THERAPEUTIC DIET

 
Dietetics is the branch of medicine concerned with how food and nutrition affects human
health comprising the rules to be followed for preventing, relieving or curing disease by
diet. Dietetics deals with feeding individuals based on the principles of nutrition.
 
Clinical Dietetics is the application of dietetics in a hospital or health care institutional
setting. Clinical dietetics focuses on individual nutrition support and symptom
management.
 
Diet therapy is a branch of dietetics concerned with the use of food for therapeutic
purpose. Diet therapy is a broad term used for the practical application of nutrition as a
preventive or corrective treatment of a disease. The principles of diet therapy are to:  
 Maintain good nutritional status,
 Correct deficiencies or disease, if any
 Provide rest to the body,
 Help metabolize the nutrients, and 
 Make changes in body weight, when necessary.
 
Therapeutic diet or therapeutic nutrition is based on the qualitative/quantitative
modification of nutrients or other aspects of a normal diet to meet a person’s nutritional
needs during an illness. It is modified or tailored to fit the nutrition needs of a particular
person. It is a meal plan that controls the intake of certain foods or nutrients. It is part of
the treatment of a medical condition and is normally prescribed by a physician and
planned by a dietician.
 
The purpose of diet therapy is to restore or maintain an acceptable nutritional status of a
patient. This is accomplished by modifying one or more of the following aspects of the
diet:

1. Nutrients: Basic nutrient/s or Caloric contribution

2. Texture or consistency
3. Adapt to food allergies or food intolerances: Seasonings
 
Common reasons therapeutic diets/ diet modifications may include:
 For essential or life saving treatment: For example  in celiac disease, providing gluten
free diet,
 To replete patients who are malnourished because of disease such as cancer and
intestinal diseases by providing a greater amount of a nutrient such as protein,  
 To correct deficiencies and maintain or restore optimum nutritional status,  
 To provide rest or relieve an affected organ such as in gastritis,  
 To adjust to the body's ability to digest, absorb, metabolize or excrete: For example a
low fat diet provided in fat malabsorption,  
 To adjust to tolerance of food intake. For example in case of patients with cancer of
esophagus tube feeding is recommended when patients cannot tolerate food by
mouth,  
 To exclude foods due to food allergies or food intolerance,  
 To adjust to mechanical difficulties, for example for elderly patients with denture
problems, changing the texture/consistency of food recommended due to problems with
chewing and/or swallowing,  
 To increase or decrease body weight/body composition when required, for example as
in the case of obesity or underweight,  
 As helpful treatment, alternative or complementary to drugs, as in diabetes or in
hypertension
 
Common therapeutic diets include:

1. Nutrient modifications
o No concentrated sweets diet
o Diabetic diets
o No added salt diet
o Low sodium diet
o Low fat diet and/or low cholesterol diet
o High fiber diet
o Renal diet
2. Texture modification
o Mechanical soft diet
o Puree diet
3. Food allergy or food intolerance modification
o Food allergy
o Food intolerance
4. Tube feedings
o Liquid tube feedings in place of meals
o Liquid tube feedings in addition to meals
5. Additional feedings – In addition to meal, extra nutrition may be ordered as:
o Supplements – usually ordered as liquid nutritional shakes once, twice or three times
per day; given either with meals or between meals
o Nourishments – ordered as a snack food or beverage items to be given between meals
mid-morning and/or mid-afternoon
o HS snack – ordered as a snack food or beverage items to be given at the hour of sleep

 
ROUTINE HOSPITAL DIETS

Normal or general diet in a hospital setting is a balanced diet which meets the
nutritional needs of an individual/patient. It is given when the individual's medical
condition does not warrant any specific modification. It is planned keeping the basic food
groups in mind so that optimum amount of all nutrients is provided. Because a
hospitalized patient is most commonly or on bed rest, a reduction of 10% in energy
intake should be made. The diet provides approximately 1600 to 2200 kcal and contains
around 180 to 300g carbohydrates, 60 to 80g of fat and 40 to 70 g of protein.
 
Soft diet and the liquid diets are examples of therapeutic diet.
 
