Wk. 10 Nutrition Education and Counselling Student

Wk.
10 – Nutrition Education
and Counselling
Juvy G. Reyes MAN, RN

CU 9 – Nutrition Education and Counselling
Learning Objectives:
1. Describe the need for and the factors to consider in planning for a
therapeutic diet.
2. Differentiate the types of dietary modification.

A. General Diets
B. Diets modified in consistency
C. Diets modified in composition
D. Liquid Diets
E. Soft Diets
F. Test Meals
I. Modified Diets
Diet Therapy - a specific treatment of a disease or a

supplement of other modes of treatment
that a patient may go through.
Purposes:
1. Maintenance of normal nutrition
2. Correction of nutritional deficiency, changes in
body weight
3. Adjusting the body’s ability to use one or more
nutrients
4
Normal Diet ( regular, general or house diet)
● is the foundation on which therapeutic diet modifications

are based.
● type of diet prescribed, the purpose of the diet is to supply

needed nutrients to the body in a form it can handle.
Modification of this diet includes:

a. consistency and texture
b. flavor
c. energy value
d. nutrient level
e. food category
Standard Hospital Diets:
A. Liquid diets:
a. Clear Liquid Diet
• Acute vomiting, diarrhea or surgery
• used for 24-48 hours
(Allows tea, coffee or coffee substitute and fat-free broth
b. Full Liquid Diet:

• used for acute infections and fever of short duration
• patients who’ are too ill to chew.
• liquids and foods that liquefy at body temperature, offered in 6

feedings or more
Standard hospital diets:
B. Soft diets - has reduced fiber content, bland flavor and

soft consistency
a. Used between full fluid diet and regular diet
following surgery
b. Acute infections and fevers
c. GI disturbances.
Modifications:
1. Meat and poultry being minced or ground
2. Vegetables are diced, chopped or cooked longer than usual
3. Use of soft raw fruits
4. Use of soft rolls, breads or biscuits.
Standard hospital diets
C. Test Meal - used for specific diagnostic tests
1. Fecal Fat Determination - to measure fat

globules to detect absorption
2. Meat-free Test – to determine GIT bleeding
3. Calcium Test – to determine urinary calcium excretion
4. Serotonin Test – to detect calcinoid tumors of the

intestinal tract
Good Tray Service
Tray Service
• is a style of service that makes use of a tray and does

not make use of the usual dining table
• dishes and utensils are arranged in a tray and

brought to the patient in his/her room
Essential of good Tray Service
1. Sufficient size of the tray for un

crowded arrangement
2. Clean, unwrinkled tray cover and

napkin or good quality paper
3. Attractive pattern of spotless

chinaware without chips or
cracks; clean glassware and
shining silverware
4. An orderly arrangement of all items on

the tray.
Essential of good Tray Service
5. Food portions are suitable for the patient’s appetite
6. Foods are attractively arranged with the appropriate

garnishing.
7. Meals are served on time; hot foods served warm
and cold foods served chilled
8. Trays are served promptly to the patient.

II. Therapeutic Diets
A. Nutrition Therapy for Obesity and Weight Control
Obesity- a state of adiposity in which body fat is above the

ideal weight.
• Obesity: BMI of 30 – 39.9
• Overweight: BMI of 25 – 29.9 or greater
▪ results from an imbalance of the complex system

of neural, hormonal and chemical mechanisms
that keeps the balance between energy intake
and energy expenditure
B. Nutrition Therapy for Diabetes Mellitus
Diabetes Mellitus – lack of insulin produced and

affects the used of CHO and fats
• hyperglycemia or hypoglycemia
Diets:
• initially , low calorie diet
• Protein 1 1/2 per kg body weight
• Carbohydrate is roughly twice the number of protein
• Menu plan follows recommended Food exchange List
C. Nutrition Therapy for Diseases of the Gastrointestinal Tract
• designed to alleviate symptoms, correct nutrient

deficiencies and address the primary cause of the difficulty
A. Peptic Ulcer Disease (PUD)

