FINAL-NUTRI-NOTES-1.pdf

Dietary Computation Learning Objectives: 1.Learn to compute BMI and DBW determination 2. Explain Total energy requirement and its distribution History Adolphe Quetelet, a Belgian astronomer, mathematician, statistician, and sociologist, devised the basis of the BMI between 1830 and 1850 as...

Dietary Computation Learning Objectives: 1.Learn to compute BMI and DBW determination 2. Explain Total energy requirement and its distribution History Adolphe Quetelet, a Belgian astronomer, mathematician, statistician, and sociologist, devised the basis of the BMI between 1830 and 1850 as he developed what he called "social physics“. The modern term "body mass index" (BMI) for the ratio of human body weight to squared height was coined in a paper published in the July 1972 edition of the Journal of Chronic Diseases by Ancel Keys BODY MASS INDEX AND ITS CLASSIFICATION Reasons why BMI is important 1. Health Indicator: BMI serves as a general indicator of whether an individual has a healthy body weight for their height. 2. Risk Assessment: Higher BMI values are associated with an increased risk of chronic diseases such as heart disease, diabetes, hypertension, and certain cancers. 3. Public Health Tool: BMI is used by healthcare providers and public health organizations to monitor and track the prevalence of obesity and overweight in populations. 4. Clinical Use: Healthcare professionals use BMI as part of routine health assessments to help diagnose and manage weight-related health conditions. It provides a quick and simple screening tool. 5. Research and Policy: BMI is used in research studies to investigate the relationships between body weight and health outcomes. 6. Personal Health Monitoring: Individuals can use BMI as a self- assessment tool to monitor their weight status over time. BMI and Classification Body Mass Index (BMI) ❖ is a measurement of a person’s weight with respect to his or her height. It is more of an indicator than a direct measurement of a person’s total body fat. ❖ Useful in clinical calculation for diagnosing obesity when the total body fat is relatively unaffected by height.  BMI is calculated using the following formula Alternatively, for weight in pounds and height in inches, the formula is: BMI=weight (lb)×703hei ght (in)2BMI= height (in) 2 weight (lb)×703​ Body Mass Index (BMI) ❖ Used as indicator for obesity/ overweight and health risk ❖ Correlates well with the amount of body fat ❖ Simple, quick and inexpensive WHO defines an adult who has a BMI between 25 and 29.9 as overweight - an adult who has a BMI of 30 or higher is considered obese - a BMI below 18.5 is considered underweight, and between 18.5 to 24.9 a healthy weight. BMI Categories BMI provides a simple, numeric measure of a person's thickness or thinness, allowing for comparison against a standard: Underweight: BMI less than 18.5 Normal weight: BMI 18.5–24.9 Overweight: BMI 25–29.9 Obesity: BMI 30 and above Class I: BMI 30–34.9 Class II: BMI 35–39.9 Class III (Severe or Morbid Obesity): BMI 40 and above  BMI Classifications 1. Underweight (BMI < 18.5) Health Risks: Individuals with a BMI below 18.5 may have insufficient body fat and muscle mass, leading to a higher risk of malnutrition, osteoporosis, and anemia. It can also indicate underlying health conditions like eating disorders or chronic diseases. 2. Normal Weight (BMI 18.5–24.9) Health Status: This range is associated with a lower risk of chronic diseases compared to other BMI categories. It suggests a healthy balance between height and weight. 3. Overweight (BMI 25–29.9) Health Risks: Being overweight can lead to an increased risk of cardiovascular diseases, hypertension, type 2 diabetes, and certain cancers. It can also contribute to joint and muscle problems due to excess weight 4. Obesity (BMI ≥ 30) Health Risks: Obesity significantly increases the risk of various diseases, including heart disease, diabetes, certain cancers, and musculoskeletal disorders. It is also associated with a higher mortality rate. Classifications of Obesity: Class I (BMI 30–34.9): Moderate health risks, manageable with lifestyle changes and medical support. Class II (BMI 35–39.9): Higher risk of severe health conditions, often requiring more intensive interventions. Class III (BMI ≥ 40): Extreme health risks, usually requiring comprehensive medical treatment and possibly surgical interventions. Example those with a high BMI are at risk of: ❖High blood cholesterol or other lipid disorders ❖Type 2 diabetes ❖Heart disease ❖Stroke ❖High blood pressure ❖Certain cancers ❖Gallbladder disease ❖Sleep apnea and snoring ❖Premature death ❖Osteoarthritis and joint disease Nutrition Evaluation Height: A linear measurement Indication of past or chronic nutritional status How to obtained correct height measurement? Infantometer for infants How to obtained correct height measurement? Stadiometer for children and adults  How to obtained correct height measurement? Infants: How to obtained correct height measurement? Children and adults: Nutritional Assessment ❖Ideal Body Weight ❖ Body Mass Index ❖ Waist Circumference ❖Waist-Hip Ratio  Ideal Body Weight Ideal Body Weight (IBW) refers to the optimal weight considered healthiest for an individual, based on factors such as height, sex, and age.  Important reasons of measuring the IBW 1. Health Indicator Chronic Disease Prevention: Maintaining an ideal body weight reduces the risk of developing chronic diseases such as heart disease, stroke, type 2 diabetes, hypertension, and certain cancers. 2. Mental Health Psychological Well-being: Achieving and maintaining an ideal body weight can improve self-esteem, body image, and overall mental well-being. 3. Longevity Life Expectancy: Studies have shown that maintaining an ideal body weight is associated with a longer life expectancy. 4.Disease Management Chronic Disease Management: For individuals already diagnosed with chronic diseases, maintaining an ideal body weight can help manage these conditions more effectively, reducing the need for medications and medical interventions. 5. Reproductive Health Fertility: Maintaining an ideal body weight can improve fertility and reproductive health in both men and women. 6. Economic Impact Healthcare Costs: Maintaining a healthy weight can reduce healthcare costs by preventing obesity-related conditions and reducing the need for medical treatments and hospitalizations. Ideal Body Weight (IBW) Rule of Thumb Example: Male = 106 lbs for 5ft + 6 lbs per inch over 5ft Female = 100 lbs for 5ft + 5lbs per inch over 5ft Add 10% for large framed subjects and subtract 10% for small framed subjects Hamwi Formula The Hamwi method is a straightforward formula often used to estimate ideal body weight (IBW). For men: IBW (kg) = 48 kg + 2.7 kg for each inch over 5 feet For women: IBW (kg) = 45 kg + 2.3 kg for each inch over 5 feet When to use IBW? ❖Maintenance and redistribution of food intake. ❖Used when BMI is within normal range. Waist Circumference (WC) 1.Indicator of Abdominal Fat: Waist circumference specifically measures abdominal fat, which is a key risk factor for various health conditions. 2. Risk of Chronic Diseases: A larger waist circumference is linked to an increased risk of type 2 diabetes, hypertension, dyslipidemia (abnormal cholesterol levels), and heart disease. 3. Metabolic Syndrome Indicator: Waist circumference is a key component in diagnosing metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes. 4. Monitoring Health Changes: Tracking waist circumference over time can help individuals and healthcare providers monitor changes in body fat distribution. 5. Guiding Lifestyle Interventions: Waist circumference measurements can guide lifestyle interventions such as diet and exercise plans. How to Measure Waist Circumference To measure waist circumference accurately: Locate the top of the hip bone and the bottom of the rib cage. Place the measuring tape around the abdomen at the level of the navel. Ensure the tape is snug but not compressing the skin. Measure after exhaling gently. How to compute for the Desired Body Weight (DBW) Estimate IBW – Infant (0-6 months) DBW = Birth weight (gms) + (age in months x 600) ❖ If the birth weight is not known, use 3000 gm 4 months old infant = 3000 gm + (4 x 600) = 3000 + 2400 = 5400 gm or 5.4 kg Estimate IBW – Infant (7-12 months) ❖ If the birth weight is not known, use 3000 gm 8 months old infant = 3000 gm + (8 x 500) = 3000 + 4000 = 7000 gm or 7.0 kg Tannhauser’s Method Measure height in centimeters Deduct from this factor 100 DBW obtain applies to Filipino stature by taking off 10% Example: Height is 5’2 = 5’2 to inches is 62 inches (5 x 12 + 2) 62 inches to centimeter is (62 x 2.54) = 157.48 – 100 = 57.48 kg = 10% of 57.48 kg is 5.748 = 57.48 -5.748 DBW = 52 kg Basal Metabolic Rate ❖ Basal metabolic rate (BMR) is often used interchangeably with Resting Metabolic Rate (RMR). ❖ BMR - is a minimum number of calories required for basic functions at rest ❖ also called resting energy expenditure ❖ (REE) — is the number of calories that your body burns while it’s at rest. How to estimate your BMR ❖To estimate BMR is through the Harris-Benedict formula, which takes into account weight, height, age, and gender. Formula: Women: BMR = 655 + (9.6 × weight in kg) + (1.8 × height in cm) – (4.7 × age in years) Men: BMR = 66 + (13.7 × weight in kg) + (5 × height in cm) – (6.8 × age in years) How many calories you need everyday ❖ Sedentary. If you get minimal or no exercise, multiply your BMR by 1.2. ❖ Lightly active. If you exercise lightly one to three days a week, multiply your BMR by 1.375. ❖ Moderately active. If you exercise moderately three to five days a week, multiply your BMR by 1.55. ❖ Very active. If you engage in hard exercise six to seven days a week, multiply your BMR by 1.725. ❖ Extra active. If you engage in very hard exercise six to seven days a week or have a physical job, multiply your BMR by 1.9. Estimating TER TER = IBW x Physical Activity or if Obese TER = CBW x (25-30 Weight reduction) NDAP Formula Activity Levels Factors Affecting BMR/RMR Age: Metabolism slows with age (2% to 3% per decade after 30 years of age), primarily due to a loss in muscle tissue due to inactivity, but also due to hormonal and neurological changes. Gender: Generally, men have a faster metabolism than women because they tend to be larger and have more muscle tissue.  