Types of Diet Modifications
A diet may need to be altered and adjusted in many ways before it meets the
therapeutic needs of an individual patient. These adaptations may include:  
 Change in consistency of foods, such as liquid diet, soft diet, low fibre diet, high fibre
diet.  
 Increase or decrease in energy value of the diet such as low calorie diet for weight
reduction, high calorie diet for burns. 
 Increase or decrease in specific nutrients or type of food consumed, such as sodium
restricted diet, lactose restricted diet, high fibre diet, high potassium diet.
 Elimination of spices and condiments, such as bland diets.
 Omission of specific foods such as allergy diets, gluten free diets.
 Adjustment in the ratio and balance of proteins, fats and carbohydrates such as diabetic
diet, renal diet and cholesterol lowering diets.
 Test diets: These are single meals or diets lasting one or few days that are given to
patients in connection with certain tests e.g. the fat absorption test used to determine if
steatorrhoea is present.
 Change in frequency of meals, feeding intervals, re-arrangement of the number and
frequency of the meals such as diabetic diet, diet for peptic ulcer disease.
DIETS MODIFIED IN CONSISTENCY
A. LIQUID DIET
 consists of foods that can be served in liquid or strained form
in room temperature. They are usually prescribed in febrile
states, postoperatively i.e. after surgery when the patient is
unable to tolerate solid foods. It is also used for individuals
with acute infections or digestive problems, to replace fluids
lost by vomiting, diarrhea.
 The two major types of liquid diets include: Clear liquid diet
and full liquid/fluid diet.
o
 CLEAR LIQUID DIET provides foods and fluids that are clear
and liquid at room temperature. The purpose of the clear
liquid diet is to provide fluids and electrolytes to prevent
dehydration. It provides some amount of energy but very little
amount of other nutrients. It is also deficient in fiber. Hence it
is nutritionally inadequate and should be used only for short
periods i.e. 1-2 days. An average clear liquid diet contains
600 to 900Kcal, 120 to 200g carbohydrate, minimal fat 5 to
10g protein and small amount of sodium and potassium
(electrolytes). The clear liquid diet is usually useful in
situations when the gastrointestinal tract has to be kept
functionally at rest. It is also prescribed before and after
certain types of surgery involving the mouth or
gastrointestinal tract. Also, may be used in acute vomiting or
diarrhea.

 Examples of clear liquid diet: Water, strained fruit juices,
coconut water, lime juice, whey water, barley/arrowroot
watrice kanji, clear dal soup, strained vegetable or meat
soup, tea or coffee without milk or cream, carbonated
beverages, ice pops, plain gelatin are some examples of
clear liquid diet.
  FULL LIQUID DIET provides food and fluids that are liquid or
semi liquid at room temperature. It is used as a step between
a clear liquid diet and a regular diet. The purpose of the full
liquid diet is to provide an oral (by mouth) source of fluid for
individuals who are incapable of chewing, swallowing or
digesting solid food. It provides more calories than the clear
liquid diet and gives adequate nourishment, except that it is
deficient in fiber. It is indicated for post-operative patients
and for gastrointestinal illness. An average full liquid diet can
provide approximately 1000 to 1800 calories and 50 to 65g
of protein and adequate minerals and vitamins. The nutritive
content of the full liquid diet can be increased by using
protein, vitamin and fiber supplements.
 Examples of full liquid diet: Foods allowed or included in a
full liquid diet include beverages, cream soups, vegetable
soups, strained food juices, lassi/butter milk, yogurt, hot
cocoa, coffee/tea with milk, carbonated beverages, cereal
porridges (refined cereals) custard, sherbet, gelatin,
puddings, ice cream, eggnog, margarine, butter, cream
(added to foods), poached, half boiled egg etc.
 COLD LIQUID DIET also termed as TONSIL diet, is food
preparation includes serving cold or iced liquids. This diet
varies depending on the severity of the patient’s condition,
age and overall health status. Usually, patients are instructed
to refrain from eating solid foods for a day or two only since
this diet does not provide adequate nutrition.
Purpose of a Cold Liquid Diet

o

 The aim of prescribing a cold liquid diet is to promote relief to
fresh mouth sores or following tonsillectomy. Serious
symptoms of the condition following surgery effectively
subside through this diet together with proper medication
therapy.
Guidelines in Preparing for a Cold Liquid Diet

