DIETETICS - PINKY.pdf

DIETETICS  Introduction Dietetics simply means the application of the science of nutrition to the human being in health and disease.’ However, the term ‘dietitian,’ used to describe a practitioner of dietetics, was in use long before the science of nutrition ha...

DIETETICS  Introduction Dietetics simply means the application of the science of nutrition to the human being in health and disease.’ However, the term ‘dietitian,’ used to describe a practitioner of dietetics, was in use long before the science of nutrition had become an accepted discipline. The first use of the title of dietitian was recorded in 1899 in the United States when the dietitian was described as ‘a person working in a hospital who provided nutritious meals to patients.’ The earliest dietitians were therefore mainly concerned with provision of food and usually trained as home economists. The role of the dietitian has changed markedly in the past 50 years, and the dietitian is now accepted as the expert in the planning and evaluation of nutritional care for patients requiring therapeutic dietary regimens as well as for the population in general. The field of dietetics has a strong emphasis on public health and a commitment to educating all people about the importance of making proper dietary choices.  Definition of Terms Dietetics is the science of how food and nutrition affects human health. OR The branch of knowledge concerned with the diet and its effects on health, especially with the practical application of a scientific understanding of nutrition. OR Dietetics- is the use of diet in the treatment and management of disease. the science of applying nutritional data to the regulation of a diet of both healthy people and sick ones. Diet- This is the sum of food consumed by a person or other organism Dietitians - are experts in food and nutrition. Are professionals who advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal.  Roles of Dietitian Some roles of dietitians include: Identifying nutrition problems and assessing the nutritional status of patients in a clinical setting. Developing diet plans and counseling patients on special diet modifications. Assessing, promoting, protecting, and enhancing the health of the general public in a community setting and providing strategies for prevention of nutrition-related diseases. Managing a cost effective food production operation, distributing high quality meals/snacks, and monitoring sanitation and safety standards in a food service setting. Operating private consulting practices to provide expertise in nutrition, as well as promote health and prevent disease Working with individuals, groups, workplaces and media to provide dietary advice for healthy living. Working with food and pharmaceutical companies to provide research, develop products, educate consumers, and promote and market better food and nutritional products in a business setting. Teaching nutrition, food chemistry, or food service administration to students in any health profession and at all levels of education. THERAPEUTIC DIET Therapeutic diets: are the diets used by the professional nutritional therapist to help individuals suffering from nutrition-responsive health problems. Therapeutic diets are formulated to optimise the nutritional needs of the client in order to treat a variety of diseases and disorders Purposes of therapeutic diets Regulate the amount of food Prevent or restrict oedema Assist body organs to regain and/or maintain normal function Aid in digestion Increase or decrease body weight Types of therapeutic diets Full diet- this is a traditional or ordinary diet. It can be taken by any patient e.g. nshima with chicken and vegetables. Fluid diet- consists of water, milk, glucose drinks, fruit juice and soup. They are ordered for special conditions. Gastric diet- is given in order to treat conditions such as peptic ulcers so as to reduce the peristalsis. This is given with a low residue and should be given frequently in small amounts e.g. rice with milk, in order to prevent the stomach from being left empty that is why you need to serve frequent meals in small amounts. Avoid foods which are difficult to digest. CONT…. Low protein diet-. This type of diet is ordered for patients with renal failure to rest the kidney. You give rice, corn flour, vegetables, fruits, sugar & fats. Avoid foods like meat, beans, eggs & fish. Low salt diet- this is given to patients with hypertension and those with edema because salt retains fluids in tissues. If the Doctor ordered “strict salt intake” no salt should be added to the meals. High protein diet- is given to malnourished patients & unconscious patients. The portions of food containing protein should be doubled. These should be given at the three (3) main meals e.g. Breakfast, lunch, supper then given extra drinks in between meals Low fat diet- It is given to patients with obstructive jaundice or liver disease. A person with such a condition should avoid foods like cheese and butter instead give a lot of carbohydrates. CONT… Weight reducing diet- is given to one who wants to lose weight. Avoid sugar, puddings, sweet cakes, biscuits. Reduce the intake of bread and potatoes, nshima. A person who wants to lose weight should take lean meat, fruits, fish, vegetables & unsweetened drinks. Diabetic diet- it is given to patients with diabetes mellitus. No sugar or sweet cakes should be given to the patient. The amount of carbohydrates is controlled e.g. bread, cereals, porridge. Encourage patient to eat a lot of proteins e.g. beans, meat, chicken, milk, eggs. Gluten free diet- is a protein that causes allergy especially in babies. So they should be given porridge which is gluten free. Challenges in planning of diets Planning