Dietary Modifications and Dietary Therapy PDF

NCMA215: NUTRITION AND DIET THERAPY LESSON 8: DIETARY MODIFICATIONS AND DIETARY THERAPY PROFESSOR: LEILA FERRER, MD SUMMER TERM | A.Y 2023 – 2024 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO OUTLINE...

NCMA215: NUTRITION AND DIET THERAPY LESSON 8: DIETARY MODIFICATIONS AND DIETARY THERAPY PROFESSOR: LEILA FERRER, MD SUMMER TERM | A.Y 2023 – 2024 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO OUTLINE GENERAL DIETS I. Dietary Modifications and Dietary Therapy Standard Hospital Diets: Clear Liquid Diet a) General Diets i. Clear Liquid Diet  consists of liquids without residue or fibers ii. Full Liquid Diet  used to relieve thirst and maintain water balance iii. Cold Liquid (Yin diet)  diet used for 24-48 hours following acute iv. Soft Diet o vomiting, diarrhea or vomiting v. Mechanical Soft Diet  allowance of tea, coffee, fat-free broth, ginger vi. Regular Diet vii. Light Diet ale, fruit juices in sachet viii. Vegetarian Diet  gelatin, fruit ices, hard candy and water ix. Restricted Diet Full Liquid Diet x. Controlled Diet b) Dietary Modifications with Consistency  nutritionally adequate diet consisting of fluids c) Dietary Modification with Composition and foods that liquefy at body temperature i. Low Calorie Diet and Very Low  diet used for acute infections and fever of short Calorie Diet ii. High Calorie Diet duration and for patients who are ill to chew iii. High Protein Diet  Examples: milk, cream soups, cereal, soft custard, iv. Low Protein Diet strained meat in broth, strained citrus fruits, v. Low Fat Diet tomato juice, vegetable puree, eggnog, yogurt vi. Low Carbohydrates Cold Liquid (Yin diet) vii. Low Sodium Diet viii. Low Potassium Diet  diet for patient undergone tonsillectomy and ix. Low Purine Diet adenoidectomy x. BRAT diet xi. Butterball diet  allowance for ice chips, ice cream, sherbet, ice xii. Giordano diet drops, popsicle xiii. Giordano-Giovannetti diet Soft Diet xiv. Kosher xv. Tyramine rich diet  nutritionally adequate diet differs from the xvi. South Beach Diet normal diet in having reduce the fiber content, xvii. Monothropic Diet soft consistency and bland flavor xviii. DASH diet xix. Elemental diet  used immediately between the full fluid diet and xx. Ketogenic diet regular diet following surgery, acute infections, xxi. Paleo diet fever, and GI disturbances xxii. Pureed Diet  The normal diet is modified in the following ways: o patient with no teeth or ill-fitting dentures; o those who cannot tolerate highly seasoned, DIETARY MODIFICATIONS AND DIETARY THERAPY fried or raw foods Therapeutic Diet o meat and poultry are minced and ground  Is a meal plan that controls the intake of certain o vegetables are cooked – little longer than foods or nutrients. usual  It is part of the treatment of a medical condition o soft raw fruits may be used o soft rolls, bread or biscuits are used instead and are normally prescribed by a physician and planned by a dietician. of crisp rolls, crust breads and toast o all desserts on a normal diet may be used  A therapeutic diet is usually a modification of a regular diet. Mechanical Soft Diet  Therapeutic diets are formulated by doctors and dietitians.  dental soft or mechanically altered diet  foods should be well cooked, easy to chew, chopped ground or minced RIZALYN RANGEL DIAVARRO 1|N CMA 215 LESSON 8: DIETARY MODIFICATIONS AND DIETARY THERAPY  foods are best served moist or with gravy and o Liquid Diet sauce o Thickened Liquids Regular Diet Therapeutic Diet for Specific Disease Condition  most frequently ordered among the house diets  Acute Glomerulonephritis - Low Na, Low CHON  also called general, house, full hospital diet, diet  Acute Renal Failure – Oliguric Phase - Low Na, as tolerated Low CHON, High CHO  Addison’s Disease - High Na, Low K Light Diet  Attention deficit hyperactivity disorder (ADHD) -  a transition between the soft and regular diets Finger foods  for elders who cannot tolerate rich and heavy  Bipolar Disorder - Finger foods foods  Cerebrovascular Accident - Osterized Feeding with Low Na, Low cholesterol, High fiber Vegetarian Diet  Cholecystitis - Low fat, High CHO, High CHON  usually low in saturated fatty acid, cholesterol,  Chronic Renal Failure - Low CHON, Low Na, Low K and high fiber  Congestive Heart Failure - Low Na, Low  with disadvantage is inadequate or low level of Cholesterol Vit B12, Iodine, Calcium, Zinc, Vit. B2 and Vit. D.  Cushing Disease - High K, Low Na  Decubitus Ulcer - High CHON, High Vitamin C Types of Vegetarian Diet  Dengue Fever - Diet as tolerated except dark- a. Vegan diet - total vegetarian, or strict colored food vegetarian diet or plant in origin  Diabetes Mellitus - Well-balanced diet b. Lacto-vegetarian - milk and milk products +  Diverticulitis - Low fiber items of plant origin  Dumping Syndrome - High fat, High protein c. Ovo-vegetarian - eggs and eggs products + items  Hepatic Encephalopathy - Low CHON, High of plant origin calorie d. Lacto-ovo-vegetarian - eggs + milk + plant origin  Hirschsprung’s disease - High calorie, Low e. Semi-vegetarian - lacto-ovo- vegetarian foods + residue, High CHON fish + chicken + plant  Hyperparathyroidism - Low Calcium f. Pesco-vegetarian - fish and fish products + items  Hyperthyroidism - High Calorie, High CHON of plant origin  Liver Cirrhosis - Low CHON Restricted Diet  Nephrotic syndrome - Low Na, High CHON, High Calorie  a diet limited in a specified amount or type of  Overweight and Obese - Low calorie nutrient  Pernicious Anemia - High CHON, Vitamin B  cholesterol restricted diet, salt restricted diet  Tonsillitis - Clear liquid diet Controlled Diet  Ulcerative Colitis - High CHON, High Calories, Low residue  implies careful adjustment of levels of nutrients from day to day as needed; controlled CHON, K, Bland - eliminate irritating foods to allow the stomach Na. lining to heal (ulcer patients) DIETARY MODIFICATIONS WITH CONSISTENCY High Fiber - provide bulk in the stool and bring water into the colon for patients with constipation or diverticulosis  The modified consistency diet includes all the foods you are allowed to eat in your regular diet Low residue - reduce fiber for patients with Crohn’s based on your tolerance. disease, colon or rectal surgery, esophagitis, diarrhea.  This diet may also meet all your nutrition needs High Calorie - growing periods, under nutrition, Chronic if you make healthy food choices. Obstructive Pulmonary Diseases and Cystic fibrosis  Cut starches into small pieces, mash or puree.  Cook fruits: cook or steam vegetable Low Protein - Liver and renal failure o Modified Consistency Diet High Protein - Hypercatabolic disorder, Protein Energy o Pureed Diet Malnutrition o Mechanical Soft Diet o Modified Regular Diet RIZALYN RANGEL DIAVARRO 2|N CMA 215 LESSON 8: DIETARY MODIFICATIONS AND DIETARY THERAPY Low Purine - reduce the amount of purine. It is used with  to meet their needs, most people with liver patients who have gout or uric acid kidney stones. disease should increase the amount of calories they eat each day. Low Cholesterol - reduce the intake of cholesterol in order to lower blood cholesterol levels in client heart diseases  people with Huntington’s Disease have higher calorie needs because of their constant fidgeting Sodium Restriction Salt Allowed which increases their metabolic rate.  cancer patients tend to have higher calorie Mild (3000 mg) >1/2 teaspoon per day needs because of a poor appetite related to ¼ teaspoon per day treatment. Moderate (2000 mg) 1 serving of processed foods  eating more calorie-dense foods, such as whole No salt milk, cheese and nuts, can help you increase your Strict (1000 mg) No processed foods calorie intake when you have a poor appetite. Limit bread and milk  severe burns Sodium free  underweight Very Strict (500 mg) Restrict natural foods high in  competitive athletics sodium High Protein Diet DIETARY MODIFICATION WITH COMPOSITION  a diet that contains large amounts of protein, Low Calorie Diet consisting largely of meats, fish, milk, legumes, and nuts.  calorie restriction or caloric restriction (CR)  it may be indicated in protein depletion that  dietary regimen that restricts calorie intake, results from any cause, as a preoperative where the baseline for the restriction varies preparation, or for patients with severe burns  people who are interested in going on a very low- and sepsis. calorie diet (VLCD) should first consult a  it may be contraindicated in liver failure or when physician kidney function is so impaired that added protein  a very low-calorie diet is any diet plan that could result in azotemia and acidosis. allows 800 calories or less in a day; and the diet is overseen by a physician Low Protein Diet  the length of such a diet is relatively short,  is any diet in which the protein intake is reduce. usually between 3 and 6 months.  