o

 C – Consult a nutritionist or a doctor before initiating this diet.
The cold liquid diet is not nutritionally adequate. Hence, you
should not risk your health without proper medical advice.
  O – Only soothing fluids are allowed in this diet. Selected
items should be free from irritants and acid preparations.
Wine, alcoholic beverages, coffee and etc are strong irritants
and should be avoided.
 L – Let the client shift to mechanical soft diet first before
launching this diet. The process of shifting the diet to cold
liquids should be gradual.
 D – Duration of the diet should only be two to three days to
avoid risking your health condition. A high protein beverage
can be served between meals to provide nutrients needed by
the body.
Foods Allowed:

o


 Fresh fruit juice – iced or cold
 Commercial fruit juices – iced or cold
 Blended fresh fruits – fresh or cold
 Fruit shake – iced or cold
 All chilled milk
 Dairy or non-dairy chilled yogurt
 Cold thin cereal as a rice substitute
 Any cold thin soup
 Plain ice cream
 Popsies
 Plain sherbet
 Cold soft custard
 Cold jello or gelatin
Foods NOT Allowed:

o


 All solid, hard and hot foods
 Wine and alcoholic beverages
 All hot beverages
 Tea and coffee
 Strong-flavored fruit juices
B. SOFT DIET
  as the name suggests provides soft whole food that is lightly
seasoned and are similar to the regular diet. The term 'soft'
refers to the fact that foods included in this type of diet are
soft in consistency, easy to chew and made of simple, easily
digestible foods.
 It does not contain harsh fiber or strong flavors. It is given
during acute infections, certain gastrointestinal disorders and
at the post-operative stage to individuals who are in the early
phase of recovery following a surgery.
 The soft diet provides a transition between a liquid and a
normal diet i.e. during the period when a patient has to give
up a full liquid diet but is yet not able to tolerate a normal
diet. Soft diet can be nutritionally adequate (providing
approximately 1800-2000 calories, 55-65g protein) provided
the patient is able to consume adequate amount of food.
o Examples of soft diet: A soft diet freely permits the use of
cooked vegetables, soft raw fruits without seeds, broths and
all soups, washed pulses in the form of soups and in
combination of cereals and vegetables, breads and ready-to-
eat cereals (most preferable refined such as poha, upma,
pasta, noodles etc.), milk and milk beverages, yogurt, light
desserts (including kheer, halwa, custard, jelly, ice cream),
Egg and tender and minced, ground, stewed meat and meat
products, fat like butter, cream, vegetable oil and salt and
sugar in moderation. Foods to be best avoided in the soft
diet include coarse cereals, spicy highly seasoned and fried
foods, dry fruits and nuts, rich desserts.
 Among the soft diet is also the mechanical soft diet also
known as the dental diet which is a normal diet that is
modified only in texture for ease of mastication i.e. chewing.
When an individual cannot chew or use facial muscles for a
variety of dental, medical or surgical conditions mechanical
soft diet is recommended. Elderly persons who have dental
problems are prescribed mechanical soft diets. The food in
mechanical soft diet is similar to the soft diet and may be full
liquid, chopped, pureed or regular food with soft consistency.
Simple salads, fruit salads and cottage cheese may be
included. No food is restricted unlike in the case of the
customary soft diet. Just removing the skin and seeds,
cutting or chopping the food into small fine pieces are
processes usually employed
C. BLAND DIET
 A bland diet is made of foods that are soft, not very spicy and
low in fiber. It consists of foods which are mechanically,
 chemically and thermally non-irritating i.e. are least likely to
irritate the gastrointestinal tract. Individuals suffering from
gastric or duodenal ulcers, gastritis or ulcerative colitis are
prescribed this diet.
 Foods Included: Milk and milk products low in fat or fat free;
Bread, pasta made from refined cereals, rice; cooked fruits
and vegetables without peel and seeds; Eggs and lean
tender meat such as fish, poultry that are steamed, baked or
grilled; Cream, butter; Puddings and custards, clear soups.
Foods Avoided: Fried, fatty foods; Strong flavored foods;
Strong tea, coffee, alcoholic beverages, condiments and
spices; High fiber foods; hot soups and beverages; whole
grains rich in fiber; strong cheeses.
D. RESIDUE RESTRICTED DIET
 The residue restricted diet provides food low in fiber which
will result in a small amount of fecal material in the lower
bowel. This diet is used prior to surgery of the
gastrointestinal tract. It may also be used following
gastrointestinal surgery. For a more restricted residue diet, a
clear liquid diet can be served for a short duration. Dietary
fibers that are restricted include hemicellulose, pectin
substances, mucilage, lignin and cellulose.
 This diet includes foods which are not stimulating to the
lower gastrointestinal tract and are almost completely
digestible, in order to reduce (not eliminate) the residue in
the colon.
 Hot and cold foods are eaten slowly.
 Milk and milk products are limited to 2 cups daily. For a
greater restriction of residue in the colon, milk should be
eliminated.
 Fruits and vegetables that contain 2.0 grams or less of
dietary fiber per 100 grams edible food are allowed in
controlled amounts.
 Digestibility of fiber is not appreciably altered by reducing
particle size through pureeing or blending.
 Prune juice may need to be limited due to its laxative effect.
 Ripe bananas, grapefruit; baked apple (without skin); cooked
or canned fruits without seeds; white grapes, cherries,
pineapple, plums, applesauce, peaches, apricots, mandarin
oranges; jellied cranberry sauce; all fruit juices.
 Baked, broiled, creamed or stewed: very tender beef,
chicken, lamb, liver, fish, sweetbreads, tuna, turkey, salmon,
veal, lean pork, crisp bacon, canned ham, shellfish. Sugar,
 clear jelly, honey, syrup, hard candies, milk chocolate,
gumdrops, marshmallows.
E. LOW FIBER
 Fiber is the part of fruits, vegetables and grains not digested
by your body. A low-fiber diet restricts these foods. As a
result, the amount of undigested material passing through
your large intestine is limited and stool bulk is lessened.
 A low-fiber diet may be recommended for a number of
conditions or situations. It is sometimes called a restricted-
fiber diet.
 A low-fiber diet limits the types of vegetables, fruits and
grains that you can eat. Occasionally, your doctor also may
want you to limit the amount of milk and milk products in your
diet. Milk doesn't contain fiber, but it may contribute to
discomfort or diarrhea, especially if you're lactose intolerant.
 The ability to digest food varies from person to person.
Depending on your condition and tolerance, your doctor may
recommend a diet that is more or less restricted.
o  Purpose
 Doctor may prescribe a low-fiber diet if:
 Medical conditions with narrowing of the bowel due to a
tumor or an inflammatory disease
 Before bowel surgery
 Having treatment, such as radiation, that damages or irritates
your digestive tract
Avoid these foods and products made with them:

