Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

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 Appeal to the sense of sight
Appeal to the sense of taste
Temperature of food should be correct
Digestibility of food should be considered
Nutritive value should be ample
offer small amounts of food frequently, especially if the person is not hungry.
Often a sick person prefers soft foods (e.g. gruel, mashed bananas or soup) or
sweet foods. For a few days it does not matter what the person eats, provided
he or she eats often;
give a sick person plenty to drink every 1-2 hours. For example, give boiled
water, fresh fruit juice, coconut water, soup or watery porridge. Or give boiled or
soured milk or milky tea unless the person has diarrhea;
prepare food and drinks in a clean, safe way to prevent foodborne infections

Dietary modifications are changes made during food preparation, processing, and consumption
to increase the bioavailability of micronutrients—and reduce micronutrient deficiencies—in
food at the commercial or individual/household level (Beck and Heath 2013).

Disease state, its nature, duration, intensity

Food form or nutrient modification
Patient’s individual food tolerances & food habits
Nutritional adequacy of modified diet
Patient’s physical ability & home situation

Sick people should eat well even if they are not active. They need nutrients to keep alive, fight
infections and replace lost nutrients. If sick people do not eat enough, they use their own body
fat and muscles for energy and nutrients. They lose weight and become undernourished. Their
immune systems may become less effective and they are less able to fight infections.

Lack of appetite, vomiting, pain - Appetite loss and nausea can be caused by infections.
Almost any infection can result in decreased appetite, along with fever, fatigue and
generally feeling lousy. Nausea can be caused by certain infections, including many
common bacterial and viral ones.

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 Severe diarrhea - Children and adults with diarrhea and/or vomiting lose much water
and so must drink frequently to prevent dehydration. Suitable drinks are oral
rehydration solution made from packets of oral rehydration salts or ordinary home-
made fluids containing normal amounts of salt, such as soups or rice water. People with
diarrhea must also eat because food helps the gut to recover and absorb water.
Breastfeeding children who have diarrhea should breastfeed frequently.
Fever
Bed rest/wheelchair
Metabolic diseases

Metabolic disorders can take many forms. This includes:

a missing enzyme or vitamin that’s necessary for an important chemical reaction

abnormal chemical reactions that hinder metabolic processes
a disease in the liver, pancreas, endocrine glands, or other organs involved in
metabolism
nutritional deficiencies

What causes metabolic disorders?

You can develop a metabolic disorder if certain organs — for instance, the pancreas or the liver
— stop functioning properly. These kinds of disorders can be a result of genetics, a deficiency in
a certain hormone or enzyme, consuming too much of certain foods, or a number of other
factors.

There are hundreds of genetic metabolic disorders caused by mutations of single genes. These
mutations can be passed down through generations of families. According to the National
Institutes of Health (NIH)Trusted Source, certain racial or ethnic groups are more likely to pass
on mutated genes for particular inborn disorders. The most common of these are:

Sickle cell anemia in African Americans - Sickle cell anemia, or sickle cell disease (SCD), is a
genetic disease of the red blood cells (RBCs). Normally, RBCs are shaped like discs, which gives
them the flexibility to travel through even the smallest blood vessels. However, with this
disease, the RBCs have an abnormal crescent shape resembling a sickle. This makes them sticky
and rigid and prone to getting trapped in small vessels, which blocks blood from reaching
different parts of the body. This can cause pain and tissue damage. SCD is an autosomal
recessive condition. You need two copies of the gene to have the disease. If you have only one
copy of the gene, you are said to have sickle cell trait.

Cystic fibrosis in people of European heritage - Cystic fibrosis is a serious genetic condition that
causes severe damage to the respiratory and digestive systems. This damage often results from
a buildup of thick, sticky mucus in the organs. The most commonly affected organs include the:
lungs, pancreas, liver, intestines. Cystic fibrosis affects the cells that produce sweat, mucus, and

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digestive enzymes. Normally, these secreted fluids are thin and smooth like olive oil. They
lubricate various organs and tissues, preventing them from getting too dry or infected.

Maple Syrup Urine Disease in Mennonite communities - Maple syrup urine disease (MSUD) is a
rare, inherited metabolic disorder. The disease prevents your body from breaking down certain
amino acids. Amino acids are what remain after your body digests protein from the food you
eat. Special enzymes process amino acids so they can be used to maintain all of your body
functions. If some of the necessary enzymes are missing or defective, the amino acids and their
byproducts, called keto acids, collect in your body. As the levels of these substances increase, it
can result in: neurological damage, coma, life-threatening conditions

Gaucher’s Disease in Jewish people from Eastern Europe - disease is the result of a buildup of
certain fatty substances in certain organs, particularly your spleen and liver. This causes these
organs to enlarge and can affect their function. The fatty substances also can build up in bone
tissue, weakening the bone and increasing the risk of fractures. If the bone marrow is affected,
it can interfere with your blood's ability to clot.