Bland diet - must meet:
a. Nutritive adequacy
b. Bland flavour
c. Soft consistency
d. Mechanically and chemically non-stimulating.
B. Diverticular diseases
High fiber diet

• Bran, whole grains, cellulose foods
(reduce muscle contractions and
facilitate normal muscle tone)
C. Celiac sprue and Non-tropical sprue – intolerance

for gluten.
• Gluten-free diet - high-protein, supplements of

vitamins and minerals
D. Ulcerative colitis - inflammation of the colon

and rectum
• High calorie, protein, vitamins and

minerals diet
• acute stage: low-residue diet
(to prevent irritation )
E. Lactose Intolerance - deficiency in the enzyme lactase

• Lactose (sugar in milk) can not hydrolysed
• Lactose restricted diet is prescribed
• Avoid milk, milk-products, foods containing whey and casein

are avoided.
• Whey - liquid remaining after milk has been curdled and strained
• Casein - protein in milk and essential ingredient of cheese
F. Diarrhea
• initially placed on NPO for 12 hours with IVT support
• oral fluids given liberally to prevent dehydration
• broths and rehydration solutions are given to replace

electrolytes lost and pectin-rich foods
G. Constipation
• common problem
• High- fiber diet
H. Intestinal Gas
• controlled by excluding gas-producing foods
• advised small frequent meals
• chew food thoroughly
I. Hemorrhoids
• High- fiber diet

• liberal fluids
• avoid highly-seasoned foods and relishes
J. Gastroesophageal reflux disease

(GERD) Esophagitis - a condition that
takes place 1 to 4 hours after a meal
when a decrease in sphincter pressure
happens
Diet:
• Low-fat diet, small frequent feedings
• CHON and CHO foods with low-fat content
(do not affect the lower oesophageal
sphincter pressure )
D. Nutrition Therapy for Diseases of the Liver, Gallbladder and Pancreas
A. Hepatitis - inflammation of the liver
High Protein Diet

• protein from animal sources (have superior quality)
• additional serving of protein: milk, egg, fish, cheese
Caloric intake: adjust to meet body’s need

• Fever: 2,500 to 4,000 calories per day
• Fats: taken in moderation
B. Cirrhosis - protein depleted in patients
• 100 g protein is given with sodium restricted to 250mg./day

• Caloric diet: 1,800 , fats not restricted
C. Hepatic coma
• nervous system disorder due to severe liver disease
• High calorie diet
Therapeutic Diets
D. Cholecystitis
• Low-fat diet to avoid stimulating the gallbladder
• Avoid spices and high-residue foods - can cause

distention and increase peristalsis
• excluded the use of butter, margarine and sauces as

vegetable dressing; instead, lemon juice vinegar
or low-calorie, fat-free dressings are used.
E. Pancreatitis - inflammation of the pancreas
• Low-fat , low-elemental formulas diet

(enteral feeding )
• Acute attack - NPO for 48 hours

• Chronic cases - high-calorie, moderate
protein, low to moderate fat
E. Nutrition Therapy for Cardiovascular Diseases
A. Atherosclerosis - accumulation of fatty materials,

cholesterol in the blood vessel
Diet:
• Low-fat diet, low saturated fat and cholesterol (300 mg./day)
• increase in monounsaturated fatty acid, polyunsaturated
fats, omega-6 and omega-3 fatty acids
• Simple sugar are restricted, restricted CHO and complex

dietary fiber 25-30g/day
E. Nutrition Therapy for Cardiovascular Diseases
B. Congestive heart failure (CHF)
Diet: Sodium restriction diet, Low-fat diet - recommend

unsaturated oils
C. Myocardial infarction (MI)