o
 Nuts, seeds, dried fruit and coconut
 Whole grains, popcorn, wheat germ and bran
 Brown rice, wild rice, oatmeal, granola, shredded wheat,
quinoa, bulgur and barley
 Dried beans, baked beans, lima beans, peas and lentils
 Chunky peanut butter
 Fruits and vegetables except those noted below
Choose these foods:

o
  Tender meat, fish and poultry, ham, bacon, shellfish, and
lunch meat
 Eggs, tofu and creamy peanut butter
 Dairy products if tolerated
 White rice and pasta
 Baked goods made with refined wheat or rye flour, such as
bread, biscuits, pancakes, waffles, bagels, saltines and
graham crackers
 Hot and cold cereals that have less than 2 grams of dietary
fiber in a single serving, such as those made from rice
 Canned or well-cooked potatoes, carrots and green beans
 Plain tomato sauce
 Vegetable and fruit juices
 Bananas, melons, applesauce and canned peaches (no skin)
 Butter, margarine, oils and salad dressings without seeds
DIETS MODIFIED IN COMPOSITION
LOW CALORIE
 An eating plan used to help people lose weight. It involves limiting the overall
number of calories you eat or drink in a day.
 It also known as weight-loss diet.
 Following low-calorie diet typically means consuming around 1,200-1,500 calories in
a day and must contain the right nutrients.
 Low calorie diet is not recommended for everyone including pregnant or
breastfeeding women(who need enough calorie to sustain their growing babies as
well as themselves) and athletes (who need the energy from sufficient calories to
perform).