Body size: Larger adult bodies have more metabolically active tissue, which leads to a higher BMR/RMR. Body composition: Muscle tissue uses more calories than fat, even at rest. Genetic predisposition: Metabolic rate may be partly determined by genes. Growth: Infants and children have a higher BMR/RMR related to the energy needs of growth and maintenance of body temperature.  Hormonal and nervous controls: Hormonal imbalances can influence how quickly or how slowly the body burns calories Environmental temperature: If temperature is very low or very high, the body must work harder to maintain a normal temperature; this increases the BMR/RMR. Infection or illness: BMR/RMR increases if the body must build new tissue or create an immune response to fight infection.  Crash dieting, starving, or fasting: Eating too few calories encourages the body to conserve through a potentially significant decrease in BMR/RMR. There can also be a loss of lean muscle tissue, which further contributes to reducing BMR/RMR. Physical activity: Hard-working muscles require extra energy during activity. Regular exercise increases muscle mass, which increases energy consumption, even at rest. Stimulants: Use of stimulants (e.g., caffeine) increases energy expenditure at rest. However, this is not a healthy way to lose weight. Copper Method 1 Desired Body Weight:52 kg A. Activity=moderate(housewife without maid) 52 kg x 24=1248 calories for basal metabolic needs 1248x.75=936 calories for activity 1248+936=2184 or 2200 calories/day note*-Calories are rounded off to the nearest 50 B. Activity= Bed rest 52 kgx24=1248 for basal metabolic needs 1248x.20=249.6 calories for activity 1248+250=1498 or 1500 calories Method II a. Using the same individual ( moderate active) 52 kgx 40 calories=2080 or 2100 cal b. Activity= Bed rest patient 52 kgx27.5=1430 or 1450 calories Distribution of TER into carbohydrate , protein and fat: Method 1: by percentage distribution % of TER 1. Carbohydrate -50-70% or average to 60% 2. Proteins Infants- 10% Children- Adolescents- 10-12% Adult 3. Fats Normal Adults, 20-25% moderately active Children , adolescents, 30-35% very active individuals Example: 7-year-old child CHO/day=1700x.60=1020cal.÷4=255gms CHON/day=1700x.10=170 cal.÷4=42.5 or 45 grams Fats/day=1700x.30=510 cal.÷9=56.6 or 55 **CHO, protein & fats are rounded to the nearest 5 **Diet Prescription: 1700, CHO(255),Protein(45), Fats(55) Example: Moderately active housewife , DBW of 52 kg TER/day= 2200 calories CHO/day= 2200x.60=1320cal.÷4=340 gms Protein/day=2200x.10=220 cal.÷4=55 gms fats/ day=2200x.30=660÷9= 73.3 or 75 ***Diet Prescription: 2200cal.C340 P55 F75 Method II Determine the protein calories first according to the normal allowance in gram/KDBW and divided the non protein calories into: CHO: 55-80% or the average of 70% Fats: 20-45% or an average of 30% Normal Protein Allowances/day: gm/KDBW Infants 3.0-2.5 Children 2.0 Adolescents 1.5 Adult 1.1 1. Example: 7-year-old with TER of 1700 calories Protein/day=22kg(DBW)x2=44 or 45 gms = 45x4=180 protein calories = 1700-180=1520 non protein calorie CHO/day=1520x.70=1064÷4=266 or 265 Fats/day=1520x.30=456÷9=50.6 or 50 gms *** Prescription diet:1700 cal C265,P45,F50 Example :Moderately active housewife , DBW of 52 kg TER/day=2200 calories Protein/day=52x 1.1=57.2 0r 55 gms = 55x4=220 protein calories =2200-220=1980 NPC CHO/day=1980x.70=1386÷4=345 gms Fats/day=1980x.30=594÷9=64.9 or 65gms *** Diet Prescription:2200 C345,P55,F65 Diet Modification and Diet Therapy Diet Therapy A. General Diets B. Diets Modified in Consistency C. Diets Modified in Composition Definition of Terms DIETARY MODIFICATIONS changes made during food preparation, processing, and consumption to increase the bioavailability of micronutrients and reduce micronutrient deficiencies in food MODIFIED DIET Any diet altered to include or exclude certain components, such as calories, fat, vitamins and minerals Diets are typically modified for therapeutic reasons, including treatment of high blood pressure, low body weight or vitamin and mineral deficiencies.  THERAPEUTIC DIET a meal plan that controls the intake of certain foods. It’s a practice followed in many hospitals as part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician. usually a modification of a regular diet. Diets are modified for consistency, nutrition and new methods of making regular dishes. GENERAL OBJECTIVES OF DIET THERAPY To maintain a good nutritional status To correct nutrient deficiencies which may have occurred due to the disease. To afford rest to the whole body or to the specific organ affected by the disease. To adjust the food intake to the body's ability to metabolize the nutrients during the disease. To bring about changes in body weight whenever necessary Dietary Modifications 1.Standard diet: a diet that includes all foods and meets the nutrient needs of healthy people; also called a regular diet. 2.Modified diet: a diet that is altered by changing food consistency or nutrient content or by including or eliminating specific foods; also called a therapeutic diet. Diet modification altering the types of food consumed, adjusting portion sizes, changing meal timing, and making conscious choices to support overall well-being. Purpose of Diet Modification Weight Management: Adjusting caloric intake to lose, gain, or maintain weight. Health Conditions: Managing diseases such as diabetes, hypertension, heart disease, or gastrointestinal disorders.  Nutritional Deficiency: Ensuring adequate intake of essential nutrients like vitamins, minerals, and proteins. Lifestyle Goals: Supporting athletic performance, enhancing mental clarity, or improving energy levels. Types of General Diets 1. Regular/ Standard diet Intended for hospitalized clients who do not have special a balanced diet that supplies the metabolic requirements of a sedentary person (about 2,000 Kcal). ❖Most agencies offer clients a daily menu from which to select their meals for the next day ❖others provide standard meals to each client on the general diet.  2. Vegetarian Diet ❖A vegetarian diet excludes meat but includes plant-based foods and, depending on the type, may include dairy and eggs. Types: ❖Lacto-Ovo Vegetarian: Includes dairy and eggs. ❖Lacto Vegetarian: Includes dairy but excludes eggs. ❖Ovo Vegetarian: Includes eggs but excludes dairy. 3. A vegan diet is a plant-based dietary regimen that excludes all animal products, including meat, dairy, eggs, and honey. ❖It focuses on consuming fruits, vegetables, grains, nuts, seeds, and legumes to obtain all the necessary nutrients for a balanced and healthy lifestyle. Flexitarian Diet mostly plant-based but allows for occasional consumption of meat and animal products. Foods Allowed: Fruits and Vegetables: Wide variety of fresh, frozen, or canned options. Whole Grains: Brown rice, whole grain bread, oats. Plant-Based Proteins: Beans, lentils, tofu, nuts, seeds. Animal Products: Occasional meat (poultry, fish), dairy, and eggs. Modified Consistency Diets Regular/Standard diet These diets adjust the texture and form of food to accommodate individuals with difficulties in chewing or swallowing (dysphagia). often given to clients before and after surgery or procedures or to promote healing in clients with GI distress. GI surgery clients are not permitted red-colored liquids or candy since, if vomited, the color may be confused with blood. Pureed Diet: Foods are blended to a smooth, pudding-like consistency. This diet is ideal for individuals with severe chewing or swallowing difficulties. Foods included are smooth, homogenous, and free of lumps. Pureed diet Examples: ❖Mashed potatoes ❖ pureed meats ❖pureed vegetables ❖ smoothies ❖blended soups Mechanical Soft Diet: Foods are soft and easy to chew. They are often mashed, chopped, or ground but maintain some texture. Suitable for individuals with mild to moderate chewing difficulties. Examples: Finely chopped or ground meat, scrambled eggs, mashed fruits, and cooked, soft vegetables.  