the regular diet pattern but is modified in
consistency, free from harsh fibers and connective tissues, soft in
texture, bland in flavor allowing minimum seasonings, simply
prepared and easy to digest. Select foods with the prescribed
characteristics, that can be serve whole, yet it is soft, this diet is a
transition of the full regular to full liquid diet. A diet for post-
operative cases when patient can not tolerate the normal diet. It
also indicated for mild infections, fevers, gastrointestinal
disturbance and convalescence.
 Activity:

1. List down foods under this category, arrange following the

basic food groups.
2. Prepare a regular soft diet for one day. To be presented in the
GC.

3. Liberal Soft or Light Diet. This is a transition between the soft and
regular diets. It is more liberal than the usual soft diet in that
short-fibered fruits and vegetables are allowed. Moderate
seasonings are used.
Activity: Plan a one-day Liberal Soft Diet

4. Full liquid diet. This consist of foods that are liquid or can liquify in
the mouth or is prescribe allowance of foods which melt at body
temperature. The ingredient used should be easy to digest and
absorb. The diet should be planned nutritionally adequate or even
high in calories and protein; hence it can be used for a relatively
longer period of time. Feedings should be at least six times a day;
the volume and frequency of feeding should be on case to case
basis.
Milk -based foods form an important part of the diet.
Natural or vanilla flavor is best tolerated for long-term use. The
Full Liquid diet easily provide adequate calories, protein and
essential fatty acids but not certain vitamins especially vitamin C
and B1 unless fruit juices and cereals are routinely included.
 The full liquid diet bridges the gap between the clear liquid
and soft diets. It is used in acute conditions, following surgery and
for patients too ill to eat solid foods, also for those who can not
swallow or masticate food, such as fractured jaws and oral
surgery or when esophagus is narrowed and solid foods cannot
pass.

Activity;
1. Prepare a one-week Full Liquid Diet.

5. Clear Liquid Diet: this diet is made up of clear liquids, (no milk
and milk drinks or opaque fluids) which do not leave any residue
in the gastro intestinal tract. It is a diet that does not leave any
residue in the gastro intestinal tract. A diet that does not irritate
nor stimulate peristalsis and therefore allows rest to the GI tract.
Its primary purpose is to relieve thirst and help maintain water
balance. Since it a nutritionally inadequate diet, the clear liquid
diet should not be used over 2 days or 48 hours. It is indicated for
patients of pre- and post- surgery, acute infections and fevers,
acute gastrointestinal disorders, nausea and vomiting. It is
especially useful for patients whose fecal material must be
reduced.

6. Cold Liquid Diet. This is also called T & A diet for tonsillectomy and
adenectomy and made up of cold liquids and cold soft foods that
liquefy in body temperature given to patients after tonsillectomy,
adenectomy and other mouth throat surgery.
 CALCULATIONS AND PLANNING TABLES
1. THE NORMAL DIET

TABLE 1 & 2: DAILY FOOD PLAN FOR A NORMAL DIET

FOOD No. CH PRO FAT ENERGY

EXCHANGES of O g g kcal B L D Sn
Exch. g
I.Veg. A

Veg. B

II. Fruits

III. Milk

IV. Rice

V. Meat
VII.Sugars,etc.
TOTAL

TABLE 2 SAMPLE MENU

Breakfast Lunch Dinner

snacks