What to eat:

 Fruits
 Vegetables
 Lean proteins
 Low or no fat dairy products
 Whole grains
 Herbs and spices- use them to add flavor to your food without adding calories

What not to eat:

 Refined carbohydrates
 High fat foods
 Sweetened beverages- add up a lot of calories quickly
 Advantage: accessible, effective and safe
 Disadvantage: potential for increased hunger, requires careful planning and
tracking, not for everyone
HIGH CALORIE DIET
 It leads to weight gain
 Healthcare providers recommended high calorie diet because the body is currently
burning more calories that a person is taking in
 Medical conditions and other causes that make it hard to gain weight includes:

Cancer

Eating disorders

Type 1 diabetes

Hyperthyroidism

Stress, depression or anxiety

Infections such as HIV/AIDS, TB, parasites and others

Celiac disease

Medications that causes nausea and vomiting including chemotherapy

Diarrhea

Active calorie burner(burn lots of calories at job, very physically active, frequent
workout)

Aim to eat 300-500 more calories per day to gain weight slowly.

Foods high in calorie includes:

 Proteins- red meats, pork, chicken with skin on (roast or broil, not deep fried),
salmon, beans, whole milk, eggs, cheese, full fat yogurt
 Carbohydrates – potatoes, brown rice, whole grain pasta, whole grains, whole grains
breads
 Fats – nuts and nut butters, olives, avocado, butter, salad dressings, mayonnaise,
high fat cheeses
 LOW PROTEIN
 A women need at least 50gms of protein per day and men about 60gms per day.
 Low-protein requires restriction on the amount of protein consumed, typically
constitutes 4-8% of your daily calories.
 Protein is vital to health, but reducing protein intake can be therapeutic for people
with specific conditions. In particular, low protein diet may benefits those with
decreased kidney or liver function. May be also necessary for those with disorders
that affect protein metabolism, such as homocystinuria and phenylketonuria.
 It is challenging to reduce protein intake and requires careful planning to meet the
nutritional needs.
 On a low-protein diet, a person should consume plenty of fruits, vegetables, grains
and healthy fats and minimal amount of protein food.
 Healthy low-protein foods include:
 Fruits – apples, bananas, pears, peaches, berries, grapefruit
 Vegetables – tomatoes, asparagus, peppers, broccoli, green leafy
 Grains- rice, oats, bread, pasta, barley
 Healthy fats – avocados, olive oil and coconut oil
 
HIGH PROTEIN
 Diet in which 20% or more of total daily calories comes from protein. Most high
protein diets are high in saturated fat and severely restrict intake of
carbohydrates.
 When carbohydrate intake is cut out, a person lose weight quickly because of water
lose. Then, with no extra carbs, the body begins burning more fat for fuel. These
leads to ketosis, which make losing weight easier because a person feel less hungry.
Ketosis may cause temporary headeahes, irritability, nausea, bad breath and
sleeping problems for some people.
 Foods high in protein includes: Bean, Meats, Nuts, Grains, Eggs, Seafood, Cheese,
Soy
 
LOW FAT DIET
 Low fat diets are intended to reduce the occurrence of conditions such as heart
diseases and obesity.
 A low fat diet is one that restricts fat and often saturated fat and cholesterol as
well.
 A general rule is that if a provides 100 calories and it has 3 grams or less of fat,
then it is a low-fat food.
 This diet may be given to people with health problems that make it hard to process
fat. This includes problems like long-term pancreatitis and gallbladder
 Low fat diet foods includes:
 Whole grain foods – such as oats and higher fibre versions of pasta, rice and
bread.
 Lean meats – such as skinless chicken and turkey.
 White fish.
 Reduced fat dairy – skimmed milk and low fat yoghurt and cheese.
 
LOW CHOLESTEROL DIET
 This diet is designed to reduce fat and cholesterol blood levels. The diet goals are:
decrease total dietary fat, especially saturated and trans fat, also known as
hydrogenated fat. 
 The body needs some cholesterol to work properly. But if a person have too much
in your blood, it can stick to the walls of the arteries and narrow or even block
them. This puts a person at risk for coronary artery disease and other heart
diseases.

