HND 206 W5 (T1 T2) Therapeutic Diets PDF

Dietetics-I HND-206 3(2-1) Ms. Rohma Anwar Lecturer SFAS, UMT Therapeutic Nutrition ❖ Therapeutic nutrition, as a study focuses on the nutritional management of individuals or group of individuals with established disease condition Therapeutic Diets ❖ A therapeutic diet is a meal plan th...

Dietetics-I HND-206 3(2-1) Ms. Rohma Anwar Lecturer SFAS, UMT Therapeutic Nutrition ❖ Therapeutic nutrition, as a study focuses on the nutritional management of individuals or group of individuals with established disease condition Therapeutic Diets ❖ A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients ❖ Part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician ❖ Usually, a qualitative/quantitative modification of a regular diet, modified or tailored to fit the nutrition needs of a particular person, and are used to improve specific health/disease condition Conti… ❖ It is a planned diet used to supplement the medical or surgical treatment. ❖ Normal diet, here, refers to a basic, balanced diet which meets the need of an individual. ❖ Therapeutic diets are modified for: ✔ Nutrients ✔ Texture, and/or ✔ Food allergies or food intolerances Conti…. ❖ The significance of modified or therapeutic diet is that it is useful in managing the disease condition; it promotes resistance to disease condition and is preventive or supplemental treatment ❖ For instance, when an individual suffers from a disease, the disease process may cause the patient to lose appetite and therefore eat less or in some other circumstances feel hungrier and eat more ❖ Dietary modification than becomes a part of the therapeutic demand  Why Therapeutic Diets? ❖ The reasons for modifying the diets may include: ✔ For essential or life saving treatment: e.g., 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 Conti… ❖ To adjust to the body's ability to digest, absorb, metabolize or excrete: e.g., a low-fat diet provided in fat malabsorption ❖ To adjust to tolerance of food intake: e.g., 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 balance amounts of carbohydrates, fat and protein for control of diabetes Conti…. ❖ To increase or decrease body weight/body composition when required, for example as in the case of obesity or underweight ❖ To adjust to mechanical difficulties, e.g., for elderly patients with denture problems, changing the texture/consistency of food recommended due to problems with chewing and/or swallowing ❖ As helpful treatment, alternative or complementary to drugs, as in diabetes or in hypertension  Dietary Adaptations for Therapeutic Needs ❖ The dietary adaptations may include: Change in consistency of foods, such as liquid diet, soft diet, low fiber diet, high fiber diet Caloric 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 fiber diet, high potassium diet Elimination of spices and condiments, such as bland diets Conti…. ❖ Omission of specific foods such as allergy diets, gluten free diet ❖ Adjustment in the ratio and balance of proteins, fats and carbohydrate 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 steatorrhea 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 Common Therapeutic Diets 1. Nutrient modifications No concentrated sweets diet Diabetic diets No added salt diet Low sodium diet Low fat diet and/or low cholesterol diet High fiber diet Renal diet Conti…. 2. Texture modification Mechanical soft diet Pureed diet 3. Food Allergy or Food intolerance modification Food allergy Food intolerance 4. Food Allergy or Food intolerance modification Liquid tube feedings in place of meals Liquid tube feedings in addition to meals Diets of Altered Consistency ❖ Therapeutic diets are modified for consistency, texture to fit the nutritional needs. ❖ Some individuals may require a clear liquid diet, while others a fully liquid diet or soft diet based on their medical condition. ❖ Diets modified based on consistency include: Diets of Altered Consistency ❖ Liquid Diet consists of foods that are liquid at room temperature and can be served in liquid or strained form ❖ 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.  Clear Liquid Diet ❖ Includes minimum residue fluids that can be seen through. ❖ The foods areliquid and have high transparency ❖ Examples are ❖ juices without pulp, ❖ strained broth, ❖ Jell-O ❖ ORS, Lemon tea etc ❖ Coffee (no cream and milk) Applications ❖ Is often used as the first step to restarting oral feeding after surgery or an abdominal procedure. ❖ Can also be used for fluid and electrolyte replacement in people with severe diarrhea. ❖ Should not be used for anextended period as it does not provide enough calories and nutrients. Clear Liquid Diet ❖ An average clear liquid diet contains 600 to 900 Kcal, 120 to 200g carbohydrate, minimal fat 5 to 10g protein and small amount of sodium and potassium (electrolytes). ❖ This diet is only used for short periods of time; no more than three to five days. ❖ Justification must be provided in the record if this time is extended. ❖ If this diet is used for longer than three to five days, an appropriate low-residue liquid dietary supplement should be ordered for supplementary nutrition. Clear Liquid Diet Clear Liquid Diet Full Liquid Diet ▪ Used as a step between a clear liquid diet and a regular diet. ▪ Includes fluids that are creamy, and a variety of foods that require no chewing. ▪ All foods are liquid or will become liquid at body temperature. ▪ Some examples of food allowed are ice cream, pudding, custard, strained cream soups, and juices with pulp (strained), as well as milk products. ▪ Used as the second step to restarting oral feeding once clear liquids are tolerated.  