D IETETIC TREATMENT Dr. Sumbul Fatma. O BJECTIVE To discuss the nutritional care process and how the...
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DIETETIC TREATMENT Dr. Sumbul Fatma
D IETETIC TREATMENT Dr. Sumbul Fatma. O BJECTIVE To discuss the nutritional care process and how the basic principles of nutrition can be applied to the
O BJECTIVE To discuss the nutritional care process and how the
basic principles of nutrition can be applied to the treatment of
disease
Slide 3
D IETETIC T REATMENT Also referred to as diet therapy or diet
in disease Involves the modification or adaptation of the normal or
basic diet according to the needs of the individual
Slide 4
W HY ? To maintain or improve nutritional status To improve
clinical or subclinical nutritional deficiencies To maintain,
increase or decrease body weight To rest certain organs or the
whole body To eliminate certain food constituents to which the
individual may be allergic To adjust the composition of the normal
diet to meet the ability of the body to adjust, metabolize, and
excrete certain nutrients and other substances
Slide 5
T HE DIET PRESCRIPTION It is written in terms of energy
requirements based on individuals weight and activity and
requirements for protein, fat, carbohydrate, minerals, vitamins and
fiber with regard for the increased or decreased needs for each
because of the patients illness The prescription is translated into
foods and meals by the dietitian, who, in turn, instructs the
patient regarding the diet, its importance as a single therapeutic
measure or as a supplement to medication
Slide 6
F ROM BASIC TO THERAPEUTIC DIET An increase or decrease in the
following The energy value (kilocalories) Fiber Specific
nutrient(s) Specific food or types of food (such as allergens for
persons with allergies, fried foods, or gas forming foods) Anyone
of these modified diets may be further altered to become a soft or
liquid diet
Slide 7
E XAMPLES OF THERAPEUTIC DIETS M ODIFICATIONS IN CONSISTENCY
Tube feeding- for patients with an esophageal obstruction or severe
burns or who have undergone gastric surgery Restricted-residue
diet- for patients with gastritis, Crohns disease, severe diarrhea,
ulcerative colitis, diverticulitis, typhoid fever
Slide 8
M ODIFICATIONS IN CARBOHYDRATE, PROTEIN AND FAT Diabetic diet-
carefully calculated for each patient to minimize the occurrence of
hyperglycemia and glycosuria and to attain the ideal body weight
Low calorie diet- to achieve weight loss in individuals with
cardiovascular and renal diseases, hypertension, gallbladder
disease, gout or hyperthyroidism, and for severely ill
patients
Slide 9
M ODIFICATIONS IN FAT Restricted-fat diet- for pateints with
disease of the liver, gall bladder or pancreas in which the
disturbances of digestion and absorption of fat may occur
Fat-controlled Low-cholesterol diet- In individuals with elevated
blood cholesterol and for patients with atherosclerosis
Slide 10
M ODIFICATIONS IN PROTEIN Restricted-protein diet- for patients
in hepatic coma or with chronic uremia, renal disease or liver
disease Gluten-free diet- Individuals with celiac have gluten
intolerance and must be on gluten-free diet Restricted-purine diet-
A decrease in purines is useful in lowering the blood uric acid
level in gout High protein diet- is used to correct a protein
inadequacy from any source- pre- and postoperative, high fever,
burns, injuries, increased metabolism, pernicious anemia,
hepatitis, cystic fibrosis etc
Slide 11
M ODIFICATIONS IN CARBOHYDRATE Lactose-free diet- patients with
total or partial inability to metabolize this milk sugar must avoid
lactose in their diet Dumping syndrome diet- Patients who have had
a gastrectomy or gastric bypass surgery may require this special
diet
Slide 12
M ODIFICATIONS IN ELECTROLYTES AND MINERALS Restricted-sodium
diet- prescribed for patients with congestive heart failure,
hypertension, renal disease with edema, cirrhosis of the liver with
ascites, pre-eclampsia and eclampsia and ACTH therapy
Restricted-potassium diet- when potassium is not being excreted
properly from the body High-calcium and high-phosphorus diet-
desirable in rickets, osteomalacia, tetany, dental caries, and
acute lead poisoning High-iron diet- nutritional and hemorrhagic
anemia High-vitamin diet- If a specific vitamin deficiency is
diagnosed e.g. vit A to combat night blindness and xerophthalmia,
vit D for rickets and osteomalacia, vit K in liver and gallbladder
disease
Slide 13
N UTRITIONAL A SSESSMENT Dietary history Anthropometry
Biochemical and clinical data Laboratory tests of blood and urine
to compare with normal ranges for hemoglobin, albumin, transferrin,
total plasma protein etc. (all associated with body protein stores)
Nitrogen content in 24 hour urinary output (a negative nitrogen
balance signifies that the body is using some of its protein
reserves for energy Skin tests Immunity to certain diseases
Response to antigens
Slide 14
N UTRITIONAL M ANAGEMENT IN D IABETES M ELLITUS Kilocalories-
The amount of kilocalories needed by the individual with diabetes
should be the same as the RDA for the person without diabetes but
adjustments in kcal may be necessary to maintain or attain the
normal weight Protein- The %age of kcal derived from protein is
usually 15- 20%. This allows the individual with diabetes from
1-1.5g of protein/kg of body weight and should approximate the RDA
Carbohydrates- are no longer restricted as much as they once were.