Foods low in cholesterol includes:

 Oaths
 Barley and whole grains
 Beans
 Banana and lady finger
 Nuts
 Vegetable oils
 Apple, grapes, strawberries and citrus fruits
 Soy
LOW CARBOHYDRATES DIET
 A low carb diet is one that limits carbohydrates, primarily found in sugary foods,
pasta, and bread.
 Complications such as heart arrhythmias, cardiac contractile function impairment,
sudden death, osteoporosis, kidney damage, increased cancer risk, impairment of
physical activity and lipid abnormalities can all be linked to long-term restriction of
carbohydrates in the diet.
 Very low carb diets may not be suitable for everyone, including children, people who
are pregnant, and those with certain underlying chronic health conditions, unless under
medical supervision. That's why it's best to talk with your doctor or dietitian
before lowering your carb intake drastically.
Low-carb foods include:
 lean meats, such as sirloin, chicken breast, or pork.
 fish.
 eggs.
 leafy green vegetables.
 cauliflower and broccoli.
 nuts and seeds, including nut butter.
 oils, such as coconut oil, olive oil, and rapeseed oil.
 some fruit, such as apples, blueberries, and strawberries.
 
LOW SODIUM DIET
 People with certain medical conditions such as high blood pressure, kidney disease, and
heart problemscan benefit from a diet that is lower in sodium.
 A low-sodium diet is important to follow in order to control your heart failure
symptoms and prevent future heart problems. Limiting your sodium and fluid intake
will help prevent and control the amount of fluid around your heart, lungs, or in
your legs.
 Foods low in sodium includes:
 Fresh or frozen fish or shellfish.
 Chicken or turkey breast without skin or marinade.
 Lean cuts of beef or pork.
 Unsalted nuts and seeds.
 Dried beans, peas, and lentils — like black beans and garbanzo beans (chickpeas)
  
 LOW POTASSIUM DIET
 Eatinga lower-potassium diet can help treat and lower the risk of developing
hyperkalemia.
 Eatinga lower-potassium diet can help treat and lower the risk of developing
hyperkalemia.
 A low-potassium diet, therefore, may be recommended if a patient have: Kidney
failure, Type 1 diabetes, Addison’s disease
 Low potassium foods:
 Apples (plus apple juice and applesauce)
 Blackberries
 Blueberries
 Cranberries
 Fruit cocktail
 Grapes and grape juice
 Asparagus (6 raw spears)
 Broccoli (raw or cooked from frozen)
 Cabbage
 Carrots (cooked)
 Cauliflower
 Celery (1 stalk)
 Corn (half an ear if it's on the cob)
 Cucumber
 Eggplant
 Cookies (no nuts or chocolate)
 Noodles
 Pasta
 Pies (no chocolate or high-potassium fruit)
 Rice
 Tea (16 ounces max)

 LOW PURINE DIET
 Purines are chemicals that are naturally found in certain foods and drinks. When
your body breaks down these chemicals, uric acid is the byproduct. A low-purine
diet reduces the foods and drinks with the highest purine content to reduce uric acid.
 A low purine diet will typically center around fruits, vegetables, and whole grains. The
diet will minimize the consumption of red meat, seafood, and alcohol. Healthcare
professionals often recommend a low purine diet for people who have gout, kidney
stones, or a similar condition.
 Foods low in purine includes:
 Low-fat and nondairy fat products, such as yogurt and skim milk.
 Fresh fruits and vegetables.
 Nuts, peanut butter, and grains.
 Fat and oil.
 Potatoes, rice, bread, and pasta.
 Eggs (in moderation)
TUBE FEEDING
 Tube feeding is a way of getting your body the nutrition it needs.
 Tube feed is a liquid form of food that's carried through your body through a flexible
tube.
 The nutrients within the tube feed are similar to what you would get from normal food.
 They are also digested in the same way.
 Tube feeds contain all the nutrients you need daily, including carbohydrates, proteins,
fat, vitamins, minerals, and water.

