Tittle Page

WESTERN MINDANAO STATE UNIVERSITY

COLLEGE OF HOME ECONOMICS
DEPARTMENT OF NUTRITION AND DIETETICS
ZAMBOANGA CITY

MODULES
FIRST SEMESTER
S.Y. 2020-2021

NCM 105-LECTURES
NUTRITION AND DIET THERAPY

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WESTERN MINDANAO STATE UNIVERSITY
Copyright © by Western Mindanao State University
All rights reserved. Published 2020-2021
Printed in the Philippines
ISBN _________________
No part of this publication may be reproduced or distributed
in any form or by any means, or stored in a database or
retrieval system, without prior written permission of
WESTERN MINDANAO STATE UNIVERSITY
 Acknowledgment

The contributors are profoundly grateful to Prof. Leah B. Santos (+), a friend, mentor and a

colleague in the nutrition and dietetics profession. Her indelible contributions to our students,

former students and professionals have left its engraved marks to all who have known and loved

her.

Ma'am Leah as she is fondly called by students and co-workers in the college was an agent

of change and became an instrument in the conception and development of this NCM 105 manual

for Nursing and Allied Health Courses.

Prof. Leah worked collaboratively and actively with working colleagues. Likewise her

contribution in collecting information and writings taken from different and adequately important

resources and putting them altogether for the realization and creation of this manual was an

endeavor undertaken by her which is valuable to the present contributors of this manual.

All that was mentioned has proven its worth and importance in the use of the Manual, it

helps facilitate classroom instructions to all instructors who are teaching the subject and to the

students enrolled in the subject as well.

 Table of Contents
Table of Contents Page
No.

Tittle Page ...........................................................................................................................1

Copy Right ..........................................................................................................................1
Preface ................................................................................ Error! Bookmark not defined.
Acknowledgment .................................................................................................................3
Course: Nutrition and Diet Therapy .....................................................................................6
Course Description: ..........................................................................................................7
Program Outcomes: ..........................................................................................................7
Level Outcomes: ...............................................................................................................8
Course Outcomes:.............................................................................................................8
Course Title: Nutrition and Diet Therapy .......................... Error! Bookmark not defined.
Course Description: ........................................................ Error! Bookmark not defined.
Course Content: .............................................................. Error! Bookmark not defined.
Table of Contents .................................................................................................................4
Module 1: Introduction to Basic Nutrition .................... Error! Bookmark not defined.
Introduction to Basic Nutrition .......................................... Error! Bookmark not defined.
Introduction: ................................................................. Error! Bookmark not defined.
Objectives: ..................................................................... Error! Bookmark not defined.
Topic Outline: ............................................................... Error! Bookmark not defined.
Read & Ponder: “Introduction to Basic Nutrition.” ........... Error! Bookmark not defined.
A. Nutrition and Its Importance to Human Health. ........ Error! Bookmark not defined.
B. Definition of Terms.................................................... Error! Bookmark not defined.
C. Basic Concepts in Nutrition ....................................... Error! Bookmark not defined.
D. Basic Tools in the Study of Nutrition ........................ Error! Bookmark not defined.
Module 2: Essential Nutrients and their Contribution to the Diet ... Error! Bookmark
not defined.
Essential Nutrients and their Contribution to the Diet ....... Error! Bookmark not defined.
Introduction: ................................................................. Error! Bookmark not defined.
Objectives: ..................................................................... Error! Bookmark not defined.
Topic Outline: ............................................................... Error! Bookmark not defined.
Read & Ponder: “Essential Nutrients and their Contribution to the Diet.” ................ Error!
Bookmark not defined.
1.Carbohydrates .............................................................. Error! Bookmark not defined.
2. Proteins ....................................................................... Error! Bookmark not defined.
 3.Fats............................................................................... Error! Bookmark not defined.
4.Vitamins....................................................................... Error! Bookmark not defined.
5.Minerals ....................................................................... Error! Bookmark not defined.
6.Water and Electrolytes................................................. Error! Bookmark not defined.
Module 3: Nutrition in the Life Cycle ............................ Error! Bookmark not defined.
Nutrition in the Life Cycle ................................................. Error! Bookmark not defined.
Introduction: ................................................................. Error! Bookmark not defined.
Objectives: ..................................................................... Error! Bookmark not defined.
Topic Outline: ............................................................... Error! Bookmark not defined.
Read & Ponder: “Nutrition in the Life Cycle.” .................. Error! Bookmark not defined.
1. Nutrition in Pregnancy................................................ Error! Bookmark not defined.
2. Nutrition in Lactation ................................................. Error! Bookmark not defined.
3. Nutrition in Infancy .................................................... Error! Bookmark not defined.
4.Nutrition for the Pre-school Child ............................... Error! Bookmark not defined.
5.Nutrition for the School Child ..................................... Error! Bookmark not defined.
6.Nutrition for the Teenager ........................................... Error! Bookmark not defined.
7.Nutrition for Adulthood, Elderly/Aged ....................... Error! Bookmark not defined.
Module 4: Introduction to Diet Therapy..........................................................................9
Introduction to Diet Therapy ..............................................................................................10
Introduction: .................................................................................................................10
Objectives: .....................................................................................................................10
Topic Outline: ...............................................................................................................10
Read & Ponder: “Introduction to Diet Therapy.” ..............................................................12
1. Definitions of Terms ...................................................................................................12
2.Basic Concepts and Principles of Diet Therapy ..........................................................13
3.The Routine Hospital Diet ...........................................................................................15
Background of the Module:

This Manual provides an overview of Basic Nutrition & Diet Therapy designed for nursing
and allied courses Who are taking Nutrition with Diet Therapy. The outlines of topics are selected
based on the course content in the course as well as the number of meetings to cover within one
semester.

It provides laboratory activities and classroom for every unit. It covers to complement as
well as facilitate the lectures and discussion. It also serves as a suitable reference material and
workbook for non-nutrition majors whose knowledge of the subject is quite limited; thus, provides
a wider range of knowledge significant in their field of specialization.

This manual has three units with specific topical outline. Each unit starts with
enumeration of learning objectives with the students are expected to achieve after studying the
unit.

It is good that this outline serves not only the students but also instructors in the
attainment of its course objective.

Contributors
Course: Nutrition and Diet Therapy
Course No.: NCM 105

Course Description:
This course deals with the study of food in relation to health and illness. It covers
nutrients and other substances and their action, interaction and balance in relation
to health and diseases and the process by which the human body ingests, digests,
absorbs, utilized and excrete food substances. It also focuses on the therapeutic and
food service aspects of the delivery of nutritional services in hospitals and other
healthcare institutions. The learners are expected to develop the competencies in
appropriate meal planning and education of a given client.

Course Credit: Theory: 2 units (36 hours), Lab- 1 unit (54 hours)

Placement: Second Year, First Semester

Prerequisites: Biochemistry, NCM 101, NCM 102, NCM 103

Program Outcomes:

1. Apply knowledge of physical, social, natural and health

sciences, and humanities in the practice of nursing.
2. Provide safe, appropriate, and holistic care to individuals,
families, population group, and community utilizing nursing
process.