anyone diagnosed with kidney or liver disease  any longer and serious health complications may may be prescribed a low-protein diet. arise  in any case, a diet which is especially low in Low Calorie Diets and Very Low Calorie Diets protein should only be undertaken under medical direction.  as you can see, a VLCD is different from what a  reduce amount of protein person might casually call a “low-calorie diet,”  some of each type of protein should still be which would commonly consist of 1500 to 1800 consumed each day from the two main sources: calories per day. o animal products (fish, poultry, eggs, meat,  if you’re interested in something less aggressive, dairy products) -considered high quality or there are plenty of diet plans that will allow for Complete protein. more moderate calorie restriction. o vegetable products (breads, cereals, rice, High Calorie Diet pasta, dried beans) -considered low quality or incomplete protein.  one furnishing more calories than needed to Low Fat Diet maintain weight, often more than 3500–4000 calories per day.  according to the USDA, a low-fat diet-as the  a diet containing more than 4000 calories per name implies-is a diet that consists of little fat, day. especially saturated fat and cholesterol, which is  some medical conditions require a high-calorie thought to lead to increased blood cholesterol diet to help maintain or promote weight gain. levels and heart attack.  people with liver disease are at risk of  it is important to know that dietary fat is needed malnutrition due to poor intake and altered for good health, as fats supply energy and fatty nutrient metabolism. RIZALYN RANGEL DIAVARRO 3|N CMA 215 LESSON 8: DIETARY MODIFICATIONS AND DIETARY THERAPY acids, in addition to supplying fat-soluble  if the diet contains less than 2000 mg of vitamins like A, D, E, and K potassium per day, then it is called as a “low potassium diet.” Low Carbohydrates  Low Potassium Foods  dietary programs that restrict carbohydrate o 1 serving of the following can be considered consumption usually for weight control or for the to be low potassium food. treatment of obesity. o 1 serving implies ½ cup.  foods high in digestible carbohydrates (e.g. o More than 1 serving of the following can bread, pasta) are limited or replaced with foods make it high potassium food. containing a higher percentage of proteins and  General Foods: Bread (Bread Products) fats (e.g., meat, poultry, fish, shellfish, eggs, o Cake- angel, yellow cheese, nuts, seeds, peanuts, and soy products) o Coffee (maximum 8 ounces) and other foods low in carbohydrates (e.g., most o Cookies (without nuts or chocolate) salad vegetables) although other vegetables and o Noodles fruits (especially berries) are often allowed. o Pasta  the amount allowed of these foods varies with o Pies (without chocolate or high-potassium different low-carbohydrate diets. foods)  such diets are sometimes ketogenic (ie. they o Rice restrict carbohydrate intake sufficiently to o Tea (maximum 16 ounces) cause ketosis) for example, the induction phase Low Purine Diet of the Atkins diet.  some sources, though, consider less restrictive  a low-purine diet is an eating plan that limits variants to below-carbohydrate as well. foods that contain purine. Purines are a natural  apart from obesity, low-carbohydrate diets are substance found in some foods. often used as treatments for some other  when your body digests purine, a waste product conditions, most notably diabetes and epilepsy, called uric (say: yur-ick) acid is produced. but also for chronic fatigue syndrome (see  a build-up of uric acid crystals in the joints can ketosis) and polycystic ovarian syndrome cause a type of arthritis known as gout.  purines are found in many healthy foods. The Low Sodium Diet purpose of a low-purine diet is not to completely  is a diet that includes no more than 1,500 to avoid purines. 2,400 mgs of sodium per day. (One teaspoon of  instead, the goals are to limit and monitor how salt has about 2.300mg sodium.) much purine is in the food you eat, and to learn  people who follow a vigorous or moderate how your body responds when you eat different exercise schedule are usually advised to limit foods that contain purine their sodium intake to 3,000mg per day and those BRAT Diet with moderate to severe heart failure are usually advised to limit their sodium intake to 2,000mg  banana, rice, apple, toast per day.  indicated patients with diarrhea Low Potassium Diet Butterball Diet  potassium is a mineral that assists in maintaining  spare protein but high in CHO normal blood pressure and proper contraction of  indicated with liver disorders the heart.  the nervous system, digestive system, muscles Giordano Diet and heart are kept healthy.  spare protein  it is found in whole grains, vegetables, milk,  indicated for patients with chronic renal failure fruits, peas and dried beans. (CRF)  need of a low potassium diet if an individual has kidney problems, excess potassium can Giordano-Giovannetti Diet accumulate up to dangerous levels in the blood.  a low-protein, low-fat, high- carbohydrates diet  this causes irregular heartbeats, confusion or a with controlled potassium and sodium intake, heart attack. In this case, a low potassium diet is  used in chronic renal insufficiency and liver recommended. failure RIZALYN RANGEL DIAVARRO 4|N CMA 215 LESSON 8: DIETARY MODIFICATIONS AND DIETARY THERAPY Kosher Diet  meat and milk cannot be served simultaneously diet for Orthodox Jews Tyramine Rich Diet  use to prevent hypertensive crisis for patients who are taking in MAOI anti-depressant  no to ABC – avocado, banana, canned, processed, smoked, aging and fermented foods South Beach Diet  diet developed by the Miami-based cardiologist Arthur Agatston, M.D., who says that the key to losing weight quickly and getting healthy isn’t cutting all carbohydrates and fats from your diet, but choosing the right carbs and the right fats. Monothropic Diet  a diet that involves eating only one food item, or one type of food, for a period of time to achieve a desired weight reduction. DASH Diet  Dietary Approaches to Stop Hypertension  a recommendation that those with high blood pressure consume large quantities of fruits, vegetables, whole-grains and low fat dairy foods as part of their diet, and avoid sugar sweetened foods, red meat and fats. Elemental Diet  a medical, liquid-only diet, in which liquid nutrients are consumed for ease of ingestion. Ketogenic Diet  a high-fat, low-carb diet, in which dietary and body fat is converted into energy.  it is used as a medical treatment for epilepsy. Paleo Diet  foods include meat, fish, eggs, seeds, nuts, fruits and veggies, along with healthy fats and oils.  avoid processed foods, grains and sugar. Pureed Diet  you may need to follow a pureed diet if you have trouble chewing, swallowing, or fully breaking down (“digesting”) solid foods.  