Hemochromatosis in Caucasians in the United States - Hemochromatosis is a condition caused

by the over-absorption of iron from foods that you consume, leading to an excessive
concentration of iron in your blood. This can cause serious health problems, since your body
doesn’t have a way to get rid of the excess iron. The excess iron also builds up in your: liver,
heart, pancreas, joints. This buildup of iron causes damage.

Types of metabolic disorders

Diabetes is the most common metabolic disease. There are two types of diabetes:

 Type 1, the cause of which is unknown, although there can be a genetic factor.
 Type 2, which can be acquired, or potentially caused by genetic factors as well.

In type 1 diabetes, the T cells attack and kill beta cells in the pancreas, the cells that produce
insulin. Over time, a lack of insulin can cause: nerve and kidney damage, eyesight impairment,
increased risk of heart and vascular disease

The more common types of nutritional and metabolic disorders include:

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Gaucher’s disease - This condition causes an inability to break down a particular kind of fat,
which accumulates in the liver, spleen, and bone marrow. This inability can result in pain, bone
damage, and even death. It’s treated with enzyme replacement therapy.

Glucose galactose malabsorption - This is a defect in the transport of glucose and galactose
across the stomach lining which leads to severe diarrhea and dehydration. Symptoms are
controlled by removing lactose, sucrose, and glucose from the diet.

Hereditary hemochromatosis - In this condition, excess iron is deposited in several organs, and
can cause: liver cirrhosis, liver cancer, diabetes, heart disease It is treated by removing blood
from the body (phlebotomy) on a regular basis.

Maple syrup urine disease - MSUD disrupts the metabolism of certain amino acids, causing
rapid degeneration of the neurons. If not treated, it causes death within the first few months
after birth. Treatment involves limiting the dietary intake of branched-chain amino acids.

Phenylketonuria (PKU) - PKU causes an inability to produce the enzyme, phenylalanine

hydroxylase, resulting in organ damage, mental retardation, and unusual posture. It’s treated
by limiting the dietary intake of certain forms of protein.

Food acceptability is affected by many factors, which may be related to the individual, the food,
or the environment in which the food is consumed. Acceptability is a subjective measure based
on hedonics (pleasure), which in turn is influenced by the sensory properties of the food,
previous exposure to it and subsequent expectations, contextual factors, an individual's culture,
physiological status (i.e., hunger, thirst, and presence/absence of illness), and many other
variables. The measurement of food acceptance is highly complex and relies
on psychometrics (scales) and/or behavioral models (food-choice models).

 Illness reduce a person’s interest in food

- inactivity
- intake of some drugs
- away from home
- worries: hospital bills, return to work, return to full health

· Offer food every 1-2 hours; give snacks between meals.

· Encourage the person to eat more at each meal.
· Give easy-to-eat foods that the person likes, but include energy-rich and nutrient-rich foods in
the meals. For example, give meat, offal, poultry, fish, eggs, and milk foods when possible

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(adding dry milk powder to porridges and other foods provides extra milk); add extra fat or
fatty foods and/or sweet foods, such as sugar or honey.
· Feed when the person has a low temperature, has been washed and has the mouth clean and
the nose unblocked.
· Feed the person sitting up (especially if vomiting is likely); feed a child sitting on someone’s
lap.
· Keep water and food nearby if a person has to stay in bed.
· Never force sick children to eat, as they may choke or vomit.

Nurses have the expertise and responsibility to ensure that patients and clients’ nutritional
needs are met. Providing nutrition screening and appropriate nutrition advice is essential to
improve healthy eating and subsequent health outcomes.

Forward diet prescription to the dietary department

Observing, listening & reporting
Nursing aide: records left overs

In hospital, food is an important part of the treatment and care of patients. Eating and drinking
regularly in hospital are as important to our health and wellbeing as taking our medication. Not
eating and drinking enough is a common problem for older people in hospital and it can slow
down our recovery.