ENTERAL FEEDING
 Enteral feeding refers to intake of food via the gastrointestinal (GI) tract. The GI tract is
composed of the mouth, esophagus, stomach, and intestines.
 Enteral feeding may mean nutrition taken through the mouth or through a tube that goes
directly to the stomach or small intestine. In the medical setting, the term enteral feeding
is most often used to mean tube feeding.
 A person on enteral feeds usually has a condition or injury that prevents eating a regular
diet by mouth, but their GI tract is still able to function.
 Tube feedings may become necessary when you can’t eat enough calories to meet your
nutritional needs. This may occur if you physically can’t eat, can’t eat safely, or if your
caloric requirements are increased beyond your ability to eat.
TYPES OF ENTERAL FEEDING
Your feed can be given to you using one of the following types of tubes:
 Nasogastric feeding tube (NG)
 Nasojejunal feeding tube (NJ)
 Gastrostomy tubes, e.g. percutaneous endoscopic gastrostomy (PEG), radiologically
inserted gastrostomy (RIG)
 Jejunostomy tubes, e.g. surgical jejunostomy (JEJ), jejunal extension of percutaneous
endoscopic gastrostomy (PEG-J).
Your healthcare professional will recommend the type of feeding tube that's best for
you.
Gastrostomy and jejunostomy tubes are less visible than NG or NJ tubes. They need to
be placed during a surgery. This forms the so-called stoma site.
NG or NJ tubes do not need surgery for placement. They are more visible than a
gastrostomy or jejunostomy tube. But putting in NG or NJ tube may cause discomfort.
 

TYPE OF
WHERE THE TUBE IS INSERTED  WHEN IT'S USED
FEEDING TUBE 

Usually for short-

Nasogastric (NG) Through the nose, down the oesophagus and into
term tube feeding (six
feeding tube the stomach
to eight weeks)

Nasojejunal (NJ) Through the nose, down the oesophagus, through When feeding into the
feeding tube the stomach and into the small intestine (jejunum) stomach isn't tolerated

Gastrostomy tube (e.g. Directly into the stomach through a small incision For long-term use
PEG or RIG) in the abdomen's skin (more than six weeks)

Through the stomach and into the small intestine

Jejunostomy tube (e.g. (jejunum) (PEG-J) or directly into the small For long-term use
JEJ or PEG-J) intestine (jejunum) (JEJ) through a small incision (more than six weeks)
in the abdomen's skin

 
Contraindication
 The main reason a person wouldn’t be able to have enteral feeds is if their stomach or
intestines aren’t working properly.
 Someone with a bowel obstruction, decreased blood flow to their intestines (ischemic
bowel), or severe intestinal disease such as Crohn’s disease would likely not benefit
from enteral feedings.
Possible complications of enteral feeding
 There are some complications that can occur as a result of enteral feeding. Some of the
most common include:
 aspiration, which is food going into the lungs
 refeeding syndrome, dangerous electrolyte imbalances that may occur in people who
are very malnourished and start receiving enteral feeds
 infection of the tube or insertion site
 nausea and vomiting that may result from feeds that are too large or fast, or from
slowed emptying of the stomach
 skin irritation at the tube insertion site
 diarrhea due to a liquid diet or possibly medications
 tube dislodgement
 tube blockage, which may occur if not flushed properly
 
TYPER OF ENTERAL FORMULAS

1. Intact- also called polymeric formulas, contain unaltered molecules of proteins,

carbohydrates, and fats. They are best for people who can digest and absorb nutrients
without difficult
2. Hydrolyzed – a predigested formula
3. Modular - a formula consisting of a singular macronutrient. A complete diet can be
formulated by mixing modular formulations
 