Full Liquid Diet ❖ Used for people who cannot tolerate a mechanical soft diet. ❖ Provides more calories than the clear liquid diet and gives adequate nourishment, except that it is deficient in fiber (An average full liquid diet can provide approximately 1000 to 1800 calories and 50 to 65g of protein and adequate minerals and vitamin.) ❖ Should not be used for extended periods. ❖ This diet can be used up to eight weeks only. ❖ Liquid dietary supplements should be ordered three times a day between meals to meet nutrient needs. Full Liquid Diet Mechanically Altered or Soft Diet ❖ Soft diet provides soft whole food that is lightly seasoned, and similar to the regular diet. ❖ 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, as well as does not contain harsh fiber or strong flavors. ❖ Includes chopped or ground meats as well as chopped or ground raw fruits and vegetables. ❖ Is used when there are problems with chewing and swallowing, such as for people with poor dental conditions, missing teeth, no teeth, or a condition known as dysphasia. Applications ❖ Also 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. Mechanical soft diet ❖ 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. ❖ Simple salads, fruit salads and cottage cheese may be included. ❖ No food is restricted unlike in the case of the customary soft diet, rather, just the removal of the skin and seeds, cutting or chopping the food into small fine pieces are processes usually employed. Bland Diet ❖ Made of foods that are soft, not very spicy and low in fiber. ❖ 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. Pureed Diet ❖ Changes the regular diet by pureeing it to a smooth liquid, or semi-solid consistency. ❖ Often thinned down so it can pass through a straw. ❖ Indicated for those with wired jaws extremely poor dentition in which chewing is inadequate, as well as for people with chewing or swallowing difficulties or with the condition of dysphasia. ❖ Foods should be pureed separately. ❖ Avoid nuts, seeds, raw vegetables, and raw fruits. ❖ Is nutritionally adequate when offering all food groups. Modification in Quantity ❖ Depending on the clinical condition some individuals may require a restriction diet such as sodium restricted diet (as in high blood pressure), purine restricted diet (as in gout) or low residue diet (prescribed and/or before abdominal surgery) designed to reduce the frequency and volume of fecal output. ❖ Sometimes a complete elimination diet may be recommended when there is food intolerances or complete insensitivity to a particular food such as a gluten free diet or a dairy free diet or nut free diet etc. Conti… ❖ Occasionally an increase in the amount of a specific dietary constituent may be prescribed such as a high potassium diet or a high fiber diet (as in constipation) or an iron rich diet (as in anemia) when the clinical condition demands. Diabetic or Calorie Controlled Diet (ADA) ❖ These diets control calories, carbohydrates, protein, and fat intake in balanced amounts to meet nutritional needs, control blood sugar levels, and control weight. ❖ Portion control is used at mealtimes as outlined in the ADA “Exchange List for Meal Planning.” ❖ Most commonly used calorie levels are: 1,200, 1,500, 1,800 and 2,000. Modification in Nutrient Content ❖ The nutrient content (proteins, fat, carbohydrates) of the diet is modified to treat deficiencies, change body weight or control diseases such as hypertension or diabetes. ❖ Patients with high blood sugar levels, are prescribed a diabetic diet which requires changes in the quantity and type of carbohydrates included in each meal. ❖ Refined carbohydrates (such as sugar, honey, refined flour, semolina etc.) are best avoided and use of complex carbohydrates (whole wheat flour, coarse cereals etc.) recommended. Conti… ❖ Patients with heart diseases require a fat controlled low cholesterol diet while patients with renal (kidney) failure and advanced liver diseases a low protein diet, patients with HIV disease, cancer or malnourished a high protein, high calorie diet. ❖ Others as in the case of overweight, and obesity, a weight reduction diet, low in fat and calories. No Concentrated Sweets (NCS) Diet ❖ Is considered a liberalized diet for diabetics when their weight and blood sugar levels are under control ❖ It includes regular foods without the addition of sugar ❖ Calories are not counted as in ADA calorie-controlled diets Conti… No Added Salt (NAS) Diet ❖ Is a regular