Sick room should be orderly

All food & drinks should be offered from clean dishes
Hands & face of patient should be wiped & dried
Tray should be removed as soon as patient is finished
A tray of sufficient size for uncrowded arrangement
Meals served on time
Hot food served on warm plates; cold foods on chilled dishes

 Italian: cheese, macaroni, spaghetti, legumes, dried beans in thick soup, chicken in small
amounts, fruits, oil, milk products, whole grain cereals
 Jewish: milk & sour cream, cottage cheese, poultry, fresh water fish, canned & smoked
fish, discourage use of highly seasoned foods & rich desserts

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Medical Nutrition Therapy is an evidence-based medical approach to treating certain chronic
conditions through the use of an individually-tailored nutrition plan. This nutrition plan is
ordered and approved by a primary care physician and implemented by a Registered Dietitian.

Provision of a person’s nutrient, dietary and nutrition education needs based on a

complete nutrition assessment
Nutritional assessment - is the interpretation of anthropometric, biochemical
(laboratory), clinical and dietary data to determine whether a person or groups of
people are well nourished or malnourished (over-nourished or under-nourished).
Nutritional therapy - Nutritional Therapy uses food to prevent and reverse diseases that
plague societies: diabetes, obesity, heart disease, arthritis, and depression. In order for
food to be therapeutic, it must be nutrient-dense, measured in part by the nutrients and
anti-nutrients, contained in consumed foods.
Nutritional care plan - It’s a detailed plan of interventions/actions to support a person to
achieve their nutrition goals.

The NCP includes:

Person Centered goals based on both decreasing nutrition risk and increasing
quality of life
Prescribed intake of fortified meals and fluids for 3 main meals and 3 in between
meal snacks
Details of any modification in food or fluid
Any assistive equipment required for meal times
Assistance required for eating and drinking
Home delivered pre-prepared meals (or for those eligible, Meals on Wheels) for
people living independently in the community
Food allergies and intolerances
Other details specific to the individual concerned e.g. special diet needs such as
gluten free

Changes in food consistency

Adjusting the amount of one or more nutrients/fluids
Increasing/reducing or eliminating certain foods
Altering the number of meal

To maintain or restore good nutritional status

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 To correct nutritional deficiency
To afford rest to a particular part of the body
To adjust the diet
To treat or prevent edema
To eliminating offending food substances

As we enter the 21st century, a new era of nutrition in the prevention and treatment of disease
emerges. Clinical nutrition involves the integration of diet, genetics, environment, and behavior
promoting health and well being throughout life. This integrates principles and concepts and
how to apply this knowledge in new creative ways. Nutrition in the Prevention and Treatment
of Disease is an essential part of the tool chest for clinical nutritionists, physicians, nurse
practitioners, and dieticians in this new era of practice.

Liberalization – the diet should meet the body’s requirement for essential nutrients as
generously as the disease condition permits.
Individualization – diet regimen should take into account the patient’s food habits,
preferences other factors that have bearing on the diet
Simplification – therapeutic diet should vary from the adequate, normal diet as little as
possible

 Diet order: doctor’s written statement in the medical record and it is in regard of what
diet the patient should receive

o Diet manuals – describes the foods allowed and avoided on a diet, outlines the rationale
and the use of each diet and provide sample menus.

Oral Nutrition - Good and nutritious food is a major contributor to quality of life and wellbeing.
Oral nutrition with normal food should therefore always represent the first - line dietary
measure for patients who are able to eat in
order to prevent or correct malnutrition.

Enteral Nutrition - generally refers to any

method of feeding that uses the
gastrointestinal (GI) tract to deliver part or
all of a person's caloric requirements. It can
include a normal oral diet, the use of liquid
supplements or delivery of part or all of the

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 daily requirements by use of a tube (tube feeding).

Short-term Enteral Access

Long-term enteral access

Enteral access device Length of use Pros Cons

Nasogastric tube (NGT; through the
nose)
Orogastric tube (through the
mouth)
Nasoenteric tube (generally thought
of as a tube beyond the stomach)
Oroenteric tube (postpyloric feeding
tube)
Gastrostomy tube (can be placed
radiologically, endoscopically or
surgically)
Jejunostomy tube (can be placed
radiologically, endoscopically or
surgically)
Short-term use Easy to place, variety of sizes
available for patient comfort
Short-term use Lower incidence of sinusitis than
NGTs
Short-term use Smaller diameter than NGTs and
less patient discomfort; may be
used in delayed gastric emptying
Short-term use Same as orogastric tubes
Short-term use Easily cared for and replaceable;
Long-term use large size tube allow for bolus
feeding, and administration of
medications
Long-term use Decreases the risk of food and
fluids passing into the lungs; allows
for early postoperative feeding
Not indicated if bleeding disorder,
nasal/facial fractures and certain esophageal
disorders
Not tolerated for long periods of time in alert
patients; tube may damage teeth
May be difficult to position; smaller size tubes
may make administration of some
medications difficult, and an infusion pump is
needed
Same as orogastric tubes
Compared with oral and nasal route, this
technique is more invasive
Technically more difficult to place; smaller
size tubes may make administration of some
medications more difficult, and an infusion
pump is needed