pureed means that all food has been ground, pressed, and or strained to a soft, smooth consistency like pudding. RIZALYN RANGEL DIAVARRO 5|N CMA 215  NCMA215: NUTRITION AND DIET THERAPY LESSON 9: NUTRITION EDUCATION AND COUNSELING PROFESSOR: LEILA FERRER, MD SUMMER TERM | A.Y 2023 – 2024 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO OUTLINE Nutrients are required to control illness and sustain life. I. Modified Diets The nurse will play specific roles in the patient’s and/or a) Liquid diets the family’s nutritional care. i. Clear Liquid Diet ii. Full Liquid Diet Diet Therapy b) Soft diets c) Test Meals  May be a specific treatment of a disease or a d) Good Tray Service supplement of other modes of treatment that a II. Therapeutic Diets patient may go through. a) Nutrition Therapy for Obesity and Weight  Included in its purposes are maintenance of Control normal nutrition; correction of nutritional b) Nutrition Therapy for Diabetes Mellitus deficiency, changes in body weight and c) Nutrition Therapy for Diseases of the adjusting the body’s ability to use one or more Gastrointestinal Tract nutrients. d) Nutrition Therapy Diseases of the Liver, Gallbladder, and Pancreas Normal Diet e) Nutrition Therapy for Cardiovascular Diseases  Also known as regular, general or house diet, is f) Nutrition Therapy for Diseases of the the foundation on which therapeutic diet Kidneys modifications are based. g) Nutrition Therapy for Cancers  Regardless of the type of diet prescribed, the h) Nutrition Therapy for Human Immune purpose of the diet is to supply needed nutrients Deficiency Syndrome (HIV/AIDS) to the body in a form it can handle. III. Nutrition Education and Counseling:  Modification of this diet include: Behavioral Change a) Behavioral Models o consistency and texture i. Health Belief Model (HBM) o flavor ii. Self-Efficacy Theory (Bandura, A. o energy value 1997) o nutrient level iii. Stages of Change Model (Prochaska & o food category DiClemente, 1996) Liquid Diets iv. Teaching Plan Format v. Theory of Reasoned Action & Theory of  Clear Liquid Diet: indicated for patients Planned Behavior experiencing acute vomiting, diarrhea or vi. Therapeutic Alliance Model (Barofsky, 1978) surgery; the diet is used for 24-48 hours; it allows vii. The Teaching-Learning Process tea, coffee or coffee substitute and fat-free viii. Counseling for Change broth. ix. Community Resources  Full Liquid Diet: used for acute infections and fever of short duration; patients who are too ill to chew. It consists of liquids and foods that MODIFIED DIETS liquefy at body temperature, generally offered in 6 feedings or more.  Refers to changes in texture and composition being made from a regular diet (normal diet) to Soft Diets meet a patient’s nutritional need.  These diet is often used immediately between full Illness affects numerous bodily processes, including how fluid diet and the regular diet following surgery, one nutrients are being processed; acute infections and fevers, and in GI disturbances. A sick person’s usual interest in food may change and the  It has reduced fiber content, bland flavor and disease process may put limitations to his/her food choices soft consistency. and thus, food acceptance. Patients are affected by the  Modifications are done by having the meat and dynamics of illness and food acceptance - thus the need to modify the diet. poultry being minced or ground; RIZALYN RANGEL DIAVARRO 1|N CMA 215 LESSON 9: NUTRITION EDUCATION AND COUNSELING  Vegetables are diced, chopped or cooked longer There are reasons why an individual may have an than usual; the use of soft raw fruits and the use excessive intake of calorie; but obesity can be prevented of soft rolls, breads or biscuits. and the intention to lose weight is planned. A Low Calorie Diet and exercise may help in weight control. Test Meals Nutrition Therapy for Diabetes Mellitus  Used for specific diagnostic tests such as o Fecal Fat Determination – to measure fat Diabetes Mellitus is a condition that results from the lack globules to detect fat absorption. of insulin produced by the body. This metabolic problem o Meat-free Test – to determine GIT bleeding. affects the use of carbohydrates and fats by the body. o Calcium Test – to determine urinary calcium Hyperglycemia or hypoglycemia often occur. These signs excretion. along with the excess in weight can be prevented by o Serotonin Test – to detect calcinoid tumors controlling the amount of food and their distribution in of the intestinal tract. meals in a day to day basis. Good Tray Service Patients may initially be placed on a low calorie diet; those with normal weight are given sufficient calories to  Tray service is a style of service that makes use maintain their weight. Protein of about 11/2 per kg body of a tray and does not make use of the usual weight may be allowed; the same may be given to the dining table; dishes and utensils are arranged in amount of fat allowed. The amount of carbohydrate is a tray and brought to the patient in his/her room. roughly twice the number of protein. Menu Plan follows  Essentials of good tray service are as follows: the recommended Food Exchange List. 1) Sufficient size of the tray for un crowded arrangement. Nutrition Therapy for Diseases of the 2) Clean, unwrinkled tray cover and napkin or Gastrointestinal Tract good quality paper. Dietary modifications in disorders of the intestinal tract 3) Attractive pattern of spotless chinaware are designed to alleviate symptoms, correct nutrient without chips or cracks; clean glassware deficiencies, and where possible, address the primary and shining silverware. cause of the difficulty. The nature of the modification will 4) An orderly arrangement of all items on the depend on the medical condition that the patient has. tray. 5) Food portions are suitable for the patient’s Bland diet may be prescribed to manage Peptic ulcer. This appetite. diet must meet nutritive adequacy, bland flavor and soft 6) Foods are attractively arranged with the consistency, and mechanically and chemically non- appropriate garnishing. stimulating. Long term use is not recommended as this may 7) Meals are served on time; Hot foods served lead to the patient becoming malnourished. warm and cold foods served chilled. Management of Diverticular diseases may include the 8) Trays are served promptly to the patient. increase of fiber in the diet, with Bran, whole grains and THERAPEUTIC DIETS cellulose foods to reduce muscle contractions and facilitate normal muscle tone. Celiac sprue and Non-  Is a form of a diet prescribed, specifying the tropical sprue will show intolerance for gluten; thus food type, amount and frequency of feeding based on sources containing gluten are removed from the diet. A the patient’s disease process and management high-protein diet is usually necessary, along with goals. supplements of minerals and vitamins.  It specifies the caloric level, restrictions or increase in various components of the diet such A diagnosis of Ulcerative colitis – where there is an as the carbohydrate, protein, fat, specific inflammation of the colon and the rectum - implies a diet vitamins, minerals, fiber or water. with high calorie, high protein, high vitamins and mineral. In its acute stages, the patient is placed on a Low-residue Nutrition Therapy for Obesity and Weight Control diet, avoiding heavy roughage to prevent irritation. Lactose intolerance is a condition brought about by a Obesity is said to be a state of adiposity in which body fat deficiency in the enzyme lactase; the lactose (sugar in is above the ideal weight. Assessment will show a body milk) then, cannot be hydrolyzed. A lactose-restricted diet mass index of 30 – 39.9. Whereas, being overweight is is prescribed. Milk, milk-products, foods containing whey having a body mass index of 25 – 29.9 or greater. Often and casein are avoided. this results from an imbalance of the complex system of neural, hormonal and chemical mechanisms that keeps the Patients suffering from diarrhea may initially be placed balance between energy intake and energy expenditure. on NPO for 12 hours with IVT support; as the condition RIZALYN RANGEL DIAVARRO 2|N CMA 215 LESSON 9: NUTRITION EDUCATION AND COUNSELING improves, Oral fluids may be given liberally to prevent hand, patients with cystic fibrosis are given high-protein dehydration. Broths and rehydration solutions are given diet to compensate for fecal losses, with liberal fat intake. to replace the