FEEDING ADMINISTRATION
1. Continuous Drip
 Continuous drip feeding may be delivered without interruption for an unlimited period of
time each day. However, it is best to limit feeding to 18 hours or less.
 Feeding around the clock is not recommended as this limits a child's mobility and may
elevate insulin levels contributing to hypoglycemia.
 Commonly, it is used for 8 to 10 hours during the night for volume-sensitive patients so
that smaller bolus feedings or oral feeding may be used during the day.
 Continuous drip feeding is delivered by either gravity drip or infusion pump. The infusion
pump is a better method of delivery than gravity drip. The flow rate of gravity drip may
be inconsistent and, therefore, needs to be checked frequently.
 One advantage of continuous feeding over bolus feeding is that it may be tolerated
better by children who are sensitive to volume, are at high risk for aspiration, or
have gastroesophageal reflux.
 Continuous feeding can be administered at night, so it will not interfere with daytime
activities. Continuous feeding increases energy efficiency, allowing more calories to be
used for growth. This can be important for severely malnourished children.
 When feedings are delivered continuously, stool output is reduced, a consideration for
the child with chronic diarrhea. Continuous infusions of elemental formula have been
successful in managing infants with short bowel syndrome, intractable diarrhea,
necrotizing enterocolitis, and Crohn's disease.
 A disadvantage of continuous feeding is that the child is "tied" to the feeding equipment
during the infusion, although feedings can be scheduled for night time and naptime
feedings. Additionally, continuous feeding is more expensive because of the cost of the
pump and additional feeding supplies which may be necessary. A child's medication
needs to be considered as continuous feeding may interfere with serum concentration
of some drugs.
 
2. Bolus
 Bolus feeding is a way of receiving a set amount of feed as required, without use of a
feeding pump. This is given over a period of time, as advised by your healthcare
professional, using an enteral feeding syringe.
 Feedings are most often given every 4 to 6 hours during waking hours.
 There are different ways of bolus feeding. Your healthcare professional will advise on
the best method for you.

1. Gravity feeding (with or without a gravity feeding set), where gravity naturally

draws the feed through into feeding tube, OR
2. Syringe feeding, where the feed may need help to be pushed through your
feeding tube using the syringe with its plunger.
PARENTERAL FEEDING
 Parenteral nutrition means feeding intravenously (through a vein).
 Parenteral means "outside of the digestive tract."
 Parenteral nutrition bypasses your entire digestive system, from mouth to anus.
 Certain medical conditions may require parenteral nutrition for a short or longer
time. Some people need it to supplement their diet, and some people need to get
all of their calories intravenously.
 
Two types of parenteral nutrition

1. Partial parenteral nutrition (PPN) is parenteral nutrition given to supplement other kinds
of feeding. If you’re eating but still have malnutrition, healthcare providers may offer you
partial parenteral nutrition to replace missing elements in your diet or give you additional
calories.
2. Total parenteral nutrition (TPN) is complete nutrition delivered intravenously to people
who can’t use their digestive systems at all. TPN might be required when certain
conditions impair your ability to process food and absorb nutrients through your
 digestive tract, or when you need to avoid using your digestive system for a while so it
can heal.
Contraindications
 Parenteral nutrition is not indicated if gastrointestinal tract is fully functional with
adequate absorption of macro and micronutrients.
 Parenteral nutrition is not a treatment of choice when administration of parenteral
nutrition is anticipated for less than 5 days in patients without severe malnutrition.
 
Complications
 One of the most dramatic side effects of parenteral nutrition is the so-called refeeding
syndrome, which can occur in severely malnourished patients who are receiving
aggressive parenteral nutrition.
 In addition, hyperglycaemia can occur due to parenteral carbohydrate intake in diabetic
patients, in response to postaggression metabolism or the systemic inflammatory
response syndrome (SIRS), or due to systemic steroid therapy. In extreme cases PN
can result in a hyperosmolar, hyperglycaemic non-ketotic coma.
 When suddenly discontinuing parenteral intake, rebound hypoglycaemia, although rare,
may occur. Abnormalities in the acid-base-balance can occur due to parenteral
nutrition and may result in significant electrolyte shifts. Hypertriglyceridemia with
dyslipoproteinaemia may occur. High carbohydrate intakes may result in excessive
carbondioxide production. Hepatic complications of parenteral nutrition include steatosis
(fatty liver) and cholestasis.
 Special complications like metabolic bone disease with bone demineralisation and
osteoporosis may occur in patients receiving long-term parenteral nutrition. In all forms
of parenteral nutrition there is an imminent risk of infectious complications.
 Finally, intestinal side-effects (mucosal atrophy, increased translocation of micro
organisms and their toxins) may also occur.