3. Apply guidelines and principles of evidence-based practice

in the delivery of care.
4. Practice nursing in
accordance with existing laws, legal,
ethical and moral principles.

5. Communicate effectively in speaking, writing, and

presenting using culturally appropriate language.
6. Document to include reporting up-to-date client care
accurately and comprehensively.

7. Work effectively in collaboration with inter-, intra-and

multidisciplinary and multi-cultural teams.
8. Practice beginning management and leadership skills in the
delivery of client care using a system approach,
9, Engage in lifelong learning with a passion to keep current with
national and global developments in general, and nursing and
health developments in particular.

10. Demonstrate responsible citizenship and pride of being a

Filipino.
11. Apply techno-intelligent care systems and processes in
health care delivery.
 12. Adopt the nursing core values in the practice of the
profession.
13. Apply entrepreneurial skills in the delivery of nursing care.
Level Outcomes:
At the end of the second year, given a normal and
high risk mother and newborn, child, family, population group and
community in any health care setting. The learners demonstrate safe,
appropriate and holistic care utilizing the nursing process.
Course Outcomes:
1.Apply knowledge of physical, social, natural and health sciences
and humanities in nutrition and diet therapy.
2.Provide safe, appropriate and holistic care to individuals,
families, population group, and community utilizing the nutrition
care process.
3.Apply guidelines and principles of evidence-based practice in
nutrition and diet therapy.
4.Practice nursing in accordance with existing laws, legal, ethical,
and moral principles related to nutrition and diet therapy.
5.Communicate effectively in speaking, writing, and presenting
using age and culturally appropriate language in nutrition and diet
therapy.
6.Document client care in nutrition and diet therapy accurately and
comprehensively.
7.Work effectively, in collaboration with inter-, intra-, and
multi¬cultural teams in providing nutritional care.
8.Practice beginning management and leadership skills using
systems approach in nutrition and dietary management of the
client.
9.Engage in lifelong learning with a passion to keep current with
national and global developments in general, and nutrition and
dietary management in particular.
10.Demonstrate responsible citizenship and pride of being a
Filipino.
11.Apply techno-intelligent care systems and processes in nutrition
and diet therapy.
12.Adopt the nursing core values in the application of nutrition and
diet therapy.
13.Apply entrepreneurial skills in nutrition and diet therapy in the
delivery of nursing care.
 NCM 105
NUTRITION AND DIET THERAPY -LECTURES
1ST Semester, SY 2020-2021

________________________________________________________________________

Module 5: Introduction to Diet Therapy

________________________________________________________________________

ASST. PROF. NARHUDA H. UNGA

COLLEGE OF HOME ECONOMICS

_____________________________________________________________________
Unit IV Lesson
05

Introduction to Diet Therapy

Introduction:
What is Diet Therapy?

Diet therapy is a broad term for the practical application of nutrition as a

preventative or corrective treatment of disease. This usually involves the modification of
an existing dietary lifestyle to promote optimum health.

Diet therapy is the branch of dietetics concerned with the use of foods for
therapeutic purpose. It is a method of eating a prescribed diet by a physician or Nutritionist-
Dietitian to improve health. Diet therapy usually involves the modification of an existing
dietary lifestyle to promote optimum health.

Therapeutic diets are modified for nutrients, texture and food allergies or food
intolerances. Diet therapy involves the modification of an existing dietary lifestyle for good
health. Some common therapeutic diets are clear liquid diet, full liquid diet, high fiber diet,
renal diet, pureed/osteorized diet, food allergy modification etc.

It is a branch of dietetics related with the use of food for therapeutic purposes. It is
ordered to maintain, restore and correct nutritional status, to decrease calorie for weight
control, provide extra calorie for weight gain. It also balances amount of carbohydrate,
protein, fats and other nutrient for diet modification and disease prevention.
________________________________________________________________________

Objectives:
At the end of the lesson, the student should be able to:
1. Discuss the importance of diet therapy on patients care.
2. Describe the various routine hospital diets.
3. Plan, prepare, and evaluate a simple routine hospital diet.
4. Present Diet Counselling

Topic Outline:

Nutrition in the Life Cycle:

1.Definitions of Terms
2.Basic Concepts and Principles of Diet Therapy
3.The Routine Hospital Diet
4.Diet Counselling
 Try this!

Activity 5.A. Research Work.

*Search and Draw the following:

1.The Model for Hospital tray service.
-Identify and write each utensil’s according to the arrangement in the tray service hospital
set up and discuss the concept.

2.Different Tube Feeding Routes and gives each brief description.

2.a.Nasogastric Route
2.b.Nasoduodenal Route
2.c.Nasojejunal Route
2.d.Esophagostomy Route
2.e.Gastronomy Route
2.f.Jejunostomy Route

3.Conclusion and Recommendation.

________________________________________________________________________

Godspeed…
 Read & Ponder: “Introduction to Diet Therapy.”

1. Definitions of Terms
1) Diet
 An allowance of food and drink consumed regularly by an individual
 The usual food and drink regularly consumed.
2) Diet therapy
 The branch of dietetics that is concerned with the use of food for therapeutic
purposes.
 The modifications of the normal diet to meet the physiological requirements of
the sick individual.
 The use of food as a factor in aiding recovery from illness.
3) Dietetics
 The combined science and art of regulating the planning, preparing, serving of
meals to individuals or groups under various conditions of health and diseases
according to the principles of nutrition and management with due consideration
to economic, cultural, social and psychological factors (RA 2674)
 Refers primarily to the therapeutic and food service aspects of the delivery of
nutritional service in hospital and other health care institution (PD 1286)
4) Diet Prescription
 Serves the same purpose as drug prescription in medicine.
 It may indicate the daily caloric requirement and the amount needed for
protein, fat and carbohydrate, vitamin and minerals or non-nutrient substances.
5) Therapeutic Diets
 A diet modified or adopted from the normal diets commonly to suit specific
disease conditions; one designed to treat or cure diseases
6) Nutritional Care
 Science and art of human nutrition in helping people select and obtain food for
the purpose of nourishing their bodies in health and disease throughout the life
cycle.
7) Cinical/Medical Nutrition
 The treatment of patients requiring modifications in their nutritional
requirement.
 That branch of the health sciences having to do with diagnosis, treatment, and
prevention of human disease cause by deficiency, excess or metabolic
imbalance of dietary nutrient.
8) Nutritionist-Dietitian (ND)
 A person professionally qualified to provide leadership and assume
responsibilities for the promotion of the nutritional well-being of individuals
or groups within the framework of community life.
 These responsibilities include the preventive, therapeutic and food service
administration aspects of nutritional care.
 His/Her role includes:
a) Administrative
b) Therapeutics
c) Teaching
 d) Research
9) Health Team
 Professionals involved directly or indirectly with the care of the people. The
following are included in the health team: Physician, Nurse, N.D., Social
Worker, Pharmacist, Physical Therapist, Medical technologist, and Health
Educator.
 The team concept in health care implies that the professional health personnel
work together in planning, prescribing, and evaluating patient’s care.