Soft Diet: Foods that are naturally soft or can be made soft with cooking. This diet excludes hard, crunchy, or sticky foods, making it easier for individuals with minor chewing issues. Examples: Tender meats, soft fruits without skins, cooked vegetables, and soft bread. Types of Liquid Diet without Solids Thickened Liquids: For individuals with dysphagia, liquids may need to be thickened to various consistencies (nectar, honey, or pudding-like) to prevent choking and aspiration. Examples: Thickened water, juice, milk, and soups. LIQUID DIET Description: Consists only of liquids and foods that turn into liquid at room temperature. It is often used as a transitional diet. INDICATIONS prescribed after surgery as a person’s first step toward taking solid foods. may be used during an acute illness certain body disturbances, such as irritation of the intestinal tract. Examples: Broth, clear juices, gelatin, ice pops, and clear nutritional supplements. CLEAR LIQUID DIET Includes minimum residue fluids that can be seen through. A short-term diet (24 to 36 hours) provided for clients after certain surgeries or in the acute stages of infection, particularly of the GI tract. Note That “Clear” Does Not Necessarily Mean “Colorless.” Is often used as the first step to restarting oral feeding after surgery or an abdominal procedure. should not be used for more than 3 days, unless the client is receiving nutritional support (nasogastric [NG] tube feedings or intravenous [IV] feedings) or other nutritional supplements.  Foods allowed in CLEAR LIQUID DIET ❖Water, Bouillon; fat-free clear broth ;Carbonated beverages; coffee, tea, Fruit juices, strained and clear juices (apple, cranberry, grape), ginger ale ❖ Plain Gelatin; popsicles Sugar; honey ❖ INDICATIONS: 1. Initial feeding after surgery or parenteral nutrition 2. in preparation for surgery and various diagnostic tests of the bowel(GI tract) ❖ CONTRAINDICATIONS: Long term used Full liquid diet ❖Includes fluids that are creamy. ❖Some examples of food allowed are ice cream, pudding, thinned hot cereal, custard, strained cream soups, and juices with pulp. ❖Used as the second step to restarting oral feeding once clear liquids are tolerated. ❖Used for people who cannot tolerate a mechanical soft diet. ❖Should not be used for extended periods. Food allowed in Full liquid diet All foods included in clear liquid plus All milk and milk drinks, puddings, custards, ice cream, sherbet All vegetable and fruit juices, Refined or strained cereals(e.g. cream of rice), Eggs in custard, Butter, margarine, cream, Dietary supplements such as Ensure INDICATIONS Used as a transitional diet between a clear diet and a soft diet, and by clients who have difficulty chewing or swallowing CONTRAINDICATIONS: Severe lactose intolerance (diet relies heavily on milk and dairy products for protein and calories) Unless modified to decrease the cholesterol content, a liquid diet is not suitable for long- term use by clients with hypercholesterolemia Transitional Diet Description: This diet serves as a step between a liquid diet and a regular diet. It often includes pureed or mechanically altered foods. Examples: Soft scrambled eggs, pureed vegetables, mashed potatoes, and thickened soups. General Guidelines in Transitional Diet Avoid high-fiber foods like raw vegetables, whole grains, and nuts. Avoid spicy, fried, and fatty foods which can be hard to digest. Limit dairy if lactose intolerance is an issue. Stay hydrated with plenty of fluids, especially water and clear liquids. Blenderized Tube Feeding Diet ❖Description: For individuals who cannot eat by mouth, this diet involves blending regular foods to be administered through a feeding tube. ❖Examples: Blended vegetables, fruits, proteins, and grains that can be given through a feeding tube. Indication for Blenderized feeding Food Allergies and Intolerances: Patients with multiple food allergies or intolerances might benefit from blenderized feeding to avoid allergens present in commercial formulas. Formula Intolerance: Patients who experience gastrointestinal issues, such as nausea, vomiting, or diarrhea, with commercial formulas might tolerate blenderized feeding better.  Tube Dependency: Long-term tube-fed patients may benefit from a more natural diet to improve quality of life and potentially support better digestive health. Home Care Settings: In certain cases, home care providers may find it more practical or cost-effective to prepare blenderized feeds rather than purchasing commercial formulas.  DIET AS TOLERATED “Diet as tolerated” describe a flexible approach to a patient's diet.- this means that the patient can eat foods that they can tolerate based on their symptoms and overall condition. For example: on the first postoperative day a client may be given a clear liquid diet. If no nausea occurs, normal intestinal motility has returned as evidenced by active bowel sounds and client reports passing gas, and the client feels like eating, the diet may be advanced to a full liquid, light, or regular diet. BLAND DIET often prescribed for those with ulcers, esophagitis, gastroesophageal reflux disease (GERD) or heartburn, gastritis, hiatal hernia, or other disorders of the gastrointestinal tract. goal is to limit foods that stimulate the production of gastric acid. Individuals following a bland diet should be encouraged to avoid other foods that may cause them discomfort because intolerances are often individual. FOODS TO BE AVOIDED ON THE BLAND DIET: Alcohol, Caffeine (including chocolate and cola drinks) and decaffeinated coffee and tea, Red and black pepper, Chili powder, Fried foods and foods high in fat, Peppermint and spearmint oils Foods allowed in Bland diet Lean meats: Skinless chicken, turkey, and lean cuts of beef or pork. Fish: Non-fatty, baked, grilled, or poached. Milk: Low-fat or skim. Bread: White or refined wheat bread, without seeds. Cereals: Low-fiber, refined cereals like Cream of Wheat Cooked or canned fruits: Applesauce, canned peaches or pears (without added sugar).  2. Modified Diet in Composition Low-Sodium Diet: ❖Designed for individuals with hypertension or heart disease. This diet limits sodium intake to reduce blood pressure and fluid retention. ❖This diet typically limits sodium intake to 1,500 to 2,300 milligrams per day. Low Sodium Diet ❖ Recommended Sodium Intake: Adult : less than 2,300 mg or about 1 teaspoon of table salt/day MILD SODIUM RESTRICTION called a no-added-salt diet Recommended if adults take more than 2,500 mg/day A limited amount of salt is allowed in cooking, but no salt is added at the table. Overtly salty foods, such as canned soups, beef stew, chili, pickles, olives, potato chips, soy sauce, and cured meats are discouraged. This diet is used when a person suffers from mild hypertension and stable kidney or heart disease. Moderate sodium restriction 1,000 to 2,000 mg/day is used in cases of severe edema, hypertension, and heart disease. Salt is not used in cooking or at the table. Milk and milk products are limited to the equivalent of 2 cups of milk daily, and the use of regular bread may be restricted. Strict and severe sodium restrictions 500 and 250 mg/day, respectively unpalatable and hard to follow. used only in severe conditions and for short periods (usually only in a hospital setting). LOW SODIUM DIET(SODIUM- CONTROLLED) ❖ This diet is used both to prevent and treat edema. ❖ Edema - excess accumulation of water and salts in tissues, especially in the lower extremities, which can sometimes be controlled by limiting sodium intake. INDICATIONS: ▪ congestive heart failure, hypertension, liver and renal diseases. ❖ A low salt diet in hypertensive people resulted in a decrease in systolic blood pressure Foods allowed in a low sodium diet: Fresh Fruits and Vegetables Fruits: Apples, oranges, bananas, berries, grapes, melons, pears Vegetables: Leafy greens, bell peppers, carrots, cucumbers, broccoli, cauliflower, zucchini, green beans, tomatoes Fresh Meat, Poultry, and Fish Meat: Beef, pork, lamb (preferably lean cuts)Poultry: Chicken, turkey (without added sodium solutions) Fish and seafood: Fresh or frozen fish (salmon, cod, tuna), shrimp (fresh or frozen without added salt) Grains and Starches Whole grains: Brown rice, quinoa, barley, oats Foods to Limit or Avoid in Low Sodium Diet Processed and packaged foods: Canned soups, frozen meals, processed meats (bacon, ham, sausage), snack foods (chips, pretzels) Canned vegetables and legumes: Choose low-sodium or rinse thoroughly Salted nuts and seeds Pickled foods and condiments: Pickles, olives, soy sauce, ketchup Cheese: High-sodium varieties like feta, blue cheese, processed cheese Restaurant and fast foods: Often high in sodium Salt substitutes: Use with caution and consult with a healthcare provider, especially if you have kidney problems  Neutropenic diet- diet is prepared and served under strict sanitary conditions to minimize the microbial count especially pathogens Indication for Used: ❖Before and after organ transplantation, chemotherapy and other treatment to reduce the risk of food borne infection. ❖Immuno-compromised patients ❖Patients treated for HIV/AIDS Foods Allowed in Neutropenic diet  Cooked vegetables, well washed raw fruits, frozen fruits, pasteurized juice , powdered milk ,rice , all meats cooked to well done/canned meats, eggs cooked until both white and yolk are firm Foods Restricted in Neutropenic diet  Fresh vegetables, unwashed raw fruits, yogurt and eggnog , raw/undercooked meat, soft boiled egg, fish, game , fresh squeezed fruit juices , blenderized fresh fruits/vegetable HIGH-CALORIE DIET diet is made up of foods that are high in calories(high in protein, carbohydrate, fat, vitamins, and minerals) Indications: Severe weight loss due to prolonged illness. hyperthyroidism, undernutrition, and general malnutrition. severely burned person needs a large amount of protein to rebuild lost tissue and carbohydrate to spare protein. Food allowed in high calorie diet Proteins Meats: Beef, pork, lamb, poultry (chicken, turkey) Fish and seafood: Salmon, tuna, mackerel, shrimp Fats and Oils Healthy oils: Olive oil, coconut oil, avocado