of soft diets and modified diets presents one of the most difficult problems in hospitals especially those with untrained dietary personnel. Policies and procedures for dietary personnel, food purchasing, food preparation, cost control, and selection and arrangement of equipment should be available to guide the administrators. Dietary Management of NON COMMUNICABLE Diseases (NCDs) NCDs are a major public health concern in Zambia and the major NCDs, namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, are leading causes of mortality and accounted for 23% of all deaths in 2008. NCDs include the following: Cancer - is an abnormal proliferation of cells in the body. Some cancers can cause cachexia characterised by anorexia, weight loss, anaemia, weakness and muscle wasting. Patient with cancer should be managed as follows; Dietary management for Cancer Add butter or margarine to hot foods such as soup, vegetables, mashed potatoes, cooked cereals and rice. Serve small meals frequently. Prepare energy dense food such as soups and hot cereals. Add sauces to cooked vegetables. For problems like nausea and vomiting; serve liquids such as lemonade, juices and soft foods cold. For problems like anorexia; serve foods attractively, with variety in texture; small frequent feedings. For problems like diarrhoea, serve low-lactose, low fat; increase fluids; emphasise starches. Hypertension is a condition where there is persistent elevation of blood pressure where the systolic blood pressure greater than/equal to140mmHg and the diastolic pressure greater than/equal to 90mmHg. Increases in blood volume, heart rate and peripheral vascular resistance can lead to hypertension. RISK FACTORS A number of factors have been associated with hypertension. These include: Excessive intake of alcohol Excessive dietary sodium intake can contribute or may trigger development of high blood pressure in some individuals. A high sodium intake can cause water retention. Obesity – excessive intake of diet containing more energy than needed will lead to hyperlipidemia or high cholesterol level in the blood leading to fat being deposited in blood vessel lumen. This results in narrowing the blood vessel and contributes to hypertension. Dietary management for Hypertension Weight reduction is encouraged for individuals who are overweight or obese Diet should be balanced which contain all the nutrients required by the body. The diet should be rich in fruits, vegetables, low fat-daily products, low in saturated fats and cholesterol. Limit red meats, sweets and sugar containing beverages. Fish, nuts and whole grains are encouraged. Reduce sodium intake and avoid foods with high sodium e.g. canned soups. The client should not add salt at meal time. Food containing caffeine should be avoided for they cause vasoconstriction and can increase the blood pressure. Daily Approaches to Stop Hypertension (DASH) The patient should adopt the DASH eating plan which emphasizes on fruits, vegetables and fat free or low fat milk and milk products, whole grain, fish, poultry, beans, seeds and nuts A physically active life style is essential to promote and maintain good health. It should be safe and enjoyable and should fit into one’s daily activities. Heart Diseases Heart disease is one of the major causes of deaths in western world but currently cases of heart diseases are being recorded in Zambia. The commonest heart disease is coronary Heart disease. The heart needs supply of oxygen through the coronary arteries so that it can pump blood to all parts of the body. If one of these arteries is blocked, then blood supply cannot reach the heart muscle. and becomes partially starved with oxygen resulting into the patient complaining of cramp like pain known as angina. If there is complete blockage by the blood clot, then no blood will go to the heart and the individual will suffer a heart attack. The client should have the following diet: Foods high in saturated fats should be avoided because these can cause high cholesterol in blood and this has been linked to heart disease. CONT… Therefore, the patient should food low in saturated fats, low sweet foods such as sugar. Reduce salt intake Eat a variety of foods, fresh vegetables and salads. Take anti oxidants e.g. vitamin C and E. these help in prevention of heart disease because they assist in stopping cholesterol being picked up by oxygen so that it is deposited less readily in coronary arteries. Take exercises as advised. Congestive Heart Failure is a state in which the heart fails to maintain an adequate circulation for the needs of the body. This condition results from decreased myocardial efficiency, and most commonly as a result of hypertension and ischemic heart disease. Other causes include damage to the heart valves and congenital lesions of the heart. Dietary management for Congestive Heart Failure Reduce weight Eat five to six small meals per day than three large meals. Reduce dietary sodium to decrease fluid retention. Control fluid intake to help reduce circulatory volume. Diabetes mellitus- is a disorder of carbohydrate, fat and protein metabolism as a result of insulin deficiency and is characterised by polyphagia, polydypsia, polyuria, glycosuria and hyperglycaemia. Despite the increase in liberation of glucose from the liver, cells cannot utilise glucose due to lack or very little insulin to facilitate its entry into the cells. Dietary management for Diabetes Mellitus Avoid sugar, marmalade, honey, syrup, sweets, lemonade and chocolate. Eat in moderation bread, starch foods, breakfast, cereals, porridge, milk, potatoes and rice. Eat without restriction meat, fish, eggs, tea, vegetables such as cabbage, spinach, mushroom, cucumber, tomatoes and all green leafy vegetables. End