2.Basic Concepts and Principles of Diet Therapy

A. Therapeutic Diets
 Are modifications of the normal diet and have one or more of the following
objectives:
1. To maintain good nutrition or correct any deficiency
2. To provide rest to an organ or to the whole body as affected by the illness.
3. To adjust weight to a desirable level
4. To supply a dietary regimen according to the patient’s tolerance and
metabolism for kind, amount and time of eating of the food.

B. General Principles in the Dietary Management for a Specific Disease:

 Simplifications – the therapeutic diet should vary from the adequate normal diet as
little as possible.
 Liberalization – the diet therapy should meet the body requirement for essential
nutrients as generously as the disease condition permits.
 Individualization – the diet program should take cognizance of the patient’s food
intake habits, preference, economic status, religious practices, and any
environmental factors that have a bearing on the diet.

C. Responsibilities of the Dietary Department in Patient Care

 Provides food services primary for the patients and oftentimes feed the hospital
staff and personnel.
 Food Service Director or Administrative Dietitian
a) Supervises food production and service, utilizing the principles of nutrition and
efficient management.
b) Maintains close communication with the hospital administrator with regards to
food and equipment budget, personnel policies, sanitation and safety, physical
lay-out
c) Continually plans, evaluates, and varies her menus
d) Provide in-service training for her staff and personnel and teach dietetic interns
and trainees.
 Clinical or Therapeutic Dietitians
a) Coordinates her activities with the physician and nurse in the comprehensive
teamwork for patients cure and care.
b) Participates in ward rounds, visits and interviews patients, provide diet
counseling especially for those requiring specials diets, and record food intake
of some patients.
c) She also teaches student nurses, dietetic interns, and trainees in her area of
specialization
  The Clinical Dietitian or an authorized alternate professional is responsible for
documenting nutrition information and actual dietary care provided for a patient.
 Dietetic Technician
a) Assist either the administrative or clinical dietitian whenever needed.
b) Usually checks in-coming food and equipment, helps plan menus, bring food
service in wards, work out personnel schedules, complies educative materials,
and helps in food recording.

D. Responsibilities of Nursing Department in Patient Care

1) The nurse is usually the first person who observes the patient’s feeding problem
(inability to chew, any physical handicap to feed him, complaints about the food,
etc).
2) She has more direct and continuous communication with the patients and must
therefore be well-informed about the principles of diet, food allowed and avoided.
3) If she is not sure for her answer to the patient regarding his food, she must notify
the dietitian as soon possible.
4) a) A nurse should immediately forward the diet prescription slips as ordered by the
physician as soon possible to the dietary department.
b) If the patient is going home on special diet (discharge diet, take home diet), the
nurse should notify the dietitian immediately.
c) Usually food charting is accomplished by the nursing staff.
5) a) The nursing aides sees to it that the patient ready for his food try.
b) The patient may need help in washing his hands, sitting-up, cutting his meat,
pouring water. Etc.
c) She helps in encouraging the patient to eat, tidying his besides table, and
cleaning up.
d) She should remove the try promptly and make sure to note down left-over if
food recording is needed.

E. Types of Tray Service

 The types of food service in the hospital are:
i. Centralized – all trays are prepared completely from the main kitchen and
delivered to the patient unit.
ii. Decentralized – food is transported in bulk using a conveyor or food carts
to the patients units and the individual trays are setup in ward kitchen.

F. Types of Menu in the Hospital

 Selective – the dietary technician or nursing aides help the patient in checking his
choices on the menu card.
 Non-selective - patients have no choice but the dietary department makes an effort
to interview patients who are on special or therapeutic diets and consider their food
likes, dislikes, religion, allergy, etc.

G. Checklist for Proper Tray Service

1) Is the tray correctly identified with patient’s name ward and room number and right
diet prescription?
2) Is the size of the tray suitable to the amount and kind of diet?
3) Is the cover clean and neat, free from wrinkles and from spoilage?
 4) Are the silverwares and glasswares free from grease marks, chips, and cracks?
5) Is the arrangement of dishes and cover appointments in proper order?
6) Are the meals served on time?
7) Are the hot foods served hot and cold foods cold?
8) Are the serving portions according to the dietary prescription and suitable to the
patients appetite?
9) Are the color, texture, and flavor combinations pleasing?
10) Are the seasoning and other food adjuncts correctly included? (restricted sodium
diets should not have salt packets and bland diets must not have pepper shakers?).

3.The Routine Hospital Diet

A. Routine Diets
1. Full, house, general or regular diet – designed for patients who require no special dietary
modification or restrictions.
2. Soft diet
3. Liquid diets – clear, full, cold, and blenderized or tube feeding.

Characteristics and Indications For Use of Different Routine Hospital Diets

Type of Diet

1. Clear liquid
Aims:
To provide an oral source of fluids and small amounts of calories and electrolytes
order to prevent dehydration, relieve thirst, maintain water balance, and reduce caloric
residue to a minimum.

Characteristics:
Inadequate in nutritional essentials. Foods included are liquid or become liquid at
body temperature, leaves no residue, non-distending, non-irritating and non-stimulating to
peristaltic action. This diet is also called non-residue diet which made of clear liquid foods
which leaves no residue in the G.I. tract.

Indications for Use:

Illness or surgery accompanied by marked intolerance to foods, acute inflammatory
conditions of the G.I tract, in conditions when it is necessary to minimize fecal material,
pre-operative and post-operative cases, acute diarrhea, vomiting and intestinal obstruction.

Feeding Administration/Intervals of feeding:

It should be used for 1 to 2 days or 24 to 48 hours only. Given every 2 to 3 hours,
when it is necessary, not more than 300ml. per feeding.

Food Allowed:
Clear, fat – free broths, strained juices, tea, black coffee, salabat, plain gelatin, plain
sugar, hard candies, ginger ale, non-carbonated soft drinks, honey, corn syrup, egg white.

Food Avoided:
All solid foods, milk & milk products, fruit shakes, soup cooked with fat and
creams, fruit juices with residue.
2. Full liquid Diet
Aims:
To provide oral nourishment to the patient who cannot tolerate solid foods, prevent
dehydration and alteration in nutrition. It is often used after surgery or fasting, which require
least effort for digestion and absorption.

Characteristics:
Intermediate between clear liquid and soft diet. Consist of liquid or strained semi-
liquids foods and foods that liquefy at room and body temperature, free from cellulose and
irritating spices and condiments. When carefully planned, the diet may be made adequate
in energy value and protein and can be used for several days. A termination diet from clear
liquid to soft and regular diet and nutritionally adequate diet by proper planning.

Indication for Use:

Post-operative cases with normal gastro-intestinal function, fevers and infection,
difficulty in swallowing as fractured jaw and after oral surgery, patients too ill to eat solid
or semi-solid foods, face lifting and lesions in the mouth and G.I. disturbances.

Feeding Administration/Intervals of feeding:

The diet is given is 6 or more feeding and can be used for several days. Given every
2 to 3 hours feeding interval but not more than 300 ml. per feeding.