oil Nuts and seeds: Almonds, walnuts, cashews, chia seeds, flaxseeds Grains and Starches Whole grains: Brown rice, quinoa, oats, barley, whole wheat bread and pasta Starchy vegetables: Potatoes, sweet potatoes, corn LOW CALORIE DIET diet that controls calorie, carbohydrates, proteins and fat consumption per day. normal diet with energy values reduced to 1500, 1200 or 1000 calories prescribed on a case-to-case basis for weight loss (eg. 3 to 5 pounds per week) in patients with Body Mass Index of 30 and above. The health care provider can recommend the diet to a patient with BMI between 27 and 30 if the medical complications the patient has due to overweight present serious health risk. Low-Fat /Fat Controlled Diet diet consists of little fat, especially saturated fat and cholesterol, which lead to increased blood cholesterol levels and heart attack. INDICATIONS: Gall bladder diseases, Celiac disease, Cystic fibrosis, Atherosclerosis, Myocardial infarction, Hyperlipidemia, Obesity/overweight, etc. Better for Low Cholesterol, Heart, prevention of cancer, better for health and weight Foods high in fat: Dairy foods (whole milk, ice cream, creams) , Fatty red meats , Butter, Oils are fat, although some may have lower saturated fat., Egg yolks, which are particularly high in cholesterol, Cheese, Processed meats (sausage, salami, hot dogs, bologna) High-Protein Diet Purpose: For muscle building, weight loss, or managing specific health conditions like malnutrition or sarcopenia. Modifications: Increases protein intake to more than the typical 10-35% of daily calories. Examples: Lean meats, fish, eggs, dairy products, legumes, and protein supplements. INDICATIONS for High protein diet: Burns Post surgery Malabsorption syndromes that waste protein Diseases of the GIT , acute phases of inflammatory bowel disease and celiac disease Protein-losing hemodialysis and peritoneal dialysis patients LOW PROTEIN DIET(PROTEIN RESTRICTED DIET) diet in which people are required to reduce their intake of protein used by persons with abnormal kidney or liver function to prevent worsening of their disease.(Hepatic encephalopathy, Acute and chronic renal failure , Acute and chronic glomerulonephritis ) Protein should never be completely eliminated from the diet. Patients with Kidney require low protein diets since the kidney cannot excrete nitrogenous wastes. Rich in Insoluble Fiber Wheat and corn bran, Whole wheat breads and cereals, Brown rice, Bananas, Cauliflower, Nuts, Green beans Rich in Soluble Fiber Citrus fruit, Pectin Rich in Both Insoluble and Soluble Fiber Oat bran, Barley, Kidney beans, Apples, Broccoli, Carrots LOW-FIBER /LOW RESIDUE DIET ❖composed of foods that the body can absorb completely, so that little residue is left for the formation of feces. ❖ also known as “LOW-RESIDUE” DIETS. ❖ often utilized with tube feeding INDICATIONS: ❖ for severe diarrhea, colitis, diverticulitis, other gastrointestinal disorders, intestinal obstruction, and before and after intestinal surgery. LOW-RESIDUE DIET INCLUDE Ground and well-cooked meats, chicken, and fish, Seafood ,Eggs (not fried) and mild cheese, Fruit and vegetable juices without pulp, Pureed or strained vegetables, Canned fruit and firm bananas, White rice, plain noodles, plain pasta, and potatoes, Refined white or seedless rye breads and crackers, 2 cups of milk or the equivalent (e.g., yogurt), strained or cream soups made from allowed foods, Plain desserts in moderation  HIGH-FIBER DIET has an increased amount of both insoluble and soluble fiber. 1. Insoluble fiber helps increase stool bulk and stimulates peristalsis. 2. Soluble fiber helps lower the serum cholesterol level and improves glucose tolerance in diabetes. often ordered as part of the treatment for constipation and diverticulosis. Potential problems with a high fiber diet cramping, diarrhea, and gas, especially if fiber is added to a diet too quickly or in excessive amounts. Increased fluid intake is important in following a high-fiber diet. Low-Carbohydrate Diet: ❖Designed for individuals managing diabetes or those aiming for weight loss. This diet reduces carbohydrate intake and focuses on protein and fat sources. Examples: Non-starchy vegetables, lean proteins, nuts, and seeds. Limit or avoid sugars, grains, and starchy vegetables. TYPICAL MENU for Low Carbohydrate A low-carb diet focuses on meat, poultry, fish, eggs and some non-starchy vegetables. A low-carb diet excludes or limits most grains, beans, fruits, breads, sweets, pastas and starchy vegetables. Results of Low Carbohydrate Diet A low-carbohydrate diet is likely to promote weight loss. Contributing factors may include: Loss of water weight. Low-carb diets often have a diuretic effect. Increased feeling of fullness. A low-carb diet is relatively high in fat and protein. Since fat and protein take longer to digest than do carbs, you may feel fuller longer. Reduced calories. A low-carb diet strictly limits the variety of foods eaten. This generally results in fewer calories overall. LOW CHOLESTEROL DIET Cholesterol in the body comes from two sources. 1. Most cholesterol is made by the liver from various nutrients and especially from ingested fats. ** The liver makes just about all the cholesterol the body will ever need. 2. Since all animals can make their own cholesterol, some cholesterol in the human body comes directly from eating animal foods. **include meats, poultry, egg yolks, organ meats, whole milk and milk products. **This cholesterol is absorbed through the intestines and added to what the liver makes. diet high in saturated fat increases cholesterol production in the body. Reducing dietary cholesterol and fats helps to keep blood cholesterol levels within a healthy range. LACTOSE-RESTRICTED DIET People with lactose intolerance lack enough of the enzyme lactase, which is needed to digest the sugar (lactose) in dairy products. As a result, they develop cramping, gas, and diarrhea after ingesting lactose. Often, individuals who are unable to tolerate a glass of milk between meals can tolerate yogurt, aged cheeses, lactose-reduced milk, or milk consumed with food. ❖Gluten-Free Diet: Essential for individuals with celiac disease or gluten sensitivity, this diet eliminates gluten-containing foods like wheat, barley, and rye. Examples: Gluten-free grains (rice, quinoa), fruits, vegetables, meat, and gluten-free bread and pasta products. Foods to avoid: breads and cereals, beer, commercial chocolate milk, malted milk, cakes, cookies, commercial salad dressing (gluten is a stabilizer), and meat substitutes, such as textured protein products. Special gluten-free products are commercially available, but they tend to be expensive. Avoid unless labeled gluten free  Beer , bread, cakes and pies, candies, cereals, communion wafers, cookies and crackers, French fries, Gravies, salad dressing, pasta, soups and soup bases Uremic Diet  Uremic diet-aims of maintaining a balance of minerals, fluids, electrolytes in patient who are in advanced kidney disease in advanced stages  Indicated to limit the build-up of waste products in their body  It controls the amount of protein and phosphorous in their diet Foods allowed Up to one matchbox size per meal, lean meat, fish and chicken without the skin Cheddar cheese, ½ cup milk daily Salted free crackers, homemade bread, low in baking soda and powder, macaroni, spaghetti, ampalaya, raddish, soda crackers , star-apple, okra, sitsaro Chayote, chicos, apple, atis Foods Avoided Salted foods , scallop, salted/smoked fish, internal organ, all canned meat, salted eggs, beans, corn grits, fresh corn, ube, potato chips, pancit canton, oatmeal, all green leafy vegetables, kalamansi, batong, long tongue, All canned fruits, prunes, banana, watermelon, guava, dried fruits, candies without chocolates, maja blanca, native delicacies, coconut milk HIGH SODIUM DIET ❖Sodium can be found naturally in most foods and is also added to various food products. ❖ Added forms of sodium to foods: ▪ ingredients in condiments and seasonings such as Worcestershire sauce, soy sauce, onion salt, garlic salt, and bouillon cubes. ▪ Processed meats, such as bacon, sausage, and ham, and canned soups and vegetables are all examples of foods that contain added sodium. CALCIUM- OR PHOSPHORUS- MODIFIED DIETS A high calcium intake is indicated for both the prevention and treatment of osteoporosis. Excellent sources of calcium include milk, yogurt, and cheese. A low-phosphorus diet may be indicated for the person with kidney failure. HIGH POTASSIUM DIET ❖ Potassium is a mineral that is found in many foods. ❖ A high-potassium diet is given to clients who are taking diuretics. ❖Potassium is widespread in the diet; excellent sources include milk, fresh or dried fruits (especially bananas), fresh vegetables, dried peas and beans, whole- grain bread and cereals, fruit juices such as orange and prune, sunflower seeds, watermelon, nuts, cocoa beans, fresh fish, beef, ham, and poultry. LOW POTASSIUM DIET (POTASSIUM MODIFIED DIET) ❖Diuretics flush excess salt and water out of the body but also cause a loss of potassium. ❖ The kidneys maintain the correct level of potassium in the blood. ❖ People who take certain medicines or who have chronic kidney disease must limit the amount of potassium in their diet to keep their potassium level close to normal. ❖ Potassium intake may be limited during end-stage renal failure. Foods to Increase or Limit in Potassium ❖ Below are some common types of foods that contain potassium. ❖ If blood levels are too