electrolytes lost as well as foods rich in Calories are often according to the need for growth. pectin. Nutrition Therapy for Cardiovascular Diseases Constipation is also a problem that is commonly Atherosclerosis is caused by the accumulation of fatty experienced. It may have a variety of causes but the materials including a high proportion of cholesterol and management often includes high –fiber diet and liberal fluid intake. Intestinal gas is controlled by excluding gas- other substances in the blood vessel, causing it to narrow. producing foods; the patient is advised to take small Thus Dietary management is low-fat, low in saturated fat and cholesterol (300 mg/day). Increase in frequent meals and to chew food thoroughly. Hemorrhoids monounsaturated fatty acid, polyunsaturated fats, are managed with intake of high –fiber diet, liberal fluids and avoidance of highly-seasoned foods and relishes. omega-6 and omega-3 fatty acids – with at least 2 servings per week are recommended to decrease plasma Gastroesophageal reflux disease, hiatal hernia and cholesterol levels. Simple sugars are restricted. Complex esophagitis is a condition that takes place 1 to 4 hours carbohydrates and dietary fiber are increased to 25-30 after a meal when a decrease in sphincter pressure g/day and restriction of carbohydrates are also done. happens. Maintaining the ideal body weight is Congestive heart failure is managed by restricting sodium recommended; Dietary management includes avoiding in the diet. Depending on the severity of the condition, foods high in fat and eating of large meals. Protein and carbohydrate foods with low-fat content are preferred as sodium restriction may range from mild (2-3 g) to severe these do not affect the lower esophageal sphincter (250 mg) restriction. Low-fat diet with emphasis on pressure. unsaturated oils is recommended. Diet for patients with Myocardial infarction (MI) are designed to help reduce Nutrition Therapy Diseases of the the work load of the heart. Small frequent meals are done; Liver, Gallbladder, and Pancreas Liquid diet is used on the initial stages gradually progressing as the condition of the patient improves. Hepatitis is the inflammation of the liver. Diet Therapy Among the food items restricted are caffeine-containing includes protein coming from animal sources as these are beverages, sodium, cholesterol, fat and calorie. considered to have a superior quality. Additional serving Consumption of omga-3 fatty acid-rich foods may be done of foods rich in protein is recommended – like an to reduce blood clots. additional milk, an extra egg, as well as meat, fish and cheese. Caloric intake must also be adjusted to meet the Nutrition Therapy for Diseases of the Kidneys body’s energy needs. Patients with fever may have 2,500 Acute glomerulonephritis is a condition consequent to an to 4,000 calories per day. Fat should be taken in moderation. The foods added to the diet are sufficient to antigen-antibody complex in which some of the complexes meet the daily requirements for minerals and vitamins. become ensnared in the glomeruli leading it to swell. Emphasis of nutritional care is the overall nutritional Protein is often depleted in patients with cirrhosis. Often needs of the patient rather than the Restriction in protein; a 100 g protein is given, with Sodium restriction to 250 mg restriction in sodium is done only when edema is present. a day; and a 1,800 calorie diet is recommended. Fat High Calorie from carbohydrates is recommended. restriction is not necessary. Patients with hepatic coma are prescribed with a high calorie diet. Malnutrition may result from Nephrotic syndrome, as lesions in the nephrons can effect massive albuminuria Cholecystitis may be managed with a low-fat diet, to and protein losses. Thus, recommended is a diet high avoid stimulating the gallbladder. Spices and high-residue calorie, and high protein, low sodium. foods are avoided as these can cause distention and In contrast, Acute renal failure patients are given high increase in peristalsis. Selection of food items must be calorie, low to moderate protein and moderate fat diet. carefully done as these may either be restricted or limited. Adequate caloric intake prevents tissue break down; There also items to be excluded from food preparation such as the use of butter, margarine and sauces as Potassium and sodium are controlled according to the vegetable dressing; instead, lemon juice vinegar or low- patient’s capacity to excrete them. Water intake is also restricted to a liter a day and is carefully monitored. calorie, fat-free dressings are used. Patients with pancreatitis are placed on low-fat, low- Renal calculi require a large intake of fluids to dilute the urine and prevent concentration of stones. The type of elemental formulas when enteral feeding is appropriate. stone present influence the nature of the diet. During acute attacks, the patient may be placed on NPO for 48 hours. In chronic cases, the diet is high calorie, Such that: moderate protein and low to moderate fat. On the other RIZALYN RANGEL DIAVARRO 3|N CMA 215 LESSON 9: NUTRITION EDUCATION AND COUNSELING a) Calcium oxalate stones – low calcium, low  A partnership approach can provide clients with phosphate or oxalate – according to the Calcium opportunities to explore and expand their self- compound, acid ash. Calcium-rich foods are care abilities as they transition from being Eliminated; alkaline foods are controlled; passive to active participants of their care. potassium-rich Foods are increased. b) Uric acid stones – low purine; limited protein with BEHAVIORAL MODELS emphasis of milk, fruits and Decreased intake of Health Belief Model (HBM) bread products.  Explains and predicts health behaviors based on c) Cystine stones – High fluid intake, controlled intake patient’s beliefs about the health problem and of meat, milk, egg and cheese. the health behavior. Nutrition Therapy for Cancers  Relies on the assumptions that patients are willing to participate and that they believe that Cancer is a group of many dissimilar diseases categorized health is highly valued (Becker, 1990) by unfettered replication of Cells. The clinical status of the  Components: patient also warrants the appropriate route of feeding. o Individual perceptions Oral nutrition is high calorie, high protein. Tube feedings o Modifying factors may range from complete products – meal replacements o Likelihood of Action that require digestion and absorption; chemically- defined products – minimal or no digestion – or Specialty Self-Efficacy Theory (Bandura, A. 1997) products – which may vary in terms of amino acid,  Based on a person’s expectations relative to a carbohydrate or fat content. Total parenteral nutrition may also be done when the digestive tract is not specific course of action. functioning well.  It deals with the belief that one is competent and capable of accomplishing a specific behavior – a Nutrition Therapy for precursor to expected outcomes. Human Immune Deficiency Syndrome (HIV/AIDS)  The behavior-specific predictions of this theory can be used for understanding the likelihood of HIV/AIDS is an infection that is transmitted via sexual individuals participating in existing or a planned contact, transfusion of contaminated blood, sharing of contaminated needles and mother to child during educational program. pregnancy, childbirth or breast feeding. Nutritional  4 Principal sources of info cognitively appraised management for patients with HIV/AIDS include Energy of and processed: 35 – 45 kcal/kg BW; Protein 2 – 2.5 g/kg BW ; Fats – o Performance accomplishment increase in omega-3 sources and decrease in saturated o Vicarious experiences fats in the diet; Vitamins and minerals - an increase to be o Verbal persuasion recommended in case of altered metabolism. o Emotional arousal NUTRITION EDUCATION AND COUNSELING: Stages of Change Model (Prochaska & DiClemente, 1996) BEHAVIORAL CHANGE  This theory is useful in staging the client’s  Is any combination of educational strategies, intentions and behaviors for change as well as to accompanied by environmental supports, determine the strategies that will enable designed to facilitate voluntary adoption of food completion of a specific stage. choices and other food- and nutrition-related  The six stages that the authors used begins with behaviors conducive to health and well-being. 