Foods Allowed:
Those foods that included in the clear liquid diet plus strained cream soups, pureed
strained meat and fish, vegetable pureed and juices, strained lugao and oatmeal, strained
fruit juices, plain ice cream, plain gelatin, custard or cornstarch pudding, milk and milk
drinks, cocoa, melted butter or margarine.

Foods Avoided:
All solid foods, breads and other cereals, cheese, all raw and cooked vegetables, all
frozen/fresh or canned foods or fruits.

3. Cold Liquid Diet

Aims:
To rest the organ included and avoid irritation at the side of the resection. Also, to
minimize pain in oral cavity and avoid bleeding of operated area. To promote rapid wound
healing and replaces nutrient losses. It also provides on oral source of fluids for individual
who are capable of chewing, swallowing, or digesting solid foods.

Characteristics:
Cold liquid diet is sometimes referred to as T and A diet after tonsillectomy and
adenectomy. Cold fluids given to prevent bleeding of the operated area which consist of
food and iced smooth liquids. All liquids are served cold or iced or foods that have been
allowed to cool may also be given.

Indication for Use:

Tonsillectomy, dental extraction, other minor operation on the mouth or throat and
adenoid surgery.
 Feeding Administration/Intervals of Feeding:
Cold liquid diet is given on the first day after surgery.
 Day 1 – Ice chips or sips of cold water are given progressing with cold milk and
non-
irritating fruit juices.
 Day 2 – Cold liquids, gels, and ice are added for example like ginger ale, gelatin,
bland
strained fruit juice, plain ice cream and weak iced tea or coffee. For some
other
patients who can tolerate plain pudding, custard and 3-minutes egg is
given before
the 3rd day.
 Day 3 & 4 – strained warm cream soups, fruit, vegetable puree, soft – cooked eggs,
strained
warm cereals, milk, cheese, butter, lugao or gruel and mashed
potato are
added to the cold liquid diet.
 Day 5 – soft to liquid diet is prescribed.

Foods Allowed:
Plain ice cream, and milk, iced tea, iced coffee, soft drinks, cooked soft and bland
foods which have been cooled are allowed.

Foods Avoided:
Acidic or sour fruit juices and hot soups or foods are avoided.

4. Soft Diet
Aims:
a. To provide dietary and nutritional needs to the patient who is psychological and
physically unable to tolerate regular diet.
b. To supplement foods that is modified in consistency and easily digestible to facilitate
mechanical case in eating. And therefore reduce the work load of the digestive
system.

Characteristics:
This diet follows the regular pattern but is designed for patients who are psychologically
or physically unable to tolerate the regular diet. This diet serves as a transition from full
liquid to the regular or full diet. It is a nutritionally adequate diet, modified in consistency
and texture. These foods that easily digestible with low cellulose content and with little or
no tough connective tissues like elastin and are generally bland in flavor. The foods were
prepared through cooking, washing, cutting, and removal of skin and seeds from fruits and
vegetables, gristle and elastin from meat can improved the digestibility of these foods.

Indication for Use:

Post – operative cases – when patient can tolerate solid food but not a full diet, fevers
and infections, G.I. disturbance, convalescence and patient who are unable to chew,
swallow or digest foods included in the full diet.

Feeding Administration/Intervals of feeding:

 5 -6 feeding a day which includes breakfast, lunch, and supper, 2 snacks (a.m./p.m.)
and 1 evening snacks.

Foods Allowed:
The food selection guide includes low in cellulose content, low in fiber, free from tough
connective tissue and strong flavors, simple and easily digested foods.
(Note: For list of food for soft diet refer to books on Diet Therapy or Diet Manual or Guides)
Foods Avoided:
Those foods that were not included on the foods allowed lists were avoided.

5. Regular diet
This is the most frequently ordered among hospital diets. It is also called as full.
House, normal, or general diets. The preferred term is “regular diet”.

Aims:
a. To bring and maintain a person in a state of nutritive sufficiency.
b. Used as a basis for planning therapeutic diets and it should be practiced to serve
simply prepared foods.
c. Designed to maintain optimal nutritional status and follows the principles of good
meal planning and permits the use of all foods.

Characteristics:
Consist of all foods eaten by a person in health but required good menu planning.

Indication of Use:
For ambulatory or bed patients whose conditions do not necessitate a modified diet.

Feeding Administration/Interval of Feeding:

About 5 to 6 feeding a day which includes Breakfast, Lunch, and Supper with 2 snacks
(a.m./p.m.) or 1 evening snacks.

Food Allowed:
All food are allowed but is sound practice to serve simply – prepared foods.

Food Avoided
Those foods that are highly spicy, rich-fatty, and gas-forming foods.

6. Tube Feeding
A form of enteral nutrition support designed to provide adequate nutrition in a form
that can be administered through a tube, used for persons that are unable to tolerate an oral
diet or who have inadequate oral intake and have functioning gastrointestinal tract.

Aims:
To provide a source of complete nutrition in a form that will easily pass through a tube
in patients in whom oral feeding methods are contraindicated or not tolerated or whose
condition warrant supplementation in the form of natural foods.

Characteristics:
 Composed of foods included in the soft and liquid diet, blended, and liquefied to
enable the mixture to pass thru a polyvinyl tube.
May be administered through a gastrostomy or jejunostomy. A satisfactory tube
feeding formula must be nutritionally adequate except for prescribe modifications for
specifies nutrients. It must be inexpensive, easier, prepared, and stored.

Types of Tube Feeding:

Homogenized or blenderized mixture of foods selected from a normal diet.

Indication for Use:

When patient is unable to chew or swallow due to deformity or inflammation of
mouth or throat, corrosive poisoning, coma, unconsciousness, paralysis of throat, muscles,
surgery of the head and neck, esophageal obstruction, surgery of the GIT, in severe burns,
mental disturbances, anorexia nervosa, mandibular fractures, strokes, or trauma to the oral
pharyngeal cavity.

Feeding Administration/Intervals of Feeding:

Tube feeding may be given as continuous drip or at intervals throughout the day. The
regimen should be adjusted to the patient’s condition, nutiture, and dietary prescription by
the doctor. To initiate tube feeding used dilute mixture at first, about half the required
concentration. Try 50 ml of the mixture at hourly interval then gradually increase the
concentration and volume until patient can tolerate 300 ml at 2-3 hourly intervals. Do not
exceed 300 ml per feeding.
For continuous drip method, the flow of the tube feeding should be very slow at first
then increase gradually but kept at constant, steady rate. Total volume should not exceed
100 ml/hr. with a dilution of 1 kcal/ml.
Additional water should be given as needed to make fluids requirement as patient’s
condition improve, whenever possible food should be given orally.
Again, small amount of liquid food is introduced, gradually, increasing the volume
and consistency until part of the days feeding is by normal route.

Food Allowed:
Well – cooked meat, ripe fruit, cooked vegetable whole or non-fat dry milk, cooked
eggs, sugar, oil, homogenized milk, and low fibrous fruit.

Food Avoided:
Plain pasteurized milk, course fibrous food that tend to clog the blender.