high and a low potassium diet is required, omit them from the diet, and if a high potassium diet is needed simply increase the intake. ❖ Vegetables: ▪ Asparagus ,Avocado ,Broccoli , Cauliflower ,Celery, Mushrooms , Spinach ,Sweet potatoes ❖ Fruits: ▪ Bananas , Cantaloupe melon , Dried apricots , Grapefruit , Kiwifruit, Oranges, Strawberries Low Purine Diet ❖eating plan that limits foods that contain purine. Purines are a natural substance found in some foods. ❖ When body digests purine, a waste product called URIC ACID is produced. ❖ GOUT –a type of arthritis where there is a buildup of uric acid crystals in the joints ❖ Purines are found in many healthy foods. The purpose of a low-purine diet is not to completely avoid purines. Low Purine diet FOODS TO AVOID: ▪ Avoid Beer ▪ Soft drinks that contain sugar ▪ Fatty food ▪ Organ meats, such as liver, Anchovies, sardines, mussels, codfish, scallops, Gravy , Vegetables Beans ❖Diabetic Diet: Focuses on controlling blood sugar levels through balanced intake of carbohydrates, proteins, and fats. Emphasizes whole grains, fruits, and non-starchy vegetables. Foods allowed in Diabetic diet Leafy greens: Spinach, kale, Swiss chard. Whole wheat: Bread, pasta, and tortillas. Fish: Salmon, mackerel, sardines, trout, and other fatty fish rich in omega-3 fatty acids. Lean meats: Lean cuts of beef, pork, and lamb. Citrus fruits: Oranges, grapefruits, lemons, limes. Apples: With the skin. Foods not allowed in Diabetic diet Sweets and desserts: Candy, cookies, cakes, pastries, and ice cream. White rice Pastries and baked goods: Donuts, muffins, croissants, and similar items made from white flour and sugar. Fried foods: French fries, fried chicken, and other deep-fried items. Beer and sweet wines: Can cause spikes in blood sugar levels. Ketogenic Diet: Purpose: Primarily for managing epilepsy, but also used for weight loss and controlling blood sugar levels in type 2 diabetes. Examples: Avocado, cheese, nuts, seeds, fatty fish, and low-carb vegetables. Avoid grains, sugars, and most fruits.  DASH Diet (Dietary Approaches to Stop Hypertension) Purpose: To prevent and control hypertension and promote overall heart health. Examples: Fruits, vegetables, whole grains, low-fat dairy, and lean protein sources like poultry and fish. Mediterranean Diet Purpose: To promote heart health and longevity. Examples: Olive oil, nuts, fruits, vegetables, whole grains, and moderate amounts of red wine. DIETS MODIFIED FOR ALLERGENS ❖ Sometimes people have an allergic reaction to certain food substances. ❖ This reaction is caused by an autoimmune response to specific proteins called allergens in these foods. ❖ Allergies to chicken, seafoods, eggs are common ❖ When necessary, these foods are eliminated from the diet. Indications for Modified Diets Dysphagia: Difficulty swallowing can be due to neurological conditions (e.g., stroke, Parkinson’s disease) or structural problems in the mouth, throat, or esophagus. Dental Issues: Missing teeth, dentures, or oral surgeries can necessitate softer food textures.  Digestive Disorders: Conditions like gastroparesis or certain surgeries can require easier-to- digest foods. Post-Surgery: After surgeries involving the mouth, throat, or digestive tract, a softer diet may be needed to prevent irritation and promote healing. NUTRITION THERAPY FOR OBESITY AND WEIGHT CONTROL  Obesity is a medical condition characterized by an excessive accumulation of body fat, which can have a negative impact on health. It is typically measured using the Body Mass Index (BMI), where a BMI of 30 or higher is classified as obese.  Losing weight means balancing food calorie intake with the body’s needs for calories 1 pound of fat =3,500 calories If one has 500 calories less everyday-she will lose about 1 pound/week Low calorie diet- **Women- 1,000-1,500 calories ** Men-1,200-1,800 calories Foods allowed: Meat ,fish and poultry should be lean and prepared by boiling, broiling, roasting and stewing Low calorie diets should not include alcoholic beverages, sweetened beverages, cakes, candies, cookies, ice cream, fried foods, sweetened fruits, pastries, potato chips, pudding Nutrition therapy for Diabetes Mellitus  Diabetes Mellitus-is a metabolic disease that affects the endocrine system of the body.  Hyperglycemia-increase blood sugar  Glycosuria-excreted in the urine  Signs and Symptoms of Diabetes Mellitus  Polyuria- frequent urination  Polydipsia- increase thirst  Polyphagia- increase in appetite 2 types of DM ❖ Juvenile diabetes occurs at any age from birth through adolescence ❖ Adult diabetes- occurs primarily among obese patient Carbohydrate Management: Consistent Carbohydrates: Eating a consistent amount of carbohydrates at each meal to help maintain stable blood sugar levels. Low Glycemic Index Foods: Choosing carbohydrates that have a low glycemic index (e.g., whole grains, legumes, non-starchy vegetables) to avoid rapid spikes in blood sugar. Characteristic diet for managing diabetes mellitus Unsaturated Fats: Choosing healthy fats such as those found in avocados, nuts, seeds, olive oil, and fatty fish (e.g., salmon, mackerel). Adequate Fluid Intake: Drinking plenty of water and choosing low-calorie beverages to stay hydrated and avoid sugary drinks. Blood Sugar Monitoring: Regularly checking blood sugar levels to understand how different foods affect them and to make necessary adjustments.  Meats maybe boiled, baked, roasted or stewed Frozen or canned fruits packed with sugar must be avoided Concentrated sweets and desserts are avoided: sugar, candies, jellies, jams, marmalade, syrup, honey, molasses, soft drinks, cakes, cookies, pies and sweet rolls NUTRITION THERAPY FOR CARDIOVASCULAR DISEASES DIET AND CARDIOVASCULAR DISEASES ANGINA PECTORIS Pain in the heart muscle due to inadequate blood supply THROMBUS blood clot INFARCT dead tissue resulting from blocked artery CEREBROVASCULAR ACCIDENT (CVA) either a blockage or bursting of blood vessel leading to the brain PERIPHERAL VASCULAR DISEASE (PVD) narrowed arteries some distance from the heart ATHEROSCLEROSIS hardening of the arteries (plaque accumulation) making the passage of blood difficult considered one of the major causes of heart attack. PLAQUE deposits of cholesterol, fats, and other substances accumulate over time, thickening and weakening artery walls. Narrows the lumen of the artery ISCHEMIA Interferes/reduced blood flow causing an inadequate supply of nutrients and oxygen to, and wastes from, tissues. Plaque Formation in Atherosclerosis Causes of Artherosclerosis -shear stress/hypertension Abnormal blood lipids ▪ LDL accumulate in susceptible artery wall regions ▪ High VLDL influences production of other atherogenic lipoproteins , promotes inflammation - Cigarette smoking - Diabetes mellitus - Age and gender ▪ Risk increases in men more than 45 years, women less than 55 years ▪ Risk increases for women after menopause  Diet Therapy of Atherosclerosis 1. Low fat diet, low saturated fat and cholesterol 2. Increase in monounsaturated fatty acids to lower plasma total cholesterol and LDL cholesterol levels. 3. Increase in polyunsaturated fats, Omega 6(corn oil, soybean oil , safflower oil and sunflower oil) and Omega 3 fatty acids ( fatty fish like salmon, tuna, mackerel, sardines trout and herring) at 2 servings/week to decrease plasma cholesterol level 4. Dietary fiber should be 25-30 g/day RISK FACTORS HYPERLIPIDEMIA - excessive amounts of fats in the blood hypertension (high blood pressure) smoking are major Obesity, fatty foods diabetes mellitus Male heredity personality type (ability to handle stress), age (risk increases with years) sedentary lifestyle.  ❖Low fat diet, Low calorie diet, Low cholesterol diet ❖ Only lean meat should be selected, and all visible fat must MEDICAL be removed. NUTRITION THERAPY FOR ❖ Fat-free milk and fat-free milk HYPERLIPIDEMIA cheeses should be used instead of whole milk and natural cheeses. ❖ Desserts containing whole milk, eggs, and cream are to be avoided. MEDICAL NUTRITION THERAPY FOR HYPERLIPIDEMIA Organ meats, egg yolks, and some shellfish are especially rich in cholesterol and should be used in limited quantities Water-soluble fiber food (oat bran, legumes, and fruits) bind with cholesterol-containing substances and prevent their reabsorption by the blood. 20 to 25 grams of soluble fiber a day will effectively reduce serum cholesterol by as much as 15%. MEDICAL NUTRITION THERAPY FOR HYPERLIPIDEMIA If appropriate blood lipid levels cannot be attained within 3 to 6 months using a fat- restricted diet alone, the physician can prescribe a cholesterol- lowering drug such as atorvastatin (Lipitor) or simvastatin (Zocor). CORONARY HEART DISEASE  Lifestyle Management for Coronary Heart Disease Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity each week, such as walking, cycling, or swimming. Follow a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Examples include the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. Reduce saturated fats found in red meat, butter, and full-fat dairy products.  Omega-3 fatty acids such as fatty fish (salmon, mackerel, sardines), flaxseeds, and walnuts. Limit salt to less than 2,300 milligrams per day (about one teaspoon). Soluble fiber from oats, beans, lentils, fruits, and vegetables.  