1) Precontemplation  Is delivered through multiple venues and involves 2) Contemplation activities at the individual, community, and 3) Preparation policy levels. 4) Action  Patient education is a process of assisting people 5) Maintenance 6) Termination to learn health-related behaviors that can be used in their everyday life and achieve optimal  Among its current applications are in health health. promotion and the processes by which people  It aims to increase the competence and decide to change. confidence of clients for self-management; Teaching Plan Format increasing the responsibility and independence of clients for self-care. Patient name: Age/Gender: RIZALYN RANGEL DIAVARRO 4|N CMA 215 LESSON 9: NUTRITION EDUCATION AND COUNSELING Topic:  Concordance – emphasis on the consultative Goal: process (Hobden, 2006). (Columns) The Teaching-Learning Process Objectives: 1) Assessment of Learning needs, readiness to learn, Content/Time: and learning styles Method: 2) Mutually setting the goals/objectives. Resources: 3) Teaching-learning sessions Indicators: 4) Determination of behavior changes (outcomes) in Theory of Reasoned Action & Theory of Planned Behavior knowledge, attitudes and skills Counseling for Change  A person's behavior is determined by their intention to perform the behavior and that this  When a person makes a lifestyle change, he or intention is, in turn, a function of their attitude she is giving up something; adapting new toward the behavior and subjective norms behaviors entails “costs” and “benefits”. (Fishbein & Ajzen, 1975).  In communities where individual health care  It focuses on the construction of a system of providers and mass media promote healthy observation of two groups of variables, which habits, there may be more motivation for people are: to make changes. o attitudes defined as a positive or negative  By using motivational interviewing techniques, feeling in relation to the achievement of an the counselor can help the patient move through objective; the stages of change. o subjective norms, which are the very  The goal is to increase the client’s intrinsic representations of the individuals’ motivation so that he or she can express the perception in relation to the ability of rationale for the changes. reaching those goals with the product.  Persuasion and support are key elements in  The premise of this theory is that humans behave counseling. in a rational way that is consistent with their beliefs. Community Resources  Suggesting that a person’s behavior can be  Basic in communities are the availability of predicted by examining the individual’s attitudes wellness centers where patients may be referred about the behavior as well as the individual’s beliefs about how others might respond to the to for assistance. behavior.  The Barangay Nutrition Scholar is tasked to do  In designing the educational program for preliminary assessment, monitoring and ensuring patients, nurses as educators need to take availability of food supplements for children who beliefs, attitudinal factors and subjective norms may be suffering from Vit A Deficiency, Iron into consideration. Deficiency Anemia, malnutrition or Iodine deficiency. Therapeutic Alliance Model (Barofsky, 1978)  Available from the Web are various literatures and sites that may be used for specific  Addresses the shift of power from the provider to nutritional needs and support groups, such as a learning partnership in which collaboration Overeaters Anonymous, glutenfreediet.com and and negotiation with the consumer are key. thelike.  Fundamental to this model is the shift toward self-determination and control over one’s own life.  A therapeutic alliance is formed between the caregiver and the care receiver in which the participants are viewed as having equal power.  The client is viewed as active and responsible, with an outcome expectation of self-care.  The therapeutic is significant as it relates to the patient’s adherence to therapeutic interventions and achievement of set goals. RIZALYN RANGEL DIAVARRO 5|N CMA 215  NCMA215: NUTRITION AND DIET THERAPY LESSON 10: EVIDENCED BASED GUIDELINES IN NUTRITION PRACTICE PROFESSOR: LEILA FERRER, MD SUMMER TERM | A.Y 2023 – 2024 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO OUTLINE Statement of Evidence I. Evidence Based Practice (EBP) a) Evidence Based Practice (EBP) I. a. Evidence obtained from meta-analysis of RCTs Guideline I. b. Evidence obtained from at least 1 RCT b) Statement of Evidence c) Grade Ranking Recommendation I I. a. Evidence obtained from at least 1 well-designed d) The Iowa Model of Evidence-Based controlled study without randomization Practice I I. b. Evidence obtained from at least 1 other type of well- designed quasi-experimental study EVIDENCE BASED PRACTICE (EBP) I I I. Evidence obtained from well-designed non-  Is the conscientious use of current best evidence experimental descriptive studies, such as comparative in making decisions about patient care (Sackett, studies, correlation studies, and case reports Straus, Richardson, Rosenberg, & Haynes, 2000).  Is a conscientious, problem-solving approach to IV. Evidence obtained from expert committee reports or clinical practice that incorporates the best opinions and/ or clinical experiences of respected authorities evidence from well-designed studies, patient values and preferences, and a clinician's Grade Ranking Recommendation expertise in making decisions about a patient's care. High - Confident that the effect in the study reflects the  Is using the best evidences culled from various actual effect. studies, integrating clinical experiences and Moderate - Quite confident that the effect in the study is patient’s preferences in the practice of close to the true effect, but it is also possible it is professional care. The hierarchy of evidences are substantially different. as follows: Low - True effect may differ significantly from the estimate. Very low - True effect is likely to be substantially different from the estimated effect. The Iowa Model of Evidence-Based Practice It is a five-step process: 1) Beginning with the identification of the nursing problem and readings about the situation/problem identified. 2) Reconciling with the priorities of the Organization. 3) A core group or a team is identified; 4) Implementation of the project 5) Evaluate the project/study implemented. Evidence Based Practice (EBP) Guideline 1. Identifying the nursing problem and conduct a search of the literature.  Is a guide for nurses in their practice that came The nursing problem prioritized may be about meeting from an integration of an exhaustive literature the nutritional need of a well patient or a patient with an review, input of clinical experts and identified health deficit, such as over or undernutrition; studies/evaluation of patient preferences. post-surgery or problems pertaining to absorption. Cost-  Is customized to the patients’ nutritional needs, effectiveness may be also be a concern with the family or specific to their condition. the inadequacy of their skills for food preparation. RIZALYN RANGEL DIAVARRO 1|N CMA 215 LESSON 10: EVIDENCED BASED GUIDELINES IN NUTRITION PRACTICE 2. Determine whether the issue is a priority for the organization. Organizational priorities must also be known – should a research into the problem identified be needed. The conduct of studies will require resources. Collaboration will help guide the nurses to an appropriate direction or focus. 3. Form a team to develop, implement and evaluate the project. The authors of the model suggest that the team include representatives from those who may have an interest on the project. Also, this avoids duplication of tasks as committees may already be in place. 