Parenteral Nutrition - refers to the delivery of calories and nutrients into a vein. This could be as
simple as carbohydrate calories delivered as simple sugar in an intravenous solution or all of the
required nutrients could be delivered including carbohydrate, protein, fat, electrolytes (for
example sodium and potassium), vitamins and trace elements (for example copper and zinc).

 The normal diet may be modified for:

 Consistency & texture
 Flavor
 Energy value
 Nutrient level - is a nutrition claim that describes the level of a nutrient
contained in a food, such as, ‘source of calcium’ and ‘low in fat.
 Allowing only specific foods

Food categories - The food groups are part of a method of classification for the various foods
that humans consume in their everyday lives, based on the nutritional properties of these types
of foods and their location in a hierarchy of nutrition.

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Eating certain amounts and proportions of foods from the different categories is recommended
by most guides to healthy eating as one of the most important ways to achieve a healthy
lifestyle through diet.
Different food guides vary in the number of categories used to divide types of food, but the
majority of them include the following classifications: grain products; vegetables; fruits; dairy
products; meat and alternatives; fats, oils and sugars.

Steaming: Locks in nutrients that would be lost if the same item was boiled in water. Some
vitamins are water soluble and sensitive to heat and air.
Frying: Using non-stick pans can drastically reduce the use of oils and fats. Use
mono/polyunsaturated oils sparingly or use spray oils.
Baking/roasting: Silicone bakeware and draining on paper reduces the amount of oil eventually
consumed.
Meat: Choose meats trimmed of visible fat.
Microwaving: May be suitable for heating single items that will be served straightaway.
Fruit and vegetables:
 Take care handling fruits and vegetables.
 Choose fresh, undamaged fruit.
 Don’t add baking soda to cooking – increased losses of vitamin C.
 Serve and eat vegetables/fruits as soon as possible after preparation – cutting,
shredding, juicing exposes surfaces to oxygen, which reduces antioxidant levels and
therefore increases oxidisation – causing a loss of vitamin C.

1. Regular diet

 A well balanced diet created to provide 100% of the recommended nutrient intakes

When is it used?

 when a person’s health and medical condition does not require any food restriction

Guidelines for making proper choices:

a. Choose a wide variety of foods

b. Use the Food Guide Pyramid
c. Buy foods that are available, cheap and in season
d. Include 2-3 servings of vegetable daily
e. Eat fruits at least 2-3 servings everyday

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 f. Choose lean meat, poultry, fish, seafoods and dried beans
g. Include milk or milk products in the diet
h. Use herbs and spices, seasonings, sauces, and flavorings in moderation
i. Drink 8-10 glasses of fluids daily

2. Clear liquid diet

 A temporary diet containing foods and fluids that are clear and liquid at room
temperature and is served at frequent intervals
 Designed to provide adequate amounts of fluid & electrolytes
 Easily absorbed & leave minimal residue in the GIT
 Minimizes stimulation of the GIT

When is it used?

 As an initial feeding progression between IVF and a full liquid diet or a solid diet
following surgery
 As a dietary preparation for medical tests
 As pre- diet for surgery
 As a diet when there is acute disturbance of GI function
 As an initial feeding for a severely debilitated patient

HOW ADEQUATE IS THE DIET:

 Cannot meet all the calories & essential nutrients needed by the body
 400-800 kcal/day
 Use must be limited

Guidelines for Making Proper Food Choices

1. Choose only those food items that are clear and liquid or that can be liquefied at room
temperature
2. Avoid solid and opaque food items
3. All fruit juices should be clear and strained
4. Consume allowed foods in one or two-hour intervals
5. Drink 5-8 large glasses of clear liquids a day

3. Full liquid diet

 Provides both clear and opaque liquid foods and some semiliquid at body temperature
 General liquid diet

When is it used?

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  As a step between clear liquid and soft diets
 For person who has difficulty chewing or swallowing
 For individuals who have problems digesting solid foods
 For persons with moderate GI inflammation and mouth lesions
 For patients who are too ill to eat

How adequate is the diet?