Reduce consumption of sugary beverages, desserts, and snacks. If you drink alcohol, do so in moderation. Up to one drink per day for women and up to two drinks per day for men. MYOCARDIAL INFARCTION ❖ caused by the blockage of a coronary artery supplying blood to the heart. CAUSES: 1. Atherosclerosis 2. hypertension 3. abnormal blood clotting 4. infection (rheumatic fever) which damages heart valves DIETARY TREATMENT FOR MYOCARDIAL INFARCTION The client should be on nothing by mouth (NPO) status until the physician evaluates the condition. If the client remains nauseated after the period of shock, IV infusions are given to prevent dehydration A liquid diet may be recommended for the first 24 hours if tolerated low-cholesterol– low-sodium diet is usually given, with the client regulating the amount eaten DIETARY TREATMENT FOR MYOCARDIAL INFARCTION ❖ Foods should not be extremely hot or extremely cold. ❖ Food should be easy to chew and digest and contain little roughage so that the work of the heart will be minimal. ❖ Sodium is usually limited to prevent fluid accumulation. ❖ The dual goal is to allow the heart to rest and its tissue to heal. CONGESTIVE HEART FAILURE ❖ Heart’s inability to pump adequate blood ❖ CAUSES: 1. coronary artery disease (CAD) severe narrowing of the arteries that supply blood to the heart 2. heart attack 3. Cardiomyopathy 4. Valve disease 5. Heart defects present at birth 6. Diabetes mellitus 7. chronic renal disease. CONGESTIVE HEART FAILURE Because of the reduced circulation, tissues retain fluid Sodium builds up, and more fluid is retained, resulting in EDEMA. In an attempt to compensate for this pumping deficit, the heart beats faster and enlarges. In advanced cases when edema affects the lungs, death can occur. With the INADEQUATE CIRCULATION, body tissues do not receive enough nutrients causing malnutrition and underweight Diet Therapy of Congestive heart Failure 1. Sodium restricted diet is used primarily for the prevention, control and elimination of edema: a. mild restriction(2-3 grams) - no added table salt (light use in cooking) - no salted foods - all other foods as desired b. Moderate restriction(1000 mg Na) -same as above plus elimination of salt in cooking and canned vegetables -basic food as desired, unprocessed with salt c. Strict restriction(500 mg Na) -all above restriction plus tighter control of natural sodium(smaller amounts of eggs, meat, milk limited to 2 cups) also limiting vegetables such as leafy greens, beets and carrots , celery d. Severe restriction (250 mg Na) - All above restriction plus tighter control of natural food sources - Meat limited 2-3 oz/day - 2-3 eggs per week HYPERTENSION (HTN) When blood pressure is chronically high sometimes called the “silent” disease because patient can be asymptomatic (without symptoms) Types: Primary/Essential hypertension high blood pressure resulting from an unknown cause Secondary hypertension high blood pressure caused by another condition such as kidney disease, problems of the adrenal glands, and use of oral contraceptives. HYPERTENSION Predisposing Factors 1. Heredity 2. obesity 3. Smoking 4. stress also contribute to hypertension 5. Excessive use of ordinary table salt  HYPERTENSION Blood pressure categories : ❖ Normal—less than 120/less than 80 mm Hg ❖ Prehypertension—120–139/80–88 mm Hg ❖ Stage 1 hypertension—140– 159/90–99 mm Hg ❖ Stage 2 hypertension—160/100 mm Hg DIETARY TREATMENT FOR HYPERTENSION ❖ sodium- restricted diet ❖ Diuretics ❖ weight reduction diet and calorie-restricted diet for obese client ❖ More fiber, potassium, magnesium and calcium ❖ serving of fruits and vegetables to 8 to 12 servings per day, depending upon calorie intake. NUTRITION THERAPY FOR KIDNEY DISEASES  Overview of the Kidneys The kidneys are a pair of bean- shaped organs located on either side of the spine, just below the rib cage. They play a vital role in maintaining overall health and homeostasis in the body. NEPHRON functional unit of the kidney, responsible for filtering blood and forming urine. GLOMERULUS filtering unit in the kidneys URETERS tubes leading from the kidneys to the bladder UREA chief nitrogenous waste product of protein metabolism URIC ACID ▪ one of the nitrogenous waste products of protein metabolism CREATININE an end (waste) product of protein metabolism  Etiology of Renal Disease Kidney disorders can be initially caused by: infection, degenerative changes, diabetes mellitus, high blood pressure cysts, renal stones, or trauma (surgery, burns, poisons). When these conditions are severe, renal failure may develop.  CLASSIFICATION OF RENAL DISEASE CHRONIC KIDNEY DISEASE develops slowly, causing the number of functioning nephrons to diminish. UREMIA a condition in which protein wastes that should normally have been excreted are instead circulating in the blood. Symptoms: nausea, headache, convulsions, and coma. Severe renal failure can result in death unless dialysis is begun, or a kidney transplant is performed CLASSIFICATION OF RENAL DISEASE ❖ NEPHRITIS ▪ the inflammatory diseases of the kidneys. ▪ caused by infection, degenerative processes, or vascular disease. ❖ GLOMERULONEPHRITIS ▪ inflammation affecting the capillaries in the glomeruli. ▪ may occur acutely in conjunction with another infection and be self-limiting, or it may lead to serious renal deterioration CLASSIFICATION OF RENAL DISEASE ❖ NEPHROSCLEROSIS ▪ the hardening of renal arteries. ▪ caused by arteriosclerosis and hypertension. ▪ usually occurs in older people, but sometimes develops in young diabetic clients. ❖ POLYCYSTIC KIDNEY DISEASE ▪ relatively rare, hereditary disease. ▪ Clusters of Cysts form and press on the kidneys causing it to enlarge and lose function. ▪ Although people with this condition have normal kidney function for many years, renal failure may develop near the age of 50. CLASSIFICATION OF RENAL DISEASE ❖ NEPHROLITHIASIS ▪ condition in which stones develop in the kidneys. ▪ The size of the stones varies from that of a grain of sand to much larger. ▪ Some remain at their point of origin, and others move. ▪ Although the condition is sometimes asymptomatic, symptoms include : hematuria (blood in the urine),infection, obstruction, and, if the stones move, intense pain. Acute Glomerulonephritis may be deferred hypersensitivity reaction initiated by infectious agents related with tonsilitis or scarlet fever or is an antigen- antibody complex reaction in which it become ensnared in the glomeruli leading to swelling. Diet Therapy of Acute Glomerulonephritis  Short term problem give adequate amount of protein rather than restricted protein  No sodium restriction unless edema is seen  High calorie diet from CHO and fat to spare tissues from being used as an energy source Nephrotic Syndrome  Describes a composite of symptoms that occurs because of injury to the capillary walls of the glomerulus  Characterized by massive loss of protein in the blood and edema.  Nephron lesions with massive albuminuria as well as other protein losses in urine; high protein diet  100-150 high calories to spare protein for tissue synthesis and provide energy  Edema is severe so Na is restricted to 500 mg DIALYSIS Remove excess fluid and wastes from the blood HEMODIALYSIS cleansing the blood of wastes by circulating the blood through a machine that contains tubing of semipermeable membranes PERITONEAL DIALYSIS removal of waste products from the blood by injecting the flushing solution into the abdomen and using the client’s peritoneum as the semipermeable membrane  DIET DURING DIALYSIS Hemodialysis Patient: requires 1.0 to 1.2 grams of protein per kilogram of body weight to make up for losses during dialysis Peritoneal Dialysis Patient: require 1.2 to 1.5 grams of protein per kilogram of body weight Potassium is usually restricted for dialysis clients The daily intake allowed clients in renal failure is 3,000 to 4,000 mg. End-stage renal disease further reduces intake allowed to 1,500 to 2,500 mg a day. The physician will prescribe the milligrams of potassium needed by the client DIET AFTER KIDNEY TRANSPLANT Acute Renal Failure Is a sudden decline in kidney function or abrupt loss of kidney function. Three Phases of AFR: 1. Oliguric-lasts 24 hours to 3 weeks, characterized by acidosis, high serum potassium, high phosporous, hypertension, anorexia and edema a. Diuretic- lasts from 2-3 weeks, urine output gradually increases b. Recovery- lasts from 3-12 months, function of kidney improves gradually Chronic Renal Failure  Renal calculi(urolithiasis)  Formation of the renal or urinary calculi in the urine that precipitate as stones in the urinary passages. Diet According to Type of Stone 1. Calcium oxalate stones- low calcium, low phosphate according to calcium compound  Calcium foods-dairy products are limited  Acid ash foods such as meat, egg, grains are emphasized  Alkaline foods such as milk, vegetables, fruits are controlled except strawberries  Oxalate is found in beets, nuts, chocolates, strawberries, tea, wheat bran and rhubard  Potassium foods and water are increased 2. Uric acid stones-low purine such as meat, meat extractives and to lesser extent, plant sources such as whole grains and legumes -protein is limited 58-67 g/day emphasis on milk, fruits and decrease intake of bread products. 3. Cystine Stones-with rare genetic type, diet is low protein foods as meat, milk, egg, cheese -high fluid intake is recommended CYSTINE STONES ❖ Cystine is an amino acid. ❖ form when the cystine concentration in the urine becomes excessive because of a hereditary metabolic disorder. ❖ Encourage increase fluids ❖ ALKALINE-ASH DIET ❖ A diet consisting mainly of fruits, vegetables, milk, little meat, fish, eggs, cheese, and cereals, that when catabolized leaves an alkaline residue to be excreted in the urine.  