Tube Feeding
INSERTION
METHOD & ADVANTAGES DISADVANTAGES
FEEDING SITE
Does not require surgery or Easy to remove by disoriented
Trans – nasal incisions for placement clients; long-term use may
irritate the nasal passages,
throat, and esophagus.
Nasogastric Easiest to insert and confirm
placement; feedings can often be Highest risk of aspiration in
 given intermittently and without anCompromised clients.
infusion pump.
Tube Enterostomies Allow lower esophageal sphinter to May require general anesthesia for
remain closed, reducing the risk of insertion;
aspiration; more comfortable than
transnasal insertion for long-term
use, site is not visible under clothing.
Gastrostomy Feeding can often be given Moderate risk of aspiration in high-
intermittently without a pump; easier
risk clients.
to insert than a jejunostomy.
Jejunostomy Lowest risk of aspiration; allows forMost difficult to insert; feeding
Enteral nutrition earlier followingrequire an infusion pump for
severe stress; may allow for enteral administration; may take longer to
feeding when partial obstructions,reach nutrition goals.
fistulas, or medical conditions prevent
gastric feeding

2. ENTERAL NUTRITION:

Enteral Nutrition – refers to the provision of nutrient via the gastro intestinal tract,
includes oral and tube feeding.

Modes of Enteral Support:

1. Oral Supplementation – suitable for person who are able to eat nutritional requirements
through solid food.
a. Types of Oral Supplementation
 Nutritionally complete with lactose: powder (designed to be mixed with milk)
or liquids containing milk.
 Nutritionally complete, lactose-free: powder (designed to be mixed with
water) or lactose-free liquids
 Saturated module: 8 individual sources of carbohydrates, protein or fat
designed to mixed with other supplements (or with food) to increase the
nutrient content of the diet.
b. Effectiveness of oral supplementation depends on individual acceptance.
c. Problem encountered in oral supplementation
 Diarrhea
 Bloating
 Retention
2. Tube Feeding – a form of enteral nutrition support to designed to provide adequate
nutrition in a form that can be administered through a tube, used for person who are
unable tolerate on oral diet or who have inadequate oral intake and have a functioning
GIT.

A. Benefits of Enteral over Parental Feeding:

Enternal feeding has the following advantages:
1. Intraaluminal effect. The presence and absorption of nutrients in the GIT help
prevent atroply of the intestinal muscosa.
 2. Safety. There is less chance of infection and fluid electrolyte imbalance if GIT is
used to oppose the direct infusion of the nutrients into the viens.
3. Norma insulin – glucagon ratio. Absorption of carbohydrates through the
intestine helps to keep the blood the levels of the glucagon and insulin normal.
4. Reduced cost. Feeding the enternal route requires less staff and equipment than
parenteral nutrition.

B. Contraindications:
Enteral nutrition is contraindicated when there is need to rest the GIT or where
altered GIT integrity and/or functions such as in:
1. Diffuse peritonitis
2. Intestinal obstruction
3. Intractable vomiting
4. Paralytic ileus/hypomotility of the intestine
5. Severe diarrhea with or without oral absorption
6. Gastro intestinal bleeding
7. Certain small bowel fistulas
8. Severe acute pancreatitis
9. Shock
10. Client (or legal guardian) does not desire aggressive nutrition support
11. Prognosis/ does not warrant Enteral support.

C. Factors to consider in table feeding:

1. Condition indicating tube feeding or special Enteral formulas:
CONDITION EXAMPLES
A. Psychiatric/eating disorders, when  Anorexia nervosa
Patient refuses or cannot take food  Severe depression
By mouth  Dementia/alzheimer’s disease
 Insanity

B. Impaired swallowing  Central neurons System disorders

 Cerebrovascular accident
 Neoplasma affecting central nervous
system
 Trauma
 Inflammation
 Demyelinating disease
 Coma
 Motor Disorders of the esophagus
 Cerebral palsy

C. Increase nutrional losses or  Fever and infection

needs  Sepsis
 Surgically or medically related stresses
 Cancer
 Aids
 Severe undernutrition
  Cachexia
 Burns

D. Gastro-intestinal disorders  GI diseases associated of

malabsorption
 Short bowel syndrome
 Inflammamtory bowel disease
 Bile acid-induced disorder
 Pancreatic (w/o ileus)

E. Oropharyngeal – esophageal  Oropharyngeal-esophageal neoplasm

disorders  Inflammation
 Maxilla facial fractures or other types
of traumas
 Head and neck & neck surgery
 Chemotherapy
 Esophageal obstruction

F. Specialized nutritional needs  Renal failure

 Live fracture
 Respiratory faulire
Also, as an effect of;
 Chemotherapy
 Radiotheraphy

G. Other conditions characterized by  Supplement parenteral or oral feeding

inadequate oral/ parenteral intake  Impaired nutritional status
 Geriatric condition
 Prematurity/growth failure in infants
 Inborn errors of metabolism/
congenital abnormalities in infant

Route of Access:

a. Nasoenteric feeding tubes

 Nasogastric – tube extending from the nose into the stomach
 Nasodoendenal – tube extending from the nose through the pyloric into the
duodenum
 Nasojejunal – tube extending from the nose through the pyloric into the duodenum
 Nanojejunal – tube extending from the nose through the pyloric into the jejunum
placed radioscopically.

b. Tube enterostomy. Surgical incision is necessary and the placement often done at a time of
other surgical procedures.
 Esophagostomy – surgical opening into the neck through which a feeding tube
pushed into the esophagus and down into the stomach.
 Gastrostomy – placement of tube in stomach
  Jejunatomy – types include needle catheter placement, direct tube placement and
creation of jejuna stoma which can be intermittently and catheterized.

c. Percutaneous Endoscopic Grastrostomy

 Under endoscopic guidance, feeding is percataneously palced into the stomach at
severe and secure by rubber “bumpers” or an inflated balloon catheter.

Types of Enteral Formulation:

TYPE INDICATION FOR USE CHARACTERISTICS

1. Intact formulas For patients who are able to Also called “meal
(polymeric formulas) digest and absorb nutrients replacement formulas”
 Standard polymeric without difficulty - Lactose free; low
Formula osmolatily

 High nitrogen polymeric - Lactose free, designed to

formulas most increased demands.
 Fiber-containin formula - Contain fiber from
natural food or
- From added
polysaccharide lactose
free, low osmotality

 Blenderized formulas - Composed of a mixture

Of ordinary foods

2. Hydrolyzed formulas For patients who cannot digest Lactose free, generally low in
(Predisgested/ certain nutrients or who have total fat
Monomeric) smaller than normal area for
Elemental formulas absorbing have unpleasant facts

3. Modular formulas For patients who have specific - Composed of

metabolic or fluid imbalances single predigested
that preclude the administration nutrient
of a standard formula eg. CHO, Protein)

- Do not contain vitamins

minerals, electrolytes,
and may have
supplementation of
these.