4. Assemble the relevant literature. Review of literatures relevant to the project is done. Abstracts, bibliographies, conference proceedings, theses and dissertations may be included. 5. Begin the process of critiquing the literature. At this stage, literatures are synthesized. Members of the group may divide the workload and understand the scientific basis for implementing changes. The group need to decide if the materials gathered are enough to guide the practice. The following need to be looked into: a) Consistency of the findings across the studies. b) Types and the quality of the studies. c) Relevance of the findings to clinical practice. d) Adequacy of the studies using a population similar to that of the organization, where the findings may be applied. e) Feasibility of the findings in practice. f) Risk-benefit ratio. RIZALYN RANGEL DIAVARRO 2|N CMA 215  NCMA215: NUTRITION AND DIET THERAPY LESSON 11: LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY PROFESSOR: LEILA FERRER, MD SUMMER TERM | A.Y 2023 – 2024 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO OUTLINE In compliance of the Philippine government to the goals, I. Legal Mandates in the Philippines Related to objectives and targets of the World Health Organization Nutrition and Diet Therapy (WHO), food and nutrition policies were mandated as an a) Presidential Decree No. 491 (1974) - attempt to significantly improve the nutritional status of Nutrition Act of the Philippines the people, particularly vulnerable groups including the b) Executive Order 51 (1986) - National Code elderly and thereby contribute to the improvement in the of Marketing of Breastmilk Substitutes, quality of life in the socio-economic development. Breastmilk Supplements and Other Related Products YEAR CODE T I TLE PURPOSE c) Republic Act 7394 (1992) - Consumer Act SIGNED of the Philippines 1974 Presidential Nutrition Act Creation of the d) Republic Act 7600 (1992) - The Rooming- Decree of the National Nutrition in and Breastfeeding Act No. 491 Philippines Council (NCC) of e) Republic Act 8172 (1995) - Act for Salt the Philippines as Iodization Nationwide (ASIN Law) the highest policy-making f) Republic Act 8976 (2000) - Food and coordinating Fortification Act body on nutrition. g) Republic Act 9711 (2008) - Food and Drug 1986 Executive National Provision of safe Administration Act Order 51 Code of and adequat e h) Republic Act 10028 (2009) - Expanded Marketing of nutrition for Breastfeeding Promotion Act Breastmilk infants; i) Republic Act 10611 (2013) - Food Safety Substitutes, protection and Act Breastmilk promotion of j) Republic Act 10862 (2015) - Nutrition and Supplements breast feeding; Dietetics Law of 2016 and Other ensuring the k) Republic Act 11148 (2018) - Kalusugan at Related proper use of Products breastmilk Nutrisyon ng Mag-Nanay Act substitutes and i. First 270 Days of Conception and breastmilk Pregnancy supplements when ii. For The Next 180 Days (0-6 Months necessary. of The Child) 1992 Republic Act Consumer Provides iii. For The Last 550 Days (6 Months Up 7394 Act of the protection to To 2 Years Of The Child) Philippines consumers II. Terminologies against hazards to health and. Safety and deceptive, unfair LEGAL MANDATES IN THE PHILIPPINES RELATED TO and NUTRITION AND DIET THERAPY unconscionable sales acts and LOI 441 - mandated the Integration of Nutrition Education practices. in the school curriculum. 1992 Republic Act The Rooming- An act providing 7600 in and incentives to all For most of human history including much of the 20th Breast- government and century, insufficient food was the greatest nutritional feeding Act private health challenge. The government sought to stimulate the institutions with production and distribution of as much inexpensive food rooming-in and breastfeeding as possible. At the time, a global pandemic of obesity and practices and for chronic diseases from the widespread availability of other purposes inexpensive, unhealthy food was inconceivable 1995 Republic Act Act for Salt Contribute to the (BMJ,2018). 8172 Iodization elimination of Nationwide micronutrient The relatively recent rise of diet related chronic diseases (ASIN Law) malnutrition in the including obesity, type 2 diabetes, cardiovascular country, diseases, and several cancers is at least partly a particularly iodine deficienc y byproduct of these historical approaches and the responses of industry and consumers (BMJ,2018). RIZALYN RANGEL DIAVARRO 1|N CMA 215 LESSON 11: LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY disorders, through undergone thorough the cost-effective and rigid inspection. preventive 2015 Republic Nutrition (a) the measure of salt Act and Dietetics standardization iodization; require 10862 Law and regulation of all producers, nutrition and manufacturers of dietetics education; food-grade salt to (b) the examination, iodize the salt registration and that they produce, licensing of manufacture, nutritionist- import, trade or dietitians; distribute (c) the standardization, supervision, control, YEAR CODE T I TLE PURPOSE and regulation of SIGNED the practice of 2000 Republic Food To prevent and limit nutrition and Act 8976 Fortification nutritional dietetics; Act deficiency problems (d) the development in the Philippines, a of professional Food Fortification competence of plan provides for the nutritionist- addition of nutrients dietitians through to processed foods continuing or food products as profession per the 2018 Republic Kalusugan at An act scaling up the Recommended Act Nutrisyon ng national and local Dietary Allowances 11148 Mag-Nanay health and nutrition (RDA) Act programs 2008 Republic Food and Drug Republic Act (RA) through a Act 9711 Administration 3720 of the Republic strengthened Act of the Philippines integrated strategy was amended with for maternal, the passage of a new neonatal, child law RA 9711 - “The health and nutrition Food and Drug in the first one Administration (FDA) thousand (1,000) Act of 2009” days of life The FDA Act of 2009 created the Food and Drug PRESIDENTIAL DECREE NO. 491 (1974) Administration (FDA) Nutrition Act of the Philippines in the Department of Health (DOH) to be Under Section 4, the National Nutrition Council was headed by a created as the country’s policy-making and coordinating Director General body on nutrition. Council was reorganized through with the rank of Undersecretary of Executive Order No. 234 s. 1987 and Administrative Order Health. No. 88 s. 1988. It was attached to the Department of 2009 Republic Expanded An act expanding Health (DOH) on November 30, 2005. The NCC was Act Breastfeeding the promotion of instructed to realign its operations to focus on client- 10028 Promotion Act breastfeeding, based activities and to address hunger and malnutrition amending for the in the context of Millennium Development Goals (MDG). purpose Republic Act No. 7600 Objectives of the National Nutrition Council (NCC): 2013 Republic Food Safety Strengthens food Act Act safety regulatory  Formulate national food and nutrition policies 10611 system in the country; provides and strategies; protection to  Coordinate the planning, monitoring and consumers so they evaluation of the national nutrition program; will have access to  Coordinate the release of funds, loans and grants local foods and food from the government and non-government products that have organizations; and RIZALYN RANGEL DIAVARRO 2|N CMA 215 LESSON 11: LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY  Call on any department, bureau, office, agency promote the use of breastmilk substitutes or bottle and other instrumentalities of the government feeding, nor shall any other groups, institutions or for assistance in the form of personnel, facilities individuals distribute such gifts, utensils or and resources as the need arises. products to the general public and mothers. e) Marketing personnel shall be prohibited from The month of July was designated as Nutrition Month advertising or promoting in any other manner the under Section 7 to create greater awareness among products covered by this