 Diet is adquate in protein, calcium, phosphorus, riboflavin & ascorbic acid

 Lacks fiber, low in iron, Vit. B12, Vit. A, niacin & thiamin
 1300-1500 kcal

Guidelines for Making Proper Food Choices

 Use a blender to liquefy solid foods and then strain

 Select only those food items that are clear or opaque liquid
 Omit the ff. foods – all forms of cheese, fruits, meats, vegetables
 Use seasonings in moderation
 Distribute foods in six or more meals per day

Modifications of Full Liquid

1. Cold liquid diet

2. High calorie, high protein liquids

How to increase the CHON and calorie content of the liquid diet:

 Add non fat, dry milk to beverage & soups

 Add butter to hot soups & cereals
 Add strained meats
 Use sugar or syrup in beverages
 Use smooth ice cream in desserts & beverages

4. Soft diet

 A modification of the regular diet to provide a selection of foods that are soft in texture
and consistency, easily digested, and simply prepared
 Limits food items
 Strongly flavored vegetables & fried foods are restricted

When is it used?

1. As a transition diet from liquids to a regular diet

2. For conditions in which ease of chewing, swallowing, and digestion are desired

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3. For patients recovering from trauma or debilitating disease

HOW ADEQUATE IS THE DIET?

 Can be nutritionally complete in essential nutrients

 The adequacy is affected by coupling restrictions
 Supplemented with nutritional formula or snacks

Guidelines for Making Proper Food Choices

 Fried foods, most raw fruits and vegetables, chewy and very coarse breads and cereals,
and highly seasoned foods are prohibited
 All foods can be prepared in any way except frying
 Choose moist and tender meats, fish, chicken and organ meats
 All types of milk and milk drinks preferably low-fat types are allowed
 Alcoholic beverages are prohibited
 Do not use chili or other strong seasonings
 Consume meals 5-6 times a day

 essentially a regular diet, contains about 20 to 35 grams of dietary fiber/day

 consuming generous amounts of fiber in your everyday diet potentially can
improve overall health. Fruits and vegetables appear to exert a strong healthy
effect.

When is it used?

Cancer prevention
Constipation
Coronary heart disease
DM
Diarrhea

Guidelines for Making Proper Food Choices

 Eat 2-4 servings of fruits, 3-5 servings of vegetables, and 6-11 servings of cereal and
grains
 When possible, eat vegetables raw
 Avoid peeling fruits and vegetables

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  In labeled food products, select those with at least 10% of the daily values of dietary
fiber
 Add more fluids
 Mix high-fiber foods with other foods

Which fibers and foods are best?

 Whole grains: wheat, oats , wild & brown rice

 Fruits: apple, pear; organic fruits
 Vegetables

1. cruciferous : brocoli
2. brussels sprouts & cauliflower (sulforaphane)- anticancer properties
Fruit juices contains pulp
Homemade soups: adding vegetables to chicken or vegetable stock

 Limits the consumption of fiber-rich foods by avoiding whole-grain bread and cereal
products, nuts, seeds, legumes, and certain fruits and vegetables

When is it used?

1. After surgery
2. Inflammatory bowel diseases
3. intestinal gas reduction

Guidelines for Making proper Food Choices

Eat a variety of nutritious foods and limit those high in fiber

Select refined breads, cereals, rice and pasta
Choose only tender meat, poultry, seafoods, and eggs
Remove skin and seeds from fruits and vegetables
Chew foods thoroughly, eat slowly, and avoid large meals

- provides foods and drinks that are easily digested and almost completely absorbed to produce
only a moderate amount of stool

When is it used?

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1. Acute diarrhea with abdominal cramping
2. As an intermediate diet after intestinal or rectal surgery
3. Colostomies

Guidelines for Making proper Food Choices

 In general, only vegetable juices are permitted

 All milk and milk products are permitted
 Use cooked and canned fruits without skins and seeds
 Consume only tender and no-fry meats, poultry, internal organs and fish
 Tea, coffee, fruit drinks, carbonated beverages, butter, cream, margarine, mayonnaise
are allowed in moderation
 Eat smaller, more frequent meals
 Avoid tobacco and cut down on alcohol consumption

Highly individualized diet that is basically a regular diet with the omission of foods known to
cause GI discomfort

When is it used?