4. Specialty formulas -for patients who require - Some are unpalatable

different proportions or
types of protein, amino acid, - Most are very expensive
carbohydrate, fat, and
electrolytes. (e.g. patient with - May be constructed from
liver, renal and pulmonary modular formulas.
disease and diebetes)
Feeding Administrative Methods:

1. Continuous drip – tube feeding is administered at a constant, steadily rate usually a 24-hr
period. Use of an infusion pump is recommended a accurately of volume delivered is
assured.
2. Intermittent infusion – the feeding is infused at a specific interval throughout the day. The
volume of desired feeding is divided into equal portion and given four to six times per day.
The feedings are usually given by gravity drip over a 30-minute to 1-hr time span.
3. Bolus feeding – refers to rapid instillation of a feeding into the GI tract by syringe or funnel.
(240-480 ml) using large volume formula.

Common complication of tube feeding

a. Mechanical Problem
 Occlusion or clogging of the feeding tube
 Misplacement of feeding tube
 Skin irritation aroused feeding ostony site
b. Physical Problem
 Diarrhea
 Constipation, nausea, and abdominal distention and discomfort
 Vomiting
 Aspiration of tube feeding formula

c. Metabolic Problem
 Electrolyte and metabolic abnormalities (e.g. hyperglycemia, hypokalemia
hypophasphatemia)
 Dehydration

Parenteral Nutrition:

Parenteral Nutrition. The delivery of nutrient by-passing the gastrointestinal tract (e.g.
intravenously). It is designed for individual who can neither accept or assimilate nutrients given
enterally because of non-functioning of GI tract, e.g. paralytic, ileus. A team effort involving the
doctor, nurse, pharmacist and nutritionist-dietitian. The N-D role is assessing the patient’s
nutritional states needs and monitoring his nutritional states

Route of Parenteral Feeding:

1. Peripheral vein route – is used for patients with mild to moderate nutritional deficiencies.
2. Parenteral hyperalimentation (Intravenous Hyperalimentation IVH) – an intravenous
feeding system designed tp provide nutrients in sufficient quality and quantity to persons
who can not or should not be fed through the GIT.

Total Parenteral Nutrition (TPN) – designed for patients with increased nutritional
requirements and need parenteral nutrition support longer than 5-7 days.

Indications for TPN are:

1. Patients with inability to absorp nutrients via the GI tract. Examples:

 Massive bowel resection, diseases of the small intestine
  Radiation enteritis
 Severe diarrhea
 Intractable vomiting
2. Patients undergoing high-dose chemotherapy, radio-therapy or bone marrow
3. Moderate to severe pacreatitis
4. Severe malnutrition in the face of non-functioning GIT
5. Severely catabolic patients with or without malnutrition. When GIT is not usable with in
6-7 days.

Administration of TPN:

a. Continuous
b. Cyclic TPN – refers to intermittent infusion of solution over a specified amount of time.
TPN is given for 10 – 18 hours and TPN is discontinuous. This include allow more patient
mobility and should free up more nursing time during the day.

Complication of TPN:

1. Problems related to catheter misplacement

2. Pneumotherma
3. Air embolism
4. Infection (Sepsis)
5. Metabolic problem
6. Glucose Problem
a. Hyperglycemia – gradually increase the concentration of dextrose (over 48 hrs.)
b. Hypoglycemia – gradually decrease dextrose concentration before TPN is discontinue.

VEGETARAIN DIET

The diet is designed to utilize a combination of vegetable protein, providing a similar

quantity of protein as animal protein. People follow vegetarian diets for health, political,
cultural, or economic seasons, or combination of these.

Classification of Vegetarian Diets:

1. Lacto-ovo – eggs, milk and their products are allowed besides items of plant origin.
2. Lacto vegetarian – in this diet, milk and milk products are allowed in addition to food
items of plant origin.
3. Total vegetarian – also called diet or strict vegetarian diet. Foods allowed are strictly of
plant origin devoid of any animal product. Foods included are fruits, vegetables, whole
grains, soybeans, legumes and nuts, breads, cereals and processed foods made from these
items such as peanut butter, soy milk, meat-like gluten. Foods avoided are all animals and
animal product.

Other types:

1. Ovo-vegetarian – in this regimen, eggs and eggs products are allowed besides items of
plant origin.
2. Semi-vegetarian – fruits, grains, legumes, nuts, and seeds, vegetable, milk and milk
product, eggs, chicken and fish are included in the diet. All other animal meats are
excluded.
 3. Pesco-vegetarian – in this diet, fish and fish products are added to the list of items of plant
origin, all animal meats are excluded.

Vegetarian diets are usually low in saturated fatty acids and cholesterol. It has high fiber
content and is generally more economical that diets with meats, fish and poultry. One
disadvantage is the inadequate or low level of Vit. B12, iodine, calcium, zinc, riboflavin and
vitamin D.

FOOD SOURCES FOR IMPORTANT NUTRIENTS IN THE VEGETARIAN DIET

NUTRIENT SOURCES
Vitamin B12 Milk, and eggs, fortified soybean milk, and fortified soya products

Riboflavin Vit. B Milk, legumes, whole grains and certain vegetables

Calcium Milk, and milk products, cheese and yogurt, fortified soy milk, dark green leafy
vegetables such as gabi leaves, malunggay, pechay, saluyot, and ampalaya
leaves, lime processed tortillas.

Iron Legumes, dark green leafy and other vegetablesd, whole grains or enriched
cereals or breads, some nuts and dried fruits.
Zinc Nuts, beans, wheat grains and cheese
Protein Eggs, milk, nuts and seeds, legumes especially soybean and tofu.

1. Mechanical Soft Diet – it is called “dental soft diet” or “mechanical altered diet”. It is used
for patients with difficulty in chewing due to poor dental condition, lack of taste or
presence of sores and lesion in the mouth following head and neck injury and for those
who are debilitated and too ill to eat the regular diet. Foods should be well-cooked, easy
to chew necessary, chopped ground or minced. Foods are best served moist or with gravy
and sauce. The diet should be individualized to allow for each patient’s chewing because
all beverages are allowed, although patients with lesions in the mouth may not be able to
take to take fast juices.

2. Bland Diet – diet previously used in treating gastric ulcers irritation and other
gastrointestinal dysfunction; eliminates or restricts the intake of substances known to
cause gastric irritation and excessive gastric acid secretion. These substances include black
pepper, chili powder and red pepper, coffee, both regular and decaffeinated, alcohol,
softdrinks with caffeine and any food that is not tolerated. The diet is highly
individualized. Spices are restricted by individual tolerance.

3. Low Fiber Diet – diet that contains a minimal amount of indigestible carbohydrates or
dietary fiber. The fiber content of the diet may be reduced by removing growth and tough
connective tissue in meats, removing seeds and skins from fruits and vegetables, omitting
high-fiber foods, and using refined cereals and breads. It is indicated in narrowing of the
intestine, gastroporesis, small bowel obstruction, and acute diverticulitis or inflammatory
bowel disease.
4. Low Calorie Diet – diet planned to permit loss of weight while maintaining health. If
reduction of 500 kcal/day from usual intake, while keeping activity constant, should bring
about a loss in the body weight of about 1 lb/wk. It is best to arrive at a caloric allowance
that is acceptable to the patient.

5. High Calorie Diet – diet with prescribed caloric intake above normal meet increased
energy requirement and to promote weight gain. It is indicated in febrile conditions,
hyperthyroidism, atherosclerosis, undernutrition and other conditions that result in loss of
weight.