Code, either directly or people on the importance of nutrition. Activities thereto indirectly, to pregnant women or with mother of shall be approved and coordinated by the Council. infants, except as otherwise provided by this Code. EXECUTIVE ORDER 51 (1986) f) Nothing herein contained shall prevent donations National Code of Marketing of Breastmilk Substitutes, from manufacturers and distributors of products Breastmilk Supplements and Other Related Products within the scope of this Code upon request by or with the approval of the Ministry of Health. In consistent with Article 11 of the International Code of Marketing of Breast-milk Substitutes, the government REPUBLIC ACT 7394 (1992) adopted an appropriate legislation to give effect to the Consumer Act of the Philippines principles and aim of the aforesaid International Code to This law is designed to prevent business that engage in ensure that safe and adequate nutrition for infants is fraud or specified unfair practices from gaining an provided, to protect and promote breastfeeding and to advantage over competitors and provide additional inform the public about the proper use of breastmilk protection for the weak and those unable to take care of substitutes and supplements and related products themselves. through adequate, consistent and objective information and appropriate regulation of the marketing and Objectives: distribution of the said substitutes, supplements and related products.  Protection against hazards to health and safety; protection against deceptive, unfair and Some of the important policies under Section 6: The unconscionable sales acts and practices; General Public and Mothers are the following:  Provision of information and education to facilitate sound choice and the proper exercise a) No advertising, promotion or other marketing of rights by the consumer; materials, whether written, audio or visual, for  Provisions of adequate rights and means of products, within the scope of this Code shall be redress; and printed, published, distributed, exhibited and broadcast unless such materials are duly  Involvement of consumer representatives in the authorized and approved by an inter-agency formation of social and economic policies. committee created herein pursuant to the Consumer Rights: applicable standards provided for in this Code. b) Manufacturers and distributors shall not be  Right to basic needs permitted to give, directly, or indirectly, samples  Right to safety and supplies of products within the scope of this  Right to information Code or gifts of any sort to any member of the  Right to choice general public, including members of their  Right to representation families, to hospitals and other health institutions,  Right to redress as well as to personnel within the health care  Right to consumer education system, save as otherwise provided in this Code.  Right to a healthy environment c) There shall be no point-of-sale advertising, giving of samples or any other promotion devices to The following are some important policies under the induce sales directly to the consumers at the retail Republic Act 7394: level, such as special displays, discount coupons, premiums, special sales, bonus and tie-in sales for Article 11. The department shall also direct the the products within the scope of this Code. This manufacturer, distributor or seller of such provision shall not restrict the establishment of product to extend any or all of the following pricing policies and practices intended to provide remedies to the injured person: products at lower prices on a long term basis. o to bring such product into conformity with d) Manufacturers and distributors shall not the requirements of the applicable distribute to pregnant women or mothers of consumer product standards or to repair infants any gifts or articles or utensils which may RIZALYN RANGEL DIAVARRO 3|N CMA 215 LESSON 11: LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY the defect in order to conform with the Provisions are stated in Chapter 3 of the act for the same; continuing education and training of health personnel and o to replace the product with a like or the education and counseling of parents. equivalent product which complies with the Other provisions indicated in Chapter 4 states that the applicable consumer product standards only milk formula to be stocked in the hospital is to be which does not contain the defect; o to refund the purchase price of the product kept in a closed cabinet out of sight and used for only less a reasonable allowance for use; and emergency purposes upon issuance of a prescription. These prohibitions extend to the use of pacifiers, the o to pay the consumer reasonable damages as may be determined by the department. donation of samples of formula, and the promotion of infant formulas in hospitals. Government and private Some Articles under Chapter I I and III: hospitals will receive financial incentives for compliance. Noncompliance will place health personnel and Article 23. Adulterated Food institutions in danger of losing their licenses and of being Article 24. Regulations of unprocessed food found guilty of a wrongdoing. Article 29. Adulterated drugs and device Article 32. Dangerous drugs REPUBLIC ACT 8172 (1995) Article 33. Banned or restricted drugs Act for Salt Iodization Nationwide (ASIN Law) Article 35. Adulterated cosmetics Include in its policy is to protect and promote the health Article 46. Prohibited Acts. Every product should label their products if those are hazardous or of the people, to maintain an effective food regulatory dangerous, banned hazardous products but still system and to provide the entire population especially delivered by products are strictly prohibited. women and children with proper nutrition. For this purpose, the State shall promote the nutritional Article 77. Minimum labelling requirements for fortification of food and combat micronutrient consumer products malnutrition as a priority health program for the nation. Article 78. Philippine Products Standard Mark Article 80. Special packaging of consumer Section 3. Purposes. The purposes of this Act are to: products for the protection for children Article 84. Additional labelling requirements for  Contribute to the elimination of the food (such as expiration date, semi-cooked, fully micronutrient malnutrition in the country, processed etc.) particularly iodine deficiency disorders, through Article 87. Additional labelling requirements for cost-effective preventive measure of salt cosmetics iodization; Article 94. labelling requirements for cigarette  Require all producers/manufacturers of food- grade salt to iodize the salt that they produce, REPUBLIC ACT 7600 (1992) manufacture, import, trade or distribute; The Rooming-in and Breastfeeding Act  Require the Department of Health (DOH) to An act providing incentives to all government and private undertake the salt iodization program and for its health institutions with rooming-in and breastfeeding Bureau of Food and Drugs (BFAD) to set and practices and for other purposes. enforce standards for food-grade iodized salt and to monitor compliance thereof by the food- This law is in promotion of the State policy to encourage grade salt manufacturers; the practice of breastfeeding in the Philippines. It  Require the local government units (LGU), composes of 14 Sections divided into 4 chapters. through their health officers and Chapter 1 states the rules and regulations which contain nutritionist/dietitians, or in their absence standard procedures to be followed for rooming-in and through their sanitary inspectors, to check and breastfeeding in all private and government health monitor the quality of food-grade salt being sold institutions. Specific provisions are made for complicated in their market in order to ascertain that such births. The right of the mother to breastfeed and the right salt is properly iodized; of the infant to receive breast milk is expressed, and  Require the Department of Trade and Industry mothers may only exercise their right to bottle feed after (DTI) to regulate and monitor trading of iodized being fully informed of the benefits of breastfeeding and salt; by expressing their intention to formula feed in writing.  