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NUTRITION & DIET IN VARIOUS DISEASE
STATES
D M O (H)PATHANAMTHITTA
“You are what you eat”
- Krause & Mahan
• Decision making based on
– Scientific principles
– Not by food faddism
What is nutrition?
The combination of processes by the living organism receives and utilizes the materials necessary
for the maintenance of its functions and for the growth and
renewal of its components.
What is applied nutrition?
To adapt the principles of
science of nutrition to meet
the needs of an individual.
What is dietetics?
Science and art of utilizing food
and fundamentals of knowledge
of nutrition and metabolism in
various conditions of health
and disease.
NORMAL PARAMETERS
• Expected Wt. newborn: 2.5 – 4 kg
• 1 year: (Age (month) + 9 kg
2
• 1 – 6 years: 2A + 8 Kg
• 7 – 12 years: 7A - 5 Kg
2
•Acute malnutrition – only
weight is affected
•Chronic malnutrition – the
height is also affected
•Acute on chronic malnutrition
– Weight for actual height is also
affected
KWASHIORKAR & MARASMUS
Kwashiorkar
• Clinical diagnosis
– 60-80% of the expected Wt.
– Oedema
– Skin and Hair changes
– Mental apathy
MARASMUS
• < 60% of the expected
weight
• No oedema
MANAGEMENT
1. Hypothermia - Adress it
2. Hypoglycaemia - RBS < 40 mg%
10% glucose 2-4ml/Kg
3. Dehydration– Skin pinch not useful
– Examine oral mucosa
– Use Resomal (Glucose – 125, Na-45, K-40, Cl-70, Citrate-7, Mg-3, Zn-0.3, Cu-0.04)
MANAGEMENT (Contd…)
4. Vit. A – 2L on day 1, Day 2 and Day 14
5. Seizures - 4ml/Kg 10% dextrose
- 0.5 – 1 ml/kg Ca Gluconate
- 0.2 ml/Kg of Mg SO4
Restoration phase (/Kg of actual Wt.)
Cal – 150 – 120
Proteins – 3- 4 gms
Fluid – 100-150
INFANT FEEDING
• BFHI (1992)
• WABA – World alliance for breast feeding action
• World breast feeding week – 1 to 7 Aug. of every year
• Exclusive breast feeding for 6 months
• Breast feeding + home made semi solids
ENERGY REQUIREMENTS
• 1st Year – 1000 cals then 100 cal / year• Proteins
– 1-3 years: 20gms– 4-6 years: 27gms– 7-9 years: 34gms– 10-12 years: 41gms
• Previous recommendations– 50% from carbohydrates– 35% form fat– 15% from proteins
•Recommendations (contd…)
– Carbohydrates : 40-60%
– Fat : 20-30%
– Proteins : 10-15%
– Direct sugar : 5 gm
– Iodized salt : 2.5gms/day
– PUFA : 10%
CARBOHYDRATES
• Main source – Cereals
• Pectins & Gums decrease blood
sugar
• Uluva – 40% gum
• Fibres – Hypocholestrolemic effect
• Fibre requirements – 40 gm/day
PROTEINS
Egg & Milk – first class protein
FATS• Saturated fatty acids (SFA)
– Lauric, Myristic & Palmitic– Myristic is more dangerous – Increase LDL cholesterol – SFA content – Coconut oil- 92%, Sun
flower and saw flower – 10%• PUFA
– EFA are PUFA– Linoleic, Linolenic, Arachidonic– N6 to N3 ratio should be 5:1 to 10:1– PUFA both LDL & HDL
• PUFA (Contd…)
– Sun flower & Saw flower oil n6-n3 ratio is 69-70:0
– Coconut oil n6-n3 ratio is 4:1– PUFA of coconut oil is only 2%– High n6-n3 ratio
•Freeradicles diseases – Angiotoxicity, . platelet aggregation, and . immune function
– Answer for . N3 - use fish, Legumes and greens
MONO UNSATURATED FATTY ACIDS (MUA)
• Increases HDL (Good cholesterol)
• Decreases LDL (Bad cholesterol)
• Olive oil – 77% (n6-n3 ratio 8:1)
• Coconut – 6% (n6-n3 ratio 4:1)
• Palmolein – 48% (n6-n3 ratio 11:1)
FISH OIL
• Omega 3 fatty acids
• EPEA (Eicosa Penta Enoic Acid)
• DHEA (Docosa Hexa Enoic Acid)
• Decreases thromboxane A2
• Thromboxane A2, potent vasoconstrictor and platelet aggregator
RECOMMENDATIONS
• 10% SFA (Coconut oil)
• 10% PUFA (Saw flower oil)
• 10% MUFA (Olive oil or
Palmolein)
NUTRITIVE VALUE / 100 GMProtein (gm) Cal
• Breast milk 1 67• Cows milk 3 67• Rice (1 tumbler-cooked) 4 175• Egg 6 80• 1 tsp. cooked dhal 0.5 8• 1 oz fish 6 50• Mutton 1 oz 6 70• Bread 1 slice 2 70• Dosa 2 70• Iddili 2 50• Chappati 2 70