Esophagitis - is inflammation that may damage tissues of the esophagus, the muscular
tube that delivers food from your mouth to your stomach. Esophagitis can cause painful,
difficult swallowing or dysphagia and chest pain.
GERD - Gastrointestinal reflux disease - occurs when stomach acid frequently flows back
into the tube connecting your mouth and stomach (esophagus). This backwash (acid
reflux) can irritate the lining of your esophagus.
PUD - Peptic ulcer disease - Peptic ulcers are open sores that develop on the inside
lining of your stomach and the upper portion of your small intestine. The most common
symptom of a peptic ulcer is stomach pain. Peptic ulcers include: Gastric ulcers that
occur on the inside of the stomach. Symptoms: Vomiting; Weight loss; Abdominal pain

Guidelines for Making Proper Food Choices

 A variety of foods may be selected similar to the regular diet

 To minimize gastric and esophageal irritation:

1. Coffee, carbonated drinks and other caffeine-containing foods are limited

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2. Most spices can be used in limited amounts but avoid any food or spice that repeatedly
causes discomfort
3. Avoid alcohol

 In case of GERD

1. Do not consume large meals

2. Have a relax mealtime and eat foods slowly
3. Avoid foods that weaken the LES
4. Quit smoking

 In case of PUD
1. Eat a variety of nutritious foods
2. Avoid overeating, frequent meals, and bedtime snacks
3. Avoid alcohol, non-steroidal anti- inflammatory agents, and cigarette smoking

 Provides extra kcal above the prescribed level for an individual

When is it used?

 hypermetabolic conditions
 febrile conditions
 fractured bones
 transplant/surgery
 growing periods
 undernutrition

Guidelines for Making Proper Food Choices

 A variety of foods everyday is encouraged

 Serving three meals daily with snacks is recommended
 Increase kcal consumption
 Nutritious and high calorie liquid formulas are also available

☻a modification of the regular diet designed to bring about a steady loss of body weight until
the reasonable weight goal has been achieved

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When is it use

• CHF – congestive heart failure

• Excess weight associated with diabetes
• Heart disease
• Gout
• Hypertension
• Pre-surgery patients

Guidelines for making proper food choices

1. Put emphasis on foods with low energy value but high in satiety value
2. prepare foods without adding considerable fat
3. use artificial sugar in place of regular sugar to sweeten foods and beverages
4. use non-fat milk, fat-free cheese, fat-free yogurt and fruit juices
5. keep away from snacks rich in fats

♦provides no more than 45% CHO of the total calorie intake but should not be less than 100
grams per day

When is it used?

♥ COPD, spontaneous hypoglycemia, epilepsy

Guidelines for making proper food choices

1. CHO sources in the diet should come mainly from starches and dietary fiber
2. avoid sugar and sugar-rich foods
3. read food labels

♣ highly individualized regular diet that often limit, but do not exclude milk and milk products
When is it used?
♠ lactose deficiency, malabsorption syndrome associated with lactose intolerance

Guidelines for making proper food choices

1. low lactose dairy products may be eaten

2. try chocolate milk which may be better tolerated than plain milk
3. examining food labels is important

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4. calcium supplements may be needed in children, pregnant, lactating and post-
menopausal women

♥ provides a protein level substantially above the normal amount required

When is it use
1. preparing the nutritionally wasted patient for surgery
2. primary and secondary PEM
Guidelines for making proper food choices
1. eat a variety of foods everyday
2. eat three meals with between- meal snacks
3.increase protein intake

♦ regulates the dietary intake of protein to a prescribed level

When is it used
1. acute renal failure
2. acute glomerulonephritis
3. chronic renal failure without dialysis
4. liver failure with impending coma

Guidelines for Making proper Food Choices

1. sources of protein should come mainly from high quality protein foods
2. use milk in the diet only when allowed in the meal plan
3. eat plenty of CHO foods
4. consume foods as desired unless contraindicated by the doctor

*helps eliminate excess uric acid

When is it used
☻hyperuricemia, gout, uric acid stones

Guidelines for Making proper Food Choices

1. foods high in purine are avoided
2. consume these foods in moderation: seafoods, legumes, and vegetables
3. alcohol should be avoided
4. in case of gout and the client is overweight, weight loss is important
5. drink 2-4 liters of fluid daily

☻eliminates all food sources of gluten

Gluten is a family of proteins found in wheat, barley, rye and spelt. Its name comes from the
Latin word for “glue,” as it gives flour a sticky consistency when mixed with water. This glue-like

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property helps gluten create a sticky network that gives bread the ability to rise when baked. It
also gives bread a chewy and satisfying texture.
When is it used: celiac disease?
Guidelines for Making proper Food Choices
1. sources of barley, rye, oats and wheat are omitted from the diet
2. avoid foods containing significant gluten
3. consume these as desired: milk and dairy products, coffee, tea, soft drinks, wine,
meat, fish, poultry, fruits and veggies