diet with no salt packet on the tray. ❖ Food is seasoned as regular food. Low Sodium (LS) Diet ❖ May also be called a 2-gram Sodium Diet. ❖ Limits salt and salty foods such as bacon, sausage, cured meats, canned soups, salty seasonings, pickled foods, salted crackers, etc. ❖ Is used for people who may be “holding water” (edema) or who have high blood pressure, heart disease, liver disease, or first stages of kidney disease. Low Fat/low Cholesterol Diet ❖ Is used to reduce fat levels and/or treat medical conditions that interfere with how the body uses fat such as diseases of the liver, gallbladder, or pancreas ❖ Limits fat to 50 grams or no more than 30% calories derived from fat ❖ Is low in total fat and saturated fats and contains approximately 250-300 mg cholesterol High/Low Fiber Diet ❖ Is prescribed in the prevention or treatment of a number of gastrointestinal, cardiovascular, and metabolic diseases ❖ Increased fiber should come from a variety of sources including fruits, legumes, vegetables, whole breads, and cereals ❖ Low fiber diet includes foods that are low in indigestible carbohydrates and connective tissues which reduce intestinal motility Renal Diet ❖ Is prescribed for people with renal/kidney problems ❖ The diet plan is individualized depending on if the person is on dialysis ❖ The diet restricts sodium, potassium, fluid, and protein specified levels ❖ Lab work is followed closely ❖ The pre-dialysis diet contains 60-65 g protein and 2.0- 3.0 g sodium ❖ Potassium and phosphorus is limited only as medically necessary to treat high levels in the blood Conti… ❖ This diet contains three meals per day. ❖ Criteria for this diet: Chronic Kidney Disease stage three or four. ❖ The dialysis diet contains 95-105 gm protein, 2.0-3.0 g sodium, and 3.0-3.2 g potassium and 1.0-1.2 g phosphorus ❖ This diet is indicated for individuals receiving dialysis, and contains three meals Food Allergy Modification ❖ Food allergies are due to an abnormal immune response to an otherwise harmless food ❖ Foods implicated with allergies are strictly eliminated from the diet ❖ Appropriate substitutions are made to ensure the meal is adequate ❖ The most common food allergens are milk, egg, soy, wheat, peanuts, tree nuts, fish, shellfish, and sesame. ❖ A gluten free diet would include the elimination of wheat, rye, and barley, and replacement with potato, corn, and rice products Food Intolerance Modification ❖ The most common food intolerance is intolerance to lactose (milk sugar) because of a decreased amount of an enzyme in the body ❖ Other common types of food intolerance include adverse reactions to certain products added to food to enhance taste, color, or protect against bacterial growth ❖ Common symptoms involving food intolerances are vomiting, diarrhea, abdominal pain, and headaches Modification in the Method of Feeding ❖ To provide adequate nutrition, normally oral feeding (by mouth) is recommended. ❖ Sometimes oral feeding is not possible, under such circumstances special feeding methods such as enteral feeding (provision of liquid formula diet delivered via nasogastric feeding tube) and parenteral feeding (fluids containing water, glucose, amino acids, minerals, vitamins given through the peripheral and central veins) is recommended. ❖ All or parts of nutritional needs are met through tube feedings. Conti… ❖ Enteral nutrition (EN) via tube feeding provides life- sustaining nutrients and is often required as a first option feeding method when a person is unable to consume food orally and/or has an impaired digestive system. ❖ EN therapy includes specialized liquid feeding containing protein, carbohydrates, fats, vitamin minerals, and other nutrients needed to live ❖ These nutrition support products are formulated to meet individual needs for a variety of disease states and conditions. Conti… ❖ Parenteral nutrition (PN) is theintravenous administration (feeding into a vein) of nutrients directly into the systemic circulation, bypassing the gastrointestinal tract. ❖ It is a special liquid mixture containing proteins, carbohydrates, fats, vitamins, minerals, and other nutrients needed to live. ❖ PN represents an alternative or additional approach for nutrition intervention when nutrition needs cannot be met from the oral or enteral routes alone, or are contraindicated. Conti… Conti… Modification in the Method of Cooking ❖ Leaching is indicated for cooking vegetables for people with chronic kidney diseases because the kidneys no longer maintain the ideal level of potassium necessary for optimum health. ❖ Leaching (soaking in water) drains out excessive potassium and phosphorus from the vegetables. ❖ In elderly people food may be modified by mechanical processing such as mashing, blenderizing or chopping. ❖ For patients on bland diet foods steamed, baked or grilled are recommended. Modification in Meal Frequency ❖ Individuals suffering with gastro-esophageal reflux disease (GERD) stand to benefit by consuming small but frequent meals. ❖ 5 to 6 small meals instead of three regular meals are recommended.