NUTRITIVE VALUE / 100 GM (Contd…)
Protein (gm) Cal• Uppuma 1 cup 6 250• 50 ground nut 5 110• Plantain 0.5 50• Pappadam 0.5 20• Biscut 0.5 20• Cereals 7-11 350• Legumes 17-20
350• Soya 43 500• Nuts 20 600• Meat 20 200• Beef 80 400
DIET IN DISEASE
• Acute nephritis – Fluid 400 ml/m2 surface area +
previous day output– SA = Ht (cm) X Wt. (Kg)
3600– Calories - Sweetened carbohydrates – Proteins – 0.75 gm/kg– Na – No added salt – Protein – No fruits
DIET IN DISEASE (Contd…)
• CRF diet
– Restrict proteins, sodium and potassium
– CRF induced rickets
– Aluminium hydroxide – 1ml/kg/day
– Calcium – 1 gm/day
– Alpha D3 – 0.25 gm / day
– Restrict milk as it contains phosphates
DIET IN DISEASE (Contd…)
• Nephrotic syndrome
– Protein RDA
– Carbohydrate – Non easily assimilable
– Lipid – PUFA
– Potassium – Liberal
– Sodium – Adequate
– Calcium – Supplement
DIET IN HEART DISEASE
•CCF
– Calories – 30% extra
– Protein – RDA
– Sodium – 0.5 to 1 gm
DIET IN RESPIRATORY DISEASE
• 10-20% extra calories
• Exclusion diet in asthma
• Citrous fruit, nuts, chocolates
cows milk, egg, fish, meat
DIET IN LIVER DISEASE
•Hepatitis
– No restriction
– Encourage salt
– Fat may cause delayed gastric
emptying
DIET IN CHRONIC LIVER DISORDERS
• Calories – 120-150%• Protein – Gr. 1 & Gr.2
encephalopathy – No restriction
• Gr. 3 & Gr. 4 – 80% of the RDA – Use milk and veg. Proteins as they
increase BCAA/Tyrosene ratio– As they increase arginine and ornithine – Helpful to remove ammonia
• FAT – Use MCT
DIET IN CHRONIC LIVER DISORDERS (Contd….)
• Vit. A – 10,000 unit daily• Vit. D2 – 5000 – 8000 units or • Vit. D3 – 3 to 5 micro gm/Kg/day• Vit. E – 50-400 IU/day• Vit. K – 2-5 mg alternate day• Micronutrient – Ca, Phosphorus & Zn• Avoid – Al, Manganese & Cu• Water soluble vitamins – double dose
DIET IN MALABSORPTION
• Lactose intolerance – Restrict lactose for 2 days
• Protein indigestion – Protease enzymes
• Fat indigestion– MCT and lipase enzymes
• Pancreatic insufficiency– MCT and enzymes
DIET IN CELIAC DISEASE
•Gluten free diet
–Avoid wheat & wheat
products, Rye, Barley & Oats
DIET IN DIABETES MELLITUS
• Aim – FBS < 115– PPBS < 140– S. Chol. < 200– S. LDL < 130
• Carbohydrate – Non easily assimilable – Wheat preferable
• Low fat – PUFA, SFA – 1.2:1• Fibres – 20-30 gm /day
DIET IN DIABETES MELLITUS (contd…)
• Carbohydrate < 5%
– Cabbage, Bringal, Tomato, Water melon, Snake gourd
• Carbohydrate – 5 to 20 %
– Beetroot, Papaya, grapes
• Carbohydrate > 20%
– Potato, Cereals, Jam
DIET IN HYPER LIPIDEMIA
• Cholesterol: < 170 - No intervention
• Cholesterol: 170 to 199 – Repeat
• Do lipid profile if in the same range
• LDL: < 110 – Acceptable
• LDL: 110 to 130 – Borderline
• LDL: > 130 – Elevated
DIET IN HYPER LIPIDEMIA (Contd…)
• Treatment – Total fat – 30%,
– SFA, PUFA, MUFA – 10%
– Cholesterol – 100mg/1000 cal.
– Aim – to keep LDL < 130
– If not, reduce SFA to < 6%, cholesterol – 66mg/1000, total 200 mg/day
DIET IN HYPER LIPIDEMIA (Contd…)
•Cholesterol content
–1 egg : 250 mg
–100 gm liver : 400 mg
–100 ml milk : 23mg
–100 gm meat : 135 mg
LONGEVITY DIET
Calorie distribution
•Fat – 10%
•Protein – 10%
•Carbohydrates – 80%
DIET IN OBESITY
• BMI - Wt. in kg / Ht. in m2
• Normal – 15-25
• Grade 1 – 25 – 30
• Grade 2 – 30 – 40
• Grade 3 - > 40
• Avoid – Oils, direct sugar and bakery items
DIET IN PKU
•Avoid – meat, fish, eggs, nuts,
pulses, cereals & bread
DIET IN GALACTOSEMIA
•Avoid – all milk and milk
products
•Favourable – Cheese, fruits,
eggs, vegetables, breads, soups
DIET IN GSD
• Use uncooked cornstarch
DIET IN GOUT
•Avoid – beef, chicken,
spinach, chocolates, coco,
alcoholic beverages
DIET IN EPILEPSY
•Ketogenic diet
– 80% calories from fat
– 60% as MCT
– Rest proteins and
carbohydrates
DIET IN DIARRHOEA
•Normal diet
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