♠ a modification in fat content which is designed to limit the total amount of fat in the diet to
less than 10-15 % of total calorie intake
When is it used
1. cardiovascular disorders
2. chronic renal disease
3. chronic pancreatitis
4. disorder in the digestion, absorption and transport of fat including steatorrhea and fat
malabsorption
5. gallbladder disease
6. after surgery of cholecystectomy
Guidelines for Making proper Food Choices
1. when choosing meat and alternates, use only lean cuts of pork and beef, poultry without
skin
2. limit the use of fat and oils in foods
3. cook foods in any way except frying
4. use non-fat milk, fat-free cheese, fat-free yogurt
5.keep away from snacks rich in fats
6. use jellies or jams instead of butter and margarine

♥ restrict the quantity of sodium to a prescribed level

When is it used
1. hypertension
2. kidney disease
3. edema

Guidelines for Making proper Food Choices

1. choose unprocessed foods to the greatest degree possible
2. Select fresh foods and frozen or canned without salt
3. when eating out, ask that meals be prepared without salt
4. avoid foods with high sodium content
5. use low sodium spices and condiments to enhance the taste of foods
6. avoid high sodium seasonings

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7. read food labels

-- retards the formation of alkaline renal stones

A diet consisting largely of meat or fish, eggs, and cereals with a minimal quantity of milk, fruit,
and vegetables, that when catabolized leaves an acid residue to be excreted in the urine.

– retards the formation of acid renal stones

A diet consisting mainly of fruits, vegetables, and milk with little meat, fish, eggs, cheese, and
cereals, that when catabolized leaves an alkaline residue to be excreted in the urine.

– banana, rice, apple, toast

The BRAT diet (Bananas, Rice, Applesauce, Toast) staple for children with an upset stomach. The
idea is to give the gut a chance to rest and reduced the amount of stool produced.

– spare CHON protein but high in CHO carbohydrate

A special diet indicated for patients with liver disorder.

– maintain near to normal blood glucose level

In case of diabetes the body cannot make or properly use insulin. This leads to high blood
glucose, or blood sugar, levels. Healthy eating helps keep the blood sugar in target range. It is a
critical part of managing diabetes, because controlling blood sugar can prevent
the complications of diabetes.

– spare CHON
a diet designed for patients with renal failure; it provides small amounts of protein, primarily as
essential amino acids, along with α
keto derivatives of amino acids; breakdown of protein in skeletal muscle is retarded and, becau
se transminase reactions are reversible, a small proportion of the ammonia released by urea br
eakdown is used for synthesis of nonessential amino acids.

– no pork diet

A halal diet includes all domestic birds, cattle, sheeps, goats, camels, buck, rabbits, fish &
shellfish, locusts, fruit & vegetables, dairy, eggs, pulses, and legumes. Of all of these food
groups, meat is the most regulated. Unlawful foods are specified within the chapters of the
Quran. Chapter 5, Verse 3 explicitly lists which foods are prohibited, while Chapter 5, Verse 9
also calls out the consumption of alcohol and other intoxicants as impermissible.

The following animal meat and by-products are not allowed to be consumed by those with a
halal diet. Any animal that has not been ritually slaughtered (including those that have died by
natural cause or injury), pigs, carnivorous animals with fangs, birds of prey, reptiles, mules,
donkeys, pests, and insects. Specific organs and animal by-products are also prohibited,

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including testicles, bladder, pancreas, and flowing blood. Ingredients that have been
contaminated by or derived from non-halal animal products are also not allowed. This includes
some of the more obscure ingredients such as L-Cysteine (animal hair), calcium phosphates
(bone), rennet (stomach enzyme) and gelatine (connective tissue). Whilst for many this may
seem like a restrictive list, for Muslims these are divine orders.
– meat and milk can not be used simultaneously
The laws of kashrut, also referred to as the Jewish dietary laws, are the basis for the kosher
observance. These rules were set forth in the Torah and elucidated in the Talmud. The Hebrew
word "kasher" literally means "fit," and the kosher laws concern themselves with which foods are
considered fit to eat. Those who keep kosher follow Jewish dietary laws.
The Jewish dietary laws explain the rules for choosing kosher animal products, including the
prohibition of what is considered "unclean" animals and the mixing of meat and dairy. The laws
also outline what are considered to be "neutral" foods (pareve).
Any meat (the flesh of birds and mammals) cannot be eaten with dairy. Utensils that have come
into contact with meat (while hot) may not be used with dairy and vice versa. In addition, utensils
that have come into contact with non-kosher food (while hot) may not be used with kosher food.