The recommended allowance is 50-60% of total calories. Complex
carbohydrates are emphasized as are high- fiber foods Fat- ~20-30%
of the total calories. Low-fat foods, lean meats, and
polyunsaturated fats are emphasized to prevent cardiovascular
disease (a common complication of diabetes)
Slide 15
R ENAL D ISEASES The kidneys perform two main functions 1. To
excrete waste products, unnecessary material and superfluous fluids
(water) from the body 2. To retain all material valuable to the
system In disturbances of the kidney two sets of phenomenon are
noticeable 1. Accumulation in the blood of substances which should
have been eliminated 2. Excretion from the blood of material that
should have been retained
Slide 16
R ENAL D ISEASES Management of the renal disease is complex
involves controlling several nutritional components like- proteins,
kcalories, phosphorus, sodium and potassium Generally all are
restricted except kcal, which need to be maintained at a high level
to prevent protein from being broken down for energy needs,
resulting in nitrogenous waste material Once the dialysis begins
the restrictions are often reversed in order to compenstate for the
excess losses incurred The reduction of nitrogenous excretory
wastes resulting from the breakdown of proteins is crucial in the
prevention of further kidney damage
Slide 17
D IETARY TREATMENT FOR RENAL DISEASES Calories- Adequate
calories are provided in the treatment of renal disease,
particularly when the diet is restricted in protein, so that the
body protein will not be used to meet energy needs (~35-45kcal/kg
body weight) Protein- An adequate amount of protein is provided as
long as the kidney function remains unimpaired. Amounts range from
very low(20g) to low (40-50g) to high (100-125g), depending on the
disorder. Protein is increased to make up for the albumin loss in
urine or it is restricted to various levels with lessened kidney
function and retention of end products of protein metabolism in
blood. Calculations are based on 0.5-1.5g/kg, depending on the
disorder
Slide 18
D IETARY TREATMENT FOR RENAL DISEASES CONTD.. Electrolytes- A
low protein diet will also be a restricted- sodium diet, because
protein foods are high in sodium. A more liberal sodium restriction
is appropriate for hypertension without edema Potassium is
restricted because its excretion lessens with progressive kidney
damage, and it is retained in the blood of patients with renal
failure- usually to the 1.5 g level. Restricting phosphorus to
450-600mg should maintain desirable serum phosphorus levels Fluids-
are restricted for patients with renal failure; a balance between
intake and output must be achieved. The general guidelines are
500ml plus urinary output
Slide 19
C ARDIOVASCULAR D ISEASES The main nutrition-related risk
factors associated with CVD are obesity (the need to reduce
calories) Hypertension (the need for a reduction in sodium intake)
Elevated levels of blood cholesterol and LDL (the need for
reduction in total dietary fat, saturated fat, and cholesterol, and
a moderate increase in PUFA and soluble fiber) Diabetes mellitus
(the need for control of blood glucose levels)
Slide 20
AHA NUTRITIONAL GUIDELINES Kcal modification is necessary to
achieve and maintain ideal weight Total dietary fat reduction to
30% of total kcal consisting of 10% each of saturated, MUFA and
PUFA fats Dietary cholesterol reduction to less than 300mg daily
Dietary carbohydrate consisting mainly of fruits, vegetables, whole
grain and enriched breads, and cereals
Slide 21
D IETARY THERAPY FOR HIGH BLOOD CHOLESTEROL NutrientRecommended
Intake Step One dietStep two diet Total fatLess than 30% of total
calories Saturated fattyacids < 10% of total