• Goal to help reduce the work load of the heart.
• Small frequent meals
• liquid diet initially
• Restrict - caffeine-containing beverages, sodium,
cholesterol, fat and calorie.
• omega-3 fatty acid-rich foods to reduce blood
F. Nutrition Therapy for Diseases of the Kidneys
A. Acute Glomerulonephritis (AGN) - inflammation and

subsequent damage of glomeruli
(hematuria, proteinuria, azotemia)
Goal:
• nutritional needs rather than protein restriction
• Sodium restriction only when edema is present
• high calorie from CHO
F. Nutrition Therapy for Diseases of the Kidneys
B. Nephrotic syndrome
• lesion in the nephron can affect massive
albuminuria and protein losses
Diet: High-calorie diet, High-protein diet, Low-sodium
C. Acute Renal failure (ARF)

• High-calorie diet
• Low to moderate protein diet
• Moderate fat diet
• Controlled: Potassium, Sodium, water to a liter/day
G. Nutrition Therapy for Cancers
a. Oral nutrition - high calorie, high protein
b. Tube feedings - complete products

• meal replacements requiring digestion and absorption
• chemically-defined products
• minimal or no digestion
• specialty products
• varies in amino acid, CHO or fat content
c. Total parenteral nutrition (TPN) - when digestive tract is not

functioning well

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Wk.

Juvy G. Reyes MAN, RN

2. Differentiate the types of dietary modification.

Diet Therapy - a specific treatment of a disease or a

Normal Diet ( regular, general or house diet)

● is the foundation on which therapeutic diet modifications

● type of diet prescribed, the purpose of the diet is to supply

Modification of this diet includes:

b. Full Liquid Diet:

• liquids and foods that liquefy at body temperature, offered in 6

B. Soft diets - has reduced fiber content, bland flavor and

C. Test Meal - used for specific diagnostic tests

1. Fecal Fat Determination - to measure fat

2. Meat-free Test – to determine GIT bleeding

3. Calcium Test – to determine urinary calcium excretion

4. Serotonin Test – to detect calcinoid tumors of the

• is a style of service that makes use of a tray and does

• dishes and utensils are arranged in a tray and

1. Sufficient size of the tray for un

2. Clean, unwrinkled tray cover and

3. Attractive pattern of spotless

4. An orderly arrangement of all items on

5. Food portions are suitable for the patient’s appetite

6. Foods are attractively arranged with the appropriate

8. Trays are served promptly to the patient.

A. Nutrition Therapy for Obesity and Weight Control

Obesity- a state of adiposity in which body fat is above the

• Overweight: BMI of 25 – 29.9 or greater

▪ results from an imbalance of the complex system

B. Nutrition Therapy for Diabetes Mellitus

Diabetes Mellitus – lack of insulin produced and

C. Nutrition Therapy for Diseases of the Gastrointestinal Tract

• designed to alleviate symptoms, correct nutrient

A. Peptic Ulcer Disease (PUD)

High fiber diet

C. Celiac sprue and Non-tropical sprue – intolerance

• Gluten-free diet - high-protein, supplements of

D. Ulcerative colitis - inflammation of the colon

• High calorie, protein, vitamins and

E. Lactose Intolerance - deficiency in the enzyme lactase

• Lactose restricted diet is prescribed

• Avoid milk, milk-products, foods containing whey and casein

• initially placed on NPO for 12 hours with IVT support

• oral fluids given liberally to prevent dehydration

• broths and rehydration solutions are given to replace

• High- fiber diet

J. Gastroesophageal reflux disease

A. Hepatitis - inflammation of the liver

High Protein Diet

Caloric intake: adjust to meet body’s need

B. Cirrhosis - protein depleted in patients

• 100 g protein is given with sodium restricted to 250mg./day

• Avoid spices and high-residue foods - can cause

• excluded the use of butter, margarine and sauces as

E. Pancreatitis - inflammation of the pancreas

• Low-fat , low-elemental formulas diet

• Acute attack - NPO for 48 hours

A. Atherosclerosis - accumulation of fatty materials,

• Simple sugar are restricted, restricted CHO and complex