NUTRITION THERAPY FOR ACQUIRED IMMUNE DEFICIENCY SYNDROME  IS CAUSED BY Human Immunodeficiency Virus. An infected person can transmit the virus through: a. Sexual intercourse b. Sharing contaminated needles c. Blood transfusion d. Exchange between mother and baby during pregnancy, childbirth or breastfeeding  Dietary Management AIDS patient a. Energy-35-45 kcal/kg BW b. Protein-2 to 2.5 g/kg BW c. Fats-increase Omega 3 sources and decrease saturated fats in the diet d. Vitamins and Minerals-additional may be recommended in case of altered metabolism ❖ High calorie, high protein, low fat NUTRITION THERAPY FOR GASTROINTESTINAL DISEASES DIET AND GASTROINTESTINAL DISORDERS ❖ The gastrointestinal (GI) tract is where digestion and absorption of food occur. ❖ Primary organs ▪ mouth, esophagus, stomach, and small and large intestine. ❖ Accessory organs ▪ liver, gallbladder, and pancreas  NAUSEA AND VOMITING Abdominal with pain: Gastrointestinal disorder or obstruction Abdominal without abdominal pain: medications, food illness, pregnancy, morning sickness, neurological disorders, etc… DYSPEPSIA ( INDIGESTION) ❖ Symptoms of pain or discomfort in the upper abdominal area ❖ Either physical or psychological in origin. ❖ Symptoms: ▪ heartburn ▪ Bloating ▪ pain ▪ regurgitation. ❖ Physical Causes: due to overeating or spicy foods, or it may be a symptom of another problem(appendicitis, kidney, gallbladder, or colon disease or possibly cancer, medications, dietary supplements ❖ Psychological Causes: stress can affect stomach secretions and trigger dyspepsia. Treatment should include counseling to help the client: ✓ Find relief from the underlying stress ✓ Allow sufficient time to relax and enjoy meals ✓ Learn to improve eating habits  Potential food intolerances: -consume small, frequent meals -avoid fatty or highly spicy foods -avoid the specific foods believed to trigger symptoms Bloating and stomach gas - Avoid air swallowing practices: gum chewing, smoking, rapid eating, drinking carbonated beverages and using straw ESOPHAGITIS ❖ inflammation of mucosal lining of the Esophagus ❖ caused by the irritating effect of acidic gastric reflux on the mucosa of the esophagus. ❖ SYMPTOMS: ▪ Heartburn, regurgitation, and dysphagia (difficulty swallowing) ❖ Acute esophagitis ▪ caused by ingesting an irritating agent, by intubation, or by an infection. ❖ Chronic, or reflux, esophagitis ❖ caused by recurrent GASTROESOPHAGEAL REFLUX (GER). ▪ backflow of stomach contents into the esophagus ▪ Heartburn or acid indigestion Causes: ▪ Weak lower esophageal sphincter muscle, hiatal hernia, reduced lower esophageal sphincter (LES) pressure, abdominal pressure, recurrent vomiting, alcohol use, overweight, or smoking. HIATAL HERNIA ❖ a condition in which a part of the stomach protrudes through the diaphragm into the thoracic cavity ❖ Hernia prevents the food from moving normally along the digestive tract, although the food does mix somewhat with the gastric juices. ❖ Sometimes the food will move back into the esophagus, creating a burning sensation (heartburn), ❖ sometimes food will be regurgitated into the mouth.  Medical Nutrition Therapy for Hiatal Hernia small, frequent meals from a well-balanced diet Avoid irritants (as carbonated beverages, citrus fruits and juices, tomato products, spicy foods, coffee, pepper, and some herbs. Avoid foods that can cause the lower esophageal sphincter to relax (alcohol, garlic, onion, oil of peppermint and spearmint, chocolate, cream sauces, gravies, margarine, butter, and oil) Weight loss if the client is obese, to reduce pressure on the abdomen. avoid late-night dinners and lying down for 2 to 3 hours after eating. Elevate head when sleeping If discomfort cannot be controlled, surgery may be necessary GASTRITIS PEPTIC ULCERS ❖ erosion of the mucous membrane of the stomach (gastric ulcer) or the duodenum (duodenal ulcer). CAUSES: 1. genetic predisposition 2. abnormally high secretion of hydrochloric acid by the stomach 3. Stress 4. excessive use of aspirin or ibuprofen (analgesics) 5. cigarette smoking 6. a bacterium Helicobacter pylori PEPTIC ULCERS ❖ Symptoms ▪ “burning” gastric pain ▪ Bleeding usually requires surgery. ▪ pain is relieved with food or antacid ❖ Generally treated with drugs: ❖ Antibiotics (kill the bacteria) ❖ Cimetidine. (inhibits acid secretion) ❖ Antacids containing calcium carbonate (neutralize any excess acid ❖ Stress management may also be beneficial in the treatment of ulcers Medical Nutrition Therapy for Peptic Ulcer ❖ Sufficient low-fat protein but not in excess because of its ability to stimulate gastric acid secretion. ❖ Vitamin and mineral supplements, especially iron if there has been bleeding ❖ Although fat inhibits gastric secretions, because of the danger of atherosclerosis, the amount of fat in the diet should not be excessive. ❖ Avoid Spicy foods, Coffee, tea, or anything else that contains caffeine ❖ Avoid Alcohol and aspirin irritate the mucous membrane of the stomach ❖ Avoid cigarette smoking that decreases the secretion of the pancreas that buffers gastric acid in the duodenum. ❖ Well balanced diet of three meals a day consisting of non irritating foods DIVERTICULOSIS/DIVERTICULITIS ❖ intestinal disorder characterized by little pockets forming in the sides of the large intestine (colon) ❖ When fecal matter collects in these pockets instead of moving on through the colon, bacteria may breed, and inflammation and pain can result, causing DIVERTICULITIS (inflammation of the Diverticula) ❖ If a diverticulum ruptures, surgery may be needed. ❖ CAUSES: ❖ Low fiber diet  Medical Nutrition Therapy for Diverticulosis/Diverticulitis ❖ high-fiber diet ❖ Antibiotics ❖ diet therapy may begin with a clear liquid diet, followed by a low-residue diet that allows the bowel to rest and heal. Then a high-fiber diet will be an initiated. ❖ The bulk provided by the high-fiber diet increases stool volume, reduces the pressure in the colon, and shortens the time the food is in the intestine, giving bacteria less time to grow INFLAMMATORY BOWEL DISEASE(IBDS) ❖ chronic conditions causing inflammation in the gastrointestinal tract. ❖ inflammation causes malabsorption that often leads to malnutrition. ❖ The acute phases of these diseases occur at irregular intervals and are followed by periods in which clients are relatively free of symptoms. ❖ Neither cause nor cure for these conditions is known INFLAMMATORY BOWEL DISEASE(IBDS) 1. ULCERATIVE COLITIS ▪ disease characterized by inflammation and ulceration of the colon, rectum, and sometimes entire large intestine 2. CROHN’S DISEASE ▪ a chronic progressive disorder that that causes inflammation, ulcers, and thickening of intestinal walls, sometimes causing obstruction INFLAMMATORY BOWEL DISEASE(IBD) SYMPTOMS: ❖bloody diarrhea, cramps, fatigue, nausea, anorexia, ❖ malnutrition, and weight loss ❖ Electrolytes, fluids, vitamins, and other minerals are lost in the diarrhea, ❖ Bleeding can cause loss of iron and protein. INFLAMMATORY BOWEL DISEASE(IBD) Treatment anti-inflammatory drugs plus medical nutrition therapy. low-residue diet to avoid irritating the inflamed area and to avoid the danger of obstruction. When tolerated, the diet should include about 100 grams of protein, additional calories, vitamins, and minerals. total parenteral nutrition (TPN) for severe cases  INFLAMMATORY BOWEL DISEASE(IBDS) ILEOSTOMY OR COLOSTOMY Clients with severe ulcerative colitis or Crohn’s disease frequently require a surgical opening from the body surface to the intestine for the purpose of defecation. STOMA surgically created opening in the abdominal wall ILEOSTOMY Opening from the ileum to abdomen surface is required when the entire colon, rectum, and anus must be removed. COLOSTOMY Opening from the colon to abdomen surface can provide entrance into the colon if the rectum and anus are removed. Can be a temporary or a permanent procedure. Patient with colostomy bag Medical Nutrition Therapy for Client with Ileostomies A vitamin C supplement is recommended Vitamin B12 supplement may be needed. Eating a well-balanced individualized diet to prevent a nutritional deficiency  CELIAC DISEASE also called nontropical sprue or gluten sensitivity a disorder characterized by malabsorption of virtually all nutrients. It is thought to be due to heredity. SYMPTOMS: diarrhea, weight loss, and malnutrition. foul-smelling stool , light-colored, and bulky. The cause is unknown, but it has been found that the elimination of gluten from the diet gives relief. If untreated, it is life-threatening because of the severe malnutrition and weight loss it can cause.  Medical Nutrition Therapy for Client with CELIAC DISEASE A gluten-controlled diet Gluten protein found in barley, oats, rye, and wheat. All products containing these grains are disallowed. Rice and corn may be used. Low fiber content is also frequently recommended. If the client is under weight, diet must be high in calories, carbohydrates, and protein Fat may be restricted until bowel function is normalized. Vitamin and mineral supplements may be prescribed.  Medical Nutrition Therapy for Client with CELIAC DISEASE Lactose intolerance sometimes develops with celiac disease. It is not easy to avoid food products containing wheat. Breads, cereals, crackers, pasta products, desserts, gravies, white sauces, and beer contain wheat or other cereal grains with gluten. The client will have to learn to read food labels carefully and to avoid restaurant foods such as breaded meats or fish, meatloaf, creamed vegetables, and cream soups. DISORDERS OF THE ACCESSORY ORGANS ❖ Liver plays many roles in, metabolism. 