6. Low Protein Diet – a protein allowances of .5 to .9 g/kg/day for adults, but at least 30g/day
for adults, but at least 30g/day. Indicates in chronic Glomerulonephritis and chronic
uremia. The protein in the diet is supplied by 1 egg, ½ cup of milk, 2 oz. meat, 3 slices of
bread or equivalents, fruit and low-protein vegetables.

7. High Protein Diet – an allowances of 1.5 to 2.0g/kg protein for adults. Indicated in severe,
stress, depleted protein stones, hepatitis and long bone fractures.

8. Low Fat Diet – reduction in the fat content of the diet to supply about 15% to 20% of
caloric intake. This amount of fat is supplied by about 5-6 oz. lean meat, poultry or fish
per day. No foods rich in fat are allowed. Visible are timed from meat and foods are
prepared simply by broiling, baking or boiling. Avoid fried, fully or heavily marbled meat,
cold cuts, sausages, canned fish in oil, nuts creamed sauces, gravies and all fats including
butter, margarine, mayonnaise, vegetables oils and cream. Indicated for acute attacks of
pancreatitis and cholecistitis.

9. Low Cholesterol Diet/Cholesterol Restricted Diet – diet in which the intake of dietary
cholesterol bladder stones with cholesterol esters. The American Heart Association
(AHA) recommends limiting the average cholesterol intake of all healthy individuals to
<300mg/day and <200mg/day in heart diseases and cholesterolemia. Cholesterol is found
only in animal tissue, with high amounts occurring in meats, especially glandular organs
and red meat, dairy bproducts/eggyolks and shellfish. Limiting eggs 2-3 yolk/wk and red
meats to 5g/day.

10. Low Salt/Low Sodium Diet/Low Restricted Diet – diet in which the sodium content is
limited to a specified level which may range from mild restriction to severe restriction.
Sodium restriction is used primarily for the elimination, control and prevention of edema
accompanying congestive heart failure, cirrhosis of the liver, nephritis, nephrosis,
toxemias of pregnancy and adrenocorticotropic hormone therapy. It is also beneficial in
the treatment of some cases of hypertension sensitive to sodium. Sodium in the diet comes
from two sources: sodium naturally present in foods and sodium added during cooking
and food processing.

Degree of Sodium Restriction – mg Na per day:

 Mild Na restriction - 3000mg Na

  Moderate Na restriction - 2000mg Na
 Strict Na restriction - 1000mg Na
 Very Strict Na restriction - 500mg Na
 Severe Na restriction - 250mg Na

Sources of Sodium (Na) in the diet:

Salt or NaCI:

 Canned vegetables, frozen with salt or sodium – containing additives; pickles, sauerkraut,
mustard green, celery and spinach, diabetic pack fruits and vegetables are allowed.
 Glazed or candied fruits, dried or frozen fruits to which salt, sulfite and other additives
containing sodium has been added.
 Breads with baking soda, baking powder, salt and sodium-containing additives,
commercial mixes, quick-cooking cereals and dry-cereals, potato chips, pretzels, popcorn,
crackers, cookie, cakes etc.
 Noodles such as miki, mami, miswa, and canton; native delicacies as suman sa lihia,
kutsinta and puto.
 Canned, salted, cured, smoked or processed meats containing additives with sodium like
buring isda, frozen or canned meat or fish, shellfish or seafoods, regular cheese and peanut
butter, salted or pickled eggs, textured vegetables proteins.
 Miscellaneous items which includes instant cocoa mixes, commercial gelatin desserts,
molasses, bouillon cubes, catsup, celery, salt, chili sauce, garlic salt. MSG, meat extract,
meat tenderizer, meat sauces, onion salt & Na cyclamate (a sugar substitute)

11. Low Purine/Purine Restricted Diet – diet restricting the daily intake of purine to
approximately 120 to 150mg compared to normal intake of 600 to 1000mmg/day. The diet
is prescribed as an adjoint to drug therapy for gout and other disorder affecting purine
metabolism; it is designed to lower the uric acid level in the body.

Levels of Purine Content of Foods:

Group I – High Purine Content (100-1000mg of Purine Nitrogen per 100g of Food)

Food sources: anchovies, bouillon, broth, carabeef, gizzards, gravy, heart, kidney, liver,
mackerel, mussel, roe, sardines, sweet bread, and yeast.

Group II – Moderate Purine Content (9-100mg of Purine Nitrogen per 100g of food)

Food Sources: meat & fish – except those in group I brains, fish, meat, poultry, shellfish

Vegetables – asparagus, beans dry, cauliflower, lentils, mushroom, peas,

spinach

Cereals – oatmeal

Group III – Negligible Purine Content

Food Sources: bread, crackers, butter, margarine, cakes and cookies, carbonated beverages,
coffee etc. Those foods not included in the list of group I and group II may be used daily.

_____________________________________________________________________________
 Diet Counseling

Diet counseling is the act of providing individualized professional guidance to assist

a person in adjusting his daily food consumption to meet his health needs. Proficiency in
diet counseling should be a basic skill of the Nutritionist-Dietitian, as a counselor, should
have a well-organized idea of what counseling entails.

Dietetic counselors should have knowledge in food composition, cooking,

availability of foods, food combination for meals, economic, social, ethnic, and physical
factors affecting food consumption and the role of food in the maintenance of health. It
is the counselor's task to impart this knowledge to her patients.

The process of diet counseling actually involves three activities: Interviewing,

counseling, and consulting.

1. Interviewing is the gathering of information and/or data. Expert interviewing

requires training and experience since accurate, selective information is basic to
effective counseling.
2. Counseling is listening, accepting, clarifying, and helping the patient form his own
conclusions and develop his own plan of action. The focus is on the patient. An
effective diet counselor must be able to guide the patient's thinking, focus, on
objectives, interpret and evaluate information accurately and effectively. The
counselor translates for the patient, the regimen prescribed by the physician.
3. Consulting involves developing plans or proposals for a patient based on
observations and evaluations. The consultant's purpose is to add to and enhance
the knowledge and understanding of the person seeking help. By keeping in mind
these important factors in the process of diet counseling, effective methods may be
readily developed based on:
a. The reason for the session (i.e., therapeutic treatment, general nutritional
assessment, nutrition education, etc.);
b. The skills and resources of the counselor; and
c. The motivation, needs, and interest of the patient.

Procedural Guide for Diet Counseling

A. Preparation

1. Read the patient's medical record.

2. Obtain information from suffering source.
3. Make a tentative plan for the nutritional care program.
4. Have a equipment on hand.
5. Plan ahead to avoid interruptions.
6. Designate a flexible time element for the interview.
B. Interview
1. Introduce yourself Be friendly. Talk to the patient about the purpose of the visit.
Include family members whenever possible during the initial and follow-up
visits.
2. Find out what the physician has discussed with him regarding his prescribed
diet.
3. Discuss the reasons of giving the diet.
4. Check the patient for the usual statistics, such as height, weight, and age, even
though this information is available in the medical record. Find out what the
patient's occupation is and where eats his meals. This provides the patient an
opportunity to become accustomed to the situation and to establish rapport.
5. Obtain a typical day's (24 hrs.) intake to gain an idea of the patient's food
patterns, habits, and the amount consumed. This information is used in evaluating
and interpreting the diet, as well as for review in follow-up visits. It is also
important in correlating pother medical or social information and for writing
meaningful notes in medical records and reports.