– used to prevent hypertensive crisis for patients who are taking

MAOI
If you experience migraine headaches or take monoamine oxidase inhibitors (MAOIs), you may
have heard of a tyramine-free diet. Tyramine is a compound produced by the breakdown of an
amino acid called tyrosine. It’s naturally present in some foods, plants, and animals.
Certain foods have high amounts of tyramine, especially foods that are:
 fermented
 cured
 aged
 spoiled
Specific foods with high tyramine content include:
 strong or aged cheeses like cheddar, blue cheese, or gorgonzola
 cured or smoked meats or fish, such as sausage or salami
 beers on tap or home-brewed
 some overripe fruits
 certain beans, such as fava or broad beans
 some sauces or gravies like soy sauce, teriyaki sauce, or bouillon-based sauces
 pickled products like sauerkraut
 sourdough breads
 fermented soy products like miso soup, bean curd, or tempeh; some forms of tofu are
also fermented and should be avoided such as “stinky tofu”

– vegetarian diet
A vegetarian diet focuses on plants for food. These include fruits, vegetables, dried beans and
peas, grains, seeds and nuts. There is no single type of vegetarian diet. Instead, vegetarian
eating patterns usually fall into the following groups:

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  The vegan diet, which excludes all meat and animal products
 The lacto vegetarian diet, which includes plant foods plus dairy products
 The lacto-ovo vegetarian diet, which includes both dairy products and eggs

– cold desserts after a surgery

The easiest way to grasp these is that of the yin and yang, where yin embodies qualities such as
passivity, cold, dark and the feminine while activity, heat, light and masculine qualities
characterize yang. Yin and yang exist in relation to, and mutually counteract, each other to
achieve a dynamic balance. So health and balance can be achieved by eating the right types of
foods at the right times of the year, according to the condition of one's body. These explains
that yin foods are those that generate cold or cool energy in the body, such as watermelon,
bitter gourd, crab and most green vegetables.

Yang foods, such as red meat, ginger, pepper and garlic, generate warm or hot energy.

(also known as the monotrophic diet) – eating only one food

When you follow a mono diet, you eat only one food for several days or even weeks. There are
different variations of the mono diet. There is a banana mono diet, an egg mono diet, a potato
mono diet, and even a chocolate mono diet.

– excludes most synthetic ingredients such as food colorings and flavorings

eliminates artificial food colors, flavorings, sweeteners, preservatives, and some salicylates
(naturally occurring compounds found in some fruits and vegetables), and is intended to reduce
or eliminate ADHD symptoms in certain children.

The Feingold diet was originally designed for an adult patient with a severe case of hives, but
Dr. Feingold noted that behavioral changes occurred as well in the patients he studied. Today,
it’s mainly recommended for children with attention problems, but the Feingold Association
also claims it can help treat asthma, eczema, migraines, or other behavioral problems not
necessarily related to ADHD. The Feingold diet can be used for children and adults of any age.

– consumption of organically grown fresh fruits and

vegetable juices.
It is a natural alternative treatment system that claims to “activate the body’s extraordinary
ability to heal itself.” The Gerson Therapy aims to restore your health by removing toxins and
increasing immunity. Anyone on this diet is asked to consume approximately 15–20 pounds (7–
9 kg) of organic produce per day. This is said to help “flood the body with nutrients.”
Most of that produce is used to make raw juices. Dieters are asked to drink up to one 8-ounce
(240-ml) glass of raw juice per hour — up to 13 times per day.

– avoiding CHO meals completely and eat fruit-only meals or protein

The Hay diet is named for the New York physician who created a plan that prohibited the
consumption of starches and proteins during the same meal. William Howard Hay began

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developing the food-combining diet in 1904 to treat himself for medical conditions including a
dilated heart. He lost 50 (22.7 kilograms) pounds in approximately three months and recovered
from the conditions.

Hay created his meal plan to treat medical problems associated with obesity. He claimed that a
change in eating habits rather than medication was beneficial in the treatment of conditions
such as cardiac disease, kidney disease, and kidney disorders.
The Hay diet is used as a weight-loss plan by the general public and people interested in
alternative treatments. Advocates of natural health maintain that the plan reverses conditions
such as arthritis, indigestion, constipation, and flatulence. The Hay diet is also regarded as a
natural method for providing relief to people diagnosed with asthma and allergies.

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