1. Nutrients absorbed in the intestines are transported to the liver. 2. Dismantles some nutrients, stores others, and uses some to synthesize other substances. 3. Determines where amino acids are needed and synthesizes some proteins, enzymes, and urea. 4. Changes the simple sugars to glycogen, provides glucose to body cells, and synthesizes glucose from amino acids if needed. 5. Converts fats to lipoproteins and synthesizes cholesterol. It stores iron, copper, zinc, and magnesium as well as the fat-soluble vitamins and B vitamins. 6. synthesizes bile and stores it in the gallbladder. 7. detoxifies many substances such as barbiturates and morphine.  CIRRHOSIS general term referring to all types of liver disease characterized by cell loss. CAUSES: Alcohol abuse (most common cause) congenital defects Infections toxic chemicals FIBROSIS development of tough, stringy tissue ASCITES abnormal collection of fluid in the abdomen Medical Nutrition Therapy for Client with Cirrhosis The dietary treatment of cirrhosis provides at least 25 to 35 calories or more 0.8 to 1.0 gram of protein per kilogram of weight each day, depending on the client’s condition. Supplemental vitamins and minerals In advanced cirrhosis, 50% to 60% of the calories should be from carbohydrates Fat restricted diet protein may not be well tolerated, so it is restricted to 35 to 40 grams a day. Low Sodium and decrease fluids if client has Ascites Low fiber diet if there is bleeding in the esophagus, Smaller feedings No alcohol is allowed.  HEPATITIS inflammation of the liver. CAUSES: viruses or toxic agents such as drugs and alcohol. Necrosis occurs, and the liver’s normal metabolic activities are constricted. Hepatitis may be acute or chronic.  HEPATITIS Hepatitis A virus (HAV) contracted through contaminated drinking water, food, and sewage via a fecal-oral route. Hepatitis B virus (HBV) and hepatitis C virus (HCV) transmitted through blood, blood products, semen, and saliva. Hepatitis B and C can lead to chronic active hepatitis (CAH), which is diagnosed by liver biopsy. Chronic active hepatitis can lead to liver failure and end- stage liver disease (ESLD).  HEPATITIS SYMPTOMS: nausea, headache, fever, fatigue, tender and enlarged liver, anorexia, and jaundice. Weight loss In mild cases, the cells can be replaced. In severe cases, the damage can be so extensive that the necrosis leads to liver failure and death. There can be bile stasis and decreased blood albumin levels  Medical Nutrition Therapy for Client with Hepatitis bed rest, plenty of fluids, and medical nutrition therapy. Diet : 35 to 40 calories per kilogram of body weight. if the necrosis has not been severe, up to 70 to 80 grams of protein for cell regeneration. If the necrosis has been severe and the proteins cannot be properly metabolized, they must be limited to prevent the accumulation of ammonia in the blood. frequent, small meals Clients with liver disease require a great deal of encouragement because their anorexia and consequent feelings of general malaise can be severe.  CHOLECYSTITIS AND CHOLELITHIASIS The dual function of the gallbladder is the concentration and storage of bile. After bile is formed in the liver, the gallbladder concentrates it to several times its original strength and stores it until needed.  CHOLECYSTITIS AND CHOLELITHIASIS Etiology of gallbladder disease is unknown Risk Factors: heredity factors Women develop gallbladder disease more often than men do. Obesity, total parenteral nutrition (TPN), very low-calorie diets for rapid weight loss, the use of estrogen, and various diseases of the small intestine are frequently associated with gallbladder disease CHOLECYSTITIS AND CHOLELITHIASIS Cholecystitis- inflammation of the gallbladder Cholelithiasis (gallstones) Both inhibit the flow of bile and cause pain. Cholecystitis can cause changes in the gallbladder tissue, which in turn can affect the cholesterol (a constituent of bile), causing it to harden and form stones. CHOLECYSTITIS AND CHOLELITHIASIS SYMPTOMS: Severe pain Indigestion vomiting, particularly after the ingestion of fatty foods. Treatment diet therapy medication to dissolve the stones If medication does not succeed, (CHOLECYSTECTOMY) surgery to remove the gallbladder Medical Nutrition Therapy abstinence during the acute phase. Followed by a clear liquid diet and, gradually, a regular but fat- restricted diet. Amounts of fats allowed run from 40 to 45 grams a day. In chronic cases, fat may be restricted on a permanent basis. For obese clients, weight loss is recommended in addition to a fat- restricted diet may require the water-miscible forms of fat-soluble vitamins.  PANCREATITIS ❖inflammation of the pancreas. ❖ CAUSES: 1. Infections 2. Surgery 3. alcoholism 4. biliary tract (includes bile ducts and gallbladder) disease 5. certain drugs. PANCREATITIS may be acute or chronic. SYMPTOMS: Abdominal pain nausea, steatorrhea (presence of excess fat in feces) Malabsorption (particularly of fat-soluble vitamins) and weight loss occur In cases where the islets of Langerhans are destroyed, diabetes mellitus may result.  Medical Nutrition Therapy As recovery progresses, small, frequent feedings of carbohydrates and protein with little fat or fiber are given. The fat is restricted because of deficiencies of pancreatic lipase. The client is gradually returned to a less restricted diet as tolerated. Vitamin supplements may be given. Alcohol is forbidden in all cases Medical Nutrition Therapy Diet therapy is intended to reduce pancreatic secretions and bile. Just as fat stimulates the gallbladder to secrete bile, protein and hydrochloric acid stimulate the pancreas to secrete its juices and enzymes. During acute pancreatitis, the client is nourished strictly parenterally. Later, when the client can tolerate oral feedings, a liquid diet consisting mainly of carbohydrates is given because, of these three nutrients, carbohydrates have the least stimulatory effect on pancreatic secretions.  RESIDUE-CONTROLLED DIETS Dietary Fiber is that part of food that is not broken down by digestive enzymes. Most dietary fiber is found in plant foods. Some is soluble and some is insoluble Examples of dietary fiber in plants: the outer shells of corn kernels, strings of celery, seeds of strawberries, and the citrus fruits fibers  RESIDUE-CONTROLLED DIETS Residue is the solid part of feces. Residue is made up of all the undigested and unabsorbed parts of food (including fiber), connective tissue in animal foods, dead cells, and intestinal bacteria and their products. Most of this residue is composed of fiber. Diets can be adjusted to increase or decrease fiber and residue. The specific foods allowed and thus the amount of fiber and residue allowed will depend on the client’s condition  HIGH-FIBER DIET High-fiber diets( 30 grams or more ) help prevent diverticulosis, constipation, hemorrhoids, and colon cancer and help in treatment of diabetes mellitus, atherosclerosis A high-fiber diet is often 25 to 35 grams and should not exceed 50 grams a day. Recommended foods: coarse- and whole-grain breads and cereals, bran, all fruits, vegetables (especially raw), and legumes. High-fiber diets must be introduced gradually to prevent the formation of gas and the discomfort that accompanies it. Increase amount of fluids must be consumed along with the increased fiber.  LOW-RESIDUE DIET diet of 5 to 10 grams of dietary fiber/day is intended to reduce the normal work of the intestines by restricting the amount of dietary fiber and reducing food residue. Low-fiber or residue-restricted diets for severe diarrhea, diverticulitis, ulcerative colitis, and intestinal blockage and in preparation for and immediately after intestinal surgery. “low-residue” foods foods that do not leave residue in the colon increase stool volume or provide a laxative effect. Milk and prune juice are examples. Milk increases stool volume, and prune juice acts as a laxative. Diarrhea  Refers to frequent loose or liquid bowel movement that prevents complete digestion and absorption  Types of Diarrhea 1. Acute-diarrhea less than 2 weeks caused by viral, bacterial or protozoan infections, medication side effects or altered dietary intake 2. Chronic-diarrhea more than 2 weeks resulting from disorders like malabsorption or PEM or medical treatments Diet Therapy: 1. NPO for 12 hours with IVF and electrolytes 2. Oral fluids as condition improves 3. Liberal fluids to prevent dehydration 4. broths and electrolytes solutions to replace Na &K losses 5. pectin may help control diarrhea 6. oral rehydration must be administered( ¾ tsp salt, 1 tsp baking soda, 1 cup juice, 4tbsp sugar and 1 liter of water Constipation  A condition in which person experiences hard feces that are difficult to egest.  Symptoms: lack of appetite , lethargy, bad breath, distended stomach and caked tongue. Diet herapy(constipation)    Hemorrhoids  ❖ ❖ ❖ ❖ Cystic Fibrosis is a hereditary disease in which there are high levels of sodium and chloride in tears and saliva, high levels of electrolytes in sweat, high viscous secretions in the small intestine, pancreas, bile duct and bronchi  Diet Therapy 1. Calorie to supply demands for growth 2. High protein to compensate for fecal losses 3. Fat-important source of calories, liberal fat intake is prescribed 4. Vitamins and minerals should be emphasized 5. Liberal fluid intake is recommended