Case Study: Laboratory

 See if you can do this!

Activity 5.B.

1.Make a Video Presentation of the food that you will take within a meal for a whole week or
within 7 days per meal.

To note: The presentation should be the same with the written output.

3.Conclusion and Recommendation.

Note: Please see attached Mode of Submission.

___________________________________END___________________________________
Reference

Claudio; et.al. (1998). Basic Diet Therapy for Filipinos.

Merriam and Webster Bookstore, Inc., Manila, Philippines

Food and Nutrition Research Institute (1994). Food Exchange list.

FNRI, Manila, Philippines

Food and Nutrition Research Institute (2002) Recommended Energy and Nutrient
Intakes. FNRI, Manila Philippines

Leocadio, Corazon G. ) Essential in Meal Management.

Leocadio, C.G.

Nutritionist — Dietitian Association of the Philippines.

Fundamentals in Applied and Public Health Nutrition

Panlasigue; et. al. . Nutrition in the Life Cycle Laboratory Manual

Me'rriam and Webster Bookstore Inc., Manila, Philippines

RTP-FNP. ( Training Modules on Short Term Course on Food

And Nutrition Programme Planning and Management, RTP-FNP, UPLB

Tanchoco, C. . Diet Manual. NDAP, Manila Philippines

 APPENDIX I- A
Table of Weight and Measure

3 tsp = 1 Tbsp

1 Tbsp = 15 g = 15 ml = 15 cc = 1/2 oz.

30 gm = 30 cc = 1 oz = 2 Tbsp

1 gm = 1 cc = 1 mi

1 tsp = 5 cc = 5 ml = 5 gm

16 tsp = 240 cc = 240 ml = 8 oz = 1 cup

2 cups = 480 cc = 480 ml = 480 gm = 16 oz = 1 pint

2 pints= 960 cc = 960 ml = 960 gm = 32 oz = 1 quart

1 inch = 2.54 cm =
1 liter = 1.0567 quarts

1 k calorie = 4.180 joules

1 milliequivalent = one thousandth of an equivalent

1 microgram (ug) = one thousandth of a milligram

1 milligram (mg) = one thousandth of a gram

1 gram (gm) = one thousandth of a kilogram

4 quarts = 1 gallon 1 pound = 454 gm 2.2 pounds = 1

kilogram (kg)
APPENDIX I-B
ACRONYMS
1. AP
2. AW - As Purchased
3. BMI - Actual Weight
4. BW - Body Mass Index
5. DBW - Body Weight
6. DOH - Desirable Body Weight
7. DOST - Department of Health
- Department of Science &
8. EAA Technology
9. EFA - Essential Amino Acids
10. EP - Essential Fatty Acids
11. FCT - Edible Portion
12. FEL - Food Composition Table
13. FNRI - Food Exchange List
- Food and Nutrition Research Institute
14. IBW
15. IRS - Ideal Body Weight
16. IU - International Reference Standard
17. NC - International Unit
18. NDAP - - Nutrient Content
- Nutritionist Dietitian Association of
19. NE the Philippines
20. NGF - Niacin Equivalent
21. NPC - Nutrition Guidelines for Filipinos
22. NS - Non-Protein Calories
23. NV - Nutritional Status
24. PRS - - Nutrient Value
25. RE - - Philippine Reference Standard
26. RENI - Retinal Equivalent
27. RND - Recommended Daily Allowance
28. TEA - Registered Nutritionist Dietitian
29. TER - Total Energy Allowance
- Total Energy Requirements
APPENDIX I - C

DIETARY COMPUTATION GUIDE

I. Dietary Computations

A. ESTIMATION OF DBW

1) INFANTS

i) First 6 months of age

DBW (g) = Birth weight (g) + (age in months x 600)

5 months old whose birth weight6 lbs. and 1 oz.

ii) After 6 months of age

DBW (g) = Birth weight + (age I months x 500)

Example:

8 months old whose birth weight = 2.5 kg.

a) Convert BW to grams
1 kilogram = 1000 gram

BW g = 2.5 kg x 100g/kg = 2500 grams

b) DBW = 2500 G + (8 MONTHS X 500) =

6500g or 6.5 kg.

■ If the birth weight is not known, use 3000g

Example: 6 months old

DBW (kg) = (6/2) + 3

= 6 kg.

iii) Age 13 years old and above

Based on the Height using Tannhausers Method

Conversion:
1 feet = 12 inches
1 inch = 2.54 ems
1 kg = 2.2 lbs

Example; 5'0"

5 feet x 12 inches/feet = 60 in. x 2.54 cm/in

= 152.40 cm
 = 152.40 cm — 100 (F)

= 52.40 — (10%)
= 52.40 - .10
= 5.24
= 52.40 — 5.24

DBW (kg) = 47.16 kg

= 47 kg x 2.2 lb/kg

= 103.4 lbs
3) CHILDREN

DBW (kg) = (age in years x 2) + 8 Example: 7 years old

DBW(kg) = (7x2) + 8

=22 kg

B. ESTIMATION OF TER

1) INFANTS

1— 6 months = 120 Kcals./kg. DBW 7 —12 moths = 110

Kcals/kg. DBW

Formula: TER = DBW x Kcal/kg

2) CHILDREN

i. TER = 1000 + (age in years x 100)

ii. Age Range Kcal/kg DBW
1— 3 years 100
4 — 6 years 90
7 — 9 year 80
10 —12 years 70 — boys
60 — girls
Formula: TER = DBW x kcals./kg DBW

3) ADOLESCENTS Age Range

13 — 15 years Kcal/kg DBW
55 — boys
16 —19 years 50 — girls
50 — boys
45 - girls
 4) PREGNANCY
TER = N TER + 300 kcals - 50 — 59 years old(2" and 3rd Trimesters)
- 60 — 69 years old
- 70 years above
5)LACTATION

TER = N TER + 500 KCALS

(1sT 6 months and 2" 6 moths)

Convert to Months:
12 months/years x 4 years = 36 months + 21 months + 57 moths

Note:
1) If the number of days is less than 30 days, disregard
2) If it is 30 days or would exceed, add 1 moth to the number of months.

Total Energy Requirement (TER)

Activity Cals/KDBW

Bed Rest - 27.5 cals.

Sedentary - 30 cals.

Light 35 cals

Moderate 40 cals
Heavy 45 cals.

6) ADULT

TER = N TER — 7.5%

= N TER — 15%

= N TER— 10%

To compute in terms of Age in Months

Formula: Date of weighing

Date of Birth

Example: DW = January 27, 1993

DB = February 3, 1988

DW = 1993 — 01 — 27 DB = 1988 — 02 — 03 Age = 04 — 21 — 24