Provide mechanisms and incentives for the salt industry in the production, marketing and The regulations cover the establishment and operation of distributi0on of iodized salt; and human milk banks and the donation of human milk which is stated in Chapter 2 of the act. RIZALYN RANGEL DIAVARRO 4|N CMA 215 LESSON 11: LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY  Ensure the sustainability of the salt iodization Otherwise, the importer shall have responsibility of program. fortifying the imported processed foods or food products before said products are allowed to be distributed or sold REPUBLIC ACT 8976 (2000) to the public: Provided, further, That the implementation Food Fortification Act of the mandatory fortification for wheat flour, refined The Philippine Food Fortification Program, hereinafter sugar, cooking oil and rice, including those milled and/or referred to as the Program, shall cover all imported or distributed by the National Food Authority, shall locally processed foods or food products for sale or commence after four (4) years from the effectivity of this distribution in the Philippines; Provided, That, dietary Act. supplements for which established standards have (c) The DOH guidelines on micronutrient fortification of already been prescribed by the DOH through the BFAD and processed food or food products included in which standards include specifications for nutrient Administrative Order No. 4-A series of 1995 and such other composition or levels of fortification shall not be covered necessary guidelines that may be issued by the DOH, shall by this Act. serve as a basis for the addition of micronutrient(s) to The program shall consist of: processed foods or food products to avoid over or under fortification that may create imbalance in the diet as well 1) Voluntary Food Fortification as avoid misleading label claims to gain competitive 2) Mandatory Food Fortification marketing advantage. Section 5. Voluntary Food Fortification. - Under the (d) Manufacturers of processed foods or food products Sangkap Pinoy Seal Program (SPSP), the Department shall shall include on the label a statement of “nutrition facts” encourage the fortification of all processed foods or food indicating the nutrient(s) and the quantities of said products based on rules and regulations which the DOH nutrients added in the food. through the BFAD shall issue after the effectivity of this act. Manufacturers who opt to fortify their processed (e) Imported rice, wheat flour, refined sugar, cooking oil foods of food products but do not apply for Sangkap Pinoy and other processed foods or food products that may Seal shall fortify their processed food or food products identified later by the NCC, shall comply with the based on acceptable standards on food fortification set requirements of this Act on entry in country, at the end of by the DOH through the BFAD. manufacturing process and/or at all points of sale or distribution. Section 6. Mandatory Food Fortification. The National Food Fortification Day is observed annually (a) the fortification for staple foods based on standards on November 7, pursuant to Executive Order 382, which sets by the DOH through the BFAD is hereby made recognizes the persistence of micronutrient deficiencies as mandatory for the following: a public health problem that has affected a significant proportion of the population, resulting in adverse 1) Rice - with Iron; 2) Wheat flour 0 with vitamins A and Iron; physical, mental, social, and economic consequences to individuals, communities, and country. 3) Refined sugar - with vitamin A; 4) Cooking oil - with vitamin A; and The key agencies in the program: 5) Other staple foods with nutrients as may later required by The NCC.  Department of Health (DOH), responsible for the implementation and monitoring of the law; The National Nutrition Council (NCC) shall require other  National Nutrition Council that serves as the processed foods or food products to be fortified based on policy-making body, particularly relative to the findings of nutrition surveys. Such requirement shall determining what food vehicles should be be promulgated through regulations to be issued by the fortified and with what nutrients; Department of Health (DOH) through the Bureau of Food  Department of Trade and Industry, which assists and Drugs (BFAD) and other concerned agencies. manufacturers in upgrading their technologies (b) The fortification of processed foods or food products by providing financial assistance and other non- under this Section shall be undertaken by the monetary assistance; manufacturers: Provided, that in the case of imported  Department of Science and Technology, which processed foods or food products, the required helps in developing and implementing fortification shall be done by the comprehensive programs for the acquisition, producers/manufacturers of such imported processed design, and manufacture of machines and foods or food products. technologies and their transfer to manufacturers; and RIZALYN RANGEL DIAVARRO 5|N CMA 215 LESSON 11: LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY  Land Bank of the Philippines and Livelihood months of giving birth. This law, which bolsters Corporation that assist manufacturers by breastfeeding moms in the work environment, will no providing preferential loans at preferential doubt urge more Filipino children to be breastfed. rates. REPUBLIC ACT 10611 (2013) REPUBLIC ACT 9711 (2008) Food Safety Act Food and Drug Administration Act The Food Safety Act of 2013 shall be the framework for An act strengthening and rationalizing the regulatory implementing the farm to fork Food Safety Regulatory capacity of the bureau of food and drugs BFAD by System. establishing adequate testing laboratories and field Section 2. Declaration of Policy. – Section 15, Article II of offices. Upgrading its equipment, augmenting its human the 1987 Philippine Constitution declares that the State resource complement, giving authority to retain its shall protect and promote the right to health of the people income, renaming it the Food and Drug Administration and instill health consciousness among them. Furthermore, (FDA), amending certain sections of Republic Act No. 3720, Section 9, Article XVI provides that the State shall protect as amended and appropriating funds thereof. consumers from trade malpractices and from substandard This Act has the following objectives: or hazardous products. Toward these ends, the State shall maintain a farm to fork food safety regulatory system  To enhance and strengthen the administrative that ensures a high level of food safety, promotes fair and technical capacity of the FDA in the trade and advances the global competitiveness of regulation of establishments and products under Philippine foods and food products. its jurisdiction;  To ensure the FDA’s monitoring and regulatory Section 3. Objectives. – To strengthen the food safety coverage over establishments and products regulatory system in the country, the State shall adopt under its jurisdiction; and the following specific objectives:  To provide coherence in the FDA’s regulatory  Protect the public from food-borne and water- system for establishments and products under its borne illnesses and unsanitary, unwholesome, jurisdiction. misbranded or adulterated foods; REPUBLIC ACT 10028 (2009)  Enhance industry and consumer confidence in Expanded Breastfeeding Promotion Act the food regulatory system; and  Achieve economic growth and development by An act expanding the promotion of breastfeeding, promoting fair trade practices and sound amending for the purpose Republic Act No. 7600. regulatory foundation for domestic and Provisions: international trade.  Lactation stations in every private enterprises, Towards the attainment of these objectives, the following measures shall be implemented: government agencies, government-owned a